有非自杀性自伤行为首发儿童青少年抑郁障碍患者的大脑自发神经活动特点

目的 探讨有非自杀性自伤(non-suicidal self-injury,NSSI)行为的首发儿童青少年抑郁障碍患者静息状态下的大脑自发神经活动特点.方法 选择2021年2—6月就诊于河北医科大学第一医院精神卫生中心符合美国精神障碍诊断与统计手册第5版(DSM-5)中抑郁障碍诊断标准的50例首发儿童青少年抑郁障碍患者...     

伴非自杀性自我伤害行为的青少年抑郁障碍患者危险因素分析

目的:探讨青少年抑郁障碍患者发生非自杀性自我伤害(NSSI)行为相关危险因素。方法:回顾性收集269例青少年抑郁障碍患者,将其划分为伴NSSI行为组209例及不伴NSSI行为组60例。收集患者的人口学资料、临床基本信息及儿童抑郁量表(CDI)、儿童青少年多维度焦虑量表(MASC)评分等。筛选出自变量(P<0.05)纳入Logistic回归,分析各自变量与患者NSSI行为的关系。结果:两组年龄、性别、年级、既往疗效、自杀未遂史、伴精神病性症状、CDI评分、MASC评分差异有统计学意义(P<0.05)。Logistic回归分析显示性别、自杀未遂史、既往疗效、抑郁严重程度为青少年抑郁障碍患者NSSI行为的独立危险因素(P<0.05)。在预测青少年抑郁障碍NSSI行为方面,受试者工作特征(ROC)曲线下面积AUC为0.820,95%CI为0.761～0.879,约登指数为0.48,灵敏度为0.938,特异度为0.542。结论:性别、自杀未遂史、既往疗效、抑郁严重程度为伴NSSI行为青少年抑郁障碍患者的独立危险因素,联合各危险因素建立的模型检验效能良好。     

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。     

青少年抑郁障碍患者非自杀性自伤行为诊断性预测模型的建立及验证

目的 建立青少年抑郁障碍患者非自杀性自伤（NSSI）行为诊断性预测模型,以期对青少年抑郁障碍患者NSSI行为的早期识别提供参考。方法 回顾性分析2021年1月1日-12月31日在深圳市康宁医院儿少科住院的抑郁障碍患者（n=366）临床资料。根据《精神障碍诊断与统计手册（第5版）》（DSM-5）诊断标准,将患者分为伴NSSI行为组（n=289）和不伴NSSI行为组（n=77）。将366例患者按7∶3随机分为训练集（n=258）和验证集（n=108）。使用Logistic回归分析筛选青少年抑郁障碍患者NSSI行为的独立危险因素,建立预测模型。使用受试者工作特征（ROC）曲线下面积（AUC）评估训练集和验证集模型的区分度,使用校准曲线评估训练集和验证集模型的校准度,使用Homser-Lemeshow(HL)检验评估模型的拟合优度,使用临床决策分析（DCA）曲线评价模型的临床获益情况。结果 性别（β=1.734,OR=5.561,95%CI:2.678～11.964）、受教育程度（β=0.864,OR=2.737,95%CI:1.174～4.795）、自杀未遂史（β=0.932,OR=2.53...     

