医学生的绝望感与自杀意念:心理韧性的作用机制

目的:探讨医学生的绝望感与心理韧性和自杀意念的关系,以及心理韧性在医学生的绝望感与自杀意念之间是否具有补偿、调节及中介效应。方法:采用贝克绝望量表(BHS)、自杀意念自评量表(SIOSS)和青少年心理韧性量表(RSCA)对1120名医学生进行施测。结果:绝望感各因子及总分与自杀意念呈显著正相关(r=0.443,0.472,0.493,0.608;P0.01),心理韧性总分与绝望感总分及各因子呈显著负相关(r=-0.555,-0.300,-0.500,-0.470;P0.01),心理韧性总分与自杀意念总分呈显著负相关(r=-0.528,P0.01)。医学生的心理韧性在其绝望感与自杀意念之间同时具有补偿(β=-0.275,-0.247,-0.199;P0.001)、中介(β=0.455,0.481,0.515;P0.001)和调节效应(B=-1.096,-1.013,-1.105;P0.001)。结论:心理韧性是抑制医学生自杀意念的重要保护因素,它可以补偿、缓冲和调节绝望感对自杀意念的促进作用,同时这一保护因素也会受到绝望感的削弱。     

生活事件、自尊和抑郁对大学生自杀意念的影响

目的:探讨生活事件、自尊和抑郁对大学生自杀意念的影响,为大学生自杀预防提供依据。方法:采用青少年生活事件量表、自尊量表、症状自评量表—抑郁分量表、贝克抑郁自评量表—"自杀想法"条目对2802名大学生进行问卷调查。结果:自杀意念检出率为16.95%,有自杀意念组的生活事件各因素得分及总分、抑郁总分显著高于无自杀意念组,人际关系(t=-17.039,P0.001)、学习压力(t=-13.000,P0.001)、受惩罚(t=-11.000,P0.001)、丧失(t=-8.800,P0.001)、健康适应(t=-15.631,P0.001)、其他(t=-12.240,P0.001)、生活事件总分(t=-16.060,P0.001)、抑郁总分(t=-29.821,P0.001),有自杀意念组的自尊总分(t=-3.92,P0.001)显著低于无自杀意念组;生活事件、抑郁与自杀意念呈显著正相关(r=0.179,0.638,P0.01),自尊与自杀意念呈显著负相关(r=-0.259,P0.01);生活事件通过自尊和抑郁的中介效应间接影响自杀意念(中介效应值分别为0.054和0.255),生活事件通过自尊作用于抑郁,又通过抑郁间接影响自杀意念(中介效应值为0.112)。结论:减少负性生活事件,消除抑郁情绪,提高自尊水平,能够有效降低大学生自杀意念的发生率。     

医学院学生自杀意念与希望特质、抑郁情绪的关系以及希望特质的调节作用

目的:探讨医学院学生的自杀意念与希望特质和抑郁情绪的关系,以及在其中希望特质的调节作用。方法:选择某医学院各年级学生按比例进行分层整群随机抽样调查,发放自杀意念自评量表(SIOSS)、希望特质量表(DHS)和抑郁自评量表(SDS)。回收有效问卷148份。结果:样本中自杀意念检出率为8.1%,其中有自杀意念组抑郁得分高于无自杀意念组(t=8.699,P0.001),希望特质评分低于无自杀意念组(t=-6.077,P0.001);抑郁得分与自杀意念得分成正相关(t=0.681,P0.01),希望特质得分与自杀意念得分成负相关(t=-0.328,P0.01)。并且分层回归显示,抑郁自评量表得分与希望特质的交互作用显著(t=-4.727,P0.01),即希望特质在抑郁情绪与自杀意念之间有显著的调节作用。结论:自杀意念与抑郁情绪消极相关,与希望特质积极相关。关注大学生抑郁情绪,提高大学生希望特质水平,可以增强危机因素的抵抗作用,有助于对大学生自杀危机干预工作提供科学参考。     

