焦虑和抑郁三种理论模式的研究进展

焦虑和抑郁是临床上常见的两组症状 ,二者常同时存在。目前 ,关于焦虑和抑郁的关系不外有三种观点 :(1)一元论 :即连续谱论 ,认为焦虑和抑郁是同一疾病的不同表现形式 ;(2 )二分论 :认为焦虑障碍和抑郁障碍是两种不同性质的疾病 ;(3)共病论 :认为焦虑和抑郁共存时 ,是一种不同于焦虑障碍或抑郁障碍的独特的疾病实体[1] 。我们就此展开讨论。一、一元论早在 1934年Ｌｅｗｉｓ就提出了焦虑和抑郁两组症状间的连续性 ,认为焦虑症状从整体或部分上是抑郁的一部分[2 ] 。1.流行病学[3 ] :Ｓａｎｄｅｒｓｏｎ等报道 ,一半以上的抑郁症(ｍａｊｏｒ…     

睡眠障碍临床研究的主要进展

睡眠是人类既熟悉又陌生的过程,是机体必不可少的生理过程,它不仅能恢复体力,还伴随着激素分泌、蛋白质合成、突触重建和记忆巩固等.随着医学的进步,对睡眠及睡眠障碍有了更深的认识.睡眠障碍发病率高,美国为35％[1]、加拿大29.9％[2],我国普通人群失眠为45.4％.1990年国际睡眠组织对睡眠障碍进行了分类,并先后进行两次修订.为引起人们对睡眠与睡眠障碍的重视,国际精神卫生和神经科学基金会将3月21日定为“世界睡眠日”.     

轻度认知障碍筛查研究中神经心理学量表的应用和评述

轻度认知障碍(mild cognitive impairment,MCI)是一种认知损伤状态,Petersen等[1]认为MCI是健康老龄人和早期老年性痴呆之间的过渡阶段,特指有轻度记忆力损害但其他功能保持完好,达不到临床诊断痴呆标准的老年人所处的认知损伤状态.最新修订和扩展的MCI包括3个亚型:单纯的遗忘型、单个的非记忆认知损害、轻微的多方面认知损害.     

癫(癎)与睡眠关系的研究进展

目前研究[1]认为,睡眠及睡眠剥夺可能活化癫(癎)发作或活化脑电图的癫(癎)样放电,某些类型的发作可能只发生或主要发生在睡眠中;而癫(癎)发作本身又可干扰睡眠,改变睡眠模式.睡眠中的同一种异常行为可能是癫(癎)发作的表现,也可能是睡眠行为异常.睡眠障碍影响对癫(癎)发作的控制,而癫(癎)发作又可能以睡眠异常为唯一表现.为此,对癫(癎)与睡眠之间的关系综述如下.     

普拉克索治疗原发性不宁腿综合征的疗效和安全性观察

不宁腿综合征(RLS)是一种感觉运动性疾病,其主要特征是:患者在静息状态下出现难以名状的腿部不适感,迫使其活动肢体以缓解症状.疾病可引起入睡困难和睡眠中断,严重影响患者的睡眠质量,使患者在白天出现困倦、注意力不集中、记忆力下降,甚至使其生活缺乏动力,出现抑郁和焦虑[1].     

老年性发作性睡病的研究进展

发作性睡病(narcolepsy)是一种多在青少年时期起病且持续终生不加重的慢性睡眠障碍性疾病[1].发作性睡病这一概念于1880年由法国内科医师Gelineauin[1]首次提出,典型临床表现为四联征:日间过度嗜睡、猝倒、睡眠瘫痪、睡眠幻觉.     

抑郁症早醒与血浆褪黑素水平的关系

睡眠障碍是抑郁症的常见症状,其中早醒最具特征性.属睡眠节律紊乱的表现[1],而失眠可能是抑郁症患者自杀的诱发因素[1].生理状态下褪黑素(Melatonin,MT)与睡眠及生物节律有密切关系,因此,褪黑素与抑郁症的关系引起了国内外学者重视,但研究结果不一致[2].     

