精神疾病患者伴发低血钾417例临床分析

目的:了解住院精神疾病患者伴发低血钾的原因及特点,从而采取相应的措施. 方法:对3 071例精神疾病住院患者进行回顾性调查. 结果:低血钾的发生率为13.58%;与患者的性别、饮食状态、合并躯体疾病、季节、联合使用抗精神病药及合用他科药物等因素密切相关. 结论:精神疾病住院患者常规进行血钾浓度的检测对早期发现低血钾十分必要.     

浙江省精神病专科医院住院患者治疗费用调查

背景目前很少有关于精神疾病住院患者精神疾病和非精神疾病治疗费用的研究,而这方面的信息对规划精神卫生服务和医疗保险具有重要意义。目的对2010年浙江省精神病专科医院住院患者的住院费用进行评估。方法采用两阶段分层随机抽样方法从浙江省42家精神专科医院中抽出14家精神病院,再从抽出的各家医院中以月份为基本单位系统抽出2010年3个月（3、7、11月）的出院患者进行调查。编制《出院患者住院情况调查表》,收集患者的人口学特征、临床特征及多项住院费用信息。结果共调查住院患者7684例。患者的平均住院时间（四分位数）为30（20-52）d,平均总住院费用为10005（6419．14728）元（1539美元）,平均药费为2512（1161—4182）元,其中65％为非精神科药费,1798（24．3％）例患者入院时伴有需要治疗的一种或多种躯体疾病,包括高血压、白细胞减少、糖尿病和各种感染。患者的精神疾病诊断不同,其躯体疾病合并症不同。经过排除其他混杂因素后,共病躯体疾病患者的住院费用显著增加,但住院时间未增加。对于精神分裂症患者,精神科的药费显著高于非精神科药费,但其他精神疾病患者的花费情况与之相反。结论精神病院住院患者的费用中,躯体疾病的治疗费用占较大比例。在修订精神疾病的补偿措施、建立诊断相关的支付方案以及建立诊断特定的治疗指南时,都需要考虑到精神疾病伴发躯体疾病的高患病率和治疗费用,也需要确保精神科医生的在职培训能使他们及时了解常见躯体疾病的诊断和治疗的新进展。     

精神疾病患者合并躯体疾病的诊治策略

目的探讨精神疾病患者合并躯体疾病的特点及诊治方法。方法对351例精神疾病合并躯体疾病患者的临床资料进行回顾性分析。结果 351例患者都能及时得到确诊和治疗;有249例痊愈,3例死亡,99例在出院后还需服用躯体疾病治疗药物。对这99例患者随访1年,12例失访,78例病情稳定,9例因服药不规范而复发。结论精神疾病患者合并躯体疾病的诊治需要运用一些技巧,治疗上更要注意避免药物间的相互作用和精神科药物对躯体疾病的影响。     

上海市民政系统精神病院住院的精神疾病患者共病躯体疾病分析

目的:了解上海市民政系统精神病医院住院慢性精神疾病患者共病躯体疾病状况。方法:采用自制《病例收集表》调查上海市民政系统精神病医院住院的所有精神疾病患者合并躯体疾病情况及影响因素。结果:1 707例患者中900例(52.7%)共病躯体疾病;前6位依次为高血压病(349例,20.5%)、糖尿病(204例,12.0%)、贫血(145例,8.5%)、心律失常(141例,8.3%)、白细胞减少症(131例,7.7%)及冠心病(120例,7.0%);共病躯体疾病1种600例(35.2%),2种228例(17.0%),≥3种72例(4.2%);共病率随患者年龄及住院时间增加显著增高(P0.01或P0.05)。服用抗精神病药患者糖尿病和心律失常的共病率明显高于未服药患者(P0.05或P0.01);服用第二代抗精神病药患者心律失常和冠心病共病率明显高于服用第一代药患者,白细胞减少发生率明显低于服用一代药患者(P均0.05);联合用药患者心律失常及冠心病发生率明显高于单一用药者(P0.01或P0.05);躯体疾病共病为因变量的回归分析显示患者年龄及服用抗精神病药数量进入模型(P均0.01)。结论:民政系统长期住院的慢性精神疾病患者躯体疾病共病率高,以高血压病、糖尿病、贫血、心律失常和白细胞减少症常见;年龄及服用抗精神病药数量是其影响因素;对共病躯体疾病的患者更应单一用药。     

