van de Sande Roland, Noorthoorn Eric, Wierdsma Andre, Hellendoorn Edwin, van der Staak Cees, Mulder Cornelius L, Nijman Henk
Department of Health, Utrecht University of Applied Science, Utrecht, Netherlands; Acute Psychiatric Care, ParnassiaGroep, Capelle aan den Ijsel, Netherlands.
Int J Ment Health Nurs. 2013 Dec;22(6):475-84. doi: 10.1111/inm.12033. Epub 2013 Jul 10.
Research findings indicate that the symptoms and behaviour of acute psychiatric patients can fluctuate drastically within hours, and that structured daily risk assessments can reduce the risk of aggressive incidents and the duration of seclusion. The aim of this study was to investigate the validity of two structured observation tools, the Brøset Violence Checklist (BVC) and the Kennedy Axis V), as an aid in seclusion-related clinical decision-making. In this study, 7403 day-to-day risk assessments were collected over 10 725 admission days (72% of the maximum number of structured assessments). A total of 7055 daily assessment scores from 301 acute psychiatric patients were used for the multilevel analysis. The sample demonstrated that dynamic and static factors were related to seclusion. Dynamic factors included dysfunctional scores on the item 'confusion' of the Brøset Violence Checklist, and psychological impairment and impairment of social skills on the Kennedy Axis V. Static factors included non-Western descent, male sex, age less than 35 years, unmarried, and to some extent, a personality disorder. McFadden's pseudo R(2) value showed that most of the final model was related to the dynamic factors. We concluded that the incorporation of the BVC and the Kennedy Axis V into standard practice was helpful in identifying patients at high risk of seclusion.
研究结果表明，急性精神病患者的症状和行为可能在数小时内急剧波动，而结构化的每日风险评估可以降低攻击事件的风险和隔离的时长。本研究的目的是调查两种结构化观察工具——布罗泽特暴力清单（BVC）和肯尼迪轴V——在与隔离相关的临床决策中的有效性。在本研究中，在10725个入院日收集了7403次日常风险评估（占结构化评估最大数量的72%）。来自301名急性精神病患者的总共7055份每日评估分数用于多层次分析。样本表明，动态因素和静态因素与隔离有关。动态因素包括布罗泽特暴力清单中“混乱”项目的功能失调得分，以及肯尼迪轴V上的心理障碍和社交技能障碍。静态因素包括非西方血统、男性、年龄小于35岁、未婚，以及在一定程度上的人格障碍。麦克法登的伪R(2)值表明，最终模型的大部分与动态因素有关。我们得出结论，将BVC和肯尼迪轴V纳入标准实践有助于识别有高隔离风险的患者。
