住院成年早期双相情感障碍患者自杀相关因素研究

目的 探索分析成年早期双相情感障碍住院患者自杀行为的相关因素。方法 选取 2018 年 1— 12 月在首都医科大学附属北京安定医院住院的 521 例成年早期（18～25 岁）双相情感障碍 患者为研究对象,按照是否曾有过自杀,分为自杀组（n=140）与无自杀组（n=381）,比较两组患者的 一般资料及疾病亚型。通过二分类 Logistic 回归分析探讨成年早期双相情感障碍患者自杀危险因素。 结果 与无自杀组比较,自杀组女性［70.0%（98/140）比 47.8%（182/381）］、冲动性格者［29.3%（41/140） 比 19.2%（73/381）］、有重大精神创伤史者［14.3%（20/140）比 4.5%（17/381）］占比更高,差异均有统计 学意义（χ2 =20.350、6.141、16.941;P＜ 0.05）。二分类 Logistic 回归分析显示,女性［OR=0.375,95%CI （0.226～0.564）,P＜ 0.001］、冲动性格［OR=0.603,95%CI（0.377～0.963）,P=0.034］、有重大精神创伤史 ［OR=0.295,95%CI（0.144～0.604）,P=0.001］是成年早期双相情感障碍患者发生自杀的独立危险因素。 结论 女性、性格冲动、有重大精神创伤史的成年早期双相情感障碍患者发生自杀的风险更高。     

住院老年抑郁症患者自杀行为影响因素分析

目的 分析老年抑郁症（late life depression, LLD）患者自杀行为的相关因素。方法 采用回顾性研究的分析方法，按照近2周有无自杀行为将343例住院的LLD患者分为自杀行为组（n=161）和无自杀行为组（n=182），比较两组人口学特征和临床特征，采用logistic回归探讨LLD患者自杀行为的风险因素。结果 单因素比较分析显示，自杀行为组和无自杀行为组在婚姻状况（已婚73.9%vs. 83.5%，离异9.3%vs. 3.3%，丧偶16.8%vs.13.2%）、饮酒史（16.8%vs. 9.3%）、重大精神创伤史（17.4%vs. 7.1%）、自杀家族史（18.0%vs. 8.8%）及抑郁严重程度（轻度0.0%vs. 3.3%，中度7.5%vs. 15.9%，重度92.5%vs. 80.8%）方面差异具有统计学意义（P<0.05）。进一步二分类logistic回归分析表明，饮酒史（OR=2.164,95%CI:1.103～4.245）、重大精神创伤史（OR=2.663,95%CI:1.307～5.427）、抑郁严重程度（OR=2.798,95%CI:1.432～...     

女性双相情感障碍住院患者高自杀风险的相关因素 分析

目的 分析女性双相情感障碍（BD）住院患者高自杀风险的相关因素。方法 收集 2010 年 4 月至 2019 年 6 月首都医科大学附属北京安定医院 378 例女性 BD 住院患者的病历资料。根据患者 自杀风险,分为低自杀风险组（n=220）和高自杀风险组（n=158）。比较两组患者的一般人口学资料及 临床特征差异,采用二项 Logistic 回归分析女性 BD 住院患者高自杀风险的相关因素。结果 与低自 杀风险组相比,高自杀风险组患者的本次住院天数少、首发年龄及首次抑郁发作年龄小、总发作次 数及抑郁发作次数多、躁狂发作次数少、首发症状为抑郁者和双相Ⅱ型障碍者（BD-Ⅱ）比例高、有精 神病性症状者比例少,差异均有统计学意义（均P＜ 0.05）。二项Logistic回归分析显示,抑郁发作次数 （OR=1.56,95%CI=1.32～1.83）、BD类型（OR=2.30,95%CI=1.16～4.58）以及是否伴精神病性症状（OR=0.56, 95%CI=0.35～0.90）是女性 BD 患者高自杀风险的相关因素（P＜ 0.05）。结论 抑郁发作次数频繁、 BD-Ⅱ、不伴精神病性症状是影响女性 BD 患者高自杀风险的因素。     

