Verlinde A A, Noorthoorn E O, Snelleman W, van den Berg H, Snelleman-van der Plas M, Lepping P
Mediant mental health trust, 1050 7546 TA Broekheurnering, The Netherlands.
Forensic ward and long stay ward, Ggnet mental health trust, 12, Vordenseweg, 7231 DA Warnsveld, The Netherlands; VU medical centre, Amsterdam, The Netherlands; Dutch information centre of coercive measures, Bilthoven, The Netherlands.
Eur Psychiatry. 2017 Jan;39:86-92. doi: 10.1016/j.eurpsy.2016.08.002. Epub 2016 Dec 16.
In the Netherlands, seclusion is historically the measure of first choice in dealing with aggressive incidents. In 2010, the Mediant Mental Health Trust in Eastern Netherlands introduced a policy prioritising the use of enforced medication to manage aggressive incidents over seclusion. The main goal of the study was to investigate whether prioritising enforced medication over seclusion leads to a change of aggressive incidents and coercive measures.
The study was carried out with data from 2764 patients admitted between 2007 and 2013 to the hospital locations of the Mediant Mental Health Trust in Eastern Netherlands, with a catchment area of 500,000 inhabitants. Seclusion, restraint and enforced medications as well as other coercive measures were gathered systematically. Aggressive incidents were assessed with the SOAS-R. An event sequence analysis was preformed, to assess the whether seclusion, restraint or enforced medication were used or not before or after aggressive incidents.
Enforced medication use went up by 363% from a very low baseline. There was a marked reduction of overall coercive measures by 44%. Seclusion hours went down by 62%. Aggression against staff or patients was reduced by 40%.
When dealing with aggression, prioritising medication significantly reduces other coercive measures and aggression against staff, while within principles of subsidiarity, proportionality and expediency.
在荷兰，从历史上看，隔离一直是处理攻击性行为事件的首选措施。2010年，荷兰东部的梅迪安特心理健康信托机构出台了一项政策，优先使用强制药物治疗而非隔离来管理攻击性行为事件。该研究的主要目的是调查优先使用强制药物治疗而非隔离是否会导致攻击性行为事件和强制措施的变化。
该研究使用了2007年至2013年间入住荷兰东部梅迪安特心理健康信托机构医院的2764名患者的数据，其服务区域覆盖50万居民。系统收集了隔离、约束和强制用药以及其他强制措施的数据。使用SOAS-R评估攻击性行为事件。进行了事件序列分析，以评估在攻击性行为事件之前或之后是否使用了隔离、约束或强制用药。
强制用药的使用从非常低的基线上升了363%。总体强制措施显著减少了44%。隔离时长下降了62%。对工作人员或患者的攻击行为减少了40%。
在处理攻击行为时，优先使用药物治疗可在辅助性、相称性和权宜性原则范围内，显著减少其他强制措施以及对工作人员的攻击行为。
