某精神科急性病房住院病患自殺行為與臨床處置之初探

A Study of Inpatient's Suicidal Behavior and Clinical Management in an Acute Psychiatric Ward

本研究乃針對某一精神科急性病房的病患在住院中的自殺行為，探討病 患的特質、自殺行為經驗與醫護人員實際處理狀況，並暸解住院期間的自殺 行為與住院前自殺的相關性。採曰：朔病歷的方式，以結構性調查表進行資料 收集，自89 年10 月到92 年1 月，共回溯739 本病歷（ 974 人次），住院中有出現 自殺行為的病患共26 人次（56 次自殺）。 研究結果顯示：發生自殺的病患皆為女性，診斷以重度憂鬱症最多，自 殺行為在次數方面以1 次為最多；發生的時間多在白班；地點以病室內為最 多。最常使用的方式為撞物，在醫療處置方面最常用的醫囑為限制外出，在 護理措施方面立即性措施最常用到的為通知醫師並與病人會談。最常用到的 預防性措施為密切觀察及預防自殺，在保護性措施方面最常用到的是加強安 檢，提供安全物品使用，支持性措施最常用到的則是給予同理心及支持，在 其他護理措施方面會給予家屬情緒支持及注意其他病人反應。26 人次住院期 間發生自殺者，住院前亦有自殺行為者共21 人次（P< 0.001） ，顯示住院中的 自殺行為與住院前自殺有顯著性相關。故住院時應審慎評估其自殺意念及行 為表徵，依自殺分級施予常規及制度性之防範措施，以降低住院中自殺事件 之發生。

This study focuses on the inpatients in an acute psychiatric ward who made suicide attempts. We discuss the patients' characteristics, the suicidal behavior, and how health care workers managed the episodes. Also, we consider the relevance of previous suicidal behavior before and during hospitalization. We used a structured instrument in a retrospective analysis of data from October 2000 to January 2003. Among 739 medical records reviewed, we found that 26 inpatients had attempted suicide. Major depression was the most prevalent diagnosis among the 26 patients. Most patients made only one attempt, and these mostly occurred on the ward during daytime. Immediate medical management included limiting the patient's range of activities and calling a psychiatrist to interview the patient. Patients were closely monitored to prevent suicide attempts, careful surveillance was maintained on the ward, safety equipment was used, and psychological support for the patients was provided. In addition, we observed the emotional reaction of patients' families and of other patients to the attempts. Of the 26 patients who attempted suicide, 21 had a history of suicidal behavior before hospitalization. Our study thus shows that suicide attempts during hospitalization are strongly related to previous suicidal behavior. Therefore, it is of primary concern to evaluate suicidal ideation and behavioral signs at the very beginning of an admission, so that routine preventive strategies can be instituted to minimize suicide attempts during hospitalization.