知情权和选择权在精神分裂症急性期住院的应用研究

目的探讨知情权和选择权在精神分裂症急性期住院过程中的应用方法。比较知情状况对就诊、住院合作程度的影响。方法先让患者法定监护人享受知情权和选择权，法定监护人同意让患者享受知情权和（或）选择权为知情组，否之为非知情组；患者同意住院为同意组，否之为非同意组。信果非知情组对就诊、住院和治疗的合作率及法定监护人对住院方式的满意率明显高于知情组，经χ^2检验，有显著性差异（P〈0．05）；非知情组就诊、住院和治疗的被强制率显著低于知情组。经χ^2检验，有极显著性差异（P〈0．01）。结论把急性期精神分裂症患者的知情权和选择权转移给患者法定监护人的方法是切实可行。     

急性脑出血患者下肢深静脉血栓形成的危险因素分析

目的 分析急性脑出血患者住院期间下肢深静脉血栓形成（deep venous thrombosis，DVT）发生率、发生时间及危险因素。方法 选取首都医科大学附属北京天坛医院急性卒中入院后并发症队列研究中的脑出血患者，根据患者住院期间是否发生下肢DVT分为DVT组和无DVT组，比较两组患者的临床特征，采用多因素logistic回归分析脑出血患者发生DVT的危险因素。 结果 研究最终纳入314例脑出血患者，其中18例（5.7%）住院期间发生了DVT，发生脑出血至DVT确诊的中位时间为7.5（4.0～9.0）d。多因素logistic回归分析结果显示：女性（OR 3.43，95%CI 1.04～11.37，P=0.0436）、既往冠心病病史（OR 6.89，95%CI 1.90～25.04，P=0.0034）、入院NIHSS评分高（OR 1.18，95%CI 1.06～1.23，P=0.0004）、住院时间长（OR 1.07，95%CI 1.01～1.13，P=0.0273）是脑出血患者发生DVT的独立危险因素。结论 急性脑出血患者发生下肢DVT时间在卒中后1周左右，女性、既往冠心病病史、入院时病情重、住院时间长的患者更容易发生下肢DVT。     

急性脑卒中老人接受神经营养药物联合早期康复治疗的转归

在1年的时间里,对入住浙江大学附属第一医院老年病科的60例老年急性脑卒中患者给予神经营养药物联合早期康复治疗,借助Hunt-Hess 量表、功能独立性评测、简易智力测定量表和日常生活能力量表,对患者入院时和出院时的肢体运动、认知功能和日常生活自理能力变化做出了评估。纳入的60位患者平均住院时间35 d。出院时有40例患者存在不同程度的认知功能损害,56例接受康复治疗评估的脑卒中患者中,25例（45%）在日常生活方面获得了自理能力,11例（20%）日常生活的部分时间里需要有人照顾,20例（36%）在基本生活上需要全天24 h有人照顾。     

精神障碍者知情同意能力评估问卷的临床应用

目的临床应用半定式知情同意评估问卷(SSICA),探讨影响精神障碍者知情同意能力的相关因素。方法对上海市精神卫生中心148例年龄18岁以上诊断为精神分裂症、抑郁症和神经症的患者,入院72小时内收集人口学资料和临床资料,并于第0、2、6周用半定式知情同意能力评估问卷(SSICA)、自知力与治疗态度问卷(ITAQ)评估患者的知情同意能力;采用临床疗效总评量表(CGI)、简明精神病量表(BPRS)或汉密顿抑郁量表(HAMD)等评定其精神症状及严重程度,统计分析知情同意能力的影响因素。结果(1)精神分裂症组SSICA分数明显低于抑郁和神经症组(p<0.001);(2)BPRS、HAMD、CGI及ITAQ总分与知情同意能力显著相关(p<0.05),ITAQ分有助于区分有、无知情同意能力(OR=1.73);(3)患者第0、2、6周的知情同意能力有显著差异(p<0.001);(4)知情同意能力还与患者的年龄、首次发病年龄及入院方式有关,而与性别、文化程度、婚姻状况、总病程及总住院次数无关。结论影响精神障碍者知情同意能力的因素是综合和多方面的,需要在评定时予以考虑。     

