Troutman B, Myers K, Borchardt C, Kowalski R, Bubrick J
Division of Child Psychiatry, University of Iowa, Iowa City 52242-1057, USA.
J Am Acad Child Adolesc Psychiatry. 1998 May;37(5):554-8. doi: 10.1097/00004583-199805000-00018.
This article discusses the controversial use of restraints with a persistently violent adolescent on a child and adolescent psychiatry unit. The authors present an individualized program that used a series of ambulatory restraints on a long-term basis and prophylactically to contain the aggression of a psychotic girl. Clozapine was used concomitantly to control her psychosis. The prophylactic use of mechanical restraints allowed this teenager to be integrated into the milieu and to receive multiple treatments that the standard protocol precluded. This case underscores the difficulties in managing aggression when youths do not respond to standard protocols and do not conform to our assumptions about the least restrictive alternative. It is concluded that prophylactic mechanical restraint provided the least restrictive alternative to personal freedom for this teenager and had therapeutic benefit.
本文讨论了在儿童和青少年精神科病房对一名持续暴力的青少年使用约束措施这一颇具争议的问题。作者介绍了一个个性化方案，该方案长期且预防性地使用了一系列非固定约束措施来控制一名患有精神病女孩的攻击行为。同时使用氯氮平来控制她的精神病症状。预防性使用机械约束措施使这名青少年能够融入环境并接受标准方案所排除的多种治疗。该案例凸显了在青少年对标准方案无反应且不符合我们关于限制最少替代方案假设时，管理攻击行为的困难。得出的结论是，预防性机械约束措施为这名青少年的个人自由提供了限制最少的替代方案，并具有治疗益处。
