精神障碍患者长期住院多因素分析

目的了解长期住院精神障碍患者的现状,并对有可能造成患者长期住院的多因素进行分析。方法采用自制的长期住院病人调查问卷对我院住院1年以上的72例精神障碍患者进行调查分析。结果长期住院病人中男性比例高于女性,以精神分裂症患者居多,多为反复住院。婚姻状况以单身者（未婚、离异）居多,此类病人病程长,反复发作,预后不理想,缺乏家庭监护和被社会忽略。结论精神病人滞留医院既有自身疾病原因,也有家庭和社会因素。发展以医院为依托的社区和家庭康复治疗既有助于降低医疗成本,又有利于改善康复期精神障碍患者的生活质量。     

长期住院精神障碍患者的特点分析

目的通过对长期住院患者的特点分析,寻找原因制定干预措施。方法采用自制调查表,临床疗效总评量表(CGI)、阳性与阴性症状量表(PANSS)和简明精神病评定量表(BPRS),对连续住院1年以上的131例精神病患者的相关情况进行调查。结果 131例长期住院的精神病患者男性占69.5%,女性占30.5%;精神分裂症占73.8%,其次是精神发育迟滞5.4%,第三位是脑器官和情感障碍各占4.6%。未出院原因:监护人拒接出院占57.7%,精神疾病因素占21.5%,因强制治疗拒接出院占20.8%。结论患者长期住院既有其自身因素,也有家庭因素和社会因素,应引起各方面的重视。     

上海郊区首发精神分裂症住院患者家庭负担及家属心理健康状况与患者自知力的关系

目的:了解上海郊区首发精神分裂症住院患者家庭负担及家属心理健康的状况,及其与患者自知力的关系。方法:研究选取上海市浦东新区南汇精神卫生中心2014年8月-2016年8月的首发精神分裂症住院患者,评估患者的基本情况、自知力与治疗态度量表(ITAQ),家属的基本情况、家庭负担(FBS)和症状自评量表(SCL-90)。根据患者的自知力的平均得分3.86,分为高自知力水平组(ITAQ3)71例和低自知力水平组(ITAQ≤3)44例,比较高低自知力治疗态度水平下的精神分裂症患者的家庭负担和家属心理健康水平。结果:家庭负担得分有95%的阳性率;低自知力首发精神分裂症住院患者的家庭负担在总分、日常活动、娱乐活动、家庭关系、心理健康因子得分上高于高自知力患者组家庭负担得分(t=3.798,3.873,2.913,2.11,2.155;P0.05);在躯体化、抑郁和焦虑得分上,低自知力组的家属得分高于高自知力组的家属得分(t=2.378,2.425,2.737;P0.05)。结论:自知力作为病情因素是首发精神分裂症住院患者的家庭负担和家属心理健康状况的影响因素。     

急诊及住院自杀未遂者危险因素的病例对照研究

目的:探讨急诊及住院自杀未遂者危险因素,提出自杀未遂预防建议。方法:收集2013-2015年山东省内10个县级医院急诊或住院登记系统自杀未遂病例,按照与病例同社区、同性别、年龄相仿(±2岁)原则选择社区对照;采用调查问卷收集数据。单因素初步筛选自杀未遂影响因素,多因素logistic回归分析建立影响因素模型。结果:本研究病例组424例,男性148 (34. 9%),女性276 (65. 1%);对照组434例,男性158 (36. 4%),女性276 (63. 6%)。单因素和多因素logistic回归分析均显示,有精神疾病、家庭经济状况差、夫妻关系差、有自杀未遂家族史、社会关系差、个体受教育机会差是自杀未遂的危险因素,家庭人口数多是自杀未遂的保护因素。结论:鉴于筛选危险因素,应采取相应对策降低自杀未遂发生。     