尤瑞克林治疗急性脑梗死的疗效及对血清MMP-9的影响

目的探讨尤瑞克林治疗急性脑梗死的临床疗效及对血清基质金属蛋白酶-9（matrix metalloproteinase-9,MMP-9）水平的影响。方法采用随机单盲对照研究,将发病48h内入院的大面积脑梗死患者40例分为对照组和治疗组（尤瑞克林组）。评价治疗前后血清MMP-9水平,应用美国国立卫生研究院卒中量表（NIHSS）及Barthel指数（BI）记分法对入院后当天及治疗2周时神经功能缺损程度进行评分。结果各组2周后神经功能缺失程度评分与入院时相比,差异均有统计学意义（P〈0.01）,尤瑞克林组优于对照组（P〈0.05）。治疗后2组血清MMP-9水平均下降,与对照组相比,尤瑞克林组下降更明显（P〈0.05）。结论短期应用尤瑞克林可改善脑梗死患者的预后,其机制可能与降低血清MMP-9水平有关。     

阿托伐他汀对进展性脑梗死进展时间及神经功能的影响

目的观察阿托伐他汀对进展性脑梗死进展时间和神经功能的影响。方法选取80例进展性脑梗死患者,分为治疗组和对照组,均给予降压、抗凝常规治疗。治疗组加用阿托伐他汀;治疗4周后观察2组神经功能缺损程度、发病至症状高峰时间和生化改变。结果入院时和进展停止时2组神经功能缺损程度比较差异无统计学意义（P〉0．05）;治疗4周后,治疗组神经功能缺损评分明显低于对照组（P〈0．05）;2组AST、ALT、CK治疗前、后均无明显变化（P〉0．05）;治疗组TC、TG明显低于对照组（P〈0．05）。结论应用阿托伐他汀治疗进展性腑梗死可改善预后,安全,值得临床推广。     

急性缺血性卒中后炎症因子水平与神经功能恢复的关系研究

目的 分析急性大动脉粥样硬化性缺血性卒中后炎症因子水平及其与神经神经功能恢复的相关性。 方法 收集2015年11月-2018年1月中国康复研究中心北京博爱医院神经内科收治的轻中度 （NIHSS≤15分）大动脉粥样硬化性急性缺血性卒中患者。分别在入院时、1周、2周、4周进行白细胞计数 （white blood cell,WBC）、中性粒细胞计数（neutrophils,NEU）及纤维蛋白原（fibrinogen,Fib）、IL-6、TNF-α 等炎症因子的检测,同时进行NIHSS评分;并在发病4周进行mRS评分。根据入组时NIHSS评分,将患者 分为轻型卒中（NIHSS 0～4分）和中型卒中（NIHSS 5～15分）两组,比较两组间发病4周内的炎症因子 水平。分析WBC、NEU和Fib水平与同期NIHSS的相关性,入院时WBC、NEU和Fib水平与后续随访（1周、2 周和4周）时NIHSS以及4周时mRS的相关性。 结果 研究共入组61例患者,轻型卒中组5 0例、中型卒中组11例。入院时中型卒中组W B C [（8.87±2.99）×109/L v s（7.07±2.06）×109/L,P =0.019]、N E U [（6.38±2.77）×109/L v s （4.72±1.66）×109/L,P =0.010]和Fib[3.31（2.74～4.24）g/L vs 2.71（2.36～3.30）g/L,P =0.041] 水平均高于轻型卒中组;发病1周时,中型卒中组WBC（[ 8.80±1.47）×109/L vs（6.99±2.32）×109/L, P=0.032]、NEU（[ 6.16±1.09）×109/L vs（4.72±2.14）×109/L,P =0.049]和Fib[3.73（2.92～4.39）vs 2.65 （2.25～3.11）,P=0.022]水平均高于轻型卒中组;发病2周时,中型卒中组WBC（[ 8.40±1.68）×109/L vs（6.89±1.28）×109/L,P=0.012]、NEU（[ 5.76±1.46）×109/L vs（4.59±1.12）×109/L,P =0.024]仍 高于轻型卒中组,但两组Fib水平差异无统计学意义;发病4周时两组的WBC、NEU和Fib水平差异均无 统计学意义。两组各个时间点IL-6、TNF-α水平差异均无统计学意义。入院时（r =0.225,P =0.048）、 发病1周时（r =0.413,P =0.005）和发病2周（r =0.382,P =0.034）时NIHSS与Fib水平呈正相关;入院 时（r =0.257,P =0.046）和发病2周时（r =0.396,P =0.027）NIHSS与NEU水平呈正相关;发病2周时 （r =0.451,P =0.011）NIHSS与WBC水平呈正相关。入院时WBC水平与发病2周（r =0.442,P =0.007）和 4周（r =0.518,P =0.011）时的NIHSS呈正相关;入院时NEU水平与发病1周（r =0.268,P =0.048）、2周 （r =0.402,P =0.015）和4周（r =0.431,P =0.040）时的NIHSS评分呈正相关;入院时Fib水平与发病1周 （r =0.318,P =0.023）和2周（r =0.378,P =0.025）时NIHSS呈正相关。 结论 对于轻中度大动脉粥样硬化性缺血性卒中,发病2周内神经功能缺损程度与Fib和NEU水平呈 正相关;中型缺血性卒中在发病2周内的WBC、NEU和Fib水平高于轻型缺血性卒中,该差异在发病4周时 逐渐消失。     

