神经心理评估在临床痴呆诊断中的应用

<正> 随着神经心理学的发展,神经心理评估在临床上得到广泛应用。通过神经心理评估所取得的资料对痴呆的诊断具有重要价值。神经心理评估方法包括神经心理检查相关的成套测验和量表。临床神经心理学应用心理测验测量人的行为,进而分析其与大脑功能系统结构的相互关系。     

中医心理治疗与中国传统文化

中医心理学是祖国医学的一个分支,也是中国传统文化的重要组成部分。早在二千多年前,中医经典著作《黄帝内经》,就从理论与实践中提出了心理预防,心理诊断、心理治疗医学,并十分精辟阐述着心理学思想占全书约87％以上。更值得注意的是,在中医心理治疗的漫长发展过程中,显然历尽坎坷,遭受过歧视与打     

精神医学的文化特征与思考

文章根据文化的特性，从普通心理学、精神应激、精神症状表现、心理诊断与心理治疗、酒与非法物质使用、网络相关的心理障碍等方面论述了文化特征对精神医学的影响，提出要坚持文化相通论与文化相对论的辩证统一；在精神医学实践中，要注意文化特征，坚持心理治疗本土化；根据临床实际，要增加相应教学内容，拓宽与转换服务方式，以适应病人需要。     

医学心理学PBL教学法与案例教学结合的应用体会

<正>医学心理学是医学和心理学相结合的交叉学科,它研究心理变量与健康或疾病变量之间的关系,研究解决医学领域中的有关健康和疾病的心理行为问题。医学心理学涉及心理学基础、心理发展与心理健康、心理应激、心身医学等内容。学习起来有些内容较抽象,理解有一定难度,为了方便学生学习,必须加大理论与实践相结合的力度,为此,我们尝试在教学中将以问题为导向的教学法(ProblemBased Learning,PBL)[1]和案例教学相结合。     

基于人工神经网络与人工智能的计算机系统在儿童心理障碍诊断领域的应用

背景：将人工智能和人工神经网络二者相结合应用于精神卫生领域的文献在国内外还未见报道,更未见将人工神经网络与人工智能相结合用于模拟人类医学专家大脑诊断思维模式诊断儿童心理障碍的相关报道。 目的：用计算机模拟人脑诊断思维模式,建立一套基于人工神经网络与专家系统的儿童心理障碍标准化诊断与防治的人工智能专家系统。 方法：儿童心理障碍标准化诊断与防治的人工智能专家系统涉及儿童心理学、儿童精神病学、心理测量、心理治疗、计算机科学等诸多学科,诊断系统结合了ICD-10、DSM IV及CCMD-2等诊断标准、大规模流行病学调查数据、资深精神医学专家的丰富临床经验和临床资料。临床资料来源于全国14 家医院流调及门诊收集的原始病例,共回收有效资料1 125份,用基于神经网络与专家系统相结合的方法进行智能诊断系统的编制。 结果与结论：诊断系统能诊断61种儿童心理障碍,它包括95%以上的儿童心理障碍,在诊断之后,计算机将给出一个治疗方法建议。将195例计算机系统诊断结果与资深儿童心理精神医学专家的诊断结果进行双盲比较,诊断符合率是99%,有助于年轻医生学习资深儿童心理精神医学专家丰富的临床经验,也能帮助全国各地的心理障碍患儿,更好地为儿童心理卫生事业服务。     

帕金森病诊断及鉴别诊断

虽然临床医生对于帕金森病及其综合征的诊断重视程度日益提高，但作出正确的诊断仍很困难。本通过回顾在临床表现、电生理检查、自主神经测试、神经心理学检查、影像学及生化标记物等方面的最新进展，指出它们在区别不同类型帕金森综合征中的价值。     

神经心理测验在痴呆诊断中的应用

随着医学进步,人类平均寿命不断延长,人口老龄化问题越来越突出。老年期痴呆如阿尔茨海默病(AD)、血管性痴呆(VD)、轻度认知功能损害(MCI)的病人逐步引起人们的注意。而神经心理测验在这类疾病的筛选及诊断中的作用,已日益引起重视,因为测验可以提供较客观的辅助证据。近年来,早期诊断AD和其它类型痴呆成为研究热点之一。神经心理测验能够探测到非常细微的认知功能损害,而这些损害可能在痴呆症状明显之前就早已存在,所以神经心理测验对识别早早期和临床前期AD可能是有用的,而且它对其     

