精神伤残评定相关问题的思考

近年来,精神伤残评定的案例日益增多,国内伤残评定有多种标准,不同标准之间评定原则、等级划分不一,评定人对现行评定标准的理解不同,造成对同一案例得出不同评定结论的情况时有发生。通过比较,作者首先阐明精神伤残的概念;然后结合目前使用的伤残评定标准,燕点比较了常用的《道路交通事故受伤人员伤残评定》及《职工工伤与职业病致残程度鉴定》标准之间的异同,最后提出了精神伤残评定中应注意的问题。     

道路交通事故精神伤残评定相关问题

近年来,道路交通事故频繁发生,造成严重的人身伤害。许多颅脑损伤患者伤后常出现明显的行为或认知缺陷,创伤性脑损伤患者精神障碍的患病率明显增高,精神伤残的评定日益增多。但同时,关于精神伤残评定的争议也日益激烈。首先介绍国内外精神伤残的相关概念,然后分析道路交通事故精神伤残评定标准存在的不足和缺陷,重点分析道路交通事故中精神伤残程度的影响因素,并介绍精神伤残评定中的检查方法,最后提出解决精神伤残评定分歧的思路。     

对精神伤残程度评定的司法鉴定相关问题的探讨

精神伤残是指在各种物理、化学等损伤因素作用下，导致个体长期的精神障碍，存在社会功能（严重）受损，且此精神障碍与损伤事件相关性一致，才属于精神伤残。因此精神伤残程度评定与精神损伤程度评定是两个不同的概念，精神损伤并不一定达到精神伤残程度，在我国，精神伤残程度的评定，大多是涉及到各种行业的行政执法需要。通常司法鉴定中遇到的精神伤残程度评定，多是因为当事人一方对行政执法过程中的伤残评定结论持有异议，使一般行政执法的伤残评定，上升为有关法律诉讼的司法鉴定。精神伤残程度评定的司法鉴定，可出现在民事人身损害…     

172例道路交通事故受伤人员精神伤残鉴定分析

目前,道路交通事故的发生率高,伤者出现精神损伤的也相对较多,受伤者涉及精神伤残评定的数量有增多的趋势。。为了探讨道路交通事故受伤人员精神伤残等级的评定及其相关的影响因素,本文作者对172宗道路交通事故案例中受伤人员的相关资料进行了回顾性分析。     

事件相关电位在道路交通事故精神伤残评定中运用的初步研究

目的探讨事件相关电位在道路交通事故精神伤残评定中的价值。方法以进行精神伤残评定的被鉴定人为研究对象,进行常规精神伤残评定的同时采用视觉P300检测事件相关电位,分析行为学表现数据及P300潜伏期、波幅等在不同精神伤残等级和颅脑损伤程度组之间差异。结果纳入272例被试,其中13例(4.8%)未能有效完成测试,51例(18.8%)图谱无法识别,2例因按键缺失导致行为学数据未能采集,205例为7级以上精神伤残者。靶刺激和标准刺激平均反应时在不同精神伤残等级组之间具有差异,但区分度并不明显。F4、C4、P4位点不同伤残等级之间P300波幅有差异外,其他各指标在各组之间无差异;ERP异常程度在不同精神伤残等级之间的构成比无差异。结论 ERP检查主要适用于轻度精神伤残者,当前检测结果尚不能成为有效划分精神伤残等级的重要指标。     

交通事故脑外伤所致精神障碍伤残评定有关问题

在交通事故受伤人员脑外伤所致精神障碍伤残评定中,由于《道路交通事故受伤人员伤残评定》中涉及精神伤残评定条款内容可操作性差,精神伤残评定客观检查及量化指标较少,导致评定意见不一致,给交通事故理赔带来困难。在此就精神伤残评定技术操作中的有关问题提出一些经验性观点。     

道路交通事故中脑外伤所致人格改变与精神伤残评定

目的探索道路交通事故中颅脑损伤所致轻度精神伤残者人格改变的主要表现形式及其在伤残评定中的价值。方法运用《脑外伤后人格改变评定量表》量化评定道路交通事故所致颅脑外伤者后遗人格改变状况,并探讨人格改变与颅脑损伤程度、精神伤残程度的相关性。结果 271例样本中239例(88.2%)存在人格改变,其中178例(65.7%)为轻度,46例(17.0%)为中度,15例(5.5%)为重度。人格改变程度在不同颅脑损伤程度之间的构成比差异无统计学意义(P0.05),但各组之间量表总分差异具有统计学意义(P0.05),两两比较显示中型与重型颅脑损伤之间差异无统计学意义。人格改变程度越明显,精神伤残等级越高,轻度精神伤残不同等级者人格改变评定量表总分差异具有统计学意义(P0.05),除七级与八级之间差异无统计学意义外,其余各组之间差异均具有统计学意义(P0.05)。结论交通事故中提出精神伤残评定的脑外伤者中人格改变发生比例较高,人格改变严重程度与精神伤残程度相关,《脑外伤后人格改变评定量表》能有效量化评定交通事故中脑外伤所致人格改变程度,量表总分与颅脑损伤程度具有相关性。     

