1276例精神科重症监护病房患者合并躯体疾病及联络会诊的临床分析

目的调查精神科重症监护病房患者的躯体合并症及请综合科联络会诊情况。方法采用自编调查表对2014年入住绵阳市第三人民医院精神科重症监护病房的患者进行调查。结果 1276例入住精神科重症监护病房的患者中,检出躯体合并症1052例(82.45%),累计会诊1513人次,其中紧急/限期转综合科治疗57例。结论入住重症精神科病房患者躯体合并症多,在临床治疗中需加强多学科联络会诊及处置。     

对精神病房中具有痴呆症状患者的护理现状分析

痴呆多发生于老年期 ,发病率高。由于痴呆患者的临床特殊性 ,客观要求护理人员应根据其特殊性实施护理 ,但由于种种原因 ,精神病院病房中具有痴呆症状或达到痴呆诊断标准的患者通常与其他患者混住在一起 ,致该类患者得不到相应的特别护理。为此 ,作者对其护理现状作如下分析 ,并报道于后。1　资料与方法1 1　对象　作者就北京市三所精神病专科医院老年病房中具有痴呆症状或达到痴呆诊断标准的患者在老年病房的分布及老年科护士关于痴呆患者管理的知识方面进行调查。1 2　测试工具　①以简易智力检查表 (ｍｉｎｉｍｅｎｔａｌｓａｔｅｅｘａ…     

老年精神科115例重症监护病人临床特征初步分析

人口老龄化是21世纪一大社会问题，目前我国60岁以上的老年人已达1．26亿，约占总人口的10％，已经进入了老年型国家的行列，并且还将以每年3．2％的速度增长，据估计到2025年将达到2．9亿。另据流行病学调查发现65岁以上老年人痴呆的患病率为7．2％，其中阿尔茨海默病（AD）为4．2％，老年期抑郁症的患病率为1．78％。老年病人躯体疾病较多，老年精神科住院病人躯体疾病的处理也是临床工作的重点之一，目前对老年精神科危重病人的监护和及时处理的情况在国内罕见有相关报道，所以我们对上述人群的相关临床特征进行初步分析，希望能对老年精神科危重病人的处理提供一些资料。     

日常生活能力评定量表在精神科病房分级护理管理中的应用研究

目的探析日常生活能力评定量表在精神科病房分级护理管理中的应用效果。方法选取我院精神科病房178例患者作为研究对象,随机分为观察组与对照组各89例;其中对照组由护理人员遵照医生开具的护理级别医嘱进行护理,观察组由护理人员通过观察患者病情,参照日常生活能力评定量表(Activity of daily living scale,ADL)制定护理分级从而进行护理。比较分析两组患者的基础护理质量(皮肤与口腔卫生、衣着卫生、饮食护理、排泄护理、睡眠护理)、护理满意度以及住院期间不良事件发生率。结果观察组的皮肤与口腔卫生、衣着卫生、饮食护理、排泄护理、睡眠护理评分均显著高于对照组(均P0.001);观察组的护理满意度为96.6%,显著高于对照组85.4%(P0.001);观察组的不良事件发生率为7.9%,显著低于对照组20.2%(P=0.033)。结论通过结合ADL确定精神科病房患者的护理分级可有效提高基础护理质量、护理满意度,并有效减少患者住院期间的不良事件发生率,同时增加患者的依从性,具有良好的临床实用价值。     

优质护理服务在精神科男性病房应用中的效果研究

目的探讨优质护理服务在精神科男性病房临床应用中的效果。方法在芜湖市第四人民医院两个男性病房中抽取2012年10月-2013年4月入院的急性精神障碍住院患者60例,采用随机数字表法分为优质护理组和对照组各30例,采用护士用住院患者观察量表(NOSIE)及医院住院患者满意度调查表进行测评。结果两组住院第2周末NOSIE社会兴趣因子分、个人整洁因子分、迟缓因子分、总消极评分、总评分比较,差异有统计学意义(P0.05或0.01),出院前1周优质护理组社会兴趣因子评分高于对照组(P0.001)。优质护理组与对照组的综合满意度分别为100%、96.34%。结论优质护理服务可能会对住院精神病患者的治疗和康复起到积极作用。     

