精神分裂症的注意障碍

本介绍注意的特征及其与神经系统的关系、精神分裂症与注意障碍的关系及抗精神病药对注意功能的影响。     

精神分裂症的注意障碍

本文主要概述了精神分裂症的注意障碍,就其与阴、阳性症状的关系、在缺陷、非缺陷型精神分裂症间的不同表现以及可能的病理解剖学机制进行了探讨。 注意是心理活动对一定事物的指向和集中,其基本特征包括注意集中性、注意稳定性、注意选择性、注意范围、注意分配和注意转移等。当丘脑、内囊后肢、皮质下结构、双侧边缘系统和额叶发生损害时均可导致注意障碍。关于精神分裂症的注意损害,Kraepelin和E.Bleuler早已给予描述,并已有公认,认为可能具有其独特的特征。目前的研究认为精神分裂症病人存有注意集中和分散能力的损害以及信息超载情况下处理信息能力的损害。已有假说认为这种注意/信息处理过程损害,既是精神分裂症发展易损性的标记,也是精神分裂症病理学的直接表现。然而注意本身并非独立系统,加之精神分裂症之异质性疾病学说的存在,使精神分裂症注意损害的表现与特有组别或特有症状领域的关系至今不甚明了。目前精神分裂症的研究仍然以症状描述性研究为主,特别是精神分裂症的诊断更是依靠临床发现的症状组合,鉴于此点,通过不同的精神症状或疾病亚型来研究精神分裂症的注意损害,显得更为实际和可靠。     

注意功能与精神分裂症的注意障碍

本文介绍注意的特征及其与神经系统的关系,精神分裂症与注意障碍的关系及抗精神病药对注意功能的影响。     

有无注意障碍的精神分裂症对照研究

目的：探讨有无注意障碍的精神分裂症患者间的临床差异。方法：在住院的精神分裂症患者中，以有注意障碍者为研究组，无注意障碍者为对照组，对两组病人的年龄、病程、用药剂量、药物副反应、疾病分型、疗效、症状量表评分、智能水平及神经系统软体征（NSS）进行比较。结果：两组病人除用CCMD-3诊断标准划分的亚型、用药剂量、药物副反应无显著性统计学差异外，其他各项指标均有显著性统计学差异。结论：研究组缺陷型病人多、年龄大、病程长、病情重、疗效及社会功能差、具有更为明显的NSS。     

注意功能与精神分裂症的注意障碍

正常的注意力对维持完善的精神活动、尤其是对行使正常的认知功能极为重要。早在克雷丕林时代人们对精神分裂症的注意障碍已有认识［１］。Ｂｒａｆｆ等认为,注意障碍可能是精神分裂症的特征性症状,并发现尚未发病的患者亲属及处于精神分裂症疾病谱上的人群都有注意障碍［２］。由于注意功能不是独立的心理过程,而精神分裂症又是一种异源性疾病,本文将就有关问题作简要介绍。作者单位：２５００１４　山东省精神卫生中心１　注意的特征以及与神经系统的关系注意是指意识对一定事物的指向性,可分为主动及被动注意两类。主动注意是自觉的…     

Alzheimer病的注意障碍

本概述了目前对注意的研究方法及其在Alzheimer病中的应用,指出Alzheimer病各种注意亚型的损害情况。     

脑外伤患者的心理护理

目的探讨心理护理在脑外伤患者的临床及院后影响。方法对我院收治的43例脑外伤患者进行心理分析,了解其精神状态,有针对性地进行精神支持和心理安慰。结果经过耐心、细致的心理护理,除2例死亡外,其余41例术均取得临床及院后较满意效果。结论有针对性的心理护理,可以有效减轻患者的紧张、恐惧心理,有利于手术配合和术后康复,提高患者的生存质量。     

