Skip to main content

Advertisement

Log in

Lack of motivation for treatment in emergency psychiatry patients

  • ORIGINAL PAPER
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Background

A lack of motivation for treatment on the part of patients is a major problem for emergency psychiatric services. Little is known about its determinants. The aim of this study was to investigate determinants of treatment motivation in emergency psychiatric patients.

Method

A cross-sectional study of 719 patients was made. Motivation for treatment and other clinical variables were assessed using the Severity of Psychiatric Illness scale and the Brief Psychiatric Rating Scale.

Results

In all, 47% of patients were not motivated for treatment and they also had severe clinical problems. Lack of motivation was associated with danger to others [odds ratio (OR) 2.03; confidence interval (CI) 1.21–3.40], substance abuse (OR 1.71; CI 1.09–2.67), suspiciousness (OR 1.4; CI 1.19–1.64), grandiosity (OR 1.19; CI 1.01–1.4), anxiety (OR 0.74; CI 0.64–0.86), and GAF score (OR 0.98; CI 0.96–0.99).

Conclusions

Lack of motivation for treatment is a common phenomenon among severely mentally ill patients seen by emergency psychiatric services. Lack of motivation was associated with danger and paranoid symptoms. Motivational techniques as well as involuntary treatment may help to overcome problems due to lack of motivation in these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Amador XF, Flaum M, Andreasen NC, Strauss DH, Yale SA, Clark SC, Gorman JM (1994) Awareness of illness in schizophrenia. Arch Gen Psychiatry 51:826–836

    PubMed  Google Scholar 

  2. Bebbington PE, Bhugra D, Brugha T, Singleton N, Farrell M, Jenkins R, Lewis G, Meltzer H (2004) Psychosis, victimisation and childhood disadvantage: evidence from the second British National Survey of Psychiatric Morbidity. Br J Psychiatry 185:220–226

    PubMed  Google Scholar 

  3. Blume AW, Davis JM, Schmaling KB (1999) Neurocognitive dysfunction in dually-diagnosed patients: a potential roadblock to motivating behavior change. J Psychoactive Drugs 31:111–115

    PubMed  Google Scholar 

  4. Burns T, Firn M (2002) Assertive outreach in mental health. Oxford University press, Oxford

  5. Flashman LA, McAllister TW, Andreasen NC, Saykin AJ (2000) Smaller brain size associated with unawareness of illness in patients with schizophrenia. Am J Psychiatry 157:1167–1169

    PubMed  Google Scholar 

  6. George L,Durbin J, Sheldon T,Goering P (2002) Patient and contextual factors related to the decision to hospitalize patients from emergency psychiatric services. Psychiatric Serv 53:1586–1591

    Google Scholar 

  7. Kapur S (2003) Psychosis as a state of aberrant salience: a framework linking biology, phenomenology, and pharmacology in schizophrenia. Am J Psychiatry 160:13–23

    PubMed  Google Scholar 

  8. Kemp R, Hayward P, Applewhaite G, Everitt B, David A (1996) Compliance therapy in psychotic patients: randomised controlled trial. BMJ 312:345–349

    PubMed  Google Scholar 

  9. Lyons JS (1998) The Severity and Acuity of Psychiatric Illness Scales. An Outcomes Management and Decision Support System. Adult Version. Manual. The Psychological Corporation, Harcourt Brace and Company, San Antonio

  10. McGrath J (1991) Ordering thoughts on thought disorder. Br J Psychiatry 158:307–316

    PubMed  Google Scholar 

  11. Mojtabai R, Olfson M, Mechanic D (2002) Perceived need and help-seeking in adults with mood, anxiety, or substance use disorders. Arch Gen Psychiatry 59:77–84

    PubMed  Google Scholar 

  12. Mulder CL, Koopmans GT, Lyons JS (2005) The admission process untangled. Determinants of indicated vs. actual level of care in mobile psychiatric emergency services. In press in Psychiatric Serv 56:452–457

    Google Scholar 

  13. Mueser KT, McGurk SR (2004) Schizophrenia. Lancet 19; 363 (9426):2063–2072

    Google Scholar 

  14. Overall JE, Gorham DR (1962) The Brief Psychiatric Rating Scale. Psychol Rep 10:799–812

    Google Scholar 

  15. Rollnick S, Miller WR (1995) What is motivational interviewing. Beh Cogn Psychoth 23:325–334

    Google Scholar 

  16. Rüsch N, Corrigan PW (2002) Motivational interviewing to improve insight and treatment adherence in schizophrenia. Psychiatr Reh J 26:23–32

    Google Scholar 

  17. Smith TE, Hull JW, Israel LM, Willson DF (2000) Insight, symptoms and neurocognition in schizophrenia and schizoaffective disorder. Schiz Bull 26:193–200

    Google Scholar 

  18. Tait L, Birchwood M, Trower P (2002) A new scale (SES) to measure engagement with community mental health services. J Ment Health 11:191–198

    Google Scholar 

  19. Tait L, Birchwood M, Trower P (2003) Predicting engagement with services for psychosis: insight, symptoms and recovery style. Brit J Psychiatry 182:123–128

    Google Scholar 

  20. Torrey EF, Zdanowicz M (2001) Outpatient commitment: what, why and for whom. Psychiatr Serv 52:337–341

    PubMed  Google Scholar 

  21. Trauer T, Sacks T (2000) The relationship between insight and medication adherence in severely mentally ill patients treated in the community. Acta Psychiatr Scand 102:211–216

    PubMed  Google Scholar 

  22. Turkington D, McKenna P (2002) Is cognitive-behavioral therapy a worthwhile treatment for psychosis? Brit J Psychiatry 182:477–479

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Cornelis L. Mulder M.D., Ph.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mulder, C.L., Koopmans, G.T. & Hengeveld, M.W. Lack of motivation for treatment in emergency psychiatry patients. Soc Psychiat Epidemiol 40, 484–488 (2005). https://doi.org/10.1007/s00127-005-0913-2

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-005-0913-2

Key words

Navigation