Prospective study of patients' refusal of antipsychotic medication under a physician discretion review procedure.
OBJECTIVE
The authors examined the refusal of antipsychotic medications and associated outcomes prospectively in a group of 348 psychiatric patients admitted to three acute inpatient units in a state-operated mental health facility in Virginia where psychiatrists have the discretionary power to administer treatment over patients' objections.


METHODS
Newly admitted patients were administered both a questionnaire to ascertain their attitudes toward admission and the Brief Psychiatric Rating Scale (BPRS). Patients who refused antipsychotic medication were identified, and data were collected on the length of refusal and whether the refusal episode was terminated voluntarily or involuntarily. A group of patients compliant with antipsychotic medication was selected for comparison on outcome measures, including the rate of seclusion and restraint and length of hospitalization.


RESULTS
Patients who refused treatment were found to have significantly higher BPRS scores than were patients who complied with antipsychotic treatment and more negative attitudes toward hospitalization and past, present, and future treatment. Refusal episodes were brief, on average 2.8 days, and all patients, who refused treatment were treated. When compared with the compliant patients, patients who refused treatment were more likely to be assaultive, were more likely to require seclusion and restraint, and had longer hospitalizations.


CONCLUSIONS
Psychiatrists exercised their discretion to promptly treat all patients who refused treatment. Nonetheless, these patients suffered more morbidity than compliant patients. This study suggests that the negative sequelae of in-hospital treatment refusal cannot be eliminated by rapid treatment. The policy implications are discussed.
Kasper
J A
JA
Institute of Law, Psychiatry, and Public Policy, University of Virginia School of Law, Charlottesville 22903, USA.
Hoge
S K
SK
Feucht-Haviar
T
T
Cortina
J
J
Cohen
B
B
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001294:Attitude to Health; D005260:Female; D006291:Health Policy; D006760:Hospitalization; D006778:Hospitals, Psychiatric; D006783:Hospitals, State; D006801:Humans; D008297:Male; D016743:Mental Competency / Q000331:legislation & jurisprudence; D001523:Mental Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D028642:Persons with Psychiatric Disorders; D010344:Patient Advocacy / Q000331:legislation & jurisprudence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D016312:Treatment Refusal / Q000331:legislation & jurisprudence*; D014768:Virginia
D014150:Antipsychotic Agents