精神障碍患者遭受躯体暴力和性侵害状况调查

目的了解精神障碍患者遭受躯体暴力和女患者遭受性侵害状况。方法应用自编"精神障碍患者遭受躯体暴力及性侵害状况调查问卷"对康复期的住院精神障碍患者进行调查。对不同因素相关的暴力发生比率差异进行分析比较。结果在所有患者中躯体暴力发生率为48.9%。在精神分裂症患者中发生率为52.9%,其他诊断的患者发生率为39.2%。男性患者发生率为53.2%,女性患者发生率为44.1%。城市患者发生率为47.3%,乡村患者发生率为52.5%。病程超过4年发生率为61.2%,住院次数超过2次发生率为64.9%。暴力侵害主要来自于工作学习场所(50.8%)、社区(43.8%)以及家庭(37.7%)等,其中女性患者报告48.2%的暴力侵害来源于家庭内,性别差异具显著性意义,P=0.031。59.2%的被侵害患者认为遭受躯体暴力使自己的尊严受到了严重伤害。69.2%的患者在被暴力侵害时感到无助,其中女患者为80.4%,男患者为60.8%,性别差异具显著性意义,P=0.017。29.9%的女性患者报告曾遭遇性侵害,其中的75.9%在报告遭遇过性侵害的同时也报告遭遇过躯体暴力。结论精神障碍患者在遭遇各种社会歧视的基础上,易于成为暴力侵害对象。     

严重精神障碍患者暴力行为相关因素的研究进展

暴力攻击行为常见于严重精神障碍患者,且具有突发性、无目的性等特点,给患者个人及家庭带来沉重负担,甚至威胁到社会公共安全.本文对近年来国内外严重精神障碍患者暴力攻击行为相关因素的研究做一综述,为早期识别及干预严重精神障碍患者的暴力倾向提供参考.     

住院精神病患者暴力风险评定量表的初步编制

目的本研究旨在编制能够全面、正确、灵敏地反映住院精神病患者暴力风险的评估工具。方法于2013年10月-2014年7月,随机选取云南省内8家精神病医院,根据量表编制的程序及要求,先后3次(预测、初测、再测)对876例住院精神病患者进行量表评定并修订量表,最终编制形成具有27个条目的住院精神病患者暴力风险评定量表。结果自编住院精神病患者暴力风险评定量表在不同样本群体中总分与各条目的相关系数r=0.11~0.58,内部一致性系数为0.77,分半信度为0.69,与NGASR、BPRS校标相关系数分别为0.12、-0.10。结论此次自编的住院精神病患者暴力风险评定量表可以及时甄别出具有高暴力风险的住院精神病患者,从而能够更好地采取针对性的预防性护理措施,减少精神病患者暴力行为及医疗纠纷的发生,提高医疗护理安全质量。     

常德地区严重精神障碍患者暴力攻击行为研究

目的了解常德市严重精神障碍患者的暴力攻击行为现状,探索暴力攻击行为的危险因素,为优化对这一人群的管控策略提供参考。方法于2017年7月-12月,在常德市康复医院接受暴力危险性评估的2 362例疑似精神障碍患者中,采用Excel生成随机整数的方式,随机选出790名被试,并将其中757例符合入组标准的患者纳入本研究,收集其一般人口学资料和临床资料,并进行修订版外显攻击行为量表(MOAS)评定。将MOAS加权总分≥5分者定义为研究组(n=505),MOAS加权总分5分者定义为对照组(n=252),比较两组一般人口学资料和临床资料,采用二元Logistic回归分析探索暴力攻击行为的独立相关因素。结果研究组中男性、年龄相对较小、单身、近半年无业、不(规律)服药、存在被关锁情况、伴有反社会人格特征者所占比例高于对照组(P0.05或0.01)。二元Logistic回归分析显示,不(规律)服药(OR=2.659,95%CI:1.892～3.738)、年龄≤30岁(OR=1.845,95%CI:1.163～2.926)、男性(OR=1.486,95%CI:1.085～2.036)、无业(OR=1.621,95%CI:1.069～2.457)与高暴力攻击风险呈独立正相关(P0.05或0.01)。结论常德市严重精神障碍患者发生暴力攻击行为的危险因素主要包括不(规律)服药、年龄≤30岁、男性、无业。     

