云南基诺族精神分裂症患病率的30年随访研究

目的 了解2009年基诺族精神分裂症的患病率和发病率,并了解其近30年的患病率变化趋势.方法 2009年对基诺族44个自然村总计10610人进行单纯整群随机抽样,对实际抽样的1984人进行精神分裂症的患病率调查.采用一般健康问卷12项(12-item general health questionnaire,GHQ-12)进行筛查,依据GHQ-12得分按比例抽取危险人群,采用SCID-I/P工具进行面检并作出诊断.同时,对有精神分裂症患病线索资料的个体进行入户访谈,其中包括既往流行病学调查中已诊断的33例精神分裂症病例.比较两种调查方法得到的精神分裂症患病率,对近30年来的精神分裂症患病率进行*9掊2趋势检验.结果 线索调查中精神分裂症的终生和时点患病率、年发病率均高于抽样调查,但差异均无统计学意义(P ＞ 0.05).线索调查结果显示,基诺族精神分裂症终生患病率0.37%(39/10610),时点患病率0.27%(29/10610),男性均高于女性(*9掊 2 ＝ 10.27,P ＜ 0.01;*9掊 2 ＝ 8.02,P ＜ 0.01).近10年新发病例12例,其中近一年新发病1例,年发病率9.43/10万(1/10610).与1979年、1989年、1999年比较,基诺族30年来的精神分裂症的终生患病率和时点患病率并无明显变化(*9掊 2 ＝ 0.18,P ＞ 0.05;*9掊 2 ＝ 0.18,P ＞ 0.05).结论 基诺族精神分裂症终生患病率及时点患病率近30年来无明显变化趋势.     

云南省基诺族人群饮酒情况及其相关精神障碍患病率现况调查

为了解云南省西双版纳州景洪市基诺山中的基诺族人群饮酒相关精神卫生问题的患病情况,我们于2002年11—12月进行了调查。对象按行政级别进行分层随机整群抽样,选定生牛、巴朵、巴奎、么羊、回珍5个寨子中长年在家的>15岁基诺族人群为研究对象。调查时基诺族乡人口共11357人,其中男6108人,女5249人。共访谈>15岁人口625人,其中男338人,女287人。方法调查者为精神科医生,调查前经系统培训,严格掌握国际疾病分类第10版(ICD-10)诊断标准。使用自拟的一般情况调查访谈提纲和饮酒调查访谈提纲进行入户筛查,调查首次饮酒及醉酒、平时饮酒及醉酒的…     

中国云南基诺族癫痫流行病学调查

目的 调查云南独有少数民族--基诺族的癫痫流行病学,癫痫发病的可能病因、危险因素.方法 以WHO在中国用过的问卷和ICBERG筛查问卷为基础,运用近期国际统一的癫痫诊断标准,采用多阶段分层整群抽样,入户面见调查.结果 基诺族癫痫发病率为22.39/10万,终身患病率为3.58‰,活动性癫痫患病率为2.69%.;患病人群中62.50%为全面性强直一阵挛发作,6.25%为复杂部分性发作,12.50%为复杂部分性发展为全面性一强直阵挛发作,1 8.75%为混合型发作,0.224‰可自然缓解;治疗缺口为75%.结论 基诺族癫痫发病率、活动性癫痫患病率较国内其他地Ⅸ低,终身患病率与国内报道一致,但较国内其他农村地区低,治疗缺口高于国内其他农村地区.     

基诺族脑梗死的流行病学调查

目的 调查云南省西双版纳州基诺族脑梗死的患病率及其发病特点,为开展防治工作提供依据.方法 以全国第四届脑血管病会议修订的脑血管病诊断标准为诊断标准,采取整群抽样的方法,对云南省西双版纳州44个自然村共10610人采取初筛以后确诊与确诊患者的二次线索收集相结合的调查方法,收集其人口学和病史资料,进行社会功能缺陷筛选量表(Social Disability Screening Schedule,SDSS)评定、美国国立卫生院神经功能缺损评分(NIH Stroke Scale,NIHSS )、日常生活能力指数(Barthel Index,BI)评分.结果 西双版纳州基诺族脑梗死发病率9.4/10万.基诺脑梗死的患病率273.3∕10 万,时点平均年龄61.20 岁,37 ～86岁.其中男16 例,时点患病率为284.0∕10万;女13例,时点患病率为261.3∕10万;男女时点患病率无统计学差异(χ2＝0.05,P=0.82).初发年龄平均57.58 岁,男性最小38 岁,最大83 岁;女性最小36岁,最大75岁;初发年龄男女无统计学差异(t=0.12,P=0.90 ).结论 基诺族脑梗死发病率低于全国水平,但是未进行继续的正规药物治疗率和康复训练.     

