痴呆是一类常见的老年疾病，痴呆患者除认知功能受损外，精神行为症状也较为常见。由于药物治疗的不良反应等问题，音乐治疗作为一项重要的非药物性干预措施获得了临床工作的重视。音乐治疗对于精神行为症状有着较为广泛的干预效果，患者淡漠、激越、焦虑、抑郁等症状均能获得较好的改善。而个体化及主动式的音乐治疗方式相比传统、被动式的治疗方式有着更为显著的效果。

目的：了解两种音乐治疗方式对痴呆患者精神行为症状的改善效果。方法从3个老年病房随机各挑选25例住院痴呆患者，随机分为联合治疗组（主动式音乐治疗联合被动式音乐治疗），被动治疗组（被动式音乐治疗）及对照组，进行为期12周的研究，在干预前后使用神经精神科问卷（NPI）对3组患者的精神行为症状进行评定。结果联合治疗组及被动治疗组在 NPI 量表的激越、抑郁、焦虑、淡漠及激惹的得分均有明显改善（ P ＜0．01）。而且联合治疗组改善程度优于被动治疗组。结论联合及被动式音乐治疗均能改善患者的精神行为症状，而联合式音乐治疗效果更佳。

目的：探讨认知行为治疗对慢性精神分裂症患者执行功能的影响。方法将120例慢性精神分裂症患者随机分为两组，干预组在使用药物治疗的同时合并认知行为治疗，对照组单纯使用药物治疗。观察时间为12个月。在入组时、6个月后及12个月后分别采用阳性与阴性症状量表（PANSS ）、威斯康星卡片分类测验（WCST ）进行临床疗效与执行功能评定。结果治疗前，两组间PANSS评分及WCST各指标差异无统计学意义（P ＞0．05），治疗12个月后，干预组PANSS总分及各因子分较治疗前和对照组明显降低，WCST总测验数、持续错误数、随机错误数较治疗前和对照组减少，而正确应答数、分类数明显增多，差异均有统计学意义（P＜0．01）；而对照组治疗前后各项评分差异均无统计学意义（P ＞0．05）。结论认知行为治疗能有效改善慢性精神分裂症患者的精神症状及执行功能。

目的 了解社会技能训练对住院慢性精神分裂症患者康复效果.方法 采用整群抽样方法,随机抽取我院男女治疗病房各1作为研究组,共入组78名慢性精神分裂患者；再随机抽取男女治疗病房各1作为对照组,共入组66名慢性精神分裂症患者,研究组患者接受进行为期12周的社会技能训练.分别在训练前及训练12周后对两组使用SANS及NOSIE量表进行精神症状评定.结果 研究组在康复训练后SANS总分、各综合得分及NOSIE各因子得分无论是自身前后比较还是与对照组比较,得分均有明显的改善(P＜0.01).结论 社会技能训练对住院慢性精神分裂症患者的康复有较好的效果.

<正>精神分裂症是一类严重的精神疾病,临床表现包括幻觉、妄想、思维散漫、情感不协调、意志要求减退,病情常慢性迁延或反复发作逐渐出现社会或职业功能退化。因此,精神分裂症是一种易导致精神残疾的疾病。现将国内住院慢性精神分裂症患者社会功能康复现状研究综述如下。1目前国内精神卫生服务及患者情况

Objective To explore the characteristics of executive function in adolescents with major depressive disorder(MDD). Me-thods A total of 36 first-episode drug naive adolescents with MDD and 40 healthy controls were involved.The current and historical psychia-tric conditions were assessed with the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version.The depression severity was assessed with the children′s depression inventory.The executive function was measured in digit span test,Stroop color word test and cambridge neuropsychological test automated battery(CANTAB)[including spatial working memory(SWM),stockings of cambridge(SOC),intra-dimensional/extra-dimensional shifts(IED)].Performances on executive function were compared between the 2 groups. Results In digit span test and Stroop color word test,there was no significant difference between the 2 groups(Pa0.05).In CANTAB,adolescents with major depression showed more SWM between errors(8 boxes)(20.27±12.51 vs 13.91±9.72),greater SWM strategy score(34.79±3.35 vs 32.14±4.25),more SOC mean moves(5.98±1.25 vs 5.33±0.96) and more IED total trials(60.74±37.45 vs 35.44±27.40) than those of healthy control group,there were significant differences between the 2 groups(Pa0.05). Conclusions Adolescents with MDD showed deficits in spatial working memory,set-shifting and planning.Executive function impairments of verbal working memory and inhibitory control are not obvious.

