法医学杂志

法医学杂志

• 论著 •    

精神伤残等级鉴定意见不一致的原因分析

朱陈淮玉1(), 王婕妤1, 刘迎1, 王碧玉2, 黄志军2, 于洋1, 曾燕妮1,3,4(), 时燕薇1,2,3,4()   

  1. 1.中山大学中山医学院法医学系，广东 广州 510080
    2.中山大学法医鉴定中心，广东 广州 510080
    3.广东省法医学转化医学工程技术研究中心，广东 广州 510080
    4.广东省脑功能与脑疾病重点实验室，广东 广州 510080
  • 收稿日期:2024-10-21
  • 通讯作者: 曾燕妮,时燕薇
  • 作者简介:朱陈淮玉（2000—），女，硕士研究生，主要从事法医精神病学研究；E-mail：zhuchhy@mail2.sysu.edu.cn
  • 基金资助:
    国家自然科学基金资助项目(81772032);科技创新2030资助项目(2021ZD0202000)

Analysis of the Reasons for the Inconsistent Opinions on the Mental Disability Assessments

Chen-huai-yu ZHU1(), Jie-yu WANG1, Ying LIU1, Bi-yu WANG2, Zhi-jun HUANG2, Yang YU1, Yan-ni ZENG1,3,4(), Yan-wei SHI1,2,3,4()   

  1. 1.Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
    2.Forensic Medicine Center, Sun Yat-sen University, Guangzhou 510080, China
    3.Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Guangzhou 510080, China
    4.Guangdong Province Key Laboratory of Brain Function and Disease, Guangzhou 510080, China
  • Received:2024-10-21
  • Contact: Yan-ni ZENG, Yan-wei SHI

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摘要：

目的 分析脑外伤所致精神伤残等级鉴定意见不一致的原因。 方法 回顾性分析中山大学法医鉴定中心2018—2019年50例脑外伤所致精神伤残重新鉴定的案例，收集被鉴定人的一般人口学信息、脑损伤情况、初次鉴定与重新鉴定意见等信息。采用描述性统计、Spearman相关性分析、独立样本t检验、二元logistic回归与多元logistic回归分析两次鉴定精神障碍诊断与伤残等级的差异，分析鉴定意见不一致的原因。采用R 4.3.1软件绘制分析结果。 结果 两次鉴定意见不一致率为70.0%（包括仅精神障碍诊断不一致、仅精神伤残等级不一致和两者均不一致）。在初次鉴定报告中有64.0%的案件缺少近3个月的头颅影像学检查资料，并显著影响两次鉴定的等级级差。鉴定时对答反应、记忆、智能、情感活动、意志行为活动、自知力与脑外伤后遗留的脑软化灶部位具有相关性。两次鉴定在部分精神症状受损程度和日常生活有关的活动能力的评定上有明显的差异。 结论 两次鉴定意见不一致的原因可能是：（1）依据的脑影像学信息不同（包括是否有近3个月脑影像学信息、遗留脑软化灶的部位）；（2）鉴定人对精神障碍受损程度的把握不同；（3）鉴定人对生活能力受损程度的鉴别不同。

关键词: 法医精神病学, 脑损伤, 精神伤残, 重新鉴定, 影像学检查, 日常生活能力评定

Abstract:

Objective To analyze the factors contributing to inconsistent opinions on assessments of mental disability degrees caused by traumatic brain injury （TBI）. Methods A retrospective analysis was conducted on 50 cases of re-assessment of mental disability caused by TBI at Sun Yat-sen University Forensic Medicine Center from 2018 to 2019.General demographic information of the assessed individuals, TBI conditions, and initial and re-assessment opinions were collected. Descriptive statistics, Spearman’s correlation test, unpaired t test, binary logistic regression and multinomial logistic regression were used to analyze the differences in mental disorder diagnosis and disability degrees between initial and re-assessment. The reasons for inconsistent opinions were analyzed. The analysis results were plotted using R 4.3.1. Results The inconsistency rate for two mental disability assessment opinions was 70.0% （including only mental diagnosis were inconsistent, only disability degrees were inconsistent and both inconsistent）. In the initial assessment reports, 64% of the cases lacked brain imaging data of the past three months, which significantly affected the degree difference between these two assessments. The differences of the location of cerebral malacia foci were significantly correlated with the responses during assessment, memory, intelligence, emotional activities, willpower and self-awareness. There were significant differences between the two assessments in the degree of impairment to some mental symptoms and the ability of activities related to daily life. Conclusion The reasons for the inconsistent opinions on the two assessments may be: （1） depending on different brain imaging information （including whether there is brain imaging information in the recent three months, and the location of cerebral malacia foci）; （2） examiners have different understandings of the degree of damage caused by mental disorders; （3） examiner’s identification of the degree of impairment in living ability varies.

Key words: forensic psychiatry, cerebral injury, mental disability, reappraisal, imageological examination, evaluation of activities of daily living

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