听神经瘤病人抑郁与焦虑状况调查及影响因素分析

目的调查听神经瘤病人的抑郁与焦虑状况并分析其相关影响因素。方法以62例行开颅听神经瘤切除术的病人为研究对象,分别于术前1 d、出院前1 d及出院后6个月,应用Zung抑郁自评量表(SDS)和Zung焦虑自评量表(SAS)评估病人的抑郁及焦虑状况,自制调查表记录人口学特征和疾病特征,面神经功能分级采用House-Brackmann(H-B)分级法。结果病人处于抑郁、焦虑状态在术前、出院前与出院后6个月的例数分别为13例(20.9%)、24例(38.7%)和15例(30.0%,15/50)。术前住院时间长、合并慢性疾病、中青年病人术前容易出现抑郁、焦虑。病人的性别、年龄、面神经功能H-B分级影响出院前及术后6个月抑郁、焦虑的发生率。结论听神经瘤病人手术前后抑郁、焦虑发生率均较高。女性、中青年、面神经功能障碍严重者可能为术后发生抑郁、焦虑的高危病例,应引起重视,必要时给予心理干预或药物治疗。     

听神经瘤患者手术前后焦虑、抑郁及相关因素评估

目的评估颅内听神经瘤患者手术前后的神经心理状态改变,初步分析影响听神经瘤患者情绪变化的相关因素。方法选取2009年3月至2012年3月94例诊断为单侧颅内听神经瘤患者,所有患者均由同一神经外科医生经枕下乙状窦入路进行手术治疗。随访时应用9项病例健康问卷(PHQ-9)和7项广泛性焦虑(GAD-7)自评量表评定患者术后情绪状态及回顾评估术前心理状态,对手术前后患者的抑郁焦虑情况与年龄、性别、肿瘤部位、术后House-Brackmann分级和肿瘤最大直径行Logistic回归分析。结果最终完成有效问卷82例(因不能完成问卷和既往精神疾病史等原因排除12例)。其中,男28例、女54例,平均年龄(47.88±11.05)岁,随访时间(33.83±11.98)个月。情绪量表评定结果显示,术前存在抑郁9/82例(11.0%),焦虑4/82例(4.9%);术后存在抑郁6/82例(7.3%),焦虑3/82例(3.6%)。经Fisher's精确检验,术前有抑郁症状的患者多于术后(x~2=10.09,df=1,P=0.016);Logistic回归分析显示听力障碍改善不佳(P=0.012)和年龄(P=0.044)是术后患者出现抑郁症状的危险因素。结论听神经瘤患者的术前抑郁、焦虑症状在肿瘤切除后可明显改善,随着术后康复时间的延长抑郁状况可进一步好转。对存在听力恶化或高龄患者,及时发现抑郁焦虑症状并予干预,有助于术后恢复。     

自我效能训练联合高频重复经颅磁刺激治疗脑梗死后认知障碍的随机对照研究

目的:探讨自我效能训练联合高频重复经颅磁刺激(repeated transcranial magnetic stimulation,rTMS)对脑梗死后认知障碍患者的认知功能、自我效能水平和心理状况的改善作用。方法:80例脑梗死后认知障碍患者随机分为自我效能训练联合rTMS组和rTMS组(对照组),每组均为40例。2组患者均接受常规治疗(药物治疗和认知康复训练),rTMS组同时接受高频rTMS治疗,自我效能训练联合rTMS组同时接受自我效能训练联合高频rTMS治疗,共治疗4周。治疗前及治疗4周后,采用蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)、一般自我效能感量表(General Self-Efficacy Scale)、Zung抑郁自评量表和Zung焦虑自评量表对患者的认知功能、自我效能水平和心理状况进行评估和比较。结果:2组患者的性别、年龄、病程、病灶侧别、受教育年限以及治疗前的MoCA评分、一般自我效能感量表评分、Zung抑郁自评量表评分和Zung焦虑自评量表评分的差异均无统计学意义(P0.05)。治疗4周后,2组患者的MoCA评分、自我效能水平、Zung抑郁自评量表评分和Zung焦虑自评量表评分与本组治疗前相比,均有显著改善(P0.05)。与rTMS组相比,自我效能训练联合rTMS组患者治疗4周后的MoCA评分、自我效能水平、Zung抑郁自评量表评分和Zung焦虑自评量表评分的改善均较rTMS组更为显著(P0.05)。结论:自我效能训练联合高频rTMS治疗能够改善脑梗死后认知障碍患者的认知功能、自我效能水平和心理状况,且安全性高,有助于提高患者的生活质量。     

原发性三叉神经痛行微血管减压术患者的心理分析及护理

目的 探讨原发性三叉神经痛行微血管减压术患者术前术后的心理特点,为临床治疗和心理护理提供依据.方法 采用Zung焦虑自评量表SAS(Self-Rating Anxiety Scale) 和Zung抑郁自评量表SDS(Self-Raing Depression Scale)对75例三叉神经痛的患者在入院后1～2天及手术后4～5天分别进行评定.结果 入院时SAS为39.25±8.41,SDS为44.89±8.26,入院时与手术后SAS、SDS评分分别比较,差异有显著性.结论 三叉神经痛患者存在明显的焦虑和抑郁心理,通过积极有效的手术治疗、护理干预,可降低和减轻病人的不良情绪,促进疾病的康复.     

