精神分裂症患者凶杀行为多因素分析

目的探讨精神分裂症患者凶杀行为的影响因素。方法应用人口学资料、阳性与阴性症状量表（PANSS）、明尼苏达多相人格调查表（MMPI）、生活事件量表（LES）和社会支持评定量表（SSRs）等对31例具有凶杀行为的精神分裂症患者和50例无凶杀行为的患者进行对照研究。结果两组的PANSS量表阳性症状量表分、阴性症状量表分、MMPI的D（抑郁）、Hy（癔病）、Pd（人格偏移）,Mf（男性化和女性化）、Pa（偏执）、Pt（精神衰弱）、Sc（精神分裂症）、Si（社会内向性）量表分、负性事件刺激量、客观支持量表分等项目得分的差异,有统计学显著意义。多因素分析中,阴性症状,客观支持,D,Mf,Pt,sc进入回归方程。结论本研究提示负性事件、阴性症状、客观支持、D、Mf、Pt、Sc与精神分裂症患者凶杀行为有关联,可作为其预测因子。     

攻击性精神分裂症患者MMPI对照研究

本研究采用病例对照研究方法，使用MMPI对150例有攻击行为和150例没有攻击行为的精神分裂症患者进行研究。结果发现，攻击性精神分裂症患者具有控制力差和过度控制两类人格特征．MMPI的Pb，Re分量表对精神分裂症患者的攻击行为有一定预测价值。     

精神分裂症患者攻击行为的预测

试图对精神分裂症患者的攻击行为进行预测，采用病例对照研究方法，主要从人格特征、智力结构、脑电图、社会支持和早年不良家庭环境等方面，研究１５０例精神分裂症患者攻击行为的相关因素，并试图对患者的攻击行为进行预测。结果显示，既往攻击行为史、社会支持少、悲观抑郁、早年不良家庭环境、脑电图异常、明尼苏达多项人格调查表社会责任感量表分低，是本组精神分裂症患者攻击行为的主要预测因子。因此制定了一个有２１个条目的攻击行为预测表，其预测准确性达９０．３％，有一定预测效度。     

住院精神分裂症患者攻击行为的相关因素研究

目的 分析住院精神分裂症患者攻击行为的特征及相关因素，以利防范。方法 采用自制调查表和父母养育方式评价量表（EMBU）调查住院精神分裂症患者235例，以有攻击行为的52例为研究组，无攻击行为的183例为对照组。结果 两组在年龄、文化程度、既往攻击行为史、自知力、幻觉妄想、脑电图和地形图方面有显著性差异。有攻击行为的精神分裂症患者，父母养育方式中的惩罚严厉、过分干涉、过度保护、拒绝否认因子分显著高于对照组。结论 住院精神分裂症患者发生攻击行为的相关因素是多方面的，应了解精神分裂症患者发生攻击行为的各种可能因素，对重点病人采取及时有效的药物治疗和心理疏导，并加强精神科监护，以减少精神分裂症患者攻击行为的发生。     

男性新入院精神分裂症患者攻击行为相关因素分析

目的了解精神分裂症攻击行为的相关因素,以加强防范。方法应用简明精神病量表(BPRS)及一般资料分析对45例(观察组)有攻击性行为的精神分裂症患者和92例(对照组)无攻击性行为的精神分裂症患者进行临床对照研究。结果攻击行为的发生率为32.85%,一般资料显示:年龄低、受教育年限低,从事体力劳动,性格外向,家族史阳性,既往有攻击史是精神分裂症攻击行为的特点和易感因素(P<0.01 P<0.05)观察组BPRS中敌对猜疑、激惹性思维障碍、行为紊乱因子分显著高于对照组(P<0.05 P<0.01)。结论年龄低,受教育年限低,从事体力劳动,性格外向,阳性家族史,既往有攻击行为,敌对猜疑,易激惹,思维障碍,行为紊乱等可能是精神分裂症患者攻击行为的危险因素,早期识别,并进行有效的干预,可预防和减少其攻击行为的发生。     

