7 results on '"10222 Institute of Biomedical Ethics and History of Medicine"'
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2. Palliative Psychiatry for Patients With Severe and Persistent Mental Illness: A Survey on the Attitudes of Psychiatrists in India Compared to Psychiatrists in Switzerland
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Julia Stoll, Manuel Trachsel, Anna Lisa Westermair, Anil Prabhakaran, Chitra Venkateswaran, Anju Mathew, University of Zurich, and Trachsel, Manuel
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2738 Psychiatry and Mental Health ,Psychiatry and Mental health ,medicine.medical_specialty ,Persistent mental illness ,business.industry ,mental disorders ,10222 Institute of Biomedical Ethics and History of Medicine ,Medicine ,610 Medicine & health ,business ,Psychiatry ,behavioral disciplines and activities - Abstract
ObjectivesPalliative psychiatry is a new approach for the care of patients with severe and persistent mental illness (SPMI) which systematically considers biological, psychological, social, and existential factors of care. To assess the attitudes of psychiatrists in India toward palliative psychiatry for patients with SPMI and to compare these to the attitudes of psychiatrists in Switzerland.MethodsIn an online survey, data from 206 psychiatrists in India were collected and compared with data from a previous survey among 457 psychiatrists in Switzerland.ResultsPsychiatrists in India generally considered it very important to prevent suicide in SPMI patients (97.6%). At the same time, they considered it very important to reduce suffering (98.1%) and to ensure functionality in everyday life (95.6%). They agreed that palliative psychiatry is important for providing optimal care to SPMI patients without life-limiting illness (79.6%) and considered palliative psychiatry as indicated for patients with SPMI (78.2%). By contrast, curing the illness was considered very important by only 39.8 % of respondents. Relative to psychiatrists in Switzerland, psychiatrists in India were significantly more concerned about preventing suicide and less willing to accept a reduction in life expectancy, even at the expense of quality of life in patients with severe and persistent schizophrenia and recurrent major depressive disorder. At the same time, they were significantly more likely to advocate palliative psychiatry.ConclusionMost of the participating psychiatrists in India agreed that palliative psychiatry can be indicated for patients with SPMI. The comparison with psychiatrists in Switzerland highlights the need to take account of cultural differences in future studies of this kind. In summary, this study shows the potential of palliative psychiatry as a genuine biopsychosocio-existential approach which systematically integrates biological, psychological, social, and existential factors of care.
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- 2022
3. Editorial: Ethics in Psychiatry and Psychotherapy
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Cynthia M. A. Geppert, Rebecca Weintraub Brendel, Manuel Trachsel, University of Zurich, and Trachsel, Manuel
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Decision making capacity ,coercion ,Psychiatry ,medicine.medical_specialty ,Psychotherapist ,media_common.quotation_subject ,RC435-571 ,610 Medicine & health ,Coercion ,ethics ,digitalization ,psychotherapy ,2738 Psychiatry and Mental Health ,Psychiatry and Mental health ,Informed consent ,medicine ,10222 Institute of Biomedical Ethics and History of Medicine ,autonomy ,Psychology ,Autonomy ,media_common - Published
- 2021
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4. Compulsory Interventions in Severe and Persistent Mental Illness: A Survey on Attitudes Among Psychiatrists in Switzerland
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Florian Riese, Julia Stoll, Martina A. Hodel, Manuel Trachsel, Scott A. Irwin, Nikola Biller-Andorno, Paul Hoff, University of Zurich, and Trachsel, Manuel
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coercion ,medicine.medical_specialty ,Palliative care ,media_common.quotation_subject ,Psychological intervention ,RC435-571 ,paternalism ,610 Medicine & health ,behavioral disciplines and activities ,Paternalism ,severe and persistent mental illness ,03 medical and health sciences ,2738 Psychiatry and Mental Health ,0302 clinical medicine ,Quality of life (healthcare) ,mental disorders ,medicine ,compulsory interventions ,autonomy ,Psychiatry ,Depression (differential diagnoses) ,media_common ,Original Research ,palliative care ,business.industry ,ethics ,030227 psychiatry ,Psychiatry and Mental health ,Anorexia nervosa (differential diagnoses) ,10054 Clinic for Psychiatry, Psychotherapy, and Psychosomatics ,10222 Institute of Biomedical Ethics and History of Medicine ,Seclusion ,business ,030217 neurology & neurosurgery ,Autonomy - Abstract
