Involuntary Treatment Research Articles

Comparison of coercive practices in worldwide mental healthcare: overcoming difficulties resulting from variations in monitoring strategies.

Coercive or restrictive practices such as compulsory admission, involuntary medication, seclusion and restraint impinge on individual autonomy. International consensus mandates reduction or elimination of restrictive practices in mental healthcare. To achieve this requires knowledge of the extent of these practices. We determined rates of coercive practices and compared them across countries. We identified nine country- or region-wide data-sets of rates and durations of restrictive practices in Australia, England, Germany, Ireland, Japan, New Zealand, The Netherlands, the USA and Wales. We compared the data-sets with each other and with mental healthcare indicators in World Health Organization and Organisation for Economic Cooperation and Development reports. The types and definitions of reported coercive practices varied considerably. Reported rates were highly variable, poorly reported and tracked using a diverse array of measures. However, we were able to combine duration measures to examine numbers of restrictive practices per year per 100 000 population for each country. The rates and durations of seclusion and restraint differed by factors of more than 100 between countries, with Japan showing a particularly high number of restraints. We recommend a common set of international measures, so that finer comparisons within and between countries can be made, and monitoring of trends to see whether alternatives to restraint are successful. These measurements should include information about the total numbers, durations and rates of coercive measures. We urge the World Health Organization to include these measures in their Mental Health Atlas.

Self-Described Training Needs of Special Operations Forces Medics and the Birth of the TACMED Division.

Training needs of Special Operations Forces (SOF) medics were surveyed and new training initiatives have been created to meet their needs. SOF medics perform an array of medical procedures in austere environments with minimal supervision. Medical skills decay over time after initial training and the perceived training needs of active SOF medics were unclear. To fill this gap, active SOF medics (n=57) completed a survey that included confidence ratings and indications of whether additional training would make them more proficient in 70 medical knowledge and procedural skills, assembled into categories by a panel of experts (airway, trauma, neuro, differential diagnosis, administrative, infection, critical care, environmental, other). Data were analyzed with analysis of variance (ANOVA) and nonparametric statistics at P<.05. Confidence was highest in the trauma, administrative, and airway categories, and lowest in the infection, differential diagnosis, and neuro categories (P<.05 or less). Categories indicating the greatest need for additional training were environmental and critical care, while those indicating lowest need were the airway and trauma categories (P=.05). Additional training was endorsed by >75% of participants in each category. SOF medics also wanted additional training in all areas, preferably hands-on with live patients in realistic scenarios, taught by experienced medics. Findings highlight the training needs of SOF medics and demonstrate the value of bottom-up feedback toward optimizing sustainment training. Based on present findings, two TACMED (Tactical Medicine) Divisions at the SOF Echelon III level were created to meet the sustainment training needs of SOF medics.

Social Determinant of Unconventional Resilience: Tactical Engagement in Medical-Martial Creativity.

Building on our strategic framework and operational model, we will discuss findings from our ethnographic study entitled, "The Impact of Catastrophic Injury Exposure on Resilience in Special Operations Surgical Teams (SOST)." Our goal is to establish that medical-martial creativity supports Special Operation Forces (SOF) medics' ability to fluidly modulate pressure amid real-time military medical decision-making in austere environments. We will use qualitative quotes to explore how SOST medics express medical-martial creativity in support of unconventional resilience. We continue to highlight tactical engagement by using bag sets as a metaphor for understanding the practical performance of this social determinant. To achieve our goals, we will: 1) define the social determinant of medical-martial creativity and provide a brief background on creativity; 2) thematize various ways in which medical-martial creativity is optimized or degraded; and 3) relate tactical engagement with medical-martial creativity to our metaphor of bag sets. We conclude by gesturing to how medical-martial creativity enables SOF medics' ingenuity, which allows them to freely maneuver complex real-time decision-making to support SOF mission success.

Social Determinant of Unconventional Resilience: Tactical Engagement with Impression Management.

