A proposal of a patient psychiatric treatment and hospitalisation consent form

The Polish medical law has accepted the rule of equivalence in the doctor-patient relationship. In this way it gave up on the medical paternalism”. To a large extent, the newly passed or renewed Rules and Regulations were responsible for this. All Polish hospitals, the psychiatric ones amongst them, must abide the rules on patients’ agreement to being hospitalised, examined and treated in accordance with the regulations on: the profession of the doctor and the dentist (passed on the 5th December 1996); on the patient’s laws and the Speaker of Patient’s Laws (passed on the 6th November 2008) and the Minister of Health Regulation on the type and range of medical records kept in the health care centres and the means of dealing with those records (from the 21st December 2006). Many hospitals have use their own adapted records, which are in accordance with those rules and regulations. There is no universal forms concerning the patient’s consent to being admitted and treated in a psychiatric hospital. The problem that is taken on by the psychiatrists about the difference and specificity of psychiatric treatment and the situation of the patient being admitted onto a psychiatric ward, proves the general consent forms to be inadequate. mThe article shows the current and running regulations on the patient’s consent to hospital admission, an agreement to receiving health care and receiving medical information and insight into medical records. The character, scope, types of patient’s agreement and their forms have been discussed here. Appropriate form types and outlines are presented

Incapacitation — is this institution still needed?

Ubezwłasnowolnienie jest instytucją cywilnoprawną, która wzbudza wiele kontrowersji. W ciągu ostatnich kilkunastu lat, wraz ze wzrostem popularności idei równouprawnienia i niedyskryminacji osób z zaburzeniami psychicznymi, zaczęto zastanawiać się nad sensem istnienia owej instytucji, w kontekście jej celowości. Wątpliwości dotyczą przede wszystkim zakresu ingerencji w podmiotowość i autonomię osoby, względem której jest orzekane ubezwłasnowolnienie. Przeciwnicy tej instytucji wręcz podnoszą, że ubezwłasnowolnienie całkowite, którego konsekwencją jest utrata zdolności do czynności prawnych, narusza godność człowieka, narusza zasady konstytucyjne oraz jest niezgodne z przepisami ratyfikowanej przez Polskę w 2012 roku. Konwencji o ochronie osób z niepełnosprawnościami. Poniższy artykuł przedstawia analizę ubezwłasnowolnienia z punktu widzenia sytuacji prawnej i faktycznej osoby, względem której je orzeczono (regulacje, konsekwencje prawne, praktyka) i celowości jego stosowania na tle alternatywnych uregulowań w innych krajach europejskich.Incapacitation is a very controversial institution of polish civil law. Especially in the last several years, due to the increasing popularity of the concept of equality and non-discrimination of people with mental disorders, the meaning of the existence of this institution has been questioned in the context of its purpose. Concerns relate primarily to the scope of interference with the subjectivity and autonomy of the person in respect of which it is predicated incapacitation. The opponents of this theory even argue that total incapacitation, the consequence of which is the loss of legal capacity, violates human dignity, also constitutional principles and it is contrary to the provisions ratified by Poland in 2012 Convention On The Protection Of Individuals With Disabilities. The following article presents an analysis of incapacitation from the legal situation point of view and the actual person to whom it was issued (regulations, legal consequences, the practice of using) and the appropriateness of its use against the alternative arrangements in other European countries

Classification of mental disorders : a conceptual framework for the ICD-11

The World Psychiatric Association (WPA) and World Health Organization (WHO) are currently engaging in the revision of the International Classification of Diseases and Related Health Problems (ICD-10). Polish Psychiatric Association (PPA) is participating in that process and the first step was an international survey of Polish psychiatrists expressing their experiences and concepts about the new ICD-11. The mission is to produce an international classification that is up to the contemporary challenge, is ready for electronic health records, serves as a standard for scientific comparability and facilitates communication in psychiatry. This is the review of works currently underway, including PPA members’ tasks and efforts, regarding ICD-10 revision

Factors influencing length of stay of forensic patients : impact of clinical and psychosocial variables in medium secure setting

Objectives: Forensic psychiatric care has two, often contradictory, aims-the treatment of mentally ill offenders and the isolation of the perpetrators to ensure public safety. It is essential to ensure that any periods of liberty deprivation do not last longer than necessary to provide appropriate treatment. Therefore, identifying the factors affecting the length of stay (LoS) is one of the most important research areas in the forensic psychiatry. The literature on this subject is scarce and to date there no data available on LoS for patients in Eastern or Central European patients. Methods: We conducted a retrospective analysis of data for 150 inpatients in a medium secure unit. Based on a literature review and clinical experience, variables potentially influencing LoS were identified and included in the analysis. Results: The variables that were significantly associated with LoS included duration of mental illness; severity of index offense; whether a crime was committed as a result of hallucinations or during drug treatment discontinuation; if the index offenses was a continuous crime (crimes committed over an extended period of time); persistent psychosis; multiple antipsychotic treatments; as well as a diagnosis of schizophrenia and schizoaffective disorder. Conclusions: Our findings are highly consistent with observations made by other researchers. However, contrary the majority of previous studies our project incorporates data concerning the clinical presentation of patients. For example, we demonstrate that variables measuring treatment resistance might be one of the crucial determinants of LoS, which is a novel research finding

