首發精神分裂癥患者的住院模式分析

袁園　熊江容　冉哨東

摘 要：目的 分析《精神衛生法》實施前后5年，首發精神分裂癥患者非自愿住院和自愿住院占比有無差異，非自愿住院的主要原因分布及占比有無變化。方法 統計2008年1月～2017年12月在我中心住院的首發精神分裂癥患者，按前后各5年分為對照組和觀察組。10年間，每年隨機向60位非自愿住院患者的家屬發放調查問卷，了解迫使患者家屬為患者選擇非自愿住院的最直接原因。結果 10年共入組1728例，對照組904例，觀察組824例。對照組中非自愿住院占比為69.58%，觀察組為70.75%，數據差異無統計學意義（P>0.05）。兩組對象中，非自愿住院的原因分類構成比均依次為：無自知力或者治療依從性差>傷人行為或者傾向>自傷自殺行為或者傾向>其他，但觀察組相較對照組，因傷人行為或傾向而非自愿住院的構成比呈增加（P<0.01），因無自知力或者治療依從性差而非自愿住院的占比下降（P<0.05）。結論 ①首發精神分裂癥住院患者依然以非自愿住院為主；②在《精神衛生法》實施前后5年里，迫使首發精神分裂癥患者非自愿住院的原因分類占比排序，均依次為無自知力或治療依從性差、傷人行為或傾向、自傷自殺行為或傾向、其他；③《精神衛生法》的實施后，在非自愿住院的首發精神分裂癥患者中，傷人行為或傾向的占比上升，無自知力或者治療依從性差的占比下降。

關鍵詞：精神衛生法；首發精神障礙；住院現狀

中圖分類號：R749.307 文獻標識碼：A DOI：10.3969/j.issn.1006-1959.2018.22.039

文章編號：1006-1959（2018）22-0136-03

Analysis of Hospitalization Patterns in Patients with First-episode Schizophrenia

YUAN Yuan，XIONG Jiang-rong，RAN Shou-dong，LI Dao-yang，YANG Long，LIU Lin-yi

（Mental Health Center of Zhijiang City，Zhijiang 443200，Hubei，China）

Abstract：Objective To compare the admission rate between involuntary hospitalization and voluntary hospitalization of first schizophrenics and analyze the main reason and the ratio of involuntary hospitalization in 5 years before and after implementation of "Mental Health Law".Methods The first schizophrenia patients hospitalized in our center from January 2008 to December 2017 were divided into control group and observation group according to the 5 years before and after. In the past 10 years， a questionnaire was randomly distributed to the families of 60 involuntary inpatients each year to understand the most direct reason for forcing the family members to choose involuntary hospitalization for patients.Results A total of 1728 patients were enrolled in 10 years， 904 in the control group and 824 in the observation group. The proportion of involuntary hospitalization in the control group was 69.58%， and that in the observation group was 70.75%. There was no significant difference in the data （P>0.05）. Among the two groups of subjects， the classification of the causes of involuntary hospitalization was in order： no self-awareness or poor treatment compliance> wounding behavior or tendency> self-injury suicidal behavior or tendency> other， but the observation group compared with the control group， The composition ratio of wounded behavior or tendency rather than voluntary hospitalization increased （P<0.01）， and the proportion of non-intelligence or poor treatment compliance rather than voluntary hospitalization decreased （P<0.05）. Conclusion ①The first inpatients with schizophrenia are still involuntary hospitalization；②In the 5 years before and after the implementation of the "Mental Health Law"， the reasons for the involuntary hospitalization of patients with first-episode schizophrenia are classified as follows： Poor knowledge or treatment compliance， injury behavior or inclination， self-injury suicidal behavior or tendency， others； ③After the implementation of the "Mental Health Law"， in the involuntary hospitalized first-episode schizophrenia， injury behavior or tendency The proportion increased， and the proportion of lack of self-awareness or poor treatment compliance decreased.

Key words：Mental health law；First episode mental disorder；Hospitalization status

當前的精神障礙患者住院模式大多分為封閉式病房的非自愿住院或開放式病房的自愿住院兩種住院模式，研究發現[1]，《精神衛生法》實施前有61.8%的精神障礙患者為非自愿住院模式。調查顯示[2]，在《精神衛生法》實施后仍然有59.1%的精神障礙患者以非自愿模式住院，但長期以來，精神障礙患者的非自愿入住封閉式病房的合法性和合理性，存在著較大的爭議。在此背景下，枝江市精神衛生中心要求從2013年1月1日開始嚴格參照《精神衛生法》開展診療活動。精神分裂癥是封閉式病房非自愿住院精神障礙患者的主要病種構成[3]。本文著重……