单相抑郁症患者自杀行为遗传效应及其遗传方式的研究

背景遗传因素在抑郁症自杀行为的发生中占有一定的地位,以往的关注的重点主要为双相抑郁自杀的遗传效应,单相抑郁症自杀行为的遗传方式和遗传效应有何特征?目的探讨单相抑郁症自杀行为的遗传效应及遗传方式.设计回顾性调查.单位一所市级精神卫生中心.对象单相抑郁症组(n=115)为1983-06-01/2002-05-31无锡市精神卫生中心门诊和住院诊断为抑郁症的患者.诊断均符合中国精神障碍分类与诊断标准第3版抑郁发作及美国精神障碍诊断与统计手册第4版重性抑郁发作标准,且抑郁发作次数≥3次或发作一两次已缓解≥8年者.方法以符合入组标准的单相抑郁症患者为先证者,由2名主治医师及其以上医师对每一家系进行调查,填写自行编制的精神病家系调查表,内容主要包括患者及一级亲属所有成员社会人口学资料、疾病发作特点及次数、以往治疗及自杀情况.由2名主治医师或以上医师对每一患者进行再诊断,并由1名主任医师核查,一致确诊的病例则予入组.对所有现存活的先症者(107例)及一级亲属中有自杀行为者(14例)进行面检;对无自杀行为的一级亲属(337名)进行面检和信函调查(380名);死亡者(患者8例,一级亲属5例)的资料由一两名一级亲属提供有关情况填写调查表.对照组由2名研究者进行面检,同时询问一级亲属情况并填写家系调查表.对所得资料行单因素分析,用多基因阈值理论Falconer模式估算自杀行为的遗传率和标准误,用医学遗传数学方法中分离分析法和多基因阈值理论进行遗传方式的探讨.主要观察指标单相抑郁症患者自杀行为的遗传效应和遗传方式.结果单相抑郁症患者自杀危险性51.30%(59/115)较其一级亲属2.58%(19/736)高(x2=283.16,P＜0.01),单相抑郁症患者一级亲属自杀危险性2.58%(19/736)较对照组0.12%(3/2469)高(x2=50.36,P＜0.01),有自杀行为患者的一级亲属自杀危险性3.8%(14/372)较无自杀行为患者的一级亲属自杀危险性1.4%(5/363)高(x2=4.14,P＜0.05).单相抑郁症自杀行为的加权平均遗传率及标准误为(70.16±0.79)%;多基因遗传方式验证显示,多基因遗传方式验证显示一级亲属自杀行为预期发病率为3.1%,实际发病率为2.6%,两者差异无显著性意义(u=0.766,P＞0.05).结论单相抑郁症自杀行为有明显的遗传效应,其遗传方式符合多基因遗传.     

老年患者自杀行为原因分析与防范措施

为了预防老年患者自杀行为的发生，通过对2003～2005年收治我院干部科有自杀行为的10例老年患者的分析发现：老年患者自杀行为多发生在夜间，以服药、割脉、自缢为主，自杀首要原因为合并抑郁症，其次是癌症晚期；依此提出了防范措施：①加强安全措施；②加强睡眠药物管理；③加强深夜巡视病房；④加强心理护理；⑤进行有针对性的出院指导和病人随访。     

精神病患者自杀行为临床特征分析及预防措施

目的：探讨精神病患者自杀行为的临床特征,为制定临床预防措施提供依据。方法对30例有自杀行为的精神病患者的临床资料进行回顾分析。结果本组自杀者以抑郁症（60．0％）、精神分裂症（36．7％）居多,自杀行为多发生于凌晨1时-2时（50．0％）,自杀前主要表现为焦虑、绝望、痛苦、抑郁等,自杀地点多发生在卫生间、病房、窗户、床头。结论精神病患者自杀行为具有一定的规律性,护理人员应加强安全管理,积极采取综合预防措施,杜绝或减少自杀的发生。     

抑郁症自杀未遂者的危险因素调查

目的探讨抑郁症患者自杀未遂的临床特征及危险因素。方法采用汉密尔顿抑郁量表与自编抑郁症自杀行为调查表,分别对149例抑郁症患者进行调查评分。结果65例(43.6%)患者出现过自杀未遂,自杀平均年龄为(39.2±15.1)岁,呈双峰分布;主要自杀方式依次为过量服药、割腕、自缢、溺水。单因素分析显示主要危险因素有年龄、病程、自杀家族史、负性生活事件以及绝望感、认识障碍、焦虑躯体化。结论抑郁症自杀未遂与生物心理社会因素有关,临床工作中应重视对其危险因素的评估和干预。     

