30例海洛因依赖者与30例氯胺酮依赖者的BDI-13量表、社会支持量表、VAS量表的比较与分析

目的:比较海洛因依赖者与氯胺酮依赖者在抑郁程度、社会支持以及药物渴求之间的区别,为制定相应的干预措施提供相应的依据。方法:对珠海市某自愿戒毒中心的64例(海洛因依赖者32例,氯胺酮依赖者32例)戒毒人员,采取自愿的方式,随机抽样,使用BDI-13量表、社会支持量表、VAS量表进行调查并作出比较与分析。结果:共60名调查对象的问卷有效,在医院进行脱毒期间,海洛因依赖者与氯胺酮依赖者在抑郁程度、社会支持、药物渴求方面存在一定的差异。结论:海洛因依赖者的抑郁程度明显高于氯胺酮依赖者,在社会支持方面,氯胺酮依赖者获得的社会支持(主要是家庭支持)比海洛因依赖者较多,海洛因依赖者社会支持较差,具有较强的消极应对倾向,这种消极应对倾向与其心理健康状况密切相关,住院期间,海洛因依赖者对药物的渴求度普遍高于氯胺酮依赖者。     

ATS药物依赖者血液传染性疾病危险因素分析

目的:分析苯丙胺类兴奋剂(ATS)药物依赖者血液传染性疾病危险因素,为该人群病情监测和治疗提供有效依据。方法:收集万源市戒毒所2017年1月15日至2018年9月30日入所的289名ATS类戒毒人员的调查问卷和血清学样本,分析社会学指标的相关因素,所有数据使用SPSS 22. 0统计学软件进行分析。结果:289名ATS药物依赖者中,男性235名(81. 31%),女性54名(18. 69%),平均年龄36. 12±3. 67 a; ATS药物依赖者中感染HIV有14名(4. 84%),感染HCV103名(35. 64%),感染梅毒19名(6. 57%),两种病毒混合感染11名(3. 81%),三种病毒混合感染1名(0. 34%); ATS药物依赖者HIV感染的危险因素为注射吸毒(OR=5. 546)、商业性行为(OR=14. 546)、吸毒年限(OR=5. 019)和吸毒量(OR=14. 558); ATS药物依赖者HCV感染的危险因素为商业性行为(OR=4. 686)、吸毒年限(OR=5. 033)和吸毒量(OR=2. 711); ATS药物依赖者HCV感染的危险因素为初中及以下学历(OR=3. 873)、商业性行为(OR=4. 686)和吸毒量(OR=3. 291)。结论:ATS滥用是导致HIV和性传播疾病感染的重要危险因素。建议在ATS滥用群体加强宣传HIV、HCV及梅毒的基本知识,预防、干预吸毒人群经血和性途径传播感染性疾病。     

海洛因依赖者脱毒后药物渴求的初步调查

目的··:观察国内临床脱毒后未染毒的海洛因依赖者的渴求状况。方法··:采用单项目的自评量表 ,对705例在北京和重庆地区的强制戒毒机构脱毒后的住院者进行药物渴求程度调查。结果··:在调查期间 ,有38.7 %的被调查者有不同程度的药物渴求。临床脱毒后 ,一个月、二个月、三个月及三个月以上 ,渴求分值的变化没有显著性(F=1.345,P=0.259)。渴求强度与吸香烟的数量之间有相关关系 (标准化回归系数为0.225,t=6.128,P<0.001)。结论·· :部分海洛因依赖者临床脱毒后 ,药物渴求持续存在     

