80岁以上老年精神障碍住院患者躯体疾病共病调查

目的 了解80 岁以上老年精神病住院患者的躯体疾病共病情况。方法 筛查首都医科 大学附属北京安定医院2010 年1 月1 日至2017 年12 月30 日的住院患者,符合ICD-10 的精神障碍诊断, 年龄＞ 80 岁且资料完整者,调查该人群的合并躯体疾病情况等资料。结果 187 例患者中183 例合并 躯体疾病,共病率97.9%,平均共病数目为6.9 种。不同精神障碍患者的共患躯体疾病数目上差异无统 计学意义（P＞ 0.05）;平均共病种数方面,脑损害和功能紊乱及其他躯体疾病所致精神障碍、心境障碍明 显低于其他4 种精神疾病,差异有统计学意义（P ＜ 0.05）;183 例老年精神科患者共患躯体疾病例数 达1 297 例种,其中神经系统、循环系统、内分泌系统、呼吸系统及消化系统共769 例种,占59.29%,前 5 位疾病分别为高血压115 例（62.8%）、便秘84 例（45.9%）、脑梗死71 例（38.8%）、糖尿病54 例（29.5%）、冠 心病48 例（26.2%）。患者的躯体疾病共病种数与年龄相关（P＜ 0.01）。结论 80 岁以上老年精神障碍住 院患者的躯体共病现象非常普遍;且合并疾病种类较多,以心脑血管及代谢类疾病居多。     

精神障碍患者低钠血症危险因素研究

目的评估在精神障碍患者中出现低钠血症的相关危险因素。方法采用自制调查表,回顾记录87例在住院期间出现低钠血症的精神障碍患者与87例同期未出现低钠血症精神障碍患者的社会人口学特征、精神科诊断、精神科用药、躯体疾病诊断、躯体疾病用药情况,采用1:1配对进行病例对照研究。结果多因素条件logistic回归分析显示,器质性疾病所致精神障碍(OR=3.08,95%CI:1.43~6.05)、抗抑郁药(OR=2.14,95%CI:1.01~1.27)、躯体疾病用药(OR=3.50,95%CI:1.96~4.60)与低钠血症相关联(P0.05)。结论患有器质性疾病所致精神障碍、使用抗抑郁药、使用躯体疾病用药是精神障碍患者低钠血症的重要危险因素。     

老年精神科住院患者综合医学会诊的研究

目的 探讨老年精神科住院患者综合医学会诊的临床状况,了解老年精神病患者的自身特征.方法 查阅2001～2003年、2008～2010年我院老年精神科住院患者的综合医学会诊记录共303例,并进行归纳分析.结果 老年精神科住院患者病程长,住院时间长.会诊患者诊断以器质性精神障碍、精神分裂症、心境障碍为多发病种.2001～2003年的器质性精神障碍患者总会诊人数高于2008～2010年,2001～2003年的精神分裂症患者的总会诊人数低于2008～2010年,差异均有统计学意义(P<0.01).2001～2003年的总会诊率低于2008～2010年,差异有统计学意义(P<0.01).会诊因为中,2001～2003年以原有躯体疾病为主,而2008～2010年以首发躯体疾病为主,两者差异有统计学意义(P<0.05).会诊科室以呼吸内科、神经内科、骨科最多.会诊处理中,要求转院和实际转院的人数2001～2003年低于2008～2010年,两者比较有统计学意义(P<0.05或P<0.01).死亡人数占总人数和占会诊人数的比例2001～2003年均大于2008～2010年,差异均有统计学意义(P<0.05).结论 我们需重视老年住院精神病患者的躯体情况,定期进行全面的身体检查,及早发现躯体疾病,及早治疗,应努力提高精神科医生综合医学知识水平.     

综合性医院住院病人的会诊精神病学

目的:探讨在综合医院设置精神科开放式病房后精神病学会诊的现状,方法:对我院近20年290例申请会诊的住院病人的科,地诊前后的论断对照,误诊情况及转科治疗情况进行分析.结果:总会诊率为1.38%,申请会诊的科室以内科最多138例(47.6%),会诊的精神科疾病中多见的是神经症84例(29.0%),躯体疾病致精神障碍60例20.7),器质性精神障碍50例(17.2%),精神分裂症37例(12.8%),误诊病例85例(29.3%),转科治疗64例(22.1%),结论:精神科会诊在综合医院呈增加趋势.综合设置精神科开放式病房既有利于精神科的发展,也有利于各类有精神障碍的患者得到及时妥善的治疗.     

