对比研究视野下的中国卫生立法迫切性

本文以中美两国卫生立法对比研究为切人点探讨中国卫生立法的迫切性，在医疗控费、患者保护、医疗保险市场、医生监管等几个方面介绍了美国立法体系，从执行力、立法理念、前瞻性等环节上进行了对比分析，从差异上找出可改进之处。     

精神病人的凶杀行为研究(附116例分析)

目的　探讨凶杀行为的特征及相关因素。　方法　采用回顾性研究方法 ,对 116例凶杀案例资料进行统计分析。　结果　凶杀行为与患者的性别、年龄、社会经济状况、疾病诊断、精神症状等因素关系密切 ,案发前多有先兆。　结论　加强精神卫生知识的宣传教育和精神卫生立法是预防精神病人肇事、肇祸的有效途径。     

论强制医疗启动程序决定主体

强制医疗制度是国家医疗保健制度的有机组成部分,强制医疗有广义与狭义之分。狭义的强制医疗,如实施危害行为的精神病患者、甲类传染病患者等;广义的强制医疗,包括预防接种、指定医保单位就医等。强制医疗程序启动的决定主体必须是国家赋予相应权力的机关,其他任何单位不具有这样的权力,因而无权决定强制医疗程序启动。强制医疗主体的确定取决于强制医疗对象的危害程度、广度及时间等因素。     

强制医疗程序的实施与反思

＂强制医疗程序＂的＂社会防卫功能＂,不仅受到限制刑事责任能力精神病人和接受过治疗精神病人社会危害性的抑制,还会因＂被精神病＂现象而打折扣。破解此困境需从三方面入手：一是参照《精神卫生法》,将涉嫌犯罪的限制刑事责任能力精神病人,纳入＂非自愿性住院治疗＂范围;二是增加精神病治疗资源投入,强化＂强制医疗＂适用与解除的风险防范意识;三是堵塞《精神卫生法》中＂非自愿性住院治疗＂的漏洞,防止其成为＂被精神病＂新生代的寄生区。     

Characteristics and offences of women with borderline personality disorder in forensic psychiatry: a multicentre study

Although female forensic patients diagnosed with borderline personality disorder (BPD) are generally considered taxing in clinical practice, little is known about their specific characteristics or offences. In this study, 156 female forensic psychiatric patients diagnosed with BPD were compared to 113 diagnosed otherwise. Information on demographic and psychiatric characteristics, victimization, index offences, and incidents during treatment was gathered from patient files. Risk factors for recidivism were assessed using the PCL-R and historical items of the HCR-20, including items from the new Female Additional Manual (FAM). Compared to non-BPD women, BPD women were more likely to have been abused as children and to have a history of outpatient treatment. While less likely to be convicted for (attempted) homicide, a higher percentage of BPD women was convicted for arson. Comorbid substance abuse was more frequent in the BPD group and incidents towards others and themselves were more violent in nature. The PCL-R and the H-scale of the HCR-20/FAM indicated several risk factors especially important for BPD women, such as poor behavioural control, impulsivity, and irresponsibility. The results support the clinical impression that women diagnosed with BPD are a subgroup within the female forensic psychiatric population, with specific focus points for treatment and management.     

日本社会对华心态析论

中日关系被认为是中国与20多个邻国中最重要的双边关系之一.尽管中日关系大体上是好的,但是两国之间仍然存在着许多不容忽视的矛盾.为此,本文从中日双方角度对两者之间矛盾的表现及其原因进行分析,进而分析日本失衡的民族心态与当前日本消极民族主义的郁结.在此基础上,作者认为在当前的国际形势下,在如何处理中日矛盾问题上,除了事关两国政治基础的历史问题和台湾问题之外,对于双方之间不断涌现的具体摩擦,我们应该继续坚持"韬光养晦"的原则,一切服从于国家"全面实现小康社会"发展战略的大局.     

Building from the ground up: exploring forensic mental health staff’s relationships with patients

Recovery-orientated care is becoming generally accepted as the best practice, and continued development in the ways it is practiced is necessary to ensure improvement of ongoing care. Forensic patients often experience double stigmatization (the dual stigma of mental illness and offending behaviour) and during admission to hospital may lose touch with their community supports. While working through their personal recovery, patients develop therapeutic relationships with their multidisciplinary team members. When positive, these relationships can enhance a patient’s recovery. Clinical staff members participated in 88 in-depth interviews, which were transcribed, reviewed, and analysed using thematic analysis. From analysing the data, main themes and subthemes emerged related to staff’s perceptions of therapeutic relationships. When developing relationships, staff need to overcome receptiveness issues by increasing trust through understanding their preconceptions, reducing stigma, sharing innocuous stories, and giving patients the time they need. The key pillar underpinning all traits ascribed to patients and staff is collaboration and approaching treatment protocols with a social approach is essential to enhancing recovery. Staff shared a holistic view of recovery that incorporated the benefits of positive relationships and the need to create a sense of home within the institution.     

Constructing patient–psychiatrist relations in psychiatric hospitals: the role of space and personal action

This essay investigates the role of space and personal action in the construction of patient–psychiatrist relations at psychiatric hospitals. In order to explore such a theme, the writings of R.D. Laing prove to be salutary. This is namely accredited to Laing's tenet that the staff and patients of a psychiatric hospital are institutionalised by both physical structures and personal action. A central approach taken in this essay is to explore Laing's theory through an inter-textual reading of Michel Foucault's Madness and Civilization (1967) and Erving Goffman's Asylums (1961).     

重点精神病人管控问题及其对策

近年来,全国各地陆续发生多起精神病人肇事肇祸事件,严重威胁到了人民群众生命财产安全和社会治安秩序,精神病人一时间成为人们恐惧的对象。当前我国对重点精神病人的管控工作仍然薄弱,管控机制、管控措施等依然存在诸多问题。总结重点精神病人肇事肇祸的特点,分析当前重点精神病人管控工作存在的问题,以公安机关在该项工作中的角色定位为出发点,借鉴国外先进的管理经验,从而提出完善法律制度保障、建立多部门联动机制、动态核查机制及加强民警培训等方面的可行性建议。     

Is the genie out of the bottle? Digital platforms and the future of clinical trials

Is it possible to conduct impartial clinical trials in a world full of digital networking tools that patients can use to coordinate themselves and act against research protocols? This paper builds on an ethnography of PatientsLikeMe, a company running an internet social media network where patients with different conditions share their clinical data with standardized questionnaires. The company faced a serious dilemma in 2011 when some ALS patients, members of the site, started sharing data about a phase II clinical trial of an experimental drug (NP001) in which some of them were participating, to anticipate the experiment’s outcomes and understand each one’s allocation over trial arms. In parallel, some other patients were using the site and other web tools to coordinate and run their own replication of the trial with homebrew mixes of industrial grade chemicals. PatientsLikeMe researchers reflected on their position as networks managers and eventually decided to use the collected data to develop their own analysis of the efficacy of the original compound, and of the homebrewers’ compound. They presented the NP001 events as a case in point for articulating a new social contract for clinical research. This paper analyses these events, first, by understanding the clinical trial as an experiment organization form that can succeed only as long as its protocol can be enforced; second, we observe how web networks make it dramatically easier for the trial protocol to be violated; finally, we point out how a potentially dangerous confluence of interests over web networks could incubate developments that disrupt the status quo without creating a robust and safe alternative for experimentation. We conclude by warning about the interests of the pharmaceutical industry in exploiting patients’ methodological requests to its own advantage.