发病情景摄像回放对精神分裂症自知力的影响

目的：探讨精神分裂症患者发病情景摄像回放治疗方法对自知力恢复的影响。方法：60例精神分裂症患者随机分为研究组29例和对照组31例,两组在传统抗精神病药治疗的基础上,于治疗2周和6周时,研究组给予观看入院时拍摄的医生面诊及患者发病情景的录像带,对照组则观看娱乐新闻类录像,分别于治疗前、治疗2周和6周观看录像后进行简明精神病评定量表（BPRS）、自知力与治疗态度问卷（ITAQ）评定。结果：治疗后两组均有不同程度的BPRS评分降低及ITAQ评分升高,以研究组更为显著（P〈0.01或P〈0.001）。研究组BPRS总分及各因子评分较对照组均降低显著（P〈0.01或P〈0.001）,对照组仅BPRS总分和焦虑抑郁因子分降低明显（P〈0.05）。结论：精神分裂症患者发病时情景和症状摄像回放辅助传统药物治疗可提高患者的自知力。     

武汉地区脑梗死患者住院天数的影响因素分析

目的探讨武汉地区脑梗死患者住院天数及其影响因素。方法收集本院近5年间出院脑梗死患者的病例772份,排除院内感染及并发症患者。采取回顾性分析方法,按住院天数分为5~10d组,11~14d组,15~20d组三组,选取性别、意识状态、糖尿病史、心脏病史、脑卒中史、遗传倾向、中医治疗、神经康复等因素,进行Ridit统计分析,并对相关因素行住院天数的非条件logistic回归分析。结果 （1）不同性别、糖尿病史、入院时患者意识清楚与否、是否神经康复治疗患者的住院天数差异具有统计学意义（P〈0.05）;（2）既往是否有心脏病史,脑梗死病史、脑卒中遗传倾向及住院期间是否接受过中医药治疗患者的住院天数上虽有差异,但无统计学意义;（3）糖尿病史和神经康复因素进入回归方程,二者均有统计学意义。结论脑梗死患者的住院天数与不同性别、糖尿病史、入院时不同的意识状态及神经康复治疗与否有关。其中糖尿病史和康复治疗可能为影响武汉地区脑梗死患者住院天数的重要因素。     

C-反应蛋白在精神分裂症患者中的阳性率及其与精神症状及住院时长的相关性分析

目的回顾性分析精神分裂症患者血清C反应蛋白(C-reactive protein,CRP)的水平和阳性率以及CRP阳性和阴性的精神分裂症患者精神病性症状严重程度及住院时长的差异。方法选取广州市脑科医院符合《国际疾病分类(第10版)》(ICD-10)诊断标准的精神分裂症住院患者90例,对其入院后1周内血清CRP水平进行回顾分析,以CRP10mg/L为界,将患者划分为CRP阳性组和阴性组。采用阳性与阴性症状量表(PANSS)评定入院1周内及出院前1周精神症状的严重程度。结果 90例精神分裂症患者中,入院时CRP阳性患者15例(16.7%),血清CRP平均浓度为(26.8±11.8)mg/L;CRP阴性患者75例(83.3%),平均浓度为(4.8±1.7)mg/L。入院时两组患者PANSS阳性、阴性、一般病理学分量表评分及PANSS总评分差异无统计学意义(P0.05)。两组患者出院时PANSS分量表评分及总评分差异无统计学意义(P0.05),但CRP阳性患者住院时间长于CRP阴性患者,差异有统计学意义(P0.05)。结论血清CRP水平在部分精神分裂症患者中较高,CRP水平与精神症状严重程度没有相关性。CRP阳性患者住院时间长于CRP阴性者,炎症反应的存在可能会影响住院时间。     

Physical and Sexual Abuse and Neglect and Eating Disorder Symptoms

Abstract

For eating-disordered patients with a history of post-traumatic stress, childhood abuse and neglect, and dissociative disorder, eating behavior symptoms may function as a rational response to unmetabolized traumatic experiences. This paper will review trauma-based theory, dissociation, abreactive, and ego-states therapy as they apply to eating disorder patients.     

