儿童焦虑性情绪障碍筛查量表的临床应用

目的研究儿童焦虑性情绪障碍筛查量表SCARED在儿童及青少年情绪障碍中的应用。方法随机抽取上海市精神卫生中心儿童心理门诊符合CCMD-3诊断标准的焦虑症患儿35例，多动障碍患儿31例，随机抽取上海市某中小学45例健康儿童为对照组。研究组患儿及父母均填写SCARED量表，对照组填写SCARED量表并在一周后重测，多动症组评估SCARED量表。结果研究组SCARED量表总分及各因子分均分别显著高于对照组、多动症组。患儿自评与父母评定的相关系数在0．618至0．839之间。重测信度在0．451～0．872之间，各因子分与总分相关系数在0．331～0．852之间，Cronbach‘s a系数在0．2331至0．8032之间。SCARED量表总分与焦虑自评量表总分相关系数为0．661。结论SCARED量表信、效度良好，可作为临床辅助诊断及科研的筛查工具。     

30例学校恐惧症人格和情绪特征研究

目的：探讨学校恐惧症的临床特征。方法：对30例学校恐惧症患儿（研究组）和30名正常对照儿童（对照组）进行艾森克个性问卷（EPQ）,儿童焦虑性情绪障碍筛选量表（SCARED）,焦虑自评量表（SAS）及抑郁自评量表（SDS）评估。结果：研究组患儿EPQ结果显示神经质得分显著高于对照组,掩饰程度得分显著低于对照组（P均〈0.05）;SCARED、SAS、SDS的评估显示,与对照组相比,研究组存在明显焦虑和抑郁症状（P〈0.05）。结论：学校恐惧症患儿可能具有神经症的个性特点,普遍存在焦虑和抑郁症状。     

门诊青少年焦虑障碍患者团体认知行为治疗的3个月随访研究

目的:评估门诊焦虑障碍青少年团体认知行为治疗(GCBT)的有效性。方法:对儿童青少年门诊就诊的70例13～18岁焦虑障碍青少年采用随机抽样方法,分为GCBT组和等待对照(WLC)组。GCBT组接受为期8周、每周1次、每次120 min的GCBT治疗。在治疗前填写自制一般情况问卷,治疗前、治疗8周后、治疗结束3个月后用儿童焦虑性情绪障碍筛查表(SCARED)进行测试。结果:GCBT组共34例完成研究,3个月后的随访有17例参加。WLC组共22例完成8周随访。与WLC组相比GCBT组治疗后青少年焦虑障碍患者SCARED总分及广泛性焦虑、躯体化、社交焦虑、分离性焦虑因子分呈显著性下降(t=6.24,P0.01;t=4.58,P0.01,t=4.31,P0.01,t=4.17,P0.01)。治疗结束后3个月随访发现患者SCARED总分及广泛性焦虑、躯体化、社交焦虑、分离性焦虑因子分呈明显下降趋势(F=11.26,P0.01;F=11.38,P0.01;F=11.01,P0.01;F=20.02;P0.01)。结论:GCBT能有效缓解门诊焦虑障碍青少年的焦虑情绪。     

家庭环境因素与青少年抑郁情绪的相关性

目的 探讨家庭环境因素对青少年抑郁情绪及共病焦虑的影响。方法 采用整群抽样法, 于2014 年12 月对河南省新乡市170 名初中生进行一般社会资料问卷、儿童抑郁障碍自评量表、焦虑自 评量表（SAS）、家庭环境量表中文版（FES-CV）评估测评后,对结果进行分析。结果 （1）有效问卷167 份, 有抑郁情绪27名,女性9名,男性18名;（2）抑郁情绪组的家庭环境亲密度因子分明显低于对照组（t=4.51, P ＜ 0.05）,矛盾性因子分明显高于对照组（t=-4.33,P ＜ 0.05）;（3）抑郁情绪非共病焦虑情绪组和抑郁情 绪共病焦虑情绪组的家庭环境因子,矛盾性因子分比较,差异无统计学意义（P ＞ 0.05）。结论 青少年 家庭环境亲密度和矛盾性是影响青少年抑郁情绪及共病焦虑的重要因素。     

