家族史和性别对精神分裂症精神病理学结构的影响

为了解家族史和性别对精神分裂症精神病理学构成的影响及联合效应，对符合中国精神疾病分类方案与诊断标准第２版精神分裂症诊断标准的１９４例病人进行简明精神病评定量表评定，并依性别和家族史分组。结果显示，单因素分析时，家族性精神分裂症阴性症状构成显著高于散发性精神分裂症，而阳性症状构成显著低于散发性精神分裂症；同时还发现，男性精神分裂症非特异性症状构成显著高于女性精神分裂症。双因素分析时，男性家族性精神分裂症阳性症状构成显著低于女性散发性精神分裂症，散发组男性非特异症状构成显著高于女性，提示性别、家族史对精神分裂症某些精神病理现象有影响，且有联合效应。     

精神分裂症患者临床特征的性别差异

目的 比较男性和女性住院精神分裂症患者临床特征的差异.方法 采用自编项目调查表对458份符合国际疾病和相关健康问题分类第十版（ICD-10）诊断标准的出院精神分裂症患者病历进行不同性别的对比分析.结果 在住院精神分裂症患者中,男性患者的平均年龄低于女性患者,男性患者的已婚比例低于女性患者,男性患者的首发年龄比女性患者早,男性患者中出现被害妄想和夸大妄想的比率高于女性患者,而出现嫉妒妄想、情感淡漠和情感不协调的比率低于女性患者;在药物使用中,男性患者使用芮迭的比例高于女性患者,而使用齐拉西酮的比例低于女性患者,两组比较差异均有统计学意义（P＜0.05）.男性与女性患者在文化程度、家族史、起病形式、病程、病程特点、住院时间、是否单一用药及临床疗效方面的比较差异均无统计学意义（P＞0.05）.结论 男性和女性住院精神分裂症患者在临床特征方面存在较多差异,这提示在实际诊疗及制定精神康复计划时,不同性别应区别对待.     

精神分裂症遗传的性别差异

目的：探讨精神分裂症遗传的性别差异。方法：对1013例精神分裂症患者不同性别家族史阳性率，不同性别父系、母系、同胞、子女患病情况，不同性别先证者一、二、三级亲属患病情况进行比较。结果：男性有遗传史者11．9％，女性24．3％，男性低于女性，差异显著。女性同胞患病构成比明显高于男性，差异有显著性。男女一级亲属患病高于二级亲属，二级亲属患病高于三级亲属。结论：精神分裂症与遗传密切相关。     

精神分裂症家族史性别差异调查

目的 了解不同性别精神分裂症遗传的差异及父系、母系阳性家族史的差异.方法 对长沙市城、乡在我院住院的及同时段各社区进行免费药物求助的共1938例精神分裂症患者进行精神障碍遗传的问卷调查,发现精神分裂症阳性家族史患者253例,其中男性139例,女性114例.对家族史阳性率,先证者父系、母系、同胞子女患病情况作统计分析.结果 男性阳性家族史比率较女性稍低,但无统计学意义;父系、母系、同胞子女的阳性家族史无明显性别差异;母系阳性家族史明显高于父系.结论 遗传因素对精神分裂症有很大的影响,不同性别精神分裂症的阳性家族史无明显差异.精神分裂症中母系后代比父系后代有更高的发病风险.     

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。     

男女儿童青少年精神分裂症患者临床特征的比较

目的:比较儿童青少年精神分裂症男性与女性患者临床特征的差异。方法:对125例男性(男性组)和133例女性(女性组)儿童青少年精神分裂症患者的年龄、发病年龄、病前诱因、阳性家族史、病程特点、住院天数、简明精神病量表(BPRS)、大体评定量表(GAS)及临床疗效总评量表(CGI)评分等临床特征进行比较。结果:男性与女性患者在年龄、发病年龄、病前诱因、阳性家族史、病程特点、住院天数方面比较差异无统计学意义(P均0.05)。BPRS评分中敌对性、动作迟缓、情感淡漠、缺乏活力因子分男性组高于女性组(t=2.164,t=3.317,t=2.096,t=2.230;P0.05或P0.01);幻觉、思维障碍因子分女性组高于男性组(t=3.682,t=2.987;P0.01或P0.001)。入院时GAS、CGI-SI评分及出院时CGI-GI评分两组间差异无统计学意义(P均0.05),出院时CGI-EI评分女性组高于男性组(t=2.466)、自知力评分男性组高于女性组(t=2.403),差异有统计学意义(P均0.05)。结论:男性儿童青少年精神分裂症患者的临床特征以情感淡漠、缺乏活力等阴性症状为主,女性则以幻觉、思维障碍等阳性症状更突出;女性临床疗效优于男性。     

