10例待分类的精神病性障碍资料分析

我们以广州市相关医疗单位在司法精神病鉴定中诊断的待分类的精神病性障碍为对象,对他的临床特征进行分析,报告如下。     

偏执性精神病与偏执型精神分裂症的临床特点比较

目的　探讨偏执性精神病与偏执型精神分裂症的临床表现差异。　　方法　比较 65例偏执性精神病与 1 0 3例偏执型精神分裂症的临床特点。　　结果　偏执性精神病发病年龄较大 ,起病缓慢 ,病程冗长 ,疗效较差。　　结论　两者临床特点存在明显差异。     

精神病患者血清中腺苷脱氨酸活性的研究

对３２１例精神病患者进行了血清ＡＤＡ活性测定，发现精神分裂症和情感性精神病患者高于对照组。而神经症患者与对照组无异常，服用与未服精神病药及家族史阳性与有性患者之间无明显差异，根据上述结果，推测精神分裂症和情感性精神病患者ＡＤＡ增高可能与精神病患者免疫功能障碍有关。提高精神病治愈率和纠正免疫功能障碍，注意纠正ＡＤＡ活性可能是一个有效的途径。     

区分精神病性症状的意义

区分精神病性症状和非精神病性症状有其临床、教学、司法意义。     

抗精神病药物与高血糖关系探讨

目的：了解分析目前在我院住院治疗的精神分裂症患者血糖增高情况及其与患者病程，服抗精神病药物等因素关系。方法：调查分析符合CCMD3诊断标准的住院精神分裂症患者中高血糖发生情况，以及分析患者患病病程，糖尿病家族史，抗精神病药物的使用情况等相关因素，并观察患者体重，体重指数，血糖变化。将精神分裂症患者高血糖发生率与脸群患病率进行比较，分析产生高血糖的相关因素。结果：165例精神分裂症住院患者中高血糖发生率16．4％，为普通人群患糖尿病率2．5％的7倍。长期服用抗精神病药物会引起体重、体重指数增加及患者高血糖的发生与病程长短，患者年龄，糖尿病家族史阳性等因素有关。患者的高血糖发生，服非经典与经典抗精神病药物相比较无显著差异。两种以上抗精神病药物联用者高血糖发生率高。结论：精神分裂症患者长期服抗精神病药物引起体重、体重指数增加及其高血糖的发生率远高于一般人群。精神分裂症患者血糖增高可能是长期服抗精神病药物所致的一种延迟性，慢性药物不良反应的表现。应引起临床工作者关注。     

精神病的跨诊断维度:对精神疾病的分类学与研究的意义（英文）

如果精神病是一种跨诊断的维度,精神病性症状的出现受动态变化的情境和情感因素左右,而后者又是可治疗的,那么目前精神科疾病的分类学和治疗研究的方法可能需要修改。迄今为此,无论在临床工作上还是在疾病概念上,占主导地位的方法是将精神病性症状置于精神分裂症的框架中。然而,终生患病率为1%的精神分裂症只代表了部分预后不佳的精神病谱系障碍,而后者发生更多,终生患病率为3.5%。因此,精神分裂症的研究结果可能反映了预后相关的机制,而非精神病和其他症状维度之间本质上的相关性。同样,常见的非精神病性精神障碍中高达30%的个体有阈下精神病性症状,他们会被归于精神病的跨诊断维度之下,这些精神症状还会影响临床严重程度和治疗有效性。上述发现也同样提示武断区分"精神病性"与"非精神病性"的做法妨碍了临床实践和研究。精神病学诊断手册可以借鉴跨诊断维度(包括精神病的跨诊断维度)的体系。引入跨诊断维度,则既能根据原则进行分类诊断(即疾病分组的特异性),又可结合个体特有的多维度综合评分(即个体特异性)。这样的益处在于促使人们思考在精神病理学中症状之间是如何动态地交互作用的,并思考社会环境是如何影响精神病理症状的。     

