Erickson W D, Realmuto G
J Clin Psychiatry. 1983 Jul;44(7):238-41.
The frequency and character of seclusion and restraint use on an adolescent psychiatric ward were analyzed by examining 369 written reports and comparing characteristics of low-frequency with high-frequency seclusion years. Contributors to high-frequency use of seclusion included lack of staff response to persistent limit testing, appeals to cognitive mechanisms and dynamic understanding at times of behavioral outbursts, staff conflicts, and unduly restrictive criteria for use of antipsychotic medications. Patients with borderline personality characteristics were allowed to act in increasingly disordered fashion without staff intervention before seclusion and restraint were used, and were likely to be secluded in disproportionately large numbers during outbreaks of violence. Changes in expectations and performance by staff lowered the number of seclusions by 66% during a period when the patient load increased.
通过审查369份书面报告，并比较低频隔离年份和高频隔离年份的特征，分析了青少年精神科病房使用隔离和约束的频率及特点。高频使用隔离的因素包括工作人员对持续的极限测试缺乏应对措施、在行为爆发时诉诸认知机制和动态理解、工作人员冲突以及使用抗精神病药物的标准过于严格。具有边缘型人格特征的患者在使用隔离和约束之前，在没有工作人员干预的情况下，行为越来越混乱，并且在暴力爆发期间，被隔离的人数可能会不成比例地增加。在患者数量增加的时期，工作人员期望和表现的改变使隔离次数减少了66%。
