酒精中毒致精神障碍患者脑内神经递质功能研究

目的利用脑涨落图仪检测酒精中毒所致精神障碍患者脑内多种神经递质功能,探讨酒精中毒所致精神障碍的发病机制。方法筛选符合《中国精神障碍分类及诊断标准(第3版)》(CCMD-3)酒精所致精神障碍的诊断标准的患者为实验组,健康人员为正常对照组,对两组人员均进行脑涨落图仪检测,比较分析两组人员的检测结果。结果与正常组对比,实验组的9种神经递质功率均降低,差异有统计学意义(P0.05)。实验组的NE相对功率显著低于对照组(P0.05)。实验组的全脑总功率、运动指数和血管舒缩指数均显著低于对照组(P0.05)。结论酒精中毒所致精神障碍患者脑内多种神经递质功能降低,尤其是NE功能降低更为明显,同时还有脑血管舒缩功能障碍。脑涨落图仪能够检测分析脑内神经递质的功能和脑神经细胞的供血情况,对研究酒精中毒所致精神障碍发病机制有帮助。     

Changes in CSF neurotransmitters during the first year of life

Changes in cerebrospinal fluid neurotransmitter metabolites in 25 children younger than 1 year of age were analyzed to assess maturation of the central nervous system and were compared to cerebrospinal fluid from older children and adults. Significant inverse correlations (P < .05) with aging were observed for tryptophan, 5-hydroxytryptophan, 5-hydroxyindoleacetic acid, kynurenine, tyrosine, dopa, dopamine, dihydroxyphenylacetic acid, homovanillic acid, norepinephrine, and 3-methoxy-4-hydroxyphenylglycol concentrations. There were no significant differences observed with respect to age in the cerebrospinal fluid serotonin, 3-hydroxykynurenine, and 3-methoxytyramine concentrations. This study suggests that changes in the major cerebrospinal fluid neurotransmitters occur with increasing age during the neonatal period. Because these findings are preliminary, additional patients require study.     

Hearing loss in brainstem disorders.

A retrospective study of 309 unselected patients with brainstem disorders was carried out to establish the incidence and degree of hearing loss in this group as a whole and in each of three separate pathologies: multiple sclerosis, vertebro-basilar ischaemia and brainstem tumours. Pure tone audiograms were corrected for age and sex and upon analysis, thereafter, 59% and 26% of patients were found to have hearing thresholds in excess of 10dB and 30dB respectively. The hearing loss tended to be slight to moderate, 87% of those with a deficit were in the range 11--59dB, and tended to involve the higher frequencies. No characteristic audiometric configuration emerged. 75% of those with a hearing loss suffered a bilateral deficit. Considering the multiple sclerosis, vertebro-basilar insufficiency and tumour groups individually, similar findings were observed with the mildest losses occurring in multiple sclerosis and the most severe in the tumour group.     

抽动障碍患儿执行功能损害特征的研究

目的：研究抽动障碍（TD）患儿执行功能损害特点及其与症状之间的相关性。方法：运用标准化剑桥神经心理成套测试（CANTAB）对31例儿童TD患者和31例健康对照进行执行功能评估,采用耶鲁综合抽动严重程度量表（YGTSS）对患者症状进行评定,最后进行统计分析。结果：TD患儿的运动筛选（MOT）平均延迟时间（t=-3.476,P〈0.01）、反应时间（RTI）5次选择运动时间（t=-2.291,P〈0.05）、5次选择反应时间（t=-2.163,P〈0.05）和单次选择运动时间（t=-3.637,P〈0.05）、空间工作记忆（SWM）4格错误间隔（t=-2.728,P〈0.01）、目标内外注意转换（IED）完成阶段数（t=-2.422,P〈0.05）皆多于对照组,而IED总尝试次数（t=-2.836,P〈0.01）显著少于对照组。TD患儿MOT平均延迟时间、RTI单次选择反应时间与YGTSS运动性抽动得分呈负相关。结论：TD患儿执行功能多种成分存在损害,某些损害可能与抽动症状的严重性存在相关。     

