金刚烷胺治疗奥氮平所致精神分裂症患者体质量增加的Meta分析

目的探讨金刚烷胺治疗奥氮平所致精神分裂症患者体质量增加的效果。方法计算机检索英文数据库(PubMed、PsycINFO、EMbase和Cochrane Library)和中文数据库(中国期刊全文数据库、万方数据库和中国生物医学文献数据库),纳入关于金刚烷胺治疗奥氮平所致精神分裂症患者体质量增加的随机对照研究(RCT),检索时限均从建库至2015年12月,手工检索相关的已发表文献。由两位研究者独立进行文献筛选、资料提取和方法学质量评价后,采用RevMan 5.3软件进行Meta分析。结果最终纳入3篇RCTs,共207例患者(干预组103例,对照组104例),观察时间8~16周。3篇RCTs均为双盲设计。Meta分析结果显示,干预结束时,干预组体质量减轻值优于对照组(WMD=-2.22,95%CI:-3.58~-0.86,P=0.001),干预组体质量下降7%的例数多于对照组(RR=2.74,95%CI:1.09~6.86,P=0.03);差异均有统计学意义。结论金刚烷胺在一定程度上能有效减轻奥氮平所致精神分裂症患者的体质量增加。受样本量及方法学质量的影响,可能会降低本研究结论的可靠性,需要更多高质量的RCTs来验证上述结论。     

精神病患者Schneider一级症状的10年随访研究

为进一步比较一级症状在精神分裂症中的示病性,我们对具有一级症状的精神科病例作了10年临床随访研究。对象和方法　收集1984年1月至1986年12月连续入本院精神科的病例,共507例。入院时用精神症状现状检查第9版(ＰＳＥ9)作定式检查。其中研究组[具有≥1个一级症状者(ＰＳＥ中第55,56,57,58,62,63,71,81条等)]共182例,对照组(无一级症状者)共325例;所有入组病例均按全国精神疾病流调标准(1980年,以下简称流调标准)进行诊断。随访时间自1994年1月至1996年12月。随访诊断须同时符合流调标准和中国精神疾病分类方案与诊断标准第2版。507例中有41…     

华人精神分裂症吸烟患者首次发病前吸烟率的Meta分析

目的系统评价华人精神分裂症吸烟患者首次精神病发作前的吸烟率(病前吸烟率)。方法计算机检索中国知网、万方、维普中文期刊网、台湾电子期刊全文数据库、PubMed、EMbase和PsycINFO,查找华人精神分裂症吸烟患者病前吸烟率的原始文献,检索时间均从建库至2016年12月25日。由两位研究者按纳入与排除标准筛选文献、提取数据并评价纳入研究的方法学质量,采用R 3.1.1进行Meta分析。结果共17项研究(2 445例精神分裂症吸烟患者)纳入分析,所有研究均为低质量。华人精神分裂症患者的合并病前吸烟率为72.0%(95%CI:61.0%~86.8%,P0.01);亚组分析结果显示,近年发表(2012年-2016年)文献的病前吸烟率高于早年发表(2002年-2011年)文献(83.0%vs.61.0%,P=0.02),首发精神分裂症患者的病前吸烟率高于非首发患者(88.0%vs.67.0%,P=0.047)。结论大多数华人吸烟精神分裂症患者的吸烟行为发生在首次精神疾病发作之前。     

中国康复医学系统评价/Meta分析的研究进展*

背景：循证医学与康复医学的结合日益紧密,尤其是为康复医学的临床实践工作,提供了遵循科学的原则、方法和依据。 目的：系统回顾国内康复医学系统评价/Meta分析的研究情况。 方法：由第一作者用计算机全面检索中国知网数据库(CNKI：1979/2009)、维普数据库(VIP：1989/2009)、万方数字化期刊群(WF：1998/2009)、中国生物医学文献数据库(CBM：1978/2009)数据库,每个数据库都进行二次检索,第一检索词都为“系统综述”,“系统评价”,“Meta分析”和“荟萃分析”,语言设定为中文;第二检索词都为“康复疗法”,“物理疗法”,“作业疗法”,“言语治疗”,“音乐疗法”,“physiotherapy”,“physical Therapy”,“occupational therapy”,“speech therapy”和“music therapy”等,语言分别设定为中文和英文。对所得相关文献的评价方法、干预对象、发表年份、文献来源、纳入试验等进行描述性分析。 结果与结论：2002年至今,共检索到59篇文献,经筛选有10篇符合纳入标准的文献;其中物理疗法6篇、音乐疗法3篇、康复综合治疗1篇;评价病症有8种,大多为神经系统疾病。文献篇数逐年增加,研究内容以物理疗法居多,并从多角度评价康复疗法的临床疗效国内康复医学系统评价/Meta分析研究尚处于起步阶段,希望今后的研究在遵循循证医学理念和方法的基础上,探索出符合康复医学自身特点的方法学。 关键词：康复医学;循证医学;系统评价;Meta分析     

