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评估与管理有自杀倾向的患者:忘掉贝叶斯牧师吧,试试博弈论。

Assessing and managing the suicidal patient: forget the Reverend Bayes and try game theory.

作者信息

Nielssen Olav

机构信息

Macquarie University, Sydney, New South Wales, Australia.

出版信息

BJPsych Bull. 2025 Jun;49(3):169-173. doi: 10.1192/bjb.2024.76.

DOI:10.1192/bjb.2024.76
PMID:39291459
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12171854/
Abstract

Probability-based estimates of the future suicide of psychiatric patients are of little assistance in clinical practice. This article proposes strategic management of the interaction between the clinician and the patient in the assessment of potentially suicidal patients, using principles derived from game theory, to achieve a therapeutic outcome that minimises the likelihood of suicide. Further developments in the applications of large language models could allow us to quantify the basis for clinical decisions in individual patients. Documenting the basis of those decisions would help to demonstrate an adequate standard of care in every interaction.

摘要

基于概率对精神科患者未来自杀风险的评估在临床实践中帮助不大。本文提出,在评估潜在自杀患者时,运用博弈论的原理对临床医生与患者之间的互动进行策略性管理,以实现将自杀可能性降至最低的治疗效果。大语言模型应用的进一步发展可能使我们能够量化针对个体患者做出临床决策的依据。记录这些决策的依据将有助于在每次互动中证明达到了适当的护理标准。

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本文引用的文献

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Learning from partnership tensions in transcultural interdisciplinary case discussion seminars: A qualitative study of collaborative youth mental health care informed by game theory.从跨文化跨学科案例讨论研讨会上的合作紧张关系中学习:基于博弈论的合作青少年心理健康照护的定性研究。
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2
Suicide and all-cause mortality following routine hospital management of self-harm: Propensity score analysis using multicentre cohort data.常规医院处理自伤后的自杀和全因死亡率:使用多中心队列数据的倾向评分分析。
PLoS One. 2018 Sep 27;13(9):e0204670. doi: 10.1371/journal.pone.0204670. eCollection 2018.
3
Pokorny's complaint: the insoluble problem of the overwhelming number of false positives generated by suicide risk assessment.
波科尔尼的抱怨:自杀风险评估产生大量假阳性结果这一无法解决的问题。
BJPsych Bull. 2017 Feb;41(1):18-20. doi: 10.1192/pb.bp.115.053017.
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The limitations and future of violence risk assessment.暴力风险评估的局限性与未来
World Psychiatry. 2017 Feb;16(1):25-26. doi: 10.1002/wps.20394.
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Game theory and strategy in medical training.医学培训中的博弈论与策略
Med Educ. 2016 Nov;50(11):1094-1106. doi: 10.1111/medu.13116.
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Risk of suicide attempt and suicide death following completion of the Patient Health Questionnaire depression module in community practice.社区实践中完成患者健康问卷抑郁模块后自杀未遂和自杀死亡的风险。
J Clin Psychiatry. 2016 Feb;77(2):221-7. doi: 10.4088/JCP.15m09776.
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Predicting suicides after psychiatric hospitalization in US Army soldiers: the Army Study To Assess Risk and rEsilience in Servicemembers (Army STARRS).预测美国陆军士兵精神病院出院后的自杀率:军人研究评估风险和服役人员弹性(军人 STARRS)。
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