Seclusion and the use of antipsychotics in hospitalized psychiatric patients

Abstract

The purpose of this study is to measure the incidence of seclusion, identify possible determinants of seclusion and to gain insight into the use of antipsychotics before and after seclusion in acutely admitted patients. In The Netherlands, special treatment methods including seclusion and involuntary medication may only be applied in involuntarily hospitalized patients in cases of danger to the patient or others, with exclusion of emergencies. Data were retrospectively collected over the years 1997 Á/1999 from a consecutive sample of 996 patients hospitalized on adult psychiatric admission wards. Young age, low Global Assessment of Functioning score, involuntary hospitalization and manic episode were significantly associated with seclusion, applied in 28.6% of the patients. The median time from admission to seclusion among psychotic patients who used antipsychotics during the first week was 7 days. In patients not using antipsychotics this was 2.5 days. In a substantial proportion of the psychotic patients antipsychotic treatment was initiated during or shortly after seclusion with a two times higher risk on antipsychotics in secluded patients compared with nonsecluded patients (relative risk: 2; 95% confidence interval: 1.2 Á/3.4). It was concluded that the use of antipsychotics is associated with a later application of seclusion. In a substantial proportion of the patients, treatment with antipsychotics was initiated during or shortly after seclusion.

From numbers to understanding: The impact of demographic factors on seclusion rates

“…Significant results were found for age, with secluded patients tending to be younger than those who were not secluded. This is consistent with the findings from other research from New Zealand (El‐Badri & Mellsop 2002), the United Kingdom (Morrison & Lehane 1996), Norway (Sorgaard 2004), the Netherlands (Stolker et al. 2005), the United States (Smith et al.…”

“…No research could be located that measured the relationship between HoNOS scores and seclusion. However, Stolker et al. (2005) used the Global Assessment of Functioning Scale to measure social, psychological and occupational function, and found an association between seclusion and lower levels of functioning according to this scale.…”

“…2005). The research findings in relation to diagnosis are very diverse, the work of Stolker et al. (2005) found a higher proportion of secluded consumers had a diagnosis of bipolar disorder, Tunde‐Ayinmode and Little (2004) identified schizophrenia as a predictive factor and van Heeringen et al .…”

Professionals’ Attitudes Toward Reducing Restraint: The Case of Seclusion in The Netherlands

“…Differences in the law mean that countries vary in their use of formal restraint [7,13,28]. In the Netherlands, psychiatrists prefer seclusion to forced medication [26,29]; while in some other countries psychiatrists regard seclusion as the most restrictive intervention [7,[30][31][32][33].…”

Use of seclusion for managing behavioural disturbance in patients

“…One study of almost 1000 in-patients in The Netherlands (Stolker 2005) found a close correlation between scores on the Global Assessment of Functioning (GAF) scale and seclusion. Scores < 55 were correlated with higher seclusion rates, and the lower the score, the stronger the correlation.…”