住院精神疾病患者合并糖尿病的调查

目的：调查住院精神疾病患者合并糖尿病的情况，探索相关因素。方法：自制一般情况调查表，回顾性调查住院精神疾病患者的糖尿病患病情况，检测空腹血糖、餐后2小时血糖、血脂，计算体重指数。结果：2647例住院精神疾病患者中，213例合并糖尿病，患病率8．05％，为正常人群的3．22倍。213例中体重超重的占44．13％，肥胖的占40．38％，有28．63％的患者空腹血糖控制不佳，85．92％的患者餐后2小时血糖控制不佳。合并糖尿病与超重、肥胖、高血脂、高血压等因素相关。结论：精神疾病患者中糖尿病的患病率远高于普通人群，临床上应予以关注。     

住院精神疾病患者自杀调查

对我院建院以来自杀身亡的病例进行调查分析1　一般资料1975～ 2 0 0 1年期间 ,我院共收治精神疾病患者 2 2 917例次 ,自杀身亡者 15例。其中男 9例 ,女 6例。年龄 2 2～ 49岁 ,平均 31 7岁 ,其中 2 2～ 39岁 12例。文盲 1例 ,小学 3例 ,中学 10例 ,大学 1例。已婚 6例 ,未婚 9例。2　临床分析诊断为精神分裂症 12例 ,精神分裂症后抑郁 1例 ,抑郁症 2例。伴有躯体疾病 2例。均无精神疾病家族史。住院前有轻生意念或自杀行为者 4例。自杀由精神病性症状 (幻觉、妄想 )所致 9例 ,由抑郁、自责所致 4例 ,由生活事件、心理负担所致 2例。自杀方…     

精神疾病患者住院时自杀调查

ＷＨＯ(1999)估计 ,至 2 0 0 0年全世界约有 10 0万人自杀死亡 ,约 10～ 2 0倍于此数的人自杀未遂[1] 。精神疾病患者自杀率为 5 1/ 10万 ,较一般人口大 6～ 12倍[2 ] 。现对我院住院期间出现自杀行为的精神疾病患者进行研究。1　对象与方法研究组为 1988～ 2 0 0 1年期间在我院住院自杀未遂的 5 6例精神疾病患者 ,按美国精神障碍诊断与统计手册第 4版和中国精神障碍分类与诊断标准第 3版进行再诊断 ,其中精神分裂症 16例 ,情感性精神障碍 2 4例 ,创伤后应激障碍 8例 ,酒精所致精神障碍 6例 ,人格障碍 2例 ;男 2 0例 ,女 36例 ;年龄 15～ 5 …     

住院精神疾病患者血糖水平调查

目的：了解抗精神病药物对精神疾病患者血糖的影响。方法：检测全院所有住院病人的空腹血糖；对血糖浓度超标者，结合年龄、性别、体重、病程、既往使用精神药物等情况，进行相关研究。结果：340例住院患者中，血糖高于正常者65例，服用抗精神病药物后血糖升高者45例，大多数患者既往或正在使用氯氮平治疗，平均体重大于其他患者，41岁以上者居多，有较长的精神疾病史。结论：长期使用抗精神病药可能会导致高血糖，尤以氯氮平为甚。年龄、病程、体重可能与高血糖相关。     

住院精神病患者恢复期焦虑症状及其影响因素的调查分析

应用焦虑自评量表(SAS)测查了190例恢复期精神病患者,37.89％的患者有不同程度的焦虑症状,逐步回归揭示主要影响因素为:与父母或子女感情、从家中得到安慰和理解的机会。与家人交流感情的机会、与医务人员交流感情的机会、同亨或邻居的歧视及病程。     

住院未成年精神疾病患者抗精神病药物使用情况调查

目的调查2018年广州医科大学附属脑科医院住院未成年精神疾病患者抗精神病药物使用情况。方法通过电子住院信息系统收集2018年广州医科大学附属脑科医院所有住院年龄≤18岁且确诊为精神疾病的患者的临床、人口学和出院当日使用抗精神病药物情况,进行统计和分析。结果共入组626例未成年精神疾病患者,出院时93例(14.9%)患者未使用抗精神病药物,92例(14.7%)患者接受两种抗精神病药物联合治疗,441例(70.4%)患者使用一种抗精神病药物治疗;双相障碍(233例)、抑郁症(124例)、精神分裂症(108例)是诊断频率最高的三种精神疾病,其抗精神病药物使用率为别为94.0%、74.2%和99.1%。使用频率最高五种抗精神病药物依次为喹硫平、奥氮平、阿立哌唑、利培酮和帕利哌酮;双相障碍和抑郁症使用频率最高的抗精神病药物为喹硫平,精神分裂症最常使用奥氮平;儿童组患者最常使用阿立哌唑,青少年组患者最常使用喹硫平;男性患者最常使用奥氮平,女性患者最常使用喹硫平。儿童组患者阿立哌唑、利培酮和喹硫平剂量显著低于青少年组,男女两组间抗精神病药物剂量无显著差异。结论大部分住院未成年精神疾病患者在出院时接受单种抗精神病药物治疗,不同诊断抗精神病药物使用种类不同,不同年龄组抗精神病药物使用种类、剂量不同。     

