双相情感障碍伴自杀行为的流行病学分析

目的分析双相情感障碍伴自杀行为患者的流行病学特征,提高对其诊治水平。方法选取2016年5月至2018年5月洛阳市第五人民医院(太康路院区)精神科收治的186例双相情感障碍患者,年龄(43.15±5.66)岁,年龄范围为23~55岁,对患者流行病学特征进行统计,并通过logistic回归分析与各种危险因素之间的关系。结果根据有无自杀行为将患者分为有自杀行为组(n=96)和无自杀行为组(n=90),两组患者性别、婚姻状况、人际关系、是否为独生子女方面比较,差异无统计学意义(P>0.05);两组患者年龄、吸烟史、精神异常史、饮酒史方面比较,差异有统计学意义(P<0.05)。男性有自杀行为组与男性无自杀行为组患者年龄、婚姻状况、吸烟史、人际关系、是否为独生子方面比较,差异无统计学意义(P>0.05);男性有自杀行为组与男性无自杀行为组患者精神异常史、是否饮酒、家族自杀史、既往自杀史比较,差异有统计学意义(P<0.05)。女性有自杀行为组与女性无自杀行为组患者婚姻状况、人际关系、是否为独生子女方面比较,差异无统计学意义(P>0.05);女性有自杀行为组与女性无自杀行为组患者年龄、吸烟史、精神异常史、饮酒史、家族自杀史、既往自杀史方面比较,差异有统计学意义(P<0.05)。logistic回归分析显示,女性、年龄大、重大精神创伤、既往自杀史与双相情感障碍伴自杀行为均呈正相关。结论女性、年龄大、有重大精神创伤、有自杀家族史、既往自杀史等都可能是双相情感障碍伴自杀行为患者的危险因素临床上应给予高度重视并及早采取干预措施,以免延误最佳治疗时机。     

住院男性精神分裂症患者自杀危险因素分析

目的:分析住院男性精神分裂症患者自杀危险因素。方法:对38例有自杀行为的男性精神分裂症患者进行临床资料分析,再将可能与自杀行为相关的症状因素列为观察指标进行危险度逐步Logistic回归分析。结果:本组有自杀史占84.2%,年龄偏小(30.1±14.5)岁,无职业者占65.8%,内向性格者占63.1%;妄想、睡眠紊乱自杀危险度分别增加2.303 1倍、1.878 2倍。结论:住院男性精神分裂症患者自杀行为可以预防,有自杀史、妄想、睡眠紊乱是住院男性精神分裂症患者自杀危险因素。     

双相情感障碍患者攻击行为的列线图预测模型构建

目的 探讨双相情感障碍患者攻击行为的影响因素,构建列线图预测模型。方法 选择2021年3月至2023年4月本院收治的80例双相情感障碍患者作为研究对象,分为未攻击组和攻击组,对两组患者的资料进行单因素分析,并将有统计学意义的因素进行logistic回归分析,绘制列线图,确定双相情感障碍患者攻击行为的影响因素。结果 共纳入80例患者,其中28例患者为攻击组（35.0%）,52例患者为未攻击组（65.0%）。攻击组患者长期独居的占比、总住院时间、既往有自杀倾向的占比均高于未攻击组,且ITAQ、SSRS的评分均低于未攻击组（P <0.05）。多因素logistic回归分析显示长期独居、既往有自杀倾向为双相情感障碍患者攻击行为的危险因素,ITAQ与SSRS的高评分为双相情感障碍患者攻击行为的保护因素（P <0.05）,并构建列线图,有良好预测价值。结论 患者的长期独居、既往有自杀倾向可能会增加双相情感障碍患者出现攻击行为的风险。     

