长期住院精神病患者多因素分析

目的 了解长期住院精神病患者的状况.方法 用自制的调查表对住我院精神科5年以上的163例患者进行调查.结果 男124例(76.07%),女39例(23.93%);精神分裂症患者148例(90.8%);未婚89例(54.6%),离婚41例(25.15%);反复住院多次的149例(91.41%).此类病人病程长,迁延不愈,反复发作,治疗状况差,缺乏家庭监护,家庭经济困难.结论 患者长期住院既有自身因素,也有家庭因素和社会因素,应引起各方面的重视.     

长期住院精神障碍患者的社会支持状况调查

目的了解长期住院精神障碍患者的社会支持状况,为护理人员开展健康教育提供依据。方法用社会支持量表(SSPR)对80例长期住院(住院时间6个月)的精神障碍患者与80例内科住院患者进行对照研究。结果长期住院精神障碍患者的SSPR评分低于内科住院患者(t=7.77,5.45,6.50,P0.01;t=2.37,P0.05),且病程超过10年的患者SSPR各项分值均低于病程10年以下者(t=2.42,2.50,2.24;P0.05);有配偶组的病人SSPR评分高于无配偶组,差异有统计学意义(t=8.39,9.47,8.54,3.12;P0.01)。结论良好的社会支持及对支持的利用度对长期住院精神障碍患者的社会能力及个人意志起积极作用。护士应加强对长期住院精神障碍患者及家属的健康教育,帮助其获得社会支持,提高对社会支持的利用,以延缓患者的衰退,提高生命质量。     

86例酒精所致精神障碍患者临床分析

目的　探讨酒精所致精神障碍的临床特点。方法　采用半定式表格分别对 86例住我院诊断酒精所致精神障碍的患者资料进行回顾性调查。结果　酒精所致精神障碍以男性 ( 96.5 % )、低文化水平 ( 68.6% )、体力劳动者 ( 77.8% )居多 ;女性( 3 .5 % )饮酒有增多倾向 ,年龄呈低龄化趋势 ( 4 0 .5± 1 3 .7岁 ) ,离婚、分居者 (共 2 3 .3 % )较多 ,社会功能受损明显 ;开始持续饮酒越年轻 ,出现精神障碍时间越短。近期疗效尚好 (近愈 94.2 % )。结论　酒精所致精神障碍多与饮酒时间有关 ,对患者心理、生理和社会功能有不同程度的损害。应大力宣传长期过量饮酒的危害 ,早期干预。     

肾内科医院感染的分析

目的:分析肾内科住院病人医院感染的临床特征,为预防肾内科住院病人医院感染提供预防措施。方法:回顾性分析本院肾内科2011年3月~2015年3月982例住院患者的临床资料,揭示医院感染与住院情况,诊疗操作和临床指标的关系。结果:982例肾内科住院患者发生医院感染97例,医院感染率为9.9%。医院感染部位以呼吸道感染为主,其中上呼吸道感染占47.4%,肺部感染占22.7%。肾内科住院病人医院感染与年龄、住院天数、激素使用、插管时间、血肌酐和血白蛋白有关(P0.05)。结论:肾内科住院病人的医院感染率较高,病人年龄、住院时间、激素的使用、插管时间、血肌酐和血白蛋白为医院感染的危险因素。     

长期住院精神分裂症患者社会功能缺陷的相关因素分析

目的探讨长期住院精神分裂症患者社会功能缺陷的相关因素。方法用住院精神病人社会功能评定量表（SSPI）,对136例长期住院的精神分裂症患者进行评定。结果社会功能缺陷程度与患者的精神症状、住院时间、家庭结构有关。结论积极治疗患者的精神症状．缩短住院时间．增加假出院次数及时间．积极调动社会和家庭的关心,对减轻病人社会功能缺陷,提高其社会功能具有重要意义。     

