司法精神医学鉴定案例性别差异分析

目的了解司法精神医学鉴定中的性别差异。方法回顾性调查我院1996~2000年5年间全部鉴定案例共283例,对鉴定中的性别差异进行分析。结果案例的数量、婚姻、文化程度、案件性质、鉴定诊断、责任能力等方面,男女间均有显著性差异。结论精神医学司法鉴定案例有明显性别差异。     

司法精神医学鉴定无精神病171例分析

目的探索司法精神鉴定诊断为无精神病案例的特点。方法对171例司法精神医学鉴定中被诊断为“无精神病”的鉴定案例资料进行回顾性分析。结果无精神病案例占鉴定总数的26.80%,被鉴定人作案动机明确,自我保护良好,“精神症状”及提出鉴定的理由有一定的特点。结论多因素综合分析有助于无精神病案例的司法鉴定。     

不同时期精神疾病司法鉴定案例比较

目的探讨我院不同时期所进行的精神疾病司法鉴定案例特点。方法对我院1987年-1996年司法鉴定的292例(A组)与1997年-2003年鉴定的1097例(B组)案例,按鉴定类型、疾病种类、犯罪类型等进行对照分析。结果责任能力、受审能力、申办户口等的例数显著增多,性防卫能力、服刑能力鉴定例数显著减少且评定标准趋严;在责任能力鉴定中,精神正常者、精神发育迟滞(MR)患者的比例显著增多,应激障碍者显著下降;MR和癫痫所致精神障碍的责任能力评定明显趋严。强奸犯罪的亦显著改变。结论应加强对司法精神病学,尤其是责任能力评定的研究,以便更加规范、客观。     

精神损伤司法鉴定特点分析

为探讨精神损伤的司法鉴定特点，分析了10例精神损伤案例的司法鉴定资料。结果，精神损伤既涉及到损伤原因，损伤性质，损伤程度，伤病关系和赔偿等一系列司法精神医学问题，也涉及到一系列复杂的社会关系问题，因此鉴定工作复杂。提示，应加强普法教育及精神卫生普及，尽快制订精神损伤鉴定标准，对精神损伤应尽快送鉴和及早结案，以免精神障碍迁延。     

1979～1998年司法精神病鉴定案例的分析

目的 探讨１９７９～１９９８年司法精神病鉴定变化的特点。方法 以１９８９年《精神疾病司法鉴定暂行规定》颁布为界,对１９７９～１９９８年经南京医科大学附属南京脑科医院司法精神鉴定的１ ８９４例案例,进行前后１０年「１９７９～１９８８（１９７９～１９８８年组,５４９例）及１９８９～１９９８年（１９８９～１９９８年组,１ ３４５例）」的比较。结果 （１）刑事责任能力鉴定减少（１９７９～１９９８年组和１９     

232例司法精神医学鉴定为无精神病的凶杀案例分析

目的：探索司法精神医学鉴定诊断为无精神病凶杀案例的特点。方法：对232例司法精神医学鉴定中被诊断为“无精神病”的凶杀案例资料进行回顾性分析。结果：无精神病占凶杀案例鉴定总数的69．9％,被鉴定人作案动机明确,自我保护良好,“精神症状”及提出鉴定的理由有一定的特点。结论：掌握精神疾病患者与精神正常者不同的作案规律和特征,多因素综合分析有助于凶杀案无精神病的司法鉴定。     

精神发育迟滞性被害人司法鉴定（附12例案例分析）

精神发育迟滞性被害人司法鉴定（附１２例案例分析）瞿金达，徐声汉在司法精神病鉴定案例中，被害人遭到性侵犯占有相当比例，精神发育迟滞在此类案件中居首位．据郑氏报导ｌ’ｌ，ｌｏｐ年至１９８６年上海市精神卫生中心司法鉴定案例中本症性被害案占年性被害案的Ｍ．Ｚ...     

