Defining Severe and Persistent Mental Illness—A Pragmatic Utility Concept Analysis

Zumstein, Naomi; Riese, Florian

doi:10.3389/fpsyt.2020.00648

Cited by 54 publications

(48 citation statements)

References 41 publications

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“…Severe mental disorders. Severe mental disorders were defined as major depressive disorder, bipolar disorder, and schizophrenia spectrum disorders in the present study (Grubaugh et al, 2011;Zumstein and Riese, 2020). Participants were first screened for psychiatric symptoms on the World Health Organization-Composite International Diagnostic Interview Version 3.0 (WHO-CIDI 3.0) by trained interviewers.…”

Section: Measurement Instrumentsmentioning

confidence: 99%

Positive mental health framework of transdiagnostic protective factors in elucidating the association between adverse childhood experiences and severe mental disorders

Liu

Abdin

Vaingankar

et al. 2021

Aust N Z J Psychiatry

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Objectives: Transdiagnostic risk factors—disrupted processes common to psychopathology—link adverse childhood experiences to severe mental disorders (i.e. major depressive disorder, bipolar disorder, and schizophrenia spectrum disorders); however, transdiagnostic protective factors are understudied. The present study investigated the association between a positive mental health framework of protective intra- and interpersonal resources and severe mental disorders in individuals with adverse childhood experiences. We hypothesized that (1) individuals with adverse childhood experiences will experience more severe mental disorders and poorer intra- and interpersonal resources than those without adverse childhood experiences; (2) intrapersonal (e.g. general coping) and interpersonal resources (e.g. emotional support) will interact to predict severe mental disorders. Methods: A total of 1929 adults participated in this population-based study. Participants were assessed for adverse childhood experiences, severe mental disorders, and intra- and interpersonal resources (general coping, general affect, emotional support, interpersonal skills, spirituality, and personal growth and autonomy) via structured interviews and self-reports. Results: As hypothesized, individuals with adverse childhood experiences (62.6%) experienced more severe mental disorders and poorer intra- and interpersonal resources than those without adverse childhood experiences. Among those with adverse childhood experiences, emotional support interacted with general coping and general affect to predict severe mental disorders; general coping and general affect were negatively associated with severe mental disorders at high (+1 SD) and low (−1 SD) emotional support, respectively. Conclusions: The present study identified interactions between specific intrapersonal (i.e. general coping and general affect) and interpersonal resources (i.e. emotional support); knowing among whom and when to intervene are essential for optimal treatment of adverse childhood experiences and severe mental disorders.

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Section: Measurement Instrumentsmentioning

confidence: 99%

Positive mental health framework of transdiagnostic protective factors in elucidating the association between adverse childhood experiences and severe mental disorders

Liu

Abdin

Vaingankar

et al. 2021

Aust N Z J Psychiatry

View full text Add to dashboard Cite

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“…Some patients with psychiatric disorders develop severe and persistent mental illness (SPMI). For the present study, we defined SPMI as a chronic or long lasting and severe mental illness, persisting after several competent treatment attempts and causing significantly impaired functioning in daily life [see ( 1 ); for a review of definitions see ( 2 )]. Further, some patients with SPMI might perceive psychiatric treatment as intrusive, and additional treatments might not be helpful or improve an already poor quality of life.…”

Section: Introductionmentioning

confidence: 99%

Compulsory Interventions in Severe and Persistent Mental Illness: A Survey on Attitudes Among Psychiatrists in Switzerland

et al. 2021

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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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“…Despite all best efforts to treat mental illness and promote recovery, some patients develop a severe and persistent mental illness (SPMI) that overwhelms their life, such as severe treatment-refractory major depressive disorder, extremely disabling chronic schizophrenia, or anorexia nervosa [( 1 , 2 ); for a systematic review of definitions of SPMI, see ( 3 )]. Patients with SPMI should be offered all treatment options, including palliative care ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Perceived Burdensomeness and the Wish for Hastened Death in Persons With Severe and Persistent Mental Illness

2021

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Background: In several European countries, medical assistance in dying (MAID) is no longer confined to persons with a terminal prognosis but is also available to those suffering from persistent and unbearable mental illness. To date, scholarly discourse on MAID in this population has been dominated by issues such as decision-making capacity, uncertainty as to when a disease is incurable, stigmatization, isolation, and loneliness. However, the issue of perceived burdensomeness has received little attention.Objective: The study explores the possible impact of perceived burdensomeness on requests for MAID among persons with severe and persistent mental illness (SPMI).Method: Using the method of ethical argumentation, we discuss the issue of access to MAID for persons with SPMI and perceived burdensomeness.Conclusion: Perceived burdensomeness may be a contributing factor in the wish for hastened death among persons with SPMI. MAID is ethically unsupportable if SPMI causes the individual to make an unrealistic assessment of burdensomeness, indicating a lack of decision-making capacity in the context of that request. However, the possibility that some individuals with SPMI may perceive burdensomeness does not mean that they should be routinely excluded from MAID. For SPMI patients with intact decision-making capacity who feel their life is not worth living, perceived burdensomeness as a component of this intolerable suffering is not a sufficient reason to deny access to MAID.

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Defining Severe and Persistent Mental Illness—A Pragmatic Utility Concept Analysis

Cited by 54 publications

References 41 publications

Positive mental health framework of transdiagnostic protective factors in elucidating the association between adverse childhood experiences and severe mental disorders

Positive mental health framework of transdiagnostic protective factors in elucidating the association between adverse childhood experiences and severe mental disorders

Compulsory Interventions in Severe and Persistent Mental Illness: A Survey on Attitudes Among Psychiatrists in Switzerland

Perceived Burdensomeness and the Wish for Hastened Death in Persons With Severe and Persistent Mental Illness

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