Sectioned Research Articles

The Use of Telepsychiatry Services in Emergency Settings: Scoping Review.

Telepsychiatry (TP), a live video meeting, has been implemented in many contexts and settings. It has a distinct advantage in the psychiatric emergency department (ED) setting, as it expedites expert assessments for psychiatric patients. However, limited knowledge exits for TP's effectiveness in the ED setting, as well as the process of implementing TP in this setting. This scoping review aimed to review the existing evidence for the administrative and clinical outcomes for TP in the ED setting and to identify the barriers and facilitators to implementing TP in this setting. The scoping review was conducted according to the guidelines for the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Three electronic databases were examined: PubMed, Embase, and Web of Science. The databases were searched from January 2013 to April 2023 for papers and their bibliography. A total of 2816 potentially relevant papers were retrieved from the initial search. Studies were screened and selected independently by 2 authors. A total of 11 articles were included. Ten papers reported on administrative and clinical outcomes of TP use in the ED setting and 1 on the barriers and facilitators of its implementation. TP is used in urban and rural areas and for settings with and with no on-site psychiatric services. Evidence shows that TP reduced waiting time for psychiatric evaluation, but in some studies, it was associated with prolonged total length of stay in the ED compared with in-person evaluation. Findings indicate lower admission rates in patients assessed with TP in the ED. Limited data were reported for TP costs, its use for involuntary commitment evaluations, and its use for particular subgroups of patients (eg, those with a particular diagnosis). A single paper examined TP implementation process in the ED, which explored the barriers and facilitators for implementation among patients and staff in a rural setting. Based on the extant studies, TP seems to be generally feasible and acceptable to key stakeholders. However, this review detected a gap in the literature regarding TP's effectiveness and implementation process in the ED setting. Specific attention should be paid to the examination of this service for specific groups of patients, as well as its use to enable assessments for possible involuntary commitment.

Examination of Cases Who Admitted to the Emergency Department of a Mental Health Hospital in 2020

Objective: This study aimed to retrospectively examine the sociodemographic and clinical characteristics of cases who admitted to the emergency department of a mental health hospital in 2020. Material and Methods: Cases who admitted to the emergency department of XXX Mental Health and Diseases Hospital between 01.01.2020 and 31.12.2020 were included. Sociodemographic and clinical data of the cases were accessed through the patient record system. Results: The total number of applications to the XXX MHDH emergency department between the specified dates was 7071 [5262 (74.4%) male and 1809 (25.6%) female].Sixty-four percent of the cases admitted through the Social Security Institution and 28% through the Ministry of Justice. Seven thousand fifty-five cases (99.7%) were the Republic of Turkey citizens. Three thousand two hundred fifty-four (46.0%) of the cases were evaluated within the scope of medical examination, 1599 (22.6%) were injection, 156 (2.2%) were involuntary hospitalization, and 1887 (26.7%) were judicial illegal substance screening. While 5877 (83.1%) of the cases left the emergency department after examination, 1194 (16.9%) were hospitalized at XXX MHDH. Two thousand one hundred forty-six (30.3%) of the cases were diagnosed with general psychiatric examination, 866 (12.2%) were anxiety spectrum disorders, 1464 (20.7%) were schizophrenia spectrum disorders, and 1658 (23.4%) were bipolar spectrum disorders. A statistically significant difference was found between male and female cases in terms of health insurance (p

Клинико-психологические факторы в контексте правосознания больных шизофренией, совершивших общественно опасные деяния

<p style="text-align: justify;">The work is aimed at the study of clinical and psychological factors that determine the legal consciousness of schizophrenia patients who have committed SDA. The materials of an empirical study obtained on a sample of schizophrenia patients undergoing compulsory treatment in a psychiatric hospital are presented. The study involved male 62 patients aged 18 to 35 years. Methods of pathopsychological research: Dembo—Rubinstein’s “Self-assessment”, MMPI, “The level of subjective control” by Rotter, “Ways of coping behavior” by Lazarus, pathopsychological functional tests — “Exclusion of objects”, “Pictogram”. The pathopsychological features reflecting significant differences in the patients’ legal consciousness have been established. New psychological information confirms the need to personalize psychological support during compulsory treatment. The key aspects of psychological work aimed at the prevention of socially dangerous behavior are the consideration of the attitude of patients to the disease and to the committed offense, as well as their individual psychological characteristics in order to reduce maladaptive and criminogenic behavioral stereotypes and the transformation of defects of legal consciousness.</p>

