长期住院精神病患者伴发躯体疾病的临床观察及护理

目的 对长期住院精神病患者伴发躯体疾病的主要种类、特点及相应的护理对策做进一步的探讨分析.方法 对住院3年以上的精神病患者在住院期间出现的躯体疾病病种和例数进行调查和分析.结果 长期住院的精神病患者在住院期间所患躯体疾病多种多样,合并躯体疾患的发生率是62.50%.以感染、营养代谢疾病及管理不善所致疾病为多,心血管疾病是主要致死原因.排列前几位的是：各类感染、高脂血症、脂肪肝、心脑血管疾病、高尿酸血症等.结论 长期住院的精神分裂症患者合并躯体疾病的患病率高,应定期检查,做到早诊断早治疗,以减少不良后果.护理涉及饮食、心理、治疗、医院的环境设施及家属等多方面,护理人员的素质和主动性对保证伴发躯体疾病的精神病患者护理质量是至关重要的.     

慢性精神病住院患者躯体疾病的现况调查

目的探讨慢性精神病住院患者合并躯体疾病的特点及影响因素,促进医疗安全。方法对572例慢性精神病住院患者采用横断面研究的方法进行时点调查和统计分析。结果合并躯体疾病者397例（69.41%）,罹患躯体疾病依次为原发性高血压病、2型糖尿病、高脂血症、脂肪肝、乙肝、慢性支气管炎、贫血、阻塞性肺气肿、冠心病、胆石症等。合并躯体疾病的发生与患者年龄、病程、长期服用抗精神病药等有关。结论应充分重视慢性精神病住院患者伴发的躯体疾病,根据其临床特点及影响因素,采取适宜的治疗、管理方法,有助于改善患者的预后,并降低医疗风险和确保医疗安全。     

连云港市康复医院医保住院精神病患者的现状分析

目的：了解本院职工医保住院精神病患者的临床特点,分析应对策略。方法：用自编调查表对本院2013年7月22日住院状态的93例精神病患者进行调查分析。结果：本院职工医保住院精神病患者占多数,为41.9%;男性高于女性,差异有统计学意义（P〈0.05）;精神分裂症为主（92.5%）;入院前曾多次住院治疗;目前病程长、年龄大、多伴有躯体疾病、需要多种精神病药物及改善躯体疾病的药物联合治疗、呈衰退状态而无自伤、伤人及有自伤、伤人危险的患者居多。结论：职工医保长期住院的精神病患者,应对照精神卫生法,加强医患沟通,更新理念,回归社区康复。     

精神病住院患者死亡相关因素的临床分析及护理对策

目的:通过分析住院精神病患者死亡资料,探讨死亡原因及相关因素,为临床护理及制定安全防范措施提供依据。方法:对合肥市精神病医院20年间收治的精神病患者57555例病历进行回顾性调查分析。结果:住院期间病死39例,住院病人病死率为0.68‰。主要死亡原因为躯体疾病17例,猝死14例。死亡时间多发生在4∶00～7∶00,13∶00～15∶00,尤其是起床活动时。死亡前处于兴奋躁动状态10例,躯体状况差13例,无任何先兆的死亡13例。结论:躯体疾病、猝死是精神科住院患者最主要的死亡原因,护理人员应高度重视兴奋躁动、进食差或拒食以及合并躯体疾患的病人,并加强特殊时段的病情观察,以降低住院病人病死率。     

高原地区精神病患者合并躯体疾病的分析

[目的]探讨高原地区精神病患者合并躯体疾病的临床特点.[方法]对150例资料完整的精神病患者合并躯体疾病的临床资料,按来自不同海拔地区分为3组进行回顾性分析.[结果]合并躯体疾病总体排列在前3位的是:循环系统54例(36.0%)、呼吸系统49例(32.7%)、消化系统47例(31.3%);海拔3000 m以上地区合并循环、呼吸、泌尿、内分泌、神经系统疾病与海拔2 000 m以下地区比较差异有统计学意义(P＜0.05),其中合并高血压、骨关节病海拔3000 m以上地区较海拔2 000 m以下地区明显增多(P＜0.05).[结论]精神病患者合并躯体疾病病种在不同海拔地区亦不相同,在临床工作中应引起足够的重视,及时给予正确的诊断和治疗,预防药物副作用加重躯体疾病.     