Background: Some psychiatric patients develop severe and persistent mental illness (SPMI), which, for a variety of reasons, can be therapy-refractory. Sometimes, treatment is not considered helpful by the patients themselves and does not improve their subjective quality of life. Furthermore, many SPMI patients experience compulsory interventions such as seclusion, restraint, or treatment against their will, which can cause harm.Methods: In a cross-sectional survey of 1,311 German-speaking psychiatrists in Switzerland, participants were asked about the care of SPMI patients in general, and about their attitudes with regard to compulsory interventions in particular, using three case vignettes of patients with severe and persistent anorexia nervosa, schizophrenia and depression.Results: Out of 1,311 contacted psychiatrists, 457 (34.9%) returned the completed survey. In general, 91.0% found it important or very important to respect SPMI patients' autonomy in decision making. However, based on three different clinical case vignettes, 36.8% of psychiatrists would act against the wishes of the patient with severe and persistent schizophrenia, 34.1% against the wishes of the patient with severe and persistent depression, and 21.1% against the wishes of the patient with severe and persistent anorexia nervosa, although all patients were stated to have preserved decision-making capacity. With regard to the case vignettes, 41.1% considered compulsory interventions leading to a temporary reduction of quality of life acceptable in the patient with severe and persistent schizophrenia, 39.4% in the patient with severe and persistent depression, and 25.6% in the patient with severe and persistent anorexia nervosa, although it was stated in all three case vignettes that two independent experts ascribed the patients decision-making capacity regarding their illness and further treatment.Conclusions: Many psychiatrists in our sample found themselves in an ethical dilemma between autonomy and the provision of medical care. While most respondents respect the autonomy of SPMI patients, many saw the need to perform compulsory interventions even though it was clearly and prominently stated that two independent psychiatrists had ascribed the patients in the case vignettes decision-making capacity. Further examination of these conflicting views is warranted, perhaps along with the development of guidelines for such situations.
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- 2021
5. The Ethical Use of Telepsychiatry in the Covid-19 Pandemic
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Manuel Trachsel, John Z. Sadler, Julia Stoll, University of Zurich, and Trachsel, Manuel
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Psychiatry ,medicine.medical_specialty ,2019-20 coronavirus outbreak ,Opinion ,Coronavirus disease 2019 (COVID-19) ,lcsh:RC435-571 ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Telepsychiatry ,MEDLINE ,telepsychiatry ,610 Medicine & health ,Social justice ,Mental health ,ethics ,2738 Psychiatry and Mental Health ,Psychiatry and Mental health ,Family medicine ,lcsh:Psychiatry ,Pandemic ,medicine ,10222 Institute of Biomedical Ethics and History of Medicine ,social justice ,Psychology ,COVID 19 ,mental health - Published
- 2020
6. Ethical Issues in Online Psychotherapy: A Narrative Review
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J. Müller, Manuel Trachsel, Julia Stoll, University of Zurich, and Trachsel, Manuel
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Argumentative ,Psychotherapist ,lcsh:RC435-571 ,telepsychiatry ,610 Medicine & health ,PsycINFO ,Review ,2738 Psychiatry and Mental Health ,03 medical and health sciences ,0302 clinical medicine ,lcsh:Psychiatry ,Confidentiality ,online psychotherapy ,Competence (human resources) ,Psychiatry ,Ethical issues ,Telepsychiatry ,ethics ,030227 psychiatry ,telepsychology ,Psychiatry and Mental health ,technology ,10222 Institute of Biomedical Ethics and History of Medicine ,Professional ethics ,Narrative review ,Psychology ,030217 neurology & neurosurgery - Abstract
