精神障碍的眼动研究概述

发现精神障碍的生物学指标是目前相关研究的重点,已有大量研究表明精神障碍存在眼动指标方面的异常。本文概述了眼动检测技术在精神分裂症、抑郁症、焦虑症等精神障碍的研究概况,并对今后的研究趋势进行展望。     

精神分裂症探究性眼动分析与P300电位研究

目的探讨精神分裂症患者探究性眼动分析与P300电位对精神分裂症患者的诊断价值。方法对42例精神分裂症患者和40例正常健康者分别进行探究性眼动分析与P300电位测定．并进行比较分析。结果精神分裂症组中探究性眼动分析和P300电位测定的异常率分别为85．7％和81．0％．两者异常吻合率为76．2％。精神分裂症组探究性眼动测定结果中凝视点和反应探索评分值显著低于对照组（P〈0．01），P300电位测定中N2、P3波潜伏期和P3波幅较对照组分别延长和降低（P〈0．01）。结论探究性眼动分析和P300电位测定可作为精神分裂症患者的诊断指标应用于临床。     

眼动检测评估精神分裂症的可行性及其价值

目的：探讨眼动检测对精神分裂症的诊断价值。方法：于2005-01／03选择在山东省精神卫生中心住院的115例精神分裂症患者作为精神分裂症组，同时选择本院职工51例作为正常对照组。应用DEM-2000眼动检测系统分别对调查对象做眼动检测，通过自动记录各组凝视点数目和反应探索评分，分别按凝视点数≤31、28、27、26，反映探索评分≤6，≤5作为阳性，分析各组阳性及阴性检出人数，分别计算敏感度、特异度、阳性预测值和阳性似然比。敏感度=病例组真阳性数&;#247;病例组总数&;#215;100％，可衡量实验正确的识别患某病者的能力；特异度=非病例组的真阴性数&;#247;非病例组总数&;#215;100％，可衡量试验正确的识别非病例的能力；阳性预测值=真阳性数&;#247;总阳性数&;#215;100％，表示试验结果阳性者属于真病例的概率；阳性似然比为试验结果真阳性率与假阳性率之比，阳性预测值和阳性似然比是综合评价敏感度和特异度的指标。当阳性预测值达到70％，阳性似然比为2．06时，敏感度特异度均较理想。结果：所有调查对象测试结果全部进入结果分析。①精神分裂症组的凝视点数、反映探索评分两项指标均显著低于正常对照组（P〈0．01）。②分别按凝视点数≤31、28、27、26，反映探索评分≤6，≤5作为阳性，计算敏感度、特异度、阳性预测值和阳性似然比可以看出，将本调查眼动检测分界值定为凝视点数≤27或反映探索评分≤5，其阳性预测值可达70％以上，阳性似然比2、06以上，其敏感度特异度均较理想。若大于此值，其敏感度升高、而特异度降低，假阳性率增高，误诊率将增加，若小于此值，敏感度降低、而特异度升高，漏诊率增高。结论：眼动检测能在一定程度上反映被检测者的精神状态，对诊断精神分裂症有一定的辅助价值。     

利培酮治疗以阳性症状为主的首发女性精神分裂症患者EEM研究

目的探讨利培酮治疗以阳性症状为主的首发女性精神分裂症患者的探查性眼球活动，为电生理指标在精神科临床的应用提供依据。方法将44例以阳性症状为主的首发女性精神分裂症患者设为研究组，口服利培酮治疗，观察6w，于治疗前及治疗6w末采用阳性与阴性症状评定量表评定患者的精神症状，同时进行探究性眼动分析，测定眼球运动注视点数和反应性探索分；同期随机抽取40例健康体检女性设为对照组，测定眼球运动注视点数和反应性探索分，并与研究组测定结果进行对比分析。结果研究组治疗6w末，阳性与阴性症状量表评分阳性症状分、阴性症状分及总分均较治疗前有显著下降（P〈0．01），治疗前后眼球运动注视点数及反应性探索分均显著低于对照组（P均〈0．01），但治疗6w末眼球运动注视点数及反应性探索分均显著高于治疗前（P均〈0．01）。结论首发女性精神分裂症患者发作期存在明显探查性眼球活动的病理改变，探查性眼球活动异常是首发精神分裂症较特异的生物学标志。随着临床症状的缓解，探查性眼球活动获得部分改善。     

