不同性别强迫障碍的临床特征比较

1对象与方法1.1对象均为住院患者,由两名副主任医师分别诊断,同时符合CCMD-2-R及DSM-Ⅲ-R强迫障碍(Obsessive-compulsivedisorder,OCD)的诊断标准,排除器质性强迫障碍。共61例,其中男39例,女22例。1.2方法在入院前、住院中每30d及出院时常规行ADIS-P、简明精神病评定量表(BPRS)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评定,同时采用CCMD-2-R及DSM-Ⅲ-R诊断,必要时再临时增加评定及诊断次数。2结果见表1。3讨论在研究中,男女性别之间有显著差异的表现在:男性起病年龄早,初诊年龄早,住院次数多,受教育年限长;女性患…     

考研学生心理亚健康状况及相关因素的研究

心理亚健康是亚健康的一种重要类型,它是介于心理健康与精神疾病之间的中介状态,这些状态均未达到CCMD-3、ICD-10、DSM-Ⅳ等精神病学诊断标准,但给人们的工作和生活带来很大的影响,如不引起重视可能诱发躯体疾病、精神疾病和心理危机[1].     

儿少组与未成年组神经症患者的临床特征

1对象与方法1.1对象为在中心4个病区住院的8～18岁儿童青少年。符合中国精神疾病分类方案与诊断标准(CCMD-2-R)犤1犦中关于神经症的诊断标准及排除标准的共40例,其中男20例,女20例,平均年龄(15.5±1.5)岁。在校生占60%。1.2方法将40例患者分为儿童少年组(8～15岁,以下简称儿少组)和未成年组(16～18岁)。由两名取得良好一致性的主治医师依据CCMD-2-R中神经症的诊断标准,ICD-10精神与行为障碍诊断要点犤2犦,及现代儿童精神医学相关部分犤3犦自制的调查表,对其一般资料、临床分型资料和临床症状进行对照分析,数据应用SPSS8.0统计软件包…     

心理疾病专家诊断系统与CCMD-3诊断精神分裂症的临床试验

【目的】评价心理疾病专家诊断系统（心理CT）诊断精神分裂症的信度和效度。【方法】以中国精神障碍分类与诊断标准第3版（CCMD-3）作为“金标准”,评估心理CT3．20版诊断精神分裂症的效标效度。共入组93名来自本院门诊和住院的患者,每个患者由2名临床医师分别独立做出诊断,与心理CT进行对照诊断。间隔5-d后对所有患者进行第二次检查,以评价心理CT的重测一致性。【结果】心理CT诊断的（包括精神分裂症和双相障碍）病例与CCMD-3诊断的符合率为96．8％。就诊断精神分裂症而言,心理CT和CCMD-3效标效度的Kappa值为0．87。心理CT诊断精神分裂症的灵敏度为97．7％,特异度为85．7％,阳性预测值为98．8％,阴性预测值为75％,阳性似然比6．83,阴性似然比0．16。重测信度Kappa值为1．00,有非常高的诊断一致性,诊断结果稳定。心理CT检查时间显著短于日常临床访谈。【结论】心理CT诊断精神分裂症有较高的信、效度,简单、耗时短,可作为临床诊断精神分裂症的辅助工具。     

三氟噻吨与氯丙嗪治疗精神分裂症的观察护理

三氟噻吨属硫杂蒽类药物,自1963年应用于精神科临床,20世纪70年代初就被肯定为一种有效的抗精神病药物。目前该药与吩塞嗪类、丁酰苯类药物共同构成治疗精神分裂症的三大类经典药物。近年来,三氟噻吨已在国内陆续应用,但报道者不多。为此笔者将该药与氯丙嗪进行了对照研究,现将观察和护理体会介绍如下。1资料与方法1.1研究对象精神分裂症住院患者153例,用中国精神障碍诊断量表(DSMD)评定,符合CCMD-2-R与DSM-Ⅳ精神分裂症妄想型、青春型、紧张型、单纯型与未定型的诊断;入组时简明精神症状量表(BPRS)总分≥36(前18项),性别不限,年龄18…     

