精神科儿少病房留守儿童的流行病学资料分析及相关因素

目的对精神科儿少病房留守儿童进行流行病学调查,分析其发病的主要原因。方法回顾性分析诊断符合《国际疾病及相关健康问题分类第十版》(ICD-10)的青少年住院患者共207例,比较留守儿童所占的比例,留守儿童的主要发病诊断以及首发年龄。结果所有住院病人中留守儿童106例(51.2%),非留守儿童101例(48.8%)。以精神分裂症、心境障碍及儿童情绪障碍为主。儿童情绪障碍中,有近70%为留守儿童,而在精神分裂症和心境障碍中两者比例接近1∶1。留守儿童组中男性比例(64.2%)明显大于女性(35.8%),农村与非农村的比例相当(51.9%,48.1%),外出务工的父母中双方均外出的占绝大多数(57.5%),其次是父亲在外打工的占到(34%)。留守儿童组中首发年龄是14岁的最多。结论本研究显示留守儿童的心理疾病呈增长趋势,缺乏父母心理及生活上的照料可能是导致其发病的主要因素。     

成都市儿童青少年抑郁障碍临床特征调查

目的 探讨成都市儿童青少年抑郁障碍的临床特征.方法 采用量表筛查和访谈结合的方法对成都市五城区6 ～ 16岁的4585名在校学生进行抑郁障碍调查.首先应用长处和困难问卷(strength and difficulty questionnaire,SDQ)进行筛查,筛查阳性的进一步用精神发育和健康状况评定量表(the development and well-being assessment,DAWBA)进行定式检查以明确诊断.诊断标准按照美国精神障碍诊断和统计手册第4版.结果 SDQ筛查阳性的占50.2%(2302/4585).共检出儿童青少年抑郁障碍患者55例,重性抑郁障碍29例,恶劣心境0例,未标明的抑郁障碍26例,总的抑郁障碍患病率1.2%(55/4585).起病年龄的中位数为13岁(P25:11岁,P75:15岁),高峰年龄在15岁,占21.8%(12/55).出现频率居前3位的抑郁症状依次是情绪低落(74.5%)、易激惹(72.7%)、精力减退(72.7%).34.5%(19/55)的儿童青少年抑郁障碍患者曾经试图伤害自己或自杀.55例患者中39例过去曾有抑郁发作,占70.9%.抑郁障碍对儿童青少年的学习、社交和娱乐具有不同程度的影响,74.5%(41/55)的患者学习受影响.患者的病情有轻有重,大多数(78.2%)为轻度或中度.结论 儿童青少年抑郁障碍应受到重视,做到早发现早治疗.     

儿童丘脑肿瘤的长期随访和治疗方针

本文报告了加拿大多伦多儿童医院(1951～1983)60例丘脑肿瘤的长期随访结果和治疗方针。本组男30例,女30例,左侧丘脑肿瘤32例,右侧肿瘤28例。年龄范围5个月～18岁(平均7.7岁).诊断前症状持续时间为1天～3年,其中1个月内33例(38%),1～4个月22例(37%),5个月～1年11例(18%),1～3年4例(7%)。最常见的症状和体征是颅内压增高或局限性神经系统障碍。用颅骨X 线平片、气脑或脑室造影、动脉造影及放射性脑扫描确诊33例,用CT 扫描确诊27例。非手术16例(27%),穿刺活检3例(5%),术中活检20例     

儿童青少年学校恐惧症的相关因素及心理治疗特点

<正>1概述儿童青少年因害怕学习和学校而拒绝上学,俗称"厌学"。Johnson于1941年首先提出学校恐惧症(school phobia)一词[1],特指那些对学校环境产生异常恐惧,强烈拒绝上学的儿童,认为其是儿童情绪障碍的一种类型。20世纪50年代,一些教育界学者发现,由于心理因素造成的拒绝上学行为,其背景是由于儿童与母亲的分离焦虑而导致对学校的恐惧,与逃学有本质区别,后者往往伴有品行问题和反     

