The Predictive Value of Risk Categorization in Schizophrenia
The Predictive Value of Risk Categorization in Schizophrenia
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DOI：
10.3109/10673229.2011.549770
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发表时间：
2011-01-01
影响因子：
3.8
通讯作者：
Nielssen, Olav B.
中科院分区：
文献类型：
--
作者：
Large, Matthew M.;Ryan, Christopher J.;Nielssen, Olav B.
背景资料：风险评估越来越多地用于为精神分裂症和其他严重精神障碍患者的精神治疗决策提供信息。目的：检查应用于已知与精神分裂症相关的一系列伤害的风险评估和风险分类的理论局限性。研究方法：使用已知的自杀率，杀人，自我伤害，精神分裂症和暴力，一个假设的工具，具有不切实际的高水平的准确性被用来计算真阳性和假阳性风险分类的比例。结果：风险分类错误地将很大一部分患者归类为对自己和他人暴力的高风险患者。结论：风险评估和分类有严重的局限性。事实上，被列为高风险的大部分患者不会造成或遭受任何伤害。风险分类不准确的意外后果包括对一些患者的无理拘留，未能治疗其他人，稀缺的卫生资源分配不当，以及因患者被贴上危险标签而产生的耻辱。(HARV《心理学评论》2011年;19：25-33。）
Background: Risk assessment is increasingly used to inform decisions regarding the psychiatric treatment of patients with schizophrenia and other serious mental disorders. Aims: To examine the theoretical limits of risk assessment and risk categorization as applied to a range of harms known to be associated with schizophrenia. Methods: Using known rates of suicide, homicide, self-harm, and violence in schizophrenia, a hypothetical tool with an unrealistically high level of accuracy was used to calculate the proportion of true- and false-positive risk categorizations. Results: Risk categorization incorrectly classified a large proportion of patients as being at high risk of violence toward themselves and others. Conclusion: Risk assessment and categorization have severe limitations. A large proportion of patients classified as being at high risk will not, in fact, cause or suffer any harm. Unintended consequences of inaccurate risk categorization include unwarranted detention for some patients, failure to treat others, misallocation of scarce health resources, and the stigma arising from patients' being labeled as dangerous. (HARV REV PSYCHIATRY 2011;19:25-33.)