某医院出院精神障碍患者疾病构成变化趋势分析

目的了解精神障碍出院患者疾病构成变化趋势,为防治精神疾病和加强亚专科建设提供参考依据。方法对云南省大理州第二人民医院2012年-2014年出院患者的基本信息和疾病构成情况及其变化情况进行比较。结果 3年来,我院出院患者共10476例,其中,男性占57.65%,女性占42.35%;年龄21~50岁有70%。多次住院的患者比例由13.61%上升到16.10%。精神分裂症与使用酒精所致的精神和行为障碍始终为前两位疾病,使用酒精所致的精神和行为障碍构成比由16.48%上升到19.01%,双相情感障碍构成比由7.71%上升到15.73%,脑损害和功能紊乱以及躯体疾病所致的其它精神障碍构成比由2.01%上升到4.57%。结论精神分裂症和使用酒精所致的精神和行为障碍始终为我院的服务重点,双相情感障碍、使用酒精所致的精神和行为障碍、脑损害和功能紊乱以及躯体疾病所致的其它精神障碍的构成比有上升趋势,应加强这些亚专科建设。     

精神障碍患者童年创伤经历及其与文化智力的关联研究

目的:探究精神障碍患者的童年创伤经历及与其文化智力水平的关联。方法:纳入就诊于昆明医科大学第二附属医院精神科的203例精神障碍患者(包括抑郁障碍、焦虑障碍、目前为抑郁发作的双相情感障碍患者),采用童年创伤问卷简化版(CTQ-SF)、文化智商问卷(CIQ)进行调查。根据童年创伤类型对患者进行分组,比较各组间童年创伤和文化智商的关联。结果:忽视组与忽视+虐待组患者的童年创伤经历、文化智商量表总分及各因子分均低于不伴童年创伤组的患者(P均<0.05)。情感忽视与文化智商量表总分、认知因子得分负向关联(β=-0.3、-0.3);躯体忽视与元认知因子得分、行为因子得分负向关联(β=-0.2、-0.2)。结论:与不伴有童年创伤经历的精神障碍患者相比,伴有童年创伤经历的患者的文化智力水平低。情感忽视和躯体忽视与此类患者的文化智力水平有较强的关联性。     

利培酮在非精神分裂症中的应用进展

本文综述了利培酮在器质性精神障碍、情感性精神障碍、边缘型人格障碍、强迫症、精神发育迟滞、注意缺陷多动障碍、抽动障碍、孤独症、酒精所致精神障碍、气功所致精神障碍、谵妄、创伤后应激障碍、躯体变形障碍、迟发性运动障碍等疾病中的应用情况。     

精神分裂症患者述情障碍与执行功能及情绪障碍的关系

目的 探讨精神分裂症患者的述情障碍与执行功能和焦虑、抑郁情绪之间的关系.方法 用多伦多述情障碍20个条目量表(TAS-20)、威斯康星卡片分类测试(WCST)、焦虑自评量表(SAS)和抑郁自评量表(SDS)对150例精神分裂症患者分别进行述情障碍、执行功能及焦虑和抑郁症状的评定,抽取TAS总分≥62为高分组(38例)和TAS总分≤53为低分组(42例),比较两组的WCST成绩并与TAS-20总分及各因子分进行相关分析.同时将SAS、SDS标准分与TAS-20进行相关分析.结果 述情障碍高分组的错误应答数、非持续性错误数、完成第一次分类应答数均高于低分组(P＜0.05);而高分组的完成分类数、正确应答数、正确应答百分数、概念化水平应答率则明显低于低分组(P＜0.01);相关分析显示,TAS-20的总分及因子分与WCST成绩呈负相关(P＜0.05),TAS-20的总分及因子分与SAS、SDS标准分呈正相关(P＜0.05).结论 精神分裂症患者的述情障碍与执行功能损害、负性情绪密切相关.     

首次抑郁发作患者米那普仑治疗后负性自动思维、述情障碍及生活质量的变化

目的:探讨首次抑郁发作患者米那普仑治疗后负性自动思维、述情障碍及生活质量的变化。方法:对89例首次抑郁发作患者给予米那普仑治疗,分别于治疗前、治疗12周后进行负性自动思维问卷(ATQ)、多伦多述情障碍量表(TAS-20)及生活质量综合评定问卷(GQLI)评估,并进行比较及相关性分析。结果:米那普仑治疗12周后,患者ATQ评分显著低于治疗前(t=5.90,P0.01);TAS-20中情感辩别不能因子分、情感描述不能因子分及总分较治疗前显著降低(P均0.01);外向性思维因子分治疗前后差异无统计学意义;GQLI中的躯体健康、心理健康、社会功能维度评分及总分较治疗前显著增高(P均0.01);物质生活条件维度评分治疗前后差异无统计学意义。治疗前ATQ评分与TAS-20中情感辩别不能、情感描述不能因子分及总分呈正相关(P均0.01),与外向性思维因子分无相关性;治疗前ATQ评分与GQLI各维度评分及总分呈负相关(P0.01或P0.05)。结论:米那普仑治疗能够改善首次抑郁发作患者的负性自动思维水平,降低述情障碍的强度,提高生活质量。     

