The Association between Psychiatric Inpatients’ Restraint/Seclusion and Diagnoses and Other Indicators of Taiwan Clinical Performance Indicators

精神科住院病人隔離約束與其他台灣臨床成效指標（TCPI）相關研究：比較經常及不常隔離約束精神病人之差異

蕭欽誌(Chin-Chih Hsiao)；戴月明(Yueh-Ming Tai)；蘇碧玉(Pi-Yu Su)

seclusion ； restraint ； Taiwan Clinic Performance Indicator (TCPI) ； psychiatry inpatients ； 隔離 ； 約束 ； 台灣臨床成效指標 ； 精神科住院病人

台灣精神醫學

31卷3期（2017 / 09 / 01）

214 - 221+iii

英文

Background: After introducing the concept of ＂restraint-free environment＂ in a hospital, we intended to study the changes of restraint/seclusion (R/S) uses in psychiatric units and associations with other psychiatric diagnoses and adversities by the frequency of R/S in their histories. Methods: With four-year database (2012 - 2015) of Taiwan Clinic Performance Indicator (TCPI) in one psychiatric teaching hospital, we included 1,921 psychiatric inpatients and compared their clinical adversities including R/S, and analyzed them in three groups - never-, infrequent- (less than or equal to twice) and frequent- (more than twice) R/S groups, namely, NR, IR, and FR groups. Results: About 80% of inpatients in TCPI records experienced R/S during this study period. A steady increasing trend of R/S uses was found over those study years. And the most frequent reason was electroconvulsive therapy (ECT)-related treatments (44%). FR group showed significantly higher prevalence in patients with schizophrenia, bipolar disorder, but significantly lower for those with adjustment disorder and major depression (all p ＜ 0.001), and significantly higher risks of almost other TCPI indicators (all p ＜ 0.001) except suicide attempt and against advice discharge. But the IR group were those more with adjustment disorder and major depression, and lowest prevalence of all other TCPI indicators than other groups. Conclusion: This study reconfirms the vigorous association between R/S and major psychiatric diagnoses and other TCPI indicators among psychiatric inpatients. But our findings first reveal that patients with less frequent R/S use may be more likely associated with depression and less likely with violence/aggression porn.

目的：本研究目的在了解隔離／約束與精神科相關異常事件之相關性，並比較經常組及不常組病人性質之異同。方法：本研究收集某精神科專科醫院住院病人四年（2012 至2015 年）台灣臨床成效指標 (TCPI) 記錄。並依四年內隔離約束次數區分經常組（大於等於3 次）、不常組（小於等於2 次）及對照組（0 次）作比較分析。結果：所有TCPI 歸人記錄中約有80% 個案有隔離／約束，原因 44% 為電氣痙攣 (ECT) 相關治療最多、40% 則為非ECT 相關治療及13% 感染隔離。經常組有顯著較高之思覺失調症及雙相情緒障礙症診斷 (p＜ 0.01)，同時在大部份其他 TCPI 指標中均有顯著的較高流行率 (p ＜ 0.001)。但不常組有較多之憂鬱症診斷且較低之其他 TCPI 指標比例相關性。討論：本研究發現精神科住院病人隔離約束的次數確與思覺失調症、雙相情緒障礙的診斷相關並與其他大部份TCPI 指標顯著的有關。不常隔離約束病人則並無上述相關且可能較多適應障礙及憂鬱症診斷，尤其較其他兩組更不具有攻擊或危險性。故其臨床上針對不常被隔離約束之個案施行隔離約束前，建議慎重考慮之。

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