住院精神病患者使用精神药物一日分析

目的　了解我院住院的精神疾病患者所接受的精神药物治疗现状及是否合理。方法　采用一日法 ,自行设计的问卷 ,调查我院住院病人 3 98例用药情况。结果　 5 9 3 %的病人为单一用药 ,精神分裂症最常用的药用为氯氮平 (5 7 3 % ) ,最常用的联合用药为氯氮平 舒必利 ;情感障碍最常用的药物是碳酸锂 41 6% ,最常用的联合用药是氯氮平 碳酸锂、抗抑郁剂 碳酸锂 ,无ECT治疗者。结论　我院住院精神病者的用药比较规范 ,不合理用药的现象应引起临床医生的重视。     

健康教育在住院精神病患者中的应用

对67例精神分裂症患者定时采取有针对性的内容进行宣教,印证健康教育可提高患者药物治疗依从性及对自身疾病的认识,增加患者的信任感,促进疾病的康复。     

住院精神疾病患者的吸烟情况调查结果

关于吸烟与精神疾病之间的关系国外已有较多研究，而国内却相对滞后。为此，我们对住院精神疾病患者的吸烟情况进行调查并作初步分析，现报道于后。     

住院精神分裂症患者抗精神病药物联合治疗的处方调查

目的了解住院精神分裂症患者抗精神病药物联合治疗(APP)的情况,为精神分裂症的临床用药提供参考。方法连续入组2014年1月1日-12月31日在广州医科大学附属脑科医院住院的精神分裂症患者,收集患者的社会人口学资料,使用临床总体印象量表-病情严重程度量表(CGI-SI)评估患者疾病严重程度,在患者出院日记录抗精神病药物的使用情况,比较接受单一抗精神病药物治疗患者(单药组)与接受APP患者(APP组)的临床特点,描述APP中具体抗精神病药物的使用情况。结果共入组801例住院精神分裂症患者,其中364例(45.4%)使用APP。与单药组相比,APP组发病年龄更小、本次住院时间和总病程更长、住院次数更多,差异均有统计学意义(P均0.05)。APP组中78.0%的患者为同时使用两种第二代抗精神病药物(SGA),常见的联用方式为利培酮(47.3%)、氯氮平(44.5%)和奥氮平(40.1%)联合另一种抗精神病药物。结论住院精神分裂症患者中,接受APP方案的患者发病较早且病程迁延;两种SGA联用是APP中最常见的疗法,APP方案中使用频率最高的药物依次为利培酮、氯氮平和奥氮平。     

Suicidal ideation in medical inpatients: psychosocial and clinical correlates

Objective

To identify psychosocial and clinical correlates of suicidal ideation in medical inpatients.

Method

In a cross-sectional study, all adults consecutively admitted to the medical wards of a University Hospital had their names recorded and were randomized and evaluated during the first week of admission. Suicidal ideation was assessed using Item 9 of Patient Health Questionnaire-9. The Beck Depression Inventory, the Beck Anxiety Inventory, the WHO Subjective well-being scale, the Charlson Comorbidity Index and other numerical rating scales (pain and self-reported physical illness severity) were used. Patients with less than four confidants were considered with poor social support. The Student's t test, Mann-Whitney U test, chi-square test and stepwise logistic regression analysis were used.

Results

Of the 1092 patients who composed the sample, 7.2% reported having suicidal ideation. After adjusting for psychosocial and clinical confounders, prior suicide attempts (OR: 4.41; 95% CI: 2.12–9.15; P<.001), depressive symptoms (OR: 1.11; 95% CI: 1.06–1.17; P<.001), severe anxiety symptoms (OR: 3.04; 95% CI: 1.47–6.26; P=.003) and poor social support (OR: 2.02; 95% CI:1.03–3.96; P=.04) were independently associated with suicidal ideation.