氯氮平和氯丙嗪维持治疗期精神分裂症认知功能与述情障碍比较

目的比较以氯氮平和氯丙嗪维持治疗的精神分裂症患者的认知功能与述情障碍。方法分别纳入以氯氮平、氯丙嗪维持治疗且病情稳定的男性精神分裂症患者各24例,以及男性正常对照24名。采用数字划消测验、言语流畅性测验、连线测验A和B、动物命名测验、Stroop色—词测验、韦氏智力测验中国版木块图、空间广度测验等神经心理测验评估三组被试的认知功能,并采用多伦多述情障碍量表(the twenty-item Toronto alexithymia scale,TAS-20)评估被试述情障碍。结果两患者组所有神经心理测验得分均低于对照组(P=0.02),两患者组TAS-20各因子分及总分均高于对照组(P0.01),两患者组之间认知功能及述情障碍评分差异均无统计学意义(P0.05)。多因素线性回归分析显示,氯氮平组注意功能与TAS总分(β=-0.20,P=0.02)相关联,执行功能与TAS情感辨别能力因子(β=-0.26,P=0.03)相关联,空间功能与TAS情感描述能力因子(β=-0.24,P0.01)相关联;氯丙嗪组注意功能与TAS情感描述能力因子(β=-1.24,P0.01)相关联,执行功能与TAS情感描述能力因子(β=-0.33,P=0.02)相关联。结论精神分裂症患者在药物维持治疗期仍存在广泛的认知功能损害及述情障碍,且认知损害与述情障碍间具有一定关联。     

首发精神分裂症与双相障碍及抑郁障碍认知功能比较

目的探讨首发精神分裂症、双相障碍及抑郁障碍患者认知功能差异。方法纳入首发精神分裂症患者61例,双相障碍患者57例,抑郁障碍患者48例,另设正常对照59名。所有研究对象采用重复性神经心理测查系统(Repeatable Battery for the Assessment of Neuropsychological Status,RBANS)评估认知功能,首发精神分裂症组采用阳性和阴性症状量表(positive and negative syndrome scale,PANSS)评定精神病性症状,双相障碍组、抑郁障碍组采用汉密尔顿抑郁量表(Hamilton depression scale,HAMD)、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)评估抑郁和焦虑症状,贝克—拉范森躁狂(Bech-Rafaelsen mania scale,BRMS)量表评估躁狂症状。结果 4组对象的RBANS总分(F=5.18,P0.01)、即刻记忆(F=4.09,P0.01)、言语功能(F=9.53,P0.01)、注意(F=3.87,P=0.01)、延时记忆(F=9.86,P0.01)因子得分差异具有统计学意义,其中首发精神分裂症、双相障碍组RBANS总分低于对照组(P0.01),首发精神分裂症、双相障碍、抑郁障碍组即刻记忆、言语功能、延时记忆得分低于对照组(P0.05),双相障碍组言语功能得分低于首发精神分裂症组(P0.01),首发精神分裂症组注意得分低于抑郁障碍及对照组(P0.01)。结论首发精神分裂症、双相障碍、抑郁障碍患者均存在认知功能损伤,首发精神分裂症认知功能缺陷重于抑郁障碍,轻于双相障碍。     

系统干预对康复期精神分裂症患者症状和社会功能改善的对照研究

目的 探讨系统干预对康复期精神分裂症患者症状和社会功能改善的影响.方法 将282例康复期精神分裂症患者随机分成研究组和对照组,对研究组患者进行有针对性的系统干预,而对照组只给予一般性随访,共干预1年.在基线及干预后采用阳性与阴性症状量表(PANSS)、社会功能缺陷筛选量表(SDSS)及副反应量表(TESS)进行效果评定.结果 干预后,研究组PANSS和SDSS的各因子分及总分均显著低于对照组(P＜0.05),研究组SDSS总分较基线时显著降低(P<0.05),而PANSS的各因子分和总分无明显变化(P>0.05).干预后的研究组中,使用非典型杭精神病药物患者的PANSS和SDSS各因子分及总分均显著低于使用典型杭精神病药物者(P<0.05).研究组不良反应发生率显著低于对照组(P<0.05).结论 系统干预可有效改善康复期精神分裂症患者的症状和社会功能,非典型抗精神病药亦有助于改善患者的症状和社会功能.     