基诺族青少年自我同一性发展特征的叙事研究

目的 研究在外来文化冲击和社会经济发展环境下,基诺族青少年自我同一性发展特征及其对民族传统文化影响,探讨基诺族青少年的自我定位、性别角色认同、理想自我特征等同一性特征的形成过程和同一性选择问题.方法 应用质性研究,采用了田野调查及访谈法.结果 基诺族女性青少年自我同一性的形成和选择更多地是以本民族传统特征为参照,她们身上具有现代社会少见的男耕女织的典型传统;基诺族男性青少年在青春期后则出现明显的两极分化,他们在自我同一性发展特征上表现出不同差异,其自我同一性发展的选择均存在着一定矛盾和冲突.结论 基诺族青少年男女的自我同一性发展具有本民族的特色,本研究为当代基诺族青少年教育提供一定参考,以便更好地保护和发展基诺族文化.     

偏头痛与睡眠质量关系的研究

目的:探讨偏头痛与睡眠质量的关系.方法:采用阿森斯睡眠量表(AIS)对112例偏头痛患者(偏头痛组)及112名健康体检者(正常对照组)的睡眠质量进行评分,比较两组间失眠的发生率.对偏头痛组中无睡眠障碍亚组、可疑失眠亚组和失眠亚组先兆发作率及疼痛程度进行比较,分析睡眠质量与偏头痛的关系.结果:偏头痛组失眠的发生率(58.9%)明显高于正常对照组(24.1%)(P<0.001).偏头痛各亚组间先兆发作率的差异无统计学意义;失眠亚组中、重度头痛的比例(53.0%,37.9%)明显高于无睡眠障碍亚组(23.8%,19.1%)和可疑失眠亚组(40.0%,16.0%)(均P<0.001).相关性分析显示,偏头痛组睡眠质量与头痛程度呈负相关(P<0.001).结论:偏头痛患者睡眠质量较差,且睡眠质量越差的患者头痛程度越重,改善睡眠质量有可能减轻头痛程度.     

松弛疗法在失眠障碍中的应用进展

失眠障碍(Insomnia Disorders)是临床上常见的一种病症,也是最常见的睡眠障碍之一,其特征是入睡困难、睡眠维持困难、早醒和(或)睡眠质量差.文献报道,约25%的成人对自己睡眠不满意,其中6%~10%符合失眠障碍的诊断标准,长期失眠、睡眠质量低下可增加心血管疾病及慢性病的发生率,睡眠问题越来越受到重视[1-2].2013年出版的《精神疾病诊断与统计手册第5版》(DSM-5)将过去"原发性失眠"和"继发性失眠"的诊断条目删除,依据病程将失眠分为急性失眠、慢性失眠和其他类型失眠 3部分,不再用因果关系解释失眠与其他疾病共病的现象,更强调失眠障碍本身在临床工作中的重要意义、应根据诊断标准进行独立评估[3].失眠的治疗主要包括药物治疗和非药物治疗,临床上较常使用的催眠药是苯二氮 类,但长期使用可导致认知功能障碍、记忆损害、睡眠结构受损等不良反应[4-5].非药物治疗作为更安全的治疗方法日益受到推崇.其中松弛疗法治疗在临床应用有较多突破,本文主要就近年国内外松弛疗法治疗失眠障碍的研究进展做一简单综述.     

中国成人失眠诊断与治疗指南

失眠是临床最为常见的睡眠障碍类型.长期失眠对于正常生活和工作会产生严重负面影响,甚至会导致恶性意外事故的发生[1].2002年全球10个国家失眠流行病学研究(同卷调查)结果显示45.4％的中国人在过去1个月中曾经历过不同程度失眠[2].为了规范失眠治疗药物的临床应用,失眠诊疗共识专家组于2004年起草了中国失眠定义、诊断及药物治疗专家共识,历经多次修订,于2006年正式发表.该共识对于规范失眠的临床诊治已经发挥重要指导作用.2010年,中华医学会神经病学分会睡眠障碍学组邀请相关学科专家,按照循证医学原则,参考近年来失眠诊疗领域相关的进展资料,结合我国国情,经多次讨论形成中国成人失眠诊断与治疗指南,旨在为临床医师提供一套规范化的成人失眠诊疗框架.在临床实践过程中,医师在参照本指南时仍应结合患者具体病情进行个体化处理.     

