CSP1

Chairs: Wenyuan Wu, Chinese Mainland
Shenxun Shi, Chinese Mainland

CSP1-1

银杏叶提取物对迟发性运动障碍的疗效及可能机制 - The Effect of Extract of Ginkgo Biloba on Tardive Dyskinesia and Possible Mechanisms

Wufang Zhang 1 , Yunlong Tan 2 , Haora Wu 3 , Lianyuan Cao 2 , Fude Yang 2 , Yizhuang Zou 2 , Weihui Huang 2 , Xiangyang Zhang 2 , Dongfeng Zhou 1
1 Institute of Mental Health, Peking University, Beijing, Chinese Mainland, 2 Beijing Huilongguan Hospital, Beijing, Chinese Mainland, 3 Rongjun Hospital, Hebei Province, Shandong, Chinese Mainland

背景 ： 迟发性运动障碍 (TD ） 是抗精神病 药物所诱发的运动系统副作用 ， 发生率约 20-30% ， 并随年 龄增长而升高。 TD 具有明 显的致残性，目前病因不明，尚无有效的干预措施，严重影响治疗的依从性和康复。既往研究提示： TD 可能与 长期服用抗精神病药导致的黑质 - 纹状体部位神经元变性、凋亡有关。临床研究发现抗氧化剂（如维生素 E ）能有效 缓解 TD 症状，但 长期大剂量服用 VitE 副作用明 显。银杏叶提取物（ EGb-761 ）具有清除自由基和神 经保护两方面的作用，与 TD 发病机制更为吻合。

目的： （ 1 ） 观察 EGb-761 对 TD 的 疗 效；（ 2 ）通 过测定治疗前后血清 MDA 、 BDNF 浓度探索氧化损伤、神经保护因素在 TD 发病机制中的作用及 EGb761 治 疗 TD 的作用机制；

方法： 共入 组 TD 患者 157 例，随机分成治 疗组（ n=78 ）和 对照组（ n=79 ），分 别予 EGb-761 （ 240mg/ 天）和安慰 剂治疗 12 周（治 疗期间维持原有抗精神病药不变），其中 5 例脱落，最 终分析治疗组 77 例， 对照组 75 例。治 疗组与对照组在年龄、发病年龄、总病程、首次住院年龄、住院次数、本次病程、目前使用的抗精神病药折合氯丙嗪剂量等状态指标上无显著差异。治疗前后分别评定 PANSS 、 SANS 、 AIMS 及 RBANS ，并 测定血清 MDA 、 BDNF 浓度。

结果 : （ 1 ）治 疗前，治疗组与对照组 PANSS 总分、阳性分量表总分、阴性分量表总分、 SANS 总分、 AIMS 总分、 AIMS 7 项分之和均无显著差异（ P>0.05 ）。（ 2 ）治 疗前后，对照组 AIMS 总分减分率 ≥30% 有 3 例，占 4.0% ， AIMS 7 项分之和减分率 ≥30% 有 4 例，占 5.3% ；治 疗组 AIMS 总分减分率 ≥30% 有 49 例，占 63.6% ， AIMS 7 项分之和减分率 ≥30% 有 40 例，占 51.9% 。（ 3 ）治 疗组 AIMS 总分和 AIMS 7 项分之 和在治 疗前后均有显著性差异（ p<0.01 ）， 对照组在治疗前后无显著性差异（ p>0.05 ）；采用 单个重复测量因素的方差分析， EGb-761 和安慰 剂对 AIMS 总分和 AIMS7 项分之和的影响均有显著性差异（ p<0.01 ）。（ 4 ） EGb-761 和安慰 剂对 PANSS 总分、阳性分量表总分、阴性分量表总分、 SANS 总分的影响均无显著性差异（ p>0.05 ）。（ 5 ）两 组治疗前后 RBANS 各量表分无 显著性差异（ p>0.05 ）， TD 患者 RBANS 即刻 记忆量表分（ 52.80±10.92 ） 显著低于非 TD 患者（ 55.99±13.66 ）（ p=0.049 ）。（ 6 ）治 疗前两组血清 MDA 、 BDNF 水平均无差异（ p>0.05 ）。（ 7 ）治 疗前血清 MDA 水平与 AIMS 7 项分之和显著正相关（ r=0.278 ， p=0.001 ）；治 疗组血清 MDA 水平治 疗后（ 3.44±0.63 ） 显著低于治疗前（ 3.76±0.64 ）（ p=0.003 ）， 对照组血清 MDA 水平治 疗前（ 3.85±0.83 ）与治 疗后（ 3.87±0.65 ）无 显著性差异（ p>0.05 ）；治 疗组 MDA 水平降低程度与 AIMS 7 项分之和减分程度有正相关趋势（ r=0.198,p=0.097 ）， 对照组二者之间无相关性（ p=0.48 ）。（ 8 ）治 疗组血清 BDNF 水平治 疗后（ 6.32±3.47 ） 显著高于治疗前（ 4.86±3.49 ）（ p=0.039 ）； 对照组血清 BDNF 水平治 疗前（ 4.98±3.39 ）与治 疗后（ 4.16±2.84 ）无 显著性差异（ p>0.05 ）。