精神病司法鉴定中威斯康星卡片分类测验结果对照分析

目的 初步探讨精神病司法鉴定中威斯康星卡片分类测验（WCST）的应用。方法 将我院2004～2005年鉴定中的刑事案例，分成具有精神病诊断的研究组54例和正常组32例，收集一般资料，完成WCST，并对数据进行统计学处理。结果 两组WCST结果不存在显著性差异；研究组中的精神分裂症患者与正常组无显著性差异；研究组中完全责任者、限定责任者、无责任者之间WCST结果的两两比较也不存在显著性差异。结论 WCST结果受多种因素影响，在精神病司法鉴定中，WCST的运用有待进一步研究。     

精神病司法鉴定中无精神病者暴力犯罪对照分析

目的探讨精神病司法鉴定中无精神病者暴力犯罪的特点。方法将我院2003～2008年鉴定中的无精神病案例,分成暴力犯罪组和非暴力犯罪组,调查一般人口学、提请鉴定方面、犯罪学特征、精神检查等方面的资料,并对数据进行统计学检验。结果两组在年龄、性别、自己强调有精神病、前科次数、犯罪诱因、犯罪动机、犯罪后表现、拘禁反应的发生比例等方面存在显著性差异,其他方面差异无统计学意义。结论应加强对既往资料、犯罪学特点等多方面的分析,以提高精神病司法鉴定的准确性．     

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。     

Influences of Prolonged Bed Rest and Cognitive Impairment on Nursing Home Residents

Abstract: Seventy nursing home residents with and 87 without cerebrovascular diseases (CVD) were examined by the modified Stockton Geriatric Rating Scale (modified SGRS) which measures four aspects of impairments; physical disability, socially irritating behavior, communication failure and apathy. They were divided into 3 subgroups according to walking ability; prolonged bed rest, walking with aids and walking by themselves in both groups. Physical disability of mental decline was significantly aggravated more than that of normal intelligence in all the subgroups. Although communication failure and apathy of mental decline had deteriorated more than those of normal intelligence in prolonged bed rest in residents without CVD, apathy of the former had deteriorated more than that of the latter in walking by themselves in residents with CVD.     

苯妥英钠对癫痫儿童牙齿生长 发育影响的研究

目的观察长期苯妥英钠（ＤＰＨ）治疗对癫痫儿童牙齿生长发育的影响。方法把１８８例长期单服ＤＰＨ的患者按开始服的年龄分为乳牙组（Ａ组），换牙组（Ｂ组）及恒牙组（Ｃ组）。比较三组牙齿的色泽、排列、形状、乳牙滞留、恒牙萌出异常以及与齿龈增生的关系。结果三组牙异常发生率分别为３７２１％、３３３３％及８３３％，Ａ、Ｂ组明显高于Ｃ组；Ａ组较Ｂ组严重，但两组间无统计学意义的差异。１１例停药后随访３年以上，未见明显改善。结论换牙前接受ＤＰＨ治疗，牙的生长发育将会受到影响，并对牙齿带来难以逆转的影响，因此对儿童选用ＤＰＨ时应十分慎重。     

Neurological deficit and cerebral infarction after temporary middle cerebral artery occlusion in unanesthetized cats

Forty-four unanesthetized cats underwent temporary middle cerebral artery (MCA) occlusion with an implanted, externally controlled balloon cuff occluder. The occlusion was reversed to allow reperfusion of the MCA after 2 min to 24 hr of ischemia. Fourteen cats had temporary occlusions lasting 2 min to 3 hr; their neurological deficits improved or resolved after reperfusion, and brain sections showed only scattered microscopic areas of necrosis. After a 4-hr occlusion, five of nine cats (55%) recovered completely within 24 hr; two had persistent deficit when sacrificed, 10 days later, and each had a circumscribed infarct. All 18 cats undergoing 5-, 6-, 8-, and 24-hr occlusions sustained permanent neurological deficits. Three 3-hr occlusions at 2-day intervals in three cats resulted in permanent deficits and infarcts that were 25% larger than those after single 8-hr occlusions. Ten cats underwent permanent MCA occlusion; three deteriorated neurologically and died, and the survivors showed no improvement. Infarcts after 5-, 6-, and 8-hr occlusions followed by reperfusion were 66% smaller (p less than 0.05) than those after permanent occlusion; reperfusion after 24 hr of occlusion did not reduce infarct size. Hemorrhagic infarction occurred after two permanent occlusions, but after only one 5-hr temporary occlusion. The results obtained with this method of temporary regional ischemia indicate that restoration of flow after 1-8 hr, but not after 24 hr, of MCA occlusion resulted in less severe neurological deficit and smaller infarcts than did permanent occlusion. The infarct size correlated with the duration of MCA occlusion (p less than 0.05) rather than with the degree of deficit during occlusion.     

Edema, cation content, and ATPase activity after middle cerebral artery occlusion in rats.

