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。     

等级诊断和多轴诊断体系在人格障碍诊断中的应用

目的 了解等级诊断和多轴诊断体系在人格障碍诊断中的应用.方法 对随机抽样的3075例精神科门诊患者进行人格障碍调查.以人格障碍诊断问卷为筛查工具,采用美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)配套的轴Ⅱ人格障碍临床访谈(SCID-Ⅱ)对筛查阳性者进行面检并作出诊断.同时,根据中国精神障碍分类与诊断标准(CCMD-3)对患者的PD患病情况作出临床诊断.结果 根据DSM-IV多轴诊断体系,3075例门诊患者中982例(31.93%)符合人格障碍诊断标准,以回避型(8.10%)和强迫型(7.58%)人格障碍最为常见,其中44.40%(436/982)合并两种或以上人格障碍.而根据CCMD-3诊断体系明确诊断人格障碍的仅9例(0.3%).结论 精神专科医院门诊患者中人格障碍较为常见,DSM-Ⅳ诊断体系对人格障碍的诊断较国内目前的临床诊断体系敏感.     

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。     

注意缺陷多动障碍患儿的成人早期精神状况随访研究

Objective To investigate the psychiatric status in their young adulthood of children with attention deficit hyperactivity disorder (ADHD).Methods This was a prospedive study.The follow-up study of a cohort of clinic-referred ADHD children was conducted.At baseline, The consecutively referred children (n = 300) with DSM-Ⅳ ADHD, aged 7.5 - 17.0 years were assessed.At the 2.0 - 13.5-year follow-up, 116 ( 38.7% ) of them were reassessed ( aged 18.0 - 23.5 years ) using the structured psychiatric interviews to make DSM-Ⅳ diagnoses by trained clinicians, including the Conners Adult ADHD Diagnostic Interview for DSM-Ⅳ (CAADID), Structured Clinical Interview for DSM-Ⅳ Axis Ⅰ Disorders, Non-Patient Version ( SCID- Ⅰ/NP), and Structured Clinical Interview for DSM-Ⅳ Personality Disorders (SCID-Ⅱ).Results In the former 116 ADHD children, 50.9% (n =59) still met the ADHD criteria, in which 15.5% (n = 18) with pure ADHD, and 35.3% (n =41 ) fulfilled both ADHD and psychiatric/ personality disorders, 14.7% ( n = 17) met the criteria of psychiatric/personality disorders, but not ADHD,34.5% (n = 40) fulfilled none of the psychiatric/personality diagnoses at follow-up.Among 116 former ADHD children, 34.5% (n=40) had at least one DSM-Ⅳ axis Ⅰ disorders, in which 18.1% comorbid mood disorders, 10.3% anxiety disorders, 5.2% abuse disorders; and 32.8% (n=38) had at least one DSM-Ⅳ axis Ⅱ personality disorders, in which 5.2% type A personality disorders, 19.8% type B ( 17.2%anti-social personality disorders), 15.5% type C, and 6.0% others.Conclusion It indicates that ADHD youth be at high risk for a wide range of adverse psychiatric outcomes, and 2/3 of them have diagnoses of adult ADHD and/or psychiatric/personality disorders.     

注意缺陷多动障碍患儿的成人早期精神状况随访研究

Objective To investigate the psychiatric status in their young adulthood of children with attention deficit hyperactivity disorder (ADHD).Methods This was a prospedive study.The follow-up study of a cohort of clinic-referred ADHD children was conducted.At baseline, The consecutively referred children (n = 300) with DSM-Ⅳ ADHD, aged 7.5 - 17.0 years were assessed.At the 2.0 - 13.5-year follow-up, 116 ( 38.7% ) of them were reassessed ( aged 18.0 - 23.5 years ) using the structured psychiatric interviews to make DSM-Ⅳ diagnoses by trained clinicians, including the Conners Adult ADHD Diagnostic Interview for DSM-Ⅳ (CAADID), Structured Clinical Interview for DSM-Ⅳ Axis Ⅰ Disorders, Non-Patient Version ( SCID- Ⅰ/NP), and Structured Clinical Interview for DSM-Ⅳ Personality Disorders (SCID-Ⅱ).Results In the former 116 ADHD children, 50.9% (n =59) still met the ADHD criteria, in which 15.5% (n = 18) with pure ADHD, and 35.3% (n =41 ) fulfilled both ADHD and psychiatric/ personality disorders, 14.7% ( n = 17) met the criteria of psychiatric/personality disorders, but not ADHD,34.5% (n = 40) fulfilled none of the psychiatric/personality diagnoses at follow-up.Among 116 former ADHD children, 34.5% (n=40) had at least one DSM-Ⅳ axis Ⅰ disorders, in which 18.1% comorbid mood disorders, 10.3% anxiety disorders, 5.2% abuse disorders; and 32.8% (n=38) had at least one DSM-Ⅳ axis Ⅱ personality disorders, in which 5.2% type A personality disorders, 19.8% type B ( 17.2%anti-social personality disorders), 15.5% type C, and 6.0% others.Conclusion It indicates that ADHD youth be at high risk for a wide range of adverse psychiatric outcomes, and 2/3 of them have diagnoses of adult ADHD and/or psychiatric/personality disorders.     

