目的:探讨阿尔茨海默病(AD)患者血清胱抑素C (CysC)水平及影响因素. 方法:应用免疫比浊法检测74例AD患者(轻度28例,中度25例,重度21例)血清CysC水平,分析影响血清CysC水平的人口学及临床因素. 结果:AD患者血清CysC水平[(1.182±0.286) mg/L]显著高于本院正常值(1.03 mg/L) (P ＜0.05);轻度AD组及＞80岁组血清CysC水平显著高于其他组(P均＜0.05);不同性别、文化程度及有无脑梗死患者间血清CysC水平比较差异无统计学意义;AD患者血清CysC水平与年龄、日常生活能力(ADL)评分正相关,与病程负相关(P均＜0.05);与性别、文化程度、有无脑梗、简易智力状态检查(MMSE)评分、痴呆程度无相关. 结论:AD患者血清CysC水平明显升高;年龄、病程是影响AD患者血清CysC水平的因素.

Background: Meta-analyses support the efficacy of cognitive behavioural therapy (CBT) for obsessive-compulsive disorder (OCD) in Western cultures. However, there are no adequately powered multicentre studies in China. This study aimed to compare the effectiveness of treatment with CBT combined with medication and medication alone in OCD patients in China. Methods: OCD patients (N = 167) were recruited from outpatient clinics at three large tertiary psychiatric hospitals and one general hospital in China. Participants were randomly allocated to receive either CBT combined with medication (n = 92) or medication alone (n = 75) for a 24-week treatment period. Participants' symptoms and social functioning were assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Hamilton Anxiety Rating Scale (HAM-A), Global Assessment of Functioning (GAF) and Clinical Global Impression Scale for Severity (CGI-S) at 0, 4, 8, 12 and 24 weeks, and the effectiveness of the two treatments compared using linear mixed-effects models. Results: At 24 weeks, both groups showed large within-group effects in all measures. Significantly more patients receiving combined therapy than medication alone had a decrease in symptom severity of at least 35% (based on Y-BOCS total score). The CGI-S and GAF scores decreased in both groups, and significant differences were found between the groups. Limitations: Study limitations included lack of consideration of medication types and dosages, and the absence of a CBT-only arm. Conclusions: CBT combined with medication may be effective in alleviating symptoms and social functioning impairment associated with OCD, and is more effective than medication alone in China, particularly for the treatment of compulsive behaviours.

Objectives: Although cognitive behavioral therapy (CBT) is an effective treatment for obsessive-compulsive disorder (OCD), the treatment mechanisms remain poorly understood. This study aimed to investigate the effects of CBT on changes in the intrinsic whole-brain functional network of OCD patients. Materials and Methods: Twenty drug-naive and noncomorbid OCD patients were recruited, and resting-state functional magnetic resonance imaging was performed before and after 12 weeks of CBT. Moreover, 20 healthy controls were scanned twice with a 12-week interval. A graph-theory degree centrality (DC) approach and functional connectivity method were used to analyze the whole-brain functional network hub and connectivity changes in OCD patients before and after CBT treatment. Results: A significant groupxtime interaction on DC was found in the left dorsolateral prefrontal cortex (DLPFC); the DC in the left DLPFC was significantly reduced after CBT treatment. Resting-state functional connectivity (RSFC) between the left DLPFC and right orbitofrontal cortex was increased in the OCD patients at baseline, and normalized after CBT treatment. RSFC changes between the left DLPFC and default mode network (DMN) positively correlated with changes in clinical symptoms in OCD patients. Conclusions: These findings suggest that CBT can modulate changes in intrinsic functional network hubs in the cortico-striato-thalamo-cortical circuit in OCD patients. Cognitive control network and DMN connectivity may be a potential imaging biomarker for evaluating CBT treatment for OCD.