Building upon our operational model, we will discuss findings from our ethnographic study titled "The Impact of Catastrophic Injury Exposure on Resilience in Special Operations Surgical Teams" to establish that impression management allows Special Operation Forces (SOF) medics to navigate implicit social status symbols to either degrade or optimize performance. We will use qualitative quotes to explore how Special Operations Surgical Team (SOST) medics engage in impression management to establish individual, team, and/or organizational competency to deal with ambiguity. To achieve our goals, we will: 1) provide a background on impression management and perception of competency; 2) define the social determinant of impression management extrapolated from qualitative data as well as use qualitative data to thematize various types of impression management; and 3) relate tactical engagement with impression to our metaphor of bag sets. We conclude by gesturing to the importance of impression management in orienting SOF medics' proprioception and kinesthesia in the SOF performance space.

Los derechos humanos y el poder psiquiátrico en disputa. ¿Hacia una radicalización de la democracia?

Abstract This article analyzes the type of power that is disputed in contemporary debates on human rights, mental health and equal recognition before the law (Art. 12 of the Convention on the Rights of Persons with Disabilities: CRPD), where the most burning issue is the abolition of involuntary treatment and commitment. To do so, we intersect Foucault's and Agamben's perspectives on sovereign power and biopowers. We analyze the emergence of the psychiatric device as institution; legal medicine; biological determinism, and; line of thanatopolitical escape, the point of emergence of Nazi extermination. We connect this analysis with the emergence of human rights and UN regulations on "disability/mental illness" up to the CRPD. Among other things, we conclude that the authoritative interpretation of Art. 12 abolishes a state of exception to human rights, which is constitutive of modern democracy and of the emergence and deployment of the psychiatric device, whose competencies of sovereign power are in dispute.

Use of Loco-regional Anesthesia in Austere Environments: A Review by and for Special Forces Medics.

Special Forces increasingly operate in austere environments, which are known to have limited medical support and prolonged evacuation times. On the battlefield, pain remains the first complaint of casualties and can impact direct autonomic stability, recovery, and the development of posttraumatic stress disorder. Although medical education has been improving, medical providers still encounter difficulties, such as lack of human and material resources, while trying to achieve pain management. This article summarizes a survey sent to 35 Special Operations medical providers and suggests possible strategies to address challenges to pain management on the battlefield. Potential solutions have been gathered through medical texts, medical/NATO documents, and medical expertise. Nerves blocks have been identified as valuable tools for pain management in the current battlefield environment, where prolonged evacuation and limited freedom of movement are the norm. The survey showed that, although the vast majority of providers had already received lectures on regional anesthesia, 83% were not trained in it, and 54% had never been made aware of multimodal analgesia. This lack of familiarity highlights knowledge and training gaps in nerve block techniques. Diffusion blocks are a very low-risk, useful, and safe pain management technique, which requires less skill sustainment and resources than more complex techniques. The use of epinephrine as adjunct can be useful for decreasing local anesthetic toxicity and increasing long-term pain management. The need for both education on and training in the use of nerve blocks has been identified by the Special Operations health provider community.

Association of Serum Vitamin D with Risk of Breast Carcinoma: An Observational Case-control Study from Western Maharashtra, India

Introduction: Breast carcinoma is one of the most prevalent types of carcinoma and the leading cause of death among all carcinomas. Recently, vitamin D deficiency has been reported as a risk factor for breast carcinoma. Vitamin D, as an anticarcinoma agent, prevents cellular differentiation, stimulates cell death, reduces angiogenesis, tumour progression, and metastasis. Aim: To investigate the relationship between vitamin D deficiency and the risk of breast carcinoma. Materials and Methods: An observational study was conducted at the Armed Forces Medical College, Pune, Maharashtra, India, between November 2018 and October 2020. A total of 57 cases diagnosed with breast carcinoma and 57 healthy controls were analysed. Physical and reproductive health parameters were compared, along with vitamin D status using student’s t-test and Mann-Whitney U test. Logistic regression was used to assess the risk of breast carcinoma. Results: Out of 114 women, 57 were cases and 57 were controls with a mean age of 52 vs 48 years. The mean value of serum vitamin D levels was significantly lower (19.45 vs 27.91 ng/mL, p&lt;0.001) than controls. The percentage of serum Vitamin D deficiency was significantly higher in cases (28 (49.1%) vs 12 (21.1%), p&lt;0.001) compared to controls. Vitamin D concentration &lt;20 ng/mL was significantly associated with a higher risk of breast carcinoma (OR 10.8, 95% CI 3.1-37.6). Multiparity ≥3 was associated with a decreased risk of breast carcinoma (OR 2.250, 95% CI 0.599-8.447) compared to parity ≤2 (OR 3.241, 95% CI 0.916-11.466). In luminal A and triplenegative subtypes, severe vitamin D deficiency (&lt;20 ng/mL) was observed (p=0.045) compared to other subtypes. Conclusion: The present study findings showed that women diagnosed with breast carcinoma had low vitamin D levels, which were linked to an increased risk and prognosis of breast carcinoma. Furthermore, multiparity lowers the risk of breast carcinoma.

