目的 探讨德国Galli心理剧治疗对少年精神疾病患者的自尊水平及疗效的干预效果.方法 60例少年精神疾病患者按入组先后顺序分为德国Galli心理剧治疗合并综合治疗组(研究组)和综合治疗组(对照组),各30例,用自尊量表(SES)、缺陷感量表(FIS)、临床大体印象量表(CGI)分别在治疗前1天、4周治疗后进行评定,比较两组的评分变化情况.结果 自尊量表、缺陷感量表的评分,两组治疗前后差值无显著性差异(P>0.05),临床大体印象量表的评分,研究组治疗前后差值大于对照组得分.结论 德国Galli心理剧治疗可提高少年精神疾病患者的疗效,但对自尊水平无明显效果.

Objective:To explore the correlation between depression and comorbidity of cerebral small vessel disease（CSVD） in patients with depression, so as to provide evidence for early prevention and treatment.Methods:Totally 80 patients with stable depressive episode and recurrent depressive disorder according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision（ICD-10）,as well as 97 normal controls were included.Medical historywas collected, and cognitive function and mental status were assessedusing Montreal Cognitive Assessment（MoCA）,Mini-Mental State Examination（MMSE）,Hamilton Depression Scale and Hamilton Anxiety Scale.Positive rate of CSVD diagnosis and the relevant magnetic resonance imaging（MRI） diagnostic features were evaluated by cranial MRI.Logistic regression analysis was used to analyze the correlation between depression and CSVD.Results:The age of depression group and normal control group were（59±9） years and（58±8） years, respectively（P＞0.05）.Higher proportion of hypertension and lower MoCA total scores were seen in the depression group than in the normal control group（Ps＜0.05）.The proportion of CSVD was higher in the depression group than in the normal control group（83.8% vs.64.9%,P＜0.01）.Logistic regression analysis showed that lacunar cerebral infarction（OR=4.4,95%CI:1.07-18.23）,frontal lobe demyelination（OR=2.4,95%CI:1.05-5.42） and MoCA＜26（OR=2.3,95%CI:1.16-4.47） were the risk factors of depression.Conclusion:Comorbid CSVD is common in the middle-aged and elderly patients with depression, for whom lacunar cerebral infarction and frontal lobe demyelination maybe the risk factors.

Background This study aimed to explore the validity and reliability of the Patient Health Questionnaire-9 (PHQ-9) on screening of depression among patients with neurological disorders, and to explore factors influencing such patients. Methods In this study, 277 subjects who were admitted to the department of neurology of our hospital due to different neurological disorders completed the PHQ-9 questionnaire. The Mini-International Neuropsychiatric Interview (MINI) and Hamilton Rating Scale for Depression (HAMD) were employed to evaluate the depressive symptoms of patients who completed the PHQ-9 questionnaire. The internal consistency, criterion validity, structural validity, and optimal cut-off values of PHQ-9 were evaluated, and the consistency assessment was conducted between the depression severity as assessed by PHQ-9, HAMD and MINI. Logistic regression analysis was used to calculate the risk factors of depression. Results The Cronbach’s α coefficient of the PHQ-9 was 0.839. The Pearson’s correlation coefficient among the 9 items of the PHQ-9 scale was 0.160 ~ 0.578 ( P < 0.01), and the Pearson’s correlation coefficient between each item and the total score was at the range of 0.608 ~ 0.773. Taking the results of MINI as the gold standard, the area under the receiver operating characteristic (ROC) curve of the PHQ-9 results for all the subjects ( n = 277) was 0.898 (95% confidence interval (CI): 0.859 ~ 0.937, P < 0.01). When the cut-off score was equal to 5, the values of sensitivity, specificity, and the Youden’s index were 91.2, 76.6%, and 0.678, respectively. Multivariate logistic regression analysis showed that the influence of unemployment on the occurrence of depression was statistically significant ( P = 0.027, OR = 3.080, 95%CI: 1.133 ~ 8.374). Conclusions The application of PHQ-9 for screening of depression among Chinese patients with neurological disorders showed a good reliability and validity.

