新疆维吾尔自治区阿拉尔市金银川街道社区汉族居民心理状况及影响因素调查

目的了解新疆阿克苏地区阿拉尔市金银川街道社区汉族居民心理状况及其影响因素。方法于2013年9月28日-10月10采取整群分层抽样方法抽取新疆阿拉尔市金银川街道社区1000名汉族居民为调查对象,采用症状自评量表(SCL-90)和一般情况调查表进行问卷调查。结果阿拉尔市金银川街道汉族居民SCL-90的躯体化、强迫、人际敏感、抑郁、焦虑、敌对、偏执、精神病因子评分低于全国常模,差异有统计学意义(P0.001);恐怖因子得分与全国常模比较差异无统计学意义(P0.05);女性的强迫、抑郁、敌对等因子得分均高于男性,差异有统计学意义(P0.05)。结论新疆维吾尔自治区阿拉尔市金银川街道社区汉族居民心理健康状况良好;但女性较男性更易发生强迫、抑郁等心理问题。     

群体事件后医护人员心理健康状况调查

目的了解群体事件突发后,参加抢救的医护人员心理应激状况,为心理危机干预提供科学理论依据。方法对2014年新疆乌鲁木齐市突发暴力事件中,参与抢救工作的77名医护人员采用症状自评量表(SCL-90)、焦虑自评量表(SAS)及抑郁自评量表(SDS)进行横断面调查。结果参加抢救的医护人员SAS及SDS总评分均高于中国常模[SAS:(40.38±8.38)分vs.(37.23±12.58)分;SDS:(49.26±7.70)分vs.(41.88±1.57)分],差异均有统计学意义(P0.05);参与抢救的医护人员SCL-90中躯体化(1.53±0.47)、人际关系(1.73±0.54)、抑郁(1.91±0.46)、焦虑(1.73±0.48)、敌对性(1.80±0.57)、恐怖(1.62±0.52)因子评分高于常模,差异均有统计学意义(P0.05)。结论突发暴力事件后,参加抢救的医护人员存在不同程度的心理问题,如焦虑、抑郁、恐怖、躯体不适、敌对等,应高度重视,及时加强心理干预。     

精神分裂症患者亲属心理健康状态分析

目的分析精神分裂症患者亲属心理状态。方法随机选取2016年10月～2019年10月我院精神分裂症患者的亲属100例,采用症状自评量表(SCL-90)对患者亲属的心理健康状况进行评定,统计分析患者亲属和全国常模、男性和女性、完成和未完成九年义务教育、一级和二级亲属的SCL-90评分比较。结果患者亲属的焦虑、抑郁、偏执、躯体化评分及SCL-90总分均显著高于全国常模(P0.05)。男性亲属的敌对评分及SCL-90总分均显著高于女性亲属(P0.05)。完成九年义务教育的亲属的焦虑、抑郁、躯体化评分及SCL-90总分均显著高于未完成九年义务教育的亲属(P0.05),恐怖评分显著低于未完成九年义务教育的亲属(P0.05)。一级亲属的焦虑、抑郁、恐怖、强迫症状、精神病性症状评分及SCL-90总分均显著高于二级亲属(P0.05)。结论精神分裂症患者亲属一般心理健康状况较差,性别、文化程度、与患者关系可能是其影响因素,临床应该据此积极采取有针对性的健康教育策略改善患者亲属的心理健康状况。     

度洛西汀联合喹硫平治疗躯体化障碍的临床研究

目的探讨度洛西汀联合喹硫平治疗躯体化障碍的疗效及安全性。方法 100例躯体化障碍患者随机分为研究组(度洛西汀联合喹硫平组)和对照组(度洛西汀组),疗程8周。用症状自评量表(SCL-90)、汉密尔顿抑郁、焦虑量表(HAMD、HAMA)评定严重程度,用副反应量表(TESS)评定不良反应;用SCL-90躯体化因子分和HAMD量表减分率评定疗效。结果1治疗8周后,两组SCL-90各因子分、HAMD及HAMA分均呈下降趋势;研究组HAMD、HAMA、SCL-90躯体化、强迫、抑郁、焦虑及偏执因子分均较对照组下降显著(P0.05或0.01)。研究组和对照组有效率分别为81.6%和64.0%,差异有统计学意义(P0.05)。2研究组和对照组不良反应发生率分别为42%和36%(P0.05),TESS评分为[(5.21±3.60)vs.(4.80±3.80),P0.05]。结论度洛西汀联合喹硫平治疗躯体化障碍疗效优于单用度洛西汀,且安全性好。     

