南宁市兴宁区肇事肇祸重性精神疾病患者情况调查

目的:了解南宁市兴宁区重性精神疾病患者肇事肇祸情况及危险因素。方法:对登记在册的兴宁区712例重性精神疾病患者进行危险性评估,了解其有无肇事肇祸情况。结果:712例重性精神疾病患者中有肇事肇祸患者148例,占20.79%,其中精神分裂症患者中最多,占20.96%;肇事肇祸的发生与患者的性别、婚姻、家族史、服药依从性等原因有关。结论:需要针对高危的社区重性精神疾病患者加强监管和治疗。     

农村重性精神疾病患者肇事肇祸情况调查

目的：了解农村重性精神疾病患者肇事肇祸情况。方法：从已登记的1427例农村重性精神疾病患者中调查有无肇事肇祸情况。结果：1427例中有肇事肇祸患者308例（21.6%）,其中以精神分裂症最多1067例（74.8%）。肇事肇祸的发生率与患者的性别、文化程度、诊断、监护人、病程、住院次数和服药依从性等有关。结论：对农村重性精神疾病患者的监护和治疗工作应引起充分重视。     

精神疾病患者发生肇事肇祸行为的危险因素分析

目的:探讨精神疾病患者发生肇事肇祸行为的危险因素,为防范肇事肇祸行为的发生提供依据。方法:比较研究组206例肇事肇祸精神疾病患者与对照组200例非肇事肇祸精神疾病患者基本人口学资料、入院情况以及疾病类型等。结果:单因素分析结果显示患者肇事肇祸行为的发生受其职业(P0.001)、婚姻(P0.05)、家族史(P0.05)、自知力(P0.05)、入院时PSP评分(P0.05)、疾病类型(P=0.001)等影响;多因素分析结果显示患者肇事肇祸行为的发生与其职业、婚姻、家族史、疾病类型有关。结论:农民、无业、无配偶、家族史阴性、酒精引起的精神疾病患者更易发生肇事肇祸行为。     

山东日照地区重性精神疾病患者管理治疗和肇事肇祸情况调查分析

目的:对山东日照地区重性精神疾病患者管理治疗状况和肇事肇祸情况进行调查分析。方法:对日照市城乡部分登记在册的重性精神疾病患者进行疾病分类管理并对肇事肇祸情况进行危险性评估。结果:重性精神疾病患者中未治疗的患者占26.34%、门诊治疗的患者占34.31%,住院治疗的患者占39.35%。患者中肇事肇祸发生率为82.37%,其中精神分裂症患者肇事肇祸最多。危险性评估为高风险患者占53.30%。结论:重性精神疾病患者治疗不足,肇事肇祸发生多,应该加强这一特殊人群的管理和治疗。     

佛山市顺德区重性精神疾病患者肇事肇祸情况调查

目的了解佛山市顺德区重性精神疾病患者的肇事肇祸等情况。方法对登记在册的4107例重性精神疾病患者进行一般信息统计和基础情况调查,评估其危险性,了解其肇事肇祸情况。结果4107例重性精神疾病患者中,肇事肇祸患者共962例（23％）,肇事肇祸患者以精神分裂症（62％）最多见,并且具有男性（63．7％）为多、未婚和丧偶较多、经济状况较差、服药依从性差和阳性家族史较多的特点。结论要重视重性精神疾病患者的药物治疗,并建立有效的社区干预模式。     

肇事肇祸精神疾病患者的临床特征及其相关因素研究

目的 探讨肇事肇祸精神疾病患者的临床特征及其相关因素.方法 对139例肇事肇祸精神疾病患者进行一般人口学、卫生经济学、相关因素调查及PANSS量表评定.结果 肇事肇祸患者以精神分裂症为主,其PANSS量表评分显著高于全国常模(P＜0.01).首发年龄低、病程短、住院次数少、男性、家族史阴性、家庭负担重、无医保支持、监护差是患者发生肇事肇祸行为的高危因素.结论 曾有精神异常史却因缺乏监管及经济支持而未能得到及时治疗的男性复发精神疾病患者易发生肇事肇祸行为.     

