青少年生活事件量表的编制与信度效度测试

为了定量的评价青少年社会心理应激状况，作者编制了和年自评生活事件量表。ＡＳＬＥＳ由２７项可能引起青少年心理应激的负性生活事件构成。以１４７４名１３－２０岁青少年学生为测试对象，应用心理统计分析技术，探讨了ＡＳＬＥＣ的测量品质，结果表明ＡＳＬＥＣ内部一致性Ｃｒｏｎｂａｃｈα系数为０．８４９２，分半信度系数为０．８８０９，一周后重测相关系数为０．６８６１。     

哌泊噻嗪、氟哌啶醇癸酸酯与氟奋乃静癸酸酯治疗精神分裂症的对照研究

建桐翁正【摘要】目的验证和比较哌泊噻嗪、氟哌啶醇癸酸酯、氟奋乃静癸酸酯三种长效抗精神病制剂对精神分裂症的疗效及副反应。方法采用多中心、开放随机对照研究，以简明精神病评定量表（ＢＰＲＳ）、阳性症状评定量表（ＳＡＰＳ）、阴性症状评定量表（ＳＡＮＳ）、临床疗效总评量表（ＣＧＩ）和副反应量表（ＴＥＳＳ）、锥体外系副反应量表（ＲＳＥＳＥ）综合评定。结果治疗后哌泊噻嗪组患者的ＣＧＩＳＩ与ＣＧＩＧＩ分值和ＳＡＮＳ量表总分均低于其它两组，差异均有显著性（Ｐ＜０．０５），而ＢＰＲＳ和ＳＡＰＳ量表总分治疗结束时三组间差异无显著性（Ｐ＞０．０５）。ＴＥＳＳ总分和ＲＳＥＳＥ总分在整个治疗过程中均以氟奋乃静癸酸酯组最高，哌泊噻嗪组最低。结论三组中以哌泊噻嗪对精神分裂症的疗效较好，对阴性症状的改善优于氟哌啶醇癸酸酯组和氟奋乃静癸酸酯组，对阳性症状的疗效近似。哌泊噻嗪组副反应较少，安全度较好     

抗精神病药物疗效、锥体外系副作用与血清泌乳素

服用ＣＰＺ、ＨＰ、氯氮平的５０例精神分裂症疗效相似。ＣＰＺ、ＨＰ组病例ＰＲＬ（血清泌乳素）水平明显升高，大多数病人均发生ＥＰＳ（锥体外系症状）。ＰＲＬ水平与ＥＰＳ总分间呈正相关。ＣＰＺ组的显效者与ＰＲＬ水平间呈线性正相关，ＨＰ组有效患者ＥＰＳ总分较无效者明显为高，ＣＰＺ组也有类似现象，符合精神分裂症的ＤＡ假说。但氯氮平组ＰＲＬ水平变化很小，ＥＰＳ发生者很少，故精神分裂症的ＤＡ假说仍需进一步完善。     

氯氮平与氯丙嗪治疗精神分裂症的对照研究

为进一步验证氯氮平在治疗精神分裂症中的地位。方法对病程＜５年的１２２例首次住院的精神分裂症患者，采用分层随机法分为两组，分别首选氯氮平和氯丙嗪进行８周治疗。以ＢＰＲＳ、ＳＡＰＳ、ＳＡＮＳ评定疗效，以ＴＥＳＳ评定副反应。结果治疗前后比较，两组ＢＰＲＳ、ＳＡＰＳ分均显著下降（Ｐ＜０．０１），ＳＡＮＳ分氯氮平组显著降低（Ｐ＜０．０１），氯丙嗪组无明显差异（Ｐ＞０．０５）；疗后氯氮平组的ＢＰＲＳ、ＳＡＰＳ、ＳＡＮＳ总分均明显低于氯丙嗪组（Ｐ＜０．０１）；ＴＥＳＳ总分氯氮平组亦低于氯丙嗪组，且无锥体外系副反应。结论氯氮平确是一种十分有效且药物副反应并不多见的抗精神病药。在严密监测血象的情况下，氯氮平实际上可作为一个可供选择的治疗精神分裂症的第一线药使用。     