男性住院精神分裂症患者的攻击行为特征研究

背景：精神分裂症等重性精神障碍患者攻击行为发生率高于普通人群,相关因素的探讨对于该人群攻击行为的预防和干预有重要意义。
　　目的：了解某综合医院精神科男性住院精神分裂症患者的攻击行为特征。
　　方法：采用连续取样法,收集了75例自2015年8月至2016年2月在中南大学湘雅二医院精神科男病房住院的精神分裂症患者。使用自编的一般情况调查问卷、修订版外显攻击行为量表（MOAS）、暴力历史、临床、风险评估量表（HCR-20）、精神病态清单（PCL-R）、阳性与阴性症状量表（PANSS）在入院后3天内对患者进行评估。根据MOAS各项的得分,将研究对象分为攻击组（39例）和非攻击组（36例）,比较两组间在社会人口学特征以及各个评估工具上得分的差异。
　　结果：HCR-20中的H1（既往暴力事件）、H2（年轻时的暴力事件）、H10（既往不服从管教）、C4（冲动性）, PCL-R的反社会因子,PANSS的激活性症状群、偏执症状群、抑郁症状群在攻击组得分高于非攻击组,且差异有统计学显著性。
　　结论：有暴力行为史,既往不服管教,具有反社会人格特征,表现冲动,伴有焦虑抑郁情绪可能是男性住院精神分裂症患者发生攻击行为的相关因素。     

男性住院精神分裂症患者的攻击行为特征研究（英文）

背景:精神分裂症等重性精神障碍患者攻击行为发生率高于普通人群,相关因素的探讨对于该人群攻击行为的预防和干预有重要意义。目的:了解某综合医院精神科男性住院精神分裂症患者的攻击行为特征。方法:采用连续取样法,收集了75例自2015年8月至2016年2月在中南大学湘雅二医院精神科男病房住院的精神分裂症患者。使用自编的一般情况调查问卷、修订版外显攻击行为量表(MOAS)、暴力历史、临床、风险评估量表(HCR-20)、精神病态清单(PCL-R)、阳性与阴性症状量表(PANSS)在入院后3天内对患者进行评估。根据MOAS各项的得分,将研究对象分为攻击组(39例)和非攻击组(36例),比较两组间在社会人口学特征以及各个评估工具上得分的差异。结果:HCR-20中的H1(既往暴力事件)、H2(年轻时的暴力事件)、H10(既往不服从管教)、C4(冲动性),PCL-R的反社会因子,PANSS的激活性症状群、偏执症状群、抑郁症状群在攻击组得分高于非攻击组,且差异有统计学显著性。结论:有暴力行为史,既往不服管教,具有反社会人格特征,表现冲动,伴有焦虑抑郁情绪可能是男性住院精神分裂症患者发生攻击行为的相关因素。     

青年精神分裂症患者攻击行为的预测因素

目的探讨青年精神分裂症患者社会支持、自我效能、临床症状以及执行功能与攻击行为的关系。方法随机抽取 16~44岁的精神分裂症患者 107例,评估其一般资料、社会支持、自我效能、临床症状,采用箭头测验检测执行功能,并于首次检测 6个月后再次检测其外显攻击行为,比较 6个月后有攻击行为的患者与无攻击行为患者首次检测时的相关资料,并分析患者 6个月后攻击行为的预测因素。结果无攻击行为组患者的客观支持、主观支持高于攻击行为组,阳性症状、一般病理症状得分、箭头测验 2干扰分（AT-2-I）低于攻击行为组（P＜ 0.05）,青年精神分裂症患者的客观支持、阳性症状、抑制功能可预测其 6个月后的攻击行为。结论青年精神分裂症患者的客观支持、阳性症状、抑制功能是其 6个月后的攻击行为的预测因素。     

