长期住院精神分裂症患者的孤独感与共情缺陷

目的探讨长期住院精神分裂症患者的孤独感和共情缺陷特征。方法采用病例对照研究,67例住院时间超过2年的精神分裂症患者为研究组,66例病史大于2年的门诊精神分裂症患者为对照组。所有受试完成一般情况调查表、感情-社会孤独量表(ESLS)和人际反应指针量表(IRI-C)。结果①两组性别、年龄、文化程度差异均无统计学意义(P均0.05);②研究组感情-社会孤独量表总评分高于对照组[(29.78±5.58)分vs.(27.16±3.79)分],差异有统计学意义(t=-3.17,P=0.002),情感孤独与社会孤独因子分也均高于对照组,差异有统计学意义(P均0.05);③研究组IRI-C总评分低于对照组[(31.39±11.02)分vs.(39.69±9.61)分],差异有统计学意义(t=4.61,P0.001),反映共情缺陷的"同情关心"因子评分研究组低于对照组[(9.21±3.46)分vs.(11.18±2.93)分],差异有统计学意义(t=3.55,P=0.001)。结论长期住院精神分裂症患者共情缺陷和孤独感明显,需鼓励患者回归社区以缓解孤独感,降低共情缺陷。     

巴林特小组对儿科护士职业倦怠、抑郁和焦虑情绪的影响

目的探讨巴林特小组对儿科护士职业倦怠、抑郁和焦虑情绪的影响,为改善其心理健康状况提供参考。方法选取天津市儿童医院儿科护士共72例,采用随机数字表法分为研究组和对照组各36例。对照组接受常规护理培训,研究组在此基础上接受巴林特小组培训,培训时间均为8周。于培训前后采用职业倦怠量表(MBI)、抑郁自评量表(SDS)和焦虑自评量表(SAS)进行评定。结果培训后,研究组MBI中情感枯竭和去人性化因子评分低于对照组,个人成就因子评分高于对照组,差异均有统计学意义[(15. 86±6. 63)分vs.(20. 45±7. 91)分,t=2. 668,P=0. 009;(4. 28±2. 64)分vs.(6. 37±3. 48)分,t=2. 871,P=0. 005;(29. 43±5. 58)分vs.(24. 82±6. 87)分,t=3. 125,P=0. 003];培训后,研究组SDS、SAS评分均低于对照组,差异均有统计学意义[(27. 31±5. 56)分vs.(30. 46±5. 88)分,t=2. 336,P=0. 022;(26. 18±5. 27)分vs.(29. 76±5. 62)分,t=2. 788,P=0. 007]。结论运用巴林特小组可能有助于改善儿科护士的职业倦怠、抑郁和焦虑情绪,提高其心理健康水平。     

应用轻躁狂检测清单甄别抑郁症中可能存在的双相障碍

目的 通过轻躁狂检测清单(HCL-32)测评结果甄别抑郁症中可能存在的双相障碍.方法 对128例抑郁症患者应用软双相建议性诊断标准进行诊断,并比较软双相与非软双相抑郁症患者HCL-32的差异.结果 (1)128例抑郁症患者中,HCL-32评分0～19(5.7±4.7)分;(2)是否软双相抑郁者分别为15例和113例,HCL-32评分分别为[(9.4±6.7)分vs(5.2±4.2)分,t=3.40,P=0.001],是否宽松软双相抑郁者HCL-32评分分别为[(7.8±5.6)分vs(4.3±3.4)分,t=4.34,P=0.000],有无双相障碍家族史者HCL-32评分分别为[(9.2±6.8)分vs(5.4±4.4)分,t=2.39,P=0.018],有无躁狂转相史者HCL-32评分分别为[(8.6±7.3)分vs(5.3±4.3)分,t=2.05,P=0.043],有无环性人格或明显外向者HCL-32评分分别为[(8.4±5.7)分vs(5.3±4.4)分,t=2.58,P=0.011],有无旺盛性人格素质者HCL-32评分分别为[(9.0±6.7)分vs(5.0±3.9)分,t=3.90,P=0.000],有无边缘性人格者HCL-32评分分别为[(8.6±4.3)分vs(5.4±4.7)分,t=2.22,P=0.028],是否呈发作性病程者HCL-32评分分别为[(8.9±5.7)分vs(5.2±4.3)分,t=3.19,P=0.002];(3)男女患者HCL-32评分分别为[(4.3±3.7)分vs(6.6±5.1)分,t=2.87,P=0.005];(4)有抑郁症家族史者、有自杀家族史者、发病年龄≤25岁者、有非典型抑郁者、有精神运动抑制者、有精神病性抑郁者、有生物节律明显者HCL-32评分与对应组的差异无统计学意义;(5)HCL-32＞7分37例(28.9%),＞10分17例(13.3%),＞14分7例(5.5%),其中＞10分者所占比例与软双相所占比例接近.结论 HCL-32＞10分可能有助于在抑郁症患者中筛选诊断双相障碍.     

