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Sante Mentale Au Quebec 2023Context In the exercise of his practice, the psychiatrist is commonly called upon to assess the suicidal risk of a patient and may, under the circumstances, engage his...
Context In the exercise of his practice, the psychiatrist is commonly called upon to assess the suicidal risk of a patient and may, under the circumstances, engage his professional liability and become the subject of a civil suit in the event of the death of the patient. Despite the existence of guidelines and tools for the assessment and management of suicide risk, the practice often remains unstandardized. Few studies have focused on the assessment and management of this risk from a legal perspective. Some knowledge of case law could be useful to psychiatrists in making future decisions, both from a medico-legal point of view and to improve the care offered. Objectives This article aims to study the civil liability of the psychiatrist following the suicide of a patient by analyzing Canadian case law from a perspective of continuous improvement of practice with particular attention to the assessment and management of suicide risk. Method A systematic review of the judgments was carried out on CanLII.org, a virtual library of Canadian legal information allowing access to the judgments rendered by the courts of first instance, the Courts of Appeal as well as those of the Supreme Court of Canada. The search strategy consisted in using the key words "suicide," "psychiatrie," "faute" and "responsabilité" as well as their English translation to retain the recourses where a judgment was rendered by the court and where at least one psychiatrist acted as a defendant or co-defendant following the suicide of a patient. Results Nine judgments met our inclusion criteria. Since elements were of interest for our research question, it seemed wise to us to also include three decisions where the patient did not die of his suicidal attempt but kept significant sequelae. The analysis of the judgments made it possible to identify the alleged faults most often reproached to the psychiatrist by the plaintiff and to present the usual position of the courts, and the arguments which underlie them. The alleged faults can be grouped into three categories: an assessment of the suicide risk deemed faulty, a management of the suicide risk by supervisory measures deemed faulty and an omission to have used legal custody measures when they should have been applied. In nearly all cases, Canadian courts render a decision in favor of the psychiatrist, demonstrating sensitivity to the reality of psychiatrists' practice. The recommendations resulting from our analysis of Canadian case law support the guidelines of the American Psychiatric Association and the Ontario Hospital Association practice guidelines for suicide risk assessment and management, particularly in terms of the content of evaluation, specific moments of re-evaluation and documentation. Conclusion Knowledge of Canadian case law on civil liability for the suicide of a patient represents an additional asset for the practice of responsible and quality psychiatry.
Topics: Humans; United States; Psychiatrists; Suicide; Psychiatry; Liability, Legal; Ontario
PubMed: 38578190
DOI: No ID Found -
International Journal of Environmental... Mar 2024Grief after suicide or patient-perpetrated homicide can be complex for those involved in the patient's care. Mental health practitioners with patients who die...
What Are the Experiences of Mental Health Practitioners Involved in a Coroner's Inquest and Other Inquiry Processes after an Unexpected Death of a Patient? A Systematic Review and Thematic Synthesis of the Literature.
Grief after suicide or patient-perpetrated homicide can be complex for those involved in the patient's care. Mental health practitioners with patients who die unexpectedly may be called to assist in the formal investigation processes that follow. The aim of this study was to examine the experience of mental health practitioners called to attend a coroner's inquest or other forms of formal inquiry. A protocol for a systematic review was prospectively registered on PROSPERO (CRD42023400310). A thematic synthesis of existing literature was conducted. We identified six articles for inclusion and constructed three themes from our analysis: Blame and enduring hostility, In the dark, and Limited learning. We found mental health practitioners may construct narratives of self-blame. These can be reinforced by the investigatory processes that follow. Feedback from inquiries is often delivered haphazardly and may not reflect the realities of clinical work. The support given to assist practitioners through inquiry processes varied-both in amount and how helpful it was. The research conducted on this topic is limited. More qualitative research should be conducted to understand the factors that make this experience more or less difficult as well as well as what support is needed for whom.