Endobronchial Lipoma: A Rare Cause of Bronchial Stenosis or Obstruction.

Endobronchial lipoma (EL) is a rare benign tumor characterized by tracheobronchial smooth-surfaced mass, often resulting in bronchial obstruction without standard guidelines for management. This study seeks to clarify the clinical features and interventions of EL, aiming to improve its diagnosis and outcomes. A retrospective review was conducted on 28516 outpatients treated between January 2015 and December 2019 at the Department of Respiratory and Critical Care Medicine of the Second Affiliated Hospital of Air Force Medical University to collect patients diagnosed with EL. Their clinical, bronchoscopic, chest imaging, and histopathological features along with management were analyzed. Among the patients reviewed, nine were histopathologically diagnosed with EL, comprising seven males and two females. All EL patients exhibited noticeable symptoms, including cough (in eight patients), dyspnea (in six patients), fever (in three patients), expectoration (in two patients), chest pain (in two patients), hemoptysis (in one patient), and fatigue (in one patient). Chest CT abnormalities included endobronchial mass (in four patients), inflammatory exudation (in three patients), atelectasis (in three patients), and infiltration or consolidation (in two patients). In three patients, imaging showed fat density, directly leading to the diagnosis of EL. The EL lesions were distributed with six in the right lung and three in the left lung, all located within the first three subdivisions of the tracheobronchial tree. Treatment approaches varied, with one patient undergoing combined bronchoscopic resection and surgery. The remaining patients received bronchoscopic intervention such as electrosurgical snare resection, argon plasma coagulation (APC), cryotherapy, and holmium laser. Histopathological analysis confirmed the EL diagnosis. Finally, the mass removal restored bronchus patency. Taken together, EL symptoms lack specificity, necessitating reliance on histopathology for EL accurate diagnosis. Bronchoscopic interventions emerge as the preferred option for EL management, surpassing surgical approaches.

Involuntary Treatment for Child and Adolescent Anorexia Nervosa-A Narrative Review and Possible Advances to Move Away from Coercion.

Children and adolescents with psychiatric disorders frequently experience hospital treatment as coercive. In particular, for patients with severe anorexia nervosa (AN), clinical and ethical challenges often arise if they do not voluntarily agree to hospital admission, often due to the ego-syntonic nature of the disorder. In these cases, involuntary treatment (IVT) might be life-saving. However, coercion can cause patients to experience excruciating feelings of pressure and guilt and might have long-term consequences. This narrative review aimed to summarize the current empirical findings regarding IVT for child and adolescent AN. Furthermore, it aimed to present alternative treatment programs to find a collaborative method of treatment for young AN patients and their families. Empirical data on IVT show that even though no inferiority of IVT has been reported regarding treatment outcomes, involuntary hospital treatment takes longer, and IVT patients seem to struggle significantly more with weight restoration. We argue that more patient- and family-oriented treatment options, such as home treatment, might offer a promising approach to shorten or even avoid involuntary hospital admissions and further IVT. Different home treatment approaches, either aiming at preventing hospitalization or at shortening hospital stays, and the results of pilot studies are summarized in this article.

A country report: impact of COVID-19 lockdowns on involuntary psychiatric treatment in Austria.

