164例住院老年期痴呆患者的精神和行为障碍

目的:研究老年期痴呆病人的精神和行为障碍(BPSD).方法:采用BEHAVE-AD量表对164例住院的老年期痴呆病人进行评定.结果:所有病例均有不同程度的BPSD,其中以行为紊乱,攻击行为,日夜节律紊乱和偏执与妄想多见,且阿尔茨海默病(AD)和血管性痴呆(VD)大致相似,结论:DPSD的发生率极高,对老年期痴呆的论断,治疗,预后等有重要影响,应予重视和加强研究.     

为照料者实施干预对老年痴呆患者BPSD症状的影响

目的 探讨为照料者实施综合干预对稳定老年痴呆患者精神行为(BPSD)症状的影响.方法 对100例住院老年痴呆患者的照料者实施为期6个月的综合干预,于干预前、干预3,6个月末采用AD病理行为评分量表(BEHAVE-AD)、总体衰退量表(GDS)分别对患者的BPSD症状及痴呆衰退程度进行评定、比较.结果 干预3,6个月末患者BEHAVE-AD总分及除妄想、幻觉外的各因子分均较干预前显著降低;其中尤以攻击行为、焦虑恐惧、行为紊乱因子分值降低最明显.而GDS评分干预前后均无明显变化,差异无统计学意义.结论 为照料者实施综合干预,可有效改善老年痴呆患者BPSD症状,稳定患者病情,利于护理.     

美金刚与喹硫平治疗痴呆的行为和精神症状对照研究

目的探讨美金刚与喹硫平治疗痴呆的行为和精神症状(BPSD)的疗效及安全性。方法将78例BPSD患者随机分为美金刚组与喹硫平组,每组39例,观察8周,于治疗前后采用痴呆病理行为评定量表(BEHAVE-AD)评定疗效,简易精神状况检查量表(MMSE)评定认知功能,日常生活能力量表(ADL)评定生活质量,副反应症状量表(TESS)评定不良反应。结果美金刚组BEHAVE-AD评分、MMSE评分、ADL评分、不良反应、锥体外系反应及嗜睡方面均优于喹硫平组,差异有统计学意义(P0.05)。结论美金刚可有效控制BPSD患者的行为和精神症状,改善其认知功能,提高其日常生活能力,且安全性好。     

阿尔茨海默病行为和精神症状对于照料者心理健康的影响

目的探讨阿尔茨海默病(AD)行为和精神症状(BPSD)对照料者心理健康状况的影响。方法46例AD患者均作AD病理行为评分表(BEHAVE-AD),日常生活能力量表,简易智力状态检查,临床痴呆评定表评定,并作头颅CT,脑电图检查。患者之照料者均作一般调查问卷及90项症状清单(SCL-90)测定。对相关数据作统计分析。结果SCL-90总分除与BEHAVE-AD的幻觉分量表分无统计学显著性相关外,与其他分量表分及总分均呈正相关(P＜0．05)；SCL-90除强迫、精神病性两因子分与常模的差异无统计学显著性外,其他因子分和总分均较常模高(P＜0．01)；高BEHAVE-AD总分组照料者的SCL一90总分、因子分中的躯体化、抑郁、焦虑、恐怖及其他均较低BEHAVE—AD总分组照料者高(P＜0．05)。逐步回归分析发现影响照料者心理健康状况的因素主要是BEHAVE-AD总分和攻击行为分量表分。结论影响AD照料者心理健康状况的因素主要是患者的BPSD。     

阿尔茨海默病患者精神行为症状复发的影响因素

目的探讨影响阿尔茨海默病(AD)患者精神行为症状复发的相关因素。方法选取2008年3月至2011年9月在我院确诊为AD患者107例,采用神经精神量表(NPI)、病理行为评分表(BEHAVE-AD)、简易智力状态检查(MMSE)、日常生活活动能力量表(ADL)调查AD患者精神行为症状发作的特征,分析影响AD患者精神行为症状复发的因素。结果复发率为41.4%,居住环境改变(RR=4.96,95%CI:2.54～12.34,P<0.05),发作时NPI评分高(RR=1.26,95%CI:1.04～1.27,P<0.05),可增加AD患者BPSD的复发。结论发作时NPI评分、居住环境改变是AD患者BPSD复发的危险因素。     