脑出血患者恢复期护理体会

高血压是脑出血最常见的基础疾病之一,高血压患者往往在情绪波动或过度紧张时,导致血压突然升高,血液从血管壁渗出或动脉壁直接破裂而出血。1资料与治疗结果1.1一般资料2010-06-2012-06我院收治85例脑出血患者,男53例,女32例;年龄49～72岁。所有患者均通过脑CT检查,确诊为脑出血,均有高血压史。脑出血临床症状为:剧     

脑外伤患者气管切开的护理

重型颅脑外伤患者咳嗽反射差,呼吸道分泌物增多且不易排出,易引起肺部感染,导致机体缺氧,加重脑水肿,早期气管切开可改善脑缺氧状况,促使脑组织功能恢复[1].因此,气管切开术后护理是否正确完善,会直接影响脑外伤患者抢救效果和愈后,是预防肺部感染、呼吸困难、呼吸衰竭等并发症的有效护理措施.     

A longitudinal study of awareness of deficit after moderate to severe traumatic brain injury

Lack of awareness of deficits is a common problem after traumatic brain injury (TBI), and is associated with worse functional outcome and poor compliance with rehabilitation. Little is known, however, about the course of awareness of deficits after TBI. Using a longitudinal design, we examined changes in self-awareness between the subacute stage (about 45 days after injury) and one-year follow-up in a sample of 123 individuals with moderate to severe TBI. Awareness of deficits was operationalised as the discrepancy between patient and family ratings on the Awareness Questionnaire (AQ) and Patient Competency Rating Scale (PCRS). Compared to baseline, awareness was improved at one year, as evidenced by smaller discrepancy scores and stronger correlations between participant and family ratings. Changes in awareness were most pronounced for the behavioural/affective domain and least pronounced for the motor/sensory domain, which showed best agreement at baseline. Even at one year, participants rated themselves as higher functioning than did their relatives. Awareness at baseline and, for the AQ, time to follow commands, significantly predicted awareness at one year. These results suggest that awareness of deficits improves between the subacute and post-acute stages after TBI, and highlight the need for effective interventions for persons with impaired awareness and for flexible timing of rehabilitation efforts.     

Addressing deficits in emotion recognition after severe traumatic brain injury: The role of focused attention and mimicry

Deficits in emotion perception are prevalent in people with severe traumatic brain injury (TBI) and are an important target for remediation. Preliminary work has indicated that emotion perception can improve with treatment but there is a dearth of studies examining the efficacy of specific techniques. In this study we examined two remediation strategies: (1) focusing attention on relevant aspects of the facial expression, and (2) mimicking the facial expression. Twenty-two people with chronic, severe brain injuries and 32 people matched on basic demographic variables were asked to label six basic emotions spontaneously followed by either a Focus or Mimic instructional strategy. Contrary to expectations, the TBI group was not poorer than the control group in the Spontaneous condition. Consequently, the effects of Focus vs. Mimic were examined for participants who had average scores or less in the Spontaneous condition (n = 14 and 20, respectively). The poorer performing control group was found to benefit from repeated exposure regardless of remediation strategy. The TBI group did not. Over and above repeated exposure, the Focus instruction assisted control participants but lead to poorer performance in those with TBI. The Mimic strategy resulted in little improvement for either group. Those who benefited least from the Focus strategies in the TBI group were those with poor abstract reasoning and flexibility. There was no such association in the control group and no associations between cognitive abilities and changes in scores using the Mimic strategy in either group.     

颅脑外伤对患者智能状况的影响及相关因素研究

目的：研究颅脑外伤对患者智能状况的影响,探讨与之相关的生物、心理、社会因素。方法：本研究对63例急性期颅脑外伤患者,采用标准化测评工具,包括《格拉斯哥昏迷评分（GCS）》、《简易智力状态检查》、《数字划消测验》、《社会支持评定量表》、《日常生活能力量表》及自制颅脑外伤患者人口学与相关因素调查表等,逐例进行现场临床测评,将拟分析的因素进行量化,最后将汇总的资料进行整理,分析、总结。所有统计分析均使用SAS软件包完成。结果：颅脑外伤患者智能缺陷的发生率为71．43％,其显著性差异表现在文化程度、治疗措施及手术类型三个方面,主要影响因素有外伤程度、外伤部位、社会支持、文化程度及治疗措施。结论：不同外伤类型的颅脑外伤对患者的智能状 况产生不同程度的影响,其相关因素包括生物、心理、社会学三个方面,基础的生物学病因虽然对智能起决定作用,而社会心理因素的影响仍不可忽视。     

