住院慢性精神分裂症患者个体和社会功能的评估及影响因素分析

目的:分析住院慢性稳定期精神分裂症患者的个人和社会功能及其影响因素。方法:对120例住院慢性稳定期精神分裂症患者采用个人和社会功能量表中文版(PSP)、患者健康问卷(PHQ)及阳性和阴性症状量表(PANSS)等进行个人和社会功能及精神病性状的评估。并对结果进行分析。结果:个人和社会功能低下患者2例(1.7%),有不同程度的能力缺陷患者72例(60.0%),社会功能和人际交往无困难或有轻微困难患者46例(38.3%);患者的个人和社会功能与性别(r=0.568,P0.01)及本次病程(r=-0.362,P0.01)存在显著相关性,患者的干扰和攻击行为与其精神症状显著相关(r=0.30,P0.01)。结论:住院慢性稳定期精神分裂症患者大部分存在不同程度的个人和社会能力缺陷;其中,社会中有用的活动及干扰和攻击行为与患者的精神症状、躯体症状群严重程度及抑郁症状群严重程度显著相关。     

强化无错性节奏训练治疗稳定期精神分裂症患者疗效的研究

目的研究稳定期精神分裂症患者在药物治疗基础上经强化无错性节奏训练治疗12周后,临床症状、生活质量的变化。方法纳入稳定期精神分裂症患者90例,随机分为治疗组(n=45)和对照组(n=45)。在药物治疗种类、剂量不变基础上,治疗组给予强化无错性节奏训练,对照组无其他干预,共12周。分别于基线及干预12周末,采用阳性与阴性症状量表(positive and negative symptom scale,PANSS)评估临床症状,精神分裂症患者生活质量量表(schizophrenia quality of life scale,SQLS)评估生活质量,功能大体评定量表(global assessment function,GAF)评估社会功能。结果基线时两组间各量表及其分量表评分差异均无统计学意义(P0.05)。重复测量方差分析示PANSS总分、阴性症状、一般精神病理症状、反应缺乏、思维障碍、偏执、抑郁评分及SQLS中心理社会、动力和精力评分的分组与时间交互效应有统计学意义(P0.05),而GAF评分交互效应无统计学意义(P0.05)。简单效应分析提示治疗结束时PANSS总分、阴性症状分、一般精神病理症状、反应缺乏、偏执、抑郁评分及SQLS中心理社会、动力和精力评分在治疗组下降具有统计学意义(P0.01),而在对照组变化无统计学意义(P0.05)。结论强化无错性节奏训练可有效改善稳定期精神分裂症患者缺陷症状及生活质量。     

社区康复与长期住院治疗对慢性精神分裂症效果的比较

目的比较长期住院与社区康复治疗对慢性精神分裂症的效果。方法以2016年1月-6月在成都某医院进行社区康复及长期住院治疗的符合《国际疾病分类(第10版)》(ICD-10)诊断标准的慢性精神分裂症患者,符合研究标准的共220例。其中社区组120例,住院组100例。采用阳性和阴性症状量表(PANSS)、个体和社会功能量表(PSP)、精神分裂症患者生活质量量表(SQLS)以及简易精神状态检查表(MMSE)对两组患者进行评定,比较两组的临床疗效。结果两组年龄、性别、受教育年限、首发年龄、病程及干预前PANSS、PSP、SQLS及MMSE评分差异均无统计学意义(P均0.05)。干预后,住院组PANSS总评分及阴性症状量表评分高于社区组,差异有统计学意义(P0.05或0.01);社区组PSP评分高于住院组,差异有统计学意义(P0.01);两组SQLS及MMSE评分差异均无统计学意义(P均0.05)。结论社区康复治疗对慢性精神分裂症患者的精神症状改善及社会功能恢复效果优于住院治疗,但两种疗法对患者生活质量和认知功能的效果可能无差异。     

舞蹈疗法对慢性精神分裂症的临床观察

目的探讨舞蹈疗法对慢性精神分裂症的康复疗效。方法将58例住院慢性精神分裂症患者随机分为舞蹈组和对照组。舞蹈组进行舞蹈训练,共训练12周。采用PANSS和SSPI量表于治疗前后进行评定。结果舞蹈组训练后PANSS和总分及各分量表分值均下降,SSPI量表总分及各因子分值均上升,差异有统计学意义（P〈0．01）。对照组治疗前后PANSS、SSPI量表评分其差异无统计学意义。结论舞蹈疗法能协助改善慢性精神分裂症患者的精神症状和社会功能。     

