甘肃省重性精神疾病现况调查

目的 了解甘肃省重性精神疾病的患病率和分布构成特点,为进一步开展重性精神疾病的社区防治和康复工作提供基础数据。方法 采用线索调查与整群抽样相结合的方法,于2015年4-9月对甘肃省内常住居民按照村、居委会、小区逐个摸底和排查,以精神与行为障碍分类(ICD-10)和中国精神障碍分类与诊断标准第三版(CCMD-3)为诊断标准对排查出的疑似患者进行确定诊断,采用SPSS 19.0软件进行统计分析。结果 截至2015年9月30日,甘肃省重性精神疾病确诊病例共47 215例,时点患病率为1.832‰,精神分裂症患病率为1.339‰,各类型患病率差异有统计学意义(χ²=109 928.571,P=0.000);农村地区重性精神疾病患病率(2.483‰)高于城市地区(0.803‰)(χ²=9 441.793,P=0.000);总体上,男性患病率(1.877‰)高于女性(1.784‰)(χ²=30.250,P=0.000),其中男性精神发育迟滞伴发精神障碍和癫痫所致精神障碍患病率均高于女性(χ²=326.274,P=0.000; χ²=120.624,P=0.000),而女性双相情感障碍和分裂情感障碍的患病率均高于男性(χ²=24.590,P=0.000; χ²=30.218,P=0.000);重性精神疾病患者主要集中在46~55岁年龄段(27.1%),多为汉族(94.6%)、小学以下文化程度(44.1%)、已婚(55.9%)、农民(79.5%)。结论 精神分裂症是重性精神疾病的管理治疗重点,同时应针对不同人群特征采取不同的管理治疗措施,今后应进一步加强对农村地区重性精神疾病患者的政策帮扶。     

成都市重性精神疾病社区防治现况调查

目的了解成都市社区精神卫生服务及重性精神疾病社区防治工作开展情况。方法采用两阶段分层抽样方式,选取6个区县共16家社区卫生服务中心/乡镇卫生院进行问卷调查。结果不同圈层的重性精神疾病患者管理率、重性精神疾病患者规范管理率、管理患者肇事肇祸率及管理患者体检率等指标有较大差异。结论 （1）社区卫生服务中心在管理的规范性方面普遍好于乡镇卫生院,但乡镇卫生院在工作总量和工作的扎实程度上好于社区卫生服务中心;（2）一、三圈层工作开展情况好于二圈层。     

潜江市4038例重性精神疾病患者现状调查分析

目的了解潜江市2016年中央补助地方重性精神疾病管理治疗项目在管重性精神疾病患者的现状。方法对在管的重性精神疾病患者按人口学特征和疾病特征进行统计分析。结果 4 038例患者中18～44岁占53.99%;初中学历占37.22%;农民占56.91%;精神分裂症占78.75%。结论精神分裂症是重性精神疾病防治的重点,政府部门应做好相关的政策支撑。     

杭州市社区重性精神疾病患者现况调查

目的 调查和分析杭州市重性精神疾病患者的评估和治疗情况,为制定和完善重性精神疾病社区防治策略和管理措施提供依据.方法 选取杭州市2012-2014年重性精神疾病患者社区管理数据,采用描述流行病学方法进行分析.结果 2012年重性精神疾病报告30 324例,2013年30 371例,2014年30 033例,检出率分别为4.63‰、4.34‰和4.29‰;规范管理率分别为90.6％、94.6％和94.9％;治疗率为66.9％ 、66.8％和66.2％.2012-2014年间杭州市8个主城区与7个区、县(市)的检出率均在4.04％～4.62％之间,每年的检出率比较两者差异无统计学意义(x2=0.04、2.86、0.90,P均＞0.05).2012-2014年的规范服药率为57.82％、59.12％和60.65％,呈逐年上升趋势,3年间比较差异有统计学意义(x2=31.20,P＜0.01).2012-2014年间,仅2012年报告1例次重性精神疾病患者肇事肇祸.各年度轻度滋事和肇事肇祸的男性患者明显多于女性,两者相比差异均有统计学意义(x2=7.17、7.74和6.98,P均＜0.01).结论 主城区与区县(市)重性精神疾病患者的检出率无显著性差异,规范服药率逐年上升,提示目前城乡一体化管理、重性精神疾病患者的社区管理纳入基本公共卫生服务项目等防治措施是有效、切实可行的.     

