Recovery Michigan

The never-ending attempt to justify the appropriation of personal autonomy by professionals, as though autonomy was an unimportant by-product of disease, rather than the core of human personhood. This article reminds me of the worst of the theological distinctions of the middle ages....

https://goo.gl/Qpx6Sq

Some of the most ethically challenging cases in mental health care involve providing treatment to individuals who refuse that treatment. Sometimes when persons with mental illness become unsafe to themselves or others, they must be taken, despite their outward and often vigorous refusal, to an emergency department or psychiatric hospital to receive treatment, such as stabilizing psychotropic medication. On occasion, to provide medical care over objection, a patient must be physically restrained.

The modifier “involuntary” is generally used to describe these cases. For example, it is said that a patient has been involuntarily hospitalized or is receiving involuntary medication ostensibly because the patient did not consent and was forced or strongly coerced into treatment. Importantly, a person may be involuntarily hospitalized but retain the right to refuse treatment. “Involuntary” is also used to describe instances when an individual is committed to outpatient treatment by a court. The fact that a person is being treated involuntarily raises numerous challenges; it raises concerns about protecting individual liberty, respect for patient autonomy, and the specter of past abuses of patients in psychiatric institutions.

Although it has become both a clinical colloquialism and legal touchstone, the concept of involuntary treatment is used imprecisely to describe all instances in which a patient has refused the treatment he or she subsequently receives. In some cases, a patient outwardly refuses treatment but may have previously expressed a desire to be treated in crisis or, according to a reasonable evaluator, he or she would have agreed to accept stabilizing treatment, such as antipsychotic medication. A similar scenario occurs in the treatment of individuals who experience a first episode of psychosis and who outwardly refuse treatment. With no prior experience of what it is like to have psychosis, these patients are unable to develop informed preferences about treatment in advance of their first crisis. In these cases, some believe it is reasonable to provide treatment despite the opposition of the patient, although this could be debated.

To more precisely distinguish such cases, clinicians and policy makers should begin to refer to these instances as nonvoluntary, not involuntary, treatment. Nonvoluntary treatment suggests that the patient exists in an intermediate domain of decision-making capacity and voluntariness. In this momentary refusal of care, the patient contradicts long-held values and a deeper desire to be autonomous. This nomenclature may provide additional ethical justification for treating patients who momentarily refuse psychiatric treatment and may provide nuance about challenging cases.

Around 5.7 million adults in the United States have bipolar disorder. A healthcare professional who specializes in mental health conditions will discuss the best treatment plan, which will likely include medications and psychotherapy, for your specific symptoms.

In addition to support from healthcare professionals and family, coping mechanisms and support can be gained through blogs that focus on bipolar disorder. People who are going through similar experiences as well as experts in the bipolar field usually write these blogs. Here are Medical News Today's choices of the top 10 best bipolar blogs.

Jennifer Marshall

Better understanding the gastrointestinal microbiome may help psychiatrists treat mental health disorders such as depression, highlights a review in Frontiers in Psychiatry.

From a psychiatric standpoint, the underlying causes of depression are still not fully understood and depression remains difficult to treat in some cases. Given increasing interest in the role of the microbiome in a range of human health issues, this has led many researchers to also investigate potential links between mental health and the microbiome — specifically the microbial flora of the gut.

“The main idea of our review is that there is strong communication between the gastrointestinal tract and the brain, and that changes to the microbiome-gut-brain axis could be associated with the etiology of different neuropsychiatric disorders such as depression,” says Juan M. Lima-Ojeda, lead author of the review and a physician and researcher at the University of Regensburg, Germany.

Lima-Ojeda and his colleagues reviewed the body of literature on the role of the gut microbiome with a particular emphasis on the connections, or axis, formed between the microbiome, the gut, and the brain. The brain and the gastrointestinal tract are bi-directionally linked through the central nervous system, endocrine system, and immune system, and perturbations to any of these systems can have repercussions across the others, in turn potentially influencing a person’s overall wellbeing.

Nothing seemed to help the patient—and hospice staff didn’t know why.

The answer came when the woman’s daughter, who was taking care of her at home, showed up in the emergency room with a life-threatening overdose of morphine and oxycodone. It turned out she was high on her mother’s medications, stolen from the hospice-issued stash.

