Emergency psychiatry: physical and chemical restraint in the psychiatric emergency service.
Emergency psychiatry: physical and chemical restraint in the psychiatric emergency service.
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紧急精神病学：精神科紧急服务中的物理和化学约束。
DOI：
10.1176/appi.ps.51.6.717
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发表时间：
2000
影响因子：
3.8
通讯作者：
Michael H. Allen
中科院分区：
文献类型：
--
作者：
G. Currier;Michael H. Allen
近年来，我们目睹了对滥用所谓医生警察权力的可能性的明显增加的敏感性。非自愿入院的标准已经从治疗模式转变为自愿模式，而在最不受限制的情况下进行治疗的哲学转变已经被艰难的经济现实所加速。在1970年至1994年期间，精神病护理的次数增加了一倍多，而住院床位的数量减少了一半以上（1）。支付精神病医院护理费用也变得令人烦恼。现在，缺乏接触可能更多地是一个权利问题，而不是剥夺自由。因此，医院中攻击性患者的集中度上升（2），医院已成为越来越危险的地方。社区中精神病患者的暴力行为也引起了人们的高度关注。在对消费者和社区造成严重后果的过程中，紧急服务是一个日益重要的组成部分。在这种复杂的情况下，紧急精神卫生专业人员被要求权衡一些临床，法律的和经济问题，现在出现了关于使用物理和化学约束或隔离的辩论。虽然在精神病急救服务中，在许多情况下，约束可能是合理的，但其最终价值仍不清楚。在对文献的广泛回顾中，Fisher（3）强调了约束和隔离在各种精神病治疗环境中维护患者和工作人员安全的实用性和临床疗效。然而，该综述和其他综述也令人信服地指出了限制和隔离对患者的有害影响，他们认为这些限制和隔离是强制性的和创伤性的（4，5）。对使用限制措施的早期审查
In recent years we have witnessed a markedly increased sensitivity to the potential for abuse of the socalled police powers of physicians. The criteria for involuntary admission have shifted from a treatment model to a dangerousness model, while the philosophical shift toward treatment in the least restrictive setting has been accelerated by hard economic reality. Between 1970 and 1994, the number of episodes of psychiatric care more than doubled, while the number of inpatient beds was cut by more than half (1). Payment for psychiatric hospital care has also become entwined with dangerousness. Lack of access may now be more of a rights issue than is deprivation of liberty. Consequently, the concentration of aggressive patients in the hospital has risen (2), and hospitals have become increasingly dangerous places. Concern has also heightened about violence committed by mentally ill persons in the community. Emergency services are an increasingly important component in a process with very serious consequences for the consumer and the community. In this complex situation where emergency mental health professionals are asked to weigh a number of clinical, legal, and economic issues, debate now arises about the use of physical and chemical restraint or seclusion. Although restraint may well be justifiable in many instances in the psychiatric emergency service, its ultimate value remains unclear. In an extensive review of the literature, Fisher (3) underscored the utility and clinical efficacy of restraint and seclusion in maintaining patient and staff safety in a variety of psychiatric treatment settings. However, that review and others also convincingly point to deleterious effects of restraint and seclusion on patients, who perceive them to be coercive and traumatic (4,5). Early scrutiny of use of restraint in