本研究对110例住院的精神分裂症患儿进行临床分析. 1 对象和方法 为2006年5月至2009年6月期间住院的精神分裂症患儿共129例,其中≤16岁且符合中国精神障碍分类与诊断标准第3版精神分裂症诊断标准的患儿共110例.

Background:Stressful life events are common precipitants of internet addiction in youth.The mechanism by which stress leads to addictive behavior is mediated by an individual's copying style and method of seeking social support.Objective:Assess the social support networks and coping mechanisms employed by middle-school students who meet criteria for internet addiction.Method:205 students who met Beard's criteria for Internet addiction and had associated functional impairment based on a clinical interview were identified and 176(85.9%)of them completed self-completion questionnaires that assessed coping style(a Chines adaptation of the Coping Style Questionnaire)and social support(the Social Support Scale developed in China).The results were compared to those of 352 students(2-to-1 matched for age and gender)who did not meet criteria for internet addiction.Results:Compared to students without internet addiction,those with internet addiction had significantly lower mean scores on the problem-solving subscale and the asking for help subscale of the Coping Style Questionnaire,but they had higher scores on the self-blame subscale and the fantasy subscale.The mean total score,subjective support subscale score,and utilization of support subscale score of the Social Support Scale were significantly lower in the internet addiction group.Logistic regression analysis found that internet addiction was independently related to decreased use of problem-solving coping styles,increased use of fantasy and self-blame coping styles,and decreased utilization of available social support.Conclusion:Among middle-school students internet addiction is associated with poor psychological coping styles and with a lack of utilization of available social support.Further research is needed to determine whether or not promotion of positive coping styles in students and training to develop and use social support networks will prevent internet addiction or ameliorate its negative effects.

Objective To observe the application,efficacy and adverse reactions of olanzapine in the treatment for elderly patients with mental disorders.Methods Fifty-seven elderly patients(age≥60 years) administered with olanzapine for four weeks were divided into two groups(with or without cerebral organic mental disorders).The application information,the total efficacy and adverse reactions of olanzapine after four-week therapy were retrospectively analyzed.Results For all patients,the initial dosage was(4.74±1.62)mg/d and the therapeutic dosage was(10.97±5.38)mg/d.The total efficacious rate was 87.7%.The dosage[(8.30±3.36)mg/d] for patients with cerebral organic mental disorders was lower than that for patients without organic mental disorders[(13.05±5.78)mg/d].The incidence of weight increase(12.3%) and plasma lipids increase(7%)were observed.Conclusion For olanzapine in treatment of elderly patients with mental disorders,the efficacy is good,the dosage is lower(especially in organic mental disorders).Negative influence on body weight and the level of plasma lipids should not be ignored.

Objective:To explore the effect of atomoxetine on the bebavioral problems of children with attention-deficit hyperactivity disorder(ADHD) after treatment.Method:65 children who met criteria for ADHD participated the study.We evaluated behavior prolems of ADHD at baseline and after atomoxetine treatment for 4 weeks and 8 weeks.Behavioral problems were assessed with Conners parent symptom questionnaire(PSQ) and strenghths and difficulties questionnaires(SDQ).Results:Most of all subscales improved significantly after 4 weeks and 8 week treatments(P0.05).The factor of impulsive-hyperactivity and hyperactivity index of PSQ and the subscale of Hyperactivity-Inattention of SDQ got significantly improvement at the end of 4th and 8th weeks.The factors of conduct problems and learning problems of PSQ and the total difficulties of SDQ improved significantly at the end of 8th week.Conclusion:Atomoxetine may improve part of related behavioral problems.

