心理咨询门诊抑郁障碍的识别与氟西汀治疗

目的 探讨综合性医院心理咨询门诊抑郁障碍的识别与治疗。方法 将各科以躯体不适就诊，经多方检查治疗无效而转来心理咨询门诊的患，进行汉密尔顿抑郁量表（HAMD）测评，HAMD≥18分入组共69例，分别每日给氟西汀20mg治疗6周，治疗后查HAMD，并进行疗效评定。结果 69例中轻度、中度抑郁占73．9％，重度抑郁占26．1％，有81．2％的初诊患第一主诉是睡眠障碍和躯体不适，经服用抗抑郁剂氟西汀治疗6周后，HAMD评分明显下降（P＜0．01），痊愈67．3％，显效24．5％，进步4．9％，无效3．3％。治疗前后HAMD量表五项因子评分均有明显下降，具显意义（P＜0．01）。结论 心理咨询门诊抑郁患及时识别、诊断，适当应用抗抑郁剂可有效缓解抑郁症状和躯体症状，减少不必要的检查和治疗，利于患疾病的康复。     

强迫性神经症的心理─药物治疗(附16例报告)

强迫性神经症状是临床心理门诊中最常见的一组以强迫观念、强迫动作为主要症状的心理疾病［１］。关于它的治疗,无论是单纯的心理治疗,还是药物治疗,效果都不甚理想。自１９９７年以来,我们先后对１６名前来心理咨询的强迫性神经症患者,采用了综合性心理治疗辅以药物治疗,收到良好效果,现报告如下：１临床资料 １６例强迫性神经症患者均为我院心理咨询门诊病人,其诊断标准符合ＣＣＭＤ－２Ｒ,并排除躯体性疾病。其中男１０例,女６例;年龄１４－４１岁（２６．５ ± ８．７６）;病程１－１０年（３．５６±２．９２）;受教育：…     

综合性医院精神科会诊210例分析

通过综合性医院精神科会诊２１０例分析，发现在综合性医院临床各科存在大量精神医学问题。会诊主要原因是躯体疾病出现精神障碍（５７．６％）及躯体化症状（２６．２％）要求诊断和处理；内科会诊占首位（６７．６％），其中神经内科最多（１９．５％），其次是心血管内科（１３．８％）和消化内科（１３．３％）；病种以器质性精神障碍最多见（４１．０％），其次是神经症（２１．４％），以焦虑症及抑郁性神经症为多见；躯体疾病心理反应（１３．０％）也不少，症状以情绪焦虑、抑郁为常见表现。作者认为，在综合性医院设置精神种，开展会诊一联络精神病学工作甚为必要。     

综合医院精神医学心理咨询676例临床分析

目的 了解综合医院精神科、心理咨询患的临床特点。方法 用《中国精神障碍分类与诊断标准-3》(CCMD-3)，将上海邮电医院2001年1月～2004年1月间精神科及心理咨询门诊、会诊676例患的年龄、疾病分布及治疗情况进行分析。结果 神经症发病率最高268例，占39．64％，器质性精神障碍151例，占22．33％。女性发病高于男性，60岁以上老年人占多数303例占多数44．82％，治疗有疗效77．1％。结论 综合医院开展精神科、心理咨询门诊是十分必要的，需要大力加强精神卫生服务能力。     

综合医院心理咨询1600例分析

报告综合医院门诊心理咨询１６００用分析，其中神经症１１２３例，性心理障碍１２例，少儿行为问题５３例，其它功能性障碍９９例。分析了宁夏地区咨询者的临床特点，提出了综合医院开设心理咨询很有必要，值得推广。     

恐怖症222例临床分析

恐怖症为神经症的一种,过去我国认为这类病很少见,国外占18岁以上神经症患者的5％以下。近年发现恐怖症的患者并不少见。现将我院在83年4月～86年8月的心理咨询门诊(以下简称门诊)和书信心理咨询(以下简称书信)中,符合1982年10月成都神经症学术讨论会标准而诊断为恐怖症的222例进行分析。     

