专业门诊5年内儿童少年心理疾病(障碍)就诊状况调查

目的回顾性分析某院门诊诊治儿童青少年患者的状况。方法对2005年1月1日～2009年12月31日某院全部儿童青少年(≤18岁)门诊初诊患者做回顾性分析,对就诊人数、疾病分类及用药做统计描述。结果 1初诊就诊人数逐年增多,患者年龄以12～18岁青少年为主;2疾病分布以精神分裂症、情绪障碍、情感障碍、精神发育迟滞、癫痫、注意缺陷多动障碍、抽动障碍为主要病种,共涉及14个诊断,情绪障碍患者初诊人数逐年增多;3用药以单一用药为主,使用占前5位的是利培酮、喹硫平、舍曲林、阿立哌唑、氯氮平,各种咨询与心理辅导逐年增多。结论就诊人数逐年增多,重性精神病一直是儿童青少年心理专科门诊的重点病种。     

从专科门诊看儿童精神卫生的需求

本文根据深圳市康宁医院儿童精神卫生科门诊记录，总结两年多时间内该专科门诊的就诊人数和病种分布情况，进而对儿童精神卫生的需求进行初步探讨。方法查阅本科门诊日志，以首次就诊为准分性别统计就诊人数和诊断归类，首次诊断不明者，进一步查阅门诊病历，以最近一次就...     

近12年广泛性发育障碍就诊情况的资料分析

目的了解上海交通大学医学院附属精神卫生中心儿少心理咨询门诊12年间广泛性发育障碍(PDD)患儿的就诊情况,以预见其发展趋势。方法自2000年1月-2011年12月间的病历中,每年随机抽取250份、共3000份,其中再选出诊断PDD的病历,逐一记载资料进行分析。结果 12年间PDD患儿占所有就诊儿童的7.2%,儿童孤独症占其中76.4%;Asperger综合征近年确诊人数明显上升。男女比例维持在7.3:1;上海与外地户籍比例维持在1.5:1;初诊年龄为4～6岁的患儿比例最多,但近年有下降趋势。确诊患儿初诊时平均病程为54.5个月;平均就诊次数为2次、且近年仅1次就诊的比例增多。结论 PDD在近年所受的关注度不断提升。作为专业人员要进一步加强相关知识的宣传,从而对疾病进行更有效的干预。     

1986-2006年唐山地区精神科住院患者年出院人次与病种变化趋势

目的: 了解唐山地区精神科住院患者年出院人次及诊断构成比的变化趋势,为该地区及国内类似地区精神卫生政策发展提供依据.方法: 分析唐山地区全部精神病专科医院1986、1996、2001和2006年出院患者的基本信息和诊断类别及其变化情况.结果: 唐山地区1986、1996、2001和2006各年度出院的精神科住院患者分别为832、1705、2279和3154人次,区间增长近4倍,估计每5年平均增长速度为1.39.出院患者的诊断分布在4个年度间存在不同.精神分裂症的出院诊断构成比有下降趋势,而物质滥用或依赖、癔症和应激相关障碍的比例增加.结论: 唐山地区精神障碍患者住院服务利用在20年间呈快速上升趋势;与县级精神病院相比,市级精神病院提供的住院服务增长显著;物质滥用和老年精神障碍住院治疗需求呈快速上升趋势,但精神分裂症、情感障碍和神经症仍然是精神科住院服务的重点.     

潍坊市精神卫生机构建设及服务现况调查

目的:了解、掌握潍坊市精神卫生机构建设及服务现状,为制定潍坊市精神卫生工作政策和规划提供科学依据。方法:采用问卷调查法,通过自行设计的潍坊市精神卫生资源调查表,对全市16个县、市区的全部精神卫生机构进行普查,数据统计时间为2008年1月1日至2008年12月31日。结果:全市共有各级各类精神卫生机构15家,每万人口拥精神科病床1.04张,每10万人口精神科医师数为1.15人,护士数为2.12人,医生、护士本科以上学历分别占32.32%、13.74%,医生、护士高级职称分别占15.16%、0,业务用房床均面积为37.84m2,对精神卫生的投入占全市卫生预算的2.95%,每医师年门诊人次为989.5,每医师年住院人次为70.6,平均住院日为46.9天,床位平均使用率为73.5%,平均每住院床日收费68.56元。结论:潍坊市精神卫生服务网络已基本建立起来,但存在精神科床位、人员数量不足、人员素质较低,基础设施缺乏和落后、政府财政投入不足等问题。     