不同社区康复模式对稳定期精神分裂症患者的康复效果比较

目的:探讨居家康复、社区综合康复和日间机构康复3种不同社区康复模式对稳定期精神分裂症患者康复效果的影响。方法:选取社区稳定期精神分裂症患者200例,随机分成综合组、居家组各100例,在社区日间康复中心随机选取精神分裂症患者100例,构成机构组。居家组接受常规随访服务和康复指导,综合组接受团队综合干预服务,机构组在社区日间康复中心接受课程培训和康复活动。在干预前及干预的第3、6、9及12个月,分别运用阳性与阴性症状量表(PANSS)和社会功能筛选量表(SDSS)对康复效果进行评定。结果:干预后综合组与居家组、机构组与居家组的PANSS评分和SDSS评分差异有统计学意义(P均0.05);综合组与机构组的PANSS评分和SDSS评分均仅在第3个月时差异有统计学意义(P均0.05)。结论:相比于居家康复,社区综合康复和日间机构康复对进一步改善稳定期精神分裂症患者的精神症状和提升社会功能有更好的效果,对推动社区精神分裂症患者回归社会有积极作用。     

始动性功能训练对慢性稳定期住院精神分裂症患者生活质量和社会功能的影响

目的 了解始动性功能训练对慢性稳定期住院精神分裂症患者的生活质量和社会功能的影响.方法 将84例慢性稳定期住院精神分裂症患者随机分为两组,一组为研究组,接受始动性行为干预、物质奖励强化等功能强化训练,另一组作为对照组,采用常规护理,两组原来的抗精神病药物治疗不变,均干预52周,采用阳性和阴性综合征量表(PANSS)、精神分裂症患者生活质量量表(SQLS)、住院精神病人社会功能评定量表(SSPI)评价入组前及入组52周后的生活质量.结果 入组52周后研究组与对照组比较,PANSS量表的阴性症状分,SQLS量表的总分以及心理社会、动力和精力分量表评分均有显著性差异(P ＜0.05);SSPI量表的总分以及日常生活能力、动性和社会交往情况因子评分有显著性差异(P＜0.05).结论 始动性功能训练能改善慢性住院精神分裂症患者生活质量和社会功能.     

社区康复训练对慢性精神分裂症患者的效果观察

目的探讨社区康复训练对慢性精神分裂症患者的效果。方法选取我社区慢性精神分裂症患者92例,根据完全随机化原则将其分为对照组和干预组,每组各46例。其中对照组患者给予常规抗精神分裂症药物治疗,干预组在此基础上给予社区康复训练。6个月后观察比较两组患者阳性和阴性症状量表(PANSS)、自知力与治疗态度问卷(ITAQ)、社会功能缺陷筛选量表(SDSS)评分。结果两组患者干预前PANSS、ITAQ与SDSS评分比较,差异均无统计学意义(P0.05)。干预后,干预组PANSS阳性量表、阴性量表、一般精神病理量表评分及总分、ITAQ与SDSS评分改善情况均优于对照组;且与同组干预前比较,以上评分均明显改善,差异均具有统计学意义(P0.05);而对照组以上评分无明显变化,差异无统计学意义(P0.05)。结论社区康复训练可明显改善慢性精神分裂症患者的症状,增强患者自知力和社会功能,促进其康复。     

支持性心理干预联合社区日间康复训练对慢性精神分裂症患者的远期疗效

目的探讨支持性心理干预联合社区日间康复训练对慢性精神分裂症患者的远期康复疗效。方法 2011年10月至2012年9月选取慢性精神分裂症患者,按照随机抽样方法,入选样本84例,随机分为两组:干预组和对照组,每组42例。干预组接受支持性心理干预和社区日间康复干预6个月,对照组按社区常规随访6月。12个月末采用采用阳性与阴性症状量表(PANSS)、康复量表(MRSS)、自知力与态度问卷调查(ITAQ)、复发率和再住院率评估两组的康复疗效。结果干预组、对照组患者入组时PANSS、MRSS以及ITAQ评分差异无统计学意义(P0.05)。干预后干预组的PANSS总分及阴性量表分显著低于对照组,差异有显著性(P0.05)、MRSS总分及依赖性、活动能力、社交能力较对照组下降,ITAQ评分显著高于对照组,差异有显著性(P0.05),症状行为因子分两组无差异(P0.05)。干预组复发率及再住院率显著低于对照组(P0.05),差异具有统计学意义。结论支持性心理干预联合社区日间康复能更好地改善慢性精神分裂症患者的症状、提高其自知力,降低复发率和再住院率,对促进其康复水平有积极意义。     

