精神科住院患者HBV感染状况调查

为探讨精神科住院患者乙肝病毒（HBV）感染状况，为防治HBV的院内感染提供参考依据，采用酶联免疫吸附试验（ELISA）对1295例住院精神病患者进行血清HBV标志物检测。结果，血清HBsAg、抗－HBs、HBeAg、抗－HBe、抗－HBc五项HBV标志物阳性率分别为8．80％、30．81％、2．78％、21．54％、15．29％，HBV总感染率为43．63％，565例阳性标本检出HBV感染模式15种，HBsAg( )、抗－HBs(-)、HBeAg(-)、抗－HBe( )、抗－HBc( )（小三阳）占12．21％，HBsAg（＋）、抗－HBsAg( )、抗－HBe(-)、抗HBe( )（大三阳）占5．84％。提示，精神科住院患者中存在HBV传染源，病原应加强监测、隔离、消毒等综合性措施，预防住院患者HBV的院内感染。     

精神分裂症患者乙型肝炎病毒感染调查

目的:调查精神分裂症患者的乙型肝炎病毒(HBV)感染与肝功能异常情况。方法:对312例精神分裂症住院患者的HBV感染及丙氨酸氨基转移酶(ALT)异常进行流行病学调查,以健康体检者279名为对照。结果:精神分裂症患者的HBV感染率为71.8%,ALT异常率为29.5%,明显高于对照组,精神分裂症患者中两性间HBsAg阳性率以男性显著较高。再次住院患者的HBV感染显著比首次住院患者高。结论:对精神分裂症患者应加强隔离措施,特别是HBsAg阳性的患者,防止交叉感染;加强健康教育,加强饮食营养支持和乙肝疫苗的接种等措施。     

精神分裂症患者乙型肝炎病毒感染与代谢综合征的关系

目的探讨精神分裂症患者乙型肝炎病毒(HBV)感染与代谢综合征(MS)的关系。方法收集600例住院精神分裂症患者人口学资料和病史资料,测量身高、体质量、腰围、血压等生理指标,采集血清样本检测其HBV携带情况以及空腹血糖、总蛋白、白蛋白、球蛋白、肌酐、尿素氮、尿酸、甘油三酯、总胆固醇、高密度脂蛋白(HDLC)和低密度脂蛋白(LDL-C)等生化指标,按2007年颁布的《中国成人血脂异常防治指南》中MS诊断标准诊断。结果 600例精神分裂症患者乙型肝炎表面抗原(HBsAg)阳性有71例,阳性率为11.83%。MS组HBsAg阳性率为19.78%,非MS组10.41%,差异有统计学意义(P0.05)。HBV感染和MS相关的粗OR为2.121,95%CI为(1.342～3.324),调整年龄和性别后,其调整OR为2.068,95%CI为(1.322～3.228)。结论 HBV感染可能会增加精神分裂症患者MS的患病风险。     

自体外周血CD34+细胞移植后巨细胞病毒感染的检测*

背景：巨细胞病毒活动性感染，尤其是巨细胞病毒肺炎死亡率极高，并易合并细菌、真菌、原虫等感染，直接影响患者的长期存活。因此，寻找一种早期、敏感的巨细胞病毒检测方法显得特别重要。 目的：探讨酶联免疫吸附法、免疫组织化学法及流式细胞仪检测在自体外周血造血干细胞移植后巨细胞病毒感染的早期诊断价值。 设计、时间及地点：对比观察，病例来自2002/2005南方医科大学南方医院。 对象：选择行自体外周血CD34＋细胞移植的系统性红斑狼疮(16例)和天疱疮(3例)患者19例，其中男5例，女14例，年龄11~38岁。所有受试者均无糖尿病、哮喘、荨麻疹、湿疹、炎症性肠病和其他风湿病。 方法：分别于移植前、移植后3，6，12，24个月进行外周血采集。 主要观察指标：应用酶联免疫吸附法、免疫组织化学法及流式细胞仪检测19例接受自体外周血造血干细胞移植患者移植前、移植后3，6，12，24个月时的抗巨细胞病毒抗体及巨细胞病毒抗原。 结果：19例患者均进入结果分析。血清学检测显示，全部标本抗巨细胞病毒IgG全部阳性，阳性率100%。抗巨细胞病毒IgM阳性3例，阳性率3.2%。免疫组织化学法检测巨细胞病毒抗原阳性14例，阳性率14.7%。流式细胞仪检测巨细胞病毒抗原阳性13例，阳性率13.7%。4种检测巨细胞病毒感染方法的阳性率存在显著差异(χ2=261.929，P < 0.01)。 结论：自体外周血造血干细胞移植后存在不同程度的巨细胞病毒感染，临床上开展流式细胞仪检测巨细胞病毒感染具有重要意义。     

