氟哌啶醇合并托吡酯治疗难治性Tourette综合症

目的 探讨氟哌啶醇合并托吡酯治疗难治性Tourette综合征(TS)的临床疗效和安全性。方法 将65例难治性TS患儿按病例编号分为试验组(33例)和对照组(32例)。试验组给予氟哌啶醇合并托吡酯治疗,对照组采取常规治疗[单一或联合使用氟哌啶醇(6-14mg／d)、泰必利(300-600mg／d)、安定类药物],共治疗8周。采用YGTSS、国际TS临床信息调查表、儿童行为量表(CBCL)及副反应量表(TESS),于治疗后第1、4、8周末对两组进行评估。结果 治疗第8周末,试验组的有效率为96％,高于对照组68％(P<0.01);试验组YGTSS总分低于对照组(P<0.01),减分率高于对照组(P<0.01);试验组的CBCL评分低于对照组(P<0.01);从第4周末开始试验组TESS评分低于对照组(P<0.05),并持续至第8周末(P<0.01)。结论 氟哌啶醇合并托吡酯治疗难治性TS,疗效肯定,副反应相对较轻。     

抽动障碍儿童心理行为调查分析

目的对抽动障碍（TD）儿童与正常儿童行为问题进行比较。方法采用儿童行为量表（CBCL）对126例TD儿童和81例正常儿童进行病例对照研究。结果TD组儿童行为问题异常率（23．02％）明显高于正常儿童组（3．7％）,P〈0．05;TTD组与CTD组、TS组、TD伴ADHD组之间异常率有显著性差异（P〈0．05）。结论TD组儿童行为问题异常率高于正常对照组儿童。     

6～11岁肥胖儿童行为问题调查

目的：调查6～11岁肥胖儿章行为问题。方法：采用Achenbach’s儿童行为量表（CBCL），对安徽省安庆市与铜陵市111名调查对象进行问卷调查。结果：肥胖儿童行为问题发生率为36．94％，男、女分别为40．38％和33．90％，性别间差异无统计学意义（P〉0．05）。4～16岁正常儿童青少年行为问题总发生率为12．97％（男童13．44％、女童12．52％），肥胖儿童整体及按性别比较，行为问题发生率均较高（u分别为7．52、5．70和4．96，P均〈0．01）。男童行为问题各因子发生率由高到低依次为：强迫行为34．62％、分裂焦虑23．08％、抑郁19．23％、体诉15．39％、交往不良13．46％、社交退缩9．62％、多动9．62％、攻击性9．62％和违纪表现5．77％，各因子发生率差异有统计学意义（X^2=25．25，P〈0．05）；女童行为问题各因子发生率依次为：分裂强迫23．73％、抑郁11．86％、多动10．17％、性问题10．17％、体诉848％、攻击性8．48％、社交退缩6．78％、残忍表现6．78％和违纪表现5．09％，差别有统计学意义（X^2=15．59，P〈0．05）。男、女童共有的6个行为问题因子：社交退缩、多动、体诉、违纪表现、攻击性、抑郁，无性别差异（P均〉0．05）。结论：肥胖儿童行为问题发生率远远高于全国4～16岁儿童青少年，肥胖男童主要表现在强迫行为、分裂焦虑、抑郁、体诉、交件不良，女童主要表现在分裂强迫、抑郁、多动、性问题。     

桂林市儿童注意缺陷多动障碍的流行病学调查及相关因素分析

目的：了解桂林市5～12岁儿童注意缺陷多动障碍的发病情况及其有关因素。方法：使用Conner多动症评分量表、DSM-Ⅳ诊断标准量表、调查组自编的ADHD发病相关因素和儿童行为表现问卷调查表，对9162名学龄儿童进行教师、家长问卷调查。结果：总患病率为4．25％，男童为5．86％，女童为2．69％，8岁、9岁组患病率最高。其中Ⅰ型(注意缺陷型)42．42％，Ⅱ型(多动，冲动型)23．65％，Ⅲ型(注意缺陷伴多动冲动型)33．13％。有父母性格不良和父母文化程度低的儿童患病率最高，为76．09％和49．36％，有分娩过程异常史的儿童为46．53％。结论：桂林市5—12岁儿童注意缺陷多动障碍患病率较低，与发病有关的因素复杂多样。     