目睹特大火灾1年后初中生的焦虑情绪及影响因素

目的:探讨目睹特大火灾1年后初中生的焦虑情绪以及影响因素. 方法:采用方便抽样方法抽取距某火灾现场200 m某中学初中生311名(研究组)及与之学校性质、年级相匹配的某中学430名初中生(对照组)在火灾发生后1年时进行儿童焦虑性情绪障碍筛查量表(SCARED)、父母养育方式评价量表(EMBU)、青少年应对方式量表、儿童抑郁障碍自评量表(DSRSC)及埃森儿童青少年创伤问卷(ETI-KJ)调查;以火灾发生1个月后相同人群的调查资料作为基线,对调查结果进行对照分析. 结果:研究组焦虑情绪的变化率(6.4％)明显高于对照组(1.3％)(x2=13.03,P ＜0.001);SCARED总分、广泛性焦虑及躯体化/惊恐因子分明显高于对照组(P均＜0.05).研究组中14～16岁年龄段、火灾1个月后有焦虑症状及创伤后应激障碍、应对方式为自我反思、暴力宣泄及自我感受、养育方式中父母亲过分干涉、过度保护、以及父亲拒绝否认、惩罚、严厉的学生更容易出现焦虑情绪(P均＜0.05).结论:目睹特大火灾1年后初中生焦虑情绪仍在增加;个人及环境等多种因素是其影响因素.     

对89例儿童少年精神障碍的自杀分析

作者对有自杀意念和行为的儿童、少年精神障碍89例进行了临床资料分析 ,旨在引起全社会及临床医生重视并及时给予危机干预。1　临床资料1.1　一般资料　本文调查了 1987～ 1996年间在本院住院和门诊就诊并符合ＣＣＭＤ - 2 -Ｒ中诊断标准的89例伴有自杀行为或 /和意念的精神障碍儿童与少年(仅 1例自杀死亡 )。其中诊断为精神分裂症 6 1例 ,情感性精神障碍 14例 ,品行障碍 5例 ,情绪障碍 3例 ,抽动症 6例。男 4 4例 ,女 4 5例 ,男∶女 =0 .98∶1。年龄为12～ 16岁 ,平均为 14.8岁。病程 8个月～ 4年。1.2　自杀与年龄和季节的关系　本组年龄…     

左乙拉西坦治疗儿童癫(癎)的疗效观察

目的 观察左乙拉西坦(Lev)治疗儿童癫(癎)的疗效.方法 62例癫(癎)患儿(9个月～14岁)根据病情分为Lev单药治疗组(34例)和添加治疗组(28例).Lev的起始剂量为10～20 mg/(kg·d),分两次服用,每1～2周增加10 mg/(kg·d),在4周内增加至27～46 mg/(kg·d),持续服用6个月.观察治疗过程中癫(癎)发作频率、脑电图变化及不良反应;治疗6个月时评定疗效.结果 本组的总有效率和控制率为64.5%和29.0%.单药治疗组和添加治疗组总有效率分别为76.5%及50.0%,完全控制率分别为41.2%及14.3%,两组间差异有统计学意义(P＜0.05～0.01).治疗前13例脑电图出现睡眠中癫(癎)性电持续状态(ESES),治疗后7例消失.22例(35.5%)出现不良反应,表现为食欲下降、呕吐、思睡、头痛头昏、情绪及行为异常,均自行缓解.结论 无论单药还是添加治疗,Lev对儿童癫(癎)均有显著疗效,对ESES有部分改善作用;不良反应轻.     

