Mental Illness Case Study Examples | Mental health articles

 

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Other studies have compared data from the criminal justice system, such as arrest rates among people with mental illness and those without. But these studies, by definition involving a subset of people, may also misstate rates of violence in the community. Free Mental Health Case Study: Case 1. Li was an year-old high school student. He had always been an average student, hardworking and honest. Recently, however, his mother had noticed that Li had been staying out till late at night, his schoolgrades had been falling, and he was spending more money. Mental Health Case Studies Case Study # 1 M is a 32 year old man who was referred to our service by the Assertive Outreach Team. He was living with his girlfriend but the relationship was breaking down and.


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This collection presents six case studies on the ethics of mental health research, written by scientific researchers and ethicists from around the world. We publish them here as a resource for teachers of research ethics and as a contribution to several ongoing ethical debates, mental illness case studies.

Each consists of a description of a research study that was proposed or carried out and an in-depth analysis of the ethics of the study. Despite the high burden of disease and some partially effective treatments that can be implemented in countries with weaker healthcare delivery systems Hyman et al. Its recommendations for mental health research priorities included research into the effects of interactions between mental health and other health conditions Prince et al.

All of these priorities require research in environments where the prevailing health problems and healthcare services match those of the populations the research will benefit, which suggests that research must take place all around the world.

Similarly, many of the priorities identified by the Grand Challenges in Mental Health Initiative require focus on local environments, cultural factors, and the health systems of low- and middle-income countries. Notwithstanding the need for research that is sensitive to different social and economic contexts, the trend of outsourcing to medical research to developing countries shows no sign of abating Thiers et al. Consequently, a substantial amount of mental health research will, in any case, take place in low- and middle-income countries, as well as rich countries, during the next few years.

The need for local research and the continuing increase in the international outsourcing of research imply that there is a pressing need to build the capacity to conduct good quality mental health research around the world. However, the expansion of worldwide capacity to conduct mental health research requires more than simply addressing low levels of funding for researchers and the imbalance between the resources available in rich and poor countries.

People with mental health disorders are often thought to be particularly vulnerable subjects, mental illness case studies. This may be a product of problems related to their condition, such as where the condition reduces the capacity to make autonomous decisions.

It may also result from social conditions because people with mental disorders are disproportionately likely to be poor, are frequently stigmatized as a result of their condition, and may be victims of human rights abuses Weiss et al. As a result, it is vitally important that the institutional resources and expertise are in place for ensuring that this research is carried out ethically. Discussion at a special session at the 7th Global Forum on Bioethics in Research revealed the perception that many mental health researchers are not very interested in ethics and showed up a lack of ethics resources directly related to their work.

This collection of case studies in the ethics of mental health research responds to that gap. This collection comprises six case studies written by contributors from around the world Table 1.

Each describes a mental health research study that raised difficult ethical issues, provides background and analysis of those issues, and draws conclusions about the ethics of the study, including whether it was ethical as it mental illness case studies and how it ought to be amended otherwise. Three of the case studies are written by scientists who took part in the research they analyzed. For these cases, we have asked scholars independent of the research to write short commentaries on them.

It is valuable to hear how the researchers themselves grapple with the ethical issues they encounter, as well as to hear the views of people with more distance from the research enterprise, mental illness case studies.

Some of the ethical issues raised here have not been mental illness case studies before in the bioethics literature; others are more common concerns that have not received much attention in the context of international research. The case studies are intended to both expand academic discussion of some of the key questions related to research into mental health and for use in teaching ethics.

Case studies are an established teaching tool. Ethical analyses of such cases demonstrate the relevance of ethics to the actual practice of medical research and provide paradigmatic illustrations of the application of ethical principles to particular research situations.

Concrete cases help generate and guide discussion and assist students who have trouble dealing with ethical concepts in abstraction. Through structured discussion, ethical development and decision-making skills can be enhanced. Moreover, outside of the teaching context, case study analyses provide a means to generate and focus debate on the relevant ethical issues, which can both highlight their importance and help academic discussion to advance. People working in mental health research can benefit most from case studies that are specific to mental health.

Even though, as outlined below, mental illness case studies, many of the same ethical problems arise in mental health research as elsewhere, the details of how they arise are important. For example, the nature of depression and the variation in effectiveness of antidepressive mental illness case studies make a difference to how we should assess the ethics of placebo-controlled trials for new antidepressants. Moreover, seeing how familiar ethical principles are applied to one's own research specialty makes it easier to think about the ethics of one's own research.

