血管迷走性晕厥患者直立倾斜试验初期血流动力学特征

目的 分析血管迷走性晕厥（vasovagal syncope，VVS）患者在直立倾斜试验（head-up tilt test，HUTT）
初始阶段的血流动力学变化。
方法 连续入选2016年6月-2019年12月在首都医科大学附属北京天坛医院神经心脏病学中心就诊
并进行HUTT的VVS患者进行回顾性研究。分析HUTT结果阴性及不同阳性类型患者在HUTT平卧期和倾
斜初期的收缩压、舒张压、平均动脉压、心率、每搏量、心输出量、系统血管阻力的差异。
结果 研究共入组VVS患者303例，其中HUTT阴性组102例（33.7%），HUTT阳性患者中混合型组67例
（22.1%）、血管减压型组132例（43.6%）、心脏抑制型组2例（0.6%）（例数过少未纳入统计分析）。混
合型组在平卧期收缩压、平均动脉压、每搏量、心输出量均显著低于HUTT阴性组（均P＜0.05），在
倾斜初期收缩压、平均动脉压、每搏量、心输出量均低于HUTT阴性组；血管减压型组在平卧期舒张
压、平均动脉压低于HUTT阴性组，在倾斜初期收缩压、舒张压和平均动脉压低于HUTT阴性组。混合
型组平卧期和倾斜初期心输出量均低于血管减压型组，系统血管阻力均显著高于血管减压型组（均P
＜0.05）。
结论 不同HUTT结果的VVS患者在倾斜试验初始阶段已存在了明显的血流动力学差异。     

血管迷走性晕厥患者直立倾斜试验初期血流动力学特征

目的 分析血管迷走性晕厥（vasovagal syncope,VVS）患者在直立倾斜试验（head-up tilt test,HUTT）初始阶段的血流动力学变化。方法 连续入选2016年6月-2019年12月在首都医科大学附属北京天坛医院神经心脏病学中心就诊并进行HUTT的VVS患者进行回顾性研究。分析HUTT结果阴性及不同阳性类型患者在HUTT平卧期和倾斜初期的收缩压、舒张压、平均动脉压、心率、每搏量、心输出量、系统血管阻力的差异。结果 研究共入组VVS患者303例,其中HUTT阴性组102例（33.7%）,HUTT阳性患者中混合型组67例（22.1%）、血管减压型组132例（43.6%）、心脏抑制型组2例（0.6%）（例数过少未纳入统计分析）。混合型组在平卧期收缩压、平均动脉压、每搏量、心输出量均显著低于HUTT阴性组（均P＜0.05）,在倾斜初期收缩压、平均动脉压、每搏量、心输出量均低于HUTT阴性组;血管减压型组在平卧期舒张压、平均动脉压低于HUTT阴性组,在倾斜初期收缩压、舒张压和平均动脉压低于HUTT阴性组。混合型组平卧期和倾斜初期心输出量均低于血管减压型组,系统血管阻力均显著高于血管减压型组（均P＜0.05）。结论 不同HUTT结果的VVS患者在倾斜试验初始阶段已存在了明显的血流动力学差异。     

直立倾斜试验对不明原因晕厥的应用价值

目的探讨直立倾斜试验对不明原因晕厥的应用价值。方法选取2018-11—2019-11郑州大学第二附属医院门诊和住院收治的晕厥患者170例,行直立倾斜试验。结果(1)170例患者中阳性98例(57.65%),其中1型60例(61.22%),2型12例(12.24%),3型26例(26.53%);(2)98例阳性患者中女性阳性68例(69.38%),男性阳性30例(30.62%)(χ^2=20.129,P<0.001);(3)98例阳性患者中SNHUT阳性88例(51.76%),BHUT阳性10例(5.88%)(χ^2=87.222,P<0.001);(4)SNHUT倾斜5分钟内出现阳性症状81例(82.65%),SNHUT倾斜5 min后出现阳性症状17例(17.35%)(χ^2=58.722,P<0.001)。结论直立倾斜试验可以对不明原因晕厥进行初步晕厥筛查,在临床诊断血管迷走性晕厥方面具有明显优势,因此,具有重要的临床诊断与治疗价值。     

Prevalence of family history in vasovagal syncope and haemodynamic response to head up tilt in first degree relatives