80岁以上老年精神障碍住院患者躯体疾病共病调查

目的 了解80 岁以上老年精神病住院患者的躯体疾病共病情况。方法 筛查首都医科 大学附属北京安定医院2010 年1 月1 日至2017 年12 月30 日的住院患者,符合ICD-10 的精神障碍诊断, 年龄＞ 80 岁且资料完整者,调查该人群的合并躯体疾病情况等资料。结果 187 例患者中183 例合并 躯体疾病,共病率97.9%,平均共病数目为6.9 种。不同精神障碍患者的共患躯体疾病数目上差异无统 计学意义（P＞ 0.05）;平均共病种数方面,脑损害和功能紊乱及其他躯体疾病所致精神障碍、心境障碍明 显低于其他4 种精神疾病,差异有统计学意义（P ＜ 0.05）;183 例老年精神科患者共患躯体疾病例数 达1 297 例种,其中神经系统、循环系统、内分泌系统、呼吸系统及消化系统共769 例种,占59.29%,前 5 位疾病分别为高血压115 例（62.8%）、便秘84 例（45.9%）、脑梗死71 例（38.8%）、糖尿病54 例（29.5%）、冠 心病48 例（26.2%）。患者的躯体疾病共病种数与年龄相关（P＜ 0.01）。结论 80 岁以上老年精神障碍住 院患者的躯体共病现象非常普遍;且合并疾病种类较多,以心脑血管及代谢类疾病居多。     

老年与非老年住院精神疾病患者死因比较

目的了解老年与非老年住院患者死亡原因。方法：按死亡年龄分成老年组（≥60岁）和非老年组（＜60岁）,对两组临床资料进行比较。结果：1987－1997年上海市精神卫生中心住院精神疾病患者死亡306例,占同期住院病人的1．2％,老年死亡者166例,死亡率为6．1％,非老年院精神疾病患者死亡306例,老年死亡者以脑器质性精神障碍为主,致死原因以躯体疾病及猝死为死亡者140例,死亡率为0．6％,老年死亡者以脑器质性精神障碍为主,致死原因以躯体疾病及猝死为主,非老年死亡者以精神分裂症为主,致死原因以躯体疾病,消极自杀及猝死为主,;两组死亡原因有显著差异,（P＜0．01）。结论：老年患者病死率显著高于非老年患者,两者病种及死因分布不一致。     

91例社区中精神疾病患者死因分析

目的：分析社区中精神疾病患者的死因。方法：对1999年度宝山区死亡病例进行1次复查,并在死亡报告卡中增加精神疾病病程、工作情况、躯体疾病治疗、家庭照料情况等项目。结果：社区精神疾病患者死因有躯体疾病、意外、自杀3类,躯体疾病死亡中心脑血管病占首位,慢性患者生活不能自理,家庭人员照顾又不周,长期进食较少至衰竭死亡。结论：社区精神疾病患者的死因与患者的精神疾病病程、躯体疾病、家庭照料及看护管理等多种因素有关。     

精神病院住院患者并发乙型肝炎28例临床分析

２８例精神疾病合并乙型肝炎的患者与同期无精神疾病的乙型肝炎病人作比较，其临床表现、体征与肝损害程度有较大差异，且疗效差，表明精神疾病患者罹患乙型肝炎较一般肝炎患者为重。提出在精神病院应重视合并存在的躯体疾病。     

