会诊联络精神病学在综合医院的现状分析

目的对综合医院精神病学会诊现状进行分析研究。方法2007年度申请精神科会诊的病例279例,分析其申请科室、原发病、申请理由及精神科诊断处理。结果综合医院精神病学会诊中最常见的精神科诊断是脑器质性精神障碍、躯体疾病伴发精神障碍、焦虑障碍和抑郁障碍。结论应在综合医院积极开展会诊联络精神病学服务及对综合科医生加强精神病学知识教育。     

上海某综合医院老年住院患者精神病学联络会诊现状

目的:了解综合医院老年住院患者精神医学联络会诊的特点。方法:回顾性分析1年间老年科住院患者精神病学联络会诊资料,并分析。结果:176例次精神科联络会诊对象共100例患者,平均87岁。住院时平均每位患者有6种诊断,人均患4个系统疾病。女性患者会诊前已使用精神药物的比例高于男性(64%比36%,χ~2=6.00,P=0.014)。58%会诊诊断为神经认知障碍。176例次会诊中建议使用抗精神病药治疗为45%,抗焦虑药为38%,抗抑郁药物为25%,不建议药物治疗为32%。需要2次或更多次会诊者约占1/3。本调查中涉及病房总的开放床位180张,平均每100张床位每周精神科会诊数为1.9例次。结论:综合医院老年住院患者中联络会诊的需求高,会诊患者中神经认知障碍的比例及需要用精神药物的患者比例高。     

某综合医院168例老年住院患者精神科会诊-联络资料分析

目的 了解综合医院老年患者精神(心理)服务需求的特点.方法 选取2010年1月～2012年12月某综合医院老年精神科会诊的168例患者,对其社会人口学资料、会诊科室、会诊原因、精神科诊断及治疗等进行分析.结果 在申请会诊的各科室中,前三位分别为神经内科(34.5％)、呼吸内科(19.1％)、高干病房(10.1％);常见会诊原因依次为以谵妄为主的意识障碍(20.8％)、躯体不适(19.6％)、焦虑抑郁(17.9％)、睡眠障碍(11.9％);会诊常见诊断主要为脑器质性精神障碍(34.5％);处理方式主要包括药物治疗及心理治疗等.结论 综合医院老年患者对精神(心理)服务需求大,精神科会诊联络服务有助于住院老年患者全面诊断和治疗.     

综合性医院住院病人的会诊精神病学

目的:探讨在综合医院设置精神科开放式病房后精神病学会诊的现状,方法:对我院近20年290例申请会诊的住院病人的科,地诊前后的论断对照,误诊情况及转科治疗情况进行分析.结果:总会诊率为1.38%,申请会诊的科室以内科最多138例(47.6%),会诊的精神科疾病中多见的是神经症84例(29.0%),躯体疾病致精神障碍60例20.7),器质性精神障碍50例(17.2%),精神分裂症37例(12.8%),误诊病例85例(29.3%),转科治疗64例(22.1%),结论:精神科会诊在综合医院呈增加趋势.综合设置精神科开放式病房既有利于精神科的发展,也有利于各类有精神障碍的患者得到及时妥善的治疗.     

