农村特殊家庭留守儿童自我意识及家庭环境状况

目的 了解农村特殊家庭留守儿童自我意识和家庭环境状况及其关系.方法 采用Piers-Harris儿童自我意识量表(CSCS)、家庭环境量表(FES-CV)对用分层随机抽样方法抽取的南充市阆中金城中心小学校四到六年级的203名在校学生的自我意识水平和家庭环境状况进行调查.结果 ①特殊家庭留守儿童(A组)49人,一般家庭留守儿童(B组)79人,非留守儿童(C组)75人;②A组儿童的行为、合群、幸福满足感因子得分均低于非留守儿童(P＜0.05);③方差分析显示,除焦虑因子分外,六年级特殊家庭留守儿童自我意识总分、身体、幸福因子分均高于四、五年级(P＜0.05);A组儿童的亲密度、情感表达、独立性、娱乐性、文化性、道德宗教因子分均低于C组,而矛盾因子分高于B、C两组(P＜0.01);④相关分析显示,家庭环境亲密度、情感表达、文化性、娱乐性、道德宗教和组织性6个因子分与CSCS总分、行为、智力、躯体、焦虑、合群和幸福因子分呈正相关(r=0.11～0.40,P＜0.05),矛盾性因子分与CSCS所有因子得分呈负相关(r=-0.31～-0.18,P＜0.05),家庭环境独立性和控制性因子分与CSCS中的智力因子分呈正相关(r=0.09～0.11,P＜0.05).结论 特殊家庭留守儿童的心理健康状况及家庭环境状况均较差,家庭环境状况可能是其心理健康水平的重要影响因素之一.     

温州留守小学生自我意识与家庭环境状况调查

目的了解温州地区留守小学生的心理特点以及存在的问题。方法对温州地区二所小学共160例小学生的心理状况进行评定,其中留守小学生91例,非留守小学生69例。评定工具采用儿童自我意识量表(CSCS)和家庭环境量表(FES-CV)。结果留守儿童与非留守儿童相比,CSCS焦虑因子分较高(P<0.01)、合群因子分较低(P<0.05)。FES-CV控制性、矛盾性、娱乐性和成功性因子分均明显高于对照组(P<0.05),情感表达因子相对低于对照组(P=0.07)。结论留守儿童的心理状况不容乐观,他们更倾向焦虑、不合群、情感交流相对困难,可能潜在较多的愤怒与内心冲突。     

改善父母教养方式对破坏性行为障碍儿童自我意识的影响

目的探讨父母教养方式对破坏性行为障碍儿童自我意识的影响,为通过改善父母教养方式来提高患儿的自我意识提供依据。方法选取苏州市广济医院门诊和住院的68例符合《美国精神障碍与统计手册(第4版)》(DSM-Ⅳ)的破坏性行为障碍儿童68例,采用随机数字表法分为研究组(药物治疗+父母教养方式培训)32人和对照组(药物治疗+常规诊疗交谈)36人,采用研究组与对照组比较的前瞻性干预研究设计,在干预前和一年后对两组儿童进行儿童自我意识量表(CSCS)测评。结果两组CSCS各分量表得分及总分均较一年前升高(P0.05或0.01),研究组一年后的行为、焦虑、合群及总评分均高于对照组(P0.05或0.01);进一步比较显示,研究组焦虑得分差值和总分差值均高于对照组(P0.05)。结论改善父母教养方式可能提高破坏性行为障碍儿童的自我意识,对破坏性行为障碍儿童的预后具有积极作用。     

