不同工作年限社区医务人员精神卫生知晓率 及对精神疾病的态度

目的 比较河北省保定市不同工作年限社区医务人员心理健康和精神疾病预防知识的 知晓率及对精神疾病的态度。方法 以2016 年3 月10 日至4 月10 日保定市25 个县区进行集中培训的 社区医务人员2 541 人为调查样本,实际完成问卷调查2 433 份。采用卫生部办公厅精神卫生工作指标 调查评估方案制定的《普通人群心理健康知识和精神疾病预防知识知晓率调查问卷》《病例测验》及 《精神疾病有关态度问卷》调查,以工作年限20 年为界,分为＜ 20 年组1 246 人及≥ 20 年组1 187 人, 并进行对比分析。结果 ＜ 20 年组与≥ 20 年组对精神卫生与心理保健知识知晓率的比较（98.1% 比 94.8%）差异有统计学意义（χ2=19.38,P ＜ 0.001）。病例测验中阳性症状为主精神分裂症知晓率在＜ 20 年组与≥ 20 年组比较（52.9% 比43.1%）差异有统计学意义（χ2=23.17,P ＜ 0.001）。＜ 20 年组及≥ 20 年组对精神疾病有关态度问卷总分比较［（34.90±6.42）分比（35.59±6.64）分］差异有统计学意义 （t=2.60,P=0.009）。结论 保定市不同工作年限社区医务人员对精神卫生知识知晓率不同,应加强对高 工作年限医务人员精神卫生培训力度,提高对低工作年限医务人员精神疾病态度的教育。     

保定市乡、村两级医院医务人员精神卫生知识知晓率及对精神疾病态度的调查

目的 比较保定市乡、村两级医院医务人员心理健康和精神疾病预防知识的知晓率及对精神疾病的态度.方法 以在保定市22个县及3个区进行集中培训的基层医务人员2 558人为调查样本,采用卫生部办公厅精神卫生工作指标调查评估方案制定的心理健康知识和精神疾病预防知识知晓率调查问卷及精神疾病有关态度问卷进行调查,并进行对比分析.结果 乡(镇)卫生院/社区卫生中心(乡卫生院组)467人,村卫生所/社区卫生服务站(村卫生所组)1 966人完成调查.乡卫生院组精神卫生知识知晓率高于村卫生所组(98.1％比96.1％,x2=4.380,P=0.036).乡卫生院组及村卫生所组对精神疾病有关态度问卷总分比较差异无统计学意义[(34.82±6.357)比(35.34土6.574),t=1.547,P=0.122].但乡卫生院组条目“到精神病院看病是个人失败的标志”态度好于村卫生所组,而务目“不太看得起住过精神病院的人”“大多数人会像对待其他人一样对待精神病人”态度差于村卫生所组(P＜0.05).结论 保定市村级医院医务人员精神卫生知识知晓率低于乡级医院,两级医院对精神疾病的态度不同,应加强对村级医院医务人员的培训力度.     

农村居民对精神卫生知识知晓率及精神疾病有关态度问卷的性别差异

目的分析保定市农村居民对精神卫生知识现状及相关问题的态度,为进一步开展精神卫生工作提供依据。方法采用多阶段、分层、整群随机抽样方法抽取保定市农村居民共1100人,采用卫生部《精神卫生工作指标调查评估方案》制定的精神卫生和心理保健问卷、《病例测验》及精神疾病有关态度问卷进行调查并分析。结果完成调查1055人．其中男380人,女675人。男性及女性对精神卫生与心理保健知识知晓率的差异无统计学意义（66．8％比63．4％;χ^2=1．26,P=0．263）,但两组问卷正确率总分比较差异有统计学意义[（12．71±2．41）比（12．40±2．29）;t=2．10,P=0．036]。男性及女性对精神疾病有关态度问卷总分比较差异无统计学意义[（33．16±8．09）分比（32．65±7．57）分;t=1．01,P=0．311],但部分条目男女之间比较有统计学意义（P〈0．05）。结论农村居民对精神卫生知识知晓率低,男女之间也存在差异,应继续加大对农村的宣传力度。     

