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上海精神医学

上海精神医学

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Shanghai Archives of Psychiatry
《上海精神医学》杂志创办于1959年，1989年正式公开发行，是国内第一本精神科专业的学术期刊。《上海精神医学》面向全国精神卫生工作者，着重报道精神医学领域的临床研究成果、实用经验及相关领域的最新知识。现任总编为肖泽萍教授，主编王祖承教授，主要栏目有：论著、病例报告、综述、临床病例讨论、争鸣与讨论、临床经验笔谈等。《上海精神医学》的宗旨是：立足临床、求新求精。
  • 发文量：2335
  • 被引量：19716
  • H指数：3
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  • 国内刊号/CN：31-1564/R
    国际刊号/ISSN：1002-0829
  • 发行周期：双月刊
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  • 主管单位：上海市卫生局
    主办单位：上海市精神卫生中心
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  • 主编：江开达，费立鹏
  • 电话：021-34773296
  • 邮箱：shtougao3296@163.com
  • 地址：上海市宛平南路600号
  • 邮编：200030
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上海精神医学 >2018年第3期

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  • 摘要：Obsessive-compulsive disorder (OCD) is a common mental disorder of uncertain etiology.Neuroimaging studies of patients with OCD in China started to appear in the late 1990s,identifying structural abnormalities in the gray matter and white matter of the prefrontal lobe,the corpus striatum,and the thalamus.Studies using positron emission tomography (PET),functional magnetic resonance imaging (fMRI),and magnetic resonance spectroscopy (MRS) have found increased metabolism and activation in these brain regions that are correlated with the duration,severity and cognitive symptoms of OCD.After surgery for OCD the activation in these target areas decreases.These results in China are similar to those presented in previous neuroimaging studies,including several meta-analyses from other countries.
  • 摘要：背景 老年抑郁症伴有的认知损害可能不随抗抑郁治疗而好转,可能会进展为痴呆.目的 探讨老年抑郁症患者抗抑郁治疗前后认知和抑郁症状变化的关系及其与ApoEε4等位基因的关联.方法 检测64例首发老年抑郁症患者和31名非抑郁老年人的ApoEε4等位基因.抑郁症患者接受标准化的选择性5-羟色胺再摄取抑制剂(Selective Serotonin Reuptake Inhibitors,SSRIs)治疗,在基线和治疗12个月后分别对研究对象进行老年抑郁量表(The Geriatric Depression Scale,GDS)、简易智能状态检查(Mini-Mental State Examination,MMSE)、数字广度测验(digit span task)和连线测验A,B(Trail making test,TMT-A,TMT-B)的测评.结果 与对照组比较,治疗前老年抑郁症组患者的认知功能较差,其中31 (48％)例符合轻度认知功能损害(mild cognitive impairment,MCI)的标准.治疗后,无论共病MCI与否,抑郁症患者的认知和抑郁症状均有改善,但伴MCI者残留症状更多.基线时认知症状的严重程度与抑郁症状的严重程度不存在相关性,但在12个月随访时二者存在正相关.患者中有14％ (9/ 64)携带ApoEε4等位基因,而对照中仅有3％ (1/31)携带APOEε4等位基因(Fisher精确检验,p=0.158).与未携带ApoEε4等位基因的抑郁症患者相比,携带此等位基因的抑郁症患者治疗前、后均有较严重的认知症状,但仅某些方面的差异具有统计学意义.结论 老年抑郁症患者普遍存在认知损害.经标准的SSRI治疗后,患者的抑郁和认知症状均有所改善,但共病MCI的患者治疗后残留更多的抑郁和认知症状.老年抑郁症患者中携带ApoEε4等位基因与较严重的认知损害有关,可能与抗抑郁剂治疗认知症状疗效欠佳有关.%Background:Co-occurring cognitive impairment in geriatric depression may not improve with antidepressant treatment and it may progress to dementia.Aim:Assess the relationship between changes in cognitive and depressive symptoms among patients with geriatric depression and their association with the APOE epsilon 4 allele before and after antidepressant treatment.Methods:The presence of the APOE epsilon 4 allele was assessed in 64 incident cases of geriatric depression and 31 elderly individuals without depression and the Geriatric Depression Scale (GDS),Mini-Mental State Examination (MMSE),digit span test,and Trail Making Tests A and B (TMT-A,TMT-B) were administered to these subjects at baseline and 12 months after baseline,during which time the depressed group received standardized treatment with selective serotonin reuptake inhibitors (SSRIs).Results:Prior to treatment patients with geriatric depression had significantly worse cognitive functioning than control subjects and 31 (48％) met criteria for mild cognitive impairment (MCI).After treatment depressed patients with and without comorbid MCI both had significant improvements in their depressive and cognitive symptoms,but those with MCI had more residual symptoms.The severity of cognitive symptoms was not associated with the severity of depressive symptoms at baseline,but they were positively correlated at the 12-month follow-up.The APOE epsilon 4 allele was identified in 14％ (9/64) of the patients and in 3％ (1/31) of the controls (Fisher's Exact Test,p=0.158).Compared to depressed patients without the allele,depressed patients with the allele had more severe cognitive deficits both before and after treatment,though only some of these differences were statistically significant.Conclusions:There is substantial cognitive impairment in elderly individuals with geriatric depression.Both the depressive and cognitive symptoms improve with standard SSRI treatment,but individuals with comorbid MCI have more residual depressive and cognitive symptoms after treatment.The APOE epsilon 4 allele is associated with greater cognitive impairment in geriatric depressed patients and may be associated with less responsiveness of cognitive symptoms to antidepressant treatment.
