Hsu Mei-Chi, Ouyang Wen-Chen
Department of Nursing, I-Shou University, Kaohsiung City 82445, Taiwan.
Department of Geriatric Psychiatry, Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan City 71742, Taiwan.
J Clin Med. 2022 Feb 22;11(5):1169. doi: 10.3390/jcm11051169.
Moral cognition is an important and multidimensional, but often overlooked, determinant of violence. Very few interventions have systematically examined the role of moral reasoning, anger management and problem-solving together in violence. A randomized controlled trial was conducted to comprehensively evaluate the sustained effects of an integrated Moral Reasoning Development Intervention (MRDI) in the management of repetitive violence in schizophrenia. This study placed special emphasis on essential components related to moral reasoning and violence in patients with schizophrenia. Evaluations, including measures of violence, moral reasoning, ethical valuation and judgement, decision-making, conflict management style, and personality traits, were performed at baseline, end of intervention, and 1-month follow-up after intervention. We found that MRDI was superior to treatment-as-usual, in improving moral reasoning and related variables and violence outcomes (p < 0.05). In comparison with the treatment-as-usual group (n = 22), patients in the MRDI group (n = 21) showed improved levels of moral reasoning, with decreased levels of violent behaviors. The MRDI participants also experienced significantly greater improvements or changes (p < 0.05) in their ethical valuation and judgement, decision-making style and preferences, and conflict management style. Our findings provide important implications for risk assessment and violence management and prevention.
道德认知是暴力行为一个重要且多维度但常被忽视的决定因素。极少有干预措施系统地考察道德推理、愤怒管理和解决问题在暴力行为中共同发挥的作用。开展了一项随机对照试验，以全面评估综合道德推理发展干预（MRDI）对精神分裂症患者反复出现的暴力行为管理的持续效果。本研究特别强调了精神分裂症患者中与道德推理和暴力行为相关的关键要素。在基线、干预结束时以及干预后1个月随访时进行了评估，包括暴力行为、道德推理、伦理评价与判断、决策、冲突管理风格以及人格特质等方面的测量。我们发现，在改善道德推理及相关变量和暴力行为结果方面，MRDI优于常规治疗（p < 0.05）。与常规治疗组（n = 22）相比，MRDI组（n = 21）的患者道德推理水平有所提高，暴力行为水平有所降低。MRDI参与者在伦理评价与判断、决策风格与偏好以及冲突管理风格方面也有显著更大的改善或变化（p < 0.05）。我们的研究结果对风险评估以及暴力行为的管理和预防具有重要意义。
