74例头部外伤后精神障碍司法精神病鉴定临床分析

Jurisdictional Identification of Dysphrenia after Craniocerebral Injury

目的探讨司法鉴定中头部外伤后精神障碍的临床特点及有关因素.方法收集74例头部外伤后司法鉴定案例的资料并对其进行统计学分析.结果本组资料中最多见的精神障碍是人格改变,34例(45.95%);其次是脑外伤后精神障碍,22例(29.73%);外伤性癫痫及认知功能障碍,18例(24.32%).颅脑损伤的类型中,以重型颅脑损伤最为多见,46例(62.16%);其次为中型颅脑损伤,18例(24.32%);轻型颅脑损伤少见,10例(13.52%).鉴定时机以伤后6～12月最多,其次为3～6个月,而大于1a者和小于3个月者最少.智力缺损以智力边缘状态和轻度智力缺损最为多见,两者合计占74.3%,而极度智力缺损仅占1.4%.结论在颅脑损伤后精神障碍的伤者进行伤残评定时,结合原发性损伤、精神障碍的类型以及对伤者的认知功能和行为能力的影响程度、智商测定的结果综合进行分析,得出鉴定结论是较为可行的方法.

Objective To explove the clinical characteristics and correlated factors of dysphrenia after craniocerebralinjury. Method We collected 74 patients with dysphrenia after craniocerebral injury, a retrospective analysis was applied to the data. Results Among these cases, the most common type of dysphrenia was personality change, 34 cases （45.95 % ） ; the second was psyehogenia seeondum of cerebral trauma, 22 cases （29.73%） ; traumatic epilepsy and lightly cognitive handicap, 18 cases （24.32%）. The severe type of craniocerebral injury was 46 cases （62.16%） ; the minor type of craniocerebral injury was 18 cases （24.32%） ; the slight type of eraniocerebral injury was 10 cases （13.52%）. The time term which were done assessment of impairment, the most common was six months to twelve months after injury, the second was three months to six months, above one year or below three months was rarely. The common type of defect of intelligence was borderline state intelligence and lightly degree of defect, total 55 cases （74.3%） ; supreme degree of defect was only 1.4%. Conclusions The data indicate that when we assess the degree of impairment of patients with dysphrenia after craniocerebral injury, we should consider the primary injury, the types of dysphrenia and it＇ s effect of recognition function and capability, as well as result of determination of intelligence quotient.