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1.
目的分析上海市某城区连续3年严重精神障碍患者应急处置案例,为社区处置应急事件提供科学依据。方法对上海市某城区2016~2018年连续3年共964例的严重精神障碍应急处置工作记录表进行梳理、统计、分析。结果 964例应急处置中,在册患者435例,非在册529例;危害公共安全事件876例,占90.87%;2018年应急处置案例数远超于2016年和2017年应急处置数,占41.28%;危险评估主要以0级~3级为主,共882例,占91.49%;疾病分类中以精神分裂症和其他精神病性障碍为主,共523例占54.25%;发生1次应急处置的患者650人次,≥2次133人共314人次。结论应急处置以"危害公共安全或者危害他人安全"事件为主。做好社区精神障碍患者应急处置工作,能有效控制和减少严重精神障碍患者危险行为的发生,维护公共安全和社会和谐稳定。  相似文献   

2.
目的分析流浪疑似精神障碍患者入院初期常规检查结果,为这类特殊人群的诊断及治疗提供参考依据。方法 2015年7月~2016年3月,回顾性统计分析上海市救助站送住我院的疑似精神障碍患者入院初期的常规检查结果。结果共收治患者101例,男性74例,女性27例;诊断为精神分裂症及急性精神分裂症样精神病性障碍的患者最多,66例(65%);心电图(ECG)明显异常者51例(50%),低钾血症者41例(41%),白细胞总数和(或)中性粒细胞比例高于正常值上限者57例(56%),糖尿病6例(6%),高血压1例(1%),猝死1例(1%)。结论由于流浪社会的特殊性,这些患者易合并躯体疾病,常规检查结果异常率高,精神专科医院收治后完善相关检查尤为重要。  相似文献   

3.
目的:对云南省社区管理的严重精神障碍患者自杀状况进行调查分析。方法:对全省2005至2014年纳入社区管理、符合国际疾病分类第10版诊断标准的严重精神障碍(包括精神分裂症、分裂情感性障碍、偏执性精神病、双相情感障碍、癫痫所致精神障碍、精神发育迟滞伴发精神障碍)的158 161例患者的基本信息进行调查分析,并对自杀率及自杀行为特征进行比较。结果:精神障碍患者总自杀率16.692(264/158 161例),其中男性(17.244)高于女性(15.896);各类因素中以分裂情感性障碍(35.280)及精神分裂症(18.350)、大专及以上文化程度(36.810)、下岗或无业(22.422)、离婚(33.351)及布朗族(90.909)等自杀率位居首位;66.7%的患者自杀行为发生在发病后的10年内。结论:云南省严重精神障碍患者的自杀行为具有男性、青壮年、较高文化程度、下岗或无业、离婚、少数民族及在初次发病后的10年内较易发生等特点。  相似文献   

4.
目的 探讨急性期精神障碍住院患者暴力风险的相关因素,为医务人员对精神障碍患者暴力风险的早期识别与干预提供参考。方法 查阅广州医科大学附属脑科医院病历系统,选取2016年1月-12月急性发病的1 107例住院精神障碍患者为研究对象,均符合《国际疾病分类(第10版)》(ICD-10)诊断标准。入院时采用危险性评估表评定患者的暴力行为危险性等级,选取一般人口学资料和临床资料共8个变量探讨急性期精神障碍住院患者暴力风险的相关因素。采用Logistic回归分析精神障碍患者高暴力风险的影响因素。结果 在1 107例急性期精神障碍患者中,高暴力风险者357例(32.25%)。回归分析显示:男性(OR=1.747,95% CI:1.303~2.342)、诊断为躁狂发作(OR=2.018,95% CI:1.310~3.108)、急诊入院(OR=4.244,95% CI:3.083~5.840)是患者存在高暴力风险的危险因素。诊断为抑郁障碍(OR=0.397,95% CI:0.233~0.677)的患者较其他精神障碍患者的暴力风险更低。结论 对于急性期精神障碍患者,急诊入院的男性以及诊断为躁狂发作的患者更可能存在高暴力风险。  相似文献   

