桂林市农村地区精神疾病流行病学调查

目的:了解桂林市15岁以上农村居民各类精神疾病的患病水平和分布特征。方法:2007年7月至12月采用多阶段分层整群抽样方法随机抽取桂林市3个县2800名15岁以上农村居民为对象进行入户调查。以中国疾病预防控制中心精神卫生中心提供的中文版复合性国际诊断问卷为筛查工具,以国际疾病及相关健康问题分类第10版为诊断标准。结果:完成调查2628人,调查完成率93.9%。桂林农村15岁以上人群精神疾病的总时点患病率23.59‰,总终生患病率29.30‰。终生患病率前3位病种为酒依赖(11.42‰)、精神分裂症(8.37‰)和抑郁症(7.61‰)。农村地区女性终生患病率为20.56‰,低于男性的38.70‰(χ2MH=6.969,P=0.008)。酒依赖终身患病率在55～74岁年龄段和壮族人群中患病率较高结论:酒依赖、精神分裂症和抑郁症是桂林市农村地区精神疾病防治重点。     

住院抑郁症患者联合心境稳定剂治疗的影响因素研究

目的对联合心境稳定剂(MS)治疗的住院抑郁症患者的临床特征进行分析,探讨其影响因素,为临床治疗提供参考。方法回顾性分析2013年12月-2016年11月于首都医科大学附属北京安定医院抑郁症治疗中心住院的共472例抑郁症重度发作患者的临床资料,对联合或不联合MS治疗的抑郁症患者人口学资料和疾病特征进行比较。结果联合MS治疗的患者比例为8.3%(39/472)。与未联合MS治疗组相比,联合MS治疗组患者年龄较小(Z=-4.435,P0.01),更多男性(64.1%vs.37.6%,χ~2=10.451,P0.01),更多无配偶(41.0%vs.19.9%,χ~2=9.460,P0.01),更多无业(38.5%vs.21.0%,χ~2=6.253,P0.05),更多18岁前起病(43.6%vs.7.2%,χ~2=51.977,P0.01),更多难治性抑郁(17.9%vs.4.6%,χ~2=11.787,P0.01),较少伴有焦虑特征(23.1%vs.44.7%,χ~2=6.813,P0.01),抗精神病药物使用率更高(76.9%vs.54.5%,χ~2=7.311,P0.01)。多元回归分析显示,患者年轻(OR=0.9,95%CI:0.91~0.98,P0.05),男性(OR=2.4,95%CI:1.1~5.7,P0.05),18岁前起病(OR=0.2,95%CI:0.05~0.4,P0.01),难治性抑郁(OR=4.9,95%CI:1.5~15.9,P0.01),更多使用抗精神病药物(OR=2.4,95%CI:1.1~5.7,P0.05)均是联合MS治疗的影响因素。结论青壮年、起病早、男性、难治性、接受抗精神病药物治疗的抑郁症患者可能更多联合心境稳定剂进行治疗。     

精神疾病共病高血压病的调查

目的 调查精神疾病患者共病高血压病的现状,探讨相关的危险因素.方法 回顾性分析河北医科大学第一医院精神卫生科住院的精神疾病患者,采用自制量表调查所有患者共病高血压病的情况,分析精神疾病共病高血压病的危险因素.结果 (1)2770例患者中,男性1234例(44.5%),女性1536例(55.5%);其中共病高血压病者528例(19.1%).(2)不同精神疾病患者共病高血压病的比例:精神分裂症10.6%,双相障碍10.7%,抑郁症24.7%,焦虑障碍29.0%,应激障碍20.0%,器质性精神疾病41.8%,其他19.8%;各组间的差异有统计学意义(χ2=124.90,P<0.01).(3)年龄大、精神疾病的病程长、患器质性精神疾病是精神疾病共病高血压病的危险因素.结论 综合医院精神科住院患者共病高血压病的比例为19.1%,其中器质性疾病共病高血压病的比例最高,精神分裂症和双相障碍患者共病高血压病的比例最低.     