综合性医院精神科450例会诊分析

对我院从1997年1月至2003年1月对精神科会诊450例病人进行了回顾性分析,以中国精神障碍分类与诊断标准第三版(CCMD-3)进行再诊断。其中男性208例,女性242例,年龄14～82岁。结果:会诊原因大致有4种情况:①有明确躯体疾病出现精神障碍,要求诊断及治疗者209例(46.4％)。②有躯体不适主诉,经检查未发现器质性疾病,或所发现的器质性改变不能解释症状,疑为精神方面问题要求诊断和治疗行167例(37.1％)。③原患精神疾病又患躯体疾病要求指导临床处理者68例(15.1％)。④原有精神疾病,过量服用精神科药物等,要求协助处理者6例(1.3％)。临床各科会诊例数:内科290例(64.4％),其中神经内科108例,心血管内科76例,消化内科41例,内分泌科26例,呼吸内科18例,肾内科15例,血液科6例;外科82例     

综合性医院精神科会诊178例分析

作者对综合性医院精神科会诊178例分析发现，会诊的主要原因是躯体疾病伴发精神障碍(38.2%）及原患精神疾病又患躯体疾病(32．0％)要求诊断和处理，内科会诊占首位(34.3％)，以器质性精神障碍(36．5％)最多见；其次为神经症(18．8％)，以癌症为多见，随后为精神障碍(8．4％)；会诊后44．8％病人转精神科治疗，未转科者使用精神活性药物治疗者占17.9％，综台治疗占11．8％，心理治疗占8．5%。作者建议，在综台性医院设置精神科，开展会诊一联络精神病学(CLP)工作甚为必要。     

男女反应性精神障碍患者临床表现的比较分析

笔者对60例反应性精神障碍患者临床表现的性别差异作一比较,现报告如下：1资料和方法为我院2006年2月～2011年2月精神科首次住院的反应性精神障碍患者,诊断符合中国精神障碍分类与诊断标准（第三版）标准,无精神病家族史,无躯体疾病病史,共60例,男性30例,年龄20～62岁,平均（25.8±16.1）岁。女性30例,年龄18～58岁,平均（28.2±11.4）岁。两者差异无显著性（P〉0.05）。比较男女患者主要精神症状及躯体症状的差异。     

对住院精神病人躯体健康状况调查的结果

精神病人由于精神症状的影响 ,主动反映躯体不适感差 ,或因精神药物掩盖了躯体疾病的征象 ,常易贻误诊治。因此 ,探讨精神病人躯体健康状况 ,将有助于精神科临床工作。为此 ,我们对精神病人的躯体健康状况进行了调查分析 ,现报道如下。1　资料和方法1.1　资料　对象为 1994年 10月～ 1997年 10月出院的精神疾病病人 ,住院期间曾患躯体疾病 (排除脑器质性和躯体疾病所致的精神障碍 ,精神活性物质所致的精神障碍 )者均可入组 ;其诊断标准 :①精神疾病符合中国精神疾病分类方案与诊断标准第二版修订版(ＣＣＭＤ - 2 -Ｒ)诊断[1] 。②躯体疾病符…     

老年与非老年住院精神疾病患者死因比较

目的了解老年与非老年住院患者死亡原因。方法：按死亡年龄分成老年组（≥60岁）和非老年组（＜60岁）,对两组临床资料进行比较。结果：1987－1997年上海市精神卫生中心住院精神疾病患者死亡306例,占同期住院病人的1．2％,老年死亡者166例,死亡率为6．1％,非老年院精神疾病患者死亡306例,老年死亡者以脑器质性精神障碍为主,致死原因以躯体疾病及猝死为死亡者140例,死亡率为0．6％,老年死亡者以脑器质性精神障碍为主,致死原因以躯体疾病及猝死为主,非老年死亡者以精神分裂症为主,致死原因以躯体疾病,消极自杀及猝死为主,;两组死亡原因有显著差异,（P＜0．01）。结论：老年患者病死率显著高于非老年患者,两者病种及死因分布不一致。     

292例青少年精神障碍门诊病历回顾分析

目的:探讨少年期与青年期精神疾病的不同点. 方法:对292例精神科12～18岁少年组及19～25岁青年组门诊病历资料,进行统计分析. 结果:少年期与青年期精神障碍患者的求医方式、主诉、诱因、躯体症状等有差异. 结论:少年期与青年期精神障碍较不易确诊,需进一步研究.     