5.
目的探讨社区医生督导对重性精神障碍患者的服药依从性及治疗效果的影响。方法选取于2013年2月2日至2015年2月1日期间居住于同一社区的重性精神障碍患者175例,对所有患者进行六级危险性评估,依据临床表现对所有患者作四级管理分类,并根据管理分类,为每位患者制定个性化社区医生督导方案。2年后,收集所有患者服药依从率、症状好转率、社区集体康复活动参与率、肇事肇祸率等资料,并与2年前进行对比。结果与管理前相比,患者服药依从率从59.1%上升到70.2%;社区集体康复活动参与率从27.3%上升到70.1%;肇事肇祸率从44.4%下降到11.4%,差异具有统计学意义(P0.01)。结论应用社区医生督导能有效提高重性精神障碍患者的服药依从性和疗效,对提高患者医疗效果有着积极作用。  相似文献   

6.
目的了解男女精神障碍患者长期住院的原因。方法采用自编长期住院原因调查问卷对2014年1月1日在广州市民政局精神病院普通精神科住院超过1年、病情控制稳定并能够配合医护人员的370名符合《国际疾病分类(第10版)》(ICD-10)诊断标准的精神障碍患者进行调查。结果男性住院时间比女性长(P0.01);女性长期住院问卷总评分比男性高(P0.01);女性客观维度评分比男性高(P0.01);男性受家庭因素影响明显(P0.01);女性受社会因素影响明显(P0.01)。结论客观因素可能是精神障碍患者长期住院的主要因素,其中男性受家庭因素影响明显,女性受社会因素影响明显。  相似文献   

7.
目的分析深圳市社区严重精神障碍不服药患者暴力行为发生的相关因素。方法利用深圳市精神卫生防治工作信息管理系统收集严重精神障碍患者个案资料和随访资料,描述分析不服药患者暴力行为的发生现状,应用Logistic回归模型分析其影响因素。结果3163例社区严重精神障碍不服药患者中9.1%(288/3163)的患者发生暴力行为。多元Logisitic回归分析显示,急性起病(OR=1.589,95%CI 1.181~2.139)为暴力行为发生的危险因素;有共同居住者(OR=0.596,95%CI 0.410~0.867)、精神发育迟滞伴发精神障碍(OR=0.432,95%CI 0.199~0.938)、申请监护补助(OR=0.440,95%CI 0.319~0.606)、签约家庭医师服务(OR=0.642,95%CI 0.492~0.838)和社区面访(OR1-2次=0.633,95%CI 0.466~0.861;OR3-4次=0.546,95%CI 0.368~0.811)为暴力行为发生的保护因素。结论急性起病的严重精神障碍不服药患者暴力行为发生率较高。提升社区精神卫生综合服务水平,制定有针对性的干预措施,有助于降低社区严重精神障碍不服药患者暴力行为的发生。  相似文献   

8.
目的了解常德市严重精神障碍患者的暴力攻击行为现状,探索暴力攻击行为的危险因素,为优化对这一人群的管控策略提供参考。方法于2017年7月-12月,在常德市康复医院接受暴力危险性评估的2 362例疑似精神障碍患者中,采用Excel生成随机整数的方式,随机选出790名被试,并将其中757例符合入组标准的患者纳入本研究,收集其一般人口学资料和临床资料,并进行修订版外显攻击行为量表(MOAS)评定。将MOAS加权总分≥5分者定义为研究组(n=505),MOAS加权总分5分者定义为对照组(n=252),比较两组一般人口学资料和临床资料,采用二元Logistic回归分析探索暴力攻击行为的独立相关因素。结果研究组中男性、年龄相对较小、单身、近半年无业、不(规律)服药、存在被关锁情况、伴有反社会人格特征者所占比例高于对照组(P0.05或0.01)。二元Logistic回归分析显示,不(规律)服药(OR=2.659,95%CI:1.892~3.738)、年龄≤30岁(OR=1.845,95%CI:1.163~2.926)、男性(OR=1.486,95%CI:1.085~2.036)、无业(OR=1.621,95%CI:1.069~2.457)与高暴力攻击风险呈独立正相关(P0.05或0.01)。结论常德市严重精神障碍患者发生暴力攻击行为的危险因素主要包括不(规律)服药、年龄≤30岁、男性、无业。  相似文献   

