Study On The Correlation Between The Site Of Craniocerebral Injury And The Impairment Of Social Function After Injury And The Grade Of Mental Disability

Background and Purpose With the development of industrialization,urbanization and transportation,accidents of craniocerebral injury frequently occur due to accidents,such as traffic accidents,falling and violence.Patients with craniocerebral injury often have cognitive,emotional and behavioral problems,which seriously affect the daily life and social function of the injured.Therefore,the identification cases of the level of mental disorders caused by craniocerebral injury are increasing.Since such cases involve economic compensation,the amount of compensation varies greatly between different levels of mental disability,and the objective and correct assessment of the mental disability level of the identified person can reflect the fairness of the law and protect the interests of the victim.Therefore,the correct assessment of the mental disability of the identified person has become an important subject in the practice of forensic psychiatry appraisal.The purpose of this study is to explore the relationship between different regions of craniocerebral injury and the objective indicators of activities of daily living and social function and the level of mental disability in patients with craniocerebral injury,To provide more objective theoretical and practical basis for improving the accuracy of appraisal of mental disability grade opinion.Methods A total of 201 cases of mental disability grade identification from 2009 to 2020 in the Forensic Expertise Center of Shantou University were collected and analyzed.According to the identification grade group,the different mental disability grade cases were compared,i.e.the demographic characteristics and injury characteristics;The craniocerebral injury sites were counted based on the clinical imaging CT or MRI results of the identified persons,and the relationship between the sum of the number of injury sites and the level of disability was discussed.Using the Social Disability Screening Schedule(SDSS),Daily activity and social functioning scales,such as the Modified Barthel Index(MBI),the Adult Intellectual Disability Rating Scale(IDRS),etc.To evaluate the degree of impairment of daily living ability and social function after injury,to explore the correlation between the degree of impairment of daily living ability and social function and the level of mental disability,and to evaluate the boundary value between the scale scores in the level of mental disability,in order to find out the mathematical relationship between the two.Result1.Among the 201 cases of mental disability rating,161 cases were male(80.1%)and 40 cases were female(19.9%);The average age was(43.02±16.86)years old.Unmarried 55 cases(27.2%),married or divorced 146 cases(72.3%);Occupation: 74(57.4%)cases were workers,14(10.9%)cases were farmers,15(11.6%)cases were students and intellectuals,19(14.7%)cases were self-employed,4(3.1%)cases were freelancers,3(2.3%)cases were retired.Causes of injury: car accident 187(93.0%),fall 5(2.5%),violence 7(3.5%),other 2(1.0%);The differences of gender(χ~2=2.751,P > 0.05),age(χ~2= 8.945,P > 0.05),marriage(χ~2= 2.904,P > 0.05),occupation(χ~2=7.458,P > 0.05),Time interval between craniocerebral injury and disability grade assessment(χ~2=2.430,P > 0.05),the mode of craniocerebral injury(χ~2= 7.264,P > 0.05)and the degree of craniocerebral injury(χ~2=6.343,P > 0.05)had no statistical significance.2.In this study,132 patients with mild mental disability,accounting for 65.7%;51 cases of moderate mental disability,accounting for 25.4%;18 cases of severe mental disability(9.0%).Among the patients with craniocerebral injury,the top three were organic personality change(190 cases,94.5%),organic amnesia(140 cases,69.7%),and organic mental impairment(111 cases,55.2%).The 4th to 10 th places were neurologic-like syndrome,psychotic symptom group,affective disorder,aphasia,depressive state,disorder of consciousness,and post-traumatic stress disorder.3.According to the imaging diagnosis results of patients with craniocerebral injury,the craniocerebral injury areas were divided into 39 areas,including subarachnoid space,left and right frontotemporal pariocerebral epidural space,and left and right frontotemporal pariocerebral epidural space,The age was divided into three groups: 16-44 years old(young group),45-60 years old(middle age group)and ≥61 years old(old group).The craniocerebral injury site and mental disability grade were compared according to age group.There was significant difference between craniocerebral injury site and mental disability grade in middle age group(χ~2=0.025,P <0.05),however,there was no obvious difference between the a man youth group(χ~2=4.683,P>0.05)and the old age group(χ~2= 4.614,P> 0.05).4.The results showed that the Adult Mental Disability Rating Scale(IDRS)was suitable for the assessment between Grade 1 and Grade 7 disability.The modified Barthel Index Rating Scale(MBI)has a good distinction between severe mental disability(level-3)and moderate mental disability(except level-4 and level-5).The average score of SDSS had no significant difference to disability grade.According to the ROC curve,the boundary range of IDRS score was obtained:0～9 was classified as mild mental disability,10～14 as moderate mental disability,and 15～20 as severe mental disability.The cutoff interval was defined according to the MBI score: 0 to 45 for severe mental disability,46 to 85 for moderate mental disability,and 85 to 100 for mild mental disability.Boundary ranges were defined according to SDSS scores: 0 to 14 for mild mental disability,15 to 18 for moderate mental disability,and 19 to 20 for severe mental disability.conclusion1.There was no correlation between gender,age,marriage,occupation,time interval of craniocerebral injury and disability grade,craniocerebral injury mode,craniocerebral injury degree and disability grade.2.There is no correlation between gender,age,marriage,occupation,time interval of craniocerebral injury,mode of craniocerebral injury,degree of craniocerebral injury and disability grade of the identified person.3.Among mental disorders caused by craniocerebral injury,organic personality change was the most important,followed by organic amnesia,and organic intelligence disorder was the third.In the grade of mental disability caused by craniocerebral injury,mild mental disability(grade 7-10)was the most common.4.The relationship between the site of craniocerebral injury and the level of mental disability showed that there was a significant correlation between the site of craniocerebral injury and the level of mental disability in the 45-60 age group.、5.The scores of Adult Mental Disability Rating Scale(IDRS)and modified Barthel Index Rating Scale(MBI)have a certain mathematical relationship with the rating of mental disability.IDRS can best reflect the relationship between social function,daily living ability and the rating of mental disability,and can be used as a reliable tool to identify the rating of mental disability in practice.