重型颅脑损伤后并发精神障碍临床分析

目的回顾分析重症颅脑损伤后并发精神障碍。方法总结我院1998-10~2006-10收治的重症颅脑损伤后并发精神障碍46例病人,分析伤情、受伤部位与并发的精神障碍间的关系。结果本组病人共出现4型精神障碍:躁狂型、抑郁型、精神分裂样型、痴呆型。损伤部位分别为:额叶损伤、颞叶损伤、胼胝体损伤、脑干损伤。损伤类型为:脑挫伤、弥漫性轴索损伤(DAI)、脑挫伤并发颅内血肿或并发脑疝。结论额叶脑挫伤或颞叶脑挫伤并发躁狂型精神障碍最多见,脑干损伤及DAI常出现痴呆型精神障碍。     

颅脑外伤患者的抑郁症状及相关因素研究

目的：研究颅脑外伤后患者的抑郁症状及相关因素,方法：对63例急性期颅脑外伤患者,采用标准化测评工具,包括《格拉斯哥昏迷评分（GCS）》,《汉密顿抑郁量表（HRSD）》,《社会支持评定量表》,《日常生活能力量表》及自制颅脑外伤患者人口学与相关因素调查表等。逐例进行现场临床测评,汇总资料进行整理,分析,所有统计分析均使用SAS软件包完成。结果。颅脑外伤患者抑郁症状的发生率为42．86％,其中,重度,中度,轻度抑郁的发生率辚3．17％,7．93％,31．74％,不同外伤类型,年龄,性格,外伤原因及患者对外伤持不同态度的颅脑外伤患者抑郁症状的发生率存在显著性差异,主要影响颅脑外伤后抑郁症状的因素有外伤程度,性格,社会支持,病理征及年龄。结论：提示除了外伤的生物学影响外,抑郁的发生与患者个体的生理心理特点和社会环境因素密切相关。     

Neural correlates of self-evaluative accuracy after traumatic brain injury

Individuals who have sustained a traumatic brain injury (TBI) often exhibit an array of cognitive deficits, yet perhaps most maladaptive of these sequelae is the frequent occurrence of reduced insight into one's own condition. In such cases, TBI individuals may overestimate their post-injury level of socio-cognitive functioning, leading to disparities between how they perceive themselves and what others observe. This functional MRI (fMRI) investigation examined the relationship between level of insight into one's post-injury condition (i.e. trait/ability status) and neural activation evoked during an fMRI task involving self-appraisal of one's traits and abilities. Twenty TBI patients (8-12 weeks post-injury, ER Glasgow Coma Scale Average = 10.9+/-2.8) were selected on the criterion that they overestimate their current trait/abilities (as detected on the patient competency rating scale, PCRS). fMRI activation on the self-appraisal task was compared between the TBI patients and 20 matched controls. For both groups, the fMRI task evoked activation at mid-line prefrontal and retrosplenial cortices. TBI patients exhibited greater signal change in the anterior cingulate, precuneus and right temporal pole. Subsequently, a linear regression analysis was conducted for the TBI group, with the PCRS and a measure of cognitive speed entered as predictor variables to determine the selective effect of insight on self-evaluative brain activation. A more accurate level of trait/ability-based insight was related to increased signal change in the right anterior dorsal prefrontal cortex (PFC). The results suggest that one's post-injury level of self-referential insight is related to a network inclusive of the medial and right dorsal PFC.     