某院精神障碍患者长期住院原因调查

目的了解男女精神障碍患者长期住院的原因。方法采用自编长期住院原因调查问卷对2014年1月1日在广州市民政局精神病院普通精神科住院超过1年、病情控制稳定并能够配合医护人员的370名符合《国际疾病分类(第10版)》(ICD-10)诊断标准的精神障碍患者进行调查。结果男性住院时间比女性长(P0.01);女性长期住院问卷总评分比男性高(P0.01);女性客观维度评分比男性高(P0.01);男性受家庭因素影响明显(P0.01);女性受社会因素影响明显(P0.01)。结论客观因素可能是精神障碍患者长期住院的主要因素,其中男性受家庭因素影响明显,女性受社会因素影响明显。     

精神障碍患者攻击风险与甲状腺激素水平的关系

正有暴力攻击行为的精神障碍患者是否都存在相似的甲状腺素水平改变?如果有,是否可作为患者暴力攻击行为的生物学标志?本研究拟对这些问题进行初步探讨。1对象和方法为2014年5月至2015年5月我院急诊收入留观病房的精神障碍或疑似精神障碍患者。入组标准:符合《国际疾病分类》第10版精神分裂症、情感障碍、分裂情感性精神障碍、应激相关障碍、分离转换障碍等精神障碍的症状学标准。     

心境障碍科青年人群住院患者非自杀性自伤行为的回顾性分析

目的:调查分析精神专科医院心境障碍科青年住院患者非自杀性自伤(non-suicidal self-injury, NSSI)行为的发生情况及相关因素。方法:回顾性分析168例精神专科医院心境障碍科住院的所有14～25岁患者的病历资料,包括人口学和临床资料、自杀风险评估表、精神病患者暴力危险分级评估表。根据现病史中有无自伤行为记录,将患者分为NSSI组和非NSSI组;比较两组在性别、父母是否离异、有无家族史、童年是否受创伤、自杀风险评估量表得分、精神病患者暴力危险分级评估表得分上的差异。结果:NSSI组48例(28.6%),非NSSI组120例(71.4%);NSSI组在自杀风险评估量表(t=-3.21,P=0.002)与精神病患者暴力危险分级评估表(t=-4.07,P=0.000)得分显著高于非NSSI组(P均0.01);暴力冲动程度及自杀风险程度进入二分类Logistic回归方程,高暴力冲动(P=0.001,OR=1.158,95%CI:1.060～1.265)、高自杀风险(P=0.007,OR=1.129,95%CI=1.033～1.234)是NSSI行为的危险因素。结论:心境障碍科青年住院患者的NSSI行为发生率较高,其危险因素为高暴力冲动性和高自杀风险。     

10年间酒精所致精神障碍住院患者流行病学变迁

目的探讨酒精所致精神障碍患者的流行病学及临床特征。方法对2005年1月-2014年12月在攀枝花市第三人民医院诊断为酒精所致精神障碍/酒相关障碍(符合ICD-10诊断标准)的住院病历档案进行回顾性调查分析。结果 10年间共收治酒精所致精神障碍患者986例,住院构成比10年增长约1.5倍,男性961例(97.46%),女性25例(2.54%),男女比例约为38:1,平均发病年龄(46.16±11.92)岁;农民285例(28.9%),工人337例(34.2%),二者占酒精所致精神障碍住院患者的63.1%;病理分型中依赖综合症占33%,精神病性症状占48.1%;伴发躯体疾病中,肝损害142例(14.4%),心血管系统疾病121例(12.3%);平均初饮年龄(25.31±11.07)岁,平均嗜酒年限(21.08±10.91)年。结论酒精中毒导致的精神和躯体障碍逐渐增加,已是一个日趋严重的社会问题,应提倡早期干预,酒精所致精神障碍患者宜尽早戒酒。     

