上海市中学生网络过度使用者心理特征的调查

目的 调查网络过度使用（internetoveruse，IOU）在上海市中学生中的发生率，并研究IOU者的心理卫生问题和人格特征。方法 采用系统分层随机抽样的方法对上海市10所中学的3068名学生进行互联网过度使用的筛查，并用长处和困难问卷（Strengths and Difficulties Questionnaire，SDQ）及艾森克个性问卷（Eysenck Personality Questionnaire，EPQ）进行评估。结果 网络过度使用在上海市中学生中的发生率为2．62％，男生IOU的发生率明显高于女生（P〈0．05）；男生中IOU组EPQ中的L量表分高于对照组，E量表分低于对照组（P〈0．05）；女生中IOU组EPQ中的L得分高于对照组（P〈0．05）。IOU组SDQ中情绪症状、品行问题、多动注意不能、同伴交往问题4个因子均高于对照者，社会行为因子低于对照组（P〈0．001）。结论 网络过度使用者与对照组相比更多地受情绪和行为问题、同伴交往等问题的心理困扰；网络过度使用者存在特定的人格特征，需要给予社会心理干预。     

影响初中生学习成绩的相关因素

目的：探讨影响初中生学习成绩的相关因素。方法：用儿童焦虑性情绪障碍筛查表（SCARED）、儿童抑郁障碍自评量表（DSRSC）、应对方式问卷、父母养育方式问卷（EMBU）对上海市杨浦区一所普通中学288名学生进行调查。结果：成绩优良组与普通组在性别、年龄、父母亲文化、家庭结构、经济条件、是否独生子女方面差异显著（P〈0．05或P〈0．01）。普通组与优良组在学校恐怖，焦虑、抑郁总分，应对方式、解决问题、自责、合理性，父母养育方式存在显著差异（P〈0．05或P〈0．01）。回归分析显示性别与年龄、解决问题、情感温暖和理解对学习成绩有影响（P〈0．01）。结论：影响初中生学习成绩的因素除了有智力因素外，还与家庭环境、性别、年龄、焦虑和抑郁情绪、应对方式、父母养育方式等心理社会因素密切相关。     

30例学校恐惧症人格和情绪特征研究

目的：探讨学校恐惧症的临床特征。方法：对30例学校恐惧症患儿（研究组）和30名正常对照儿童（对照组）进行艾森克个性问卷（EPQ）,儿童焦虑性情绪障碍筛选量表（SCARED）,焦虑自评量表（SAS）及抑郁自评量表（SDS）评估。结果：研究组患儿EPQ结果显示神经质得分显著高于对照组,掩饰程度得分显著低于对照组（P均〈0.05）;SCARED、SAS、SDS的评估显示,与对照组相比,研究组存在明显焦虑和抑郁症状（P〈0.05）。结论：学校恐惧症患儿可能具有神经症的个性特点,普遍存在焦虑和抑郁症状。     

儿童焦虑性情绪障碍筛查量表的临床应用

目的研究儿童焦虑性情绪障碍筛查量表SCARED在儿童及青少年情绪障碍中的应用。方法随机抽取上海市精神卫生中心儿童心理门诊符合CCMD-3诊断标准的焦虑症患儿35例，多动障碍患儿31例，随机抽取上海市某中小学45例健康儿童为对照组。研究组患儿及父母均填写SCARED量表，对照组填写SCARED量表并在一周后重测，多动症组评估SCARED量表。结果研究组SCARED量表总分及各因子分均分别显著高于对照组、多动症组。患儿自评与父母评定的相关系数在0．618至0．839之间。重测信度在0．451～0．872之间，各因子分与总分相关系数在0．331～0．852之间，Cronbach‘s a系数在0．2331至0．8032之间。SCARED量表总分与焦虑自评量表总分相关系数为0．661。结论SCARED量表信、效度良好，可作为临床辅助诊断及科研的筛查工具。     

