流浪精神病患者肇事肇祸行为临床相关因素分析
|
摘要
目的分析流浪精神病患者肇事肇祸行为的临床特征及其相关因素,探索流浪精神病人救助管理新思路。方法将2008年1月—2014年12月南宁市社会福利医院收治的2 332例流浪精神病患者按其是否肇事肇祸分为研究组和对照组,并用SPSS 22.0软件对数据进行χ~2检验和多因素logistic分析。结果 2 332例流浪精神病人中肇事肇祸742例(31.8%),其中男性肇事肇祸发生率高于女性(P=0.001),外省患者肇事肇祸发生率高于南宁本市患者(P=0.000),离异患者肇事肇祸发生率高于已婚患者(P=0.025);肇事肇祸患者较非肇事肇祸患者更易出现骨折(P<0.05),流浪精神病人营养不良比例(70.9%)较高,且传染病发病率(15.5%)高于正常人群;肇事肇祸患者的主要精神病种为精神分裂症(75.9%),活性物质所致精神障碍患者肇事肇祸发生率54.4%(37/68)、心境障碍患者肇事肇祸发生率52.4%(22/42),均高于精神分裂症患者肇事肇祸发生率43.9%(563/1 283)(P<0.05);研究组出现妄想、幻觉、违拗、易激惹、被动性服从、情绪高涨等阳性症状多于对照组(P<0.05),情绪淡漠、思维贫乏、注意减弱、缄默等阴性症状低于对照组(P<0.05);多元回归显示,离异、无职业、精神分裂症、易激惹、幻觉、情绪高涨是肇事肇祸发生的危险因素。结论流浪精神病患者肇事肇祸有其明显的临床特征。肇事肇祸发生率较高;阳性精神症状促使其肇事肇祸;离异、无职业、精神分裂症患者更易肇事肇祸。建议加强流浪精神病患者家庭及社会支持,促进社会功能恢复,并将其救助工作纳入政府及相关部门的重要议程;救助医疗机构设立外科及传染病区等,提高综合救助力度。
Objective To analyze clinical characteristics and influencing factors of troublemaking behavior among homeless psychiatric patients and explore new strategies for relief and management of the patients. Methods We collected data on 2 332 homeless psychiatric patients having treatment in Nanning Municipal Social Welfare Hospital from 2008 through 2014 and divided the patients into a case and a control group according to their history of troublemaking behavior.Chi-square test and multivariate analysis were performed in data analyses with SPSS 22.0. Results The prevalence of malnutrition and incidence of infectious diseases were higher in all the patients than those in general populations. Among the patients, 742(31.8%) were identified with the history of troublemaking behavior; higher ratio of troublemaking behavior history was observed among the males, those from other provinces, and the divorced than among the females(P = 0.001),those with local residence(P < 0.001), and the married(P = 0.025). The patients with troublemaking behavior history were more likely to suffer from fracture compared to those without the history(P < 0.05). Of the patients with troublemaking behavior history, 75.9% were diagnosed with schizophrenia. The ratio of troublemaking behavior history was 54.4% among68 patients with psychoactive substance use related to mental disorders and 52.4% among 42 mood disorder patients,significantly higher than the ratio(43.9%) among 1 283 schizophrenia patients(both P < 0.05). Among the patients with troublemaking behavior history, the prevalences of delusion, hallucination, negativism, irritability, passiveness, and elation were higher but the prevalences of apathy, poverty of thought, hypoprosexia, and mutism were lower compared to those among the patients without the history(P < 0.05 for all). The results of multivariate regression analysis revealed that divorce,unemployment, suffering from schizophrenia, irritability, hallucinations, and elation were risk factors of troublemaking behavior among the patients. Conclusion Troublemaking behavior is prevalent among homeless psychiatric patients and the patients with troublemaking behaviors are of obvious clinical characteristics. Positive psychosis symptoms are risk factors of troublemaking behavior and the patients of divorced, unemployed, and diagnosed with schizophrenia are more likely to have troublemaking behavior.
