儿童少年情感性精神障碍42例临床分析

分析了42例儿童少年情感性精神障碍的临床资料。发现男：女为2．23：1,以双相情感障碍最多;多有精神病家族史,其性格特征多偏内向;发病多在春季,起病有一定的精神因素;临床症状及治疗与成人相仿,成人的诊断标准稍加修改可以用于儿童少年。     

1例发作性睡病的6岁孩子最初误诊为不典型癫痫的病例报告(英文)

本文报告1例6岁女童首次发生发作性睡病被误诊为不典型癫痫。之后10个月在8家不同医院被误诊为其他疾病,最后才得以确诊。发作性睡病的诊断在小儿中比较困难,因为睡眠发作、猝倒、入睡前幻觉和睡眠麻痹四个主要症状都存在的病例在儿童中极少见到。患儿往往发作期更长、症状多样化。为了缩短从首次发病到确诊的时间,我们建议对所有不明原因过度睡眠的患儿监测睡眠并进行睡眠潜伏期试验,以排除发作性睡病的可能,而不论其相关症状如何。该病例凸显出罕见精神障碍的表现可以是多种多样的,特别是儿童。这就需要临床医生在采集病史时要充分考虑这些病例的非典型表现。     

188例情感性精神障碍患者临床分析

目的：调查情感性精神障碍患者的诊断和治疗情况。方法：选取某日我院心理科住院的188例情感性精神障碍患者,分析其临床资料。结果：双相谱系障碍诊断率为12．8％,新型抗抑郁药应用比例96．3％,合并苯二氮革类药物比例达95．2％,情感稳定剂使用率＜5％。结论：医生对双相障碍识别率不高,对情感稳定剂的认识不够全面.     

情感性障碍发病与性别关系的分析

为探讨情感性障碍发病与性别的关系，对３０年前首次入院经再确诊的１０２例情感性障碍Ⅰ级亲属中同病者的发病与性别关系进行了分析。结果发现，Ⅰ级亲属情感性障碍患者总体分析未见发病与性别有关；但从遗传学角度分析，显示女先证者Ⅰ级亲属情感性障碍患病风险率比男先症者Ⅰ级亲属大得多（Ｐ＜０．０１）。此结果有助于提高对情感性精神障碍遗传学的认识，对本病女病人的婚育及心理卫生保健也有重要意义。     

30例儿童情感性精神障碍临床分析

分析了３０例住院治疗的儿童情感性精神障碍者的临床资料，发现单相患者５例，双相患者２５例，其中４例诊断为快速循环型，临床症状与成人基本相似。４３．３３％有阳性精神病家族史，疗效和学业优秀、业余爱好、外向性格及阳性家族史呈正相关，并就儿童情感性精神障碍的诊断，临床表现及治疗等问题进行了讨论。     

军人精神障碍与生活事件的相关研究

为探讨军人精神障碍与生活事件的关系,对２４６例首次住院军人精神障碍患者进行分析研究。结果显示：军人精神障碍以精神分裂症最多,其次为心因性精神障碍、神经症、情感性精神障碍。生活事件以评优受挫、人际关系紧张,名誉受损为多见;生活事件不但与心因性精神障碍有密切关系,而且在神经症、情感性精神障碍及发病中也起着一定的作用。     

儿童青少年双相情感障碍的研究进展

由于儿童双相情感障碍 (以下简称情感障碍 )的症状受发育性因素影响 ,症状易重叠于其他儿童期障碍等原因 ,常给儿童精神科医师对其诊断带来一定的困难 ,易导致漏诊和误诊[1 ,2 ] 。然而 ,据报道 ,在情感障碍患者中有 2 0 %～ 54 %首次发病在青少年期 ,有近 1 0 %的病例在 1 2岁以前就已起病[2 ,3] ,故儿童情感障碍已并非罕见。为此 ,我们就儿童青少年双相情感障碍的研究进展进行综述。一、流行病学1 患病率 :由于采用的诊断标准与研究方法不一 ,致使报道的患病率也颇不一致 ,但大多数的意见认为其患病率至少不低于成人[1 ,2 ,4] 。Ｃａｒｌ…     

与迷信巫术相关的精神障碍44例分析

目的：探讨与迷信巫术相关的精神障碍的临床特征、治疗和转归。方法：对出院诊断为与迷信巫术相关的精神障碍患者44例进行2年随访，按中国精神疾病分类方案与诊断标准第2版修订本进行再诊断。结果：23例(52．3％)患者维持原诊断，21例(27．7％)的患者更正诊断，精神分裂症10例，情感性精神障碍8例，癔症3例。结论：迷信、巫术是致病因素，可引发“与迷信巫术相关的精神障碍”疾病，也可是其他精神障碍，尤其是精神分裂症、情感性精神障碍的一种诱因。     

