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DOI: 10.1055/s-0042-105861
Psychiatrische Zwangsmaßnahmen: Prävention und Präferenzen aus Patientenperspektive
Coercive Interventions in Psychiatry: Prevention and Patients’ PreferencesPublication History
Publication Date:
11 July 2016 (online)
Zusammenfassung
Anliegen Präventionsstrategien und Präferenzen von Zwangsmaßnahmen (ZM) wurden aus der Sicht von psychiatrischen Patienten erfasst.
Methode Teilstrukturierte Interviews mit 90 überwiegend zwangserfahrenen Patienten mit psychotischen Erkrankungen.
Ergebnis und Diskussion Aus Patientensicht könnten ZM durch ein größeres Angebot an Einzeltherapien, Verbesserungen der Personalschlüssel, Ausbildung und Kommunikation sowie räumliche Rückzugsmöglichkeiten reduziert werden. Die Mehrheit der Befragten präferierte eine – im Falle der Selbstgefährdung durch Festhalten, bei Fremdgefährdung durch Fixierung ermöglichte – Zwangsmedikation gegenüber anderen Sicherungsmaßnahmen.
Abstract
Objective This study explores patients’ preferences and measures of prevention of coercive methods in psychiatric treatment.
Methods Structured interviews of 90 patients with psychotic disorders were undertaken, most of whom had previously experienced coercive methods.
Results Participants saw preventive potential in a wider availability of individual non-pharmacological therapy, improvement of staff professional competence and communication skills, high staff-to-patient ratios and retreat facilities. The majority of participants preferred forced medication and manual restraint in case of self-endangerment, and forced medication and mechanical restraint in the event of endangerment of others.
Conclusion Patients’ suggestions relating to prevention of coercion are in line with most expert’s opinions. In case coercive methods are required, manual restraint and application of forced medication is accepted as the treatment of choice according to most patients in case of self-endangerment.
Keywords
coercion - involuntary treatment - consumers’ perspective - prevention strategies - preference* Beide Autorinnen haben gleiche Anteile zu dieser Arbeit beigetragen.
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Literatur
- 1 Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde. Achtung der Selbstbestimmung und Anwendung von Zwang bei der Behandlung von psychisch erkrankten Menschen – Eine ethische Stellungnahme der DGPP. (23.09.2014). Im Internet: www.dgppn.de/en/presse/pressemitteilungen/detailansicht/article/307/achtung-der.html (Stand 17.12.2015)
- 2 Terkelsen TB, Larsen IB. Fear, danger and aggression in a Norwegian locked psychiatric ward: Dialogue and ethics of care as contributions to combating difficult situations. Nurs Ethics
- 3 Bundesverfassungsgericht (BVerfG). Beschluss des Zweiten Senats vom 23. März 2011. – 2 BvR 882/09 – Rn. (1-83) (23.3.2011). Im Internet: www.bverfg.de/e/rs20110323_2bvr088209.html (Stand: 17.12.2015)
- 4 Müller S, Walter H, Heinz A. Zwangsbehandlungen bei psychisch Kranken: Fixieren statt behandeln?. Dtsch Ärztebl International 2012; 109: 198-202
- 5 Steinert T, Hinüber W, Arenz D. et al. Ethische Konflikte bei der Zwangsbehandlung schizophrener Patienten. Nervenarzt 2001; 72: 700-708
- 6 Petit M, Klein JP. Zwangsbehandlung mit richterlicher Genehmigung wieder möglich. Dtsch Arztebl 2013; 110: 377-379
- 7 Berry K, Ford S, Jellicoe-Jones HG. PTSD symptoms associated with the experiences of psychosis and hospitalisation: a review of the literature. Clin Psychol Rev 2013; 33: 526-538
- 8 Grubaugh AL, Frueh BC, Zinzow HM. et al. Patients’ perceptions of care and safety within psychiatric settings. Psychol Serv 2007; 4: 193-201
- 9 O’Donoghue B, Lyne J, Hill M. et al. Physical coercion, perceived pressures and procedural justice in the involuntary admission and future engagement with mental health services. Eur Psychiatry 2011; 26: 208-214
- 10 Swartz MS, Swanson JW, Hannon MJ. Does fear of coercion keep people away from mental health treatment? Evidence from a survey of persons with schizophrenia and mental health professionals. Behav Sci Law 2003; 21: 459-472
- 11 Lincoln TM, Heumann K, Teichert M. The last resort? An overview on discussion and research on the use of compulsary drug treatment in psychiatry. Verhaltenstherapie 2014; 24: 22-32
