情感性障碍患者的条件负变化

目的 探讨情感性障碍与正常成人在条件负变化(CNV)检测中的不同表现.方法 应用光和声两种成对刺激,对29例情感性障碍患者和27例正常成人的CNV作了检测.结果 显示躁狂相组患者波幅B增高(P＜0.01),抑郁相组患者A-S'2面积缩小(P＜0.01),PINV潜伏期延长(P＜0.05),并且抑郁相单相组比双相组的PINV潜伏期显著延长(P＜0.01).结论 CNV和指令信号后负变化等提示PINV潜伏期延长可能是抑郁相单相患者的素质标记,而CNV波幅的变化则可能是情感性障碍患者的状态标记.     

抑郁症诱发电位波形变异与自杀行为史的关联性研究

目的 探讨抑郁症患者脑诱发电位(BEP)波幅下降与自杀行为史的关系以及临床意义.方法 应用美国尼高力公司Spirit脑诱发电位仪,记录了39例抑郁相、22例躁狂相患者和33名正常对照者的3种诱发电位.结果 1.与正常对照组相比,抑郁相和躁狂相组均出现诱发电位主成分波幅降低,抑郁相VEP/P2潜伏期延迟(正常对照组(194±19)ms,自杀史阳性组(211±21)ms,自杀史阴性组(209±17)ms, P＜0.01).2.两组患者的SEPs改变主要与患者有无自杀行为史有关.结论 诱发电位临床应用价值得到了初步证实,与自杀行为相关的生物学指标研究中需进一步重视.     

情感性精神病患者脑电图分析

本文通过情感性精神病躁狂相７７例患者和抑郁相６３例患者脑电图分析，发现躁狂相组与抑郁相组脑电图异常率分别为２８．６％和２０．６％，其异常改变均以θ波增多为主，尤以前部导联为显，男、女患者脑电图改变相近似。两组比较，发现躁狂相组的α波较抑郁相组频率稍快、波幅较高，α脑电图明显多于抑郁相组；而抑郁相组中有１２．７％患者出现低波幅脑电图，而躁狂相组则无，均有统计学意义（Ｐ＜０．０５）。此外，通过躁狂相组和抑郁相组分别与神经症组脑电图比较，发现他们的脑电图改变相近似，从而进一步证实情感性精神病患者脑电图异常改变无特异性。     

情感性精神病患者脑电图分析

本文通过情感性精神病躁狂相７７例患者和抑郁相６３例患者脑电图分析，发现躁狂相组与抑郁相组脑电图异常率分别为２８．６％和２０．６％，其异常改变均以θ波增多为主，尤以前部导联为显，男、女患者脑电图改变相近似。两组比较，发现躁狂组的α波较抑郁相组频率稍快、波幅较高，α脑电图明显多于抑郁相组；而抑郁相组中有１２．７％患者出现低波幅脑电图，而躁狂相组则无，均有统计学意义（Ｐ＜０．０５）．此外，通过躁狂相组和抑郁相组分别与神经症组脑电图比较，发现他们的脑电图改变相近似，从而进一步证实情感性精神病患者脑电图异常改变无特异性。     

抑郁障碍患者的关联性负变化研究

目的探索关联性负变化（ CNV）在抑郁障碍患者中的应用价值。方法应用事件相关电位工作站的相关检测技术，检测29例抑郁障碍患者（抑郁障碍组）和28名健康成人（正常对照组）的CNV。结果检查发现抑郁障碍组的CNV波形不规则， FZ和CZ部位的命令信号后负变化（PINV）复合波波幅低于正常对照组（P＜0.05），PZ部位的O波和E波潜伏期较正常对照组延长（ P＜0.05）。结论抑郁障碍患者的PINV复合波波幅及O波和E波潜伏期改变诸特点，对临床诊断有帮助，值得进一步研究。     

抑郁障碍的条件负变化实验研究

目的 用新的分析软件验证条件负变化(CNV)在抑郁障碍中的临床价值.方法 应用美国BROVO脑电生理仪及光和声两种刺激和反应时间技术,检测24例抑郁障碍患者和22名正常人的CNV.结果 抑郁障碍组波形不规则,CNV-Ⅱ型(延迟型)尤甚.与正常对照组比较,抑郁障碍患者CNV潜伏期A点延迟(P＜0.01),波幅B降低(P＜0.01).结论 新软件为CNV临床应用提供强有力的技术支持.抑郁障碍CNV变化诸特点值得进一步随访.     