强化门诊干预对社区稳定期精神分裂症患者社会功能的影响

目的:探讨强化门诊干预(IOP)对社区精神分裂症患者社会功能的影响。方法:将96例精神分裂症患者随机分为干预组和对照组,干预组给予药物及IOP干预;对照组只给予药物治疗。在干预前、干预后3、6个月采用阳性和阴性症状量表(PANSS)、个人和社会表现量表(PSP)对两组进行评估。结果:重复测量方差分析结果显示干预前两组PANSS、PSP评分组间差异无统计学意义(P0.05);干预6个月后,干预组PANSS量表阳性症状、阴性症状及一般精神症状评分的时间主效应(F=9.06,F=7.62,F=12.11;P均0.01),PANSS总分的组间主效应(F=4.22,P0.05)显著,差异有统计学意义;干预组PSP评分时间主效应和交互效应显著(F=10.90,F=5.90;P均0.01)。干预前PANSS分值越低,康复效果越好(t=12.86,P0.01)。结论:IOP干预能够改善稳定期社区精神分裂症患者的社会功能。     

户外有氧运动结合精神康复治疗对住院慢性 精神分裂症患者精神康复的影响

目的 探究户外有氧运动结合精神康复治疗对住院慢性精神分裂症患者精神康复的影 响。方法 以 2015 年 6 月至 2018 年 3 月期间在上海市精神卫生中心住院的 200 例精神分裂症患者为研 究对象,用随机数字表法分为运动组与对照组各 100 例,住院期间均给予药物治疗,并配合精神康复治 疗,运动组患者在此基础上给予户外有氧运动干预。干预前、干预后 3 个月采用阳性与阴性症状量表 （PANSS）、焦虑自评量表（SAS）、抑郁自评量表（SDS）、护士用住院病人观察量表（NOSIE-30）评估其精神症 状康复情况。结果 PANSS 评分中,运动组干预后阳性量表、阴性量表、一般精神病理量表与对照组比 较差异无统计学意义（t=1.858、1.909、1.867,P＞ 0.05）,但总分均显著低于对照组（t=3.196,P＜ 0.05）;干 预后运动组 SAS、SDS 评分均明显较对照组低（t=3.251、3.925,P＜ 0.05）;在 NOSIE-30 评分中,干预后运 动组与对照组比较,社会能力、社会兴趣、个人整洁评分升高更明显,激惹、迟缓、抑郁、精神病性评分 降低更明显（t=5.606、7.527、5.706、3.630、8.183、10.389、6.029,P＜ 0.05）。结论 户外有氧运动结合精 神康复治疗住院慢性精神分裂症有利于稳定患者病情,改善其心理症状和促进精神康复。     

Correlation of risk-taking propensity with cross-frequency phase–amplitude coupling in the resting EEG

Objective

Recent evidence has suggested that the weak inhibitory influence of the prefrontal cortex on the subcortical structures may be responsible for risk-taking behaviour. The aim was to determine the possibility that this weakness in top-down control is reflected in changes in the cross-frequency phase–amplitude coupling (CFPAC) in the electroencephalography (EEG).

Methods

Nineteen-channel EEGs were recorded from 50 healthy volunteers with their eyes closed before risk-taking propensity was assessed by behavioural measures, the domain-specific risk-taking (DOSPERT) scale and the Barrett impulsiveness scale (BIS). Correlation analyses between the CFPACs and the behavioural measures were performed.

Results

The CFPACs were negatively correlated with the risk-taking DOSPERT and BIS scores in frontal (Fp2) and centro–parietal (C3, C4 and P4) regions. By contrast, the CFPACs were positively correlated with the risk-taking DOSPERT and BIS scores in the right hemisphere (T8 and P8).

Conclusions

We suggest that frequent risk-taking behaviour is closely associated with the reduced interference of the cortical control network on the reward-oriented system. The CFPAC, which reflects the degree of interactions among functional systems, provides information about an individual’s risk-taking propensity.

Significance

The CFPAC may be a useful neurophysiological indicator of an individual’s tendency towards risk-taking behaviours, which thus potentially contributes to evaluating the severity of the psychiatric diseases exhibiting abnormal risk-taking behaviours.     

