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Seclusion and Restraint in Patients With Schizophrenia: Clinical and Biographical Correlates

Steinert, Tilman Prof Dr med*; Bergbauer, Gabriele Dipl Psych; Schmid, Peter*; Gebhardt, Ralf Peter*

The Journal of Nervous and Mental Disease: June 2007 - Volume 195 - Issue 6 - p 492-496
doi: 10.1097/NMD.0b013e3180302af6
Original Article

Seclusion and restraint represent adverse experiences that cause negative attitudes against psychiatric treatment and psychopathologic sequels such as posttraumatic stress disorder. We examined 117 consecutive admissions with schizophrenia, with an average of 8.7 previous admissions. Positive and Negative Syndrome Scale and Global Assessment of Functioning were obtained at admission and discharge, and traumatic events in the biography were recorded using the Posttraumatic Diagnostic Scale. Twenty-four men (42.9%) and 18 women (29.0%) had experienced seclusion or restraint in their psychiatric history. Seclusion or restraint during the present admission was best predicted in a logistic regression model by physical aggressive behavior [odds ratio (OR), 11.5] and the Positive and Negative Syndrome Scale hostility item at admission (OR, 23.6). Seclusion or restraint ever in the psychiatric history, however, was mostly associated with lifetime exposure to life-threatening traumatic events (OR, 7.2). We conclude that exposure to traumatic events in the biography severely enhances the risk of revictimization and retraumatization during inpatient treatment.

*Department of Psychotherapy, Center for Psychiatry Weissenau, Department of Psychiatry I, University of Ulm, Ulm, Germany; and †Hochgratklinik, Oberstaufen, Germany.

Part of the study was funded by the German Ministry of Education and Research as project of the competence network schizophrenia.

Send reprint requests to Prof. Dr. Tilman Steinert, Centre for Psychiatrie Weissenau, University of Ulm, Weingartshofer Straße 2, D 88214 Ravensburg-Weissenau, Germany. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.