10例待分类的精神病性障碍资料分析

我们以广州市相关医疗单位在司法精神病鉴定中诊断的待分类的精神病性障碍为对象,对他的临床特征进行分析,报告如下。     

精神病性症状和非精神病性症状

介绍精神病性症状与非精神病性症状的来源及精神症状的组合与诊断.     

精神分裂症,偏执性精神障碍自杀行为与抗精神病药治疗关系的病例…

本文回顾性分析了３６例精神分裂症或偏执性精神障碍性住院自杀病人的精神药物治疗，既往病史及有关精神症状资料，并与同期住院的３６例匹配对照者进行比较。结果显示，自杀组的既往自杀未道次数，抑郁症状及阴性症状九明显多于对照组；而抗精神病药剂量则显著低于对照组。     

精神分裂症、偏执性精神障碍自杀行为与抗精神病药治疗关系的病例对照研究

本文回顾性分析３６例精神分裂症或偏执性精神障碍住院自杀病人的精神药物治疗、既往病史及有关精神症状资料，并与同期住院的３６例匹配对照者进行比较。结果显示，自杀组的既往自杀未遂次数、抑郁症状及阴性症状项目数明显多于对照组；而抗精神病药（ＡＰＤ）剂量则显著低于对照组。逐步Ｌｏｇｉｓｔｉｃ回归分析结果提示，抑郁症状、阴性症状及低ＡＰＤ剂量是精神分裂症或偏执性精神障碍自杀病人的三个非依赖性危险因素。     

癫痫性分裂样精神障碍与精神分裂症的临床特征对比分析

癫痫性分裂样精神障碍较为常见，极易误诊为精神分裂症。为探讨癫痫性分裂样精神障碍的临床特征，我们将其与精神分裂症进行对比分析。现报道于后。     

偏执性精神病与偏执型精神分裂症的临床特点比较

目的　探讨偏执性精神病与偏执型精神分裂症的临床表现差异。　　方法　比较 65例偏执性精神病与 1 0 3例偏执型精神分裂症的临床特点。　　结果　偏执性精神病发病年龄较大 ,起病缓慢 ,病程冗长 ,疗效较差。　　结论　两者临床特点存在明显差异。     

伴精神病性症状情感性精神障碍的随访观察

目的　探讨伴精神病性症状的情感性精神障碍（ Ｐ Ａ Ｄ） 的预后。方法　对６５ 例 Ｐ Ａ Ｄ 及６９ 例不伴精神病性症状的情感性精神障碍（ Ｎ Ｐ Ａ Ｄ） 进行３ ～６ 年随访,调查其再入院及转归情况。并比较其在人口学特征、疾病表现等方面的异同。结果　４６ ．６７ ％的躁狂症,４４ ％ 的抑郁症及５２ ．１７ ％ 的双相情感障碍都伴发精神病性症状。 Ｐ Ａ Ｄ 与 Ｎ Ｐ Ａ Ｄ 在人口统计学,疾病对目前生活、工作的影响等方面无显著差异。有１８ ．９ ％ 的 Ｐ Ａ Ｄ 再入院诊断改变为精神分裂症,它们有如下特征：起病年龄较小,平均住院日较长,再入院次数较多,伴与情感不一致的妄想症状较多。结论　 Ｐ Ａ Ｄ 是一种常见疾病。 Ｐ Ａ Ｄ 与 Ｎ Ｐ Ａ Ｄ 在预后上无显著差异。有１８ ．９ ％ 的 Ｐ Ａ Ｄ 再入院诊断改变为精神分裂症。     

癫癎性精神分裂症样精神病的临床资料分析

目的探讨癫疴性精神分裂症样精神病的临床特征和预后。方法69例瘢疴性精神分裂症样精神病患者的。临床资料进行回顾性分析。结果癫疴性精神分裂症样精神病患者86．96％为缓慢起病,精神病性症状出现于癫疴发作11.9年之后,88．4％的患者在癫疴发作控制和发作减少之后出现精神病性症状,76．8％患者的异常脑电图恢复正常或得到改善。临床精神症状以思维障碍和幻听为主。33％的患者有智能低下。结论良性病程,不呈精神分裂症性衰退,愈后无精神分裂症的残留症状。     