创伤性四肢骨折患者住院期间焦虑和抑郁现状及其与家庭支持间相关性

目的:研究创伤性四肢骨折患者住院期间焦虑及抑郁发生状况,并对其与家庭支持间相关性分析。方法:回顾性分析我院2017年5月至2018年5月住院创伤性四肢骨折患者108例,调查患者一般资料,使用焦虑自评量表(SAS)、抑郁自评量表(SDS)调查住院期间焦虑和抑郁现状,再使用家庭支持自评量表分析患者家庭支持情况,并分析焦虑、抑郁与家庭支持间相关性。结果:108例创伤性四肢骨折患者住院治疗期间焦虑67例(62.04%)、抑郁63例(58.33%),且焦虑和抑郁评分均显著高于中国常模评分(t=23.134,23.057;P0.05)。108例创伤性四肢骨折住院患者不同性别、文化程度、家庭经济状况、职业分布、医疗费用支付方式、家庭支持水平的SAS量表评分差异有统计学意义(t=-3.350,-12.877,-2.301,-3.810,26.332,16.379;P0.05);108例创伤性四肢骨折住院患者不同性别、文化程度、家庭经济状况、职业分布、医疗费用支付方式、家庭支持水平的SAS量表评分差异有统计学意义(t=-3.016,-14.172,-2.367,-3.847,20.282,13.531;P0.05)。家庭支持量表得分与SAS量表、SDS量表得分均呈负相关(r=-0.546,-0.489;P0.05)。结论:创伤性四肢骨折患者住院期间存在明显焦虑、抑郁情绪,且与家庭支持情况存在一定相关性。     

精神分裂症患者噎食原因分析

目的对住院精神分裂症患者发生噎食的原因进行分析,为临床预见性护理干预,减少意外事件的发生提供可靠依据。方法对2000年1月1日至2010年1月1日住院治疗期间发生噎食的30例精神分裂症患者的资料采用自制调查表进行记录和回顾性分析。结果发生噎食的30例患者中男21人(70%),女9人(30%);年龄50岁以上最多(57%);精神分裂症各型中以紧张型(50%)及青春型(30%)发生噎食最多;住院时间≥3个月者最常见(83%);噎食在午餐最多(50%),其次是早餐(37%);最容易引起噎食的食物是面食(47%),其次是米饭(27%);服用典型抗精神病药者(73%)较服用非典型抗精神病药者(27%)发生率高。结论高龄,长期住院,男性,服用高剂量典型抗精神病药,进食面食,精神分裂症紧张型及青春型是住院精神分裂症患者发生噎食的高危因素。     

晚发性分裂症患者回归社会多因素分析

目的探讨影响晚发性分裂症患者回归社会的因素。方法收集2006-2013年首次住院的晚发性(起病年龄45岁)分裂症患者(研究组)62例和同期首次住院的精神分裂症患者(对照组)60例,采用自制一般情况调查表、社会功能缺陷量表(SDSS)、日常生活能力量表(ADL)及大体评定量表(GAS),以随访与量表现场测评相结合的方法获得资料,数据采用多因素回归分析。结果 1研究组服药依从性好于对照组(χ2=5.208,P0.05);复发率低于对照组(χ2=4.504,P0.05);2研究组预后良好者显著高于对照组(χ2=9.360,P0.05);3研究组的社会功能和日常生活能力优于对照组(P0.01);4经多因素回归分析,影响晚发性分裂症回归社会的主要因素有6个,即发病年龄、首次住院疗效、起病形式、维持服药时间、病程和家庭社会支持程度(P0.01)。结论晚发性分裂症患者回归社会的情况较精神分裂症好;发病年龄晚,急性起病,病程短,首次住院疗效好,坚持长期治疗,有充分的家庭社会支持有利于患者回归社会。     