河北省精神分裂症的患病率、人口学特征及功能状况分析

目的了解精神分裂症的患病率、人口学特征及社会生活功能状况。方法采用随机抽样方法,调查河北省18岁以上人群24000人,调查筛选工具采用改编后的一般健康问卷12项(GHQ-12),以《DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查》病人版(SCID-I/P)为调查的诊断工具。功能状况评价采用功能大体评定量表(GAF)。结果精神分裂症时点患病率为0.546%(95%CI:0.445%~0.646%),终生患病率为0.662%(95%CI:0.551%~0.772%)。时点患病率:城市0.440%,农村0.561%,农村虽高于城市,但无显著性差异(u=0.80,P>0.05);女性0.649%,男性0.443%,女性明显高于男性(u=2.01,P<0.01);30~60岁患病率较高。偏执型占63.8%。Logistic回归分析显示,影响精神分裂症的危险因素有分居/离婚(OR=9.58)、独身(OR=6.99)、家庭年收入0~5000元(OR=4.2),保护性因素有已婚(OR=0.38)、无宗教(OR=0.46);严重程度以中度和重度多见,社会和生活功能受损明显,GAF评分平均为(48.41±19.07)分。结论精神分裂症是一种患病率相对较高的重性精神疾病,严重影响患者的社会生活功能。     

广东中山市精神疾病流行病学调查

目的 了解中山市精神疾病流行病学情况。方法 采用WHO提供,1982年和1993年两次全国精神疾病流行病学调查使用的方法,对中山市城乡3721人行社会人口学调查及15岁以上人口精神疾病患病情况调查。结果 中山市精神疾病(不含神经症和海洛因依赖)时点患病率26.13‰,终生患病率为29.91‰;两者明显高于1993年中国七地区精神疾病流行病学调查结果(相应为11.18‰和13.74‰,P均小于0.01)。神经症(均为现患病例)的时点患病率为29.70‰,海洛因依赖终生患病率为7.56‰。结论 中山市精神分裂症和精神发育迟滞仍居前两位,而酒依赖、情感性精神障碍、脑器质性眠精神障碍及镇静眠药物依赖患病率升高,神经症、海洛因依赖患病率居国内较高水平,应列为防治和研究的重点。     

天水市城市与农村普通人群精神卫生知识知晓率及对精神疾病的态度

目的比较天水市城市与农村普通人群的心理健康、精神疾病预防知识知晓率及对精神疾病的态度。方法于2016年3月1日-4月30日采用多阶段分层整群随机抽样方法抽取天水市≥15岁的500名城市和1000名农村普通人为调查对象。采用精神卫生工作指标调查评估方案中的《普通人群心理健康知识和精神疾病预防知识知晓率问卷》、《病例测验》、《精神疾病有关态度问卷》进行调查,并比较农村和城市人群的各问卷结果。结果实际完成调查的城市与农村人口分别为485名、968名。城市人群对精神卫生与心理保健知识的知晓率高于农村(88.2%vs.65.4%,χ~2=99.89,P0.01),对精神疾病态度好于农村[(36.74±6.43)分vs.(35.83±7.62)分,t=2.27,P0.05]。城市人群对抑郁症、阳性症状为主精神分裂症、躁狂症及强迫症的知晓率均高于农村人群(35.5%vs.30.2%,40.2%vs.31.1%,65.4%vs.41.9%,77.1%vs.39.1%,χ~2=3.92、11.93、70.88、187.49,P0.05或0.01),对阴性症状为主精神分裂症的知晓率城市与农村人群差异无统计学意义(12.3%vs.14.3%,χ~2=0.59,P0.05)。结论天水市农村人群心理健康知识知晓率低于城市,对抑郁症、阳性症状为主精神分裂症、躁狂症、强迫症的知晓率低于城市人群,农村人群对精神疾病的态度有待提高,应加强对农村人群精神卫生知识的宣传力度。     

