Electronic Letters to:
|
|
eLetters: Electronic letters published:
-
![[Read eLetter]](/icons/misc/sectionDOWN.gif)
Humane care for vulnerable people
- Harvey Gordon, n/a (16 January 2006)
|
|
|||
|
Harvey Gordon, Consultant Forensic Psychiatrist Oxford Clinic Medium Secure Unit, n/a
Send letter to journal:
Anna.Kennedy{at}oxmhc-tr.nhs.uk Harvey Gordon, et al.
|
The article on depot antipsychotic medication by Patel and David (2005) is welcome as is the invited commentary (Barnes, 2005). An issue hinted at but understated in the articles is that of the risk to others posed by some patients with schizophrenia and related disorders. Whilst people with schizophrenia whose symptoms are well-controlled are no more a risk to others than the general population, those with active psychosis do pose an elevated risk. The number of patients with schizophrenia who kill others or who pose serious violence to others when stabilised on depot, though not zero, is very low. A number of homicides by patients with schizophrenia have followed discontinuation of depot and replacement by oral medication with which full compliance has not occurred (Howlett, 1998). Even amongst psychiatric in- patients, I have known patients returned to intensive care units following depot discontinuation in preference for oral medication, both in general psychiatric and forensic psychiatric units. In a few cases all that stands holding back relapse into dangerous behaviour is the treatment for the mental illness, and some tragedies may be prevented by ensuring the patient takes the treatment. The article refers to the modern ethos of a partnership with the patient rather than paternalism. In my view a good father develops a partnership with his children but he still takes care to protect them from harm when they are as yet unable to do so themselves. Adult psychiatric patients are not children but they are vulnerable people often with impaired judgement. The contemporary adverse perspective on medical paternalism need not serve to discredit an historical medical tradition involving humane care. Yours sincerely Dr Harvey Gordon Consultant Forensic Psychiatrist and Honorary Senior Lecturer in Forensic Psychiatry University of Oxford Refs Barnes, T.R.E. (2005) “Why indeed? Invited commentary on…why aren’t depot antipsychotics prescribed more often and what can be done about it?” Advances in Psychiatric Treatment 11:211 - 213 Howlett, M (1998) “Medication, Non-Compliance and Mentally Disordered Offenders”: The Role of Non-Compliance in Homicide by People with Mental Illness and Proposals for Future Policy. A study of Independent Inquiry Reports”. London. Zito Trust. Patel, MX and David, AS (2005) “Why aren’t depot antipsychotics prescribed more often and what can be done about it?” Advances in Psychiatric Treatment 11:203-211 |
|||