认知行为疗法治疗精神分裂症后抑郁的研究

目的探讨认知行为疗法对精神分裂症后抑郁的临床疗效。方法 64例精神分裂症后抑郁患者随机分为两组,即西酞普兰合并认知行为治疗组(研究组,32例)及西酞普兰治疗组(对照组,32例)疗程8周。采用汉密尔顿抑郁量表(HAMD)、阳性和阴性症状量表(PANSS)评定临床疗效。副反应量表(TESS)评定副反应。结果研究组4、6、8周末HAMD评分较对照组显著改善(t=10.15,12.98,14.29;P<0.01);入组前及8周末PANSS总分、各因子评分和TESS评分两组比较无显著性差异(t=0.13,0.36;P>0.05)。结论认知行为治疗能促进精神分裂症后抑郁的康复,提高治疗依从性,更好地适应社会生活。     

认知行为治疗改善精神分裂症患者生活质量的随机单盲对照试验

目的:探讨认知行为治疗对精神分裂症患者生活质量的效果及相关因素,为寻找有效改善精神分裂症患者生活质量的方法提供依据。方法:本研究为单盲随机对照临床试验。选取符合美国精神障碍诊断与统计手册第4版(DSM-IV)中精神分裂症诊断标准的医院门诊和住院患者共120例,随机分配到认知行为治疗组(CBT组,n=60)和支持性心理治疗组(ST组,n=60),在药物治疗基础上分别接受15次认知行为治疗和支持性心理治疗。在基线采用世界卫生组织生存质量量表简表(WHOQOL-BREF)、阳性和阴性症状量表(PANSS)、应付方式问卷(CSQ)、非理性信念量表(IBS)及自编药物副反应问卷对两组患者进行盲法评定。第12周、24周采用WHOQOL-BREF和自编药物副反应问卷对患者进行随访评估。结果:第12周,CBT组患者WHOQOL-BREF总分各因子分均高于基线[(77.0±13.9)vs.(73.1±13.8),(22.4±4.5)vs.(21.5±4.7),(18.9±4.1)vs.(17.8±4.3),(9.3±2.2)vs.(8.9±2.3),(26.4±5.0)vs.(24.7±5.3),均P0.05],而ST组患者仅环境因子有显著改善[(23.9±4.7)vs.(25.0±5.2),P0.05],其余因子差异无统计学意义(P0.05)。第24周,两组在WHOQOL-BREF的社会关系和环境因子分上组间效应显著(F=6.77,7.21,均P0.05),CBT组得分均高于ST组。Logis-tic回归分析发现,基线应对方式分数较低、接受CBT及男性对患者的生活质量有正性预测作用(B=-0.25,2.31,-1.64,均P0.05)。结论:认知行为治疗能够有效改善精神分裂症患者的生活质量,且基线应对方式得分相对更低、能接受认知行为治疗及男性患者更容易从治疗中获得生活质量的改善。     

银杏叶片联合小剂量氯氮平治疗老年慢性精神分裂症的临床研究

目的:观察银杏叶片联合小剂量氯氮平对老年慢性精神分裂症的疗效、心电图QTc间期及认知功能的影响。方法:将收治的114例老年慢性精神分裂症患者随机分为两组,对照组57例给予小剂量氯氮平治疗,治疗组57例给予银杏叶片联合小剂量氯氮平治疗,两组均持续治疗12周。比较两组治疗后临床疗效,记录两组治疗前后阳性与阴性症状量表(PANSS)评分、QTc间期以及认知功能,统计两组治疗期间不良反应发生情况。结果:治疗组治疗后临床治疗总有效率显著高于对照组(χ~2=6.886,P0.05);两组治疗后阳性症状、阴性症状、精神病理和PANSS总分均显著降低(P0.05),且治疗组均显著低于对照组(t=-8.950,-6.151,-4.311,-2.441;P0.05);两组治疗后QTc间期均显著缩短(P0.05),且治疗组QTc间期显著低于对照组(t=-2.017,P0.05);两组治疗后注意力、视觉广度、延迟记忆和即刻记忆评分均显著升高(t=-10.822,-12.774,-10.579,-11.672;-6.856,-5.533,-5.739,-5.245;P0.05),且治疗组均显著高于对照组(t=2.540,2.078,2.824,2.226;P0.05)。治疗组治疗期间嗜睡、头晕、流涎、便秘不良反应发生率均显著低于对照组(t=4.431,4.036,4.912,5.447;P0.05)。结论:银杏叶片联合小剂量氯氮平治疗老年慢性精神分裂症,疗效显著,同时能明显抑制QTc间期延长,改善认知功能。     

