Involuntary outpatient treatment for mental health problems in Switzerland: a literature review.

BACKGROUND: In 2008, the Swiss Civil Code was amended. From 1 January 2013, each Swiss canton may propose specific provisions for involuntary outpatient treatment (community treatment orders (CTOs)) for individuals with mental disorders. AIM: This review catalogues the legal provisions of the various Swiss cantons for CTOs and outlines the differences between them. It sets this in the context of variations in clinical provisions between the cantons. METHODS: Databases were searched to obtain relevant publications about CTOs in Switzerland. The Swiss Medical Association, Swiss Federal Statistical Office, Swiss Health Observatory and all the 26 Cantonal medical officers were contacted to complete the information. Conférence des cantons en matière de protection des mineurs et des adultes (COPMA), the authority which monitors guardianship legislation, and Pro Mente Sana, a patients' right association, were also approached. RESULTS: Three articles about CTOs in Switzerland were identified. Psychiatric provisions vary considerably between cantons and only a few could provide complete or even partial figures for rates of compulsion in previous years. Prior to 2013, only 6 of the 20 cantons, for which information was returned, had any provision for CTOs. Now, every canton has some form of legal basis but the level of detail is often limited. In eight cantons, the powers of the measure are not specified (for example, use of medication). In 12 cantons, the maximum duration of the CTO is not specified. German speaking cantons and rural cantons are more likely to specify the details of CTOs. CONCLUSION: Highly variable Swiss provision for CTOs is being introduced despite the absence of convincing international evidence for their effectiveness or good quality data on current coercive practice. Careful monitoring and assessment of these new cantonal provisions are essential.

Smoking behaviour, involuntary smoking, attitudes towards smoke-free legislations, and tobacco control activities in the European Union

The six most important cost-effective policies on tobacco control can be measured by the Tobacco Control Scale (TCS). The objective of our study was to describe the correlation between the TCS and smoking prevalence, self-reported exposure to secondhand smoke (SHS) and attitudes towards smoking restrictions in the 27 countries of the European Union (EU27).

Reliability and clinical utility of a Portuguese version of the Abnormal Involuntary Movements Scale (AIMS) for tardive dyskinesia in Brazilian patients

The objective of the present study was to evaluate the reliability and clinical utility of a Portuguese version of the Abnormal Involuntary Movements Scale (AIMS). Videotaped interviews with 16 psychiatric inpatients treated with antipsychotic drugs for at least 5 years were evaluated. Reliability was assessed by the intraclass correlation coefficient (ICC) between three raters, two with and one without clinical training in psychopathology. Clinical utility was assessed by the difference between the scores of patients with (N = 11) and without (N = 5) tardive dyskinesia (TD). Patients with TD exhibited a higher severity of global evaluation by the AIMS (sum of scores: 4.2 ± 0.9 vs 0.4 ± 0.2; score on item 8: 2.3 ± 0.3 vs 0.4 ± 0.2, TD vs controls). The ICC for the global evaluation was fair between the two skilled raters (0.58-0.62) and poor between these raters and the rater without clinical experience (0.05-0.29). Thus, we concluded that the Portuguese version of the AIMS shows an acceptable inter-rater reliability, but only between clinically skilled raters, and that it is clinically useful.

The implications of being an international medical graduate (IMG) in Canadian society : a qualitative study of foreign-trained physicians' resettlement, sense of identity and health status

This qualitative research study used grounded theory methodology to explore the settlement experiences and changes in professional identity, self esteem and health status of foreign-trained physicians (FTPs) who resettled in Canada and were not able to practice their profession. Seventeen foreign-trained physicians completed a pre-survey and rated their health status, quality of life, self esteem and stress before and after coming to Canada. They also rated changes in their experiences of violence and trauma, inclusion and belonging, and racism and discrimination. Eight FTPs from the survey sample were interviewed in semi-structured qualitative interviews to explore their experiences with the loss of their professional medical identities and attempts to regain them during resettlement. This study found that without their medical license and identity, this group of FTPs could not fully restore their professional, social, and economic status and this affected their self esteem and health status. The core theme of the loss of professional identity and attempts to regain it while being underemployed were connected with the multifaceted challenges of resettlement which created experiences of lowered selfesteem, and increased stress, anxiety and depression. They identified the re-licensing process (cost, time, energy, few residency positions, and low success rate) as the major barrier to a full and successful settlement and re-establishment of their identities. Grounded research was used to develop General Resettlement Process Model and a Physician Re-licensing Model outlining the tasks and steps for the successfiil general resettlement of all newcomers to Canada with additional process steps to be accomplished by foreign-trained physicians. Maslow's Theory of Needs was expanded to include the re-establishment of professional identity for this group to re-establish levels of safety, security, belonging, self-esteem and self-actualization. Foreign-trained physicians had established prior professional medical identities, self-esteem, recognition, social status, purpose and meaning and bring needed human capital and skills to Canada. However, without identifying and addressing the barriers to their full inclusion in Canadian society, the health of this population may deteriorate and the health system of the host country may miss out on their needed contributions.

