目的:观察疏肝益阳胶囊对抑郁症伴勃起功能障碍的患者情绪、勃起功能及中医证候及症状的疗效和安全性.方法:选取2017年11月至2019年11月首都医科大学附属北京中医医院等全国7家医院的精神心理科或心身医学科门诊收治的抑郁症伴勃起功能障碍的患者154例作为研究对象,按3:1的比例随机分为观察组(n=115)和对照组(n=39).观察组采用疏肝益阳胶囊进行治疗,对照组采用安慰剂治疗,疗程均为8周.观察情绪、勃起功能、中医证候及安全性情况.结果:治疗后,观察组抑郁疗效总有效率优于对照组(P<0.05),焦虑疗效总有效率优于对照组(P<0.05);观察组中医证候疗效总有效率优于对照组(P<0.05),单项症状疗效等级的改善在心情抑郁、胸闷善太息、腰膝酸软、头晕耳鸣优于对照组(P<0.05),单项症状消失率在腰膝酸软、头晕耳鸣优于对照组(P<0.05);试验过程中发生的不良事件,2组比较差异无统计学意义.结论:疏肝益阳胶囊可显著改善抑郁症伴勃起功能障碍患者的抑郁情绪、焦虑情绪,并显著改善肝郁肾虚的中医证候,心情抑郁、胸闷善太息、腰膝酸软、头晕耳鸣的症状,显示出良好的改善情绪和肝郁肾虚状态的疗效,且显示出良好的临床安全性.

在经济飞速发展的新时代背景下,物质生活日益丰富的同时,也给人们精神生活带来一定的挑战.根据近期发表在《柳叶刀》精神病学子刊上的中国精神卫生调查,我国精神障碍患病率为9.32％.《中国国民心理健康发展报告(2019-2020)》指出,自新冠肺炎疫情暴发以来,随着心理健康知识的宣传普及,公众的心理健康意识进一步增强.然而即使在这样的背景下,人们对于精神障碍的病耻感依然显著存在.

Background and Aims:Irritable bowel syndrome (IBS) and depression have high tendencies of comorbidity. In particular, diarrhea-predominant IBS (IBS-D) and depression exhibit similar fecal microbiota signatures, yet little is known about their pathogenic mechanism. Here, we propose that the differences in structure and composition of IBS-D and depression gut microbiota give rise to different downstream functions, which lead to distinct clinical phenotypes via host metabolism and further influence the interaction of brain-gut axis.Methods:We performed multiomics study, including fecal metagenome-wide sequencing and serum metabolomics profiling in 65 individuals with IBS-D (n=22), depression (n=15), comorbid patients (n=13), and healthy controls (n=15). We analyzed functional genes contributed by the primary genus and evaluated their correlations with clinical indices and host metabolites.Results:Metagenomic analysis revealed 26 clusters of orthologous groups of protein (COG) categories consisting of a total of 4,631 functional genes. Trehalose and maltose hydrolase (COG1554) and fucose permease (COG0738) were the most relevant and enriched functional genes in the IBS-D patients; urease accessory proteins UreE (COG2371) was that in the depression patients. Context based genome annotation suggest that an alteration of Escherichia coli and Enterobacter cloacae in IBS-D and depression respectively may be responsible for the enrichment described above. Correlation with host metabolites, such as maltotriose and isomaltose in carbohydrate metabolism and anandamide in neuroactive metabolism, drew further connections between these findings.Conclusions:These changes led us to propose a connection between genomic signatures and clinical differences observed in IBS-D and depression. Our findings provide further insights into the involvement of gut microbiota in diseases related to brain-gut disorder.