Treatment Considerations in Anticonvulsant Monotherapy

Summary: The long-standing practice of polypharmacy in treating epilepsy is giving way to use of monotherapy. Monotherapy can improve seizure control as well as reduce the risk of serious idiosyncratic reactions, dose-related side effects, and complex drug interactions. Monotherapy also offers improved compliance and cost-effectiveness. The basis of monotherapy is accurate diagnosis and assessment of the patient's seizure type(s), followed by selection of a single appropriate anticonvulsant drug. Many patients currently treated with multiple anticonvulsants can be successfully converted to monotherapy with a carefully monitored program in which troublesome and redundant drugs are gradually withdrawn from the therapeutic regimen.     

Dextromethorphan: Cellular Effects Reducing Neuronal Hyperactivity

Summary: Dextromethorphan is a dextrorotary morphinan without affinity for opioid receptors, commonly used as an antitussive medication. During the past 5 years, interest in the compound and its demethylated derivative, dextrorphan, has been revived because additional neuroprotective and an-tiepileptic properties were found in in vitro studies, animal experiments, and a few clinical cases. Both morphinans are able to inhibit N -methyl-D-aspartate (NMDA) receptor channels and voltage-operated calcium and sodium channels with different potencies. The inhibition of the NMDA receptor is believed to be the predominant mechanism of action responsible for the anticonvulsant and neuroprotective properties of the compounds.     

Pediatric Epilepsy Surgery

Summary: The use of implantable arrays of epidural electrodes has made it possible to carry out extraoperative electrocorticography (ECoG) and functional localization in the awake child. This has permitted cortical excisions that are determined by criteria similar to those obtained during surgical procedures performed under local anesthesia in adults. In addition, the method also permits simultaneous ECoG and video monitoring during the child's symptomatic seizures, providing additional important localizing information that is impractical to obtain in operations under local anesthesia. We report our experience with 75 children, ages 5 months to 15 years, whom we have managed with epidural electrode arrays. The method of extraoperative ECoG is described and illustrative cases are presented to demonstrate its feasibility and utility in children. In addition, we call attention to gliomas as a common cause of chronic focal seizures in children. Of 49 children undergoing resection and followed for from 1 to 14 years (mean of 5.8 years), 32 (65%) are either seizure free or have had a significant reduction in seizure frequency that has unambiguously improved their quality of life. The results are analyzed further by relating the surgical outcome to each of the pathologic entities that caused the seizures. This analysis reveals the variety of neurological conditions that commonly cause intractable focal seizure disorder in children and distinguishes those pathologic entities in which the seizure disorder is apt to respond to surgical intervention from those that will not.     

Un nouveau cadre conceptuel de travail pour une psychiatrie revisitée ? Introduction à deux articles de E. Kandel

In two articles which appeared in the American Journal of Psychiatry and that were subsequently translated for Évolution Psychiatrique, E. Kandel examines the bases for a reinterpreted psychiatry that is prepared to confront the major challenge of the 3rd millenium: that of insight into the mind and brain. This requires a major reorganization of the discipline, which involves a reinvestment of the scientific approach and a critical  assessment of the data provided by psychoanalytical psychiatry and cognitive neurosciences. Seven concepts have therefore been proposed for interactive re-examination: consciousness, the unconscious, memory, emotion, development, desire, impulse. The dynamic relations existing between genetics and the environment allow one to see how evolutions are possible from actions at different levels, both psychotherapeutic and pharmacological. Imaging and other techniques provide additional objective information to the process of human interaction which remains the basis of psychiatry. A common framework for psychiatry and the neurosciences, a reconsideration and renewal of the psychoanalytical approach are both possible and necessary.     

Opioids and the developing organism: A comprehensive bibliography, 1984–1988

A comprehensive bibliography of the literature concerned with opioids and the developing organism for 1984-1988 is presented. Utilized with companion papers (Neurosci. Biobehav. Rev. 6:439-479; 1982; 8:387-403; 1984), these articles cover the clinical and laboratory references beginning in 1875. For the years 1984, 1985, 1986, 1987, and 1988, a total of 877 citations were recorded. A series of indexes accompanies the citations in order to make the literature more accessible. These indexes are divided into clinical and laboratory topics, and subdivided into such topics as the type of opioid explored and the general area of biological interest (e.g., physiology).     

