精神分裂症患者心理防御机制的性别差异及其影响因素

目的　探讨精神分裂症患者防御方式的性别差异及其影响因素。方法　应用防御方式问卷对 96名男性和 84名精神分裂症患者进行防御机制的测定 ,进行t检验 ;选取影响防御方式的 9个因素进行相关分析和多元回归分析。结果　男女两组 4个防御因子未发现明显差异 ,不成熟防御机制中的投射、退缩得分男性高于女性 (P <0 0 5 ,P <0 0 1) ,幻想、躯体化得分女性高于男性 (P <0 0 5 ) ;中间型防御机制中的理想化和否认得分女性明显高于男性 (P <0 0 5 ,P <0 0 1)。男性成熟防御机制与文化程度呈正相关 (r=0 6 99,P <0 0 1) ,与病程呈负相关 (r =- 0 36 2 ,P <0 0 5 ) ,与住院时间呈负相关 (r= - 0 32 9) ;男性中间型防御机制得分与职业呈负相关 (r =- 0 4 4 6 ,P <0 0 5 ) ;女性的掩饰因子得分与疗效呈正相关 (r =0 5 89,P <0 0 1) ,与住院时间呈负相关 (r =- 0 36 9,P <0 0 5 )。结论　四种防御机制的性别差异不显著 ,但部分条目男女差异较大 ,文化程度、病程、职业、住院时间和疗效对防御机制的影响比较明显。     

精神分裂症患者病耻感与生活质量的关系

目的:探讨精神分裂症患者病耻感与生活质量的关系。方法:采用一般情况调查表、贬低-歧视感知量表及精神分裂症患者生活质量量表对95例住院及152例社区精神分裂症患者进行问卷调查。结果:住院患者的贬低-歧视感知量表评分与生活质量量表总分分别为(29.53±4.57)分、(26.02±14.16)分;社区患者分别为(28.03±3.48)分、(37.44±13.44)分;住院患者的贬低-歧视感知量表评分与生活质量总分(r=0.214)、动力与精力因子分(r=0.024)呈正相关(均P<0.05);社区患者贬低-歧视感知量表评分与生活质量总分(r=-0.255)、动力与精力因子分(r=-0.349)呈负相关(P均<0.01)。结论:生活质量越差,住院精神分裂症患者病耻感越强;社区精神分裂症患者生活质量越差,病耻感越少。     

住院精神分裂症患者家属自测健康状况调查研究

目的探讨住院精神分裂症患者家属的自测健康状况,为改善患者的家庭支持系统提供依据。方法采用分层随机取样法,抽取2012年9月-12月在广东省河源市源城区精神卫生防治所住院的精神分裂症患者的家属(家属组)和一般人群(对照组)各100例,进行自测健康评定量表(SRHMS)调查,并采用简易应对方式量表(SCSQ)调查家属组的应对方式特点。结果家属组SRHMS的健康总体自测维度得分和社会健康子量表得分均低于对照组[(28.39±8.95)分vs.(32.51±3.65)分,(75.47±25.52)分vs.(88.66±11.94)分],差异有统计学意义(t=3.015、3.311,P0.01);家属组的积极应对方式和消极应对方式得分与常模比较差异有统计学意义(t=2.056、4.494,P0.05或0.01);家属组SRHMS各维度与积极因子正相关(r=0.728~0.299,P0.05或0.01);除维度1、5、8、9及社会健康子量表分、健康量表总分外,其余各维度与消极因子负相关(r=-0.416~-0.304,P0.05或0.01)。结论精神分裂症患者家属的健康水平偏低,可能与消极应对方式有关。     

稳定期精神分裂症患者血浆白介素-1β 水平及其与症状关系

目的:探讨稳定期精神分裂症患者血浆白介素-1β(IL-1β)水平及其与临床症状的关系。方法:纳入稳定期精神分裂症患者75例(患者组)和健康对照者40名(对照组),采用流式多重蛋白分析技术检测血浆炎症因子IL-1β的浓度,采用阳性与阴性症状量表(PANSS)评定患者临床症状。结果:患者组IL-1β水平[(2.10±0.59)pg/ml]较对照组[(1.90±0.28)pg/ml]高(P0.05);不同性别、是否吸烟、是否有精神疾病家族史患者之间血浆IL-1β水平差异无统计学意义(P均0.05);患者组血浆IL-1β水平与性别、年龄、受教育年限、首次发病年龄、首次住院年龄、总病程、用药剂量(折合氯丙嗪等效剂量)无相关(P均0.05)。患者组血浆IL-1β水平与PANSS中反应缺乏因子(r=-0.24,P=0.05)、偏执性因子(r=-0.36,P=0.00)、激活因子(r=-0.29,P=0.02)呈负相关。结论:稳定期精神分裂症患者血浆IL-1β浓度高于健康对照者,其与临床症状严重程度存在一定联系。     

