Seclusion and restraint for people with serious mental illnesses

 

Abstract

Background

Seclusion and restraint are interventions used in the treatment and management of disruptive and violent behaviours in psychiatry. The use of seclusion varies widely across institutions. The literature does offer numerous suggestions for interventions to reduce or prevent aggression.

Objectives

1. To estimate the effects of seclusion and restraint compared to the alternatives for those with serious mental illnesses.
2. To estimate the effects of strategies to prevent seclusion and restraint in those with serious mental illnesses.

Search methods

Electronic searches of The Cochrane Controlled Trials Register (Issue 1, 1999) and The Cochrane Schizophrenia Group's Register (January 1999) were supplemented with additional searches of Biological Abstracts (1989-1999), CINAHL (1982-1999), EMbase (1980-1999), MEDLINE (1966-1999), MEDIC (1979-1999), PsycLIT (1974-1999), Sociofile (1974-1999), SPRI & SWEMED (1982-1999), Social Sciences Citation Index (1996-1999), and WILP (1983-1999). In addition, trials were sought by hand searching the reference lists of all identified studies and conference abstracts and contacting the first author of each relevant study.

Selection criteria

Randomised controlled trials were included if they focused on the use (i) of restraint or seclusion; or (ii) of strategies designed to reduce the need for restraint or seclusion in the treatment of serious mental illness.

Data collection and analysis

Studies were reliably selected, quality rated and data extracted. For dichotomous data relative risks (RR) with 95% confidence intervals (CI) were estimated. Normal continuous data were summated using the weighted mean difference (WMD).

Main results

1. Effect of seclusion and restraint
The search strategy yielded 2155 citations. Of these, the full articles for 35 studies were obtained. No studies met minimum inclusion criteria and no data were synthesised. Most of the 24 excluded studies focused upon the restraint of elderly, confused people and preventing them from wandering or falling.

2. Prevention of seclusion and restraint
Work ongoing.

Authors' conclusions

No controlled studies exist that evaluate the value of seclusion or restraint in those with serious mental illness. There are reports of serious adverse effects for these techniques in qualitative reviews. Alternative ways of dealing with unwanted or harmful behaviours need to be developed. Continuing use of seclusion or restraint must therefore be questioned from within well-designed and reported randomised trials that are generalisable to routine practice.

 

Plain language summary

Seclusion and restraint for people with serious mental illnesses

Synopsis pending.

 

摘要

背景

嚴重精神疾病患者的隔離和約束

在精神科隔離及約束是用來治療及處理破壞與暴力行為。各醫療院所對隔離使用方式不一,本回顧提供多減少或預防攻擊行為的建議治療方式

目標

1.估計隔離和約束與替代療法對嚴重精神疾病患者的影響.2.評估預防隔離和約束的策略對嚴重精神疾病患的療效

搜尋策略

電子搜尋The Cochrane Controlled Trials Register (Issue 1, 1999), The Cochrane Schizophrenia Group's Register (January 1999)和Biological Abstracts (1989 – 1999), CINAHL (1982 – 1999), EMbase (1980 – 1999), MEDLINE (1966 – 1999), MEDIC (1979 – 1999), PsycLIT (1974 – 1999), Sociofile (1974 – 1999), SPRI & SWEMED (1982 – 1999), Social Sciences Citation Index (1996 – 1999), and WILP (1983 – 1999). 手動搜尋相關試驗的文獻和會議摘要,連絡相關試驗第一作者

選擇標準

納入所有隨機對照試驗,對嚴重精神疾病患者比較(i)隔離和約束或(ii)用來減少隔離和約束的策略

資料收集與分析

仔細選擇試驗,評估品質和擷取資料. 計算二元資料的RR和95%CI.常態分布連續資料則用加權平均差表示(WMD)

主要結論

1.隔離和約束的效果. 得到2155篇文獻,取得其中35篇文獻全文。但沒有符合最低納入條件的.24個被排除試驗中，大部分研究限制老年人或意識混亂病人的活動,以減少亂走或摔倒.2.預防隔離和約束:仍在進行中

作者結論

沒有對照試驗對嚴重精神疾病患者評估隔離和約束的價值. 文獻指出這些作法有嚴重不良反應. 需要發展替代療法來處理不恰當或有害的行為. 有良好設計和撰寫並可推廣到例行療法的隨機試驗一定會質疑是否該使用持續性的隔離和約束。

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

摘要待補