脑外伤精神伤残鉴定案例中伪装分析

目的：探讨脑外伤鉴定案例中伪装精神伤残及其相关因素。方法：用瑞文测验和伪装测验对110例不同程度脑外伤鉴定案例中的精神伤残和伪装情况进行评定和分析。结果：在110例中，伪装智力伤残者82例(74．5％)，伪装精神症状者6例(5．5％)：智力伤残程度越轻者，伪装人数比例越高；而不同程度脑外伤之间的伪装人数比例无显著差异。伪装组与非伪装组之间瑞文测验成绩存在显著差异；而各组内不同程度脑外伤者瑞文成绩的差异均无显著性：结论：脑外伤伤残鉴定中伪装精神伤残相当普遍，且以伪装智力伤残为多见。脑外伤所导致的智力伤残程度是影响伪装的因素之一。     

颅脑外伤后智力损伤鉴定中装坏的临床分析

目的：了解颅脑外伤后智力损伤鉴定中伪装坏劣的临床特点和鉴定中存在的问题。方法：由2名鉴定人中用定性评估的方法对被鉴定人进行伪装坏评估,并对评估后的伪装坏和基本合作的案例进行比较。结果：颅脑外伤后智力鉴定案例中的伪装坏占这类鉴定案例的67．6％;伪装坏与基本合作者的一般人口学资料均无显著差异;轻型颅脑外伤案例中有95．5％的人表现为伪装坏,90．6％的伪装坏者的瑞文（Raven）测验成绩低于70分;脑外伤严重程度与智力损伤程度无显著相关。结论：在颅脑外伤后智力损伤鉴定中应常规进行伪装坏的定量评定,并应参考伤者的伤前智力水平等因素进行综合评定。     

95例交通事故类司法精神医学鉴定案例分析

目的:探讨交通事故类司法精神医学鉴定案例的特点。方法:对95例交通事故类鉴定案例,自拟内容逐一统计。结果:智能损害67例(70.5%),精神障碍29例(30.5%),癫13例(13.7%),符合伤残标准76例(80.0%)。受伤情况和精神伤残等级精神障碍的发生及文化程度与智能状态均无对应关系。结论:颅脑损伤后精神障碍和精神伤残的发生以及智能损害程度受多因素的影响。     

61例精神损伤司法鉴定案例分析

目的探讨精神损伤司法鉴定案例的特点。方法对61例精神损伤鉴定案例,自拟内容逐一统计。结果智能损害33例(54.1%),精神障碍34例(55.7%),癫3例(4.9%),符合伤残标准47例(77.0%)。受伤情况和精神伤残等级、精神障碍的发生、文化程度与智能状态均无对应关系。结论颅脑损伤后精神障碍和精神伤残的发生以及智能损害程度受多因素的影响。     

外来打工者与本地涉案者司法鉴定案例的对照研究

目的 探讨外来打工者与本地区涉案者司法精神病学鉴定案例的特征及其异同点。方法 对我院鉴定的96例外来打工者与本地区的111例进行对照研究。结果 与对照组比较,研究组的年龄轻、未婚、文化低、农村、农民及无业人员占的比例高;案件类型研究组以盗窃抢劫居首位(40.6％),其次是凶杀伤害(22.9％),与对照组和有关报道不同;鉴定诊断研究组精神发育迟滞少见(5.2％),伪装精神病占的比例较高(8.3％),拘禁性精神障碍占的比例也较高(9.4％)。结论 两组司法精神病学鉴定的特点有所不同,打工者犯罪后诈病多见,应引起司法精神病学界的重视。     

脑外伤后伪装认知功能损伤者事件相关电位研究

目的探讨检测伪装认知功能损伤的神经电生理技术。方法鉴定专家结合临床检查及二项必选数字记忆测验对193例脑外伤后精神伤残鉴定进行评估,区分出伪装认知功能损伤者52例与非伪装者120例为研究对象,通过高低音听觉刺激高低概率范式(oddball)引发事件相关电位,并同步记录被试判断高低音的正确率,分析伪装与非伪装组事件相关电位相关参数的差异。结果①伪装组在P300之后的负慢波潜伏期显著短于非伪装组[(412.0±181.6)msvs(424.0±170.1)ms,Z=3.25,P=0.001];而波幅也大于非伪装组,但未达到统计学意义(P>0.05)。②伪装组P300潜伏期短于非伪装组,而波幅大于非伪装组,但差异未达到统计学意义(P>0.05)。③伪装组听觉高低音判断的正确率显著低于非伪装组[(79.2±19.8)%vs(93.1±9.3)%,t=5.195,P<0.001〗。结论伪装认知功能损伤者客观脑电生理反应(潜伏期短,波幅大)与其主观行为表现(判断高低音的正确率低)的"矛盾现象"可以作为伪装认知功能损伤的判断依据之一。     