医护人员职业倦怠状况调查

目的了解临床医护人员的职业倦怠状况,为预防和干预职业倦怠提供科学依据。方法采用职业倦怠调查问卷对崇州市三家医院的临床医护人员进行横断面调查。结果情感耗竭维度:女性高于男性[(24.74±7.25)vs.(21.97±7.43)],医生高于护士[(23.58±7.45)vs.(20.26±7.14)],低职称高于高职称[(22.76±7.43)vs.(18.15±7.18)],低学历高于高学历[(22.62±7.26)vs.(18.97±7.48)];成就感降低维度:男性高于女性[(25.48±5.24)vs.(23.50±5.10)],已婚高于未婚[(21.71±4.73)vs.(24.80±5.12)],医生高于护士[(25.74±5.39)vs.(22.75±4.70)],高职称高于低职称[(28.05±6.08)vs.(22.35±4.86)]、高学历高于低学历[(25.36±5.28)vs.(22.45±6.60)],均差异有统计学意义(P<0.05或0.01);人格解体维度:各变量差异无统计学意义(P>0.05)。结论医护人员的职业倦怠水平随人口学特征的不同而有差异,女性、医生、未婚、低职称、低学历的医务人员是预防和干预的重点人群。     

精神疾病患者家庭环境及其一级亲属人格特征

目的探讨精神疾病患者的家庭环境及其一级亲属人格特征,为改善精神疾病患者康复环境进行有针对性的心理干预提供参考。方法将2014年1月-5月在郑州大学第一附属医院精神医学科住院的190例符合《国际疾病分类(第10版)》(ICD-10)精神与行为障碍诊断的患者作为病例组,进行家庭环境量表中文版(FES-CV)测评,对179名精神疾病患者一级亲属进行艾森克人格问卷(EPQ)测评,同期选取181名健康志愿者作为对照组,对所有入组的健康志愿者进行FES-CV和EPQ测评。结果病例组FES-CV中矛盾性和控制性因子评分均高于对照组[(3.58±2.02)分vs.(2.80±1.64)分,(3.43±2.08)分vs.(2.96±1.49)分,t=4.14、2.52,P0.05或0.01];病例组FES-CV中亲密度、情感表达、娱乐性、组织性评分均低于对照组[(5.91±2.20)分vs.(6.57±1.20)分,(4.56±1.82)分vs.(5.31±1.44)分,(3.43±2.29)分vs.(4.40±1.95)分,(4.75±2.06)分vs.(5.31±1.99)分,t=-3.07、-4.39、-4.43、-2.65,P0.05或0.01]。病例组一级亲属EPQ中精神质和神经质评分均高于对照组[(52.71±9.90)vs.(42.71±10.59)分,(54.44±11.97)分vs.(45.96±11.49)分,t=9.26、6.84,P均0.01]。结论精神疾病患者的家庭环境存在低亲密度、低情感表达、低娱乐性及低组织性特征,同时矛盾性和控制性在患者的家庭氛围中比较明显,且精神疾病患者的一级亲属多具有神经质和精神质的人格特点。     

具有心理咨询师资格的精神科护士职业倦怠与应对方式的关系

目的探讨具有心理咨询师资格的精神科护士职业倦怠和应对方式现状及其关系。方法采用Maslach工作倦怠通用量表(MBI-GS)和简易应对方式问卷(SCSQ)分别对20名具有心理咨询师资格的精神科护士(心理咨询师组)及未取得心理咨询师资格的精神科护士(对照组)进行调查。结果心理咨询师组自我成就感、积极应对得分均高于对照组[(22.55±5.24)分vs.(16.32±4.51)分][(2.22±0.50)分vs.(1.69±0.46)分],差异有统计学意义(P0.05),积极应对与自我成就感呈正相关,消极应对与去个性化呈正相关(r=0.33、0.41,P0.05)。结论具有心理咨询师资格的护士职业倦怠状况可能好于未取得心理咨询师资格的护士,较多采用积极应对方式;积极的应对方式可能有助于提升自我成就感。     

单双相抑郁患者的情感气质特征及其与抗抑郁治疗反应的关系

目的探索单相抑郁、双相I型和双相II型抑郁患者情感气质特征的差异及其与抗抑郁治疗反应的关系。方法收集广州医科大学附属脑科医院和暨南大学第一附属医院的住院和门诊患者,包括332例单相抑郁患者、116例双相I型患者和152例双相II型患者,所有患者均处于重性抑郁发作期。在为期6周的半自然临床试验中,所有患者均接受抗抑郁药治疗,完成情感气质问卷中文版(TEMPS-A)和汉密尔顿抑郁量表17项版(HAMD-17)评定。比较治疗4、6周末不同气质类型为主导气质患者HAMD-17评分减分率。结果双相I型患者旺盛情感气质评分高于单相抑郁患者和双相II型患者[(9.91±4.53)分vs.(8.20±4.34)分vs.(8.53±4.14),F=6.562,P=0.002];而双相II型患者环性气质评分高于单相抑郁患者[(10.05±5.02)分vs.(7.47±5.22)分,F=12.89,P0.01]。治疗6周后,情感旺盛气质主导组HAMD-17评分减分率高于情感旺盛气质非主导组(F=6.44,P=0.011)。结论单双相抑郁患者的情感旺盛气质和环性气质的特征有所差异,旺盛情感气质可能可以作为处于重性抑郁发作期的情感障碍患者抗抑郁治疗反应的预测因子。     