威海市精神疾病流行病学调查

目的：了解威海市≥15岁人群各类精神疾病的患病率和分布特点。方法：2006年9月至2007年2月随机抽取≥15岁人群共50174人，使用心理卫生筛选表、神经症筛选表、精神现状检查（PSE）140题等工具进行调查，以中国精神疾病分类方案与诊断标准第3版为诊断依据。结果：各类精神障碍的时点患病率为70．34‰，终生患病率为89．51‰。排在前3位的为抑郁症（37．49‰）、神经症（30．06‰）和酒依赖（11．38‰）。农村患病率（93．22‰）高于城市（84．30‰），女性（95．27‰）高于男性（83．82‰）。3种精神疾病均存在较高的未识别率，且农村高于城市。结论：山东威海市精神疾病的患病率以女性和农村较高；抑郁症是威海市患病率最高的精神疾病。     

MECT在住院老年精神病患者中的应用情况及相关影响因素分析

目的了解改良电抽搐治疗(MECT)在住院老年精神病患者中的应用情况及相关影响因素,为对其进行MECT提供参考。方法采用回顾性分析方法,从本院电子病历数据库调取2016年在老年精神科病房住院的患者病历共403例,收集患者的社会人口学及临床资料,研究MECT在老年精神病患者中的使用率,采用单因素及多因素方法探索其相关因素。结果 MECT治疗在住院老年精神病患者中的使用率为25.6%。多因素分析显示,60岁≤年龄65岁(OR=0.433)、不合并心脏病(OR=0.362)、有自杀风险(OR=2.980)、诊断为情感障碍(OR=14.265)和精神分裂症(OR=17.260)的住院老年精神病患者更倾向于合并使用MECT。MECT组患者住院天数更少(OR=0.882),住院费用高于非MECT组(OR=5.157)。结论 MECT在精神专科医院老年患者中使用率较高,但年龄大、有心脏疾病及器质性精神障碍的老年患者应谨慎使用。     

精神障碍患者低钠血症危险因素研究

目的评估在精神障碍患者中出现低钠血症的相关危险因素。方法采用自制调查表,回顾记录87例在住院期间出现低钠血症的精神障碍患者与87例同期未出现低钠血症精神障碍患者的社会人口学特征、精神科诊断、精神科用药、躯体疾病诊断、躯体疾病用药情况,采用1:1配对进行病例对照研究。结果多因素条件logistic回归分析显示,器质性疾病所致精神障碍(OR=3.08,95%CI:1.43~6.05)、抗抑郁药(OR=2.14,95%CI:1.01~1.27)、躯体疾病用药(OR=3.50,95%CI:1.96~4.60)与低钠血症相关联(P0.05)。结论患有器质性疾病所致精神障碍、使用抗抑郁药、使用躯体疾病用药是精神障碍患者低钠血症的重要危险因素。     

广州地区常住人口精神障碍的患病率调查

目的 了解广州地区≥15岁人群各类精神障碍的患病率和分布特点.方法 2006年8月1～31日采取分层、整群和随机抽样法,使用复合性国际诊断交谈表3.0中文版(CIDI-3.0)对广州地区≥15岁的居民7418人完成访谈,其中"精神病性障碍"筛查阳性者由精神科医生按照美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)轴I障碍定式临床检查患者版(SCID-I/P)进行疾病诊断.结果 广州地区各类精神障碍加权时点患病率为4.33%,加权终生患病率为15.76%.在加权时点患病率中,排在前三位的是酒精使用障碍(1.38%)、重性抑郁障碍(0.80%)和精神分裂症(0.49%).各类精神障碍加权时点患病率农村明显高于城市(5.92%vs 3.73%,χ2=17.12,P＜0.001);酒精使用障碍男性明显高于女性(2.54%vs 0.17%,χ2=86.74,P＜0.001)、农村明显高于城市(2.19%VS 0.87%,χ2=20.65,P＜0.001);烟草依赖男性明显高于女性(0.50%vs 0.02%,χ2=17.78,P＜0.001);重性抑郁障碍、广泛性焦虑及未特定抑郁障碍女性明显高于男性(1.03%V8 0.59%,χ2=4.20,P=0.041;0.53%vs0.16%,χ2=6.88,P=0.009;0.43%vs 0.13%,χ2=5.75,P=0.016).结论 广州地区的精神卫生问题值得重视.其中,重性抑郁障碍、酒精使用障碍和精神分裂症患者是社区开展精神卫生服务中的重点人群.     

