儿童青少年精神障碍流行病学及相关因素研究

儿童青少年的心理和精神健康关系到是否能够健康成长,并更好的适应社会,是全民健康的重要组成部分.近年来,儿童青少年的心理精神问题越来越引起人们的广泛关注.本文综述了国内外儿童青少年精神障碍的流行病学调查及影响因素的研究,以及公众对儿童精神卫生的就诊态度进行了详尽介绍.     

儿童青少年精神障碍患者睡眠不足及相关因素

目的 探讨儿童青少年精神障碍患者睡眠不足的现况及相关影响因素。方法 选取2021年2月-6月就诊于阜阳市第三人民医院且符合《国际疾病分类（第10版）》（ICD-10）精神分裂症、抑郁障碍、童年情绪障碍诊断标准的131例儿童青少年患者为研究对象,采用自制调查问卷收集患者的一般人口学资料、睡眠情况、生活情况、家庭和学校情况等信息,比较睡眠充足组和睡眠不足组人口学资料的差异,采用Spearman法分析患者睡眠不足的相关因素。结果 ①在131例儿童青少年精神障碍患者中,93例（71.0%）存在睡眠不足,睡眠不足组与睡眠充足组在疾病类别（χ²=8.798,P=0.012）、近6个月内被打（χ²=3.427,P=0.035）或被骂（χ²=4.145,P=0.031）以及一年内遭受网络欺凌（χ²=4.187,P=0.041）方面,差异均有统计学意义。②在睡眠不足的患者中,77例（82.8%）存在入睡困难,69例（74.2%）存在夜间多醒。③儿童青少年精神障碍患者睡眠不足与近6个月内有被骂经历（r=0.210,P=0.037）或被打经历（r=0.145,P=0.023）以及一年内遭受网络欺凌（r=0.179,P=0.041）呈正相关。结论 儿童青少年精神障碍患者睡眠不足的发生风险较高,且与抑郁障碍、有被打和被骂经历、经受过网络欺凌相关。     

儿童青少年时期精神障碍的遗传学研究Ⅱ

儿童和青少年时期除易患成年期精神疾病外，有些精神障碍易在这一年龄段中发生，如脆性X综合征、神经性厌食和神经性贪食、注意缺陷与多动障碍、Tourette’S综合征、儿童孤独症和反社会人格障碍等。本文拟就近年来注意缺陷与多动障碍、Tourette’S综合征、儿童孤独症和反社会人格障碍等的遗传学研究进展概述如下。     

无抽搐电休克治疗在儿童青少年精神障碍患者中的应用

对MECT在儿童青少年精神障碍患者中应用作以综述,介绍了儿童青少年患者MECT治疗的历史情况,国内外的研究现况以及儿童青少年患者MECT治疗的风险、适应证、禁忌证和展望。     

儿童青少年脑外伤所致精神障碍远期调查及其与成年人的比较分析

目的探讨儿童青少年脑外伤后4～10年远期器质性精神障碍的发生率及其与成年人的差异。方法对深圳市39家医院的脑外伤病例进行系统抽样,采用自编的《颅脑外伤后精神障碍状况调查手册》对抽样的105例脑外伤儿童青少年患者的精神障碍进行随访调查,并与同期调查的570例成人脑外伤患者进行比较。由二名副主任及以上职称的精神科医师面检筛查阳性者,并按照CCMD-3脑外伤所致精神障碍的诊断标准明确诊断。结果 20.0%(21/105)儿童青少年在调查时符合脑外伤所致精神障碍的诊断,包括:行为(人格)改变12.38%(13/105),智能损害8.57%(9/105),脑外伤后综合征6.67%(7/105),抑郁综合征1.90%(2/105)。重型脑外伤所致精神障碍发生率显著高于中型和轻型(2=8.08,P0.05;2=20.43,P0.01)。儿童青少年组颅脑外伤所致远期精神障碍总发生率明显较成人组低(2=6.49,P0.05),主要是智能损害和抑郁综合征发生率低于成人组(2=6.84,P0.05;2=6.02,P0.05)。结论儿童青少年脑外伤对精神损伤的远期影响较成人好。     

