Sociodemographic, Circumstantial, and Psychopathological Predictors of Involuntary Admission of Patients with Acute Psychosis

Abstract

Studies have consistently determined that patients with acute psychosis are more likely to be involuntarily admitted, although few studies examine specific risk factors of involuntary admission (IA) among this patient group. Data from all patients presenting in the psychiatric emergency department (PED) over a period of one year were extracted. Acute psychosis was identified using specific diagnostic criteria. Predictors of IA were determined using logistic regression analysis. Out of 2533 emergency consultations, 597 patients presented with symptoms of acute psychosis, of whom 118 were involuntarily admitted (19.8%). Involuntarily admitted patients were more likely to arrive via police escort (odds ratio (OR) 10.94) or ambulance (OR 2.95), live in a psychiatric residency/nursing home (OR 2.76), report non-adherence to medication (OR 2.39), and were less likely to suffer from (comorbid) substance abuse (OR 0.53). Use of mechanical restraint was significantly associated with IA (OR 13.31). Among psychopathological aspects, aggressiveness was related to the highest risk of IA (OR 6.18), followed by suicidal intent (OR 5.54), disorientation (OR 4.66), tangential thinking (OR 3.95), and suspiciousness (OR 2.80). Patients stating fears were less likely to be involuntarily admitted (OR 0.25). By understanding the surrounding influencing factors, patient care can be improved with the aim of reducing the use of coercion.

Clinical and sociodemographic predictors of inpatient admission after presentation in a psychiatric emergency room: an observational study

“…2580 patients sought consultation at MHH’s PER in the year 2022. The number of patients presenting at the MHH’s PER per year seem to be stable, as a similar number of consultations was found by Seifert et al [ 27 ] in the year 2019/2020 and Ziegenbein et al [ 26 ] in 2002 (mean 2607, SD 26). Out of the 2387 consultations included in the analysis, 1300 of the cases (54.5%) resulted in subsequent IPA, indicating a very similar admission rate as found by Ziegenbein et al [ 26 ] at the same hospital twenty years prior.…”

“…Similar to Seifert et al [ 27 ], cases in which a psychopathological item appeared to be present but could not be verified with certainty, e.g., because of the patient being uncooperative, the item was classified as “being present”. If negated or no indication on the PPA-item could be found, it was not selected.…”

“…In Hannover and surrounding areas, Hannover Medical school (German: Medizinische Hochschule Hannover, MHH) provides service to about 138,500 inhabitants and represents one of four psychiatric hospitals [ 27 ]. Among these, the MHH has the only PER which also has on-site access to other disciplines such as internal medicine, neurology and gynecology that are also represented in the central emergency department.…”

Psychiatric inpatient services in Ontario, 2019–2021: a cross-sectional comparison of admissions, diagnoses and acuity during the COVID-19 prerestriction, restriction and postrestriction periods

“…Furthermore, increased rates of psychosis and mania [12][13][14] and suicidal behaviour 9,10 suggest increased acuity of the admission population, which is important information for planning clinical services (e.g., staffing ratios, skill sets, interventions). Evidence of increased involuntary admissions 6,15-17 also suggests an added burden to hospitals given their association with acute illness and aggression, 18,19 longer stays, readmissions 20 and use of restraints. 21 In Ontario, Canada, rates of admission to psychiatric hospitals for psychotic and substance-related disorders approximated prerestriction levels by the time initial COVID-19 restrictions were eased, in June 2020.…”