综合医院心理咨询门诊儿童咨询者临床资料分析

目的 了解综合医院心理咨询门诊儿童咨询者的有关特征和疾病分布特点。方法 采用自制调查表,按照顺序收集近3年来12岁以下,且就诊2次以上409例咨询者的资料,并进行分析。结果 ①409例咨询者中,6～12岁儿童占84％。②就诊原因:疾病诊治(49.9％),学习困难(22.2％),要求写诊断证明(21.3％),咨询教育方法(6.6％)。③心理咨询涉及21种精神障碍,位于前三位的诊断是:精神发育迟滞(25.7％),儿童情绪障碍(20.5％)和多动综合征(16.9％)。结论 儿童、少年期心理问题较多;涉及的精神障碍较为广泛,应注意教养方式、提高家长素质和少儿精神卫生知识的宣传和普及。     

综合医院内精神科会诊258例临床分析

本文报告天津市第三中心医院 2 0 0 1年 8月 -2 0 0 2年 9月住院病人中临床各科申请精神 (心理 )科会诊 2 5 8例患者共42 0例次会诊情况。男性 117例( 4 5 3 % ) ,年龄 18-80岁 ,平均年龄 42±11岁。女性 14 1例 ( 5 4 6% ) ,年龄 19-78岁 ,平均年龄 49± 12岁。采用回顾分析将所有会诊病例以国际疾病分类法ICD -10及中国精神障碍分类与诊断标准CCMD -3进行多维诊断 ,并对各科室会诊分布及精神障碍诊断、治疗转归采用SPSS做统计学分析。结果 :1、会诊人次及科室分布 :申请精神科会诊者 2 5 8例共会诊 42 0次。会诊科室分布见表 1。各…     

河北省地市级以上精神卫生机构专科医生状况调查

目的了解河北省地市级以上精神卫生机构专科医生数量、构成及动态发展,探讨对精神科医生的需求。方法分别调查了2001年和2008年全省地市级以上精神卫生机构专科医生数量与构成,结合各项医疗指标,运用统计学百分率的方法进行统计分析。结果民众精神卫生需求大幅度增加,平均年门诊人次增加了44.78%,但精神科医生分布不均,发展缓慢,7年间仅增加了4.52%。结论河北省地市级以上精神科医生数量严重不足,提高精神科医生队伍的数量和质量,对精神卫生事业的发展具有重要意义。     

综合医院精神科门诊就诊者心理健康状况调查分析

目的探讨综合医院精神科门诊就诊者心理健康状况。方法首先就664例就诊者的职业性别构成和病种构成进行分析;使用症状自评量表(SCL-90)对就诊者进行评定,将就诊者分为有诊断有问题组、有诊断无问题组、无诊断有问题组和无诊断无问题组,并将就诊者的SCL-90得分情况与中国成人常模比较。结果综合医院精神科门诊就诊者女性多于男性,就诊比例较多的依次为退休人员、待业人员、学生、工人和教师。疾病分布以抑郁障碍、焦虑障碍、精神分裂症、躯体化障碍、双向情感障碍为多见。就诊者的SCL-90评分总分、总均分、阳性项目数和各因子分均高于常模(P0.05)。68.37%就诊前有诊断者SCL-90各条目均高于常模,尽管31.63%就诊前有诊断者各因子分均在正常范围内,但他们的量表总分和阳性项目数均高于常模;62.61%的就诊前无诊断者SCL-90总分、总均分、阳性项目数和各因子分均高于常模。就诊者中心理健康状况异常与正常者分别为73.64%与26.36%。结论综合医院精神科门诊就诊者多数为心理健康状况异常者,超过1/4的就诊者心理健康状况正常。     

精神分裂症儿童适应及影响因素的分析

现代社会文明及医学模式转变的客观需求 ,不仅仅是对患儿精神症状的治疗 ,更要注重其社会功能的整体康复。儿童精神分裂症由于诸多因素影响 ,预后不良 ,严重阻碍了儿童社会适应能力的发展 ,造成很大的家庭及社会负担。本研究用儿童适应行为量表[1] 对患儿进行检测 ,考查影响其适应能力的因素 ,探讨改善精神分裂症儿童适应行为发展的措施。1　对象和方法1.1　对象收集 1997年～ 1999年首次来我院精神科就诊 ,符合ＣＣＭＤ - 2 -Ｒ诊断标准[2 ] 的精神分裂症儿童 ,其中农村 16名 ,城市 2 2名 ;男 2 3名 ,女 15名 ;6～ 9岁 11名 ,10～ 12岁 2 7…     

