北京市抑郁症患者首次就诊地点调查及原因分析

目的 探索北京市抑郁症患者首次就诊地点选择及其影响因素。方法 以2019 年2— 8 月在北京14 家医疗机构门诊确诊的抑郁症患者作为调查对象，采用自制的首诊抑郁症患者就诊现状 调查问卷对患者进行首次就诊地点调查及进行原因分析。结果 4 317 人参与调查，2 770 人填写调查 内容并纳入分析。首次就诊选择综合医院者占42.58%（1 061/2 492），主要原因是就诊方便（238 人）；首次 就诊选择精神专科医院占32.10%（800/2 492），主要原因是精神专科医院或医师更专业（577 人）。在首次 就诊选择精神专科医院的患者中，北京市医保（72.16%，425/589）、45 岁以下（89.25%，714/800）、本科及以 上学历（84.63%，556/657）、自我评估疾病为中度（46.40%，316/681）及重度（16.89%，115/681）患者比例高于 选择综合医院的患者，差异有统计学意义（均P＜0.05）。结论 抑郁症患者首次发病时选择综合医院就诊 者比例高于精神专科医院；北京市、高学历、青年、中重度患者更倾向于选择至精神专科医院就诊。     

躯体形式障碍患者就医行为研究

目的 探讨躯体形式障碍(SFD)患者就医行为及其影响因素.方法 采用自编的就医行为与躯体症状报告单对115例SFD患者进行评定.结果 完成研究的109例SFD中,首诊于综合性医院者73例(67％),私人诊所者10例(9％),药店购药者4例(4％),求助于巫医者2例(2％),精神病专科医院者19例(17％);曾经到非精神专科诊疗的98例患者中,仅有24例患者得到明确诊断.相关分析显示,非专科诊疗次数与患者年龄、对精神疾病相关信息了解程度、前后非专科诊疗的经济花费、运动系统、心血管系统、呼吸系统、感觉系统功能障碍及症状清单总分呈正相关(r =0.21 ～0.35,P＜0.05或0.01).患者对精神疾病相关信息了解程度、症状清单总分、经济花费、年龄依次进入非专科治疗次数的回归方程(P＜0.05).结论 SFD患者首诊于精神专科的比率较低,非精神专科对疾病的检出率较低.对精神疾病相关信息了解少、躯体化症状严重等可能为SFD患者就诊于非专科的重要影响因素.     

抑郁症患者延误治疗的影响因素分析

目的:探讨抑郁症患者延误治疗的影响因素。方法:以是否有延误治疗的情况将67例住院的抑郁症患者分为延误治疗组(47例)和非延误治疗组(20例);采用自制调查表收集入组者一般及临床资料,并进行分析比较。结果:本组70%患者延误治疗。延误治疗组中,≤高中文化、居住在农村、间断性病程、急性起病、抑郁症家族史、首诊主诉为躯体症状、在综合医院就诊、有自知力、接受抑郁症诊断及有药物治疗意愿的比率与非延误治疗组比较差异有统计学意义(P均0.05);Logistic回归分析显示文化程度、病程、起病形式、家族史、求医方式、自身对疾病的认识、诊断的接受性、是否愿意接受药物治疗进入回归方程,标准回归系数分别为0.34,0.23,0.35,0.26,0.11,0.20,0.36,0.38。结论:抑郁症患者延误治疗的发生率高;高中以下文化程度、连续性病程、急性起病、阴性家族史、在综合医院治疗、无自知力、不愿接受诊断标签和药物治疗可能是延误治疗的因素。     