精神分裂症应用维思通治疗的临床观察

我院自1997年10月～1999年7月应用维思通治疗精神分裂症53例,总有效率达88.7％。现报道如下: 对象与方法 一、对象:53例均符合CCMD-2-R精神分裂症诊断标准,简明精神病评定量表     

奎的平与氯氮平治疗首发精神分裂症对照研究

目的 了解奎的平与氯氮平对精神分裂症的疗效及不良反应的差别。方法 选择符合DSM-Ⅳ和CCMD-2-R关于精神分裂症诊断标准的患者,且阳性和阴性症状量表(PANSS)评分>60分。共108例患者完成了8w的研究,其中奎的平组55例,氯氮平组53例。在治疗前及治疗后1、2、4、6w分别评定PANSS,CGI及ESPS量表。结果 奎的平对精神病性症状的总有效率与氯氮平组相比无明显差异。但奎的平对抑郁症状、攻击行为和敌意、认知功能障碍的疗效明显好于氯氮平,两组有显著性差异。在8w的治疗过程中,奎的平组的总体副反应,特别是行为障碍和肌张力障碍明显少于氯氮平组,两组有显著性差异。结论 奎的平是一种较理想的抗精神病药,对首发精神分裂症有较好的疗效和耐受性,并且起效较快,安全性高,值得临床推广使用。     

情感性精神病亚型家系调查

为进一步探索情感性精神障碍病因及发病机理,为其诊断治疗、预防提供依据,对我院1993-10～1994-09情感性精神障碍先证者60例进行家系调查如下. 1对象和方法 1.1对象依据CCMD-2,将确诊为情感性精神障碍的患者作为先证者的筛选对象,再依据DSM-Ⅲ-R进行诊断和区别亚型,同时符合BRMS评分＞18分及HAMD评分＞20分者方可作为调查对象.     

血管性痴呆动物模型的实验研究进展

<正>血管性痴呆(vascular dementia,Va D)是指由缺血性卒中、出血性卒中和造成认知和行为等脑区低灌注的脑血管疾病所致的严重认知功能障碍综合征[1]。VD是继Alzheimer’s disease(AD)后导致老年人认知损害的第二大原因,尽管有相关的诊断标准,包括ICD-10诊断标准、DSM-Ⅳ诊断标准、美国加州AD诊断和治疗中心(ADDTC)标准、美国国立神经系统疾病与卒中研究所和瑞士神经科学研究国际协会(NINDS-AIREN)标准,但目前对其定义、分类、诊断标准仍存在争议[2]     

精神分裂症患者利培酮治疗前后血清泌乳素 含量的变化及其与疗效的关系

目的研究非典型抗精神病药物对精神分裂症患者血清泌乳素(PRL)的影响及其与疗效的关系。方法选择符合ICD-10和CCMD-2-R诊断标准的精神分裂症患者和无中枢神经系统疾病的健康受试者各40例,其中精神分裂症患者以利培酮治疗8周,采取阳性和阴性症状量表(PANSS)在治疗前后分别评定一次,用放射免疫法在治疗前后测定血浆PRL浓度,健康受试者也分别在0周和8周用放射免疫法测定血清PRL浓度。结果利培酮治疗后PANSS总分均有不同程度的下降。精神分裂症患者血清PRL水平在治疗前与健康受试者之间无明显差异,治疗后血清PRL水平显著升高,且与健康受试者存在显著差异,并且治疗后PRL水平较高,治疗前后差异较大或治疗前PRL水平较高者,疗效较好,尤其是阳性症状改善明显。结论利培酮可明显增加血清PRL水平;而且治疗前、后血清PRL水平与疗效相关,主要与阳性症状的疗效有关。     

Diagnostic criteria for Asperger syndrome

The diagnostic criteria for Asperger syndrome (AS) are still controversial. ICD-10 and DSM-IV are usually used as a formal diagnostic criteria for AS. However, many papers point out there are many problems in ICD-10/DSM-IV. It is indicated that the diagnosis of AS using ICD-10/DSM-IV criteria is virtually impossible due to the rule of onset and precedence. ICD-10/DSM-IV criteria don't include core symptoms of AS, such as odd speech and limited intelligent interests reported by Hans Asperger. Most of the cases which are diagnosed as AS clinically meet the diagnostic criteria for autism or atypical autism(PDD-NOS) in ICD-10/DSM-IV. ICD-10/DSM-IV criteria is too narrow to diagnose AS. This causes much confusion and disadvantage for families, clinicians and researchers. We need to establish the clinically useful and reliable diagnostic criteria for AS.     

