Narcissism in patients admitted to psychiatric acute wards: its relation to violence, suicidality and other psychopathology

<p>Abstract</p> <p>Background</p> <p>The objective was to examine various aspects of narcissism in patients admitted to acute psychiatric wards and to compare their level of narcissism to that of an age- and gender-matched sample from the general population (NORM).</p> <p>Methods</p> <p>This cross-sectional study interviewed 186 eligible acute psychiatric patients with the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF). The patients filled in the Narcissistic Personality Inventory-21 item version (NPI-21), The Hospital Anxiety and Depression Scale (HADS) and the Rosenberg Self-Esteem Scale. High and low narcissism was defined by the median of the total NPI-21 score. An age- and gender-matched control sample from the general population also scored the NPI-21 (NORM).</p> <p>Results</p> <p>Being male, involuntary admitted, having diagnosis of schizophrenia, higher self-esteem, and severe violence were significantly associated with high narcissism, and so were also low levels of suicidality, depression, anxiety and GAF scores. Severe violence and high self-esteem were significantly associated with high narcissism in multivariable analyses. The NPI-21 and its subscales showed test-retest correlations ≥0.83, while the BPRS and the HADS showed lower correlations, confirming the trait character of the NPI-21. Depression and suicidality were negatively associated with the NPI-21 total score and all its subscales, while positive association was observed with grandiosity. No significant differences were observed between patients and NORM on the NPI-21 total score or any of the NPI subscales.</p> <p>Conclusion</p> <p>Narcissism in the psychiatric patients was significantly associated with violence, suicidality and other symptoms relevant for management and treatment planning. Due to its trait character, use of the NPI-21 in acute psychiatric patients can give important clinical information. The similar level of narcissism found in patients and NORM is in need of further examination.</p

Communication in Psychiatric Coercive Treatment and Patients’ Decisional Capacity to Consent

An effective communication and the acquisition of a valid consent is central to a good and supporting doctor-patient relationship and a clinician’s ethical obligation in o order to respect patients’ autonomy, as well as their right to be involved in treatment decisions. However, often clinicians face several issues in performing this task, among which the most frequently reported are the fear of hurting the patient by communicating a bad diagnosis or not knowing how to manage the patient’s emotional reactions. In addition, there are vulnerable populations, such as those represented by psychiatric patients, who are at higher risk of decisional incapacity. Especially for those patients it is in fact particularly difficult for clinicians to find the proper balance between respecting the right of capable patients to make choices about their treatment and the right of incapable patients to be protected from the possible harmful consequences of their improper decisions. However, nor the presence of a severe psychiatric disorder nor a status of “involuntary hospitalized patient” have been reported to be a label for incapacity. Several tools have been developed to assist clinicians in patients’ decisional capacity evaluations, together with interventions aimed at enhancing informed consent acquisition in order to achieve a shared decision-making and lead the patient to become actively involved in his/her treatment decisions. Such approach would lead to a decrease in the perceived coercion, often reported in mental health care setting also from patients who are not involuntarily hospitalized, and to an increase in patients’ adherence to treatment