Le rapport Displaced Persons and Their Resettlement in the United States et le début des politiques d’accueil aux États-Unis

RÉSUMÉ : Avec le dénouement de la Deuxième Guerre mondiale, le problème des réfugiés en Europe devient un enjeu international. Plusieurs millions de personnes, que l’on nomme les Displaced Persons (DP), sont sans refuge et doivent recevoir une aide immédiate pour survivre. Même si la majorité de ces gens retourneront dans leurs pays d’origine, il reste encore des centaines de milliers de réfugiés en 1948. La seule solution concrète pour régler cette problématique est l’émigration des réfugiés dans des pays prêts à les accepter. Les Américains jouent un rôle crucial en acceptant 415 000 DP entre 1948 et 1952 grâce au Displaced Persons Act de 1948 et ses amendements en 1950 et 1951. Après d’âpres discussions entre les restrictionnistes et ceux qui défendent la libéralisation des lois d’immigration, naîtra le Displaced Persons Act (DP Act) signé avec beaucoup de réticence, le 25 juin 1948, par le président Harry S. Truman. Cette loi qui prévoit la venue de 202 000 DP en deux ans, contient des mesures jugées discriminatoires à l'endroit de certaines ethnies. Afin d'améliorer le DP Act, le Congrès effectue des recherches sur la situation des réfugiés toujours dans les camps en 1949 tout en étudiant l’impact de la venue des DP aux États-Unis entre 1948 et 1950. Cette étude est soumise sous forme de rapport, le Displaced Persons and Their Resettlement in the United States, le 20 janvier 1950. Ce mémoire propose une analyse minutieuse du rapport et de son contexte politique afin de démontrer le rôle important de cette étude dans le processus décisionnel du Congrès américain visant à accueillir un plus grand nombre de DP tout en posant les bases pour une politique d’accueil en matière de refugiés.

'To move or not to move': Reflections on the resettlement of artisanal miners in the western region of Ghana

This article critically reflects upon the shortcomings of the 'Prestea Action Plan', an ambitious initiative undertaken to facilitate the resettlement of artisanal miners operating in the Western Region of Ghana. The aim of the exercise was to identify viable areas for the thousands of operators who were working illegally in the town of Prestea, an area under concession to the US-based multinational, Golden Star Resources Ltd. At the time of its launch, it was one of the few support initiatives to target artisanal miners, whose claims to land are generally not recognized by governments. It was a particularly significant exercise in Ghana because it suggested that the authorities, who traditionally have exercised a policy of non-negotiation with such groups, had finally recognized that dialogue was needed if the growing rift between the country's indigenous artisanal miners, foreign mining companies and government bodies was to be bridged. It soon emerged, however, that despite its commendable policy objectives, the Plan was fundamentally flawed-problems which would undermine the entire exercise.

Involuntary inhibition of movement initiation alters oculomotor competition resolution

Identifying a stimulus as the target for a goal-directed movement involves inhibiting competing responses. Separable inhibitory interconnections bias local competition to ensure only one stimulus is selected and to alter movement initiation. Behavioural evidence of these inhibitory processes comes from the effects of distracters on oculomotor landing positions and saccade latencies. Here, we investigate the relationship between these two sources of inhibition. Targets were presented with or without close and remote distracters. In separate experiments the possible position and identity of the target and distracters were manipulated. In all cases saccade landing position was found to be less affected by the presence of the close distracter when remote distracters were also present. The involuntary increase in the latency of saccade initiation caused by the presence of the remote distracters alters the state of competitive processes involved in selecting the saccade target thus changing its landing position.

