脑卒中吞咽障碍患者疾病病耻感与主要照顾者负担的关系：家庭复原力和个体复原力的链式中介效

目的 分析家庭复原力和个体复原力在脑卒中吞咽障碍患者疾病病耻感和主要照顾者 照顾负担之间的中介效应。方法 采用便利抽样法,选择 2022 年 12 月— 2023 年 8 月于新疆医科大学 第一附属医院康复医学科住院的 235 例脑卒中吞咽障碍患者及其主要照顾者作为研究对象。采用疾病 病耻感量表（SSCI）、个体复原力量表（CD-RISC-10）、照顾者负担量表（ZBI）及家庭复原力量表（WFRQ-R-CHI）对脑卒中吞咽障碍患者的心理状态、个体复原力及其主要照顾者的照顾负担情况及家庭复原力进 行调查。采用Spearman 相关分析患者的病耻感状态、个体复原力、主要照顾者负担及家庭复原力的相关 性。采用Process V4.1插件中的Model 6和Amos软件构建链式中介模型。结果 脑卒中吞咽障碍患者主 要照顾者的 ZBI 得分为 50（42,59）分,处于中度负担水平。患者的 SSCI 得分为 87（72,95）分。Spearman 相关分析显示,脑卒中吞咽障碍患者疾病病耻感与照顾者负担呈正相关,与家庭复原力和个体复原力 呈负相关,照顾者负担与家庭复原力和个体复原力呈负相关,家庭复原力与个体复原力呈正相关（均P＜ 0.01）。家庭复原力和个体复原力在脑卒中吞咽障碍患者疾病病耻感和照顾者负担中起链式中介效应, 占总效应量的 69.04%。结论 降低患者疾病病耻感可减轻照顾者负担,同时也可从增强脑卒中吞咽障 碍患者的家庭复原力和个体复原力的角度出发,探索减轻脑卒中吞咽障碍患者主要照顾者负担的干预 方案。     

老年精神分裂症患者病耻感影响因素研究

目的探讨老年精神分裂症患者病耻感现状及影响因素。方法采用精神分裂症患者病耻感量表、自知力与治疗态度问卷(ITAQ)对在我院住院随访的120名老年精神分裂症患者进行问卷调查。结果老年精神分裂症患者病耻感总平均分为(2.51±0.53)分,处于中度水平;病程、住院次数、有无家属照顾是老年精神分裂症患者病耻感状况的影响因素。结论老年精神分裂症患者病耻感现状并不容乐观,需要给予患者更多的家庭支持和照顾,改善患者社会功能,提高依从性,帮助患者提高应对病耻感的能力。     

精神分裂症患者病耻感相关因素调查

目的 探讨精神分裂症患者病耻感程度及相关因素.方法 采用一般情况调查表和精神疾病病耻感量表(ISMI)评估191例精神分裂症患者的病耻感水平,分析病耻感发生率与其影响因素.结果 本研究中,135例患者出现病耻感(70.68％),其中20.41％为中重度病耻感者.在五个维度中,患者对抗病耻感比例最高(79.06％),歧视经历体验比例最低(42.41％);患者学历、工作状况、家庭经济状况、病程、发病情况、住院次数是精神分裂症患者病耻感高危因素,而性别、年龄、婚姻状况与其无相关性.结论 精神分裂症患者普遍存在病耻感,医护人员应高度重视这个问题,帮助患者提高应对病耻感的能力,改善其生活质量.     

网络干预对社区精神分裂症患者病耻感的影响及其机制

目的 探讨网络干预对社区精神分裂症患者病耻感的影响极其机制.方法 随机抽取的社区精神分裂症患者105例分为网络干预组(n=53)和对照组(n=52),对干预组进行5个月的网络干预,采用问卷调查法,比较两组患者社会支持、临床症状、自我效能感以及病耻感,并分析影响患者病耻感的因素.结果 经5个月的网络干预后,干预组患者主观支持、客观支持、支持的利用度、一般自我效能感量表分高于对照组患者,简明精神病评定量表的缺乏活力因子、思维障碍因子、焦虑抑郁因子得分和病耻感量表分均低于对照组患者,差异均有统计学意义(P＜0.05),患者的自我效能感、主观支持和焦虑抑郁因子分与患者的病耻感相关.结论 网络干预可以提高患者社会支持并增强自我效能感,减轻临床症状和病耻感,自我效能感、主观支持和焦虑抑郁因子分是网络干预影响患者病耻感的重要因素.     

家庭动力对精神分裂症患者病耻感的影响

目的 对康复期精神分裂症患者家庭动力与病耻感的分析,为临床上改善患者病耻感,促进康复提供实践参考.方法 以方便取样的方式顺序入组,抽取上海市浦东新区辖区10个街镇在社区康复的精神分裂症患者以及上海市浦东新区精神卫生中心住院患者各300名.研究采用问卷法,评估精神分裂症患者的家庭动力特征及病耻感.结果 住院与社区精神分裂...     