护士观察量表在住院精神病患者中的应用探讨

目的应用护士观察量表(NOSIE)对住院精神病患者病情进行纵向观察评定,调查不同住院阶段、不同病种患者病情变化特点,协助护士完善护理评估、护理诊断及制定护理措施。方法运用护士用住院病人观察量表(NOSIE-30)对129例住院精神病患者进行评定。入院48小时内进行第一次评定,以后每周评定一次,出院时再评定一次。结果随着病情的缓解,患者的各项评分虽有明显改善,但是,在社会兴趣评分方面仍然处于较低水平。精神分裂症组与非精神分裂症组第一次评分比较显示：精神分裂症组个人整洁、总分、总积极分低于非精神分裂症组(P＜0．05)；而精神病表现分高于非精神分裂症组(P＜0．001),与精神分裂症患者精神病性症状较多相吻合。第二次评分比较显示：精神分裂症组精神病表现分仍然高于非精神分裂症组(P＜0．01),提示一周内精神病性症状缓解不明显；总积极分低于非精神分裂症组(P＜0．05)。第三次评分比较显示：非精神分裂症组激惹、抑郁分高于精神分裂症组(P＜0．05)。结论对新入院的精神分裂症患者护理工作重点在于生活护理和精神病症状的观察、处理；针对恢复期精神病患者存在社会兴趣的障碍,应该及早进行心理干预、行为治疗、健康教育,提高患者的康复效果。     

阿立哌唑治疗脑器质性精神障碍疗效观察

我们以阿立哌唑治疗脑器质性精神障碍,观察疗效和不良反应,报告如下。1对象和方法为我院2004年8月至2005年12月收治的脑器质性精神障碍患者,符合中国精神障碍分类与诊断标准第3版诊断标准,简明精神病评定量表(BPRS)总分>45分,未用过其他抗精神病药。共12例,男7例,女5例,平均年龄(44·8±22·9)岁;其中脑外伤所致精神障碍6例,脑血管疾病所致精神障碍2例,癫疒间所致精神障碍4例。均使用阿立哌唑治疗,阿立哌唑初始剂量为5 mg/d,逐渐增至15~25 mg/d,疗程6周。脑血管疾病(脑梗死)加用尼莫地平和吡拉西坦(脑复康),癫疒间所致精神障碍加用抗癫疒…     

综合性医院精神科会诊中奥氮平的应用

目的　为了解奥氮平在联络精神医学中的对急性器质性精神障碍的治疗作用及安全性。方法　对 30例院外急会诊的器质性精神障碍的患者用奥氮平治疗 1周 ,按用药前后的BPRS(兴奋因子 )、CGI SI(临床总体印象量表 )、睡眠时间、心电图、肝肾功能进行自身T检验。结果　BPRS(兴奋因子 )、CGI SI测评的一同减分率≥ 75 % 3例、5 0 %～ 74 % 16例、2 5 %～ 4 9% 11例 ,显效率 6 6 33% ,总有效率 10 0 0 0 %。CGI SI、睡眠时间、医疗保健评分前后比较非常显著性差异 (P <0 0 0 1)、BPRS(兴奋因子 )减分率≥ 4 0 % ,而副反应量表 (TESS)、心电图、肝肾功疗前、疗后无差异 (P >0 0 5 )。结论　奥氮平在联络精神医学中对急性器质性精神障碍治疗有效 ,且安全性较高     

Delusional parasitosis. A comparative study to late-onset schizophrenia and organic mental disorders due to cerebral arteriosclerosis

Delusional parasitosis (DP) was found in about 7 of 10,000 psychiatric admissions. The comparison of patients suffering from DP (n = 20) with 170 cases of late-onset schizophrenia (LOS) and 120 patients diagnosed as organic mental disorder due to cerebral arteriosclerosis (CAS) showed more similarities of DP with organic than with schizophrenic disorders. In addition, the phenomenological analysis supports the classification of the majority of DP cases as organic mental disorders. Even careful analysis cannot always answer the question, whether the main symptoms of DP have to be classified as delusions, hallucinations or misidentifications.     