云南基诺族及汉族特发性全面强直-阵挛性癫(癎)与CLCN2基因的相关性

目的 研究氯离子通道CLC-2基因是否与中国云南地区基诺族及汉族特发性全面强直-阵挛性癫(癎)(IGTCS)相关.方法 以14例云南西双版纳傣族自治州景洪市基诺乡基诺族IGTCS患者及其16名未发病亲属、67例云南籍汉族IGTCS患者及57名云南籍汉族健康体检者为对照,对常染色体3q26上CLCN2基因的内含子2及外显子5、19(内含子18)进行研究,采用PCR及直接基因测序技术,应用病例-对照研究法对CLCN2基因与云南基诺族及汉族IGTCS进行相关性分析.结果 CLCN2基因的内含子2及外显子5、19在病例组和对照组中均没有发现已报道的易患突变,但我们在对外显子19的序列测定过程中发现了其上游内含子18的146位上存在1个单核苷酸多态性位点:146T→C.该位点的3种基因型(TT、TC、CC)在汉族病例组(9、3、29例)和汉族对照组(22、9、26例)之间的分布差异有统计学意义(x2=16.079,P＜0.05);在基诺族组(基诺族病例组+基诺族亲属组,6、12、12例)与汉族对照组(22、9、26例)之间分布差异亦有统计学意义(x2=7.027,P＜0.05).汉族病例组与汉族对照组间TT型与非TT型基因型(分别为9、32例和22、35例)、TC型与非TC型基因型(分别为3、38例和9、48例)比较差异有统计学意义(x2=10.694,OR=4.121,P＜0.05;x2=11.592,OR=0.238,P＜0.05).结论 CLCN2基因内含子18的多态性位点146T→C可能是中国云南地区基诺族与汉族IGTCS患者的1个相关性位点,且在本组有限的样本数量研究中,此SNP位点在两个民族IGTCS患者之间的分布无民族差异.基因型TT为IGTCS的1个保护性因素,基因型TC则增加了患者的易患性.     

5000名国企在职人群的睡眠状况调查分析

目的探讨在职人群的睡眠,了解员工健康状况,提高心理素质,提高工作效率.方法根据<中国精神障碍分类与诊断标准第三版(CCMD-3)>,采用ATHENS失眠量表进行改良后,以问卷的方式进行调查.结果5000员工中实际回收调查表4142份(82.84%),其中有失眠3085人(74.48%),伴有各种躯体症状2673人(64.53%),伴有情绪问题1476人(35.62%).结论失眠给健康带来一定影响,另外会给有些人带来一些心理问题,特别是情绪问题.     

Global sleep dissatisfaction for the assessment of insomnia severity in the general population of Portugal

BACKGROUND AND PURPOSE: This study examines the prevalence and associated factors of insomnia symptoms and sleep dissatisfaction in the general population of Portugal. PATIENTS AND METHODS: We interviewed by telephone 1858 participants aged 18 years or older and representative of the general population of Portugal using the Sleep-EVAL system. Participation rate was 83%. The questionnaire included the assessment of sleep habits, insomnia symptomatology according to DSM-IV and ICSD classifications, associated and sleep/mental disorders and daytime consequences. RESULTS: Insomnia symptoms occurring at least 3 nights per week were reported by 28.1% of the sample and global sleep dissatisfaction (GSD) by 10.1%. Difficulty maintaining sleep was the most frequent symptom (21.0%); 29.4% of subjects with insomnia symptoms reported GSD. Daytime consequences, medical consultations for sleep and use of sleep medication were at least 2 times more frequent among subjects with insomnia symptoms and GSD compared to subjects with insomnia symptoms without GSD; insomnia diagnoses were also more frequent in the GSD group. CONCLUSIONS: The results show a severity gradation among subjects with only 1 insomnia symptom, those with 2 or 3 insomnia symptoms but without GSD and those with at least 1 insomnia symptom and GSD. Specific sleep or psychiatric disorders were identified for the majority of GSD subjects (86%); this rate dropped to 50.6% when only 1 insomnia symptom without GSD was reported. GSD appeared to be a good indicator of the presence of a sleep or psychiatric disorder and a good discriminator of the severity of sleep disturbances among subjects with insomnia symptoms.     

