Prefrontal modulation of frustration-related physiology in preschool children ranging from low to severe irritability

Limbic-prefrontal connectivity during negative emotional challenges underpins a wide range of psychiatric disorders, yet the early development of this system is largely unknown due to difficulties imaging young children. Functional Near-Infrared Spectroscopy (fNIRS) has advanced an understanding of early emotion-related prefrontal activation and psychopathology, but cannot detect activation below the outer cortex. Galvanic skin response (GSR) is a sensitive index of autonomic arousal strongly influenced by numerous limbic structures. We recorded simultaneous lateral prefrontal cortex (lPFC) activation via fNIRS and GSR in 73 3- to 5-year-old children, who ranged from low to severe levels of irritability, during a frustration task. The goal of the study was to test how frustration-related PFC activation modulated psychophysiology in preschool children, and whether associations were moderated by irritability severity. Results showed lPFC activation significantly increased, and GSR levels significantly decreased, as children moved from frustration to rest, such that preschoolers with the highest activation had the steepest recovery. Further, this relation was moderated by irritability such that children with severe irritability showed no association between lPFC activation and GSR. Results suggest functional connections between prefrontal and autonomic nervous systems are in place early in life, with evidence of lPFC down-regulation of frustration-based stress that is altered in early psychopathology. Combining fNIRS and GSR may be a promising novel approach for inferring limbic-PFC processes that drive early emotion regulation and psychopathology.     

地佐辛联合氟比洛芬酯静脉自控镇痛对开胸术后烦躁状态的影响分析

摘 要 目的： 探讨在开胸手术中采用地佐辛联合氟比洛芬酯麻醉处理的临床效果,以及对患者术后烦躁状态的影响。方法: 98例行开胸手术的患者随机分为对照组与观察组各49例,对照组在手术结束后采用芬太尼与地佐辛静脉自控镇痛,观察组联合应用地佐辛与氟比洛芬酯静脉自控镇痛。观察两组患者临床麻醉效果、药品不良反应及术后躁动状况,比较两组患者不同时点的VAS评分与Ramsay镇静评分。结果:观察组患者在术后2 h与4 h的VAS评分均显著低于对照组（P<0.05）,拔管时与拔管后5 min的Ramsay镇静评分明显好于对照组（P<0.05）;术后苏醒期躁动率和不良反应发生率明显低于对照组（P<0.01）。结论: 开胸手术患者术后联合应用地佐辛与氟比洛芬酯静脉自控镇痛可充分保证镇痛效果,缓解术后躁动情况,具有良好的临床应用价值。     

Risk for emerging bipolar disorder,variants, and symptoms in children with attention deficit hyperactivity disorder,now grown up

AIM: To determine the prevalence of bipolar disorder (BD) and sub-threshold symptoms in children with attention deficit hyperactivity disorder (ADHD) through 14 years’ follow-up, when participants were between 21-24 years old.METHODS: First, we examined rates of BD type I and II diagnoses in youth participating in the NIMH-funded Multimodal Treatment Study of ADHD (MTA). We used the diagnostic interview schedule for children (DISC), administered to both parents (DISC-P) and youth (DISCY). We compared the MTA study subjects with ADHD (n = 579) to a local normative comparison group (LNCG, n = 289) at 4 different assessment points: 6, 8, 12, and 14 years of follow-ups. To evaluate the bipolar variants, we compared total symptom counts (TSC) of DSM manic and hypomanic symptoms that were generated by DISC in ADHD and LNCG subjects. Then we sub-divided the TSC into pathognomonic manic (PM) and non-specific manic (NSM) symptoms. We compared the PM and NSM in ADHD and LNCG at each assessment point and over time. We also evaluated the irritability as category A2 manic symptom in both groups and over time. Finally, we studied the irritability symptom in correlation with PM and NSM in ADHD and LNCG subjects.RESULTS: DISC-generated BD diagnosis did not differ significantly in rates between ADHD (1.89%) and LNCG 1.38%). Interestingly, no participant met BD diagnosis more than once in the 4 assessment points in 14 years. However, on the symptom level, ADHD subjects reported significantly higher mean TSC scores: ADHD 3.0; LNCG 1.7; P < 0.001. ADHD status was associated with higher mean NSM: ADHD 2.0 vs LNCG 1.1; P < 0.0001. Also, ADHD subjects had higher PM symptoms than LNCG, with PM means over all time points of 1.3 ADHD; 0.9 LNCG; P = 0.0001. Examining both NSM and PM, ADHD status associated with greater NSM than PM. However, Over 14 years, the NSM symptoms declined and changed to PM over time (df 3, 2523; F = 20.1; P < 0.0001). Finally, Irritability (BD DSM criterion-A2) rates were significantly higher in ADHD than LNCG (χ² = 122.2, P < 0.0001), but irritability was associated more strongly with NSM than PM (df 3, 2538; F = 43.2; P < 0.0001).CONCLUSION: Individuals with ADHD do not appear to be at significantly greater risk for developing BD, but do show higher rates of BD symptoms, especially NSM. The greater linkage of irritability to NSM than to PM suggests caution when making BD diagnoses based on irritability alone as one of 2 (A-level) symptoms for BD diagnosis, particularly in view of its frequent presentation with other psychopathologies.     

