How to improve clinical practice on forced medication in psychiatric practice: Suggestions from the EUNOMIA European multicentre study.

Background: The decision to adopt forced medication in psychiatric care is particularly relevant from a clinical and ethical viewpoint. The European Commission has funded the EUNOMIA study in order to develop European recommendations for good clinical practice on coercive measures, including forced medication.

Methods: The recommendations on forced medication have been developed in 11 countries with the involvement of national clinical leaders, key-professionals and stakeholders' representatives.

Behavioral and Neural Signatures of Reduced Updating of Alternative Options in Alcohol-Dependent Patients during Flexible Decision-Making.

Unlabelled: Addicted individuals continue substance use despite the knowledge of harmful consequences and often report having no choice but to consume. Computational psychiatry accounts have linked this clinical observation to difficulties in making flexible and goal-directed decisions in dynamic environments via consideration of potential alternative choices. To probe this in alcohol-dependent patients (n = 43) versus healthy volunteers (n = 35), human participants performed an anticorrelated decision-making task during functional neuroimaging.

Is employment-focused case management effective for patients with substance use disorders? Results from a controlled multi-site trial in Germany covering a 2-years-period after inpatient rehabilitation.

Background: Substance use disorders are associated with unemployment. An employment-focused case management (CMRE) has been conceptualised as a specific intervention to help substance use disorder patients return to competitive employment immediately after inpatient rehabilitation. This study investigated the effect of the intervention on return to work of persons with substance use disorders.

Do patient and ward-related characteristics influence the use of coercive measures? Results from the EUNOMIA international study.

Purpose: This study aims to identify whether selected patient and ward-related factors are associated with the use of coercive measures. Data were collected as part of the EUNOMIA international collaborative study on the use of coercive measures in ten European countries.

Methods: Involuntarily admitted patients (N = 2,027) were divided into two groups.

Gender differences in coerced patients with schizophrenia.

Background: Despite the recent increase of research interest in involuntary treatment and the use of coercive measures, gender differences among coerced schizophrenia patients still remain understudied. It is well recognized that there are gender differences both in biological correlates and clinical presentations in schizophrenia, which is one of the most common diagnoses among patients who are treated against their will. The extent to which these differences may result in a difference in the use of coercive measures for men and women during the acute phase of the disease has not been studied.

Symptoms associated with victimization in patients with schizophrenia and related disorders.

Background: Patients with psychoses have an increased risk of becoming victims of violence. Previous studies have suggested that higher symptom levels are associated with a raised risk of becoming a victim of physical violence. There has been, however, no evidence on the type of symptoms that are linked with an increased risk of recent victimization.

Friends and symptom dimensions in patients with psychosis: a pooled analysis.

Background: Having friends is associated with more favourable clinical outcomes and a higher quality of life in mental disorders. Patients with schizophrenia have fewer friends than other mentally ill patients. No large scale studies have evaluated so far what symptom dimensions of schizophrenia are associated with the lack of friendships.

Caregivers' appraisals of patients' involuntary hospital treatment: European multicentre study.

Background: Mental health policies emphasise that caregivers' views of involuntary psychiatric treatment should be taken into account. However, there is little evidence on how caregivers view such treatment.

Aims: To explore caregivers' satisfaction with the involuntary hospital treatment of patients and what factors are associated with caregivers' appraisals of treatment.

Quality of longer term mental health facilities in Europe: validation of the quality indicator for rehabilitative care against service users' views.

Background: The Quality Indicator for Rehabilitative Care (QuIRC) is a staff rated, international toolkit that assesses care in longer term hospital and community based mental health facilities. The QuIRC was developed from review of the international literature, an international Delphi exercise with over 400 service users, practitioners, carers and advocates from ten European countries at different stages of deinstitutionalisation, and review of the care standards in these countries. It can be completed in under an hour by the facility manager and has robust content validity, acceptability and inter-rater reliability.

Symptom levels and initial appraisal of hospital treatment in patients with schizophrenia.

The initial appraisal of treatment by inpatients with schizophrenia has been found to be a significant predictor of clinical outcomes. The study aim was to examine whether specific types of symptoms are associated with the initial appraisal of treatment after controlling other patient characteristics. Data of 2105 inpatients with schizophrenia (ICD-10 F20-9) were pooled from three national and international multi-centre studies.

Involuntary psychiatric hospitalization: current status and future prospects.

The general aims of this article are: a) to cover the current status of research on the important clinical and human rights issue of involuntary psychiatric hospitalization, and b) to discuss some factors which might influence future developments in this area of mental health care provision. Firstly, the article will outline main results from two literature reviews on outcomes of involuntary hospital admission. Secondly, selected results from the clinical part of a recent European multi-site research project on coercion in psychiatry (Acronym: EUNOMIA) will be presented in detail on the following issues: the association of patients' views of involuntary hospital admission and differences in legislation, patient characteristics associated with more or less positive outcomes of coerced hospital admission, coercive measures (e.

Coerced hospital admission and symptom change--a prospective observational multi-centre study.

Introduction: Coerced admission to psychiatric hospitals, defined by legal status or patient's subjective experience, is common. Evidence on clinical outcomes however is limited. This study aimed to assess symptom change over a three month period following coerced admission and identify patient characteristics associated with outcomes.