不同亚型注意缺陷多动障碍男童自我意识和行为问题特征研究

目的探讨注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)男性患儿中注意缺陷型(predominantly inattentive type,PI)、多动/冲动型(predominantly hyperactive/impulsive type,HI)和混合型(combined type,CT)自我意识和行为问题的特征,以及两者关系。方法对68例8~11岁ADHD儿童(PI 31例,HI 12例,CT 25例)和70名正常儿童采用Piers-Harris儿童自我意识量表(the Piers-Harris children’s self-concept scale,PHCSS)、Achenbach儿童行为量表(Achenbach child behavior checklist,CBCL)进行评估。结果 PHCSS中,三亚型组总分和因子分均低于对照组(P0.01),PI组ADHD患儿自我意识总分高于HI组和CT组(P0.05),PI组躯体与外貌属性因子分和幸福与满足因子分高于HI组和CT组(P0.05),智力与学校情况因子分HI组低于PI组和CT组(P0.05)。CBCL中,三亚型ADHD患儿与对照组的总分及抑郁性、多动、攻击性、违纪因子分的差异均有统计学意义(P0.01),交往不良因子分HI组高于PI组(P0.01),社交退缩因子分HI组高于PI组(P0.01)。ADHD患儿自我意识总分与CBCL总分(r=-0.64)、抑郁(r=-0.47)、交往不良(r=-0.50)、社交退缩(r=-0.12)、多动(r=-0.66)、攻击性(r=-0.41)均呈负相关(P0.05)。结论不同亚型ADHD患儿行为问题均较正常儿童多,与其自我意识水平偏低关系密切。多动冲动型和混合型较注意缺陷型自我意识水平低,行为问题更突出。     

厌学儿童自我意识及行为问题研究

目的厌学儿童自我意识及行为问题状况,为有针对性的干预提供参考。方法收集门诊8~14岁厌学儿童86例为研究对象,同一时间段按同年龄、性别及受教育程度匹配的原则随机抽取佛山市某中小学的在校学生86例为对照组。采用自制一般情况调查表、Piers-Harris儿童自我意识量表(CSCS)、Conner's儿童行为父母问卷对两组进行测评。结果研究组0~3岁主要带养人为父母所占比例、父母文化水平均低于对照组(P0.05或0.01),父母婚姻状况中紧张、离异及其他高于对照组(P0.05)。CSCS中研究组在行为、智力与学校情况、躯体外貌与属性、焦虑、幸福与满足5个因子评分均低于对照组(P0.01)。Connor's量表中品行问题、学习问题、躯体问题、焦虑、冲动、多动指数因子评分高于对照组(P0.05)。结论厌学儿童家庭情况不良、自我意识水平较低,存在较多的不良行为问题。     

儿童青少年焦虑与抑郁障碍共病的临床研究

目的了解焦虑和抑郁障碍患儿中焦虑与抑郁共病的发生率和行为特点。方法在门诊收集符合中国精神障碍分类与诊断标准第3版中焦虑障碍和抑郁障碍诊断标准的5～17岁儿童青少年,其中单纯焦虑障碍41例(焦虑组),单纯抑郁障碍31例(抑郁组),焦虑与抑郁共病31例(共病组)。由父母、儿童、医师分别采用自编一般资料表、Achenbach儿童行为量表(CBCL)、儿童焦虑性情绪障碍筛查表(SCARED)、儿童抑郁障碍自评量表和儿童大体评定量表,评定三组儿童。结果(1)焦虑障碍患儿有16%(8例)合并抑郁;抑郁障碍患儿有42%(23例)合并焦虑。(2)CBCL焦虑组的活动情况及社会能力总分[(15.74±3.65)分]优于共病组[(12.98±4.00)分]和抑郁组[(14.02±3.67)分],均P<0.01和<0.05;共病组行为问题总分[(61.74±28.96)分]高于焦虑组[(43.44±22.54)分]和抑郁组[(47.74±25.99)分;F=4.62,P<0.05]。(3)SCARED共病组的总分高于焦虑组和抑郁组(P<0.05)。(4)儿童抑郁障碍自评量表抑郁组和共病组总分高于焦虑组(P<0.01)。(5)儿童大体评定量表焦虑组[(67.71±9.54)分]优于抑郁组[(58.55±8.08)分]和共病组[(61.16±7.60)分;F=11.10,P<0.001]。结论儿童焦虑、抑郁共病现象常见,共病患儿比单纯焦虑或抑郁患儿的内化性问题、外化性问题更严重,社会功能损害更明显。     

