对受洪灾群体创伤后应激反应的调查

目的 探讨洪灾中受灾程度、灾前社会支持、应付方式等变量与灾后激反应的关系。方法 于１９９８年１１月采用整群抽取的方法,对１９９８年夏季长江中下游受洪灾程度不同的两个村１８～６０岁的村民５６４人,进行创伤后应激反应的调查,并测评事件影响表Ｉ（ＩＥＳ）、社会支持量表、应付方式量表。结果 （１）受灾群体普遍存在创伤后应激反应,受试中６１．５％ＩＥＳ总分超过１９分;（２）受灾突然、损失方式与创伤后应激反应     

行为治疗与森田疗法的异同(摘要)

本次报告的目的在于：1、描述西密西根大学焦虑障碍实验室进行的治疗恐怖症、创伤后应激障碍等几项对照研究。2、探讨帮助咨客克服害怕、恐惧及创伤后应激反应治疗中，我们认为的一些治疗关键点。3、讨论这些治疗特点与森田治疗概念的共同点。     

汶川地震灾民创伤后应激反应的影响因素分析

目的 调查地震灾民创伤后应激反应的影响因素.方法 汶川地震后第12天开始调查337名灾民的人口学背景、受灾情况等,应用创伤后应激反应筛查表(PTSS20)进行心理评估.采用非参数检验和多元线性回归等筛出应激反应的影响因素.结果 从PTSS20总分来看,女性比男性高;青、中年组比儿童或青少年组高;视听觉刺激极重组比中度组及无刺激组高;有亲人死亡组比无亲人死亡组高;调查时间30 d以上组比15 d及以下组或16～30 d组高(均有显著差异);以PTSS20总分为因变量进行逐步回归,性别、调查时间、对领导救灾满意度、亲人死亡、家庭关系、年龄进入回归方程.结论 女性、青中年、有亲人死亡者、视听觉刺激极重者、受重伤者是危机干预的重点对象.调查时间在30 d以上、对领导救灾满意度低、家庭关系差是创伤后应激反应的危险因素.     

胶质瘤立体定向术后“急性期反应”观察

胶质瘤立体定向术后“急性期反应”观察张明华任何手术对机体是一种创伤，可诱发机体的应激反应。通过对３０例脑胶质瘤立体定向活检和后装施源管插入行间质内放疗回顾性分析，发现病人术后心率、体温和白细胞计数均有所提高，符合“急性相反应”的临床表现。所以此类手术...     

颅脑创伤后的血清皮质醇变化及对机体的影响

颅脑创伤后的血清皮质醇变化对于疾病的发展与转归起重要作用,其变化原因主要包括应激反应、下丘脑-垂体损伤和免疫反应等,其适当的增高可以增强机体对创伤损害的抵抗能力,长期过度的血清高浓度或者低浓度皮质醇水平则可能导致体内代谢紊乱,出现一系列并发症,主要包括神经系统损害、脑心综合征、应激性溃疡、免疫系统损害、凝血功能障碍、糖代谢紊乱以及肾上腺皮质功能减退症等,有必要动态观察颅脑创伤后血清皮质醇的变化,通过各种方法避免血清皮质醇过高或者过低对机体的损害。     

胸腰椎骨折伴截瘫病人的心理反应及护理

胸腰椎骨折伴截瘫是骨科常见创伤，由于脊椎骨折易导致脊髓或马尾神经损伤，使病人面临生命危险或终生残疾，加之创伤大多来自突发意外事故，可引起病人强烈的心理应激反应，往往表现为极度恐惧、焦虑和绝望，甚至自杀。病人能否树立信心，积极配合治疗，接受手术和康复训练，对其预后及生存质量影响很大。现将24例胸腰椎骨折伴截瘫病人心理反应分析及护理对策报告如下。     

对重症颅脑创伤镇静镇痛的认识

颅脑创伤是一种常见外伤,可单独存在,也可合并其他脏器伤,病情复杂多变,伤后常表现出不同程度的烦躁,造成脑耗氧量增加、颅内压升高等不良后果。因此,合理科学的镇痛、镇静治疗尤为重要,可缓解疼痛、焦虑和躁动,降低应激反应及其对机体的损害,利于诊断、护理和治疗性操作,减少并发症,尤其对于重症患者更加有益。本文针对颅脑创伤后的病理生理、常用镇静镇痛药物、镇痛镇静治疗的新进展等几个方面进行综述。     

第十三届全军战伤创伤学术会议暨中国神经科学会神经创伤与修复大会会议通知

由全军战创伤专业委员会、中国神经科学会神经创伤与修复委员会主办，第四军医大学西京医院神经外科承办的“第十三届全军战伤创伤学术会议暨中国神经科学会神经创伤与修复大会”既定于2012年9月14-16日在陕西西安举行。本次大会是我国创伤领域的一次盛会，将为业内同仁搭建一个交流平台。大会将邀请创伤研究领域的高层专家参会，就创伤发生发展的病理学、病理生理学、分子生物学等范畴的基础问题，以及各类创伤规范化救治、救治策略的思考和经验总结等临床问题展开专题讨论与交流。     

急诊手术与保守治疗对颅脑创伤患者血清皮质醇CBG水平及预后的影响

目的探讨急诊手术与保守治疗对颅脑创伤患者血清皮质醇(COR)、类固醇结合蛋白(CBG)及对预后的影响。方法选取我院收治的颅脑创伤患者148例为研究对象,根据治疗方式分为2组,符合手术指征行急诊手术37例为手术组,37例行保守治疗为保守组,观察2组治疗前后COR、CBG水平变化,了解2组预后。结果急性创伤后、创伤第1天上午6时COR、CBG水平无明显差异(P0.05);37例患者手术后COR、CBG水平分别为(27.31±11.20)μg/dL、(34.21±9.53)μg/mL均显著低于手术前,差异具有统计学意义(P0.05)。结论急诊手术能够解除颅脑创伤患者应激反应,减少神经功能障碍,改善预后。     

创伤后脑缺血与脑、颈部血管损伤

创伤后脑缺血是颅脑损伤病人较常见的并发症．已被人们逐渐认识和重视，有越来越多的学者对其发生机制进行了大量的研究。近年来随着医学影像学的发展，发现创伤后脑、颈部血管损伤与创伤后脑缺血的发生关系密切。本文从血管损伤的角度，介绍了创伤后脑缺血的发生机制。     

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.     

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.     

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.     

Special Pharmacokinetic Considerations in Children

Summary: Pediatric patients have greater degrees of pharmacokinetic variability and unpredictability than adults. This variability results from the effects of pharmacogenetics, age and growth, prior and current comedication, and disease. Newborns with seizures have the least predictable dosage requirements, and their needs change as drug-eliminating mechanisms mature in the neonatal period. Infants have the highest relative capacities to eliminate antiepileptics of any age group and require the largest relative doses. In addition to age-related trends, children demonstrate the same drug-specific, pharmacokinetic phenomena that adults do, including nonlinear phenytoin elimination, nonlinear valproate binding, and autoinduction of carbamazepine. Intercurrent illness and drug interactions further modify the age-related pharmacokinetic patterns in children and make dosage requirements even more unpredictable. Recent studies have shown that febrile illness can affect drug elimination, sometimes decreasing drug levels by 50% or more. Intermittent treatment with benzodiazepines administered either orally or rectally can be an important adjunct and help minimize this type of problem for children with marginally controlled epilepsy. Intermittent benzodiazepines are also helpful for children who have febrile seizures and who need only occasional antiepileptic protection.