Objective:To explore the improvement rate of the cognitive function of computerized cognitive remediation therapy (CCRT) on patients with schizophrenia and the clinical effect of CCRT in patients with different levels of cognitive impairment.Methods:A random number table was used to divide 311 patients with schizophrenia into CCRT group ( n=196) and work and amusement therapy (WAT) group ( n=115). The independently developed CCRT and operational music and dance therapy were given for 12 weeks to two treatment groups respectively. All patients were assessed using the MATRICS Consensus Cognitive Battery (MCCB) before and after treatment. According to the total score of MCCB at baseline, the patient′s cognition function was divided into 4 levels: severe cognitive impairment, moderate cognitive impairment, mild cognitive impairment and normal cognitive function. According to the change of MCCB total score, the efficacy of the treatment was divided into 3 levels: no improvement (≤0 points), improvement (0-9.57 points), superior improvement (>9.57 points). The improvement rate of cognitive function between two treatment groups was compared. Results:In the CCRT group, there were 19 cases with superior improvement, 105 cases with improvement, and 46 cases with no improvement. In the WAT group, there were 7 cases with superior improvement, 39 cases with improvement, and 41 cases with no improvement. The improvement of cognitive function of CCRT group was better than that of WAT group, and the difference was statistically significant ( Z=2.978, P=0.003). The patients with serious cognitive impairment in the CCRT group had a higher improvement rate than those in the WAT group ( Z=1.860, P=0.032). The patients with moderate cognitive impairment in the CCRT group had a lower no improvement rate than those in the WAT ( Z=-1.817, P=0.035).The patients with mild cognitive impairment in the CCRT group had a lower no improvement rate ( Z=-3.294, P=0.001) and higher improvement rate and superior improvement rate ( Z=2.084, P=0.019; Z=1.969, P=0.025) than those in the WAT group. There was no statistically significant difference in improvement rate between patients with normal cognitive function in the CCRT group and in the WAT group ( P>0.05).The patients with improvement and superior improvement of cognition were combined as responder, and the two treatment groups were compared. The patients with mild cognitive impairment in the CCRT group had a higher improvement rate than those in the WAT group (77.2%（44/57） vs. 41.4%（12/29），χ2=10.853， P=0.001). However, for patients with serious and moderate cognitive impairment or with normal cognitive function at baseline, rates of improvement after treatment did not differ significantly between CCRT group and WAT group. According to Cohen′s d, the level of effect size in cognition improvement after CCRT treatment in patients with different cognitive dysfunction level was: mild cognitive impairment (0.59)>moderate cognitive impairment (0.48)>normal cognitive function (-0.12)>serious cognitive impairment (-0.24). Conclusions:Schizophrenic patients treated with CCRT had a higher improvement rate of cognitive function than those with WAT, and the improvement rate of cognitive function is higher in patients with mild cognitive impairment after CCRT treatment.

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.

AbstractBackgroundComputerized cognitive remediation therapy (CCRT) is generally effective for the cognitive deficits of schizophrenia. However, there is much uncertainty about what factors mediate or moderate effectiveness and are therefore important to personalize treatment and boost its effects.MethodIn total, 311 Chinese inpatients with Diagnostic and Statistical Manual of Mental Disorders-IV schizophrenia were randomized to receive CCRT or Active control for 12 weeks with four to five sessions per week. All participants were assessed at baseline, post-treatment and 3-month follow-up. The outcomes were cognition, clinical symptoms and functional outcomes.ResultsThere was a significant benefit in the MATRICS Consensus Cognitive Battery (MCCB) total score for CCRT (F1,258 = 5.62; p = 0.02; effect size was 0.27, 95% confidence interval 0.04–0.49). There were no specific moderators of CCRT improvements. However, across both groups, Wisconsin Card Sort Test improvement mediated a positive effect on functional capacity and Digit Span benefit mediated decreases in positive symptoms. In exploratory analyses younger and older participants showed cognitive improvements but on different tests (younger on Symbol Coding Test, while older on the Spatial Span Test). Only the older age group showed MSCEIT benefits at post-treatment. In addition, cognition at baseline negatively correlated with cognitive improvement and those whose MCCB baseline total score was around 31 seem to derive the most benefit.ConclusionsCCRT can improve the cognitive function of patients with schizophrenia. Changes in cognitive outcomes also contributed to improvements in functional outcomes either directly or solely in the context of CCRT. Age and the basic cognitive level of the participants seem to affect the cognitive benefits from CCRT.