南充市某农村地区特殊家庭留守儿童心理健康状况

目的探讨农村特殊家庭留守儿童心理健康状况。方法于2011年3月~2012年10月采用分层随机抽样方法抽取南充市阆中金城乡中心小学校四到六年级的在校学生203名,分为特殊家庭留守儿童(A组)、一般家庭留守儿童(B组)和普通家庭儿童(C组),采用儿童孤独量表(CLS)、儿童自我意识量表(CSCS)和艾森克个性调查问卷(EPQ)对其人格特征、孤独感、自我意识进行测量。结果①方差分析显示,三组儿童的个性、孤独感与自我意识得分差异有统计学意义(P<0.05)。多重比较显示,A组的内外向因子分、行为及合群性因子分低于B、C两组,而情绪不稳因子分、孤独感总评分高于B、C两组,差异有统计学意义(P<0.05);②特殊家庭留守儿童中男性自我意识高于女性,女性焦虑因子分高于男性,行为因子分低于男性(P<0.05);③年龄<10岁的特殊家庭留守儿童其合群、幸福、内外向因子分低于年龄>10岁者,而孤独总分和神经质因子分高于年龄>10岁者(P<0.05)。结论特殊家庭留守儿童心理健康水平低于一般家庭留守儿童和非留守儿童,其中女性更倾向于情绪问题,男性更倾向于行为问题,年龄越小行为与情绪问题越多。     

对立违抗性障碍儿童的自我意识及家庭环境因素分析

目的探讨对立违抗性障碍(ODD)儿童的有关影响因素。方法对34例ODD患儿和34名正常对照组儿童采用Piers-Harris儿童自我意识量表(CSCS)及家庭环境量表中文版(FES-CV)进行评估。结果ODD儿童CSCS中的行为分量表得分低于对照组儿童,差异有显著性(t=2.274,P<0.05);ODD儿童FES-CV中的矛盾性分量表得分高于对照组儿童,差异有高度显著性(t=2.725,P<0.01)。结论自我意识程度低以及家庭环境中高的矛盾性,可能是儿童发生ODD的危险因素。提示改善家庭环境,采用科学的养育方式可能有利于预防和减少儿童ODD的发生。     

综合干预对农村精神分裂症患者家庭环境的影响

目的 探讨生物-心理-社会综合干预措施对农村精神分裂症患者家庭环境、情感表达的影响。方法 将符合入组条件的300例患者分为干预组和对照组,每组各150例。两组均服用小剂量抗精神病药(折合氯丙嗪剂量为<300 mg/d),共3年;同时对干预组实施生物-心理-社会综合干预。于入组时和随访时(每半年评定1次,共7次)对患者评定家庭环境量表、坎伯威家庭问卷和家庭会谈量表。结果(1)入组时,两组患者家庭环境及家庭负担的差异均无显著性;干预组家属热情性和赞扬性因子分高于对照组(P<0.05)。(2)研究结束时,干预组患者的情感表达和矛盾因子分低于对照组(P<0.01),亲密度、独立性、成功性、文化性、娱乐性、组织性和道德性等因子分均高于对照组(均P<0.01-0.05),对其家庭娱乐影响、对家人的躯体健康、心理健康影响及家庭负担总分均低于对照组(P<0.01)。干预组家属的批评、敌对和情感参与等因子分低于对照组(P<0.05～0.01),热情性、赞扬性等因子分高于对照组(P<0.01)。结论 生物-心理-社会综合干预方法对农村精神分裂症患者能有效地改善家庭环境、降低照料者的情感表达,并减低患者的疾病严重程度。     

父母养育方式与儿童自我意识关系的研究

目的　探讨父母养育方式与儿童自我意识之间的相关性。方法　选用Piers Harris儿童自我意识量表(中文版 )和父母养育方式评价量表 (中文版 )对 10 0名儿童进行测查 ,将儿童自我意识量表评分分为低自我意识组( 5 1)、正常范围组及高自我意识组 ( 6 3)进行比较 ,并对父母养育方式与儿童自我意识总分及各因子进行相关分析。结果　低自我意识组的父母情感温暖因子分明显低于另外两组 (P <0 0 5或P <0 0 1) ;父母惩罚严厉因子和拒绝否认因子分明显高于另外两组 (P <0 0 5或P <0 0 1)。父母情感温暖和理解因子、母亲偏爱被试因子与儿童自我意识总分和部分因子均呈显著相关 (P <0 0 5或P <0 0 1) ;父母惩罚严厉因子、拒绝否认因子与自我意识总分和部分因子呈显著负相关 (P <0 0 5或P <0 0 1)。结论　父母养育方式与儿童自我意识水平显著相关     

