首发青少年精神病患者亲属心理应激状况调查与对策

目的探讨青少年精神病患者亲属心理健康状况。方法对我院首次住院青少年精神病患者的93例亲属,采用症状自评量表（SCL-90）、焦虑自评量表（SAS）及自制一般情况调查表进行测评,并进行t检验和统计学描述。结果患者亲属SCL-90评分高于国内常模,且女性评分高于男性。SAS评分高于国内常模（P〈0.01）,差异有显著性。结论青少年精神病患者亲属普遍存在心理问题,为促进患者的康复,应及时有效的对其亲属进行心理干预,改善他们的心理障碍,提高他们的心理健康水平。     

精神科护士保护性约束态度、行为与伦理氛围认知的现状及相关性分析

目的了解精神科护士保护性约束态度、行为与伦理氛围认知的现状并分析其相关性。方法采取便利取样的方法,对湖南长沙2所精神病专科医院、1所三级甲等综合医院的330名精神科护士,采用精神科护士保护性约束态度、行为问卷和伦理氛围认知量表进行问卷调查,采用Pearson相关分析法分析两者之间的相关性。结果精神科护士保护性约束态度总分为(30.47±4.83)分,保护性约束行为总分为(31.67±3.17)分,精神科护士伦理氛围认知总分为(88.15±11.82)分。330名精神科护士在临床工作年限、性别、学历、职位、婚姻状况、所在病房保护性约束态度得分比较,差异有统计学意义(P<0.05),精神科护士在年龄、性别、是否接受过医学伦理教育培训保护性约束行为得分比较,差异有统计学意义(P<0.05),精神科护士在性别、有无精神心理专科护士证、是否接受过医学伦理教育培训伦理氛围认知得分比较,差异有统计学意义(P<0.05)。精神科护士保护性约束态度与伦理氛围认知呈正相关(r=0.242,P<0.001)。结论精神科护士保护性约束态度和伦理氛围认知均处于中等水平,精神科护士保护性约...     

Pédopsychiatrie et pharmacogénétique : pharmacorésistance aux psychotropes et duplication du cytochrome P450 2D6, à propos de trois cas cliniques

Severe mental health diseases in children and adolescents–such as schizophrenia, bipolar disorder or depression–are chronic impairing diseases representing a major public health issue. Despite adequate pharmacological treatment, some patients will present pharmacoresistant disease and in consequences psychotropic poly-therapy. Those patients are at more important risk to present adverse advents as well as longer in- our outpatient treatment. Psychotropics are predominantly metabolised at hepatic level, and for a high number of them by cytochrome P450 and its CYP2D6 subunit. A functional abnormality of this subunit induces a dysfunctioning of metabolisation of these treatments (inefficiency or adverse events). Several studies demonstrated a link between pharmacogenetics and treatment efficiency. This clinical presentation describes three pharmacoresistant patients aged between 13 and 16 years. All presented psychiatric disease since several years and requiring one or several full-time hospitalisation in a child and adolescent psychiatry department. Psychotropic treatments with market authorization or frequently used in our speciality had been without clinical efficiency for the symptomatology of these adolescents. As a consequence, clinical management implicated poly-therapy, adverse events and repeated hospitalisation with a high impact on social, family and school functioning. In this context of pharmacoresistance, pharmacogenetic testing has been realised. Two patients presented functional pharmacogenetic anomalies of cytochrome P450 2D6 and were ultrarapid metaboliser for CYP2D6. Accordingly, treatment decisions had been revised using psychotropics not metabolized by CYP2D6 as well as non-pharmacological approaches. This readjustement was followed by clinical improvement and psychosocial rehabilitation. The third patient we describe did not present a pharmacogenetic abnormality of CYP2D6, thus illustrating the complex mechanism of pharmacoresistance, not only explained by CYP2D6 dysfunctioning. This clinical case also allows questioning about our clinical practices.     

Forensic Implications of the New Classification of ICD-11 Paraphilic Disorders in Brazil

IntroductionThe World Health Organization (WHO) Department of Mental Health and Substance Abuse appointed a Working Group on Sexual Disorders and Sexual Health in order to revise and propose changes to ICD-10 categories.AimAnalyze ethical and legal implications in Brazil of the proposed ICD-11 diagnostic criteria for paraphilic disorders.MethodsA forensic working group of Brazilian experts in collaboration with representatives of WHO reviewed the proposed modifications to the classification of Disorders of Sexual Preference in ICD-10 (F65), which is recommended to be replaced by Paraphilic Disorders in ICD-11. Proposals were reviewed through a medicolegal lens, using a legal and policy analysis guide put forth by WHO. The premise of this review was to understand that, although the ICD classification is intended to provide a basis for clinical and statistical health interventions, medical diagnostics may also be entangled in the complex legal, normative, and political environment of various countries.Main Outcome MeasureThe most important proposed change to this section is to limit the concept of paraphilic disorders primarily to patterns of sexual arousal involving a focus on others who are unwilling or unable to consent, but this change has not affected the ethical and legal aspects of psychiatric functioning in the Brazil.ResultsBecause Brazilian criminal law is directed toward criminal behavior and not to specific psychiatric diagnoses, the changes proposed for ICD-11 are not expected to create obstacles to health services or to modify criminal sentencing.Clinical ImplicationsAlthough ICD-11 has a number of changes in its content, there are no significant clinical implications in the Brazilian context, but a better clarity of conceptual definitions and diagnostic criteria.Strengths & LimitationsThe study is conducted with people from different Brazilian states, which is important for a comprehensive view. On the other hand, considering that it is a very heterogeneous country, there is the limitation that an even wider scope of the study is not possible.ConclusionIn the Brazilian context, the new guidelines for paraphilic disorders contribute to clinical utility and are not expected to create difficulties related to the legal, social, and economic consequences of sexual offenses in the country.Abdalla-Filho E, de Jesus Mari J, Diehl A, et al. Forensic Implications of the New Classification of ICD-11 Paraphilic Disorders in Brazil. J Sex Med 2019; 16:1814–1819.     

