Patients' perception of coercion with respect to antipsychotic treatment of psychotic disorders and its predictors

Treatment without consent in adult psychiatry inpatient units: a retrospective study on predictive factors

Background

Coercion is one of the most important challenges in mental health. In Switzerland, forced medication can be applied during an emergency (Art. 435 of the Civil Code) or over a longer period in case of endangerment of others or oneself (Art. 434). We aimed to analyze the predictors of this specific treatment without consent.

Methods

Forced medication prescriptions in the Division of Adult Psychiatry of the Geneva University Hospitals between 2018 and 2021 were retrospectively analyzed. Medication under Article 434 was the main outcome variable. Age, gender, admission mode, main diagnosis, and the Health of the Nation Outcome Scales (HoNOS) score at admission were considered as potential predictors. T-test and Pearson's chi-square test were used to compare continuous and categorical variables. A logistic regression was performed to find significant predictors of forced medication.

Results

Seventy-one out of 4,326 inpatients were subjected to forced medication under Art. 434. HoNOS global scores at admission were not significantly different in the forced medication group compared to the control group. Aggressive behavior was lower in the former at the univariate level. Forced medication was associated at the multivariate level with female gender, involuntary admission, and psychosis.

Conclusion

Women suffering from psychosis are more at risk of receiving involuntary and repeated medication. The risk of deterioration in psychosocial functioning or behavioral disorganization seems to be the main argument for this coercive measure. Future studies should focus on the patient's perception of this coercion to prevent it and improve adherence to care. Follow-up after discharge might be useful to evaluate a long-term benefit.

An update on recently approved long-acting injectable second-generation antipsychotics: Knowns and unknowns regarding their use

There are now 9 available FDA-approved second-generation long-acting injectable antipsychotics including aripiprazole (3), olanzapine (1), paliperidone (3), and risperidone (2). These high-cost medications are commonly used with the goal of improving adherence and patient outcomes. With almost 2 decades of use, key aspects have been well studied, including population pharmacokinetics, CYP interactions and various clinical and economic outcomes. However, there are still unknowns with these medications. Issues including adherence, transition from oral antipsychotics, renal dosing, pharmacogenomics, and managing missed doses will be addressed in the context of 4 patient cases.

Development and Validation of the Psychiatric Inpatient Experience (PIX) Survey: A Novel Measure of Patient Experience Quality Improvement

Objective: Managing patient experience is critical in transforming organizational cultures into high-quality patient-centered care systems. Patient experience measurement should ideally entail a framework for understanding a patient's interactions and perceptions across the continuum of care. The purpose of this study was to develop a psychometrically valid survey via a rigorous measurement development and validation process. Methods: An initial 28-item, five-domain survey with 2 additional open-ended prompts for narrative feedback was developed and piloted using exploratory and confirmatory factor analyses on a sample of 2438 individuals. A thematic analysis was subsequently performed based on the open-ended items to elucidate primary and secondary themes of patients’ narrative feedback. Results were used to further inform a conceptual framework and item design. Results: Factor analyses produced 4 factors (treatment team relationships, nursing team presence, treatment effectiveness, and healing environment). These 4 factors are associated with inpatient psychiatric patient experience, suggesting validity. Discussion: The Psychiatric Inpatient Experience (PIX) ysurvey integrates patient experience theory as well as aspects of patient-centered care that are important to psychiatric inpatients. It provides organization and discipline-specific feedback to facilitate opportunities for patient experience improvements.