脂质过氧化和氧自由基酶活性变化与强迫症临床症状的关系研究

目的 :探讨强迫症患者体内氧化、抗氧化系统的状态及其与临床症状的关系。方法 :采用超氧化物歧化酶超微量快速测定法、DTNB直接法、改良红细胞还原型谷胱甘肽二硫双硝基苯甲酸定量测定法和TBA法。测 30例强迫症患者 ,30例正常对照血中SOD、GSH -PX活性 ,GSH含量和血清中LPO含量并做SAS、SDS、Y -BOCS评分。结果 :强迫症组LPO含量 ,SOD活性明显高于正常组、GSH含量则显著降低 (p <0 .0 5 )。强迫症组SAS与SOD呈显著直线正相关。多元逐步回归分析 ,以SAS为应变量显示SAS只与SOD相关。结论 :强迫症患者体内可能存在脂质过氧化亢进 ,氧自由基酶活性变化与临床症状之间可能有相关关系     

青少年强迫现象及其发展特点

目的 :探讨青少年强迫现象及其发展特点。方法 :以班为单位用 L OI- CV调查北京市四所中学六个年级 72个班的学生 ,收回有效问卷 31 85份。平均年龄 1 4 .68± 1 .75岁 ,男生占 52 .2 %。结果 :中学生L OI- CV是 /否得分 :男 8.65± 3.56,女 8.61± 3.40 ;干扰分 :男 9.42± 7.42 ,女 8.50± 6.97。整齐清洁因子是 /否分女生高于男生 (F3 1 0 4,1 =1 3.85,P<0 .0 0 1 )而检查重复因子男生高于女生 (F3 1 1 5,1 =1 5.52 ,P<0 .0 0 1 )。总干扰分男生高于女生 (P<0 .0 5) ,年级对总干扰分及其四个因子的主效应均达显著性水平(F3 0 76～ 3 0 92 ,5=3.0 2～ 1 8.59,P<0 .0 5)。强迫症状总检出率为 1 3.6% ,且男生高于女生 (χ2 =5.40 ,P<0 .0 5)。男生各年级间强迫症状检出率的差异具有显著性 (χ2 =2 2 .81 ,df=5,P<0 .0 1 ) ,女生年级间的差异无显著性(χ2 =5.50 ,P>0 .0 5)。结论 :中学生普遍存在强迫性体验 ,男生以检查与重复内容多见 ,女生以整齐与清洁内容的几率较高。强迫现象具有随年龄增长而呈似‘W’型的发展曲线。强迫症状总检出率为 1 3.6% ,具有在新入学和即将毕业的年级学生中较高的特点 ,提示在中学开展心理健康教育干预是非常必要和紧迫的     

强迫症患者人格特征研究

目的：探讨强迫症患者的人格特征。方法：运用三维人格问卷（TPQ）对39名强迫症患者和31名正常对照者进行人格测定。结果：强迫症患者在猎奇性分量表中因子4（循规蹈矩）评分高于正常对照（t=2．59，P〈0．05），其余因子无统计学差异；在躲避伤害分量表中，各因子及总分均高于对照组（t=3．2．5．45，均P〈0．01）：在奖赏依赖分量表中，因子4（依赖）高于对照组（t=3．64，P〈0．01）；强迫症患者TPQ总分高于对照组（t=5．19．P〈0．001）。两组TPQ各因子评分无性别差异（P〉0．05）。结论：强迫症患者做事循规蹈矩，经常害怕、焦虑，悲观，回避不熟悉的场所和人，更容易疲劳，更需要情感支持。     

Somatization Disorder in Relatives of Children and Adolescents with Functional Abdominal Pain

The mothers of 20 children and adolescents with functional abdominalpain and 20 with abdominal pain from a clear organic ailmentwere given a standardized interview concerning first-and second-degreerelatives of the child. Interviewers were blind to the diagnosisof the children. A significantly higher proportion of childrenwith functional abdominal pain had relatives with either alcoholism,antisocial or conduct disorder, attention deficit disorder,or somatization disorder, compared to children with organicallybased abdominal pain. In particular, 10 of the 20 children withfunctional pain had one or more relatives with somatizationdisorder, while only I child with organic pain had such a relative.Significantly more of these relatives were female than male.The two groups of children also differed significantly on theSomatization scale of the Achenbach Child Behavior checklist.The findings were interpreted as further evidence for the existenceof precursors of somatization disorder in childhood.     

