Objective:To evaluate the medical service quality of psychiatric hospitals in Beijing based on diagnostic related group (DRG), analyze the evaluation effect, for refences to constructe a DRG performance evaluation system suitable for psychiatric hospitals.Methods:This study extracted data such as the number of DRG groups, etc. of hospitalized patients in 14 tertiary and secondary psychiatric hospitals in Beijing from 2018 to 2020 from the Beijing inpatient medical performance evaluation platform, and analyzed data on DRG performance evaluation indicators, as well as the average length of hospital stay and average cost of DRG enrolled cases. All data were analyzed using descriptive research methods, and inter group comparisons were conducted using the Mann Whitney U-test. Results:From 2018 to 2020, the average number of DRG groups in tertiary hospitals (28) was higher than that in secondary hospitals (10) ( P<0.05), and the average CMI values of both were the same(1.79); The average cost consumption index (1.15) of tertiary hospitals was higher than that of secondary hospitals (0.65) ( P<0.05), while the average time consumption index (1.11) was slightly lower than that of secondary hospitals (1.30); The mortality rate of the low-risk group in tertiary hospitals (0.01%) was generally lower than that in secondary hospitals (0.88%), and the average percentage of DRG admitted inpatients (82.8%) was significantly higher than that in secondary hospitals (27.3%) ( P>0.05). The average length of stay and cost per case for DRG enrolled inpatients in tertiary and secondary hospitals were lower than the overall hospital discharge cases ( P<0.05). Conclusions:The number of DRG groups, CMI value, and low-risk mortality rate could be used for evaluating the medical service capacity and safety of psychiatric hospitals, but the cost and time consumption index could not objectively reflect the efficiency of hospital medical services. DRG performance evaluation indicators are more suitable for evaluating short-term hospitalization of psychiatric patients. The proportion of DRG enrolled cases might be a potential indicator for evaluating the service quality of psychiatric hospitals.

目的 分析总结以精神症状起病的抗-N-甲基-D-天冬氨酸受体(N-methyl-D-aspartate receptor,NMDAR)脑炎的临床特征为临床识别提供策略.方法 回顾2018年1月至2020年2月以精神症状起病且疑似自身免疫性脑炎在首都医科大学附属北京安定医院急诊留观及住院的患者62例,经过随访后其中确诊抗NMDAR脑炎18例,精神障碍患者为44例.回顾性统计患者的人口学因素、临床资料、脑脊液及血清抗体、颅脑MRI检查等资料,先后以单因素分析、logistic回归分析研究以精神症状起病的抗NMDAR脑炎患者的临床特征.结果 单因素分析结果显示:两组患者在癫痫发作、意识水平下降、不自主运动、言语障碍、自主神经紊乱等5类临床症状中差异有显著性(P<0.05).二元logistic回归分析结果显示:癫痫发作、不自主运动、自主神经功能紊乱是以精神症状起病的抗NMDAR脑炎相较于急性精神障碍的特征性症状(P<0.05).结论 癫痫发作、不自主运动、自主神经功能紊乱是以精神症状起病的抗NMDAR脑炎患者的特征性临床症状.

目的 了解精神科急诊就诊的老年患者的临床特征.方法 选取2015年1月至2017年1月就诊于首都医科大学附属北京安定医院精神科急诊的患者865例,年龄≥65岁,调查该人群的临床特征.结果 总共入组865例患者,平均年龄(74.94±7.58)岁,最大年龄99岁,其中男性占340例(39.3％).所有样本按年龄大小分组,≥65～80岁组低龄老人624例,≥80岁组高龄老人241例.与低龄老人组相比,高龄老人组目前婚姻状况为无配偶的比例(68％)更高,差异有显著性(P<0.001),首次发病比例(37.3％)更高,差异有显著性(P<0.001),伴有慢性躯体疾病的比例(77.2％)更高,差异有显著性(P=0.002).低龄老人组焦虑抑郁状态的比例(39.3％)明显高于高龄老人组(24.5％),而高龄老人组谵妄(10.8％)、痴呆状态(10.8％)的比例明显高于年轻老人组,分层卡方检验组间比较,差异有显著性(P<0.001).高龄老人组使用抗精神病药的比例(56.8％)高于低龄老人组(47.6％)(P=0.015),相反,使用抗抑郁药的比例低龄老人组(24.5％)高于高龄老人组(16.6％)(P=0.012).低龄老人组在就诊后留院的比例(14.3％)显著高于高龄老人组(2.9％),差异有显著性(P<0.001).结论 老年期精神障碍的表现在不同年龄阶段有不同的特征.精神科急诊临床医生接诊高龄老人时需关注躯体疾病和认知障碍的评估和诊治.

