BackgroundRestraint or seclusion measures in acute psychiatric care are used as a last resort when all other methods for removal of physical threat have failed. The purpose of this study is to find a correlation between coercive measures, demographic characteristics within this patient group, and factors associated with shortened periods of restriction.MethodsThis is a one-year retrospective study conducted in a male acute closed ward of a psychiatric hospital in Israel. The data from January 1, 2014 to December 31, 2014 were retrieved from the records of patients who underwent restraint and/or seclusion interventions during this period. The analyzed data included age, psychiatric diagnosis, marital status, education, race, ethnicity, length of hospital stay, legal status during admission, type of coercive measure (mechanical restraint, seclusion), number and duration of coercive episodes, reasons for coercion, time of event, number of previous hospitalizations, aggression in past and present treatment, and treatment during events.ResultsDuring this time period, there were 563 admissions in the study ward. Over this period, 176 subjects (31.3%) underwent 488 restraints and/or seclusions. 98% were aggressive in the past. (Although some results reached statistical significance, we prefer to emphasize here only the most important results, while the others will be presented in the text.) Patients with personality disorders were physically limited for the longest time, while schizophrenia patients were restricted for the shortest time compared with other diagnoses (p = 0.007). A negative correlation was found between the length of coercion and the number of academic female nurses on duty (p = 0.005), as well as the administration of sedative medications during the restricting procedure.ConclusionsWe believe that the presence of registered, academic female nurses on duty and medication administration during coercive measures can reduce the length of restriction.

We extensively reviewed the medical records of violent patients restrained in a locked psychiatric ward of a university-based hospital for 6 years (1980-1985). A total of 551 patients were restrained at least once during hospitalization, of which 186 patients had affective disorders and 365 had nonaffective psychiatric illnesses. While the number of restrained nonaffective patients was constant throughout the year, the number of restrained affective patients showed a circannual rhythm with nadirs in May and November and peaks in June and December. This pattern of restraints correlated to changes in the length of daily sunlight (photoperiod). These results suggest that the aggressiveness of patients with affective disorders correlates with photoperiod duration and that the aggressiveness of patients with nonaffective disorders does not correlate with photoperiod.