医务人员职业倦怠与工作满意度现状调查

目的调查医务人员职业倦怠与工作满意度情况。方法采用随机数字表法选取佛山市公立医院医务人员1 620名,采用职业生活质量量表(Pro QOL)、明尼苏达工作满意度问卷短式量表(MSQ)、主观幸福感量表(SHS)进行评定。结果共收集有效问卷1 423份;30≤年龄40岁的医务人员职业倦怠评分高于20≤年龄30岁者[(28.29±5.38)分vs.(27.27±5.20)分,t=-1.02,P=0.014],医生职业倦怠评分高于护士[(28.34±5.29)分vs.(27.34±5.16)分,t=-1.00,P=0.009],中级职称医务人员职业倦怠评分高于初级职称者[(28.28±5.16)分vs.(27.36±5.25)分,t=0.92,P=0.020],硕士学历者职业倦怠评分高于专科学历者[(28.49±4.96)分vs.(27.08±5.30)分,t=1.42,P=0.043],精神专科医院及口腔医院的医务人员职业倦怠评分低于其他医院医务人员[(25.39±5.00)分vs.(26.03±4.22)分,F=11.62,P0.01],而工作满意度评分[(72.98±9.52)分vs.(71.18±8.07)分,F=7.31,P0.01]和主观幸福感评分[(20.02±3.94)分vs.(20.33±3.67)分,F=5.65,P0.01)]均高于其他医院。结论 30≤年龄40岁、医生、中级职称、硕士学历的医务人员职业倦怠水平较高,精神专科医院及口腔医院医务人员职业倦怠水平较低且工作满意度和主观幸福感较高。     

基层行政管理人员抑郁情绪与精神卫生知识知晓度及精神疾病态度的关系

目的 了解基层行政管理人员抑郁情绪与精神卫生知识知晓度及精神疾病态度的关系,为进一步提高精神卫生服务和建设社会心理服务体系提供参考。方法 于2020年10月选取济南市历城区690名街道办事处基层行政管理人员为研究对象,采用自编一般情况调查表、精神卫生与心理保健知识问卷、精神疾病有关态度问卷和抑郁自评量表(SDS)进行评定。采用多因素线性逐步回归分析探讨基层行政管理人员精神卫生知识知晓度及精神疾病态度的影响因素。结果 共检出248人(37.07%)存在抑郁情绪,不同年龄(χ²=16.110)、受教育程度(χ²=18.949)、婚姻状况(χ²=8.611)、职务(χ²=11.584)者抑郁情绪检出率差异均有统计学意义(P<0.05或0.01)。基层行政管理人员精神卫生与心理保健知识问卷评分为(15.20±2.77)分,知晓率为75.99%,精神疾病有关态度问卷评分为36(31～38)分。抑郁情绪严重程度与精神卫生与心理保健知识问卷评分呈负相关(r=-0.379,P<0.01),与精神疾病有关...     

天水市城市与农村普通人群精神卫生知识知晓率及对精神疾病的态度

目的比较天水市城市与农村普通人群的心理健康、精神疾病预防知识知晓率及对精神疾病的态度。方法于2016年3月1日-4月30日采用多阶段分层整群随机抽样方法抽取天水市≥15岁的500名城市和1000名农村普通人为调查对象。采用精神卫生工作指标调查评估方案中的《普通人群心理健康知识和精神疾病预防知识知晓率问卷》、《病例测验》、《精神疾病有关态度问卷》进行调查,并比较农村和城市人群的各问卷结果。结果实际完成调查的城市与农村人口分别为485名、968名。城市人群对精神卫生与心理保健知识的知晓率高于农村(88.2%vs.65.4%,χ~2=99.89,P0.01),对精神疾病态度好于农村[(36.74±6.43)分vs.(35.83±7.62)分,t=2.27,P0.05]。城市人群对抑郁症、阳性症状为主精神分裂症、躁狂症及强迫症的知晓率均高于农村人群(35.5%vs.30.2%,40.2%vs.31.1%,65.4%vs.41.9%,77.1%vs.39.1%,χ~2=3.92、11.93、70.88、187.49,P0.05或0.01),对阴性症状为主精神分裂症的知晓率城市与农村人群差异无统计学意义(12.3%vs.14.3%,χ~2=0.59,P0.05)。结论天水市农村人群心理健康知识知晓率低于城市,对抑郁症、阳性症状为主精神分裂症、躁狂症、强迫症的知晓率低于城市人群,农村人群对精神疾病的态度有待提高,应加强对农村人群精神卫生知识的宣传力度。     