佛山顺德区有肇事肇祸倾向重性精神疾病患者社区个案管理效果的干预12个月随访

目的:探讨社区个案管理对佛山市顺德区有肇事肇祸倾向的重性精神疾病患者社会功能、生活质量和家庭负担的影响。方法:将有肇事肇祸倾向的重性精神疾病患者分成干预组和对照组,对干预组实施个案管理模式,而对照组仅维持原来的社区随访服务。用简明精神病量表(BPRS)、社会功能缺陷筛查量表(SDSS)、Morning Side康复状态量表(MRSS)、生活质量量表和家庭负担会谈量表(FIS)评定两组患者的精神症状、社会功能、生活质量和家庭负担,并计算两组患者的肇事肇祸率。结果:在干预12个月后,干预组BPRS评分[(32.51±4.03)和(34.18±4.46)]、SDSS评分[(7.51±2.90)和(7.99±4.16)]、MRSS评分[(56.09±20.61)和(58.74±22.30)]和FIS量表评分[(35.20±10.31)和(37.28±14.24)]显著低于对照组(P0.05或P0.01),而干预组生活质量量表评分(13.32±4.75)显著高于对照组[(12.58±4.97)(P0.05)];干预组的肇事肇祸率(12.6%)显著低于对照组(18.2%,P0.05)。结论:对有肇事肇祸倾向的重性精神疾病患者实施个案管理,能有效改善患者的精神症状,降低肇事肇祸率,改善社会功能和生活质量,减轻患者的家庭负担。     

绵阳市游仙区农村重性精神疾病线索调查

目的调查西部经济欠发达地区农村重性精神疾病的肇事肇祸及其治疗状况．方法根据线索对绵阳市游仙区农村546例重性精神疾病患者进行调查．结果绵阳市游仙区农村重性精神疾病患者的肇事肇祸率达100％，肇事肇祸严重，诸如杀人、纵火、严重扰乱社会治安的肇事肇祸行为发生率高，自伤及自杀行为明显；从未就医者为20％；未住院者为43％；10年中未正规治疗的重性精神疾病患者占75％。结论西部经济欠发达地区的农村重性精神疾病的肇事肇祸发生率高，其治疗状况不容乐观。     

个案管理服务对社区重性精神疾病的效果

目的探讨个案管理服务对社区重性精神疾病的效果,为推进个案管理工作提供参考。方法选取2015年1月-2016年1月佛山市某社区参加个案管理服务的50例重性精神疾病患者为研究对象,采用量表(BPRS)、服药态度量表(DAI)和自制个案管理实施效果评估访谈表,评估个案管理服务的效果。结果参加个案管理后,患者及家人总满意度为85.26%,肇事肇祸为0,复发住院率下降了66.67%,就业率由参加前的8%提高到18%。结论个案管理服务可能有利于稳定社区重性精神疾病患者的病情,减少肇事肇祸发生率和复发住院率,提高就业率,提高家属的满意度及社会效益。     

上海杨浦区肇事肇祸精神疾病患者的临床特征及相关因素

精神疾病患者在精神病性症状的支配和影响下容易产生毁物、伤人、自杀、放火、无故上访等肇事肇祸行为,因此越来越引起政府和精神卫生专业人员的重视.国内对肇事肇祸精神疾病患者的系统研究较少,本研究对上海市杨浦区肇事肇祸精神疾病患者的临床特征及相关因素进行深入调查,以期为今后更有效地治疗和干预提供线索.     

Schizophrenia-like illness in velo-cardio-facial syndrome: a genetic subsyndrome of schizophrenia?

BACKGROUND: The study of genetic illnesses that have a behavioral phenotype resembling psychosis can provide important insights into the genetic basis of psychotic disorders and their patho-mechanisms. An important example of such a genetic disorder is the velo-cardio-facial syndrome (VCFS) associated with 22q11 microdeletion. CASE REPORT: The case of a 22-year-old male, who had the typical genotype and phenotype of VCFS and developed a psychotic illness characterized by withdrawal, catatonic posturing, inappropriate affect, stereotyped behavior, negativism and poverty of speech, is described. He had a partial response to an atypical neuroleptic, but developed myoclonus that was controlled with an anticonvulsant. CONCLUSION: The association of VCFS with schizophrenia-like psychosis is worthy of further study as it may provide insights into the molecular basis of neurodevelopment and its aberrations in psychotic disorders.     