Objective:To investigate expression and influence factors of plasma macrophage migration in-hibitory factor(MIF)levels in patients with mild cognitive impairment(MCI),alzheimer disease(AD),and vascular dementia(VD). Method:All subjects including MCI(45 cases),AD(44 cases),VD(30 cases) and healthy elderly controls(NC,40 cases)came from the epidemiological survey in the urban and rural com-munities in Guangzhou from 2001 to 2002. The plasma MIF level of all the cases was detected by enzyme-linked immunosorbent assay and compared;and the influence factors of plasma MIF level were analyzed. Results:There were not statistically significant differences on the plasma MIF concentrations among AD group[(40.99 ± 33.34)μg/L],VD group[(39. 16 ± 23. 87)μg/L],MCI group[(39. 9 ± 38. 5)μg/L]and NC group [(32.1 ± 13)μg/L](F=0.751,P>0.05),and among the patients with different degrees of cognitive impair-ment(F=0.654,P>0.05).There was negative correlation between plasma MIF concentration and mini mental state examination(MMSE)scores in AD group(r= -0.303,P<0.05),and positive correlation between plas-ma MIF concentration and frequency of stroke in mild VD patients(r=0.757,P=0.007).There were not sig-nificant correlations between plasma MIF concentration and gender,age,duration,educationyears,scores of clini-cal dementia rating scale and activities of daily living. Conclusion:MIF may be involved in the pathological process of MCI,AD and VD.

Objective To identify the differences inneuropsychological characteristics between amnestic(AMCI)and vascular mild cognitive impairment(VMCI).Methods Totally 297 old community residents with mild cognitive impairment(MCI)were divided into amnestic MCI(AMCI)and vascular MCI(VMCI)subgroup from Guangzhou MCI prevalence survey.The elderly with MCI were interviewed and tested with the Chinese version of Montreal Cognitive Assessment(MoCA),the Mini-Mental state examination(MMSE),Auditory Verbal Learning Test(AVLT),the Clinical Dementia Rating scale(CDR),Functional Activity Questionnaire(FAQ),the Modified Hachinski Ischemic Scale(M-HIS),Center for Epidemiologic Studies(CES-DC)to evaluate neuropsychological characteristics.Results AMCI versus VMCI group showed that the total scores of MoCA were(9.63±5.17 vs.9.98±6.02),total scores of MMSE were(16.90±4.84 vs.16.90±6.19),AVLT immediate memory was(2.35±1.39 vs.2.91±1.84),AVLT delayed recall was(2.23±2.09 vs.2.47±2.20),AVLT delayed recognition was(7.33±3.98 vs.6.85±4.02)and total scores of CDR(0.5 vs.0.5),with no differences between the 2 groups(all P>0.05).Based on MoCA survey,AMCI versus VMCI group showed statistically significant differences(all P<0.05)in parameters of visual space and execution(0.71±1.02 vs.0.92±1.26),language function(0.34±0.56 vs.0.50±0.80)and abstract thinking(0.25±0.49 vs.0.15±0.43),but based on MMSE survey,no difference was found in the various cognitive domains between the two groups.The AMCI versus VMCI group showed statistically significant differences(all P<0.05)in parameters of CES-DC scale(1.75±4.27 vs.2.76±6.72),FAQ scale(4.42±4.66 vs.8.71±7.03),M-HIS scale(0.40±0.64 vs.7.59±3.53).Conclusions There is no significant difference in general cognitive impairment between AMCI and VMCI,but the visual space and execution,language function are more impaired in AMCI than VMCI,and the abstract thinking,social function are more impaired with more depressive symptoms in VMCI than in AMCI.

Objective To compare the effect between the group of 5-selective serotonin reuptake inhibitor（SSRIs）treatment and the group of SSRIs combining cognitive behavioral therapy（CBT）.Methods Eighty patients meeting the Diagnostic and Statistical Manual of Mental Disorders,Fourth edition criteria for obsessive-compulsive dis-

Objecti ve:To explore the effects of repetitive Transcranial Magnetic Stimulation ( rTMS ) in treatment of behavioral and psychological symptoms of dementia ( BPSD) of patients with mild-to-moderate Alzheimer's disease ( AD ) .Methods:45 mild -to moderate AD patients accompanied with BPSD were randomly divided to active rTMS group (20 cases) and Risperidone group (25 cases).Sub-jects of rTMS group were treated with rTMS respectively for 20 times during 6 weeks,and the subjects of Risperidone group were treated with risperidone ,all patients were received with stable cholinesterase in-hibitors.Neuropsychiatric Inventory ( NPI)and Mini -Mental Status Examination ( MMSE) were as-sessed before treatment and 2 weeks and 6 weeks after treatment .Results:45 subjects completed the trial . The NPI improved significantly after 6 weeks of active treatment .There was no statistical significance in TESS between two groups .Conc lusion:In this study ,rTMS seems a promising effective and safe therapies for BPSD of mild-to-moderate AD.