目的:了解我国单用奥氮平治疗精神分裂症的现状,为进一步合理用药提供理论依据.方法:选取全国26家医院(包括精神专科医院和综合性医院)门诊或住院的精神分裂症患者3061例,采用自制调查问卷进行单用奥氮平治疗的现况调查.结果:①单用奥氮平治疗有效患者2572例(84％),治疗前后临床疗效总评量表-病情严重程度(CGI-SI)评分显著下降(P<0.01);②服用奥氮平剂量越大,维持治疗时间越长,越有可能达到治疗有效;③最常合并镇静催眠药物,其次是抗抑郁剂、心境稳定剂、抗胆碱能药、β受体阻滞剂和降糖药;④最常出现的实验室检查异常依次为血清催乳素,低密度脂蛋白、三酰甘油、高密度脂蛋白、空腹血糖、总胆固醇.结论:①单用奥氮平治疗后精神分裂症患者疾病严重程度明显下降,且服用时间越长,剂量越大,疗效越好;②单用奥氮平治疗的患者糖脂异常比例远高于一般人群.③有较多患者合并使用抗抑郁药或心境稳定剂.

A family history of psychiatric disorders is one of the strongest risk factors for schizophrenia. The characteristics of patients with a family history of psychiatric disorders have not been systematically evaluated.

目的 探讨德国Galli心理剧治疗对少年精神障碍患者的社会适应能力及疗效的干预效果.方法 60例少年精神障碍患者按入组先后顺序分为研究组和对照组,各30例,用社会适应能力诊断量表、临床大体印象量表(CGI)分别在治疗前1天、治疗4周后的次日进行评定,比较两组评分变化.结果 社会适应能力诊断量表的评分,两组治疗前后差值无显著性差异(P＞0.05),临床大体印象量表的评分,两组治疗前后差值有显著性差异(P＜0.05).结论 德国Galli心理剧治疗可提高少年精神疾病患者的疗效,但对社会适应能力的改变无明显效果.

Objective To explore the functional connectivities of default-mode network related brain regions in female patients with depression by using resting-state functional magnetic resonance imaging (rs-fMRI). Methods Twenty-seven female patients (outpatients and inpatients of Peking University Sixth Hospital) with depression were enrolled as the case group from January 2013 to September 2014. In the same period, 37 age- and education-matched healthy females were enrolled as the control group from residents of communities surrounding Peking University Health Science Center and the families of the staff of Peking University Sixth Hospital. All subjects received rs-fMRI scanning. The left precuneus and the left inferior parietal lobule were selected as the two regions of interest (ROI). We used voxel-based correlation analyses to measure functional connectivities in the ROI in both groups, and compared the functional connectivity differences of the default-mode network related brain regions between the two groups. Results Compared with the control group, the case group showed significantly increased functional connectivity (P<0.05, corrected by Alphasim) between the left inferior parietal lobule and the right cingulate cortex, and between the left precuneus and both the right thalamus and the bilateral midbrain. Conclusion The results suggest that abnormal functional connectivities between default-mode network related brain regions and multiple brain networks existed in depressed female patients during the resting state. These abnormalities may play a role in the pathogenesis of depression in these patients.

目的 了解综合医院住院谵妄老年患者与成年谵妄精神科会诊前后处置的不同.方法 对明确诊断为谵妄的690例患者的会诊前后处置进行分析,将其按年龄分为老年组(547例)和成年组(143例)进行比较.分类资料采用x2检验.结果 老年谵妄组会诊前精神药物使用中,中短效镇静催眠药和长效镇静催眠药比例均低于成年组(P＜0.05);会诊前抗精神病药的使用中,老年组只在使用其他第一代抗精神病药(除氟哌啶外)上低于成年组(P＜0.01).会诊后精神药物使用上,老年谵妄组使用抗精神病药(P＜0.05)、长效镇静催眠药(P＜0.01)以及这两类药的合并使用(P＜0.01)上都低于成年组.在精神药物的使用上,老年谵妄组会诊前未用药比例高于会诊后(P＜0.01),而使用抗精神病药(P＜0.01)和抗精神病药合并中短效镇静催眠药(P＜0.01)则低于会诊后;成年组在未用药高于会诊前(P＜0.01),使用抗精神病药上低于会诊前(P＜0.01).结论 较之成年谵妄住院患者,非精神科医师对老年谵妄住院患者用药更审慎,体现在镇静催眠药或合并抗精神病药使用上;会诊后镇静法对成年谵妄患者最常用,其中单独使用抗精神病药最常见,而老年谵妄患者更常用.

