儿童精神分裂症强迫症状的临床特征研究

目的　了解儿童精神分裂症强迫症状的临床特征。方法　采用自编的调查表 ,对 110例住院精神分裂症患者 (年龄≤ 15岁 )的病案资料进行分析。根据有无强迫症状 ,分为两组 ,即研究组 (有强迫症状 )和对照组 (无强迫症状 )。结果　 (1)强迫症状的发生率为 2 2 .73% (2 5 / 110 ) ;(2 )强迫观念主要见于 13～ 15岁儿童 ,强迫动作主要见于 8～ 12岁儿童 ;(3)研究组和对照组在住院天数、住院次数以及疗效方面差异均有显著性 (P <0 .0 1或P <0 .0 5 )。结论　强迫症状可能出现于儿童精神分裂症的各个时期 ,表明它是精神分裂症的一个组成部分 ,并且与精神分裂症的预后有关     

儿童精神分裂症患者的预后及相关因素分析

目的探讨儿童精神分裂症的预后及其影响因素。方法收集1987—1997年首次住院的儿童(起病年龄≤14岁)精神分裂症患者(儿童组)124例和同期首次住院的成人(起病年龄25～30岁)精神分裂症患者(成人组)120例,采用社会功能缺陷量表(SDSS)、日常生活能力量表(ADL)、大体评定量表(GAS)及自制调查表,以随访与量表现场测评相结合的方法获得资料,数据采用多因素回归分析。结果(1)儿童组服药依从性(90例,77.6%)好于成人组(73例,64.0%；)χ~2= 5.11,P＜0.05)；复发率(29.3%)低于成人组(42.1%；χ~2=4.10,P＜0.05)。(2)儿童组预后良好者(91例,78.4%)显著多于成人组(65例,57.0%)。(3)儿童组的社会功能[(2.11±1.02)分]和日常生活能力[(18.78±9.17)分]优于成人组[(3.48±1.86)分和(21.82±8.67)分；P＜0.01和P＜0.05]。(4)经多因素回归分析,影响儿童精神分裂症预后的主要因素有：社会家庭关爱程度,首次住院疗效,起病形式,服药时间和病期(P＜0.01)。结论儿童精神分裂症患者总体预后较好；充分的家庭关爱,首次住院疗效好,急性起病,坚持长期治疗和病期较短者的预后更好。     

儿童精神分裂症的认知功能

目的 :探讨儿童精神分裂症患者认知功能障碍的特点。　方法 :采用中国 韦氏儿童智力量表 (C WISC)对 4 1例 13～ 16岁儿童精神分裂症患者进行测试 ,其结果与常模相比较。　结果 :全量表智商为 (80 .0 0± 17.2 1)分 ,操作智商为 (6 7.4 1± 2 0 .89)分 ,言语智商为 (92 .5 1± 17.5 4 )分。 3种智商 <89及 <6 9者所占的百分比分别与常模比较 ,差异均具有显著性。　结论 :儿童精神分裂症患者智商多低于正常 ,以操作智商损伤为主 ,言语智商与操作智商明显不平衡。     

阿立哌唑联合小剂量氯氮平治疗儿童精神分裂症的疗效观察

<正>本研究应用阿立哌唑联合小剂量氯氮平治疗儿童精神分裂症,现将报告如下。1对象和方法为2010年1月至2013年6月在我院住院儿童精神分裂症患者64例,均符合中国精神障碍分类与诊断标准第3版诊断标准;阳性与阴性症状量表(PANSS)总分≥60分。随机分成两组,阿立哌唑+氯氮平(研究)组:男18例,女14例;年龄8~14岁,平均(12.6±2.1)岁;病程(4.6±1.1)年。阿立哌唑(对照)组:男20例,女12例;年龄7~14岁,平均(12.4±2.5)岁;病程(4.0±1.5)年。两组性别、年龄及病程差异无统计学意义。     

