McMillan T M, Papadopoulos H, Cornall C, Greenwood R J
Atkinson Morleys Hospital, Copse Hill, London, UK.
Brain Inj. 1990 Oct-Dec;4(4):399-406. doi: 10.3109/02699059009026193.
Violent and sexually disinhibited behaviour together with poor self-care developed in a 38-year-old teacher following herpes simplex encephalitis. These behaviours were sufficiently severe to make rehabilitation difficult and return to the community impossible. Initially, only violent behaviour was treated, both by medication and a behaviour programme, and sexual disinhibition subsequently by the latter. In order to implement the programme a special (psychiatric) nurse was required on a 24 h basis. The incidence of violent behaviour was reduced from up to 55 times per day to zero over a period of 2 months. Whether this was affected by medication or behaviour management, or by spontaneous recovery, is discussed. Sexual disinhibition was eliminated in supervised settings, but continued to occur if left unsupervised and this improvement resulted from behaviour management. Poor personal hygiene also improved markedly over the 6-month period. The goal of returning the patient home to live with her family was achieved and she remained there at follow-up. This intervention was carried out in a rehabilitation unit that does not specialize in the treatment of such cases; clearly this has implications for cost and quality of care.
一名38岁的教师在患单纯疱疹性脑炎后出现了暴力和性抑制行为，同时自我护理能力差。这些行为严重到使康复变得困难，无法回归社区。最初，仅对暴力行为进行了治疗，包括药物治疗和行为干预计划，随后对性抑制行为采用了后者进行治疗。为了实施该计划，需要一名特殊（精神科）护士全天候值班。在2个月的时间里，暴力行为的发生率从每天多达55次降至零。讨论了这是受药物治疗、行为管理的影响，还是自发恢复的结果。在有监督的环境中，性抑制行为得以消除，但如果无人监督则会继续出现，这种改善是行为管理的结果。在6个月的时间里，个人卫生状况也有了显著改善。患者回家与家人生活的目标得以实现，随访时她仍住在家里。这项干预是在一个并非专门治疗此类病例的康复单位进行的；显然，这对成本和护理质量都有影响。
