儿童青少年思维形式障碍的相关研究

思维形式障碍是思维障碍的一种,常见于精神分裂症;目前针对儿童青少年思维形式障碍的研究国内尚缺,本文就国外的研究现状作一综述。     

躯体形式障碍的评估方法

本文通过查阅有关躯体形式障碍的近期相关文献,对评估方法的研究情况予以综述。     

创伤后应激障碍评估量表综述

对创伤后应激障碍(Posttraumatic stress disorder,PTSD)进行及时、准确的评估和诊断,有助于对PTSD的早期识别和治疗。目前临床上PTSD的评估量表种类很多,主要包括筛查量表和诊断量表两类,不同量表的编制原理和使用方法不尽相同。本研究就常用评估量表进行总结。     

蒙特利尔认知评估量表和简易精神状态量表在帕金森病轻度认知功能障碍筛查中的应用

目的探讨蒙特利尔认知评估量表(MOCA)和简易精神状态量表(MMSE)在帕金森病轻度认知功能障碍(PDMCI)筛查中的应用。方法采用随机抽样方法,应用MOCA和MMSE对75例诊断为PDMCI患者、帕金森病认知功能正常(PDN)患者180例和健康患者145例进行评估,比较二者筛查PDMCI的敏感性和特异性。结果在文盲组MMSE的敏感性为93.10%,特异性为100%,而MOCA的敏感性仅为0%,特异性为92.72%;在小学组MMSE的敏感性为87.50%,特异性为100%,而MOCA的敏感性为41.67%,特异性为79.17%;在初中及以上学历组MMSE的敏感性为27.27%,特异性为100%,MOCA的敏感性为90.91%,特异性为85.71%。结论 MOCA适合初中及以上学历的PDMCI筛查工具,MMSE适合初中以下学历PDMCI筛查工具。     

儿童焦虑性情绪障碍筛查量表的临床应用

目的研究儿童焦虑性情绪障碍筛查量表SCARED在儿童及青少年情绪障碍中的应用。方法随机抽取上海市精神卫生中心儿童心理门诊符合CCMD-3诊断标准的焦虑症患儿35例,多动障碍患儿31例,随机抽取上海市某中小学45例健康儿童为对照组。研究组患儿及父母均填写SCARED量表,对照组填写SCARED量表并在一周后重测,多动症组评估SCARED量表。结果研究组SCARED量表总分及各因子分均分别显著高于对照组、多动症组。患儿自评与父母评定的相关系数在0．618至0．839之间。重测信度在0．451～0．872之间,各因子分与总分相关系数在0．331～0．852之间,Cronbach‘s a系数在0．2331至0．8032之间。SCARED量表总分与焦虑自评量表总分相关系数为0．661。结论SCARED量表信、效度良好,可作为临床辅助诊断及科研的筛查工具。     

躯体形式障碍患者躯体症状自评量表与SCL-90躯体化因子的相关性

目的探讨躯体症状自评量表(SSS)与症状自评量表(SCL-90)躯体化因子是否存在相关性。方法收集符合《精神障碍诊断与统计手册(第4版)》(DSM-IV)诊断标准的躯体化障碍和未分化型躯体形式障碍患者25例,采用自制一般情况调查表、SSS和SCL-90躯体化因子进行记录和评定,将受试者SCL-90躯体化因子评分与中国常模进行比较,分析SCL-90躯体化因子和SSS的相关性。结果受试者SCL-90躯体化因子评分高于中国常模水平[(12.28±7.63)分vs.(1.37±0.48)分,t=7.15,P0.01];躯体化严重程度指数(SSI)和症状数分别为(154.04±38.97)分和(18.0±13.0),SCL-90躯体化因子评分与SSS中的SSI和症状数均呈正相关(r=0.750,0.730,P均0.01)。结论 SSS可作为评估SFD的工具,是SCL-90躯体化因子的补充。     

蒙特利尔认知评估量表在轻度认知功能障碍中的应用

目的探讨蒙特利尔认知评估量表在轻度认知功能障碍患者中的应用。方法测试年龄及教育程度相匹配的42例MCI患者及39例正常对照组进行MoCA测查。结果与对照组（27.36±1.38）相比,MCI组的MoCA总分（23.93±3.69）更差,差异有统计学意义（P〈0.01）;MCI组在命名、语言及定向方面与对照组无明显差异（P〉0.05）。MCI组在视空间与执行功能（HC 4.46±0.78,MCI 3.57±1.23）、注意（HC 5.95±0.22,MCI 5.61±0.73）、抽象思维（HC 1.61±0.54,MCI1.21±0.68）及延迟回忆（HC 3.54±0.88,MCI 1.97±1.20）方面,均较对照组更差,差异有统计学意义（P〈0.01）。结论MCI患者不仅在记忆上较正常人差,可能在视空间与执行功能、注意、抽象思维方面存在损害。MoCA量表对MCI患者各认知方面可起到初筛作用。     

