发作期抑郁症患者述情障碍影响因素的多元分析

目的探讨发作期抑郁症患者述情障碍的相关因素。方法采用多伦多述情量表（TAS）中文版、Beck抑郁自评量表（BDI）对80例发作期抑郁症患者进行评定,并与95名健康志愿者（对照组）比较。结果（1）抑郁症组TAS因子Ⅰ、Ⅱ、Ⅲ、总分及BDI评分均显著高于对照组（P〈0．01）。（2）患者住院与他人交流、抑郁总分依次进入TAS因子Ⅰ的回归方程;抑郁总分、工作学习应激、性别依次进入TAS因子Ⅱ的回归方程;受教育年限、住院与他人交流依次进入TAS因子Ⅲ的回归方程;抑郁总分、治疗信心依次进入TAS总分的回归方程。结论抑郁发作患者存在明显的述情障碍。性别、受教育年限、抑郁的严重程度等为发作期抑郁症患者述情障碍的重要影响因素。述情障碍不同因子的影响因素不尽相同。     

脑血管病患者的述情障碍

目的 探讨脑血管病患者的述情障碍及严重程度。方法 对82例确诊的脑血管病患者运用多伦多述情障碍量表（TAS）进行测试，并与健康对照组进行比较。结果 脑血管病患者存在明显的述情障碍。TAS总分及各因子分明显高于对照组，且女性高于男性，脑血管病患者的诊断及严重程度与述情障碍无关。结论 脑血管病患者存在较多的述情障碍，不仅影响患者的治疗，而且可导致医源性疾病或延长住院时间。临床医师若能及时确切地了解患者有无述情障碍，可帮助选择心理治疗的种类指导康复期治疗。     

消化性溃疡患者的情绪障碍和述情障碍

用汉密顿焦虑量表（HAMA）、汉密顿抑郁量表（HAMD）和多伦多述情障碍量表（TAS）对57例住院的消化性溃疡患进行评定，并与57例正常健康自愿为对照，结果发现消化性溃疡患HAMA、HAMD总分和TAS总分及四个因子分均显高于对照组，说明消化性溃疡患中存在情绪障碍和述情障碍。     

神经症和抑郁障碍患者的述情障碍及相关因素研究

目的探讨神经症和抑郁障碍患者的述情障碍及影响因素。方法对57例神经症和抑郁障碍患者运用多伦多述情障碍量表(TAS)进行评定，并与常模进行比较。结果神经症和抑郁障碍患者存在明显的述情障碍，TAS总分及各因子分明显高于常模，男女之间无显著性差异，多元回归分析进入方程的是SCL-90躯体化因子和焦虑因子。结论正确评定神经症和郁郁障碍患者的述情障碍及影响因素，具有重要的临床现实意义，对采用适当的心理治疗提供依据。     

海洛因依赖者述情障碍研究

目的:了解海洛因依赖者(PHD)述情障碍特征及与负性情绪的关系. 方法:对194例男性PHD(PHD组),采用自编一般情况问卷、多伦多述情障碍量表(TAS)、抑郁自评量表(SDS)及焦虑自评量表(SAS)进行心理评估;107名健康男性作为对照,采用TAS进行述情障碍测评. 结果:PHD组TAS总分及各因子分、SDS及SAS评分均显著高于对照组(P<0.05或P<0.01);TAS总分及因子Ⅰ、因子Ⅱ、因子Ⅳ与SDS、SAS总分均呈显著正相关(r=0.178～0.294,P均<0.05或P<0.01);TAS因子Ⅲ与SAS总分均呈显著负相关(r=-0.147,P<0.05). 结论:男性PHD存在明显述情障碍,并与负性情绪密切相关.     

精神分裂症患者述情障碍与执行功能及情绪障碍的关系

目的 探讨精神分裂症患者的述情障碍与执行功能和焦虑、抑郁情绪之间的关系.方法 用多伦多述情障碍20个条目量表(TAS-20)、威斯康星卡片分类测试(WCST)、焦虑自评量表(SAS)和抑郁自评量表(SDS)对150例精神分裂症患者分别进行述情障碍、执行功能及焦虑和抑郁症状的评定,抽取TAS总分≥62为高分组(38例)和TAS总分≤53为低分组(42例),比较两组的WCST成绩并与TAS-20总分及各因子分进行相关分析.同时将SAS、SDS标准分与TAS-20进行相关分析.结果 述情障碍高分组的错误应答数、非持续性错误数、完成第一次分类应答数均高于低分组(P＜0.05);而高分组的完成分类数、正确应答数、正确应答百分数、概念化水平应答率则明显低于低分组(P＜0.01);相关分析显示,TAS-20的总分及因子分与WCST成绩呈负相关(P＜0.05),TAS-20的总分及因子分与SAS、SDS标准分呈正相关(P＜0.05).结论 精神分裂症患者的述情障碍与执行功能损害、负性情绪密切相关.     

