芦山地震受灾人群创伤后应激障碍的流行病学调查北大核心CSCD

目的 调查芦山地震受灾人群PTSD的患病率及其影响因素.方法 采用横断面调查,在四川省雅安市芦山县、宝兴县两地分层随机抽取1110名成年被调查者,使用自编问卷采集一般人口学资料、芦山地震受灾情况以及芦山地震、汶川地震对被调查者影响的比较等,PTSD筛查量表平民版（PTSD Check List-Civilian Version,PCL-C）筛查被调查者对芦山地震的应激反应程度,MINI-自杀风险评估其自杀风险.PCL-C＞38分者由精神科医师采用MINI中文版中的PTSD章节诊断其是否患有PTSD.采用线性回归分析方法对PTSD的影响因素进行相关分析.结果 998名被调查者纳入分析,其中男372名（37.27％,372/998）,女626名（62.73％,626/998）.PCL-C＞38分者251名（25.15％,251/998）,PTSD患者24例,PTSD患病率2.40％（24/998）.自杀高风险者11名（1.10％,11/998）.回归分析显示,PCL-C总分与女性（β=-2.041）、家庭低收入（β=-3.870）、地震中亲属遇难（β=0.164）、朋友遇难（β=-0.059）、地震中被掩埋（β=-14.335）、受伤（β=0.495）等因素相关（均P＜0.05）.女性（OR=4.304）、地震中被掩埋（OR=15.688）是罹患PTSD的危险因素（均P＜0.05）.家庭低收入（OR=3.147）、罹患PTSD （OR=25.101）是自杀高风险的危险因素（均P＜0.05）.结论 5年内连续2次遭受地震创伤的受灾人群中PTSD的患病率并不高,女性及在地震中自身生命受威胁是罹患PTSD的危险因素,应有针对性地进行干预.     

帕罗西汀预防创伤后应激障碍对照研究

目的:探讨帕罗西汀预防创伤后应激障碍(PTSD)的效果。方法:矿难2个月后对31名矿难幸存者和22名配偶非PTSD者随机分为预防组和对照组。预防组予帕罗西汀10mg/d或20mg/d进行干预。1个月后再次进行PTSD诊断,干预前后对两组进行PTSD自评量表和PTSD症状清单(PCL)评定。结果:1个月后对照组有4人符合PTSD诊断标准,预防组无1例PTSD者。干预前,预防组和对照组PTSD自评量表及PCL评分差异无显著性(P>0.05)。干预后,预防组PTSD总分、PTSD闪回因子以及PCL评分比干预前显著减少(P<0.05或P<0.01),对照组仅PCL评分比干预前显著下降(P<0.05)。干预后预防组与对照组闪回及PTSD总分差异显著(P<0.05或P<0.01)。结论:帕罗西汀对PTSD的发生有预防作用。     

玉树地震后罹患创伤后应激障碍、焦虑症和抑郁症调查

目的:调查玉树地震后不同人群创伤后应激障碍(PTSD)、焦虑症、抑郁症的发生情况。方法:抽取震后灾区人群、其非灾区的亲属人群、灾区救援人群及非灾区人群为对象,每一人群进行随机分成两组,第1组每周进行1次集体心理干预;第2组每周进行3次集体心理干预。采用PTSD检查量表平民版(PCL-C)、焦虑自评量表(SAS)、抑郁自评量表(SDS)对不同人群在3个月、6个月进行问卷调查。结果:各人群在干预3个月和6个月均检出PTSD、焦虑症、抑郁症。各人群中第2组干预6个月时PTSD、焦虑症、抑郁症检出率明显低于干预3个月时(P均0.05)。结论:震后不同人群均存有PTSD、焦虑症、抑郁症发生;随着时间推移及积极干预可明显降低其发生。     

中国汶川地震现场救援军人创伤后应激障碍及相关因素的调查

目的 调查抗震救灾一线救援军人任务完成6个月创伤后应激障碍(PTSD)的患病率及相关因素.方法 采用目前美国PTSD流行病学调查和诊断工具,按整群分层抽样原则对1125名汶川抗震救灾现场救援军人PTSD的患病率及相关因素进行调查.PTSD诊断采用Davidson创伤量表(DTS)症状发生频率和严重程度总分≥40分标准确定,并使用美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)诊断标准复查,使用SPSS13.0软件对调查资料和DTS诊断结果进行单因素和Logistic回归分析.结果 实际调查1056人;DTS诊断PTSD 69例,患病率6.53%;DSM-Ⅳ复查符合诊断63例,患病率5.97%;独生子女、服役满意度低、吸烟、创伤暴露阶段未进行心理干预及有饮酒习惯者PTSD患病率显著高于相对应的人群(P＜0.05);地震经历暴露程度高(P＜0.01,OR=6.258)、创伤暴露阶段未进行心理干预(P=0.019,OR=3.106)是抗震救灾现场救援军人PTSD的显著危险因素,而独生子女是PTSD潜在的危险因素(P=0.057,OR=2.235).结论 PTSD是抗震救灾现场军人常见的心理障碍,加强创伤暴露者的心理防护和危机干预十分必要.     