Accuracy of referring psychiatric diagnosis on a consultation-liaison service

The authors determined the accuracy of the initial psychiatric diagnosis of primary medical providers requesting psychiatric consultation in a general medical inpatient setting. A retrospective review of 346 consecutive psychiatric consultations was conducted in which the initial diagnostic impression of primary medical providers was compared with the final psychiatric diagnosis. Accuracy rates for cognitive disorders, substance use disorders, and depressive disorders were 100%, 88.9%, and 53.6%, respectively. Thus, initial diagnoses of a cognitive or substance use disorder by primary medical providers are likely to be accurate, whereas an initial diagnosis of a depressive disorder will be inaccurate in approximately half of the cases.     

A five-year study on the interactive effects of depression and physical illness on psychiatric unit length of stay

OBJECTIVE: Previous research has shown that hospital length of stay among medical patients is significantly increased by comorbid mental illness, in particular depression. However, few studies have examined the length of stay effect of comorbid physical and mental illness among psychiatric patients. METHOD: The present study examined the effect of comorbid physical and psychiatric illness on hospital length of stay among 2323 psychiatric inpatient admissions over a 5-year period. Patients were grouped into seven diagnostic categories. RESULTS: Average length of stay was significantly longer for patients with comorbid physical diagnoses (mean = 20.01 days) than for patients with no physical diagnoses (mean = 16.63 days). Analyses of the psychiatric categories revealed that the average length of stay for depressed patients was significantly greater for those with comorbid physical diagnoses (mean = 19.73 days) than for depressed patients with no comorbid physical diagnoses (mean = 13.96 days). No other psychiatric group evidenced a significant increase in length of stay for comorbid physical illness. CONCLUSIONS: Results suggest that comorbid physical diagnosis increases length of stay among psychiatric patients overall, with increased hospitalization stay for depressed patients, in particular.     

Heterogeneity of admission history among patients with bipolar disorder

BACKGROUND: Patients on a first admission for bipolar disorder often have a history of other psychiatric diagnoses for previous admissions. AIMS: The current study examines the time course and diagnoses of psychiatric admissions prior and subsequent to a first hospitalisation for a diagnosis of bipolar disorder. METHOD: The prior admission histories (over the period 1965-1989) of 1167 patients who had been hospitalised in state mental health facilities with their first admission with diagnosis of bipolar disorder between 1983 and 1989 were examined. RESULTS: A total of 542 (46.4%) patients had at least one previous hospitalisation with a psychiatric diagnosis other than bipolar disorder. Two prominent groups emerged; one group which had primarily a history of prior admissions with diagnoses of depression over 1-3 years, and a second which mainly had previous admissions for schizophrenia, over a period longer than for those with a primarily depressive history. The group with a history of schizophrenia was significantly younger and had a greater number of admissions prior to the first bipolar disorder diagnosis than the depression group. LIMITATIONS: This was a record-based study which did not examine cases which were not hospitalised. CONCLUSIONS: There appeared to be three distinct patterns of prior presentations in those patients admitted with a diagnosis of bipolar disorder.     

Readmission rates for adjustment disorders: comparison with other mood disorders

BACKGROUND: The diagnostic category of adjustment disorders continues to receive little attention in the research literature despite its estimated incidence of 5-21% in psychiatric consultation services for adults and 7.1% in inpatient admissions. METHODS: Ten years of readmission data were reviewed for six diagnostic categories: adjustment disorders, major depressive disorder (single episode and recurrent), dysthymia, any anxiety disorder and depression NOS. Cox regression analysis was used. RESULTS: Admission diagnosis was a significant predictor of readmission, with adjustment disorders resulting in significantly fewer readmissions than the group as a whole, and major depression recurrent resulting in significantly more readmissions. LIMITATIONS: Structured interviews were not used for the establishment of admission diagnoses. CONCLUSIONS: Readmission rates in this sample support the construct validity of the adjustment disorders category. The category includes a significant minority of patients admitted to psychiatric hospitalization.     