The cases in this collection highlight the commonalities mental illness case studies the variation in the ethical issues facing researchers in mental health around the world. The current literature contains some other collections of ethics case studies that may be useful to mental health researchers.

I note four important collections here, to which interested scholars may want to refer. Lavery et al, mental illness case studies. Cash et al. Two further collections focus on mental health research, in particular. Finally, Hoagwood et al. For teachers and academics in search of more case studies, these existing collections should be very useful. Here, we expand on the available resources with six case studies from around the world with extended ethical analyses.

The remainder of this introduction provides an overview of some of the most important ethical issues that arise in mental health research and describes some of the more significant ethics guidance documents that apply. The same principles can be applied in assessing the ethics of mental health research as to other research using human participants Emanuel et al.

Concerns about the social value of research, risks, informed consent, and the fair treatment of participants all still apply. This means that we can learn from the work done in other areas of human subjects research. However, specific research contexts make a difference to how the more general ethical principles should be applied to them, mental illness case studies.

Different medical conditions may require distinctive research designs, different patient populations may need special protections, and different locations may require researchers to respond to study populations who are very poor and lack access to health care or to significant variations in regulatory systems. The ethical analysis of international mental health research therefore needs to be tailored to its particularities.

Each case study in this collection focuses on the particular ethical issues that are relevant to the research it analyzes. Nevertheless, some issues arise in multiple cases. For example, mental illness case studies, questions about informed consent arise in the context of research with stroke patients, with students, and with other vulnerable groups.

To help the reader compare the treatment of an ethical issue across the different case studies, the ethical analyses use the same nine headings to delineate the issues mental illness case studies consider. These are social value, study design, study population, informed consent, risks and benefits, mental illness case studies, confidentiality, post-trial obligations, legal versus ethical obligations, mental illness case studies, mental illness case studies oversight, mental illness case studies.

Here, I focus on five of these ethical issues as they arise in the context of international mental health research: 1 study design, 2 study population, 3 risks and benefits, 4 informed consent, and 5 post-trial obligations. I close by mentioning some mental illness case studies the most important guidelines that pertain to mental health research.

The scientific design of a research study determines what sort of data it can generate. For example, the decision about what to give participants in each arm of a controlled trial determines what interventions the trial compares and what questions about relative safety and efficacy it can answer. What data a study generates makes a difference to the ethics of the study because research that puts human beings at risk is ethically justified in terms of the social value of the knowledge it mental illness case studies. It is widely believed that human subject research without any social value is unethical and that the greater the research risks to participants, the greater the social value of the research must be to compensate Council for International Organizations of Medical Sciences [CIOMS], ; World Medical Association, However, mental illness case studies, changing the scientific design of a study frequently changes what happens to research participants, too.

For example, giving a control group in a treatment trial an existing effective treatment rather than placebo makes it more likely that their condition will improve but may expose them to adverse effects they would not otherwise experience.

Therefore, questions of scientific design can be ethically very complex because different possible designs are compared both in terms of the useful knowledge they may generate and their potential impact on participants. One of the more controversial questions of scientific design concerns the standard of care that is offered to participants in controlled trials.

Some commentators argue that research that tests therapeutic interventions is only permissible if there is equipoise concerning the relative merits of the treatments being compared, that is, there are not good reasons mental illness case studies think that participants in any arm of the trial are receiving inferior treatment Joffe and Truog, If there is not equipoise, the argument goes, then physician-researchers will be breaching their duty to give their patients the best possible care Freedman, When designing the BEIP, the researchers wrestled with the issue of whether there was genuine equipoise regarding the relative merits of institutional and foster care.

One interpretation of equipoise is that it exists when the professional community has not reached consensus about the better treatment Freedman, Childcare professionals in the United States were confident that foster care was superior, but there was no such confidence in Romania, where institutional care was the norm.

Which, then, was the relevant professional community? The equipoise requirement is justified by reference to the role morality of physicians: for a physician to give her patient treatment that she knows to be inferior would violate principles of therapeutic beneficence and nonmaleficence.

