精神病院中谵妄病人的临床分析

目的：探讨谵妄的病因和临床特点。方法：对符合ＣＣＭＤ－２－Ｒ意识障碍和ＤＳＭ－Ⅳ谵妄诊断标准１２１例患者的临床资料进行回顾性分析。结果：引起谵妄的病因很多,以颅脑疾病为最常见,其次是综合因素。临床表现以意识障碍伴有思维不连贯,遗忘,视幼觉和行为紊乱等为主。结论：引起谵妄的病因很多,往往是多种原因作用的结果。谵妄的临床特点是急性起病,以意识障碍伴全面认识功能障碍,症状节律变化为主的临床症状群。     

使用SCID—P比较三种诊断标准对神经症的再诊断

目的 比较ＩＣＤ－１０，ＤＳＭ－Ⅳ和ＣＣＭＤ－２－Ｒ对神经症再诊断。方法 将２１１例临床拟诊为神经症的病人以ＤＳＭ－Ⅲ－Ｒ用临床定式检查（ＳＣＩＤ－Ｐ）重新收集临床资料，分别以三种诊断标准进行再诊断。比较分析三者间的异同。结果 三者应用于精神症的再诊断一致性较高。结论：ＣＣＭＤ－２－Ｒ在诊断抑郁性神经症、广泛性焦虑、惊恐障碍上具有简洁易辨认的优点，但总的来说存在病程衔接不足，未能将临床所见病例完全     

癌症病人伴发精神障碍的类型及其预后分析

目的探讨癌症病人伴发精神障碍的类型与预后。方法采用ＣＣＭＤ－２－Ｒ诊断标准对２３８例癌症病人进行再诊断。结果本文病例中有３０．２５％符合ＣＣＭＤ－２－Ｒ中相应精神疾病的诊断标准。结论提示癌症伴发精神障碍最常见的诊断类型是适应性障碍、颖病症、人格改变和谵妄状态，并影响其预后。     

复合性国际诊断交谈检查核心本和神经精神病学临床评定表的 …

目的 对比研究计算机诊断系统复合性国际诊断交谈检查核心本（ＣＩＤＩ－Ｃ）／国际疾病分类第１０版（ＩＣＤ－１０）、ＣＩＤＩ－Ｃ／美国精神障碍诊断统计手册第３版修订本（ＤＳＭ－Ⅲ－Ｒ）、神经精神病学临床评定表（ＳＣＡＮ）／ＩＣＤ－１０、ＳＣＡＮ／ＤＳＭ－Ⅲ－Ｒ对精神分裂症、心境（情感）障碍、神经症诊断的信度效度。方法 培训５个单位研究者对其单位中符合中国精神疾病分类方案与诊断标准第２版（ＣＣＭＤ－２）     

纳络酮治疗震颤谵妄13例报告

现将本院１９９７年１２月～１９９９年２月以纳络酮治疗酒精所致震颤谵妄１３例报告如下。１　对象与方法１３例患者均符合ＣＣＭＤ－２－Ｒ震颤谵妄诊断标准;均为男性;年龄４１～５２岁,平均（４７．０±２．５）岁;无其他器质性疾病。持续饮酒１８～３０年,平均（２２．０±３．５）年;日均饮酒量（以５０度白酒计算）２５０～１２００ｍｌ,平均（５３０±５０）ｍｌ。２例酒量减少后１２～２４小时发生,１０例末次戒酒后２４～１２０小时发生,１例患肺炎后２４小时出现。１３例均有意识障碍,意识范围狭窄;感知觉障碍１０例,…     

心脏病病人的惊恐障碍

心脏病病人的惊恐障碍［英］／ＣｈｉｇｎｏｎＪＭ…∥ＡｍＪＰｓｙｃｈｉａｔｒｙ．－１９９３，１５０（５）；－７８０～７８５心血管症状和焦虑一直密切相关，Ｋａ－ｔｏｎ发现，因心前区痛或心动过速为最初症状而就医的病人中，有４０％符合ＤＳＭ－Ⅲ惊恐障碍的诊断...     

