精神科医生言行艺术的探讨

本文介绍精神科医生一些具体的言行艺术。精神科医生的言行艺术是揭露精神病人人心世界，打开心灵之窗折重要工具之一，产医生必须熟练掌握的技术；加强言行艺术的修养和训练，有利于医生提高自身的心理健康水平和专业素质水平，是做好心理治疗的关键。     

小学老师与精神专科医生对儿童多动症的症状评估比较

目的：本研究使用“过度活跃症状检查量表（SNAP）”，比较广州市芳村小学的老师与广州市精神病医院的精神专科医生对多动症儿童注意缺陷和多动行为表现的评估。了解了小学老师和SNAP量表在我们以后将进行的有关儿童多动症（ADHD）研究中的作用，方法：使用SNAP症状量表，让精神专科医生和在职前以及在职老师（每组各30位）分别对同一录像带上多动症患儿的表现进行症状评估；采用SPSS统计软件对评定结果进行统计。结果：三者整体比较结果显示：广州市精神病医院临床医生，在职前老师和在职老师大部分评定结果一致。差异无显著性，少数症状项目评分不一致，进一步两两比较发现主要在职前老师和医生间存在差异。结论：经验丰富的小学老师对儿童多动症的SNAP量表评定可以作为专科医生诊断和评定治疗疗效的重要参考资料。     

对精神科医生了解程度的中英对比

目的：考察人们对精神科医生的了解程度，比较中国、英国不同文化背景的差异。方法：采用Williams（2001）的问卷进行调查，中国被试97名，英国被试165名。结果：在训练时间方面，正确选择的比率是，中国被试心理专业学生25％、非心理专业学生22％，英国被试普通民众5％、心理专业学生31％；在入院途径方面，英国心理专业学生选择“自己”的比例（55％）显著高于中国被试（34％）（x^2=4.17，P〈0．05）．而中国选择“亲属”的比例（83％）显著高于英国（45％）（x^2=15．26，P〈0．001）；在治疗方面，中英被试都高比率地选择了精神科医院（中国92％的心理专业学生和46％的非心理专业学生；英国95％的心理专业学生和68％的普通民众），中国学生选择“药片”（93％）和“注射”（70％）的比率显著高于英国学乍（分别74％，18％，x^2=-5．98，P〈0．05；x^2=-28．28，P〈0．001），英国对“咨询”的选择（94％）显著高于中国（34％）（x^2=42．67，P〈0．001）。结论：中英被试对精神科医生的了解程度既有共同点也有差异，它同时进一步支持了民众对精神疾病，特别是精神科医生了解程度有限的观点。     

精神科医生职业倦怠及相关因素分析

目的:了解精神科医生职业倦怠的特点,探讨其组织环境相关因素.方法:采用工作倦怠问卷、工作要求和决策自主量表、分配和程序公平量表、跨文化的角色冲突、角色混淆和角色过载量表、工作影响家庭和家庭影响工作量表及社会支持量表对106名精神科医生进行调查.结果:分层回归分析显示,控制了人口学变量之后,工作影响家庭、角色冲突、工作负荷和角色混淆对情感衰竭有显著预测作用;家庭影响工作对人格解体有显著预测作用;同事支持和角色混淆对成就感降低有显著预测作用.结论:精神科医生成就感降低明显,职业倦怠具有特异性的相关因素.     

学习困难和多动儿童父母个性特点的初步探讨

采用明尼苏达个性测查表(MMPI)中国版,对学习困难儿童73名父母、多动症儿童的94名父母及同校学习成绩优秀儿童的78名父母进行了个性调查。结果提示,学习困难和多动症儿童的母亲在疑病、抑郁、癔病分量表得分高于对照组母亲,多动组儿童母亲在社会责任感分量表得分低于对照组,父亲社会内向分、依赖分和焦虑分明显高于对照组。而父亲的支配性评分明显低于对照组,学习困难和多动症儿童的母亲有个性偏离者明显多于对照组,主要为类神经症性个性偏离。     

