综合医院建立开放式心理病房治疗神经症及精神病患者的可行性

背景目前国内大多数综合医院对神经症及精神病患者治疗都是采取单纯门诊心理咨询方式,这一方式的应对己难于满足社会的精神障碍服务需求,成立开放式心理病房是否可行?目的探讨建立综合医院开放式心理病房治疗神经症及精神病患者的新型管理模式的可行性.设计以患者为观察对象,病例分析.单位广东医学院附属医院心理科.对象选择2000-07/2003-07在广东医学院附属医院心理病房住院的各类神经症患者688例,精神病患者112例,其中男523例,女377例,年龄11～80岁,平均年龄(42±8)岁,平均住院(17.0±6.5)d.方法实行开放式管理模式,包括病房敞开式,建立支持系统,人性化约束,集体健身,精神支持等方法.由经过培训过的精神科医生采用症状自评量表对经过2个月康复指导的各类神经症及精神病患者900例进行疗效评定.对其中169例抑郁症患者在治疗2,4,8周时进行汉密顿抑郁量表测试.主要观察指标①169例抑郁症患者治疗前后汉密顿抑郁量表评定结果.②900例患者疗效评定结果.结果综合医院开放式心理病房管理模式具有患者生活自由、可保持与外界社会的接触好等特点,900例各类神经症及精神病患者基本恢复正常531例(59.0%)、显著好转264例(29.4%)、好转81例(9.0%)、无效24例(2.6%),总有效率97.4%,无一例发生意外.169例抑郁症患者治疗前汉密顿抑郁量表评分为32.3±3.6住院治疗2周时为17.4±4.2;治疗4周时为11.5±4.8;治疗8周时为5.8±3.6;治疗2,4,8周时均明显低于治疗前,差异有非常显著性意义(P＜0.01).结论综合医院开放式心理病房治疗的900例各类神经症及精神病患者的治疗有效率97.4%,并无意外发生,169例抑郁症患者治疗后的抑郁症状均较治疗前明显改善,说明综合医院建立开放式管理的心理病房具有可行性.     

综合医院开放式心理病房精神心理性疾病患者3803例分析

目的分析综合医院开放式心理病房患者基本情况及疗效,探讨精神心理疾病新的治疗和管理模式。方法对本院开放式心理病房设置以来收治的3 803例患者进行回顾性统计分析。结果患者的病种构成、基本情况、住院时间及疗效均与传统精神病院情况不同。结论综合医院开放式心理病房对精神心理疾病患者是一种有效的、值得进一步探索和发展的治疗与管理模式。     

精神心理疾病患者入住综合医院开放式心理病房的护理效果评价

目的 分析综合医院开放式心理病房患者基本情况及疗效,探讨精神心理疾病新的管理模式.方法 对开放式心理病房设置以来收治的5394例患者的临床资料进行回顾性统计分析.结果 5394例患者的疾病种类以精神分裂症为主,占26.71％,年龄分布以成年组(21～40岁)居多,占41.43％,平均住院时间12.1 d.5394例患者痊愈3181例,占58.97％.结论 综合医院开放式心理病房对精神心理疾病患者是一种有效的、值得进一步探索和发展的治疗与管理模式.     

对精神障碍患者开放式管理的探讨

目的探讨在综合医院开放式心理病房的设置管理,病种构成,治疗护理的方法及可行性.方法对在开放式心理病房住院患者800例进行分析及护理方法分析.结果病种构成中以焦虑症、抑郁症居多,其次为心因性精神障碍、早期轻型精神分裂症、分裂样精神病、心身疾病;治疗效果理想.结论对精神障碍患者实行开放性管理是有效的,可行的,安全的.     

对精神障碍患者开放式管理的探讨

目的探讨在综合医院开放式心理病房的设置管理，病种构成，治疗护理的方法及可行性。方法对在开放式心理病房住院患者800例进行分析及护理方法分析。结果病种构成中以焦虑症、抑郁症居多，其次为心因性精神障碍、旱期轻型精神分裂症、分裂样精神病、心身疾病；治疗效果理想。结论对精神障碍患者实行开放性管理是有效的，可行的，安全的。     

开放式与封闭式精神科病区管理模式比较

目的　探讨在精神病专科医院同时设置开放式和封闭式管理病区的优越性及可行性。方法　对 6 7例开放式管理病区住院患者和 10 0例封闭式管理病区住院患者的临床资料进行分析。结果　开放组的病种中精神分裂症相对较少 ,病程短 ,首次住院较多 ,使用非典型抗精神病药及新型抗抑郁剂治疗相对多 ,与封闭组有显著性差异 (P <0 .0 5 0 ) ,两组的治疗效果虽无显著性差异 ,但开放组的住院时间比封闭组缩短近一半。结论　在专科医院同时设置开放式和封闭式病房符合“生物 -心理 -社会医学模式” ,适应患者及其家属的要求 ,具有一定的优越性 ,是被患者及其家属认可、接受的一种管理模式     

