Fire seclusion and restraint carried out arbitrarily?

Due to media reports and psychiatric literature coercive measures (seclusio n, restraint, forced medication) seem to be carried out rather arbitrarily in psychiatric hospitals. We examined whether associations between severity of psychopathological symptoms, patients' aggressive behaviour and coerciv e measures would be found. Method: 193 consecutive treatment episodes of ou r department for general psychiatry were examined. The psychopathological s tatus at admission was recorded with the PANSS, aggressive behaviour during in-patient treatment with the Modified Overt Aggression Scale (MOAS). For each treatment episode we recorded whether coercive measures were carried o ut or not. Results: Coercive measures were carried out in 47 patients (24.3 %). MOAS scores in these patients were six fold higher than in patients who were not exposed to coercive measures. 56% of coercive measures occurred i n the quarter of patients with the highest psychopathology, none in the qua rter with the lowest psychopathology (p < 0.0001). Conclusion: Contrary to frequent presumptions, the application of coercive measures in psychiatric hospitals is predominantly indicated by patients' psychopathology and viole nt behaviour.