中国精神疾病分类和诊断标准第二版修订本的现场测试报告

为考核中国精神疾病分类和诊断标准第２版修订本（ＣＣＭＤ－２－Ｒ）的性能与临床推广的可行性，作者于１９９３年１０月至１９９４年３月进行了现场测试，全国有１８个单位的５５位精神科医师参加，共测试了７５０例，８７．１％认为文本的可理解性好，易于接受；８４．０％认为可操作性好；６４．６％认为ＣＣＭＤ－２－Ｒ比ＣＣＭＤ－２有所进步ＣＣＭＤ－２标准诊断与临床诊断的一致率为９３．６％（Ｋ＝０．８０），与ＣＣＭＤ     

非器质性慢性疲劳综合征的诊断归属

应用ＣＣＭＤ－２，ＩＣＤ－１０，ＤＳＭ－Ⅱ－Ｒ，ＣＤＣ诊断标准定式评估９６例非器质性慢性疲劳为主诉的门诊病人，以比较不同分类诊断系统的差异。结果发现，２６例病人诊断一致性较好，其余７０例符合ＣＣＭＤ－２神经衰弱诊断标准的病人，应用ＩＣＤ－１０标准，６２例诊断为神经衰弱，８例诊断为未分化性躯体形式障碍。应用ＤＳＭ－Ⅱ－Ｒ标准，５８例符合ＵＳＤ和ＣＦＳ。     

32例精神分裂样障碍的诊断追踪

本文对３２例首次发病、首次住院诊断为精神分裂样障碍患者在平均出院１．８８年后，用ＣＣＭＤ－２和ＤＳＭ－Ⅱ－Ｒ标准进行了再诊断，结果，临床痊愈和显著好转率为８１．３％，６５．６％的患者符合精神分裂症诊断标准，１８．８％的患者维持精神分裂样障碍诊断，１５．６％的患者诊断为其他三种精神障碍。追踪诊断病程在３个月内的精神分裂样障碍患者显著高于３～６月者（Ｐ＜０．０５），提示ＣＣＭＤ－２规定病程３个月诊断精神分裂样障碍的效度较高，２１例追踪诊断为精神分裂症的患者，症状标准项目的出现率高，这可能与本组患者处在疾病发展阶段有关，最后对精神分裂样障碍诊断术语作了初步讨论。     

两种精神分裂症诊断标准的比较

两种精神分裂症诊断标准的比较杨火高，黄问一，曾文英四川省自贡市精神卫生中心（６４３０２０）刘勇，杨翔鸽为了检验ＣＣＭＤ－２的临床实用性，我们对９２例首次住院诊断为精神分裂症和精神分裂样障碍患者，用ＤＳＭ－Ⅲ－Ｒ与ＣＣＭＤ－２中精神分裂症的诊断标准进行...     

抗N-甲基-D-天冬氨酸受体脑炎研究的新进展

抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎是一组关于记忆缺失、精神症状、意识水平下降等症状的疾病。女性多见,多伴有卵巢畸胎瘤;亦可发生于儿童或青年男性。目前发现,抗NMDAR脑炎在免疫介导的脑炎中的比例逐步上升。本文就其发病机制、临床表现、辅助检查及鉴别诊断等方面作一综述,并阐述目前国外对NMDAR脑炎的临床与发病机制方面的研究进展。     

Remitting brief psychotic disorder in a 15-year-old male

We present a case of remitting brief psychotic disorder in a 15 year old male, who had 4 phenomenologically alike episodes consisting of the following symptoms; sudden onset, unstructured delusions, hallucinations, clouding of consciousness, and a rapid return to his premorbid level of functioning. No evidence was found indicating a metabolic disease or a neurological disorder. The diagnostic criteria of brief psychotic disorder were fulfilled, although the clinical picture could not be described adequately by using only DSM-IV criteria. Remitting brief psychosis and the validity of different diagnostic systems are discussed.     