Conclusions

Three out of the four correlates of suicidal ideation in medical inpatients are potentially modifiable factors: severe anxiety, depressive symptoms and poor social support. The fourth variable, prior suicide attempts, is not modifiable but should serve as a red flag to suspect and investigate current suicide risk. These findings highlight the importance of suicidal ideation as a proxy for the distress that is incumbent upon physicians to manage if they wish to provide excellent and comprehensive inpatient care.     

Profiles of psychiatric symptoms among amphetamine type stimulant and ketamine using inpatients in Wuhan,China

Amphetamine type stimulants (ATS) and ketamine have emerged as major drug problems in China, and chronic extensive exposure to these substances frequently co-occurs with psychiatric symptoms. This study compares the psychiatric symptoms of patients reporting ATS use only, ATS and ketamine use, or ketamine use only who were admitted to an inpatient psychiatry ward in Wuhan, China between 2010 and 2011. Data on 375 study participants collected during their ward admission and extracted from their clinical records included their socio-demographics, scores on the Brief Psychiatric Rating Scale (BPRS), and urine toxicology screens.ResultsThe ketamine-only group had significantly lower total BPRS scores and significantly lower scores on Thinking Disorder, Activity, and Hostility-Suspicion BPRS subscales than the ATS-only and ATS + ketamine groups (p < 0.001 for all comparisons). The ketamine-only group also had significantly higher scores on the subscales of Anxiety-Depression and Anergia. The ATS-only group had significantly higher scores on subscales of Thinking Disorder, Activity, and Hostility-Suspicion and significantly lower scores on Anxiety-Depression and Anergia subscales than the ketamine-only and ATS + ketamine groups (p < 0.001 for all comparisons). A K-means cluster method identified three distinct clusters of patients based on the similarities of their BPRS subscale profiles, and the identified clusters differed markedly on the proportions of participants reporting different primary drugs of abuse. The study findings suggest that ketamine and ATS users present with different profiles of psychiatric symptoms at admission to inpatient treatment.     

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％。     

生活技能训练对住院精神障碍患者的康复作用

目的探讨生活技能训练（social skills training,SST）对精神障碍患者康复的有效性。方法根据患者的具体情况制订训练计划,采用日本SST的训练模式,结合放松训练,以小组训练的方法,对54例住院患者（精神分裂症30例,双相障碍17例,器质性精神障碍7例）进行为期6周的集中训练。结果经过6周的训练,54例患者的SST评价表总分（从第一周至第六周依次为：28.2±14.4,37.0±13.6,48.9±13.5,57.9±12.8,68.4±15.1,74.1±17.0,F=81.85,P〈0.01）、日常基本技能得分（从第一周至第六周依次为：5.9±3.8,8.2±3.6,11.4±4.0,14.4±3.5,16.8±4.1,18.2±4.7,F=85.15,P〈0.01）、日常生活能力得分（从第一周至第六周依次为：5.6±4.1,8.4±3.9,11.8±4.1,13.9±3.6,17.3±4.2,19.0±4.6,F=85.52,P〈0.01）及人际交往能力得分（从第一周至第六周依次为：17.0±7.7,20.5±7.5,25.8±7.5,29.9±6.9,34.6±7.8,37.2±8.4,F=57.71,P〈0.01）均逐步增加。结论生活技能训练对住院精神障碍患者的康复具有一定的作用。     

50年精神科住院病人死亡原因的变迁

目的：探讨不同年代精神科病人住院期间死亡原因的变迁。方法：对我院精神科１９４８￣１９９７年期间住院病人５４３４１例中死亡的１７８例作回顾性调查。结果：总死亡率为０．３３％,逐年有明显下降,并发症及躯体疾患死亡者亦逐年下降。死亡以自杀最多（３７．６％）,其次为躯体疾患（３０．９０％）。结论：说明５０年来医院管理水平、医疗质量有明显提高,但仍应做好病房管理工作。     

Somatization, depression and medical illness in psychiatric inpatients

In a study to determine the relationship between somatic symptoms and psychiatric diagnosis, 206 consecutively admitted inpatients at the University of Iowa Psychiatric hospital were given a structured medical history (MH) and physical examination (PE). Depressed patients were significantly older, had an increase in number of medical diagnoses (NDX), and were found to have a significant increase in somatic symptoms in which there was no confirmatory evidence on the PE and in which there was confirmation on the PE. When age, sex, and NDX were controlled for, depressed patients did not have an increase in either of the types of somatic symptoms noted above but did have a slight increase in the vague somatic symptoms in which PE findings would be unlikely. Our results suggest that the majority of the increases in somatic symptoms in depressed patients may not be due to depressive psychopathology but rather to their increased number of medical problems and increased age.     

