Lawrence Ryan E, Rolin Stephanie A, Looney Diane V, Birt Adriane R, Stevenson Ellen M, Dragatsi Dianna, Appelbaum Paul S, Dixon Lisa B
Dr. Lawrence is Assistant Professor of Psychiatry, Department of Psychiatry, New York State Psychiatric Institute, New York, NY. Dr. Rolin is Research Fellow, Division of Law, Ethics, and Psychiatry, Department of Psychiatry, New York State Psychiatric Institute, New York, NY. Ms. Looney is Administrator for Psychiatry, Department of Psychiatry, New York Presbyterian Hospital, New York, NY. Dr. Birt is Assistant Professor of Psychiatry, Department of Psychiatry, Columbia University, New York, NY. Dr. Stevenson is Associate Professor of Psychiatry and Director of Psychiatry, Department of Psychiatry, Columbia University, New York, NY. Dr. Dragatsi is Associate Professor of Psychiatry, Columbia University and Associate Clinical Director, Department of Psychiatry, Rockland Psychiatric Center, Orangeburg, NY. Dr. Appelbaum is the Dollard Professor of Psychiatry, Medicine, and Law, and Directory of the Center for Law, Ethics, and Psychiatry, Department of Psychiatry, New York State Psychiatric Institute, New York, NY. Dr. Dixon is the Edna L. Edison Professor of Psychiatry and Director, Division of Behavioral Health Services and Policy Research, Department of Psychiatry, New York State Psychiatric Institute, New York, NY.
J Am Acad Psychiatry Law. 2020 Dec;48(4):484-495. doi: 10.29158/JAAPL.200022-20. Epub 2020 Oct 19.
Previous studies of physical assaults in hospitals focused primarily on inpatient psychiatric units, leaving unanswered questions about the extent to which findings generalize to psychiatric emergency rooms. Assault incident reports and electronic medical records from one psychiatric emergency room and two inpatient psychiatric units were reviewed. Qualitative methods were used to identify precipitants. Quantitative methods were used to describe characteristics of each event, as well as demographic and symptom profiles associated with incidents. During the five-year study period, there were 60 incidents in the psychiatric emergency room and 124 incidents on the inpatient units. Precipitating factors, incident severity, means of assault, and interventions were similar in both settings. Among patients in the psychiatric emergency room, a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder with manic symptoms (Adjusted Odds Ratio (AOR) 27.86) and presenting with thoughts to harm others (AOR 10.94) were associated with an increased likelihood of having an assault incident report. Similarities between assaults in the psychiatric emergency room and inpatient psychiatric units suggest that the broader literature from inpatient psychiatry can be generalized to the psychiatric emergency room setting, although some differences exist.
以往关于医院内身体攻击行为的研究主要集中在住院精神科病房，关于这些研究结果在多大程度上适用于精神科急诊室的问题尚无定论。对一家精神科急诊室和两个住院精神科病房的攻击事件报告及电子病历进行了审查。采用定性方法确定诱发因素。运用定量方法描述每个事件的特征，以及与事件相关的人口统计学和症状概况。在为期五年的研究期间，精神科急诊室发生了60起事件，住院病房发生了124起事件。两种环境下的诱发因素、事件严重程度、攻击方式和干预措施相似。在精神科急诊室的患者中，精神分裂症、分裂情感性障碍或伴有躁狂症状的双相情感障碍诊断（调整优势比[AOR]为27.86）以及出现伤害他人的想法（AOR为10.94）与攻击事件报告的可能性增加相关。精神科急诊室和住院精神科病房的攻击行为之间的相似性表明，尽管存在一些差异，但住院精神科的更广泛文献可以推广到精神科急诊室环境。