脑梗死患者的生活质量与其焦虑、抑郁情绪的相关性研究

目的 探讨脑梗死患者的生活质量与其焦虑、抑郁情绪的关系。方法 采用Zung焦虑自评量表（SAS）、Zung抑郁自评量表（SDS）及生活质量综合评定问卷（GQOLI）对80例脑梗死患者（脑梗死组）及80名健康人（对照组）进行问卷调查，并对生活质量与其焦虑、抑郁情绪作相关分析。结果 脑梗死患者的生活质量总分及躯体功能、心理功能、社会功能3个维度评分均明显低于对照组（P〈0．01），而SAS及SDS评分均明显高于对照组（P〈0．01）。脑梗死患者的生活质量总分及躯体功能、心理功能、社会功能3个维度评分均与SAS及SDS评分呈显著性负相关。结论 脑梗死患者的生活质量较差，焦虑、抑郁情绪明显；其生活质量与焦虑、抑郁情绪密切相关。     

对立违抗性障碍患儿行为特征的初步研究

目的了解对立违抗性障碍（ODD）患者的行为特征。方法应用Achenbach儿童行为量表（CBCL）、教师报告表（TRF）及青少年自我报告表（YSR）对213例ODD儿童和213名正常儿童（对照组）进行评定和比较。结果（1）CBCL：ODD组的社交情况、学校情况及社会能力总分低于对照组，而退缩、躯体主诉、焦虑／抑郁、社交问题、思维问题、注意问题、违纪行为、攻击性行为、内化性问题、外化性问题和行为问题总分高于对照组（均P〈0．01）。（2）TRF：ODD组的学习努力、行为适当得体、学习效果、快乐、适应能力总分等的评分低于对照组，而退缩、焦虑／抑郁、社交问题、思维问题、注意问题、违纪行为、攻击性行为、内化性、外化性问题评分和行为问题总分高于对照组，差异有统计学意义（P〈0．05—0．01）。（3）YSR：ODD组的焦影抑郁、注意问题、违纪问题、攻击性问题、自我身份、外化性问题评分高于对照组（均P〈0．05和〈0．01）。结论ODD儿童存在更多的行为问题，以攻击、对抗、情绪不稳为主要特征，伴有退缩、焦虑抑郁等内化性问题。     

心理剧治疗对强迫症患者焦虑、抑郁及生活质量的影响

目的探讨心理剧治疗对强迫症患者焦虑、抑郁及生活质量的影响。方法将100例强迫症患者随机均分为研究组和对照组，在两组均给予足量足疗程的药物治疗及接受一般健康教育的基础上，仅对研究组辅以心理剧治疗，4周为一个疗程。生活质量测评工具SF-36量表、Yale—Brown强迫症量表（Y—BOCS）、17项汉密顿抑郁量表（HAMD17）、汉密顿焦虑量表（HAMA）对两组患者进行治疗前后效果评定。结果干预后研究组患者的Y—BOCS总分和HAMD17HAMA总分值均显著低于对照组（P〈0．01），而疗效显著高于对照组（P〈0．01），研究组患者的显效率显著高于对照组（P〈0．01），研究组患者的SF-36量表各维度分值显著高于对照组（P〈0．01）。结论心理剧治疗可巩固患者的疗效，并改善其焦虑、抑郁情绪，能显著提高患者的心理健康水平及生活质量，可作为一种有效的心理治疗手段应用于临床。     

万州中学生网络成瘾现状的调查

目的：调查网络成瘾在重庆万州中学生之中的发生率；研究网络成瘾者情绪问题、心理卫生问题和人格特征。方法：采用网络一般使用问卷、网络成瘾诊断问卷、儿童焦虑性情绪障碍筛选表（SCAEED）、并用长处和困难问卷（SDQ）及艾森克个性问卷（EPQ）对4703名重庆万州9所学校内初一、高一、职业学校一年级中学生进行评估。结果：网络成瘾比例3．5％，网络成瘾者存在特定的人格特征，其焦虑情绪明显高于非成瘾者；男性成瘾比例高于女性。结论：网络成瘾行为与情绪状态和性别密切相关，严重影响学习和社会功能，网络成瘾者存在特定的人格特征，需要社会心理干预。     