心理CT与精神科医师诊断精神疾病一致性的调查

目的了解精神科医师应用心理疾病专家诊断系统（心理CT）的状况及其效果评价。方法于2011-2012年，甩匿名问巷调查了9所专科医院152名精神科医师，询问医生应用心理CT诊断的病例数及效果。结果152名医师应用心理CT诊断抑郁症、精神分裂症等9种疾病的患者总共51988例，医师人均用心理CT诊断患者342例。初级医师、中级医师和高级医师认为心理CT诊断结果与自己临床诊断一致性≥85％的，依次为71．15％（365／513人次）、79．66％（466／585人次）、81．48％（220／270人次）。经卡方检验，差异具有统计学意义（x^2=4405．57，P〈0．01），且医师级别越高与心理CT诊断结果的一致性越高。结论心理CT的辅助诊断价值得到了使用医师的认可，其诊断精神疾病的水平接近或达到了中、高级医师的水平。     

整体护理在手术患者心理护理中的应用

由于医学模式转变为"生物—心理—社会医学模式",护理学范畴也扩展到社会医学、心理学领域,在对疾病治疗护理的同时,要配合以心理护理[1]。无论何种手术,对病人都是比较强烈的应激刺激,会产生一定的心理反应,严重的消     

神经症患者MMPI测查资料分析：Ⅰ.一般模式及其诊断意义

本文对1112例神经症患者的 MMPI 资料按中国常模进行分析,结果表明78.56%男性、77.89%女性符合两点编码模式12/21、13/31、27/72或四点编码模式2137型和1237型。作者认为,MMPI 对神经症可提供较为有效的心理诊断依据,但心理诊断不是疾病诊断,所以不应以此即作出疾病诊断。     

Environmental factors in the development and progression of late-onset Alzheimer＇s disease

Late-onset Alzheimer＇s disease （LOAD） is an age-related neurodegenerative disorder characterized by gradual loss of synapses and neurons, but its pathogenesis remains to be clarified. Neurons live in an environment constituted by neurons themselves and glial cells. In this review, we propose that the neuronal degeneration in the AD brain is partially caused by diverse environmental factors. We first discuss various environmental stresses and the corresponding responses at different levels. Then we propose some mechanisms underlying the specific pathological changes, in particular, hypothalamic-pituitary adrenal axis dysfunction at the systemic level; cerebrovascular dysfunction, metal toxicity, glial activation, and Aβ toxicity at the intercellular level; and kinase-phosphatase imbalance and epigenetic modification at the intracellular level. Finally, we discuss the possibility of developing new strategies for the prevention and treatment of LOAD from the perspective of environmental stress. We conclude that environmental factors play a significant role in the development of LOAD through multiple pathological mechanisms.     

Edema and neuronal apoptosis in the hippocampus and cortex of elderly rats following transient cerebral ischemia/reperfusion injury

BACKGROUND： Previous studies of cerebral ischemia have used young animals, with an ischemic time greater than 5 minutes （safe time limit）. Despite an increased understanding of neuronal apoptosis, it remains uncertain whether brief cerebral ischemic events of 5 minutes or less damage brain tissue in elderly rodents. OBJECTIVE： To investigate the effects of transient cerebral ischemia （5 minutes）/reperfusion injury on brain cortical and hippocampal edema, aquaporin-4 （AQP-4） expression, and neuronal apoptosis in aged rats, and to compare ischemic sensitivity between cortex and hippocampus. DESIGN, TIME AND SETTING： A randomized, controlled, animal experiment was performed at the Institute of Cerebrovascular Disease, Qingdao University Medical School from April 2008 to March 2009. MATERIALS： Rabbit anti-AQP-4 polyclonal antibody, TUNEL kit, and SABC immunohistochemistry kit were purchased from Wuhan Boster Bioengineering, China. METHODS： A total of 160 healthy, male, aged 19-21 months, Wistar rats were randomly assigned to 4 groups： sham-surgery, and ischemia 1-, 3-, and 5-minute groups, with 40 rats in each group. The global cerebral ischemia model was established using the Pusinelli four-vessel occlusion, and the three cerebral ischemia groups were subdivided into reperfusion 12-hour, 1-, 2-, 3-, and 7-day subgroups, with 8 rats in each subgroup. The sham-surgery group was subjected to exposure of the first cervical bilateral alar foramina and bilateral common carotid arteries. MAIN OUTCOME MEASURES： The dry-wet weight assay was used to measure brain water content and histopathology of the cortex and hippocampus was observed following hematoxylin-eosin staining. In addition, cortical and hippocampal AQP-4 expression was detected by streptavidin-biotin complex immunohistochemistry, and neuronal apoptosis was detected by the TUNEL method. RESULTS： There was no significant difference in brain water content or AQP-4 expression in the cortex and hippocampus between ischemia 1- and 3-minute groups and the sham-surgery group or brain water content or AQP-4 expression in the cortex between ischemia 5-minute group and sham-surgery group （P 〉 0.05）. However, brain water content and AQP-4 expression in the hippocampus after 5 minutes of cerebral ischemia were significantly increased compared with the sham-surgery group （P 〈 0.05 or P 〈 0.01）. Several TUNEL-positive cells were observed in the cortex and hippocampus of the sham-surgery group and ischemia 1-minute group, as well as in the cortex of the ischemia 3-minute group. In addition, the number of apoptotic neurons in the hippocampus of ischemia 3-minute group and in the cortex and hippocampus of ischemia 5-minute group was significantly increased （P 〈 0.05 or P 〈 0.01 ）. Neuronal apoptosis was increased after 12 hours of ischemia/reperfusion, and it reached a peak by 2 days （P 〈 0.01）. CONCLUSION： Transient cerebral ischemia （5 minutes） resulted in increased hippocampal edema, AQP-4 expression, and neuronal apoptosis. Moreover, cerebral ischemia had a greater effect on neuronal apoptosis than brain edema or AQP-4 expression, and the hippocampus was more sensitive than the cortex.     