10省市双相情感障碍患者药物治疗的现况调查

目的了解国内双相情感障碍患者精神药物的治疗现状。方法按一定的抽样比例，选择10个省市46家专科医院或综合医院精神科同时进行药物处方方式的调查。结果（1）在558例双相情感障碍患者中，躁狂相472例（84．6％），抑郁相86例（15．4％）；555（99．5％）例患者接受精神药物治疗。（2）主要治疗药物为心境稳定剂（80．7％），404例（72．8％）患者使用了抗精神病药。（3）躁狂相患者以心境稳定剂（84．7％）和抗精神病药（81．4％）单一或联合治疗为主，抑郁相患者单一或联合使用抗抑郁药的频率较高（80．2％）。（4）联合两种及其以上药物治疗者占80．2％。（5）145例（26．1％）患者合并使用了苯二氮Zhuo类药。结论国内双相情感障碍药物处方方式与国内外的指南推荐方案基本相符；双相障碍抑郁相抗抑郁药使用频率较高，有待于将来的临床实践论证。     

门诊心理咨询152例临床资料分析

本文对１５２例门诊心理咨询对象进行分析。咨询者大多为青壮年，初中及初中以下文化者居多，咨询对象６７．１％来自郊县，职业分布中个体户占相当比例。咨询内容涉及精神疾病的诊治以及家庭问题、工作或学习问题以及社交问题等诸方面。疾病以神经症居首位，其次为常见重型精神病。对６０例神经症患者作了ＥＰＱ或ＭＭＰＩ和ＳＣＬ－９０测定，发现大部分病例个性内向或倾向内向，情绪不稳定，抑郁、恐怖、强迫等评分均较高。治疗以支持性心理治疗和生物反馈治疗为主。     

高压氧治疗69例失眠患者的疗效观察

高压氧治疗６９例失眠患者的疗效观察绵阳市精神卫生中心（６２１０００）张中念，杨玉英作者采用高压氧治疗６９例神经症和非神经症中伴有失眠症状态者，其中，男性３６例（５２．２％），女性３３例（４７．８％）；平均年龄４１．２岁（２２～６２岁）。并按ＣＣＭＤ－...     

综合医院住院患者对会诊联络服务的需求

目的：调查综合医院住院患者对精神科会诊联络服务（CLS）的需求。方法：对我院临床各科申请精神科会诊的住院患者,共131例,进行精神科会谈,得出精神障碍的诊断及治疗建议;并对患者进行综合医院焦虑抑郁量表（HADS）及综合医院住院患者精神科会诊联络服务需求临床调查表评估和调查。结果：①精神科会诊率为1．37％（95％可信区间：1．14％-1．59％）,精神科会诊后精神障碍的诊断：神经症性、应激相关以及躯体形式障碍为30．5％（n=40）,器质性精神障碍22．2％（n=29）,心境障碍16．0％（n=21）,与生理紊乱和躯体因素有关障碍12．2％（n=16）,精神分裂症,分裂性障碍和妄想性障碍9．9％（n=13）。②综合医院焦虑抑郁量表评分：焦虑症状检出比例为37．9％（39／103）,抑郁症状检出比例为61．2％（63／103）。③对精神科治疗的需求：72．8％患者对精神药物治疗表示兴趣;57．3％对心理社会治疗有兴趣。④需求相关因素：患者对精神药物治疗需求与3个因素有关：是否有焦虑症状（P：0．001）,既往是否接受过精神科药物治疗（P=0．005）,以及患者最近一段时间（至少1周以内）的睡眠状况（P=0．014）。心理社会支持需求与2个因素有关：是否有焦虑症状（P=0．006）,是否患者自己提出会诊申请（P=0．038）。结论：综合医院住院患者伴发心理社会问题及精神障碍时,对精神药物及心理社会治疗的需求均相当高。     