医院女职工心理健康状况调查

目的 了解医院女职工的心理健康状况.方法 采用身心症状自评量表 (Smptom Cheklist 90,SCL-90)、ZUNG氏焦虑自评量表(SAS)和ZUNG氏抑郁自评量表(SDS)调查了杭州市第一人民医院301名在职女职工.结果 女职工SCL-90的躯体化、抑郁、焦虑因子分高于国内正常人水平(P＜0.05),而人际关系因子分低于国内正常人水平(P＜0.05),其他因子分与国内常模比较差异无显著性,SCL-90、SAS和SDS的各因子分在各个年龄段的比较差异无显著性.结论 医院女职工心理健康状况较差,低于一般普通人群,有必要对她们进行适当的心理干预.     

立体定向术对阿片类药物依赖者心理障碍治疗前后的对照研究

目的观察立体定向手术治疗对阿片类药物依赖病人术后近期病理性心理症状的影响。方法选择自愿要求手术的戒毒病人26例,采用90项症状自评量表（SCL-90）进行评估。治疗前后选择自身配对t检验,治疗前后与国内常模比较、治疗后与强制戒毒、冷火鸡脱毒、美沙酮脱毒治疗后比较采用单样本t检验。结果术后73.1%病人总体病理性心理障碍症状完全改善。57.7%病人的躯体不适症状、73.1%病人的强迫症状得到矫治。手术消除了80.8%病人的抑郁症状、69.2%病人的焦虑症状。同时手术也改善了69.2%病人的人际关系、57.7%病人的恐怖、73.1%病人的敌对、61.5%病人的偏执、57.7%病人的精神病和65.4%病人其他不良症状。与常模比较,术前SCL-90各项差异均有统计学意义（P〈0.05）,术后仅躯体症状差异有统计学意义（P〈0.001）。与强制戒毒组比较,术后SCL-90各项差异均有统计学意义（P〈0.05）;与冷火鸡组比较,仅躯体症状差异有统计学意义;与美沙酮组比较,躯体症状、抑郁、焦虑差异有统计学意义。结论手术能够不同程度地矫治阿片类药物依赖病人的病理性心理障碍,且近期疗效好于强制戒毒、冷火鸡和美沙酮疗法。     

Neuman健康系统模式的心理危机干预对新型冠状病毒肺炎患者焦虑、抑郁情绪的影响

目的探讨Neuman健康系统模式的心理危机干预对新型冠状病毒肺炎患者焦虑、抑郁情绪的影响。方法选取2020年1月3日～2月27日南阳市某定点医院收治的新型冠状病毒肺炎患者72例为研究对象,随机将其分为观察组(n=36)和对照组(n=36),对照组给予常规心理护理,观察组给予Neuman健康系统模式的心理危机干预,运用zung焦虑自评量表(SAS)、抑郁自评量表(SDS)、自我效能量表(GSES)、及症状自评量表(SCL-90)评价两组患者焦虑、抑郁发生情况及自我效能感的改变。结果观察组患者SAS、SDS评分明显低于对照组(P0.05),观察组GSES评分明显高于对照组(P0.05);观察组患者SCL-90量表中焦虑、抑郁、躯体化、偏执4类因子得分明显低于对照组,差异有统计学意义(P0.05)。结论 Neuman健康系统模式的心理危机干预能够显著降低新型冠状病毒肺炎患者焦虑抑郁情绪,提高患者自我效能,促进感染患者康复,利于疫情控制。     

