心理健康测查表对某些精神疾病的测试分析

目的：研究心理健康测查表（psychological health inventory,PHI)在精神科临床中的适用性。方法：采用宋维真等编制修订的PHI问卷,对325例精神分裂症、躁狂症及抑郁症患者进行测查,并以全国常模作对照分析。结果：各组患者PHI的绝大多数量表原始分均明显高于常模组;精神分裂症、躁狂症及抑郁症各组PHI测图结果与临床诊断基本符合率分别为67．00％、71．74％、93．98％。结论：PHI及其常模对精神正常与否具有较高的鉴别力,对抑郁症的临床辅助诊断更具参考价值,但就精神分裂症与躁狂症两组间的测图结果分辨力欠佳,有待于进一步探讨。     

精神分裂症和情感障碍混合家系的遗传调查

目的 探讨精神分裂症和情感障碍混合家系的遗传效应。方法 采用严格的纳入标准,应用家族史法对55例混合家系的各级亲属2134人进行详细的调查记录。分三组进行分析。结果 (1)精神分裂症为先证者组,各级亲属精神分裂症的患病率为1.1％,与1993年全国七地区调查精神分裂症的群体患病率0.655％比较,P>0.05,统计学上无显著差异,一级亲属患病率为4.79％,各群体比较,P<0.05。各级亲属情感障碍的患病率为3.78％,与1992年全国七地区调查情感障碍的群体患病0.083％比较,P<0.05,统计学上有显著差异,一级亲属患病率为17.96％。(2)情感障碍为先证者组,各级亲属情感障碍患者率为1.234％,与群体比较,P<0.05,一级亲属患病为4.76％。各级亲属精神分裂症的患病率为3.67％,与群体比较,P<0.05,一级亲属患病率为12.24％。(3)混合组,各级亲属精神分裂症的患病率为2.27％,与群体比较,P<0.05,一级亲属患病率为9.44％。结论 混合家系中,血缘关系越近,亲属中精神分裂症和情感障碍的患病率越高;精神分裂症和情感障碍在遗传传递上可能具有交叉性。     

Predictors of components of expressed emotion in major caregivers of Turkish patients with schizophrenia

Background Expressed emotion (EE) is a concept reflecting the emotional atmosphere of the home environment. Specific components of EE, namely criticism, hostility and emotional over-involvement, have been found to be important predictors of relapse for schizophrenic patients. The main aim of this study was to examine the predictive power of patient and caregiver characteristics and caregivers' perceptions of frequency, coping, distress/discomfort, control of symptom behaviours by the patient, and attributions on locus of causality for the development of the illness on two components of EE (criticism/hostility and emotional over-involvement) in a sample of major caregivers of Turkish schizophrenic patients. Methods Seventy-two caregivers of schizophrenic patients were administered a set of questionnaires tapping socio-demographic and illness-related variables, the family questionnaire tapping perceived frequency, distress/discomfort, coping and control of symptom behaviours, causal attributions for illness and, finally, the Expressed Emotion Scale in the hospital setting. Results The results showed that caregivers' perceptions of coping with specific symptom behaviours decreased criticism/hostility (C/H), whereas perceptions of higher frequency of symptom behaviours increased C/H. For emotional over-involvement (EOI), the number of individuals living in the household, being the mother, father or the spouse, perceptions of coping with symptom behaviours and reported distress/discomfort about symptom behaviours were significant predictors. Conclusions Caregivers' perceptions of their ability to cope with symptom behaviours and their reported distress due to these behaviours are important variables related to components of EE and need to be targets in intervention studies. The cultural and clinical implications of the results for the management of schizophrenia and for support for the caregivers are discussed. Accepted: 26 September 2001     

The volumes of the fornix in schizophrenia and affective disorders: A post-mortem study

Structural and functional pathology of limbic structures including the hippocampus are frequently replicated in schizophrenia. Although the fornix is the main afferent system of the hippocampus to the septal nuclei and the hypothalamus (especially the mammillary bodies), relatively few studies have investigated structural changes of the fornix in schizophrenia. We measured the volume of the fornix in post-mortem brains in 19 patients with schizophrenia, 9 patients with bipolar disorder, 7 patients with unipolar depression, and 14 control subjects by planimetry of serial sections. The volumes, the mean cross-sectional areas, and the anterior to posterior distances of the fornix did not differ among patients with schizophrenia, bipolar disorder, unipolar depression, and control subjects. No lateralization existed between the right and the left fornices in among patients in the diagnostic groups and the control subjects. The fornix does not show morphometrical abnormalities in patients with schizophrenia, bipolar disorder and unipolar depression compared with control subjects, which might indicate that the fornix is not a primary focus of structural changes in these diseases.     

