产后抑郁症全程综合性社区干预探讨

目的:探讨产后抑郁症全程综合性社区干预的效果。方法:采用自编一般情况和相关因素问卷、综合性医院所用焦虑抑郁量表(HAD)和总甲状腺素(TT4)、游离甲状腺素(FT4)测定孕晚期386例孕妇,筛查出产后抑郁症的高危孕妇122例,按随机自愿的原则分为干预组和对照组各61例;干预组给予全程综合性社区干预。2组均在产后1周、4周、8周、12周采用HAD、爱丁堡产后抑郁量表(EPDS)及美国精神障碍分类与诊断手册第4版-修订版轴Ⅰ障碍用临床定式检查(SCID)分别进行评估。结果:①产后4周、8周、12周HAD、EPDS评分,干预组比对照组明显降低,差异有统计学意义(P均0.05);②孕晚期、产后1周、4周、8周、12周干预组HAD、EPDS评分逐渐降低,差异有统计学意义(P0.01);③产后4个时点抑郁发生率:干预组分别为50%、29.09%、16.36%和9.09%,对照组分别为66.67%、57.89%、44.64%和23.21%。产后4周、8周、12周两组抑郁症发生率比较差异有统计学意义(P均0.05)。结论:全程综合性社区干预能显著降低产后抑郁症的发生率。     

产后抑郁症患者HPA轴激素、甲状腺功能及性激素的水平分析

目的探讨产后抑郁患者下丘脑-垂体-肾上腺(HPA)轴激素、甲状腺功能及性激素的水平及其意义。方法选取产后6～7周经我院精神科门诊检测评估为产后抑郁的产妇100例作为抑郁组、100例同期产后未发生抑郁的产妇作为对照组;检测对比两组的HPA激素、甲状腺激素、性激素水平;并分析抑郁组患者各项激素水平与爱丁堡产后抑郁量表(EPDS)评分的关系。结果抑郁组患者的CHR、ACTH水平高于对照组(P0.05),抑郁组患者的CORT水平低于对照组(P0.05);抑郁组患者的TSH水平低于对照组(P0.05),抑郁组患者的TG-Ab、TPO-Ab、FT3、FT4水平与对照组比较,无统计学意义的差异(P0.05);抑郁组患者的E2水平低于对照组(P0.05),抑郁组患者的PRL、P值高于对照组(P0.05);抑郁组患者的E2、TSH、CORT水平与EPDS评分负相关(P0.05),抑郁组患者的PRL、CHR、ACTH测定值与EPDS评分正相关(P0.05)。结论产后抑郁患者自身激素水平异于正常产妇,调节产后激素水平可能有利于改善产后抑郁。     

苏州市某社区产后抑郁流行病学调查及相关危险因素

目的调查苏州市某社区产后抑郁的检出率及相关危险因素,为产后抑郁的防治提供参考。方法选取苏州市某社区88例产妇,采用爱丁堡产后抑郁量表(EPDS)评定其产后抑郁情况,采用艾森克人格问卷(EPQ)和社会支持评定量表(SSRS)评定产妇的个性特征及社会支持情况。以EPDS评分9分为界将产妇分为产后抑郁组和正常组,分析影响产后抑郁的相关因素。结果苏州市某社区产后抑郁检出率为21.6%;产后抑郁组EPQ神经质(N)维度评分高于正常组,差异有统计学意义[(88.45±8.07)分vs.(37.16±8.22)分,t=2.625,P0.05]。产后抑郁组与正常组SSRS总评分与各维度评分比较差异均无统计学意义(t=-1.411~-0.590,P均0.05)。产后抑郁组SSRS客观支持及主观支持评分与EPDS评分均呈负相关(r=-0.471、-0.459,P均0.05)。结论苏州市某社区产后抑郁的检出率较高,产妇的神经质人格特质与产后抑郁有关。     

