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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 ,
Dinesh Bhugra ,
Mauro G. Carta  and
Bernardo Carpiniello
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
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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.

Keywords

ricoveroTrattamento Sanitario Obbligatorioricovero involontarioetica medicapericolositàospedale psichiatrico.
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 10 , Issue 1 , March 2001 , pp. 37 - 45
Copyright
Copyright © Cambridge University Press 2001

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References

Bibliografia

Appelbaum, P.S., Mirkin, S.A. & Bateman, A.L. (1981). The effect of consumer's social characteristics and behaviour on psychiatric admission decisions. Social Psychiatry and Psychiatric Epidemiology 18, 161–168.Google Scholar
Apsler, R. & Bassuk, E. (1983). Differences among clinicians in the decision to admit. Archives of General Psychiatry 40, 1133–1137.CrossRefGoogle ScholarPubMed
Bagby, R.M., Thompson, J.S., Dickens, M.A. & Nohara, M. (1991). Decision making in psychiatric Civil Commitment: An Experimental Analysis. American Journal of Psychiatry 148, 28–33.Google ScholarPubMed
Biffi, G., Cuttitta, G., Bezzi, R., Magnani, G., Piacentini, D., Ramonda, M., Ferrigno, L. & Morosini, P. (1997). Variability delle decisioni gestionali e cliniche nei servizi di salute mentale della Regione Lombardia con il metodo delle vignette. Epidemiologia e Psichiatria Sociale 6, 48–58.CrossRefGoogle Scholar
Bosh, G. (1974). Zwangseinweisungen psychisch Kranker. Sozialpsychiatrische Informationen 4, 70–83.Google Scholar
Carpiniello, B., Pintor, G., Lotta, A. et al. (1982). La terapia farmacologica nei servizi psichiatrici ospedalieri. Primi risultati di un'indagine nell'area urbana di Cagliari. In Atti del XXXV Congresso Nazionale Societd Italiana di Psichiatria, pp 116–129. II Pensiero Scientifico: Roma.Google Scholar
Dawson, H. (1972). Reasons for compulsory admission. In Evaluating a Community Psychiatric Service: the Camberwell Register, 1964-71 (ed. Wing, J.K. and Hailey, A.H.). Oxford University Press: Oxford.Google Scholar
Dazzan, P. & Murray, R.M. (1999). Schizophrenia is not (simply) a neurodevelopmental disorder. Epidemiologia e Psichiatria Sociale 8, 235–241.CrossRefGoogle Scholar
Dazzan, P. & Pariante, C.M. (1999). II Trattamento Sanitario Obbligatorio e I'assistenza sul territorio. In Manuale del Maudsley Hospital di Psichiatria Pratica di D.P. Goldberg (versione italiana a cura di P. Dazzan e CM. Pariante), pp.241–250. II Pensiero Scientifico Editore: Roma.Google Scholar
Dazzan, P. & Bhugra, D. (2000). Decision making process for compulsory admission – A survey of psychiatrists in England. Medicine, Science and the Law 40, 336–334.Google Scholar
Fioritti, A., Lo Russo, L. & Melega, V. (1997). Reform said or done? The case of Emilia-Romagna within the Italian psychiatric context. American Journal of Psychiatry 154, 94–98.Google ScholarPubMed
Flannigan, C.B., Glover, G.R., Wing, J.K., Lewis, S.W., Bebbington, P.E. & Feeney, S.T. (1994). Inner London Collaborative Audit of Admission in Two Health Districts III: reasons for acute admission to psychiatric wards. British Journal of Psychiatry 165, 750–759.CrossRefGoogle ScholarPubMed
Friedman, S., Feinsilver, D.L., Davis, G.W., Margolis, R., David, O.J. & Kesselman, M. (1981). Decision to admit in an inner-city psychiatric emergency room: beyond diagnosis, the psychosocial factors. Psychiatric Quarterly 53, 259–274.CrossRefGoogle Scholar
Glantz, S.A. (1992). Alternative all'analisi della varianza e al test t basate sui ranghi. In Statisticaper Discipline Biomediche di S.A. Glantz (Versione italiana a cura di A. Marinoni, V. Balestra e S. Favilli), pp. 279–323. McGraw-Hill Libri Italia: Milano.Google Scholar
Gleisner, J., Hewett, S. & Mann, S. (1972). Reasons for admissions to hospital. In Evaluating a Community Psychiatric Service: The Camberwell Register, 1964-71 (ed. Wing, J.K. & Hailey, A.H.). Oxford University Press: Oxford.Google Scholar
Gove, W.R. & Fain, T. (1977). A comparison of voluntary and committed psychiatric patients. Archives of General Psychiatry 34, 669–676.CrossRefGoogle ScholarPubMed
Hanson, G.D. & Babigian, H.M. (1974). Reasons for hospitalization from a psychiatric emergency service. Psychiatric Quarterly 48, 336–351.CrossRefGoogle ScholarPubMed
Hiday, V.A. (1988). Civil commitment: a review of empirical research. Behavioural Sciences and the Law 6, 15–44.CrossRefGoogle Scholar
Hillard, J.R., Slomowitz, M. & Deddens, J. (1988). Determinants of emergency psychiatric admission for adolescents and adults. American Journal of Psychiatry 145, 1416–1419.Google ScholarPubMed
Lewis, G., Croft, J.C. & David, A. (1990). Are British psychiatrists racist? British Journal of Psychiatry 157, 410–415.CrossRefGoogle ScholarPubMed