Coercive measures such as involuntary psychiatric admission are considered a last resort in the treatment of people with psychiatric disorders. So far, numerous factors have been identified that influence their use. However, the link between a pandemic - in particular, restrictions such as lockdowns - and the use of involuntary psychiatric admission is unclear. To examine the association between COVID-19 lockdowns and involuntary psychiatric admissions in Austria. This retrospective exploratory study assessed all involuntary psychiatric admissions and use of mechanical restraint in Austria, except for the federal state of Vorarlberg, between 1 January 2018 and 31 December 2020. Descriptive statistics and regression models were used. During the 3-year study period, 40 012 individuals (45.9% females, mean age 51.3 years) had 66 124 involuntary psychiatric admissions for an average of 10.9 days. Mechanical restraint was used during 33.9% of these admissions. In weeks of nationwide COVID-19 lockdowns (2020 v. 2018/2019), involuntary psychiatric admissions were significantly fewer (odds ratio = 0.93, P = 0.0001) but longer (11.6 (s.d.: 16) v. 10.9 (s.d.: 15.8) days). The likelihood of involuntary admission during lockdowns was associated with year (2020 v. 2018-2019; adjusted odds ratio = 0.92; P = 0.0002) but not with sex (P = 0.814), age (P = 0.310), use of mechanical restraint (P = 0.653) or type of ward (P = 0.843). Restrictions such as lockdowns affect coercive measures and resulted in fewer but longer involuntary psychiatric admissions during weeks of lockdown in Austria. These results strengthen previous findings that showed the dependence of coercive measures on external factors, highlighting the need to further clarify causality and desired prevention effects when using coercive measures.

Analysis of a Chinese pedigree affected with Hereditary coagulation factor Ⅻ deficiency due to compound heterozygous variants of F12 gene

To analyze the clinical phenotypes and genetic variants of a Chinese pedigree affected with Hereditary coagulation factor Ⅻ (FⅫ) deficiency. A pedigree presented at the First Affiliated Hospital of Air Force Medical University on December 24,2021 was selected as the study subject. Activated partial thromboplastin time (APTT) and coagulation factor Ⅻ activity (FⅫ:C) were determine by a clotting method, and FⅫ antigen was detected with an ELISA assay. Following the extraction of genomic DNA, all exons and flanking regions of the F12 gene were subjected to Sanger sequencing. Clustalx-2.1-win, PROVEAN and Swiss-PDB Viewer software was used to analyze the conservation of amino acids at the variant sites, impact of of the variants on the amino acid substitutions and the protein structure. The APTT of the proband has prolonged to 70.2 s. Her FⅫ:C and FⅫ:Ag have decreased to 12% and 13%, respectively. DNA sequencing revealed that the proband has harbored c.346G>A (p.Gly97Ser) and c.1583C>A (p.Ser509Tyr) heterozygous compound missense variants in exons 5 and 13 of the F12 gene, respectively. Her father and sister were heterozygous carriers for the c.346G>A (p.Gly97Ser) variant, whilst her mother and brother were heterozygous for the c.1583C>A (p.Ser509Tyr) variant. The c.346G>A (p.Gly97Ser) and c.1583C>A (p.Ser509Tyr) compound heterozygous variants of the F12 gene probably underlay the pathogenesis of hereditary coagulation FⅫ deficiency in this pedigree.

Effectiveness of Involuntary Treatment for Individuals With Substance Use Disorders: A Systematic Review