  • 摘要：Stoichiometric LaMnO3and LaCoO3nanoparticles were synthesized via calcination of a dried solution,containing molar ratio of La(NO3)3·6H2O/[Mn(NO3)2·4H2O or Co(NO3)2·6H2O]=1 and citric acid as disperser at temperature range of 600–900 oC for 5 h.The role of organic additive concentration,which was 0.0,1.0,2.5 and 5 times of the total number of moles of the nitrate ions,was investigated on phase formation,morphology,extent of crystallization and particle size of the products.Products were characterized by X-ray diffraction(XRD),Fourier-transform infrared spectroscopy(FT-IR),scanning electron microscopy(SEM)and transmission electron microscopy(TEM)analysis.The tendency of lanthanum ion toward manganese cation was observed to be more than to cobalt cation for the formation of LaBO3(B:Mn or Co)perovskite phase.A spongy product was formed on perovskite phase formation or in the presence of citric acid.A constructive or destructive effect was observed for the organic disperser on perovskite phase formation,which depended on mole of the citric acid.
  • 摘要：Background:There are no reliable estimates of the prevalences of autism and autism spectrum disorders(ASD)in China.Objective:Combine results across studies to estimate the prevalences of autism and ASD among Chinese children under the age of 18,and assess variations in the prevalences with respect to gender,ethnicity,and urban versus rural residence.Methods:Based on pre-defined inclusion and exclusion criteria,studies were identified by searching the following databases:Chinese National Knowledge Infrastructure,Chongqing VIP database for Chinese Technical Periodicals,WANFANG DATA,Chinese Biological Medical Literature Database,Pubmed,and Web of Science.Statistical analysis was conducted using R-2.15.2 software.Results:The 24 studies meeting inclusion criteria included 5 registry studies from Taiwan and Hong Kong (covering a total of 14 570 369 children) and 19 community-based screening and diagnostic studies from mainland China (with a combined sample of 771 413 children).The annually reported prevalence of autism in the registry studies ranged from 1.8 to 424.6 per 10 000.A meta-analysis of 18 of the studies from mainland China (excluding a large nationwide study with the lowest prevalence of autism) with a range in rates from 2.8 to 30.4 per 10 000 generated an estimated pooled prevalence of autism of 12.8 per 10 000 (95％CI,9.4 to 17.5).The pooled prevalence of ASD estimated from 5 of these studies (which had a range in rates from 7.3 to 75.3 per 10000) was 24.5 per 10000 (95％CI,10.4 to 57.4).The reported prevalence of autism varied substantially by gender,location of residence,date of publication,and source of the sample.Conclusion:The huge difference between the rates for autism reported from registry systems in Hong Kong and Taiwan (a 200-fold difference) and the large differences in rates reported from community-based screening studies in mainland China (a 10-to 15-fold difference) highlight the urgent need for establishing standardized methods for estimating the prevalences of autism and ASD.Until these methodological improvements have been made,it will not be possible to develop evidence-based prevention and treatment strategies for the management of these uncommon but seriously disabling conditions.%背景 中国孤独症和孤独症谱系障碍(autism spectrum disorders,ASD)的患病率缺乏可靠的估计.目的 运用Meta分析综合评价中国18岁以下人群孤独症和ASD患病情况,并分析其在性别、民族、城乡等不同因素间的差异.方法 检索中国知识资源总库、中国科技期刊数据库、万方数据检索系统、中国生物医学文摘数据库、PubMed和Web of Science等数据库,收集关于中国孤独症谱系障碍患病率的文献,按照预先制定的纳入及排除标准筛选相关研究.采用R-2.15.2软件对资料进行统计学分析.结果 共纳入24项研究,其中5项来自香港和台湾的注册研究(涉及14,570,369名儿童),19项来自大陆以人群为基础的筛查和诊断研究(合并样本量为771,413名儿童).港台注册研究报道的孤独症年患病率为1.8～424.6/10,000.中国大陆的18项研究(剔除一个患病率最低的全国性研究)报道孤独症患病率为2.8～30.4/10,000,合并后孤独症患病率为12.8/10,000 (95％CI,9.4～17.5).5项研究报道ASD(患病率为7.3～75.3/10,000)合并后患病率24.5/10,000(95％CI,10.4～57.4).不同性别、居住地点、发表时间和抽样来源之间报道的患病率存在明显差异.结论 港台注册研究报道的孤独症患病率存着巨大差异(达200倍),大陆以人群为基础的筛查诊断研究报道的患病率存在较大差异(10～15倍),凸显迫切需要建立标准的方法来估计孤独症和ASD的患病率.只有方法学质量得到改善,才有可能为这些不常见但严重致残的疾病提供循证的防治策略.
  • 摘要：A 23-year-old female student presented with a five-year history of abnormal sleep in which she would sit up or stand up for brief periods in the early morning,talk loudly for a couple of minutes and then lie back down.When woken by family members she would remember vivid dreams and nightmares.In one episode she had a fall that resulted in a subdural hematoma.On presentation at the psychiatric hospital she had a normal mental status exam except for being mildly depressed and anxious about the chronic fatigue from poor sleep.Overnight polysomnography (PSG) showed multiple waking periods each night,poor sleep efficiency and a lack of normal muscle paralysis during REM sleep.The patient was diagnosed with REM Sleep Behavior Disorder and treated with 1 mg clonazepam nightly.Her sleep improved dramatically and remained better at a six-month follow-up,but.repeat PSG exam found that the lack of muscle paralysis during REM sleep remained.