初次住院精神病人躯体健康状况调查

目的 了解初次住院精神病人躯体健康情况。方法 对2002年和2003年共375例初次住院精神病人，在躯体检查中发现的生物学指标异常及躯体疾病，进行发生率及相关统计学研究。结果 375例精神病患者中，87例合并躯体疾病，发生率为23．2％。排前6位的躯体疾病或异常生物学指标依次为：高血脂(14．4％)；肝病或肝功能异常(12．8％)；贫血(10．4％)；急性感染(5．6％)；糖尿病(5．1％)；心脏病／心电图异常、低血钾(分别为4％)。结论 初次住院精神病人合并躯体疾病的风险相当高。可能对精神药物等专科治疗的安全性构成潜在或现实风险。应在治疗决策中加以重视。     

躯体疾病对老年精神分裂症患者临床及认知功能的影响

对一所精神病院１９９２年８￣１０月连续住院的４２例患有躯体疾病与４５例无躯体疾病的老年精神分裂症患者应用ＢＰＲＳ、ＧＡＳ、ＣＧＩ来评价精神疾病的严重程度及治疗效果，应用ＨＤＳ、ＭＭＳＥ评价患者认知功能损害情况。结果表明：躯体疾病可使精神分裂症患者症状加重、复发次数增多、病程延长，并使患者的认知功能减退。     

87例流浪精神障碍患者临床分析

目的：对比住院的流浪与非流浪精神障碍患者临床特点差异。方法：选择2006年住院的87例流浪精神障碍患者作为流浪者组，男52例，女35例；在同期入院的其他精神障碍患者中随机选取90例作为对照组，男59例，女31例；比较分析两组有关情况，并作护士用住院病人观察量表（NOSIE）与阳性与阴性症状量表（PANSS）评定。结果：两组在入院原因，出入院方式，诊断，住院时间，疗效，NOSIE和PANSS评分等方面均有显著差异。结论：流浪精神障碍患者精神症状较重，多伴发躯体疾病，阳性症状突出，生活自理能力低，疗效较差，医院负担重。     

Use of complementary therapy among internal medical inpatients. Prevalence, costs and association with mental disorders and physical diseases

OBJECTIVES: The aims of this study were to determine the prevalence of complementary therapy/medicine (CT) use among internal medical inpatients. Furthermore, to examine the association between the use of CT and (a) mental disorders, (b) physical diseases, and (c) use of health care. METHODS: A total of 294 consecutive medical inpatients were interviewed about their use of CT. A stratified subsample of 157 people was assessed for current mental disorders, using an extensive, standardized, semistructured interview (Schedules for Clinical Assessment in Neuropsychiatry version 2.1 [SCAN]). Health care use was assessed by use of national patient registers. RESULTS: There were 22.5% CT utilizers. More females than males used CT (P=.033). CT utilization was not associated with age, mental disorders, life-threatening or chronic physical diseases or with use of health care services. CONCLUSIONS: The use of CT is common among medical inpatients. More research is needed to understand why a significant proportion of patients seeks CT.     

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.     

住院精神疾病患者药物治疗临床分析

目的:分析目前住院精神疾病患者所接受的药物治疗是否规范.方法:采用自行设计的问卷,调查湖南省7所精神病院住院病人658例用药情况.结果:62.6%的病人为单一用药.精神分裂症治疗最常用药物是氯氮平(41.9%),最常用的联合用药为氯氮平 舒必利;情感障碍治疗最常用药物是碳酸锂(41.8%),最常用的联合用药是碳酸锂 氯氮平.结论:多数精神病院的住院病人的用药是规范的,但也存在不合理用药的现象.     

