Strain J J, DeMuth G W
Ann Surg. 1983 Feb;197(2):210-4. doi: 10.1097/00000658-198302000-00014.
The acutely psychotic self-amputee may be brought to the emergency room out of control, refusing treatment. Although these conditions make it difficult for the surgeon to provide restorative surgery, these patients may be quite grateful when resolution of psychosis restores realistic thinking and better judgment. This article describes the treatment of two such patients and provides practical guidelines for general behavioral management. The focal point of the approach is the formation of a surgeon/psychiatrist team that actively and consistently confronts and manages the disturbed behavior from the time the patient arrives in the emergency room until after discharge. Responsibility for deciding to operate when the patient is verbally refusing must be shared by surgeon and psychiatrist. Both surgeon and psychiatrist must be active in the treatment, each contributing his particular expertise to the collaborative effort.
急性精神病性自残患者可能会在失控状态下被送往急诊室，拒绝治疗。尽管这些情况使外科医生难以进行修复性手术，但当精神病症状消退，恢复现实思维和更好的判断力时，这些患者可能会非常感激。本文描述了对两名此类患者的治疗，并提供了一般行为管理的实用指南。该方法的重点是组建一个外科医生/精神科医生团队，从患者抵达急诊室到出院后，积极并持续地应对和管理其紊乱行为。当患者口头拒绝时，决定是否进行手术的责任必须由外科医生和精神科医生共同承担。外科医生和精神科医生都必须积极参与治疗，各自为合作努力贡献其特定的专业知识。
