心理干预对康复期抑郁症患者的影响

目的探讨心理干预对康复期抑郁症患者的影响。方法以汉密尔顿抑郁量表（HAMD）和、NOSIE为量化指标,将60例患者分为研究组和对照组各30例,研究组除一般治疗外,另进行心理干预,2个月后与对照组做对比分析。结果经t检验研究组与对照组相比较,HAMD总分及6个因子减分值和NOSIE总估计分及6个因子减分值均有显著差异（P〈0．05）。结论心理干预可明显改善康复期抑郁症患者的情绪和认知能力,从而提高疗效。     

首发和复发抑郁症患者临床特征比较

目的:描述首发和复发抑郁症患者的人口学特征、临床特征、治疗特征和生理指标,并探讨抑郁复发的临床特征。方法:以简明国际神经精神疾病访谈、精神症状维度评定量表、汉密顿抑郁量表等为工具,共纳入符合精神障碍诊断与统计手册第5版(DSM-5)的抑郁症诊断标准的患者858例,其中首发529例(58.6%),复发329例(36.0%)。采用χ²检验、Kruskal-Wallis秩和检验比较首发和复发抑郁症在人口学特征、临床特征、治疗特征和生理指标上的差异,运用logistic回归探索复发抑郁症的影响因素。结果:复发抑郁症相对首发抑郁症更有可能存在精神障碍共病(OR=2.11,95%CI:1.00～4.44)、无法工作/学习/从事家务劳动的天数更多(OR=1.26,95%CI:1.01～1.56)、既往使用过1个月以上的精神科药物(OR=1.41,95%CI:1.02～1.97)、既往接受过电休克治疗(OR=3.23,95%CI:1.42～7.36)、腰臀比更大(OR=33.88,95%CI:2.88～399.32)。结论:复发性抑郁症与存在精神障碍共病、无法工作/学习/从事家务...     

文拉法辛与舍曲林治疗首发抑郁症对照研究

目的:探讨文拉法辛与舍曲林治疗首发抑郁症的临床疗效及安全性。方法:选取首发抑郁症患者64例,随机分为2组,分别予以文拉法辛、舍曲林治疗。在治疗前、治疗1周、2周、4周、6周、8周、26周末评定临床疗效及安全性;采用汉密尔顿抑郁量表(HAMD)评定临床疗效,副反应量表(TESS)评定药物不良反应。结果:1两组治疗前后HAMD总分比较:在治疗26周末,文拉发辛组和舍曲林组的HAMD总分较治疗前都有明显下降,差异均有统计学意义(t=39.296,37.547;P0.001);2两组间抗抑郁显效时间比较:在治疗2周、4周末HAMD总分两组间比较,文拉法辛组比舍曲林组下降明显,差异都有统计学意义(t=-3.269,-2.847;P0.01)。治疗1周末显效率文拉法辛组21.88%舍曲林组0.00%,治疗2周末显效率文拉法辛组87.50%舍曲林组53.13%,差异均有统计学意义(P0.05,P0.01)。两组临床总疗效比较:26周末两组间总有效率比较和两组间总显效率比较,差异无统计学意义(P0.05);3不良反应比较:文拉法辛组以头昏、血压升高、便秘和食欲减退等4种不良反应多见,舍曲林组以口干口苦、便秘、恶心呕吐等3种不良反应多见。结论:文拉法辛与舍曲林的抗抑郁作用在治疗2周后均显效,两种抗抑郁药物的临床疗效肯定,总体临床疗效相当;安全性好,不良反应少;文拉法辛抗抑郁作用起效时间早于舍曲林,在治疗前4周文拉法辛抗抑郁作用的临床疗效优于舍曲林,更能较快控制患者抑郁症状。     

首发精神分裂症重复神经心理测查系统分析

目的用重复神经心理测查系统探讨首发精神分裂症的认知功能损害特点。方法对53例首发精神分裂症患者和62例健康对照用重复神经心理测查系统（RBAN S）和Stroop色词测验进行检测。结果在Stroop色词测验中,病人组的成绩均比对照组差,且差异有统计学意义（P〈0.05）。在RBAN S测查中,病人组5个因子的成绩均比对照组差,且差异有统计学意义（P〈0.05）。结论首发精神分裂症患者可能存在比较严重的全面认知功能损害,范围比较广。     