精神分裂症患者出院后忧郁自杀情况分析

目的：探讨获得显著进步的出院精神分裂患者,不久即出现忧郁自杀的原因。方法：对符合ＣＣＭＤ－２精神分裂症诊断标准的８例患者进行追踪随访。结果：８例中１例自杀未遂,４例自杀身亡。结论：２例系药源性忧郁;６例为出院后心理社会适应不良导致其中４例自杀死亡。建议对精神分裂症患者出院前,特别首次住院者做好心理、社会适应性辅导的心理康复治疗工作。     

女性精神分裂症伴高泌乳素血症患者泌乳素水平观察分析

目的探讨女性精神分裂症伴有高泌乳素血症患者后泌乳素水平变化。方法选择符合中国精神疾病分类与诊断标准(CCMD-2-R)关于精神分裂症的诊断标准,同时符合高泌乳素血症的诊断标准的患者130例分两组进行利培酮和阿立哌唑治疗,用化学发光法在治疗前后同时对患者组和对照组泌乳素水平进行测定分析。结果治疗后与治疗前比较,对照组血清泌乳素水平无变化;利培酮组患者的血清泌乳素水平显著升高,比较差异有统计学意义(P<0.01);阿立哌唑组患者的血清泌乳素水平无明显升高,比较差异无统计学意义(P>0.05)。结论治疗女性精神分裂症患者时,要充分考虑抗精神病药物对其生理功能的影响。选择对泌乳素影响小的抗精神病药物是关键。     

Quantifying headache symptoms and other headache features from chart notes

OBJECTIVES: To describe a method for quantifying headache symptoms/features in family practice charts for patients diagnosed with headache NOS (not otherwise specified, ICD-9: 784) and to determine the share of NOS headache diagnoses with clinical data strongly suggestive of migraine or probable migraine headache. BACKGROUND: Headache is one of the most common pain symptoms that brings patients to a family physician. However, the majority of headache sufferers do not receive a specific headache diagnosis when they visit physicians. METHODS: We examined the chart notes of 454 patients exclusively diagnosed with one or more ICD-9 coded headache NOS diagnoses from July 1, 1995 through December 31, 1999 at a large suburban, university-affiliated practice. We developed a template containing 20 headache items combining International Headache Society diagnostic criteria and additional headache symptoms/features, and decision rules for coding symptoms/features and collected data from patient charts. We then developed decision rules and reclassified NOS headaches into categories strongly suggestive of migraine, probable migraine headache, or other diagnosis. Our main outcome measure is the consistency in the application of decision rules and diagnostic criteria. RESULTS: With this method we estimate 3 in 10 (29%) headache NOS patients may have had migraine (8%) or probable migraine headache (21%). Reclassified migraine visits averaged 6.5 migraine symptoms and reclassified probable migraine headache visits 4.7 migraine symptoms. Logistic regression analysis supports the consistency of diagnostic criteria for classifying headache based on coded symptoms/features--our model correctly predicted 96% of visits. Evidence of physical examination was recorded at 75% of visits suggesting that physician attention is focused on elimination of secondary headache. CONCLUSIONS: We think the use of our rigorous procedures reveals that a substantial amount of migraine and probable migraine headache may be missed in everyday practice. We hope our findings will provide a basis for the development of diagnostic methods more closely suited to the needs of nonspecialists, and contribute to a better standard of care for headache patients seen in primary care practice. Finally, we are hopeful that other researchers will consider using our template and guideline procedures in their efforts to identify diagnostic patterns and study headache and other health problems.     

