某县/市级综合性医院精神科联络-会诊资料分析

目的 了解县/市级综合性医院精神科联络-会诊的特点。方法收集苏南地区某县/市级综合性医院113例邀请精神科联络-会诊的住院病例,对其人口学资料、科室分布、会诊原因、会诊诊断及处理等进行分析。结果 该院精神科联络-会诊率为0.03%,会诊群体中70岁以上患者占比接近半数(49.56%)。会诊申请科室主要来源于内科系统(66.37%),其中神经内科最多(17.70%)。会诊申请原因前三位的是急性脑病综合征(34.51%)、精神病性症状(13.27%)、抑郁状态(13.27%)。会诊诊断中躯体疾病所致精神障碍最多(26.55%),其次为抑郁症(12.39%)和精神分裂症(11.50%)。结论县/市级综合性医院精神科联络-会诊率低,相关工作有待加强。     

综合性医院精神科会诊178例分析

作者对综合性医院精神科会诊178例分析发现,会诊的主要原因是躯体疾病伴发精神障碍(38.2%)及原患精神疾病又患躯体疾病(32.0%)要求诊断和处理;内科会诊占首位(34.3%),以器质性精神障碍(36.5%)最多见;其次为神经症(18.8%),以癔症为多见,随后为精神障碍(8.4%);会诊后44.8%病人转精神科治疗,未转科者使用精神活性药物治疗者占17.9%,综合治疗占11.8%,心理治疗占8.55。作者建议,在综合性医院设置精神科,开展会诊—联络精神病学(CLP)工作甚为必要。     

综合医院内联络精神病学会诊科室及病种分布特征:154例分析

背景:在综合医院临床专科存在着越来越多的精神心理问题,需要在医院内进行联络会诊。目的:在综合医院中,通过开展精神心理的联络会诊,加强非精神科临床医师对精神医学疾病的认识。设计:病例分析。单位:广东医学院附属医院心理科。对象:选择广东医学院附属医院2003-04/2004-04心理科会诊,不同性别、年龄与文化程度的住院患者154例。方法:统计会诊例数,对154例患者进行申请精神心理科会诊的科室分布和精神障碍病种的分布情况的调查。主要观察指标:①申请精神心理科会诊的科室分布。②精神障碍病种的分布情况。结果:纳入患者154例,均进入结果分析,无脱落者。①申请精神心理科会诊的科室分布:申请会诊的科室中,内科占首位57例(37.0%),其次是急诊科26例(16.8%),传染科17例(11.0%)和神经内科13例(8.4%)。②精神障碍病种的分布情况:会诊诊断最多见的是脑器质性神经症性障碍(31.1%)、精神障碍(25.3%)和躯体疾病所致的精神障碍(13.6%)。结论:在综合医院临床各科均存在精神医学问题。在综合医院中,加强开展联络精神病学会诊是必要的。     

精神科住院患者转住综合医院137例分析

目的 了解精神科住院患者转住综合医院的临床特点.方法 对137例转住综合医院的精神障碍患者的转院率、转院原因、会诊情况、临床诊断、转入科室等资料进行分析.结果 转院率为2.3％,转院原因精神障碍合并躯体疾病占81.8％,以精神症状为首发或突出表现的躯体疾病占18.2％.转入科室以心血管内科、神经内科、消化内科、内分泌科、骨外科、传染科居多.会诊率为29.2％(40/137).结论 精神科医师应加强综合科知识的学习,提高对于会诊-联络精神医学的认识.     

