流浪精神病人诊治与救助探讨

目的 探讨流浪精神病人的诊治与救助.方法 对2004年1月~2005年2月入院的流浪精神病人进行回顾性分析.结果 流浪精神病人的治疗效果较好.结论 流浪精神病人需要更多的社会关怀及救助.     

流浪精神病人管理的探讨

目的 探讨流浪精神病人的管理.方法 对2004年1月~2005年2月入院的流浪精神病人情况进行分析.结果 流浪精神病人入院时病情复杂,难于管理,但经过治疗能取得较满意的效果.结论 流浪精神病人的管理需要卫生、公安、司法、民政、财政等行政管理部门的通力协作.     

42例骨髓增生异常综合征细胞遗传学研究

本研究对４２例骨髓增生异常综合征（ＭＤＳ）进行研究,采用骨髓细胞短期培养法,共１３例ＭＤＳ检出染色体异常核型,占３１％,ＭＤＳ－ＲＡＥＢ和ＲＡＥＢＴ（４１％）比ＭＤＳ－ＲＡ（２９％）异常核型检出率高（Ｐ＜０．０５）,检出７种类型染色体异常核型,染色体数量异常８例,以三体８多见,染色体结构异常５例,均为平衡易位。ＭＤＳ－ＲＡ异常核型均为数量异常,ＭＤＳ－ＲＡＥＢ、ＲＡＥＢＴ则以结构异常为主。观察中发现２例具有核型异常的ＭＤＳ－ＲＡＥＢ转化为ＡＮＬＬ－Ｍ２和ＡＮＬＬ－Ｍ５,表明ＭＤＳ染色体核型与ＭＤＳ亚型、转归和预后密切相关。     

SLE患者血液SC5b—9,ANA及AdsDNA浓度的测定及意义

目的：对５３例ＳＬＥ患者血液中的补体末端复合体（Ｃ５ｂ－９）、补体溶血总活性（ＣＨ５０）、抗核抗体（ＡＮＡ）及抗双链ＤＮＡ（ＡｄｓＤＮＡ）抗体的浓度进行了测定。结果：３３例活动期ＳＬＥ患者，其ＳＣ５ｂ－９、ＡＮＡ及ＡｄｓＤＮＡ的水平均较２０例非活动期ＳＬＥ患者高，ＣＨ５０活性则较非活动期ＳＬＥ患者低，活动期与非活动期ＳＬＥ患者４项指标间的差异均显著（Ｐ＜００１）。此外，用不同方法检测各项指标的敏感性以ＳＣ５ｂ－９敏感性最高。结论：患者ＳＣ５ｂ－９、ＡｄｓＤＮＡ、ＡＮＡ和ＣＨ５０指标的变化，可为临床正确判断ＳＬＥ患者的病情活动，指导用药及评估预后等提供科学依据     

系统性红斑狼疮皮肤表皮抗核抗体的探讨

本文对１９１例ＳＬＥ患者的“正常”皮肤进行了免疫荧光的研究，结果发现６．８％（１３／１９１）的患者伴有“体内”ＡＮＡ或称ＥＮＳ，其中以Ｓ型ＩｇＧ在表皮细胞核内沉积最为多见。同时与其他检测结果做了比较，未发现ＥＮＳ的核型或荧光强度受血清ＡＮＡ，抗ｄｓ－ＤＮＡ抗体，ＢＭＺ荧光染色的影响，因此我们认为，ＥＮＳ的出现对ＳＬＥ具有协助诊断价值。     

