心理干预对重性精神疾病患者肇事肇祸危险度的影响

目的：探讨心理干预对社区重性精神疾病患者肇事肇祸危险度的影响。方法对603例社区重性精神疾病患者进行肇事肇祸危险度评估,并在常规治疗的基础上于随访时进行社区心理干预,观察1a。干预后再次评定患者的肇事肇祸危险度,并与干预前进行对比分析。结果心理干预后入组患者的肇事肇祸等级构成有显著变化（P＜0．05）,其中精神分裂症患者和初中及以上文化程度患者的肇事肇祸危险等级显著降低（P＜0．01）,精神发育迟滞患者和小学及以下文化程度患者的肇事肇祸危险等级无明显变化（P＞0．05）。结论心理干预能显著降低社区重性精神疾病患者的肇事肇祸危险度,但对精神发育迟滞患者及文化程度低的患者效果不明显。     

铜陵地区重性精神病肇事肇祸状况调查

目的：了解铜陵地区重性精神病患者肇事肇祸状况,为重性精神病患者的防治提供依据。方法对4107例重性精神病患者的临床资料及肇事肇祸状况进行回顾性分析。结果本组重性精神病患者肇事肇祸发生率为23．4％,是否肇事肇祸患者性别、年龄、婚姻状况、疾病类型、家族史、服药依从性及经济状况比较差异有极显著性（P＜0．01）。结论铜陵地区重性精神病患者肇事肇祸发生率较高,应加强对这一特殊人群的监管和治疗。     

中山市住院流浪精神病患者现状分析

目的 了解中山市住院流浪精神病患者的现状,为制定政策、采取有效救治和管理措施提供依据.方法 对中山市第三人民医院收治的316例流浪精神病患者,采用自拟住院精神病患者调查表统计临床资料,采用肇事肇祸危险性5级评定法评估肇事肇祸危险性,采用临床总体印象量表、简明精神病量表、护士用住院病人观察量表评定疾病状况.结果 住院流浪精神病患者以未婚青年男性为主,籍贯以省内及邻近省份为主,肇事肇祸危险性评估1级以上占58.72%,以脏臭流浪(24.68%)、影响社会治安(44.30%)入院为主,54.81%既往有精神病史,49.68%诊断为精神分裂症者,21.52%合并内科疾病,91.14%使用典型抗精神病药物治疗,全院年平均床位占有率23.27%.结论 住院流浪精神病患者的救治工作关系到社会和谐稳定,患者长期滞留医院是当前亟待解决的问题.     

城市重性精神疾病患者肇事肇祸相关影响因素调查

目的 了解城市重性精神疾病患者肇事肇祸情况,旨在为社区干预提供依据.方法 对1226例城市重性精神疾病患者肇事肇祸状况进行了调查分析.结果 重性精神病患者肇事肇祸发生率为22.10%,肇事肇祸发生率与患者的性别、年龄、文化程度、疾病类型、监护人、病程、住院次数和服药依从性呈显著相关(P＜0.05或0.01),与患者婚姻状况无关(P＞0.05);肇事肇祸患者以男性居多,年龄较大,文化程度较低,以精神分裂症较多,病程较长,多次住院,服药依从性较差,多为单一用药患者或从未就医的患者,监护人多为患者父母和配偶.结论 对城市重性精神疾病患者的监护和治疗工作应引起社会各界的充分重视.     

阿拉尔市肇事肇祸精神病患者临床特征分析

目的 了解阿拉尔市肇事肇祸精神病患者的临床特征,为精神病患者的三级防治提供依据.方法 对368例肇事肇祸精神病患者采用自制调查表及残联统一印制的调查表进行调查分析.结果 368例肇事肇祸精神病患者中男性占54.89%,25岁-40岁占48.64%,小学文化程度占40.48%,精神分裂症占94.02%,无业者占67.93%,未服药者占45.11%,社会适应差者占58.70%.结论 肇事肇祸精神病患者多为青壮年男性,文化程度较低,以精神分裂症、无业、未服药及社会适应差者居多;建立健全精神病患者的三级防治干预体系,对减少患者肇事肇祸的发生具有重要意义.     

