中国汉族人群5-羟色胺转运体基因多态性与神经性厌食的关联研究

目的:探讨中国汉族人群5-羟色胺转运体基因启动子区域(5-HTTLPR)多态性与神经性厌食的关系。方法:应用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术对198例神经性厌食患者和225例正常健康对照者进行基因分型和关联分析。结果:①5-HTTLPR基因的3种基因型S/S、L/S和L/L在神经性厌食组的分布频率分别为65.7%、26.8%、7.6%,对照组为48.8%、37.8%、13.4%,两组差异有统计学意义(P<0.05)。等位基因S、L在神经性厌食组的分布分别为79.0%、21.0%,对照组为69.3%、30.7%,差异有统计学意义(P<0.05)。患病与携带L等位基因成负关联(OR=0.52,95%CI:0.35～0.77),患病与L/S基因型成负关联(OR=0.52,95%CI:0.34～0.79)。②5-HTTLPR功能三等位基因型(LA/LA、S/LA+LA/LG、S/S+S/LG+LG/LG)在神经性厌食组分布频率分别为2.0%、12.2%、85.8%,对照组为4.1%、23.4%、72.5%,两组差异有统计学意义(P<0.05)。患病与携带LA等位基因成负关联(OR=0.44,95%CI:0.25～0.77),患病与S/LA基因型成负关联(OR=0.44,95%CI:0.24～0.81)。结论::5-HTTLPR基因启动子区域多态性与中国汉族人群AN可能存在关联,L、LA等位基因及L/S、S/LA基因型为AN患病的保护等位基因及基因型。     

5-羟色胺2A受体基因102T/C多态性与汉族神经性厌食患者的关联分析

目的:探讨5-羟色胺2A受体基因102T/C的多态性与汉族神经性厌食(AN)患者的关系。方法:应用多重碱基延伸SNP分型技术(Multiplex SNaPshot),对198例AN患者和147例健康对照者进行5-羟色胺2A受体基因102T/C多态的基因分型。结果:在AN组和正常对照组之间,等位基因频率(χ2=1.134,P>0.05)和各种基因型(χ2=1.612,P>0.05)分布差异无显著性。结论:未发现5-羟色胺2A受体基因102T/C多态性与汉族人群AN患者存在关联。     

神经性厌食患者5-羟色胺2A受体基因多态性与人格特性的关联研究

目的探讨5-羟色胺2A(5-HT2A)受体基因102T/C多态性与神经性厌食患者人格特性之间的关系。方法应用多重碱基延伸SNP分型技术,对107例神经性厌食患者进行5-HT2A102T/C基因多态进行检测,并进行明尼苏达多项人格调查表(Minnesoda Multiphasic Personality Inventory,MMPI)评定。结果 5-HT2A102T/C的三种多态基因型的Pd(心理病理性偏离)量表T分差异有统计学意义(F=7.698,P=0.001);其中,纯合子C/C和T/T基因型Pd量表T分(67.3±12.7;65.8±12.7)均高于中国常模(60),并均显著高于杂合子T/C基因型的Pd量表T分(58.2±9.8)(P1=0.001;P2=0.005)。结论 5-HT2A102T/C基因多态可能与神经性厌食的易感人格特性存在关联,MMPI中Pd量表T分很可能是神经性厌食的人格特性内表型。     

帕金森病伴发抑郁患者血小板5-羟色胺浓度的对照研究

目的 了解5-羟色胺(5-HT)在帕金森病(PD)伴发抑郁症状中的作用.方法 采用高效液相色谱法,分别测定60例PD患者(伴发抑郁症状31例)和48 例正常对照者的血小板5-HT含量.结果 51. 7 %的PD患者伴发抑郁症状,PD组5-HT浓度较正常组显著下降,伴发抑郁组PD患者血小板5-HT浓度较未伴发抑郁组亦显著降低.结论 本文研究结果支持5- HT 代谢异常在PD患者中起重要作用的理论,纠正血小板5-HT浓度异常可能会促进PD患者神经功能康复.     