结论： （ 1 ） EGb-761 能有效 缓解 TD 症状；（ 2 ） EGb-761 能升高 TD 患者血清 BDNF 浓度，具有降低氧化应激和神经保护双重作用；（ 3 ） EGb-761 对慢性精神分裂症患者阴性症状、认知功能无明显改善作用。

关键词 : 迟发性运动障碍 银杏叶提取物 氧化 应激 脑源性 神 经营养因子

Introduction: TD is a syndrome of late-onset, abnormal and choreoathetoid involuntary movement that develops in some patients who receive chronic neuroleptic medications. The average prevalence of TD is estimated to be about 20%-40% or more of patients treated chronically with neuroleptic drugs.

Objectives:

1) To investigate the effect of Extract of Ginkgo Biloba on Tardive Dyskinesia;

2) To investigate the correlation between the TD severity and the changes of plasma maleic dialdehyde （ MDA ） level; To compare the changes of the MDA and BDNF level before and after the treatment. To investigagte possible therapy mechanism and to verify the advanced relationship between TD and abnormal free radicals metabolism.

Methods: 152 Eligible patients are randomly assigned to receive either EGb-761 (240mg/day) (n=77) or placebo (n=75). Patients are maintained on a constant, fixed oral dose of antipsychotic medication during the study. The study consists of a 12 weeks of double-blind treatment. Efficacy and cognitive assessments are performed at the start and at the end of treatment. Serum MDA and BDNF levels were measured before and after treatment.

Results:

1) No significant differences in demographic data were observed between EGb-761 and placebo groups (p>0.05). There was no a significant difference in any of the AIMS total scores, PANSS total scores or SANS total scores before treatment between the two groups.

2) The results showed that the reduction in AIMS total score from baseline was significantly higher with EGb-761 treatment compared with placebo (51.9% vs. 5.3%). Repeated-measures one-way analyses of variance on the AIMS total score showed a significant drug effect (p<0.01).

3) At baseline, there was no significant difference in serum MDA or BDNF level between EGb-761 and placebo groups (p>0.05).

4) There was a significant and positive correlation between MDA level and AIMS score (r=0.278, p=0.001). Serum MDA levels were significantly decreased after treatment with EGb-761 (p=0.003), but no change with placebo treatment (p>0.05). Pearson correlation analysis showed that there was a significant trend relationship between an decrease in MDA at pretreatment and posttreatment and the reduction in AIMS total scores (r=0.198,p=0.09).

5) Serum BDNF levels were significantly increased after treatment with EGb-761 (p=0.039), but no change with placebo treatment (p>0.05).

Conclusions: Free radial damage and oxidative stress play an important role in the etiopathology and development of TD EGb-761 is markedly effective in reducing the severity of dyskinesia in TD. Neuronal apoptosis and degeneration in the basal ganglia, by some mechanism, such as free radical damage, is a underlying pathological mechanism in the development of TD ．

Keywords: Tardive Dyskinesia, Extract of Ginkgo Biloba, Oxidative stress, Brain-derived neurotrophic

CSP1-2

综合认知训练对社区老人认知功能的影响 - Efficacy of Compositive Cognitive Training for Community Elderly

Wei Feng 1 , Chunbo Li 1 , Wenyuan Wu 1 , You Chen 1
1 Department of Psychiatry, Tongji Hospital of Tongji University , Shanghai , Chinese Mainland

