司法鉴定中不同程度颅脑损伤所致精神障碍的临床特征对照研究

A comparative study of the clinical features of the psychiatric disorder after different seriously traumatic brain injury in the psychiatric expert tesimony.

目的探讨精神疾病司法鉴定中严重程度不同的颅脑损伤所致精神障碍的临床特征及鉴定工作须注意的相关问题。方法根据综合医院神经外科的诊断和格拉斯哥昏迷量表(GCS)评分,把118例被鉴定人分为重型颅脑损伤(A组)、中型颅脑损伤(B组)和轻型颅脑损伤(C组)3组,将被鉴定人及亲属提供的病史、社会功能受损状况同精神检查和社会调查进行对照分析。结果轻、中度颅脑损伤所致的精神障碍以神经症样综合征最多见,重度颅脑损伤所致的精神障碍以智能损害为多,3组间有显著性差异(P<0．01)。3组中出现频度均较高的是躯体不适症状群和痴呆样症状群,3组间无著性差异(P<0．05)。在鉴定时,被鉴定人及亲属均有过分描述精神症状和社会功能受损严重程度的倾象。结论在精神疾病司法鉴定中,不同严重程度的颅脑损伤所致的精神障碍既有不同的临床现象学特征,也有共同的社会-心理学特点,应予以注意。

Objective The purpose of this study was to explored the clinical features of the patients with mental disorder due to brain damage in the expert testimony. Methods According to initial Glasgow coma scale scores and a diagnosis of brain damage by made neurosurgeries, 118 patients with traumatic brain injury were classified as A group （severe, n = 55 ） , B group（ moderate,n = 33 ） and C group（ mild, n = 30 ）. Mental disorder diagnoses were made according to CCMD - 3 criteria on the basis of data from patients of the medical history and psychiatry interview. Results All of 118 patients had a CCMD - 3 diagnoses of a Mental disorder due to brain damage. In the A group,the most common CCMD - 3 diagnoses were Orgabic intellectual deficiency （n =22,40.0% ） and B group, C group were Organic neurosis -like syndrome （n =42,66. 67% ）. There are a condition in all patients in which the exaggerates physical or mental symptoms. Conclusions In the psychiatric expert tesimony,the patients who had suffered trauma tic brain injury were easily suffered from mental disorder and there were some specified clinical feature.