精神分裂症的探查性眼球活动研究

用自制眼球活动记录仪对４１例急性精神分裂症病人（其中服药者２４例，未服药者１７例），２５例已缓解的精神分裂症病人，２２例部分缓解的精神分裂症病人，以及７４例正常对照者的探查性眼球活动进行研究。结果发现，各精神分裂症组的眼球活动指标（注视点数ＮＥＦ，总扫描距离ＴＥＳＬ反应性探查分ＲＳＳ）均显著低于正常对照组；而各患者组之间无差异，这一发现提示，眼球活动异常可能是精神分裂症的生物学标志。     

血管性痴呆和脑梗塞患者载脂蛋白E基因多态性的分析比较

目的探讨ＡＰＯＥ多态性与血管性痴呆（ＶＤ）和脑梗塞（ＣＩ）的关系。方法应用ＰＣＲ－ＲＦＬＰ技术分析２０例ＶＤ、２４例ＣＩ及２４例健康老年人的ＡＰＯＥ基因型。结果ＶＤ和ＣＩ患者ε３频率均降低（Ｐ＜０．０５），ε４频率均升高（Ｐ＜０．０５），而两组患者间各等位基因频率差异均无统计学意义（Ｐ＞０．０５）；且ε４与血清ＡＰＯＥ、ＡＰＯＢ、ＴＣ、ＬＤＬ－Ｃ正相关，与ＡＰＯＡ、ＨＤＬ－Ｃ负相关。结论ＡＰＯＥ多态性与ＶＤ和ＣＩ的发病机制有关，其在这两种疾病中的作用可能相似。     

精神分裂症语音和音乐刺激时的闭眼眼球活动

目的 探索精神分裂症患者在语音和音乐刺激时闭眼眼球活动的特征。方法 对７０例精神分裂症，３４例情感性精神障碍和３３例正常对照者进行语音和音乐刺激，观察其闭眼眼球活动（ＣＥＭＳ）的变化。结果 精神分裂症组中，ｒ波次数的平均秩和与怀古性精神障碍相似，但高于正常对照组（Ｐ〈０．０１）；ｓ波则分别低于后二者（Ｐ〈０．０５￣０．０１）；此外，每次语音刺激前和刺激时的ｒ波次数均无显著性差异。ＣＥＭＳ值与ＢＰＲ     

安定引起癫痫病人脑电活动β功率改变与CSF中DynA1—13,L—EK…

报道对４３例有不同转归的癫痫病人和１１例正常对照组进行静注安定致脑电活动β功率改变和脑脊液（ＣＳＦ）中强啡肽Ａ１－１３（ＤｙｎＡ１－１３）、亮脑啡肽（Ｌ－ＥＫ）、生长抑素（ＳＳ）变化和前瞻性结果。发现复发病人静注安定后电活动β功率增加的量比复发组相对照组低（Ｐ〈０．０５），而ＣＳＦ中ＤｙｎＡ１－１３，Ｌ－ＥＫ则高于未复发组和对照组（Ｐ〈０．０５），两者之间呈负相关（ｒ＝－０．７８，ｒ＝－０．６６。     

氯氮平,氯丙嗪治疗阴性型精神分裂症临床疗效对照研究

作者采用前瞻性单盲对照研究方法，评价了氯氮平、氯丙嗪对３２例阴性型精神分裂症病人阴性症状的疗效，以阴性症状评定量表（ＳＡＮＳ）的得分结果来评价。结果显示，氯氮平治疗组在治疗前后ＳＡＮＳ总分及各分量表的综合评分均显著降低（Ｐ＜０．０５或０．０１），氯氮平对阴性症状的疗效显著优于氯丙嗪，差异有极显著性意义（Ｐ＜０．０１）。     

氯氮平的早期副作用治疗窗

寻找氯氮平早期副作用治疗窗。方法 给６６例精神分裂症患者单服氯氮平,并且评价了０周ＰＡＮＳＳ、２周ＴＥＳＳ和血清氯氮平浓度、４周ＰＡＮＳＳ和ＴＥＳＳ。结果 ２周ＴＥＳＳ总分和诸因子分与４周ＰＡＮＳＳ总分减分率均无显著相关性,２周抗α１－肾上腺素因子分在窗内（０～５分）的显效率４７％比窗外的２２％显著为高（Ｐ〈０．０５）,２周氯氮平血清浓度在内（２３０～３３０μｇ／Ｌ）的显效率５１％比窗外的１９％显     

Reliability of life event information: a study on 83 psychiatric patients

Summary The reliability of life event information reported by a mixed group of 83 psychiatric patients was ascertained by comparing it with the reports of the same events as given by close relatives. The overall reliability was 86%, which appears satisfactory. Possible reasons for the results are discussed and suggestions offered to make life event studies more reliable.     