不同年代住院精神病患者自杀的相关因素及护理策略

目的：了解不同年代住院精神病患者自杀的相关因素,以探索有效的预防精神病患者自杀的护理策略。方法：回顾性调查1961年～2000年32例不同年代住院精神病患者的自杀原因,并采用Logistic回归分析患者自杀的危险因素。结果：各种精神疾病患者自杀率差异无显著性（P〉0.05）;自杀与精神病理症状有关;既往有自杀史、负性生活事件、家庭成员有自杀史、病情严重和社会支持不足,是住院精神病患者发生自杀的危险因素;治疗依从性好是患者自杀的保护因素;各年代自杀率呈下降的趋势（P〈0.01）。结论：做好风险评估和实施预见性护理,控制病情,加强监护管理等综合护理措施,有利于预防住院精神病患者自杀行为。     

不同年代住院精神病患者自杀的相关因素及护理策略

目的：了解不同年代住院精神病患者自杀的相关因素,以探索有效的预防精神病患者自杀的护理策略。方法：回顾性调查1961年～2000年32例不同年代住院精神病患者的自杀原因,并采用Logistic回归分析患者自杀的危险因素。结果：各种精神疾病患者自杀率差异无显著性（P〉0.05）;自杀与精神病理症状有关;既往有自杀史、负性生活事件、家庭成员有自杀史、病情严重和社会支持不足,是住院精神病患者发生自杀的危险因素;治疗依从性好是患者自杀的保护因素;各年代自杀率呈下降的趋势（P〈0.01）。结论：做好风险评估和实施预见性护理,控制病情,加强监护管理等综合护理措施,有利于预防住院精神病患者自杀行为。     

双相情感障碍患者自杀倾向的影响因素分析

目的探讨双相情感障碍(BD)患者自杀倾向的影响因素。方法回顾性分析2019年5月～2020年6月我院78例BD患者的临床资料,采用Beck自杀意向量表评估所有患者的自杀倾向,并收集其基线资料,分析BD患者自杀倾向的影响因素。结果 78例BD患者有自杀倾向44例,占比56.41%;有自杀倾向组中女性占比、有自杀家族史占比、有酒精和药物滥用史占比均高于无自杀倾向组,5-羟色胺(5-HT)水平低于无自杀倾向组,差异均有统计学意义(P0.05);经Logistic回归分析发现,女性、有自杀家族史、有酒精和药物滥用史、5-HT水平低为BD患者自杀倾向的影响因素(OR1,P0.05)。结论 BD患者自杀倾向较高,且可能受女性、自杀家族史、酒精和药物滥用史、5-HT水平的影响。     

不同年代住院精神病患者自杀的相关因素及护理策略

目的 了解不同年代住院精神病患者自杀的相关因素,探索预防精神病患者自杀的护理策略.方法 回顾性调查1961～2000年住院精神病患者的自杀原因,并采用Logistic回归分析患者自杀的危险因素.结果 各种精神疾病患者自杀率差异无显著性(P>0.05);自杀与精神病理症状有关;既往有自杀史、负性生活事件、家庭成员有自杀史、病情严重、负性生活事件和社会支持不足,是住院精神病患者发生自杀的危险因素;治疗依从性好是患者自杀的保护因素;各年代自杀率呈下降的趋势(P<0.01).结论 做好风险评估和实施预见性护理,在控制病情的基础上加强监管等综合护理措施,有利于预防住院精神病患者自杀.     

非风湿性心脏病引起的房颤患者并发脑栓塞相关因素分析

目的 探讨非风湿性心脏病引起的房颤并发脑栓塞的相关因素.方法 221例非风湿性心脏病房颤患者,按是否新发生脑栓塞分为脑栓塞组(92例)和无脑栓塞组(129例)两组,分析非风湿性心脏病引起的房颤并发脑栓塞与患者的年龄、性别及高血压、糖尿病、吸烟、饮酒、卒中史、冠心病、心力衰竭、前白蛋白(PAB)、尿酸等的关系.结果 与非脑栓塞组相比,脑栓塞组患者年龄较大,女性、卒中史、PAB降低及合并高血压病、糖尿病者比例高,两组差异有统计学意义(P<0.01),在吸烟、饮酒、冠心病、血脂异常、心力衰竭、尿酸方面差异无统计学意义(P>0.05).多因素Logistic分析显示,年龄≥75岁、有高血压病和卒中史是脑栓塞的独立危险因素.结论 非风湿性心脏病房颤引起的脑栓塞患者,独立相关因素为年龄、女性、高血压病史、卒中史;前白蛋白(PAB)降低和并发糖尿病为相关因素.     