综合护理干预对小儿支原体肺炎患儿负面情绪的影响

目的 探讨分析综合护理干预对小儿支原体肺炎患儿负面情绪的影响.方法 选定本院2019年1月～2021年1月我院住院治疗的140例支原体肺炎患儿作为主要研究对象.按随机数字表法将研究对象随机分为观察组和对照组.对照组70例患儿给予常规护理,观察组70例患儿在对照组基础上给予综合护理干预,观察比较两组患儿临床症状消失时间、家属满意度,以及干预前后的儿童抑郁障碍自评量表(DSRSC)评分、儿童焦虑性情绪障碍筛查表(SCARED)评分.结果 观察组患儿肺部湿啰音、气促、咳嗽、发热症状消失时间均短于对照组(P＜0.05);观察组干预后DSRSC评分、SCARED评分低于对照组(P＜0.05);观察组家属满意度(95.71％)高于对照组(78.57％)(P＜0.05).结论 综合护理干预可有效缓解支原体肺炎患儿临床症状,减轻其焦虑、抑郁等负面情绪,提高家属满意度,值得临床推广应用.     

上海中心城区初中生早期不同创伤类型与抑郁、焦虑情绪的关系

目的:探讨早期不同创伤类型与焦虑、抑郁的关系。方法:采用早年创伤问卷简表中文版(ETI-SF)、儿童焦虑性情绪障碍筛查表(SCARED)、儿童抑郁障碍自评量表(DSRSC)对2 402名上海市中心区3所学校中预初至初二的学生施测。结果:有创伤经历者有更高的焦虑和抑郁检出率(χ~2=90.48,χ2=45.51;均P=0.00),在普通创伤得分上焦虑抑郁共存组与单纯抑郁组无差异,在其他各创伤因子上焦虑抑郁共存组得分均高于单纯焦虑组与单纯抑郁组(P=0.00~0.03)。多重线性回归分析显示,除性创伤外,情感虐待、躯体虐待和普通创伤均与焦虑/抑郁关联,标准化回归数(β)分别为0.341/0.443,0.14/0.119,0.07/0.078(P均0.01)。结论:情感和躯体上的虐待,以及丧失等普通创伤均与初中生的情绪障碍存在较大相关性,其中情感上的虐待和忽视与焦虑抑郁的相关性更大。     

重庆市儿童青少年焦虑抑郁发生情况调查

目的 调查重庆市儿童青少年焦虑抑郁发生情况,为儿童青少年学生心理疏导提供参考.方法 通过整群抽样选取儿童青少年学生425名,年龄范围为7～16岁,采用儿童焦虑性情绪障碍筛查量表及儿童抑郁障碍自评量表对被试进行评估.结果 ①34.6％(147/425)的青少年存在焦虑情绪,9.9％(42/425)的青少年存在抑郁情绪;5.6％(24/425)同时存在焦虑抑郁情绪,33.2％(141/425)仅有焦虑或抑郁情绪,61.2％(260/425)无情绪问题.②男性、女性间焦虑抑郁情绪分布差异具有统计学意义(x 2=12.592,P＜0.05),男性中66.1％的无任何情绪问题,25.3％仅存在焦虑情绪,5.6％仅存在抑郁情绪,3.0％存在焦虑抑郁情绪;女性中55.2％的无任何情绪问题,33.3％仅存在焦虑情绪,2.6％仅存在抑郁情绪,8.9％存在焦虑抑郁情绪.不同性别间焦虑得分差异具有统计学意义(t=4.638,P＜0.05),抑郁情绪得分差异无统计学意义(t=0.672,P＞0.05).③年龄与焦虑(r=-0.42,P＞0.05)、抑郁情绪(r=0.071,P＞0.05)间相关关系无统计学意义,焦虑情绪与抑郁情绪评分之间存在相关关系(r=0.420,P＜0.001).结论 儿童青少年焦虑抑郁发生率较高,需要给予积极心理关注.     