广州市精神病医院50年住院病人自杀危险因素的病例对照研究

目的:识别精神分裂症住院病人自杀的潜在危险因素,为探讨如何进一步预防住院精神病人的自杀提供依据。方法:对广州市精神病医院1956-2005年住院精神病人自杀进行回顾性分析,并对其中的精神分裂症病人按同性别、同诊断、相同或相近年龄、住院进行1:1匹配的病例对照研究。结果:共有77例住院精神病人发生自杀,自杀发生率为133.1/10万(95%CI103.4-162.85/10万)。多数自杀者为精神分裂症病人(64例,占83.1%),多数自杀者采取自缢的方式(59例,占76.6%),多数病人的自杀行为发生在病房内(52例,占67.5%);自杀组的住院次数明显高于对照组(2.13±1.89/1.23±0.75,P=0.001);自杀组本次住院前1月及住院期间的自杀未遂次数明显高于对照组(0.39±0.85/0.09±0.39,0.59±1.52/0.00±0.00,P=0.017,0.003)。自杀组有罪恶观念、心境抑郁者多于对照组(18.8%/3.1%,28.1%/6.3%,P=0.006,0.004);住院精神分裂症病人的罪恶观念、心境抑郁、本次住院前1月有自杀意念和自杀未遂是其自杀行为发生的危险因素(β=2.407、1.566、1.201、1.643)。结论:该院50年住院病人的自杀发生率与国外近似,精神分裂症病人自杀的危险因素是罪恶观念、心境抑郁、住院前1月自杀意念和自杀未遂。     

抑郁症患者的抑郁状态与自杀意念

目的探讨抑郁症患者抑郁状态与自杀意念的关系。方法采用贝克自杀意念量表中文版(BSI-CV)与汉密顿抑郁量表(HAMD)对352名抑郁症患者进行调查。结果抑郁症患者的抑郁总评分为(18.80±8.06);抑郁与自杀意念,特别是抑郁各因子中认识障碍与自杀意念强度(r=0.292,P<0.01)、自杀危险程度(r=0.336,P<0.01)呈显著正相关,阻滞与自杀意念强度(r=0.243,P<0.01)、自杀危险程度(r=0.267,P<0.01)呈显著正相关,绝望感与自杀意念强度(r=0.267,P<0.01)、自杀危险程度(r=0.289,P<0.01)呈显著正相关。结论抑郁因子中认识障碍、阻滞及绝望感与自杀意念呈显著正相关。     

大学生生活事件与自杀意念:生命价值观的中介与调节作用

目的:研究大学生生命价值观在生活事件和自杀意念之间的中介与调节作用。方法:采用青少年生活事件量表(ASLEC)、大学生生命价值观问卷(CSLVQ)和自杀意念量表(SIOSS),对4120名大学生进行测量。结果:生活事件与自杀意念呈显著正相关(r=0.226,P0.01),生活事件与生命价值观呈显著负相关(r=-0.137,P0.01),生命价值观与自杀意念呈显著负相关(r=-0.488,P0.01)。有自杀意念组在生活事件各维度上都显著高于无自杀意念组,有自杀意念组在生命价值观各维度上都低于无自杀意念组。大学生生命价值观在生活事件和自杀意念间起调节效应和部分中介效应。结论:帮助大学生建立积极生命价值观,有利于缓解和降低自杀意念。     

阈下MECT联合抗抑郁药改善抑郁症患者自杀意念的随机对照试验

目的:评估阈下MECT联合抗抑郁药改善抑郁症患者自杀意念的疗效。方法:采用随机对照试验,选取符合美国精神障碍诊断与统计手册(DSM-IV)抑郁障碍诊断标准的住院抑郁症患者108例,随机分为20%电量组、40%电量组及80%电量组。3组给予不同电量MECT治疗8次,分别采用汉密顿抑郁量表-17条目去除自杀条目(HAMD-16)、自杀意念自评量表(SIOSS)评估患者的抑郁症状和自杀意念。结果:3组HAMD-16评分(F=6.55)及SIOSS评分(F=4.29)时间×分组交互作用差异有统计学意义(P0.05),不同分组评分随时间的变化趋势不同。在MECT末次治疗后, HAMD-16评分差值20%电量组小于40%和80%电量组[(-2.3±1.5)vs.(-5.4±3.5),(-4.1±2.3),均P0.001],SIOSS评分差值20%电量组也小于40%和80%电量组[(-2.8±2.2)vs.(-6.1±3.3),(-4.9±2.2),均P0.01],而40%电量组与80%电量组的HAMD-16和SIOSS评分差值的差异均无统计学意义(P0.05)。结论:本试验提示40%电量MECT改善抑郁症患者自杀意念的疗效较好, 20%电量MECT疗效较差不建议选择。     