高龄老年认知功能障碍人群精神和行为异常症状的临床分析

目的研究高龄老年认知障碍人群精神和行为症状的发生率和严重程度。方法采用横断面研究方法,应用神经精神科问卷知情者版(neuropsychiatric inventory-questionnaire,NPI-Q)量表对作者医院住院和记忆门诊收治的80岁以上有记忆力障碍主诉的高龄老年人群进行调查,比较认知功能正常者和痴呆患者间精神和行为症状的发生率和严重程度。结果共纳入535例病例,其中认知功能正常组159例,痴呆组376例。NPI-Q检查结果显示,在过去1个月内高达86.7%的痴呆患者出现过至少一种精神和行为症状,而对照组的发生率为72.3%,显著低于痴呆组(P0.01)。在痴呆组,情感淡漠/漠不关心(59.8%)、夜间行为与睡眠障碍(47.3%)和易激惹/情绪不稳(46.8%)是最常见和最严重的3种表现,其中情感淡漠/漠不关心和易激惹/情绪不稳症状均显著高于认知功能正常组(P0.01)。痴呆患者组NPI-Q总分显著高于对照组(P0.01)。结论在高龄老年痴呆人群中精神和行为异常症状的发生率和严重程度均显著高于认知功能正常者,正确认识和治疗这些症状有利于提高高龄老年痴呆患者的生存质量。     

音乐治疗对不同严重程度痴呆患者精神行为症状的影响

目的 比较音乐治疗对不同严重程度痴呆患者精神行为症状的影响。方法 选取2017年 1—6 月在重庆市精神卫生中心住院的痴呆患者80 例,所有患者均接受精神科药物治疗,在此基础上进 行为期12 周的音乐治疗。采用神经精神科问卷（Neuropsychiatric Inventory, NPI）评估患者的精神行为症 状,采用临床痴呆评定量表（Clinical Dementia Rating scale, CDR）评估患者的痴呆严重程度,比较不同痴 呆严重程度患者的NPI评分情况。结果 干预结束后轻、中、重3组痴呆患者的NPI评分均较干预前改善, 但不同组间评分差异无统计学意义（P＞ 0.05）。结论 音乐治疗对不同严重程度痴呆患者精神行为症 状干预均有效。     

精神科住院患者病毒性肝炎感染状况调查

目的调查精神科住院患者病毒性肝炎感染的阳性率。方法对2004年1月～2005年12月的住院精神科患者4990例采用ELISA方法进行HBsAg、抗-HBs、HBeAg、抗-HBe、抗-HBc、抗-HCV、抗HEV-IgG检测。结果4990例住院精神科患者中HBsAg阳性174例,阳性率为3.5%;抗-HCV阳性28例,阳性率为0.56%;抗HEV-IgG阳性9例,阳性率为0.18%。结论根据精神科患者的特点,应加强病房患者管理,防止病毒性肝炎的院内感染。     

他汀类药物在阿尔茨海默病防治中的应用前景

老年性痴呆主要由两类病因构成:AD和血管性痴呆(vascular dementia,VaD),其中AD约占50%~60%,VaD约占10%~20%,其他为混合性痴呆(MID)或其他痴呆[1].我国最新的流行病学调查表明,65岁以上人群痴呆的发病率约为10%,并以每5年增加1倍的速度递增,在80岁以上人群中可高达40%,且与国外资料相比,其发病率和疾病种类构成比均无国籍和人种的明显差异[2].鉴于老年性痴呆对个人、家庭、社会的巨大危害性,将老年性痴呆的防治提高到国家战略性高度已迫不容缓.     