盐酸多奈哌齐与奥氮平治疗痴呆行为和精神症状疗效观察

目的观察盐酸多奈哌齐与奥氮平治疗痴呆行为和精神症状(BPSD)的疗效及安全性。方法将86例BPSD患者随机分为盐酸多奈哌齐组与奥氮平组,每组43例,观察8周,于治疗前后采用痴呆病理行为评定量表(BEHAVE-AD)评定疗效,简易精神状况检查量表(MMSE)评定认知功能,日常生活能力量表(ADL)评定生活质量,治疗中需处理的不良反应症状量表(TESS)评定不良反应。结果盐酸多奈哌齐组BEHAVE-AD评分、MMSE评分、ADL评分、不良反应以锥体外系反应及头晕、嗜睡、视物模糊、体质量增加等方面均优于奥氮平组,差异有统计学意义(P0.05)。结论盐酸多奈哌齐与奥氮平相比,治疗BPSD疗效肯定,能有效改善患者认知功能及提高日常生活能力,安全性好。     

上海社区阿尔茨海默病行为和精神症状的发生率及影响因素

目的调查上海社区阿尔茨海默病（AD）患者行为和精神症状（BPSD）的发生率及分析可能的相关影响因素。方法对符合美国精神障碍诊断和统计手册第4版（DSM—IV）诊断标准的378例社区AD患者,进行一般资料调查,评定简易智力状态检查（MMSE）、临床痴呆评定表（CDR）及AD病理行为评分表（BEHAVE—AD）,分析BPSD症状发生率及有关的影响因素。结果BPSD的发生率为62．2％,其中以行为紊乱发生率最高（35．4％）,幻觉及焦虑恐惧最低（均为11．4％）,在接受BPSD治疗上仅为20％～25％。重度痴呆的幻觉及行为紊乱的发生率或因子分要高于轻、中度痴呆,而中度痴呆的情感障碍因子分最高。与AD患者BPSD有关的影响因素为病前生活事件、MMSE总分、年龄及CDR评分。结论社区AD患者的BPSD有较高的发生率,与BPSD发生的可能危险因素有生活事件、年龄及认知功能损害程度,需要引起足够的重视。     

美金刚与奥氮平治疗老年期痴呆的行为和精神症状对照研究

目的 探讨美金刚与奥氮平治疗老年期痴呆的行为和精神症状(BPSD)的疗效及不良反应.方法 将86例老年期BPSD患者分为美金刚组与奥氮平组,治疗8周.在治疗前、治疗2周末、4周末和8周末,采用痴呆病理行为评定量表(BEHAVE-AD)评定疗效,简易精神状况检查量表(MMSE)评定患者认知功能,日常生活能力量表(ADL)评定患者生活质量,治疗中需处理的不良反应症状量表(TESS)评定不良反应.结果 美金刚组在治疗后第2、4、8周末BEHAVE-AD评分较奥氮平组显著下降(t=2.12、t=2.23、t=2.28,P＜0.05).美金刚组在治疗后第8周末MMSE评分较治疗前显著升高(t=2.33,P＜0.05),奥氮平组治疗前后MMSE评分差异无显著性(t=0.42,P＞0.05),两组比较差异有显著性(t=2.04,P＜0.05).两组治疗后第8周末ADL评分显著下降(t1=2.35,t2=2.49,P＜0.05),两组比较差异无显著性(t=0.45,P＞0.05).美金刚组不良反应少于奥氮平组(x2=5.09,P＜0.05),两组在锥体外系反应(EPS)、口干、嗜睡、体质量增加方面差异有显著性(x2=4.62～6.86,P＜0.05).结论 美金刚对老年期痴呆患者的认知功能及行为和精神症状的改善均有效,且安全可靠.     

