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Electroconvulsive therapy is restricted in Italy
Electroconvulsive therapy is restricted in Italy he Italian Ministry of Health updated its electroconvulsive therapy (ECT) guidelines on Feb 15. ECT is now restricted to disorders such as major depression with psychotic symptoms and psychomotor inhibition but only when drug treatment is contra-indicated, ineffective, or precluded by its side effects. The only other approved indications for ECT in the updated regulations are for drug-resistant manic psychoses, malignant neuroleptic syndrome, and malignant catatonia, although the
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ministry’s guidelines themselves admit that evidence of ECT’s efficacy for these conditions is “limited and questionable”. ECT has been expressly discouraged for schizophre nia—an indication in the former 1996 guidelines—and is now banned as a means of achieving “rapid remission of symptoms” in psychiatric disease. ECT can now only be legally done in approved inpatient institutions (public and private) by both a psychiatrist and an anaesthetist. Also, the patient’s written informed
consent is now mandatory, unlike before. The psychiatric community is still split over ECT’s place in modern psychiatric therapy. Some welcomed the guidelines as justly rectifying the previous regulations, which allowed too much space for ECT in psychiatric therapy. Whereas others deplored the way the new guidelines had made use of ECT in Italy almost impossible. Bruno Simini
Eating disorders may warrant compulsory hospital admission
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norexia nervosa and bulimia should be included among psy chiatric disorders for which patients may need compulsory admission to hospital, ruled a judge in Barcelona on March 10. Judge Ignacio Sancho-Gargallo, who specialises in cases dealing with mentally-ill people, believes compulsory admission falls into two categories. If a patient resists home treatment the patient’s parents should be able to get a court order
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to admit the patient to hospital. Or if the patient has been admitted to hospital because of a suicide attempt, and then refuses to eat anything, the hospital staff should then be able to get a court order to detain the patient in hospital. Sancho-Gargallo says the measures are not designed to penalise the patients but to “coerce” them. Each week Sancho-Gargallo, accompanied by a forensic physi cian, visits eating-disorder treat-
Irish injunction against antiabortion protesters he Irish Family Planning Association (IFPA) has won High Court injunctions against militant antiabortion protesters based in Ireland and the USA, after protesters invaded its clinic and headquarters in central Dublin alleging the IFPA was referring women to abortion clinics in Britain. A temporary injunction against members of the Irish-based Youth Defence (YD) and the Washington DC-based leader of the Christian Defence Coalition was granted on March 8, followed by an interlocutory injunction on March 11 that will remain in place until a full court hearing is held. The court orders prohibit the protesters from picketing or trespassing at any IFPA clinic in Dublin as well as obstructing, harassing, intimidating, molesting, or interfering with staff and clients. The IFPA told the court at the injunction hearing that YD picketed the clinics regularly but on March 6 about 70 protesters, including 39 Americans, led by Presbyterian minister, Patrick Mahony—founder of the Christian Defence Coalition,
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THE LANCET • Vol 353 • March 20, 1999
ment units to determine whether the patients recommended for obligatory admission by the doctors actually need such admission. Currently, about 16 patients per month are being detained by court order in Barcelona hospitals. The measures have been welcomed by psychiatrists and parents associa tions and both groups hope the rul ing will be adopted nationwide. Xavier Bosch
National body unites UK ethics committees
which he set up in 1995—forced their way into the premises. Some staff and clients locked themselves in back offices for several hours and the clinic was forced to close. People phoning the IFPA were told by the protesters that they could not talk to anyone in the clinic as they were murderers. After the injunctions were issued, YD which is the most hard-line of the Irish antiabortion groups, said it will ignore the injunctions warning that there would be “a few surprises” in the next month and claiming that “something big is about to happen”. It has been reported that YD has received money from American antiabortion groups but this is the first time an American group has taken part in a protest in Ireland. Mahony is one of the most high profile antiabortion protesters in the USA. In the early 1990s, when he was spokesman for the antiabortion group Operation Rescue, he tried to dispel the “myth that we’re clinic bombers or fringe radicals”.
arch 12 saw the first attempt to create a national body to bring together and advise research ethics committees in the UK. It was marked by the first annual general meeting of the Association of Research Ethics Committees in London. Research ethics committees in the UK have sprung up largely independently during the past two decades and it has become apparent that there would be advantages to forming a single national body. Richard Nicholson, editor of the Bulletin of Medical Ethics, encouraged delegates at the meeting to adopt an interim constitution in order that the association might be able to form a limited company and apply for charitable status. Some delegates were unhappy with the absence of lay nominees to serve on the AREC inaugural council. But despite this and other reservations, the constitution was adopted almost unanimously. The Association aims to provide training and advice on, for example, how to deal with suspected fraud and misconduct.
