Containment strategies for people with serious mental illness

 

Abstract

Background

The management of acutely disturbed people during periods of psychiatric crisis poses a particular challenge for mental health professionals. The challenge is to maintain safety while providing a safe and therapeutic environment. Non-pharmaceutical methods currently used to accomplish this include special observations, de-escalation, behavioural contracts and locking doors.

Objectives

To compare the effects of various strategies used to contain acutely disturbed people during periods of psychiatric crisis (excluding seclusion and restraint and the use of 'as prescribed medication).

Search methods

For the 2006 update of this review, we searched the Ovid interface of CINAHL, CENTRAL and The Schizophrenia Groups register, EMBASE, MEDLINE, PsycINFO.

Selection criteria

Relevant randomised controlled trials involving people hospitalised with serious mental illness, comparing any non-pharmacological interventions aimed at containing people who were at risk of harming themselves or others, (such as those approaches that change observation levels, lock wards, manage staff patient ratios, use de-escalation techniques or behavioural contracts).

Data collection and analysis

Trials would have been reliably quality assessed and data extracted. Relative risks (RR) and 95% confidence intervals (CI) would have been calculated with a random effects model. Where possible, numbers needed to treat and harm (NNT, NNH) would have been estimated.

Main results

The initial 1999 search identified over 2000 reports and the update search of 2006, an additional 2808 reports. Of these, only six seemed to have the potential to be relevant, but once they were obtained it was clear they could not be included. None focused upon non-pharmacological methods for containment of violence or self harm in people with serious mental illness.

Authors' conclusions

Current non-pharmacological approaches to containment of disturbed or violent behaviour are not supported by evidence from controlled studies. Clinical practice is based on evidence that is not derived from trials and continued practice entirely outside of well designed, conducted and reported randomised studies is difficult to justify.

 

Plain language summary

Containment strategies for people with serious mental illness

People with severe mental illness can experience violent and aggressive episodes which can threaten both their safety and that of their carers. We looked for trials comparing different non-pharmaceutical containment strategies for people with severe mental illness to measure their effects but found none. The widespread use of these strategies is subsequently not supported by evidence from randomised trials, although such studies are both ethical and possible.

 

摘要

背景

對嚴重精神疾病的管制策略

對於精神衛生專家而言，急性發作、混亂的精神疾病患者的管理是一個特別的挑戰。這個挑戰是藉由提供一個安全、治療性的環境來保有安全。目前使用非藥物的方法包括:觀察、降階、行為契約和鎖門

目標

比較用來管制急性發作、混亂的精神病患者的不同策略的效果。(不包括:隔離、約束，和使用處方藥物)

搜尋策略

這篇文獻是到2006年，我們搜尋the Ovid interface of CINAHL, CENTRAL 和 The Schizophrenia Groups register, EMBASE, MEDLINE, PsycINFO.

選擇標準

比較患有嚴重精神疾病的人入院治療的相關隨機控制試驗和非藥物處置(例如:各級的變化觀察、病房上鎖、管理工作人員和病人的比率、使用降階和行為契約)，以期管制會傷害自己或他人的病人

資料收集與分析

所挑選的研究是做好品質評估及資料摘錄。用隨機效果模式來計算相對風險 (RR)和95%信賴區間。視需要評估需要治療的人數和被傷害的病人數目(NNT, NNH)

主要結論

在1999年搜尋，超過2000篇研究，而到2006年再次搜尋，找到額外的2808篇。其中只有6篇可能跟這篇文獻有關，但是觀察下，它們都不應被納入。沒有一篇研究是利用非藥物的方法來管控嚴重精神疾病患者的暴力或自我傷害

作者結論

現今對混亂或暴力行為的非藥物取向的管制策略並非由研究支持。臨床上的應用也並非根據研究的證據，而繼續應用是完全不考量隨機研究的報告，是難以自圓其說的

翻譯人

本摘要由彰化基督教醫院胡淑惠翻譯

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

總結

患有嚴重精神疾病的人在某些時候會表現暴力和攻擊，常會威脅他們自己的安全和照顧者的安全。我們想要找有關非藥物的，對嚴重精神疾病的管制策略，並且來評估這些策略的效果，但是沒有找到。雖然這些的研究是符合倫理且可行的，但是這些廣泛使用的策略後來並沒有從研究中得到證據支持