Keep calm and carry on: Mental disorder is not more “organic” than any other medical condition

Psychiatry as a discipline should no longer be grounded in the dualistic opposition between organic and mental disorders. This non-dualistic position refusing the partition along functional versus organic lines is in line with Jean Delay, and with Robert Spitzer who wanted to include in the definition of mental disorder discussed by the DSM-III task force the statement that “mental disorders are a subset of medical disorders”. However, it is interesting to note that Spitzer and colleagues ingeniously introduced the definition of “mental disorder” in the DSM-III in the following statement: “there is no satisfactory definition that specifies precise boundaries for the concept “mental disorder” (also true for such concepts as physical disorder and mental and physical health)”. Indeed, as for “mental disorders”, it is as difficult to define what they are as it is to define what constitutes a “physical disorder”. The problem is not the words “mental” or “organic” but the word “disorder”. In this line, Wakefield has proposed a useful “harmful dysfunction” analysis of mental disorder. They raise the issue of the dualistic opposition between organic and mental disorders, and situate the debate rather between the biological/physiological and the social. The paper provides a brief analysis of this shift on the question of what is a mental disorder, and demonstrates that a mental disorder is not more “organic” than any other medical condition. While establishing a dichotomy between organic and psychiatry is no longer intellectually tenable, the solution is not to reduce psychiatric and non-psychiatric disorders to the level of “organic disorders” but rather to continue to adopt both a critical and clinically pertinent approach to what constitutes a “disorder” in medicine.     

Cognitive phenotype and psychiatric disorder in 22q11.2 deletion syndrome: A review

The behavioural phenotype of 22q11.2 deletion syndrome syndrome (22q11DS), one of the most common human multiple anomaly syndromes, frequently includes intellectual disability (ID) together with high risk of diagnosis of psychotic disorders including schizophrenia. Candidate cognitive endophenotypes include problems with retrieval of contextual information from memory and in executive control and focussing of attention. 22q11DS may offer a model of the relationship between ID and risk of psychiatric disorder. This paper reviews research on the relationship between the cognitive phenotype and the development of psychiatric disorders in 22q11DS.Aspects of cognitive function including verbal I.Q., visual memory, and executive function, are associated with mental health outcome in people with 22q11DS. This relationship may result from a common neurobiological basis for the cognitive difficulties and psychiatric disorders. Some of the cognitive difficulties experienced by people with 22q11DS, especially in attention, memory retrieval, and face processing, may, however, in themselves constitute risk factors for development of hallucinations and paranoid delusions.Future research into factors leading to psychiatric disorder in people with 22q11DS should include assessment of social and psychological factors including life events, symptoms associated with trauma, attachment, and self-esteem, which together with cognitive risk factors may mediate mental health outcome.     

Screening for mental illness in a Veterans Affairs women's health clinic.

This study examined the prevalence of self-reported mental illness and related impairment in social and occupational functioning among 209 female veterans enrolled in a primary care clinic. Ninety-four (45 percent) of the women screened positive for at least one psychiatric disorder, 46 (22 percent) for two or more coexisting psychiatric disorders, and 40 (19 percent) for only subthreshold disorders. The degree of self-reported impairment in social and occupational functioning was strongly related to the number of psychiatric diagnoses. Women who were under the age of 50 and those who had a service-connected disability were more likely to screen positive for a mental disorder.     

Prevalence of dual diagnoses of mental and substance abuse disorders in general hospitals

Data from a 1980 discharge survey of general hospitals were analyzed to determine the prevalence of cases with coexisting diagnoses of mental and substance abuse disorders. Twelve percent of total cases (or 208,000 episodes) had dual diagnoses, a proportion similar to that found in another analysis of 1985 data. Of these cases, 55.5 percent had a primary diagnosis of an alcohol or drug disorder, most commonly alcohol- or drug-induced organic brain syndrome. Thirty-four percent of cases with a primary diagnosis of mental disorder had depressive neurosis, 24 percent had psychosis, and 19 percent had personality disorder. An additional 18.9 percent of all cases had two or more mental or substance abuse disorders. Dual-diagnosis cases had a shorter mean hospital stay than cases with mental disorder only.     

Organic mental disorders associated with bupropion in three patients.