- 12 Nelstrop L, Chandler-Oatts J, Bingley W. et al. A systematic review of the safety and effectiveness of restraint and seclusion as interventions for the short-term management of violence in adult psychiatric inpatient settings and emergency departments. Worldviews Evid Based Nurs 2006; 3: 8-18
- 13 Lang UE, Hartmann S, Schulz-Hartmann S. et al. Do locked doors in psychiatric hospitals prevent patients from absconding?. Eur J Psychiat 2010; 24: 199-204
- 14 Ketelsen R, Zechert C, Driessen M. Kooperationsmodell zwischen psychiatrischen Kliniken mit dem Ziel der Qualitätssicherung bei Zwangsmaßnahmen. Psychiat Prax 2007; 34: 208-211
- 15 Anderl-Doliwa B, Breitmaier J, Elsner S. et al. Leitlinien für den Umgang mit Zwangsmaßnahmen. Psych Pflege Heute 2005; 11: 100-102
- 16 Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde e. V. (DGPPN). Therapeutische Maßnahmen bei aggressivem Verhalten in der Psychiatrie und Psychotherapie. Heidelberg: Springer; 2010
- 17 Steinert T, Bohnet U, Eisele F. et al. Freiheitseinschränkende Zwangsmaßnahmen bei Patienten in psychiatrischen Krankenhäusern. Epidemiologie und Qualitätsaspekte. Nervenarzt 2006; 12: 1539-1544
- 18 Georgieva I, Mulder CL, Wierdsma A. Patients’ Preference and Experiences of Forced Medication and Seclusion. Psychiatr Q 2012; 83: 1-13
- 19 Bergk J, Einsiedler B, Flammer E. et al. A Randomized Controlled Comparison of Seclusion and Mechanical Restraint in Inpatient Settings. Psychiatr Serv 2011; 62: 1310-1317
- 20 Steinert T, Birk M, Flammer E. et al. Subjective Distress After Seclusion or Mechanical Restraint: One-Year Follow-Up of a Randomized Controlled Study. Psychiatr Serv 2013; 64: 1012-1017
- 21 Steinert T. After 200 years of psychiatry: are mechanical restraints in Germany still inevitable?. Psychiat Prax 2011; 38: 348-351
- 22 Bundesärztekammer. Stellungnahme der Zentralen Kommission zur Wahrung ethischer Grundsätze in der Medizin und ihren Grenzgebieten (Zentrale Ethikkommission) bei der Bundesärztekammer Zwangsbehandlung bei psychischen Erkrankungen. Dtsch Ärztebl 2013; 110: A-1334 / B-1170 / C-1154
- 23 van der Schaaf PS, Dusseldorp E, Keuning FM. et al. Impact of the physical environment of psychiatric wards on the use of seclusion. Br J Psychiatry 2013; 202: 142-149
- 24 Kho K, Sensky T, Mortimer A. et al. Prospective study into factors associated with aggressive incidents in psychiatric acute admission wards. Br J Psychiatry 1998; 172: 38-43
- 25 Lanza M, Kayne H, Hicks C. et al. Environmental characteristics related to patient assault. Iss Ment Health Nurs 1994; 15: 319-335
- 26 Dresler T, Rohe T, Weber M. et al. Effects of improved hospital architecture on coercive measures. World Psychiatry 2015; 14: 105-106
- 27 van der Merwe M, Bowers L, Jones J. et al. Locked doors in acute inpatient psychiatry: a literature review. J Psychiatr Ment Health Nurs 2009; 16: 293-299
- 28 Chou KR, Lu RB, Mao WC. Factors relevant to patient assaultive behavior and assault in acute inpatient psychiatric untis in Taiwan. Arch Psychiat Nurs 2002; 16: 187-195
- 29 Soininen P, Putkonen H, Joffe G. et al. Methodological and ethical challenges in studying patients’ perceptions of coercion: a systematic mixed studies review. BMC Psychiatry 2014; 14: 162
- 30 Nelstrop L, Chandler-Oatts J, Bingley W. et al. A systematic review of the safety and effectiveness of restraint and seclusion as interventions for the short-term management of violence in adult psychiatric inpatient settings and emergency departments. Worldviews Evid Based Nurs 2006; 3: 8-18
- 31 National Collaborating Centre for Mental Health. Violence and Aggression – Short-term management in mental health, health and community settings. 2015. Im Internet: www.nice.org.uk/guidance/ng10/evidence/full-guideline-70830253 (Stand: 17.02.2015)
- 32 Bowers L, Jarrett M, Clark N. et al. Absconding: why patients leave. J Psychiatric Mental Health Nurs 1999; 6: 199-205
- 33 Dilling H, Mombour W, Schmidt MH. et al. Internationale Klassifikation psychischer Störungen: ICD-10 Kapitel V (F) Klinisch-diagnostische Leitlinien. 5. Aufl. Bern: Hans Huber; 2004
- 34 Mielau J, Gallinat J, Heinz A. et al. Subjective experience of coercion in psychiatric care: a study comparing the attitudes of patients and healthy volunteers towards coercive methods and their justification. Eur Arch Psychiatry Clin Neurosci