96例精神药物过量患者资料分析

目的　分析服用过量精神病药物患者的临床相关资料及血药浓度。方法　回顾 1992～2 0 0 0年在上海市精神卫生中心就诊的精神药物过量的精神病患者的临床资料 ,分析疾病诊断、中毒药物的种类及血药浓度等。结果　共分析了 96例精神药物过量患者 ,诊断主要为精神分裂症 (6 5例 )及抑郁症 (2 3例 )。过量精神药物主要为氯丙嗪 (38例 )、氯氮平 (33例 )及苯二氮 卓艹 类 (2 1例 )。氯丙嗪血药浓度为 (1380 4± 1731 5 )ng/ml,氯氮平血药浓度为 (16 80 3± 2 337 4 )ng/ml。 结论　精神病患者中精神药物中毒以精神分裂症患者为主 ,其次为抑郁症患者。过量药物为常用的抗精神病药物氯丙嗪、氯氮平及苯二氮 卓艹 类。过量服药的患者的血药浓度较高 ,平均血药浓度明显高于治疗浓度。对服用这些药物的精神病患者更需要看护并加强对精神药物的管理     

Clinical Studies of Schizophrenia-Like State in Epileptic Patients

Abstract: Six subjects who suffered from epileptic seizures followed by a schizophrenia-like state were examined. The mean duration between the onset of seizures and the psychotic state was 13.5 ± 6.6 years (mean ± S.D.). Five female subjects had episodic psychotic states and one man had a persistent one. Four subjects had localized temporal EEG abnormalities and the EEGs during psychotic states were different in each subject. During the psychotic state, no seizure was seen in the four subjects, a dierent seiznre frequency in the episodic case and an unchanged frequency in the persistent case. The psychotic features were characterized by K. Schneider's first-rank symptoms. In order to understand the mechanisms of psychotic states, it will be useful to take into consideration the excitatory and inhibitory effects of neurotransmitters on limbic discharges.     

The Critical Period for Early Intervention

Abstract

Therapeutic intervention in psychotic disorders has been evolving steadily in recent years with notable changes in the content of treatment (e.g., atypical neuroleptics and the cognitive/psychosocial interventions) and the locus of care. While the therapeutic focus continues to emphasize acute and treatment symptoms, and longer-term interventions, for example assertive community treatment, the primary and secondary prevention of psychosis has received little attention since Cameron's (1938) pioneering work. It is now believed that the variables influencing the early phase of psychosis are sufficiently well developed to begin exploring their therapeutic implications. More speculatively, the early phase of psychosis is believed to be formative in biological, psychological, and social terms, thus affording major opportunities for secondary prevention. Three key elements of an early intervention strategy are proposed: early detection of “at-risk” mental states; early treatment of first psychotic episode; and interventions targeted during the early phase of psychosis (the “critical period”).     

The four dimensions: a model for the social aetiology of psychosis

Recently, there has been increasing focus on prevention of mental illness, early intervention and the promotion of mental health. The social determinants of health and public health approaches are considered key. Early intervention has focused on psychotic disorders but prevention has not. This may in part reflect the fact that public health planners do not have a clear model for how social determinants influence the risk of developing a psychotic illness. Drawing on biological, genetic and epidemiologic evidence regarding the relationship between social risk factors and psychosis, this paper outlines a conceptual framework for understanding how individual and ecological factors contribute and interact to modulate the risk of developing psychotic illness. The framework asserts that there are four dimensions: individual factors; ecological factors; the interaction between individual and ecological factors; and time. It may help those considering interventions to understand the multilevel and multifactorial effects of social factors on the aetiology of psychotic illness, to develop targeted strategies for the prevention of psychotic illness and serve as a template for the assessment of initiatives.     

Identification and treatment of the prodromal phase of psychotic disorders: perspectives from the PACE Clinic

Aim: To describe the development of the field of prodromal intervention in psychotic disorders and to summarize the findings from the PACE Clinic, the inaugural service devoted to this area. Method: A review of the PACE Clinic studies, with reference to the work of other groups. Results: The aims of intervention before the onset of psychosis are to alleviate current distress and impairment and to either prevent, delay or ameliorate the onset of more severe psychotic disorder. To do this, it is necessary to be able to first accurately identify those in the earliest stages of a potentially serious psychotic disorder, and second to effectively slow or prevent progression to more advanced illness. Criteria have been developed which have predicted onset of psychotic disorder inover 30% of so‐called ‘ultra high risk’ individuals. Treatment trials have been promising, and to date have examined the effects of antipsychotic medication, cognitive therapy and a combination of the two. Recently, omega‐3 fatty acids have also been shown to be effective. However, there are also pitfalls of working in the prodromal area, including ethical concerns and more recently the possibility that there is a decline in the rate of transition from ultra‐high‐risk state to first‐episode psychosis. Conclusions: The field of prodromal intervention in psychotic disorders is an exciting one as it offers the possibility of prevention of full‐blown disorder and its related negative sequelae. However, there are many issues that need to be dealt with in order to achieve this goal, and ongoing evaluation of methods to identify and treat such individuals is needed.     