恢复期精神分裂症病人述情障碍的对比分析

目的　评估恢复期精神分裂症病人的述情障碍 ,并比较其缺陷型和非缺陷型的述情障碍严重程度。方法　采用多伦多述情障碍量表 (Torontoalexithymiascale ,TAS)对 6 6例恢复期精神分裂症病人及 6 2例正常人进行测查。结果　恢复期精神分裂症病人的TAS得分显著高于正常人 (P <0 0 5或P <0 0 1) ,其缺陷型的TAS得分也显著高于非缺陷型 (P均 <0 0 1)。结论　恢复期精神分裂症病人大多存在述情障碍 ,其中缺陷型病人的述情障碍更为严重。严重的述情障碍可能是精神分裂症病情加重或存在原发阴性症状的一个标志。     

Ⅰ型、Ⅱ型精神分裂症自知力及述情障碍研究

目的比较Ⅰ型、Ⅱ型精神分裂症患者的自知力及述情障碍,并探讨二者之间的关系.方法依SANS、SAPS评分和Aedreason精神分裂症的分型标准进行Ⅰ型、Ⅱ型精神分裂症的分型诊断,用ITAQ和TAS分别评定患者的自知力和述情障碍.结果评定时Ⅰ型和Ⅱ型精神分裂症患者的CGI评分分别为5.19±1.95和5.65±1.34(t=0.82,P＞0.05),ITAQ总分分别为12.01±4.63和9.15±4.70(t=2.06,P＜0.05),述情障碍评分分别为64.50±13.10和74.00±10.20(t=2.49,P＜0.05).Ⅰ型和Ⅱ型精神分裂症TAS总分与ITAQ总分均无明显的相关性,但Ⅰ型精神分裂症TAS总分及描述情感的能力、认识和区别情感与躯体感受的能力、外向性思维3因子分与ITAQ的对疾病和治疗的认识这一因子分具有显著相关.结论在总体疗效评定没有显著差异的情况下,Ⅱ型精神分裂症的自知力缺乏和述情障碍均较Ⅰ型精神分裂症明显.Ⅰ型精神分裂症患者的述情障碍和自知力之间有一定相关性,Ⅱ型精神分裂症二者之间相关性不明显.     

精神分裂症患者述情障碍与自我和谐的相关性

目的:探讨精神分裂症患者述情障碍与自我和谐的相关性。方法:采用单纯随机对照研究,将62例符合《国际疾病分类》第10版诊断标准的精神分裂症患者作为研究组,并随机选取70名正常健康者为对照组。采用多伦多述情障碍量表与自我和谐量表分别对两组进行测评。结果:研究组多伦多述情障碍量表各项因子分高于对照组(P均0.05)。研究组自我和谐量表中的自我与经验的不和谐因子分和自我的刻板性因子分高于对照组(P均0.05),自我灵活性因子分低于对照组(P0.05)。研究组多伦多述情障碍量表的缺乏识别情感的能力因子与自我和谐量表的自我与经验的不和谐和自我的刻板性因子呈正相关(r=0.433,r=0.345;P均0.05)。结论:精神分裂症患者存在述情障碍,其自我和谐性差;精神分裂症患者的述情障碍与自我和谐存在一定的相关性。     

舰艇军人述情障碍与应对方式的关系

目的 探讨舰艇军人述情障碍程度与所采用应对方式的关系.方法 采用多伦多述情障碍20个条目量表(TAS-20)、应付方式问卷(CSQ)时489例舰艇军人的述情障碍情况及应对方式进行评定.以 TAS得分≥(x)+1s作为述障碍高分组,TAS得分≤(x)-1s作为述情障碍低分组,(x)-1s＜TAS得分＜(x)+1s作为述情障碍中分组,对三组的应付方式各分量表得分进行比较;将489例舰艇军人的应付方式分量表得分与TAS得分进行相关分析.结果 述情障碍高、低、中分组的应付方式6个分量表得分差异均具有统计学意义(P＜0.01),两两比较中高分组在不成熟型或混合型应对方式自责、幻想、退避和合理化因子得分上显著高于述情障碍低、中分组(P＜0.01);在成熟型应对方式解决问题和求助因子得分上显著低于低、中分组(P＜0.01).相关分析显示,应付方式量表中解决问题,求助分量表得分与TAS总分及各因子分呈显著负相关(r=-0.184～-0.386,P＜ 0.01).自责、幻想、退避、合理化各分量表得分与TAS总分及各因子分呈显著正相关(r=0.139～0.444,P＜0.01).结论 舰艇军人的应对方式与述情障碍程度有关,高述情障碍者倾向于采用不成熟应对方式.     