团体认知行为治疗联合常规治疗对社区精神分裂症患者的康复作用

目的:探讨团体认知行为治疗(GCBT)联合常规治疗对社区精神分裂症患者的康复作用。方法:132例社区精神分裂症患者随机分为常规治疗组(64例)和联合治疗组(68例),两组在常规治疗的基础上,对联合治疗组患者进行GCBT 12周;治疗前及治疗4、8、12周后采用阳性和阴性症状量表(PANSS)、自知力与治疗态度问卷(ITAQ)、社会功能缺陷筛选量表(SDSS)、日常生活能力量表(ADL)、大体评定量表(GAS)、Morisky问卷对两组患者进行评估和比较。结果:与基线比较,两组第4、8、12周末PANSS、SDSS总分均显著下降,联合治疗组明显低于常规治疗组;第4、8、12周末两组ITAQ、ADL、GAS及Morisky问卷总分显著提高,联合治疗组显著高于常规治疗组(P均0. 01)。随访结束时,联合治疗组有效率(76. 47%)明显高于常规治疗组(53. 13%),复发率(7. 35%)明显低于常规治疗组(29. 69%);每周工作时间明显长于常规治疗组(P均0. 01)。结论:GCBT联合常规治疗对社区精神分裂症患者康复作用优于常规治疗。     

精神分裂症患者出院后心理康复指导的意义

目的　探讨心理康复指导对精神分裂症患者出院后康复的意义。方法　对 12 0例出院的精神分裂症患者随机分成干预组 6 0例和对照组 6 0例 ,两组均接受抗精神药物的维持治疗 ,在此基础上干预组进行心理康复指导 ,而对照组仅限于一般情况的介绍 ,于干预前和干预后 6个月、一年对二组进行简明精神病量表(BPRS)、日常生活能力量表 (ADL)、功能大体评定量表 (GAF)、社会功能缺陷筛选量表 (SDSS)评定。结果　干预后 6个月BPRS、GAF、ADL评分分别为 2 1.4± 4 .5 ,79.0± 18.4和 19.6± 4 .8,对照组分别为 2 3.5±5 .1,6 8.0± 16 .8和 2 1.7± 5 .5 ,两组各项评分差异有显著性 ,干预组 12个月后BPRS、GAF、ADL、SDSS评分分别为 16 .3± 3.4 ,82 .0± 113.4 ,4 .1± 2 .2和 14 .5± 5 .5 ,对照组分别为 19.7± 8.2 ,5 8.0± 14 .7,6 .7±2 .8和 18.7± 5 .5 ,两组各项评分差异均有显著性 ,1年内干预组 8例 (13.3% )复发 ,对照组 2 1例 (3.5 % )复发 ,有差异显著性 (P <0 .0 1)。结论　心理康复指导能降低精神分裂症患者的复发率 ,有利于社会功能的康复     

立体定向手术治疗难治性精神分裂症近期疗效及远期预后分析

目的　探讨立体定向手术治疗难治性精神分裂症的近期疗效和远期预后。方法　回顾性分析 1987年 3月～ 2 0 0 4年 3月间应用立体定向多靶点毁损手术治疗的 39例精神分裂症患者 ,对术后超过 10年的 15例患者设立非手术对照组 ,采用简明精神病量表 (BPRS)、大体评定量表 (GAS)、临床疗效总评量表 (CGI)、阳性和阴性症状量表 (DANSS)、社会功能缺陷量表 (SDSS)和日常生活能力量表 (ADL)等对治疗结果和远期预后进行评定。结果　 39例手术患者优 3例 ,显著进步 16例 ,进步 14例 ,无效 4例。手术前后GAS、BPRS、CGI评分有显著性差异(P <0 .0 1)。长期随访 ,手术组与非手术组BPRS中的激活因子分、PANSS中的攻击危险性和偏执 /好斗因子分有显著性差异 (P <0 .0 1) ,余各项评分及SDSS和ADL评分两组间的差异无显著性 (P >0 .0 5 )。结论　立体定向手术是治疗难治性精神分裂症的安全、有效的方法 ,手术对患者的社会和生活能力无明显影响。     

利培酮治疗首发儿童精神分裂症的临床观察

目的了解利培酮治疗儿童少年期首发精神分裂症或分裂样精神病的临床疗效、安全性和药物剂量。方法用利培酮对62例年龄<14岁的儿童精神分裂症患者治疗8周,采用简明精神病评定量表(BPRS)评定疗效,副反应量表(TESS)及实验室相应检查评定安全性及副反应。结果总有效率85%。不良反应主要为锥体外系反应及失眠,平均治疗剂量(3.26±0.88)mg/d。结论利培酮对于首发儿童少年期精神分裂症或分裂样精神病的治疗,用药安全、疗效可靠、副反应小、依从性高。     

