15年间儿童心理门诊的资料分析

目的:了解从1985年8月本院正式成立儿少心理咨询门诊以来的15年患儿就诊的情况,以掌握了解儿童和少年精神障碍的发展趋势.方法:从1985年8月到1999年6月30日之间就诊患儿的病历中,每年随机抽取200份,共3000份病历,做逐一记载,然后将资料进行分析,结果:15年来门诊中外地患儿呈增高趋势;患儿年龄在门诊初期主要集中于儿童期,以后涉及到儿童和青少年的各年龄段,以儿童期和少年期最多;文化程度以中,小学生居多,在初期,精神障碍各类论断单一,论断不规范,90年代以后论断趋于标准化,位于前三位的论断是:儿童多动症,情绪障碍和精神发育迟滞,治疗以药物为充,利他林是治疗“多动症“的常用药物,各种心理治疗呈逐年增多趋势.结论:我国儿童和青少年精神卫生事业的发展已经达到一个新的水平,社会对儿童和青少年精神医学和需求普遍增国,加强儿少精神卫生知识的宣传,普及,提高干预和治疗是专业人员的责任.     

边缘系统多靶点毁损术治疗精神障碍性疾病10例报告

自1990年以来,我们对10例有严重危害社会行为的精神障碍疾病患者进行了立体定向手术治疗,现将初步观察结果报告如下。资料和方法本组男性8例,女性2全,年龄20～38岁,病程8～18年。住院次数3～11次。诊断为精神分裂症7例,反社会型人格障碍1例,精神发育迟滞伴性行为紊乱1例,癫痫性精神障碍1例。所有病例均经过住院正规精神科治疗疗效不佳,严重影响家庭、社会和病房工作,由家属和     

某综合医院精神科开放病房4年病例资料分析

目的 了解某综合医院精神科开放病房4年病例的临床特点.方法 抽取2006年10月～2010年12月在广东省人民医院开放式管理和综合治疗模式的精神科病房住院的2723例精神障碍患者,对其临床特征、疗效和住院天数等资料进行总结与分析.结果 2723例住院患者中,排在前三位的疾病分别是抑郁症（20.49%）、双相障碍（15.57%）和广泛性焦虑症（14.69%）;治愈率前3位的精神障碍分别为焦虑症90.3%,双相障碍87.7%,抑郁症84.6%,平均住院天数较短.结论 综合医院精神科病房开放式管理模式可能有利于精神疾病的治疗和缩短住院周期.     

精神病人的脑肿瘤

作者报告巴黎 Sainte-Anne 医院1944～1970年从精神科转入神经外科的150例脑肿瘤病例。男女各半,平均年龄50岁。83%的病人诊断为脑肿瘤时已年过40岁。以在精神科住院的时间为限,住院2个月以内的算为急性组,有89例;超过2个月的归为慢性组,有61例。急性组中有半数病例住精神科病房仅2周,慢性组中半数病例的精神症状超过2年,其中9例曾长期住精神科病房。70%     

上海地区精神科病房中痴呆的诊断和护理状况调查

目的调查上海市精神科病房痴呆的分布及护理配备情况。方法采用横断面调查的方法,对8个精神卫生机构,对共计714例诊断为痴呆的患者进行了社会人口学调查表、ADL、MMSE等的调查。结果在精神科病房中的患者有44．3%患痴呆,75岁以上约占90%,5年以上病程的约占47．2%。80%以上患者生活能力严重受损,90%以上患者认知严重受损。结论精神科病房中的痴呆患者负担很重,给痴呆病人提供照料的护理配备相对不足。     

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.     