의료용 마약류 오남용에 대한 대응 방안

The social problems caused by the misuse of medical drugs are increasing. Therefore, countermeasures to reduce the misuse of medical drugs are needed. First, as a way to control the supply of medical drugs, it is necessary to increase the number of medical drug monitoring personnel, link the NIMS with the drug safety service system, revise the Act so that it can be reported immediately after the prescription of the drug for medical use, establish a legal basis for reporting the plan to dispose of medical drugs to the authorities when medical institutions and pharmacies are closed, establish a legal basis for a total ban on business if the reporting of drug handling details is violated, improve medical drug return regulations under the Narcotics Control Act, establish objective standards for re-issuance of medical licenses, strengthen medical drug education for doctors and pharmacists, restrict medical drug prescription qualifications, improve the system to handle medical drugs only at high-level hospitals, and introduce a system to require identification through the introduction of a fingerprint search system when prescribing medical drugs. Second, as a way to curb the demand for misuse of medical drugs, the following are required: The establishment of an infrastructure for collecting and disposing of medical drugs at home, establishing an investigative organization specializing in medical drugs, strengthening the iInternet monitoring system, education and promotion of the harmfulness of medical drugs, introducing compulsory treatment and education order systems, introducing a drug treatment and testing system, and integrating medical drug offenders for treatment purposes.

Clinical and Psychopathological Features of Patients with Paranoid Schizophrenia with Non-Suicidal Auto-Aggression on Compulsory Treatment

Clinical and Psychopathological Features of Patients with Paranoid Schizophrenia with Non-Suicidal Auto-Aggression on Compulsory Treatment

Involuntary psychiatric hospitalisation – differences and similarities between patients detained under the mental health act and according to the legal guardianship legislation

BackgroundInvoluntary psychiatric hospitalisation occurs under different legal premises. According to German law, detention under the Mental Health Act (MHA) is possible in cases of imminent danger of self-harm or harm to others, while detention according to the legal guardianship legislation (LGL) serves to prevent self-harm if there is considerable but not necessarily imminent danger. This study aims to compare clinical, sociodemographic and environmental socioeconomic differences and similarities between patients hospitalised under either the MHA or LGL.MethodsWe conducted a retrospective health records analysis of all involuntarily hospitalised cases in the four psychiatric hospitals of the city of Cologne, Germany, in 2011. Of the 1,773 cases, 87.3% were detained under the MHA of the federal state of North Rhine-Westphalia and 6.4% were hospitalised according to the federal LGL. Another 6.3% of the cases were originally admitted under the MHA, but the legal basis of detention was converted to LGL during the inpatient psychiatric stay (MHA→LGL cases). We compared sociodemographic, clinical, systemic and environmental socioeconomic (ESED) variables of the three groups by means of descriptive statistics. We also trained and tested a machine learning-based algorithm to predict class membership of the involuntary modes of psychiatric inpatient care.ResultsCases with an admission under the premises of LGL lived less often on their own, and they were more often retired compared to MHA cases. They more often had received previous outpatient or inpatient treatment than MHA cases, they were more often diagnosed with a psychotic disorder and they lived in neighbourhoods that were on average more socially advantaged. MHA→LGL cases were on average older and more often retired than MHA cases. More often, they had a main diagnosis of an organic mental disorder compared to both MHA and LGL cases. Also, they less often received previous psychiatric inpatient treatment compared to LGL cases. The reason for detention (self-harm or harm to others) did not differ between the three groups. The proportion of LGL and MHA cases differed between the four hospitals. Effect sizes were mostly small and the balanced accuracy of the Random Forest was low.ConclusionWe found some plausible differences in patient characteristics depending on the legal foundation of the involuntary psychiatric hospitalisation. The differences relate to clinical, sociodemographic and socioeconomical issues. However, the low effect sizes and the limited accuracy of the machine learning models indicate that the investigated variables do not sufficiently explain the respective choice of the legal framework. In addition, we found some indication for possibly different interpretation and handling of the premises of the law in practice. Our findings pose the need for further research in this field.