感染SARS的医务人员抑郁情绪发生率及危险因素的系统评价

目的对传染性非典型肺炎(SARS)期间医务人员感染者的抑郁情绪发生率及其危险因素进行系统评价。方法检索PubMed、Embase、Web of Science、Cochrane Library、中国知网、万方数据库、中文科技期刊数据库、中国生物医学文献数据库,纳入报道了感染SARS的医务人员抑郁情绪发生率及其危险因素的文献。应用加强观察性流行病学研究报告规范(STROBE)声明为参照标准评价文献质量,采用MedCalc 18.6进行Meta分析。结果共10项研究纳入系统评价,其中5项研究报道了医务人员感染者抑郁情绪的发生率,为10.53%～43.12%,随机效应Meta分析结果显示,总样本量为989例,感染SARS的医务人员抑郁情绪发生率为22.76%(95%CI:13.63%～33.43%)。抑郁的危险因素为年纪轻、工作暴露、隔离等。结论感染SARS的医务人员抑郁情绪发生率较高。     

不同剂量甘露醇降低颅内压效果的系统评价

目的系统评价应用不同剂量甘露醇治疗颅内压增高的效果,为临床使用甘露醇的用量提供依据。方法计算机检索The Cochrane Library、PubMed、Ovid、Web of Science、EMbase、Google学术搜索引擎、知网、万方、维普、中文生物医学期刊数据库,纳入使用125mL(或0.25~0.5g/kg-1)和250mL(或0.5~1g/kg-1)两种剂量的20%甘露醇降低颅内压的随机对照试验(RCT),检索时限均为建库至2014-06。由2名评价者按照纳入与排除标准独立进行文献筛选、资料提取和方法学质量评价,采用RevMan 5.2软件进行Meta分析。结果最终纳入6个RCT,共1 582例患者。经Meta分析,5篇文章中125mL与250mL的20%甘露醇降低颅内压效果差异无统计学意义(P0.05),6篇文章显示,125mL的20%甘露醇不良反应较250%mL的20%甘露醇少。2篇文章治疗结束时2组的病死率相同。结论 125mL与250mL的20%甘露醇降低颅内压效果相当,而125mL甘露醇的不良反应250mL甘露醇,推荐临床使用125mL甘露醇降低颅内压。     

轻度脑损伤病人任务态fMRI脑区激活:元分析

目的 运用激活似然估计(activation likelihood estimation,ALE)元分析探讨轻度创伤性脑损伤(mild traumatic brain injury,mTBI)病人认知相关脑区激活特点,并试图阐明mTBI病人认知功能改变的神经机制.方法 系统检索中文及外文数据库,检索时间从建库开始至20...     

维生素D不足与卒中的荟萃分析

目的探讨维生素D不足是否为卒中危险因素。方法英文以PubMed、Cochrane Library、EMBASE作为检索数据库,以25-hydroxy vitamin D(25[OH]D)、vitamin D与stroke为主题词进行检索;中文以中国学术期刊网全文数据库(China National Knowledge Infrastructure,CNKI)、万方科技期刊全文数据库(Wanfang Data)、重庆维普中文科技期刊全文数据库(VIP)作为检索数据库,以维生素D、卒中、脑梗死、脑血栓形成为关键词进行检索,时间截止到2013年1月。用stata12.0软件进行Meta分析计算合并HR值(95%CI)。结果共纳入12篇文献,总样本量为28824。荟萃分析结果显示25(OH)D不足者与充足者相比的HR值(95%CI)是1.53(95%CI,1.43-1.64),差异有统计学意义(P0.05)。结论维生素D不足可能是卒中的一个潜在危险因素,对人群进行维生素D干预尚需进一步研究。     

