强迫症与社交恐怖症的防御机制及其相关因素的比较研究

目的　对强迫症和社交恐怖症患者的防御方式、父母教养方式和个性特征进行比较研究。方法　对强迫症组、社交恐怖症组和正常对照组 (各 6 0例 )进行父母教养方式评价量表评定 ,并分别填写防御方式问卷 (DSQ)和艾森克个性问卷 (EPQ)。结果　 (1)单因素方差分析 ,两组患者的中间型防御机制因子分 [分别为 (4 6 4± 0 72 )分 ,(4 90± 0 5 9)分 ]和不成熟型防御机制因子分 [(4 6 9±1 0 7)分 ,(4 71± 0 92 )分 ]高于正常对照组 [(4 34± 0 5 8)分和 (3 86± 0 98)分 ;P =0 0 0 ],成熟防御机制因子分 [分别为 (5 32± 1 4 4 )分和 (5 36± 1 0 9)分 ]低于正常组 [(5 80± 0 81)分 ;P =0 0 4 ];(2 )多元方差分析 ,强迫症组与社交恐怖症组间及其与正常对照组的防御方式明显不同 ,强迫症组和社交恐怖症组与正常对照组的父母教养方式和个性特征亦不同 (Pillai检验 ,均P =0 0 0 ) ,但两患者组间的差异无显著性 ;(3)两患者组的父母过度保护、拒绝和惩罚等变量、EPQ神经质和精神质变量 ,与中间型和 /或不成熟防御机制变量显著相关。结论　强迫症、社交恐怖症与正常对照三组间的防御方式明显不同 ;防御机制的使用与患者父母不良的教养方式和个性特征显著相关。     

伴与不伴抑郁症状的精神分裂症患者临床特征的性别差异

目的:探讨伴与不伴抑郁症状的精神分裂症患者临床症状的性别差异。方法:纳入精神分裂症患者138例及正常对照者94名,采用阳性和阴性症状量表(PANSS)评估患者的精神症状、卡尔加里精神分裂症抑郁量表(CDSS)评估患者的抑郁症状;同时运用重复性神经心理状态测验(RBANS)评估受试者的认知功能。结果:精神分裂症伴有抑郁组PANSS总分及因子分高于不伴抑郁症状组(P均0.001),RBANS总分及因子分低于不伴抑郁症状组(P0.05或P0.01)。性别分层后,PANSS总分及因子分、RBANS总分及因子分在女性精神分裂症患者伴与不伴抑郁症状组间差异有统计学意义(P0.05或P0.01),男性伴与不伴抑郁症状组PANSS总分、阴性症状、一般精神症状分、RBANS总分及即时记忆因子分差异有统计学意义(P0.05或P0.01)。男、女精神分裂症患者CDSS分与PANSS总分呈正相关(P均0.001),而CDSS评分与RBANS总分的相关性只存在于女性精神分裂症患者中(女:r=-0.334,P=0.008)。结论:伴与不伴抑郁症状的精神分裂症患者精神症状及认知功能存在男女性别差异。     

不同年代首次住院精神分裂症患者症状学变化

目的:探讨不同年代首次住院精神分裂症患者症状学变化。方法:对1989年、1999年及2009年各128例首次住院的精神分裂症患者精神病性症状进行分析。结果:感知及情感障碍中各症状出现率各组间差异无统计学意义;思维障碍中被害妄想、夸大妄想、罪恶妄想、关系妄想、钟情妄想出现率差异有统计学意义(P0.05或P0.01);与1989年组比较,2009年组被害妄想、关系妄想出现率明显增高,罪恶妄想、钟情妄想出现率明显下降(P均0.05)。结论:随年代变迁,首次住院的精神分裂症患者思维障碍更多为被害妄想及关系妄想。     

