Impact of short-acting vs. long-acting antipsychotic use on time in seclusion on a forensic assessment unit: a retrospective chart review

Abstract

Background: Seclusion, a strategy used to manage aggressive behavior in patients posing safety risks, can result in prolonged hospitalization and trauma. Antipsychotics, used to treat major mental illnesses including schizophrenia and bipolar disorder, are available as long-acting (LA) and short-acting (SA) formulations, with evidence suggesting LA antipsychotics may improve patient outcomes such as reducing hospitalizations and decreasing aggression, which is primarily driven by an increase in medication adherence. Objective & Methods: This retrospective chart review evaluated the impact of SA versus LA antipsychotics on seclusion duration in adult patients at the Southwest Centre for Forensic Mental Health Care (Ontario, Canada) between April 1, 2017, and December 31, 2023. Results: Of 83 patients (60 in the SA cohort, 23 in the LA cohort), no significant difference was found in seclusion time for SA compared to LA antipsychotics (2.7 hours, 95% CI: -67.8, 62.5, p > 0.05). Mood stabilizer use was associated with longer seclusion (SA: 112.7 hours, LA: 215.3 hours, p < 0.05), but no difference was observed with anxiolytics. Conclusion: Clinicians should consider individual patient needs and treatment contexts when prescribing antipsychotics. Further research is warranted to investigate broader patient outcomes and the implications of antipsychotic formulations in forensic mental health