Manic episode, aggressive behavior and poor insight are significantly associated with involuntary admission in patients with bipolar disorders.

Chenyuli Luo,Hui Chen,Qiguang Li,Huijuan Guo,Jiansong Zhou,Weixiong Cai,Giovanni De Girolamo,Shaoling Zhong,Xiaoping Wang

doi:10.7717/peerj.7339

Abstract

Objective(s)Serious mental illnesses, such as bipolar disorders and schizophrenia, are closely associated with involuntary admission. Many studies have focused on involuntary admission in people with schizophrenia, but little is known about the factors associated with involuntary admission in Chinese patients with bipolar disorders. This study aimed to investigate socio-demographic and clinical factors associated with involuntary admission in Chinese patients with bipolar disorders.MethodsIn this multi-center cross-sectional survey in China, a total of 155 newly admitted patients with bipolar disorders were consecutively recruited from 16 psychiatric institutions from 15 March to 14 April, 2013. Patients’ socio-demographic and clinical data were collected from their medical records. The Modified Overt Aggression Scale and the Insight and Treatment Attitudes Questionnaire were used to measure patients’ level of aggression and insight of current psychiatric illness.ResultsThe prevalence of involuntary admission was 52% in this sample of Chinese inpatients with bipolar disorders. In multiple logistic regression, a high level of aggression (odds ratio (OR) = 2.48), diagnosis of manic episode (OR = 3.65), poor insight (OR = 7.52), and a low level of education (OR = 3.13) were significantly associated with involuntary admission.ConclusionManic episode, aggressive behavior, and poor insight were the significant contributing factors to involuntary admission in Chinese patients with bipolar disorders.

Highlights

Involuntary admission is a common and controversial issue in psychiatric clinical practice and may raise clinical, ethical, and legal concerns (Hoffmann et al, 2017)
We reported that male gender, history of hospitalization, aggressive behavior, and diagnosis of schizophrenia or related disorders were the risk factors of involuntary admission in China (Zhou et al, 2015)
Our study found that 52.3% of the Chinese inpatients with bipolar disorders were involuntary patients, and involuntary admission were significantly associated with manic episode, poor insight, more severe aggression and a low level of education

Summary

Introduction

Involuntary admission is a common and controversial issue in psychiatric clinical practice and may raise clinical, ethical, and legal concerns (Hoffmann et al, 2017). The study found that the percentages of psychiatric patients receiving involuntary treatment ranged from 21% to 59%, and aggression against others was the most frequent reason for patients being prescribed involuntary treatment. In another study with a large sample of 2,030 involuntary hospitalized psychiatric patients in 10 European countries, 770 patients (38%) were prescribed coercive measures (Raboch et al, 2010). In some countries, such as Italy, the percentage of involuntary patients among all patients in general psychiatric wards does not exceed 9% (De Girolamo et al, 2008). The above data indicate that involuntary admission is common in psychiatric clinical practice, the rates vary widely across countries

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