精神分裂症恢复期社交焦虑的研究

为探讨精神分裂症恢复期社交焦虑（SAD），对200例精神分裂症恢复期患者用汉密顿焦虑量表（HAMA），社交焦虑量表（LSAS）进行评分。结果，200例精神分裂症恢复期患者出现社交焦虑者占33．5％，其中社会功能和学习功能受影响者占41．79％。提示，对精神分裂症恢复期患者出现SAD者应引起高度重视。     

社交焦虑障碍患者父母养育方式分析

目的：探讨社交焦虑障碍（SAD）患者的发病与父母养育方式的关系。方法：采用自编社会人口学资料调查表、父母养育方式量表（EMBU）对30例SAD患者（患者组）和30名正常人（对照组）进行评估;以Liebowitz社交焦虑量表（LSAS）≥38分为界,评估SAD的严重程度。结果：患者组LSAS评分平均（78.0±27.8）分显著高于对照组的（22.2±9.0）分,两组比较差异有统计学意义（χ2=10.477,P〈0.01）。患者组EMBU中父亲的拒绝、否认因子分和过度保护因子分平均（11.10±3.93）分和（10.77±2.57）分显著高于对照组的（8.67±1.97）分和（9.30±1.77）分（t=3.035、2.578,P〈0.01或P〈0.05）;父亲的情感温暖、理解因子分和偏爱被试因子分平均（43.30±11.45）分和（10.50±2.91）分显著低于对照组的（51.20±8.10）分和（12.87±5.43）分（t=3.085、2.104,P〈0.01或P〈0.05）。母亲的拒绝、否认因子分平均（13.93±5.34）分显著高于对照组的（11.33±2.26）分（t=2.457,P〈0.05）,母亲的情感温暖、理解因子分和偏爱被试因子分平均为（43.07±12.07）分和（10.50±2.91）分显著低于对照组的（51.53±8.26）分和（12.87±5.43）分（t=3.170、2.104,P〈0.01或P〈0.05）。结论：SAD的发生与父母养育方式有关,不良的父母养育方式可能是SAD的发病原因之一。     

社交焦虑障碍与认知功能的相关性研究

目的:探讨社交焦虑障碍(SAD)患者的社交障碍与认知功能的关系。方法:对60例SAD患者(SAD组)及60名性别、教育程度和年龄匹配的健康对照者(正常对照组)进行成套神经认知功能[包括威斯康辛卡片分类测验(WCST)、持续操作功能测试(CPT)、踪迹描绘测验(TMT)、词语流畅性测验(WFT)和听觉词语学习测验(AVLT)]评估及比较;并对患者进行利博维茨社交焦虑量表(LSAS)、状态-特质焦虑量表(STAI)及贝克抑郁量表第2版(BDI-II)临床评估;采用皮尔逊相关性对SAD患者临床状况评分与神经心理测试指标进行相关性分析。结果:SAD组WCST测试的完成分类数的测试分(5.2±1.4)明显低于正常对照组(5.3±0.6),持续性错误数(1.6±2.7)明显高于正常对照组(0.7±0.7)(P均0.05); LSAS评分(63.5±25.5)明显高于正常值(28.4±21.5);SAD组LSAS评分与WCST的持续性错误数呈正相关(r=0.535,P0.05),与WCST分类成绩呈负相关(r=-0.353,P0.05)。结论:SAD患者认知功能中的执行能力明显降低,并与SAD严重程度相关。     

强迫症患者持续性注意功能的相关性研究

目的了解强迫症（OCD）持续性注意功能损害情况及其相关因素。方法对65例OCD患者在入组时进行连续操作试验（CPT）测试，以65例正常健康人进行对照，采用耶鲁-布朗强迫量表（Y—BOCS）、汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）评定病情与情绪，并对测试结果与病程、年龄、病情严重度和焦虑、抑郁情绪等进行回归分析。结果OCD患者CPT视觉单目标持续性注意测验（VOT）、视觉连续目标持续性注意测验（VST）、听觉持续性注意测验（ET）均高于正常对照组（z=3．79～8．62，P〈0．05），CPT评分与病程、年龄无关（标准化回归系数Beta=0．012—0．198，P〉0．05），与病情严重度和情绪有相关性（VOTCV Beta=0．566，VOTHAMA Beta=0．382，VOTHAMD Beta0．294，P〈0．05）。结论OCD患者存在一定的注意损害，注意损害与病情严重度和情绪有关。     

