广泛性焦虑症患者应对方式、社会支持与心理健康的关系

目的 探讨广泛性焦虑症患者应对方式、社会支持与心理健康的关系.方法 采用一般情况问卷、简易应对方式问卷(SCSQ)、社会支持评定量表(SSRS)、症状自评量表(SCL-90),对221例广泛性焦虑症患者进行问卷调查.结果 (1)广泛性焦虑症患者SCL-90得分与积极应对、主观支持、客观支持、支持利用度得分呈负相关(P＜0.05),与消极应对正相关(P＜0.01).(2)结构方程模型分析结果显示:积极应对对社会支持有直接(正向)效应(β=0.47,P＜0.01),对SCL-90得分有直接(负向)效应(β=-0.28,P＜0.01);消极应对对社会支持有直接(负向)效应(β=-0.23,P＜0.01),对SCL-90得分有直接(正向)效应(β=0.22,P＜0.01);社会支持对SCL-90得分有直接(负向)效应(β=-0.33,P＜0.01);积极应对和消极应对还可以通过社会支持间接影响心理健康.结论 应对方式对广泛性焦虑患者的心理健康有直接效应和间接效应;社会支持作为中介变量调节应对方式与心理健康的关系.运用积极应对、减少消极应对既可直接改善患者的心理健康水平,又可通过提高患者的社会支持来改善患者心理健康状况.     

精神疾病患者家属积极应对在社会支持与焦虑间的中介作用

目的了解精神疾病患者家属的社会支持、应对方式及焦虑状况之间的相关性,探讨应对方式在社会支持与焦虑间的中介作用,为提高精神疾病患者家属心理健康水平、进一步促进患者康复提供参考。方法采用计算机随机方法选取2016年3月-6月在西南医科大学附属医院精神科住院精神疾病患者的家属50人,于患者住院期间分别采用焦虑自评量表(SAS)、简易应对方式量表(SCSQ)和社会支持评定量表(SSRS)评定家属的焦虑状况、应对方式以及社会支持情况。结果精神疾病患者家属SAS评分高于国内常模(t=9.26,P0.01),其SAS评分与SCSQ总评分及各维度评分均呈负相关(P均0.01),与SSRS总评分、主观和客观支持评分均呈负相关(P均0.01)。中介分析显示,社会支持可预测焦虑(P0.01),当积极应对进入方程后,整个方程的解释力无统计学意义(P0.05)。结论精神疾病患者家属的应对方式、社会支持和焦虑三者之间相关,积极应对在社会支持与焦虑程度间起完全中介作用,积极的应对方式可能有利于提高精神疾病患者家属心理健康水平。     

某部队基层战士的心理健康、应对方式及个性特征调查研究

目的调查分析某部队基层战士的心理健康、应对方式及个性特征。方法采用症状自评量表(SCL-90)、简易应对方式量表(SCSQ)和艾森克人格测验问卷(EPQ)量表对某部队362名基层战士进行调查。结果 (1)362名基层战士的SCL-90除人际敏感与抑郁因子外,其余各因子评分均显著高于全国常模(P0.05),且人际敏感、抑郁、偏执评分显著低于军队常模(P0.05);(2)战士的SCSQ积极应对评分显著高于全国常模,而消极应对评分显著低于全国常模(P0.05);(3)基层战士的EPQ-E评分显著高于全国常模,EPQ-N与EPQ-P显著低于全国常模(P0.05),EPQ-L无明显差异(P0.05);(4)EPQ-N、EPQ-P与SCL-90各维度评分、消极应对呈显著正相关性,与积极应对呈显著负相关性(P0.05);EPQ-L维度与SCL-90各维度评分、消极应对呈显著负相关性(P0.05),与积极应对无明显相关性(P0.05);EPQ-E与SCL-90人际敏感、抑郁、敌对、恐怖、总评分及消极应对呈显著负相关性,与积极应对呈显著正相关性(P0.05)。结论基层战士的整体心理健康状况良好,个性属于外向稳定,普遍采取积极应对方式,应对方式及个性特征可直接或间接影响心理健康。     

