诉讼与非诉讼颅脑外伤患者伪装记忆缺损的心理学研究

发布时间：2018-05-19 02:24

本文选题：颅脑外伤 + 诉讼　；参考：《汕头大学》2010年硕士论文

【摘要】： 目的在精神损伤或精神伤残的民事案件或工伤、交通事故伤残鉴定的案例中,往往涉及到颅脑损伤的问题,这类案件大多要求对被鉴定人记忆和智力损伤的性质及程度进行评定。由于案件大多涉及到经济赔偿、或获得某种社会福利等问题,记忆和智力评估的结果将直接影响到被鉴定人的切身利益。有相当一部分被鉴定人在记忆和智力评估的过程中表现出夸大损伤的程度,其记忆和智力测验结果往往不能反映他们的真实水平。本课题通过对颅脑外伤诉讼组、颅脑外伤非诉讼组及神经症组三组的神经心理学研究,验证对颅脑外伤后伪装记忆缺损诈病的识别能力,从而提高对伪装记忆缺损的甄别水平,为记忆相关障碍的司法鉴定和临床评估提供可靠的理论依据。对象和方法对颅脑外伤诉讼组(汕头市潮南民生医院神经外科住院及汕头大学司法鉴定中心鉴定的颅脑外伤患者,共入组40例)、颅脑外伤非诉讼组(汕头市潮南民生医院神经外科住院患者,共入组40例)、神经症对照组(汕头市精神卫生中心、山东省安康医院门诊及住院的神经症患者,共入组40例)三组受试者分别进行症状自评量表(Scl-90)、格拉斯格昏迷量表(GCS)、脑震荡后综合症症状问卷(Rivermead问卷)评定及二项必选数字记忆测验(BFDMT)、智力测验(WAIS)及明尼苏达多相人格问卷第二版(MMPI-2)等工具的心理学测试,并记录一般情况(如性别、年龄、受教育年限、优势手等),于伤后6个月跟踪随访诉讼组,进行RPQ、RHFUQ测试及认知、社会功能调查。结果 (1)三组在性别、年龄方面比较无统计学意义;诉讼组与非诉讼组在受教育年限方面比较无统计学意义(P0.05);诉讼组在受教育年限方面稍低于神经症组,比较有统计学意义(P0.05)。 (2)诉讼组与非诉讼组在Scl-90结果总分、总均分、阳性项目数、阴性项目数及阳性症状均分方面比较无统计学意义(P0.05);而各分值的均分则低于神经症组,比较有统计学意义(P0.01)。 (3)诉讼组Rivermead问卷总分与非诉讼组、神经症组比较均有统计学意义(P0.01);且总分高于伤后6个月随访结果,比较有统计学意义(P0.01)。 (4)诉讼组在BFDMT总分、困难条目得分及容易条目得分均值低于非诉讼组和神经症组,比较差异有统计学意义( P0.05和P0.01)。三组伪装比例分别为32.5%、5%及12.5%;诉讼组伪装比例高于非诉讼组及神经症组( P0.05)。 (5)诉讼组与非诉讼组、神经症组智力测验的总智商、言语智商、操作智商均值比较差异均有统计学意义( P0.05和P0.01);诉讼组智商在正常范围的有17例与非诉讼组31例、神经症组35例比较有统计学意义( P0.01);诉讼组智商大部分为边缘状态,仅有2例为轻度智力障碍,无中度、重度智力障碍。 (6)MMPI-2测验中,诉讼组的TTRIN量表、TK量表及S量表分值低于非诉讼组,TF量表、TFB量表、TDS量表、TFP量表、O量表的分值低于神经症组,比较均有显著统计学意义(P0.05和P0.01));而TDS量表、O量表分值高于非诉讼组,TK量表分高于神经症组,比较均有显著统计学意义(P0.05和P0.01)。 (7)MMPI-2测验中,诉讼组的掩饰量表、癔病量表、精神病态量表及男性/女性化量表的分值均高于常模,比较均有显著统计学意义(P0.01);而效度量表、疑病量表、精神衰弱量表、精神分裂症量表及轻躁狂量表分值则低于常模,比较均有显著统计学意义(P0.01)。 (8)MMPI-2测验中,诉讼组的K(掩饰)量表与智力测验的言语因子、记忆因子、言语分、操作分、言语智商、操作智商、总分及总智商呈正相关;而F-K指数与言语因子、记忆因子、言语分及总智商呈负相关。 (9)MMPI-2测验中,诉讼组的TRIN量表与偏因商数呈正相关,与BFDMT的容易条目得分呈负相关;而F-K指数与BFDMT的容易条目得分呈正相关,与偏因商数呈负相关。 (10)MMPI-2测验中,诉讼组的L量表与HS量表、D量表、HY量表、PT量表、SC量表、MA量表;F量表、FB量表、FP量表与HS量表、D量表、HY量表、PD量表、PT量表、SC量表、MA量表;DS量表与HY量表、PD量表、MF量表、PT量表、SC量表、MA量表偏因商数均呈正相关。结论 (1)BFDMT测验是辨别伪装的有效心理测查工具,有助于司法精神病鉴定工作中提高对被鉴定者伪装的识别率,其总分、容易条目及困难条目得分可以作为鉴别伪装记忆缺损的有效指标,特别适用于临床评定有困难的被鉴定患者。 (2)诉讼组在智力测验中表现为明显的不合作或伪装记忆缺损,与临床评定结果不相符,其数字广度分测验及图形拼凑分测验可以作为鉴别伪装记忆缺损的参考指标,在鉴定实践中其结果的采用应持谨慎态度。 (3)随访结果说明颅脑损伤后6个月症状才有较好的改善,在司法精神病学鉴定实践中应引起重视。 (4)MMPI-2测验中掩饰量表及F-K指数与总智商有关,也从另一角度说明有伪装能力的患者其智力损害不会太严重,真正的中度及重度智力障碍患者是不具备伪装能力的;掩饰量表及F-K指数可以作为鉴别伪装记忆缺损的有效指标。 (5)BFDMT、智力测验合并MMPI-2测验可以作为鉴别伪装记忆缺损的有效评定工具。
[Abstract]:objective