精神科病房实施开放式管理的做法与效果

目的探讨精神科病房实施开放式管理对提高病人治疗效果和出院后社会适应能力的效果及存在的问题。方法以我院3个精神病区开放式病房的105名病人为实验组,以同期封闭式病房的984名病人为对照组,比较两组的治疗效果,探讨在实施开放式管理过程中出现的护理问题及采取的做法。结果经过采取正确、有效的病房管理和安全管理,以及贯穿整个住院过程的心理护理和健康教育指导,开放式病房病人的治疗效果明显优于对照组,差异具有统计学意义(P<0.05),意外事件发生率明显低于对照组(P<0.01),住院期间病人的服从性以及出院后病人的社会适应能力等方面都有明显提高,但仍存在安全隐患。结论精神科病房实施开放式管理效果较好,所采取的病房管理模式正确有效,值得推广。     

开放式管理对精神分裂症患者疗效的影响

对于精神病患者来说,传统的封闭式住院管理模式使其因长期住院而隔绝正常的社会生活,从而导致精神衰退。随着精神医学的发展,住院开放式管理模式已被临床广泛应用,现将我院实行开放式管理模式治疗的精神分裂症患者的临床效果总结如下。     

半开放式管理下精神病患者死亡原因分析及对策

目的 寻找半开放式管理下精神病房中临床护理的工作缺陷，为改进护理工作，减少意外事件的发生提出对策。方法 回顾分析1988年1月～2003年7月本中心7786例住院精神病患者中16例死亡患者的致死原因及护理相关因素，并与国内相关资料作比较。结果 半开放式精神病房患者死亡率为0．21％，比国内报道的封闭式精神病房住院患者死亡率0．40％～1．17％低。其中无1例死于感染性疾病；自杀37．50％、猝死31．25％；12例死于非正常办公时间。结论 精神病患者的死亡具备隐蔽性、突发性．提出从建筑物设计、病房管理、护士素质3方面加强管理和改进，以提高护理质量，有效减少住院精神病患者的死亡率。     

开放式与封闭式管理对精神分裂症患者回归社会的对照研究

目的 探索出一条更适合精神病人回归社会的管理模式.方法 把100例符合人组标准的精神分裂症住院病人随机分为研究组与对照组,各50例,研究组采用开放式管理,对照组则采用传统封闭式管理.两组均给予常规的抗精神病药物治疗,并实施整体化及人性化护理,注重与病人的沟通与信息交流,做好心理护理,并观察病情,掌握病人动态,及时记录与交班.用住院病人观察量表(NOSIE)、简明精神病量表(BPRS)、日常生活能力量表(ADL)、社会功能缺陷筛选量表(SDSS)、总体幸福感量表(GWS)作为评价工具.结果 开放式病房提高精神病人生活质量;病人在症状改善方面比封闭式管理的要快;开放管理病人的平均住院时间明显少于封闭式管理(P<0.01).结论 开放式管理对住院精神分裂症患者回归社会有良好的促进作用.     

联合救治模式下综合医院新型冠状病毒肺炎隔离病房的护理管理

目的 探索联合救治模式下,综合医院新型冠状病毒肺炎隔离病房中应急护理管理的方式和效果。 方法 通过对病房环境、医疗条件、患者病情和护士结构现状进行评估后,对武汉市某新型冠状病毒肺炎定点医院的隔离病房采用联合救治模式进行护理管理。通过重构三级责任制护理管理,进行护士优势组合排班、多形式规范培训、“两手准备”保障物资供应、“双保险”供氧、落实网格化督导防控措施等方式对隔离病房实施应急护理管理。结果 在医护人员的紧密合作下,联合救治模式开展顺利。2020年1月27日—3月15日,病房共治疗新型冠状病毒肺炎患者97例,治愈出院84例（86.59%）,病死1例（1.03%）。无院内感染和医护人员交叉感染发生。结论 通过开展联合救治,实现对新型冠状病毒肺炎定点医院的人力资源、医疗物资和专业技术支援,为患者成功救治赢得时间,同时有效避免医护人员院内感染的发生。     

Palliative care in district general hospitals: the nurse's perspective

Most patients with a terminal illness die in hospital, yet the opinions of their prime carers are largely ignored. This study investigated registered nurses' perceptions of palliative care in district general hospitals. A random sample of 263 nurses was surveyed, using a pre-piloted questionnaire, and results showed that 70% of general ward nurses believe that managing care of the dying is an integral part of hospital care. However, their dissatisfaction with the care they give is reflected in the mere 8% who consider hospital an ideal setting for patients who are dying. Although nurses are confident in their physical/clinical role, dealing with psychosocial issues is more problematic. A minority feel confident in discussing death and dying with the patient. Barriers to optical palliative care on general wards were perceived as lack of appropriate education and training, work pressures, and lack of support from medical colleagues and managers.     

