DRUG TREATMENT REFUSAL IMPACT ON SEVERELY MENTALLY ILL

拒绝药物治疗对严重精神疾病患者的影响

• 批准号: 3384074
• 负责人: JULIE M ZITO
• 金额: $ 16.62万
• 依托单位: NEW YORK STATE CNCL FOR MTL HYGIENE PLNG
• 依托单位国家: 美国
• 财政年份: 1990
• 资助国家: 美国
• 起止时间: 1990-04-01 至 1993-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3384074
• 关键词: chronic disease /disorder; health behavior; health related legal; hospital length of stay; human population study; human subject; mental disorder chemotherapy; mental disorders; patient care management; therapy compliance

A prospective study of drug treatment refusal will be conducted in 180 state psychiatric hospital admissions, aged 18-55, who are involuntarily committed and legally competent. Three groups appropriately matched on key clinical variables will be studied: refusers who are referred for court decision to treat over the patient's objection (I), refusers who are not referred (II) and consenting patients (III). The course of the index episode the reasons for drug refusal, attitude toward medication and prior medication history of group I and II refusers will be determined . For group I refusers, the decision of the court and the satisfaction of the treating doctor will be determined. Time intervals related to the court process (pre, pending, post-adjudication) will be computed. The incidence and prevalence of drug treatment refusal as defined by court application or prior formal review will be compared with data from other states' formal review programs. For the three groups, patients will be characterized on sociodemographic, past and current clinical characteristics including SCID-P verified diagnosis, symptoms (BPRS or Hamilton scores), medications (specific drugs, daily dosages and chlorpromazine- equivalents for the antipsychotics) and side effects (SAFTEE). Assaultiveness, measured as the number of assault-related incidents/ seclusion/restraints/and transfers to a secure unit, will be compared among the three groups. Treatment outcome measures include discharge status at one-year, length of hospitalization (corrected for placement differences) and readmissions in one-year. From the comparison in the drug management and treatment outcome between consenting patients and the subgroup of severely mentally ill patients who must undergo court review for their refusal to accept medications, epidemiologically based patterns will emerge for pharmacologic treatments targeted to these difficult-to-treat patients.

拒绝药物治疗的前瞻性研究将在180年进行 国家精神病医院收治的18-55岁非自愿者 承诺并具有法律资格。 三组适当匹配 将研究关键的临床变量： 被转诊的拒绝者 法院不顾患者反对而决定治疗（I），拒绝者 未经转诊 (II) 和同意的患者 (III)。 课程的 索引事件拒绝药物的原因、对药物的态度 第一组和第二组拒绝者的既往用药史将被记录 决定 。 对于第一组拒绝者，法院和法院的决定 将确定主治医生的满意度。 时间间隔 与法庭程序（裁决前、裁决中、裁决后）相关的 计算出来的。 拒绝药物治疗的发生率和流行率 将比较法院申请或事先正式审查所定义的 与其他州正式审查计划的数据。 对于这三组，患者的特征是 社会人口统计学、过去和当前的临床特征，包括 SCID-P 验证的诊断、症状（BPRS 或汉密尔顿评分）、 药物（特定药物、每日剂量和氯丙嗪- 抗精神病药的等效物）和副作用（SAFTEE）。 攻击性，以攻击相关事件的数量/ 将比较隔离/限制/和转移到安全单位 三组之中。 治疗结果指标包括出院 一年时的状况、住院时间（根据安置情况进行更正） 差异）和一年内的再入院。 从比较中 同意患者和患者之间的药物管理和治疗结果 必须接受法庭审判的严重精神疾病患者亚群 根据流行病学审查他们拒绝接受药物的情况 针对这些疾病的药物治疗模式将会出现 难以治疗的患者。