妄想性与非妄想性抑郁症的临床对照研究

为探讨妄想性与非妄想性抑郁症的临床特征差异,对71例妄想性抑郁症与132例非妄想性抑郁症进行了临床对照研究。结果显示,妄想性抑郁症的精神病家族史、幻觉、自责自罪、绝望、自杀行为等出现率显高于非妄想性抑郁症;妄想性抑郁症的自杀行为危险必理非妄想性抑郁症的1.99倍;妄想性抑郁症可能需联合治疗。提示妄想抑郁症可能抑郁症中的一种独特的亚型,值得进一步探讨。     

分裂样精神病与精神分裂症阴性、阳性症状比较

目的：探讨分裂样精神病与精神分裂症阴性和阳性症状的特点。方法：对49例分裂样精神病与70例精神分裂症患者的阴性和阳性症状作对照研究。结果：两组患者阳性和阴性症状的发生率差异无显著性（P〉0.05）;分裂样精神病组中有妄想症状者明显多于精神分裂症组;而精神分裂症组中情感平淡、思维贫乏等阴性症状者明显多于分裂样精神病（P〈0.01）。结论：分裂样精神病与精神分裂症在阴性、阳性症状方面存在差异。     

不同年代首次住院精神分裂症患者症状学变化

目的:探讨不同年代首次住院精神分裂症患者症状学变化。方法:对1989年、1999年及2009年各128例首次住院的精神分裂症患者精神病性症状进行分析。结果:感知及情感障碍中各症状出现率各组间差异无统计学意义;思维障碍中被害妄想、夸大妄想、罪恶妄想、关系妄想、钟情妄想出现率差异有统计学意义(P0.05或P0.01);与1989年组比较,2009年组被害妄想、关系妄想出现率明显增高,罪恶妄想、钟情妄想出现率明显下降(P均0.05)。结论:随年代变迁,首次住院的精神分裂症患者思维障碍更多为被害妄想及关系妄想。     

妄想、抑郁和自杀行为

采用回了性的方法，分析了81例妄想性和140例非妄想性抑郁症病人的自杀行为，并用122例伴有妄想症状的精神分裂症作为对照，结果表明，妄想性抑郁症的自杀行为的相对危险性是非妄想性抑郁症的2．87倍，但男性病人两者的自杀行为无明显的差异，而女性病人两者的差异非常显著（P＜0．005），精神分裂症的自杀行为远远少于妄想性和非妄想性抑郁症（P＜0．005）。     

妄想性抑郁症与非妄想性抑郁症临床对照研究

对83例妄想性抑郁症和133例非妄想性抑郁症进行临床对照研究。结果表明,妄想性抑郁症在阳性家族史、内倾性格,临床症状中的自责自罪和自杀行为方面显著高于非妄想性抑郁症;治疗时多采用三环抗抑郁剂联合抗精神病药;伴有的妄想依次为罪恶妄想,关系妄想、被害妄想和疑病妄想等。     

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。     

妄想性和非妄想性抑郁症的遗传

目的：探索妄想性抑郁症的遗传情况。方法：对８１例妄想性抑郁症和１４０例非妄想性抑郁症的亲属进行了病历、家访和信函调查。结果：两组病人的亲属所患的精神疾病的总数无明显差异（Ｐ＞０．７５）；妄想性抑郁症病人的亲属所患的情感性精神障碍明显多于非妄想性抑郁症的亲属（Ｐ＜０．０５）；妄想性抑郁症的亲属所患的双相情感障碍也多于非妄想性抑郁症的亲属（Ｐ＜０．０２５）；而两组病人的亲属所患的妄想性抑郁症无明显差异（Ｐ＞０．５）。结论：妄想性抑郁症的亲属比非妄想性抑郁症的亲属易患情感性精神障碍和双相情感障碍     

三环抗抑郁药使妄想型抑郁症恶化

三环抗抑郁药可产生三类精神病反应:1.使精神分裂症恶化;2.诱发躁狂症发作;3.引起精神错乱状态,或中毒性精神病。本文报告另一类情况,即三环抗抑郁药使具有妄想的单相抑症症状恶化。Classman 等观察到有妄想的抑郁症对三环抗抑郁药的反应比无妄想者差。认为有妄想的单相抑郁症似乎属于单相抑郁症的一个     