Objective To assess the characteristics of visual P300 and mismatch negativity(MMN) of patients with attention deficit hyperactivity disorder(ADHD) before and after methylphenidate treatment. Methods 1.Forty-one ADHD patients(ADHD group),35 healthy children(NC group) were selected in this study.Optical P300 and mismatch negativity of them were tested,using an American Instrument.All ADHD patients received methylphenidate treatment(10-16 mg·d-1,take orally,average 12 mg·d-1).Thirty-six ADHD patients were followed up after 6 months treatment,Optical P300 and MMN were examined.According to the international society of EEG stan-dards,ADHD patients stopped to take methylphenidate 3 to 7 days before examing. Results 1.Compared with NC group,ADHD patients showed significantly prolonged N2/P300 latency [ADHD group:(275±21) ms,NC group(259±17) ms,P<0.01]and P3/P300 latency[ADHD group:(340±20) ms,NC group:(327±16) ms,P<0.01],decreased P3/P300 amplitude [ADHD group:(3.0±1.8) μV,NC group:(5.2±1.5) μV,P<0.05].2.Compared with NC group,ADHD patient showed prolonged MMN latency[ADHD group:(199±20) ms,NC group:(180±23) ms,P<0.01] and decreased MMN amplitude[ADHD group:(3.2±1.5) μV,NC group:(5.6±1.7) μV,P<0.01].3.Compared with the baseline,ADHD patients showed shortened N2/P300 latency[before treatment:(275±21) ms,after treatment:(261±19) ms,P<0.01] and P3/P300 latency[before treatment:(340±20) ms,after treatment:(329±19) ms,P<0.05],increased P3 amplitude after medication of methylphenidate[before treatment:(3.0±1.8) μV,after treatment:(4.7±2.0) μV,P<0.01]. Conclusions Abnormal optical P300 and MMN would be found in ADHD patients.And optical P300 variations before and after medication suggested that attention deficit of ADHD patients might be improved through methylphenidate treatment.

目的 通过对中学生网络成瘾与时间管理倾向关系的分析,为中学生网络成瘾的有效干预提供依据.方法 随机选取上海市15所中学不同年级学生,首先采用问卷筛查的方法得到网络成瘾筛选阳性学生,然后采用临床访谈形式,对筛选阳性学生以Beard改编Young的网络成瘾诊断标准(YDQ)结合功能受损程度,诊断出网络成瘾学生,在同一学校参加筛查结果阴性的学生中随机抽取部分学生作为对照组.采用青少年时间管理倾向量表(ATMD)对上述3组学生(网络成瘾组、筛选阳性但非网络成瘾组即倾向组和对照组)进行调查分析.结果 3组学生在时间管理倾向总分(F=12.447,P=0.000)和3个维度上的得分存在着显著的差异(时间价值感:F=4.771,P=0.009;时间监控观F=10.828,P=0.000;时间效能感:F=19.385,P=0.000),这种差异在3组学生的同性别或同类型学校的比较中也类似存在.倾向组(t=3.599,P=0.000)和对照组(t=2.320,P=0.021)在时间价值感上得分都是女性高于男性.对照组中职校学生在时间控制观(F=3.413,P=0.034)和时间效能感(F=4.976,P=0.007)上的得分高于高中和初中学生.结论 时间管理能力低下是中学生网络成瘾的影响因素之一.

Objective:Assess the mental health profile of middle-school,regular high-school and technical-course high-school students with internet addiction in Shanghai.Methods:A sample of students at high risk for internet addiction were identified by a self-completion questionnaire and by information provided by teachers and parents.A clinical interview administered to these high-risk students identified 199 who met Beard's revision of Young's criteria for internet addiction and were functionally impaired due to the condition.The development and well being assessment(DAWBA)was used to identify co-morbid mental health problems in these students.Results:In the 199 students with internet addiction,65(33.7%)met diagnostic criteria for at least one other disorder.There was no significant difference in the prevalence of co-morbid disorders for males(32.5%)versus females(33.3%)(χ2=0.01,P=0.92),but the prevalence was higher in middle-school students than in regular high-school students or technical-course high-school students(χ2=17.22,P<0.01).The prevalence of Attention Deficit and Hyperactivity Disorder(ADHD)was 20.6% in all 199 students;it was 23.8% in boys and 7.7% in girls(χ2=4.94,P=0.03).However,the prevalences of specific phobia,obsessive and compulsive disorder,and generalized anxiety disorder were significantly higher in girls than in boys.Conclusion:Middle-school and high-school student who meet criteria for internet addiction often have other co-morbid diagnoses.ADHD is the most common co-morbid condition in boys with internet addiction but anxiety disorders are more common in girls with internet addiction.

