Nitschke Joachim, Sünkel Zara, Mokros Andreas
Klinik für Forensische Psychiatrie, Bezirksklinikum Ansbach, Feuchtwanger Straße 38, 91522, Ansbach, Deutschland.
Fern-Universität Hagen, Hagen, Deutschland.
Nervenarzt. 2020 May;91(5):439-445. doi: 10.1007/s00115-019-0752-0.
Patients suffering from severe mental disorders and who have an increased risk of violent behavior, tend to be insufficiently cared for until committing a violent offense leads to compulsory placement in a forensic psychiatric clinic.
The concept of the preventive outpatient clinic has been recently published in this journal. The aim of the study was to evaluate whether treatment in the outpatient clinic is preventive with respect to violence and whether there is a positive therapeutic outcome.
The study design was quasi-experimental and longitudinal. The control group consisted of comparable patients from an adjacent healthcare catchment area. Measurements were taken on admission (t) and after 6 and 12 months of treatment (t and t, respectively). Dynamic risk factors, i.e. subscales C and R of the history clinical risk-20 version 2 (HCR-20 V2) scale and global assessment of functioning (GAF) scale were used as indicators of treatment success, involving both clinician ratings and self-reports. Multiple imputed data for 70 subjects in the experimental group and 51 in the control group were analyzed by mixed effects models with group as a fixed effect.
The interaction effect between time and group was statistically significant for the R (risk management) subscale and the GFA values but not for the C (clinical risk) value (after Bonferroni correction), whereby controls were made for multiple testing.
The hypothesis with respect to the efficacy of the treatment could be maintained regarding risk markers and global assessment of functioning. With respect to clinical parameters there was a positive tendency in the expected direction. The data therefore indicate a positive effect of the preventive outpatient clinic for the patients treated.
患有严重精神障碍且有暴力行为风险增加的患者，在实施暴力犯罪导致被强制安置到法医精神病诊所之前，往往得不到充分的照料。
预防性门诊的概念最近已在本期刊发表。本研究的目的是评估门诊治疗对暴力行为是否具有预防性，以及是否有积极的治疗效果。
研究设计为准实验性和纵向研究。对照组由来自相邻医疗服务区域的可比患者组成。在入院时（t）以及治疗6个月和12个月后（分别为t和t）进行测量。动态风险因素，即历史临床风险-20第2版（HCR-20 V2）量表的C和R子量表以及功能总体评估（GAF）量表，被用作治疗成功的指标，包括临床医生评分和自我报告。对实验组的70名受试者和对照组的51名受试者的多重插补数据，采用以组为固定效应的混合效应模型进行分析。
时间和组之间的交互作用对于R（风险管理）子量表和GFA值具有统计学意义，但对于C（临床风险）值不具有统计学意义（经Bonferroni校正后），同时对多重检验进行了控制。
关于治疗效果的假设在风险标志物和功能总体评估方面可以成立。在临床参数方面，有朝着预期方向的积极趋势。因此，数据表明预防性门诊对接受治疗的患者有积极作用。
