RESTRAINING MEASURES IN THE PSYCHIATRIC HOSPITAL AND CORRELATIONS WITH DIAGNOSIS AND TREATMENT

RESTRAINING MEASURES IN THE PSYCHIATRIC HOSPITAL AND CORRELATIONS

WITH DIAGNOSIS AND TREATMENT

UNIVERSITY OF MEDICINE AND PHARMACY OF TÎRGU MUREȘ

Author: Alexandra Paula SărmășanCoauthor: Melania Renata Simon

Coordinator: Lect. Adriana Mihai As. Prof. Istvan Zsolt Szasz

Violence is a negative deviation of the healthy behavior; having a multifactorial etiology, numerous risk factors and psycopathological manifestations, the required treatment

measures are both necesary and controversial: the restraining measures.

Restraining measures are representing the restriction of a persons freedom and movement to prevent the free

movement of one arm, both arms, a leg or both legs or to completely immobilize the patient by specific means of

protection to not cause injury.

INTRODUCTION

The purpose of this study was to evaluate the risk of restraint and correlations with diagnosis and treatment of hospitalized

patients in the Acute Psychosis department of Psychiatric Hospital, Tîrgu-Mureș.

OBJECTIVE

We realised a retrospective study based on:

• one year data collection (2014-2015) • sample of 50 patients• demographic data(age, gender, residency) • clinical data(diagnosis, treatment, restraining reasons) • data collection: patient`s medical paper and restaining register • department of acute psychosis of Psychiatry Clinic II of Tîrgu-Mureș

Method of analysis:

• program of data analysis MedCalc• Microsoft Excel

MATERIAL AND METHOD

Gender ratio

RESULTS

60%• 30 Male out of 50 patients

40%• 20 Female out of 50 patients

40%

Rural

Urban

RESULTS

60%

schizophre-nia

22%

al-co-hol

abuse

dis-or-der and

Preponderant diagnosis

brief psychoticdisorder 10%

major depressive disorder 16%

RESULTS

0%

10%

20%

30%

40%

50%

60%

70%

80%Elected drugs

771,4%1

50%

35,7%

RESULTS

Schi

zoph

reni

a

Major

Dep

ress

ive

Disor

der

Alcoh

ol A

buse

Brief p

sych

otic D

isor

der

Diagnosis and medication

Clonazepanum Valproic acid Zopiclonum

RESULTS

Correlation between residency and diagnosis

Schizophrenia Alcohol Abuse Major Depressive Disorder

Brief Psychotic Disorder

Urban N=9 69,23% N=4 44,44% N=2 40% N=3 60%

Rural N=4 30,76% N=5 55,55% N=3 60% N=2 40%

RESULTS

RESULTS

Average:47,65 Medium:43 Maximum: 95 Minimum :19

Subject age

RESULTS

Correlation between restraint and:

Schizophrenia Alcohol Abuse Major Depressive Disorder

Brief Psychotic Disorder

Aggressivebehaviour disorders

P=0,016(significant association)RR = 11,3 (pozitive association)

P=0,68 (insignificant association)RR=0,52(negative association)

P=0,89(insignificant association)RR=1,22(no association)

P=0,89(insignificant association)RR=1,22(no association)

Correlation between male gender, restraint and:

Schizophrenia Alcohol Abuse Major Depressive Disorder

Brief Psychotic Disorder

Aggressive behaviour disorders

P=0,03(significant association)RR=9(pozitive association)

P=0,96 (insignificant association)RR=0,91 (negative association)

P=0,37 (insignificant association)RR=3,66(pozitive association)

P=0,001 (insignificant association)RR=21(pozitive association)

RESULTS

Correlation between female gender, restraint and:

Schizophrenia

Alcohol Abuse Major Depressive Disorder

Brief Psychotic Disorder

Aggressivebehaviour disorders

P=0,009(significant association)RR=14(pozitive association)

P=0,69 (insignificant association)RR=1,83 (no association)

P=0,80 (insignificant association)RR=1,46(no association)

P=0,37 (insignificant association)RR=3,66 (pozitive association)

RESULTS

From a number of 14 diagnosis found in data retrieval, Schizophrenia, Major Depressive Disorders, Alcohol Abuse and Brief Psychotic Disorder are the predominant diagnosis with a prevalence of 22%, 16% and 10%.

We observed that:

• masculine gender prevails with a percentage of 60% (n=30) aged between 22-85 years.

• female gender followed it with a percentage of 40%( n=20 ), aged between 19-75 years.

• a significant number of patients with urban recidency are diagnosed with Schizophrenia, and those with rural recidency are diagnosed with Alcohol Abuse

DISCUSIONS

• an increased restraining risk ratio exists at patients diagnosed with Schizophrenia and aggressive behaviour

disorders

• male patients with Brief Psycotic Disorder and aggressive behaviour disorders had a raising risk ratio of restraining comparative to other diagnosis or manifestation disorders

• female patients with Schizophrenia and Aggressive Behaviour disorders had an significant risk ration

comparative to other diagnosis or associated disorders

DISCUSIONS

The elected drugs were: • Clonazepamum 71.4%• Alprazolamum, Valproic acid and Midazolamum 50%• Diazepamum, and Haloperidolum 35.7%

Also, reviews of specialized literature on restrained patients showed that researches on the subject included demographic and precipitant characteristics, and it had been discovered that younger patients diagnosed with schzophrenia are at a considerable major risk of restraining than patients with other ages and diagnosis.

DISCUSSIONS

We noticed an increased risk of restraint :

1. young male patients

2. urban residency

3. diagnosis of Schizophrenia

4. male patients with Brief Psycotic Disorder

5. female patients with Schizophrenia

6. control treatment is composed of antipsychotic medication like anxiolytics(Clonazepamum, Alprazolamum, Diazepamum) and conventional antipsychotics(Haloperidolum, Zopiclonum)

CONCLUSIONS

1. Legea sănătăţii mintale şi a protecţiei persoanelor cu tulburări psihice nr. 487, 11 iulie 2002/republicata în 9 septembrie 2012)

2. Codul penal, Decretul 313/1980

3. Mihai A., Agresivitatea, o abordare bio-psiho-sociala. Editura Risoprint, 2013, 350-352.

4. Flannery RB Jr1, Walker AP., Characteristics of patients in restraint: fifteen-year analysis of the Assaulted Staff Action Program (ASAP) with EMS implications. Int J Emerg Ment Health. 2008 Summer;10(3):191-6.

5. Wanda K. M., Restraints and the code of ethics: An uneasy fit, Psychiatric Mental Health Nursing, UMDNJ School of Nursing, Stratford, NJ, Published Online: August 07, 2009

6. Hecser L., Ardelean M, Jung H., Psihiatria si medicina legală: elemente correlative, University Press Tg. Mureș, 2008, 56.

7. Birț M.A. , Phihiatrie, prolegomena clinice. Ed. Dacia, Cluj Napoca 2001, 599-600.

8.Boncu Ş., Psihologie socială, Comportamentul agresiv, Cursul 30 http://www.psih.uaic.ro/~sboncu/romana/Curs_psihologie_sociala/Curs30.pdf

9. http://e-psihiatrie.ro/medicatia-psihiatrica/

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