  • 摘要：背景:心脏移植术逐渐增多,但对等待心脏移植患者的情绪状态却知之甚少.方法:2010年10月至2011年12月,由精神科医生对上海某大型综合性医院心外科住院等待心脏移植的38例患者进行汉密尔顿抑郁量表和汉密尔顿焦虑量表的评估,住院时评定一次,以后每周评估一次,直至手术.结果:共入组男性30例,女性8例,平均年龄44.7(12.9)岁,因为心脏疾病使活动严重受限(即心功能III级)的平均病程为18.5 (24.0)个月.这些患者中存在中度和严重抑郁症状的比例为7.9%(3/38),中度和严重焦虑症状的比例为47.4%(18/38),同时存在中重度抑郁和焦虑症状的仅有1人(2.6%).住院第一周焦虑症状和抑郁症状均轻度加重.逐步logistic回归分析(向后法)显示患者自我报告的焦虑水平与以下因素相关,心功能III级的病程越长,焦虑越轻;既往住重症监护病房者,焦虑程度轻;随年龄增大焦虑加重;既往存在因心脏疾病而接受急诊抢救史者焦虑更明显.多元线性回归分析还发现心功能III级的病程越长、受教育程度越高,患者报告的抑郁症状越少,但是心脏疾病的总病程越长,患者报告的抑郁症状越明显.结论:与国外的研究结果不同,我们发现在上海住院等待心脏移植者的焦虑症状比抑郁症状更为普遍、更为严重.疾病导致严重功能障碍的病程与术前自我报告的焦虑症状和抑郁症状的严重度负相关:心功能III级超过1年者报告的焦虑和抑郁症状要比不足1年者少.%Background: Although heart transplants have become more common, little is known about the psychological status of patients waiting for a heart transplant.Methods: Thirty-eight inpatients waiting for heart transplantation from October 2010 to December 2011 in a large general hospital in Shanghai were assessed by a psychiatrist using the Hamilton Depression Scale and the Hamilton Anxiety Scale at admission and weekly thereafter until the operation took place.Results: The patients included 30 males and 8 females with a mean (sd) age of 44.7 (12.9) years who had been seriously limited due to their heart disease (i.e., Stage III heart disease) for a mean of 18.5 (24.0) months. Among them, 7.9% (3/38) were moderately or severely depressed and 47.4 % (18/38) had moderate or severe anxiety symptoms; only one (2.6%) had concurrent moderate to severe anxiety and depression. There was a slight but statistically significant increase in both anxiety and depressive symptoms during the first week of hospitalization. In the stepwise backward logistic regression, the reported level of anxiety was significantly associated with the duration of Stage III heart disease (less anxiety in those with longer Stage III disease), prior treatment in an intensive care unit (associated with less anxiety), age (anxiety increases with age), and prior emergency cardiac treatment (associated with greater anxiety). Multivariate linear regression analysis also found that longer duration of Stage III disease and higher educational status were associated with reporting less depressive symptoms, but a longer total duration of heart disease was associated with reports of more depressive symptoms.Conclusion: Unlike reports from other countries, we found that anxiety symptoms are more prevalent and more severe than depressive symptoms among inpatients waiting for heart transplantation in Shanghai. There is an inverse relationship between duration of disabling illness and the preoperative self-reports of anxiety and depressive symptoms: those who had had Stage III disease for over a year reported less severe anxiety and depressive symptoms than those who had had Stage III disease for less than a year.
  • 摘要：Background: Antipsychotic medications can cause an increase in blood glucose and the development of type II diabetes. Metformin may ameliorate these side effects.Objective: Assess whether or not metformin reduces the abnormalities in glucose metabolism that occur with use of the antipsychotic clozapine.Methods: Eighteen adult Sprague-Dawley (SD) rats were divided into three groups that were intragastrically administered saline, clozapine (20 mg/kg), or a combination of clozapine (20 mg/kg) and metformin (78 mg/kg) for 28 days. Fasting blood glucose was assessed at baseline and every seven days thereafter. The animals were euthanized on the 28th day at which time aortic blood was obtained to assess blood insulin and C-peptide by radioimmunoassay, and pancreatic tissue samples were collected and used to determine the expression of the glucose transporter-2 (GLUT2) by real-time polymerase chain reaction (RT-PCR) and Western Blot.Results: Fasting blood glucose in the clozapine group was significantly higher at the 14th, 21st, and 28th day compared to baseline, but rats receiving clozapine and metformin only had significantly elevated levels on the 14th day of treatment. However, repeated measures ANOVA found no statistically significant differences in blood glucose levels over time between the three groups (p=0.136). Multiple comparison tests found that the mean insulin level in the clozapine+metformin group was significantly lower than the levels in the clozapine and saline groups. There were statistically significant differences in the expression of GLUT2 mRNA (clozapine+metformin group < clozapine group < saline group) and in the expression of GLUT2 protein (clozapine+metformin group, clozapine group < saline group).Conclusion: This study found a non-significant increase in fasting blood glucose in SD rats treated with clozapine that was partially counteracted by concurrent administration of metformin. Rats administered clozapine showed the expected decrease in the expression of GLUT2, but concurrent administration of metformin and clozapine for 28 days did not show the expected normalization of the expression levels of GLUT2.%背景:抗精神病药物可引起血糖升高甚至导致2型糖尿病.二甲双胍可能会减轻上述副作用.目的:评价二甲双胍能否减轻使用抗精神病药氯氮平时发生的糖代谢异常.方法:将18只成年SD大鼠分为3组,分别用生理盐水、氯氮平(20mg/kg)及氯氮平(20mg/kg)+二甲双胍(78mg/kg)灌胃28d.在基线及其后每隔7天测空腹血糖.实验第28d麻醉大鼠使其安乐死,此时取腹主静脉血,用放射免疫法检测血胰岛素和C肽水平;取胰腺组织,采用实时聚合酶链反应和Western Blot技术检测葡萄糖转运体2(glucose transporter-2,GLUT2)的表达水平.结果:氯氮平组第14天、21天和28天的空腹血糖值均显著高于基线值,但氯氮平+二甲双胍组仅第14天时的空腹血糖值较基线明显升高.尽管如此,重复测量的方差分析并未发现三组间随时间变化的血糖水平差异有统计学意义(p=0.136).多组比较发现氯氮平+二甲双胍组的胰岛素均值显著低于盐水组及氯氮平组.组间GLUT2 mRNA的表达差异具有统计学意义(氯氮平+二甲双胍组<氯氮平组<盐水组),组间GLUT2 蛋白的表达差异亦有统计学意义(氯氮平+二甲双胍组,氯氮平组<盐水组).结论:本研究发现氯氮平一定程度上能使SD大鼠空腹血糖水平升高,联合使用二甲双胍可部分抵消血糖的升高.正如预期,接受氯氮平的SD大鼠GLUT2的表达水平降低.然而,意料之外的是氯氮平联合二甲双胍治疗28 d并未使GLUT2的表达水平正常化.