Nogle erfaringer fra et moderne psykiatrisk plejehjem

Abstract

Background: Disruptive behavioral disorders (DBD) and attention-deficit hyperactivity disorder (ADHD) are both characterized by certain patterns of misbehavior among adolescents. Aims: The aim of this study was to examine how the comorbidity of DBD and ADHD affects in misbehavior among adolescents. Methods: A total of 158 adolescents aged 16–18 years, from a subsample of the Northern Finland Birth Cohort 1986 (NFBC 1986), were interviewed with the Finnish translation of the semi-structured Schedule for Affective Disorders and Schizophrenia for School-Age Children—Present and Lifetime (K-SADS-PL) in order to obtain DBD, including conduct disorder (CD) and oppositional defiant disorder (ODD), and ADHD diagnoses. The structure of the CD symptoms, obtained from the K-SADS-PL, was compared with the previously formed model about the development of the problematic behavior. The severity of the CD symptoms was compared with adolescents diagnosed with only DBD, only ADHD and with both DBD and ADHD. Also, the associations with other psychiatric disorders diagnosed at age 16 were evaluated. Results: The boys in the study sample were diagnosed with ADHD or with comorbid DBD and ADHD more often than girls. The severity of CD symptoms was statistically significantly associated with the comorbid DBD and ADHD group. The adolescents diagnosed with comorbid DBD and ADHD had an increased risk for anxiety disorders, depressive disorders and substance abuse disorders. Conclusions: The comorbidity of DBD and ADHD seems to indicate the severity of CD symptoms. Clinical implications: The comorbidity between DBD and ADHD should be considered in clinical practice because it could indicate more serious problematic behavior than pure disorders alone.     

Hyperactivity and comorbidity in Japanese children with attention-deficit/hyperactivity disorder

No previous study about comorbidity of attention-deficit/hyperactivity disorder (ADHD) in Japan have carried out both a comprehensive investigation using a structured interview and a comparison between ADHD subtypes. The aim of the present study was to clarify the relationship between hyperactivity and disruptive behavior disorder (DBD) in ADHD by comparing a hyperactivity group (HG) with a non-hyperactivity group (non-HG). After diagnosis was carried out by strict exclusion, the 41 ADHD subjects (6-14 years old; IQ, 70-121) diagnosed according to DSM-IV were divided into HG (n = 24) and non-HG (n = 17), and compared for comorbidities and psychopathologies. This was done via semistructured interview with children and parents and questionnaires to parents and teachers. The results demonstrate that (i) most ADHD children had comorbidity (e.g. DBD or anxiety disorder); (ii) the HG had a significantly higher rate of DBD than the non-HG, but the total number of anxiety disorders was not different between subgroups, and (iii) the HG generally had more serious psychopathologies both at home and at school than the non-HG. Both groups had more serious externalizing and internalizing problems at home than at school. The present study provides evidence of a strong relationship between hyperactivity and DBD.     

Comorbidity of attention deficit hyperactivity disorder in juvenile bipolar disorder

OBJECTIVE: There is some evidence to suggest that attention deficit hyperactivity disorder (ADHD) and juvenile bipolar disorder could be related. This is based on studies of comorbidity and some preliminary family study data. However, doubts continue to be raised about the relationship between the two disorders. This study examined the comorbidity of disruptive behavior disorders (DBD) that include ADHD, oppositional defiant disorder (ODD) and conduct disorder (CD) in juvenile bipolar disorder. METHOD: Seventy-three subjects with onset of bipolar disorder at age 18 years or younger were evaluated using structured interviews (Missouri Assessment of Genetics Interview for Children, Structured Clinical Interview for DSM-IV Axis I disorders--Clinician Version, and Operational Criteria Checklist for Psychotic Disorders version 3.4). Information was collected from subjects as well as from their parents. Patients with comorbid DBD were compared with patients without DBD. RESULTS: Ten subjects (14%) had one or more comorbid DBD. ADHD, CD, and ODD were present in three (4%), two (3%), and eight (11%) subjects, respectively. Those with DBD had earlier onset of bipolar disorder and spent more time ill compared to those without DBD. CONCLUSIONS: The rates of comorbid DBD in juvenile bipolar disorder are low. The study does not support a definite relationship between ADHD and juvenile bipolar disorder. Higher rates reported previously may be due to differing methods of subject ascertainment. Samples recruited from community and general psychiatric settings may help to clarify the relationship between bipolar disorder and ADHD.     

Facial EMG responses to dynamic emotional facial expressions in boys with disruptive behavior disorders

Based on the assumption that facial mimicry is a key factor in emotional empathy, and clinical observations that children with disruptive behavior disorders (DBD) are weak empathizers, the present study explored whether DBD boys are less facially responsive to facial expressions of emotions than normal controls. Facial electromyographic (EMG) activity in the zygomaticus major and corrugator supercilii muscle regions, and heart rate activity were studied in 22 clinically referred 8-12-year-old DBD boys and 22 age-matched normal controls during exposure to dynamic happy and angry expressions. Dispositional emotional empathy was assessed by a self-report questionnaire for children. The happy and angry facial expressions evoked distinct facial EMG response patterns, with increased zygomaticus muscle activity to happy expressions and increased corrugator muscle activity to angry expressions. The corrugator (but not the zygomaticus) muscle response pattern was less pronounced for DBD boys than the normal controls. Attending to the emotional expressions was associated with equivalent cardiac deceleration in both groups, reflecting a similar orienting/attention response. Lower empathy scores were obtained for DBD boys than for normal controls. In conclusion, facial mimicry responses to angry facial expressions were subnormal in DBD boys, which may be a sign of a deficient early component in the process of emotional empathy, and thus play a role in impaired empathic responding.     

抑郁症和糖尿病共病患者的瘦素水平

目的:探讨抑郁症和糖尿病共病患者血清瘦素水平的特点。方法:采用放射免疫方法测定抑郁症和糖尿病共病患者(共病组:n=30)和单纯抑郁症患者(单纯抑郁症组:n=30)给予抗抑郁药治疗前后的血清瘦素水平,并与正常人(正常对照组:n=30)的血清瘦素水平进行比较。结果:治疗前共病组血清瘦素水平与单纯抑郁症组差异有统计学意义(t=3.42,P<0.01);与正常对照组差异无统计学意义(t=0.35,P>0.05);治疗后共病组与单纯抑郁症组血清瘦素水平均较治疗前显著下降(t分别=2.455,7.002;P<0.05或P<0.001);共病组与正常对照组差异有统计学意义(t=-4.18,P<0.001)。结论:抑郁症和糖尿病共病可能存在瘦素分泌不足,抗抑郁药可降低血清瘦素水平。     

White matter abnormalities associated with disruptive behavior disorder in adolescents with and without attention-deficit/hyperactivity disorder

Disruptive behavior disorders (DBD) are among the most commonly diagnosed mental disorders in children and adolescents. Some important characteristics of DBD vary based on the presence or absence of comorbid attention-deficit/hyperactivity disorder (ADHD), which may affect the understanding of and treatment decision-making related to the disorders. Thus, identifying neurobiological characteristics of DBD with comorbid ADHD (DBD+ADHD) can provide a basis to establish a better understanding of the condition. This study aimed to assess abnormal white matter microstructural alterations in DBD+ADHD as compared to DBD alone and healthy controls using diffusion tensor imaging (DTI). Thirty-three DBD (19 with comorbid ADHD) and 46 age-matched healthy adolescents were studied using DTI. Fractional anisotropy (FA), and mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AD) were analyzed using tract-based spatial statistics (TBSS). Significantly lower FA and higher MD, RD and AD in many white matter fibers were found in adolescents with DBD+ADHD compared to controls. Moreover, lower FA and higher RD were also found in the DBD+ADHD versus the DBD alone group. Alterations of white matter integrity found in DBD patients were primarily associated with ADHD, suggesting that ADHD comorbidity in DBD is reflected in greater abnormality of microstructural connections.     