城镇与农村精神分裂症患者病耻感的研究

目的 了解缓解期精神分裂症患者的病耻感情况,分析比较城镇与农村精神分裂症患者病耻感的特点.方法 对本院住院和门诊治疗的133例缓解期精神分裂症患者进行人口学特征、精神病简明评定量表(BPRS)、阳性阴性症状量表(PANSS)、不良反应量表(TESS)、临床疗效总评量表严重度( CGI-SI)和病耻感量表进行测量和评估,分析68例城镇患者与65例农村患者的各量表的评定结果.结果 精神分裂症患者普遍存在被歧视、自我感觉的病耻感及对疾病的掩饰性,但城镇患者对病耻感的掩饰性因子和积极效应因子高于农村患者,差异有统计学意义(P＜0.05).结论 对精神分裂症患者开展心理健康教育和积极的心理干预策略对减轻病耻感非常重要,对城镇患者个体化的心理干预、促进其及早回归社会,而对于农村的患者,应重在普及精神卫生知识的宣教.     

精神分裂症对患者家庭的影响

本文将从精神分裂症伴随的病耻感,家庭负担及对家属生活质量的影响三个方面就精神分裂症对患者家庭的影响作一综述。     

健康教育对精神分裂症患者病耻感影响的持续性

目的探讨不同健康教育模式对精神分裂症患者病耻感的影响及持续性,并分析其作用机制。方法抽取深圳市南山区慢性病防治院及南山区人民医院心理科门诊精神分裂症患者104例为研究对象,按照随机数字表法分为联合教育组(n=35)、常规教育组(n=35)和对照组(n=34),对联合教育组进行5个月的常规教育联合在线教育,对常规教育组进行5个月的常规教育,对照组不干预。于入组时、干预第5个月、干预结束后5个月采用病耻感量表(SOS)、简明精神病量表(BPRS)、社会支持评定量表(SSRS)、一般自我效能量表(GSES)对患者进行评定,比较其病耻感、临床症状、社会支持和自我效能感。结果健康教育结束后5个月,联合教育组BPRS焦虑抑郁因子、缺乏活力因子评分均低于常规教育组和对照组,差异均有统计学意义(P均0.01);SSRS评分高于常规教育组和对照组,差异均有统计学意义(P均0.01);SOS评分、BPRS敌对猜疑因子评分均低于对照组,差异均有统计学意义(P0.05或0.01)。社会支持、焦虑抑郁因子可预测病耻感(F=8.25,P0.01)。结论联合教育干预对减轻精神分裂症患者病耻感的效果优于常规教育,可能有助于持续减轻精神分裂症患者临床症状,社会支持、焦虑抑郁症状是影响患者病耻感的重要因素。     

精神分裂症患者康复期心理状态与耻感、应对方式及社会支持的关系

目的 探讨精神分裂症患者康复期心理状态与耻感、应对方式及社会支持之间的关系,为康复干预方案的制定提供参考.方法 选择2015年1～12月在精神病医院住院治疗的178例恢复期精神分裂症患者作为研究对象,根据卡尔加里精神分裂症抑郁量表(CDSS)评分将其分为抑郁组(54例)和非抑郁组(124例),采用精神病患者病耻感评估量表、应对方式量表和社会支持量表分别对两组患者进行调查,分析其各量表得分差异,以及抑郁评分和各量表得分之间的相关性.结果 抑郁组和非抑郁组患者在年龄、性别比例、病程等一般资料方面比较差异无统计学意义(P＞0.05);抑郁组患者病耻感中社交因子、能力因子评分以总评分均明显高于非抑郁组;积极应对评分明显低于非抑郁组,而消极应对评分明显高于非抑郁组;抑郁组患者社会支持各方面评分以及总分均明显低于非抑郁组患者.相关性分析表明抑郁心理与患者病耻感评分呈正相关(P＜0.05);消极应对与抑郁呈正相关(P＜0.05),积极应对与抑郁呈负相关(P＜0.05);社会支持各方面评分均与抑郁呈负相关(P＜0.05).结论 精神分裂症患者康复期抑郁心理状态与耻感呈正相关,与消极应对方式呈正相关,与社会支持呈负相关.     

缓解期精神分裂症患者的病耻感及住院态度

目的 通过对缓解期精神分裂症患者病耻感及对住院态度的调查,分析缓解期精神分裂症的病耻感特点,不同治疗方式和环境对精神分裂症病耻感的影响,为减轻病耻感,提高治疗效果提供依据.方法 对浙江同德医院门诊或住院治疗的缓解期精神分裂症患者120例进行人口学特征、BPRS、CGI-SI、SSMI-C、TESS和自制的对住院态度问卷进行测量和评估,分析比较门诊或住院患者缓解期病耻感特点.结果 调查发现缓解期精神分裂症患者普遍存在被歧视、自我感觉的病耻感及对疾病的掩饰性,其中与门诊组患者比较,住院组患者的歧视因子较高,积极效应因子评分较低,两组比较差异有统计学意义（P＜0.01）;住院组患者对被欺骗、强行住院、强行治疗和被搜身等抵抗态度的发生率明显高于门诊组,两组比较差异有统计学意义（P＜0.05）.结论 门诊治疗对患者产生病耻感的影响较小,对积极效应影响小.住院患者被强制住院、强制治疗、限制自由均加重患者对住院治疗的抵抗和病耻感,采取积极有效的治疗模式或改善住院环境可能对减轻病耻感、提高生活质量有积极作用.     

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.     

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.     

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.     

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.     

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.     

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.