精神分裂症误诊为旅途性精神病原因分析

目的分析精神分裂症与旅途性精神病的临床特点及鉴别诊断要点,减少误诊的发生。方法回顾分析精神分裂症误诊为旅途性精神病1例临床资料。结果本例1年前因旅途中出现精神异常入院,存在幻听,被害妄想,情感不协调,恐惧,行为冲动,有攻击行为,诊断为旅途性精神病,给予阿立哌唑治疗后症状好转出院。此次因未坚持服药,精神症状再次加重,第2次入院,经查体排除器质性精神障碍及精神活性物质和非成瘾物质所致的精神障碍等疾病,阳性与阴性症状量表评分91分,诊断为精神分裂症。给予奥氮平治疗并坚持用药,随访1年病情稳定。结论对于旅途中以精神异常为首发症状者,不应单纯诊断为旅途性精神病,应注意与精神分裂症鉴别。     

20例旅途性精神病患者的护理

旅途性精神病是旅行者在旅途(铁路、公路、水路、航空)中常见的一种突发性精神障碍,常发于长途列车上,往往由内外因素共同作用而引发[1]。以幻听、关系妄想、被害妄想为主要表现。我院2005至2010年收治了20例急性旅途性精神病患者,由铁路部门发现,民政或公安部门救助送入我院治疗,其诊断均符合中国精神障碍分类与诊断标准第3版(CCMD-3)[2]。     

成人麻疹暴发流行68例观察

1990年2月25～4月14日,河南大学发生成人麻疹暴发流行。发病总数为88例,收治住我院68例,年龄17～25岁。有接种史20例(应急接种17例,74年接种3例),无接种史48例。首例麻疹患者,无明确接触史,考虑是否与探家和旅途乘车被传染有关。68例中,其中2例幼年曾患过麻疹(轻、中型各1例)。患者一般治疗时间7天左右,最长治疗时间22天,均治愈。     

旅途性精神病12例分析

旅途性精神病１２例分析王炜黄岩市第三人民医院３１８０２０人们在长途旅行中尤其是初次远行，由于过度疲劳、饮食不习惯、睡眠时间不足、担心钱物被窃等种种因素导致特别紧张而恐惧的情绪突然诱发精神病，表现为猜疑、幻觉、情感障碍、攻击邻座旅客、无故向铁路乘警请求...     

舒适护理在原发性肝癌病人中的应用

总结了60例原发性肝癌病人实施舒适护理的方法。包括生理舒适护理、心理舒适护理、社会舒适护理以及灵魂舒适护理。认为对原发性肝癌病人实施舒适护理大部分能减轻各种不适,使患者的生命质量得以提高,能够无痛苦、舒适的走完人生的最后旅途。     

随车健康零食

外出游玩是一种体力活，爬山、涉水、踏青，哪样都要消耗能量，而能量消耗之后适时吃一些零食，能够很好地补充体能，保证在接下来的旅途中有充沛的精力。那么，哪些食品比较适合在旅途中携带呢？大家一起来晒一晒。     

飞行员2 269例疗养期间患病情况分析

调查和分析 2 269例飞行人员在疗养期间的患病情况,并进行详细分析.逐月统计飞行员疗养期间的发病率,并对各种疾病的发病率进行比较.结果表明患病比例以内科疾病最高;按年龄,上呼吸道感染以 40～ 49岁最高,屈光不正和腰腿痛以≥ 50岁最高;按入院旅途时间,急性胃肠炎和上呼吸道感染以大于 24 h最高;按季节,上呼吸道感染以冬季最高,皮肤病均以秋季最高,慢性胃炎春季最高,急性胃肠炎夏季最高.飞行人员疗养期间的患病情况与年龄、入院旅途时间、季节有一定的相关性.     

飞行员2269例疗养期间患病情况分析

调查和分析2269例飞行人员在疗养期间的患病情况，并进行详细分析。逐月统计飞行员疗养期间的发病率，并对各种疾病的发病率进行比较。结果表明患病比例以内科疾病最高；按年龄，上呼吸道感染以40～49岁最高，屈光不正和腰腿痛以≥50岁最高；按入院旅途时间，急性胃肠炎和上呼吸道感染以大于24h最高；按季节，上呼吸道感染以冬季最高，皮肤病均以秋季最高，慢性胃炎春季最高，急性胃肠炎夏季最高。飞行人员疗养期间的患病情况与年龄、入院旅途时间、季节有一定的相关性。     

酚妥拉明、硝苯吡啶、肝素治慢性肺心病难治性心衰(附54例临床疗效观察)

