常德地区严重精神障碍患者暴力攻击行为研究
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摘要
目的了解常德市严重精神障碍患者的暴力攻击行为现状,探索暴力攻击行为的危险因素,为优化对这一人群的管控策略提供参考。方法于2017年7月-12月,在常德市康复医院接受暴力危险性评估的2 362例疑似精神障碍患者中,采用Excel生成随机整数的方式,随机选出790名被试,并将其中757例符合入组标准的患者纳入本研究,收集其一般人口学资料和临床资料,并进行修订版外显攻击行为量表(MOAS)评定。将MOAS加权总分≥5分者定义为研究组(n=505),MOAS加权总分<5分者定义为对照组(n=252),比较两组一般人口学资料和临床资料,采用二元Logistic回归分析探索暴力攻击行为的独立相关因素。结果研究组中男性、年龄相对较小、单身、近半年无业、不(规律)服药、存在被关锁情况、伴有反社会人格特征者所占比例高于对照组(P<0.05或0.01)。二元Logistic回归分析显示,不(规律)服药(OR=2.659,95%CI:1.892～3.738)、年龄≤30岁(OR=1.845,95%CI:1.163～2.926)、男性(OR=1.486,95%CI:1.085～2.036)、无业(OR=1.621,95%CI:1.069～2.457)与高暴力攻击风险呈独立正相关(P<0.05或0.01)。结论常德市严重精神障碍患者发生暴力攻击行为的危险因素主要包括不(规律)服药、年龄≤30岁、男性、无业。
Objective To investigate the current situation of violent aggressive behaviors of patients with severe mental disorders in Changde city, and to explore the risk factors of violent aggressive behaviors, so as to provide references for optimizing the management and control strategies for this population.Methods Between July and December 2017, 790 subjects were randomly selected from a total of 2 362 patients who suspected had mental disorders in Changde Rehabilitation Hospital. Only 757 patients who met the inclusion criteria were included in analysis. They filled both demographic and clinical information and Modified Overt Aggression Scales(MOAS). Patients with MOAS scored 5 and more were defined as the study group(n=505), while those with less than 5 were defined as the control group(n=252). Differences in demographic and clinical characteristics between two groups were compared, and the independent related factors of violent aggressive behaviors were explored using binary Logistic regression analyses.Results The study group had more males and they were younger than control group. Besides, they tended to be single, unemployed for at least half a year, irregular taking medicine, locked at home, accompanied with anti-social personality than the control group(P<0.05 or 0.01). Binary Logistic regression analysis showed that not(regularly) taking medicine(OR=2.659, 95% CI: 1.892～3.738), younger than 30 years old(OR=1.845, 95% CI: 1.163～2.926), male(OR=1.486, 95% CI: 1.085～2.036) and unemployment(OR=1.621, 95% CI: 1.069～2.457) were independently and positively correlated with violent aggressive behaviors(P<0.05 or 0.01). Conclusion Risk factors for violent aggressive behaviors in patients with severe mental disorders in Changde area including not(regularly) taking medicine, younger than 30 years old, male and unemployed.
Objective To investigate the current situation of violent aggressive behaviors of patients with severe mental disorders in Changde city, and to explore the risk factors of violent aggressive behaviors, so as to provide references for optimizing the management and control strategies for this population.Methods Between July and December 2017, 790 subjects were randomly selected from a total of 2 362 patients who suspected had mental disorders in Changde Rehabilitation Hospital. Only 757 patients who met the inclusion criteria were included in analysis. They filled both demographic and clinical information and Modified Overt Aggression Scales(MOAS). Patients with MOAS scored 5 and more were defined as the study group(n=505), while those with less than 5 were defined as the control group(n=252). Differences in demographic and clinical characteristics between two groups were compared, and the independent related factors of violent aggressive behaviors were explored using binary Logistic regression analyses.Results The study group had more males and they were younger than control group. Besides, they tended to be single, unemployed for at least half a year, irregular taking medicine, locked at home, accompanied with anti-social personality than the control group(P<0.05 or 0.01). Binary Logistic regression analysis showed that not(regularly) taking medicine(OR=2.659, 95% CI: 1.892～3.738), younger than 30 years old(OR=1.845, 95% CI: 1.163～2.926), male(OR=1.486, 95% CI: 1.085～2.036) and unemployment(OR=1.621, 95% CI: 1.069～2.457) were independently and positively correlated with violent aggressive behaviors(P<0.05 or 0.01). Conclusion Risk factors for violent aggressive behaviors in patients with severe mental disorders in Changde area including not(regularly) taking medicine, younger than 30 years old, male and unemployed.
