Islam Shofiq, Hooi Helena, Hoffman Gary R
Department of General Surgery, Birmingham Heartlands Hospital, Bordesley Green, Birmingham, UK.
J Oral Maxillofac Surg. 2009 Sep;67(9):1889-94. doi: 10.1016/j.joms.2009.04.044.
To document the presence and demographics of an adult patient cohort who were identified as having a pre-existing psychiatric condition while being treated for a facial injury.
A retrospective medical chart audit was conducted on 300 consecutive patients electing public treatment and subsequently admitted to a tertiary referral teaching hospital with a facial injury over a 21-month period from April 2006 to January 2008. Patients who were recruited into the study were identified as having features suggestive of psychological disturbance sufficient to confirm a pretraumatic psychiatric diagnosis as formally established by psychiatry trained staff.
Of the 300 patients initially included in the study, 16 were subsequently identified as having a psychiatric diagnosis. Most cases attracted dual diagnosis according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria for Axis I and II disorders. The most common were substance abuse/dependence (n = 10), followed by mood disorder (n = 6) and schizophrenia (n = 4). Four patients had a co-occurring personality disorder. No significant correlation between sociodemographic and clinical characteristics and psychological outcomes was identified in this study. Those at risk of psychological deterioration were referred to liaison psychiatry for formal intervention.
This preliminary study indicates that a small but significant number of patients (5%, n = 16) presented with a demonstrated pretraumatic psychiatric comorbidity. As such, they have some requirement for psychiatric input into their peri- and postoperative care. The broad spectrum of psychiatric disorders that we identified in this study highlights the need for vigilance by surgeons and other health care providers when dealing with facially injured patients and that, where appropriate, early referral to liaison psychiatry for management advice is desirable.
记录一组成年患者的情况及人口统计学特征，这些患者在接受面部损伤治疗时被确定存在既往精神疾病。
对2006年4月至2008年1月这21个月期间连续300例选择接受公共治疗并随后因面部损伤入住三级转诊教学医院的患者进行回顾性病历审查。纳入该研究的患者被确定具有提示心理障碍的特征，足以确诊由接受过精神病学培训的工作人员正式确立的创伤前精神疾病诊断。
在最初纳入研究的300例患者中，16例随后被确诊患有精神疾病。根据《精神疾病诊断与统计手册（第四版，修订版）》中轴I和轴II障碍的标准，大多数病例为双重诊断。最常见的是物质滥用/依赖（n = 10），其次是情绪障碍（n = 6）和精神分裂症（n = 4）。4例患者同时患有人格障碍。本研究未发现社会人口统计学和临床特征与心理结果之间存在显著相关性。有心理恶化风险的患者被转介至联络精神科进行正式干预。
这项初步研究表明，一小部分但数量可观的患者（5%，n = 16）存在已证实的创伤前精神疾病合并症。因此，他们在围手术期和术后护理中需要一些精神科方面的投入。我们在本研究中确定的广泛精神疾病谱凸显了外科医生和其他医疗服务提供者在处理面部受伤患者时保持警惕的必要性，并且在适当情况下，尽早转介至联络精神科以获取管理建议是可取的。