精神分裂症与情感障碍患者弓形虫感染率及相关因素分析

目的 比较精神分裂症和情感障碍患者弓形虫抗体阳性率及动物接触史，以进一步探讨弓形虫感染与精神分裂症的关系。方法 采用酶联免疫吸附法检测首次发病的精神分裂症患者和情感障碍患者（各600例）血清弓形虫免疫球蛋白（Ig）G、IgM抗体水平，并调查动物接触史。结果 （1）精神分裂症组IgG抗体阳性率为13.7％，高于情感障碍组[6．7％，P〈0．01；比值比（OR）=2．22]；两组IgM抗体阳性率的差异无统计学意义。（2）精神分裂症组，母孕期居住于农村（401例，66．8％；χ^2=21．72，OR=1．74）、母孕期家中养狗（89例，14．8％；χ^2=13．85，OR=2．00）和养猫（57例，9．5％；χ^2=21．63，OR=3．39）的比例、13岁前居住于农村的患者比例（394例，65．7％；χ^2=28．34，OR=1．88）均高于情感障碍组（分别为53．7％，8．0％，3．0％，50．5％；P〈0．01）。在精神分裂症组和情感障碍组母孕期家中养狗的患者中，母孕期居住于农村的比例（分别为17．2％和10．8％）均高于不居住于农村的比例（分别为9．8％和3．5％，P〈0．05和P〈0．01）。结论 精神分裂症患者IgG阳性率及动物接触史与情感障碍患者不同；既往弓形虫感染史可能与精神分裂症有关联。     

Self-perceived social integration and the use of day centers of persons with severe and persistent schizophrenia living in the community: a qualitative analysis

Background The study examined how persons with severe and persistent schizophrenia perceive their social integration and how particular types of social integration are related to the use of day centers and patient clubs. Methods Problem-focused interviews on self-perceived social integration and the use of day structuring services were done with 100 persons with an ICD–9 diagnosis of schizophrenia living in Leipzig. Transcribed interviews were subjected to computer-aided qualitative content analysis. Results Results of the qualitative content analysis show that the study participants can be classified in five different groups according to their self-perceived degree of social integration. The use and the subjective meaning of existing day structuring services was found to be associated with the type of self-perceived social integration. Conclusion The heterogeneous ways persons with chronic schizophrenia organize their social lives lead to different kinds of needs for support. In order to meet the needs of the whole spectrum of patients this heterogeneity must be taken into account in the process of service planning. Accepted: 4 September 2001     

Family history of affective illness in schizophrenia patients: Symptoms and cognition

This study examined the relationship between having a family history of affective disorder and neuropsychological functioning and PANSS symptoms in schizophrenia patients falling into four exclusive family history groups (affective spectrum disorders, schizophrenia spectrum disorders, both, or neither). Schizophrenia patients with a family history of affective illness had the best performance on IQ tests and executive function measures. Symptoms showed fewer family history group differences. Schizophrenia patients with a family history of affective disorder may be a distinct subtype in the group of schizophrenias and may be biologically more similar to patients with serious affective disorder.     

The role of stress in the onset of depressive disorders

Background: We conducted the present study to evaluate the impact of stressful events on the onset of depressive disorders in a Spanish clinical sample, compared to a control group matched for age, sex, civil status and social class. We compared our results with those of other studies carried out with samples that were both clinically and culturally similar to ours. Method: Fifty depressed patients that were diagnosed with a depressive episode in the 6 months prior to the interview and 50 healthy controls were included in the study. Both groups were compared on the “Life Events and Difficulties Schedule” (LEDS). Results: Of the depressive patients, 68 % compared to only 18 % of the control individuals experienced at least one provoking agent in the 12 months prior to the onset of the symptoms. The risk of developing a depressive disorder was 9.7 % greater in subjects exposed to such provoking agents. Chronic difficulties are equally important to the genesis of depressive disorders as severe life events. No significant differences were seen between the two diagnostic subgroups of depressed patients in the accumulation of severe events, major difficulties or provoking agents. Conclusion: The results support the view that stress is a major factor in the aetiology of depressive disorders. The amount of stress suffered by the patients, however, was less than that found in our healthy sample. Important issues about the model of interaction between stress and depression are discussed. Accepted: 29 July 2002 Correspondence to L. Rojo     

