慢性失眠患者病耻感及影响因素研究

目的 探究慢性失眠（CID）患者的病耻感及相关影响因素。方法 连续选取2019 年9 月 至2020 年6 月在安徽某三甲医院睡眠障碍科门诊就诊或住院的72 例CID患者作为CID 组,选取同时期 在本院体检的72 名健康人群作为对照组。采用慢性疾病病耻感量表评估其病耻感,采用匹兹堡睡眠质 量指数（PSQI）和健康调查简表（SF-36）评估其睡眠质量和生活质量,采用蒙特利尔认知评估量表（MoCA） 和汉密尔顿抑郁量表17 项版本（HAMD-17）评估其总体认知功能和抑郁状况,比较两组的各量表评分, 并分析CID 患者病耻感的影响因素。结果 CID 组患者的病耻感评分为（38.6±11.7）分,高于对照组的 （24.2±0.6）分（t=-6.747,P＜ 0.001）;CID 组患者的PSQI评分为16.0（15.0,18.0）分,高于对照组的7.0（5.0, 8.0）分（Z=-11.687,P ＜ 0.001）;CID 组患者的MoCA 评分为（22.3±4.5）分,低于对照组的（25.3±2.1）分 （t=5.168,P＜ 0.001）;CID 组患者的SF-36 各成分（生理功能、生理职能、躯体疼痛、一般健康状况、精力、 社会功能、情感职能、精神健康）评分均降低（P＜0.001）。偏相关分析显示,CID组的病耻感与年龄、病程、 PSQI评分、HAMD-17评分呈正相关（P＜0.001）,与文化程度、MoCA评分、SF-36评分呈负相关（P＜0.05）。 多因素回归分析显示,病程和SF-36 精神健康域是病耻感的危险因素（P＜ 0.001）。结论 CID 患者存在 病耻感,病程、生活质量、抑郁状况和睡眠质量是其发生的影响因素。     

睡眠质量对糖尿病患者记忆功能影响的临床研究

根据记忆功能将200例糖尿病患者分为记忆力减退组和无记忆力减退组（对照组）,分析睡眠质量对糖尿病患者记忆功能的影响。结果显示,记忆力减退组有62%（62/100）患者合并睡眠障碍,高于对照组的27%（27/100;χ^2=24.800,P=0.000）;单因素Logistic回归分析提示伴睡眠障碍的糖尿病患者发生记忆力减退的风险明显高于睡眠正常患者（OR=4.411,95%CI：2.425-8.024;P=0.000）。糖尿病患者应注意改善并保持良好睡眠,以避免记忆功能障碍的发生。     

急性脑梗死后不宁腿综合征的临床特征

目的  了解急性脑梗死后不宁腿综合征（restless legs syndrome,RLS）的临床特征,以及其对急性脑梗死预后的影响。 方法  按照国际不宁腿工作组（International Restless Legs Syndrome Study Group,IRLSSG）定义标准,连续筛查住院治疗的急性脑梗死患者中RLS患者,选择年龄、性别、梗死部位匹配的同时期住院的非RLS脑梗死患者为对照组,比较2组的临床特征及预后。 结果  研究筛查275例急性脑梗死患者,其中RLS患者19例,患病率为6.91%（19/275）。RLS组年龄（62.89±10.26）岁;非RLS组19例,年龄（62.63±9.96）岁。与对照组比较,RLS组Epworth嗜睡量表（Epworth Sleepiness Scale,ESS）>10分的比例更高（57.9% vs 21.1%,P=0.020）,匹兹堡睡眠质量指数（Pittsburgh Sleep Quality Index,PSQI）>15分的比例也更高（47.4% vs 15.8%,P=0.040）。脑梗死后90?d和180?d,RLS组Barthel指数（Barthel Index,BI）低于非RLS组（P值分别是＜0.001和＜0.001）,改良Rankin量表（modified Rankin Scale,mRS）评分高于非RLS组（P值分别是0.64和0.04）。RLS组14例（73.68%）患者合并周期性腿动,15例（78.9%）患者合并阻塞性睡眠呼吸障碍。 结论  急性脑梗死后RLS患者较无RLS患者睡眠质量及预后更差。     