目的:对精神科急诊患者攻击行为发生风险的相关因素进行调查及分析,构建预测模型并对模型进行评价.方法:筛选精神科急诊患者12 345例纳入分析,使用攻击风险评估表评分将患者分为低风险组(≤Ⅰ级)与高风险组(＞Ⅰ级),对两组患者进行人口学及疾病学资料的调查,使用Logistic回归分析确定攻击行为发生的危险因素,并进行模型构建.结果:纳入分析的患者中低风险组6 771例,高风险组5 574例;两组在性别、婚姻状况、受教育年限、就业情况、家庭月收入、与父母同胞的关系等人口学变量及就诊时间、发病诱因、病前性格、起病形式、精神病家族史、首发年龄、精神科总住院次数等疾病学变量均有统计学意义(P＜0.05或P＜0.01).对模型进行评价,区分度、灵敏度均较好,但校准度一般.结论:攻击风险预测模型对精神科急诊患者攻击风险的预测能力一般,提示攻击行为发生的危险因素可能与人口疾病学危险因素之外的其他因素也相关.

精神疾病导致患者思维、情绪及行为发生变化,给患者正常的工作和生活带来持久的困扰,其中自杀和攻击行为,即两害行为,是精神疾病不同于其他疾病最具特点的急重症,不仅是医学问题,而且是社会安全的跨界问题.而精神疾病共病躯体疾病,在无论精神专科医院急诊还是综合医院急诊,都是常见且棘手的临床状况,诊疗中对无论精神科医生还是躯体疾病医生的诊断处理能力均提出很高的要求.国内关于精神科急重症的研究,大多数为精神科急诊的现状描述、护理干预等,对于病因学和治疗学的研究鲜见,本文筛选了近5年与精神科急重症研究有关的200余篇SCI期刊论文,对精神与躯体疾病共病及两害行为的研究进行述评,以期对精神科急重症领域的研究提供更好的方向.

目的 检验修订版外显攻击行为量表(modified overt aggression scales,MOAS)在我国精神科急症患者中的信效度,探讨其在意识障碍患者中的应用前景.方法 采用方便抽样法,选取2017年6月至2018年4月首都医科大学附属北京安定医院急诊科留观患者500例,其中意识障碍患者33例,使用MOAS对受试者施测.信度检验采用Cronbachα系数,效度检验采用探索性因子分析;通过Pearson相关分析检验攻击风险评估表与MOAS的效标效度.结果 MOAS共4个条目,探索性因子分析各条目因子载荷为0.895～1.000;删除自身攻击条目后,Cronbachα系数为0.813,在意识障碍患者中Cronbachα系数为0.942,各条目因子载荷为0.828～0.994.Pearson相关分析显示,攻击风险评估表与MOAS得分之间具有相关性.结论 MOAS在我国精神科急症患者以及意识障碍患者中的信度和效度均较为稳定.

目的 构建门诊病案首页质量评价指标与方法.方法 以北京市30家三级医疗机构2017年度的数据为基础,围绕首页数据上报的及时性和准确性设立指标,利用赋权综合打分方法,量化评价医疗机构门诊病案首页上报质量.结果 获取了各家医疗机构上报的数据,对各家医疗机构病案首页数据上报的及时性和准确性进行评分,直观反映出在门诊病案首页上报工作中存在的问题.结论 本研究设立的评价指标,在实际工作中有较强的科学性和可操作性,便于向各医疗机构反馈问题,可为提高数据质量、服务医改监测政策研究工作奠定基础.