精神科住院患者发生医院感染的临床分析

目的探讨精神科住院患者发生医院感染的危险因素,为医院感染的防控提供依据。方法采用回顾性分析方法,对天津市安定医院2013年11月-2014年11月期间发生医院感染的住院患者的临床资料进行分析。结果2086例患者中共74例患者发生感染,占3.55%,感染79例次;感染患者的感染部位主要集中在泌尿道和呼吸道(泌尿道30例次占37.97%,呼吸道43例次占54.43%),患者年龄、住院时间、病程、疾病种类、基础疾病、侵入性操作及药物不良反应与医院感染的发生有关(P0.05或0.01)。年龄、住院时间、侵入性操作及药物不良反应是精神专科医院感染的独立危险因素。结论呼吸道及泌尿道感染是精神科医院感染控制的重点,对于发现的危险因素采取针对性的预防措施,对有效预防与控制医院感染非常重要。     

精神科糖尿病住院患者医院感染的临床特点

目的 探讨精神科糖尿病住院患者医院感染的临床特点.方法 选择我科2009-06-2012-06住院治疗的320例糖尿病合并精神疾病患者为研究对象,探讨医院感染的发生率、感染部位、医院感染相关因素及病原菌分布.结果 320例患者中共42例患者发生医院感染,发生率13.1%;感染部位分布构成比以呼吸系统为首位,占40.5%（17例）,其次为胃肠道、皮肤软组织及泌尿系统（23.8%、11.9%和9.5%）.Logistic分析结果显示：性别、年龄、病程、血糖控制情况及住院时间是糖尿病合并精神疾病患者发生医院感染的影响因素（P〈0.05）;42例患者病原菌阳性率为61.9%（26株）,其中革兰阴性杆菌占57.7%（15株）,革兰阳性菌占30.8%（8株）,真菌11.5%（3株）.结论 糖尿病合并精神疾病患者医院感染发生率高,临床工作中应针对相关因素进行干预,减少医院感染的发生.     

精神科老年住院患者药物治疗时点调查

目的 了解精神科老年住院患者精神药物及内科药物应用情况.方法 采用一日法对上海市精神卫生中心闵行院区老年住院患者的精神药物及内科药物应用状况进行调查.结果 (1)精神科老年住院患者抗精神病药物使用频度依次为奥氮平(37.1%),氯氮平(26.8%),利培酮(24.7%),以单一药物使用为主(80.4%),部分患者二药联合(19.6%),未发现三类抗精神病药物合用;(2)合并躯体疾病的患者较多,均予相应的降压、降糖、降脂治疗.结论 精神科老年住院患者以非典型抗精神病药物治疗为主,并重视了躯体疾病的诊疗.     