精神分裂症患者攻击行为相关因素分析

目的:探讨精神分裂症患者发生攻击行为的相关因素及预测因子。方法:将132例精神分裂症患者按修改版外显攻击行为量表(MOAS)得分分为伴攻击行为(研究组)64例和不伴攻击行为(对照组)68例,分别进行一般人口学资料、阳性和阴性症状量表(PANSS)及气质性格问卷(TCI)的测定。结果:一般人口学资料中既往攻击行为史两组间差异有统计学意义(P=0.001)。PANSS分量表中阳性症状分、思维障碍、激活性及偏执条目分值研究组明显高于对照组(t=-6.90,t=-3.41,t=-4.43,t=-4.40;P均≤0.001)。TCI各维度中寻求新奇得分(t=-6.74)研究组高于对照组,合作性、自我定向得分低于对照组(t=3.42,t=5.96;P均≤0.001)。Logistic回归分析显示,寻求新奇、阳性症状和合作性对攻击行为的发生有预测意义(P0.05或P0.01)。结论:精神分裂症患者的阳性症状、思维障碍、激活性及偏执是引起攻击行为的重要因素;寻求新奇和低合作性可较好地预测患者的攻击行为。     

精神分裂症攻击行为的对照研究

为了探讨精神分裂症攻击行为的相关因素，对４３例有攻击行为的精神分裂症患者和８２例无攻击行为的精神分裂症患者进行了对照研究。结果显示：既往暴力史，ＥＰＱ—Ｎ分，ＢＰＲＳ的思维障碍、敌对猜疑和激活性三个因子，以及命令性幻听和被害妄想等精神症状是精神分裂症患者攻击行为的主要危险因素。提示这些危险因素对精神分裂症攻击行为具有预测价值     

精神分裂症患者攻击行为与单胺氧化酶A、色氨酸羟化酶基因多态性的关联研究

目的探讨精神分裂症患者攻击行为与单胺氧化酶A(MAOA)、色氨酸羟化酶(TPH)基因多态性的相关性。方法参照ICD-10诊断标准,选取212例精神分裂症患者,应用修订版外显攻击行为量表(MOAS)进行评定,98例MOAS加权总分≥4分者纳入有攻击行为组(研究组),114例MOAS加权总分0分者为无攻击行为组(对照组)。采用聚合酶链式反应扩增及限制性片段长度多态性技术检测单胺氧化酶A基因、色氨酸羟化酶基因多态性,与精神分裂症患者攻击行为进行关联分析。结果 MAOA、TPH基因型频率和等位基因频率在有攻击行为患者组与无攻击行为患者组比较无显著差异(P0.05)。结论单胺氧化酶A、色氨酸羟化酶基因多态性与精神分裂症患者攻击行为无关联。     

精神分裂症患者冲动伤人与其冲动性人格特征及相关因素的研究

目的探讨住院精神分裂症患者冲动伤人行为的发生率及患者的冲动性人格特点等相关因素。方法对195例住院精神分裂症患者冲动伤人行为进行调查,并用攻击性量表、冲动性量表和阳性与阴性症状量表对其行为特征及症状进行评定。结果195例精神分裂症患者住院前56例（28．72％）有冲动伤人行为,住院期间20例（10．26％）有冲动伤人行为。分析显示,有冲动行为患者的冲动性量表中行为分量表评分和攻击性量表总分及身体攻击性、指向自我的攻击性两因子分均明显高于无冲动行为患者（P〈0．05）。两组患者PANSS量表总分及因子分差异不显著。冲动性量表和攻击性量表总分及因子分与PANSS量表总分及因子分相关性不显著。结论精神分裂症患者冲动行为发生主要与其冲动性和攻击性人格特点有关,与患者精神病性症状直接关系不显著。     

Lack of association between brain-derived neurotrophic factor Val66Met polymorphism and aggressive behavior in schizophrenia

We investigated the association of the Val66Met gene polymorphism in the Brain-Derived Neurotrophic Factor (BDNF) gene with aggressive behavior among Southern Han Chinese schizophrenia patients. We used polymerase chain reaction-restriction fragment length polymorphism to determine the genotypes and the Modified Overt Aggression Scale (MOAS) to measure aggressive behavior. No significant differences in genotype or allele distribution of Val66Met were identified between aggressive and non-aggressive schizophrenia patients.     