Psychiatric emergency patients constitute a population at high risk of suicidal thoughts and behaviors (STB). However, the risk factors for STB in this population have not been clearly defined. This study aimed to explore the risk factors for STB in psychiatric emergency patients in China. A cross-sectional analysis was conducted at the emergency department of psychiatry, Anding Hospital, Capital Medical University from 2015 to 2017. The Chinese suicide risk factors scale was used to test the STB of the patients. Multivariable logistic regression analysis was used to determine the risk factors of STB. A total of 12,345 patients were included. Their average age was 36 years. According to the suicide risk scale, 3436 cases (27.83%) were at risk of STB, mainly young adults. The multivariable analysis showed that urban residence, years of education, living in Beijing, ethnic Han, living alone, unemployment, poor relationship with parents, one or more siblings, visit time in the night, family history, disease course, total duration, the total number of psychiatric hospitalizations, a clear diagnosis, Brief Psychiatric Rating Scale total score ≥28.5, Hamilton Depression Rating Scale total score ≥20, and Young Mania Rating Scale total score ≥12 were independent risk factors for STB.

Objective: Aggression is common and challenging in psychiatric emergency departments (PED). However, the prevalence of aggression and its correlates in PED patients are not well documented. This study compared the prevalence of aggression between patients with acute schizophrenia and manic episodes. Methods: In this cross-sectional study, patients at a psychiatric emergency department were assessed with measurements of aggression, psychotic and manic symptoms. Results: A total of 4,172 patients were included. The prevalence of aggression was 54.8% (95%CI=53.3%-65.2%) in the whole sample, with 48.0% (95%CI=45.8%-50.1%) in patients with an acute schizophrenia episode, and 61.8% (95%CI=59.8%-63.9%) in patients with a manic episode. Multiple logistic regression analysis revealed that, within the acute schizophrenia episode group, male gender (OR=1.47, P<0.01), involuntary admission (OR=3.61, P<0.01) and more severe manic symptoms (OR=1.30, P<0.01) were significantly associated with aggression. Within the manic episode group, living in Beijing (OR=1.51, P<0.01), unemployment (OR=1.34, P=0.03), involuntary admission (OR=7.93, P<0.01), lower education (OR=0.95, P=0.01) and more severe psychotic symptoms (OR=1.05, P<0.01) were significantly associated with aggression. Conclusion: In this study, aggression appeared to be more common among patients with a manic episode than those with an acute schizophrenia episode. Considering the significant risk of aggression on psychiatric emergency care, appropriate and effective management of aggression in this population group need to be developed.

目的 对精神科急诊重复就诊患者进行人口学和疾病学资料的调查.方法 筛选精神科急诊就诊的12345例非取药患者,分为单次、两次及多次就诊组,采用Logistic回归分析重复就诊患者的危险因素.结果 单因素Logistic回归分析结果显示,与单次就诊患者相比,两次及多次就诊患者在年龄、居住地、婚姻、职业、收入、家庭关系、急诊目的、起病形式、急诊目的、首次发病年龄、就诊时间、总病程、是否确定诊断、精神科总住院次数、攻击风险评估表、BPRS及YMRS评分上比较差异均有统计学意义(P<0.05).无序多分类Logistic回归校正混杂因素分析结果显示,对于多次就诊患者,保护因素:年龄大、居住在非北京城区、无收入、父母关系好、急诊目的为攻击行为(P<0.05);危险因素:精神科住院次数、非首次发病、急诊用药途径为肌肉及口服(P<0.05).结论 精神科急诊重复就诊患者较单次就诊患者,具有年龄小、居住在北京城区、家庭有收入、父母关系不良的人口学特征,并非以冲动等精神科重症就诊、住院次数少、非首次发病,口服或肌肉用药更多.

