注意缺陷多动障碍患儿的成人早期精神状况随访研究

目的 了解注意缺陷多动障碍(ADHD)患儿在成人早期罹患精神障碍的状况.方法 采用前瞻性设计方法,对就诊于北京大学精神卫生研究所精神科门诊的300例ADHD患儿进行随访,同意参加随访者116例(随访率38.7%),基线至随访为2.0～13.5年;患儿基线年龄为7.5～17.0岁,随访时年龄为18.0～23.5岁;采用以美国精神障碍诊断与统计手册第4版为诊断标准制订的定式会谈工具确定诊断,包括Conners成人ADHD诊断会谈量表(Conners Adult ADHD Diagnostic Interview for DSM-Ⅳ,CAADID)、DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查(SCID-Ⅰ)和DSM-Ⅳ轴Ⅱ障碍定式临床检查(SCID-Ⅱ)工具.结果 随访时116例中符合成人ADHD诊断者共59例(50.9%),其中单纯符合成人ADHD诊断标准者18例(15.5%),同时符合成人ADHD及精神障碍/人格障碍者41例(35.3%);不符合成人ADHD诊断,但符合精神障碍/人格障碍者17例(14.7%);不符合任何精神疾病诊断者40例(34.5%),其中功能缓解29例(25.0%),功能未缓解11例(9.5%).116例中,40例(34.5%)至少共患1种DSM-Ⅳ轴Ⅰ障碍,其中21例(18.1%)共患情感障碍,12例(10.3%)共患焦虑障碍,6例(5.2%)共患物质滥用;38例(32.8%)符合DSM-Ⅳ轴Ⅱ人格障碍诊断,其中6例(5.2%)符合A组人格障碍诊断,23例(19.8%)符合B组人格障碍诊断,包括20例(17.2%)反社会型人格障碍,18例(15.5%)符合C组人格障碍诊断,6例(6.0%)符合其他人格障碍诊断.结论 ADHD患儿至成人早期预后较差,2/3左右罹患成人ADHD、精神障碍或人格障碍,其中50.9%符合成人ADHD.     

精神科门诊边缘型人格障碍的共病情况调查

目的调查边缘型人格障碍（Borderline Personality Disorder,BPD）与轴I、轴Ⅱ疾病的共病情况。方法2006年5月至2006年11月随机抽取符合入组标准的3402名就诊者进行调查。先由研究对象自行填写一般情况问卷及人格诊断问卷（PDQ-4^＋）进行筛查,再由精神科医生按照美国精神障碍诊断与统计手册第四版（DSM-Ⅳ）人格障碍定式临床检查（SCID-Ⅱ）对PDQ-4^＋筛查阳性者进行临床诊断。结果1.诊断为BPD者178人（5．8％）;2.BPD常与多种人格障碍共病,抑郁型人格障碍共病率最高（35．4％）;3.轴I疾病中,BPD与心境障碍者共病率最高（46．1％）。结论边缘型人格障碍与轴I、轴Ⅱ疾病存在广泛共病。     

海洛因依赖与人格障碍共病调查

目的：调查海洛因依赖者的人格障碍共病状况。方法：采用美国精神障碍诊断与统计手册第4版（DSM-Ⅳ）系统轴Ⅱ人格障碍访谈问卷（SCID-II）（第2版）对90例海洛因依赖者进行评定及相关统计分析。结果：79例（87.8%）符合至少一种人格障碍,常见的为偏执型、强迫型、反社会型、未加标明组（被动攻击型及抑郁型）、边缘型、回避型、自恋型等,人均患2.5种人格障碍。以戏剧化-情绪组人格障碍最常见。结论：在海洛因依赖者中人格障碍共病现象相当普遍。     

环性情感气质问卷在鉴别单相抑郁和双相Ⅱ型抑郁中的价值

目的:评估环性情感气质问卷临床检查版(CT-CQ)及环性气质情感自评问卷(CT-SQ)在鉴别单相及双相Ⅱ型抑郁的价值。方法:以美国《精神障碍诊断与统计手册》第4版(DSM-Ⅳ)为诊断标准、DSM-Ⅳ轴Ⅰ障碍临床定式检查-病人研究版(SCID-I/P)为诊断方法,将就诊的急性期抑郁发作患者分为抑郁障碍(MDD)组及双相障碍Ⅱ型(BDⅡ)组;使用CT-CQ及CT-SQ评估两组的环性情感气质,分析CT-CQ及CT-SQ筛查BDⅡ抑郁发作的敏感度及特异度。结果:MDD组纳入208例,BDⅡ组纳入150例;CT-CQ筛查BDⅡ抑郁的敏感度及特异度分别为28.7%及85.1%;以9分为CT-SQ最佳临界值,筛查BDⅡ抑郁的准确率为61.5%(95%CI:56.2%～66.5%),敏感度为64.4%(95%CI:58.3%～71.2%),特异度为57.3%(95%CI:49.6%～65.1%)。结论:对CT-CQ及CT-SQ的综合判断可作为鉴别单相及BDⅡ抑郁的补充工具。     

海洛因依赖者的人格障碍及性别差异分析

目的了解海洛因依赖者的人格障碍及其性别差异。方法用DSM-Ⅲ-R人格障碍用定式临床检查手册,调查了93名自愿戒毒的海洛因依赖者DSM-Ⅲ-R轴Ⅱ人格障碍的诊断情况并对其进行不同性别间比较。结果轴Ⅱ人格障碍发生率达到89．2％。边缘型人格障碍(62．4％)和强迫型人格障碍(59．1％)最常见,其次是偏执型人格障碍(52．7％)。除反社会型人格障碍外,其它类型人格障碍不同性别间未发现显著性差异。结论海洛因依赖者存在各种类型的人格障碍。反社会型人格障碍更多见于男性患者。为了加强治疗效果预防复吸应针对不同性别个体采取个性化的治疗方法。     