Comorbidity of internalizing disorders in children with oppositional defiant disorder

Oppositional defiant disorder (ODD) is often comorbid with other psychiatric disorders in childhood. Its association with attention deficit hyperactivity disorder and conduct disorder has been well studied. Recent studies suggest that children with ODD have substantial comorbidity with anxiety and depressive (internalizing) disorders, as well. Identifying the pattern of internalizing comorbidity with ODD in childhood and adolescence and how this varies across age and gender may help to identify mechanisms of such comorbidity. This systematic review presents evidence on the association of internalizing disorders with ODD across childhood and adolescence. Data from cross-sectional and longitudinal studies in clinic, community and epidemiologic samples are considered separately. Findings suggest that while internalizing comorbidity with ODD is present at all ages, the degree of comorbidity may vary over time in particular groups of children. Girls and boys appear to have different patterns of ODD comorbidity with either anxiety or depression, as well as ages of onset of ODD, however more large studies are required. Children with ODD in early life require further study as they may be a subgroup at increased risk for anxiety and affective disorders. This could have important implications for the treatment of these ODD children and the prevention of sequential comorbidity.     

Differences in cortisol response affect the distinction of observed reactive and proactive aggression in children with aggressive behaviour disorders

Summary. Various researchers distinguished two categories of aggressive behaviour, namely reactive and proactive aggression. Reactive aggression is an aggressive response to a perceived threat or provocation, whereas proactive aggression is behaviour that anticipates a reward. In the present study, including both a sample of disruptive behaviour disordered (DBD) and normal control (NC) children, we observed reactive and proactive aggressive behaviour during an experimental dyadic play session. DBD children showed more observed reactive and proactive aggression. Subsequently, we investigated whether the observed measures correlated with parent-rated measures of reactive and proactive aggression in. We distinguished in both NC and DBD children a subgroup showing a rise in cortisol level, i.e. responders, and a subgroup who did not show a rise in cortisol, i.e. non-responders. Results suggest that differences in the cortisol response affects the correspondence between observed and parent-rated reactive and proactive aggression since only DBD non-responders showed the expected correlations. Correspondence: Maaike Kempes, Department of Child and Adolescent Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Heidelberglaan 100, 3508GA, PB 85500, Hpnr.B01.324, Utrecht, The Netherlands     

Comorbid Depressive Disorders in ADHD: The Role of ADHD Severity,Subtypes and Familial Psychiatric Disorders

Objective

To evaluate the presence of Major Depressive Disorder (MDD) and Dysthymic Disorder (DD) in a sample of Italian children with Attention Deficit Hyperactivity Disorder (ADHD) and to explore specific features of comorbid depressive disorders in ADHD.

Methods

Three hundred and sixty-six consecutive, drug-naïve Caucasian Italian outpatients with ADHD were recruited and comorbid disorders were evaluated using DSM-IV-TR criteria. To evaluate ADHD severity, parents of all children filled out the ADHD Rating Scale. Thirty-seven children with comorbid MDD or DD were compared with 118 children with comorbid conduct disorder and 122 without comorbidity for age, sex, IQ level, family psychiatric history, and ADHD subtypes and severity.

Results

42 of the ADHD children displayed comorbid depressive disorders: 16 exhibited MDD, 21 DD, and 5 both MDD and DD. The frequency of hyperactive-impulsive subtypes was significantly lower in ADHD children with depressive disorders, than in those without any comorbidity. ADHD children with depressive disorders showed a higher number of familial psychiatric disorders and higher score in the Inattentive scale of the ADHD Rating Scale, than children without any comorbidity. No differences were found for age, sex and IQ level between the three groups.

Conclusion

Consistent with previous studies in other countries, depressive disorders affect a significant proportion of ADHD children in Italy. Patient assessment and subsequent treatment should take into consideration the possible presence of this comorbidity, which could specifically increase the severity of ADHD attention problems.