Alzheimer病与血管性痴呆的认知及生活功能变化的随访研究

目的　探讨Alzheimer病(AD)与血管性痴呆(VD)的认知功能和生活功能的衰退模式。方法　入组时、1年后,采用痴呆严重程度临床评定量表(CDR)、简易智能状态检查量表(MMSE)、生活功能量表(ADL)对住院的Alzheimer病与血管性痴呆患者进行检查。患者出院1 年后对原有样本进行面检随访研究,并同时进行上述量表的测查,并分析对认知功能及生活功能的影响因素。结果　1年后AD病死率为3.45%(2/58)、VD病死率为12.12%(4/33)。入组时AD与VD组比较,各痴呆严重程度之间、MMSE总分差异无显著意义(均P>0.05),两者均以记忆力的减退最为明显, 1年后AD组MMSE总分及地点定向、图形描述因子分下降较为显著(P<0.05),而VD组MMSE总分及个因子分下降不明显(均P>0.05),AD组ADL总分及躯体生活功能、工具性生活功能因子分均有不同程度的升高(P<0.05),而VD组ADL总分及躯体生活功能、工具性生活功能因子分没有明显的变化(均P>0.05)。MMSE分与年龄、病程、GDS评级正相关,与ADL总分负相关,ADL总分与年龄、病程、GDS评级正相关,与MMSE分负相关。反映VD患者的空间感知能力损害较AD患者更为明显。结论　AD与VD患者的认知功能和日常生活能力减退各具其特点,这些特点有助于AD和VD的诊断和治疗。     

多奈哌齐联合奥氮平治疗老年痴呆精神行为障碍的随机对照研究

目的探讨多奈哌齐联合奥氮平治疗老年痴呆精神行为症状的疗效。方法 100例伴精神行为症状的痴呆患者随机分为治疗组与对照组,比较治疗前后痴呆病理行为评定量表(BEHAVE-AD)评分、简易智力状态检查(MMSE)评分、日常生活能力量表(ADL)评分等。结果治疗组在改善BEHAVE-AD量表评分方面优于对照组(P0.05);两组MMSE、ADL评分差异无统计意义(P0.05)。结论奥氮平联合多奈哌齐治疗老年痴呆精神行为症状有效。     

Polymorphisms of DRD4 and DRD3 and risk of avoidant and obsessive personality traits and disorders

We investigated whether polymorphisms of the dopamine D4 receptor (DRD4) and polymorphisms of the dopamine D3 receptor (DRD3) were associated with personality disorder symptomatology rather than with personality traits such as novelty seeking. DNA was obtained from 145 depressed patients in a clinical trial. These patients were assessed for the presence of personality disorder symptoms and disorders. The 2-repeat allele of the DRD4 exon III polymorphism was associated with increased rates of avoidant and obsessive personality disorder symptomatology. The T,T genotype of the DRD4 -521 C>T polymorphism was also associated with increased rates of avoidant and obsessive personality disorder symptomatology. The Gly9,Gly9 genotype of the DRD3 Ser9Gly polymorphism was associated with increased rates of obsessive personality disorder symptomatology. None of these three polymorphisms were associated with novelty seeking or other temperament traits on the Temperament and Character Inventory. Our results suggest that genetic polymorphisms of DRD4 and DRD3 may well be associated with personality traits, and that conflicting findings to date may arise from the problem of phenotype definition.     

The neuroendocrinology of stress and the pathophysiology and therapy of depression and anxiety

Clinical and preclinical studies have gathered substantial evidence that stress response alterations play a major role in the development of major depression, panic disorder, and post-traumatic stress disorder. The stress response, the hypothalamic pituitary adrenocortical (HPA) system and its modulation by corticotropin-releasing hormones (CRH),corticosteroids,and their receptors, and the roles of natriuretic peptides and neuroactive steroids are described. We review the role of the HPA system in major depression, panic disorder, and post-traumatic stress disorder and its possible relevance for treatment. Impaired glucocorticoid receptor function in major depression is associated with an excessive release of neurohormones such as CRH, to which a number of signs and symptoms characteristic of depression can be ascribed. In panic disorder, a role of central CRH in panic attacks has been suggested. Atrial natriuretic peptide (ANP) is causally involved in sodium lactate-induced panic attacks. Furthermore, preclinical and clinical data on its anxiolytic activity suggest that nonpeptidergic ANP receptor ligands may be potentially useful in the treatment of anxiety disorders. Post-traumatic stress disorder is characterized by a peripheral hyporesponsive HPA system and elevated CRH concentrations in the CSF. This dissociation is probably related to an increased risk of this disorder. We further review recent data that describe an important role of GABA(A)-receptor modulatory,3 alpha-reduced neuroactive steroids in major depression, anxiety, and its treatment. Antidepressants are effective in both depression and anxiety disorders and have major effects on the HPA system,especially on glucocorticoid and mineralocorticoid receptors. Normalization of HPA system abnormalities is a strong predictor of the clinical course, at least in major depression and panic disorder. Currently,CRH-R1 or glucocorticoid receptor antagonists and ANP receptor agonists are being studied and may provide future treatment options more closely related to the pathophysiology of these disorders.     

