• Vol. 34 No. 1, 134–136
  • 15 January 2005

Legal Issues in the Treatment of a Violent Manic Patient in a Non-Gazetted Setting: A Case Report

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ABSTRACT

Introduction: Psychiatrists in non-gazetted treatment settings, like psychiatric wards in restructured general hospitals and private hospitals, face a major problem when psychiatric patients who require admission are either not competent or refuse to consent to admission and treatment, although they are clearly in need of such inpatient management. Admission to the state mental hospital is often refused by their relatives for a number of reasons, like the stigma attached to admission to such a hospital, and the fear that future employment prospects might be affected. Clinical Picture: Mr X, a manic, violent patient, had no insight into his disorder and refused admission and treatment for his manic episode. He was the head of a large corporation, and his relatives were apprehensive he would make decisions that could jeopardize the company. Treatment: He refused oral medication, could not tolerate parenteral haloperidol and had lithium nephrotoxicity. Inpatient electroconvulsive therapy had to be administered, after which he responded satisfactorily. Conclusion: The legal implications in this case, like consent for treatment and admission, and ethical issues, are discussed.


Mr X, a 68-year-old Indian, was the chairman of a big corporation. He had had a history of bipolar disorder for the past 40 years, with an episode of depression and mania that started 40 years ago, and then 3 episodes of mania in the past 6 years. About 2 months prior to admission, he had a coronary bypass operation. The postoperative period was uneventful and he remained well till a week prior to admission when he started to have a relapse of mania because of non-compliance with regard to medication. Mr X became very agitated and irritable, and developed a sudden violent aversion to his previous psychiatrist whom he felt had labelled him falsely, as he believed himself to be well and not of unsound mind. In his manic state, he feverishly carried out several transactions involving large sums of money

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