Secondary abnormalities of neurotransmitters in infants with neurological disorders

Neurotransmitters are essential in young children for differentiation and neuronal growth of the developing nervous system. We aimed to identify possible factors related to secondary neurotransmitter abnormalities in pediatric patients with neurological disorders. We analyzed cerebrospinal fluid (CSF) and biogenic amine metabolites in 56 infants (33 males, 23 females; mean age 5.8mo [SD 4.1mo] range 1d-1y) with neurological disorders whose aetiology was initially unknown. Patients were classified into three clinical phenotypes: epileptic encephalopathy, severe motor impairment, and non-specific manifestations. All patients showed normal results for screening of inborn errors of metabolism. We report clinical, neuroimaging, and follow-up data. Among the patients studied, 10 had low homovanillic acid (HVA) levels and in four patients, 5-hydroxyindoleacetic acid (5-HIAA) was also reduced. Patients with neonatal onset had significantly lower levels of HVA than a comparison group. HVA deficiency was also associated with severe motor impairment and the final diagnosis related to neurodegenerative disorders. 5-HIAA values tended to be decreased in patients with brain cortical atrophy. The possibility of treating patients with L-Dopa and 5-hydroxytryptophan, in order to improve their neurological function and maturation, may be considered.     

Sleep-related disorders in neurologic disease during childhood

Sleep disorders commonly are associated with neurologic disorders in childhood. This review discusses primary sleep disorders that affect children with primary neurologic diseases. Primary sleep disorders are discussed as they relate to the primary neurologic disease. In addition, sleep disorders secondary to neurologic disorders commonly seen in the practice of pediatric neurology are reviewed. A useful sleep history to improve diagnostic and therapeutic interventions is outlined.     

产后抑郁症与孤啡肽及单胺类递质的相关性研究

目的　探讨孤啡肽 (OFQ)及单胺类递质与产后抑郁症的关系。方法　采用放射免疫法测定 2 5名健康产妇 (对照组 )及 17例产后抑郁症妇女 (抑郁组 )静脉血中孤啡肽及单胺类递质含量。结果　①抑郁组及对照组血孤啡肽含量分别为 (2 7 39± 6 0 4 )ng/L及 (10 37± 3 6 5 )ng/L ,与对照组相比 ,抑郁组孤啡肽含量显著升高 (P <0 0 1) ;抑郁组及对照组血 5 羟色胺 (5 HT)含量分别为 (0 93± 0 2 1) μmol/L及 (1 4 3± 0 36 ) μmol/L ,二者间有显著差异 (P <0 0 5 ) ;抑郁组血多巴胺 (DA)含量为 (2 15± 0 4 1) μmol/L ,显著低于对照组 (P <0 0 5 )。②抑郁组孤啡肽与5 HT及DA含量呈显著负相关 (r为 0 6 0 1及 0 5 93,P <0 0 5 )。③抑郁组爱丁保产后抑郁量表总分 (EPDS)与OFQ含量呈显著正相关 (r为 0 5 12 ,P <0 0 5 ) ,与 5 HT、DA含量呈显著负相关 (r分别为 - 0 5 71及 - 0 5 2 6 ,P <0 0 5 )。结论　孤啡肽与产后抑郁症的发生发展密切相关。     

Otoacoustic emission in patients with neurological disorders who have auditory brainstem response abnormality

