Compulsory Interventions in Severe and Persistent Mental Illness
A Survey on Attitudes Among Psychiatrists in Switzerland
Bibliographic Data
| ID | 15518233 |
|---|---|
| Authors | Júlia Stoll (0000-0003-1278-4140, University of Zurich), Martina Hodel (0000-0003-1547-472X, Zug Cantonal Hospital), Martina A Hodel, Florian Riese (0000-0001-5531-5833, University Hospital of Zurich), Scott A Irwin (0000-0001-7868-1641, Sinai Health System), Paul Hoff (0000-0002-9854-414X, University Hospital of Zurich), Nikola Biller-Andorno, Nikola Biller‐Andorno (0000-0001-7661-1324, University of Zurich), Manuel Trachsel (0000-0002-2697-3631, University of Zurich, corresponding author) |
| Year | 2021 |
| Volume | 12 |
| Pages | 537379-537379 |
| Publication date | 2021-05-25 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Frontiers in Psychiatry (JOURNAL) |
| Journal identifiers | ISSN: 1664-0640 • E-ISSN: 1664-0640 |
| Publisher | Frontiers Media (PUBLISHER • CH) |
| DOI | 10.3389/fpsyt.2021.537379 |
| PMID | 34113265 |
| OpenAlex | W3164826908 |
| Language | EN |
| Citations received | 1 |
| References cited | 38 |
Background: Some psychiatric patients develop severe and persistent mental illness (SPMI), which, for a variety of reasons, can be therapy-refractory. Sometimes, treatment is not considered helpful by the patients themselves and does not improve their subjective quality of life. Furthermore, many SPMI patients experience compulsory interventions such as seclusion, restraint, or treatment against their will, which can cause harm. Methods: In a cross-sectional survey of 1,311 German-speaking psychiatrists in Switzerland, participants were asked about the care of SPMI patients in general, and about their attitudes with regard to compulsory interventions in particular, using three case vignettes of patients with severe and persistent anorexia nervosa, schizophrenia and depression. Results: Out of 1,311 contacted psychiatrists, 457 (34.9%) returned the completed survey. In general, 91.0% found it important or very important to respect SPMI patients' autonomy in decision making. However, based on three different clinical case vignettes, 36.8% of psychiatrists would act against the wishes of the patient with severe and persistent schizophrenia, 34.1% against the wishes of the patient with severe and persistent depression, and 21.1% against the wishes of the patient with severe and persistent anorexia nervosa, although all patients were stated to have preserved decision-making capacity. With regard to the case vignettes, 41.1% considered compulsory interventions leading to a temporary reduction of quality of life acceptable in the patient with severe and persistent schizophrenia, 39.4% in the patient with severe and persistent depression, and 25.6% in the patient with severe and persistent anorexia nervosa, although it was stated in all three case vignettes that two independent experts ascribed the patients decision-making capacity regarding their illness and further treatment. Conclusions: Many psychiatrists in our sample found themselves in an ethical dilemma between autonomy and the provision of medical care. While most respondents respect the autonomy of SPMI patients, many saw the need to perform compulsory interventions even though it was clearly and prominently stated that two independent psychiatrists had ascribed the patients in the case vignettes decision-making capacity. Further examination of these conflicting views is warranted, perhaps along with the development of guidelines for such situations
Anorexia nervosa · Autonomy · Depression (economics · Eating disorders · Mental health · Mental illness · Psychiatry · Psychological intervention · Quality of life (healthcare · Schizophrenia (object-oriented programming · Seclusion · Healthcare Decision-Making and Restraints · Medicine · Mental Health and Psychiatry · Nursing · Psychosomatic Disorders and Their Treatments
| Unique citing works | 1 |
|---|---|
| Citations per year | 0,25 |
| Citation span | 2022 - 2022 (1) |
| Citation velocity | historical |
| Highly cited | No |
| Citation types | Neutral: 1 |