ABSTRACT Background: The Canadian Society of Addiction Medicine La Societe medicale canadienne sur l’addiction Policy Committee created a task force to conduct a systematic review examining the effectiveness of involuntary treatment for individuals with substance use disorders (SUDs). Methods: We followed Preferred Reporting Items for Systematic Reviews &amp; Meta-analyses (PRISMA) guidelines and searched 2 databases for peer-reviewed articles assessing the effectiveness of involuntary treatment modalities for substance use disorders from inception to July 2021. Effectiveness was defined as any SUD-related outcome, including treatment retention, post-treatment substance use frequency, overdose mortality, improvement in functioning, or other patient-centred outcomes. Involuntary treatment was defined as any modality not fully motivated by the individual’s volition to seek treatment. Results: Forty-two studies met the review criteria, with 354,420 participants. Most studies were from the United States, Canada, and China: most measured substance use changes, criminal recidivism, and retention in treatment. Only 7 studies comparing involuntary to voluntary intervention reported improved outcomes in the involuntary group, with most for retention in treatment and only one showing a reduction in substance use. Six out of 7 studies comparing different involuntary interventions occurred in the context of prison or probation. No studies compared the involuntary treatment to no treatment. Only 11 described evidence-based treatment for SUDs, while 5 diagnosed and co-treated psychiatric comorbidity and 11 discussed the motivation for treatment. Conclusions: There is a lack of high-quality evidence to support or refute involuntary treatment for SUD. More research is needed to inform health policy. Contexte: Le comité d’orientation de la Canadian Society of Addiction Medicine La Societe medicale canadienne sur l’addiction a créé un groupe de travail chargé d’effectuer une étude systématique sur l’efficacité du traitement non volontaire des personnes souffrant de troubles liés à l’utilisation de substances (TLUS). Méthodes: Nous avons suivi les directives PRISMA et cherché dans deux bases de données des articles évalués par des pairs sur l’efficacité des modalités de traitement non volontaire des troubles liés à l’utilisation de substances, depuis sa création jusqu'à juillet 2021. L’efficacité a été définie comme tout résultat lié aux troubles liés à l’utilisation de substances, y compris la rétention du traitement, la fréquence de l’utilisation de substances après le traitement, la mortalité par overdose, l’amélioration du fonctionnement ou d’autres résultats centrés sur le patient. Le traitement non volontaire est défini comme toute modalité qui n’est pas entièrement motivée par la volonté de l’individu de se faire soigner. Résultats: 42 études ont répondu aux critères d’examen, avec 354 420 participants. La plupart des études provenaient des États-Unis, du Canada et de la Chine: la plupart mesuraient les changements dans la consommation de substances, la récidive criminelle et la rétention en traitement. Seules sept études comparant l’intervention non volontaire à l’intervention volontaire ont fait état de meilleurs résultats dans le groupe non volontaire, la plupart concernant la rétention en traitement et une seule montrant une réduction de la consommation de substances. Six des sept études comparant différentes interventions non volontaires ont eu lieu dans le contexte de la prison ou de la probation. Aucune étude n’a comparé le traitement non volontaire à l’absence de traitement. Seules 11 études décrivaient un traitement basé sur des preuves pour les TLUS, tandis que cinq études diagnostiquaient et traitaient la comorbidité psychiatrique et 11 études discutaient de la motivation pour le traitement. Conclusions: Il y a un manque de preuves de haute qualité pour soutenir ou réfuter le traitement non volontaire des TLUS. Des recherches supplémentaires sont nécessaires pour éclairer la politique de santé.

Using coercion in mental disorders or risking the patient’s death? An analysis of the protocols of a clinical ethics committee and a derived decision algorithm

While principle-based ethics is well known and widely accepted in psychiatry, much less is known about how decisions are made in clinical practice, which case scenarios exist, and which challenges...

Identifying a panel of nine genes as novel specific model in endometriosis noninvasive diagnosis

To study biomarkers to develop a novel diagnosis model for endometriosis and validate it using clinical samples. We used publicly available data sets and weighted gene coexpression network analysis to identify differentially expressed genes. Ten machine learning algorithms were used to develop an integrative model for predicting endometriosis. The accuracy and robustness of the model were validated using data sets and clinical samples. Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China. The study included clinical patients between the ages of 20 and 40 years who required laparoscopic surgery and who had not undergone hormone therapy within the previous 3 months. All the healthy individuals had given birth to a child at least once in their lives. Patients with inflammatory conditions, malignant diseases, immune diseases, myoma, or adenomyosis were excluded. Paraffin blocks of the samples were collected (case, n = 5; control, n = 5). Blood samples of 58 individuals were collected (case, n = 28; control, n = 30). None. The areas under the receiver operator characteristic curve of our diagnostic model were measured for data sets and clinical samples. Multiplex immunohistochemical staining and real-time quantitative polymerase chain reaction assays were used for the validation of the model from tissue slides and peripheral blood samples. A nine-gene panel endometriosis messenger RNA score (EMScore), was constructed to distinguish the patients with endometriosis from healthy individuals using algorithms. The EMScore accurately predicted endometriosis, and the areas under the receiver operator characteristic curve of our diagnostic model were 0.920, and 0.942 for tissue and blood samples, respectively. Moreover, the EMScore outperformed other acknowledged signatures for predicting endometriosis across seven clinical cohorts. Overall, the EMScore constitutes a sensitive and specific noninvasive diagnostic method for endometriosis. We developed the EMScore, a novel model that can aid in the diagnosis of endometriosis using peripheral blood samples. This study will contribute to the development of improved clinical noninvasive and sensitive diagnostic tools for endometriosis. These nine genes might be potential target molecules for treating endometriosis.