54例颅脑创伤有关精神障碍的司法鉴定

目的 探讨精神损伤的司法鉴定。方法 对54例与颅脑创伤有关精神障碍司法鉴定进行分析,按精神损伤程度分重伤组与非重伤组统计,卡方检验。结果 54例中,颅脑创伤所致智能障碍38例(70.4％),遗忘综合征1例(1.8％),精神病7例(12.9％),反应性精神病3例(5.6％),诱发精神疾病5例(9.3％),均没有评定损伤或伤残等级。重伤组与非重伤组颅脑外伤等级的差异有显著性(x~2=18.54,P<0.01)。与颅脑创伤有关精神障碍的司法鉴定有增多的趋势。结论 颅脑创伤所致精神障碍的严重程度和颅脑外伤损伤程度有关,制定统一的精神损伤鉴定标准,进一步完善颅脑创伤所致精神障碍的司法鉴定刻不容缓。     

颅脑损伤所致精神障碍的司法精神医学鉴定分析

目的探讨颅脑损伤所致精神障碍类型,以及颅脑受损程度、范围及鉴定时间与智力障碍程度的关系。方法对85例颅脑损伤患者的司法精神医学鉴定资料进行回顾性分析。结果85例颅脑损伤所致精神障碍中,以智力障碍为首位,共70例（82．4％）;伤残等级评定为Ⅶ—Ⅹ级共81例（95．3％）;智力障碍程度与损伤时间及鉴定时间无相关性（χ^2=0．53,P〉0．05）,但与脑损伤的程度有相关性（P〈0．05）;有智力障碍组脑干损伤（30．0％）、脑内血肿（29．1％）的比例高于无智力障碍组（分别为20．0％和13．3％;P〈0．01）,≥2个脑叶损伤的比例（62．5％）高于无智力障碍组（36．4％,P〈0．05）。结论颅脑损伤所致智力障碍占第一位,颅脑损伤程度与智力障碍有明显相关性,伤残等级以Ⅶ-Ⅹ级为高。     

道路交通事故伤残鉴定中影响智残程度的相关因素分析研究

目的研究道路交通事故伤残鉴定中影响智残程度的相关因素。方法 100例交通事故伤残鉴定案例,按照鉴定结论分为轻度组、中度组、重度组;对三组的一般资料、临床病史资料、社会功能和智力进行组间比较,同时以上述资料作为自变量,组别为应变量,进行logistic回归分析。结果 3组一般资料差别不具有显著性(P0.05);3组的临床病史资料中,颅内出血灶、挫伤处、昏迷时间组间差别均具有显著性(P0.05),GCS评分差别不具有显著性(P0.05);3组的伤后鉴定社会功能和智力组间差异具有显著性(P0.05);颅内出血灶、家庭职能、生活自理、智力进入logistic回归方程。结论临床病史资料中颅内出血灶、社会功能中的家庭职能、生活自理和智力测定中的智商是影响智残程度鉴定的相关因素,可以作为精神伤残鉴定的指标。     

颅脑损伤所致精神障碍的司法精神医学鉴定分析

目的探讨颅脑损伤所致的精神障碍类型，以及颅脑损伤受损程度、范围及距鉴定间隔时间与智力损害程度的关系。方法 对182例颅脑损伤患者的司法精神医学鉴定资料进行回顾性分析。结果 （1）182例颅脑损伤所致精神障碍者中，以智力障碍为首位，共123例次（67．6％）。（2）伤残等级评定为Ⅶ-Ⅹ级者共142例（78．0％）。（3）智力损害程度与受伤时间距鉴定时间无相关性（X^2=0．41，P〉0．05），但与脑损伤程度有相关性（P〈0．05）。（4）有智力损害组的脑干损伤（30．9％）、脑内血肿（25．2％）的比例高于无智力损害组（分别为16．9％和11．9％；P〈0．01），≥2个脑叶损伤（61．7％）的比例也高于无智力损害组（34．9％；P〈0．05）。结论颅脑损伤所致智力障碍占第1位，脑损伤受损程度与智力损害程度有明显的相关性，伤残等级以Ⅶ-Ⅹ等级的比例高。     