抑郁症患者自杀行为的相关危险因素分析

目的:研究抑郁症自杀行为的危险因素,为预防自杀提供依据。方法:按中国精神障碍分类与诊断标准第二版(CCMD-2-R)收集221例住院的抑郁症患者,采用多因素Logistic回归分析与抑郁症自杀行为有关的危险因素。结果:抑郁症自杀未遂71例(32.1%),自杀与绝望(相对危险度RR=9.312)、负性生活事件(RR=3.843)、自杀家族史(RR=3.625)、妄想(RR=3.567)及自责(RR=2.982)呈正相关(P均<0.01)。结论:绝望、负性生活事件、自杀家族史、妄想及自责是抑郁症患者自杀的危险因素。     

抑郁症患者自杀行为的相关危险因素分析

目的：研究抑郁症自杀行为的危险因素，为预防自杀提供依据。方法：按中国精神障碍分类与诊断标准第二版(CCMD-2-R)收集221例住院的抑郁症患者，采用多因素Logistic回归分析与抑郁症自杀行为有关的危险因素。结果：抑郁症自杀未遂71例(32.1％)，自杀与绝望(相对危险度RR=9.312)、负性生活事件(RR=3.843)、自杀家族史(RR=3.625)、妄想(RR=3.567)及自责(RR=2.982)呈正相关(P均&;lt;0.01)。结论：绝望、负性生活事件、自杀家族史、妄想及自责是抑郁症患者自杀的危险因素。     

双相抑郁症患者自杀行为的遗传方式

目的:对双相抑郁症患者自杀行为的遗传方式进行分析,以探讨抑郁症患者自杀行为的遗传实质。方法:来源于1983-07-01/2003-06-01无锡市精神卫生中心门诊和住院诊断为抑郁症,无严重躯体疾病或脑器质性疾病,既往至少有一次躁狂发作的患者235例。359名对照组为患者的朋友、同事及领居,与研究对象无血缘关系。以双相抑郁症患者为先证者,采用自行编制的精神病家系调查表(内容主要包括患者及一级亲属所有成员社会人口学资料、疾病发作特点及次数、自杀情况),由两名主治医师或以上的研究人员对每一家系进行调查。由两名研究人员在互不知情的情况下按照中国精神障碍分类与诊断标准第3版(CCMD-3)抑郁发作及美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)双相抑郁标准对每一患者进行再诊断。对所有先证者及一级亲属中有自杀行为者进行面检(面检率>95%);对无自杀行为的一级亲属则进行信函调查(54%)及面检(46%)。已死亡及不能进行面检者的资料由一两名一级亲属提供有关情况填写调查表。观察双相抑郁症患者自杀行为的遗传方式。用医学遗传数学方法中分离分析和多基因阈值理论进行遗传方式的探讨。结果:完成家系调查的共209例,其中可纳入分析的共184例(男68例,女116例),对照组共359名(男134名,女225名)。经分离分析表明本组双相抑郁症自杀行为不符合单基因常染色体显性遗传,不符合单基因常染色体隐性遗传,亦不符合性连锁遗传;双相抑郁症自杀行为的加权平均遗传率及标准误为(50.15±9.7)%;一级亲属自杀行为预期发病率为1.38%,实际发病率为1.27%,两者差异无显著性意义(u=0.3056,P>0.05)。结论:双相抑郁症自杀行为遗传方式符合多基因遗传。根据多基因遗传因素所起的作用,应注意对有自杀行为的双相抑郁症患者及其亲属加以监测,以防止自杀的发生。     

住院抑郁症病人自杀未遂情况调查

[目的]探讨住院抑郁症病人自杀发生率、性别差异、自杀因素及护理干预对策。[方法]利用问卷调查表对150例自杀未遂的抑郁症病人自杀相关资料进行回顾性调查。[结果]住院抑郁症病人出现自杀意念、自杀意图、自杀行为较高;女性病人自杀行为明显多于男性,但男性自杀行为的后果更为严重;精神病家族史、自杀家族史、家庭环境等均与自杀行为密切相关。[结论]住院抑郁症病人存在较多的自杀问题,特别是病程长、多次住院、具有精神病家族史和自杀家族史者是自杀预防的重点人群。     

自杀风险评估在精神科病房管理中的应用

精神疾病是自杀的高危因素,其中抑郁症的危险性最高.抑郁症患者的自杀风险比其他精神疾病高近20倍,自杀观念和行为是抑郁症患者最严重而危险的症状.25%的重性抑郁症患者有过自杀未遂[1],其中15%的患者最终死于自杀[2].近年来抑郁症的自杀干预已逐渐受到广泛重视.本文对抑郁症的自杀风险进行了连续、动态的护理评估,为提高对抑郁症患者自杀行为的预测性和精神科病房更好地实施风险管理提供依据.     