精神分裂症患者自我面孔识别能力与自我接纳、自我效能及自尊的相关性

目的:探讨精神分裂症患者自我面孔识别能力及其与自我接纳、自我效能及自尊的关系.方法:采用自我面孔识别任务(SFRT)对62例精神分裂症患者(患者组)进行测试,并与54名健康者(正常对照组)作比较,同时采用自我接纳问卷(SAQ)、一般自我效能感量表(GSES)和罗森伯格自尊量表(SES)作评估. 结果:患者组SFRT平均反应时(2189±1138) ms明显长于对照组(1152±326)ms(Z=-6.86,P＜0.001),正确率(81±16)％低于对照组(88±6)％(Z=-2.82,P＜0.01).患者组SAQ评分平均(38.37±7.25)分低于对照组(43.19±5.61)分(Z=-3.42,P＜0.01);SES评分平均(21.21±5.22)分低于对照组(23.33±4.44)分(Z=-2.13,P＜0.05);GSES评分平均(22.27±5.98)分低于对照组(24.41 ±4.83)分(Z=-2.29,P＜0.05).相关分析显示,患者组SFRT平均反应时与SES得分(r=-0.430)、GSES得分(r=-0.396)均呈负相关(P均＜0.01);SFRT正确率与SAQ总分(r=0.367)、自我接纳因子分(r=0.298)、自我评价因子分(r=0.266)均呈正相关(P＜0.05或P＜0.01).结论:精神分裂症患者存在自我面孔识别能力的缺损,自我接纳、自尊水平及自我效能均低于正常人.     

早期帕金森病隐喻理解研究

目的了解早期帕金森病患者是否存在隐喻理解障碍,并探讨帕金森病患者隐喻理解障碍的相关因素。方法设计隐喻理解检查软件对42例帕金森病患者(PD组)及30例健康对照(对照组)进行隐喻理解研究,比较两组间隐喻理解成绩是否存在差别,以及起病侧、疾病分型对隐喻理解成绩的影响。结果帕金森病患者隐喻理解得分低于对照组〔(71.7±10.8)分vs.(81.6±7.7)分,t=4.204,P=0.000〕。病程与隐喻理解成绩呈负相关(r=-0.355,P=0.023)。右侧起病患者隐喻理解得分与左侧起病者比较〔(72.3±13.2)分vs.(70.9±7.9)分,t=0.415,P=0.681〕,以震颤为主型患者隐喻理解得分与强直少动为主型患者比较〔(72.4±10.5)分vs.(70.5±11.4)分,t=0.541,P=0.592〕差异均无统计学意义。结论帕金森病患者可能存在隐喻理解障碍,且该障碍可能随着病程的延长逐渐加重。     

丛集性头痛患者共情能力相关研究

目的丛集性头痛患者(cluster headache,CH)共情能力损害情况,并进一步探讨其共情能力损害的可能机制。方法采用人际指针量表(IRI-C)对25例发作间期CH患者和25例年龄及教育程度相匹配的健康对照组(health control,HC组)进行研究。结果与HC组比较,CH患者组IRI-C总分(46.12±10.13),共情性关心(EC)(14.34±6.50)、个人痛苦(PD)(5.60±4.32)差异均有统计学意义(t=-4.233,P0.05;t=-2.478,P0.05;t=-3.976,P0.05),且CH组的病程时间与IRI-C总分、个人痛苦(PD)呈负相关(r=-0.620;r=-0.613,P0.05),CH组的HAMD得分与共情性关心(EC)呈负相关(r=-0.645;P0.05)。结论丛集性头痛患者存共情能力缺陷,主要以情感功能损害为主,下丘脑边缘叶系统的损害以及5-HT递质代谢紊乱可能是导致患者共情能力损害的机制。     

