奈良県立医科大学精神医療センターにおける隔離・身体拘束の実態調査

Abstract

Background: Seclusion/restraint are interventions legally permitted for use in psychiatry practice to man-age a person’s behavior. Nara Medical University Psychiatric Institute (NMU-PI) functions as a local core hospital providing medical care services across all ages. Thus, we accept a wide range of patients, from those with psychiatric disorders in acute and/or resistant cases, to those who need to receive advanced physical treatment comorbided with psychiatric disorders. Previous studies on seclusion/restraint use have been reported from around the world. However, no substantial studies on seclusion/restraint use under such a singular situation have been reported at least in Japan. The purpose of this study was to examine the frequency of seclusion/restraint in NMU-PI and to analyze which variables may have significantly influence the use of this procedure. Materials and methods: The data from 2014 to 2018 were retrieved from the medical records of patients who underwent seclusion/restraint interventions during this period in NMU-PI. The analyzed data included age, gender, psychiatric diagnosis, the number of seclusion/restraint and its duration, reasons led to seclusion/restraint, days of hospital stay and psychiatric severity of patients with dementia and psychotic disorders. Results: Consistent with the national survey named '630 survey', the number of the secluded/restrained patients became increasing yearly in NMU-PI. During the observation period, 89 subjects (20.8%) and 41 subjects (9.6%) underwent seclusion and restraint interventions, respectively. In addition, median days of seclusion/restaint were 32 and 27 days, respectively. A large proportion were secluded/restrained due to hurting others with psychomotor agitation, followed by prevention of injury and/or treatment of physical comorbidity. Patients diagnosed with schizophrenia (ICD-10, F2) were the most secluded, whereas patients diagnosed with dementia (F0) were the most restrained. The duration of restraint was significantly longer in male, and patients with F0. Total Neuro-psychiatric Inventory (NPI) score was significantly higher in restrained patients with F0 than in those who were not. Total Brief Psychiatric Rating Scale (BPRS) score in patients with F2 was positively correlated with the length of seclusion/restraint in patients with F2, whereas total NPI score in patients with F0 was not correlated with the length of coercive interventions. Finaly, the duration of seclusion was significantly correlated with the length of hospital stay. Conclusions: The present study provided the first real evidence of the current status of seclusion/restraint at the level of university hospital in Japan. Given the potentialy negative effects of these practices, further studies using larger samples and a wide range of quantitative outcome measures are required to identify the crucial factors of seclusion/restraint in all psychiatric diagnoses in NMU-PI.