伴与不伴非自杀性自伤行为青少年抑郁障碍的焦虑、应对方式对比及相关性分析

目的 探讨伴与不伴非自杀性自伤行为(NSSI)青少年抑郁障碍的焦虑情绪、应对方式的差异及其相关性,从而为制定有效的干预措施提供有利依据.方法 选取我院2017年11月～2019年12月期间就诊的符合ICD-10诊断标准的8～18岁抑郁障碍患者,根据有无NSSI分为两组,其中伴NSSI的71名为研究组,不伴NSSI的59名为对照组.两组均使用宗氏抑郁自评量表(SDS)、汉密尔顿抑郁量表(HAMD)评估抑郁症状,状态-特质焦虑问卷(STAI)评估焦虑症状,简易应对方式问卷(SCSQ)评估应对方式.分析两组患者应对方式及焦虑的差异性,并对其积极和消极应对方式与状态焦虑和特质焦虑分别进行相关性分析.结果 伴NSSI组的积极应对评分显著低于不伴NSSI组(P＜0.05),伴NSSI组的消极应对评分显著高于不伴NSSI组(P＜0.05).伴NSSI组患者无论在状态焦虑情绪还是在焦虑特质方面均显著高于不伴NSSI组患者.患者的状态焦虑与其消极应对方式具有相关性(P＜0.05),但与其积极应对方式并无相关性.而其特质焦虑无论是与积极应对方式还是消极应对方式均无明确相关性.结论 在相同抑郁状态下,伴有NSSI的青少年抑郁障碍患者在面对负性生活事件及抑郁、焦虑情绪时更容易采取消极应对方式,焦虑更为明显的患者也更容易采取消极应对方式.提示早期培养积极应对方式,可能减轻焦虑、减少NSSI的发生.     

抑郁障碍患者非自杀性自伤行为及其风险因素分析

目的:探讨抑郁障碍患者非自杀性自伤(NSSI)行为及其风险因素。方法:采用自编的一般情况调查表收集153例抑郁障碍患者一般资料(性别、年龄、受教育年限、病程等);应用NSSI行为问卷对入组者进行评估并将其分为伴与不伴NSSI两组,应用简明国际神经精神访谈中文版(MINI)评估患者是否共病焦虑障碍;分析NSSI行为的风险因素。结果:59例(38. 6%)患者有NSSI行为,归为伴NSSI组;不伴NSSI组(94例)。伴NSSI组女性患者的比率及共病焦虑障碍的比率明显高于不伴NSSI组(P均0. 01),年龄明显低于不伴NSSI组(P 0. 05)。伴NSSI组中,女性患者NSSI行为方式依次为割伤、阻止伤口愈合、刺伤,男性患者依次为割伤、灼烧伤、过度摩擦皮肤;性别间NSSI行为分布比较差异有统计学意义(P 0. 05);共病焦虑障碍患者NSSI方式及频率与非共病焦虑障碍者比较差异具有统计学意义(P均0. 05)。二分类Logistic回归分析显示共病焦虑障碍是抑郁障碍患者NSSI危险因素。结论:抑郁障碍患者中NSSI行为发生率较高,尤其是女性患者;共病焦虑障碍抑郁障碍患者更容易发生NSSI。     

中学生抑郁情绪与非自杀性自伤的关系：冲动性的中介作用

背景 非自杀性自伤（NSSI）行为是危害中学生心身健康的重要因素,中学生NSSI行为相关危险因素的内在机制尚不清楚。目的 探索中学生抑郁情绪、冲动性和NSSI行为之间的关系及内在机制,为预防和干预中学生NSSI行为提供参考。方法 于2021年3月,采用整群随机抽样法纳入1 161名中学生为研究对象。中学生均接受青少年NSSI行为评定问卷（ANSAQ）、流调中心抑郁量表（CES-D）和Barratt冲动量表（BIS-II）评定。采用Spearman相关分析考查中学生抑郁情绪、冲动性与NSSI行为的相关性,采用Process中介效应检验分析冲动性在中学生抑郁情绪与NSSI之间的中介作用。结果 检出存在NSSI行为的共122人（10.51%）。CES-D与BIS-II总评分及各维度评分均呈正相关（r=0.340~0.556,P均<0.01）,与ANSAQ总评分及各维度评分均呈正相关（r=0.437~0.540,P均<0.01）,BIS-II总评分及各维度评分与ANSAQ总评分及各维度评分均呈正相关（r=0.157~0.437,P均<0.01）。冲动性在抑郁情绪与NSSI行为之间起部分中介作用［间接效应=0.035（95% CI：0.004~0.067,P<0.01）,间接效应占总效应的5.81%］。结论 中学生的抑郁情绪可以直接影响其NSSI行为,也可以通过冲动性间接影响NSSI行为,冲动性在抑郁情绪和NSSI行为之间起部分中介作用。     

