Objective:To explore efficacy and medication adherence of three kinds of atypical antipsychotics combined with lithium in the treatment of acute mania in women. Methods: Eighty-four female patients with acute mania were randomly divided into three groups and received olanzapine, risperidone or clozapine combined with lithium. Acute phase efficacy during hospitalization period was evaluated for at least 4 weeks, using Bech-Rafaelsen manic scale and clinic global impression. Medication adherence during follow-up period was examined for 8 weeks, using self-made scales based Morisky's questionnaire, as rated by patients and their family members. Results:Median time to onset of action during hospitalization period for olanzapine group was 3 days, significantly shorter than that of risperidone (7 days) (Z = 4.75,P < 0.01). There was no significant difference between clozapine ( 3 days) and olanzapine in term of time to onset of action. At week 2 and week 4, reduction in BRMS scores was comparable between olanzapine and clozapine groups (Z= 0.54、0.67,P=0.40、0.49), and was significantly larger in olanzapine group than in risperidone group (Z=3.04、1.98,P<0.01、P=0.04). Score of adherence during follow-up period was higher in olanzapine group than in risperidone and clozapine groups. Conclusion:Olanzapine combined with lithium has more rapid onset of action in female patients with acute mania and has good adherence during follow-up period. Common adverse events include over-sedation, dizziness and weight gain.

目的:了解独生子女精神分裂症患者父母的心理健康状况.方法:于2000-07/2002-03选择山东省精神卫生中心、济南市精神卫生中心、济宁市精神病防治院及沂南县精神病医院住院的87例独生子女精神分裂症患者的父母173人为观察对象(患者组).同期选择济南市、济宁市、沂南县在性别、年龄、职业、文化程度等均与患者组相匹配的93名正常独生子女的父母186人为对照组.以自制一般情况调查表调查人口学方面内容.以症状自评量表评定心理健康状况.症状自评量表共90个项目,包括躯体化、强迫、人际关系、抑郁、焦虑、敌对、恐怖、偏执、精神病性9个因子,采用5级评分,1从无,2轻度,3中度,4重度,5严重,评定标准参照全国成人常模标准:因子分＜1.8分为正常;1.8～2.0分为轻度异常;2.1～3.0分为中度异常;＞3.0分为重度异常.在发放问卷时使用统一指导用语,将收集到的问卷当即核实,发现缺漏项,及时补正.主要观察患者组及对照组症状自评量表评分情况以及患者组与全国常模的比较.结果:发放问卷353份,收回合格问卷353份,有效率100%.①患者组及对照组症状自评量表评分比较:独生子女精神分裂症患者父母症状自评量表总分及各因子分均明显高于正常独生子女父母,差异有显著性(t=2.75～5.71,P＜0.01).并以抑郁、焦虑、恐怖、精神病性更为突出.②患者组父亲与正常组父亲,患者组母亲与正常组母亲症状自评量表比较:父亲间的对照,患者父亲相对突出的症状为偏执、恐怖、敌对、抑郁、焦虑,而躯体化、人际关系因子分与正常组父亲比较差异无统计学意义;母亲间的比较,患者母亲相对突出的症状为抑郁、恐怖、躯体化、敌对、精神病性.人际关系及偏执因子分与正常组母亲比较差异无显著性.③患者组症状自评量表评分与全国常模的比较:独生子女精神分裂症患者父母症状自评量表总分及各因子分明显高于全国常模,除人际关系因子分外,差异均有显著性(t=4.47～9.49,P＜0.001),其中以躯体化、抑郁、焦虑、恐怖、敌对、精神病性更为突出.(④患者组父亲与母亲症状自评量表评分比较:患者父亲偏执分较母亲高,且差异有显著性(P＜0.05);母亲的躯体化和抑郁因子分较父亲偏高[(1.83±0.56,1.65±0.40,t=2.44,P＜0.05);(1.98±0.51,1.81±0.54,t=2.10,P＜0.05)].父亲的偏执因子分高于母亲(1.81±0.59,1.62±0.58,t=2.13,P＜0.05).结论:独生子女精神分裂症患病给其父母心理上造成的压力,带来许多心理卫生问题.独生子女患者父母的症状自评量表总分及各因子分均明显高于正常独生子女的父母及全国常模,且差异有显著性.其中以躯体化、抑郁、焦虑、恐怖、精神病性等因子更为突出.

目的探讨复发性躁狂症的临床特征及诊断稳定性,为CCMD-3制定标准提供科学数据.方法作为全国CCMD-3现场测试的一部分,从1996年至2000年,全国16所精神卫生机构的34位医师参加本研究,评定员对使用的RTHD等量表进行了一致性测试,其Kappa=0.91,选择符合CCMD-2R标准的54例复发性躁狂症患者.确定37例(68.5%)进行3年的前瞻性随访观察.结果54例患者中男性35例,女性19例,平均年龄(37±10)岁;发作次数达3次或3次以上;入组时均处于躁狂发作期,并在住院治疗;平均总病程(113.3±102.5)月,平均本次病程(3.5±9.1)月,病程类型为发作性者47例(87.0%).本组患者以情感性症状为主,其中情感高涨发生率为94.1%,易激惹发生率为81.5%,40.7%伴有精神病性症状如妄想.1年时随访到32例患者,均保持原诊断,无1例抑郁发作.3年末随访的27例患者中,25例保持原诊断.2例出现抑郁发作,更改为双相障碍抑郁相.结论我国确实存在复发性躁狂症,该诊断稳定性高,故CCMD-3继续保持其分类学地位.

本文就ICD、DSM与CCMD三个诊断系统发展过程中有关情感障碍的分类学演变,并结合近年来关于复发性躁狂症的有关研究作简要综述.

To investigate the applicability of the seven-axial diagnostic system for schizophrenic patients. Methods: Based on the DSMD Diagnostic Scale for Mental Disorders (DSMD), 726 patients with 17 established diagnoses of mental disorders were re-assessed independently by three psychiatrists, using a double-blind method. 382 of these patients met the criteria of CCMD-2R for schizophrenia were analyzed. Results: In addition to Axis-1 diagnoses of mental disorders, the seven-axis system provided clear and useful information on personality functioning (Axis-2), physical disorders (Axis-3), types and degrees of biopsychosocial stressors (Axis-4), current and pre-morbid social functioning (Axis-5), current global condition (Axis-6), and relationship with other relevant conditions (Axis-7). Conclusion: The results supported the use of the seven-axis diagnostic system of DSMD for schizophrenic patients.