焦虑症患者关联性负变

目的 探讨焦虑症患者关联性负变(CNV)的特点.方法 采用光和声成对刺激以及反应时间技术,对24例焦虑症患者和22名正常成人的CNV进行对照研究.结果 焦虑症组波形不规则,CNV-Ⅱ型(延迟型)尤甚.与正常对照组比较,焦虑症患者CNV潜伏期A点延迟(P<0.05),波幅B降低(P<0.05).结论 焦虑症CNV变化诸特点值得进一步随访.     

双相障碍抑郁发作与单相抑郁症失匹配负波的对照研究

目的:比较双相障碍I型抑郁发作与单相抑郁症失匹配负波(MMN)的差异及其与各自临床特征的相关性。方法:对55例双相障碍I型抑郁发作患者(双相组)、55例单相抑郁患者(单相组)以及50名正常对照者(正常对照组)进行MMN检测;采用大体功能评定量表(GAF)评定各组总体功能水平,汉密尔顿抑郁量表(HAMD)评估患者组病情严重程度。在控制性别、年龄、教育年限后,偏相关分析患者组MMN与临床特征及功能的相关性。结果:患者组较正常对照组GAF评分降低(F=53.96,P0.01);患者组较正常对照组MMN潜伏期延长(F=44.31,P0.01)、MMN波幅降低(F=5.39,P0.01);双相组与单相组MMN潜伏期及MMN波幅差异无统计学意义(P均0.05)。双相组MMN潜伏期与HAMD评分和发作次数呈正相关(r=0.51,0.46;P0.01);MMN波幅与HAMD评分和发作次数呈负相关(r=-0.35,-0.39;P0.01);单相组MMN潜伏期与HAMD评分呈正相关(r=0.52,P0.01),MMN波幅与HAMD评分呈负相关(r=-0.47,P0.01)。结论:双相障碍I型抑郁发作与单相抑郁症患者的异常MMN可能是抑郁发作的状态性标记。     

首发精神分裂症人面孔彩照诱发关联性负变的初步研究

目的 研究熟悉人和陌生人面孔彩色照片与短声组成不同的刺激序列诱发关联性负变(CNV)在精神分裂症中的应用.方法 应用中国广州三甲J-1脑电生理仪,检测30例首发精神分裂症患者和29名正常对照的CNV,进行横断面的病例对照研究.结果 精神分裂症组波形不规则.对照组A点潜伏期为(320±57)ms,精神分裂症组为(373±61)ms,精神分裂症患者CNV潜伏期A点延迟(t=4.59,P＝0.007),对照组波幅B(16±5)μV,精神分裂症组为(9±6)μV,精神分裂症患者波幅B降低(t=4.51,P＝0.008 ).结论 首发精神分裂症患者面孔照片诱发CNV A点潜伏期延迟,波幅B降低,CNV变化有待进一步探讨.     

血管性抑郁患者关联性负变的临床研究

目的 观察抑郁症各亚型患者事件相关电位关联性负变的特征,从神经电生理角度探讨血管性抑郁发生可能的病理生理机制.方法 应用意大利EB-NEURO事件相关电位工作站,对19例血管性抑郁患者、13例非血管性抑郁患者和16名年龄匹配的正常对照检测关联性负变成分的潜伏期、波幅和面积.结果 [1]与正常对照相比,血管性抑郁患者关联性负变波形欠规则.[2]血管性抑郁患者组的关联性负变潜伏期A较正常对照组明显延长[(519.68±41.59)ms、(307.50±28.02)ms],命令信号前期待波(EW)平均波幅均较正常对照和非血管性抑郁患者组明显降低[(6.23±1.39)μV、(16.13±2.66)μV、(8.92±1.99)μV]、EW面积也分别较后两组明显减少[(7592.06±628.58)、(20016.7±1005.37)、(10592.54±718.84)],上述差异均有统计学意义(P＜0.05).结论 血管性抑郁患者关联性负变异常的特征提示脑血管病变既影响情感调节通路,又影响了注意等认知神经环路.     