BACKGROUND & AIMS:Patients with irritable bowel syndrome (IBS) often have psychiatric comorbidities. Alterations in the intestinal microbiota have been associated with IBS and depression, but it is not clear if there is a microbial relationship between these disorders. We studied the profiles of fecal microbiota samples from patients with IBS, depression, or comorbidities of IBS and depression; we determined the relationships among these profiles and clinical and pathophysiological features of these disorders.METHODS:We used 454 pyrosequencing to analyze fecal microbiota samples from 100 subjects (40 with diarrhea-predominant IBS [IBS-D], 15 with depression, 25 with comorbidities of IBS and depression, and 20 healthy individuals [controls]), recruited at Peking University. Abdominal and psychological symptoms were evaluated with validated questionnaires. Visceral sensitivity was evaluated using a barostat. Colonic mucosal inflammation was assayed by immunohistochemical analyses of sigmoid tissue biopsy specimens.RESULTS:Fecal microbiota signatures were similar between patients with IBS-D and depression in that they were less diverse than samples from controls and had similar abundances of alterations. They were characterized by high proportions of Bacteroides (type I), Prevotella (type II), or nondominant microbiota (type III). Most patients with IBS-D or depression had type I or type II profiles (IBS-D had 85% type I and type II profiles, depression had 80% type I and type II profiles). Colon tissues from patients with type I or type II profiles had higher levels of inflammatory markers than colon tissues from patients with type III profiles. The level of colon inflammation correlated with the severity of IBS symptoms.CONCLUSIONS:Patients with IBS-D and depression have similar alterations in fecal microbiota; these might be related to the pathogenesis of these disorders. We identified 3 microbial profiles in patients that could indicate different subtypes of IBS and depression or be used as diagnostic biomarkers.

Voluntary service is an important aspect of hospital's construction of spiritual civilization,and medical students are the main participants of the hospital volunteer service;besides,as the important base of medical students' learning and practice,the hospital should take the initiative to give a full play to the superiority of the volunteer service,and make full use of the volunteer service to perfect the way of education and optimize the education process.So through the concrete practice,how to explore a long-term mechanism of medical students involved in hospital volunteer service is imperative.This article mainly introduced one actual cases of medical students' participation in hospital volunteer service from a Beijing hospital,combined with the questionnaire survey,pointed out the importance of the hospital's appropriate guidance,reasonable arrangement and continuous improvement,and the importance of cultivating motive and interest for medical students involved in hospital volunteer service.

自媒体时代的来临,使医院突发事件信息的传播方式发生了深刻的变化.自媒体时代,信息的传播主体更为多样,传播速度加快,互动性加强;加之医院管理者观念陈旧,应对能力缺乏,使得医院在突发事件的应对中更为困难,严重影响了公立医院在突发事件中话语权的掌控,很有可能会影响公立医院的发展.因此,公立医院应当通过增强自媒体信息的敏感性;转变观念;建立信息发布的机制,主动公开公布相关信息;加强信息的保护工作等方面应对新媒体对医院突发事件中话语权的冲击.

Scientific research funds management is an important part of the construction of a clean and honest government.The Party committee should fulfill the main responsibility.Based on the practice of hospital management,this paper discusses how to implement the main responsibility of the Party committee in scientific research funds management.

In this double-blind, randomized controlled study, we assessed the therapeutic effects of high-frequency left dorsolateral prefrontal cortex (DLPFC) repetitive transcranial magnetic stimulation (rTMS) on negative symptoms of schizophrenia. For the study, 117 patients with prominent negative symptoms were randomized to a 20-day course of either active rTMS applied to the left DLPFC (n = 78) or sham rTMS (n = 39). The primary outcome measures were the Positive and Negative Symptom Scale (PANSS) and the Scale for the Assessment of Negative Symptoms (SANS). Secondary outcomes included the Clinical Global Impressions Scale (CGI) and the Udvalg for Kliniske Under sogelser (UKU) Side Effect Rating Scale. We found that treatment with high-frequency rTMS for 6weeks significantly improved negative symptoms in the active group as compared to the sham group. However, active rTMS was not correlated with significant improvement in the CGI severity of illness scale (CGI-S). The improvement of negative symptoms persisted to the 24-week follow-up assessment. These results indicate that there is a lasting beneficial effect of rTMS on negative symptoms in absence of decrease in CGI scores. We conclude that rTMS may serve as a relatively noninvasive treatment that alleviates negative symptoms in patients with schizophrenia.