神经症患者的生活质量及影响因素研究

目的探讨神经症患者的生活质量及其影响因素。方法用生活质量综合评定问卷比较100例神经症患者和100名健康人的生活质量差异。以自编调查表项目、社会支持量表、匹兹堡睡眠质量指数、症状自评量表评分为自变量，以生活质量综合问卷评分为因变量，进行相关分析和多元线性回归分析。结果除物质生活维度外，与健康对照组比较，神经症患者的生活质量综合问卷总分和各维度分都明显下降（P〈0．01）。相关分析结果显示，神经症患者的经济收入、社会支持量表总分与生活质量问卷总分呈显著正相关（P〈0．01）；病程、共病、睡眠质量指数及躯体化、强迫症状、抑郁、焦虑、恐惧因子分与生活质量问卷总分呈显著负相关（P〈0．01）．多元线性回归分析结果显示，生活质量问卷中的4个维度（因变量）与经济收入、社会支持量表总分、病程、共病、睡眠质量指数及躯体化、强迫症状、抑郁、焦虑、恐惧因子分10个自变量整体都具显著线性相关（P〈0．01）。结论神经症患者的生活质量较正常人差，生活质量各维度有27．4％～57．2％由经济收入、社会支持量表总分、病程、共病、睡眠质量指数及躯体化、强迫症状、抑郁、焦虑、恐惧因子分10个因素变化所决定。     

高中毕业生焦虑、抑郁情绪及相关性分析

目的探讨青岛市高中毕业生的焦虑、抑郁情绪及其相关因素。方法从青岛市4所高中以班为单位整群抽取,采用抑郁自评量表（SDS）、焦虑自评量表（SAS）、个人评价问卷（PEI）、自尊量表（SES）及青少年生活事件量表（ASLEC）对337名高三学生进行测查。结果有焦虑情绪63名,占20．1％,男女两性比较差异无显著性（P〉0．05）;有抑郁情绪92名,占29．4％,男女两性比较差异无显著性（P〉0．05）;相关性分析显示焦虑、抑郁情绪与自我评价、自尊、生活事件总分及其各因子分均有非常显著相关性（P〈0．01）。结论高中毕业生焦虑、抑郁情况严重,不容忽视。     

Diagnostic Difficulties and Treatment Implications

Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.     

Cognitive Dysfunction Associated with Antiepileptic Drug Therapy

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.     

Carbamazepine Efficacy in Adults With Partial and Generalized Tonic-Clonic Seizures

Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.     

Etiologic and Preventive Aspects of Epilepsy in the Child–Bridging the Gap Between Laboratory and Clinic

Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.     

Treatment Considerations in Anticonvulsant Monotherapy

Summary: The long-standing practice of polypharmacy in treating epilepsy is giving way to use of monotherapy. Monotherapy can improve seizure control as well as reduce the risk of serious idiosyncratic reactions, dose-related side effects, and complex drug interactions. Monotherapy also offers improved compliance and cost-effectiveness. The basis of monotherapy is accurate diagnosis and assessment of the patient's seizure type(s), followed by selection of a single appropriate anticonvulsant drug. Many patients currently treated with multiple anticonvulsants can be successfully converted to monotherapy with a carefully monitored program in which troublesome and redundant drugs are gradually withdrawn from the therapeutic regimen.     

Predisposing and Causative Factors in Childhood Epilepsy

Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non-febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.     

