To see, if voluntary admission for treatment in first-episode psychosis results in better adherence to treatment and more favourable outcome than involuntary admission.
We compared consecutively first-admitted, hospitalised patients from a voluntary (n = 91) with an involuntary (n = 126) group as to psychopathology and functioning using Positive and Negative Syndrome Scale and Global Assessment of Functioning Scales at baseline, after 3 months and at 2 year follow-up. Moreover, duration of supportive psychotherapy, medication and number of hospitalisations during the 2 years were measured.
More women than men were admitted involuntarily. Voluntary patients had less psychopathology and better functioning than involuntary patients at baseline. No significant difference as to duration of psychotherapy and medication between groups was found. No significant difference was found as to psychopathology and functioning between voluntarily and involuntarily admitted patients at follow-up.
Legal admission status per se did not seem to influence treatment adherence and outcome.
The results of a survey of pretrial examination cases admitted to the provincial psychiatric hospital in Saskatchewan from 1966 to 1975 are reported. The demographic and psychiatric data and data from the psychiatric reports to the Court are analyzed. Some deficiencies noted in the reports to the Court are discussed and some remedial measures are suggested.
Swedish penal law does not exculpate on the grounds of diminished accountability; persons judged to suffer from severe mental disorder are sentenced to forensic psychiatric care instead of prison. Re-introduction of accountability as a condition for legal responsibility has been advocated, not least by forensic psychiatric professionals. To investigate how professionals in forensic psychiatry would assess degree of accountability based on psychiatric diagnoses and case vignettes, 30 psychiatrists, 30 psychologists, 45 nurses, and 45 ward attendants from five forensic psychiatric clinics were interviewed. They were asked (i) to judge to which degree (on a dimensional scale from 1 to 5) each of 12 psychiatric diagnoses might affect accountability, (ii) to assess accountability from five case vignettes, and (iii) to list further factors they regarded as relevant for their assessment of accountability. All informants accepted to provide a dimensional assessment of accountability on this basis and consistently found most types of mental disorders to reduce accountability, especially psychotic disorders and dementia. Other factors thought to be relevant were substance abuse, social network, personality traits, social stress, and level of education.
The knowledge of the impact of coercion on psychiatric treatment outcome is limited. Multiple measures of coercion have been recommended. The aim of the study was to examine the impact of accumulated coercive incidents on short-term outcome of inpatient psychiatric care
233 involuntarily and voluntarily admitted patients were interviewed within five days of admission and at discharge or after maximum three weeks of care. Coercion was measured as number of coercive incidents, i.e. subjectively reported and in the medical files recorded coercive incidents, including legal status and perceived coercion at admission, and recorded and reported coercive measures during treatment. Outcome was measured both as subjective improvement of mental health and as improvement in professionally assessed functioning according to GAF. Logistic regression analyses were performed with patient characteristics and coercive incidents as independent and the two outcome measures as dependent variables
Number of coercive incidents did not predict subjective or assessed improvement. Patients having other diagnoses than psychoses or mood disorders were less likely to be subjectively improved, while a low GAF at admission predicted an improvement in GAF scores
The results indicate that subjectively and professionally assessed mental health short-term outcome of acute psychiatric hospitalisation are not predicted by the amount of subjectively and recorded coercive incidents. Further studies are needed to examine the short- and long-term effects of coercive interventions in psychiatric care.
Cites: Int J Law Psychiatry. 1997 Spring;20(2):227-419178064
Cites: Int J Law Psychiatry. 1996 Spring;19(2):201-178725657
The aim of this study was analyze the admission and inpatient stay at psychiatric hospital in northern Norway among people from the Sami-speaking municipalities (Sami group) and a control group (non-Sami group). Are they treated equally?
All admissions and inpatient stay from the administration area of the Sami language law (eight municipalities) was matched with a control group of 11 municipalities. All adult patients treated during the 2-year time period 2009-2010 and registered by the Norwegian Patient Registry (NPR) were included in the study. Population data as of 2009 was accessed from Statistics Norway. The admission rate and the days in hospital (DiH) rate per 10,000 inhabitants/year were set as 1.0.
Both study groups had a significantly higher admission and DiH-rate than northern Norwegians in general. The median annual admission rate/10,000 inhabitants was 284 (Sami) and 307 (non-Sami), respectively (P =?0.23). Whereas there were no difference between groups with regard to DiH/10,000 inhabitants/year (P =?0.24), the males of the Sami group spent significantly fewer DiH when any form of coercion was used (RR =?0.41).
Sami did not experience significantly more or fewer admissions (voluntary and compulsory) to psychiatric hospitals than the control group. There were significant intergroup variations in both groups.
This investigation is a retrospective registration on the basis of the case histories of 290 patients with the main diagnosis dementia who were admitted to a psychiatric hospital in the years 1982 and 1983. The average age was 77 years. Patients with their own homes comprized 61% but only 28% were admitted from their own homes. More than 70% of the patients admitted were described as suffering from moderate or severe dementia on admission. 93% were admitted voluntarily and 91% during the daytime. The reason for admission most frequently registered was the patient's suffering. In 66% of the cases, the general practitioner had attempted treatment prior to admission. During hospitalization the majority of the patients received medicinal treatment. At the conclusion of treatment, 52% were found to be improved and 34% unchanged. 46% of the patients were assessed as requiring maximum nursing-home treatment and 29% were considered to need psychiatric nursing-home treatment. 8% could be discharged to their own homes. The average durations of hospitalization, duration of treatment and waiting-time were reviewed. It is noteworthy that the waiting-time, 311 days, was found to be nearly as long as the duration of treatment, 316 days. In addition, the waiting-times for nursing-homes with maximum care were calculated to be 229 days on an average and for psychiatric nursing homes 596 days.