  • 摘要：There is a long history of using antipsychotic medications in the treatment of depressive disorders. Atypical antipsychotics, which have fewer side effects than traditional antipsychotics, have been used as monotherapy or adjunctively with antidepressants to treat depressive disorders with or without psychotic symptoms. The antidepressant effect of atypical antipsychotics involves regulation of monoamine, glutamate, gamma-aminobutyric acid (GABA), cortisol, and neurotrophic factors. To date, the United States Food and Drug Administration (USFDA) has approved aripiprazole and quetiapine slow-release tablets as adjunctive treatment for depressive disorders, and the combination of olanzapine and fluoxetine for the treatment of treatment-resistant depression. When using atypical antipsychotics in the treatment of depressed patients, clinicians need to monitor patients for the emergence of adverse effects including extrapyramidal symptoms (EPS), weight gain, and hyperglycemia.
  • 摘要：Background: There were 1.2 million registered heroin users in China by the end of 2011, but little research in the country has focused on the neuropsychological functioning of these individuals.Aim: Assess error-related negativity (ERN) - an important indicator of high-level cognitive functioning - among males with heroin dependence undergoing rehabilitation.Method: Twenty male patients in a rehabilitation center who met DSM-IV criteria for heroin dependence and 15 healthy male controls completed 800 trials of Erikson flanker tasks to provoke ERN waves on the 32-electrode electroencephalograph (EEG) when erroneous responses are induced by presenting incongruent flankers around the target stimulus. Mean error rates and reaction times for the task, and the amplitude and latency of crude ERN waves and standardized ERN waves (created by subtracting the wave for correct responses from that for incorrect responses) at three frontal midline EEG electrodes (Fz, FCz, and Cz) were compared between patients and controls.Results: There was no significant difference in error rates between patients and controls but the reaction times for both erroneous and correct responses were shorter in patients than controls. The amplitude of both crude and standardized ERN waves was lower in patients than controls, but this difference became non-significant after adjustment for the lower educational level in the patient group. The latency of the peak value in both the crude and standardized ERN waves was significantly shorter in the patient group; this difference remained significant after adjustment for educational level. There was a significant correlation between the negative amplitude of the standardized ERN wave and the duration of heroin use.Conclusion: These findings suggest impaired impulse control and abnormal error-monitoring functions in persons with a history of heroin dependence and add to the growing literature on the neurological mechanisms related to cognitive dysfunction in individuals with addictive disorders.%截止2011年底,全国登记吸毒人群中滥用海洛因人员共115.6万人,然而国内对海洛因依赖者神经心理功能的研究较少.目的:探讨康复期男性海洛因依赖者高级认知功能的重要指标之一,即错误相关负电位(error-related negativity,ERN)的特征.方法:符合DSM-IV诊断标准的男性海洛因依赖者20例和健康对照者15人完成视觉Eriksen Flanker刺激任务.该任务共800个刺激,在目标刺激两侧呈现与目标不完全一致的干扰刺激,以此诱发错误应答及ERN.记录被试头皮32导脑电图(EEG)信号.比较患者组与对照组的平均错误率和执行任务的反应时,并比较额叶中线3处EEG电极位置(Fz、FCz和Cz)原始ERN以及ERN差异波(在错误应答波基础上减去正确应答波后的负波)的波幅和潜伏期.结果:两组的错误率无明显差异,但与对照组相比,患者组的正确反应时和错误反应时均缩短.无论是原始ERN还是ERN差异波,患者组的波幅均低于对照组.由于患者组受教育年限较低,经校正后,两组波幅差异无统计学意义.患者组的原始ERN和ERN差异波的潜伏期均比对照组短,校正受教育水平后差异仍有统计学意义.海洛因依赖组ERN差异波波幅与吸毒年限呈正相关.结论:研究结果提示有海洛因依赖史的个体存在冲动控制能力受损以及错误监控功能异常.关于成瘾障碍个体认知功能障碍的神经机制的研究日益增加,本研究也为这一文献库添砖加瓦.
