维思通治疗以听幻觉和妄想为主的精神病56例临床体会

我院近 3年用维思通治疗具有听幻觉和妄想为主的精神分裂症偏执型 36例 ,酒精所致精神障碍和颅脑创伤所致精神障碍各 10例 ,均取得较满意疗效 ,治愈率为 72 %。现将临床体会分析如下 :1　临床资料　1 1　一般资料　 5 6例精神病均选自本科 1997- 0 1～1999- 0 8住院患者。 (1)其临床表现均以妄想和听幻觉为主要精神症状 ;(2 )全部患者在用维思通治疗前除 4例对典型的抗精神病药物〔1〕有效外 ,其余均无效 ;(3)均按ＣＣＭＤ - 2—Ｒ〔2〕诊断标准进行诊断 :精神分裂症 36例 ,酒精所致精神障碍和颅脑创伤所致精神障碍各 10例 ;(4 ) 5 6例中男…     

冠状动脉造影对心房颤动患者的冠心病诊断价值

目的　用冠状动脉造影比较心房颤动 (房颤 )患者冠心病诊断的准确性 ,提高房颤患者冠心病诊断水平及临床价值。方法　 87例房颤患者包括阵发性房颤 5 6例、持续性房颤 31例 ,均行 18导联心电图、冠脉造影检查。对比心电图有缺血型ST T改变的阵发性房颤与持续性房颤患者的冠脉病变。通过房颤患者冠脉狭窄的分布 ,评价两者冠心病的诊断价值。冠脉狭窄 >5 0 %诊断冠心病。结果　① 87例心电图有缺血型ST T改变 36例 ,其中 ,阵发性房颤 2 0例 (5 5 .6 % ) ,冠脉造影示冠脉有不同程度狭窄者 12例(6 0 % ) ;持续性房颤 16例 (4 4.4 % ) ,冠脉造影示不同程度冠脉狭窄者 13例 (81.3% )。②房颤患者的冠脉狭窄的分布 :阵发性房颤 5 6例中冠脉造影正常者 4 4例 (78.6 % ) ;粥样硬化 8例 ;轻度狭窄 2例 ;中度狭窄及完全闭塞各 1例 ,计 12例 (12 .4 % )。持续性房颤 31例中冠脉造影正常者 3例 (9.7% ) ,有 18例 (5 8.1% )冠脉造影有不同程度狭窄 (粥样硬化、轻度狭窄各 10例、中度狭窄 4例、完全闭塞 3例、重度狭窄 1例 )而且多为 2、3支血管病变 ,两组比较有差异非常显著 (P <0 .0 1)。③冠脉造影对房颤冠心病的诊断价值 :阵发性房颤 5 6例中确诊为冠心病者 4例 (7.1% ) ;持续性房颤 31例中确诊冠心病者 18例 (5 8.     

肺肿块穿刺标本癌基因蛋白检测

目的　研究流式细胞仪 (FCM)检测肺癌穿刺标本p5 3蛋白、增殖细胞核抗原 (PCNA)表达的价值。资料与方法　运用FCM检测 6 6例穿刺标本p5 3蛋白、PCNA表达。结果　 (1) 6 6例肺肿块中病理诊断恶性 5 3例 ,13例病理诊断及临床随防诊断为良性病变。 (2 ) 5 3例肺恶性病变p5 3蛋白表达阳性率为 6 2 .3% ,PCNA阳性率为4 5 .3% ;13例良性病变p5 3蛋白表达阳性率为 30 .8% ,PCNA阳性率为 7.7% ;两组p5 3蛋白、PCNA阳性表达有显著性差异 (P <0 .0 5 )。 (3) 5 3例肺恶性病变穿刺敏感性为 94 .3% ,13例肺良性病变穿刺特异性为 76 .9% ,6 6例穿刺诊断准确性为 90 .9% ,气胸发生率为 4 .6 %。结论　运用FCM可以检测肺癌穿刺标本p5 3蛋白、PCNA表达 ,为了解肺癌的分子生物学行为特性提供帮助。     

