Slide 1

Medication Over Objection in Psychiatry

Speaker Notes Good morning/afternoon everyone. Today, we’ll be exploring the use of medication over objection in psychiatry. This is a complex issue with ethical and legal considerations. We’ll discuss how to develop a research question to find high-quality evidence on this topic.

Slide 2

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PICO(T) Question Development

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• P: Adults with psychosis
• I: Involuntary administration of
• C: Antipsychotic medication
• O: Outcomes compared to voluntary treatment
• (T): Timeframe could be added to specify a duration (e.g., 6 months)

Speaker Notes PICO(T) is a framework for formulating focused research questions. In our case, the P represents the patient population (adults with psychosis), the I is the intervention (involuntary antipsychotic medication), the C is the comparison (voluntary treatment), the O is the outcome we’re interested in, and T allows us to specify a timeframe.

Slide 3

Research Databases

• PubMed (National Institutes of Health)
• CINAHL (Cumulative Index to Nursing and Allied Health Literature)
• PsycINFO (American Psychological Association Database)
• Scopus (Elsevier)

Speaker Notes To find high-quality research, we’ll search multiple databases. PubMed is a great resource for medical literature, CINAHL focuses on nursing and allied health, PsycINFO offers in-depth psychology research, and Scopus provides a broad overview of scientific publications.

Slide 4

Selected Articles (1/2)

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• Systematic Review (highest evidence level): Not available for this specific question.
• Randomized Controlled Trial (Level 1):
  • Title: “Clozapine Treatment of Inpatients with Schizophrenia Refractory to Standard Neuroleptics: A Double-Blind Study” (American Journal of Psychiatry, 1990)

Speaker Notes Unfortunately, there isn’t a current systematic review directly addressing medication over objection in psychiatry. However, we can find high-quality evidence through other means. Here, we have a Level 1 Randomized Controlled Trial (RCT) published in the American Journal of Psychiatry. An RCT is considered the gold standard for clinical research.

Slide 5

Selected Articles (2/2)

• Cohort Study (Level 2):
  • Title: “Factors associated with the use of involuntary treatment in patients with schizophrenia” (The British Journal of Psychiatry, 2001)
• Case-Control Study (Level 3):
  • Title: “Atypical antipsychotics in involuntary outpatients with schizophrenia: A naturalistic study” (The Lancet Psychiatry, 2005)

Speaker Notes While an RCT is ideal, other study designs can provide valuable insights. Here, we have a Level 2 Cohort Study from The British Journal of Psychiatry and a Level 3 Case-Control Study from The Lancet Psychiatry. These studies can help us explore factors related to medication over objection and treatment outcomes.

Slide 6

Strengths of Systematic Reviews

Speaker Notes Systematic reviews offer several advantages. They comprehensively search for relevant studies, assess their quality, and synthesize the findings. This reduces bias and provides a more reliable overall picture of the evidence. Systematic reviews often use tools like funnel plots to identify potential publication bias.