肇事肇祸精神病患者司法鉴定分析

目的 探讨精神病患者肇事肇祸的相关因素.方法 对56例肇事肇祸精神病患者的临床资料进行回顾性分析.结果 肇事肇祸精神病患者以精神分裂症居多(35.71%),情感性精神障碍次之(21.43%);以男性、少数民族、农村及未婚患者居多;肇事肇祸以伤害他人案件最为多见(41.07%),其中34.78%伤害案件由精神分裂症造成;凶杀案、纵火、盗窃常见于精神分裂症和阿尔茨海默病,且以精神分裂症居多.结论 精神病患者肇事肇祸影响因素众多,应引起社会各界的关注,使其得到及时的治疗和监管.     

不同性别流浪精神病患者特点分析及护理

目的探讨不同性别流浪精神病患者特点及总结护理要点。方法对本院2014年7月~2015年7月收治的流浪精神病患者1165例进行回顾性分析,比较不同性别流浪精神病患者其院内感染、攻击行为、肇事肇祸行为、约束情况发生率及日常生活能力情况。结果 1165流浪精神病患者中,男性患者735例,占63.1%,女性患者430例,占36.9%;男性流浪精神病患者医院感染、攻击、肇事肇祸、约束情况发生率及日常生活依赖程度明显高于女性患者,男女比较,均P0.01,差异具有统计学意义。结论流浪精神病患者中男性多于女性,而且男性患者攻击、肇事肇祸及住院后约束率、日常生活依赖程度明显高于女性患者,提示对不同性别流浪精神病患者应有侧重性采取针对性护理防范措施。     

社区精神障碍患者肇事肇祸防治现状分析

目的：了解社区精神障碍患者肇事肇祸防治现状。方法对社区精神障碍患者肇事肇祸现状及干预模式的相关文献进行统计分析。结果肇事肇祸率重性精神障碍患者为22.1%,流浪乞讨精神病患者为83.6%,旅途性精神障碍患者为54.8%；农村及西部欠发达地区重性精神障碍患者肇事肇祸率高达到100%；20.0%的患者从未就医,43.0%的患者未住院治疗,75.0%的重性精神障碍患者10年中未接受正规治疗。我国根据“三级预防”的原则,依托“686项目,构建了不同类型的社区精神卫生服务模式。结论我国精神卫生服务需求较大,但资源相对缺乏,应根据“三级预防”的原则,依托“686项目构建“医院、社区、家庭、个人”四位一体的综合系统处置体系,加强社区对精神障碍患者的综合干预能力,以减少其肇事肇祸行为的发生。     

住院肇事肇祸精神病患者噎食状况调查

目的 了解住院肇事肇祸精神病患者噎食状况,为临床干预提供依据.方法 对21例住院肇事肇祸精神病患者发生噎食的相关资料进行回顾性分析.结果 本组患者噎食年发生率为1.8％,不同性别患者噎食发生率比较差异无显著性(P＞0.05);发生噎食者精神分裂症患者居多,合并躯体疾病者20例,主要为糖尿病和脑梗后遗症.结论 住院肇事肇祸精神病患者噎食发生率高于普通精神病患者,合并躯体疾病者易发生噎食,采取得当措施可大幅提高抢救成功率.     

大理州易肇事肇祸精神病患者救助救治状况调查

近年来,精神病患者肇事肇祸的事件不断发生,特别是伤害、杀人案件,手段残忍、危害严重,直接威胁人民群众的生命财产安全,影响社会秩序,成为一种潜在的社会不安定因素。目前,精神疾病已成为我国严重的公共卫生和社会问题,重性精神疾病患者的救治和监管仅靠亲属远远不够,需要政府将这一群体的救治纳入国家公共卫生投资的视野,真正帮助精神疾病患者,特别是对重性精神病患者实现“病能有医,疯能有控。大理州政府高度重视易肇事肇祸精神病患者的管理工作,根据《国家基本公共卫生服务规范》和省州《基本公共卫生服务项目实施方案》,在云南省率先出台了《大理州易肇事肇祸精神病患者管理救助救治工作实施办法（试行）》（以下简称《办法》）,推进精神病患者救助救治项目的实施。现将该项目实施1年来的状况报告如下。     