精神科急诊患者自杀自伤行为相关因素的调查分析

目的:对精神科急诊患者自伤自杀行为发生及相关因素进行初步调查。方法:采用自杀危险因素评估表对精神专科医院急诊非取药患者1 325例进行评估,并根据评分将其分为自伤自杀组146例(评分≥21分)和非自伤自杀组1 179例(评分≤20分),分别对两组社会人口学及疾病学资料进行调查分析。结果:女性就诊者自伤自杀行为高于男性(χ2=6.158,P0.05),白天就诊者高于其他时间段就诊者(χ2=27.740,P0.001),父母关系不和的就诊者高于父母关系好的就诊者(χ2=9.771,P0.01),存在疾病诱因的就诊者高于无疾病诱因的就诊者(χ2=15.134,P0.01),多次发病的就诊者高于首次发病的就诊者(χ2=8.578,P0.05),临床诊断焦虑抑郁状态的就诊者高于其他临床诊断的就诊者(χ2=125.203,P0.001)及有躯体疾病的就诊者高于无躯体疾病的就诊者(χ2=9.039,P0.05)。结论:女性、发病诱因、发病次数、躯体疾病、父母关系、就诊时间及焦虑抑郁状态是精神科急诊患者发生自伤自杀行为的主要相关因素。     

长期住院慢性精神分裂症患者血清尿酸分析及意义

目的探讨长期住院慢性精神分裂症患者血清尿酸的变化。方法采用单纯随机抽样方法抽取2014年在苏州民康医院住院的年龄≥55岁的符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)诊断标准的慢性精神分裂症患者110例作为观察组;随机抽取2014年苏州市金阊区未患精神分裂症的年龄≥55岁的正常老年人500例作为对照组。采用尿酸酶法进行尿酸测定。结果慢性精神分裂症患者高尿酸血症的检出率随着年龄与病程的增加而呈上升趋势,男性明显,差异有统计学意义(χ2=7.73,P0.05)。精神分裂症患者血清尿酸浓度均值低于对照组,差异有统计学意义(t=-3.557,P0.05)。结论慢性精神分裂症患者存在尿酸代谢异常。     

89例首发住院老年期抑郁症的临床特征分析

目的　研究首发住院老年期抑郁症的临床特征。方法　应用自编一般资料调查表 ,回顾 1994～ 2 0 0 1年 89例住院首发老年期抑郁症患者的临床特征 ,并与同期住院的 2 4 9例非老年期首发抑郁症比较。结果　老年期组男性有自杀观念者多于女性 ,并发躯体疾病者少于女性 (P <0 0 0 5 ) ;老年期组并发躯体疾病多于非老年期组 ,精神焦虑比青年组多 ,自杀观念和自杀行为比老年前期少 ,较多单一使用麦普替林 (P <0 0 5 ) ;临床疗效和非老年期无显著差异。结论　老年期抑郁症有较多的精神性焦虑。充分的治疗可以取得满意的疗效     

A population study of the association between sleep disturbance and suicidal behaviour in people with mental illness

