儿童青少年精神障碍流行病学及相关因素研究

儿童青少年的心理和精神健康关系到是否能够健康成长,并更好的适应社会,是全民健康的重要组成部分.近年来,儿童青少年的心理精神问题越来越引起人们的广泛关注.本文综述了国内外儿童青少年精神障碍的流行病学调查及影响因素的研究,以及公众对儿童精神卫生的就诊态度进行了详尽介绍.     

儿童青少年精神障碍患者睡眠不足及相关因素

目的 探讨儿童青少年精神障碍患者睡眠不足的现况及相关影响因素。方法 选取2021年2月-6月就诊于阜阳市第三人民医院且符合《国际疾病分类（第10版）》（ICD-10）精神分裂症、抑郁障碍、童年情绪障碍诊断标准的131例儿童青少年患者为研究对象,采用自制调查问卷收集患者的一般人口学资料、睡眠情况、生活情况、家庭和学校情况等信息,比较睡眠充足组和睡眠不足组人口学资料的差异,采用Spearman法分析患者睡眠不足的相关因素。结果 ①在131例儿童青少年精神障碍患者中,93例（71.0%）存在睡眠不足,睡眠不足组与睡眠充足组在疾病类别（χ²=8.798,P=0.012）、近6个月内被打（χ²=3.427,P=0.035）或被骂（χ²=4.145,P=0.031）以及一年内遭受网络欺凌（χ²=4.187,P=0.041）方面,差异均有统计学意义。②在睡眠不足的患者中,77例（82.8%）存在入睡困难,69例（74.2%）存在夜间多醒。③儿童青少年精神障碍患者睡眠不足与近6个月内有被骂经历（r=0.210,P=0.037）或被打经历（r=0.145,P=0.023）以及一年内遭受网络欺凌（r=0.179,P=0.041）呈正相关。结论 儿童青少年精神障碍患者睡眠不足的发生风险较高,且与抑郁障碍、有被打和被骂经历、经受过网络欺凌相关。     

儿童青少年抑郁症自杀及相关影响因素研究

目的 探讨儿童青少年抑郁症患者中自杀相关影响因素.方法 选取2018年1月至2019年12月就诊于河北省第六人民医院的389例儿童青少年抑郁症患者作为研究对象,其中自杀组171例,非自杀组218例.对两组间的一般情况与临床特征进行比较,并采用Logistic回归方法对青少年儿童抑郁症伴自杀的影响因素进行分析.结果 自杀...     

学校恐惧症的研究进展

学校恐惧症是儿童对学校特定环境异常恐惧、强烈地拒绝上学的一种情绪障碍,有时将其作为社交焦虑障碍的一种特殊形式。国外常称这类儿童为拒绝上学儿童。近年来,由于儿童情绪障碍发病率的逐年上升而受到了国内外研究人员的广泛关注,作为情绪障碍的特殊形式学校恐惧症也引起了人们的逐渐重视,但关于儿童学校恐惧症的研究文献却相对较少,国内有关方面的文献综述更少。本文复习近年来学校恐惧症的流行病学资料、病因、临床表现、评估手段、诊断、治疗及其进展的文献并综述如下。     

认知行为团体心理治疗对恐惧症患者的近期和远期疗效

目的分析认知行为团体心理治疗对恐惧症患者的近期疗效和远期疗效。方法选择我院2011-01—2014-05收治的100例恐惧症患者为研究对象,随机分为对照组和观察组各50例,2组患者入组后均给予选择性5-羟色胺回收抑制剂(SSRIs)药物,对照组在此基础上采用认知行为团体心理治疗方法,连续治疗8周后停止认知行为团体心理治疗并随访1a。于治疗前、治疗后4周和8周及随访后4个月、8个月和12个月时用焦虑自评量表(SAS)、抑郁自评量表(SDS)和社会支持评定量表(SSRS)评价2组近期和远期疗效。结果治疗前,2组SAS、SDS和SSRS评分基线水平相当,差异均无统计学意义(P0.05);治疗后4周、8周及开始随访后4、8和12个月时的SAS、SDS和SSRS评分比较,观察组均显著优于对照组,差异均有统计学意义(P0.05)。结论临床上对恐惧症患者在给予常规抗精神疾病药物的基础上采用认知行为团体心理治疗,有助于改善恐惧症患者的焦虑和抑郁状态,进一步提高患者的健康状况和社会生活质量。     

30例学校恐惧症人格和情绪特征研究

目的：探讨学校恐惧症的临床特征。方法：对30例学校恐惧症患儿（研究组）和30名正常对照儿童（对照组）进行艾森克个性问卷（EPQ）,儿童焦虑性情绪障碍筛选量表（SCARED）,焦虑自评量表（SAS）及抑郁自评量表（SDS）评估。结果：研究组患儿EPQ结果显示神经质得分显著高于对照组,掩饰程度得分显著低于对照组（P均〈0.05）;SCARED、SAS、SDS的评估显示,与对照组相比,研究组存在明显焦虑和抑郁症状（P〈0.05）。结论：学校恐惧症患儿可能具有神经症的个性特点,普遍存在焦虑和抑郁症状。     

