Stolker J J, Hugenholtz G W K, Heerdink E R, Nijman H L I, Leufkens H G M, Nolen W A
Institute for Pharmaceutical Sciences, Disciplinegroep Farmaco-epidemiologie en Farmacotherapie, Utrecht.
Ned Tijdschr Geneeskd. 2003 Mar 22;147(12):557-61.
To establish the incidence and determinants of seclusion and to gain insights into the use of antipsychotics before and after the seclusion of acutely admitted patients.
Retrospective cohort analysis.
We collected data from a consecutive sample of 996 patients in adult psychiatric admission wards for the period 1997-1999. Secluded patients were compared with non-secluded patients and the correlations between antipsychotic use and seclusion were calculated.
The average age of the 996 patients (507 men and 489 women) was 38.0 years (median: 37.0; range: 16-84). Seclusion was applied in the case of 285 patients (28.6%). Young age (< 30 years), low Global Assessment of Functioning score (< 55), involuntary hospitalisation and bipolar disorder (manic episode) were significantly associated with seclusion. For patients with psychotic disorders who used antipsychotics during the first week, the median time from admission to seclusion was 7 days (in patients not using antipsychotics this was 2.5 days). Furthermore, the use of antipsychotics was, although not significant, associated with a lower risk of seclusion (relative risk: 0.7; 95% CI: 0.5-1.2). In a substantial number of the psychotic patients, antipsychotic treatment was initiated during or shortly after seclusion; they used these drugs more often than psychotic non-secluded patients (relative risk: 2.0; 95% CI: 1.2-3.4).
The use of antipsychotics is associated with a later application of seclusion as well as its possible delay. For a considerable number of patients, treatment with antipsychotics was started either during or shortly after seclusion.
确定隔离的发生率及其决定因素，并深入了解急性入院患者隔离前后抗精神病药物的使用情况。
回顾性队列分析。
我们收集了1997 - 1999年期间成人精神科住院病房连续996例患者的数据。将被隔离患者与未被隔离患者进行比较，并计算抗精神病药物使用与隔离之间的相关性。
996例患者（507例男性和489例女性）的平均年龄为38.0岁（中位数：37.0；范围：16 - 84岁）。285例患者（28.6%）接受了隔离。年轻（<30岁）、功能总体评定分数低（<55）、非自愿住院以及双相情感障碍（躁狂发作）与隔离显著相关。对于在第一周使用抗精神病药物的精神障碍患者，从入院到隔离的中位时间为7天（未使用抗精神病药物的患者为2.5天）。此外，抗精神病药物的使用虽然不显著，但与较低的隔离风险相关（相对风险：0.7；95%置信区间：0.5 - 1.2）。在相当数量的精神病患者中，抗精神病药物治疗是在隔离期间或隔离后不久开始的；他们比未被隔离的精神病患者更频繁地使用这些药物（相对风险：2.0；95%置信区间：1.2 - 3.4）。
抗精神病药物的使用与隔离的较晚应用及其可能的延迟有关。对于相当数量的患者，抗精神病药物治疗是在隔离期间或隔离后不久开始的。