Retrospective Analysis of the Effect of Uric Acid on the Prognosis of Immunoglobulin A Nephropathy With Stage 3-4 Chronic Kidney Disease

To investigate the effect of uric acid on the clinicopathological characteristics and prognosis of immunoglobulin A nephropathy (IgAN) in patients with stage 3-4 chronic kidney disease (CKD). The clinical and pathological data of 263 IgAN patients who had stage 3-4 CKD and who had confrimed diagosis through renal biopsy at the First Affiliated Hospital of Air Force Medical University between December 2008 and January 2020 were retrospectively collected. According to the levels of uric acid, the patients were divided into a hyperuricemia group (n=102) and a normal uric acid group (n=161), and the clinicopathological characteristics of the two groups were compared accordingly. With progression to end-stage renal disease or death as the endpoint event, the renal survival rate of the two groups was compared by the Kaplan-Meier method and the relationship between uric acid and the prognosis was analyzed by Cox regression and LASSO regression. Compared with the normal uric acid group, the hyperuricemia group had a significantly higher proportion of male patients and patients with a history of hypertension, a significantly higher level of blood urea nitrogen, and lower levels of estimated glomerular filtration rate and high-density lipoprotein. In terms of pathology, patients in the hyperuricemia group had significantly higher proportion of glomerulosclerosis, higher mesangial hypercellularity, and higher tubular atrophy/interstitial fibrosis (P<0.05). Kaplan-Meier curve showed that there was a significant difference in renal survival rate between the two groups (P<0.0001). LASSO regression showed that high uric acid was a risk factor for the prognosis of IgAN patients with stage 3-4 CKD. Further multivariate Cox analysis showed that, compared with the normal uric acid group, the hyperuricemia group had a higher risk of incurring composite outcomes (hazard ratio [HR]=1.61, 95% confidence interval [CI]: 1.10-2.34). When uric acid was used as a continuous variable, the increase of 1 mg/dL in uric acid concentration was associated with an increased HR of 1.18 (95% CI: 1.08-1.29) for the composite outcome. High uric acid is a risk factor for poor renal prognosis in IgAN patients with stage 3-4 CKD and reducing uric acid levels may effectively improve the prognosis of high-risk IgAN patients.

Should people with mental illness be able to commit themselves to future involuntary treatment?

Should people with mental illness be able to commit themselves to future involuntary treatment?

Augmenting mental health literacy of troops in a large military station: A novel approach.

Mental health literacy (MHL) helps in acknowledging the symptoms at an early stage, thus promoting prompt management of negative stress behaviors. Despite the central thrust towards augmentation of MHL of troops, there is a paucity of available literature on the subject matter, especially in the Indian context. Current research explores the efficacy of a standardized Information Education and Communication (IEC) module for the promotion of MHL among troops. 1200 soldiers posted in a large military station underwent a psycho-educational module about stress and related mental health conditions in an open-label experimental study. Data was collected using a simple demographic tool and a specially constructed Armed Forces Medical College (AFMC) mental health awareness questionnaire. The same sample was studied before the IEC activity, immediately after the IEC activity, and again after six months. Community-based psycho-educational module helped in improvement in MHL and the gains were stable at six months. Well-standardized and structured module was found to be an effective strategy for improving MHL. The authors consider this study as seminal for bringing objectivity to mental health promotional programs in the Armed Forces.