女性失眠症患者心理健康状况及相关因素分析

目的探讨女性失眠症患者心理健康状况及其影响因素,为改善其心理健康提供参考。方法选取2012年1月-6月在中山大学附属第三医院就诊的符合《国际疾病分类(第10版)》(ICD-10)诊断标准的女性失眠症患者42例,采用匹兹堡睡眠质量指数量表(PSQI)、症状自评量表(SCL-90)、焦虑自评量表(SAS)、抑郁自评量表(SDS)和艾森克人格问卷(EPQ)评定患者睡眠质量、心理健康状况、人格特征,并分别对SCL-90和PSQI、EPQ评分进行相关分析。结果除人际关系敏感因子外,42例患者的SCL-90总评分及其他8个因子评分均高于常模,差异均有统计学意义(P0.05或0.01);PSQI总评分及7个因子评分、SAS、SDS评分均高于常模,差异均有统计学意义(P均0.01);PSQI的睡眠质量因子评分与SCL-90总评分及其9个因子评分均呈正相关(r=0.605～0.934,P均0.01);EPQ的精神质因子评分与SCL-90总评分及其8个因子评分(除恐怖因子外)均呈正相关(r=0.413～0.725,P0.05或0.01),神经质因子评分与SCL-90总评分及其9个因子评分均呈正相关(r=0.642～0.868,P均0.01)。结论女性失眠症患者的心理健康状况较差且常伴有焦虑、抑郁症状,其心理健康状况与睡眠质量和个性特征相关。     

强迫症患者儿茶酚氧位甲基转移酶基因表达的研究

目的 探讨汉族人群中外周血儿茶酚氧位甲基转移酶(COMT)基因表达与强迫症的关系.方法 采用实时定量逆转录-聚合酶链反应技术检测35例强迫症首次发病患者(强迫症组)与31名健康对照(对照组)外周血COMT基因表达水平;使用美国精神障碍诊断与统计手册第4版轴Ⅱ诊断结构式临床访谈问卷(SCID-Ⅱ)评估强迫症与强迫性人格障碍的共病情况.结果 强迫症组COMT基因表达水平明显低于对照组(t=2.56,P＜0.05),下调约32%;无强迫人格患者(15例)与对照组间COMT基因表达水平的差异有统计学意义(t=2.41,P＜0.05),而伴强迫人格患者(20例)与对照组的差异无统计学意义(t=1.50,P＞0.05);伴强迫人格与无强迫人格的强迫症患者COMT基因表达水平分别下调14%和56%;COMT表达水平与症状严重度无显著相关(r＝0.09,P＜0.05).结论 COMT基因表达下调可能与强迫症发病有关;伴或无强迫人格患者的遗传机制可能存在差异.     

司法鉴定中颅脑外伤所致精神障碍患者人格特征分析

目的探讨司法鉴定中颅脑外伤所致精神障碍患者人格特征及相关影响因素。方法收集2014年12月-2015年12月新疆维吾尔自治区两所精神病司法鉴定所在法医精神病司法鉴定中鉴定为颅脑外伤所致精神障碍的400例患者为研究对象,采用艾森克人格问卷(EPQ)评定人格特征,采用简明精神病量表(BPRS)评定精神症状。结果研究组EPQ的内外向(E)分量表评分高于全国常模(P0.05),精神质(P)与神经质(N)分量表评分均低于全国常模(P均0.01),掩饰程度(L)评分两组差异无统计学意义(P0.05)。研究组BPRS的焦虑抑郁、缺乏活力因子评分与全国常模比较差异均有统计学意义(P均0.05)。多重线性回归分析显示,受教育程度、受伤原因和EPQ的神经质、内外向、精神质进入回归方程(P0.05)。结论颅脑外伤所致精神障碍患者缺乏活力、易焦虑抑郁。精神质、神经质、内外向可能是其影响因素。     

基于艾森克人格问卷探讨社交恐惧症的人格特征

目的 探讨社交恐惧症患者的发病与人格特征的关系.方法 采用自编社会人口学资料调查表、Liebowitz社交焦虑量表（LSAS）、艾森克人格问卷（EPQ）对40例社交恐惧症（Social Phobia,SP）组患者和40名健康对照组人群进行评估.结果 社交恐惧症组与健康对照组在EPQ四个因子分及LSAS评分方面比较差异均有统计学意义（t分别为6.26,8.19,3.84,2.25,12.76;P＜0.05）,社交恐惧症组的LSAS评分与患者的神经质因子分呈正相关（r=0.545,P＜0.01）.结论 社交恐惧症患者有特别的人格特征,可能是其发病原因之一.     