目的 ： 探索 综合认知训练对社区老人认知功能的影响效果。

方法 ： 对上海市甘泉街道的社区老人 （ 年龄 ≥70 岁 ） 按居民里委进行随机整群抽样筛查 ， 将 151 例符合入 组标准的老人随机分为认知干预组 ( 以下 简称干预组 ， 90 例 ) 和 对照组 （ 61 例 ） 。 对干预组进行 12 周（共 24 次）的 认知训练。干预前后采用中国老年成套神经心理测验（ NTBE ）、中文版 Stroop 字色干 扰测验及自制健康问卷对两组进行测评。

结果： 1. 基 线两组年龄、教育程度和性别差异无统计学意义。除 NTBE 中 3 项干预组高于对照组，差异有显著性外，其他测验两组差异均无显著性。 2. 干 预后随访，干预组在 NTBE 和 Stroop 字色干 扰测验的多个项目有提高（延迟回忆保持率等）或优于对照组（推理测验等），差异有显著性（ P<0.05 ）。 对照组提高项目较少（即刻记忆）并有个别项目有所下降（前摄抑制等）（ P<0.05 ）。

结论： 综合认知训练对社区老人执行功能、加工速度、推理能力等多项认知功能有提高作用，为今 后大 规模开展社区老人认知干预提供了客观依据。

关键词： 社区老人， 认知训练，认知功能，神经心理测验

资金来源：上海市自然科学基金项目（编号： 06ZR14086 ）；上海市 预防精神医学学科建设子项目（编号： 05 Ⅲ 028-09 ）

Objective: To evaluate the efficacy of compositive cognitive training for community elderly.

Method: All subjects were selected from in Ganquan subdistrict of Putuo District, Shanghai . 151 community elderly were collected. The age ranged from 70~89 years old. It was random divided into two groups, cognitive intervention group (90 samples) and control group (61 samples). The interventions were conducted in small group settings in 24 sessions over 12 weeks. All individuals were assessed by Neuropsychological Test Battery for Elderly (NTBE) and a questionnaire “Shanghai Health Survey for the Elderly (VER2006)”in baseline and follow-up phase.

Results: 1. Except 3 items of NTBE, there were no significant differences between intervention group and control group in gender, age, education level and scores of neuropsychological test at baseline. 2. Some subscales of NTBE and Stroop color-word tests were significantly improved(delayed recall probability, et al) or higher than control group(reasoning test, et al) after cognitive training in intervention group （ P<0.05 ） . Only a few subscales improved significantly in control group （ P<0.05 ） .

Conclusion: The compositive cognitive training could improve the cognitive function of community elderly. It also provides some methods for the future community elderly health promotion.

Key words: Community elderly, Cognitive training, Cognition, Neuropsychological tests

The study was granted by: Shanghai Natural Science Foundation(No: 06ZR14086); Mental Health Branch of Shanghai CDC Foundation(05 Ⅲ 028-09)

CSP1-3

精神分裂症 认知功能评定的新标准 - The New Criteria for the Cognitive Function Assesment of the Patients with Schizophrenia

Yizhuang Zou 1 , Jiefeng Cui 1 , Nan Chen 1 , Jian Wang 1 , Dong Zhang 1 , Ze Xu 1 , Shaogang Song 1 , Yunhui Wang 1 , Shuping Tan 1 , Biao Han 1 , Chongsheng Song 1 , Lixia Zhang 1 , Xiaoling Li 1 , Yongchang Liu 1 , Yue Li 1
1 Beijing Huilongguan Hospital , Beijing , Chinese Mainland

目的 ： 随着抗精神病 药物临床疗效研究的进展 ， 对精神分裂症患者认知功能标准化的疗效评定变得越来越重要。 NIMH2003 年 开始 “ 改善精神分裂症 认知功能的测量与治疗研究 （ Measurement and Treatment Research to Improve Cognition in Schizophrenia ， MATRICS ） ” 。 该项目集中了美国各方面的人才，通过数百专家的投票和大量的临床测试，确定了 “ 精神分裂症 认知功能成套测验－共识版（ MATRICS Consensus Cognitive Battery, MCCB ） ” ，正在成 为精神分裂症神经认知疗效评定的新标准。本研究使用中国样本对 MCCB 中文修 订版的主要信、效度指标进行系统的评测，并对应用的范围、存在的问题和未来的研究需要进行探讨。

