司法精神病鉴定的人工智能技术应用

司法精神病鉴定实践中的主要问题表现为鉴定意见的信度不足。这一方面源于涉及精神医学、心理学、法学在内的司法精神病学本身属于交叉学科,学科间话语系统融合存在困难;另一方面,司法精神病鉴定的对象本身存在一因多果、多因一果、多因多果方面的复杂性。随着人工智能技术在执法、司法领域的普及应用,以及算法、算力、数据的不断成熟,遵循新型技术嵌入精神病学、心理学而产生新型理论的“一级嵌入”与新型理论嵌入司法精神病鉴定实践“二级嵌入”的“双嵌入”路径,采用“分块开发”“系统整合”“流程整合”三大操作程序,并借鉴人工智能技术中的自然语言处理技术、心理计算技术和智能辅助决策技术资源,能够直接回应并一定程度解决司法精神病鉴定实践中信度不足的问题。这为人工智能辅助鉴定系统的研发,赋能司法精神病鉴定实践提供了可能。     

双镜联合序贯中药治疗肝外胆管结石术后肝郁脾虚型患者40例临床观察

目的 观察腹腔镜、术中胆道镜双镜联合序贯中药治疗肝外胆管结石术后肝郁脾虚型患者的临床疗效,为胆道术后围手术期应用中药提供依据。方法 选取安徽中医药大学第一附属医院普外科2019年1月至2021年12月住院的肝外胆管结石患者40例,将患者随机分为观察组与对照组,每组20例。对照组患者采用双镜联合的术式加常规术后西药治疗;观察组在对照组的基础上,术后加服补中益气汤联合四逆散加减。观察患者的临床疗效,中医证候分级量化积分,胆汁引流量,炎性指标：白细胞计数、中性粒细胞百分比、超敏C-反应蛋白、血清白三烯B4,肝功能及血清胆汁生化指标。结果 治疗后临床疗效方面,对照组和观察组总有效率分别为90.00％和95.00％,差异无统计学意义。中医证候分级量化积分方面,观察组各项积分均明显低于对照组（P＜0.05）。同时相比T管胆汁引流量,观察组患者术后第5 dT管胆汁引流量即开始出现明显减少,相比对照组,引流量改善具有统计学意义（P＜0.05）。炎性指标方面,两组患者各项指标均得到改善,与对照组相比,观察组各项指标改善更明显（P＜0.05）。肝功能及血清胆汁生化指标方面,观察组各指标改显著善优于对照组（P＜0.01）。结论 补中益气汤联合四逆散加减对双镜联合治疗肝外胆管结石肝郁脾虚型患者临床疗效显著,有效地改善临床症状和体征,改善肝功能,减轻术后炎性反应,减少胆汁淤积,临床应用安全有效。     

Mental Health Review Tribunals: A comparison of the content of tribunal reports for discharged and not discharged patients and for the effect of legal classification

Abstract

This study examined the content of reports provided for Mental Health Review Tribunals. A retrospective design was used to compare the tribunal reports of fifty patients. Two groups of twenty five patients were compared, one including patients discharged by tribunals and the other patients not discharged. Social combination theory and valence theory were used to analyse the content of the reports and to assess whether they were associated with tribunal outcome. Opinion statements discussing suitability for discharge were more closely associated with outcome than fact statements. For the statements presenting subjects positively or negatively, fact statements were more closely associated with outcome. The valence of both types of statements was also found to be related to outcome, with more positive values being achieved for discharged subjects. Comparison of reports written for previous tribunals before any of the subjects in the study were discharged indicated that those subjects who went on to be discharged at their next tribunal had the least negative valences. In addition to this, the effect of legal classification on outcome was explored, and indicated a difference in the valence of reports for discharged and not discharged patients, depending on classification of mental illness or psychopathic disorder.     

精神障碍医学鉴定制度设计及相关问题探究

《精神卫生法》对于精神病人合法权益的保障、社会安全防卫作用的实现具有重要意义,其不仅能为精神病患者和监护人提供非自愿住院治疗的救济渠道,在一定程度上避免“被精神病”现象的发生,同时能够保障社会公共秩序和社会公众人身安全.在对精神障碍医学鉴定的制度设计及作用进行分析的基础之上,正确辨析精神障碍医学鉴定的实施主体以及管理模式、并对精神障碍医学鉴定的实施主体、要求、委托主体等有关内容进行阐述,以期为精神障碍医学鉴定制度的良性运行提供保障.     

Mental discipline,punishment and recidivism: reading Foucault against de-radicalisation programmes in the War on Terror

This article uses Michel Foucault’s Discipline and Punish to examine how de-radicalisation programmes in the War on Terror transform power–knowledge relations, mental discipline and punishment by attempting to instil self-governance through non-violence. Foucault’s theories on the evolution of discipline and punishment can be applied to de-radicalisation programmes, but only after considerable revision. By asking questions on the nature of knowledge, practice, state involvement and recidivism of de-radicalisation, I contend that many programmes may be ultimately limited by a disproportionate focus on religious rehabilitation rather than political dialogue regarding the motivations for such violence.     