Objective To analyze clinical characteristics and influencing factors of troublemaking behavior among homeless psychiatric patients and explore new strategies for relief and management of the patients. Methods We collected data on 2 332 homeless psychiatric patients having treatment in Nanning Municipal Social Welfare Hospital from 2008 through 2014 and divided the patients into a case and a control group according to their history of troublemaking behavior.Chi-square test and multivariate analysis were performed in data analyses with SPSS 22.0. Results The prevalence of malnutrition and incidence of infectious diseases were higher in all the patients than those in general populations. Among the patients, 742(31.8%) were identified with the history of troublemaking behavior; higher ratio of troublemaking behavior history was observed among the males, those from other provinces, and the divorced than among the females(P = 0.001),those with local residence(P < 0.001), and the married(P = 0.025). The patients with troublemaking behavior history were more likely to suffer from fracture compared to those without the history(P < 0.05). Of the patients with troublemaking behavior history, 75.9% were diagnosed with schizophrenia. The ratio of troublemaking behavior history was 54.4% among68 patients with psychoactive substance use related to mental disorders and 52.4% among 42 mood disorder patients,significantly higher than the ratio(43.9%) among 1 283 schizophrenia patients(both P < 0.05). Among the patients with troublemaking behavior history, the prevalences of delusion, hallucination, negativism, irritability, passiveness, and elation were higher but the prevalences of apathy, poverty of thought, hypoprosexia, and mutism were lower compared to those among the patients without the history(P < 0.05 for all). The results of multivariate regression analysis revealed that divorce,unemployment, suffering from schizophrenia, irritability, hallucinations, and elation were risk factors of troublemaking behavior among the patients. Conclusion Troublemaking behavior is prevalent among homeless psychiatric patients and the patients with troublemaking behaviors are of obvious clinical characteristics. Positive psychosis symptoms are risk factors of troublemaking behavior and the patients of divorced, unemployed, and diagnosed with schizophrenia are more likely to have troublemaking behavior.
引文
[1]伍业光.用科学发展观探索流浪精神病的救助问题[J].中国卫生事业管理,2009,10:659-660.
[2]刘宗莹.违法肇事肇祸精神病人临床及现状分析[J].四川医学,2004,25(6):643-644.
[3]何水平.海南地区肇事肇祸精神疾病患者的特征分析[J].中国热带医学,2009(9):1941-1942.
[4]中华医学会精神科分会.中国精神障碍分类与诊断标准第三版(CCMD-3)[M].济南:山东科学技术出版社,2004.
[5]张怀惠,陈圣祺,张寿宝,等.肇事肇祸精神疾病患者的临床特征及其相关因素研究[J].四川精神卫生,2009,22(2):99-102.
[6]黄志宏.敦化市1487例重性精神疾病患者病例分析[D].长春:吉林大学,2010.
[7]诸亚萍.1 143例流浪精神病人临床现状分析[J].中国公共卫生管理,2011,27(3):242-243.
[8]Madianos MG,Chondraki P,Papadimitriou GN.Prevalence of psychiatric disorders among homeless people in Athens area:a cross-sectional study[J].Social Psychiatry and Psychiatric Epidemiology,2013,48(8):1225-1234.
[9]王丽娟,高素文,蔡成华,等.北京市流动人口肇事肇祸精神病人特征对照分析[J].中国健康心理学杂志,2011,19(2):160-162.
[10]丁万涛,郭辉,胡立荣.流浪精神病患者危险因素的病例对照研究[J].中国预防医学杂志,2009,10(3):1836-1838.
[11]卫雪新.流浪救助对象精神病人41例临床分析[J].中国民康医学,2003,15(12):740-741.
[12]孙远,罗炳华,刘成华,等.贵阳市流浪精神病人管理现状调查[J].中国民康医学,2007,19(5):403-407.
[13]苏亚梅,刘铭涛,罗传琳.云南普洱50例肇事肇祸精神疾病患者临床状况分析[J].中国民康医学,2012,24(23):2838-2840.
