Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Curr Opin Psychiatry. 2009 Nov;22(6):582-6. doi: 10.1097/YCO.0b013e328330cd15.
Compulsory treatment is a common, yet controversial, practice in psychiatry. This paper reviews recent studies on the use of compulsory measures in hospital, the community and special populations.
Researchers continue to examine the rates and patterns of involuntary hospitalization. However, they have extended their investigations to care in the community, acknowledging it as the primary locus of treatment for most patients. Research shows that the implementation of community mental health legislation presents complex clinical and practical issues that require further investigation. Recognition that compulsory treatment is an objective event which is subjectively experienced by patients, families and clinicians has led to research investigating stakeholder views. The therapeutic relationship has been found to be an important modifier of the experience of compulsory treatment. Recent studies have also focused on specific coercive practices, such as forced medication and seclusion, and the use of these in patient subgroups, including those with eating disorders and adolescents. The debate about whether compulsory treatment is ethical continues in the literature.
Compulsory treatment in psychiatry remains an ethically and clinically contentious issue. As ethical concerns are generally countered by the argument that compulsory measures can lead to beneficial clinical outcomes, further empirical investigation in this area is required.
强制治疗是精神病学中一种常见但有争议的做法。本文综述了近期关于在医院、社区和特殊人群中使用强制措施的研究。
研究人员继续检查非自愿住院的比率和模式。然而，他们已经将调查范围扩大到社区护理，承认这是大多数患者的主要治疗场所。研究表明，实施社区精神卫生立法带来了复杂的临床和实际问题，需要进一步调查。认识到强制治疗是一种客观的事件，被患者、家属和临床医生主观地体验，这导致了对利益相关者观点的研究。治疗关系被发现是强制治疗体验的一个重要调节剂。最近的研究还集中在特定的强制性做法上，如强制用药和隔离，以及这些做法在特定患者群体中的应用，包括饮食失调症患者和青少年。关于强制治疗是否符合伦理道德的争论在文献中仍在继续。
精神病学中的强制治疗仍然是一个伦理和临床有争议的问题。由于伦理问题通常被认为是强制措施可以带来有益的临床结果的论点所抵消，因此需要在这一领域进行进一步的实证研究。
