保定市精神分裂症的流行病学调查

目的了解保定市精神分裂症的患病率和分布特点。方法2004年10月～2005年3月采用多阶段分层整群抽样方法随机抽取≥18周岁的人群,共10073名,用扩展的一般健康问卷（GHQ-12）将调查对象分为高、中、低危险组,采用美国精神障碍诊断标准（DSM-Ⅳ）,以美国精神障碍诊断与统计手册-第四版（DSM-Ⅳ）轴Ⅰ障碍定式临床检查患者版对调查对象进行精神分裂症的诊断。心理、社会及职业功能评定采用大体功能评定量表（GAF）。结果9021名完成调查,精神分裂症的终生患病率为0.62%（95%CI=0.46%～0.78%）,时点患病率为0.54%（95%CI=0.39%～0.69%）。时点患病率：女性高于男性（P〈0.01）;30～39岁、40～49岁、50～59岁患病率较高。Logistic回归分析结果：女性、分居/离婚、低收入增加精神分裂症的患病危险性。心理、社会及职业功能受损程度：重度57.41%,中度35.19%,无或轻度7.41%。精神分裂症的精神科门诊就诊率为35.56%,住院率28.89%。结论精神分裂症是一类患病率较高的精神障碍,在女性及30～59岁中更常见,严重影响患者的心理、社会及职业功能,精神卫生服务利用率低。     

保定市酒精滥用和酒精依赖的流行病学调查

目的了解保定市酒精滥用和酒精依赖的患病率和分布特点。方法2004年10月至2005年3月采用多阶段分层整群抽样方法随机抽取≥18周岁的人群,共10073名,用扩展的一般健康问卷（GHQ-12）将调查对象分为高、中、低危险组,采用美国精神障碍诊断标准（DSM-Ⅳ）,以美国精神障碍诊断与统计手册-第四版（DSM-Ⅳ）轴Ⅰ障碍定式临床检查病人版对调查对象进行酒精滥用及酒精依赖的诊断。心理、社会及职业功能采用大体功能量表（GAF）评定。结果9021人完成调查。酒精滥用：终生患病率为27.49‰,时点患病率为10.37‰;时点患病率：男性（20.01‰）明显高于女性（0.69‰）（P〈0.01）,农村（11.44‰）明显高于城市（2.76‰）（P〈0.01）,18-59岁患病率较高;心理、社会及职业功能无或轻度91.67%、中度2.38%、重度5.95%。酒精依赖：终生患病率为14.25‰、时点患病率为10.47‰;时点患病率：男性（20.69‰）明显高于女性（0.22‰）（P〈0.01）;20-69岁患病率较高;心理、社会及职业功能无或轻度68.68%、中度27.71%、重度3.61%。酒精滥用和酒精依赖均与心境障碍和焦虑障碍共病常见。结论酒精滥用和酒精依赖是常见的精神障碍,在男性及中青年人群中患病率高,已成为严重的社会公共卫生问题。     

保定市抑郁症的流行病学调查

目的:了解保定市抑郁症的患病率和分布特点。方法:2004年10月至2005年3月,采用美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)轴Ⅰ障碍定式临床检查患者版对调查对象进行抑郁症的诊断。结果:9021人完成了调查,抑郁症的终生患病率为6.05%,时点患病率为4.52%。Logistic回归分析显示:女性、年龄、受教育年限及家庭年收入等因素影响抑郁症的患病;抑郁症的精神科就诊率为1.82%。结论:抑郁症是保定市常见的精神障碍,女性、农村及中老年患病率高,抑郁症患者的精神服务利用率低。     

河北省双重抑郁症的患病率、临床特征及社会功能状况分析

目的了解双重抑郁症的患病率、临床特征及社会生活功能状况。方法采用随机抽样方法,以美国精神障碍诊断与统计手册-第四版修订版(DSM-Ⅳ-TR)为诊断标准,以DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查病人版(SCID-I/P)为诊断工具,对河北省完成流行病学调查的20716名18岁以上人群中双重抑郁症的患病率、共病、社会功能等临床特征进行分析。采用功能大体评定量表(global assessment of function,GAF)和匹茨堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)中国修订版分别评定患者的功能状况和睡眠质量。结果 20716名被调查者中现患心境恶劣障碍411例,其中56例(13.6%)叠加了重性抑郁发作,符合双重抑郁症的诊断标准。双重抑郁症的时点患病率为0.27%(56/20716),按精神障碍高、中、低危险组SCID诊断的比例校正后的时点患病率为0.47%(95%CI:0.38%～0.56%)。单一的心境恶劣组和双重抑郁症组均有较高的其他精神障碍的共病率(30.99%和46.43%),后者的共病率更高(P0.05),但两组均以共病未特定的焦虑障碍、广泛性焦虑障碍、特殊恐怖症、创伤后应激障碍、酒依赖/酒滥用等常见。双重抑郁症组GAF评分明显低于单一心境恶劣组(P0.01),PSQI的总分及入睡时间、睡眠障碍、日间功能因子的评分明显高于心境恶劣组(P0.05),但两组在性别、文化程度、居住方式、城乡、婚姻状况方面无明显差异(P0.05)。结论心境恶劣障碍中双重抑郁症的比例不低,而双重抑郁症共病其他精神障碍和社会功能的损害更明显,应引起临床重视。     