共患其他精神障碍的Tourette’s综合征患儿的父母养育方式

目的:初步探讨Tourette’s综合征(TS)患儿有无共患其他精神障碍与其父母养育方式特点的关系,为探索父母养育方式在TS发病机制和治疗中的意义提供线索。方法:采用个体匹配对照研究设计,以87例7～17岁共患其他精神障碍(注意缺陷多动障碍24例,强迫障碍33例,抑郁状态21例,分离和转换障碍9例)的TS患儿(TS共病组)、87例无共患其他精神障碍TS患儿(TS无共病组)以及87例正常少年对照(健康对照组)为研究对象。采用美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)标准做出相应诊断。全部被试均完成一般情况调查表及父母养育方式问卷中文版(EMBU)的评估。结果:TS共病组、TS无共病组的EM-BU父亲惩罚严厉、拒绝否认、过度保护因子分均高于健康对照组,且TS共病组父亲惩罚严厉因子分高于TS无共病组;TS共病组的母亲的惩罚严厉、拒绝否认、过度保护因子分高于TS无共病组、健康对照组(均P<0.01)。回归分析结果显示父母惩罚严厉、过分干涉、拒绝否认、过度保护因子分与"是TS共病患儿"呈正相关(β=1.8～5.3,均P≤0.01)。结论:TS患儿的父母养育方式主要表现为父母对子女拒绝接纳、否定及过度保护,父母养育方式中的惩罚严厉、拒绝否认、过度保护可能与Tourette’s综合征共患其他精神障碍及发病存在更为密切的联系,值得今后研究重点关注。     

儿童抑郁障碍自评量表的中国城市常模

目的 :建立儿童抑郁障碍自评量表 (DSRSC)的中国城市常模并检验其信度和效度。方法 :在全国 14个城市采样 1943例 (男 968名 ,女 975名 ) ,年龄 8～ 16岁 (平均 11 46± 2 2 4岁 ) ,由学生填写DSR SC。结果 :间隔半个月量表总分的重测相关r =0 65 ,间隔 3个月时重测相关r =0 5 3 (P <0 0 1) ;半分信度为 0 72、Crobacha系数 0 73、项目与总分的一致性在 0 2～ 0 60之间。量表的效度较好 ,与AchenbachCBCL、儿童自我意识量表的相应分量表相关 ,抑郁组儿童得分高于常模组 ,对抑郁障碍诊断的灵敏度为 86% ,特异度为 82 %。结论 :儿童抑郁障碍自评量表可用于我国儿童抑郁症状的评估。     

注意缺陷多动障碍儿童行为问题的对照研究

目的：比较注意缺陷多动障碍（Attention Deficit Hyperactivity Disorder，ADHD）临床亚型和正常儿童的行为问题。方法：将符合DSM—Ⅳ ADHD诊断标准的男童70例分为注意障碍为主型（PI）44例，以多动／冲动为主型（HI）6例、混合型（CT）20例，采用儿童行为量表（Child Behavior Checklist，CBCL）比较各亚型和正常儿童的行为问题。结果：ADHD组行为问题发生率（48．57％）明显高于对照组（12．70％），P〈0．01；ADHD各亚型行为问题发生率存在统计学差异（P〈0．01）。混合型最高；ADHD亚型与对照组CBCL因子分的4组间比较显示分裂性、强迫性、体诉、多动、攻击性、违纪因子及CBCL总分存在统计学差异；分裂性因子PI〉HI，攻击性因子CT，HI〉PI，违纪因子HI〉PI，CT。结论：ADHD男童行为问题发生率高于正常儿童，其中混合型行为问题发生率最高；ADHD临床亚型行为问题特点不同。     

低出生体重儿童的气质特征和行为问题

目的：探讨低出生体重对2～3岁儿童气质特征和行为发育的影响。方法：采用1～3岁婴幼儿气质问卷(TTQ)、2～3岁Aehenbaeh儿童行为量表(CBCL)和自编的家庭一般环境问卷，对50名2～3岁低出生体重(LBW)儿童和380名正常出生体重（NBW)儿童进行气质和行为问题的调查。结果：①在九个气质维度中，只有活动水平，LBW组儿童低于NBW组，差异有统计学显著性(t=-2．192，P=0．029)，而两组儿童气质类型的分布无统计学显著差异，均以中间型和易养型为主。②LBW组社交退缩的发生率高于NBW儿童差异有显著性(x^2=5．427，P=0．02)，而NBW儿童的睡眠障碍高于LBW组，差异有统计学显著性(t=2．20,P=0．031)。结论：2～3岁LBW儿童的活动水平低，社交退缩的发生率高，需通过养育方式适当干预。     

弱视少年心理行为问题的临床研究

目的：探讨弱视患儿的心理行为问题，方法：采用Achenbach儿童行为量表（CBCL），抑郁自评量表（SDS）和焦虑自评量表（SAS），对78例弱视患儿和82例正常对照组患儿进行评定分析。结果：与正常对照组相比，弱视患者CBCL家长用表和学生用表的异常率以及SDS，SAS评分明显增高，差异显著（P＜0．01），结论：弱视患得存在明显的心理行为问题。     