Topics: Humans; Bereavement; Coroners and Medical Examiners; Grief; Mental Health
PubMed: 38541356
DOI: 10.3390/ijerph21030357 -
Scandinavian Journal of Public Health Mar 2024This systematic review aims to identify and describe how children of parents with mental illness, substance dependence, or severe physical illness/injury, experience... (Review)
Review
This systematic review aims to identify and describe how children of parents with mental illness, substance dependence, or severe physical illness/injury, experience and practise their everyday life. The review followed the four stepwise recommendations of Harden and colleagues when including quantitative and qualitative studies on peoples' experiences and views. In all, 23 studies with data from Norway (2010-2022) have been included. Brown and Clark's thematic analysis was applied. Three themes were constructed from the reviewed articles: (a) Children practice their relational agency by actively doing practical tasks, occasionally jobs to maintain family economy, and organising fun activities with the ill parent. (b) Emotional ambivalence when their own needs were set aside in favour of the parents. They loved their parents but also felt guilt, anger, disappointment, shame, fear of inheriting the illness and longed for a 'normal' everyday life. (c) Supportive contextual factors were, for example, at least one significant adult recognising them, participating in leisure activities, socialising with friends, and talking with other peers who shared similar experiences as next of kin. Obstructive factors were lack of information and recognition as well as silence and lack of dialogue within the family and/or health professional.
PubMed: 38506846
DOI: 10.1177/14034948241232040 -
CNS & Neurological Disorders Drug... Mar 2024Multiple illnesses commonly involve both the Central Nervous System (CNS) and the Gastrointestinal Tract (GI) simultaneously. Consistent evidence suggests that...
INTRODUCTION
Multiple illnesses commonly involve both the Central Nervous System (CNS) and the Gastrointestinal Tract (GI) simultaneously. Consistent evidence suggests that neurological disorders impair GI tract function and worsen the symptomatology and pathophysiology of digestive disorders. On the other hand, it has been proposed that early functional changes in the GI tract contribute to the genesis of several CNS illnesses. Additionally, the role played by the gut in these diseases can be seen as a paradigm for how the gut and the brain interact.
METHODS
We mentioned significant GI symptoms and discussed how the GI tract affects central nervous system illnesses, including depression, anxiety, Alzheimer's disease, and Parkinson's disease in this study. We also explored potential pathophysiological underpinnings and novel targets for the creation of future therapies targeted at gut-brain connections.
RESULTS & DISCUSSION
In this situation, modulating the gut microbiota through the administration of fecal microbiota transplants or probiotics may represent a new therapeutic option for this population, not only to treat GI problems but also behavioral problems, given the role that dysbiosis and leaky gut play in many neurological disorders.
CONCLUSION
Accurate diagnosis and treatment of co-existing illnesses also require coordination between psychiatrists, neurologists, gastroenterologists, and other specialties, as well as a thorough history and thorough physical examination.
PubMed: 38500273
DOI: 10.2174/0118715273289138240306050532 -
Psychiatry, Psychology, and Law : An... 2024Police negotiators respond to crisis and high-risk situations including mental health crises, but little is known about the nature, frequency and characteristics of...
Police negotiators respond to crisis and high-risk situations including mental health crises, but little is known about the nature, frequency and characteristics of these events. This systematic review examined literature about mental disorder and suicidality prevalence in negotiation events from peer-reviewed articles published within the last 20 years. Of 1455 articles identified, 11 met study inclusion criteria. Most contributed only indirect evidence using data on fatal police encounters, case reviews and analysis of communication techniques. Reliable prevalence estimates were not found, though findings suggest suicidality was a precipitating factor in more than half of events and was present during most events. Mental disorder (primarily substance use, mood and psychotic disorders) was also identified as a significant factor prior to and during events. Few articles described frequency or characteristics of these critical events. Further research is needed to inform frontline responses, resourcing and support pathways for police providing this crucial service.
PubMed: 38455272
DOI: 10.1080/13218719.2023.2175066 -
Frontiers in Neurology 2024Tardive dyskinesia (TD) is a movement disorder that can arise as a side effect of treatment with dopamine receptor-blocking agents (DRBAs), including antipsychotic drugs...