用基因工程表达的抗原早期诊断鼻咽癌

目的为了建立鼻咽癌（ＮＰＣ）早期诊断方法。方法以基因工程表达的、经纯化的ＥＢ病毒（Ｅｐｓｔｅｉｎ－Ｂａｒｖｉｒｕｓ，ＥＢＶ）早期抗原（ＥＡ）成分ＥＡ－Ｄ和ＥＡ－Ｒ作为诊断抗原，建立了酶联免疫吸附试验（ＥＬＩＳＡ），检查３０例ＮＰＣ病人及４９例正常人血清中的ＥＡ／ＩｇＡ抗体。结果用ＥＬＩＳＡ检测抗体较用细胞涂片免疫酶方法（ＩＥ）敏感。ＥＬＩＳＡ检测ＮＰＣ病人血清中ＥＡ／ｌｇＡ抗体，阳性率为１００％，ＥＡ／ｌｇＡ抗体效价均≥１∶１００。而用ＩＥ法，平行检测３０例ＮＰＣ病人血清中ＥＡ／ｌｇＡ抗体效价，结果６例为阴性（＜１∶１０），抗体阳性率为７０％。ＥＬＩＳＡ明显地提高了ＮＰＣ的检出率。以ｐ１３８（ＥＡ－Ｒ）和ｐ５４（ＥＡ－Ｄ）分别或混合包被，检测对ＥＢＶ特异的ＥＡ－Ｄ和ＥＡ－Ｒ的抗体。结论表明在ＮＰＣ病人血清中存在对ＥＡ两种抗原的抗体，对ＥＡ－Ｄ的抗体滴度高于对ＥＡ－Ｒ的抗体。因此，以两种抗原混合包被作为诊断抗原建立的ＥＬＩＳＡ方法，为ＮＰＣ的早期诊断提供更敏感、特异和简便的手段。     

HLA-DR4亚型及其分子三维结构模拟 分析在骨髓移植中的应用研究

目的 :建立ＨＬＡ -ＤＲ4亚型的套式ＰＣＲ -ＳＳＰ分型方法 ,为临床骨髓移植提供可靠依据 ,并寻找ＨＬＡ-ＤＲ4亚型与各种白血病之间的联系。探讨ＨＬＡ三维构象模拟分析在预测ＧＶＨＤ中的作用 ,以及寻找ＨＬＡ移植可容许抗原。方法 :盐析法提取 75例人外周血标本ＤＮＡ。建立并使用套式ＰＣＲ -ＳＳＰ分型方法。使用ＭＬＲ实验对 1例无血缘关系骨髓移植供、受体进行ＧＶＨＤ发病风险分析。通过ＩＮＴＥＲＮＥＴ进入ＥＸＰＡＣＹ -ＳＷＩＳＳＭＯＤＥＬＬＩＮＧ分子模拟服务器 ,对有关ＨＬＡ -ＤＲ4基因亚型进行ＨＬＡ三维结构的分析比较…     

自身免疫病患者T淋巴细胞表型分析

本文报告利用流式细胞仪检测了１０例系统性红斑狼疮（ＳＬＥ）患者、１８例干燥综合症（ＳＳ）患者、３７例风湿性关节炎（ＲＡ）患者和１６例人外周血Ｔ淋巴细胞表型，发现ＳＬＥ患者ＣＤ３＾＋Ｔ细胞明显降低，ＳＳ和ＲＡ患者正常；ＳＬＥ患者ＣＤ４＾＋／ＣＤ８＾＋Ｔ细胞比值倒置，ＳＳ和ＲＡ正常，但ＳＳ和ＲＡ ＣＤ８＾＋Ｔ细胞明显减少。文中对这三种疾病发病机理进行了初步讨论。     

112例肺癌患者血浆sE—SLT与血清LN,HA水平分析

应用ＥＬＩＳＡ、ＲＩＡ法对１１２例肺癌患者进行血清可溶性Ｅ－选择素（ｓＥ－ＳＬＴ）、层粘连蛋白（ＬＮ）、透明质酸（ＨＡ）的测定,旨在探讨其在肺癌转移中的意义。结果显示肺癌患者三项指标含量明显高于正常对照组（ｐ〈０．０１）,ｓＥ－ＳＬＴ、ＬＮ、ＨＡ的含量Ⅲ－Ⅳ期肺癌患者明显高于Ⅱ期,表明ｓＥ－ＳＬＴ、ＬＮ、ＨＡ参与了肺癌转移的过程,且其含量变化与病情进行密切相关。     