烟雾病的临床及影像研究

目的:研究烟雾病(moyamoya disease,MMD)的临床及影像学特征。方法:回顾性分析27例烟雾病,观察其临床及影像学特点。结果:本组病例多为儿童及青壮年起病,女性居多。病程为多发,主要有脑梗死、出血和短暂脑缺血发作等起病形式,临床表现为肢体麻木、无力、头痛、智力减退等症状;DSA在脑底动脉环发现血管闭塞、狭窄及烟雾状毛细血管网形成,MRA对本病有一定阳性发现。结论:对于儿童及青壮年反复发作的脑卒中患者要考虑MMD的可能,目前仍依靠数字减影血管造影确诊,MRA对本病有一定阳性发现。     

Syndromic validity of apathy in Alzheimer's disease

OBJECTIVE: The study examined the usefulness and clinical correlates of specific diagnostic criteria for apathy in Alzheimer's disease. Whereas apathy is a frequent behavioral change in patients with Alzheimer's disease, the lack of standardized diagnostic criteria may explain the wide discrepancies in estimates of the frequency and demographic and clinical correlates of apathy. METHOD: A consecutive series of 319 patients who met the criteria for probable Alzheimer's disease established by the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association, 117 patients who met the DSM-IV criteria for depression without dementia, and 36 healthy individuals were assessed with a structured psychiatric interview. On the basis of modified Marin's criteria for apathy, they were classified into groups with or without apathy. RESULTS: Apathy was diagnosed in 37% of the 319 Alzheimer's disease patients, compared to none of the healthy comparison subjects. In 24% of the Alzheimer's disease sample, apathy coexisted with either dysthymic disorder or major depressive disorder, whereas 13% had apathy without depression. Apathy was diagnosed in 32% of the depressed nondemented patients, mostly in those with major depressive disorder. Apathy in Alzheimer's disease was significantly associated with severe impairments in activities of daily living and cognitive functions, older age, and poor awareness of behavioral and cognitive changes. CONCLUSIONS: This study provides partial validation of specific clinical criteria for apathy in Alzheimer's disease.     

A hypergraphic syndrome of automatic writing, affective disorder, and temporal lobe epilepsy in two patients

Two patients are described who wrote complex textual material suddenly, automatically, and without volitional control. Each met DSM-III criteria for a major affective disorder, had clinical and electrophysiologic temporal lobe epilepsy, absence spells, episodic expressive aphasia, and a history of traumatic loss of consciousness. The episodes of automatic writing met the criteria for ictal events. These patients may have experienced an ictal analogue of interictal hypergraphia. The behavioral neurologic features of this syndrome are discussed in relation to its clinical presentation and known disorders of writing.     

精神科急诊670例紧急抢救患者临床特点分析

目的:了解精神科急诊留院抢救患者的临床情况. 方法:应用自编调查表对2001年1月至2011年2月北京安定医院急诊因急重症就诊留院抢救治疗的670例患者,就性别、年龄、病种、意识状态、抢救天数、转归、有无季节性的特点进行总结,并对急性药物中毒患者过量服用药物的种类、数量及对患者预后的影响进行归纳及分析. 结果:精神科急诊重症抢救患者以急性药物中毒为主,其次为酒精戒断综合征和严重躯体疾病伴发精神障碍;54.03％的患者存在意识问题,25.97％的患者存在昏迷及谵妄;绝大多数患者经抢救可好转离院,但也有12.39％患者因病情加重需要转院甚至死亡;随着新型药物使用的增多,药物中毒及其重症病例的发生减少. 结论:应该重视精神科急诊医生的综合培训,使用新型药物可减少药物过量的发生风险及其不良预后.     

Recurrent cases of corticosteroid-induced mood disorder: clinical characteristics and treatment

BACKGROUND: Corticosteroids often induce steroid psychosis, a collection of heterogeneous syndromes with different pathophysiologic mechanisms. To date, no study has focused specifically on recurrent corticosteroid-induced mood disorders and considered their long-term outcome and treatment strategies. METHOD: Nine patients whose initial clinical presentation met DSM-IV criteria for a substance-induced mood disorder were identified by a review of medical records. Their clinical characteristics and treatments were examined. RESULTS: All 9 corticosteroid-treated patients had a clinical course of bipolar disorder. Seven patients initially developed a manic or hypomanic state with subacute onset ranging from 1 to 3 months. Six patients had manic episodes accompanied by psychotic features. The proportion of manic episodes relative to total mood episodes of the 9 patients was 65.6%, suggesting manic predominance. Seven patients showed mood episodes that had no direct relationship to corticosteroid therapy and were preceded by various psychosocial stressors. Four of 5 patients who received steroid pulse therapy rapidly became manic or hypomanic. Antidepressants as well as mood stabilizers were useful for treatment of the present 9 patients. CONCLUSION: Recurrent cases of corticosteroid-induced mood disorder have interesting clinical features, such as subacute onset, manic predominance, frequent accompanying psychotic features, and similar recurrent episodes in association with psychosocial stressors and corticosteroid use. Management, including psychopharmacologic intervention, should be indicated by a consideration of the underlying illnesses and psychosocial stressors.     

