Worcester State Hospital, Massachusetts Department of Mental Health, Worcester, MA, USA.
Psychiatr Q. 2011 Jun;82(2):85-93. doi: 10.1007/s11126-010-9155-x.
Psychiatric patient assaults are a serious community health hazard. Risk management strategies to identify common single precipitants have had limited value and this limitation has resulted in the emergence of multiple determinant studies. This 16-year retrospective study of assault precipitants in one, public sector mental health-care system assessed single common, immediate precipitants; the multiple clinical precipitants of history of violence, personal victimization, and substance use disorder (the violence triad); and both combined. Denial of services, acute psychoses, and excess sensory stimulation were the most common single precipitants. The multicomponent violence triad yielded greater association with subsequent assault than single precipitants. The combination of the violence triad and single precipitants did not yield statistically significant greater associations. Discussion of the clinical risk management implication, and methodological issues are presented.
精神科患者攻击行为是严重的社区健康危害。识别常见单一诱发因素的风险管理策略价值有限，这导致了多种决定因素研究的出现。这项对一个公共部门精神卫生保健系统中攻击诱发因素的 16 年回顾性研究评估了单一常见的直接诱发因素；暴力史、个人受害和物质使用障碍的多种临床诱发因素（暴力三联征）；以及两者的结合。拒绝服务、急性精神病和过度感官刺激是最常见的单一诱发因素。多成分暴力三联征与随后的攻击行为的相关性大于单一诱发因素。暴力三联征和单一诱发因素的组合并没有产生统计学上显著更大的关联。本文还讨论了临床风险管理的意义和方法学问题。
