综合医院1417例住院病人会诊精神病学资料分析

发布时间：2018-08-28 08:52

【摘要】：目的:1.了解综合性医院精心理卫生科会诊患者的临床特点，以更好地指导心理科医生的会诊工作。 2.明确不同科室联络会诊病人的特点,有目的的有针对性的对不同科室临床医生进行相关培训，以提高临床医生对精神科相关疾病的识别及处理能力。 3.探索一种新的联络会诊精神病学的发展模式。方法:汇总2000年4月～2011年9月我院精神科联络会诊病历，资料完整者共1417例,采用SPSS16.0统计分析一般人口资料、各科会诊人数及病种构成、会诊原因、诊断、处理、随访次数构成，并与心理卫生门诊病种对比。结果：1417例会诊病例中年龄段以36-50岁和51-70岁为主，占59.5%，与国内外报道结果一致。性别男:女为0.782:1。教育程度以小学初中为主,占52.9%。会诊较多的科室依次为神经内科、心内科、急诊科和消化内科，与国内相关文献对比有差异。会诊病例中无精神科诊断者92例，占6.5%；有精神科诊断的1325例,占93.5%，其中病种以神经症(包括焦虑障碍、强迫症、恐怖症等)、抑郁障碍、器质性精神障碍列前3位。处理：建议药物治疗1254例，占88.5%；建议医学检查或其他科室会诊59例，占4.2%；转精神专科医院住院治疗11例,占0.8%；建议心理咨询10例,占0.7%。追踪1254例药物治疗的患者，遵医嘱服药者1244例，其中随诊1次者427例,随诊2次者257例,随诊3-5次者249例，随访5-10次者214例，长期随访者(㧐10次)97例；其中疗效好转623例,显效434例，痊愈130例，无效57例。比较综合医院心身科门诊病例的病种分布，前三位为：神经症、抑郁障碍、器质性精神障碍，而门诊就诊随访次数最多的病种前三位是：抑郁障碍、神经症、精神分裂症。结论:①综合医院临床各科住院病人均存在心理、精神疾病及心身障碍，各科室会诊病种有差异，应加强精神科联络会诊工作,以提高临床科室病人的痊愈率和住院满意度。②综合医院心身科门诊最常见病种依次为抑郁症，焦虑症，神经症。CLP会诊最常见病种依次为焦虑症、抑郁症，器质性精神病。③应该尽快改变精神病院与综合医院的分裂割据局面,同时应加强综合医院各科室轮转医生的培训，，进一步提高各科医生对精神疾病的识别和处理能力。
[Abstract]:Purpose 1. To understand the clinical characteristics of the consultation patients in the department of fine mental health in general hospital, and to guide the consultation work of the psychiatrist better. 2. In order to improve the ability of the clinicians to recognize and deal with the psychiatric diseases, the characteristics of the patients in different departments were determined, and the relevant training for the clinicians in different departments was carried out with the aim of improving the ability of the clinicians to recognize and deal with the psychiatric diseases. 3. To explore a new approach to the development of psychiatry. Methods: from April 2000 to September 2011, a total of 1417 cases with complete data were collected. The general population data, the number of consultations, the types of diseases, the causes of consultation, diagnosis and treatment were analyzed by SPSS16.0. The frequency of follow-up was compared with that of mental health outpatient. Results among 1417 consultation cases, 36-50 years old and 51-70 years old were the main age groups, accounting for 59.5%, which was consistent with the results reported at home and abroad. Sex: male: female: 0.782: 1. The education level is mainly primary school junior middle school, accounting for 52.9%. The departments of consultation were neurology, cardiology, emergency department and digestive department, which were different from domestic literatures. There were 92 cases (6.5%) without psychiatric diagnosis and 1325 cases (93.5m) with psychiatric diagnosis. Among them, neurosis (including anxiety disorder, obsessive-compulsive disorder, phobia, etc.), depressive disorder and organic mental disorder ranked first 3. Management: 1254 cases (88.5%) were recommended to be treated with drugs; 59 cases (4.2%) were recommended to be consulted by medical examination or other departments; 11 cases (0.885%) were hospitalized in psychiatric hospital; 10 cases (0.775%) were recommended psychological counseling. Of the 1254 patients who were followed up by drug therapy, 1244 were treated with medicine according to the doctor's advice, including 427 patients who were followed up once, 257 patients were followed up twice, 249 patients were followed up for 3-5 times, 214 patients were followed up for 5-10 times, 97 patients were followed up for a long period of time, among them, 623 patients had improved the curative effect. There were 434 cases with remarkable effect, 130 cases were cured and 57 cases were ineffective. The first three diseases were neurosis, depressive disorder, organic mental disorder, and the first three diseases were depressive disorder, neurosis and schizophrenia. Conclusion there are psychological, mental disorders and psychosomatic disorders in all the clinical departments of the General Hospital, and there are differences in the types of consultation in different departments, so it is necessary to strengthen the work of liaison and consultation in psychiatric departments. In order to improve the recovery rate and hospital satisfaction of patients in clinical departments, the most common diseases in psychosomatic outpatient department in general hospital were depression, anxiety disorder, neurosis, CLP consultation, anxiety disorder and depression, respectively. At the same time, we should strengthen the training of rotation doctors in general hospitals to further improve the ability of identifying and handling mental diseases.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R749

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