Tardive dyskinesia (TD) is a movement disorder that can arise as a side effect of treatment with dopamine receptor-blocking agents (DRBAs), including antipsychotic drugs (APDs) used to manage psychotic illnesses. Second-generation APDs (SGAs) are often preferred to first-generation drugs due to their lower propensity to cause TD, however many SGAs-treated patients still develop the condition. Although TD is a global health concern, evidence regarding the occurrence of TD and how it is managed in Asian countries is currently limited. This article reports the results of a systematic review of the published literature on TD focusing on its prevalence, types of patients, knowledge of the condition, causative factors, and usual treatment pathways in clinical practice in Asian countries. Epidemiological data suggest that the prevalence of TD is increasing globally due to an overall rise in APD use, contributing factors being polypharmacy with multiple APDs, the use of higher than necessary doses, and off-label use for non-psychotic indications. Although exact prevalence figures for TD in Asian countries are difficult to define, there is a similar pattern of rising APD use which will result in increasing numbers of TD patients in this region. These issues need to be addressed and strategies developed to minimize TD risk and manage this disabling condition which impacts patients' quality of life and daily functioning. To date, both research into TD has been predominantly psychiatry focused and the perspectives from neurologists regarding the clinical management of this challenging condition are scarce. However, neurologists have an essential role in managing the movement disorders manifestations that characterize TD. Optimum management of TD, therefore, should ideally involve collaboration between psychiatrists and neurologists in joint care pathways, wherever practical. Collaborative pathways are proposed in this article, and the challenges that will need to be addressed in Asian countries to improve the care of people with TD are highlighted, with a focus on the neurologist's viewpoint and the implications for the management of TD globally.
PubMed: 38419696
DOI: 10.3389/fneur.2024.1356761 -
BMJ Open Feb 2024Patient involvement in mental health professional education is required by policy but lacks a robust evidence base. The impact of involvement in education on patients...
OBJECTIVES
Patient involvement in mental health professional education is required by policy but lacks a robust evidence base. The impact of involvement in education on patients with mental health conditions may differ from that of patients with other conditions. This study aims to review the impact of involvement in mental health professional education on the patients with mental health conditions involved.
SETTING
Electronic databases MEDLINE, PubMed, AMED, EMBASE, PsycINFO, Emcare, BNI, HMIC and CINAHL were systematically searched to find articles reporting on health professional teaching interventions involving patients with mental health conditions and the psychological, social or physical impact of involvement. The search took place in August 2023.
RESULTS
Findings from 20 articles were amalgamated into four synthesised findings: (1) Impact of general involvement (2) impact of making a difference through teaching, (3) impact of new relationships and (4) impact of talking about experiences.
CONCLUSIONS
Patient involvement in mental health professional education can be beneficial for patients with mental health conditions when their experiences are respected and valued as expertise by students and academic staff. The experiences of patient educators in the mental health field are unique in that teaching activities interact with their mental health. Future research should evaluate patient involvement in the mental health field separately and report research findings according to reporting guidelines.
PROSPERO REGISTRATION NUMBER
CRD42020224907.
Topics: Humans; Mental Health; Health Personnel; Health Education; Educational Status; Mental Disorders
PubMed: 38388502
DOI: 10.1136/bmjopen-2024-084314 -
Journal of Eating Disorders Feb 2024The purpose of this meta-analysis was to provide a pooled prevalence estimate of self-reported disordered eating (SRDE) in athletes based on the available literature,...
BACKGROUND
The purpose of this meta-analysis was to provide a pooled prevalence estimate of self-reported disordered eating (SRDE) in athletes based on the available literature, and to identify risk factors for their occurrence.
METHODS
Across ten academic databases, an electronic search was conducted from inception to 7th January 2024. The proportion of athletes scoring at or above predetermined cutoffs on validated self-reporting screening measures was used to identify disordered eating (DE). Subgroup analysis per country, per culture, and per research measure were also conducted. Age, body mass index (BMI), and sex were considered as associated/correlated factors.
RESULTS
The mean prevalence of SRDE among 70,957 athletes in 177 studies (132 publications) was 19.23% (17.04%; 21.62%), I = 97.4%, τ = 0.8990, Cochran's Q p value = 0. Australia had the highest percentage of SRDE athletes with a mean of 57.1% (36.0%-75.8%), while Iceland had the lowest, with a mean of 4.9% (1.2%-17.7%). The SRDE prevalence in Eastern countries was higher than in Western countries with 29.1% versus 18.5%. Anaerobic sports had almost double the prevalence of SRDE 37.9% (27.0%-50.2%) compared to aerobic sports 19.6% (15.2%-25%). Gymnastics sports had the highest SRDE prevalence rate, with 41.5% (30.4%-53.6%) while outdoor sports showed the lowest at 15.4% (11.6%-20.2%). Among various tools used to assess SRDE, the three-factor eating questionnaire yielded the highest SRDE rate 73.0% (60.1%-82.8%). Meta-regression analyses showed that female sex, older age, and higher BMI (all p < 0.01) are associated with higher prevalence rates of SRDE.