首发与复发性抑郁症患者执行功能的比较

目的比较首发与复发性抑郁症患者的认知执行功能。方法对43例首发抑郁症患者以及48例复发抑郁症患者,采用17项汉密尔顿抑郁量表测定抑郁严重程度,采用威斯康星卡片分类测验测定执行功能,并进行治疗前后的执行功能比较。结果治疗前首发组与复发组各项执行功能指标均较对照组差（P〈0.05）;分类数首发组高于复发组（P〈0.05）。治疗后首发组除分类数外,其它指标均与对照组有统计学差异（P〈0.05）;复发组各项指标仍较对照组为差（P〈0.05）;首发组与复发组治疗后比较,各项指标首发组均优于复发组（P〈0.05）;治疗后,无论是首发组还是复发组,其HAMD17评分及执行功能的各项指标均有显著性改善（P〈0.05）。结论首发与复发性抑郁症患者均存在执行功能的损害;复发性抑郁症患者的执行功能损害更为严重。药物治疗后,首发、复发性抑郁症患者执行功能均有一定程度的恢复。     

综合心理护理干预对抑郁症康复的影响

目的探讨综合心理护理干预对抑郁症患者康复的影响。方法对60例住院抑郁症患者随机分为实验组和对照组,2组患者均接受常规治疗和护理,实验组在常规治疗的基础上,由护士对患者进行综合心理护理干预,内容包括集体心理护理、个别心理护理、认知干预、行为干预、家庭干预等,应用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)量表,比较2组患者评分差异。结果治疗前2组HAMD、HAMA评分差异与对照组比较无统计学意义(P>0.05),治疗4、8周时,2组HAMD、HAMA评分均比治疗前显著下降(P<0.05),实验组下降更明显(P<0.05)。结论综合心理护理干预对抑郁症患者的抑郁、焦虑情绪有改善作用,能够促进疾病的早日康复。     

老年抑郁症患者治疗前后血清细胞因子水平的研究

目的观测老年抑郁症患者使用盐酸帕罗西汀治疗前后血清细胞因子水平的变化。方法采用酶联免疫吸附法(ELISA)检测30例首发老年抑郁症患者(研究组)治疗前后的血清IL-6、IL-1β、TNF-α的水平并和30例健康老年人(对照组)比较,结合汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)总分及各因子分进行相关分析。结果研究组治疗前血清IL-6(63.24±15.67ng/1)、IL-1β(33.24±17.27ng/1)、TNF-α(29.24±15.67ng/1)水平显著高于对照组IL-6(31.41±11.51ng/l)、IL-1β(18.36±8.17ng/l)、TNF-α(18.24±10.56ng/l);P0.05。帕罗西汀治疗后血清IL-6、IL-1β、TNF-α水平较治疗前显著下降(P0.05)。结论血清IL-6、IL-1β、TNF-α水平升高可能是老年抑郁症的免疫学标志之一;帕罗西汀抗抑郁的同时降低血清IL-6、IL-1β、TNF-α水平。     

生物反馈辅助治疗抑郁症的临床研究

目的探讨生物反馈辅助治疗抑郁症的疗效。方法对符合CCMD-抑郁症诊断标准的60例患者,随机分为研究组和对照组,研究组在对照组基础上辅以多参数生物反馈治疗。采用汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)分别观察疗效,连续观察8周。结果在治疗第1周,两组HAMD和HAMA评分均下降,但两组间有显著性差异(t=4.64,4.35;P<0.05)。第2周末开始两组间HAMD和HAMA评分差异无显著性。第8周末两组显效率分别为93.3%和86.7%,差异无统计学意义。结论生物反馈辅助治疗抑郁症起效更快,病人的满意度和依从性更好。     

抑郁症患者临床特征的性别差异

目的探讨性别因素对抑郁症的影响。方法符合CCMD-3抑郁症诊断标准共195例,按男、女性别分组进行一般情况、汉密尔顿抑郁量表(HAMD)、明尼苏达多项人格测定(MMPI)评定。结果男性抑郁症未婚多、离婚少,首次发病和本次住院年龄小;HAMD评分睡眠障碍轻;MMPI测试D、Mf、Pt和Sc分高。结论男女抑郁症患者临床症状的差异较少,男性抑郁症病理性异常更严重,可能是社会文化变迁对男女心理尤其是人格的影响,并在抑郁症的病理塑形中反映出来。     