  • 摘要：Background: Childhood schizophrenia is a severe mental disorder that is believed to affect both conscious and unconscious cognitive functioning, but there have been few studies that have assessed this.Objective: Develop a version of the binocular rivalry test that will assess the conscious and unconscious cognitive processing of interpersonal information and use this test to determine whether or not social cognition is impaired in children with schizophrenia.Methods: Thirty images of three types - with no persons, with 2-3 persons and with 4+ persons - were selected for use in a binocular rivalry test that presented the images both in an interocularly suppressed (unconscious) format and an unsuppressed (conscious) format. Fifteen children under 16 years of age with schizophrenia who had prominent delusional symptoms and 15 healthy children were administered the test. Accuracy rates (in assessing the left or right orientation of a patch presented immediately after the target images) and reaction times were compared between patients and controls.Results: For all types of pictures, the accuracy of patients was less than that of controls, though the differences were only significant in two of the twelve comparisons assessed. Compared to controls, patients showed a non-significant increase in the attention paid to images with people in them compared to images without people in them, both for conscious and unconscious presentations of the images. We did not find any relationship between the severity of psychotic symptoms in the patients and the degree of impairment in the cognitive processing of images. When asked to assess the attributes of the images, patients reported significantly higher levels of happiness depicted in images with 2-3 people than controls.%背景:儿童期精神分裂是一种严重的精神障碍,有理论认为其认知功能无论是意识水平还是潜意识水平都存在异常.但目前尚无针对儿童期精神分裂的潜意识认知功能研究.目的:开发新的双眼竞争测验版本,用于评估个体在意识和潜意识状态下对人际交往信息的认知加工过程,并依此判断儿童期精神分裂症患者的社会认知功能是否受损.方法:选取3种不同类型的图片(图片中无人物、有2~3个人物、有4个及以上的人物)共30张,这些图片在双眼竞争测验不可见模式(存在双眼竞争性抑制,反映潜意识状态下认知加工)和可见模式(无双眼竞争性抑制,反映意识状态下)中展示.对15名年龄≤16岁、以妄想为主要症状的精神分裂症患者及15名健康儿童进行双眼竞争测验,通过对目标图片出现后立即在其左侧或右侧出现光栅的方向的判别来比较两组儿童的正确率,并比较两组间的反应时间.结果:患者组对所有类型图片中光栅方向判断的正确率均低于对照组,但是12对比较中仅2对的差异有统计学意义.与对照组相比,无论是在可见模式还是非可见模式下,患者对人物图片的注意要比对无人图片的注意有所增加,但无显著性意义.我们并未发现精神病性症状的严重程度与对图像认知加工的受损程度之间存在任何关联.当要求被试对三组图片进行评分时,患者组对存在2~3个人物的图片报告的高兴程度明显高于对照组的评分,差异有统计学意义.结论:儿童期精神分裂症患者对描绘人际关系的图片注意一定程度的增加,提示该病与社会信息的认知处理过程受损相关,但目前结果尚不能证实这一关系.我们将双眼竞争范式应用于认知功能差异的研究,只是取得部分的成功,其主要原因是该测验中对不同类型图片的反应注意量的关键指标存在较大的变异.
  • 摘要：Summary: Neuroleptic malignant syndrome (NMS) is a rare, life-threatening adverse reaction to antipsychotic medication that typically includes high-fever, extrapyramidal symptoms, autonomic nervous system dysfunction and disturbances in consciousness. Though reported to be more common following use of the older, first generation antipsychotic medications, it can also occur in patients taking the newer, second generation antipsychotic medications. This report discusses the clinical presentation, possible etiology, pathogenesis and treatment of two cases of NMS that occurred in elderly patients after taking atypical antipsychotics. With the increasing use of atypical antipsychotic medication in elderly patients - who may be more susceptible to this adverse reaction - there is a need to increase clinical vigilance about this condition, particularly among internists and gerontologists who may be unfamiliar with this rare complication to antipsychotic medication.
  • 摘要：Background:Attention-Deficit/Hyperactivity Disorder (ADHD) is the most common diagnosis among children treated in outpatient psychiatric clinics in China, accounting for up to 50%of all patients. Objective:Understand changes over time in the characteristics and treatment of children with ADHD seen at specialty psychiatric clinics in China. Methods:For each year from 2000 through 2011, 250 charts of patients who made their initial visit to the Child and Adolescent Psychological Counseling Clinic of the Shanghai Mental Health Center were randomly selected. Among the 3000 selected patients, 998 (33%) had a diagnosis of ADHD. Results:About 80%of the ADHD patients were male and the majority of them fell ill prior to the age of seven. The mean (sd) age at the time of first attendance at the clinic was 10.0 (2.6) years and the mean duration of illness at the time of the initial visit was 2.9 (1.2) years;both of these values decreased significantly over time. About 20%of them were non-residents of Shanghai and about 11%had comorbid psychiatric diagnoses (primarily depression and tic disorder);both of these proportions increased significantly over time. Among the 576 (58%) who visited the clinic more than once, 77%were treated with central nervous system stimulants, but the proportion administered behavioral treatments (either solely on in combination with medications) increased significantly over time. Conclusion:ADHD remains the most common diagnosis of children seen in specialty psychiatric clinics in China but the proportion of clinic attendees with ADHD is gradually declining as non-specialty treatment services expand and other diagnoses become more prominent. There are encouraging trends of earlier identification and treatment of ADHD and of increasing use of non-pharmacological interventions. Nevertheless, most children with ADHD have been ill for at least two years at the time of the initial diagnosis, so continued research efforts are needed to identify the best ways to speed up the recognition and treatment of this disabling condition.%背景：注意缺陷多动障碍（Attention Deficit/Hyperactivity Disorder, ADHD）是中国精神科门诊儿童患者中最常见的诊断，最高比例约占所有患儿的50%。目的：了解中国精神科儿童门诊ADHD患儿特征和治疗情况的变迁。方法：随机抽取2000年至2011年间在上海市精神卫生中心儿少心理咨询门诊初诊患儿的病历，每年抽取250份。在所抽取的3000例患儿中，998例（33%）诊断为ADHD。结果：约80%的ADHD患儿为男性，大多数在7岁之前患病。确诊患儿初诊时平均（标准差）年龄为10.0（2.6）岁，初诊时平均病程为2.9（1.2）年，近年趋势为初诊年龄变小，初诊时病程变短。约20%的患儿为非上海户籍，约11%合并其他精神疾病诊断（主要是抑郁症和抽动障碍），近年来上述比例呈上升趋势。576例（58%）有复诊记录的患儿中，77%接受中枢兴奋剂，但是，行为治疗（单用或合并药物）的比例近年来明显增加。结论：ADHD仍然是中国精神科门诊儿童患者中最常见的诊断，但由于非专科治疗服务的扩大以及其他疾病诊断的增加，门诊ADHD患儿的比例在下降。令人欣慰的是ADHD呈现早诊断和早治疗的趋势以及非药物干预的应用有所增加。尽管如此，多数ADHD患儿确诊前至少已有2年病程，因此需要进一步研究来确定更好的方法以便更早地识别和治疗这一障碍。
  • 摘要：Summary:Neuroleptic malignant syndrome (NMS) is a life-threatening neurologic complication associated with the use of neuroleptic agents and characterized by a distinctive clinical syndrome of fever, rigidity, autonomic nervous system dysfunction and mental status change. This report discusses the clinical presentation, possible etiology, pathogenesis and treatment of one case of recurrent NMS in a middle-aged woman with schizophrenia. NMS occurred after combined treatment with haloperidol and aripiprazole (the first episode) and, four years later, after combined treatment with haloperidol and clozapine (the second episode). This case highlights the need to be particularly cautious in the use of antipsychotic medications in patients with a history of NMS and, whenever possible, to avoid combined treatment with multiple antipsychotic medications in these patients.