儿童少年精神分裂症的临床分析

目的 了解儿童少年精神分裂症的临床特点。方法 对1995年6月至2000年6月在华西医科大学附属第一医院精神科住院的56例精神分裂症患者（年龄≤15分）的病案资料进行分析，56例均符合中国精神疾病分类方案与诊断标准第2版修订本中的诊断标准。结果 发病例数有随年龄增大而增多的趋势。在56例中，63％（35例）为慢性病，79％（44例）在疾病早期存在非特征性症状；86％（48例）存在幻觉，79％（44例）存在妄想，其中年龄小于12岁的患儿妄想症状少见。30％（17例）患儿接受电休克治疗，副反应少见。结论 儿童少年精神分裂症的发病例数随年龄增大而增多，疾病早期存在非特征性症状，年龄较小的患儿妄想较少见。     

综合医院住院患者精神科会诊及随访研究

目的了解综合医院精神科会诊住院患者的症状变化。方法调查复旦大学附属中山医院2003年6月至12月所有精神科会诊的住院患者,根据《中国精神障碍分类与诊断标准-第3版》 (CCMD-3)进行诊断并作相应处理,评定汉密尔顿抑郁量表17项(HAMD)、汉密尔顿焦虑量表(HAMA)、总体评定量表(GAS)、临床疗效总评量表(CGI),并在会诊后第3天和第7天随访重复量表评定。结果共计136名患者请精神科会诊,诊断以器质性精神障碍最多,为24．2％。第7天随访时,患者 HAMD和HAMA的均分明显降低,差别有统计学显著性差异,总体功能显著改善。结论精神科会诊有助于改善患者的精神症状。     

对89例儿童少年精神障碍的自杀分析

作者对有自杀意念和行为的儿童、少年精神障碍89例进行了临床资料分析 ,旨在引起全社会及临床医生重视并及时给予危机干预。1　临床资料1.1　一般资料　本文调查了 1987～ 1996年间在本院住院和门诊就诊并符合ＣＣＭＤ - 2 -Ｒ中诊断标准的89例伴有自杀行为或 /和意念的精神障碍儿童与少年(仅 1例自杀死亡 )。其中诊断为精神分裂症 6 1例 ,情感性精神障碍 14例 ,品行障碍 5例 ,情绪障碍 3例 ,抽动症 6例。男 4 4例 ,女 4 5例 ,男∶女 =0 .98∶1。年龄为12～ 16岁 ,平均为 14.8岁。病程 8个月～ 4年。1.2　自杀与年龄和季节的关系　本组年龄…     

安神疏郁法治疗脑血管病所致精神障碍60例

脑血管病伴发精神障碍临床发病率较高．严重影响脑血管病患者的康复。笔者自2002-2005年在门诊应用安神疏郁疗法，治疗脑血管病所致精神障碍，疗效满意。1一般资料选择90例我院精神科门诊中，诊断为脑血管病所致精神     

Changes in the clinical features of child and adolescent psychiatric inpatients: a nationwide time-trend study from Finland

Background: Few studies have focused on the recent trends in clinical features child and adolescent inpatient. Aims: This study focuses on the change in the characteristics of child and adolescent psychiatric inpatients in Finland. Methods: The data collection was carried out on selected study days in 2000 and 2011. Questionnaires were sent to the psychiatrists of all child and adolescent wards in Finland. Results: By comparing the data obtained in 2000 (n = 504) and 2011 (n = 412), several changes were found: the percentage of girls in adolescent wards grew and the diagnoses of depression, anxiety disorders, attention deficit hyperactivity disorder and eating disorders increased. In contrast, the diagnoses of psychosis and conduct or oppositional disorders decreased. General functioning was evaluated with the Childreńs Global Assessment Scale (CGAS). There were no changes in the distribution of CGAS scores among child inpatients, whereas among adolescents the share of inpatients with lowest CGAS scores (1–30) increased significantly. The mean length of stay dropped. Conclusions: The growing percentage of girls in adolescent wards is associated with an increase in diagnoses that are more prevalent among girls than boys, namely depression, anxiety, and eating disorders. The changes in the distribution of diagnoses may be due to changes in diagnostic or referral practices, or reflect true changes in the prevalence of disorders among children and adolescents in need of inpatient treatment. The share of adolescent inpatients with the poorest general functioning has increased. The observed shortening in inpatient treatment time seems to be a result of changes in treatment practices.     