Liebowitz 社交焦虑量表在社交焦虑障碍评定中的应用

背景在过去20年,越来越多的量表应用于评估社交焦虑障碍。Liebowitz社交焦虑量表(LiebowitzSocialAnxietyScale,LSAS)在临床及流行病学调查中应用广泛,尤其对社交焦虑障碍药物治疗疗效的评估优于其他量表[3],同时该量表是唯一一个将社交焦虑障碍的回避症状及害怕症状分开评定的量表。因此我们探讨LSAS在评定社交焦虑障碍患者与正常人群的信度及效度,以及该量表在医生评定及患者自评之间可能存在的差别。方法本研究收录在2002年10月至2003年11月期间于中山大学附属第三医院精神科门诊求诊的未经治疗的社交焦虑障碍患者作为患者组,所有患者符合美国精神障碍诊断和统计手册第四版(DSM-IV)社交焦虑障碍的诊断标准。共55例患者纳入本研究,其中男性40例,女性15例。年龄为18～37岁,平均(26.2±4.8)岁,病程2～12年,平均(5.5±4.3)年,均为社交焦虑障碍的广泛亚型。收录中山大学168名社交恐怖症量表分小于24分的大学生作为正常对照组。其中男92例,女76例,年龄为20～22岁,平均(21±0.8)岁。所有研究对象均填写由作者翻译成中文的LSAS(中文版LSAS)及自编的一般情况量表。在正常对照组中随机抽取31名学生于4周后重测LSAS量表以观其重测信度。在55例患者中随机抽取33例在自己完成量表后和一名精神科医生会晤。该精神科医生就患者的情况使用LSAS量表评分。并比较自评与医评得分的可能差别。结果①患者组及正常对照组的LSAS总分与24条项目的Cronbathα信度系数分别为0.83及0.77;②LSAS总分及各因子分在31名正常对照组4周后的重测信度为0.68～0.79;③LSAS对判别社交焦虑障碍患者与在校大学生的ROC曲线下面积为0.87±0.03,以总分大于35分为界来判断有无社交焦虑障碍,其敏感度为0.77,特异度为0.81;④患者组LSAS总分明显高于正常对照组(66.6±28.3与29.1±17.3比较;P<0.001);⑤对33例患者既行自评又行医评,自评与医评得分无明显差异(64.1±30.1与61.9±23.8比较;P>0.05)。⑥无论在患者组还是在正常组,LSAS的总害怕分均高于总回避分(分别为36.8±14.1与30.0±16.0比较及16.5±9.4与12.6±9.6比较;P<0.001)。结论LSAS具有良好的内部一致性及重测信度,在评定社交焦虑障碍患者与正常人群中有很高的敏感度与特异度,并且我们建议LSAS自评总分大于或等于35分者为可能有社交焦虑障碍。LSAS在患者中的医评与自评结果无明显差异,所以临床上可使用患者自评代替医评以节约时间。我们的结果也显示出患者与正常人群的害怕症状明显均高于回避症状,因此我们认为害怕症状可能先于回避症状出现,并且可能是对社交的害怕(负性思维)导致了回避症状的出现。     

护理干预对颅内肿瘤患者术前焦虑的影响

目的探讨护理干预对减轻颅内肿瘤患者术前焦虑的效果。方法将入选的70例颅内肿瘤患者随机分为干预组和对照组，每组35例。干预组人院后即进行术前护理干预，对照组仅在术前1d进行常规访视，分别于人院后次日及术前采用焦虑自评量表（SAS）测评和汉密尔顿抑郁量表（HAMD）测定，比较干预前后的焦虑水平。结果干预后干预组的HAMD总分[（17．37±2．51）分]与干预前[（36．28±4．21）分]及对照组[（37．73±4．17）分]相比显著降低（P〈0．05）；干预后干预组的SAS总分[（31．25±3．13）分]与干预前[（45．53±3．76）分]及对照组[（44．82±3．48）分]相比也显著降低（P〈0．05）。结论护理干预能有效地改善患者术前焦虑状况，有利于手术的顺利进行和促进患者术后康复。     

