心理健康教育多元家庭治疗对抑郁障碍患者的疗效及家庭功能的影响

目的 探讨心理健康教育多元家庭治疗（The psychoeducational multiple family group,PMFG）对抑郁障碍患者的疗效及家庭功能的影响。方法 从张家港市第四人民医院门诊中选取60名抑郁障碍患者随机分为研究组和对照组,两组研究对象均采用抗抑郁药物治疗,研究组使用PMFG模式治疗,对照组使用门诊随访及社区支持性治疗;采用汉密尔顿抑郁量表（Hamilton Depression Scale,HAMD）、汉密尔顿焦虑量表（Hamilton Anxiety Scale,HAMA）、家庭功能评定量表（Family Function Rating Scale,FAD）对两组患者治疗前后进行HAMD、HAMA、FAD评分比较。结果 干预后研究组HAMD和HAMA评分均低于对照组（t=6.749,P<0.01;t=5.165,P<0.01）;FAD评分低于对照组（P<0.01）;差异均有统计学意义。结论 心理健康教育多元家庭治疗能减轻抑郁障碍患者的临床症状,并有助于提高患者的家庭功能。     

抑郁症与心境恶劣障碍患者的甲状腺素水平

目的:测定抑郁症与心境恶劣障碍患者的甲状腺素水平,探讨其神经内分泌改变。方法:对抑郁症30例和心境恶劣障碍30例进行汉密尔顿抑郁量表(HAMD),艾森克人格问卷(EPQ)及生活事件量表(LES)评定。测血清三碘甲状腺原氨酸(T3)、甲状腺素(T4)及促甲状腺素(TSH)浓度。结果:两组间在HAMD总分及T4水平差异显著。抑郁症组T3与EPQ的内外向分及HAMD的迟缓因子分呈正相关;T4与HAMD总分、焦虑因子分及负性生活事件刺激量呈正相关;TSH与正性生活事件刺激量呈正相关。心境恶劣障碍组T3与认知障碍因子分呈负相关;T4与HAMD总分、负性生活事件及迟缓因子分呈正相关。结论:负性生活事件促进了抑郁发作,T4水平可预测抑郁症状的严重程度。     

双相障碍患者稳定期残留症状与社会功能调查

目的:调查双相障碍(BD)患者稳定期残留症状及其社会功能。方法:收集64例BD稳定期患者的人口学及临床资料,应用杨氏躁狂量表(YMRS)、汉密顿抑郁量表(HAMD-17)、社会功能缺陷筛选量表(SDSS)对患者进行评估;以10≤YMRS20、8≤HAMD-1721为界将患者分为残留症状组及无残留症状组,对两组情况进行分析。结果:残留症状组16例,无残留症状组48例;两组性别、年龄、文化程度、婚姻状况、就业情况、发病年龄、病程比较差异无统计学意义;残留症状组YMRS、HAMD-17、SDSS评分明显高于无残留症状组(t=-4.365~-2.413,P0.05或P0.01)。SDSS评分显示残留症状组家庭职能、对外界的兴趣与关心、责任心与计划性与无残留症状组比较差异有统计学意义(Z=-2.992~-2.157,P0.05或P0.01)。Logistic回归分析显示残留症状与婚姻状况相关(OR=0.304,P0.05,95%CI:0.101~0.918)。结论:BD患者稳定期有残留症状的比率较高;其社会功能有所损害;婚姻状况与发生残留症状相关。     

抑郁障碍患者家庭功能的跨文化研究

目的:探讨中国和美国抑郁障碍患者的家庭功能特征.方法:采用家庭功能量表(FAD)对92例中国抑郁障碍患者(中国组)及92例美国抑郁障碍患者(美国组)进行评估及比较.结果:两组FAD各维度均分均高于健康的家庭功能临界值,为不健康的家庭功能.中国组FAD中的情感反应维度评分及行为控制维度评分明显高于美国组;中国男性组情感反...     

住院抑郁症患者疾病严重度的相关因素分析

目的探讨影响住院抑郁症患者疾病严重程度的相关因素。方法对符合(CCMD-2-R)抑郁症诊断标准的55例患者评定了一般情况问卷、生活事件量表(LES)、社会支持评定量表(SSRS)、A型行为问卷(TABQ)、汉密顿抑郁量表(HAMD)和汉密顿焦虑量表(HAMA)。结果住院抑郁症患者中92.7%存在中重度抑郁,83.6%存在中重度焦虑;HAMD和HAMA评分与A型行为量表总分、客观支持分存在显著正相关;社会支持量表的主观支持分和社会支持利用度与HAMD评分呈显著负相关。结论影响住院抑郁症患者疾病严重程度的因素主要是A型行为量表和社会支持量表的评分。     

影响新型抗抑郁药物疗效的相关因素

目的 探讨影响新型抗抑郁药物疗效的相关因素.方法 纳入符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)重性抑郁障碍诊断标准的患者241例,接受单一的帕罗西汀(121例,最大剂量40 mg/d)或文拉法辛(120例,最大剂量225 mg/d)治疗6周.以治疗前后汉密尔顿抑郁量表(HAMD)的减分率评定疗效,≥50%为治疗有效.收集治疗前的HAMD、汉密尔顿焦虑量表(HA-MA)、简明精神病评定量表(BPRS)、明尼苏达多相个性凋查表(MMPI)、生活事件量表(LES)和自动思维量表(ATQ)等临床资料,比较治疗有效和无效两组的芹异,并通过Logistic同归分析疗效的主要影响因素.结果 有效组和无效组之间在精神障碍家族史、总病程、1年内未及时治疗、非单次发作、是否伴有焦虑症状、ATQ总分、HAMD迟滞因子分、BPRS焦虑忧郁因子分和总分、MMPI的疑病(HS)分和抑郁(D)分等方面的差异有统计学意义(P＜0.05).Logistc回归分析显示,总病程(6=0.02,OR=1.02,P=0.002)、1年内未及时治疗(6=1.09,OR=2.96,P=0.01)、精神障碍家族史(6=1.44,OR=4.22,P=0.03)、足含伴有焦虑症状(6=1.67,OR=5.30,P=0.02)对疗效影响显著.结论 提示及时治疗和有效控制焦虑症状可能提高抗抑郁药物的疗效.     

