反复上访者司法精神病鉴定案例分析

目的探讨反复上访者的司法精神病鉴定特点。方法采用自制调查表对17例反复上访者的鉴定资料进行分析,统计其上访动机、诊断及责任能力。结果上访动机：妄想支配7例（41．18％）,现实动机9例（52．94％）,不明动机1例;诊断：精神分裂症6例（35．29％）,偏执性精神病2例（11．76％）,无精神病5例（29．41％）,其它4例;完全责任能力7例（41．18％）,部分责任能力1例（5．88％）,无责任能力9例（52．94％）。结论反复上访者多有精神异常,有关部门应考虑其是否具有病理性动机。     

精神病司法鉴定中性自我防卫能力鉴定分析

目的探讨精神病司法鉴定中女性精神障碍患者被性侵害案例的特征。方法对91例女性精神障碍患者被性侵害案例的鉴定资料进行回顾性分析。结果被性侵害的女性精神障碍患者中以精神发育迟滞者居多（68．1％）,其次为精神分裂症（24．2％）;性自我防卫能力削弱者（63．7％）明显多于性自我防卫能力丧失者（34．1％）及性自我防卫能力存在者（2．2％）;无性自我防卫能力者以精神分裂症居多（58．1％）,其次为中度精神发育迟滞（22．6％）、轻度精神发育迟滞（9．7％）。结论女性精神障碍患者性自卫能力丧失或削弱者居多,社会及家庭应加强对女性精神障碍患者的监护与管理。     

50例具有攻击行为精神分裂症病人的临床分析及护理对策

[目的]了解具有攻击行为精神分裂症病人的临床特点,总结其护理措施。[方法]回顾性分析50例具有攻击行为精神分裂症病人的临床资料。[结果]本组偏执型28例,有精神病家族史11例,被动住院42例,有攻击诱因7例,精神病性症状支配22例,无自制力48例,既往有攻击行为32例,治疗依从性差27例,有明确的攻击指向38例,攻击发生的时间以中、晚班为主,为29例;经积极的治疗与心理干预,有效36例。[结论]具有攻击行为精神分裂症病人具有一定的临床特点,采取预见性护理非常必要。     

人格障碍与精神分裂症患者凶杀案特征比较分析

目的探讨人格障碍与精神分裂症患者凶杀行为的犯罪学特征及刑事责任能力评定的特点。方法对98例鉴定为精神分裂症、16例鉴定为人格障碍者的鉴定资料进行回顾性对比分析。结果两组的病理性动机和现实性动机（x^2=5．27，P〈0．05）、作案对象（x^2=15．16，P〈0．01）、责任能力（x^2=92，P〈0．01）、作案后即刻表现（x^2=18．97，P〈0．01）差异均有显著性或极显著性。结论人格障碍与精神分裂症凶杀案具有不同的犯罪学特征，这些差别是刑事责任能力评定的重要依据。     

中山市流浪精神病患者救治现状调查

目的：了解中山市流浪精神病患者的救治现状,为进一步完善流浪精神病患者救治体制提供依据。方法对中山市114例流浪精神病患者的临床资料进行回顾性分析。结果本组患者98．2％由110及120送入院,79．8％来自广东省外,婚姻状况以未婚为主（62．3％）,文化程度较低;流浪原因以受精神病性症状影响为主（85．1％）,救治原因以言语紊乱为主（76．3％）,诊断以精神分裂症（40．4％）、精神活性物质所致精神障碍（21．1％）居多,多应用第一代抗精神病药物治疗（69．3％）,部分患者合并有躯体疾病或传染病。结论中山市流浪精神病患者来源地域分布广,文化程度较低,未婚者居多,多由公安机关及医疗机构联合送治,部分患者合并传染病或躯体疾病,救治任务复杂且繁重。     