普外科围手术期健康教育视频的应用效果

目的探讨视频健康教育方式在普外科围手术期患者中的应用效果。方法将某三级甲等医院普外科2个病区120例患者按病区分为两组,1病区和2病区各60例患者,1病区患者设为试验组,2病区患者为对照组。试验组采用视频教育方式,对照组采用常规健康教育方式,均结合针对患者疑问的一对一指导。结果试验组患者满意度、围手术期知识知晓率、自我护理技能准确率高于对照组,差异有统计学意义（P〈O．01）。结论普外科围手术期健康教育视频的应用有利于提高健康教育效果。     

Treatment of behavioural symptoms and dementia in Parkinson's disease

Behavioural symptoms such as anxiety, depression and psychosis are common in Parkinson's disease (PD), and dementia occurs in about 90% of the patients. These symptoms can be more disabling than the motor dysfunction and they negatively impact quality of life, increase caregiver distress and are more frequently associated with nursing home placement. Depression can be treated with counselling and pharmacotherapy. Tricyclic antidepressants or selective serotonin reuptake inhibitors are widely used, but there is still need for controlled clinical trials. Management of psychosis in PD is complex and includes elimination of identifiable risk factors, reduction of polypharmacy and administration of atypical neuroleptics, which can alleviate psychotic symptoms without worsening motor functions. Clozapine is the best documented atypical neuroleptic shown to be effective against psychosis in PD patients. Cholinesterase inhibitors may prove additional benefit in psychotic PD patients. Recent evidence from small double-blind and open-label trials suggests that cholinesterase inhibitors may be effective in the treatment of dementia associated with PD.     

Metoclopramide-induced supersensitivity psychosis

OBJECTIVE: To report 2 cases of metoclopramide-induced supersensitivity psychosis. CASE SUMMARIES: A 74-year-old Taiwanese man was treated with metoclopramide 5 mg 4 times daily for 6 months. A second patient, a 65-year-old Taiwanese man, was treated with metoclopramide 5 mg 4 times daily for 3 months. After discontinuation of metoclopramide, both patients developed hallucinatory experiences and delusions. DISCUSSION: This is the first report of metoclopramide-induced supersensitivity psychosis. Chronic administration of a dopamine antagonist (e.g., metoclopramide) might induce dopamine receptor supersensitivity. It is hypothesized that exacerbation or occurrence of psychotic symptoms following neuroleptic withdrawal results from mesolimbic dopamine supersensitivity. CONCLUSIONS: The complications of long-term metoclopramide therapy should be seriously considered when the treatment regimens are being planned. Clinicians should attempt to treat patients with the lowest effective dosage of medication for the briefest therapeutic period to minimize the risks of adverse reactions.     

Patients' opinions and experiences regarding the hospital bed and the bedside equipment: an interview study

As it is important for patients' recovery that hospital beds are comfortabke and adapted to patients' needs, 60 adult patients were interviewd during their stay in hospital about the experiences and opinions regarding the hospitals beds, bedside equipment and the general milieu in the ward. The patients were recruited from one ear, nose and throat, one general surgery and one internal medicine ward respectively, at the Sahlgrenska University Hospital in Göteborg. A standardized questionnaire containing both open and closed questions concerning bed function and bed comfort was designed and used. The study revealed substantial and serious dissatisfaction among the patients regarding the comfort of beds, bedside equipment and the physical milieu in the wards. Younger patients were more critical than elderly patients. The patients had many relevant suggestions on how to improve the conditions in the wards with respect to the needs they themselves had experienced as patients.     

Atypical antipsychotics for acute agitation. New intramuscular options offer advantages

Violent or threatening behavior is a common reason for a visit to the emergency department. Patients with aggressive behavior must first be assessed for the possibility of comorbid medical conditions, which can complicate management. The introduction of intramuscular preparations of atypical antipsychotics provides new treatment options for acute agitation. These agents appear to be fast-acting and well tolerated and do not induce the akathisia of the older neuroleptic agents. Short-term sedation with lorazepam remains a safe and effective choice for managing acute agitation, in particular when withdrawal from alcohol may be a precipitating factor. However, lorazepam does not address the psychotic symptoms that may be at the core of much of this behavior. The intramuscular preparations of the atypical antipsychotics will probably supplant the intramuscular formulations of the older neuroleptics, much in the same way that the oral forms of these agents have become the agents of choice in treating psychosis. In addition, development of depot preparations of atypical antipsychotics is progressing rapidly. These products may further revolutionize the emergency and postemergency care of psychotic patients.     

依托咪酯用于无抽搐电休克治疗精神病287例的临床观察

目的 探讨现代无抽搐电休克(MECT)治疗精神病的麻醉药物及监测选则.方法 采用回顾性调查的方法,对我院2004年9月至2006年9月期间,接受治疗的287例精神病患者2181例次的临床资料进行归纳、整理、总结.结果 2181例次MECT治疗未出现医疗意外和并发症;依托咪酯与异丙酚应用于无抽(搐电)休克治疗时,两者相比无太大差别.电刺激后两组心率和血压均明显升高,乙组变化较甲组大,但两组相比无特异性,入睡与清醒的时间相近,而且依托咪酯更易出现可供监测的麻醉慢波.结论 依托咪酯作为价格相对较低的全麻醉药,可完全替代异丙酚应用于无抽(搐电)休克治疗,且效果更佳.