The Casino Attitudes Scale: The Development of a New Brief Psychometric Instrument

Over the course of the last decade, increasing liberalisation throughout the world has led to a massive growth of the gambling industry, particularly in the area of casino gambling. Casino gambling has frequently been found to be one of the most problematic forms of gambling. Given that there are no identified scales that measure attitudes toward this type of gambling, the aim of this study was to develop a psychometrically valid instrument to measure attitudes (and more specifically personal appeal) towards casinos. A sample of 139 participants (85 male, 54 female ranging in age from 18 to 62 years) completed the Casino Attitudes Scale. Exploratory factor analysis revealed two factors that explained 67% of the variance in the data. These were Recreational Appeal (34%) and Psychological Comfort (33%) respectively. As a preliminary test of the CAS’s reliability and validity, the psychometric data look promising. It is suggested that the CAS may be used in future studies in an attempt to identify how positive or negative attitudes toward casinos are associated with other psychosocial variables (e.g., personality factors). The CAS could also be administered to residents of local communities where casinos are planning to be introduced.     

Development of a Korean version of the behavior rating scale for dementia (BRSD-K)

OBJECTIVE: The purpose of this study was to develop a Korean version of the behavior rating scale for dementia (BRSD-K) for evaluating behavioral and psychological symptoms of dementia. METHODS: The BRSD-K was administered to the informants of 268 subjects with dementia. Internal, inter-rater and test-retest reliabilities were tested. To evaluate construct validity, exploratory factor analysis was performed. To evaluate concurrent validity, Pearson correlation coefficients between BRSD-K scores and the corresponding scores of the Korean version of the neuropsychiatric inventory (NPI-K) were calculated. RESULTS: BRSD-K demonstrated substantially high levels of reliabilities. Factor analysis identified seven factors, i.e. depressive symptoms, irritability/aggression, psychotic symptoms, behavioral dysregulations, sleep disturbance, inertia, and appetite. Correlations between BRSD-K and corresponding NPI-K scores were statistically significant (p < 0.05). CONCLUSIONS: BRSD-K was found to be a reliable and valid instrument for evaluating BPSD.     

颈内动脉系统急性缺血性脑血管病溶栓干预的风险-效益评价量表的编制及其应用价值研究

目的:本研究旨在于编制急性缺血性脑血管病溶栓干预风险-效益评价量表,以期预测溶栓干预的风险和收益,从而达到指导临床溶栓决策和提高溶栓疗效的目的。方法:本研究以2003-2～2006-9月间宣武医院卒中中心收治的88例颈内动脉系统急性缺血性脑血管病溶栓患者为研究对象,采用评分者信度、准则关联效度,以及受试者工作特征曲线(receiver operator characteristic curve,ROC)的方法对量表的信度、效度、临床预测价值进行检测分析。结果:信度检测结果提示,量表的总评分和分项评分均显示较高的α信度系数(0.9～1.0)。以患者接受溶栓干预后24小时NIHSS改善作为准则,溶栓干预前风险-效益量表评分与准则间的效度系数为-0.601,P<0.001;同时,对不同溶栓干预预后患者的基线风险-效益量表评分进行显著性检测分析提示,溶栓后改善组、无改善组、恶化组之间有十分显著的统计学差异(P<0.01)。ROC曲线分析结果提示,该量表用于溶栓干预安全性和有效性预测的ROC曲线下面积分别为0.832,95%CI=0.723～0.941,P=0.000和0.873,95%CI=0.795～0.950,P=0.000,同时以35分和55分分别作为溶栓干预有效性和安全性的评分界点显示较好的敏感性、特异性和阳性似然比。结论:在本研究的平台上,急性缺血性脑血管病溶栓干预的风险-效益评价量表显示较好的信度、效度和临床应用价值,有望成为一种新的用于预测溶栓治疗风险和收益、指导临床溶栓干预决策的简便、有效评价工具。     

歧视与病耻感量表(DISC)中文版在精神障碍患者中的信度和效度研究

目的:评估歧视与病耻感量表(DISC)在中国精神障碍患者中的信度和效度。方法:引进Thornicroft团队研发的DISC,按初译、回译等步骤形成DISC中文版,以242例精神障碍患者作为受访对象,验证量表的信度和效度。结果:DISC的Cronbach'α系数为0.70,分半信度为0.85,总分重测信度为0.83;DISC分量表1总分与精神疾病内在病耻感调查表(ISMI)歧视经历因子分呈正相关(r=0.417,P0.01),分量表2总分与ISMI社会退缩因子分呈正相关(r=0.332,P0.01);分量表2总分与自尊量表(SES)总分呈正相关(r=0.250,P0.01),分量表3总分与SES总分呈负相关(r=-0.187,P0.01);分量表4总分与社会支持评定量表(SSRS)客观支持分以及对支持的利用度分均呈正相关(r=0.177,0.170,P均0.01)。结论:DISC中文版具有较好的信度和效度,可作为评估精神障碍患者歧视与病耻感的临床工具。     

