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3 Dev. Mental Health L. 1 (1983)

handle is hein.journals/dvmnhlt3 and id is 1 raw text is: A Quarterly Publication of the Institute of Law, Psychiatry & Public Policy at the University of Virginia Developments In Mental Health Law Box 100, Blue Ridge Hospital, Charlottesville, VA 22901 (804) 924-5435 Vol.3, Nos. I & 2 Jan.-June 1983 The Refusal of Antipsychotic Medication: A Clinical View by Michael A. Solomon, M.D.* and John M Davis, M.D.** The right of involuntarily committed mental patients to refuse antipsychotic medications is currently an issue of lit- igation in courts across the country and of debate in the legal and psychiatric literature. Though lawyers and psychia- tt bring to the controversy widely divergent perspectives, the ultimate aim of their dialogue should be to pro- tect patients' rights while delivering effective care. Unfortunately, however, many legal decisions and commentar- ies are based upon a limited number of law review articles which present in- complete and inaccurate versions of medical facts and thus do little to rec- tify the widespread misunderstanding of antipsychotic medications. This arti- cle describes some of the realistic benefits and risks of treatment with antipsychotic medication and outlines the complex clinical issues involved in the refusal of medication by involuntar- ily committed patients. A basic under- standing of these clinical issues is a prerequisite to formulation of respon- *Michael A. Solomon, R.D., will be Director of the Court Evaluation and Treatment Program at Western State Hospital and Assistant Pro- fessor of Behaioral Medicine and Psychlatry at the Unirsi ofVirginia School of Medicine begftin I July 1983. 'John R Davis, M.D., is Director of Research at linois Sote Pahlamtic Institute and Gilman Profeo of fPlhiaby at the University of Illi- nois School of Medicine. sible policy regarding the refusal of medication. The Risk/Benefit Calculation Virtually every type of medication carries with it both beneficial and un- desired effects. A familiar example of this is aspirin, which relieves fever, inflammation, and pain but can also cause severe gastrointestinal irritation. The decision of whether to treat with aspirin, therefore, inevitably involves the weighing of benefits against risks. This risk/benefit ratio varies according to the type of medication prescribed and the circumstances under which the medication is to be administered, including the duration of the proposed treatment An important distinction when cal- culating the risk/benefit ratio of antip- sychotic medications is between short term administration and long term maintenance treatment In the discus- sion which follows short term admin- istration refers to a time ranging from several days to several months. Long term maintenance therapy, on the other hand, refers to a time ranging from many months to years. Benefits and Risks of Short Term Treatment with Antipsychotic Medication The evidence for the benefits of treatment with antipsychotic drugs is compelling. There are now over ten thousand reports in the literature sup- porting the efficacy of pharmacother- apy in treating major mental disorders. Several hundred studies investigate the pharmacologic treatment of schizoph- renia using random assignment of sub- jects and double-blind procedures. The best of these are the approximately seventy studies that are controlled, i.e., that compare the efficacy of active medication with that of a placebo. The most comprehensive of the ran- domized, controlled, double-blind stu- Continued Also in this issue... 3/ In the Virginia General Assembly - 1983 5/ Civil Commitment Revisions Fail 7/ In the United States Supreme Court 10/ 1983 Forensic Proposals

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