This is the first of two articles reviewing consent in those under the age of 18 (also referred to as ‘minors’ in UK law). This can be a complex issue in clinical practice because the law endows competent/capacitated minors with the absolute right to accept treatment, but a limited right to refuse. This first article summarises recent cases of refusal of treatment in minors. It uses them to ask two central questions: how do we, as clinicians, think about autonomous self-determination in minors and to what extent does the rights agenda support minors’ autonomous self-determination? Autonomy as one of the principles of biomedical ethics is explored. How the minors’ rights agenda supports the development of autonomy is considered. The amount of weight given in the domestic courts to the rights of minors with reference to the Human Rights Act 1998 and the United Nations Convention on the Rights of the Child is described. These considerations demonstrate the way that the courts are giving the views of the minor greater weight in decision-making in keeping with age and maturity. This article introduces the second article, which comprehensively reviews decision-making in minors, explores competence and capacity in minors and examines the differential treatment of acceptance and refusal.
{"title":"Consent in minors: the differential treatment of acceptance and refusal. Part 1 Autonomy and children's rights","authors":"T. Hawkins, M. Curtice, Tom Adams","doi":"10.1192/bja.2023.23","DOIUrl":"https://doi.org/10.1192/bja.2023.23","url":null,"abstract":"\u0000 This is the first of two articles reviewing consent in those under the age of 18 (also referred to as ‘minors’ in UK law). This can be a complex issue in clinical practice because the law endows competent/capacitated minors with the absolute right to accept treatment, but a limited right to refuse. This first article summarises recent cases of refusal of treatment in minors. It uses them to ask two central questions: how do we, as clinicians, think about autonomous self-determination in minors and to what extent does the rights agenda support minors’ autonomous self-determination? Autonomy as one of the principles of biomedical ethics is explored. How the minors’ rights agenda supports the development of autonomy is considered. The amount of weight given in the domestic courts to the rights of minors with reference to the Human Rights Act 1998 and the United Nations Convention on the Rights of the Child is described. These considerations demonstrate the way that the courts are giving the views of the minor greater weight in decision-making in keeping with age and maturity. This article introduces the second article, which comprehensively reviews decision-making in minors, explores competence and capacity in minors and examines the differential treatment of acceptance and refusal.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":"61 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73822441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SUMMARY Many persons with intellectual developmental disorders and/or autism spectrum disorder presenting problem behaviours undergo pharmacotherapy without receiving an appropriate psychiatric assessment and diagnosis. Instead, prescription of psychotropic medication should have specific aims and involve interdisciplinary assessment, personalisation and patient and family participation. Current knowledge about pharmacological management of problem behaviours in this population is limited, necessitating extreme caution in clinical practice and more research into the complex interrelated factors that affect presentation, course and treatment response.
{"title":"Psychotropic medication for problem behaviours in intellectual disability and autism spectrum disorder: the need for caution","authors":"M. Bertelli","doi":"10.1192/bja.2023.22","DOIUrl":"https://doi.org/10.1192/bja.2023.22","url":null,"abstract":"SUMMARY Many persons with intellectual developmental disorders and/or autism spectrum disorder presenting problem behaviours undergo pharmacotherapy without receiving an appropriate psychiatric assessment and diagnosis. Instead, prescription of psychotropic medication should have specific aims and involve interdisciplinary assessment, personalisation and patient and family participation. Current knowledge about pharmacological management of problem behaviours in this population is limited, necessitating extreme caution in clinical practice and more research into the complex interrelated factors that affect presentation, course and treatment response.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":"13 1","pages":"334 - 336"},"PeriodicalIF":1.3,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85219482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SUMMARY Almost a quarter of people with intellectual disabilities have epilepsy. This life-long condition adversely affects their health, safety and well-being and carries an increased risk of sudden unexpected death in epilepsy (SUDEP) in this population. This commentary considers what not only health and social services but also communities and people with intellectual disabilities themselves can do to improve outcomes.