1 临床资料 本组54例均符合1977年全国第二次肺心病专业会议制定的标准。本组难治性心衰指:①病情本身重、明显紫绀、哮喘较重、神志模糊;②经一般休息及正规治疗效果差者;③伴有较重的并发症如高血压、冠心病、心律失常、呼吸衰竭者。其男43例,女11例。咳喘病史为10～35年,年龄为29～83岁。原发病为慢性支气管炎者38例,支气管哮喘者5例,支气管扩张者6例,肺结核者5例。有肺淤血或/和肺水肿征—呼吸困难、紫绀、肺部湿罗音者47例。有体循环充血征—少尿、肝肿大、顽固性水肿者38例。并发心律失常者8例,高血压者7例,冠心病者5例,肺性脑病者6例。 2 治疗方法 在综合治疗抗感染、吸氧、适时强心、利尿、维持水电解质平衡等措施及查出凝血时间后,加用肝素100mg溶于10％葡萄糖250ml中每分钟20～25滴     

中西医结合治疗小儿肾病综合征

我院儿科于近年来系统地用中西医结合分阶段的方法治疗小儿肾病综合征,经随访观察临床疗效比较满意。现将1984年前治疗的17例,小结报道如下: 治疗对象本组病例均按全国肾脏病协作组的诊断标准确诊为肾病综合征。一、陆床资料本组17例中年龄<3岁者4例,3～7岁者10例,>7岁者3例,其中男性11例,女性6例,入院前病史在1周以内者5例,1周至1个月者5例,1～3个月者3例,3～6个月者2例,6个月以上者2例,其中病史最短者为3天2例,最长者为1年1例。在病史1个月以内10例中有6例入院时初诊为     

A journey of leadership: from bedside nurse to chief executive officer

Understanding leadership from the inside out was a journey that spanned a 40-year career in health care. This article describes an individual's journey of becoming an effective executive leader using the LEADS in a caring environment--capabilities framework. This framework was recently developed in Canada and is now used broadly to understand the complexity and depth of health care leadership skills and challenges. The author utilizes the framework to explore leadership skill development from a personal perspective to a broader system transformation level. Challenges and successes along this journey are included to highlight the manner in which leadership evolves with experience, time, and determination. A retrospective view of a successful career in health care provides the model for others to consider a similar career path using a theoretical base and a thoughtful process of personal development.     

Modeling erotomania delusion in the laboratory with hypnosis

Erotomania is the delusional belief that one is loved from afar by another person (the target). This study used hypnosis as a novel cognitive neuropsychological research tool to model erotomania. The authors developed 2 versions of a hypnotic erotomania suggestion and tested their impact by asking subjects to recall and interpret a story featuring ambiguous scenarios. They also challenged the delusion by asking subjects to justify their beliefs. The hypnotic erotomania suggestions successfully recreated the features of the clinical delusion for many high hypnotizable subjects. They believed that the target loved them, interpreted ambiguous information consistent with this belief and confabulated evidence in service of their delusion. Some also resisted all challenges to their delusion. These features are strikingly similar to clinical cases and highlight the value of using hypnosis to model clinical delusions. The authors also discuss some limitations of this approach.     

老年痴呆中的嫉妒妄想分析

为了解老年痴呆患者中嫉妒妄想的发生频率及妄想的特征,我们对88例住院的痴呆病人进行了分析。结果发现嫉妒妄想占15.8％,在各型痴呆中均有。所有伴有嫉妒妄想的痴呆患者与60％无嫉妒妄想的痴呆患者均至少伴有一种或一种以上的其它精神症状,嫉妒妄想组在伴有被害妄想及幻听症状中有显著性差异。提示,老年病人伴有嫉妒妄想和其它精神症状时应考虑痴呆的诊断。     

住院精神病患者自杀死亡特点分析与护理对策

回顾性分析1975年12月-2004年12月住院27例精神病患者自杀死亡的特点。结果显示:自杀多发生于夜间(19例),在厕所居多(16例),以自缢为首要方式(23例),青壮年精神分裂症占多数(21例)。通常采用被服、毛巾等撕成布条自缢,多发生于疾病的急性期与缓解期。认为在护理工作中要加强责任心,细心观察与评估自杀先兆,禁止患者单独外出,高度关注命令性幻听和自罪妄想两个高危症状,减少或杜绝突然的外界刺激,加强心理治疗和护理,在一定程度上预防自杀。     

Creating a future worth experiencing: nursing strategic planning in an integrated healthcare delivery system

The application of a strategic planning methodology for the discipline of nursing is described in use by a large, nonprofit integrated healthcare system. The methodology uses a transformational leadership assessment tool, quality planning methods, and large group intervention to engage nurses in the implementation of strategies. Based on systems theory, the methodology outlined by the author has application at any level in an organization, from an entire delivery network, to a patient care unit. The author discusses getting started on a strategic planning journey, tools that are useful in the process, integrating already existing business plans into the strategies for nursing, preliminary measures to monitor progress, and lessons learned along the journey.     

