Barnett Brian S, Kusunzi Veronica, Magola Lucy, Borba Christina Pc, Udedi Michael, Kulisewa Kazione, Hosseinipour Mina C
Department of Psychiatry, McLean Hospital; Department of Psychiatry, Harvard Medical School, Boston, USA.
Vanderbilt University School of Medicine, Nashville, USA.
Malawi Med J. 2018 Sep;30(3):197-204. doi: 10.4314/mmj.v30i3.12.
Data on the use of seclusion for psychiatric inpatients in sub-Saharan Africa are extremely limited. Though seclusion is sometimes necessary for patients that pose a threat to themselves or others, adverse physical and psychological sequelae from the experience are increasingly being recognized, leading to efforts to reduce its use. The purpose of this study was to calculate the frequency of seclusion in patients hospitalized in an inpatient psychiatric unit in Lilongwe, Malawi, and to identify factors associated with its use.
Records of 419 psychiatric inpatients hospitalized at Kamuzu Central Hospital's Bwaila Psychiatric Unit in Lilongwe, Malawi, from January 1, 2011 to December 31, 2011, were reviewed. Multivariate logistic regression analysis was employed to identify factors associated with the use of seclusion.
Seclusion was used for 30.3% (127/419) of patients during the study period. Male patients had increased odds of being secluded (aOR: 2.22, p=0.02). Assaulting other patients on the unit (aOR 7.92, p<0.01) and presenting to the unit in mechanical restraints (aOR 2.33, p<0.01) were also associated with seclusion. There was no association between seclusion and age; diagnosis of alcohol use disorder, marijuana use disorder, or schizophrenia; involuntary admission; presence of extra pyramidal side effects; presence of hallucinations; suicidality; or commission of violent acts prior to admission.
Documentation about the rationale for the use of seclusion on the unit was minimal. Improved record keeping requirements will be essential to future efforts to study seclusion and reduce its use. Development of strategies to address patient violence on the unit could decrease the use of seclusion for aggressive patients. Patients arriving to the unit in restraints would benefit from increased efforts by staff to apply behavioural interventions or administer medications, in order to deescalate these individuals and limit the use of seclusion in their treatment.
关于撒哈拉以南非洲地区精神病住院患者使用隔离措施的数据极其有限。尽管有时对于对自己或他人构成威胁的患者有必要进行隔离，但人们越来越认识到这种经历会带来不良的身体和心理后遗症，从而促使各方努力减少隔离措施的使用。本研究的目的是计算马拉维利隆圭一家住院精神科病房中住院患者的隔离频率，并确定与隔离使用相关的因素。
回顾了2011年1月1日至2011年12月31日在马拉维利隆圭卡木祖中央医院布瓦伊拉精神科病房住院的419名精神病患者的记录。采用多因素逻辑回归分析来确定与隔离使用相关的因素。
在研究期间，30.3%（127/419）的患者使用了隔离措施。男性患者被隔离的几率更高（校正比值比：2.22，p = 0.02）。在病房内袭击其他患者（校正比值比7.92，p < 0.01）以及戴着机械约束装置进入病房（校正比值比2.33，p < 0.01）也与隔离有关。隔离与年龄、酒精使用障碍、大麻使用障碍或精神分裂症的诊断、非自愿入院、锥体外系副作用的存在、幻觉的存在、自杀倾向或入院前实施暴力行为之间没有关联。
关于在病房使用隔离措施的理由记录极少。改进记录保存要求对于未来研究隔离措施并减少其使用的努力至关重要。制定应对病房内患者暴力行为的策略可以减少对有攻击行为患者的隔离使用。戴着约束装置进入病房的患者将受益于工作人员加大力度应用行为干预措施或给药，以便缓和这些人的情绪并限制在其治疗中使用隔离措施。
