The prevention of deep venous thrombosis in physically restrained patients with schizophrenia.
BACKGROUND
Physical restraint and seclusion are associated with several risks. Antipsychotic drug use increases this risk.


OBJECTIVE
To evaluate whether the risk of thromboembolism in physical restraint and seclusion of patients with psychosis, treated with antipsychotic medication, was considered by taking preventive measures.


METHODS
Anonymous data on all consecutively admitted patients with schizophrenia, treated with antipsychotic medication, between 2002 and 2009, were analysed. Diagnostic information and data about seclusion procedures and medication were collected. Preventive measures of thromboembolism in patients in physical restraint were assessed by reviewing case notes and the medication prescribed at the time of seclusion.


RESULTS
Seclusion of patients with psychosis is common. Out of 679 identified patients, 170 had been secluded (472 events). Physical restraint use was not a rare event (N seclusions with restraint use 296, 62.7%). Pharmacological preventive measures (use of heparine drugs) were taken frequently to prevent deep vein thrombosis (DVT) by physical restraint or isolation. Sixty-five (38.2%) out of 170 secluded patients, including a majority of patients who had been under physical restraint, had been administered anticoagulants at the time of seclusion. No cases of DVT occurred.


CONCLUSIONS
Preventive measures were routinely administered in clinical practice and were effective in the prevention of DVT. For a clinical setting, it is important to establish a clear and detailed management plan on seclusion and fixation taken into account in all possible risks of physical restraint.
De Hert
M
M
University Psychiatric Center Catholic University, Campus Kortenberg, Kortenberg, Belgium. marc.de.hert@uckortenberg.be
Einfinger
G
G
Scherpenberg
E
E
Wampers
M
M
Peuskens
J
J
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000009:adverse effects*; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D012149:Restraint, Physical / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012559:Schizophrenia / Q000150:complications / Q000188:drug therapy*; D012934:Social Isolation; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants; D014150:Antipsychotic Agents; D006495:Heparin, Low-Molecular-Weight