综合医院精神科紧急会诊的特点

Psychiatric acute consultation in general hospital

目的了解综合医院精神科紧急会诊服务需求的特点，与普通会诊服务需求的区别，探索综合医院急诊精神医学的发展方向。方法汇总北京协和医院2009年7月至2012年6月期间精神科紧急会诊和普通会诊共2789例次，其中紧急会诊249例，普通会诊2540例。分析比较紧急会诊与普通会诊服务在人口学资料、会诊科室、会诊原因、精神科诊断及处理的区别。结果3年来249例次紧急会诊中，会诊患者225人，男性患者比例（51．1％）高于普通会诊患者（43．2％），二者在年龄构成差异无统计学意义。急诊科、加强医疗科、手术科室选择提请紧急会诊的比例明显高于非手术科室，分别为35．2％、34．8％、15．6％和4．2％。紧急会诊中最常见的会诊原因是精神病性症状，占41．4％，其次为情绪症状，占30．1％。精神病性症状、自杀相关问题、不配合治疗作为会诊原因，在紧急会诊中的比例高于其在普通会诊中的比例。器质性精神障碍是紧急会诊中最常见的精神科诊断（37．8％），远高于其在普通会诊中所占的比例（15．5％）。会诊后发现紧急会诊中存在自杀问题的比例为20．5％，远高于紧急会诊中将自杀相关问题作为会诊原因的比例（8．0％），也高于普通会诊中存在自杀问题的比例（8．2％）。在紧急会诊中接受药物治疗的比例为79．9％，其中60．8％的患者使用了抗精神病药物，二者均高于普通会诊中的相应比例（63．7％、24．1％）；接受心理治疗的比例为26．9％，低于普通会诊中的比例（53．0％）。结论目前综合医院精神科紧急会诊服务以精神病性症状的鉴别与处理为主。自杀的识别、评估和干预是综合医院急诊精神医学的重要内容。因此，建立综合医院精神科会诊的紧急程度分层体系，有助于合理运用会诊资源。

Objective To explore the characteristics of psychiatric acute consultation in general hospital. Methods During 3 years （ 2009. 07. .01 - 2012.06. 30） , 2789 referrals of psychiatric consultations were enrolled, among which 249 referrals were acute consultations, while others were common consultations as control group. The demographic characteristics, reasons for referral, referral department, psychiatric diagnosis according to the International Statistical Classification of Diseases 10th Revision, management were analyzed. Results In acute consultations, the rate of male patients （51.1%） was higher than that in common consultations. The age range of patient in the two groups was similar. The rates of acute consultation in the referrals from emergency department （35.2%） , intensive care unit （34. 8% ） and surgical department （ 15.6% ） were higher than that from nonsurgical department （4. 2% ）. The major reason of acute consultation was ＂ psychotic symptoms＂ （41.4%） followed by ＂ emotional symptoms＂ （30. 1% ） which was the major reason of common consultation. The rates of ＂ psychotic symptoms＂ ,＂ suicide-related issues＂ （8.0%） , ＂ uncooperative behavior＂ （ 14.8% ） as referral reasons were higher in acute consultation group than in common consultation group. The most common psychiatric diagnosis among acute consultations was organic mental disorder （37.8%）. Medication was given in 199 out of 249 acute consultations. The rate of medication was higher in acute consultation group, while the rate of psychotherapy was higher in common consultation group. Antipsychotics were the most common medications given in acute consultations. Conclusions Psychotic symptom is the most common referral reason for psychiatric acute consultation. The doctors have to pay attention to identification, evaluation and management of suicide risk. Setting up triage model can optimize the psychiatric consultation management.