奎硫平治疗儿童精神分裂症30例疗效分析

目的:了解奎硫平对儿童精神分裂症的疗效和安全性。方法:对30例9～15岁符合中国精神障碍分类与诊断标准第3版精神分裂症的诊断标准患者,应用奎硫平治疗,疗程8周。以简明精神病评定量表(BPRS)评定疗效,以副反应量表(TESS)及实验室监测评价安全性。结果:奎硫平治疗量平均为(42 3±2 0 )mg/d ,有效率为86 .7% ,不良反应主要为体质量(体重)增加。结论:奎硫平治疗儿童精神分裂症安全有效,不良反应少,值得临床推广。     

利培酮治疗儿童精神分裂症36例的疗效观察

目的 研究应用利培酮治疗儿童精神分裂症的疗效和安全性。方法 对36例9～15岁经CCMD-3诊断为儿童精神分裂症的患者,应用利培酮治疗12周,平均起始剂量(0.86±0.05)mg/日,平均治疗剂量为(3.44±1.08)mg/日,采用简明精神病量表(BPRS)评定疗效,锥体外系症状量表(ESRS)和实验室检查评价不良反应。结果 利培酮对儿童精神分裂症各种症状均有较好疗效,显效率为83％,有效率94.4％,不良反应主要有轻度的睡眠增多和锥体外系反应,其他不良反应少见。结论 利培酮对儿童精神分裂症疗效较好,不良反应少,依从性较好,值得推广使用。     

社区精神分裂症日托站卫生经济学研究

目的：探讨社区精神分裂症日托站的卫生经济学效益。方法：共166例精神分裂症患者，其中日托组78例，社区组88例。以简明精神病评定量表（BPRS）、社会功能评定量表（DAS）、生活质量量表（QOLs）及自编卫生经济调查问卷测定。随访2年。结果：两组相比，日托组的患者精神症状较稳定，费用较省。结论：社区日托站能改善精神分裂症患者的精神症状，降低医疗费用。日托可作为精神分裂症患者康复措施之一。     

Prevalence and course of schizophrenia in a Chinese rural area

OBJECTIVE: To assess the characteristics and factors affecting course of schizophrenia in a Chinese rural area. METHOD: An epidemiological investigation was conducted to identify all the patients with schizophrenia among 149 231 people in Xinjin County, Chengdu. RESULTS: The total prevalence of schizophrenia was 4.13 per 1000 population. Males had an earlier mean age of onset (29.6 years) than females (32.3 years). Duration of illness before treatment and the total duration of illness were found to be significantly associated with level of remission. The status of treatment, family economy, housing, and families' care of patients had a significant effect on the clinical course of the illness. CONCLUSIONS: Duration of illness before treatment may be an important predictor of course in schizophrenia. Early treatment for the patients may produce higher level of improvement in prognosis. Education intervention and community-based service are urgent priorities for these patients.     

儿童期与成人期首发精神分裂症患者的临床特征差异分析

目的　探讨首发精神分裂症儿童与成人患者之间是否存在临床差异。方法　选择首发、未经系统治疗的儿童精神分裂症患者及成人患者 ,作为研究对象 ,自编调查表 ,分别对两组患者的一般资料及临床资料进行调查分析。结果　儿童组幼年缺乏家庭温暖的明显多于成人组 ;精神病家族史阳性率也明显高于成人组 ;儿童组的不良发病因素以学校因素居多 ,成人组则以家庭因素居多 ;儿童组的就诊病程明显短于成人组 ;儿童组未见嫉妒妄想 ,自语自笑、伤人损物、自杀等表现亦较少见 ;两组预后则无明显差异。结论　儿童与成人精神分裂症患者之间确实存在一定的差异     

健康问题与疾病定量测试法逻辑判别系统对精神分裂症的多轴诊断及其效度

目的探讨健康问题与疾病定量测试法逻辑判别系统(RTHD-LVS)对偏执型和未定型精神分裂症的多轴诊断及其效度。方法运用RTHD对临床符合中国精神障碍分类与诊断标准第三版(CCMD-3)诊断为精神分裂症偏执型和未定型的患者106例进行半定式评估,然后运用RTHD-LVS科研版和临床版对这些病例进行再诊断。以临床诊断作为金标准,比较两种版本诊断与临床诊断的符合率及两种版本诊断的一致性。结果①轴l诊断:RTHD-LVS科研版轴l诊断与临床诊断符合者99例(93.4%),RTHD-LVS临床版轴l诊断与临床诊断符合者100例(94.3%)。RTHD-LVS两种版本对于偏执型和未定型精神分裂症的诊断一致性均较好(Kappa值分别为0.83和0.92)。②其他轴:本组患者中内向人格特征突出73例(68.8%)。病前1年内有肯定的精神刺激作为诱因者20例(18.9%)。最重社会功能损害稍差或更差者106例(100.0%),目前功能稍差或更差者81例(76.4%)。目前评为无效或恶化者40例(37.7%)。结论RTHD-LVS对精神分裂症患者作了全面的定性与定量评估,结果表明两种版本轴1精神障碍的诊断对精神分裂症诊断效度高,且两种版本之间的一致性好。     

Clinical study of schizophrenia--application of jacksonism.

