Fisher W A
New York State Office of Mental Health, Creedmoor Psychiatric Center, Queens Village.
Am J Psychiatry. 1994 Nov;151(11):1584-91. doi: 10.1176/ajp.151.11.1584.
The author reviewed the literature published since 1972 concerning restraint and seclusion.
The review began with a computerized literature search. Further sources were located through citations from articles identified in the original search.
The author synthesized the contents of the articles reviewed using the categories of indications and contraindications; rates of seclusion and restraint as well as demographic, clinical, and environmental factors that affect these rates; effects on patients and staff; implementation; and training.
The literature on restraint and seclusion supports the following. 1) Seclusion and restraint are basically efficacious in preventing injury and reducing agitation. 2) It is nearly impossible to operate a program for severely symptomatic individuals without some form of seclusion or physical or mechanical restraint. 3) Restraint and seclusion have deleterious physical and psychological effects on patients and staff, and the psychiatric consumer/survivor movement has emphasized these effects. 4) Demographic and clinical factors have limited influence on rates of restraint and seclusion. 5) Local nonclinical factors, such as cultural biases, staff role perceptions, and the attitude of the hospital administration, have a greater influence on rates of restraint and seclusion. 6) Training in prediction and prevention of violence, in self-defense, and in implementation of restraint and/or seclusion is valuable in reducing rates and untoward effects. 7) Studies comparing well-defined training programs have potential usefulness.
作者回顾了自1972年以来发表的有关约束和隔离的文献。
该综述始于计算机化的文献检索。通过最初检索中确定的文章的参考文献找到了更多的资料来源。
作者使用适应证和禁忌证的类别；隔离和约束的发生率以及影响这些发生率的人口统计学、临床和环境因素；对患者和工作人员的影响；实施情况；以及培训等内容，对所综述文章的内容进行了综合。
关于约束和隔离的文献支持以下观点。1）隔离和约束在预防伤害和减少躁动方面基本有效。2）对于有严重症状的个体，若没有某种形式的隔离或身体或机械约束，几乎不可能开展相关项目。3）约束和隔离对患者和工作人员有有害的身体和心理影响，而精神疾病消费者/幸存者运动强调了这些影响。4）人口统计学和临床因素对约束和隔离的发生率影响有限。5）当地的非临床因素，如文化偏见、工作人员的角色认知以及医院管理部门的态度，对约束和隔离的发生率有更大影响。6）在暴力预测与预防、自卫以及约束和/或隔离实施方面的培训，对于降低发生率和不良影响具有重要价值。7）比较明确界定的培训项目的研究具有潜在用途。
