童年创伤、生活事件与大学生抑郁情绪的关系——心理韧性的中介和调节作用

目的探讨大学生心理韧性与童年创伤、生活事件和抑郁情绪之间的关系,以及心理韧性在它们之间的作用,为大学生抑郁情绪的干预提供参考。方法采用分层整群随机抽样法在济南市和烟台市共3所高校抽取700名在校大学生,使用流调中心用抑郁量表(CES-D)、童年创伤问卷(CTQ)、青少年自评生活事件量表(ASLEC)和青少年心理韧性量表(RSCA)进行评定。结果相关分析显示,CES-D与ASLEC、CTQ评分均呈正相关(r=0. 271、0. 237,P均0. 01);RSCA评分与CES-D、ASLEC、CTQ评分均呈负相关(r=-0. 429、-0. 226、-0. 290,P均0. 01)。中介效应检验显示,心理韧性在童年创伤和抑郁情绪之间的中介效应显著,中介效应占总效应的45. 19%;调节效应检验显示,心理韧性在生活事件与抑郁情绪之间的调节效应显著(R~2=0. 232,P 0. 01)。结论心理韧性在童年创伤和抑郁情绪之间起到部分中介作用,在生活事件与抑郁情绪之间起到调节作用。     

父母婚姻适应与青少年抑郁症状的关系:母亲抑郁症状的中介作用

目的 分析父母婚姻适应与青少年抑郁症状的关系,以及母亲抑郁症状在其中的中介作用。方法 于2021年11—12月选取河南省某高中的学生及其母亲为研究对象。采用洛克-华莱士婚姻适应量表（LW）、儿童抑郁量表（CDI）调查青少年的父母婚姻适应水平、抑郁症状,采用流调中心抑郁量表（CES-D）调查青少年母亲的抑郁症状。采用Spearman相关分析青少年抑郁症状、父母婚姻适应与母亲抑郁症状之间的相关性。采用SPSS中Process 3.3插件进行中介效应检验。结果 本研究获得1 039份有效的匹配问卷。1 039名青少年父母的LW得分为[84(71,95)]分,CDI得分为[13(8,18)]分,1 039名青少年母亲的CES-D得分为[3(0,12)]分。21.56%(224/1 039)的青少年CDI得分≥19分,20.31%(211/1 039)的母亲CES-D得分≥16分。相关分析结果显示,青少年父母婚姻适应与青少年抑郁症状、母亲抑郁症状呈负相关（r=-0.10、-0.48;P<0.01）,母亲抑郁症状与青少年抑郁症状呈正相关（r=0.12,P<0.01）。母亲抑郁症状在青少...     

新冠肺炎救治医务人员抑郁症状与急性应激反应及心理韧性的关系

目的:探讨新冠肺炎救治医务人员抑郁症状与急性应激反应、心理韧性的关系。方法:采用方便取样法选取参加武汉新冠肺炎救治45 d的167名医务人员进行9项患者健康问卷(PHQ-9)、斯坦福急性应激反应问卷(SASRQ)和Connor-Davidson心理韧性量表(CD-RISC)自评;以PHQ-9≥10分为抑郁症状阳性分界值,分析新冠肺炎救治医务人员抑郁症状与急性应激反应、心理韧性的关系。结果:131名医务人员(78.44%)为抑郁组,包括中度77人,中重度35人,重度19人。抑郁组PHQ-9总分与SASRQ各因子分呈正相关,与CD-RISC总分及各因子分呈负相关(P均0.01)。抑郁组SASRQ的唤醒、再体验因子和CD-RISC的主体性、稳定性因子对PHQ-9总分有显著预测作用(P0.05或P0.01),分别可解释PHQ-9方差变异的62.9%、30.9%。心理韧性在抑郁组急性应激反应与抑郁之间起部分中介作用,中介效应占总效应的59.02%。结论:急性应激反应、心理韧性对新冠肺炎救治医务人员抑郁症状有显著预测作用;心理韧性在其急性应激反应与抑郁之间起部分中介作用。     

新冠肺炎疫情下大学生心理健康现状及求助方式调查

目的 调查新冠肺炎(COVID-19)疫情下大学生心理健康现状,为对其进行心理干预提供参考.方法 采用电子问卷的方式,通过问卷星网络平台,随机对四川省某高校在读大学生进行调查,采用焦虑自评量表(SAS)、抑郁自评量表(SDS)及躯体化症状自评量表(SSS)评估其焦虑、抑郁及躯体化症状情况,同时使用自制问卷调查其求助方式...     

混合性焦虑抑郁障碍青少年同伴关系对孤独感的影响：睡眠质量和心理弹性的链式中介效应分析

目的 探讨睡眠质量和心理弹性在混合性焦虑抑郁障碍（MADD）青少年同伴关系与孤独感中的作用。方法 采用方便抽样法，选取2020年9月至2021年6月在大庆市第三医院青少年心理门诊就诊或住院的265例MADD青少年为研究对象。采用儿童青少年同伴关系量表、美国加州大学洛杉矶分校（UCLA）孤独感量表、青少年心理韧性量表（RSCA）、匹兹堡睡眠质量指数（PSQI）进行调查。采用Pearson相关分析MADD青少年同伴关系、孤独感、睡眠质量、心理弹性之间的相关性。采用SPSS PROCESS宏程序中的模型6进行中介效应检验。本研究共发放问卷280份，回收有效问卷265份，有效回收率为93.00%。结果 MADD青少年的儿童青少年同伴关系量表得分为（59.69±12.93）分，UCLA孤独感量表得分为（56.49±10.83）分，RSCA得分为（67.68±15.72）分，PSQI得分为（10.31±3.92）分。MADD青少年中睡眠质量与同伴关系、睡眠质量与孤独感、同伴关系与孤独感呈正相关（r=0.49、0.50、0.76;P<0.01），心理弹性与同伴关系、孤独感、睡眠质量呈负相关（r...     