抗内皮细胞抗体及内皮素在系统性红斑狼疮中的致病作用

目的：探讨抗内皮细胞抗体（ＡＥＣＡ）及内皮素（ＥＴ）与系统性红斑狼疮（ＳＬＥ）发病之间的关系。方法：采用ＥＬＩＳＡ法检测了４６例ＳＬＦ病人血浆中ＡＥＣＡ,并同步检测血浆内皮素水平。结果：发现活动期ＳＬＥ病人组ＡＥＣＡ阳性率明显较非活动期及正常对照组高,ＡＥＣＡ阳性的ＳＬＥ病人皮肤粘膜损害、浆膜炎、肾损害发生率较ＡＥＣＡ阴性病人明显增高,ＡＥＣＡ阳性组ＥＴ浓度也明显增高。结论：提示ＡＥＣＡ不仅直接参     

Psychotic symptoms in patients with bipolar mania

BACKGROUND: Psychosis has been identified in as many as 68% of patients with bipolar mania. This analysis identified psychotic symptoms in these patients. METHODS: Data were from two placebo-controlled, 3-week studies in patients with an acute episode of bipolar mania. Symptoms were identified by the 30-item Positive and Negative Syndrome Scale (PANSS; item ratings, 1 = absent to 7 = extremely severe), the Young Mania Rating Scale, and the Global Assessment Scale. RESULTS: Psychotic features at study entry were diagnosed in 264 (51.3%) of the 515 patients. At baseline, these patients had significantly more severe scores on the PANSS, Young Mania Rating Scale, and Global Assessment Scale than patients without psychotic features. Patients with psychotic features had mean (+/-SD) scores of mild (3) or greater on six PANSS items: grandiosity (4.5+/-1.4), delusions (4.4+/-1.4), lack of judgment/insight (4.1+/-1.5), excitement (3.9+/-1.3), suspiciousness/persecution (3.1+/-1.6), and hostility (3.1+/-1.5). Grandiosity symptoms of delusional proportions (scores > or = 4) were noted in 205 (78%) of patients with a diagnosis of psychotic features and in 113 (45%) patients without the diagnosis. LIMITATIONS: The study was not specifically designed to assess patients with psychotic features and the PANSS was developed to evaluate symptoms of schizophrenia. CONCLUSIONS: These findings support prior reports indicating high rates of psychosis in patients with bipolar mania and identify the most prominent symptoms in these patients.     

The association between pre-morbid adjustment, duration of untreated psychosis and outcome in first-episode psychosis

BACKGROUND: The association between the duration of untreated psychosis (DUP) and outcome of schizophrenia may be confounded by other factors such as poor pre-morbid adjustment. The aim of the present study was to examine the independent contributions of DUP and of pre-morbid adjustment to the clinical and social outcomes of schizophrenia. METHOD: A longitudinal, prospective, 2-year follow-up study of 423 patients with first-episode schizophrenia-spectrum psychosis was conducted. Patients were comprehensively assessed at entry, 1-year and 2-year follow-up. At entry, DUP was measured by IRAOS (an instrument for the assessment of onset and early course of schizophrenia) and pre-morbid adjustment was measured by the Pre-morbid Adjustment Scale (PAS) as 'pre-morbid social adaptation' and 'pre-morbid school adaptation'. Outcome measures included the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), the Social Network Schedule and social information. Multiple linear regression models were used for data analysis. RESULTS: The median DUP was 48 weeks, which is long compared to other studies. Longer DUP was independently associated with more psychotic symptoms at entry, 1-year and 2-year follow-up. Poorer pre-morbid social adaptation was independently associated with more negative symptoms and smaller social network at entry and 1-year follow-up. Poorer pre-morbid school adaptation was independently associated with poor vocational outcome at 1-year and 2-year follow-up. CONCLUSIONS: Longer DUP is associated with poorer 2-year outcome of psychosis in schizophrenia-spectrum disorders, when pre-morbid functioning and other prognostic factors are controlled for. Impaired pre-morbid development is independently associated with more negative symptoms and poorer social outcome.     

