精神损伤的伤害因素参与度评定量表的临床特征分析

摘要

目的：编制“精神损伤的伤害因素参与度评定量表”，并分析量表的临床特征及其与鉴定专家等级评定结果的关系。方法：在全国13家司法精神病鉴定机构用该量表进行测评精神损伤因果关系鉴定案例402例，并由鉴定人对这些案件做出“无作用、轻微作用、小部分作用、部分作用、大部分作用、完全作用”6级评定。结果：鉴定专家作出的无作用、轻微作用、小部分作用、部分作用、大部分作用及完全作用在该量表上的划界分值分别为0~10、11~25、26~40、41~60、61~89及90~100。66.9%（81/121）器质性精神障碍的伤害因素参与度值落在90~100（完全作用）范围；51.3%（20/39）精神分裂症与妄想性障碍及40.9%（9/22）心境障碍的参与度值落在0~10（无作用）范围；59.5%（22/37）神经症性障碍和64.4%（38/59）分离转换性障碍的参与度值落在11~25（轻微作用）及26~40（次要作用）范围；94%（17/18）急性应激反应和72.9%（43/59）创伤后应激障碍的参与度值落在90~100（完全作用）及61~89（主要作用）范围。精神损伤的伤害因素参与度量表的等级划分与鉴定专家做出的因果关系等级评定的总体符合率为91.0%。结论：精神损伤的伤害因素参与度评定量表能较好的反映精神损伤的临床特点及鉴定专家意向的因果关系。%Objective:To develop a scale of hurting factors participation for mental impairment( SHFP-MI),and to analyze the clinical features of SHFP-MI and its relationship with the experts assessment for grading of causality identified as mental injury. Method:Four hundred and two cases involving mental injury causa-tion identification were collected from 13 forensic psychiatric institutes in China. Each case was identified by fo-rensic psychiatrists as one of six levels( no,minor,mild,moderate,most,full role)according to hurting factor contribution and assessed by SHFP-MI at the same time. Results:SHFP-MI scores of no,minor,mild,moder-ate,most and full role group were 0-10,11-25,26-40,41-60,61-89 and 90-100,respectively. The hurting factors participation(HFP)of 66. 9%(81/121)of organic mental disorders fell from 89 to 100(full role). HFP of 51. 3%(20/39)of schizophrenia and delusional disorders and 40. 9%(9/22)mood disorders were arranged in the level of 0-10(no role). HFP of 59. 5%(22/37)of neurotic disorders and 64. 4%(38/59)of separation conversion disorder fell in 11-25(minor role)and 26~40(mild role). HFP of 94%(17/18)of acute stress re-sponse and 72. 9%(43/59)of post-traumatic stress disorder fells in 90 ~100( full role)and 61 ~89( most role). The total coincidence rate was 91. 0% between the demarcation scores of SHFP-MI and the grade identifi-cation of forensic psychiatrists(χ2 =8. 512,p=0. 073 ). Conclusion:SHFP-MI can better reflect the the causal relationship between clinical features of mental illness( mental impairment)and the intent of the ex-perts.