1150例神经内科会诊病例分析

目的了解神经内科会诊病例的科室分布、申请会诊方式以及疾病种类特点,探讨神经系统疾病与其他系统疾病的关系。方法对申请神经内科会诊病例的一般情况、疾病诊断以及神经系统疾病与其他系统疾病的关系等进行统计分析。结果会诊患者总数1150例,其中男性485例,女性665例,年龄分布7～95岁;平均年龄59.5±6.8岁。申请会诊科室以内科最多,共655例(56.9%)。急会诊例数285例(24.8%),常规会诊例数865例(75.2%)。531例(46.2%)继发于申请会诊科室所属的系统疾病,89例(7.7%)为医源性神经系统损害,75例(6.5%)为精神障碍性疾病。常规会诊以头晕/眩晕最多共243例,占常规会诊的25.5%;急会诊以急性脑血管病最多,共79例,占急会诊总数的39.9%。结论会诊病例神经系统损害多数与其他系统疾病有关;急会诊最常见的病种为急性脑血管病,常规会诊最常见的病种为头晕;部分神经系统损害与医源性因素有关;外科会诊主要目的为手术风险评估,内科会诊主要目的为脑血管病二级预防。     

综合医院精神科急会诊与普通会诊的比较

目的探讨综合医院精神科急会诊与普通会诊的特征差异。方法2007年度申请精神科会诊的病例279例,分析申请科室、原发病、申请理由、精神科诊断处理,比较急会诊与普通会诊的差异。结果综合医院精神病学急会诊主要为脑器质性精神障碍及躯体疾病所致精神障碍(75%~85%),普通会诊以抑郁障碍、焦虑障碍及神经症为主。结论应在综合医院积极开展会诊-联络精神病学服务,急会诊与普通会诊的诊断差异有助于精神科会诊临床实践。     

某三甲综合医院会诊-联络精神病学3年资料分析

目的了解3年来宁夏医科大学总医院会诊-联络精神病学的状况和住院患者会诊的临床特点。方法抽取2009年6月～2012年5月申请心身医学科会诊的1020例住院患者,对患者的人口学资料、会诊原因、科室分布、诊断及处理方案,进行总结与对比分析。结果会诊原因居前三位的依次为睡眠障碍211例(20.70%),不能解释的躯体症状135例(13.30%),原有精神疾病107例(10.50%)。其它原因分别为焦虑、抑郁、精神症状及治疗困难等。会诊科室32个,排名前三位分别是消化内科(14.90%)、心血管内科(10.50%)、神经内科(9.90%)。诊断居前5位的分别为抑郁发作173例(17.00%)、惊恐发作102例(10.00%)、精神分裂症82例(8.00%)、躯体形式障碍和脑血管病所致精神障碍62例(6.10%)。会诊后的处理方案有药物治疗(抗精神病药、抗抑郁药、焦虑药)和心理治疗,同时结合生物反馈治疗或低频脉冲治疗等。结论会诊-联络精神病学的服务在综合医院尤为重要,临床各科需求量大,有待于加强和提高。     

综合性医院住院病人的会诊精神病学

目的:探讨在综合医院设置精神科开放式病房后精神病学会诊的现状,方法:对我院近20年290例申请会诊的住院病人的科,地诊前后的论断对照,误诊情况及转科治疗情况进行分析.结果:总会诊率为1.38%,申请会诊的科室以内科最多138例(47.6%),会诊的精神科疾病中多见的是神经症84例(29.0%),躯体疾病致精神障碍60例20.7),器质性精神障碍50例(17.2%),精神分裂症37例(12.8%),误诊病例85例(29.3%),转科治疗64例(22.1%),结论:精神科会诊在综合医院呈增加趋势.综合设置精神科开放式病房既有利于精神科的发展,也有利于各类有精神障碍的患者得到及时妥善的治疗.     

某综合医院168例老年住院患者精神科会诊-联络资料分析

目的 了解综合医院老年患者精神(心理)服务需求的特点.方法 选取2010年1月～2012年12月某综合医院老年精神科会诊的168例患者,对其社会人口学资料、会诊科室、会诊原因、精神科诊断及治疗等进行分析.结果 在申请会诊的各科室中,前三位分别为神经内科(34.5％)、呼吸内科(19.1％)、高干病房(10.1％);常见会诊原因依次为以谵妄为主的意识障碍(20.8％)、躯体不适(19.6％)、焦虑抑郁(17.9％)、睡眠障碍(11.9％);会诊常见诊断主要为脑器质性精神障碍(34.5％);处理方式主要包括药物治疗及心理治疗等.结论 综合医院老年患者对精神(心理)服务需求大,精神科会诊联络服务有助于住院老年患者全面诊断和治疗.     

