tag:blogger.com,1999:blog-7772182113499451603.post1693178983733325471..comments2024-03-27T10:50:53.692-05:00Comments on Real Psychiatry: The Rights Versus Treatment DebateGeorge Dawson, MD, DFAPAhttp://www.blogger.com/profile/03474899831557543486noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-7772182113499451603.post-58360655828365058232023-01-01T15:06:10.793-06:002023-01-01T15:06:10.793-06:00Interesting dilemma - Jim. You probably know that...Interesting dilemma - Jim. You probably know that catatonia is one of the conditions that Michael Taylor and Max Fink have written about as a biomedical diagnoses. Their main thesis is that the DSM should be pared down to only those diagnoses that can be considered biomedical because it would decrease diagnostic heterogeneity and improve medical testing of these conditions. But these days there is a list of 15-20 conditions that can mimic catatonia at various stages.George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-46118258235166553482023-01-01T14:02:56.374-06:002023-01-01T14:02:56.374-06:00Outstanding post. As a consulting psychiatrist, I ...Outstanding post. As a consulting psychiatrist, I often had to navigate a complicated legal process to making the most effective treatment for catatonia accessible. It was not unusual for members of the legal profession to get snarled in deciding whether catatonia is a medical or a psychiatric condition. In fact, many times it was both-which did not fit our state's mental health code standard.Go Retire Psychiatristhttps://www.blogger.com/profile/08858765717035289309noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-5268695853573400402022-12-31T21:34:33.430-06:002022-12-31T21:34:33.430-06:00Thanks for that additional history on involuntary ...Thanks for that additional history on involuntary treatment. I did not touch on it - but the issue of conservatorships and guardianships for dementias is also problematic. If I had to speculate, I would say that most people who need a substitute decision maker do not have one. That often comes to light during a medical emergency when the issue of consent comes up. In acute care it is also an issue when the probate court wants to change a commitment proceeding to a conservatorship. In the counites where I worked, that meant that the family had to pay a set fee to a legal practice contracted to do this work or hire their own attorneys. In the worst case scenario, it meant a patient could be stranded in the hospital because of that process or the fact that those hearings were never scheduled on a timely manor. The best intervention in that case is also a well trained staff. Unfortunately - there is probably more stigma attached to agitated, aggressive patients with dementia rather than facilities adequately staffed and willing to face the problem. George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-9545946058860601862022-12-31T19:00:59.815-06:002022-12-31T19:00:59.815-06:00I wonder if these patients' "rights"...I wonder if these patients' "rights" folks think that people with Alzheimer's disease should be free to wander the streets aimlessly. After all, there's no such thing as mental illness; those folks just remember things differently. When I first started residency in 1970 in California, the model Lanterman-Petris-Short act was relatively new but was already eliminating some of the excesses seen in psych institutions in the past with judicial review after 72 hours and limits of 17 days of involuntary hospitalization (with an additional 14 days for someone who is actively suicidal). And there was a third criteria of involuntary hospitalization called "grave disability," defined as the patient's inability to provide for their own food clothing and shelter. And living in a cardboard box under an overpass did not qualify as showing those abilities. Seems the patients' rights folks would rather see people with chronic schizophrenia in jail (which is actually more expensive that psychiatric hospitalization).David M. Allen M.D.https://www.blogger.com/profile/06280912088483192599noreply@blogger.com