司法精神医学鉴定案例130例分析

目的：探讨司法精神医学鉴定案例的临床特征。方法对130例司法精神病鉴定资料进行回顾性分析。结果本组鉴定诊断排前3位的依次为精神分裂症（19．2％）、精神发育迟滞（15．4％）、颅脑外伤所致精神障碍（13．9％）;进行刑事责任能力评定者占70．8％,其中评定为完全责任能力占32．6％,限制责任能力占29．4％,无责任能力占38．0％。结论司法精神病鉴定案例中以刑事责任能力评定案例居多,鉴定诊断以精神分裂症为首位。     

首发精神分裂症患者的成人亲附类型及其与临床类型的关系

目的：探索首发精神分裂症患者的成人亲附类型及其与临床类型的关系,为进一步理解精神分裂症患者的心理特点提供相关的研究基础。方法：依据中国精神障碍分类标准第三版（CCMD-Ⅲ）选取32例确诊为精神分裂症的首发患者作为研究组,选择性别、年龄、婚姻匹配的正常人32名及边缘型人格障碍（BPD）患者30例分别作为正常对照组和BPD对照组。采用成人亲附量表（AAS）、阳性和阴性症状量表（PANSS）以及有关轴Ⅱ障碍的结构性访谈（SCID-Ⅱ）为主要的测量工具。结果：与正常对照组比较,研究组成人亲附类型中不安全型较多,并且焦虑维度得分高;研究组和正常对照组不同性别的亲附类型分布差异均无统计学意义;研究组与BPD对照组的成人亲附类型分布差异无统计学意义;研究组中,非偏执型患者成人亲附以先占型居多且焦虑维度得分高;偏执型患者成人亲附以回避型居多且亲近依赖（回避维度）得分低。结论：首发精神分裂症患者的成人亲附类型以不安全型为主,主要表现为强烈地担心被拒绝或担心不被喜欢,其中,偏执型患者以回避型为主,非偏执型患者以先占型为主。     

女性精神障碍患者被性侵害司法鉴定案例分析

目的：探讨女性精神障碍患者被性侵害案例的特征。方法对273例女性精神障碍患者被性侵害的鉴定资料进行回顾性分析。结果被性侵害的女性精神障碍患者中以精神发育迟滞者居多（68．1％）,其次为精神分裂症（19．4％）;性自我防卫能力削弱者（55．3％）明显多于性自我防卫能力丧失者（26．7％）及性自我防卫能力存在者（18．0）;无性自我防卫能力者以精神分裂症居多（57．5％）,其次为重度精神发育迟滞（21．9％）、中度精神发育迟滞（12．3％）、器质性精神障碍（5．5％）。结论女性精神障碍患者性自卫能力丧失或削弱者居多,社会及家庭应加强对女性精神障碍患者的监护与管理。     

阳性症状为主型精神分裂症和伴有精神病性症状双相障碍患者MMPI对照研究

目的探讨阳性症状为主型精神分裂症和伴有精神病性症状的躁狂或抑郁的双相障碍患者的个性特征,为其鉴别诊断提供线索。方法采用MMPI测试软件,评估24例精神分裂症阳性症状为主型患者(精神分裂症组)和37例伴有精神病性症状的躁狂或抑郁的双相障碍患者(双相障碍组)人格特征,分别计算临床量表10个因子分值。采用SPSS 13.0进行统计处理,比较两组患者之间的差异。结果精神分裂症阳性症状为主型男性患者的社会内向因子分高于女性患者,差异有统计学意义(t=2.186,P=0.040);双相障碍男、女性患者之间的临床量表10个因子分均未见差异。两组患者的临床量表10个因子分差异无统计学意义(P>0.05),但精神分裂症阳性症状为主型患者的精神病态、偏执性人格、精神分裂症、轻躁狂因子分高于中国常模划界的T分,双相障碍患者的偏执性人格因子分高于中国常模划界的T分,其余均低于中国常模标准。结论精神分裂症阳性症状为主型与伴精神病性症状的双相障碍患者存在人格特征改变,两组患者MMPI无明显差异,精神分裂症阳性症状为主型患者的社会内向人格可能存在性别差异。     