不同时期儿童青少年心理门诊资料对照分析

目的　探讨我院儿童青少年心理门诊在成立初期及成立 5年后两个不同时期患者就诊情况的变化 ,以掌握儿童青少年心理障碍、精神疾病的发展以及治疗趋势。方法　分别截取 1997年 1～ 10月与 2 0 0 2年 1～ 10月两个不同时期就诊于儿童青少年心理门诊的初诊病例。按照CCMD 3的诊断标准 ,重新将门诊所见到的 34种疾病归为 14类 ,将家长为其子女的行为、情绪、青春期性心理、人际关系及家庭教育等问题来院咨询要求心理指导的另归一类 ,共为 15类。按年龄分为 <6岁、7～ 12岁、13～ 18岁三个组。将两个不同时期相同年龄范围的病例进行对照分析。结果　初诊人数从 1997年的 4 5 7例增至 2 0 0 2年的 6 14例 ,提高了 34.4 % ;父母为子女寻求咨询人数从 31例增至 14 4例 ,提高 2 4 .7% (P均 <0 .0 1)。儿童情绪障碍的初诊人数明显增加 ,提高了 12 % (P <0 .0 1)。在治疗方法上 ,心理治疗、心理咨询及药物合并心理治疗的比例2 0 0 2年占 73.5 % ,而单一药物治疗人数比 1997年减少了 4 3.5 %。在各综合性医院普遍开展心理门诊的情况下我院儿童青少年心理门诊数量仍有明显提高。结论　 (1)专科医院具有较强的技术实力赢得社会的信任。 (2 )广大群众的心理卫生意识在不断提高 ,认识到心理健康的重要性 ,主动接受心理     

成都市学龄前儿童情绪行为问题现状调查

目的 了解成都市学龄前儿童情绪行为问题的现状.方法 应用长处和困难问卷(SDQ)(家长版),采用整群分层随机抽样,对成都市5个辖区17所幼儿园的949名3~7岁学龄前儿童进行调查.结果 21.3%的学龄前儿童存在情绪问题.其中24.9%的女童有情绪问题,17.3%的男童有情绪问题,女童情绪问题的发生率高于男童(χ2=7.298,P=0.007).女童在情绪问题方面的得分高于男童(t=-2.770,P=0.006).分别有13.0%,19.7%,18.6%,19.2%的学龄前儿童存在品行、多动、同伴交往、亲社会行为问题,但其发生率均不存在性别差异.男童在同伴交往问题方面的得分高于女童(t=2.442,P=0.015),女童在亲社会行为方面的得分高于男童(t=2.940,P=0.003).综合年龄、性别、家庭状况等因素对于学龄前儿童情绪障碍具有61.3%的预测准确性.结论 部分学龄前儿童存在明显的情绪及行为问题,女童的情绪问题更多及发生率更高,同伴关系和亲社会性发展更好.学龄前儿童的情绪障碍与多种因素有关.     

儿童青少年精神分裂症与GRM5基因的全基因组关联分析和家系对照研究

目的 对既往有阳性发现的促代谢型谷氨酸受体5基因(glutamate receptor,metabotropic 5,GRM5)与精神分裂症的关联进行验证.方法先用affymetrix 6.0芯片对89例儿童青少年精神分裂症与1000例正常对照的DNA分别进行全基因组关联分析,而后在另一个样本-100个儿童青少年精神分裂症核心家系中采用高分辨率溶解曲线(High Resolution Melting,HRM)进行了GRM5基因6个 SNP 位点 (rs591849,rs16915130,rs3899716,rs2133395,rs597462,rs1942486)的检测.用 HaploView4.1软件进行数据的统计分析.结果 89例儿童青少年精神分裂症与1000例正常对照的全基因关联分析显示,GRM5基因的rs16915130位点与精神分裂症存在关联(χ2=39.895,P=2.68×10-10),然而通过6个SNP位点及所构建的单倍型在儿童青少年精神分裂症家系的验证却不支持GRM5基因与精神分裂症关联(P＞0.05).结论 本研究不支持GRM5基因与儿童青少年精神分裂症关联.     