CCU申请院内会诊分析及护理管理对策

目的分析CCU申请院内会诊信息的统计,探讨护理工作如何辅助医疗工作开展院内会诊。方法对CCU申请院内他科会诊病例的一般情况、疾病诊断、科室分布、会诊意见等进行统计分析。结果申请院内他科会诊396例,其中男211例,女185例,年龄35~95岁,平均年龄64.5±7.27岁。申请科室分布为内科系统249例(62.62%),外科系统89例(22.47%),其他科室59例(14.89%)。结论 CCU申请会诊例数较高,申请会诊最多的科室为内科系统。     

综合医院联络会诊住院治疗模式对住院患者精神障碍治疗的可行性研究

  目的  分析通过联络会诊住院治疗模式在综合医院实现住院患者精神障碍住院式治疗的可行性。  方法  本研究为回顾性分析。以2020年7月1日至2021年6月30日北京协和医院躯体疾病科室所有接受心理医学科联络会诊住院式治疗的患者为研究组, 以2019年1月1日至2019年12月31日所有接受心理医学科会诊-联络精神医学(consultation-liaison psychiatry, CLP)会诊的患者为对照组。对照组基于CLP理念, 开展联络会诊与应邀会诊; 研究组在CLP理念的基础上, 整合了三级查房和随访制度, 通过会诊、随诊的方式促进住院患者精神障碍的诊断与治疗。根据会诊记录提取诊断结果和干预方式, 并计算会诊率、随诊率。  结果  共纳入研究组患者1196例(会诊1647例次), 对照组患者1269例(会诊1558例次), 两种会诊模式涉及的会诊科室均包括全院所有躯体疾病科室。相较于对照组, 研究组全院总会诊率[1.21%(1196/98 496)比1.10%(1269/114 917)]、总随诊率[23.08%(276/1196)比17.65%(224/1269)]均有不同程度提高。联络会诊住院式治疗对患者的诊断结果涉及几乎所有精神障碍, 其中以焦虑障碍(18.76%, 309/1647)、抑郁障碍(17.12%, 282/1647)、脑器质性精神障碍(16.45%, 271/1647)的占比较高; 对于干预方式, 单纯采用心理咨询/治疗者占比30.66%(505/1647), 且几乎所有患者均进行了非药物治疗干预。  结论  综合医院基于CLP理念, 结合三级查房和随访制度, 实现住院患者精神障碍住院式治疗具有可行性。     

综合医院精神科住院患者请其他科室联络会诊特征分析

目的 整理综合医院精神科住院患者住院期间请其他科室会诊的信息,分析综合医院精神科住院患者合并躯体疾病的情况。方法 收集1 890例综合医院精神科住院患者的人口学、住院资料和会诊记录,根据住院期间是否请过会诊分为会诊组（n=395）和非会诊组（n=1 495）。比较两组的性别、年龄、住院时长、住院花费等;统计会诊组的会诊信息,分析不同精神障碍患者的会诊特征。结果 会诊组的年龄、中年人占比、老年人占比、住院时长、住院花费明显高于非会诊组（P<0.05）。请会诊次数排名前六位的科室分别为内分泌科、神经内科、心内科、耳鼻喉科、皮肤科和眼科。焦虑障碍、抑郁障碍患者因躯体不适请会诊的占比高于精神分裂症谱系障碍患者,差异具有统计学意义（P=0.001、0.032）;精神分裂症谱系障碍患者因意外伤害请会诊的占比高于焦虑障碍、抑郁障碍患者,差异具有统计学意义（P=0.002、0.025）。结论 不同精神障碍患者请会诊具有不同的特征。综合医院精神科医生除应具备专业知识外,还应对常见的慢性疾病和躯体问题具有一定的诊疗能力,同时与神经内科保持密切联系。     

综合医院内联络精神病学会诊科室及病种分布特征：154例分析

背景：在综合医院临床专科存在着越来越多的精神心理问题。需要在医院内进行联络会诊。 目的：在综合医院中。通过开展精神心理的联络会诊，加强非精神科临床医师对精神医学疾病的认识。 设计：病例分析。 单位：广东医学院附属医院心理科。 对象：选择广东医学院附属医院2003—04／2004—04心理科会诊，不同性别、年龄与文化程度的住院患者154例。 方法：统计会诊例数，对154例患者进行申请精神心理科会诊的科室分布和精神障碍病种的分布情况的调查。 主要观察指标：（1）申请精神心理科会诊的科室分布。（2）精神障碍病种的分布情况。 结果：纳入患者154例。均进入结果分析，无脱落者。（1）申请精神心理科会诊的科室分布：申请会诊的科室中。内科占首位57例（37．0%），其次是急诊科26例（16．8％），传染科17例（11．0％）和神经内科13例（8．4％）。（2）精神障碍病种的分布情况：会诊诊断最多见的是脑器质性神经症性障碍（31．1％）、精神障碍（25．3％）和躯体疾病所致的精神障碍（13．6％）。 结论：在综合医院临床各科均存在精神医学问题。在综合医院中，加强开展联络精神病学会诊是必要的。     

