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。     

Mental Disorder, Violence, and Gender

Recent studies have reported comparable rates of violence among men and women with mental disorder, raising important issues for clinical risk assessment. This study examines the relationship between gender and violence using data from the MacArthur Violence Risk Assessment Study. Patients in acute psychiatric wards were interviewed 5 times over the year following their discharge to the community. Results showed some differences between men and women in the violence committed immediately following discharge, with rates for men being higher. But the prevalence of violence over the 1 year was similar for female and male discharged patients. However, there were substantial gender differences in the situational context of the violence committed. Men were more likely to have been drinking or using street drugs, and less likely to have been adhering to prescribed psychotropic medication, prior to committing violence. The violence committed by men was more likely to result in serious injury than the violence committed by women, and men were more likely than women to be arrested after committing a violent act. Women were more likely to target family members and to be violent in the home.     

Work Impairment and Disability in Posttraumatic Stress Disorder: A Review and Recommendations for Psychological Injury Research and Practice

Work impairment and disability are common consequences of posttraumatic stress disorder (PTSD), as reflected by significant rates of sickness absence, failure to return to work, and reduced work performance. Within the psychological injury field, the issue of work impairment and disability in PTSD often arises in workers’ compensation and disability insurance claims and in personal injury litigation. In this context, clinical and forensic practitioners are faced with challenges in rendering expert opinions on diagnosis, causality, prognosis, and recommendations for treatment and rehabilitation. To promote understanding of this important, yet understudied area, there are three aims of this paper: first, to review the current literature on work impairment and disability associated with PTSD; second, to draw on this literature to present a biopsychosocial framework of work impairment and disability in PTSD; and third, to offer suggestions for improving the assessment and management of PTSD-related work impairment and disability.     

Disentangling the Disability Quagmire in Psychological Injury and Law

This paper aims to critically analyze the evolution of six models of conceptualization, determination, and prediction of occupational disability relevant in the medico-legal context of psychological injury. The six models are the (a) biomedical, (b) forensic, (c) psychosocial, (d) ecological, (e) economic, and (f) biopsychosocial. We will discuss the key commonalities and differences among the models, including disciplinary tradition, research paradigm, recognition of person–environment interaction, key tenets, and implications for practice and research in psychological injury. The paper will highlight and discuss psychosocial issues, often underemphasized in forensic psychological practice, including: (a) balanced assessment of primary, secondary, and tertiary gains and losses, (b) self-perception, (c) disability identity, (d) beliefs and expectations, (e) coping, (f) adaptation and positive growth, (g) social stigma and social reactions to disability, including disability harassment, and (h) recognition of system-based environmental influences and demands. We will provide a special focus on the current state of the science and practice of prediction of disability, of particular interest to researchers and clinicians involved in clinical and occupational prognostication in psychological injuries. Finally, we will draw conclusions and recommendations for future research and best practices in the psychological injury area using a cross-diagnostic, dynamic, functionally based, and integrated biopsychosocial and forensic model of disability.     

Biopsychosocial Considerations in Unnecessary Work Disability

The current definition and management of medical conditions causing impairment and unnecessary disability in workers’ compensation (WC) systems are suboptimal. Fundamental problems include the failure to recognize and address the unique biopsychosocial diathesis of each individual; the powerful influence of human psychology in the genesis, perpetuation, and refractoriness to treatment of many conditions, including medically unexplained symptoms and chronic pain; the work relevance of even non-work-related conditions; the considerable effects of administrative and clinical iatrogenicity; and the plethora of complex factors potentially affecting the course of conditions treated in WC systems. Once claims are established in WC, administrative and medical management of both identifiable pathologic conditions and unexplained symptoms are fragmented, not based on available scientific evidence, and adherent to a biomedical care approach which is not appropriate for a significant number of cases. These obstacles prevent effective understanding and management of many WC cases and may contribute to eventual recovery failure and unnecessary work disability (UWD). This article explores biopsychosocial factors in WC claimants and elements that may contribute to or ameliorate progression to UWD. The author offers a heuristic diathesis stress model of work-related disability as a framework for general and specific interventions to improve system performance and outcomes for all stakeholders.     