癫痫性精神分裂样精神病与精神分裂症的对照研究

本文对癫痫性精神分裂样精神病与精神分裂症各52例进行对照分析,结果发现癫痫性精神分裂样精神病患者精神症状出现于癫痫发作9.12年之后;与精神分裂症相比,其精神症状出现年龄较大,发病多无诱因,多为急性、亚急性起病,病前性格外向者较多,其癫痫家族史的比率较高,而其精神病家族史的比率较低,其幻听、思维粘滞、病理性赘述、易激惹的出现率较高,而感知综合障碍、破裂性思维、关系妄想、被害妄想、钟情妄想、情感淡漠、情感不协调、意志行为减退的出现率较低,其抗精神病药用量较低,而疗效与精神分裂症组无显著性差异。最后,对癫痫与精神分裂样精神病的关系进行了讨论。     

多发性脑梗死性痴呆的精神症状及治疗

目的：探讨多发性脑硬死性痴呆（ＭＩＤ）精神症状出现率及特点,以及对抗精神病药物治疗的反应。方法：回顾性分析５６例ＭＩＤ患者的临床资料,并与４８例精神分裂症（ＳＣ）对照。结果：ＭＩＤ有５５．４％出现精神病性症状。多风的症状是意志减退,情感淡漠,妄想和幼觉。抗精神病药治疗阳性症状效果较好,与ＳＣ组无显著差异。副反应并不比ＳＣ病人多。结论：ＭＩＤ伴发精神症状相当常见,其阳性症状抗精神病药治疗可得到很好控     

精神分裂症与分裂情感性障碍的核心特征与治疗

精神分裂症是一种严重的精神障碍,在普通人群中的患病率为0.5%~1.0%,在住院患者中,其比例更高。由于精神分裂症的不同亚型在治疗上并无区别,并且容易给临床诊断造成混乱,因此,DSM-5去除了精神分裂症的亚型。分裂情感性障碍的患病率约为精神分裂症的一半。其症状相当于既有精神分裂症的A组症状,同时又有心境症状,例如重性抑郁或躁狂。诊断此障碍必须符合两个关键标准:(1)在半数以上的病程中,除了存在精神分裂症诊断标准A的症状以外,还伴有重性抑郁发作或躁狂发作;(2)在没有心境发作至少2周(抑郁或躁狂)的情况下,存在持续的妄想或幻觉,即证明这些精神病性症状并非由心境发作所致。     

Psychosis in a pediatric mood and anxiety disorders clinic: phenomenology and correlates

OBJECTIVES: To examine the demographics and phenomenology of psychosis in a sample of children and adolescents referred to a mood and anxiety disorders clinic. METHOD: Patients (N = 2,031) were assessed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present Episode version and classified as definite, probable, or nonpsychotic. Clinical and demographic characteristics of the groups were compared,and symptoms of psychosis were analyzed using factor analysis. RESULTS: Definite psychotic symptoms were seen in approximately 90 (4.5%) patients: 80% of these reported hallucinations (mainly auditory), 22% delusions, and 3.3% thought disorder. Of the patients with definite psychotic symptoms, 24% had bipolar disorder, 41% had major depression, 21% had subsyndromal depression, and 14% had schizophrenia spectrum disorders (schizophrenia and schizoaffective disorders). Factor analysis of the definite psychotic symptoms yielded 4 factors: hallucinations, thought disorder, delusions, and manic thought disorder. Psychotic patients had a higher frequency of comorbid disorders and suicidal ideation than nonpsychotic patients. CONCLUSIONS: Outpatient youngsters with mood disorders frequently present with psychotic symptoms, in particular auditory hallucinations. These patients commonly have comorbid psychiatric disorders and suicidal ideation.     

