【摘要】 目的:通过对颅脑损伤所致器质性人格改变的患者进行量化评估分析,以寻找一种最适合颅脑损伤后人格改变的量化评估方法。方法:全部病例来自2003-01-03/2005-01-31期间到深圳市康宁医院法医精神病司法鉴定所进行工伤鉴定的工伤所致颅脑损伤患者116例,所有病例首先由综合医院神经外科行头颅CT或MRI检查,并对颅脑损伤的部位、性质、严重程度等做出诊断和治疗。治疗终结后,由两名副高级主任医师及以上职称的精神医学鉴定专家对患者的精神状况进行评估,并分别做出有无人格改变的诊断。同时采用慢性脑器质性人格改变评定量表(包括10个条目)及自编脑外伤后人格改变评定量表(包括5个因子17个条目)对患者人格改变的情况进行量化评定。以专家诊断结果为效标,对两种量表对颅脑损伤所致人格改变的判定灵敏度和特异性以及两量表的内部条目进行分析。结果:①颅脑损伤所致人格改变专家评定及量表评定结果:经专家鉴定,116例颅脑损伤患者中诊断为颅脑损伤所致器质性人格改变的患者22例,占所有调查对象的19%,评估者的诊断一致性kappa值为0.86(P<0.01)。以专家诊断为效标,慢性脑器质性人格改变评定量表对本组颅脑损伤患者所致人格改变诊断的假阳性率为0,假阴性率为50%;自编脑外伤后人格改变评定量表的假阳性率为2.4%,假阴性率为4.5%。②两种量表评定颅脑损伤所致人格改变的内部条目分析:慢性脑器质性人格改变评定量表各条目评分结果显示有人格改变与无人格改变的患者在情绪不稳、情感淡漠或不协调、社会功能减退、个性改变、行为障碍5个条目的差异显著(t=2.082～5.921,P<0.01～0.05)。自编脑外伤后人格改变评定量表除认知偏离因子中的所有条目外,情感偏离因子中的情绪不稳,情感脆弱,易激惹,情感平淡、不关心人4个条目,意志行为偏离中的意志缺乏,欲望增强,行为冲动、不计后果,自我中心4个条目,人际关系偏离及原有人格变化及其所有条目上均有显著性差异(t=13.339～2.094,P<0.01～0.05)。结论:自编脑外伤后人格改变评定量表提高了对颅脑损伤所致人格改变诊断的灵敏度,其各条目能更准确地反映颅脑损伤所致人格改变的临床特点,但其信度和效度还需进一步完善。更多还原

【Abstract】 AIM: To conduct the quantitative evaluation and analysis on patients with organic personality changes induced by craniocerebral injury, so as to look for a most suitable method of quantitative evaluation for personality changes following craniocerebral injury.METHODS: A total of 116 patients with craniocerebral injury induced by trauma between January 3rd 2003 and January 31st 2005 came from the Verification Institute of Forensic Psychiatry, Shenzhen Kangning Hospital, and all of them received head CT and MRI examination in the Department of Neurosurgery of General Hospital. The location, nature and severity of craniocerebral injury were diagnosed and treated, after that, the mental status of patients were evaluated by two psychiatric experts of associate chief physician or above and the diagnosis on personality changes was established. Meanwhile, the quantitative evaluation on personality changes of patients was conducted by using of assessment scale of chronic brain organic personality changes (including 10 items) and the assessment scale of personality changes following traumatic brain injury (including 5 factors and 17 items). The sensibility and specificity of the assesment on personality changes induced by craniocerebral injury as well as the inner items in both of the scales were analyzed according to expert’s diagnosis.RESULTS: ① Evaluation by experts and scales on personality changes induced by craniocerebral injury: It was diagnosed by experts that there were totally 22 patients with organic personality changes induced by craniocerebral injury in 116 patients with craniocerebral injury, which accounted for 19% in the subjects, and the Kappa value of diagnosis consistance was 0.86 (P < 0.01). According to the diagnosis of experts, the false positive rate (FRR) of diagnosis of chronic cerebral organic personality changes rating scale on the personality changes induced by craniocerebral injury was 2.4%, and the false negative rate of that was 4.5%; ②Analysis of inner items on personality changes induced by craniocerebral injury in the two scales: Assessment of each items in the scales on chronic cerebral organic personality changes indicated that differences in 5 items such as emotional lability, apathy, emotional inconsistency, social function degeneration, personality change and behavioral disturbance between patients with or without personality changes were markedly(t=13.339-2.094, P < 0.01-0.05). Except all items of cognitive deviated factors in the scales, there were significant differences in 4 items of emotional deviated factors such as: Emotional lability, emotional fragility, irritableness, apathy as well as lack of intimacy and 4 items in will and behavior deviated factors such as: Hypobulia, appetition enlarging, impulse, regardless of results and egocentricity, and interperonal relationship deviation, and personality changes as well as its all items (t =13.339-2.094, P < 0.01-0.05=.CONCLUSION: Personality change following scalepost-traumatic brain injury rating scale enhances the sensitivity of diagnosis on personality changes induced by craniocerebral injury, and the clinical features of personality changes induced by craniocerebral injury can be reflected more accurately by the items of the scale. While the reliability and validity still need to be completed furtherly.更多还原