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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