中国七个地区精神残疾,智力残疾流行病学调查

目的了解９０年代我国精神残疾和智力残疾状况。方法于１９９３年在国内７个地区进行精神疾病流行病学调查，采用我国精神残疾与智力残疾评定工具，对确诊的未治愈患者进行残疾评定。结果在调查的总人口（２３３３３人）中残疾率为７．４６‰，其中精神残疾率为４．１６‰，智力残疾率为３．３０‰；在≥１５岁的１９２２３人中，精神残疾率为５．０５‰（９７例），多为精神分裂症所致；在≥７岁的２１８１５人中，智力残疾率为３．５３‰（７７例），多为精神发育迟滞所致。结论应重点防治精神分裂症和精神发育迟滞，并加强对患者病后的康复医疗     

九江市精神疾病及其残疾流行病学调查

目的：了解九江市各类精神障碍患病率及精神残疾和智力残疾状况。方法：采用中国精神障碍分类与诊断标准第3版、精神残疾与智力残疾评定工具，对九江市11个抽样地区进行流行病学调查。结果：共调查市辖区55户，市辖县550户，共调查2636人。在≥15岁人口中，各类精神障碍的时点患病率为24．33‰，终生患病率为27．80‰，精神残疾率为8．94‰，智力残疾率为4．97‰。在≥7岁人口中，精神发育迟滞的时点患病率为3．31‰。在调查的总人口中，精神残疾率为6．83‰，智力残疾率为3．79‰。结论：心境障碍患病率居首位，精神分裂症和精神发育迟滞居2、3位，酒依赖患病率升高，均应列为防治和研究重点。     

中国七个地区精神发育迟滞流行病学调查

目的了解９０年代精神发育迟滞患病率的变化。方法于１９９３年在７个地区进行流行病学调查。在１９８２年调查方法的基础上，增加儿童用韦克斯勒智力量表对７～１４岁患儿进行智商测查和适应行为判定；用成人智残评定量表评定≥１５岁患者的智力残疾。结果在≥１５岁人口（１９２２３人）中精神发育迟滞的患病率为２．８４‰（６２例），较１９８２年（３．３３‰）有降低趋势（Ｐ＞０．０５）；成人智力残疾平均分为１１．２７分，６２例均为中度及其以上智力残疾。结论精神发育迟滞应列为精神疾病防治重点之一。     

安徽阜阳市精神发育迟滞流行病学调查

目的：了解阜阳市城乡精神发育迟滞患病率及其发生的危险因素。方法：于2000年11月在阜阳市区和3县农村进行精神疾病流行病学调查，共调查≥15岁者33332人。以成人智残评定量表测定智力及进行残疾评定，以CCMD－2－R为诊断标准。结果：共检出中、重度精神发育迟滞患者91例，患病率及残疾率均为2．73‰。随年龄增加患病率有逐步降低趋势，男性患病率高于女性，农村高于城市，单身者占绝大多数。近亲婚配、地区经济落后，母亲文化均为较重要的危险因素。结论：应在经济欠发达的农村及边远地区，大力普及优生优良知识，并将精神发育迟滞为重点防治疾病之一。     

精神疾病患者劳动力鉴定2380例分析

目的：了解精神疾病患者劳动力鉴定情况。方法：收集１９９６～１９９７年劳动力鉴定２３８０例,应用中国精神残疾和智力残疾量表进行评定。结果：精神疾病鉴定９７５例（４１．０％）,智力残疾鉴定７０２例（２９．５％）,精神与智力均残疾者４４例（１．８％）。精神分裂症１１６６例（４９．０％）,精神发这滞７４７例（占３１．４％）,其他４６７例（１９．６％）。结论：两类残疾主要病种为精神分裂症和精神发育迟滞,也是     

496例精神分裂症残疾评定分析

目的：了解精神分裂症致残情况。方法：收集我院1998年1月至2003年7月进行残疾评定的精神分裂症502例，采用中国实用残疾人评定标准评定精神残疾及等级。结果：502例中496例(98．8％)评定为精神残疾，其中Ⅰ级、Ⅱ级、Ⅲ级分别为12．1％、54．8％、33．1％。结论：精神分裂症致残率较高，其程度受性别、婚姻状况、药物依从性及社会支持系统的影响。     

胜利油田1992年精神疾病流行学抽样调查资料分析

参照１９８２年全国精神疾病流行学调查的设计方案、调查流程和调查工具，１９９２年５月～８月进行了胜利油田精神疾病流行学抽样调查。根据整群分层随机抽样的原则，抽取４０００户居民、１４０７６人（其中≥１５岁者１１８０１人）。调查人口占油田总人口的３．８０％。统计结果，胜利油田各种精神疾病的总患病率为１５．５９‰，时点患病率为１４．３２‰。其中，精神分裂症的总患病率为４．４９‰，时点患病率为３．３０‰；酒精依赖的患病率为７．５４‰；精神发育迟滞的患病率为１．０７‰；神经症的患病率为１．６７‰。资料显示。经济文化水平偏低、地理位置偏僻及６０岁以上人群中，精神疾病的患病率水平相对偏高。     

昆明市儿童精神发育迟滞流行病学调查

目的掌握昆明市儿童精神发育迟滞的患病率。方法在昆明市按分层容量比例概率法随机抽取常住居民5033户，以每户家庭中年龄在7~14岁的儿童作为调查对象，采用儿童精神发育迟滞初筛问卷进行筛查。若该问卷初筛阳性者，再进行儿童韦氏智力量表评定。结果共初筛7~14岁儿童847例，其中男431例（50.89%），女416例（49.11%），年龄（10.12±3.92）岁,在校接受教育842例（99.41%）,未接受教育5例（0.59%），城市儿童364例（42.98%），农村儿童483例（57.02%）。儿童精神发育迟滞9例，终生患病率为10.63‰。男性患病率11.60‰，女性患病率9.62‰，不同性别患病率分布有显著性差异（P＜0.05）；城市患病率8.24‰，农村患病率12.42‰，城乡患病率分布有显著性差异（P＜0.05）。儿童精神发育迟滞轻度6例，中度2例，重度1例。结论发生儿童精神发育迟滞与产前因素、围产期因素和产后因素等有关，防治重点应放在农村。     

90年代首都精神卫生问题的现况与前瞻──北京市1991年精神障碍流行学调查报告

１９９１年北京市１６个区县精神卫生流行学调查显示，全市１５岁及以上３５３８５人中精神病总患病率１１．６７‰，现患病率为１０．０３‰；其中精神分裂症总患病率７．２‰居首位，神经症患病率３５．１８‰，精神发育迟滞６．１０‰。此外，酒依赖为１４．３０‰，药物依赖为２．１８‰。上述数字提示，近１０年来各类精神障碍的患病率有增高趋势。     

青海高原精神残疾抽样调查及阳性病例的12例随访

目的：了解青海高原地区精神残疾情况及阳性病例的转归。方法：按照国务院、民政部的全国残疾人抽样调查方案，青海省于1987年4月1日零时对精神疾病进行农家庭户抽样调查，共调查了15105人，并于12年后进行了阳性病例的随访。结果①青海海精神疾病患病率，残疾率较低；②精神分裂症为首要病因，其次为情感性精神病，脑外伤及精神发育不全；③女性患病率高于男性；④汉族患病率于少数民族；⑤12年随访结果表明，由于治疗的严滞后导致残疾率升高，症状明显者比较大。结论青海高原地区的精神残疾有其自身特点，阳性病例的预后较差。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.