精神分裂症遗传的性别差异

目的：比较不同性别精神分裂症遗传的差异。方法：在同期出院的877例精神分裂症患者中,整群连续抽取精神分裂症阳性家族史患者107例：按性别分为男性组45例,女性组62例。对家族史阳性率,先证者父系、母系、同胞、子女患病情况,一、二、三级亲属患病情况,胎次,患病个数及疗效作统计分析。结果：男性阳性家族史比率较女性低,且疗效差异有显著性;女性患者4胎及以上者显著较多。结论：不同性别精神分裂症的遗传有差异。     

影响女性精神分裂症甲状腺素水平相关因素研究

目的研究影响女性精神分裂症患者血清甲状腺激素（FT3,FT4、TSH）水平的相关因素。方法将60例符合CCMD-3诊断标准的精神分裂症患者随机分为利培酮组和阿立哌唑组,在治疗前后检测血清FT3、FT4、TSH水平,分别与健康对照组比较。结果年龄对甲状腺素无明显影响;病程越长FT3越高;阳性家族史患者FT4明显高于阴性家族史患者。结论女性精神分裂症患者甲状腺素受多种因素影响。     

儿童及少年期首发精神障碍患者的随访

目的了解儿童及少年期情感障碍和精神分裂症的临床特征.方法收集1984年至1999年之间在本院就诊患者中符合DSM-Ⅲ情感障碍和精神分裂症诊断的儿童及少年期首次发作病例64例,年龄5～17岁.入组时进行基线评定,然后长期随访.至随访结束,对两组疾病进行对照分析.结果58例（91%）完成随访,平均随访时间12.4年.儿童少年期入组诊断为情感障碍者36例,至成年随访结束时,92%诊断为情感障碍,8%诊断为精神分裂症;儿童少年期入组诊断为精神分裂症者22例,至成年随访结束时,32%诊断为情感障碍,68%诊断为精神分裂症.儿童少年期情感障碍患者在成年期诊断为精神分裂症者明显高于精神分裂症患者修改诊断为情感障碍（χ^2=22.852,P＜0.001）.儿童少年期精神障碍至成年期的诊断一致性较低（Kappa=0.62）.儿童及少年期发作的情感障碍与精神分裂症比较,起病年龄低、发作次数少、社会关系良好和较好的社会功能.情感障碍的精神症状多与精神分裂症重叠,但精神分裂症出现频率较高的情感不协调、注意力分散、关系妄想、情感迟钝、被洞悉感等症状,在情感障碍患者中始终未存在.结论儿童及少年期的情感障碍在症状学上与精神分裂症有许多相似之处,是导致误诊的重要原因.但儿童少年期精神分裂症存在的一些核心症状可能是两者鉴别诊断的症状学指标.     

精神分裂症的强迫障碍临床现象学研究

对１０９例精神分裂症伴强迫障碍的临床现象学进行研究，结果显示强迫障碍及强迫性思维常见。男性多于女性；２６￣３５岁的患者居多；家族史阳性率偏高；高中以上文化，性格内向，固絷，多颖，做事刻求完美的脑力工作者多见。起病缓且多无明显原因，强迫症状先于精神分裂症特征性症状出现者易于误诊。     

精神疾病患者血清睾酮和雌二醇水平研究

目的：了解首发精神分裂症和情感性精神障碍患者血清睾酮和雌二醇的变化。方法：以放射免疫法对首次发病的５４例精神分裂症患者和３７例情感性精神障碍患者血清中睾酮和雌二醇进行测定,并与正常健康者作对照。结果：男性精神分裂症患者者血清雌 二醇浓度显著高于对照组男性,女性情感性精神障碍患者血清睾酮浓度显著高于对照组和精神分裂症组女性。治疗后女性患者血清雌二醇浓度显著下降,对睾酮浓度影响不大。结论：精神分裂症和     

