29例癔症误诊为精神分裂症的原因分析

２９例癔症误诊为精神分裂症的原因分析空军获鹿医院李秀珍，李光海作者对所在医院１９８０年以来收冶的７１例后症患者，按ＣＣＭＤ－２中有关精神分裂症及癔症诊断标准进行了再诊断，结果发现误诊为精神分裂症者２９例，误诊率为４０．８５％。其误诊的原因，一是对癔症...     

综合医院心理咨询门诊中的精神分裂症

作者分析了在本院心理门诊十年内收集到的７００例精神分裂症病人，其中男性居多，住城市者居多，１６岁至３０岁者居多，４０．７１％的病人首诊时无人陪诊，病程在１年内者为４１．４８％，仅３０．４３％的病人来诊前曾接受过专科诊治，咨询原因包括幻觉、妄想、淡漠、懒散等，治疗３周以上者９５．４５％取得了较好疗效。作者认为，综合医院心理咨询门诊在精神分裂症的二级预防中能起极为重要的作用，也能为其三级预防提供便利．     

神经症患者就医情况调查

目的：了解神经症患者发病后的在情况。方法：对１９９８年７月～１９９９年８月前来门诊咨询,符合ＣＣＭＤ－２Ｒ神经症诊断标准的患者１００例,了解其发病后的就医情况。结果：有４８例首诊于精神科‘４７例首诊或反复长期就诊于综合医院内科等,尤以焦虑症和凝症症患者为多;５例癔症发作时求助于迷信活动。结论：约有半数神经症患者发病后去综合医院治疗,因此在综合医院普及精神医学知识,设立心理咨询或精神科门诊,开展联络     

32例精神分裂样障碍的诊断追踪

本文对３２例首次发病、首次住院诊断为精神分裂样障碍患者在平均出院１．８８年后，用ＣＣＭＤ－２和ＤＳＭ－Ⅱ－Ｒ标准进行了再诊断，结果，临床痊愈和显著好转率为８１．３％，６５．６％的患者符合精神分裂症诊断标准，１８．８％的患者维持精神分裂样障碍诊断，１５．６％的患者诊断为其他三种精神障碍。追踪诊断病程在３个月内的精神分裂样障碍患者显著高于３～６月者（Ｐ＜０．０５），提示ＣＣＭＤ－２规定病程３个月诊断精神分裂样障碍的效度较高，２１例追踪诊断为精神分裂症的患者，症状标准项目的出现率高，这可能与本组患者处在疾病发展阶段有关，最后对精神分裂样障碍诊断术语作了初步讨论。     

对交叉诊断为精神分裂症和噪郁症的再诊断

对１８１例住院２次以上交叉诊断为精神分裂或躁郁症者，以中国精神疾病分类与诊断标准－Ⅱ（ＣＣＭＤ－Ⅱ）作再诊断。结果：末次诊断为精神分裂症者４０例全部符合标准，躁狂发作者１３３例中有４例不符合标准。８例抑郁症中１例不符合标准，诊断符合率为９７．２０％。随访１２１例，与末次住院诊断的符合率为８７．０％，证明ＣＣＭＤ－Ⅱ对诊断较实用可靠。     

精神疾病求医途径首诊情况调查

目的：了解精神疾病患者首诊情况。方法：以2000年3－5月入院治疗的300例病人首诊情况，进行问卷式调查。结果：首诊于非精神科，中、西医占36．7％，精神科占34．3％，迷信活动占29％。结论：精神疾病患者首诊于精神科仅为34．3％，而迷信活动达29％。必须加强精神卫生知识宣传，普及精神病知识，改善精神病人的求医现状。     

门诊首诊老年精神障碍患者10年对比分析

目的 了解１０年间老年患者就诊情况及相关问题。方法 采集１９８９上半年及１９９９上半年６０岁以上、符合ＣＣＭＤ－２－Ｒ诊断标准，首诊且病历完整者进行比较分析。结果 １９８９年和１９９９年≥６０岁的老年患者分别占同期首诊病人数的６．７５％及８．９２％；首诊人数１９９９年是１９８９年的２．７２倍，均女性多于男性；９９年较８９年患者就诊时年龄有所增加，精神疾病由社会心理因素诱发者１９８９年为８０．６５％     