影响精神分裂症患者自杀行为的因素

本文对影响精神分裂症患者自杀行为的心理因素，环境因素及死亡原因进行调查分析，结果表明：有自杀行为者的病程以４－７年居多；住院次数为２－４次为多；病态心理活动以妄想，情绪抑郁，思想障碍和幻觉为常见，自杀多段以自缢，坠楼，过量服药为主，造成自杀的环境因素多种的，主要以家庭矛盾，婚恋，人际关系等为主。     

精神专科医院长期与短期住院患者对照研究

目的评估精神专科医院长期住院与短期住院精神障碍患者的特征,探讨导致患者延迟出院的相关因素。方法病例对照研究。对在规定的标定日期内住院时间120天的长期住院组(病例组)与住院时间≤120天的短期住院组(对照组)进行社会人口学与临床特征的比较。结果病例组患者占有的床位数为我院总床位使用数的7%。社会人口学特征两组对比在年龄(χ2=11.7,P0.05)、婚姻(χ2=15.8,P0.001)、居住地(χ2=33.5,P0.001)、付费方式(χ2=32.3,P0.001)、家庭人均月收入(χ2=18.6,P0.001)、监护人情况(χ2=50.5,P0.001)方面的差异均存在统计学意义。临床特征病例组在平均病程(t=6.2,P0.001)、入院次数(χ2=64.3,P0.001)、有无躯体疾病(χ2=21.5,P0.001)及精神科诊断(χ2=11.6,P0.05)与对照组比较存在统计学差异。多因素logistic回归分析结果显示,患者长期住院的主要影响因素依次为付费方式、居住地、年龄、婚姻、文化、躯体疾病、职业。结论造成三级精神专科医院患者延迟出院的原因既有疾病本身的原因,也有家庭社会因素以及医保政策的原因。     

住院精神障碍患者家属心理弹性与社会支持的关系

目的:通过对四川省某三甲综合医院精神科住院精神障碍患者的家属进行调查研究,探究精神障碍患者家属心理弹性与领悟社会支持的状况以及二者的关系。方法:采用自编的一般资料调查表、心理弹性量表(CDRISC)和领悟社会支持量表(PSSS)进行研究,用SPSS 21.0统计软件进行描述统计分析、差异检验、相关分析及回归分析。结果:领悟社会支持得分为(60.24±10.97),心理弹性得分为(60.00±13.18);心理弹性在月家庭收入上差异显著(P0.01);相关分析研究发现,心理弹性与领悟社会支持呈显著正相关(r=0.619,P0.01),且家庭支持、其他支持能有效预测心理弹性。结论:精神障碍患者家属具有中等偏上的心理弹性和领悟社会支持水平,领悟社会支持在一定程度上能预测家属的心理弹性。     

176例儿童精神障碍住院临床资料分析

目的：了解住院儿童精神障碍患者临床特征，方法：对我院十年间住院儿童精神障碍患者（≤15岁）病历资料回顾性调查，主要对患者诊断及治疗情况进行分析，结果：176例儿童住院患者占住院病人的1．15％，男性92例（52．27％），女性84例（47．72％），诊断以精神分裂症，情感性精神病最多分别占54．6％，13．6％，氯氮平，氯丙嗪，奋乃静，舒必利占用频度的前四位，联合用药偏多，治疗方法不理想，结论：儿童精神障碍在住院精神病人中所占比例不高，以重型精神病为主，治疗手段，服务模式落后，应重视儿童精神卫生工作，加强儿童精神卫生 知识的宣传。     

152例酒精所致精神障碍患者中合并酒精性肝病的临床分析

我院是一家以精神卫生为特色的医院，酒精所致精神障碍是我院精神科最常见的病种之一，为了解酒精所致精神障碍患者中合并酒精性肝病的情况，笔者对2005～2010年住院的精神所致精神障碍患者中随机抽取152例进行回顾性临床分析，现报告如下：     