瘦素与产后抑郁症状的相关性研究

目的探讨血清瘦素水平与产后抑郁症状的关系。方法收集200名待产孕妇,应用酶联免疫分析法(enzyme-linked immunosorbent assay,ELISA)测定其产前血清瘦素水平,在产后3 d采用爱丁堡产后抑郁量表(Edinburg postnatal depression scale,EPDS)调查其抑郁状况,产后42 d采用电话随访再次评估EPDS情况。分别将产后3 d和产后42 d EPDS得分≥13分者作为有产后抑郁症状组。结果产后3 d有抑郁症状组(52例)和对照组(148例)产前血清瘦素含量[M(QL,QU)]分别为1.36(1.15,1.68)μg/L和1.49(1.28,1.91)μg/L,经正态转换后比较,有抑郁症状组低于对照组(P=0.021)。产后42 d有抑郁症状组(30例)和对照组(164例)产前血清瘦素含量[M(QL,QU)]分别为1.17(1.01,1.36)μg/L和1.50(1.29,1.90)μg/L,经正态转换后比较,有抑郁症状组低于对照组(P0.001)。产后3 d(r=-0.199,P=0.014)、产后42 d(r=-0.254,P=0.002)EPDS得分分别与产前血清瘦素含量呈负相关。多因素logistic回归分析显示,瘦素水平与产后42 d抑郁症状有关联(OR=0.026,P=0.001)。结论产前血清瘦素水平下降可能与产后抑郁症状有关,高水平瘦素是产后抑郁症状的保护因素。     

血清甲状腺激素、肾上腺皮质激素水平变化与产后抑郁的关系研究

目的探讨分娩前后一周血清甲状腺激素及肾上腺皮质激素水平变化对产后抑郁的影响。方法选取2012年3月-2012年9月在贵阳医学院附属医院就诊的395例孕产妇为研究对象,采用爱丁堡产后抑郁量表(EPDS)对其产后抑郁状况进行评定,并用采用生物素双抗体夹心酶联免疫吸附法(ELISA)测定产妇血清皮质醇(Cor)、三碘甲状腺原氨酸(T3)、四碘甲状腺原氨酸(T4)、促甲状腺激素(TSH)、五羟色胺(5-HT)水平。结果 1产后一周抑郁症状检出人数为48例,检出率为12.15%。2抑郁组与非抑郁组COR均高于正常值,抑郁组产后COR稍高于非抑郁组,两两间差异均无统计学意义(P0.05)。3抑郁组产后血清TSH水平低于非抑郁组,差异有统计学意义(P0.05)。4相关分析显示:产后EPDS得分与产后血清皮质醇水平呈正相关、与产后5-HT、T3及TSH水平呈负相关(P0.05)。5逐步线性回归分析显示:甲状腺激素水平及肾上腺皮质醇水平对产后抑郁的直接预测效应无显著意义(P0.05),对5-HT水平有显著预测效应,预测变异量为65.6%(P0.05)。结论 5-HT及其受体功能对产后抑郁的发病起重要作用,产后血清甲状腺激素水平及肾上腺皮质醇水平对的产后抑郁没有直接作用,但通过作用于5-羟色胺水平影响产后抑郁症状的发生。     

重复经颅磁刺激与抗抑郁药物联合治疗对产后抑郁患者认知功能及哺乳的影响

目的分析单用重复经颅磁刺激、抗抑郁药物及其联合治疗产后抑郁的临床效果。方法将120例产后抑郁患者随机分为A(氟西汀治疗)、B(重复经颅磁刺激治疗)、C组(氟西汀+重复经颅磁刺激治疗)各40例,比较三组治疗效果及认知功能改善情况,分析不同疗法对患者产后泌乳的影响。结果 (1)治疗10周,B、C组分类数高于A组(t=13.514、37.104,P均0.05),RE低于A组(t=4.593、6.115,P均0.05),C组PE、RE均低于B组(t=2.252、7.140,P均0.05),其分类数高于B组(t=32.109,P0.05);(2)治疗10周,B、C组汉密尔顿抑郁量表评分(HAMD)、爱丁堡产后抑郁量表(EPDS)量表评分降低幅度高于A组(t=4.775、9.984、4.604、9.549,P均0.05),C组降低幅度又高于B组(t=4.715、4.686,P均0.05);(3)治疗10周,B、C组睡眠质量各维度评分降低幅度高于A组(t=24.464、35.332、14.039、30.454、18.617、51.600、19.000、44.308,P均0.05),C组降低幅度高于B组(t=12.181、18.895、43.544、26.167,P均0.05);(4)C组泌乳量少所占比例低于A组(χ~2=5.591,P0.05),泌乳量多所占比例高于A组(χ~2=3.887,P0.05)。结论采用重复经颅磁刺激联合抗抑郁药物治疗产后抑郁症患者,可明显改善患者认知功能、睡眠质量及抑郁症状,且对产后泌乳影响小。     

