耶鲁抽动症整体严重度量表对抽动障碍患儿的临床评估

目的引进耶鲁抽动症整体严重度量表(YGTSS)并评估其与临床症状轻重的关系，以及以量表积分在观察者间的一致性。 方法2001年7月至2002年6月成都市儿童医院全文翻译YGTSS，未予修改，观察72例抽动患儿YGTSS总积分与临床抽动症状严重度分型的关系和该量表积分进步率与治疗后症状改善程度的关系(临床效度检验)，观察24例患儿该量表运动和发声抽动数量、频度、强度、复杂性、干扰性5个维度积分及总积分在观察者间一致性。 结果抽动患儿该量表总积分与临床抽动症状严重度分型之间和该量表积分进步率与治疗后症状改善程度之间有较好的效度(F值分别为59.31和124.44，P均<0.01)，运动和发声抽动数量、频度、强度、复杂性、干扰性5个维度积分及总积分的组内相关系数(ICC)值均大于0.7，显示较好的观察者间一致性。 结论耶鲁抽动症整体严重度量表中译本具有较好的信度和效度，是衡量抽动症状严重程度的工具之一。     

Symptom dimensions in recent-onset schizophrenia and mania: a principal components analysis of the 24-item Brief Psychiatric Rating Scale

Previous four- and five-factor solutions of the 18-item Brief Psychiatric Rating Scale (BPRS) suggested the possibility of an affective dimension in psychosis. A principal components analysis was used to analyze psychiatric symptom data rated on an expanded 24-item version of the BPRS. BPRS data were collected during a period of acute psychotic and affective illness with 114 young adult, recent-onset schizophrenia and schizoaffective patients and 27 bipolar manic patients. Principal components analyses of the 18-item and 24-item BPRS indicated a four-factor solution was the most interpretable. Principal components analysis of the 24-item BPRS produced a clear mania factor characterized by high loadings from items added to the 18-item BPRS, which included elevated mood, motor hyperactivity, and distractibility. This factor solution suggests that the 24-item BPRS allows for an expanded assessment of affective symptoms relating to a manic dimension. Potentially important symptoms that were added to the traditional 18-item version, namely suicidality, bizarre behavior, and self-neglect, also make clear contributions to other factors.     

Adolescent hyperactivity and general psychopathology

The aim of this study was to explore the relationship between activity and psychopathology in adolescents. A total of 289 high school students completed the Symptom Check List-90-R (SCL-90-R) and Wender Utah Rating Scale (WURS) in December 1998. The WURS was used to measure the students' activity level and the SCL-90-R was used as a measure of general psychopathology. Forty-one students (14.18%) scored higher than 46, the cut-off point for differentiation of attention deficit hyperactivity disorder (ADHD) from the general population according to Ward's report, in the WURS (WURS(+)). The WURS(+) students scored significantly higher than the WURS(-) students in all the subscales of SCL-90-R. The prevalence rate of adolescent WURS(+) in this study is 14.18%. This result shows that ADHD adolescents have overlapping symptoms with depression.     

Developing confidence in mental health students to recognise and manage physical health problems using a learning intervention

Globally, there is increased recognition of a higher prevalence of physical ill health and mortality in individuals with mental health problems. A review of the literature highlighted the need to address deterioration in physical health of those with mental health problems through better recognition and management on the part of mental health nurses. However, mental health nurses have been found to lack confidence and be unsure of their role within this area. The aim of the project was to develop pre-registration mental health students' confidence to be able to recognise and manage physical health deterioration through the use of high fidelity human patient simulation, the development of contextualised clinical scenarios and additional theory around the A to E mnemonic structured assessment. The project involved 95 third year mental health student nurses, using a self-rating pre and post intervention questionnaire to measure their perceived confidence levels and to evaluate the effectiveness of the learning intervention. Findings demonstrate improved overall confidence levels in recognising and managing physical health deterioration in human patient simulators displaying mental health problems.     

Biomechanical characteristics of handstand walking initiation

BackgroundThe initiation in human locomotion is defined as the transition between upright stance and steady-state gait. While past literature abundantly investigated the initiation in bipedal gait, the initiation of handstand walking remains unexplored.Research questionThe current study aims to characterise the centre of pressure (CoP) and centre of mass (CoM) trajectory of handstand walking initiation as well as the spatiotemporal and kinematic parameters and balance strategy of this task. Also, the study examined the CoP trajectory similarity within- and between-participants using a coefficient of multiple correlation analysis.MethodsNineteen gymnasts took part in this study. Handstand walking initiation trials were recorded using force plates and a stereophotogrammetric system. CoM and CoP trajectories were analysed during the Baseline, Preparation and Execution phases of the motor task.ResultsWe found that to successfully perform the handstand walking initiation, a shift of the CoM forward and towards the stance hand is required as a result of a lateral and posterior CoP shift. All participants performed a similar CoP pattern in the mediolateral direction, whereas two anteroposterior CoP displacement strategies were identified across participants based on different timing execution of posterior CoP shift. While CoP and CoM kinematic differences were identified during the Preparation Phase due to the adopted strategy, no significant difference was found in the Execution Phase for the spatiotemporal and kinematic characteristics.SignificanceA better understanding of the required CoP/CoM patterns and balance control provides the basis for further neuromechanics research on the topic and could contribute to individualise training protocols to improve the learning of the task.     