Objective To investigate the variations of event related potentials(P300) and contingent negative variation(CNV) in healthy children before and after taking methylphenidate hydrochloride.Methods Comparison of the changes of P300 and CNV in 30 healthy children before and after taking 10 mg methylphenidate hydrochloride.Results The changes of the major component of P300(P1-N1) were that the latency delay(P<0.05) and volatility elevated(P<0.01) and the major component of CNV(reaction time) also had significant statistical difference(P<0.05) in healthy children before and after taking methylphenidate hydrochloride.Conclusion The effect of methylphenidate hydrochloride on P1-N1 confirms that it is related to the selective attention of the subjects.The further study of its influence on CNV should be made.

近年来,大陆与港台地区之间各方面交流日益增多,本文简单介绍台湾香港地区的精神科教育现状,希望能有所借鉴.

注意缺陷多动障碍(attention deficit hyperactivity disorder, ADHD)是儿童时期常见的中枢神经系统疾病,其主要表现为注意力不集中、多动及冲动.西方国家患病率为3%～5%之间,国内患病率为3%～10%.ADHD的症状可以造成儿童的学习、人际关系、社交等多个领域的功能明显缺损,部分儿童的症状还可以持续至成年而不愈,成为成人ADHD.

Objective: To translate and amend the kiddie formal thought disorder rating scale(K-FTDS) into Chinese,to test its consistency coefficient,sensitivity and specificity and to explore the difference of formal thought disorder(FTD) between children with schizophrenia and children with non-psychotic disorders.Methods: The K-FTDS was translated and amended into Chinese,then was used in 27 schizophrenic children and 31 children with non-psychotic disorders.The consistency coefficient,sensitivity and specificity were tested.Results:The inter-raters Kappa value of K-FTDS was 0.71.The sensitivity and specificity were 0.852 and 0.935 respectively when we set the cut-off point of FTD score at 0.0115.The schizophrenic children had significantly more FTD scores than that of children with non-psychotic disorders(z=565.5,P<0.01).Conclusion:The K-FTDS has good consistency coefficient,sensitivity and specificity.It can be used in the assessment of formal thought disorders in Chinese children in the differential diagnosis between schizophrenic children and children with non-psychotic disorders.

Objective: To explore the children's mental health status after kidnap. Methods: Thirty-nine students in a primary school in Shanghai and 45 age-sex-matched students were assessed with Achenbach Child Behavior Checklist (CBCL),Screen for child Anxiety Related Emotional Disorders (SCARED) and Rutter questionnaire one month after kidnap.Results:Except for the social withdraw factor of CBCL(1.4±1.8,3.1±2.6;t=2.218,P=0.033), there were no significant differences among the scores of CBCL, SCARED and Rutter questionnaire between two groups (P>0.05). Conclusion:The results didn't show kidnap has obvious effect on children's mental health in this study.

目的 探讨具阴性症状的精神分裂症病人的病程与其认知功能改善的关系.方法 对60例具阴性症状的精神分裂症病人在氯氮平或利培酮治疗前后进行阴性症状评定量表(SANS)、简明精神病评定量表(BPRS)评定精神症状;用Wisconsin卡片分类测验(WCST),Wechsler记忆测验(WMS)、Wechler成人智力量表(WAIS-RC)评定认知功能;以及对病程与认知功能的改善程度进行比较和相关性分析.结果 WMS理解量表分的前后差值与病程为0～5年和病程为11～15年有显著差异(P＜0.05),在WSCT测验中总测验数的差值与病程为0～5年、6～10年和11～15年比较有显著差异(P＜0.05),持续错误数的改善在病程为6～10年和11～15年两个组,有显著差异(P＜0.05);WAIS-RC和WMS前后的差值与病程无相关性(P＞0.05).结论 具阴性症状的精神分裂症的部分认知功能改善程度与病程有关.

Objective To explore the relationship of cognitive function improvement and illness duration in schizophrenia with negative symptoms.Methods Negative symptoms,memory,attention,executive function were assessed with BPRS,SANS,WMS,WAIS-RC and WCST before and after treatment in 60 patients taking clozapine or risperidone.Results There were significant difference in improvement of comprehension scale of WMS and five years disease course and ten years disease course.Total test count and continual fault count of WCST after and before treatment were connected to illness duration,while significant correlation were not found between improvement of WMS and WAIS-RC and illness duration.Conclusions It indicated that part of cognitive function improvement may be related to illness duration.