The relation between emotional awareness and hallucinations and delusions in acute psychiatric inpatients

BACKGROUND: Although negative affect has been frequently implicated in the formation of cognitive and perceptual disturbances ranging from odd perceptions and beliefs to delusions and hallucinations it represents only one of the many aspects of emotional disturbances that may contribute to psychopathology. Surprisingly, no past research has examined in a psychiatric sample whether levels of cognitive-perceptual symptoms are associated with levels of emotional awareness (i.e., attention to emotion and clarity of emotion). In the present study we examined, in an acute psychiatric inpatient sample, the relations between emotional awareness and the severity of delusions and hallucinations. METHOD: Two groups were included: 34 schizophrenia and schizophrenia spectrum disordered inpatients and 30 mood and substance use disordered inpatients. Patients were assessed on emotional awareness (attention to emotion and emotional clarity) and severity of psychiatric symptomatology. RESULTS: We found that lower levels of emotional clarity were associated with more severe hallucination ratings in both groups of patients. Among schizophrenia spectrum patients, lower levels of attention to emotion were also associated with more severe hallucination ratings. Among mood/substance disorder participants, higher levels of attention to emotion were associated with more severe delusion ratings, whereas the opposite pattern was found among schizophrenia spectrum participants. CONCLUSIONS: Consistent with the results of past research using college and community samples, we found that diminished emotional clarity is associated with elevated levels of hallucinations in both mood disorder/substance abuse and schizophrenia spectrum inpatients. We also found that greater attention to emotion was associated with more severe delusions, though only among the mood disorder/substance use group. The present research findings support the role of emotional awareness in hallucination formation and suggest that the factors that contribute to delusions in schizophrenia spectrum patients differ, in part, from the factors that contribute to delusion formation in other groups of individuals.     

Bizarre delusions and first-rank symptoms in a first-admission sample: A preliminary analysis of prevalence and correlates

This report examines the prevalence and correlates of bizarre delusions and Schneider's first-rank symptoms (FRS) in a first-admission sample with psychosis. A total of 196 patients were assessed with the Structured Clinical Interview for DSM-III-R (SCID) and given a consensus diagnosis. Project psychiatrists blind to the consensus diagnoses coded each delusion and hallucination in the sample for both FRS and DSM-III-R bizarreness. Interrater reliability of bizarreness was lower than that of FRS (κ = .681 v 861). The majority of symptoms (72%) were neither bizarre nor FRS, and of the remainder, bizarre delusions that were not also FRS were extremely uncommon. The prevalence of FRS was 70% in schizophrenia, 29% in psychotic bipolar disorder, and 18% in psychotic depression. For seven schizophrenic patients (7.45%), diagnosis of that disorder depended on the presence of a DSM-III-R bizarre delusion to meet criteria. There was a trend for FRS to be associated with poorer prognostic features in the schizophrenic sample. We concluded that although the constructs of bizarre delusions and FRS overlap, FRS were a more important feature in schizophrenia than bizarreness. The rarity of bizarre delusions that were not FRS, combined with the lower reliability of their assessment as compared with that of FRS, raises questions about the continued emphasis on this phenomenon in the definition of schizophrenia.     

幻觉、妄想在精神分裂症中的诊断价值

目的:探讨幻觉、妄想在精神分裂症中的诊断价值。方法:采用临床流行病学方法,在患者入院后2周内以半定式、盲法评定幻觉、妄想。分别按《中国精神障碍分类与诊断标准》第3版和幻觉、妄想进行诊断,并计算诊断的效度与信度指标。结果:幻觉、妄想出现频率精神分裂症组明显高于非精神分裂症组(P0.01)。幻觉、妄想诊断精神分裂症的Youden指数为0.36,Kappa值为0.43,有10.4%漏诊率和53.8%的误诊率。其中,与心境不协调妄想的诊断效度稍好,Youden指数为0.62,有38.5%漏诊率和10.3%的误诊率,但Kappa值只有0.38。结论:仅凭幻觉、妄想诊断精神分裂症较片面,主张横向症状学与纵向预后观察相结合诊断。     

高抗素对精神分裂症幻觉妄想的疗效观察

目的：探索高抗素治疗精神分裂症幻觉妄想的效果。方法：随机选择符合ＣＣＭＤ－２－Ｒ诊断的偏执型精神分裂症患者住院病例１４例，门诊病例１６便，合计３０例。采用保留病人的原有抗精神病药和半量联合高抗素的治疗方法。３个月为一疗程。结果：经过一个疗程的观察，经联合应用高抗素皇２８例具有幻觉的病便中２２便显效，幻觉消失率达７８．６％，６例无效；２４例具有妄想的病例中１６例显效，妄想消失率为６６．６％，其中真属     

Long-term follow-up and phenomenologic differences distinguish among late-onset schizophrenia, late-life depression, and progressive dementia.