Association between symptoms and quality of life in patients with schizophrenia: a pooled analysis of changes over time.

Quality of life is an important outcome in the treatment of patients with schizophrenia. It has been suggested that patients' quality of life ratings (referred to as subjective quality of life, SQOL) might be too heavily influenced by symptomatology to be a valid independent outcome criterion. There has been only limited evidence on the association of symptom change and changes in SQOL over time.

Acute psychopathology as a predictor of global functioning in patients with ICD-10 non-affective psychosis: a prospective study in 11 European countries.

This prospective analysis aimed to study the influence of psychopathological dimensions on the global functioning of persons suffering from psychotic disorders, taking into account the role of a broad range of potential confounders. A large international cohort (n=1888) with ICD-10 non-affective psychosis was evaluated both at baseline during a hospital admission and three months after discharge. Trained interviewers administered a global functioning scale (GAF) and a psychopathological scale (BPRS) at baseline and follow-up).

Patient characteristics predicting better treatment outcomes in day hospitals compared with inpatient wards.

Objective: The study aimed to identify patient characteristics associated with differences in outcomes of acute treatment in day hospitals and conventional hospital wards.

Methods: Data were from the European Day Hospital Evaluation (EDEN) (2000-2003), a multicenter randomized controlled trial comparing acute treatment in day hospitals and conventional wards in five European countries. All 880 adult patients in the EDEN study who had a diagnosis of schizophrenia, mood disorders, neurotic disorders, and behavioral syndromes (ICD-10 codes F20-F59) and complete data on baseline variables were included.

Factorial validity and measurement equivalence of the Client Assessment of Treatment Scale for psychiatric inpatient care - a study in three European countries.

Patients' views of inpatient care need to be assessed for research and routine evaluation. For this a valid instrument is required. The Client Assessment of Treatment Scale (CAT) has been used in large scale international studies, but its psychometric properties have not been well established.

Use of coercive measures during involuntary hospitalization: findings from ten European countries.

Objective: Involuntary treatment in mental health care is a sensitive but rarely studied issue. This study was part of the European Evaluation of Coercion in Psychiatry and Harmonization of Best Clinical Practice (EUNOMIA) project. It assessed and compared the use of coercive measures in psychiatric inpatient facilities in ten European countries.

Factors influencing subjective quality of life in patients with schizophrenia and other mental disorders: a pooled analysis.

Subjective quality of life (SQOL) is an important outcome in the treatment of patients with schizophrenia. However, there is only limited evidence on factors influencing SQOL, and little is known about whether the same factors influence SQOL in patients with schizophrenia and other mental disorders. This study aimed to identify the factors associated with SQOL and test whether these factors are equally important in schizophrenia and other disorders.

Patients' views of involuntary hospital admission after 1 and 3 months: prospective study in 11 European countries.

Background: Legislation and practice of involuntary hospital admission vary substantially among European countries, but differences in outcomes have not been studied.

Aims: To explore patients' views following involuntary hospitalisation in different European countries.

Method: In a prospective study in 11 countries, 2326 consecutive involuntary patients admitted to psychiatric hospital departments were interviewed within 1 week of admission; 1809 were followed up 1 month and 1613 3 months later.

[The prevalence of depressive symptomatology in the german elderly population and the impact of methodical aspects on the identified prevalence].

Objectives: The issue of whether depression increases or decreases with age remains unclear. Methodical aspects play an important role in the research on depression in the elderly.

Methods: In a representative survey of the German general population aged 50 years and older (n = 1.

[Direct health-related costs of severely mentally ill patients and their informal carers in community care].

Objective: Within the last few years, a small number of German cost analyses of patients treated in community mental health care settings was presented. None of these studies, however, examined direct health care costs of the patients' close reference persons focusing on costs associated with providing informal care. Therefore, our study aimed to analyse health-related direct costs of severely ill patients suffering from affective or schizophrenic disorders, and of their informal carers during community mental health care; further, we examined if these costs differed between the diagnostic groups.

A systematic review of the international published literature relating to quality of institutional care for people with longer term mental health problems.

Background: A proportion of people with mental health problems require longer term care in a psychiatric or social care institution. However, there are no internationally agreed quality standards for institutional care and no method to assess common care standards across countries. We aimed to identify the key components of institutional care for people with longer term mental health problems and the effectiveness of these components.

Study protocol for the development of a European measure of best practice for people with long term mental health problems in institutional care (DEMoBinc).

Background: This study aims to build a measure for assessing and reviewing the living conditions, care and human rights of people with longer term mental health problems in psychiatric and social care institutions. Protection of their human rights is imperative since impaired mental capacity secondary to mental illness can make them vulnerable to abuse and exploitation from others. They also constitute a major resource pressure for mental health services, social services, informal carers and society as a whole.

Coercion in psychiatry.

Purpose Of Review: This paper highlights issues in the field of coercion in psychiatry which have gained importance in 2007.

Recent Findings: Reviews on 'involuntary hospital admission' demonstrated negative and positive consequences on various outcome domains. Papers on 'coercion and the law' identified cross-national differences of legal regulations, or addressed justice and equality issues.