Bursztajn H J, Chanowitz B, Gutheil T G, Hamm R M
Massachusetts Mental Health Center, Boston 02115.
Bull Am Acad Psychiatry Law. 1992;20(1):59-66.
The decision to prescribe neuroleptics for the treatment of psychosis involves a potentially tragic choice between, on the one hand, a probability of psychosis and a probability of side effects, such as tardive dyskinesia, on the other. In an experimental paradigm, we examined this decision process. We hypothesized that linguistic factors considered irrelevant under classical formulations of individual choice behavior would have a significant effect on this decision. All subjects were presented with a case vignette involving a potentially psychotic patient. Subjects were then asked what probability of tardive dyskinesia they would either "accept" or "risk" in order to prevent psychotic decompensation. In addition this factor was crossed with a contextual factor that varied the patient's age. The effect of "risk" versus "accept" language was evident in significantly different patterns of decision making across age groups. The data have important implications for clinical decision making, the elicitation of informed consent, and the directions that the courts have taken in malpractice and patient's rights cases.
一方面是精神病发作的可能性，另一方面是诸如迟发性运动障碍等副作用的可能性。在一个实验范式中，我们研究了这个决策过程。我们假设，在个体选择行为的经典表述中被认为不相关的语言因素会对这个决策产生重大影响。所有受试者都收到了一个涉及潜在精神病患者的病例 vignette。然后，受试者被问及为了防止精神病失代偿，他们会“接受”或“冒”多大迟发性运动障碍的风险。此外，这个因素与一个改变患者年龄的情境因素交叉。“冒险”与“接受”语言的影响在不同年龄组的决策模式中表现出显著差异。这些数据对临床决策、知情同意的获取以及法院在医疗事故和患者权利案件中所采取的方向具有重要意义。
