48例首发抑郁症患者的精神科初诊情况调查

目的:了解抑郁症患者有关精神科初诊情况。方法:对48例首发抑郁症患者初次就诊精神科时的病程、主动性、非精神科诊治史等进行调查分析。结果:初诊时平均病程(6.4±4.4)个月,仅33.3%患者主动来诊,72.9%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躯体症状、起病形式、发病年龄及悲观程度;影响就诊主动性的因素是自知力;非精神科就诊行为主要受躯体症状影响。结论:抑郁症患者多就诊不够及时、主动和恰当,其根本原因是对该病的认识不足。     

精神专科医院门诊抑郁症患者就诊影响因素分析

目的 调查精神专科医院门诊抑郁症患者的就诊特点,探讨影响抑郁症患者及时就诊和选择首次就诊(首诊)医疗机构的因素.方法 选择北京市2所精神专科医院的156例抑郁症患者,采用自编调查表对患者的一般情况、患病及就诊情况进行调查.结果 (1)及时就诊组(发病≤3个月到精神科就诊,61例)与非及时就诊组(发病＞3个月到精神科就诊,95例)在对疾病性质的认识、第一主诉、病耻感、首诊医疗机构、就诊途径、花费的医疗费用及抑郁症阳性家族史等的差异有统计学意义(经x<'2>检验,P＜0.05或P＜0.01);(2)精神专科组(首诊医疗机构选择精神专科,52例)与非精神专科组(首诊医疗机构选择非精神专科,104例)在对疾病性质的认识、第一主诉、抑郁症阳性家族史、花费的医疗费用、婚姻状况、受教育程度等的差异有统计学意义(经X<'2>检验,P＜0.05或P＜0.01);(3)以患者首诊医疗机构作为因变量,将以上项目作为自变量进行Logistic回归,第一主诉、疾病性质的认识进入回归方程,各变量比值比分别为6.379和2.714.结论 (1)对疾病性质的认识、第一主诉、病耻感、就诊途径、首诊医疗机构的选择、受教育程度、抑郁症阳性家族史等因素,对抑郁症患者能否及时就诊有较大影响;(2)对疾病性质的认识、第一主诉、抑郁症阳性家族史、受教育程度、婚姻状况等因素可影响抑郁症患者对首诊医疗机构的选择.     

抑郁症病人就诊途径分析

目的 探讨抑郁症病人的就诊途径，为临床干预提供依据。方法 采用自制的《精神疾病有途径调查表》对９１例抑郁症病人的就诊行为及影响因素进行调查，并与１３８例精神分裂症进行同期比较。结果 ９０．１％的抑郁症病人首诊于非精神科，就诊过程中仅１９．８％的抑郁症被检出；８５．７％已接受各种非抑郁剂治疗；３６．３％用过气功、宵信治疗；８０．１％从未接受过心理咨询。结论 抑郁症病人有较严重的就诊行为偏差，专科就诊     

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。     

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。     

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。     

影响精神分裂症首次门诊诊断的因素

目的 调查门诊精神分裂症(包括分裂样精神病)患者首诊时影响确诊的相关因素。方法 对于1999年1月及2002年1月在上海市精神卫生中心门诊首次就诊的患者,进行回顾性调查后,分为三组:确诊组(首诊确诊为分裂症)、延迟诊断组(首诊未确诊为分裂症)和更改诊断组(首诊为分裂症,随访后诊断被更改),分析各组资料的差异。结果 诊断为分裂症的患者中有27.9％的需经一次以上随访才能确诊,6.7％的首诊为分裂症者在随访中被重新诊断。分裂性症状,情感性症状,Schneider一级症状,患者年龄,医师年资在组间存在显著性差异。结论 精神症状,患者年龄,医师经验是影响门诊精神分裂症首诊确诊的主要因素。     

抑郁症与强迫症就诊途径与医疗费用的卫生经济学分析

目的　了解强迫症及抑郁症患者的疾病负担及相关影响因素。方法　采用自编卫生经济学调查表对心理咨询门诊 77例强迫症和 4 4例抑郁症患者进行调查 ,采用T检验及相关因素分析资料。结果　强迫症组在精神科的花费显著高于抑郁症组 (t=2 6 99,P =0 0 0 8) ,抑郁症组非精神科的花费显著高于强迫症组 (t=2 170 ,P =0 0 33) ;直接花费两组无显著性差异 (T =1 2 2 4 ,P =0 2 2 3) ,间接花费强迫症组显著高于抑郁症组 (T =2 0 36 ,P =0 0 4 5 )。结论　不同的疾病特点及健康常识是影响患者不同就诊途径及花费的主要因素     

