青少年网络成瘾特点及生理-心理-社会后果研究

目的探讨青少年网络过度使用所产生的生理、心理和社会后果。方法 2007年10-12月,以职校学生作为目标人群,采用随机整群抽样的方法。结果①网络成瘾32人,检出率为6.7%;②网络成瘾组与正常组在性别、城乡及是否独生子女方面无显著性差异(P>0.05);③网络成瘾组在网龄、每次上网时间上高于正常组,两组有显著性差异(P<0.05)。网络成瘾组在上网次数、在线时间、每天/每周上网时间上显著高于正常组(P<0.001),网络成瘾组在线时间更长,上网次数更多;④网络成瘾组与正常组的上网内容比较,两组在信息与技术、性与游戏、娱乐放松、网络人际关系上均无显著性差异(P>0.05)。在网络态度上,两组的网络效能感、对网络的积极评价无显著性差异(P>0.05),而在对网络的消极评价上两组有显著性差异(P<0.05),成瘾组的得分高于正常组。两组的网络情感上的比较显示,成瘾组的网络满意度明显高于正常组(P<0.001);⑤网络成瘾组与正常组抑郁得分有显著性差异(P<0.05),成瘾组的得分高于正常组。两组在焦虑、生理后果、行为后果、经济后果、心理-社会后果方面存在极其显著性差异(P<0.001),成瘾组后果更严重。结论网络成瘾的青少年花更多的时间上网,而且产生了更消极的生理、行为、经济和心理-社会后果等。     

Assessment of behavioral and psychological symptoms of dementia by family caregivers

This study was designed to test the performance and related factors of a self-administered instrument in assessing behavioral and psychological symptoms of dementia (BPSD) by family caregivers. We recruited 173 patients with dementia and major caregivers from two neurological clinics. Information about clinical diagnosis, the Mini Mental State Examination (MMSE), the Clinical Dementia Rating (CDR), the Dementia Behavior Disturbance Inventory (DBDI), and global caregivers’ strain were collected from interview and chart review. We found that DBDI has acceptable construct validity and good internal consistency reliability. BPSD was more frequently found in patients with advanced dementia, poor cognitive function and highly correlated to caregivers’ strain. Multivariate analysis revealed that female patients and caregivers, advanced CDR stages, patient-caregiver relationship, types of dementia and MMSE score were related to the increase of frequency and disturbance index of DBDI. We concluded that BPSD could be evaluated by family caregivers using a self-administered instrument. Further study is indicated to clarify how caregiver characteristics affect the report of behavioral symptoms, and its clinical importance.     

Lifestyle interventions targeting changes in body weight and composition among youth with an intellectual disability: A systematic review

Over the past three decades, the potential effects of lifestyle interventions targeting changes in body weight and composition (weight, body mass index, fat mass, waist circumference) among adults with an intellectual disability (ID) have been examined in various systematic reviews. Nevertheless, since the middle of the 1980s, the potential effects of these interventions for youth with an ID remain an open question. The purpose of this article is to review the effects of lifestyle interventions targeting changes in body weight and composition among youth with an ID. This review will focus on changes in body weight and composition, healthy lifestyle, and secondary health conditions. A systematic review of English- and French-language studies, published between 1981 and 2013, was performed on Academic Search Complete, PsycARTICLES, Medline and Scopus. The nine studies included in this review focused mainly on: a sample with a wide age range (e.g., 7–22 years); males; overweight-obese youth having a mild-to-moderate ID with Down or Prader-Willi syndrome; physical activity interventions; cohort pre- and post-test designs with/without a control group; and changes in body weight and composition. Taken together, results from these studies suggest successful changes in weight, body mass index and fat mass. However, intervention effects on healthy lifestyle and secondary health conditions are scarce and inconclusive. Given the weaknesses of the reviewed studies, the present findings should be considered preliminary and indicative of the need for future research.     

Gaining insight into adolescent vulnerability for social anxiety from developmental cognitive neuroscience

Social anxiety disorder (SAD) markedly impairs daily functioning. For adolescents, SAD can constrain typical development precisely when social experiences broaden, peers’ opinions are highly salient, and social approval is actively sought. Individuals with extreme, impairing social anxiety fear evaluation from others, avoid social interactions, and interpret ambiguous social cues as threatening. Yet some degree of social anxiety can be normative and non-impairing. Furthermore, a temperament of behavioral inhibition increases risk for SAD for some, but not all adolescents with this temperament. One fruitful approach taken to understand the mechanisms of social anxiety has been to use neuroimaging to link affect and cognition with neural networks implicated in the neurodevelopmental social reorientation of adolescence. Although initial neuroimaging studies of adolescent SAD and risk for SAD underscored the role of fear-processing circuits (e.g., the amygdala and ventral prefrontal cortex), recent work has expanded these circuits to include reward-processing structures in the basal ganglia. A growing focus on reward-related neural circuitry holds promise for innovative translational research needed to differentiate impairing from normative social anxiety and for novel ways to treat adolescent SAD that focus on both social avoidance and social approach.     

