住院脑器质性精神障碍病例应用苯二氮Zhuo类药物的调查

为了解住院脑器质性精神障碍病人的苯二氮Zhuo类药物（BZD）使用情况，作按自制的药物使用调查表调查243例病人。结果，146例（60．1％）病人使用了BZD，其中7例单独使用，32例用于癫痫性精神障碍病例，139例与其它精神药物合用，58例用药超过2个月。提示，临床并用BZD并非完全必要。     

住院精神障碍患者应用镇静催眠药状况调查分析

目的 调查住院精神障碍患者镇静催眠药的应用状况.方法 随机抽取2880例精神障碍患者的用药信息,并采用自制调查表进行相应调查.结果 在2 880例患者中,合并使用镇静催眠药的患者为768例,各类精神障碍合并使用镇静催眠药的患者分别为:精神分裂症432例(56.2％),心境障碍171例(22.3％),器质性精神障碍49例(6.4％),神经症39例(5.1％),暂时性精神病26例(3.4％),癔症14例(1.8％)等.镇静催眠药使用频率依次为:阿普唑仑、氯硝西泮、地西泮、艾司唑仑、劳拉西泮等.使用镇静催眠药时间:＜60d者为479例(62.5％),＞60d者为288例(37.5％).结论 精神科住院患者服用镇静催眠药基本规范,也有不合理用药.     

综合医院住院患者对会诊联络服务的需求

目的：调查综合医院住院患者对精神科会诊联络服务（CLS）的需求。方法：对我院临床各科申请精神科会诊的住院患者,共131例,进行精神科会谈,得出精神障碍的诊断及治疗建议;并对患者进行综合医院焦虑抑郁量表（HADS）及综合医院住院患者精神科会诊联络服务需求临床调查表评估和调查。结果：①精神科会诊率为1．37％（95％可信区间：1．14％-1．59％）,精神科会诊后精神障碍的诊断：神经症性、应激相关以及躯体形式障碍为30．5％（n=40）,器质性精神障碍22．2％（n=29）,心境障碍16．0％（n=21）,与生理紊乱和躯体因素有关障碍12．2％（n=16）,精神分裂症,分裂性障碍和妄想性障碍9．9％（n=13）。②综合医院焦虑抑郁量表评分：焦虑症状检出比例为37．9％（39／103）,抑郁症状检出比例为61．2％（63／103）。③对精神科治疗的需求：72．8％患者对精神药物治疗表示兴趣;57．3％对心理社会治疗有兴趣。④需求相关因素：患者对精神药物治疗需求与3个因素有关：是否有焦虑症状（P：0．001）,既往是否接受过精神科药物治疗（P=0．005）,以及患者最近一段时间（至少1周以内）的睡眠状况（P=0．014）。心理社会支持需求与2个因素有关：是否有焦虑症状（P=0．006）,是否患者自己提出会诊申请（P=0．038）。结论：综合医院住院患者伴发心理社会问题及精神障碍时,对精神药物及心理社会治疗的需求均相当高。     

老年失眠患者门诊用药情况调查

目的：调查了解老年失眠患者门诊用药情况。方法：调查2009年11月至2010年3月无锡地区因失眠而就诊的老年患者1224例,采用世界卫生组织建议的限定日剂量和Ghodse药物利用指数（DUI）,对苯二氮类（BZD）等药的临床使用情况进行分析。结果：老年患者中,使用BZD者1124例（91.83%）;BZD联合抗精神病药及抗抑郁药使用者786例（64.22%）;≥2种BZD使用者327例（26.72%）;艾司唑仑、阿普唑仑、氯硝西泮、硝西泮、地西泮的DUI均≥1。结论：老年人BZD临床使用不尽合理,BZD依赖情况严重,联合用药较多;改变BZD使用模式迫在眉睫。     

