慢性精神分裂症与脑肿瘤患者认知状况比较分析

目的　探讨慢性精神分裂症患者脑功能缺陷与不同脑叶损伤间的关系。方法　运用威斯康星卡片分类测验、词汇流畅性测验、Stroop测验,对30名正常人、39例精神分裂症及88例脑肿瘤患者(其中左、右额叶各2 4例、颞叶2 0例、顶枕叶2 0例)进行测试。结果　精神分裂症患者与脑肿瘤患者均存在不同程度、不同特征的认知损伤,其中阴性症状为主的精神分裂症与右额叶脑肿瘤患者损伤类似,除完成分类数、总词汇数外,本研究所采用的测查其余指标差异无显著性(P >0 . 0 5)。结论　阴性症状为主的慢性精神分裂症患者右侧额叶功能受损明显,精神分裂症起病的器质性因素可能涉及右额叶。     

抑郁症≠自杀

世界卫生组织不久前公布的题为“精神健康:新认识,新希望”的年度报告揭示,抑郁症目前已位居世界十大疾病之第四,预计到2020年将跃至第二,紧随于心肌梗死之后,甚至排在癌症之前。据估计,在未来的一年里,将有5.8％的男子和9.5％的女子会有抑郁症症状。此外,每4人中就有一人一生中遭受某种精神和神经方面的不适,这类人数全球目前已达4.5亿人,其中,有5000万人患有癫痫病,2400万人患有精神分裂症,1000万～2000万人企图自杀,并有100万人实施了自杀。我国目前各种重症精神病人约1600万,我国的抑郁症患者至少有7000万。因此,我们请邹院解答了一些有关抑郁症的读者来信,欢迎读者多多来信,我们会请有关专家给您解惑。     

柴胡桃仁汤对迟发性运动障碍模型大鼠的治疗作用

目的观察柴胡桃仁汤对迟发性运动障碍(tardive dyskinesia,TD)大鼠模型行为及血清超氧化物歧化酶(superoxide dismutase,SOD)活力、脂质过氧化代谢物丙二醛水平变化,探讨TD可能的病理生理机制.方法将24只雄性Sprague-Dawley(SD)大鼠随机分为空白、模型、治疗四组,每组8只,分别予腹腔注射生理盐水+第5周始灌胃生理盐水、腹腔注射氟哌啶醇+第5周始灌胃生理盐水、腹腔注射氟哌啶醇+第5周始灌胃柴胡桃仁汤处理,共9周;每周末观察大鼠口部异常运动,进行评分.研究结束时取静脉血,分离血清,测定血清超SOD活力、及丙二醛水平.结果腹腔注射氟哌啶醇使SD大鼠口部异常运动增加明显,第5周达峰值;柴胡桃仁汤可使TD模型大鼠口周异常运动评分下降,减分为12.0±9.9,与TD组(0.6+4.2)相比,差异有显著性(u=5.0,P＜0.05);TD组大鼠血清SOD活力(kat/L)明显降低(5.4±0.7),丙二醛水平(kat/L)显著升高(20.4±6.0),柴胡桃仁汤可缓解这一改变(SOD6.5±0.3,丙二醛7.7±3.2),而且差异均有显著性(P＜0.01).可用于制作TD动物模型;而可使这些行为异常显著缓解(P＜0.05);与模型组比较,治疗组血清SOD活力升高,丙二醛水平下降,差异有显著性意义(P＜0.01).结论柴胡桃仁汤通过阻制氧化损伤,有效缓解TD模型大鼠口周异常运动,氧化应激在TD发生过程中起重要作用.     

认知矫正治疗对慢性精神分裂症患者临床症状和社会功能的影响

目的:观察认知矫正治疗对慢性精神分裂症患者临床症状和社会功能的改善作用。方法:选择2003-01/08在北京回龙观医院住院的慢性精神分裂症患者104例。均符合CCMD-Ⅲ及DSM-Ⅳ关于精神分裂症诊断标准;年龄25～55岁;病程≥2年;病情稳定,处于迁延、残留或部分缓解状态;药物治疗状况稳定,近期无换药打算;纳入对象或家属同意入组并签署知情同意书。应用随机数字表法将患者分认知矫正治疗组和对照组,每组52例。在相近药物治疗的基础上,认知矫正治疗组以Ann Delahunty和Rodney Morice等制定的神经认知矫正手册(汉化)为治疗工具,在治疗师的指导下进行认知作业练习,内容包括认知灵活性、工作记忆、计划执行功能3大功能模块。对照组予以相同时间的工娱治疗,主要包括有治疗师指导的操作性音乐治疗和舞蹈治疗。治疗前后两组患者分别进行PANSS、住院精神患者社会功能缺陷量表和护士观察量表的评定。结果:实验共纳入慢性精神分裂症患者104例,认知矫正治疗组44例,对照组46例进入结果分析,14例脱落。①治疗前后两组患者PANSS量表总分以及阴性症状量表、复合量表、一般精神病理量表、反应缺乏量表4个分量表的评分均有下降,组内比较差异有显著性意义(t=2.12～4.59,P<0.05);减分情况在两组间差异不明显(P>0.05)。②两组患者的社会功能缺陷量表总分在治疗后均有下降,与治疗前比较,差异有显著性意义(t=3.89,2.04,P<0.05);两组间比较,差异无显著性意义(P>0.05)。认知矫正治疗组治疗后护士观察量表的总病情以及总消极、迟滞2个分量表评分下降,与治疗前比较差异有显著性意义(t=1.49,1.19,2.81,P<0.05);其中迟滞项的减分在两组间比较,差异具有显著性意义(F=4.97,P<0.05)。③社会功能量表的改善与词语流畅性的改善呈正相关(R2=0.36,P<0.05),护士观察量表中总病情与积极两项评分的改善也与言语流畅性测验的改善正相关(R2=0.37,0.34,P<0.05)。结论:认知矫正治疗能在一定程度上改善精神分裂症患者的社会功能,并与部分认知功能的改善相关,但对临床症状无明显改善作用。     