Duration of Untreated Psychosis, Referral Route, and Age of Onset in an Early Intervention in Psychosis Service and a Local CAMHS

Background:  The aim of this study was to investigate associations between demographic and clinical variables and duration of untreated psychosis (DUP) in a sample of cases of psychosis across an adult early intervention in psychosis service and a child and adolescent community team.
Method:  Cross-sectional baseline data for cases of psychosis across the two teams on the caseload at a given time point were collected, including age of onset, gender, ethnicity, referral route, and DUP.
Results:  The median DUP across the entire sample was 91 days, while those patients with initial treatment for psychosis from the child and adolescent team had a median DUP of 69 days. Using multiple linear regression, there were two variables that showed a significant association with DUP: referral route ( p  < .001), and age of onset, with earlier age of onset associated with shorter DUP ( p  = .015).
Conclusion:  These findings are discussed in relation to possible explanatory factors, with particular focus on service-level variables and pathways to care. It is suggested that the involvement of child and adolescent teams is vital to the work of early intervention in psychosis services.     

Stability of diagnosis: a 20-year retrospective cohort study of Israeli psychiatric adolescent inpatients.

Outcome according to diagnosis and stability of diagnosis were investigated in a follow-back study of 351 adolescents with various psychiatric disorders hospitalized in a closed psychiatric ward. The duration of follow-back was 15-19 years. All diagnoses were based on the ICD-9. Data were collected from the Health Ministry registry and, in the patients who could be located, by structured telephone interview. Special attention was directed at the diagnosis of transient adolescent psychosis (TAP) vs. schizophrenia and prognostic indicators of suicide. The results showed that the most stable diagnosis was anxiety disorder. The stability of the different diagnoses over time was greater between the second and last admission than between the first and last (for patients with three or more admissions). Number of hospitalizations correlated negatively with prognosis. TAP at second admission was an unstable diagnosis; 66% of these patients had a final diagnosis of schizophrenia. However, patients with a diagnosis of TAP at first admission had a higher predictive index score and a higher outcome score than schizophrenic patients. TAP appeared to be a valid diagnostic entity, distinguishable from schizophrenia in course, frequency of suicidal behaviour and social-occupational outcome. Suicide victims had a higher cumulative length of stay than age- and sex-matched non-suicidal patients. Fifty per cent of the suicide victims had a final diagnosis of schizophrenia, compared to 30 per cent for the whole sample. In conclusion, these findings indicate that TAP is associated with a relatively good prognosis and should probably be differentiated from schizophrenia. Further retrospective and prospective studies of adolescent psychiatric inpatients may help delineate the nature and course of psychosis and other psychopathology in this age group.     

The Reliability and Validity of Kiddie‐Schedule for Affective Disorders and Schizophrenia ‐ Present and Life‐time Version ‐ Persian Version

Background: The validity and reliability of a Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia‐Present and Lifetime Version (K‐SADS‐PL‐P) was evaluated. Method: The K‐SADS‐PL‐P was administered to 102 inpatients (mean age = 15.3 yrs, SD = 1.81) in a child and adolescent psychiatric ward. The psychometric properties were evaluated in comparison to the results of clinical diagnosis. Results: The K‐SADS‐PL‐P showed good‐to‐excellent concurrent validity in diagnosing current major disorders. Test‐retest reliabilities of most of the current diagnoses were also good to excellent. Conclusion: The Persian version of the K‐SADS‐PL provides reliable and valid youth psychiatric diagnoses.     

Combined psychopharmacological treatment among child and adolescent inpatients in Finland

The aim of this study is to report the prevalence and factors associated with combined pharmacotherapy among child and adolescent psychiatric inpatients in Finland. The target group was all child and adolescent psychiatric inpatients at the beginning of the year 2000. Information about medication use was obtained for 475 patients. The prevalence of combined pharmacotherapy was 16%. Of those taking pharmacotherapy, 36% had combined treatment. The most common combinations were neuroleptics and SSRIs. Most of the patients with combined pharmacotherapy had depressive or psychotic disorder. Among those with medication, older age (13-18 years), psychotic disorder, bipolar disorder, low functioning level (CGAS > 40) and involuntary treatment were associated with combined treatment. Illness severity and treatment resistance were associated with combined pharmacotherapy. Further studies on indications, safety and efficacy of combined pharmacotherapy are warranted.     