精神疾病患者首诊情况调查及健康指导的作用

目的:了解精神疾病患者首诊情况及给予精神健康指导的作用. 方法:调查453例精神疾病患者,了解其首诊情况,并进行精神健康指导,随访1年,观察指导前后的差别. 结果:有141例患者首诊于非精神科,在到精神科就诊前,大多不能得到正确的诊断和治疗,给予精神健康指导后,患者和家属对精神疾病和用药有关知识的了解有显著提高,依从性增加,复发率降低. 结论:应加强精神卫生的宣传,使精神疾病患者能及早获得正确诊断与治疗.     

抑郁症躯体症状的研究进展

抑郁症患者的躯体表现是影响抑郁症低识别率的原因之一。躯体化导致了大量抑郁症患者表现为各种各样的躯体症状、低情感症状而就诊于非精神科,造成了误诊或漏诊。现将国内外对抑郁症患者躯体化的临床表现和生物心理社会中介作用因素如文化因素、述情障碍、躯体感觉放大及生物学因素的相关研究做一综述。     

Consultation frequency and perceived consultation time in a Japanese psychiatric clinic: their relationship with patient consultation satisfaction and depression and anxiety

Aim:  To examine the relationship of the consultation frequency and the perceived consultation time of psychiatric clinic attenders with their satisfaction towards the consultation and depression and anxiety (measured by the Hospital Anxiety and Depression Scale).
Methods:  Questionnaires were distributed to 186 outpatients attending a psychiatric clinic.
Results:  In a path analytic model, a longer session with shorter interval ('dense' session) predicted lowered depression and anxiety level of the patientsthrough the perceived satisfaction of the patients, and it was also predicted by the higher anxiety level. The dense session was also influenced by shorter duration of clinic attendance.
Conclusion:  Dense psychiatric sessions in busy Japanese outpatient clinics may benefit patients.     

浙江省精神病专科医院住院患者治疗费用调查

背景目前很少有关于精神疾病住院患者精神疾病和非精神疾病治疗费用的研究,而这方面的信息对规划精神卫生服务和医疗保险具有重要意义。目的对2010年浙江省精神病专科医院住院患者的住院费用进行评估。方法采用两阶段分层随机抽样方法从浙江省42家精神专科医院中抽出14家精神病院,再从抽出的各家医院中以月份为基本单位系统抽出2010年3个月（3、7、11月）的出院患者进行调查。编制《出院患者住院情况调查表》,收集患者的人口学特征、临床特征及多项住院费用信息。结果共调查住院患者7684例。患者的平均住院时间（四分位数）为30（20-52）d,平均总住院费用为10005（6419．14728）元（1539美元）,平均药费为2512（1161—4182）元,其中65％为非精神科药费,1798（24．3％）例患者入院时伴有需要治疗的一种或多种躯体疾病,包括高血压、白细胞减少、糖尿病和各种感染。患者的精神疾病诊断不同,其躯体疾病合并症不同。经过排除其他混杂因素后,共病躯体疾病患者的住院费用显著增加,但住院时间未增加。对于精神分裂症患者,精神科的药费显著高于非精神科药费,但其他精神疾病患者的花费情况与之相反。结论精神病院住院患者的费用中,躯体疾病的治疗费用占较大比例。在修订精神疾病的补偿措施、建立诊断相关的支付方案以及建立诊断特定的治疗指南时,都需要考虑到精神疾病伴发躯体疾病的高患病率和治疗费用,也需要确保精神科医生的在职培训能使他们及时了解常见躯体疾病的诊断和治疗的新进展。     

Depression and cerebrospinal fluid citrate

In relation to studies of calcium metabolism in manic-melancholic patients, the calcium binding metabolite citrate was analyzed in cerebrospinal fluid from 163 psychiatric and non-psychiatric patients. Patients with symptoms of depression, irrespective of whether the origin of the depression was endogenous or exogenous, had significantly higher cerebrospinal fluid citrate concentrations than non-psychiatric patients. Manic patients and other psychiatric patients without symptoms of depression were not significantly different from the non-psychiatric patients. When the mood was normalized after various treatments, cerebrospinal fluid citrate decreased in all groups of depressed patients.     