精神分裂症患者发病年龄与临床特征的相关性研究

目的 探讨精神分裂症发病年龄与临床特征的关系。方法 对符合DSM-IV精神分裂症诊断标准的294例住院患者进行BPRS评估和BEAM检查，并收集其人口学资料和病史资料。结果 BPRS总分和迟滞因子分与发病年龄呈负相关，而BPRS总分、迟滞因子分和敌对猜疑因子分与未治疗期的长短呈正相关。发病年龄在性别和遗传因素中的差异无显著性，而在发病诱因、BEAM检查结果和诊断类型间的差别有统计学意义。结论 精神分裂症的临床特征与发病年龄明显相关，发病年龄越小病情越严重，阴性症状也越突出，提示在制定治疗康复方案方面，应有所区别。     

Predictors of quality of life in inpatients with schizophrenia

Shortening hospital stays has become a key focus in psychiatric care in recent years. However, patients with schizophrenia account for about 60% of inpatients in psychiatry departments in Japan. This study was designed to investigate the relationship between quality of life (QOL) and key indicators for long-term hospital stays among schizophrenia inpatients. A further aim was to elucidate the clinical determinants of QOL among long-stay inpatients. The study sample consisted of 217 inpatients with schizophrenia. Age, duration of illness, duration of hospitalization, years of education, body mass index, neurocognitive function, drug-induced extrapyramidal symptoms, involuntary movements, psychiatric symptoms, and dose equivalents of antipsychotics and anticholinergic agents were used as index factors. Pearson linear correlation and regression analyses were performed to examine the associations between QOL and the above-mentioned factors. Negative symptoms, psychological discomfort, and resistance as rated on the Brief Psychiatric Rating Scale (BPRS) were correlated with all subscale scores of the Japanese version of the Schizophrenia Quality of Life Scale (JSQLS). Stepwise regression showed that negative symptoms, psychological discomfort, and resistance predicted the dysfunction of psycho-social activity score and the dysfunction of motivation and energy score on the JSQLS. This study shows that active treatment for negative symptoms, psychological discomfort, and resistance should be recommended to improve QOL among inpatients with schizophrenia.     

Evaluation of Mini Mental State Examination and Brief Psychiatric Rating Scale on aged schizophrenic patients

Abstract  Mini Mental State Examination (MMSE), Brief Psychiatric Rating Scale (BPRS) and subscales of the BPRS were performed on 73 elderly inpatients (mean age: 67.9 years; standard deviation: 7.2; range: 60–89) diagnosed with DSM-III-R chronic schizophrenia. Forty of the subjects were men and 33 were women. A significant negative correlation was observed between MMSE and the age, factor negative, factor depressive, and total score of BPRS. We believe, however, that it is relatively sufficient to screen for demented illness of schizophrenics using MMSE when considering the age and the psychiatric symptoms (especially negative or depressive symptoms). Forty-eight (66%) of the 73 patients were categorized as 'demented' by MMSE. These results suggest that the aged inpatients with schizophrenia in a hospital showed certain kinds of cognitive deficits (including senile dementia) more frequently than the general population.     

长期住院男性精神分裂症患者认知功能调查

目的：探讨长期住院男性精神分裂症患者的认知功能。方法：采用数字划消测验、空间广度测验评定57例男性长期住院精神分裂症患者（患者组）和57名正常对照者（正常对照组）的认知功能。结果：患者组在数字划消测验的完成时间、漏划个数以及空间广度测验的总分、顺行得分、逆行得分上明显差于正常对照组（t=8．21,t=3．47,t=4．72,t=2．36,t=5．88;P〈0．05或P〈0．001）。相关分析显示,患者的病程、服药时间与数字划消测验的完成时间呈显著正相关（r=0．41,P〈0．01;r=0．30,P〈0．05）。结论：长期住院男性精神分裂症患者的认知功能明显受损,且与患者的病程和服药时间相关。     

住院精神分裂症患者生存质量研究

目的：探讨住院精神分裂症患者的生存质量及其影响因素。方法：量表采用MOS健康状况调查问卷(SF-36)、简明精神病评定量表(BPRS)、副反应量表(TESS)、焦虑自评量表(SAS)、抑郁自评量表(SDS)等对125例住院精神分裂症患者进行评定，并与120名正常健康者进行对照。结果：精神分裂症患者SF-36评分显著低于对照组；家庭支持少、病程短、年龄轻、初次住院、住院时间短的患者生存质量差。多因素逐步回归分析显示，影响患者生存质量的主要因素依次为BPRS、SAS、TESS和病程。结论：住院精神分裂症患者的生存质量全面低下，影响因素是多方面的，应予以重视。     