丁丙诺啡药物依赖性评价

目的:调查评价阿片滥用人群中丁丙诺啡(buprenorphine,Bup)的药物依赖性及滥用潜力。方法:采用询问调查方法,对戒毒机构收治的阿片依赖者进行Bup使用情况、药物依赖性及滥用潜力的调查。被调查对象为使用Bup 3天以上,无精神障碍的阿片依赖者;调查内容包括药物滥用史,Bup一般使用情况和药物依赖性评价等。Bup的身体依赖性采用30项阿片戒断症状量表(OWS)评价。根据被调查对象先前出现过的Bup戒断症状经历(及严重程度)将各项症状/体征分为0-3分进行评价。对Bup的主观欣快效应采用视觉类比量表(VAS)评价。结果:共对1235例符合条件者进行了调查。被调查者初次使用Bup目的(多选择回答)以“戒毒目的使用”(占77.4％)和“治疗稽延性戒断症状”(占26.6％)为主。30项阿片戒断症状量表(OWS)平均分值介于0.2至1.3之间,除失眠、骨关节疼痛和烦躁不安平均分值分别为1.3、1.2和1.0外,其余症状均为1分以下,表明身体依赖性低。Bup“连续使用”,“间断使用”和“有时连续,有时间断使用”三种不同使用时间方式的OWS均分分别为0.9±0.9,0.4±0.5和0.7±0.4;ANOVA方差检验F值=70.846,P<0.05,差异具有极显著性。VAS测查结果表明,VAS均值为(27±24)mm,属“轻度”至“次中等”欣快程度;对Bup含服、注射两种不同使用途径的群体进     

失眠患者第二类精神药品使用现状及产生依赖的危险因素分析

目的:观察失眠患者第二类精神药品使用现状，并分析其产生药物依赖的危险因素。方法:选取2020年4月—2022年10月于本院就诊的失眠患者，采用本院自拟第二类精神药品使用状况调查表进行调查，获得有效问卷147份(最终纳入147例患者),分析第二类精神药品使用情况；并筛选出产生药物依赖的患者，分析第二类精神药品产生依赖的危险因素。结果:147例失眠患者中，服用第二类精神药品的时长平均为(52.25±8.94)个月；药品使用比例前五名依次为氯硝西泮、艾司唑仑、劳拉西泮、阿普唑仑、佐匹克隆。147例失眠患者中，有22例患者出现药物依赖，占14.97%。依赖组有酒精依赖史、家庭功能障碍、经历重大事件占比高于无依赖组，有统计学差异(P<0.05);两组其他一般资料比较，无统计学差异(P>0.05)。经Logistic回归分析，结果显示，酒精依赖、家庭功能障碍、经历重大事件均为失眠患者对药品产生依赖的危险因素(P<0.05)。结论:失眠患者第二类精神药品使用时间偏长，多以氯硝西泮、艾司唑仑、劳拉西泮等药物为主，且部分患者会产生依赖，酒精依赖、家庭功能障碍、经历重大事件均为产生依赖的...     

西酞普兰治疗重度网络依赖27例疗效分析

目的:探讨新型抗抑郁药对重度网络依赖者的疗效,以寻找恰当有效的药物治疗手段.方法:符合I Goldberg提出的网络成瘾的10条标准作为诊断标准,选择其中的重度网络依赖患者作为研究对象,口服新型抗抑郁药物西酞普兰治疗,6周为1个疗程,采用症状自评量表(SCL-90)、临床总体印象量表(CGI)评定疗效.结果:用药2周后开始,患者SCL-90、CGI与用药前比较差异有显著性,疗效肯定,治疗指数高,安全性高.结论:新型抗抑郁药西酞普兰对伴有严重的焦虑、抑郁、易激惹、冲动等情绪和行为的重度网络依赖患者有肯定疗效,在心理治疗的同时可以作为药物治疗的有效手段,今后有待进行盲法和对照研究.     

苯丙胺类兴奋剂依赖者的风险倾向及其对成瘾行为的影响

目的:探讨苯丙胺类兴奋剂依赖者的风险倾向特征及其对成瘾行为的影响.方法:采用一般风险倾向量表(RPS)、感觉寻求量表(SSS)、冲动性量表(BIS)对42名男性苯丙胺类兴奋剂依赖者和24名健康男性对照进行调查.结果:苯丙胺类兴奋剂依赖者一般风险倾向、感觉寻求及冲动性水平显著高于健康对照(均P＜0.05);Logisti...     

甲基苯丙胺依赖者冲动性特征和执行功能的关系

目的:探讨甲基苯丙胺(methamphetamine,MA)依赖者冲动性特征和执行功能的关系.方法:本研究通过社区招募MA依赖者52名,健康对照组51名,通过Barratt冲动量表(BIS-11)评估冲动性,以计算机化的综合认知测验(CogState量表)测试认知功能,并收集研究对象一般资料及药物滥用史.结果:MA依赖...     

