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A biopsychosocial rationale for coerced community treatment in the management of schizophrenia

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Abstract

Coerced community treatment in its various forms is receiving increasing attention and generating considerable controversy. Few attempts, however, have been made to articulate a rationale for its use. The author presents material in support of the concept that schizophrenia can be viewed as a set of biopsychosocial deficits and that some of the deficits can be efficaciously addressed using coerced community treatment. The biological, psychological, and social deficits are each examined and then a biopsychosocial-coerced intervention hypothesis is generated. The underpinning of the use of coerced community treatment in this model is its ability to affect structure and motivation and thereby to alter the customary community living equation. The charge that one can just treat the deficits and then coercion becomes superfluous is answered. The concerns that the employment of coercion could become too widespread or be used in lieu of adequate community resources for mental health services are also considered. The conclusion is that coerced community treatment is a logical component of the treatment of schizophrenia in outpatient settings.

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References

  1. Geller JL: Rights, wrongs and the dilemma of coerced community treatment. American Journal of Psychiatry 143:1259–1264, 1986.

    Google Scholar 

  2. Schmidt MJ, Geller JL: Involuntary administration of medication in the community: The judicial opportunity. Bulletin of the American Academy of Psychiatry and the Law 17:283–292, 1989.

    Google Scholar 

  3. Geller JL: Clinical guidelines for the use of involuntary outpatient treatment. Hospital and Community Psychiatry 41:749–755, 1990.

    Google Scholar 

  4. Geller JL: Clinical encounters with outpatient coercion at the CMHC: Questions of implementation and efficacy. Community Mental Health Journal 28:81–94, 1992.

    Google Scholar 

  5. Geller JL: Treating revolving-door patients who have “hospitalphilia:” Compassion, coercion and common sense. Hospital and Community Psychiatry 44:141–146, 1993.

    Google Scholar 

  6. Hiday VA, Goodman RR: The least restrictive alternative to involuntary hospitalization, outpatient commitment: Its use and effectiveness. Journal of Psychiatry and Law 10:81–96, 1982.

    Google Scholar 

  7. Miller RD, Fiddleman PB: Outpatient commitment: Treatment in the least restrictive environment? Hospital and Community Psychiatry 35:147–151, 1984.

    Google Scholar 

  8. Hiday, VA, Scheid-Cook TL: The North Carolina experience with outpatient commitment: A critical appraisal. International Journal of Law and Psychiatry 10:215–232, 1987.

    Google Scholar 

  9. Scheid-Cook TL: Commitment of the mentally ill to outpatient treatment. Community Mental Health Journal 23:173–182, 1987.

    Google Scholar 

  10. Hiday VA, Scheid-Cook TL: A follow-up of chronic patients committed to outpatient treatment. Hospital and Community Psychiatry 40:52–59, 1989.

    Google Scholar 

  11. Lamb HR, Weinberger LE: Conservatorship for gravely disabled psychiatric patients: A four-year follow-up study. American Journal of Psychiatry 149:909–913, 1992.

    Google Scholar 

  12. Lamb HR, Weinberger LE: Therapeutic use of Conservatorship in the treatment of gravely disabled psychiatric patients. Hospital and Community Psychiatry 44:147–150, 1993.

    Google Scholar 

  13. Wood WD, Swanson DA: Use of outpatient treatment during civil commitment: Law and practice in Nebraska. Journal of Clinical Psychology 41:723–728, 1985.

    Google Scholar 

  14. Bursten B: Posthospital mandatory outpatient treatment. American Journal of Psychiatry 143:1255–1258, 1986.

    Google Scholar 

  15. Van Putten RA, Santiago JM, Berren MR: Involuntary outpatient commitment in Arizona: A retrospective study. Hospital and Community Psychiatry 39:953–958, 1988.

    Google Scholar 

  16. Schneider-Braus K: Civil commitment to outpatient psychotherapy: A case study. Bulletin of the American Academy of Psychiatry and the Law 14:273–279, 1986.

    Google Scholar 

  17. Geller JL: The quandaries of enforced community treatment and unenforceable outpatient commitment statutes. Journal of Psychiatry and Law 14:149–158, 1986.

    Google Scholar 

  18. Zanni, G., de Veau L: Inpatient stays before and after outpatient commitment. Hospital and Community Psychiatry 37:941–942, 1986.

    Google Scholar 

  19. Scott-Moncrieff L: Comments on the discussion document of the Royal College of Psychiatrists regarding community treatment orders. Bulletin of the Royal College of Psychiatrists 12:220–223, 1988.