Factors influencing prognosis and relapses in schizophrenia were investigated systematically. The results were agreed with Jacksonism. Data were collected from 166 patients who suffered relapses and were readmitted to hospital from November 15, 1971, to December 31, 1974. The psychiatric symptoms were classified from A to G, positive to negative. The initial symptoms were divided into 4 groups. There was interrelation between the somatic and psychiatric symptoms; in the initial symptoms and prognosis, courses, and psychiatric symptoms. Based on my results, I suggest that an evolutional and hierarchical interpretation, which Jackson emphasized, in the correlation between brain and mind is applicable in the psychopathology of schizophrenia.     

Neurocognitive functioning in dually diagnosed middle aged and elderly patients with alcoholism and schizophrenia

BACKGROUND: Alcohol abuse and dependence have important clinical implications for managing patients with schizophrenia. Alcoholism in schizophrenia patients can interfere with the course and prognosis of the schizophrenic illness. OBJECTIVE: The purpose of the present study was to compare the cognitive status, symptom profile and quality of life of middle aged and older patients (>44 years old) with schizophrenia and alcohol abuse/dependence vs those without alcohol abuse/dependence. We initially hypothesized that more males in this age group with schizophrenia would exhibit alcoholism. We also examined the characteristics of the 45-54 year age group with those of the > or = 55 year old group and hypothesized that comorbidity with alcohol would be associated with worse cognition and quality of life in later life. METHODS: Data were obtained from a database from the Center for Services and Interventions research at the University of California, San Diego. Patients had diagnoses of schizophrenia or schizoaffective disorder. Data collected included demographic characteristics, cognitive status (tested with the Mattis Dementia Rating Scale learning, the Figural and Story Memory Test of the Wechsler Memory Scale-Revised and the California Verbal Learning Test [CVLT]). In addition, patients had undergone psychopathologic assessment and were screened for quality of life using the Quality of Well Being scale. RESULTS: We demonstrated that the older aged patients with alcoholism had worse scores assessing cognition relative to the same aged group without alcoholism. In addition, they had worse cognitive scores relative to the younger group (45-54 year old) with alcoholism. There was no significant difference with regards to quality of life. In addition, more males than females exhibited alcoholism. CONCLUSION: The results are consistent with the premise that the higher cognitive function in the younger schizophrenia patients with alcoholism appear to mask the effects of alcohol use on cognition at that age. However, for the older group of schizophrenia patients, the effects of alcohol use on neuropsychological functioning appear to be deleterious.     

Sleep problems and their correlates and comorbid psychopathology of children with autism spectrum disorders

This study examined sleep problems and their correlates and comorbid psychopathology in children with autism spectrum disorders (ASDs). Participants consisted of 166 ASD children and 111 unaffected siblings aged 4–15 years. Parents completed a self-administered child sleep questionnaire. Of the children with ASDs, 47.0% (78/166) had at least one sleep problem. Children with ASDs were more likely to have bedtime resistance (OR 2.72, 95% CI 1.02–7.21), insomnia (OR 4.07, 95% CI 1.60–10.35), and daytime sleepiness (OR 7.62, 95% CI 1.17–49.38) compared to their unaffected siblings. Among children with ASDs, multivariate logistic regression analyses indicated that communication abnormalities and repetitive stereotyped behaviors were associated with increased risk of sleep problems. ASD children with sleep problems were more likely to have withdrawal problems, somatizing problems, aggressive behaviors, internalizing problems, externalizing problems, and total behavioral problems compared to those without sleep problems. Sleep problems are prevalent in children with ASDs and are associated with both internalizing and externalizing problems. Clinicians should pay close attention to sleep problems when assessing and treating autistic behaviors.     