神经科总住院医师607例会诊病例分析

目的分析神经科总住院医师会诊病例的构成特点,从一个方面反映总住院医师的工作情况。方法统计北京协和医院神经科1名总住院医师在2003年8月1日至2004年1月31日会诊的病例。结果共新会诊患者607例,女性305例,男性302例,年龄5个月至92岁,平均年龄55·2岁,平均每周新会诊24例。急症会诊208例(34·3%),常规会诊399例(65·7%)。362例(59·6%)继发于系统性疾病;66例(10·9%)与医源性因素有关。急症会诊以代谢性脑病最多(92例),占急症会诊的44·2%,病因包括呼吸衰竭、肾功能衰竭、多器官功能衰竭等;其次为急性脑血管病51例;第三为癫发作23例。内科常规会诊病例以周围神经病最多(69例),占内科常规会诊的17·3%(69/398),病因包括糖尿病、血管炎/结缔组织病、肿瘤相关的周围神经病等。外科和妇科约请神经科常规会诊主要目的是围手术期的神经科疾病评估和预防。结论会诊工作具有特殊性和挑战性,神经科总住院医师应该了解会诊病例特点,在会诊中学习和积累经验。     

综合医院精神科会诊临床分析

目的 对综合性医院精神科会诊情况进行分析研究.方法 回顾性分析我科会诊的718例住院病人的临床资料,包括请会诊科室、会诊病人的诊断和处理等.结果 申请会诊科室共19个,其中针灸科（神经内科）会诊的人数最多,占43.3%.会诊的疾病前三类是：器质性精神障碍（71%）、心境障碍（8.6%）和神经症（6.0%）.所选的药物以苯二氮类（67.8%）、新型抗抑郁药（51.8%）和非典型抗精神病药（27%）应用较多.结论 我综合性医院会诊有年会诊率更高、患者年龄更大、以器质性精神障碍多见以及多选用新型药物治疗为主等特点.     

综合医院精神科联络会诊分析

目的:探讨综合医院内精神科联络会诊的分布特征。方法:收集某综合医院1年内精神科联络会诊病例688例,完成自制调查问卷,使用SPSS统计软件进行描述性统计分析。结果:会诊病例最多分布在神经内科(19.3%),其次为心内科(9.7%)、骨科(9.3%)、消化内科(8.9%)、呼吸科(8.7%)以及脑外科(7.0%);患者年龄分布以40~69岁(53.2%)和20~29岁(13.5%)为多;会诊主要原因为急性脑病综合征(25.7%)、精神病性症状(22.8%)、不能解释的躯体症状(12.9%)和既往有精神障碍史而目前无明显症状者(13.8%);会诊诊断主要包括躯体疾病伴精神障碍(21.4%)、精神分裂症和其他精神病性障碍(20.9%)、脑器质性精神障碍(20.1%)等。结论:综合医院精神科联络会诊涉及各科室、各年龄段;主要会诊原因为急性脑病综合征和阳性精神病性症状,而抑郁、焦虑症状关注较少。     

综合综合精神科会诊185例分析

目的探讨会诊--联络精神病学在综合性医院的作用.方法回顾性的分析3年中综合性医院精神科向非精神科提供的185次会诊资料.结果在185次会诊中,男性72例(38.9%),女性113例(61.1%),男/女11.6,平均年龄(51±14.7)岁;急会诊40例(21.6%),一般会诊145例(78.4%);有自杀行为者29例(15.7%);会诊诊断脑器质性及躯体疾病所致精神障碍82例(44.3%),神经症61例(33.0%),精神分裂症和情感性精神障碍21例(11.4%),精神活性物质所致精神障碍13例(7.0%);会诊医嘱的总执行率达94.9%,治疗总有效率92.1%.结论综合医院内精神科会诊可及时发现和治疗各科患者的精神障碍,更好地落实医学模式的转变.     

