Martinaki S, Tsopelas Ch, Ploumpidis D, Douzenis A, Tzavara H, Skapinakis P, Mavreas V
1st Psychiatric Clinic of the University of Athens-Εginition Hospital.
Psychiatriki. 2013 Jul-Sep;24(3):185-96.
There is a diachronic interest on the evaluation of the risk of violence by mental patients.Difficulties that have been underlined concern the definition of the term dangerousness and the different methods of approaching it. Accurate risk assessments are particularly important for psychiatric patients, with history of violence, in indoor care. The accuracy of predictions can better determine the patients designated as "at risk" for violence and avoid false designations. The aim of this study was to investigate the probability of patients, from several psychiatric units, to become violent after their discharge and over the next three years. We also investigate the predictive validity and accuracy of the HCR-20 in relation to post-discharge outcomes. Two hundred ninety five (295) psychiatric patients, from several psychiatric units, were assessed with the HCR-20, PCL: SV and GAF scales at discharge (using case file data, interviews with the patients and the clinicians of the units, and also information from the collateral informants) and were monitored for violent episodes over the following three years. The study was conducted in two phases: 1st phase: During the last week before discharge. 2nd phase: Every six months, over the following three years. Both the HCR-20 and PCL: SV scales and their subscales are significant predictors of readmission, suicide attempts and violent behavior. The GAF scale had a low positive correlation with the HCR-20 scale. A number of other variables such as duration of hospitalization, previous violent acts, diagnosis, gender, marital status, socioeconomic status, number of previous hospitalizations, were statistically related with failure of re-integration in the community. The results provide a strong evidence base that the HCR-20 is a good predictor of violent behavior in psychiatric patients, following their discharge from psychiatric wards in Greece, and hence can be used by clinicians in routine clinical practice.
对于评估精神病患者的暴力风险存在一种历时性的关注。所强调的困难涉及危险性这一术语的定义以及处理该问题的不同方法。准确的风险评估对于在室内护理中具有暴力史的精神病患者尤为重要。预测的准确性能够更好地确定被指定为有暴力“风险”的患者，避免错误指定。本研究的目的是调查来自多个精神科病房的患者在出院后及接下来三年发生暴力行为的可能性。我们还研究了HCR - 20与出院后结果相关的预测效度和准确性。来自多个精神科病房的295名精神病患者在出院时（使用病历数据、对患者及病房临床医生的访谈以及来自旁证的信息）接受了HCR - 20、PCL:SV和GAF量表的评估，并在接下来的三年中监测暴力事件。该研究分两个阶段进行：第一阶段：出院前最后一周。第二阶段：在接下来的三年中每六个月一次。HCR - 20和PCL:SV量表及其子量表都是再入院、自杀未遂和暴力行为的重要预测指标。GAF量表与HCR - 20量表呈低度正相关。一些其他变量，如住院时间、既往暴力行为、诊断、性别、婚姻状况、社会经济地位、既往住院次数，在统计学上与社区重新融入失败相关。结果提供了有力的证据基础，表明HCR - 20是希腊精神病患者出院后暴力行为的良好预测指标，因此临床医生可在常规临床实践中使用。
