Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic.
BMC Psychiatry. 2013 Oct 11;13:257. doi: 10.1186/1471-244X-13-257.
Despite the recent increase of research interest in involuntary treatment and the use of coercive measures, gender differences among coerced schizophrenia patients still remain understudied. It is well recognized that there are gender differences both in biological correlates and clinical presentations in schizophrenia, which is one of the most common diagnoses among patients who are treated against their will. The extent to which these differences may result in a difference in the use of coercive measures for men and women during the acute phase of the disease has not been studied.
291 male and 231 female coerced patients with schizophrenia were included in this study, which utilized data gathered by the EUNOMIA project (European Evaluation of Coercion in Psychiatry and Harmonization of Best Clinical Practice) and was carried out as a multi-centre prospective cohort study at 13 centers in 12 European countries. Sociodemographic and clinical characteristics, social functioning and aggressive behavior in patients who received any form of coercive measure (seclusion and/or forced medication and/or physical restraint) during their hospital stay were assessed.
When compared to the non-coerced inpatient population, there was no difference in sociodemographic or clinical characteristics across either gender. However coerced female patients did show a worse social functioning than their coerced male counterparts, a finding which contrasts with the non-coerced inpatient population. Moreover, patterns of aggressive behavior were different between men and women, such that women exhibited aggressive behavior more frequently, but men committed severe aggressive acts more frequently. Staff used forced medication in women more frequently and physical restraint and seclusion more frequently with men.
Results of this study point towards a higher threshold of aggressive behavior the treatment of women with coercive measures. This may be because less serious aggressive actions trigger the application of coercive measures in men. Moreover coerced women showed diminished social functioning, and more importantly more severe symptoms from the "excitement/hostile" cluster in contrast to coerced men. National and international recommendation on coercive treatment practices should include appropriate consideration of the evidence of gender differences in clinical presentation and aggressive behaviors found in inpatient populations.
尽管最近人们对非自愿治疗和强制性措施的使用越来越感兴趣，但受强制的精神分裂症患者中的性别差异仍研究不足。众所周知，精神分裂症在生物学相关性和临床表现方面存在性别差异，这是最常见的非自愿治疗的诊断之一。这些差异在多大程度上可能导致男女患者在疾病的急性期使用强制性措施的差异尚未得到研究。
本研究纳入了 291 名男性和 231 名女性受强制的精神分裂症患者，该研究利用了 EUNOMIA 项目（欧洲精神病学强制评估和最佳临床实践协调）收集的数据，在欧洲 12 个国家的 13 个中心进行了多中心前瞻性队列研究。在住院期间，对接受任何形式强制性措施（隔离和/或强制服药和/或身体约束）的患者的社会人口统计学和临床特征、社会功能和攻击行为进行了评估。
与非强制性住院患者相比，无论性别如何，社会人口统计学或临床特征均无差异。然而，与受强制的男性患者相比，受强制的女性患者的社会功能更差，这一发现与非强制性住院患者不同。此外，男女之间的攻击行为模式不同，女性更频繁地表现出攻击行为，而男性更频繁地实施严重的攻击行为。工作人员更频繁地对女性使用强制服药，更频繁地对男性使用身体约束和隔离。
本研究结果表明，对女性采取强制性措施的攻击性行为门槛较高。这可能是因为男性更频繁地触发强制性措施来治疗较轻的攻击行为。此外，与受强制的男性相比，受强制的女性表现出社会功能减退，更重要的是，与受强制的男性相比，“兴奋/敌对”症状集群的症状更严重。强制性治疗实践的国家和国际建议应适当考虑到住院人群中临床表现和攻击行为的性别差异的证据。