肠梗阻的腹部X线平片和CT诊断

目的 :探讨腹部X线平片和CT检查在肠梗阻诊断中的价值。方法 :经手术病理证实的 5 6例肠梗阻病人 ,男性2 9例 ,女性 2 7例 ,平均 4 2 .3± 11.5岁。术后均行腹部CT和X线平片检查。将腹部CT和X线平片表现与手术病理对照 ,分析其在判断肠梗阻有无、部位、类型及病因的准确性。结果 :5 6例肠梗阻中 ,判断肠梗阻的有无 :CT检查诊断 5 5例(98% ) ,X线平片诊断 4 5例 (80 .4 % ) (P <0 .0 5 )。肠梗阻部位的判断 ,CT正确诊断 5 0例 (89.3% ) ,平片正确诊断 38例(6 7.9% ) (P <0 .0 5 )。肠梗阻类型的判断 ,39例单纯机械性肠梗阻 ,CT诊断 36例 (92 .3% ) ,平片诊断 35例 (89.7% )(P >0 .0 5 ) ;10例绞窄性肠梗阻 ,CT诊断 9例 (85 .7% ) ,平片仅 1例做出诊断 (10 .0 % ) (P <0 .0 5 ) ;8例动力性肠梗阻 ,CT诊断 7例 (87.5 % ) ,平片诊断 5例 (6 2 .5 % ) (P >0 .0 5 )。肠梗阻病因的判断 ,CT诊断 5 0例 (89.3% ) ,平片诊断 2 8例(5 0 0 % ) (P <0 .0 1)。结论 :腹部X线平片和CT检查均可准确诊断肠梗阻 ,但在判断肠梗阻的部位、类型和病因方面 ,CT检查优于X线平片。     

睾丸肿瘤及肿瘤样病变的超声图像特征

目的探讨不同病理类型睾丸肿瘤的超声图像特点。方法回顾分析46例睾丸肿块的超声图像特征,将其分为6种二维超声类型与3种彩色多普勒类型,并与病理结果进行对照。结果根据肿块的二维超声分型,在总共46例肿块中,I型12例(26%)、II型14例(30%)、III型6例(13%)、IV型4例(9%)、V型6例(13%)、VI型4例(9%)。根据肿块的彩色多普勒分型,在46例中,高血供36例(78%)、低血供6例(13%)、无血供4例(9%)。精原细胞瘤与淋巴瘤多数为I型及II型;非精原细胞生殖细胞瘤为III、IV、V型;而表皮囊肿均呈无血供。结论超声对睾丸肿瘤的诊断有很大的价值,总结各种病理类型肿瘤的超声图像对提高诊断能力十分有帮助。     

颈部神经鞘瘤85例临床分析

我们回顾性总结了 85例颈部神经鞘瘤的诊断和治疗 ,并对其临床特点、CT表现、治疗方法进行了分析。1　对象与方法1.1　对象 :我院自 1985～ 1995年手术切除并经病理确诊的颈部神经鞘瘤 85例 ,其中男 83例 ,女 2例 ,年龄 2 0～ 5 0岁 ,平均 36 .5岁。病程 1.5～ 12年 ,平均 6 .5年。瘤体平均直径5 .0cm。原发于迷走神经 33例 (38.8% ) ,合并声音嘶哑 2例 ,颈动脉内侧移位 3例。交感神经发生 2 6例 (30 .6 % ) ,4例出现Horner氏征 ,颈动脉向前移位 1例。臂丛神经 8例(9.4 1% ) ,并同侧上肢放射电击感 6例。舌下神经来源 4例(4.70 % ) ,其中 …     

孤立性肺结节的CT计量诊断研究

目的:探讨应用改良最大似然法对周围型肺癌、良性肿瘤、结核球及炎性结节4种孤立肺结节(SPN)的鉴别诊断价值.方法:按要求筛选国内文献病例建立改良最大似然法评价方法,然后对我院证实的60例SPN(56例病理证实,2例结核球及2例炎性结节经临床证实)进行盲法回顾性诊断分析,其中周围型肺癌36例、良性肿瘤6例、结核球8例、炎性结节10例,其结果与病例中记录(常规阅片法)的诊断结果行比较.结果:筛选出10个常见CT征象建立改良最大似然法评价方法,60个SPN的诊断正确率分别为周围型肺癌80.5%(29/36)、良性肿瘤83.5%(5/6)、结核球75.0%(6/8)及炎性结节80.0%(8/10),总的诊断正确率为80.0%(48/60);常规阅片法诊断正确率分别为周围型肺癌69.4%(25/36)、良性肿瘤66.7%(4/6)、结核球62.5%(5/8)及炎性结节70.0%(7/10),总诊断正确率为68.3%(41/60);最大似然法诊断正确率略高于常规阅片法,但未见统计学显著性差异(χ2=1.89,P=0.167>0.05).结论:改良最大似然法对SPN的诊断有较好的准确率,有可能高于常规阅片法,可用于指导日常阅片工作,尤其是年轻医师或基层医院医师的工作.     