儿童青少年抑郁障碍肥胖患病率及相关因素分析

目的:探讨儿童青少年抑郁障碍患者的肥胖率及相关影响因素。方法:选取抑郁障碍儿童青少年患者757例,收集一般人口学资料及临床数据;评估非自杀性自伤(NSSI)行为;测量体质量及生化指标。结果:儿童青少年抑郁障碍患者的肥胖率为10.4%。肥胖组与非肥胖组比较,发病年龄、首次住院年龄、总病程、住院次数及体质量指数(BMI)、空腹血糖、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白(HDL-C)及低密度脂蛋白(LDL-C)、NSSI行为、使用抗抑郁药物种类差异存在统计学意义(P<0.05)。肥胖与总病程、住院次数、空腹血糖、TG、TC、LDL-C及NSSI呈正相关;与年龄、首次住院年龄、HDL-C、使用几种抗抑郁药物及抗抑郁药物剂量呈负相关(P<0.05)。回归分析显示空腹血糖(OR=2.114,P=0.007)、TG (OR=2.086,P=0.001)及NSSI行为(OR=2.103,P=0.010)是抑郁障碍患儿伴肥胖的危险因素,而较高剂量的抗抑郁药(OR=0.970,P=0.015)是肥胖发生的保护性因素。结论:儿童青少年抑郁障碍患者肥胖率较高,且与空腹血糖、TG、NSS...     

童年期虐待、应对方式、自尊与青少年社交恐惧症的相关研究

目的 探讨童年期虐待、应对方式、自尊与青少年社交恐惧症的相关性,并探讨其与青少年社交恐惧症的起病年龄、病程及严重程度的关系.方法 对符合CCMD-3诊断标准的110例青少年社交恐惧症患者(病例组)以及142例健康对照(对照组)进行童年期虐待问卷(Childhood Trauma Questionnaire-28 item Short Form,CTQ-SF)、简易应对方式量表(Simplified Coping Style Questionnaire,SCSQ)、自尊量表(Self-Esteem Scale,SES)评估,并对青少年社交恐惧症患者进行临床资料、社交回避及苦恼量表(Social Avoidance and Distress Scale,SAD)的评定.结果 相对于对照组,病例组CTQ-SF总分及其各维度分、积极应对和消极应对分更高(P＜0.05),SES 评分更低(P＜0.05).相关分析结果表明:青少年SAD分与CTQ-SF总分及其各维度分、消极应对分存在显著正相关(P＜0.01),与积极应对分、SES分呈显著负相关(P＜0.01).非条件Logistic回归分析发现,童年期虐待水平、情感虐待(EA)、情感忽视(EN)、消极应对、自尊为影响青少年社交恐惧症发病的因素,且CTQ-SF总分、EA分、EN分与青少年社交恐惧症患者的起病年龄成显著负相关(P＜0.01),EA、EN的严重程度与病程呈显著正相关(P＜0.05).结论 青少年社交恐惧症患者有更多的童年期虐待经历.童年期虐待水平、情感虐待、情感忽视、消极应对、自尊为影响青少年社交恐惧症发病的危险因素,积极应对是青少年社交恐惧症发病的保护因素,且童年期虐待经历越多,其起病年龄越早,经历的情感虐待、情感忽视越多,其病情越严重、病程越长.     

中山市儿童青少年心理健康状况调查及相关因素分析

目的了解中山市儿童青少年心理健康状况及相关影响因素,为提高其心理健康水平提供科学依据。方法采用分层整群随机抽样方法,抽取中山市小学和初中共4所学校的2281名学生,采用Achenbach儿童行为量表(CBCL)、父母教养方式量表(EMBU)及儿童青少年一般情况调查表进行问卷调查。结果 2281名学生中行为问题检出率为18.76%(428名),其性别差异无统计学意义(P0.05)。非父母抚养组及低收入组外化性行为得分分别高于父母抚养组及中高收入组[(7.08±6.41)vs.(6.12±7.10);(6.63±6.72)vs.(5.93±7.59),P均0.05],非家庭和睦组在内化性行为得分、外化性行为得分及行为问题总分上都高于家庭和睦组(P均0.01)。Pearson相关分析显示,儿童青少年内化性行为得分、外化性行为得分及行为问题总分均与父、母的温暖理解因子得分呈负相关(r=-0.18~-0.13,P均0.01),与父母的惩罚严厉、拒绝否认、过度保护干涉等因子得分呈正相关(r=0.11~0.24,P均0.01)。进一步logistic回归分析显示儿童青少年行为问题相关因素依次是:家庭氛围、父亲温暖理解、母亲过度保护及干涉(P均0.05)。其中,家庭氛围越紧张,父亲温暖理解得分越低,母亲过度保护及干涉得分越高,儿童青少年越倾向于出现行为障碍(P均0.05)。结论中山市儿童青少年行为问题较突出,紧张的家庭氛围、母亲过度保护干涉及缺乏父亲温暖理解的教养方式对行为问题的发生有不利影响。     

