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Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.
The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.
We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.
We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.
The aim of this study was to investigate face recognition in subjects with an at risk mental state for psychosis (ARMS) compared with healthy controls (HC) and patients with schizophrenia (SchP).
We examined the performance of 40 healthy controls, 47 ARMS individuals and 28 patients with schizophrenia using the Emotions Battery of the University of Pennsylvania computerized Neuropsychological Battery. ARMS subjects putatively met early prodromal state of schizophrenia, mainly characterized by the presence of basic symptoms. All ARMS individuals met the risk criterion cognitive-perceptive basic symptoms (COPER) using the SPI-A (Schizophrenia Proneness Instrument, Adult version). The ARMS participants were recruited for this study during the medical check-up before the conscription. All subjects were male. A one-way ANOVA and non-parametric Kruskall-Wallis test were performed to determine group differences.
There were several differences in Emotional processing between ARMS and HC with poorly performance in emotion recognition and discrimination, facial memory tasks in ARMS subjects. At the same time differences between HC and schizophrenia patients were more prominent and significant in most parameters of emotion recognition and discrimination. ARMS subjects had significantly greater reaction times in emotion recognition tasks than HC.
Deficit in emotional processing is related to the presence of basic symptoms and early prodromal state of schizophrenia. The performance of the ARMS group is between that of the schizophrenia patients and control groups.
Clinical high risk (CHR) for psychosis state is characterized by presence of potentially prodromal for schizophrenia symptoms. The aim of this study was to assess the predictors of transition to first psychotic episode.
The study included 123 CHR subjects. All the subjects were characterized by the presence of one of the group of criteria: (1) UHR criteria, (2) basic symptoms criteria and (3) negative symptoms and formal thought disorders (FTD). The presence of FTD in clinical high-risk individuals was assessed with methods of experimental pathopsychology. The mean length of follow-up was 26 months (SD 18). All subjects were males, mean age = 20.2 (SD: 2.1). We examined the subjects’ performance using the Cambridge automated neuropsychological test battery. We applied survival analyses to determine associations between a transition to psychosis and sociodemographic, clinical and neurocognitive parameters. To determine which items are the best predictors, Cox regression analyses were applied.
The psychosis developed in 39 subjects (31.7%). Global assessment of functioning, positive symptoms, blunted affect, social isolation, impaired role function, disorganizing/stigmatizing behavior, basic symptoms (thought pressure, unstable ideas of reference), neurocognitive parameters (visual memory and new learning, decision making, executive function) significantly influenced the transition to psychosis. A prediction model was developed and included unusual thought content (Wald = 12.386, P < 0.0001, HR = 2.996), perceptual abnormalities (Wald = 4.777, P = 0.029, HR = 1.43) and impaired role function (Wald = 1.425, P < 0.028, HR = 4.157).
Clinical measures are important predictors for transition to psychosis in high-risk individuals.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
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