Efficacy of Strattera in Children and Adolescents with Attention Deficit Hyperactivity Disorder

Children and adolescents (25 boys, nine girls, aged from six to 17 years) with attention deficit hyperactivity disorder (ADHD) were treated with Strattera at the optimal dose of 1.2 mg/day in out-patient conditions. After use of Strattera for three months, assessment of treatment efficacy demonstrated marked and moderate clinical effects in 78.1% of patients. Psychologists’ assessment indicated that 80% of children showed improvements in the volume and rate of switching of attention and almost 60% showed improvements in measures of the stability of attention. EEG studies showed decreases in the “index of slowing” in 70.2% of patients. Strattera was found to have good safety and tolerance in the treatment of children and adolescents with ADHD.     

强迫症与人格障碍的共病研究

目的：评估强迫症患者中人格障碍的发生率，探讨强迫症患者与人格障碍的共病情况。方法：使用SCID—Ⅱ对47例强迫症患者和47例正常对照进行人格障碍的评估。结果：61．7％的强迫症患者至少符合一种人格障碍的诊断标准，显著高于对照组，且34％同时患有两种以上的人格障碍；强迫症患者中员常见的人格障碍为强迫型、回避型、消极型以及偏执型；患者的性别及是否有精神疾病家族史对人格障碍的共病率无显著影响。结论：强迫症与人格障碍常有共病现象，强迫型人格障碍同强迫症具有特殊关系，今后在强迫症的生物学研究中应考虑人格特质与人格障碍的影响。     

Attention Deficit Hyperactivity Disorder and Enuresis in Children and Adolescents

The incidences of comorbid disorders and the status of neuropsychological executive functions were evaluated in two groups of patients aged 5–14 years: patients with attention deficit hyperactivity disorder (ADHD) in combination with enuresis (53 patients) and ADHD without enuresis (71 patients). Most cases of enuresis among patients of group 1 (50 of 53) had primary nocturnal enuresis. This group showed a significant increase in the total number of cases of comorbidity with such disorders as oppositional-defiant behavioral disorder, anxiety disorders, ticks, and encopresis, seen in 77.7% of cases as compared with 60.6% in group 2. The presence of enuresis in patients with ADHD was associated with a significant increase in the incidence of anxiety disorders (54.7% as compared with 39.4%). In addition, at age 5–9 years, patients with ADHD with enuresis had a tendency to a higher frequency of oppositional-defiant behavioral disorder and encopresis; those aged 10–14 years showed an increase in the proportion with obsessive-compulsive disorder and tics as compared with patients with ADHD without enuresis. Assessment of measures of executive functions using the Wisconsin card sorting test revealed no differences between patients of the two groups.     

强迫性障碍患者的执行功能研究

目的:探讨影响强迫性障碍患者执行功能的因素。方法:纳入强迫性障碍患者60例,采用威斯康星卡片、连线测验、河内塔测验、Stroop测验,言语流畅性测验等神经心理学测验评定执行功能。同时使用社会功能缺陷量表评定社会功能水平,耶鲁布朗量表评定疾病严重程度,汉米尔顿量焦虑抑郁量表评定合并的焦虑抑郁程度。结果:强迫怀疑的出现与模式转换的威斯康星卡片分类测验的概念认知下降相关(r=-0.388,P<0.01),强迫检查的出现与计划的河内塔测验开始时间长短成正比(r=0.295,P<0.05),强迫仪式动作的出现与抑制的Stroop测验的时间延长和错误数目增加成正比(r=0.278、0.300,P<0.05),强迫询问与流利性的说出数目多少成负相关(r=-0.261,P<0.05)。合并的焦虑抑郁情绪与模式转换的威斯康星卡片分类测验和连线测验的操作时间成正比,与计划的河内塔测验总时间成正比(r=0.297,0.359,P<0.05)。结论:不同强迫症状与执行功能的不同层面相关,合并的焦虑抑郁情绪程度与模式转换、计划能力的下降有关。     

强迫症患者心理防御机制与人格特征研究

目的 :探讨强迫症 (OCD)患者的心理防御机制和人格特征以及二者的关系。方法 :分别运用防御方式问卷 (DSQ)和MMPI对 3 1例强迫症患者和 2 6例正常对照进行防御机制评定和人格测定。结果 :强迫症患者与对照组相比更多地使用被动攻击、潜意识显现、分裂、幻想、退缩等不成熟防御机制 ,而较少使用升华等成熟防御机制 ;强迫症患者MMPI的抑郁、癔症、心理变态、精神衰弱、外显性焦虑等 9个分量表值显著高于对照组 ;强迫症患者的不成熟防御机制同心理变态、偏执、精神衰弱、精神分裂、社会内向等存在显著正相关 (P <0 0 5 ) ;成熟防御机制同社会内向呈显著负相关 (P <0 0 5 )。结论 :强迫症患者更多地使用不成熟的防御机制 ,存在病态的人格特征 ,且二者之间存在明显的相关性 ,有关结果对于强迫症的心理治疗有一定的指导意义。     