生物反馈治疗在抑郁症患者中的应用

目的研究生物反馈治疗对伴有焦虑症状的抑郁症患者疗效的影响。方法抑郁症患者60名,随机分为实验组和对照组各30人。实验组和对照组均接受常规治疗与护理。实验组在此基础上应用生物反馈治疗1次/日,共3周。实验组和对照组均在患者入院及治疗后第1周、第3周、第6周末,分别采用汉密尔顿抑郁量表(HAM D)、汉密尔顿焦虑量表(HAMA)进行评定并计算减分率。结果经6周治疗,实验组30人抑郁症患者HAM D、HAMA治疗后与治疗前评分比较减分率有显著性差异(P分别为0.031和0.003);对照组的HAM D、HAMA治疗前与治疗后评分比较减分率在第3周有差异(P分别为0.038,0和0.013);有效率:实验组有效率为90%,对照组有效率为76%,两组的差异有显著性。结论抑郁症患者在药物治疗的基础上,联合生物反馈治疗可以辅助缓解抑郁症患者的焦虑、抑郁等负性情绪,从而提高疾病的整体疗效,对抑郁症患者的早日康复,有良好的促进作用。     

The Repeatable Battery for the Assessment of Neuropsychological Status effort scale

The measurement of effort is now considered to be an important component of neuropsychological assessment. In addition to stand-alone measures, built-in, or embedded measures of effort have been derived for a limited number of standard neurocognitive tests. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a widely used brief battery, employed as a core diagnostic tool in dementia and as a neurocognitive screening battery or tracking/outcome measure in a variety of other disorders. An effort index (EI) for the RBANS has been published previously (Silverberg, N. D., Wertheimer, J. C., & Fichtenberg, N. L. 2007. An EI for the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Clinical Neuropsychology, 21 (5), 841-854), but it has been reported to result in high false positive rates when applied to patients with "true" amnesia (e.g., Alzheimer's disease). We created a new effort scale (ES) for the RBANS based on the observation of patterns of free recall and recognition performance in amnesia versus inadequate effort. The RBANS ES was validated on a sample of patients with amnestic disorders and a sample of mild traumatic brain injury participants who failed a separate measure of effort. The sensitivity and specificity of the new ES was compared with the previously published EI. Receiver-operating characteristic analyses demonstrated much better sensitivity and specificity of the ES, with a marked reduction in false positive errors. Application and limitations of the RBANS ES, including indications for its use, are discussed.     

首发抑郁症患者认知功能与事件相关电位P300研究

目的:研究首发抑郁症患者的认知功能与应用事件相关电位P300的关系,探讨抑郁症合并认知损害的机制。方法:按ICD-10中抑郁发作诊断标准,收集40例首发抑郁患者(研究组),Hamilton抑郁量表(HAMD)评分≥17分;40名正常人(对照组)。应用威斯康星卡片分类测验(WCST)进行认知功能评分,应用Oxford Medelec Synergy肌电/诱发电位仪进行事件相关电位P300检测。分别检测WCST各亚项得分、P3潜伏期和P3波幅,并对两者进行相关性分析。结果:研究组WCST中F2、F3、F4、F5各项评分较对照组显著增高(t=2.536~6.282,P<0.05);研究组P300潜伏期(393.17±22.13)ms较对照组(326.15±21.44)ms显著延长(t=13.757,P<0.05);波幅(4.24±1.36)vμ较对照组(6.36±1.82)vμ明显降低(t=-5.901,P<0.05)。研究组P300潜伏期与持续性错误数、完成第一个分类所需应答数呈正相关关系(r=0.671,0.313;P<0.05),P300波幅与持续性错误数、不能维持完整分类数均呈负相关关系(r=-0.763,-0.655;P<0.05)。结论:抑郁症患者认知功能受损,与事件相关电位P300有关,这从神经电生理方面证实了抑郁症患者存在脑额叶功能损伤。     

复发性抑郁患者的强迫症状及个性因素

目的探讨强迫症状对复发性抑郁障碍患者的影响以及复发性抑郁障碍患者个性因素分析。方法采用症状自评量表(SCL-90),结合临床,对56例复发性抑郁障碍患者进行评定;采用艾森克人格问卷(EPQ)对伴有强迫症状的复发性抑郁障碍患者42例与不伴强迫症状的复发性抑郁障碍患者14例进行对照研究。结果75%的患者伴有强迫症状,伴有强迫与无强迫患者相比EPQ的E分较低和N分较高,差异有显著性(P<0.01)。结论强迫症状是复发性抑郁障碍的一个重要的危险因素,人格因素中内向和神经质与强迫症状有关。     

Component structure of the Repeatable Battery for the Assessment of Neuropsychological Status in dementia.

