急性短暂性精神病6例报告

1　病例报告例 1,男性 ,2 9岁 ,未婚 ,小学文化 ,农民。性格内向 ,精神病家族史阳性。 1995年 10月 17日刑满释放 ,在返家途中 ,夜宿旅店 ,耳闻人声 ,说“要把我摆平” ,还有人说“喊出来整” ,即惊慌外逃 ,并窜至陌生农家躲藏 ,被误认为是小偷将其围住 ,患者当即抓起刀连伤数人。审讯时坚定地认为听到有人在说他 ,有人要加害他。调查核实 ,一是服刑期精神正常 ,二是所住旅馆周围无人追打患者。入看守所 2天后自述没有听到有人再说他了。例 2 ,女性 ,2 5岁 ,已婚 ,初中文化 ,个体户。性格外向 ,精神病家族史阳性。 1996年 6月 30日因无故哭…     

急性短暂性精神病一家系报告

急性短暂性精神病的病因至今未明，在精神疾病的归类上也存在争议，本例家族聚集性病例的发现，对上述问题的探讨有一定启发。     

急性短暂性精神病47例临床分析

对急性短暂性精神病进行临床分析，报道如下。     

新冠肺炎疫情期间农民工焦虑与抑郁状况

目的 调查新冠肺炎（COVID-19）疫情期间农民工焦虑、抑郁状况及其影响因素,为公共卫生事件中农民工心理问题防治提供参考。方法 采用方便抽样法,选择陕西省汉中地区某镇110名农民工为调查对象。采用焦虑自评量表（SAS）和抑郁自评量表（SDS）通过电子版问卷调查农民工群体的焦虑抑郁情况。结果 COVID-19疫情期间,农民工SAS和SDS总评分分别为（44.25±8.77）分、（47.50±10.55）分。焦虑与抑郁症状检出率分别为19.09%、25.45%。焦虑危险因素：未婚（β=-4.152,95% CI：-6.199~-3.352,P<0.01）、月收入低（β=-1.740,95% CI：-2.301~-1.442,P<0.01）、女性（β=5.022,95% CI：3.612~6.256,P=0.034）、低年龄（β=-2.792,95% CI：-3.551~-2.105,P=0.002）、受教育程度初中组SAS总评分低于小学及以下（β=-4.225,95% CI：-2.056~-5.261,P=0.024）,高中组SAS总评分低于小学及以下组（β=-4.612,95% CI：-2.275~5.035,P=0.021）。抑郁危险因素：月收入低（β=-5.406,95% CI：-6.292~-4.520,P<0.01）、女性（β=12.518,95% CI：9.916~15.121,P=0.001）、未开始上班（β=6.192,95% CI：3.695~8.688,P=0.042）、低年龄（β=-3.208,95% CI：-4.324~-2.092,P=0.009）。结论 疫情期间农民工焦虑与抑郁水平较高,农民工焦虑危险因素有未婚、月收入低、女性、低年龄、低受教育程度,抑郁危险因素有月收入低、女性、未开始上班、低年龄。     

新冠肺炎疫情期间居民急性应激障碍症状检出情况及影响因素

目的 探讨新冠疫情期间居民急性应激障碍（ASD）症状的检出情况及影响因素,为后续心理危机干预提供客观依据。方法 于2020年2月13日-24日通过问卷星对国内居民进行问卷调查,采用自编基本情况调查表和斯坦福急性应激反应问卷（SASRQ）进行评定。结果 获得有效问卷16 048份。不同性别、受教育程度、与确诊患者的距离和媒体暴露情况的居民SASRQ评分差异有统计学意义（χ²=13.460、40.736、138.678、43.609,P均<0.01）;检出存在中度ASD症状者共1 630例（10.2%）、重度ASD症状者共2 744例（17.1%）,且不同性别、年龄、受教育程度、与确诊患者的距离和媒体暴露情况的居民检出率差异具有统计学意义（χ²=10.814、11.522、97.625、176.867、36.646,P<0.05或0.01）。Logistic回归分析结果显示,女性、受教育程度较低、离确诊患者近为影响居民发生中度或重度ASD症状的危险因素（P<0.05或0.01）,年龄较小、低水平媒体暴露为影响居民发生重度ASD症状的保护因素（P<0.05或0.01）。结论 新冠肺炎疫情期间居民ASD症状发生率较高,女性、受教育程度较低、离确诊患者近是发生ASD症状的危险因素,年龄较小、低水平媒体暴露是发生ASD症状的保护因素。     

