48例首发抑郁症患者的精神科初诊情况调查

目的:了解抑郁症患者有关精神科初诊情况。方法:对48例首发抑郁症患者初次就诊精神科时的病程、主动性、非精神科诊治史等进行调查分析。结果:初诊时平均病程(6.4±4.4)个月,仅33.3%患者主动来诊,72.9%曾求治过非精神科。逐步回归分析显示,影响初诊时病程的因素为躯体症状、起病形式、发病年龄及悲观程度;影响就诊主动性的因素是自知力;非精神科就诊行为主要受躯体症状影响。结论:抑郁症患者多就诊不够及时、主动和恰当,其根本原因是对该病的认识不足。     

精神科首诊病人的疾病诊疗分析

目的 通过对首诊门诊病人的诊断、治疗分析,了解首诊疾病分布特点。方法 采用自制调查问卷,对3063例首诊病人的一般资料及疾病的诊断、治疗及相关情况进行调查分析。结果 轻型精神疾病,如神经症、心理障碍是首诊的主要疾病(占43.65％);农民是首诊病人主体,而农民中癔症的就诊人数明显高于其他各群体(P<0.0001)。结论 精神科门诊病人的疾病种类和分布特点已发生变化,健康教育应有针对性进行。     

精神科门诊误诊原因分析

目的：探讨精神科门诊首诊误诊的原因。方法：按照ＣＣＭＤ－２－Ｒ诊断标准，对比门诊诊断与住院诊断的差别，栓出误诊病例６５例。结果：病程不足３个月和大于３年者较易误诊。误诊为神经症者４０％以上，精神分裂症者接近４０％，精感性精神障碍２０％。结论：精神科门诊首诊误诊的原因可能与病史提供不全面，病程较短，早期症状不曲型及诊断标准变迁等有关。     

不同时期精神科门诊初诊病人的临床特征分析

目的分析不同时期初诊病人一般情况及诊断,旨在为精神科诊疗提供参考。方法自编调查表比较1994年1月1日-12月31日与2005年同期精神科门诊初诊病人,并进行统计学分析。结果2005年组门诊初诊病人为1994年组的两倍,其中,城镇病人显著增加,平均年龄显著增大,大学、高中文化程度者显著增多,农民和工人显著减少,已婚病人显著减少,精神分裂症、急性短暂性精神病、癔症和神经衰弱显著减少;而抑郁症、焦虑症、非器质性睡眠障碍和精神发育迟滞则显著增多。结论不同时期精神科门诊初诊病人的临床特征不同,应进一步加强对精神病的防治工作。     

综合医院精神科会诊患者失眠的临床研究

目的：探讨综合医院精神科会诊患者失眠的临床特征及与其它精神障碍的关系。方法：对168例精神科会诊患者进行分析。结果：128例(76、2％)会诊患者有失眠．其中61．7％(79／128)为慢性失眠。原发性失眠仅占5．5％(7／128)，85．1％(109／128)是与其它精神障碍有关的失眠。常见的精神障碍诊断为焦虑障碍、心境障碍和谵妄。60．9％的失眠患者在会诊前得到了处理。结论：应对临床医师进行精神卫生教育，提高他们对失眠等常见精神障碍的识别和处理能力。     

综合医院精神科会诊患者谵妄的临床特点

目的:探讨综合性医院精神科会诊中的谵妄与精神病专科医院中的谵妄的临床特点。方法:对综合性医院中精神科会诊中的58例谵妄患者(会诊组)与同期在精神病院的54例患者(非会诊组)的临床资料进行对照分析,并使用谵妄评分量表中文修订版(CAM-CR)测评。结果:会诊组中的谵妄患者年龄偏大,病因复杂,内科疾病以呼吸系统感染、脑卒中、心血管疾患多见,外科疾病以脑外伤、手术后、骨折多见,其中多系统疾病引起谵妄的几率最高,CAM-CR精神运动性抑制因子分显著高于非会诊组;非会诊组相对年龄偏小,病因简单,以精神活性物质依赖戒断、老年痴呆、抗精神病药应用不当多见,CAM-CR总分及意识水平的改变、知觉障碍、精神运动性兴奋因子分均显著高于会诊组。结论:综合性医院中的谵妄患者年龄大,病因症状复杂,误诊率高,预后差。会诊联络亟待加强。     

不同性别首次发作抑郁症的临床特征对比

目的：探讨不同性别首次发作抑郁症临床特征的异同。方法：采用一般情况问卷、抑郁白评量表(SDS)和汉密顿抑郁量表(HAMD)对不同性别首发抑郁症患者进行测查。结果：女性首发抑郁症患者发病年龄显著低于男性，HAMD的躯体化／焦虑、睡眠因子显著高于男性，而认识障碍、迟缓和绝望因子评分显著较男性为低。另外，女性抑郁症患者的共病显著高于男性。结论：不同性别首次发作抑郁症的临床特征存在一定的差异。     

北京市抑郁症患者首次就诊地点调查及原因分析

目的 探索北京市抑郁症患者首次就诊地点选择及其影响因素.方法 以2019年2—8月在北京14家医疗机构门诊确诊的抑郁症患者作为调查对象,采用自制的首诊抑郁症患者就诊现状调查问卷对患者进行首次就诊地点调查及进行原因分析.结果 4317人参与调查,2770人填写调查内容并纳入分析.首次就诊选择综合医院者占42.58％(10...     