中国精神疾病分类和诊断标准第二版修订本的现场测试报告

为考核中国精神疾病分类和诊断标准第２版修订本（ＣＣＭＤ－２－Ｒ）的性能与临床推广的可行性，作者于１９９３年１０月至１９９４年３月进行了现场测试，全国有１８个单位的５５位精神科医师参加，共测试了７５０例，８７．１％认为文本的可理解性好，易于接受；８４．０％认为可操作性好；６４．６％认为ＣＣＭＤ－２－Ｒ比ＣＣＭＤ－２有所进步ＣＣＭＤ－２标准诊断与临床诊断的一致率为９３．６％（Ｋ＝０．８０），与ＣＣＭＤ     

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...     

帕罗西汀治疗抑郁症200例副反应观察

对弋矶山医院心理科１９９６年８月～１９９７年１０月期间的门诊及住院病人中，符合ＣＣＭＤ－２－Ｒ抑郁症诊断标准者２００例使用帕罗西汀治疗，剂量分别为２０ｍｇ／ｄ，３０ｍｇ／ｄ及４０ｍｇ／ｄ。其中男１１９例，女８１例。年龄１４～７６岁，平均３８±３岁。除...     

Diagnosing bipolar disorder and the effect of antidepressants: a naturalistic study

OBJECTIVES: To determine if bipolar disorder is accurately diagnosed in clinical practice and to assess the effects of antidepressants on the course of bipolar illness. METHOD: Charts of outpatients with affective disorder diagnoses seen in an outpatient clinic during 1 year (N = 85 with bipolar or unipolar disorders) were reviewed. Past diagnostic and treatment information was obtained by patient report and systematic psychiatric history. Bipolar diagnosis was based on DSM-IV criteria using a SCID-based interview. RESULTS: Bipolar disorder was found to be misdiagnosed as unipolar depression in 37% of patients who first see a mental health professional after their first manic/hypomanic episode. Antidepressants were used earlier and more frequently than mood stabilizers, and 23% of this unselected sample experienced a new or worsening rapid-cycling course attributable to antidepressant use. CONCLUSION: These results suggest that bipolar disorder tends be misdiagnosed as unipolar major depressive disorder and that antidepressants seem to be associated with a worsened course of bipolar illness. However, this naturalistic trial was uncontrolled, and more controlled research is required to confirm or refute these findings.     

肌萎缩侧索硬化症的院前误诊分析

目的 回顾分析115例肌萎缩侧索硬化症患者院前误诊情况，加深对该病临床特点的认识，减少误诊，实现尽早诊断和尽早治疗，方法收集北京大学第三医院2003年1月-2005年3月全部诊断为运动神经元病住院患行的临床资料，按照肌萎缩侧索硬化症的诊断标准（修订版）对所有患者进行严格诊断，将其中“确诊为肌萎缩侧索硬化症”和“很可能肌萎缩侧索硬化症”（包括很可能和实验室支持的很可能）115例患者作为观察对象。结果 115例患者中符合“确诊”标准者74例，“很可能”标准41例；平均诊断间期为14．80个月，平均误诊间期6．40个月。其中误诊者72例，未误诊28例，余15例为我院首诊患者，无一例误诊，院前误诊率为72．00％（72／100）。“确诊”和“很可能”患者的误诊率分别为72．31％和71．43％，二者相比差异显著件意义（P〉0．05）：症状首发部位分别为球部合并上肢（5例）、单侧上肢（49例）、单侧下肢（15例）以及偏侧上下肢者（2例），共71例，其误诊率达80．28％（57／71）。在误诊病种中，以颈椎病最为多见，其次为脑血管疾病：北京市与外埠患者的误诊率分别为50．00％（13／26）和79．73％（59／74），二者相比差异具有显著性意义（P〈0．05）。80％以上误诊发生于基层医院，最终明确诊断局限于教学医院。结论 引起肌萎缩侧索硬化症误诊的原因除疾病本身具有临床较少见的特点外，医生对其认识不足亦是发生误诊的重要因素之一，故提高医生对该病的了解并加强专业修养，是降低肌萎缩侧索硬化症误诊率的有效方法和必要手段。     

