脑外伤所致精神障碍司法鉴定400例分析

Analysis of 400 forensic cases of mental disorders due to brain damage

目的探讨精神疾病司法鉴定中颅脑损伤所致精神障碍的临床特征及相关因素。方法收集脑外伤后司法鉴定案例资料,按照神经外科GCS评分把脑损伤所致精神障碍鉴定案例分为重型(A组)、中型(B组)及轻型(C组)颅脑损伤;对案例的临床症状进行分析,根据中国精神障碍分类与诊断标准(第三版)(CCMD-3)进行精神障碍诊断,并探索临床症状与脑外伤程度之间的关系。结果轻、中度颅脑损伤所致精神障碍以器质性神经症样综合征最多见。重度颅脑损伤所致精神障碍中以智能损害综合征为多。三组间有显著性差异(P≤0.01)。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有不同的临床特征。

Objective To explore the clinical characteristics and related factors of mental disorder caused by brain injury in the judicial identification of mental illness. Methods Forensic case data of brain injury ware collected and analized. Brain injury sverity was classied into 3 groups, namely severe group（group A）; moderate group（group B） and mild group（group C） according to neurosurgery GCS scores; clinical characteristics were analyzed, diagnosis were made against the Chinese Classification of Mental Disorders（the 3rd ed.）（CCMD-3）. Relationship between the clinical characteristics and brain damage severity was analyzed. Results Organic neurosis-like syndromes are the main manifestation of mental disorders caused by mild and moderate brain injuries. Organic intellectual deficiency is the main manifestation of mental disorders due to severe brain injury. The difference between the three groups was significant（P ≤ 0.01）. Conclusion Different clinical features are related to different brain injury severities in the forensic evaluation of mental disability.