Substance use disorders in forensic psychiatric patients

There is a lack of detailed information on the role of substance use disorders (SUD) as a substantial factor in offences and treatment in forensic psychiatric patients. The aim of this study was to get a better understanding of these specifics. Clinical records of 193 male patients admitted to a Dutch forensic psychiatric hospital were scrutinized on anamnestic, diagnostic and risk assessment data. One of the central findings was that the prevalence of SUDs was high. Patients with an SUD had a more extensive criminal history, unstable and deviant lifestyle and higher risk of violent behavior than patients without a substance use disorder. No differences were found in duration of treatment, aggressive incidents and leave. Another important finding was that a distinction could be made between patients with substance use as a primary criminogenic risk factor and patients with substance use as a secondary risk factor. Although substance use is identified as a general risk factor, this study supports the idea of sub categorization of patients with an SUD and emphasizes the need for a different treatment approach. Further study is needed to identify specific treatment approaches, based on more differentiated profiles of these patients.     

精神障碍患者非自愿收治程序设计的若干法律问题研究(上)刘瑞爽

对于精神障碍患者的非自愿收治,应注意保障患者的人身权利,尤其是合理程序保障的权利。比较分析国际上的各国立法,在收治程序各个环节上,均须体现出对人权的保护,其主要问题有：制定强制收治的标准、送治主体、收治主体、初步裁定的步骤和时限、对初步裁定的救济、法律代表人制度、司法审查的介入（或独立第三方的介入）、危险的证明、避免无限期拘留而进行的后续定期审查、患者方获取信息的权利保障、上诉等。我国应坚持程序正义原则,借鉴国际上先进立法经验,弥补我国精神障碍患者非自愿收治程序设计的立法漏洞。     

病危/重病人的医疗安全管理及卫生监督机制探讨

医患矛盾逐步激化,医患关系趋于紧张,缓解医患关系是摆在医疗管理者面前刻不容缓的任务。研究发现,重点环节重点管理可以降低医疗安全风险。本文从病危/重病人重点管理的角度来探讨促进医疗安全管理的有效方法,并以期推广至所有病人,同时也进一步讨论了在病危/重病人重点管理中要注意的问题。     

Increased risk of fatal intoxication and polypharmacy among psychiatric patients at death

Patients suffering from psychiatric disorders have an excess mortality and a shorter life span expectancy compared to the general population. Furthermore, they are treated with multiple drugs and are known to have an increased risk of drug abuse. In this study, we aimed at investigating the pharmaceutical drug and drug of abuse profiles of the deceased included in the Danish prospective autopsy‐based forensic study on psychiatric patients, SURVIVE. Using the postmortem systematic toxicological analysis results, we identified 129 different consumed compounds in our population (n = 443). Polypharmacy (≥5 compounds) was detected in 39.5% of the deceased. Deceased with a psychiatric diagnosis or who died from a fatal intoxication had significantly more compounds at the time of their death compared to having either no psychiatric diagnosis or another cause of death, respectively. Evidence of drug abuse was present, as 29.8% of our total population had consumed either methadone or illicit drugs of abuse, excluding tetrahydrocannabinol. Of those deceased with a psychiatric diagnosis, 33.6% had either consumed methadone or illicit drugs of abuse, a greater number than those without a psychiatric diagnosis. Fatal intoxication was the most frequent cause of death (40.6%) with methadone as the major intoxicant. Here, we found that those without a psychiatric diagnosis had fewer fatal pharmaceutical drug intoxications compared to the psychiatric diagnosis groups. Our findings add further context to understanding the excess mortality of psychiatric patents, since there is an increased occurrence of fatal intoxication, polypharmacy, and drug abuse in this population.     

论患者权利类型

患者权利类型的确定是构建患者权利保护体系的理论基础，应分为两大类：患者作为“人”在医疗领域所享有的个体权利和作为“公共卫生体系使用人”的集体权利。前者是患者在接受医疗服务过程中基本人权的实现，包括人格尊严权、不受歧视的权利、私生活和秘密被尊重的权利、生命健康权、获得有质量的医疗服务的权利等。后者则包括患者群体通过自己的社团——患者组织——在卫生法规决策过程中的介入权、在卫生机构中的代表权、在卫生监督部门中的参与权等等，与国家公权力机关共同实现卫生领域的民主，以构建和谐的医患关系及促进医疗水平提高。在现有立法、司法及理论对患者个人权利已逐步承认并加强保障的情况下，认识患者集体权利的实现具有更强的理论意义及实践价值。