9.
目的:探讨行造血干细胞移植患者隔离期间精神科联络会诊特点。方法:回顾性分析2014年至2016年行造血干细胞移植且在隔离期间并发精神障碍邀请精神科会诊的111例患者的一般资料及临床资料。结果:共有1 523例患者(男839例,女684例)行造血干细胞移植,111患者(7.3%)入住净化舱隔离期间并发精神障碍而邀请精神科会诊;女性患者并发精神障碍的比率(9.1%,62例,)明显多于男性(5.8%,49例)(χ~2=5.796,P0.05);2014年至2016年精神科每年会诊率(6.2%、6.6%及8.6%)比较差异无统计学意义;精神科会诊诊断依次为焦虑状态31例(30.0%)、抑郁状态29例(26.1%)、应激相关障碍14例(12.6%)、躯体疾病所致精神障碍13例(11.7%)、睡眠障碍9例(8.1%)、焦虑及抑郁状态9例(8.1%)、药物所致精神障碍2例(1.8%)、其他4例(3.6%);其中82例(73.9%)建议给予药物治疗或药物联合心理治疗。结论:造血干细胞移植隔离期间患者、尤其是女性患者并发各种精神障碍的比率很高,多半为情绪障碍。  相似文献   

10.
目的 探讨住院老年精神障碍患者意外事件发生及其相关因素,提出干预措施.方法 对2007年9月~2009年12月老年精神障碍患者住院期间出现的意外事件及其相关危险因素进行前瞻性观察研究,对其结果进行统计学分析.结果 研究期间共130例患者入组,发生意外者47例(36.15%),其中各种感染37例,占发生意外者的78.72%,后依次为跌倒4例(8.5%),噎食3例(6.38%),外伤2例(4.26%),骨折1例(2.13%).讨论老年精神障碍患者是发生意外的高危人群,相关因素有年老体弱多病、生活能力缺损、认知能力下降及病房设施缺陷等.因此应重视对老年精神障碍患者住院的护理,做到个体化、人性化和科学化,以免意外发生.  相似文献   

11.
《Brain stimulation》2021,14(4):913-921
BackgroundElectroconvulsive therapy is an important somatic treatment for severe mental disorders with established efficacy and safety. However, data on the relationship between ECT and the readmission rate of patients with schizophrenia are scarce. This study will explore the association between the administration of ECT and readmission rates using a machine learning method.MethodsInpatient medical records from the year of 2016 in one large psychiatric hospital in Beijing, China, were analyzed using a machine learning algorithm to determine the most important variables affecting readmission of patients with schizophrenia.ResultsThe medical records of 2131 inpatients with schizophrenia were reviewed. 1099 patients were followed up within 3 months of their index admission (642 ECT cases and 457 non-ECT cases) and 1032 patients were followed up within 6 months (596 ECT cases and 436 non-ECT cases) after discharge. The 3- and 6-month readmission rates in the ECT group (11.37% and 17.94%, respectively) were significantly lower than that of the patients who did not receive ECT (18.79% and 29.36%, respectively, both p < 0.001). The risk of readmission was significantly associated with male sex, older age, being married, having a lower income, a shorter inpatient length of stay, and receiving specific antipsychotic medications including olanzapine, paliperidone, clozapine, and haloperidol during the index admission. In the ECT group, patients who received 9 or more treatments were significantly less likely to be readmitted.ConclusionReceiving ECT may be associated with a lower risk of readmission in patients with schizophrenia.  相似文献   

12.
目的分析急诊患者晕厥的常见原因及治疗对策。方法选择2013-05—2015-05我院就诊的急诊晕厥患者68例,对其临床资料进行回顾性分析,总结急诊晕厥患者的常见原因,提出相关对策。结果所有68例急诊晕厥患者中,神经介导性晕厥患者28例(41.18%),心源性晕厥23例(33.82%),脑源性晕厥8例(11.76%),直立性低血压性晕厥6例(8.82%),其他原因晕厥3例(4.41%),其中,神经介导性晕厥的发病人群主要以中青年为主,而心源性晕厥的好发人群主要以老年人为主。结论神经介导性晕厥是中青年急诊患者最常见的晕厥原因,而老年急诊患者最常见的晕厥原因则是心源性晕厥,急诊工作中医护人员应根据患者临床表现和体征及时查明并确认晕厥原因,并给予合理有效的对症治疗和处理措施,以改善预后,保障患者的生命安全和生活质量。  相似文献   