方法： 122 名符合 DSM-IV 诊断标准的住院精神分裂症患者（男性 84 例，女性 38 例），接受精神分裂症 认知功能成套测验－共识版（ MCCB ）， 简明精神分裂症认知测验（ BACS ）、色 词测验（ STROOP ）、威斯康星卡片分 类测验（ WCST ）、瑞文推理 测验（ RAVEN ）， 4 周后重 测。同时，使用词汇记忆测验（ WMT ）作 为控制测验过程被试精 神努力度（ mental effort ）的指 标。实验采用了 7 级评分量表来对被试耐受性和主试可操作性进行评定，并对 MCCB 中除 计算机记分之外的主观评分分测验视觉记忆，进行评定者间一致性的测定。整个测验过程记录各分测验实际施测所需时间。

结果： （ 1 ）在 MCCB 测验的 10 个分量表中， 连线、符号编码、语言记忆、空间广度、数字序列、迷宫、视觉记忆、语义流畅性、情绪管理和持续操作测验的重测信度显示， Pearson 相 关分别为 0.633 、 0.852 、 0.647 、 0.761 、 0.696 、 0.629 、 0.778 、 0.745 、 0.678 、 0.724 ，均呈 显著相关。 MCCB 总分的重测信度为 0.9 ，内部一致性 α 系数 为 0.78 。（ 2 ） MCCB4 周前后 测验零分 / 满分的人次分别为 0/0 、 0/0 、 0/0 、 3/0 、 0/2 、 4/0 、 0/0 、 0/0 、 0/0 、 0/0 ， “ 地板效 应 ” 为 2.9 ％， “ 天花板效 应 ” 为 0.8 ％。 虽然某些分测验具有一定的学习效应，但可通过 A/B 题套来克服，适合重复测定。（ 3 ） MCCB 总分与 BACS 总分的 Pearson 相 关为 0.897 （ p<0.01 ），与 RAVEN 总分的 Pearson 相 关为 0.64 （ p<0.01 ）；与 WCST 中的完成分 类数、正确应答数、错误应答数、完成第一分类所需应答数、持续性错误各指标的 Pearson 相 关分别为 0.56 ， 0.48 ， -0.56 ， -0.45 ， -0.23 （ p<0.01 ）；与 Stroop 的 Pearson 相 关为 0.51 （ p<0.01 ）， 证明具有较好的关联效度；（ 4 ） MCCB 与 WMT 的即 时回忆、延迟回忆、一致性、不寻常答案的相关分别为 0.26 ， 0.34 ， 0.35 ， -0.24 （ p<0.01 ）；按照 WMT 的 标准，对分为两组的被试 MCCB 总分进行 t 检验，组间均有显著差异（ p<0.001 ），提示患者的精神努力度与 认知测验的 成 绩呈显著相关。（ 5 ） MCCB 被 试的耐受性（ n=26 ， 5.54±1.44 ）及主 试可操作性（ n=8 ， 5.38±1.23 ） 7 级评分结果好。（ 6 ）主 观评分测验的 8 名 评定者间信度（ n=10 ）的 ICC 值为 0.966 。

结论： MCCB 测验大约需要 1 小 时，被试耐受性较好，计算机测验便于施测和评分。很少有一般神经认知测验所具有的 “ 地板效 应 ” 和 “ 天花板效 应 ” ， 对神经认知改变的敏感性高，适合动态测定精神分裂症患者认知水平的变化。 MCCB 的重 测信度、内部一致性信度、评定者间信度和效标关联效度等指标满足心理测量学要求，适合国内环境 ，可以作 为精神分裂症神经认知疗效变化的标准化临床测量工具，值得在今后的使用中进一步修订和完善。

关键词 : MCCB 神 经认知 心理 测验 精神分裂症 信度 效度

注：本 项目为北京市科委重大项目资助专项，编号为 D0906001000091

CSP1-4

母 亲孕期集体心理干预对婴儿气质的影响 - The Effect of Group Intervention to Women with Pregnancy on Infant Temperament