临床护理路径在偏执型精神分裂症患者健康教育中的应用

目的：探讨临床护理路径在偏执型精神分裂症患者健康教育中的应用效果。方法将100例偏执型精神分裂症患者随机分为两组,均予以常规抗精神病药物治疗及护理,研究组应用临床护理路径开展健康教育,对照组予以常规健康教育,观察住院全程。对两组病情相关知识掌握程度、满意度及住院时间进行对比分析。结果出院时研究组病情相关知识掌握率及满意度显著高于对照组（P＜0．05）,住院时间显著少于对照组（P＜0．01）。结论对偏执型精神分裂症患者开展临床护理路径服务,能显著提高护理质量及患者满意度,缩短住院时间。     

Simulation in Nursing Education: iPod As a Teaching Tool for Undergraduate Nurses

Most people with psychosis and schizophrenia experience auditory hallucinations, particularly the hearing of voices. A common cause of frustration and alienation for consumers is the lack of understanding by therapists, family members and caregivers, who find it difficult to relate to the consumers’ experiences. The purpose of this study is to examine and evaluate whether students’ participation in a simulated auditory hallucination will increase their understanding and knowledge about psychosis and auditory hallucinations. The design method consisted of a lecture on psychosis and schizophrenia disorders, followed by a simulation of auditory hallucinations using iPods. Students’ knowledge and perceptions of psychosis and hallucinations was assessed using quasi-experimental pre-post matched-design questionnaires. The questionnaire was divided into two parts, the first comprised closed questions to assess students’ knowledge, and the second part consisted of open-ended questions to collect information about students’ perceptions of auditory hallucinations. The results confirmed that students’ knowledge of psychosis and hallucination increased following the teaching session and simulation is a useful tool to prepare students for clinical placements in mental health practice.     

Community health-care staff's experiences of support to prevent type 2 diabetes among people with psychosis: An interview study with health staff

The aim of the study was to describe mental health staff experiences of giving support to prevent type 2 diabetes mellitus (DM) among people with psychosis in community psychiatry. A qualitative interview study with a purposeful sample of 12 community health staff was conducted. Data were analysed using qualitative content analysis. The results show how staff reported continuously supporting people with psychosis to adapt to healthy lifestyles, but stated that support is not given until after a person becomes overweight or is diagnosed with type 2 DM. Support was described as a never-ending process of motivation facing many reverses. Individually-adapted support given in practical situations was perceived as most successful. Cooperation between health-care organizations was seen as essential, but inadequate. Limitations in income and social network, and easy access to fast food and alcohol, were seen as obstacles to support. The results indicate that community health staff are in a position to make a considerable impact in motivating and supporting healthy lifestyle changes in practical situations in daily life among people with psychosis. This study raises awareness of how community health staff's support can be useful when developing nursing skills and health-care plans for people with psychosis.     

Clinical and social changes in severely mentally ill individuals admitted to an outpatient psychosis team: an 18-month follow-up study

AIM: The study investigated clinical and social changes during an 18-month follow-up period in a group (n = 76) of schizophrenic outpatients admitted to a newly implemented outpatient psychosis team. Changes related to level of contact with the psychosis team were also examined as well as aspects of the content of the treatment interventions and work situation from a staff perspective. METHODS: Structured face-to-face interviews with the patients were performed at baseline and after 18 months. The Camberwell Assessment of Need instrument, the Lancashire Quality of Life Profile and the Interview Schedule for Social Interaction were used on both interview occasions along with Global Assessment of Functioning Scale and Brief Psychiatric Rating Scale. Thematic open-ended questions were used in staff interviews. RESULTS: Psychiatric symptoms, number of needs and number of met needs decreased, and perceived quality of life improved for the total sample during the follow-up period. Patients only in contact with a psychiatrist in the psychosis team improved more in symptoms and spent fewer days in hospital during follow-up time compared with those who had combined psychiatric and supportive contacts, and were also more satisfied with their medication. Patients with a combined contact deteriorated in psychosocial functioning compared with the group only in contact with a psychiatrist. Some of the elements in treatment interventions and work situation as well as hindrances in providing community-based care adapted to the patients' needs were identified. CONCLUSIONS: Community-based psychiatric services, to a larger extent, need to embrace evidence-based interventions and to perform regular, structured and comprehensive need assessments in order to ensure the effectiveness of interventions. Attention should be paid to staff motivation and education as well as to providing practical guidelines, supervision and support.     

