Psychiatric symptomatologies and disorders related to epilepsy and antiepileptic medications

Introduction: Psychiatric comorbidities (such as depression, anxiety, psychosis, inattention, obsession, personality traits, aggression and suicide) are frequent in patients with epilepsy and have a significant impact on medical management and quality of life.

Areas covered: A literature search was performed in MEDLINE for epidemiological, longitudinal, prospective, double-blind clinical trial studies published between 1990 and 2011 using the following words: epilepsy, antiepileptic drugs (AEDs), behavioral/emotional/psychiatric comorbidities, suicide and aggression. In this review, the author discusses: i) the characterization and prevalence of behavioral disturbances associated with epilepsy, ii) variables correlated with behavioral comorbidities which include: psychosocial-, clinical- and treatment-related variables, iii) the complex mechanisms of behavioral comorbidities associated with epilepsy, which include both psychosocial (functional) and organic; the process of epileptogenesis, neuronal plasticity, abnormalities in hypothalamic-pituitary axis and neurotransmitters and pathways are fundamental determinants, iv) the negative psychotropic effects of AEDs and their mechanisms and v) the suggested biopsychosocial model of management (pharmacological and non-pharmacological).

Expert opinion: The relationship between psychiatric disorders and epilepsy has relevant therapeutic implications which should be directed towards a comprehensive biopsychosocial approach that focuses on the whole person rather than simply on the disease process.     

Generalized ℋ︁2 model approximation for differential linear repetitive processes

This paper investigates the generalized ??₂ model approximation for differential linear repetitive processes (LRPs). For a given LRP, which is assumed to be stable along the pass, we are aimed at constructing a reduced‐order model of the LRP such that the generalized ??₂ gain of the approximation error LRP between the original LRP and the reduced‐order one is less than a prescribed scalar. A sufficient condition to characterize the bound of the generalized ??₂ gain of the approximation error LRP is presented in terms of linear matrix inequalities (LMIs). Two different approaches are proposed to solve the considered generalized ??₂ model approximation problem. One is the convex linearization approach, which casts the model approximation into a convex optimization problem, while the other is the projection approach, which casts the model approximation into a sequential minimization problem subject to LMI constraints by employing the cone complementary linearization algorithm. A numerical example is provided to demonstrate the proposed theories. Copyright © 2010 John Wiley & Sons, Ltd.     

谈中医伤科学框架研习式教学

“框架研习式”教学法根据中医伤科学的学科特点，突出“框架一填充一演练或模仿一创新”4个环节，突出学生为主体、教师为主导的教学思想，充分发挥学生的学习主动性。框架研习式教学，模式新颖，条理清晰，一目了然，便于学生对知识的全面理解及综合运用，符合中医整体观念的思想。在当前教学内容多而课时又有限的矛盾教育体制形势下，较之传统教学模式更能提高课堂吸收率及学生分析问题、解决问题的能力。     

单纯前路手术治疗无明显后方压迫的陈旧性颈椎半脱位

目的 探讨无明显后方压迫的陈旧性颈椎半脱位行单纯前路手术减压内固定的可行性及手术方法.方法 2004年5月至2006年7月收治陈旧性颈椎半脱位患者16例,受伤至手术时间均超过2个月,行前路减压,术中试图通过撑开螺钉及钛网钢板同定的运用,以获得减压固定、恢复正常序列.结果 16例患者术后均恢复正常颈椎序列及椎间隙高度,随访6-11个月,平均8.5个月,无植骨未融合及钛板螺钉松动、断裂病例.所有患者症状均得到改善,JOA评分由术前的平均13.4分恢复为最后随访时平均15.9分,改善率为69.4%.结论 对于陈旧性颈椎半脱位,后方结构已纤维愈合稳定,而且无明显后方脊髓压迫,前路减压技术完全能达到减压融合重建颈椎序列的目的 .     

