Management of Attention Deficit Disorders

Attention deficit disorders are not uncommon in the clinics and office practice of child psychiatrists. The diagnosis, evaluation, and comprehensive treatment of this disorder are discussed.     

焦虑障碍患者家庭关怀度及其影响因素和护理对策

目的探讨焦虑障碍患者的家庭关怀度及其影响因素并提出相应的心理护理对策。方法应用自编一般情况调查表、家庭关怀度指数问卷和艾森克个性问卷调查175例焦虑障碍患者。结果焦虑障碍患者在适应度、合作度、成长度、情感度和亲密度5个项目中回答很少出现这样的情况所占的比例为12.6%~28.6%,有时这样的比例为40.0%~44.6%。55.4%家庭被评定为中度和重度障碍,其中重度障碍达18.9%。多元回归分析显示,家庭功能与患者的年龄、受教育程度、P量表分及E量表分有关(F=8.138,P<0.01)。其中,E分最为重要,年龄次之,P分第三,文化程度最小。结论 55.4%焦虑障碍患者的家庭功能存在中重度障碍,而且精神质弱,外向、年龄大和学历高的患者家庭功能良好。提示通过矫正患者的不良认知、应对方式等心理护理措施可以改善其家庭功能。     

精神分裂症患者和心境障碍患者抗精神病药物使用现状分析

目的　了解我院抗精神病药的使用情况。方法　于 2 0 0 2年 7月调查我院住院精神分裂症和心境障碍患者的抗精神病药使用情况。结果　住院患者的用药以氯氮平、氯丙嗪、碳酸锂和丙米嗪为最常用 ,分别为 :3 8.2 %、2 5 .2 %、8.3 %和3 .8%。结论　精神分裂症临床上常用氯氮平和氯丙嗪 ,心境障碍临床上常用碳酸锂和丙咪嗪。     

Salivary Secretory Disorders,Inducing Drugs,and Clinical Management

Background: Salivary secretory disorders can be the result of a wide range of factors. Their prevalence and negative effects on the patient''s quality of life oblige the clinician to confront the issue.Aim: To review the salivary secretory disorders, inducing drugs and their clinical management.Methods: In this article, a literature search of these dysfunctions was conducted with the assistance of a research librarian in the MEDLINE/PubMed Database.Results: Xerostomia, or dry mouth syndrome, can be caused by medication, systemic diseases such as Sjögren''s Syndrome, glandular pathologies, and radiotherapy of the head and neck. Treatment of dry mouth is aimed at both minimizing its symptoms and preventing oral complications with the employment of sialogogues and topical acting substances. Sialorrhea and drooling, are mainly due to medication or neurological systemic disease. There are various therapeutic, pharmacologic, and surgical alternatives for its management. The pharmacology of most of the substances employed for the treatment of salivary disorders is well-known. Nevertheless, in some cases a significant improvement in salivary function has not been observed after their administration.Conclusion: At present, there are numerous frequently prescribed drugs whose unwanted effects include some kind of salivary disorder. In addition, the differing pathologic mechanisms, and the great variety of existing treatments hinder the clinical management of these patients.The authors have designed an algorithm to facilitate the decision making process when physicians, oral surgeons, or dentists face these salivary dysfunctions.     

综合医院住院病人精神障碍调查

目的了解综合医院住院患者焦虑、抑郁、疑病、躯体化等精神障碍及其相关因素。方法采用自编的一般情况调查表,医院焦虑、抑郁量表（HAD）,焦虑自评量表（SAS）,抑郁自评量表（SDS）和症状自评量表（SCL-90）对综合医院住院患者1278例进行调查评定,筛查后再进行精神科诊断。结果综合医院住院患者的焦虑、抑郁总粗分显著高于正常人群（P〈0.05）,且SAS总粗分高于正常人群上限者占40.69%,SDS总粗分高于正常人群上限者占35.99%,既有焦虑又有抑郁症状者占总调查人数的25.01%。焦虑抑郁症状与患者的年龄,患者对疾病的认识,社会支持系统均有关。医院住院患者的SCL-90总分、均分,9项因子分显著高于常模（P〈0.05）。结论综合医院住院患者中存在较多的焦虑、抑郁、疑病和躯体化等精神症状,住院患者的整个心理健康状况较差,综合医院医生识别精神症状率低。     

哈尔滨市道外区精神障碍流行病学调查报告

目的：了解哈尔滨市道外区精神障碍流行学资料。方法：采用传统流行病学调查法对哈尔滨市道外区的４３６６人（１５岁～６５岁）进行了精神障碍流行病学调查；结果：各类精神病的总患病率为４０．０７‰，神经症患病率为２５．６５‰。与１９８２年全国１２地区精神障碍患病率水平相比呈增高趋势。同时，本文从年龄、职业、文化、婚姻、经济条件等方面作了分析，对可能的原因进行了探讨。     

Guidelines for Evaluation and Management of Cognitive Disorders in HIV-Positive Individuals