Life events and primary affective illness

Life events at the onset of primary affective illness were assessed in 183 patients with primary affective disorder who were attending a research lithium clinic. About 50% of patients recalled significant life events in the 3-month interval preceding their initial affective episode. Family history data of those patients who reported life events were not significantly different from those who did not report life events at onset. Furthermore, there were no significant differences among patients classified as bipolar or unipolar regarding reporting of life events at onset of illness. These data suggest that the delineation of a subgroup of patients with “reactive” primary affective illness is not supported by a decreased familial load for affective disorder in their relatives.     

A case-control study of risk factors on Alzheimer's disease. Multicenter collaborative study in China]

A case control study to assess the possible risk factors associated with Alzheimer's disease (AD) among Chinese population was conducted on 126 clinical diagnosed AD patients and 252 matched by sex, age, nationality non-demand neighborhood as control. Factors significantly associated with AD cases were: family history of dementia in first degree relatives, family history of psychoses in first degree relatives, few interests and heavy negative life events during individual's life time. Neither family history of Down's syndrome, antecedent history of head trauma, nor other condition that might support immune hypotheses were significantly associated with AD cases. The data from this study support the familial/genetic hypotheses of AD and also the role of psychosocial factors in AD.     

A procedure for reducing errors in reports of life events

Despite the widespread use of life event inventories, relatively little research has been conducted evaluating whether recall techniques can reduce reporting errors. This study evaluated whether memory aids would reduce errors in reports of life events and explored subjects' explanations for why they had given inconsistent answers to life event questions over the course of two interviews. Seventy-one college students were randomly assigned to two groups: memory aids (MA: n = 36) and no memory aids (NMA: n = 35). Memory aids, as used in this study, reduced errors in reports of life events as reflected in the following results: (1) significantly fewer subjects in the MA group reported dating events incorrectly; (2) subjects in the MA group consistently gave more reliable responses between the two interviews as measured by intraclass correlations; (3) there was a significantly higher test-retest reliability correlation for life events reported by MA subjects; and, (4) MA subjects recalled more life events and had fewer inconsistent responses. A further probe revealed that memory aids differentially aided recall of subjective as compared to objective life events. Overall, the findings of this study suggest that memory aid procedures can differentially reduce errors in reporting life events.     

Social factors and the outcome of dementia

Previous studies have linked reduced survival in dementia with male sex, older age, longer duration of illness and increased severity of cognitive impairment. However, little is known about the potential influence of social factors (such as life events and social support) on the outcome of dementia. Sixty recently admitted patients with dementia (27 in-patients and 33 day patients) were given detailed psychiatric and social assessments. These included information on life events and social supports. At follow-up, 3 years later, data were collected on outcome. The hypotheses were that adverse life events and lack of social support would be associated with reduced survival. Nearly half the patients (48%) died during the follow-up period. The experience of life events before the first assessment was not associated with outcome. However, receiving meals on wheels (p=0.01) was associated with reduced survival, while attending a day centre (p=0.06) and having support from relatives (p=0.06) were associated with increased survival. Higher dependency (p=0.004) and poorer physical health (p=0.07) were associated with reduced survival. These results suggest that factors related to social support are associated with the outcome of dementia. In particular, receiving meals on wheels or home help may be a marker of a lack of social support, which influences outcome. Further studies are required to examine these associations in more detail.     

