Koekkoek Bauke, van Meijel Berno, Hutschemaekers Giel
Department of Outpatient Community Care of Altrecht Mental Health Care, Oude Arnhemseweg 260, Zeist, 3705 BK, the Netherlands.
Psychiatr Serv. 2006 Jun;57(6):795-802. doi: 10.1176/ps.2006.57.6.795.
This article provides an overview of what is known about "difficult patients" in mental health care. It aims to answer three main questions: What are the defining characteristics of difficult patients, how is the difficulty explained, and which treatment strategies are available?
A search of the MEDLINE, PsycINFO, and CINAHL databases was conducted for articles published between 1979 and 2004 that had "difficult patients" as their main topic, resulting in 94 eligible articles.
Characteristics of difficult patients in psychiatric care were consistent across several studies. Explanations for these difficulties widely varied: individual, interpersonal, and social factors were identified. Interventions were described in little detail and offered relatively few specific guidelines for daily practice, although some general principles are summarized. Difficult patients are classified into three subgroups, and some prevailing discourses on difficult patients in mental health care are discussed.
Treatment strategies or settings exist for two of the three groups of difficult patients-those with severe mental illness (unwilling care avoiders) and those with the least severe psychiatric symptoms but the most difficult behaviors (demanding care claimers). The remaining group (ambivalent care seekers), which consists of those who seek care but exhibit ambivalent behaviors that could be interpreted as both difficult and ill, is not supported sufficiently by effective treatment strategies. Further development and research into effective interventions is suggested for this group.
本文概述了心理健康护理中“难缠患者”的相关已知情况。其旨在回答三个主要问题：难缠患者的定义特征是什么，如何解释这种难缠情况，以及有哪些可用的治疗策略？
对MEDLINE、PsycINFO和CINAHL数据库进行检索，查找1979年至2004年间发表的以“难缠患者”为主要主题的文章，共得到94篇符合条件的文章。
多项研究中精神病护理中难缠患者的特征具有一致性。对这些难缠情况的解释差异很大：个体、人际和社会因素均被提及。干预措施的描述细节较少，且为日常实践提供的具体指导相对较少，不过总结了一些一般原则。难缠患者被分为三个亚组，并讨论了心理健康护理中关于难缠患者的一些主流观点。
对于三组难缠患者中的两组——患有严重精神疾病的患者（不愿接受护理者）和精神症状最轻但行为最难缠的患者（要求苛刻的护理者），存在治疗策略或相应的治疗环境。剩下的一组（矛盾的护理寻求者），即那些寻求护理但表现出矛盾行为（这些行为可被解释为既难缠又患病）的患者，目前没有足够有效的治疗策略支持。建议针对这一组进一步开发和研究有效的干预措施。