Smoking behaviour and interaction: the observation process in research

To those starting off on the research journey, the term 'qualitative research' can often seem a daunting prospect. The world of research methodology and theory is emerged in a rich history of its own terminology, meanings and experiences. Research and innovation are integral parts of the nurse practitioner's role, yet many have little understanding of the theoretical frameworks and methodologies surrounding the vast areas of qualitative and quantitative research. As part of a doctorate, the author undertook a small qualitative study, choosing her own method and question. Intrigued by the phenomenon of smoking addiction, she observed the behaviours and interactions of people who smoke. The focus of this article, however, is the process by which the study was carried out, rather than the observations themselves. This paper presents observational research from the perspective of a nurse practitioner embarking on a journey with qualitative designs.     

NBOMe and 2C substitute phenylethylamine exposures reported to the National Poison Data System

Abstract

Background. Hallucinogenic designer drugs, especially NBOMe and the 2C substitute phenylethylamine series, have been increasing ubiquitous in past years. The purpose of this study is to characterize and compare clinical features of NBOMe and 2C exposures in humans. Method. This is a retrospective cohort study of all single agent exposures to NBOMe and 2C substitute phenylethlamine reported to the National Poison Data System (NPDS) from 1st September 2012 to 30th September 2014. Results. Over the study period, there were a total 341 cases including 148 NBOMe exposures and 193 2C exposures. The majority cases involved men (73.9%); median age was 18 years (Interquartile-range, 16–21). Similar clinical effects were reported in both groups including tachycardia (45.2%), agitation/irritable (44.3%), hallucination/delusion (32.0%), confusion (19.1%) and hypertension (18.5%). There were higher incidences of hallucination/delusion, single episode seizure and benzodiazepine administration in NBOMe exposures (40.5%, 8.8% and 50.0%respectively) than those of 2C exposures (25.4%, 3.1%, and 32.6% respectively). There were 2.3% death; no difference between two groups. Discussion. The higher rate of symptoms in NBOMe is consistent with the higher 5HT2A agonistic effects of NBOMe described in both molecular and animal studies. Conclusion. Common clinical effects of NBOMe and 2C exposures were tachycardia, agitation/irritable, hallucination/delusion, confusion, and hypertension. There were higher incidences of hallucination/delusion, single episode seizure and benzodiazepine administration in NBOMe.     

The many roles of families in family-centered care--part VI

The mother of a child with cystic fibrosis describes her journey from sorrow and fear to hope. Her journey to hope began as partnership with a knowledgeable pediatrician and cystic fibrosis team. The journey wound through demanding care requirements, anguishing questions, and new realizations. The support of friends, and immersion in information about the disease, were also empowering. An introduction to the Cystic Fibrosis Foundation led this mother to volunteering, then to serving on a chapter Board of Directors, and finally to employment by the Foundation as a fundraiser. Both parents and health care organizations benefit from such arrangements. As this author states: "Working with the Cystic Fibrosis Foundation gives me a 'big picture' view of the state of my daughter's disease, and a sense of contributing a small part to the product of its big mission to cure and control CF, and [gives me] hope."     

Caring perspectives in nursing education: liberation, transformation and meaning

The author's personal journey through many years of nursing education as both a student and faculty member lead to a theoretical exploration of a caring pedagogy between students and teachers The author places this exploration in a historical context and examines education, feminist and nursing literature to evolve common themes in describing caring pedagogy within nursing Finally, the author suggests a model that forms the foundation for nursing curricula based on caring values     

精神分裂症患者凶杀案件的犯罪学特征

目的探讨精神分裂症患者和精神正常者凶杀案件犯罪学特征的差异性。方法采用自行编制的司法精神病学鉴定案例调查表对精神医学鉴定案例中鉴定结论为精神分裂症的146例案例（研究组）和鉴定结论为正常者（对照组）的103例案例进行比较分析。结果研究组平均年龄显著高于对照组（t=2．46，P〈0．01）。研究组89．7％被评定为无责任能力，对照组99％被评定为完全责任能力（P〈0．01）。研究组更多地采取公开作案方式，对照组隐蔽作案多见；研究组危害对象更多地涉及近亲和同事，而对照组涉及朋友多见；研究组作案动机主要为病理动机、混合动机和不明动机，现实动机较少，而对照组主要为现实动机，不明动机较少。两组作案方式、危害对象、作案动机均有极显著性差异（P〈0．01）。研究组89％在精神症状直接支配下作案，最常见的精神症状（前四位）依次为被害妄想、幻听、关系妄想、逻辑障碍。结论精神分裂症患者凶杀案件的犯罪学特征明显不同与正常人，其责任能力的评定与其精神病理学特征及严重程度有关。