河北省2004-2005年抑郁症的现况调查

目的 了解河北省抑郁症的患病率、抑郁症患者的人口学特征及社会生活功能状况。方法 采用随机抽样方法对河北省≥18岁人群进行调查，共24000人。以改编的一般健康问卷12项（GHQ-12）为筛选工具，以美国精神障碍诊断与统计手册第4版轴Ⅰ障碍定式临床检查患者版为诊断工具。采用功能大体评定量表（GAF）评价功能状况。结果 （1）抑郁症时点患病率为27．01％o[399例；95％可信区间（CI）=24．80％0～29．22％0]，终生患病率为47．47‰（608例；95％CI=44．58％0～50．37％0）。（2）时点患病率：城市[20．98％o（40例）]低于农村[27．88％0（359例）；u=4．02；P〈0．01]；女性[31．53％0（248例）]高于男性[22．48％0（151例）；u=2．05；P〈0．05]。1〉40岁者患病率高（30．51％～44．19％）。（3）Logistic回归分析：危险因素有女性、年龄40～70岁、农民、无业和失业、学生和家庭妇女、年家庭总收入0～5000元等。（4）反复发作抑郁症占29．11％；严重程度以中度（39．6％）和重度（53．9％）多见，社会和生活功能受损明显[GAF评分为（58．95±14．86）分]。结论 河北省抑郁症的患病率较高，严重影响患者社会生活功能。     

保定市特殊恐怖症的流行病学调查

目的探讨保定市民特殊恐怖症的患病率和分布特点。方法2004年10月～2005年3月采用多阶段分层整群抽样方法随机抽取18周岁及以上的人群10073例,用扩展的一般健康问卷（GHQ—12）将调查对象分为高、中、低危险组,采用美国精神障碍诊断标准（DSM—Ⅳ）,以美国精神障碍诊断与统计手册第4版（DSM-Ⅳ）轴Ⅰ障碍定式临床检查病人版对调查对象进行特殊恐怖症的诊断。结果9021例完成调查,特殊恐怖症的终生患病率为0．74％,时点患病率为0．68％;各类型的终生及时点患病率分别为：动物型0．38％、0．36％,自然环境型0．31％、0．27％,其他型0．07％、0．03％;血液-注射-损伤型的终生和时点患病率均为0．09％,情景型仅终生患病率为0．01％。女性时点患病率高于男性;农村时点患病率高于城市;30-39岁的患病率最高,18～19岁的患病率最低。特殊恐怖症的精神科就诊率为2．5％。结论特殊恐怖症常见于年轻的女性,各类型患病率不同,且就诊率低。     

河北省精神障碍的现况调查

目的了解河北省≥18岁人群各类精神障碍的患病率和分布特点。方法2004年10月至2005年3月采用多阶段分层整群抽样方法随机抽取≥18岁人群，共24000名，以美国精神障碍诊断与统计手册第4版（DSM-Ⅳ）轴Ⅰ障碍定式临床检查患者版进行调查，用DSM，Ⅳ对各类精神障碍进行诊断。结果（1）患病率：20716人完成调查，精神障碍的时点患病率为162．43‰[95％可信区间（95％CI）为15．8％-16．7％]，排在前三位的是重性抑郁障碍（27．01‰）、未特定的焦虑障碍（25．09‰）和心境恶劣障碍（23．12‰）；终生患病率为185．12‰（95％CI为18．0％～19．0％），排在前三位的是重性抑郁障碍（47．47‰）、酒精依赖性和滥用性障碍（38．62‰）和未特定抑郁障碍（25．51‰）。（2）时点患病率：女性（167．95‰）高于男性（156．95‰），农村（165．63‰）高于城市（144．31‰），均P〈0．05～0．01；并随年龄的增长而不断上升，其中30～49岁为137．17‰～156．71‰，50-≥70岁为201．44‰～285．41‰。结论河北省精神疾病的患病率较高，其中女性和农村的患病率高；重性抑郁障碍是省内患病率最高的精神疾病。     

创伤后应激障碍流行病学调查地区差异的比较

目的比较保定地区和承德地区18岁及以上人群创伤后应激障碍患病率的差异。方法采用多阶段分层整群抽样方法随机抽取保定地区10073名,承德地区3358名均≥18岁的人群为调查对象,用扩展的一般健康问卷（GHQ—12）将调查对象分为高、中、低危险组,以美国精神障碍诊断与统计手册第4版（DSM—IV）对调查对象进行DSM—IV修订版轴I障碍定式临床用治疗提纲（SCID-1／P）,对各类精神障碍进行诊断-结果保定地区9021人完成调查,创伤后应激障碍时点患病率3．7％e,终生患病率5．7％e;承德地区3025人完成调查,创伤后应激障碍时点患病率4．3％c,终生患病率7．27‰。。保定地区和承德地区时点患病人数分别为33例,13例;终生患病的人数分别为51例,22例。两地男性与男性之间,女性与女性之间,城市与城市之间,农村与农村之间时点患病率没有显著性差异（P均〉0．05）,两地区终生患病率无显著差异（U=0．901P〉0．05）。结论创伤后应激障碍在我省两地区之间发病无差异,但发病率逐渐增高,为迫切需要关注的公共卫生问题之一。     