抑郁症患者总体幸福感与社会支持和应对方式的相关性

目的调查抑郁症患者的幸福感,探讨其总体幸福感与社会支持和应对方式的相关性。方法于2019年2月-9月在安徽省精神卫生中心焦虑抑郁科门诊及住院患者中选择120例符合《国际疾病分类(第10版)》(ICD-10)抑郁症诊断标准的抑郁症患者作为抑郁症组,同时从社区人员及患者家属中选择122例作为对照组。采用总体幸福感量表(GWB)(中国版)、社会支持评定量表(SSRS)、简易应对方式问卷(SCSQ)进行评定,应用Pearson相关分析及多元线性回归分析比较抑郁症患者GWB、SSRS与SCSQ评分的相关性。结果抑郁症患者GWB评分低于对照组,差异有统计学意义[(62.43±13.48)分vs.(84.97±10.02)分,t=-14.780,P<0.01];抑郁症患者GWB评分与SCSQ总评分和积极应对方式评分均呈正相关(r=0.378、0.460,P均<0.01);抑郁症患者GWB评分与SSRS客观支持、主观支持、对支持的利用度评分及总评分均呈正相关(r=0.354~0.561,P<0.05或0.01);SSRS客观支持、主观支持、对支持的利用度评分及总评分与SCSQ总评分和积极应对方式评分均呈正相关(r=0.234~0.398,P<0.05或0.01)。结论抑郁症患者幸福感较低,且其幸福感水平与社会支持和积极应对方式相关。     

军人失眠症患者的心理健康状况及影响因素调查

目的:探讨军人失眠症患者的心理健康状况与人格特征、社会支持和应对方式的关系.方法:采用一般情况调查表、90项症状清单(SCL-90)、艾森克个性测验(EPQ)、社会支持量表(SSRS)和简易应对方式问卷对48名军人失眠症患者进行问卷调查. 结果:①军人失眠症患者SCL-90总分及各因子均显著高于军人常模,其中以躯体化、人际敏感和焦虑尤为突出(P＜0.01);②军人失眠症患者的EPQ-N、消极应对与SCL-90各因子呈显著正相关,EPQ-E、主观支持、客观支持、支持利用度和社会支持总分与SCL-90各因子呈显著负相关(P＜0.05或0.01).③回归分析显示,军人失眠症患者SCL-90总分有显著性影响的因素由大到小依次为EPQ-N、自责、主观支持、社会支持利用度和婚恋. 结论:军人失眠症患者心理健康状况可能受个性、对应方式、社会支持及婚恋等的综合影响.     

住院精神分裂症患者家属自测健康状况调查研究

目的探讨住院精神分裂症患者家属的自测健康状况,为改善患者的家庭支持系统提供依据。方法采用分层随机取样法,抽取2012年9月-12月在广东省河源市源城区精神卫生防治所住院的精神分裂症患者的家属(家属组)和一般人群(对照组)各100例,进行自测健康评定量表(SRHMS)调查,并采用简易应对方式量表(SCSQ)调查家属组的应对方式特点。结果家属组SRHMS的健康总体自测维度得分和社会健康子量表得分均低于对照组[(28.39±8.95)分vs.(32.51±3.65)分,(75.47±25.52)分vs.(88.66±11.94)分],差异有统计学意义(t=3.015、3.311,P0.01);家属组的积极应对方式和消极应对方式得分与常模比较差异有统计学意义(t=2.056、4.494,P0.05或0.01);家属组SRHMS各维度与积极因子正相关(r=0.728~0.299,P0.05或0.01);除维度1、5、8、9及社会健康子量表分、健康量表总分外,其余各维度与消极因子负相关(r=-0.416~-0.304,P0.05或0.01)。结论精神分裂症患者家属的健康水平偏低,可能与消极应对方式有关。     