儿童青少年抑郁障碍肥胖患病率及相关因素分析

目的:探讨儿童青少年抑郁障碍患者的肥胖率及相关影响因素。方法:选取抑郁障碍儿童青少年患者757例，收集一般人口学资料及临床数据；评估非自杀性自伤(NSSI)行为；测量体质量及生化指标。结果:儿童青少年抑郁障碍患者的肥胖率为10.4%。肥胖组与非肥胖组比较，发病年龄、首次住院年龄、总病程、住院次数及体质量指数(BMI)、空腹血糖、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白(HDL-C)及低密度脂蛋白(LDL-C)、NSSI行为、使用抗抑郁药物种类差异存在统计学意义(P<0.05)。肥胖与总病程、住院次数、空腹血糖、TG、TC、LDL-C及NSSI呈正相关；与年龄、首次住院年龄、HDL-C、使用几种抗抑郁药物及抗抑郁药物剂量呈负相关(P<0.05)。回归分析显示空腹血糖(OR=2.114,P=0.007)、TG (OR=2.086,P=0.001)及NSSI行为(OR=2.103,P=0.010)是抑郁障碍患儿伴肥胖的危险因素，而较高剂量的抗抑郁药(OR=0.970,P=0.015)是肥胖发生的保护性因素。结论:儿童青少年抑郁障碍患者肥胖率较高，且与空腹血糖、TG、NSS...     

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...     

威廉姆斯生活技能训练在伴非自杀性自伤行为青少年抑郁症患者中的应用

目的探讨威廉姆斯生活技能训练(WLST)在伴非自杀性自伤(NSSI)行为青少年抑郁症患者中的应用效果。方法选取2019年1月-6月在苏州市广济医院住院的伴NSSI行为的青少年抑郁症患者88例。按入院顺序编号,偶数者为干预组(n=44),奇数者为对照组(n=44)。两组均接受为期4周的常规抑郁症疾病护理,干预组在此基础上接受WLST。两组患者分别于入院和出院时接受汉密尔顿抑郁量表17项版(HAMD-17)、一般自我效能感量表(GSES)、青少年学生生活满意度量表评定,并比较两组患者住院期间NSSI行为发生率、出院时HAMD-17评分减分率。结果两组患者住院期间NSSI行为发生率差异有统计学意义(χ~2=11.702,P=0.001)。出院时,两组HAMD-17、GSES、青少年学生生活满意度量表评分与入院时比较差异均有统计学意义(t_(对照组)=-5.256、10.690、-21.220,t_(干预组)=-12.540、11.300、-32.840,P0.01),两组组间HAMD-17、GSES、青少年学生生活满意度量表评分及HAMD-17评分减分率比较差异均有统计学意义(t=0.851、-12.809、-4.883,χ~2=75.990,P0.05或0.01)。结论 WLST可能有助于降低伴NSSI行为的青少年抑郁症患者NSSI行为发生率,减轻抑郁程度,增强自我效能感,提高生活满意度。     

Impulsiveness in obsessive-compulsive disorder: results from a family study

OBJECTIVE: Although obsessive-compulsive disorder (OCD) is usually conceptualized as an anxiety disorder some studies suggested it to be a deficit of impulse control. The purpose of this study was to assess impulsiveness in OCD families and compare it to control families. METHOD: Seventy cases and their 139 relatives were compared with 70 controls and their 134 relatives from a German family study on OCD (German Epidemiologic Network for OCD Studies). All subjects were interviewed and diagnosed according DSM-IV criteria and were administered the Barratt Impulsiveness Scale (BIS) and PADUA-Inventory to assess obsessive-compulsive symptoms. RESULTS: OCD subjects had significantly higher scores of cognitive impulsiveness. However, first-degree relatives of OCD cases and of controls had comparable BIS-11 scores. Significant associations of aggressive obsessions and checking with cognitive impulsiveness were found. CONCLUSION: OCD is a severe mental disorder that is characterized by a lack of cognitive inhibition. However, impulsiveness does not represent a familial trait in families of OCD subjects.     