600例精神分裂症患者使用苯二氮(艹卓)类药物的调查报告

苯二氮(艹卓)类药物(BZD)在精神分裂症患者中的使用相当普遍,本文就此进行了调查。现将结果报道于后。 1 资料与方法、 调查样本为我院1996年10月～1998年10月住院精神分裂症患者,随机抽取600例,并均符合DSM-3-R精神分裂症的诊断标准。同时以自编BZD使用情况调查表,记录一般人口学特征、用药情况以及入院时贝克焦虑量表评分,并作统计和分析。 2 结果 2．1 一般情况 600例精神分裂症患者中,合并使用过BZD者共500例(83.33％),其中男218例,女282例；平均年龄为(37.2±4.8)岁；文化程度：小学以下115例(23％),初中220……     

住院精神分裂症患者药物使用现况调查

目的调查2013年5月在上海交通大学医学院附属精神卫生中心住院的精神分裂症患者药物使用情况。方法本次研究为横断面研究,以2013年5月22日为时点调查日,对我院802例精神分裂症住院患者使用自制调查表进行药物使用的现况调查。结果（1）单一使用抗精神病药物患者比例为43．45％。（2）抗精神病药物使用频度前5位：氯氮平421例（52．56％）,奥氮平225例（28．09％）,利培酮196例（24．47％）,阿立派唑158例（19．73％）,奎硫平126例（15．73％）。（3）精神分裂症患者中合并糖尿病的比例为21．70％,且年龄因素、是否使用氯氮平治疗与糖尿病的发生有相关性。（4）精神分裂症患者中合并高血压的比例为33．04％,且年龄因素与高血压的发生有相关性。结论我院单一用药比例低,氯氮平的使用率高,抗精神病药物的治疗仍需进一步规范。精神分裂症患者中合并糖尿病、高血压的比例高,年龄因素可增加糖尿病、高血压的发生率,服用氯氮平可增加糖尿病的发生率。     

住院精神分裂症患者使用苯二氮(艹卓)类药物的调查

目的 探讨住院精神分裂症合并使用苯二氮(艹卓)类药物(BZD)的合理性、依赖性及其增效作用,评价苯二氮(艹卓)类药物依赖自评量表(BDEPQ)对精神分裂症病人诊断BAD依赖的价值。方法 调查住院≥2月,诊断为精神分裂症,其中合并使用BAD≥1月,用BDEPQ量表评分,对评分在24～39分者停药1周观察。用ICD-10药物依赖的诊断标准再诊断。结果 精神分裂症病人合并使用BZD为41.4％,发生依赖为8.5％,BDEPQ评分≥34分作为评定依赖的划界分与ICD-10诊断一致性较高,合并使用BZD可减少抗精神病药物(APD)用量,而疗效相同。结论 BDEPQ是BZD依赖较好的筛查工具,住院精神分裂症病人长期使用BZD是不合理的,本组BZD依赖与药物剂量及用药时间无关。     

精神科门诊会诊癫痫40例临床特点分析

目的：探讨精神科门诊会诊癫痫患者的临床特点和诊治效果。方法分析我院40例精神科门诊会诊癫痫患者的资料和治疗方案。结果40例中,17例（42．5％）诊断为发作性“精神障碍”,14例（35．0％）于强直痉挛发作前后伴有精神障碍;2例（5．0％）诊断为Lennox‐Gastau综合征;3例（7.0％）上肢痉挛性抽搐伴有失神症状;4例（1.0％）躯干发作性抖动严重。其中22例有精神障碍,18例为意识障碍。经服用抗癫痫药物后大部分患者发作次数明显减少,治疗有效率较高。结论精神科门诊会诊癫痫,能显著提高疾病的诊治率和确定最佳治疗方案。     

内科住院病人精神科会诊213例分析

目的：探讨综合医院内科住院病人精神科会诊的现状。方法：对我院近3年来213例内科住院病人申请科学会诊的临床资料进行回顾性分析。结果：近3年来内科申请精神科会诊的 病例数逐年上升。申请会诊的科室,以神经内科最多,其次为心血管内科、呼吸内科、内分泌科和消化内科,会诊后精神科疾病以器质性精神障碍居多（46．4％）,其次为神经症（32．4％）及精神分裂症（7．0％）。申请会诊的病人中40例（18．8％）转入精神科治疗。结论：内科住院病人常伴发精神障碍,并有逐年增加的趋势,对普通内科医师加强精神科专业知识的培训,将有利于患有各类精神障碍的病人得到及时妥善的治疗。     

