Am J Psychiatry 1991; 148:489-494
Copyright © 1991 by American Psychiatric Association
Outcome of involuntary medication in a state hospital system
F Cournos, K McKinnon and B Stanley
New York State Psychiatric Institute, New York 10032.
OBJECTIVE: The purpose of the study was to examine the course of
involuntarily administered medication in a state hospital population.
METHOD: The authors retrospectively examined the records of all 51
involuntarily medicated patients in six state hospitals in New York City in
a single calendar year. Clinical course was recorded for the period of
involuntary medication and for 12 months thereafter. These patients were
compared to 51 patients on the same wards who accepted medication. RESULTS:
Clinicians assessed involuntarily medicated patients as more dangerous to
themselves or others and less delusional after treatment than the
comparison patients. Long-acting intramuscular antipsychotics were
prescribed more frequently for involuntarily medicated patients. No
differences were observed in rates of discharge, outpatient cooperation, or
rehospitalization. Half of the patients in both groups remained
continuously institutionalized, and of those who left the hospital, only
30% of the involuntarily medicated group and 40% of the comparison group
took medication as outpatients. CONCLUSIONS: For these chronically severely
ill patients, involuntary medication did not appear to enhance insight or
cooperation or result in rapid return to the community. Involuntary
medication is often a necessary short-term, in-hospital management
strategy, but it does not replace the need to develop comprehensive,
long-term inpatient and community-based approaches to the management of
treatment refusal.