精神病住院患者的躯体疾病会诊资料分析

精神病患者可同时伴有躯体疾病,住院精神病患者由于精神病的特殊性、长期服用抗精神病药的副作用可以导致躯体疾病,精神病患者对自身患有躯体疾病缺乏主诉,极易延误病情,导致发生严重躯体疾病而要求会诊。我们通过调查住院精神病患者发生躯体疾病的会诊情况,分析其患病的特征,采取针对性的措施提高住院精神病患者的康复质量。我们对2007—2009年住院精神病患者发生躯体疾病后会诊的资料进行分析,现将结果分析如下。     

改良森田疗法治疗长期住院精神分裂症患者的应用研究

目的探讨改良森田疗法对长期住院精神分裂症患者的疗效和社会康复作用。方法将符合CCMD-3诊断标准、住院1年以上无严重躯体疾病的精神分裂症患者108例，随机分为实验组和对照组各54例，两组均用抗精神病药维持治疗．实验组合并Neo Morita therapy治疗。治疗前后用阴性症状量表（SANS）、社会功能缺陷筛选量表（SDSS-1）、精神科护理观察量表（NOSIN）进行评定。结果治疗后实验组SANS、SDSS-1总分降低，差异显著（P〈0．01），NOSIN总积极因素分增高．总消极因素分降低，病情总估计分较治疗前差异显著（P〈0．01）。结论Neo Morita therapy合并抗精神病药，在精神分裂症患者长期住院治疗中有明显效果．并能促进其社会康复。     

住院精神病患者感染性腹泻影响因素病例对照研究

目的 调查住院精神病患者感染性腹泻的影响因素,为医院感染的控制与预防提供依据.方法 对2008年1月-2010年12月确诊为医院感染性腹泻的64例住院精神病患者进行回顾性调查,按照1∶2的比例,选择同一时期、同一病区、同性别、年龄相差≤2岁、未发生腹泻的精神病患者作为对照组,做单因素回归分析和多因素条件logistic回归分析.结果 单因素条件logistic回归分析,文化程度、疾病类型、躯体疾病、自制力、长期服药史、合并其他躯体疾病、生冷食物、零食、饮水习惯、洗手习惯、一周前服用抗菌药物、季节为住院精神病患者医院感染性腹泻危险因素(P＜0.05);经多因素分析OR值分别为:夏秋季节19.347(5.386～23.476)、合并躯体疾病6.821(2.457～19.642)、无自制力4.446(1. 809～18.934)、洗手习惯差3.892(1.743～16.973)、生冷食物3.642(1.672～12.652)、饮冷水3.243(1.462～10.354),与老年抑郁症状的发生显著相关,差异有统计学意义(P＜0.05).结论 住院精神病患者感染性腹泻的独立危险因素为季节、躯体疾病、自制力、洗手习惯、生冷食物、饮水习惯.     

精神疾病患者合并糖尿病的发生情况及护理对策

目的:了解精神病患者合并糖尿病的患病及治疗情况,并探讨相应的的护理对策。方法:纳入2017年4月至2019年4月在我院住院符合标准的患者1284例,根据WHO标准进行糖尿病诊断,并统计血糖控制的方法。结果:1284例住院精神病患者中糖尿病235例(18.3%),检出率显著高于普通人群;血糖控制以口服药物为主,血糖控制理想状态者较少。结论:精神疾病患者中糖尿病的患病率远高于普通人群,临床护理工作中应予以重视。     

肝硬化患者医院感染危险因素分析及中医护理对策

目的探究肝硬化患者产生医院感染的危险因素,并采用中医预防及护理对策,为临床防控医院感染提供参考。方法收集2014年10月1日—2016年10月31日住院治疗的176例肝硬化患者资料,回顾性分析医院感染产生的危险因素,并总结中医预防及护理对策。结果176例肝硬化患者中有5例发生医院感染,其感染率是2.84%,感染部位主要有三种,即肺部感染、胃肠道及腹腔感染,其中,居于感染部位首位的是肺部感染3例(60%),其次为肠道感染1例(20%)和腹腔感染1例(20%)。5例感染病例均采样送细菌培养,检出4株病原菌,分别为2株的肺炎克雷伯菌(50%),1株的大肠埃希菌(25%),1株金黄色葡萄球菌(25%)。年龄≥55岁,住院时间≥30 d、侵入性操作、预防用药、肝功能评级高、合并肝炎是肝硬化患者发生医院感染的危险因素。结论针对肝硬化患者发生医院感染的危险因素,采取相应的中医预防及护理,增强身体免疫能力,可提高肝硬化患者生活质量,促进疾病恢复。     

Trends in length of stay of psychiatric inpatients based on "patient survey"]