中国精神科医师对精神疾病误诊率的Meta分析

目的运用Meta分析综合评价国内精神疾病的误诊情况,为提高精神疾病的诊断水平提供参考。方法计算机检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、Embase、Cochrane Library、PsycINFO、PubMed,收集公开发表的关于中国精神疾病误诊率的文献。由两位研究者独立进行文献筛选、资料提取和方法学质量评价后,采用R 3.3.3进行Meta分析。结果共10项研究(n=11 053)纳入分析。Meta分析结果显示,中国精神疾病合并误诊率为10.29%(95%CI:6.48%～15.95%,P0.01)。亚组分析显示:①不同来源的患者误诊率差异有统计学意义(P0.05);②不同地域的患者误诊率差异有统计学意义(P0.05);③不同发表年份的研究误诊率差异有统计学意义(P0.05);④采用不同诊断标准的误诊率差异无统计学意义(P0.05);⑤不同病程的患者误诊率差异无统计学意义(P0.05);⑥对治疗合作和不合作患者的误诊率差异有统计学意义(P0.05)。Egger's线性回归未见明显的发表偏倚(P0.05)。结论中国精神科医师对精神疾病合并误诊率较高,患者来源、所在地域、研究发表年代及对治疗的态度可能是影响精神疾病误诊的因素。     

国内脑出血领域系统评价／Meta分析的方法学与报告质量

目的评价国内期刊所发表的脑出血领域系统评价／Meta分析的方法学及报告质量,以期了解该领域的研究现状,探索影响质量的原因并提出相关建议。方法计算机检索中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、万方医药期刊数据库（wF）、维普中文科技期刊数据库（VIP）,查找涉及国内脑出血领域的所有系统评价／Meta分析,检索时限自建库至2013年7月20El。由2位评价员分别筛查文献并采用多系统评价评估问卷（AMSTAR）和系统评价及Meta分析优先报告条目（PRISMA）评分量表对纳入文献的方法学与报告质量进行评价。采用Excel2003软件进行数据统计。结果共纳入41篇文献,43．9％的文献未被同研究领域的其他研究者引用。AMSTAR平均得分（5．2±1．6）分（满分11分）,PRISMA平均得分（15．2±3．7）分（满分27分）。结论目前国内脑出血领域系统评价／Meta分析文献方法学与报告质量仍较低,建议杂志编辑及系统评价作者按照PHISMA及AMSTAR量表的要求进行评价与撰写。     

Mental health problems among homeless adolescents

This paper reviews 18 surveys of mental health problems among homeless adolescents and reports on a pilot study of the same topic conducted in Amsterdam. Sampling methods and measures of mental health are discussed. The reported estimates of mental health problems vary greatly, very probably because of methodological differences. Despite the different methods used, there seems to be considerable research evidence to support a high prevalence of mental disorders among homeless adolescents. The results of the pilot study of 50 homeless adolescents in Amsterdam are consistent with the surveys reviewed. A highly structured interview was conducted at all four services sites for homeless adolescents in Amsterdam. Of the homeless adolescents interviewed, 78% had at least one lifetime DIS/DSM-III-R diagnosis, and 64% had at least one 1-month diagnosis.     

Non-traditional lifestyles and prevalence of mental disorders in adolescents in Goa, India