儿童青少年精神障碍患者问题性网络使用发生率及危险因素分析

目的:新冠肺炎疫情流行期间,问题性网络使用(problematic internet use, PIU)发生率较前明显升高。本研究拟探讨儿童青少年精神障碍患者PIU的发生率及危险因素。方法:选取精神分裂症、抑郁障碍、童年情绪障碍儿童青少年患者,收集一般人口学资料及临床数据,采用中文版杨氏网络成瘾量表(IAT)评估患者PIU的严重程度。结果:PIU组与非PIU组患者在疾病类别、自身健康水平、体育锻炼、每周早饭次数、入睡困难、夜间多醒、师生关系、家庭经济情况、遭受网络欺凌、自杀意念及自杀行为等方面存在统计学差异(P<0.05)。相关分析显示,精神障碍患儿共病PIU与较差的健康水平,较少的体育锻炼及每周早饭次数,较差的师生关系、睡眠质量及家庭经济状况,遭受过网络欺凌、既往存在自杀意念或行为等方面差异有统计学意义(P<0.05)。二元Logistic回归分析发现,较差的自身健康水平、较差的师生关系是精神障碍患儿伴PIU的危险因素。结论:与不伴PIU的精神障碍患儿相比,伴PIU的患儿表现出更多的不良生活方式、睡眠质量欠佳、较多的行为障碍。而PIU的解决可能有效缓解精神障碍儿童的病情程...     

儿童青少年强迫症研究进展

儿童青少年强迫症是儿童青少年期常见的精神障碍之一.本文就儿童青少年强迫症病因,临床表现、诊断、治疗以及预后等方面的研究进展进行综述.     

SSRIs在儿童及青少年精神障碍中的应用

目的：了解选择性5—羟色胺回收抑制剂(SSRI)类在儿童及青少年精神障碍中的应用。方法：对儿童精神科门诊使用SSRIs的75例患者进行回顾性分析。结果：SSRIs已广泛应用于治疗多种儿童及青少年精神障碍。结论：SSRIs对部分儿童及青少年精神障碍疗效较好，安全性高。     

首次住院儿童青少年精神障碍患儿父母压力调查及干预研究

目的 调查首次住院儿童少年精神障碍患儿父母的心理压力状况,并通过干预指导,改善父母心理状况.方法 采用心理身体紧张松弛测试表(PSTRI)和自编问卷的方法 ,对121例患儿父母的心理压力及对精神障碍相关知识了解程度进行了调查,并对其实施有针对性地干预指导.结果 通过干预,患儿出院时其父母心理压力状况明显优于患儿入院时,有显著性差异(X2=147.02,P<0.01);患儿父母在精神疾病基本知识、药物治疗知识、护理知识、促进康复知识、预防知识掌握上,入院时与出院时相比具有显著性差异(X2=144.39～171.68,P<0.01).结论 首次住院的儿童少年精神障碍患儿父母心理压力普遍较重,对其进行有针对性地干预指导,可有效改善父母心理状况,有助于精神障碍患儿的治疗及减少复发.     

Autism spectrum disorders in children and adolescents with Moebius sequence

Moebius sequence is a rare congenital disorder usually defined as a combination of facial weakness with impairment of ocular abduction. A strong association of Moebius sequence with autism spectrum disorders (ASDs) has been suggested in earlier studies with heterogenous age groups. The primary caregivers of all children and adolescents with Moebius sequence aged 6–17 years known to the German Moebius foundation were anonymously asked to complete two screening measures of ASD [Behavior and Communication Questionnaire (VSK); Marburger Asperger’s Syndrome Rating Scale (MBAS)]. For those who reached the cut-off for ASD, well standardized diagnostic instruments (Autism Diagnostic Interview-Revised, Autism Diagnostic Observation Schedule, WISC-III, and Kinder-DIPS) should be administered. Minimal diagnostic criteria for Moebius sequence were congenital facial weakness (uni- or bilateral) and impairment of ocular abduction (uni- or bilateral). Familiar cases should be excluded. The primary caregivers of 35/46 children and adolescents (18 males, 17 females, mean age 11.5 years) sent back completed questionnaires, but only 27 subjects met inclusion criteria. According to the primary caregivers, none of these subjects showed mental retardation. Two probands (both males 9 and 16 years old) reached the cut-off of the MBAS whereas the results of the VSK did not indicate ASDs in any of the patients. The 9 year old boy could be examined personally and did not meet diagnostic criteria of ASD. ASDs might be not as frequent as reported in previous studies on patients with Moebius sequence, at least not in patients without mental retardation.     

