广东中山市精神疾病流行病学调查

目的 了解中山市精神疾病流行病学情况。方法 采用WHO提供,1982年和1993年两次全国精神疾病流行病学调查使用的方法,对中山市城乡3721人行社会人口学调查及15岁以上人口精神疾病患病情况调查。结果 中山市精神疾病(不含神经症和海洛因依赖)时点患病率26.13‰,终生患病率为29.91‰;两者明显高于1993年中国七地区精神疾病流行病学调查结果(相应为11.18‰和13.74‰,P均小于0.01)。神经症(均为现患病例)的时点患病率为29.70‰,海洛因依赖终生患病率为7.56‰。结论 中山市精神分裂症和精神发育迟滞仍居前两位,而酒依赖、情感性精神障碍、脑器质性眠精神障碍及镇静眠药物依赖患病率升高,神经症、海洛因依赖患病率居国内较高水平,应列为防治和研究的重点。     

安徽淮北矿区职工精神疾病流行病学调查

目的：了解安徽淮北市矿区职工各类精神障碍的患病率。方法：采用精神疾病流调手册推荐的方法和流程,于2009年9月1日至12月31日对淮北市矿区职工进行精神疾病流行病学调查。结果：通过多级分层整群概率比例,随机抽样2830人完成调查,患有精神疾病177例（其中神经症88例）,精神疾病患病率为62．54‰;若不含神经症,患病率为31．45‰,与1993年全国7个地区精神疾病流行病学调查结果相比明显升高。结论：淮北矿区职工精神疾病患病率较高,各类精神疾病患病率以神经症和酒依赖居前两位。矿区职工精神卫生防治工作亟待加强。     

无锡市神经症流行病学调查

目的:了解无锡市神经症的患病率及人口学特点.方法:采用1993年中国7地区精神疾病流行学调查方法,于2003年在无锡市进行神经症流行病学调查.结果:在城乡15～59岁的1928人中,神经症患病率为38.38‰,其中以抑郁性神经症患病率最高(20.75‰),其余按患病率高低依次为焦虑症(8.30‰)、神经衰弱(4.67‰)、疑病症(2.59‰)、癔症(1.04‰)和强迫症(1.04‰).患病率与性别、经济状况、职业等因素有关.结论:神经症是一类十分常见的精神疾病,患病率呈上升趋势,应列为社区精神卫生保健工作的重点疾病.     

1986～2001年某部新兵精神疾病调查

目的；探讨入伍新兵精神疾病的患病率及相关因素。方法：应用新兵精神疾病调查的工具，对1986－2001年某部入伍的所有集训期新兵进行精神疾病的流行病学调查。结果：15年共调查入伍新兵656540名，检查出各类精神疾病共539名，总检出率（时点患病率）为0．82‰。新兵各类精神疾病的时点患病率以精神分裂症（0．29‰）、神经症（0．20‰）和精神发育迟滞（0．10‰）为高。入伍前已患病者占83．1％，入伍后新发病者占16．9％。有明显精神疾病家族史者占28．4％。结论：开展新兵精神疾病调查，在集训期内把患有精神疾病者作退兵处理，对提高兵员质量具有重要意义。     

沈阳战区精神疾病流行学调查资料分析

应用全国统一调查工具，对沈阳战区陆海空三军进行精神疾病流行学调查，结果表明精神疾病总患病率１．９８７‰，现患病率为１．５２０‰；精神分裂症总患病率１．３６０‰，现患病率１．１２０‰；神经症患病率３．１９７‰。     

中山市老年精神疾病流行病学调查

目的：了解中山市老年精神疾病流行病学情况。方法：采用1982年和1993年2次全国精神疾病流行学调查使用的方法。结果：中山市老年精神疾病（不含精神症）终生患病率47.62%，显著高于一般人口（≥15岁）。结论：随着人口的老龄化，老年精神疾病应列为防治和研究的重点。     

广州战区精神疾病流行学和心理卫生调查分析

本文分析广州战区精神疾病的流行学调查资料，重精神病抽样１００３０人，总患病率为３．１９‰，现患病病率为１．９０‰，神经症抽样１９３９人，患病率为２６．８２‰，创伤后应激障碍的患病率为７．７４‰。心理卫生测查ＳＣＬ－９０结果与全国常模基本一致，性格特征Ｅ，Ｐ，Ｑ测查结果Ｅ分高于全国常模，Ｎ分低于全国常模。     

神经症住院病人入院前就诊方式的临床资料分析

1993年全国七个地区神经症流行病学调查结果表明：各种神经症总患病率为15．11％，以躯体症状为主诉首次就诊于综合性医院者占93％，而内科医生的神经症诊断率仅为25．7％。为此，本调查旨在了解神经症病人发病后就诊行为特点以及影响因素，为神经症的防治提供一定的参考资料。现报道如下：     

胜利油田1992年精神疾病流行学抽样调查资料分析

参照１９８２年全国精神疾病流行学调查的设计方案、调查流程和调查工具，１９９２年５月～８月进行了胜利油田精神疾病流行学抽样调查。根据整群分层随机抽样的原则，抽取４０００户居民、１４０７６人（其中≥１５岁者１１８０１人）。调查人口占油田总人口的３．８０％。统计结果，胜利油田各种精神疾病的总患病率为１５．５９‰，时点患病率为１４．３２‰。其中，精神分裂症的总患病率为４．４９‰，时点患病率为３．３０‰；酒精依赖的患病率为７．５４‰；精神发育迟滞的患病率为１．０７‰；神经症的患病率为１．６７‰。资料显示。经济文化水平偏低、地理位置偏僻及６０岁以上人群中，精神疾病的患病率水平相对偏高。     

威海市精神疾病流行病学调查

目的：了解威海市≥15岁人群各类精神疾病的患病率和分布特点。方法：2006年9月至2007年2月随机抽取≥15岁人群共50174人,使用心理卫生筛选表、神经症筛选表、精神现状检查（PSE）140题等工具进行调查,以中国精神疾病分类方案与诊断标准第3版为诊断依据。结果：各类精神障碍的时点患病率为70．34‰,终生患病率为89．51‰。排在前3位的为抑郁症（37．49‰）、神经症（30．06‰）和酒依赖（11．38‰）。农村患病率（93．22‰）高于城市（84．30‰）,女性（95．27‰）高于男性（83．82‰）。3种精神疾病均存在较高的未识别率,且农村高于城市。结论：山东威海市精神疾病的患病率以女性和农村较高;抑郁症是威海市患病率最高的精神疾病。     

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.