Longitudinal follow up of primary insomnia patients in a psychiatric clinic

OBJECTIVE: Insomnia could be a symptom of underlying psychiatric or physical disorder, a risk factor for other psychiatric disorder, or a discrete psychiatric disorder per se. In order to determine the nosological status of primary insomnia, an outcome study was carried out to investigate its diagnostic stability and its relationship to subsequent psychiatric disorders. METHODS: Fifty-three primary insomnia patients in a university hospital psychiatric outpatient clinic were assessed by retrospective case note review, followed by a 6 month prospective follow up with Structured Clinical Interview Schedule for DSM-IV In-patient (SCID-I/P, version 2.0, and a sleep questionnaire. RESULTS: The majority of patients (n =44, 83%) did not develop other psychiatric disorders after 13.4+/-1.2 years from the onset of insomnia. Nine patients (17%) developed mood disorder (n =6), anxiety disorder (n =2) and somatoform disorder (n =1) at 6.3+/-2.3 years after the onset of insomnia. Subjective deterioration of insomnia and a shorter duration of sleep symptoms at the first consultation were associated with the development of secondary psychiatric disorders. Approximately one-third (n =17, 32%) reported symptoms improvement and six (13.2%) were free from medications. Better education was the only factor that predicted improvement in symptoms. CONCLUSIONS: There existed a longitudinal diagnostic stability of primary insomnia in a majority of clinical patients. However, in a proportion of patients, it might either be a risk factor or a prodrome of mood or anxiety disorders.     

The efficacy of ECT in adults with mental retardation experiencing psychiatric disorders

There is a paucity of empirical data establishing the efficacy of electroconvulsive therapy (ECT) in patients with mental retardation and psychiatric disorders. This study examines the efficacy of ECT on specific symptoms and between psychiatric diagnoses in patients with mental retardation who are psychiatrically ill. A chart review was performed on 20 inpatients who had received ECT on a dedicated Mental Retardation-Dual Diagnosis Unit and were divided into 3 categories: mood disorders (n = 12), psychotic disorders (n = 6), and intermittent explosive disorder (n = 2). Ratings were performed 1 week before ECT treatment and 1-week after its termination using the Aberrant Behavior Checklist and the Clinical Global Impressions Severity Scale. A repeated-measures analysis of variance comparing Aberrant Behavior Checklist scale scores revealed a significant time-by-treatment interaction (F = 75.43, df = 1,9, P = 0.000, 2 t). The mood disorder and psychotic disorder groups had significantly lower irritability and hyperactivity scores after treatment compared with the intermittent explosive disorder group. The Clinical Global Impressions Severity Scale rating scores showed significant improvement in the mood disorders group (67%), in contrast to the intermittent explosive disorder group (0%). Our data suggests the utility of ECT for patients with mental retardation who also have treatment-resistant mood disorders and psychotic disorders, particularly with symptoms of hyperactivity and irritability. The data are sufficiently encouraging to justify prospective research of this question.     

Fibromyalgia is associated with panic disorder and functional dyspepsia with mood disorders. A study of women with random sample population controls

BACKGROUND: We compared ICD-10 psychiatric disorders in female patients with fibromyalgia (n=45) or functional dyspepsia (n=18) with age-matched random sample controls (n=49). METHOD: Version 2 of The Schedules for Clinical Assessment in Neuropsychiatry (SCAN) was used for present state examination and lifetime diagnoses. RESULTS: Current psychiatric disorders (somatoform pain disorder and specific phobia omitted) were diagnosed in 80% of fibromyalgia patients (OR=8.3), 83% of functional dyspepsia patients (OR=10.3) and 33% controls. Among fibromyalgia patients 27% had lifetime panic disorder. Lifetime mood disorders were found in 83% of functional dyspepsia patients. First-degree relatives with psychiatric disorder were found in 16% of the fibromyalgia patients, 50% of functional dyspepsia patients and 20% of controls. CONCLUSIONS: Fibromyalgia is associated with panic disorder and functional dyspepsia with mood disorders in substantial subgroups. Psychiatric symptoms and somatic complaints are closely related in these disorders.     

Differentiating DSM-IV anxiety and depressive disorders in the general population: comorbidity and treatment consequences.