Vasovagal syncope is an exaggerated form of the common faint affecting all age groups. Aetiology is unknown but the tendency for the disease to run in families has previously been noted. Aim: To determine the true prevalence of family history in subjects with a definitive diagnosis of vasovagal syncope made by positive head up tilt with symptom reproduction. To determine the strength of the genetic effect in vasovagal syncope by calculation of sibling (λs) and offspring (λo) relative risk. Haemodynamic responses to head up tilt were also examined in a sample of first-degree relatives of those with vasovagal syncope. Results: All subjects identified from the Cardiovascular Investigation Unit database with a definitive diagnosis of vasovagal syncope (n = 603) between 1993–2001 were asked to complete a questionnaire. 19 % had positive family history for blackouts or faints. From these pedigrees and using a crude estimate of population prevalence, sibling and offspring relative risk was calculated: λs = 1080, λo = 1356. Eleven first-degree relatives from 6 families attended for head up tilt testing with glyceryl trinitrate (GTN) provocation (4 unaffected, 7 affected). All subjects had symptoms in response to tilt in association with a range of haemodynamic responses. Conclusions: Vasovagal syncope has a strong genetic component. Elucidating underlying genetic mechanisms may lead to more effective, specific treatments. Received: 6 November 2001, Accepted: 31 October 2002 Correspondence to Julia L. Newton, MD, PhD     

Usefulness of the Head-Upright Tilt Test for Distinguishing Syncope and Epilepsy in Children

PURPOSE: Episodic loss of consciousness in children, whether or not associated with hypertonia or short-duration clonic movements, presents a diagnostic challenge to the pediatrician and child neurologist. We provide some evidence of the usefulness of the head-upright tilt test for investigating the causes of transient loss of consciousness in children, and for distinguishing between syncope, convulsive syncope, and epilepsy. METHODS: We studied nine children previously diagnosed as epileptic on the basis of compatible clinical events and epileptiform findings in routine EEGs who were treated over the long term with antiepileptic drugs, but whose clinical records suggested syncope or convulsive syncope rather than epilepsy on reevaluation. All subjects underwent head-upright tilt testing. RESULTS: The tilt-test result was positive in all nine cases, with the patients reporting the same symptoms as in the previously considered epileptic attacks. CONCLUSIONS: Inadequate histories and misuse/overinterpretation of EEG results often lead to misdiagnosis of epilepsy in children. The head-upright tilt test is a useful and reliable diagnostic technique, allowing syncopal events to be induced and evaluated under controlled conditions. In a subset of patients, it may help to distinguish epilepsy from simple or convulsive syncope.     

Tilt table testing in patients with suspected epilepsy

Background –  Approximately 20–30% of patients with epilepsy are misdiagnosed and syncope often seems to be the mistaken cause. We re-evaluated patients referred to an epilepsy clinic where suspicion of neurally mediated (reflex) syncope were raised using tilt table testing (HUT).
Methods –  HUT laboratory results and medical records of 120 consecutive patients were reviewed retrospectively over a period of 27 months.
Results –  HUT was positive in 59 (49%) patients. Seventeen of 38 (45%) patients previously diagnosed with epilepsy and taking antiepileptic drugs were found to be misdiagnosed. Four of 21 patients with epilepsy (19%) had dual diagnoses of reflex syncope and epilepsy.
Conclusion –  HUT is an informative investigation when suspicions of reflex syncope are raised in patients referred to an epilepsy clinic. Reflex syncope is an important and common differential diagnosis of epilepsy.     

0.25?mg低剂量硝酸甘油激发直立倾斜试验在血管迷走性晕厥诊断中的应用

目的评价0.25 mg低剂量硝酸甘油激发直立倾斜试验(head-uptilttesting,HUTT)诊断血管迷走性晕厥(vasovagal syncope,VVS)的临床可行性。方法入选疑似VVS患者进行0.25 mg低剂量硝酸甘油激发HUTT检查,通过无创连续逐搏血压监测数据的脱机分析,获取阳性率和达到阳性反应时间,并与既往国内外研究相比较。结果共入组疑似VVS患者343例,241例(70.3%)在HUTT过程中出现了阳性结果,其中混合型83例(34.4%),心脏抑制型2例(0.8%),血管减压型156例(64.7%)。低剂量硝酸甘油药物激发阶段阳性率与国外既往研究差异无统计学意义,整体阳性率与国外既往研究差异无统计学意义,但高于国内既往研究(70.3%vs 64%,P=0.016)。低剂量硝酸甘油激发阶段出现阳性反应的时间低于国外既往使用0.3 mg片剂舌下含服激发的研究(5.0±2.2 min vs 7±8 min,P=0.001),与使用0.4 mg硝酸甘油舌下喷雾研究结果的差异无统计学意义(P0.99)。结论 0.25 mg低剂量硝酸甘油激发HUTT的阳性率和达到阳性反应时间与国外0.4 mg硝酸甘油激发HUTT的结果无差异,具有临床应用的可行性。     

Post-influenzal psychiatric disorder in adolescents

The association between influenza and psychiatric disorder in adolescents was studied at a time when both were highly prevalent concurrently. First 505 secondary school pupils aged 15-18 completed questionnaires, including a symptom inventory derived from the SCL-90-R. Subsequently, 113 blood samples were examined for influenza antibody titers of five virus strains. Statistical analysis showed that adolescents who had been ill with influenza in the previous six months had significantly more psychiatric disorder than those who had not been ill with influenza in that period.     