精神病人暴力行为相关因素分析

目的探讨造成精神病人暴力行为的有关因素,为预防暴力行为的发生提供依据。方法由专科和兼职精防医生填写《精神疾病患者基本情况核查表》,对每位患者进行临床评估。结果 1精神病人2746例,有暴力行为212例(7.72%)。其中精神分裂症有暴力行为143例(10.45%),心境障碍有暴力行为6例(8.21%),精神发育迟滞有暴力行为55例(6.11%);2男性精神病人有暴力行为153(11.01%),女性精神病人有暴力行为59例(5.15%);3有配偶的精神病人有暴力行为80例(6.74%),离婚的精神病人有暴力行为26例(16.88%),再婚的精神病人有暴力行为27例(72.97%),丧偶的精神病人有暴力行为8例(21.05%);4核心型家庭有暴力行为154例(8.58%),中间型家庭有暴力行为43例(16.04%),大家庭有暴力行为15例(3.17%);5病症期有暴力行为44例(14.96%),被动期有暴力行为41例(11.26%)。结论精神分裂症、心境障碍、精神发育迟滞易发生暴力行为;男性,离婚、再婚、丧偶,缺少家庭支持,处于疾病期和波动期是危险因素;良好的婚姻状况和大家庭的支持是保护因素。     

精神病患者意外受伤特征分析

目的:了解住院精神病患者意外发生外伤的特点,为预防意外发生外伤提供依据。方法:回顾2007年1月1日-2012年6月31日我院住院期间发生外伤的患者,进行回顾性的调查研究和分析。结果:8753名住院精神病患者发生外伤148例(1.7%),男性(70.9%)明显多于女性(29.1%)(χ2=20.96,P=0.004);≥60岁者外伤最多(χ2=26.18,P=0.025);精神分裂症患者发生外伤100例(67.6%),明显多于其他疾病患者(χ2=104.43,P=0.005);外伤类型以摔伤最多(52.0%);外伤最常发生在普通病室、饭厅,每个地点均好发生摔伤。休息日发生外伤多于工作日(χ2=77.88,P=0.000);外伤在白班发生最多(χ2=39.95,P=0.008);长期住院者(≥3个月)发生外伤比例较高(χ2=21.11,P=0.099)。结论:住院精神病患者外伤多见于男性、老年人、长期住院、精神分裂症患者,休息日与白班多发,外伤以摔伤较多,地点以普通病室、饭厅较多,外伤与癫痫发作与否无关。     

早期乳腺癌患者术后家庭类型与生活质量的相关性

目的: 研究早期乳腺癌患者术后家庭类型现状和对生活质量的影响,为家庭干预提供依据.方法: 采用家庭亲密度和适应性量表中文版(Family Adaptability and Cohesion Scale,Second Edition,Chinese Version,FACESⅡ-CV)和乳腺癌生活质量专用量表(EORTC Quality of Life Questionnaire,Breast Cancer 53,EORTC QLQ-BR53),对196例早期乳腺癌患者术后家庭类型构成、家庭类型对生活质量的影响及影响生活质量的因素进行调查.结果: 本组乳腺癌患者术后家庭类型,与既往研究中122个正常家庭类型相比,极端型和中间型较多(29.6% vs.16.4%,39.8% vs.29.5%),平衡型较少(30.6% vs.54.1%)(χ2= 18.028,P<0.001);极端型家庭患者的整体生活质量得分高于中间型和平衡型[(70.0±19.6)vs.(61.0±19.8),(57.4±18.0);P＜0.01],而疲乏、系统疗法副作用得分低于中间型和平衡型 [疲乏:(23.2±20.5)vs.(29.3±15.2),(32.8±18.2);P＜0.01.系统疗法副作用:(20.7±17.1)vs.(27.1±14.7),(28.9±16.0);P＜0.05],恶心呕吐得分低于平衡型[(5.5±13.7)vs.(11.7±19.0);P＜0.05].回归分析显示家庭类型是影响乳腺癌患者整体生活质量及系统疗法副作用的最主要因素(β=0.252,β=-0.183).结论: 早期乳腺癌患者术后家庭类型现状为极端型和中间型增多,平衡型减少.家庭类型是影响乳腺癌患者生活质量的重要因素,极端型家庭患者生活质量好于平衡型和中间型.临床中应加强对乳腺癌患者家庭干预,有意识引导其他家庭类型向极端型转化.     