家庭环境与学习障碍儿童行为、自我意识、个性的相关性

目的 :探讨学习障碍 (learningdisorders ,LD)儿童的家庭环境特点及其与儿童行为、自我意识、个性特征的相关性。方法 :选用家庭环境量表中文版 (FES -CV)、Rutter儿童行为问卷 (父母问卷 )、艾森克个性问卷 (EPQ -儿童版 )和Piers -Harris儿童自我意识量表分别对 110名LD和 110名学习优秀 (对照 )组儿童进行评定。结果 :资料齐全的LD组儿童 91名 ,对照组 98名。LD组儿童的家庭在FES量表的亲密度、情感表达、成功性、知识性的评分低于对照组 (P <0 0 5 ) ,而矛盾性则高于对照组 (P <0 0 1) ;LD组儿童的行为和自我意识总分显著低于对照组 (均P <0 0 0 1) ,在EPQ的精神质和神经质得分高于对照组(P <0 0 5 ) ,内外向得分低于对照组 (P <0 0 0 1)。FES的某些环境因素分别与LD和对照组儿童的行为、自我意识、个性特点有关。结论 :LD儿童处在相对不良的家庭环境中 ,家庭环境因素对LD组和对照组儿童行为、自我意识、个性的影响不同。     

Tourette's and comorbid syndromes: obsessive compulsive and attention deficit hyperactivity disorder. A common etiology?

Tourette's syndrome (TS), a neuropsychiatric movement disorder that manifests itself in childhood, is often associated with comorbid symptomatology, such as obsessions, compulsions, hyperactivity, distractibility, and impulsivity. Epidemiological studies suggest that a substantial number of TS patients develop clinical levels of obsessive-compulsive disorder (OCD) and/or attention deficit hyperactivity disorder (ADHD). This review aims to provide an integrated account of the three disorders in terms of their comorbidity. Neuroimaging studies suggest that all three disorders involve neuropathology of the basal-ganglia thalamocortical (BGTC) pathways: TS in the sensorimotor and limbic BGTC circuits; OCD in the prefrontal and limbic BGTC pathways; and ADHD in the sensorimotor, orbitofrontal, and limbic BGTC circuits. The pattern of comorbidity and other evidence indicates that the TS gene(s) may be responsible for a spectrum of disorders, including OCD and ADHD, but also that the disorders OCD and ADHD can exist in their own right with their own etiologies.     

Personality disorders in bipolar and depressive disorders.

The association of mood disorders with personality disorders (PDs) is relevant from a clinical, therapeutic and prognostic point of view. To examine this issue, we compared the prevalence of DSM-III-R personality disorders assessed with SCID-II in patients with depressive (n = 117) and bipolar (n = 71) disorders both recovered from a major depressive index episode that needed hospital admission. PDs prevalence and comorbidity with axis I were calculated. Avoidant PD (31.6%) (O.R. = 1.7, C.I. = 1.06-2.9. P < 0.01), borderline PD (30.8%) and obsessive-compulsive PD (30.8%) were the most prevalent axis II diagnoses among patients with depressive disorder. In bipolar disorder group, patients showed more frequently obsessive-compulsive PD (32.4%), followed by borderline PD (29.6%) and avoidant PD (19.7%). Avoidant PD showed a trend toward being significantly more prevalent among depressives (P < 0.07). A different pattern of PDs emerges between depressive and bipolar patients.     

Psychiatric comorbidity in primary care somatization disorder

Lifetime prevalence rates were calculated for comorbid psychiatric disorders in 119 patients who were referred from primary care physicians for unexplained somatic complaints and who met DSM III-R criteria for somatization disorder. Comparisons were made with general population norms from the ECA study. Prevalence of nine comorbid conditions was significantly higher than in the general populations. The most prevalent comorbid diagnoses were major depression (54.6%), generalized anxiety disorder (33.6%), and phobic disorders (31.1%). The least common comorbid disorders were mania (4.2%) and drug abuse (4.9%); drug abuse prevalence rates did not significantly exceed general population estimates. Risk ratios were highest for panic disorder (16.25), major depression (9.41), schizophrenia (7.77), and obsessive-compulsive disorder (7.04).     

Polygenic inheritance of Tourette syndrome,stuttering, attention deficit hyperactivity,conduct, and oppositional defiant disorder: The additive and subtractive effect of the three dopaminergic genes—DRD2, DβH,and DAT1

Polymorphisms of three different dopaminergic genes, dopamine D₂ receptor (DRD2), dopamine β-hydroxylase (DβH), and dopamine transporter (DAT1), were examined in Tourette syndrome (TS) probands, their relatives, and controls. Each gene individually showed a significant correlation with various behavioral variables in these subjects. The additive and subtractive effects of the three genes were examined by genotyping all three genes in the same set of subjects. For 9 of 20 TS associated comorbid behaviors there was a significant linear association between the degree of loading for markers of three genes and the mean behavior scores. The behavior variables showing the significant associations were, in order, attention deficit hyperactivity disorder (ADHD), stuttering, oppositional defiant, tics, conduct, obsessive-compulsive, mania, alcohol abuse, and general anxiety-behaviors that constitute the most overt clinical aspects of TS. For 16 of the 20 behavior scores there was a linear progressive decrease in the mean score with progressively lesser loading for the three gene markers. These results suggest that TS, ADHD, stuttering, oppositional defiant and conduct disorder, and other behaviors associated with TS, are polygenic, due in part to these three dopaminergic genes, and that the genetics of other polygenic psychiatric disorders may be deciphered using this technique. © 1996 Wiley-Liss, Inc.     