退休干部罹患躯体疾病伴发抑郁障碍73例临床资料分析

目的 探讨退体干部罹患躯体疾病伴发抑郁障碍患者的临床特征,为临床治疗提供依据.方法对73例退休干部罹患躯体疾病伴发抑郁障碍患者的临床资料进行回顾性分析.结果 73例退休干部罹患躯体疾病伴发抑郁障碍患者中,心脑血管疾病伴发抑郁障碍60.27%,恶性肿瘤伴发抑郁障碍16.44%,糖尿病伴发抑郁障碍10.96%,骨折后伴发抑郁障碍6.85%,退行性骨关节炎伴发抑郁障碍4.11%,外伤手术后伴发抑郁障碍1.37%;主要临床表现:情感障碍100%,思维障碍95.89%,认知功能下降67.12%,意志行为障碍45.21%,躯体性焦虑26.03%.结论退休干部罹患躯体疾病伴发抑郁障碍患者以心脑血管疾病和恶性肿瘤者居多,主要表现为情感障碍和思维障碍,在临床治疗躯体疾病的同时,要不断提高对抑郁障碍的诊治率.     

综合医院患者精神科会诊220例临床分析

目的：通过对综合医院申请精神科会诊住院患者的临床研究,发现综合性医院临床各科存在大量的精神医学问题,探讨在综合医院设置精神科后精神病学联络会诊的现状及诊治情况。方法：对2006年9月—2009年4月期间220例申请精神科会诊住院患者的年龄、科室分布、申请科别、年会诊患者情况、原发病构成比、会诊理由、会诊后诊断及治疗进行分析。结果：综合医院精神病学会诊中最常见的精神科诊断是：脑器质性精神障碍、神经症、失眠症等。结论：综合医院设置精神科病房,既有利于各类有精神障碍的患者得到及时、准确的专科诊治,又有利于会诊—联络精神病学的发展,同时应加强综合医院医生精神病学知识的教育培训。     

Factors affecting the presence of depression,anxiety disorders,and suicidal ideation in patients attending primary health care service in Lithuania

Objective. The aim of this study was to establish prevalence, recognition, and risk factors for mental disorders and suicidal ideation in PC patients. Design. A cross-sectional survey based on standard mental health evaluation. Setting. Lithuanian primary care. Subjects. 998 patients from four urban PC clinics. Main outcome measures. Current mental disorders and suicidal ideation assessed using the Mini International Neuropsychiatric Interview (MINI). Results. According to the MINI, 27% of patients were diagnosed with at least one current mental disorder. The most common mental disorders were generalized anxiety disorder (18%) and major depressive episode (MDE) (15%), followed by social phobia (3%), panic disorder (3%), and post-traumatic stress disorder (2%). Some 6% of patients reported suicidal ideation. About 70% of patients with current mental disorder had no documented psychiatric diagnosis and about 60% received no psychiatric treatment. Greater adjusted odds for current MDE were associated with being widowed or divorced patients (odds ratio, OR = 1.8, 95% CI 1.2–2.8) and with lower education (OR = 1.6, 95% CI 1.1–2.3), while greater adjusted odds for any current anxiety disorder were found for women (OR = 1.9, 95% CI 1.3–2.8) and for patients with documented insomnia (OR = 2.2, 95% CI 1.2–4.2). Suicidal ideation was independently associated with use of antidepressants (OR = 5.4, 95% CI 1.7–16.9), with current MDE (OR = 2.9, 95% CI 1.5–5.8), and with excessive alcohol consumption (OR = 2.0, 95% CI 1.1–3.8). Conclusions. Depression, anxiety disorders, and suicidal ideation are prevalent but poorly recognized among PC patients. The presence of current MDE is independently associated with marital status and with lower education, while current anxiety disorder is associated with female gender and insomnia. Suicidal ideation is associated with current MDE, and with antidepressants and alcohol use.Key Words: Anxiety disorder, depression, general practice, Lithuania, primary care, recognition, suicidal ideation