首诊强迫症患者的认知功能特点研究

目的探讨首诊强迫症患者的认知功能特点。方法选取我院符合ICD-10的首诊强迫症住院患者24人为病例组;从医护人员中选取年龄、性别及受教育程度类似的被试24人作为对照组。分别对两组人员进行划销测验和《临床记忆量表》检查,应用SPSS13.0进行统计分析。结果在划销测验中,强迫症组与对照组相比反应时延长,正确数减少,漏划数增加,且差异显著（P〈0．05）;在《临床记忆量表》测验中两组的记忆商、联想学习、图像自由回忆、人像特点回忆得分均有显著差异（P〈0．05）,强迫症组较差,指向学习、无意义图形再认得分两组差异不显著（P〈0．05）。结论强迫症患者存在明显的认知功能障碍,认知功能损害是使其症状不易缓解的原因之一。     

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。     

矿工焦虑、抑郁水平与应对方式的相关分析

目的了解矿工的焦虑、抑郁现状,探讨其焦虑、抑郁与应对方式的关系。方法采用焦虑自评量表（SAS）、抑郁自评量表（SDS）和应对方式问卷（CSQ）对678名矿工进行问卷调查。结果矿工的SAS、SDS得分（43．41±9．60）和（47．51±11．50）分均显著高于国内常模（37．23±12．59）和（41．88±10．57）分,差异有统计学意义（t=16．749,12．757;P〈0．01）;男性矿工的SAS得分显著高于女性（P〈0．05）,农村来源的矿工SDS得分显著高于城市来源的矿工（P〈0．05）,井下矿工的SAS、SDS得分均显著高于地面矿工和管理人员（P〈0．01）。在应对方式上,男性矿工多采用解决问题和自责（P〈0．05）,农村来源的矿工多采用自责和幻想（P〈0．01）,井下矿工多采用自责、幻想、合理化（P〈0．01）。矿工的SAS得分与应对方式各因子（除解决问题外）显著相关（P〈0．01）,SDS得分与应对方式各因子均显著相关（P〈0．01）。消极应对方式对矿工的焦虑、抑郁水平均影响显著（P〈0．05）。结论矿工的焦虑、抑郁水平较高,消极应对方式不利于矿工的心理健康。     

拉莫三嗪对癫痫患者生活质量影响的研究

目的：评价拉莫三嗪对癫痫患者生活质量的影响。方法：采用多中心、前瞻性的研究方法，对新诊断癫痫患者应用拉莫三嗪治疗，并在基线期及用药6个月后，采用QOLIE-31、MOSSF-36量表、数字符号转换测验、HAMD抑郁量表和女性专用调查问卷对患者进行生活质量评价。结果：共纳入新诊断癫痂患者282例。MOSSF-36量表的8个项目得分在用药后均有显著提高（P〈0．01）；QOLIE-31问卷中“对癫痫的担心”、“情绪”、“活力”、“认知”、“药物不良反应”、“社会功能”及“总体自身健康评价”项目得分在用药后均有显著提高（P〈0．01）。用药后，患者Hamilton抑郁量表平均3．65分，显著低于基线期6．42分（P〈0．01）；数字符号转换测验得分在用药后与基线期比较有显著提高（P〈0．01）。结论：拉莫三嗪初始单药治疗能在一定程度上改善新诊断癫痫患者的生活质量。     

Screening for social anxiety disorder in the clinical setting: using the Liebowitz Social Anxiety Scale

OBJECTIVE: We sought to determine optimal cutoff values for the Liebowitz Social Anxiety Scale (LSAS) total and subscale scores for the diagnosis of social anxiety disorder (SAD) and designation of the generalized subtype of SAD. METHOD: Three hundred and sixty-four patients from a multi-site sample who met criteria for SAD according to structured diagnostic interview, 262 of whom met criteria for the generalized subtype, and 34 control participants free of current Axis I disorders participated in this study. All participants were given the Liebowitz Social Anxiety Scale by an independent assessor. RESULTS: Receiver Operating Characteristics analysis revealed that the LSAS performed well in identifying individuals who met criteria for SAD and for the generalized subtype of SAD. Cutoffs of 30 for SAD and 60 for its generalized subtype on the LSAS total score represented the best balance of specificity and sensitivity. CONCLUSIONS: These findings provide support for the use of the Liebowitz Social Anxiety Scale for the identification of individuals with SAD and its generalized subtype in clinical settings. Identification of patients with SAD should increase the percentage of these patients who receive appropriate treatment for this impairing disorder.     