BACKGROUND AND PURPOSE: Reduction of cerebral blood flow results in several acute metabolic disturbances, including a reduction in Na,K-ATPase activity. The relation between this reduction and the onset of edema is unknown, as is the effect of restoration of blood flow. Therefore, we investigated the role of decreased Na,K-ATPase activity in the pathogenesis and time course of ischemic brain edema and reperfusion. METHODS: The middle cerebral arteries of rats were occluded by cannulation with a nylon suture for 30, 60, 120, or 240 minutes. The animals were then decapitated (permanent occlusion) or the suture was withdrawn to allow 24 hours of reperfusion before decapitation (temporary occlusion). Na,K-ATPase activity and Na+, K+ and water contents were measured at various intervals. RESULTS: In the ischemic hemisphere, Na,K-ATPase activity was significantly decreased at 30, 60, 120, and 240 minutes of permanent occlusion (p less than 0.05). There was also a significant decrease in rats subjected to 60 or 120 minutes of temporary occlusion followed by 24 hours of reperfusion. Water content increased after 60, 120, or 240 minutes of permanent occlusion (p less than 0.01); after 24 hours of reperfusion, water content remained elevated (p less than 0.01). The Na+ content increased after both permanent and temporary occlusion, and the K+ content decreased only after permanent occlusion. Increases in water content correlated with decreases in Na,K-ATPase activity after temporary occlusion and with the Na+:K+ ratio after permanent occlusion. CONCLUSION: Reduction in Na,K-ATPase activity resulting in disruption of cellular ionic homeostasis may account for early development of cytotoxic brain edema after permanent occlusion of the middle cerebral artery. Such edema is also present 24 hours after 60 and 120 but not 30 minutes of temporary occlusion.     

中国四城市社区居民卒中知识水平相关因素分析

目的 调查中国四城市社区居民卒中知识水平,分析其知识水平的相关因素。方法 在北京、上海、长沙及成都四城市各选择两个社区,在两个社区内以户为单位采用系统抽样方法,每个社区至少选择300户居民,每户确定一人填写自行设计的调查问卷。调查前统一培训社区医生,调查问卷由社区医生入户填写完成。调查问卷内容包括：①接受调查者的一般资料：性别、年龄、文化程度等;②卒中相关知识：卒中危险因素、高血压及糖尿病的治疗、卒中的早期症状、发生卒中症状后如何就诊,以及获得卒中知识来源等。结果 共完成2519份调查问卷。①社区居民对卒中危险因素的知晓率为44.2%～87.7%,对常见卒中症状的知晓率为58.2%～80.2%;②社区居民希望获取卒中知识的主要途径为医生讲解的健康大课堂（77.7%）、电视（73.1%）、报纸（59.6%）、宣传短片（43.6%）、杂志（39.2%）;③社区居民卒中知识积分与其文化程度正相关（rs =0.114,P <0.001）,与年龄呈负相关（rs =-0.152,P <0.001）;④女性的卒中知识水平高于男性（P <0.001）。结论 本研究所调查的中国四城市社区居民对卒中相关知识认知不足,需要给予健康教育。加强教育目标人群主要为高龄、低文化程度、男性及卒中风险高危的居民。教育途径主要应集中在医生（包括社区医生）举办的健康大课堂、电视及报纸等。     

A Study of Common Carotid Arterial Blood Flow Volume of Nursing Home Residents

Abstract: Ninety-seven nursing home residents were divided into 2 groups according to whether they had had an episode of stroke or not. Each group was classifled into 3 subgroups: prolonged bed rest, walking with aids or walking by themselves. They were investigated for both the carotid blood flow volume and the modifled Stockton geriatric rating scale (SGRS), In chronic stroke residents, the total blood flow volume of prolonged bed rest residents was lower than that who can walk by themselves. In residents without stroke, the total blood flow volume of prolonged bed rest residents was lower than the other 2 subgroups. The total blood flow volume was significantly correlated with the scores of 3 : factors of the modifled SGRS.     

Successful Long‐Term Outcomes of Spinal Cord Stimulation Despite Limited Pain Relief During Temporary Trialing

