Accumulated coercion and short-term outcome of inpatient psychiatric care

School of Health and Medical Sciences, Psychiatric Research Centre, Orebro University, Orebro, Sweden.
BMC Psychiatry (Impact Factor: 2.21). 06/2010; 10(1):53. DOI: 10.1186/1471-244X-10-53
Source: PubMed

ABSTRACT The knowledge of the impact of coercion on psychiatric treatment outcome is limited. Multiple measures of coercion have been recommended. The aim of the study was to examine the impact of accumulated coercive incidents on short-term outcome of inpatient psychiatric care
233 involuntarily and voluntarily admitted patients were interviewed within five days of admission and at discharge or after maximum three weeks of care. Coercion was measured as number of coercive incidents, i.e. subjectively reported and in the medical files recorded coercive incidents, including legal status and perceived coercion at admission, and recorded and reported coercive measures during treatment. Outcome was measured both as subjective improvement of mental health and as improvement in professionally assessed functioning according to GAF. Logistic regression analyses were performed with patient characteristics and coercive incidents as independent and the two outcome measures as dependent variables
Number of coercive incidents did not predict subjective or assessed improvement. Patients having other diagnoses than psychoses or mood disorders were less likely to be subjectively improved, while a low GAF at admission predicted an improvement in GAF scores
The results indicate that subjectively and professionally assessed mental health short-term outcome of acute psychiatric hospitalisation are not predicted by the amount of subjectively and recorded coercive incidents. Further studies are needed to examine the short- and long-term effects of coercive interventions in psychiatric care.

