Violence and leveraged community treatment for persons with mental disorders.
Violence and leveraged community treatment for persons with mental disorders.
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针对精神障碍患者的暴力和杠杆社区治疗。
DOI：
10.1176/ajp.2006.163.8.1404
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发表时间：
2006
期刊：
影响因子：
--
通讯作者：
Swartz,MarvinS
中科院分区：
文献类型：
--
作者：
Swanson,JeffreyW;VanDorn,RichardA;Monahan,John;Swartz,MarvinS
本文探讨了暴力和法律强制治疗的做法，在社区或利用社会福利制度的好处，如补贴住房和残疾人收入的支持，以确保坚持treatment.MethodData之间的联系，从一项调查的1,011人接受治疗的精神疾病在美国五个城市的公共精神卫生服务系统。多项logit分析被用来研究身体攻击行为和社会福利杠杆，法律的杠杆，或两种类型的杠杆经验之间的关联，与控制人口统计学和临床特征的分析。3%至9%的人报告说，他们使用或威胁使用致命武器，实施性侵犯或造成伤害。报告这种严重暴力的受试者中约有四分之三也报告经历过某种形式的杠杆治疗，而没有报告严重暴力的受试者中约有一半。与经历这两种类型的杠杆作用的可能性独立相关的人口统计学和临床因素包括年龄较小，男性，临床功能较差，治疗年限更长，住院频率更高，门诊就诊频率更高以及对药物依从性的负面态度。在没有自愿服用精神药物的参与者中，即使是轻微的攻击性与经历过法律的leverage.ConclusionsA组合的安全性和治疗不依从性的关注可能会影响临床医生和法官的决定，适用法律的杠杆作用。
ObjectiveThis article explores the link between violence and the practice of legally mandating treatment in the community or leveraging benefits from the social welfare system, such as subsidized housing and disability income support, to ensure adherence to treatment.MethodData are presented from a survey of 1,011 persons with psychiatric disorders receiving treatment in public mental health service systems in five U.S. cities. Multinomial logit analysis was used to examine the association between physically assaultive behavior and experience of social welfare leverage, legal leverage, or both types of leverage, with the analyses controlling for demographic and clinical characteristics.ResultsAcross study sites, 18% to 21% of participants reported having committed violent acts in the past 6 months; 3% to 9% reported having used or made threats with a lethal weapon, committed sexual assault, or caused injury. About three-quarters of subjects who reported such serious violence also reported having experienced some form of leveraged treatment, compared with about one-half of subjects who did not report serious violence. Demographic and clinical factors that were independently associated with the likelihood of experiencing both types of leverage included younger age, male gender, poorer clinical functioning, more years in treatment, more frequent hospitalizations, higher frequency of outpatient visits, and negative attitudes toward medication adherence. Among participants who did not voluntarily take psychotropic medication, even minor assaultiveness was associated with having experienced legal leverage.ConclusionsA combination of concerns about safety and treatment nonadherence may influence decisions by clinicians and judges to apply legal leverage.