注意缺陷/多动障碍诊断标准的研究☆

目的使用DSM-Ⅳ中注意缺陷/多动障碍(AD/HD)诊断标准对一组多动综合征和一组无多动的儿童进行诊断,探讨DSM-Ⅳ的分布特征及在我国的适用性.方法多动组为就诊的多动症儿童,符合临床诊断和ICD-10诊断标准,共92例.对照组无多动的学校儿童96名.由家长填DSM-Ⅳ诊断表.结果在188名儿童中,符合DSM-ⅣAD/HD诊断99例,多动组87例(94.57%),对照组12例(12.5%),后者包括单纯注意障碍、学习障碍、情绪障碍及无问题的儿童.如以临床诊断/ICD-10为金标准,DSM-Ⅳ的诊断灵敏度为94.57%,特异度87.50%,诊断一致性为0.91.结论中国多动症儿童的多动/冲动症状难以达到DSM-Ⅳ的标准;DSM-Ⅳ标准扩大了诊断范围,主要是注意障碍为主型.在使用DSM-Ⅳ诊断时应考虑民族、文化、年龄、性别因素.     

成人注意缺陷多动障碍临床特点的初步分析

目的初步分析我国成人注意缺陷多动障碍(ADHD)患者的症状特点、共病及社会功能情况。方法对6～16岁曾就诊于我院的88例符合美国精神障碍诊断与统计手册第4版(DSM-IV)的ADHD患儿在≥18岁时采用DSM-IV配套的定式会谈工具进行再评估,以满足成人ADHD诊断标准者59例为研究组,对照组为29例不满足ADHD诊断标准且GAF评分70分者,比较两组临床特点的不同。结果成人ADHD临床分型以ADHD-I为主,占86.4%(51/59);"经常"出现的症状依次是:"组织事情有困难"(98.3%)、"逃避需要大量持续用脑的任务"(96.6%)、"不能注意细节"(94.9%)、"很难遵从指令且完不成工作"(96.6%)、"注意持续时间短"(88.1%)和"因外界刺激而分心"(72.9%)。成人ADHD中共患任何一种DSM-Ⅳ轴Ⅰ或轴Ⅱ障碍者66.1%(39/59),其中39.0%(23/59)至少共患一种轴Ⅰ精神障碍,49.2%(29/59)至少共患一种轴Ⅱ障碍。成人ADHD组功能大体评定量表得分明显低于对照组(t=12.96,P0.001),74.6%(44/59)出现轻或中度社会功能损害。结论成人ADHD的临床表现以注意缺陷型为主,共患其他精神障碍及人格障碍较多,总体社会功能相对较差。     

焦虑障碍的脑电生理学研究进展

焦虑障碍(anxiety disorder,AD)是中国精神科门诊最常见的神经症之一[1],按照中国精神疾病诊断标准 (CCMD-3),可根据其临床表现主要分为广泛性焦虑和惊恐发作两类.但在DSM-Ⅳ中,焦虑障碍则包括广泛性焦虑(generalized anxiety disorder, GAD)、惊恐障碍(panic disorder, PD)、社交焦虑(social anxiety disorder, SAD)、强迫症(obsessive-compulsive disorder, OCD)和创伤后应激障碍(posttraumatic stress disorder, PTSD),其终身患病率3.5%～13.3%.本文结合DSM-Ⅳ诊断标准,以中国临床上常见的4种神经症(广泛性焦虑、惊恐障碍、社交焦虑和强迫症)为例,复习其脑电生理学领域的最新热点.     

双相谱系诊断量表在鉴别单相抑郁和双相抑郁中的应用研究

目的评估双相谱系诊断量表(bipolar spectrum diagnostic scale,BSDS)中文版在鉴别单相抑郁和双相抑郁中的应用价值。方法使用BSDS对抑郁发作期患者进行评定,以《精神障碍诊断与统计手册第四版》轴Ⅰ障碍临床定式检查-病人研究版(structured clinical interview for DSM-Ⅳ Axis Ⅰ Disorders,research version for patients,SCID-I/P)对患者进行诊断,并将SCID-I/P诊断与BSDS筛查结果比较,分析BSDS筛查双相障碍的准确率、敏感度和特异度。结果 582例抑郁发作期患者完成BSDS评分及诊断。以BSDS得分≥13分标准判断为双相障碍患者238例(40.20%),根据SCID-I/P标准诊断为双相障碍患者261例(44.80%),其中BSDS得分≥13分者162例。BSDS筛查双相障碍的准确率为69.59%,敏感度为65.13%,特异度为73.21%。结论采用BSDS从抑郁发作期患者中筛查出双相障碍患者有一定的应用价值,对临床早期识别双相障碍患者有重要意义。     

中国精神障碍分类与诊断标准第3版临床使用情况调查

目的:调查中国精神障碍分类与诊断标准第3版(CCMD-3)临床使用情况。方法:对广慈医院2006年精神科全部出院病例1070例精神障碍诊断按照CCMD-3进行分析。结果:1070例的CCMD-3使用率为77.9%;未使用CCMD-3者中有68.2%继续使用CCMD-2-R的诊断标准。结论:CCMD-3临床使用率偏低。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of Legislation of 1933 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -