[Coercive stress in psychiatric intensive care unit: What link with insight?]

Encephale. 2019 Dec;45(6):488-493. doi: 10.1016/j.encep.2019.05.010. Epub 2019 Aug 14.
[Article in French]


The aim of this work was to study the correlations between the coercive experience level in patients in a psychiatric intensive care unit and clinical insight. We included 40 patients without specific diagnosis criteria at the end of their hospitalization in the intensive care unit. We assessed patients with the Coercion Experience Scale (CES) to measure their coercive stress level, and the Scale to Assess Unawareness of Mental Disorder (SUMD) which measures clinical insight. A total of 42.5 % of our sample suffered from mood disorders, 50 % suffered from psychotic disorders and 7.5 % from other disorders. On the one hand, we found that patients' coercive stress level was neither correlated with the awareness of their mental disorder nor with the awareness of social consequences of their mental disorder. On the other hand, we found that coercive stress level was significantly correlated with patients' awareness of treatment efficacy and that the specific CES factor measuring coercion showed a strong trend to significantly correlate with patients' awareness of treatment efficacy. These results seem to show that education about benefits of treatment is a key point to improve patients' coercive stress in a psychiatric intensive care unit, more than an education about awareness of the mental disorder itself.

Keywords: Closed ward; Coercion; Coercition; Insight; Psychiatric intensive care unit; Psychiatrie; Psychiatry; Unité de soins intensifs psychiatrique; Unité fermée.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Awareness / physiology*
  • Coercion*
  • Female
  • France / epidemiology
  • Hospitalization / statistics & numerical data
  • Hospitals, Psychiatric
  • Humans
  • Intensive Care Units
  • Male
  • Mental Disorders / epidemiology
  • Mental Disorders / psychology*
  • Mental Disorders / therapy
  • Middle Aged
  • Psychotic Disorders / epidemiology
  • Psychotic Disorders / psychology
  • Psychotic Disorders / therapy
  • Restraint, Physical / psychology*
  • Self Concept
  • Stress, Psychological* / epidemiology
  • Stress, Psychological* / etiology
  • Stress, Psychological* / psychology
  • Young Adult