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involuntary admission

Emmanuel Umama-Agada, Muhammad Asghar, Aoife Curley, Jane Gilhooley, Richard M Duffy, Brendan D Kelly
Involuntary psychiatric admission is an established practice for patients who are acutely or severely mentally ill but the factors contributing to involuntary (as opposed to voluntary) admission are not fully clear. Nor is it clear why rates of involuntary admission often vary between hospitals within the same jurisdiction. We studied all admissions, voluntary and involuntary, in three inpatient psychiatry units in Dublin, Ireland, which cover a population of 552,019 people, over a one-year period (1 July 2014 until 30 June 2015, inclusive), as part of the Dublin Involuntary Admission Study (DIAS)...
March 2018: International Journal of Law and Psychiatry
Barry A Finegan, Daniel Roblin, Fadi Hammal
Quality problem: For smokers, hospital admission is accompanied by forced involuntary nicotine abstinence due to smoke-free site/grounds policies. An audit of patients admitted to our surgical wards revealed that identification of smoking status was inadequate and that nicotine addiction management (NAM) was infrequently offered. The project aimed to enhance both these metrics by initiating NAM in the post anesthesia care unit (PACU). Initial assessment: Out of 744 patients admitted to our PACU in August 2015, 54% had their smoking status documented...
March 14, 2018: International Journal for Quality in Health Care
Patricia S Mann-Poll, Annet Smit, Eric O Noorthoorn, Wim A Janssen, Bauke Koekkoek, Giel J M Hutschemaekers
International comparative studies show that Dutch seclusion rates are relatively high. Therefore, several programs to change this practice were developed and implemented. The purpose of this study was to examine the impact of a seclusion reduction program over a long time frame, from 2004 until 2013. Three phases could be identified; the phase of development and implementation of the program (2004-2007), the project phase (2008-2010) and the consolidation phase (2011-2013). Five inpatient wards of a mental health institute were monitored...
March 12, 2018: Psychiatric Quarterly
Tomasz Pawlowski, Piotr Baranowski
Background: Coercive measures are applied in psychiatry as a last resort to control self- and hetero-aggressive behaviors in situations where all other possible strategies have failed. For ethical and clinical reasons, the number of instances of coercion should be reduced as far as possible. Aim: The aim of the study was to identify sociodemographic and clinical characteristics of patients that were associated with coercion during hospital treatment. Materials and Methods: The study has a descriptive, longitudinal design, based on a 1 year prospective observation of patients admitted to a psychiatric hospital consisting of six inpatient psychiatric wards with a total of 236 beds...
October 2017: Indian Journal of Psychiatry
Daniel Schöttle, Benno G Schimmelmann, Friederike Ruppelt, Alexandra Bussopulos, Marietta Frieling, Evangelia Nika, Luise Antonia Nawara, Dietmar Golks, Andrea Kerstan, Matthias Lange, Michael Schödlbauer, Anne Daubmann, Karl Wegscheider, Anja Rohenkohl, Gizem Sarikaya, Mary Sengutta, Daniel Luedecke, Linus Wittmann, Gunda Ohm, Christina Meigel-Schleiff, Jürgen Gallinat, Klaus Wiedemann, Thomas Bock, Anne Karow, Martin Lambert
The ACCESS-model offers integrated care including assertive community treatment to patients with psychotic disorders. ACCESS proved more effective compared to standard care (ACCESS-I study) and was successfully implemented into clinical routine (ACCESS-II study). In this article, we report the 4-year outcomes of the ACCESS-II study. Between May 2007 and December 2013, 115 patients received continuous ACCESS-care. We hypothesized that the low 2-year disengagement and hospitalization rates and significant improvements in psychopathology, functioning, and quality of life could be sustained over 4 years...
2018: PloS One
Mikkel Højlund, Lene Høgh, Anders Bo Bojesen, Povl Munk-Jørgensen, Elsebeth Stenager
BACKGROUND: Decrease in coercive measures can lead to increased exposure to antipsychotics and benzodiazepines. This is not desirable as these drugs are associated with harmful side effects and reduced life expectancy. AIM: To quantify and compare the use of antipsychotic and anxiolytic medications in connection with the implementation of a programme to reduce coercion and restraint. METHODS: Observational study in a general psychiatric ward comparing psychopharmacological treatment after implementation of non-pharmacological interventions to reduce coercion and mechanical restraint with a historical reference cohort from the same ward...