螺旋CT双期扫描对胰腺癌的诊断价值

目的　探讨螺旋CT双期扫描对胰腺癌的诊断价值。方法　回顾性分析 5 2例经病理证实的胰腺癌的CT表现。双期扫描方法时间为动脉期 (AP)延迟 2 5s,门静脉期 (PVP)延迟 6 5s,以 3～ 4ml s团注造影剂 80～ 10 0ml。结果　CT表现为胰腺内低密度肿块 4 3例 (82 .7% ) ,胰腺形态和轮廓改变 30例 (5 7.7% ) ,胰胆管扩张 39例 (75 % ) ,胰周血管侵犯 36例(6 9.2 % ) ,胰周淋巴转移 31例 (5 9.6 % ) ,肝转移 2 0例 (38.5 % ) ,腹膜种植 12例 (2 3% )。结论　螺旋CT双期扫描对胰腺癌的诊断准确率高 ,对诊断胰腺癌是否伴有周围血管侵犯和转移的准确性也较高。     

高压氧治疗脑器质性精神障碍患者的护理体会

脑器质性精神障碍指原发于脑部病变所致的精神障碍 ,高压氧 (HBO)对其治疗具有一定的疗效。但患者的精神症状往往会给治疗带来很多的不便和困难。我们自 1992年 3月～ 2 0 0 0年 12月采用 HBO治疗了 36 0例脑器质性精神障碍患者 ,护理方面取得了满意的效果 ,现将体会报告如下。一、临床资料1.一般资料 :本组患者共 36 0例 ;男 2 2 8例 ,女 132例 ;年龄最小 8岁 ,最大 75岁 ,平均 (45 .5± 3.7)岁。其中脑血管病 118例 ,颅脑外伤 15 4例 ,颅内感染 5 6例 ,中毒性脑病 32例。有临床精神症状包括 :精神运动性兴奋 180例 ,抑郁状态45例 ,焦虑…     

肾上腺手术282例分析

为探讨肾上腺肿瘤的病种分布特点及诊断方法 ,对 1993年 3月～ 2 0 0 1年 12月住院行肾上腺手术的 2 82例病案资料行回顾性分析。其中男 135例 ,女 14 7例 ,年龄 4 3 6± 13 0岁 ;病变位于左侧 136例 ,右侧 131例 ,双侧 15例 ;肾上腺皮质肿瘤 16 1例 ,髓质肿瘤 75例 ,间叶病变 33例 ,转移恶性肿瘤 13例。有内分泌功能的肿瘤中以醛固酮增多症最多 ,为 83例 ,库欣综合征 2 7例 ,嗜铬细胞瘤 5 9例 (19例为意外发现 )。意外瘤共 10 5例(37 2 % ) ,恶性肿瘤共 36例 (12 8% )。肾上腺肿瘤的最大直径为 4 8± 3 4cm(0 3～ 2 2 5cm) ,醛固酮腺瘤最小 ,恶性肿瘤最大。2 82例术前诊断与术后病理诊断的符合率为 6 5 2 % ,其中有内分泌功能的皮质腺瘤符合率最高     

Matricide and psychiatric evaluation: An update

Matricide is an infrequent crime that has often raised to the suspicion that the offender could suffer from a pathological mental status. Although it is hard to establish a relationship between mental disorders and specific forms of homicide, several studies suggest that matricide offender frequently suffers from schizophrenia or other psychotic disorders. Aim of the study was to review the literature in order to explore epidemiologic and psychiatric characteristics of matricide offenders with a focus on the cause of death and crime circumstances. According to the PRISMA statement, 16 out of 225 studies were included. Main findings were the following: 80 victims were reported in total, killed by 81 offenders. In one case two brothers were responsible for the matricide. 81.5% of the offenders were young males. The most represented psychiatric pattern of the offenders was schizophrenia and psychotic disorders (43.2%). 6.2% of victims had also psychiatric disorders. Sharp force injuries were the first cause of death (55%), followed by blunt trauma (15%) and asphyxia (15%). In 12% of cases overkilling was also reported. 13.6% of offenders were considered not guilty for reason of insanity while 25.9% of the offenders had diminished criminal responsibility. A case study of a young homicide offender suffering from personality disorder is reported. In this case the victim also suffered from psychiatric disorders and an overkilling occurred as she was stabbed multiple times post-mortem. In a second case of matricide, the victim was dismembered and the human remains were concealed in several plastic bags.     