《精神卫生法》实施后精神病人长期住院原因调查

目的了解《精神卫生法》实施后精神病人长期住院的原因。方法统计2013年5月1日和2014年1月1日两个时点在本院普通精神科住院的精神病人总数和住院超过1年的病人数;并随机选择2014年1月1日在本院普通精神科病房住院超过1年的370名合作患者,采用自编长期住院原因调查问卷进行调查。结果 2013年5月1日和2014年1月1日在本院普通精神科住院的精神病人总数分别为1170人和1157人;住院超过1年的人数分别为1033人和1042人。精神病人长期住院有主观因素,也有客观因素。主观因素主要表现在"出不出院无所谓"(34.1%)、"不会照顾自己"(28.1%)、"担心出院后再发病"(20.3%)、"病未治好不能出院"(19.5%)和认为"住院比出院后单独生活条件好"(18.4%)等。客观因素主要是"家人不同意"(64.6%)、"没有经济来源"(54.1%)、"没有房子住"(38.6%)、"没有监护人"(21.6%)、"医院(医生)不同意"(20.5%)和"街道领导不同意"(18.4%)等。知道国家出台了《精神卫生法》的只有34.6%;知道《精神卫生法》主要内容的仅占8.4%;认为《精神卫生法》对自己"没有好处"和"不知道"有没有好处的患者高达70.8%;小部分患者认为对自己"有一点好处"(27%);认为"有很大好处"的仅占2.2%。结论精神病人长期住院的主要原因受主客观多因素影响。     

Psychological practice in a pediatric rehabilitation hospital

Described 127 consecutive referrals to a newly formed psychological consultation service in a pediatric rehabilitation hospital. This setting served children whose needs for comprehensive care and long-term hospitalization could not be met effectively elsewhere in the community. The complex patient population included children with permanent mental and/or physical handicaps who had survived due to advances in medical technology, those with traumatic or congenital brain injury, failure to thrive, feeding problems, apnea, tracheostomy, child abuse, and psychosomatic disorders. A range of psychological services were offered, including specialized assessments and treatment planning for rehabilitation, home and school placement, direct treatment and monitoring of behavioral progress, and consultation with staff. Implications for the practice of pediatric psychology and service delivery to patients in pediatric rehabilitation settings are discussed.     

老年髋部骨折患者术后功能恢复的长期强化家庭康复训练

文题释义： 家庭康复训练：主要由主管医师、康复医师、康复治疗师及护理人员指导康复训练,主管医师与康复医师共同评估病情并制定康复训练计划,康复治疗师指导训练内容,护理人员协助加强患者管理。出院时向患者及家属发放康复手册,通过文字及视频内容指导患者院外进行长期强化家庭康复训练。每周通过移动电话、网络工具对患者及家属进行线上随访,要求家属定期录制患者康复的视频,并根据实际状态及时调整康复训练处方。建立网络线上交流群,将患者纳入该群,及时向患者解答康复过程中的疑问,防止康复训练不足及康复过度等情况。 日常生活能力量表(Activity of DailyLiving Scale,ADL)：由美国的Lawton和Brody制定于1969年。由躯体生活自理量表(PSMS)和工具性日常生活能力量表组成。共有14项：一是躯体生活自理量表,共6项,包括上厕所、进食、穿衣、梳洗、行走和洗澡;二是工具性日常生活能力量表,共8项,包括打电话、购物、备餐、做家务、洗衣、使用交通工具、服药和自理经济。主要用于评定被试者的日常生活能力。 背景：老年髋部骨折患者术后存在极高的功能致残率,传统康复更多地关注患者住院期间的康复,而忽视院外家庭康复训练。6个月的强化家庭康复训练已被证实为一种确实有效的方法,但更长时间的家庭训练仍有待进一步研究。 目的：探究进行长期强化家庭康复训练法对老年髋部骨折患者术后功能恢复情况的影响。 方法：前瞻性纳入接受手术治疗的老年髋部骨折患者89例,采用随机数字表法分为试验组42例和对照组47例。对照组采用传统康复训练方法,试验组采用长期强化家庭康复训练法,指导功能锻炼并进行规律随访,利用网络工具及时调整康复计划。2组患者均规律随访12个月,分别在术后3,6,12个月进行日常生活能力评分、6分钟步行试验、髋关节Harris评分、功能独立性测量量表评分、SF-36评分,评估患者术后功能改善情况。研究方案的实施符合成都市第六人民医院的相关伦理要求,参与试验的患病个体对试验过程完全知情同意。 结果与结论：①2组患者术后功能逐渐恢复,试验组患者术后3,6,12个月的日常生活能力评分、功能独立性测量量表评分、6分钟步行试验、Harris评分及SF-36评分均优于对照组(P < 0.05);②结果说明,老年髋部骨折患者术后长期强化家庭康复训练法可提高患者日常生活能力,改善患者生活质量,但该康复计划及其疗效仍需要进一步研究。 ORCID: 0000-0002-0570-9065(王可心) 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Burden, reward and family functioning of caregivers for relatives with mood disorders: 1-year follow-up