Otoacoustic emissions (OAEs) were evaluated in 51 ears of 30 patients with a severe auditory brainstem response (ABR) waveform abnormality. Thirteen ears showed no ABR to click sound of higher intensity than 100 dBSPL (group 1). Fourteen ears exhibited only wave V or a decreased amplitude pattern of ABR (group 2). Twenty-four ears showed a predominant wave I or no wave III pattern (group 3). Almost all the ears with absent ABR showed no OAE, which strongly suggested hearing loss of cochlear origin, although one patient with alternating hemiplegia of childhood exhibited definite OAEs and auditory reactions without ABR. One patient with mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes (MELAS) and her mother in group 2 had OAE abnormalities, which also suggested mild to severe hearing impairment. When OAEs are present, an accompanying ABR abnormality may be produced by brainstem dysfunction of the underlying disorder such as Pelizaeus-Merzbacher disease. There was a significant relationship (chi-square test P<0.001) between the positivity of the distortion product OAE response and the clinical auditory reactions in 24 patients, although their ABR abnormalities did not reflect hearing impairment directly. Careful examination of both audiometry and OAEs might be necessary for further assessment of the hearing function in pediatric patients with neurological disorders and specific auditory nerve disease.     

Psychotherapeutic treatment concepts of personality disorders in patients with childhood traumatization

The psychotherapeutic treatment of personality disorders in patients with childhood traumatization is still a major challenge. The broad range of clinical problems includes disturbed emotion regulation, reduced mentalization function, impaired integration of personality, maladaptive patterns of behavior and a high degree of comorbidity. A variety of treatment concepts of psychodynamic, cognitive-behavioral, and other origin have been developed to treat this patient population. The aim of this paper is to identifiy those concepts whose effectiveness has been sufficienty demonstrated by controlled studies. The concepts will be briefly described and evaluated with regard to their utility in focusing specific clinical problem areas. While a variety of treatment approaches has been developed for this condition, only a limited number of concepts of cognitive-behavioral and psychodynamic origin show up with sufficient evidence in terms of controlled studies. Among the cognitive-behaviorally oriented concepts are: Dialectical-behavioral Psychotherapy (Linehan), Affect Management Training (e. g. Cloitre), and Schema Therapy (Young). The psychodynamic concepts with evidence of effectiveness are: Tranference-focused Psychotherapy (Kernberg/Clarkin), Psychodynamic-interactional and Structure-related Psychotherapy (Heigl-Evers & Heigl, Rudolf), Mentalization-based Treatment (Bateman & Fonagy), and Psychodynamically Oriented Trauma Therapy (Reddemann, Sachsse). However, a critical discussion of these concepts reveals that, because of the heterogeneity of the patient population, none of these concepts is able to cover all types of clinical problems presented by the patients.     

Skin-testing with neurotransmitters in schizophrenic patients

Pilot data are presented on a methodology to study a profile of simultaneous reactivity to intradermally injected norepinephrine, dopamine, serotonin, and histamine. The subject groups were young and old schizophrenics on medication and young control volunteers. Skin reactivity in terms of vasoconstriction, vasodilation, and whealing was measured over the course of 3 hours after the injections. Although interpretation of the results is limited by several sources of confounding error and the small number of subjects, the data suggest that skin-test profiles are sensitive enough to yield significant differences between the groups, particularly in the area of vasoconstriction. Further, abnormal skin reactivity may mirror the hypothesized alterations in CNS neurotransmitter physiology in schizophrenic patients.     

Auditory brainstem responses in childhood psychosis

Auditory brainstem responses were compared in 24 autistic children, 7 children with other childhood psychoses, and 31 normal children. One-third of the autistic children showed abnormal ABR indicative of brainstem dysfunction and correlating with muscular hypotonia and severe language impairment. The children with other psychoses and the normal children showed normal results.     

Dysfunctional parental styles perceived during childhood in outpatients with substance use disorders

People who suffer from substance use disorders (SUDs) frequently report to have undergone childhood adversity that is often associated with father or mother dysfunction, or both. Yet that issue has been barely addressed in opiate dependent patients. Therefore we sought to evaluate parent-specific dysfunctional styles perceived during childhood in a clinical sample from an outpatient addiction treatment program using the Measure Of Parental Styles (MOPS) questionnaire. DSM-IV diagnoses of substance use disorders and history of suicide attempts, family structure and changes of caregiver during childhood were obtained from 159 consecutive outpatients, along with their perception of parental bonding with the MOPS, in which mother and father scores are separate. Mother neglect dimension was significantly correlated with an earlier age at onset of several substances' use, the number of prior hospitalizations and of lifetime suicide attempts. Most of these associations remained significant in multivariate models. This was the first assessment of a representative sample of outpatients with SUDs by the MOPS questionnaire. Given its excellent acceptance and its association with several key correlates of SUDs, it should be used to design specific interventions targeted at attachment and familial management as well as in research models on gene×environment interactions.     