Measuring the expressed emotion in Chinese family caregivers of persons with dementia: Validation of a Chinese version of the Family Attitude Scale

BackgroundExpressed emotion (EE) captures the affective quality of the relationship between family caregivers and their care recipients and is known to increase the risk of poor health outcomes for caregiving dyads. Little is known about expressed emotion in the context of caregiving for persons with dementia, especially in non-Western cultures. The Family Attitude Scale (FAS) is a psychometrically sound self-reporting measure for EE. Its use in the examination of caregiving for patients with dementia has not yet been explored.ObjectivesThis study was performed to examine the psychometric properties of the Chinese version of the FAS (FAS-C) in Chinese caregivers of relatives with dementia, and its validity in predicting severe depressive symptoms among the caregivers.MethodsThe FAS was translated into Chinese using Brislin's model. Two expert panels evaluated the semantic equivalence and content validity of this Chinese version (FAS-C), respectively. A total of 123 Chinese primary caregivers of relatives with dementia were recruited from three elderly community care centers in Hong Kong. The FAS-C was administered with the Chinese versions of the 5-item Mental Health Inventory (MHI-5), the Zarit Burden Interview (ZBI) and the Revised Memory and Behavioral Problem Checklist (RMBPC).ResultsThe FAS-C had excellent semantic equivalence with the original version and a content validity index of 0.92. Exploratory factor analysis identified a three-factor structure for the FAS-C (hostile acts, criticism and distancing). Cronbach's alpha of the FAS-C was 0.92. Pearson's correlation indicated that there were significant associations between a higher score on the FAS-C and greater caregiver burden (r = 0.66, p < 0.001), poorer mental health of the caregivers (r = −0.65, p < 0.001) and a higher level of dementia-related symptoms (frequency of symptoms: r = 0.45, p < 0.001; symptom disturbance: r = 0.51, p < 0.001), which serves to suggest its construct validity. For detecting severe depressive symptoms of the family caregivers, the receiving operating characteristics (ROC) curve had an area under curve of 0.78 (95% confidence interval (CI) = 0.69–0.87, p < 0.0001). The optimal cut-off score was >47 with a sensitivity of 0.720 (95% CI = 0.506–0.879) and specificity of 0.742 (95% CI = 0.643–0.826).ConclusionsThe FAS-C is a reliable and valid measure to assess the affective quality of the relationship between Chinese caregivers and their relatives with dementia. It also has acceptable predictability in identifying family caregivers with severe depressive symptoms.     

Impairments of balance,stepping reactions and gait in people with cervical dystonia

BackgroundImpaired balance is common in neurological disorders. Cervical dystonia is a neurological movement disorder affecting the neck. The effect of this aberrant head posture on physical function is unknown.ObjectivesTo compare balance, mobility, gait and stepping reactions between ten people with cervical dystonia and ten control adults.MethodsSpatiotemporal gait parameters and walking speed were assessed using a computerised walkway. Step length and time, time in double support and gait variability were calculated, then normalised to gait speed. Centre of pressure path length was assessed with eyes open and eyes closed to calculate a Romberg Quotient. Simple and choice reaction times were measured using customised apparatus while mobility was assessed by the timed up and go. Cervical spine range of motion was measured using a head mounted goniometer. Self-reported scales included Falls Self Efficacy Scale and Dystonia Discomfort Scale.ResultsThere was a difference between groups for most outcome measures. The timed up-and-go and walking speed was slower (both P < 0.005) and the Romberg Quotient lower (P = 0.046) in cervical dystonia. People with cervical dystonia had lower falls self-efficacy (P = 0.0002). Reduced cervical range of motion was correlated with balance, stepping reaction time and mobility (all P < 0.05). Timed up and go was positively associated with stepping reaction time (P < 0.01). Dystonia discomfort did not impact function.ConclusionsPeople with cervical dystonia displayed deficits in balance, gait and stepping reactions, and expressed higher fear of falling. Studies to further elucidate functional limitations and their impact on activity and participation in daily life are required.