综合医院与精神专科医院抑郁障碍患者的临床特征比较

目的 比较不同性质医疗机构精神科门诊抑郁障碍患者的临床特征和治疗情况.方法 使用一般情况调查表和简明国际神经精神访谈对综合医院和精神专科医院精神科门诊100例抑郁障碍患者进行调查,对不同性质医疗机构患者的临床特征和治疗情况进行比较分析.结果 综合医院精神科门诊抑郁障碍患者的年龄和首次抑郁发作的年龄都大于精神专科医院患者(P ＜ 0.01).综合医院患者抑郁发作时有不典型症状的比例高于精神专科医院(P ＜ 0.05),而精神专科医院患者中有焦虑症状(P ＜ 0.05)、复发性抑郁(P ＜ 0.01)和有精神病性症状(P ＜ 0.05)的比例均高于综合医院,自杀风险的等级也高于综合医院(P ＜ 0.05).综合医院精神科门诊抑郁障碍患者使用苯二氮类药物的比例较高(P ＜ 0.05),而精神专科医院心境稳定剂的使用比例较高(P ＜ 0.05).两类医院中抗精神病药物的使用和是否有精神病性症状的内部一致性均不高(Kappa ＜ 0.4).结论 综合医院的抑郁障碍患者的临床表现更多不典型的特征,抑郁障碍的药物治疗情况也与专科医院不同,值得临床注意和深入分析.     

61例以躯体化症状为主诉的临床资料分析

报告 6 1例抑郁症均以躯体不适为突出症状 ,因误诊而久治无效 ,后经确诊后给予抗抑郁治疗取得了显著疗效。现将临床资料报告于后。1　对象和方法1 1　对象　为 1999年 6月～ 2 0 0 2年 6月首次就诊于我院的抑郁症患者 6 1例 (门诊 33例 ,住院 2 8例 ) ,按中国精神障碍分类与诊断标准第三版再诊断 ,均符合抑郁症的诊断标准 ,且汉密顿抑郁量表评分≥ 2 1分 ,排除其他精神疾病和躯体疾病导致躯体症状的患者。入组病例若首诊虽有躯体不适主诉 ,但躯体化症状≤ 3项者 ,则纳入精神症状组 (35例 ) ,若首诊也以各种躯体化症状为主诉 ,且躯体不适症状…     

双相障碍患者的临床特征及诊治途径回顾性分析

目的了解双相障碍患者的临床特征、诊治情况,为双相障碍的诊疗提供参考。方法采用回顾性调查方法,对2015年12月-2017年6月在北京回龙观医院住院治疗的227例符合《精神障碍诊断与统计手册(第4版)》(DSM-IV)双相障碍诊断标准的患者进行资料收集,包括发病年龄、首次就诊年龄、发作次数、家族史等人口学资料以及既往诊断治疗等临床资料。结果双相障碍患者平均发病年龄(25.41±9.64)岁,首次就诊年龄(27.02±10.52)岁。抑郁发作、躁狂发作及混合发作三组患者的住院次数比较差异有统计学意义(χ2=15.78,P0.01)。首次发病即就诊者疾病发作次数与首次发病后未就诊者比较差异无统计学意义(P0.05)。而首次就诊于精神专科医院的患者在发病次数相对较少时便被确诊(P0.01)。首次就诊于精神科专科医院的患者使用情感稳定剂的人数与首次就诊于非精神科专科医院者比较差异有统计学意义(χ2=60.00,P0.01)。结论首次发病就诊于精神专科医院的患者应用情感稳定剂的人数较首次就诊于非精神专科医院多,且在发病次数较少时被确诊。     

河北省精神障碍伴其他慢性疾病人群就诊情况及影响因素

目的 了解河北省精神障碍伴其他慢性疾病人群精神疾病的就诊情况及分布情况,探讨 影响患有慢性疾病的精神障碍患者就诊的相关因素。方法 数据来源自2016 年河北省第二次精神卫 生流行病学调查。此次调查采用多阶段分层整群抽样方法,使用河北省精神卫生中心自制调查问卷对 省内10 个地市常住居民进行精神卫生服务利用调查。本研究选取患有慢性疾病的精神障碍患者,对其 精神疾病就诊情况进行进一步分析。结果 在961 例研究对象中,有101 例患者出现精神症状后进行就 诊,就诊率为10.5%。女性就诊率（11.9%）高于男性就诊率（8.7%）,农业户口就诊率（12.0%）显著高于城 镇户口（6.5%）。此外,不同年龄、距离、婚姻状况、就业情况以及家庭年收入等情况的患者就诊率差异 有统计学意义。Logistic 回归分析结果显示,距离、婚姻状况、是否是贫困户和低保户是影响精神障碍伴 其他慢性疾患者群精神障碍就诊的因素。101 例曾经就诊的患者中,有29 例（28.7%）患者曾就诊于精神 专科医院。结论 河北省精神障碍伴其他慢性疾病人群精神卫生服务利用率偏低,大多数有精神卫生 服务需求的慢性疾病人群未能享有精神卫生专业服务。     