43例情感性精神障碍司法精神病鉴定分析

目的：探讨情感性精神障碍司法精神病鉴定特点。方法：回顾性分析43例情感性精神障碍司法精神病鉴定特点。结果：情感性精神障碍占同期鉴定案例的4.5%，以男性、21－40岁为多。凶杀案在抑郁症的发生率明显高于躁狂症，盗窃抢劫和性犯罪在躁狂症的发生率明显高于抑郁症。抑郁症和躁狂症部分责任能力与无责任能力评定例数相仿。结论：情感性精神障碍患者涉及刑事案件有其大致规律，其责任能力评定有一定分歧，鉴定时应掌握全部材料作综合分析，并重视认知功能对辨认能力的影响。     

不同性别情感性障碍患者临床特征的研究

为探讨本地区不同性别情感性精神障碍的临床表现、治疗及疗效等的差异 ,本文对 1996～ 1997年间在我院住院治疗的情感性精神障碍患者的临床资料进行了分析 ,现将结果报告如下。1　资　　料1 1　一般资料　对象为 1996年 1月至 1997年在我院住院 ,出院诊断为情感性精神障碍共 115例 ,由二位高年资医师按照ＣＣＭＤ— 2—Ｒ中的诊断标准进行再诊断 ,剔除 16例诊断依据不足者 ,99例确诊为情感性精神障碍。其中单相型 2 9例 ,双相型[1] 70例。单、双相之比为 1 2 4;单相型男 11例 ,女 18例 ,男女之比为 1 1 64。双相型男 44例 ,女 2 6例 ,男女之…     

Beyond genetics: childhood affective trauma in bipolar disorder

Objectives: Despite the demonstrated high heritability of bipolar disorder, few susceptibility genes have been identified and linkage and/or association studies have produced conflicting results. This search for susceptibility genes is hampered by several methodological limitations, and environmental risk factors for the disease (requiring incorporation into analyses) remain misunderstood. Among them, childhood trauma is probably the most promising environmental factor for further investigation. The objectives are to review the arguments in favor of an association between childhood trauma and bipolar disorder and to discuss the interpretations of such an observation. Methods: We computed a literature search using PubMed to identify relevant publications concerning childhood trauma and bipolar disorder. We also present some personal data in this field. Results: Growing evidence suggests that incidences of childhood trauma are frequent and severe in bipolar disorder, probably affect the clinical expression of the disease in terms of suicidal behavior and age at onset, and also have an insidious influence on the affective functioning of patients between episodes. The relationships between childhood trauma and bipolar disorder suggest several interpretations, mainly a causal link, a neurodevelopmental consequence, or the intergenerational transmission of traumatic experiences. The neurobiological consequences of childhood trauma on a maturing brain remain unclear, although such stressors may alter the organization of brain development, leading to inadequate affective regulation. Conclusions: Childhood trauma is associated with bipolar disorder and its clinical expression and may interact with genetic susceptibility factors. Although not completely understood, the relationships between childhood trauma and bipolar disorder require further attention. Several suggestions for further exploration of this environmental factor and of its interaction with susceptibility genes are proposed.     

Borderline personality disorder criteria associated with prospectively observed suicidal behavior

OBJECTIVE: The authors prospectively examined associations between each DSM-IV borderline personality disorder criterion and suicidal behaviors. METHOD: Borderline personality disorder diagnosis and criteria, major depressive disorder, substance use disorders, and history of childhood sexual abuse were assessed with semistructured interviews. Participants (N=621) were followed for 2 years with repeated structured evaluations that included assessments of suicidality. RESULTS: With the self-injury criterion excluded, the borderline personality disorder criteria of affective instability, identity disturbance, and impulsivity significantly predicted suicidal behaviors. Only affective instability and childhood sexual abuse were significantly associated with suicide attempts (i.e., behavior with some intent to die). CONCLUSIONS: Affective instability is the borderline personality disorder criterion (excluding self-injury) most strongly associated with suicidal behaviors. Since major depressive disorder did not significantly predict suicidal behaviors, the reactivity associated with affective instability (more so than negative mood states) appears to be a critical element in predicting suicidal behaviors.     

