Beiträge zur Vermeidung von Zwang in der Akutpsychiatrie

Abstract

Reduction in coercion in psychiatric treatment requires successful interaction between changes in structural preconditions and therapeutic processes, as well as in individual therapeutic skills and attitudes. The article gives an overview of current approaches and possibilities to minimize the use of coercive interventions and to create non-violent and participative therapeutic settings. These opportunities are discussed against the background of structural and staff resources, social and legal aspects, as well as subjective experience of patients and their right to protection and treatment in phases when freedom of will and self- determination are compromised.

Same, Same But Different: How the Interplay of Legal Procedures and Structural Factors Can Influence the Use of Coercion

“…In recent years, complex interventions for acute psychiatric settings have been increasingly recommended to achieve a reduction of coercive interventions, as described in the “Weddinger Model”—a recovery-oriented treatment concept that has been introduced in the Charité University Department of Psychiatry at the St. Hedwig Hospital in 2010 and which aims to promote team competence on multiple levels (25–27). With regard to the outlined clinical cases, it should be elucidated that such interventions need to ensure an active participation of all team members in order to recognize their competences and collectively promote decision-making processes, as team dynamics seem to play a role in decision-making processes leading to coercion (28).…”

Effect of standardized post-coercion review session on symptoms of PTSD: results from a randomized controlled trial

“…When analyzing the clinical probability of PTSD across the studied sample using the formula proposed by Maercker et al, results highlight that 13 patients (28.3%) in the control group and 4 (11.1%) in the intervention group showed a high diagnostic probability of having a PTSD [26]. This difference, however, was not statistically significant, X 2 (1) = 3.614, p = 0.057.…”

“…Although their life-saving potential is undisputed in emergency scenarios such as a delirium tremens, their use should be restricted to situations in which other alternatives have been exhausted [1]. Moreover, the known potential consequences of coercion on clinical outcomes, therapeutic relationship or satisfaction with care render the need to reduce their application urgently [2]. Concurrently, the presence and management of trauma experiences and related post-traumatic stress disorder (PTSD) among patients suffering from severe mental disorders such as psychosis has raised much attention over the last decades.…”

Auswirkungen der Etablierung des psychiatrischen Behandlungskonzepts „Weddinger Modell“ auf mechanische Zwangsmaßnahmen

“…Die Fremdgefährdung stellt dabei den häufigsten Grund für die Anordnung von ZM in der Psychiatrie dar [3,4]. Aufgrund der schwerwiegenden Konsequenzen ist die Vermeidung von ZM eine sowohl medizinisch als auch politisch höchst relevante Frage, die Gegenstand vieler Initiativen und wissenschaftlicher Untersuchungen darstellt [5,6]. Dabei haben sich insbesondere komplexe Interventionen, die mehrere Ebenen der Praxis und der Behandlungsgestaltung betreffen, als wirksam erwiesen [7,8].…”