Patients' perception of coercion with respect to antipsychotic treatment of psychotic disorders and its predictors

Soc Psychiatry Psychiatr Epidemiol. 2021 Aug;56(8):1381-1388. doi: 10.1007/s00127-021-02083-z. Epub 2021 Apr 27.


Purpose: The present study investigates perceived coercion in psychiatric inpatients under prescribed antipsychotic medication without a court order. The objective of this study was to investigate whether and to what extent involuntary and voluntary inpatients feel coerced to take their medication and which factors affect perceived coercion.

Methods: Voluntarily and involuntarily admitted patients (55 and 36, respectively) were interviewed about the extent of perceived coercion. In addition, socio-demographic and clinical data were collected. The Admission Experience Scale (aAES) was used to assess perceived coercion concerning medication. To measure insight into illness, attitude towards medication, and symptom severity, we used a questionnaire on insight into illness (FKE-10), the Drug Attitude Inventory (DAI-10), and the Brief Psychiatric Rating Scale (BPRS-24), respectively.

Results: Voluntarily treated patients experienced significantly less coercion when taking prescribed medication in inpatient settings than involuntarily treated patients. The experience of coercion was not related to socio-demographic or clinical variables nor to the BPRS-24 score, but to insight into illness and attitude towards medication. Patients who had experienced at least one coercive measure during the index hospital stay showed a higher level of perceived coercion.

Conclusion: Perceived coercion related to medication is dependent on insight into illness and experience of previous coercive interventions rather than on the severity of psychopathological symptoms. These findings are very similar to a previous study in a forensic psychiatric sample. Having experience of at least one coercive measure seems to be a decisive aspect of the extent of the patients' perceived coercion.

Keywords: Attitude towards medication; Insight into illness; Patient and staff perspectives; Perceived coercion; Symptom severity.

MeSH terms

  • Antipsychotic Agents* / therapeutic use
  • Coercion
  • Hospitals, Psychiatric
  • Humans
  • Mental Disorders*
  • Patient Admission
  • Perception
  • Psychotic Disorders* / drug therapy


  • Antipsychotic Agents