绘画治疗在儿童情绪障碍治疗中的作用

目的:探讨绘画治疗对儿童情绪障碍治疗的作用。方法:采用自身对照研究,将32例符合儿童情绪障碍诊断标准的儿童作为研究对象,进行为期6个月的绘画治疗。于治疗前及治疗后使用儿童焦虑性情绪障碍筛查量表(SCARED)和艾森克人格问卷(EPQ)儿童版对患儿进行评估。结果:治疗6个月后,患儿SCARED评分低于治疗前(P<0.05);EPQ中情绪稳定性量表分低于治疗前(P<0.05)。结论:绘画治疗能够有效改善和稳定情绪障碍儿童的情绪。     

一次偶发劫持事件后对儿童心理卫生状况影响的对照研究

目的了解劫持事件对儿童心理卫生状况的影响。方法在上海某小学发生学生被劫持事件后的一月，对被劫持事件发生班级中暴露于劫持事件的全体39名学生使用Achenbach儿童行为量表（CBCL），儿童焦虑性情绪障碍筛查量表（SCARED），Rutter父母及教师问卷进行评估。选取同年级的另外一个班级的所有45名学生作为对照组，采用同样方法进行评估。结果除研究组女生CBCL社交退缩因子与对照组之间有统计学差异外（分别为1．4±1．8，3．1±2．6；t=2．218，P=0．033），研究组与对照组在其他CBCL因子、SCARED和Rutter父母及教师问卷得分差异无统计学意义。结论本次研究未发现偶发劫持事件对儿童心理卫生状况的影响。     

影响初中生学习成绩的相关因素

目的：探讨影响初中生学习成绩的相关因素。方法：用儿童焦虑性情绪障碍筛查表（SCARED）、儿童抑郁障碍自评量表（DSRSC）、应对方式问卷、父母养育方式问卷（EMBU）对上海市杨浦区一所普通中学288名学生进行调查。结果：成绩优良组与普通组在性别、年龄、父母亲文化、家庭结构、经济条件、是否独生子女方面差异显著（P〈0．05或P〈0．01）。普通组与优良组在学校恐怖，焦虑、抑郁总分，应对方式、解决问题、自责、合理性，父母养育方式存在显著差异（P〈0．05或P〈0．01）。回归分析显示性别与年龄、解决问题、情感温暖和理解对学习成绩有影响（P〈0．01）。结论：影响初中生学习成绩的因素除了有智力因素外，还与家庭环境、性别、年龄、焦虑和抑郁情绪、应对方式、父母养育方式等心理社会因素密切相关。     

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.     

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.     

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.     

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.     

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.     

Pediatric Epilepsy Surgery

Summary: The use of implantable arrays of epidural electrodes has made it possible to carry out extraoperative electrocorticography (ECoG) and functional localization in the awake child. This has permitted cortical excisions that are determined by criteria similar to those obtained during surgical procedures performed under local anesthesia in adults. In addition, the method also permits simultaneous ECoG and video monitoring during the child's symptomatic seizures, providing additional important localizing information that is impractical to obtain in operations under local anesthesia. We report our experience with 75 children, ages 5 months to 15 years, whom we have managed with epidural electrode arrays. The method of extraoperative ECoG is described and illustrative cases are presented to demonstrate its feasibility and utility in children. In addition, we call attention to gliomas as a common cause of chronic focal seizures in children. Of 49 children undergoing resection and followed for from 1 to 14 years (mean of 5.8 years), 32 (65%) are either seizure free or have had a significant reduction in seizure frequency that has unambiguously improved their quality of life. The results are analyzed further by relating the surgical outcome to each of the pathologic entities that caused the seizures. This analysis reveals the variety of neurological conditions that commonly cause intractable focal seizure disorder in children and distinguishes those pathologic entities in which the seizure disorder is apt to respond to surgical intervention from those that will not.