法医学杂志

法医学杂志 ›› 2018, Vol. 34 ›› Issue (1): 44-48.DOI: 10.3969/j.issn.1004-5619.2018.01.009

• 论著 • 上一篇    下一篇

日常生活活动量表在轻度精神伤残评定中的应用

刘  露1，2，李豪喆2，陈  琛2，刘  超2，蔡伟雄1，2   

  1. 1. 温州医科大学，浙江 温州 325035； 2. 司法鉴定科学研究院 上海市法医学重点实验室 上海市司法鉴定专业技术服务平台，上海 200063
  • 发布日期:2018-02-25 出版日期:2018-02-28
  • 通讯作者: 蔡伟雄，男，研究员，主任法医师，主要从事司法精神病学研究；E-mali：tsaise@163.com
  • 作者简介:刘露（1991—），女，硕士研究生，主要从事司法精神病学研究；E-mail：lucy_12199@126.com
  • 基金资助:

    “十三五”国家重点研发计划资助项目（2016YFC0800 701）；中央级科研院所基本科研业务费资助项目（GY2018G-7）；国家社会科学基金资助项目（13BFX054）；上海市法医学重点实验室资助项目（17DZ2273200）；上海市司法鉴定专业技术服务平台资助项目（16DZ2290900）

Application of Activities of Daily Living Scale in Mild Psychiatric Impairment Assessment

LIU Lu1,2, LI Hao-zhe2, CHEN Chen2, LIU Chao2, CAI Wei-xiong1,2   

  1. 1. Wenzhou Medical University, Wenzhou 325035, China; 2. Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai 200063, China
  • Online:2018-02-25 Published:2018-02-28

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摘要： 目的 在《人体损伤致残程度分级》标准指引下，探讨日常生活活动（activities of daily living，ADL）量表在轻度精神伤残者等级评定中的适用性。 方法 纳入符合器质性精神障碍且进行精神伤残评定的轻度精神伤残者（七至十级） 124例，正常对照组106例，应用ADL量表、躯体生活自理量表（physical self-maintenance scale，PSMS）、工具性日常生活活动（instrumental activities of daily living，IADL）进行评定，比较正常对照组与研究组各量表得分间的差异、伤残等级与量表得分之间的关系，并依据ROC曲线判定界限值。 结果 正常对照组与研究组的ADL量表、IADL量表、PSMS得分总差异有统计学意义（P＜0.05）。各伤残等级间的ADL量表、IADL量表、PSMS得分差异均具有统计学意义（P＜0.05），且ADL量表、IADL量表、PSMS分值与伤残等级具有相关性。十级、九级、八级、七级伤残对应的ADL量表界限区间分别为14~17分、18~23分、24~29分、30~34分，量表判定伤残等级与鉴定人鉴定意见具有较好的一致性（κ=0.914，P＜0.05）。 结论 ADL量表得分与轻度精神伤残等级具有相关性，ADL量表得分越高，致残程度越重。ADL量表可作为初步判断轻度精神伤残等级的参考指标。

关键词: 司法精神病学, 精神障碍, 脑损伤, 日常生活活动, 精神伤残

Abstract: Objective To explore the application of activities of daily living （ADL） scale in mild psychiatric impairment assessment under the guideline of Classification of Human Body Disability Caused by Injury. Methods A total of 124 subjects with organic mental disorders and mild psychiatric impairments （levels 7 to 10）, and 106 healthy controls were included in. All participants were assessed by the ADL scale, physical self-maintenance scale （PSMS） and instrumental activities of daily living （IADL） scale. The difference between the scores of control group and study group, and the relationship of impairment level and the scores were compared, and the threshold value was determined according to the ROC curve. Results The total scores of ADL, IADL and PSMS were significantly different between the control group and the study group （P<0.05）. The scores of ADL, IADL, PSMS were significantly different among the impairment levels （P<0.05）, which showed a relativity with impairment level. The scores of ADL corresponding to levels 10, 9, 8 and 7 were 14-17, 18-23, 24-29 and 30-34, respectively, which showed a good correlation between the conclusion according to the scale and the expert’s opinion （κ= 0.914, P<0.05）. Conclusion The score of ADL was significantly related to mild psychiatric impairment, and the higher ADL score represents the more severe disability, which can be used as a reference index for preliminarily judging the level of mild psychiatric impairment.

Key words: forensic psychiatry, mental disorders, brain injuries, activities of daily living, psychiatric impairment

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