534例脑外伤所致精神障碍的司法精神病鉴定分析

目的分析脑外伤所致精神障碍的类型及鉴定的合理时间,探讨脑损伤程度及鉴定时间与智能损害程度的关系。方法对534例脑外伤患者的司法精神病鉴定资料进行回顾性分析。结果脑外伤所致精神障碍的类型中,器质性情感障碍最多(51.1%),其次为器质性神经症样综合征(24.0%)、器质性智能损害(18.0%)。伤残程度鉴定为Ⅷ级和Ⅸ级伤残最多,分别为219例(41.0%)和177例(33.1%)。智能损害组的脑损害程度、中国修订版韦氏成人智力量表(WAIS-RC)评定智力缺损程度明显高于非智能损害组(P0.05)。伤残等级和脑损伤分级、WAIS-RC评定结果、鉴定时的脑CT变化以及脑电地形图(brain electrical activity mapping,BEAM)异常分级具有相关性(P0.05),而智能损害程度与鉴定时间及脑损伤分级均无相关性(P0.05)。结论影响智能损害的因素很复杂,伤残程度鉴定时脑CT、BEAM、WAIS-RC等客观检查也是重要的参考指标。

Forensic Psychiatric Cases of 534 Mental Disorders Caused by Traumatic Brain Injury

Objective To analyze the types of mental disorders caused by traumatic brain injury and the optimal time for forensic psychiatric appraisal. To explore the relationship between the degree of trau- matic brain injury, the time of appraisal and the grade of intellectual deficiency. Methods Five hundred and thirty-four forensic psychiatric cases of mental disorders caused by traumatic brain injury were retro- spectively analyzed. Results In the types of mental disorders caused by traumatic brain injury, the most cases were diagnosed as organic mood disorders （51.1%）, following organic neurosis-like syndrome （24.0%） and organic intellectual deficiency （18.0%）. For the disability grades, the most cases were the level ~ and IX disability grades, 219 cases （41.0%） and 177 cases （33.1%）, respectively. The degree of brain injury and the degree of intelligence defection according to WAIS-RC were higher in intellectual deficiency group compared with non-intellectual deficiency group （P〈0.05）. The grade of disability correlated with the degree of brain injury, the result of WAIS-RC, the result of cerebral CT scanning, and the grade of brain electrical activity mapping （BEAM） abnormality （P〈0.05）. Nevertheless, the degree of intellectual deficiency did not correlate with appraisal time and the degree of brain injury （P〉0.05）. Conclusion The fac- tors influencing intellectual deficiency are complex. The findings of objective examination including cere- bral CT scanning, BEAM, WAIS-RC and others should be considered as important indexes for disability evaluation.