Impulsiveness and deliberate self-harm: a comparison of ‘first-timers' and ’repeaters‘

Evans J, Platts H, Liebenau A. Impulsiveness and deliberate self-harm: a comparison of ‘first-timers’ and ‘repeaters’. Acta Psychiatr Scand 1996: 93: 378–380. © Munksgaard 1996. This study investigated differences in impulsivity between patients admitted to hospital for the first time after an act of deliberate self-harm (DSH), and those admitted after repetition of DSH. A total of 185 subjects, who were admitted to general hospital wards and referred for psychiatric assessment after DSH, completed self-report questionnaires including the impulsiveness (I-V-E) questionnaire. The presence of factors known to be predictive of repetition was recorded. including any history of DSH. Subjects with a history of DSH had significantly higher scores for impulsiveness than those who were presenting for the first time. Those presenting for the first time had higher scores than expected when compared with normative data after correcting for age and sex. Impulsiveness appears to be an important personality trait in DSH, in particular repeated DSH, and merits further investigation.     

Impulsiveness as a factor in sexual offending by people with mild intellectual disability

Background It has been suggested that sexual offending by people with intellectual disability (ID) results from a pattern of impulsive behaviour that is consistent with psychosocial disadvantage, rather than sexual deviancy. This study aimed to explore this hypothesis by assessing levels of impulsiveness in sexual offenders, non‐sexual offenders and non‐offenders with mild ID. Method Impulsiveness was assessed using a modified version of the Barratt Impulsiveness Scale (11th edition). Total impulsivity scores were compared between sexual offenders, non‐sexual offenders and non‐offenders, all with mild ID. Results There was a significant difference in the levels of impulsiveness between sexual offenders and non‐sexual offenders with ID (t = 2.83, P < 0.01). The sexual offenders were less impulsive than non‐sexual offenders. Conclusions This study did not support the hypothesis that sexual offending by people with ID is better explained by impulsive behaviour rather than sexual deviancy. It supports recent findings that among the general population, sexual offenders are less impulsive than controls and violent offenders.     

Selective difficulty in recognising facial expressions of emotion in boys with ADHD

Research on emotion understanding in ADHD shows inconsistent results. This study uses control methods to investigate two questions about recognition and understanding of emotional expressions in 36 five- to eleven-year-old boys with ADHD: [1] Do they find this task more difficult than judging non-emotional information from faces, thus suggesting a specific social-cognitive impairment? [2] Are their judgements about faces impaired by general limitations on task performance, such as impulsive responding? In Part 1, 19 boys with ADHD and 19 age-matched typically developing boys matched facial expressions of emotion to situations, and did a control non-emotional face-processing task. Boys with ADHD performed more poorly than age-matches on both tasks, but found the emotion task harder than the non-emotion task. In Part 2, 17 boys with ADHD and 13 five-to six-year-old typically developing boys performed the same tasks, but with an ‘inhibitory scaffolding’ procedure to prevent impulsive responding. Boys with ADHD performed as well as the younger controls on the non-emotional task, but still showed impairments in the emotion task. Boys with ADHD may show poorer task performance because of general cognitive factors, but also showed selective problems in matching facial emotions to situations.     

Impulsivity and dyscontrol in bulimia nervosa: is impulsivity an independent phenomenon or a marker of severity?

Fifty-eight normal-weight DSM-III-R bulimia nervosa patients were compared with 27 normal controls on measures of bulimia nervosa, depression, impulsivity, obsessionality and impulse control (dyscontrol) behaviours. Patients scored higher than controls on all these measures. Almost half the patient cohort met Lacey's multi-impulsive bulimia criteria. When bulimic symptoms were controlled for in an analysis of covariance, multi-impulsive bulimics did not score significantly differently to non-impulsive bulimics on psychometric measures of impulsivity, obsessionality and depression. The concept of impulsivity is critically reviewed and newer concepts linking obsessionality and impulsivity are explored.     