自主神经功能与产后抑郁的相关性分析

目的探讨妊娠期自主神经功能对产后抑郁的影响及相关性。方法以2015-06—2016-06在我院产科门诊建立产检保健卡的257例妊娠期妇女为研究对象进行前瞻性研究,所有妊娠妇女于妊娠12周内进行早期自主神经系统功能检查,并于产后42d给予爱丁堡产后抑郁量表(EPDS)进行产后抑郁评估,根据是否发生产后抑郁进行分组,并对临床资料和早期自主神经功能检测结果进行比较分析。结果 257例产妇中EPDS≥13分者39例(抑郁组),EPDS13分者218例(正常组),产后抑郁发生率为15.18%,组间比较,抑郁组与正常组在是否首胎、分娩方式、孕周方面差异具有统计学意义(P0.05);抑郁组SDNN、LF/HF比值明显低于正常组,而压力指数相比正常组明显增高(P0.05);SDNN与产后抑郁呈负相关,压力指数与产后抑郁呈正相关(P0.05)。结论妊娠早期进行常规自主神经功能检查对于筛查和干预产后抑郁有一定的指导作用。     

心理护理干预对孕产妇的妊娠结局及产后抑郁状况的影响

目的研究孕产妇实施心理护理干预对其妊娠结局及产后抑郁状况的影响。方法以2012年3月~2013年12月期间在我院妇产科分娩的70例孕产妇为对照组。选取2014年1月~2016年2月期间于我院妇产科分娩的100例孕产妇为观察组研究对象。对照组实施常规护理干预,观察组在对照组基础护理干预的基础上实施心理护理干预。对比分析两组的妊娠结局、产后5天与3周后的爱丁堡产后抑郁量表(EPDS)评分情况。结果观察组患者的自然分娩率显著高于对照组,而产后出血率与剖宫产率显著低于对照组;产后5天以及产后3周,观察组患者的EPDS评分显著低于对照组,且产后抑郁的发生率显著低于对照组,差异均具有统计学意义(P0.05)。结论为孕产妇实施心理护理干预能有效改善孕产妇的妊娠结局,降低产后抑郁的发生率,是临床效果显著的护理方式。     

80例产后抑郁症患者血清雌二醇及5-羟色胺变化分析

目的研究产后抑郁症(PPD)与血清雌二醇(E2)以及5-羟色胺(5-HT)的关系。方法选取2015年1月至2016年1月期间于我院待产分娩且接受随访产妇680例,产后42d内采用爱丁堡产后抑郁量表(EPDS)进行PPD筛查,其中80例PPD患者作为观察组,在其余600例正常产妇中随机抽取80例作为对照组,检测比较两组的血清E2以及5-HT水平变化,评价比较两组的EPDS评分、汉密尔顿抑郁量表(HAMD)评分及汉密尔顿焦虑量表(HAMA)评分。结果 PPD发生率为11.76%(80/680);观察组的EPDS、HAMD、HAMA评分均显著高于对照组(P0.05);观察组的血清E2、5-HT水平高于对照组,差异均有统计学意义(P0.05);E2与EPDS、HAMD、HAMA评分均呈显著负相关性(r=-0.52,-0.75,-0.66;P0.05),5-HT与EPDS、HAMD、HAMA评分均呈显著负相关性(r=-0.18,-0.29,-0.21;P0.05)。结论血清E2及5-HT水平降低可能是PPD的发生机制之一,检测血清E2及5-HT水平对于PPD的预测、诊断和干预治疗具有积极意义。     

