[When is psychosis dangerous? Ethical, professional en juridical considerations concerning psychosis and coercion in Belgium].
BACKGROUND
In Belgium a patient can only be compulsorily admitted to a psychiatric hospital if he is a danger to himself or others (law concerning coercion in Belgium, 26/06/1990).


OBJECTIVE
To explore the relationship between psychosis and danger, and to analyse the various interpretations of the 'dangerousness' criterion in the context of psychotic disorders and the underlying ethical positions.


METHODS
We studied the literature by means of PubMed, PsycINFO, manuals and references and used the search terms: 'coercion', 'commitment of mentally ill', 'dangerous behaviour', and 'psychotic disorders'. results The correlation between psychosis and danger is limited but is strengthened by comorbid substance abuse and non-compliance. The clinical assessment of danger does not have a firm scientific basis. The underlying ethical position determines when danger is regarded as being serious enough to justify coercion.


CONCLUSIONS
Danger is a problematical criterion for coercion. We propose a model that weighs up the likelihood of danger against the expected pros and contrasts of coercion and the extent to which the disorder can be treated. The fluid nature of the 'dangerousness' criterion and the principle of proportionality call for a more varied arsenal of coercive measures which are less drastic than compulsory admission.
Verbrugghe
A
A
Universitair CGG Leuven, CGG-VBO.
Nys
H
H
Vandenberghe
J
J
D001530:Belgium; D003068:Coercion; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence*; D003617:Dangerous Behavior; D003657:Decision Making; D004992:Ethics, Medical; D006801:Humans; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D012307:Risk Factors