成人的注意缺陷与多动障碍

注意缺陷与多动障碍(attention deficit/hyperactivity disorder, ADHD)是儿童和青少期最常见的精神障碍,其主要特征是注意分散、活动过度和行为冲动.过去认为ADHD特发于儿童和青少年期,仅有少数患儿症状持续到成人.但近年来研究却发现,约30%～50%患儿在进入成人后仍持续上述症状[1],并有多项研究证实成人ADHD可视为独立的一种精神障碍[2],美国在1994年出版的<精神障碍诊断和统计手册>第4版(DSM-Ⅳ)中就专为成人ADHD列出了独立的诊断标准.该病常共病多种精神障碍如焦虑、抑郁、双相情感障碍、反社会型人格障碍、物质滥用和依赖等,造成患者生活、工作、社会功能受损及很大的医疗和社会经济负担[3,4],越来越受到人们关注.许多学者就其病因、流行病学、临床表现、诊断及治疗等方面进行了大量研究,本文就有关研究进展作一综述.     

纵向评价DSM-Ⅲ-R人格障碍的结构效度

自DSM-Ⅲ问世以来,尽管对人格障碍做了大量的系统性研究,对问题仍不尽解答。为有助于人格障碍的研究,产生了许多测量工具,包括临床医师进行的检查,如DSM-Ⅲ人格障碍定式检查、人格测验和DSM-Ⅲ-R轴Ⅱ临床定式检查(SCID-Ⅱ),能对DSM-     

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。     

强迫障碍共病强迫型人格障碍的研究

目的:研究强迫型人格障碍(OCPD)在强迫障碍(OCD)中的共病情况,并研究OCD共病OCPD对OCD影响。方法:以69例门诊OCD患者为研究对象,采用DSM-Ⅳ轴Ⅱ障碍用临床定式检查(SCID-Ⅱ)研究强迫障碍患者的共病人格障碍(PD)情况,将研究对象分为2组:OCD共病OCPD组和OCD不共病OCPD组,对比研究2组间临床特征的不同。结果:79.7%强迫障碍患者合并有PD,C类中的OCPD和OCD共病率达43.5%。共病组较不共病组疾病严重程度更重,表现为发病年龄早、病程更长、强迫思维更严重。结论:OCPD和OCD关系密切,OCD共病OCPD是OCD严重程度的一个标志。     

家长培训对注意缺陷多动障碍儿童的干预

目的探讨家长培训对注意缺陷多动障碍(ADHD)儿童的干预效果。方法将30例符合DSM-Ⅳ诊断标准的ADHD患儿作为干预组,进行为期8周的家长培训;30例符合DSM-Ⅳ诊断标准的ADHD患儿作为对照组,不给予任何干预措施。干预前评诂Connem父母症状问卷(PSQ),干预8周后再次评诂Conners父母症状问卷、临床疗效总评和培训满意度调查问卷。结果干预组的PSQ各项因子分干预后比干预前均有下降,品行问题、学习问题、多动指数因子分改变有统计学显著性差异。主观评价家长认为培训方式容易接受、培训内容有帮助。结论家长培训对ADHD儿童干预效果较好,药物治疗结合家长培训可以增加干预效果,家长培训方式容易接受,方法值得推广。     

Quality of life in patients with chronic idiopathic urticaria: the impact of Axis I and Axis II psychiatric disorders