谵妄在综合医院住院患者中的临床特点分析

目的 了解谵安在综合医院住院患者中的临床特点.方法 对1年内综合医院伟院患者中精神科联络会诊明确诊断为谵妄的93例患者的临床特点进行分析,并与336例会诊后明确为非谵妄患者进行比较.结果 谵妄患者的平均年龄高于非谵妄患者[(71±15)岁vs(59±18)岁,P＜0.05].会诊时精神障碍的病程短于1周的比例,谵妄组高于非谵妄组(56.0%vs18.3%,P＜0.05).谵妄组来自重症监护病房(10.8%)和外科者(36.4%)高于非谵安组(4.2%和21.4%),而来自内科较少(56.5%vs36.6%),上述差异均有统计学意义(P＜0.05).谵妄组以精神病性发作(61.8%)和认知障碍(20.2%)作为会诊原因的比例高于非谵妄组(18.5%和1.0%),差异有统计学意义(P＜0.05).谵妄组罹患创伤或手术、呼吸系统疾病和多系统疾病(26.7%、10.5%、20.9%)者高于非谵妄组(15.9%、4.7%、10.9%),而循环系统疾病较少(3.5%vs16.5%),差异均有统计学意义(P＜0.05).高龄(≥165岁)、被非精神科医生识别为精神病性发作和认知障碍、精神科会诊时刻较早、罹患创伤或者手术、呼吸系统疾病和多系统疾病、在重症监护病房治疗与谵妄密切相关(P＜0.05).80.6%的患者应用了药物治疗,常用的药物为氟哌啶醇、奥氮平、喹硫平和利培酮.结论 对于在外科和重症监护病房治疗的创伤、呼吸系统疾病、多系统疾病或术后的老年患者应高度注意发生谵妄的可能性.     

否认躯体疾病的适应性障碍（附一例报告）

否认躯体疾病的适应性障碍（附一例报告）新疆石河子绿洲医院（８３２０００）贾新生，赵秀荣，唐安平Ｓｔｒａｕｓｓ等报道［１］，在联络精神病学临床工作中，要求精神科医生会诊的病例中约有１０％不承认患躯体病拒绝治疗。患者否认躯体疾病并非无躯体疾病或因医生未将...     

综合医院精神心理科会诊患者特点分析

目的 了解综合医院精神心理科联络会诊的原因、患者的科室分布、病种构成及处理情况,以更好地指导精神心理科医生的联络会诊工作,为进一步完善会诊精神医学在综合医院内的发展提供参考.方法 本研究采用回顾性方法复习综合医院住院患者的精神科会诊情况,分析在现代医学模式下综合医院的患者对精神卫生服务需求的特点,汇总2012年1月-2013年12月精神心理科联络会诊病历,资料完整者共612例,对一般人口资料、各科会诊人数及病种构成、会诊原因、诊断、处理构成等情况进行描述分析.结果 全部临床科室都有邀请精神心理科会诊,比例最高的科室前5位为：神经内科113例（18.5％）、心血管内科83例（13.6％）、消化内科69例（11.3％）、干部科56例（9.2％）、急诊科52例（8.5％）.病种主要为神经症性、应激相关的及躯体形式障碍151例（24.7％）,心境障碍139例（22.7％）,器质性精神障碍108例（17.6％）,伴有生理紊乱和躯体因素的行为综合征84例（13.7％）;精神科用药以SSRIs类药物、非典型抗精神病药物及苯二氮革类应用较多.结论 综合性医院各科存在较多的精神医学问题,住院患者伴发的精神障碍涉及各类疾病,综合医院就诊的患者精神心理障碍应引起重视,精神科会诊联络非常重要,可以提高临床各科医师对精神障碍的认识,减少或消除人们对精神科会诊的顾虑与不信任,提高会诊效率,治疗躯体疾病的同时应及时使用心理和药物等多种干预手段,使患者得到全面康复,从而提高患者的生命质量.     

综合医院精神科联络会诊6年的变化

目的:比较2008年与2014年综合医院精神科联络会诊的变化。方法:回顾性分析、比较2008年及2014年武汉大学人民医院各科室邀请精神科会诊情况。结果:精神科会诊患者2008年257例,2014年为688例;两年的会诊率、会诊患者的年龄、性别分布差异无统计学意义。与2008年相比,2014年患者单次会诊比例显著增加(Z=4.20,P0.05);内科、妇产科、儿科、五官科、肿瘤科会诊比例显著增高,外科、感染科和老年科会诊比例显著降低(P均0.05);患者因不能解释的躯体症状和既往精神障碍史但目前无症状的会诊比例明显增高,而急性脑综合征和精神病性症状的比例明显降低(P均0.05)。结论:6年间综合医院住院患者对精神科联络会诊需求无明显变化;非精神科医生对患者精神问题的关注增高,但识别能力不足。     