目的:对精神科急诊患者的自杀行为风险进行预测.方法:收集精神科急诊求医患者的一般人口学及临床资料,并进行自杀危险因素评估表评定,以10分为分界值将患者分为安全组(≤10分)及危险组(>10分),比较两组患者的人口学及临床资料,分析影响自杀行为发生的相关因素,构建自杀行为预测模型.结果:12345例急诊求医的患者中,安全组8909例,危险组3436例;单因素Logistic回归分析显示,自杀的危险因素为户籍地、居住地、年龄、男性、民族、无伴侣、独居、无职业或目前未在职/在读、家庭月收入水平低、父母非原生健在、与父母关系不好、有>1个兄弟姐妹、与兄弟姐妹关系不好、于22:00至次日7:00就诊、3至5月及9至11月就诊、发病有诱因、病前性格内向、精神疾病家族史阳性、首次发病年龄小、总病程与本次病程短、未曾在精神科医院住院或精神科医院住院1次、有明确精神科诊断、伴躯体疾病、攻击风险评估表≤Ⅰ级、简明精神病评定量表(BPRS)、汉密尔顿焦虑量表(HAMA)及汉密尔顿抑郁量表(HAMD)总分高(P均<0.01);保护因素为受教育年限、发病诱因为家庭事件、Young躁狂评定量表(YMRS)总分高(P均<0.01).多因素Logistic回归建立自杀风险预测模型,其区分度良好,通过内部验证,且模型校正能力良好(χ2=14.644,P=0.066).结论:精神科急诊患者自杀风险预测模型对精神科急诊患者自杀风险有较好的预测能力.

目的 总结分析北京地区30家三级医疗机构门诊病案首页上报中存在的迟报和一般信息上报错误,提出改进数据质量的措施.方法 描述性分析北京市30家三级甲等医院2017年1月1日-12月31日的46390934条门诊病案首页上报数据的质量,考核医改监测的相关系列指标,进行及时性和准确性的讨论.结果 门诊病案首页上报及时性方面只有编号为H13的机构上报及时率超过了90％,大部分机构的上报准时率在50％以下,有3家机构几乎从未准时上报过门诊病案首页数据;在准确性方面各家医疗机构计算几项重要门诊病案首页信息上报的错误率方法 不同,是否为外地来京就医出现的问题最多,大部分医疗机构该项目上报错误率超过了30％,国籍、年龄和证件号上报的错报率不高.结论 各家医疗机构应当从人员培训、系统升级、逻辑审核等方面入手,最大程度上保证上报数据质量,更好的为医政管理服务.

目的 旨在评估精神科急诊患者自杀的临床、心理、社会学和生物学危险因素.方法 对首都医科大学附属北京安定医院2015至2017年精神科急诊就诊患者进行横断面分析,采用自杀危险因素评估表对患者进行自杀想法和行为(suicidal thoughts and behaviors,STB)检测,得分≤10分和>10分分别表示STB的存在和不存在,多因素Logistic回归分析确定STB的危险因素.结果 共纳入12345例患者,其中女性6885例(56％).患者年龄36(27～50)岁,简明精神病评定量表(Brief Psychiatric Rating Scale,BPRS)总分、汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)总分、汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)总分、杨氏躁狂量表(Yung Manic Rating Scale,YMRS)总分平均分分别为32(27～39)分、7(3～13)分、10(6～15)分和7(4～18)分.根据自杀风险评估表,有3436例(27.83％)患者有STB的危险.多因素分析显示,居住地、性别、婚姻状况、同住者、受教育年限、职业状况、与父母和兄弟姐妹的关系、诱因、性格、确定诊断、躯体疾病、简明精神疾病总分、焦虑总分、抑郁总分、躁狂总分、就医时间、精神科住院总次数是STB的独立危险因素.结论 精神科急诊患者自杀风险较高,以中青年为主,尤其以男性、未婚、失业、社会和家庭支持较差的精神疾病患者为著.STB在这一人群中受到生理、心理和社会因素的影响.

