Krieger Eva, Fischer Rabea, Moritz Steffen, Nagel Matthias
Klinik für Psychiatrie und Psychotherapie, Asklepios Klinik Nord - Wandsbek, Jüthornstraße 71, 22043, Hamburg, Deutschland.
Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Deutschland.
Nervenarzt. 2021 Jan;92(1):44-49. doi: 10.1007/s00115-020-00969-y.
Research on measures to prevent or reduce the use of coercive measures is steadily gaining momentum in research. Post-seclusion/post-restraint debriefings with the affected patients are recommended in treatment guidelines but the effectiveness as an intervention has so far only scarcely been studied.
This article briefly outlines the existing literature on post-seclusion/post-restraint debriefings, the legal basis in Germany, recommendations by various treatment guidelines as well as the existing evidence of the effectiveness. Furthermore, challenges pertaining to the implementation of debriefings are discussed.
Various treatment guidelines recommend post-seclusion/post-restraint debriefings with patients and the individual Mental Health Laws (PsychKG) of the German federal states provide more or less specific guidance on how to implement the intervention. So far, hardly any scientific studies on the effectiveness of post-seclusion/post-restraint debriefings exist but they are already carried out in a variety of complex treatment concepts. Various parameters, e.g. who participates and when the debriefing is conducted, also vary across implementations. Initial pilot studies have shown indications for positive effects in terms of reducing coercive measures through the implementation of post-seclusion/post-restraint debriefings; however, structured debriefings are not yet part of routine practice.
Structured post-seclusion/post-restraint debriefings with patients constitute a possible intervention to reduce coercive measures, but as of now there is little scientific evidence for the efficacy. Incorporating them into complex therapeutic treatment concepts for ward programs appears to be meaningful.
预防或减少强制措施使用措施的研究在科研中势头渐强。治疗指南推荐对受影响患者进行隔离/约束后情况汇报,但作为一种干预措施的有效性目前研究甚少。
本文简要概述了关于隔离/约束后情况汇报的现有文献、德国的法律依据、各种治疗指南的建议以及有效性的现有证据。此外,还讨论了情况汇报实施过程中面临的挑战。
各种治疗指南推荐对患者进行隔离/约束后情况汇报,德国联邦各州的《精神健康法》(PsychKG)或多或少对如何实施该干预措施提供了具体指导。目前,几乎没有关于隔离/约束后情况汇报有效性的科学研究,但它们已在各种复杂的治疗概念中开展。不同的实施中,各种参数,如谁参与以及何时进行情况汇报,也各不相同。初步试点研究表明,通过实施隔离/约束后情况汇报,在减少强制措施方面有积极效果的迹象;然而,结构化的情况汇报尚未成为常规做法。
对患者进行结构化的隔离/约束后情况汇报是减少强制措施的一种可能干预措施,但目前几乎没有科学证据证明其疗效。将其纳入病房项目的复杂治疗概念中似乎是有意义的。