The prevalence of obsessive compulsive symptoms in a sample of Egyptian psychiatric patients

Obsessions can occur in many psychiatric disorders or they may constitute the entire illness, which is then referred to as an obsessional state (Rees, 1993). The relationship of obsessive compulsive symptoms (OCS) to different psychiatric disorders is still controversial. This work was undertaken to study the co-occurrence and phenomenology of OCS with other psychiatric disorders. We examined a sample of 372 psychiatric outpatients using the arabic version of Yale Brown obsessive-compulsive symptom (Y-BOCS) checklist and compared them with a control group composed of 308 non-psychiatric subjects. Subjects were additionally assessed by means of the obsession symptom section of the PSE (10th) edition for trait rating, the arabic version of the Eysenck rigidity scale and the arabic version of the religious orientation scale. OCS were found to be significantly higher in the different psychiatric categories than in the non-psychiatric categories; 83% of patients with neurotic, stress related and somatoform disorders, 51% of patients with mood disorders and 47% of patients with schizophrenia, schizotypal and delusional disorders were found to have OCS in their symptomatology. Furthermore, the data suggest that OCS in psychiatric patients have a distinct phenomenology from that in non-psychiatric subjects. The results did not however reveal a relationship between OCS and either rigidity or religious orientation.     

The use of alternative medicine among Taiwanese psychiatric outpatients

The present study is intended to examine the use of alternative therapy and their help-behavior among patients who first visited psychiatric clinic in Taiwan. We recruited 150 patients from three general hospital psychiatric clinics. We collected the information of their demographic data, help-seeking behavior, and the use of alternative therapy, then screened them using Beck's Depression Inventory, Beck Anxiety Inventory, and World Health Organization's Quality of Life assessment. We found that 53 (35.3%) of 150 psychiatric outpatients visited an alternative therapists or received some type of alternative therapy at least once. Alternative medicine users were more likely to be married (P=0.004), to suffer from more intensive anxiety symptoms (P=0.018), to have visited more psychiatrists (P=0.006), to have visited more clinics (P=0.001), and to have taken longer between onset of the symptoms and their first visit to the psychiatric clinic (P=0.028). Based on these findings we suggest that alternative therapy plays important roles in the help-seeking behavior of Taiwanese psychiatric patients, and that alternative medicine users tend to delay proper psychiatric care. Clinicians should inquire about patients' past history of seeking alternative therapy, build a firm trust in the doctor-patient relationship, and increase the compliance of psychiatric treatment in alternative therapy users.     

Current smoking rate in patients with psychiatric disorders in Japan: Questionnaire survey

The association between smoking and psychiatric disorders (PD) has been known for many years. Support for smoking cessation among patients with PD is provided in advanced nations, but there is a little support for smoking cessation among patients with PD in Japan, where few studies have investigated the smoking rate. The aim of the present study is to determine the smoking rate and smoking habits of Japanese patients with PD. The subjects included outpatients who visited the outpatient psychiatric clinic at a University hospital between January and March of 2011. They answered a questionnaire consisting of questions about their sociodemographic background and smoking habits. In an analysis of 733 subjects, the overall smoking rate was 25.1%. The smoking rates among the patients with schizophrenia and depression were 17.3% and 23.9%, respectively, and these rates were lower than the results of previous studies. Among the current smokers, 43.4% had experienced smoking cessation, and only 26.1% were not interested in smoking cessation. Of the current smokers, 37.5% spent between US$128.88 and US$257 per month on cigarettes.     

The initial presentation of depression in family practice and psychiatric outpatients

Most reports characterizing the initial presentation of depression are based on patients seen in psychiatric settings. It is not clear whether the difficulty in identifying depression in medical clinic outpatients is due to physician unfamiliarity with the diagnostic criteria or because the psychiatric syndrome is not the same in early, mild cases that present with somatic symptoms. In this study, depressed patients choosing the medical clinic for care presented the same somatic symptoms as nondepressed medical patients. In comparison to depressed patients who presented to the psychiatric clinic, depressed medical patients' chief complaints were more somatic, obscure, and less psychologically focused. Depressed psychiatric patients had more symptoms on a medical review of systems checklist than did medical patients with an equivalent level of depression. When DSM-III criteria were applied, depressed patients from each clinic tended to fulfill the major and minor criteria in a similar pattern. However, the prevalence of depression in the medical setting was much lower and milder than was that presenting to the psychiatry clinic. Once present at a diagnosable stage, however, the syndrome appeared to be the same in both patient groups.