Patient choice: deciding between psychotropic medication and physical restraints in
Y. Sheline and T. Nelson,
Bull. Amer. Acad. Psychiatry & the Law
21(3): 321-9, 1993.
The legal requirement to use least restrictive interventions in emergency psychiatric treatment does
not stipulate whether physical restraints or medication is least restrictive. There is no current
consensus about how to determine least restrictive interventions in a generalizable manner. In this
study patients who were clients in a public psychiatric emergency service were anonymously
surveyed and asked to state their preferences for specific interventions in a psychiatric emergency.
In a choice between physical restraints versus psychotropic medication, 64 percent of clients
preferred medication; 36 percent preferred seclusion or restraint. The rank order of preferred
modality was 1) benzodiazepines--31 percent, 2) neuroleptics--26 percent, 3) seclusion--24 percent,
4) restraints--10 percent. The rank order of last choice was different. Patients preference is an
important factor in determining the appropriate intervention in an emergency. Patient participation
offers an opportunity reconcile to clinical and legal objectives, to i improve compliance, and to
enhance patient and staff safety.