强迫症、抑郁症及焦虑症患者血小板5-羟色胺浓度的对照研究

目的　研究 5 羟色胺 ( 5 HT)在强迫症发病中的作用及强迫思维与强迫动作亚组、抑郁症及焦虑症患者间血小板 5 HT含量的差异。方法　采用高效液相色谱法 ,分别测定 2 9例强迫症患者 [(强迫症组 ,根据Y BOCS强迫量表因子得分将其分为强迫思维 ( 16例 )、强迫动作 ( 7例 )和混合性( 6例 ) 3组 ]、2 0例抑郁障碍患者 (抑郁症组 )、17例焦虑障碍患者 (焦虑症组 )和 2 8名正常人 (正常人组 )的血小板 5 HT含量。结果　强迫症组血小板 5 HT水平 [( 139± 172 ) μg/L]低于正常人组 [( 2 4 8±2 15 ) μg/L]及焦虑症组 [( 397± 4 0 1) μg/L],差异具有显著性 (P =0 0 39;P =0 0 2 0 ) ;与抑郁症组 [( 2 0 2± 16 2 ) μg/L]的差异无显著性 ( P >0 0 5 ) ;强迫思维 [( 85± 6 6 ) μg/L]与强迫动作组 [( 16 9± 10 0 ) μg/L]间血小板 5 HT含量的差异有显著性 (P =0 0 2 5 )。结论　强迫症患者 5 HT浓度变化与抑郁障碍患者趋同 ,与焦虑障碍患者的差异有显著性 ;单纯强迫思维者的 5 HT浓度与单纯强迫动作患者的差异有显著性     

利培酮辅助治疗难治性抑郁症对患者血小板5-羟色胺浓度的影响

目的探索小剂量利培酮合并抗抑郁剂对难治性抑郁症患者血小板5-羟色胺(5-HT)浓度的影响。方法38例难治性抑郁症患者在合并利培酮治疗前及治疗后4周末分别检测患者外周血血小板5-HT浓度,并评估汉密顿抑郁量表17项(HAMD17)、汉密顿焦虑量表(HAMA)。结果在合并利培酮治疗后血小板5-HT浓度减低,与合并治疗前相比,接近显著变化水平(P=0.05),治疗后HAMD、HAMA总分及各因子分与治疗前相比有显著差异(P<0.05);合并利培酮治疗后患者血小板5-HT浓度与本次病程、HAMD阻滞因子分、HAMA总分与精神焦虑因子分呈正相关,与HAMD总分减分值及睡眠因子减分值呈负相关;治疗前后5-HT浓度差值与发作次数负相关,与HAMD阻滞因子减分值正相关。结论小剂量利培酮合并抗抑郁剂对难治性抑郁症患者治疗4周症状有改善,同时可能引起患者血小板5-HT浓度减低;血小板内5-HT浓度与焦虑症状、阻滞等症状可能相关;血小板5-HT浓度降低与患者的阻滞症状改善可能存在一定的关系。     

精神疾病患者血小板5-羟色胺水平与自杀

目的：探讨精神分裂症和抑郁症患者血小板5-羟色胺（5-HT）水平与自杀的关系。方法：对66例精神分裂症患者、61例抑郁症患者和26名正常对照组,采用高效液相-电化学检测法测定血小板5-HT水平并作5年的随访。结果：精神分裂症自杀组血小板5-HT水平显著高于正常对照组,抑郁症患者血小板5-HT水平显著低于正常对照组。在入组后的5年间有26例再次发生自杀,再次自杀组的血小板5-HT水平显著低于未再自杀组。结论：低血小板5-HT水平可能对预测精神疾病患者未来的自杀有一定的参考价值。     

1例神经性厌食患者的结构式家庭治疗

目的探索结构式家庭治疗理论与方法在神经性厌食中的应用及效果.方法应用结构式家庭治疗理论,采用参与、重新框视、行动促发等技巧,通过按摩问题、维持问题、改变问题进行1例神经性厌食患者的家庭治疗,共10次,为期3个月.结果经过家庭治疗,患者体重上升6公斤,抑郁症状等改善.结论应用结构式家庭治疗神经性厌食近期疗效较明显.     

神经性厌食生物学病因研究进展

本文就神经性厌食的5-HT功能、神经内分泌、遗传学、脑电生理、脑影像等生物学病因研究现状作一综述。     

A clinical and phenomenological study of 185 Spanish adolescents with anorexia nervosa

The objectives of the present study were the following: to determine the socio-familial, academic and interpersonal characteristics specific to anorexia nervosa (AN); to study comorbidity in patients with anorexia and morbidity in their parents; and to ascertain whether patients with anorexia nervosa in Spain are similar to those in other countries. The research team revised the clinical records of 185 Spanish adolescents with AN (aged 11–18 years). The results were compared with those obtained from a group of 185 psychiatric patients without AN matched by sex, age, time of consultation and centre. No significant differences were found with regard to broken home, birth order or parent-patient conflict. The parents of patients with anorexia have a higher standard of education and develop more affective disorders. When compared with other patients, the individuals with anorexia nervosa perform much better academically but are more socially withdrawn. Males with anorexia nervosa perform worse academically than females and have more anxiety diagnoses. Patients with anorexia have a high comorbidity for affective and obsessive-compulsive disorders. Sufferers from anorexia nervosa in Spain are clinically analogous to patients with anorexia in other countries. The two characteristics specific to these patients are a high standard of academic performance and an intense degree of social withdrawal, although there are certain factors common to other pathologies relating to adolescence.