Schizotypal personality and vulnerability to involuntary autobiographical memories

Background and objectives: Individuals who score high on positive schizotypy personality traits are vulnerable to more frequent trauma-related intrusive memories after a stressful event. This vulnerability may be the product of a low level of contextual integration of non-stressful material combined with a heightened sensitivity to a further reduction in contextual integration during a stressful event. The current study assessed whether high scoring schizotypes are vulnerable to frequent involuntary autobiographical memories (IAMs) of non-stressful material. Methods: A free-association word task was used. Participants completed three recorded trials which were then replayed to allow the identification of any associations where an involuntary autobiographical memory had come to mind. Self-report measures of schizotypy and anxiety were completed. Results: All participants retrieved at least one IAM from the three free-association word trials, with 70% experiencing two or more IAMs. Individuals scoring high in schizotypy reported more IAMs than those who scored low. Over 75% of the memories retrieved were neutral or positive in content. Limitations: The current study is an improvement on previous methodologies used to assess IAMs. However, bias due to retrospective recall remains a possibility. Conclusions: Individuals scoring high in schizotypy are vulnerable to an increased level of neutral intrusive memories which may be associated with a ‘baseline’ level of information-processing which is low in contextual integration.

Individual differences in mental control predict involuntary musical imagery

The experience of earworms, a type of involuntary musical imagery, may reflect a systematic failure in mental control. This study focused on how individual differences in each of two factors, schizotypy, or “openness to experience”, and thought suppression might relate to the appearance of the involuntary musical image (earworm). Schizotypy, was measured by Raine’s schizotypal personality questionnaire (SPQ; Raine, 1991) and thought suppression was measured by the White Bear Suppression Inventory (WBSI; Wegner & Zanakos, 1994). Each was found to contribute independently to the overall experience of involuntary musical imagery. Schizotypy was correlated with the length and disruptiveness of earworms, the difficulty with which they were dismissed and the worry they caused, but was not correlated with the frequency of such intrusive imagery. In turn, schizotypy was predicted by suppression and intrusion components of WBSI. The WBSI is associated with the length, disruptiveness, difficulty dismissing and interference but not with the worry caused or the frequency of earworms. The assumption of “ownership” of earworms was also found to affect the extent to which the earworms were considered worrying. Multiple regression analysis showed that both schizotypy and the WBSI predicted the difficulty with which unwanted musical images were dismissed, but that the WBSI accounted for additional variance on top of that accounted for by schizotypy. Finally we consider how earworm management might relate to wider cognitive processes.

Examining vulnerability to involuntary memories in schizophrenia comorbid with post-traumatic stress disorder

The current study explored whether individuals diagnosed with schizophrenia and a high level of PTSD symptoms experience more frequent neutral intrusive memories than individuals diagnosed with schizophrenia with low level PTSD symptoms. Results supported a vulnerability to neutral intrusive memories within the comorbid group, which did not seem to be related to psychotic symptom severity. It is possible that a subgroup of psychotic individuals’ process information in a manner that make them susceptible to frequent intrusive memories, characteristic of a PTSD presentation. A longitudinal study is required to specify the development of this vulnerability so as to inform future interventions.

The classification of involuntary musical imagery: the case for earworms

Involuntary musical imagery (INMI) is the subject of much recent research interest. INMI covers a number of experience types such as musical obsessions and musical hallucinations. One type of experience has been called earworms, for which the literature provides a number of definitions. In this paper we consider the origins of the term earworm in the German language literature and compare that usage with the English language literature. We consider the published literature on earworms and conclude that there is merit in distinguishing between earworms and other types of types of involuntary musical imagery described in the scientific literature: e.g. musical hallucinations, musical obsessions. We also describe other experiences that can be considered under the term INMI. The aim of future research could be to ascertain similarities and differences between types of INMI with a view to refining the classification scheme proposed here.

Resilience as transformative capacity: exploring the quadripartite cycle of structuration in a Mozambican resettlement programme

The concept of resilience has emerged out of a complex literature that has sought to make sense of an increasingly interconnected world that appears ever more beset by crises. Resilience’s appeal is reflected by the burgeoning mass of literature that has appeared on the subject in the past five years. However, there is ongoing debate surrounding its usage, with some commentators claiming that the term is inherently too conservative a one to be usefully applied to situations of vulnerability in which more radical social change is required. This article extends existing efforts to formulate more transformative notions of resilience by reframing it as a double-edged outcome of the pre-reflective and critical ways in which actors draw upon their internal structures following the occurrence of a negative event, thus reproducing or changing the external structural context that gave rise to the event in the first place. By employing a structuration-inspired analysis to the study of small-scale farmer responses to a flood-induced resettlement programme in central Mozambique, the article presents a systematic approach to the examination of resilience in light of this reframing. The case study findings suggest that more attention should be paid to the facilitative, as well as constraining, nature of structures if vulnerable populations are to be assisted in their efforts to exert transformative capacity over the wider conditions that give rise to their difficulties.