Nauðungarlyfjagjafir á geðdeildum Landspítala árin 2014-2018

Abstract

INNGANGUR Þvinguð meðferð hefur verið gagnrýnd víða um heim og er nauðungarlyfjagjöf ein tegund þvingaðrar meðferðar en umfang nauðungarlyfjagjafa á Íslandi er lítið þekkt. Tilgangur rannsóknarinnar var að kanna umfang nauðungarlyfjagjafa á Landspítala, hvenær þær eru helst notaðar og hvort sé munur milli sjúklinga sem fá nauðungarlyfjagjafir og þeirra sem ekki fá slíka meðferð. EFNIVIÐUR OG AÐFERÐIR Rannsóknin er afturskyggn og nýtti gögn úr sjúkraskrám með úrtaki allra inniliggjandi sjúklinga á geðdeildum Landspítala almanaksárin 2014-2018 með 4053 þátttakendum. Þátttakendum var skipt í tvo hópa, hóp 1 með sjúklingum sem fengu nauðungarlyf (n=400, 9,9%) og hóp 2 með sjúklingum sem ekki fengu nauðungarlyf (n=3653, 90,1%). NIÐURSTÖÐUR Heildarfjöldi nauðungarlyfjagjafa var 2438 talsins og um 1% heildarúrtaks fékk um helming allra nauðungarlyfja. Nauðungarlyfjagjafir voru helst gefnar yfir daginn á virkum dögum og seint um kvöld en ekki sást afgerandi munur milli mánaða. Þegar hóparnir voru skoðaðir sást að hlutfallslega fleiri karlar og sjúklingar með erlent ríkisfang voru í hópi 1 en hópi 2, en ekki sást afgerandi munur á aldursdreifingu milli hópanna. Þeir sem voru í hópi 1 voru með fleiri komur á Landspítala, og fleiri innlagnir og legudaga á geðdeildum Landspítala á sjúkling, en þeir í hópi 2. Hjá sjúklingum í hópi 1 voru geðrofsgreiningar (F20-29) og lyndisraskanir (F30-39) algengastar en í hópi 2 voru það fíknisjúkdómar (F10-19) og lyndisraskanir (F30-39). ÁLYKTUN Niðurstöður benda til ákveðinna áhættuþátta nauðungarlyfjagjafa varðandi lýðfræðilegar breytur sjúklinga, sjúkdómsgreiningar, nýtingu þjónustunnar og tímasetningar nauðungarlyfjagjafa. Nánari greining gæti nýst til þess að draga úr þvingaðri meðferð. Frekari rannsókna er þörf á þvingaðri meðferð á geðdeildum á Íslandi. INTRODUCTION: Coercion is considered controversial and is criticized around the world. Involuntary medication is one type of coercion, but the extent of its use in Iceland is not well known. The aim of this study is to shed light on the extent and time of involuntary medication in Landspitali University Hospital in Iceland, when it is most often used and whether there is a difference between patients who receive involuntary medication and those who do not receive such treatment. MATERIAL AND METHODS: This study is a quantitative descriptive retrospective study using data obtained from medical records. The sample consisted of all patients admitted to the psychiatric inpatient wards at Landspitali University Hospital in Iceland in the years 2014-2018 (N=4053). The sample was divided into two groups, group 1 with patients who received involuntary medication n=400 (9.9%) and group 2 with patients who did not receive such treatment n=3653 (90.1%). RESULTS: The total number of involuntary medications was 2438 and about 1% of the total sample received about half of all involuntary medication. Involuntary medications were most frequent during the daytime during weekdays and late at night, but no notable difference was seen between months of the year. When comparing the groups, it appears that proportionally more men and patients with foreign citizenship are in group 1 than in group 2, but no notable difference is seen in age between groups. Patients in group 1 had more visits to the emergency services at Landspitali, more admissions, and patient days per patient at psychiatric wards in Landspitali than those in group 2. The most common medical diagnosis in group 1 were within the schizophrenia spectrum (F20-F29) and mood disorders (F30-39) but in group 2 the most common medical diagnosis were mental and behavioral disorders due to psychoactive substance use (F10-19) and mood disorders (F30-F39). CONCLUSION: Findings indicate certain risk factors for involuntary medication regarding demographic, medical diagnosis, use of services as well as external factors such as timing of involuntary medication. A more detailed analysis could be used to reduce the use of coercive treatment. Further research is needed on the use of coercion in psychiatric wards in Iceland.