儿童青少年非自杀性自伤的研究现状

本文目的是对儿童青少年非自杀性自伤（NSSI）的研究现状进行综述,为儿童青少年NSSI行为的认识与干预提供参考。NSSI行为是自杀的独立危险因素,不仅严重威胁到儿童青少年的身心健康,而且也给其家庭及社会带来了极大的负担。本文将对儿童青少年NSSI行为的流行病学、病因学、与其他精神疾病之间的关系以及治疗进行阐述。     

青少年非自杀性自伤行为与反刍思维相关性的研究进展

非自杀性自伤（NSSI）是自杀意念和自杀行为的重要预测因素，其在全球青少年中的患病率呈逐渐上升趋势，成为青少年常见的公共卫生问题之一。反刍思维作为一种认知过程和情绪调节策略，与NSSI密切相关，高水平的反刍思维易诱发NSSI。本文从青少年NSSI和反刍思维的相关理论、反刍思维对青少年产生的影响及相关干预措施进行综述，旨在为早期发现青少年NSSI并进行针对性的干预提供方向。     

辩证行为疗法治疗非自杀性自伤的效果研究进展——来自脑功能影像的证据

本文拟针对目前辩证行为疗法(DBT)治疗非自杀性自伤(NSSI)的效果及影像学相关研究进行系统性综述,为NSSI的DBT治疗提供参考。NSSI在人群中发生率极高,是青少年身心健康的重大威胁。DBT对NSSI的干预具有一定的优势。已有研究初步揭示了DBT对NSSI患者带来的脑神经影响,为DBT治疗的效果提供了客观依据。本文从DBT治疗NSSI的效果及其脑影像学证据等方面进行综述,从而为DBT治疗NSSI提供参考。     

辩证行为治疗在青少年非自杀性自伤行为中的应用

本文目的是分析辩证行为治疗(DBT)在青少年非自杀性自伤(NSSI)行为治疗中的有效性,以期为我国青少年NSSI行为的干预提供参考。NSSI行为是青少年常见的心理健康威胁,近年来已经成为全球范围内不容忽视的精神卫生问题,目前对于NSSI行为的干预主要采用心理治疗,其中越来越多的证据显示DBT在减少NSSI行为方面有效。本文从NSSI行为发生的危险因素、DBT的概述及DBT在NSSI应用中的疗效等方面进行阐述。     

青少年非自杀性自伤心理干预的研究进展

青少年非自杀性自伤（NSSI）是全球重大公共卫生事件之一，对其进行有效干预具有重要意义。本文对青少年常见NSSI特定和非特定性的心理干预进行综述，以期提高医护人员对NSSI的重视，为后续研究选择合适的干预方式提供借鉴。     

青少年非自杀性自伤治疗的研究进展

非自杀性自伤行为（NSSI）严重威胁青少年的心身健康，已成为全球重要的公共卫生问题， 对其进行积极有效的干预尤为重要。但是，目前对青少年NSSI 的治疗尚缺乏有效证据。现就青少年 NSSI心理治疗、药物治疗及物理治疗的研究现状进行阐述，为进一步探索青少年非自杀性自伤治疗提 供依据。     

青少年非自杀性自伤行为评估的系统性评价

非自杀性自伤(NSSI)已成为全球突出的公共卫生问题,是青少年未来发生自杀行为的重要危险因素,严重威胁青少年的身心健康.目前尚缺乏对NSSI统一评估的工具,导致NSSI的流行病学研究结论不一.如何对其进行可靠、精准、有效的评估至关重要.为此,本文对目前国内外关于NSSI评估方法的文献进行综述,以期为青少年非自杀性自伤行...     

青少年非自杀性自伤与依恋、情绪调节关系的研究进展

非自杀性自伤（NSSI）是一种适应不良的情绪调节策略，多见于青少年群体，严重危害青少年的身心健康。依恋对青少年个体的心理发展具有深远影响，对理解个体的情绪调节方式具有重要意义。本文对依恋、情绪调节、NSSI 3者之间的相互关系进行综述，旨在为青少年NSSI的预防与控制提供参考依据。     

青少年情绪障碍患者非自杀性自残行为及其影响因素分析

目的探讨研究青少年情绪障碍患者非自杀性自残(NSSI)行为及其影响因素。方法选取116例青少年情绪障碍患者作为研究对象,通过NSSI行为问卷表结果将患者分为伴NSSI组(n=80)与不伴NSSI组(n=36),比较两组的人口学和临床资料。结果伴NSSI组在性别、共病抑郁、学习压力、网络成瘾、遭受校园欺凌与不伴NSSI组具有明显差异(P<0.05),而在年龄、年级、病程与不伴NSSI组没有明显差异(P>0.05);伴NSSI组中NSSI行为发生频率较高,女性NSSI行为6次或以上的发生频率为44.44%,明显高于男性的19.23%(P<0.05);Logistic多元回归结果显示性别、共病抑郁、学习压力、网络成瘾、遭受校园欺凌是NSSI的危险因素(P<0.05)。结论青少年情绪障碍患者NSSI行为发生率较高,且女性高于男性,性别、共病抑郁、学习压力、网络成瘾、遭受校园欺凌是NSSI行为的危险因素。     

同伴侵害对青少年抑郁发作患者非自杀性自伤的影响：自尊的中介作用

目的 探讨青少年抑郁发作患者的自尊在同伴侵害与非自杀性自伤（NSSI）频率中的中介作用。方法 选取2021年1—12月在苏州市广济医院儿少精神科住院的142例青少年抑郁发作患者为研究对象，采用自残功能性评估量表（FASM）、罗森伯格自尊量表（RSES）、多维同伴侵害问卷（MPVS）与9项患者健康问卷（PHQ-9）对患者的NSSI行为、自尊程度、同伴侵害情况及抑郁程度进行调查。采用Spearman相关分析青少年抑郁发作患者同伴侵害、自尊与NSSI频率之间的相关性。采用PROCESS 3.0统计学软件进行中介效应检验。结果 青少年抑郁发作患者的NSSI检出率为76.8%(109/142)。NSSI组青少年抑郁发作患者的PHQ-9得分为（20.39±4.85）分，RSES得分为19.00(14.75,23.00)分，MPVS总分为16.00(4.00,32.00)分。NSSI组患者的同伴侵害及身体侵害、言语侵害、关系侵害、财物侵害各维度与NSSI频率呈正相关（r=0.432、0.303、0.407、0.387、0.278;P<0.01）；自尊与NSSI频率呈负相关（r=-0.460,P...     

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.     

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.     

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.     

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.     

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.     

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.