Nivoli Alessandra M A, Milia Paolo, Depalmas Cristiano, Nivoli Giancarlo, Biondi Massimo, Zanalda Enrico, Lorettu Liliana
Clinica Psichiatrica, Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali, Università di Sassari, AOU-Sassari.
Dipartimento di Neuroscienze Umane, Sapienza Università di Roma.
Riv Psichiatr. 2020 Nov-Dec;55(6):40-46. doi: 10.1708/3504.34906.
Treatment guidelines (GL) in psychiatry represent a useful and functional tool to be explored and enhanced in terms of the contribution of patient care and the promotion of scientific improvement. However, they show some limitations, both clinical and forensic. The objective of this paper is to examine the objectives, the clinical limitations and the applicability of the GL on professional liability (forensic aspects). From a clinical point of view, the GL have objectives that are functional to the promotion of physical and mental health, among which the constitutional observance of the right to health, the improvement of public health, the implementation of best clinical practices, the promotion of scientific research, the professional training of operators in the field of physical and mental health. However, GL cannot replace a contextualized clinical judgment. GL must be applied, in the single clinical case, in light of their multiple criticalities, including the limits of the methodology used for their formulation, the differences between the GL' recommendations, the difficulty of their application in daily clinical practice, the lack of specific treatment interventions. From a forensic psychiatric point of view, GL, as currently conceived, cannot be used in terms of professional liability without their interpretation on a legal basis with forensic psychiatric methodology, similarly to any other clinical and scientific information, with its qualifications and criticalities.
精神病学治疗指南（GL）是一种有用且实用的工具，在患者护理贡献和促进科学进步方面有待探索和完善。然而，它们在临床和法医方面都存在一些局限性。本文的目的是探讨GL在职业责任（法医方面）的目标、临床局限性和适用性。从临床角度来看，GL的目标有助于促进身心健康，其中包括对健康权的宪法遵守、公共卫生的改善、最佳临床实践的实施、科学研究的促进、身心健康领域从业者的专业培训。然而，GL不能取代情境化的临床判断。在单个临床病例中，必须根据GL的多种关键性因素来应用它们，包括其制定所使用方法的局限性、GL建议之间的差异、在日常临床实践中应用的难度、缺乏具体治疗干预措施等。从法医精神病学角度来看，就像任何其他临床和科学信息及其资质和关键性因素一样，按照目前的构想，GL在没有基于法医精神病学方法进行法律解释的情况下，不能用于职业责任方面。
