广东中山市精神疾病流行病学调查

目的 了解中山市精神疾病流行病学情况。方法 采用WHO提供,1982年和1993年两次全国精神疾病流行病学调查使用的方法,对中山市城乡3721人行社会人口学调查及15岁以上人口精神疾病患病情况调查。结果 中山市精神疾病(不含神经症和海洛因依赖)时点患病率26.13‰,终生患病率为29.91‰;两者明显高于1993年中国七地区精神疾病流行病学调查结果(相应为11.18‰和13.74‰,P均小于0.01)。神经症(均为现患病例)的时点患病率为29.70‰,海洛因依赖终生患病率为7.56‰。结论 中山市精神分裂症和精神发育迟滞仍居前两位,而酒依赖、情感性精神障碍、脑器质性眠精神障碍及镇静眠药物依赖患病率升高,神经症、海洛因依赖患病率居国内较高水平,应列为防治和研究的重点。     

桂林市农村地区精神疾病流行病学调查

目的:了解桂林市15岁以上农村居民各类精神疾病的患病水平和分布特征。方法:2007年7月至12月采用多阶段分层整群抽样方法随机抽取桂林市3个县2800名15岁以上农村居民为对象进行入户调查。以中国疾病预防控制中心精神卫生中心提供的中文版复合性国际诊断问卷为筛查工具,以国际疾病及相关健康问题分类第10版为诊断标准。结果:完成调查2628人,调查完成率93.9%。桂林农村15岁以上人群精神疾病的总时点患病率23.59‰,总终生患病率29.30‰。终生患病率前3位病种为酒依赖(11.42‰)、精神分裂症(8.37‰)和抑郁症(7.61‰)。农村地区女性终生患病率为20.56‰,低于男性的38.70‰(χ2MH=6.969,P=0.008)。酒依赖终身患病率在55～74岁年龄段和壮族人群中患病率较高结论:酒依赖、精神分裂症和抑郁症是桂林市农村地区精神疾病防治重点。     

广西壮族自治区城市居民精神疾病流行病学调查

目的了解广西壮族自治区≥15岁城市居民各类精神疾病的患病率和分布特征。方法 2007年7～12月采用多阶段分层整群抽样方法随机抽取6个地级市7380名≥15岁的城市居民为调查对象进行入户调查。以复合性国际诊断问卷(CIDI3.0)为筛查工具,以国际疾病及相关健康问题分类第10版(ICD-10)为诊断标准。结果完成调查7028人,调查完成率为95.23%。广西城市居民精神疾病总时点患病率和总终生患病率分别为1.86%和2.31%.按终生患病率高低排列,广西城市居民前三位特定精神疾病是精神分裂症(1.07%)、抑郁障碍(0.54%)和酒依赖(0.19%)。总终生患病率女性(1.72%)低于男性(2.95%),差异有统计学意义(RR=0.56,95%CI:0.41～0.77,P0.01)。抑郁障碍患病率在离婚人群患病率较高(P0.01);不同的年龄段、文化程度、婚姻状况和职业等亚组的精神分裂症患病率差异均有统计学意义(P0.05),25～44岁、初中与小学及以下文化、未婚与离婚、无业等人群的患病率较高;初中文化程度者和离婚人群的酒依赖患病率较高(P0.05)。结论精神分裂症、抑郁障碍和酒依赖是广西城市居民主要精神疾病,应针对其患病高发人群开展防控干预工作。     

济宁市农村精神疾病流行情况再调查的结果及其比较

为掌握我市农村精神疾病患病情况及其相关因素,并与１９８４年资料进行对照研究。方法 依据精神疾病流行病学调查的有关内容,对１９８４年三个样本县进行复调。结果 各类精神疾病总患病率为１０．３５‰,时点患病率为９．４１‰,其中精神分裂症患病率３．６２‰,情感性障碍０．２５‰,脑因管疾病所致精神障碍０．００‰,人格障碍１．０４‰。结论 除脑血管疾病所致精神障碍,人格障碍有显著性差异外,总患病率,时点患病率     

