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[Involuntary medication in psychiatry].

Tilman Steinert1, Thomas W Kallert

  • 1Psychiatrische Versorgungsforschung am Zentrum für Psychiatrie, Die Weissenau, Abt. Psychiatrie I der Universität Ulm. tilman.steinert@zfp-weissenau.de

Psychiatrische Praxis
|May 9, 2006
PubMed
Summary

Involuntary medication for psychiatric patients is controversial, with limited data on efficacy and safety. Patient opinions are critical, highlighting the need for improved guidelines and European harmonization in mental health treatment.

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Area of Science:

  • Psychiatry
  • Mental Health Law
  • Public Health

Background:

  • Involuntary medication in psychiatric care presents complex epidemiological, clinical, ethical, and legal challenges.
  • Existing literature on the frequency and efficacy of involuntary medication is scarce, particularly for inpatients.
  • Patient perspectives on involuntary medication are predominantly critical, underscoring a significant gap in understanding and acceptance.

Purpose of the Study:

  • To systematically review the epidemiological, clinical, ethical, and legal aspects of involuntary medication in psychiatric treatment.
  • To evaluate the current state of evidence regarding the efficacy and safety of involuntary medication.
  • To assess patient attitudes and existing guidelines on involuntary treatment.

Main Methods:

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  • A systematic literature search was conducted using Medline and Medpilot databases.
  • Relevant guidelines were sourced from the internet and ongoing research projects.
  • The review considered epidemiological data, clinical trial results, and patient opinion studies.

    • Main Results:

    • Epidemiological data on involuntary medication incidence is limited, with estimates ranging from 2-8% in psychiatric wards, predominantly affecting patients with schizophrenia or bipolar disorder.
    • Empirical evidence on the clinical safety and efficacy of involuntary medication is sparse, with only a few randomized controlled trials available, primarily concerning outpatient commitment.
    • A substantial body of literature reveals highly critical patient attitudes towards involuntary medication, indicating a need for improved patient-centered approaches.

    Conclusions:

    • The discourse surrounding involuntary medication is evolving from ideological critique towards evidence-based practice, guideline development, and legislative clarity.
    • There is a discernible trend towards European harmonization of legislation concerning the involuntary treatment of individuals with serious mental illness.
    • Further research and development of comprehensive guidelines are essential to address the complexities and improve the practice of involuntary medication.