精神病患者血清中腺苷脱氨酶活性的研究

对３２１例精神病患者进行了血清ＡＤＡ活性测定，发现精神分裂症和情感性精神病患者高干对照组（ｐ＜０．０１）．而神经症患者与对照组无异常（Ｐ＞０．０５），服用与未服精神病药物及家族史阳性与阴性患者之间无明显差异（Ｐ＞０．０５）．根据上述结果，推测精神分裂症和情感性精神病患者ＡＤＡ增高可能与精神病患者免疫功能障碍有关，提高精神病治愈事和纠正免疫功能障碍，注意纠正ＡＤＡ活性可能是一个有效的途径。     

心理干预与药物治疗对文化相关的短暂精神病性障碍的疗效

目的 探讨心理干预在文化相关的短暂精神病性障碍的作用。方法 将32例与文化相关的短暂精神病性障碍患者随机分为两组,A组为单纯药物治疗组,B组为心理干预合并药物治疗组。药物治疗8周前后行简明精神病量表(BPRS)评定,随访半年。结果 药物治疗文化相关的短暂精神病性障碍疗效肯定,治疗2周、4周、8周后BPRS评分与治疗前相比差异有显著性(P<0.01);治疗后8周BPRS评分B组下降更明显且半年复发率较低。结论 文化相关的短暂精神病性障碍需要药物控制精神病性症状,心理干预合并药物治疗是治疗的较好方法且能降低疾病复发率。     

不同原因的精神病残疾296例评定分析

目的 探讨精神病的致残率及病种的关系。方法 对２９６例精病残疾患者进行分析。结果一、二、三、四级精神病残疾分别为１２、５２、１００、１３２例；致残疾病依次为精神分裂症、癫痫所致精神障碍、脑血管病所致精神障碍、情感性障碍和酒依赖。结论 积极开展精神病的防治工作是预防和减少精神残疾的关键。     

分裂样精神病与精神分裂症阴性、阳性症状比较

目的：探讨分裂样精神病与精神分裂症阴性和阳性症状的特点。方法：对49例分裂样精神病与70例精神分裂症患者的阴性和阳性症状作对照研究。结果：两组患者阳性和阴性症状的发生率差异无显著性（P〉0.05）;分裂样精神病组中有妄想症状者明显多于精神分裂症组;而精神分裂症组中情感平淡、思维贫乏等阴性症状者明显多于分裂样精神病（P〈0.01）。结论：分裂样精神病与精神分裂症在阴性、阳性症状方面存在差异。     

The familial aggregation of psychotic symptoms in bipolar disorder pedigrees

OBJECTIVE: Symptomatic overlap between affective disorders and schizophrenia has long been noted. More recently, family and linkage studies have provided some evidence for overlapping genetic susceptibility between bipolar disorder and schizophrenia. If shared genes are responsible for the psychotic manifestations of both disorders, these genes may result in clustering of psychotic symptoms in some bipolar disorder pedigrees. The authors tested this hypothesis in families ascertained for a genetic study of bipolar disorder. METHOD: Rates of psychotic symptoms-defined as hallucinations or delusions-during affective episodes were compared in families of 47 psychotic and 18 nonpsychotic probands with bipolar I disorder. The analysis included 202 first-degree relatives with major affective disorder. RESULTS: Significantly more families of psychotic probands than families of nonpsychotic probands (64% versus 28%) contained at least one relative who had affective disorder with psychotic symptoms. Significantly more affectively ill relatives of psychotic probands than of nonpsychotic probands (34% versus 11%) had psychotic symptoms. An analysis of clustering of psychotic subjects across all families revealed significant familial aggregation. Clustering of psychosis was also apparent when only bipolar I disorder was considered the affected phenotype. CONCLUSIONS: Psychotic bipolar disorder may delineate a subtype of value for genetic and biological investigations. Families with this subtype should be used to search for linkage in chromosomal regions 10p12-13, 13q32, 18p11.2, and 22q11-13, where susceptibility genes common to bipolar disorder and schizophrenia may reside. Putative schizophrenia-associated biological markers, such as abnormal evoked response, oculomotor, and neuroimaging measures, could similarly be explored in such families.     

