精神病患者自杀、白伤、白残致伤的救治策略

目的：探讨精神病患者自杀、自伤、自残致伤在外科的急救与治疗策略。方法：回顾分析88例精神病患者自杀、自伤、自残致伤后的急救与治疗经过、方法。结果：经过针对性的救治，78例患者满意出院或转精神科继续治疗，4例放弃治疗自动出院，5例死亡，1例住院期间再次自伤。结论：精神病患者自杀、自伤、自残致伤后的急救与治疗关键在于准确科学的诊断、及时有效的救治和预防再次自杀、自伤和自残。     

危机干预预防精神疾病患者再次自杀的研究

目的评价危机干预预防有自杀观念、自杀未遂的精神疾病患者再次自杀的作用。方法将280例符合CCMD-3诊断标准、有自杀观念、自杀未遂的精神疾病患者随机分为干预组和对照组,各140例。对照组只在住院期间进行常规治疗和护理,出院后按原来的服药要求进行药物维持治疗。干预组在对照组治疗方法的基础上进行综合性危机干预治疗。入院时及出院后第6个月和第12个月进行评定。结果出院后6个月和12个月时,干预组患者的社会支持度、治疗依从性均明显高于对照组(P<0.01),而有自杀观念和再次自杀的人数均较对照组明显减少。结论危机干预能明显提高精神疾病患者的社会支持度和治疗依从性,消除自杀观念,预防有自杀观念、自杀未遂的患者再次自杀。     

精神病患者住院前后自杀行为分析及护理干预

目的:分析精神病患者自杀的潜在危险因素,探讨如何从护理角度进一步预防住院精神病患者的自杀行为。方法:对2004年1月至2008年12月住院且在住院前后有自杀史的258例患者的临床资料进行回顾性分析。结果:258例患者住院前的自杀方式以服毒、自缢、割腕、跳楼居多,住院后的自杀方式以自缢居多;出院后自杀成功7例,住院期间自杀成功1例。结论:住院精神病患者自杀具有一定的规律性,通过增强护理防范意识,及早对患者实施有针对性的护理干预,可预防、降低患者的自杀成功率。     

精神病患者自杀未遂临床分析及护理对策

目的:分析精神病患者自杀未遂的临床资料,探讨预防、护理措施。方法:对80例自杀未遂患者病历进行了回顾性分析,归纳了他们的疾病类型、自杀原因、自杀方式。结果:疾病类型:抑郁症自杀未遂者70例,占87.5%;精神分裂症、抑郁状态10例,占12.5%。自杀方式:服用过量药物32例,占40%;割腕19例,占23.8%;自伤11例,占13.8%;喝农药和自缢各7例,各占8.8%;放煤气4例,占5%。自杀原因:情感障碍72例,精神病性症状8例。结论:对有自杀未遂史、抑郁心境患者及早干预;增加家属和社会对患者的支持,激励患者提高生活信心;提高患者服药依从性;加强康复治疗与社会技能训炼,可预防和降低精神病自杀未遂者再次发生自杀行为。     

1例服用有机磷农药自杀患者的人文关怀护理

对1例服用有机磷农药自杀的ICU患者,从入院昏迷期至清醒期实施全方位、个性化人文关怀护理,关注患者心理护理,预防患者再次自杀。该患者ICU住院期间情绪稳定,以健康、积极的态度配合治疗,住院期间无再次自杀、自伤事件发生,治疗护理过程顺利。     

MMPI测试对住院精神病患者危机状态预测分析及心理干预

目的:了解精神病患者住院期间的心理变化,预测患者危机状态发生.方法: 采用明尼苏达多相人格测验计算机诊断系统,对307例住院精神患者心理状态进行测试.结果:自杀自伤、暴力行为的风险倾向高的患者年龄分布在20～40岁之间,疾病类型以情感性精神障碍最为明显.结论:对住院精神患者进行MMPI测查,及时了解患者的心理状态,制订相应的心理干预措施,能够减少自杀自伤、暴力行为等危机事件的发生.     