Evidence-Based Assessment of Attention Deficit Hyperactivity Disorder in Children and Adolescents

This article examines evidence-based assessment practices for attention deficit hyperactivity disorder (ADHD). The nature, symptoms, associated features, and comorbidity of ADHD are briefly described, followed by a selective review of the literature on the reliability and validity of ADHD assessment methods. It is concluded that symptom rating scales based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994), empirically and rationally derived ADHD rating scales, structured interviews, global impairment measures, and behavioral observations are evidence-based ADHD assessment methods. The most efficient assessment method is obtaining information through parent and teacher rating scales; both parent and teacher ratings are needed for clinical purposes. Brief, non-DSM based rating scales are highly correlated with DSM scales but are much more efficient and just as effective at diagnosing ADHD. No incremental validity or utility is conferred by structured interviews when parent and teacher ratings are utilized. Observational procedures are empirically valid but not practical for clinical use. However, individualized assessments of specific target behaviors approximate observations and have both validity and treatment utility. Measures of impairment that report functioning in key domains (peer, family, school) as well as globally have more treatment utility than nonspecific global measures of impairment. DSM diagnosis per se has not been demonstrated to have treatment utility, so the diagnostic phase of assessment should be completed with minimal time and expense so that resources can be focused on other aspects of assessment, particularly treatment planning. We argue that the main focus of assessment should be on target behavior selection, contextual factors, functional analyses, treatment planning, and outcome monitoring.     

影响强迫症患者健康状况的相关因素分析

目的：探讨强迫症患者健康状况的影响因素。方法：对59名强迫症患者进行SF-36测查．同时进行Yal-Brown Scale、HAMD、HAMA、SDSS、CGI评定及治疗方法、对疾病主观痛苦感、经济负担等调查。结果：相关分析显示强迫症患者的健康状况与强迫、抑郁、焦虑症状；社会功能的各个方面，主观痛苦感、经济负担、是否接受心理治疗呈负相关：多元逐步回归分析在α=0.05水平分别有Yale-Brown的强迫思维，HAMD、HAMA，治疗方法，疾病痛苦感，经济负担及SDSS中的4项进入了SF-36的8个因子方程。结论：强迫症患者健康的影响因素包括疾病的严重程度，社会功能、社会支持及是否接受心理治疗等诸多方面。     

强迫障碍与人格障碍共病患者的人格五因素特征

目的:了解强迫障碍(OCD)与人格障碍共病患者的人格五因素(FFM)特征。方法:符合DSM-IV临床诊断标准的OCD患者,用DSM-IV-TR轴I障碍定式临床检查病人版(SCID-I/P)做定式检查,最终确诊44例患者为被试。用PDQ 4在44例被试中筛查,再用PDI-IV做半定式查询确定其中的人格障碍患者,用NEO-PI-R对所有被试做人格测查并与全国12个城市正常成人NEO-PI-R分比较。结果:44例OCD患者中有32例同时符合人格障碍的诊断,共病率为72.7%。OCD与人格障碍共病组的FFM特征为高神经质(67.9±7.7),低外向性(39.0±10.3)、低顺同性(42.6±7.7)和低严谨性(39.3±12.4),开放性正常(45.6±8.8)。OCD不伴有人格障碍组除开放性维度(38.3±13.4)较低外,其余四个维度均正常。结论:OCD与人格障碍共病的患者除了高神经质、内向以及严谨性较差外,人际关系方面信任感、坦诚性和利他性也较低,体现了人格障碍患者核心的人格特征。OCD不伴有人格障碍的患者主要表现兴趣狭窄,缺乏好奇心,不适应变化,保守等人格特质,却有较好的人际关系。     

Attention Deficit Hyperactivity Disorder in Children and Adolescents Following Traumatic Brain Injury

