Psychiatric advance statements: An Indian experience

Kumar, TC Ramesh; John, Sujit; Gopal, Subhashini; Mohan, Greeshma; Joseph, Jainey; Rangaswamy, Thara

doi:10.1177/0020764012443756

Cited by 49 publications

(24 citation statements)

References 8 publications

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“…This is in contrast to findings from another study on PAD in India, which found carers to be very supportive of PADs [16]. The role of family in PADs is a delicate one, as carers may influence preferences articulated in a PAD, or may lead to tense relations if the client and carer preferences differ.…”

Section: Discussioncontrasting

confidence: 89%

Unpacking the psychiatric advance directive in low-resource settings: an exploratory qualitative study in Tamil Nadu, India

Shields

Pathare

Zelst

et al. 2013

Int J Ment Health Syst

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BackgroundPsychiatric advance directives, a tool to document preferences for care in advance of decisional incapacity, have been shown to benefit persons with mental illness in a number of countries through improving medication adherence, reducing symptoms from escalating in a crisis, accelerating recovery, and enhancing service user autonomy. While concepts such as autonomy are important in a number of high-income country settings, it remains unclear whether tools like psychiatric advance directives are suitable in a different context. The recent introduction of the psychiatric advance directive into draft legislation in India prompts the question as to how feasible psychiatric advance directives are in the Indian context. The aim of this study is to explore the feasibility and utility of PADs in India, with a focus on the need for individual control over decision making and barriers to implementation, by exploring views of its central stakeholders, service users and carers.MethodsQualitative semi-structured interviews (n = 51) with clients (n = 39) and carers (n = 12) seeking mental health treatment at outpatient clinics in urban and rural settings provided by a non-profit organisation in Tamil Nadu, India.ResultsClients engaged in a number of forms of decision-making (passive, active, and collaborative) depending on the situation and decision at hand, and had high levels of self-efficacy. Most clients and carers were unfamiliar with PADs, and while some clients felt it is important to have a say in treatment wishes, carers expressed concerns about service user capacity to make decisions. After completing PADs, clients reported an increase in self-efficacy and an increased desire to make decisions.ConclusionsThe introduction of psychiatric advance directives in India appears to be associated with positive outcomes for some service users, however, there is a need to better understand how this tool can be adapted to better suit the care context in India and hold meaning and value for service users to complete.

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Section: Discussioncontrasting

confidence: 89%

Unpacking the psychiatric advance directive in low-resource settings: an exploratory qualitative study in Tamil Nadu, India

Shields

Pathare

Zelst

et al. 2013

Int J Ment Health Syst

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“…1) (Weinstock et al 1984;Veliz & James, 1987;Norko et al 1990;Bean et al 1994;Grisso et al , 1997Carpenter et al 2000;Moser et al 2002Moser et al , 2005Moser et al , 2006Valletto et al 2002;Wong et al 2000Wong et al , 2005Bellhouse et al 2003;Kovnick et al 2003;Vollmann et al 2003;Cohen et al 2004;Palmer et al 2004Palmer et al , 2005Srebnik et al 2004;Cairns et al 2005;Eyler et al 2005Eyler et al , 2007Koren et al 2005;Stroup et al 2005;Candilis et al 2006Candilis et al , 2008Dunn et al 2007;Moye et al 2008;Kavanagh et al 2008;Jeste et al 2009;Owen et al 2009aOwen et al , 2011De Marco et al 2010;Capdevielle et al 2009;Linder et al 2012;Di & Cheng, 2013;Fischer et al 2013;Kumar et al 2013;Lan et al 2013;Raffard et al 2013;Skipworth et al 2013;Chiu et al 2014). A clinician with expertise in the field [G Shields (GS)] ...…”

Section: Resultsmentioning

confidence: 99%

Diversity or disarray? A systematic review of decision-making capacity for treatment and research in schizophrenia and other non-affective psychoses

et al. 2017

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Background. Valid consent for treatment or research participation requires that an individual has decision-making capacity (DMC), which is the ability to make a specific decision. There is evidence that the psychopathology of schizophrenia can compromise DMC. The objective of this review was to examine the presence or absence of DMC in schizophrenia and the socio-demographic/psychopathological factors associated.Methods. We searched three databases Embase, Ovid MEDLINE(R), and PsycINFO for studies reporting data on the proportion of DMC for treatment and research (DMC-T and DMC-R), and/or socio-demographic/psychopathological associations with ability to make such decisions, in people with schizophrenia and related illnesses.Results. A total of 40 studies were identified. While high levels of heterogeneity limited direct comparison, meta-analysis of inpatient data showed that DMC-T was present in 48% of people. Insight was strongly associated with DMC-T. Neurocognitive deficits were strongly associated with lack of DMC-R and to a lesser extent DMC-T. With the exception of years of education, there was no evidence for an association with socio-demographic factors.Conclusions. Insight and neurocognitive deficits are most closely associated with DMC in schizophrenia. The lack of an association with socio-demographic factors dispels common misperceptions regarding DMC and characteristics such as age. Although our results reveal a wide spectrum of DMC-T and DMC-R in schizophrenia, this could be partly due to the complexity of the DMC construct and the heterogeneity of existing studies. To facilitate systematic review research, there is a need for improvement within research study design and increased consistency of concepts and tools.

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“…Predictably, ECT use remained a contentious area-a slender majority of patients (39 v/s 30) were unwilling to consider it at all (Pathare et al, 2015). A second study evaluated 92 completed model PADs of patients at SCARF, Chennai (Kumar et al, 2013). Yet again, all patients wanted to continue treatment.…”

Section: Resultsmentioning

confidence: 99%

Psychiatric Advance Directives in India: What will the future hold?

Ratnam

Rudra

Chatterjee

et al. 2015

Asian Journal of Psychiatry

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Psychiatric advance statements: An Indian experience

Abstract: Psychotic patients with a long-term illness, a third of them from non-urban areas, were able to write a valid PAS.

Cited by 49 publications

References 8 publications

Unpacking the psychiatric advance directive in low-resource settings: an exploratory qualitative study in Tamil Nadu, India

Unpacking the psychiatric advance directive in low-resource settings: an exploratory qualitative study in Tamil Nadu, India

Diversity or disarray? A systematic review of decision-making capacity for treatment and research in schizophrenia and other non-affective psychoses

Psychiatric Advance Directives in India: What will the future hold?

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