Seclusion and restraint in patients with schizophrenia: clinical and biographical correlates.
Seclusion and restraint represent adverse experiences that cause negative attitudes against psychiatric treatment and psychopathologic sequels such as posttraumatic stress disorder. We examined 117 consecutive admissions with schizophrenia, with an average of 8.7 previous admissions. Positive and Negative Syndrome Scale and Global Assessment of Functioning were obtained at admission and discharge, and traumatic events in the biography were recorded using the Posttraumatic Diagnostic Scale. Twenty-four men (42.9%) and 18 women (29.0%) had experienced seclusion or restraint in their psychiatric history. Seclusion or restraint during the present admission was best predicted in a logistic regression model by physical aggressive behavior [odds ratio (OR), 11.5] and the Positive and Negative Syndrome Scale hostility item at admission (OR, 23.6). Seclusion or restraint ever in the psychiatric history, however, was mostly associated with lifetime exposure to life-threatening traumatic events (OR, 7.2). We conclude that exposure to traumatic events in the biography severely enhances the risk of revictimization and retraumatization during inpatient treatment.
Steinert
Tilman
T
Department of Psychotherapy, Center for Psychiatry Weissenau, Department of Psychiatry I, University of Ulm, Ulm, Germany. tilman.steinert@zfp-weissenau.de
Bergbauer
Gabriele
G
Schmid
Peter
P
Gebhardt
Ralf Peter
RP
D000328:Adult; D000374:Aggression / Q000523:psychology; D005260:Female; D006760:Hospitalization; D006791:Hostility; D006801:Humans; D038801:International Classification of Diseases / Q000706:statistics & numerical data; D008016:Life Change Events; D016015:Logistic Models; D008297:Male; D008960:Models, Psychological; D010359:Patient Readmission; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012008:Recurrence; D012149:Restraint, Physical / Q000523:psychology*; D012307:Risk Factors; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology; D012934:Social Isolation / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000523:psychology