立体定向手术干预伏隔核治疗神经性厌食症

目的通过立体定向毁损术及脑深部电刺激能有效治疗神经性厌食症。方法共8例罹患神经性厌食症的患者通过立体定向手术干预伏隔核治疗神经性厌食症（其中6例患者接受双侧伏隔核毁损术,2例患者接受双侧伏隔核脑深部电刺激）。患者术前均接受正规的抗精神类药物及心理、营养治疗无效。患者术前及术后接受BMI指数、YBOCS,HAMA,HAMD量表的测定,评价疗效。结果 8例患者术后BMI指数均得到明显改善（P〈0.01）,除1名患者外,其余患者BMI指数均大于18.5kg/m^2。接受双侧伏隔核毁损术的患者术后YBOCS,HAMA,HAMD指数均得到立即改善,接受双侧伏隔核脑深部电刺激的患者术后经过程控,各项评定也均得到有效控制。结论伏隔核是治疗神经性厌食症的有效靶点,立体定向手术干预伏隔核可有效改善神经性厌食症患者的各项症状。     

小儿厌食症的中医治疗进展

从病因病机、内治法、外治法及内外结合法几个方面对小儿厌食症的中医治疗进展进行了综述,为小儿厌食症的临床治疗提供文献支持。     

小儿厌食中药新药临床试验设计与评价技术指南

《儿科常见疾病中药新药临床试验设计与评价技术指南》是中华中医药学会儿科分会临床评价学组制定的、指导儿科中药Ⅱ期、Ⅲ期临床试验和上市后有效性再评价方案设计的、具有病种特色的系列临床评价技术指南, 旨在推动儿科中药临床试验设计与评价水平的提高, 并为临床提供安全有效的儿童用药。采用世界卫生组织(WHO)推荐的"共识会议法"和美国国立卫生研究院(NIH)发展共识方案(GPP)有关原则, 国内全部18个国家药物临床试验机构中医儿科专业的临床儿科专家以及国内相关临床评价专家参加了急性上呼吸道感染、急性支气管炎、支气管哮喘、反复呼吸道感染、厌食、轮状病毒性肠炎、注意缺陷-多动障碍、抽动障碍、遗尿症、手足口病、湿疹11个儿科常见病种指南的起草或多次提出修改建议, 历经3年反复完善, 最终形成共识, 并由中华中医药学会儿科分会于2013年10月发布。本指南从研究背景、研究目标、总体设计、诊断标准、受试者的选择、给药方案、安全性评价、有效性评价、试验流程、数据管理与统计分析、质量保证、相关伦理学要求、试验结束后的医疗措施、资料保存等方面阐述了小儿厌食中药新药临床试验的设计与评价技术要点, 期望能为申办者与研究者在临床试验方案设计中提供指导。     

Dynamics of nurses’ authority in the inpatient care of adolescent consumers with anorexia nervosa: A qualitative study of nursing perspectives

Nurses caring for adolescent consumers with anorexia nervosa in the inpatient setting are challenged in a unique way, in that they are caring for people with whom they do not have a mutually held concept of well‐being. Their efforts to ensure weight gain are frequently against the wishes of the consumer. This dissonance results in challenging interactions, where nursing care and authority may be undermined. This study investigated the dynamics of nurses’ authority within this context. Interviews with nurses (n = 10) were conducted and analysed through thematic analysis. Nurses reported that consumers, compelled by the psychopathology of anorexia nervosa, often sought to challenge or undermine their authority. Some nurses experienced the opposition and conflict as demoralizing, whereas others were able to maintain confidence in the therapeutic merit of their care. Younger, inexperienced nurses in this study were particularly vulnerable to interactions that mitigated their authority, due to their tendency to engage in friend‐like relationships. Nurses caring for adolescents with anorexia nervosa should be prepared to be confronted by interactions that overtly and surreptitiously undermine their capacity to exercise professional authority. It is important that nurses recognize the importance of maintaining their authority, and how it can be threatened in subtle and unexpected ways.     

A Retrospective lyrical analysis of songs written by adolescents with anorexia nervosa

Song‐writing plays a central role in music therapy with adolescents. A retrospective lyrical analysis of songs written by adolescents with anorexia nervosa was undertaken in order to identify common themes solicited through song‐writing interventions. Fifteen participants contributed 17 songs, from which 368 lyrical units were identified. A modified content analysis approach was used with each lyrical unit being categorised to one of six themes determined from the literature and clinical experience. The theme of ‘identity’ was used most frequently (28%), with the sub‐theme of ‘exploring new behaviours, positive self‐talk’ being addressed most often (12.5% of total). The dominance of the developmentally important theme of ‘identity’ may reflect the relationship between adolescents, music and identity or may be related to the way in which anorexia nervosa has been theorised to assist the adolescent in managing challenges to the emerging sense of self. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association.     

Impaired inhibitory control in anorexia nervosa elicited by physical activity stimuli

Besides food restriction, hyperactivity is considered a key behavioral trait of anorexia nervosa (AN), playing a major role in the pathogenesis and progression of the disorder. However, the underlying neurophysiology remains poorly understood. We used functional magnetic resonance imaging during two affective go/no-go tasks to probe inhibitory control in response to stimuli depicting physical activity vs inactivity and food vs non-food in AN patients compared with 26 healthy athlete and non-athlete controls. We hypothesized that neural correlates of behavioral inhibition are biased by the emotional information of the stimuli in AN patients, leading to a differential neural inhibitory pattern during the two tasks. Indeed, we found reduced response inhibition for food and non-food images in the putamen, while stimuli depicting physical activity resulted in an exaggerated response of the prefrontal cortex (PFC) and cerebellum in AN patients. However, both AN patients and athletes revealed an increased response in the somatosensory cortex to physical activity stimuli. These results suggest that physical activity stimuli might place an increased demand on the inhibitory control system in AN patients. The resulting hyperactivity of the PFC and cerebellum may lead to altered executive function and motor control, sustaining increased physical activity in AN patients.