流浪精神病患者肇事肇祸行为临床相关因素分析

Clinical influencing factors of troublemaking behavior among homeless psychiatric patients

目的分析流浪精神病患者肇事肇祸行为的临床特征及其相关因素,探索流浪精神病人救助管理新思路。方法将2008年1月—2014年12月南宁市社会福利医院收治的2 332例流浪精神病患者按其是否肇事肇祸分为研究组和对照组,并用SPSS 22.0软件对数据进行χ~2检验和多因素logistic分析。结果 2 332例流浪精神病人中肇事肇祸742例(31.8%),其中男性肇事肇祸发生率高于女性(P=0.001),外省患者肇事肇祸发生率高于南宁本市患者(P=0.000),离异患者肇事肇祸发生率高于已婚患者(P=0.025);肇事肇祸患者较非肇事肇祸患者更易出现骨折(P<0.05),流浪精神病人营养不良比例(70.9%)较高,且传染病发病率(15.5%)高于正常人群;肇事肇祸患者的主要精神病种为精神分裂症(75.9%),活性物质所致精神障碍患者肇事肇祸发生率54.4%(37/68)、心境障碍患者肇事肇祸发生率52.4%(22/42),均高于精神分裂症患者肇事肇祸发生率43.9%(563/1 283)(P<0.05);研究组出现妄想、幻觉、违拗、易激惹、被动性服从、情绪高涨等阳性症状多于对照组(P<0.05),情绪淡漠、思维贫乏、注意减弱、缄默等阴性症状低于对照组(P<0.05);多元回归显示,离异、无职业、精神分裂症、易激惹、幻觉、情绪高涨是肇事肇祸发生的危险因素。结论流浪精神病患者肇事肇祸有其明显的临床特征。肇事肇祸发生率较高;阳性精神症状促使其肇事肇祸;离异、无职业、精神分裂症患者更易肇事肇祸。建议加强流浪精神病患者家庭及社会支持,促进社会功能恢复,并将其救助工作纳入政府及相关部门的重要议程;救助医疗机构设立外科及传染病区等,提高综合救助力度。

Objective To analyze clinical characteristics and influencing factors of troublemaking behavior among homeless psychiatric patients and explore new strategies for relief and management of the patients.Methods We collected data on 2 332 homeless psychiatric patients having treatment in Nanning Municipal Social Welfare Hospital from 2008 through 2014 and divided the patients into a case and a control group according to their history of troublemaking behavior. Chi-square test and multivariate analysis were performed in data analyses with SPSS 22.0.Results The prevalence of malnutrition and incidence of infectious diseases were higher in all the patients than those in general populations. Among the patients, 742 （31.8%） were identified with the history of troublemaking behavior; higher ratio of troublemaking behavior history was observed among the males, those from other provinces, and the divorced than among the females （P=0.001）, those with local residence （P 〈 0.001）, and the married （P=0.025）. The patients with troublemaking behavior history were more likely to suffer from fracture compared to those without the history （P 〈 0.05）. Of the patients with troublemaking behavior history, 75.9% were diagnosed with schizophrenia. The ratio of troublemaking behavior history was 54.4% among 68 patients with psychoactive substance use related to mental disorders and 52.4% among 42 mood disorder patients, significantly higher than the ratio （43.9%） among 1 283 schizophrenia patients （both P 〈 0.05）. Among the patients with troublemaking behavior history, the prevalences of delusion, hallucination, negativism, irritability, passiveness, and elation were higher but the prevalences of apathy, poverty of thought, hypoprosexia, and mutism were lower compared to those among the patients without the history （P 〈 0.05 for all）. The results of multivariate regression analysis revealed that divorce, unemployment, suffering from schizophrenia, irritability, hallucinations, and elation were risk factors of troublemaking behavior among the patients.Conclusion Troublemaking behavior is prevalent among homeless psychiatric patients and the patients with troublemaking behaviors are of obvious clinical characteristics. Positive psychosis symptoms are risk factors of troublemaking behavior and the patients of divorced, unemployed, and diagnosed with schizophrenia are more likely to have troublemaking behavior.