长期住院男性精神分裂症患者血清催乳素水平调查

目的:调查长期住院服用典型抗精神病药的男性精神分裂症患者血清催乳素(PRL)水平。方法:114例长期住院的男性精神分裂症患者(患者组)使用电化学发光免疫分析技术检测血清PRL水平,并与性别、年龄相匹配的57名正常男性(对照组)相比较。结果:患者组的血清PRL水平平均(24.1±18.8)ng/ml显著高于对照组(10.6±5.5)ng/ml(t=7.06,P<0.01)。患者组中吸烟精神分裂症患者血清PRL水平平均(21.2±15.4)ng/ml显著低于非吸烟精神分裂症患者(30.7±23.9)ng/ml(t=-2.17,P<0.05)。精神分裂症患者血清PRL水平与患者年龄(r=0.003)、服药剂量(折算为氯丙嗪,r=-0.12)、服药时间(r=-0.18)以及体质量指数(r=-0.07)之间无明显相关性(P均>0.05)。结论:长期服用典型抗精神病药可显著增高男性精神分裂症患者血清PRL水平,吸烟对血清PRL水平有一定的影响。     

强迫症患者生活质量状况及其影响因素

目的 调查强迫症患者的生活质量及其影响因素.方法 采用世界卫生组织生活质量评定量表简表(WHOQOL-BREF)调查78例门诊强迫症患者(病例组)及60例正常对照组的生活质量,同时采用耶鲁-布朗强迫量表(Y-BOGS)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评定患者强迫、抑郁及焦虑症状.结果 病例组WHOQOL-BREF量表的生理领域、心理领域、社会关系领域、环境领域得分[分别为(64.70±10.30)分,(47.60±11.50)分,(53.10±12.20)分,(63.70±10.60)分]均低于正常对照组[分别为(79.20 ±9.60)分,(71.20±10.40)分,(74.10 ±9.80)分,(75.10±10.30)分],差异有统计学意义(t=-12.50 ～-6.30,P均＜0.01).Y-BOCS总分、强迫观念总分、HAMD总分均与WHOQOL-BREF所有领域得分负相关(r=-0.28～-0.61,P＜0.05);强迫行为总分仅与生理领域得分负相关(r=-0.49,P＜0.01).多元回归分析显示,强迫行为、HAMD总评分和HAMA总评分进入“生理领域”回归方程;在“心理领域”回归方程中除HAMA总评分外其余自变量均进入方程;强迫观念总评分、强迫行为总评分及HAMD总分进入“社会领域”回归方程;强迫观念总评分和HAMD总分进入“环境领域”回归方程.结论 强迫症患者生活质量低于正常人群;强迫观念、强迫行为、伴发的抑郁症状是强迫症患者生活质量的重要影响因素.     

长期服用抗精神病药的男性精神分裂症患者骨密度与血清泌乳素的关系

目的:探讨长期服用抗精神病药的男性精神分裂症患者骨密度与血清泌乳素水平(PRL)的关系。方法:将98例长期住院的男性精神分裂症患者按照PRL水平分为PRL升高组(390 m IU/L,66例)和PRL正常组(86~390 m IU/L,32例),测定两组患者的足后跟骨密度T值,并对两组结果进行分析比较。结果:与PRL正常组相比较,PRL升高组骨密度T值明显偏低(t=3.58,P=0.00)。控制年龄因素后,骨密度T值与PRL水平呈负相关(r=-0.101,P=0.043);与体质量指数呈正相关(r=0.199,P=0.012);与病程无显著相关(r=-0.066,P=0.414)。结论:长期服用抗精神病药的男性精神分裂症患者的骨密度与PRL水平呈负相关。     

新一代卒中电子病历系统的建立与应用

在卒中患者的治疗过程中,患者临床信息、化验检查信息、病情转归信息及随访信息等数据对临床医生从事临床和科研工作极为重要。但是,由于卒中病历需要记载的医疗信息内容繁多,且通常以纸质形式存在,使得卒中病历相关信息在临床科研及教学等工作中无法得到充分利用。本研究将针对以上问题,重点阐述卒中电子病历系统的设计与功能。从而说明该系统符合卒中临床诊治信息承载功能,能够实现科学研究的电子病历系统。     