Background: The provision of psychotherapy over distance using technology is a growing market reaching many patients and therefore the risks and benefits need to be known by all psychotherapists whether they themselves practice online or not. This comprehensive review of the main ethical arguments for and against different forms of online psychotherapy aims to enhance discussion of ethical issues in this growing area. Methods: A search of three databases (PubMed, PsycINFO, Web of Science) was conducted in August 2019 using a specific search protocol yielding 249 publications. Results: Of 24 ethical arguments in favor of online psychotherapy and 32 against, the top five ethical arguments in favor of online psychotherapy were (1) increased access to psychotherapy and service availability and flexibility; (2) therapy benefits and enhanced communication; (3) advantages related to specific client characteristics (e.g., remote location); (4) convenience, satisfaction, acceptance and increased demand; and (5) economic advantages. The top five ethical arguments against engagement in online psychotherapy were (1) privacy, confidentiality and security issues; (2) therapist competence and need for special training; (3) communication issues specific to technology; (4) research gaps; and (5) emergency issues. Conclusions: The findings may be of help to practitioners in deciding whether to engage in online psychotherapy, and in informing patients about risks and benefits, improving ethical guidelines, and stimulating further ethical discussion. The findings are argumentative and qualitative in nature, and further quantitative research is needed.
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- 2020
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7. Conflicting Priorities Between Risk Management and Treatment of Schizophrenia in Swiss Forensic Services—A Case Report
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Sarah Steinau, Nathalie Brackmann, Ulf Sternemann, Nikola Biller-Andorno, Elmar Habermeyer, and University of Zurich
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medicine.medical_specialty ,Alogia ,incarceration ,lcsh:RC435-571 ,media_common.quotation_subject ,Case Report ,610 Medicine & health ,Context (language use) ,Prison ,03 medical and health sciences ,0302 clinical medicine ,lcsh:Psychiatry ,Forensic psychiatry ,medicine ,correctional psychiatry ,030212 general & internal medicine ,Psychiatry ,Imprisonment ,Risk management ,media_common ,business.industry ,forensic psychiatry ,ethics ,Mental health ,deprivation of liberty ,Psychiatry and Mental health ,10054 Clinic for Psychiatry, Psychotherapy, and Psychosomatics ,correctional psychiatry deprivation of liberty ethics forensic psychiatry incarceration therapeutic measures ,10222 Institute of Biomedical Ethics and History of Medicine ,therapeutic measures ,medicine.symptom ,business ,Psychology ,Risk assessment ,030217 neurology & neurosurgery - Abstract
The Swiss Criminal Code provides measures for mentally-ill offenders focusing on their need for treatment. This may lead to the deprivation of the patient's liberty up to several years. Under certain circumstances the mentally-ill offender can be sentenced to an indefinite incarceration. This case presentation we will describe a forensic psychiatric patient diagnosed with schizophrenia who was ordered an indefinite incarceration in Switzerland after he had been sentenced to 8 years of imprisonment for a deliberate killing. Initial presentation of symptomatology included formal thought disorders and negative symptoms such as affective flattening and alogia. Due to a scarcity of adequate treatment sites in the 90s and lack of scope for risk assessment and management, the patient could only be treated within highly regiment prison environments in the past. There, the patient's treatment concept primarily focused on short-term psychiatric care instead of providing an adequate treatment plan that would have been essential for the patient's improvement of chronic symptoms. This case description aims to present some of the fundamental issues observed in the forensic mental health system, where strong efforts are made to balance risk management and the treatment of severe mental health disorders. We will put the patient's own course of treatment and his progress within the penal system into context with ethical challenges in the forensic and correctional services and will provide potential recommendations for future research in the field of forensic psychiatry.
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- 2018
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