Invasive Procedures Used in Tuberculosis with Questionable Indications: Report from Russia

Surgical treatment of tuberculosis has been applied in the former Soviet Union more frequently than in other countries. On the contrary to the international practice, tuberculoma cases have been often operated on. There was a decreasing tendency since the last decades; but the surgery rate is still comparatively high. Surgeries were sometimes performed without preceding chemotherapy. Among others, an argument in favor of the early surgery was non-compliance increasing with time. Compulsory treatments of patients with Tb and/or alcoholism are discussed here. The factors predisposing to the use of invasive procedures with questionable indications included the partial isolation from international scientific community, insufficient consideration of the principles of informed consent, professional autonomy and scientific polemics, as well as paternalistic attitude to patients. The message of this review is that patients should not undergo operations to comply with doctrines. Evidence-based clinical indications must be determined individually.

Surgical Procedures with Questionable Indications Used in Russia

This review summarizes available data on invasive procedures applied with questionable indications in Russia in the recent past: mastectomy with the removal of muscles, gastrectomy for peptic ulcers, spleno-renal anastomosis for diabetes mellitus, thoracic surgery for bronchial asthma, overuse of surgery in tuberculosis, excessive and compulsory treatments of alcohol-dependent patients, etc. Among factors contributing to the use of invasive procedures with unproven efficiency have been the partial isolation from international scientific community, insufficient consideration of the principles of professional autonomy, informed consent and scientific polemics, training of medical personnel. It is known that invasive procedures can exert a placebo effect, which might have contributed to reported efficiency of some methods discussed here. However, by definition, placebo must be free of risks.

Impact of the SARS-CoV-2 Pandemic on Hospitalizations in an Acute Psychiatric Ward.

The Sars-CoV-2 pandemic imposed unprecedented and drastic changes in health care organizations all over the world. To evaluate the impact of the pandemic on hospitalizations in an acute psychiatric ward. We retrospectively identified and compared acute psychiatric hospitalizations in the Service for Psychiatric Diagnosis and Care (SPDC) of AUSL-Modena during the pre-pandemic (n = 1858) and pandemic period (n = 1095), from 01/01/2017 to 31/12/2022. Data were statistically analyzed using STATA12. We collected 1858 hospitalizations in the pre-pandemic and 1095 in the pandemic. During the pandemic, we observed a progressively sharp reduction in voluntary hospitalizations, whereas involuntary ones remained stable with an increase in 2022 (p < 0.001), longer hospital stays (12.32 mean days vs 10.03; p < 0.001), longer periods of involuntary hospitalizations (8.45 mean days vs 5.72; p < 0.001), more frequent aggressive behaviour (16.10% vs 9.12%; p < 0.001) and referral to psychiatric communities at discharge (11.04% vs 6.13%; p < 0.001); non-Italians (p = 0.001), people with disability pension (p < 0.001) and Support Administrator (p < 0.001) were more frequently hospitalized. During the pandemic, voluntary psychiatric hospitalizations decreased, but not involuntary ones, and the most vulnerable people in serious clinical conditions were hospitalized.

Guido Oldani’s poetics of terminal realism

Terminal Realism (TR) is an avant-garde movement founded in the literary-artistic field in 2010 by Guido Oldani, a contemporary Italian poet who aims to critically represent the globalised civilisation of the third millennium. In particular, TR presents itself as a movement of civil commitment. The Founding Manifesto is presented in 2010 and sets out the principles of poetics, the relationship of man with the object, the artificial versus the natural, the piling up of people and things, and pandemics. The poetry of the new millennium therefore expresses the artificial and the artefact using a new poetic language including: the stacking, the Inverted simile and the irony.

