住院酒依赖患者合并酒精所致其他精神障碍及独立精神障碍的特征

目的 探讨酒精依赖综合征(酒依赖)住院患者合并精神障碍情况及特点。方法 在某专科医院连续纳入住院酒依赖患者，采用DSM-IV诊断工具SCID-I详细评估患者是否有其他精神障碍并鉴别是否由酒精所致。结果 完成访谈的287例酒依赖住院患者中，171例(59.6%)患除酒依赖之外的DSM-IV轴I障碍(终身患),其中106例(36.9%)为现患。最常见的是酒精所致精神病性障碍(终身患38.7%、现患22.6%)、独立精神障碍(15.0%、7.3%)、酒精所致的心境障碍(14.3%、9.1%)。酒精所致的精神病性症状中，常见的依次是幻视(59.5%)、幻听(50.5%)和被害妄想(21.6%)。结论 住院酒依赖患者合并酒精所致其他精神障碍和独立精神障碍的比例非常高，制定酒依赖治疗方案时须充分考虑各种合并精神障碍的评估和治疗。     

延续性护理在酒精所致精神障碍患者中的应用

酒精所致精神障碍是指因长期反复过量饮酒导致躯体、心理强烈渴求,且造成精神、躯体功能损害.酒依赖的患病率逐年升高,已成为当前日益严重的医学和社会问题[1].酒精所致精神障碍患者住院期间经过药物治疗病情能得到控制,但是出院后不久因为复饮酒病情复发再次入院.     

973例次酒精所致精神障碍住院患者(2000年-2007年)的资料分析

目的:了解我院2000年-2007年酒精所致精神障碍住院患者的例次、构成比、诊断构成和人口学特征。方法:收集各年度精神障碍住院患者和酒精所致精神障碍住院患者的人次,查阅酒精所致精神障碍住院患者的病历并收集相关信息。结果:(1)2000年-2007年间共收治酒精所致精神障碍患者973例次,占精神病总住院患者人次的2.04%(973/47730);(2)酒精所致精神障碍住院患者人次虽逐年增加,但趋势分析表明各年度间在全部精神障碍住院患者人次的构成比差异无显著性(χ2=1.56,P>0.05);(3)诊断构成中,酒精所致精神病性障碍为82.6%,其次为酒依赖综合征16.2%;(4)酒精所致精神障碍住院患者以男性(97.9%)、中学文化程度者(64.5%)、已婚者(94.6%)和农民(57.3%)、工人(19.6%)居多,住院时年龄47.6 a±s9.6 a。结论:在精神病专科医院中,酒精所致精神障碍住院患者的构成比近年处于较高水平,住院诊断以酒精所致精神病性障碍为主。     

26例酒精中毒性精神障碍的护理

人对酒精的反应个体差异很大，一次相对大量饮酒即可导致精神失常，如果长期饮用可引起各种精神障碍，包括依赖和戒断综合症，以及精神病性症状，还会损害躯体，影响脑、肝、肾等器官功能，并且带来许多社会问题。近20多年来，随着我国经济的发展，酒生产及人均消耗量均有明显增多，酒精中毒、酒依赖住院率明显增加，在国外，酒精所致精神障碍已成为最常见的精神障碍，在瑞士、德国、英国、丹麦、瑞典等国家中，男性慢性酒精中毒的患病率为3％。5％，女性也接近1％，从2001年1月-2005年3月止，我科收治26例酒精中毒所致精神障碍患者。治疗护理效果显著，现将护理体会报告如下。     

酒精所致精神障碍48例临床分析

目的：探讨酒精所致精神障碍的临床特征及疗效。方法：对48例酒精所致精神障碍住院患者的临床资料进行回顾性分析。结果：酒精所致精神障碍患者均男性,占同期住院患者总数的2.83%;低文化水平、工人居多,平均饮酒时间17年;精神症状以幻觉、妄想、兴奋躁动、智能障碍为主;27.08%的患者伴发躯体症状,31.25%的患者化验异常。治疗有效率89.58%,复发率22.92%。结论：酒精既可导致精神障碍,又可造成躯体损害,规范的治疗可以有效控制复发。     