Objectives. In spinal cord stimulation (SCS) therapy, limited pain relief during the temporary trial period is generally considered to be predictive of poor long‐term benefit. To validate or refute this perception, the long‐term outcomes of subjects who reported less than 50% pain relief during a temporary SCS trial were examined. Materials and Methods. Twelve subjects with intractable pain underwent implantation of trial SCS systems. After a trial period in which they reported less than 50% pain relief, they each received a permanent SCS implant. Pain ratings and complications were tracked for 6–18 months. Results. At the end of the temporary trial period, the average pain relief was 21%; no subject reported 50% or better pain relief. More favorable outcomes were reported after activation of the permanent system, however. At all follow‐up time points, at least a third of the subjects reported better than 50% pain relief, and the average pain relief varied over time between 44% and 83%. All complications were readily resolved and no subjects withdrew from the study. Conclusions. Although SCS provided limited pain relief during the trial period, efficacy was more satisfactory after permanent implantation. Several subjects went on to experience nearly complete pain relief for up to 18 months (the maximum follow‐up visit for study purposes), and no subject chose to discontinue SCS therapy. SCS appears to be a viable treatment option for patients who fail trials, raising some doubt as to the predictive sensitivity and specificity of the trial period. Thus, although outcome of a temporary trial period may be suggestive of later efficacy with SCS, it may not be the sole predictor of success. Alternatively, the arbitrary benchmark of 50% pain relief that is typically used to define the success of a temporary trial may be too stringent and unreliable.     

Wandering behavior in veterans with psychiatric diagnoses residing in nursing homes

OBJECTIVE: To investigate nursing home residents with psychiatric diagnoses who wander and who are not diagnosed with dementia. METHOD: A national cross-sectional study was conducted in a male Veterans Administration Nursing Home Care Unit population using a retrospective review of the MDS. RESULTS: Eleven thousand six hundred and nineteen residents were identified as having a psychiatric diagnosis without significant cognitive impairment; just under 1% (n = 113) wandered. Using rare events logit regression, we determined that a diagnosis of schizophrenia/bipolar disorder or comorbid psychiatric conditions were associated with increased risk of wandering compared to residents diagnosed with anxiety/depression. Psychiatric wanderers were also more likely to, have symptoms of delirium, exhibit socially inappropriate behavior, manifest problems in decision-making, take anti-psychotic medications, and to be more independent in locomotion. CONCLUSIONS: Psychiatric wanderers may be conceptualized better as exhibiting ambulatory concomitants of unremitted neurological/psychiatric symptoms or medication side effects of their treatment. Findings have implications for addressing treatable causes of wandering.     

Prediction of stroke before and after unilateral occlusion of the common carotid artery in gerbils

A method was developed to predict the severity of cerebral ischemia before permanent occlusion of a common carotid artery in gerbils by observing the diameter and appearance of the artery after temporary occlusion and observing clinical signs after permanent occlusion. The severity of cerebral ischemia was confirmed by a sensitive immunohistochemical method and measurement of focal cerebral blood flow after 30 minutes' ischemia. All gerbils with greater than 40% reduction of the diameter and a white arterial margin distal to temporary occlusion developed severe neurologic signs following permanent occlusion, but no gerbils with reduction of less than 30% and a red arterial margin developed neurologic signs. With the cumulative neurologic score, gerbils could be divided into classes with no, mild, moderate, and severe symptoms, mostly after 10 minutes. Severely symptomatic gerbils were identified in 3 minutes. Extensive ischemic damage was observed in severely symptomatic gerbils, but no immunohistochemical lesion was detected in mildly symptomatic gerbils. Cerebral blood flow was markedly reduced in severely symptomatic gerbils but more selectively reduced in the cortical structures of moderately symptomatic gerbils. This prediction method is useful for investigating early cerebral ischemia and for evaluating the effectiveness of pharmacologic agents.     

Suicide Risk Assessments: Which Suicide Risk Factors Psychiatric Residents Consider Significant?

Objective

Patients visiting the emergency department (ED) after a suicide attempt are generally assessed for suicide risk by psychiatric residents. Psychiatric residents'' competence in evaluating the risk posed by the patients who attempted suicide is critical to preventing suicide.

Methods

We investigated factors considered important by psychiatric residents when evaluating suicide risk. This study included 140 patients admitted to the ED after attempting suicide. Psychiatric residents rated patients'' severity of current and future suicide risk as low/moderate/high using the Brief Emergency Room Suicide Risk Assessment (BESRA). The association between each BESRA variable and level of suicide risk was analyzed.

Results

Many factors were commonly considered important in evaluating the severity of current and future suicide risk. However, the following factors were only associated with future suicide risk: female gender, having no religion, family psychiatric history, history of axis I disorders, having a will, harboring no regrets, and social isolation.

Conclusion

Psychiatric residents use diverse factors when assessing suicide risk. Psychiatric residents might put more emphasis on non-modifiable demographic and clinical factors, concrete evidence showing suicide determination, and social isolation to assess the risk of future suicide.