伴发精神行为症状的高龄痴呆患者应用抗精神病药的安全性分析

目的:分析伴精神行为症状(BPSD)的高龄痴呆患者抗精神病药使用情况。方法:采用回顾性分析方法,根据是否应用抗精神病药治疗,将住院治疗的伴BPSD的80岁以上痴呆患者分为抗精神病药组(56例)和非抗精神病药组(34例),比较两组间安全性。结果:抗精神病药组中血管性痴呆患者的比例(32.1%)明显高于非抗精神病药组(8.8%)(χ~2=6.43,P0.05);不同痴呆类型的患者间奥氮平、喹硫平、利培酮、阿立哌唑、氟哌啶醇的药物剂量比较,差异无统计学意义(P均0.05)。不同痴呆类型间发生不良事件的比较,差异无统计学意义(P均0.05)。结论:应用小剂量抗精神病药治疗伴有BPSD的高龄痴呆患者未升高不良事件发生的风险。     

驻舰艇军人心理状况与人格特征的相关研究

目的:探讨驻舰艇军人心理健康状态及相关因素。方法:采用症状自评量表(SCL-90)、艾森克人格问卷(EPQ)评估海军某水面舰艇200名驻舰航行(长航)前后的心理健康状况。结果:长航前,除人际关系因子外,驻舰军人SCL-90总分及其他因子分均较男性军人常模显著低(P<0.01)。长航后SCL-90总分及各因子分均有所提高,其中总分、躯体化、焦虑、恐惧及精神病性因子分变化有统计学意义(P<0.05或P<0.01)。驻舰军人EPQ各分量表得分与男性常模比较差异均无显著性(P均>0.05)。SCL-90各因子分与EPQ精神质、神经质呈显著正相关(P<0.01),与掩饰性呈显著负相关(P<0.01);而人际关系、抑郁、恐惧因子分与内外向呈负相关(P<0.05或P<0.01)。结论:驻舰军人心理健康水平较好。人格特征与应激状态下心理健康水平关系密切。     

急性期双相障碍与重性抑郁障碍患者认知功能损害的对照研究

目的:探讨急性期双相障碍(BD)与重性抑郁障碍(MDD)患者认知功能损害的特点。方法:对57例BD患者(BD组)、48例MDD患者(MDD组)进行重复性成套神经心理状态测验(RBANS)认知功能测验,结果与59名年龄、性别、受教育程度与患者相匹配正常对照者(NC组)比较;分析BD及MDD组中伴精神病性症状的30例患者(伴精神病性症状组)与无精神病性症状患者认知功能差异。结果:BD组中即刻记忆、言语功能、延时记忆及RBANS总分低于NC组,MDD组即刻记忆、言语功能、延时记忆分显著低于NC组(P均0.05),BD组与MDD组间RBANS总分及各因子分差异无统计学意义。伴精神病性症状组的注意量表分明显低于MDD无精神病性症状组(P0.05)。结论:BD及MDD患者均存在多领域的认知功能障碍,伴有精神病性症状的心境障碍患者注意功能受损更严重。     

Differences in cytokines between non-suicidal patients and suicidal patients in major depression