蒙特利尔认知评估量表在血管性认知功能障碍中的应用

目的 探讨蒙特利尔认知评估(MoCA)量表(中文版)在血管性认知功能障碍(VCI)中的应用.方法 选择166例具有脑血管病危险因素或脑血管疾病患者,根据VCI诊断标准分为无认知功能障碍(NCI)组(52例)、无痴呆的血管性认知功能障碍(VCIND)组(76例)及血管性痴呆(VD)组(38例),分别给予MoCA量表和简易精神状态检查(MMSE)量表测试.结果 将认知功能障碍MoCA分界值定为26分时,VCIND组MoCA的敏感性为90.79%,MMSE为26.31%;VD组MoCA的敏感性为100%,MMSE为86.84%;MoCA和MMSE特异性分别为84.62%和100%.结论 与MMSE量表相比,MoCA量表更适用于VCI的筛查.     

蒙特利尔认知评估量表在轻度认知功能障碍筛查中的应用

目的 探讨蒙特利尔认知评估量表(MoCA)在轻度认知功能障碍(MCI)患者筛查中的应用.方法 应用简易精神状态检查量表(MMSE)、MoCA对32例MCI患者和50例健康对照者进行神经心理评估,比较二者筛查MCI的效果.结果 以26分为分界值,MoCA筛查MCI的敏感性为96.87%、特异性为76%,MMSE筛查MCI的敏感性为56.25%、特异性为96%;MoCA中除抽象思维、地点定向两项外,其余各亚项的评分在MCI组和对照组间差异均有统计学意义(P＜0.05):MMSE中仅计算与注意力、延迟回忆两项在MCI组和对照组间差异有统计学意义(P＜0.05),其余各项差异均无统计学意义(P＞0.05).结论 MoCA为高敏感性的MCI筛查工具,能全面评估MCI患者的认知功能.且可用于筛查MMSE得分正常的MCI患者.     

Continuity of formal thought disorder from childhood to adulthood in a high-risk sample

Within a longitudinal prospective study of children of schizophrenic mothers, premorbid, childhood levels of formal thought disorder correlated positively with measures of formal thought disorder obtained in adulthood. It is therefore concluded that schizophrenic symptomatology develops by gradual accretion and that schizophrenia is not a sudden, unexpected disease. Orthogonal factor analysis of formal thought disorder measures obtained in adulthood revealed two factors: one reflecting vague and drifting thinking, and the second relating to the richness of speech.     

Abnormal object recall and anterior cingulate overactivation correlate with formal thought disorder in schizophrenia.

BACKGROUND: The neural basis of formal thought disorder (FTD) is unknown. An influential theory is that FTD results from impaired semantic memory processing. We explored the neural correlates of semantic memory retrieval in schizophrenia using an imaging task assessing semantic object recall. METHOD: Sixteen healthy control subjects and sixteen schizophrenia patients whose FTD symptoms were measured with the Thought Disorder Index completed a verbal object-recall task during functional magnetic resonance imaging. Participants viewed two words describing object features that either evoked (object recall) or did not evoke a semantic concept. RESULTS: Schizophrenia patients tended to overrecall objects for feature pairs that did not describe the same object. Functionally, rostral anterior cingulate cortex (ACC) activation in patients positively correlated with FTD severity during both correct recalled and overrecalled trials. Compared with control subjects, during object recalling, patients overactivated bilateral ACC, temporooccipital junctions, temporal poles and parahippocampi, right inferior frontal gyrus, and dorsolateral prefrontal cortex, but underactivated inferior parietal lobules. CONCLUSIONS: Our results support impaired semantic memory retrieval as underlying FTD pathophysiology. Schizophrenia patients showed abnormal activations of brain areas involved in semantic memory, verbal working memory, and initiation and suppression of conflicting responses, which were associated with semantic overrecall and FTD.     

The PDD Behavior Inventory: a rating scale for assessing response to intervention in children with pervasive developmental disorder

The PDD Behavior Inventory (PDDBI) is a rating scale filled out by caregivers or teachers that was designed to assess children having a Pervasive Developmental Disorder (PDD; autism, Asperger disorder, PDD-NOS, or childhood disintegrative disorder). Both adaptive and maladaptive behaviors are assessed in the scale, making it useful for treatment studies in which decreases in maladaptive behaviors and improvements in adaptive social and language skills relevant to PDD are expected. The adaptive behaviors assessed include core features of the disorder such as joint attention skills, pretend play, and referential gesture. The maladaptive behaviors sample a wide variety of behaviors observed in both lower- and higher-functioning individuals and include stereotyped behaviors, fears, aggression, social interaction deficits, and aberrant language. The inventory was found to have a high degree of internal consistency. Inter-rater reliability was better for adaptive behaviors than for maladaptive behaviors. Factor analyses confirmed the structure of the PDDBI and indicated good construct validity. In a subsample of children between 3 and 6 years of age, raw scores for adaptive behaviors increased with age in the parent and teacher versions, as did measures of social pragmatic problems. It was concluded that the PDDBI is both reliable and valid and is useful in providing information not typically available in most instruments used to assess children with PDD.     