老年癫痫55例临床分析

目的 探讨老年癫痫的临床特征。方法 回顾性分析55例老年癫痫患者的临床表现、脑电图、头部影像学和治疗效果等临床资料。结果 55例老年癫痫患者中，全身性强直一阵挛发作30例（54．55％），部分性发作23例（41．82％）；有脑血管病者34例（61．82％），脑萎缩4例（7．27％），药物不良反应4例（7．27％），脑肿瘤4例（7．27％）。18例尸检结果：8例为脑梗死，4例为脑软化灶（出血后），4例为吸人性肺炎，1例为肿瘤多发脑转移，1例为脑血管粥样硬化（管腔狭窄Ⅱ～Ⅲ级）。结论 老年癫痫患者病因中以脑血管病最为常见，其次为脑肿瘤、脑萎缩及药物中毒等。     

Treatment of acute schizophrenia in open general medical wards in Jamaica

OBJECTIVE: The study assessed the efficacy of treating acute psychotic illness in open medical wards of general hospitals. METHODS: The sample consisted of 120 patients with schizophrenia whose first contact with a psychiatric service in Jamaica was in 1992 and who were treated as inpatients during the acute phase of their illness. Based on the geographic catchment area where they lived, patients were admitted to open medical wards in general hospitals, to psychiatric units in general hospitals, or to acute care wards in a custodial mental hospital. At first contact, patients' severity of illness was assessed, and sociodemographic variables, pathways to care, and legal status were determined. At discharge and for the subsequent 12 months, patients' outcomes were assessed by blinded observers using variables that included relapse, length of stay, employment status after discharge, and clinical status. RESULTS: More than half (53 percent) of the patients were admitted to the mental hospital, 28 percent to general hospital medical wards, and 19 percent to psychiatric units in general hospitals. The three groups did not differ significantly in geographic incidence rates, patterns of symptoms, and severity of psychosis. The mean length of stay was 90.9 days for patients in the mental hospital, 27.9 days in the general hospital psychiatric units, and 17.3 days in the general hospital medical wards. Clinical outcome variables were significantly better for patients treated in the general hospital medical wards than for those treated in the mental hospital, as were outpatient compliance and gainful employment. CONCLUSIONS: While allowing for possible differences in the three patient groups and the clinical settings, it appears that treatment in general hospital medical wards results in outcome that is at least equivalent to, and for some patients superior to, the outcome of treatment in conventional psychiatric facilities.     

189例老年住院精神病人分析

目的 分析住院老年精神病人的年龄和病种。方法 回顾性查阅住院60岁以上老年精神病人的病例资料,对其年龄和病种进行分析。结果 60岁以上(含60岁)住院老年精神病人占同期住院精神病人3.12％;60岁及以上住院老年精神病人随年龄增长,比例减少;以精神分裂症(含分裂样精神病)最多,其次为情感性障碍。结论 建议加强老年精神病诊断与治疗业务开拓。     