本地与外来人口精神分裂症患者就医行为调查

目的调查上海市嘉定区本地人口与外来人口精神分裂症患者的就医行为。方法应用"精神分裂症患者精神卫生服务利用调查问卷",对上海市嘉定区精神卫生中心门诊精神分裂症患者进行调查。结果①、两组患者在性别、年龄、宗教信仰、工作、年收入、家庭人均收入、病程及家族史上,差异均无统计学意义(P0.05);本地人口精神分裂症患者受教育年限较外来人口患者长(P0.01),已婚比例明显低于外来患者(P0.05),且具有医保的比例明显高于外来患者(P0.05)。②、两组患者在最先求助措施上,差异无统计学意义(P0.05);本地人口精神分裂症患者距首诊专科时间明显长于外来人口患者(P0.05)。结论本地人口精神分裂症患者婚姻状况差、距首诊专科时间较长,对这类患者应加以关注,在精神病防治工作方面需要加强。     

抑郁症患者病耻感现状及影响因素分析

目的 探讨抑郁症患者的病耻感现状及影响因素.方法 选择2018年7月～2020年7月100例抑郁症患者为研究对象,采用《抑郁症病耻感量表(DSS)》评估患者病耻感现状,调查患者性别、年龄、居住地等临床资料,并采用多元线性回归分析调查抑郁症患者病耻感的影响因素.结果 100例患者共回收有效问卷92份,回收率92.00％;DSS评分(42.12±6.91)分;不同年龄、居住地、社会支持水平、急性发作次数、病程、歧视经历、文化程度、居住情况患者DSS评分差异存在差异(P＜0.05),而不同性别及在职情况的患者DSS评分无明显差异(P＞0.05);多元线性回归分析显示,居住情况、文化程度、急性发作次数、病程、歧视经历、居住地是抑郁症患者病耻感的影响因素.结论 抑郁症患者具有中等水平的病耻感,受到居住地、文化程度、急性发作次数等因素的影响,临床应采取针对性干预措施以降低患者病耻感水平.     

以疼痛障碍为主诉的抑郁症66例临床分析

目的探讨以疼痛障碍为主诉的抑郁症临床特征。方法通过HAMD、HAMA及自制躯体症状量表评定北京某医院及河北某医院66例以疼痛障碍为主诉的抑郁症患者。结果以疼痛障碍为主诉的抑郁症患者女性多于男性,80.30%的患者首诊于综合医院非精神科,在非精神科就诊的患者中,约88.68%的患者没有得到及时有效的治疗,在主诉疼痛障碍的基础上,患者多伴疲倦乏力、食欲减退、头晕、失眠、性欲减退、心动过速、心悸等,常累及多个器官和系统。结论普及宣传抑郁症知识,要全面掌握以疼痛障碍等躯体症状为主的抑郁症的临床特点,打破传统生物医学模式的心理定势,避免误诊及医疗资源浪费,尽快解除患者的精神痛苦,恢复患者社会功能。     

首发精神分裂症患者就诊途径调查

目的：调查首发精神分裂症患者在精神病医院和非精神病医院就诊途径。方法：完成对71例首发患者及家属调查,包括人口学资料、非精神病专科就诊情况、延迟至精神科求助原因、精神科就诊途径及原因、精神病未治疗期病程等。结果：非精神科主要求助方式为宗教迷信和非专科医生;精神科求助途径主要为家属意愿;精神病未治疗期病程（DUP）中位数为6个月,未发现DUP与其他调查因素相关;造成延迟至精神科求助主要原因是患者及家属对精神卫生知识缺乏。结论：加强社区精神卫生知识宣传普及对于缩短DUP非常必要。     

抑郁症患者首次至精神科首次就诊的特征

目的:调查精神科首诊抑郁症患者特征.方法:调查196例初次就诊精神科的抑郁症患者,对病程、就诊主动性、非精神科求治史等特征及其他相关因素进行分析. 结果:患者至精神科门诊初诊时平均病程(6.4±4.4)个月,仅37.6％患者主动来诊,46.7％曾求治过非精神科.逐步回归分析显示,影响初诊时病程的因素为性别、文化程度及发...     