Objective:To analyze the situation of rescued patients in psychiatric emergency in 5 years. Method:The data of rescued patients in psychiatric emergency from January 2011 to June 2016 were retro-spectively analyzed. Results:In the 5 years,463 patients(male 314 cases,female149 cases)were rescued in psychiatric emergency. The main causes of emergency in turn were alcohol dependence(240 cases;male 231cases,female 9 cases),overdose(198 cases;male 67 cases,female 131 cases)and accompanied severe physiccal conditions(25 cases). There were 65.9%(305 cases)had conscious disturbance to different de-grees,but only 10.1% overdose patients had delirium or coma. The rescued patients with different causes were more in the spring. Outcome of the patients were stable or improving in 424 cases(91.6%),aggravating or worsening in 39 cases(8.4%). Conclusion:The number of rescued patients with alcohol withdrawal in psy-chiatric emergency in the five years is more than drug overdose. The deeper consciousness in the overdose pa-tients is less.The rescued patients are more in the spring. And the conditions in the patients accompanied se-vere physical problems are more complicated.

目的 对经精神科急诊就诊后留院治疗(留院观察或抢救:半封闭急诊病房)及住院治疗(封闭式住院病房)的患者,就两种留在医院治疗的方式选择上,影响直接住院的因素进行调查分析,提供管理策略,为患者进行更好的服务.方法 2016年1月19日～5月10日在北京安定医院急诊就诊留院及住院患者共868例,使用自编调查表对影响直接住院的患者躯体因素、家属因素和其他因素3个方面进行调查.结果 留院237例(27.3％),住院631例(72.7％);需要留在医院治疗的总体患者女性(54.95％)多于男性(45.05％),留院女性(63.29％)远多于男性(36.71％),住院女性(51.82％)多于男性(48.18％);首诊:留院100(32.79％),住院205(24.33％);伴有躯体疾病:留院86(36.29％):住院92(14.58％),糖尿病、高血压最常见,留院的程度重;影响患者不能直接住院的家属及其他因素中,家属要求陪护患者最常见,其次是病房没有床位.结论 调整病房结构;加强全体精神科医生的高血压、糖尿病的诊疗培训,加强精神科急诊医生其余合并躯体疾病的培训;就家属能否住院陪护进行论证,找到适合的管理方法,解决影响直接住院的因素、提升患者满意度.

Objective To investigate the demographic and disease data of patients in psychiatric emergency who were not taking medicine. Methods Totals of 6433 cases of non-medication patients who were treated in department of emergency,Beijing Anding Hospital were included. According to the attack risk rating scale and the suicide risk factor rating scale,all patients were divided into attack group,suicide group, attack-suicide group and non-attack-non-suicide group. The demographic and disease data of each group were analyzed. Results According to the demographic data,ratio of female to male was 3628 to 2805. Most patients were living in Beijing,Han nationality,between 21-30 years old. Based on disease data,most patients were with no inducement,introverted and with no family history. There were significant differences in gender (χ2=18.513), residence (χ2=9.46),partner (χ2=17.40),relationship between parents (χ2=27.21),job (χ2=11.078),in-ducement (χ2=8.402),character (χ2=11.059) and family history (χ2=9.129) between attack group and non-attack-non-suicide group (P < 0.01). There were significant differences in gender (χ2=15.894),relationship between parents (χ2=6.594),inducement (χ2=67.309),character (χ2=4.309),family history (χ2=5.719) and physical disease (χ2=32.779) between suicide group and non-attack-non-suicide group (P < 0.05). Patients diagnosed with manic state were easier to show aggressive behaviour,while patients diagnosed with anxiety and depression were easier to have suicidal behavior (P < 0.01). Conclusions Most patients in psychiatric emer-gency department are women,aged 21-30 years old. Male patients who are living in Beijing,without partner, with bad relationship between parents,on duty,with inducement,extrovert,with family history of mental dis-eases and diagnosed with manic state are more likely to show aggressive behaviour. However female patients who are with bad relationship between parents,introvert,with inducement,with family history,with physical disease and diagnosed with anxiety and depression are more likely to have suicidal behavior.