Identity,grief and self-awareness after traumatic brain injury

The objective of this study was to investigate perceived identity change in adults with traumatic brain injury (TBI) and explore associations between identity change, grief, depression, self-esteem and self-awareness. The participants were 29 adults with TBI who were being followed up by a community brain injury rehabilitation service. Participants were longer post-injury than those more commonly studied. Time since injury ranged from 2.25 to 40 years (mean?=?11.17 years, SD?=?11.4 years). Participants completed a battery of questionnaires. Significant others and clinicians completed a parallel version of one of these measures. Questionnaires included the Head Injury Semantic Differential Scale (HISDS-III), Brain Injury Grief Inventory (BIGI), Hospital Anxiety and Depression Scale – Depression, Rosenberg Self-Esteem Scale (RSES) and the Awareness Questionnaire (Self/Significant other/Clinician versions). The main findings were that participants reported significant changes in self-concept with current self being viewed negatively in comparison to pre-injury self. Perceived identity change was positively associated with depression and grief and negatively associated with self-esteem and awareness. Awareness was negatively associated with self-esteem and positively associated with depression. These findings were consistent with previous research, revealing changes in identity following TBI. Further research is needed to increase our understanding of the psychological factors involved in emotional adjustment after TBI and to inform brain injury rehabilitation interventions, including psychotherapy approaches.     

颅脑创伤后凝血功能障碍的研究进展

颅脑创伤作为一种常见的创伤类型,给社会以及家庭造成了沉重的负担。凝血功能障碍在颅脑创伤后十分常见,尤其多见于服用了抗凝或抗血小板聚集药物的患者。颅脑创伤后凝血功能障碍的发生机制复杂,并且没有统一的诊断标准,但是其出现往往导致进展性颅内出血的发生,严重影响患者预后。成分输血以及相关血液制品和止血药物的应用是目前纠正颅脑创伤后凝血功能障碍的主要治疗手段。本文将对颅脑创伤后凝血功能障碍的发生机制、诊断和治疗的研究现状做一综述。     

脑外伤后进展性出血性脑损伤的诊治体会

目的研究脑外伤后进展性出血性脑损伤的临床特点,总结其发病机制,探讨及时诊断、治疗的方法。 方法回顾性分析解放军第二五一医院神经外科自2015年1月至2017年6月收治的167例脑外伤后进展性出血性脑损伤患者的临床资料。本组患者入院时按GCS评分：3~5分11例,6~8分36例,9~12分83例,13~15分37例。临床表现均有不同程度的颅高压症状,观察治疗过程中,76例患者出现意识障碍或意识障碍加深,94例患者肢体肌力减退,81例患者频繁呕吐,43例患者躁动,5例患者脑疝。 结果手术治疗94例,保守治疗73例。所有患者依据GOS评分判断：恢复良好114例,中残32例,重残13例,死亡8例（4.8%）。 结论动态CT观察是早期发现进展性出血性脑损伤的有效方法。对外伤性颅内血肿的患者绝不能仅仅依赖首次CT结果即制定一成不变的治疗方案,应进行专科监测和动态CT观察,根据患者血肿量的变化及时调整治疗方案。     

Understanding deficits in empathy after traumatic brain injury: The role of affective responsivity

People with traumatic brain injury (TBI) often find social situations challenging because they can no longer respond to the emotional state of the people they are with. Many also lack emotional empathy in their social interactions. But are these problems related? The present study addressed this question by examining psychophysiological indices of emotional responding, including facial electromyography (EMG) and skin conductance during exposure to happy and angry facial expressions, in addition to self-rated emotional empathy in 21 adults with severe TBI and 22 control participants. In comparison to control participants, those in the TBI group displayed a reduction in the ability to empathize emotionally, and showed reduced physiological responding to the emotional expression of anger. By contrast, the control group spontaneously mimicked the emotional expressions they were exposed to, regardless of affective valence, and also demonstrated higher skin conductance responsivity to angry faces. The data further suggested that a loss of emotional empathy plays a role in the emotional response deficits to angry facial expressions following TBI. The results have implications for understanding the impaired social functioning and poor quality of interpersonal relationships commonly seen as a consequence of TBI.