OBJECTIVE: The diagnosis of patients with late-life onset of hallucinations and delusions but an absence of mood or cognitive disorder remains controversial. The authors used long-term follow-up and phenomenology to assess whether outcome varied by diagnosis. METHODS: Twenty-eight individuals with late-life psychosis but no mood or cognitive disorder were compared with 48 individuals with late-life major depression and 47 individuals with psychotic symptoms and late-life dementia. All subjects were followed for a minimum of 1 year. Data from the last time examined were used to determine likelihood of death at 84 months by Kaplan-Meier analysis in all groups and the likelihood of developing dementia in the depression and late-life onset psychosis groups at 120 months. RESULTS: Patients with dementia-plus-psychosis were more likely to die at 84 months than those with major depression or late-onset hallucinations and delusions. Subjects with depression or late-onset hallucinations and delusions did not differ in likelihood of developing dementia at 120 months. CONCLUSIONS: These results support the hypothesis that a condition characterized by psychiatric symptoms and no mood symptoms can begin in later life and that this disorder is not a precursor to dementia.     

躁狂症与精神分裂症妄想特征比较

目的：比较躁狂症与精神分裂症妄想特征及病理机制的差异。方法：用自编妄想特征调查表对躁狂症和精神分裂症患者各56例的妄想特征进行比较。结果：精神分裂症最多见的被害、关系妄想；躁狂症患者最多见夸大妄想，其次为被害、关系妄想。两者的持续时间，隐蔽性、协调性、稳定性以及伴随症状均有差异。结论：精神分裂症与躁狂症患者妄想特征及病理心理机制可能不同。     

Delusions and suicidality

OBJECTIVE: Delusions have been considered a risk factor for suicidal behavior. To determine whether specific delusion types are related to suicidal behaviors, the authors compared the clinical characteristics of patients with mood disorders and schizophrenia who did and did not have a history of suicide attempts. METHOD: After admission for inpatient or outpatient psychiatric treatment, 429 patients (ages 14-72 years; 47.1% male; and 73.0% Caucasian) were assessed with a structured clinical interview that generated axis I and II diagnoses. In addition, their psychiatric symptoms, history of suicide attempts, and overall functioning were rated. RESULTS: Data for three diagnostic subgroups (223 patients with major depression, 150 with schizophrenia, and 56 with bipolar disorder) were analyzed separately. Multivariate analyses did not find evidence of a relationship between delusions and history of suicidal ideation or suicide attempts in any of the diagnostic groups. CONCLUSIONS: This study did not find evidence that the presence of delusions distinguished persons with or without a history of suicide attempt.     

Cross-sectional similarities and differences between schizophrenia, schizoaffective disorder and mania or mixed mania with mood-incongruent psychotic features.

BACKGROUND: The cross-sectional clinical differentiation of schizophrenia or schizoaffective disorder from mood-incongruent psychotic mania or mixed mania is difficult, since pathognomonic symptoms are lacking in these conditions. AIMS OF THE STUDY: To compare a series of clinical variables related to mood and cognition in patient groups with DSM-III-R diagnosis of schizophrenia, schizoaffective disorder, mood-incongruent psychotic mania and mood-incongruent psychotic mixed mania. METHODS: One hundred and fifty-one consecutive patients were evaluated in the week prior to discharge by using the structured clinical interview for DSM-III-R-patient edition (SCID-P). Severity of psychopathology was assessed by the 18-item version of the brief psychiatric rating scale (BPRS) and negative symptoms by the scale for assessment of negative symptoms (SANS). Level of insight was assessed with the scale to assess unawareness of mental disorders (SUMD). RESULTS: There were no differences in rates of specific types of delusions and hallucinations between subjects with schizophrenia, schizoaffective disorder, psychotic mania and psychotic mixed mania. SANS factors scores were significantly higher in patients with schizophrenia than in the bipolar groups. Patients with mixed state scored significantly higher on depression and excitement compared to schizophrenia group and, to a lesser extent, to schizoaffective group. Subjects with schizophrenia showed highest scores on the SUMD indicating that they were much more compromised on the insight dimension than subjects with psychotic mania or mixed mania. CONCLUSION: Negative rather than affective symptomatology may be a useful construct to differentiate between schizophrenia or schizoaffective disorders from mood-incongruent psychotic mania or mixed mania.