引文
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[2] Wang J, Li C, Zhu XM, et al. Association between schizophrenia and violence among Chinese female offenders[J]. Sci Rep, 2017, 7(1): 818.
[3] Witt K, van Dorn R, Fazel S. Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies[J]. PLoS One, 2013, 8(2): e55942.
[4] Fazel S, Gulati G, Linsell L, et al. Schizophrenia and violence: systematic review and meta-analysis[J]. PLoS Med, 2009, 6(8): e1000120.
[5] Fleischman A, Werbeloff N, Yoffe R, et al. Schizophrenia and violent crime: a population-based study[J]. Psychol Med, 2014, 44(14): 3051-3057.
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[7] Bruce M, Cobb D, Clisby H, et al. Violence and crime among male inpatients with severe mental illness: attempting to explain ethnic differences[J]. Soc Psychiatry Psychiatr Epidemiol, 2014, 49(4): 549-558.
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[9] 徐江玲, 邹海欧, 张丽, 等. 重性精神疾病患者主要照顾者遭受暴力攻击的现状调查[J]. 中华现代护理杂志, 2014, 20(36): 4558-4562.
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[12] 钱秀莲, 徐裕, 汪芳军, 等. 丙戊酸钠对精神分裂合并梅毒感染患者MOAS与PANSS评分的影响[J]. 中华医院感染学杂志, 2018, 28(12): 1802-1805.
[13] 薛坤喜, 张传福, 盛东方, 等. 精神分裂症患者攻击行为与临床症状、记忆及智力的相关性[J]. 四川精神卫生, 2017, 30(2): 126-131.
[14] 张作记. 行为医学量表手册[M]. 北京: 中华医学电子音像出版社, 2005: 352-353.
[15] 何建锋, 洪武, 邵阳, 等. MOAS在住院精神障碍患者暴力风险评估中的应用[J]. 法医学杂志, 2017, 33(1): 28-31.
[16] 张素贞, 宓为峰, 张鸿燕. 精神疾病激越症状的临床评估和处理[J]. 中国心理卫生杂志, 2016, 30(4): 287-291.
[17] Krakowski MI, Czobor P. Distinctive profiles of traits predisposing to violence in schizophrenia and in the general population[J]. Schizophr Res, 2018, 202: 267-273.
[18] 国家卫生健康委员会. 关于印发严重精神障碍管理治疗工作规范(2018年版)的通知[EB/OL]. http://www.nhc.gov.cn/jkj/s7932/201806/90d5fe3b7f48453db9b9beb85dfdc8a8.shtml, 2018-06-08.
[19] SanSegundo MS, Ferrer-Cascales R, Bellido JH, et al. Prediction of violence, suicide behaviors and suicide ideation in a sample of institutionalized offenders with schizophrenia and other psychosis[J]. Front Psychol, 2018, 9: 1385.
[20] Frommberger U, Hamann K, Kammerer J, et al. A feasibility study on violence prevention in outpatients with schizophrenia[J]. Int J Law Psychiatry, 2018, 58: 54-62.
[21] Fazel S, Zetterqvist J, Larsson H, et al. Antipsychotics, mood stabilisers, and risk of violent crime[J]. Lancet, 2014, 384(9949): 1206-1214.
[22] Kageyama M, Solomon P, Kita S, et al. Factors related to physical violence experienced by parents of persons with schizophrenia in Japan[J]. Psychiatry Res, 2016, 243: 439-445.
[23] Hao W, Xiao S, Liu T, et al. The second National Epidemiological Survey on illicit drug use at six high-prevalence areas in China: prevalence rates and use patterns[J]. Addiction, 2015, 97(10): 1305-1315.
[24] Moeller SJ, Fink DS, Gbedemah M, et al. Trends in illicit drug use among smokers and nonsmokers in the United States, 2002-2014[J]. J Clin Psychiatry, 2018, 79(3): 17m11718.
[2] Wang J, Li C, Zhu XM, et al. Association between schizophrenia and violence among Chinese female offenders[J]. Sci Rep, 2017, 7(1): 818.
[3] Witt K, van Dorn R, Fazel S. Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies[J]. PLoS One, 2013, 8(2): e55942.