阻塞性睡眠呼吸暂停对记忆巩固的影响及机制

本文目的是梳理阻塞性睡眠呼吸暂停(OSA)对记忆巩固影响的相关研究进展,推测其所涉机制,为探索可逆转OSA记忆巩固障碍的治疗措施提供参考。目前研究认为,轻度OSA可致不同类型记忆巩固效应损伤,且发现这些损伤与多导睡眠监测多个指标(如睡眠微结构、呼吸暂停低通气指数、觉醒指数等)密切相关,推测睡眠结构的破坏及间歇性缺氧所致的睡眠依赖性记忆巩固相关脑区和神经通路损伤可能引发记忆巩固效应的衰退。长期持续正压通气治疗可缓解OSA的记忆巩固损伤,但其他干预方法的效果还未可知。     

抑郁症首次发病患者睡眠障碍与认知功能的关系

目的:探讨首发抑郁症患者睡眠障碍和认知功能损害的关系。方法:采用17项汉密尔顿抑郁量表(HAMD-17)评估378例首发抑郁症患者的抑郁症状,根据是否伴有睡眠障碍分为睡眠障碍组(HAMD总分≥14分且睡眠因子分≥4分)253例和非睡眠障碍组(HAMD总分≥14分且睡眠因子分≤3分)125例;采用重复性成套神经心理状态测验(RBANS)、威斯康星卡片分类测验(WCST)、Stroop色-词关联测验评估两组认知功能并进行比较。结果:睡眠障碍组RBANS即刻记忆(t=-4.309)、视觉广度(t=-2.321)、注意因子(t=-4.555)、延时记忆(t=-2.282)得分及总分(t=-2.549)、WCST完成分类数(t=-3.459)、学习到学会(t=-2.406)得分显著低于非睡眠障碍组(P0.05或P0.001);错误应答数(t=3.621)、持续性错误百分比(t=3.753)、Stroop色-词关联测验单色时间(t=2.010)、字义干扰反应时(t=2.168)、颜色干扰反应时(t=3.089)显著高于非睡眠障碍组(P0.05或P0.001)。结论:首发抑郁症患者的睡眠障碍与认知功能损害有一定关联;伴睡眠障碍者较不伴睡眠障碍者认知功能损害更严重。     

情绪记忆的神经机制

记忆是最重要的认知功能之一。众所周知,在记忆中情绪性事件更易于被回忆起,情绪因素对记忆效率有调节作用,这种情绪对记忆影响效应被称之为情绪记忆。情绪记忆是指情绪对编码、巩固和提取等不同记忆加工阶段的影响[1]。从进化观点看,情绪记忆是人类很重要的认知功能,情绪刺激无论是有利或无利的,都对生物的生存和物种的繁衍产生重大影响。情绪记忆确保一些重要信息被记住而有利于生存[2]。因此,情绪记忆的神经机制成为认知神经科学研究领域的热点。以往,情绪记忆的研究是通过动物行为和社会/临床心理学研究;当前,情绪记忆的研究是探讨情绪性事件如何在脑部进行记忆和学习。对编码阶段研究[2]表明,情绪对记忆的影响是通过增强注意和预测能力,编码后阶段是通过应激激素的释放和记忆痕迹的巩固等。这些研究成果开始从系统水平来探讨情绪记忆的组织网络,为动物模式转换向临床疾病的研究提供了重要桥梁。情绪通常被看作包含两个垂直的维度:情绪效价和唤醒度,两者影响不同形式记忆。1情绪记忆的神经机制神经心理学和脑功能成像研究[3]显示,杏仁核与其他记忆相关的脑区存在大量的纤维联系,并且其交互影响可能在记忆形成过程中起着关键作用,以杏仁核为中心的多个脑区的互动可能...     

Efficacy and Effectiveness of Child and Adolescent Psychotherapy and Pharmacotherapy

Decades of intervention research have produced a rich body of evidence on the effects of psychotherapies and pharmacotherapies with children and adolescents. Here we summarize and critique that evidence. We review findings bearing on the efficacy of psychosocial treatments and medications under controlled experimental conditions. We also report evidence, where available, on the effectiveness of both classes of treatment with clinically referred youth treated in real-world clinical contexts. In general, the large body of evidence on efficacy contrasts sharply with the small base of evidence on effectiveness. Addressing this gap through an enriched research agenda could contribute importantly to linking scientific inquiry and clinical practice—to the benefit of both ventures. This is one element of a multifaceted agenda for future research and for synthesis of research, which will require the interplay of multiple disciplines related to child and adolescent mental health.     

