精神病住院病例45年抽样分析

目的　对 4 5年来本院住院精神病病例的病种、分型、治疗措施和疗效等作一简要的回顾总结。方法　将自 195 4年 5月到 1999年 9月入院的病人 ,按首次入院日期每隔五年连续抽取 10 0份病例 ,扼要摘录有关内容进行登记、统计、分析。结果　男女病例数大致相仿。平均年龄 (31 9± 12 1)岁 ,平均住院日期 (6 2 1± 36 3)月 ,遗传史阳性率占 2 3 4 % ,精神分裂症占 5 4 % ,心境障碍占 13% ,癔症占 12 5 % ,电休克应用例数自 195 4年的 4 1 5 %降到 1999年的 2 % ,胰岛素治疗自 195 4年的 4 8%逐渐降低到 1989年 4 % ,1999年后为零。药物治疗西药自 5 7年的一种 (氯丙嗪 )增加到 1999年的 2 0余种。中药治疗经过 195 9年和 1970年的两个高潮 ,新针治疗自 196 9年至 1989年亦告结束。两者均无明显疗效。精神分裂症和心境障碍的显效率平均为 70 6 %和 90 8%。但均有评价过高之嫌。结论　根据我院的实践 ,传统的中药方剂、单味草药和“新针”治疗对主要精神病无明显疗效 ,195 9年后住院病人的疗效有明显的提高 ,愈来愈多的抗精神病药和取代了原有的胰岛素休克和电休克治疗。     

精神病人与正常人戒烟前后焦虑抑郁症状的对照研究

目的　了解精神病人和正常人戒烟前后精神状况的变化及差异性 ,探讨戒烟措施。方法　对 71例精神病人和 5 0例正常人戒烟前及戒烟后 1周分别应用汉密顿焦虑量表 (HAMA)、汉密顿抑郁量表 (HAMD)、焦虑自评量表 (SAS)、抑郁自评量表 (SDS)、简明精神病量表 (BPRS )进行测评。结果　精神病人强制性戒烟前HAMA、HAMD、SAS、SDS、BPRS分值分别为 (8.2 1± 6 .4 1)、(7.6 4± 5 .71)、(36 .81± 7.14 )、(33.71± 7.1)、(2 9.4 5± 8.4 7) ;戒烟后HAMA、HAMD、SAS、SDS、BPRS分值分别为 (16 .4 5± 6 .34)、(19.73± 8.71)、(5 8.1± 12 .12 )、(5 6 .31± 11.4 )、(37.32± 7.95 ) ;戒烟前后 5种量表分值变化与正常人戒烟前后分值变化比较有极显著性差异(P <0 .0 1)。结论　对精神病人强制性戒烟可引起明显的情绪反应 ,应适宜控制病人吸烟 ,建立一个合理的管理制度     

Identifying patients at risk for,and treatment of major psychiatric complications of cancer

A critically important aspect of supportive care in cancer is the prompt recognition and effective treatment of psychiatric complications. Psychiatric disorders such as depression, anxiety and delirium occur in a signifcant percentage of cancer patients, particularly as disease advances and as cancer treatments become more aggressive. This paper reviews factors that can be utilized to identify patients who are at increased risk for developing psychiatric complications, such as those with advanced disease, certain cancer treatments, uncontrolled physical symptoms, functional limitations, lack of social support, and past history of psychiatric disorder. Methods of diagnostic assessment and strategies for managing depression, anxiety, delirium and suicidal ideation are also reviewed.Presented as an invited lecture at the 6th International Symposium: Supportive Care in Cancer, New Orleans, La., USA, 2–5 March 1994     

精神科护士的职业压力调查

目的调查精神科护士在工作中面临的职业压力。方法采用问卷调查法,对贵州省贵阳市两所医院精神科61名护士与贵州省贵阳市多所医院173名护士的职业压力进行调查分析。结果精神科护士职业压力处于较高水平,其他科护士压力处于中等水平。结论建议从管理角度减轻精神科护士工作压力,并对精神科护士进行减轻工作压力的训练。     

Intravenous drug abuse and Type 1 diabetes: financial and healthcare implications.

AIMS: To determine the morbidity, mortality and healthcare costs of intravenous drug-abusing patients with Type 1 diabetes (IVDA-DM), who are admitted to hospital. METHODS: Retrospective case note analysis of admissions, complications and cost estimation over a 6-year period. Each drug-abusing patient (IVDA-DM) (n = 9) was compared with two controls (n = 18) with Type 1 diabetes but without a history of intravenous drug abuse (DM-controls). Admissions were also analysed for patients with intravenous drug abuse, but without Type 1 diabetes (IVDA-controls) (n = 198). Admissions were at a University teaching hospital in Liverpool, UK. DM-controls were drawn from a population attending diabetes outpatient clinics between 1997 and 2002 at the same hospital. The main outcome measures were: the duration and healthcare costs of hospital admissions per year, outpatient attendances per year, glycated haemoglobin (HbA(1c)), weight, micro- and macrovascular complications and mortality. RESULTS: Multiple admissions, mainly related to ketoacidosis, led to marked differences in mean (95% CI) inpatient days per year per patient [IVDA-DM 28.1 (13.6-42.7) vs. DM-control 1.1 (0.2-1.9); P < 0.0001], mean inpatient days per year per patient in critical care bed (IVDA-DM 1.7 (-0.7-4.2) vs. DM-control 0; P < 0.02) and mean costs of admission, per patient per year (pound sterling 7320 vs. pound sterling 230). The IVDA-DM group frequently omitted insulin, were underweight, failed to attend as outpatients and five had died by the end of 2002. The IVDA-controls spent considerably less time in hospital [3.4 (2.8-3.9) days per patient per year]. CONCLUSION: IVDA-DM patients have higher rates of diabetes complications, are admitted more frequently and have a high mortality compared with DM and IVDA-controls. The cost of inpatient care of this small group of patients was considerable.     

Extraction of Potential Difficult-to-Manage Psychiatric Cases among Criminal Offenders: 5-Year Data from the Tokyo District Public Prosecutors Office

Abstract: In order to examine the characteristics of potential difficult-to-manage psychiatric cases, seven potential subgroups were extracted from the criminal offenders who were sent to the division of psychiatric diagnosis, Tokyo District Public Prosecutors Office for Pre-Prosecution Psychiatric Justice (PPPJ). The following criteria were used to select the potential subgroups: offenders who had experienced compulsory discharge from a mental hospital, those who had experienced Involuntary Admission to the mental hospital by the Prefectural Governor at least twice, those who had experienced admission to mental hospitals on more than 5 occasions, those who had been put on PPPJ previously for other criminal matters at least 3 times, those who had previously attempted suicide, and those who had committed homicide or arson. From the results of this study, it could be concluded that at least two types of "difficult-to-manage" psychiatric cases exist in the criminal offenders.     

家庭暴力及其应对策略

近几十年来，公众和社会逐渐认识到家庭暴力是一种主要的公共健康问题，它影响着不同种族、不同社会、不同经济背景中的个体。目前家庭暴力依然是当今社会中的一大问题。结束家庭暴力要求全体社会的共同关注，包括卫生保障部门、执法部门、社会服务系统联合起来应对家庭暴力。     

脑肿瘤伴发精神障碍─—附36例分析

９８例颅内肿瘤经手术和病理检查证实，其中３６例脑瘤伴精神障碍，最常见的精神症状是情感淡漠，情感不稳，遗忘，意识模糊，嗜睡、痴呆。为最常见的部位为额顶部和颞叶部。