13.
OBJECTIVE: This study examined medical emergency department utilization for patterns among uninsured patients with psychiatric disorders. METHODS: Billing records of 15,672 uninsured adult patients treated in the emergency department of an academic medical center in southeast Texas over a 12-month period were analyzed for information on demographic characteristics, diagnosis, number of emergency department visits, and hospitalization. RESULTS: Overall, 11.8% of the population was diagnosed as having at least one psychiatric disorder during an emergency department visit. Patients with psychiatric disorders had an increased risk of having multiple emergency department visits and hospitalization compared with patients without psychiatric disorders. The risk of multiple emergency department visits was particularly high for patients with either bipolar disorder or psychotic disorders. CONCLUSIONS: Uninsured patients with psychiatric disorders appear to be heavy users of medical emergency department services. These findings may be helpful in developing more efficient strategies to serve the mental health needs of the uninsured.  相似文献   

14.
目的 了解荆门市重性精神疾病患者的流行病学分布、生活状态、就医情况及影响因素,为开展公共卫生服务、社区防治工作提供依据.方法 以ICD-10和CCMD-3为诊断标准,向各乡镇卫生院、社区卫生服务中心下发统一的线索调查表,由精神科专业医生对可疑患者进行复核确诊,对2010~2013年纳入国家管理系统的重性精神疾病患者信息进行核对和整理,导出信息并与调查数据进行比较分析.结果 2010~2013年全市共管理重性精神疾病患者9612例,检出率为3.34‰;以精神分裂症(76.77%)为主,检出率为1.99‰;男女比例为1:1.125;患者以18~44岁的青壮年(54.23%)为主;婚姻状况以已婚(55.33%)为主;经济状况以贫困(63.31%)为主;文化程度以文盲(24.15%),小学(31.42%),初中(34.16%)为主;职业以农民(76.51%)及无业(20.89%)为主;病程多在10年以上;精神发育迟滞伴发精神障碍患者住院及治疗比例最低(28.78%);躯体疾病及并发症(66.15%)和意外事故(28.46%)为患者的主要死亡因素.结论 精神分裂症、精神发育迟滞伴精神障碍、双相(情感)障碍患者居荆门市重性精神疾病前3位,女性多于男性,年龄集中在18~45岁,已婚比例低,离婚及丧偶比例高,文化程度低,患者经济负担重,病情迁延,治疗负担重,建议加强和完善各级防治网络建设及社区精神卫生服务,加强重性精神疾病患者的管理,加大政府及公益资金投入.  相似文献   

15.
The purpose of the present study was to investigate the prevalence, distribution of psychiatric diagnoses, and treatment responses of patients with post-partum mental illness at an emergency unit at Chang Gung Memorial Hospital at Kaohsiung in Taiwan. During a 1 year period a total of 636 Taiwanese women received psychiatric consultation on their visits to the emergency room. Fifteen of these were noted to have post-partum mental illnesses. All subjects were followed up for a minimum of 3-6 months. The prevalence of patients with post-partum mental illness at an emergency unit at Chang Gung Memorial Hospital at Kaohsiung was 2.4% (15/636). The distribution of psychiatric diagnoses according to Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) criteria included eight cases of major depressive disorders (53.3%), three cases of bipolar I disorder (20%), three cases of schizophrenia (20%), and one case of psychotic disorder due to a general medical condition (6.7%). Four subjects manifested catatonic features. Of these four, three had complete remission in catatonic symptoms after receiving intramuscular injection of lorazepam. The fourth subject died of multiple medical diseases. The treatment results suggest that most of the clinical presentations in patients with post-partum mental illness could be relieved by antipsychotics, mood stabilizers or antidepressants. In addition, it was found that intramuscular injection of lorazepam was also effective in patients with catatonic features and post-partum depression or psychosis.  相似文献   

16.
We reviewed the records of all patients with recurrent seizures and severe head injury-induced traumatic intracranial hemorrhage (TIH) between 1989 and 2003 in three Israeli medical centers. We identified 52 cases (44 males, mean age=43+/-19 years, range=8-84; 8 females; mean age=74+/-12 years, range=48-85). Twenty-seven (52%) had additional known risk factors for TIH, e.g., older age, alcohol abuse, and anticoagulant use. All five children and adolescents had mental retardation. Approximately one-half of patients with seizures and TIH have additional risk factors for TIH. Non-mentally retarded children and adolescents with seizures are probably at low risk of developing TIH. Women less than 70 years old with seizures are much less prone to TIH than men. In young "otherwise healthy" patients with epilepsy, suboptimal treatment seems to be an important factor in the occurrence of TIH.  相似文献   