Is there a complex relation between social anxiety disorder,childhood traumatic experiences and dissociation?

Background: A possible relationship has been suggested between social anxiety and dissociation. Traumatic experiences, especially childhood abuse, play an important role in the aetiology of dissociation.

Aim: This study assesses childhood trauma history, dissociative symptoms, and dissociative disorder comorbidity in patients with social anxiety disorder (SAD).

Method: The 94 psychotropic drug-naive patients participating in the study had to meet DSM-IV criteria for SAD. Participants were assessed using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), the Dissociation Questionnaire (DIS-Q), the Liebowitz Social Anxiety Scale (LSAS), and the Childhood Trauma Questionnaire (CTQ). Patients were divided into two groups using the DIS-Q, and the two groups were compared.

Results: The evaluation found evidence of at least one dissociative disorder in 31.91% of participating patients. The most prevalent disorders were dissociative disorder not otherwise specified (DDNOS), dissociative amnesia, and depersonalization disorders. Average scores on LSAS and fear and avoidance sub-scale averages were significantly higher among the high DIS-Q group (p?p?Conclusions: It is concluded that, on detecting SAD symptoms during hospitalization, the clinician should not neglect underlying dissociative processes and traumatic experiences among these patients.     

Self esteem,dependency, self-efficacy and self-criticism in social anxiety disorder

BackgroundSocial anxiety disorder (SAD) is characterized by fear and avoidance in social situations where one perceives being in danger of scrutiny by others. Low self-esteem, low self-efficacy, high self-criticism and high dependency are additional potential features of SAD, and thus their examination is warranted, as is the elucidation of their inter-relationship.MethodThirty-two SAD subjects diagnosed with the Mini-International Neuropsychiatric Interview and 30 healthy controls, were administered the Liebowitz Social Anxiety Scale (LSAS), the Rosenberg Self Esteem Scale, the Depressive Experiences Questionnaire (DEQ) that assesses self-criticism, dependency and self-efficacy, and a socio-demographic questionnaire. We hypothesized that the SAD group would present higher scores of dependency and self-criticism and lower self-esteem and self-efficacy. We also hypothesized that low self-esteem, low self-efficacy, high self-criticism and high dependency will predict the severity of SAD.ResultsIn line with the hypotheses, SAD patients had higher scores of self-criticism and dependency and lower scores of self-esteem. The social anxiety score correlated negatively with self-esteem and self-efficacy, and positively with dependency and self-criticism. Self-criticism, but not the other measures, predicted the total LSAS score.ConclusionsSelf-esteem, self-criticism, dependency and self-efficacy are related to SAD and their relations should be examined in future studies that will employ larger samples. It is suggested to search for ways to affect these factors through cognitive-behavioral interventions and additional psychotherapeutic treatments. Research should also focus on the specific role of self-criticism in SAD.     

Shyness and social phobia in Israeli Jewish vs Arab students

Background

Social anxiety disorder (SAD) has been repeatedly shown to be very prevalent in the Western society with prevalence rates of 10% or above. However, very few studies have been performed in the Middle East and in Arab countries.

Methods

A total of 300 Israeli students participated in our study and were administered the Liebowitz Social Anxiety Scale (LSAS), the Cheek and Buss Shyness Questionnaire (CBSQ), and a sociodemographic questionnaire.

Results

A total of 153 Jewish and 147 Arab students participated in the survey. Social anxiety disorder was found in 12.33% of the sample, according to the LSAS cutoff score of more than 60. The 2 subsamples had similar LSAS and CBSQ scores and similar SAD-positive rates (LSAS >60). Females had higher scores on the LSAS, as were those without a spouse and those who had been in psychological treatment. Based on a regression analysis, the significant predictors of the LSAS score were the CBSQ score and female sex. A very high correlation was found between the LSAS and the CBSQ scores.