心率变异指标在焦虑症评估中的应用

目的 探讨心率变异指标在焦虑症评估中的作用.方法 对33例焦虑症患者及28例正常对照者进行心率变异检测,结束后进行焦虑自评量表及匹兹堡睡眠质量指数评定.结果 焦虑症患者的窦性RR间期的标准差、极低频带低于正常对照者,差异非常显著,总频谱、高频带低于正常组,差异显著,睡眠质量指数得分明显低于对照组;时域指标窦性RR间期的标准差与频域各指标存在明显相关.结论 焦虑症患者心率变异性降低.     

吸烟对精神分裂症男性患者精神病理症状的影响

Objective To compare the differences of psychopathologic symptoms between smokers and non-smokers in chronic and first-episode,drug-nalve schizophrenics.then it was attempted to explain the reasons why there is higher rate of smoking behavior in schizophrenia.Methods In all.427 male chronic schizophrenic patients(332 smokers and 95 non-smokers)and 63 male first-episode drug-naive patients with schizophrenia(22 smokers and 41 non-smokers)were collected.All patients were assessed with the Positive and Negative Syndrome Scale(PANSS).Results In chronic patients.the item scores of poor rapport and passive/apathetic social withdrawal of PANSS negative subscale were significantly lower in smokers than non-smokers(3.9 ±1.5 vs.4.4±1.7;3.6±1.6 vs.4.0±1.7.respectively,P＜0.05),and so was the total scores of PANSS negative subscale(24.0±8.2 vs.26.3±9.5).In first-episode.drug-ndive patients.the itern scores of emotional withdrawal and passive/apathetic social withdrawal of PANSS negative subscale were significant lower in smokers than non-smokers(2.7±1.3 vs.3.5±1.3:2.7±1.3 vs.3.5±1.4,respectively,P＜0.05).Conclusion It is suggested there are positive effects of cigarette smoking on the psychopathological symptoms of patients with schizophrenia,which misht be one of the mechanisms for higher rates of smoking behavior in schizophrenia.     

吸烟对精神分裂症男性患者精神病理症状的影响

Objective To compare the differences of psychopathologic symptoms between smokers and non-smokers in chronic and first-episode,drug-nalve schizophrenics.then it was attempted to explain the reasons why there is higher rate of smoking behavior in schizophrenia.Methods In all.427 male chronic schizophrenic patients(332 smokers and 95 non-smokers)and 63 male first-episode drug-naive patients with schizophrenia(22 smokers and 41 non-smokers)were collected.All patients were assessed with the Positive and Negative Syndrome Scale(PANSS).Results In chronic patients.the item scores of poor rapport and passive/apathetic social withdrawal of PANSS negative subscale were significantly lower in smokers than non-smokers(3.9 ±1.5 vs.4.4±1.7;3.6±1.6 vs.4.0±1.7.respectively,P＜0.05),and so was the total scores of PANSS negative subscale(24.0±8.2 vs.26.3±9.5).In first-episode.drug-ndive patients.the itern scores of emotional withdrawal and passive/apathetic social withdrawal of PANSS negative subscale were significant lower in smokers than non-smokers(2.7±1.3 vs.3.5±1.3:2.7±1.3 vs.3.5±1.4,respectively,P＜0.05).Conclusion It is suggested there are positive effects of cigarette smoking on the psychopathological symptoms of patients with schizophrenia,which misht be one of the mechanisms for higher rates of smoking behavior in schizophrenia.     