眼动检测评估精神分裂症的可行性及其价值

目的:探讨眼动检测对精神分裂症的诊断价值。方法:于2005-01/03选择在山东省精神卫生中心住院的115例精神分裂症患者作为精神分裂症组,同时选择本院职工51例作为正常对照组。应用DEM-2000眼动检测系统分别对调查对象做眼动检测,通过自动记录各组凝视点数目和反应探索评分,分别按凝视点数≤31、28、27、26,反映探索评分≤6,≤5作为阳性,分析各组阳性及阴性检出人数,分别计算敏感度、特异度、阳性预测值和阳性似然比。敏感度=病例组真阳性数÷病例组总数×100%,可衡量实验正确的识别患某病者的能力;特异度=非病例组的真阴性数÷非病例组总数×100%,可衡量试验正确的识别非病例的能力;阳性预测值=真阳性数÷总阳性数×100%,表示试验结果阳性者属于真病例的概率;阳性似然比为试验结果真阳性率与假阳性率之比,阳性预测值和阳性似然比是综合评价敏感度和特异度的指标。当阳性预测值达到70%,阳性似然比为2.06时,敏感度特异度均较理想。结果:所有调查对象测试结果全部进入结果分析。①精神分裂症组的凝视点数、反映探索评分两项指标均显著低于正常对照组(P<0.01)。②分别按凝视点数≤31、28、27、26,反映探索评分≤6,≤5作为阳性,计算敏感度、特异度、阳性预测值和阳性似然比可以看出,将本调查眼动检测分界值定为凝视点数≤27或反映探索评分≤5,其阳性预测值可达70%以上,阳性似然比2.06以上,其敏感度特异度均较理想。若大于此值,其敏感度升高、而特异度降低,假阳性率增高,误诊率将增加,若小于此值,敏感度降低、而特异度升高,漏诊率增高。结论:眼动检测能在一定程度上反映被检测者的精神状态,对诊断精神分裂症有一定的辅助价值。     

外周血单个核细胞在精神分裂症中的作用

精神分裂症是一种复杂且病因未明的慢性精神疾病，目前诊断主要依据患者的临床表现、医生对症状的观察及评估，缺乏客观的生物学指标，导致临床诊断存在一定困难。近年来，有研究发现免疫炎症反应在精神分裂症的发病机制中发挥作用，通过抗炎治疗后部分患者的精神分裂症症状可在一定程度上缓解，免疫细胞在精神疾病诊疗中的作用逐渐受到重视。本文主要综述外周血单个核细胞作为探索精神分裂症生物标志物的载体在疾病发病机制中的作用及潜在的诊断意义，以期增加对精神分裂症免疫表型理解。     

血清唾液酸测定在急性白血病中的临床意义

血清唾液酸测定在急性白血病中的临床意义裴晓玲，魏平，胡少东，高彦荣近年来，血清唾液酸的测定作为对恶性肿瘤生物学标志的研究已逐渐深入。其适用范围广，是实验诊断肿瘤的较好的指标。我们对５２例急性白血病患者血清唾液酸含量进行了检测，并在临床治疗过程中作了动...     

利培酮治疗首发偏执型精神分裂症患者EEM分析

目的 探讨利培酮治疗首发偏执型精神分裂症患者探究性眼动分析(exploratory eye movement,EEM)与疗效的关系.方法 对40例首发偏执型精神分裂症患者进行治疗前后的EEM及阳性和阴性症状量表(PANSS)测定,并设对照组.结果 治疗后病例组EEM测定各指标较治疗前均明显增高(P<0.05).治疗后PANSS量表各项得分明显降低(P<0.05).结论 利培酮治疗首发偏执型精神分裂症有较好的疗效,EEM可作为评价指标应用于临床.     

传统与非传统抗精神病药及情感矫正剂对探究性眼球轨迹运动的影响

目的：研究精神药物治疗精神分裂症前、后对探究性眼球轨迹运动的影响。方法：38例住院精神分裂症患者，10例情感性精神障碍患者在接受精神药物治疗前和治疗后(30．19&;#177;8．21)d，测试并分析眼球轨迹运动，应用阳性和阴性量表(PANSS)评定精神症状。结果：PANSS在治疗前、后比较其差异有非常显著性(t=13．10，P&;lt;0.01)，判别分析值、眼固定点数、反应性探索分、认知性探索分眼示踪总距离，眼示踪平均距离治疗前、后其差异均无显著性(t=0．36．0．56，0，47，0．77，0．06；P均&;gt;0．05)。判别分析值在精神分裂症患者治疗前、后自身一致性分别为84．2％和81．6％，比较其差异无显著性(t=0，36．P&;gt;0．05)结论：传统与非传统抗精神药物及情感矫正剂对眼球轨迹运动各项指标均无影响；传统抗精神病药物、非传统抗精神病药物对眼球轨迹运动的各项指标在治疗前、后两组间比较其差异无显著性，眼球轨迹运动的指标基本不受抗精神药物影响。判别分析值在药物治疗前、后一致性是稳定，并反应眼球轨迹运动在很大程度上是精神分裂症的生物学指征。     

