[Seclusion of admitted psychotic patients: later in the case of antipsychotic use and also possibly less often].
OBJECTIVE
To establish the incidence and determinants of seclusion and to gain insights into the use of antipsychotics before and after the seclusion of acutely admitted patients.


METHODS
Retrospective cohort analysis.


METHODS
We collected data from a consecutive sample of 996 patients in adult psychiatric admission wards for the period 1997-1999. Secluded patients were compared with non-secluded patients and the correlations between antipsychotic use and seclusion were calculated.


RESULTS
The average age of the 996 patients (507 men and 489 women) was 38.0 years (median: 37.0; range: 16-84). Seclusion was applied in the case of 285 patients (28.6%). Young age (< 30 years), low Global Assessment of Functioning score (< 55), involuntary hospitalisation and bipolar disorder (manic episode) were significantly associated with seclusion. For patients with psychotic disorders who used antipsychotics during the first week, the median time from admission to seclusion was 7 days (in patients not using antipsychotics this was 2.5 days). Furthermore, the use of antipsychotics was, although not significant, associated with a lower risk of seclusion (relative risk: 0.7; 95% CI: 0.5-1.2). In a substantial number of the psychotic patients, antipsychotic treatment was initiated during or shortly after seclusion; they used these drugs more often than psychotic non-secluded patients (relative risk: 2.0; 95% CI: 1.2-3.4).


CONCLUSIONS
The use of antipsychotics is associated with a later application of seclusion as well as its possible delay. For a considerable number of patients, treatment with antipsychotics was started either during or shortly after seclusion.
Stolker
J J
JJ
Institute for Pharmaceutical Sciences, Disciplinegroep Farmaco-epidemiologie en Farmacotherapie, Utrecht. j.stolker@altrecht.nl
Hugenholtz
G W K
GW
Heerdink
E R
ER
Nijman
H L I
HL
Leufkens
H G M
HG
Nolen
W A
WA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy / Q000628:therapy*; D008875:Middle Aged; D010356:Patient Isolation / Q000523:psychology* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors
D014150:Antipsychotic Agents
Separatie van opgenomen psychotische patiënten: later bij gebruik van antipsychotica en mogelijk ook minder vaak.