- 35 Young RC, Biggs JT, Ziegler VE, Meyer DA. Young Mania Rating Scale. Handbook of Psychiatric Measures. Washington, DC: American Psychiatric Association; 2000: 540-542
- 36 Addington D, Addington J, Maticka-Tyndale E. et al. Reliability and validity of a depression rating scale for schizophrenia. Schizophrenia Res 1992; 6: 201-208
- 37 Müller MJ, Benkert O. German version of the Calgary Depression Rating Scale for Schizophrenia (CDSS): Validity and Specificity. Pharmacopsychiatry 1999; 32: 198
- 38 Kay S, Fiszbein A, Opler L. The positive and negative syndrome scale (PANSS) for Schizophrenia. Schiz Bull 1987; 13: 261-276
- 39 American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, DC: American Psychiatric Association; 1994
- 40 David AS. Insight and psychosis. Br J Psychiatry 1990; 156: 798-808
- 41 Mahler L, Jarchov-Jádi I, Montag C, Gallinat J. Das Weddinger Modell. Resilienz- und Ressourcenorientierung im klinischen Kontext. 1. Aufl. Bonn: Psychiatrie-Verlag; 2013
- 42 Ljungberg A, Denhov A, Topor A. The Art of Helpful Relationships with Professionals: A Meta-ethnography of the Perspective of Persons with Severe Mental Illness. Psychiat Quart 2015; 86: 471-495
- 43 Sheehan KA, Burns T. Perceived coercion and the therapeutic relationship: a neglected association?. Psychiatr Serv 2011; 62: 471-476
- 44 Beauford JE, McNiel DE, Binder RL. Utility of the initial therapeutic alliance in evaluating psychiatric patients’ risk of violence. Am J Psychiatry 1997; 154: 1272-1276
- 45 Schöttle D, Schimmelmann BG, Karow A. et al. Effectiveness of integrated care including therapeutic assertive community treatment in severe schizophrenia spectrum and bipolar I disorders: the 24-month follow-up ACCESS II study. J Clin Psychiatry 2014; 75: 1371-1379
- 46 Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde. Behandlungsleitlinie Psychosoziale Therapien bei Menschen mit schweren psychischen Erkrankungen. Heidelberg: Springer; 2012
- 47 Needham I, Abderhalden C, Meer R. et al. The effectiveness of two interventions in the managements of patient violence in acute mental inpatient settings: report on a pilot study. J Psych Men Health Nurs 2004; 11: 595-601
- 48 Lang UE. Innovative Psychiatrie mit offenen Türen. Berlin, Heidelberg: Springer; 2013
- 49 Price O, Baker J, Bee P. et al. Learning and performance outcomes of mental health staff training in de-escalation techniques for the management of violence and aggression. Br J Psychiatry 2015; 206: 447-455
- 50 Sheline Y, Nelson T. Patient choice: deciding between psychotropic medication and physical restraints in an emergency. Bull Am Acad Psych Law 1993; 21: 321-329
- 51 Naber D, Kircher T, Hessel K. Schizophrenic patients’ retrospective attitudes regarding involuntary psychopharmacological treatment and restraint. Eur Psychiatry 1996; 11: 7-11
- 52 Georgieva I, Mulder CL, Whittington R. Evaluation of behavioral changes and subjective distress after exposure to coercive inpatient interventions. BMC Psychiatry 2012; 12: 54
- 53 Georgieva I, Mulder CL, Noorthoorn E. Reducing seclusion through involuntary medication: a randomized clinical trial. Psychiatry Res 2013; 205: 48-53
- 54 Huf G, Coutinho ES, Adams CE. Physical restraints versus seclusion room for management of people with acute aggression or agitation due to psychotic illness (TREC-SAVE): a randomized trial. Psychol Med 2012; 42: 2265-2273
- 55 Bowers L, Wright S, Stewart D. Patients subject to high levels of coercion: staff’s understanding. Issues Ment Health Nurs 2014; 35: 364-371
- 56 Bowers L, van der Merwe M, Paterson B. et al. Manual restraint and shows of force: the City-128 study. Int J Ment Health Nurs 2012; 21: 30-40
- 57 Wesuls R, Heinzmann T, Pester U. et al. Das Vier-Stufen-Immobilisationskonzept (4-SIK), Revolutionierung der Fixierungspraxis?. Psych Pflege 2013; 19: 69-73
- 58 UN-General-Assembly. Convention on the rights of persons with disabilities. 2006. Im Internet: www.un.org/disabilities/convention/conventionfull/shtml (Stand: 17.12.2015)
- 59 Gaskin CJ, Elsom SJ, Happell B. Interventions for reducing the use of seclusion in psychiatric facilities: review of the literature. Br J Psychiatry 2007; 191: 298-303
- 60 Heinz A, Müller S, Wackerhagen C. et al. Human rights in psychiatry. Swiss Arch Neurol Psych 2015; 166: 4-7
- 61 Wolff J, Berger M, Normann C. et al. Wohin führt die Konvergenz der Psychiatriebudgets?. Nervenarzt 2015; 86: 852-856