Geropsychiatric consultation in a general hospital in Taiwan

The aim of this study was to characterize clinically significant issues in a psychiatric consultation service for geriatric inpatients in a general hospital in Taiwan. This was a case-control study. During a 5-month period, 100 geriatric (age > or =65 years) inpatients consecutively referred for consultation-liaison psychiatric service from non-psychiatric departments formed the study group. Another 100 medical inpatients, also referred for consultation-liaison to the psychiatric service, but aged 17-50, formed the control (non-geriatric) group. The diagnosis, demography, reason for referral, symptomatology, and other clinical characteristics were determined by consensus between two psychiatrists. Psychiatric diagnosis was made according to criteria in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders. The geropsychiatric consultation rate was 0.9%. Geriatric patients constituted 20.1% of all psychiatric referrals. Common reasons for referral of geriatric inpatients were confusion (32%), depression (17%), disturbing behaviors (14%), and psychosis (14%). The most common psychiatric disorder among geriatric patients was an organic mental disorder (79%), followed by a depressive disorder (13%). More geriatric patients suffered from cancers and cerebrovascular diseases than non-geriatric patients. The geriatric group was more likely to have multiple physical illnesses. Organic mental disorder and depressive disorders are the most common psychiatric diagnoses in the geropsychiatric consultation service of the authors. In the authors' experience, both psychotropic medication treatment and psychosocial intervention are important in geropsychiatric consultation.     

54例颅脑创伤有关精神障碍的司法鉴定

目的 探讨精神损伤的司法鉴定。方法 对54例与颅脑创伤有关精神障碍司法鉴定进行分析,按精神损伤程度分重伤组与非重伤组统计,卡方检验。结果 54例中,颅脑创伤所致智能障碍38例(70.4％),遗忘综合征1例(1.8％),精神病7例(12.9％),反应性精神病3例(5.6％),诱发精神疾病5例(9.3％),均没有评定损伤或伤残等级。重伤组与非重伤组颅脑外伤等级的差异有显著性(x~2=18.54,P<0.01)。与颅脑创伤有关精神障碍的司法鉴定有增多的趋势。结论 颅脑创伤所致精神障碍的严重程度和颅脑外伤损伤程度有关,制定统一的精神损伤鉴定标准,进一步完善颅脑创伤所致精神障碍的司法鉴定刻不容缓。     

精神疾病司法鉴定中无精神病案件特点

目的：通过对无精神病的精神疾病司法鉴定案例分析，探究此类案件的特点。方法：对入选案件进行一般人口学、案件类型、申请鉴定的原因、精神检查等情况进行分析。结果：无精神病的案件219例占总鉴定案例24．7％；既往曾在精神科就诊者65例，由办案人员发现“精神异常”的51例。结论：相关法律意识增强，有精神科就诊史是申请鉴定的主要原因。     

Diagnostic subtypes of bipolar disorder in older versus younger adults

OBJECTIVE: To investigate differences in diagnostic subtypes of bipolar disorder as according to ICD-10 between patients whose first contact with psychiatric health care occurs late in life (over 50 years of age) and patients who have first contact earlier in life (50 years of age or below). METHODS: From 1994 to 2002 all patients who received a diagnosis of a manic episode or bipolar disorder at initial contact with the mental healthcare system, whether outpatient or inpatient, were identified in Denmark's nationwide register. RESULTS: A total of 852 (49.6%) patients, who were over age 50, and 867 patients, who were 50 or below, received a diagnosis of a manic episode or bipolar disorder at the first contact ever. Older inpatients presented with psychotic symptoms (35.4%) significantly less than younger inpatients (42.6%) due specifically to a lower prevalence of manic episodes with psychotic symptoms. Conversely, older inpatients more often presented with severe depressive episodes with psychotic symptoms than younger inpatients (32.0% versus 17.0%). Among outpatients, no significant differences were found between patients older than 50 years and patients 50 years of age or younger. However, a bimodal distribution of age at first outpatient contact was found with an intermode of 65 years and outpatients older than 65 years more often presented with severe depressive episodes with psychosis. CONCLUSIONS: Bipolar patients who are older at first psychiatric hospitalization (>50 years) present less with psychotic manic episodes and more with severe depressive episodes with psychosis than younger patients. The distribution of age at first outpatient contact is bimodal with an intermode of 65 years and outpatients older than 65 years more often present with severe depressive episodes with psychosis.     