儿童青少年非自杀性自伤的研究现状

本文目的是对儿童青少年非自杀性自伤（NSSI）的研究现状进行综述,为儿童青少年NSSI行为的认识与干预提供参考。NSSI行为是自杀的独立危险因素,不仅严重威胁到儿童青少年的身心健康,而且也给其家庭及社会带来了极大的负担。本文将对儿童青少年NSSI行为的流行病学、病因学、与其他精神疾病之间的关系以及治疗进行阐述。     

2153例儿少精神科住院患者精神疾病分布及药物使用

目的 调查南京脑科医院儿童心理卫生研究中心住院部儿童青少年患者疾病谱的分布以及临床最终治疗方案中药物的选择。方法 对2012年3月-2019年7月在南京脑科医院儿童心理卫生研究中心住院部住院治疗的儿童青少年患者出院时的诊断分类及出院当日药物治疗的种类、剂量等进行回顾性分析。结果 ①共纳入2 153例患者,调查结果显示,最常见的病种分别为精神分裂症及相关谱系障碍（40.8%）、神经发育障碍及其伴发障碍（17.4%）、抑郁障碍（16.6%）。②共2 098例（98.3%）患者的处方中有精神类药物,精神类药物处方频率前5位依次为阿立哌唑677例（32.3%）、舍曲林570例（27.2%）、奥氮平407例（19.4%）、利培酮352例（16.8%）、丙戊酸钠256例（12.2%）。③不同年代药物使用变化趋势分析显示,近3年抗精神病药物的使用频率均低于前4年的使用频率（P<0.05）,其余药物在不同年代的使用频率差异无统计学意义（P>0.05）。④儿童组使用阿立哌唑、利培酮的频率高于青少年组（P<0.05）,青少年组使用奥氮平、帕利哌酮、喹硫平的频率高于儿童组（P<0.05）。与女性患者相比,男性患者使用利培酮的频率更高（P<0.05）,使用阿立哌唑、喹硫平的频率更低（P<0.05）。结论 住院儿童青少年精神疾病患者的药物使用情况随着年代的变迁而不断变化,处方药物的种类与病种、患者年龄、性别及年代密切相关。     

Peripheral psychophysiological reactivity to mental tasks in children with psychiatric disorders

Summary Peripheral psychophysiological reactivity (skin conductance and heart rate changes) to mental activity tasks (imagery and listening to music) was examined in child psychiatric day or in-patients with conduct and emotional disorders. Children with predominant antisocial symptomatology showed higher electrodermal than cardiovascular reactivity to the experimental tasks, whilst children with predominant neurotic symptoms showed more marked cardiovascular reactivity. No statistical differences between the groups emerged in response to listening to music, but antisocials were more responsive (with higher skin conductance level increases) to imagining pleasant situations, whereas neurotics were more reactive (increased heart rate levels and decreases in skin conductance) to imagining unpleasant situations. The results are compatible with an enhanced biological responsiveness by antisocials to reward and with neurotics experiencing an unusually marked sense of threat and withdrawal to aversive stimuli.     