Antiretroviral therapy has revolutionised the treatment for people living with HIV (PLWH). Where antiretroviral coverage is high, the treatment paradigm for HIV-disease is now one of managing the long-term consequences of the virus and its treatment rather than the consequences of untreated HIV-disease such as immunosuppression and opportunistic infections. One such long-term consequence is HIV-associated cognitive impairment which is reported to occur in up to 50 % of treated PLWH and has been associated with poorer outcomes. Given the ageing cohort and increased frequency of comorbidities, the prevalence of symptomatic cognitive impairment may increase with time. High quality evidence for management strategies including screening, diagnosis and treatment of HIV-associated cognitive impairment are lacking and in general guidelines are based on best clinical practice. In this article, we assessed recent guidelines concerning the management of HIV-associated cognitive impairment by performing a systematic review of the MEDLINE database using PubMed. We report that, in general, guidelines from around the world regarding the management of HIV-associated cognitive impairment are converging. Screening is generally not recommended in asymptomatic PLWH. Diagnosis of HIV-associated cognitive impairment should be made only after a comprehensive assessment and exclusion of other potential causes. Antiretroviral therapy forms the cornerstone of management of HIV-associated cognitive impairment and should be guided by plasma and cerebrospinal fluid (CSF) genotype(s).     

Management of Bleeding Uterine Arteriovenous Malformation with Bilateral Uterine Artery Embolization

Purpose

To evaluate the technical feasibility and clinical outcome of bilateral uterine artery embolization (UAE) as a first-line therapeutic option for bleeding uterine arteriovenous malformation (AVM).

Materials and Methods

Between 2002 and 2012, 19 patients were diagnosed with acquired uterine AVM clinically and through imaging studies. The clinical characteristics, angiographic features, technical success rate of embolization, procedure-related complications, imaging, and clinical follow-up data were assessed. Clinical success was defined as immediate symptomatic resolution with disappearance of vascular abnormality on subsequent imaging studies.

Results

A total of 20 bilateral UAE, with or without embolization of extra-uterine feeders, were performed as the first-line treatment. Technical and clinical success rate was 90.0% (18/20) and 89.5% (17/19), respectively. Embolization was incomplete in two patients who had residual extra-uterine fine feeders to the AVM or a procedure-related complication (ruptured uterine artery); the former showed slow regression of the vascular malformation during the observation period, while the latter underwent a successful second bilateral UAE. Immediate clinical success was achieved in the remaining 17 patients after a single session and no recurrence of bleeding was found. Recovery to normal menstrual cycle was seen in all 17 patients with clinical success within one or two months, two of whom subsequently had uneventful intrauterine pregnancies carried to term.

Conclusion

Bilateral UAE is a safe and effective first-line therapeutic option for the management of bleeding uterine AVMs. However, incomplete embolization due to unembolizable feeders or difficult access into the uterine artery may lead to suboptimal treatment.     

躯体形式障碍的治疗分析

目的探讨躯体形式障碍的治疗方法。方法用钟友彬的认识领悟疗法对躯体形式障碍3案例治疗通程予以报告和分析。结果认识领悟疗法对躯体形式障碍有一定的临床治疗效果。结论认识领悟疗法治疗躯体形式障碍是有效的和可行的。     

Bleeding times, platelet adhesion, and aspirin.

The effects of aspirin on well-standardized commercially produced platelet adhesiveness devices and template bleeding times were simultaneously studied in 19 normal volunteers. As expected, there was significant prolongation of the bleeding time after aspirin, but there was no change in platelet adhesion. Reason for the different effects of aspirin on the two tests are discussed. In addition, the normal range of platelet adhesion was further defined utilizing commercially prepared glass-bead columns.     

综合医院躯体形式障碍临床特点的初步研究

目的：了解综合医院门诊病人中符合ＩＣＤ－１０躯体形式障碍的比率及其临床症状特点。方法：采用躯体形式障碍筛选表和躯体形式障碍评定表检查内科和神经科门诊病人。结果：共筛查了３３４６位综合医院的门诊病人,ＩＣＤ－１０躯体形式障碍的估计比率为１８２％。躯体形式障碍各亚型之间重叠较多。１３５例患者在过去一年平均就医１３１次;经过治疗６０％的自感无变化或恶化。躯体化障碍患者的症状中以“对医生的诊断和治疗不信任”最为突出。结论：躯体形式障碍在综合医院内科、神经科门诊有较高的比率。其就医次数较多而治疗效果较差。ＩＣＤ－１０躯体形式障碍各亚型的诊断标准缺乏特异性     

对精神病患者歧视状况的大样本调查

目的:调查人群对精神病患者的歧视状况,探讨其影响因素及降低歧视的策略。方法:采用歧视精神疾病患者评估量表对公众进行问卷调查。结果:1864名调查对象歧视量表总分与常模无显著差异(P0.05)。除能力维度评分外,家属、护士及学生3组人群对精神病患者的歧视总分、隔离维度以及危险维度评分存在显著差异(F=30.765,51.447,21.260;P0.001)。护士和毕业班学生对精神病患者的歧视总分、隔离维度、危险维度评分均显著高于患者家属(F=21.260,P0.001)。护士的隔离维度评分显著高于毕业班学生(F=51.447,P0.001)。对歧视量表总分的影响因素为调查对象类别,性别,年龄,文化程度,是否参加过精神、心理知识讲座,与精神病患者接触程度和生活联系程度。结论:调查对象对精神病患者存在歧视,不同类别的调查对象对患者的歧视程度,歧视维度存在差异。护士及学生对患者的歧视比家属更严重。护士在社会交往方面的歧视态度或行为比学生更严重。文化程度越高,参加过精神、心理知识讲座,与精神病患者接触越多,生活联系越紧密的调查对象对精神病患者的歧视程度越低。