Limited representative research has considered the relationship between sleep disturbance and suicidal behaviour among people with mental illness. We investigated the relationship between sleep disturbance and suicidal behaviour across Part II interview of the National Comorbidity Survey Replication (NCSR). The associations between sleep disturbance and suicidal behaviour (thoughts, plans and attempts) were investigated using logistic and multinomial logistic regressions and stratified across six mental disorder groups (depression, anxiety, substance use disorders (SUD), eating disorders (ED), bipolar disorders (BD) and early life disorders). From 5701 participants (mean age 43.4 years 58% women), people with any mental disorder experiencing sleep disturbance were at increased odds of suicidal thoughts (odds ratio (OR): 2.5; 95% CI: 1.7, 3.6) and suicidal plans and attempts (OR: 5.7; 95% CI: 2.7, 11.9) adjusting for age, sex and income. People with BD (OR: 8.9; 95 CI: 2.1, 38.1), early life disorders (OR 6.98, 95% ci 2.48, 19.67), depression (OR 1.88, 95% CI 1.14, 3.11), anxiety (OR 1.90, 95% CI 1.28, 2.85) and SUD (2.60, 95% CI 1.23, 5.49) but not ED, were at increased odds of suicidal thoughts in the presence of sleep disturbance. Adjusting for anti-depressant intake attenuated the effect sizes by up to 20% but the associations remained significant. In conclusion, sleep disturbance is a potential risk factor for suicidal behaviours in people with mental illness. Monitoring and management of sleep disturbance in clinical practice might be an important strategy to mitigate suicidal behaviours in people with mental illness.     

Major mental disorders and criminal violence in a Danish birth cohort

BACKGROUND: This epidemiological investigation was designed to examine the relationships between each of the major mental disorders and criminal violence. Specifically, we assessed whether a significant relationship exists between violence and hospitalization for a major mental disorder, and whether this relationship differs for schizophrenia, affective psychoses, and organic brain syndromes. METHODS: Subjects were drawn from a birth cohort of all individuals born between January 1, 1944, and December 31, 1947, in Denmark (N = 358 180). Because of the existence of accurate and complete national registers, data were available on all arrests for violence and all hospitalizations for mental illness that occurred for individuals in this cohort through the age of 44 years. RESULTS: There was a significant positive relationship between the major mental disorders that led to hospitalization and criminal violence (odds ratios 2.0-8.8 for men and 3.9-23.2 for women). Persons hospitalized for a major mental disorder were responsible for a disproportionate percentage of violence committed by the members of the birth cohort. Men with organic psychoses and both men and women with schizophrenia were significantly more likely to be arrested for criminal violence than were persons who had never been hospitalized, even when controlling for demographic factors, substance abuse, and personality disorders. CONCLUSIONS: Individuals hospitalized for schizophrenia and men hospitalized with organic psychosis have higher rates of arrests for violence than those never hospitalized. This relationship cannot be fully explained by demographic factors or comorbid substance abuse.     

中老年抑郁症患者执行功能障碍及其与血清脑源性神经营养因子的关系

目的探讨中老年抑郁症患者执行功能及其与血清脑源性神经营养因子(BDNF)的关系,为了解中老年抑郁症患者执行功能及生化指标的变化提供理论基础。方法选取2014年6月-2015年1月在贵州医科大学附属医院心理科住院的、符合《精神障碍诊断与统计手册(第4版)》(DSM-IV)抑郁症诊断标准的中老年住院患者78例(抑郁组),并于同期选取贵州医科大学附属医院职工、心理科患者家属80例(对照组),根据抑郁自评量表(SDS)评分将抑郁组分为轻中度抑郁组和重度抑郁组。采用执行功能行为评定量表成人版自评问卷(BRIEF-A)评定抑郁组和正常对照组的执行功能,包括行为管理指数(BRI)和元认知指数(MI)。采用生物素双抗体夹心酶联免疫吸附法(ELISA)测定BDNF水平。结果抑郁组BRIEF-A总评分、BRI、MI及各因子评分均高于正常对照组(P均0.01);重度抑郁组的抑制、转移、工作记忆因子评分与轻中度抑郁组差异无统计学意义(P均0.05),而BRIEF-A总评分及其他因子评分均高于轻中度抑郁组(P均0.05)。中老年抑郁组BDNF水平低于正常对照组,重度抑郁组BDNF水平低于轻中度抑郁组(P均0.05)。执行功能总评分及各因子评分与BDNF水平的相关均无统计学意义(P均0.05)。结论与正常中老年人相比,中老年抑郁症患者执行功能明显受损,中老年抑郁组患者BDNF水平较低,且随抑郁程度加重而下降。抑郁症患者的执行功能和BDNF水平无明显相关性。     

