本文選題：顱腦外傷 + 訴訟�。� 參考：《汕頭大學(xué)》2010年碩士論文

【摘要】： 目的 在精神損傷或精神傷殘的民事案件或工傷、交通事故傷殘鑒定的案例中,往往涉及到顱腦損傷的問題,這類案件大多要求對被鑒定人記憶和智力損傷的性質(zhì)及程度進(jìn)行評定。由于案件大多涉及到經(jīng)濟(jì)賠償、或獲得某種社會福利等問題,記憶和智力評估的結(jié)果將直接影響到被鑒定人的切身利益。有相當(dāng)一部分被鑒定人在記憶和智力評估的過程中表現(xiàn)出夸大損傷的程度,其記憶和智力測驗(yàn)結(jié)果往往不能反映他們的真實(shí)水平。本課題通過對顱腦外傷訴訟組、顱腦外傷非訴訟組及神經(jīng)癥組三組的神經(jīng)心理學(xué)研究,驗(yàn)證對顱腦外傷后偽裝記憶缺損詐病的識別能力,從而提高對偽裝記憶缺損的甄別水平,為記憶相關(guān)障礙的司法鑒定和臨床評估提供可靠的理論依據(jù)。 對象和方法 對顱腦外傷訴訟組(汕頭市潮南民生醫(yī)院神經(jīng)外科住院及汕頭大學(xué)司法鑒定中心鑒定的顱腦外傷患者,共入組40例)、顱腦外傷非訴訟組(汕頭市潮南民生醫(yī)院神經(jīng)外科住院患者,共入組40例)、神經(jīng)癥對照組(汕頭市精神衛(wèi)生中心、山東省安康醫(yī)院門診及住院的神經(jīng)癥患者,共入組40例)三組受試者分別進(jìn)行癥狀自評量表(Scl-90)、格拉斯格昏迷量表(GCS)、腦震蕩后綜合癥癥狀問卷(Rivermead問卷)評定及二項(xiàng)必選數(shù)字記憶測驗(yàn)(BFDMT)、智力測驗(yàn)(WAIS)及明尼蘇達(dá)多相人格問卷第二版(MMPI-2)等工具的心理學(xué)測試,并記錄一般情況(如性別、年齡、受教育年限、優(yōu)勢手等),于傷后6個月跟蹤隨訪訴訟組,進(jìn)行RPQ、RHFUQ測試及認(rèn)知、社會功能調(diào)查。 結(jié)果 (1)三組在性別、年齡方面比較無統(tǒng)計學(xué)意義;訴訟組與非訴訟組在受教育年限方面比較無統(tǒng)計學(xué)意義(P0.05);訴訟組在受教育年限方面稍低于神經(jīng)癥組,比較有統(tǒng)計學(xué)意義(P0.05)。 (2)訴訟組與非訴訟組在Scl-90結(jié)果總分、總均分、陽性項(xiàng)目數(shù)、陰性項(xiàng)目數(shù)及陽性癥狀均分方面比較無統(tǒng)計學(xué)意義(P0.05);而各分值的均分則低于神經(jīng)癥組,比較有統(tǒng)計學(xué)意義(P0.01)。 (3)訴訟組Rivermead問卷總分與非訴訟組、神經(jīng)癥組比較均有統(tǒng)計學(xué)意義(P0.01);且總分高于傷后6個月隨訪結(jié)果,比較有統(tǒng)計學(xué)意義(P0.01)。 (4)訴訟組在BFDMT總分、困難條目得分及容易條目得分均值低于非訴訟組和神經(jīng)癥組,比較差異有統(tǒng)計學(xué)意義( P0.05和P0.01)。三組偽裝比例分別為32.5%、5%及12.5%;訴訟組偽裝比例高于非訴訟組及神經(jīng)癥組( P0.05)。 (5)訴訟組與非訴訟組、神經(jīng)癥組智力測驗(yàn)的總智商、言語智商、操作智商均值比較差異均有統(tǒng)計學(xué)意義( P0.05和P0.01);訴訟組智商在正常范圍的有17例與非訴訟組31例、神經(jīng)癥組35例比較有統(tǒng)計學(xué)意義( P0.01);訴訟組智商大部分為邊緣狀態(tài),僅有2例為輕度智力障礙,無中度、重度智力障礙。 (6)MMPI-2測驗(yàn)中,訴訟組的TTRIN量表、TK量表及S量表分值低于非訴訟組,TF量表、TFB量表、TDS量表、TFP量表、O量表的分值低于神經(jīng)癥組,比較均有顯著統(tǒng)計學(xué)意義(P0.05和P0.01));而TDS量表、O量表分值高于非訴訟組,TK量表分高于神經(jīng)癥組,比較均有顯著統(tǒng)計學(xué)意義(P0.05和P0.01)。 (7)MMPI-2測驗(yàn)中,訴訟組的掩飾量表、癔病量表、精神病態(tài)量表及男性/女性化量表的分值均高于常模,比較均有顯著統(tǒng)計學(xué)意義(P0.01);而效度量表、疑病量表、精神衰弱量表、精神分裂癥量表及輕躁狂量表分值則低于常模,比較均有顯著統(tǒng)計學(xué)意義(P0.01)。 (8)MMPI-2測驗(yàn)中,訴訟組的K(掩飾)量表與智力測驗(yàn)的言語因子、記憶因子、言語分、操作分、言語智商、操作智商、總分及總智商呈正相關(guān);而F-K指數(shù)與言語因子、記憶因子、言語分及總智商呈負(fù)相關(guān)。 (9)MMPI-2測驗(yàn)中,訴訟組的TRIN量表與偏因商數(shù)呈正相關(guān),與BFDMT的容易條目得分呈負(fù)相關(guān);而F-K指數(shù)與BFDMT的容易條目得分呈正相關(guān),與偏因商數(shù)呈負(fù)相關(guān)。 (10)MMPI-2測驗(yàn)中,訴訟組的L量表與HS量表、D量表、HY量表、PT量表、SC量表、MA量表;F量表、FB量表、FP量表與HS量表、D量表、HY量表、PD量表、PT量表、SC量表、MA量表;DS量表與HY量表、PD量表、MF量表、PT量表、SC量表、MA量表偏因商數(shù)均呈正相關(guān)。 結(jié)論 (1)BFDMT測驗(yàn)是辨別偽裝的有效心理測查工具,有助于司法精神病鑒定工作中提高對被鑒定者偽裝的識別率,其總分、容易條目及困難條目得分可以作為鑒別偽裝記憶缺損的有效指標(biāo),特別適用于臨床評定有困難的被鑒定患者。 (2)訴訟組在智力測驗(yàn)中表現(xiàn)為明顯的不合作或偽裝記憶缺損,與臨床評定結(jié)果不相符,其數(shù)字廣度分測驗(yàn)及圖形拼湊分測驗(yàn)可以作為鑒別偽裝記憶缺損的參考指標(biāo),在鑒定實(shí)踐中其結(jié)果的采用應(yīng)持謹(jǐn)慎態(tài)度。 (3)隨訪結(jié)果說明顱腦損傷后6個月癥狀才有較好的改善,在司法精神病學(xué)鑒定實(shí)踐中應(yīng)引起重視。 (4)MMPI-2測驗(yàn)中掩飾量表及F-K指數(shù)與總智商有關(guān),也從另一角度說明有偽裝能力的患者其智力損害不會太嚴(yán)重,真正的中度及重度智力障礙患者是不具備偽裝能力的;掩飾量表及F-K指數(shù)可以作為鑒別偽裝記憶缺損的有效指標(biāo)。 (5)BFDMT、智力測驗(yàn)合并MMPI-2測驗(yàn)可以作為鑒別偽裝記憶缺損的有效評定工具。