基于机器学习算法的双相情感障碍患者躁狂发作时暴力行为的预测模型

目的 探讨双相情感障碍患者躁狂发作时产生暴力行为的影响因素,基于机器学习算法建立预测双相情感障碍患者躁狂发作时暴力行为的风险模型。方法 回顾性选取2021年7月—2022年11月在本院治疗过的双相情感障碍且均发作躁狂的患者104例,根据躁狂发作时有无暴力行为分为暴力行为（Violent act,VA）组（n=51）和非VA组（n=53）,通过单因素Logistic回归分析得出对应的影响因素,应用R语言、SPSS软件,使用基于机器学习的Logistic回归、决策分类回归树（Classification regression tree,CRT）、支持向量机（Support vector machine,SVM）算法构建双相情感障碍患者躁狂发作时暴力行为的预测模型,并采用受试者工作(Receiver operating characteristic,ROC)曲线比较3种方法构建的模型对发生暴力行为的预测价值。结果 单因素Logistic回归分析结果显示,文化程度、自知力、病程、住院次数、杨氏躁狂量表（Young manic rating scale,YMRS）分数、近期应激事件、既往暴力史均与暴力行为发生有关,差异有统计学意义（P＜0.05）,多因素Logistic回归分析结果显示,自知力（β=1.519,OR=4.566,95％Cl=1.211-17.209）、病程（β=0.250,OR=1.284,95％Cl=1.017-1.622）、YMRS分数（β=0.063,OR=1.066,95％Cl=1.011-1.134）、既往暴力史（β=1.955,OR=7.065,95％Cl=2.272-21.969）均是躁狂发作产生暴力行为的独立危险因素（P＜0.05）。采用决策树CRT法构建的暴力行为预测模型显示,病程、既往暴力史、YMRS分数、住院次数、文化程度是患者躁狂发展时暴力行为的影响因素。SVM结果显示影响暴力因素发生重要性的前4位因素依次为既往暴力史、近期应激事件、YMRS分数、病程。3种机器学习算法构建的模型中,SVM模型预测效能最佳,曲线下面积（area under curve,AUC）为0.861,最佳截断值0.539对应的灵敏度、特异度分别为0.784、0.849。结论 双相情感障碍患者的病程、既往暴力史、住院次数等因素对躁狂发作时暴力行为的预测有重要意义,基于机器学习算法构建的双相情感障碍患者躁狂发作时暴力行为的预测模型具有较好的预测效能,其中以SVM模型诊断效能最佳,可进一步推广应用以验证预测模型的效能。     

青年急性心肌梗死危险因素研究

目的分析青年急性心肌梗死危险因素,寻找解决措施。方法随机选取我院2017年1月～2018年12月收治的青年急性心肌梗死患者80例纳入观察组。另选80例老年急性心肌梗死患者纳入对照组。收集两组患者病案信息,包括冠状脉造影结果、年龄、性别、饮酒、吸烟、合并症及梗死部位。比较两组患者一般指标,并进行多因素分析。结果观察组吸烟、饮酒、家族病史比例显著高于对照组,差异有统计学意义(P<0.05);观察组高血压、2型糖尿病发病率低于对照组,差异有统计学意义(P<0.05);两组患者性别成分比较,差异无统计学意义(P>0.05)。Logistic分析结果显示,吸烟、饮酒、家族病史、高血压、2型糖尿病是青年急性心肌梗死危险因素(P<0.05)。结论青年急性心肌梗死危险因素包括吸烟、饮酒、家族病史等,典型胸痛、前壁梗死是其主要临床特征;建议开展针对性急诊干预预。     

