关于精神疾病诊断学的一点体会

关于精神疾病诊断学的一点体会赵传绎解放后一段时间内，全面学习苏联，精神疾病分类学及诊断学比较简要，形成诊断思维以诊断为主，鉴别诊断考虑不足，直观、片面。１９８０年后，联合国卫生组织及美国精神病协会先后在北京、苏州等举办的研讨会中，系统介绍了ＩＣＤ及Ｄ...     

关于精神分裂症诊断标准的探讨

关于精神分裂症诊断标准的探讨郭汲源ＣＣＭＤ—２—Ｒ关于精神分裂症的诊断标准做出了进一步的完善，并向国际靠拢。但是可以说仍是沿袭过去的模式，使用中仍存在某些实质性的问题。结合使用２年来的体会，在此谈谈本人的粗浅认识，供同道参考，望能起到抛砖引玉的作用。...     

颅脑肿瘤的MRI诊断

自20世纪80年代初磁共振成像(MRI)应用于临床以来,在全身各系统疾病的诊断中,以它良好的软组织分辨能力,直观的解剖定位能力以及所特有的血管流空特性和脂肪抑制特性,使影像学诊断的阳性率和准确性大大的提高,特别是在中枢神经系统肿瘤性疾病的影像学诊断中,MRI更因为它良好的诊断价值和富于发展的潜力,而成为首选的诊断手段。近几年来,MRI的成像技术又有新的发展,人们利用这些新技术对脑肿瘤的诊断进行初步的探讨。在此我们想结合我们多年的临床实践就脑肿瘤的MRI诊断问题作概要性的阐述。     

西方诊断标准应用于中国患者的一点体会

西方诊断标准应用于中国患者的一点体会李诚，宇红近年来与国内精神病学界交流日益增多，几乎每个国内同行都询问过这样的问题：“你们香港精神病学界使用什么分类诊断标准？”过去几年香港医生主要使用美国精神疾病诊断与统计手册ＤＳＭ－Ⅲ－Ｒ但最近英国皇家医学会规定...     

怎样给诊断作出诊断？—介绍ROC分析

现代的精神科医生往往都在应用一些公认的诊断标准作为临床诊断或鉴别诊断的依据或参考,例如我国的 CCMD-2,美国的DSM-(?)-R,或 WHO 的 ICD-10等等。在这些诊断标准的条文里,往往有:“答合以下项目之二”或“之三”……,才算符合这一标准,才能诊断。这个“之二”或“之三”是怎么得来的     

痴呆的诊断与鉴别诊断

<正> 痴呆的定义 痴呆(Dementia)是由于脑功能障碍而产生的获得性智能障碍综合症,从临床角度可将痴呆下定义为:因脑功能障碍致获得性,持续性智能损害,并在记忆、认知(概括、计算、判断等)、语言、视空间功能和人格中,至少三项受损。此定义以床边检查的障碍结果为基础。获得性是为区别先天精神发育迟滞,持续性是为排除常见的急性脑外伤、代谢障碍和中毒疾病引起的意识错乱状态。     

三种诊断标准对癔症住院患者的再诊断

三种诊断标准对癔症住院患者的再诊断郑成畴郭华梅温达民作者回顾１９９２～１９９５年期间临床按传统诊断为“癔症”的住院患者５２例。其中男８例，女４４例；年龄１６～５７岁，平均３３．５±１０．４岁；发病１～４次，平均１．６±０．８次；总病程１２天～２６年，...     

128例癫痫病因诊断分析

<正> 临床资料 一、一般资料 本组128例中,男80例,女48例,男女之比为1.7:1;年龄6个月～67岁,其中12岁以下32例(25％),12～20岁30例(23.4％),20～60岁58例(45.3％),60岁以上8例(6.3％);病程6个月～25年;临床发作类型;全身性发作89例,部分性发作33例,混合性发作6例。     

强迫症的诊断研究进展

本文对于强迫症的诊断、鉴别诊断和共病研究的新进展进行了综述，并进一步比较了国内外三个诊断标准对强迫症的诊断不同之处。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of legislation of 1935 of interest to the department of Mental Hygiene

Psychiatric Quarterly -