The relatively good prognosis of bipolar disorders in a Turkish bipolar clinic

BACKGROUND: Bipolar affective disorder is considered to be a disabling illness with a relapsing and remitting course resulting in enduring psychosocial consequences. In this study, we aimed to determine the demographic and clinical characteristics of patients with bipolar illness, types of treatment at inpatient and outpatient settings and their outcome. METHOD: Life charts of 61 bipolar outpatients and hospital charts of 47 manic inpatients were retrospectively evaluated regarding the demographics, course of illness and the treatment at both settings. RESULTS: 82.5% of the outpatients were euthymic and 42.5% were on lithium monotherapy at the time of investigation. Psychosocial adjustment was good. High level of education and marital status affected compliance positively. In the outpatient group, 24.2% were bipolar 2 (BP-II): they differed from bipolar 1 (BP-I) patients in having a higher number of lifetime episodes. Females outnumbered males in both settings, 11 had suffered higher numbers of previous episodes, as well as longer stays in hospital. Lithium was the most commonly used agent in acute mania (78.7%); 89.4% of the inpatients received combination treatment, mainly a mood stabilizer with a neuroleptic. Adjunctive neuroleptics decreased from 82.4 to 56.7% after 1995: This resulted in longer lengths of stay in hospital. LIMITATIONS: Data were collected naturalistically in a non-blind fashion. CONCLUSION: Lithium is still the leading mood stabilizer of choice for the acute and maintenance phases of bipolar disorder in our patient population. We submit that family support, high levels of education as well as an in-depth follow-up represented the contributory factors in the good overall outcome.     

Patient follow-up is a major problem at genetics clinics

Children with genetic diseases must be followed for long periods of time to seek new findings. Other patients require further check-ups and studies to be diagnosed. Some patients never return for medical care after the first consultation, which may have serious consequences. We reviewed 400 medical charts of patients with genetic disease to analyze overall attendance to the genetics clinic, investigate some of the causes of failure to seek medical advice, and determine the differences between those first seen as outpatients or as inpatients. The mean follow-up period was 8.3 months (range 0-79), and the average number of visits was 2.8 (range 1-16). Forty eight percent of the cases first seen as inpatients were evaluated only once and 14% twice; while 22 and 21% of the 300 cases first seen as outpatients attended once and twice, respectively (P = 0.0). Appointment keeping was apparently not affected by the presence or absence of diagnosis. Overall, 97 patients were discharged, 7 died, 55 continued on follow-up, 62 attended other hospital services-but not genetics-and 179 were completely lost to follow-up. Diagnosed patients were counseled more frequently than undiagnosed patients (62 vs. 5%); and 71% of the diagnosed patients first seen as outpatients but only 36% of undiagnosed cases first seen as inpatients were counseled, differences between these two groups were significant (P = 0.005). We conclude that keeping the patient with genetic disease on follow-up is a difficult task. New educational strategies must be planned to improve this worrisome situation.     

四川省肿瘤医院2005~2018年肿瘤住院患者HIV抗体筛查结果分析

目的 了解四川省肿瘤医院2005~2018年肿瘤住院患者HIV的感染状况和流行特征。方法 采用酶联免疫吸附（ELISA）法对我院237472例住院患者进行HIV抗体检测,同时对HIV抗体阳性患者的临床资料进行回顾性分析。结果 住院肿瘤患者HIV抗体的总体阳性率为1.42‰（338/237472）,其中男性患者HIV抗体阳性检出率为2.18‰（244/111885）,女性患者HIV抗体阳性检出率为0.75‰（94/125587）,性别差异有统计学意义（P＜0.05）;年龄组以21~30岁检出率最高2.18‰;病种以头颈病区的头颈部肿瘤所占构成比最大21.89%;职业分布较广,且以农村居民为主（48.57%）。结论 住院肿瘤患者HIV感染例数呈逐年上升趋势,以中老年男性为主,并存在病区、病种、职业构成差异的特点,为确保医患安全和防止院内感染,应对住院肿瘤患者HIV进行长期监测。     