A no-win situation: psychiatrists navigating competing obligations between free will, paternalism, duty of care, and position of guarantee

This paper examines the ethical tensions psychiatrists encounter in balancing competing obligations to patients and society, heightened in the COVID-19 era. With reference to the Italian situation, legal concepts such as duty of care or the rule of law defined “position of guarantee” engender heightened duties of care but generate discordance concerning patient autonomy. As a matter of fact, Italian psychiatrists are considered responsible for the effects of their interventions on patients and their behaviors. Consequently, managing involuntary treatment, assessing risk, and worrying about liability strain practitioners' efforts to uphold non-maleficence. As mental healthcare needs escalate globally amidst resource constraints, the application of ethical principles is imperative. Evidence-based approaches prioritizing collaborative harm reduction over social control must be reinforced through education, oversight, and organizational policies. With balanced civil commitment criteria and realistic expectations acknowledging risk prediction limits, therapeutic alliances can be maintained. Greater investment in community-based systems can mitigate coercion and marginalization. Psychiatrists worldwide endeavor to uphold beneficence and non-maleficence within shifting accountability landscapes. This perspective advocates collective efforts to promote patient welfare through equitable, quality care. Navigating the multifaceted nexus of competing obligations demands thoughtful dialogue and judicious reforms responsive to both practitioner and patient needs. By engaging with ethical complexities with scientific rigor and compassion, psychiatry can uphold humane, ethical standards despite mounting challenges.

District nurses’ experiences with involuntary treatment in dementia care at home: a qualitative descriptive study

BackgroundResearch shows that half of person(s) living with dementia (PLWD) receive care which they resist and/or have not given consent to, defined as involuntary treatment. District nurses play a key role in providing this care. Knowledge about how district nurses experience involuntary treatment is lacking. Therefore, the aim of this study was to describe the experiences of district nurses who used involuntary treatment for PLWD at home.MethodsA qualitative descriptive design using semi-structured interviews. Sixteen district nurses with experience in involuntary treatment for PLWD were recruited through purposive sampling. Data were analysed using the Qualitative Analysis Guide of Leuven.ResultsDistrict nurses’ experiences with involuntary treatment were influenced by their involvement in the decision-making process. When they were involved, they considered involuntary treatment use to be appropriate care. However, at the moment that involuntary treatment use was started, district nurses were worried that its use was unjust since they wished to respect the wishes of the PLWD. Eventually, district nurses found, from a professional perspective, that involuntary treatment use was necessary, and that safety outweighed the autonomy of the PLWD. District nurses experienced dealing with this dilemma as stressful, due to conflicting values. If district nurses were not involved in the decision-making process regarding the use of involuntary treatment, family caregivers generally decided on its use. Often, district nurses perceived this request as inappropriate dementia care and they first tried to create a dialogue with the family caregivers to reach a compromise. However, in most cases, family caregivers stood by their request and the district nurse still provided involuntary treatment and found this difficult to tolerate.ConclusionsOur results show that district nurses experience involuntary treatment use as stressful due to dealing with obverse values of safety versus autonomy. To prevent involuntary treatment use and obverse values, we need to increase their ethical awareness, communication skills, knowledge and skills with person-centred care so they can deal with situations that can evolve into involuntary treatment use in a person-centred manner.

INVOLUNTARY TREATMENT OF PERSONS WITH MENTAL DISORDERS IN THE REPUBLIC OF SRPSKA - WHERE WERE WE AND WHERE ARE WE NOW?

The first Law on the Protection of Persons with Mental Disorders of the Republic of Srpska was passed in 2004 and in it the social interest (endangering others) and vital interest (endangering oneself) are emphasized as indications for involuntary detention of a person for treatment, and the new Law of 2020 puts medical indication (health condition) in the foreground which is in line with the humanization of attitudes towards those persons. In this paper, special emphasis is placed on the analysis of the applicability of the first adopted Law critically from the aspect of the profession which implemented it. In the empirical research we conducted on the frequency of involuntary treatment in the institution for mental disorders of the highest health level, which receives patients from all over the Republic of Srpska, we show that our data are not different from data in other European countries, according to the frequency of involuntary detention, the type of disease and the socio-demographic data of persons forcibly detained and then accommodated.. However, when viewed from the aspect of the Law, not all articles were respected, because it was influenced by objective circumstances and the impossibility of implementing certain legal stipulations. A special problem was caused by the impossibility of imposing medical measures on insane persons by the legislator. It remains to be seen whether the greater reorientation of the new Law from 2020 towards professional medical recommendations will affect better respect for the rights of those persons, but also reduce the need for their involuntary detention. What we assume is that moving away from clear legal guidelines will be a stumbling block in its implementation.