OBJECTIVE: Chronic idiopathic urticaria (CIU) associated with lower quality of life (QoL) levels. Psychiatric disturbances are frequently present in patients with CIU. This study examined the impact of Axis I and Axis II psychiatric disorders on the QoL of patients with CIU. METHOD: The study sample consisted of 100 subjects including CIU patients with only Axis I psychiatric diagnoses (n=25), CIU patients with only Axis II diagnoses (n=25), CIU patients with both Axis I and Axis II diagnoses (n=25), CIU patients without any Axis I and Axis II diagnosis (n=25), and healthy control subjects with respect to urticaria and psychiatric disorders (n=25). The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (SCID-1) and the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders (SCID-II) was used to determine Axis I and Axis II psychiatric disorders, respectively. QoL levels were assessed by means of the World Health Organization QoL Assessment-Brief (WHOWOL-BREF). RESULTS: There were significant differences among the groups with respect to all WHOQOL-BREF subscale scores. The QoL levels were similar among CIU patients with only Axis I psychiatric diagnoses, CIU patients with only Axis II diagnoses and CIU patients with both Axis I and Axis II diagnoses, and between CIU patients without any Axis I and Axis II diagnosis, and healthy control subjects. When compared with those of CIU patients without any Axis I and Axis II diagnosis, CIU patients without concurrent psychiatric diagnoses had significantly lower scores in most domains of the QoL scale. CONCLUSIONS: Axis I and Axis II psychiatric disorders seem to be considerable factors influencing the QoL in CIU patients.     

Axis I and Axis II diagnoses in patients with chronic idiopathic urticaria

OBJECTIVE: This study presents the current prevalence of Axis I and Axis II psychiatric diagnoses and factors associated with the existence of Axis I psychiatric disorders in patients with chronic idiopathic urticaria (CIU). METHOD: The study sample was composed of 89 patients with CIU and 64 control subjects. Axis I and Axis II psychiatric disorders were ascertained by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders, respectively. RESULTS: Of patients with CIU, 44 (49.4%) had at least one Axis I diagnosis, and 40 (44.9%) had at least one personality disorder. The most common Axis I disorder was obsessive-compulsive disorder (25.8%), and the most common Axis II disorder was obsessive-compulsive (30.3%) personality disorder in patients with CIU. Obsessive-compulsive disorder, major depression, obsessive-compulsive and avoidant personality disorders were more prevalent in patient group compared to control group. Obsessive-compulsive and avoidant personality disorders were related to the existence of Axis I disorders in patients with CIU. CONCLUSION: Psychiatric morbidity seems to be a frequent healthy problem in patients with CIU.     

自杀相关研究中识别抑郁症状的不同方法比较

目的在自杀相关研究中对不同方法识别抑郁症状的情况进行比较。方法纳入自杀死亡案例(自杀组)151例和自杀未遂案例(未遂组)120例,每个案例的同吃住家属和其他亲友各1名及自杀未遂者本人接受访谈,均采用抑郁症诊断筛查量表(筛查表)和定式临床精神科检查(structured clinical interview for DSM-ⅣaxisⅠdisorders,SCID-Ⅰ)识别案例对象的抑郁症状,并以认可任一来源阳性信息为原则将每个案例的家属和其他亲友的报告合并成知情人信息。比较两种工具在相同信息来源情况下抑郁症状阳性率,以及各自在不同信息来源的情况下抑郁症状阳性率。结果自杀组中,知情人信息筛查表和SCID-Ⅰ符合"重性抑郁发作"的阳性率为41.1%(62例)和41.7%(63例),Kappa值0.77。未遂组中,本人受访时两工具的"重性抑郁发作"阳性率分别为23.7%(27例)和22.0%(24例),Kappa值0.74;而依据知情人信息,相应的阳性率分别为13.3%(16例)和12.5%(15例),Kappa值0.89。相对于家属和亲友单独提供信息,合并知情人信息后,两工具各症状阳性率以及符合症状学标准的比例均有所提高(均P0.05)。未遂者本人受访时两工具检出"重性抑郁发作"的阳性率均高于知情人信息(均P0.05)。结论相同信息来源下,SCID-Ⅰ对抑郁症状的识别能力不弱于筛查表;增加信息来源可提高识别抑郁症状的阳性率。自杀未遂者本人受访时抑郁症状的阳性率高于其知情人信息。     

Restless legs syndrome as a possible predictor for psychiatric disorders in parents of children with ADHD