Satellite cells and myonuclei in young and elderly women and men

The overall aim of this study was to assess the effects of aging on the satellite cell population. Muscle biopsies were taken from the tibialis anterior muscle of healthy, moderately active young (age range, 20-32 years; n = 31) and elderly (age range, 70-83 years; n = 27) women and men with comparable physical activity pattern. Satellite cells and myonuclei were visualized using a monoclonal antibody against neural cell adhesion molecule and counterstained with Mayer's hematoxylin. An average of 211 (range, 192-241) muscle fibers were examined for each individual. Compared with the young women and men, the elderly subjects had a significantly lower (P < 0.011) number of satellite cells per muscle fiber but a significantly higher (P < 0.004) number of myonuclei per muscle fiber. The number of satellite cells relative to the total number of nuclei [satellite cells/(myonuclei + satellite cells)] was significantly lower in the elderly than in the young women and men. These results imply that a reduction in the satellite cell population occurs as a result of increasing age in healthy men and women.     

Opiate and digitalis receptor assays distinguish between neuroexcitant and inactive organochlorines and between anesthetics and convulsants

Specific binding of [3H]naloxone to rat brain tissue in vitro was inhibited by the excitant organochlorinated insecticides (OCI), by ether (E) and octanol (OCT), and by the convulsant indoklon (IND) and its anesthetic isomer, isoindoklon (ISO). In the presence of 100 mM NaCl the inhibition of naloxone binding by E, OCT and ISO was greatly potentiated, whereas that by OCI and IND was attenuated. KCl (100 mM) was equally effective as NaCl on the action of anesthetics, but the effect of the excitant drugs was, in contrast to NaCl, unaffected by KCl. Specific binding of [3H]ouabain in the absence of Na, was depressed by anesthetics and enhanced by neuroexcitants. In the presence of NaCl, which by itself inhibits ouabain binding to brain, both anesthetics and excitants enhanced ouabain binding. DDE, a non-insecticidal analog of DDT, and the dimethyl derivative of the OCI, lindane, were inactive in the receptor assays. These observations point to a unique isolated system which responds consistently to anesthetic agents as a class and, in a different way, to neuroexcitant compounds.     

Learning and forgetting new names and objects in MCI and AD

We studied how subjects with mild cognitive impairment (MCI), early Alzheimer's disease (AD) and age-matched controls learned and maintained the names of unfamiliar objects that were trained with or without semantic support (object definitions). Naming performance, phonological cueing, incidental learning of the definitions and recognition of the objects were tested during follow-up. We found that word learning was significantly impaired in MCI and AD patients, whereas forgetting patterns were similar across groups. Semantic support showed a beneficial effect on object name retrieval in the MCI group 8 weeks after training, suggesting that the MCI patients’ preserved semantic memory can compensate for impaired episodic memory. The MCI group performed equally well as the controls in the tasks measuring incidental learning and recognition memory, whereas the AD group showed impairment in this respect. Both the MCI and the AD group benefited less from phonological cueing than the controls. Our findings indicate that word learning is compromised in both MCI and AD, whereas long-term retention of newly learned words is not affected to the same extent. Incidental learning and recognition memory seem to be well preserved in MCI.     

Necdin蛋白与神经元的生长分化

在神经系统 ,Necdin只在成熟神经元的细胞核中表达 ,可能与成熟神经元分裂静止状态的保持有关。近年的研究表明 ,Necdin是一种生长抑制蛋白 ,能与多种因子如SV4 0大T抗原 ,腺病毒E1A ,转录因子E2F1以及肿瘤抑制蛋白p5 3等结合 ,在功能上类似于成视网膜瘤蛋白Rb。necdin基因缺陷时 ,会引起脑内 ,特别是下丘脑神经元分化障碍。人类necdin基因位于PWS综合征的基因缺失区 ,可能与PWS的一些症状有关。本文从Necdin蛋白的基本概况 ,生物功能以及Necdin与疾病三个方面进行了综述     

Retrospective and prospective design and data

The study of the presentation, symptomatology and family characteristics of an exclusively adolescent sample of patients with borderline personality disorder (BPD) was undertaken. Twenty-four cases of borderline personality disorder, 20 females, 4 males, identified using chart review and meeting the criteria of the Diagnostic Interview for Borderlines (DIB) and DSM III-R, were matched with psychiatric controls. Adolescents with borderline personality disorder were found to have high rates of affective symptomatology with Axis I diagnosis of major depressive disorder - MDD (DSM-III-R), and high rates of interpersonal psychopathology, i.e., manipulation, devaluation, and a pervasive sense of boredom. The latter seem to be characteristic as for adults with borderline personality disorder. The families were particularly angry and volatile.     

