Kocher Sophia, Swartz Marvin
From the Wilson Center for Science and Justice, Duke University School of Law and the Duke School of Medicine.
The Department of Psychiatry and Behavioral Sciences, Duke School of Medicine and the Wilson Center for Science and Justice, Duke University School of Law, Duke University, Durham North Carolina.
CNS Spectr. 2025 Jan 28;30(1):e17. doi: 10.1017/S1092852925000045.
Assisted Outpatient Treatment (AOT) is a controversial civil court program wherein a judge orders a person with severe mental illness to adhere to an outpatient treatment plan designed to improve treatment adherence, prevent relapse and dangerous deterioration. Several states, including California and New York, have recently promoted use of AOT to try to address high rates of homelessness among person with severe mental illness. Under AOT, clinicians treating these patients must balance the ethical principles of patient autonomy and beneficence, and employ AOT only when previous treatment failed as a result of treatment non-adherence. However, some critics of AOT argue that not only is it coercive and ineffective but that the court mandate to adhere to prescribed medications, usually antipsychotic medications, compels AOT recipients to take ineffective and even harmful medications. This article examines the assertion of these critics and reviews the evidence of antipsychotic effectiveness and potential harms in treating psychotic disorders under a civil court order.
辅助门诊治疗（AOT）是一项颇具争议的民事法庭程序，在此程序中，法官会命令患有严重精神疾病的人遵守旨在提高治疗依从性、预防复发和危险病情恶化的门诊治疗计划。包括加利福尼亚州和纽约州在内的几个州，最近都在推动使用AOT，试图解决严重精神疾病患者中高比例的无家可归问题。在AOT模式下，治疗这些患者的临床医生必须平衡患者自主和行善的伦理原则，并且只有在先前的治疗因治疗依从性差而失败时才采用AOT。然而，一些AOT的批评者认为，它不仅具有强制性且无效，而且法庭要求遵守规定的药物治疗，通常是抗精神病药物，迫使AOT接受者服用无效甚至有害的药物。本文审视了这些批评者的断言，并回顾了在民事法庭命令下使用抗精神病药物治疗精神障碍的有效性和潜在危害的证据。