Use of intravenous levetiracetam for management of acute seizures in neonates

Antiepileptic drugs used for the treatment of neonatal seizures have limited efficacy and undesirable side effects, leading to increased off-label use in neonates. Intravenous levetiracetam became available in August 2006 for use in patients above 16 years of age. Insufficient data are available about the efficacy and safety of intravenous levetiracetam in neonates. Data captured from our institution's electronic medical records were retrospectively analyzed for neonates treated with intravenous levetiracetam between January 2007 and December 2009. Data were acquired by reviewing our electronic medical records. Twenty-two patients received a levetiracetam load of 10-50 mg/kg for neonatal seizures. Nineteen of 22 patients (86%) demonstrated immediate seizure cessation at 1 hour. Seven of 22 patients (32%) achieved complete seizure cessation after administration of the loading dose, 14 (64%) achieved seizure cessation by 24 hours, 19 (86%) by 48 hours, and all 22 (100%) by 72 hours. No serious side effects were evident. Nineteen patients (86%) were discharged on oral levetiracetam, and only two patients (9%) were discharged with an additional oral antiepileptic drug. Intravenous levetiracetam can be used as monotherapy and adjunctively in acute seizure management during the neonatal period.     

基于BP人工神经网络模型构建电子病历系统的数据分析

背景：电子病历中包含大量能够辅助临床诊断和决策的医疗信息。 目的：利用BP人工神经网络进行电子病历的数据挖掘。 方法：针对BP人工神经网络的原理及算法进行了分析,提出BP人工神经网络模型构建的6个步骤,分别为训练数据集的确定,数据准备,网络模型的建立,进行数据挖掘,评估BP网络得到的结果及预测结果的应用。并分析了BP人工神经网络在电子病历中的相关应用。 结果与结论：利用BP人工神经网络可以对电子病历进行分析预测,查找存在的危险因素。证实BP人工神经网络在电子病历系统数据分析中具有实际应用价值。     

Patients' concerns about and perceptions of electronic psychiatric records

This study assessed concerns about and perceptions of electronic psychiatric records in a university psychiatric adult outpatient clinic. Forty-one patients who refused to have their psychiatric records transferred to the electronic record system were compared with 39 patients who agreed to an electronic record. Regardless of whether or not they refused to have their information transferred to an electronic record, a majority of patients reported numerous concerns about electronic records, such as concerns about unauthorized access to their records by parties within the university health care system. Patients' concerns may affect patient disclosure and other help-seeking behavior and therefore must be addressed by clinicians and health care systems.     

Using quality improvement teams to improve documentation in records at a community mental health center

OBJECTIVE: A community mental health center sought a system for qualitative review of patients' records to improve the quality of documentation through the engagement of clinical staff in the review process. METHODS: The center developed a quality improvement system in which treatment team clinicians use a scored 30-item protocol to measure the quality of record documentation by peers. Questions address whether the record documents the full range of the psychiatric treatment process, including assessment and diagnosis, treatment planning, and provision of clinical services. Other questions address specific contractual or regulatory requirements, such as whether procedure codes are correct, and evaluate the physician's record of medication management. Each treatment team at the mental health center's six clinics has a quality improvement work group, composed of the team psychiatrist and at least one other team clinician. Each month the work group meets to review two randomly selected medical records from another treatment team at the same clinic and arrive at a consensus score. An administrative oversight team meets regularly with clinician-reviewers to foster uniform scoring of the protocol throughout the center. RESULTS: An analysis of the trend in protocol scores over a 21-month period suggests that the procedure improves the quality of the documentation in patients' records. CONCLUSIONS: A team-based quality review process appears to have a positive impact on the quality of medical record documentation. Improved documentation may improve continuity of care and improve the accuracy of record information used for other quality measurement systems.     

Characterization of patients with schizophrenia and related psychoses: evaluation of different diagnostic procedures