武汉市洪山区2145例重性精神疾病患者现状调查分析

目的：了解武汉市洪山区重性精神疾病流行病学现况,为社区管理和综合防控提供依据。方法由社区卫生服务中心和乡镇卫生院的公共卫生管理人员采集辖区内重性精神疾病患者的基本信息,再统一汇总给区疾控部门,按人口学特征和疾病特征进行统计分析。结果洪山区共排查出重性精神疾病患者2145例,患病率为2.27‰,其中精神分裂症占一半以上,患病率为1.28‰,各病种患病率差异有统计学意义(P <0.01)。男性总患病率明显高于女性,差异有统计学意义(P <0.01);患病年龄集中在18~44岁(52.59%);民族以汉族为主(99.72%);婚姻状况中以未婚为主(49.70%);文化程度中以大学及以上最多(26.20%);职业分布中以下岗或无业人员最多(33.05%);经济状况以非贫困为主(51.52%)。患者管理率为98.69%,服药总人数为1587人,治疗率为73.98%。危险性评估0级占75.96%;危险度较高的3~5级占5.81%。结论精神分裂症是重性精神疾病防治的重点,重性精神疾病的发生与性别、年龄、婚姻状况、教育程度等密切相关,政府部门还应进一步加大对重性精神疾病患者的救治力度。     

南岸区重性精神疾病患者社区管理模式研究

目的：研究分析重性精神疾病患者的社区管理模式。方法针对本区内200例重性精神疾病患者,制定合理的社区管理模式。结果经过为期一年的社区管理,全部患者病情状况稳定,没有复发,没有肇事肇祸现象,没有发生自杀现象。结论重视加强对重性精神疾病患者的社区管理,是保障社会秩序稳定,降低突发事件发生的关键措施。     

120例农村重性精神疾病患者管理现况分析

目的了解农村重性精神疾病患者管理现况及存在问题,为卫生行政部门制定政策提供相关建议与对策。方法抽取120例重性精神病患者,通过调查监护人了解患者管理现状。采用自行设计的调查问卷,对抽取的120名农村重性精神病患者的监护人进行调查。结果 120名监护人以父母、年龄集中在36~60岁、农民、文化程度低、家庭经济条件差、监护能力差为主;享受免费发药的患者的服药依从性好于自费买药的患者,两者差异有统计学意义(P0.05),享受免费发药患者病情稳定情况好于自费买药的患者,两者差异有统计学意义(P0.05),监护人管理药物的患者持续服药人数好于患者自身管理药物,两者差异有统计学意义(P0.05);患者建档率为99.16%,免费体检参与率为73.33%,随访率为81.66%。结论监护人管理药物,免费发药对稳定重性精神病患者的病情具有很好作用,应强化对患者救治救助并全面实行免费发药政策,同时加强患者及监护人的精神卫生健康教育。     

44例重性精神疾病患者自杀未遂相关因素分析

目的分析重性精神疾病患者自杀未遂的相关因素,为防范重性精神疾病病人自杀管理提供科学依据。方法对符合重性精神疾病诊断并自杀未遂的44人入户调查,了解自杀未遂的相关因素。结果自杀病种以情感性精神障碍居首位(6 5.9 1%),自杀首因是经济困难(52.2 7%),自杀方式以服农药为主(54.55%),自杀未遂主要是家人发现及时(6 1.3 6%),自杀时间以白天多见(59.09%)。结论重性精神疾病患者出现自杀既有个人因素,同时存在复杂的社会因素。因此,呼吁全社会对精神病人给予更多的理解和关爱。     

龙里县重性精神疾病的流行病学调查分析

目的:了解龙里县重性精神疾病患病率和流行病学特征,为有效开展重性精神疾病管理治疗措施提供科学依据。方法:对龙里县常住居民进行普查与线索调查,依据《中国精神障碍分类与诊断标准》第3版为诊断标准,对每例疑似病例进行诊断,确定重性精神疾病的类型。结果:龙里县重性精神疾病患病率为2.43‰,15岁以上人群患病率为3.11‰,以精神发育迟滞伴发精神障碍为主为53.86%,其次为精神分裂症占40.44%;男性患病率(133.5/万)高于女性患病率(90.69/10万),差异有统计学意义;30~49岁居民重性精神疾病患病率最高,占56.07%;职业以农民为主,占92.83%,婚姻状况以未婚患病为主,占55.88%,文化程度以文盲为主,占69.12%。结论:精神分裂症和精神发育迟滞伴发精神障碍患病率居前两位,占94.3%,农民和小学以下文化程度者发病率高,是龙里县重性精神疾病管理治疗的重点。     

