Insight and other predictors of physical examination refusal in psychotic illness

Poor physical health in psychiatric patients is well recognized, yet factors contributing to physical examination noncompliance in psychotic illness have not been previously studied.

To examine whether insight or any other variables were independent predictors of physical examination noncompliance.

A case-note study (N = 200) of inpatient psychiatric patients in four hospitals in London, UK was conducted to examine the relationship between insight and physical examination noncompliance within 24  h of admission and over 2 weeks. Clinical variables including illness severity were also examined.

Patients who were noncompliant with physical examinations offered within 24  h and over 2 weeks were associated with lack of insight, higher illness severity, female gender, longer history of illness, current compulsory admission, and previous history of detention. After adjusting for confounding factors, lack of insight, female gender, and previous history of detention were found to be independent predictors of physical examination noncompliance for 24  h and 2 weeks.

Lack of insight is highly predictive of physical examination noncompliance for up to 2 weeks, indicating that mental incapacity to consenting to medical care may be common and that more proactive physical screening may be required for these patients.