February 1, 2018: International Journal of Social Psychiatry
Michael Lebenbaum, Maria Chiu, Simone Vigod, Paul Kurdyak
BACKGROUND: Involuntary admissions to psychiatric hospitals are common; however, research examining the trends in prevalence over time and predictors is limited. Aims To examine trends in prevalence and risk factors for involuntary admissions in Ontario, Canada. METHOD: We conducted an analysis of all mental health bed admissions from 2009 to 2013 and assessed the association between patient sociodemographics, service utilisation, pathway to care and severity characteristics for involuntary admissions using a modified Poisson regression...
March 2018: BJPsych Open
Liam Trevithick, Jane Carlile, Sunil Nodiyal, Patrick Keown
BACKGROUND: Community treatment orders (CTOs) were introduced in England in 2008. Aims To measure the rate of CTO use in England during the first 5 years following introduction. METHOD: The number of involuntary detentions and CTOs in National Health Service (NHS) hospital trusts was collected between 2009 and 2014. Rates of CTO use and the ratio of CTOs to detentions on admission were calculated, and how these varied between trusts. RESULTS: The number of new CTOs each year ranged between 3834 and 4647...
March 2018: British Journal of Psychiatry: the Journal of Mental Science
J van Os, P H Delespaul
In a given year, around 25% of the Dutch population may experience significant mental health problems, much more than the mental health service can attend to, given a maximum capacity of 6% of the population per year. Due to the lack of a public mental health system, there is fierce competition over who gets to receive care from mental health services and little control over how the level of needs can be matched with the appropriate intensity of care. As a result, resources are being wasted and both overtreatment and undertreatment are prevalent...
2018: Tijdschrift Voor Psychiatrie
Jane Gilhooley, Brendan D Kelly
Rates of involuntary admission are increasing in England. Personality disorder should be excluded as a criterion for involuntary admission; stronger restraint reduction programmes should be instigated; and involuntary care should be based on treating illness (something we can do) and not on predicting violence (something we cannot). Declaration of interest None.
February 2018: British Journal of Psychiatry: the Journal of Mental Science
Z Xu, B Lay, N Oexle, T Drack, M Bleiker, S Lengler, C Blank, M Müller, B Mayer, W Rössler, N Rüsch
AIMS: Compulsory admission can be experienced as devaluing and stigmatising by people with mental illness. Emotional reactions to involuntary hospitalisation and stigma-related stress may affect recovery, but longitudinal data are lacking. We, therefore, examined the impact of stigma-related emotional reactions and stigma stress on recovery over a 2-year period. METHOD: Shame and self-contempt as emotional reactions to involuntary hospitalisation, stigma stress, self-stigma and empowerment, as well as recovery were assessed among 186 individuals with serious mental illness and a history of recent involuntary hospitalisation...
January 31, 2018: Epidemiology and Psychiatric Sciences
Theis Skovsgaard Itenov, Maria Egede Johansen, Morten Bestle, Katrin Thormar, Lars Hein, Louise Gyldensted, Anne Lindhardt, Henrik Christensen, Stine Estrup, Henrik Planck Pedersen, Matthew Harmon, Uday Kant Soni, Silvia Perez-Protto, Nicolai Wesche, Ulrik Skram, John Asger Petersen, Thomas Mohr, Tina Waldau, Lone Musaeus Poulsen, Ditte Strange, Nicole P Juffermans, Daniel I Sessler, Else Tønnesen, Kirsten Møller, Dennis Karsten Kristensen, Alessandro Cozzi-Lepri, Jens D Lundgren, Jens-Ulrik Jensen
BACKGROUND: Animal models of serious infection suggest that 24 h of induced hypothermia improves circulatory and respiratory function and reduces mortality. We tested the hypothesis that a reduction of core temperature to 32-34°C attenuates organ dysfunction and reduces mortality in ventilator-dependent patients with septic shock. METHODS: In this randomised, controlled, open-label trial, we recruited patients from ten intensive care units (ICUs) in three countries in Europe and North America...
March 2018: Lancet Respiratory Medicine
Eva Krieger, Steffen Moritz, Ricarda Weil, Matthias Nagel
Coercive interventions for psychiatric patients are controversial. Research on different preventive measures has increased over the last years. The present study examined patients' attitudes towards and understanding of previously experienced coercive measures as well as their preferences related to coercive measures and possible alternatives. In total, 213 patients who had experienced coercion and 51 patient controls (patients staying voluntarily on a closed ward with no coercive treatment) from three acute wards were examined via expert interviews and questionnaires in the framework of a naturalistic trial...
