European Psychiatry - Volume 41 - April 2017

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S582 25th European Congress of Psychiatry / European Psychiatry 41S (2017) S521–S582
Clinical case 83 years-old-man with a gastric cancer state IV. Mar-
ried with a woman with Dementia who is waiting for a long stay
public residence. No children. No cognitive damage. Fatal progno-
sis with a need of permanent enteral nutrition, which, he doesn’t
want to use and clinicians strongly recommends. Great anxiety and
suffering. Decision making capacity. Wish to die.
Discussion Patients with the capacity to make medical decisions
can refuse medical care even if this refusal results in their death.
Sometimes, a “comfort measures only” can be a better option
than trying to keep life. Old people with no family are often less
informed and taken in count in making decisions. A symptom
management, good patient-clinicians communication, psychoso-
cial, spiritual, and practical support and respecting patient’s wishes
and decisions is a main goal in any medical care.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV0546
Defensive psychiatry. An ethical
perspective
A. Riolo , F. Babici , F. Tassi ∗
ASS 1 Triestina, Department of Mental Health, Trieste, Italy
∗ Corresponding author.
Introduction The legal dispute between doctors and patients
is increasing. The “frivolous lawsuit” is spreading and the psy-
chiatrist is being dragged to court in the dock. Guidelines and
operational protocols become the bastions of the defensive psychi-
atry. Defensive psychiatry involves, for example, a larger number
of hospitalizations, also involuntary admissions, and psycopharma-
cological prescriptions.
Objectives We want to see if the issue of defensive psychiatry is
perceived by psychiatrists as a risk in their clinical practices and
what consequences may result in the relationship with the patient.
Methods Through an audit and through a literature review get to
define the defensive psychiatry.
Conclusions Though there is much confusions and uncertainty in
this field, the defensive psychiatry distorts the relationship with
the patients and proposes the questions of social control.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV0547
Whose insight is it anyway?
M. Sewell ∗, V. Mondello , T. Styles , D. Paul ,
D. Vecchio
1 Peel and Rockingham Kwinana Mental Health Service, WA, USA
2 Aboriginal Health School of Medicine Fremantle, University of Notre
Dame, USA
3 Fiona Stansley Hospital, WA, USA
4 Metropolitan Health Service, WA, USA
∗ Corresponding author.
Introduction There is little research comparing patients’ views
with those of their treating psychiatrists. In a survey of patients’
views conducted in 1993 for MIND (UK) by Rogers, Pilgrim
and Lacey only 10% saw their problems in terms of mental ill-
ness. This highlights the tension between psychiatric codifications
of mental abnormalities and explanations provided by patients
themselves.
Aims This pilot project explores the perceptions of mental health
issues in patients and their psychiatrists in a regional Western Aus-
tralian setting.
Methods A mixed methods approach including semi-structured
interviews of patients and their treating psychiatrists. Recruiting
5 consecutive people in the categories of involuntary in-patients,
voluntary in-patients, patients on CTO, community patients and
their psychiatrists.
Questions asked of the patients were:
– Why are you here?
– What problems do you have?
– What can be done?
– What control do you have?
– What control do other people have?
Psychiatrists were asked similar questions. Responses were
recorded, transcribed and thematically analyzed to reveal key
themes. Quotations are used to illustrate points participantswished
to make.
Results We report on differences in understanding in both
groups. This study reveals areas for further enquiry.
Conclusions Considerable diversity is revealed. A key conclusion
is that insight is a concept relevant both for treated and treating.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.