老年抑郁症患者预后的影响因素

目的：探讨老年抑郁症患者预后的影响因素。方法：以标准化评定工具对老年抑郁症住院患者在出院后3年时进行随访评定。结果：逐步回归分析表明，影响老年抑郁症患者预后的主要因素依次为：伴精神病性症状、生活事件，治疗依从性，伴躯体疾病，艾森克个性问卷（EPQ）的N分及家庭社会支持。结论：老年抑郁症患者的预后受生物、心理、社会多种因素的影响。应对心理、社会因素进行干预，以改善患者的预后。     

抑郁症患者家属的社会支持及家庭功能研究

目的:探讨抑郁症患者家属感知的的社会支持和家庭功能特征。方法:采用社会支持量表(MSPSS)和家庭功能量表(FAD)对50例抑郁症患者的家属(抑郁症患者家属组)及50名正常人(对照组)进行调查。结果:①抑郁症患者家属组MSPSS评分中的社会支持总分(45.1±11.8)分明显高于正常对照组(25.5±9.7)分,两组间比较,差异有显著性(P<0.05);②抑郁症患者家属组的FAD评定除情感卷入维度外,其他5个维度(问题解决、交流、角色、情感反应、行为控制)和总体功能均在不健康家庭功能范围之内;并与社会支持均呈正相关[问题解决(r=0.228,P<0.05),交流(r=0.250,P<0.05),角色(r=0.209,P<0.05),情感反应(r=0.291,P<0.01),行为控制(r=0.289,P<0.01)和总体功能(r=0.217,P<0.05)]。结论:抑郁症患者家属体验到社会支持程度较低,家庭功能有缺陷;社会支持可能影响到家庭功能。     

抑郁症患者家庭功能调查

目的:探讨抑郁症患者的家庭功能及其相关因素。方法:选择94例抑郁症患者,应用中文版家庭亲密度与适应性量表第2版(FACESⅡCV),从亲密度和适应性2个维度评定抑郁症患者的家庭功能,并应用多元回归分析其相关因素。结果:与正常对照组相比,治疗前家庭亲密度与适应性显著较差,治疗后有显著改善。其相关因素有性别、文化程度、成长地、病程及是否首发等。结论:抑郁症患者的家庭亲密度与适应性存在缺陷。     

早期干预对首发精神分裂症患者的影响

目的：探讨早期干预对首发精神分裂症患者疗效和社会功能康复的影响。方法：干预组为50例首发精神分裂症患者，在药物治疗同时辅以心理和社会综合干预措施，50例与之匹配的对照患者单用药物治疗。采用阳性症状和阴性症状量表(PANSS)及社会功能缺陷筛选量表(SDSS)分别进行随访评定。结果：干预组随访时PANSS阴性量表分的改善明显优于对照组；SDSS的职业和工作、家庭外社会活动、家庭职能、个人生活自理、责任性和计划性5项因子分的改善明显优于对照组。结论：早期干预措施有助于提高精神分裂症患者的疗效和促进社会功能的康复。     

影响抑郁症疗效的多因素分析

目的探讨三环类抗抑郁剂治疗抑郁症疗效差的相关因素。方法以标准化评定工具评定对三环类抗抑郁剂疗效差的52例抑郁症患者,并与疗效好的188例进行对照。结果经单因素分析,疗效差者与精神病家族史、诊断分型、合并精神病性症状、病前适应状况、家庭经济状况、家庭社会支持、发病年龄、发作次数、起病形式、病前生活事件、既往自杀史、HAMD因子Ⅰ、因子Ⅲ分值、既往治疗不恰当、治疗依从性、EPQ的N分和P分、EEG异常等因素有关,而与性别、年龄、婚姻状况、受教育时间、职业等因素无关。经多元逐步回归分析,影响抑郁症疗效的主要因素依次为阳性精神病家族史、慢性起病、合并精神病性症状、非单次发作抑郁症、家庭社会支持差、EPQ的N分高。结论抑郁症的疗效受生物、心理、社会综合因素的影响,在临床治疗的同时,应对心理社会因素进行干预。     

社交技能训练对精神分裂症患者社会功能的影响

目的：探讨社交技能训练对精神分裂症缓解期患者社会功能的影响。方法：将95例缓解期患者随机分为干预组和对照组。对干预组给予小组社交技能训练，于干预前及干预12个月后采用社会功能缺陷筛选表（SDSS）、家庭负担量表（FBS）进行评定。结果：干预组训练前后的SDSS评分及FBS中家庭日常活动、家庭关系等差异均有显著性（P均〈0．05），对照组在治疗前后差异无显著性。结论：在药物治疗的基础上，系统而规则的社交技能训练能有效地改善患者处理家庭关系和家庭日常活动的能力并促进患者的社会功能恢复。     

以躯体症状与以精神症状为主的抑郁症社会功能损害的对比分析

目的 比较以躯体症状与以精神症状为主的两种抑郁症患者出院后社会功能损害状况及其影响因素。方法 收集符合CCMD-2-R诊断标准的抑郁症患者67例，按不同的主诉分成两组，用病史问卷及汉密尔顿抑郁量表(HAMD)进行调查与评定；出院后1年随访时，再次进行HAMD评分，同时采用SDSS评定患者的社会功能损害，以及对其影响因素进行相关分析。结果 1年后随访发现，两组的社会功能存在极显著差异；患者的社会功能与随访时的HAMD评分、复发次数、迟滞因子分和阳性家族史等因素相关。结论 以躯体症状为主的抑郁症患者治疗后能保持较好的社会功能，关键在于早期识别与治疗。     

社区精神分裂症患者性功能状况调查

目的：研究社区精神分裂症患者性功能状况及其相关因素。方法：采用国际勃起功能指数(IIEF—5)问卷对50例愿意接受调查的社区男性精神分裂症患者进行性功能状况调查，同时调查患者一般情况，采用社会支持评定量表、临床疗效总评量表、社会功能缺陷筛选量表评定，并进行相关分析。结果：患者性功能障碍的发生率为58％，性功能状况的良好与否与其病程、残疾程度、疾病严重程度等有显著相关，与社会支持、对疾病的恢复信心及经济收入都有一定相关。结论：对患者性功能的影响是多方面的，家庭干预中应就其影响因素综合干预，以提高患者性生活满意度，利于稳定病情。     

内观认知疗法对抑郁症患者临床症状、生活质量和社会功能的影响

目的探讨了内观认知疗法（NCT）合并药物对于改善抑郁症患者抑郁症状、社会功能和生活质量的疗效。方法对抑郁症患者在药物治疗基础上,分别合并给予NCT和支持性心理治疗（SP）;以汉密尔顿抑郁量表（HAMD-17）、抑郁自评量表（SDS）、临床总体印象量表（CGI）、健康状况调查问卷（SF-36）、社会功能量表（SFRS）进行评估。结果NcT治疗后较SP治疗后CGI—S、HAMD、SDS、SFRS评分降低;SF-36评分提高。结论合并药物治疗前提下NCT较SP能够更显著改善抑郁症患者的抑郁症状、社会功能和生活质量。     

米氮平门诊治疗抑郁症对照观察

目的：探讨米氮平治疗门诊抑郁症患者的疗效及不良反应。方法：对44例抑郁症患者分别应用米氮平与文拉法辛治疗，以汉密顿抑郁量表(HAMD)评定疗效，以副反应量表(TESS)评定药物不良反应。结果：治疗结束时，两组疗效及见效时间差异无显著，但米氮平在改善失眠、减少不良反应方面明显优于文拉法辛，且服用方便，依从性较好。结论：米氮平更适用于门诊抑郁症患者的治疗。     

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 -