精神分裂症患者出院后2年的复发情况调查

目的:调查精神分裂症患者出院后2年的服药依从性和复发情况以及复发的相关影响因素。方法:选取出院的精神分裂症患者371例,自制调查问卷,回顾性调查出院后第1年及第2年时的复发率、服药认识、依从性、就诊及工作/学习情况;使用Logistic回归分析复发的相关影响因素。结果:患者出院后第1年及第2年复发率分别为32.9%(122例)和40.2%(72例)。出院后第1年复发组与未复发组在对服药的认识、依从性、复诊频率及坚持正常工作/学习比较差异无统计学意义(P0.05);第2年复发组对服药的认识(χ2=17.554)、依从性(χ2=62.514)、复诊频率(χ2=4.131)及坚持正常工作/学习(χ2=9.806)方面均明显差于未复发组(P0.05或P0.001)。Logistic回归分析显示,第1年及第2年对服药认识积极、服药依从性好及能坚持正常工作/学习的患者复发风险更低(OR=0.152~0.376,P0.05或P0.01);而第1年的依从性、服药认识与第2年复发无相关。结论:精神分裂症患者出院后对服药认识积极、依从性好、定期复诊及能坚持正常工作/学习可有效降低复发的风险。     

Treatment for co-occurring mental and substance use disorders in five state Medicaid programs

OBJECTIVES: This study described the locations and patterns of psychiatric and substance abuse treatment for Medicaid beneficiaries with co-occurring mental and substance use disorders in five states. METHODS: Medicaid beneficiaries aged 21 to 65 with psychiatric or substance use disorders were identified with claims and encounter records. Groups were further divided into those with and those without a diagnosed substance use disorder. Adjusted odds of treatment in community-based settings, inpatient facilities, emergency departments, and hospital outpatient departments were calculated. RESULTS: A total of 92,355 persons had a psychiatric disorder, 34,158 had a substance use disorder, and 14,256 had co-occurring psychiatric and substance use disorders. In all five states, beneficiaries with severe mental illness (schizophrenia, bipolar disorder, or major depression) and a substance use disorder had higher odds of inpatient, emergency department, and hospital-based outpatient psychiatric treatment, compared with those with severe mental illness alone. In four of five states, both severe and less severe mental illness and a co-occurring substance use disorder were associated with lower odds of community-based treatment compared with those with the respective mental illness alone. Compared with those with less severe mental illness alone, individuals with less severe psychiatric disorders and a co-occurring substance use disorder had higher odds of inpatient treatment in all states and of emergency department use in three of five states. Odds of inpatient and outpatient hospital use and emergency department use for substance abuse treatment were higher for persons with severe mental illness and a co-occurring substance use disorder in most states, compared with odds for those with a substance use disorder alone. CONCLUSIONS: Heavy inpatient and emergency department use by Medicaid beneficiaries with co-occurring substance use disorders is a consistent cross-state problem. Co-occurring disorders may decrease the likelihood of community-based treatment for those with less severe mental disorders and for those with severe mental illness, suggesting that policies focusing only on these settings may miss a significant proportion of people with these co-occurring disorders.     

Mental health service use by elderly patients with bipolar disorder and unipolar major depression.

Symptoms, functioning, and mental health service use were compared in older out-patients with bipolar disorder and unipolar depression. Bipolar outpatients (n = 37, mean age = 69.7) had higher total symptom severity and positive symptom scores, more impaired community-living skills, and earlier age at onset of illness than patients with unipolar depression (n = 85, mean age = 70.9). Bipolar elderly patients used almost four times the total amount of mental health services and were four times more likely to have had a psychiatric hospitalization over the previous 6 months. These findings underscore the need for effective services for elderly patients with bipolar disorder, who account for a minority of patients with affective disorders, but use a disproportionate amount of costly services.