墨蝶呤还原酶基因与精神分裂症相关性的研究进展

墨蝶呤还原酶（SPR）催化四氢生物蝶呤（BH4）从头合成途径的最后一步反应。SPR基因遗传缺陷或突变可导致BH。的合成紊乱,影响单胺类神经递质（如多巴胺、5-羟色胺及谷氨酸等）的合成或释放,进而参与包括精神分裂症在内的多种神经精神系统疾病的发生发展过程。此外,SPR基因敲除小鼠表现出持续增强的自主活动等类精神分裂症症状,说明该基因在精神分裂症的发病中扮演重要的角色。进一步研究SPR基因及其单核苷酸多态性的功能,可为阐明精神分裂症的发病机制提供重要的线索,也为新一代抗精神病药物的研制及开发开拓新的视野。现对SPR基因与精神分裂症的相关研究做一综述。     

癫痫与自杀

自杀而导致死亡被为是增加癫痫患者死亡率的最重要原因之一。国外许多研究报道都表明癫痫患者的自杀率比普通人群的自杀率高几倍到二十几倍。可能导致癫痫患者自杀的危险性因素是有多方面的,本文将从5-HT、抗癫痫药及癫痫手术治疗、精神病理等方面对癫痫患者可能存在自杀危险因素进行综述,并希望在癫痫的综合治疗中对这些危险因素能加以考虑。     

Wnt信号通路与骨髓间充质干细胞增殖及分化的关系

骨髓间充质干细胞（bonemarrow—derived mesenchymal stem cells,BMSCs）是骨髓中不同于造血干细胞的一类细胞,其来源丰富,取材简便,易分离、纯化、培养,在一定的条件下可以迅速体外扩增,具有多向分化潜能,可以通过不同的方法被诱导分化成骨细胞、软骨细胞、肌细胞、神经胶质细胞、神经元细胞等,而且它具有低免疫源性,向病变部位迁移的能力,     

Total saponins of Panax ginseng effects on proliferation and differentiation of human embryonic neural stem cells and in a Parkinson’s disease mouse model