To better characterize pediatric psychopathology after neurological insult, secondary attention deficit hyperactivity disorder (SADHD)-or ADHD that develops after traumatic brain injury (TBI)-and its clinical and neuroimaging correlates were investigated. Outcome data were available for 118 children, ages 5 through 14 at the time of hospitalization following TBI (severe TBI n = 37; mild-moderate TBI n = 57) and orthopedic injury (n = 24). Standardized psychiatric, adaptive functioning, cognitive functioning, family functioning, and family psychiatric history assessments were conducted on all participants. Severity of injury and neuroimaging lesion assessments were conducted on TBI participants only. The diagnosis of SADHD was mutually exclusive with preinjury ADHD, which occurred in 13 of 94 TBI participants and 4 of 24 orthopedic injury participants. SADHD occurred in 13 of 34 eligible participants with severe TBI but resolved in 4 of 13 of these participants. SADHD also occurred in 1 of 8 eligible moderate TBI participants, only in the presence of preinjury ADHD traits and 3 of 39 of eligible mild TBI cases. SADHD occurred in 1 of 20 of eligible participants with orthopedic injury without any brain injury. SADHD was significantly associated with TBI severity recorded by categorical and dimensional measures, intellectual and adaptive functioning deficits, and personality change due to TBI, but not with lesion area or location. These results suggest that SADHD is a clinically important syndrome after severe TBI in children and adolescents.     

Attention Deficit Hyperactivity Disorder in Children and Adolescents Following Traumatic Brain Injury

To better characterize pediatric psychopathology after neurological insult, secondary attention deficit hyperactivity disorder (SADHD)-or ADHD that develops after traumatic brain injury (TBI)-and its clinical and neuroimaging correlates were investigated. Outcome data were available for 118 children, ages 5 through 14 at the time of hospitalization following TBI (severe TBI n = 37; mild-moderate TBI n = 57) and orthopedic injury (n = 24). Standardized psychiatric, adaptive functioning, cognitive functioning, family functioning, and family psychiatric history assessments were conducted on all participants. Severity of injury and neuroimaging lesion assessments were conducted on TBI participants only. The diagnosis of SADHD was mutually exclusive with preinjury ADHD, which occurred in 13 of 94 TBI participants and 4 of 24 orthopedic injury participants. SADHD occurred in 13 of 34 eligible participants with severe TBI but resolved in 4 of 13 of these participants. SADHD also occurred in 1 of 8 eligible moderate TBI participants, only in the presence of preinjury ADHD traits and 3 of 39 of eligible mild TBI cases. SADHD occurred in 1 of 20 of eligible participants with orthopedic injury without any brain injury. SADHD was significantly associated with TBI severity recorded by categorical and dimensional measures, intellectual and adaptive functioning deficits, and personality change due to TBI, but not with lesion area or location. These results suggest that SADHD is a clinically important syndrome after severe TBI in children and adolescents.     

Assessment of Social Anxiety in Children and Adolescents With Autism Spectrum Disorder

Despite the high prevalence of social anxiety in individuals with autism spectrum disorder (ASD), there is little agreement on how to best assess such problems in this population. To inform evidence‐based assessment, we conducted a comprehensive review of research that has assessed social anxiety in children and adolescents with ASD without co‐occurring intellectual disability. Although some evidence in support of the reliability of existing measures exists, there are concerns about inflated estimates of the co‐occurrence of social anxiety because of symptom overlap with ASD diagnostic criteria, and the diagnostic sensitivity of existing measures is questionable. Recommendations for clinical assessment of social anxiety in this population and future directions for research on this topic, including the development of new measures, are provided.     

强迫症的自尊和自我和谐研究

目的:对门诊强迫症患者的自尊和自我和谐状况进行研究.方法:对52例符合CCMD-3诊断标准的门诊强迫症患者进行一般资料,MAUDSLEY强迫问卷(MOCI),耶鲁布郎强迫量表(Y-BOCS),社会功能缺陷筛选量表(SDSS),主观幸福感阶梯量表(Subjective well-being,SWB),自尊量表(Self-esteem),自我和谐量表(Self consistency and congruence scale,SCCS)评定,并与正常人作对照.结果:(1)强迫症患者的不和谐性(51.40±9.02)、自尊水平(23.67±4.81)高于对照组(35.64±6.91,18.12±5.88)(t=10.008及5.728,P<0.01).(2)主观幸福感与自尊,不和谐性与自尊相关(r=0.580,0.387,P<0.01).结论:强迫症患者的自我和谐性差、自尊水平高可能是疾病的病理基础.     