阴性症状为主的精神分裂症男性患者认知功能及灰质密度改变

目的:运用基于体素的脑形态测量学方法(VBM),探讨以阴性症状为主的精神分裂症男性患者大脑结构形态学的改变,及其与精神病理学症状的关系。方法:15例阴性症状为主的成年男性精神分裂症患者和15例正常对照参与实验,所有研究对象均接受威斯康星卡片分类测验(WCST)与磁共振检查,获取磁共振T1加权像和高分辨率3D图像后进行VBM分析,比较患者组和正常对照组局部脑区灰质密度的差异性。结果:在威斯康星测验中,阴性症状为主的精神分裂症患者完成测查的总应答数、错误应答数和持续性错误数显著高于正常对照组,正确应答数和完成分类数与正常对照组没有显著差异。VBM分析显示患者右侧额上回,左侧额中回,左额内侧回,右侧楔叶,左侧颞中回的灰质密度较正常对照组低,未发现患者组灰质密度有明显增高的脑区。结论:以阴性症状为主的精神分裂症患者存在显著的额叶执行功能低下;双侧额叶灰质密度的下降可能是其执行功能损害的病理生理基础。     

行为矫正疗法促进慢性精神分裂症患者精神康复的疗效观察

目的 探讨行为矫正疗法促进慢性精神分裂患者精神康复的临床疗效.方法 在抗精神病药物治疗及护理的基础上,对60例入组病例进行3个月行为矫正疗法并配合正性强化措施,选用阴性症状量表(SANS)和护士用住院病人观察量表(NOSIE)进行行为矫正疗法前后比较.结果 行为矫正疗法后SANS总分及各因子分均较行为矫正疗法前有显著差...     

Neurocognitive and clinical predictors of functional outcome in patients with schizophrenia and bipolar I disorder at one-year follow-up

OBJECTIVE: Many studies have reported that cognitive ability may be predictive of the functional outcome for patients with schizophrenia. However, no study has prospectively examined these aspects in schizophrenia and bipolar disorders simultaneously. The present study attempted to analyze if neurocognition and clinical status predicts the real-life functioning for patients with schizophrenia or bipolar I disorder, using a longitudinal design. METHOD: Forty-seven schizophrenic and 43 bipolar I outpatients were assessed twice with a neurocognitive battery (Executive Functions, Working Memory, Verbal Memory, Visual Memory, Visual-Motor Processing, Vigilance, Vocabulary and Motor Speed tasks), clinical scales (the Positive and Negative Symptom Scale, the Hamilton Rating Scale for Depression and the Clinician Administered Rating Scale for Mania) and functional outcome measures (the Global Assessment of Functioning Scale, the WHO's Disability Assessment Scale and occupational adaptation level) over a one-year follow-up period. The cognitive performance of the patients was compared, at baseline and one year later, with that of 25 healthy subjects. RESULTS: In schizophrenia patients, global functioning one year later was predicted by a composite neurocognitive score and three specific domain (verbal memory, motor speed, vocabulary). Symptoms appeared to explain less of the variance in functioning. In bipolar I patients, changes in the composite neurocognitive score over one year, deficits in the visual/motor processing domain, severity of symptoms (psychotic, excitatory and affective symptoms) and premorbid adjustment at the first assessment were the variables that better predicted functioning or disability changes over follow-up period. CONCLUSIONS: Although the relationships between cognition, symptoms and functional capacity differ for schizophrenia or bipolar I patients, neuropsychological performance seems to be a principal longitudinal predictor of functioning in both disorders. Baseline neurocognition and cognitive changes over 12 months predicted changes in functioning over the same period, but only in bipolar I patients. These cognitive domains could be potential neurocognitive endophenotypes (endophenocognitypes) with regard to bipolar I disorder.     

工娱治疗对慢性精神分裂症患者的作用

目的 探讨工娱治疗对长期住院慢性精神分裂症患者的作用.方法 随机抽取我院长期住院的慢性精神分裂症患者60例.工娱治疗第180天时评定简明精神病性评定量表(BPRS)、社会功能缺陷筛选量表(SDSS)、阴性症状评定量表(SANS)、阳性症状评定量表(SAPS).结果 简明精神病性评价量表(BPRS)、社会功能缺陷筛选量表...     

