Pro Persona Pompestichting, Nijmegen, The Netherlands.
Pro Persona Research, Wolfheze, The Netherlands.
Adm Policy Ment Health. 2024 Sep;51(5):725-737. doi: 10.1007/s10488-024-01355-5. Epub 2024 Mar 23.
Disruptive behavior of patients in acute psychiatric care is a problem for both patients and staff. Preventing a patient's impending disruption requires recognizing and understanding early signals. There are indications that a change in a patient's global functioning may be such a signal. The global functioning of patients is a multidimensional view on their functioning. It captures a patient's psychological symptoms, social skills, symptoms of violence, and activities in daily living. The aim of this study was to gain insight into the predictive value of global functioning on the risk of disruptive behavior of patients in acute psychiatric care. Also assessed was the time elapsed between the change in global functioning and a patient's disruptive behavior, which is necessary to know for purposes of early intervention. In a longitudinal retrospective study, we used daily measurements with the Brøset Violence Checklist (BVC) and the Kennedy Axis V (K-As) of each patient admitted to two acute psychiatric units over a period of six years. Data from 931 patients for the first 28 days after their admission were used for survival analysis and cox regression analysis. Disruptive behavior was mostly observed during the first days of hospitalization. Global functioning predicted disruptive behavior from the very first day of hospitalization. A cut-off score of 48 or lower on the K-As on the first admission day predicted a higher risk of disruptive behavior. If functioning remained poor or deteriorated substantially over three days, this was an additional signal of increased risk of disruptive behavior. Improvement in global functioning was associated with a decreased risk of disruptive behavior. More attention is needed for early interventions on global functioning to prevent disruptive behavior.
急性精神病护理中患者的破坏性行为是患者和工作人员共同面临的问题。预防患者即将发生的破坏性行为需要识别和理解早期信号。有迹象表明，患者整体功能的变化可能就是这样的信号。患者的整体功能是对其功能的多维观察。它捕捉了患者的心理症状、社交技能、暴力症状和日常生活活动。本研究的目的是深入了解整体功能对急性精神病护理中患者破坏性行为风险的预测价值。还评估了整体功能变化与患者破坏性行为之间的时间间隔，这对于早期干预是必要的。在一项纵向回顾性研究中，我们使用了 Brøset 暴力检查表 (BVC) 和每位患者入院后六年内入住两个急性精神病病房的肯尼迪轴 V (K-As) 的每日测量。对入院后 28 天内的 931 名患者的数据进行了生存分析和 Cox 回归分析。破坏性行为大多发生在住院的最初几天。入院第一天的 K-As 得分为 48 或更低预示着更高的破坏性行为风险。如果功能在三天内持续较差或明显恶化，则是破坏性行为风险增加的另一个信号。整体功能的改善与破坏性行为风险的降低相关。需要更加关注早期干预整体功能，以预防破坏性行为。
