成人体外循环术后精神症状原因分析

目的 研究成人体外循环手术以后发生精神症状的高危因素。方法 对52例16岁以上的体外循环手术后发生精神症状的病人进行分析。结果 主要表现有认知障碍、情感障碍、意志行为障碍及意识障碍。男女之间无明显差异，而在患者年龄、术前心功能、既往精神病史、监护室监护时间等方面精神病组和健康组间存在显著差异。结论 成人体外循环手术后发生精神症状的高危因素有患者年龄、术前心功能、既往精神病史、心脏病史、监护室停留时间等，应高度重视加强护理和观察。     

护士观察量表在住院精神病患者中的应用探讨

目的应用护士观察量表(NOSIE)对住院精神病患者病情进行纵向观察评定,调查不同住院阶段、不同病种患者病情变化特点,协助护士完善护理评估、护理诊断及制定护理措施。方法运用护士用住院病人观察量表(NOSIE-30)对129例住院精神病患者进行评定。入院48小时内进行第一次评定,以后每周评定一次,出院时再评定一次。结果随着病情的缓解,患者的各项评分虽有明显改善,但是,在社会兴趣评分方面仍然处于较低水平。精神分裂症组与非精神分裂症组第一次评分比较显示：精神分裂症组个人整洁、总分、总积极分低于非精神分裂症组(P＜0．05)；而精神病表现分高于非精神分裂症组(P＜0．001),与精神分裂症患者精神病性症状较多相吻合。第二次评分比较显示：精神分裂症组精神病表现分仍然高于非精神分裂症组(P＜0．01),提示一周内精神病性症状缓解不明显；总积极分低于非精神分裂症组(P＜0．05)。第三次评分比较显示：非精神分裂症组激惹、抑郁分高于精神分裂症组(P＜0．05)。结论对新入院的精神分裂症患者护理工作重点在于生活护理和精神病症状的观察、处理；针对恢复期精神病患者存在社会兴趣的障碍,应该及早进行心理干预、行为治疗、健康教育,提高患者的康复效果。     

Decreased prefrontal 5-HT2A receptor binding in subjects at enhanced risk for schizophrenia

The brain serotonin-2A receptor (5-HT_2AR) has been implicated in both the pathology of schizophrenia and the therapeutic action of atypical antipsychotics. However, little is known about the 5-HT_2AR status before the onset of schizophrenia and before the exposure to antipsychotics. We used [¹⁸F] altanserin and positron emission tomography (PET) in a pilot study of 6 individuals suspected to be at elevated risk for schizophrenia and seven age-matched controls to test the hypothesis that regional 5-HT_2AR binding is altered in the prodromal stages of schizophrenia. Distribution volume ratios (DVRs) as a proxy for 5-HT_2AR availability were significantly reduced in prefrontal cortex regions of at-risk subjects, implicating early abnormalities of serotonergic neurotransmission that antecede the onset of schizophrenia.     

门诊精神病人治疗依从性及其影响因素分析

目的 了解门诊精神病人治疗依从性及其影响因素,探讨提高治疗依从性的对策.方法 对500例门诊精神病人进行有关治疗依从性方面的调查,分析影响治疗依从性的有关因素及所采取的对策等.结果 治疗依从性差多发生于疾病的复发期(64.9%)和进展期(63.1%),平均持续8.7天.依从性差的原因主要为:病情较严重、无自知力、药物副作用以及缺乏经济和情感上的支持.所采取的对策为:应用长效针剂、调整剂量、加强监管等.结论 应加强用药指导、健康教育和心理辅导,以提高精神病人的用药依从性.     

Phenomenology and family history in DSM-III psychotic depression

Depressed inpatients with psychotic features were compared to those without them in terms of demographic features, depressive symptoms at intake and family history. These variables were then used to compare patients with mood-congruent psychotic features to those with mood-incongruent psychotic features. Patterns of familial psychopathology were similar for psychotic and non-psychotic patients. In accord with other studies, the families of mood-incongruent patients had slightly more schizophrenia and significantly less depression than did the families of mood-congruent patients. Depressive symptoms, particularly those used to define major depression and melancholia, were more severe in psychotic patients. Moreover, these particular depressive symptoms were more likely to distinguish mood-congruent from mood-incongruent patients than were other depressive symptoms. Thus mood-congruent psychotic features accompanied a more typical depressive syndrome than did mood-incongruent psychotic features.     

Targeting physical health in schizophrenia: Results from the Physical Activity Can Enhance Life (PACE-Life) 24-week open trial

