Restraint or not restraint. Involuntary transport from home of schizophrenic patients

Introduction Although physical restraint (PR) is a non-rarely practice on psychiatry there are few studies that focus the attention on the risk factors for this intervention. PR is a legitimacy practice when is needed and well applied but is not free from side effects. Knowing risk factors might be useful to improve the application of PR. Objectives Study the risk factors involved with the use of PR at patient's home in individuals with schizophrenia before the involuntary transport (IT) to a psychiatric facility. Methods Is a descriptive and observational study of 267 psychotic patients that were assisted by a psychiatric home care unit (EMSE) in Barcelona during their IT. The sample was divided in two groups, depending on the need of PR. Socio-demographic data were collected as well as positive and negative syndrome scale (PANSS), WHO disability assessment schedule (WHO/DAS), global assessment of functioning scale (GAF), Scale to assess unawareness of mental disorder (SUMD). Aggressiveness was assessed by PANSS-EC consisting of 5 items: excitement, tension, hostility, uncooperativeness and poor impulse. Results From the 267 psychotic patients 109 required PR. 154 were male and the average of age was 47. The results were significant in the PR group versus no PR for PANSS-EC ( P  = 0.000), as well as WHO/DAS ( P  = 0.017), GAF ( P  = 0.042), Positive PANSS ( P  = 0.000), age ( P  = 0.001) and substance use ( P  = 0.012). Were no significant for gender, insight or Negative PANSS. Conclusions Aggressiveness and violence were the most important PR related factors followed by positive symptoms, age, substance use and global functioning.