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      Psychiatrists' attitudes towards autonomy, best interests and compulsory treatment in anorexia nervosa: a questionnaire survey


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          The compulsory treatment of anorexia nervosa is a contentious issue. Research suggests that psychiatrists have a range of attitudes towards patients suffering from anorexia nervosa, and towards the use of compulsory treatment for the disorder.


          A postal self-completed attitudinal questionnaire was sent to senior psychiatrists in the United Kingdom who were mostly general adult psychiatrists, child and adolescent psychiatrists, or psychiatrists with an interest in eating disorders.


          Respondents generally supported a role for compulsory measures under mental health legislation in the treatment of patients with anorexia nervosa. Compared to 'mild' anorexia nervosa, respondents generally were less likely to feel that patients with 'severe' anorexia nervosa were intentionally engaging in weight loss behaviours, were able to control their behaviours, wanted to get better, or were able to reason properly. However, eating disorder specialists were less likely than other psychiatrists to think that patients with 'mild' anorexia nervosa were choosing to engage in their behaviours or able to control their behaviours. Child and adolescent psychiatrists were more likely to have a positive view of the use of parental consent and compulsory treatment for an adolescent with anorexia nervosa. Three factors emerged from factor analysis of the responses named: 'Support for the powers of the Mental Health Act to protect from harm'; 'Primacy of best interests'; and 'Autonomy viewed as being preserved in anorexia nervosa'. Different scores on these factor scales were given in terms of type of specialist and gender.


          In general, senior psychiatrists tend to support the use of compulsory treatment to protect the health of patients at risk and also to protect the welfare of patients in their best interests. In particular, eating disorder specialists tend to support the compulsory treatment of patients with anorexia nervosa independently of views about their decision-making capacity, while child and adolescent psychiatrists tend to support the treatment of patients with anorexia nervosa in their best interests where decision-making is impaired.

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          Most cited references34

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          Fusion of mental health and incapacity legislation.

          The enactment of a single legislative scheme governing nonconsensual treatment of both 'physical' and 'mental' illnesses, based on incapacity principles, has been mooted in recent law reform debates in the UK. We propose a framework for such legislation and consider in more detail the provisions it should contain. The design of legislation that combines the strengths of both incapacity and civil commitment schemes can be readily imagined, based on the criteria for intervention in England and Wales found in the Mental Capacity Act 2005. Such legislation would reduce unjustified legal discrimination against mentally disordered persons and apply consistent ethical principles across medical law.
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            Attitudes of medical professionals towards patients with eating disorders.

            A questionnaire examining attitudes to patients with eating disorders was completed by 352 medical and nursing staff in a general hospital. Patients with eating disorders were less liked than patients with schizophrenia and were seen as responsible for their illness almost to the same degree as recurrent overdose takers. Factor analysis showed a first factor in which patients with eating disorders were construed as vulnerable to external pressures (from others, the media) while also self-inducing their illness, and this was associated with treatment recommendations for education, urging the patient to take self-control and psychotherapy. The professions differed significantly in attitudes.
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              Competence to Make Treatment Decisions in Anorexia Nervosa: Thinking Processes and Values


                Author and article information

                Child Adolesc Psychiatry Ment Health
                Child and Adolescent Psychiatry and Mental Health
                BioMed Central
                17 December 2008
                : 2
                : 40
                [1 ]The Ethox Centre, Department of Public Health, University of Oxford, Oxford, UK
                [2 ]Department of Public Health, University of Oxford, Oxford, UK
                [3 ]Oxfordshire and Buckinghamshire Mental Health Foundation NHS Trust, Oxford, UK
                Copyright © 2008 Tan et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


                Clinical Psychology & Psychiatry
                Clinical Psychology & Psychiatry


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