精神分裂症异质性及其中枢五羟色胺功能研究

本文应用高效液相色谱(HPLC)对67例精神分裂症及10例健康对照组脑脊液中色氨酸(TRP)、五羟色胺(5-HT)、五羟吲哚乙酸(5-HIAA)进行测试,同时引入5-HT相对代谢率概念用5-HIAA/5-HT表示,并以Andreasen分型标准划分42例阳性精神分裂症和25例阴性精神分裂症。结果发现,精神分裂症患者脑脊液中TRP明显低于正常对照组,阳性(Ⅰ型)分裂症5-HIAA以及5-HIAA/5-HT明显低于阴性(Ⅱ型)精神分裂症,并对精神分裂症的5-HT代谢障碍假说及其异质性进行了讨论。     

老年认知功能缺损者二项必选数字记忆测验结果分析

目的：探讨认知功能缺损程度对二项必选数字记忆测验(简称二项测验)成绩的影响。方法：用简易智力状态量表和韦氏成人智力量表简式调查出38例认知功能缺损者(研究组)和19例无认知功能缺损者(对照组)，同时实施二项数字测验。结果：(1)研究组与对照组二项测验容易条目、困难条目、总分的得分差异均无显著性。(2)智商70-89者困难条目分及总分显著高于智商50-69及34-49者；各组间容易条目分的差异均无显著性。(3)二项测验的假阳性率随着认知功能缺损的加重而有增加趋势。结论：二项测验成绩在一定程度上受认知功能缺损的影响，尤其是严重认知功能减退者，应注意假阳性率的问题。     

Role of negative affects in pathophysiology and clinical expression of irritable bowel syndrome

Irritable bowel syndrome(IBS)is regarded as a multifactorial disease in which alterations in the brain-gut axis signaling play a major role.The biopsychosocial model applied to the understanding of IBS pathophysiology assumes that psychosocial factors,interacting with peripheral/central neuroendocrine and immune changes,may induce symptoms of IBS,modulate symptom severity,influence illness experience and quality of life,and affect outcome.The present review focuses on the role of negative affects,including depression,anxiety,and anger,on pathogenesis and clinical expression of IBS.The potential role of the autonomic nervous system,stress-hormone system,and immune system in the pathophysiology of both negative affects and IBS are taken into account.Psychiatric comorbidity and subclinical variations in levels of depression,anxiety,and anger are further discussed in relation to the main pathophysiological and symptomatic correlates of IBS,such as sensorimotor functions,gut microbiota,inflammation/immunity,and symptom reporting.     

Grey matter volume abnormalities in patients with bipolar I depressive disorder and unipolar depressive disorder:a voxelbased morphometry study

Bipolar disorder and unipolar depressive disorder(UD) may be different in brain structure. In the present study,we performed voxel-based morphometry(VBM) to quantify the grey matter volumes in 23 patients with bipolar I depressive disorder(BP1) and 23 patients with UD,and 23 age-,gender-,and educationmatched healthy controls(HCs) using magnetic resonance imaging. We found that compared with the HC and UD groups,the BP1 group showed reduced grey matter volumes in the right inferior frontal gyrus and middle cingulate gyrus,while the UD group showed reduced volume in the right inferior frontal gyrus compared to HCs. In addition,correlation analyses revealed that the grey matter volumes of these regions were negatively correlated with the Hamilton depression rating scores. Taken together,the results of our study suggest that decreased grey matter volume of the right inferior frontal gyrus is a common abnormality in BP1 and UD,and decreasedgrey matter volume in the right middle cingulate gyrus may be specifi c to BP1.     

Consensus‐based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I

This guideline was developed as a joint interdisciplinary European project, including physicians from all relevant disciplines as well as patients. It is a consensus‐based guideline, taking available evidence from other guidelines, systematic reviews and published studies into account. This first part of the guideline covers methods, patient perspective, general measures and avoidance strategies, basic emollient treatment and bathing, dietary intervention, topical anti‐inflammatory therapy, phototherapy and antipruritic therapy, whereas the second part covers antimicrobial therapy, systemic treatment, allergen‐specific immunotherapy, complementary medicine, psychosomatic counselling and educational interventions. Management of AE must consider the individual clinical variability of the disease; highly standardized treatment rules are not recommended. Basic therapy is focused on treatment of disturbed barrier function by hydrating and lubricating topical treatment, besides further avoidance of specific and unspecific provocation factors. Topical anti‐inflammatory treatment based on glucocorticosteroids and calcineurin inhibitors is used for flare management and for proactive therapy for long‐term control. Topical corticosteroids remain the mainstay of therapy, whereas tacrolimus and pimecrolimus are preferred in sensitive skin areas and for long‐term use. Topical phosphodiesterase inhibitors may be a treatment alternative when available. Adjuvant therapy includes UV irradiation, preferably with UVB 311 nm or UVA1. Pruritus is targeted with the majority of the recommended therapies, but some patients may need additional antipruritic therapy. Antimicrobial therapy, systemic anti‐inflammatory treatment, immunotherapy, complementary medicine and educational intervention will be addressed in part II of the guideline.     

Depression in patients referred for psychiatric consultation A need for a new diagnosis

The authors analyzed 329 referrals for psychiatric consultation from medical and surgical wards. They found depression to be the most prevalent diagnosis (34%), with Major Depression being the most common DSM-III subtype (49%). Depression was predominant in the elderly (p<0.05), in women (p<0.05), and in patients with a high degree of psychosocial stressors (p<0.01). There were significant differences among the DSM-III subtypes of depression in some of these correlates. The authors emphasize the importance of DSM-III in differentiating among the subtypes of depression in referred patients but they suggest the need for a new diagnosis for depression in the physically ill.     

Alan Gregg and the rise of general hospital psychiatry

The authors review the forces that encouraged the entry of psychiatry into the general hospital in the 1930s. Those forces, which included concern about increasing health care costs, pressure to reform medical and psychiatric education, and the growth of dynamic psychiatry and psychosomatic medicine, are described. The activities of Alan Gregg, Director of the Medical Sciences Division of the Rockefeller Foundation during that era are highlighted. Gregg encouraged research in neurobiologic correlates of psychiatric illness and funded psychiatric units in eight general hospitals in the United States. The authors suggest that the development of general hospital psychiatry was strongly influenced by Alan Gregg and his support for a medical model of psychiatric illness. In addition to other forces that spurred the growth of general hospital psychiatry, the authors suggest that Gregg's influence significantly aided psychiatry's entrance into the general hospital.     

Responsibility and choice in addiction

The treatment of patients with substance use disorders requires that providers be aware of their own views on the relative roles of personal responsibility and of forces outside personal control in the onset and progression of and recovery from these disorders. The authors review the role of responsibility for addiction from several viewpoints: biological, psychological, sociocultural, self-help, religious, and forensic. Factors that affect personal responsibility in addictive diseases include awareness of the problem, knowledge of a genetic predisposition, understanding of addictive processes, comorbid psychiatric or medical conditions, adequacy of the support network, nature of the early environment, degree of tolerance of substance abuse in the sociocultural context, and the availability of competent psychiatric, medical, and chemical dependency treatment. Factors that affect societal responsibility include degree of access to illicit drugs, society's level of tolerance of drug use, the courts' approach to deterring substance abuse (punishment versus treatment), individuals' refusal to obtain substance abuse treatment, presence of clear behavioral norms, availability of early assessment and prevention, presence of community education, and degree of access to outpatient and community treatment.