Shenxun Shi 1 , Jie Yang 1 , Wen Yu 2 , Yuefeng Tang 1 , Yongyong Zhu 1 , Yan Chen 2 , Qingqing Wang 2 , Liwei Wang 1 , Jianfeng Luo 3
1 Shanghai Huashan Hospital, Psychiatry Department, Shanghai, Chinese Mainland, 2 International Peace Maternity & Child Health Hospital of Shanghai, Shanghai, Chinese Mainland, 3 Statistic Department of Medical College of Fudan University, Shanghai, Chinese Mainland

目的 ： 本研究探索母 亲在孕期接受集体心理干预是否对婴儿气质的影响。

方法 ： 本研究于 2005 年 3 月 -2006 年 2 月在上海中国福利会国 际妇幼保健院对 2544 名 怀孕 16-24 周孕 妇通过入组和排除标准入组 800 例。使用艾森克人格 问卷 , 综合性医院焦虑抑郁量表（ Hospital Used Anxiety and Depression Scale HAD ） , 生活事件量表和自 编的相关危险因素问卷在入组时、孕 24 、 28 、 32 、 36 和 40 周 进行上述问卷和量表评估，共六次。焦虑抑郁症状的划分以 HAD 量表 A 或 D 单项分 9 分 为界。产后第 3 、 42 天和 3 个月 时用爱丁堡产后抑郁量表（ the Edinburgh Postpartum Depression Scale EPDS ）和 HAD 随 访产妇。对有焦虑抑郁症状的产妇由专科医生用 SCID-I(Structured Clinical Interview For DSM-IV-TR Axis I Disorders, Research Version) 进行评估。产后 3 个月 时由母亲填写婴儿气质量表 EIPQ （ the Early Infant Temperament Questionnaire ），以确定其 婴儿气质。

所有入 组孕妇按随机方法进入心理干预组和常规随访组。心理干预包括六节课，孕妇参加 5 节，丈夫参加 1 节。每节课 10-15 人， 90 分 钟，一半时间孕妇与授课医生互动讨论提问，一半时间医生授课，每次课后孕妇 和丈夫填写反 馈表。集体心理治疗课程六节，内容包括：产后抑郁相关危险因素、焦虑抑郁识别、如何应对相关危险因素、心理防卫机制、放松训练与分娩、丈夫课程。

结果： 758 例孕 妇完成产前评估， 42 例因流 产、转院、拒绝参加研究脱落。产后 8 例 产妇回家乡修养， 4 例拒 绝参加继续研究随访，最后得到 746 例母 亲的资料。其中有两队双胞胎，最终得到 750 例新生儿 资料。 148 例新生儿在 产后 3 月随 访没有回访， 4 位母 亲拒绝填写 EIPQ 量表，本文 报告 598 婴儿气质结果。

根据 婴儿气质量表 EIPQ 结果我们发现 598 例新生儿中易 养型比例为 45.0% （ 269 例），中 间易养型为 39.8% （ 238 例），中 间难养型为 4.0% （ 24 例）， 难养型为 8.9% （ 53 例）， 迟缓型为 2.3% （ 14 例）。集体心理干 预组和常规随访组中新生儿易养型比例为 50.3% （ 150/298 例）比 39.7% （ 119/300 ），中 间易养型为 37.6% （ 112/298 ）比 42.0% （ 126/300 ），中 间难养型为 2.7% （ 8/298 ）比 5.3% （ 16/300 ）， 难养型为 7.4% （ 22/298 ）比 10.3% （ 31/300 ）， 迟缓型为 2.0% （ 6/298 ）比 2.7% （ 8/300 ），两 组比 例差异没有 统计意义（ P=0.064 ）。将上述 类型合并为易养型和难养型两类，干预组的易养型和难养型比例分别为 87.9% 和 12.1% ，而常 规随访组为 81.70% 和 18.3% ，两 组差异比较有统计意义， P=0.033 。我 们发现孕期集体心理干预与婴儿气质中趋避性和反应阈两个维毒密切相关， P=0.040 和 P=0.049 。

结论 : 本研究 显示孕妇孕期心理干预有助于新生儿易养型比例升高，对婴儿气质的某些维度有影响作用。为了母亲和孩子的健康，建议在孕妇中常规开展集体心理治疗干预。

致 谢 : 该课题获得北京回龙观医院临床流行病 学研究室 费立鹏教授和中国协和医科大学张学教授负责的中华医学基金会（ CMB ） 资助的 “ 提高中国精神 卫生研究质量并赞助开展多个高质量小型研究项目 ” 的技 术支持和资助。 CMB 项目编号为 “Small Grants Program #02-777” 。

本研究 课题获上海市卫生局课题基金支持，编号 044108 。中国福利会上海国 际妇幼保健院提供了研究场地。

Objective: The aim of this study was to test whether it would be work that group psychological intervention to women with pregnancy had effect on infant temperament.