Autism spectrum and attention-deficit disorders in girls. Some neuropsychological aspects

This study compared the neuropsychological test profiles of non-mentally retarded girls and boys consecutively referred to a neuropsychiatric clinic and those of contrast cases of girls from mainstream classrooms of one G?teborg school district. To avoid overreliance on the male prototype with regard to diagnostic criteria the clinical group comprised a mixed sample of girls and boys without diagnostic subgrouping. Clinic girls had a lower IQ than comparison girls. Girls were more impaired than the boys with respect to executive functions and scored less well on theory of mind tasks. Previous studies have shown girls with autism and mental retardation to be more severely affected than boys both with regard to level of intellectual functioning and overall measures of brain dysfunction. The present study indicates that clinic girls with a variety of neuropsychiatric disorders at higher levels of intellectual functioning (some of which met diagnostic criteria for autism spectrum disorder) may also be more severely affected than boys with corresponding types of "surface" problems.     

Relationships of affective temperament ratings to diagnosis and morbidity measures in major affective disorders

BackgroundRatings of affective temperament types show promise in helping to differentiate diagnostic groups among major affective disorders as well as to predict associations with important aspects of morbidity including suicidal risk.MethodsThe Temperament Evaluation of Memphis, Pisa, Paris, and San Diego auto-rating (TEMPS-A) questionnaire was completed by 858 unselected, consecutive, consenting adults diagnosed with a DSM-5 major affective disorder (173 bipolar-1 [BD-1]), 250 BD-2, 435 major depressive disorder [MDD]) to score for anxious (anx), cyclothymic (cyc), dysthymic (dys), hyperthymic (hyp), and irritable (irr) affective temperaments. We tested their associations with diagnosis and selected clinical factors, including diagnosis, depression scores, suicidal ideation or acts, substance abuse, episodes/year, and %-time ill.ResultsScores for cyc ranked: BD-2 > BD-1 > MDD; anx ranked: MDD > BD-2 > BD-1; irr was greater in BD than MDD; dys was greater in MDD than BD; hyp did not differ by diagnosis. We confirmed associations of suicidal risk with higher scores of all temperament types except lower hyp scores. Higher cyc and irr scores and lower anx scores were associated with substance abuse. Several scores were higher with measures of greater affective morbidity: cyc with current depression, episodes/year, and %-time ill; irr with more episodes and depressions/year and greater %-time manic. Some of these associations were selective for BD or MDD.ConclusionsThe findings indicate that TEMPS-A ratings of affective temperament types can contribute to differential diagnoses and predict types and amounts of affective morbidity, as well as detecting suicidal risks.     

The prevalence of autism spectrum disorders. Recent evidence and future challenges

Background: Until recently best estimate prevalence rates for autism spectrum disorders (ASD) were 0.5/1,000 for autism and 2.0/1,000 for the broader spectrum. Three recent studies have suggested a significantly higher prevalence rate for ASD of 6.0/1,000 (mean 95 % CI = 4.8–8.0). Method: Possible determinants of the apparent increase in the prevalence of ASD are outlined. Methodological aspects of the three recent studies are examined. Findings: Increased recognition, the broadening of the diagnostic concept over time and methodological differences across studies may account for most or all of the apparent increase in prevalence, although this cannot be quantified. Conclusions: Findings from ongoing studies should help confirm or disconfirm the putative rate of 6.0/1,000 for all ASD. The possibility that autism has been over-diagnosed in recent studies needs to be ruled out. Notwithstanding these outstanding questions, it appears likely that the current true prevalence of ASD is considerably greater than previously recognised. This has significant implications for our scientific understanding of ASD and for families and services. Future directions for epidemiological research are outlined. Accepted: 30 September 2002 Correspondence to Tony Charman     