Poor health and low cardiorespiratory fitness (CRF) contribute substantially to the shortened lifespan of individuals with schizophrenia spectrum disorders (SSDs). Increasing physical activity has demonstrated value; however, there are limited interventions that are accessible and adequately address motivational challenges. This paper reports on an open trial of Physical Activity Can Enhance Life (PACE-Life), a motivational theory-based manualized multicomponent walking intervention. The primary aim was to examine the feasibility of implementing PACE-Life through meeting the recruitment target (n = 14), attendance and adherence rates, and participant feedback. The secondary aim was to assess the impact of PACE-Life on intermediate targets (autonomous motivation and satisfaction of autonomy, relatedness, and competence needs), proximal outcomes (Fitbit steps/day and minutes spent walking), the primary outcome (CRF), and secondary outcomes (loneliness, symptoms, resting heart rate, blood pressure, weight, body mass index, and hip and waist circumference). Seventeen participants with SSDs enrolled in a 24-week open trial. Assessments occurred at baseline, mid-point, post-test, and one-month follow-up. The recruitment target was exceeded, the group attendance rate was 34%, Fitbit adherence rate was 54%, and participant feedback indicated satisfaction with the intervention as well as a positive group environment. There was a large improvement in the primary outcome of CRF with 77% of participants achieving clinically significant improvement at post-test. Small and medium effect size increases were observed in autonomous motivation and satisfaction of autonomy, relatedness, and competence needs. Fitbit data and secondary outcomes generally remained unchanged or worsened during the intervention. Results from this open trial indicate that PACE-Life leads to meaningful changes in CRF among people with SSDs.     

Routine participation in sports and fitness activities among out-patients with psychotic disorders: A multi-site cross-sectional survey in England

BackgroundSedentary lifestyle is a significant contributor to poor outcomes in people with psychotic disorders. However, little is known about the extent of routine participation in specific sports and fitness activities among those who do take part. We investigated the frequency, intensity, time and type of sports and fitness activities (“fitness”) completed by people with psychotic disorders in their daily life and explored correlates associated with fitness participation.MethodsWe conducted a cross-sectional survey among out-patients with psychotic disorders (n = 529) recruited from six different NHS sites in England. Subjective participation in fitness activities during the previous week was assessed by an adaptation of the UK Time Use Survey. The main outcome was whether participants met the minimum World Health Organization recommendations for moderate intensity physical activity (≥150 min/week) through fitness. Poisson regression models with robust error variance were used to examine associations of this outcome with participant variables.ResultsIn total, 267 (52.2%) participants reported taking part in routine fitness activities in the previous week, many of whom did so alone (n = 163, 59.1%). Only 21.5% (n = 114) completed ≥150 min of fitness activities in the previous week. The likelihood of attaining these recommendations was lower among participants who were female, older in age, in a relationship, unemployed and with fewer social contacts.ConclusionMental health services promoting physical activity interventions among people with psychotic disorders may need to modify their approaches based on previous patient preference and increase their focus on sub-groups of patients who are less likely to routinely engage in fitness activities.     

Interactive risk factors for treatment adherence in a chronic psychotic disorders population

This study identified the unique and primary contributions of several concurrent risk factors for poor adherence to treatment recommendations in a clinic population of individuals with chronic psychotic disorders, i.e. 48% had DSM-IV diagnoses of schizoaffective disorder, 38% had schizophrenia, paranoid type, 12% had schizophrenia, undifferentiated type, and 2% had affective disorder with psychotic features. The target cohort consisted of 87 consecutive admissions to a continuing day treatment program. As part of a services-oriented quality assurance program, clinical staff completed rating scales for all patients. These included the BASIS-32 rating scale, which consisted of the following five subscales: psychosis; depression/anxiety; impulsive/addictive behavior; relation to self and others; and daily living and role functioning, and the Working Alliance Inventory-short form (therapist version), which consisted of the following three subscales: goal; task; and bond. These data were used to identify risk factors that weaken a patient's adherence to medication and non-medication treatment during the first 2 weeks of treatment in the clinic. Medication treatment consisted of both typical and atypical neuroleptic medications, with most patients being on multiple medications. Correlational analyses suggested that many of the risk factor variables were significantly associated with poor treatment adherence. Regression analyses suggested that the degree of psychoticism was most strongly associated with poor adherence to medication treatment and that difficulties relating to self and others were the strongest predictor of poor adherence to non-medication treatment. A large-sample services research design such as this can begin to determine patterns of associations between previous identified risk factors and poor treatment adherence in individuals with chronic psychotic disorders.     

The dopamine D3 receptor antagonist nafadotride inhibits development of locomotor sensitization to amphetamine

Behavioral sensitization is a well-studied model of behavioral plasticity mediated at least in part by dopaminergic systems believed to play an important role in several psychiatric conditions. In the rodent, locomotion is regulated by the opposing balance of D3 and D2 receptors, with D2 activation increasing and D3 stimulation inhibiting locomotion. However, receptor occupancy of D3 dopamine receptors is far greater than D2 or D1 occupancy at typical post-stimulant dopamine concentrations. We therefore hypothesized that tolerance of D3 receptor inhibition of locomotion contributes to the development of sensitization. To test this hypothesis, we examined the effect of the D3 receptor antagonist nafadotride on sensitization. As predicted, nafadotride inhibits augmentation of the locomotion response to repetitive amphetamine. This finding is consistent with the proposed model of adaptive down-regulation of D3 dopamine receptor function contributing to the development of behavioral sensitization.     

健康教育在住院精神病人康复中的作用

目的探讨健康教育在住院精神病人康复中的作用。方法实验组78例,采用药物与健康教育相结合的方式;对照组82例,单用药物治疗。对两组的治疗结果采用《护士用住院病人观察量表》(NOSIE)评定。结果实验组与对照组的病情康复程度存在显著性差异(P<0.05)。结论健康教育对精神患者的康复有一定的促进作用。