Conclusions

Although our sample is not representative of the whole Israeli population, we conclude that SAD and shyness were similarly prevalent in Jewish and Arab students in Israel. Social anxiety disorder scores were higher among females, those without a spouse, and those who received psychological treatment. Further studies on the clinical and cultural characteristics of SAD in Israeli subcultures would add to the growing body of knowledge on SAD in various cultures.     

History of trauma and dissociative symptoms among patients with obsessive-compulsive disorder and social anxiety disorder

We aimed to compare the history of trauma and the profile and severity of dissociative symptoms of patients with obsessive-compulsive disorder (OCD) to those of patients with social anxiety disorder (SAD). Patients with OCD (n = 34) and patients with SAD (n = 30) were examined with the following instruments: Trauma History Questionnaire (THQ), Dissociative Experience Scale (DES), Obsessive-Compulsive Inventory (OCI), Liebowitz Social Anxiety Scale (LSAS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Patients with OCD reported significantly lower rates of exposure to traumatic events. Nevertheless, the severity of dissociative symptoms was not significantly different between the groups. Regression analyses showed that, while the OCI scores better predicted the variance on DES scores in the OCD sample, the LSAS and the BAI better predicted the variance on the DES among patients with SAD. Patients with OCD are probably less vulnerable to some types of traumatic experiences. Dissociative symptoms may cut across different anxiety disorders.     

社交焦虑障碍的认知行为集体治疗效果的影响因素

目的 探讨社交焦虑障碍的认知行为集体治疗疗效的影响因素。方法 上海市精神卫生中心就诊的社交焦虑障碍患者中自愿参加认知行为集体治疗者,每个治疗小组6～8人,治疗8周,每周1次2．5小时,内容包括认知重建、放松训练、社交技巧训练、系统暴露、现场暴露和家庭作业。疗效评定工具为Liebowitz社交焦虑评定量表。结果 58例患者中社交焦虑评定量表总分、恐惧因子分和回避因子分治疗前后差异均有统计学显著性意义。在研究可能影响治疗的20种因素中有19种因素有显著的影响作用。结论 认知行为集体治疗社交焦虑障碍有效,但影响疗效因素较多,应用该治疗方案时应予充分考虑。     

Comparison of anxiety-related traits between generalized and nongeneralized subtypes of social anxiety disorder

This study aimed to investigate the possible difference in anxiety-related traits between the generalized and nongeneralized subtypes of social anxiety disorder (SAD). Two hundred seventy-three SAD Korean outpatients completed the Anxiety Sensitivity Index (ASI), the Trait Form of the State-Trait Anxiety Inventory (STAI-T), Retrospective Self-Report of Inhibition (RSRI), and the Liebowitz Social Anxiety Scale (LSAS) as part of their assessments. The unadjusted total scores of the ASI, STAI-T, RSRI, and LSAS differed between the two subtypes, according to an independent t-test. However, this result was not significant (ASI: F = 2.363, p = 0.127; STAI-T: F = 0.004, p = 0.949; RSRI: F = 1.518, p = 0.220) after adjusting for LSAS total score. The comparison of anxiety-related traits did not show any difference between the subtypes after adjusting for illness severity. These results may suggest that the two SAD subtypes are on a continuum of the same illness, differentiated only by symptom severity.     

精神分裂症和抑郁症伴焦虑障碍的研究

目的 了解精神分裂症和抑郁症住院病人与焦虑障碍的共病发生率及相关因素分析。方法 住院精神分裂症病人41例和抑郁病人40例,用简明精神病量表（BPRS）、Hamilton抑郁量表（HAMD）、Hamilton焦虑量表（HAMA）、Liebowitz社交焦虑量表（LSAS）进行评定。结果 精神分裂症病人焦虑障碍的共病率为29．26％,抑郁症与焦虑障碍的共病率为50L。LSAS与HAMA呈正相关（r=0.465)。有关精神分裂症和抑郁症病人共病焦虑障碍经多元逐步回归可排除药源性焦虑。结论 对精神分裂症和抑郁症共患焦虑障碍应引起临床高度重视。