Prevalence and consequences of insomnia disorders in the general population of Italy

OBJECTIVES: To assess the prevalence of insomnia disorders using DSM-IV classification, and the consequences of insomnia in the Italian general population. METHODS: A representative sample of the Italian general population composed of 3970 individuals aged 15 years or older were interviewed by telephone using the Sleep-EVAL system (participation rate: 89.4%). Participants were interviewed about their sleep habits and sleep disorders. DSM-IV classification was used by Sleep-EVAL to determine the sleep disorder diagnosis. RESULTS: Insomnia symptoms were reported by 27.6% of the sample. Sleep dissatisfaction was found in 10.1% and insomnia disorder diagnoses in 7% of the sample. The use of sleep-enhancing medication was reported by 5.7% of the sample. Most of these subjects were using anxiolytics. Dissatisfaction with sleep was associated with daytime sleepiness. Middle-aged drivers dissatisfied with their sleep were three times more likely to have had a road accident in the previous year compared to other drivers. However, fewer than 30% of subjects dissatisfied with their sleep or with an insomnia disorder diagnosis had consulted a physician about their sleep problem. CONCLUSIONS: As in other European and non-European countries, insomnia is widespread in Italy. The consequences are important. Appropriate recognition and treatment of insomnia should be part of an educational program for general practitioners everywhere.     

Insomnia in the elderly : Prevalence,gender differences and relationships with morbidity and mortality

A sample of 1070 people aged 65 and over living in the Liverpool community was interviewed in 1982/3. Those traced were then reinterviewed 3 years later. Information was collected on the prevalence of perceived insomnia using a community version of the Geriatric Mental State (GMS), which also provided a diagnosis using AGECAT. Thirty-five per cent reported trouble sleeping, which was twice as common in women as men and was not wholly accounted for by the increased prevalence of mental illness in elderly women. There was no change in prevalence with age, but insomnia was more frequent in the depressed group (70%). Insomnia is more likely with increasing serverity of depression but was also common in the well group and hence is not a specific indicator. No relationship was found between mortality at year 3 and insomnia or hypnotic use at year 0. Use of hypnotics was related to the presence of sleep disturbance, but not to having a psychiatric diagnosis. Medical intervention may be much more successful in reducing the prevalence of benzodiazepine usage than may have been realized.     

Association of insomnia disorder with sociodemographic factors and poor mental health in COVID-19 inpatients in China

PurposeTo examine insomnia disorder and its association with sociodemographic factors and poor mental health in 2019 novel coronavirus (COVID-19) inpatients in Wuhan, China.Designand Methods: A total of 484 COVID-19 inpatients in Wuhan Tongji Hospital were selected and interviewed with standardized assessment tools. Insomnia disorder was measured by the Chinese version of the Insomnia Severity Index (ISI-7), a total score of 8 or more was accepted as the threshold for diagnosing insomnia disorder.ResultsThe prevalence of insomnia disorder in the whole sample was 42.8%. Binary logistic regression analysis revealed that female gender, younger age, and higher fatigue and anxiety severity were more likely to experience insomnia disorder.ConclusionGiven the high rate of insomnia disorder status among COVID-19 inpatients in Wuhan, China, and its negative effects, follow-up assessments and appropriate psychological interventions for insomnia disorder are needed in this population.     

Insomnia and hypnotic use in Campo Grande general population,Brazil

The insomnia prevalence in general population was determined by means of 408 home interviews of adults, in a representative sample of Campo Grande city, Brazil. The random sample was stratified by sex, age and economic social status. Insomnia subtypes evaluated were the disorders of sleep initiation (DSI), sleep maintenance (DSM) and early awakening (DEA). A structured questionnaire was used with the consent from the interviewed subjects. Statistics used chi-square, and Fisher tests; and inferences based on binomial distribution parameters; the significance level was 5% and confidence interval (CI) was 95%.The general prevalence of insomnia was 19.1% (sd=2.0%), mostly women (p=0.0015), and people of less years of schooling (p=0.0317), subtype DSI (14.2%, p=0.0043), and chronic (p=0.7022). Hypnotic drugs were used by 6.9%(sd=1.3%) in the last month. Use in the last 2 years, 70.3% mostly insomniacs (p<0.0001), women (p=0.0372) and people over 30 years of age (p=0.0536).     