Social phobia in children and adolescents

Epidemiological data indicate that anxiety disorders are the most common childhood disorders. 1% of children and adolescents suffer from social phobia and it may influence further adult life. The aim of the article is to show differences of child and adolescent social phobia and its diagnostic criteria. Contrast and distinction of childhood social phobia symptoms are also shown, such as risk factors of appearance of childhood social phobia. The article presents main therapeutic methods--psychotherapy and pharmacotherapy applied to children with phobia and difficulties with estimating efficacy of the particular therapy in this group of patients. Phobic children perceive surroundings more negatively. They have reduced estimations of their own competency to cope with danger. They also show cognitive impairments of ambiguous situations. As much as 60% children with social phobia suffer from a second, concurrent disorder. Widening of information about symptoms and therapeutic methods may reduce the intensity of the disorder during adulthood.     

Avoidant disorder and social phobia in children and adolescents.

The diagnoses of avoidant disorder and social phobia in children have received little research attention. Although DSM-III-R describes avoidant disorder and social phobia as data are available to support this notion. The current study examined characteristics of avoidant disorder and social phobia by comparing outpatient youngsters with avoidant disorder, social phobia, and avoidant disorder plus social phobia on demographic variables and patterns of comorbidity. The psychiatric groups were compared with matched normal controls on symptom measures of depression and fear. Findings indicated that the three psychiatric groups were strikingly similar on all but one variable, age at intake. These findings question the notion of avoidant disorder and social phobia as distinct disorders in children and adolescents.     

Efficacy of psychotherapy with children and adolescents

Psychotherapeutic interventions require empirical as well as scientific assessment. Specifically, the proven efficacy of psychotherapy for children and adolescents is essential. Thus, studies examining treatment efficacy and meta-analyses are necessary to compare effect sizes of individual therapeutic interventions between treatment groups and waiting control groups. Assessment of 138 primary studies from 1993-2009 documented the efficacy of psychotherapy for children and adolescents. Furthermore, behavioural therapy outperformed non-behavioural interventions, as 90% of behavioural interventions showed larger effect sizes compared to non-behavioural psychotherapy. Analysis of moderator variables demonstrated an improved treatment efficacy for individual therapy, inclusion of the family, treatment of internalised disorders, and in clinical samples. Stability of psychotherapeutic treatment effects over time was demonstrated.     

The prevalence of specific phobia and associated co-morbid features in children and adolescents

ObjectiveThe aims of this study were to investigate the prevalence, associated co-morbid psychiatric disorders and behavioral/emotional problems associated with the subtypes of specific phobia in children and adolescents.MethodsA total of 2673 randomly selected children and adolescents from Seoul, Korea were assessed using the parent version of the Diagnostic Interview Schedule for Children (DISC-IV) and Children's Behavior Checklist (CBCL). We analyzed differences in psychiatric co-morbidities and CBCL profiles among the subtypes of specific phobia.ResultsThe 1-year prevalence of specific phobia was 7.9% (95% CI 7.63–8.17). Animal phobia was associated with anxiety disorder (OR 8.68, 95% CI 1.91–39.51) and oppositional defiant disorder (OR 2.55, 95% CI 1.27–5.12). Nature–environment phobia was associated with anxiety disorder (OR 25.70, 95% CI 6.16–107.10). Blood–injection–injury phobia showed associations with attention-deficit/hyperactivity disorder (ADHD: OR 6.74, 95% CI 2.81–16.15). Subjects with nature–environment phobia scored higher than did controls on the anxious/depressed, social problems, attention problems, and total behavioral problem profiles of the CBCL. Subjects with blood–injection–injury phobia scored significantly higher than did controls on the attention problems, aggressive behaviors, and externalizing problem profiles.ConclusionsContrary to animal phobias, nature–environment and blood–injection–injury phobias were associated with various behavioral and emotional problems and approximately correlated to their co-morbid psychiatric disorders. Among these subtypes, significant differences were found in demographic characteristics, co-morbid psychiatric disorders, and emotional/behavioral problems. These findings suggest that distinctive clinical characteristics might be related with different subtypes of specific phobia and clinician must consider psychiatric co-morbidities when treating children & adolescents with specific phobia.     

Prospective open-label pilot trial of mirtazapine in children and adolescents with social phobia

Mirtazapine is indicated for major depression and used for anxiety in adults; however, little is known about its application in pediatric populations. This is an 8-week open-label pilot study of mirtazapine in children with social phobia age 8-17 years. Primary outcomes were symptom improvement based on clinician rating and self-report, as well as tolerability based on rates of discontinuation due to adverse effects. Fifty-six percent (10/18) responded to treatment, 17% (3/18) achieved full remission. Social phobia symptoms improved significantly during the first 2 weeks of treatment, as did comorbid symptoms of depression and anxiety. Eleven patients (61%) did not complete all 8 weeks of treatment; four patients (22%) discontinued due to adverse effects including fatigue and irritability. The others discontinued due to study burden (28%), insufficient response (6%), or to pursue herbal treatment (6%). Significant weight gain was observed. Larger controlled trials are needed to further evaluate efficacy and safety.