Urinary 3-methoxy-4-hydroxyphenylglycol and psychiatric diagnosis

The authors examined the quantities of 3-methoxy-4-hydroxyphenylglycol (MHPG) in the urine of 11 schizophrenic female patients, 14 primary affective disorder (depressed type) female patients, and 10 healthy comparison women. The primary affective disorder patients had significantly less MHPG in their urine than did the comparison subjects. The schizophrenic patients when compared with the healthy subjects or the depressed patients did not excrete significantly different amounts of MHPG in urine. The variance in MHPG in schizophrenic patients was quite large; some had very low urinary MHPG. There was a significant positive correlation between agitation and urinary MHPG for schizophrenic but not depressed patients. The authors discuss theoretical and practical implications of these findings.     

Suicidal behavior in bipolar manic-depressive patients and their families

There is a high risk of suicidal behavior in patients with primary affective disorder. An extensive investigation in patients with primary affective disorder reported attempted suicide in 26% of bipolar patients and 21% of unipolar patients, the highest rate occurring in female bipolar patients.¹ Woodruff et al.²⁰ found attempted suicide in 14% of unipolar patients as against 32% of bipolar patients with the highest rate in male bipolar patients. Winokur¹⁸ in a study of bipolar manic depressive patients found that 25% of patients had made at least one suicidal attempt and 70% had made threats of suicide at least some time in their lives. Venkabo Rao¹⁶ reported that suicidal ideas occurred in 75% of patients with recurrent affective disorder.Family studies have also reported a high incidence of suicide in the relatives of patients with affective disorder.⁸Mendlewicz et al.⁷ studying a matched group of bipolar probands with and without a family history of manic depressive illness, found high rates of suicide in first and second degree relatives but there was no significant difference in relation to sex or family history. The diagnosis of the relative that suicided was not stated. A study of relatives of patients with primary affective disorder¹⁰ reported that 79% of the suicides in first degree relatives were associated with a diagnosis of probable affective disorder and 10% by a diagnosis of probable alcoholism in the relative. Fathers in index cases were more likely to have committed suicide than mothers. A family history of suicide is considered a major risk factor in assessment of potentially suicidal patients,¹³ however, the relationship between attempted suicide in patients and suicide or attempted suicide in relatives has received little attention and the nature and predictability of this association is uncertain.The following report concerns an analysis of suicidal behavior in a population of bipolar manic-depressive patients and the relationship of this attempt to suicide or attempted suicide in their first and second degree relatives.     

Diagnostic issues in chronic schizophrenia: kraepelinian schizophrenia, undifferentiated schizophrenia, and state-independent negative symptoms

Data are presented concerning three recent clinical distinctions in schizophrenia: kraepelinian versus non-kraepelinian patients; mixed versus simple undifferentiated subtypes; and state-dependent versus state-independent negative symptoms. Schizophrenic patients who have been ill and dependent on others for the past 5 years ('kraepelinians') were compared to other chronic schizophrenics. The kraepelinian patients met the criteria for schizophrenia by more diagnostic systems than other patients, were less responsive to haloperidol, had more severe negative symptoms and formal thought disorder, and had similarly severe positive symptoms. They also had cerebral ventricles that demonstrated more left-to-right asymmetry and a greater family history of schizophrenia spectrum disorders. Mixed undifferentiated schizophrenic patients, who met criteria for more than one schizophrenic subtype, were compared to simple undifferentiated schizophrenic patients, who met criteria for no subtype. The mixed group was characterized by more severe positive and negative symptoms and formal thought disorder, worse social functioning, and a worse response to haloperidol. In a subgroup of patients who were studied once while in a state of exacerbation and once while in a state of relative remission, the negative symptoms of inattention and affective flattening were state-dependent, while anhedonia-asociality was state-independent.     