他汀类药物在阿尔茨海默病防治中的应用前景

老年性痴呆主要由两类病因构成:AD和血管性痴呆(vascular dementia,VaD),其中AD约占50%~60%,VaD约占10%~20%,其他为混合性痴呆(MID)或其他痴呆[1].我国最新的流行病学调查表明,65岁以上人群痴呆的发病率约为10%,并以每5年增加1倍的速度递增,在80岁以上人群中可高达40%,且与国外资料相比,其发病率和疾病种类构成比均无国籍和人种的明显差异[2].鉴于老年性痴呆对个人、家庭、社会的巨大危害性,将老年性痴呆的防治提高到国家战略性高度已迫不容缓.     

Prevalence of dementia disorders in institutionalized Swedish old people THE WORK LOAD IMPOSED BY CARING FOR THESE PATIENTS

The prevalence of dementia disorders was determined among 3,523 institutionalized patients aged 65 years or more in the county of Vasterbotten. Approximately one-third of the clientele were considered demented. The prevalence was calculated to be 3.7 % of the population in the county. The frequency of dementia disorders among the patients in the somatic long-stay wards, the nursing homes, and the mental hospital was rather similar (55–65 %). A surprisingly high percentage of demented (17.1 %) was found in the homes for the aged. The work load was nighest in the somatic long-stay wards and in the nursing homes. Patients in the mental hospital, however, differed markedly from those in other institutions with higher scores for aggressive and disturbing behaviour, which accounted for the large number of patients in the mental hospital with maximal work load. The findings are discussed with regard to future institutional care of demented patients and point out the need for better education in psychiatric care for the staff.     

Mental Health Care Deficiency Citations in Nursing Homes and Caregiver Staffing

In this paper, we examine the association between caregiver staffing levels and mental health outcomes in approximately 17,000 U.S. nursing homes. As outcomes, we focus on deficiency citations available in the Center for Medicare and Medicaid Services’ Online Survey, Certification, And Recording data. We examine nurse aide, licensed practical nurse, registered nurse, and mental health provider staffing. Our results show that the level of nursing staff matter with respect to mental health outcomes. Whereas greater RN staffing was associated with a lower likelihood of being cited for deficiencies in mental health care, greater LPN and NA staffing were associated with a higher likelihood. We found no association between mental health provider staffing levels and mental health outcomes.     

住院老年痴呆患者监护人的心理状态及其影响因素

目的探讨住院老年痴呆患者监护人的心理状态及其影响因素。方法采用一般情况调查表、症状自评量表（SCL-90）、社会支持评定量表（SSRS）、简易智力状态检查（MMSE）及AD病理行为评分表（BEHAVE-AD）对住院老年痴呆患者及门诊老年痴呆（AD和VD）患者和其监护人进行评定，并与正常老人的监护人和老年非痴呆患者的护理人员进行比较。结果住院痴呆患者监护人SCL-90总分及因子分比正常对照组和老年非痴呆患者护理组评分高，但较门诊痴呆组评分低，均有显著差异（P〈0．01-0．05）。单因素分析发现不同性别、年龄、文化程度、婚姻状况、工作情况、性格、病程、与患者的关系及有无躯体疾病之间SCL-90总评分均具有非常显著差异（P〈0．01）：逐步回归分析显示影响监护人心理状态的因素依次为患者痴呆的严重程度、精神行为症状、与患者关系、性别及社会支持。结论住院老年痴呆患者监护人的心理状态较差，影响因素是多方面的，应引起社会高度重视。     