The comparison of disposal attitudes towards forensic psychiatric patients among police officers,psychiatrists and community members in China

ObjectiveTo understand disposal attitudes towards forensic psychiatric patients among police officers, psychiatrists and community members in China.Method118 community members, 121 psychiatrists and 105 police officers completed a questionnaire regarding disposal attitudes towards forensic psychiatric patients.ResultSurveyed respondents (87.4%) believed patients with mental disorders experienced discrimination, and 97.4% were in favor of providing livelihood security for them. Police officers (89.5%) agreed that patients with mental illness were more violent than the general population, which was significantly higher than 74.4% of psychiatrists (X² = 14.29, P = 0.000). Among three groups, the most preferred disposal option for those found not guilty by reason of insanity (NGRI) was to treat them in the custody of a forensic psychiatric hospital, such as an Ankang Hospital (86.9%). The respondents agreed (96.8%) that an independent review board should be established for disposing decisions for forensic psychiatric patients. The percentage who agreed that police officers, prosecutors, and judges should be included in the review board was significantly higher among police officers than among community members (x² = 6.60, P = 0.01; x² = 9.74, P = 0.002; x² = 7.38, P = 0.007). When asked, “who has the legal right to determine whether offenders with mental disorders should bear criminal responsibility”, forensic psychiatrists and judges were the top two responders (79.5% and 63.4%, respectively).ConclusionThis study suggested that the majority of those surveyed, especially police officers, held that patients with mental illness were violent and should receive violence risk assessments. Although psychiatrists paid more attention to the rights of patients, they also lacked legal knowledge, similar to community members and police officers. Therefore, it is necessary to inform the public regarding mental health, and to provide legal knowledge.     

Psychological profiles of adult sexual assault victims

This is a retrospective analysis of the psychological and psychiatric history of adult patients who attended the Lancashire Sexual Assault and Forensic Examination Centre between April 1st 2010 and March 31st 2011 for forensic examination. During this time 269 adults attended for forensic examination; the records of these patients were audited for evidence of psychological or psychiatric ill health. Affective disorders were disclosed in 48.7% of cases (depression, depression and anxiety, anxiety, bipolar affective disorder) and 3.0% declared having been diagnosed with a psychotic illness (schizophrenia, psychotic illness, psychotic behaviour). Furthermore, deliberate self-harm was disclosed by 29.4% of complainants and 22.3% of attendees had attempted suicide at least once in their lifetime. This study highlights increased prevalence of mental illness in sexual assault complainants which contributes to increased states of vulnerability. This and further similar research efforts have a role to influence prevention schemes, management strategies and healthcare planning for those individuals who are sexually assaulted.     

Psychiatric evidence in extenuation: assessment and testimony in homicide defendants

The role of psychiatric evaluation and testimony on 202 cases demonstrates the participation of mental health experts in the legal process. The majority of these cases fall outside the mental abnormal groupings of 'incompetent to stand trial' or 'criminal insane'. A finding of diminished responsibility on account of mental illness provides for a finding of extenuating circumstances on account of mental illness. The numerous factors and categories influencing the defendant's behaviour are specific to each, requiring presentation for the court's discretion as to significance of psychiatric factors in extenuation of sentence. The population studies as representative of psychiatric extenuation are a personal consecutive sample of court referrals for formal evaluation undertaken in a psychiatric hospital unit. Reasons for referral all include possible psychiatric disorder. One third of referrals were accused of killing a family member. Alcohol and drugs were contributory to the behaviour in 50 per cent of cases. The contributions of witchcraft and history of head injury to the sample are evident in subgroupings. The value of psychiatric contribution to the courts is discussed in relation to South African legal process and clinical experiences.     

Rechtsradikale Gewalttäter

This study uses expert assessments to compare crime patterns and forensic psychiatric characteristics in German violent offenders, 24 with and 44 without a right-wing extremist background. There are considerable similarities between the groups with regard to dissocial predispositions. However, the right-wing offenders were on the average 6 years younger (median 18.5 years) and committed almost 90% of their offenses as a group (compared to 21% of the control group), and 75% of the assessed homicides (compared to 52%) involved complete strangers (compared to 45%). A considerably smaller number of psychiatric diagnoses were established in the study group, but every third subject exhibited a dissocial pattern. In two of three cases, diminished criminal responsibility due to alcohol consumption could not be excluded or was confirmed.     

Schuldfähigkeit unter dem Einfluss psychotroper Substanzen

In addition to the analytically determined concentrations and the theoretically possible effects, a wide range of further information is needed for a professional assessment of criminal responsibility for crimes committed under the influence of psychoactive substances. Are substance-related disorders, such as dependence or mental disorders present and what is the personality structure of the perpetrator? In addition to the levels of active substances detected, of special importance for an assessment are not only analysis of the behaviour before, during and after the act, the psychopathology under consideration of subjective and objective details but also capabilities shown during the crime. Perception of reality, control of impulses and affectivity are the most important criteria. In complex cases the close cooperation between forensic toxicology and forensic psychiatry is necessary.     