17.
This study addressed factors associated with six-month post-acute dispositions (continuous community stay, medical hospitalization, psychiatric rehospitalization, nursing home placement, death) for older adults hospitalized for depression and discharged to the community. The sample included 199 older adults; and data were collected via medical records, interviews with discharge planners, patients, and family members. Over half of the sample remained in the community throughout the observation period; 23% experienced psychiatric re-admission and 10% entered a nursing home. Several factors associated with nursing home placement were identified: less improvement in depression during the hospitalization, lower Global Assessment of Functioning (GAF) scores at discharge; and less mental health service use in the post-acute period. Those at higher risk of psychiatric re-admission had more previous psychiatric hospitalizations and were marginally more likely to be married and have lower Brief Psychiatric Rating Scale (BPRS) scores at discharge. Differentiating those at risk for nursing home placement may be easier than differentiating those at risk of psychiatric readmission.  相似文献   

18.
ObjectiveThis study examined differences by age in suicide risk screening and clinical actions to reduce suicide risk among patients with visits to Veterans Health Administration (VHA) medical facilities in the year prior to an attempt.MethodsNinety-three VHA patient records were reviewed specific to the last visit before an attempt. Information was extracted regarding documentation of individual suicide risk factors and provider actions to reduce risk.ResultsThe authors examined differences by patient age (≥50 versus 18–49). Older patients’ medical records were less likely to have evidence of 1) screening for impulsivity and firearms access and 2) engagement in safety planning, referrals for mental health services, and consideration of psychiatric hospitalization. General medical providers were less likely to document these risk factors and action steps in comparison with mental health clinicians.ConclusionLethal means education and collaborative care are universal strategies that may improve identification of and lower suicide risk in older veterans.  相似文献   

19.
OBJECTIVE: The needs and characteristics of patients who are referred for psychiatric emergency services vary by the source of referral. Such differences have wider implications for the functioning of the mental health care system as a whole. This study compared three groups of patients in a two-month cohort of 189 patients who were referred for emergency psychiatric assessment at a hospital in England: those who were referred by general practitioners (family physicians), those who were receiving specialist services from community mental health teams, and those who arrived at the hospital from the broader community. METHODS: The three groups were compared on demographic characteristics, clinical and service use variables, risk to self or others, factors that contributed to the emergency presentation, and ratings on standardized scales of functioning. RESULTS: The patients who were receiving specialist services from community mental health teams had high rates of psychosis, often relapsed, and had a history of contact with a psychiatrist. These patients were the most likely to be admitted to the hospital after emergency assessment. The patients who had been referred by general practitioners tended to have fewer indicators of social problems and were more likely to be experiencing a new episode of mental illness. Their referral to the emergency department was most likely to be deemed inappropriate by emergency department clinicians. The patients who came from the broader community were more likely to be male and to exhibit self-harming behavior, substance misuse, and behavioral difficulties. CONCLUSIONS: The rate of emergency referral is one indicator of the functioning of the service system as a whole. Improvements to the system should include better access to community mental health team services and a greater capacity of the primary care system to manage mental health crises. Services need to be developed that are acceptable to male patients who are experiencing social and behavioral problems.  相似文献   

20.
The purpose of this study was to examine the individual characteristics and mental health factors of dysthymic and nondysthymic substance abusers. Out of a total of 1,209 medical records reviewed to select cases of dysthymic and nondysthymic substance abusers attending a community drug treatment program, 183 medical records were selected, 48% of which were dysthymic substance abusers. Bivariate analyses indicated that dysthymic substance abusers were more likely to be male, older individuals, reported high levels of alcohol dependence, lower quality of life, and higher number of previous substance abuse treatment. Results from hierarchical multiple logistic regression analyses indicated that age, gender, and quality of life were significant predictor for having dysthymia. Implications for the mental health field are discussed, underlining the importance of developing and providing competent treatment for substance abusers with co-occurring disorders.  相似文献   

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