某监狱在监罪犯伪装精神病的特征分析(附四例报告)

通过对 4例服刑期间伪装精神病 (以下简称诈病 )者的分析 ,讨论犯罪嫌疑人与服刑犯诈病在动机、症状表现等方面的异同。一般资料　 2 0 0 2年 3月 ,笔者对某监狱 89例被怀疑患有精神病的服刑犯进行了司法精神病鉴定。诊断标准采用中国精神障碍分类与诊断标准第 3版。 89例服刑犯中有 4例 (4% )诈病。 4例均为男性 ;年龄为 2 5～ 34岁 ;均系汉族 ;文化程度 :小学 3例、文盲 1例 ;均系刑期 10年以上的重刑犯。诈病前在监表现差 ,尤其怕劳动、怕吃苦 ,且易与他人发生冲突。诈病主要表现 :缄默 ,目光较呆滞 ;肢体功能“障碍”、少动 ,对疼痛刺激…     

服刑人员诈病36例临床分析

<正>诈病指故意模拟或夸大躯体或精神障碍的行为,其目的在于逃避外界某种不利于个人处境,摆脱某种责任,或者获得某种个人利益[1]。罪犯在监狱服刑过程中为了逃避或减轻惩罚,诈精神病的案例较为多见。对诈病的诊断一般建立在经验性评估之上,诊断的必要条件是诈病者承认伪装,承认后症状消失[2]。本研究对36例明确诊断为诈病的案例进行回顾性分析,旨在归纳其特点,为罪犯诈病的识别提供参考。     

产后精神病42例的临床分析及随访

目的 探讨产后精神病的临床特点及产后精神病是否为独立的疾病单元。方法 对42例产后精神病作回顾性研究,根据中国精神疾病分类方案与诊断标准（CCMD－2－R）对42例产后精神病进行重新诊断分类并对其中23例进行随访调查。结果 42例产后精神病中30例在产后二周内起病,39例呈急性起病,28例有躯体或心理因素作为起病诱因。根据CCMD－2－R诊断为精神分裂症19例,器质性精神障碍13例,抑郁症5例,神经症5例;27例临床短期疗效达痊愈;随访到23例患者7例未再出现精神异常,改诊为精神分裂症10例,情感障碍4例,分裂情感性精神病1例,周期性精神病1例。结论 产后精神病以急性起病,临床症状不典型,易变性和混乱为特点;按国内现有诊断标准本组42例产后精神病均可归类,未发现区别于其它精神障碍的特有症状,提示产后精神病并非独立的疾病单元。     

利培酮治疗器质性精神障碍疗效分析

目的：探讨利培酮治疗器质性精神障碍的疗效及不良反应。方法：应用利培酮治疗器质性疾病所致精神障碍患者30例，疗程2周。用简明精神病评定量表(BPRS)评价疗效，用副反应量表(TESS)和实验室检查评价不良反应。结果：利培酮对器质性精神障碍有明显疗效，未发现严重不良反应。结论：利培酮对器质性精神障碍的治疗效果及耐受性良好。     

奥氮平治疗脑器质性及躯体疾病所致精神障碍的临床分析

我们从 1 999年 6月至 2 0 0 0年 1 2月用小剂量奥氮平治疗 3 1例脑器质性和躯体疾病所致精神障碍 ,取得较好疗效。对象　为本院及二院住院和门诊患者 ,共 3 1例。入组标准为符合中国精神疾病分类方案与诊断标准第 2版修订本中的脑器质性及躯体疾病所致精神障碍的诊断 ,简明精神病评定量表 (ＢＰＲＳ)总分≥ 1 8分 ,临床总体印象量表 (ＣＧＩ)总分≥ 3分 ,病前无精神病史 ,未用过任何抗精神病药 ,病后排除重性精神病和活性物质所致精神障碍。 3 1例中男 1 6例 ,女 1 5例 ;年龄 3 0～ 90岁 ,平均 ( 64± 5)岁。精神障碍病程1～ 7天 ,平均 ( 2…     

