Prospective study of patients' refusal of antipsychotic medication under a physician discretion review procedure

Kasper, John A.; Hoge, Steven K.; Feucht‐Haviar, Thomas; Cortina, Jorge; Cohen, Bruce J.

doi:10.1176/ajp.154.4.483

Cited by 44 publications

(2 citation statements)

References 22 publications

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“…High intensity of delusional symptoms and suspiciousness and low socioeconomic status are the main risk factors for medication nonadherence in subjects with schizophrenia. A prospective study 38 of patients' refusal of antipsychotic medication in a setting in which physicians have discretionary power to administer treatment over patients' objections reported that patients who refused treatment were found to have significantly higher BPRS scores than were patients who complied with antipsychotic treatment. The antipsychotic-free patients from the rural area in this study had fewer BPRS anxiety symptoms and more prominent positive symptoms, a finding that perhaps is partly explained by the antipsychotic-free status but still deserves further research.…”

Section: Discussionmentioning

confidence: 99%

Antipsychotic-Free Status in Community-Dwelling Patients With Schizophrenia in China

Hou¹,

Chen²,

Cai³

et al. 2018

J. Clin. Psychiatry

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Antipsychotic-free status was more common in community-dwelling patients with schizophrenia in the rural area than in the urban area. Older age and poorer attitude toward medication treatment were common features of antipsychotic-free patients. There were correspondingly different risk factors for antipsychotic-free status between rural and urban areas. Building a positive medication treatment attitude is an important strategy for establishing medication adherence in older, community-dwelling patients with schizophrenia.

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Section: Discussionmentioning

confidence: 99%

Antipsychotic-Free Status in Community-Dwelling Patients With Schizophrenia in China

Hou¹,

Chen²,

Cai³

et al. 2018

J. Clin. Psychiatry

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“…Many involuntarily admitted patients use antipsychotics, often several types in combination [ 31 ], and an important reason for hospitalization of patients suffering from schizophrenia is failure to adhere to drug regimens [ 32 ]. Patients who refuse medication tend to be more ill and more negative to treatment in general [ 33 ], and thus at a higher risk of involuntary admission. Nevertheless, 58 % was a high figure, considering that approximately a quarter of involuntarily admitted patients in Norway suffer from non-psychotic disorders, including substance abuse and more serious personality disorders [ 34 , 35 ], and are consequently not admitted primarily in order to begin or reinstate therapy with neuroleptics.…”

Section: Discussionmentioning

confidence: 99%

Involuntary psychiatric admission: how the patients are detected and the general practitioners’ expectations for hospitalization. An interview-based study

Røtvold

Wynn

2016

Int J Ment Health Syst

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BackgroundIn Norway, it is usually GPs that refer patients to involuntary admission. A high proportion of such referrals come from out-of-hours clinics. Little is known about who first initiate the contact between the patients and the referring doctors and which expectations the referring doctors have with respect to the involuntary admissions. The aim of the study was to examine who first detected the patients who were subsequently involuntarily admitted, and to examine the referring doctors’ expectations for the admissions.MethodsSemi-structured interviews with 74 doctors that had referred patients for involuntary admission at a psychiatric hospital.ResultsPatients who were involuntarily admitted were detected by other branches of the health service (52 %, n = 39), family (25 %, n = 19), and the police (17 %, n = 13). The doctors mentioned these expectations for the admission (more than one expectation could be given): start treatment with neuroleptics: 58 % (n = 43), take care of the patient: 45 % (n = 34), extensive changes to the treatment regime: 37 % (n = 28), solve an acute situation: 35 % (n = 26), and clarify the diagnosis: 22 % (n = 17). Female doctors significantly more often expected that the patients would be examined and treated, while the male doctors significantly more often expected that the patients would be cared for.ConclusionsInvoluntary admissions are typically complex processes involving different people and services and patients with various needs. More knowledge about the events preceding hospitalization is needed in order to develop alternatives to involuntary admissions.Electronic supplementary materialThe online version of this article (doi:10.1186/s13033-016-0048-8) contains supplementary material, which is available to authorized users.

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Einwilligungsfähigkeit bei psychisch Kranken

Bauer

Vollmann

2002

Der Nervenarzt

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In clinical practice, patients' self-determination has become more and more important. However, in psychiatry, the practice of informed consent encompasses several problems. In many cases the psychiatrist is faced with the issue of determining patients' competence. This paper gives an overview of empirical studies on competence assessment in psychiatry. In the course of some of these studies, test instruments were developed which allow objective and reliable assessment of different standards of competence. The applicability of these tests is discussed. We present empirical data on the relationship between competence and psychopathologic symptoms and cognitive factors. In recent empirical research, a shift from an initial skepticism of the applicability of informed consent in psychiatry towards a more differentiated approach and an interest in multidisciplinary research can be observed.

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Prospective study of patients' refusal of antipsychotic medication under a physician discretion review procedure

Cited by 44 publications

References 22 publications

Antipsychotic-Free Status in Community-Dwelling Patients With Schizophrenia in China

Antipsychotic-Free Status in Community-Dwelling Patients With Schizophrenia in China

Involuntary psychiatric admission: how the patients are detected and the general practitioners’ expectations for hospitalization. An interview-based study

Einwilligungsfähigkeit bei psychisch Kranken

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