{"title":"Managing epilepsy in people with intellectual disabilities – creating capable communities","authors":"R. Shankar","doi":"10.1192/bja.2023.19","DOIUrl":"https://doi.org/10.1192/bja.2023.19","url":null,"abstract":"SUMMARY Almost a quarter of people with intellectual disabilities have epilepsy. This life-long condition adversely affects their health, safety and well-being and carries an increased risk of sudden unexpected death in epilepsy (SUDEP) in this population. This commentary considers what not only health and social services but also communities and people with intellectual disabilities themselves can do to improve outcomes.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":"13 1","pages":"305 - 307"},"PeriodicalIF":1.3,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84102995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Autism spectrum disorders (ASD) include autistic disorder, Asperger’s disorder and pervasive developmental disorder not otherwise specified (PDD-NOS). Antipsychotics have been used as a medication intervention for irritability related to ASD. Aripiprazole, a third-generation, atypical antipsychotic, is a relatively new drug that has a unique mechanism of action different from that of other antipsychotics. This review updates a previous Cochrane review on the safety and efficacy of aripiprazole for individuals with ASD, published in 2011 (Ching 2011).
{"title":"Aripiprazole for autism spectrum disorders (ASD), a Cochrane Review","authors":"Lauren Hirsch, T. Pringsheim","doi":"10.1192/bja.2023.15","DOIUrl":"https://doi.org/10.1192/bja.2023.15","url":null,"abstract":"Autism spectrum disorders (ASD) include autistic disorder, Asperger’s disorder and pervasive developmental disorder not otherwise specified (PDD-NOS). Antipsychotics have been used as a medication intervention for irritability related to ASD. Aripiprazole, a third-generation, atypical antipsychotic, is a relatively new drug that has a unique mechanism of action different from that of other antipsychotics. This review updates a previous Cochrane review on the safety and efficacy of aripiprazole for individuals with ASD, published in 2011 (Ching 2011).","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":"17 1","pages":"289 - 289"},"PeriodicalIF":1.3,"publicationDate":"2023-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83310429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SUMMARY This month's Cochrane Corner meta-analysis evaluates the evidence for the use of aripiprazole in ‘autism spectrum disorders’ – although in fact, outcome measures mainly included subtypes of challenging behaviour and side-effects. Aripiprazole was found to be effective in reducing irritability and hyperactivity, while causing extrapyramidal side-effects and weight gain. Only three trials were included in the review, with two small trials eventually included in the meta-analysis. All trials were conducted in under-18s in the USA, with no requirement for a trial of behavioural management before psychotropic medication, and excluding under-18s with important comorbidities such as medicated attention-deficit hyperactivity disorder. All three studies were sponsored and funded by the manufacturer of aripiprazole. Further, a discontinuation trial showed no evidence of sustained benefit beyond 16 weeks of treatment.
{"title":"Aripiprazole in autism spectrum disorder: current evidence for use","authors":"A. Bunting, Harriet Feldman","doi":"10.1192/bja.2022.77","DOIUrl":"https://doi.org/10.1192/bja.2022.77","url":null,"abstract":"SUMMARY This month's Cochrane Corner meta-analysis evaluates the evidence for the use of aripiprazole in ‘autism spectrum disorders’ – although in fact, outcome measures mainly included subtypes of challenging behaviour and side-effects. Aripiprazole was found to be effective in reducing irritability and hyperactivity, while causing extrapyramidal side-effects and weight gain. Only three trials were included in the review, with two small trials eventually included in the meta-analysis. All trials were conducted in under-18s in the USA, with no requirement for a trial of behavioural management before psychotropic medication, and excluding under-18s with important comorbidities such as medicated attention-deficit hyperactivity disorder. All three studies were sponsored and funded by the manufacturer of aripiprazole. Further, a discontinuation trial showed no evidence of sustained benefit beyond 16 weeks of treatment.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":"29 1","pages":"290 - 294"},"PeriodicalIF":1.3,"publicationDate":"2023-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82471136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CPD credits: 0.5 Podcast Coping, resilience and surviving trauma In this podcast Dr Raj Persaud talks to Dr Vajrin Malin about the immediate psychological impact of a sudden physical trauma, the importance of having goals and a sense of purpose when faced with challenges and how trainee doctors who may be struggling to cope with stress or trauma can be supported.