慢性酒中毒所致精神障碍的临床特征及综合式家庭治疗的远期疗效对照

目的:分析慢性酒中毒所致精神障碍的临床特征,探索综合式家庭干预对远期戒酒的疗效。方法:对231例符合ICD-10中使用酒精所致精神障碍患者的临床资料进行回顾性分析,并将其中的163例依入组先后分为干预组(82例)和对照组(81例),干预组进行综合式家庭干预。结果:231例慢性酒中毒所致精神障碍患者中妄想症占29.4%、急性醉酒状态占25.1%、戒断综合征占24.6%及肝功异常占55.0%。干预组和对照组在再住院、完全或基本戒酒、社会功能与饮酒有关的负性事件(违法行为、离异和失业等)等多个方面差异有显著性(P<0.01)。结论:慢性酒中毒所致精神障碍患者的临床特征以戒断综合征、急性醉酒和妄想等为主,主要的躯体损害为肝功异常。对慢性酒中毒所致精神障碍患者而言,综合式家庭干预是维持疗效的较好方法。     

酒精所致精神障碍230例临床分析

目的:探讨酒精所致精神障碍患者的临床特征。方法:对2005年-2008年间在本院住院的230例酒精所致精神障碍患者临床资料进行回顾性分析。结果:患者均为男性,文化程度低、经济条件差、体力劳动者患病率高。患者的主要精神症状为妄想(20.00%)、幻觉(27.83%)、伤人和毁物(35.65%);主要神经系统症状为震颤(61.30%),周围神经炎(19.57%);有71.30%的患者伴有躯体疾病;住院≥2次者占40.43%。结论:酒精所致精神障碍患者的精神与躯体都受到了损伤,对其应积极进行治疗与干预。     

老年人酒精所致精神障碍的远期结局

目的:对老年人酒精所致精神障碍的预后结局进行随访研究。方法:54例住院酒精所致精神障碍老年病人出院5年后,对其预后结局状况进行纵向追踪调查。结果:76．7%病人出院后出现复饮,平均每日饮酒量比过去降低(P＜0．01),嗜酒者晚年躯体状况较差,部分人向酒精中毒性脑病发展,患者5年后死亡率较高(＜28．3%)。结论:过度饮酒对老年人的精神、躯体损害明显,患者晚期结局较差,应引起社会各界高度重视。     

酒依赖合并外科疾病者围手术期的处理

目的:探讨酒依赖合并外科疾病时其对外科手术的不利影响及其预防.方法:对1994年9月-2003年7月收治的33例合并酒依赖的外科患者围手术期间出现的精神障碍与躯体损害及相应治疗作回顾性分析.结果:23例患者存在与酒依赖相关的心、肝或凝血功能损害;所有患者在围手术期均出现不同程度的戒断综合征,需用药物治疗;与酒依赖相关手术并发症7例.结论:酒依赖对外科手术存在不利影响,在围手术期需采取相应干预措施.     

慢性乙醇中毒所致精神障碍66例分析

目的：探讨慢性乙醇中毒所致精神障碍的临床基本特征。方法：对66例慢性乙醇中毒所致精神障碍患者进行回顾性分析。结果：慢性乙醇中毒所致精神障碍以工人、农民、从事体力劳动的男性居多，导致精神和躯体均明显受损，并严重影响社会功能，同时合并多种躯体疾病。日饮酒量、酒龄对合并躯体疾病及出现精神症状的年龄有明显影响。结论：长期大量饮酒对人体造成精神、躯体及社会功能的全面损害，需加强乙醇危害的宣传与教育，严格控制饮酒，对酒依赖者应早期进行戒酒治疗。     

对94例慢性酒精中毒病人的临床分析

本文通过对９４例慢性酒精中毒病人的临床分析，发现酒中毒的病人中男性多于女性，低文化水平者高于高文化水平者。初次饮酒年龄１６－２５ａ，占６５．９６％，从初次饮酒到形成依赖的时间以１－３ａ最多，占４５．７４％。酒中毒后出现多种躯体症状，肝功能异常占４７．８７％，性功能异常占４２．５５％，脑萎缩占２０．２１％，脑电图异常和末梢神经炎的发生率为１３．８３％；酒中毒后还可出现多种精神症状，平均每例有２．６种，以记忆力下降最为显著，占７１．２８％，幻觉症占４８．９４％，人格改变占４７．８７％，酒后抑郁占３２．９８％，妄想占１５．９６％。因此，作者提出对酒的问题应予以足够的重视。     

