MedWire News: Patients who are voluntarily admitted for treatment of first-episode psychosis are no more likely to adhere to treatment or to have more favorable clinical and functional outcomes than patients involuntarily admitted, Norwegian researchers report.

They found that over 2 years of observation, adherence to treatment was similar for voluntarily and involuntarily admitted patients, and contrary to expectations, most clinical improvement was recorded in the involuntary group.

The findings contradict previous research suggesting that patients who are coerced into hospital admission often turn away from health services, putting them at increased risk of poor treatment adherence, say Stein Opjordsmoen (Oslo University Hospital) and colleagues.

The researchers used the Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) Scales to assess 217 patients admitted to hospital for first-episode psychosis at baseline and after 3 months and 2 years. Of these, 91 were admitted voluntarily and 126 involuntarily.

More women than men were admitted involuntarily, at 66 versus 60, but otherwise the demographics of the two groups were similar.

Patients involuntarily admitted tended to have more psychopathology and worse functioning than voluntarily admitted patients at baseline, but there was no significant difference in duration of psychopathology or medication.

In both groups, and especially in the involuntarily admitted group, most improvement in psychopathology occurred during the first 3 months of treatment. At 2 years, there was no significant difference between the two groups in terms of the negative and general subscales of the PANSS. But involuntarily admitted patients showed significantly better improvements than voluntarily admitted patients on the positive subscale of the PANSS (9.9 vs 6.8 points) and on the GAF function and symptom subscales (26.8 vs 15.9 and 27.1 vs 19.6 points, respectively).

During the 2 years of observation, the two groups showed no significant difference in adherence to treatment, with voluntarily admitted patients adhering to psychotherapy for an average of 90.7 weeks and medication for an average of 77.8 weeks, compared with 83.9 and 75.3 weeks, respectively, for involuntarily admitted patients. Opjordsmoen and team conclude in the journal Acta Psychiatrica Scandinavica: “Legal admission status per se did not seem to influence treatment adherence or outcome.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

• Free abstract