精神障碍患者童年创伤经历及其与文化智力的关联研究

目的:探究精神障碍患者的童年创伤经历及与其文化智力水平的关联。方法:纳入就诊于昆明医科大学第二附属医院精神科的203例精神障碍患者(包括抑郁障碍、焦虑障碍、目前为抑郁发作的双相情感障碍患者),采用童年创伤问卷简化版(CTQ-SF)、文化智商问卷(CIQ)进行调查。根据童年创伤类型对患者进行分组,比较各组间童年创伤和文化智商的关联。结果:忽视组与忽视+虐待组患者的童年创伤经历、文化智商量表总分及各因子分均低于不伴童年创伤组的患者(P均<0.05)。情感忽视与文化智商量表总分、认知因子得分负向关联(β=-0.3、-0.3);躯体忽视与元认知因子得分、行为因子得分负向关联(β=-0.2、-0.2)。结论:与不伴有童年创伤经历的精神障碍患者相比,伴有童年创伤经历的患者的文化智力水平低。情感忽视和躯体忽视与此类患者的文化智力水平有较强的关联性。     

童年虐待对精神分裂症患者认知功能和临床症状的影响

目的:探讨精神分裂症患者的童年虐待经历对其认知功能和临床症状的影响。方法:对46例精神分裂症患者依据儿童期虐待问卷(CTQ)评分分为轻度虐待组(27例)和重度虐待组(19例);并采用阳性和阴性症状量表(PANSS)、临床总体印象量表(CGI)及CogState量表(CSB)评估其临床症状及认知功能;分析童年虐待与认知功能和临床症状的关系。结果:重度虐待组CTQ总分及情感虐待、躯体虐待、性虐待、躯体忽视评分显著高于轻度虐待组(P均0.01);PANSS总分、阳性因子及CGI评分明显高于轻度虐待组(P0.05或P0.01);CSB中的注意力及警觉高于轻度虐待组,工作记忆评分明显低于轻度虐待组(P0.05或P0.01)。结论:童年经历严重虐待的精神分裂症患者其精神症状更重,认知功能损害更明显。     

抑郁障碍患者家庭功能的跨文化研究

目的:探讨中国和美国抑郁障碍患者的家庭功能特征.方法:采用家庭功能量表(FAD)对92例中国抑郁障碍患者(中国组)及92例美国抑郁障碍患者(美国组)进行评估及比较.结果:两组FAD各维度均分均高于健康的家庭功能临界值,为不健康的家庭功能.中国组FAD中的情感反应维度评分及行为控制维度评分明显高于美国组;中国男性组情感反...     

青少年抑郁障碍患者非自杀性自伤行为的特征及相关因素分析

目的 研究青少年抑郁障碍患者非自杀性自伤行为的特征及其相关因素。方法 选取安徽省某精神病专科医院符合《精神疾病诊断手册第五版》中青少年抑郁障碍诊断标准的门诊和住院患者共131例,采用汉密尔顿抑郁量表、童年创伤问卷、青少年非自杀性自伤问卷进行评估。结果 1）青少年抑郁障碍患者出现非自杀性自伤（Non-suicidal self-injury,NSSI）行为占总人数69.5%,NSSI行为按频率高低依次为：故意掐伤自己、故意割伤自己（如用刀片、玻璃等）、故意用拳头打击硬物;NSSI行为功能依次为：缓解压力或焦虑的心情、应对悲伤或失望的情绪、有伤害自己的欲望且无法停止;2）伴NSSI组和不伴NSSI组在性别、父母婚姻、抑郁得分、童年期创伤均有统计学差异（P<0.05）;3）青少年抑郁障碍患者NSSI行为与抑郁严重程度、童年期创伤呈显著正相关（r=0.513、r=0.356,P<0.01）;4）抑郁严重程度在童年期创伤与青少年抑郁障碍NSSI行为之间起中介作用。结论 童年期创伤会影响青少年抑郁障碍抑郁严重程度进而增加出现NSSI行为的风险。     

童年创伤、生活事件与大学生抑郁情绪的关系——心理韧性的中介和调节作用

目的探讨大学生心理韧性与童年创伤、生活事件和抑郁情绪之间的关系,以及心理韧性在它们之间的作用,为大学生抑郁情绪的干预提供参考。方法采用分层整群随机抽样法在济南市和烟台市共3所高校抽取700名在校大学生,使用流调中心用抑郁量表(CES-D)、童年创伤问卷(CTQ)、青少年自评生活事件量表(ASLEC)和青少年心理韧性量表(RSCA)进行评定。结果相关分析显示,CES-D与ASLEC、CTQ评分均呈正相关(r=0. 271、0. 237,P均0. 01);RSCA评分与CES-D、ASLEC、CTQ评分均呈负相关(r=-0. 429、-0. 226、-0. 290,P均0. 01)。中介效应检验显示,心理韧性在童年创伤和抑郁情绪之间的中介效应显著,中介效应占总效应的45. 19%;调节效应检验显示,心理韧性在生活事件与抑郁情绪之间的调节效应显著(R~2=0. 232,P 0. 01)。结论心理韧性在童年创伤和抑郁情绪之间起到部分中介作用,在生活事件与抑郁情绪之间起到调节作用。     