大学生自杀态度对父母教养方式和自杀意念的中介作用

目的:探讨自杀态度对大学生父母教养方式与自杀意念之间的中介作用。方法:2016年12月,通过方便取样的方式,采用父母教养方式问卷、自杀态度问卷和自杀意念问卷,对天津市某大学488名在校大学生进行问卷调查。结果:大学生自杀意念检出率为17.6%;年级对自杀意念的形成有重要影响(P0.05),而性别、生源地对其无显著影响(P0.05);母亲关爱、母亲鼓励自主、父亲关爱与对自杀行为的态度呈显著正相关(r=0.197,0.112,0.145;P0.05),母亲控制与对自杀者家属的态度呈显著正相关(r=0.193;P0.01),母亲控制、父亲控制与对自杀行为的态度呈显著负相关(r=-0.189,-0.157;P0.01),母亲关爱、母亲鼓励自主与对自杀者的态度呈显著负相关(r=-0.092,-0.093;P0.05),母亲关爱、母亲鼓励自主与对自杀者家属的态度呈显著负相关(r=-0.155,-0.089;P0.05);对自杀行为的态度与自杀意念呈显著负相关(r=-0.192,-0.177;P0.01),对自杀者的态度与自杀意念最抑郁时的得分呈显著负相关(r=-0.117;P0.01),对安乐死的态度与自杀意念呈显著负相关(r=-0.155,-0.127;P0.01)。自杀态度在父母教养方式与自杀意念之间共建立8个中介模型,且全部为部分中介作用。结论:父母教养方式对自杀意念有直接影响,且部分是通过自杀态度的中介作用实现。     

抑郁症患者单次小剂量氯胺酮的疗效及血清瘦素和5-HT水平变化

目的:探索单次小剂量氯胺酮对抑郁症患者疗效和血清瘦素及5-羟色胺(5-HT)水平的影响。方法:符合精神障碍诊断与统计手册第5版(DSM-5)中重性抑郁障碍的诊断标准的39例患者,随机分为氯胺酮组(n=19)和对照组(n=20)。氯胺酮组静脉持续推注0. 5 mg/kg氯胺酮溶液50 mL,推注时间40 min,对照组推注等容量生理盐水50 mL。在治疗前及治疗后第1、3、7天进行病情评估、清晨外周静脉血采样,测量血清中瘦素及5-HT的浓度。用汉密顿抑郁量表(HAMD-24)评定抑郁情绪、贝克绝望量表(BHS)评定绝望、自杀意念自评量表(SIOSS)评定自杀意念。结果:治疗前两组HAMD分、BHS分、SIOSS分均无明显差异(P 0. 05)。氯胺酮组治疗后1、3、7天HAM D量表分较治疗前均明显减少(P 0. 05),BHS分及SIOSS分治疗后1、3天较治疗前有明显下降,而治疗后7天恢复到治疗前水平(P 0. 05)。对照组治疗前后各时点的HAMD分、BHS分、SIOSS分统计学意义均无明显差异(P0. 05)。氯胺酮组治疗后第1天血清瘦素水平明显上升[(1. 16±0. 76)μg/L vs.(1. 75±1. 00)μg/L,P0. 01],第3天、第7天仍增高(P 0. 05),对照组治疗前后无统计学意义;两组治疗前后各时间节点5-HT浓度差异均无统计学意义(P 0. 05)。结论:氯胺酮有快速的抗抑郁疗效,可能与血清瘦素水平上升有关。     

伴非自杀性自伤的青少年抑郁症患者的自杀意念

目的:分析伴非自杀性自伤行为(NSSI)的青少年抑郁症患者的自杀意念及其风险因素.方法:连续入组重庆医科大学附属大学城医院2018年9月-2019年9月住院的伴NSSI的抑郁症患者177例为研究对象,评估自编一般资料问卷、17项汉密尔顿抑郁量表(HAMD-17)和汉密尔顿焦虑量表(HAMA),再使用贝克自杀意念量表(beck)将其分为伴/不伴自杀意念组,并使用Logistic回归分析检验自杀意念的危险因素.结果:①177例伴NS-SI青少年抑郁症患者中有自杀意念的为120例(67.80％).②单因素分析显示,童年创伤史、自杀未遂史、总病程、NSSI 病程、抑郁、焦虑在两组之间有统计学差异(X2=13.135,13.765,t=4.003,31.06,-2.532,-3.684;P＜0.05).③Logistic回归分析显示,童年创伤史(r=5.73,P＜0.05)、自杀未遂史(r=10.588,P＜0.05)、焦虑(r=8.25,P＜0.05)是伴NSSI青少年抑郁症患者出现自杀意念的危险因素.结论:伴NSSI青少年抑郁症住院患者的自杀意念发病率较高,有童年创伤史、自杀未遂史和焦虑情绪者更容易出现自杀意念.     

Secular change in menarche in women in Madrid

The age at menarche was estimated by recollection in 1617 women between the ages of 18 and 60 in Madrid and a nearby suburb, Pinto. The population of Pinto is working-class and the Madrid group, taken from residential neighbourhoods , belongs to the upper middle class. In both groups we found a diminution in average age at menarche, from 14.04 to 13.02 years in Madrid and from 14.55 to 13.16 years from about 1935 to about 1965 in Pinto. These changes have been more intense in the group which is less well-off economically, where living conditions have varied much more drastically.     

