Nitschke J, Sünkel Z, Mokros A
Klinik für Forensische Psychiatrie, Bezirksklinikum Ansbach, Feuchtwanger Str. 38, 91522, Ansbach, Deutschland.
FernUniversität in Hagen, Hagen, Deutschland.
Nervenarzt. 2018 Sep;89(9):1054-1062. doi: 10.1007/s00115-018-0573-6.
Since 2012, a forensic preventive outpatient clinic has been established at Ansbach District Hospital to fill a gap in general psychiatric care for patients with schizophrenia or severe personality disorders and having a high risk for violent behavior. An interdisciplinary team drawing on forensic psychiatric knowledge applies instruments for forensic risk prognosis and treatment or interventions to prevent violent crimes and to protect potential victims. Admissions depend on certain criteria, e.g., increased risk potential for violent crimes against the background of schizophrenia or severe personality disorders.
How can a forensic psychiatric preventive treatment be organized, which helps to avoid detention in a forensic commitment and is complementary to general psychiatric treatment structures? Can such a model project reach the target group?
In forensic preventive outpatient care the treatment is based on violence prevention (e.g., psychoeducation, group training, individual treatment on violence risk co-management). Data are collected using general psychiatric and forensic instruments on, e.g., risk of violence (HCR-20), global functional level (GAF), violent behavior (SDAS-9) on a regular basis. The values with respect to these instruments on admission were compared to published key factors from population samples with general and forensic psychiatric patients.
A total of 146 patients between the ages of 18 and 79 years have so far been treated. About 4,000,000 EUR could be saved during the duration of the project because of preventing involuntary admission to a forensic hospital apart from preventing violent crimes. In contrast 3,000,000 EUR had to be spent for the new outpatient service.
Indications for the efficacy of a forensic preventive care for patients with schizophrenia and severe personality disorders with a risk for violence are confirmed. Therefore, an institutionalization and a statewide implementation of forensic preventive care in terms of the forensic preventive out-patient clinic are recommended.
自2012年以来，安斯巴赫地区医院设立了法医预防门诊，以填补精神分裂症或严重人格障碍且有暴力行为高风险患者在一般精神科护理方面的空白。一个利用法医精神病学知识的跨学科团队应用法医风险预后及治疗或干预手段，以预防暴力犯罪并保护潜在受害者。入院取决于某些标准，例如，在精神分裂症或严重人格障碍背景下暴力犯罪风险增加。
如何组织法医精神病学预防治疗，以帮助避免在法医强制住院中被拘留，并补充一般精神科治疗结构？这样一个示范项目能否触及目标群体？
在法医预防门诊护理中，治疗基于暴力预防（例如，心理教育、团体培训、暴力风险共同管理的个体治疗）。使用一般精神科和法医工具定期收集数据，例如关于暴力风险（HCR-20）、整体功能水平（GAF）、暴力行为（SDAS-9）的数据。将入院时这些工具的数值与已发表的一般和法医精神病患者人群样本的关键因素进行比较。
到目前为止，共治疗了146名年龄在18至79岁之间的患者。除了预防暴力犯罪外，由于防止非自愿入住法医医院，在项目期间节省了约400万欧元。相比之下，新的门诊服务花费了300万欧元。
对于有暴力风险的精神分裂症和严重人格障碍患者，法医预防护理的有效性得到了证实。因此，建议就法医预防门诊而言，将法医预防护理制度化并在全州范围内实施。
