脑外伤所致精神障碍的司法精神病鉴定案例比较分析

Study of forensic psychiatric appraisals of cases with mental disorders due to brain injury

目的探讨新司法管理体系下脑外伤所致精神障碍的司法精神病鉴定案例在精神障碍类型分布、伤残等级方面的差异,为脑外伤所致精神障碍的司法鉴定工作提供有益的参考依据。方法收集嘉兴市康慈医院司法鉴定所2007年10月—2009年9月及2002年10月—2004年9月受理的534例和182例道路交通事故所致脑外伤后出现精神障碍的鉴定案例,对2组精神障碍类型分布、智力损害程度、伤残等级、受伤时间据鉴定时间、脑损伤程度进行回顾性对比分析。结果 2007—2009年组中脑外伤所致智力障碍、精神病性症状、神经症样症状少于2002—2004年组,而情感障碍明显多于2002—2004年组,差异均具有统计学意义（P〈0.05）。2007—2009年组中重度伤残（Ⅰ～Ⅲ级伤残）比例明显低于2002—2004年组,而轻度伤残（Ⅶ～Ⅹ级伤残）比例明显高于2002—2004年组,差异均具有统计学意义（P〈0.01）。中度伤残（Ⅳ～Ⅵ级伤残）比例2组间差异无统计学意义（P〉0.05）。结论司法精神病鉴定中脑外伤所致智能损害的诊断应慎重。把握恰当的鉴定时机、规范鉴定程序在伤残等级的评定中具有重要地位。

Objective To study the differences in the levels of disability and the types of mental disorders of the forensic psychiatric clients with mental disorders due to brain injury under the new administration of justice, and to provide helpful references for the forensic psychiatric appraisal Methods The data of 534 cases （ from October 2007 to September 2009 ） and 182 cases（ October 2002 to September 2004） of mental disorders due to traumatic brain injury caused by traffic accidents in our hospital was collected respectively. The genres of mental disorders, level of disability and intelligence damage,the interval between injury time and appraisal, and the severity of brain injury between the two groups were compared. Results The cases diagnosed with intellectual impairment, neurosis-like symptoms, psychotic symptoms due to traumatic brain injury in the 2007 - 2009 group were significantly less than that in the 2002 - 2004 group, while the cases diagnosed with affeetive disorder were more than the 2002 -2004 group significantly（ P 〈 0.05 ）. The severe disabled ca- ses in the 2007 -2009 group were significantly lower than that in the 2002 -2004 group, while the mild disabled cases in the 2007 -2009 group were significantly higher than that in the 2002 -2004 group（ P 〈 0.01 ）. The moderate disabled cases were not significantly different between two groups （ P 〉 0.05 ）. Conclusion To make a diagnosis as intellectual impairment due to traumatic brain injury in forensic psychiatric appraisal should be carefully. Appropriate timing of appraisal and standardizing appraisal procedures are major important for the evaluation of disability rating.