Several studies have shown that there is an imbalance between pro-inflammatory and anti-inflammatory cytokines in major depressive disorder (MDD). However, little is known about the role of cytokines in suicide. In the present study, amounts of IL-6, IL-2, IFN-gamma, IL-4, and TGF-beta1 produced by mitogen-stimulated whole blood were measured in 36 MDD patients who had recently attempted suicide, 33 non-suicidal MDD patients, and 40 normal controls. The severity of depression symptoms and suicidal behaviors was evaluated using Hamilton's depression rating scale (HDRS), the Lethality Suicide Attempt Rating Scale (LSARS), and the Risk-Rescue Rating (RRR). Non-suicidal MDD patients had significantly higher IL-6 production than suicidal MDD patients and normal controls (p<0.001). Suicidal MDD patients had significantly lower IL-2 compared with non-suicidal patients and normal controls (p<0.001). Both MDD groups, with or without attempted suicide, had significantly lower IFN-gamma and IL-4 and higher TGF-beta1 production. HDRS scores had significant positive correlations with IL-6, IFN-gamma, and the Th1/Th2 ratio and significant negative correlations with IL-4 in non-suicidal depression patients (p<0.005); however, these correlations did not hold true for suicidal patients. Suicidal MDD patients had no significant correlations between the LSARS or RRR scores and cytokine release. Our findings suggest that the immune response has distinct differences between non-suicidal patients and suicidal patients. Non-suicidal MDD may be associated with increased IL-6 production and a Th1/Th2 imbalance with a shift to Th1, while suicidal MDD may be associated with decreased IL-2.     

Recognition of facial expression and visual P300 in schizophrenic patients: differences between paranoid type patients and non-paranoid patients

This study compared the effects of facial affective stimuli on visual event-related potentials (ERP) in schizophrenic patients and healthy subjects using photographs of babies depicting sadness (crying face), neutrality (neutral face), and pleasure (smiling face). Visual ERP were recorded using an oddball paradigm in 32 schizophrenic patients (16 paranoid type and 16 non-paranoid patients) and 32 age-matched healthy subjects. The P300 amplitude, latency, and the subject's reaction time were recorded. The P300 amplitude when viewing a photograph of a smiling baby was the smallest registered of three photographs for healthy subjects and paranoid type patients with successively greater amplitudes for neutrality and sadness. However, the P300 amplitude was the smallest while viewing crying photographs and was the largest while viewing a smiling photograph for non-paranoid patients. These results suggest that the P300 amplitude is influenced by viewing emotionally moving facial expressions and that the effect is different for different subtypes of schizophrenia. These differences may reflect differences in information processing resulted from emotional influences caused by visual-affective stimuli.     

Studies of the platelet fibrinogen receptor in Glanzmann patients and uremic patients.

The purpose of the present study was to investigate the binding of fibrinogen to the platelet fibrinogen receptor. Glycoprotein (GP) IIIa was measured utilizing a fluorescein isothiocyanate (FITC)-labelled monoclonal antibody and an Ortho Spectrum III flow cytometer. The number of binding sites per platelet was calculated to be 30,200. Using this technique it appears possible not only to diagnose Glanzmann's thrombasthenia but also to identify carriers. In uremic patients a slightly lower number of GPIIIa molecules per cell than in control subjects was found. Treatment with erythropoietin had no significant effect on the expression of GPIIIa. Thrombin, and to a less extent ADP, increased the binding of FITC-conjugated fibrinogen to normal platelets but had no significant effect on the expression of GPIIIa.     

Choice reaction time performance in hospitalized schizophrenic patients and depressed patients

Summary The choice reaction time performances of matched groups of hospitalized patients diagnosed schizophrenic or depressed were compared with normal controls to test a hypothesis concerning thought disorder specific to schizophrenia. Both patient groups were abnormal compared to controls providing evidence inconsistent with the diagnostic specificity issue. The results are discussed in terms of cognitive dysfunction in depression, the effects of institutionalization and the problems of diagnostic heterogeneity.     