Suicidal ideation, plans, and attempts in chronic pain patients: factors associated with increased risk

This study describes suicidal behavior in a cross-sectional sample of chronic pain patients and evaluates factors associated with increased risk for suicidal ideation. One hundred-fifty-three adults with nonmalignant pain (42% back pain) who were consecutively referred to a tertiary care pain center completed a Structured Clinical Interview for Suicide History, the McGill Pain Questionnaire, and the Beck Depression Inventory. Nineteen-percent reported current passive suicidal ideation (PSI), 13% had active thoughts of committing suicide (ASI), 5% had a current suicide plan, and 5% reported a previous suicide attempt. Drug overdose was the most commonly reported plan and method of attempt (75%). Thirteen-percent reported a family history of suicide attempt/completion. Pain-specific and traditional suicide risk factors were evaluated as predictors of current PSI and ASI. Logistic regression analyses revealed that a family history of suicide attempts/completions was associated with a 7.5 fold increase in risk of PSI (P=0.001) and a 6.6 fold increase in ASI (P=0.003), after adjusting for significant covariates. Having abdominal pain was associated with an adjusted 5.5 fold increase in PSI (P=0.05) and a 4.2 fold increase in ASI (P=0.10). Neuropathic pain significantly reduced risk for both PSI (P=0.002) and ASI (P=0.01). Demographics, pain severity, and depression severity were not associated with suicidal ideation in multivariate analyses. These findings highlight the need for routine evaluation and monitoring of suicidal behavior in chronic pain, especially for patients with family histories of suicide, those taking potentially lethal medications, and patients with abdominal pain.     

Suicidal behavior in psychiatric emergency room patients

BACKGROUND: Psychiatric emergency room (ER) patients are thought to be at increased risk of suicide. The prevalence and characteristics of suicidal behavior in a recent sample of patients who came to the ER for psychiatric evaluation were examined. METHODS: Charts of 311 consecutive psychiatric ER patients were reviewed. Suicidal behavior was considered present if current suicidal ideation or attempts within 24 hours of or during the emergency evaluation were noted in the chart. RESULTS: Suicidal behavior was present in 38% of the psychiatric ER patients. Younger age, white race, affective disorders in female patients, and substance abuse disorders in male patients were features of the suicidal group. Sex of the patient was not associated with suicidal behavior. CONCLUSIONS: Suicidal behavior is prevalent in the psychiatric ER. Effective suicide prevention in this setting will hinge on finding more specific risk factors.     

单相抑郁症患者自杀行为遗传效应及其遗传方式的研究

背景遗传因素在抑郁症自杀行为的发生中占有一定的地位,以往的关注的重点主要为双相抑郁自杀的遗传效应,单相抑郁症自杀行为的遗传方式和遗传效应有何特征?目的探讨单相抑郁症自杀行为的遗传效应及遗传方式.设计回顾性调查.单位一所市级精神卫生中心.对象单相抑郁症组(n=115)为1983-06-01/2002-05-31无锡市精神卫生中心门诊和住院诊断为抑郁症的患者.诊断均符合中国精神障碍分类与诊断标准第3版抑郁发作及美国精神障碍诊断与统计手册第4版重性抑郁发作标准,且抑郁发作次数≥3次或发作一两次已缓解≥8年者.方法以符合入组标准的单相抑郁症患者为先证者,由2名主治医师及其以上医师对每一家系进行调查,填写自行编制的精神病家系调查表,内容主要包括患者及一级亲属所有成员社会人口学资料、疾病发作特点及次数、以往治疗及自杀情况.由2名主治医师或以上医师对每一患者进行再诊断,并由1名主任医师核查,一致确诊的病例则予入组.对所有现存活的先症者(107例)及一级亲属中有自杀行为者(14例)进行面检;对无自杀行为的一级亲属(337名)进行面检和信函调查(380名);死亡者(患者8例,一级亲属5例)的资料由一两名一级亲属提供有关情况填写调查表.对照组由2名研究者进行面检,同时询问一级亲属情况并填写家系调查表.对所得资料行单因素分析,用多基因阈值理论Falconer模式估算自杀行为的遗传率和标准误,用医学遗传数学方法中分离分析法和多基因阈值理论进行遗传方式的探讨.主要观察指标单相抑郁症患者自杀行为的遗传效应和遗传方式.结果单相抑郁症患者自杀危险性51.30%(59/115)较其一级亲属2.58%(19/736)高(x2=283.16,P＜0.01),单相抑郁症患者一级亲属自杀危险性2.58%(19/736)较对照组0.12%(3/2469)高(x2=50.36,P＜0.01),有自杀行为患者的一级亲属自杀危险性3.8%(14/372)较无自杀行为患者的一级亲属自杀危险性1.4%(5/363)高(x2=4.14,P＜0.05).单相抑郁症自杀行为的加权平均遗传率及标准误为(70.16±0.79)%;多基因遗传方式验证显示,多基因遗传方式验证显示一级亲属自杀行为预期发病率为3.1%,实际发病率为2.6%,两者差异无显著性意义(u=0.766,P＞0.05).结论单相抑郁症自杀行为有明显的遗传效应,其遗传方式符合多基因遗传.     

