如何改善精神科强制医疗中的临床实践：来自 EUNOMIA 欧洲多中心研究的建议。
How to improve clinical practice on forced medication in psychiatric practice: Suggestions from the EUNOMIA European multicentre study.
机构信息
Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy.
Department of Psychiatry, Medical University Sofia, Sofia, Bulgaria.
出版信息
Eur Psychiatry. 2018 Oct;54:35-40. doi: 10.1016/j.eurpsy.2018.07.002. Epub 2018 Aug 15.
BACKGROUND
The decision to adopt forced medication in psychiatric care is particularly relevant from a clinical and ethical viewpoint. The European Commission has funded the EUNOMIA study in order to develop European recommendations for good clinical practice on coercive measures, including forced medication.
METHODS
The recommendations on forced medication have been developed in 11 countries with the involvement of national clinical leaders, key-professionals and stakeholders' representatives. The national recommendations have been subsequently summarized into a European shared document.
RESULTS
Several cross-national differences exist in the use of forced medication. These differences are mainly due to legal and policy making aspects, rather than to clinical situations. In fact, countries agreed that forced medication can be allowed only if the following criteria are present: 1) a therapeutic intervention is urgently needed; 2) the voluntary intake of medications is consistently rejected; 3) the patient is not aware of his/her condition. Patients' dignity, privacy and safety shall be preserved at all times.
CONCLUSION
The results of our study show the need of developing guidelines on the use of forced medication in psychiatric practice, that should be considered as the last resort and only when other therapeutic option have failed.
背景
在精神科护理中，决定采用强制药物治疗从临床和伦理角度来看尤为重要。为了制定关于强制性措施（包括强制药物治疗）的良好临床实践的欧洲建议，欧盟委员会资助了 EUNOMIA 研究。
方法
在 11 个国家，有国家临床领导、关键专业人员和利益攸关方代表的参与，制定了关于强制药物治疗的建议。随后，这些国家的建议被总结为一份欧洲共享文件。
结果
在强制药物治疗的使用方面存在一些跨国差异。这些差异主要是由于法律和政策制定方面的原因，而不是临床情况。事实上，各国一致认为，只有在以下情况下才可以允许强制药物治疗：1）急需治疗干预；2）患者持续拒绝自愿服用药物；3）患者不知道自己的病情。应始终保护患者的尊严、隐私和安全。
结论
我们的研究结果表明，有必要制定精神科实践中使用强制药物治疗的指南，该指南应被视为最后的手段，只有在其他治疗选择失败时才应使用。
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