济南市18岁及以上人群睡眠质量现状调查

目的 调查济南市18岁及18岁以上人群睡眠质量现状和睡眠质量问题的发生率,探讨不同人群的睡眠质量特点.方法 采用多阶段分层整群抽样方法对全市18岁及18岁以上人群进行抽样,共抽取4 800人,实际完成问卷调查4 774 人(99.82％).以匹兹堡睡眠质量指数(PSQI)总分＞7分为有睡眠质量问题.结果 (1)平均睡眠时间为(7.99±1.52)h；PSQI评分为(3.33±3.74)分,高于烟台市(2.52±3.49)分(u =0.09,P＜0.01),其中男性(3.14±3.60)分显著低于女性(3.49±3.84)分(t=3.22,P＜0.01)；(2)共688例(14.70％)有睡眠质量问题,高于烟台市(10.52％,x2=35.82,P＜0.01)高于山东省(13.18％,x2 =7.70,P＜0.01),女性睡眠质量问题的发生率16.43％,明显高于男性12.60％(x2=13.57,P＜0.01)；随年龄增长睡眠质量问题发生率增高,18 ～39岁者低于40～54岁者,亦低于≥55岁者(x2 =274.70,,P＜0.01)；农村(15.59％)高于城市(12.07)(x=8.66,P＜0.01)；婚姻状况不良和低文化程度人群(受教育年限0～6年)睡眠质量问题的发生率高,上述差异均有统计学意义(P＜0.01).结论 济南市18岁及18岁以上人群的睡眠质量存在明显问题,严重性和发生率高于同类研究.     

我国医务人员精神卫生知识知晓率研究现状

本文目的是了解我国医务人员精神卫生知识知晓率现状及其影响因素,为提高医务人员精神卫生知识知晓率提供参考。精神卫生知识知晓率是反映各类人群对精神卫生知识知晓程度的指标,医务人员对精神卫生知识的了解和掌握有利于医疗卫生工作的开展,减少误诊和漏诊。本文对我国医务人员精神卫生知识知晓率和常用调查工具进行综述,结果显示我国医务人员的精神卫生知识知晓率参差不齐,影响知晓率的因素较多。     

细胞外信号调节激酶的磷酸化水平对星形胶质细胞增殖及其细胞周期的影响

目的 探讨细胞外信号调节激酶(ERK1/2)的磷酸化水平对体外星形胶质细胞(Ast)增殖及其细胞周期的影响.方法 将培养成熟的大鼠原代Ast分为两组,其中一组用ERK1/2磷酸化的特异性抑制剂U0126进行处理(U0126组),另一组不做处理,作为对照组.通过Western Blot技术、Click-iT Edu技术和流式细胞术分别检测两组Ast中ERK1/2磷酸化水平、Ast增殖细胞百分比及各期细胞百分比.结果 U0126组ERK1/2的磷酸化水平(39.13％±6.71％)明显低于对照组(100％).U0126处理24 h后,U0126组Ast增殖细胞百分比[(2.63±1.14)％]低于对照组[(21.43±3.81)％](t=21.13,P＜0.01).G1期U0126组Ast[(93.67±0.68)％]高于对照组[(84.63±1.00)％](t=12.91,P＜0.01);S期U0126组Ast[(2.90±0.23)％]低于对照组[(14.21±1.14)％] (t=16.87,P＜0.01);G2期U0126组Ast[(3.43±0.88)％]高于对照组[(2.08±0.21％)％](t=4.35,P＜0.05).结论 降低ERK1/2的磷酸化水平可抑制Ast的增殖,并将其阻断在G1期,抑制Ast从G1期向S期的转化,同时抑制其分裂将其阻断在G2期.     