BACKGROUND: Adolescents comprise a fifth of the population of India, but there is little research on their mental health. We conducted an epidemiological study in the state of Goa to describe the current prevalence of mental disorders and its correlates among adolescents aged between 12 and 16 years. AIMS: To estimate the prevalence and correlates of mental disorders in adolescents. METHOD: Population-based survey of all eligible adolescents from six urban wards and four rural communities which were randomly selected. We used a Konkani translation of the Development and Well-Being Assessment to diagnose current DSM-IV emotional and behavioural disorders. All adolescents were also interviewed on socio-economic factors, education, neighbourhood, parental relations, peer and sexual relationships, violence and substance use. RESULTS: Out of 2,684 eligible adolescents, 2,048 completed the study. The current prevalence of any DSM-IV diagnosis was 1.81%; 95% CI 1.27-2.48. The most common diagnoses were anxiety disorders (1.0%), depressive disorder (0.5%), behavioural disorder (0.4%) and attention-deficit hyperactivity disorder (0.2%). Adolescents from urban areas and girls who faced gender discrimination had higher prevalence. The final multivariate model found an independent association of mental disorders with an outgoing 'non-traditional' lifestyle (frequent partying, going to the cinema, shopping for fun and having a boyfriend or girlfriend), difficulties with studies, lack of safety in the neighbourhood, a history of physical or verbal abuse and tobacco use. Having one's family as the primary source of social support was associated with lower prevalence of mental disorders. CONCLUSIONS: The current prevalence of mental disorders in adolescents in our study was very low compared with studies in other countries. Strong family support was a critical factor associated with low prevalence of mental disorders, while factors indicative of adoption of a non-traditional lifestyle were associated with an increased prevalence.     

The changing prevalence and severity of obsessive-compulsive disorder criteria from DSM-III to DSM-IV

OBJECTIVE: Relative to other mental disorders, the prevalence of obsessive-compulsive disorder (OCD) in the general population is not well established. Some epidemiological surveys have determined the prevalence of DSM-III OCD, but this is one of the first reports, to the authors' knowledge, of DSM-IV OCD's prevalence. METHOD: Data from the Australian National Survey of Mental Health and Well-Being, a nationally representative epidemiological survey of mental disorders, were analyzed. The prevalence and associated characteristics of DSM-IV OCD were identified, and then the data were rescored for DSM-III OCD. Cases defined by each system were compared. RESULTS: The 12-month prevalence of DSM-IV OCD was 0.6%, considerably less than found in surveys employing DSM-III diagnostic criteria. DSM-IV OCD showed significantly higher levels of comorbidity, disability, health service use, and treatment received. CONCLUSIONS: Changes in the reported prevalence and severity of OCD between DSM-III and DSM-IV cases are most likely a function of the differences in diagnostic criteria between DSM-III and DSM-IV.     

A community-based telephone survey of panic disorder in Hong Kong

Panic disorder (PD) is prevalent, impairing, under-recognized, and often mistreated. Previous surveys in Chinese communities indicate very low prevalence estimates and provide limited information about its clinical characteristics. A random telephone survey of the general population (age range, 15-60 years) in Hong Kong was conducted using a questionnaire that generated the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV-based diagnosis of PD, its symptom profile, help-seeking behavior, and health visit expenditure. Of 3,004 interviews successfully completed, 3.89% of participants (n=117) met criteria of PD in the previous 6 months. Their demographic and clinical profile resembled that of their Western counterparts. Excessive physical investigations and under-treatment were common. Participants with subthreshold PD (14.9%; n=449) exhibited a similar but attenuated clinical profile. We conclude that PD may be more common in Chinese people than what previous epidemiological surveys suggest. The present study is limited by the lack of clinical reappraisal, examination of comorbidity, and a low overall response rate. Nonetheless, it suggests that telephone interviews may provide a cost-effective alternative to large-scale epidemiological surveys for communities with limited resources for mental health research and high unmet needs for treatment.     

Mental disorders among adolescents in juvenile detention and correctional facilities: a systematic review and metaregression analysis of 25 surveys

