{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T06:31:08Z","timestamp":1767853868687,"version":"3.49.0"},"reference-count":32,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2020,3,23]],"date-time":"2020-03-23T00:00:00Z","timestamp":1584921600000},"content-version":"unspecified","delay-in-days":1177,"URL":"https:\/\/www.cambridge.org\/core\/terms"},{"start":{"date-parts":[[2017,1,1]],"date-time":"2017-01-01T00:00:00Z","timestamp":1483228800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["europsy-journal.com","clinicalkey.jp","clinicalkey.com","clinicalkey.es","clinicalkey.com.au","clinicalkey.fr","em-consulte.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Eur. psychiatr."],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0924933800068395_abst0005\" sec-type=\"other\"><jats:title>Background<\/jats:title><jats:p>In the Netherlands, seclusion is historically the measure of first choice in dealing with aggressive incidents. In 2010, the Mediant Mental Health Trust in Eastern Netherlands introduced a policy prioritising the use of enforced medication to manage aggressive incidents over seclusion. The main goal of the study was to investigate whether prioritising enforced medication over seclusion leads to a change of aggressive incidents and coercive measures.<\/jats:p><\/jats:sec><jats:sec id=\"S0924933800068395_abst0010\" sec-type=\"methods\"><jats:title>Methods<\/jats:title><jats:p>The study was carried out with data from 2764\u00a0patients admitted between 2007 and 2013 to the hospital locations of the Mediant Mental Health Trust in Eastern Netherlands, with a catchment area of 500,000\u00a0inhabitants. Seclusion, restraint and enforced medications as well as other coercive measures were gathered systematically. Aggressive incidents were assessed with the SOAS-R. An event sequence analysis was preformed, to assess the whether seclusion, restraint or enforced medication were used or not before or after aggressive incidents.<\/jats:p><\/jats:sec><jats:sec id=\"S0924933800068395_abst0015\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>Enforced medication use went up by 363% from a very low baseline. There was a marked reduction of overall coercive measures by 44%. Seclusion hours went down by 62%. Aggression against staff or patients was reduced by 40%.<\/jats:p><\/jats:sec><jats:sec id=\"S0924933800068395_abst0020\" sec-type=\"conclusions\"><jats:title>Conclusions<\/jats:title><jats:p>When dealing with aggression, prioritising medication significantly reduces other coercive measures and aggression against staff, while within principles of subsidiarity, proportionality and expediency.<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.eurpsy.2016.08.002","type":"journal-article","created":{"date-parts":[[2016,12,17]],"date-time":"2016-12-17T00:40:43Z","timestamp":1481935243000},"page":"86-92","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":25,"title":["Seclusion and enforced medication in dealing with aggression: A prospective dynamic cohort study"],"prefix":"10.1017","volume":"39","author":[{"given":"A.A.","family":"Verlinde","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.O.","family":"Noorthoorn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W.","family":"Snelleman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H.","family":"van den Berg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Snelleman \u2013 van der Plas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.","family":"Lepping","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2020,3,23]]},"reference":[{"key":"S0924933800068395_bib0145","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.111.095141"},{"key":"S0924933800068395_bib0070","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-015-1094-2"},{"key":"S0924933800068395_bib0015","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijlp.2008.09.002"},{"key":"S0924933800068395_bib0135","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2012.08.002"},{"key":"S0924933800068395_bib0120","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2850.2006.00931.x"},{"key":"S0924933800068395_bib0060","doi-asserted-by":"publisher","DOI":"10.3109\/01612840903484113"},{"key":"S0924933800068395_bib0025","first-page":"1","volume-title":"Van alle tijden en toch uniek","author":"Vrijlandt","year":"2002"},{"key":"S0924933800068395_bib0045","unstructured":"[9] Richtlijn Dwang, Nederlandse Vereniging Voor Psychiatrie [Guideline Coercion Dutch Association of Psychiatry], 2007."},{"key":"S0924933800068395_bib0065","unstructured":"[13] Lepping, P Massood, B Flammer, E Noorthoorn, EO Comparison of restraint data from four countries. 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