La biologie et le futur de la psychanalyse : un nouveau cadre conceptuel de travail pour une psychiatrie revisitée

The American Journal of Psychiatry has received a number of letters in response to my earlier “Framework” article (1). Some of these are reprinted elsewhere in this issue, and I have answered them briefly there. However, one issue raised by some letters deserves a more detailed answer, and that relates to whether biology is at all relevant to psychoanalysis. To my mind, this issue is so central to the future of psychoanalysis that it cannot be addressed with a brief comment. I therefore have written this article in an attempt to outline the importance of biology for the future of psychoanalysis.     

Facteurs de risque environnementaux à la schizophrénie

Schizophrenia is currently a major concern, its prevalence being estimated at around 1% and its social consequences being severe. The elucidation of the pathophysiology of the disease is difficult due to the great variability of clinical expressions, the instability of the clinical symptoms during the evolution and the absence of reliable biological markers. The existence of a familial aggregation in schizophrenia is well known, the risk of presenting the disease for first-degree relatives of patients being 5 to 10 times higher than the risk observed in the general population. The genetic component was further confirmed by twin and adoption studies. Although the concordance for the disease is higher (40 to 70%) among monozygotic twins as compared with dizygotic twins (15%) it does not reach 100%, which implies that environmental factors modulate the effects of the genotype. However, the role of these factors and especially their interaction with genetic factors remain unclear but the implications of some specific environmental factors are well documented by recent research data. The current literature on sex differences in schizophrenia is consistent. Several studies have suggested that male and female patients may differ in age at the onset and expression of clinical symptoms. Complications during pregnancy or birth-giving may increase the risk of developing schizophrenia later in life. The major complications are oxygen deprivation during pregnancy, bleeding, maternal malnutrition or infection (exposure to influenza, for example). A low birth weight is associated with an increased risk of schizophrenia. Psychoses are more common among people living in an urban environment and among those born during winter months. Schizophrenia is probably more prevalent in people who are living promiscuously, are subject to toxic abuse, poor nutrition and stress but here more precise data are needed. Moreover, immigrants have a higher risk of developing psychotic disorders. In addition, head traumas are associated with an increased risk of schizophrenia. Though they are contentious, some studies suggest that substance abuse (cannabis use in European countries) is related to the development of schizophrenia, especially in people with genetic vulnerability. Moreover, substance misuse may worsen the symptoms. If the environment is sufficiently stressful, people with a high genetic vulnerability will develop some degree of mental illness, including schizophrenia. Conversely, a less stressful or a protective environment may decrease the risk of its onset in persons with a predisposition to schizophrenia.     

Introduction: Goals

Summary: Epilepsy is characterized by recurrent seizures. Many epilepsies with focal seizures as well as convulsive generalized seizures respond satisfactorily to antiepileptic drugs (AEDs) that reduce repetitive firing (e.g., phenytoin, carbamazepine, and valproate) or that augment GABA_A-mediated inhibition (e.g., phenobarbital and benzodiazepines). A number of drugs presently under development, such as NMDA receptor antagonists, loreclezole, losigamone, meth-ysticine, and dextromethorphan, are promising in acute animal models of otherwise drug-resistant convulsant activity. As a result of recent studies in both experimental models and surgically resected human epileptic brain, the prospects for development of AEDs have significantly improved. Several new AEDs recently have reached the commercial market or are in experimental or clinical trials. A comparative presentation of the standing of the new AEDs with respect to their efficacy and side effects is necessary, but still very difficult. Because initial experience with new AEDs is restricted to populations with severe drug-resistant epilepsy, the crucial question whether potential new AEDs can alter prognosis is not yet definitively answered. There is a clear need to compare the effects of standard AEDs and new AEDs in naive patients and over longer follow-up periods. Moreover, because of the strong desire to develop antiepileptic therapy that directly treats the primary etiology of a given epileptic syndrome , or modifies the neurobiological processes that cause recurrent seizures, better experimental epilepsy models for chronic epilepsy and further clinical studies are necessary to increase the knowledge on the pathophysiology of distinct epileptic syndromes. In this respect, studies on the differences between responders and nonresponders to a given AED treatment are extremely valuable.