A clinical study of a group psychotherapy program for adolescents

Summary The introduction of adolescents with serious personality problems into a constructively-oriented group-therapeutic program is a valuable procedure during this troubled period in their growth. The program discussed in this paper illustrates a close and effective working relationship between the psychiatrist and the social service department in a general hospital.The director of social service implemented the program by integrating and co-ordinating the service within the hospital setting and the community (school, court, family agency etc.). The psychiatrist and social worker used a team approach to a community problem.The combined individual and group psychotherapy sessions were particularly useful in enabling the writers to help their troubled patients to overcome their resistances and their blocks to progress. Finally, there are definite advantages to having the psychiatric and medical facilities of a voluntary general hospital at the disposal of the patients.     

Monitoring service utilization of persons with mental disorders--a case for mapping pathways of care

Routinely collected and reported indicators for health service utilization have traditionally been event/episode related and hospital centered. This is also the case for service utilization by persons with mental disorders, for whom national and international databases usually report rates of hospital discharges, mean length of stay for hospital episode and the like. Such event/episode-related indicators are of limited use for planning and improving services for persons with mental disorders. It is argued that new reporting systems are needed that allow the monitoring of the pathways of persons with mental disorders through the service system. It is shown how--owing to recent developments in techniques of 'pseudonymization' and the ever-increasing computer power for dealing with large volumes of patient data--such a system can be established and how it can contribute to analyzing empirically such mental health-care issues as 'heavy utilizers', 'revolving door psychiatry', 'continuity of care', 'de-institutionalization' and the like. Results of a record linkage study for the total population of a federal state of Austria monitoring both psychiatric and non-psychiatric health service utilization are reported. Some unexpected findings include the high utilization of non-psychiatric services by patients discharged from a psychiatric hospital bed, results which could not have been found by psychiatric case registers which usually only monitor utilization of psychiatric services.     

Isolating the impact of psychiatric consultations in the general hospital: psychiatric comorbidities and nursing intensity

The amount of nursing services represents a substantial portion of the total cost of hospital treatment of medical/surgical patients. Patients receiving psychiatric consultations were compared to matched patients (DRG and LOS) who did not receive psychiatric services on the intensity of their nursing service needs. These two groups were then compared on the measure of nursing intensity before and after the timing of the consultation. Those who received a consultation had significantly lower intensity scores prior to seeing the psychiatrist. Although patients receiving psychiatric consultations did not show a significantly greater reduction in nursing acuity relative to their baseline levels than did the matched control patients, the amount of time the psychiatrist spent with consultation patients was positively related with the change in nursing intensity post-consultation.     

Psychiatric Presentations/Manifestations of Medical Illnesses

Psychiatry is clearly an integral part of medicine. With a history and physical exam (called the mental status exam in psychiatry), appropriate laboratory or imaging studies, a differential diagnosis is made. If a specific DSM-IV-TR diagnosis is made, then the treatment will naturally follow. The diagnoses are scientifically established with good validity, specificity, sensitivity and inter-rater reliability. Similarly the treatments are established through scientific research. However, sometimes medical illnesses may present with symptoms seemingly pointing to a psychiatric origin. Making a misdiagnosis can be quite problematic and dangerous for the patient. The opposite is also true, that psychiatric illnesses may present with symptoms implying a medical diagnostic origin. Finally, psychiatric patients may have more than one psychiatric diagnosis and in addition, a medical diagnosis too. A high degree of suspicion should always be entertained by the diagnosing physician, psychiatric or non-psychiatric. This paper reviews the literature regarding these situations and then presents several clinical cases where this conundrum was present. Making the correct diagnosis was critical in the successful treatment outcome of each of the clinical cases. When asked to consult on a patient by non-psychiatric physicians, the psychiatrist must be careful to also look for non-psychiatric origins for the referring symptoms. It is important for psychiatrists to build on their medical knowledge from medical school and internship and continue to be kept abreast of confounding symptomatology.     

