强迫谱系障碍与第Ⅱ组代谢型谷氨酸受体相关候选基因位点的连锁分析

目的 了解代谢型谷氨酸受体mGlu2受体（mGluR2）基因、mGlu3受体（mGluR3）基因等与强迫谱系障碍（OCSDs）的连锁关系。方法 选取一个连续三代发病的强迫谱系障碍家系，采集到该家系中12个正常个体，8个受累个体的血样，选取mGluR2、mGluR3基因附近7对微卫星标记引物，采用两点和多点非参数分析的方法对该家系进行连锁分析。结果 7对微卫星标记位点的两点和多点非参数分析LOD值（NPL值），位于mGluR3基因附近的标记D7S644两点非参数分析NPL值为1．719（P=0．078），多点非参数分析NPL值为1．712（P=0．078），达到验证性连锁的阈值（NPL=1．2），但未达到提示性连锁的阕值（NPL=2．2），D7S2481两点非参数分析NPL值为0．628（P=0．179），多点非参数分析NPL值为0．852（P=0．141），接近验证性连锁的阈值，其余5对微卫星标记位点非参数分析NPL值均未达到验证性连锁的阈值。结论 提示mGluR3基因与OCSDs可能存在连锁关系，不能排除mGluR2基因与OCSDs的相关性。     

强迫症的局部脑血流动态显像研究

目的　探讨强迫症患者各脑叶的代谢状态及脑功能异常与其发病的关系。　　方法　采用单光子发射计算机扫描 (SPECT)技术 ,对未服药的 2 2例强迫症患者于静息及症状诱发状态下行局部脑血流 (rCBF)动态显像研究。　　结果　 1 8例有rCBF异常 ,表现为皮层内局限性放射性分布稀疏、缺损区 ,异常脑叶主要为顶叶、额叶、颞叶 ,并发现脑功能异常与强迫症状的严重程度及药物治疗反应有关。　　结论　大脑顶叶、额叶等脑叶的功能异常是部分强迫症发病的神经病理学基础     

强迫症疾病行为的精神病理机制研究

目的对研究获得的强迫症疾病行为特征探索其精神病理学机制。方法以符合CCMD-Ⅱ的门诊强迫症患者50例为对象，选取非精神科病人50例组成对照，应用“强迫症疾病行为特征量表（OBPS）”，确定其有无强迫症疾病行为。同时调查研究组与对照组的人格特质、偶发事件、应对策略等方面，研究这些因素在疾病发生、发展中的作用。结果①研究组全部符合李一高量表的疾病行为特征，积分明显高于对照组（t=26．480，P〈0．01）；②强迫症患者人格当中的强迫质偏高，积分明显高于对照组（t=15．93，P〈0．01）；③研究组中绝大多数患者存在偶发事件，而对照组中偶发事件的发生率低于研究组（X^2=21．374，P〈0．01）；④应对策略特征方面研究组不成熟应对方式的应用明显多于对照组。结论强迫神经症形成中人格特质作为基础，偶发事件起到启动对“不完全的恐怖”，错误的应对策略不断强化病感，促进疾病形成。李一高强迫症疾病行为理论的3项内容，特征性的反映了强迫症的疾病行为。     

穴位刺激合并小剂量氯米帕明治疗强迫症30例临床研究

目的:研究穴位刺激治疗强迫症的临床疗效.方法:60例强迫症患者分为两组,氯米帕明组(对照组)及穴位刺激调控法加氯米帕明组(治疗组)各30例.采用Yale-Brown强迫症量表、汉密尔顿抑郁量表(HAMD)、简明精神病量表(BPRS)、副反应量表(TESS)临床疗效评定标准,分别评定疗效和副反应.结果:对照组痊愈率为26.7%,显效率为56.6%.治疗明组痊愈率为43.3%,显效率为76.7%.治疗组疗效优于对照组.对照组不良反应发生率为73.33%,治疗组不良反应发生率为46.67%.两组不良反应发生率差异有显著性(P<0.05).结论:穴位刺激调控法加小剂量氯米帕明疗效好于氯米帕明.提示穴位刺激调控法的疗效肯定,副作用小,安全性好.     

Musical Alexia for Rhythm Notation: A Discrepancy Between Pitch and Rhythm

In the process of reading music, the reading of rhythm and pitch might be differentiated, although there is no evidence of this to date. There have been cases of disorders restricted to the reading of pitch, but none in which the disorder has been restricted to the reading of rhythm. We present a case of musical alexia and agraphia with Wernicke’s aphasia. An in-depth assessment of the subject’s musical reading ability showed that her musical alexia was restricted to unfamiliar melodies. When a melody was divided into rhythm elements and pitch elements, pitch reading was preserved, but rhythm reading was severely disturbed. This is the first case reported of a disorder restricted to rhythm reading, and suggests the independence of rhythm reading and pitch reading.     