Differentiation of alcoholics high and low in childhood hyperactivity

Fifty alcoholics who reported a greater number of childhood hyperactivity/minimum brain damage (MBD) symptoms (HA+ alcoholics) were compared to 49 alcoholics low in childhood hyperactivity/MBD (HA- alcoholics) with respect to patterns and severity of alcoholism, psychosocial functioning and physical status, personality and psychopathology, and familial alcoholism. HA+ alcoholics were found to report considerably more psychopathology on the MMPI and the Psychopathic State Inventory (PSI), findings which were suggestive of an underlying personality disorder. HA+ alcoholics were also found to differ significantly from the HA- alcoholics in several areas of psychosocial functioning and with respect to their pattern of alcoholism. That is, HA+ alcoholics had more interpersonal difficulties and had experienced more psychological/emotional problems; they were more likely to use alcohol to alter their moods and to use non-alcoholic illicit drugs; and they had less ability to internalize control of their impulses to consume alcohol. These findings, taken together, suggest that alcoholics reporting more symptoms of childhood hyperactivity/MBD may represent a subgroup within the larger alcoholic population. High and low hyperactivity alcoholics did not differ in severity of alcoholism or in alcohol-related physical effects or medical problems. Additionally, no evidence was obtained for a significant relationship between childhood hyperactivity and familial alcoholism.     

851例住院酒相关精神障碍患者的临床特征及治疗转归

目的 :探讨酒依赖和酒相关精神障碍的流行病学特点、临床特点、治疗和转归。方法 :收集 1991年 - 2 0 0 1年北京安定医院全部诊断为酒依赖和 或酒相关精神障碍的住院病历 ,制定调查记录表格 ,对调查纪录结果进行汇总、分析。结果 :诊断为酒依赖和 或酒相关精神障碍的住院病历 85 1份 ,占我院总住院人数的 3 33% ( 85 1 2 5 5 4 0 )。自 1996年 ,住院构成比有所增加 ,分别为 :1997年 4 2 7% ( 93例 ) ,1998年 4 0 8% ( 90例 ) ,1999年 3 89% ( 82例 ) ,2 0 0 0年 4 0 2 % ( 94例 )和 2 0 0 1年 4 0 3% ( 10 3例 )。男∶女 =93 4 5∶1。发病年龄为 4 1 38a±s 8 5 6a。诊断为戒断综合征4 5 8例 ( 5 3 82 % ) ,震颤谵妄 12 5例 ( 14 6 9% ) ,伴幻觉 2 85例 ( 33 4 9% ) ,伴妄想 2 14例 ( 2 5 15 % )。治疗措施主要为 :地西泮替代治疗、抗精神病药物治疗、抗抑郁治疗和匿名戒酒互助 12步法治疗。临床完全缓解的占 6 0 % ( 5 16例 ) ,好转占 35 % ( 2 91例 ) ,死亡 1% ( 5例 )。结论 :酒相关精神障碍住院比率近 5a有逐年增加的趋势。住院诊断以戒断综合征、酒相关幻觉妄想症为主     

84例住院酒精中毒性精神障碍患者的临床分析

目的:探讨酒精中毒性精神障碍的临床特点、治疗用药和转归。方法:收集乐山市精神卫生中心1988年-2007年诊断为酒精中毒性精神障碍的住院病历,对调查结果进行汇总、分析。结果:诊断为酒精中毒性精神障碍的住院病历84份,占总住院人数的3.43%(84/2450)。男∶女=83∶1。发病的年龄为49.37 a±s11.57 a。诊断为酒戒断综合征39例(46.43%)、酒精性妄想症21例(25.00%)、酒精性幻觉症16例(19.05%)、震颤谵妄6例(7.14%)、癫痫样发作2例(2.38%)。治疗用药排前4位的为:氟哌啶醇22例,舒必利20例,奋乃近9例,氯丙嗪8例。临床治愈21.43%(18例),显著进步40.48%(34例),好转19.05%(16例),进步7.14%(6例),自动出院8.33%(7例),转院3.57%(3例)。结论:酒精中毒性精神障碍患者住院诊断以戒断综合征、酒精性幻觉妄想症为主。治疗用药以抗精神病药物治疗为主。治疗有助于患者恢复。     