December 13, 2017: Psychiatry Research
Patricia Westmoreland, Craig Johnson, Michael Stafford, Richard Martinez, Philip S Mehler
Anorexia nervosa has the highest mortality rate of any psychiatric illness. Predictors of mortality include chronicity of the illness, critically low body weight, and binging and purging behavior. Delusional beliefs body image, coupled with impaired judgment and cognition caused by starvation, often result in these patients adamantly resisting efforts to treat them. Guardianship, although useful in assisting with medical treatment decisions for patients with anorexia nervosa who are critically medically ill, is usually an inadequate intervention with respect to psychiatric treatment for these patients...
December 2017: Journal of the American Academy of Psychiatry and the Law
Solveig Osborg Ose, Jorid Kalseth, Marian Ådnanes, Tone Tveit, Solfrid E Lilleeng
BACKGROUND: Inpatient bed numbers are continually being reduced but are not being replaced with adequate alternatives in primary health care. There is a considerable risk that eventually all inpatient treatment will be unplanned, because planned or elective treatments are superseded by urgent needs when capacity is reduced. AIMS OF THE STUDY: To estimate the rate of unplanned admissions to inpatient psychiatric treatment facilities in Norway and analyse the difference between patients with unplanned and planned admissions regarding services received during the three months prior to admission as well as clinical, demographical and socioeconomic characteristics of patients...
December 20, 2017: Health Policy
Pierfrancesco Maria Balducci, Francesco Bernardini, Luca Pauselli, Alfonso Tortorella, Michael T Compton
BACKGROUND: Involuntary admission is challenging in terms of providing the most effective but least restrictive care in accordance with the country's regulations. A better understanding of correlates of voluntary versus involuntary admission legal status is crucial to improve clinical decision-making and effectiveness of the overall mental health care system. SUBJECTS AND METHODS: We collected chart-review data pertaining to 848 patients, discharged between June 2011 and June 2014, from an Italian inpatient psychiatric unit...
December 2017: Psychiatria Danubina
Jørgen Aagaard, Bartosz Tuszewski, Pernille Kølbæk
BACKGROUND: The growing number of compulsory admissions in Denmark and other countries is a compelling challenge. We hypothesized that Assertive Community Treatment (ACT) may have the quality to reduce the use of several type of coercion including compulsory admissions. Although ACT is not designed for coercion prevention, it may prove efficient in averting major crisis among the included patients. Studies in Denmark showed that ACT has a major and significant advantage in reducing number and length of admissions...
December 2017: Archives of Psychiatric Nursing
Claire Henderson, Simone Farrelly, Clare Flach, Rohan Borschmann, Max Birchwood, Graham Thornicroft, Waquas Waheed, George Szmukler
BACKGROUND: In the UK, crisis planning for mental health care should acknowledge the right to make an informed advance treatment refusal under the Mental Capacity Act 2005. Our aims were to estimate the demand for such treatment refusals within a sample of service users who had had a recent hospital admission for psychosis or bipolar disorder, and to examine the relationship between refusals, and service user characteristics. METHODS: To identify refusals we conducted content analysis of Joint Crisis Plans, which are plans formulated by service users and their clinical team with involvement from an external facilitator, and routine care plans in sub-samples from a multi-centre randomised controlled trial of Joint Crisis Plans (plus routine mental health care) versus routine care alone (CRIMSON) in England...
November 24, 2017: BMC Psychiatry
Annika Reintam Blaser, Mette M Berger
The feeding of critically ill patients has recently become a controversial issue, as several studies have provided unexpected and contradictory results. Earlier beliefs regarding energy requirements in critical illness-especially during the initial phase-have been challenged. In the current review, we summarize existing evidence about fasting and the impact of early vs. late feeding on the sick organism's responses. The most important points are the non-nutritional advantages of using the intestine, and recognition that early endogenous energy production as an important player in the response must be integrated in the nutrient prescription...
November 23, 2017: Nutrients
Inge Joa, Kjetil Hustoft, Liss Gøril Anda, Kolbjørn Brønnick, Olav Nielssen, Jan Olav Johannessen, Johannes H Langeveld
PURPOSE: The role of compulsory treatment of serious mental disorders has been the topic of ongoing public debate involving among others mental health professionals, service providers, service user advocates, relatives of service users, media commentators and politicians. However, relatively little is known about general public attitudes towards involuntary admission and compulsory treatment of people with various mental disorders. This article examines the attitudes in a representative sample of Norway's population towards the use of involuntary admission and treatment, and under which circumstances does the general public consider compulsory treatment to be justified in the Norwegian mental health care services...
November 2017: International Journal of Law and Psychiatry
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