Objective To investigate the relationship between the 5-hydroxytryptamine (5-HT)1A receptor gene C(-1019)G polymorphism and geriatric depression and Alzheimer′s disease (AD) with depressive symptoms in Han Chinese. Methods The case control study was used in the study among 106 patients with geriatric depression, 72 AD patients with depressive symptoms and 150 healthy old individuals in China. The C(-1019)G polymorphism of 5-HT1A was analyzed with the technique of polymerase chain reaction-restriction fragment length polymorphism. Results The frequencies of 5-HT1A genotype C/G (39.6%), G/G(24.5%) and allele G (44.3%) in the patients with geriatric depression were significantly higher than those in the controls (respectively 35.3%, 13.3%, 31.0%, P < 0.05). The frequencies of 5-HT1A G allele in the AD patients with depressive symptoms (41.0%) were significantly higher than those in the controls (31.0%,X2=4.2879, P<0.05). No significant difference in distribution of (5-HT)1A C (-1019) G polymorphism between the patients with geriatric depression and the AD patients with depressive symptoms was observed (P > 0.05). Conclusion The 5-HT1A gene C (-1019)G polymorphism may be associated with geriatric depression and AD with depressive symptoms and (-1019)G allele may be a risk factor for them.

目的 探讨重复经颅磁刺激(rTMS)对轻、中度阿尔茨海默病(AD)患者精神行为症状(BPSD)的疗效.方法 将38例有BPSD的AD患者随机分为rTMS治疗组(20例)和对照组(18例),分别接受20次5 Hz rTMS真刺激和伪刺激治疗,治疗期间维持原有的胆碱酯酶抑制剂治疗.治疗前及治疗后2周、6周采用神经精神科问卷(NPI)观察疗效,采用治疗不良反应量表(TESS)观察不良反应.结果 38例患者均完成治疗,治疗6周时治疗组NPI评分(16.69±6.62)分较治疗前(27.65±4.38)分明显降低,差异有统计学意义(t=6.16,P＜0.05);且显著低于对照组(23.44±5.49)分,差异有统计学意义(t=3.33,P＜0.05).两组TESS总评分比较差异无统计学意义(x2=2.06,P＞0.05).结论 rTMS可能是控制轻、中度AD患者BPSD的一种有效而安全的治疗方法.

Objective To examine the association among the various components of the metabolic syndrome( MS),risk factors of cardiovascular and Alzheimer's disease( AD). Method 58 patients with AD were divided into MS group and non-MS group( NMS grooup) according to the diagnostic criteria of MS by Chinese Medical Association Diabetes Branch. Blood fasting sugar,fasting insulin,triglyceride,angiotensin converting enzyme and hypersensitive C-reactive protein( hs-CRP) were evaluated in all the cases and then the insulin sensitive index( ISI) was calculated. Results( 1) The level of fasting insulin and abdominal circumference in MS group were significantly higher than those in NMS group( P < 0. 05).( 2) The level of homocysteine and insulin resistance in MS group were significantly higher than those in NMS group( P < 0. 05).( 3) The level of angiotensin converting enzyme was significantly positively correlated with abdominal circumference( P = 0. 021). Level of insulin resistance was significantly positively correlated with fasting sugar( P = 0. 000),as well as fasting insulin( P = 0. 000). Level of hs- CRP was significantly negatively correlated with triglyceride( P = 0. 018) and level of angiotensin converting enzyme was significantly correlated with fasting insulin( P =0. 039). Conclusion Vascular factors may be one of the risk factors of AD in AD patients combined with MS.

Objective To investigate the relation of alzheimer disease(AD),vascular dementia(VD)and mild cognitive impairment(MCI)with plasma brain-derived neurotrophic factor(BDNF).Methods All subjects included 50 MCI,45 AD,30 VD and 40 healthy elderly.The concentration of BDNF were tested by enzyme-linked immunosorbent assay(ELISA).Results BDNF concentrations were significant different in MCI group(6.2 ± 5.1)μg /L,AD group(8.1 ± 5.0)μg /L,VD group(5.6 ± 4.8)μg /L,compared with control group(6.4 ± 3.1)μg /L(P = 0.013),and BDNF concentrations in AD group was higher than MCI and VD groups(P < 0.05).There were significant differences between moderate-to-severe AD group and MCI group(P = 0.023).There were no significant correlation between BDNF concentration and gender,age,duration,stroke frequency,MMSE score,CDR score and ADL score in all groups.Conclusions Plasma BDNF concentration in AD group were higher than MCI and VD groups,but BDNF concentration were not related with the course of disease course and cognitive impairment in the three groups.