Hallucinations and delusions in 1,715 patients with unipolar and bipolar affective disorders

The prevalence of hallucinations and delusions was studied in 1,715 patients with unipolar or bipolar affective disorders hospitalized at a tertiary care facility. The authors found that the presence of psychotic features was significantly associated with diagnostic subtype. Bipolar manics were more likely than primary depressives, secondary depressives, and bipolar depressives to have hallucinations and/or delusions; primary depressives were significantly more likely than secondary depressives to have psychotic features. Among psychotic patients, bipolar manics were more likely than the other diagnostic groups to have delusions only and less likely to have hallucinations only. Possible explanations for these findings are discussed.     

Mortality in patients with primary unipolar depression, secondary unipolar depression, and bipolar affective disorder: a comparison with general population mortality

Mortality data are presented from a two to fourteen year follow-up of 705 primary unipolar depressives, 302 secondary unipolar depressives, and 586 patients with bipolar affective disorder (BAD) hospitalized at a tertiary care facility. Death ascertainment was made through a record-linkage process. Using sex- and age-standardized mortality ratios (SMRs), the mortality experience of the study population was compared with that of Iowa, the geographical area served by the admitting medical facility for this study group. Results show that risk for all-cause mortality was most pronounced during the first two years following hospital discharge, although secondary unipolar depressives continued to show a significant excess of deaths throughout the entire follow-up period. Deaths occurring from natural causes were significantly excessive only during the initial portion of the follow-up. Deaths from unnatural causes were significantly excessive throughout follow-up except for patients with bipolar affective disorder.     

A型行为与情感性障碍

目的 为研究A型行为与情感性障碍的关系。方法 采用A型行为问卷评估120例情感性障碍患者与120例健康人的行为类型,并比较单、双相情感性障碍患者的行为类型。结果情感性障碍患者中A型行为占62.7％,显著高于正常对照组(43.9％)。单、双相情感性障碍者在行为类型方面有明显差别,双相以A型行为为主,单相者以B型行为多见;并发现反复发作性躁狂症者的行为类型与双相情感性障碍者类似。结论 情感性障碍患者以A型行为多见。单相躁狂症与双相情感性障碍应为情感性障碍同一临床亚型。     

Is death from natural causes still excessive in psychiatric patients? A follow-up of 1593 patients with major affective disorder

A follow-up of 1593 Iowans with major affective disorder showed excessive mortality from unnatural causes in primary and secondary depression, and bipolar depression, but not mania, compared with age- and sex-matched controls from the general population. Excessive death from natural causes was found in women with secondary unipolar depression and bipolar depression and in manics (men and women combined) who had concurrent organic mental disorders or serious medical illnesses. Natural death was not excessive in the absence of these conditions. We conclude that excessive natural death reported in psychiatric patients is due to complicating physical disorders and not to the primary psychiatric disorder per se, whereas excessive unnatural death is due to the psychiatric disorder. Also, psychiatrically ill persons are probably referred for hospitalization more frequently when complicating physical disorders are present. Finally, we conclude that mortality patterns were similar in patients with primary and secondary unipolar depression, but bipolar patients were at lower risk for unnatural death than were unipolar patients.     

Perceptual span in schizophrenia and affective disorders

Perceptual span was assessed in schizophrenic, bipolar affective disorder-manic, bipolar affective disorder-depressed, and nonpsychotic inpatients. Both schizophrenics and manics processed less information than depressives, and did not differ from each other. This suggests that reduced span may be a concomitant of psychoses characterized by distractibility and thought disorder, rather than a trait specific to schizophrenia.     

Personality and psychosis: use of the Standardized Assessment of Personality

The Standardized Assessment of Personality, a semistructured interview for use with an informant, was used with a relative or a close friend to determine the premorbid personality of 100 consecutive patients admitted with major psychiatric disorders - major affective disorders (18 manics, 35 depressives), schizophrenia (28) and other functional psychoses (19). Forty-four per cent of the entire sample had an abnormal personality as defined by the presence of one of 10 prominent traits to a marked degree. A further 6% had the same traits to a lesser degree. The proportion of patients with an abnormal personality (all types) was comparable across the four diagnostic groups (manics 39%, depressives 54%, schizophrenics 39%, other functional psychotics 37%). However, if one included all traits (marked and mild), patients with an affective disorder had more between them than did the non-affective groups. This difference was largely accounted for by cyclothymic, anxious and obsessional traits. The schizophrenics and other functional psychotics had surprisingly few prominent traits and, in particular, a schizoid personality rarely preceded a schizophrenic illness.     