新型毒品依赖患者社会适应评估量表的初步编制

目的:编制适用于新型毒品依赖患者的社会适应量表,并检验其信效度。方法:从个体、家庭、社会三个层面进行量表构念设计。以武汉市强制隔离戒毒机构中的新型毒品依赖患者作为量表施测对象,分别进行量表初测(n=82)和正式施测(n=288)。采用初测样本数据进行条目分析,采用正式施测样本数据进行探索性因子分析、验证性因子分析、相关分析和信度分析。结果:修订形成的新型毒品依赖患者社会适应评估量表共有17个条目,包括"个体心理适应"、"对家庭环境的适应"、"对社会环境的适应"3个因子,累计解释总方差的57.59%。量表的三因子结构模型拟合良好(χ^2/df=1.331,CFI=0.962,NNFI=0.952,SRMR=0.078,RMSEA=0.048)。量表及各因子得分与成功戒毒信心量表得分、心理韧性量表得分之间均呈正相关,相关系数均有统计学意义(P<0.05)。总量表的Cronbach α系数为0.848,重测信度系数为0.841;各因子的Cronbach α系数为0.644~0.856,重测信度系数为0.702~0.784。结论:新型毒品依赖患者社会适应评估量表具有良好的信效度,可用于测量新型毒品依赖患者的社会适应水平。     

药物相关环境线索对戒断不同时间海洛因依赖者冲动性选择的影响

目的:药物依赖者的典型特征是反复发作的强迫性觅药和摄药。戒断后数月乃至数年,虽然躯体症状已经消失,但当再次接触与药物相关的环境时,仍然表现为对行为的选择和控制能力下降,在行为上显得冲动而不考虑后果,最终导致不断地觅药和摄药。药物相关环境线索暴露能引起药物依赖者的渴求增加而导致复吸已经被多数研究者证实,但是药物相关环境线索暴露对戒断不同时间海洛因依赖者冲动性选择的影响尚无相关的研究。本研究从认知行为学的角度研究药物相关的环境线索对戒断不同时间海洛因依赖者冲动性选择的影响。方法:本研究采用冲动性选择的实验室评价方法IGT(IowaGamblingTask)对药物相关的环境线索暴露前后海洛因依赖者的冲动性选择进行评估。选择年龄在20-45a之间,选择戒断时间30d、3m、12m、24m,符合DSM-Ⅳ阿片类药物依赖诊断标准的男性受试者签定知情同意书;然后进行基本人口学资料的采集以及焦虑量表(HAMA)、抑郁自评量表(BDI)、Barratt冲动量表(BIS)等量表的评分,并且同时进行注意力、工作记忆(workingmemory)的测试;在给予海洛因相关环境线索以及自然场景前后进行生命体征(心率、血压)的监测和分化情绪量表评分,以及心理渴求评分以确定所给干预的有效性;在海洛因相关环境线索和自然场景前后分别用IGT对其冲动性选择进行评价。结果:本研究发现,给予有效的海洛因相关环境线索暴露之后,短期戒断和长期戒断的海洛因依赖者的冲动性选择增加,与干预之前有显著性差异。结论:本研究提示药物相关的环境线索暴露强化海洛因依赖者的冲动性选择,为解决药物依赖者强迫用药和复吸问题奠定了基础,但对于药物相关线索暴露后冲动行为增加的神经机制需要进一步的研究。     

西红门地区2011年宫颈癌筛查结果分析

目的 通过对2011年西红门地区两癌筛查结果进行分析,了解本地区宫颈病变情况,为宫颈癌防治提供依据.方法 回顾性分析2011年大兴区西红门镇农村妇女两癌筛查的宫颈液基细胞学检测结果.结果 两癌筛查1607例,筛查率为23.8%,宫颈癌筛查全部使用宫颈液基细胞学检测,细胞学异常者95例(5.9%),对95例细胞学异常者进行病理检测,发现宫颈病变10例(0.6%).结论 西红门地区宫颈癌筛查率较低,宫颈疾病患病率为0.6%,应加大宣传力度,加强宫颈癌的早期筛查对降低宫颈癌的发病率具有重要意义.     