Delirium: screening, assessment and diagnosis

Delirium is an acute decline in attention and cognition. To make a diagnosis, there are two classification systems: the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the International Classification of Diseases (ICD-10). While the core criteria are similar in both systems, ICD-10 requires three additional criteria to make a diagnosis: disturbed psychomotor behaviour and sleep-wake-cycle and emotional disturbances. Thus, making a diagnosis according to ICD-10 criteria is more stringent. Depending on the population, up to 60 percent of patients with delirium, diagnosed by DSM-IV criteria, are missed by ICD- 10. In clinical practice, several screening and assessment instruments are available. Most of them are based on DSM-IV criteria. In this article, two instruments will be discussed, which have been used by nurses in the Basel Delirium Management Program in Switzerland. Screening for delirium is accomplished with the Delirium Observatie Screening Schaal (DOS) Scale developed by Schuurmans (2001). For assessment, the Confusion Assessment Method (CAM), developed by Inouye, is used. While the DOS is a classical observation instrument, the CAM requires a structured interview, similar to the Mini-Mental State Exam by Folstein. Both the DOS and CAM instruments were scientifically translated into German. This article will present the translated versions of both DOS and CAM, report their use in a Swiss population of patients at risk for delirium and provide the theoretical background of diagnosing delirium with the criteria of the DSM-IV and ICD-10.     

对精神分裂症病人实施认知疗法的效果观察

[目的]探讨对精神分裂症病人实施认知行为疗法的效果.[方法]将62例符合CCMD-2-R诊断标准,以阴性症状为主的精神分裂症病人随机分为单纯药物治疗组(B组)和药物联合认知行为心理护理治疗组(A组),疗程8周,采用阴性症状评定量表、住院病人护士观察量表评定疗效.[结果]治疗第4周、第8周A组阴性症状评分较治疗前明显降低;住院护士观察量表评定总积极因素分较B组高,总消极因素分较B组低.[结论]对精神分裂症病人实施认知行为疗法对阴性症状的改善有辅助疗效.     

Comparison of proposed diagnostic criteria with FACT-F and VAS for cancer-related fatigue: proposal for use as a screening tool

The objective was to validate the use of the proposed International Statistical Classification of Diseases and Related Health Problems (10th revision) (ICD-10) criteria for fatigue (P-ICD10) through comparison with the Functional Assessment of Cancer Therapy Fatigue (FACT-F) subscale and three visual analogue scale (VAS) qualities in cancer patients thought to be fatigued. Fatigue was assessed in 834 cancer patients at three clinical centres in Belgium, using P-ICD10, FACT-F, and VAS to assess: level of energy (VAS1), quality of life (VAS2), and ability to perform daily activities (VAS3). Of the 834 interviewed cancer patients, 54% were classified as fatigued by the P-ICD10 criteria. Internal consistency of P-ICD10 was very good (alpha coefficient 0.82). The principal component analysis corroborated good internal consistency with all variables included in the first component; a second component was used to identify psychological fatigue (concentration and short-term memory disabilities). An abridged set of screening tools based on the first three general symptoms of the P-ICD10 is proposed with 100% specificity and 86% specificity, respectively. There was a marked decrease in FACT-F and VAS1 scores in patients diagnosed as fatigued by the P-ICD10 (mean±SD, FACT-F 20±9 vs 39±8, VAS1 34±21 vs 61±21). A logistic regression model between P-ICD10 criteria diagnosis and FACT-F (VAS1) identified a score of 34 (61) on the FACT-F scale as a proposed cut-off point for the diagnosis of fatigue. The ICD-10 criteria can be recommended as a diagnostic tool, whereas the FACT-F scale and the level of energy 100-mm VAS assess the intensity of fatigue, and are more suitable for follow-up of cancer-related fatigue.Professor Evers passed away suddenly. The authors will always remember his enthusiastic collaboration, wise counsel, and powerful vision.This work was supported by an unrestricted grant from Janssen-Cilag Belgium.     

维思通治疗首发精神分裂症临床观察

为观察维思通对首发精神分裂症的疗效,对符合CCMD-2-R精神分裂症诊断的首发病人,接受维思通治疗,并于治疗前及治疗后1、2、4、8周使用简明精神病量表(BPRS)及副反应量表(TESS)评定。结果,维思通对于首发精神分裂症各种类型均有较好疗效,不良反应以静坐不能、口干、便秘、心动过速较常见。提示,维思通对于首发精神分裂症有较好的疗效。