认知行为疗法对大学生焦虑行为的缓解作用

目的:研究认知行为疗法(CBT)对大学生焦虑行为的缓解改善作用。方法:选取40名大学生焦虑症患者,随机分为对照组和CBT治疗组。分别于治疗前、治疗后用焦虑自评量表(SAS)和汉密尔顿焦虑量表(HAMA)进行评分,对结果进行汇总统计分析。结果:两组患者治疗前的SAS评分和HAMA评分对比差异无统计学意义,经CBT治疗9周后,CBT治疗组的SAS和HAMA评分均明显低于治疗前(t=13.796,16.193;P0.01),对照组的SAS和HAMA评分均明显低于治疗前(t=8.800,7.187;P0.01)。治疗后9周CBT组的SAS和HAMA评分均显著低于对照组,具有显著性差异(t=-6.327,-6.957;P0.01),两组两项评分在治疗后1周对比无显著性差异,治疗后第三周CBT组的SAS评分和HAMA评分显著低于对照组(t=-5.061,-2.965;P0.01),治疗6周后,CBT组的SAS评分和HAMA评分显著低于对照组(t=-5.067,-5.147;P0.01)。CBT治疗组SAS和HAMA达标率均显著高于对照组(χ~2=5.013,4.927;P0.01)。结论:认知行为疗法能显著改善大学生的焦虑行为,降低焦虑程度。     

药物联合认知行为治疗对精神分裂症患者自我效能感的影响

目的:观察常规药物联合认知行为治疗对精神分裂症患者自我效能感的影响。方法:以2014年2月-2015年8月在我院接受治疗的精神分裂症患者为观察对象,随机分为对照组和观察组各40例。其中对照组给予常规药物治疗,观察组在常规药物治疗的基础上给予认知行为治疗。治疗前后采用阴性症状和阳性症状量表(PANSS)、智力测定工具、成人公认认知测评(MCCB)以及自我效能量表对其治疗效果进行调查。结果:治疗前两组患者的自我效能无明显差别(P0.05),治疗3个月和6个月时,观察组自我效能得分明显高于对照组(t=-3.115,-2.736;P0.01);治疗前两组患者的PANSS总分和各因子得分无明显差别,治疗后3个月和6个月时,观察组的PANSS总分和各因子得分低于对照组(t=8.286,4.745,5.030,10.018;P0.001);治疗前两组患者的瑞文智力测验结果无明显差别,治疗后3个月和6个月时,观察组瑞文智力测验结果高于对照组(t=-3.148,-4.812;P0.001);两组患者治疗前MCCB测验各项得分无明显差别,治疗后3个月和6个月时,观察组MCCB得分明显高于对照组。结论:常规药物联合认知行为治疗对精神分裂症患者有较好的治疗效果,可明显提高患者的自我效能,改善其临床症状。     

集体心理治疗对改善中、青年精神分裂症症状的效果

目的探讨集体心理治疗对缓解中、青年精神分裂症症状的有效性。方法对首次住院的中、青年精神分裂症患者(研究组,n=60),在接受抗精神病药治疗2周后,同时进行为期8周,每周1次,每次1小时的集体心理治疗,分别于研究后4、6、8、10周评定阳性与阴性症状量表(PANSS);另选择单一应用抗精神病药治疗的精神分裂症患者(对照组,n=60)进行对照,并对患者随访2年观察病情复发情况。结果集体心理治疗4周起,两组PANSS分值均低于治疗前(t=2.881~3.012,P0.01),而研究组在集体心理治疗后各时点的PANSS总分均低于对照组(t=2.667~2.890,P0.01)。随访期2年时研究组患者服药依从性显著好于对照组(χ2=13.34,P0.01),复发率显著低于对照组(χ2=2.14,P0.05)。结论在药物治疗的基础上,集体心理治疗能有效帮助精神分裂症患者早日康复、减少病情复发。     

