Compulsory treatment in anorexia nervosa - Short-term benefits and long-term mortality

London Research Institute, Londinium, England, United Kingdom
The British Journal of Psychiatry (Impact Factor: 7.99). 09/1999; 175(2):147-53. DOI: 10.1192/bjp.175.2.147
Source: PubMed

ABSTRACT Anorexia nervosa is a mental disorder with a high long-term mortality. Patients are ambivalent about treatment and often avoid it. Of necessity, compulsory treatment sometimes must be considered. A report from the Mental Health Act Commission has helped to reduce previous confusion.
To identify the premorbid and clinical features that predisposed to compulsory admissions, the short-term benefits of the treatment and the long-term mortality rates (derived from the National Register).
Eighty-one compulsory patients were compared with 81 voluntary patients.
Predisposing factors to a compulsory admission were a history of childhood sexual or physical abuse or previous self-harm. Detained patients had more previous admissions. Detained patients gained as much weight during admission as voluntary patients, but took longer. More deaths among compulsory than voluntary patients (10/79 v. 2/78) were found 5.7 years (mean) after admission.
Compulsory treatment is effective in the short term. The higher long-term mortality in the detained patients is due to selection factors associated with an intractable illness.

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    • "This section addresses these limitations by examining the literature on the use of coercion. Ramsay et al.'s (1999) study (conducted in Britain) found that most involuntary patients originally entered treatment services on a voluntary basis. Involuntary patients were not more severely ill than their voluntary counterparts, but their condition was more intractable and more commonly associated with psychiatric comorbidity . "
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    ABSTRACT: This paper argues that there is a relationship between understandings of anorexia nervosa (AN) and how the ethical issues associated with involuntary treatment for AN are identified, framed, and addressed. By positioning AN as a construct/discourse (hereinafter "AN: the diagnosis") several ethical issues are revealed. Firstly, "AN: the diagnosis" influences how the autonomy and competence of persons diagnosed with AN are understood by decision-makers in the treatment environment. Secondly, "AN: the diagnosis" impacts on how treatment and treatment efficacy are defined and the ethical justifiability of paternalism. Thirdly, "AN: the diagnosis" can limit the opportunity for persons with AN to construct an identity that casts them as a competent person. "AN: the diagnosis" can thus inherently affirm professional knowledge and values. Postmodern professional ethics can support professionals in managing these issues by highlighting the importance of taking responsibility for professional knowledge, values, and power and embracing moral uncertainty.
    Journal of Bioethical Inquiry 12/2013; 11(1). DOI:10.1007/s11673-013-9496-x · 0.75 Impact Factor
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    • "Dock visar sig effekterna vara kortvariga vid behandling med enbart medicinering (Fairburn, 1995). Hos individer med anorexia nervosa ser symtomatologin annorlunda ut vilket medför att effekterna av medicinering blir annorlunda, individer med anorexia nervosa är även ofta svåra att medicinera eftersom de inte vill låta sig påverkas att öka i vikt (Ramsay et al., 1999). Läkemedel eller psykofarmaka har i studier inte visat sig bidra med viktökning hos individer med anorexia nervosa, däremot kan viss typ av psykofarmaka vara framgångsrik hos individer som upplever depression och ångestliknande symtom (Hägglöf, 2002a). "
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