The average length of occupancy for psychiatric beds in Japan has been pointed out to be among the longest in the world. However, neither the average length of occupancy since admission of psychiatric resident patients present at a facility at a given point of time (e.g. at the end of every October) nor the average length of stay of psychiatric patients until discharge have been reported in national health statistics. Using data from the "Patient Survey (1974-1984, 1987)" by the Ministry of Health and Welfare, estimates of trends for 1) length of hospitalization since admission of resident patients at the end of every October and 2) length of hospital stay from admission to discharge in patient cohorts admitted each year from 1974 to 1984, were determined. A remarkable difference in distribution was observed in the length of hospitalization in psychiatric residents and length of stay until discharge. For psychiatric residents surveyed at the end of October 1987, 13% had been resident for less than 3 months, 27% within one year, and 54% within 5 years. On the other hand, 33% of the patient cohort admitted in 1984 were discharged within one month, 59% within 3 months, and 85% within one year. Six percent of the cohort, however, had remained hospitalized for more than 3 years, some of whom were potential 'new' long-stay patients. The proportion of patients staying more than ten years shows an increase from 17% in 1974 to 30% in 1987, with the distribution of length of hospitalization in residents demonstrating a definite shift to increased length. On the other hand, length of stay until discharge shows a slight shortening.     

早期生活技能训练对流浪精神分裂症患者预后的影响

目的探讨流浪精神分裂症患者入院后,早期实施生活技能训练对其生活自理能力及预后的影响。方法选择入住我院流浪精神分裂症患者46例,随机分成研究组和对照组各23例。两组均接受常规药物治疗,精神科常规护理。研究组增加早期生活技能训练。采用日常生活能力量表(ADL)对两组患者生活能力情况进行评定,并用简明精神病评定量表(BPRS)观察两组患者的预后。结果研究组进行生活技能训练1个月后与对照组比较,经统计学分析,均p<0.01,差异有统计学意义。结论对流浪精神分裂症患者入院后实施早期生活技能训练有助于提高其生活自理能力,改善其精神症状,促进其预后。     

Impact of travel distance on the disposition of patients presenting for emergency psychiatric care

For veterans presenting for emergency psychiatric care, this research tested the hypothesis that patients with poor geographic accessibility to ambulatory mental health services would be more likely to be hospitalized. Logistic regression results indicated that distant patients (>60 miles) were 4.8 times more likely (p<.05) to be admitted for acute psychiatric treatment than were proximal patients (<60 miles), controlling for clinical and demographic case-mix factors. This finding suggests that the Department of Veterans Affairs might be less effective in its effort to substitute intensive out-patient care in place of expensive inpatient treatment for rural veterans with emergent mental health problems.     

Smoking and suicidality among adolescent psychiatric patients.

PURPOSE: To investigate the relationship between smoking and suicidality among adolescent psychiatric patients in Finland. METHODS: Data from 157 patients (aged 12-17 years) admitted to inpatient psychiatric hospitalization between April 2001 and July 2002 were collected. Logistic regression analyses were used to examine the association between regular daily smoking and suicidality. The data were adjusted for several sociodemographic and clinical characteristics. RESULTS: The results showed over four-fold risk for definite and/or life-threatening suicide attempts among smoking adolescents in inpatient psychiatric facility compared with nonsmoking ones (OR 4.33, 95% CI 1.23-15.20). Also, the smoking adolescents had three times greater risk for occasional (OR 3.32, 95% CI 1.09-10.10) or frequent (OR 3.00, 95% CI 1.08-10.10) self-mutilation. Suicidality was more common among girls than boys and among those adolescents who suffered from depression. CONCLUSIONS: Among teens hospitalized for psychiatric illnesses, daily smoking was significantly related to suicide attempts and self-mutilation, even after controlling for several confounding factors, including psychiatric diagnosis.     

Hospitalized younger: a comparison of a national sample of homeless and housed inpatient veterans

BACKGROUND: Homelessness is associated with high rates of hospitalizations and age-adjusted mortality. Few studies have examined whether homeless people are admitted to the hospital at an earlier age than the general population or for different diagnoses. METHODS: We compared the age at admission and the primary discharge diagnoses in a national sample of 43,868 hospitalized veterans. RESULTS: The difference in median age between homeless and housed inpatients ranged from 10-18 years for medical-surgical diagnoses and 3-4 years for psychiatric and substance abuse diagnoses (p#.005 for all diagnoses). Homeless veterans were more likely to have been admitted for psychiatric and substance abuse diagnoses (79.9%), compared with housed veterans (29.1%). CONCLUSIONS: Substance abuse and psychiatric illness account for the majority of admissions among homeless veterans. Among all diagnostic groups, homeless people were admitted at younger ages. Our findings suggest that homeless people have either a more rapid disease course, leading to earlier morbidity, or lower admission threshholds sufficient to generate hospital admission.     

Psychotic inpatients' social class and their first admission to state or private psychiatric Baltimore hospitals.

