Increased use of coercive procedures and prolonged hospitalization in compulsory admitted psychotic patients, who refuse antipsychotic medication

• Published in: Nordic journal of psychiatry Vol. 74; no. 5; pp. 1 - 326
• Main Authors: Nielsen, Mette Ødegaard, Milting, Kristina, Brandt-Christensen, Anne Mette, Ebdrup, Bjørn H
• Format: Journal Article
• Language: English
• Published: England 03-07-2020
• Subjects: Compulsory hospitalization; coercive measures; psychiatric legislation; forced medication
• ISSN: 0803-9488; 1502-4725
• DOI: 10.1080/08039488.2019.1709220

Current Danish legislation imposes that compulsory admitted psychotic patients have the right to refuse antipsychotic medication, which markedly delays pertinent medical treatment.
In a retrospective, observational cohort study, we analyzed data from a 1-year period on 34 consecutively admitted patients with schizophrenia, who had been compulsory admitted due to need of treatment, or because they were judged to constitute an acute danger to themselves or others. We compared the use of other coercive procedures and hospitalization time.
Twenty-three patients accepted to commence antipsychotic treatment immediately, and 11 patients submitted an official complaint, which significantly delayed initiation of antipsychotic treatment (1 day ±0.9 versus 14 days ±10.1,
 = 0.002). The 11 complaining patients were subjected to 6.8 times more coercive procedures of forced sedative medication compared to the 23 patients without delay (2.7 ± 2.3 episodes versus 0.4 ± 0.7 episodes,
 = 0.007). Moreover, the treatment-delay prolonged duration of hospitalization by a factor 2.3 (73.3 ± 28.3 days versus 31.7 ± 22.0 days,
 < 0.001).
The current legislation intends to preserve patient rights and promote voluntary treatment alliance but may instead lead to prolonged hospitalization and increased use of other coercive measures such as forced sedative medication. Modification of current legislation may therefore be considered.