Objective:To explore the etiological factors of obsessive compulsive disorder(OCD) by investigating characteristics of irrational beliefs, social support and their relationship with symptoms of OCD.Methods:80 OCD pa tients and 40 normal participants were assessed with Irrational Beliefs Scale(IBS) and Social Support Rating Scale(SSRS). Logistic regression analysis and multiple stepwise regression analysis were applied to examine the relationship between clinical symptoms and the irrational beliefs and social support.Results:①The scores of all the sub-scales in the irrational beliefs in the patient group were significantly higher(P0.05) than control group, the scores of objective support and subjective support in the patient group were also significantly lower than control group(P0.05). ②The de mandingness is the risk factor for OCD(OR=1.149, P0.05). The severity of obsessive compulsive symptoms was posi tively correlated with the level of low frustration tolerance(β=0.404, P0.01). The severity of depression and anxiety were positively correlated with the level of low frustration tolerance(β=0.558, P0.01) and utilization of support(β=-0.363, P0.01).Conclusion:OCD patients have more irrational beliefs and less social support, relative to the controls.The demandingness is the risk factor of OCD. The severity of obsessive compulsive symptoms can be predicted by low frustration tolerance, and the depression and anxiety symptoms were influenced by low frustration tolerance and utiliza tion of support in the OCD patients.

怎样才算是一个"乖宝宝"?一般认为就是听话、不淘气、不吵闹的孩子就"乖".不过,在我看来,孩子要适当的淘气和不听话,那是孩子的天性,而家长的责任就是要引导孩子,而不是简单的呵斥.写这篇文章的时候,我静静地回忆着,这些年养育孩子的点点滴滴一幕幕浮现在眼前;这个过程与其说是孩子的成长,倒不如说是我自己的成长,是孩子教会了我如何做一个母亲.下面是我在教育孩子时的一些心得,与大家分享.

Objective:To explore the status of cognitive-behavioral therapy(CBT) components for generalized anxiety disorder(GAD) by Delphi Poll,in order to lay a foundation to standard domestic CBT techniques.Methods:Totally 35 technique components for GAD were chosen from foreign literatures of randomcontrol study.Questionnaires including these 35 components were filled in by 31 experts of CBT.After two rounds of expert consultation,the CBT components for GAD were sorted.Results:The components of establishing therapeutic alliance,psychoeducation,assessment and relaxation training were on the first 4 ranks.However the commonly used components in foreign clinical trials such as socratic questioning and worry exposure,only on the rank of 26 and 22,and the coefficient of variation of thought stopping on the dimensions of operability,frequency of utilization and contribution of treatment were 0.25,0.36,and 0.31,respectively.Conclusion:It suggests that in the GAD therapy,establishing therapeutic alliance,psychoeducation,collection/assessment and relaxation training are reached agreement by CBT experts,and whether the technique of thought stopping should be rejected need to be further studied.

Objective:To evaluate the efficacy of pharmacotherapy combined with cognitive behavioral therapy( CBT) in the treatment of obsessive compulsive disorder( OCD) w ith meta-analysis of data came from randomized controlled trials( RCTs) and to help choose suitable treatment plan in clinic. Methods: The databases of Pubmed, Embase and Central w ere searched to collect efficacy data of pharmacotherapy combined w ith CBT versus either alone in RCTs,the mean difference w as used as effect size and the measured data of Yale-Brow n Obsessive Compulsive Scale( Y-BOCS) w ere extracted from each study to conduct a meta-analysis w ith RevM an5. Results: Seven studies w ere involved in the meta-analysis,including 468 patients w ith OCD. There w as no heterogeneity betw een 3 sets of data w hich compared the efficacy of combined therapy and pharmacotherapy alone after excluding 1 set of data w hich possibly caused the heterogeneity( Q = 0. 48,P > 0. 1) and combined therapy w as superior to pharmacotherapy alone in improving obsessive compulsive symptom( MD = 6. 46,Z = 5. 03,P≤0. 05). There w as no heterogeneity betw een 7 sets of data w hich compared the efficacy of combined therapy and CBT alone( Q = 9. 08,P > 0. 1) and combined therapy w as not superior to CBT alone in improving obsessive compulsive symptom( MD = 0. 87,Z = 1. 22,P > 0. 05). Conclusion: It suggests that pharmacotherapy combined w ith CBT may be superior to pharmacotherapy alone but be comparable to CBT alone in improving obsessive compulsive symptom and further study is necessary.