Anxiety disorders comorbidity in bipolar I, bipolar II and unipolar major depression: results from a population-based study in Hungary

BACKGROUND: The aim of this study was to analyze the lifetime comorbidity between DSM-III-R anxiety disorders in separate subgroups of patients with major depression, bipolar II and bipolar I disorder in a community sample of a Hungarian population. METHODS: Randomly selected subjects (aged between 18 and 64 years, N=2953) were interviewed by the Diagnostic Interview Schedule (DIS) which generated DSM-III-R diagnoses. RESULTS: The prevalence of generalized anxiety disorder, agoraphobia and simple phobia was the highest among bipolar II patients (20.8, 37.5 and 16.7%, respectively), social phobia was most prevalent in (nonbipolar) major depression (17.6%), while the rate of panic disorder was the same in the (nonbipolar) major depressive and bipolar II subgroups (12.4 and 12.5%, respectively). Bipolar I patients showed a relatively low rate of comorbidity. CONCLUSIONS: The findings support previous results on the particularly high rate of lifetime comorbidity between anxiety disorders and unipolar major depression and particularly bipolar II illness. LIMITATIONS: Underestimation of the prevalence of bipolar II disorder by the diagnostic methodology used, resulting in a small number of bipolar II cases, lack of analysis of data by gender, no data on obsessive-compulsive disorder.     

A family study of Tourette syndrome in Japan.

Although the mode of inheritance remains in doubt, twin and family studies conducted mostly in the United States and western Europe suggest that genetic factors play an important role in the transmission and expression of Tourette syndrome (TS). In an effort to evaluate population-based genetic differences, we generated risk estimates for first-degree relatives of TS probands in Japan using methods similar to those utilized in recent Western studies. The subjects were 52 TS probands seen at an outpatient clinic of Tokyo University Hospital and their 165 first-degree relatives. All probands and one or more first-degree relatives in each family were interviewed concerning the presence of tic and obsessive-compulsive symptoms by expert clinicians. The age-corrected rates of TS, chronic motor tics, obsessive-compulsive disorder, and subclinical obsessive-compulsive symptoms in the first-degree relatives were 2.0%, 12.0%, 1.6%, and 7.0%, respectively. Rates of TS and related disorders in Japan appear to be much lower than those in recent Western family studies. If replicated, these data suggest that there may be differences in the nature and frequency of vulnerable alleles for TS and related disorders in the Japanese compared to European populations.     

强迫症与人格障碍的共病研究

目的：评估强迫症患者中人格障碍的发生率，探讨强迫症患者与人格障碍的共病情况。方法：使用SCID—Ⅱ对47例强迫症患者和47例正常对照进行人格障碍的评估。结果：61．7％的强迫症患者至少符合一种人格障碍的诊断标准，显著高于对照组，且34％同时患有两种以上的人格障碍；强迫症患者中员常见的人格障碍为强迫型、回避型、消极型以及偏执型；患者的性别及是否有精神疾病家族史对人格障碍的共病率无显著影响。结论：强迫症与人格障碍常有共病现象，强迫型人格障碍同强迫症具有特殊关系，今后在强迫症的生物学研究中应考虑人格特质与人格障碍的影响。     

妇科门诊患者的精神障碍患病率调查

目的：调查综合医院妇科门诊精神障碍的患病率情况。方法：在一所综合医院的妇科门诊连续收集1626名就诊者，应用《问题导向的患者报告》进行筛查。按筛查阳性阴性各半收集其中198名就诊者，由两名精神科医师采用《简明国际神经精神检查》进行精神状况检查，并根据标准DSM-IV做出精神科诊断。结果：妇科门诊就诊患者精神障碍患病率为38％，符合两种精神障碍者为6％。各精神疾病障碍中的患病率较高的为：广泛性焦虑障碍7．38％，抑郁障碍8．76％，躯体化障碍8．40％，心境恶劣7．64％。依据DSM-IV附录条目发现的经前情绪障碍为2．85％，自杀问题（包括自杀意念或自杀未遂）5．71％。结论：妇科门诊患者的精神障碍患病率高，并且以抑郁、焦虑、躯体化等障碍和自杀问题多见。