食管胃底静脉曲张内镜治疗住院患者焦虑现状及其影响因素

目的 探讨我院肝病科食管胃底静脉曲张（GEV）内镜治疗住院患者焦虑与其发生的影响因素,以期为临床护理、健康教育、家庭支持提供参考依据。方法 选取 2018年8月~2019年2月深圳市第三人民医院肝病医学中心GEV内镜治疗的76例住院患者。采用焦虑自评量表（SAS）对患者的焦虑状况进行评分,并分析相关影响因素。结果 年龄偏大、文化程度越高、病程越长、收入越低、GEV越重、合并并发症、住院次数多、治疗次数多的患者行GEV治疗时焦虑症状越明显（P＜0.05）。婚姻、Child分级、性别等与患者焦虑症状关系比较,差异无统计学意义（P＞0.05）;影响GEV治疗患者焦虑情况最重要的因素为有收入情况、治疗次数、文化程度、年龄、GEV程度和病程（P＜0.05）。结论 焦虑在GEV内镜治疗的住院患者中普遍存在,且受多种因素影响,提示对于GEV内镜治疗住院患者在实施对症治疗及护理之外, 还需要关注其心理状况,并给予干预。     

Pediatric pain: prevalence,assessment, and management in a teaching hospital

The goal of this study was to examine the prevalence, assessment and management of pediatric pain in a public teaching hospital. The study sample consisted of 121 inpatients (70 infants, 36 children, and 15 adolescents), their families, 40 physicians, and 43 nurses. All participants were interviewed except infants and children who could not communicate due to their clinical status. The interview included open-ended questions concerning the inpatients'' pain symptoms during the 24 h preceding data collection, as well as pain assessment and pharmacological/non-pharmacological management of pain. The data were obtained from 100% of the eligible inpatients. Thirty-four children/adolescents (28%) answered the questionnaire and for the other 72% (unable to communicate), the family/health professional caregivers reported pain. Among these 34 persons, 20 children/adolescents reported pain, 68% of whom reported that they received pharmacological intervention for pain relief. Eighty-two family caregivers were available on the day of data collection. Of these, 40 family caregivers (49%) had observed their child''s pain response. In addition, 74% reported that the inpatients received pharmacological management. Physicians reported that only 38% of the inpatients exhibited pain signs, which were predominantly acute pain detected during clinical procedures. They reported that 66% of patients received pharmacological intervention. The nurses reported pain signs in 50% of the inpatients, which were detected during clinical procedures. The nurses reported that pain was managed in 78% of inpatients by using pharmacological and/or non-pharmacological interventions. The findings provide evidence of the high prevalence of pain in pediatric inpatients and the under-recognition of pain by health professionals.     

综合医院住院病人精神障碍调查

目的了解综合医院住院患者焦虑、抑郁、疑病、躯体化等精神障碍及其相关因素。方法采用自编的一般情况调查表,医院焦虑、抑郁量表（HAD）,焦虑自评量表（SAS）,抑郁自评量表（SDS）和症状自评量表（SCL-90）对综合医院住院患者1278例进行调查评定,筛查后再进行精神科诊断。结果综合医院住院患者的焦虑、抑郁总粗分显著高于正常人群（P〈0.05）,且SAS总粗分高于正常人群上限者占40.69%,SDS总粗分高于正常人群上限者占35.99%,既有焦虑又有抑郁症状者占总调查人数的25.01%。焦虑抑郁症状与患者的年龄,患者对疾病的认识,社会支持系统均有关。医院住院患者的SCL-90总分、均分,9项因子分显著高于常模（P〈0.05）。结论综合医院住院患者中存在较多的焦虑、抑郁、疑病和躯体化等精神症状,住院患者的整个心理健康状况较差,综合医院医生识别精神症状率低。     