吸烟对精神分裂症男性患者精神病理症状的影响

Objective To compare the differences of psychopathologic symptoms between smokers and non-smokers in chronic and first-episode,drug-nalve schizophrenics.then it was attempted to explain the reasons why there is higher rate of smoking behavior in schizophrenia.Methods In all.427 male chronic schizophrenic patients(332 smokers and 95 non-smokers)and 63 male first-episode drug-naive patients with schizophrenia(22 smokers and 41 non-smokers)were collected.All patients were assessed with the Positive and Negative Syndrome Scale(PANSS).Results In chronic patients.the item scores of poor rapport and passive/apathetic social withdrawal of PANSS negative subscale were significantly lower in smokers than non-smokers(3.9 ±1.5 vs.4.4±1.7;3.6±1.6 vs.4.0±1.7.respectively,P＜0.05),and so was the total scores of PANSS negative subscale(24.0±8.2 vs.26.3±9.5).In first-episode.drug-ndive patients.the itern scores of emotional withdrawal and passive/apathetic social withdrawal of PANSS negative subscale were significant lower in smokers than non-smokers(2.7±1.3 vs.3.5±1.3:2.7±1.3 vs.3.5±1.4,respectively,P＜0.05).Conclusion It is suggested there are positive effects of cigarette smoking on the psychopathological symptoms of patients with schizophrenia,which misht be one of the mechanisms for higher rates of smoking behavior in schizophrenia.     

吸烟对精神分裂症男性患者精神病理症状的影响

Objective To compare the differences of psychopathologic symptoms between smokers and non-smokers in chronic and first-episode,drug-nalve schizophrenics.then it was attempted to explain the reasons why there is higher rate of smoking behavior in schizophrenia.Methods In all.427 male chronic schizophrenic patients(332 smokers and 95 non-smokers)and 63 male first-episode drug-naive patients with schizophrenia(22 smokers and 41 non-smokers)were collected.All patients were assessed with the Positive and Negative Syndrome Scale(PANSS).Results In chronic patients.the item scores of poor rapport and passive/apathetic social withdrawal of PANSS negative subscale were significantly lower in smokers than non-smokers(3.9 ±1.5 vs.4.4±1.7;3.6±1.6 vs.4.0±1.7.respectively,P＜0.05),and so was the total scores of PANSS negative subscale(24.0±8.2 vs.26.3±9.5).In first-episode.drug-ndive patients.the itern scores of emotional withdrawal and passive/apathetic social withdrawal of PANSS negative subscale were significant lower in smokers than non-smokers(2.7±1.3 vs.3.5±1.3:2.7±1.3 vs.3.5±1.4,respectively,P＜0.05).Conclusion It is suggested there are positive effects of cigarette smoking on the psychopathological symptoms of patients with schizophrenia,which misht be one of the mechanisms for higher rates of smoking behavior in schizophrenia.     

慢性精神分裂症前瞻性记忆损害与回顾性记忆损害分析

目的分析慢性精神分裂症患者前瞻性记忆(prospective memory,PM)与回顾性记忆(retrospective memory,RM)损害状况,探讨慢性精神分裂症患者PM与RM的关联。方法纳入50例慢性精神分裂症患者和50名正常对照,用中文版剑桥前瞻性记忆测试量表(Cambridge prospective memory test,C-CAMPROMPT)评估基于事件的前瞻性记忆(event-based PM,EBPM)和基于时间的前瞻性记忆(time-based PM,TBPM),数字序列(digital span,DS)测验评估工作记忆(working memory,WM),逻辑记忆(logical memory)测验和视觉再现(visual reproduction,VR)测验分别评估即刻听觉逻辑记忆(immediate auditory logical memory,IALM)、延迟性听觉逻辑记忆(delayed auditory logical memory,DALM)和即刻视觉再现记忆(immediate visual reproduction memory,IVRM)、延迟性视觉再现记忆(delayed visual reproduction memory,DVRM),并根据标准分数将患者各量表得分转换为可进行量表间比较的损伤指数。结果患者组的EBPM[(7.9±3.4)vs.(13.7±2.9)]、TBPM[(6.9±3.6)vs.(13.0±3.2)]、DS-顺背[(5.8±2.0)vs.(7.5±2.2)]、DS-倒背[(6.5±1.9)vs.(8.2±2.8)]、IALM[(8.3±3.1)vs.(11.9±2.5)]、DALM[(7.4±3.7)vs.(11.8±2.6)]、IVRM[(8.0±2.7)vs.(11.2±3.8)]及DVRM[(7.7±3.5)vs.(10.8±2.7)]得分均低于对照组,差异有统计学意义(均P<0.05);患者组EBPM损伤指数和TBPM损伤指数均大于DS-顺背损伤指数、DS-倒背损伤指数、IALM损伤指数、IVRM损伤指数、DVRM损伤指数(均P<0.05),与DALM损伤指数差异均无统计学意义(P>0.05)。患者组PM总分与除IVRM(P=0.155)外RM各测验得分的相关关系均有统计学意义(均P<0.05)。结论慢性精神分裂症患者存在前瞻性记忆和回顾性记忆损害,前瞻性记忆损害较回顾性记忆损害严重,且两种损害相互关联。