Is insomnia a marker for psychiatric disorders in general hospitals?

BACKGROUND AND PURPOSE: The aim was to evaluate the relationship between insomnia and psychiatric disorders in general hospital inpatients. PATIENTS AND METHODS: Information about insomnia was collected using a structured and codified questionnaire adapted from a previously validated one in Brazil. For Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) psychiatric diagnosis, the Portuguese version of the International Neuropsychiatric Interview (MINI) was used. RESULTS: Out of the 200 patients interviewed, 56.5% complained of insomnia, and 50.0% suffered from at least one psychiatric disorder. Major depressive episode (MDE) (P<0.001), generalized anxiety disorder (P=0.025) and suicide risk (P=0.034) were associated with insomnia (univariate analysis). The results of the multivariate analysis showed that only MDE had a statistically significant association with insomnia (OR=3.6; 95% CI=1.9-6.9). CONCLUSIONS: This study found a high prevalence of psychiatric disorders and insomnia in a general hospital population and found that insomnia can be a marker for MDE.     

Prevalence of insomnia and associated factors in South Korea

INTRODUCTION: In Western countries, insomnia is associated with daytime impaired functioning, as well as physical and psychiatric illnesses. However, little information exists on insomnia in Asian countries. This study investigates the prevalence and correlates of insomnia in the general population of South Korea. METHODS: A representative sample of the South Korean general population composed of 3719 noninstitutionalized individuals aged 15 years or older were interviewed by telephone using the Sleep-EVAL system. The participation rate was 91.4%. The interviews covered sleep habits, sleep symptomatology, physical and psychiatric illnesses. DSM-IV sleep and psychiatric disorder diagnoses were also assessed. RESULTS: Insomnia symptoms occurring at least three nights per week were reported by 17.0% of the sample; difficulty initiating sleep (DIS) was mentioned by 4.0% of the sample, difficulty maintaining sleep (DMS) by 11.5%, early morning awakenings (EMA) by 1.8%, and nonrestorative sleep (NRS) by 4.7% of the sample. DSM-IV insomnia disorder diagnoses were found in 5% of the sample. Over 50% of subjects with insomnia symptoms reported important daytime consequences and another 20% reported mild or moderate consequences. However, the proportion of insomnia subjects seeking medical help for their sleep problems was very low (6.8%). CONCLUSIONS: As in Western countries, insomnia is widespread in South Korea, affecting nearly one in five individuals. Many of them would benefit from medical help; however, few insomnia subjects are consulting for this problem. An educational effort is needed for both the general population and the physicians.     

Prevalence of sleep complaints and associated factors in community-dwelling older people in Brazil: the Bambuí Health and Ageing Study (BHAS)

BACKGROUND: Population-based studies of insomnia among older people residing in communities in developing countries are rare. The objectives of this population-based study were to determine the prevalence and factors associated with insomnia among older adults (60 years and over) living in a Brazilian town with 15,000 inhabitants (Bambuí MG). METHODS: All 1742 residents in this age group were selected for a structured interview and blood tests. From these, 1516 (87.0%) participated in the study. RESULTS: The prevalence of insomnia was 38.9%, being higher among women (45.3%) than among men (28.8%). The use of sleeping pills was reported by 380/1513 (25.1%) of the participants; 186 (49.0%) of these complained of insomnia, suggesting that their treatment should be reassessed. Factors independently associated with insomnia were: female sex (OR=1.78, 95% CI=1.41-2.24), dissatisfaction with free time arrangements (OR=1.88, 95% CI=1.28-2.77), self-rated health as reasonable or bad/very bad (OR=2.02, 95% CI=1.50-2.72 and OR=3.12, 95% CI=2.21-4.39, respectively), history of previous medical diagnosis of some chronic conditions (OR=1.38, 95% CI=1.10-1.73), inability to perform routine activities due to a health problem in the previous 2 weeks (OR=1.54, 95% CI=1.10-2.15), and staying in bed in the previous 2 weeks (OR=1.61, 95% CI=1.04-2.48). CONCLUSIONS: The prevalence of insomnia was high, indicating that this was a public health problem for older adults living in the study community. Our results emphasize the necessity for further investigations about insomnia among older people living in small communities in Brazil and other developing countries.