Intestinal helminthiasis in school children in Haiti in 2002

A survey on intestinal helminths in school children was conducted in Haiti in 2002. This first nationwide study involving the entire country was stratified by department according to urban and rural zones using the cluster method. Focusing on elementary school children (n=5792; age range 3 to 20 years), it involved 26 urban and 49 rural schools randomly selected. Stools were preserved in formalin and examined by the Ritchie technique. Thirty-four per cent of stools (1981/5792) tested positive for intestinal helminths with the following parasites identified: Ascaris lumbricoides (27.3%), Trichuris trichiura (7.3%), Necator americanus (3.8%), Hymenolepsis nana (2%), Taenia sp. (0.3%) and Strongyloides stercoralis (0.2%). The helminth prevalence was higher in rural (38.4%) compared to urban areas (30%). There was no significant difference in prevalence by sex and age. The importance of geohelminths changed from one department to another with the highest prevalence found in the Southern department of Grande Anse (73.7%) and the lowest prevalence in the Center department (20.6%). Five out of the country's nine departments had a similar prevalence varying from 25.5% to 28.2%. Intestinal helminthic polyparasitism was observed in a percentage of infested school children comprise between 3.4% and 28.6% according in relation to the geographical area. A program to fight against geohelminths in school children should be initiated as a public health priority. Albendazole is the drug of choice. Frequency of drug distribution should be based on the prevalence of geohelminths in each department.     

Experience in adult population in dengue outbreak in Delhi

A dengue outbreak has recently hit the Indian capital. We studied the clinical profile of adult patients. Five hundred and sixty patients of dengue infection were admitted in a specially created ward according to the criteria laid down by WHO. Haematemesis (28.28%), epistaxis (26.78%) and malena (14.28%) were some of the common presentations. Similarly lymphadenopathy, especially cervical (30.89%), palatal rashes (26.96%) and hepatomegaly (23.75%) were the most commonly encountered findings on physical examination. Most of the cases were of dengue fever with haemorrhage and only 2.5% cases were classified under dengue haemorrhagic fever or dengue shock syndrome. The average hospital stay was 3.4 days but only 9.8 hours in the eleven patients who died, suggesting their late arrival in preterminal situation giving little time for resuscitation. Thrombocytopenia was not a feature and only 12.85% patients had platelet count less than 70,000/cmm. Most of the patients who were admitted with thrombocytopenia, showed normalization in their platelet counts in next few days. Serological examination demonstrated evidence of recent dengue infection in 41.17% patients. Few patients required blood or platelet concentrate transfusion. Eleven patients died, three due to DIC, one of intracranial haemorrhage and seven due to massive gastric haemorrhage. Rest of the patients recovered completely. Thus we can conclude that recent outbreak in Delhi was of dengue fever with haemorrhage and mortality was very low in patients who came early to the hospital.     

Changes in the hypothalamic nuclei in in experimental allergy

Summary In rabbits subjected to prolonged sensitization and in which the Arthus phenomenon was induced there was a marked reaction of the hypothalamic nuclei. Staining by Gomori's method indicated a cellular swelling, loss of granules, and protoplasmic vacuolization in the supraoptic nucleus. There was a considerable increase in the size of the cross-sectional area of the cells. The same effects were much less well shown in the paraventricular nucleus. These results show that marked signs of increased neurosecretion developed in the animals at the height of the Arthus phenomenon.(Presented by Active Member AMN SSSR V. V. Parin) Translated from Byulleten Éksperimental'noi biologii i Meditsiny, Vol. 55, No. 4, pp. 110–113, April, 1963.     

Cerebellar noradrenergic systems in aging: studies in situ and in in oculo grafts

Age-related changes in noradrenergic function in the rat cerebellum were examined using electrophysiological and electrochemical techniques. Sprague-Dawley and Fischer 344 rats showed subsensitivity to norepinephrine (NE) locally applied onto cerebellar Purkinje neurons. The modulatory actions of NE on Purkinje cell-evoked activity was also examined. In young rats NE preferentially inhibits spontaneous activity more than evoked excitations when compared to control. These modulatory actions of NE are not seen in senescent Fischer 344 rats. The intrinsic vs. extrinsic influences determining the loss of efficacy to NE were examined using three groups of rats with in oculo cerebellar grafts. The first group had young grafts grown in young hosts and these grafts showed a potent response to perfused NE. The second group, old grafts in old hosts, showed a diminished responsiveness to NE with respect to the first group. The third group consisted of young grafts in old hosts. These grafts demonstrated a responsiveness to NE that was indistinguishable from those in the first group. The integrity of the presynaptic NE fibers was examined in the grafts using electrochemical techniques. No difference in the release of NE was observed in the old grafts. Taken together, these results suggest a loss of postsynaptic NE function that is intrinsically determined. The change in NE modulation could influence information processing within the aged cerebellar cortex. This deficit could underlie behavioral changes seen in senescence.