Types of childhood trauma and spirituality in adult patients with depressive disorders

ObjectiveThe aim of this study was to investigate the differences in spirituality among adult patients with depressive disorders, who had suffered various types of abuse or neglect in childhood.MethodsA total of 305 outpatients diagnosed with depressive disorders completed questionnaires on socio-demographic variables, childhood trauma history, and spirituality. We used the Childhood Trauma Questionnaire-Short Form (CTQ-SF) to measure five different types of childhood trauma (emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect) and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale (FACIT-Sp-12) to assess spirituality.ResultsDepressive symptoms and total CTQ-SF scores showed a negative correlation with spirituality. In the regression model, being older and belonging to a religion significantly predicted greater spirituality. Depressive symptoms significantly predicted lower spirituality. From among the five types of childhood trauma assessed by the CTQ-SF, only emotional neglect significantly predicted lower spirituality.ConclusionA history of childhood emotional neglect was significantly related to lower spirituality, especially in the case of the Meaning aspect of spirituality. This finding suggests the potential harmful influence of childhood emotional neglect on the development of spirituality in psychiatric patients. Investigating different aspects of childhood trauma might be important in order to develop a more comprehensive psychiatric intervention that aids in the development of spirituality.     

Lesion detection in MS patients with and without clinical brainstem disorders: magnetic resonance imaging and brainstem auditory evoked potentials compared

The findings of the present study can be summed up in the following points: (1) brainstem auditory evoked potentials (BAEP), as compared with magnetic resonance imaging (MRI), has a greater capacity and a lower cost in disclosing brainstem plaques both in MS patients with symptoms or signs of actual brainstem involvement and in clinically silent ones. This makes BAEP a useful technique for the neurologist, who can confirm the clinical suspicion of a brainstem lesion and follow the evolution of the disease in the patient. (2) The sensitivity of BAEP is lower than that of MRI as far as the anterior lesions of the brainstem are concerned. (3) MRI is more specific than BAEP, inasmuch as several types of injuries can alter the BAEP, while the demyelinating plaque has a specific image and can only be confused with little lacunar infarcts. (4) Plaques that produced symptoms or signs in the past can eventually disappear and be no longer detected by a subsequent MRI.     

Cognitive functioning in patients with a small infarct in the brainstem.

Earlier findings in patients with a small supratentorial white matter infarct demonstrated subtle impairments of cognition. This is in line with reported difficulties in regaining premorbid level of functioning in daily life activities, even though any physical neurological deficits are no longer present. Either a "bystander effect" of adjoining gray matter or a long distance effect through hypometabolism or other neurochemical changes might underlie these impairments. To find the best explanation, a group of 17 patients with a lacunar infarct in the brainstem was neuropsychologically evaluated and compared with a closely matched control group. The patients demonstrated significantly impaired task performance on a constellation of neuropsychological tasks that was very similar to the findings previously found in patients with a supratentorial lacunar infarct (Boston Naming Test, TEA visual elevator, category fluency, Trailmaking Test). We conclude that a small white-matter infarct may affect cognitive functioning in a nonspecific way independently of its location.     

Personality disorders in patients with panic disorder: association with childhood anxiety disorders, early trauma, comorbidity, and chronicity.