Karen Birchard
Sarah Ramsay
M
993
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ministry’s guidelines themselves admit that evidence of ECT’s efficacy for these conditions is “limited and questionable”. ECT has been expressly discouraged for schizophre nia—an indication in the former 1996 guidelines—and is now banned as a means of achieving “rapid remission of symptoms” in psychiatric disease. ECT can now only be legally done in approved inpatient institutions (public and private) by both a psychiatrist and an anaesthetist. Also, the patient’s written informed
consent is now mandatory, unlike before. The psychiatric community is still split over ECT’s place in modern psychiatric therapy. Some welcomed the guidelines as justly rectifying the previous regulations, which allowed too much space for ECT in psychiatric therapy. Whereas others deplored the way the new guidelines had made use of ECT in Italy almost impossible. Bruno Simini
Eating disorders may warrant compulsory hospital admission
A
norexia nervosa and bulimia should be included among psy chiatric disorders for which patients may need compulsory admission to hospital, ruled a judge in Barcelona on March 10. Judge Ignacio Sancho-Gargallo, who specialises in cases dealing with mentally-ill people, believes compulsory admission falls into two categories. If a patient resists home treatment the patient’s parents should be able to get a court order
-
to admit the patient to hospital. Or if the patient has been admitted to hospital because of a suicide attempt, and then refuses to eat anything, the hospital staff should then be able to get a court order to detain the patient in hospital. Sancho-Gargallo says the measures are not designed to penalise the patients but to “coerce” them. Each week Sancho-Gargallo, accompanied by a forensic physi cian, visits eating-disorder treat-
Irish injunction against antiabortion protesters he Irish Family Planning Association (IFPA) has won High Court injunctions against militant antiabortion protesters based in Ireland and the USA, after protesters invaded its clinic and headquarters in central Dublin alleging the IFPA was referring women to abortion clinics in Britain. A temporary injunction against members of the Irish-based Youth Defence (YD) and the Washington DC-based leader of the Christian Defence Coalition was granted on March 8, followed by an interlocutory injunction on March 11 that will remain in place until a full court hearing is held. The court orders prohibit the protesters from picketing or trespassing at any IFPA clinic in Dublin as well as obstructing, harassing, intimidating, molesting, or interfering with staff and clients. The IFPA told the court at the injunction hearing that YD picketed the clinics regularly but on March 6 about 70 protesters, including 39 Americans, led by Presbyterian minister, Patrick Mahony—founder of the Christian Defence Coalition,
T
THE LANCET • Vol 353 • March 20, 1999
ment units to determine whether the patients recommended for obligatory admission by the doctors actually need such admission. Currently, about 16 patients per month are being detained by court order in Barcelona hospitals. The measures have been welcomed by psychiatrists and parents associa tions and both groups hope the rul ing will be adopted nationwide. Xavier Bosch
National body unites UK ethics committees
which he set up in 1995—forced their way into the premises. Some staff and clients locked themselves in back offices for several hours and the clinic was forced to close. People phoning the IFPA were told by the protesters that they could not talk to anyone in the clinic as they were murderers. After the injunctions were issued, YD which is the most hard-line of the Irish antiabortion groups, said it will ignore the injunctions warning that there would be “a few surprises” in the next month and claiming that “something big is about to happen”. It has been reported that YD has received money from American antiabortion groups but this is the first time an American group has taken part in a protest in Ireland. Mahony is one of the most high profile antiabortion protesters in the USA. In the early 1990s, when he was spokesman for the antiabortion group Operation Rescue, he tried to dispel the “myth that we’re clinic bombers or fringe radicals”.
arch 12 saw the first attempt to create a national body to bring together and advise research ethics committees in the UK. It was marked by the first annual general meeting of the Association of Research Ethics Committees in London. Research ethics committees in the UK have sprung up largely independently during the past two decades and it has become apparent that there would be advantages to forming a single national body. Richard Nicholson, editor of the Bulletin of Medical Ethics, encouraged delegates at the meeting to adopt an interim constitution in order that the association might be able to form a limited company and apply for charitable status. Some delegates were unhappy with the absence of lay nominees to serve on the AREC inaugural council. But despite this and other reservations, the constitution was adopted almost unanimously. The Association aims to provide training and advice on, for example, how to deal with suspected fraud and misconduct.
Karen Birchard
Sarah Ramsay
M
993