European Psychiatric Association (EPA) guidance on forensic psychiatry : Evidence based assessment and treatment of mentally disordered offenders

Forensic psychiatry in Europe is a specialty primarily concerned with individuals who have either offended or present a risk of doing so, and who also suffer from a psychiatric condition. These mentally disordered offenders (MDOs) are often cared for in secure psychiatric environments orprisons. In this guidance paper we first present an overview of the field of forensic psychiatry from a European perspective. We then present a review of the literature summarising the evidence on the assessment and treatment of MDOs under the following headings: The forensic psychiatrist as expert witness, risk, treatment settings for mentally disordered offenders, and what works for MDOs. We undertook a rapid review of the literature with search terms related to: forensic psychiatry, review articles, randomised controlled trials and best practice. We searched the Medline, Embase, PsycINFO, and Cochrane library databases from 2000 onwards for adult groups only. We scrutinised publications for additional relevant literature, and searched the websites of relevant professional organisations for policies, statements or guidance of interest. We present the findings of the scientific literature as well as recommendations for best practice drawing additionally from the guidance documents identified. We found that the evidence base for forensic-psychiatric practice is weak though there is some evidence to suggest that psychiatric care produces better outcomes than criminal justice detention only. Practitioners need to follow general psychiatric guidance as well as that for offenders, adapted for the complex needs of this patient group, paying particular attention to long-term detention and ethical issues. (C) 2017 Elsevier Masson SAS. All rights reserved.Peer reviewe

External factors influencing length of stay in forensic services : A European evaluation

Objectives. A growing number of patients whose length-of-stay in forensic services is above average length are identifiable in several European countries. Forensic services are situated within a particular sociocultural setting. Accordingly, this trend to increased admission length cannot be solely attributed to patient characteristics. This is the first known study exploring the influence of external factors on length-of-stay in forensic services. Methods. Representatives from 16 European countries, members of the international COST project, focused on forensic psychiatric service, analyzed their respective forensic services using a structured tool. Responses were combined and analyzed using thematic analysis. Results. Four themes described the factors influencing length-of-stay: care and treatment pathways; resources; legal and systemic impact; and sharing expertise. Conclusions. Findings suggest multidisciplinary consideration of the whole care pathway is required to address increased length-of-stay. Further research is required to support development of evidence-based standards applicable across Europe, and improve outcomes for patients at risk of increased length-of-stay in forensic services.Peer reviewe

Decision-making and risk-taking in forensic and non-forensic patients with schizophrenia spectrum disorders: A multicenter European study

Studies of patients with schizophrenia and offenders with severe mental disorders decision-making performance have produced mixed findings. In addition, most earlier studies have assessed decision-making skills in offenders or people with mental disorders, separately, thus neglecting the possible additional contribution of a mental disorder on choice patterns in people who offend. This study aimed to fill this gap by comparing risk-taking in patients with schizophrenia spectrum disorders (SSD), with and without a history of serious violent offending assessing whether, and to what extent, risk-taking represents a significant predictor of group membership, controlling for their executive skills, as well as for sociodemographic and clinical characteristics. Overall, 115 patients with a primary diagnosis of SSD were recruited: 74 were forensic patients with a lifetime history of severe interpersonal violence and 41 were patients with SSD without such a history. No significant group differences were observed on psychopathological symptoms severity. Forensic generally displayed lower scores than non-forensic patients in all cognitive subtests of the Brief Assessment of Cognition in Schizophrenia (except for the "token motor" and the "digit sequencing" tasks) and on all the six dimensions of the Cambridge Gambling Task, except for "Deliberation time", in which forensic scored higher than non-forensic patients. "Deliberation time" was also positively, although weakly correlated with "poor impulse control". Identifying those facets of impaired decision-making mostly predicting offenders' behaviour among individuals with mental disorder might inform risk assessment and be targeted in treatment and rehabilitation protocols

Pharmacological interventions to reduce violence in patients with schizophrenia in forensic psychiatry.

Abstract Background The purpose was to systematically investigate which pharmacological strategies are effective to reduce the risk of violence among patients with Schizophrenia Spectrum Disorders (SSD) in forensic settings. Methods For this systematic review six electronic data bases were searched. Two researchers independently screened the 6,003 abstracts resulting in 143 potential papers. These were then analyzed in detail by two independent researchers. Of these, 133 were excluded for various reasons leaving 10 articles in the present review. Results Of the 10 articles included, five were merely observational, and three were pre-post studies without controls. One study applied a matched case-control design and one was a non-randomized controlled trial. Clozapine was investigated most frequently, followed by olanzapine and risperidone. Often, outcome measures were specific to the study and sample sizes were small. Frequently, relevant methodological information was missing. Due to heterogeneous study designs and outcomes meta-analytic methods could not be applied. Conclusion Due to substantial methodological limitations it is difficult to draw any firm conclusions about the most effective pharmacological strategies to reduce the risk of violence in patents with SSD in forensic psychiatry settings. Studies applying more rigorous methods regarding case-definition, outcome measures, sample sizes, and study designs are urgently needed