Compulsory admissions and preferences in decision-making in patients with psychotic and bipolar disorders
Abstract
Purpose Participation in medical decisions and taking into account patients' values and preferences are especially important for psychiatric patients who may be treated against their will. The increasing rates of coercive measures and the underlying clinical, ethical, and legal issues highlight the need to examine their use in psychiatry. Although limited congruence in decision-making preferences may be on the basis of these coercive practices, this issue has not been adequately addressed. We explore the relationship between compulsory admissions and congruence in decision-making preferences in mental health settings.Methods Cross-sectional study among 107 outpatients with DSM diagnoses of schizophrenia of bipolar disorder using the Control Preference Scale to assess congruence in decision-making experienced and preferred style. History of compulsory admissions was obtained through review of available records. Descriptive statistics and multivariate analyses were used.Results 70% of patients reported experiencing their preferred style of decision-making and 44% patients had history of compulsory admissions. These patients were more autonomous and preferred to take a more active role. The degree of congruence was lower in patients with previous compulsory admissions. The best predictors of compulsory admissions were not having a regular doctor and the unmatched participation preferences.Conclusions Patients who experienced a different level of participation in decision-making than desired more frequently had compulsory admissions. We propose to assess participation preferences each time a relevant treatment decision is about to be made and tailor care accordingly. We identified several factors leading to compulsory admissions that can be modified to prevent further coercive measures.
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Perceived coercion was associated with decreased involvement in, and control over, care.
“In general, perceived coercion was associated with decreased involvement in, and control over, care (21,31,32).”
From The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review (2025) · cites this paper as [32]
Decreased involvement in care was associated with involuntary status.
“Decreased involvement in care was also associated with involuntary status (20,31,32).”
From The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review (2025) · cites this paper as [32]
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The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review
Corderoy, A., Kisely, S., Zirnsak, T., & Ryan, C. J. (2025) · Psychiatry, Psychology and Law · doi:10.1080/13218719.2024.2346734 · Cited by 19 · see citing works
“In general, perceived coercion was associated with decreased involvement in, and control over, care (21,31,32).”
- Authors
- Morán-Sánchez, I., Bernal-López, M. A., & Pérez-Cárceles, M. D.
- ORCID
- Morán-Sánchez, Inés
- Venue
- Social Psychiatry and Psychiatric Epidemiology
- Published
- 2019-11-14
- Volume
- 55
- Issue
- 5
- Pages
- 571-580
- ISSN
- 0933-7954 (ISSN-L)
- 1433-9285
- OpenAlex
- W2987870777
- Cited by
- 7
- References
- 46
- Citations by year
- 2024: 2 · 2023: 1 · 2022: 1 · 2021: 2 · 2020: 1
- FWCI
- 1.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Psychiatry and Psychiatric Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- involuntary admission, involuntary treatment, decision-making preferences, patient autonomy, schizophrenia, bipolar disorder, psychiatric outpatients, Control Preferences Scale, patient participation in treatment decisions, continuity of care
- MeSH terms
- Bipolar Disorder, Cross-Sectional Studies, Female, Hospitalization, Humans, Male, Middle Aged, Patient Participation, Psychotic Disorders, Spain
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