精神科医生与护理人员心理健康状况调查

目的探讨某精神病院精神科医生与护理人员心理健康状况及人格特点的差异。方法采用匹兹堡睡眠质量指数(PSQI)、症状自评量表(SCL-90)、卡特尔十六种人格因素量表(16PF)对某精神病院184名职工进行施测。结果①精神科医生与护理人员在睡眠总分、SCL-90总分、总均分、躯体化等因子上的得分无差异(t=-0.016,-1.303,-1.290,-1.344;P0.05);②精神科医生在H因素,次级人格因素Ⅱ(内向外向),次级人格因素Ⅲ(安详机警)上的得分高于护理人员,在I因素上的得分低于护理人员(t=3.605,2.356,2.447,-2.656;P0.05)。结论精神科医生与护理人员的心理健康水平相当。在个性特征方面精神科医生更具有敢为性,开朗、外倾,更加果断刚毅。护理人员则更加敏感细腻。     

一位精神科医生的酸甜苦辣

迄今为止,绝大多数精神疾病的病因仍然是不清楚的,不知道病因就找不到"根",根治疗法也就无从谈起。虚假广告还大有市场,从另一个角度说明精神病人就医渠道还不方便。     

159名精神科医生的心理健康状况调查

目的了解精神科医生心理健康状况。方法应用统一编制的一般状况调查表、焦虑自评量表(SAS)、症状自评量表(SCL-90)对某精神病专科医院临床一线工作的医生,共计159人进行问卷调查。结果159名精神科医生的SAS总的标准分为37.54士8.73,SCL-90中至少1个因子平均分大于3分者占15.06%;SCL-90各因子得分除恐怖因子外,其他因子分均高于国内正常人的水平,差异均有显著性(P<0.05);男女医生之间差异无显著性。结论精神科医生普遍存在心理卫生问题,社会应该给予充分关注。     

综合医院精神科门诊中专科和非专科医师抑郁障碍治疗模式的比较

目的:比较综合性医院精神科门诊中专科和非专科医生对抑郁障碍的治疗模式,为提高综合医院精神科室的功能提供参考依据.方法:连续收集来自上海市9所综合性医院精神科门诊的抑郁障碍患者297例(专科医师组180例,非专科医师117例).在入组时和入组后第2周、第4周、第8周、第12周进行汉密顿抑郁量表24项(HAMD24)、汉密顿焦虑量表(HAMA)、自编药物依从性评估量表的评定.依据就诊病例资料,以两组的药物使用情况来评估两组治疗模式的差异.结果:① HAMD减分率显示,在治疗后第8周、第12周两组疗效差异有统计学意义(第8周:显著进步及痊愈率专科组分别为56%、43%,非专科组66%、20%,χ2=29.91, P<0.001;第12周:专科组分别为12%、88%,非专科组38%、54%,χ2=46.46,P<0.01).两组患者在治疗后第2周、第4周、第8周、第12周HAMD总分及相应因子分减分率上的差异均有统计学意义.②两组均以(选择性5-羟色胺再摄取抑制剂)SSRIs类药物治疗为主;治疗过程中非专科医师组中约有12.7%的患者疗程不满12周,而专科医师组仅为2%(χ2=13.67,P<0.01);非专科医师组中有24.5%的减药比例,且用药不合理,而专科医师组则为6%(χ2=19.37,P<0.01).③在12周随访结束时,专科组有62%的患者评价药物无副反应,91%的患者认为疗效好,有78%的患者表示愿意长期服药,非专科组结果则分别为40%、81%、57%(均P<0.05),且患者依从性随着病情的好转而增强.结论:综合性医院精神科门诊中非专科医师对抑郁障碍的治疗用药存在一定问题,对抑郁障碍足疗程的治疗原则掌握不足,其诊治能力不及专科医师,需加强非专科医师进行系统的精神卫生培训.     

儿童多动综合征的病因、诊断与治疗

从20世纪初有人开始描述儿童多动综合征（ADHD）以来，人们对其起因、危害、症状特点、诊断鉴别和治疗措施的研究和探索从未间断过．回顾前人研究的历史，对儿童多动综合征的名称和归属问题，不同年龄阶段的表现特征，如何鉴别诊断及矫治儿童多动综合征进行全面的总结和整理，有助于更好地认识和了解儿童多动综合征，为其治疗更好地服务．     

教师与家长采用DSM-IV评估儿童ADHD的结果比较

注意力缺损多动障碍（ADHD）是儿童期常见的心理障碍之一。本研究探究中国父母和教师在使用DSM—IV评估儿童ADHD时的一致性。 1．1对象从北京、哈尔滨、开封、汕尾、石家庄、萧山六个城市选取17所小学，在每所学校的每个班由班主任依据学生名单随机挑选6名左右本班儿童，排除明显精神障碍和智力落后者，     

