某精神科教學醫院在精神衛生法修訂前後強制住院的嚴重病人特徵與相關因子

The Characteristics of Severe Mentally Ill Patients Who Need Forced Hospitalization before and after the Amended Mental Health Act in Taiwan

目的：台灣修訂後之精神衛生法在民國97年7月4日正式施行。本研究目的在於比較嚴重病人強制住院在精神衛生法修訂前後其特徵之差異。方法：凱旋醫院為南台灣精神科教學醫院，也是高雄市公立的精神科醫院。擁有820張精神科病床，佔了高雄市精神科病床70%。我們採病例回顧方式，使用psychiatrist-ratedbattery蒐集相關症狀與基本資料分析，2008年持續七個月共146位強制住院個案。同時蒐集2007年相同時間共214位個案資料作為對照組。資料來自個案的急診病歷紀錄，包括國籍、教育程度、婚姻狀況、發病年齡、先前住院次數、強制住院次數等，由研究助理用標準表格記錄。結果：與對照組比較，精神衛生法修訂後強制住院的個案在精神症狀上有顯著差異，有較高的緊張(p=0.003)，較少的活動過度(p=0.007)，注意力分散(p=0.006)，多疑(p=0.036)，誇大(p=0.044)。暴力的部分在破壞行為有顯著差異(p=0.008)，較少的言語暴力(p=0.016)。結論：精神衛生法修訂後，強制住院的人數減少為前一年的三分之二，顯示精神科醫師使用了更嚴格的或是不同的標準。透過審查會審查強制住院的流程，使得精神科醫師在強制病患住院前更謹慎。強制住院的結果需要更進一步研究來探討。

Objectives: The Amended Mental Health Act (AMHA) in Taiwan became effective on July 4, 2008. In this research, we aimed to identify the characteristics of severe mental illness (SMI) patients who needed forced hospitalization before and after the implementing of the AMHA. Method: Kai-Suan Psychiatric Hospital is the only government civilian psychiatric hospital in Kaohsiung, Taiwan. This 820- bed hospital is accounted for about 70% of the psychiatric beds in the city of Kaohsiung. After implementing AMHA, we used the psychiatrist-rated battery to collect psychopathological symptoms from medical records to collect demographic data and a psychiatric history of 146 SMI inpatients who were admitted involuntarily for seven months. Before implementing AMHA, we also collected data from 224 SMI inpatients who were admitted in the same period in 2007 as the control group. The collected information included patients’ nationality, educational level, marital status, age of onset , the number of previous admissions, and the number of forced hospitalization. Results: Compared with the control group, the involuntarily admitted inpatients after the implementing the AMHA showed signifi cant differences in their psychiatric symptoms, of more tension and less motor hyperactivity (p=0.007), distractibility (p=0.006), suspiciousness (p=0.036), and grandiosity (p=0.044). Signifi cant differences were also found in the types of violence in more destructive behavior (p=0.008), and less verbal aggression (p=0.016). Conclusion: The AMHA was implemented, the number of forced involuntary admissions has been decreased by two-thirds compared to the year before. Based on this fi nding, we suggest that stricter or different criteria are used by psychiatrists in the AMHA.