Platelet 3H-imipramine binding and familial transmission of affective disorders

We studied platelet 3H-imipramine binding and family history of affective illness in 26 patients with bipolar affective disorder and 24 patients with unipolar affective disorder. The density of platelet 3H-imipramine binding sites (Bmax) was significantly lower in bipolar patients with family history of affective illness than in healthy controls; however, there was a considerable overlap in Bmax values between the familial cases and the normal controls. A similar trend was observed in familial cases of unipolar disorder but the differences fell short of statistical significance. The nonfamilial cases of affective disorder did not differ from the healthy controls. The possible role of reduced platelet 3H-imipramine binding as a genetic vulnerability 'marker' in affective disorder was discussed.     

Childhood head trauma and psychosis

The medical histories of 200 schizophrenic patients were compared to those of 203 depressed patients, 122 manic patients, and 134 surgical controls. All subjects were hospital inpatients. Charts were specifically examined to record any head injury before age 10 that had required medical attention or caused loss of consciousness. Schizophrenics had a significantly greater history of head trauma than the manics, depressives, and surgical controls. There were no significant differences between manics and depressives or between affective disorders as a group and surgical controls. Childhood trauma may be a contributing factor to the development of psychosis in some individuals.     

Association analysis of the insertion/deletion polymorphism in serotonin transporter gene in patients with affective disorder.

A polymorphism of serotonin transporter was studied in 226 patients with affective disorders (n = 132 for bipolar, n = 94 for unipolar affective disorder) and in 213 healthy subjects. Consensus diagnosis by at least two psychiatrists, according to the ICD-10 and DSM-IV criteria was made for each patient using SCID (Structured Clinical Interview for DSM-IV Axis I Disorders). A functional polymorphism in the promoter region of serotonin transporter gene, where 44 bp are either inserted (long allele) or deleted (short allele) was analysed. Genotype s/s was significantly more frequent in patients comparing to the control group (P = 0.011 for bipolar and P = 0.003 for unipolar affective disorder)--the most marked association was found in males with bipolar and unipolar illness. The allele frequencies also differ significantly between patients and controls (P = 0.003 for bipolar and P = 0.001 for unipolar affective disorder). The frequency of the low activity (short) allele was higher in patients than in controls (51.1% in bipolar, and 54.3 in unipolar vs 39.4% in controls). We suggest that the presence of allele s may increase the susceptibility to occurrence of affective disorder.     

Biogenic amine metabolites in cerebrospinal fluid of patients with affective disorders

Concentrations of homovanillic acid (HVA), 5-hydroxyindoleacetic acid (5-HIAA) and 3-methoxy-4-hydroxyphenylglycol (MHPG) were measured in lumbar CSF from 33 patients with affective illnes and from 23 neurological controls. The group of patients with affective illness comprised 29 depressed and four manic patients. During illness, the concentration of HVA was higher in the depressed patients (P >0.001) than in the controls. Both unipolar and bipolar depressed patients had increased HVA levels (P >0.001 and P >0.05, respectively). The concentration of MHPG was greater than control values in the unipolar (P < 0.001) and bipolar (P < 0.002) subgroups but did not differ from control values in the depressed group as a whole. The concentration of 5-HIAA in the depressed patients as a whole and in the unipolar and bipolar subgroups did not differ from control concentrations. During illness the manic patients had increased levels of HVA (P >0.01) and normal levels of 5-HIAA and MHPG. Sixteen of the 29 depressed patients had a second lumbar puncture after they had recovered. Compared with the pre-recovery values, the concentration of HVA was reduced in the unipolar depressives (P < 0.01) and the concentration of 5-HIAA lowered in the depressed group as a whole (P >0.02). The present findings suggest involvement of catecholamines in affective disorders.