Bupropion hydrochloride is a phenylaminoketone antidepressant whose clinical pharmacology is poorly understood. Part of bupropion's action may be attributed to inhibition of dopamine reuptake that may induce organic mental disorders in certain susceptible patients. We report three cases of organic mental disorders in patients receiving bupropion hydrochloride for treatment of the depressed phase of their bipolar-type mood instability. The organic mental disorders that occurred in these patients were characterized largely by visual disturbances--visual hallucinations and visual illusions--although one patient also experienced auditory hallucinations. The patients' use of concomitant medications and potential drug interactions are carefully evaluated and the literature on bupropion's ability to induce organic mental disorders is reviewed. We suggest a number of possible mediating mechanisms for these syndromes including dose-related dopaminergic augmentation, accumulation of toxic metabolites, predisposition to psychosis, and drug interactions.     

Social position and the common mental disorders with disability

BACKGROUND: Published studies linking the common mental disorders with social disadvantage lack basic comparability. This project aimed to estimate effect sizes and independence of social position markers as risk factors for common mental disorders. Disorders with disability were examined to identify groups with high clinical and policy priority. METHODS: Data from the 1993 household survey of psychiatric morbidity in Great Britain were analysed using logistic regression models, using traditional and more specific markers of social position. RESULTS: Of those with a common mental disorder, 22 % reported difficulty doing at least one activity of daily living, linked to their mental symptoms. In comprehensive statistical analyses, having two or more physical illnesses was associated with an odds ratio of 6.42 (95 % CI 4.34-9.51) for common mental disorder with disability, while odds ratios of 3 or more were present for being economically inactive or having had two or more recent adverse life events. Occupational social class was not an independent marker of raised rates of disorder. Similar patterns of result were present for common mental disorders irrespective of disability, although odds ratios were smaller. CONCLUSIONS: Several specific markers of less privileged status are independently associated with raised rates of common mental disorders, with or without disability. There may be scope to target specific high-risk groups within comprehensive programmes to reduce mental health inequalities.     

Considering comorbidity in social phobia

BACKGROUND: Considering comorbidity in social phobia contributes to our understanding of causal pathways and improved classifications for psychiatric disorders. Comorbidity also has important clinical implications. While a number of studies have investigated comorbidity in social phobia, only one other study has used the Composite International Diagnostic Interview (CIDI) and considered comorbidity in subtypes of social phobia. This study evaluated lifetime social phobia comorbidity with other common mental disorders as well as comorbidity in subtypes of social phobia. We also considered whether social fears, reported by respondents with social phobia, had an earlier or later age of onset than other disorders. METHODS: Data came from the Mental Health Supplement to the Ontario Health Survey, a survey of 8,116 Canadian respondents, ages 15-64. Psychiatric diagnoses were determined using the CIDI. This instrument is considered more sensitive than earlier instruments for diagnosing social phobia. RESULTS: Fifty-two percent of respondents with lifetime social phobia reported at least one other lifetime mental disorder and 27% reported three or more lifetime mental disorders. Social phobia, in this sample, is strongly comorbid with anxiety and affective disorders, and moderately comorbid with substance abuse disorders. When two social phobia subgroups were considered, the largest odds ratios were found among the not-exclusively-speaking social phobia group. This subgroup would include most of the respondents with a generalized form of social phobia. Age of onset of social fears, in respondents with social phobia, preceded age of onset of the comorbid disorder in 32% of cases with comorbid anxiety disorder, 71% of cases with comorbid affective disorder and 80% of cases with comorbid substance dependence/abuse disorder. CONCLUSIONS: Comorbidity and relative age of onset among respondents with social phobia in this study are generally consistent with previous epidemiologic studies. Clinicians should be vigilant for comorbidity in social phobia and should select treatments that target the full range of comorbid disorders. Early intervention or prevention of social fears or social phobia has the potential to reduce the risk of comorbid disorders.     

136例工伤伤残案例的精神医学鉴定

目的 分析工伤鉴定案例精神伤残评定及其相关因素。方法 对136例工伤鉴定案例的损伤因素、伤残类型、伤残等级、精神医学鉴定诊断等问题进行总结分析,并对工伤精神伤残中的伪装进行了对比分析。结果 有精神伤残94例,占69.0％,其中,智力伤残合并精神障碍伤残17例(12.5％),单一智力伤残者64例(47.1％),单一精神障碍伤残2例(1.5％),性功能伤残10例(7.4％)。未达到伤残程度者42例,占31.0％,包括17例脑挫裂伤后综合征及6例与创伤因素有直接或间接关系的功能性精神障碍。在既有临床评估又有测验评估的71例案例中,临床判断伪装智力低下25例(35.2％),测验判断有伪装智力低下58例(81.7％),临床评估与测验评估之间存在显著差异(P<0.01)。结论 (1)现有的工伤伤残标准有待于完善;(2)工伤伤残鉴定中伪装智力低下的比例较高,值得重视。