[Involuntary medication in psychiatry].

OBJECTIVE

A systematic review should take into account epidemiological, clinical, ethical, and legal aspects.

METHOD

Search for literature was performed by Medline and Medpilot, guidelines were obtained via the internet or from own ongoing research projects.

RESULTS

Epidemiological data on the frequency of involuntary medication is only scarcely available. The incidence on psychiatric wards seems to be between 2 % and 8 % of patients, predominantly with schizophrenic or bipolar disorder. In general, the efficacy of involuntary medication has been poorly evaluated in inpatients, two randomised controlled trials from the U. S. are available regarding involuntary outpatient commitment including involuntary medication. Therefore, the empirical database on aspects of clinical safety of involuntary medication is quite small. However, a considerable body of literature exists with respect to patients' opinions on involuntary medication, mostly demonstrating a highly critical attitude. Some European countries already have guidelines, but the overall situation suggests the need for further improvement. In 2004, the EU Council ratified a guideline for future European legislation on involuntary treatment of people with serious mental illness (white paper).

DISCUSSION

A very controversial discussion of former years has become more reasonable, ideological anti-psychiatric criticism being increasingly replaced by search for evidence, development of guidelines, clearer legislation, and a tendency of European harmonization.