Psikiyatri servisinde yatışı yapılan hastalarda istemsiz tıbbı uygulamaların travma sonrası stres bozukluğu riski ve ilaç uyumuna etkisi
Thesis Type: Expertise In Medicine
Institution Of The Thesis: Istanbul University, Istanbul Medical Faculty, Division Of Medical Sciences , Turkey
Approval Date: 2024
Thesis Language: Turkish
Student: SİMGE ERGÜN
Supervisor: Ezgi İnce Guliyev
Open Archive Collection: AVESIS Open Access Collection
Abstract:Objectives: Coercive measures are defined as interventions against the person's will, and represent an issue of worldwide importance in psychiatry. Formal coercion often includes involuntary admission, involuntary treatment, seclusion, and restraint. Studies show that coercive measures can negatively impact mental health by making patients less willing to seek psychiatric help in the future or making them vulnerable to PTSD. In our study, we aimed to investigate the effect of coercive measures on PTSD risk and treatment adherence in patients hospitalized in a psychiatric ward and to examine the relationship between past trauma burden and exposure to coercive measures. Patients and Methods: The study included 31 patients who were admitted to the inpatient ward of Istanbul University, Istanbul Faculty of Medicine, Department of Mental Health and Diseases, diagnosed with psychotic disorder or mood disorder according to DSM-5 and exposed to at least one of the coercive measures (involuntary hospitalization, isolation, mechanical restraint, chemical restraint) during hospitalization and 29 patients who were not exposed to any coercive measures during hospitalization. Patients were evaluated in terms of sociodemographic and clinical characteristics. CTQ and CTS were performed for past trauma assessment. IES-R and MARS were conducted to assess the development of PTSD and treatment compliance in patients after hospital discharge. Patients were categorized into two groups according to their exposure to coercive measures, and the differences between the groups were analyzed. In addition to exposure to coercive measures, the relationship between the number of coercive measures and the scales applied was also examined. Logistic regression analysis was also performed to determine the factors associated with exposure to coercive measures. Results: No relationship existed between exposure to coercive measures and IES-R and MARS scores. The findings showed that exposure to coercive measures was associated with past trauma burden. Exposure to coercive measures was positively associated with CTS total, CTS frequency, and all CTS subscales, as well as CTQ total and all subscales. It was found that the number of coercive measures was positively associated with the CTQ subscales and total, except for the CTQ physical abuse subscale, and with the CTS subscales, total, and frequency. Exposure to coercive measures was found to be positively associated with homicidal ideation, history of violent behavior, history of substance abuse, number of previous hospitalizations, history of exposure to coercive measures, PANNS positive and YMRS score; and negatively associated with inpatient insight level, inpatient GAF, HAMD, MSPSS family subscale, and MSPSS total score. The number of coercive measures was positively associated with PANNS positive, YMRS, CGI-Severity, and PSS scores and negatively associated with inpatient GAF and HAMD scores. Conclusion: As a conclusion of our study, no association was found between exposure to coercive measures and PTSD and treatment adherence. On the other hand, past traumatic experiences and increased cumulative trauma were associated with exposure to coercive measures. The increase in the number of coercive measures was also found to be related to the severity of past trauma burden. A high number of previous hospitalizations, homicidal ideation, history of violent behavior, history of substance abuse, history of exposure to coercive measures, high clinical severity of the disease, and poor social support were found to increase the risk of exposure to coercive measures.