伴精神病性症状单相与双相抑郁障碍临床特征分析

目的：探讨伴精神病性症状单相与双相抑郁障碍的临床特征,为临床诊断提供依据。方法将56例伴精神病性症状单相抑郁障碍患者设为单相组,53例伴精神病性症状双相抑郁障碍患者设为双相组。两组均予以艾司西酞普兰联合喹硫平治疗,双相组辅以碳酸锂治疗。采用自制一般资料调查表、汉密顿抑郁量表、阳性与阴性症状量表进行测评分析。结果双相组病程显著长于单相组（ P＜0．05或0．01）,阳性精神病家族史及病前不良个性检出率显著高于单相组（ P＜0．05或0．01）;治疗前妄想、被动体验、情感低落检出率显著低于单相组（ P＜0．05或0．01）,自杀观念和自杀行为检出率显著高于单相组（ P＜0．05或0．01）。结论伴精神病性症状的双相抑郁障碍与单相抑郁障碍相比,具有病程较长、家族史阳性率较高、病前不良个性较多、伴精神病性症状时间较长等特点,自杀风险较高。     

探究与大学生抑郁症自杀未遂行为相关的社会心理因素

目的:探究与大学生抑郁障碍患者自杀未遂行为相关的童年创伤、家庭功能及社会支持。方法:招募大学生抑郁障碍患者156例,根据既往是否存在自杀行为分为自杀未遂组(n=78)和非自杀未遂组(n=78)。采用儿童创伤问卷中文版(CTQ)、家庭功能量表(FAD)、社会支持量表(SSRS)对2组进行评估。结果:与非自杀未遂组相比,自杀未遂组的情感虐待(P0.001)、情感忽视(P=0.001)、性虐待(P=0.002)、躯体虐待(P0.001)、躯体忽视(P=0.001)因子评分及总分(P0.001)更高;角色(P=0.039)、情感介入(P=0.023)、家庭总功能(P=0.010)及总分(P=0.018)更高;主观支持(P=0.007)、支持利用率(P=0.005)因子评分及总分(P=0.011)更高。情感虐待、性虐待、支持利用率是导致自杀行为发生的独立危险和保护因素。结论:伴自杀未遂行为的大学生抑郁障碍患者存在更严重的童年创伤、更差的家庭功能以及更少的社会支持。     

Prevalence of Bipolar Disorder symptoms in Primary Care (ProBiD-PC): A Canadian study