服刑能力鉴定中拘禁性精神障碍与精神分裂症对照分析

目的了解服刑能力鉴定中精神分裂症与拘禁性精神障碍的差异。方法回顾性调查60例拘禁性精神障碍与130例精神分裂症,就服刑相关资料、病情特点、服刑能力两组间进行比较。结果拘禁性精神障碍女性比例较高、羁押至发病时间短（P描〈0．05）,刑期较短、起病急、病程短、出现睡眠障碍较多、思维散漫少见、症状内容多与拘禁相关（P描〈0．01）;精神分裂症慢性起病较多、病程长,幻觉妄想、思维散漫、情感不协调、无自知力及无服刑能力较多（P描〈0．01）,Logistic回归分析发现,男性、羁押至发病时间及病程长、思维散漫、妄想及情感不协调是精神分裂症的危险因素。结论拘禁性精神障碍与精神分裂症有不同的特点,性别、羁押至发病的时间、病程、是否存在思维散漫及妄想、情感协调性是两者鉴别的要点。     

“未特定的精神病性障碍”的访谈与诊疗

一位男性建筑工人,20岁出头,中学学历,目前正在住院治疗,因为害怕在得不到救助的时候死掉,所以拒绝出院。患者反复表现出惊恐症状、担心自己在劫难逃、害怕死亡并且脸上有刀割感。他先前使用抗焦虑药物治疗无效,而使用电抽搐治疗获得短期疗效。数年前,他是毒品滥用者,在使用毒品时出现过严重的幻觉,现已戒毒5年。医生的诊断是未特定的精神病性障碍,伴物质滥用缓解期,患者的严重程度还没有达到精神分裂症的诊断标准。在干预措施上,给患者处方抗精神病药并预防再次接触毒品,并叮嘱患者在工作中操作重型机械时谨防事故,因为服用阻断多巴胺受体的药物会影响其认知和运动技能。     

Acute and transient psychotic disorder: comorbidity with personality disorder

A study sample of 51 patients with acute and transient psychotic disorder (ATPD) (ICD-10) is presented. The findings suggest that, in hospital settings, ATPD is a non-frequent condition with onset in early adult life and most often associated with female sex, good premorbid social functioning and no or minor/moderate psychosocial stressors. The DSM-IV criteria distribute the patients into three diagnostic categories: schizophreniform disorder (41%), brief psychotic disorder (33%) and psychotic disorder not otherwise classified (25%). A high prevalence (63%) of personality disorders (PD) is revealed after recovery from the psychotic episode. The ATPD is not related to any specific PD, and in a substantial minority (37%) of cases no PD is found. The unspecified category is by far the most frequent PD in patients with ATPD. The sample will be followed up and reassessed.     

Acute and transient psychotic disorder: a 1-year follow-up study

A study sample consisting of 51 patients suffering from acute and transient psychotic disorder (ATPD) (ICD-10) on initial examination was evaluated at 1-year follow-up. The findings show a diagnostic change in half of the patients (48%), most often to schizophrenia (15%) and affective disorder (28%). From index admission to follow-up, patients with an unchanged diagnosis of ATPD manage fairly well with regard to psychosocial functioning, and no deteriorating development is observed. In the majority of cases no personality disorder (PD) (ICD-10, 54%; DSM-IV, 71%) is apparent, and the ATPD is not related to any specific PD. With regard to diagnostic stability, no significant demographic, social or clinical predictors were found. The findings highlight the need for validation of the concept of ATPD, and point to the fact that brief psychotic episodes with an acute onset may be an early manifestation of severe mental disorder (schizophrenia and affective disorder).     

气功所致精神病与精神分裂症的临床特征对照研究

目的　比较气功所致精神病与精神分裂症的临床特征。方法　比较分析按CCMD - 2诊断为气功所致精神病 84例、气功所致精神分裂样障碍 4 4例和精神分裂症 37例的临床特征。结果　气功所致精神病平均发病年龄大于精神分裂症。三组BPRS总分均值比较 ,说明初次精神病发作时症状严重程度没有差别。抗精神病药平均日剂量 ,气精组 <分裂样组 <分裂症组 ,而显效率分别为 88.1%、75 .0 %、32 .4 %。结论　气功所致的精神病初次发作严重程度与分裂症没有明显差异 ,且抗精神病药物能有效地控制其精神病发作 ;短期治疗效果比分裂症要好 ;发病有独特的文化基础与病因。如果属于气功诱发精神分裂样精神障碍 ,而短期内又不能确诊者 ,笔者倾向于诊断为精神分裂症 ,而临床表现和精神障碍内容是气功所致精神障碍和精神分裂症的早期诊断参考指标     

A family study of psychotic symptomatology in schizophrenia,schizoaffective disorder,unipolar depression,and bipolar disorder