    Google Scholar 

  20. Sensky, T, Hughes T, Hirsch S: Compulsory psychiatric treatment in the community 1. A controlled study of compulsory community treatment with extended leave under the mental health act. Special characteristics of patients treated and impact of treatment. British Journal of Psychiatry 158:792–799, 1991.

    Google Scholar 

  21. Sensky T, Hughes T, Hirsch S: Compulsory psychiatric treatment in the community II. A controlled study of patients whom psychiatrists would recommend for compulsory treatment in the community. British Journal of Psychiatry 158:799–804, 1991.

    Google Scholar 

  22. Dedman P: Community treatment orders in Victoria, Australia. Psychiatric Bulletin 14:462–464, 1990.

    Google Scholar 

  23. Andrews G, Teesson M, Stewart G, Hault J: Follow-up of community placement of the chronic mentally ill in New South Wales. Hospital and Community Psychiatry 41:184–188, 1990.

    Google Scholar 

  24. Dawson J: Community treatment orders. Otago Law Review 7:408–425, 1991.

    Google Scholar 

  25. Appelbaum PS: Outpatient commitment: The problems and the promise. American Journal of Psychiatry 143:1270–1272, 1986.

    Google Scholar 

  26. Mulvey EP, Geller JL, Roth LH: The promise and peril of involuntary outpatient commitment. American Psychologist 42:571–584, 1987.

    Google Scholar 

  27. Wilk RJ: Involuntary outpatient commitment of the mentally ill. Social Work 33:133–137, 1988.

    Google Scholar 

  28. Schwartz SJ, Costanzo CE: Compelling treatment in the community: Distorted doctrines and violated values. Loyola of Los Angeles Law Review 20:1329–1429, 1987.

    Google Scholar 

  29. Stefan S: Preventive commitment: The concept and its pitfalls. Mental and Physical Disability Law Reporter 11:288–302, 1987.

    Google Scholar 

  30. Involuntary Commitment to Outpatient Treatment. Task Force Report 26. Washington, DC, American Psychiatric Association, June 1987.

    Google Scholar 

  31. Miller RD: Outpatient civil commitment of the mentally ill: An overview and an update. Behavioral Sciences and the Law 6:99–118, 1988.

    Google Scholar 

  32. Hoge SK, Appelbaum PS, Geller JL: Involuntary treatment, in Review of Psychiatry. Edited by Tasman A, Hales RE, Frances AJ. Washington, DC, American Psychiatric Press, 1989.

    Google Scholar 

  33. Geller JL, Rx: A tincture of coercion in outpatient treatment? Hospital and Community Psychiatry 42:1068–1070, 1991.

    Google Scholar 

  34. Meloy JR, Haroun A, Schiller EF: Clinical Guidelines for Involuntary Outpatient Treatment. Sarasota, FL, Professional Resource Exchange, 1990.

    Google Scholar 

  35. Crow TJ, Ball J, Bloom SR, Brown R, Bunon CJ, Coltar N, Frith CD, Johnstone EC, Owens DGC, Roberts GW: Schizophrenia as an anomaly of development of cerebral asymmetry. Archives of General Psychiatry 46:1146–1150, 1989.

    Google Scholar 

  36. DeLisi LE, Hoff AL, Schwartz JE, Shields GW, Halthore SN, Gupta SM, Henn FA, An and AK: Brain morphology in first-episode schizophrenic-like psychotic patients: A quantitative magnetic resonance imaging study. Biological Psychiatry 29:159–175, 1991.

    Google Scholar 

  37. Schwartz JM, Aylward E, Barta PE, Tune LE, Pearlson GD: Sylvian fissure size in schizophrenia measured with the magnetic resonance imaging rating protocol of the consortium to establish a registry for Alzheimer's disease. American Journal of Psychiatry 149:1195–1198, 1992.

    Google Scholar 

  38. Judd LL, McAdams LA, Budnick B, Braff DL: Sensory grating deficits in schizophrenia: New results. American Journal of Psychiatry 149:488–493, 1992.

    Google Scholar 

  39. Bellack AS, Mueser KT, Morrisson RL, Tierney A, Podel K: Remediation of cognitive deficits in schizophrenia. American Journal of Psychiatry 147:1650–1655, 1990.

    Google Scholar 

  40. Goldberg TE, Weinberger DR, Berman KF, Pliskin NH, Podd MH: Further evidence for dementia of the prefrontal type in schizophrenia? Archives of General Psychiatry 44:1008–1014, 1987.