麻痹性痴呆误诊的原因分析

目的探讨麻痹性痴呆易被误诊的可能原因,提高临床诊断率。方法回顾性分析14例曾被误诊的麻痹性痴呆患者的临床资料。结果以不典型的精神症状群首发而被误诊为功能性精神障碍10例,其中误诊例次率最高的是精神分裂症占47．3％,其次是躁狂症占31．6％;以进行性加重的痴呆为主要首发症状而被误诊为阿尔兹海默病的2例及血管性痴呆1例;以酒依赖伴有痴呆样症状为主被误诊为酒精所致精神障碍的1例。〈40岁的占总数的28．5％。否认或故意隐瞒治疗史9例,根本不知情5例。误诊时处于发病早期无神经系统的阳性体征8例;处中晚期有神经系统阳性体征且呈不同程度表现的共6例,其中仅1例伴有特异性阿-罗氏瞳孔特征。14例辅助检查均不够完善,均未及时进行相关梅毒血清学检查。结论麻痹性痴呆易被误诊的首要原因是首发精神症状不典型,其次是冶游史易被隐瞒、早期神经系统阳性体征不明显或中晚期缺乏阿-罗氏瞳孔特异性体征、辅助检查不够完善和及时。     

朊蛋白病所致精神障碍误诊为抑郁发作1例

本文报告一例29岁的朊蛋白所致精神障碍被误诊为伴躯体症状的抑郁发作的男性患者,患者首发症状主要为精神症状,后出现进行性加重的躯体症状,距首次发病一年余死亡。朊蛋白病引起的精神症状表现多样,易导致漏诊和误诊。本文通过对该案例进行讨论,以期为临床医生对诊断朊蛋白病所致精神障碍提供参考。     

Physical restraints in the emergency department and attendance at subsequent outpatient psychiatric treatment

While an estimated 8.5% of psychiatric patients treated in emergency departments require physical restraint, the impact of restraint on attendance at post-discharge outpatient psychiatric appointments has not been investigated. This study evaluated two groups of patients aged 18 or over: 1) 67 individuals who presented voluntarily or involuntarily (being brought in by the police) to the emergency department and who were physically restrained in the course of clinical care, and 2) a comparative group of 84 individuals who presented involuntarily but were not restrained. Perception of quality of care, recollection of the restraint episode, and attendance at follow-up outpatient appointments were compared between these two groups. Of the 151 patients, 33% were from minorities, 45% were female, and the median age was 36 years (range of 18 to 77 years). Both minority race and use of physical restraints were related to less frequent attendance at the prescribed outpatient psychiatric appointment, based on multivariate logistic regression (odds ratios of 0.40 and 0.38, respectively). Although physical restraint may sometimes be necessary to manage aggression and agitation in the emergency department, being restrained appears to be associated with decreased likelihood of attending prescribed outpatient follow-up mental health treatment. Clinicians should consider alternatives to physical restraints whenever possible to minimize impact on treatment compliance after discharge from the emergency department.     

Factors related to admission of new patients consulting geriatric psychiatric services in montreal

The development of and the demand for geriatric psychiatric services (GPS) have increased over the past decade. Psychopathology, autonomy, physical disorders, sociodemographics, social support and caregivers' burden have all been advanced as influencing the elderly's risk of hospitalization. These factors were examined in a 1-year prospective study of 87 new patients consulting a catchment-area GPS. Standardized assessments were used, including both patients' and caregivers' independent measures of patients' social network. Entry points to the study were as follows: 70.1% of patients came from an outpatient clinic and 25.3% were admitted directly to psychiatric wards. Subjects were followed up 1 year after discharge or first contact. Overall, 47.1% of the sample was admitted to a higher-supervision setting during the 1-year follow-up, including 20.7% of the total sample admitted to GPS wards. Multivariate logistic regression analysis indicated different factors influencing admission according to the definition of admission. Loss of autonomy was a key factor related to both psychiatric and overall admissions. Previous admission was a predictor of psychiatric admissions only. Relatives' strain and not living with spouse were predictors of overall admissions. The results indicate that functional consequences of disease (eg loss of autonomy) and resilience of relatives are key in predicting the elderly's need for greater supervision.     

