Restrictive measures in psychiatry

Abstract

Introduction Informed consent is guarantor of the three principles that guide the professional activity of physicians concretely, information, comprehension and volunteerism, based on bioethical values of autonomy, non-maleficence, beneficence and justice. Psychopathological alterations undermine the capacity to consent treatment, requiring, sometimes, restrictive measures for risk prevention and treatment, including involuntary admission, intra-muscular medication and physical restraint. Objectives This study aims to analyze the therapeutic measures of restriction, according Spanish legislation, article 763 of Civil Procedure Law, under the condition of a mental disorder. Method We will proceed to the descriptive statistical analysis of total cohort of hospital admissions in the Dr. Lopez Ibor Neuropsychiatric Institute in the calendar year 2014 and we will review the coercive measures to the treatment of those patients who have decline of the ability to provide informed consent. Results Of the cohort of income, 10.5% has been involuntary admission, 51% men versus 49% women. Forty-one percent of patients have been diagnosed with schizophrenia, schizotypal and delusional disorder; the other 30% with affective disorders (21% bipolar disorder or manic disorder); and the 12.2% with disorders of adult personality and behaviour. Eighteen percent have needed intra-muscular medication and physical restraint. Conclusions The proportion of patients with decline of the decisional-making capacity is less than that found in studies in other countries of the European Union. The involuntary commitment is more frequently associated with severe mental disorders and the use of restrictive measures is associated to situations of danger to the patient or others.