癫痫共病抑郁的机制及临床诊疗

本文目的是探讨癫痫共病抑郁的可能机制及临床诊疗。癫痫是一种常见的、慢性的、致残性的神经疾病,癫痫患者生活质量下降,存在明显的负性情绪,常伴发各种精神疾病。癫痫与抑郁具有共同的神经生物学基础,可能存在共同的发病机制。本文从癫痫共病抑郁的发病机制、临床诊断及治疗方面予以总结归纳。     

沙盘游戏疗法在地中海贫血患儿心理干预中的应用

本文目的是对沙盘游戏疗法在地中海贫血患儿心理干预中的应用进行综述,以期为地中海贫血患儿的心理康复提供参考。地中海贫血是以珠蛋白生成障碍为主要特征的遗传性疾病,由于长期输血治疗,患儿存在较多的心理和行为问题。沙盘游戏疗法作为一种有效、实用的儿童心理治疗方法,对提高地中海贫血患儿的康复效果、改善生存质量有重要的临床意义。     

Cultural Identity and Experiences of Prejudice and Discrimination of Afghan and Iranian Immigrant Youth

In culturally diverse and immigrant receiving societies, immigrant youth can be subject to prejudice and discrimination. Such experiences can impact on immigrant youth’s cultural identity and influence their psychosocial outcomes. This paper presents findings of a study that examined cultural identity and experiences of prejudice and discrimination among Afghan (N = 9) and Iranian (N = 17) immigrant youth in Canada. The study had a prospective, comparative, longitudinal qualitative design. Data was gathered through focus groups, interviews, journals and field logs. Four main themes emerged on participants’ experiences of prejudice and discrimination: (a) societal factors influencing prejudice; (b) personal experiences of discrimination; (c) fear of disclosure and silenced cultural identity; and (d) resiliency and strength of cultural identity. Drawing from Rosenberg’s (Conceiving the self, Basic Books, New York, 1979) self-concept framework and Romero and Roberts (J. Adolesc., 21:641–656, 1998) distinction between prejudice and discrimination, results indicated that youth’s extant and presenting cultural identity were affected. Inclusive policies and practices are needed to promote youth integration in multicultural and immigrant receiving settings.

躯体化障碍和未分化躯体形式障碍患者辅助检查项目和费用调查

目的 了解躯体化障碍和未分化躯体形式障碍患者辅助检查项目和费用及其相关因素.方法 对115例躯体化障碍或未分化躯体形式障碍的患者,采用自编既往就诊检查情况调查表、自编躯体症状自评清单、症状自评量表、汉密尔顿焦虑量表和汉密尔顿抑郁量表进行评估.结果 患者就诊前辅助检查总费用为 72～10 948 元(中位数 1 068 元);检查频度为 1 ～ 53 次(中位数9.0次);检查项目数为 1～13 项(中位数6.0项).重复检查频度为 0～44 次(中位数 3 次),重复项目数为 0 ～ 9 项(中位数 2 项).检查频度及重复频度较高的项目为血常规、B超、CT、尿常规、摄片、生化常规、MRI、心电图、粪常规.检查频度与病程、就诊科室数及HAMD总分均呈正相关(P＜0.05),检查总费用与检查频度呈正相关(P＜0.01). 结论躯体化障碍和未分化躯体形式障碍患者辅助检查种类多,重复检查多,应引起重视.     

Seclusion and restraint and prediction of violence

The authors studied the use of seclusion and restraint on an inpatient unit in a state psychiatric hospital. Of 69 randomly selected inpatients, 51% experienced seclusion or restraint at least once. More psychotic than nonpsychotic patients required seclusion or restraint. However, neither psychosis/nonpsychosis nor voluntary/involuntary admission status predicted the likelihood of violent threats or actions. Patients experiencing seclusion and restraint showed a nonsignificant trend toward longer mean length of stay in the hospital. The frequency of patient behavior leading to seclusion or restraint appeared to be directly related to the stimulation caused by the presence of many staff members and other patients.