What factors are associated with seclusion in patients with psychosis?

Objective: 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.

Patients and methods: 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.

Results: 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.

Discussion and conclusion: 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.