ObjectiveTo systematically review and perform a meta-analysis of the research literature on the prevalence of mental disorders in adolescents in juvenile detention and correctional facilities.MethodSurveys of psychiatric morbidity based on interviews of unselected populations of detained children and adolescents were identified by computer-assisted searches, scanning of reference lists, hand-searching of journals, and correspondence with authors of relevant reports. The sex-specific prevalence of mental disorders (psychotic illness, major depression, attention-deficit/hyperactivity disorder [ADHD], and conduct disorder) together with potentially moderating study characteristics were abstracted from publications. Statistical analysis involved metaregression to identify possible causes of differences in disorder prevalence across surveys.ResultsTwenty-five surveys involving 13,778 boys and 2,972 girls (mean age 15.6 years, range 10–19 years) met inclusion criteria. Among boys, 3.3% (95% confidence interval [Cl] 3.0%-3.6%) were diagnosed with psychotic illness, 10.6% (7.3%-13.9%) with major depression, 11.7% (4.1%-19.2%) with ADHD, and 52.8% (40.9%-64.7%) with conduct disorder. Among girls, 2.7% (2.0%-3.4%) were diagnosed with psychotic illness, 29.2% (21.9%-36.5%) with major depression, 18.5% (9.3%-27.7%) with ADHD, and 52.8% (32.4%-73.2%) with conduct disorder. Metaregression suggested that surveys using the Diagnostic Interview Schedule for Children yielded lower prevalence estimates for depression, ADHD, and conduct disorder, whereas studies with psychiatrists acting as interviewers had lower prevalence estimates only of depression.ConclusionsAdolescents in detention and correctional facilities were about 10 times more likely to suffer from psychosis than the general adolescent population. Girls were more often diagnosed with major depression than were boys, contrary to findings from adult prisoners and general population surveys. The findings have implications for the provision of psychiatric services for adolescents in detention. J. Am. Acad. Child Adolesc. Psychiatry, 2008; 47(9):1010–1019.     

The prevalence of narcolepsy among Chinese in Hong Kong

Narcolepsy is a lifelong, crippling sleep disorder. Although the discovery of the hypocretin system has been a breakthough in genetics, the epidemiological aspects of narcolepsy remain elusive. Ethnic predisposition was suggested to partially account for the 2,500-fold difference in the reported prevalence rates of narcolepsy between Japanese (0.59%) and Israeli Jews (0.00023%). We carried out a general population study, conducting a random telephone survey with a structured questionnaire, which included a validated screening instrument (a Chinese version of the Ullanlinna Narcolepsy Scale). It was followed by clinical-polysomnographic-HLA confirmation of the subjects determined to be positive for narcolepsy based on the questionnaire. Of 9,851 subjects interviewed, 28 subjects (0.28%, 58% female) were screened positive. Ninety percent had a second detailed interview, 64% had HLA typing, and over half of them had a sleep assessment. Only three subjects were found to have genuine narcolepsy. The most common nonnarcolepsy diagnoses were sleep apnea syndrome and sleep-wake schedule disorder. The prevalence rate of narcolepsy in Southern (Hong Kong) Chinese was found to be 0.034% (95% confidence interval = 0.010-0.117%). All available narcoleptic subjects were HLA DRB1-1501 positive and 50% were DQB1-0602 positive. The prevalence rate of narcolepsy among Chinese is comparable to the rates for other populations in studies with stringent epidemiological designs, suggesting that major cross-ethnic differences in the prevalence rates of narcolepsy previously reported likely resulted from methodological limitations.     

Prevalence of DSM-IV disorders in Chinese adolescents and the effects of an impairment criterion

Purpose

To provide preliminary prevalence estimates of common DSM-IV (Diagnostic and Statistical Manual of Mental Disorders—4th Edition) disorders in a sample of Hong Kong Chinese adolescents.

Methods

541 Chinese adolescents were recruited from Grades 7, 8 and 9 of 28 mainstream high schools in Hong Kong (mean age=13.8 years; SD=1.2). The adolescents and their parents were separately administered the Youth and Parent versions of DISC-IV (Diagnostic Interview Schedule for Children-Version 4), respectively.

Results

Based upon both symptom and impairment criteria, as required by DSM-IV, the overall prevalence estimate of DSM-IV disorders in our sample of Chinese adolescents was 16.4%. Estimates for such individual disorders/diagnostic groupings as anxiety disorders, depressive disorders, attention deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD), and substance use disorders were 6.9, 1.3, 3.9, 6.8, 1.7, and 1.1%, respectively. These rates were largely compatible with those reported in previous studies with perhaps lower rates of generalized anxiety disorder (GAD), depressive disorders, CD, and substance use disorders, but a higher rate of ODD. The rate of ADHD was somewhat higher, but this might reflect the current DSM-IV diagnostic practice. The rate of anxiety disorders was not as high as predicted from some previous questionnaire surveys. The application of an impairment criterion had discernible impacts on prevalence estimates, greater on anxiety and substance use disorders, but smaller on depressive and disruptive behavior disorders. There was a lack of gender difference in rates of ODD and CD.