强迫症合病现象的临床研究

目的：探索强迫症的合病现象，为临床诊断、鉴别诊断和治疗提供依据。方法：以ＳＣＩＤ－Ｐ定式检查提纲收集临床资料，获得符合ＤＳＭ－Ⅲ－Ｒ和ＣＣＭＤ－２－Ｒ的强迫症诊断标准者１２０例，对其整个病程中的临床症状和合病现象进行分析。结果：１２０例强迫症患者在其病程中合并其他精神障碍者８７例，合病率７２．５％。其中，合并１种精神障碍者４０例（３３．３％），合并两种或两种以上精神障碍者４７例（３９．２％）。常见合病有抑郁性障碍（４７．７％）、焦虑性障碍（２７．５％）、人格障碍（２６．７％）、抽动障碍（１７．５％）和一过性精神障碍（１３．３％）。强迫症的不同亚型合并其他精神障碍的类型也有所不同。结论：强迫症合并其他精神障碍相当常见。     

强迫症大五人格与临床症状的相关性

目的:探讨强迫症患者与健康对照相比人格特质的表现,并分析其与焦虑、抑郁症状的关系。方法:分别运用大五人格量表和耶鲁-布朗强迫量表、汉密尔顿焦虑量表(HAMA)及汉密尔顿抑郁量表(HAMD)量表测量和评估47例强迫症患者及47例健康对照的人格特质及临床症状状况,并进行大五人格量表与临床症状的相关分析。结果:强迫症组与健康对照组相比在神经质、外向性及宜人性上具有显著差异;强迫症组在神经质上得分更高;在外向性、宜人性与健康对照组比得分更低(t=7.349,-4.716,3.676;P0.001);另外强迫症患者的神经质,外向性及宜人性方面与临床症状得分显著相关,且神经质与临床症状得分存在正相关;外向性、宜人性与强迫症的临床症状呈现负相关。开放性及尽责性方面没有发现显著的相关性。结论:强迫症组与健康对照组相比具有异常的神经质、外向性及宜人性的人格特质,且与临床症状具有相关性,对于强迫症的心理治疗具有一定指导意义。     

氟伏沙明合并利培酮治疗儿童强迫症的随机对照研究

目的探讨氟伏沙明合并利培酮治疗儿童强迫症的疗效和安全性。方法 96例符合国际疾病分类第10版(ICD-10)诊断标准的强迫症患者随机分为氟伏沙明合并利培酮组(简称合用组,n=48)和单用氟伏沙明组(简称单用组,n=48),治疗6周。采用耶鲁-布朗强迫症量表(Y-BOCS)、焦虑自评量表(SAS)、抑郁自评量表(SDS)评定疗效,采用不良反应症状量表(TESS)评定安全性。结果治疗前,两组在一般人口学资料、病程、Y-BOCS、SDS、SAS各项评分差异均无统计学意义(P>均0.05)。治疗6周末,合用组使用氟伏沙明平均剂量(150.37±23.92)mg,单用组氟伏沙明平均剂量((153.61±21.32)mg,差异无统计学意义(P>0.05)。治疗6周后,合用组的显效率(66.7%)高于单用组(45.8%),差异有统计学意义(χ2=5.671,P<0.05);合用组Y-BOCS评分(12.66±4.41)较单用组(14.53±4.11)低,差异有统计学意义(P<0.05);合用组SDS评分[(41.12±5.69)vs(42.58±6.32),P>0.05]及SAS评分[(45.83±7.76)vs(48.37±9.13),P>0.05]与单用组比较差异无统计学意义;两组TESS评分在治疗后第2、4、6周末差异均无统计学意义(P均>0.05)。结论氟伏沙明合并小剂量利培酮治疗儿童强迫症可提高疗效,安全性较好。     

The Validity of Attention Deficit Hyperactivity and Hyperkinetic Disorder Symptom Domains in Nonclinical Dutch Children

Examined the validity of attention deficit hyperactivity disorder (ADHD) and hyperkinetic disorder (HKD) symptom domains in a sample of Dutch school children aged 10 to 14 years (N = 558). Confirmatory factor analysis indicated that symptoms of inattention, hyperactivity, and impulsivity were satisfactorily represented in various models. Psychopathological correlates of ADHD/HKD symptom domains were examined through their associations with the Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR). As expected, all three symptom domains were strongly associated with externalizing problems. Furthermore, inattention and hyperactivity were more strongly related to CBCL/YSR attention problems, whereas impulsivity was more strongly associated with symptoms of aggression and delinquency.