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Zusammenfassung Die Ziele der vorliegenden Studie bestanden darin, die sozio-familiären, bildungsmäßigen und interpersonellen Charakteristika zu bestimmen, die für Patienten mit Anorexia nervosa spezifisch sind. Außerdem wurde die Komorbidität der Patienten ebenso wie die Morbidität der Eltern untersucht. Es sollte geklärt werden, ob die spanischen Patienten mit Anorexia nervosa mit Patienten aus anderen Ländern vergleichbar sind. Die Forschungsgruppe untersuchte die Krankengeschichte von 185 spanischen Jugendlichen mit AN im Alter von 11 bis 18 Jahren. Die Ergebnisse wurden mit einer psychiatrischen Kontrollgruppe verglichen, die im Hinblick auf Geschlecht, Alter, Vorstellungszeitpunkt und -Zentrum parallelisiert war. Es fanden sich keine signifikanten Unterschiede im Hinblick auf den Anteil zerrütteter Familien, Geburtsrang oder Konflikte zwischen Eltern und den Patienten. Die Eltern von Patienten mit Anorexia hatten eine höherwertige Ausbildung; sie zeigten häufiger affektive Störungen. Im Vergleich zu anderen Patienten schneiden die Anorexia nervosa-Patienten in bezug auf Schulerfolge besser ab, sie sind jedoch in sozialer Hinsicht zurückgezogener. Männliche Jugendliche mit Anorexia nervosa wiesen schlechtere Schulleistungen auf als die weiblichen und litten häufiger unter Angststörungen. Patienten mit Anorexia nervosa weisen eine hohe Komorbidität mit affektiven Störungen und Zwangsstörungen auf. Insgesamt ähnelt die Symptomatik der Patienten aus Spanien der anderer Länder. Die beiden Charakteristika, die für diese Patienten spezifisch sind, sind der hohe schulische Leistungsstandard und der ausgeprägte soziale Rückzug, obwohl es bestimmte Faktoren gibt, die sich auch bei anderen psychiatrischen Störungen im Jugendalter häufiger finden.

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Résumé Les objectifs de cette étude étaient: de déterminer le caractéristiques socio-familiales, scolaires et interpersonnelles spécifiques à l'anorexie mentale; d'étudier la comorbidité des patients anorexiques et la morbidité de leurs parents; et de vérifier si les patients anorexiques espagnols ressemblent à ceux des autres pays. L'équipe de recherche a réexaminé les histoires cliniques de 185 adolescents espagnols anorexiques (âgées de 11 à 18 ans). Les résultats obtenus ont été comparés avec ceux d'une groupe des 185 patients psychiatriques sans anorexie mentale appariés selon le sexe, l'âge, da durée de la consultation et le service. Aucune différence significatives n'ont été trouvées concernant les ruptures familiales, l'ordre de naissance ou les conflits entre parents et patients. Les parents des patients anorexiques ont un niveau d'éducation plus élevé et développent plus souvent des troubles affectifs. Par rapport aux autres patients, les patients anorexiques ont des performances scolaires plus élevées mais sont plus inhibés socialement. Les gar¢ons avec une anorexie mental ont un moindre niveau scolaire que les filles et ont plus souvent un diagnostic d'anxiété. Les patients anorexiques ont une comorbidité plus importante concernant les troubles affectifs et obsessionnels compulsifs. Les patients anorexiques espagnols ressemblent cliniquement à ceux des autres pays. Les deux caractéristiques propres à ces patients sont un niveau élevé de performance scolaire et un degré intense d'inhibition sociale bien qu'ils présentent également certains facteurs communs aux autres pathologies de l'adolescence.

     

A prospective study of 133 patients with anorexia nervosa

One hundred and thirty-three patients with anorexia nervosa have been treated in a prospective study from 1958 to 1976. The doctor and the patient alone formed the therapeutic team, the doctor playing the role as an instructor in the pathophysiology of hunger without discussing social or psychological problems. At follow-up 58 % of the patients were grouped as ‘good’, and 28 % as ‘intermediate’, figures which are in accordance with those obtained from other authors. Fourteen per cent of the patients were grouped as ‘poor’. None of the patients died. That therapists with different attitudes to treatment may obtain fairly similar results strengthens our view of a strong tendency to spontaneous recovery in anorexia nervosa. The outlook for patients with a short history of anorexia nervosa seems good.     