首次住院的青少年抑郁障碍患者非自杀性自伤行为与冲动性的关系

目的 探讨伴有非自杀性自伤(NSSI)行为的青少年抑郁障碍患者在冲动性方面的特征,分析NSSI行为与冲动性的关系,以便早期识别有NSSI行为风险的患者并及时干预.方法 采取顺序入组的方式,选取在深圳市康宁医院首次住院的青少年抑郁障碍患者共53例,根据《精神障碍诊断与统计手册(第5版)》(DSM-5)诊断标准评估患者有无...     

"红牛"饮料致精神分裂症复发11例

1 病例 为2007年1月至2009年2月曾在我院住院患者11例,均符合中国精神障碍分类与诊断标准第3版精神分裂症诊断标准;男10例,女1例;平均年龄(25.4±5.3)岁;平均病程(10.6±35.0)个月.     

Factors associated with satisfaction with care among patients with epilepsy

OBJECTIVE: The purpose of the work described here was to determine those variables associated with satisfaction with care among patients with epilepsy. METHODS: We interviewed patients followed at a tertiary epilepsy center. Predictor variables included age, gender, race, education, income, insurance, seizure frequency, and Quality of Life in Epilepsy-10 inventory (QOLIE-10) results. Target variables were the subscales of the Short Form Patient Satisfaction Questionnaire (PSQ-18). We used univariate analysis to identify those variables significantly associated with the subscales and multiple linear regression to determine those independently significant. RESULTS: The study population comprised 193 patients. Lower education and better QOLIE-10 scores were independently associated with general satisfaction with care. The mental health scale was associated with general satisfaction with care. Lower educational level was the only variable independently associated with patient satisfaction with communication, the financial aspect of care, and time spent with physician. CONCLUSION: Lower educational level and better quality of life are the main variables associated with higher general satisfaction with care among patients with epilepsy.     

Treatment with rituximab in patients with polyneuropathy with anti-MAG antibodies

Journal of Neurology -     

Surgical Outcome in Patients with Epilepsy with Occult Vascular Malformations Treated with Lesionectomy

Summary: Purpose: This retrospective study reports the long-term surgical outcome of patients with medically refractory epilepsy and vascular malformations who were treated with lesionectomy. A detailed analysis of surgical failures had been performed in an attempt to define predictors of surgical success and failure.
Methods: Fifteen patients with medically intractable epilepsy and angiographically occult vascular malformations (AOVMs) were treated surgically with lesionectomy at Duke University Medical Center. Lesionectomy consisted of removal of the AOVM and surrounding hemosiderin-stained brain only, without the use of electrocorticography (ECoG) to guide resection.
Results: Eleven (73%) patients are seizure free after lesionectomy. Three showed no significant improvement, and one patient died, presumably after a seizure. Age of onset, duration of seizures, age at resection, and gender did not affect outcome. All patients with neocortical AOVMs in whom EEG findings correlated with the site of the lesion were seizure free after lesional resection. Treatment failures were associated with the presence of multiple intracranial lesions, poorly localized or diffuse EEG findings, discordant positron emission tomography (PET) imaging, or with a lesion in close proximity to the limbic system.
Conclusions: Lesionectomy, with removal of surrounding hemosiderin-stained brain, can be considered the procedure of choice in carefully selected patients with epilepsy with occult vascular malformations.     