综合医院有自杀倾向的住院患者发生自杀行为的影响因素分析

目的描述综合医院具有自杀倾向患者的特征,并分析此类患者发生自杀行为的危险因素.方法回顾性连续纳入南方医科大学南方医院2012年10月至2017年10月的住院患者中具有自杀倾向的病例共680例,根据是否发生自杀行为分为自杀倾向组(有自杀倾向无自杀行为,527例)和自杀行为组(有自杀倾向亦有自杀行为,153例).收集他们的性别、年龄、婚姻状况、户籍、入院科室、自杀诱因、自杀方式、精神疾患、躯体疾患及显著的精神症状等资料.采用单因素分析比较两组间的社会人口学和临床特征差异,采用二分类Logistic回归分析研究自杀行为的危险因素.结果自杀倾向组主要为女性[66.6%(351例)]、已婚[77.4%(458例)]、心理科[74.4%(392例)]、抑郁症[66.2%(349例)].自杀行为组中,男性和女性的自杀方式差异有统计学意义(χ^2=12.489,P=0.014),选择跳楼方式的男性较多,药物及割脉方式的女性更多.Logistic回归分析结果表明,入住重症医学科(OR=7.844,95%CI:2.240~27.475,P=0.001)、婚恋受挫(OR=3.646,95%CI:1.217~10.917,P=0.021),肿瘤(OR=4.620,95%CI:1.552~13.755,P=0.006),双相情感障碍(OR=3.734,95%CI:1.157~12.052,P=0.028)是自杀行为的危险因素.结论具有自杀倾向的患者中,入住重症医学科、双相情感障碍、肿瘤、婚恋挫折是发生自杀行为的危险因素,而且两性的自杀方式有所不同,需要临床高度重视,并采取针对性预防措施.     

未治疗抑郁障碍患者自杀风险与认知情绪调节策略的关系

目的探讨具有自杀风险的抑郁障碍患者在认知情绪调节策略方面的特征及其影响因素,以早期识别具有自杀风险的患者,有针对性地给予干预。方法选取117例来自北京回龙观医院门诊、经简明国际神经精神访谈(MINI)5. 0中文版筛查符合抑郁障碍诊断标准的未治疗抑郁障碍患者,根据MINI 5. 0中文版自杀模块的访谈结果,将患者分为自杀风险组(n=52)和无自杀风险组(n=65)。采用认知情绪调节问卷(CERQ-C)进行认知调节策略的测评,采用汉密尔顿抑郁量表17项版(HAMD-17)评定抑郁症状的严重程度。结果抑郁障碍患者自杀风险发生率为44. 4%(52/117)。与无自杀风险组相比,自杀风险组患者更多见于女性、未婚、平均年龄更小、发病年龄更早、HAMD-17总评分更高、伴精神病性症状率较高,自杀风险组自我责难、接受、沉思、灾难化4个认知调节策略维度及消极认知情绪调节评分均高于无自杀风险组(P均<0. 05)。Logistic回归分析显示,女性(OR=3. 539,95%CI:1. 383~9. 057)、发病年龄(OR=0. 931,95%CI:0. 895~0. 968)、HAMD-17总评分(OR=1. 207,95%CI:1. 063~1. 370)和灾难化(OR=1. 143,95%CI:1. 002~1. 305)与抑郁障碍患者自杀风险相关(P均<0. 05)。结论女性、发病年龄早、抑郁症状严重和灾难化可能为未治疗抑郁障碍患者自杀风险的危险因素。     

住院精神分裂症患者暴力行为危险因素研究

目的:探讨住院精神分裂症患者发生暴力行为的危险因素。方法:以外显行为攻击量表(MOAS)评分≥5分为界将220例住院精神分裂症患者分为暴力组(62例)和非暴力组(158例);对两组的人口学及临床资料进行收集、比较;采用多元Logitic回归分析探讨住院精神分裂症患者发生暴力行为的危险因素。结果:与非暴力组比较,暴力组患者更年轻、内向型人格比率低、既往有暴力行为史、有敌对情绪、被害妄想、兴奋易激惹的比率高(P<0.05或P<0.01);多元Logistic回归分析显示,既往暴力行为史(OR=2.169,95%CI:1.095～4.296)、有敌对情绪(OR=2.561,95%CI:1.117～5.869)、非内向人格特征(OR=1.496,95%CI:1.021～2.191)和被害妄想(OR=3.800,95%CI:1.592～9.070)进入方程。结论:既往暴力行为史、有敌对情绪、人格特征和被害妄想是住院精神分裂症患者发生暴力行为的危险因素。     

SSRI 治疗首发为抑郁发作的双相障碍患者对自杀风险的相关因素分析

目的 探讨双相障碍首次抑郁发作使用SSRI类抗抑郁剂治疗后,出现自杀风险的相关因素.方法 回顾性记录177例以抑郁发作为首次发作形式的双相抑郁障碍患者人口学资料和临床特征,并比较它们在没有出现自杀组和出现自杀组之间的差异,采用逐步Logistic回归方法进行分析,受试者工作特征曲线(ROC)与Hosmer-Lemeshow分别评估危险因素模型的准确度和拟合优度.结果 没有出现自杀风险患者154例,出现自杀风险患者23例.出现自杀风险的患者组中饮酒史、心境障碍家族史、有易激惹症状、绝望感和伴随精神病性症状的比例高于未出现自杀风险的患者组(均P<0.05).进一步回归分析显示,使用SSRI类抗抑郁剂治疗而导致自杀风险的相关因素为:易激惹(OR=4.04,95%CI:1.40-11.67,P<0.05),有精神病性症状(OR=6.23,95%CI:1.41-27.56,P<0.05).ROC为0.71.Hosmer-Lemeshow为0.58.结论 易激惹症状、精神病性症状是双相障碍首次抑郁发作予SSRI治疗出现自杀风险的潜在预测因素.     

