头部外伤后精神损伤的法医学鉴定(附204例分析)

目的　研究颅脑外伤所致精神障碍的损伤程度评定标准。方法　通过对２０４ 例由司法部门委托进行法医学精神损伤程度鉴定实践，重点对颅脑外伤所致神经症的损伤程度评定标准及其他相关问题进行了讨论。结果　２０４ 例中，男、女比例无差异。年龄组以２１ ～３０ 岁（６３ 例） 、３１～４０ 岁（５３ 例） 居多。表明上述年龄组的社会活动多，受到伤害的可能性大；职业以工人、农民为多，文化程度相对较低。损伤原因以伤害（１０７ 例） 、交通事故（４９ 例） 为多。损伤与精神障碍间隔时间，半年以内１５２ 例，半年至１ 年为２３ 例，表明鉴定时间选择在１ 年内为佳。精神障碍的种类与性质：器质性精神障碍１０８ 例，占５２－８％ ；功能性精神障碍８４ 例，占４１－４％ ，其中外伤后神经症（ 含癔症３５ 例）６６ 例，占３２－３ ％ 。社会功能评定：无社会功能受损７７ 例，轻度受损４１ 例，明显受损８６ 例。神经系统检查：２０４ 例中有一过性神经体征３８ 例，有明显阳性体征６２ 例。损伤与精神障碍的关系：直接因果关系１０４ 例、间接因果关系６１ 例；条件相关３４ 例、无相关５ 例。损伤程度评定结果：重伤８５ 例，轻伤６７ 例，伤病关系评定４７ 例。结论　通过对２０４ 例头部外伤

Forensic assessment of mental disorder after head trauma:analyses of 204 cases.

Objective To study the assessment criteria of mental disorder after head trauma. Methods 204 cases of forensic opinion on mental disorder after head trauma, which entrusted by judiciaries, were retrospectively investigated. Results There were no significant sex differences in 204 cases. The predominance age group was found in the groups of 21-30 years (63 cases) and 31-40 years (53 cases).Most of patients were workers and farmers with lower level of education. The cause of trauma were mainly body injuries (107 cases) and traffic accident (49 cases). The emergence of mental disorder was observed in post trauma 6 months (152 cases) and 6-12 months (23 cases). Classification of mental disorder indicated 108 cases with organic mental disorder (52.8%), 84 cases with functional mental disorder (41.4%), in which post trauma neurosis 66 cases (32.3%) (including 35 cases with hysteria). Assessment of social function found that there was no social function loss in 77 cases, 41 cases with slight disorder and 86 cases with obvious disorder. Neurological examination found 204 cases with transient neurologic signs and 62 cases with obvious positive signs. Determining the relationship between head trauma and mental disorder found 104 cases with direct causality; 61 cases with indirect causality, 34 cases with conditional correlation and 5 cases with no correlation. Assessing degree of injury found 85 cases with serious injury and 67 cases with minor injury. 47 cases were assessed about the relationship between injury and disease.Conclusion The results suggest that there are significance correlation between head trauma and mental disorder, the best time of forensic assessment is considered within one year after head trauma.