Objective To describe the prevalence of patients who screen positive for symptoms of bipolar disorder in primary care practice using the validated Mood Disorders Questionnaire (MDQ). Design Prevalence survey. Setting Fifty-four primary care practices across Canada. Participants Adult patients presenting to their primary care practitioners for any cause and reporting, during the course of their visits, current or previous symptoms of depression, anxiety, substance use disorders, or attention deficit hyperactivity disorder. Main outcome measures Subjects were screened for symptoms suggestive of bipolar disorder using the MDQ. Health-related quality of life, functional impairment, and work productivity were evaluated using the 12-Item Short-Form Health Survey and Sheehan Disability Scale. Results A total of 1416 patients were approached to participate in this study, and 1304 completed the survey. Of these, 27.9% screened positive for symptoms of bipolar disorder. All 13 items of the MDQ were significantly associated with screening positive for bipolar disorder (P < .05). Patients screening positive were significantly more likely to report depression, anxiety, substance use, attention deficit hyperactivity disorder, family history of bipolar disorder, or suicide attempts than patients screening negative were (P < .001). Health-related quality of life, work or school productivity, and social and family functioning were all significantly worse in patients who screened positive (P < .001). Conclusion This prevalence survey suggests that more than a quarter of patients presenting to primary care with past or current psychiatric indices are at risk of bipolar disorder. Patients exhibiting a cluster of these symptoms should be further questioned on family history of bipolar disorder and suicide attempts, and selectively screened for symptoms suggestive of bipolar disorder using the quick and high-yielding MDQ.     

Suicidal ideation among Viennese high school students

OBJECTIVE: Suicidality spans a spectrum ranging from suicidal thoughts to suicidal acts, and suicidal ideation is more prevalent in youth populations, suggesting important developmental issues. We assessed the prevalence of lifetime suicidal ideation and associated psychosocial factors among Viennese high school students. METHOD: An anonymous self-report survey assessing demographic characteristics and the major psychiatric risk factors of teenage suicide was completed by students at three Viennese high schools (n = 214; mean age 15.4 years). RESULTS: Eighty-one (37.9%) high school students reported having had suicidal thoughts at some point in their lives, girls significantly more often than boys (48.5% vs. 29.1%, P = 0.004). Furthermore, lifetime suicidal ideation in Viennese high school students was associated with living in broken-home families, cigarette smoking, substance problems (alcohol/drugs), self-reported depression, and high school type (the highest prevalence was in grammar school). After adjusting for confounders, we found that female gender, substance problems, school type and cigarette smoking were significantly associated with lifetime suicidal ideation in Viennese high school students. CONCLUSIONS: The psychosocial factors associated with adolescent suicidal ideation require attention in the contexts of suicide prevention and mental health promotion.     

Assessing suicide risk in stroke patients: review of two cases

Poststroke depression can be accompanied by suicidal ideation, yet reports of suicide among stroke patients are rare. When untreated, depression can become prolonged and severe. Risk factors for suicide include depression, severe insomnia, chronic illness, and organic brain syndrome. Early clinical assessment of suicide risk factors is essential in the rehabilitation setting. Two patients who developed mood disturbances in the acute poststroke period and eventually committed suicide are presented. Neither patient openly expressed suicidal thoughts to staff or family members. Retrospective analysis of medical records was compared to established suicide risk factors reported in the medical literature. Indirect verbal cues and nonverbal behavior patterns indicating potential suicide risk may have been present. Strategies for evaluation and management of suicidal behavior are discussed. These cases emphasize the need for early assessment of suicide risk by the entire rehabilitation team.     

某部新兵自杀未遂心理社会危险因素调查

目的 探讨新兵自杀未遂的心理社会危险因素.方法 采用多级整群抽样法随机抽取某部986名新兵,采用自编调查问卷、父母教养方式问卷、青少年生活事件量表和艾森克个性问卷进行调查.结果 2.1%曾有自杀未遂史,其中28.6%为反复自杀未遂.自杀未遂的原因以家庭矛盾居多.自杀方式以过量服药或服毒居多.自杀未遂的危险因素有生活事件、自杀行为家族史、父亲酗酒、家庭适应性、家庭经济困难、父亲过分干涉、受惩罚、父母离婚或再婚等.结论 自杀未遂在新兵中并不罕见,应认识其危险因素并积极进行干预.