经单鼻孔-蝶窦入路垂体腺瘤显微手术治疗及其策略

目的 总结采用经单鼻孔-蝶窦入路显微手术治疗垂体腺瘤的临床疗效.方法 从2003年1月至2007年12月,经单鼻孔-蝶窦入路显微手术治疗垂体腺瘤241例,并对其临床表现、肿瘤病理、肿瘤切除率、术后并发症进行总结分析.结果 垂体腺瘤241例中,全切除171例(71%),次全切除28例(11.6%),大部分切除26例(10.7%),部分切除16例(6.6%).术后多饮、多尿38例(15.8%)、术后视力一过性下降12例(4.9%)、术后脑脊液漏4例(1.6%)、一侧动眼神经损伤2例(0.8%),无死亡病例.除动眼神经损伤的2例外,其余病例的术后并发症在出院时已治愈.随访1-36个月,所有病例的临床症状均有不同程度改善.结论 经单鼻孔-蝶窦人路显微切除垂体腺瘤手术时间缩短,创伤小,手术效果好.     

Experiences of daycare children of divorce

Research shows that children of divorce are at risk of adjustment problems and school problems. In previous studies of young children of divorce, most often parents or teachers have supplied data. In this study, we explore the children's own feelings and experiences through Q methodology with visual images. The study includes 17 children of divorce and 20 living with both biological parents. Three child viewpoints were detected: the first was characterised by many happy feelings, and few sad or angry feelings. The second was more mixed with a variety of feelings. The third view was characterised by several sad and lonely feelings among adults and child. Children of divorce seemed to be more prone to end up on the two latter factors. Possible implications are discussed.     

The Monster in Between: Working with Couples in Intensive Group Treatment

ABSTRACT

In this article we elaborate on an inpatient clinical group program for couples suffering from nonpsychotic psychiatric disorders, personality disorders, and/or complex partner relational problems. In general, one of the partners has a long history in mental health care. The intervention history often includes at least some sessions of couple therapy but without sufficient success. These couples are part of that group of mental health patients that can be described as, or describe themselves as, “everything was done but nothing really helped.” The clinical inpatient couple group program was initiated in 1991 and to date (February 2004) 415 couples have been treated in 91 groups. Although our Center for Relational Problems is situated in a rural area in the northern part of the Netherlands, these couples are referred from all over the country. This proves that there is a need for highly intensive couple treatment in an inpatient setting. Nevertheless, as far as we know, this type of treatment does not exist anywhere else in the world. In this article we give details of the program and the rationale behind it.     

枕正中入路相关静脉的显微解剖及其临床意义

目的对枕下后正中入路相关静脉的显微解剖研究为临床在后颅窝病变手术中减少静脉损伤和减轻术后并发症提供形态学依据。方法利用20具成人尸头标本,动、静脉分别用红蓝色乳胶灌注,在显微镜下模拟枕下后正中入路,观察与此入路密切相关的静脉及其的属支,并对其进行统计和测量相关的数据。结果小脑下蚓静脉和小脑半球下静脉出现率100.0%,小脑延髓裂静脉出现率87.5%,小脑下脚静脉出现率77.5%,延髓后正中静脉出现率55.0%,小脑延髓池静脉出现率35.0%。结论枕下后正中入路相关静脉及其属支的构成复杂,变异大,提高对静脉显微解剖学的认识,可减少术中不必要的出血和降低术后并发症的发生。     

儿科专业护生在病房实习中教学程序改革的初探

随着护理学的发展和医学模式的转变,把当今以疾病为中心的功能制护理转变为以病人身心健康为中心的系统化整体护理已成为护理工作的目标。我们儿童医院护校自1993年开始在护生毕业实习中安排功能制护理和系统化整体护理两种护理模式,采用这种新的教学程序,使护生毕业后既能熟练掌握各种护理技能,又能在临床工作中开展系统化整体护理,使我国的护理水平尽快与世界接轨。