Use of constraints and their correlates in Norwegian nursing homes

OBJECTIVE: To analyse the effect of patient and ward characteristics on the use of constraints in nursing homes. METHOD: Primary carers in 222 wards in Norwegian nursing homes were asked about use of constraints towards 1926 patients during seven days. Constraints were grouped as mechanical restraints, non-mechanical restraints, electronic surveillance, force or pressure in medical examination or treatment, and force or pressure in ADL. The patients' mental capacity (CDR score), activity in daily living (ADL) and behaviour (BARS score) were rated. Type and size of ward, staffing level and educational level of the staff was recorded. RESULTS: In all 758 of the patients were subjected to any constraint. Degree of dementia, aggressive behaviour and loss of function in ADL had significant impact on all types of constraint except for electronical surveillance. The strongest associations were found between degree of dementia and mechanical restraint (OR 5.14), impaired ADL and mechanical restraint (OR 9.23) and aggression and force or pressure in ADL (OR 3.75). Mechanical restraint was less used towards patients in special care units for persons with dementia (SCU) (OR 0.38) compared to patients in regular units (RU), whereas non-mechanical restraint was more frequent used in SCUs (OR 2.28). Type of ward had no significant impact on use of other types of constraints. Staff level and education level of the staff had no significant impact on the use of constraint. CONCLUSION: Constraint is frequently used in nursing homes, and most frequent toward patients with severe dementia, aggressive behaviour or low ADL function.     

Psychiatric morbidity in elderly patients admitted to non-psychiatric wards in a general/teaching hospital in Nigeria

OBJECTIVE: To determine the mental morbidity rate and types of disorders in elderly patients admitted to non-psychiatric wards of a teaching hospital in Nigeria; the ability of the non-psychiatrists to recognise the mental disorders was also assessed. METHOD: All subjects aged 60 years and above who were admitted into the medical, surgical and gynaecological wards were assessed with the Self-Reporting Questionnaire, Mini Mental State Examination and the Geriatric Mental State Schedule. Diagnoses of mental disorders were made with the ICD-10 Diagnostic Criteria for Research. The patients' case records were then examined to determine the medical and any mental disorder diagnoses made by the attending physicians. The data were analysed by the SPSS/PC(+) computer package. RESULTS: The mental morbidity rate was 45.3% with depression being the commonest disorder, followed by organic disorders (delirium and dementia), adjustment disorder and generalised anxiety disorder. There were also cases of alcohol and drug abuse. The physicians recognised only 2.8% of the mental disorders and referred one dementia patient to the mental health team. The negative predictive value for the physicians was poor. CONCLUSION: Non-psychiatrist medical practitioners in Nigeria need adequate training in mental health to enhance their ability to recognise psychiatric disorders.     

Closure of an Asylum: The Friern Study of Older People

This article reports a naturalistic study following the closure of Friern Hospital and the movement of elderly long-stay patients, who in the main suffered from severe dementia, to psychiatric nursing homes and hospital beds. It describes changes in the environments and in the patients’ cognition, behaviour and use of medical services. The results suggest that psychiatric nursing homes seem able to care for the majority if patients with severe dementia. Future studies should consider whether long-stay hospital beds may, however, be necessary for those with both psychiatric and physical health needs, where increased contact with health service personnel is essential. Prospective examination of the reasons for breakdown of placements in nursing homes and the differences between those placed in various settings may help future planning of services. Relatives’ opinions of the long-stay settings also require study. © 1997 by John Wiley & Sons, Ltd.     

Mental illness and use of home care nationally in the U.S. Department of Veterans Affairs.

OBJECTIVE: To determine whether patients with mental health diagnoses are more likely to utilize home-based primary care (HBPC), and to identify characteristics associated with HBPC admission among elderly and nonelderly veterans, specifically. METHODS: Patients receiving treatment during fiscal year (FY) 2003 and having no evidence of home care utilization during FY2002 were followed through FY2005 using administrative claims data of the Veterans Health Administration of the U.S. Department of Veterans Affairs (VA). Participants were 4,411,677 VA patients with no prior HBPC use. Cox proportional hazard models were developed to identify correlates of HBPC use. RESULTS: Of VA patients with no prior use of HBPC, 24.2% received a mental health diagnosis, of whom 1.5% eventually used HBPC. Two in five new HBPC admissions were diagnosed with mental illness. Patients diagnosed with dementia were 66% more likely to be admitted. Patients diagnosed with nonschizophrenia psychoses (hazard ratio [HR]: 1.30), miscellaneous affective disorders (HR: 1.22), and schizophrenia (HR: 1.21) had the next highest probabilities. Risk of admission was highest for > or = 3 outpatient medical visits (HR: 2.61), followed by any inpatient medical/surgical days (HR: 1.79) or outpatient mental health visits (HR: 1.30). Elderly patients with any inpatient mental health days were less likely to be admitted; younger patients with nursing home use, community residential care, and mental health intensive care management were more likely to be admitted. CONCLUSION: Given that mental illness is independently associated with the likelihood of admission, it is critical that providers develop the skills and resources necessary to meet the psychiatric needs of home care recipients.     