Objective:To compare the cognitive functions in patients with depressive disorder,hyperlipidemia disorder,and comorbid both of the disorders.Methods:A cross-sectional study was performed in age,gender and education year matched patients with depressive disorder (n =51)(according to the ICD-10),hypedipidemia(n =38) (according to the Chinese adult lipid guideline),comorbid both of the disorders(n =40) and normal controls (n =56) were recruited in this study.All subjects received a battery of neuropsychological tests to access the anxiety and depression symptoms and cognitive function.Results:The scores of MoCA were lower in the patients with comorbid both disorders and patients with depression than patients with hypedipidemia [(24 ± 3),(24 ± 4)vs.(26 ± 3),Ps ＜0.05],and were lower in patients with depression than in normal controls(25 ±3),P ＜0.05.Stroop color test amends numbers were higher in patients with comorbid disorder than in the other three groups (Ps ＜0.05).The scores of immediate and delayed logical memory were higher in patients with hyperlipidemia than in other three groups (Ps ＜0.05).The total number of words in verbal fluency test were lower in patients with comorbid disorders and patients with depression than in patients with hyperlipidemia (Ps ＜0.05).Wisconsin card sorting test category completes were lower in patients with comorbid disorders and patients with depression than in patients with hyperlipidemia and normal controls (Ps ＜ 0.05).The scores of persistent errors were higher in patients with comorbid disorders and patients with depression than in patients with hyperlipidemia and normal controls (Ps ＜0.05).Conclusion:In this study,patients with depressive disorder have impairment of cognitive function,while hyperlipidemia may probably do not impair cognitive function.

Objective To evaluate cerebral white matter lesions in patients with depression using fractional anisotropy (FA) values of diffusion tensor imaging(DTI) and kurtosis fractional anisotropy (KFA) values of diffusion kurtosis imaging (DKI),and the correlation between KFA values and degree of depression.Methods Twenty patients with depression and 20 control subjects were recruited.DTI and DKI were performed.FA values of DTI and FKA values of DKI were obtained.FA values in patients with depression were compared with controls.KFA values were processed in the same way.FA values of DTI were compared with FA values of DKI.Correlations between KFA values and Hamilton depression scale (HAMD17) were investigated using correlation analysis.Results FA values decreased slightly in patients with depression,but the voxels were below 50.KFA values decreased in more areas than FA values.There were no significant differences between FA values of DTI and FA values of DKI.There were negative correlations between KFA values and degrees of depression in certain gyri in patients with depression.Conclusion FA values of DTI and KFA values of DKI decreased in certain regions in patients with depression.KFA values decreased in more regions than FA values.DKI values were more sensitive to detect underlying extensive white matter impairments in patients with depression.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的:探索抑郁障碍患者自助小组的效果,为推进抑郁障碍患者自助、拓展康复措施提供参考。方法:选取1年内参加4次以上抑郁自助小组的患者21例,根据访谈提纲进行半结构式访谈,采用扎根理论的方法对访谈资料进行深度分析。采用自编小组效果调查表调查患者参加小组后的感受、收获或发生的变化。结果:访谈分析发现,自助小组的效果包括症状改善、规范治疗及提高依从性、促进康复、提升自尊自信4方面。自编小组效果调查表结果显示,收获较大的前3个方面为获得经验、对治疗有信心、学习自我调节。结论:抑郁自助小组可帮助患者缓解抑郁症状,改善治疗依从性,从提高社交技能、接纳疾病等多方面促进康复,可有效提升患者的自尊感,值得推广。</span>