ADHD Combined Type and ADHD Predominantly Inattentive Type Are Distinct and Unrelated Disorders

We comprehensively reviewed research assessing differences in attention-deficit hyperactivity disorder (ADHD) subtypes to examine the possibility that ADHD/ combined type (ADHD/Q and ADHD/predominantly inattentive type (ADHD/I) are distinct and unrelated disorders. Differences among subtypes were examined along dimensions identified as being important in documenting the distinctiveness of two disorders. These include essential and associated features, demographics, measures of cognitive and neuropsychological functioning, family history, treatment response, and prognosis. Important differences among subtypes were found in several areas of study, supporting the conclusion that ADHD/C and ADHD/I may best be characterized as distinct disorders. We identify major limitations of the available research and present future directions for research.     

Effects of methylphenidate on saccadic responses in patients with ADHD

This study examined the effects of methylphenidate on different measures of saccade control, using a repeated measurement design, and the experimental and statistical control of practice effects. Twenty-seven boys with ADHD (mean age 12.6 years, range 10-15 years) were randomly assigned to two testing order conditions (first on-, second off-medication versus first off-, second on-medication) and accomplished the pro-saccadic overlap and the anti-saccadic 200-ms gap tasks (200 trials each). Methylphenidate was found to reduce pro- and anti-saccadic reaction times, error correction times, and the proportion of direction errors during the anti-saccade task. Furthermore, the drug augmented the proportions of express saccades and error corrections. Overlain practice effects were found for most of these measures. Our results suggest a weakening of the fixation, and a strengthening of the "voluntary" system of saccade control by methylphenidate.     

Attentional processing in adults with ADHD as reflected by event-related potentials

Attention deficit/hyperactivity disorder (ADHD) is a well known childhood disease and well researched via event-related potentials (ERPs), but unfortunately there is little information on this illness in adults in ERPs. In the present study, 12 adults diagnosed with ADHD and 12 healthy control adults were examined with respect to ERPs in a visual Go/NoGo-experiment to gain information about target evaluation processing in these patients. Two attention-related ERP-components, the N1 and N2 were significantly increased for the ADHD adults compared to the healthy control adults. These findings were illustrated using source analysis results: In the time frame corresponding to the N1, significant increases of activity were found in the medial frontal gyrus and during the N2 time frame significant increases were detected in the lingual gyrus. The P300 showed a tendency towards decreased activity in the patient group, however, only a subsequent slow wave activity indicated significant differences. Neuronal activity related to early attentional mechanisms (N1 and N2) appears to be enhanced in ADHD patients. Together with the finding of a reduction in the P300, the data suggest that ADHD adults have learned to gather their attention more strongly than healthy adults in order to achieve the same results and compensate for their impairment. This is supported by the source analysis results which show activity in additional brain areas.     

IVA-CPT与脑电神经电生理检测对ADHD诊断的比较

目的：通过整合视听连续执行测试(IVA-CPT)和脑电神经电生理检测，探讨两种辅助诊断方法在ADHD诊断中的差异，为临床上选择ADHD辅助诊断方法提供参考。方法：对113名儿童进行整合视听连续执行测试和脑电神经电生理检测，以为参照标准，计算出各自的灵敏度、特异度、误诊率、漏诊率。结果：IVA-CPT诊断ADHD的灵敏度为92．54％，特异度为76．09％，误诊率为23．91％，漏诊率为7．46％。脑电神经电生理检测诊断ADHD的灵敏度为83．58％，特异度为82．61％，误诊率为17．39％，漏诊率为16．42％。结论：相对而言，IVA-CPT的灵敏度和误诊率较高，特异度和漏诊率较低，脑电神经电生理检测的特异度和漏诊率较高，灵敏度和误诊率较低。     

Risky driving in adolescents and young adults with childhood ADHD

OBJECTIVE: To examine risky driving behaviors and negative driving outcomes in a large sample of adolescents and adults diagnosed in childhood with Attention Deficit Hyperactivity Disorder (ADHD) compared with demographically similar controls without ADHD. METHODS: 355 adolescents and young adults of the Pittsburgh ADHD Longitudinal Study (PALS) (n = 203 probands; n = 152 controls) were administered the Young Adult Driving Questionnaire. Parent and self-report of current ADHD symptoms and conduct problems were tested as potential mediators of the association between childhood ADHD and negative driving outcomes. RESULTS: ADHD group differences, of small to medium effect size, were found for number of tickets and accidents, and hyperactivity-impulsivity at follow-up emerged as a significant mediator of this association. Current conduct problems were associated with both risky and alcohol-impaired driving. CONCLUSIONS: Childhood ADHD elevates risk for driving-related problems, especially when symptoms persist. Co-occurring conduct problems capture some of this risk.     