Thalamic deep brain stimulation for Tourette Syndrome: A naturalistic trial with brief randomized,double-blinded sham-controlled periods

BackgroundThere is still a lack of controlled studies to prove efficacy of thalamic deep brain stimulation for Tourette's Syndrome.ObjectivesIn this controlled trial, we investigated the course of tic severity, comorbidities and quality of life during thalamic stimulation and whether changes in tic severity can be assigned to ongoing compared to sham stimulation.MethodsWe included eight adult patients with medically refractory Tourette's syndrome. Bilateral electrodes were implanted in the centromedian-parafascicular-complex and the nucleus ventro-oralis internus. Tic severity, quality of life and comorbidities were assessed before surgery as well as six and twelve months after. Short randomized, double-blinded sham-controlled crossover sequences with either active or sham stimulation were implemented at both six- and twelve-months’ assessments. The primary outcome measurement was the difference in the Yale Global Tic Severity Scale tic score between active and sham stimulation. Adverse events were systematically surveyed for all patients to evaluate safety.ResultsActive stimulation resulted in significantly higher tic reductions than sham stimulation (F = 79.5; p = 0.001). Overall quality of life and comorbidities improved significantly in the open-label-phase. Over the course of the trial two severe adverse events occurred that were resolved without sequelae.ConclusionOur results provide evidence that thalamic stimulation is effective in improving tic severity and overall quality of life. Crucially, the reduction of tic severity was primarily driven by active stimulation. Further research may focus on improving stimulation protocols and refining patient selection to improve efficacy and safety of deep brain stimulation for Tourette's Syndrome.     

Phenomenology of OCD: Lessons from a large multicenter study and implications for ICD-11

This study aimed to investigate the phenomenology of obsessive–compulsive disorder (OCD), addressing specific questions about the nature of obsessions and compulsions, and to contribute to the World Health Organization's (WHO) revision of OCD diagnostic guidelines. Data from 1001 patients from the Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders were used. Patients were evaluated by trained clinicians using validated instruments, including the Dimensional Yale–Brown Obsessive–Compulsive Scale, the University of Sao Paulo Sensory Phenomena Scale, and the Brown Assessment of Beliefs Scale. The aims were to compare the types of sensory phenomena (SP, subjective experiences that precede or accompany compulsions) in OCD patients with and without tic disorders and to determine the frequency of mental compulsions, the co-occurrence of obsessions and compulsions, and the range of insight. SP were common in the whole sample, but patients with tic disorders were more likely to have physical sensations and urges only. Mental compulsions occurred in the majority of OCD patients. It was extremely rare for OCD patients to have obsessions without compulsions. A wide range of insight into OCD beliefs was observed, with a small subset presenting no insight. The data generated from this large sample will help practicing clinicians appreciate the full range of OCD symptoms and confirm prior studies in smaller samples the degree to which insight varies. These findings also support specific revisions to the WHO's diagnostic guidelines for OCD, such as describing sensory phenomena, mental compulsions and level of insight, so that the world-wide recognition of this disabling disorder is increased.     

Relationship of Quality of Life with Disability Grade in Obsessive Compulsive Disorder and Dysthymic Disorder

Background:

There is paucity of information on the relationship of quality of life (QOL) in obsessive compulsive disorder (OCD) and dysthymic disorder (DD) with disability grade in India.

Aim:

To assess the relation of QOL with disability level in OCD and DD.

Materials and Methods:

This hospital based study was conducted in a medical institution in Davanagere, Karnataka, India. Data was collected by using Diagnostic and Statistical Manual IV Text Revision (DSM IV TR) criteria, WHO QOL BREF and IDEAS. Relationship between disability grade and QOL was assessed by independent sample t test.

Results:

Mild disabled OCD patients had a significantly better QOL in the Q1 domain i.e. perception on quality of life as compared to moderately disabled patients (P < 0.05), while in other domains of QOL, there was no statistically significant difference (P > 0.05). But, QOL score in physical domain showed significant difference across disability grades (56.00, SD = 6.89; 48.50, SD = 12.28) in DD, but not in other domains.

Conclusion:

Perception of QOL is better in those with mild disability in OCD, but in DD, physical domain of QOL score is more in mild disability compared to moderate disability.     

The spontaneous decay and persistence of mental contamination: An experimental analysis

Background and objectives

It has recently been identified that feelings of contamination can arise in the absence of physical contact with a stimulus. This concept, known as ‘mental contamination’ has particular relevance to Obsessive Compulsive Disorder in which compulsive cleaning is a common symptom presentation. Experimental studies have begun to examine the psychopathology of mental contamination. The aims of the two experiments reported here were to explore the evocation and spontaneous decay of mental contamination.

Methods

In Experiment 1, a variant of the autobiographical memory task was used in which 40 non-clinical participants were asked to recall autobiographical memories associated with betrayal, harm, humiliation and violation of moral standards. In Experiment 2, 60 participants with moderate levels of mental contamination were asked to complete five short tasks designed to induce mental contamination, including recalling unwanted memories and images.

Results

In both experiments, participants reported significant increases in mental contamination, anxiety, urges to wash and actual washing behaviour. In experiment 1, the effect of the induction decayed spontaneously. Experiment 2 found that re-evoking contamination and repeated washing led to the persistence of mental contamination.

Limitations

The studies were conducted on non-clinical samples.

Conclusions

These findings demonstrated that repeated triggers may be causally connected to the maintenance of mental contamination fears in non-clinical samples.