Children with ADHD and motor dysfunction compared with children with ADHD only

The purpose of this study was to identify group differences in children with attention-deficit-hyperactivity disorder and motor dysfunction (ADHD-MD) and ADHD only, and to evaluate the medication responsiveness of ADHD-MD. Sixty-three children (49 males and 14 females; mean age 9 years 10 months, SD 2 years 10 months) underwent a triple blind, placebo-controlled crossover study evaluating two dose levels of methylphenidate (0.3 mg/kg and 0.5 mg/kg [corrected], twice daily) and placebo. Forty-nine trials were completed. Nineteen were children with ADHD-MD, 44 had ADHD only. Behavior and functioning were assessed at home and at school. Treatment effects were assessed using the Abbreviated Symptom Questionnaire for Parents and Teachers. Children with ADHD-MD were more likely to have severe ADHD-combined type and other neurodevelopmental and behavioral problems. Both groups of children had a linear dose response to medication (placebo, low, high) and there was no evidence of a group by dose interaction or an overall group effect at home or school. The lack of group effect suggests that these children responded to medication like the other subgroups.     

Valproate is associated with new-onset oligoamenorrhea with hyperandrogenism in women with bipolar disorder.

BACKGROUND: Preliminary evidence suggests that valproate is associated with isolated features of polycystic ovarian syndrome (PCOS), while contradictory data support an association between epilepsy and PCOS. The development of PCOS features after initiation of valproate was therefore examined in women with bipolar disorder using a standardized definition of PCOS. METHODS: Three hundred women 18 to 45 years old with bipolar disorder were evaluated for PCOS at 16 Systematic Treatment Enhancement for Bipolar Disorder sites. A comparison was made between the incidence of hyperandrogenism (hirsutism, acne, male-pattern alopecia, elevated androgens) with oligoamenorrhea that developed while taking valproate versus other anticonvulsants (lamotrigine, topiramate, gabapentin, carbamazepine, oxcarbazepine) and lithium. Medication and menstrual cycle histories were obtained, and hyperandrogenism was assessed. RESULTS: Among 230 women who could be evaluated, oligoamenorrhea with hyperandrogenism developed in 9 (10.5%) of 86 women on valproate and in 2 (1.4%) of 144 women on a nonvalproate anticonvulsant or lithium (relative risk 7.5, 95% confidence interval [CI] 1.7-34.1, p = .002). Oligoamenorrhea always began within 12 months of valproate use. CONCLUSIONS: Valproate is associated with new-onset oligoamenorrhea with hyperandrogenism. Monitoring for reproductive-endocrine abnormalities is important when starting and using valproate in reproductive-aged women. Prospective studies are needed to elucidate risk factors for development of PCOS on valproate.     

血管内栓塞治疗未破裂脑动静脉畸形并发癫痫患者的预后分析

目的分析血管内栓塞治疗未破裂脑动静脉畸形(CAVM)并发癫痫患者的预后情况。方法选择2013年3月至2017年6月收治的符合诊断标准的CAVM并发癫痫发作患者49例为研究对象,分析血管内栓塞治疗后患者的临床症状、生活质量(QOLIE-31)改善情况。结果患者经血管内栓塞治疗后,QOLIE-31各项指标(除了药物影响)评分均明显提高,高于治疗前(P0.05);Spetzler-Martin分级与Engel分级的I~II级例数多于治疗前(P0.05),同时Spetzler-Martin分级I~II级生活质量评分(76.04±18.33)分明显高于III~V级的(65.65±16.76)分(P0.05);Engel分级I~II级的生活质量评分(75.25±17.78)分明显高于III~V级的(66.23±13.22)分(P0.05);血管内栓塞比例80%的生活质量总评分(78.37±18.87)分明显高于栓塞比例80%的(64.16±16.92)分(P0.05);术后患者的头疼症状中重度例数明显低于治疗前(P0.01);患者的NIHSS评分和MRS评分均明显低于治疗前,头疼症状的生活质量评分高于治疗前(均P0.05)。结论血管内栓塞能明显改善未破裂脑动静脉畸形并发癫痫患者的头疼症状、癫痫发作情况、神经功能缺损,提高血管内栓塞比例能够提高患者生活质量。