住院精神病患者自杀行为与对策

分析 1 36例有自杀行为的住院精神病患者 ,35例自杀死亡 ,自杀死亡率为 2 5.7% ;自杀患者以中青年男性居多 ;精神分裂症占 61 .8% ,抑郁症占 30 .2 % ,自杀多由精神症状引起 ;65.4%为自缢 ;自杀行为多发生于夜间 ;42 .7%的患者既往有自杀史。针对以上特点提出了相应的预防措施     

The importance of the complete history in the discovery of a potential suicide: a case report

Suicidal ideation and completed suicides are an increasing problem among the elderly. In 1992, the elderly accounted for 13% of the population but represented 20% of all completed suicides. There are recognized risk factors for suicides in elderly patients, which include depression, deteriorating physical health, and loss of independent functioning. A complete history enables the examiner to establish a relationship with the patient and to formulate a diagnosis. Unfortunately, histories are often incomplete. Many factors can account for this, including financial pressures, patient volume, and overspecialization. The physiatric history is the integration of many parts. It incorporates not only the physiatrist's evaluation but those of other disciplines as well, for example, physical and occupational therapy. The physiatric history is a sensitive tool for assessing the state of being of the whole patient. We describe a case in which a careful and complete physiatric history and physical examination revealed an elderly patient with suicidal ideation and a plan.     

反复自杀患者36例回顾性分析

近十年来我院急诊室和内、外科病房共收治自杀病人９８２例。其中两次或两次以上反复自杀者３６例，占３．６７％。自杀原因有两个或两个以上者１１例，因同样原因而自杀者３０例。自杀方式主要为过量服药。常服用的药物有有机磷农药、安眠药、汽煤油、强酸、强碱等。两次自杀间隔时间最短者１天，最长者３年，平均３．２个月。其中间隔１月内者７９例次，占７６．７％。且绝大多数患者自杀前有先兆表现，常有情绪与性格方面的改变。作者对反复自杀者做了综合护理方面的初步探讨。     

Psychosocial characteristics of victims of suicide in prisons

BACKGROUND: Besides some cases reported by the media in recent years about prison inmates who committed suicide, hardly anything is known concerning social, criminological and psychiatric characteristics of suicide victims in jails and prisons in Austria. It therefore seems necessary to evaluate jail and prison suicides in order to establish effective means of prevention. METHODS: A study was conducted evaluating all suicides in Austrian prisons between 1975 and 1999. In addition to nationality, education and working status, other indicators of social integration and psychiatric history of suicide victims were studied. RESULTS: 220 personal files of 250 suicides were available. During the observation period the suicide rate of imprisoned foreigners decreased slightly (mean 106.6/100,000), whereas the suicide rate of Austrian citizens increased significantly (mean 172.0/100,000). Of all suicide victims, 41% had neither finished school nor had they any professional education. 44% were unemployed before incarceration, 50% did not work while incarcerated. A high frequency of suicidal behavior amongst suicide victims before committing suicide (49% suicide attempts, 37% suicide threats), and a high prevalence of mental disorders (37% psychopharmacological treatment, 48.6% were assessed by a psychiatrist) could be detected. CONCLUSIONS: Screening instruments should be applied which are easy to handle for prison officers and indicate the appropriate management of inmates at a high suicide risk.     

Suicide in the elderly: a two-year study of data from death certificates

Data from death certificates in Kentucky in 1987 and 1988 for persons 65 years old and older were analyzed. There were 205 suicides in the 2-year study period. Suicide rates were higher for the elderly than for any other population group. White men, the group at highest risk, committed approximately 80% of the suicides in the elderly group. Suicide among minorities was rare. Self-inflicted gunshot wounds accounted for 88% of the suicides in the elderly group. Despite their high risk of suicide, elderly white men are underrepresented in terms of psychiatric admissions.     

经历住院患者自杀事件护士心理体验的质性研究

目的 了解经历住院患者自杀事件护士的心理体验。方法 采用半结构性访谈法,对15名经历过住院患者自杀事件的护士进行访谈,使用Colaizzi七步分析法收集相关资料并进行分析。结果 躯体疾病、经济负担、自尊水平降低、负性生活事件是导致住院患者自杀行为的原因;经历住院患者自杀事件后,护士普遍感觉到害怕﹑恐惧和内疚。结论 应做好住院患者生理和心理评估,重视患者自杀行为的影响因素,积极关注患者自杀事件对护士造成的心理伤害。     

Characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to whether the arrest took place during office hours