上饶市精神疾病流行病学调查

目的　了解上饶市精神疾病流行病学情况。方法　采用初级单位含量比例分层、整群、随机的抽样方法 ,以ICD 10、CCMD 3为诊断标准 ,以《复合性国际诊断检查》(CIDI)为筛查和诊断工具 ,以社会功能缺陷筛选量表 (SDSS)、成人智残评定量表、儿童韦氏智力量表 (C WISC)、克来顿修定行为量表(CRBRS)、日常生活能力量表 (ADL)、Hachinski缺血指数量表 (HIS)及我国残疾定义和分级标准为评定工具。结果　各类精神疾病时点患病率为 2 5 2 5‰ ,终生患病率为 31 6 6‰ ,排前三位的为精神分裂症、酒依赖、心境障碍。残疾率为 13 19‰。结论　精神分裂症仍然是防治和研究的重点疾病 ,酒依赖、心境障碍的患病率升高     

温州地区精神疾病流行病学调查

目的 了解温州地区精神疾病的流行病学情况。方法 采用初级单位含量分层,整群,随蛩塑垫登玄法及线索调查。以ICD-10,CCMD-3为诊断标准,以精神卫生筛选表,神经症筛选表社会粤能缺陷筛选量表（SDSS）。老年痴呆量表为评定工具。结果 各类精神疾病时点患病率为30．81‰,苎竺璺尊堂垄34.50‰;排前三位的是精神分裂症,酒依赖,心境障碍。结论 精神分裂症仍是防治和研究的重点疾病,酒依赖,心境障碍的患病率升高。     

潍坊市精神疾病流行学十年对照研究

对潍坊市1984年精神疾病流行学调查样本区进行10年追踪调查发现,各类精神疾病患病率上升至15.04‰(1984年7.63‰)。5年平均发病率上升至0.92‰(1984年0.40‰)。以精神分裂症、精神发育迟滞和Alzheimer老年型患病率升高最为显著。     

威海市精神疾病流行病学调查

目的：了解威海市≥15岁人群各类精神疾病的患病率和分布特点。方法：2006年9月至2007年2月随机抽取≥15岁人群共50174人，使用心理卫生筛选表、神经症筛选表、精神现状检查（PSE）140题等工具进行调查，以中国精神疾病分类方案与诊断标准第3版为诊断依据。结果：各类精神障碍的时点患病率为70．34‰，终生患病率为89．51‰。排在前3位的为抑郁症（37．49‰）、神经症（30．06‰）和酒依赖（11．38‰）。农村患病率（93．22‰）高于城市（84．30‰），女性（95．27‰）高于男性（83．82‰）。3种精神疾病均存在较高的未识别率，且农村高于城市。结论：山东威海市精神疾病的患病率以女性和农村较高；抑郁症是威海市患病率最高的精神疾病。     

中国七个地区精神疾病流行病学调查

目的了解９０年代各类精神障碍患病率及与１９８２年比较的变动情况。方法由１９８２年调查协作组中的７个单位，于１９９３年在７个原抽样地区进行流行病学调查，方法与１９８２年基本相同。结果各类精神障碍（不含神经症）时点患病率１１．１８‰，终生患病率１３．４７‰；与１９８２年比较，均有所上升。结论精神分裂症和精神发育迟滞患病率仍居前两位，而酒依赖、情感性精神障碍、阿尔茨海默病和脑血管病所致精神障碍患病率升高，均应列为防治和研究的重点     

汕头市精神分裂症流行病学调查

采用全国精神疾病流调统一方法，调查了汕头市城乡户口各５００户，１５岁以上总人口３３２０人，查出精神分裂症３１例，现患２６例，总患病率９．３４‰，时点患病率７．８３‰，标化率７．８１‰，高于全国１２地区精神分裂症平均患病率。调查结果发现，经济发达地区精神分裂症患病率高，而经济水平低，无支持系统者有较高的患病率。     

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.