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.     

Patterns of overt sexual interaction among acute psychiatric inpatients

An indepth study was carried out over 1 year on all instances of overt heterosexual interactions among acute psychiatric patients on mixed-sex intensive treatment units. Sixteen of the 1060 patients treated on the units were involved in nine instances of overt heterosexual interactions. Analysis of the interactions showed three distinct patterns, called Types 1, 2 and 3. In Type 1 interactions, overt sexual behavior approaches normality. In Type 2 interactions, overt sexual behavior is of a pronounced demonstrative quality but avoids genital involvement. In Type 3, overt sexual interaction is confined exclusively to sexual intercourse. Multiple determinants of the patients' involvements in overt heterosexual interaction are presented. The type of overt sexual interaction engaged in by inpatients depended more on each patient's history, including past sexual life, than on clinical diagnosis. As a rule, the patient's most relevant and central problems were expressed in a very distinct manner in the overt sexual interaction on the unit. Thus, a thorough investigation of every case of such interaction provides an opportunity to discern these problems rapidly and to elaborate on them therapeutically.     

Frequency and predictors of perioperative psychiatric symptom worsening among patients with psychiatric disorders

ObjectiveThis study aimed to clarify the frequency of perioperative psychiatric symptom worsening among patients with psychiatric disorders and investigate factors predictive of symptom aggravation.MethodThis study adopted a retrospective cohort study design. The sample consisted of perioperative inpatients who were diagnosed with psychiatric disorders on admission and received psychiatric intervention between January 1, 2015 and November 31, 2017.ResultsOf 176 inpatients who met our inclusion criteria, 15 (8.5%) exhibited symptom worsening. Factors associated with symptom worsening included changes in surface morphology during surgery (p < 0.01; odds ratio (OR) = 10.58; 95% confidence interval (CI), 3.40–32.87), otolaryngological surgery (p = 0.01; OR = 6.95; 95% CI, 1.81–26.75), stay in the intensive care unit (p < 0.01; OR = 5.65; 95% CI, 1.79–17.81), and surgery duration longer than 180 min (p = 0.03; OR = 3.40; 95% CI, 1.04–11.13).ConclusionThis was the first retrospective analysis to focus on the perioperative worsening of psychiatric symptoms. As only few inpatients exhibited symptom aggravation, general hospitals without psychiatric beds can receive perioperative patients with psychiatric comorbidity. However, caution should be exercised to address the potential worsening of symptoms in cases of surface-morphology changing surgery, otolaryngological surgery, long-duration operations, and when ICU stay is required.     

肝豆状核变性精神症状特点、影响因素及排铜治疗的临床研究

目的研究肝豆状核变性（Wilson disease,WD）精神症状的特点、影响因素及排铜治疗对精神症状的治疗效果。方法选取WD患者80例（脑型60例,肝型20例）,正常对照20例,用症状自评量表（SCL-90）、简易智能量表（MMSE）、汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）进行精神症状评估。脑型WD患者神经症状用改良Young量表进行评估。所有患者进行脑脊液铜、血清铜、尿铜、头部核磁共振检查。二巯基丙磺钠排铜治疗后,进行上述量表评分,复查铜代谢指标,对结果进行统计学分析。结果WD患者SCL-90显著高于正常对照者。精神症状依次是：行为障碍、情感障碍、智能障碍、记忆力下降、思维障碍、感知障碍。改良Young评分与精神量表评分无相关（P〉0．05）。改良Young量表震颤项目评分与SCL-90量表中躯体化、焦虑、敌对项目评分呈正相关（P〈0．05）;咽喉肌张力障碍、肢体肌张力增高、步态异常项目评分与抑郁项目评分呈正相关（P〈0．05）。基底节、丘脑病变是出现情感障碍的影响因素（P〈0．05）。脑脊液铜、血清铜、尿铜与精神量表评分无相关性（P〉0．05）。排铜治疗后,40％患者SCL-90量表总分降低,其中躯体化、焦虑、敌对项目评分明显下降（P〈0．05）。结论WD患者出现精神症状比例高。基底节、丘脑病变可能涉及WD患者异常情绪产生的病理机制。单独排铜治疗对精神症状的治疗效果不佳。精神症状的治疗应以排铜为基础,结合抗精神病药物。