Childhood attention deficit hyperactivity disorder features in adult mood disorders

A significant overlap between childhood mood disorders and many aspects of attention deficit hyperactivity disorder (ADHD) has been established. High rates of co-occurrence, familial aggregation, and more severe clinical manifestations of the illnesses when they are comorbid suggest that common genetic and environmental factors may contribute to the development of both disorders. Research on the co-occurrence of childhood ADHD and mood disorders in childhood has been conducted. We retrospectively investigated childhood ADHD features in adults with mood disorders. Childhood ADHD features were measured with the Korean version of the Wender Utah Rating Scale (WURS). The sample consisted of 1305 subjects: 108 subjects were diagnosed with bipolar disorder type I, 41 with bipolar disorder type II, 101 with major depressive disorder, and 1055 served as normal controls. We compared total WURS scores as well as scores on 3 factors (impulsivity, inattention, and mood instability and anxiety) among the 4 different diagnostic groups. The 4 groups differed significantly from one another on all scores. The group with bipolar disorder type II obtained the highest total scores on the WURS. The impulsivity and inattention associated with childhood ADHD were more significantly related to bipolar disorder type II than with bipolar disorder type I. The mood instability and anxiety associated with childhood ADHD seem to be significantly related to major depressive disorder in adulthood. In conclusion, multifactorial childhood ADHD features were associated with mood disorders of adulthood.     

Comorbidity of attention deficit hyperactivity disorder with early- and late-onset bipolar disorder

OBJECTIVE: The relationship between attention deficit hyperactivity disorder (ADHD) and earlier age at onset of affective illness was examined in probands with a history of bipolar disorder. METHOD: The authors assessed 56 adult bipolar subjects. Those with a history of childhood ADHD (N=8) were age and sex matched with bipolar subjects without a history of childhood ADHD (N=8). RESULTS: The age at onset of the first affective episode was lower for the subjects with bipolar disorder and a history of childhood ADHD (mean=12.1 years, SD=4.6) than for those without a history of childhood ADHD (mean=20. 0 years, SD=11.3). CONCLUSIONS: ADHD in children of bipolar probands might identify children at highest risk for development of bipolar disorder.     

Social competence and positive and negative symptoms: a longitudinal study of children and adolescents at risk for schizophrenia and affective disorder

OBJECTIVE: The authors longitudinally examined social competence and positive and negative symptoms in children at risk for schizophrenia, children at risk for affective disorder, and matched normal subjects. METHOD: The subjects were offspring of parents with schizophrenia or affective disorder and normal comparison subjects matched on age, sex, and socioeconomic status. Ratings of social competence (Premorbid Adjustment Scale), affective flattening and poverty of speech (Scale for the Assessment of Negative Symptoms), and positive formal thought disorder (Scale for the Assessment of Positive Symptoms) were based on videotaped psychiatric interviews conducted in childhood (N = 144), early adolescence (N = 127), and adolescence (N = 106). RESULTS: In childhood, there were no significant group differences. In early adolescence, the subjects at risk for schizophrenia had poorer social competence than those at risk for affective disorder and the normal subjects. In early adolescence, the subjects at risk for schizophrenia also had greater positive thought disorder than those at risk for affective disorder but did not differ significantly from the normal subjects; there were no differences in negative symptoms. In adolescence, the subjects at risk for schizophrenia had poorer social competence and greater positive and negative symptoms than the adolescents at risk for affective disorder and the normal subjects. CONCLUSIONS: During early adolescence and adolescence, poor social competence may be more characteristic of children at risk for schizophrenia than those at risk for affective disorder. Higher levels of positive and negative symptoms may also be specific to subjects at risk for schizophrenia, but only during adolescence.     

Childhood abuse and platelet tritiated-paroxetine binding in bulimia nervosa: implications of borderline personality disorder

BACKGROUND: Co-occurrence of bulimia nervosa and borderline personality disorder has been attributed to shared factors, including childhood abuse and disturbances in central serotonin (5-hydroxytryptamine; 5-HT) mechanisms. To explore this notion, we conducted a controlled assessment of childhood abuse and 5-HT function in bulimics with and without borderline personality disorder. METHOD: Forty patients with bulimia nervosa, confirmed with the Eating Disorders Examination interview (14 with borderline personality disorder and 26 without), and 25 normal-eater controls were assessed for clinical symptoms (eating disturbances, mood lability, impulsivity, and dissociation) and childhood sexual and physical abuse. We also conducted tests of platelet tritiated-paroxetine binding in blood samples from 27 of the bulimics (11 with borderline personality disorder and 16 without) and 16 of the controls. RESULTS: Relative to normal eaters, bulimics showed greater affective instability, overall impulsivity, and a history of physical abuse. However, borderline bulimics alone showed elevated motor impulsivity, dissociation, and rates of sexual abuse. Paroxetine-binding tests indicated no differences attributable to comorbid borderline personality disorder, instead linking bulimia nervosa with or without borderline personality disorder to substantially reduced 5-HT transporter density. CONCLUSION: Results suggest relatively autonomous pathologic entities: one, relevant to bulimia nervosa, being associated with abnormal 5-HT transporter function and affective instability, but relatively independent of childhood sexual abuse; another, relevant to borderline personality disorder, onto which sexual abuse, dissociative symptoms, and behavioral impulsivity converge. We propose that abnormal 5-HT function may, however, constitute one basis for the frequent co-occurrence of bulimic and borderline disturbances.     