镇静治疗在肝移植术后患者早期护理中的效果分析

目的评价镇静治疗在肝移植术后患者临床护理工作中的意义。方法将肝移植术后使用镇静治疗的108例患者和未使用镇静治疗的77例患者术后监护期并发症发生情况进行比较。结果未进行镇静治疗仅进行约束带制动的77例患者发生自行拔除胃管、气管插管或试图拔除的为48例(62.3%),躁动不安导致皮肤破损的为40例(51.9%),自伤自残或试图自伤自残的为32例(41.5%)。而进行镇静治疗的108例患者中,分别只有5例(4.62%)、7例(6.48%)和3例(2.77%),2组患者比较,各项p值<0.001。结论镇静治疗在肝移植术后早期护理中能有效减少意外的发生。     

预见性护理对老年肺癌患者安全的影响

目的:探讨预见性护理对老年肺癌患者安全的影响。方法:对220例老年肺癌患者给予预见性护理,包括加强心理护理,保证环境安全,充分细致的评估,制定详细护理措施,加强基础护理及家属健康教育。结果:本组220例老年肺癌患者经积极治疗与精心护理,发生深静脉血栓2例,经抗凝、溶栓治疗后恢复出院,病情稳定出院203例,死亡15例,无一例发生跌倒、坠床、走失、自杀、自伤、压疮及其他不安全事件。结论:预见性护理可以有效预防、减少老年肺癌患者不安全事件的发生,值得临床推广应用。     

心理急救路径在抑郁症自杀未遂患者心理康复中的运用

目的:通过建立心理急救路径,使护理人员对抑郁症自杀未遂患者的心理护理有章可循,达到系统、连贯、科学的要求,促进自杀未遂患者的心理康复并有效预防其再次自杀。方法:根据抑郁症自杀未遂患者的心理活动特点和自杀的心理动机,建立不同的心理急救路径,在救治中提供有针对性的心理护理。结果:实施心理急救路径,较之传统的一般心理护理,更有利于帮助患者调整心态、重树信心,有效预防自杀未遂者再次自杀。结论:心理急救的主要内容是心理护理,心理急救路径的优势就在于为护士提供了有指导性的工作模式和步骤,路径的每一步目标清晰、内容科学、标准明确,使护理工作更具针对性、系统性、完整性,提高了护士开展心理护理的有效性,促进了患者的心理康复。     

普外科重度失血性休克38例急救护理

目的:探讨普外科重度失血性休克患者的急救护理方法与效果。方法:将76例重度失血性休克患者随机分为观察组和对照组各38例,对照组给予常规护理治疗,观察组在常规护理的基础上实施特定的急救护理,对两组患者术后生活水平进行测评。结果:观察组患者中37例经手术治疗后痊愈出院,1例因病情严重抢救无效死亡,治愈率为97.37%;对照组患者中30例经手术治疗后痊愈出院,1例死亡,7例术后有不同程度的切口未愈合、剧痛等病症,治愈率为78.95%;两组比较差异有统计学意义(P<0.05)。观察组患者生活质量明显高于对照组(P<0.05)。结论:在对普外科重度失血性休克患者进行急救时,应临危不乱、随机应变,对待突发情况要认真严谨,在救治过程中与医生配合好,给予有效的特定急救护理,以提高治愈率和患者治疗后生活质量。     

5-羟色胺 2A受体基因 A-1438G多态性与精神疾病患者自杀意念及行为的关联性

背景精神疾病患者是易发生自杀的高危人群,目前有关自杀的神经生物学和遗传学研究主要集中于 5 HT系统.有研究发现 5 HT2A受体基因的 T102C多态性与抑郁症患者的自杀有关联. 目的探讨 5 羟色胺 2A( 5 HT2A)受体基因 A 1438G多态性与精神疾病患者的自杀未遂之间的关系. 设计以患者为研究对象,以健康体检者为对照组的观察对比研究. 单位一所市级医院的精神科和一所大学医院的神经科. 对象本研究所有病例的标本收集于 2002- 3/2002- 9在扬州市五台山医院精神科完成,基因型分析在 2002- 10/2002- 12于徐州医学院神经生物学实验室完成.病例纳入标准符合<中国精神障碍分类与诊断标准>第 3版( CCMD 3)和<美国精神障碍诊断与统计手册>第 4版( DSM Ⅳ)"精神分裂症"或"情感障碍"诊断标准.病例排除标准有自伤的意愿或行为,但并不真正想死的准自杀者.根据有无自杀行为或意图 /意念将 116例患者分为 2组,即自杀未遂组 52例(男 35例,女 17例),平均年龄( 44± 13)岁;无自杀组 64例(男 44例,女 20例),平均年龄( 48± 15)岁.正常对照组 63例(男 33例,女 30例),平均年龄( 55 ± 17)岁. 方法所有入组者按常规氯仿饱和酚白细胞提取法提取 DNA,用限制性片段长度多态性方法分析 5 HT2A受体基因的多态性. 主要观察指标① 3组的 5 HT2A受体基因 A 1438G多态性位点的等位基因频率和基因型分布的比较.②自杀未遂组中精神分裂症者与情感障碍者的 5 HT2A受体基因 A 1438G多态性位点的等位基因频率和基因型分布的比较. 结果自杀未遂组的 A 1438G多态性位点的 G等位基因频率( 0.52)高于正常对照组( 0.39),差异有显著性意义(χ 2=3.91,P< 0.05);自杀未遂组 3种基因型的分布 AA( 0.23)、 AG(0.50)及 GG(0.27)与正常对照组 AA( 0.32)、 AG(0.59)及 GG(0.09)的差异也有显著性意义(χ 2=6.12,P< 0.05). 结论精神疾病患者的自杀未遂与 5 HT2A受体基因的 A 1438G多态性有关, G等位基因可能是自杀行为的危险因素.     