奥氮平与利培酮治疗脑器质性精神障碍的对照分析

目的 比较奥氮平与利培酮治疗脑器质性精神障碍的临床疗效和安全性.方法 将60例脑器质性精神障碍患者随机分成奥氮平组和利培酮组,疗程均为4周.采用阳性与阴性症状量表(PANSS)、治疗中出现的症状量表(TESS)评定疗效及不良反应.结果 奥氮平与利培酮的疗效差异无显著性.奥氮平的主要不良反应是嗜睡、体重增加,利培酮的主要不良反应是锥体外系反应、失眠.结论 奥氮平与利培酮均是治疗脑器质性精神障碍安全有效的非典型抗精神病药物,可根据患者不同的个体需要分别选择.     

阿立哌唑治疗脑器质性精神障碍疗效观察

我们以阿立哌唑治疗脑器质性精神障碍,观察疗效和不良反应,报告如下。1对象和方法为我院2004年8月至2005年12月收治的脑器质性精神障碍患者,符合中国精神障碍分类与诊断标准第3版诊断标准,简明精神病评定量表(BPRS)总分>45分,未用过其他抗精神病药。共12例,男7例,女5例,平均年龄(44·8±22·9)岁;其中脑外伤所致精神障碍6例,脑血管疾病所致精神障碍2例,癫疒间所致精神障碍4例。均使用阿立哌唑治疗,阿立哌唑初始剂量为5 mg/d,逐渐增至15~25 mg/d,疗程6周。脑血管疾病(脑梗死)加用尼莫地平和吡拉西坦(脑复康),癫疒间所致精神障碍加用抗癫疒…     

肝豆状核变性所致精神障碍违法犯罪1例

以精神症状为首发症状肝豆状核变性(Wilson’s disease, WD)通常存在症状不典型、诊疗不及时、容易误诊等情况,该病患者因违反法律法规时通常会因其有精神障碍而需要对其进行法医精神病鉴定。本文报道1例WD患者因偷窥女性涉案进行受处罚能力鉴定的案例,借此探讨司法精神病鉴定中器质性精神障碍有关鉴定所面临的困境。     

180例颅脑外伤后精神障碍的鉴定结果分析

目的探讨颅脑外伤后精神障碍的临床类型及相关因素。方法收集180例颅脑外伤后司法鉴定案例资料,并对精神障碍的临床类型及相关因素进行分析。结果精神障碍的鉴定诊断类型为:器质性遗忘综合征、器质性人格改变、器质性智能损害、器质性神经症样症状和器质性精神症状。以颞叶、额叶、弥漫性损伤多见,共163例,且CT显示多有颞叶、额叶软化灶等异常,共123例。影响智能损害的因素为颞叶或额叶损伤、外伤程度严重,CT及EEG异常。器质性神经症样症状多见于女性,外伤程度轻,多无弥漫性损伤,CT未见明显异常。结论颅脑外伤后精神障碍多见于颞叶、额叶、弥漫性损伤;智能损害者外伤程度严重,EEG异常率高;器质性神经症样症状与轻度脑损伤有关。     

奥氮平治疗器质性精神障碍26例临床观察

奥氮平作为一种非典型抗精神病药物在临床已经广泛应用 ,对精神分裂症的阳性、阴性症状、情感症状以及认知功能都有比较理想的效果。近来研究发现 ,除精神分裂症外 ,奥氮平对某些器质性精神障碍有良好的治疗作用 ,不仅可改善其伴发的精神病性症状 ,还可以有效地控制冲动、消除激惹 ,同时也可以使意识障碍得到有效治疗[1,2 ] ,为此我们对过去应用奥氮平治疗 2 6例器质性精神障碍患者进行了回顾分析 ,报告如下。1　研究资料共 2 6例 ,其中男性 2 2例 ,女性 4例。诊断 :阿尔采默氏病 (AD) 6例 ,血管性痴呆 (VD) 6例 ,脑外伤引起精神障碍 4例 …     

Psychogenic (reactive) and hysterical psychoses: a cross-system reliability study

