综合性医院精神科会诊210例分析

通过综合性医院精神科会诊２１０例分析，发现在综合性医院临床各科存在大量精神医学问题。会诊主要原因是躯体疾病出现精神障碍（５７．６％）及躯体化症状（２６．２％）要求诊断和处理；内科会诊占首位（６７．６％），其中神经内科最多（１９．５％），其次是心血管内科（１３．８％）和消化内科（１３．３％）；病种以器质性精神障碍最多见（４１．０％），其次是神经症（２１．４％），以焦虑症及抑郁性神经症为多见；躯体疾病心理反应（１３．０％）也不少，症状以情绪焦虑、抑郁为常见表现。作者认为，在综合性医院设置精神种，开展会诊一联络精神病学工作甚为必要。     

综合医院会诊-联络精神病学10年间变化

目的：了解综合医院会诊-联络精神病学10年变化的情况。方法：对本院1991年和2001年临床各科住院病人邀请精神科会诊的数量、科室分布、精神科诊断与处理情况进行对比分析。结果：年会诊率1991年与2001年分别为0．45％与0．71％，呈上升趋势；会诊的科室以内、外科为主，会诊的疾病种类1991年与2001年前三种疾病仍分别是躯体疾病所致精神障碍、脑器质性疾病所致精神障碍及神经症。结论：综合医院住院病人精神医学问题呈上升趋势，应加强会诊-联络精神病学的研究与推广。     

综合医院住院病人精神科会诊分析

目的了解综合医院精神科会诊的临床特点。方法将中南大学湘雅第二医院2001年4月至10月间申请精神科会诊的129例住院病人年龄、科室分布、会诊后诊断及治疗情况进行分析。结果总会诊率为1．67％，40岁以上年龄组申请会诊率较高，总会诊人数以内科最多(69例)，而会诊率以中医科最高(3．68％)，器质性精神障碍为会诊的主要精神科疾病，会诊后疗效(好转 痊愈)达89．9％。结论综合医院精神科医师协助处理临床各科疾病所伴／致精神障碍是十分必要的，且这种会诊作用正在不断加强。     

会诊联络精神病学在综合医院的现状分析

目的对综合医院精神病学会诊现状进行分析研究。方法2007年度申请精神科会诊的病例279例,分析其申请科室、原发病、申请理由及精神科诊断处理。结果综合医院精神病学会诊中最常见的精神科诊断是脑器质性精神障碍、躯体疾病伴发精神障碍、焦虑障碍和抑郁障碍。结论应在综合医院积极开展会诊联络精神病学服务及对综合科医生加强精神病学知识教育。     

综合医院住院病人精神科会诊病例的临床分析

本文报告一综合医院一年度的精神科会诊情况，总会诊率１．８１％，会诊率无性别差异，＞６０岁年龄组会诊率最高（３．２％）。会诊科室以内科和传染科会诊率最高（分别为４．８％和３．２％）。会诊诊断以器质性精神障碍为主，占会诊病例的８５．７％，经精神科处理后，总有效率达７０％。     

综合性医院精神科会诊178例分析

作者对综合性医院精神科会诊178例分析发现，会诊的主要原因是躯体疾病伴发精神障碍(38.2%）及原患精神疾病又患躯体疾病(32．0％)要求诊断和处理，内科会诊占首位(34.3％)，以器质性精神障碍(36．5％)最多见；其次为神经症(18．8％)，以癌症为多见，随后为精神障碍(8．4％)；会诊后44．8％病人转精神科治疗，未转科者使用精神活性药物治疗者占17.9％，综台治疗占11．8％，心理治疗占8．5%。作者建议，在综台性医院设置精神科，开展会诊一联络精神病学(CLP)工作甚为必要。     

综合医院精神科急会诊与普通会诊的比较

目的探讨综合医院精神科急会诊与普通会诊的特征差异。方法2007年度申请精神科会诊的病例279例,分析申请科室、原发病、申请理由、精神科诊断处理,比较急会诊与普通会诊的差异。结果综合医院精神病学急会诊主要为脑器质性精神障碍及躯体疾病所致精神障碍(75%~85%),普通会诊以抑郁障碍、焦虑障碍及神经症为主。结论应在综合医院积极开展会诊-联络精神病学服务,急会诊与普通会诊的诊断差异有助于精神科会诊临床实践。     

内科住院病人精神科会诊213例分析

目的：探讨综合医院内科住院病人精神科会诊的现状。方法：对我院近3年来213例内科住院病人申请科学会诊的临床资料进行回顾性分析。结果：近3年来内科申请精神科会诊的 病例数逐年上升。申请会诊的科室,以神经内科最多,其次为心血管内科、呼吸内科、内分泌科和消化内科,会诊后精神科疾病以器质性精神障碍居多（46．4％）,其次为神经症（32．4％）及精神分裂症（7．0％）。申请会诊的病人中40例（18．8％）转入精神科治疗。结论：内科住院病人常伴发精神障碍,并有逐年增加的趋势,对普通内科医师加强精神科专业知识的培训,将有利于患有各类精神障碍的病人得到及时妥善的治疗。     