Atypical Kawasaki disease with remarkable paucity of signs and symptoms

We report on a 7-month-old infant with Kawasaki disease (KD) whose only manifestations were high-grade fever of 7 days duration, “non-toxic look” and “extreme irritability”, thereby not meeting the criteria for the classical or the atypical form of the disease. The diagnosis was confirmed by the demonstration of a solitary aneurysm in the proximal left anterior descending coronary artery. The present case raises the concern that the presently laid guidelines for the diagnosis of atypical KD may not be adequate.     

激惹、抑郁和焦虑量表(IDA)的信度和效度研究

目的 评价IDA量表的信度和效度。方法 使用IDA、SDS和SAS对291例大学生和64例抑郁症患者进行评定。结果 IDA具有良好的心理测量特性，Cronbach α系数在0.419-0.769,IDA各分量表的劈半相关系数在0.427-0.639,IDA各分量表与SDS、SAS间的相关系数均在0．400－0．776，IDA各分量表得分在非抑郁大学生、抑郁大学生和抑郁症患者之间存在非常显著性差异。结论 IDA量表具有良好的信度和效度，值得推广使用。     

青少年易激惹特征及其神经机制

青少年时期是一个身体迅速发育不断成熟的时期,而心理的发育成熟情况却是滞后于身体的发育速度,激惹心境（Irritable mood）（即易激惹性）的出现就是一个常见现象[1].     

中医“烦躁状态”概述及脉象探要

＂烦躁状态＂是人体的一种心理紊乱状态,这种状态持续不缓解,最终成为导致诸多疾病发生和维持的症结所在。在对＂烦躁状态＂内涵进行诠释和发病机制分析的基础上,对其相关脉象进行总结,以期为临床辨识和辨治提供重要的理论依据。     

行为改变教育策略对应激性消化不良患者的影响

目的分析、比较行为改变教育策略对肠易激综合征（IBS）的影响。方法采取问卷回顾性调查法调查行为改变教育策略对沈阳医学院奉天医院2008年3月～2012年5月100例应激性消化不良患者的影响,另选择我院同期收治人院的采用常规护理的应激性消化不良患者100例作为对照组,分析干预前、后简明健康状况问卷（SF-36）、生存质量评定量表（QLQ—C30）;观察两组临床症状改善情况。结果200例患者中a型行为者124例,占62．0％,非a型者（b型与混合型）76例,占38．0％。其中观察组总有效100例（100．0％）,对照组总有效75例（75．0％）,两组比较差异有统计学意义（x2=4．294,P〈0．05）;观察组QLQ—C30、SF-36总分与对照组相比差异有统计学意义（P〈0．05）。结论心理因素对IBS的发病有着重要影响,改变教育策略能显著改善IBS患者的生存质量。对该病的康复有确切的效果。     

Olfactory bulbectomy: emotional behavior and defense responses in the rat

Removal of the olfactory bulbs of male hooded rats caused a reduction in defensive reactions to an unconditioned aversive stimulus (mechanical robot). In the presence of the robot, bulbectomized rats showed significantly less freezing and significantly less suppression of feeding behavior than sham-operated controls. At the same time, the bulbectomized rats were significantly more irritable to handling and showed a significant increase in muricide. These effects could not be attributed to loss of olfactory perception alone. Rats made peripherally anosmic through surgical removal of olfactory afferents were virtually indistinguishable from controls. These results provide further evidence for the view that in addition to their sensory functions, the olfactory bulbs of the rat have important tonic influences on emotional behavior. These tonic influences can occur independently of sensory processing and seem to be critical for the normal expression of emotional behavior or defense responses in this animal.