盐酸纳洛酮与盐酸纳美芬用于急性酒精中毒催醒的疗效比较

目的:比较盐酸纳洛酮与盐酸纳美芬用于急性酒精中毒催醒的临床疗效和安全性。方法:124例急性酒精中毒患者随机均分为对照组和观察组。两组患者均给予常规治疗。在此基础上,对照组昏睡者给予盐酸纳洛酮0.4 mg加入5%葡萄糖注射液20 ml中静脉推注,浅昏迷者给予盐酸纳洛酮0.8 mg加入5%葡萄糖注射液20 ml中静脉推注,所有患者再给予盐酸纳洛酮20μg/kg(剂量范围1.2².0 mg)加入5%葡萄糖注射液200 ml中静脉滴注;观察组患者给予盐酸纳美芬0.1 mg加入5%葡萄糖注射液25 ml中静脉推注后,浅昏迷者给予盐酸纳美芬0.2 mg加入5%葡萄糖注射液200 ml中静脉滴注,昏睡者给予盐酸纳美芬0.1mg加入5%葡萄糖注射液200 ml中静脉滴注。两组患者均治疗3 h后评价疗效,观察清醒时间、症状消失时间、用药剂量、平均住院时间、治疗费用及不良反应发生情况。结果:观察组患者总有效率显著高于对照组,清醒时间、症状消失时间、用药剂量、平均住院时间、主治药费、总费用、不良反应发生率均显著低于对照组,两组比较差异均有统计学意义(P<0.05)。结论:盐酸纳美芬用于急性酒精中毒催醒较盐酸纳洛酮疗效更显著,且治疗费用较低,安全性较好。     

Alcoholism and prevalence of medical and psychiatric disorders

Prevalence of medical disorders was determined for 10,758 consecutive admissions for inpatient alcoholism treatment to 13 hospitals located in eight states of the United States. The majority of patients (approximately 70% of the men and 73% of the women) had a significant medical problem other than alcoholism. The most prevalent disorders were diseases of the liver, gallbladder and pancreas; bronchitis; emphysema; and asthma. Hypertensive disease was found in 15% of the men and 7% of the women. Psychiatric disorders associated with alcoholism were neuroses, personality disorders and other nonpsychotic states. Less than 10% of all patients were referred by physicians; more than 90% had not been previously diagnosed or treated for medical or psychiatric disorders associated with alcoholism. The high prevalence of medical disorders indicates that inpatient treatment of alcoholism should be undertaken in facilities that have expertise and resources for concurrent treatment of serious medical illness.     

脑出血早期血肿扩大与既往病史关系探讨

目的:探讨既往病史对自发性脑出血早期血肿扩大的影响。方法:选择发病6 h以内入院的自发性脑出血患者300例,依据血肿扩大标准分为血肿扩大组及无血肿扩大组。将可能与早期血肿扩大相关的既往病史因素进行χ2检验,筛选具有显著性差异既往病史因素的行多因素Logistic回归分析。结果:自发性脑出血早期血肿扩大的发生率为20.33%,既往有高血压病史、脑萎缩病史、酗酒史及长期服用抗血小板聚集药物史者在2组病例中有显著性差异。Logistic回归分析示高血压病史、酗酒史及长期服用抗血小板聚集药物史是自发性脑出血患者早期血肿扩大相关危险因素。结论:既往有高血压病史、酗酒史及长期服用抗血小板聚集药物史的自发性脑出血患者易发生早期血肿扩大。     