老年精神病患者白细胞减少症临床资料分析

目的：了解老年精神病患者白细胞减少症的临床特征,为临床诊治提供依据。方法对40例老年精神病白细胞减少症患者的临床资料进行回顾性分析。结果本组患者临床症状复杂,其中17.5%的患者无任何临床症状;抗精神病药物应用状况：未应用2例、单用17例、联用21例;应用抗精神病药物时间<21 d33例(82.5%)、≥21 d5例(12.5%)。本组合并感染14例,其中重症感染5例预后不定,其余患者经治疗后均恢复正常。结论老年精神病白细胞减少症临床症状复杂,多发生在用药初期,以联用多种抗精神病药物者居多,合并感染率较高,临床上应重视白细胞的监测。     

Systematic screening for metabolic syndrome in consumers with severe mental illness

The high prevalence of metabolic syndrome (MetS) in people with a mental illness has been reported recently in the literature. Gaps have emerged in the widespread use of systematic screening methods that identify this collection of critical risk factors for cardiac and metabolic disorders in people with severe mental illness. A sample (n = 103) of consumers with severe mental illness was screened for MetS using the Metabolic Syndrome Screening Tool and compared to a sample (n = 72) of consumers who were not receiving a systematic approach to screening for MetS. The results demonstrated ad hoc screening of consumers for MetS in the comparison group, potentially leaving patients at risk of cardiac and metabolic disorders being untreated. Mental health nurses are well placed to show leadership in the screening, treatment, and ongoing management of MetS in people with severe mental illness. A potential new speciality role entitled the ‘cardiometabolic mental health nurse’ is proposed as a means leading to improved outcomes for consumers who have both the complication of physical health problems and a severe mental illness.     

凝血酶原活动度与危重病患者预后的相关性研究

目的：研究凝血酶原活动度（PTA）与危重病患者预后的相关性。方法选取在重症医学科救治的100例危重病患者，根据不同预后，分为死亡组（50例）和存活组（50例），对两组患者的PTA及其他实验室和临床资料进行回顾性研究。结果死亡组PTA明显低于存活组（t=-3.09，P＜0.05）。 PTA、活化部分凝血活酶时间（APTT）及出科前急性生理和慢性健康评分（APACHEⅡ）是危重病患者预后的危险因素。 PTA预测危重病患者预后的ROC曲线下面积为0.71，95%CI为（0.61～0.82），最佳诊断值为42.50，灵敏度为66.00%，特异度为66.00%。 PTA逐渐下降，死亡率逐渐上升，当PTA在0～10%时，死亡率高达100%。结论 PTA是危重病患者预后的危险因素，PTA越低，病情越重，死亡率越高。     

精神分裂症患者精神残疾现状及相关因素分析

目的：了解精神分裂症患者的精神残疾现状及相关影响因素。方法抽取广东省封开县区重性精神病管理系统登记在册的300例精神分裂症患者进行调查分析。结果本组86.0％的患者存在不同程度的精神残疾,其中精神残疾4级占33.7％、精神残疾3级占16.3％、精神残疾2级占40.6％、精神残疾1级占8.5％。经济收入、文化程度与精神残疾的程度呈负相关,患病次数、家庭结构、阴性症状量表总分与精神残疾呈正相关。结论精神分裂症患者精神残疾发生率较高,影响因素众多,对患者进行系统性的家庭干预、职业康复、社会技能训练等,能有效改善患者的精神残疾状况,促进患者重归社会。     

老年精神病患者护理风险评估及应对措施

目的 探讨老年精神病患者护理风险因素及应对措施.方法 将2012年9月-2013年9月住院的50例老年精神病患者设为观察组,2011年8月-2012年8月住院的50例老年精神病患者设为对照组,两组均予以精神科常规护理,观察组在此基础上分析护理风险,并制定应对措施予以干预.对两组风险事件率、护理满意度及家属投诉率进行对比分析.结果 观察组风险事件率显著低于对照组（P＜0.05）,家属投诉率低于对照组,但差异无显著性（P＞0.05）;护理满意度显著高于对照组（P＜0.01）.结论 加强老年精神病患者护理风险评估,并制定安全应对措施,可显著提高临床安全性,减少不良事件的发生.     