[Abstract]:objective
In cases of mental injury or mental disability in civil or industrial injuries, and in the cases of disability identification of traffic accidents, the problems of head injury are often involved. Most of these cases require the assessment of the nature and extent of the memory and intellectual impairment of the identified persons. Most of the cases involve economic compensation or social welfare, and so on. The results of memory and intelligence assessment will directly affect the vital interests of the identified people. A considerable portion of the appraisers show a degree of exaggeration in the process of memory and intelligence assessment, and the results of their memory and intelligence tests often fail to reflect their true level. The neuropsychological study of the three groups of the lawsuit group and the neurosis group verified the ability to identify the malingering of the camouflage memory defect after craniocerebral trauma, thus improving the screening level of the camouflage memory defect, and providing a reliable theoretical basis for the judicial identification and clinical evaluation of the memory related disorders.
Objects and methods
40 cases of craniocerebral trauma, which were identified by the Department of neurosurgery in the Department of neurosurgery and the Judicial Expertise Center of Shantou University in Chaonan Minsheng hospital in Shantou City, were included in the non litigation group of craniocerebral trauma (40 cases in the Department of neurosurgery in the Department of neurosurgery in Chaonan people's livelihood hospital in Shantou city), and the neurosis control group (Shantou mental health center, Shandong province) 40 cases of neurotic patients in the outpatient and hospital of Kang Hospital were enrolled in 40 cases. The three groups were treated by the symptom self rating scale (Scl-90), the Glass G Coma Scale (GCS), the post concussion syndrome symptom questionnaire (Rivermead questionnaire) and the two required digital memory tests (BFDMT), the intelligence test (WAIS) and the Minnesota multiphase personality questionnaire second edition. (MMPI-2) a psychological test of tools such as a general case (such as sex, age, years of education, dominant hands, etc.), followed up 6 months after the injury to follow up the follow-up group, RPQ, RHFUQ test and cognition, and social function survey.