Profile of psychiatric disorders and life events in medically ill elderly: experiences from geriatric clinic in Northern India

BACKGROUND: Morbidity among elderly people has an important influence on their psychological well-being. Evaluation of the morbidity profile and its determinants, which have implications for management of medical problems of elderly people, are scarce in developing countries. Even the physicians' detection rate of mental distress in elderly populations is low in medical outpatient clinics. This could be due to the large caseloads and also, importantly, underestimation of psychological concerns of the elderly. The objective of this study was to study the psychiatric co-morbidity and life events among elderly medical outpatients. METHODS: One hundred medically ill elderly (>60 years) patients attending the Geriatric Clinic at Bikaner (North India) constituted the study population. The physical diagnosis was made by a physician based on reported illness, clinical examination and medical records. Psychiatric diagnosis was made by detailed clinical psychiatric interview using ICD-10 guidelines. Life events were assessed by the Indian adaptation of Presumptive Stressful Life Events Scale. RESULTS: Hypertension was the most commonly reported physical diagnosis (50%), other specific medical illnesses were osteoarthritis (15%), diabetes (13%) and constipation (8%). The study found 18% subjects had depression and 11% had other mental disorders. Patients with mental disorders had suffered more recent stressful life events. Among life events, conflicts in family (16%); unemployment of self or children (9%) was reported by elderly psychiatric patients. Other reported life events in psychiatric diagnosed elderly were conflict in family (7%), illness of self (6%) or family members (5%) and death of family members (5%) or close relatives (4%). CONCLUSION: Mental disorders are common among medically ill elderly patients, but they are poorly recognized and treated. Assessment of the psychiatric morbidity will help in strengthening psycho-geriatric services and thus, improve the quality of life of the elderly.     

Validity of family history data on primary adult-onset dystonia

BACKGROUND: To our knowledge, no study has assessed the validity of family history data provided by probands with adult-onset dystonia. OBJECTIVE: To measure the sensitivity and specificity of interviewing patients with primary adult-onset dystonia as a method for obtaining information on dystonia in first-degree relatives. PARTICIPANTS: Seventy probands with primary adult-onset dystonia were asked to identify first-degree relatives who had dystonia. Available relatives were then directly examined by a trained neurologist. The validity of the probands' reports was tested against the neurologists' diagnoses. RESULTS: Among 300 first-degree relatives who were examined, 26 received a diagnosis of dystonia. Only 7 of the 26 were identified by the probands' reports. Among the 274 relatives free of dystonia, the probands reported 5 as having dystonia. The probands' reports therefore yielded a sensitivity of 27.0% and a specificity of 98.2%. CONCLUSIONS: Because the family history method yields low sensitivity and incurs a risk of misclassification, it is of limited use in family studies of adult-onset dystonia. The only valid means of ascertaining dystonia among relatives remains neurological examination of at-risk subjects.     

The impact of depression in old age on close social relationships

Changes in the ratings of intimacy of personal relationships in depressed elderly patients were studied over a 1-year period. Those patients who had recovered by the end of the year were significantly more likely to report an improvement in the quality of their close relationships then were patients who had a poor clinical outcome. Changes in reports of intimacy were due not only to the effect of depression on the quality of relationships but also to independent life events occurring in the follow-up period.     

Transcultural differences in the perception of life events

The perception of life events of Italian and English subjects was compared. Psychiatric patients and relatives rated 58 life events according to the degree to which the event was regarded as upsetting. The similarity between the two groups was noted, although Italian subjects tended to rate events as less upsetting than the English. The findings excluded that the rating differences between the two groups reflected differences in reaction to life and confirmed the existence of scaling similarity over national groups.     

Quality of life of relatives of patients with obsessive-compulsive disorder

BACKGROUND: Obsessive-compulsive disorder (OCD) affects the lives of both patients and their relatives. Clinical observations suggest that family members of patients with OCD are involved in the patients' rituals, often impairing their own everyday life. OBJECTIVE: The objective of this study was to compare the quality of life (QoL) of relatives of patients with OCD with that of the general German population. METHODS: Seventy-four relatives (29 parents, 33 spouses, 8 children, and 4 siblings) of patients with OCD (International Statistical Classification of Diseases, 10th Revision F42.0-F42.2) were recruited from the outpatient clinic for anxiety disorders of the University of Leipzig Department of Psychiatry. The WHOQOL-BREF, a self-administered questionnaire developed by the World Health Organization, assessed QoL. These findings were compared with the QoL of a representative sample of the general German population. RESULTS: Compared with that of the general population, the QoL of relatives of patients with OCD was significantly lower in the domains physical well-being, psychologic well-being, and social relationship. CONCLUSIONS: Obsessive-compulsive disorder has an adverse effect on the subjective QoL of relatives of patients with OCD. Therefore, these findings suggest that professionals working with relatives must focus not only on the care given to persons with an illness but also on their relatives' situation and personal QoL.