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.     

Physical and Sexual Abuse and Neglect and Eating Disorder Symptoms

For eating-disordered patients with a history of post-traumatic stress, childhood abuse and neglect, and dissociative disorder, eating behavior symptoms may function as a rational response to unmetabolized traumatic experiences. This paper will review trauma-based theory, dissociation, abreactive, and ego-states therapy as they apply to eating disorder patients.     

Presence and severity of anorexia and bulimia among male and female Omani and non-Omani adolescents

OBJECTIVE: The population of Oman is a heterogeneous mix of nationalities providing a natural setting for studying the cross-cultural differences in the presence and severity of eating disorders as well as an opportunity for evaluating the performance of measurement instruments for these disorders. METHOD: Disordered eating screening instruments (the Eating Attitude Test and the Bulimic Investigatory Test) were administered to Omani teenagers, non-Omani teenagers, and Omani adults. RESULTS: On the Eating Attitude Test, 33% of Omani teenagers (29.4% females and 36.4% males) and 9% of non-Omani teenagers (7.5% of males and 10.6% females) showed a propensity for anorexic-like behavior. On the Bulimic Investigatory Test, 12.3% of Omani teenagers showed a propensity for binge eating or bulimia (13.7% females and 10.9% males). Among the non-Omani teenagers, 18.4% showed a tendency toward bulimia, with females showing a slightly greater tendency than males. In contrast, barely 2% of Omani adults showed either a presence of or a severity of disorderly behavior with food. CONCLUSION: Omani teenagers scored significantly higher than other ethnic groups and Omani adults. This finding is discussed in the light of emerging evidence from many parts of the world suggesting that cultural transition, compounded by demographic constraints, plays a significant role in abnormal eating attitudes.     

Spatial attention and conscious perception: interactions and dissociations between and within endogenous and exogenous processes

A current controversy exists about the relationship between spatial attention and conscious perception. While some authors propose that these phenomena are intimately related (Bartolomeo, 2008, Chun and Marois, 2002, O’Regan and Noë, 2001, Posner, 1994), others report dissociations between them (Kentridge et al., 1999, Koch and Tsuchiya, 2007, Wyart and Tallon-Baudry, 2008). However, spatial attention is not a unitary mechanism, and it is possible that not all forms of attention dissociate from conscious perception. In the present study we used a paradigm in which endogenous and exogenous forms of attention are orthogonally manipulated in order to investigate their relation with conscious perception within the same design. By analyzing two different cue-related components, our results demonstrated that while endogenous attention was electrophysiologically dissociated from conscious perception, exogenous attention was not, consistent with the hypothesis that exogenous attention is an important antecedent of our conscious experience. Our results support previous claims of dissociations between some forms of spatial attention and conscious perception, but also highlight the importance of exogenous orienting on the selection of information for conscious access.     

Serious emotional and behavioral problems and mental health contacts in American and British children and adolescents

OBJECTIVE: To compare prevalence of serious emotional and behavioral problems and mental health contacts for these problems among American and British children and adolescents. METHOD: Data on children and adolescents ages 5 to 16 years were drawn from the 2004 U.S. National Health Interview Survey (response rate = 79.4%) and the 2004 survey of Mental Health of Children and Young People in Great Britain (response rate = 76.0%). Emotional problems, hyperactivity/inattention, and conduct problems were assessed using the parent version of the Strengths and Difficulties Questionnaire (SDQ). Psychometric properties of SDQ scales were compared across countries. RESULTS: The SDQ has similar psychometric properties across countries. More British than American children met the criteria for emotional and conduct problems, but not hyperactivity/inattention. Prevalence was higher for all problems in 5- to 8-year-old British boys and for emotional problems in 13- to 16-year-old British girls. American children with serious emotional and behavioral problems had a higher prevalence of mental health contacts overall and with mental health providers but not with general medical providers. CONCLUSIONS: British children have a higher prevalence of parent-reported serious emotional and behavioral problems than American children. However, British children with these problems are less likely than American children to receive mental health care.