原发性妄想和印度的社会政治环境——一例病例报告和简短综述（英文）

妄想一直是精神科研究的一个中心主题,研究涉及其病因、发病机制、诊断、治疗和司法精神病学的相关内容。许多精神科医生似乎对其中的原发性妄想尤为感兴趣。妄想的内容一直是文化精神病学感兴趣的领域。我们试图探讨原发性妄想的不同方面,试图解释在印度这样的国家中文化和社会政治环境如何决定原发性妄想的形成并影响其精神病理学。     

341例精神分裂症被鉴定人精神症状与社会危害行为的关系

目的探讨精神分裂症被鉴定人精神症状与社会危害行为的相关性。方法采用自制的调查表,通过查阅委托单位的鉴定委托送交材料和鉴定意见书的方式对湖南省341名无责任能力精神分裂症被鉴定人实施社会危害行为时存在的主要精神症状如幻觉、妄想、同时存在幻觉和妄想、思维逻辑障碍、行为紊乱等与其社会危害行为包括严重暴力社会危害行为、非严重暴力社会危害行为等信息进行登记,并进行关联性检验。结果①严重暴力社会危害行为组与非严重暴力社会危害行为组间不同精神症状构成比存在差异(χ2=16.259,P=0.003),精神症状与社会危害行为之间有关联(列联系数为0.213)。②精神分裂症被鉴定人实施严重暴力社会危害行为时以妄想症状出现的频数最多128例(45.7%);实施非严重暴力社会危害行为时以思维逻辑障碍出现的频数最多27例(44.3%)。③与严重暴力社会危害行为有关的妄想症状类型以被害妄想为主占106例(82.8%)、幻觉症状类型以命令性幻觉为主占13例(54.2%)、同时存在幻觉、妄想症状的以其它言语性幻听和被害妄想为主占76.6%。结论精神分裂症被鉴定人严重暴力社会危害行为可能主要与妄想有关,其非严重暴力社会危害行为可能主要与思维逻辑障碍有关。其中被害妄想、命令性幻听、同时存在其它言语性幻听和被害妄想的精神症状类型可能与精神分裂症被鉴定人严重暴力社会危害行为有关。     

从一例司法鉴定看智能发育和社会监护

目的强化智能发育和减少智能障碍封社会的危害。方法从个案调查中分析发现问题。结果强化训练封智能发育的重要及智能障碍的危害行为缺乏社会监护．结论封智能障碍的训练和监护是全社会的责任。     

原发性脑室出血的诊断、病因及预后(附20例病例报告)

目的 :探讨原发性脑室出血 (PIVH)的诊断、病因和预后。方法 :回顾性分析 2 0例 PIVH患者的临床资料、辅助检查、治疗结果。结果 :2 0例中 19例经头颅 CT、 1例经 MRI检查证实为 PIVH,8例行脑血管造影检查 ,病因为脑动静脉畸形者 5例 (2 5 % ) ,脑动静脉畸形伴动脉瘤者 1例 (5 % ) ,Moyamoya病 1例 (5 % ) ,高血压者 5例 (5 5 % ) ,病因不明者 2例 (10 % )。 5例全脑室出血者全部存活 ,15例部分脑室出血者 3例发生再出血 ,其中 2例死亡。结论 :头颅CT可以确诊 PIVH,脑血管造影对于明确出血的病因很有帮助 ,PIVH的病死率与出血量之间关系不大 ,而与再出血之间关系密切     

原发性中枢神经系统淋巴瘤的诊断和治疗（附12例报告）

目的探讨原发性中枢神经系统淋巴瘤（PCNSL）的诊断和治疗原则。方法收集和分析12例PCNSL患者的临床资料并进行相关的文献复习。结果PCNSL患者12例,其中肿瘤位于额顶部的大脑凸面6例,一侧脑叶深部3例,跨中线及矢状窦1例,左桥小脑角1例,右岩骨尖向中颅窝扩展1例。术后随访10例,术后患者生存期最长26个月,最短1个月。术后进行了正规放疗和化疗的8例患者,平均生存期为10个月,而未行放、化疗的患者平均生存期为3.5个月。结论PCNSL的诊断仅能依靠一些特征性的影像学资料,但因其发病率低,很难在术前明确诊断。治疗上不主张手术,而倾向于放疗＋化疗为中心的综合治疗。     

表现为多种脑干损害症状的原发性脑桥出血1例报告

原发性脑桥出血引起多种脑干损害症状较少见,现报告1 例如下.     

