Steinert Tilman, Eisele Frank, Goeser Ulla, Tschoeke Stefan, Uhlmann Carmen, Schmid Peter
Centre for Psychiatry Weissenau, Clinical Department, Germany.
Clin Pract Epidemiol Ment Health. 2008 Nov 17;4:27. doi: 10.1186/1745-0179-4-27.
Self-directed and other violence as well as subsequent coercive interventions occur in a substantial proportion of patients with personality disorders during in-patient treatment. Different strategies may be required to reduce coercive interventions for patients of different diagnostic groups.
We specialised one of our acute admission wards in the treatment of personality disorders and adjustment disorders (ICD-10 F4 and F6). Patients are not transferred to other acute wards in case of suicidal or violent behaviour. Violent behaviour and coercive interventions such as seclusion or restraint were recorded in the same way as in the rest of the hospital. We recorded the percentage of subjects affected by diagnostic group and average length of an intervention in the year before and after the change in organisational structure.
The total number of coercive interventions decreased by 85% both among patients with an F4 and those with an F6 primary diagnosis. Violent behaviours decreased by about 50%, the proportion of involuntary committed patients decreased by 70%.
The organisational change turned out to be highly effective without any additional cost of personnel or other resources.
在住院治疗期间，相当一部分人格障碍患者会出现自我暴力和他人暴力行为以及随后的强制性干预措施。对于不同诊断组的患者，可能需要不同的策略来减少强制性干预措施。
我们将其中一个急性入院病房专门用于治疗人格障碍和适应障碍（国际疾病分类第十版F4和F6）。患者出现自杀或暴力行为时不会被转至其他急性病房。暴力行为和强制性干预措施（如隔离或约束）的记录方式与医院其他地方相同。我们记录了组织结构改变前后按诊断组划分的受影响受试者百分比以及干预的平均时长。
F4原发性诊断患者和F6原发性诊断患者中，强制性干预措施的总数均减少了85%。暴力行为减少了约50%，非自愿住院患者的比例减少了70%。
事实证明，组织变革非常有效，且无需额外的人力或其他资源成本。
