血清皮质醇、醛固酮水平在男性伪装精神病司法鉴定中的变化特点

目的:探讨血清皮质醇(COR)、醛固酮(ALD)水平在暴力违法精神疾病司法鉴定中对伪装精神病(诈病)的诊断与鉴别作用。方法:将男性暴力违法(被控故意杀人和伤害)者作为研究对象,分别比较完全责任能力伪装精神疾病组(简称诈病组)、无精神病无诈病表现完全责任能力组(简称完全组)、精神分裂症限定责任能力组(简称限定组)、精神分裂症无责任能力组作为对照组(简称对照组)血清COR、ALD水平。结果:(1)鉴定前后COR、ALD水平自身对照比较:诈病组COR、ALD水平差异均有极显著性(P<0.001);完全组COR有差异(P<0.05),ALD降低但无统计学意义(P>0.05);限定组COR有差异(P<0.05),ALD差异有显著性(P<0.01);对照组COR、ALD均降低,但无统计学差异(P>0.05)。(2)诈病组血清COR、ALD水平下降率高于其他组,差异均有显著性(P<0.001)。(3)鉴定前诈病组COR、ALD水平与其他组比较差异均有极显著性(P<0.001);完全组与限定组比较COR无差异(P>0.05),ALD有差异(P<0.05);完全组与对照组比较COR无差异(P>0.05),ALD差异有极显著性(P<0.001);限定组与对照组比较COR无差异(P>0.05),ALD差异有显著性(P<0.01)。(4)鉴定后诈病组与完全组比较:COR高于完全组差异有极显著性(P<0.001);ALD高于完全组,但差异无显著性(P>0.05)。诈病组与限定组比较:COR高于限定组差异有显著性(P<0.01);ALD高于限定组差异有极显著性(P<0.001)。诈病组与对照组比较:COR高于对照组,差异有显著性(P<0.05);ALD高于对照组,差异有极显著性(P<0.001)。结论:血清COR、ALD水平在应激层面对伪装精神疾病的诊断与鉴别以及对不同责任能力的判定具有一定的客观参考价值。

CHANGES OF SERUM CORTISOL AND ALDOSTERONE LEVEL IN THE FORENSIC PSYCHIATRIC EXPERTISE OF MALE PSYCHOTIC MALINGERING

Objective:To explore the role of serum cortisol(COR)and aldosterone(ALD)level in the diagnosis and differential diagnosis of psychotic malingering(simulation)in the forensic psychiatric expertise of violent illegal psychosis.Methods:Male violent criminals who were charged by intentioned homicide and harm were included in the study and divided into simulation group,who had appearance of psychotic malingering with complete responsibility;responsibility group,who had no appearance of psychotic malingering with complete responsibility,diminished group,who had schizophrenia with diminished responsibility and control,who had schizophrenia with no responsibility.The serum COR and ALD level of the above four groups were compared,respectively.Results:(1)The self-comparison of COR and ALD pre-and post-expertise: there were significant differences in both COR and ALD in the simulation group(P<0.001);significant difference was found in COR(P<0.05),ALD level decreased but had no statistic difference(P>0.05)in the responsibility group;there were significant differences in both COR(P<0.05)and ALD(P<0.01)in the diminished group;no differences were found in the control group(P>0.05).(2) The degree of the COR and ALD decrease of the simulation group was higher than that in the other groups(P<0.001).(3)There were significant differences in both COR and ALD in the simulation group compared with the other groups(P<0.001)before expertise.Significant difference was found in ALD(P<0.05),but not in COR(P>0.05)between responsibility group and diminished group.Significant difference was found both in ALD(P<0.001) and COR(P>0.05)between responsibility group and the control groups.Significant difference was also found in ALD(P<0.001) and COR(P>0.05)between diminished group and the control group before expertise.(4)The COR was significantly higher in simulation group compared with responsibility group(P<0.001),the ALD level was also higher but had no statistic meaning(P>0.05).The COR(P<0.01)and ALD(P<0.001)were both significantly higher in simulation group than in diminish group.The COR(P<0.05)and ALD(P<0.001)level were both significantly higher in simulation group compared with the control group.Conclusion:In the light of stress,serum COR and ALD level have an objective reference value in the diagnosis and differential diagnosis of psychotic malingering and in the judgment of different responsibilities.