10年间老年精神病患者住院概况分析

本文收集我院精神科１０年间８２０例老年期精神病患者进行住院概况分析，发现老年期疾病中，仍以精神分裂症居多，但有递年逐渐减少趋势；从住院的构成比看，老年期精神病患者逐年增多，其中功能性精神疾病逐渐减少，器质性精神疾病逐渐增多，主要残废原因是肺心病发感染及脑血管疾病。     

Barriers to Seeking Early Psychiatric Treatment amongst First-episode Psychosis Patients: A Qualitative Study

Aims: The aim of this study was to explore the family members' determinant of the delay in seeking psychiatric care to patients diagnosed with psychosis. Methods: Qualitative semi-structured interviews were carried out with twenty-seven family members of patients with psychosis at psychiatric outpatient clinics in Amman, Jordan. Results: The findings revealed that perceived stigma and fears about being labelled are the main barriers to requesting early psychiatric health care. The participants cited many different reasons linked to finding help led to delay in seeking help in the early stages of the illness including misattribution of the cause and symptoms of mental illness, family and financial factors. Conclusions: The study highlights the importance of enhancing knowledge about the schizophrenia-related spectrum to ensure patients seek treatment in a more timely manner.     

Psychosis

Psychosis is the term used to describe a mental state of dysfunction in behavior and thought processes. In patients with psychoses, mental capacity is grossly distorted and thought is disorganized. These factors cause an inability to recognize reality or relate to others in a meaningful way. A medical cause is found in approximately 20% of patients with acute psychosis. Emergency medicine physicians must differentiate psychotic symptoms caused by general medical conditions from psychosis caused by a primary psychiatric disorder. A careful evaluation must be performed to identify the cause of the psychosis. Correction of reversible causes, sedation, and appropriate disposition are the keys to the successful management of these patients.     

Postpartum psychosis induced by bromocriptine

Two multigravida patients with no prior psychiatric history were seen with postpartum psychosis, having received bromocriptine for inhibition of lactation. Bromocriptine given in high doses has been associated with psychosis in patients receiving the drug for Parkinson's disease. These cases demonstrate that bromocriptine may cause psychosis even when given in low doses.     

Research priorities for burn nursing: report of the psychosocial issues group.

This study was designed to identify nursing research priorities in burn care. The Delphi technique of sequential questionnaires was used for data collection. Ninety-four participants completed four rounds of questionnaires. One hundred and one research questions were identified, and priorities were assigned according to their impact on patient welfare and on the profession of burn nursing. Twenty-two of these research questions concerned psychosocial issues. This group of questions was then analyzed for priority research issues. The top five ranked questions in the psychosocial issues group for impact on patient welfare concerned: (1) stress reduction techniques, (2) social reentry strategies, (3) management of psychosis and post-traumatic stress disorder, (4) strategies to assist patients with impaired communication capabilities, and (5) the role of recovered burn survivors in encouraging patient compliance with treatments. Similarly, the top five ranked questions for impact on the profession of burn nursing concerned: (1) stress reduction strategies, (2) coping techniques for burn survivors, (3) management of psychosis and post-traumatic stress disorder, (4) nursing's supportive role in regard to "do not resuscitate" orders, and (5) coping strategies to be used with patients who express a desire to die.