长期住院精神分裂症患者伴发抑郁症状的影响因素分析

目的:探讨长期住院精神分裂症患者伴发抑郁症状及影响因素。方法:采用卡尔加里精神分裂症抑郁量表(CDSS-C)对长期住院(≥12个月)的200例精神分裂症患者进行抑郁症状的评估,以CDSS-C总分是否≥6分,将患者划分为伴抑郁组58例和非抑郁组142例,运用Logistic回归模型分析伴发抑郁症状的影响因素。结果:抑郁组在女性构成比、探视频率1次/月、抗精神病药单药治疗率、合并苯海索或苯二氮艹卓类药、有自杀意念构成比、阳性症状量表(SAPS)总分、阴性症状量表(SANS)总分和一般精神病理总分明显高于非抑郁组(P0.05或P0.001);主要探视人为I级亲属的构成比及平均住院周期显著低于非抑郁组(P0.05或P0.001)。Logistic回归分析显示主要探视人为I级亲属(OR=0.207,95%CI:0.072~0.591)、探视频率1次/月(OR=3.869,95%CI:1.332~11.239)、有自杀意念(OR=9.256,95%CI:3.191~26.854)是抑郁症状的影响因素(P0.01或P0.001)。结论:探视人(I级亲属)、探视频率及有自杀意念是长期住院精神分裂症患者伴发抑郁症状的主要影响因素。     

住院精神分裂症患者伴发非酒精性脂肪肝相关因素的性别差异

目的 探讨住院精神分裂症患者伴非酒精性脂肪肝（NAFLD）的患病率以及影响因素的性别差异。方法 选取2020年7月1日至2021年6月30日在上海市嘉定区精神卫生中心住院的316例精神分裂症患者为研究对象。采用多因素Logistic回归分析住院精神分裂症患者以及不同性别患者伴NAFLD的影响因素。结果 住院精神分裂症患者的NAFLD患病率为41.1%(130/316)，其中男性患者为42.1%(82/195)，女性患者为39.7%(48/121)。多因素Logistic回归分析显示，女性（OR=2.345,95%CI=1.159～4.743）、体重指数高（OR=1.445,95%CI=1.296～1.610）、甘油三酯高（OR=2.715,95%CI=1.709～4.315）、丙氨酸氨基转移酶（ALT）高（OR=1.019,95%CI=1.002～1.037）、住院时长长（OR=1.099,95%CI=1.040～1.162）、合并糖尿病（OR=2.879,95%CI=1.225～6.768）是住院精神分裂症患者伴NAFLD的危险因素（P<0.05）。多因素Logistic回归分...     

银杏内酯 K 通过 PI3K/Akt/mTOR 通路促进 血管生成改善缺血性卒中

目的 描述综合医院具有自杀倾向患者的特征,并分析此类患者发生自杀行为的危险因 素。方法 回顾性连续纳入南方医科大学南方医院 2012 年 10 月至 2017 年 10 月的住院患者中具有自杀 倾向的病例共 680 例,根据是否发生自杀行为分为自杀倾向组（有自杀倾向无自杀行为,527 例）和自杀 行为组（有自杀倾向亦有自杀行为,153 例）。收集他们的性别、年龄、婚姻状况、户籍、入院科室、自杀诱 因、自杀方式、精神疾患、躯体疾患及显著的精神症状等资料。采用单因素分析比较两组间的社会人口 学和临床特征差异,采用二分类 Logistic 回归分析研究自杀行为的危险因素。结果 自杀倾向组主要为 女性［66.6%（351例）］、已婚［77.4%（458例）］、心理科［74.4%（392例）］、抑郁症［66.2%（349例）］。自杀行为 组中,男性和女性的自杀方式差异有统计学意义（χ2 =12.489,P=0.014）,选择跳楼方式的男性较多,药物 及割脉方式的女性更多。Logistic回归分析结果表明,入住重症医学科（OR=7.844,95%CI：2.240～27.475, P=0.001）、婚恋受挫（OR=3.646,95%CI：1.217～10.917,P=0.021）,肿瘤（OR=4.620,95%CI：1.552～13.755, P=0.006）,双相情感障碍（OR=3.734,95%CI：1.157～12.052,P=0.028）是自杀行为的危险因素。结论 具 有自杀倾向的患者中,入住重症医学科、双相情感障碍、肿瘤、婚恋挫折是发生自杀行为的危险因素,而 且两性的自杀方式有所不同,需要临床高度重视,并采取针对性预防措施。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.