3000例神经内科门诊患者的病种分析

目的　通过对神经内科门诊疾病谱的分析 ,确定神经系统疾病的防治重点。方法　对 2 0 0 1年我院神经内科门诊 3 0 0 0例患者的病种进行分析。结果　神经系统疾病谱依次以头痛、眩晕、脑血管疾病及神经症为多见。结论　随着我国经济的迅速发展 ,工作及生活节奏的加快 ,饮食习惯的改变 ,神经系统疾病谱也会发生某些变化 ,需要我们不断调整疾病的防治战略 ,以适应我国社会变革和心理卫生保健的需要     

综合医院精神心理科会诊患者特点分析

目的 了解综合医院精神心理科联络会诊的原因、患者的科室分布、病种构成及处理情况,以更好地指导精神心理科医生的联络会诊工作,为进一步完善会诊精神医学在综合医院内的发展提供参考.方法 本研究采用回顾性方法复习综合医院住院患者的精神科会诊情况,分析在现代医学模式下综合医院的患者对精神卫生服务需求的特点,汇总2012年1月-2013年12月精神心理科联络会诊病历,资料完整者共612例,对一般人口资料、各科会诊人数及病种构成、会诊原因、诊断、处理构成等情况进行描述分析.结果 全部临床科室都有邀请精神心理科会诊,比例最高的科室前5位为：神经内科113例（18.5％）、心血管内科83例（13.6％）、消化内科69例（11.3％）、干部科56例（9.2％）、急诊科52例（8.5％）.病种主要为神经症性、应激相关的及躯体形式障碍151例（24.7％）,心境障碍139例（22.7％）,器质性精神障碍108例（17.6％）,伴有生理紊乱和躯体因素的行为综合征84例（13.7％）;精神科用药以SSRIs类药物、非典型抗精神病药物及苯二氮革类应用较多.结论 综合性医院各科存在较多的精神医学问题,住院患者伴发的精神障碍涉及各类疾病,综合医院就诊的患者精神心理障碍应引起重视,精神科会诊联络非常重要,可以提高临床各科医师对精神障碍的认识,减少或消除人们对精神科会诊的顾虑与不信任,提高会诊效率,治疗躯体疾病的同时应及时使用心理和药物等多种干预手段,使患者得到全面康复,从而提高患者的生命质量.     

Current status and needs of the department of neurology as a specialized department of a general hospital]

In this report, I have summarized the current situation surrounding diagnosis, treatment and related needs in the department of neurology in relation to postgraduate neurology training considered from the standpoint of a specialized department within a general hospital. This summary is based on the responses to a questionnaire that was sent to the persons in charge of education and training at 180 institutions affiliated with the Japanese Society of Neurology and 478 education and training institutions among Japanese city hospitals, excluding university hospitals and special research institutions. Replies were received from 305 hospitals, amounting to a response rate of 63.8%. The number of doctors working in the department of neurology was found to be low at 2 in 84 hospitals and 3 in 65 hospitals. The majority of neurologists at general hospitals are fully engaged in examining outpatients as well as inpatients, and they do not have adequate time for research, education and training and participation in the activities of academic associations. Of the 10 items cited in the questionnaire relating to the types of postgraduate neurology training desired by neurologists employed in general hospitals, the most common selections in order of decreasing frequency were improvement in the capacity to manage common disorders (such as headache, dizziness, numbness, etc.) diagnosed in the outpatient clinic, improvement in the capacity to diagnose the acute phase of cerebral apoplexy, further education about EEG (electroencephalogram) and EMG (electromyogram), and medical ethical issues such as informed consent. The views about postgraduate neurological education and training described in detail in writing by the respondents were as follows. 1) Neurologists required by a city general hospital Numerous respondents commented that the capacity to diagnose medical neurological diseases associated with internal (systemic) medical disorders is needed since there are remarkably few doctors in general hospitals whose interest is confined only to neurological diseases ranging from rare to common complaints. In contrast, neurologists whose knowledge and training derives from a wide clinical base of internal medicine are in great demand. 2) Points of disparity between postgraduate neurology training in a university hospital and neurologists required by a city general hospital In addition, many respondents expressed the view that under the medical school system, neuroscience and research are given a higher priority than the cultivation of clinical medical skills and although there may be keen academic interest in the clinical diagnosis and treatment of rare diseases, there is not necessarily the same level of keen interest in common diseases, hence the universities may be educating researchers effectively, but are not necessarily producing capable clinicians. 3) Measures that should be taken to address this difference in postgraduate neurology training between university and city general hospitals The university hospital is separated into research and clinical groups and the time has now come for a system of management under which a professor leads the research group and another professor leads the clinical group. There should be a clear-cut clarification of the responsible roles of university and city general hospitals in the postgraduate education and training of neurologists. Furthermore, the professional staff and facilities of general hospitals that are affiliated with universities should be upgraded and expanded to enable them to serve more effectively as sites of clinical education and training. The position and status of neurologists at city general hospitals should be raised to the same level as that of university professors and institutions affiliated with the Japanese Society of Neurology.     