Experience of child and adolescent mental health clinicians working within an at-risk mental state for psychosis service: a qualitative study

Aim: To qualitatively examine the common experiences of child and adolescent mental health clinicians working with adolescents suspected of having an ‘at‐risk mental state’ (ARMS) for psychosis. Methods: A semistructured interview was conducted with six experienced child and adolescent mental health clinicians working in North East England. Results: A thematic analysis of clinicians' experiences indicated that the identification and management of an ARMS within this patient group is particularly complex. In terms of treatment options, approaches that promoted social inclusion were favoured, but the use of antipsychotic medication was perceived as a ‘last resort’, requiring serious consideration. Clear guidelines and an overall consensus were judged to be lacking in terms of coordinating care and multi‐agency working practices. Conclusions: Establishing a formalized care pathway that also incorporates regular training and supervision may be required by this and other clinical services working with adolescents suspected of having an ARMS. Improved identification, a firmer evidence base regarding treatment practices and clear guidelines are required for this age group. This need will become more urgent should a psychosis risk syndrome be included as a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐V).     

Should an adolescent psychiatric clinic be managed as an open setting? Initial evaluation of 7 years experiences

After a controversial discussion, the adolescent department of the child and adolescent psychiatry clinic of the university of Basle (KJUP) opened seven years ago as an open ward for the treatment of acute psychiatric breakdowns in adolescents. Meanwhile more than 22.000 days of care have been provided. The patients suffered from the whole range of psychiatric illnesses. The lack of possibilities to engage in an examination of security measures lead to an increased involvement in relationships between patients and his/her parents and the staff. Yet there are limits in treating psychiatric patients in an open ward. A conditio sine qua non is the possibility to hospitalize patients in peaks of crisis in the locked ward of the adult department of the university clinic. In the first seven years, 13 patients had to be transferred to the locked ward for a total of 0.05@1000 of the days of care, 6 of whom returned to the adolescent department after a short while (2.6 days in average). In the rest of the time, the advantages of an open setting could be used to the full extent.     

Intramuscular ziprasidone in youth: a retrospective chart review

OBJECTIVE: The aim of this study was to assess the tolerability and effectiveness of intramuscular ziprasidone in inpatient children and adolescents. METHOD: A retrospective chart review was conducted of child and adolescent inpatients at a private psychiatric hospital in central New York between January 1, 2003 and August 30, 2003. Subjects who had received intramuscular ziprasidone were identified, and their age, gender, and dosage were recorded. Nursing-shift notes were reviewed to ascertain the need for repeat injection and for adverse reactions. RESULTS: Forty-nine youths received intramuscular ziprasidone; 43 injections were 20 mg and 6 injections were 10 mg. Readministration within 4 hours was required in only 1 subject. No adverse events were recorded. CONCLUSION: Intramuscular ziprasidone was well tolerated and effective for acutely agitated and aggressive inpatient youth.     

Characteristics of assaultive behavior among psychiatric inpatients

OBJECTIVE: The purpose of this study was to assess the extent to which psychosis, disordered impulse control, and psychopathy contribute to assaults among psychiatric inpatients. METHODS: The authors used a semistructured interview to elicit reasons for assaults from assailants and their victims on an inpatient research ward. Video monitoring provided supplemental information to confirm participants' identities and activities before and during the assault. RESULTS: Consensus clinical ratings indicated that approximately 20 percent of the assaults in this sample were directly related to positive psychotic symptoms. Factor analysis revealed two psychosis-related factors, one related to positive psychotic symptoms and the other to psychotic confusion and disorganization, as well as a third factor that differentiated impulsive from psychopathic assaults. CONCLUSIONS: Information obtained from interviews with assailants can reveal the underlying causes of specific assaults. This information is potentially useful in the selection of rational antiaggressive treatment strategies.