Outcome for adjustment disorder with depressed mood: comparison with other mood disorders.

BACKGROUND: A review of the research literature on the diagnostic category of adjustment disorder indicates that its construct validity has not been established. Nevertheless, the diagnosis is made frequently, with an estimated incidence of 5-21% in psychiatric consultation services for adults. METHODS: Retrospective data was used to evaluate the construct validity of the adjustment disorder diagnostic category. The data primarily consisted of SF-36 Health Status Survey responses by a large group of adult psychiatric outpatients before treatment and again six months after beginning treatment. Subjects were divided into five diagnostic groups, and MANOVA, MANCOVA and chi square were used to clarify relationships among diagnoses, sociodemographic data and SF-36 scores. RESULTS: Diagnostic categories were significantly different at baseline, but did not differ in terms of outcome at six-months follow-up. There was a significant gender difference at baseline and a significant difference in gender distribution across diagnostic categories. LIMITATIONS: Structured interviews were not used for initial diagnoses, nor is there an estimate of the reliability of diagnoses among the clinicians. The patient attrition rate for six-months follow-up data was about 50%. Finally, patients received individualized treatment, with some patients receiving both medication and psychotherapy. CONCLUSIONS: Female patients were significantly more likely to be diagnosed with major depression or dysthymia than with an adjustment disorder. Females were also more likely than males to score lower on the mental health related scales of the SF-36 at admission. Patients diagnosed with an adjustment disorder scored higher on all SF-36 scales than did the other diagnostic groups at baseline and again at follow-up. There was no significant difference among diagnostic groups with regard to treatment outcome, suggesting that the adjustment disorder group can benefit as much as the other groups from treatment.     

Characteristics of a telecytology consultation service

Although numerous reports describe the application of remote video microscopy to pathologic diagnosis (telepathology), only a few address some of the special issues surrounding remote cytologic diagnosis (telecytology). These studies have generally suggested a high correlation between telecytologic diagnoses and those arising from direct examination of the glass slides, but factors affecting the clinical utility of routine cytologic diagnosis have not been examined. In this report, we describe our experience in telecytologic consultation on 99 cases seen at the Armed Forces Institute of Pathology between October 1995 and November 1999. The mean time between receipt of the telecytologic images and the contributor receipt of the faxed report was 9.9 hours (median, 5.13 hours). Using stringent criteria for agreement, we find fair to good (48%) concordance between the contributor's impression and the consultant's opinion. The concordance between the consultant's telecytologic diagnosis and the subsequent glass slide diagnosis is imperfect; in 8 (31%) of 26 cases in which the glass slide was sent after the telecytology consultation, a minor discrepancy between these diagnoses was found. No major discrepancies were found between the consultant's telecytologic and glass slide diagnoses.     

A follow-up study of psychiatric consultations in the general hospital: What happens to patients after discharge?

BACKGROUND: An appropriate follow-up is considered essential in the consultation-liaison psychiatry setting, but it is often neglected. This study evaluated the effectiveness of the psychiatric consultation process in the general hospital, by investigating what occurred to patients 3-5 months after discharge. METHODS: We used a three-part questionnaire: (1) the results of the consultation process; (2) a telephone interview with patients, and (3) a telephone interview with the patients' primary care physician, to whom the patients were referred after discharge from hospital. We contacted all consecutive, unselected patients referred to psychiatric consultation from January to July 1999. Complete data were available for 119 patients from an initial group of 318. RESULTS: The consultation process was well accepted by patients and useful to general hospital physicians to complete the final diagnosis of the patient when discharged from hospital. In most cases (78.9%), the psychiatric letter was attached to the discharge letter. The second part of the questionnaire indicated that most patients were satisfied with the consultation process. They thought it helped focus their problems and 60% asserted that they felt better after following their psychiatrists' instructions or therapy. The primary care physicians agreed with the diagnostic results of the psychiatric consultation, mainly followed the psychiatrists' advice, and generally expressed positive comments about the consultation-liaison service. CONCLUSIONS: Compliance of hospital physicians, patients, and primary care physicians was good. Follow-up studies on outcome of psychiatric consultations are few and further analysis is strongly recommended.     