  • 摘要：Summary:The importance of genetic factors in substance addiction has long been established. The rationale for this work is that understanding of the function of addiction genes and delineation of the key molecular pathways of these genes would enhance the development of novel therapeutic targets and biomarkers that could be used in the prevention and management of substance abuse. Over the past few years, there has been a substantial increase in the number of genetic studies conducted on addiction in China;these studies have primarily focused on heroin, alcohol, and nicotine dependence. Most studies of candidate genes have concentrated on the dopamine, opioid, and serotonin systems. A number of genes associated with substance abuse in Caucasians are also risk factors in Chinese, but several novel genes and genetic risk factors associated with substance abuse in Chinese subjects have also been identified. This paper reviews the genetic studies of substance abuse performed by Chinese researchers. Genotypes and alleles related to addictive behavior in Chinese individuals are discussed and the contributions of Chinese researchers to the international corpus of knowledge about the genetic understanding of substance abuse are described.
  • 摘要：背景：世界各地关于进食障碍的流行病学研究得到的患病率数据不尽一致，目前尚缺乏系统综述研究以明确这些差别的原因所在。目的：运用Meta分析的方法汇总不同地区普通人群进食障碍的患病率数据，以确定与患病率相关的因素。方法：系统检索PubMed/Medline、PsycINFO、ISI web of knowledge、Ovid、中国知识资源总库，中国科技期刊数据库，万方数据，中国生物医学文献服务系统的数据库，收集关于进食障碍患病率的文献，按照预先制定的纳入及排除标准筛选相关研究。采用R-2.15.2软件进行统计分析。结果：共检索到9315篇不重复的文献（约四分之一为中文文献），其中仅15项研究符合纳入标准，累计调查72961人。纳入的15项中无国内研究，仅一项来自于亚洲国家（韩国）。估计的进食障碍的终生患病率为1.01%（95%CI，0.54～1.89%），12个月患病率为0.37%（95%CI，0.22～0.63%），4周患病率为0.21%（95%CI，0.15～0.28%）。神经性厌食、神经性贪食、暴食性障碍的终生患病率分别为0.21%（95%CI，0.11～0.38%）、0.81%（95%CI，0.59～1.09%）、2.22%（95%CI，1.78～2.76%）。女性进食障碍终生患病率与男性之比为4.2。欧洲国家进食障碍的终生患病率约为韩国研究报告数据的6.1倍。随着时间推移，总的进食障碍患病率有所升高，但无统计学意义，但神经性厌食症的患病率有统计学意义的升高。结论：普通人群中进食障碍较为常见，女性比男性多，西方国家比亚洲国家多。可能由于进食障碍的诊断标准有了变动，近年来报道的患病率有增高趋势。研究局限性包括可获得的流行病学资料非常有限，不同研究中进食障碍包括的类别有所不同以及缺少中低收入国家（包括中国）中合适的流行病学研究。%Background:The estimated prevalence of eating disorders reported in community surveys from different parts of the world varies widely but there has been no systematic attempt to identify the reasons for these differences. Objective:Use meta-analysis methods to pool data from community surveys about the prevalence of eating disorders in different locations and to identify the factors that are associated with the reported prevalence of eating disorders. Methods:Based on pre-defined inclusion and exclusion criteria, studies were identified from the following databases: PubMed/Medline, PsycINFO, ISI web of knowledge, Ovid, Chinese National Knowledge Infrastructure, Chongqing VIP database for Chinese Technical Periodicals, WANFANG DATA, and Chinese Biological Literature Service System. Statistical analysis was conducted using R software. Results:Among the 9315 unduplicated reports reviewed (one-fourth of which were published in Chinese) only 15-with a pooled sample size of 72,961 individuals-met the inclusion criteria for the analysis. None of the included studies were from China and only one Asian country (South Korea) was included in the analysis. The estimated lifetime prevalence, 12-month prevalence, and 4-week prevalence of any eating disorder was 1.01%(95%confidence interval [CI], 0.54-1.89), 0.37%(CI, 0.22-0.63), and 0.21%(CI, 0.15-0.28), respectively. Estimated lifetime prevalence of anorexia nervosa, bulimia nervosa, and binge eating disorder was 0.21%(CI, 0.11-0.38), 0.81%(CI, 0.59-1.09), and 2.22%(CI, 1.78-2.76), respectively. The estimated female-male ratio for lifetime prevalence of any eating disorder was 4.2. The lifetime prevalence of any eating disorder reported from studies conducted in Western countries was 6.1-fold greater than that reported in a single study from South Korea. Over time there has been a non-significant increase in reported prevalence of any eating disorder and a significant increase in reported prevalence of anorexia nervosa. Conclusions:Eating disorders are common in the general population, more common in women than men, and more common in Western countries than in Asian countries.The reported prevalence is increasing over time, but this may be due to changes in diagnostic criteria. There are serious limitations in the available epidemiological data, primarily differences in the conditions included among eating disorders and the lack of acceptable epidemiological studies from low-and middle-income countries (including China).