颅脑损伤后精神障碍的复核鉴定资料分析

目的　对有争议的颅脑损伤后各种精神障碍案例的复核鉴定结论一致性及相关影响因素进行回顾性研究。方法　制定调查项目 ,分别对 38例颅脑损伤后精神障碍者的初次鉴定 (以下称初鉴 )和复核鉴定 (以下称复鉴 )资料进行分析比较卡方检验。结果　初鉴和复鉴在颅脑损伤所致精神病性症状、人格改变、外伤性癫痫及神经症性症状等类型的发生率上差异较大 ;在伤残等级评定以及选择鉴定的时机等方面亦存在显著性差异 (P <0 .0 1)。结论　颅脑损伤伤情复杂 ,对损伤所致各种精神障碍程度的认定 ,应依据伤情的严重程度 ,损伤与现有体征和症状之间、损伤与心因性关系等综合评定 ;并选择有效的鉴定时机 ,提高鉴定结论的准确性。     

海洛因依赖者伪装和制造疾病临床研究(附221例分析)

目的：了解海洛因依赖者在脱毒过程中伪装和制造疾病的原因和临床表现。方法：对符合中国精神疾病分类方案与诊断标准第2版修订本有关诈病诊断标准的海洛因依赖者进行回顾性研究。结果：发现22l例诈病，发生率4．6％，以青年男性、未婚、初中以下文化、无业占多数，吸毒时间长、多药滥用、涉嫌违法犯罪问题者较多。其动机依次是企图逃避法律惩罚、企图提前解除强戒．骗取成瘾药物、受人唆使胁迫等。方式有说谎、伪装、造伤等。结论：海洛因依赖诈病者较多，应引起注意。     

Prevalence and severity of mental health-related disability and relationship to diagnosis.

OBJECTIVE: Psychiatric disability has been defined largely from measures that focus on serious mental illness. This practice may have led to substantial underestimation of the total impact of mental disorders on community health. In this study a generic measure of mental health-related disability was used to examine disabilities attributable to various common mental disorders. METHODS: Data were drawn from the Australian National Survey of Mental Health and Wellbeing, a household survey of 10,641 adults that assessed participants for 14 DSM-IV disorders with use of the Composite International Diagnostic Interview. Screening instruments were used to identify likely cases of ICD-10 personality disorder, neurasthenia (an undifferentiated somatoform disorder), and psychosis. Mental health disability was assessed with the Medical Outcomes Study 12-item Short Form (SF-12) mental health summary scale, which was administered to all participants. RESULTS: Disability was significantly greater among participants with a current psychiatric diagnosis, and disability varied by type of disorder. Diagnosis remained a strong predictor of disability after sociodemographic factors and physical illness were controlled for. Disorders found to be independently associated with disability were depression, panic disorder, agoraphobia, social phobia, generalized anxiety disorder, alcohol dependence, and drug dependence. CONCLUSIONS: Substantial proportions of persons with mental disorders that are not usually classified as major mental disorders reported moderate and severe disability. A generic measure of mental health-related disability was able to detect variations in disability among persons with different diagnoses. Although such a measure is not as sensitive as a disorder-specific measure developed for use in psychiatric populations, it can facilitate comparison of disability across common mental disorders.     

Employment equity and mental disability

PURPOSE OF REVIEW: Recent research on the civil rights issue of employment equity for people with psychiatric disabilities is reviewed. RECENT FINDINGS: Mental disorders, particularly depression, are the most frequent source of occupational disability worldwide and are expected to grow. Employers are increasingly aware of the productivity costs associated with mental disorders and the importance of fostering a mentally healthy workforce. Few firms, however, have explicit policies to include disabled people in their workforce, and many employers continue to express prejudicial views toward people with mental disabilities which would exclude them from competitive work. At the same time, disability legislation has not offered the hoped-for protection for people with mental disorders. Employers have expressed concerns over the costs of making workplace accommodations and have successfully battled for a legal definition of disability that excludes many individuals with mental disorders. CONCLUSION: In the absence of antistigma efforts directed toward the business community, one wonders if the growing awareness of the productivity costs associated with mental disability will foster greater employment equity, or fuel more subtle forms of employment discrimination. Low employment levels among people with disabilities remain a major determinant of the social disparities they face.     