传统与非传统抗精神病药及情感矫正剂对探究性眼球轨迹运动的影响

目的:研究精神药物治疗精神分裂症前、后对探究性眼球轨迹运动的影响。方法:38例住院精神分裂症患者,10例情感性精神障碍患者在接受精神药物治疗前和治疗后(30.19±8.21)d,测试并分析眼球轨迹运动,应用阳性和阴性量表(PANSS)评定精神症状。结果:PANSS在治疗前、后比较其差异有非常显著性(t=13.10,P<0.01),判别分析值、眼固定点数、反应性探索分、认知性探索分眼示踪总距离,眼示踪平均距离治疗前、后其差异均无显著性(t=0.36,0.56,0.47,0.77,0.06;P均>0.05)。判别分析值在精神分裂症患者治疗前、后自身一致性分别为84.2%和81.6%,比较其差异无显著性(t=0.36,P>0.05)结论:传统与非传统抗精神药物及情感矫正剂对眼球轨迹运动各项指标均无影响;传统抗精神病药物、非传统抗精神病药物对眼球轨迹运动的各项指标在治疗前、后两组间比较其差异无显著性,眼球轨迹运动的指标基本不受抗精神药物影响。判别分析值在药物治疗前、后一致性是稳定,并反应眼球轨迹运动在很大程度上是精神分裂症的生物学指征。     

Using unstructured interviews with participants who have schizophrenia

Unstructured interviews offer a potential source of rich data in nursing research. In this paper, Terence McCann and Eileen Clark examine the challenges presented when unstructured interviews are used with participants who have schizophrenia. They consider unstructured interviewing in the context of an Australian study of how community mental health nurses promote wellness with clients who are experiencing an early episode of schizophrenia.     

神经干细胞在精神分裂症患者治疗中的研究进展

精神分裂症作为一种慢性、致残率高的精神疾病，存在多巴胺假说、失连接假说、神经发育障碍假说、氧化应激假说等多种假说解释其发病机制。神经干细胞具有分裂分化的潜能和修复中枢损伤的作用，在中枢神经系统多个脑区广泛分布。相关研究表明，精神分裂症与胚胎神经干细胞异常和神经发生有关。目前药物治理是精神疾病的主要临床治疗手段，但不可避免地存在多种弊端。根据多巴胺假说，腹侧海马在精神分裂症的治疗中处在关键地位，是各个假说的“共同通路”。借助诱导性多能干细胞建立精神分裂症疾病模型，对疾病发病机制的研究陆续取得进展。神经干细胞在胚胎发育和神经系统发生损伤时的修复过程中发挥着重要作用，将其用于精神分裂症的治疗具有显著优势，这为精神分裂症的治疗提供了新的思路。     

Healthy babies for mothers with serious mental illness: A case management framework for mental health clinicians

Women with a serious mental illness (SMI), notably schizophrenia, bipolar disorder, and personality disorders are considered high risk for adverse pregnancy and birth outcomes, which in turn, are associated with poor neurodevelopment in the child. Failure to access antenatal care, poor adherence with folate supplementation, an unhealthy lifestyle, and inappropriate health decisions can contribute to poor outcomes. Many women with SMI continue contact with mental health services while pregnant. This primary prevention project aimed to develop a framework for community mental health clinicians to improve the reproductive health outcomes for women with SMI. The consultation process involved discussions with key stakeholders, an environmental scan to determine current service delivery issues, a literature review, and individual and group interviews with community mental health clinicians, consumers, general practitioners, and midwives. Three key elements underpin the framework: early detection and monitoring of pregnancy, providing reproductive choices, and implementing a ‘small known team approach’ in the management of the pregnant client. Specific modules within the framework focus upon establishing a professional support network, assessing the risk of pregnancy, the early detection of pregnancy, monitoring during pregnancy, preparing for birth, and planning for the postnatal period. Implementation of the framework has the potential to significantly improve obstetric and neonatal outcomes for this high‐risk group.     

The effects of family work training on mental health nurses' attitude to and knowledge of schizophrenia: a replication

The association between expressed emotion and the outcome of schizophrenia is well established, and the efficacy of family work for schizophrenia has been demonstrated. Mental health nurses are an expanding group in mental health service provision but their training does not include family work. Although there is some evidence that training mental health nurses in schizophrenia family work increases their knowledge of, and changes their attitudes towards schizophrenia, very little research has been conducted in this area. This paper replicates a previous study, and investigates whether mental health nurses can change their attitude and beliefs, and increase their knowledge about schizophrenia. Knowledge increased and attitudes changed during the initial period (3 months), and the gains were maintained throughout the %month course. However, in order to incorporate the skills learnt into their routine practice, mental health nurses will continue to need ongoing recognition, support, and enthusiasm from colleagues and managers.     

