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Compulsory admissions and preferences in decision-making in patients with psychotic and bipolar disorders

  • Inés Morán-SánchezEmail author
  • María A. Bernal-López
  • Maria D. Pérez-Cárceles
Original Paper

Abstract

Purpose

Participation in medical decisions and taking into account patients’ values and preferences are especially important for psychiatric patients who may be treated against their will. The increasing rates of coercive measures and the underlying clinical, ethical, and legal issues highlight the need to examine their use in psychiatry. Although limited congruence in decision-making preferences may be on the basis of these coercive practices, this issue has not been adequately addressed. We explore the relationship between compulsory admissions and congruence in decision-making preferences in mental health settings.

Methods

Cross-sectional study among 107 outpatients with DSM diagnoses of schizophrenia of bipolar disorder using the Control Preference Scale to assess congruence in decision-making experienced and preferred style. History of compulsory admissions was obtained through review of available records. Descriptive statistics and multivariate analyses were used.

Results

70% of patients reported experiencing their preferred style of decision-making and 44% patients had history of compulsory admissions. These patients were more autonomous and preferred to take a more active role. The degree of congruence was lower in patients with previous compulsory admissions. The best predictors of compulsory admissions were not having a regular doctor and the unmatched participation preferences.

Conclusions

Patients who experienced a different level of participation in decision-making than desired more frequently had compulsory admissions. We propose to assess participation preferences each time a relevant treatment decision is about to be made and tailor care accordingly. We identified several factors leading to compulsory admissions that can be modified to prevent further coercive measures.

Keywords

Coercion Patient admissions Risk factors Psychiatry Decision-making Patient participation 

Notes

Acknowledgements

We would like to thank everyone who participated in the study and Dr Ibañez-López and Dra Ruiz-Merino for their statistical advice.

Compliance with ethical standards

All authors declare that the submitted work has not been published before and that the work is not under consideration for publication elsewhere.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

This study has been approved by the ethics committee of our referral hospital and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Spanish laws have been observed, too.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Mental Health CentreHealth Service of Murcia, CSM CartagenaMurciaSpain
  2. 2.Department of Legal and Forensic Medicine, Faculty of MedicineBiomedical Research Institute (IMIB), Regional Campus of International Excellence “Campus Mare Nostrum”, University of MurciaMurciaSpain

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