精神科医生对伴有自杀意念和自杀未遂抑郁症患者的诊疗现况调查

目的 基于精神科医生视角，调查我国伴有自杀意念和自杀未遂的抑郁症患者的疾病特征、治疗现状以及目前临床诊疗中未被满足的需求。方法 本研究为横断面研究。采用便利抽样法，于2020年12月至2021年1月选取在我国24个省/直辖市的三甲综合医院或精神专科医院精神科工作的医生为研究对象。基于文献回顾和临床实践设计电子调查问卷，由专家顾问委员会审核完成问卷设计，采用该问卷收集医生的基本信息、接诊抑郁症患者的构成、接诊的伴自杀意念和自杀未遂抑郁症患者的临床特征、对伴自杀意念和自杀未遂患者的临床诊疗现况、医生与患者的临床需求和期望。本研究发放问卷317份，回收有效问卷209份，有效问卷回收率为65.9%。结果 分别有29.2%(61/209)和10.0%(21/209)的医生认为其接诊的抑郁症患者中，>50%有自杀意念和自杀未遂；而认为住院抑郁症患者>50%有自杀意念和自杀未遂的医生分别占58.4%(122/209)和16.3%(34/209)。46.9%(98/209)的医生认为有自杀意念的抑郁症患者会发展出现自杀未遂的比例在10%～30%。医生认为自杀未遂常见的风险因素包括既往自杀史...     

Consultation frequency and perceived consultation time in a Japanese psychiatric clinic: their relationship with patient consultation satisfaction and depression and anxiety

Aim:  To examine the relationship of the consultation frequency and the perceived consultation time of psychiatric clinic attenders with their satisfaction towards the consultation and depression and anxiety (measured by the Hospital Anxiety and Depression Scale).
Methods:  Questionnaires were distributed to 186 outpatients attending a psychiatric clinic.
Results:  In a path analytic model, a longer session with shorter interval ('dense' session) predicted lowered depression and anxiety level of the patientsthrough the perceived satisfaction of the patients, and it was also predicted by the higher anxiety level. The dense session was also influenced by shorter duration of clinic attendance.
Conclusion:  Dense psychiatric sessions in busy Japanese outpatient clinics may benefit patients.     

Sick-leave certificates granted to psychiatric outpatients with major depression

We investigated to what extent and for what reasons depressive outpatients are given certificates for sick-leaves and whether there are particular factors associated with the given sick-leaves. Our retrospective case note study was based on 213 adult psychiatric outpatients with first-time documented DSM-III-R major depression. Several sociodemographic, clinical, and treatment characteristics were detected during the follow-up of 3 months' medical care. This information was related to official registers of granted sick-leave certificates with a follow-up time of 30 months for the study patients. Sick-leave certificates were granted to 61% of patients. The mean duration of time off work due to documented illness was 142 days. Eighty-seven percent of the total sum of sick-leave days was for depressive disorders. Living with someone else, being employed, and early recognition of the illness were associated with the granted sick-leaves.     

Prevalence and clinical characteristics of psychotic versus nonpsychotic major depression in a general psychiatric outpatient clinic

Background: Psychotic major depression (PMD) is a severe mental disorder characterized by high levels of illness severity, chronicity, impairment, and treatment resistance. However, most past research on PMD has been conducted in inpatient hospital samples, and relatively little is known about PMD patients presenting for treatment in the community specifically. Methods: In this study, we examined the prevalence and clinical characteristics of PMD in a large sample (n=2,500) of treatment‐seeking outpatients who were administered structured clinical interviews by trained diagnosticians. Results: Of the patients diagnosed with major depression, 5.3% had psychotic features. PMD patients were more likely to be members of a racial/ethnic minority and to have lower educational attainment compared to those with nonpsychotic major depression. In addition, PMD patients were found to have greater current depression severity, suicidal ideation, and social and work impairment. These patients also were more likely to have histories of suicide attempts and psychiatric hospitalizations, to report an earlier age of illness onset, and to meet criteria for chronic depression. In terms of psychiatric comorbidity, PMD patients had higher rates of certain anxiety disorders as well as more somatoform and cluster A personality disorders. Conclusions: Results indicated that PMD was present in a relatively small percentage of treatment‐seeking outpatients but was associated with disproportionately high levels of severity and impairment. Similarities and differences between the current findings and those from past research are discussed, including clinical implications for the identification and treatment of PMD in routine practice settings. Depression and Anxiety, 2009. © 2008 Wiley‐Liss, Inc.     

76例首诊精神科的神经梅毒患者治疗和转归

目的 了解神经梅毒患者就诊于精神科的现状,探讨该人群的转归及预后.方法 选择2008年1月~2015年12月在我院门诊就诊、RPR筛查结果阳性、经确诊为神经梅毒的精神疾病患者.在确诊后3,6,12个月进行随访.结果 纳入随访的76例患者中,男性43例,女性33例.随访至12个月时,36例出现不同程度的认知功能下降;18例为躁狂或抑郁状态;10例出现幻觉及妄想状态;9例好转,2例临床治愈,1例死亡.76例患者均使用抗精神病、抗抑郁、抗躁狂或抗焦虑药物治疗.32例患者进行驱梅治疗,44例未用驱梅药物治疗,将随访患者分为驱梅治疗组与未驱梅治疗组,两组患者的MMSE评分差异无统计学意义(P>0.05);两组患者的MMSE评分于随访12个月与基线比较差异均有统计学意义(P<0.05).结论 抗精神病药物和驱梅治疗对神经梅毒患者的疗效并不显著,神经梅毒患者存在认知功能下降.     

Treatment compliance among psychiatric outpatients in Kenya

One hundred psychiatric outpatients discharged from mental hospital in Kenya were studied to estimate the treatment compliance after 3 months. The relatives and patients were interviewed separately to assess treatment adherence; 55 percent of them had defaulted in their treatment. Various factors were responsible for failure of compliance which included amongst many: unavailability of drugs which appears to be a common factor in Third World countries. Suggestions for better compliance included easily available injectable depot preparations or simple generic psychotropic drugs.