抗抑郁药物治疗儿童青少年抑郁症的临床试验进展

本文目的是归纳并总结新型抗抑郁药物治疗儿童青少年抑郁症的效果和安全性,为儿童青少年抑郁症的药物干预提供参考。抑郁症是儿童青少年常见的精神疾病之一,严重影响患者的健康成长,可造成自杀等严重不良后果。使用抗抑郁药物是治疗儿童青少年抑郁症的重要手段,然而可用于儿童青少年的抗抑郁药物种类较少,临床应用受到一定限制。本文就近十年抗抑郁药物治疗儿童青少年抑郁症的临床试验进展进行综述。     

精神障碍冲动性攻击的相关机制研究进展

攻击是任何形式的有目的的伤害另一生物体而为该生物体所不愿接受的行为[1],是很多精神障碍的共同特征,重性精神障碍攻击行为发生率为34%~70%.攻击行为有多种分类方法,最常见的是将其分为"冲动性攻击"和"预谋性攻击".冲动性攻击指无计划的、不可控的、非目标取向的爆发式攻击行为,预谋性攻击则指有计划的、可控的、目标取向的攻击行为[2].冲动性攻击在间歇性暴发性障碍中尤为典型,关于冲动性攻击的研究也多在相关领域开展.冲动性攻击的机制十分复杂,目前的研究提示其发生可能受生物学因素、心理学因素、社会学因素以及它们之间相互作用的影响.本文围绕上述几个方面在精神障碍冲动性攻击行为的研究进展进行综述.     

儿童青少年品行障碍门诊病案分析

目的了解儿童及青少年品行障碍的发生情况及其相关因素。方法以l990年1月至2001年12月期间就诊的96例品行障碍者(年龄在8～18岁之间)作为病例组，根据当时的病历记载所需资料内容．与对正常健康儿童及青少年的调查内容作对照。结果96例品行障碍者以男性多于女性．且随年龄增长有呈逐年增长的趋势，其中以12～15岁为发病率最高。父母文化程度、教育方式及教育态度对品行障碍的发生有着直接影响。结论儿童及青少年品行障碍的发生虽取决于多种因素，但是与其父母的文化程度、家庭教养方式及教育态度有着密切的关系。     

Prevalence of psychiatric disorders in children and adolescents with and without intellectual disability

Background There have been very few population‐based studies of the prevalence of psychiatric disorders among children and adolescents with and without intellectual disability (ID). Methods Secondary analysis of the 1999 Office for National Statistics survey of the Mental Health of Children and Adolescents in Great Britain was performed. This survey collected information on a multistage, stratified, random sample of 10 438 children between 5 and 15 years of age across 475 postcode sectors in England, Scotland and Wales. Results The prevalence of any diagnosed ICD‐10 disorder, conduct disorder, anxiety disorder, hyperkinesis and pervasive developmental disorders were significantly greater among children with ID than among their non‐ID peers. There were no statistically significant differences between children with and without ID with regard to the prevalence of depressive disorders, eating disorders or psychosis. Factors associated with an increased risk of psychopathology among children and adolescents with ID included age, gender, social deprivation, family composition, number of potentially stressful life events, the mental health of the child's primary carer, family functioning and child management practices. Conclusions Children and adolescents with ID are at significantly increased risk of certain forms of psychiatric disorder. Careful consideration of the social and economic adversity facing such families will be necessary to ensure that support services are responsive to both the needs of child as well as the needs of the family in which they are living.     

Frequency and patterns of mental health services utilization among adolescents with anxiety and depressive disorders

The main aim of this study was to examine the frequency and patterns of mental health services utilization among 12- to 17-year-old adolescents with anxiety and depressive disorders. Another aim was to examine the factors associated with the use of mental health services. The study population comprised 1,035 adolescents randomly recruited from 36 schools. Anxiety and depressive disorders were coded based on DSM-IV criteria using the computerized Munich version of the Composite International Diagnostic Interview. Only 18.2% of the adolescents who met DSM-IV criteria for anxiety disorders, and 23% of those with depressive disorders, used mental health services. Among adolescents with anxiety disorders, mental health services utilization was associated with past suicide attempt, older age, the presence of comorbid disorders, as well as parental anxiety and depression. The only factor that predicts the use of mental health service among adolescents with depressive disorder was a history of suicide attempt. The implication of the results in terms of tailoring services for children and adolescents with anxiety and depressive disorders are discussed.