Genetic findings in obsessive-compulsive disorder in childhood and adolescence and in adulthood

Obsessive-compulsive disorders (OCD) are on the rise, and affected children, 1-2% of the general population, often are seriously impaired in their development. OCD is characterized by recurrent, intrusive and disturbing thoughts as well as by repetitive stereotypic behaviours. Depending on their age and developmental status, patients usually try unsuccessfully to suppress the obsessive thoughts and compulsive behaviours. The current state of genetic research on OCD and early-onset OCD is presented and discussed. OCD, especially early-onset OCD, has been shown to be familial. Convincing evidence indicates that both environmental and genetic factors substantially influence OCD. Various approaches, including linkage and association studies, yielded conflicting results as well as the notion that multiple genes of modest effect sizes, in interaction with environmental factors, cause vulnerability to the disorder. The phenotypic and genetic heterogeneity of OCD complicate the identification of specific genetic factors. Further studies have to be designed in consideration of subtypes, e.g. age at onset, symptom dimensions, or comorbid disorders.     

Changes in extra- and intracellular pH in the brain during and following ischemia in hyperglycemic and in moderately hypoglycemic rats

Incomplete forebrain ischemia of 15-min duration was induced in rats made hyperglycemic or moderately hypoglycemic prior to ischemia. Tissue CO2 tension, CO2 content, labile tissue metabolites, and extracellular pH (pHe) were measured, and intracellular pH (pHi) was derived by calculation on the assumption that cerebral intracellular fluids can be lumped into one space. In hypoglycemic animals, mean tissue lactate content increased from 2 to 10 mumol g-1. Tissue CO2 content was virtually unchanged and the CO2 tension increased from approximately 50 to approximately 145 mm Hg. In hyperglycemic animals, tissue lactate content rose to 20 mumol g-1, and the CO2 content decreased by 25%, demonstrating that some CO2 was lost to the blood supplied by the remaining perfusion. Accordingly, tissue CO2 tension did not rise above 200 mm Hg. pHe was reduced in proportion to the amount of lactate accumulated, the values obtained in hypo- and hyperglycemic animals showing relatively little scatter (6.76 +/- 0.03 and 6.25 +/- 0.04, respectively). In hypoglycemic animals the extracellular HCO-3 concentration was virtually unchanged, demonstrating that any influx of lactic acid from the cells must have been accompanied by H+ efflux and/or HCO-3 influx via independent routes. In hyperglycemic animals [HCO-3]e fell by greater than 10 mumol ml-1. In both groups [HCO-3]e was reduced during the first 5 min of recovery. Recovery of pHe was slower in hyper- than in hypoglycemic animals. During ischemia calculated pHi fell to 6.37 +/- 0.04 and 5.95 +/- 0.06 in hypo- and hyperglycemic animals, respectively. Differences in pHi were maintained for the first 15 min of recovery, but in both hypo- and hyperglycemic animals pHi had normalized after 30 min. It is concluded that preischemic hyperglycemia leads to a more pronounced intra- and extracellular acidosis than normo- and hypoglycemia, an acidosis that also resolves more slowly during recirculation.     

Dopamine-derived alkaloids in alcoholism and in Parkinson's and Huntington's diseases

Summary Tetrahydroisoquinoline (TIQ) alkaloids and 1-carboxy TIQ derivatives have been found in human fluids and/or tissues. The possible biosynthetic pathways of salsolinol (Sal), taken as an example of TIQs, are discussed, and the possibility that biosynthesis occurs through a stereospecific enzymatic reaction is considered. In this respect, it is reported that the R enantiomer of Sal predominates in urines of healthy volunteers, whereas the S enantiomer predominates in port wine and possibly in other beverages and foods, suggesting that Sal present in humans could have, at least partially, and endogenous enzymatic origin.TIQs and other dopamine-derived alkaloids are weak MAO inhibitors, the R enantiomer of Sal and salsolidine being more potent than the S form.The changes in monoamine oxidase activity and the nigrostriatal concentrations of dopamine and homovanillic acid in Parkinson's and Huntington's diseases and in alcoholism are reviewed. In these pathological situations, changes in the levels of dopamine-derived alkaloid levels may occur. The possibility that the modifications found might cause or contribute to changes in mental and/or neurophysiological states in these pathological situations is considered.