计算机认知矫正治疗对慢性精神分裂症患者社会功能的影响

目的:探索计算机认知矫正治疗对慢性精神分裂症患者社会功能的影响。方法:选取慢性精神分裂症患者100例作为研究对象,随机分为研究组和对照组各50例,对照组给予基础治疗,研究组在基础治疗上进行计算机认知矫正治疗,持续治疗24周。两组均于治疗前、治疗12周、24周及治疗后24周进行阳性和阴性症状评定量表(PANSS)、住院精神病人社会功能评定量表(SSPI)及个人和社会功能量表(PSP)评定。结果:两组患者在性别、年龄、首发年龄、病程、受教育年限、治疗前PANSS、SSPI、PSP总分方面的差异均无统计学意义(P0.05)。组间比较:研究组PANSS总分在治疗12周、24周及治疗后24周时均低于对照组(t=-4.264,-4.331,P0.01;t=-2.149,P0.05);研究组SSPI总分在治疗12周、24周及治疗后24周时高于对照组(t=8.728,24.829,18.298,P0.01);研究组PSP总分在治疗12周、24周及治疗后24周时均高于对照组(t=3.015,P0.01;t=5.952,P0.05;t=2.984,P0.01)。组内比较:研究组PANSS总分在治疗24周时低于治疗12周(t=3.174,P0.01);SSPI总分在治疗24周高于治疗12周(t=-13.749,P0.01);PSP总分在治疗24周高于治疗12周(t=-10.803,P0.01)。结论:计算机认知矫正治疗能够改善慢性精神分裂症患者的精神症状及其社会功能,治疗时间越长,疗效越明显,在停止治疗后仍具有一定的远期疗效。     

利培酮联合阿立哌唑治疗对精神分裂症患者的有效性及对认知功能的影响

目的:探讨利培酮联合阿立哌唑对精神分裂症患者的疗效及对患者认知功能的影响。方法:将126例该院收治的精神分裂症患者分为联合治疗组及对照组。对照组患者接受利培酮治疗,联合治疗组患者在对照组基础上接受阿立哌唑治疗。比较两组患者治疗前及治疗8周后阳性与阴性症状量表(PANSS)总分及各维度得分、韦氏成人智力量表(WAIS-RC)总分及各维度得分、血清泌乳素(PRL)水平;比较两组患者利培酮应用剂量;比较两组患者治疗8周后的疗效及不良反应。结果:治疗8周后,联合治疗组患者PANSS量表总分及各维度得分均低于对照组患者及治疗前(t=-4.928,-3.245,-3.148,-5.835;P0.01));联合治疗组患者WAIS-RC量表总分及各维度得分高于对照组患者及治疗前(t=2.859,3.619,3.313;P0.01));联合治疗组患者血清PRL水平均低于对照组患者(t=-23.458,P0.01);联合治疗组患者利培酮应用剂量低于对照组患者及治疗前(t=-3.154,P0.01);联合治疗组患者总有效率高于对照组患者(χ~2=4.881,P0.05);联合治疗组患者不良反应发生率均低于对照组患者(χ~2=4.203,3.910,4.308,4.148;P0.05)。结论:利培酮联合阿立哌唑对精神分裂症患者的疗效显著,能够迅速改善患者的疾病症状及认知功能,降低患者血清PRL水平,且不良反应较少,联合用药的安全性更高。     

对首发精神分裂症康复期患者实施认知行为干预的效果观察

目的 探讨对首发精神分裂症康复期患者实施认知行为干预(CBT)的效果.方法 将60例首发精神分裂症康复期患者随机分为研究组(n=30)和对照组(n=30),研究组在精神科护理常规的基础上行CBT8周.干预前后分别对两 组患者用症状自评量表(SCL-90)评定心理健康状况.结果 干预后研究组SCL-90评分较干预前明显降低,差异有显著性意义(P＜0.01);治疗后研究组除偏执、精神病性外SCL-90评分低于对照组,差异有显著性意义(P＜0.01).结论 CBT可提高首发精神分裂症康复期患者的心理健康水平,提高治疗依从性.     

阿立哌唑与舒必利治疗以阴性症状为主精神分裂症临床对照观察

目的:探讨阿立哌唑治疗以阴性症状为主精神分裂症的疗效与安全性。方法:将80例以阴性症状为主精神分裂症患者随机分入研究组和对照组,每组40例,分别使用阿立哌唑和舒必利治疗12周,用阳性与阴性综合征量表(PANSS)和副反应量表(TESS)评定临床疗效和安全性。结果:1两组治疗后PANSS评分均较治疗前下降(P0.01或0.05);2同期对照比较,阴性症状和精神病理因子积分在治疗后第4、8、12周末(t=-2.014、-4.359、-6.162,-2.180、-3.042、-6.810;P0.01或0.05)、总分在第8、12周末(t=-3.235、-6.080,P0.01),研究组显著低于对照组;但阳性症状因子积分在第8、12周末,研究组显著高于对照组(t=4.630、6.142,P0.01);3在第12周末,研究组临床疗效优于对照组(Z=-2.112,P=0.035);4不良反应总发生率研究组显著低于对照组(χ2=13.333,P=0.000)。结论:阿立哌唑治疗以阴性症状为主精神分裂症疗效确切,安全性高,优于舒必利。     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.