In cases of mental injury or mental disability in civil or industrial injuries, and in the cases of disability identification of traffic accidents, the problems of head injury are often involved. Most of these cases require the assessment of the nature and extent of the memory and intellectual impairment of the identified persons. Most of the cases involve economic compensation or social welfare, and so on. The results of memory and intelligence assessment will directly affect the vital interests of the identified people. A considerable portion of the appraisers show a degree of exaggeration in the process of memory and intelligence assessment, and the results of their memory and intelligence tests often fail to reflect their true level. The neuropsychological study of the three groups of the lawsuit group and the neurosis group verified the ability to identify the malingering of the camouflage memory defect after craniocerebral trauma, thus improving the screening level of the camouflage memory defect, and providing a reliable theoretical basis for the judicial identification and clinical evaluation of the memory related disorders.
Objects and methods
40 cases of craniocerebral trauma, which were identified by the Department of neurosurgery in the Department of neurosurgery and the Judicial Expertise Center of Shantou University in Chaonan Minsheng hospital in Shantou City, were included in the non litigation group of craniocerebral trauma (40 cases in the Department of neurosurgery in the Department of neurosurgery in Chaonan people's livelihood hospital in Shantou city), and the neurosis control group (Shantou mental health center, Shandong province) 40 cases of neurotic patients in the outpatient and hospital of Kang Hospital were enrolled in 40 cases. The three groups were treated by the symptom self rating scale (Scl-90), the Glass G Coma Scale (GCS), the post concussion syndrome symptom questionnaire (Rivermead questionnaire) and the two required digital memory tests (BFDMT), the intelligence test (WAIS) and the Minnesota multiphase personality questionnaire second edition. (MMPI-2) a psychological test of tools such as a general case (such as sex, age, years of education, dominant hands, etc.), followed up 6 months after the injury to follow up the follow-up group, RPQ, RHFUQ test and cognition, and social function survey.