社区重性精神疾病患者的流行病学特征及相关因素分析

目的探讨社区重性精神疾病患者病种构成及精神分裂症、双相障碍、癫痫所致精神障碍和精神发育迟滞4种主要重性精神疾病的流行病学特征,并对社区重性精神疾病患者分析其是否同意参加社区网络管理的相关因素。方法以中国精神障碍分类诊断标准第2版修订本为标准,将2011年8月至2012年7月厦门市国家重性精神疾病数据收集基本分析系统的5220例社区患者进行统计分析。结果社区重性精神疾病患者男性多于女性,男女比为1.23:1,平均年龄为(46.45±14.48)岁,平均发病年龄为(30.13±13.98)岁,平均发病病程为(16.32±11.09)年。病种构成中居于前4位的依次为精神分裂症(88.20%),双相障碍(4.23%),癫痫所致精神障碍(2.99%)和精神发育迟滞(2.84%)。四种主要重性精神疾病在年龄、性别、职业、婚姻状况、受教育程度和经济状况上均有统计学差异(均P<0.05)。单因素logistic回归分析显示,同意参加社区网络管理患者多为36-55岁、有职业、现婚、小学和经济状况为贫困人群;多因素logistic回归分析结果显示性别、受教育程度、婚姻状况、居住地和经济状况为独立的危险因素,女性、受教育程度为小学及以上人群、现婚人群和其他(离异或丧偶)人群、农村和贫困人群同意参加社区网络管理的可能性更大。结论不同重性精神疾病发病与患者性别、年龄、职业、婚姻状况、受教育程度和经济状况等等因素有关,社区精神卫生防治人员须重点关注受教育程度为文盲、未婚、城镇和非贫困等不同意参加社区网络管理的患者。     

Categorizing Temporal Patterns of Arrest in a Cohort of Adults with Serious Mental Illness

Temporal patterns of arrest among mental health systems' clientele have not been well explored. This study uses “trajectory analysis,” a methodology widely employed by criminologists exploring patterns of desistence in offending, to examine patterns of criminal justice involvement in a cohort of mental health service recipients. Data for this study are from a statewide cohort of individuals who received services from the Massachusetts Department of Mental Health in 1991 (N = 13,876) and whose arrests were followed for roughly 10 years. Zero-inflated Poisson trajectory analysis applied to cohort members having two or more arrests identified five trajectories with widely varying arrest patterns. Analysis of differences in the composition of the five trajectory-based groups revealed few between-group differences in members' demographic and service use characteristics, while certain offense types were disproportionately prevalent among particular trajectory-based groups. The implications of these findings for understanding criminal justice involvement in this population and the utility of the trajectory model for system planning are discussed.     

社会支持模式对重性精神疾病患者家属心理状况的影响

目的调查深圳市福田区在社区康复的重性精神疾病患者家属的心理健康状况,探讨福田区社会支持模式对改善重性精神疾病患者家属心理状况的效果。方法采用症状自评量表(SCL-90)在模式开展前对深圳市福田区174例重性精神疾病患者的家属进行测评;建立给予重性精神疾病患者家属以心理干预和健康教育为主的社会支持模式,为期一年;项目实施一年后再次对深圳市福田区174例重性精神疾病患者的家属进行第二次症状自评量表(SCL-90)测评。结果通过对患者家属给予以心理干预和健康教育为主的社会支持后,患者家属的SCL-90躯体化、抑郁、焦虑因子的评分较干预前有显著性降低(P<0.05)。结论重性精神疾病患者家属心理状况不容乐观,对在社区进行康复的重性精神疾病患者进行社会支持的同时,要重视对家属的社会支持,对家属实施以心理干预和健康教育为主的社会支持非常有必要,可有效改善患者家属的心理状况。     