Objective To explore the features of resting state brain activity of hypertension and hypertension co-morbid depression by resting state functional magnetic resonance imaging (fMRI) technology based on the amplitude of low frequency fluctuation (ALFF). Methods Thirty patients with hypertension co-morbid depression group (HD), 30 patients with hypertension group (H), and 30 normal controls group (NC) were selected. The demographic data and clinical features of all groups were collected. All participants underwent the fMRI and the resting state data of whole brain were analyzed by ALFF method. Results Four clusters with statistically significant differences in one-way analysis of variance in ALFF between the three groups including the left cerebellum, right thalamus, left superior temporal gyrus, and left superior medial frontal gyrus (F=14.99,15.90,11.52,12.64,all P<0.05, AlphaSim corrected). Group H showed more decreased ALFF in right thalamus than group NC(MNI coordinates (x, y, z):6,-15, 12;F=-3.96). Compared group HD with group NC, decreased ALFF was found in left cerebellum (MNI coordinates (x, y, z):-48,-63,-27;F=-4.87), right thalamus(MNI coordinates (x, y, z):6,-15, 9;F=-5.20) and increased ALFF in left superior medial frontal gyrus(MNI coordinates (x, y, z):-24, 36, 42, F=5.08). Compared group HD with group H, decreased ALFF was found in the left superior temporal gyrus(MNI coordinates (x, y, z):-54,-12, 12; F=-4.32), increased ALFF in right superior frontal gyrus(MNI coordinates (x, y, z):18, 36, 48;F=3.99)and left superior frontal gyrus(MNI coordinates (x, y, z):-15, 48, 42;F=3.57;all P<0.05, AlphaSim corrected). Conclusion Abnormal resting-state brain activity emerge in regulatory areas in patients with hypertension co-morbid depression,which is more seriously than ones with hypertension, and early positive and effective control of blood pressure may alleviate damage to brain function.

Objective To explore the abnormally functional brain regions of female patients with depression by resting state functional magnetic resonance imaging(fMRI), and analyze the correlation with the severity of depressive symptoms. Methods 32 female patients diagnosed with depressive disorder and 40 matched healthy controls completed resting state fMRI scans. The whole brain’s regional homogeneity (ReHo) and amplitude of low-frequency fluctuation(ALFF) were calculated, and the correlation analysis between ReHo and ALFF of brain regions with significant difference and the severity of depressive symptoms was conducted. Results Compared with control group, the left precuneus/left cuneus(MNI: -18, -81, 45), bilateral precentral gyrus(MNI: -58, -5, 35 and 57, -6, 33), left inferior parietal lobule(MNI: -42, -36, 45) and right inferior temporal gyrus(MNI: 60, -45, -18)(P<0.05, corrected by AlphaSim)in the case group showed significantly decreased ReHo, with statistical significance. Compared with control group, the left cuneus(MNI: -3, -87, 30), right inferior temporal gyrus(MNI: 60, -48, -18) and left precentral gyrus(MNI: -63, -3, 26)(P<0.05, corrected by AlphasSim)in the case group showed significantly decreased ALFF. The ReHo in the right inferior temporal gyrus was negative correlated with the HAMD-17 total score and retardation factor(r=-0.484, P=0.017; r=-0.408, P=0.048), the ALFF in the right inferior temporal gyrus was positively correlated with weight factor(r=0.574, P=0.003), and negative correlated with the number of depressive episodes(r=-0.416, P=0.043). Conclusion Female with depression in resting state have several abnormally functional brain regions and the extent of damage is correlated with the severity of depressive symptoms.Combination of the two parameters may yield a more comprehensive pathophy-siological mechanism for depressive disorder. Key words: Depressive disorder; Gender; Resting-state function magnetic resonance imaging; Regional homogeneity; Low frequency amplitude

目的 探讨脑卒中后抑郁患者的临床影响因素.方法 应用《复合性国际诊断问卷-3.0》(CIDI-3.0)对405例住院脑卒中患者进行筛查与诊断,以脑卒中后抑郁患者作为研究组(PSD组),脑卒中后非抑郁患者为对照组(非PSD组),对2组患者家庭收入等一般资料及卒中性质等临床影响因素进行对照研究.结果 研究组农村居民(86.4％与52.3％)、低收入家庭(81.8％与50％)的比例显著高于对照组(P＜0.05);与对照组相比,研究组言语障碍(54.5％与22.7％,P＜0.05)、肢体瘫痪(68.2％与40.9％,P＜0.05)、脑出血(40.9％与9.1％,P＜0.05)率更高.研究组卒中部位涉及基底节脑区的比率明显高于对照组,2组患者在婚姻状况、民族、受教育程度、职业、吸烟史、饮酒史、高血压病史、脑卒中发作次数及意识障碍方面比较差异无统计学意义(P＞0.05).结论 脑卒中后抑郁的发生可能与卒中性质、部位(特别是基底节脑区)以及脑卒中导致的语言和运动功能受损有关,临床工作中应重视上述情况.此外,在卒中后抑郁的防治中应重视农村或低收入家庭的患者.