BACKGROUND： Total saponins of Panax ginseng （TSPG） exhibits neuroprotection against Parkinson＇s disease in the substantia nigra. OBJECTIVE： To investigate the effects of TSPG on human embryonic neural stem cells （NSCs） proliferation and differentiation into dopaminergic neurons using in vitro studies, and to observe NSC differentiation in a mouse model of Parkinson＇s disease, as well as behavioral changes before and after transplantation. DESIGN, TIME AND SETTING： In vitro neural cell biology trial and in vivo randomized, controlled animal trial were performed at the Institute of Basic Medical Sciences, Chongqing Medical University between September 2004 and December 2007. MATERIALS： TSPG （purity 〉 95%） was isolated, extracted, and identified by Chongqing Academy of Chinese Materia Medica. Recombinant human basic fibroblast growth factor （bFGF） and recombinant human epidermal growth factor （EGF） were purchased from PeproTech, USA. A total of 25 C57/BL6J mice, aged 18-20 weeks were included. Twenty were used to establish a Parkinson＇s disease model with i.p. injection of MPTP （1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine） and TSPG alone or combined with interleukin-1 （IL-1）-treated NSCs prior to transplantation into the corpus striatum. The remaining five mice were pretreated for 3 days with TSPG prior to MPTP injection, serving as the TSPG prevention group. METHODS： Primary NSCs were isolated, cultured and purified from embryonic cerebral cortex. Immunocytochemistry was employed to detect specific antigen expression in the NSCs. In vitro experiment： （1） to induce proliferation, NSCs were treated with TSPG, EGF＋bFGF, or TSPG＋EGF＋bFGF, respectively; （2） to induce dopaminergic neuronal differentiation, NSCs were treated with TSPG, IL-1, or TSPG＋IL-1, respectively. MAIN OUTCOME MEASURES： In vitro experiment： the effects of TSPG on NSCs proliferation were evaluated with flow cytometry and MTT assay. Tyrosine hydroxylase expression was determined by immunocytochemistry assay to observe effects of TSPG on dopaminergic neuronal differentiation. In vivo experiment： differentiation of grafted NSCs in the mouse brain was determined by immunohistochemical staining. Behavioral changes were evaluated by spontaneous activity frequency, memory function, and score of paralysis agitans. RESULTS： （1） NSCs were cultured and passaged for more than three passages. Immunocytochemistry revealed positive nestin staining, as well as neurofilament protein and glial fibrillary acidic protein. （2） TSPG significantly increased NSC proliferation, in particular when combined with EGF and bFGF, which was twice as effective as FGF or bFGF alone. TSPG also induced dopaminergic differentiation in NSCs, in particular when TSPG was added together with IL-1, resulting in an effect five times greater than that of IL-1 alone. （3） At day 30 following transplantation, most NSCs in the TSPG prevention group differentiated into dopaminergic neurons, and the scores of paralysis agitans, spontaneous activity, and memory function were significantly increased compared with TSPG alone or TSPG＋IL-1 groups （P 〈 0.05）. CONCLUSION： TSPG stimulated NSC proliferation, in particular when combined with FGF and bFGF. TSPG significantly induced dopaminergic neuronal differentiation of NSCs, and the effect was greater when combined with IL-1. In addition, TSPG greatly improved behavior in the Parkinson＇s disease mouse model following NSC transplantation. Following NSC transplantation, TSPG pretreatment exhibited superior efficacy over either TSPG alone or TSPG in combination with IL-1, in terms of behavioral improvements in the Parkinson＇s disease mouse model.     

Disrupted structural and functional brain connectomes in mild cognitive impairment and Alzheimer＇s disease

Alzheimer＇s disease （AD） is the most common type of dementia, comprising an estimated 60-80% of all dementia cases. It is clinically characterized by impairments of memory and other cognitive functions. Previous studies have demonstrated that these impairments are associated with abnormal structural and functional connections among brain regions, leading to a disconnection concept of AD. With the advent of a combination of non-invasive neuroimaging （structural magnetic resonance imaging （MRI）, diffusion MRI, and functional MRI） and neurophysiological techniques （electroencephalography and magnetoencephaJography） with graph theoretical analysis, recent studies have shown that patients with AD and mild cognitive impairment （MCI）, the prodromal stage of AD, exhibit disrupted topological organization in large-scale brain networks （i.e., connectomics） and that this disruption is significantly correlated with the decline of cognitive functions. In this review, we summarize the recent progress of brain connectomics in AD and MCI, focusing on the changes in the topological organization of large-scale structural and functional brain networks using graph theoretical approaches. Based on the two different perspectives of information segregation and integration, the literature reviewed here suggests that AD and MCI are associated with disrupted segregation and integration in brain networks. Thus, these connectomics studies open up a new window for understanding the pathophysiological mechanisms of AD and demonstrate the potential to uncover imaging biomarkers for clinical diagnosis and treatment evaluation for this disease.     

焦虑与心血管疾病的相关性分析

近年来,我国所患心血管疾病的人口比例越来越高,而焦虑症作为伴发心血管疾病的常见性疾病,对其识别与否以及处理的是否得当将对心血管疾病的预后产生重大影响,但目前国内外对此的研究还相对欠缺,现对此做一综述,综合相关文献,对此方面的问题进行研究。     

Neuronal failure in Alzheimer＇s disease： a view through the oxidative stress looking-glass

Considerable debate and controversy surround the cause（s） of AIzheimer＇s disease （AD）. To date, several theories have gained notoriety, however none is universally accepted. In this review, we provide evidence for the oxidative stress-induced AD cascade that posits aged mitochondria as the critical origin of neurodegeneration in AD.     

癫痫持续状态危险因素及神经化学的改变

癫痫持续状态是内科常见的急症,了解其常见的危险因素有利于病因的明确.其发生过程中的神经化学改变如γ氨基丁酸活性的变化,谷氨酸、离子通道及相关炎性因子的改变正逐渐被认识.明确神经化学的变化将有助有癫痫持续状态发病机制的研究和干预手段的改进.