Linking measures of adolescent nicotine dependence to a common latent continuum

Using the theoretical model of nicotine dependence (ND) operationalized within the Diagnostic and Statistical Manual of Mental Disorder, fourth Edition (DSM-IV: American Psychiatric [American Psychiatric Association, 1994. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. American Psychiatric Association, Washington, DC]) as a frame of reference, we used methods based in item response theory to link alternative instruments assessing adolescent nicotine dependence severity to a common latent continuum. A multi-ethnic cohort of 6th-10th graders selected from the Chicago Public Schools (CPS) completed five household interviews over 2 years. Youth who reported at least some cigarette use in the last 30 days prior to the interviews at waves W3-W5 completed measures of DSM-IV ND, the Modified Fagertrom Tolerance Questionnaire (mFTQ: Prokhorov et al., 1998) and the Nicotine Dependence Syndrome Scale (NDSS: Shiffman et al., 2004), yielding samples of 253, 241, and 296 respondents at W3-W5, respectively. Confirmatory factor analysis supported a primary dimension of ND. Each instrument's items had complementary and stable relationships to ND across multiple waves of assessment. By aligning symptoms along a common latent ND continuum, we evaluated the consistency of symptoms from different instruments that target similar content. Further, these methods allowed for the examination of the DSM-IV as a continuous index of ND, evaluation of the degree of heterogeneity in levels of ND within groups above and below diagnostic thresholds, and the utility of using the pattern or particular DSM-IV symptoms that led to each score in further differentiating levels of ND. Finally, we examined concurrent validity of the ND continuum and levels of current of smoking at each wave of assessment.     

Sub-diagnostic psychiatric comorbidity in alcoholics

BACKGROUND: Psychiatric comorbidity in alcohol use disorders is clearly established, however most studies ignore data on psychiatric symptom counts that do not meet criteria for a diagnosis. We examined psychiatric symptom counts and psychological measures in the domains of anxiety, mood and externalizing pathology in 48 long-term abstinent alcoholics (LTAA) compared to 48 age/gender comparable light/non-drinking controls (NC). METHODS: Continuous measures of pathology (i.e., symptoms counts and psychological assessments) in each domain were compared between groups for: (1) all study participants, (2) excluding individuals with a lifetime psychiatric diagnosis in the domain, and (3) excluding individuals with a current psychiatric diagnosis in the domain. RESULTS: Psychiatric symptom counts and psychological pathology were greater in LTAA than NC. The differences between groups on these measures were not reduced by removal of individuals with lifetime or current diagnoses. CONCLUSIONS: The bulk of the difference between LTAA and NC in psychiatric illness was carried by sub-diagnostic psychopathology. In comparison to the limited view provided by using only symptomatology that meets criteria for a diagnosis, the use of continuous measures of psychiatric symptomatology and psychological abnormality yields a much more accurate picture of psychiatric illness co-occurring with alcoholism.     

Situation analysis of obstetric care services in a rural district in Zimbabwe

OBJECTIVE: To conduct a situation analysis of obstetric services in a rural district of Zimbabwe. DESIGN: Observational study. SETTING: 13 primary health care centres in Murewa district in Zimbabwe. MAIN OUTCOME MEASURES: Number of maternity beds, antenatal attendance, deliveries per month, availability of antenatal, intrapartum and neonatal care equipment, intrapartum monitoring and neonatal resuscitation skills. RESULTS: 13 of 15 primary health care clinics providing obstetric care in Murewa district were surveyed in 1995. Median number of maternity beds were nine (Q1 = 0, Q3 = 11) per clinic, median number of first ANC attenders per month was 15 (Q1 = 3, Q3 = 18), median number of deliveries per clinic per month were eight (Q1 = 0, Q3 = 16). While all clinics had laboratory facilities, 6/13 could estimate haemoglobin, 5/13 syphilis serology, none of the clinics sent blood to district hospitals for blood grouping and there were no microscopes at clinics for malaria parasite determination. Only 6/13 clinics used partographs for monitoring labour, 10/13 had suction machines for neonatal resuscitation while only 3/13 had ambu bags, 3/13 had oxygen and 2/13 had heaters. Correct methods for neonatal resuscitation were used in 3/13 clinics. Clean water supply, reliable power supply and the referral system were not optimal. CONCLUSION: Basic equipment for antenatal, intrapartum and neonatal care was inadequate. Essential laboratory facilities for obstetric care were lacking. Skills for intrapartum monitoring and neonatal resuscitation were inadequate. The referral system was poor. There is need for more strategic planning at primary health care level in this district which is known to have high perinatal and neonatal death rates. More emphasis should be placed on strengthening basic laboratory back up service for obstetric care, strengthening infrastructural and referral systems as well as training in areas of lost or no skills.     