慢性硬膜下血肿并发行为异常的影响因素分析

目的研究慢性硬膜下血肿并发行为异常的影响因素。方法回顾性连续纳入2009年1月至2019年10月四川省德阳市人民医院收治的慢性硬膜下血肿207例,将所有患者依据是否并发行为异常分为行为异常组及非行为异常组。收集患者一般人口学资料如性别、年龄及病史(如外伤史、吸烟史、饮酒史、脑血管病史、高血压病史、糖尿病史、血脂异常病史、凝血异常史),记录患者入院时格拉斯哥昏迷量表(GCS)评分,收集入院时CT及脑CT灌注等影像学资料,包括血肿量、血肿部位、血肿密度、CT中线移位、镰下疝、脑灌注缺损等资料。由专业的心身医学科医师进行精神检查,并进行汉密尔顿抑郁量表(HAMD)、修订韦氏成人记忆量表(WMS-RC)及力量表(WAIS-RC)测试。以HAMD评分>7分为抑郁状态,记忆商及总智商<79分作为记忆障碍和智能障碍的判断标准。采用Logistic回归分析影响慢性硬膜下血肿并发行为异常的独立危险因素。结果慢性硬膜下血肿患者并发行为异常的发生率为73.43%(152/207)。单因素分析结果显示,两组慢性硬膜下血肿患者在性别、年龄、凝血异常史方面差异无统计学意义(均P>0.05);两组患者在外伤史(χ^2=8.763)、吸烟史≥10年(χ^2=11.491)、饮酒史≥10年(χ^2=14.365)、脑血管病史(χ^2=11.492)、高血压病史≥10年(χ^2=13.057)、糖尿病史≥10年(χ^2=9.534)、血脂异常病史(χ^2=13.274)、病程≥3个月(χ^2=7.731)、血肿量≥30 ml(χ^2=12.763)、额颞部血肿(χ^2=21.458)、混杂密度血肿(χ^2=8.736)、CT中线移位≥5 mm(χ^2=14.572)、镰下疝(χ^2=10.396)、GCS<8分(χ^2=7.216)、额颞叶脑灌注缺损(χ^2=6.781)方面比较,差异均有统计学意义(均P<0.05)。Logistic回归分析结果显示,外伤史(OR=2.164,95%CI:1.083~2.934)、吸烟史≥10年(OR=2.346,95%CI:1.191~2.835)、饮酒史≥10年(OR=2.941,95%CI:1.284~3.157)、脑血管病史(OR=3.178,95%CI:1.893~4.597)、高血压病史≥10年(OR=2.783,95%CI:1.231~2.957)、糖尿病史≥10年(OR=2.841,95%CI:1.309~3.637)、有血脂异常病史(OR=3.237,95%CI:1.794~5.124)、病程≥3个月(OR=3.957,95%CI:1.997~5.463)、血肿量≥30 ml(OR=4.875,95%CI:1.982~5.875)、额颞部血肿(OR=4.763,95%CI:1.898~5.968)、混杂密度血肿(OR=4.537,95%CI:1.795~5.362)、CT中线移位≥5 mm(OR=4.876,95%CI:1.897~5.985)、并发镰下疝(OR=4.495,95%CI:1.754~5.247)、GCS<8分(OR=4.875,95%CI:1.897~5.876)、额颞叶脑灌注缺损(OR=4.237,95%CI:1.651~4.896)是影响慢性硬膜下血肿患者并发行为异常的独立危险因素。结论慢性硬膜下血肿并发行为异常受外伤史、吸烟史、饮酒史、脑血管病史、高血压病史、糖尿病史、高血脂病史、病程、血肿量、血肿部位、血肿密度、CT中线移位、镰下疝、GCS、脑灌注等因素影响,有针对性给予干预可能有效降低慢性硬膜下血肿发生行为异常的发生率。     

Du parricide rêvé à l’infanticide réel,ou l’expertise mentale dans tous ses états

The authors describe at length the case of a 33-year-old woman who shot and killed her 9-year-old daughter and attempted suicide immediately afterwards. The judicial inquiry revealed that this infanticidal mother originally intended to kill her own father, who she accused of having sexually abused her in her own childhood and now her daughter, but that unforeseen circumstances changed the mode of operation. She was the subject of seven more or less contradictory psychiatric experts opinions over a period of more than three years before finally being found criminally irresponsible by the court of assizes. She was suffering from delusional psychotic mental disorders at the time of the homicide-suicide. The authors discuss and criticize the conclusions of the experts opinions and instead recommend a multidisciplinary criminological analysis that takes all the objective ans subjective aspects on the case into account.