Attention-deficit hyperactivity disorder (ADHD) is a common disorder with estimated prevalence of 5% in children and 3.4% in adults. Psychiatric disorders are a frequent concomitant feature. Restless legs syndrome (RLS) may mimic the symptoms of ADHD. The aim of the study is to evaluate whether the presence of RLS predicts occurrence of psychiatric disorders in parents of children with ADHD. Thirty-seven parents of 26 children with ADHD were examined for RLS and for lifetime prevalence rates of psychiatric disorders and personality disorders based on the Structured Clinical Interview for DSM-IV Diagnoses (SCID). Prevalence rates in parents were 29.7% for RLS, 67.6% for Axis I and 40.5% for Axis II disorders. Mothers revealed higher rates for depression, anxiety disorders and ADHD than fathers, whereas personality disorders occurred at higher rates in fathers. The presence of RLS predicted a diagnosis of ADHD (odds ratio (OR) 21.9), agoraphobia (OR = 20.4) and any anxiety disorder (OR = 8.5). Although limited by the small sample size, we found evidence for increased rates of cluster B personality disorders (OR = 59.3) in parents with RLS. All parents of the latter group (100%) reported a positive family history of psychiatric disorders which was not the case in parents without RLS (69.2%) excluding the index children with ADHD. RLS seems to indicate increased vulnerability for psychiatric disorders, i.e., ADHD and anxiety disorders, in a subgroup of parents from ADHD children. Synaptic dysfunction affecting dopaminergic transmission among other transmitter systems may be a common final pathway related to the phenotypic spectrum of ADHD.     

Prevalence of attention deficit–/hyperactivity disorder (ADHD) and comorbid disorders in young male prison inmates*

OBJECTIVE: This study was performed to evaluate the prevalence of ADHD as well as comorbid conditions among young male prison inmates. METHOD: We investigated 129 prison inmates (mean age+/-SE: 19.2+/-2.0 years) and 54 healthy male control subjects (mean age+/-SE: 22.2+/-3.12 years) for the presence of adult ADHD using the Wender Utah Rating Scale (WURS), the Eysenck Impulsivity Questionnaire (EIQ), the diagnostic criteria for ADHD according to DSM-IV and ICD-10-research criteria and the Utah criteria for adult ADHD. In order to determine comorbid personality disorders we applied the International Personality Disorder Examination (IPDE). Externalization (ED) and Internalization Disorders (ID) were evaluated by means of the Achenbach Scales. Alcoholism (ALC) was examined via the Alcohol Use Disorder Test (AUDIT) and substance use disorder (SUD) has been investigated with the Structured Clinical Interview for DSM-IV (SCID). RESULTS: The overall prevalence of ADHD according to DSM-IV was 45%. The prevalence of disturbance of activity and attention (DAA) and hyperkinetic conduct disorder (HCD) via the ICD-10 research criteria was 21.7%. Sole DAA without any comorbid condition could be detected in one case. The most common diagnostic combinations were DAA/HCD and SUD/ALC (89% of all DAA/HCD cases). CONCLUSION: The prevalence of DAA/HCD or ADHD in young adult prison inmates is significantly elevated when compared to nondelinquent controls. Generally the population of young adult male prison inmates exhibits a considerable psychiatric morbidity. Of the total sample, 64% suffered from at least 2 disorders. Only 8.5% had no psychiatric diagnoses. This indicates the urgent need for more psychiatric expertise in young offender facilities.     

DSM-III personality disorder diagnoses in a nonpatient sample. Demographic correlates and comorbidity

Seven hundred ninety-seven first-degree relatives of normal controls and patients with a variety of psychiatric disorders were interviewed with the Diagnostic Interview Schedule and the Structured Interview for DSM-III Personality Disorders. Slightly more than one sixth of the sample received a personality disorder (PD) diagnosis, and of those with a PD, almost one fourth had more than one. The most prevalent diagnoses were mixed, passive-aggressive, antisocial, histrionic, and schizotypal PD. The demographic correlates and frequency of Axis I disorders in individuals with each specific PD were examined, and all but histrionic and passive-aggressive PDs had distinctive profiles.     