Neuroimaging studies of obsessive-compulsive disorder have found abnormalities in orbitofronto-striato-thalamic circuitry, including the orbitofrontal cortex, anterior cingulate cortex, caudate, and thalamus, but few studies have explored abnormal intrinsic or spontaneous brain activity in the resting state. We investigated both intra- and inter-regional synchronized activity in twenty patients with obsessive-compulsive disorder and 20 healthy controls using resting-state functional magnetic resonance imaging. Regional homogeneity (ReHo) and functional connectivity methods were used to analyze the intra- and inter-regional synchronized activity, respectively. Compared with healthy controls, patients with obsessive-compulsive disorder showed significantly increased ReHo in the orbitofrontal cortex, cerebellum, and insula, and decreased ReHo in the ventral anterior cingulate cortex, caudate, and inferior occipital cortex. Based on ReHo results, we determined functional connectivity differences between the orbitofrontal cortex and other brain regions in both patients with obsessive-compulsive disorder and controls. We found abnormal functional connectivity between the orbitofrontal cortex and ventral anterior cingulate cortex in patients with obsessive-compulsive disorder compared with healthy controls. Moreover, ReHo in the orbitofrontal cortex was correlated with the duration of obsessive-compulsive disorder. These findings suggest that increased intra- and inter-regional synchronized activity in the orbitofrontal cortex may have a key role in the pathology of obsessive-compulsive disorder. In addition to orbitofronto-striato-thalamic circuitry, brain regions such as the insula and cerebellum may also be involved in the pathophysiology of obsessive-compulsive disorder.

Objective To evaluate the suitability of cognitive behavioral therapy (CBT) techniques for obsessive-compulsive disorder (OCD),and analyze the domestic application status of CBT techniques for OCD and lay a foundation of standard CBT in China.Methods Delphi method was adopted to evaluate 30 CBT techniques on four dimensions,including operability,frequency,contribution of treatment and acceptability,and calculated the final scores of all techniques on different dimension and their comprehensive rank.Results After two rounds of experts consulting,Kendall coefficients of four dimensions were 0.249,0.269,0.234,0.250 (P＜0.01),coefficient of variation ranged from 0.05 to 0.31 of each technology on different dimension.The operability score of thought stopping,cost-benefit analysis and pie chart belonged to general suitability.The frequency and treatment contribution score of thought stopping and pie chart belonged to occasional use and small.The acceptation score of socratic question,thought stopping,in vivo exposure and behavior prevention belonged to partial acceptation.Weight coefficients of four dimensions were 0.26,0.18,0.27,0.29 and techniques ranking in the top three were information collection and evaluation,therapeutic alliance foundation and psychological education.Conclusion Most CBT techniques for OCD are suitable in China but some techniques still need to be improved.

Objective To investigate the psycbometric characteristics of the Panic Disorder Severity Seale-Chinese Version (PDSS-CV).Method One hundred and five outpatients with panic attack in Beijing Anding Hospital were assessed with the PDSS-CV,Hamilton Anxiety Scale (HAMA14) and Clinical Global Impression Scale (CGI).Results (1) The confirmation factor analysis result of the two-factor model of PDSS-CV was x2/df=1.16,GFI =0.96,RMSEA =0.04.(2) The total scores of PDSS-CV was correlated with CGI score (r =0.85,P ＜ 0.05),and positively correlated with the HAMA score (r =0.56,P ＜0.05).(3)The internal consistency reliability was 0.83,the total test-retest correlation coefficient was 0.95,the test-retest coefficients of each item were 0.72-0.95,the intraclass correlation coefficient (ICC) among raters was 0.94,the ICCs between each item were 0.72-0.92.(4)The PDSS-CV cut-off scores for severity were as follows:score 8-10 was slight; 11-13 was moderate; 14-16 was marked,and 17 and above was the most severity.Conclusion The PDSS-CV has good psychometric features and can be used for clinical and research assessment of panic disorder in China.