{"title":"New from CPD eLearning","authors":"","doi":"10.1192/bja.2023.18","DOIUrl":"https://doi.org/10.1192/bja.2023.18","url":null,"abstract":"CPD credits: 0.5 Podcast Coping, resilience and surviving trauma In this podcast Dr Raj Persaud talks to Dr Vajrin Malin about the immediate psychological impact of a sudden physical trauma, the importance of having goals and a sense of purpose when faced with challenges and how trainee doctors who may be struggling to cope with stress or trauma can be supported.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":"266 1","pages":"167 - 167"},"PeriodicalIF":1.3,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76397604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Data collection and analysis Three review authors (TW, JI, and NP) independently assessed RCTs for inclusion in the review, collated trial data, and assessed trial quality. We contacted investigators to obtain missing data. We stratified summary statistics by medication class, and by medication agent for all medications. We calculated dichotomous and continuous measures using a random-effects model, and assessed heterogeneity.
{"title":"Pharmacotherapy for post traumatic stress disorder (PTSD), a Cochrane Review","authors":"T. Williams, N. Phillips, D. Stein, J. Ipser","doi":"10.1192/bja.2023.17","DOIUrl":"https://doi.org/10.1192/bja.2023.17","url":null,"abstract":"Data collection and analysis Three review authors (TW, JI, and NP) independently assessed RCTs for inclusion in the review, collated trial data, and assessed trial quality. We contacted investigators to obtain missing data. We stratified summary statistics by medication class, and by medication agent for all medications. We calculated dichotomous and continuous measures using a random-effects model, and assessed heterogeneity.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":"87 1","pages":"168 - 168"},"PeriodicalIF":1.3,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76132558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SUMMARY Post-traumatic stress disorder is a disabling condition resulting from a range of traumas and affecting many people worldwide. This month's Cochrane Corner review systematically searched and reported findings from 66 randomised controlled trials of pharmacotherapy for PTSD, 54 of which were included in a meta-analysis. Evidence was shown for the benefit of selective serotonin reuptake inhibitors, mirtazapine and amitriptyline in treatment response. This Round the Corner commentary critically appraises the review's findings, concluding that the summative evidence was of poor quality owing to the low number of studies, the high risk of bias and significant heterogeneity.
创伤后应激障碍是一种由一系列创伤引起的致残状况，影响着全世界许多人。本月的Cochrane Corner综述系统地检索并报告了66项PTSD药物治疗随机对照试验的结果，其中54项纳入了荟萃分析。有证据表明选择性血清素再摄取抑制剂、米氮平和阿米替林在治疗反应中有益。这篇Round the Corner评论批判性地评价了综述的发现，得出结论认为，由于研究数量少、偏倚风险高和显著的异质性，总结性证据的质量较差。
{"title":"Medication choice in post-traumatic stress disorder","authors":"Heidi Cooper","doi":"10.1192/bja.2023.16","DOIUrl":"https://doi.org/10.1192/bja.2023.16","url":null,"abstract":"SUMMARY Post-traumatic stress disorder is a disabling condition resulting from a range of traumas and affecting many people worldwide. This month's Cochrane Corner review systematically searched and reported findings from 66 randomised controlled trials of pharmacotherapy for PTSD, 54 of which were included in a meta-analysis. Evidence was shown for the benefit of selective serotonin reuptake inhibitors, mirtazapine and amitriptyline in treatment response. This Round the Corner commentary critically appraises the review's findings, concluding that the summative evidence was of poor quality owing to the low number of studies, the high risk of bias and significant heterogeneity.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":"166 1","pages":"169 - 176"},"PeriodicalIF":1.3,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90978108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：