AIM: To describe the characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to whether the arrest took place during office hours. PATIENTS: All patients suffering in hospital cardiac arrest in Sahlgrenska University hospital in G?teborg, Sweden between 1994 and 1999 in whom resuscitative efforts were attempted and for whom the time when the cardiopulmonary resuscitation (CPR) team was alerted. METHODS: Prospective recording of various factors at resuscitation including the time when the CPR team was alerted. Retrospective evaluation via medical records of patients previous history and final outcome. RESULTS: Among patients in whom the arrest took place during office hours (08:00-16:30 h) the overall survival rate was 49% as compared with 26% among the remaining patients (P<0.0001). The corresponding figures for patients found in ventricular fibrillation were 66 and 44% (P=0.0001), for patients found in asystole 33 and 22% (NS) and for patients found in pulseless electrical activity 14 and 3% (NS). When correcting for dissimilarities in previous history and factors at resuscitation the adjusted odds ratio for patients to be discharged alive who had the arrest during office hours was 2.07 (1.40-3.06) as compared with patients who had an arrest outside office hours. CONCLUSION: Among patients suffering from in hospital cardiac arrest and in whom CPR was attempted those who had the arrest during office hours had a survival rate being more than twice that of patients who had the arrest during other times of the day and night. These results indicate that the preparedness for optimal treatment of in hospital cardiac arrest is of ultimate importance for the final outcome and that an increased preparedness during evenings and nights might increase survival among patients suffering from in hospital cardiac arrest.     

Suicide in Belgian psychiatric inpatients. A matched case-control study in a Belgian teaching hospital

Background and objectivesPatients admitted to a psychiatric hospital show an increased risk for suicide but specific risk factors are not well understood.MethodsIn this case-control study we describe suicides (n = 37) that took place during admission in a Flemish psychiatric teaching hospital between 2007 and 2015 and investigate predictive factors for suicide.ResultsInpatient suicide is a rare condition (37 patients among 20,442 admission periods between 2007 and 2015). Most inpatients who completed suicide were diagnosed with a mood disorder (68%); 38% committed suicide in the first month of hospitalization and 19% in the first week following admission. The majority of suicides took place just before or during the weekend (57%), with hanging as the prominent method (41%). Multivariate analysis showed that hopelessness was the only significant risk factor for inpatient suicide.ConclusionsInpatient suicide remains a very rare event in inpatient care. Enquiring and managing hopelessness is essential in inpatient treatment of psychiatric patients.     

Suicide in Olmsted County, Minnesota, 1951 through 1985

During the 35-year period 1951 through 1985, 274 completed suicides occurred among residents of Olmsted County, Minnesota. The overall age- and sex-adjusted incidence was 12.5 per 100,000 person-years (95% confidence interval, 11.0 to 14.0), similar to the national averages, and rates were comparable for urban and rural portions of the county. Men outnumbered women 3.6 to 1, and the sex ratio of age-adjusted incidence rates was 4.5:1. The incidence rates increased after middle age for men but not for women. The most common suicide methods were gunshot wounds for men and poisoning for women. Two-thirds of the suicides occurred at home and were usually discovered by family members or friends. Almost half of all suicide victims were unmarried. This figure seems high, as does the greater proportion of unemployed persons than employed persons among those who committed suicide, but denominator data are unavailable.     

Anisakiasis presenting to the ED: clinical manifestations,time course,hematologic tests,computed tomographic findings,and treatment

BackgroundThe prevalence of anisakiasis is rare in the United States and Europe compared with that in Japan, with few reports of its presentation in the emergency department (ED). This study describes the clinical, hematologic, computed tomographic (CT) characteristics, and treatment in gastric and small intestinal anisakiasis patients in the ED.MethodsWe retrospectively reviewed the data of 83 consecutive anisakiasis presentations in our ED between 2003 and 2012. Gastric anisakiasis was endoscopically diagnosed with the Anisakis polypide. Small intestinal anisakiasis was diagnosed based on both hematologic (Anisakis antibody) and CT findings.ResultsOf the 83 cases, 39 had gastric anisakiasis and 44 had small intestinal anisakiasis based on our diagnostic criteria. Although all patients had abdominal pain, the gastric anisakiasis group developed symptoms significantly earlier (peaking within 6 hours) than the small intestinal anisakiasis group (peaking within 48 hours), and fewer patients with gastric anisakiasis needed admission therapy (5% vs 57%, P < .01). All patients in the gastric and 40 (91%) in the small intestinal anisakiasis group had a history of raw seafood ingestion. Computed tomographic findings revealed edematous wall thickening in all patients, and ascites and phlegmon of the mesenteric fat were more frequently observed in the small intestinal anisakiasis group.ConclusionsIn the ED, early and accurate diagnosis of anisakiasis is important to treat and explain to the patient, and diagnosis can be facilitated by a history of raw seafood ingestion, evaluation of the time-to-symptom development, and classic CT findings.