日常生活能力和社会功能量表在精神伤残评定应用中的初步研究

发布时间：2018-03-18 11:09

本文选题：法医临床学　切入点：司法精神病学　出处：《昆明医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：[目的]颅脑外伤对人体危害较大,是造成神经系统功能障碍的常见原因,日常生活能力、社会活动能力丧失程度是颅脑外伤后进行精神伤残等级评定的主要依据。本研究初步探讨并细化伤残评定标准中日常生活或社会功能受损的评定标准,既可为司法鉴定中精神伤残等级评定提供依据,也可为精神伤残等级条款制定分级细则提供参考。[方法]①收集昆明医科大学司法鉴定中心和云南省红十字会医院2014-2016年进行精神伤残评定的案例198例,根据被鉴定人入院临床诊断颅脑损伤类型和鉴定时提供的CT片,结合神经系统检查及精神检查,定性被鉴定人颅脑外伤后所致功能障碍的严重程度;②综合运用法医精神病鉴定、日常生活活动能力评估量表:改良Barthel指数评定量表(MBI)和日常生活自理能力评定量表(ATCO),社会功能受损评估量表:社会功能缺陷筛选量表(SDSS)和功能活动调查表(FAQ),评估颅脑损伤患者神经系统功能障碍的严重程度与精神伤残等级之间的关系。[结果]①颅脑损伤所致精神伤残者,精神伤残严重程度与SDSS量表、FAQ量表、MBI量表、ATCO量表评分结果的严重程度、颅脑损伤恢复情况之间均具有统计学意义(P0.05);②单因素logistics回归分析中以社会功能缺陷筛选量表(SDSS)、功能活动调查表(FAQ)评定的社会功能受损和以改良Barthel指数评定量表(MBI)、日常生活自理能力量表(ATCO)评定的日常生活能力受损与精神伤残严重程度具有显著相关性(P0.05);③与精神伤残严重程度具有相关性的自变量进行有序多分类logistics回归分析,得出社会功能缺陷筛选量表(SDSS)评定的社会功能受损和改良Barthel指数评定量表(MBI)评定的日常生活活动能力受损为精神伤残严重程度的危险因素(P0.05);④不同精神伤残程度间SDSS量表、FAQ量表、MBI量表、ATCO量表平均分差异均具有统计学意义(P0.05),并且SDSS量表、FAQ量表、MBI量表、ATCO量表均对精神伤残严重程度具有良好的区分;⑤不同精神伤残等级间量表评定比较得出SDSS量表适合于十级、九级、八级、七级伤残之间的评定,FAQ量表适合于十级、九级、八级、七级伤残等级之间的评定,MBI量表适用于四级、五级、六级、七级、八级伤残等级之间的评定,ATCO量表适用于六级、七级、八级伤残等级之间的评定。[结论]①精神伤残等级评定时,先采用标准化评定量表对精神伤残严重程度进行分度,然后再分级,更有利于精神伤残等级的区分;②SDSS量表、FAQ量表、MBI量表、ATCO量表适用的精神伤残等级的范围不完全相同,存在一定交叉;③建议在进行伤残等级评定时,十级伤残和九级伤残可以采用SDSS量表和FAQ量表进行区分,八级伤残和七级伤残可以综合采用MBI量表、ATCO量表、SDSS量表和FAQ量表进行区分,而六级以上精神伤残不适合采用量表区分。
[Abstract]:[objective] craniocerebral trauma is a common cause of nervous system dysfunction, which is harmful to human body. The degree of loss of social activity is the main basis for the assessment of mental disability after craniocerebral trauma. It can provide the basis for the evaluation of mental disability grade in judicial expertise. It can also provide a reference for the establishment of classification rules for the terms of mental disability grade. [methods] 1 198 cases of mental disability assessment were collected from Kunming Medical University Forensic Identification Center and Yunnan Red Cross Hospital from 2014-2016. According to the type of clinical diagnosis of craniocerebral injury and the CT film provided during the appraisal, combined with the examination of nervous system and mental examination, the degree of dysfunction caused by brain injury in the identified person was determined by the comprehensive use of forensic psychiatric examination. Activity of Daily living (ADL) scale: modified Barthel Index rating scale (Barthel) and ADL Self-Care Assessment scale (ADL), Social function impairment scale (SDSS) and functional activities questionnaire (ADL) were evaluated. The relationship between the severity of nervous system dysfunction and the degree of mental disability in patients with craniocerebral injury. [results] 1Mental disability caused by craniocerebral injury, The severity of mental disability and the severity of the scores of SDSS and SDSS. The recovery of craniocerebral injury was statistically significant. In the single factor logistics regression analysis, the social function impairment was assessed by the Social function impairment screening scale (SDSS) and the modified Barthel Index was used to evaluate the social function. There was a significant correlation between the impairment of daily living ability and the severity of mental disability. The independent variables with correlation with the severity of mental disability were analyzed by logistics regression analysis. It is concluded that the impairment of social function assessed by the Social function screening scale (SDSS) and the impairment of daily living ability assessed by the modified Barthel Index scale are the risk factors for the severity of mental disability. There were significant differences in the average scores of the SDSS scale and the SDSS scale, and the SDSS scale and the MBI scale and the ATCO scale had a good distinction in terms of the severity of mental disability. (5) there was a good distinction between the mental disability rating scale and the different mental disability rating scale (MBI scale), and there was a good distinction between the SDSS scale and the MBI scale for the severity of mental disability. Compared with each other, the SDSS scale is suitable for ten grades. Rating between Grade 9, Grade 8 and Grade 7 the FAQ scale is suitable for rating between grade 10, Grade 9, Grade 8 and Grade 7. The MBI scale is suitable for 4, 5, 6, and 7 levels. The ATCO scale can be used to evaluate the mental disability severity between grade 6, grade 7 and grade 8. [conclusion] 1 the standardized rating scale is used to grade the severity of mental disability. Then the classification is more advantageous to the differentiation of mental disability grade. The range of mental disability grade applied to MBI scale and ATCO scale is not exactly the same as that of MBI scale and ATCO scale. It is suggested that there is a certain degree of crossover in the assessment of disability grade. SDSS scale and FAQ scale can be used to distinguish the 10 and 9 degree disability, MBI scale / MBI scale and FAQ scale can be used to distinguish the 8 and 7 levels of disability, but the mental disability above grade 6 is not suitable to be distinguished by the scale.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：D919.4

【参考文献】