The rates of comorbid personality disorders in patients with panic disorder are reported to be elevated, have an adverse impact on the response to treatment, and increase the likelihood of relapse on treatment discontinuation. We examined the rates of personality disorders in panic disorder patients in a longitudinal, naturalistic study of panic disorder. Of 100 panic disorder patients studied, 42 met criteria for at least one personality disorder as determined by the Personality Disorder Questionnaire-Revised (PDQ-R). The presence of a personality disorder as determined by the PDQ-R was associated with a past history of childhood anxiety disorders, comorbidity with other anxiety disorders and depression, and a chronic, unremitting course of panic disorder in adulthood. The presence of a personality disorder in these patients was not significantly associated with a history of physical or sexual abuse in childhood. Our findings support the notion that an anxiety diathesis, demonstrated by significant difficulties with anxiety in childhood, influences the development of apparent personality dysfunction in panic patients. In other cases, personality pathology may reflect the presence of comorbid anxiety disorders or depression. The association of personality disorder in panic patients with a more unremitting course of illness underscores the importance of axis II pathology in understanding the longitudinal course of panic disorder.     

Pathophysiology of childhood anxiety disorders.

Prior reviews on the pathophysiology of anxiety consistently note the need for more research on biological aspects of childhood social phobia, separation anxiety disorder, and generalized anxiety disorder. The current review summarizes biological research that is relevant to these three disorders. In the first part of the review, barriers that have prevented progress in this area are delineated, and recent developments are discussed that set the stage for major advances in research on childhood anxiety disorders. In the second part of the review, studies are discussed that provide insights on the pathophysiology of childhood social phobia, separation anxiety disorder, and generalized anxiety disorder. Research on each specific disorder illustrates the manner in which recent developments in biological research facilitate novel research approaches uniquely suited for answering essential clinical questions in research on both childhood and adult anxiety disorders. For example, in research on social phobia, biological studies might enhance understandings of the longitudinal associations between individual childhood and adult disorders. In research on separation anxiety disorder, biological studies might enhance understanding on family-genetic associations between childhood and adult disorders. Finally, in research on generalized anxiety disorder, biological studies might enhance understandings of comorbidities among distinct childhood and adult disorders, particularly with respect to the relationship between anxiety and depressive disorders.     

脑涨落图检测精神分裂症患者无抽搐电休克治疗前后脑内神经递质功能的研究

目的探讨首发精神分裂症患者的神经递质功能特点及无抽搐电休克治疗对患者的神经递质功能的影响。方法采用脑涨落图仪(EFG)检测首发精神分裂症患者无抽搐电休克(MECT)治疗前后脑内神经递质功能。选取符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)的首发精神分裂症患者24例,MECT治疗8~12次。在首次治疗前半小时,首次治疗之后半小时及24小时、末次治疗后24小时采用EFG检测脑内γ-氨基丁酸(GABA)、谷氨酸(Glu)、5-羟色胺(5-HT)、去甲肾上腺素(NE)、多巴胺(DA)、乙酰胆碱(Ach)六种神经递质的功率。在首次治疗前及疗程结束后24小时进行阳性与阴性症状量表(PANSS)测评。结果与治疗前比较,治疗后半小时患者的全部递质功率升高(P0.05),首次治疗与末次治疗后24小时,多巴胺功率降低(P0.05)。5-HT、Ach、NE、DA的功率与P分呈正相关(P0.05),GABA与G分、PANSS总评分呈负相关(P0.05),PANSS评分P分和PANSS总评分降低(P0.01)、G分降低(P0.05)。结论 MECT治疗能降低精神分裂症患者多巴胺功能。     

小儿脑干胶质瘤的显微手术治疗

目的探讨显微手术在小儿脑干胶质瘤治疗中的作用以及手术的适应证。方法对18例显微手术治疗的脑干胶质瘤患儿的临床资料,术中影像资料和术后随访检查结果进行分析总结。结果肿瘤全切除12例,次全切除4例,部分切除2例,其中9例术后进行放疗。平均随访2.8年,总体效果良好。结论适应证明确的脑干胶质瘤患儿应积极显微手术治疗。在选择手术患儿时,除肿瘤系外生型、内生局限型或颈延髓型外,MRI上有局限性强化灶和神经功能缺失不明显也是重要的手术指征。