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.

目的 探讨盐酸度洛西汀肠溶片不同滴定剂量、给药次数对抑郁症疗效和安全性的影响.方法 共纳入抑郁症患者226例.分为3组:A组,起始剂量40 mg/d,3d后加量至60 mg/d;B组,起始剂量40 mg/d,7d后加量至60 mg/d;C组,起始剂量20 mg/d,3d后加量至40 mg/d,7d后加至60 mg/d;给药次数分1次/d和2次/d.以HAMD-17和HAMA以及临床总体印象量表(CGI)作为主要疗效评价指标;以10分制满意度调查表评价患者对治疗的满意度;记录不良反应以评价安全性.结果 基线与治疗6周后,患者的HAMD-17评分分别为(25.2±4.9)分和(5.4±3.8)分;HAMA评分分别为(21.4±7.2)分和(4.0±3.5)分;抑郁和焦虑的痊愈率分别为64.8％和71.4％;CGI-I为非常明显进步的患者占66.1％;满意度＞5分的患者占78.0％;不同剂量滴定和给药次数不影响该药对抑郁、焦虑症状的疗效;滴定方法B可更快缓解患者的抑郁、焦虑症状,且每天2次给药的疗效更为显著;治疗过程中常见的不良反应为恶心(14.9％)、头晕(4.4％);其中滴定方法A、B、C恶心的发生率分别为17.1％,7.1％,17.8％,差异趋于统计学水平(P=0.053).结论 盐酸度洛西汀肠溶片能有效治疗抑郁症患者的抑郁、焦虑症状,安全性良好;40 mg/d起始,7d滴定至60 mg/d可能对患者症状的缓解更为有益.

目的:探讨精神分裂症患者自知力及精神症状对生活质量的影响.方法:选取符合美国精神疾病诊断与统计手册第4版(DSM-Ⅳ)中精神分裂症诊断标准的医院门诊和住院患者共180例.采用世界卫生组织生存质量测定量表简表(WHOQOL-BREF)、自知力评定量表(SAI)、阳性与阴性症状量表(PANSS)对患者进行评估.结果:生活质量的生理因子与依从性、疾病意识、精神症状标识及自知力总分显著负相关(r =-0.232,-0.243,-0.171,-0.274;P ＜0.05);心理因子与疾病意识和自知力总分显著负相关(r=-0.219,-0.203;P ＜0.01);生活质量总分与疾病意识和自知力总分负相关(r =-0.169,-0.175;P ＜0.05),生活质量受自知力总分和阴性症状的影响(β=-0.312,P=0.000;β=-0.157,P=0.037),疾病意识对生活质量心理因子有预测作用(β=-0.291,P=0.003);生活质量总分受自知力总分的影响(β=-0.594,P=0.019).结论:①自知力较好的患者生活质量较低;②心理因子受疾病意识的影响;③阴性症状对生活质量有影响.

抑郁,是我们今天的头号“心灵公敌”.据世界卫生组织统计,目前全世界的抑郁症患者已达3.4亿人,位列第五大疾病,预计到2020年还将跃升至第二位.在我国,抑郁症的患病率为3％～5％,至少有2600万抑郁症患者.约13％～20％的人在一生中可能会有一次抑郁体验. 值得警惕的是,抑郁症在我国目前就诊率和治疗率都比较低.从患者来讲,很多人不愿意承认自己的心理问题,甚至有意无意地把心理问题转化为身体上的不适,比如头疼、失眠、没胃口等,影响本人、家属甚至医生的判断.由于抑郁症的患病率高、病人众多,已经成为精神疾病中的多发病、常见病,被精神科医生们戏称为“心灵感冒”.更需关注的是,约90％的抑郁症病人首诊于神经、消化、心血管、内分泌等非精神科,且曾用各种非抗抑郁药物进行过治疗;还有约1/3的病人曾求助于巫医、迷信等方法治病.可见,在大众中普及有关抑郁症的知识已经成为当务之急.