The aim of this study was to investigate the concepts of reactive and hysterical psychoses and how they are classified in standardized diagnostic Systems. To this end we identified all of the patients who had been admitted to a psychiatric in-patient unit and diagnosed as suffering from psychogenic psychosis, reactive psychosis, hysterical psychosis or hysteria, using ICD-9 criteria. The case notes of these patients were then re-examined and diagnoses reached using DSM-III-R, DSM-IV and ICD-10 criteria and the Present State Examination (PSE)/catego computer program. The objective of this study was to evaluate the agreement between the diagnoses of reactive and hysterical psychosis obtained using ICD-9 criteria with those obtained using the DSM-III-R, DSM-IV, ICD-10 and PSE diagnostic Systems. A total of 67 case notes were identified in which the above diagnoses had been made: 27 cases with ICD-9 ‘hysteria’ and 26 cases with ‘other reactive and not otherwise specified psychoses’. Using the DSM-III-R criteria, 27 cases were diagnosed as psychotic disorder NOS, 12 as brief reactive psychosis and 11 as bipolar disorder. Using the DSM-IV criteria, 21 cases were diagnosed as psychotic disorder NOS, 11 as mood disorder, 7 as brief disorder without stressor, and 12 as brief disorder with stressor. Using the ICD-10 criteria, 18 cases were diagnosed as unspecified non-organic psychosis, 12 as mood disorder, 10 as acute and transient psychotic disorder without stressor and 13 as acute and transient psychotic disorder with stressor. Using the PSE/catego program, the most common diagnoses were class ‘S’ schizophrenia (17), class ‘P?’ uncertain psychosis (16) and class ‘M+’ mixed and manic affective disorder (11). Using the kappa coefficient a very low level of agreement was found between ICD-9 ‘hysteria’ and ‘other reactive and non-specified psychoses’ and the corresponding categories of DSM-III-R and the PSE/catego program. We concluded that, although DSM-III-R provides operational criteria for brief reactive psychosis, and DSM-IV and ICD-10 provide such criteria for brief or acute psychotic disorder, these bear little relationship to the original concept of the disorder. The PSE/catego program provides a very systematic approach to symptomatology, but the diagnostic classes have little clinical usefulness.     

Diagnostic stability 2 years after treatment initiation in the early psychosis intervention programme in Singapore

OBJECTIVE: To evaluate the diagnostic stability of psychotic disorders over a 2 year period in patients presenting with first-episode psychosis. METHODS: One hundred and fifty-four patients were recruited from an early psychosis intervention programme (EPIP). They were diagnosed by the attending psychiatrist using the Structured Clinical Interview for DSM-IV Axis I at first contact (baseline) and after 24 months. The diagnoses were classified into the following categories: schizophrenia spectrum disorders (schizophrenia, schizophreniform disorder and schizoaffective disorder), affective psychosis (bipolar and major depressive disorders with psychotic symptoms), and other non-affective psychosis (delusional disorder, psychosis not otherwise specified and brief psychotic disorder). Two measures of stability, the prospective and the retrospective consistency were determined for each diagnosis. RESULTS: The diagnoses with the best prospective consistency were schizophrenia (87.0%) and affective psychosis (54.5%). The shift into schizophrenia spectrum disorder was the most frequent diagnostic change. Duration of untreated psychosis was found to be the only significant predictor of shift. CONCLUSION: It is difficult to make a definitive diagnosis at first contact. The clinical need to review the diagnosis throughout the period of follow up is emphasized.     

Acute intermittent porphyria in a children's psychiatric hospital

Acute intermittent porphyria (AIP) is a rare autosomal disease that presents with gastrointestinal, psychiatric, and neurological symptoms. Bizarre behaviors are common to several illnesses present in a psychiatric setting. Most often these are manifestations of psychotic illness such as schizophrenia or manic-depressive illness, but they can also be seen in cases of organic mental dysfunction and toxic psychotic states. The author describes the disorder and reports on two cases of AIP in children who were initially diagnosed as atypical psychosis in an inpatient children's psychiatric hospital over a 3-year period.     