Method: 800 woman with pregnancy on 16th -20th weeks were recruited randomly from 3544 ones in the Shanghai International Peace Maternity & Child Health Hospital . The Hospital Anxiety and Depression Scale (HAD) was used to evaluate each women before childbirth and the Edinburgh Postpartum Depression Scale (EPDS) was used on Day 3, Dan 42 and three month after delivery. The cut-off scores of anxiety and depressive mood were 9 score of A or D in HAD and 13 score in EPDS. Then all subjects who were suspicious anxiety and depressive mood were assessed by same psychiatrist according to SCID-I(Structured Clinical Interview For DSM-IV-TR Axis I Disorders, Research Version). The early infant temperaments were evaluated by the maternal reports with the Early Infant Temperament Questionnaire (EIPQ) on the 3rd month after delivery.

We also used Eysenck Personality Questionnaire (EPQ) at baseline, and Life Events Scale (LES) and Questionnaire of Risk-Related Factors (QRF) to each woman on the baseline, 24, 28, 32 36 and 40 weeks during pregnancy. ALL subjects were randomly assigned into regular follow-up group and group-psychological intervention group. There were six sections in the group intervention, five classes for women and one for husband. There were three parts discussing, education and giving response in each class with 90 minute and 10-15 persons. The contents of the group-psychological intervention included six sections, including the risk factors of postpartum depression, the cognition of anxiety and depression, how to copy with these risk factors, common used defense mechanisms of psychological protection, training of relaxation, and husband class.

Results: 758 subjects finished all evaluation of anxiety and depressive mood before labor, and 42 persons dropt out due to different causes ( 35 women moving to other hospital for delivery and 5 persons with abortion 2 with stopping to participate the study continuously ). There were 8 women missed due to moving house and going to the mother's family out of Shanghai after delivery, so we got 746 mothers and infants data. There were 2 pairs of twins in this sample, so we had totally 750 infants at first week after childbirth. 148 ones did not come back to our study hospital for three month examination, they went to the special hospital near by their living places, and four mothers did not finished the EIPQ scale, so we finally got 598 infants data.

According to the EIPQ scale we found that the total percentage of easy –care type was 45.0%(269 infants), middle easy-care type 39.8% (238 ones), middle difficult-care type 4.0% (24 ones), difficult-care type 8.9% (53 infants), and start-retarded type 2.3% (14 ones) respectively within 598 babies in this study. There were no significant differences between psychological intervention group and regular follow-up group ( P=0.064) comparing with early infant temperament types, but the percentage of easy –care type was 50.3%(150/298 infants), middle easy-care type 37.6% (112/298 ), middle difficult-care type 2.7% (8/298 ), difficult-care type 7.4% (22/298 ), and start-retarded type 2.0% (6/298 ) respectively in the group psychological intervention group, and 39.7%(119/300 infants), 42.0% (126/300 ), 5.3% (16/300 ), 10.3% (31/300 ), and 2.7% (8/300 ) individually in the regular group. But we found that there was significant difference between two groups with easy-care or difficult –care type of the infant temperament (87.9% and 12.1% vs 81.70% and 18.3%, P=0.033). We found that psychological intervention in women during pregnant period was significantly related with approach-withdrawal (P=0.040) and response threshold (P=0.049) two dimensions of early infant temperament.

Conclusion: This study showed that group psychological intervention could increase the ratio of easy infant temperament, and had effects on some dimensions of early infant temperament. We recommend that group psychological intervention should be supplied for women during pregnancy for mother and baby health.

Appreciation: Professor Michael Phillips of the clinical epidemiological department of Beijng Huilongguan Hospital and Professor Zhang xue of Chinese Xiehe Medical University gave their support for this study form CMB “ increasing researching quality of mental disorder in China with Small Grants Program #02-777. We also got Shanghai Health Bureau funding, 044108. And the Shanghai International Peace Maternity & Child Health Hospital supplied a place for this study.