额叶变异型阿尔茨海默病的临床和影像学特征一例

目的额叶变异型阿尔茨海默病(AD)是一种以精神行为等症状为主要表型的少见特殊类型AD,本文报道1例额叶变异型AD的临床特点、影像学特征,以增加临床医生对该病的认识。方法报道1例额叶变异型AD患者的临床资料,分析其临床表现、辅助检查及影像学资料。结果本例患者以妄想和行为异常等为主要和最早临床表现,发病2年后才出现记忆力减退、言语表达困难、计算不能等症状,头颅MRI提示双侧额颞叶萎缩,以左侧为著。头颅SPECT显示:双侧额叶、颞叶和顶叶葡萄糖摄取普遍减低。PIB-PET(淀粉样蛋白PET):大脑皮质PIB显著滞留,考虑为PIB阳性显像。结论额叶变异型AD与行为变异型额颞叶痴呆临床表现类似,淀粉样蛋白PET检查可有效区分两者。     

行为疗法治疗一例罕见的窒息恐惧症：病例报告及文献复习

概述：窒息恐怖症是一种较少见的恐怖症,是心理性吞咽困难的病因之一。患者往往在耳鼻喉科就诊,之后被转诊到精神科。如果诊断不及时、治疗不恰当,那么它会严重影响患者的身心健康。我们报告一个20岁的女性患者,表现为窒息恐怖症,接受行为治疗。此外,我们还讨论了这种罕见的焦虑障碍的鉴别诊断和治疗策略。     

原发性甲状腺功能减退致垂体增生的诊断和治疗(附3例报告)

目的探讨原发性甲状腺功能减退致垂体增生的诊断和治疗。方法回顾性总结3例原发性甲状腺功能减退患者的临床表现、影像学表现、内分泌检查资料。结果根据临床表现、影像学表现、内分泌检查可明确诊断原发性甲状腺功能减退合并垂体增生;甲状腺素替代治疗5～8个月,甲状腺功能减退症状消失,血清促甲状腺激素和三碘甲状腺原氨酸、四碘甲状腺原氨酸、泌乳素水平正常,垂体大小恢复正常。结论原发性甲状腺功能减退导致的垂体增生,不应该简单考虑垂体瘤予以手术治疗。甲状腺素替代治疗是治疗原发性甲状腺功能减退致垂体增生的有效手段。     

Delusional misidentification of the Capgras and intermetamorphosis types responding to clorazepate. A case report

A patient with chronic psychosis and intermittent psychotic misidentification of the Capgras and intermetamorphosis types refractory to neuroleptic treatment was given a trial of clorazepate. Complete remission of psychotic symptoms was achieved for the first time in 19 years, but these recurred when the patient discontinued her clorazepate. It is concluded that clorazepate may be a useful treatment for some cases of chronic psychosis and psychotic misidentification. A possible mechanism for this is discussed.     

成人颅内神经母细胞瘤(1例报告并文献复习)

目的探讨原发性颅内神经母细胞瘤的临床、影像及病理学特点,以及治疗策略和预后。方法回顾性分析南京军区福州总医院神经外科收治的1例成人左侧额叶神经母细胞瘤患者的临床资料,将其临床、影像及病理学特点结合相关文献进行分析,并对患者进行跟踪随访。结果本例患者行神经导航下开颅肿瘤切除术,病理学检查证实为颅内神经母细胞瘤,术后以替莫唑胺同步放、化疗,后继以6周期辅助化疗。患者已无瘤生存4年,无明显神经功能缺失表现。结论成人颅内神经母细胞瘤极为少见且恶性程度高,手术完全切除肿瘤及术后正规放、化疗可显著提高患者的生存率。     

Primary epithelioid hemangioendothelioma in the clival region: A case report and literature review

Epithelioid hemangioendothelioma (EHE) is a rare and low‐grade vascular tumor, which usually occurs in the soft tissue, liver, breast, lung and skeleton. Here we submit a case with EHE of the clival region. A 58‐year‐old woman was admitted with a medical history of 3 months headache and 1 month visual deterioration. MRI revealed a well‐circumscribed mass of 4.0 cm × 3.0 cm with bony invasion. The tumor was subtotally removed in a piecemeal fashion. Histologically, the tumor was composed of epithelioid cells with eosinophilic cytoplasm and intracytoplasmic vacuoles. Immunohistochemically, the tumor cells were positive for the markers CD31, CD34, factor VIII and vimentin. The pathological result was interpretated as EHE of the clival region. EHE is an uncommon vascular tumor, which is rarely seen in the clival region. Definitive diagnosis depends on histopathologic and immunohistochemical features.     

Primary central nervous system angiosarcoma: A case report and literature review

Angiosarcoma is a rare vascular malignant neoplasm that mainly occurs in skin and soft tissues. Intracranial localization is very rare and only a few cases have been reported. This report intends to present the clinical, radiological and pathological pictures of a primary central nervous system angiosarcoma along with a review of the literature. A 35‐year‐old woman presented at our institution with weakness and sensory disturbances of her right hand. Neuroimaging revealed a roughly round, hemorrhagic and moderately enhancing lesion in the left frontal posterior region. The tumor was totally removed under awake anesthesia and continuous monitoring of motor and language functions. Histopathology revealed an epithelioid angiosarcoma. Radical removal, followed by adjuvant radiotherapy and chemotherapy, is able to completely control the disease for a relatively long period.     