Objective To investigate the impairment and change of cognitive function in patients with depression in remission.Methods The cognitive function was evaluated with group neurocognitive test tool from multi -dimensional evaluation of attention,memory and execution function among 14 depressive patients during diseased episode and in remission after one year.The control group was set and the results of the two groups were compared.Results The result of the attention test showed that the error counts of the second and third situation of Continuous Performance Test (CPT)in depression group in diseased episode and in remission were more than those in the control group (P <0.05),and the time used in Stroop -C and the time used in A of Trail making test(TMT)were longer than those in the control group (P <0.05),and the right numbers in Stroop -CW were less than those in the control group (P <0.05 ).The numbers completed in Stroop -CW in diseased episode of depression group were less than those in control group(P <0.05),and the numbers completed in Stroop -CW in remission of depression group were more than those in diseased episode(P <0.01).The result of the memory test showed that the score of a in Logical memory test (LMT)in diseased episode of depression group was less than that in control group(P <0.05),and the score of b and aggregate score in LMT and the score of b in Visal reproduction test (VRT)in diseased episode and in remission of depression group were less than that in control group (P <0.05).In VRT,the score of a and aggregate score in diseased episode were less than that in remission of depression group and in control group(P <0.05),and the score of c in diseased episode and the aggregate score in remission were less than that in control group(P <0.05).The result of the execution function test showed that the numbers of sustained error of mWCST in diseased episode of depression group were more and the numbers of categories were less than those in control group (P <0.05),and the correct numbers in Verbal fluency test (VFT)of the depressive group in diseased episode and in remission were less than those in control group(P <0.01 ).Conclusion When the depressive disorder is remitted,the degree of cognitive impairment in different dimension is different,and the cognitive impairment is still exist for a long time.

Facial emotion recognition has been found to be impaired in schizophrenia, although overall results have been inconclusive. A new set of facial emotion stimuli with Chinese faces was developed, using static and dynamic avatars, the identification of which were subsequently validated in 562 healthy control subjects. This test was then used to identify facial emotion recognition accuracy in 44 patients with schizophrenia and 41 healthy controls. Overall, patients identified facial emotions significantly worse than healthy controls (p = 0.018) with a significant main effect for type of emotion (p = 0.016). Patients performed significantly worse in fear (p = 0.029) and sadness (p = 0.037), and marginally worse in anger (p = 0.052). No significant differences were evident in contempt (p = 0.254) or happiness (p = 0.943). Regarding error rates of misattribution, patients overidentified contempt (p = 0.035) and sadness (p = 0.01), but not anger, fear, or happiness. Conclusion, patients of Chinese ethnicity with schizophrenia may have significantly greater difficulties identifying negative, but not positive emotions.

Objective To explore attributional style and its relationship with personality in patients with depression.Methods A total of 106 patients with depression were measured with Chinese version Attributional Style Questionnaire(ASQ)and Eysenck Personality Questionnaire (EPQ),the attributional style and personality in patients with depression were compared with those in normal controls according to the data.We expored attributional style with different depressions.Results ①The negative events scores of depression group were significantly higher than those of normal control group (P < 0.01 ),but the other scores of depression group were much lower than those of normal control group (P < 0.01 ).② The neuroticism score and psychoticism score of depressive group were higher than those of normal control group(P <0.01).③The scores of positive events and achievement events score of neuroticism individuals were different with those of non-neuroticism individuals and intermediate type individuals(P <0.05). The scores of interpersonal events and internality dimensions of neuroticism individuals and intermediate type individuals were lower than those of non-neuroticism individuals(P < 0.05). Conclusion The attributional style of patients with depression are negative.They hold obviously&nbsp;neuroticism traits.Neuroticism affects attributional style in patients with depression.