101例首次住院气功所致精神障碍患者的5年随访

目的:探讨气功所致精神病性障碍患者的预后.方法:采用门诊检查和访问家属的形式,对101例气功所致精神障碍患者5年以后的状况进行随访.结果:67例(66.34%)稳定,34例复发(33.66%),其中3例残废,80例(79.2%)维持出院论断,18例(17.8%)改诊为其他精神疾病,72例(71.29%)停止精神科治疗,92例(91.1%)缓解期社会功能政党,9例(8.9%)减退,结论:使用CCMD论断的气动所致精神障碍患者怕短期结局比较稳定,停止治疗和继续练功可能导致疾病复发,改诊的原因比较复杂,可能与论断标准有关.     

SEX CHROMATIN ANOMALY AMONG CHINESE PSYCHIATRIC INPATIENTS COMPARED TO SCHOOLCHILDREN

In a study of sex chromatin abnormality among Chinese psychiatric inpatients, buccal smears were examined from a total of 1,253 psychiatric inpatients (639 males and 614 females). One male psychiatric inpatient (1.6/1000) was chromatin positive (+ve); two female psychiatric inpatients (3.3/1000) were found to have two sex chromatin bodies (++ve). The lower rate for male inpatients in comparison to Chinese schoolboys (2.3/1000) is thought to reflect a higher rate of mental subnormality in the primary schoolchildren. This is considered attributable to the special nature of the school system and psychiatric patient facilities in Taiwan. The higher rate for female inpatients in comparison with the schoolgirls (0.5/1000) tends to indicate a predisposition to mental disorder in favor of psychosis associated with double sex chromatin abnormality in the female.     

精神科儿少住院患者的42年资料回顾

目的了解从1958年8月本院正式成立儿童精神科以来,42年中儿童住院病人的情况,以掌握及了解儿童和少年精神障碍的发展趋势。方法从1958年8月到2000年9月之间住院的所有病人的病历共1327份,逐一记载所需资料内容,并将所有资料进行分析。结果患儿年龄主要集中在13—14岁,并涉及3—16岁各年龄段。以儿童和少年期最多,文化程度以初中和小学居多。在早期,精神障碍诊断不规范,90年代后,诊断趋于标准化,位于前五位的诊断是：精神分裂症、精神发育迟滞、脑器质性精神障碍、情感性精神障碍、行为障碍。90年代以来,每年住院儿童病人数量均呈增长趋势。结论在住院期间,儿童少年病人既要接受治疗,又需进行儿童间交友训练,而在成人精神科病房,在这一点上不能满足住院患儿的需要,不利于儿童和少年的综合治疗,所以在我院开设儿童青少年病房有重要的意义。     

The First‐Episode Psychosis Outcome Study: premorbid and baseline characteristics of an epidemiological cohort of 661 first‐episode psychosis patients

Aims: Studies conducted in first‐episode psychosis (FEP) samples avoid many biases. However, very few studies are based on epidemiological cohorts treated in specialized FEP services. The aim of this file audit study was to examine premorbid and baseline characteristics of a large epidemiological sample of FEP. Methods: File audit study of all patients admitted to the Early Psychosis Prevention and Intervention Centre between 1998 and 2000 using a specialized questionnaire. Results: There were 661 patient files included in the study. Premorbid evaluation revealed high rates of substance use disorder (74.1%), history of psychiatric disorder (47.5%), past traumatic events (82.7%) suicide attempts (14.3%) and family history of psychiatric illness (55.6%). Baseline characteristics revealed high intensity of illness (mean CGI 5.5), high prevalence of lack of insight (62%) and high rate of comorbidity (70%). Conclusion: High rates of traumatic events or episodes of mental illness before treatment for FEP must be considered when designing treatment approaches because a too narrow focus on positive psychotic symptoms will inevitably lead to incomplete treatment. Additionally, early intervention programmes need sufficient range of resources to address the multiple challenges presented by FEP patients such as high severity of illness, comorbidities and functional impairment. Finally, observation of an important degree of functional impairment despite short duration of untreated psychosis suggests that while early detection of FEP is a necessary step in early intervention, it may not be sufficient to improve functional recovery in psychosis and that efforts aimed at identifying people during the prodromal phase of psychotic disorders should be pursued.