Using the International Classification of Functioning, Disability and Health (ICF) to Conceptualize Disability and Functioning in Psychological Injury and Law

The International Classification of Functioning, Disability, and Health (ICF) is the World Health Organization’s classification of human functioning and disability. The ICF is addressed as an important development in healthcare and of specific importance for informing assessment in forensic psychology. The utility of the conceptual framework of the ICF to inform case conceptualization in psychological injury and law is explored. Future prospects for the ICF in psychological healthcare are reviewed, including the need for more research on the intersection of the ICF and the psychological–legal context.     

Genetic Testing and the Future of Disability Insurance: Ethics, Law & Policy

Predictive genetic testing poses fundamental questions for disability insurance, a crucial resource funding basic needs when disability prevents income from work. This article, from an NIH-funded project, presents the first indepth analysis of the challenging issues: Should disability insurers be permitted to consider genetics and exclude predicted disability? May disabilities with a recognized genetic basis be excluded from coverage as pre-existing conditions? How can we assure that private insurers writing individual and group policies, employers, and public insurers deal competently and appropriately with genetic testing?     

Damages for Mental Distress and Bad Faith in Disability Claims

This article examines recent changes in the law in Canada in relation to the court’s willingness to acknowledge the significance of, and award compensation for, intangible loss arising from breach of contract. When a claim for benefits is wrongly refused in a disability contract, a primary goal of the contract, which is to provide peace of mind, is unrealized. Where this causes mental distress, Canadian courts are now willing to award compensation. Similarly, if an insurer conducts itself in such a manner as to attract a punitive damages award, a consideration in assessing the quantum of the award is the vulnerability of the insured. The evidentiary basis for these claims will often include expert psychological opinion. Various considerations for determining the existence, nature, and scope of the psychological issues relevant to a claim for damages for mental distress and/or punitive damages are covered in this article.     

脑外伤所致精神障碍伤残鉴定时机

目的研究脑外伤所致精神障碍伤残相对合理准确的最佳鉴定时机。方法对93例交通事故脑外伤所致精神障碍患者进行伤残鉴定及随访调查,在伤后不同时间段（3、6、9、12月）分别收集患者颅脑影像学、脑电图及详细病史资料,并对患者家属进行调查和对患者进行精神检查及智力量表（Wechsler Intellegence Scale for Adult,WAIS）、社会功能缺陷筛选量表（Social Disability Screening Schedule,SDSS）和日常生活能力量表（Activity of Daily Living Scale,ADL）测验,据此进行诊断及评残。结果ADL、SDSS对不同等级伤残及不同时间段区分良好,整体样本显示患者ADL、SDSS平均值9月与12月无差别。轻度伤残ADL、SDSS平均值6、9、12月无差别,中度伤残ADL、SDSS平均值9月与12月无差别,重度伤残ADL平均值6、9、12月无差别。结论脑外伤所致精神障碍伤残鉴定轻度伤残以伤后6个月评定为宜,中度伤残以伤后9个月评定为宜,重度伤残统计结论显示评残时机为伤后6个月,但综合分析认为重度伤残以伤后9个月评定为宜。     

警察情绪障碍的调适与身心健康

情绪状态是衡量心理健康的重要指标。受警察职业特殊性的影响,警察情绪障碍的患病率比较高,这给警察的身心健康和公安工作带来隐患,因此,掌握调控异常情绪的方法技巧,缓解或消除情绪障碍,对警察来说尤其重要,是警察心理保健的重要内容。     

A Psychosocial Risk-Targeted Intervention to Reduce Work Disability: Development, Evolution, and Implementation Challenges

Research has been consistent in showing that certain psychosocial variables can increase the risk for prolonged work disability. Four psychosocial variables have emerged as robust predictors of disability across a wide range of debilitating health and mental health conditions. These include catastrophic thinking, symptom exacerbation fears, disability beliefs, and perceived injustice. The Progressive Goal Attainment Program (PGAP) is a psychosocial risk-targeted intervention that was developed to reduce psychosocial barriers to work resumption in individuals with debilitating health or mental health conditions. This paper describes the conception, developmental process, and the evolution of the PGAP. Research studies are summarized that have played a significant role in the developmental trajectory of the PGAP. Some of the legal and legislation-relevant challenges that were faced in the development and implementation the PGAP are discussed.     

精神障碍者刑事责任能力判定研究

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