综合医院老年精神科联络会诊：附131例分析

目的了解和探讨综合医院老年精神科联络会诊的特点。方法对申请精神科会诊的131例综合医院老年患者,通过精神检查依照ICD—10进行诊断,并电话随访疗效。结果患者年龄65～109岁,平均（77．62±9．09）岁;会诊请求中最困扰的精神问题为行为障碍（69．5％）,会诊诊断谵妄状态（42．0％）最为常见;会诊后疗效很好和有效的比例分别为36．6％、57．1％。结论综合医院老年精神科会诊有其特点,会诊有助于精神状态的判别和治疗。     

会诊-联络精神病学中的心理治疗

会诊-联络精神病学（consultation liaison psychiatry．CLP）是精神病学的一个重要分支，国外亦称综合性医院精神病学（psychiatry in general hospital），主要研究精神科医生在综合性医院中开展的临床、教学和科研工作，重点探讨心理社会因素、躯体疾病和精神障碍之间的关系，进而从心理、社会和生物医学三方面来诊断和处理患者。文就会诊一联络精神病学中的心理治疗相关问题做一简要综述。     

AIDS patients compared with others seen in psychiatric consultation

To identify similarities and differences between AIDS patients and non-AIDS patients, all psychiatric consultations done in one year in a large voluntary general hospital were reviewed. A total of 93 consultations were done on 67 AIDS patients and 138 consultations were done on 121 comparably aged patients without AIDS. The most common AIDS risk factor was intravenous drug use. The AIDS patients were more likely to be Hispanic and male than were the non-AIDS patients. The AIDS group was also more likely to have a diagnosis of organic mental disorder, particularly dementia. There were no other differences in Axis I diagnoses, including depression, substance abuse, and adjustment disorder. Suicidal risk was no greater in the AIDS patients than in the non-AIDS patients. Axis II diagnoses were made more often in the non-AIDS patients, who also required more one-to-one nursing supervision. Consultation in AIDS patients took more staff time, and AIDS patients were more likely to have required one or more repeat consultations within the period of the study, thus creating a heavier burden on consultation staff. Although these predominantly heterosexual, Hispanic, and drug-using hospitalized AIDS patients do not show significantly higher rates of psychiatric morbidity than other, non-AIDS patients, except for more organic mental disorders, AIDS seems to create a much higher demand for psychiatric consultation services.     

Geropsychiatric consultation in a general hospital in Taiwan

The aim of this study was to characterize clinically significant issues in a psychiatric consultation service for geriatric inpatients in a general hospital in Taiwan. This was a case-control study. During a 5-month period, 100 geriatric (age > or =65 years) inpatients consecutively referred for consultation-liaison psychiatric service from non-psychiatric departments formed the study group. Another 100 medical inpatients, also referred for consultation-liaison to the psychiatric service, but aged 17-50, formed the control (non-geriatric) group. The diagnosis, demography, reason for referral, symptomatology, and other clinical characteristics were determined by consensus between two psychiatrists. Psychiatric diagnosis was made according to criteria in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders. The geropsychiatric consultation rate was 0.9%. Geriatric patients constituted 20.1% of all psychiatric referrals. Common reasons for referral of geriatric inpatients were confusion (32%), depression (17%), disturbing behaviors (14%), and psychosis (14%). The most common psychiatric disorder among geriatric patients was an organic mental disorder (79%), followed by a depressive disorder (13%). More geriatric patients suffered from cancers and cerebrovascular diseases than non-geriatric patients. The geriatric group was more likely to have multiple physical illnesses. Organic mental disorder and depressive disorders are the most common psychiatric diagnoses in the geropsychiatric consultation service of the authors. In the authors' experience, both psychotropic medication treatment and psychosocial intervention are important in geropsychiatric consultation.     

综合医院精神科联络会诊分析

目的:探讨综合医院内精神科联络会诊的分布特征。方法:收集某综合医院1年内精神科联络会诊病例688例,完成自制调查问卷,使用SPSS统计软件进行描述性统计分析。结果:会诊病例最多分布在神经内科(19.3%),其次为心内科(9.7%)、骨科(9.3%)、消化内科(8.9%)、呼吸科(8.7%)以及脑外科(7.0%);患者年龄分布以40~69岁(53.2%)和20~29岁(13.5%)为多;会诊主要原因为急性脑病综合征(25.7%)、精神病性症状(22.8%)、不能解释的躯体症状(12.9%)和既往有精神障碍史而目前无明显症状者(13.8%);会诊诊断主要包括躯体疾病伴精神障碍(21.4%)、精神分裂症和其他精神病性障碍(20.9%)、脑器质性精神障碍(20.1%)等。结论:综合医院精神科联络会诊涉及各科室、各年龄段;主要会诊原因为急性脑病综合征和阳性精神病性症状,而抑郁、焦虑症状关注较少。     