Dr. Leslie Blackhall handled that case and two others at the University of Virginia’s palliative care clinic, and uncovered a wider problem: As more people die at home on hospice, some of the powerful, addictive drugs they are prescribed are ending up in the wrong hands.

In November 2015, New York City First Lady Chirlane McCray launched ThriveNYC, a comprehensive mental health prevention and treatment program funded by the city to the tune of nearly $850 million. This is the program responsible for the ads and billboards found around New York City displaying messages like “Anxiety doesn’t define me,” and for training 250,000 mental health “First Aid” responders, to help people with mental illness and substance abuse disorders. The plan has been working well enough that McCray has expanded this mission to 185 cities, which are working under the banner Cities Thrive Coalition.

McCray’s initiative unfolds right at a time when the White House and Congress have been pushing to dramatically scale back funding for mental health and substance abuse treatment as provided by the American Healthcare Act, Medicaid, and other federal programs. Which is to say, the Cities Thrive Coalition is congealing at a time when these 180-plus cities may only have each other to count on in the fight for mental wellness.

While this story still shocks me years later, it would be too easy to vilify this young woman and others suffering from opioid addiction. Most people with opioid addiction got started on prescription painkillers, whether they were directly prescribed to them or obtained illegally. That means that I as a prescribing physician have a role to play in the opioid epidemic.

Patient satisfaction surveys are one factor. Increasingly, physicians are paid and/or promoted based on their patient satisfaction ratings. In one survey of emergency room and primary care doctors, 60% reported their compensation was linked to patient satisfaction scores and 20% said their job had been threatened based on their patient satisfaction scores. Negative reviews on Yelp or Healthgrades can be damaging to a physician or practice. One doctor in Indiana was murdered because he refused to prescribe opioids.

John Yule, 53, manages Wildlife Sport Outfitters, a hunting and fishing supplies store on the edge of Manchester, N.H., and is "deeply involved in the Second Amendment community."

He decided to get involved.

Now he's part of a team of people on the front lines -- gun dealers like himself who, in many cases, claim a rural customer base -- trying a simple but radical approach to curb rates of suicide, the nation's 10th-leading cause of death.

Their methods involve noticing certain "tells" that indicate a customer is shopping for a firearm with suicide in mind. Their goal is to keep guns, the most common method of suicide, out of the hands of those they deem at risk.

"We're not trying to step on anyone's toes or deny them any rights. [But] you can guide them, or suggest to them or talk them into a different approach," Yule said. He has these conversations only with people he believes are moving toward this tragic end.

Across the country, suicide rates are higher in rural areas than in urban centers. In 2015, rural communities saw 19 people per 100,000 kill themselves, compared with 11 per 100,000 in urban areas, according to the CDC's injury statistics database.

Researchers from Johns Hopkins Bloomberg School of Public Health in Baltimore used the state medical examiner's data tracking all suicide-related deaths to tease out the role firearms play in this disparity. They analyzed a sample of about 6,200 Maryland residents, ages 15 and older, and found that when gun-related suicides were excluded, there was no significant difference in rates between rural and urban areas.

"This does point to the important role that guns play in the rural suicide rate," said Paul Nestadt, a postdoctoral student at Hopkins and the study's lead author. "It also suggests where we might focus public health."

Researchers -- both involved with the study and unaffiliated -- said these findings have national significance, even though Maryland has a lower suicide rate than other states and access to mental health care is better in rural Maryland than in other states' rural areas.

What is box breathing?

Like the four corners of a square, box breathing requires only four steps, each of which requires participants to count to four.

To try box breathing, a person should get into a comfortable position that makes it easy to breathe freely. They should then follow these steps:

1. Breathe in through the nose while counting to four. Continue inhaling for the entire 4 seconds. The breath should be slow and steady.
2. Hold the breath in the lungs for another count of four.
3. Exhale through the mouth while counting to four. As with the inhale, the exhale should be slow and steady.
4. Continue repeating this pattern for 4 minutes.

Utilizing data from the Chicago Follow-up Study, researchers followed 139 initially psychotic patients over 20 years. Published in Psychiatry Research, the study reports that while antipsychotics were beneficial during acute hospitalizations, patients not prescribed antipsychotics had significantly better work functioning than those who were prescribed antipsychotics.