脑梗死后患者负性情绪与人格特征研究

目的:探讨脑梗死患者人格特征和脑梗死后负性情绪状况. 方法:用Zung抑郁自评量表(SDS)、Zung焦虑自评量表(SAS)和A型行为问卷(TABQ)对97例脑梗死患者测试,并与正常对照组比较. 结果:①脑梗死患者存在明显的抑郁、焦虑情绪,量表评分显著高于正常人群.②脑梗死患者的A型行为发生率(68.0%)及TABQ总分、TH分和CH分均显著高于正常对照组.③SDS及SAS总分与TABQ总分、TH因子分呈显著正相关,SAS总分与CH因子分呈正相关. 结论:脑梗死患者中常见负性情绪,A型行为可能是脑梗死的高危因素.     

90例初诊Graves病患者抑郁焦虑状态及危险因素探讨

目的对初诊弥漫性甲状腺肿伴甲状腺功能亢进症即Graves（GD）疾病患者并发抑郁、焦虑症状进行分析,并探讨其危险因素。方法收集2008年4～6月就诊于宁夏医学院附属医院内分泌门诊初诊为Graves病患者90人,采用Zung抑郁自评量表（SDS）及焦虑自评量表（SAS）对其抑郁焦虑症状进行评估,记录患者性别、年龄、文化程度、职业、经济状况、家族史、婚姻等一般情况,并检测患者甲状腺功能。采用Logistic回归分析确定抑郁焦虑状态的危险因素。结果初诊Grave病患者抑郁、焦虑状态发生率分别为61.1%（55/90）、52.2%（47/90）,抑郁和焦虑共存的发生率为41.1%（37/90）。TT3水平和文化程度是初诊Graves病合并焦虑的危险因素,TT3水平、职业（分为脑力和体力劳动）、年龄是初诊Graves病合并抑郁的危险因素。结论GD抑郁焦虑患病率高,TT3水平越高、文化程度越低越易并发焦虑;TT3水平越高、从事脑力劳动的年轻患者越易并发抑郁。     

术前心理护理干预对剖宫产手术患者负性情绪、自我效能及满意度的影响

目的探讨术前心理干预对剖宫产手术患者负性情绪、自我效能及满意度的影响。方法选取2015年6月至2016年6月本院收治的220例剖宫产患者,根据随机数字表法将患者分为干预组(n=110)及对照组(n=110),对照组应用围手术期常规性护理,干预组在对照组基础上应用术前心理干预,比较两组患者干预前后负性情绪、自我效能、产后出血、产后抑郁及患者满意度情况。结果干预组干预后焦虑自评量表(Self-rating Anxiety Scale,SAS)、抑郁自评量表(Selfrating Depressive Scale,SDS)均低于对照组(P0.05)。干预组干预后自我效能感评分显著高于对照组(P0.05)。干预组患者术后出血率、产后抑郁发生率显著低于对照组(P0.05),而满意率显著高于对照组(P0.05)。结论术前心理干预能有效提高剖宫产手术患者自我效能,改善产妇焦虑、抑郁情绪,降低产妇产后出血及产后抑郁的发生率,提高产妇满意度。     

大学生网络成瘾后情感障碍与心理治疗

目的 研究大学生网络成瘾后心理状况及心理治疗的疗效.方法 采用Zung氏焦虑自评量表(SAS)及抑郁自评量表(SDS)对大学生网络成瘾发病后及心理治疗后的心理状态进行观察.结果 大学生网络成瘾后焦虑和抑郁的发生率分别为70%和61.66%,经心理治疗,患者的负性情绪水平显著下降,与对照组相比,差异有统计学意义(P<0.05).结论 心理治疗能明显改善大学生网络成瘾后的情感障碍,对大学生网络成瘾后情感障碍的治疗及患者今后生理及心理康复都有积极意义.     

颞叶癫痫患者生活质量及其影响因素的研究

目的观察颞叶癫痫患者生活质量的状况,并探讨社会人口学、临床发作以及焦虑、抑郁等因素对患者生活质量的影响。方法对93例颞叶癫痫患者和100名健康对照者进行生活质量量表-31(QOL-31)、Zung氏抑郁自评量表(SDS)和Zung氏抑郁自评量表(SAS)测定。结果颞叶癫痫患者生活质量各项得分均明显低于健康对照组(P<0.001),焦虑和抑郁自评量表得分均明显高于健康对照组(P<0.001)。多元逐步回归分析显示,影响生活质量的主要因素为抑郁、发作严重程度、焦虑和病程。结论颞叶癫痫患者生活质量存在不同程度下降。发现和治疗颞叶癫痫患者的抑郁、焦虑等精神心理问题以及选择合理治疗方法、控制癫痫发作是提高生活质量、改善预后的重要前提。     

听神经瘤的微骨窗手术切除面神经保护技术探讨

目的探讨听神经瘤微骨窗切除手术中保护面神经的技术,同时对解剖保留的面神经的功能进行进一步评价。方法 130例听神经瘤患者在面神经监测下手术,治疗完成后对手术情况、神经功能分级、术后刺激强度与神经功能预后情况以及并发症发生情况进行评价。结果 130例患者中118例(90.8%)无神经功能障碍,9例(6.9%)存在一定的神经功能障碍,2例(1.5%)存在严重的神经功能障碍,1例(0.8%)生活不能自理。神经功能分级Ⅰ、Ⅱ级60例(47.6%),Ⅲ、Ⅳ级43例(34.1%),Ⅴ、Ⅵ级23例(18.3%)。结论听神经瘤手术时,通过对面神经的监测以及提高手术的熟练度,能够加强对面神经的保护。     

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.     

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.     

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.     

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.     

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.