躯体形式障碍(somatoform disorders)是一类以各种躯体症状作为其主要临床表现(躯体形式因此而得名),不能证实有器质性损害或明确的病理生理机制存在,但有证据表明与心理因素或内心冲突密切相关的精神障碍.患者常反复陈述躯体不适,四处求医却未能发现器质性病变;或即使有某种躯体疾病也不能用以解释其主诉症状的严重程度、性质及由此产生的观念和烦恼.

Objective To evaluate the effectiveness of trypan blue marker technology in ciliary sulcus sutured fixation of intraocular lens (IOL) surgery for clinical application.Methods Non-capsular support aphakia 37 cases (37 eyes) accepted the ciliary sulcus sutured intraocular lens implantation with application of trypan blue marker technology.The IOL optical center were marked and used as location guiders.Location guiders maintained the IOL center and Cornea center on the same axis under the surgery microscope.Intermediacy of IOL optical center was observed postoperatively through photographic analysis of slit lamp microscope.The preoperative best corrected visual acuity (BCVA),postoperative uncorrected visual acuity (UCVA) at 1 day,3 months,6 months were observed.Related techniques and clinical results were discussed.The follow-up period was 6 months.Results All IOL optical center obtained satisfied intermediacy,maintained the same axis with the cornea center,no deviation occurred.UCVA at postoperative day 1 was significantly improved from preoperative 0.05±0.03 up to 0.44±0.19 (t=4.63,P=0.0017),46％ above 0.5; There was no significant difference between preoperative BCVA (0.51±0.10) and UCVA (0.56±0.19) at 3 months postoperatively (t =1.51,P=0.16).Conclusions Trypan blue marker technology can help surgeon find the IOL deviation timely and correct precisely which can conductively maintain the advantage of ciliary sulcus sutured fixation of intraocular lens surgery.

目的 分析探讨精神分裂症患者生活质量与非理性信念的关系,为认知行为治疗提高患者的生活质量提供理论指导.方法 选取符合DSM-Ⅳ中精神分裂症诊断标准的医院门诊和住院患者共200例,采用世界卫生组织生存质量测定量表简表(WHOQOL-BREF)和非理性信念量表(IBS)对患者进行测评,收回有效问卷182例,分析患者生活质量与非理性信念的相关性.结果 患者生活质量总分及4个因子分与非理性信念的低挫折耐受呈负相关(r分别为-0.348,-0.405,-0.309,-0.256,-0.394; P＜0.01),与概括化评论呈负相关(r分别为-0.357,-0.401,-0.325,-0.295,-0.413; P＜0.01).低挫折耐受和概括化评论可以作为总体生活质量和心理因子的预测指标(F分别为21.231,21.015; P＜0.01);概括化评论可以作为总体生活质量及生理、社会关系、环境因子的预测指标(F分别为15.292,12.020,9.011; P＜0.01).结论 精神分裂症患者的非理性信念影响患者的生活质量的各个层面,非理性信念中的低挫折耐受和概括化评论可作为患者生活质量的预测指标.

Objective To analyze the actual terminal phacoemulsification energy effect in intraocular space,axis motion control model of Ozil torsional handpiece and to evaluate the necessity and the impact of the non-target tissues within the eye.Methods Induced by high aspiration pressure (300～350mmHg),hard nucleus (Grade:Ⅲ～Ⅳ) of senile cataract was chopped before phacoemulsification in 126 patients (126 eyes).Sixty patients (60 eyes) accepted ultimate energy control on the base of Ozil torsional handpiece axis control model; Another 66 patients (66 eyes) were compared as the Ozil torsional handpiece non-axis control group.The differences of accumulated energy complex and 8～10 hr postoperation intraocular pressures (IOP) and 24hr postoperation comeal edema rate were compared between two groups.Results The difference of accumulated energy complex was compared between two groups.(t =2.263,P ＜0.05).Difference of 8～10hr postoperation IOP existed between two groups.(t =2.069,P ＜0.05).The rates of 24hr postoperation corneal edema was lower in energy dissipation control group than that in the reviewed group (x2=5.41,P ＜0.02).Ozil torsional handpiece axis control could focus phaco energy terminal effects more precisely and protect non-target tissues injuries from energy dissipation.Conclusions Ozil torsional handpiece axis control can minimize the level of dissipated energy and improve the accuracy and safety of Ozil phaco mode.