OBJECTIVE: To attempt, for the first time, to apply a positive and differential diagnosis process in the general population during interviews using DSM-IV classification to ascertain the profile and occurrence of concomitant mental disorders. METHOD: A representative sample of 1832 individuals aged 15 years or older living in the metropolitan area of Toronto were interviewed by means of telephone interviews. The participation rate was 72.8%. RESULTS: Overall, 13.2% (n = 242) of the sample had either a mood disorder (n = 127; 6.9%) or an anxiety disorder (n = 170; 9.3%) at the time of their interview. The prevalence was higher among women (16.5%) than among men (9.7%), with an odds ratio of 1.8. The comorbidity of mood and anxiety disorders was found in 3% (n = 55) of the sample. Less than one-third of respondents with a mood and/or anxiety disorder were being treated by a physician for a mental disorder. However, these individuals were greater consumers of health care services. Most of them consulted a physician an average of 5 times in the past year. Individuals on medication diagnosed with a mood and an anxiety disorder consulted a physician an average of 12 times in the past year. Only 13% of them were treated with antidepressants and under 9% with anxiolytics. CONCLUSIONS: More than 70% of subjects with a mood disorder also complained of insomnia. With the differential process, 12% of the subjects manifesting a full-fledged anxiety disorder were diagnosed with only a mood disorder because the anxiety occurred only in the course of the mood disorder. About two-thirds of the subjects diagnosed in this study were undiagnosed and untreated by their physician.     

Elderly suicide attempters with depression are often diagnosed only after the attempt

OBJECTIVE: No previous study has comprehensively investigated the pattern of health care contacts among elderly subjects attempting suicide. The present study compared elderly suicide attempters with younger attempters, before and after attempted suicide, in terms of health care contacts, clinical diagnoses of mental disorders, and characteristics predicting lack of treatment contact after the index attempt. METHODS: All consecutive 1198 suicide attempters treated in hospital emergency rooms in Helsinki, Finland, from 15.1.1997 to 14.1.1998 were identified and divided into two age groups: (1) elderly suicide attempters aged 60 years or more (n = 81) and (2) suicide attempters aged under 60 years (n = 1117). RESULTS: During the final 12 months before the attempt, the majority of elderly suicide attempters had a contact with primary health care, but their mood disorders were likely to have remained undiagnosed before the index attempt. In primary health care, only 4% had been diagnosed with a mood disorder before the attempt, but 57% after (p < 0.001). After the suicide attempt, most elderly suicide attempters were referred for aftercare, two thirds having contact with psychiatric care. CONCLUSIONS: For purposes of preventing suicidal behaviour, screening for depression, plus further education on recognition, diagnosis and treatment of mood disorders among the elderly in primary health care setting are needed.     

综合性医院中健康热线电话咨询的分析

目的：了解健康热线电话咨询在综合性医院中的应用,方法：对１３４９人次电话求询者资料进行汇总、分析及评估。结果：求询者主要分布在２０～３９岁年龄段,占７０．６％,咨询问题主要是健康（占６１．３％）、情绪问题（占８．４％）、睡眠问题（占５．０％）。处理方法包括解释（占６３．２％）、疏泄（占７．９％）,应对能力指导（占４．０％）。结论：在现代社会中提高青年人的心理素质值得重视,同时在综合性医院中设计热线     

Phenomenology and diagnostic stability of youths with atypical psychotic symptoms

OBJECTIVE: This study aimed to better characterize the phenomenology and diagnostic stability of youths that report atypical psychotic symptoms. METHOD: In a 2-year longitudinal follow-up study, youths reporting atypical psychotic symptoms (n = 20) were compared with youths with schizophrenia (n = 27) and youths with bipolar disorder with psychotic features (n = 22) on psychotic, dissociative, and general symptomatology, comorbid diagnoses, previous abuse, and overall functioning. Diagnoses were obtained using structured diagnostic interviews (i.e., the Structured Clinical Interview for DSM-IV and the Diagnostic Interview for Children and Adolescents). RESULTS: None of the subjects reporting atypical psychotic symptoms went on to develop a classic psychotic illness by the year 2 follow-up. These subjects had significantly higher rates of abuse and dissociative symptoms, and were significantly more likely to receive a diagnosis of posttraumatic stress disorder (PTSD) or a depressive disorder than youths with schizophrenia or bipolar disorder. CONCLUSION: Our findings suggest that youths with atypical, fleeting, or situationally specific hallucinations are more likely to have a mood or anxiety disorder (such as PTSD) than a current or prodromal psychotic illness.     