SSRIs在儿童及青少年精神障碍中的应用

目的：了解选择性5—羟色胺回收抑制剂(SSRI)类在儿童及青少年精神障碍中的应用。方法：对儿童精神科门诊使用SSRIs的75例患者进行回顾性分析。结果：SSRIs已广泛应用于治疗多种儿童及青少年精神障碍。结论：SSRIs对部分儿童及青少年精神障碍疗效较好，安全性高。     

Syncope

Syncope is a common presenting symptom, and is often a challenging diagnostic dilemma because of its various underlying causes. A careful initial clinical assessment with directed investigations is crucial in arriving at a presumptive diagnosis. Prolonged cardiac monitoring technologies have improved diagnostic accuracy in the more difficult cases.     

Referral trends of people with intellectual disabilities and psychiatric disorders

Background The Specialist Mental Health Service for people with an intellectual disability (ID) and psychiatric disorder (referred to throughout this paper as ‘the Service’) has been in operation in south‐east London for the last 18 years, during which time two local, long‐stay institutions have closed. Aims To measure the number of referrals to the Service from 1983 to 2001 and identify trends. Methods Data were recorded on 752 new referrals using the assessment and information rating profile. Diagnoses according to the International Classification of Diseases (10th edition) were made by two psychiatrists. Referrals for a one off consultation or assessment, or with an IQ > 70 were excluded from analysis. Results Over time more non‐white clients and more clients with mild ID were referred. More referrals were made in later years, and a greater proportion came from primary care. Later referrals were also more likely to have a psychiatric diagnosis than those in earlier years. Conclusion Significant trends in referrals were identified, which may be explained by various external factors.     

The origin of vasovagal syncope: to protect the heart or to escape predation?

Major lines of evidence suggest that classical (emotional and orthostatic) vasovagal syncope (VVS) is not a disease, but rather a manifestation of a non-pathological trait. It is, therefore, reasonable to investigate the possible factors that may explain its origin and evolution. We reviewed the data available in the literature on the vasovagal reaction in humans and animals in order to identify possible similarities that might provide insight into the evolution of VVS. We found two processes which appear relevant to the investigation of VVS evolution: fear and threat bradycardia in animals, and the vasovagal reflex during hemorrhagic shock in humans and animals. We suggest that VVS in humans involves physiological mechanisms similar to those found in other vertebrates, and that this may indicate a common evolutionary root. The available data seem to suggest that VVS evolved as an advantageous response to inescapable predators or to stressful and possibly dangerous heart conditions. The inhibition of the sympathetic system, together with activation of the vagal system, characterizes VVS. The consequent slowing of the heart rate induced by VVS may constitute a beneficial break of the cardiac pump, thereby reducing myocardial oxygen consumption. We suggest that classical VVS did not evolve recently in the modern human lineage; rather, it should be regarded as a selected response, which probably evolved in the ancient past as a "defense mechanism" of the organism within some ancestral group(s) of vertebrates.     

High rates of psychiatric co-morbidity in individuals with Asperger's disorder

The present study aimed to provide clinical data regarding co-morbidity of psychiatric disorders in individuals diagnosed with Asperger's disorder (AD). This study included 37 individuals (32 male, five female, mean age: 10.9±4.5 years) diagnosed with AD. Psychiatric comorbidity was assessed using the Schedule for Affective Disorders and Schizophrenia for School Age Children – Present and Lifetime Version (K-SADS – PL). Ninety-four percent of participants had at least one additional psychiatric disorder. The most common were anxiety disorders (54%), disruptive behavioural disorders (48%), and mood disorders (37%). The results of this study highlight the need for detailed assessment of additional psychiatric disorders in this population.     

三所精神病院住院患者的抑郁性障碍患病率的调查

目的 了解不同级别精神病院住院患者中抑郁性障碍的患病率。方法 对５６年内大学附属医院５１４１例,市级精神病８４７５例及区级精神病院１２９１例出院患者进行调查。结果 ５年中大学附属医院住院患者中抑郁性障碍患病率为１５．７６％,分别高于市级医院（８．１４％）和区级医院（４．８８％）且重性抑郁症的诊断率逐渐上升,心境恶劣逐渐下降,结论 不同级别精神院中抑制郁性障碍患病率差别较大,与患者对疾病的认识及医生     

Retrospective psychiatric assessment of 200 suicides in Budapest

Based on an interview with the closest family member, using the Schedule of Affective Disorders and Schizophrenia--SADS, a retrospective psychiatric assessment and diagnostic classification was carried out on 200 completed suicides. Eighty-one per cent of the victims had a recent psychiatric disorder, in 63% depression. The prevalence of psychiatric illnesses was similar to that of other studies from countries with lower suicide rates.     