Precursors to suicidality and violence on antidepressants: systematic review of trials in adult healthy volunteers

ObjectiveTo quantify the risk of suicidality and violence when selective serotonin and serotonin-norepinephrine reuptake inhibitors are given to adult healthy volunteers with no signs of a mental disorder.DesignSystematic review and meta-analysis.SettingPublished trials identified by searching PubMed and Embase and clinical study reports obtained from the European and UK drug regulators.ParticipantsDouble-blind, placebo-controlled trials in adult healthy volunteers that reported on suicidality or violence or precursor events to suicidality or violence.ResultsA total of 5787 publications were screened and 130 trials fulfilled our inclusion criteria. The trials were generally uninformative; 97 trials did not report the randomisation method, 75 trials did not report any discontinuations and 63 trials did not report any adverse events or lack thereof. Eleven of the 130 published trials and two of 29 clinical study reports we received from the regulatory agencies presented data for our meta-analysis. Treatment of adult healthy volunteers with antidepressants doubled their risk of harms related to suicidality and violence, odds ratio 1.85 (95% confidence interval 1.11 to 3.08, p = 0.02, I²= 18%). The number needed to treat to harm one healthy person was 16 (95% confidence interval 8 to 100; Mantel-Haenszel risk difference 0.06). There can be little doubt that we underestimated the harms of antidepressants, as we only had access to the published articles for 11 of our 13 trials.ConclusionsAntidepressants double the occurrence of events in adult healthy volunteers that can lead to suicide and violence.     

The Moral Career of ‘Outmates’: Towards a History of Manufactured Mental Disorders in Post-Socialist?China

This study focuses on ‘manufactured mentally ill’ (bei jingshenbing, 被精神病) individuals in post-socialist China. In Chinese society, bei jingshenbing is a neologistic catchphrase that refers to someone who has been misidentified as exhibiting symptoms of mental illness and has been admitted to a mental hospital. Specifically, it refers to those individuals who were subjected to unnecessary psychiatric treatment during the first decade of the twenty-first century. Based on archival analysis and ethnographic fieldwork, this study addresses the ways in which the voices of bei jingshenbing victims and those who support them reveal China’s experiences with psychiatric modernity. It also discusses the active role of these individuals in knowledge production, medical policymaking, and the implications for reforming the psychiatric and mental health systems in post-socialist China.     

Current State of Psychiatric Involvement on Palliative Care Consult Services: Results of a National Survey

ContextPalliative care consult services have emerged as an excellent resource for physicians seeking help with patients' symptoms. Symptoms include those of a psychiatric nature (e.g., depression, anxiety, delirium); however, little information is known about whether palliative care services include psychiatric input as part of multidisciplinary teams.ObjectivesTo explore 1) the current level of collaboration between psychiatrists and palliative care consult services across the U.S. and 2) the factors that support or restrict such involvement.MethodsA national survey was developed and distributed electronically to program directors identified in the National Palliative Care Registry maintained by the Center to Advance Palliative Care. Analyses examined trends in psychiatry involvement with hospital-based palliative care teams.ResultsThe survey had a 59% response rate, with final analyses including surveys completed by 260 palliative care program directors (67% inclusion rate from total respondents). Seventy-two percent of respondents reported some form of involvement with a psychiatrist on their palliative care service, with only 10% of those identifying a psychiatrist as a full- or part-time member of the team. Most respondents reported that they would like psychiatrists to be more involved with the palliative care services (71%). Secondary analyses of qualitative responses identified common impediments to increased psychiatry involvement, which included financial constraints, provider interest, and perceived disciplinary disconnect.ConclusionThere are shared objectives between psychiatry and palliative care; however, currently, co-involvement on treatment teams is quite limited. Future research is needed to identify ways to facilitate the interface of palliative care and psychiatry.     

精神科临床护理路径脱组原因分析及应对措施

目的：探讨精神科临床护理路径实施过程中病例脱组的原因并制定应对措施降低脱组率。方法将2012年12月1日-2013年3月31日入组患者（对照组）的脱组现象进行回顾性调查分析，明确脱组原因并制定应对措施，以此对2013年4月1日-7月31日入组患者（干预组）进行干预。将两组之间的脱组率、脱组原因等进行比较分析。结果对照组脱组率为11．3％，干预组明显下降为5．1％，两组比较差异有统计学意义（χ2＝5．747，P＜0．05）。主要脱组原因中，“家属或患者认为病情好转而出院”单项因素在干预前后的比较差异有统计学意义（2．3％比0．0％，χ2＝5．376，P＜0．05）。结论明确脱组原因，有针对性地干预可避免因素，可降低脱组率，完善变异管理，帮助精神科临床护理路径的开展。