慢性失眠障碍患者认知功能与核磁共振波谱成像的研究

目的 探讨慢性失眠障碍(Chronic insomnia disorder,CID)患者的认知功能和海马氢质子磁共振波谱成像(Proton magnetic resonance spectroscopy,¹H-MRS)特点。方法 收集自2017年1月1日-2020年1月1日就诊于新疆医科大学第五附属医院睡眠障碍门诊的60例CID患者,对照组选取同期门诊体检的60例无睡眠障碍的健康人群; 采用匹兹堡睡眠质量指数量表(Pittsburgh sleep quality index,PSQI)评估2组研究对象的睡眠质量; 分别采用简易智力状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)评估2组研究对象的总体认知功能; 应用¹H-MRS技术检测2组双侧海马N-乙酰天门冬氨酸(NAA)、胆碱复合物(Cho)和肌酸(Cr)3种代谢物水平,并计算NAA/Cr和Cho/Cr比值。结果 CID组患者PSQI评分显著高于对照组(P<0.01); CID组MMSE评分与对照组比较无显著差异(P>0.05); CID组MoCA评分显著低于对照组(P<0.01),其中注意力、瞬时记忆、延时记忆以及视空间执行功能评分均显著低于对照组(P<0.01、0.01、0.01、0.05); CID组右侧海马NAA/Cr比值低于对照组(1.76±0.32 vs.2.06±0.48)(t=2.278,P=0.027); CID组双侧海马NAA/Cr比值无明显差异(t=1.425,P=0.168); C1D组患者PSQI总分及病程与MoCA评分呈负相关(r=-0.428,-0.355,P=0.006),与右侧海马NAA/Cr比值呈负相关(r=-0.352,-0.308,P=0.019)。结论 CID患者失眠严重程度及病程与MoCA评分、右侧海马NAA/Cr 比值有关,可能导致患者轻度认知功能障碍(MCI)及右侧海马可能存在神经元受损。     

神经内科门诊抑郁障碍患者的临床特点

目的：了解神经内科门诊的抑郁障碍患者的临床特点。方法：采用流调用抑郁自评量表（CES-D）对神经内科门诊的全部初诊患者共654例进行筛查,再参照国际疾病分类第10版诊断为抑郁障碍患者78例,进行汉密尔顿抑郁量表（HAND）评分。结果：神经内科门诊初诊患者抑郁障碍患病率为11．9％。抑郁障碍患者以头晕、头痛、失眠等躯体症状为第一主诉者占85．9％。在患者的前3个主诉中出现频率高的症状依次为失眠、头晕、乏力。样本HAMD总分平均（16．9±4．0）分,以轻中度抑郁为主。神经内科门诊抑郁障碍患者入睡困难、精神性焦虑、躯体性焦虑和全身症状较重。抑郁障碍患者中躯体归因模式者占76．9％;心理归因模式者占23．1％。结论：在神经内科门诊抑郁障碍患者颇多,应引起重视。     

河北省中年人短睡眠者和失眠障碍患者合并慢性病的现况研究

目的 分析河北省中年人不同睡眠特征人群现患慢性病情况以及生活饮食、行为方式， 探究睡眠与躯体慢性疾病的潜在关系。方法 2018 年6—9 月采用分层、整群随机抽样方法对河北 省18 岁及以上人群进行调查，共纳入5 733 名被试。评估工具包括一般情况调查表、既往躯体疾病与 精神科疾病史、阿森斯失眠量表问卷、不宁腿综合征问卷、睡眠呼吸暂停-柏林问卷、发作性睡病量表 等。根据是否为短睡眠、失眠障碍分为4 组［对照组（4 343 名，75.8%）、单纯短睡眠组（526 名，9.2%）、非 短睡眠的失眠障碍组（365 名，6.4%）、短睡眠的失眠障碍组（499 名，8.7%）］，分析4 组慢性病患病率及慢 性病的风险因素。结果 各组间高血压、糖尿病、脑血管疾病患病率差异有统计学意义（均P ＜ 0.05）， 对照组慢性病患病率最低，单纯短睡眠组、非短睡眠的失眠障碍组、短睡眠的失眠障碍组分别与对照组 比较，慢性病患病率差异均有统计学意义（均P ＜ 0.05）。不同年龄、性别、体质指数、城乡居民、教育程 度、职业、摄盐习惯、是否吸烟、饮酒情况、体育锻炼情况4 组间差异均有统计学意义（均P ＜ 0.05）。在 调整了年龄、性别、体质指数、城乡、居住方式、教育程度、职业、摄盐习惯、吸烟饮酒情况、体育锻炼情 况后，Logistic 回归分析结果显示非短睡眠的失眠障碍和短睡眠的失眠障碍是患高血压［OR（95%CI）值 分别为2.074（1.606～2.679）、1.689（1.346～2.121）］和糖尿病［OR（95%CI）值分别为2.273（1.508～3.426）、 1.805（1.244～2.621）］的危险因素（均P＜ 0.01）；单纯短睡眠、非短睡眠的失眠障碍和短睡眠的失眠障 碍均是脑血管疾病的危险因素［OR（95%CI）值分别为1.826（1.203～2.770），2.149（1.389～3.324），1.613 （1.068～2.434）；均P＜ 0.05］。结论 短睡眠者与失眠障碍对躯体的影响可能不同，失眠障碍是高血压、 糖尿病的危险因素，而短睡眠和失眠障碍均是脑血管疾病的危险因素     

肝豆状核变性睡眠障碍研究

目的 探讨肝豆状核变性（HLD）睡眠障碍的临床特点及其发生率.方法 对120例WD患者和32例健康志愿者进行睡眠问卷测评和多导睡眠检测（PSG）.结果 HLD组睡眠障碍发生率明显高于对照组（P＜0.01）,入睡困难、RLS发病率脑型组高于肝型组（P＜0.05）.结论 HLD患者常合并睡眠障碍,是HLD主要的非运动障碍症状之一.     