Result
(1) the three groups had no statistical significance in gender and age; there was no statistical significance in the number of years of education between the litigation group and the non litigation group (P0.05); the litigation group was slightly lower than the neurosis group in the years of Education (P0.05).
(2) there was no significant difference (P0.05) between the total score of Scl-90 results, the number of positive items, the number of negative items and the equal score of positive symptoms (P0.05), and the scores of the scores were lower than those in the neurosis group, and the difference was statistically significant (P0.01).
(3) the total score of the Rivermead questionnaire in the lawsuit group and the non litigation group were statistically significant (P0.01), and the total score was higher than that of the 6 months after the injury (P0.01).
(4) the total score of BFDMT in the litigation group was lower than that in the non litigious group and the neurosis group. The difference was statistically significant (P0.05 and P0.01). The camouflage ratio in the three groups was 32.5%, 5% and 12.5%, respectively. The camouflage ratio in the litigation group was higher than that of the non litigation group and the neurosis group (P0.05).
(5) the total IQ of the intelligence quotient, verbal IQ and IQ of the neurosis group were statistically significant (P0.05 and P0.01), and there were 17 cases in the normal range of the litigant group and 31 cases in the non litigation group and 35 in the neurosis group (P0.01), and the most of the IQ in the litigant group was marginal. Only 2 cases were mild mental retardation, without moderate or severe mental retardation.
(6) in the MMPI-2 test, the TTRIN scale of the litigation group, the TK scale and the S scale were lower than the non litigation group, the TF scale, the TFB scale, the TDS scale, the TFP scale, and the O scale were lower than those of the neurosis group, and there were significant statistical significance (P0.05 and P0.01), while the TDS scale was higher than that of the non litigation group. Significant statistical significance (P0.05 and P0.01).
(7) in the MMPI-2 test, the score of the litigation group, the hysteria scale, the psycho morbid scale and the male / female scale were all higher than the norm, and the comparison was statistically significant (P0.01), while the validity scale, the scale of hypochondria, the mental decay scale, the schizophrenia scale and the manic maniac scale were lower than the norm, and there were significant statistics. Learning meaning (P0.01).
(8) in the MMPI-2 test, the K (disguise) scale of the litigation group was positively correlated with the speech factor, memory factor, speech score, verbal score, verbal IQ, operation IQ, total score and total IQ, while the F-K index was negatively correlated with speech factor, memory factor, speech score and total intelligence quotient.
(9) in the MMPI-2 test, the TRIN scale of the litigation group was positively correlated with the quotient, and was negatively correlated with the score of BFDMT's easy entry, while the F-K index was positively correlated with the easy entry score of BFDMT, and was negatively related to the quotient.
(10) in the MMPI-2 test, the L scale of the litigation group and the HS scale, the D scale, the HY scale, the PT scale, the SC scale, the MA scale, the F scale, the FB scale, the FP scale, the HS scale, the scale, the scale, the scale, the scale, the scale, the scale, the scale, the scale, the scale, the scale, the scale, and the scale, are all positively related to the quotient.
conclusion
(1) the BFDMT test is an effective psychological testing tool for identifying camouflage. It helps to improve the recognition rate of the disguised person in the forensic psychiatric appraisal. The total score, the easy entry and the difficult items can be used as an effective indicator to identify the false memory defect, especially for the clinically assessed patients who have difficulty.
(2) in the intelligence test, the group showed an obvious non cooperative or disguised memory defect, which was not consistent with the clinical evaluation results. The digital span test and the graphic patchwork test could be used as a reference index to identify the false memory defect, and the result should be taken prudently in the practice.
(3) follow up results showed that symptoms improved after 6 months of craniocerebral injury, and should be emphasized in forensic psychiatry practice.
(4) the cover scale and the F-K index in the MMPI-2 test are related to the total IQ, but also from the other point of view that the patients with camouflage ability are not too serious, and the real moderate and severe mental disorders are not capable of camouflage. The cover scale and the F-K index can be used as an effective indicator of the identification of camouflage memory defects.
(5) BFDMT, intelligence test combined with MMPI-2 test can be used as an effective tool to identify camouflage memory defects.
【学位授予单位】：汕头大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：D919.4;R-051

【参考文献】