Voluntary/Involuntary Admissions/Readmissions of Psychiatric Patients in a University Hospital in Turkey From 2008 to 2016

Abstract

Background:The treatment and hospitalization of psychiatric patients has been a dilemma for many years. Many countries have different specific legislations regarding the hospitalization and treatment of mental patients.Objective: In the current study, 4100 voluntary/involuntary psychiatric admissions and readmissions to a university hospital in Turkey were investigated, and patient groups were compared in terms of demographic variables and psychiatric diagnoses based on DSM IV-TR. Methods: The records of patients who had been hospitalized approximately 4-6 weeks were reviewed by two psychiatrists, and the patients were then divided into groups on the basis of single/multiple admissions and voluntary/involuntary admissions. The groups were compared based on psychiatric diagnoses. Results: Schizophrenia was the most common diagnosis in 71.5% (n = 865) of patients with multiple admissions. The second most common diagnosis was bipolar affective disorder with 13.1% (n = 159). The rate of schizophrenia in both voluntary and involuntary hospitalizations was significant (34.5% and 54.6%, respectively). However, depression, the second most common diagnosis requiring hospitalization with a rate of 23.2% of voluntary hospitalizations, accounted for only 3.7% of involuntary hospitalizations. Conclusion: Males constituted almost 75% of the single admission group. This difference may result from the socioeconomic and cultural profile of Turkey, as mental disorders make marriage impossible and are hidden in females suffering from them. Different findings from different cultures on single/multiple admissions and voluntary/involuntary admissions of patients lead to the conclusion that specific legislation covering treatment or hospitalization for mental disorders is needed in every country.

Socio-demographic and clinical characteristics of adults under involuntary hospitalization in the acute mental health services of Cyprus

“…On this basis, it could be considered that, compared to the past or other countries, the diagnosis of severe mental disorder in Cyprus is taking place at an early stage, and subsequently effective treatment is applied, thus restraining possible cognitive implications of severe mental disorders 47 − 48 . The relationship between education level and involuntary admission and/or readmission for compulsory treatment reported herein is also confirmed by other studies 27 . Previous data show an increased incidence of admissions in high security units for compulsory treatment in those with postgraduate education, and in particular holders of diplomas in vocational specializations 3,29,30,43,45,52,56 . This may suggest that in some countries the majority of mental health service users are integrated into professional specialization programmes, which enables them to acquire vocational skills and further prevent occupational exclusion, social isolation and selfstigmatisation 58 .…”

“…Special focus needs to be given in the sub-group of individuals with psychotic symptoms, and mainly schizophrenia and relevant psychotic disorders. Overall, the present study confirmed previous data which show that those with schizophrenia and relevant psychotic disorders are more often involuntary hospitalized 27−38 . Furthermore, additional emphasis needs to be given on educational programmes in pharmacotherapy and treatment options in order to enhance adherence to therapy, since the main cause of relapse herein as well as internationally seems to be non-adherence to pharmacotherapy 27 − 31,39−40 . As for other risk factors for involuntary admission and subsequent compulsory treatment, male gender has been well documented in international literature 3,[28][29][32][33][34][35][36][37][38][41][42][43][44][45][46][47][48][50][51] . Yet, other studies present data which report increased frequency of compulsory treatment among females 9,30,[52][53]55 .…”

“…Marital status was also identified herein as a risk factor, since singles were more likely to be involuntary admitted at the APH. Indeed, international literature poses singles with no supportive family or social network in increased risk for compulsory treatment 3,9,[29][30]33,[35][36][41][42][43][46][47][52][53]56 .…”