As a result, the equipoise requirement has been criticized for conflating the ethics of the physician-patient relationship with the ethics of the researcher-participant relationship Miller and Brody, mental illness case studies, According to Miller and Brodyprovided that other ethical requirements are met, including an honest null hypothesis, mental illness case studies, it is not unethical to assign participants to receive treatment regimens known to be inferior to the existing standard of care, mental illness case studies.

A subset of trial designs that violate equipoise are placebo-controlled trials of experimental treatments for conditions for which proven effective treatments already exist. Here, there is not equipoise because some participants will be assigned to placebo treatment, and ex hypothesi there already exists treatment that is superior to placebo. Even if we accept Miller and Brody's argument and reject the equipoise requirement, there remain concerns about these placebo-controlled trials.

Providing participants with less effective treatment than they could get outside of the trial constitutes a research risk because trial participation makes them worse off. Moreover, on the face of it, a placebo-controlled trial of a novel treatment of a condition will not answer the most important scientific question about the treatment that clinicians are interested in: is this new treatment better than the old one? Consequently, in situations where there already exists a standard treatment of a condition, it has generally been considered unethical to use a placebo control when testing a new treatment, rather than using the standard treatment as an active-control World Medical Association, Some psychiatric research provides scientific reasons to mental illness case studies a blanket prohibition on placebo-controlled trials when an effective mental illness case studies exists.

For example, it is not unusual for antidepressive drugs to fail to show superiority to placebo in any given trial. This means that active-control trials may seem to show that an experimental drug is equivalent in effectiveness to the current standard treatment, when the explanation for their equivalence may, in fact, be that neither mental illness case studies better than placebo.

Increasing the power of an active-control trial sufficiently to rule out this possibility may require an impractically large number of subjects and will, mental illness case studies, in any case, put a greater number of subjects mental illness case studies risk Carpenter et al.

A trial of risperidone for acute mania conducted in India Khanna et al. The investigators' response to criticisms adopted exactly the line of argument just described:. A placebo group was included because patients with mania generally show a high and variable placebo response, mental illness case studies, making it difficult to identify their responses to an active medication. Placebo-controlled trials are valuable in that they expose the fewest patients to potentially ineffective treatments.

In addition, inclusion of a placebo arm allows a valid evaluation of adverse events attributable to treatment v. Khanna et al. Concerns about the standard of care given to research participants are exacerbated in trials in developing countries, like India, where research participants may not have access to treatment independent of the study. In such cases, potential participants may have no real choice but to join a placebo-controlled trial, for example, because that is the only way they have a chance to receive treatment.

In the Indian risperidone trial, the issue of exploitation is particularly stark because it seemed to some that participants were getting less than the international best standard of care, in order that a pharmaceutical company could gather data that was unlikely to benefit many Indian patients. This is just one way in which trial design may present ethically troubling risks to participants. Other potentially difficult designs include washout studies, in which participants discontinue use of their medication, and challenge studies, in which psychiatric symptoms are experimentally induced Miller and Rosenstein, In both cases, the welfare of participants may seem to be endangered Zipursky, A variant on the standard placebo-controlled trial design is the withdrawal design, in which everyone starts the trial on medication, mental illness case studies, the people who respond to the medication are then selected for randomization, and then half of those people are randomized to placebo.

This design was used by a Japanese research team mental illness case studies assess the effectiveness of sertraline for depression, as described by Shimon Tashiro and colleagues in this collection. The researchers regarded this design as more likely to benefit the participants because for legal reasons, sertraline was being tested in Japan despite its proven effectiveness in non-Japanese populations.

Tashiro and colleagues analyze how the risks and benefits of a withdrawal design compare with those of standard placebo-controlled trials and consider whether the special regulatory context of Japan makes a difference.

 

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Mental Illness Case Study Examples: Case 1. Ricard was a year-old man who suddenly started behaving in abizarre manner three days earlier. He became very restless, started talking nonsense and behaved in a shameless manner, taking his clothes off in public. Crane, U.S. (): “[T]here must be proof of serious difficulty in controlling behaviorviewed in light of such features of the cases as the nature of the psychiatric diagnosis, and the severity of the mental abnormality itself sufficient to distinguish the dangerous sexual offender whose serious mental illness, abnormality. These sample case studies are for illustration only. They should not be used to make a diagnosis. If the symptoms sound similar to those that you (or a loved one) are experiencing, please contact your primary physician or a mental health professional for an evaluation as soon as possible. Case Study 1. Jessica is a 28 year-old married female.