湖北省某创面修复中心慢性难愈合创面住院患者的流行病学调查分析

目的通过对湖北省某创面修复中心慢性难愈合创面住院患者的病例资料进行回顾,分析其流行病学特点,以期为该病防治对策的制订提供参考。 方法回顾性分析2018年1月至2019年12月华中科技大学同济医学院附属梨园医院创面修复中心收治的慢性难愈合创面住院患者的病例资料。收集信息包括患者的性别、居住地区、职业、基础疾病、吸烟史、创面类型、年龄、住院时间、住院费用、治疗方式(手术治疗、保守治疗)、临床转归、各项医疗费用情况及创面检出病原菌情况。数据比较采用χ²检验和Kruskal-Wallis H检验。 结果(1)本研究共纳入慢性难愈合创面住院患者2 402例,其中男1 593例(66.3%),女809例(33.7 %);城市人口1 459例(60.7%),农村人口943例(39.3%);患者离退休及从事体力劳动所占比例较大,分别为52.1%、28.8%;74.4%的患者合并有糖尿病,其次是高血压(57.5%)和心脏病(31.8%);52.7%的患者有吸烟史。(2)不同创面类型中,糖尿病创面最为多见,占62.3%(1 497/2 402);其次是压力性创面,占13.9%(334/2 402);动脉性创面占6.2%(148/2 402);静脉性创面占5.0%(121/2 402),其他原因所致创面占12.6%(302/2 402)。(3)不同创面类型的慢性难愈合创面患者的性别和年龄段分布比较,差异均有统计学意义(χ²＝30.564、28.536,P<0.05);其中患病比例最高的年龄段为61～80岁(54.7%),其次为41～60岁(29.4%)和80岁以上(11.8%);41～60岁和61～80岁为糖尿病创面和静脉性创面高发年龄段,61～80岁和80岁以上为压力性创面和动脉性创面高发年龄段。(4)2 402例慢性难愈合创面住院患者中,压力性创面患者的平均住院时间最长,为31(19, 35) d,动脉性创面和静脉性创面患者的平均住院时间最短,分别为19(9, 25)d和19(11, 26)d;动脉性创面患者的平均住院费用最高,为91 361.5(17 033.5, 143 090.4)元,其次为糖尿病创面患者,为45 008.4(10 574.0, 57 020.7)元;不同类型慢性难愈合创面住院患者的住院时间及住院费用比较,差异均有统计学意义(χ²＝25.346、32.460,P<0.05)。(5)手术治疗的患者中,压力性创面患者的住院时间最长,为39(26, 42) d、动脉性创面患者的住院费用最高,为118 341.1(77 151.3, 162 281.1)元;保守治疗的患者中,其他创面患者的住院时间最长、动脉性创面患者的住院费用最高;不同治疗方式患者的住院费用及住院时间比较,差异均有统计学意义(χ²＝110.260、120.765,P<0.05)。(6)2 402例患者中,痊愈占22.0%(529/2 402),显效占76.3%(1 833/2 402),未愈占1.7%(40/2 402),未愈患者中死亡12例,占患者总人数的0.5%;痊愈、显效、未愈患者的住院时间分别为31(15, 39)、25(12, 30)、19(5, 24) d,住院费用分别为45 360.6(11 664.3, 56 208.8)、42 824.2(10 107.1, 52 415.1)、37 017.4(8 031.3, 31 942.9)元,痊愈患者的住院时间比显效及未愈患者长,其住院费用比显效及未愈患者多,不同临床转归患者住院时间和住院费用比较,差异均无统计学意义(χ²＝3.031、6.780,P>0.05)。(7)2 402例慢性难愈合创面住院患者的总医疗费用为103 973 107元,各项医疗费用中耗材费和药品费占比较高,分别为42.1%和23.4%,护理费和输血费用占比较低,分别为1.2%和0.2%。(8)2 402例患者中有926例(38.6%)进行了创面病原菌检查,其中681例创面病原菌检测结果为阳性,检测阳性率为73.5%(681/926)。其中革兰阴性菌占50.8%(346/681),主要以铜绿假单胞菌(13.5%)、大肠杆菌(11.6%)、鲍曼不动杆菌(6.2%)为主;革兰阳性菌占42.4%(289/681),主要以金黄色葡萄球菌(17.8%)、表皮葡萄球菌(7.2%)、肠球菌属(9.2%)为主;真菌占6.8%(46/681),主要为白色念珠菌(2.5%)。 结论慢性难愈合创面住院患者以中老年人为主,男性多于女性。糖尿病创面、压力性创面及血管性创面是该病主要原因。压力性创面的患者平均住院时间最长,动脉性创面患者的平均住院费用最高。治疗方式以手术为主,本中心采用多学科诊疗模式进行创面治疗,愈合率较高。创面病原菌中以革兰阴性菌最为多见,以铜绿假单胞菌、大肠杆菌、鲍曼不动杆菌为主。倡导健全大型综合医院创面治疗中心和社区卫生服务中心双向转诊机制,成立创面修复护理中心,同时加强对该病知识宣教,提高防治意识。     