"重返社区技能训练"对精神分裂症康复的作用

目的 :探讨重返社区技能训练对缓解社区精神分裂症患者的精神症状和改善其社会功能方面的作用。方法 :将 5 0例非急性期的社区精神分裂症患者随机分为技能训练组 (以下简称训练组 ;2 5例 )和对照组 (2 5例 ,其中脱落 2例 )。对技能训练组进行技能训练共 4周 ,然后随访 12周。采用阳性症状与阴性症状量表 (PANSS)、MorningSide康复状态量表 (MRSS)对患者进行评估。结果 :训练组患者的PANSS评分(3 9 96± 7 44 )、阴性量表总分 (11 92± 5 13 )、一般精神病理量表总分 (2 0 60± 2 95 )优于对照组 (分别为45 77± 8 95、 15 13± 4 79、 2 3 5 0± 5 3 7,P <0 0 5 ) ;训练组患者的MRSS总分 (3 1 60± 17 3 7)、依赖量表总分 (7 2 8± 5 41)、活动能力缺乏量表总分 (9 0 8± 5 5 2 )均优于对照组 (分别为 44 68± 13 61、 11 77± 5 17、15 0 0± 4 48) ;训练组的复发率 (4 % )低于对照组 (17% ) ,但差异无显著性。结论 :在药物治疗的基础上 ,重返社区技能训练能改善精神分裂症患者的症状及其社会功能     

Validation of the Korean-Version of the Clinical Assessment Interview for Negative Symptoms of Schizophrenia (CAINS)

The Clinical Assessment Interview for Negative Symptoms (CAINS) was developed to overcome the limitations of existing instruments and reflect the current view of negative symptoms. The aim of the present study was to evaluate the reliability and validity of the Korean version of the Clinical Assessment Interview for Negative Symptoms (K-CAINS). Inpatients (n = 49) and outpatients (n = 70) with schizophrenia were recruited from three institutions. The confirmative factor analysis, test-retest reliability, inter-rater reliability, convergent validity, and discriminant validity were assessed. The study group consisted of 71 males (59.7%) and 48 females (40.3%). Their mean age was 42.15 years (SD = 12.2). The K-CAINS was confirmed to be divided into two subscales of 9 items related to "motivation/pleasure" and 4 items related to "expression" in concordance with the original version of the CAINS. The results showed that the K-CAINS had a good inter-rater reliability (ICC = 0.84-0.94), test-retest reliability (r = 0.90, P < 0.001). Convergent validity was proven by demonstrating a significant correlation with the Positive and Negative Syndrome Scale (PANSS) negative subscale, and the Scale for the Assessment of Negative Symptoms (SANS). Discriminant validity was proven by the lack of a significant correlation with the PANSS positive subscale, the Korean version of the Beck depression inventory (BDI), the Korean version of the Calgary depression scale for schizophrenia (K-CDSS), and the Modified Simpson Angus scale (MSAS). The K-CAINS could be a reliable and valid tool to assess the negative symptoms of Korean schizophrenia patients.     

Dissociation and Schizophrenia

ABSTRACT

The authors administered the Dissociative Experiences Scale (DES), the Dissociative Disorders Interview Schedule (DDIS), the Scale for the Assessment of Positive Symptoms, and the Scale for Assessment of Negative Symptoms to 60 participants with schizophrenia. Participants were divided into two groups: those with scores below 10 on the DES and no dissociative disorder on the DDIS; and those with scores above 25 on the DES and/or a dissociative disorder on the DDIS. The dissociative participants had more severe trauma histories, more comorbidity and higher scores for both positive and negative symptoms. The authors interpret their findings as evidence in support of a trauma-dissociation subgroup within schizophrenia.     

精神分裂症患者情绪认知缺陷及其与精神症状的相关性

目的 探讨精神分裂症患者的情绪认知活动及其与精神症状的相关性.方法 采用中国人面孔情绪测验(CFET)对61例精神分裂症患者进行测试,与57名正常健康者比较,同时作阳性症状量表(SAPS)和阴性症状量表(SANS)评定.结果 分裂症患者CFET6种情绪认知正确数评分均低于对照组,而远隔错误数评分除厌恶情绪外均显著高于对照组.患者CFET评分与诊断分型、住院次数、用药无关,但SAPS和SANS部分症状评分与CFET的正确数评分呈负相关,而与CFET的错误数评分呈正相关.结论 分裂症患者情绪认知损害较为广泛,在病程过程中相对稳定存在,可能与患者广泛脑区网络功能障碍有关.而患者的症状表现与情绪认知缺陷可能存在共同的病理生理基础.