Kashiwagi Hiroko, Yamada Yuji, Umegaki Yayoi, Takeda Koji, Hirabayashi Naotsugu
Department of Forensic Psychiatry, National Center of Neurology and Psychiatry, National Center Hospital, Tokyo, Japan.
Front Psychiatry. 2020 Nov 5;11:575529. doi: 10.3389/fpsyt.2020.575529. eCollection 2020.
Little is known about the opinions of forensic inpatients with psychotic disorders like schizophrenia on factors likely to prevent or decrease future violent behavior. To understand the perspectives of forensic inpatients with psychotic disorders on protective factors against risk of violent behavior and compare them to factors identified by professional staff. Using the Structured Assessment of Protective Factors (SAPROF) checklist for self-appraisal of violence risk, we conducted semi-structured interviews with 32 inpatients of the Medical Treatment and Supervision Act Ward and compared the results with those of professionals. Inpatients scored higher in the SAPROF total score, the motivational factors of "life goals" and "motivation for treatment," and the protective level in general. Inpatients scored themselves lower in risk level than professionals. The degree of agreement between service users' and professionals' evaluations was low for all categories except external factors. Inpatients prioritized "life goals," "self-control," and "medication" as the top three key strengths currently preventing violent behavior, whereas the professionals selected "life goals" less often. The top three important future goals for preventing future violence selected by inpatients were "work," "intimate relationships," and "life goals," with the former two being selected significantly less often by the professionals. This is the first study to shed light on Japanese forensic inpatients' perspectives about preventing future violent behavior. Despite professionals' underestimation, inpatients viewed themselves as having high motivation for treatment and positive life goals. Inpatients prioritized personal values such as life goals, work, and intimate relationships, whereas professionals prioritized understanding, treating, and observing the disease. Our findings are consistent with past reports on patients' and clinicians' perspectives. Awareness of such gaps in perceptions can help build fruitful therapeutic alliances. We discuss the implications in terms of treatment, how to address the gap therapeutically, and how to design treatment accordingly. Directions for future research are also discussed.
对于患有精神分裂症等精神障碍的法医住院患者，人们对可能预防或减少未来暴力行为的因素知之甚少。为了了解患有精神障碍的法医住院患者对预防暴力行为风险的保护因素的看法，并将其与专业人员确定的因素进行比较。我们使用保护因素结构化评估（SAPROF）清单对暴力风险进行自我评估，对《医疗治疗和监督法》病房的32名住院患者进行了半结构化访谈，并将结果与专业人员的结果进行了比较。住院患者在SAPROF总分、“生活目标”和“治疗动机”等动机因素以及总体保护水平方面得分更高。住院患者对自身风险水平的评分低于专业人员。除外部因素外，服务使用者和专业人员评估之间的一致程度在所有类别中都很低。住院患者将“生活目标”“自我控制”和“药物治疗”列为目前预防暴力行为的三大关键优势，而专业人员较少选择“生活目标”。住院患者选择的预防未来暴力的三大重要未来目标是“工作”“亲密关系”和“生活目标”，专业人员选择前两项的频率明显较低。这是第一项揭示日本法医住院患者对预防未来暴力行为看法的研究。尽管专业人员估计不足，但住院患者认为自己有很高的治疗动机和积极的生活目标。住院患者将生活目标、工作和亲密关系等个人价值观放在首位，而专业人员则将对疾病的理解、治疗和观察放在首位。我们的研究结果与过去关于患者和临床医生观点的报告一致。意识到这种认知差距有助于建立富有成效的治疗联盟。我们将从治疗角度讨论其影响，如何从治疗上解决差距，以及如何据此设计治疗方案。还讨论了未来研究的方向。