综合医院精神科急会诊与普通会诊的比较

目的探讨综合医院精神科急会诊与普通会诊的特征差异。方法2007年度申请精神科会诊的病例279例,分析申请科室、原发病、申请理由、精神科诊断处理,比较急会诊与普通会诊的差异。结果综合医院精神病学急会诊主要为脑器质性精神障碍及躯体疾病所致精神障碍(75%~85%),普通会诊以抑郁障碍、焦虑障碍及神经症为主。结论应在综合医院积极开展会诊-联络精神病学服务,急会诊与普通会诊的诊断差异有助于精神科会诊临床实践。     

综合综合精神科会诊185例分析

目的探讨会诊--联络精神病学在综合性医院的作用.方法回顾性的分析3年中综合性医院精神科向非精神科提供的185次会诊资料.结果在185次会诊中,男性72例(38.9%),女性113例(61.1%),男/女11.6,平均年龄(51±14.7)岁;急会诊40例(21.6%),一般会诊145例(78.4%);有自杀行为者29例(15.7%);会诊诊断脑器质性及躯体疾病所致精神障碍82例(44.3%),神经症61例(33.0%),精神分裂症和情感性精神障碍21例(11.4%),精神活性物质所致精神障碍13例(7.0%);会诊医嘱的总执行率达94.9%,治疗总有效率92.1%.结论综合医院内精神科会诊可及时发现和治疗各科患者的精神障碍,更好地落实医学模式的转变.     

精神科重症加强监护病房

目的：探讨精神科重症加强监护病房（ＰＩＣＵ）的必要性和特点，方法：回顾性地分析６５例ＰＩＣＵ患者资料。结果：老年科病人住院期间出现严重躯体疾患转入ＰＩＣＵ者最多，其次是有严重躯体疾病在综合医院治疗同时又有精神症状而转院者，转入ＰＩＣＵ治疗原因主要是肺部疾病及急性脑血管疾病。结论：建立ＰＩＣＵ有其必要性和重要性，ＰＩＣＵ更具综合性ＩＣＵ的性质。     

Patients in intensive care after a suicide attempt with legal drugs - risk profile and course

Little is known about the risk profile and the further history of patients who attempted suicide by severe medicinal intoxication.All patients residing in Basel (n = 190) admitted to the intensive care unit between 01/01/1998 and 12/31/2001 because of a suicide attempt with legal drugs were investigated regarding psychopathology and sociodemographic features. Also, until the end of 2005, further suicide attempts as well as potential cases of death were followed up.All 190 patients had psychiatric disorders. Compared to the general population, female sex, single status, low educational level, unemployment and invalidity were found significantly more often. Until the end of 2005 almost half of 118 patients followed up in our outpatient department committed further suicide attempts. 28 patients died, 6 of these by suicide.These patients should preferably not be prescribed medication with a low therapeutic range and they should receive intensive follow-up care.     

综合性医院医学心理科会诊的回顾性分析

目的：探讨综合性医院医学心理科会诊情况。方法：2004年9月至2009年9月期间医学心理科会诊534例,分析其申请科室、申请理由以及精神障碍的诊断和处理。结果：综合性医院医学心理科会诊中最常见的精神科诊断是脑器质性精神障碍、躯体疾病所致精神障碍、神经症和心境障碍。结论：应在综合医院积极开展会诊-联络精神病学服务颇为重要。     

Psychiatric consultation in a spinal injuries unit.

The function of a consultation liaison service to a spinal injuries unit is described. Within this context, a study was conducted in which sociodemographic and clinical data were collected over a 4 year period for consecutive admissions to the unit. Data are presented for 227 patients admitted during this period. Forty-seven patients were found to have discrete psychiatric disorders (DSM III) which required treatment during the course of their inpatient care. For forty-two of these patients the psychiatric disorder first developed following spinal cord injury.     