Lieberman, P.B. & Baker, F.M. (1985). The reliability of psychiatric diagnosis in the emergency room. Hospital and Community Psychiatry 36, 291–293.Google ScholarPubMed
Lindsey, K.P. & Paul, G.L. (1989). Involuntary commitments to public mental institutions: issues involving the overrepresentation of blacks and assessment of relevant functioning. Psychological Bulletin 106, 171–183.CrossRefGoogle ScholarPubMed
Marson, D.C., McGovern, M.P. & Pomp, H.C. (1988). Psychiatric decision making in the emergency room: a research overview. American Journal of Psychiatry 145, 918–925.Google ScholarPubMed
Mattioni, T., Di Lallo, D., Roberti, R., Miceli, M, Stefani, M., Maci, C. & Perucci, C.A. (1999). Determinants of psychiatric inpatient admission to general hospital psychiatric wards: an epidemiological study in a region of central Italy. Social Psychiatry and Psychiatric Epidemiology 34, 425–431.CrossRefGoogle Scholar
Mendel, W.M. & Rapport, S. (1969). Determinants of the decision for psychiatric hospitalization. Archives of General Psychiatry 20, 321–328.CrossRefGoogle ScholarPubMed
Meyerson, A.T., Moss, J.Z., Belville, R. & Smith, H. (1979). Influence of experience on major clinical decisions. Training implications. Archives of General Psychiatry 36, 423–427.CrossRefGoogle ScholarPubMed
Mezzich, J.E., Evanczuk, K.J., Mathias, R.J. & Coffman, G.A. (1984). Admission decisions and multiaxial diagnosis. Archives of General Psychiatry 41, 1001–1005.CrossRefGoogle ScholarPubMed
Munizza, C, Furlan, P.M., D'Elia, A., D'Onofrio, M.R., Leggero, P., Punzo, F., Vidini, N. & Villari, V. (1993). Emergency psychiatry: a review of the literature. Ada Psychiatrica Scandinavica, Supplementum No. 374, vol. 88, pp. 1–51.Google ScholarPubMed
Munk-Jorgensen, P. & Tansella, M. (1986). Hospital and community based psychiatry: a comparative study between a Danish and an Italian psychiatric service. International Journal of Social Psychiatry 32, 6–15.CrossRefGoogle Scholar
Nicholson, R.A. (1986). Correlates of commitment status in psychiatric patients. Psychological Bulletin 100, 241–250.CrossRefGoogle ScholarPubMed
Pariante, C.M., Salis, P., Dazzan, P., Carta, M.G. & Carpiniello, B. (1996). Psychosocial outcome of schizophrenic patients in Sardinia, Italy. Psychiatric Services 47, 1266–1267.Google Scholar
Perris, C, Kemali, D., Dencker, S.J., Malm, U., Rutz, W., Amati, A., Stancati, G., Morandini, G., Minnai, G., Maj, M. & Gritti, P. (1985). Patients admitted for compulsory treatment to selected psychiatric units in Italy and in Sweden. In Focus on the Italian Psychiatric Reform (ed. Perris, C. and Kemali, D.), Acta Psychiatrica Scandinavica, Supplementum No. 316, vol. 71, pp.135–149.Google Scholar
Rothman, M. & Dubin, W.R. (1982). Patients released after psychiatric committment evaluation: comparison with the committed. Journal of Clinical Psychiatry 43, 90–93.Google Scholar
Rudas, N., Carpiniello, B., Toccafondi, F. & Carta, M.G. (1989). Organizzazione, sviluppo e prospettive della assistenza psichiatrica in Sardegna. In Atti della Conferenza Nazionale Societd Italiana di Psichiatria sullo Stato della Psichiatria nel Territorio, pp 19–76. Idelson: Napoli.Google Scholar
Rwegellera, G.G.C. (1980). Differential use of psychiatric services by West Indians, West Africans and English in London. British Journal of Psychiatry 137, 428–432.CrossRefGoogle Scholar
Segal, S.P. (1989). Civil commitment standards and patient mix in England/Wales, Italy and the United States. American Journal of Psychiatry 146, 187–193.Google ScholarPubMed
Shore, J.H., Breakey, W. & Arvidson, B. (1981). Morbidity and mortality in the commitment process. Archives of General Psychiatry 38, 930–934.CrossRefGoogle ScholarPubMed
Singh, S.P., Croudace, T., Beck, A. & Harrison, G. (1998). Perceived ethnicity and risk of compulsory admission. Social Psychiatry and Psychiatric Epidemiology 33, 39–44.CrossRefGoogle Scholar
Srikumar, S. & Orrell, M.W. (1995). Age and compulsory admission. International Journal of Geriatric Psychiatry 1, 611–615.CrossRefGoogle Scholar
Szmukler, G.I., Bird, A.S.. & Button, E.J. (1981). Compulsory admissions in a London borough: I. Social and clinical features and a follow up. Psychological Medicine 11, 617–636.CrossRefGoogle Scholar
Tischler, G.L. (1966). Decision-making process in the emergency room. Archives of General Psychiatry 14, 69–78.CrossRefGoogle ScholarPubMed
Waller, H. (1982). Zwangseinweisung in der Psychiatrie. Huber, Bern Stuttgart: Wien.Google Scholar
Wig, N.N., Suleiman, M.A., Routledge, R., Murthy, R.S., Ladrido-Ignacio, L., Ibrahim, H.H.A. & Harding, T.W. (1980). Community reactions to mental disorders. A key informant study in three developing countries. Acta Psychiatrica Scandinavica 61, 111–126.CrossRefGoogle ScholarPubMed
Zwerling, I., Karasu, T., Plutchik, R. & Kellerman, S. (1975). A comparison of voluntary and involuntary patients in a state hospital. American Journal of Orthopsychiatry 43, 81–87.CrossRefGoogle Scholar