Objective:To investigate risk factors for self-injurious and suicidal behaviors of patients in psychiatric emergency. Method:A total of 1 325 outpatients in psychiatric emergency was enrolled. Patients were assessed using suicide risk factors checklist,and divided into self-jurious and suicidal group(146 cases) (score≥21)and non-suicidal group(1 179 cases)(score≤20)based on the assessment scores. The demo-graphic and disease related data were compared between the two groups. Results:Female patients showed higher rate on self-injurious and suicidal behaviorse than male patients(χ2 = 6. 158,P < 0. 05);higher rate on self-injurious and suicidal behaviors were found in the patients whose parents had non-harmonious relationships than those whose parents got along well(χ2 = 9. 771,P < 0. 01);patients who came to the emergency daytime had higher self-injurious and suicidal behaviors than came other time(χ2 = 27. 740,P < 0. 001);self-injurious and suicidal behaviors were higher in the patients who had induced factors than those who did not(χ2 = 15. 134, P < 0. 01);there were higher self-injurious and suicidal behaviors in relapse patients than first onset patients(χ2 =8. 578,P < 0. 05);the patients diagnosed as anxiety and depression had higher self-injurious and suicidal be-haviors than dagnosed as other disorders(χ2 = 125. 203,P < 0. 001);patients with medical conditions demon-strated higher self-injurious and suicidal behaviors than those without medical conditions(χ2 =9.039,P < 0.05). Conclusion:Self-injurious and suicidal behaviors occur more in patients who are female,diagnosed as anxiety and depression,with recurrent disorder and physical disease,have indeced factors and discord parental relations.

目的 探讨甲状腺激素水平与抑郁症和抑郁症状的相关性及临床意义.方法 将149例伴有抑郁症状的急诊留观患者按照是否为抑郁症,分为抑郁症组(71例)和非抑郁症组(78例),测定其血清促甲状腺素(TSH)、三碘甲状腺原氨酸(TT3)、游离三碘甲状腺原氨酸(FT3)、甲状腺素(TT4)、游离甲状腺素(FT4)的水平.结果 抑郁症组血清FT4、TT4水平低于非抑郁症组(P＜0.05);男性与女性抑郁症组患者的FT4、TT4水平均低于各自非抑郁症组(P＜0.05);抑郁症组HAMD总分与TT4水平呈正相关(P＜0.05).结论 抑郁症的发病可能与甲状腺功能变化有关.FT4水平可能反映抑郁症患者的病情严重程度.

Objective To explore risk factors of aggressive behaviors in psychiatric emergency patients.Methods 1 325 psychiatric emergency patients except those returning for getting medication were assessed with general information questionnaire, Attack Risk Assessment Scale (ARAS),Brief Psychiatric Rating Scale (BPRS)and Young Mania Rating Scale (YMRS). Patients were divided into non-aggressive group (scores of ARAS range between levelⅠand Ⅱ)and aggressive group (scores of ARAS range between level Ⅲ and Ⅳ),and the differences between the two groups were explored.Results There were many significant differences between the two groups,including gender,marital status,profession,in-service or not,family income, visiting season,trigger,visiting objective,clinical diagnosis,medication,administration route (muscular injection or oral taking),disposition after emergency treatment (hospitalization,stay observation or returning home),education background and total scores of BPRS and YMRS (P <0.05).Conclusion Risk factors of aggressive behaviors in psychiatric emergency patients consist of male,divorced,unemployed,low income,low education level,diagnosed with hallucination/delusion state or mania state,etc.

有暴力攻击行为的精神障碍患者是否都存在相似的甲状腺素水平改变？如果有，是否可作为患者暴力攻击行为的生物学标志？本研究拟对这些问题进行初步探讨。