多胎家庭中儿童青少年情绪障碍患者家庭环境调查

目的调查多胎家庭中儿童青少年情绪障碍患者的家庭环境特征,为优化家庭环境、改善其情绪问题提供参考。方法选取2015年8月-2017年8月在武汉市精神卫生中心住院的、符合《国际疾病分类(第10版)》(ICD-10)通常起病于童年与少年期的行为和情绪障碍诊断标准的36例患者为研究组,同时选取36例健康志愿者(研究组同一家庭内同父同母所生的健康同胞)为对照组。收集两组一般人口学资料,并采用家庭环境量表中文版(FES-CV)进行评定。结果研究组FES-CV中知识性因子[(3. 47±1. 36)分vs.(4. 69±2. 07)分,t=-2. 961,P=0. 004]、娱乐性因子[(2. 44±2. 03)分vs.(3. 83±2. 68)分,t=-2. 478,P=0. 016]和道德宗教观因子[(4. 22±1. 62)分vs.(5. 28±1. 78)分,t=-2. 627,P=0. 011]评分均低于对照组,而矛盾性因子评分高于对照组[(5. 25±1. 83)分vs.(3. 89±1. 69)分,t=3. 285,P=0. 002]。在有儿童青少年情绪障碍患者的多胎家庭中,家庭环境影响因素有:父母婚姻状况、家庭经济情况、母亲受教育程度、出生顺序、学历和年龄(P0. 05或0. 01)。结论在多胎家庭中,儿童青少年情绪障碍患者及其同胞所感受到的家庭环境各因素之间存在差异。     

团体森田疗法对肝癌手术治疗患者生活质量的影响

目的探讨团体森田疗法对接受肝癌开腹手术治疗的患者生活质量的影响,为提高其生活质量及身心健康水平提供参考。方法选取在广西壮族自治区南宁市某医院接受手术治疗的肝癌患者170例为研究对象,并随机分为实验组(n=78)和对照组(n=92)。对照组不做心理干预,仅对实验组实施团体森田治疗。使用癌症患者生活质量测定量表(EORTC QLQ-C30)评定两组患者的生活质量,对照组进行第一次评定后间隔两周再次评定,实验组分别于团体森田治疗前和治疗结束后一周进行评定。结果实验组第二次评定的躯体功能[(83.41±14.60)分vs.(62.82±31.22)分]、角色功能[(81.83±24.70)分vs.(57.24±35.05)分]、情绪功能[(75.64±23.13)分vs.(52.17±34.98)分]、认知功能[(78.20±22.03)分vs.(57.97±34.54)分]、社会功能[(61.32±28.74)分vs.(48.91±35.70)分]和总体健康状况评分[(62.92±22.85)分vs.(46.73±29.26)分]均高于对照组第二次评分(P均0.05)。结论团体森田疗法可能有助于提高肝癌手术患者的躯体功能、角色功能、情绪功能、认知功能和社会功能,改善其总体健康状况。     

事件相关电位P300在颅脑损伤患者认知功能障碍评定中的应用

目的 探讨事件相关电位P300在颅脑损伤患者认知功能障碍评定中的应用价值。方法 选取2021年1月-9月在绵阳市第三人民医院神经外科保守治疗、并符合诊断标准的颅脑损伤患者36例作为研究组,同期在医院其他患者家属和护工中招募健康对照组共36名。采用Oddball范式对受试者进行事件相关电位P300检测,采用蒙特利尔认知评估量表（MoCA）和简易精神状态评价量表（MMSE）评定受试者的认知功能。比较两组P300的潜伏期、波幅以及MoCA和MMSE评分,比较P300潜伏期、MoCA和MMSE对颅脑损伤患者认知功能障碍的检出率。结果 研究组MoCA和MMSE评分均低于对照组[（18.08±4.29）分vs.(27.36±1.20)分,（22.53±3.54）分vs.(28.11±1.09)分,t=-12.510、-9.041,P均<0.05];研究组P300潜伏期高于对照组[（406.08±26.95）ms vs.(367.08±22.50)ms,t=6.665,P<0.05],波幅低于对照组[（7.76±0.90）μV vs.(9.87±0.99)μV,t=-9.459,P<...     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.