Chongtham Virtu, Sharma Nitasha, Parashar Kantadorshi, Pandey Chandani
Department of Psychiatry, Govt. Medical College and Hospital, Chandigarh, India.
J Neurosci Rural Pract. 2022 Aug 7;13(3):483-489. doi: 10.1055/s-0042-1750135. eCollection 2022 Jul.
The Mental Health Care Act of India, 2017 has for the first time focused on violence management interventions, especially restraint and seclusion in psychiatric settings, and recommended important guidelines in this aspect. This situation has created a strong need to review the prevalence of violence in inpatient settings, associated clinical and social correlates keeping a preventive model in context. Hence, this study was undertaken to fulfill this need. Methods: A retrospective matched case-control chart review design was employed. All patients who exhibited at least one violent incident during their ward stay were included. For each case, the control was selected by individual matching based on age ± 2 years and gender from patients who were admitted during the study period but did not exhibit any violent incident. The information about the characteristics of violent incidents and management was also collected. 8.80% of patients exhibited at least one incident of violence and a total of 186 violent incidents were recorded during the study period. Variables including involuntary admission, history of the previous admission, history of violence, impulsivity, lack of insight, and irritability at the time of admission significantly predicted the likelihood of violent incidents. The use of chemical restraining was the most common method of management of violent incidents. Violent incidents in psychiatric inpatient settings are still common. Efforts should be made to understand the risk as well as antecedent factors well in time. Verbal de-escalation should be employed and chemical and physical restraint should be used only as a last resort after exhausting the least restrictive interventions.
2017年《印度精神卫生保健法》首次关注暴力管理干预措施，尤其是精神科环境中的约束和隔离，并就此推荐了重要指导方针。这种情况使得迫切需要审视住院环境中暴力行为的发生率、相关的临床和社会关联因素，并结合预防模式进行考量。因此，开展了本研究以满足这一需求。方法：采用回顾性匹配病例对照图表审查设计。纳入所有在病房住院期间至少发生过一次暴力事件的患者。对于每例病例，从研究期间入院但未发生任何暴力事件的患者中，根据年龄±2岁和性别进行个体匹配选取对照。还收集了暴力事件特征和管理方面的信息。在研究期间，8.80%的患者至少发生过一次暴力事件，共记录了186起暴力事件。包括非自愿住院、既往住院史、暴力史、冲动性、自知力缺乏以及入院时的易怒等变量显著预测了暴力事件发生的可能性。使用化学约束是管理暴力事件最常用的方法。精神科住院环境中的暴力事件仍然很常见。应及时努力充分了解风险及先行因素。应采用言语缓和措施，只有在穷尽限制最小的干预措施后，才应将化学和身体约束作为最后手段使用。