伴有抑郁的2型糖尿病患者生活质量及家庭功能

目的:探讨伴有抑郁的2型糖尿病患者生活质量及家庭功能特征。方法:采用生活质量量表(QLESQ)、家庭功能量表(FAD)以及贝克抑郁量表(BDI)对50例2型糖尿病患者(糖尿病组)及50名正常人(正常对照组)进行调查。结果:38%(19/50例)的2型糖尿病患者伴有抑郁。糖尿病组FAD评分中情感卷入及行为控制维度在不健康家庭功能范围内;QLESQ总分(32.49±5.86)分明显低于正常对照组(37.76±5.38)分(P<0.01)。糖尿病组FAD的问题解决、角色和情感卷入维度与抑郁症状呈正相关(r分别=0.426、0.339、0.454,P<0.05或P<0.01);QLESQ总分与家庭功能的角色和行为控制维度呈负相关(r分别=-0.292、-0.344,P<0.01)。结论:伴发抑郁的2型糖尿病患者生活质量差且家庭功能有缺陷。     

躯体化症状为主抑郁症患者的述情障碍

目的:探讨以躯体化症状为主抑郁症患者和以情绪症状为主抑郁症患者述情障碍的差异。方法:50例以躯体化症状为主抑郁症患者(躯体症状组)、50例以情绪症状为主抑郁症患者(情绪症状组)和50名正常健康者(正常对照组)参加研究,采用90项症状自评量表(SCL-90)、汉密尔顿抑郁量表(HAMD)和多伦多述情障碍量表进行评定。结果:躯体症状组SCL-90总分、躯体化、焦虑、人际敏感、恐怖、偏执因子分及HAMD的焦虑/躯体化因子评分均高于情绪症状组(P<0.01或P<0.05),情绪症状组在强迫、抑郁因子评分及HAMD的认知障碍、阻滞、日夜变化、睡眠障碍及绝望因子分高于躯体症状组(P<0.05或P<0.01)。躯体症状组与情绪症状组仅在述情障碍因子II评分差异有统计学意义(P<0.05),而在述情障碍总分及因子分上均高于正常对照组(P<0.05或P<0.001)。结论:以躯体化症状为主和以情绪症状为主抑郁症患者均存在述情障碍,以前者更缺乏识别情绪和躯体感受能力。     

抑郁障碍患者自杀未遂的危险因素分析

目的:分析抑郁障碍(MDD)患者自杀未遂的危险因素。方法:入组332例MDD患者,分为自杀未遂组(95例)和非自杀未遂组(237例);对入组者进行人口学与临床资料调查、汉密尔顿抑郁量表(HAMD-24)及汉密尔顿焦虑量表(HAMA-14)评估及血清甲状腺功能检测,并进行组间比较;分析自杀未遂的危险因素。结果:自杀未遂组年龄、首次发病年龄明显小于非自杀未遂组,病程、既往住院次数明显多于非自杀未遂组;单身、无业、受教育程度低、家族史阳性、伴有精神病性症状、共病焦虑障碍比率明显高于非自杀未遂组(P<0.05或P<0.01)。HAMD总分与焦虑躯体化、认知障碍、阻滞、绝望感、体质量、日夜变化因子分及HAMA评分明显高于非自杀未遂组(P<0.05或P<0.01)。血清游离三碘甲状腺原氨酸(FT3)水平明显高于非自杀未遂组(P<0.05)。多因素Logistic回归分析显示,伴有精神病性症状、既往住院次数、HAMD评分中认知障碍、绝望感因子是影响抑郁症患者自杀未遂的主要危险因素。结论:伴有精神病性症状、既往住院次数、HAMD评分中的认知障碍、绝望感因子可能为MDD患者...     

个体化全病程干预对伴精神病性症状的抑郁症患者康复疗效的影响

目的了解个体化全病程干预对伴精神病性症状抑郁患者的疗效及预后的影响。方法将符合入组标准的81例伴精神病性症状的抑郁患者随机分为研究组与对照组(研究组39例,对照组42例),研究组实施个体化全病程干预,对照组进行常规治疗及随访,分别于入组时,治疗3个月后、6个月后、1年后进行评估比较,采用简明精神病量表(BPRS)、汉密尔顿抑郁量表(HAMD)、生活质量综合评定问卷(GQOLI-74)及治疗副反应量表(TESS)作为评定工具。结果两组患者入组时简明精神病量表(BPRS)、汉密尔顿抑郁量表(HAMD)、生活质量综合评定问卷(GQOLI-74)及治疗副反应量表(TESS)评分比较均无明显差异(P0.05);在治疗3月、6月、1年后两组间各量表评分的差异均有统计学意义(P0.05和P0.01)。结论个体化全病程干预能够有效缓解伴精神病性症状抑郁症患者的病情,能有效提高患者的社会功能、健康状况及生活质量,提高患者服药依从性及再就业率,降低复发率。     

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.