The Criminalization of Persons with Serious Mental Illness Living in Rural Areas

Abstract: In the context of restrictive admissions policies at public inpatient facilities, rates of arrest and incarceration of persons with serious mental illness (SMI) have been increasing, leading to the perception that SMI persons are being unduly "criminalized." This paper describes the characteristics of persons with SMI (N=177) in Mississippi who have been (1) jailed without charges while awaiting a hospital bed and (2) jailed for a criminal offense. Seventy-five percent (N=132) of the 177 subjects had been held in local jails awaiting state hospital admission at least once in their lives, most for more than five days. Fifteen percent (N=26) had contact with the police for a criminal offense in the past year. Rural residence markedly increased the risk for waiting in jail (OR=4.24) but was not related to committing a criminal offense. Protective factors for any type of criminal justice contact were female gender, caucasian ethnicity, better compliance with medication regimes, and nonrural residence. The phenomenon of rural criminalization, i.e., waiting in jail without criminal charges, differs qualitatively from the criminalization that occurs in urban areas and may require a different solution. To avoid criminalization of SMI persons in rural areas, public mental health systems must develop effective crisis interventions in the community or work with local law enforcement officials and medical and mental health facilities to create more immediate access to acute inpatient care.     

Serious Mental Illness and Nursing Home Quality of Care

Objective

To estimate the effect of a nursing home''s share of residents with a serious mental illness (SMI) on the quality of care.

Data Sources

Secondary nursing home level data over the period 2000 through 2008 obtained from the Minimum Data Set, OSCAR, and Medicare claims.

Study Design

We employ an instrumental variables approach to address the potential endogeneity of the share of SMI residents in nursing homes in a model including nursing home and year fixed effects.

Principal Findings

An increase in the share of SMI nursing home residents positively affected the hospitalization rate among non-SMI residents and negatively affected staffing skill mix and level. We did not observe a statistically significant effect on inspection-based health deficiencies or the hospitalization rate for SMI residents.

Conclusions

Across the majority of indicators, a greater SMI share resulted in lower nursing home quality. Given the increased prevalence of nursing home residents with SMI, policy makers and providers will need to adjust practices in the context of this new patient population. Reforms may include more stringent preadmission screening, new regulations, reimbursement changes, and increased reporting and oversight.     

Work and Health of Parents of Adult Children with Serious Mental Illness

This study examined the effects of work schedule flexibility and the spillover of work stress to family life on the health of parents of adult children with serious mental illness (SMI). The authors compared 100 parents of adult children with SMI to 500 parents with nondisabled adult children using data from the Wisconsin Longitudinal Study. The detrimental impact on health of a lack of work flexibility and of higher levels of negative work‐to‐family spillover was more pronounced among parents of adult children with SMI than parents with nondisabled adult children. The results have significant implications for developing interventions to help midlife families of persons with SMI cope with work‐related stress and for policies that provide for greater work schedule flexibility.     

Gender Differences and Risk of Arrest Among Offenders with Serious Mental Illness

Despite the increasing number of men and women with serious mental illness (SMI) incarcerated in America's jails, little research exists on the role gender may play in arrest among persons with SMI. This study examined correlates of arrests among offenders with SMI, specifically the role of gender. County criminal justice records, as well as county and statewide social service archival databases, were used to identify jail inmates with SMI in a large urban county in Florida. Of the 3,769 inmates identified, 41% were female. This study identified three distinct classes of male and female offenders within which persons had similar trajectories of arrests over the 4-year study period representing those with minimal, low, and high arrest rates. Findings suggest some important differences between women and men in risk factors for re-arrests. Attention to these factors may improve the ability to prevent future recidivism among men and women with SMI.     

Adequacy of Treatment for Serious Mental Illness in the United States

OBJECTIVES: The purpose of this study was to assess the prevalence and correlates of treatment for serious mental illness. METHODS: Data were derived from the National Comorbidity Survey, a cross-sectional, nationally representative household survey assessing the presence and correlates of mental disorders and treatments. Crude and adjusted likelihoods of receiving treatment for serious mental illness in the previous 12 months were calculated. RESULTS: Forty percent of respondents with serious mental illness had received treatment in the previous year. Of those receiving treatment, 38.9% received care that could be considered at least minimally adequate, resulting in 15.3% of all respondents with serious mental illness receiving minimally adequate treatment. Predictors of not receiving minimally adequate treatment included being a young adult or an African American, residing in the South, being diagnosed as having a psychotic disorder, and being treated in the general medical sector. CONCLUSIONS: Inadequate treatment of serious mental illness is an enormous public health problem. Public policies and cost-effective interventions are needed to improve both access to treatment and quality of treatment.     

Desire to Quit Smoking in an Outpatient Population of Persons with Serious Mental Illness

The Journal of Behavioral Health Services & Research - National survey data indicates that about 32% of adults with any mental illness smoke, compared with 23% of adults without a psychiatric...