Test-retest reliability of self-reported age at onset of selected psychiatric diagnoses in general health care

OBJECTIVE: To describe the demographic and clinical characteristics of consecutive referrals to an out-patient liaison psychiatry clinic in a large university hospital in the UK. METHOD: We studied 900 patients using a standardized proforma. Assessments of functional capacity were made using the Global Assessment of Functioning (GAF) scale, and each patient was assigned a psychiatric diagnosis using ICD-10 criteria. RESULTS: Four of five of all referrals presented with somatic complaints, and 41% had a concurrent physical illness. The most common psychiatric diagnoses were somatoform disorders (55%) and neurasthenia (11%). Although more than half (59%) had no previous psychiatric history, a surprisingly high number (35%) had significant functional impairment (scores of < 50 on the GAF scale). The lack of adequate psychological treatment services often provided a barrier to optimal management of some of the more disabled patients. CONCLUSION: The general hospital liaison psychiatry clinic provides an acceptable setting in which to assess and manage patients referred from non-psychiatric colleagues.     

Health Concerns and Health Service Utilization in a Population Cohort of Young Adults with Autism Spectrum Disorder

Individuals with autism spectrum disorder (ASD) have many health needs that place demands on the health service sector. This study used administrative data to compare health profiles in young adults 18–24 years of age with ASD to peers with and without other developmental disability. Young adults with ASD were more likely to have almost all the examined clinical health issues and health service use indicators compared to peers without developmental disability. They were more likely to have at least one psychiatric diagnosis, and visit the family physician, pediatrician, psychiatrist, and emergency department for psychiatric reasons, compared to peers with other developmental disability. Planning for the mental health care of transition age adults with ASD is an important priority for health policy.     

Psychiatric crisis intervention. Oranizational and administrative services in the Governmental health service

After describing the principles and structure of the psychiatric services in Bulgaria, the author goes in more detail into the organizational and administrative conditions of psychiatric crisis intervention. It is emphasized that the main basis for psychiatric crisis intervention must be the psychiatric out-patient service which includes and coordinates all service branches and works together with the non-psychiatric services. The author stresses two channels of information about crises: 'passive', when psychiatric services receive information from the family or non-psychiatric agencies associated with crisis interventions (e.g. general medical agencies, councelling centres, administrative authorities, etc.); 'active', if the dispensary itself collects information as e.g. by regular observation of registered patients, by psychiatric or general medical field investigation as may be carried out by the Prevention Department, etc.). A few ideas are also offered concerning the organization of a subsystem for crisis intervention within the entire psychiatric service delivery system.     

Patients with and without intellectual disability seeking outpatient psychiatric services: diagnoses and prescribing pattern

Background The present study examined the presenting problem of psychiatric outpatients, and resulting diagnostic and prescribing patterns, comparing patients with intellectual disability (ID) with non‐ID (N‐ID) patients seen in the same clinic. Methods This study was a retrospective medical chart review of information in the first psychiatric diagnostic evaluation for the most recent 100 adult patients with mild ID, 100 patients with moderate, severe or profound ID, and 100 matching N‐ID patients. Results There were significant differences in rates of medical illness, disabilities, history of marriage, children, independent living, and family history of psychiatric and neurological disorders. Individuals with ID were more likely to present with aggression, self‐injurious behaviour or physical complaints, whereas N‐ID subjects presented more frequently with depression and anxiety complaints. For all groups, depressive disorders were the most frequent class of diagnoses. For those with ID, antipsychotics were used in 32% of subjects, with mood stabilizers in 28% and antidepressants in 27%. The N‐ID subjects were most frequently prescribed antidepressants (40%) and anxiolytics (22%). Polypharmacy did not differ significantly among groups. Conclusions Psychiatric practitioners relied on the diagnostic examination to formulate their diagnosis, whereas the chief complaint reflected the view of caregivers of the subjects with ID. In contrast to previous studies, outpatient providers frequently diagnosed depression, and the prescribing pattern showed increased usage of antidepressants and mood stabilizers.