Screening for mental disorders in cancer, cardiovascular and musculoskeletal diseases

OBJECTIVE: The early detection of patients with comorbid mental illness is of high clinical importance in chronic somatic diseases. To identify cases, screening instruments are recommended. The study compared the discriminant validity of the Hospital Anxiety and Depression Scale (HADS) and the General Health Questionnaire (GHQ-12) to detect mental disorders in the most frequent chronic somatic diseases. METHODS: Five hundred sixty-nine patients with musculoskeletal, cardiovascular, and cancer diseases participated in the cross-sectional, two-stage survey. First, patients were assessed with the GHQ-12 and the HADS. Second, they were examined for DSM-IV mental disorders by clinical standardized interview (CIDI). Using CIDI diagnosis as a criterion, the validity of the instruments for the detection of any mental disorder as well as of depressive and anxiety disorders was analyzed with receiver-operating characteristics analyses. RESULTS: The HADS performed better in all analyses compared to the GHQ-12. Best screening results with the HADS total scale were achieved for depressive disorders with an area under the curve of 0.82, a sensitivity of 74%, a specificity of 80%, and a misclassification rate of 21% (cutoff point=18). The positive predictive value is best (44%) for the detection of any mental disorder, with a cutoff point of 17. CONCLUSIONS: The HADS total scale can be recommended as a valid screening instrument for the detection of comorbid mental disorders in patients with chronic somatic diseases. The use of the single HADS subscales has no advantage for screening performance.     

2005年住院精神疾病患者药物治疗时点调查

目的:了解住院精神疾病患者精神药物的应用情况及其演变。方法:采用一日法对上海精神卫生中心679例住院精神疾病患者的精神药物应用状况进行调查,将其结果与2004年和2002相比较。结果:精神药物的使用频度发生了显著变化;新型精神药物的使用正在逐渐增多;精神药物的使用剂量基本都在安全范围之内。结论:精神药物应用的多样性已是一种趋势。     

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。     

住院精神疾病患者抗精神病药物处方时点调查

目的了解住院精神疾病患者抗精神病药物的处方情况。方法采用一日法对上海市精神卫生中心(总部)住院精神疾病患者的精神药物应用状况进行调查。结果(1)住院精神疾病种类构成发生了一些变化;(2)氯氮平处方量第一,新型精神药物的使用正在逐步扩大;(3)联合用药治疗在住院患者中非常多见;(4)抗精神病药物的使用剂量基本都在推荐的安全剂量之内。结论各种抗精神病药物的处方情况发生了较大改变,对于药物的选择和用量考虑其疗效的同时也要兼顾到不良反应的影响。药物选择多样化、新型化、安全使用精神药物已成为目前临床用药的趋势。     

Incapacity for work and disability pensions in persons with mental disorders

The number of people suffering from mental disorders and receiving disability pensions is still increasing in Europe. Young persons in their working-age are receiving disability pensions more and more often. Among those who are incapable to work (due to both mental and somatic disorders), persons on benefits due to mental disorders are usually younger. The number of disability pensions depends on the sort of mental disorder. Persons suffering from affective and anxiety disorders are the most common group receiving benefits. An increase in the number of disability payments among people with several mental disorders or both, mental and somatic diseases is observed. Furthermore, research data shows Poland as the country with high costs relevant disability payments. Disability pensions assignment for persons suffering from mental disorders, as well as incapacity for work, is discussed in this article. The reason for a still increasing number of disability payments is explained, the characteristics of persons applying for disability pensions is introduced and the mental impaired persons' incapacity for work is described.     

Functioning and occupational activity of persons with mental disorders--research review

Occupational functioning of persons with mental disorders is a serious, rarely discussed problem in Polish literature. Foreign research review shows that occupational activity of persons with mental disorders seriously affects their mental functioning. It was suggested that the major way of mental health promotion was re-employment. However the risk of mental disorders (especially affective and anxiety disorders) increased with loss of some work. Despite of a healthy influence of occupational activity on the mental health among people suffering from mental disorders, the high level of unemployment in that group (higher than among people with somatic diseases) is observed. The aim of this article is to describe the problem of occupational activity of persons with mental disorders, as well as in comparison to people without mental disorders and those with somatic diseases. The relationship between mental disorders and occupational activity is shown. Psychological benefits of occupational functioning as well as difficulties at work caused by mental disorders are explained. The costs connected with mental disorders are described.