目的 探讨磁共振扩散峰度成像(DKI)在评价抑郁症及抑郁高血压共病患者脑部微观结构损害中的应用价值.方法 收集20例抑郁症患者(抑郁症组)、26例抑郁高血压共病患者(共病组)、26例高血压患者(高血压组)、23名健康志愿者(正常对照组),采用3.0T磁共振仪进行DKI扫描,使用DKE软件计算平均扩散峰度(MK)值;比较4组间MK值的差异;比较差异脑区平均MK值与17项汉密尔顿抑郁量表(HAMD-17)评分的相关性.结果 相对于正常对照组,抑郁症组MK值减低的脑区包括右额中回、右梭状回、右前扣带回、左中扣带回、左后扣带回、右岛叶、右海马、右枕下回及左枕中回、双侧楔前叶、双侧壳核、两侧颞下回和颞中回(P＜0.05),共病组MK值减低的脑区包括右额上回、右梭状回、右前扣带回、右中扣带回、左后扣带回、双侧海马、双侧海马旁回、左枕中下回、双侧楔前叶、右壳核、左舌回、双侧颞中回及颞下回及左侧丘脑(P＜0.05),高血压组无MK减低区.相对于抑郁症组,共病组MK下降脑区为右额下回、右梭状回、右岛叶、右扣带前回(P＜0.05).右侧海马(r=0.421,P＜0.001)及右侧额中回(r=0.400,P=0.001)的平均MK值与HAMD-17评分呈负相关.结论 抑郁症和抑郁共病患者存在广泛的额叶-皮层下-边缘系统脑白质微观结构损害和功能异常;高血压可能对抑郁症有协同作用.

Objective To explore the abnormally functional brain regions of female patients with depression by resting state functional magnetic resonance imaging (fMRI),and analyze the correlation with the severity of depressive symptoms.Methods 32 female patients diagnosed with depressive disorder and 40 matched healthy controls completed resting state fMRI scans.The whole brain's regional homogeneity (ReHo) and amplitude of low-frequency fluctuation(ALFF) were calculated,and the correlation analysis be tween ReHo and ALFF of brain regions with significant difference and the severity of depressive symptoms was conducted.Results Compared with control group,the left precuneus/left cuneus (MNI:-18,-81,45),bilateral precentral gyrus (MNI:-58,-5,35 and 57,-6,33),left inferior parietal lobule (MNI:-42,-36,45) and right inferior temporal gyrus(MN1:60,-45,-18) (P＜0.05,corrected by AlphaSim)in the case group showed significantly decreased ReHo,with statistical significance.Compared with control group,the left cuneus(MNI:-3,-87,30),right inferior temporal gyrus(MNI:60,-48,-18) and left precentral gyrus(MNI:-63,-3,26) (P＜0.05,corrected by AlphasSim)in the case group showed significantly decreased ALFF.The ReHo in the right inferior temporal gyrus was negative correlated with the HAMD-17 total score and retarda tion factor(r=-0.484,P=0.017;r=-0.408,P=0.048),the ALFF in the right inferior temporal gyrus was positively correlated with weight factor(r=0.574,P=0.003),and negative correlated with the number of depressive episodes(r=-0.416,P=0.043).Conclusion Female with depression in resting state have several abnormally functional brain regions and the extent of damage is correlated with the severity of depressive symptoms.Combination of the two parameters may yield a more comprehensive pathophy-siological mechanism for depressive disorder.

世界卫生组织的研究预测,到2020年抑郁症将成为继冠心病后的第二大疾病负担源.中国疾病预防控制中心统计资料表明,我国约有3 000万抑郁症患者.其中大约有15％的抑郁症患者最终死于自杀.然而,我国接受治疗的抑郁症患者人数却不到10％. 抑郁症是一种什么样的疾病 现代医学认为,抑郁症是一种常见的精神障碍,也称作心境障碍.抑郁症的主要症状表现为:持续至少2周以上时间的情绪低落并伴有兴趣减少,愉快感缺乏,精力和体力不足,活动减少.情绪低落的程度可以从闷闷不乐到悲痛欲绝.