Patterns of comorbidity in relation to functioning (GAF) among general hospital psychiatric referrals. European Consultation-Liaison Workgroup

Improvement of services for physically ill patients with concurrent psychiatric problems is a noteworthy issue in general hospitals. Among 1249 general hospital in-patients referred for psychiatric consultation, concurrent mental and behavioural disorders (ICD-10) were diagnosed in 84% of cases. Any concurrent mental and behavioural disorder was associated with dramatically low functioning (GAF = 46), indicating serious psychosocial impairment. This is a striking new finding of clinical importance. The effect on functioning was similar for substance use disorders, other mental disorders, and combined mental and substance use disorders (dual diagnoses), with no gender differences. This finding highlights the need for specialized interventions among general hospital in-patients referred for psychiatric consultation.     

综合医院精神科会诊5年变迁

目的：了解大型综合医院精神医学联合会诊的变化趋势。方法：将本院1994年和1999年邀请精神科会诊的科室分布、病种、诊断、转科及用药情况进行对比分析。结果：会诊科室中内、外科会诊比例显著上升,妇产科、神经内科会诊比例显著下降。诊断以器质性精神障碍、抑郁性神经症显著上升,情感性精神障碍,心因性精神障碍比例有一定程度上升,精神分裂症比例有较大幅度下降。会诊后转入精神科的比例显著下降,使用精神药物的比例显著上升。结论：综合医院的精神医学问题需要精神科医生的协助处理。应加强联络－会请精神病学的工作,精神医学服务特别是对轻性精神障碍的诊疗应主动延伸至综合科室。     

Diagnostic consultation to a state hospital

As part of a program to assess the needs of patients in a state hospital scheduled to be closed, a psychiatrist provided consultation for 101 chronically ill patients, including formulation of a principal diagnosis by DSM-III-R criteria. Compared with earlier diagnoses made by the hospital, the consultant diagnosed fewer cases of schizophrenia and more cases of organic mental disorders, affective syndromes, and mental retardation and pervasive developmental disorders. The largest numbers of patients no longer diagnosed as schizophrenic received diagnoses of psychosis not otherwise specified, with further assessment recommended, or organic mental disorder. The author believes consultation programs like this one can help state hospital staff take a fresh look at long-term patients and can provide useful experience for psychiatric residents who assist with such consultations.     

综合医院精神心理科会诊患者特点分析

目的 了解综合医院精神心理科联络会诊的原因、患者的科室分布、病种构成及处理情况,以更好地指导精神心理科医生的联络会诊工作,为进一步完善会诊精神医学在综合医院内的发展提供参考.方法 本研究采用回顾性方法复习综合医院住院患者的精神科会诊情况,分析在现代医学模式下综合医院的患者对精神卫生服务需求的特点,汇总2012年1月-2013年12月精神心理科联络会诊病历,资料完整者共612例,对一般人口资料、各科会诊人数及病种构成、会诊原因、诊断、处理构成等情况进行描述分析.结果 全部临床科室都有邀请精神心理科会诊,比例最高的科室前5位为：神经内科113例（18.5％）、心血管内科83例（13.6％）、消化内科69例（11.3％）、干部科56例（9.2％）、急诊科52例（8.5％）.病种主要为神经症性、应激相关的及躯体形式障碍151例（24.7％）,心境障碍139例（22.7％）,器质性精神障碍108例（17.6％）,伴有生理紊乱和躯体因素的行为综合征84例（13.7％）;精神科用药以SSRIs类药物、非典型抗精神病药物及苯二氮革类应用较多.结论 综合性医院各科存在较多的精神医学问题,住院患者伴发的精神障碍涉及各类疾病,综合医院就诊的患者精神心理障碍应引起重视,精神科会诊联络非常重要,可以提高临床各科医师对精神障碍的认识,减少或消除人们对精神科会诊的顾虑与不信任,提高会诊效率,治疗躯体疾病的同时应及时使用心理和药物等多种干预手段,使患者得到全面康复,从而提高患者的生命质量.     

Psychiatric consultation among hospitalized arthritis patients

Fifty consecutive psychiatric consultations on 48 patients over an 18-month period in an arthritis hospital are analyzed. The range of psychiatric disorders and their relationship to characteristics of the patient population, such as age, sex, and medical diagnosis, are described. Approximately 2% of patients admitted to the hospital during this period elicited psychiatric consultation. This rate is one-third of the consultation rate of an acute medical and surgical hospital serviced by the same consultants. The relative distribution of psychiatric diagnoses—depression 59%, personality disorders and drug abuse 15%, psychosis 10%, conversion reaction 10%, and “other” 6%—was similar to that encountered in an acute general hospital setting. Although depression was the most prevalent psychiatric problem, it was severe enough to elicit consultation only in 1% of the total hospitalized population; its severity did not correlate directly with the severity of rheumatoid arthritis, the most common medical diagnosis encountered. Neither a particular medical illness nor sex accounted for a disproportionate share of the psychiatric consultations.