COMT 基因多态性及社会心理因素与抑郁症伴慢性疼痛的相关性研究

目的 探讨儿茶酚胺氧位甲基转移酶（COMT）基因多态性及社会心理因素对抑郁症伴慢 性疼痛的影响。方法 纳入 2018 年 1 月至 2019 年 12 月在新疆维吾尔自治区人民医院临床心理科和疼 痛科门诊就诊或住院治疗的 292 例抑郁症患者为研究对象。抽取所有患者空腹静脉血,通过 TaqMan 单 核苷酸多态性（SNP）基因分型测序方法筛查 COMT 基因 rs6269、rs4633 位点的 SNP。根据是否伴发慢性 疼痛将患者分为研究组（141 例）和对照组（151 例）,比较两组患者的一般资料、COMT 基因多态性、社会支 持评定量表（SSRS）得分、自我认同感量表（SIS）得分以及简易应对方式问卷（SCSQ）得分。采用整体疼痛 评估量表（GPS）评估抑郁症伴慢性疼痛患者的疼痛程度。采用多因素 Logistic 回归分析抑郁症患者伴慢 性疼痛的相关因素。采用 Pearson 相关分析社会心理因素与抑郁症伴慢性疼痛患者疼痛程度的相关性。 结果 两组患者性别、文化程度比较,差异有统计学意义（P＜ 0.05）。研究组患者的 SIS 得分、SSRS 得 分、SCSQ 中积极应对条目均分低于对照组,SCSQ 中消极应对条目均分高于对照组,差异有统计学意义 （P＜ 0.01）。研究组 COMT 基因 rs6269 位点 A 等位基因频率高于对照组,差异有统计学意义（P＜ 0.05）。 多因素 Logistic 回归分析显示,SIS 得分越高（OR=0.822,95%CI=0.749～0.903）、SSRS 得分越高（OR=0.775, 95%CI=0.704～0.855）、SCSQ 中积极应对条目均分越高（OR=0.001,95%CI= ＜ 0.001～0.011）是抑郁症 患者伴慢性疼痛的保护因素（P＜ 0.05）;女性（OR=16.557,95%CI=2.364～115.936）、小学及以下文化程 度（OR=43.380,95%CI=4.297～437.978）、SCSQ 中消极应对条目均分越高（OR=187.293,95%CI=10.826～ 3 240.198）、COMT 基因 rs6269 位点 A 等位基因频率越高（OR=2.442,95%CI=1.235～4.828）是抑郁症患者 伴慢性疼痛的危险因素（P＜ 0.05）。Pearson 相关分析显示,SIS 得分、SSRS 得分、SCSQ 中的积极应对条 目均分与 GPS 条目均分呈负相关（r=-0.689、-0.677、-0.736;P＜ 0.05）,与 SCSQ 中消极应对条目均分呈 正相关（r=0.811,P＜ 0.05）。结论 COMT 基因 rs6269 位点 A 等位基因频率与抑郁症伴慢性疼痛相关, 同时抑郁症患者的社会心理状态与慢性疼痛症状也存在相关性。     

慢性精神分裂症患者家属心理健康状况性别差异调查

目的分析慢性精神分裂症患者家属心理健康状况的性别差异及相关原因。方法采用症状自评量表（SCL-90）、简易应对方式问卷及社会支持评定量表,对110名慢性精神分裂症患者家属进行调查分析。结果慢性精神分裂症患者不同性别组家属的SCL-90、社会支持评定量表、简易应对方式问卷评分差异具有统计学显著意义（P〈O．01）,社会支持评分、应对方式评分与SCL-90评分间存在相关,相关具有统计学意义（P〈O．01）。结论慢性精神分裂症患者家属心理健康状况存在性别差异,女性家属的心理问题较男性家属严重,心理健康状况与个体应对方式及社会支持度相关。     

有家庭暴力行为酒依赖患者社会支持与应对方式的研究

目的探讨酒依赖患者的家庭暴力行为与社会支持及应对方式的相关性。方法采用家庭暴力调查问卷、特质应对方式问卷(TCSQ)、社会支持评定量表(SSRS)对符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)的新疆精神卫生中心戒酒科及新疆自治区人民医院临床心理科愿意接受研究的138例住院酒依赖患者进行调查。结果施暴组(n=80)的主观支持得分(25.90±3.70)、客观支持得分(31.39±3.25)、支持利用度得分(7.40±1.67)和社会支持总得分(64.73±5.04)与无施暴组(n=58)的主观支持得分(26.81±3.62)、客观支持得分(31.28±3.18)、支持利用度得分(7.64±1.92)和社会支持总得分(65.72±5.08)之间差异无统计学意义(P0.05)。施暴组积极应对得分(31.94±5.64)、消极应对得分(20.39±4.31)与无施暴组积极应对得分(33.12±6.36)、消极应对得分(19.67±4.27)比较差异无统计学意义(P0.05)。结论酒依赖患者家庭暴力行为与其社会支持及应对方式无相关性。     

心理干预对实习期临床医生心理健康、应对方式及社会支持改善效果的对照研究

目的探讨心理干预对实习期临床医生心理健康、应对方式及社会支持改善的效果。方法将195名实习期临床医生随机分为研究组99名和对照组96名,研究组实施心理干预,对照组不接受心理干预,共12周。在基线及第12周末分别应用症状自评量表(SCL-90)、应对方式问卷(CMI)及社会支持评定量表(SSRS)评价干预效果。结果在干预后,研究组的SCL-90、CMI及SSRS各因子评分较基线时均有不同程度的改善(P<0.05),而对照组各量表评分均无明显改善(P>0.05)。结论心理干预可明显改善实习期临床医生的心理健康状况、应对方式及社会支持。     

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.     

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.     

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.     

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.     

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.     

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.