Compensation and Malingering in Traumatic Brain Injury: A Dose-Response Relationship?

The purpose of this study was to determine if there is a dose-response relationship between potential monetary compensation and failure on psychological indicators of malingering in traumatic brain injury. 332 traumatic brain injury patients were divided into three groups based on incentive to perform poorly on neuropsychological testing: no incentive; limited incentive as provided by State law; high incentive as provided by Federal law. The rate of failure on five well-validated malingering indicators across these groups was examined. Cases handled under Federal workers compensation laws showed considerably higher rates of failure and diagnosable malingering than cases handled under State law. The findings indicate that monetary compensation associated with workers compensation claims is a major motive for exaggeration and malingering of problems attributed to work-related brain injuries. The clinician's index of suspicion regarding exaggeration and malingering of symptoms and deficits should be much higher in the context of Federal workers compensation claims, particularly in patients who have suffered only mild traumatic brain injury.     

Compensation and malingering in traumatic brain injury: a dose-response relationship?

The purpose of this study was to determine if there is a dose-response relationship between potential monetary compensation and failure on psychological indicators of malingering in traumatic brain injury. 332 traumatic brain injury patients were divided into three groups based on incentive to perform poorly on neuropsychological testing: no incentive; limited incentive as provided by State law; high incentive as provided by Federal law. The rate of failure on five well-validated malingering indicators across these groups was examined. Cases handled under Federal workers compensation laws showed considerably higher rates of failure and diagnosable malingering than cases handled under State law. The findings indicate that monetary compensation associated with workers compensation claims is a major motive for exaggeration and malingering of problems attributed to work-related brain injuries. The clinician's index of suspicion regarding exaggeration and malingering of symptoms and deficits should be much higher in the context of Federal workers compensation claims, particularly in patients who have suffered only mild traumatic brain injury.     

Use of the atypical antipsychotics Olanzapine and Risperidone in adults with intellectual disability

The present study was designed to monitor the use of atypical antipsychotics in adults with intellectual disability and to evaluate the clinical effectiveness of these drugs. Twenty‐one patients were commenced on an atypical antipsychotic: 12 on Olanzapine and nine on Risperidone. The ICD‐10 diagnoses of the subjects were mild (13 cases) or moderate (8 cases) mental retardation, and psychiatric disorders (17 cases) with significant impairment of behaviour in 10 cases. Tolerability was good for 15 patients experiencing minimum or no side‐effects, and medication was only stopped as a result of side‐effects in one case. Clinical global outcome was rated as minimally improved or better for 16 cases. The present findings suggest that the atypical antipsychotics Olanzapine and Risperidone are well tolerated by patients with intellectual disability and psychiatric disorders, and are broadly effective against target symptoms.     

Understanding disability in mental and general medical conditions

OBJECTIVE: This study characterized the prevalence, characteristics, and impact of mental and general medical disabilities in the United States. METHOD: The 1994-1995 National Health Interview Survey of Disability was the largest disability survey ever conducted in the United States. A national sample was screened for disability, defined as limitation or inability to participate in a major life activity. Analyses compared cohorts who attributed their disability to physical, mental, or combined conditions. RESULTS: Of 106,573 adults, 1.1% reported functional disability from mental conditions, 4.8% from general medical conditions, and 1.2% from combined mental and general medical conditions. Disabilities attributed to a mental condition were predominantly associated with social and cognitive difficulties, those attributed to general medical conditions with physical limitations, and combined disabilities with deficits spanning multiple domains. In multivariate models, comorbid medical and mental conditions were associated with a twofold increase in odds of unemployment and a two-thirds increase in odds of support on disability payments compared to respondents with a single form of disability. More than half the nonworking disabled reported that economic, social, and job-based barriers contributed to their inability to work. One-fourth of working disabled people reported discrimination on the basis of their disability during the past 5 years. CONCLUSIONS: An estimated three million Americans (one-third of disabled people) reported that a mental condition contributes to their disability. Mental, general medical, and combined conditions are associated with unique patterns of functional impairment. Social and economic factors and job discrimination may exacerbate the functional impairments resulting from clinical syndromes.