Hughes D H
Psychiatric Emergency Service, Cambridge Hospital, MA 02139, USA.
Gen Hosp Psychiatry. 1996 Nov;18(6):416-21. doi: 10.1016/s0163-8343(96)00037-0.
Psychiatrists are increasingly expected to predict and prevent the suicidal and violent/homicidal impulses of their clients. This article reviews the current literature and research in these areas. While the debate continues on whether the clinician can successfully predict either violence or suicidal behavior in their patients, the preponderance of studies weighs in that predicting suicide and violence in the individual may not be possible currently given present knowledge. To compensate for forecasting limitations, conservative clinicians deliberately overpredict suicide or violence to help insure the safety of their patients and the greater communities in which they reside. In addition, clinicians need to perform thorough assessments and make logical clinical decisions that are in line with the perceived risks. Preventive measures for violence remain complex, but clinicians can maximize treatment effects by following specific intervention guidelines. Minimally, documentation concerning violence needs to focus on the rationale for why treatment interventions were or were not implemented. The chart does not require lengthy notations but should include a reasonable assessment of risk and the delineation of a prudent course of action.
越来越多的人期望精神科医生能够预测并预防其患者的自杀及暴力/杀人冲动。本文回顾了这些领域的当前文献和研究。尽管关于临床医生能否成功预测患者的暴力行为或自杀行为的争论仍在继续，但大量研究表明，鉴于目前的知识水平，目前可能无法预测个体的自杀和暴力行为。为了弥补预测方面的局限性，保守的临床医生会故意过度预测自杀或暴力行为，以确保其患者及其居住的更大社区的安全。此外，临床医生需要进行全面评估，并做出符合所感知风险的合理临床决策。预防暴力的措施仍然很复杂，但临床医生可以通过遵循特定的干预指南来最大限度地提高治疗效果。至少，关于暴力的记录需要关注实施或未实施治疗干预措施的理由。病历不需要冗长的记录，但应包括对风险的合理评估和谨慎行动方案的描述。
