上海某綜合醫院老年住院患者精神病學聯絡會診現狀

張紅霞,李園園,張瀟伊,陳華,劉文娟,葉塵宇,黃嘯,王立偉,季建林

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上海某綜合醫院老年住院患者精神病學聯絡會診現狀

張紅霞,李園園,張瀟伊,陳華,劉文娟,葉塵宇,黃嘯,王立偉,季建林

目的了解綜合醫院老年住院患者精神醫學聯絡會診的特點。方法回顧性分析1年間老年科住院患者精神病學聯絡會診資料,并分析。結果176例次精神科聯絡會診對象共100例患者,平均87歲。住院時平均每位患者有6種診斷,人均患4個系統疾病。女性患者會診前已使用精神藥物的比例高于男性(64%比36%,χ2=6.00,P=0.014)。58%會診診斷為神經認知障礙。176例次會診中建議使用抗精神病藥治療為45%，抗焦慮藥為38%，抗抑郁藥物為25%,不建議藥物治療為32%。需要2次或更多次會診者約占1/3。本調查中涉及病房總的開放床位180張,平均每100張床位每周精神科會診數為1.9例次。結論綜合醫院老年住院患者中聯絡會診的需求高,會診患者中神經認知障礙的比例及需要用精神藥物的患者比例高。

會診聯絡精神醫學； 老年； 神經認知障礙； 精神藥物

Abstract：Objective： To explore the features of consultation-liaison psychiatry in geriatric inpatients.Method：One-year data of consultation-liaison in elderly inpatients in a general hospital were recorded and analyzed.Results：Total of 176 times of consultation were served for 100 patients,with the mean age of 87.At their admission,the patients had an average of 6 different diseases,and an average of four systems diseases involved.Patients who had taken psychiatric medicine before consultation were more in female than in male (64% vs 36%,χ2=6.00,P=0.014).According to the diagnosis in consultation,58% patients were thought to be suffering from neurocognitive disorder.For 32% of the total 176 consultation,no psychotropic medication was thought to be in need.There was 45% in the need of antipsychotics,38% anxiolytics,and 25% anti-depressant.Nearly one-third patients needed two or more consultations.There were 180 beds in all these wards,and the average times of consultation-liaison psychiatry service per 100 beds per week were 1.9.Conclusion： There are increasing needs for consultation-liaison psychiatry in geriatric wards from general hospital.Among the patients in the need of consultation,relatively high proportion was suffering from neurocogntive disorder,and high proportion needed psychotropic medication.

Keywords： consultation-liaison psychiatry; geriatric; neurocognitive disorder; psychotropics

由于老年人軀體疾病發生率上升,認知功能較年輕時下降,精神行為問題發生率有所增高。上海早在1979年就已經步入老齡化城市行列[1],上述問題同樣突出,因而在綜合醫院開展精神病學的聯絡會診工作不可或缺。然而國內外很多綜合醫院內這一亞?？埔琅f處于起步階段[2-3]。當下對綜合性醫院老年人群的精神科聯絡會診現狀分析仍有現實意義。本研究通過調查某綜合醫院老年科住院患者，了解老年科精神科聯絡會診現況。……