Physical activity and cortisol in anorexia nervosa

Elevated physical activity is commonly observed among patients with Anorexia Nervosa (AN) and can manifest in several forms. While elevated physical activity may play a key role in the pathophysiology of this disorder, much remains unknown about it, including the relationship among its various manifestations, and their underlying mechanism(s). The purposes of the current study were to (1) quantify locomotor activity in inpatients with AN using an accelerometer, (2) determine the association between locomotor activity and exercise history and (3) determine the association between urinary cortisol and physical activity. Thirty-six women hospitalized with AN wore activity armbands for 48 h during the first 2 weeks of hospitalization, collected 24-h urine to measure cortisol, and completed rating forms. Activity counts varied more than four-fold among individuals but were consistent within individuals over the 2 monitoring days (p<0.001). Averaged 24-h activity counts were positively correlated with pre-hospitalization attitude towards exercise as measured by the Commitment to Exercise Scale (CES; p=0.032). Forty-two percent of women reported "high" exercise in the 3 months before hospitalization; compared to non-high-exercising patients, these women demonstrated a higher CES score (p<0.001) and a trend toward greater activity counts (p=0.059). Urinary cortisol was positively associated with activity counts (p=0.044) and CES score (p=0.018). These data suggest that some women with AN have a higher "drive" for physical activity that persists into early hospitalization. HPA axis abnormalities may be associated with this state.     

厌食症患者情绪障碍与家庭功能关系的对照研究

目的 探讨神经性厌食症患者发病的情绪障碍及家庭功能之间的关系.方法 使用症状自评量表(SCL-90),家庭功能量表(FAD)对29例神经性厌食症患者的心理特征及其家庭功能进行评定,并与大学生样本进行对照研究.结果 神经性厌食症患者SCL-90中躯体化,强迫,焦虑,抑郁,敌意,恐惧,偏执,精神病性评分均高于正常对照,差异有统计学意义(P<0.05).FAD问题解决,沟通,情感反应,情感介入,总的功能评分均显著高于正常对照,差异有统计学意义(P<0.05).家庭功能各因子与SCL-90各因子存在相关.结论 神经性厌食患者对情绪障碍更易感,并且存在家庭功能的失调,并且其情绪障碍与家庭功能可以互相影响.     

A follow-up study of 222 anorexia nervosa and bulimia nervosa patients, 1960-1983

Two hundred and twenty-two patients (205 females and 17 males) with anorexia nervosa and bulimia were re-examined 2-23 years (average, 8 years) after their first contact with the Department of Child and Youth Psychiatry or Department of Psychiatry of the University Hospital. Lund, Sweden. Of the 222 patients selected, 7 had died (3.2%), 5 of suicides and 2 of severe malnutrition. Two hundred and fifteen were asked to answer a postal inquiry consisting of psychometric instruments and one self-report check list. One hundred and twenty-eight answered and were statistically compared with the non-responders. On various items from hospital records no differences were found. The follow-up age for the 128 responded was 27.7 years. On basis of the recommended cut-off point for EAT-26 scores the responders were divided into two groups: one recovered and one symptomatic. There were statistical differences for all psychometric instruments between these two groups. The recovered group had a shorter delay and were thus 17.65 years old, compared with 22.6 years for the symptomatic. Bulimic behaviour, use of laxatives and attempted suicides were strong predictors of poor outcome. To test group classification, a random selection of 34 patients was asked to come in for clinical assessment (global clinical score). There was a clear significant correlation between good outcome as clinically assessed and good outcome as measured by EAT score. The study found a high proportion of still symptomatic patients, many of them not receiving any personal help. This investigation shows that with a relatively simple postal inquiry patients still affected can be identified. We propose that attempts should be made to institute this as a clinical routine.     

Fast psychomotor functioning in underweight anorexia nervosa patients

To explore whether underweight anorexia nervosa patients show psychomotor differences relative to normal controls, 32 female hospitalised patients, aged between 14 and 25 years, were compared with 32 healthy, normal weight controls, matched for sex, age and educational level. Using computerised analysis of writing and drawing behaviour, reaction times and movement times and their different components were analysed, while cognitive and motor demands were manipulated in five drawing and copying tasks. Anorexia nervosa patients were, compared to normal weight controls, significantly faster in a drawing task and showed shorter reaction times in copying tasks. Movement times did not differ significantly between the two groups. In the most complex copying task, a significant group×complexity interaction for reaction time (patients shorter) and reinspection time (patients longer) was found. Patients also made more errors than controls. The finding of a consistent pattern of shorter reaction times in underweight anorexia nervosa patients seems to run contrary to previous findings of disturbed cognitive functioning (i.e. impaired attention) in these patients. The differences seem to be related to cognitive factors more than to motor (executive) components.