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    • "In quantitative studies recruitment was accomplished by staff (n = 4) and by researcher (n = 5). Information was missing or imprecise in eight of the quantitative studies [45,47,51-53,57-59]. Voluntary participation was mentioned in one study. "
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    ABSTRACT: Background Despite improvements in psychiatric inpatient care, patient restrictions in psychiatric hospitals are still in use. Studying perceptions among patients who have been secluded or physically restrained during their hospital stay is challenging. We sought to review the methodological and ethical challenges in qualitative and quantitative studies aiming to describe patients’ perceptions of coercive measures, especially seclusion and physical restraints during their hospital stay. Methods Systematic mixed studies review was the study method. Studies reporting patients’ perceptions of coercive measures, especially seclusion and physical restraints during hospital stay were included. Methodological issues such as study design, data collection and recruitment process, participants, sampling, patient refusal or non-participation, and ethical issues such as informed consent process, and approval were synthesized systematically. Electronic searches of CINALH, MEDLINE, PsychINFO and The Cochrane Library (1976-2012) were carried out. Results Out of 846 initial citations, 32 studies were included, 14 qualitative and 18 quantitative studies. A variety of methodological approaches were used, although descriptive and explorative designs were used in most cases. Data were mainly collected in qualitative studies by interviews (n = 13) or in quantitative studies by self-report questionnaires (n = 12). The recruitment process was explained in 59% (n = 19) of the studies. In most cases convenience sampling was used, yet five studies used randomization. Patient’s refusal or non-participation was reported in 37% (n = 11) of studies. Of all studies, 56% (n = 18) had reported undergone an ethical review process in an official board or committee. Respondents were informed and consent was requested in 69% studies (n = 22). Conclusions The use of different study designs made comparison methodologically challenging. The timing of data collection (considering bias and confounding factors) and the reasons for non-participation of eligible participants are likewise methodological challenges, e.g. recommended flow charts could aid the information. Other challenges identified were the recruitment of large and representative samples. Ethical challenges included requesting participants’ informed consent and respecting ethical procedures.
    BMC Psychiatry 06/2014; 14(1):162. DOI:10.1186/1471-244X-14-162 · 2.21 Impact Factor
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    • "That is, although coercive treatments provide the benefit of immediate, therapeutic care in the short-term, their application may inadvertently have negative long-term consequences by alienating patients or fostering reluctance to voluntarily seek treatment in the future (Hiday et al. 1997; Lidz et al. 1995; Monahan et al. 1996). The few studies that have studied the long-term impact of coercion on clinical outcomes, up to one year post-discharge, have not found hypothesized associations between either objective or subjective coercive admission practices and outcomes, including clinician ratings of functioning, selfreported improvement, and medication adherence (Kjellin and Wallsten 2010; Nicholson et al. 1996; Rain et al. 2003; Salize and Dressing 2005). However, based on interviews with 104 patients with schizophrenia spectrum disorders (Swartz et al. 2003), 36 % of psychiatric patients reported that fear of coercive treatment had prevented them from seeking mental health treatment. "
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    ABSTRACT: Consumers' satisfaction with inpatient mental health care is recognized as a key quality indicator that prospectively predicts functional and clinical outcomes. Coercive treatment experience is a frequently cited source of dissatisfaction with inpatient care, yet more research is needed to understand the factors that influence consumers' perceptions of coercion and its effects on satisfaction, including potential "downstream" effects of past coercive events on current treatment satisfaction. The current study examined associations between objective and subjective indices of coercive treatments and patients' satisfaction with care in a psychiatric inpatient sample (N = 240). Lower satisfaction ratings were independently associated with three coercive treatment variables: current involuntary admission, perceived coercion during current admission, and self-reported history of being refused a requested medication. Albeit preliminary, these results document associations between patients' satisfaction ratings and their subjective experiences of coercion during both current and prior hospitalizations.
    Community Mental Health Journal 09/2012; 49(4). DOI:10.1007/s10597-012-9539-5 · 1.03 Impact Factor
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    ABSTRACT: Understanding determinants of antipsychotic medication adherence is critical as nonadherence plays a significant role in psychotic relapse and each relapse contributes to accrued social toxicity and disability. "Insight" or lack thereof and a negative medication attitude are critical variables that have repeatedly been shown to be risk factors for nonadherence. We examine how those risk factors can lead to nonadherence and describe evidence-based interventions to improve nonadherence. We also discuss newer approaches adapted from other branches of medicine that have shown some promise in increasing adherence to antipsychotics, specifically directly-observed-therapy (DOT) and providing financial incentives. Adherence-improving interventions need to be deployed in a stepped-up manner of increasing intensity and tailored to the specific etiologies of nonadherence. ANTIPSYCHOTIC NONADHERENCE Suboptimal adherence to antipsychotic medica-tions plays a major role in determining the frequent relapse and rehospitalization that is characteristic of schizophrenia. Antipsychotic medications are effec-tive in the treatment of acute episodes of psychosis (1) and in the prevention of relapse (2), reducing the risk of relapse in both first-episode (3) and chronic schizophrenia (4) patients. Although estimates of nonadherence vary widely depending on the sample, stage of illness, methodology used to assess adher-ence, and duration of follow-up, a recent review ar-ticle estimated that 41% of schizophrenia patients are nonadherent (5). It is important to note that in-sufficient adherence to medications is a pervasive problem in all of medicine (6). For example, ade-quate 2-year adherence to statins for the secondary prevention of further cardiac events was only 40% in a cohort of elderly patients following an acute coronary syndrome (7), suggesting widespread dif-ficulties adhering to maintenance medication in the general population and not just psychiatric pa-tient populations. However, while patients with schizophrenia share some risk factors for nonad-herence with medical patients (e.g. poor memory) they also pose specific challenges (e.g. lack of insight into illness). Understanding determinants of antipsychotic medication adherence in schizophrenia patients is critical as each psychotic relapse can contribute to ac-crued social toxicity and disability; or as Lieberman and Fenton put it, "untreated psychosis damages lives" (8). In addition to the undisputed social toxic-ity, some have argued that untreated psychosis may have neurotoxic effects (9), although there is currently limited evidence to support this theory and con-founding variables make this difficult to study (10). In this clinical review article, we will examine negative drug attitude and lack of insight as two important clinical risk factors for nonadherence in patients with schizophrenia and review interventions to improve adherence to antipsychotics.
    03/2012; 10(2). DOI:10.1176/appi.focus.10.2.124
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