CONCLUSION
The outcome of this review suggests that factors specific to the sport affect eating behaviors throughout an athlete's life. As a result, one in five athletes run the risk of developing an eating disorder. Culture-specific and sport-specific diagnostic tools need to be developed and increased attention paid to nutritional deficiencies in athletes.
PubMed: 38326925
DOI: 10.1186/s40337-024-00982-5 -
Clinical Child Psychology and Psychiatry Jul 2024Before the COVID-19 pandemic, the prevalence and severity of psychiatric disorders among sexual and gender diverse (SGD) young people was greater than in their... (Review)
Review
Before the COVID-19 pandemic, the prevalence and severity of psychiatric disorders among sexual and gender diverse (SGD) young people was greater than in their heterosexual/cisgender peers. We systematically reviewed literature examining the prevalence, severity, and risk factors for psychiatric disorders among SGD young people aged 25 and under during the pandemic. Four databases (MEDLINE, PsycInfo, Scopus and Web of Science) were searched. Eligibility criteria were studies assessing prevalence rates, mean symptomology scores and risk factors of psychiatric disorders using contemporaneous screening measures or diagnosis. Thirteen studies of mixed quality were identified. Most studies indicated SGD young people were at high risk of experiencing several psychiatric disorders including depressive and generalised anxiety disorder compared to the general population. This group also experienced more severe symptomology of various psychiatric disorders compared to their heterosexual/cisgender peers. Risk factors included those specific to the pandemic along with factors that led to greater risk before the pandemic. This systematic review has indicated evidence of heightened risk of psychiatric disorders among SGD young people during the COVID-19 pandemic. It is important for clinicians to acknowledge the needs of SGD young people, working with them to co-develop more inclusive care as they deal with the pandemic's fallout.
Topics: Humans; COVID-19; Risk Factors; Mental Disorders; Prevalence; Adolescent; Sexual and Gender Minorities; Young Adult; Severity of Illness Index; Female; Male; Adult
PubMed: 38290723
DOI: 10.1177/13591045241229751 -
Schizophrenia Research Feb 2024Acute laryngeal dystonia (ALD) is a rare but potentially life-threatening complication of both first-generation (FGA) and second-generation (SGA) antipsychotic... (Review)
Review
Acute laryngeal dystonia (ALD) is a rare but potentially life-threatening complication of both first-generation (FGA) and second-generation (SGA) antipsychotic medication. Delays in diagnosis and treatment have been associated with mortality. We carried out a systematic review of antipsychotic-induced acute laryngeal dystonia using the databases Ovid MEDLINE, PubMed, CINAHL, and EMBASE. Search terms included: (antipsychotic* OR antipsychotic-induced OR neuroleptic* OR neuroleptic-induced) AND (laryngeal dystonia* OR laryngo-pharyngeal dystonia* OR laryngospasm OR laryngeal spasm OR dystonic reaction* OR extrapyramidal reaction*) where * specified plural forms of the relevant word. Forty articles (describing 45 cases) met eligibility criteria. ALD occurred with both first- and second- generation antipsychotics but was more commonly reported in FGAs. ALD occurred in association with low, moderate and high doses (within the usual dose ranges of both high and low potency agents). Young males appeared to be most at risk of antipsychotic-induced ALD, especially those treated with high potency agents. Anticholinergic medication (including antihistamines with anticholinergic properties) usually provided rapid and effective relief, especially if administered parentally. Vigilance is indicated for idiosyncratic ALD emergence when initiating, or increasing the dose of, an antipsychotic medication. Rapid treatment with an anticholinergic medication is recommended to prevent adverse outcomes.
Topics: Male; Humans; Antipsychotic Agents; Dystonia; Cholinergic Antagonists
PubMed: 38185029
DOI: 10.1016/j.schres.2023.12.032