Self-harm or attempted suicide? Do suicide notes help us decide the level of intent in those who survive?

A suicide note can be a very powerful communication to the family and friends of the deceased. However, in a number of cases a note is written by an individual who survives an apparent act of attempted suicide. These cases will frequently present at a hospital accident and emergency department (A&E) and will be classified as incidents of self-harm. Despite the importance of suicide notes in determining the motivation of people who die by their own hand, research findings have been patchy and ambiguous. This is also true when someone writes a suicide note but survives an act of apparent attempted suicide. In such cases the question is raised whether the person truly intended to complete suicide or whether their actions had some other motivation. This paper seeks to throw some light on this matter by examining the meaning that should be attributed to a suicide note when it has been written by someone who presents at a hospital accident and emergency department after intentionally harming or injuring themselves. More specifically, the study addresses the question whether the presence of a suicide note in such cases is more likely to reflect a serious act of attempted suicide than it is to reflect an act of self-harm with low suicidal intent. Using a large dataset collected over a 5-year period the authors compare note-leavers with self-harm patients who have not written a suicide note, focussing on the presence or absence of other known risk indicators for completed suicide in each of the two patient groups. The aim is to test the hypothesis that patients presenting at A&E with self-harm who have left a suicide note, are at higher risk of future completed suicide than are self-harm presenters who have not left a note. The conclusion reached is that clinical staff in the emergency department should err on the side of caution and regard the presence of a suicide note as an indication of a failed but serious attempt at suicide.     

Mood disorders and the outcome of suicidal thoughts and attempts

Suicidal ideation and attempts are common reasons for visits to the emergency department and critical care hospitalizations and a common public health problem. Most patients who make a suicide attempt have a psychiatric disorder, most frequently a mood, psychotic, substance use, or personality disorder. Patients who are at high risk of another attempt and cannot be transferred promptly to a psychiatric service should be managed jointly by the psychiatric and critical care teams with an emphasis on protection of the patient, identification of substance intoxication and withdrawal, making the environment safe, and instituting treatment of the psychiatric disorder. Antidepressants reduce suicide risk but their slow onset of action may make electroconvulsive therapy a desirable alternative for severely depressed patients. Parenteral treatment is possible with benzodiazepines and antipsychotic drugs but not antidepressants.     

The meaning of suicidal psychiatric inpatients'' experiences of being treated by physicians

Twenty-one psychiatric inpatients who had thought about, expressed a wish to, or even attempted to commit suicide narrated their experiences of receiving treatment from physicians. The interview texts were transcribed and interpreted using a phenomenological-hermeneutic method inspired by the philosophy of Ricoeur. Two main themes and eight themes were found. Participating Approach: being with the patients, listening to patients without prejudice, trusting each other, respecting patients' integrity; and Observing Approach: leaving patients to themselves, listening to patients with prejudice, mistrusting each other, not respecting patients' integrity. These findings were interpreted in the light of the writings of Hegel, Buber and Cissna and Sieburg. The suicidal patients expressed their need for confirmation in their interaction with physicians, that is they needed to meet with respect and interest when staying in the hospital with suicidal thoughts or after suicidal attempts.     