新冠肺炎疫情防控某三甲精神病专科医院应急指挥体系成效分析

本研究目的是总结某三甲精神病专科医院在新冠肺炎疫情防控工作中应急指挥体系建设的经验,为响应公共卫生应急决策提供参考。结合四川省精神卫生中心(绵阳市第三人民医院)在新冠肺炎疫情防控中的应急指挥工作开展情况,从建立应急指挥体系、再造院内诊疗流程、强化防控知识培训、开展疫情防控心理干预等方面,总结精神病专科医院应急指挥体系建设的经验和教训。     

新冠肺炎疫情期间大学生抑郁伴躯体化症状情况及影响因素

目的 了解新冠肺炎(COVID-19)疫情期间大学生抑郁伴躯体化症状情况,并探讨其影响因素.方法 于2020年3月12日-19日,以中国传媒大学南广学院(现南京传媒学院)2019级本科大一全体学生为研究对象,通过网络发放问卷.采用突发性公共卫生事件心理问卷(PQEEPH)、症状自评量表(SCL-90)躯体化因子、抑郁自...     

新冠肺炎疫情期间公众睡眠状况及影响因素分析

目的:探讨新冠肺炎疫情期间公众睡眠状况及其影响因素。方法:使用一般人口学调查问卷、医院焦虑抑郁量表(HADS)、病人健康问卷抑郁量表(PHQ-9)、社会支持评定量表(SSRS)、匹兹堡睡眠质量指数量表(PSQI)向公众发放问卷进行调查评估;采用χ²检验和多因素Logistic回归方法进行统计分析。结果:共收回有效问卷4 949份;根据PSQI>7分划界,1 093例(22.1%)被调查者有睡眠问题。单因素分析显示,女性、年龄的增长、受教育程度程度高、离异者、子女已成年及有抑郁、焦虑情绪者的睡眠问题发生率显著增高(P<0.05或P<0.01)。多因素Logistics回归分析显示,年龄、受教育程度、焦虑、抑郁和主观支持是影响新冠肺炎疫情期间被试睡眠问题的主要因素,可解释总变异的84.5%。结论:新冠肺炎疫情期间公众的睡眠问题发生率较高,年龄、受教育程度、抑郁、焦虑等情绪是公众睡眠问题的影响因素。     

新冠肺炎疫情期间住院医师规范化培训学员心理健康及其影响因素

目的 了解新冠肺炎疫情爆发期及平稳期住院医师规范化培训学员的心理健康状态及其影响因素,为进一步心理健康教育提供参考.方法 通过电子问卷使用非概率抽样方法获得调查样本,分别于2020年2月8日-10日和4月11日-13日向昆明医科大学第二附属医院各年级规培群发放调查问卷,采用症状自评量表(SCL-90)、Beck压力量表...     

新冠肺炎疫情期间安徽省中学生应对方式及其与焦虑情绪的关系

目的 探讨新冠肺炎(COVID-19)疫情期间安徽省13～18岁中学生的应对方式及其与焦虑情绪的关系.方法 于2020年2月13日-19日,采用方便抽样方法,以网络问卷形式,使用中学生应对方式量表(CSSMSS)及儿童焦虑性情绪障碍筛查量表(SCARED)对安徽省中学生进行横断面调查.结果 CSSMSS评定结果 显示,...     

急性短暂性精神病106例临床分析

目的了解急性短暂性精神病的临床特点及不同亚型的差异。方法对2009年1月～2012年12月106例住院急性短暂性精神病患者的临床资料进行分析,包括人口学资料、精神症状分布、治疗情况、阳性与阴性症状量表（PANSS）评定、入出院诊断符合率、住院天数、疗效等。结果106例中,以女性（58．5％）、低文化（小学以下53．8％）、无业（65．1％）和精神障碍病程较短[（13．2±4．7）d]为特点;临床亚型以分裂样精神病（52．8％）为主;分裂样精神病患者以片断幻听、片断妄想、被控制感等症状多见;治疗均以非典型抗精神病药为主,心理治疗为辅;出院时分裂样精神病患者的PANSS总分显著高于另外3种亚型患者,且差异有统计学意义（P〈0．01）;入出院诊断符合率为95．3％,有4例分裂样精神病修正诊断为精神分裂症;平均住院（18．6±5．4）d;好转率达100．0％。结论临床上需掌握急性短暂性精神病的特点,提高识别能力,并采取综合治疗措施。     

Outcome of first-episode acute and transient psychotic disorder in Hong Kong Chinese: a 20-year retrospective follow-up study

Background: ‘Acute and transient psychotic disorder’ (ATPD) is a category in ICD-10 marked by psychosis with acute onset and early remission. It remains relatively under-researched, despite controversies over its nosological status in the current classification system.