[14]王丽丽,谢映红,曾荣斌.精神疾病患者发生肇事肇祸行为的危险因素分析[J].临床精神医学杂志,2016,5(26):338-340.
[15]谢丹.伴躯体疾病流浪精神病患者的临床特征及护理对策[J].基层医学论坛,2014(6):712-713.
[16]朱琼.伴躯体疾病的流浪精神病患者的临床特征分析[J].中国民康医学,2011(19):2440-2441.
[17]付美华,罗华,黎秀,等.流浪精神病人肇事肇祸临床调查[J].齐齐哈尔医学院学报,2017,38(1):74-76.
[18]国家卫生和计划生育委员会.2016年中国卫生和计划生育统计年鉴[M].北京中国协和医科大学出版社,2016,249-251.
[19]王楚,伍业光,潘竞志,等.流浪精神病患者传染性疾病流行病学特征及行为方式[J].中国公共卫生,2017,33(6):975-977.
[20]许意清,李越,姜宝法.重性精神病患者肇事肇祸社区综合管理干预效果meta分析[J].中国公共卫生,2015,31(8):1091-1094.
[2]刘宗莹.违法肇事肇祸精神病人临床及现状分析[J].四川医学,2004,25(6):643-644.
[3]何水平.海南地区肇事肇祸精神疾病患者的特征分析[J].中国热带医学,2009(9):1941-1942.
[4]中华医学会精神科分会.中国精神障碍分类与诊断标准第三版(CCMD-3)[M].济南:山东科学技术出版社,2004.
[5]张怀惠,陈圣祺,张寿宝,等.肇事肇祸精神疾病患者的临床特征及其相关因素研究[J].四川精神卫生,2009,22(2):99-102.
[6]黄志宏.敦化市1487例重性精神疾病患者病例分析[D].长春:吉林大学,2010.
[7]诸亚萍.1 143例流浪精神病人临床现状分析[J].中国公共卫生管理,2011,27(3):242-243.
[8]Madianos MG,Chondraki P,Papadimitriou GN.Prevalence of psychiatric disorders among homeless people in Athens area:a cross-sectional study[J].Social Psychiatry and Psychiatric Epidemiology,2013,48(8):1225-1234.
[9]王丽娟,高素文,蔡成华,等.北京市流动人口肇事肇祸精神病人特征对照分析[J].中国健康心理学杂志,2011,19(2):160-162.
[10]丁万涛,郭辉,胡立荣.流浪精神病患者危险因素的病例对照研究[J].中国预防医学杂志,2009,10(3):1836-1838.
[11]卫雪新.流浪救助对象精神病人41例临床分析[J].中国民康医学,2003,15(12):740-741.
[12]孙远,罗炳华,刘成华,等.贵阳市流浪精神病人管理现状调查[J].中国民康医学,2007,19(5):403-407.
[13]苏亚梅,刘铭涛,罗传琳.云南普洱50例肇事肇祸精神疾病患者临床状况分析[J].中国民康医学,2012,24(23):2838-2840.
[14]王丽丽,谢映红,曾荣斌.精神疾病患者发生肇事肇祸行为的危险因素分析[J].临床精神医学杂志,2016,5(26):338-340.
[15]谢丹.伴躯体疾病流浪精神病患者的临床特征及护理对策[J].基层医学论坛,2014(6):712-713.
[16]朱琼.伴躯体疾病的流浪精神病患者的临床特征分析[J].中国民康医学,2011(19):2440-2441.
[17]付美华,罗华,黎秀,等.流浪精神病人肇事肇祸临床调查[J].齐齐哈尔医学院学报,2017,38(1):74-76.
[18]国家卫生和计划生育委员会.2016年中国卫生和计划生育统计年鉴[M].北京中国协和医科大学出版社,2016,249-251.
[19]王楚,伍业光,潘竞志,等.流浪精神病患者传染性疾病流行病学特征及行为方式[J].中国公共卫生,2017,33(6):975-977.
[20]许意清,李越,姜宝法.重性精神病患者肇事肇祸社区综合管理干预效果meta分析[J].中国公共卫生,2015,31(8):1091-1094.