Saccaro Luigi F, Privé Barbara, D'Imperio Ambra, Bridel Claire, Sentissi Othman, Wullschleger Alexandre
Psychiatry Department, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Psychiatry Department, Geneva University Hospital, Geneva, Switzerland.
Front Psychiatry. 2025 Feb 5;16:1543563. doi: 10.3389/fpsyt.2025.1543563. eCollection 2025.
Coercive measures in psychiatric practice are controversial due to their potential for severe negative effects. Ethical debates focus on respecting autonomy, minimizing damaging effects, and acting in the patient's best interest.
We present a unique case of a young patient suffering from a first episode of catatonic psychosis, in which striking this balance was especially difficult given the patient's complete mutism and opposition, given the absence of immediate danger to herself or others, the lack of anamnestic information, and her avoidance of social support, which would have meant that she would not have encountered psychiatric care, were it not for an exceptional government plan in place at the time of hospitalization. The patient showed a very favorable, persistent response to nonvoluntary treatment with haloperidol and lorazepam, which could be discussed and debriefed once she recovered, after almost 5 months of hospitalization and follow-up.
Arguments for and against nonvoluntary treatment are reviewed based on discussion with the local ethics committee, providing a useful reference for future similar cases. Finally, this case highlights an atypical onset of psychosis in a previously high-functioning individual and explores the mental health impact of international tensions, particularly the Russian-Ukrainian war, on individuals.
精神科实践中的强制手段因其可能产生严重负面影响而备受争议。伦理辩论聚焦于尊重自主性、将损害性影响降至最低以及为患者的最大利益行事。
我们呈现了一个独特的病例，一名患有紧张性精神病首发的年轻患者。鉴于患者完全缄默和抵触，鉴于对她自己或他人不存在直接危险，缺乏既往病史信息，且她回避社会支持，若不是住院时实施了一项特殊的政府计划，这意味着她不会接受精神科护理，所以在这种情况下要达成这种平衡格外困难。患者对氟哌啶醇和劳拉西泮的非自愿治疗表现出非常良好且持续的反应，在住院及随访近5个月后她康复后，可以对此进行讨论和汇报。
基于与当地伦理委员会的讨论，对支持和反对非自愿治疗的观点进行了审视，为未来类似病例提供了有益参考。最后，该病例凸显了一名此前功能良好的个体出现的非典型精神病发作，并探讨了国际紧张局势，尤其是俄乌战争对个人心理健康的影响。
