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酒精所致精神障碍患者临床特征分析

目的　讨论酒精所致精神障碍患者的临床特点，为临床护理提供依据。 方法　对2010年1月－12月出院的160例符合中国精神障碍分类与诊断标准第3版诊断标准的酒精所致精神障碍患者的临床资料进行回顾性分析。 结果　酒精所致精神障碍患者以男性为主，且多为青壮年；常发病者的饮酒年限＞10年；职业以无业、职员、工人居多，其受教育程度偏低；常伴有躯体及精神方面的损害。 结论　长期大量饮酒可导致全身各系统不同程度受到损害，其晨饮及空腹饮酒导致消化系统疾病的发生率最高；酒精是细胞毒性物质，造成的损害是不可逆的，因此提倡合理、健康的饮酒。

Clinical Analysis of 10 Cases with Paralytic Dementia Misdiagnosed as Functional Mental Disorders

目的:探讨被误诊为功能性精神障碍的麻痹性痴呆患者的临床特点和诊治要点。方法:回顾性分析10例被误诊为功能性精神障碍的麻痹性痴呆患者的临床资料。结果:被误诊为功能性精神障碍的麻痹性痴呆均以精神症状为首发，多表现为精神病性症状、类躁狂、抑郁、类神经症、人格的改变及进行性痴呆等不典型症状群，本研究显示误诊率高达71.4%，误诊例次率以精神分裂症最高（47.3%），其次为躁狂症或躁狂状态（37.5%）。抗精神病药物能有效改善精神症状，青霉素驱梅能阻止病情进展使病情得到缓解，两者缺一不可。结论:被误诊为功能性精神障碍的麻痹性痴呆均以精神症状为首发且症状不典型而易被误诊，早期鉴别诊断十分重要，抗精神病药物和青霉素治疗可以有效控制症状。

体外循环心脏直视手术后并发精神障碍的临床分析

目的 探讨体外循环心脏直视手术后并发精神障碍的病因和防治措施，以减少术后精神障碍并发症的发生。 方法 对1998年1月至2007年5月收治的45例体外循环心脏直视术后发生精神障碍患者的临床资料进行回顾性分析，分析其危险因素、临床表现、防治措施和预后。 结果 45例患者经积极治疗，精神症状大多在4d内痊愈，且无复发。术后死亡2例，其中1例双瓣膜置换术患者术后3d死于低心排血量，1例于冠状动脉旁路移植术后8d死于以肾功能衰竭为主的多器官功能衰竭。随访29例，随访率67.4%(29/43)，随访时间2～43个月(21.5±7.8个月)，无精神障碍复发者；失访14例。 结论 体外循环心脏直视手术后精神障碍的发生是由于病理生理、环境、个体因素等多种因素作用的结果，应采取综合防治措施。

Analysis of the Age and Corticosteroid as the Risk Factors for Postoperative Cognitive Confusion in Intensive Care Unit

Objective　To analyze the risk factors for postoperative cognitive confusion in a surgical intensive care unit. Methods　A total of 388 consecutive patients in Surgical Intensive Care Unit of General Hospital of PLA were retrospectively studied. We posed clinical questions according to the patients with older age and large dosage corticosteroid. Using “Postoperative cognitive confusion” and“Intensive Care” as key words, we searched for evidence from MEDLINE (1968-2004). Results　We found 3.1% (10/388) of the patients developed postoperative cognitive confusion. Of the 10 postoperative cognitive confusion patients, 9 were over 65 years old. 6.6% (9/136) of the patients (≥ 65 years old) developed postoperative cognitive confusion. While 0.4%(1/252) of the patients (＜65 years old) developed postoperative cognitive confusion. Older age (≥ 65 years old) may induce more postoperative cognitive confusion (P＜0.05). While 7.0% (5/71) of the patients treated by large dose corticosteroids (≥1 000 mg) developed postoperative cognitive confusion. And 1.65% (5/317) of the patients received corticosteroid with large dosage (＜1 000 mg) developed postoperative cognitive confusion. Large dosage corticosteroid (≥1 000 mg) may induce more postoperative cognitive confusion (P＜0.05). Conclusion　Older age (≥ 65 years old) and high dose corticosteroid (≥1 000 mg) may be the two main risk factors for postoperative cognitive confusion.