THE EXERCISE OF PUBLIC HEALTH POWERS IN MENTAL HEALTHCARE - THE IMPACT ON PUBLIC SAFETY

To ensure public safety, most European states have statutory powers enabling a range of compulsory interventions for persons with infectious diseases and mental disorders. The evidence of their meaningfulness in mental health patients is dubious, especially regarding their preventive effect on public safety. To reveal the mental health services' impact on violent offense commissions after discharge from involuntary inpatient care, a retrospective three-case series study was conducted. A scoping literature review was performed to construct the recommendations for practice improvement and further studies. Based on individual clinical expertise, the common issues in delivering involuntary mental healthcare in Latvia are described. To conclude, coercive psychiatric interventions shall be considered as a part of internal security and human rights protection and, therefore, shall be surveilled, in line with communicable diseases. Legal mechanisms (temporary protection against violence, coercive measures of a medical nature) are not effective against persons with severe mental illness and fail to prevent violent incidents. By the time being, during involuntary admission and treatment, the patient is subjected to various safety risks, that are inconsistent with the basic rights or best interests, and thus determines the state's obligation to promote voluntary treatment and provide the least restrictive approach.

Need for education of psychiatric evaluation of offenders with mental disorders: A questionnaire survey for Japanese designated psychiatrists.

The management of offenders with mental disorders has been a significant concern in forensic psychiatry. In Japan, the introduction of the Medical Treatment and Supervision Act in 2005 addressed the issue. However, numerous psychiatric patients at risk of violence still find themselves subject to the administrative involuntary hospitalization (AIH) scheme, which lacks clarity and updated standards. To explore current as well as optimized learning strategies for risk assessment in AIH decision making. We conducted a questionnaire survey among designated psychiatrists to explore their experiences and expectations regarding training methods for psychiatric assessments of offenders with mental disorders. The findings of this study's survey suggest a prevalent reliance on traditional learning approaches such as oral education and on-the-job training. This underscores the pressing need for structured training protocols in AIH consultations. Moreover, feedback derived from inpatient treatment experiences is identified as a crucial element for enhancing risk assessment skills.

Using decision tree models and comprehensive statewide data to predict opioid overdoses following prison release

PurposeIdentifying predictors of opioid overdose following release from prison is critical for opioid overdose prevention. MethodsWe leveraged an individually linked, state-wide database from 2015–2020 to predict the risk of opioid overdose within 90 days of release from Massachusetts state prisons. We developed two decision tree modeling schemes: a model fit on all individuals with a single weight for those that experienced an opioid overdose and models stratified by race/ethnicity. We compared the performance of each model using several performance measures and identified factors that were most predictive of opioid overdose within racial/ethnic groups and across models. ResultsWe found that out of 44,246 prison releases in Massachusetts between 2015–2020, 2237 (5.1%) resulted in opioid overdose in the 90 days following release. The performance of the two predictive models varied. The single weight model had high sensitivity (79%) and low specificity (56%) for predicting opioid overdose and was more sensitive for White non-Hispanic individuals (sensitivity = 84%) than for racial/ethnic minority individuals. ConclusionsStratified models had better balanced performance metrics for both White non-Hispanic and racial/ethnic minority groups and identified different predictors of overdose between racial/ethnic groups. Across racial/ethnic groups and models, involuntary commitment (involuntary treatment for alcohol/substance use disorder) was an important predictor of opioid overdose.

Civil Commitment and Involuntary Treatment

Civil Commitment and Involuntary Treatment

Debate: Involuntary treatment and detention are a necessary part of mental health care for children and young people.

People of all ages are subject to involuntary psychiatric detention and treatment worldwide but there is current discussion about whether this complies with modern human rights law. The use of involuntary psychiatric hospitalisation among children and young people has largely eschewed research and policy interest to date. In this debate section, we hear from people with experience of child mental health services in the UK, USA and low- and middle-income countries about their views on the use of involuntary treatment in young people.