Parental psychiatric illness associated with schizophrenia in the siblings of schizophrenics

The diagnostic boundaries of schizophrenia remain controversial. Although there may be little disagreement about classifying process schizophrenia as schizophrenia, the inclusion of good-prognosis schizophrenia,¹ borderline syndromes, or nonpsychotic conditions has engendered more debate. The issue regarding good-prognosis schizophrenia has been clarified by a number of studies^2–6 indicating that this group has clinical and family differences from process schizophrenia. Progress in classifying borderline syndromes and nonpsychotic conditions has not been as great. As we have previously stated,⁷ the reasons seem to be difficulty in defining these disorders as well as a lack of data regarding their occurrence in the general population.Because of this impasse, we have looked for indirect ways of defining the boundaries of schizophrenia. One approach has been to compare positive family history schizophrenics with negative family history schizophrenics on the assumption that schizophrenics with a loaded family history for process schizophrenia should also have a loaded family history for other disorders that are related to schizophrenia. The frequency of other psychiatric disorders in these two groups were not significantly different;⁸ thus failing to support the extension of the concept of schizophrenia to include such nonpsychotic conditions as neuroses or personality disorder.Because there is a positive association between schizophrenia in the siblings of schizophrenics and parental schizophrenia,⁹ the present report makes the following assumption: If there are borderline or nonpsychotic psychiatric illnesses that are genetically related to schizophrenia, their occurrence in parents should be associated with schizophrenia in the siblings of schizophrenics. Conversely, if there are parental illnesses that are distinct from schizophrenia, they should be associated with other illnesses in the siblings because most mental disorders, regardless of their etiology, have been shown to run in families.¹     

A family study of psychotic symptomatology in schizophrenia,schizoaffective disorder,unipolar depression,and bipolar disorder

Summary An evaluation was made of schizophrenics (140), schizoaffectives (40), unipolar depressives (59), and bipolars (30), and their relatives who had a chart diagnosis of psychosis or depressive neurosis. The purpose was to determine whether the psychosis (delusions and hallucinations) was transmitted independently of the illness itself. If this were true, there would be an excess of pairs of probands and relatives both positive for psychosis and pairs of relatives and probands both negative for psychosis when compared to relatives and probands who were not concordant for the variable. This was found to be true in schizophrenia and schizoaffective disorder and is probably the result of the simple transmission of an illness which includes the presence of psychotic symptoms in the definition. Thus, this would be a manifestation of the genetic propensity in schizophrenia. For the affective disorders there was no evidence that psychotic probands were more likely than the nonpsychotic to have psychotic relatives. So far the reason why some patients have psychosis and others not in the affective disorders remains unexplained.     

Attentional disturbances in patients with unipolar psychotic depression: a selective and sustained attention study

Psychotic depression is a clinical subtype of major depressive disorder in the recent editions of the psychiatric diagnostic systems ICD-10 (1992) and DSM-IV (1994). Recent evidence suggests that psychotic depressed patients are more impaired on neuropsychologic tests measuring attention as compared to nonpsychotic depressed patients. However, information on this issue between psychotic and nonpsychotic depression is limited. It has become clear that attention is not a single concept; thus we studied both selective and sustained attention using the theoretic model of automatic and controlled information processing. Thirty-two patients with major depressive disorder, 16 psychotics and 16 nonpsychotics, were investigated and compared with 20 patients with schizophrenic disorder and 20 healthy volunteers who comprised the control groups, using Ruff's 2 and 7 selective attention tests. Compared to the healthy controls, both depressed groups were impaired; however, the psychotic depressed group was more severely impaired on both measures. Attentional performance speed and accuracy scores, on both effortless and effortful conditions, were significantly lower in the psychotic depressed group than in the nonpsychotic depressed group. No significant differences were found on attentional performance between the psychotic depressed patients and those with schizophrenic disorder. Attention deficits are thus more prominent in psychotic than in nonpsychotic depression. Furthermore, taking attention as a criterion, psychotic depression, although of mood congruent subtype, lies closer to schizophrenia than to nonpsychotic depression.     