Transition to schizophrenia and related disorders: toward a taxonomy of risk

The early detection and prevention of schizophrenia and other psychotic disorders are receiving rapidly growing attention subsequent to the suggestion that poorer outcome is associated with delayed onset of treatment among patients in their first psychotic episode. Although the first generation of so-called "prodromal" research programs has produced encouraging preliminary results, more information is necessary on the conversion rates from prodromal states to schizophrenia in specific samples. Early recognition and prevention strategies require a new taxonomy that classifies subjects by their status of risk of imminent onset of psychosis. Without additional knowledge of the mechanisms through which particular constellations of vulnerability factors, precursors, and prodromal symptoms predict the onset of schizophrenia, it is difficult to judge the effects of existing programs. In this paper, we discuss three sets of issues that will need to be resolved before these preventive programs can be implemented into routine care: (1) optimization of predicting the onset of psychotic disorders; (2) development and evaluation of alternative treatment strategies depending on the presenting risk status; and (3) evaluation of costs and benefits of identifying subjects at risk of psychosis/schizophrenia and receiving a specific preventive treatment.     

Pathological laughter as an obsessive-compulsive phenomenon

METHOD: Pathological laughter has been known to occur in organic and functional psychotic disorders and is sometimes seen in hysteria. Though it is an important phenomenon, its significance in other psychiatric disorders has been negligible. This case report highlights the phenomenology of pathological laughter as an obsessive-compulsive phenomenon in an adolescent girl. RESULTS: The girl was brought by her parents with a history of laughing without reason, but on detail evaluation, it was found that her laughing was an irrational and ego-dystonic phenomenon. She also showed resistance to her symptom. A family history of obsessive-compulsive disorder in the parental grandfather, the habit of smiling in her father and her childhood emotional trauma and sexual abuse could have contributed to the formation of the symptom. Selective serotonin reuptake inhibitor drugs and behavior therapy showed good improvement in this case. DISCUSSION: Pathological laughter, though common in organic and psychotic disorders, can present primarily as an obsessive-compulsive phenomenon as well. This case suggests that each and every patient with a history of pathological laughter in a psychiatry clinic should not be labeled as psychotic unless he or she is assessed in detail.     

When did neurologists and psychiatrists stop talking to each other?

Patients with epilepsy have a significantly higher prevalence of psychiatric comorbid disorders involving depression, anxiety, psychotic, and attention deficit disorders. Accordingly, one would expect that psychiatrists would be actively involved in the evaluation and management of these patients. This, however, is hardly the case. Patients who undergo temporal lobectomies, for example, are known to experience postsurgical depression and occasionally psychotic disorders. Yet, most epilepsy centers in North America do not include a psychiatric evaluation as part of the presurgical work-up. Collaboration between epileptologists and psychiatrists is often sparse, despite the intimate relationship between psychiatric comorbidities and epilepsy. The purpose of this paper is to highlight this bizarre phenomenon and to identify some of the reasons behind it.     

The general fertility rate in women with psychotic disorders

OBJECTIVE: This study determined the general fertility rate and age-specific fertility rates for women with psychotic disorders. METHOD: This historical matched-cohort study of patient records from a primary care database (the General Practice Research Database) was carried out for women of childbearing age (15-44 years) with psychotic disorders. RESULTS: The women with psychotic disorders (N=7,936) had a lower overall general fertility rate than the normal comparison subjects (N=23,023), although fertility was only significantly lower in the women aged 25 and above. This lower fertility rate was less marked in women with affective psychoses. There was no evidence that treatment with neuroleptics influenced the fertility rate in women with non-affective psychoses. CONCLUSIONS: This study found markedly lower fertility rates in women with psychotic disorders than in matched normal comparison subjects, particularly in women with non-affective disorders. Knowledge of fertility rates in women with psychotic disorders is fundamental for clinicians and researchers, since it has implications for family planning services, prevention of obstetric complications, child-care support, and hypotheses about the etiology of these disorders.