BACKGROUND: Longitudinal caregiver studies of patients with mood disorders report no consistent pattern in burden over time. This naturalistic study of caregivers of patients with mood disorders assesses caregiver perceptions of burden, reward and family functioning at hospitalization and at 1 year follow-up. METHODS: Thirty-nine caregivers of patients with mood disorders were recruited during their relative's in-patient psychiatric hospitalization. Caregivers were given an assessment packet to complete at the time of enrollment and identical assessment packets were mailed to the caregivers at 1 year. RESULTS: Caregivers of bipolar disorder relatives reported less reward, more subjective burden and worse family functioning than depression caregivers, at recruitment. Bipolar caregivers showed a significant reduction in burden 1 year after their relative was discharged from the hospital, whereas depression caregivers showed no change at 1 year. At 1 year, overall family functioning was unchanged and was in the unhealthy range in all dimensions except for behavior control. Limitations of the study include the small sample size, the selective recruitment from a hospital setting where family members did not actively seek out help and the high drop-out rate. CONCLUSIONS: Caregivers of relatives with mood disorders show a different pattern of burden and reward, over time, depending on the patient diagnosis. In all cases, however, family functioning was significantly impaired. CLINICAL RELEVANCE: Short-term family interventions can be offered at the time of hospitalization to try to reduce caregiver burden and increase caregiver reward.     

Are there racial differences in the way patients with psychotic disorders are treated at their first hospitalization?

BACKGROUND: It is now well documented that both black and white patients with severe mental illness are likely to use different types of treatment facilities, have different lengths of hospital stays, and receive different types and dosages of psychotropic medications. It is still uncertain, however, whether these differences exist at the early stages of treatment. METHOD: We examined treatment patterns for a countywide sample of patients with psychotic disorders recruited at their initial psychiatric hospitalization. Illness characteristics, prior treatment histories, admission conditions, and psychotropic medication use during this hospitalization were compared for both black and white patients. RESULTS: Black patients were less likely to have had out-patient treatment prior to their first hospitalization and were more likely to be hospitalized in public than in community psychiatric units than were white patients. Black patients were also more likely to be hospitalized primarily for a behavioral disturbance and escorted to the hospital by the emergency medical services or police, while white patients were more often hospitalized primarily for subjective suffering. These patterns were particularly significant for those with a non-schizophrenia diagnosis. However, there were few statistically significant differences between black and white patients on psychotropic medication use during the first hospitalization. CONCLUSIONS: Differences during the early stages of treatment between black and white patients with psychotic disorders appear to arise most prominently before, rather than during, their first hospitalization.     