保定市心境障碍的流行病学调查

目的了解保定市心境障碍的患病率和分布特点。方法2004年10月至2005年3月采用多阶段分层整群抽样方法随机抽取≥18周岁的人群,共10073名,用扩展的一般健康问卷(GHQ-12)将调查对象分为高、中、低危险组,采用美国精神障碍诊断与统计手册第四版(DSM-Ⅳ)的诊断标准,以其轴Ⅰ障碍定式临床检查患者版(SCID-I/P)对调查对象进行心境障碍的诊断。结果9021人完成调查,心境障碍的终生患病率为9.01%(95%CI=8.42%~9.60%),时点患病率为6.51%(95%CI=6.00%~7.02%),三种常见的心境障碍是重性抑郁障碍(4.19%,2.64%)、心境恶劣(仅现患)(2.15%)和未特定的抑郁障碍(2.49%,1.76%)。时点患病率:女性(7.65%)高于男性(5.42%)(P<0.01),农村(6.81%)高于城市(4.45%)(P<0.01);50~59岁及60~69岁患病率高,分别为9.34%、9.70%。Logistic回归分析显示:心境障碍的易患危险因素为女性、农村、低文化、低收入。心境障碍的精神科就诊率为2.13%。结论保定市心境障碍的患病率较高,其中女性、农村及中老年患病率高,重性抑郁障碍、心境恶劣是保定市需要重点防治的特定心境障碍,心境障碍的精神卫生服务利用率低。     

宜宾地区18岁及以上人群心境障碍现患病率调查

目的了解宜宾地区成年人群心境障碍的现患病率及分布特点。方法采用多阶段分层整群抽样方法抽取宜宾地区≥18岁人群12000人,用扩展的一般健康问卷筛查将调查对象分为精神障碍高、中、低危险组,然后用《DSM-Ⅳ轴Ⅰ障碍用临床定式检查》(Structured Clinical Interview for DSM-Ⅳ-TR,SCID)对不同比例的三组人群进行诊断检查。结果11227人完成了调查。调整后心境障碍总的现患率为2.48%(95%CI:1.87%～3.28%)。心境障碍中具体诊断的患病率依次为未特定抑郁障碍1.4%(95%CI:0.98%～1.99%)、重性抑郁障碍0.81%(95%CI:0.47%～1.38%)、心境恶劣障碍0.17%(95%CI:0.09%～0.33%)、双相I型障碍0.11%(95%CI:0.02%～0.68%)。心境障碍总的现患病率女性高于男性(2.97%比1.83%,RR=1.62,RR的95%CI:1.27%～2.11%),城市高于农村(3.60%比2.40%,RR=1.50,RR的95%CI:1.13%～2.05%)。在现患心境障碍者中,仅有5.9%接受过医疗机构的任何治疗,2.2%接受过精神心理机构的治疗,0.7%接受过精神科住院治疗。结论心境障碍已经成为宜宾地区重要的公共卫生问题,而患者中向精神心理机构求助的较低比例应引起高度关注。     

上海市浦东社区老人抑郁障碍与认知功能障碍流行病学调查

目的:了解上海原浦东地区老年抑郁障碍与认知功能障碍的患病率及二者之间的关系,为开展社区老年精神卫生工作提供科学依据. 方法:按照整群随机抽样方法,随机抽取其中60岁以上老人3 311名进行调查,抑郁障碍直接使用美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)轴Ⅰ障碍定式临床检查患者版(SCID-I/P)为诊断工具,以DSM-Ⅳ为诊断标准.认知功能障碍患者轻度认知功能障碍按Petersen MCI诊断标准,Alzheimer型痴呆患者以DSM-Ⅳ为诊断标准. 结果:抑郁障碍时点患病率(632例)为19.09％,认知功能障碍时点患病率(837例)为25.28％,抑郁障碍患者的患病率与认知功能障碍、年龄、独居有明显相关性(P＜0.05);认知功能障碍患者的患病率与抑郁障碍、年龄、文化程度、独居及有无躯体情况有明显相关性(P＜0.05). 结论:上海浦东新区社区老人抑郁障碍及认知功能障碍患病率高,且二者存在关联.     