强化心理护理对头部伽马刀治疗颅内恶性肿瘤患者负性情绪的影响

目的观察强化心理护理对头部伽马刀治疗颅内恶性肿瘤患者负性情绪的影响。方法选取在我院行头部伽马刀治疗的颅内恶性肿瘤患者100例,随机分为研究组(50例)和对照组(50例),对照组实施常规护理,研究组在此基础上强化心理护理,采用SAS量表和SCL-90症状自评量表分别在患者入院时和出院时评估心理状态,采用自制调查问卷调查患者对护理工作的满意度。结果研究组SAS和SDS评分显著低于对照组,差异有统计学意义(P0.05);2组患者躯体化、恐怖、焦虑、抑郁、精神病性、人际关系及总分显著低于入院时,差异有统计学意义(P0.05);研究组躯体化、恐怖、焦虑、抑郁、精神病性、人际关系及总分明显低于对照组,差异有统计学意义(P0.05),2组敌对、偏执和强迫症状等因子得分与入院时差异无统计学意义(P0.05);研究组护理总满意率98.0%,显著高于对照组的84.0%,差异有统计学意义(P0.05)。结论强化心理护理可明显改善头部伽马刀治疗颅内恶性肿瘤患者的负性情绪,提高患者对护理工作的满意度。     

男女高考生扩招前后的心理健康状况分析

目的 探讨男女高考生扩招前后的心理健康状况差异.方法 于高考前4个月采用症状自评量表（SCL-90）集体测试,结果 按性别并与扩招前比较;同时以半开放式问卷调查可能影响考生心理健康的因素.结果扩招后男生的强迫和精神病性分高于女生（P＜0.05）、女生的躯体化分高于男生（P＜0.05）,其它各项男女生间无明显差异.和扩招前比较,女生的阳性项目数及所有的因子分降低（P＜0.05～0.001）,男生的阳性项目数与躯体化分降低（P＜0.05～0.01）、恐怖分增高（P＜0.01）.男女生强迫、人际关系、抑郁、敌对、焦虑及偏执因子的异常率均达20%～56%;女生躯体化与恐怖的异常率高于男生（P＜0.05）,男生偏执的异常率高于女生（P＜0.01）.阳性症状均分≥3分者男生多于女生（χ^2=5.88）.结论 扩招后男女生心理健康的总体水平无明显差异.男女考生的心理健康状况均较扩招前有明显改善,女生更显著.男生的恐怖较扩招前加重.男女生的心理问题均仍以强迫、人际关系、抑郁、敌对、焦虑及偏执多见.女生的躯体化与恐怖,男生的偏执、强迫与精神病性症状相对较明显.     

双侧丘脑底核脑深部电刺激术可改善中晚期帕金森病患者的症状

目的 探讨双侧丘脑底核(subthalamic nucleus,STN)脑深部电刺激(deep brain stimulation,DBS)术,对中晚期帕金森病(Parkinson's disease,PD)患者运动、生活质量、情绪、睡眠、认知及术后用药剂量的影响.方法 10例接受双侧STN-DBS治疗的中晚期PD患者分别于术前1周及术后3个月、6个月、12个月应用统一帕金森病评分量表(unified Parkinson's disease rating scale,UPDRS)、Hoehn&Yahr分级、帕金森病生活质量问卷(PDQ-39)、帕金森病睡眠评估量表中文版(PDSS-CV)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA),简易智能状态检查(MMSE)评价其临床情况,同时记录各时间点抗帕金森病药物的剂量及其变化,并对相关结果进行描述性分析.结果 10例PD患者术后均获得了显著疗效,震颤、肌强直、动作迟缓等都有明显改善,术后6个月开机未服药状态下改善率分别为68%、53%、35%,开机服药状态下改善率分别为86%、78%、69%,其中以震颤改善最为显著.术后UPDRSⅢ评分及Hoehn&Yahr分级均降低,术后6个月服药状态下改善率分别为67%、32%;日常生活质量提高,PDQ-39术后6个月改善率为71%,睡眠质量较术前改善,焦虑抑郁情况较术前有不同程度减轻,认知功能尤明显影响.抗帕金森病药物用量术后6个月较术前减少45%.结论 双侧STN-DBS能明显改善中晚期PD患者的运动症状及非运动症状.     

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.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

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.     

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.     

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.     

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.