老年人交通事故精神伤残鉴定的临床特征分析

目的探讨老年人交通事故受伤后精神伤残鉴定临床特征。方法对109例老年人发生交通事故受伤后精神伤残司法鉴定资料进行回顾性分析,并与非老年组进行对照研究。结果老年人多为被动性损伤、受伤后颅内血肿发生率高、致残的原因88．07％是智能及精神障碍所致,损伤程度及伤残等级以中、重度多见。结论最佳评残时机为脑外伤一年后为宜,应结合老年人的心理、生理特点,提高交通安全防范意识。     

WAIS-RC简式与成人智残评定量表在精神伤残评定中的应用

目的 考察中国修订版韦氏成人智力量表(WAIS-RC)简式与成人智残评定量表在精神伤残评定中的适用性.方法 对台州学院司法鉴定所2009年7月-2011年3月进行精神伤残鉴定的案例,用WAIS-RC简式和成人智残评定量表分别评定并与专家鉴定意见进行比较,用SPSS11.5进行统计分析.结果 WAIS-RC简式、成人智残...     

浅谈新工伤鉴定标准关于精神伤残的评定

《劳动能力鉴定职工工伤与职业病致残等级》(GB/T 16180-2014)于2015年1月1日已正式实施。本文通过对比新、旧工伤鉴定标准中关于精神伤残评定条款的变化,探讨工伤鉴定中涉及精神伤残的相关问题与对策。     

54例脑外伤精神伤残重新鉴定分析

目的 研究有争议的脑外伤后各种精神伤残案例,分析其在初次鉴定中暴露出来的问题,并探讨解决问题的方法.方法 收集2007-2011年上海市司法鉴定中心脑外伤后致精神障碍重新鉴定案件,分别对初次鉴定和重新鉴定的资料进行分析比较.结果 鉴定时机不当,初次鉴定时鉴定人对被鉴定人的精神状态调查不全面、不客观,鉴定人对标准的理解有...     

Federal old-age, survivors, and disability insurance; listing of impairments--mental disorders--SSA. Proposed rules

These proposed amendments revise the medical evaluation criteria for mental disorders for the disability program in title II and title XVI of the Social Security Act. No substantial revisions have been made to these criteria since 1979. The proposed revisions reflect advances in medical treatment and in methods of evaluating certain mental impairments, and will provide up-to-date medical criteria for use in the evaluation of disability claims based on mental disorders.     

Deliberate ingestion of foreign bodies as a form of self-harm among inpatients within forensic mental health and intellectual disability services

Deliberate foreign body ingestion is a significant issue in prison and psychiatric settings. It is associated with serious physical complications, including bowel obstruction, perforation and haemorrhage. Episodes of deliberate foreign body ingestion were identified retrospectively from 5417 incident records from two inpatient forensic services (one mental health and one intellectual disability) over a one year timeframe, using related search terms. Rates were compared according to gender, diagnosis and level of security. Incidents of deliberate foreign body ingestion were found to occur on average every 2.7 days across the study population, with 133 incidents recorded over a one year period, accounted for by 27 patients. Women and patients in lower levels of security were significantly more likely to engage in deliberate foreign body ingestion. Staff responses to this behaviour were highly variable. Deliberate foreign body ingestion occurs frequently within inpatient forensic services, and can have significantly detrimental physical implications for affected patients. Further research should investigate the psychiatric and intellectual disability profile of such individuals in further detail, as well as exploring patient narratives; both of which will help inform development of treatment strategies.     

颈椎损伤的伤残等级及“三期”法医学评定——附64例分析

目的探讨交通事故致颈椎损伤后伤残等级和休息、护理、营养时限的法医学鉴定,以及颈部损伤、原有疾患与后遗症之间因果关系法医学鉴定的原则与方法。方法收集64例颈椎损伤的伤残等级鉴定案例,对相关资料/数据进行统计分析。收集交警部门反馈的涉及伤病关系案件的处理结果,了解案件双方当事人对鉴定结论的认可程度。结果随着对颈椎损伤后伤残评定案件中原发病的认识逐渐增加,相应颈椎损伤涉及伤病关系鉴定的案件也日益增多;在受理的颈椎损伤伤病关系案件中,均按照伤病关系理论进行鉴定,案件处理机关（交通警察）以及双方当事人对鉴定结论均表示满意。结论对于各种颈椎损伤进行伤残等级和“三期”鉴定的案例,由于损伤机制不同,自身原有颈椎健康程度不同,所造成的后果也不尽相同,鉴定中应考虑原有疾病对伤残等级的影响。     

