Riassunto
L’isolamento e la contenzione sono tecniche “manuali” che possono essere usate per gestire i pazienti violenti all’interno dei reparti di degenza psichiatrica e in Pronto Soccorso. La contenzione e l’isolamento sono pratiche destinate a rimanere controverse, essendo spesso l’unico mezzo iniziale di controllo per individui molto aggressivi e violenti prima che i farmaci diventino efficaci. Poiché usurpano così drammaticamente il diritto fisico dei pazienti e sono storicamente associate a pratiche inumane, queste tecniche sono messe in discussione anche quando sono utilizzate in aggiunta ai trattamenti convenzionali. L’isolamento e la contenzione sono stati così sottoposti ad un esame minuzioso dal pubblico profano così come dagli stessi psichiatri. Un primo sforzo della comunità psichiatrica nel discutere l’utilità della contenzione e dell’isolamento fu intrapreso da una task force dell’American Psychiatric Association tra gli anni 1981–1985. Le scoperte di questo gruppo furono pubblicate nel 1985 e ancora rimangono uno standard di cura (Tardiff, 1984), sebbene una seconda task force si sia incontrata durante gli anni 2003–2005 e abbia prodotto una relazione riveduta non ancora pienamente approvata dall’American Psychiatric Association al momento di questo scritto (American Psychiatric Association, 2006). Porzioni della relazione, tuttavia, appariranno come commento correttivo in materia di salute mentale nel Journal of the Academy of Psychiatry and the Law (J. L. Metzner, comunicazione personale, 14 ottobre 2007). La più recente task force (qui chiamata “la task force APA”) è stata convocata per dare un indirizzo alle nuove direttive pubblicate dai programmi Medicaid and Medicare e dalla Joint Commission for the Accreditation of Healthcare Organization (JCAHO). Queste direttive sono commentate nella seguente discussione.
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Tardiff, K., Lion, J.R. (2014). Isolamento e contenzione. In: Valutazione e gestione della violenza. Springer, Milano. https://doi.org/10.1007/978-88-470-1738-2_17
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