Dextromethorphan: Cellular Effects Reducing Neuronal Hyperactivity

Summary: Dextromethorphan is a dextrorotary morphinan without affinity for opioid receptors, commonly used as an antitussive medication. During the past 5 years, interest in the compound and its demethylated derivative, dextrorphan, has been revived because additional neuroprotective and an-tiepileptic properties were found in in vitro studies, animal experiments, and a few clinical cases. Both morphinans are able to inhibit N -methyl-D-aspartate (NMDA) receptor channels and voltage-operated calcium and sodium channels with different potencies. The inhibition of the NMDA receptor is believed to be the predominant mechanism of action responsible for the anticonvulsant and neuroprotective properties of the compounds.     

Anticonvulsant Drugs and Cognitive Function: A Review of the Literature

Summary: Alterations of cognitive function are separate from disturbances of behavior seen in association with epilepsy. The nature of the cognitive disability may to a certain extent depend on the seizure type. Partial seizures, mainly derived from a temporal lobe focus, impair memory tasks, while generalized seizures seem to have more effect on attentional abilities. A number of studies, reviewed in this paper, suggest that anticonvulsant drugs further impair cognitive function. Maximal impairments are seen in patients receiving polytherapy: rationalization of polytherapy improves cognitive abilities. Studies in children and adults have allowed differentiation of the effects of various commonly used antiepileptic agents. Maximal cognitive deficits are seen with. phenytoin, while phenobarbital and sodium valproate induce moderate disturbances, and carbamazepine seems relatively free from such toxicity. Further research is needed on the interrelationship between types of seizure disorders, types of anticonvulsant medications, and cognitive function.     

Effects of NMD A- and AMPA-Receptor Antagonists on Different Forms of Epileptiform Activity in Rat Temporal Cortex Slices

Summary: Lowering extracellular magnesium induces different patterns of epileptiform activity in rat hippocampus and entorhinal cortex. Short recurrent epileptiform discharges in the hippocampus are stable over time, whereas seizurelike events (SLEs) in the entorhinal cortex, the subiculum, and the neighboring neocortex develop into late recurrent discharges which are not blocked by clinically employed antiepileptic drugs. We tested the sensitivity of the different epileptiform discharge patterns to. /V-methyl-D-aspartate (NMDA)- and non-NMDA-receptor antagonists. As NMDA-receptor antagonist we used dextrorphan, ket-amine, and 2-aminophosphonovalerate (2APV); as α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA)-receptor antagonist we employed the quinoxaline derivative glutamate 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX). The findings show that the different patterns of epileptiform activity, including the late recurrent discharges, are sensitive to all NMDA-receptor antagonists. However, when dextrorphan was employed to suppress seizure-like events, later recurrent discharges did not develop during the remaining time course of the experiment. CNQX reversibly suppressed recurrent discharges in the hippocampus and SLEs in the entorhinal cortex. However, late recurrent discharges become insensitive to CNQX, even at a high concentration of 60 μM m. This finding suggests a prominent role for NMDA receptors in the generation of late recurrent discharges.     

Pediatric Epilepsy Surgery

Summary: The use of implantable arrays of epidural electrodes has made it possible to carry out extraoperative electrocorticography (ECoG) and functional localization in the awake child. This has permitted cortical excisions that are determined by criteria similar to those obtained during surgical procedures performed under local anesthesia in adults. In addition, the method also permits simultaneous ECoG and video monitoring during the child's symptomatic seizures, providing additional important localizing information that is impractical to obtain in operations under local anesthesia. We report our experience with 75 children, ages 5 months to 15 years, whom we have managed with epidural electrode arrays. The method of extraoperative ECoG is described and illustrative cases are presented to demonstrate its feasibility and utility in children. In addition, we call attention to gliomas as a common cause of chronic focal seizures in children. Of 49 children undergoing resection and followed for from 1 to 14 years (mean of 5.8 years), 32 (65%) are either seizure free or have had a significant reduction in seizure frequency that has unambiguously improved their quality of life. The results are analyzed further by relating the surgical outcome to each of the pathologic entities that caused the seizures. This analysis reveals the variety of neurological conditions that commonly cause intractable focal seizure disorder in children and distinguishes those pathologic entities in which the seizure disorder is apt to respond to surgical intervention from those that will not.