创伤后应激障碍影像遗传学研究进展

正创伤后应激障碍(posttraumatic stress disorder,PTSD)是指经历严重威胁性、灾难性事件后,个体延迟出现并持久存在的一种精神障碍,该疾病具有高患病率、高自杀风险的特征,易造成患者强烈的心理痛苦和社会功能严重损伤,甚至影响患者一生。研究表明,约70%的人在一生中会经历创伤性事件,其中10%～20%的人会发展为PTSD,PTSD是环境因素与个体因素共同作用的结果~([1])。一项针对     

新冠肺炎疫情期间的心理评估和创伤后应激障碍的预防

本文目的是为广大心理援助者介绍新冠肺炎疫情期间对大众进行心理评估的方法。目前心理援助者急需掌握对精神障碍诊断和风险评估的方法,故本文对心理评估中的关键点和侧重点进行了介绍。从评估情绪和行为的基本状态、是否患有某种精神障碍、是否有自杀风险、是否已发展为创伤后应激障碍(PTSD)以及如何预防发展为PTSD的具体方法进行了探讨。     

延时暴露疗法治疗创伤后应激障碍临床研究

目的：了解延时暴露疗法对创伤后应激障碍（PTSD）患者症状的疗效。方法：使用创伤后应激障碍自评量表（PTSD-SS）、抑郁自评量表（SDS）、焦虑自评量表（SAS）对高中生进行测评,采用延时暴露疗法对21名PTSD患者进行了治疗。结果：地震后1年高中生PTSD患病率为6.65%,女性高于男性,延时暴露治疗后症状明显改善。结论：延时暴露疗法对地震后高中生PTSD治疗有效,在以后的心理干预中应注意关注PTSD患者的恐惧和回避症状。     

自杀（伤）行为的干预手段

目的：探讨和研究自杀（伤）干预的方法与策略。方法：通过对自杀（伤）行为的现状、来源和动机、危险因素动机的分析、归纳，总结自杀（伤）干预的步骤与原则。结果：自杀动机分为两类：一类称之为人际动机，另一类称之为内心动机。自杀（伤）产生的原因及相关因素与个体素质及外界社会因素有关。自杀（伤）者的50－90％的是由于精神疾病引起的。对自杀（伤）者的干预可分为评估、制定干预目标、实施、终止4期。预防措施主要有普及心理健康知识、减少自杀（伤）工具的可获得性、建立预防自杀的专门机构，及晨对有自杀（伤）者进行早期心理干预。结论：自杀（伤）者的最积极的干预是预防，尤其是对自杀（伤）高危人群的预防是重点。     

青少年睡眠问题与自杀的相关性研究现状

本文目的是对青少年睡眠问题与自杀的相关性研究现状进行综述,以期为青少年自杀的早期临床干预提供新的方向。研究表明,睡眠问题与青少年自杀密切相关,睡眠可能成为自杀干预的潜在靶点。本文对青少年睡眠问题与自杀的相关性研究进行综述,并从改善睡眠问题着手,寻找可能的自杀干预措施。     

重症监护病房患者配偶创伤后应激障碍海马体积的研究

目的:探索重症监护病房(ICU)患者配偶中患创伤后应激障碍(PTSD)者双侧海马体积变化。方法:采用3.0 T磁共振检查(MRI)对20例ICU患者之配偶中患有PTSD者(PTSD组)及20例未患有PTSD者(对照组)进行全脑3D T1扫描;使用FreeSurfer获取并分析双侧海马体积变化,同时分析PTSD组双侧海马体积与PTSD诊断量表(CAPS)得分的相关性。结果:与对照组比较,PTSD组的双侧海马体积均显著缩小,差异具有统计学意义(P均0.01),但左侧海马体积减小比例大于右侧(左侧15%,右侧11%)。同时PTSD组的左右侧海马均与CAPS得分呈负相关(P均0.05)。结论:ICU患者配偶中患有PTSD者其海马体积存在缩小并存在偏侧性,需要给予及时有效的关心和干预。     

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.