Concordance of DSM-IV Axis I and II diagnoses by personal and informant's interview

The validity and reliability of using psychological autopsies to diagnose a psychiatric disorder is a critical issue. Therefore, interrater and test-retest reliability of the Structured Clinical Interview for DSM-IV Axis I and Personality Disorders and the usefulness of these instruments for the psychological autopsy method were investigated. Diagnoses by informant's interview were compared with diagnoses generated by a personal interview of 35 persons. Interrater reliability and test-retest reliability were assessed in 33 and 29 persons, respectively. Chi-square analysis, kappa and intraclass correlation coefficients, and Kendall's tau were used to determine agreement of diagnoses. Kappa coefficients were above 0.84 for substance-related disorders, mood disorders, and anxiety and adjustment disorders, and above 0.65 for Axis II disorders for interrater and test-retest reliability. Agreement by personal and relative's interview generated kappa coefficients above 0.79 for most Axis I and above 0.65 for most personality disorder diagnoses; Kendall's tau for dimensional individual personality disorder scores ranged from 0.22 to 0.72. Despite of a small number of psychiatric disorders in the selected population, the present results provide support for the validity of most diagnoses obtained through the best-estimate method using the Structured Clinical Interview for DSM-IV Axis I and Personality Disorders. This instrument can be recommended as a tool for the psychological autopsy procedure in post-mortem research.     

Psychological distress and psychiatric morbidity in women prisoners.

The population of a women's prison (n = 92) was screened for psychological distress and psychiatric morbidity with the 12-item General Health Questionnaire, the Hamilton Depression Rating Scale, a Recent Stressful Life Events questionnaire and the Structured Clinical Interview for DSM-III-R. High levels of symptoms of psychological distress were recorded. Distress was correlated with recent stressful life events and was more severe in women awaiting trial. Fifty-three per cent of the prisoners were diagnosed as current cases of a psychiatric disorder and the most frequent diagnoses were adjustment disorder with depressed mood and personality disorders. Lifetime prevalence of psychoactive substance use disorders was 54 per cent. Aboriginal women were over-represented in this prison population. A follow-up survey after 4 months showed no fall in the prevalence of psychological distress and psychiatric morbidity.     

Psychiatric comorbidity in young adults with a clinical diagnosis of Asperger syndrome

In children with autism spectrum disorders, previous studies have shown high rates of psychiatric comorbidity. To date, studies on adults have been scarce. The aim of the present study was to investigate psychiatric comorbidity in young adults with Asperger syndrome. Participants were 26 men and 28 women (mean age 27 years) with a clinical diagnosis of Asperger syndrome. Psychiatric comorbidity was assessed by the Structured Clinical Interview for DSM-IV Axis I Disorders. IQ was measured using the Wechsler Adult Intelligence Scale, Third Edition. Autism spectrum diagnoses were confirmed using the DIagnostic Interview for Social and Communication Disorders. In our study group, 70% had experienced at least one episode of major depression, and 50% had suffered from recurrent depressive episodes. Anxiety disorders were seen in about 50%. Psychotic disorders and substance-induced disorders were uncommon. In conclusion, young adults with autism spectrum disorders are at high risk for mood and anxiety disorders. To identify these conditions and offer treatment, elevated vigilance is needed in clinical practice.     

Prevalence of dissociative disorders among women in the general population

This study sought to determine the prevalence of dissociative disorders among women in the general population, as assessed in a representative sample of a city in central Turkey. The Dissociative Disorders Interview Schedule (DDIS), the Borderline Personality Disorder section of the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II), and the PTSD-Module of the Structured Clinical Interview for DSM-III-R (SCID) were administered to 628 women in 500 homes. The mean age of participants was 34.8 (S.D.=11.5, range: 18-65); 18.3% of participants (n=115) had a lifetime diagnosis of a dissociative disorder. Dissociative disorder not otherwise specified (DDNOS) was the most prevalent diagnosis (8.3%); 1.1% of the population was diagnosed as having dissociative identity disorder (DID). Participants with a dissociative disorder had borderline personality disorder, somatization disorder, major depression, PTSD, and history of suicide attempt more frequently than did participants without a dissociative disorder. Childhood sexual abuse, physical neglect, and emotional abuse were significant predictors of a dissociative disorder diagnosis. Only 28.7% of the dissociative participants had received psychiatric treatment previously. Because dissociative disorders are trauma-related, significant part of the adult clinical consequences of childhood trauma remains obscure in the minds of mental health professionals and of the overall community. Revisions in diagnostic criteria of dissociative disorders in the DSM-IV are recommended.