音乐治疗合并心理干预对高危孕妇孕期和产后焦虑抑郁情绪的影响

目的:探索音乐治疗合并心理干预对高危孕妇孕期和产后焦虑抑郁情绪的影响。方法:将195位孕16~20周的高危孕妇随机分为干预组(98例)和对照组(97例);孕24周时对干预组进行1次音乐治疗培训,之后在家中30 min/d的聆听音乐直到分娩;孕25~29周每周1次团体心理治疗。对照组按常规产科流程产前检查。入组时及孕6~9个月每月1次综合性医院焦虑/抑郁量表(HAD)评估;产后3~7 d、42 d及3个月时分别进行爱丁堡产后抑郁调查表(EPDS)评估。结果:孕7及8个月干预组HAD评分显著高于对照组(P均0.05);分娩前干预组HAD评分较基线显著下降(P0.05),但两组间差异无统计学意义。产后各时点EPDS评分干预组显著低于对照组(P0.05或P0.01)。结论:音乐治疗结合团体心理干预能减轻高危妊娠孕妇分娩前的焦虑、抑郁情绪及产后的抑郁症状。     

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     

帕金森病运动症状进展分析

目的分析帕金森病(PD)患者运动症状进展特点。方法采用PD统一评分量表(UPDRS)Ⅲ对912例PD患者进行评估。结果与病程1年的患者比较,除病程1~2年的患者外,其他病程患者的UPDRSⅢ评分、强直分、姿势或步态异常分、轴性症状总分、言语分、步态分显著升高(均P0.05),病程5~6年及14年患者的震颤分,病程5~6年、7~8年、9~13年、14年患者的运动迟缓分、姿势分显著升高(P0.05~0.01)。轴性症状进展速度高于UPDRSⅢ评分。结论 PD患者病程早期UPDRSⅢ评分进展快,震颤症状进展独立于其他症状,轴性症状评分较UPDRSⅢ更敏感地反映疾病加重趋势。     

Frequency of accumulation of filaments in adaxonal cytoplasm of Schwann cells of myelinated fibers of rat spinal roots

Summary The frequency of accumulation of 6-nm filaments in the adaxonal cytoplasm of Schwann cells in the 6th lumbar dorsal and ventral roots was evaluated in 4-, 8-, 26- and 45-week-old Sprague-Dawley rats. The frequency was higher in 4- and 8-week-old (growing) rats than in 26- and 45-week old (mature) rats, and also higher in ventral than in dorsal roots in 4-, 8- and 26-week old rats. There were no clusters on certain groups of myelinated fibers according to the size of transverse axonal area, in both the ventral and dorsal roots. Therefore, this accumulation may reflect certain functions of the adaxonal cytoplasm of Schwann cell during natural growth and maturation of the axon and myelin sheath.     

Function of circle of Willis

Nearly 400 years ago, Thomas Willis described the arterial ring at the base of the brain (the circle of Willis, CW) and recognized it as a compensatory system in the case of arterial occlusion. This theory is still accepted. We present several arguments that via negativa should discard the compensatory theory. (1) Current theory is anthropocentric; it ignores other species and their analog structures. (2) Arterial pathologies are diseases of old age, appearing after gene propagation. (3) According to the current theory, evolution has foresight. (4) Its commonness among animals indicates that it is probably a convergent evolutionary structure. (5) It was observed that communicating arteries are too small for effective blood flow, and (6) missing or hypoplastic in the majority of the population. We infer that CW, under physiologic conditions, serves as a passive pressure dissipating system; without considerable blood flow, pressure is transferred from the high to low pressure end, the latter being another arterial component of CW. Pressure gradient exists because pulse wave and blood flow arrive into the skull through different cerebral arteries asynchronously, due to arterial tree asymmetry. Therefore, CW and its communicating arteries protect cerebral artery and blood–brain barrier from hemodynamic stress.     