5-羟色胺2A受体基因多态性与精神疾病患者自杀未遂的关联性研究

目的　探讨 5 -羟色胺 2A(5- HT2A)受体基因A 14 3 8G、T10 2C多态性与精神疾病患者的自杀未遂之间的关系。方法　对 5 2例有自杀未遂的精神疾病患者和 64例无自杀的精神疾病患者及 63例正常人 ,按常规方法提取DNA ,用限制性片段长度多态性方法分析 5 - HT2A受体基因的多态性。结果　 5 -HT2A受体基因A 14 3 8G和T10 2C两位点多态性呈完全连锁不平衡 ;自杀未遂组的A 14 3 8G、T10 2C多态性位点的T/G等位基因频率高于正常对照组 (P <0 . 0 5 ) ,自杀未遂组与正常对照组间的基因型分布的差异也有显著性 (P <0 . 0 5 )。结论　精神疾病患者的自杀未遂与 5 - HT2A受体基因的A -14 3 8G、T10 2C多态性有关 ,T/G等位基因可能是自杀行为的危险因素。     

Shame reactions after suicide attempt

Shame reactions were spontaneously described by 13 of 18 patients interviewed in a qualitative study investigating experiences of care following a suicide attempt. The shame data from the interview study were extracted, analysed separately, and are reported in this article. The shame reactions often occurred in conjunction with the suicide attempt. Feelings of shame were accompanied by impulses to hide or flee, i.e., fear of seeking help or impulses to leave the hospital. The attempted suicide patients often experienced the initial encounter at the hospital as difficult. Having attempted suicide and survived was often perceived as yet another failure, in addition to the problems leading to the attempt. The attempted suicide patients were sensitive to the attitudes and behaviours of the personnel. Experiencing the personnel as kind, respectful, and nonjudgemental seemed to contribute to a relief from shame for some patients. Some respondents expressed that a tolerant and flexible atmosphere in the psychiatric ward, with low demands on the attempted suicide patient, helped them accept treatment and made them feel less ashamed for not living up to the expectations of everyday life. On the other hand, feeling too exposed to others or experiencing negative attitudes from the personnel seemed to contribute to an exacerbation of shame for some patients. Being aware of possible shame reactions after a suicide attempt might help caring personnel to understand and interact with attempted suicide patients in a way that could make it easier for these patients to accept and benefit from psychiatric care after a suicide attempt.     

Effect of previous emergency psychiatric consultation on suicide re-attempts – A multi-center observational study

BackgroundThe emergency department (ED) is one of the first gateways when suicide attempt patients seek health care services. The purpose of this study was to analyze the hypothesis that people who received emergency psychiatric services in previous suicide attempts will have a lower mortality rate in current ED visits owing to subsequent suicide attempts.MethodThis retrospective study included patients who visited six EDs, and participated in the injury surveillance and in-depth suicide surveillance for 10 years, from January 2008 to December 2017. The study subjects were adult patients 18 years or older who visited EDs due to suicide attempts. The main explanatory variable is whether psychiatric treatment was provided in previous suicide attempts. The main outcome variable was suicide related mortality.ResultsThe study included 2144 suicide attempt patients with a previous history of suicide attempts. Among these, 1335 patients (62.2%) had received psychiatric treatment in previous suicide attempts. Mortality was significantly different between the psychiatric consultation group (n = 33, 2.5%) and non-consultation group (n = 47, 5.8%) (P < 0.01). In multivariate logistic regression analysis, previous psychiatric consultation showed a significant association with low mortality (adjusted OR 0.41; 95% CI [0.23–0.72]) and selecting non-fatal suicide methods (adjusted OR 0.47; 95% CI [0.36–0.61]).ConclusionPatients who received psychiatric consultation in previous suicide attempts had a lower suicide-related mortality in current ED visits as compared to patients who did not, and this may have been related to choosing non-fatal suicide methods.     

Suicide: a guide to risk factors, assessment, and treatment of suicidal patients

This article summarizes what is known about risk factors for suicide in both adolescent and adult populations. It also translates this knowledge base into practical considerations for the physician on the assessment and treatment of suicidal patients. Since most patients who commit suicide have seen a physician in the weeks to month prior to their deaths, and many kill themselves with medications prescribed by their doctors, the physician's early detection and treatment of suicidal behaviors and associated psychiatric disorders in his or her patients becomes a major suicide prevention strategy.