苏州市青少年抑郁情绪调查及其影响因素研究

目的:了解苏州市青少年抑郁现状并分析其影响因素，为预防青少年抑郁的发生提供科学依据和理论指导。方法:采用整群分层随机抽样的方法，纳入研究2019年6月至12月苏州市某城区的18所中学学生，采用一般情况调查表、患者健康问卷抑郁量表(PHQ-9)、广泛性焦虑量表(GAD-7)调查其抑郁情绪及其相关影响因素。结果:本次调查的11458名青少年抑郁情绪平均得分5.34分，具有抑郁情绪者2078名，抑郁情绪检出率18.1%。多因素Logistic回归分析显示，父母关系差(OR=2.551,P<0.001)、学校欺凌(OR=1.792,P<0.001)、焦虑情绪(OR=1.500,P<0.001)、高中年级(OR=1.174,P=0.036)、女性(OR=1.310,P<0.001)、是青少年抑郁情绪的危险因素。结论:青少年抑郁情绪较为普遍，父母关系差、学校欺凌、焦虑情绪、高中年级、女性是青少年抑郁情绪的危险因素，应定期对这一人群进行心理状况筛查，提供干预策略，预防青少年抑郁。     

女青少年错(牙合)畸形患者戴固定矫治器前后的心理变化研究

目的 探讨初戴固定矫治器是否会对女青少年错(牙合)畸形患者产生一定的心理负面影晌.方法 选取150例女青少年错(牙合)畸形患者,分别在就诊当日(T1期)与固定矫治器戴入1周后(T2期)填写心理调查问卷,该问卷包含焦虑自评量表和抑郁自评量表,调查患者的焦虑和抑郁情绪.根据T1与T2期2个量表的评分,比较固定矫治器戴入前后患者的心理变化.结果 86例患者填写的调查表合格.患者T2期的焦虑与抑郁评分均较T1期有明显升高非自愿就诊患者在T2期焦虑与抑郁评分升高,与T1期相比差异有统计学意义(P＜0.05).结论 初戴固定矫治器所引起的不适与不便可使女青少年患者产生一定的焦虑与抑郁情绪,非自愿就诊者尤甚.     

灼口综合征患者负性情绪,应对方式及人格状况的调查

目的研究灼口的抑郁、焦虑、应对方式和人格状况以及上述症状之间的相关性。方法选取我院2014年1月至2016年1月80例灼口综合征患者为研究组,并选取同期80例健康者为对照组,采用抑郁自评量表(SDS)、焦虑自评量表(SAS)、医学应对方式问卷(MCMQ)、艾森克人格问卷简式量表(EPQ-RSC)与视觉模拟评分法表(VAS)进行评估对比,并分析各症状的相关性。结果研究组患者的SDS和SAS评分比对照组显著增加(P0.05),口干症状与焦虑评分、疼痛程度呈正相关,疼痛程度与焦虑评分、抑郁评分呈正相关,应对方式中的回避、屈服与抑郁评分呈正相关,人格中的掩饰、神经质、精神质与抑郁评分、焦虑评分呈正相关(P0.05)。结论灼口综合征患者会产生口干、疼痛、人格异常、应对障碍、抑郁与焦虑等症状,各症状之间不是独立存在的,心理的障碍会加重生理的症状,因此在临床实际治疗中需注重加强心理干预。     

青少年非理性信念与应激对抑郁症状预测研究

目的:探讨青少年非理性信念与生活应激对抑郁症状的影响. 方法:采用Beck抑郁自评问卷(BDI-Ⅱ)、中学生非理性信念量表(MIBS)和中学生心理应激源量表(SSMSS)等自评量表对649名中学生进行问卷调查,每2个月1次对生活应激和抑郁症状进行追踪测评,追踪为期1年完成6次测评,采用多层线性模型进行数据分析. 结果:非理性信念与抑郁症状(r=0.53,P＜0.001)、生活应激水平(r=0.31,P＜0.001)之间存在显著的正相关;多层线性模型分析表明,非理性信念[β=1.76,t(1629) =7.811,P＜0.001]和生活应激水平[β=0.13,t(12635) =7.056,P＜0.001]对青少年抑郁症状预测的主效应均显著,非理性信念与生活应激水平共同预测青少年抑郁症状的交互作用显著[β=0.04,t(12635)=4.173,P＜0.001];随着生活应激水平增加,高非理性信念水平[β=0.07,t(2635)=7.484,P＜0.001]青少年的抑郁症状水平比低非理性信念组[β=0.01,t(2635)=0.871,P＞0.05]明显增加.结论:非理性信念在生活应激中能够预测青少年抑郁症状的发生和变化.     

焦虑和认知情绪调节在青少年网络成瘾与抑郁之间的中介作用

目的 探讨青少年网络成瘾与抑郁的关系以及焦虑与认知情绪调节的中介作用.方法 采用网络成瘾测评量表、广泛性焦虑量表、Kutcher青少年抑郁量表和认知情绪调节问卷于2015年12月至2016年1月对上海市5所普通公立初级中学选取的2751名学生进行现场问卷调查.结果 初中生抑郁症状的检出率为22.2％(610/2751)...     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Diagnostic Difficulties and Treatment Implications

Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.     

Cognitive Dysfunction Associated with Antiepileptic Drug Therapy

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Carbamazepine Efficacy in Adults With Partial and Generalized Tonic-Clonic Seizures

Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.     

Etiologic and Preventive Aspects of Epilepsy in the Child–Bridging the Gap Between Laboratory and Clinic

Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.     

Predisposing and Causative Factors in Childhood Epilepsy

Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non-febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.