综合医院会诊-联络精神病学10年间变化

目的：了解综合医院会诊-联络精神病学10年变化的情况。方法：对本院1991年和2001年临床各科住院病人邀请精神科会诊的数量、科室分布、精神科诊断与处理情况进行对比分析。结果：年会诊率1991年与2001年分别为0．45％与0．71％，呈上升趋势；会诊的科室以内、外科为主，会诊的疾病种类1991年与2001年前三种疾病仍分别是躯体疾病所致精神障碍、脑器质性疾病所致精神障碍及神经症。结论：综合医院住院病人精神医学问题呈上升趋势，应加强会诊-联络精神病学的研究与推广。     

Patterns of psychiatric consultations in Kuwait general hospitals

Two hundred and nineteen consecutive referrals to psychiatric consultation services from all general hospitals in Kuwait over a 3-month period were studied and compared with a control group of 100 patients who were not referred for psychiatric consultation. The two groups differed significantly in age, sex, marital status, employment, and past psychiatric treatment. Inpatients were more often referred than outpatients with an overall low referral rate of 0.3%. The department of general medicine referred 74.4% of patients in contrast to 11.4% referred by the department of general surgery. The most common reason for referral was for assessment of a suicide attempt in the inpatient group, and the absence of organic cause for patients' physical symptoms in the outpatient group. Acute situational disturbance that resulted in a suicide attempt was the most common psychiatric diagnosis (26%), followed by depressive illness (19.5%) and organic psychotic disorders (8.2%). Our findings are similar to those reported in the literature, and the present study suggests a national underutilization of psychiatric consultation services in general hospitals.     

Addiction in the elderly - an underestimated diagnosis in clinical practice?

According to several studies in the USA, alcohol abuse is common among elder people, particularly among those admitted to hospital. Corresponding data for Germany are lacking as yet. In this study, the frequency of addiction problems in the elderly admitted to hospital was investigated using the data from 1990 to 1998 of the psychiatric department at the General University Hospital of Lübeck, Germany. Furthermore, the documentations of all consultations in that period were reevaluated. The psychiatric consultation service covers two general hospitals providing inpatient treatment for about 200,000 inhabitants. Diagnoses were made according to the ICD-10 criteria. In 17.7% of the males older than 64 years and in 4.2% of the elderly females admitted to the psychiatric department, alcohol dependency was diagnosed, while 5.8% of the elderly patients showed substance abuse, most often of benzodiazepine. Among the patients visited in the psychiatric consultation service, 10.8% of the elderly males and 3.2% of the elderly females were alcohol addicts and 3.9% substance abusers. The frequency of alcohol-induced neuropsychiatric complications, particularly withdrawal delirium and amnestic syndrome, increased with age. Also, benzodiazepine withdrawal delirium most frequently occurred in older patients. These results underscore that, although the prevalence rate seems to be lower than among the younger population, in the elderly population substance abuse still is a relevant medical problem, since the rate of neuropsychiatric complications increased with age.     

Effects of a psychiatric intensive care unit in an acute psychiatric department

Psychiatric acute units use different levels of segregation to satisfy needs for containment and decrease in sensory input for behaviourally disturbed patients. Controlled studies evaluating the effects of the procedure are lacking. The aim of the present study was to compare effects in acutely admitted patients with the use of a psychiatric intensive care unit (PICU) and not in a psychiatric acute department. In a naturalistic study, one group of consecutively referred patients had access only to the PICU, the other group to the whole acute unit. Data were obtained for 56 and 62 patients using several scales. There were significant differences in reduction of behaviour associated with imminent, threatening incidents (Broset Violence Checklist), and actual number of such incidents (Staff Observation Aggression Scale-Revised) in favour of the group that was treated in a PICU. The principles of patient segregation in PICUs have favourable effects on behaviours associated with and the actual numbers of violent and threatening incidents.