ADHD in Dutch adults: Heritability and linkage study

Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental phenotype that persists into adulthood. This study investigated the heritability of inattentive and hyperactive symptoms and of total ADHD symptomatology load (ADHD index) in adults and performed linkage scans for these dimensions. Data on sibling pairs and their family members from the Netherlands Twin Register with genotype and phenotype data for inattention, hyperactivity and ADHD index (～750 sib‐pairs) were analyzed. Phenotypes were assessed with the short self‐report form of the Conners' Adult ADHD Rating Scales (CAARS). Heritabilities were estimated in SOLAR under polygenic models. Genome‐wide linkage scans were performed using variance components (VC) in MERLIN and MINX and model‐based linkage analysis was carried out in MENDEL with empirical evaluation of the results via simulations. Heritability estimates for inattention, hyperactivity and ADHD index were 35%, 23%, and 31%, respectively. Chromosomes 18q21.31–18q21.32 (VC LOD = 4.58, p_emp = 0.0026) and 2p25.1 (LOD = 3.58, p_emp = 0.0372) provided significant evidence for linkage for inattention and the ADHD index, respectively. The QTL on chromosome 2p25.1 also showed suggestive linkage for hyperactivity. Two additional suggestive QTLs for hyperactivity and the ADHD index shared the same location on chromosome 3p24.3–3p24.1. Finally, a suggestive QTL on 8p23.3–8p23.2 for hyperactivity was also found. Heritability of inattention, hyperactivity and total ADHD symptoms is lower in adults than in children. Chromosomes 18q and 2p are likely to harbor genes that influence several aspects of adult ADHD. © 2011 Wiley‐Liss, Inc.     

婴儿和学前幼儿诊断性评估中文版注意缺陷多动障碍模块的效度和信度

目的:引进婴儿和学前幼儿诊断性评估(DIPA),评价其中注意缺陷多动障碍(ADHD)诊断模块的效度和信度。方法:经原作者同意后,将DIPA翻译为中文版。根据以注意力不集中或多动为主诉的244例疑似ADHD学龄前儿童及医院周边社区幼儿园招募的90例正常学龄前儿童,以精神科临床医生根据精神障碍诊断与统计手册的ADHD诊断标准进行的临床诊断为金标准,评价DIPA诊断学龄前ADHD的效度。4名评定者分别独立对被试进行DIPA诊断,考察评定者间一致性。其中39例被试在DIPA访谈后14d,再次接受DIPA访谈,考察重测信度。结果:以临床诊断为金标准,对DIPA进行效度检验显示,诊断一致性的kappa值为0.81,诊断学龄前注意缺陷多动障碍的灵敏度为89%,特异度为96%。DI-PA的评定者间一致性kappa值为0.79,重测信度为0.89。结论:婴儿和学前幼儿诊断性评估中文版的ADHD诊断模块具有较高的效度和信度,可用于临床学龄前ADHD的诊断。     

注意缺陷多动障碍儿童智力水平分析

注意缺陷多动障碍 (ａｔｔｅｎｔｉｏｎＤｅｆｉｃｉｔＨｙｐｅｒａｃｔｉｖｉｔｙＤｉｓｏｒｄｅｒＡＤＨＤ)在儿童群体中相当多见 ,国外文献报导发病率在 3%～ 5% [1] ,国内有报导为 2 .59%～10 .0 8% [2 ,3] 。患儿常伴有不同程度的人格缺陷、社会适应能力下降和学习困难。在儿科心理门诊就医的患儿多以学习困难为第一主诉并成为家庭关注的中心问题 ,这种学习困难是否与智力水平有关已成为国内外心理卫生工作者研究的热点。本研究拟通过测试ＡＤＨＤ患儿与正常儿童的智力水平 ,来探讨ＡＤＨＤ患儿的智力特点 ,为临床治疗干预提供依据。1…