  • 摘要：Background:The recent adoption of China’s new national mental health law provides a good opportunity to obtain baseline information about community mental health literacy in the country. Aim:Assess knowledge and attitudes about mental disorders among residents in Shanghai. Methods:A total of 1953 residents aged 15 or above selected from all 19 districts in Shanghai completed two self-report questionnaires-the Mental Health Knowledge Questionnaire (MHKQ) and the Case Assessment Questionnaire (CAQ). MHKQ total scores range from 0 to 20 (higher scores indicate better mental health literacy). The CAQ presents respondents with five case vignettes and possesses nine questions after each vignette measuring respondents’ knowledge and attitudes towards these mental illnesses. Results:Correct response rates for the 20 MHKQ items ranged from 26 to 98%, with a mean rate of 72%. The internal consistency (alpha) of the 20 items on the MHKQ was 0.69, but this decreased to 0.59 after removing four items about mental health promotion. A 5-factor model for the 20 items in the MHKQ was identified using exploratory factor analysis on one-half of the surveys, but the model was only partially validated in the confirmatory factor analysis using the second half of the surveys. On the CAQ, rates of correct recognition of mania, depression, schizophrenia with positive symptoms, schizophrenia with negative symptoms and anxiety were 42%, 35%, 30%, 19%and 21%, respectively. Work stress (37.3%), problems with thinking (30.0%) and negative life events (24.4%) were reported to be the three main causes of mental disorders. Seeing a counselor (34.2%) or a psychiatrist (33.3%) were the two most common suggestions for help-seeking. Higher education and younger age were related with better mental health literacy and higher rates of recognition of common mental disorders. Conclusions:Mental health literacy in Shanghai appears to be increasing, but the reliability and validity of the instruments used to assess mental health literacy (MHKQ and CAQ) have not been adequately assessed so this result must be considered preliminary. Further work, preferably including both qualitative and quantitative components, is needed to revise these instruments before they can be used to assess the effectiveness of mental health promotion campaigns.%背景：近期中华人民共和国精神卫生法的实施是了解中国社区居民精神卫生知识知晓度基线数据的契机。目的：了解上海市居民精神卫生知识和态度。方法：来自上海市所有的19个区县1953名15岁及以上的常住居民完成了《精神卫生与心理保健知识问卷》及《案例》部分的调查。知识问卷满分20分，得分越高，表明对相关知识的了解程度越高。案例部分包括5个案例的描述，在每个案例后提出9个相关问题以评估受访者对这些精神障碍的知识和态度。结果：精神卫生与心理保健知识问卷20个条目的正确回答率为26%～98%，平均72%。该问卷20个条目的内部一致性（α）为0.69，如果不纳入其中关于精神卫生健康促进的4个条目，α值则降至0.59。对一半的调查数据进行探索性因子分析，确定精神卫生与心理保健知识问卷20个条目的五因子模型，但用另一半数据进行验证性因子分析表明上述模型仅部分有效。案例相关知识调查发现，受访者对以下精神障碍的正确识别率分别为：躁狂症42%，抑郁症35%，阳性症状为主的精神分裂症30%，阴性症状为主的精神分裂症18%，焦虑症21%。工作压力太大（37.3%）、思想上的问题（30.0%）和受了打击（24.4%）被视为精神疾病的3个主要原因。找人做心理咨询（34.2%）和看精神科医生（33.3%）是建议求助的方法中2种最主要的方式。受教育程度愈高、愈年轻者对精神卫生知识的知晓率就愈高，对常见精神疾病的识别率也愈高。结论：调查发现上海市居民对精神卫生与心理保健知识的知晓度有所提高。由于尚未充分评估精神卫生与心理保健知识问卷及案例部分问卷的信度和效度，所以本研究结果只能视为预初性的。需要进一步的工作，如首先从质和量两方面着手修订这些工具，才能将其用于评估精神卫生促进运动的有效性。
  • 摘要：背景：盐酸美金刚是目前用于治疗阿尔茨海默病（Alzheimer's disease, AD）唯一的N-甲基-D-天门冬氨酸（N-methyl-D-aspartic acid receptor，NMDA）受体拮抗剂。目的：以进口盐酸美金刚（Ebixa）为对照，评价国产美金刚片治疗中度至重度AD的有效性及安全性。方法：采用随机、双盲双模拟、平行对照、多中心研究方法，将229例中、重度AD患者分为研究组（国产美金刚片）和对照组（进口美金刚片），治疗16周。所有的患者在基线时以及入组后第4、8、12、16周接受评估。主要疗效指标为阿尔茨海默病评定量表认知分量表（Alzheimer's Disease Assessment Scale-Cognition, ADAS-Cog）评分，次要疗效指标为简易智能状态检查量表（Mini-Mental Statue Examination, MMSE）、日常生活能力量表（Activities of Daily Living, ADL）和临床疗效总评量表（Clinical Global Impression, CGI）的评分。结果：研究组纳入安全性数据集（Safety Set，SS）、全分析数据集（Full Analysis Set，FAS）和完成方案数据集（Per Protocol Set, PPS）分析的病例数分别为112、109和103例，对照组分别为111、107和101例。两组ADAS-Cog总分和ADL总分在治疗4周、8周、12周、16周末与基线相比均有所下降（p＜0.001），两组MMSE总分在治疗4周、8周、12周、16周末与基线相比均有所增加（p＜0.001）。各观察时点的ADAS-Cog评分、ADL评分和病情改善程度（CGI评分）两组之间的比较无统计学差异。研究组和对照组不良事件发生率分别为20.5%和27.0%，差异无统计学意义（χ2=1.30，p=0.255）。结论：在治疗中、重度AD患者的前16周中，国产美金刚片的疗效和安全性与进口美金刚片相当。%Background:Memantine hydrochloride is a N-methyl-D-aspartate (NMDA) antagonist that may be useful in the treatment of Alzheimer’s disease. Aim:Compare the efficacy and safety of generic memantine hydrochloride produced in China to that of the imported proprietary version of the medication (Ebixa) in the treatment of moderate to severe Alzheimer’s disease (AD). Methods:In this multicenter, double-blind randomized controlled trial 229 patients with moderate to severe AD were randomly assigned to a 16-week trial of either the generic preparation or the proprietary preparation of memantine hydrochloride. All participants were assessed at baseline and at 4, 8, 12 and 16 weeks after enrolment. The primary outcome variable was the Alzheimer Disease Assessment Scale-cognition (ADAS-Cog) score. Secondary outcomes were scores in the Mini-Mental State Examination (MMSE), the Activities of Daily Living (ADL) scale and the Clinical Global Impression (CGI) scale. Results:Sample sizes for the safety set (SS) analysis, full analysis set (FAS) and per protocol set (PPS) analysis were 112, 109 and 103 in the generic medication group, and 111, 107 and 101 in the proprietary medication group, respectively. The ADAS-Cog and ADL total scores at the end of weeks 4, 8, 12, and 16 decreased significantly compared with baseline for both groups (p<0.001) and the MMSE total scores at the end of weeks 4, 8, 12, and 16 increased significantly compared with baseline for both groups (p<0.001). There were no significant differences in ADAS-Cog total scores, ADL total scores and level of improvement based on the CGI scores between the two groups at any of the follow-up assessments. The occurrence of adverse events was 20.5%in the generic medication group and 27.0%in the proprietary medication group;this difference was not statistically significant (χ2=1.30, p=0.255). Conclusion:There are no significant differences in the effectiveness or safety between memantine that is generically produced in China and imported proprietary memantine in the treatment of individuals with moderate and severe AD during the first 16 weeks of treatment.
