Mike (2015) Empowerment and satisfaction in a multinational study of routine clinical practice. Acta Psychiatrica Scandinavica, 131 (5). pp. 369-378. ISSN 1600-0447Access from the University of Nottingham repository: http://eprints.nottingham.ac.uk/34260/1/AFD%20APS%20CEDAR%20Empowerment %20and%20satisfaction.pdf Copyright and reuse:The Nottingham ePrints service makes this work by researchers of the University of Nottingham available open access under the following conditions. This article is made available under the University of Nottingham End User licence and may be reused according to the conditions of the licence. For more details see: http://eprints.nottingham.ac.uk/end_user_agreement.pdf A note on versions:The version presented here may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the repository url above for details on accessing the published version and note that access may require a subscription. We tested whether mental health patients are more satisfied with a decision made (a) using their preferred decision-making style and (b) with a clinician with the same decision-making style preference. MethodAs part of the CEDAR Study (ISRCTN75841675), a convenience sample of 445 patients with severe mental illness from six European countries were assessed for desired clinical decision-making style (rated by patients and paired clinicians), decision-specific experienced style and satisfaction. ResultsPatients who experienced more involvement in decision-making than they desired rated higher satisfaction (OR=2.47, p=0.005, 95%CI 1.32 to 4.63). Decisions made with clinicians whose decision-making style preference was for more active involvement than the patient preference were rated with higher satisfaction (OR=3.17, p=0.003, 95%CI 1.48 to 6.82). ConclusionMore active involvement in decision-making than the patient stated as desired was associated with higher satisfaction. A clinical orientation towards empowering, rather than shared, decision-making may maximise satisfaction. KeywordsDecision Making, Mental Health 3. The extent to which the decision topic impacted on preference and agreement is unknown.4

Background: The purpose of this paper was to examine national differences in the desire to participate in decision-making of people with severe mental illness in six European countries. Methods:The data was taken from a European longitudinal observational study (CEDAR; ISRCTN75841675). A sample of 514 patients with severe mental illness from the study centers in Ulm, Germany, London, England, Naples, Italy, Debrecen, Hungary, Aalborg, Denmark and Zurich, Switzerland were assessed as to desire to participate in medical decision-making. Associations between desire for participation in decision-making and center location were analyzed with generalized estimating equations. Results:We found large cross-national differences in patients' desire to participate in decision-making, with the center explaining 40% of total variance in the desire for participation (p<0.001). Averaged over time and independent of patient characteristics, London (mean=2.27), Ulm (mean=2.13) and Zurich (mean=2.14) showed significantly higher scores in desire for participation, followed by Aalborg (mean=1.97), where scores were in turn significantly higher than in Debrecen (mean=1.56). The lowest scores were reported in Naples (mean=1.14). Over time, desire for participation in decision-making increased significantly in Zurich (b=0.23) and decreased in Naples (b=-0.14). In all other centers, values remained stable.Conclusions: This study demonstrates that patients' desire for participation in decisionmaking varies by location. We suggest that more research attention be focused on identifying specific cultural and social factors in each country to further explain observed differences across Europe.

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A variety of relevant decision topics were shown for mental health care.Implementation rates varied in relation to topic and may need different consideration within the therapeutic dyad.

Objectives: Behavioral and psychological symptoms of dementia (BPSD) are common during the course of dementia and are associated with poor outcome for patients. There are some clinical data indicating that SSRI antidepressants have a positive influence on BPSD. Escitalopram has an excellent side-effect profile and might be a suitable treatment for BPSD in older demented patients. Methods: An open-label observation of inpatients aged 65 to 90 years with a clinical diagnosis of probable AD and an MMSE score of 6 to 20 points and NPI total score ≥20 points treated with escitalopram for 8 weeks. The evaluation of improvement/worsening counted as ±10% change from baseline score in NPI and CMAI short. The results expressed in numbers of improved, unchanged and worsened patients. Results: 13 patients, 12 women and 2 men. The average age was 79.3 years, the average MMSE was 12.8 points. Three patients discontinued due to AEs (bronchopneumonia, progressive worsening of dementia, transfer to another institution). The other AEs were mild and not related to study medication.