原发性胶质母细胞瘤:一例报告并文献复习

目的对1例有长期癫痫发作病史的原发性胶质母细胞瘤患者的临床表现以及组织病理学、免疫组织化学特点进行分析。方法与结果患者为男性，48岁，因头部外伤而致长期癫痫发作。3个月前左侧颞叶出血，CT检查显示左侧颞叶占位性病变伴出血；MRI影像呈团块状混杂信号影，边界不清，肿块明显强化，临床诊断为胶质瘤。手术中可见肿瘤边界不清，质地红色、呈鱼肉样，血供丰富，与脑膜无粘连。组织病理观察，大部分肿瘤细胞围绕血管形成乳头状结构。免疫组织化学染色，所有肿瘤细胞胶质纤维酸性蛋白表达阳性，少突胶质细胞转录因子-2、结蛋白、肌浆蛋白，平滑肌特异性抗原、上皮细胞膜抗原、CD34、S100蛋白以及抑癌基因p53和表皮生长因子受体均表达阴性；Ki-67抗原标记指数为8％。手术后2个月死亡。结论患者为原发性胶质母细胞瘤，长期癫痫发作病史与肿瘤发生无直接关系，其组织形态具有特殊的乳头状结构，须注意与室管膜瘤和脑膜瘤等相鉴别。     

Ganser syndrome after solitary confinement in prison: A short review and a case report

A short review of the Ganser syndrome is given. The condition is a rare, probably dissociative, disorder with transient Vorbeireden as the central symptom. The case of a middle-aged man developing a transient Ganser syndrome after long-term solitary confinement in a remand prison is presented. Systematic investigation of 268 remand prisoners confirms the rarity of the syndrome, as only the case subject had this disorder.     

Primary leptomeningeal gliomatosis: case report and review of the literature

Abstract A 62-year-old woman developed dysphasia, signs of intracranial hypertension and seizures. An MRI scan evidenced extra-axial contrast enhancement in the absence of mass lesions. CSF analysis was negative for malignant cytology and viral or bacterial microbiology. In the absence of other evidence, considering the acute clinical onset and MRI picture, a viral encephalitis was suspected and antiviral therapy was started, however, with no effect. Death occurred three weeks after presentation because of acute brain swelling. Autopsy revealed leptomeningeal gliomatosis and diffuse parenchymal infiltration at the cerebellar and left temporal lobe. Primary leptomeningeal gliomatosis (PLMG) is a rare event. The reported case and the reviewed literature evidence that clinical signs at presentation are non-specific, CSF negative findings are common, the diagnosis is always delayed and the prognosis dismal.*The authors contributed equally to the study     

A case report: implementing a nurse telecare program for treating depression in primary care

The treatment of depression in primary care needs improvement. Previously, we reported that a nurse telecare intervention for treating depression in primary care clinics significantly improved treatment outcomes. The usefulness of nurse telecare, however, depends upon the feasibility of dissemination. In this report we describe nurse telecare and the steps required for implementation, and describe its dissemination in various settings. In addition to medication, which is managed by a primary care physician, the key elements of nurse telecare are focused behavioral activation, emotional support, patient education, promotion of treatment adherence, and monitoring of progress, delivered in ten brief telephone appointments over four months by primary care nurses. Support from key administrators and clinical champions is crucial to success. Nurses need dedicated scheduled time for telecare activities. Nurse telecare has been piloted and disseminated in diverse settings. The model required only small modifications for dissemination, and was implemented with minimal investment of resources and no negative impact on clinic operations.     

Primary central nervous system Hodgkin lymphoma: A case report and review of the literature

Central nervous system (CNS) involvement in the context of relapsed/refractory Hodgkin lymphoma (HL) is a quite rare, but well-known complication. Nevertheless, primary CNS–HL is an exceedingly rare condition, which diagnosis is based on well-defined morphological and immunohistochemical features, in addition to isolated involvement of the CNS.In spite of limited casuistry (just over twenty cases reported in the literature), available data agree that primary and isolated CNS–HL, when treated with a combination of surgery followed by some form of adjuvant therapy (radiotherapy ± chemotherapy), carries a better prognosis than those cases with CNS involvement in the context of relapsed/refractory HL or those with CNS non-Hodgkin lymphoma.We herein report a case of a 55-year-old female patient who was diagnosed with primary CNS–HL. The patient was treated with complete surgical resection followed by intrathecal chemotherapy and whole brain radiotherapy (WBRT), showing fourteen months of disease-free survival at the time of this case report. A review of the available literature is also presented.