A follow-up study of a child psychiatric clientele with special regard to the diagnosis of psychosis

A 20-year follow-up of a child psychiatric clientele of 322 patients demonstrates that nearly one third have been admitted to psychiatric departments or mental hospitals in adulthood. One tenth belonged to the group with psychoses either as a child or grown-up. While the incidence of manic-depressive psychosis did not differ from a normal population of the same sex and age, the child psychiatric clientele is overrepresented by psychotic patients later on diagnosed as schizophrenia. The outcome of infantile psychosis was in half of the cases chronic psychosis; five of 10 psychosis proto-infantilis patients were diagnosed schizophrenia in adulthood. This result is not in accordance with the modern view that psychosis proto-infantilis is a special disease with no clinical connection to schizophrenia. The clinical entity of infantile psychosis and borderline psychosis seems to be affirmed by a common clinical and diagnostic course into borderline psychosis or schizoid character disorders. Nine patients with psychosis in adulthood did not belong to the group of psychosis in childhood.     

Early Psychosis Prevention and Intervention Centre long-term follow-up study of first-episode psychosis: methodology and baseline characteristics

Aim: This paper reports the rationale, methodology and baseline characteristics of a large long‐term follow‐up study of first‐episode psychosis from a geographically defined catchment area. Method: A total of 723 first‐episode psychosis patients were recruited from a specialized early psychosis service between 1989 and 2001 and prospectively followed up at a median of 7.4 years after initial presentation. Participants’ baseline demographic, clinical and functional characteristics are described. Sampling bias at study recruitment was assessed by comparison with a more complete sample of Early Psychosis Prevention and Intervention Centre (EPPIC) cases rated directly from the medical records. Results: At baseline, 57% of the sample were diagnosed with schizophrenia or schizophreniform disorder, whereas the full range of psychotic disorders was represented. Statistical analysis confirmed that the sample recruited was representative of total EPPIC‐treated incident cases. Conclusions: The EPPIC long‐term follow‐up study is a large and epidemiologically representative first‐episode psychosis cohort that has been subsequently prospectively followed up over a long period. Such a sample provides a rare opportunity to study the course and outcome of psychotic disorders.     

Determining the chronology and components of psychosis onset: The Nottingham Onset Schedule (NOS)

The Nottingham Onset Schedule (NOS) is a short, guided interview and rating schedule to measure onset in psychosis. Onset is defined as the time between the first reported/observed change in mental state/behaviour to the development of psychotic symptoms. Onset is conceptualised as comprising of (i) a prodrome of two parts: a period of 'unease' followed by 'non-diagnostic' symptoms; (ii) appearance of psychotic symptoms; and (iii) a build-up of diagnostic symptoms leading to a definite diagnosis. Twenty consecutive cases of first-episode psychosis were administered the NOS schedule to determine its psychometric properties including inter-rater and test-retest reliability. Its clinical and research potential as a reliable measure of duration of untreated psychosis (DUP) was assessed in a cohort of 99 cases of first-episode psychosis (56 schizophrenia, 43 affective psychoses). NOS identified all prodromal symptoms previously reported in other studies. There was high degree of inter-rater and test-retest reliability for all components of NOS. Duration of untreated psychosis was significantly longer (p<0.05) in schizophrenia (mean 179 days, S.D. 344; median 52 days) than in affective psychosis (mean 15 days, S.D. 116; median 12 days) but there were no gender differences between lengths of prodrome or treatment delays. The NOS provides a standardised and reliable way of recording early changes in psychosis and identifying relatively precise time points for measuring several durations in emerging psychosis. The scale is easy to use and is not time-consuming or labour intensive. Onset, as measured by NOS, is significantly longer in schizophrenic disorders than in affective psychosis. A small proportion of schizophrenia cases have very long DUP. Some cases with schizophrenia receive anti-psychotics in the prodromal phase, prior to the emergence of frank psychotic symptoms.     