Summary An evaluation was made of schizophrenics (140), schizoaffectives (40), unipolar depressives (59), and bipolars (30), and their relatives who had a chart diagnosis of psychosis or depressive neurosis. The purpose was to determine whether the psychosis (delusions and hallucinations) was transmitted independently of the illness itself. If this were true, there would be an excess of pairs of probands and relatives both positive for psychosis and pairs of relatives and probands both negative for psychosis when compared to relatives and probands who were not concordant for the variable. This was found to be true in schizophrenia and schizoaffective disorder and is probably the result of the simple transmission of an illness which includes the presence of psychotic symptoms in the definition. Thus, this would be a manifestation of the genetic propensity in schizophrenia. For the affective disorders there was no evidence that psychotic probands were more likely than the nonpsychotic to have psychotic relatives. So far the reason why some patients have psychosis and others not in the affective disorders remains unexplained.     

Predicting features of later development of schizophrenia among patients with acute and transient psychotic disorder

It is acknowledged that a considerable proportion of patients who have an episode of acute and transient psychotic disorder (ATPD), will develop schizophrenia after the episode is remitted. If features discriminating the patients who later developed schizophrenia from those who underwent a monomorphous ATPD-only course are discerned, they may be useful for predicting the prognosis. The authors performed a chart review study of those who were hospitalized with the diagnosis of ATPD and followed up thereafter for >5 years and compared two subject groups: 10 later-schizophrenia-developing (SD) patients and 15 non-schizophrenia-developing (non-SD) patients. Assessment of the subjects, conducted by two psychiatrist raters blind to the subject groups, included frequency of ATPD episodes, adaptation levels and life events before admission, and psychiatric symptoms before and after admission. The interrater reliability of the assessment proved to be favorable. As a result, early recurrence of psychotic episodes in the follow-up period, lack of acute upsurge of insomnia in an early phase of the episode and poor premorbid heterosexual relations characterized the SD patients. The result indicated heterogeneity of ATPD episodes.     

强迫症与精神分裂症错误相关负电位的比较研究

目的 比较强迫症和精神分裂症患者的错误相关负电位(error-related negativity,ERN).方法 检测21例强迫症患者和19例首发精神分裂症患者的ERN和正确相关负电位(correct-related negativity,CRN),并与23名正常对照进行比较.结果与正常对照组相比,强迫症组ERN波幅增高(Z=-2.60,P＜0.01),精神分裂症组ERN波幅降低(Z=-2.16,P＜0.05)而潜伏期延长(t=3.60,P＜0.01).与强迫症组相比,精神分裂症组的ERN波幅降低(Z=-3.75,P＜0.01)而ERN潜伏期延长(t=2.70,P＜0.05).CRN波幅和潜伏期在三组间差异无统计学意义(P>0.05).无论是强迫症组,还是精神分裂症组,其ERN/CRN指标与临床精神症状之间均未见相关(P>0.05).结论 强迫症和精神分裂症的ERN均存在异常但方向相反,提示ERN可能作为二者鉴别诊断的参考.     

Clinical course and outcome of cycloid psychotic disorder: a three-year prospective study

The course and outcome of cycloid psychotic disorder was explored by means of a prospective three-year follow-up of a sample of patients fulfilling the diagnostic criteria for the disorder provided by Perris & Brockington, compared to patients with a diagnosis of affective or schizoaffective disorder. The most striking difference between cycloids and affectives was the lack of manic episodes during the follow-up period in the former group. Moreover, the mean age at onset was lower in cycloids. No difference between these patient groups was observed with regard to outcome. Compared to schizoaffectives, cycloids showed several differences in the clinical picture during the index episode, and their symptomatological pattern was more consistent from one episode to another during the follow-up. Moreover, the outcome of cycloids was significantly more favourable than that of schizodepres-sives.     

精神疾病患者血清睾酮和雌二醇水平研究

目的：了解首发精神分裂症和情感性精神障碍患者血清睾酮和雌二醇的变化。方法：以放射免疫法对首次发病的５４例精神分裂症患者和３７例情感性精神障碍患者血清中睾酮和雌二醇进行测定,并与正常健康者作对照。结果：男性精神分裂症患者者血清雌 二醇浓度显著高于对照组男性,女性情感性精神障碍患者血清睾酮浓度显著高于对照组和精神分裂症组女性。治疗后女性患者血清雌二醇浓度显著下降,对睾酮浓度影响不大。结论：精神分裂症和