[4] Fazel S, Gulati G, Linsell L, et al. Schizophrenia and violence: systematic review and meta-analysis[J]. PLoS Med, 2009, 6(8): e1000120.
[5] Fleischman A, Werbeloff N, Yoffe R, et al. Schizophrenia and violent crime: a population-based study[J]. Psychol Med, 2014, 44(14): 3051-3057.
[6] Rund BR. The association between schizophrenia and violence[J]. Schizophr Res, 2018, 199: 39-40.
[7] Bruce M, Cobb D, Clisby H, et al. Violence and crime among male inpatients with severe mental illness: attempting to explain ethnic differences[J]. Soc Psychiatry Psychiatr Epidemiol, 2014, 49(4): 549-558.
[8] 朱晓敏, 李雯, 王小平. 男性住院精神分裂症患者的攻击行为特征研究[J]. 上海精神医学, 2016, 28(5): 280-288.
[9] 徐江玲, 邹海欧, 张丽, 等. 重性精神疾病患者主要照顾者遭受暴力攻击的现状调查[J]. 中华现代护理杂志, 2014, 20(36): 4558-4562.
[10] 中华人民共和国国家卫生和计划生育委员会. 卫生部关于印发《重性精神疾病管理治疗工作规范》的通知[EB/OL]. http://www.nhfpc.gov.cn/mohbgt/s9514/200911/44384.shtml, 2009-10-03.
[11] Wang J, Zhang SM, Zhong SL, et al. Gender differences among homicide offenders with schizophrenia in Hunan Province, China[J]. Psychiatry Res, 2018, 271: 124-130.
[12] 钱秀莲, 徐裕, 汪芳军, 等. 丙戊酸钠对精神分裂合并梅毒感染患者MOAS与PANSS评分的影响[J]. 中华医院感染学杂志, 2018, 28(12): 1802-1805.
[13] 薛坤喜, 张传福, 盛东方, 等. 精神分裂症患者攻击行为与临床症状、记忆及智力的相关性[J]. 四川精神卫生, 2017, 30(2): 126-131.
[14] 张作记. 行为医学量表手册[M]. 北京: 中华医学电子音像出版社, 2005: 352-353.
[15] 何建锋, 洪武, 邵阳, 等. MOAS在住院精神障碍患者暴力风险评估中的应用[J]. 法医学杂志, 2017, 33(1): 28-31.
[16] 张素贞, 宓为峰, 张鸿燕. 精神疾病激越症状的临床评估和处理[J]. 中国心理卫生杂志, 2016, 30(4): 287-291.
[17] Krakowski MI, Czobor P. Distinctive profiles of traits predisposing to violence in schizophrenia and in the general population[J]. Schizophr Res, 2018, 202: 267-273.
[18] 国家卫生健康委员会. 关于印发严重精神障碍管理治疗工作规范(2018年版)的通知[EB/OL]. http://www.nhc.gov.cn/jkj/s7932/201806/90d5fe3b7f48453db9b9beb85dfdc8a8.shtml, 2018-06-08.
[19] SanSegundo MS, Ferrer-Cascales R, Bellido JH, et al. Prediction of violence, suicide behaviors and suicide ideation in a sample of institutionalized offenders with schizophrenia and other psychosis[J]. Front Psychol, 2018, 9: 1385.
[20] Frommberger U, Hamann K, Kammerer J, et al. A feasibility study on violence prevention in outpatients with schizophrenia[J]. Int J Law Psychiatry, 2018, 58: 54-62.
[21] Fazel S, Zetterqvist J, Larsson H, et al. Antipsychotics, mood stabilisers, and risk of violent crime[J]. Lancet, 2014, 384(9949): 1206-1214.
[22] Kageyama M, Solomon P, Kita S, et al. Factors related to physical violence experienced by parents of persons with schizophrenia in Japan[J]. Psychiatry Res, 2016, 243: 439-445.
[23] Hao W, Xiao S, Liu T, et al. The second National Epidemiological Survey on illicit drug use at six high-prevalence areas in China: prevalence rates and use patterns[J]. Addiction, 2015, 97(10): 1305-1315.
[24] Moeller SJ, Fink DS, Gbedemah M, et al. Trends in illicit drug use among smokers and nonsmokers in the United States, 2002-2014[J]. J Clin Psychiatry, 2018, 79(3): 17m11718.
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