Aims: (1) To assess the changes in diagnosis over time in patients initially diagnosed as ATPD. (2) To identify factors predicting changes in diagnosis, and compare the long-term outcomes of various patterns of diagnostic shift. (3) To make recommendations on the classification and treatment of ATPD based on the findings of the study.

Methods: This was a retrospective longitudinal study based on review of medical records of patients first admitted to a regional hospital in Hong Kong for ATPD during the period from 1990–2000.

Results: Of the 87 subjects initially diagnosed as ATPD, 64.4% had their diagnoses revised over an average of 20 years, mostly to bipolar disorder and schizophrenia. Among those with diagnosis of ATPD unchanged, 54.8% had one single episode, while the remaining 45.2% had recurrence. Subjects with diagnostic shift had significantly younger age of onset, more first-degree relatives with a history of mental illness, and more subsequent psychiatric admissions.

Conclusions: ATPD is likely a composite category consisting of clinically distinct outcome groups, for which further research is warranted to identify diagnostic features that distinguish them at initial presentation and revise the current nosological status of ATPD. Long-term follow-up, judicial use of antipsychotics, and education on prognosis are of paramount importance in managing patients diagnosed with ATPD.     

Features of acute and transient psychotic disorders

Background Little is known about acute and transient psychotic disorders (ATPD), a diagnostic category introduced with ICD-10. Aims To determine the clinical and sociodemographic features, course and outcome of ICD-10 ATPD in a prospective and longitudinal study. Method We recruited all consecutive inpatients fulfilling the ICD-10 criteria of ATPD during a 5-year period. Demographic and clinical features were systematically evaluated and follow-up investigations were carried out at an average of 10 years after onset of the disorder using standardized instruments. Results ATPD patients represented 8.5% of all inpatients with non-organic psychotic disorders.ATPD were characterized by female preponderance. In two-thirds of the cases a typical polymorphic symptomatology was found. In spite of the fact that the possibility of relapse within 5 years was high, the psychopathological and social outcome for most of the patients was very favourable.Schizophrenic episodes during follow-up were rare (7.7% of patients), but a strictly monomorphous course (ATPD episodes only) from index episode to the end of the prospective follow-up was found in only 53.9% of the patients. Conclusion ATPD are not a sharply demarcated and unchanging nosological entity. Nevertheless, the present data support a delineation of ATPD as a diagnostic category with specific clinical features and with a usually favourable prognosis. Further research on the topic is necessary.     

Predicting features of later development of schizophrenia among patients with acute and transient psychotic disorder

It is acknowledged that a considerable proportion of patients who have an episode of acute and transient psychotic disorder (ATPD), will develop schizophrenia after the episode is remitted. If features discriminating the patients who later developed schizophrenia from those who underwent a monomorphous ATPD-only course are discerned, they may be useful for predicting the prognosis. The authors performed a chart review study of those who were hospitalized with the diagnosis of ATPD and followed up thereafter for >5 years and compared two subject groups: 10 later-schizophrenia-developing (SD) patients and 15 non-schizophrenia-developing (non-SD) patients. Assessment of the subjects, conducted by two psychiatrist raters blind to the subject groups, included frequency of ATPD episodes, adaptation levels and life events before admission, and psychiatric symptoms before and after admission. The interrater reliability of the assessment proved to be favorable. As a result, early recurrence of psychotic episodes in the follow-up period, lack of acute upsurge of insomnia in an early phase of the episode and poor premorbid heterosexual relations characterized the SD patients. The result indicated heterogeneity of ATPD episodes.     