483例住院精神病患者HBsAg携带情况的调查

我国是乙型病毒性肝炎的高发地区,乙型肝炎表面抗原(HBsAg)携带者广泛存在于社会。有关健康人群HBsAg携带情况的调查已不乏报道,而有关精神病患者HBsAg携带情况的调查报道甚少。我们于1992年2月至1993年4月随机对来自临沂地区各县市的住院精神病患者HBsAg携带情况进行了调查。现将结果报告如下:     

原发性干燥综合征所致精神障碍临床特征的回顾性分析

目的 探讨原发性干燥综合征( pSS)所致精神障碍的临床特征.方法 对31例由风湿免疫科和精神科联合会诊确诊为pSS所致精神障碍住院患者的临床资料,从临床表现、辅助检查、治疗措施及疗效等方面进行回顾性分析.结果 31例患者中男7例,女24例;确诊前有23例在精神科首次就诊住院,5例在精神科多次就诊住院,3例在风湿免疫科就诊住院.物理检查结果均无特异性.31例患者的红细胞沉降率、C反应蛋白和免疫球蛋白G均升高;唇腺组织学检查均显示,腺上皮萎缩,灶性淋巴细胞浸润;24例抗核抗体阳性,25例抗干燥综合征抗原A抗体阳性.确诊pSS前主要精神症状以焦虑和抑郁为主要表现.21例患者的汉密尔顿焦虑量表(HAMA)评分为8～25( 15.84±5.76)分,其中6例患者汉密尔顿抑郁量表(17项)评分为14～23( 19.50±4.23)分,伴随症状体征出现较早,自觉疲乏21例,口干18例,皮肤干燥17例,睡眠障碍(入睡困难或早醒)16例,眼干涩14例,猖獗龋齿12例.通过系统治疗,31例患者中28例精神症状明显好转,2例继续精神科治疗,1例因脑炎死亡.结论 pSS所致精神障碍临床表现复杂多样,缺乏特异性;精神障碍多为焦虑和抑郁等;很多躯体症状易与焦虑或抑郁混淆.     

精神分裂症HBsAg携带情况调查

乙型病毒性肝炎是一种严重危害人民健康的传染病,乙肝病毒表面抗原(以下简称HBsAg)携带者广泛存在于社会。其健康人群调查已有诸多报道,但精神病患者HBsAg携带情况的调查分析尚属少见。我们对青岛市精神病院1988年住院精     

Infections with HBV, HCV and HIV in patients admitted to the neurosurgical department of a teaching hospital

BACKGROUND AND PURPOSE: To estimate the prevalence of infection with HBV, HCV, HIV and immunization coverage against HBV among neurosurgical patients. MATERIAL AND METHODS: The study was designed as an anonymous serosurvey conducted at the neurosurgical department of Szczecin University Hospital. Between November and December 2007, blood samples from 100 consecutive patients were tested for anti-HIV, anti-HCV and HBsAg using a third-generation (ELISA) method. RESULTS: Response rate was 100%. Median age of participants was 51 years, 52% were males. The immunization coverage against HBV was 71% (95% CI: 61.5-79%), 24% (95% CI: 16.7-33.2%) were not immunized, and 5% of patients (95% CI: 2.2-11.2%) did not recall the procedure. There were no differences in immunization rates between emergencies and elective procedures. Four patients (4%; 95% CI: 1.6-9.8%) were positive either with HBV or HCV: 2 were HBsAg positive, 2 anti-HCV positive (2%; 95% CI: 0.6-7%). There were no HIV positive cases among patients. CONCLUSIONS: There is a potential risk to staff of contracting a blood-borne infection, as one in 25 patients was infected with HBV or HCV. Even if patients cover the cost of pre-operative immunization against HBV, with previous HBsAg testing, it would not guarantee the detection of all infected patients, as it refers only to some elective cases. Pre-operative screening for HBV, based on HBsAg testing in immunized patients, detected only 1/4 of patients infected with blood-borne hepatotropic viruses; asymptomatic patients infected with HCV remain a problem in the context of occupationally acquired infections. In the light of the low single exposure risk and lack of serological markers of infection among patients we conclude that employment at a neurosurgical department does not significantly increase the risk of contracting HIV infection.     