帕罗西汀合并奥氮平治疗伴躯体症状抑郁症的对照研究

目的探讨帕罗西汀合并奥氮平治疗伴躯体症状抑郁症的疗效及安全性。方法66例伴躯体症状的抑郁症患者随机分为帕罗西汀组33例,帕罗西汀合用奥氮平组33例,共治疗8周。于治疗前,治疗后1、2、4、8周末采用汉密尔顿抑郁量表（HAMD）,副反应量表（TESS）评定疗效和副反应。结果帕罗西汀合用小剂量奥氮平组疗效显著,合用药组与单用药组的显效率分别是84.85%和60.61%,差异有显著性（χ^2=4.89,P〈0.05）。两组的HAMD因子分在焦虑/躯体化和睡眠障碍方面差异有显著性;两组副作用均较小。结论帕罗西汀合用小剂量奥氮平治疗抑郁症起效快,可提高疗效,能迅速改善睡眠障碍和躯体症状。     

米氮平治疗抑郁症患者的早期睡眠多导图改变

目的 通过睡眠多导图(PSG)客观评价米氮平治疗早期抑郁症伴失眠患者睡眠结构的影响及改善睡眠的疗效.方法 入组25例抑郁症伴失眠患者,在进行基线量表评估和PSG监测后开始服药,米氮平起始剂量每天15 mg,3 d后增至每天30 mg,睡前1 h服用;7 d后再次进行量表评估和PSG监测;观察治疗后失眠、焦虑抑郁症状、PSG的变化.结果 25例抑郁症伴失眠患者在米氮平治疗7 d后分别进行量表评分,显示各量表减分值分别为Athens失眠量表(7.92±3.86,t=10.255,P=0.000)、汉密尔顿抑郁量表(9.80±4.41,t=12.132,P=0.000)、汉密尔顿焦虑量表(6.84±5.57,t=6.137,P=0.000);PSG结果显示治疗总睡眠时间(min)延长(402.46±80.75,t=-2.990,P=0.006)、睡眠觉醒时间(min)缩短(80.38±48.02,t=2.972,P=0.007)、睡眠效率明显提高(76.17%±10.65%,t=-2.750,P=0.011),深睡眠比例显著增加(19.66%±11.43%,t=3.236,P=0.004),而入睡潜伏期和睡眠中清醒次数、快速眼动睡眠潜伏期、比例及出现次数无差异.结论 单一使用米氮平治疗抑郁症伴失眠患者起效快,同时能增加总睡眠时间、缩短睡眠觉醒时间、提高睡眠效率、增加深睡眠比例等,达到有效改善失眠.     

心理生理性失眠伴发情绪障碍与抑郁性失眠多导睡眠图分析

目的：探讨心理生理性失眠与抑郁性失眠多导睡眠图（PSG）特点。方法：选择收治的75例慢性失眠症患者（其中心理生理性失眠39例和抑郁性失眠症36例），停用镇静药物后，在适宜条件的实验室中给予整夜多导睡眠图监测。结果：抑郁性失眠组与心理生理性失眠组相比，其快速动眼期（REM）潜伏期和非快速动眼期（NREM）百分比降低，快动眼百分比增加。结论：心理生理性失眠患者PSG无特殊表现，抑郁性失眠患者PSG呈现快动眼睡眠活跃的特征。     

Sense of coherence as a predictor of subjective state of health: results of 4 years of follow-up of adults

A number of cross-sectional population studies have shown that a strong sense of coherence (SOC) is associated with various aspects of good perceived health. The association does not seem to be entirely attributable to underlying associations of SOC with other variables, such as age or level of education. OBJECTIVE: The aim of the study reported here was to determine whether SOC predicted subjective state of health. METHODS: The study was carried out as a two-way panel mail survey of 1976 individuals with 4 years interval for two collections of data. The statistical method used was multivariate cumulative logistic modeling. Age, initial subjective state of health, initial occupational training level, and initial degree of social integration were included as potential explanatory variables. RESULTS: A strong SOC predicted good health in women and men. CONCLUSIONS: SOC can be interpreted as an autonomous internal resource contributing to a favorable development of subjective state of health. SOC data should, however, be regarded as complementary to and not a substitute for information already known to be associated with increased risk of future ill health.     

Bibliography of officers of department of mental hygiene

Psychiatric Quarterly -     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.