À propos de la chambre d’isolement en pédopsychiatrie. Étude au sein d’une unité d’hospitalisation pour adolescents

Abstract

BackgroundThe aim of this study is to examine characteristics associated with the use of locked seclusion in an adolescent in-patient unit. MethodsWe studied the seclusion room records of an adolescent in-patient unit for a six-year period. The demographic and clinical data related to all seclusions that occurred between 2005 and 2010 at an adolescent psychiatric unit were analyzed. Characteristics of adolescents who were placed in seclusion were compared to characteristics of all other adolescents at the unit. Information was abstracted from their case records and seclusion logs. ResultsThe study included 175 adolescent in-patients. The six-year prevalence of use of seclusion was 13% (23 seclusions), 57% of secluded patients were boys and the average length of stay was 59 days. Adolescents with conduct disorder diagnosis and who were admitted on an emergency basis were more likely to undergo seclusion. They consumed more drugs too (alcohol, tobacco). The most frequent behaviours leading to seclusion were agitation and hetero-aggressive behaviours. Seclusion was most frequent in the first days of hospitalization (26% occurred the first day). The average duration of seclusion (16 days) was much more than reported by other investigators. Medication was used in conjunction with the seclusion in 91% of cases and intramuscular injection was necessary in 35% of cases. A physical restraint was necessary in 22% of cases. For two adolescents, seclusion time was stopped due to the deterioration of their clinical condition. ConclusionThe use of seclusion in child and adolescent psychiatry units is particularly poorly documented in France. The prevalence of conduct disorder diagnosis indicates a need for guidelines for seclusion which takes into account the adolescent's need for protection from his own impulsive, the psychopathologic context and possible traumatic history. In this in-patient unit, seclusion is not used as a method of behaviour control. The time spends in seclusion tends to create a need for an intensive therapeutic care. The implications of the findings for practice need to be completed by further studied.