The relation of "acute and transient psychotic disorder" (ICD-10 F23) to bipolar schizoaffective disorder

The aim of this work is to investigate differences between acute and transient psychotic disorders (ATPD; F23 of ICD-10) and bipolar schizoaffective disorders (BSAD). In a controlled prospective and longitudinal study, we compared all inpatients with ATPD treated at Halle university hospital during a 5-year period with matched controls with BSAD. Sociobiographical data were collected using a semi-structured interview. Follow-up investigations were performed at a mean of 2.2-3.3 years after the index episode or 8.2-16.1 years after the first episode by means of standardized instruments. ATPD differs significantly from BSAD on various relevant levels, such as gender (more female), age at onset (older), development of the full symptomatology (more rapid), duration of the symptomatology (shorter), acuteness of onset (more acute), preceding stressful life-events (more frequent) and long-term prognosis (better). It is concluded that ATPD and BSAD are different nosological entities.     

新型冠状病毒肺炎疫情和游戏障碍风险:防控常态化形势下的回顾和思考

我国目前已基本控制住新型冠状病毒肺炎疫情,并处于常态化防控形势下。此时对2020年疫情期间游戏障碍风险的相关问题进行回顾和思考,可为精神卫生工作者防控游戏障碍提供重要参考。本文在澄清疫情期间游戏厂商的不当宣传和媒体的不实报道,回顾人们游戏使用行为大幅上升和游戏市场快速扩张的趋势之后,指出了人们因过度的游戏行为模式而可能增加的健康风险;同时也指出并分析了疫情期间女性游戏使用人群扩大的新趋势,以及游戏与赌博进一步深度复合的动向;最后,本文为精神卫生工作者在疫情常态化防控中和“后疫情时代”应对上升的游戏障碍风险提出了建议。     

Guillain Barre syndrome associated with COVID-19 infection: A case report

Novel outbreak with coronavirus 2019 began since 31 December 2019. Coronaviruses can cause multiple systemic infections that respiratory complications are the most obvious symptoms. In this report, we describe the symptoms of Guillain Barre syndrome (GBS) in one infected patient with COVID-19, for the first time. We reported a 65-years- old male patient with complaints of acute progressive symmetric ascending quadriparesis. Two weeks prior to hospitalization, the patient suffered from cough, fever, and RT-PCR was reported positive for COVID-19 infection. The electrodiagnostic test showed that the patient is an AMSAN variant of GBS. COVID-19 stimulates inflammatory cells and produces various inflammatory cytokines and as a result, it creates immune-mediated processes. GBS is an immune-mediated disorder and molecular mimicry as a mechanism of autoimmune disorder plays an important role in creating it. It is unclear whether COVID-19 induces the production of antibodies against specific gangliosides. Further investigations should be conducted about the mechanism of GBS in patients with COVID-19, in the future.     

Imaging spectrum of acute invasive fungal rhino-orbital-cerebral sinusitis in COVID-19 patients: A case series and a review of literature

BackgroundThe incidence of devastating opportunistic coinfections in patients with COVID-19 infection, their imaging features and their morbidity and mortality consequences need to be unraveled.MethodsThis is a case series presenting the radiologic features and clinical presentation of acute invasive fungal rhino-orbital-cerebral sinusitis (AIFS) in eight hospitalized patients with confirmed COVID-19 infection.ResultsOur patient cohort presented with symptoms of the invasive fungal disease within 12–35 days from their initial presentation with COVID-19 infection. The cross-sectional imaging features of AIFS associated with COVID-19 infection do not differ from those reported in the literature for AIFS associated with other risk factors, yet our patients had features of aggressive late-stage forms with high morbidity and mortality rate.ConclusionAIFS is a possible encounter in patients with COVID-19 patients and radiologists should be familiar with its imaging features.     

Acute and transient psychotic disorder: comorbidity with personality disorder

A study sample of 51 patients with acute and transient psychotic disorder (ATPD) (ICD-10) is presented. The findings suggest that, in hospital settings, ATPD is a non-frequent condition with onset in early adult life and most often associated with female sex, good premorbid social functioning and no or minor/moderate psychosocial stressors. The DSM-IV criteria distribute the patients into three diagnostic categories: schizophreniform disorder (41%), brief psychotic disorder (33%) and psychotic disorder not otherwise classified (25%). A high prevalence (63%) of personality disorders (PD) is revealed after recovery from the psychotic episode. The ATPD is not related to any specific PD, and in a substantial minority (37%) of cases no PD is found. The unspecified category is by far the most frequent PD in patients with ATPD. The sample will be followed up and reassessed.