2012—2018年上海市严重精神障碍应急事件特征分析

目的分析2012—2018年上海市严重精神障碍应急事件特征,为严重精神障碍防治提供科学依据。方法梳理上海市2012—2018年10620起经应急处置的严重精神障碍应急事件,分析不同患者、不同地区、不同年份应急事件的分布特征。结果2012—2018年上海市严重精神障碍应急事件共10620起。其中男性5745起(占54.09%),女性4875起(占45.91%);年龄为16~98岁,平均年龄(52.38±13.08)岁;贫困人员占3243起(30.54%),非贫困占7377起(69.46%)。10620起突发事件以精神分裂症患者引起为主(8315起,占78.30%),36~59岁患者最多(6368起,占59.96%)。应急事件以病情复发或先兆(4304起,占40.53%)、危害公共安全或他人安全的行为或风险居多(3899起,占36.71%)。危害公共安全或他人安全的行为或风险方面,男性比例高于女性,年纪轻的患者比例高于年长患者,偏执型精神病、未确诊患者比例高于其他患者。发生2次及以上应急事件的患者占人数的26.54%,应急事件则占总数的49.23%。对患者的处置措施主要以紧急住院和现场处置为主,处置性质主要以保护性治疗为主,处置效果以"有效"为主。徐汇区严重精神障碍应急事件发生率最高,金山区最低。应急处置突发事件总量从2012—2015年呈逐渐增加趋势,其后基本维持在较高的数量。结论上海市目前对严重精神障碍的应急处置流程发挥了稳定且重要的作用;预防病情复发和危害公共安全是严重精神障碍应急事件防控的重点内容,应加强早期监测、识别、预警报告及其干预;精神卫生防治人员应重点关注既往发生过应急处置的精神分裂症患者,在今后的工作中进一步加强工作人员的应急处置综合管理和协同能力。

Characteristization of severe mental illness emergencies from 2012 to 2018 in Shanghai

  Objective  To analyze the characteristics of severe mental illness emergencies from 2012 to 2018 in Shanghai, and provide scientific basis for the prevention and treatment of severe mental illness.  Methods  A total of 10 620 emergency incidents of severe mental illness that were dealt with from January 2012 to December 2018 in Shanghai were sorted out, and characteristics of emergency incidents, such as demography, distribution of regions and year change were analyzed.  Results  From 2012 to 2018, 10 620 serious mental disorder emergencies were treated in Shanghai, and among them there were 5 745 males (54.09%) and 4 875 females (45.91%); the patients' average age was (52.38 ± 13.08) years(between 16 and 98 years); poverty persons accounted for 3 243 cases (30.54%), while the non-poverty accounted for 7 377 cases (69.46%). Most cases were schizophrenic patients (8 315, accounting for 78.30%), and the most patients aged 36-59 years(6 368, accounting for 59.96%). The most emergency events were relapse or omen (4 304 cases, accounting for 40.53%), and behaviors or risks endangering public safety or the safety of others (3 899 cases, accounting for 36.71%). In terms of behaviors or risks endangering public safety or the safety of others, the proportion of the male was higher than that of the female; the proportion of young patients was higher than that of older patients; and the proportion of paranoid psychosis and undiagnosed patients was higher than that of other patients; 26.54% patients had two or more episodes and caused 49.23% emergency events. The treatment measures for patients were mainly emergency hospitalization and on-site treatment, the nature of treatment was mainly protective treatment, and the treatment effect was mainly "effective". The most emergency events occurred in Xuhui District, while the least occurred in Jinshan District. From 2012 to 2015, the total amount of emergency disposal showed a gradual increasing trend, and then basically maintained a stable level.  Conclusions  At present, the emergency response process for severe mental disorders in Shanghai has played a stable and important role. Preventing relapse and endangering public safety are the key elements of emergency prevention and control of serious mental disorders. Early monitoring, identification, early warning report and intervention should be strengthened. Schizophrenic patients who have had emergency response in the past should be paid more attention to, the comprehensive management and coordination ability should be further strengthened in emergency response in future.