Different patterns of movement-related cortical oscillations in patients with myoclonus and in patients with spinocerebellar ataxia

ObjectiveTo assess whether different patterns of EEG rhythms during a Go/No-go motor task characterize patients with cortical myoclonus (EPM1) or with spinocerebellar ataxia (SCA).MethodsWe analyzed event-related desynchronization (ERD) and synchronization (ERS) in the alpha and beta-bands during visually cued Go/No-go task in 22 patients (11 with EPM1, 11 with SCA) and 11 controls.ResultsIn the Go condition, the only significant difference was a reduced contralateral beta-ERS in the EPM1 patients compared with controls; in the No-go condition, the EPM1 patients showed prolonged alpha-ERD in comparison with both controls and SCA patients, and reduced or delayed alpha- and beta-ERS in comparison with controls. In both conditions, the SCA patients, unlike EPM1 patients and controls, showed minimal or absent lateralization of alpha- and beta-ERD.ConclusionsEPM1 patients showed abnormal ERD/ERS dynamics, whereas SCA patients mainly showed defective ERD lateralization.SignificanceA different behavior of ERS/ERD distinguished the two patient groups: the pattern observed in EPM1 suggests a prominent defect of inhibition occurring in motor cortex contralateral to activated segment, whereas the pattern observed in SCA suggested a defective lateralization attributable to the damage of cerebello-cortical network, which is instead marginal in patients with cortical myoclonus.     

Sleep and suicidality in psychotic patients

The purpose of the study was to determine whether polysomnographic rapid eye movement (REM) sleep parameters distinguish between psychotic patients with and without a history of suicidal behavior. We examined both hand-scored and automated measures of rapid eye movement (REM) sleep in psychotic patients with and without a history of suicidal ideation or attempts. Patients with suicidal behavior had significantly increased REM activity and time both in the whole night data and in the first REM period. These findings suggest an association between REM sleep abnormalities and suicidal behavior, perhaps related to alteration in serotonergic function.     

Hypnotizability in bulimic patients and controls

Summary Various studies have indicated that bulimics are more easily hypnotized and dissociate more readily than control groups and patients with other eating disorders. A comparison is reported of 15 inpatients with bulimia nervosa (DSM III-R) with 15 subjects in a control group comparable in age and education. The instrument used was the Harvard Group Scale of Hypnotic Susceptibility/Form A (HSGHS: A), which includes 12 standardized test suggestions. The results show that bulimics have higher scores in hypnotizability than the control group. A method study (comparison of self-evaluation with a video recording) shows that this is a result of the behaviour itself and not of the answering pattern used by the subjects in the questionnaire. It is possible that differing expectations regarding the experiment may have influenced the results. Considerations concerning the increased ability of bulimics to dissociate as a causal factor versus an accompanying phenomenon of the disorder are discussed.     

卒中后抑郁与脑卒中患者载脂蛋白E水平对照研究

目的:探讨卒中后抑郁(PSD)患者载脂蛋白E(ApoE)水平特点,为PSD的诊断提供新的客观依据。方法:采用实时荧光定量PCR技术和酶联免疫吸附法(ELISA)检测PSD患者及卒中后非抑郁患者ApoE水平。结果:PSD组ApoE基因mRNA表达量低于卒中组,差异具有统计学意义(P<0.01);PSD组血清ApoE水平高于卒中组,差异具有统计学意义(P<0.05)。结论:PSD患者外周血ApoE基因mRNA表达和血清ApoE水平与卒中非抑郁患者不同。     

Longitudinal assessment of negative symptoms in schizophrenia/schizoaffective patients, other psychotic patients, and depressed patients

This study assessed differences in negative symptom presentation between schizophrenia/schizoaffective, other psychotic, and depressed patients over a 10-year followup period. One hundred fifty individuals with schizophrenia or schizoaffective disorders (SZ/SZAF), other psychotic disorders (OP), and depressed patients (DP) were assessed at index hospitalization, then reassessed at 4.5-year, 7.5-year, and 10-year followups. SZ/SZAF patients significantly differed from DP patients in frequency and persistence of negative symptoms but were not significantly different from the OP group. Negative symptoms were not associated with depression in any diagnostic group. Dosage, but not simple use, of conventional antipsychotic medications was related to severity of symptoms in the SZ/SZAF group. Although negative symptoms were typically most severe and most common in the SZ/SZAF subjects in comparison to the DP patients, there were few statistically significant differences in the phenomenology of negative symptoms between the OP and SZ/SZAF groups. The data are consistent with a model that identifies negative symptoms as common to mental illnesses generally, with particularly high rates in psychotic illnesses.