Intellectual disability and mental illness in the NSW criminal justice system

There has been increasing international, national and local recognition of the need for more appropriate responses and services for individuals who come in contact with the criminal justice system and who have an intellectual disability and mental health issues. This article provides an overview of prevalence data that indicates a significant over representation of people with intellectual disabilities in correctional facilities and reviews the problems facing this population. Findings from two specific evaluation studies undertaken by the Centre for Developmental Disability Studies are presented, along with recommendations for future provision based on these results. One of these projects trialled a case management approach to supporting offenders with an intellectual disability upon their release from prison. The 20-month follow-up found that a number of serious barriers were encountered within the overall system of provision for this population; the most serious of which related to lack of adequate accommodation upon release. The second project involved a two-stage evaluation of one model of provision for individuals with intellectual disabilities who are sex offenders, only some of whom were on parole. This service provided both residential and therapy services in a small group home located in the community. Residents were found to have high levels of emotional and behavioural difficulties, in addition to offending behaviour, that continue to require support and supervision. Critical issues, including guardianship involvement, restrictive practices and retrieval, therapy provision, and risk management issues are discussed in relation to overall clinical and lifestyle outcomes.     

Choosing disability: preimplantation genetic diagnosis and negative enhancement

This article examines the unusual circumstance of what the author has tentatively termed "negative enhancement". This term is used to describe those instances where individuals seek to use preimplantation genetic diagnosis (PGD) to achieve outcomes that, commonly, are socially not preferred. In a recent survey by the Genetics and Public Policy Centre, it was found that 3% of IVF-PGD clinics in the United States reported having provided PGD to couples who seek to select an embryo for the presence of a particular disease or disability, such as deafness, in order that the child share the characteristic with the parents. The idea of "negative enhancement" is, therefore, both a paradox and a useful means to describe the hidden assumptions behind claims that enhancement technologies can only lead us in one direction -- towards a race of blond, blue-eyed, able-bodied, intellectually magnificent and athletically superior beings. In Australia there does appear to be a consensus that PGD should only be used to select against serious disability. This inevitably raises the question of how we define disability and who is best placed to make decisions about the kind of kin we want to create.     

Continuing disability review failure to cooperate process. Final rules

We are amending our regulations to provide that we will suspend your disability benefits before we make a determination during a continuing disability review (CDR) under title II and title XVI of the Social Security Act (the Act) when you fail to comply with our request for necessary information. Should you remain non-compliant for a period of one year following your suspension, we will then terminate your disability benefits. Although our current title XVI regulations generally provide for the termination of payments after 12 months of suspension, we are amending our regulations by adding this policy to our title II regulations and by restating it in the title XVI CDR regulatory provisions.     

Head banging as a form of self-harm among inpatients within forensic mental health and intellectual disability services

Introduction: ‘Head banging’ is a common form of self-harm, linked to numerous negative outcomes including significant brain damage. However, little research has investigated head banging behaviour and its correlates in clinical populations. Method: Head banging episodes were identified from the incident records (n = 5417) of two inpatient forensic services (one intellectual disability and one mental health), using relevant search terms. Rates were compared between individual patients, by gender, diagnosis and level of security. Incident accounts were analysed qualitatively using thematic analysis. Results: Head banging incidents occurred approximately every 3 days in each service, with 229 incidents recorded in 1 year. Individual patient rates varied widely, ranging from 1 to 38 incidents within 1 year. Women, and patients in higher levels of therapeutic security, were significantly more likely to engage in head banging. Qualitative incident reports indicated that head banging was associated with mental distress, anger and psychotic experiences. Discussion: Head banging occurs frequently in forensic services, and has documented associations with traumatic brain injury in affected individuals, thus negatively impacting progress through the care pathway and treatment outcomes. Further research should investigate short- and long-term management strategies and treatment approaches, in order to minimise harm.     

Stigma as a barrier to employment: mental disability and the Americans with Disabilities Act

In a controversial expansion of workplace civil rights, the 1990 Americans with Disability Act (ADA) extended anti-discrimination protection to individuals with "mental impairments." One of the most critical barriers to the employment of individuals with mental disabilities is the degree of social stigma such disabilities incur, and there is compelling evidence that employers have stigmatizing attitudes and have discriminated against those with mental disabilities. This study examines the role played by stigma in employers' response to the 1990 Americans with Disability Act (ADA). A stratified sample of one hundred ninety employers were surveyed in 1996-1997 in a major Southern metropolitan area. Telephone interviews were completed with one hundred seventeen employers (response rate of 61.6%). The article describes employers' experiences with employees with mental disabilities and accommodations, specific employment practices, and attitudes towards those with mental disabilities. Stigma played an important role in conformity to the ADA (operationalized as either hiring or having specific recruiting policies for hiring individuals with mental disabilities). Furthermore, employers expressing coercive (fear of a lawsuit) as opposed to normative (belief that it is the right thing to do) rationales for compliance were more likely to hold stigmatized attitudes. Employers' beliefs about mental disability form a crucial foundation for truly supportive work environments (those that value difference and diversity), and further research is needed to determine if over time the ADA is successful in changing attitudes as well as behavior.