What factors are associated with seclusion in patients with psychosis?

Seclusion is a measure used as a last resort in psychiatry to manage high-risk situations of hetero- or self-agression. However, few studies have investigated factors that could be associated with seclusion. The aim of this study was to assess the clinical and socio-demographic characteristics of patients who were prescribed seclusion.

An observational, retrospective study was carried out between January 2019 and December 2020, including patients with psychosis who had been hospitalized. Clinical and socio-demographic characteristics, as well as psychopathological scores were compared between patients who required seclusion and those who did not. A binomial logistic regression including gender, age, symptom severity, knowledge of the French language and judicial history was performed.

We included 127 patients (41 of whom were prescribed seclusion). Patients requiring seclusion had more severe symptoms, as indicated by the Positive And Negative Syndrome Scale total scores (98.8±21.95 vs 85.9±25.64; P=0.02), the positive symptoms subscale (28.4±8.89 vs 24±7.63; P=0.02), and the general psychopathology symptoms subscale (48.3±12.03 vs 41.9±12.21; P=0.02). These patients had poor knowledge of French (21% vs 4.7%; P<0.01) and a statistical trend was found in relation to judicial history (24% vs 11%; P=0.07). The differences in symptomatology (P=0.03) and language knowledge (P=0.04) were maintained in the multivariate analysis.

Our study found that the implementation of a seclusion was associated with the severity of symptoms and with a lack of knowledge of the French language. Particular attention should therefore be paid to these specific patients in order to use de-escalation techniques and provide comprehensible explanations to patients who do not speak French.