The neurology clerkship core curriculum

Neurologic symptoms are common in all practice settings, and neurologic diseases comprise a large and increasing proportion of health care expenditures and global disease burden. Consequently, the training of all physicians should prepare them to recognize patients who may have neurologic disease, and to take the initial steps in evaluating and managing those patients. We present a core curriculum outlining the clinical neurology skills and knowledge necessary to achieve that degree of preparation. The curriculum emphasizes general principles and a systematic approach to patients with neurologic symptoms and signs. The ability to perform and interpret the neurologic examination is fundamental to that approach, so the curriculum delineates the essential components of the examination in three different clinical settings. The focus of the curriculum is on symptom-based rather than disease-based learning. The only specific diseases selected for inclusion are conditions that are common or require urgent management. This curriculum has been approved by the national organization of neurology clerkship directors and endorsed by the major national professional organizations of neurologists. It is intended as a template for planning a neurology clerkship and as a benchmark for evaluating existing clerkships. It should be especially helpful to clerkship directors, neurology chairs, deans of medical education, and members of external accreditation groups.     

会诊联络精神病学在综合医院的现状分析

目的对综合医院精神病学会诊现状进行分析研究。方法2007年度申请精神科会诊的病例279例,分析其申请科室、原发病、申请理由及精神科诊断处理。结果综合医院精神病学会诊中最常见的精神科诊断是脑器质性精神障碍、躯体疾病伴发精神障碍、焦虑障碍和抑郁障碍。结论应在综合医院积极开展会诊联络精神病学服务及对综合科医生加强精神病学知识教育。     

神经内科门诊抑郁障碍患者的临床特点

目的：了解神经内科门诊的抑郁障碍患者的临床特点。方法：采用流调用抑郁自评量表（CES-D）对神经内科门诊的全部初诊患者共654例进行筛查,再参照国际疾病分类第10版诊断为抑郁障碍患者78例,进行汉密尔顿抑郁量表（HAND）评分。结果：神经内科门诊初诊患者抑郁障碍患病率为11．9％。抑郁障碍患者以头晕、头痛、失眠等躯体症状为第一主诉者占85．9％。在患者的前3个主诉中出现频率高的症状依次为失眠、头晕、乏力。样本HAMD总分平均（16．9±4．0）分,以轻中度抑郁为主。神经内科门诊抑郁障碍患者入睡困难、精神性焦虑、躯体性焦虑和全身症状较重。抑郁障碍患者中躯体归因模式者占76．9％;心理归因模式者占23．1％。结论：在神经内科门诊抑郁障碍患者颇多,应引起重视。     

Gene diagnosis in child neurology]

Current status of molecular analysis in child neurology was briefly reviewed. Two different methods are available for gene diagnosis of inherited neurological diseases; molecular analysis of the mutant gene itself, which detects single base substitutions, deletions and insertions; and linkage analysis using restriction fragment length polymorphism, which can be applied also to various neurogenetic diseases without information about mutant genes. The PCR amplification method is particularly important and useful for molecular analysis of clinical specimens. A few analytical results were presented in cases with Fabry disease, galactosialidosis and Duchenne muscular dystrophy.     

An investigation of vitamin B12 deficiency in elderly inpatients in neurology department

Objective

To investigate the status of vitamin B12 deficiency in elderly inpatients in the department of neurology.

Methods

A total number of 827 patients in the department of neurology of Shanghai Punan hospital, from March 2007 to July 2008, were employed in the present study. They were 60 years or older, and the average age was 77.1±7.5 years old. All the patients were diagnosed with no severe hepatic or renal dysfunction, without any usage of vitamin B12 during the previous 3 months before the detection. The levels of serum vitamin B12, folate and homocysteine (Hcy) were evaluated. The patients with vitamin B12 deficiency were screened. The resulting symptoms, positive signs of neurological examination, and the neuroelectricphysiological results were compared between patients with or without vitamin B12 deficiency.

Results

Vitamin B12 deficiency was found in 163 patients (19.71% of the total patients), and was more prevalent in female than in male patients, also with increased incidences with aging. Patients with low levels of serum vitamin B12 exhibited higher rate of gastrointestinal diseases, while only 9.82% of the vitamin B12 deficient patients had megaloblastic anemia. Symptoms of vitamin B12 deficiency included unsteadily walking in the darkness and hypopallesthesia, and some chronic diseases such as cerebral ischemia, hypertension, Parkinson’s disease (Parkinsonism), diabetes mellitus and coronary heart disease. Most of the vitamin B12 deficient patients had neuroelectricphysiological abnormalities.

Conclusion

Vitamin B12 deficiency is remarkably common in elderly patients in neurology department, with various and atypical clinical manifestations, and the neurological symptoms are more common than megaloblastic anemia symptoms.