Eye fixation-related potentials in free viewing identify encoding failures in change detection

We considered the hypothesis that spontaneous dissociation between the direction of attention and eye movement causes encoding failure in change detection. We tested this hypothesis by analyzing eye fixation-related potentials (EFRP) at the encoding stage of a change blindness task; when participants freely inspect a scene containing an unmarked target region, in which a change will occur in a subsequent presentation. We measured EFRP amplitude prior to the execution of a saccade, depending on its starting or landing position relative to the target region. For those landings inside the target region, we found a difference in EFRP between correct detection and failure. Overall, correspondence between EFRP amplitude and the size of the saccade predicted successful detection of change; lack of correspondence was followed by change blindness. By contrast, saccade sizes and fixation durations around the target region were unrelated to subsequent change detection. Since correspondence between EFRP and eye movement indicates that overt attention was given to the target region, we concluded that overt attention is needed for successful encoding and that dissociation between eye movement and attention leads to change blindness.     

联合筋膜鞘矫正重度上睑下垂研究进展

上睑下垂是常见的眼睑运动障碍疾病,重度上睑下垂会严重影响患者身心健康.联合筋膜鞘已成为国内外眼整形领域的研究热点,其矫正重度上睑下垂的术后睁眼、闭眼及美容效果较为显著,但目前国内研究仍处于初级阶段.本文对近年来上睑下垂的病因及发病机制、联合筋膜鞘解剖基础及手术治疗进展等有关研究做一综述.     

Neurotransmitters of the brain: serotonin, noradrenaline (norepinephrine), and dopamine.

Serotonin and noradrenaline strongly influence mental behavior patterns, while dopamine is involved in movement. These three substances are therefore fundamental to normal brain function. For this reason they have been the center of neuroscientific study for many years. In the process of this study, new understanding has been gained of the neurochemistry of several important mental health disorders, especially depression and schizophrenia, as well as epilepsy. Such knowledge offers new opportunities for advancements in neuropharmacology, for example, the development of new drugs specific to certain receptor types that will provide relief of symptoms for many sufferers.     

Alternate reality conceptualization: venturing along the fine line between genius and madness

Using A Beautiful Mind, a film about the troubled life of Nobel laureate John Forbes Nash as its focal source, this paper considers the difficulties people with mental illness struggle with in perceiving and experiencing reality. Relationships among the concepts of genius, madness, and alternate reality conceptualization are explored to establish perspective for a model illustrating the progression of paranoid schizophrenia. The importance of empathy in treating mental illness and the role that psychiatric mental health advanced practice nurses play in managing the care of people with paranoid schizophrenia are underscored. Topics for additional research are suggested.     

Genes and schizophrenia: a pseudoscientific disenfranchisement of the individual

The biological model of schizophrenia remains the dominant model within mental health services. It has a powerful influence on the culture of mental health services; providing the structure for the delivery and selection of mental health treatments. There is widespread acceptance of a genetic cause for schizophrenia. Acceptance of a genetic cause is inconsistent with a person-centred recovery-orientated approach. The following paper provides a rigorous review of the underpinning research that supports the genetic argument. Appraisal of family, twin and adoption studies uncovers serious flaws in the methodologies and statistical analyses used in studies. These flaws not only artificially inflate the genetic contribution to schizophrenia but also invalidate many of the findings. More recent micro-imaging techniques have also failed to find replicable and consistent findings indicating a clear genetic pathway to schizophrenia. Freed from the implied pessimism of an unmodifiable genetic cause for schizophrenia, mental health nurses can confidently work to instil hope with people that have a diagnosis of schizophrenia.     

Assessing movement quality in persons with severe mental illness – Reliability and validity of the Body Awareness Scale Movement Quality and Experience

Motor disturbances and disturbed self-recognition are common features that affect mobility in persons with schizophrenia spectrum disorder and bipolar disorder. Physiotherapists in Scandinavia assess and treat movement difficulties in persons with severe mental illness. The Body Awareness Scale Movement Quality and Experience (BAS MQ-E) is a new and shortened version of the commonly used Body Awareness Scale-Health (BAS-H). The purpose of this study was to investigate the inter-rater reliability and the concurrent validity of BAS MQ-E in persons with severe mental illness. The concurrent validity was examined by investigating the relationships between neurological soft signs, alexithymia, fatigue, anxiety, and mastery. Sixty-two persons with severe mental illness participated in the study. The results showed a satisfactory inter-rater reliability (n = 53) and a concurrent validity (n = 62) with neurological soft signs, especially cognitive and perceptual based signs. There was also a concurrent validity linked to physical fatigue and aspects of alexithymia. The scores of BAS MQ-E were in general higher for persons with schizophrenia compared to persons with other diagnoses within the schizophrenia spectrum disorders and bipolar disorder. The clinical implications are presented in the discussion.