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Decision making process for compulsory admission: study on a group of psychiatrists from Sardinia (Italy)

Published online by Cambridge University Press:  11 October 2011

Paola Dazzan*
Affiliation:
1Institute of Psychiatry, King's College London, London, UK
Dinesh Bhugra
Affiliation:
1Institute of Psychiatry, King's College London, London, UK
Mauro G. Carta
Affiliation:
2Istituto di Psichiatria, Universitá di Cagliari, Cagliari
Bernardo Carpiniello
Affiliation:
2Istituto di Psichiatria, Universitá di Cagliari, Cagliari
*
Indirizzo per la corrispondenza: Dr.ssa P. Dazzan, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AZ (UK). Fax: +44-(0)20-7701.9044 E-mail: spcbpad@iop.kcl.ac.uk

Summary

Objective – The aim of the study was to investigate the attitudes in the decision making process for admitting patients compulsorily under the Italian Law 180/78. Setting – A group of psychiatrists (n=81) working in the area of Cagliari (Sardinia, Italy). Main outcome measures – Three case–vignettes describing different hypothetical clinical situations: 1) a man with depression and psychotic symptoms; 2) a woman with a possible first episode of psychosis; and 3) a man with a history of substance abuse and bipolar disorder. Each vignette was followed by a list of 11 factors reported in the literature as important in the decision to admit compulsorily (current mental state, severity of the disease, dangerousness to self or others, psychiatric history, likely response of the mental state to the medical treatment, age and gender of the patient, owning a home, occupational status, social support available). Psychiatrists were asked: a) whether they would admit the patient compulsorily; and b) to rate 11 factors from the most to the least important in their decision.

Riassunto

Scopo – Valutare il processo decisionale che conduce al Trattamento Sanitario Obbligatorio. Setting – Un gruppo di psichiatri (n=81) della provincia di Cagliari (Sardegna, Italia). Principali misure utilizzate – Le attitudini verso il processo decisionale per il Trattamento Sanitario Obbligatorio sono state valutate attraverso tre ipotetici casi clinici che descrivevano: 1) un uomo con un quadro clinico di depressione e sintomi psicotici; 2) una giovane donna ad un possibile primo episodio psicotico; e 3) un uomo con una storia di abuso di sostanze e disturbo bipolare. Ciascun caso era seguito da un elenco di 11 fattori, ritenuti in letteratura come i più importanti nel processo decisionale per il ricovero obbligatorio (status psichico attuale, diagnosi, severità della malattia, pericolosità, utilità di un'eventuale terapia farmacologica, storia psichiatrica, età, sesso del paziente, possesso di un'abitazione, supporto sociale, occupazione). Per ciascun caso è stato chiesto agli psichiatri: a) se avrebbero sottoposto o meno il soggetto a Trattamento Sanitario Obbligatorio; e b) di elencare gli 11 fattori in ordine di importanza nella decisione di ricoverare obbligatoriamente. Risultati – 57 psichiatri (26 uomini e 31 donne) hanno completato il questionario. I fattori ritenuti importanti nella decisione di ricoverare obbligatoriamente sono stati: status psichico, diagnosi, severità della malattia e utilità di un'eventuale terapia farmacologica. La pericolositá per sé o per gli altri è stata ritenuta il fattore più importante dal 23% del campione. Conclusioni – In tre situazioni cliniche ipotetiche esiste un buon accordo sui fattori ritenuti importanti nella decisione di ricoverare obbligatoriamente, con ampia soggettività nell'applicazione di tali fattori. Questi fattori corrispondono ai criteri raccomandati dalla legge italiana. Il criterio della pericolosità per sé o per gli altri ha un ruolo importante nella decisione e viene occasionalmente considerato più importante dello stato psichico del paziente.

Type
Articles
Copyright
Copyright © Cambridge University Press 2001

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