Mental disorders in primary care: prevalence and co-morbidity among disorders. results from the functional illness in primary care (FIP) study

BACKGROUND: Prevalence and co-occurrence of mental disorders is high among patients consulting their family general practitioner (GP) for a new health problem, but data on diagnostics and socio-demographics are sketchy. METHOD: A cross-sectional two-phase epidemiological study. A total of 1785 consecutive patients with new complaints, aged 18-65 years, consulting 28 family practices during March-April 2000 in Aarhus County, Denmark were screened, in the waiting room, for mental and somatic symptoms with SCL-8 and SCL-Somatization questionnaires, for illness worry with Whitely-7 and for alcohol dependency with CAGE. In a stratified random sample of 701 patients, physician interviewers established ICD-10 diagnoses using the SCAN interview. Prevalence was calculated using weighted logistic regression, thus correcting for sample skewness. RESULTS: Half of the patients fulfilled criteria for an ICD-10 mental disorders and a third of these for more than one group of disorders. Women had higher prevalence of somatization disorder and overall mental disorders than men. Men had higher prevalence of alcohol abuse and hypochondriasis than women. Psychiatric morbidity tended to increase with age. Prevalence of somatoform disorders was 35.9% (95% CI 30.4-41.9), anxiety disorders 164% (95% CI 12.7-20.9), mood disorders 13.5% (95% CI 11.1-16.3), organic mental disorders 3.1% (95% CI 1.6-5.7) and alcohol abuse 2.2% (95% CI 1.5-3.1). Co-morbidities between these groups were highest for anxiety disorders, where 89% also had another mental diagnosis, and lowest for somatoform disorders with 39%. CONCLUSIONS: ICD-10 mental disorders are very prevalent in primary care and there is a high co-occurrence between most disorders. Somatoform disorders, however, more often than not exist without other mental disorders.     

Outcome of long-term hospitalization for asthma in children

Children whose asthma continues to be poorly controlled with outpatient management are often referred to a long-term hospital program for care. Although these programs have been in existence since the 1950s, there has been no systematic study of their effectiveness. The purpose of the present study was to determine outcome in 103 children discharged consecutively after a long-term hospitalization. These children had both severe asthma and significant psychologic problems. Eighty-three of the 103 children had required continuous or frequent intermittent steroids for asthma control. In the year before admission, they had been hospitalized for asthma a mean of 2.6 times for 11.8 days and had had 4.6 visits to emergency rooms and 6.6 visits to physician offices for acute wheezing. Use of medical resources for asthma decreased significantly in the year after long-term hospitalization compared to the year before hospitalization (hospitalization: -34%, p less than 0.0001; hospital days: -39%, p less than 0.0002; emergency room visits: -46%, p less than 0.00001; physician office visits for acute asthma, -42%; p less than 0.00001; and a composite score giving increasing weight to more intensive and costly care: -30%, p less than 0.0001). Long-term hospitalization for children with asthma not responsive to outpatient management is associated with improvement in their use of medical resources.     

不同人群对精神病的态度

目的：了解社会不同人群对精神病的态度。方法：采用定性研究方法建立精神病态度问卷,然后使用该问卷在北京地区对精神分裂症病人及其病人家属、社区居民和精神科医护人员进行调查,结果：病人认为宝现人不会给他人带来危险,对精神病人的社会人才 治疗希望持最积极态度;家属与病人的看法趋向一致。但对精神病人的可治疗性和社会贡献不乐观;与病人、家属比较、社区居民对精神病则持最悲观和最消极态度;精神科医护人中峄精神病人的社会价值,行为的危险性以及是否要限制精神病人的社会活动等问题的看法,与病人,家属比更显悲观,但较社区居民的看法更开明,在精神病因上精神科医护人员的看法与其他三组人群不同,更倾向精神病是生物因素导致,而非人和家庭问题引起。论：尽快实施有效的干预措施,改变人对精神病的人不良态度,消除歧视,提高病人,家属的自信心和适应能力,将会对精神病的治疗与健康,改善精神病人的生活质量有着重大意义。