Incapacitated Refusal

  Sometimes patients who lack decision-making capacity refuse treatment that would be in their best interests. Imagine, for example, a patient suffering from acute schizophrenia who adamantly and persistently refuses to take antipsychotic medication that would relieve his symptoms. And suppose, further, that this patient poses no danger to himself or others, but that his mental illness prevents him from understanding his diagnosis as well as his likely prognosis with and without the treatment. Should a provider treat such a patient over his objections?   My reflections begin with the observation that in most cases of this kind, physicians tend to respect the patient’s incapacitated refusal, either by honoring it, or, at the very least, by treating it with great seriousness. Why? The simple answer is a legal one: in New York and many other states, it is against the law to treat patients over their objections except in cases in which the treatment will prevent them from endangering themselves or others. My interest here, though, is ethical rather than legal: what ethical justification can we offer for this practice? Answering this question is challenging in part because honoring incapacitated refusals is not obviously justifiable by appeal to any of Beauchamp and Childress’s famous four principles of biomedical ethics: The decision to honor an incapacitated refusal has nothing to do with the fair distribution of benefits and burdens, and so it is not a ma...
Source: blog.bioethics.net - Category: Medical Ethics Authors: Tags: Health Care autonomy beneficence capacity syndicated Source Type: blogs

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Catatonia was first described by Karl Ludwig Kahlbaum in 1874, occurring in association with other psychiatric and medical disorders. However, in the nineteenth century the disorder was incorrectly classified as a subtype of schizophrenia. This misclassification persisted until the publication of DSM-5 in 2013 when important changes were incorporated. Although the etiology is unknown, disrupted gamma-aminobutyric acid has been proposed as the underlying pathophysiological mechanism. Key symptoms can be identified under 3 clinical domains: motor, speech, and behavioral. Benzodiazepines and electroconvulsive therapy are the ...
Source: Child and Adolescent Psychiatric Clinics of North America - Category: Psychiatry Authors: Source Type: research
American Journal of Psychiatry, Ahead of Print.
Source: American Journal of Psychiatry - Category: Psychiatry Authors: Source Type: research
AbstractSchizophrenia is among the most stigmatized mental illness. Adolescence may be a critical time to intervene, before stigmatizing attitudes have been solidified. As such, schools may be in a unique position to provide anti-stigma interventions to a large number of students. The aim of this paper was to review and critically analyze the most recent (2003-present) school-based schizophrenia stigma interventions, with seven studies identified. Studies were analyzed according to their intervention method, outcome measures, and experimental design. Substantial heterogeneity between studies precluded concrete conclusions ...
Source: Psychiatric Quarterly - Category: Psychiatry Source Type: research
Acase report inSchizophrenia Bulletin suggests that patients who are taking clozapine may be at risk of clozapine toxicity if they become infected with COVID-19. Clozapine is considered the best option for patients with treatment-resistant schizophrenia, but patients taking the medication are at heightened risk of a rare but serious condition known as neutropenia, which can increase risk of severe infections.In theSchizophrenia Bulletinreport, Thomas Cranshaw, M.B.B.S., and Thiyyancheri Harikumar, M.B.B.S., of Cumbria, Northumberland, Tyne, and Wear NHS Foundation Trust in England, described a 38-year-old man in an inpatie...
Source: Psychiatr News - Category: Psychiatry Tags: clozapine COVID-19 Schizophrenia Bulletin Thiyyancheri Harikumar Thomas Cranshaw toxicity Source Type: research
Authors: Jones MT, Strassnig MT, Harvey PD Abstract INTRODUCTION: While antipsychotics have been generally successful in treating psychosis in schizophrenia, there is a major treatment gap for negative symptoms and cognitive deficits. Given that these aspects of the disease contribute to poor functional outcomes independently of positive symptoms, treatments would have profound implications for quality of life. The 5-HT2A- receptor has been considered a potential target for interventions aimed at negative and cognitive symptoms and multiple antagonists and inverse agonists of this receptor have been tested. ARE...
Source: Expert Opinion on Emerging Drugs - Category: Drugs & Pharmacology Tags: Expert Opin Emerg Drugs Source Type: research
This study aims to analyze genome-wide the effect of SNPs on violence in schizophrenia. We...
Source: SafetyLit - Category: International Medicine & Public Health Tags: Ergonomics, Human Factors, Anthropometrics, Physiology Source Type: news
  Should people with mental illness have children? In today’s Not Crazy Podcast, Gabe and Lisa discuss their own reasons for not having kids, while also giving a platform to Amy Barnabi, a mother of two with bipolar disorder. Amy discusses her decision to have children and shares her experiences, joys and challenges thus far. What if you can’t be a good parent when your illness flares up? What if the child inherits your diagnosis? If you are a parent with mental illness, you’ve likely heard these questions. Tune in to hear these topics discussed (and much more!) on today’s podcast. (Transcript...
Source: World of Psychology - Category: Psychiatry & Psychology Authors: Tags: Bipolar Children and Teens Disorders Family General Interview Mental Health and Wellness Not Crazy Podcast Source Type: blogs
AbstractSchizophrenia (SZ) is a complex and severe psychiatric disorder, which has a global lifetime prevalence of 0.4% and a heritability of around 0.81. A number of epigenome-wide association studies (EWAS) have been carried out for SZ, with discordant results. The main aim of this study was to carry out an integrative in silico analysis of available genome-wide DNA methylation profiles in schizophrenia. In this work, an integration of multiple lines of evidence (top candidate genes from several EWAS and genome-wide expression and association data) was carried out, in order to identify top differentially methylated (DM) ...
Source: Journal of Molecular Neuroscience - Category: Neuroscience Source Type: research
DiscussionThe negative association between negative symptom severity and parasympathetic activity was significant, which may inspire further research into the corresponding treatment, the mechanisms, and the use of HRV as an applicable biomarker for treatment response.
Source: Asia-Pacific Psychiatry - Category: Psychiatry Authors: Tags: ORIGINAL ARTICLE Source Type: research
AbstractPatients with schizophrenia (SZ) have a high level of cardiovascular morbidity and some clinical symptoms of illness remain resistant to pharmacological approaches. A large number of studies support the effectiveness of physical activity (PA) in SZ. The aims of this trial is to assess the effects of a remote, web-based adapted PA program (e-APA) compared to a health education program (e-HE) on brain plasticity in SZ and healthy volunteers (HV) and on psychiatric, neurocognitive, circadian and physical variables. The study is an interventional, multicenter, randomized open-label trial. Forty-two SZ will be randomize...
Source: European Archives of Psychiatry and Clinical Neuroscience - Category: Neuroscience Source Type: research
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