Professional Values and Mental Health Tribunals: How Healthcare Professionals’ and Lawyers’ Views Are Shaped by Values, and How This Might Impede Reform

Most countries that provide for compulsory treatment for mental illness have a system by which this treatment is subject to independent legal oversight. Many countries use a special type of legal body for this purpose, called a mental health tribunal. Mental health tribunals have been subject to criticism from the points of view of both legal professionals and mental healthcare practitioners. Similar themes have manifested in these criticisms and have been consistent across several decades; legal professionals tend to focus on the tribunals being biased toward the medical opinion, and acting as a ‘rubber stamp’, whereas healthcare practitioners tend to focus on the adversarial nature of the trial, and the adverse effect that this can have on clients. However, empirical studies of the tribunals have not separated and directly compared these perspectives. This study aimed to explore this dynamic between lawyers’ views and healthcare practitioners’ views of mental health tribunals. We used thematic analysis to re-analyse data from two previous research studies, one which looked at lawyers’ views of the tribunals, and one which looked at healthcare practitioners’ views. Our results are divided into three themes: views of the problems with tribunals, professional roles in relationship to the tribunals and professional values demonstrated through these views and roles. We then consider if the ‘clash of values’ represented by these findings, and found in the literature, may pose an impediment to tribunal reform. Identifying and exploring this barrier is an important step to moving beyond critique to reform.

Mental Health Acts - Perspectives from Mental Health and Law in Ireland and in Portugal.

Mental health legislation is a cornerstone to ensure that individuals with severe mental illness access proper care and treatment. Each country establishes their own legislation. We aimed to compare the Portuguese and Irish Mental Health Acts (MHAs). We reviewed the respective MHA and the literature. While the definition of mental disorder is similar in general, who, where, when and how one can be detained differ. Judges decide on detentions in Portugal, while consultant psychiatrists may do so in Ireland. Community-based compulsory treatment is possible and used in Portugal while it is not possible in Ireland. Pros and cons of each approach are discussed with a reflection on the protection of human rights. Further theoretical and empirical studies comparing systems in different jurisdictions would be helpful to deepen our understanding of the legislation and guide on how to better serve individuals with severe mental illness.

Comparing attitudes towards compulsory interventions in severe and persistent mental illness among psychiatrists in India and Switzerland.

Psychiatrists face a major ethical challenge when deciding whether to make use of coercive measures in the treatment process of patients suffering from severe and persistent mental illness (SPMI). As India and Switzerland show major cultural, political and financial differences, it is hypothesized that attitudes towards coercive measures among Indian and Swiss psychiatrists will vary too. Exploring differences in attitudes between cultures strengthens the critical reflection on one's own stances and in consequence, on our way of action. Especially when it comes to situations involving power imbalances between patients and health practitioners, self-reflection is essential to prevent ethically inappropriate behavior. An online survey on aspects of care for patients with SPMI was sent to 3'056 members of the Indian Psychiatric Society between April and June 2020 and to 1'311 members of the Swiss Society for Psychiatry and Psychotherapy between February and March 2016. The respondents' answers were compared. This article deals with the questionnaire's items on autonomous decision making and the implementation of coercive measures in clinical practice. More precisely, participating psychiatrists were asked to rate the importance of patient's autonomy in general and their willingness to apply coercive measures regarding two specific case vignettes depicting a patient with schizophrenia and one with depression. The statistical analysis, namely descriptive data analysis and calculation of arithmetic means, Shapiro Wilks tests and Mann-Whitney U tests, was carried out using IBM SPSS Statistics version 27. Answers were received from 206 psychiatrists in India and 457 psychiatrists in Switzerland. Indian participants tended to value autonomous decision making as slightly less important than Swiss participants (62.2% vs. 91%, p =.01). Regarding a case of severe and persistent depression, psychiatrists in the Indian group were on average more in favor of acting against the wishes of the patient (55% vs. 34.1%, p <.0001) as well as of accepting a temporary decrease in quality of life due to coercion (40% vs. 23%, p =.008). Answers concerning a case of schizophrenia revealed that Indian participants were more in favor of acting against the patient's wishes than Swiss participants (39% vs. 37%, p =.007), whereas the comparison whether to accept a temporary decrease in quality of life regarding this case showed no significant difference (p =.328). The significant difference in attitudes towards coercive measures among Indian compared to Swiss psychiatrists found in this study might arise from a predominantly more collectivist society in India compared to Switzerland. Moreover, differences in financial resources, the organization of the health care system, and the historical background might have an influence. Continuous and critical reflection on one's own views and behavior is essential, especially if ethical principles and individual rights could be violated through a power imbalance, as in the case of coercive measures.

