综合医院老年和成年住院患者精神科会诊的特点比较  

Psychiatric Consultation Characteristics for Geriatric Inpatients in General Hospitals

作　　者：姜荣环[1] 刘朝忠[1] 吕秋云[1] 周沫[1] 

机构地区：[1]北京大学精神卫生研究所卫生部精神卫生学重点实验室北京大学,北京100191

出　　处：《中国心理卫生杂志》2008年第11期820-823,828,共5页Chinese Mental Health Journal

基　　金：北京大学精神卫生研究所青年科研基金(IMHYG2005-08)

摘　　要：目的:探讨综合医院老年住院患者精神科会诊的特点。方法:对一年内本院记录在案的所有精神科会诊的292例老年患者(年龄≥65岁)的人口学资料、会诊科室和原因、主要躯体疾病、精神障碍的诊断、会诊原因和精神科诊断之间的一致性进行分析,并与232例成年患者(18-64岁)进行比较。结果:老年患者会诊的性别比例相当(男性50%,女性50%),会诊时精神障碍的病程≤1周占30.2%,并多于成年组(21.7%,P<0.05);老年患者会诊的主要科室依次为内科、外科、急诊科和重症监护病房;会诊的主要原因为精神病发作(36.1%)、行为紊乱(14.4%)、抑郁障碍(14.4%)和焦虑障碍(10.3%);多系统疾病(27.0%)和循环系统疾病(17.1%)是导致入院的主要躯体疾病。谵妄(24.5%)、抑郁障碍(21.6%)和焦虑障碍(11.5%)是老年患者主要的精神障碍诊断。老年患者谵妄、痴呆的比例高于成年组(老年组分别为24.5%和14.9%,成年组分别为11.1%和1.8%,P<0.01),而精神分裂症和其他精神病性障碍、物质相关的障碍的比例低于成年组(老年组分别为6.5%和2.2%,成年组分别为15.1%和6.7%,P<0.05)。结论:谵妄、抑郁障碍和焦虑障碍是综合医院老年住院患者主要的精神障碍,提示有必要加强联络会诊培训中对这些障碍的正确识别和处理。Objective： To explore the psychiatric consultation characteristics for geriatric inpatients in general hospitals. Methods： During a 12-month period, 292 geriatric inpatients （age≥65 years） consecutively referred for consultation-liaison psychiatric service from non-psychiatric departments formed the study group. Another 232 inpaticnts aged 18 -64 formed the control （non-geriatric） group. The diagnosis, demographic characteristics, reasons for referral, referral department, major physical illness, psychiatric diagnosis according to criteria of the 4th edition of Diagnostic and Statistical Manual of Mental Disorders were analyzed. Results： In the geriatric inpatients, males and females had the similar rate of psychiatric consultation （ males 50%, female 50%）. Among the geriatric patients, 30.2% had a course of psychiatric disorders within one week, the rate was higher than that of adult patients, which was 21.7% （P 〈 0.05）. The most common referral departments among geriatric patients were internal medicine, surgery, emergency room and critical care unit. The primary reasons for referral of geriatric inpatients were psychosis （36.1%）, behavior disturbance （14.4%）, depression （14.4%）, and anxiety disorder （10.3%）. Multiple system physical illnesses （27.0%） and circulation problems （17.1%） were the major physical problems among geriatric patients. The most common psychiatric disorder among geriatric patients was delirium （24.5% ）, followed by depressive disorder （21.6%） and anxiety disorder （11.5%）. The rates of delirium （24.5%） and dementia（14.9%） among geriatric patients were higher than those among adult patients （11.1% and 1.8%, P 〈0. 01）, but the rates of schizophrenia and other psychotic disorders （6.5%）, substance related disorder （2.2%） were lower than those among adult patients （ 15.1% and 6. 7%, P 〈0. 05 ） . Conclusion： Delirium, depression and anxiety disorder are the most common coruorbid psychiatric disorders amon

关 键 词：综合医院 老年 联络会诊精神病学 谵妄 抑郁障碍 横断面调查 

分 类 号：R749.041[医药卫生—神经病学与精神病学]