男性精神障碍患者肇事肇祸行为相关因素研究

背景少数精神障碍患者的攻击行为容易演变为肇事肇祸行为,以男性患者为主,目前缺乏对该类患者发生肇事肇祸行为相关因素的分析研究。目的探讨男性精神障碍患者发生肇事肇祸行为的相关因素,为预防肇事肇祸行为的发生提供帮助。方法选取2014年3月-2016年1月在北京市安康医院司法鉴定中心进行司法精神病学鉴定的男性精神障碍患者96例纳入研究组,以及首都医科大学附属北京安定医院同期住院的男性精神障碍患者65例纳入对照组。本研究为病例对照研究,采用自编调查问卷,调查患者的一般资料,包括年龄、受教育年限、婚姻状况、民族、文化程度、居住地、职业;疾病史概况,包括首次发病年龄、治疗情况、颅脑疾病史、乙醇饮用史、吸烟史、自杀史、既往住院次数;个人成长史概况,包括是否童年家庭环境不良、是否曾遭父母虐待、是否曾被父母遗弃、父母健康状况、父母婚姻状况、父母有无因精神疾病住院、父母有无犯罪记录、父母有无乙醇或物质滥用、居住方式、家庭是否和睦、家庭月收入;家族史概况,包括有无家族犯罪史、有无家族精神疾病史。采用心理变态测评量表修订版(PCL-R)评价患者的人格特点;采用简明精神病评定量表(BPRS)评价患者的精神症状;采用修改版外显攻击行为量表(MOAS)评价患者的攻击行为。问卷在患者进行鉴定或入院当天由两名经过量表一致性培训的调查员询问患者及家属后填写。结果司法鉴定结果显示发生肇事肇祸行为的精神障碍患者多为精神分裂症(82例,占85.4%);研究组与对照组文化程度、居住地、职业,治疗情况、既往住院次数,家庭月收入比较,差异有统计学意义(P<0.05);与对照组相比,研究组PCL-R的反社会因子得分高,BPRS的思维障碍、敌对性因子得分和总分高,MOAS的财产攻击、体力攻击条目加权分和加权总分高(P<0.05);多因素Logistic回归分析结果显示,文化程度〔OR=8.732,95%CI(1.268,60.123)〕、治疗情况〔OR=45.846,95%CI(4.254,494.149)〕、财产攻击条目加权分〔OR=0.044,95%CI(0.006,0.321)〕、体力攻击条目加权分〔OR=0.035,95%CI(0.005,0.246)〕是男性精神障碍患者发生肇事肇祸行为的影响因素(P<0.05)。结论发生肇事肇祸行为的男性精神障碍患者多为精神分裂症。文化程度低、未积极接受治疗、有财产攻击、体力攻击倾向是男性精神障碍患者发生肇事肇祸行为的危险因素。加强文化教育、积极的治疗手段有助于降低该类患者发生肇事肇祸行为。

Study on Related Factors for Male Psychiatric Patients with Violent Behavior

Background　Some psychiatric patients，mainly male patients，may have violent behavior，often causing accidents and misconduct，but there is a lack of analytical research on the factors on related factors of violent behavior in this type of patients.Objective　To explore the related factors of violent behavior of male psychiatric patients，and help to prevent the occurrence of violent behavior.Methods　From March 2014 to January 2016，96 male patients who were judged by the Judicial Appraisal Center of Beijing Ankang Hospital and met the criteria were included in the study group，and 65 patients with mental illness admitted to Beijing Anding Hospital were included in the control group.This study was a case-control study.we used a self-made questionnaire to investigate the patient's general information，including age，years of schooling，marital status，ethnicity，education，place of residence，occupation；history of the disease，including the age of first onset，treatment，history of craniocerebral disease，history of alcohol consumption，history of smoking and suicide，number of past hospitalizations；overview of personal growth history，including whether you lived in poor family environment in childhood，whether you were abused by parents，whether you were abandoned by parents，parental health status，parental marriage status，mental illness hospitalization records，whether your parents had a criminal record，whether your parents had alcohol or substance abuse history，the way of living，whether the family was harmonious，and family monthly income；family history，including family crime history，family psychosis history.The Psychological Correction Scale Revision（PCL-R） was used to evaluate the personality characteristics of patients.The Concise Psychiatric Rating Scale（BPRS） was used to evaluate the psychiatric symptoms of patients.The Modified Explicit Attack Behavior Scale（MOAS） was used to evaluate patient's attacks behavior.The questionnaire was filled out after two investigators who were trained in the consistency of the questionnaire asked the patients who was identified or on the day of admission or their family members.Results　Judicial identification results showed that most of the psychiatric patients with violent behaviors were schizophrenia（82 cases，accounting for 85.4%）.The study group and the control group had statistically significant in education level，place of residence，occupation，treatment status，number of previous hospitalizations，and monthly household income per capita（P<0.05）.Compared with the control group，the study group had higher anti-social factor score of PCL-R，higher thinking disorder score，hostile factor score and the total score of BPRS，and property attack weighted score，physical attack weighted score and total weighted score of MOAS（P<0.05）.Multivariate Logistic regression analysis showed that the educational level 〔OR=8.732，95%CI（1.268，60.123）〕，treatment 〔OR=45.846，95%CI（4.254，494.149）〕，property attack weighted score 〔OR=0.044，95%CI（0.006，0.321）〕，physical attack weighted score 〔OR=0.035，95%CI（0.005，0.246）〕 was the influencing factor of the occurrence of violent behaviors in male psychiatric patients（P<0.05）.Conclusion　Male psychiatric patients with violent behaviors were mostly schizophrenia patients.Low levels of education，lack of active treatment，property attacks tendency，and physical attack tendency are the risk factors for the occurrence of violent behaviors in male psychiatric patients.To strengthen cultural education and active treatments may help to reduce the occurrence of accidents in such patients.