Takahashi Yoshitomo
Department of Disaster Psychiatry, School of Medicine, University of Tsukuba.
Seishin Shinkeigaku Zasshi. 2012;114(12):1445-50.
Suicide by a patient in therapy, which is not a rare encounter for most psychiatrists, may be a traumatic experience for the treating psychiatrist. The psychiatrist should sincerely face the patient's suicide, which can be a part of crisis management in psychiatric care. If a patient commits suicide, appropriate care should be offered to: 1) the patient's family members, 2) other vulnerable patients, 3) medical and nursing staff, and 4) the treating psychiatrist and nurse in charge of the deceased patient. The patient's family members should be informed of patient factors before the suicide and the care required by the family members. Information on what actually happened before the suicide should be given to other patients, and individuals who are severely influenced by the suicide should be offered appropriate care. The medical and nursing staff should examine the case from the viewpoint of what they can learn from the death. With the help of the supervisor, the treating psychiatrist and nurse in charge of the deceased patient should look into the case, and his/her negative countertransference and attitude toward death and suicide. This can help the psychiatrist acquire better therapeutic skills for treating suicidal patients in the future.
接受治疗的患者自杀,这对大多数精神科医生来说并非罕见经历,对负责治疗的精神科医生而言可能是一次创伤性经历。精神科医生应真诚面对患者的自杀行为,这可成为精神科护理危机管理的一部分。如果患者自杀,应向以下各方提供适当护理:1)患者家属;2)其他易受影响的患者;3)医护人员;4)负责已故患者的主治精神科医生和护士。应告知患者家属自杀前的患者因素以及家属所需的护理。应向其他患者提供自杀实际发生情况的信息,对受自杀严重影响的个人应给予适当护理。医护人员应从此次死亡中能学到什么的角度审视该病例。在上级的帮助下,负责已故患者的主治精神科医生和护士应调查该病例,以及其消极的反移情和对死亡及自杀的态度。这有助于精神科医生在未来获得更好的治疗自杀患者的技能。