Variation in opinions on coercion use among mental healthcare professionals: a questionnaire study

Introduction Even if coercive measures are widely applied in psychiatry and have numerous well-known drawbacks, there is limited known on the agreement among mental healthcare professionals’ opinions on their use. In a questionnaire study using standardized scenarios, we investigated variation in staff opinions on coercion. Methods In a web-based survey distributed to staff at three psychiatry hospitals, respondents were asked to consider if and what coercion to use by introducing two hypothetical scenarios involving involuntary psychiatric admission and in-hospital coercion. Results One hundred thirty-two out of 601 invited staff members responded to the survey (Response Rate = 22%). There was large variation in participating staff members’ opinions on how to best manage critical situations and what coercive measures were warranted. In the first scenario, 57% of respondents (n = 76) believed that the patient should be involuntarily admitted to hospital while the remaining respondents believed that the situation should be managed otherwise. Regarding the second scenario, 62% of respondents responded that some in-hospital coercion should be used. The majority of respondents believed that colleagues would behave similarly (60%) or with a tendency towards more coercion use (34%). Male gender, being nursing staff and having less coercion experience predicted being less inclined to choose involuntary hospital admission. Conclusion There is a high degree of variation in coercion use. This study suggests that this variation persists despite staff members being confronted with the same standardized situations. There is a need for evidence-based further guidance to minimize coercion in critical mental healthcare situations.

Involuntary Psychiatric Hospitalization of Minors Due to Court Orders: Effectiveness Assessing Through a Case Series

IntroductionInvoluntary treatments in forensic psychiatry represents a complex intersection of mental health, legal systems and ethics. Judicial authorities may compulsorily refer children to inpatient clinics for receiving necessarily treatment. Despite its importance, there is limited research on the reasons behind and effectiveness of such interventions in minors.ObjectivesThe objectives of this study were to describe the clinical characteristics of minors who have risks of harming themselves and/or others so receiving involuntary treatment due to a court order. It is aimed to assess the effectiveness of involuntary treatment.MethodsA follow-up case series was conducted on 9 minors who hospitalized by court orders in a secure inpatient child and adolescent psychiatry clinic, in the year of 2023. Data collected from medical records, including demographic information, clinical presentation, diagnosis and discharge treatment. After one, three and six month of the discharge, interviews made with the patients and their families. Current data collected on treatment regimen, compliance, behavioral outcomes and reoffending rates. All data were anonymized to maintain patient confidentiality.ResultsThe case series consisted of 3 males and 6 females, with a mean age of 16.5 years at the time of admission. The most common reason to hospitalization was homicide risk 88%, followed by substance use 66%. Conduct Disorder was the most common diagnosis with the rate of 88%, followed by Substance Use Disorder(66%) and Attention Deficit and Hiperactivity Disorder(50%). 44% of minors had a history of juvenile delinquency. School dropout rates were 100%. Treatment consisted of a combination of individual and group therapy and medication. Treatment refusal rates were 88% so in terms of treatment, 88% of the minors in this sample treated with depot form antipsychotic medications, with the most common medication being risperidone. Overall all of the sample showed a significant reduction in disruptive behaviors during their hospital stay. Follow-up data collecting is still continue and preliminary statistics show us that relapse rates are low and treatment compliance is relatively high of the sample.ConclusionsThe findings suggest that involuntary hospitalization can be effective in reducing disruptive behaviors and increasing treatment compliance in minors with conduct disorders, substance abuse disorders and a history of juvenile delinquency. These results underscore the need for comprehensive, multidisciplinary approaches that integrate psychiatric treatment, psychoeducation and social support. Given the relatively small sample size and short-term follow-up, further research is needed to determine the long-term effects of involuntary treatment and to identify factors that predict treatment response.Disclosure of InterestNone Declared