多排螺旋CT 后处理技术对手创伤的诊断价值

目的：探讨多排螺旋C T后处理技术对手创伤的诊断价值。方法对34例手创伤患者经DR平片检查后,应用GE64排螺旋CT薄层扫描及后处理技术进行诊断分析。结果经CT后处理技术,确诊26例手创伤,可疑骨折3例,5例正常。C T后处理技术能清晰、准确显示骨折线,直观显示骨质的移位、分离及周围解剖结构。结论多排螺旋CT后处理技术对手创伤能直观立体准确的显示骨折,是一种高效的诊断方法。     

Assessment of cardiovascular risk in an Italian psychiatric outpatient sample: A chart review of patients treated with second‐generation antipsychotics

Despite the call by the scientific community for a systematic monitoring of physical health in people with psychiatric illnesses, national and international audits have reported poor quality of cardiovascular risk assessments and management in this vulnerable population. Available evidence indicates that in people affected by mental illness, life expectancy is reduced by 10–20 years, mainly due to cardiovascular accidents and metabolic syndrome (MetS)‐related diseases. The primary aim of the present study was to evaluate the accuracy of cardiovascular risk monitoring in an outpatient sample of patients taking second‐generation antipsychotics. The sample consisted of 200 patients consecutively recruited from two community mental health centres. A clinical chart review was performed on the following laboratory tests: total cholesterol, high‐ and low‐density lipoprotein, serum triglycerides, fasting blood glucose, γ‐glutamyl transpeptidase. Blood pressure and waist circumference were measured. A complete cardiovascular risk assessment was available only in 60 patients out of 200 (33.3%). The only variable associated with laboratory tests for MetS was receiving three or more psychotropic medications, which increased fourfold the probability of metabolic screening. In the subsample of patients with full screening, the prevalence of MetS was 33.3%. Our findings suggest that mental health professionals working in community mental health services should incorporate a more systematic assessment of physical health in their practice, and intervene proactively to reduce the significant cardiovascular burden carried by people with several mental illness.     

Adolescent Suicide Risk Screening in the Emergency Department

Objectives: Many adolescents who die by suicide have never obtained mental health services. In response to this, the National Strategy for Suicide Prevention recommends screening for elevated suicide risk in emergency departments (EDs). This cross‐sectional study was designed to examine 1) the concurrent validity and utility of an adolescent suicide risk screen for use in general medical EDs and 2) the prevalence of positive screens for adolescent males and females using two different sets of screening criteria. Methods: Participants were 298 adolescents seeking pediatric or psychiatric emergency services (50% male; 83% white, 16% black or African American, 5.4% Hispanic). The inclusion criterion was age 13 to 17 years. Exclusion criteria were severe cognitive impairment, no parent or legal guardian present to provide consent, or abnormal vital signs. Parent or guardian consent and adolescent assent were obtained for 61% of consecutively eligible adolescents. Elevated risk was defined as 1) Suicidal Ideation Questionnaire‐Junior [SIQ‐JR] score of ≥31 or suicide attempt in the past 3 months or 2) alcohol abuse plus depression (Alcohol Use Disorders Identification Test‐3 [AUDIT‐3] score of ≥3, Reynolds Adolescent Depression Scale‐2 [RADS‐2] score of ≥76). The Beck Hopelessness Scale (BHS) and Problem Oriented Screening Instrument for Teenagers (POSIT) were used to ascertain concurrent validity. Results: Sixteen percent (n = 48) of adolescents screened positive for elevated suicide risk. Within this group, 98% reported severe suicide ideation or a recent suicide attempt (46% attempt and ideation, 10% attempt only, 42% ideation only) and 27% reported alcohol abuse and depression. Nineteen percent of adolescents who screened positive presented for nonpsychiatric reasons. One‐third of adolescents with positive screens were not receiving any mental health or substance use treatment. Demonstrating concurrent validity, the BHS scores of adolescents with positive screens and the POSIT scores of those with positive screens due to alcohol abuse and depression indicated substantial impairment. The addition of alcohol abuse with co‐occurring depression as a positive screen criterion did not result in improved case identification. Among the subgroup screening positive due to depression plus alcohol abuse, all but one (>90%) also reported severe suicide ideation and/or a recent suicide attempt. This subgroup (approximately 17% of adolescents who screened positive) also reported significantly more impulsivity than other adolescents who screened positive. Conclusions: The suicide risk screen showed evidence of concurrent validity. It also demonstrated utility in identifying 1) adolescents at elevated risk for suicide who presented to the ED with unrelated medical concerns and 2) a subgroup of adolescents who may be at highly elevated risk for suicide due to the combination of depression, alcohol abuse, suicidality, and impulsivity.