2015年视神经脊髓炎谱系疾病诊断标准临床应用评估

目的 评估2015年视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorder,NMOSD)诊断标准的临床应用.方法 回顾性分析作者医院2008-3-2016-8收治的605例中枢神经系统脱髓鞘疾病患者临床资料,并分别采用2015年NMOSD诊断标准及2006年NMO诊断标准对其进行诊断分析.结果 共有176例患者符合2015年NMOSD诊断标准,其中108例(61.4％)符合2006年NMO诊断标准.AQP4-IgG阳性患者139例(79.0％).当假设该139例患者AQP4-IgG水平未知时,共有91例(65.5％)符合2015年NMOSD诊断标准,而仅有55例(39.6％)满足2006年NMO诊断标准(P＜0.05).176例患者中有39例同时满足2006年NMO诊断标准和201 5年NMOSD诊断标准且以临床孤立病灶起病,在疾病早期通过2006年NMO诊断标准尚不能与多发性硬化相鉴别,但已符合2015年NMOSD诊断标准.在核心症状方面,NMOSD患者中以急性脊髓炎(50.6％)和视神经炎(31.8％)起病者所占比例最高,其次为最后区综合征(5.7％).结论 2015年NMOSD诊断标准较2006诊断标准扩大了疾病的诊断范围,且在AQP4-IgG水平未知的情况下仍具有更高的诊断敏感性,对于疾病早期与多发性硬化的鉴别中具有重要作用,且更加强调了疾病的核心症状.     

Clinical manifestations,diagnostic criteria and therapy of Hashimoto's encephalopathy: Report of two cases

Hashimoto's encephalopathy (HE) is a rare, still not well understood, autoimmune disease with neurological and psychiatric manifestations. and elevated titers of antithyroid antibodies in serum and cerebrospinal fluid (CSF) as a hallmark of the disease. Patients are mostly women. Current diagnostic criteria include corticosteroide responsiveness, but it is the case in only 50% of patients with HE. In steroid non-responders other immunomodulatory therapies or plasmapheresis could be applied. Disease course can be acute, subacute, chronic or relapsing-remitting. Two distinct forms emerged from the reported cases: a vasculitic type characterized by multiple relapsing-remitting stroke-like episodes and mild cognitive impairment and a diffuse progressive type characterized by dementia and psychiatric symptoms. Both forms may be accompanied by depressed level of consciousness (stupor or coma), tremor, seizures, or myoclonus. We present two patients with two distinct forms of HE who had different clinical manifestations and response to therapy.     

Electroencephalographic findings in Kufs disease.

OBJECTIVE: To characterize the electroencephalographic (EEG) findings in patients with Kufs disease, the adult autosomal recessive form of neuronal ceroid-lipofuscinosis. METHODS: We reviewed the EEG findings in 5 patients with biopsy-proven Kufs disease from our institution and 14 case reports of Kufs disease in the literature. The criteria used for patient inclusion were clinical evidence of a progressive neurodegenerative disorder, biopsy-proven evidence of Kufs disease, and EEG recordings during the course of the illness. RESULTS: One patient had phenotype A with generalized atypical spike and slow wave complexes and marked photoparoxysmal responses, particularly at low flash frequencies. Three patients had phenotype B with generalized slowing. One patient in the miscellaneous category showed focal sharp and spike waves and quasi-periodic slow waves maximal over anterior regions of the head. Review of the literature identified 14 case reports that met the inclusion criteria. CONCLUSIONS: The inheritance, mechanism, and manifestations of Kufs disease are not well understood. EEG findings may guide clinicians toward a confirmatory pathological diagnosis and distinguish various phenotypes of this disorder. SIGNIFICANCE: The EEG may assist in the diagnosis of Kufs disease.