重庆市基层精神卫生防治工作者职业倦怠现状调查及影响因素研究

目的 探讨重庆市基层精神卫生防治工作者职业倦怠现状及其影响因素。方法 采用整 群随机抽样的方法，从重庆市39 个区县中随机选取18 个区县（合川、巴南、涪陵、江北、荣昌、沙坪坝、 巫溪、酉阳、云阳、万州、北碚、南岸、綦江、巫山、秀山、渝中、城口、九龙坡），其中分布于主城区5 个、贫 困地区7 个及其他（既非主城区又非贫困地区）6 个。将18 个区县的基层精神卫生防治工作者（500 名）全 部作为调查对象。应用一般情况调查表及职业倦怠量表（MBI-GS）对其进行职业倦怠现状评估。职业倦 怠与社会人口学变量的相关性研究应用Pearson 双变量相关分析或Spearman 等级相关分析，不同人口学 特征职业倦怠比较采用协方差分析，职业倦怠影响因素分析采用多元线性回归。结果 知情同意参加 本研究并完成有效问卷者478 名，有效率95.6%。（1）轻度职业倦怠者占41.0%（196 例），中、重度职业倦 怠者占59.0%（282 例）。其中情绪衰竭中、重度者占68.8%（329 例），玩世不恭中、重度者占48.3%（231 例）， 成就感低落中、重度者占39.5%（189 例）。（2）玩世不恭与精神卫生防治工作年限（r=-0.175）、文化程度（r= -0.332）均呈负相关，情绪衰竭与精神卫生防治工作年限（r=-0.163）、文化程度（r=-0.371）均呈负相关，成 就感低落与文化程度呈明显负相关（r=-0.103），差异均有统计学意义（均P ＜ 0.05）。（3）精神卫生防治工 作人员玩世不恭和情绪衰竭在不同婚姻状况（F=11.274、11.820）、居住情况方面（F=24.032、34.689）差异 具有统计学意义（均P ＜ 0.01）。（4）多元线性回归分析结果显示，未婚及再婚/ 离异/ 丧偶的婚姻状况是 玩世不恭的危险因素（t=2.306、3.570，P＜ 0.01），居住于主城区（t=-5.294，P＜ 0.01）、高等教育文化程度 （t=-4.398，P＜ 0.01）、精防工作年限长（t=-2.430，P=0.015）是玩世不恭的保护因素；再婚/ 离异/ 丧偶的婚 姻状况（t=4.063，P＜ 0.01）及总工作年限长（t=2.710，P=0.007）及居住在其他区域（t=3.005，P=0.003）是情 绪衰竭的危险因素，居住于主城区（t=-5.917，P＜ 0.01）、年龄高（t=-2.313，P=0.021）、高等教育文化程度 （t=-5.361，P＜ 0.01）、精防工作年限长（t=-2.416，P=0.016）是情绪衰竭的保护因素；再婚/ 离异/ 丧偶的婚 姻状况（t=2.074，P=0.039）及初级职称（t=2.100，P=0.036）是成就感低落的危险因素。结论 重庆市基层 精神卫生防治工作者均存在不同程度的职业倦怠，情感衰竭较明显，职业倦怠受多种因素影响，精神卫 生防治工作年限长及文化程度高对职业倦怠具有保护作用。     

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.     

Special Pharmacokinetic Considerations in Children

Summary: Pediatric patients have greater degrees of pharmacokinetic variability and unpredictability than adults. This variability results from the effects of pharmacogenetics, age and growth, prior and current comedication, and disease. Newborns with seizures have the least predictable dosage requirements, and their needs change as drug-eliminating mechanisms mature in the neonatal period. Infants have the highest relative capacities to eliminate antiepileptics of any age group and require the largest relative doses. In addition to age-related trends, children demonstrate the same drug-specific, pharmacokinetic phenomena that adults do, including nonlinear phenytoin elimination, nonlinear valproate binding, and autoinduction of carbamazepine. Intercurrent illness and drug interactions further modify the age-related pharmacokinetic patterns in children and make dosage requirements even more unpredictable. Recent studies have shown that febrile illness can affect drug elimination, sometimes decreasing drug levels by 50% or more. Intermittent treatment with benzodiazepines administered either orally or rectally can be an important adjunct and help minimize this type of problem for children with marginally controlled epilepsy. Intermittent benzodiazepines are also helpful for children who have febrile seizures and who need only occasional antiepileptic protection.