Psychiatric aspects of patients with HIV infection in the general hospital

The study describes the psychiatric disorders found in 100 HIV-positive patients, in different stages of the illness, at the psychiatric consultation service of a general hospital in Madrid. Eighty-five percent of the sample fell within the intravenous drug addicts risk group, which coincides with the epidemiological characteristics of Spain's HIV-positive population. The most frequently noted psychiatric diagnosis was substance dependence disorder (41%), followed by organic mental disorder (29%), adjustment disorder (15%), and affective disorder (5%). Fifteen percent of the subjects had depressive symptoms, and 11% expressed suicidal ideation. A follow-up conducted on part of the sample showed a development towards dementia, emphasizing diagnostic difficulties in the initial evaluation of these patients.     

Comorbidity burden and its impact on psychosocial morbidity in depressed outpatients

BACKGROUND: Many studies have examined the co-occurrence of depression and one or two nondepressive disorders; however, little research has looked at broad spectrum comorbidity (i.e., comorbidity across several diagnostic categories) in depressed patients. Research on diagnostic practices in routine clinical settings--in which unstructured interviewing is the norm--suggests that comorbid conditions are often not detected [Zimmerman, M., Mattia, J. 1999. Psychiatric diagnosis in clinical practice: Is comorbidity being missed? Compr. Psychiatry, 40, 182-191]. In this study we examined the independent impact of different comorbid diagnostic categories on psychosocial morbidity in psychiatric outpatients with Major Depressive Disorder (MDD). METHODS: Participants were drawn from a pool of 1000 psychiatric outpatients interviewed with the Structured Clinical Interview for DSM-IV diagnoses (SCID-IV; [First, M.B., Spitzer, R.L., Williams, J.B.W., Gibbon, M., 1995. Structured Clinical Interview for DSM-IV (SCID). American Psychiatric Association, Washington, D.C.]). We compared the demographics, clinical characteristics, and psychosocial functioning of depressed outpatients with and without different axis I comorbidities, then conducted multivariate analyses to determine the respective impact of comorbid axis I disorders. RESULTS: Three hundred and seventy-three patients had a principal diagnosis of unipolar MDD. One hundred twenty-nine (34.6%) were diagnosed with MDD only, and 244 (65.4%) had MDD and at least one other axis I disorder. Comorbidity was associated with longer duration of index episode, more psychiatric morbidity, and more social and occupational impairment. There was also a significant relationship between increasing number of comorbid axis I disorders and greater psychiatric and psychosocial impairment. In regression analyses, comorbidity burden (i.e., the number of comorbid axis I disorders) showed the strongest relation to psychiatric and psychosocial impairment. LIMITATIONS: This is not a random sample of depressed outpatients and, thus, may not be generalizable to all outpatients with depression. Second, Axes II and III comorbidity were not assessed. CONCLUSIONS: Comorbidity burden showed the strongest relation to impairment over and above the presence of any particular class of disorders.     

Association of child maltreatment and psychiatric diagnosis in Brazilian children and adolescents

OBJECTIVES:

The objective of this study was to evaluate the association between different types of child maltreatment and the presence of psychiatric disorders in highly vulnerable children and adolescents served by a multidisciplinary program.

METHODS:

In total, 351 patients with a mean age of 12.47, of whom 68.7% were male and 82.1% lived in shelters, underwent psychiatric evaluations based on the Kiddie-Sads-Present and Lifetime Version. Two different methods were used to evaluate maltreatment: medical records were reviewed to identify previous diagnoses related to socioeconomic and psychosocial circumstances, and the Childhood Trauma Questionnaire was used to obtain a structured history of trauma. Bivariate associations were evaluated between psychiatric disorders and evidence of each type and the frequency of abuse.

RESULTS:

The most frequent psychiatric diagnoses were substance use disorders, affective disorders and specific disorders of early childhood, whereas 13.67% of the sample had no psychiatric diagnosis. All patients suffered neglect, and 58.4% experienced physical or sexual abuse. The presence of a history of multiple traumas was only associated with a diagnosis of substance use disorder. Mental retardation showed a strong positive association with reported physical abuse and emotional neglect. However, a negative correlation was found when we analyzed the presence of a history of multiple traumas and mental retardation.

CONCLUSION:

All children living in adverse conditions deserve careful assistance, but we found that physical abuse and emotional neglect were most strongly associated with mental retardation and multiple traumas with substance abuse.