Current opinion in psychiatry
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There are two contradictory views on the prognosis of delirium in older hospital patients. On one hand, the Diagnostic and Statistical Manual, 4th Text Revision (DSM-IV-TR), describes delirium as a transient cognitive disorder, the majority of affected individuals having a full recovery. On the other hand, longitudinal studies of delirium in this population report that the outcomes are poor. This review proposes to reconcile these two contradictory views. ⋯ The majority of older hospital patients with delirium may recover but the persistence of delirium in a substantial minority of patients may account, in large part, for the poor outcomes of delirium in this population. This proposal has potentially important implications for clinical practice and research.
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To highlight areas for potential refinement in assessments of capacity to give informed consent. ⋯ To find that a person is incapable by virtue of a mental disorder, a causal connection between the mental disorder and the particular inability should be assessed clinically for the very patient. Furthermore, the term 'acceptance' is more apt than 'appreciation' and 'belief' in capturing that aspect of insight by which a person with psychotic and manic disorders may be rendered incapable of giving informed consent.
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Neuroethics is a recently emerging field that deals with predominantly empirical and practical issues of ethics in neuroscience. In contrast, theoretical and methodological considerations have rather been neglected and thus what may be called theoretical neuroethics. ⋯ It is argued that we need to consider theoretical and methodological issues in order to develop neuroethics as a distinct discipline, which as such can be distinguished from both philosophy/ethics and neuroscience.
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Curr Opin Psychiatry · Nov 2009
ReviewQuality and performance improvement for mental healthcare in Japan.
Until recently, assessing the quality of mental healthcare was a relatively new concept in Japan, although universal health coverage is provided. In this study, I describe the current developments in quality and performance improvement for mental healthcare in Japan. ⋯ Assessing and improving quality and performance are gradually occurring in mental healthcare in Japan in response to the needs of society for high quality care.
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The present review focuses on forensic psychiatric aspects of new developments in preventive detention in Germany. ⋯ There is a broad consent between German forensic psychiatrists that the described changes in criminal law and the increasing application of preventive detention will intensify antiliberal tendencies not only within jurisdiction but also within forensic and general psychiatry.