Temporal sequencing of lifetime mood disorders in relation to comorbid anxiety and substance use disorders

Background: Little is known about the temporal sequencing of psychiatric disorders. The aim of this study was to obtain insight into patterns of co-occurrence of DSM-III-R mood disorders in relation to anxiety and substance use disorders, their temporal sequencing and the sociodemographic and long-term vulnerability predictors of this temporal sequencing. Methods: Data are from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a psychiatric epidemiological study in a representative sample of 7,076 adults aged 18–64. Results: Of those who had ever experienced a mood disorder, 46 % of males and 57 % of females had a history of anxiety disorders, and 43 % and 15 % of substance use disorders. Mood disorders were associated with all anxiety and substance use disorders, except with alcohol abuse among males. In the majority of anxiety-comorbid cases, the mood disorder arose after the anxiety disorder; the pattern for substance use-comorbid disorders was more variable. Deviation from the usual sequence of major depression and anxiety disorders was more often seen among females, subjects with a higher educational level, subjects who experienced childhood parental divorce, and subjects who experienced childhood emotional neglect. Conclusions: When comorbid with anxiety disorders, mood disorders clearly tend to be secondary. Few of the studied demographic factors, familial vulnerability factors and childhood life events predict the sequencing of mood disorders in relation to other disorders. Received: 20 September 2001 / Accepted: 29 July 2002 Correspondence to R. de Graaf     

The use of multiple informants in identifying the risk factors of depressive and disruptive disorders

Objective: The aim of this study was to asses whether children and their parents identify the same risk factors for disruptive and depressive disorders and to analyze whether combining informant data with a rule that classifies the diagnosis as present if confirmed by at least one informant (OR rule) masks distinctive patterns identified in informant-specific analyses. Method: Bivariate logistic regression equations were estimated using the diagnostic classification, based on DISC 2.1, as the outcome variable and informant (parent or child), characteristics of the youth (gender and age), indicators of the context of the interview (site), and family characteristics (income, parental monitoring, and adverse family environment) as predictors. The same predictors were also analyzed with the combined informant (OR rule) as outcome variable. Results: Prevalence of all diagnoses varied with informant. Depressive disorders were more prevalent when the informant was the youth and disruptive disorders when the informant was the parent. The effect of age varied with informant. Odds of being classified as having a DISC disorder increased with age when the informant was the youth but the same effect was not observed when the parent was the informant. When information from parents and youth are combined (with an OR rule) the age effect for disruptive disorders vanishes, and its effect for depressive disorders weakens. Conclusions: Informants are not interchangeable. Parent- and youth-based estimates of the prevalence of disruptive and depressive disorders were different and showed distinctive age relationships. Combining information from different sources (parents and youths) obscures the apparent effect of age noted in the two informant groups. Received: 5 September 2001 / Accepted: 8 August 2002 Dr. Garrett Fitzmaurice was funded in part by NIMH grant RO1-MH54693. Correspondence to Prof. Maritza Rubio-Stipec, Ph.D.     

Psychiatric disorders in adult children of parents with a history of psychopathology

Background The relation between major categories of psychiatric problems in parents and psychiatric disorders in their adult children has been investigated in only a few community studies. Methods In this study, data from a representative sample of the Dutch population (N = 7147) (response rate: 69.7 %) were used to examine this relation. DSM-III-R disorders were assessed using the CIDI. Parental psychiatric symptoms and childhood adversities were assessed using self-report measures. Results It was found that psychiatric symptoms in parents are strongly related to psychiatric disorders in their (adult) children, independent of type of parental psychiatric symptom. Only maternal problem drinking was not significantly related to an increased risk for their children. When controlled for childhood adversities and demographic variables, most relations between psychiatric disorders and parental psychiatric symptoms remained significant. Parental anxiety symptoms, however, were not significantly related to psychiatric disorders in the children, including anxiety disorders. It was also found that anxiety disorders in the children were not related to most parental psychiatric symptoms. Conclusions This study has once more made it clear that children whose parents have psychiatric problems constitute an important high-risk group and that prevention and early intervention in these children constitute an important public health issue. Accepted: 26 September 2001     

Gender and age-specific first incidence of DSM-III-R psychiatric disorders in the general population