精神科223例住院患者用药调查分析

目的:了解北京市顺义区精神病医院精神病住院患者药物使用情况并进行合理性分析。方法:采用1日法对北京市顺义区精神病医院住院精神病患者全部用药记录及病例资料进行调查。结果:新型抗精神病药约占全部抗精神病药的61%,并有逐年增多的趋势;绝大多数为单药治疗,个别难治性病例联合两种抗精神病药;合并躯体疾病的药物以抗高血压药、调节血脂药、抗糖尿病药为主;抗精神病药及合并的躯体疾病用药使用剂量都在推荐的安全剂量之下。结论:精神科住院患者用药基本合理,抗精神病药选择多样化、新型化,并同时更加关注药物的安全性、不良反应及躯体合并症的治疗,提高患者的整体生活质量。     

Augmentation with a second antipsychotic in patients with schizophrenia who partially respond to clozapine: a meta-analysis

OBJECTIVES: To conduct a meta-analysis of randomized placebo-controlled trials (RCTs) of clozapine augmentation with another antipsychotic drug in patient with schizophrenia who partially respond to clozapine and compare the results with the findings of relevant open studies. METHODS: A systematic literature search was conducted to identify eligible RCTs. All baseline, posttreatment, and change scores in these trials were included in the meta-analysis. For change in Brief Psychiatric Rating Scale/Positive and Negative Syndrome Scale total scores, the effect size was calculated, and for the proportion of patients with a reduction in Brief Psychiatric Rating Scale/Positive and Negative Syndrome Scale scores of 20% or more, the relative risk was calculated. RESULTS: There was a total of 166 participants in the 4 eligible RCTs. Pooling effect sizes across these studies revealed clinically important heterogeneity (I = 63.5%). Analyzing by duration accounted for the heterogeneity (I = 0%), whereas analyzing by drug did not (I = 57.5%). The 2 RCTs lasting 10 weeks or more gave an odds ratio of response to treatment of 4.41 (95% confidence interval, 1.38 to 14.07). In 8 open studies identified, the same pattern of response was seen. The main treatment-emergent side effects reported were extrapyramidal side effects and raised serum prolactin. CONCLUSIONS: Augmentation of clozapine with another antipsychotic drug in patients with schizophrenic illness that has partially responded to clozapine is worthy of an individual clinical trial. This trial may need to be longer than the 4 to 6 weeks usually recommended for acute antipsychotic monotherapy.     

2010年我院第二类精神药品临床应用分析

目的:了解并评价北京崇文区精神病防治院第二类精神药品的临床应用情况,为临床合理用药提供参考。方法:收集2010年总计779例患者2 515张处方,对第二类精神药品的用药金额、销量、用药频度、利用指数等指标进行统计分析。结果:用药金额排序前3位分别是奥沙西泮、劳拉西泮和氯硝西泮,用药频度排序前3位的是艾司唑仑、奥沙西泮和氯硝西泮。结论:本文研究结果显示,我院第二类精神药品临床应用基本合理,但种类相对较少,且存在较长的用药周期,有不合理用药趋势,应引起临床高度重视。     

阿立哌唑治疗老年期精神分裂症的疗效观察

目的:比较阿立哌唑和利培酮治疗老年期精神分裂症的疗效和安全性.方法:将60例老年期精神分裂症患者随机分为阿立哌唑组和利培酮组,分别给予阿立哌唑和利培酮治疗8周,采用简明精神病评定量表(BPRS),不良反应量表(TESS)分别评定疗效和不良反应.结果:两组疗效差异无显著性(P＞0.05),但阿立哌唑的不良反应较利培酮少而轻微.结论:阿立哌唑治疗老年期精神分裂症疗效好,起效快,不良反应少.