有攻击行为的双相障碍Ⅱ型患者认知功能特点

目的 探讨有攻击行为双相障碍Ⅱ型患者的认知功能特点.方法采用自编一般情况问卷、轻躁狂症状自评量表(HCL-32)、修订版Barratt冲动量表(BIS-11)、修改版外显行为攻击量表(MOAS)及威斯康星卡片分类测验(WCST)对新疆维吾尔自治区人民医院临床心理科愿意接受研究的60例双相障碍Ⅱ型患者进行调查,根据MOAS分为攻击组和非攻击组,各30例.结果两组患者HCL-32得分差异无统计学意义;攻击组运动冲动性评分高于非攻击组,WCST测验中完成第一个分类所需应答数高于非攻击组,差异均有统计学意义(P<0.05).结论有攻击行为的双相障碍患者表现出更明显的运动冲动性;但在执行功能方面与无攻击行为患者差异不明显,攻击行为不能作为预测认知功能进一步损害的外在因素.     

The establishment of a mood disorders unit

The establishment within a general hospital psychiatry ward of a mood disorders unit (MDU), a specialised facility for the assessment and treatment of patients with affective disorders, is described. The aims include provision of a clinical service, a teaching resource for affective disorders and the development of a research centre. Details are provided of the organisation of the MDU, the development of programs for management of patients and the difficulties encountered. In the first year, 164 patients were assessed, of whom 36 were judged not to have a primary mood disorder. For the remainder, the most common DSM-III diagnosis was major depressive episode (n = 68), with about half having the melancholic sub-type. It is argued that a specialised diagnosis-related facility is feasible within a general hospital psychiatry service with area health commitments.     

Early symptoms of mania and the role of parental risk

OBJECTIVES: The objectives of this study were to: (i) describe the phenomenology of youths diagnosed with subsyndromal bipolar disorders; (ii) describe the phenomenology of youngsters who are the children of bipolar parents, who are also experiencing subsyndromal symptoms of bipolar disorder (patients with 'cyclotaxia'); and (iii) explore which symptoms may be most useful in identifying youths with cyclotaxia. METHODS: Four hundred outpatients between the ages of 5 and 17 years received a diagnostic assessment and psychometric questionnaires pertaining to mood symptomatology and psychosocial functioning. Parental diagnostic information was also obtained. Children and adolescents were assigned to one of three diagnostic groups: a 'syndromal bipolar disorder (BP)' group (n = 118), a 'sub-syndromal bipolar (SUB-BP)' group (n = 75), or a 'non-bipolar (NON-BP)' group (n = 207). In addition, based on parental diagnoses, youths were assigned to either a high genetic risk group (n = 167) or a low genetic risk group (n = 233). RESULTS: Youths with subsyndromal bipolar disorders were found to have intermediate degrees of manic symptoms than youths with bipolar disorder and youths without a bipolar diagnosis. Offspring of parents having a bipolar disorder were more likely to show symptoms of hypomania and mania than youths without a bipolar parent. Youths at genetic risk for developing a bipolar disorder were not found to be at higher risk for having a diagnosis of attention-deficit hyperactivity disorder or a disruptive behavior disorder. Finally, results suggest that elevated mood with irritability and rapid mood fluctuations are the key distinguishing characteristics of 'cyclotaxia'. CONCLUSIONS: There exists a group of youngsters who are the offspring of a parent/parents with a bipolar disorder who do not suffer from BP 1 or BP 2, yet have elevated mood symptoms and psychosocial dysfunction. As a result of these observations, treatment studies are needed for youths with 'cyclotaxia'.