Characteristics of male medical patients referred for alcoholism treatment

Purpose: Medically ill alcoholics are frequently encountered in medical practice, yet little is known about this subgroup of alcoholics. Anecdotal evidence suggests that current treatment methods may be ineffective in some of these patients, and that many of them resist referral to treatment programs. In this pilot study, we sought to characterize this group, in order to determine whether further research was indicated. Basic Procedures: In the Minneapolis VA Medical Center, we conducted a retrospective chart review of 61 alcoholics from 3 groups of alcohol-dependent patients: medical inpatients who accepted transfer to treatment, medical inpatients who refused transfer, and ambulatory patients requesting treatment. The groups were compared on demographic, physical, psychological, and laboratory characteristics, and on compliance with medical appointments. Most Important Findings: As might be expected, inpatients were older and sicker than ambulatory patients, but also demonstrated fewer nonmedical complications of alcoholism. On psychological testing, those who transferred were more likely to exhibit anxiety and depression, while the ambulatory patients were more antisocial. Inpatients who transferred differed from those who refused in having fewer previous treatments and less severe medical illness and in showing more compliance with medical recommendations in general. Principal Conclusions: These findings raise the possibility that these groups may significantly differ from one another, and suggest that further research on the characteristics of medically ill alcoholics is indicated. Improved characterization could potentially lead to more effective treatment approaches.     

Factors associated with consulting medical or non-medical practitioners for dyspepsia: an australian population-based study

BACKGROUND: Little is known about how many dyspeptics in the population consult medical and non-medical practitioners, or the factors associated with various consulting patterns. METHODS: A cross-sectional survey of 748 Australians with dyspepsia investigated their age, sex, dyspepsia symptoms, medical and non-medical consultations, and health status on the SF-12. RESULTS: Overall, 56% had ever consulted a medical practitioner for dyspepsia. Of these, 54% consulted within 6 months of first symptoms. Non-medical practitioners were consulted by 29%. Compared to dyspeptics in all, or most, other consulting groups, subjects who did not consult (37%, group NO) were characterized by fewer symptoms, better physical health, and younger age. Those who only consulted doctors (34%, group M) were older and had better mental, but poorer physical health. Those who only consulted non-medical practitioners (7%, group N) were younger and had better physical, but poorer mental health. Dyspeptics consulting both medical and non-medical practitioners (22%, group M + N), were older, more dissatisfied with medical care, had more symptoms and poorer physical and mental health. Timing of medical consultations was similar in groups M and M + N. Group M + N dyspeptics consulted similar types, but more non-medical practitioners than group N. No sex differences were found in consulting behaviour. CONCLUSIONS: Many dyspeptics do not consult; they have fewer symptoms than consulters. Consultation with non-medical practitioners is common and is associated with poor mental health. Dyspeptics seeking advice from both medical and non-medical practitioners are less satisfied with their medical management than those who only consult doctors for their dyspepsia.     

30例原发性扁桃体恶性肿瘤的发病特征分析

目的总结30例原发性扁桃体恶性肿瘤患者的发病特征。方法30例原发性扁桃体恶性肿瘤患者,回顾性分析患者的一般资料、首发症状、就诊经过、局部查体、病理类型等。结果30例患者中,男20例,女10例;年龄33~79岁,平均年龄(58.2±11.6)岁;有吸烟史20例,吸烟时间10~50年,平均吸烟时间(30.3±11.2)年,吸烟者中男19例,女1例。无症状2例,为体检发现;其余28例患者首发症状咽部疼痛(咽痛/吞咽痛)10例,咽异物感10例,颈部包块8例。病程0.5~120.0个月,平均病程(7.9±22.2)个月。其中15例在就诊过程中有抗生素应用史,4例用药后症状有不同程度的改善。局部检查可表现为非对称性扁桃体肿大17例、溃疡型5例、菜花样肿物8例。所有患者扁桃体触诊或扁桃体肿块触诊均明显质硬,溃疡型多有明显的触痛,占80%(4/5)。所有患者血常规白细胞总数均在正常范围。30例患者中鳞状细胞癌19例(63%),淋巴瘤11例(37%)。扁桃体鳞状细胞癌分化程度为高分化3例(16%,3/19),中/低分化16例(84%,16/19)。扁桃体淋巴瘤中弥漫大B细胞淋巴瘤8例(73%,8/11),外周T细胞淋巴瘤2例(18%,2/11),小淋巴细胞淋巴瘤1例(9%,1/11)。结论扁桃体触诊在诊断中占有重要地位,有以下情况建议常规行扁桃体触诊:①咽痛持续半个月以上,或咽异物感持续2个月以上,查体见非对称性扁桃体肿大,血常规正常;②颈部包块为首发症状,查体见非对称性扁桃体肿大。