Suicide attempts in women with bulimia nervosa: frequency and characteristics

OBJECTIVE: This study aimed to estimate the lifetime frequency of suicide attempts in a large referred population of women with DSM-IV bulimia nervosa (BN), and to compare demographic and clinical characteristics of those who had attempted suicide and those who had not. METHOD: A total of 295 women (202 with BN purging type, 68 with BN non-purging type and 25 with anorexia nervosa binge/eating purging type) were assessed using a semi-structured interview and self-rated questionnaires. RESULTS: Suicide attempts were frequent (27.8% of women), often serious and/or multiple. Women who had attempted suicide differed significantly from those who had not for earlier onset of psychopathology, higher severity of depressive and general symptoms, and more impulsive disordered conducts, but not for the core symptoms or severity of BN. CONCLUSION: Interventions targeting depressive and impulsive features associated with BN are essential to reduce the risk of suicide attempt in women with this disorder.     

Abulia and impulsiveness revisited: a conceptual history

Historical analysis suggests that the decline and fall of the will was due not to any major piece of empirical work demonstrating that the concept was unsound but to general changes in philosophical fashion, and to the temporary influence of the anti-mentalistic tenets of behaviorism and the anti-volitional assumptions of psychoanalysis. Clinical disorders like abulia and impulsiveness share conceptual features that 19th-century alienists captured well in their clinical category of disorder of the will. Current accounts, which include semi-explanatory concepts such as “drive”, “motivation” or frontal lobe “executive” are not conceptually better than the old notion of will nor are they superior as correlational variables for neurobiological studies. It is suggested that the will, updated according to modern work in the philosophy of action, be re-adopted as a research category in current psychiatry.     

Volume of motor area predicts motor impulsivity

Impulsivity is a personality trait associated with many maladaptive behaviors. Trait impulsivity is typically divided into three different dimensions, including attentional impulsiveness, motor impulsiveness, and non‐planning impulsiveness. In the present study, we examined the neuroanatomical basis of the multidimensional impulsivity trait. Eighty‐four healthy participants were studied with structural magnetic resonance imaging. Multiple regression analyses revealed that the score of motor impulsiveness was negatively correlated with gray matter volumes of the right supplementary motor area and paracentral lobule. A machine‐learning‐based prediction analysis indicated that decreased gray matter volumes of the supplementary motor area and paracentral lobule strongly predicted the decrease in motor impulsiveness control. Our findings provide insights into the predictive role of motor brain structures in motor impulsivity and inhibition control.     

The healthy control subject in psychiatric research: impulsiveness and volunteer bias

Exciting and demanding biomedical experiments may attract a specific subgroup of people as volunteers. In the present study of selection bias, subjects volunteering in a psychobiological study that included a potentially painful procedure (lumbar puncture) were compared with those who declined to participate, with regard to scores on personality scales administered during a previous investigation of the same subjects. Significant differences were found on the Eysenck Personality Questionnaire and Karolinska Scales of Personality Impulsiveness scale, suggesting an over-representation of impulsive individuals among the volunteers. If the specific subject of investigation has implications for the type of individual who will participate as a healthy volunteer in biomedical research, variation will be introduced, affecting the independent variable, and the conclusions that can be drawn from such research may be questionable.     

Severe impulsiveness as the primary manifestation of multiple sclerosis in a young female

Severe impulsiveness in the absence of apparent neurological signs has rarely been reported as a clinical presentation of multiple sclerosis (MS). An 11-year-old female developed progressive and sustained personality disturbances including disinhibition, hypersexuality, drug abuse, aggressiveness and suicide attempts, without neurological signs. She was given several unsuccessful psychopharmacological and psychotherapeutic interventions. At age 21, a diagnosis of MS was made, confirmed by imaging, laboratory and neurophysiological studies. Although unusual, MS may produce pure neurobehavioral disturbances. In the present case, widespread demyelinization produced a complex behavioral disorder, with features compatible with orbitofrontal and Klüver-Bucy syndromes.