Compulsory versus voluntary admission in psychiatry: an observational study

Background: in Italy compulsory admission (ca) in psychiatry is governed in accordance with law 833/78 establishing that "all treatments are voluntary" and that "the health authorities may prescribe involuntary treatments in respect of the dignity of a person and of his civil and political rights." this study aims to observe the most frequent diagnosis both in compulsory admitted patients and in those with voluntary admission. the second aim of the study is to evaluate the most recurring clinical features in the two groups of patients and to verify the existence of a correlation between the modality of admission and the length of hospitalization (LOs). Methods: the study evaluates data from two groups of patients: 100 compulsorily admitted and 100 voluntarily admitted patients from January 2014 to March 2017. In order to include the data, patients had to be ≥18 years old; admitted in emergency regime; only data for the first hospitalization of patients who had multiple admissions were included in this analysis. Patients were tested through the Brief Psychiatric rating scale (BPrs) version 4.0, as part of the clinical routine. Results: schizophrenia, schizotypal Personality and Delusional Disorder (F20-29) and other Personality Disorders (F60-69) are the most frequent diagnosis among patients compulsorily admitted (55% vs. 35%, P value <0.01); Mood Disorder is more frequent among volunteer patients (F30-39: 32% vs. 15%, P value <0.01). A significant difference between LOs of the volunteer patients (13.033 days, Ds 8.19) and LOs of compulsory admitted patients (26.33 days, sD 22.4) was observed (P<0.003). Conclusions: schizophrenia and others psychotic disorders are more frequent among patients compulsorily admitted, with a lack of caregivers and poor social support. ca are related to higher LOs. this study has some limits such as the study design.