Result
(1) the three groups had no statistical significance in gender and age; there was no statistical significance in the number of years of education between the litigation group and the non litigation group (P0.05); the litigation group was slightly lower than the neurosis group in the years of Education (P0.05).
(2) there was no significant difference (P0.05) between the total score of Scl-90 results, the number of positive items, the number of negative items and the equal score of positive symptoms (P0.05), and the scores of the scores were lower than those in the neurosis group, and the difference was statistically significant (P0.01).
(3) the total score of the Rivermead questionnaire in the lawsuit group and the non litigation group were statistically significant (P0.01), and the total score was higher than that of the 6 months after the injury (P0.01).
(4) the total score of BFDMT in the litigation group was lower than that in the non litigious group and the neurosis group. The difference was statistically significant (P0.05 and P0.01). The camouflage ratio in the three groups was 32.5%, 5% and 12.5%, respectively. The camouflage ratio in the litigation group was higher than that of the non litigation group and the neurosis group (P0.05).
(5) the total IQ of the intelligence quotient, verbal IQ and IQ of the neurosis group were statistically significant (P0.05 and P0.01), and there were 17 cases in the normal range of the litigant group and 31 cases in the non litigation group and 35 in the neurosis group (P0.01), and the most of the IQ in the litigant group was marginal. Only 2 cases were mild mental retardation, without moderate or severe mental retardation.
(6) in the MMPI-2 test, the TTRIN scale of the litigation group, the TK scale and the S scale were lower than the non litigation group, the TF scale, the TFB scale, the TDS scale, the TFP scale, and the O scale were lower than those of the neurosis group, and there were significant statistical significance (P0.05 and P0.01), while the TDS scale was higher than that of the non litigation group. Significant statistical significance (P0.05 and P0.01).
(7) in the MMPI-2 test, the score of the litigation group, the hysteria scale, the psycho morbid scale and the male / female scale were all higher than the norm, and the comparison was statistically significant (P0.01), while the validity scale, the scale of hypochondria, the mental decay scale, the schizophrenia scale and the manic maniac scale were lower than the norm, and there were significant statistics. Learning meaning (P0.01).
(8) in the MMPI-2 test, the K (disguise) scale of the litigation group was positively correlated with the speech factor, memory factor, speech score, verbal score, verbal IQ, operation IQ, total score and total IQ, while the F-K index was negatively correlated with speech factor, memory factor, speech score and total intelligence quotient.
(9) in the MMPI-2 test, the TRIN scale of the litigation group was positively correlated with the quotient, and was negatively correlated with the score of BFDMT's easy entry, while the F-K index was positively correlated with the easy entry score of BFDMT, and was negatively related to the quotient.
(10) in the MMPI-2 test, the L scale of the litigation group and the HS scale, the D scale, the HY scale, the PT scale, the SC scale, the MA scale, the F scale, the FB scale, the FP scale, the HS scale, the scale, the scale, the scale, the scale, the scale, the scale, the scale, the scale, the scale, the scale, the scale, and the scale, are all positively related to the quotient.
conclusion
(1) the BFDMT test is an effective psychological testing tool for identifying camouflage. It helps to improve the recognition rate of the disguised person in the forensic psychiatric appraisal. The total score, the easy entry and the difficult items can be used as an effective indicator to identify the false memory defect, especially for the clinically assessed patients who have difficulty.
(2) in the intelligence test, the group showed an obvious non cooperative or disguised memory defect, which was not consistent with the clinical evaluation results. The digital span test and the graphic patchwork test could be used as a reference index to identify the false memory defect, and the result should be taken prudently in the practice.
(3) follow up results showed that symptoms improved after 6 months of craniocerebral injury, and should be emphasized in forensic psychiatry practice.
(4) the cover scale and the F-K index in the MMPI-2 test are related to the total IQ, but also from the other point of view that the patients with camouflage ability are not too serious, and the real moderate and severe mental disorders are not capable of camouflage. The cover scale and the F-K index can be used as an effective indicator of the identification of camouflage memory defects.
(5) BFDMT, intelligence test combined with MMPI-2 test can be used as an effective tool to identify camouflage memory defects.
【學(xué)位授予單位】：汕頭大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：D919.4;R-051

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