BACKGROUND: We aimed at estimating the value of structured interviews, medical records and clinical diagnoses for assessing lifetime diagnosis of patients with schizophrenia. In addition, the validity of the Operational Criteria Checklist (OPCRIT) system was analysed. SAMPLING AND METHODS: Swedish patients (n = 73), diagnosed with schizophrenia and related disorders by their treating physician, were scrutinized. Independent research diagnoses according to the Diagnostic and Statistical Manual, ed. 3, revised (DSM-III-R) were obtained by (1) a structured interview; (2) the OPCRIT algorithm, based on record analysis only; (3) the OPCRIT algorithm, based on record and interview analysis, or (4) a separate traditional research diagnosis based on both record and interview analysis. In addition, clinical International Classification of Diseases (ICD) diagnoses, given by the treating physician, were obtained from the case notes. Concordance rates for the different psychosis diagnoses were calculated. RESULTS: Diagnoses based on interviews only showed poor to fair agreement with the other research diagnoses, but patients diagnosed with schizophrenia or schizophrenic psychoses (i.e. schizophrenia, schizophreniform or schizoaffective disorder) at the interview almost always also obtained a corresponding research diagnosis based on record or combined sources. Diagnoses based on records only showed a good to excellent agreement with diagnoses based on records and interviews. Clinical ICD diagnoses generally displayed poor agreement with the research diagnoses, but 94% of patients ever given a clinical ICD diagnosis of schizophrenic psychosis received a corresponding traditional research diagnosis. OPCRIT diagnoses and independently assigned research diagnoses, based on the same information, displayed excellent concordance. CONCLUSIONS: Structured interviews performed with Swedish long-term-treated psychosis patients during non-hospitalization are a poor source for the evaluation of psychosis diagnoses, but a good screening instrument for the detection of DSM-III-R schizophrenia. In the investigated population, medical records are a valuable source for diagnostic assessment of psychoses and may serve as a stand-alone procedure in this patient category. Swedish clinical ICD diagnoses have a high positive predictive power identifying DSM-III-R diagnoses of schizophrenic psychoses, indicating validity of register-based research focusing on these diagnoses. The OPCRIT system is a valid tool for assessing DSM-III-R psychosis diagnoses. It should be emphasized that the present conclusions are based on the investigated Swedish psychosis population and cannot be generalized to populations composed of other patient groups or sampled in other settings, with other traditions regarding the use and availability of medical records.     

The validity of epilepsy or seizure documentation in nursing homes

Recent studies have reported that epilepsy and seizures are common in nursing homes. Prevalence has been reported to range from 5 to 9% and antiepileptic drug (AED) use is even more common. Most of these studies have relied on various forms of nursing home records, but the validity of this source data, while assumed, has not been verified. This study evaluated the degree of agreement between the Minimum Data Set (MDS), both paper and electronic versions, and actual medical records available at the nursing home. Records of 144 residents were evaluated; agreement between paper and electronic versions of the MDS was 97.8%. Agreement between the paper version of the MDS and neurologists review of the nursing home record was 92.3%. However, the criteria for diagnosing epilepsy or seizure were not well documented. Nevertheless, the agreement among nursing home records, paper MDS and electronic MDS is great enough to allow the electronic MDS to be used as a research tool, but more investigation of the actual criteria used by nursing home physicians in diagnosing epilepsy and seizures is necessary.     

Project VALOR: design and methods of a longitudinal registry of post-traumatic stress disorder (PTSD) in combat-exposed veterans in the Afghanistan and Iraqi military theaters of operations

Few studies have investigated the natural history of post-traumatic stress disorder (PTSD). Project VALOR (Veterans' After-discharge Longitudinal Registry) was designed as a longitudinal patient registry assessing the course of combat-related PTSD among 1600 male and female Veterans who served in Operation Enduring Freedom (OEF) in Afghanistan or Operation Iraqi Freedom (OIF). Aims of the study include investigating patterns and predictors of progression or remission of PTSD and treatment utilization. The study design was based on recommendations from the Agency for Healthcare Quality and Research for longitudinal disease registries and used a pre-specified theoretical model to select the measurement domains for data collection and interpretation of forthcoming results. The registry will include 1200 male and female Veterans with a recent diagnosis of PTSD in the Department of Veteran Affairs (VA) electronic medical record and a comparison group of 400 Veterans without a medical record-based PTSD diagnosis, to also allow for case-control analyses. Data are collected from administrative databases, electronic medical records, a self-administered questionnaire, and a semi-structured diagnostic telephone interview. Project VALOR is a unique and timely registry study that will evaluate the clinical course of PTSD, psychosocial correlates, and health outcomes in a carefully selected cohort of returning OEF/OIF Veterans.     

Quality assurance in a children's psychiatric hospital

The use of short-term isolation (STI) in a children's psychiatric hospital was examined using the Joint Commission on Accreditation of Hospitals (JCAH) quality assurance mode. A Clinical Care Evaluation addressed two questions: Are we providing quality use of STI? And are we adequately documenting its use? A medical record audit of 78 discharged patients and a review of unit records provided hospital staff with utilization and demographic statistics; structured interviews with staff and inpatients were conducted that provided information about their opinions of STI. The data gathered served as the basis for recommendations that led to planned, informed program changes.