Screening for adjustment disorders and major depression in otolaryngology patients using the Hospital Anxiety and Depression Scale

The authors conducted a study to demonstrate the prevalence of psychiatric symptoms among 100 otolaryngology inpatients (50 with non-malignant conditions; 50 with malignancies), and to investigate the efficacy of the Hospital Anxiety and Depression Scale (HADS) as a screening test for psychiatric disorders in otolaryngology. A structured interview was conducted according to the Adjustment Disorders and Major Depressive Episodes section of DSM-N, which demonstrated that 30% of the inpatients with benign diseases met the criteria for some psychiatric disorders (one patient for major depression and 14 for adjustment disorders) and that 46% of the inpatients with malignancies met the criteria (nine patients for major depression and 14 for adjustment disorders). There were highly significant differences between the HADS scores of the patients with psychiatric disorders and those without. Comparing the sensitivity and the specificity using the HADS as a screening test, the optimal cut-off point was 12, which produced 92% sensitivity, 90% specificity and 85% positive predictive value (PPV) among not only non-malignant and malignant cases taken together but also among malignant cases only.     

Human immunodeficiency virus antibody test and seroprevalence in psychiatric patients

Psychiatric inpatients are at risk for human immunodeficiency virus (HIV) infection. Investigations in the United States revealed seroprevalence rates of 5.5–8.9%. Therefore, inclusion of HIV antibody testing in routine laboratory screening is sometimes suggested. To investigate this issue for inpatients in the Department of Psychiatry, University of Munich, the incidence, reason for HIV testing and results were analyzed. Of 12,603 patients, hospitalized from 1985 to 1993, 4.9% (623 patients, 265 in risk groups) underwent the HIV test after informed consent. Thirty patients (4.8% of those tested) were found to be positive, but only in 5 cases (all of risk groups) was infection newly detected. Data indicate that, in psychiatry, HIV testing is reasonable only in patients in risk groups or if clinical variables suggest HIV infection.     

Syphilis,neither dead nor buried—A survey of psychogeriatric inpatients

Over a 5-year period, 3.8% of 423 psychogeriatric inpatients who were tested for syphilis had positive serology. Eight out of 14 received treatment, in contrast to previous suggestions that treatment was rarely instigated. Screening and adequate investigation of this population remain important, and we believe that serology should be carried out routinely in organic cases.     

不同时期麻痹性痴呆临床对照研究

目的：分析1947年至1966年和2004年至2007年丽个不同历史时期麻痹性痴呆（GPI）患者的临床差异。方法：回顾性调查1947年6月至2007年6月GPI住院患者临床情况。病例分旧患者组（1947年至1966年时期247例中随机抽取50例），和新患者组（2004年至2007年期间，计12例）两组，进行对照分析。结果：旧患者组收治12．4例／年，新患者组3．42例／年；入院前和入院3d内作血液和脑脊液梅毒抗体检测旧患者组96％，新患者组为0％；临床误诊率旧患者组4％，新患者组100％；两组差异有显著性（P〈0．01）。结论：目前GPI临床少见，患者性病冶游史隐蔽，临床血清梅毒的筛查未列为常规性检查，容易导致误诊。     

精神分裂症住院患者家庭关怀和应对方式的调查

目的探讨精神分裂症住院患者中家庭关怀和应对方式的相关性,为制定社会心理康复干预提供理论依据。方法对2007年10月~2008年1月在我院住院的精神分裂症患者237例进行家庭关怀度指数量表、简易应对方式量表的测评。结果①男性患者的积极应对维度分低于女性患者,差异有统计学意义（1.41±0.70,1.68±0.72,t=2.89,P〈0.01）;②家庭功能越好,积极应对维度分越高。严重家庭功能障碍组的积极应对维度分明显低于另外二组;③患者积极应对维度分为1.52±0.72,低于国内常模（1.78±0.52）,差异有统计学意义（t=2.92,P〈0.01）。结论精神分裂症住院患者中66.24%有不同程度的家庭功能障碍,积极应对方式明显不足,尤其是男性、严重家庭功能障碍的患者中更为明显。     