伴精神病性症状情感性精神障碍的随访观察

目的　探讨伴精神病性症状的情感性精神障碍（ Ｐ Ａ Ｄ） 的预后。方法　对６５ 例 Ｐ Ａ Ｄ 及６９ 例不伴精神病性症状的情感性精神障碍（ Ｎ Ｐ Ａ Ｄ） 进行３ ～６ 年随访,调查其再入院及转归情况。并比较其在人口学特征、疾病表现等方面的异同。结果　４６ ．６７ ％的躁狂症,４４ ％ 的抑郁症及５２ ．１７ ％ 的双相情感障碍都伴发精神病性症状。 Ｐ Ａ Ｄ 与 Ｎ Ｐ Ａ Ｄ 在人口统计学,疾病对目前生活、工作的影响等方面无显著差异。有１８ ．９ ％ 的 Ｐ Ａ Ｄ 再入院诊断改变为精神分裂症,它们有如下特征：起病年龄较小,平均住院日较长,再入院次数较多,伴与情感不一致的妄想症状较多。结论　 Ｐ Ａ Ｄ 是一种常见疾病。 Ｐ Ａ Ｄ 与 Ｎ Ｐ Ａ Ｄ 在预后上无显著差异。有１８ ．９ ％ 的 Ｐ Ａ Ｄ 再入院诊断改变为精神分裂症。     

Risk factors for psychosis in an ultra high-risk group: psychopathology and clinical features

The identification of individuals at high risk of developing a psychotic disorder has long been a goal of clinicians because it is thought that early treatment of this group may prevent onset of the disorder. However, little is known of predictive factors of psychosis, even within a high-risk group. This study followed up 104 young people thought to be at 'ultra high risk' for schizophrenia and other psychotic disorders by virtue of having a family history of psychotic disorder combined with some functional decline or the presence of subthreshold or self-limiting psychotic symptoms. All subjects were therefore symptomatic, but not psychotic, at intake. Thirty-six subjects (34.6%) developed frank psychotic symptoms within 12 months. Measures of symptom duration, functioning, disability and psychopathology were made at intake, 6 and 12 months. Poor functioning, long duration of symptoms, high levels of depression and reduced attention were all predictors of psychosis. A combination of family history of psychosis, a recent significant decrease in functioning and recent experience of subthreshold psychotic symptoms was also predictive of psychosis. Combining highly predictive variables yielded a method of psychosis prediction at 12 months with good positive predictive value (80.8%), negative predictive value (81.8%) and specificity (92.6%) and moderate sensitivity (60.0%). Within our symptomatic high-risk group, therefore, it appears possible to identify those individuals who are at particularly high risk of developing a psychotic disorder such as schizophrenia. Given the very high PPV and low false positive rate with this two-step process, it may be justifiable to target these individuals for intensive monitoring of mental state and even low-dose neuroleptic medication or other biological and psychosocial treatments depending on clinical condition. This indicated prevention approach could be further developed and preventive strategies in the psychoses refined.     

Schizoaffective disorder: a form of schizophrenia or affective disorder?