The effect of dementia on acute care in a geriatric medical unit.

Treatment of dementia costs billions of dollars in long-term care and community services every year. Dementia also burdens the acute care system and may contribute to financial problems for hospitals serving large numbers of demented elderly. In a specialized geriatric medical unit devoted to acute care of the frail elderly, Alzheimer's disease and vascular and mixed dementias afflicted 63% of inpatients and were associated with excess consumption of nursing resources, complications of treatment, nosocomial infections, lengthy hospitalizations, and financial losses to the hospital. Due in part to the effects of dementia on mobility, continence, and nutrition, demented patients suffered more frequently from life-threatening infections, sepsis, iatrogenic disease, and prolonged hospital stays. Hospital losses were 75% higher for demented patients than for nondemented patients. Dementia affected the majority of acute care patients in this study. However, it was rarely coded as an admitting diagnosis, even though it may have been the proximate cause of the medical morbidity which led to the acute hospitalization. In addition, despite the significant impact of dementia on the hospital course and costs, it was a factor in hospital reimbursement in less than one third of cases. The results indicate that dementia was not considered to be an acute diagnosis, nor was it recognized as a complex medical illness. The impact of dementia on acute hospitalization, including the mechanisms by which dementia prolongs the hospital stay, requires further investigation.     

Delirium and mental health history as predictors of aggression in individuals with dementia in inpatient settings

Objectives: Aggressive behaviors by patients with dementia present risk to health care workers and patients. An information processing model, developed to study aggressive behaviors among children, was applied to study aggression among older hospital patients with dementia. Hypotheses were that delirium and mental health or depression history, would relate to increased risk of aggressive behaviors.

Method: Electronic medical records were sampled for one year (n = 5008) and screened using the EMERSE search engine and hand review for dementia (n = 505) and aggressive behavior in individuals with dementia (n = 121). Records were reviewed for mental health history and presence of delirium.

Results: Regression analyses found interaction effects representing delirium and mental health or depression history associated with greater risk of aggressive behavior. Significant main effects were found for both dementia and mental health or depression history. Of the lowest risk group, 12% of patients exhibited aggression compared to 24%–35% of those with delirium, mental health or depression history, or the combination of these risk factors.

Conclusion: Delirium is the leading correlate of aggressive behaviors in hospitalized patients with dementia, and delirium or history of mental health diagnosis may lead to increased risk of aggressive behaviors in this setting.     

Use of nursing homes in the care of persons with severe mental illness: 1985 to 1995

OBJECTIVE: The study examined patterns of care for persons with mental illness in nursing homes in the United States from 1985 to 1995. During that period resident populations in public mental hospitals declined, and legislation aimed at diverting psychiatric patients from nursing homes was enacted. METHODS: Estimates of the number of current residents with a mental illness diagnosis and those with a severe mental illness were derived from the 1985 and 1995 National Nursing Home Surveys and the 1987 and 1996 Medical Expenditure Surveys. Trends by age group and changes in the mentally ill population over this period were assessed. RESULTS: The number of nursing home residents diagnosed with dementia-related illnesses and depressive illnesses increased, but the number with schizophrenia-related diagnoses declined. The most substantial declines occurred among residents under age 65; more than 60 percent fewer had any primary psychiatric diagnosis or severe mental illness. CONCLUSIONS: These findings suggest a reduced role for nursing homes in caring for persons with severe mental illness, especially those who are young and do not have comorbid physical conditions. Overall, it appears that nursing homes play a relatively minor role in the present system of mental health services for all but elderly persons with dementia.