方敏吕 爽何勇

【摘要】 目的：探讨动态暴力风险评估量表（DASA）在新入院精神障碍患者中的应用，为住院精神障碍患者的暴力风险评估提供理论依据。方法：选取2018年4-11月笔者所在医院具有暴力攻击行为的新入院精神障碍患者360例。按照随机数字表法将其分为研究组和对照组，各180例。研究组采用DASA量表，对照组使用暴力历史、临床、风险评估量表（HCR-20），比较两组24 h的预测结果、量表完成程度、护士满意度。结果：24 h内，两组有攻击行为者DASA评分均高于无攻击行为者（P<0.05）;DASA评分的AUC高于HCR-20评分，但差异无统计学意义（P>0.05）;DASA量表完成率、满意度均高于HCR-20量表（P<0.05）。结论：对于暴力攻击行为的新入院的精神患者，DASA与HCR-20量表的预测结果相当，护理人员对DASA量表的临床完成度高、满意度高。

【关键词】 动态暴力风险评估量表; 精神障碍患者; 攻击性行为

【Abstract】 Objective：To explore the application of dynamic appraisal of situational aggression（DASA）in newly admitted patients with mental disorders，and to provide theoretical basis for the risk assessment of violence in hospitalized patients with mental disorders.Method：A total of 360 newly admitted psychiatric patients with violent aggression in our hospital from April to November 2018 were selected.According to the random number table method，they were divided into study group and control group，180 cases in each group.The DASA scale was used in study group and historical，clinical，risk management-20（HCR-20）was used in control group.The 24 h predictive results，scale completion and nurses satisfaction between two groups were compared.Result：Within 24 h，the DASA scores of aggressors in two groups were higher than those of non-aggressors（P<0.05）.The AUC of DASA score was higher than that of HCR-20 score，but there was no significant difference（P>0.05）.The completion rate and satisfaction rate of DASA were higher than those of HCR-20（P<0.05）.Conclusion：For newly admitted psychiatric patients with violent aggression，the predicted results of DASA and HCR-20 scale were similar，nurses were highly satisfied with the clinical completion of DASA scale.

【Key words】 Dynamic appraisal of situational aggression; Mental disorders patients; Aggressive behavior

First-authors address：Baiyun Mental Disease Rehabilitation Hospital，Guangzhou 510000，China

doi：10.3969/j.issn.1674-4985.2019.17.044

精神患者是高度邊缘化的特殊群体[1]，其潜在的暴力行为容易形成社会公共问题[2-4]。建立在临床医治基础上的暴力风险评估提供了科学有效的预警和干预[5-8]。为了我国精神患者的实际需要，笔者考虑在美国精神疾病诊断与统计手册第五版（Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition，DSM-5）基础上[9-10]，结合中文版动态暴力风险评估量表（Dynamic Appraisal of Situational Aggression，DASA）进行持续风险状态监测是必要的[11-14]，有利于决定是否对患者提出合理要求、是否拒绝患者无理要求、是否需要及时介入防止暴力攻击行为[15-17]。DASA量表首次引入临床，作为预测精神障碍患者的暴力风险的工具，现缺乏足够的研究，本文选取两家精神病院具有暴力攻击行为的新入院精神障碍患者为研究对象，通过DASA量表预测新入院的精神障碍患者的暴力攻击行为[18-21]，为今后新入院的精神障碍患者的暴力风险预测提供依据。现报道如下。……