Cortisol levels and depression in men and women using heroin and cocaine

Abnormalities in the hypothalamic-pituitary-adrenal (HPA) axis are well documented in men using illicit drugs and/or infected with HIV; however, less is known about HPA function, or the health consequence of HPA dysfunction, in their female counterparts. People with depression exhibit hypercortisolemia, and depression is common in people with HIV or substance use problems. The current study investigated cortisol secretion in 209 demographically matched men and women, stratified by their HIV and drug use status. Self-reported depressive symptoms were evaluated using a standardized, validated questionnaire (CES-D). Women reported more depressive symptoms than men (p=.01). Male and female drug users exhibited higher cortisol concentrations (p=.03), and were more likely to report depressive symptoms (p=.04), than non-users. Depression was related to elevated cortisol concentrations for the study population (p=.03), and women with elevated cortisol concentrations were significantly more depressed than all other participants (p=.05). While it is unknown whether high cortisol concentrations precede depressive symptoms or vice versa, these data indicate that higher cortisol concentrations are associated with depressive symptoms in heroin and cocaine users, and that this association is more pronounced in women than men. HIV status did not act in an additive or synergistic way with drug use for either cortisol or CES-D measures in the current study. Unique therapies to treat the endocrine and mental health consequences of illicit drug use in men and women deserve consideration as depressive symptoms, and high cortisol concentrations associated with depressive symptoms, differ by gender.     

Dissociation and Counterdissociation: Nuanced and Binary Perceptions of Good and Evil

Dissociated experiences are often communicated to analysts. Clinicians may absorb patients' dissociation, thereby creating “counterdissociated” states. Counterdissociation contributes to binary thinking in the analyst similar to black- and-white thinking commonly seen in patients' dissociated states. This can have both positive and negative effects: Counterdissociation may help therapists identify with patients' experience, thereby cementing the therapeutic bond. If analysts remain counterdissociated, however, patients may remain dissociated. As analysts identify their counterdissociation, they may gain insight into patients' needs for dissociation. As they overcome counterdissociation, patients may concurrently overcome dissociation. This allows both to have a more nuanced view of inner experience. With two extended case studies of sexually abused men, this article tracks how an analyst deals with counterdissociation created through intimate contact with dissociated positive and negative introjects of victimizers, thus forming identifications or overidentifications with the patients' abused parts.     

Necdin蛋白与神经元的生长分化

在神经系统,Necdin只在成熟神经元的细胞核中表达,可能与成熟神经元分裂静止状态的保持有关.近年的研究表明,Necdin是一种生长抑制蛋白,能与多种因子如SV40大T抗原,腺病毒E1A,转录因子E2F1以及肿瘤抑制蛋白p53等结合,在功能上类似于成视网膜瘤蛋白Rb.necdin基因缺陷时,会引起脑内,特别是下丘脑神经元分化障碍.人类necdin基因位于PWS综合征的基因缺失区,可能与PWS的一些症状有关.本文从Necdin蛋白的基本概况,生物功能以及Necdin与疾病三个方面进行了综述.     

Oxytocin and vasopressin agonists and antagonists as research tools and potential therapeutics

We recently reviewed the status of peptide and nonpeptide agonists and antagonists for the V(1a), V(1b) and V(2) receptors for arginine vasopressin (AVP) and the oxytocin receptor for oxytocin (OT). In the present review, we update the status of peptides and nonpeptides as: (i) research tools and (ii) therapeutic agents. We also present our recent findings on the design of fluorescent ligands for V(1b) receptor localisation and for OT receptor dimerisation. We note the exciting discoveries regarding two novel naturally occurring analogues of OT. Recent reports of a selective VP V(1a) agonist and a selective OT agonist point to the continued therapeutic potential of peptides in this field. To date, only two nonpeptides, the V(2) /V(1a) antagonist, conivaptan and the V(2) antagonist tolvaptan have received Food and Drug Administration approval for clinical use. The development of nonpeptide AVP V(1a), V(1b) and V(2) antagonists and OT agonists and antagonists has recently been abandoned by Merck, Sanofi and Pfizer. A promising OT antagonist, Retosiban, developed at Glaxo SmithKline is currently in a Phase II clinical trial for the prevention of premature labour. A number of the nonpeptide ligands that were not successful in clinical trials are proving to be valuable as research tools. Peptide agonists and antagonists continue to be very widely used as research tools in this field. In this regard, we present receptor data on some of the most widely used peptide and nonpeptide ligands, as a guide for their use, especially with regard to receptor selectivity and species differences.