Association study of MAO-A and DRD4 genes in schizophrenic patients with aggressive behavior

Genes involved in dopamine neurotransmission are interesting candidates to be analyzed in schizophrenia and aggressive behavior. Therefore, we analyzed the functional polymorphisms of the dopamine receptor D4 (DRD4) and monoamine oxidase A (MAO-A) genes in a sample of 71 schizophrenic patients assessed with the Overt Aggression Scale to measure aggressive behavior. CLUMP analysis of the DRD4 48-bp repeat-exon III polymorphism in schizophrenic patients showed significant differences between the aggressive behavior and the nonaggressive groups (T1 = 18.77, d.f. = 6, p = 0.0046; T3 = 6.54, p = 0.0195). However, analysis of the promoter polymorphism of the MAO-A gene revealed no significant association between aggressive and nonaggressive patients. Finally, analysis of Overt Aggression Scale dimensions exhibited significant differences for the DRD4 and MAO-A genes. Our preliminary findings suggest that the DRD4 and MAO-A genes may be involved in aggressive schizophrenic patients.     

The relationship of crowding and aggressive behavior on a psychiatric intensive care unit.

During a 25-week period, all incidents of aggressive behavior in a 19-bed psychiatric acute care unit were systematically recorded using the Staff Observation Aggression Scale. Forty-seven of the 163 patients admitted to the unit were aggressive on 119 occasions. Of these incidents, 100 were physical attacks on another person, and 95 were perpetrated by 23 patients. The patients were predominantly aggressive without visible provocation or were provoked by staff's denying a request. An increased number of patients on the ward significantly increased the likelihood of aggressive behavior, especially by patients with schizophrenia or schizophreniform disorder.     

Self-perceived needs are related to violent behavior among schizophrenia outpatients

This study assessed the relationship between self-perceived clinical and social needs and aggressive behavior in outpatients with schizophrenia. A total of 895 outpatients with schizophrenia were enrolled. The presence of aggressive episodes was assessed using the Modified Overt Aggression Scale. Self-perceived needs were assessed using the Camberwell Assessment of Need in six areas of needs (food, household skills, self-care, daytime activities, psychotic symptoms, satisfaction with treatment, and company). The most common areas of needs were "psychotic symptoms" (81.6%), "daytime activities" (60.6%), and "household skills" (57.5%). More needs were expressed by patients who had more severe illnesses (p < 0.001) and more aggressive behavior (p < 0.001). Multivariate analysis showed that, in schizophrenia outpatients, self-perceived needs were associated with aggressive behavior (adjusted odds ratio, 11.43; 95% confidence interval, 5.11 to 25.56). Appropriate compliance with antipsychotic treatment was related with lower aggressive behavior (p < 0.001).     

精神分裂症患者攻击行为与临床症状、记忆及智力的相关性

目的探讨精神分裂症患者攻击行为与临床症状、记忆及智力的相关性,分析临床症状、记忆及智力能否作为精神分裂症患者攻击行为的预测因子。方法以2014年5月-2016年5月在中山市第三人民医院早期干预科住院的符合《国际疾病分类(第10版)》(ICD-10)精神分裂症诊断标准的患者为研究对象,所有患者均处于急性发作期。依据既往暴力史和修订版外显攻击行为量表(MOAS)加权总分为5分区分攻击组和非攻击组,其中攻击组69例,非攻击组39例。采用阳性和阴性症状量表(PANSS)评估临床症状,采用韦氏记忆量表修订版(WMS-R)、韦氏成人智力量表中国修订版(WAIS-RC)评估记忆和智力,并对MOAS与PANSS、WMS-R和WAIS-RC评分进行相关分析。结果攻击组MOAS加权总分、言语攻击、对财产的攻击和体力攻击的评分均高于非攻击组,差异均有统计学意义(P0.05或0.01)。攻击组PANSS总评分和阳性症状评分均高于非攻击组,差异均有统计学意义(P0.05或0.01)。两组WMS-R和WAIS-RC评分比较差异均无统计学意义(P均0.05)。MOAS加权总分、体力攻击评分与PANSS总评分、阳性症状评分和一般精神病理评分呈正相关(r=0.203~0.535,P0.05或0.01),体力攻击评分与心智评分呈负相关(r=-0.343,P0.05)。结论与非攻击组相比,攻击组的攻击行为体现在言语攻击、对财产的攻击与体力攻击方面。PANSS总评分与阳性症状可能与精神分裂症患者的攻击行为相关。记忆和智力与精神分裂症患者的攻击行为不相关,不能作为攻击行为的预测因子。     

