睡眠呼吸暂停综合征患者氧亲和力的变化

目的 :了解睡眠呼吸暂停综合征 (SAS)患者P50 (即血红蛋白氧饱和度 5 0 %时相应的氧分压 )是否有改变 ,探讨P50 与夜间血氧饱和度的相关性以及P50 可否预测SAS患者的病情严重程度。方法 :随机选择SAS患者 5 6例 ,其平均睡眠呼吸暂停 低通气指数 (AHI)为 (3 7 5 1± 2 0 2 1)次 h ,平均夜间血氧饱和度为 86 5 2 %± 1 91% ,清醒时的血氧饱和度为 95 2 0 %± 1 40 % ,并选择正常人 42例作为对照组进行P50 水平的测试。 11例患者经持续气道正压通气 (CPAP)治疗后重复进行测试。结果 :1 SAS患者日间P50 值为 (2 9 2 7± 1 3 1)mmHg(1mmHg=0 13 3kPa) ,对照组为 (2 7 63± 1 0 1)mmHg,二者存在显著性差异 (P <0 0 5 ) ;2 SAS患者P50 与夜间平均血氧饱和度呈明显负相关 (r=- 0 962 1,P <0 0 5 ) ;3 11例SAS患者经CPAP治疗 3个月后 ,P50 水平显著下降至 (2 7 2 7± 0 63 )mmHg,与正常对照组相比无显著性差异。结论 :1 SAS患者的氧离曲线右移 ,这可能是对组织低氧的一个保护性机制 ,以延迟肺动脉高压的形成 ,红细胞的增多及其它器官系统并发症的发生。 2 P50 能够反映SAS患者夜间低氧的严重程度 ,因而可以作为一个常规指标进行检测     

Reduction of depersonalization during social stress through cognitive therapy for social anxiety disorder: A randomized controlled trial

Symptoms of depersonalization during feared social situations are commonly experienced by individuals with social anxiety disorder (SAD). Despite its clinical relevance, it is not addressed in standard treatment manuals and it remains unclear if depersonalization is reduced by well-established treatments. This study investigated whether cognitive therapy (CT) for SAD effectively reduces depersonalization and whether pre-treatment severity of depersonalization predicts or mediates treatment outcome.In a randomized controlled trial, patients underwent the standardized Trier Social Stress Test before and after CT (n = 20) or a waitlist period (n = 20) and were compared to healthy controls (n = 21). Self-reported depersonalization was measured immediately after each stress test.Depersonalization significantly decreased following CT, especially in treatment responders (η_p² = 0.32). Pre-treatment depersonalization did neither predict nor mediate post-treatment severity of social anxiety.Further prospective studies are needed for a better scientific understanding of this effect. It should be scrutinized whether SAD-patients suffering from depersonalization would benefit from a more specific therapy.     

Association Between Clinical Tests Related to Motor Control Dysfunction and Changes in Pain and Disability After Lumbar Stabilization Exercises in Individuals With Chronic Low Back Pain

ObjectiveTo investigate whether clinical tests used to detect motor control dysfunction can predict improvements in pain and disability in patients with chronic nonspecific low back pain (LBP) who have undergone an 8-week lumbar stabilization exercise program.Study DesignA prospective cohort study.SettingOutpatient physical therapy university clinic.ParticipantsSeventy people with chronic nonspecific LBP were recruited, and 64 completed the exercise program (N=64).InterventionsThe lumbar stabilization program was provided twice a week for 8 weeks.Main Outcome MeasuresPain intensity (11-point numerical rating scale) and disability (Roland Morris Disability Questionnaire) and clinical tests, such as the Deep Muscle Contraction (DMC) scale, Clinical Test of Thoracolumbar Dissociation (CTTD), and Passive Lumbar Extension (PLE) test. Univariate and multivariate linear regression models were used in the prediction analysis.ResultsMean changes in pain intensity and disability following the 8-week stabilization program were ?3.8 (95% confidence interval [CI], ?3.2 to ?4.4) and ?7.4 (95% CI, ?6.3 to ?8.5), respectively. Clinical test scores taken at baseline did not predict changes in pain and disability at 8-week follow-up.ConclusionOur findings revealed that the DMC scale, CTTD, PLE test, clinical tests used to assess motor control dysfunction, do not predict improvements in pain and disability in patients with chronic nonspecific LBP following an 8-week lumbar stabilization exercise program.     

La mythomanie : ludisme bipolaire et protestation identitaire

Mythomania (Dupré, 1905) and pathological lying are imaginative fabrications resorting to deceit, imposture and lying as well as to play and delusion. Whether it be an acute or a long-duration identification to a newly formed or imaginary person, this can be understood either as self entertainment, as a hypo-manic equivalent, or as an identity replacement to restore one's self-esteem and narcissism. Some clinical examples are given to illustrate these psychopathological perspectives.     