精神分裂症有无家族史患者的血液流变学比较

目的：探讨精神分裂症患者有无家族史血液流变学特征。方法：对150例精神分裂症按一级亲属家族史阳性,二、三级亲属家族史阳性,家族史阴性分为三组,比较其血液流变学差异,并与70名健康人对照,结果：精神分裂症患者与健康人相比呈显著的高粘滞血症,阴性家族史患者的全血粘度、血浆粘度,低切还原粘度及纤维蛋白质显著高于一级亲属家族史阳性患者（P＜0．05,P＜0．01）;全血粘度显著高于二、三级亲属家族史阳性患者（P＜0．01）,一级与二、三级亲属家属史阳性患者血液流变学指标比较无显著性差异（P＞0．05）。结论：精神分裂症患者血液流变学改变与家族史有关。     

Red blood cell/plasma lithium ratio in manic-depressive, schizoaffective, and schizophrenic patients

The red blood cell/plasma lithium ratio (LR) has been studied in 14 schizophrenic (paranoid type), 22 schizoaffective, and 86 manic-depressive patients. Mean LR proved to be significantly higher in manic-depressive patients (p less than 0.001) as compared to the other two groups which on the other hand did not differ significantly from each other. There was no significant difference in the LR between female and male patients. Analyzing the LR according to family history and subtype of illness (i.e., bipolar I/bipolar II dichotomization) of 86 manic-depressive patients we found that neither sex nor type of illness had consistent influence on LR, but patients with positive family history of affective illness had a significantly higher LR than patients with negative ones (p less than 0.01).     

Comparative dexamethasone suppression test measurements in bulimia, depression and normal controls

Twenty bulimics, 20 depressives and 20 normal controls were studied using the Dexamethasone Suppression Test (DST) as defined by Carroll et al. Their past psychiatric and family histories were compared. We found that actively bulimic subjects had a rate of DST non-suppression of 20%, and that 20% of them had a past history of a major depressive disorder. Forty per cent had a history of alcoholism and/or antisocial personality in a first degree relative, but only 5% had a positive family history of affective disorder. These rates were significantly lower than those found in the depressed group except for the family history of alcoholism and/or antisocial personality for which there was no significant difference. We identified a subgroup of bulimic DST non-suppressors who, like patients with melancholia, were characterized by past history of major depressive illness and high rates of family history of affective disorder, alcoholism and/or antisocial personality in first degree relatives. This group responded to antidepressant medications in a manner similar to depressed patients.     

精神分裂症的性别差异

目的:探讨精神分裂症患者的性别差异。方法:收集240例不同性别精神分裂症患者的首次发病年龄、病程、阳性家族史、临床症状、病前人格和诊断分型等资料,并进行分析比较。结果:首次发病年龄、病程和阳性家族史无性别差异,读心症、钟情妄想、其他妄想、思维逻辑性障碍和怪异行为等阳性症状在男性患者组和女性患者组中的分布差异有显著性,其他阳性症状及阴性症状在两组中的分布差异无显著性。结论:精神分裂症患者的阳性症状存在性别差异,女性精神分裂症患者的临床症状多表现为阳性症状。     

The red blood cell/plasma lithium ratio: Marker of biological heterogeneity within bipolar affective illness?

The red blood cell/plasma concentration ratio (LR) was studied in 45 female patients with bipolar affective illness who responded to prophylactic lithium treatment. Patients were subdivided according to bipolar I vs. bipolar II diagnosis and presence vs. absence of a family history of affective illness. Mean LRs were significantly higher in bipolar II patients and in those with a positive family history of affective illness, but there was no relationship between diagnosis and family history. Results indicate that LR is genetically controlled and may be a biological marker distinguishing bipolar I and bipolar II patients, and also patients with positive or negative family history of affective illness.     

Psychiatric morbidity in the relatives of patients with DSM-III schizophreniform disorder: comparisons with the relatives of schizophrenic and bipolar disorder patients

Risks for psychiatric disorders (RDC) among first degree relatives of DSM-III schizophreniform, bipolar, and schizophrenic probands obtained from an epidemiologic sample using family history methods were examined. The relatives of the schizophreniform probands differed from the relatives of the schizophrenic and bipolar probands. The relatives of schizophreniform probands had significantly higher rates of affective illnesses (with the exception of bipolar illness) than the relatives of schizophrenic probands, and they had a significantly higher rate of psychotic affective disorders than the relatives of the bipolar probands.