Chorea Huntington Eine klinisch relevante Differenzialdiagose bei gerontopsychiatrischen Patienten?

We report on seven geropsychiatric patients, aged 62 to 86, who had received either in- or outpatient psychiatric treatment for different disorders before being diagnosed with Huntington's disease (HD) by molecular biological methods. At the time of diagnosis, these patients presented only with mild involuntary movements in addition to other, nonspecific psychiatric symptoms such as depressive, paranoid, or dementia symptoms. In six of the seven cases, the HD symptoms had previously been misdiagnosed as tardive dyskinesia because these patients had been treated with neuroleptics in the past. Family histories were nonspecific. Three of the seven patients had family members who were described as "mentally ill" and already deceased. Huntington's disease (HD) should be considered as a differential diagnosis in geropsychiatric patients presenting nonspecific psychiatric symptoms.     

Misdiagnosed patients with bipolar disorder: comorbidities, treatment patterns, and direct treatment costs

OBJECTIVE: The purpose of this study was to examine comorbidities, treatment patterns, and direct treatment costs of patients with bipolar disorder who are misdiagnosed with unipolar depression. METHOD: This study is a retrospective analysis of data from the MarketScan Commercial Claims and Encounters (CCE) database. Logistic regressions and analyses of variance were used to compare the misdiagnosis cohort to 3 age- and gender-matched comparison cohorts (recognized bipolar, depression, and no psychiatric disorders based on ICD-9-CM criteria) during the year 2000. RESULTS: Each cohort had 769 individuals (68.0% female; mean age of roughly 42 years). The misdiagnosis cohort had higher rates of several psychiatric comorbidities than the depression cohort (e.g., personality disorders, alcohol abuse, psychotic disorder) and the bipolar cohort (e.g., generalized anxiety disorder, panic) but a lower rate of psychotic disorders than the bipolar cohort (p < .05). Compared with the bipolar cohort, the misdiagnosis cohort was more likely to receive antidepressants, but less likely to receive anticonvulsants, antipsychotics, or lithium (all p < .001). Antidepressant rates were similar among the misdiagnosis and depression cohorts. Group differences were found in mean annual costs for anticonvulsants, antipsychotics, lithium, antidepressants, and total treatment costs: bipolar (USD $442, $310, $67, $497, $8600); misdiagnosis (USD $221, $185, $20, $704, $8761); depression (USD $70, $74, $5, $657, $7288). CONCLUSION: Misdiagnosed bipolar patients received inappropriate and costly treatment regimens involving overuse of antidepressants and underuse of potentially effective medications. Patterns of psychiatric comorbidity suggest one possible strategy for improving recognition of bipolar disorder among patients presenting with depressive symptoms. Patients who present with the observed pattern of comorbidities may benefit from additional screening for bipolar disorder. It is recommended that steps be taken to minimize misdiagnosis in clinical settings.     

神经梅毒临床误诊病例分析

目的分析神经梅毒误诊原因，提高诊断的准确率。方法回顾性分析2001年1月-2004年2月曾经在院外误诊的12例神经梅毒患者的临床资料及误诊原因。结果12例患者中2例脑膜血管梅毒者被误诊为动脉硬化性脑梗死，2例脑膜梅毒被误诊为结核性脑膜炎和动脉瘤，2例脊髓痨被误诊为多发性神经炎，6例全身麻痹性痴呆被误诊为阿尔茨海默病、血管性痴呆、慢性酒精中毒性脑病、急性病毒性脑炎、路易体痴呆和帕金森病合并痴呆。误诊原因主要为：临床问诊忽略了患者的冶游史以及患者和家属有意隐瞒病史；体格检查不全面和定位诊断错误；全身性神经梅毒的临床表现不典型；神经梅毒的临床表现复杂多样，临床医师对其认识不足，病因诊断时考虑不充分(误诊的最主要原因)。结论神经梅毒临床表现较为复杂，临床医师对此应有充分认识，对可疑病例应注重询问相关病史，认真进行全面体格检查及特异性的血清学、脑脊液检查，以提高对本病诊断的准确率。