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has been studied relatively extensively in normal samples, and its theoretically derived index scores have been demonstrated to be useful in the assessment of a variety of clinical conditions. However, examinations of the empirical relationships between individual subtests are limited. The intent of the present study was to explore the component structure of the instrument in a sample of 351 individuals with a diagnosed memory disorder, to examine the impact of demographic factors on these empirically derived components, and to explore differences in performance between diagnostic groups. Findings suggested a three-component solution (Memory, Visuomotor Processing, and Verbal Processing). Demographic variables had relatively small, but significant relationships with various component scores. Significant differences were observed between probable Alzheimer's disease and non-Alzheimer's type dementia groups on the memory component score, but not on other component scores or on RBANS index scores.     

Reliability and validity of the Repeatable Battery for the Assessment of Neuropsychological Status in community-dwelling elderly

Introduction

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a widely used screening instrument in neuropsychological assessment and is a brief, individually administered measure. The present study aims to assess the reliability and validity of the Chinese version of the RBANS in community-dwelling elderly.

Material and methods

All subjects come from the community-dwelling elderly in Shanghai, China. They completed a questionnaire concerning demographic information, the mini-mental state examination (MMSE) and the Chinese version of the RBANS. To test for internal consistency, Cronbach''s α was calculated for all six RBANS indices. Correlations between each of the RBANS and MMSE subtests were conducted to measure the concurrent validity. A confirmatory factor analysis (CFA) was conducted to test the construct validity.

Results

The final sample of participants included 236 community-dwelling elderly. The mean total score on the RBANS was 86.02 (±14.19). The RBANS total score showed strong internal consistency (r = 0.806), and the coefficient α value for each of the RBANS scales ranged from 0.142 to 0.727. The total RBANS score was highly correlated with that of the MMSE (r = 0.594, p<0.001), and the RBANS subtests also demonstrated strong correlations with most of the MMSE subtests. The results of the CFA indicated an acceptable fit between the Chinese version of the RBANS and the original.

Conclusions

The Chinese version of the RBANS had relatively good reliability and validity in a community-dwelling elderly sample. It may be a useful screening instrument for conducting cognitive assessments in community-dwelling elderly.     

首发精神分裂症及其健康同胞神经心理功能的比较

目的:探讨首发精神分裂症患者及其健康同胞神经心理功能差异。方法:采用范畴流利测验、连线测验(TMT)、数字符号编码测验和Stoop测验对在92例首发精神分裂症患者、56例健康同胞及62例健康对照者进行测评。结果:首发精神分裂症患者及其健康同胞所有神经心理测验成绩均差于健康对照组(P<0.05)。与健康同胞组比较,首发精神分裂症患者组除范畴流利测验外,其他神经心理测验成绩差异均有统计学意义(P<0.05)。结论:首发精神分裂症患者及其健康同胞存在认知损害,语义流畅性功能可能是精神分裂症的潜在内表型。     

重复性成套神经心理状态测验的信度、效度分析

目的:对用于精神障碍患者认知功能测评的重复性成套神经心理状态测验(Repeatable Battery for the Assessment of Neuropsychological Status,RBANS)中文版的信度和效度作初步验证.方法:从北京市城乡方便取样,做横断面调查,451名健康人群完成RBANS测验,其中97人同时完成简易韦氏成人智力、韦氏记忆测验考察效标效度;41人间隔12周再次进行了RBANS测验.对获取的数据进行相关分析和因子分析.结果:反映内部一致性的Cronbach α系数在RBANS总量表为0.90,在即刻记忆、视觉广度、言语功能、注意、延迟记忆分量表分别为0.86,0.68,0.67,0.85,0.80.总量表的重测信度为0.90,5个分量表的重测信度分别为0.65,0.68,0.53,0.80,0.79(P均＜0.01).以简易韦氏成人智力、韦氏记忆测验为效标,结果除简易韦氏成人智力量表的言语得分与RBANS量表的视觉空间因子间相关性无统计学意义,RBANS与简易韦氏成人智力和韦氏记忆量表总分和各因子分均存在有统计学意义的正相关(r=0.21-0.59,P均＜0.01).验证性因素分析结果x2/df为4.13,相对拟合指数(CFI)为0.91,非范拟合指数(NNFI)为0.93,近似均方根误差(RMSEA)为0.079.12个分测验的完全标准化解(MI)分别为:0.80,0.74,0.61,0.38,0.61,0.90,0.66,0.60,0.81,0.60,0.81,0.73.结论:重复性成套神经心理状态测验是一个信效度比较好的认知功能评定工具.