The impact of tonic immobility reaction on the prognosis of posttraumatic stress disorder

Tonic immobility is the last defense reaction to entrapment by a predator. In humans, peritraumatic tonic immobility was correlated with PTSD severity and poor response to treatment. This study compared the role of peritraumatic dissociation, panic physical symptoms and tonic immobility as predictors of response to standard pharmacotherapy for PTSD. Thirty-six PTSD patients underwent a naturalistic pharmacological treatment. The Posttraumatic Stress Disorder Checklist - Civilian Version (PCL-C) and the Clinical Global Impressions Severity of Illness item scores (CGI-S) were employed at baseline and endpoint to examine treatment outcome. Peritraumatic reactions were assessed using the Physical Reactions Subscale, the Peritraumatic Dissociative Experiences Questionnaire and four motor questions of the Tonic Immobility Scale. After controlling for confounders, tonic immobility was the best predictor of a poor response to treatment, either considering the PCL-C or the CGI-S scores. Tonic immobility seems to have a greater negative impact on PTSD prognosis than peritraumatic panic or dissociation. Additional translational and clinical research may inform about particular mechanisms underlying tonic immobility and open new avenues for prevention and treatment of PTSD.     

Nonverbal auditory agnosia with lesion to Wernicke's area

We report the case of patient M, who suffered unilateral left posterior temporal and parietal damage, brain regions typically associated with language processing. Language function largely recovered since the infarct, with no measurable speech comprehension impairments. However, the patient exhibited a severe impairment in nonverbal auditory comprehension. We carried out extensive audiological and behavioral testing in order to characterize M's unusual neuropsychological profile. We also examined the patient's and controls’ neural responses to verbal and nonverbal auditory stimuli using functional magnetic resonance imaging (fMRI). We verified that the patient exhibited persistent and severe auditory agnosia for nonverbal sounds in the absence of verbal comprehension deficits or peripheral hearing problems. Acoustical analyses suggested that his residual processing of a minority of environmental sounds might rely on his speech processing abilities. In the patient's brain, contralateral (right) temporal cortex as well as perilesional (left) anterior temporal cortex were strongly responsive to verbal, but not to nonverbal sounds, a pattern that stands in marked contrast to the controls’ data. This substantial reorganization of auditory processing likely supported the recovery of M's speech processing.     

The disconnection apraxias

Limb apraxia is the loss of the ability to perform voluntary skilled movements, when this loss cannot be attributed to elemental sensorimotor deficits. Successful manual interactions with the objects in the environment require the storage of information about movement parameters. This information is stored in specific cortical modules and the correct performance of a skilled act requires interactions between these modules. Thus, apraxia can occur with degradation of these critical representations or a disconnection between modules. The goal of this paper is to define the different forms of limb apraxia and discuss how apraxia can be induced by both a deterioration of these modules as well as disconnections between these modules that form an anatomically distributed system.     

Association analysis of SCN9A gene variants with borderline personality disorder

Borderline personality disorder (BPD) is a serious psychiatric disorder affecting about 1-2% of the general population. Key features of BPD are emotional instability, strong impulsivity, repeated self-injurious behavior (SIB) and dissociation. In the etiology of BPD and its predominant symptoms, genetic factors have been suggested. The voltage-gated sodium channel Nav1.7 is expressed in sensory neurons and in the hippocampus, a key region of the limbic system probably dysfunctional in BPD and dissociative disorders. The alpha-subunit of Nav1.7 is encoded by the SCN9A gene on chromosome 2 and variations of SCN9A can lead to complete inability to sense pain. The aim of the present study was to test for associations between SCN9A gene variants and BPD as well as BPD-related phenotypes. We genotyped ten tagging single nucleotide polymorphisms (SNPs) within the SCN9A gene in 161 well-defined Caucasian BPD patients and 156 healthy controls. We found no globally significant association of SCN9A markers with BPD at level 5%. However, in the female and in the male subsample, different SCN9A markers and individual haplotypes showed uncorrected p-values < 0.05. In addition, p-values < 0.05 were observed in the analysis of associations between SCN9A markers and dissociative symptoms. Although our results were largely negative, replication studies in an independent sample are warranted to follow up on the potential role of SCN9A gene variants in BPD and dissociative symptoms, paying special attention to a possible gender different etiology.     

Prediction of Abstinence from Heroin Addiction by Childhood Trauma,Dissociation, and Extent of Psychosocial Treatment

This study is an investigation of trauma and dissociation in 93 Israeli patients recovering from drug use disorder. The respondents showed more emotional, physical and sexual traumatization than consecutive admissions to an Israeli outpatient stress clinic, and their levels of dissociation were similar to those previously measured in Israeli patients diagnosed with Posttraumatic Stress Disorder and Acute Stress Disorder. It was posited that the level of trauma-related dissociation can make an independent contribution to explaining variance in recovery from a drug use disorder. The finding of structural equation analyses supported this model and suggests that childhood traumatization is related to the proclivity of chemically-dependent respondents to participate in psychosocial treatment and that duration of psychosocial treatment can positively predict duration of abstinence. Dissociation levels made an independent negative contribution to the prediction of abstinence. While our findings imply that tenacity in treatment could be a sustaining process associated with abstinence from drug use, they also suggest that without a thorough resolution of trauma-related dissociation, optimal treatment outcome is compromised.