大学生儿童期创伤与抑郁之间的关系:述情障碍的中介作用

目的:探究述情障碍在大学生儿童期创伤与抑郁症状间的作用。方法:采用儿童期虐待问卷(CTQ)、多伦多述情障碍量表(TAS-20)以及贝克抑郁量表(BDI)对湖南省某高校4 374名大学生进行调查。结果:伴儿童期创伤组述情障碍与抑郁得分显著高于不伴儿童期创伤组(t=15.48,P0.001;t=12.82,P0.001)。儿童期创伤总分及各维度与述情障碍总分及各维度、抑郁之间显著正相关(P均0.05)。述情障碍在儿童期创伤与抑郁间的中介效应占总效应的28.06%。儿童期创伤中的情感虐待、情感忽视和躯体忽视可以直接预测抑郁(β=0.229,0.123,0.082;P0.001),也可以通过述情障碍间接预测抑郁(β=0.178,0.094,0.035;P0.001)。结论:大学生述情障碍在儿童期创伤与抑郁症状之间具有部分中介作用。     

神经性厌食症患者的自尊、完美主义与其家庭功能的关系

目的:探究神经性厌食症(AN)患者的自尊、完美主义与其家庭功能的关系。方法:对71例AN患者(AN组)及71位健康志愿者(对照组)进行Rosenberg自尊量表(RSES)、Frost完美主义问卷中文版(CFMPS)及家庭功能评定量表(FAD)评估和比较,并对AN患者的自尊、完美主义与家庭功能进行相关分析。结果:①AN组RSES评分明显低于对照组(t=6.4207,P=0.000); CFMPS中的担心错误(CM)(t=4.8432,P=0.0000)、行动的疑虑(DA)(t=3.1363,P=0.0021)、个人标准(PS)(t=3.7448,P=0.0003)、父母期望(PE)(t=3.1805,P=0.0018)4个维度的评分及消极完美主义总分(t=14.0926,P=0.0000)明显高于对照组;FAD中的问题解决(t=4.2541,P=0.0000)、沟通(t=3.6409,P=0.0004)、情感反应(t=4.2121,P=0.0000)、情感介入(t=6.1278,P=0.0000)、行为控制(t=2.9765,P=0.0034)和总功能(t=6.4386,P=0.0000)6个维度评分明显高于对照组;②AN组FAD中的问题解决、沟通、总体功能评分与RSES评分呈负相关;问题解决评分与CFMPS中条理性(OR)评分呈正相关,行为控制评分与CM、DA评分呈正相关,情感介入、行为控制及总体功能评分与PS评分呈正相关,情感反应、情感介入、总体功能评分与PE评分呈正相关(P0.05或P0.01);③AN组RESE总分与CFMPS中CM、PE和消极完美主义总分呈负相关(P均0.01)。结论:AN患者的低自尊及消极完美主义特质与其家庭功能失调相关。     

心理健康教育多元家庭治疗对抑郁障碍患者的疗效及家庭功能的影响

目的 探讨心理健康教育多元家庭治疗（The psychoeducational multiple family group,PMFG）对抑郁障碍患者的疗效及家庭功能的影响。方法 从张家港市第四人民医院门诊中选取60名抑郁障碍患者随机分为研究组和对照组,两组研究对象均采用抗抑郁药物治疗,研究组使用PMFG模式治疗,对照组使用门诊随访及社区支持性治疗;采用汉密尔顿抑郁量表（Hamilton Depression Scale,HAMD）、汉密尔顿焦虑量表（Hamilton Anxiety Scale,HAMA）、家庭功能评定量表（Family Function Rating Scale,FAD）对两组患者治疗前后进行HAMD、HAMA、FAD评分比较。结果 干预后研究组HAMD和HAMA评分均低于对照组（t=6.749,P<0.01;t=5.165,P<0.01）;FAD评分低于对照组（P<0.01）;差异均有统计学意义。结论 心理健康教育多元家庭治疗能减轻抑郁障碍患者的临床症状,并有助于提高患者的家庭功能。     

伴有抑郁的2型糖尿病患者生活质量及家庭功能

目的:探讨伴有抑郁的2型糖尿病患者生活质量及家庭功能特征。方法:采用生活质量量表(QLESQ)、家庭功能量表(FAD)以及贝克抑郁量表(BDI)对50例2型糖尿病患者(糖尿病组)及50名正常人(正常对照组)进行调查。结果:38%(19/50例)的2型糖尿病患者伴有抑郁。糖尿病组FAD评分中情感卷入及行为控制维度在不健康家庭功能范围内;QLESQ总分(32.49±5.86)分明显低于正常对照组(37.76±5.38)分(P<0.01)。糖尿病组FAD的问题解决、角色和情感卷入维度与抑郁症状呈正相关(r分别=0.426、0.339、0.454,P<0.05或P<0.01);QLESQ总分与家庭功能的角色和行为控制维度呈负相关(r分别=-0.292、-0.344,P<0.01)。结论:伴发抑郁的2型糖尿病患者生活质量差且家庭功能有缺陷。     

青少年精神分裂症家庭功能及有关情况

目的:探讨青少年精神分裂症患者的家庭功能以及亲密度和适应性特点.方法:采用家庭功能量表(FAD)以及家庭亲密度和适应性量表(FACES Ⅱ-CV)对52例青少年精神分裂症患者(患者组)和60名健康志愿者(对照组)进行调查,并比较结果.结果:患者组在沟通、情感反应、情感介入、行为控制以及总的功能等方面的评分显著高于正常对照组(P＜0.05或P＜0.01);患者组的家庭亲密度和家庭适应性各因子评分明显低于正常对照组(P＜0.05或P＜0.01).结论:青少年精神分裂症患者家庭支持系统不良,应针对其家庭特点开展家庭干预.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.