BACKGROUND: The diagnostic status of schizoaffective disorder continues to be controversial. Researchers have proposed that schizoaffective disorder represents a variant of schizophrenia or affective disorder, a combination of the 2, or an intermediate condition along a continuum between schizophrenia and affective disorder. METHOD: We compared outpatients aged 45 to 77 years with DSM-III-R diagnosis of schizoaffective disorder (N = 29), schizophrenia (N = 154), or nonpsychotic mood disorder (N = 27) on standardized rating scales of psychopathology and a comprehensive neuropsychological test battery. A discriminant function analysis was used to classify the schizoaffective patients based on their neuropsychological profiles as being similar either to schizophrenia patients or to those with nonpsychotic mood disorder. RESULTS: The schizoaffective and schizophrenia patients had more severe dyskinesia, had a weaker family history of mood disorder, had been hospitalized for psychiatric reasons more frequently, were more likely to be prescribed neuroleptic and anticholinergic medication, and had somewhat less severe depressive symptoms than the mood disorder patients. The schizophrenia patients had more severe positive symptoms than the schizoaffective and mood disorder patients. The neuropsychological performances of the 2 psychosis groups were more impaired than those of the nonpsychotic mood disorder patients. Finally, on the basis of a discriminant function analysis, the schizoaffective patients were more likely to be classified as having schizophrenia than a mood disorder. CONCLUSION: These findings suggest that schizoaffective disorder may represent a variant of schizophrenia in clinical symptom profiles and cognitive impairment.     

Confirmation of synergy between urbanicity and familial liability in the causation of psychosis

OBJECTIVE: This study replicated a previous report that there may be substantial synergism between urbanicity (a proxy environmental risk factor) and familial clustering of psychotic disorder (a proxy genetic risk factor). METHOD: The amount of synergism was estimated from the additive statistical interaction between urbanicity of place of birth and family history of schizophrenia or family history of any severe mental disorder in a population-based Danish cohort of 1,020,063 individuals. RESULTS: There was significant interaction between urbanicity and family history; between 20% and 35% of individuals who had been exposed to both of these risk factors had schizophrenia possibly because of their synergistic effects. CONCLUSIONS: The results suggest that a substantial proportion of the population morbidity force of schizophrenia may be the result of gene-environment interactions associated with urbanicity.     

Impaired olfactory identification in relatives of patients with familial schizophrenia

OBJECTIVE: Impaired olfactory identification ability has previously been demonstrated in patients with schizophrenia. This study assessed olfactory function in psychotic and nonpsychotic members of multigenerational families with familial schizophrenia to determine whether deficits were present in both groups. METHOD: The University of Pennsylvania Smell Identification Test was administered birhinally to three groups of subjects aged less than 65 years: 19 psychotic and 27 nonpsychotic members of families with familial schizophrenia and 43 age- and sex-matched healthy volunteers. RESULTS: Nonpsychotic family members had significantly higher mean University of Pennsylvania Smell Identification Test scores than psychotic family members but were impaired relative to the healthy volunteer group. These group differences could not be accounted for by age, sex, or smoking habit. Fifty-eight percent of the psychotic and 34% of the nonpsychotic family members performed in the microsmic (impaired) range, compared to 9% of the healthy volunteers. CONCLUSIONS: Impaired olfactory deficits may aggregate in families with schizophrenia and may be indicative of a genetic predisposition to psychosis.     

情感障碍和精神分裂症的遗传调查与分析

目的　探讨情感障碍和精神分裂症的遗传学差异。方法　收集首次住我院并符合CCMD - 3诊断标准的情感障碍及精神分裂症病例 ,以有无家族史按诊断分组对照分析。结果　同类疾病比较 ,女性情感障碍家族史阳性率高于男性情感障碍家族史阳性率 ,女性精神分裂症家族史阳性率高于男性精神分裂症家族史阳性率。同性别不同疾病比较 ,即男性精神分裂症与男性情感障碍比较 ,女性精神分裂症与女性情感障碍比较 ,仅见女性精神分裂症家族史阳性率高于女性情感障碍家族史阳性率。另外 ,还发现不论是精神分裂症还是情感障碍 ,均见Ⅰ级亲属家族史阳性率高于Ⅱ级 ,Ⅱ级高于Ⅲ级。结论　遗传因素是情感障碍和精神分裂症发病的重要因素之一 ,且患病基因可能位于X染色体上。