Fludrocortisone in Pediatric Vasovagal Syncope: A Retrospective,Single-Center Observational Study

Background and PurposeThe purpose of this study was to determine the effect of fludrocortisone in patients with pediatric vasovagal syncope (VVS).MethodsThis retrospective observational single-tertiary-center study based on chart reviews included 74 patients who were newly diagnosed with VVS in the head-up tilt-table test (HUTT). Some of the patients had been treated with fludrocortisone. All patients were assessed using a brain and cardiac workup before treatment to rule out the syncope being due to other causes, which resulted in seven of them being excluded: two for epilepsy and five for brain pathologies. The remaining 67 patients were analyzed. The effect of fludrocortisone was evaluated based on the results of a follow-up HUTT, with a response to the treatment considered to be present if there was a negative change at the follow-up HUTT. Univariate logistic regression were used for statistical analyses, with the criterion for significance being p<0.05.ResultsThere were no significant differences in the characteristic of the patients between the no-medication (n=39) and fludrocortisone (n=28) groups, including age, sex, and duration of treatment. The recurrence rate of syncopal or presyncopal events was significantly lower in the fludrocortisone group (39.3%, 11 of 28) than in the no-medication group (64.1%, 25 of 39) (p=0.044), as was the rate of negative change at the follow-up HUTT: 57.1% (16 of 28) and 28.2% (11 of 39), respectively (p=0.017).ConclusionsOur findings suggest that fludrocortisone is more effective than no medication in pediatric patients with VVS.     

Diagnosing personality disorders in psychiatric inpatients

This study investigated assumptions made by DSM-III and DSM-III-R regarding Axis I-Axis II associations and sex differences for the 11 personality disorders (PD). A total of 112 patients formed 4 Axis I diagnostic groups: recent-onset schizophrenia (n = 35); recent-onset mania (n = 26); unipolar affective disorder (n = 30); and a mixed diagnostic group (n = 21). The prevalence of PD was determined using the Structured Interview for DSM-III Personality Disorders (SIDP). Schizophrenia was associated with antisocial PD and schizotypal PD; manic disorder was associated with histrionic PD; and unipolar affective disorder was associated with borderline, dependent and avoidant PD. Some of these results were consistent with DSM-III/DSM-III-R postulates. However, there was little support for the DSM-III/DSM-III-R statements on sex differences in the prevalence of PD, except for antisocial PD. The implications of the results for DSM-III/DSM-III-R assumptions are discussed.     

Epilepsy and psychiatric disorder in the mentally retarded adult

302 mentally retarded adults, sampled by epidemiological criteria, were examined with regard to epilepsy and psychiatric disorder. Each of the complications was frequent and related to degree and origin of mental retardation. In 55 (18.2%) epilepsy had occurred at some time during their lives, in 25 (8.3%) of these in the past year. In 52% of persons with seizures in the past year a present state psychiatric diagnosis was established, compared to 26% in those without seizures. The nature of the combination of epilepsy and psychiatric disorder is complex, but in the mentally retarded most often reflecting underlying brain pathology in the form of widespread cortical and subcortical cerebral damage causing epilepsy of generalised or mixed type, and predominantly interictal psychiatric disorders unrelated in time to seizures and dominated by behaviour problems.     

The usefulness of the head-up tilt test in patients with suspected epilepsy

PurposeIt is estimated that approximately 20–30% of patients diagnosed with epilepsy have been misdiagnosed, and neurocardiogenic syncope (NCS) might frequently be the real cause of transient loss of consciousness (TLOC) episodes.We assessed the role of the head-up tilt test (HUTT) in patients previously diagnosed with refractory epilepsy to evaluate the ability of this test to correctly diagnose patients with NCS.MethodWe retrospectively analysed the clinical records of 107 consecutive patients with a previous diagnosis of refractory epilepsy that were taking antiepileptic drugs and who were referred for HUTT between January 2000 and December 2010. During the subsequent follow-up, we recorded the treatments performed and the recurrence of symptoms.ResultsComplete follow-up data were available for 94 (88%) patients, and the mean follow-up period was 80 ± 36 months. The HUTT was positive in 54% of patients. Thirty-one (33%) patients were misdiagnosed with epilepsy, and 20 (21%) patients had a dual diagnosis of NCS and epilepsy. The recurrence of TLOC was reported in 55% of the patients, but it was significantly lower in the misdiagnosed group (42% versus 64%; P = 0.039).ConclusionNCS is an important cause of epilepsy misdiagnosis. The HUTT is often critical for making an accurate diagnosis and subsequently selecting the appropriate treatment for patients presenting with TLOC. The diagnostic overlap between epilepsy and NCS is not uncommon, suggesting that electroencephalographic monitoring during a HUTT may play an important role in diagnosing patients with recurrent, undiagnosed TLOC episodes.