Changing diagnosis of childhood psychosis

The case findings of thirty-three children given a diagnosis of psychosis during hospitalization in the '50s and '60s were reviewed and rediagnosed in 1973. Childhood schizophrenia was the original diagnosis in 58% of the cases but was the rediagnosis in only 18% of those same cases. Chronic brain syndrome with various reactions (psychotic reaction, nonpsychotic behavioral reaction, and mental retardation and autism) was the diagnosis in 27% of the cases, originally, but was given to 67% of the cases on rediagnosis. One-third of the children originally diagnosed as psychotic were rediagnosed as nonpsychotic. Approximately two-thirds of the children were nonpsychotic according to the DeMyer-Churchill guidelines.     

Development of acute psychotic disorders and HIV-1 infection

OBJECTIVE: To gain more understanding about the relationship between human immunodeficiency virus type 1 (HIV-1) infection and new-onset psychosis, we compared clinical and immunological findings, psychiatric symptoms, global cognitive performance and, when available, computerized tomography (CT) findings between HIV-1-seropositive patients with new-onset psychosis and well-matched nonpsychotic HIV-1-seropositives. METHODS: Two groups of subjects: HIV-1-seropositives with new-onset psychosis (n = 12) and HIV-1-seropositives without psychosis (n = 15) were recruited through outpatient departments. Organic Delusional Syndrome and Organic Hallucinosis were clinically diagnosed using DSM-III-R diagnostic criteria. Of the baseline participants, twenty-two participated in the two-year follow-up examination. RESULTS: The prevalence of new-onset psychosis in HIV-1-infected subjects was 3.7 per 100 (95% C.I. = 1.6-5.7). HIV-1-seropositive persons with new-onset psychosis had more frequently a positive past psychiatric history, no antiretroviral therapy, and a lower global cognitive performance than did the nonpsychotic HIV-1-seropositives. CT was positive, showing generalized brain atrophy, in three out of nine patients. Remission of psychotic symptoms was observed only in two HIV-1-seropositive persons with new-onset psychosis. Death occurred in two psychic HIV-1-seropositives with simple loosely held delusions. Autopsy results showed that cortical sulci and ventricle size were graded as with moderate/severe enlargement. CONCLUSIONS: New-onset psychosis in HIV infected patients could raise considerable problems in deciding whether a presentation is organic or functional. An interaction of the disease or of psychologically "having" the disease with the presence of a psychotic reaction should also be considered. Interestingly, a protective effect of antiretroviral therapy for new-onset psychosis is suggested.     

Testing the Ultra High Risk (prodromal) criteria for the prediction of psychosis in a clinical sample of young people

Criteria for identifying individuals at imminent risk for onset of a psychotic disorder, that is "prodromal" for psychosis, have recently been described. The current study set out to test the predictive validity of these criteria in a sample of help-seeking young people aged 15-24 years who were referred to, but not necessarily treated at, a psychiatric service. Ultra High Risk (UHR) status was determined at baseline and psychosis status was assessed at 6 month follow up. Baseline psychosocial functioning was also assessed as a possible predictor of psychosis. In the sample of 292 individuals, 119 (40.7%) met UHR criteria. Of these UHR+ people, 12 became psychotic within 6 months and 107 did not. Only one person not meeting UHR criteria developed psychosis in the follow up period. Sensitivity, specificity, positive predictive value and negative predictive value of UHR+ status for prediction of psychosis were, respectively, 0.923 (95% CI 0.621, 1), 0.616 (95% CI 0.556, 0.673), 0.101 (95% CI 0.056, 0.173) and 0.994 (95% CI 0.963, 1). UHR+ individuals were significantly more likely to become psychotic than UHR- individuals (Odds Ratio 19.3, 95% CI 2.5, 150.5). Low functioning at baseline was associated with psychosis onset in the whole sample and in the UHR group. The transition to psychosis rate was much lower than in previous samples. This may be a due to the sample being a more general one, not identified as possibly "prodromal". Other potential causes of this reduction in transition are also explored.     

The detection of malingered psychosis.

The detection of malingered psychosis is sometimes quite difficult. The decision that an individual is malingering is made by assembling all of the clues from a thorough evaluation of a person's past and current functioning with corroboration from clinical records and other people. Identifying malingered psychosis will prevent unnecessary hospital admissions and is critical in forensic assessments. Indeed, clinicians bear considerable responsibility to assist society in differentiating true psychosis from malingered madness.