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目的:探讨血清皮质醇(COR)、醛固酮(ALD)水平在暴力违法精神疾病司法鉴定中对伪装精神病(诈病)的诊断与鉴别作用。方法:将男性暴力违法(被控故意杀人和伤害)者作为研究对象,分别比较完全责任能力伪装精神疾病组(简称诈病组)、无精神病无诈病表现完全责任能力组(简称完全组)、精神分裂症限定责任能力组(简称限定组)、精神分裂症无责任能力组作为对照组(简称对照组)血清COR、ALD水平。结果:(1)鉴定前后COR、ALD水平自身对照比较:诈病组COR、ALD水平差异均有极显著性(P<0.001);完全组COR有差异(P<0.05),ALD降低但无统计学意义(P>0.05);限定组COR有差异(P<0.05),ALD差异有显著性(P<0.01);对照组COR、ALD均降低,但无统计学差异(P>0.05)。(2)诈病组血清COR、ALD水平下降率高于其他组,差异均有显著性(P<0.001)。(3)鉴定前诈病组COR、ALD水平与其他组比较差异均有极显著性(P<0.001);完全组与限定组比较COR无差异(P>0.05),ALD有差异(P<0.05);完全组与对照组比较COR无差异(P>0.05),ALD差异有极显著性(P<0.001);限定组与对照组比较COR无差异(P>0.05),ALD差异有显著性(P<0.01)。(4)鉴定后诈病组与完全组比较:COR高于完全组差异有极显著性(P<0.001);ALD高于完全组,但差异无显著性(P>0.05)。诈病组与限定组比较:COR高于限定组差异有显著性(P<0.01);ALD高于限定组差异有极显著性(P<0.001)。诈病组与对照组比较:COR高于对照组,差异有显著性(P<0.05);ALD高于对照组,差异有极显著性(P<0.001)。结论:血清COR、ALD水平在应激层面对伪装精神疾病的诊断与鉴别以及对不同责任能力的判定具有一定的客观参考价值。
Objective: To investigate the role of serum cortisol (COR) and aldosterone (ALD) levels in the diagnosis and identification of camouflage mental illness (maladjustment) in forensic identification of violent mental illnesses. Methods: Violence of the male (charged with intentional homicide and injury) as the research object, respectively, more fully responsible for camouflage mental illness group (referred to as malaria group), no mental illness without malaria performance complete responsibility group (referred to as the complete group) , Schizophrenia defined liability group (referred to as the limited group), schizophrenia nonresponsibility group as the control group (referred to as control group) serum COR, ALD levels. Results: (1) Compared with self-control of COR and ALD levels before and after the appraisal, the levels of COR and ALD in malaria patients were significantly different (P <0.001) (P <0.05). There was significant difference in COR between the limited group (P <0.05) and ALD (P <0.01). The levels of COR and ALD in the control group were all lower than those in the control group (P> 0.05). (2) The COR and ALD levels in malaria patients were significantly lower than those in other groups (P <0.001). (3) The levels of COR and ALD were significantly different from other groups (P <0.001) in the pre-trial marijuana group. There was no difference in COR between the complete group and the limited group (P> 0.05) (P <0.001). There was no significant difference in COR between the limited group and the control group (P> 0.05) and the difference of ALD was significant (P> P <0.01). (4) Compared with the complete group, there was significant difference (P <0.001) in COR higher than the complete group, ALD higher than the complete group, but the difference was not significant (P> 0.05). There was a significant difference between the maladjustment group and the limited group (P <0.01). The ALD was significantly higher than the limited group (P <0.001). Compared with the control group, COR was higher in the malaria-exacerbation group than in the control group (P <0.05). ALD was higher in the control group than in the control group (P <0.001). Conclusion: The levels of serum COR and ALD have certain objective reference value in the diagnosis and identification of camouflage mental diseases and the determination of different responsibilities in the stress level.