Discussion and conclusion

While the findings reported here are broadly compatible with those of other studies, there may be cross-cultural differences in rates of some individual disorders, e.g., GAD, depressive disorders, ODD, CD, and substance use disorders, as well as in gender difference regarding rates of ODD and CD. However, exact comparison between studies is confounded by methodological differences in sample characteristics, measures, and case definition. Standardization of methodology in epidemiological surveys should allow more precise identification of any within- or between-culture variations in prevalence estimation.     

Do treated psychiatric patients become later community cases?: A prospective cohort study

BACKGROUND: There have been few attempts to link two aspects of psychiatric epidemiology, severe disorder and milder 'common' mental disorder, by ascertaining whether subjects who have received psychiatric treatment for major disorders are identified later in epidemiological community surveys. METHODS: Subjects were from a national birth cohort study and had been followed prospectively from childhood to middle age, with concurrent information on treatment from psychiatric facilities. In two successive prevalence surveys of milder disorder at 36 and 43 years, the association between earlier treatment and being a later community case was examined RESULTS: Among 102 subjects who had been treated patients up to age 35 years, 52 (51%) were identified as definite community cases (36, 35%) or subthreshold cases (16, 16%) at either one or both later points. The proportion of community subjects who were previous psychiatric patients increased systematically from community non-cases, through subthreshold cases on one or both occasions, definite cases on one occasion, to definite cases on both occasions. CONCLUSIONS: About half of subjects who have received treatment from psychiatric facilities remain with persistent symptoms such as to identify them as definite or subthreshold cases of milder common mental disorder some years later.     

Mental health problems and resilience in international adoptees: Results from a population-based study of Norwegian adolescents aged 16–19 years

The aim of the study was to investigate mental health and resilience in adolescents who have been internationally adopted and their non-adopted peers and examine the potential interaction between adoption status and resilience on mental health problems. Data from the population based youth@hordaland-survey, conducted in Hordaland County, Norway, in 2012 was used. In all, 10 257 adolescents aged 16–19 years provided self-reported data on several mental health instruments. Of these, 45 adolescents were identified as internationally adopted. Adoptees reported more symptoms of depression, attention-deficit/hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD) and perfectionism than non-adopted adolescents, but there were no differences regarding resilience. Adolescents with higher resilience scores reported fewer symptoms of mental health problems, however, no interaction effects were found for adoption status and total resilience score on measures of mental health problems. Our findings indicate that knowledge of resilience factors can form the basis for preventive interventions.     

多种精神障碍患者睡眠质量的调查

目的 研究精神障碍患者的睡眠特点和规律.方法 以河北省精神疾病流行病学现场抽样调查中符合美国精神障碍诊断与统计手册第4版诊断标准的13种精神障碍患者1874例(患者组)为研究样本.以调查中元任何精神障碍者15 117名为正常对照(对照组),采用匹兹堡睡眠质量指数中国修订版,评定两组最近1个月的睡眠质量,以>7分为有睡眠问题;采用功能大体评定量表评定社会生活功能.结果 (1)患者组有睡眠问题的发生率为48.61%(911例),高于正常人(5.55%,839例;P<0.01),其中以抑郁症者(69.92%)和广泛性焦虑障碍者(58.27%)为重.(2)患者组的睡眠质量问题表现为人睡时间长[(50±60)min]、总睡眠时间短[(7.1±4.3)h;P<0.01],对照组分别为(20±26)min和(8.4±2.4)h;抑郁症、心境恶劣障碍和广泛性焦虑障碍者早醒明显.(3)精神分裂症者[(1.0±1.4)分]和双相障碍者的[(0.7±1.3)分]催眠药物评分较高.(4)抑郁症[(1.8±1.2)分]和双相障碍[(1.6±1.3)分]患者日间功能最差.(5)患者组有睡眠问题者较无睡眠问题者的年龄偏大,教育水平低,功能损害更严重,女性多于男性,丧偶、农民、离退休、病退和家庭妇女有睡眠问题者较多.结论 精神障碍患者睡眠障碍发生率高,表现为人睡困难和总睡眠时间短,其中抑郁症患者最为明显;有睡眠问题受多种因素的影响.