    Google Scholar 

  41. Hoff AL, Riordan H, O'Donnell DW, Morris L, DeLisi LE: Neuropsychological functioning of first-episode schizophreniform patients. American Journal of Psychiatry 149:898–903, 1992.

    Google Scholar 

  42. Hoff AL, Riordan H, O'Donnell D, Stritzke P, Neale C, Boccio A, Anand AK, DeLisi LE: Anomalous lateral sulcus asymmetry and cognitive function in first episode schizophrenia. Schizophrenia Bulletin 18:257–270, 1992.

    Google Scholar 

  43. Burgess JW, Zarconi VP: Cognitive impairment in dramatic personality disorder (Ltr to Edit). American Journal of Psychiatry 149:136, 1992.

    Google Scholar 

  44. Feinberg TE, Rifkin A, Schaffer C, Walker E: Facial discrimination and emotional recognition in schizophrenic and affective disorders. Archives of General Psychiatry 43:276–279, 1986.

    Google Scholar 

  45. Bellack AS, Mueser KT, Wade J, Sayers S, Morrison RL: The ability of schizophrenics to perceive and cope with negative effect. British Journal of Psychiatry 160:473–480, 1992.

    Google Scholar 

  46. Bellack AS, Morrison RL, Wixted JL, Mueser KT: An analysis of social competence in schizophrenia. British Journal of Psychiatry 156:809–818, 1990.

    Google Scholar 

  47. Weinberger DR, Berman KF, Zec RF: Physiologic dysfunction of dorsolateral prefrontal cortex in schizophrenia. I. Regional cerebral blood flow evidence. Archives of General Psychiatry 43:114–124, 1986.

    Google Scholar 

  48. Weinberger DR, Berman KF, Suddath R, Torrey EF: Evidence of dysfunction of a prefrontal-limbic network in schizophrenia: A magnetic resonance imaging and regional cerebral blood flow study of discordant monozygotic twins. American Journal of Psychiatry 149:890–897, 1992.

    Google Scholar 

  49. Cramer P, Bowen J., O'Neill M: Schizophrenics and social judgement. Why do schizophrenics get it wrong? British Journal of Psychiatry 160:481–487, 1992.

    Google Scholar 

  50. Rosanoff AJ, Cusack TS: Parole system and its relation to occupational therapy. American Journal of Insanity 77:149–163, 1920.

    Google Scholar 

  51. Liberman RP (Ed): Psychiatric Rehabilitation of Chronic Mental Patients, Washington, DC, American Psychiatric Press, 1988.

    Google Scholar 

  52. Anthony WA, Cohen MR, Cohen BF: Psychiatric rehabilitation, in Talbott JA (Ed). The Chronic Mental Patient. Five Years Later. New York, Grune & Stratton, 1984.

    Google Scholar 

  53. Moller MD, Wer JE: Simultaneous patient family education regarding schizophrenia: The Nebraska Model. Archives of Psychiatric Nursing 3:332–337, 1989.

    Google Scholar 

  54. Allen CK, Allen RE: Cognitive disabilities: Measuring the social consequences of mental disorders. Journal of Clinical Psychiatry 48:185–190, 1987.

    Google Scholar 

  55. Bachrach LL: Psychosocial rehabilitation and psychiatry in the care of the long-term patients. American Journal of Psychiatry 149:1455–1463, 1992.

    Google Scholar 

  56. Bellack AS: Cognitive rehabilitation for schizophrenia: Is it possible? Is it necessary? Schizophrenia Bulletin 18:43–48, 1992.

    Google Scholar 

  57. Summerfelt AT, Alphs LD, Funderburk FR, Strauss ME, Wagman AMI: Impaired Wisconsin Card Sort performance in schizophrenia may reflect motivational deficits. (Ltr to Edit). Archives of General Psychiatry 48:282–283, 1991.

    Google Scholar 

  58. Green MF, Satz P, Ganzell S, Vaclav JF: Wisconsin Card Sorting Test performance in schizophrenia: Remediation of a stubborn deficit. American Journal of Psychiatry 149:62–67, 1992.

    Google Scholar 

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Authors and Affiliations

  1. University of Massachusetts Medical Center, 55 Lake Avenue North, 01655, Worcester, MA

    Jeffrey L. Geller M.D., M.P.H. (Professor of Psychiatry and Director of Public Sector Psychiatry)

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  1. Jeffrey L. Geller M.D., M.P.H.
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Geller, J.L. A biopsychosocial rationale for coerced community treatment in the management of schizophrenia. Psych Quart 66, 219–235 (1995). https://doi.org/10.1007/BF02265672

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