Social class differences were investigated among patients admitted to public and private psychiatric hospitals. Participants included first admission White psychotic men admitted to Baltimore metropolitan area hospitals between 1983 and 1989. After adjusting for age and diagnosis, patients with low levels of skills/credentials were found to be more likely than patients with higher levels to be admitted to state psychiatric hospitals. These findings underscore the persistence of social class as a determinant of differences in the use of psychiatric care.     

Vitamin B12 and folate serum levels in newly admitted psychiatric patients

BACKGROUND & AIMS: Deficiencies of cobalamin and folate may play a causal role in the development or exacerbation of psychiatric illnesses. We compared cobalamin and folate levels in newly admitted psychiatric patients to mentally healthy controls and assessed their correlation with various psychiatric conditions. METHODS: All patients consecutively admitted to a psychiatric hospital were examined for serum cobalamin and folate levels. Controls were obtained from a population with no known mental illness. Values were considered to be below normal if cobalamin was <223 pg/ml and folate <3.1 ng/ml. RESULTS: The 224 newly admitted patients did not differ significantly from controls, both with regard to the mean cobalamin level and to the prevalence of lower than normal levels. About 30% of patients had low folate values compared to 2.5% in the control group (P<0.0001). Mean folate level in controls was significantly higher than in patients (P<0.0001), where a positive correlation was found between low folate levels and depression. CONCLUSIONS: The results of our study suggest that folate levels be assessed in patients admitted to psychiatric wards, especially in those with depression. Further study is needed to evaluate the role of folate and cobalamin in psychiatric illness.     

Psychiatric hospitalizations in a cohort of Danish polio patients

Although previous polio infection remains a considerable cause of long-term morbidity worldwide, few studies have examined the psychiatric consequences of poliomyelitis. The authors followed 4,660 polio patients hospitalized at the primary infectious disease hospital in Copenhagen, Denmark, between 1922 and 1954 as well as 19,017 age- and gender-matched Danes for psychiatric hospitalizations from January 1, 1977, to December 31, 1993. Incidence rates of all psychiatric disorders combined and of separate diagnostic groups of psychiatric diseases in the two cohorts were compared, yielding the incidence rate ratio, a measure of relative risk. Overall, polio patients had a 40% increased risk of being hospitalized for a psychiatric disorder (incidence rate ratio = 1.43, 95% confidence interval: 1.23, 1.66). Apparently, the overall increased risk of psychiatric hospitalizations could not be confined to specific groups of psychiatric disorders but seemed to be explained by slightly increased risks of several different disorders, especially milder psychiatric disorders. Finally, psychiatric morbidity did not differ between paralytic and nonparalytic polio patients. History of hospitalization for polio might be associated with subsequent risk of hospitalization for psychiatric disorders. The underlying mechanism for this association remains uncertain.     

Treatment patterns for schizophrenia in psychiatric hospitals

This paper analyzes the patterns of clinical treatments prescribed to patients diagnosed with schizophrenia who were admitted to state and county mental hospitals, private for-profit psychiatric hospitals, and private nonprofit psychiatric hospitals in July 1980. Treatment patterns were specified by examining the distribution of treatment types provided to patients over a 3-month period through standard tabular arrays and matrix analysis that holds constant the number of treatment types received by the patients. Data for this study are based on nationwide patient sample surveys and facility enumerations conducted in 1980 by the Survey and Reports Branch, National Institute of Mental Health. Clear differences and similarities emerged among the three types of hospitals in terms of the number and type of treatments provided to patients with schizophrenia. In general, patients with schizophrenia admitted to private psychiatric hospitals received a more comprehensive care regimen (generally inclusive of individual therapy) than similarly diagnosed patients admitted to state and county mental hospitals; private nonprofit psychiatric hospitals had marginally discernible treatment patterns from private for-profit psychiatric hospitals, especially with respect to assignment of group and self-care skill training.     

Community orientated treatment compared to psychiatric hospital orientated treatment

One hundred and twenty patients presenting for admission to a state psychiatric hospital were randomly allocated into two groups. Control patients received standard hospital care and after-care. Experimental patients were not admitted if this could be avoided; instead they and their relatives were provided with comprehensive community treatment and a 24-hour crisis service. Patients with a primary diagnosis of alcohol or drug dependence, organic brain disorder or mental retardation were excluded. Most patients were suffering from psychotic disorders—more than half specifically from schizophrenia. During the 12 months study period 96% of the control patients were admitted—51% more than once. Of the experimental patients 60% were not admitted at all and only 8% were admitted more than once. Control patients spent an average of 53.5 days in psychiatric hospital, experimental patients spent an average of 8.4 days. Community treatment did not increase the burden upon the community, was considered to be significantly more satisfactory and helpful by patients and their relatives, achieved a clinically superior outcome, and cost less than standard care and after-care. The ingredients differentiating comprehensive community-based care from prevailing methods of psychiatric care are discussed.