对苯丙胺类兴奋剂所致精神障碍患者的护理

目的　总结苯丙胺类兴奋剂（ATS）所致精神障碍患者的临床护理措施。 方法　对2010年4月－12月收治的100例ATS所致精神障碍患者的临床特点与护理经验进行回顾分析，通过加强对戒断症状及精神症状的评估与处理，有效控制其临床风险；通过系统的心理护理增强患者治疗的信心与依从性；并结合电针灸治疗缓解患者躯体不适。 结果　100例患者症状得到明显改善，临床痊愈76例，无并发症及职业暴露发生。 结论　积极有效的护理措施和标准化职业防护策略，是促进兴奋剂所致精神障碍患者临床康复及医护人员有效降低职业暴露风险的重要因素。

Clinical Study of Psychotic Disorder after Gravis Type of Craniocerebral Injury

摘要:目的:探讨重型颅脑损伤后早期精神障碍临床特征及治疗方法,以提高患者的生活质量。方法:对我院48例重型颅脑损伤后早期精神障碍患者进行回顾性分析,观察精神障碍出现的时间、精神障碍的类型及预后及颅脑损伤的部位与精神障碍的关系。结果:重型颅脑损伤后精神障碍主要出现在伤后3周内,多继发于颞叶损伤,其次为额叶。临床上主要有躁狂型、抑郁型、痴呆型、精神分裂性等四型,其中以躁狂型为多见。通过治疗后,lt;1个月精神症状痊愈25例、lt;2个月痊愈13例、治疗gt;2个月仍有精神症状10例。结论:颅脑损伤后精神障碍在原发脑损伤的有效治疗前提下,辅以抗精神障碍药物治疗、心理治疗及高压氧治疗等可取得较好疗效。

癫痫与精神障碍

癫痫患者的精神障碍患病率高于普通人群。目前尚无诊断标准，其诊断需要结合国际抗癫痫联盟推荐的癫痫诊断标准和精神疾病诊断与统计手册。癫痫患者出现精神障碍，根据精神障碍与癫痫的关系，可以分为以下三种类型：癫痫合并精神分裂症、癫痫特有的精神障碍以及抗癫痫药物诱发精神障碍。三种类别的精神障碍临床表现、病程、治疗原则以及预后均各有迥异，需要在临床诊治过程中进行鉴别。但是至今相关的研究报道仍然不多，相关的临床问题尚未引起注意得到关注，期待更多的临床研究，提供更多的循证医学证据。

放射性脑损伤所致精神障碍一例

监狱精神卫生工作研究现状

精神卫生作为重要的公共卫生问题，受到了广泛关注。而精神障碍是监狱里最主要的犯病因素，大约超过90%的罪犯患有精神障碍。2013年5月1日中国颁布实施的《精神卫生法》，明确界定了监狱精神卫生工作内容及职责，规定了监狱对精神障碍罪犯负有的责任，为监狱精神卫生工作的建设指明了方向。现就国内外监狱精神卫生工作研究现状作一综述，以期为新形势下中国监狱精神卫生工作提供相关参考。

Assessment of Risk Factors and Early Intervention of Tumble in Patients with Mental Disorders

ObjectiveTo compare the application of self-made tumble risk factors assessment scale before and after its revision in patients with mental disorder, in order to guide the clinical work. MethodsWe retrospectively analyzed the clinical data of 2 209 patients with mental disorders who were discharged from the hospital between January 1, 2012 and December 31, 2013. All the patients in our hospital underwent the assessment by "table of tumble risk factors for hospitalized patients and nursing measures" within one hour of admission. A total score of 4 or higher meant high tumble risk, and the standardized intervention measures were taken immediately. In 2013, the assessment scale was revised, and binocular vision disorder, low compliance or communication disorders, restlessness were added as risk factors for tumble. The difference among patients with a tumble score of 4 or higher between the year of 2012 and 2013 was compared and analyzed. ResultsIn 2012, 52 patients had a tumble score of 4 or higher, among whom there were 16 males and 36 females; 35 were younger than 65 years old and 17 were older than 65 years. There were 25 patients with organic mental disorders, 10 with spirit obstacle caused by active substance, 12 with schizophrenia, and 5 other cases. In 2013, 154 patients' tumble score was 4 or higher, among whom there were 58 males and 96 females; 142 were younger than 65 years old and 12 were older than 65. Organic mental disorders occurred in 22 patients, 8 had spirit obstacle caused by active substance, 120 had schizophrenia, and there were 4 other cases. In 2013, the number of patients with a tumble score of 4 or higher were significantly more than that in 2012 and young patients with schizophrenia were also significantly more than in 2012 (P<0.05). There were two cases of tumble adverse events, while no adverse events occurred in tumble in 2013. ConclusionCognitive impairment, low compliance, communication barriers and restlessness are high risk factors for tumble in patients with mental disorders. Correct evaluation and early intervention can effectively prevent the occurrence of tumble.