保定市重性抑郁障碍流行病学调查

目的：了解保定市重性抑郁障碍的患病率、人口学特征和社会生活功能状况。方法：采用多阶段分层整群抽样方法随机抽取≥18岁的人群10073人，以一般键康问卷12项（GHQ-12）为筛选工具，以美国精神障碍诊断与统计手册第4版（DSM-Ⅳ）轴Ⅰ障碍定式临床检查病人版（SCID-I／P）为调查诊断工具。用功能大体评定量表（GAF）评价功能状况。结果：重性抑郁障碍的终生患病率为4．19％（95％CI：3．78％～4．60％）；时点患病率为2．64％（95％CI：2．31％～2．97％）。时点患病率女性3．26％明显高于男性2．00％（u=3．73，P〈0．01）；农村2．84％明显高于城市1．40％（u=2．76，P〈0．01）；50～69岁年龄段患病率较高；单次发作60．80％，复发39．20％；GAF平均为（50．74±6．73）分，社会和生活功能受损明显。结论：重性抑郁障碍的患病率相对较高，严重影响患者的社会生活功能。     

1986～2001年某部新兵精神疾病调查

目的；探讨入伍新兵精神疾病的患病率及相关因素。方法：应用新兵精神疾病调查的工具，对1986－2001年某部入伍的所有集训期新兵进行精神疾病的流行病学调查。结果：15年共调查入伍新兵656540名，检查出各类精神疾病共539名，总检出率（时点患病率）为0．82‰。新兵各类精神疾病的时点患病率以精神分裂症（0．29‰）、神经症（0．20‰）和精神发育迟滞（0．10‰）为高。入伍前已患病者占83．1％，入伍后新发病者占16．9％。有明显精神疾病家族史者占28．4％。结论：开展新兵精神疾病调查，在集训期内把患有精神疾病者作退兵处理，对提高兵员质量具有重要意义。     

江西省抑郁症患病率的流行病学调查

目的 调查江西省抑郁症的患病率。方法 资料来自江西省11个地市的样本，年龄≥15岁的城区和农村常住居民，共15939人。使用复合性国际诊断交谈检查和专门设计的社会人口学调查表，采用国际疾病分类第10版精神与行为障碍分类中的诊断标准。结果 (1)11个地市抑郁症时点患病率为0．95％，总患病率为1．15％[95％的可信区间(CI)=0．91-1．49]。其中抑郁发作的时点患病率为0．35％，总患病率为0．51％；恶劣心境的时点患病率为0．60％，总患病率为0．65％。(2)年龄45—54岁[相对危险度(RR)=2．09]、女性(RR=1．91)、离婚或丧偶(RR=2．09)、文盲(RR=2．43)或低收入(RR=2．73)与抑郁症明显相关，而有无固定的职业、地区的不同、经济区域的不同对抑郁症的总患病率没有明显的关联。女性患抑郁症的相对危险度是男性的1．91倍。结论 抑郁症是一种患病率较高的精神障碍。年龄45—54岁、女性、离婚或丧偶、文盲或低收入，与抑郁症明显相关。     

河北省承德地区精神疾病流行病学调查

目的：了解河北省承德地区18岁及以上人群各类精神疾病的时点患病率和分布特点。方法：2004年10月至2004年11月采用多阶段分层整群随机抽样方法，抽取≥18岁者为调查对象。用一般健康问卷（CHQ-12）将调查对象分为高、中、低危险组，以美国精神障碍诊断与统计手册第4版（DSM-Ⅳ）轴Ⅰ用定式临床检查患者版进行调查，用DSM-Ⅳ对精神障碍进行诊断。结果：3025人完成调查，精神疾病总时点患病率为177．19‰，终生患病率为216．86‰。除精神发育迟滞和痴呆外，各类精神疾病时点患病率为175．86‰，终生患病率为215．54‰。时点患病率农村为（176．65‰），城市为（180．08‰）；女性（182．05‰）高于男性（171．94‰）。重性抑郁障碍患病率最高（51.57‰）。结论：本调查基本掌握了河北省承德地区18岁及以上人群各类精神障碍的患病水平和分布特点。     

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。     

保定市焦虑障碍流行病学调查

目的：了解保定市焦虑障碍的患病率和分布特点。方法：于2004年10月至2005年5月采用多阶段分层整群抽样方法随机抽取≥18岁的人群，共10073名，用扩展的一般健康问卷（GHQ-12）将调查对象分为高、中、低危险组，采用美国精神障碍诊断与统计手册第4版（DSM-Ⅳ）轴Ⅰ障碍定式临床检查患者版（SCID）对调查对象进行焦虑障碍的诊断。结果：共9021人完成调查，焦虑障碍的终生患病率为45．12‰，时点患病率为41．79‰，5种常见的焦虑障碍是未特定的焦虑障碍（分别是25.72‰及25．39‰）、创伤后应激障碍（5．65‰及3．66‰）、广泛性焦虑症（仅现患6．43‰）、特殊恐怖症（5.10‰及4．43‰）和惊恐障碍（3．44‰及2．66‰）。时点患病率：女性（54．21‰）明显高于男性（29．73‰）（P〈0．01）；50～59岁患病率最高（58．39‰），20～29岁最低（23．07‰）。Logistic回归分析显示，焦虑障碍的易患危险因素为女性、年龄40-69岁、低文化、低收入。焦虑障碍的精神科就诊率为1．86‰。结论：焦虑障碍是保定市常见的一类精神障碍，患病率高，而其精神卫生服务利用率低。     

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.     

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.     

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.