Trajectories of Seclusion and Restraint Use at a State Psychiatric Hospital

Beck, Niels C.; Durrett, Christine; Stinson, Jill D.; Coleman, James C.; Stuve, Paul; Menditto, Anthony A.

doi:10.1176/appi.ps.59.9.1027

Cited by 29 publications

(51 citation statements)

References 16 publications

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“…To prevent seclusion, this might mean improving the level of psychological and social functioning, which could lead to less coercive measures. In line with the findings of Beck et al (2008) and Clarke et al (2010), our study confirms that risk assessments should not only include aggression predictors, but also frequent mental health state assessments performed throughout the entire admission period.…”

Section: Dynamic Factorssupporting

confidence: 87%

Association between short‐term structured risk assessment outcomes and seclusion

Sande

Noorthoorn

Wierdsma³

et al. 2013

Int J Mental Health Nurs

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Research findings indicate that the symptoms and behaviour of acute psychiatric patients can fluctuate drastically within hours, and that structured daily risk assessments can reduce the risk of aggressive incidents and the duration of seclusion. The aim of this study was to investigate the validity of two structured observation tools, the Brøset Violence Checklist (BVC) and the Kennedy Axis V), as an aid in seclusion-related clinical decision-making. In this study, 7403 day-to-day risk assessments were collected over 10 725 admission days (72% of the maximum number of structured assessments). A total of 7055 daily assessment scores from 301 acute psychiatric patients were used for the multilevel analysis. The sample demonstrated that dynamic and static factors were related to seclusion. Dynamic factors included dysfunctional scores on the item 'confusion' of the Brøset Violence Checklist, and psychological impairment and impairment of social skills on the Kennedy Axis V. Static factors included non-Western descent, male sex, age less than 35 years, unmarried, and to some extent, a personality disorder. McFadden's pseudo R(2) value showed that most of the final model was related to the dynamic factors. We concluded that the incorporation of the BVC and the Kennedy Axis V into standard practice was helpful in identifying patients at high risk of seclusion.

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Section: Dynamic Factorssupporting

confidence: 87%

Association between short‐term structured risk assessment outcomes and seclusion

Sande

Noorthoorn

Wierdsma³

et al. 2013

Int J Mental Health Nurs

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“…For example, Beck et al found discrete seclusion restraint trajectories in a state psychiatric hospital and recommended developing specific interventions for the high-trajectory class, while also considering modifications in treatment for low-risk patients. 23 In another study, 48 out of 155 adolescent females in an RTC accounted for 76% of the restraints. 22 Thus, a small subgroup of youth contribute to the majority of seclusion/restraint.…”

Section: Discussionmentioning

confidence: 96%

“…21 Similar methods used by other investigators have demonstrated that this categorization resulted in distinct seclusion/restraint trajectories. 22,23 …”

Section: Methodsmentioning

confidence: 99%

Antipsychotic Treatment Patterns and Aggressive Behavior Among Adolescents in Residential Facilities

Miller

Riddle

Pruitt

et al. 2013

J Behav Health Serv Res

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This study examined the association between acute aggressive behavior patterns of 145 adolescents in residential treatment facilities with use of and changes in antipsychotic medication for the chronic management of aggression. Seclusion/restraint (S/R) frequency over 12 months was used to categorize youth into none, low, moderate, and high S/R groups. Data were analyzed using longitudinal mixed effects logistic regression models that allowed for intra-subject variability over time. The high and moderate S/R groups were significantly more likely to receive antipsychotics, get higher doses, and have changes in medication compared with the none S/R group. Increases in antipsychotic dose were associated with a lower likelihood of changes in antipsychotic medication over time. Despite persistent antipsychotic use at higher doses, youth in the high and moderate S/R groups continued to be secluded/restrained frequently. The findings question the adequacy of these medications in managing aggressive behavior.

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“…It is possible that gender differences in the clinical presentation, and biological correlates of severe mental illness may result in a different use of coercive measures during the acute phases of psychiatric disorders and in hospitalizations for men and women [41,42]. Studies have found that physical restraint was used more often with male patients, while forced medication and seclusion was used more often with female patients [41].…”

Section: Introductionmentioning

confidence: 99%

“…Male gender is also associated with higher rates of seclusion [43], restraint [44] and psychiatric intensive care [45]. Other studies have found that physical restraint was more often used with females [42] and female patients were more frequently secluded than their male counterparts [46]. No gender differences in the use of mechanical restraint have been found in studies conducted in the USA [47], or Finland, where all the forms of coercive measures studied were equally commonly applied to male and female patients [48,49].…”

Section: Introductionmentioning

confidence: 99%

Gender differences in coerced patients with schizophrenia

et al. 2013

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BackgroundDespite the recent increase of research interest in involuntary treatment and the use of coercive measures, gender differences among coerced schizophrenia patients still remain understudied. It is well recognized that there are gender differences both in biological correlates and clinical presentations in schizophrenia, which is one of the most common diagnoses among patients who are treated against their will. The extent to which these differences may result in a difference in the use of coercive measures for men and women during the acute phase of the disease has not been studied.Methods291 male and 231 female coerced patients with schizophrenia were included in this study, which utilized data gathered by the EUNOMIA project (European Evaluation of Coercion in Psychiatry and Harmonization of Best Clinical Practice) and was carried out as a multi-centre prospective cohort study at 13 centers in 12 European countries. Sociodemographic and clinical characteristics, social functioning and aggressive behavior in patients who received any form of coercive measure (seclusion and/or forced medication and/or physical restraint) during their hospital stay were assessed.ResultsWhen compared to the non-coerced inpatient population, there was no difference in sociodemographic or clinical characteristics across either gender. However coerced female patients did show a worse social functioning than their coerced male counterparts, a finding which contrasts with the non-coerced inpatient population. Moreover, patterns of aggressive behavior were different between men and women, such that women exhibited aggressive behavior more frequently, but men committed severe aggressive acts more frequently. Staff used forced medication in women more frequently and physical restraint and seclusion more frequently with men.ConclusionsResults of this study point towards a higher threshold of aggressive behavior the treatment of women with coercive measures. This may be because less serious aggressive actions trigger the application of coercive measures in men. Moreover coerced women showed diminished social functioning, and more importantly more severe symptoms from the “excitement/hostile” cluster in contrast to coerced men. National and international recommendation on coercive treatment practices should include appropriate consideration of the evidence of gender differences in clinical presentation and aggressive behaviors found in inpatient populations.

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Trajectories of Seclusion and Restraint Use at a State Psychiatric Hospital

Abstract: These findings have implications for clinical and administrative decision makers with regard to assigning new admissions to appropriate security levels, targeting patients with specialized treatment interventions, and moving low-risk patients into less restrictive treatment environments.

Cited by 29 publications

References 16 publications

Association between short‐term structured risk assessment outcomes and seclusion

Association between short‐term structured risk assessment outcomes and seclusion

Antipsychotic Treatment Patterns and Aggressive Behavior Among Adolescents in Residential Facilities

Gender differences in coerced patients with schizophrenia

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