J Psychiatr Pract. 2022 Nov 1;28(6):454-464. doi: 10.1097/PRA.0000000000000665.
To determine the relationships, if any, between use of seclusion and restraint and factors such as demographic parameters, diagnosis, legal admission status (voluntary or involuntary), symptoms, cognitive function, global functioning, therapeutic alliance, attitudes toward medication, and insight, among psychiatry inpatients in Ireland.
We used validated tools to perform detailed assessments of 107 adult psychiatry inpatients admitted to acute psychiatry units at 2 general hospitals in Dublin, Ireland over a 30-month period, between September 2017 and February 2020.
The most common diagnoses in our sample were affective disorders (46.7%), schizophrenia and related disorders (27.1%), and personality and behavioral disorders (11.2%). Over a quarter (n=29, 27.1%) of the participating patients had involuntary legal status. Of the 107 patients, 11 patients (10.3%) experienced sedation and/or physical restraint, with 9 patients (8.4%) experiencing at least 1 episode of seclusion and 10 patients (9.3%) experiencing at least 1 episode of physical restraint. On the basis of multivariable analyses, seclusion was associated with younger age and involuntary status, while physical restraint was associated with involuntary status. Each multivariable model explained just over one third of the variance in the distribution of these seclusion and restraint practices.
Use of seclusion and restraint was most strongly associated with involuntary admission status and, in the case of seclusion, younger age, rather than sex, diagnosis, symptoms, cognitive function, global functioning, therapeutic alliance, attitudes toward medication, or insight. The network of interactions between involuntary status and use of seclusion and restraint merits much closer attention, especially as use of seclusion and physical restraint appears to be associated with involuntary legal status independent of level of symptoms, therapeutic alliance, or insight.
确定在爱尔兰精神病住院患者中，使用约束和隔离与人口统计学参数、诊断、法律入院状态（自愿或非自愿）、症状、认知功能、总体功能、治疗联盟、对药物的态度和洞察力等因素之间是否存在关系。
我们使用经过验证的工具，对 2017 年 9 月至 2020 年 2 月期间在爱尔兰都柏林的 2 家综合医院的急性精神病病房住院的 107 名成年精神病住院患者进行了详细评估，这些患者均来自于急性精神病病房。
我们样本中最常见的诊断是情感障碍（46.7%）、精神分裂症及相关障碍（27.1%）和人格及行为障碍（11.2%）。超过四分之一（n=29，27.1%）的参与患者具有非自愿的法律地位。在 107 名患者中，有 11 名患者（10.3%）经历了镇静和/或身体约束，其中 9 名患者（8.4%）经历了至少 1 次隔离，10 名患者（9.3%）经历了至少 1 次身体约束。基于多变量分析，隔离与年龄较小和非自愿状态有关，而身体约束与非自愿状态有关。每个多变量模型仅解释了这些隔离和约束措施分布差异的三分之一以上。
隔离和约束的使用与非自愿入院状态最密切相关，而在隔离的情况下，与年龄较小而非性别、诊断、症状、认知功能、总体功能、治疗联盟、对药物的态度或洞察力相关。非自愿状态与隔离和约束使用之间的相互作用网络值得密切关注，尤其是在隔离和身体约束的使用与非自愿法律状态相关，而与症状、治疗联盟或洞察力无关的情况下。