Atypical antipsychotic agents in the treatment of violent patients with schizophrenia and schizoaffective disorder

CONTEXT: Violent behavior of patients with schizophrenia prolongs hospital stay and interferes with their integration into the community. Finding appropriate treatment of violent behaviors is of primary importance. OBJECTIVE: To compare the efficacy of 2 atypical antipsychotic agents, clozapine and olanzapine, with one another and with haloperidol in the treatment of physical assaults and other aggressive behaviors in physically assaultive patients with schizophrenia and schizoaffective disorder. DESIGN AND SETTING: Randomized, double-blind, parallel-group, 12-week trial. Physically assaultive subjects with schizophrenia or schizoaffective disorder who were inpatients in state psychiatric facilities were randomly assigned to treatment with clozapine (n = 37), olanzapine (n = 37), or haloperidol (n = 36). MAIN OUTCOME MEASURES: Number and severity of physical assaults as measured by the Modified Overt Aggression Scale (MOAS) physical aggression score and the number and severity of all aggressive events as measured by the MOAS overall score. Psychiatric symptoms were assessed through the Positive and Negative Syndrome Scale (PANSS). RESULTS: Clozapine was superior to both olanzapine and haloperidol in reducing the number and severity of physical assaults as assessed by the MOAS physical aggression score and in reducing overall aggression as measured by the MOAS total score. Olanzapine was superior to haloperidol in reducing the number and severity of aggressive incidents on these 2 MOAS measures. There were no significant differences among the 3 medication groups in improvement of psychiatric symptoms as measured by the PANSS total score and the 3 PANSS subscales. CONCLUSIONS: Clozapine shows greater efficacy than olanzapine and olanzapine greater efficacy than haloperidol in reducing aggressive behavior. This antiaggressive effect appears to be separate from the antipsychotic and sedative action of these medications.     

应用护士观察量表对精神分裂症患者冲动行为的初步研究

目的观察精神分裂症病人的冲动行为。方法将124例病人应用护士观察量表进行测定,并根据其中激惹因子得分的高低分为冲动组和非冲动组。结果冲动组,女性病人多于男性（X^2=4．65,P〈0．05）。年龄与冲动行为无显著差异。根据病史中有无冲动行为,分为观察冲动组和观察非冲动组。在激惹因子中,有5个项目两组得分有显著差异（P〈0．05）和极显著差异（P〈0．01）,观察冲动组发生冲动行为的病人明显高于观察非冲动组。结论对住院精神病人进行护士观察量表测定,有利于了解病人的激惹情绪和冲动行为,以助采取相应的护理对策,以及对医务人员的自我保护等具有一定的意义。     

Decreased platelet peripheral-type benzodiazepine receptors in persistently violent schizophrenia patients

Peripheral-type benzodiazepine receptors (PBR) have been shown to be sensitive to stressful conditions. This study aimed to explore a possible association of platelets PBR binding with aggressive behavior and homicidal history in schizophrenia patients. The authors compared [³H] PK 11195 binding to platelet membrane among 11 currently aggressive schizophrenia patients, 15 schizophrenia patients with homicidal history, 14 nonaggressive schizophrenia patients, and 15 healthy volunteers. Subjects were assessed for aggressive behavior, psychopathology, anxiety, anger, and emotional distress using standardized instruments. We found that currently aggressive patients had significantly lower (−30%) platelet PBR density (B_max), and scored significantly higher on hostility, anxiety, state anger, and emotional distress compared to homicidal and nonaggressive schizophrenia patients and healthy controls. Predominance of positive or negative symptoms, homicidal or suicidal attempt history, emotional distress levels, and conventional or atypical antipsychotic therapy is not associated with the expression of platelet PBR binding sites. Significant negative correlations emerged between PBR density and scores for aggressive behavior, hostility and anxiety. Thus, decreased platelet PBR density in aggressive schizophrenia patients is associated with higher scores for overt aggression, hostility and anxiety, but independent of illness subtype, homicidal and suicidal attempt history, distress level and type of antipsychotic treatment.