Is the incidence of schizophrenia declining?: an investigation of the examination rates in the psychiatric clinics of a medical school hospital and a general hospital]

PURPOSE: Some researchers in Europe, America and Oceania have recently reported that the incidence of schizophrenia is declining. We investigated changes in the proportion of schizophrenic patients to the total number of patients in two Japanese hospitals during the last decade. SUBJECTS AND METHODS: The subjects were patients who first consulted the psychiatric clinic of Jichi Medical School or the psychiatric clinic of Kamitsuga General Hospital between December 1993 and November 1994 or between December 2003 and November 2004. Both clinics accepted new patients without prior appointments. Patients were classified using ICD-10 criteria (F0-F9, G40). The sex distribution of the patients and the mean age at first contact were compared for the two time periods. The proportion of schizophrenia (F2 in the ICD-10 criteria) to the total number of patients was compared for the two time periods after standardizing the populations with regard to age using the "1985 model population in Japan." RESULTS: A decade ago, 398 patients first contacted the psychiatric clinic of the medical school hospital, compared with 958 patients in the recent investigation. A decade ago, 166 patients first contacted the psychiatric clinic of the general hospital, compared with 407 patients in the recent investigation. No differences in the sex ratios of the two groups were noted. The mean age of the patients visiting the medical school significantly increased by 3.5 years (36.9 to 40.4 years), while that of the patients visiting the general hospital significantly increased by 10.0 years (46.2 to 56.2 years). The proportion of schizophrenia patients in the medical hospital decreased from 8.5% to 6.9%, while that in the general hospital decreased from 11.0% to 5.4%. Only the change in the proportion of schizophrenia patients at the general hospital was significant. CONCLUSION AND DISCUSSION: The facts that the mean age of first-contact patients has risen and that the number of first-contact patients has increased approximately 2.5-fold suggests a change in the composition of first-contact patients in the last decade. We have some reservations regarding the comparison of these two groups. Although the actual number of first-contact patients with schizophrenia increased in both clinics, we found that the proportions of schizophrenia patients decreased in both clinics after standardizing the populations with regard to age. This finding must be investigated in view of other factors, including the overall age distribution of first-contact patients, increases in the proportions of affective disorders and organic mental disorders, and so on.     

Cerebral phosphate metabolism in first-degree relatives of patients with schizophrenia

OBJECTIVE: Most phosphorus-31 magnetic resonance spectroscopy ((31)P-MRS) studies have described measures of lower membrane anabolism or greater catabolism in the frontal lobes of patients with schizophrenia. The purpose of the present study was to evaluate whether these findings can also be detected in young subjects at genetic risk for schizophrenia. METHOD: Fourteen children and siblings of patients with schizophrenia (mean age=16.7 years) and 14 comparison subjects (mean age=16.9 years) were included in a (31)P-MRS study of the frontal lobe. RESULTS: The high-risk subjects had significantly lower mean ratios of phosphomonoesters to phosphodiesters (0.25 versus 0.31) and higher mean phosphodiester values (37.59% versus 34.87%) than comparison subjects. CONCLUSIONS: These findings suggest greater phospholipid breakdown even in young first-degree relatives of patients with schizophrenia. This suggestion is discussed with respect to the membrane phospholipid hypothesis of schizophrenia.     

Fertility of patients with schizophrenia,their siblings,and the general population: a cohort study from 1950 to 1959 in Finland

OBJECTIVE: Genetic factors are the most important risk factors for schizophrenia. However, despite the fact that patients with schizophrenia have significantly fewer offspring than the general population, schizophrenia persists. The authors investigated whether the siblings of patients with schizophrenia produce more offspring, thereby compensating for the low fertility of the affected individuals. METHOD: From all 870,093 individuals born in Finland from 1950 to 1959, the authors determined how many had schizophrenia or were siblings of schizophrenia patients and how many offspring they had. The population data were obtained from the Population Register Center of Finland, and the National Hospital Discharge Register was used to identify all persons who had been hospitalized because of schizophrenia. Appropriate regression models were used to model age at the birth of the first child, number of children, and proportion of males among offspring. RESULTS: Of the total population, 1.3% were patients with schizophrenia, and 2.8% were their siblings. The mean number of offspring among female siblings was slightly but significantly higher than among women in the general population (1.89 versus 1.83), while the opposite was true for the male siblings (1.57 versus 1.65 among men in the general population). The mean number of offspring among patients with schizophrenia was 0.83 for women and 0.44 for men. CONCLUSIONS: Lower than average fertility among patients with schizophrenia is not compensated for by higher fertility among their siblings. Thus, the persistence of schizophrenia in the general population is not explained by this simple evolutionary mechanism.