A comparison of different diagnostic tools for childhood depression

A comparison was made of the agreement of 5 different diagnostic tools for childhood depression. The diagnostic tools used were: 1) a non-directive interview with projective testing; 2) a semi-structured psychiatric interview developed by Herjanic; 3) the child behaviour check list developed by Achenbach; 4) the Kovacs child depression inventory and 5) the DSM-III criteria diagnosis. In the diagnostic tools using classic psychiatric techniques of interview there was a fairly high diagnostic agreement for depression, while the non-interview techniques (questionnaires) were less reliable in diagnosing affective disorder. Depressive symptoms were found to play an important part in non-affective disorder psychopathology in children. The good correlation between the standard intake procedure and the research methods is encouraging in that it seems that clinicians can make the diagnosis of childhood affective disorder in their everyday clinical work.     

Relationship between childhood behavioral disturbance and later schizophrenia in the New York High-Risk Project

OBJECTIVE: An association between childhood behavioral disturbance and adulthood schizophrenia has been seen previously in retrospective or follow-back studies and in prospective studies. The authors examined the relationship between childhood behavioral problems and adulthood schizophrenia-related psychoses. Because a high rate of childhood behavioral problems is known to be associated with adult substance abuse, these analyses controlled for substance abuse. METHOD: The subjects of this investigation (N = 185) were offspring of parents with schizophrenia or affective disorder and of normal parents from the New York High-Risk Project (sample A). Data on childhood behavioral problems were obtained in a parent interview at initial assessment in 1971-1972. Adulthood outcomes (schizophrenia-related psychoses, affective disorders, anxiety disorders, substance abuse) were based on lifetime axis I diagnoses according to the Research Diagnostic Criteria. RESULTS: Substance abuse had a significant interaction with the clinical outcome groups. In subjects without substance abuse, those with schizophrenia-related psychoses had exhibited significantly more behavioral problems as children than had adult offspring with affective or anxiety disorder or with substance abuse only or no disorder. CONCLUSIONS: These results support the view that schizophrenia-related psychoses can be followed back to early behavioral disturbances. The confounding effects of substance abuse should be statistically controlled in studies of longitudinal associations between childhood behavioral disturbance and axis I outcomes.     

Characteristics of patients with major depression in combination with dysthymic or cyclothymic disorders. Childhood and precipitating events

The relationship between patients with acute major depression and chronic affective disorders was investigated in 298 nonpsychotic outpatients. The patients were categorized into 4 groups: major depression only, major depression with dysthymic or cyclothymic disorders, dysthymic or cyclothymic disorder without major depression and one group of other psychiatric disorders. The patients were interviewed about childhood losses, relationship to parents and siblings and family atmosphere, their personality characteristics as children, as well as precipitating events. The reports in the various diagnostic groups were compared. Patients in the mixed group reported somewhat more traumatic childhood experiences compared with patients in the pure major depression group and pure dysthymic-cyclothymic group, and much more traumatic childhood experiences compared with patients in the group of other disorders. Precipitating events among patients in the acute major depression group consisted of more acute external stressors compared with the events of the patients in the group of chronic affective disorders. Patients with major depression in combination with pure dysthymic-cyclothymic disorder generally remembered their childhood as having been more traumatic, with a less satisfying relationship to their parents.     

A history of childhood attention‐deficit hyperactivity disorder (ADHD) impacts clinical outcome in adult bipolar patients regardless of current ADHD

Objective: The occurrence of comorbid attention‐deficit hyperactivity disorder (ADHD) might have an impact of the course of the bipolar disorder. Method: Patients with bipolar disorder (n = 159) underwent a comprehensive evaluation with respect to affective symptoms. Independent psychiatrists assessed childhood and current ADHD, and an interview with a parent was undertaken. Results: The prevalence of adult ADHD was 16%. An additional 12% met the criteria for childhood ADHD without meeting criteria for adult ADHD. Both these groups had significantly earlier onset of their first affective episode, more frequent affective episodes (except manic episodes), and more interpersonal violence than the bipolar patients without a history of ADHD. Conclusion: The fact that bipolar patients with a history of childhood ADHD have a different clinical outcome than the pure bipolar group, regardless of whether the ADHD symptoms remained in adulthood or not, suggests that it represent a distinct early‐onset phenotype of bipolar disorder.