• Primary care (PC) services have a key role in provision of mental health for patients with mild to moderate mental disorders.
• Mental health issues are prevalent among PC patients but are poorly identified and managed.
• Presence of depression is associated with loss of spouse and lower education; presence of anxiety disorder is associated with female gender and insomnia.
• Suicidal ideation is associated with current depression, antidepressant use and excessive alcohol consumption.

     

精神科联络会诊现状及其效果评价

目的：探讨精神科联络会诊现状及临床效果。方法对精神科联络会诊的359例患者的临床资料进行回顾性分析。结果总会诊率占同期住院患者的4．5％,其中神经内科9．9％、心内科7．0％、综合病房4．0％、消化内科3．4％、呼吸内科2．5％、外科1．8％。诊断：神经症占61．3％、躯体疾病所致精神障碍占21．7％、脑器质性疾病所致精神障碍占12．8％、非精神科诊断占4．2％。多以抗抑郁剂及抗精神病药物治疗为主,部分患者予以心理治疗或转入精神科接受治疗;显效率89．1％,总有效率98．3％。结论综合医院住院患者病种繁多,病情复杂,精神科联络会诊对鉴别诊断具有实际的临床价值。     

Comorbidity of depressive and anxiety disorders in chronic daily headache and its subtypes

OBJECTIVE: To investigate the frequency of depressive and anxiety disorders in patients with chronic daily headache. BACKGROUND: There is a lack of data in the literature on the extent of psychiatric comorbidity in patients with different subtypes of chronic daily headache. METHODS: We recruited consecutive patients with chronic daily headache seen in a headache clinic from November 1998 to December 1999. The subtypes of chronic daily headache were classified according to the criteria proposed by Silberstein et al. A psychiatrist evaluated the patients according to the structured Mini-International Neuropsychiatric Interview to assess the comorbidity of depressive and anxiety disorders. RESULTS: Two hundred sixty-one patients with chronic daily headache were recruited. The mean age was 46 years, and 80% were women. Transformed migraine was diagnosed in 152 patients (58%) and chronic tension-type headache in 92 patients (35%). Seventy-eight percent of patients with transformed migraine had psychiatric comorbidity, including major depression (57%), dysthymia (11%), panic disorder (30%), and generalized anxiety disorder (8%). Sixty-four percent of patients with chronic tension-type headache had psychiatric diagnoses, including major depression (51%), dysthymia (8%), panic disorder (22%), and generalized anxiety disorder (1%). The frequency of anxiety disorders was significantly higher in patients with transformed migraine after controlling for age and sex (P =.02). Both depressive and anxiety disorders were significantly more frequent in women. CONCLUSION: Psychiatric comorbidity, especially major depression and panic disorders, was highly prevalent in patients with chronic daily headache seen in a headache clinic. These results demonstrate that women and patients with transformed migraine are at higher risk of psychiatric comorbidity.     

