Appelbaum K L, Bazemore P H, Tonkonogy J, Ananth R, Shull S
University of Massachusetts Medical School, Worcester 01655.
Hosp Community Psychiatry. 1992 Oct;43(10):1023-5. doi: 10.1176/ps.43.10.1023.
Psychiatric patients have an increased risk for choking compared with the general population because of risk factors such as medication side effects and food gorging. A state hospital program for managing patients with dysphagia, or difficulty swallowing, includes interventions such as modified diets, mealtime monitoring, and adjusting psychotropic medications. Clinicians may find it difficult to make decisions about privileges and placement for dysphagic patients who do not comply with dietary modifications in unsupervised settings. For many such patients, close supervision and even placement on a locked ward may seem necessary. The authors recommend a risk-benefit approach: clinicians must balance the safety afforded by restrictions against the benefits of increased privileges or placement in a less restrictive setting. Quality of life and patients' preferences must also be considered.
与普通人群相比，精神疾病患者因药物副作用和暴饮暴食等风险因素，发生窒息的风险更高。一家州立医院针对吞咽困难患者制定的管理方案，包括调整饮食、用餐时监测以及调整精神药物等干预措施。对于在无人监督的情况下不遵守饮食调整要求的吞咽困难患者，临床医生可能难以决定其特权和安置方式。对于许多此类患者而言，严密监督甚至安置在封闭病房似乎很有必要。作者建议采用风险效益评估方法：临床医生必须在限制措施所带来的安全保障与增加特权或安置在限制较少环境中所带来的益处之间取得平衡。还必须考虑生活质量和患者的偏好。
