Antipsychotic treatment of psychotic disorders in forensic psychiatry: Patients’ perception of coercion and its predictors
Abstract
Background Despite the major encroachment of coercive measures on the fundamental rights of affected forensic psychiatric patients, there is relatively few research done in this field. Considering the relevance of this subject for psychiatric care and the recent changes of the legal basis of coercive treatment in Germany, more studies are needed. The present study examines forensic psychiatric inpatients' perception of coercion regarding the prescribed antipsychotic medication and factors associated with the perception of coercion.Material and methods Patients with schizophrenia, schizotypal and delusional disorders in two forensic psychiatric institutions in Southern Germany were interviewed about their experience of coercion related to antipsychotic medication. Due to a lack of appropriate psychometric scales, the perception of coercion regarding antipsychotic medication was assessed using an adapted version of the MacArthur Admission Experience Survey (aAES). The influence of sociodemographic and illness-related factors, of the attitude towards medication, insight into illness and symptom severity on the extent to which patients felt coerced to take the prescribed medication was analyzed. Two Visual Analog Scales, the Drug Attitude Inventory DAI-10, the Positive and Negative Syndrome Scale PANSS, the Fragebogen zur Krankheitseinsicht (Questionnaire about insight into illness) FKE-10 and the Coercion Experience Scale CES were used as psychometric scales.Results 50% of all patients eligible for the study gave their written consent. 70% of all participants had experienced coercive measures between admission and time of data assessment. The DAI-10 and the aAES correlated moderately, a high level of insight into illness being correlated to less perceived coercion. The FKE-10 and the aAES correlated moderately as well, a high level of insight into illness being correlated to less perceived coercion. The severity of symptoms (PANSS score) and the level of perceived coercion (aAES score) correlated weakly, participants with more severe symptoms perceived more coercion than those with less marked symptoms. A linear regression model showed that to what extent patients felt coerced to take the prescribed antipsychotic medication was mainly influenced by their attitude towards medication and the degree of insight into illness, to a lesser extent by symptom severity (R 2 = 0.565, p < 0.001). Sociodemographic factors were not related to the extent to which patients felt coerced to take the antipsychotic medication.Conclusions Predictors of the experience of coercion related to the prescribed antipsychotic medication of forensic psychiatric inpatients with schizophrenia and related disorders are not so much sociodemographic or illness-related factors as education or past medical history, but rather potentially influenceable variables such as insight into illness or attitude towards medication.
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In a previous forensic psychiatric sample, many patients felt compelled to take their antipsychotic medication although only a few were affected by emergency rapid tranquilization or compulsory medical treatment according to a court order.
“A study in two forensic hospitals in southwest Germany on the perceived coercion regarding prescribed antipsychotic medication showed that although only a few patients were affected by emergency rapid tranquilization or compulsory medical treatment according to a court order, many patients felt compelled to take their antipsychotic medication [26].”
From Patients’ perception of coercion with respect to antipsychotic treatment of psychotic disorders and its predictors (2021) · cites this paper as [26]
The findings are very similar to a previous study in a forensic psychiatric sample.
“These findings are very similar to a previous study in a forensic psychiatric sample.”
From Patients’ perception of coercion with respect to antipsychotic treatment of psychotic disorders and its predictors (2021) · cites this paper as [26]
The high accordance of findings with the forensic study supports the validity and robustness of the results.
“This high accordance of findings supports the validity and robustness of the results.”
From Patients’ perception of coercion with respect to antipsychotic treatment of psychotic disorders and its predictors (2021) · cites this paper as [26]
In that forensic sample, the extent of feeling coerced to take prescribed medication was affected mainly by the patient's attitude towards medication and the degree of insight into illness but less so, and not significantly, by symptom severity.
“The extent of feeling coerced to take the prescribed medication was affected mainly by the patient’s attitude towards medication and the degree of insight into illness but less so, and not significantly, by symptom severity.”
From Patients’ perception of coercion with respect to antipsychotic treatment of psychotic disorders and its predictors (2021) · cites this paper as [26]
The findings can be considered robust because they are very similar to a previous study in a forensic psychiatric sample.
“These findings can be considered to be robust, because they are very similar to a previous study in a forensic psychiatric sample.”
From Patients’ perception of coercion with respect to antipsychotic treatment of psychotic disorders and its predictors (2021) · cites this paper as [26]
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- Authors
- Horvath, J., Steinert, T., & Jaeger, S.
- Affiliations
- Zentrum für Psychiatrie Südwürttemberg (DE)
- Corresponding author
- Horvath, Juliane
- Venue
- International Journal of Law and Psychiatry
- Publisher
- Elsevier BV
- Published
- 2018-03
- Volume
- 57
- Pages
- 113-121
- ISSN
- 0160-2527 (ISSN-L)
- OpenAlex
- W2792316511
- Cited by
- 22
- References
- 25
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 2 · 2022: 8 · 2021: 4 · 2020: 4
- FWCI
- 2.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Law and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Keywords
- perceived coercion, antipsychotic drugs, forensic psychiatric inpatients, involuntary treatment, schizophrenia, schizotypal personality disorder, delusional disorder, insight into illness, symptom severity, patient experience
- MeSH terms
- Adult, Mental Disorders, Coercion, Commitment of Persons with Psychiatric Disorders, Female, Germany, Hospitals, Psychiatric, Humans, Inpatients, Male, Middle Aged, Patient Acceptance of Health Care, Psychotic Disorders, Restraint, Physical, Antipsychotic Agents
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