Prevalence of mental health problems and deliberate self-harm in complainants of sexual violence

The Haven Whitechapel, a sexual assault referral centre, provides a forensic service and after care to victims of serious sexual violence across North East London. Survivors of sexual assault display psychological sequelae including elevated rates of suicide ideation/attempts. Prevalence of mental health problems of 121 forensic cases seen between June and August 2004 was established. Of female clients aged over 13 years 8% had learning difficulties, 21% gave a past history of deliberate self-harm (DSH) and 20% psychiatric history. We formally assessed levels of safety and vulnerability prior to clients leaving the Haven. When mental health problems were identified additional screening questions were asked, followed by a flow chart outlining appropriate care pathways. Such practice was carried out over 6 months (September 2004 to February 2005). Of the 240 clients, 8% reported learning difficulties, 26% DSH and 21% psychiatric history. 4% of clients required urgent follow-up and 3% immediate referral to a psychiatric liaison team. There is a high background prevalence of mental health problems and DSH in our study population. Vulnerable people are at increased risk following sexual violence. Risk needs to be recognised and addressed. These findings have implications for the expansion of the SARC network.     

Forensic mental health evaluations of military personnel with traumatic life event,in a university hospital in Ankara,Turkey

IntroductionThe definition of psychological trauma has been rephrased with the DSM-5. From now on, witnessing someone else's traumatic event is also accepted as a traumatic life event. Therefore, the psychiatric examination of forensic cases gains importance for not overlooking a psychiatric trauma. This research aims to discuss the psychiatric examinations of military personnel who had a traumatic life event and to reveal psychiatric states of soldiers after trauma.Materials and methodsThe forensic reports prepared at Gulhane Military Medical Academy (GMMA), Forensic Medicine polyclinic between January 1, 2011 and November 30, 2014 were examined, and among them the cases sent to GMMA Psychiatry polyclinic for psychiatric examination were analyzed retrospectively.ResultsThere were a total of 2408 cases who applied for the arrangement of a judicial report and 167 of them required a psychological examination. Among 167 cases, 165 were male and 2 were female, and the mean age was 25.6 years. Anxiety disorder (53.9%) was the most common diagnosis as a result of the psychiatric examination, following posttraumatic stress disorder (PTSD) (18.6%), and 3.6% had no psychopathology. It was determined that injuries caused by firearms (38.3%) and explosive materials (26.3%) had caused psychological trauma the most. On the other hand, 11 (6.6%) cases were determined to have undergone a psychological trauma on account of being a witness to their friends' injuries during the conflict without experiencing any physical injury. There were not any statistically significant relationships between the severity of physical injury and being PTSD or anxiety disorder.DiscussionDevelopment of PTSD risk is directly correlated with the nature of trauma. The trauma types of the cases in our study were in the high-risk group because of the military population. Our study is of importance in terms of putting forward the psychiatric disorders seen in the military population with traumatic life history associated with war (combat-related). In this research, 26.1% of the cases followed up due to combat-related trauma were diagnosed with PTSD. Interestingly, this ratio was lower than the studies that have larger case numbers. There is still the need to conduct studies that will involve larger participants.     

Political assassins--the psychiatric perspective and beyond

Three cases of highly publicized political assassinations, which occurred during the twentieth century, are described. In two of them (Tsafendas and Amir) a head of a state was assassinated. In both cases the second author (A.Z.) was involved in the psychiatric evaluation of the perpetrator. A third case, in which a head of state was badly wounded (Hinckley) is referred due to its overwhelming impact on public opinion and legislation. Few similarities are found between the perpetrators, who came from different cultures and acted in different eras. The psychiatric examination had a crucial role in the outcome of their trial. In spite of different milieus the forensic psychiatrist found himself amidst a highly charged event. There is no single common denominator characterizing the psychopathology of the political assassin. It is suggested that there is a spectrum of psychiatric diagnoses ranging from the psychotic perpetrator who targets the victim due to his intrapsychic delusional world, to the "sane" fanatic who chooses to commit an extreme act of violence in the service of a political goal. The criminal act, as well as the trial and the verdict bring in its wake a huge emotional public response. Consequently, theories of conspiracy as well as legislation initiatives are raised. The forensic psychiatrist should adhere to the sphere of his expertise, and it is for the court to decide upon the issues of responsibility and fitness to stand trial.