Background Prospective studies in the general population are needed to identify risk factors for mental disorders. Samples of sufficient size are needed, but large-scale studies that assess the incidence of psychopathology are rare. Aims The aim of this study was to investigate the 12-month first incidence rates (IR) by age and gender for 15 specified DSM-III-R disorders in the general population. Methods The study was based on a representative sample (N = 5618) of the Dutch population aged 18–64. Results The IR for any disorder was 5.68 per 100 person-years at risk (men 4.45, women 6.94). IRs for both men and women were highest in the youngest age category. The most common 12-month incident disorders in men were alcohol abuse (IR = 4.09) and major depression (1.72). In women, the most common incident disorders were major depression (IR = 3.90) and simple phobia (3.17). Conclusions The results show the rarity of first-onset of mental disorders. IRs vary strongly between the different life phases, as well as between men and women. This suggests potential target areas for age-specific and gender-specific prevention. Accepted: 19 March 2002     

Determinants of occurrence and recovery from hallucinations in daily life

Background Data related to the dynamics of hallucinatory experiences of patients suffering from schizophrenia are scarce. Detecting antecedent conditions and coping strategies may aid development of targeted psychological interventions. Method We studied hallucinating and non-hallucinating patients suffering from schizophrenia spectrum disorder (n = 57), and non-schizophrenic severe mentally ill patients with depression (n = 37). Data were collected using the Experience Sampling Method (ESM) over a period of 1 week. Contingent on a randomly signalling beep, subjects filled in reports of ongoing hallucinations as well as thought, mood, current activity, social circumstances and places frequented. Results More subjects suffering from schizophrenia reported hallucinations, but for all hallucinating subjects the qualities of hallucination episodes were quite similar. More subjects reported visual hallucinations at least once. In contrast, the intensity of auditory hallucinations was higher. Anxiety was the most prominent emotion during hallucinations and reports of anxiety intensity exceeded baseline levels before the first report of auditory hallucinations. Context modified hallucination intensity over the course of an episode. Social withdrawal resulted in a decrease of hallucinatory intensity (AH > VH), while social engagement slightly raised intensity levels (VH > AH). Doing nothing (VH > AH) and work activities (AH > VH) led to decreases in intensity levels over time, while passive leisure activities (watching TV) resulted in increases in intensity levels of hallucinations (AH > VH). Conclusion The results suggest that hallucinating experiences are subject to a host of contextual influences. Understanding variation offers useful insights for therapy. Accepted: 14 December 2001     

A longitudinal study of schizophrenia- and affective spectrum disorders in individuals diagnosed with a developmental language disorder as children

The prevalence and types of schizophrenia- and affective spectrum disorders were studied in 469 individuals with a developmental language disorder (DLD), assessed in the same clinic during a period of 10 years, and 2,345 controls from the general population. All participants were screened through the nationwide Danish Psychiatric Central Register (DPCR). The mean length of follow-up was 34.7 years, and the mean age at follow-up 35.8 years. The results show an excess of schizophrenia spectrum disorders (F20-F29) within participants with DLD when compared with controls from the overall population (6.4% vs. 1.8%; P < 0.0001). For schizophrenia (F20.x) the respective figures were 3.8% versus 1.1%; P = 0.0001. The variable degree of expressive language disorder was significantly associated with a schizophrenia spectrum disorder diagnosis in the DPCR. There was no significant increase in affective spectrum disorders (F30-F39) in the DLD case group (3.4% vs. 2.0%; P = 0.05). Our results provide additional support to the notion that DLD is a marker of increased vulnerability to the development of schizophrenia spectrum disorders.     

情感性精神障碍的气候影响-中国7地区流行病学资料再分析

目的：探讨气候因素与情感性精神障碍患病率间的关系。方法：回顾1993年中国7地区情感性精神障碍流行病学调查资料，分析其终生患病率与年平均气温、年平均日照时数、年平均降水量、纬度及所处的气候区之间关系。结果：以大庆、吉林、沈阳、北京4个地区为代表的温带地区的情感性精神障碍终生患病率及标化患病率均显著低于南京、上海、长沙3个地区为代表的亚热带地区；情感性精神障碍终生患病率及标化患病率与气候各因素问均无显著相关性。结论：气候因素会对情感性精神障碍的患病产生影响，不同气候地区的情感性精神障碍患病率间存在差异。