Effects of prevention of afferentation of the development of the chick optic lobe

BONDY, S. C., M. E. HARRINGTON AND C. L. ANDERSON. Effects of prevention of afferentation on the developmentof the chick optic lobe. BRAIN RES. BULL. 3(5) 411–413, 1978.—The effects of unilateral extirpation of the right optic cup of the three-day incubated chick embryo upon the rate of synthesis and the stability of DNA in the non-innervated optic lobe, have been studied. This surgical procedure prevents innervation of the optic lobe contralateral to the removed eye, while the other optic lobe is normally innervated by retinal ganglion cells of the remaining eye. At the 20th day of incubation, the DNA content of the non-innervated lobe was below that of the paired lobe receiving normal innervation. This deficiency of cell number was caused by two events; death of an excess number of neurons formed early in embryogenesis and a reduced rate of glial proliferation in the later stages of incubation.     

腺垂体功能减退症临床特征变化分析

目的探讨腺垂体功能减退症患者的病因结构变化及临床表现。方法回顾性分析我院2013-01—2016-12住院及门诊78例腺垂体功能减退症患者的临床资料。结果男32例(41.03%),女46例(58.97%);诊断时年龄11~89岁,平均62.5岁;鞍区占位(包括术前及术后)52例(66.67%),席汉综合征8例(10.26%),空泡蝶鞍9例(11.65%),病因不明8例(10.26%),垂体-下丘脑发育不良1例(1.28%)。首次就诊科室:纳差厌食、恶心呕吐就诊于消化内科36例(46.15%)最常见。ACTH+TSH+Gn+G激素缺乏为19例最多,占24.36%,ACTH+TSH+Gn缺乏15例,占19.23%。结论腺垂体功能减退症病因结构发生变化,发病人群、首发症状及受累激素也不同,患者女性多于男性,发病年龄偏高,症状不典型,分布于临床多个科室,其中以低钠血症为首发临床表现就诊消化内科最多。     

Standards of instrumentation of EMG

Standardization of Electromyography (EMG) instrumentation is of particular importance to ensure high quality recordings. This consensus report on “Standards of Instrumentation of EMG” is an update and extension of the earlier IFCN Guidelines published in 1999. First, a panel of experts in different fields from different geographical distributions was invited to submit a section on their particular interest and expertise. Then, the merged document was circulated for comments and edits until a consensus emerged.The first sections in this document cover technical aspects such as instrumentation, EMG hardware and software including amplifiers and filters, digital signal analysis and instrumentation settings. Other sections cover the topics such as temporary storage, trigger and delay line, averaging, electrode types, stimulation techniques for optimal and standardised EMG examinations, and the artefacts electromyographers may face and safety rules they should follow. Finally, storage of data and databases, report generators and external communication are summarized.     

Modelling of movement of the lamprey: Control of oscillators

This article discusses the control methods of the central pattern generator (CPG). First a control model of the CPG is presented using 2 oscillators, and we suggest that phasic modulation to the CPG by means of phasic information is effective for controlling the phase difference between oscillators. Next, two models for controlling the CPG of a lamprey are proposed. One model describes a control system from the brain stem, in which the reticulospinal neurons control the CPG by receiving feedback signals and sending control signals to the neck region of the CPG. The other is a model for learning an localized control system to generate a desired motor pattern. By means of these models, a role of the efference copy is suggested.     

《绵阳市社会心理服务工作管理办法》解读

2018年,国家卫生健康委员会等10部委联合发布《关于印发全国社会心理服务体系建设试点工作方案的通知》,四川省绵阳市被列为全国第一批试点地区。绵阳市人民政府依据《中华人民共和国精神卫生法》等相关法律法规和文件精神,结合前期调查研究和社会心理服务工作的试点实际,编制出台了《绵阳市社会心理服务工作管理办法》,并于2021年12月25日起施行。本文围绕社会心理服务的相关概念、办法总则、重点内容、保障措施等方面进行解读,以期为社会心理服务工作的规范、持续和有效开展提供参考。     

利培酮对精神分裂症患者生活质量的影响

目的：比较利培酮与氟哌啶醇对精神分裂症患者生活质量的影响。方法：对门诊72例服用氟哌啶醇及74例服用利培酮的精神分裂症患者用生活质量综合评定问卷（GQOLI）、阳性与阴性症状量表（PANSS）、副反应量表（TESS）进行评定。结果：利培酮组患者治疗后生活质量有所提高,而氟哌啶醇组患者生活质量有所下降。结论：利培酮治疗有利于患者提高生活质量。