Measurable outcomes in psychiatric disorders: remission as a marker of wellness

BACKGROUND: Mental disorders are highly prevalent, heterogeneous, and of multifactorial etiology. Collectively, they are associated with significant morbidity, mortality, and economic cost. Wellness is the optimal outcome in the management of chronic medical and psychiatric disorders. OBJECTIVES: This review provides a synopsis of definitions and operational criteria for remission in major depressive disorder, bipolar disorder, schizophrenia, anxiety disorders, and attention-deficit/hyperactivity disorder (ADHD). The overall goals were to propose a treatment framework that gives primacy to therapeutic outcomes and to provide a rationale for psychiatry to quantify and measure patient outcome. METHODS: Articles proposing definitions for remission were identified using a MEDLINE search (1966-April 2005) of the English-language literature (key terms: remission, anxiety disorders, bipolar disorder, major depressive disorder, attention-deficit/hyperactivity disorder, and schizophrenia). RESULTS: Operationalizing and quantifying critical end points in psychiatric disorders may help sharpen the focus of therapeutic activity and benefit patient outcome. In the absence of a validated biomarker of psychiatric illness activity, symptomatic remission and functional restoration are the only available markers of wellness in psychiatry. There is an emerging consensus regarding a definition for remission in major depressive disorder; several working definitions for bipolar disorder, schizophrenia, and anxiety disorders have been proposed. Developments in adult mood disorders-albeit incomplete-have been informative; managing psychiatric disorders that first appear in childhood (eg, ADHD) may also benefit by objectifying patient outcome. CONCLUSIONS: Research is needed to determine the impact of applying a remission-focused model of illness management--emphasizing quantifiable, objective, and measurable end points--on overall patient outcomes.     

功能性消化不良者心理因素与食管动力的关系

目的探讨心理因素与功能性消化不良(FD)食管动力的关系。方法使用高分辨率旁道灌注测压系统对20例健康对照组及121例FD进行食管动力测定,同时以焦虑自评量表及抑郁自评量表评定两组的心理状态,并观察食管动力与心理状态的联系。结果9.8%(24/121)的FD患者有食管动力障碍,主要表现为非特异性食管动力障碍70.8%(17/24);胡桃夹食管2例、弥漫性食管痉挛5例;60.7%(73/121)的FD者有心理障碍,其中抑郁障碍38.0%(46/121)、焦虑障碍48.8%(59/121),对照组1例有轻度的抑郁障碍,P<0.01。有心理障碍FD者食管动力障碍发生率(26.0%,19/73)比非心理障碍FD者(10.4%,5/48)显著增高(P<0.05),且前者LES压力、食管体蠕动波幅、持续时间均显著高于后者(P<0.05)。结论食管动力障碍是FD重要功能紊乱之一,长期抑郁或焦虑可能影响FD食管动力。     

综合性医院精神科会诊90例分析

通过综合性医院精神科会诊90例分析,发现在综合性医院临床各科存在大量精神医学问题。会诊的主要原因是躯体疾病出现精神障碍（47.8%）要求诊断和处理;内科会诊占首位（86.7%）,其中神经内科最多（27.8%）,其次是临床免疫科和心血管内科。最多见的诊断是器质性疾病所致精神障碍（42.2%）,其次为神经症（28.9%）。由于近三年来加强了对医学生的精神病学教育并在非精神科医生中普及精神病学知识,使非精神科医生对精神疾病的诊断一致率有了较大的提高。但要向社会宣传精神卫生知识,改变社会对精神疾病的认识和态度,还有许多工作要做。     

An introduction to Kundalini yoga meditation techniques that are specific for the treatment of psychiatric disorders

The ancient system of Kundalini yoga includes a vast array of meditation techniques and many were discovered to be specific for treating the psychiatric disorders as we know them today. One such technique was found to be specific for treating obsessive-compulsive disorder (OCD), the fourth most common psychiatric disorder, and the tenth most disabling disorder worldwide. Two published clinical trials are described here for treating OCD using a specific Kundalini yoga protocol. This OCD protocol also includes techniques that are useful for a wide range of anxiety disorders, as well as a technique specific for learning to manage fear, one for tranquilizing an angry mind, one for meeting mental challenges, and one for turning negative thoughts into positive thoughts. Part of that protocol is included here and published in detail elsewhere. In addition, a number of other disorder-specific meditation techniques are included here to help bring these tools to the attention of the medical and scientific community. These techniques are specific for phobias, addictive and substance abuse disorders, major depressive disorders, dyslexia, grief, insomnia and other sleep disorders.