  • 摘要：Cognitive impairment-one of the core symptoms of schizophrenia-has become a focus of research about schizophrenia in China and elsewhere. The main reason for the interest in cognitive functioning is that the degree of cognitive impairment is associated both with the current severity of the illness and with the prognosis of the illness;cognitive functioning directly affects individuals’ ability to live independently and their occupational and social functioning. The first study on cognitive function in schizophrenia in China was conducted in the late 1970s;more recently there has been a resurgence of interest in the area because of new information that has emerged as neuroimaging technologies have improved. The current review summarizes studies on cognitive impairment in schizophrenia conducted in China and proposes directions for future research in this area.%认知功能障碍-精神分裂症的核心症状之一-已经成为国内外研究精神分裂症的热点。它不仅反映了疾病的严重程度，而且是精神分裂症功能预后的重要影响因素，因为认知功能损害的程度对患者的独立生活能力以及他们的就业和社会功能都会有影响。国内最早的精神分裂症认知功能研究可以追溯到上个世纪七十年代晚期。近年来，由于新的信息的出现，例如神经影像技术的进步，国内涌现了大量研究。本文在对国内既往研究进行综述的基础上提出了精神分裂症认知功能的未来研究方向。
  • 摘要：Background:Mental disorders account for a substantial proportion of the total disease burden in China but the number, distribution and characteristics of the mental health professionals available to provide services for mentally ill individuals is unknown. n Aim:Describe the distribution and characteristics of medical professionals working in mental health facilities around China. n Methods:Information on the numbers and characteristics of health professionals working in mental health facilities in China in 2010 was obtained from the Statistical Information Center of the Ministry of Health and the population-adjusted ratios and characteristics of these mental health professionals were compared across the seven geographic regions of the country. n Results:Among the 757 specialized mental health facilities identified, 649 (86%) were psychiatric hospitals. A total of 68,796 medical professionals (5.16/100,000 population) were working in these facilities, including 20,480 psychiatrists (1.54/100,000) and 35,337 registered nurses (2.65/100,000). Over 98%of these medical professionals worked in psychiatric hospitals. Among the psychiatrists, 29%only had a technical school degree and 14%had no academic degree at all;among the nurses, 46%had no academic qualifications. The duration of employment as a psychiatrist or as a psychiatric nurse was longer among medical professionals working in the economically less dynamic northern parts of the country. The population ratios of licensed physicians and registered nurses working in mental health facilities were significantly higher than average in the relatively wealthy eastern and northeastern parts of the country. n Conclusions:Almost all mental health professionals in China work in specialty psychiatric hospitals. The numbers and geographic distribution of trained mental health professionals in China are grossly inadequate to meet the mental health needs of the population. China has a much smaller mental health workforce per 100,000 residents than other upper-middle-income countries, and the range of professionals who provide mental health services is much narrower.%背景：精神障碍在我国疾病总负担中占有相当大的比例，但可提供于精神障碍患者心理卫生服务的专业人员数量，分布和特点还是未知数。n　　目的：全面了解我国精神卫生机构人力资源分布现状和特点。n　　方法：从卫生部统计信息中心获得2010年在中国精神卫生机构中工作的卫生技术人员的数量和特征，比较七个地理区域精神卫生专业人员的人口比例和特征。n　　结果：在757家精神卫生机构内，649家(86%)是精神病院。在这些机构内卫生技术人员共计68,796人(5.16人/10万人口)，包括精神科医师20,480人(1.54人/10万人口)和注册护士35,337人(2.65人/10万人口)。超过80%的卫生技术人员都工作在精神病院。29%的精神科医生人仅具有技校学历，而14%的精神科医生没有学位。在护士中有46%的护士没有学历。我国经济比较落后的北部地区精神科医生或护士的工龄较其长。在我国相对较富裕的东部和东北部地区，精神卫生机构中执业医师和注册护士的人口比例要高于平均水平。n　　结论：我国几乎所有的精神卫生技术人员都工作在精神科专科医院。训练有素的卫生技术人员在数量和地区的分布上远远无法满足人们对卫生健康的需求。与其他中上等收入国家相比，我国每10万人口拥有的精神卫生资源较少，所能提供精神卫生服务的专业人员范围也较窄。

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