189例老年住院精神病人分析

目的 分析住院老年精神病人的年龄和病种。方法 回顾性查阅住院60岁以上老年精神病人的病例资料,对其年龄和病种进行分析。结果 60岁以上(含60岁)住院老年精神病人占同期住院精神病人3.12％;60岁及以上住院老年精神病人随年龄增长,比例减少;以精神分裂症(含分裂样精神病)最多,其次为情感性障碍。结论 建议加强老年精神病诊断与治疗业务开拓。     

Obsessive-compulsive disorder in adolescent schizophrenia patients

OBJECTIVE: The co-occurrence of obsessive-compulsive disorder (OCD) in adult patients with schizophrenia has been increasingly recognized. However, the rate of OCD comorbidity in adolescent schizophrenia patients has yet to be systematically evaluated. METHOD: The rate of DSM-IV OCD was evaluated in 50 adolescent inpatients with schizophrenia or schizoaffective disorder. The severity of schizophrenia and OCD symptoms was assessed with the Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms (SANS), and Yale-Brown Obsessive Compulsive Scale. RESULTS: Thirteen schizophrenia patients (26.0%) also met the DSM-IV criteria for OCD. This subgroup scored significantly higher on the SANS subscale for affective flattening or blunting. The total SANS score positively correlated with the total Yale-Brown Obsessive Compulsive Scale score. CONCLUSIONS: A substantial proportion of adolescent schizophrenia inpatients have concomitant OCD. A prospective study is needed to evaluate the clinical course, response to treatment, and prognosis for this complex disorder.     

The Munich 15-year follow-up study (MUFUSSAD) on first-hospitalized patients with schizophrenic or affective disorders: comparison of psychopathological and psychosocial course and outcome and prediction of chronicity

Given the limited explanatory power of the available neurobiological findings, results of long-term follow-up studies should still be considered as one criterion among others in the development of psychiatric classification systems regarding schizophrenia and affective disorders. A total of 323 first hospitalized inpatients of the Psychiatric Department of the University Munich were recruited at index time and followed up after 15 years. The full follow-up evaluation including several standardized assessment procedures (AMDP, PANSS, SANS, DAS, GAS) could be performed in 197 patients. The patients originally diagnosed according to ICD-9 were re-diagnosed according to ICD-10 and DSM-IV, using SCID among others. Schizophrenic patients had a much poorer outcome than affective or schizoaffective patients in terms of negative syndrome, deficit syndrome, psychosocial impairments and GAS results, and a higher prevalence of a chronic course. The logistic regression analyses performed to find optimized predictor combinations for the prognosis of a chronic course found, for example, the total Strauss–Carpenter Scale score, male gender and several other psychopathological syndromes to be relevant predictors. The findings reflect some long-term related validity for the differentiation between schizophrenia and affective disorders. The Strauss–Carpenter Scale, male gender as well as several psychopathological syndromes are the most relevant predictors for chronicity.     

提高慢性精神分裂症患者的生活质量探讨

目的对慢性精神分裂症病人给予适当的行为治疗，以期提高其住院生活质量。方法对30例病人应用行为治疗并进行对照观察，以NOSIE-30及SANS评分为依据。结果行为治疗明显提高病人住院期间的生活质量。在NOSIE-30测查中的总积极因素增分值及总消极因素减分值研究组都明显高于对照组（P〈0．01）；SANS评分研究组（治疗后）总分明显低于对照组。结论行为治疗在改善慢性精神分裂症阴性症状，促进康复过程中有明显的治疗作用。     

Prediction of homelessness within three months of discharge among inpatients with schizophrenia.

OBJECTIVE: The authors' goal was to identify factors that place inpatients with schizophrenia at risk of becoming homeless after hospital discharge. METHODS: Patients with schizophrenia or schizoaffective disorder (N=263) were assessed at discharge from general hospitals in New York City and reassessed three months later to evaluate whether they had become homeless. Sociodemographic and clinical characteristics associated with homelessness were identified using likelihood ratio chi square analysis and logistic regression. RESULTS: Twenty patients (7.6 percent) reported an episode of homelessness during the follow-up period. Patients who had a drug use disorder at hospital discharge were significantly more likely to report becoming homeless than those without a drug use disorder. Patients with a total score above 40 on the Brief Psychiatric Rating Scale (BPRS) at hospital discharge were more likely to report becoming homeless than patients with lower scores, as were those with Global Assessment Scores less than 43. Twelve of 30 patients with a drug use disorder, a BPRS score above 40, and a GAS score less than 43 at hospital discharge reported becoming homeless. CONCLUSIONS: The combination of a drug use disorder, persistent psychiatric symptoms, and impaired global functioning at the time of hospital discharge poses a substantial short-term risk of homelessness among patients with schizophrenia. Patients who fit this profile may be candidates for community-based programs that are specifically aimed at preventing homelessness among patients with severe mental illness.