住院抑郁症患者自杀相关问题

目的 :探讨住院抑郁症患者自杀相关问题。方法 :调查 2 0 0 0年连续住院抑郁症患者 3 0 9例 ,记录自杀相关问题及相应临床资料。结果 :住院抑郁症患者出现自杀意念、自杀意图、自杀行为的比例相当高。女性病人自杀行为明显多于男性 ,而男性自杀行为的后果较女性更为严重。精神疾病家族史、自杀家族史均与自杀行为关系密切。终身自杀次数与病程、住院次数、总住院时间相关。结论 :住院抑郁症患者存在较多的自杀问题 ,特别对病程长、多次住院、具有精神疾病或自杀家族史者 ,更是自杀预防的重点人群     

31例住院精神疾病患者使用日常生活用具自杀未遂调查分析

目的探讨31例住院精神疾病患者使用日常生活用具自杀未遂的原因及相关因素分析。方法 1999-2011年住院精神疾病患者。运用自编自杀未遂登记表及阳性与阴性症状量表(PANSS)、焦虑自评量表(SAS)、抑郁自评量表(SDS)进行分析。结果年龄低,文化水平低,无业下岗患者多;经济收入低,家人关心少。1月内发病5例(16%),吞异物18例(58%),不安心住院12例(38%),幻觉、妄想11例(35%),冲动控制障碍14例(45%),PANSS因子分均提示偏重。6例(19%)情感性精神障碍抑郁发作,SDS、SAS显示中度抑郁和轻度焦虑。抑郁发作和精神分裂症发生率高(83%),与精神症状有关。结论自杀未遂者弱势群体多与精神症状有关,早期住院患者与不安心住院患者应引起重视。     

Validation and utility of the patient health questionnaire in diagnosing mental disorders in 1003 general hospital Spanish inpatients

OBJECTIVE: To determine whether the Spanish version of the patient health questionnaire (PHQ) has validity and utility for diagnosing mental disorders in general hospital inpatients. METHODS: Participants in the study were 1003 general hospital inpatients, randomly selected from all admissions over an 18-month period. All of them completed the PHQ, the Beck Depression Inventory (BDI), and measures of functional status, disability days, and health care use, including length of hospital stay. They also had a structured interview with a mental health professional. RESULTS: A total of 416 (42%) of the 1003 general hospital inpatients had a PHQ diagnosis. There was good agreement between PHQ diagnoses and those of an independent mental health professional (for the diagnosis of any PHQ disorder, kappa = 0.74; overall accuracy, 88%; sensitivity, 87%; specificity, 88%), similar to the original English version of the PHQ in primary care patients. Patients with PHQ diagnoses had more functional impairment, disability days, and health care use than did patients without PHQ diagnoses (group main effects for functional status measures and disability days, p < .001; group main effects for health care use, p < .01). The group main effect for hospital length of stay was not significant. An index of depression symptom severity calculated from the PHQ correlated significantly both with the number of depressive symptoms detected at interview and the total BDI score. PHQ administration was well accepted by patients. CONCLUSIONS: The Spanish version of the PHQ has diagnostic validity in general hospital inpatients comparable to the original English version in primary care.