綜合醫院精神科急性病房暴力事件分析

An Analysis of Aggressive Incidents in the Acute Psychiatric Ward of a General Hospital

張正辰(Cheng-Chen Chang)

《The Changhua Journal of Medicine》 6卷3期 (2001/07) Pp. 150-156

摘要

目的：本研究目的在探討綜合醫院精神科急性病房暴力事件發生的原因、特徵，並分析受攻擊者的反應。
方法：本研究為回溯性的研究，於研究期間內，選擇精神科急性病房住院的病人為研究對象。於每次事件後，登錄暴力事件表，詳細記載病人的基本資料、臨床症狀、暴力事件發生當時的狀況、受攻擊者的反應。
結果：於民國85年l月l日至87年12月31日止，在1413位住院人數中有149名病患(10.5%)共發生298人次的暴力事件，平均每月8.3人次；攻擊者的平均年齡為33.2歲；男性佔55.7%，女性佔44.3%; 70.5%的攻擊者沒有工作，僅26.2%攻擊者為有職業者，其餘3.4%為學生；最常發生攻擊事件的地點是病房的走廊，佔29.2%，其次是病房內、特別區及護理站； 53.6%的攻擊者其教育程度在國中以下，高中學歷者佔35.6%, 大專以上學歷者佔10.7%; 67.5%的攻擊者其精神科診斷為精神分裂症，其次為躁症、器質性精神病、其他的精神疾病、使用物質相關的精神疾患及憂鬱症； 52.1%的攻擊者在住院前二星期內曾有攻擊行為；發生暴力事件的主要原因依次是精神症狀所引起佔49.3%，其次為病人之間的衝突佔27.5%，工作人員與病人的衝突佔19.9%。工作人員與病人受到攻擊之後的身心反應不同。

關鍵字

暴力 ； 攻擊 ； 精神疾病的患者

並列摘要

Objective: The purpose of the study was to examine the incidence of aggressive behavior in an acute psychiatric unit to better understand the clinical significance and characteristics of inpatient violence.
Methods: The incidence of aggressive behavior was investigated from 1 January 1996 to 31 December 1998. Comprehensive psychiatric history and events preceding each aggressive incident were assessed.
Results: The 149 subjects (10.5%) had committed 298 assaults in a population of 1,413 hospitalized patients. The average number of aggressive incidents per month was 8.3. Their mean age was 33.2 years. Most aggressive patients were jobless (70.5%). The primary diagnosis was schizophrenia (67.5%). Other primary diagnoses were mania, organic mental disorder, psychotic disorder not otherwise specified (NOS), substance-related psychotic disorder and depression. The relative risk was higher especially in patients who had violent behavior just before admission. The responses of staff and the patient being attacked were different. The difference had statistical significance.
Conclusions: The occurrence of inpatient aggression is often unpredictable, and knowing how to prevent violence is very important.

並列關鍵字

violence ； aggression ； psychiatric patients