Ataxia clinical rating scale in Friedreich disease

The Ataxia Clinical Rating Scale was used on 22 patients with Friedreich disease. We found a positive correlation (r=0.64, p<0.005) between total score and duration of symptoms. For this reason the scale may be useful in the follow-up of patients affected by Friedreich disease.

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Sommario La Ataxia Clinical Rating Scale è stata applicata a 22 pazienti affetti da malattia di Friedreich. Abbiamo riscontrato una correlazione positiva (r=0.64, p<0.005) tra il punteggio totale e la durata della sintomatologia. Per questo motivo la scala è utile nel follow-up dei pazienti affetti da malattia di Friedreich.

     

Eye tracking,schizophrenic symptoms,and schizotypal personality disorder

Summary Schizophrenic patients and patients with schizotypal personality disorder were significantly more likely than normal controls to demonstrate impaired eye tracking performance. Fifteen of 27 schizophrenics and 15 of 27 schizotypals had impaired eye tracking, compared with 11 of 39 normal controls. In the schizophrenic group, including 10 out-patients in a stable state of relative remission, impaired eye tracking was associated with more severe formal thought disorder and more time spent in psychiatric hospitals. Among stable schizophrenic out-patients, poor eye tracking was related to more severe formal thought disorder and greater overall psychopathology. This pattern of results suggests a possible relation between eye tracking impairment and more severe enduring symptoms across the spectrum of schizophrenic and schizophrenia-related disorders.This article was presented in part at the Symposium on Eye Movements and Psychopathology, Berlin, 23–24 June 1988     

卒中评分量表新进展

卒中评分量表是评估卒中患者情况的一项重要工具,贯穿卒中全过程,包括卒中风险预测评分、神经功能缺损评分、残疾评定、预后评分、卒中复发风险预测评分等,将患者进行分层管理,从而指导临床治疗.卒中评分量表大部分内容简便,易于临床操作,已经在国内外大量卒中人群研究中很好的证实了其信度、效度、灵敏度等.随着其在临床中的应用及研究的不断深入,其优缺点日益清晰.各种量表在原基础之上已进行了不断修改,而且又陆续有一些新的量表诞生.这些量表在卒中患者的诊断、治疗、评残和评估预后中发挥着重要作用.     

Conners教师评定量表的临床效度研究

目的　检验Conners教师用评定量表的临床效度。方法　将Conners教师用评定量表(TRS)应用于符合DSM Ⅳ注意缺陷多动障碍 (ADHD)标准的 5 7例ADHD儿童及同年龄、同性别的全国常模样本上海组儿童。结果　 (1)内容效度 :ADHD组的因子分及总分均高于对照组 (t=11 2 4 0～16 6 5 2 ,P <0 0 0 1) ;(2 )效标效度 :TRS对ADHD儿童的诊断灵敏度是 86 0 % ,特异度 94 7% ,诊断符合率 90 3% ;(3)结构效度 :各因子与总分的相关 (γ =0 892～ 0 974 )超过各因子之间的相关 (γ =0 6 93～ 0 96 3) ;经最大方差旋转后得出了 5个因子 ,有 3个因子与美国TRS的因子相似 ,即多动、注意力不集中、冲动 ,并产生了 2个不同于美国儿童的因子 :社交问题、被动。结论　Conners教师用评定量表适合于我国儿童注意缺陷多动障碍儿童的评估。     

Higher-order semantic processing in formal thought disorder in schizophrenia

Higher-order semantic impairments and lack of sensitivity to linguistic context have both been implicated in formal thought disorder (FTD) in schizophrenia. Most investigations have focused on comprehension. We investigated the processing of higher-order semantic relations and the role of emotional arousal in FTD patients? linguistic comprehension and production. We compared FTD schizophrenia patients (n=14) with non-FTD schizophrenia patients (n=18) and healthy controls (n=15) on sense-judgment and repetition tasks, in emotionally negative and neutral conditions. We predicted that the FTD group would display poor sensitivity compared to the other two groups in comprehension and production, and that this would be exacerbated by sentence complexity and negative emotional arousal. The emotional manipulation was not robustly successful, and did not affect task performance in the patient groups. FTD patients made significantly more errors on sense-judgments and repetition than the other two groups. Complexity affected all groups to a similar extent in sense-judgments, but affected FTD patients disproportionately in the repetition task. These results support the view that a lack of sensitivity to context underlies FTD in comprehension and production stages of processing. Patients fail to utilise linguistic context to integrate lexical forms into a global whole and guide their access to lexical targets.