河北省精神分裂症的患病率、人口学特征及功能状况分析

目的了解精神分裂症的患病率、人口学特征及社会生活功能状况。方法采用随机抽样方法,调查河北省18岁以上人群24000人,调查筛选工具采用改编后的一般健康问卷12项(GHQ-12),以《DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查》病人版(SCID-I/P)为调查的诊断工具。功能状况评价采用功能大体评定量表(GAF)。结果精神分裂症时点患病率为0.546%(95%CI:0.445%~0.646%),终生患病率为0.662%(95%CI:0.551%~0.772%)。时点患病率:城市0.440%,农村0.561%,农村虽高于城市,但无显著性差异(u=0.80,P>0.05);女性0.649%,男性0.443%,女性明显高于男性(u=2.01,P<0.01);30~60岁患病率较高。偏执型占63.8%。Logistic回归分析显示,影响精神分裂症的危险因素有分居/离婚(OR=9.58)、独身(OR=6.99)、家庭年收入0~5000元(OR=4.2),保护性因素有已婚(OR=0.38)、无宗教(OR=0.46);严重程度以中度和重度多见,社会和生活功能受损明显,GAF评分平均为(48.41±19.07)分。结论精神分裂症是一种患病率相对较高的重性精神疾病,严重影响患者的社会生活功能。     

天水市60岁及以上人群各类精神疾病流行病学现况调查

目的为了解天水市60岁及以上人群各类精神疾病患病率、人口学特征及社会生活功能状况。方法 2014年11月~2015年5月采用多阶段分层整群抽样方法随机抽取≥60岁人群,共2430名。用扩展的一般健康问卷(GHQ-12)进行筛查,以美国精神障碍诊断与统计手册(DSM-IV)轴Ⅰ障碍定式临床检查患者版进行调查,用DSM-IV对各年龄段各类精神障碍进行诊断。采用大体功能评定量表(GAF)评价功能状态。结果 (1)患病率:2416人完成调查,精神障碍的时点患病率为177.14‰[95%可信区间(95%CI)为124.3‰~252.5‰],排在前三位的是重型抑郁障碍(87.73‰)、缘于躯体状况的心境障碍(26.33‰)和未特定焦虑障碍(15.80‰);终生患病率为192.28‰(95%CI为135.3‰~273.2‰)。(2)时点患病率:女性(212.96‰)高于男性(142.9‰),城市(238.31‰)高于农村(166.46‰);患病率随年龄的增长而不断下降,其中60~69岁为221.03‰,70~79岁为150.43‰,80岁及以上为110.34‰。结论甘肃省天水市60岁及以上人群精神障碍患病率较高,心境障碍是特别需要关注的问题。     

甘肃省留守老年人群重性抑郁障碍现况调查

目的了解甘肃省≥60岁农村留守人群重性抑郁障碍的患病率、抑郁症人口学特征及社会生活功能状况。方法 2017年11月～2018年6月采用多阶段分层整群抽样方法随机抽取≥60岁人群。用扩展的一般健康问卷(GHQ-12)以及美国精神障碍诊断与统计手册(DSM-IV)轴Ⅰ障碍定式临床检查患者版对所有纳入人群进行筛查和诊断。采用大体功能评定量表(GAF)评价功能状态。结果共6000人完成了调查。①甘肃省≥60岁农村留守人群重性抑郁障碍时点患病率为92.03‰(95%CI:7.99%～10.60%),终身患病率为92.87‰(95%CI:9.06%～10.70%);②女性重性抑郁障碍患病率(118.72‰)高于男性(62.43‰),不在婚者(123.04‰)高于在婚者(84.28‰);重性抑郁障碍患病率各年龄段间无差异(P0.05);低经济收入、不良婚姻是重性抑郁障碍的危险因素。重性抑郁障碍GAF评分52.56±10.13,83.69%为中度到严重功能损害。结论甘肃省≥60岁农村留守人群重性抑郁障碍患病率较高,严重程度以中重度为主,求治率及精神科治疗率均较低。     

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.     

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.     

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.     

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.     

The influence of comorbid depression on seizure severity

PURPOSE: To determine the relation between depressive symptoms and seizure severity among people with epilepsy. METHODS: A postal questionnaire was used to survey a nationwide community sample about seizures and depression. The Seizure Severity Questionnaire (SSQ) assessed the severity and bothersomeness of seizure components. The Centers for Epidemiological Studies-Depression scale categorized levels of depression. RESULTS: Respondents categorized as having current severe (SEV, n = 166), mild-moderate (MOD, n = 74), or no depression (NO, n = 443) differed significantly in SSQ scores (all p < 0.0001). People with SEV or MOD reported significantly worse problems than did those with NO depression for overall seizure recovery (mean, 5.3, 4.9, 4.5, respectively); overall severity (5.0, 4.5, 4.2); and overall seizure bother (5.3, 4.8, 4.4) (all p < 0.005). Cognitive, emotional, and physical aspects of seizure recovery also were rated worse among people with SEV than with NO depression (all p < 0.05). Symptoms of depression were significantly correlated with higher levels of all components of generalized tonic-clonic seizure severity (r = 0.33-0.48; all p < 0.0001), and partial seizures (r = 0.31-0.38; all p < 0.01). CONCLUSIONS: Clinically depressed people with epilepsy reported higher levels of perceived severity and bother from seizures, as well as greater problems with overall seizure recovery than did nondepressed people experiencing similar types of seizures. The pervasive influence of depressive symptoms on reports of seizure activity suggests that people with epilepsy should be screened for depression. These data highlight the importance of detecting and treating depression among people with epilepsy.     

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.