609例缺血性卒中住院患者糖调节异常的横断面研究

目的 了解北京地区首发缺血性卒中（first-ever ischemic stroke，FIS）住院患者的糖调节异常（abnormal glucose regulation，AGR）情况；了解口服葡萄糖耐量试验（oral glucose tolerance test，OGTT）在糖调节异常诊断中的重要意义。方法 选取2008年8月至2009年11月在北京天坛医院神经内科住院并连续入组的FIS患者为研究对象，有效病例609例。记录患者的年龄、性别、既往糖尿病（diabetes mellitus，DM）史、血压、各项生化指标及入院时美国国立卫生研究院卒中量表（National Institute of Health Stroke Scale，NIHSS）评分及格拉斯哥昏迷量表（Glasgow Coma Scale，GCS）评分等。于患者发病后（14±3）天行口服OGTT检查，了解FIS患者糖代谢异常情况，并采用Kappa一致性检验比较空腹血糖诊断糖调节异常标准与OGTT诊断标准间差异。结果 在609例FIS患者中，既往有明确糖尿病史患者120例，新诊断DM143例，新诊断糖调节受损（impaired glucose regulation，IGR）137例，AGR总患病率为65.7%，其中DM的患病率为43.2%，IGR的患病率为22.5%。如果仅检测空腹血糖（fasting plasma glucose，FPG），则漏诊122例IGR患者，漏诊率为89.1%，同时会漏诊95例新诊断DM患者，漏诊率为66.4%。在糖调节异常诊断上，以OGTT诊断标准为金标准，将空腹血糖标准与OGTT标准行Kappa检验，得出Kappa值=0.226，P＜0.05，提示两种诊断标准一致性较差。结论 北京地区住院FIS患者大多数合并AGR。但如果仅检测FPG则会漏诊很多AGR患者，故对入院FIS患者行OGTT筛查非常必要。空腹血糖标准不能替代OGTT标准。     

Somatic implications of generalized and/or focal EEG slowing in psychiatric patients.

The extent of medical follow-up of abnormal screening EEGs secured from psychiatric patients, particularly those reporting slow wave dysrhythmias as the single finding, still varies widely. From an earlier routine EEG screening program for psychiatric inpatients, 103 consecutive cases of abnormal EEGs with generalized, focal, or paroxysmal slowing as the only EEG finding were identified. Despite suggestions for medical follow-up, less than half (44.6%) of the patients received subsequent study. However, 74.2% of patients considered to be without organic pathophysiology at the time of the EEG had positive organic findings on medical follow-up.     

内科住院病人精神科会诊213例分析

目的：探讨综合医院内科住院病人精神科会诊的现状。方法：对我院近3年来213例内科住院病人申请科学会诊的临床资料进行回顾性分析。结果：近3年来内科申请精神科会诊的 病例数逐年上升。申请会诊的科室,以神经内科最多,其次为心血管内科、呼吸内科、内分泌科和消化内科,会诊后精神科疾病以器质性精神障碍居多（46．4％）,其次为神经症（32．4％）及精神分裂症（7．0％）。申请会诊的病人中40例（18．8％）转入精神科治疗。结论：内科住院病人常伴发精神障碍,并有逐年增加的趋势,对普通内科医师加强精神科专业知识的培训,将有利于患有各类精神障碍的病人得到及时妥善的治疗。     

Hepatitis B in the non-residential mentally handicapped population

This study describes seroprevalence and risk factors for hepatitis B in seven centres caring for non-residential mentally handicapped individuals. Overall, 11% were hepatitis B marker seropositive and 4% had the hepatitis B surface antigen (HBsAg). Male sex and increasing age were associated with seropositive status, and Down's syndrome was associated with the presence of HBsAg. Immediate family members of those with hepatitis B markers were screened and 22% had evidence of heptatitis B markers. Forty-one family members were identified when the mentally handicapped individual was HBsAg positive and of these 13 (32%) were seropositive. This study demonstrates that hepatitis B is a problem for the non-residential mentally handicapped population and confirms the risk of infection to their immediate families.