血清let-7家族水平和大面积脑梗死的严重程度的相关性研究

目的 探讨急性大面积脑梗死(MCI)患者血清let-7家族水平与MCI严重程度的相关性。方法 选择2014年1月-2017年6月在本院神经内科接受治疗的MCI患者88例作为观察组; 在入院时和2周后采用格拉斯哥昏迷量表(GCS)评估患者MCI的严重程度; 在入院48 h内和2周后采集静脉血,采用qRT-PCR检测患者的let-7 mRNA水平。另外,检测患者的血糖、血脂、血压、超敏C反应蛋白(hs-CRP)以及同型半胱氨酸水平。结果 与对照组比较,观察组中无出血性转化(HT)患者的血清Let-7水平明显降低(P<0.001),并且Let-7水平与GCS正相关(r=0.639,P<0.01)与hs-CRP负相关(r=-0.673,P<0.01); 观察组中存在出血性转化(HT)患者的血清Let-7表达水平明显增加(P<0.01)。结论 let-7水平能从一定程度上反映MCI的严重程度。     

The diagnostic validity of the Athens Insomnia Scale

OBJECTIVE: To provide documentation for the diagnostic validity of the Athens Insomnia Scale (AIS), a self-assessment psychometric tool which has previously shown high consistency, reliability and external validity for the evaluation of the intensity of sleep difficulty. METHODS: The AIS was administered to a total of 299 subjects (105 primary insomniacs, 100 psychiatric outpatients, 44 psychiatric inpatients and 50 nonpatient controls) who were also assessed for the ICD-10 diagnosis of "nonorganic insomnia" blindly in terms of the AIS scores. RESULTS: 176 subjects were identified as insomniacs and 123 as noninsomniacs. Logistic regression of AIS total score against the ICD-10 diagnosis of insomnia demonstrated that a score of 6 is the optimum cutoff based on the balance between sensitivity and specificity. When diagnosing individuals with a score of 6 or higher as insomniacs, the scale presents with 93% sensitivity and 85% specificity (90% overall correct case identification). For this cutoff score, in the general population, the scale has a positive predictive value (PPV) of 41% and a negative predictive value (NPV) of 99%. For the same cutoff score, among unselected psychiatric patients, the PPV was found to be 86% and the NPV 92%. Other cutoff scores can be also considered, however, depending on the importance of avoiding false positive or false negative results; for example, for a cutoff score of 10, the PPV in the general population reaches about 90% without the NPV becoming lower than 94%. CONCLUSION: The AIS can be utilized in clinical practice and research, not only as an instrument to measure the intensity of sleep-related problems, but also as a screening tool in reliably establishing the diagnosis of insomnia.     

Assessment of neurological symptoms in adult hydrocephalus occlusus. A pilot study

BackgroundComprehensively describe and compare (pre⁄postoperatively) the clinical symptomatology in adult non-communicated hydrocephalus. Associated hydrocephalus signs were analyzed with the idiopathic Normal Pressure Hydrocephalus Scale (iNPH Scale). A standardized clinical scale for non-communicated hydrocephalus is currently not in use.MethodsTen patients with hydrocephalus occlusus (HO) were analyzed. Hydrocephalus signs were examined with the iNPH Scale in gait, neuropsychology, continence, and balance before and three months after treatment with shunt operation or third endoscopic ventriculostomy.ResultsPatients significantly improved in iNPH total score (25.8%) and gait score (35.4%) three months after neurosurgical intervention. Domain scores in neuropsychology, continence, and balance reached statistical trends (p ≤ 0.066). Most clinical symptoms and signs at baseline improved after surgery (dizziness, lapse of concentration, gait instability, and headache).ConclusionPatients with non-communicated HO also showed classical hydrocephalus symptoms as communicated in iNPH patients. The iNPH Scale allows a structured neurological assessment over the disease’s progress and surgical intervention. Further studies with a larger patient samples are necessary to support our results.