老年精神科实践中的 "出院前综合征":临床表现和风险因素

I. A. Beltceva, N. M. Zalutskaya, N. Neznanov
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摘要

背景:老年患者住院治疗与社会和心理适应不良、日常功能水平下降以及住院病人增多有关。在精神病院出院前状态突然恶化的患者是一个难以诊断和治疗的群体,对他们的研究也不够充分。本研究旨在分析患者在计划出院前的病情变化,以确定病情恶化的临床模式以及与这一不良事件相关的因素。患者和方法:研究对象选自 V.M. Bekhterev 国家精神病学和神经病学医学研究中心老年精神病科的 181 名连续患者。主要研究方法是病史采集和心理评估。结果:81 名患者(44.8%)出院前病情恶化,其中 60 例(33.2%)精神障碍加重,12 例(6.6%)出现新症状,9 例(5.0%)躯体疾病恶化。出院前病情恶化的患者住院时间较长。这些患者接受了更多的预处理,住院率和违规率也更高。病情恶化或出现新的精神障碍症状的患者的中位精神疾病持续时间分别为 84 个月和 204 个月。他们更容易违反规定的治疗方案和剂量。躯体失调发生在中位精神障碍病程为 36 个月的患者身上,与潜在的拒绝服药有关。结论:有长期住院史的老年精神病患者出院前病情恶化的风险增加,因此在计划出院时需要尽早进行康复治疗、心理治疗和心理支持。
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“Pre-Discharge Syndrome” in Gerontopsychiatric Practice: Clinical Manifestations and Risk Factors
Background: hospitalization of elderly patients is associated with social and psychological maladaptation, reduced levels of daily functioning, and development of hospitalism. Patients whose status suddenly worsened immediately prior to discharge from psychiatric hospital make up a group that is difficult for diagnostics and treatment and not sufficiently studied. The aim of the study was to analyze changes in patients’ status before planned discharge from hospital to identify clinical patterns of deterioration and factors associated with this adverse event. Patients and methods: study participants were selected from 181 consecutive patients of the Geriatric Psychiatry Department of V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology. The main study methods were history-taking and psychological assessment. Results: predischarge deterioration was observed in 81 patients (44.8%) and was represented by exacerbation of mental disorder in 60 cases (33.2%), development of new symptoms in 12 patients (6.6%), or decompensation of somatic disease in 9 cases (5.0%). The history of patients with predischarge worsening was characterized by longer prior hospitalizations. These patients were more heavily pretreated, and had higher rates of hospitalism and non-compliance. For patients with worsening or development of new symptoms of mental disorder median duration of mental disease was respectively 84 and 204 months. They were more prone to violation of compliance, of the prescribed treatment regime and doses. Somatic decompensation occurred in patients with median duration of mental disorder 36 months and was associated with latent refusal to take medicines. Conclusions: an increased risk of predischarge deterioration in geropsychiatric patients with a history of prolonged hospitalizations needs earlier rehabilitation, psychotherapy, and psychological support when planning hospital discharge.
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