CSP1-5

家庭 动力学特征与 大学新生适 应的关系研究 - A Quantitative Study on the Relationship between Family Dynamics and Students' Adaptation to College

旭 东 赵 1 , 惠 李 2 , 春波 李 3
1 同 济大学 , 医学院 , 上海 , Chinese Mainland, 2 同 济大学 , 上海 , Chinese Mainland, 3 同 济大学附属同济医院 , 上海 , Chinese Mainland

Objective: To explore the effects of family dynamic factors on students' adaptation at a Chinese university.

Methods: (1) Baseline survey: Psychological well-being and adaptation of the students were evaluated twice when they began their university life and then when they entered into the second semester. 5208 students at a renowned university in Shanghai , who were enrolled as freshmen for Autumn Semester in 2005, were examined with PHI (Psychological Health Inventory) , Sixteen Personality Factor Questionnaire （ 16-PF ） . 456 students were screened as having adaptation problems accoding to the cut-off threshold value of PHI. (2) Follow-up controlled survey in Spring Semester of 2006: 113 from PHI-abnormal group and 250 normal students were examined with CSAS (College Student Adjustment Scale), Self-rating Scale of Systemic Family Dynamics (SSFD).

Results: (1) There were gender differences, Urban-rural difference, and parents' education in Disease Conception dimensions of family dynamics. The students whose parents were living on countryside, poorly-educated and in poverty had higher scores. There were no gender difference, urban-rural difference, and education of parents in Family Atmosphere and System Logic dimensions of family dynamics; also, occupations of parents, family type as one-child family made no differences for these two dimensions. (2) Adaptation to college was assessed with CSAS. Adaptation difficulty was operationally defined according to the cut-off scores of various sub-scales derived from the Chinese norm for undergraduates. 32 students from PHI-abnormal group (n ＝ 113) were identified as the ones who had adaptation difficulties, and the percentage of adaptation difficulty in this group was 28.31%; 19 were checked among PHI-normal group (n=250), and the percentage of adaptation difficulty in this group was 7.60%. (3) Variables of Family dynamics, as measured by the Self-rating Scale of Systemic Family Dynamics, were found be correlated with adaptation to college. (4) During the half-year interval between baseline survey and follow-up controlled survey, the negative and positive directions of changes in adaptation, measured according to differences of results between 2 evaluations, were found to be related to the scores of 3 dimensions of family dynamics except Disease Conception. In other words, the students who continued to be and had become good in adaptation had significantly lower scores of these 3 dimensions in comparison to the students who continued to be problematic and even had worsened in adaptation.

Conclusion: (1) Adaptation of the first-year students in this study had complicated correlations with the systemic dynamic features of their families. While some demographic factors such as gender and regional location of the families seemed to influence adaptation, some characteristics of the interactional patterns in families were found to be relating factors. (2) Parents' education effects global adaptation to college, which shows dipolar direction. If parents' education was high, their children had better adaptation at university, but if parents' education level was on the middle level, their children's adaptation was the best. (3) Financial condition and parents' education level might have influenced the development of the conception of diseases. It was found that the students whose parents have lower education and lower income and live in rural areas tended to attribute their difficulties and diseases to outside uncontrollable reasons. The students whose parents lived in urban areas and had better financial condition and middle education level were the ones who perceived their difficulties or diseases as conditions which they should change though own efforts. (4) The characters of family dynamics affected adaptation process and outcome. It is especially important to point out that these positive features of family dynamics might have played favorable roles for the on-going adaptational process, which enlightens clinicians that family therapy is useful also for the maladapted students who have left families.

Key Words: college students, adaptation, adjustment, family dynamics, quantitative approach

CSP1-6

湖南省在校中小学 对立违抗性障碍的流行病学调查 - The Epidemiological Investigation of Oppositional Defiant Disorder in Primary and Middle School in Hunan

臻 韦 1 , 学 荣 罗 2 , 冰清 管 3 , 海森 叶 2 , 秀洪 袁 3 , 志 军 宁 4 , 伟 杨 5
1 深圳市 妇幼保健院 , 深圳 , Chinese Mainland, 2 中南大学湘雅二医院精神 卫生研究所 , 长沙 , Chinese Mainland, 3 中南大学湘雅三医院 , 长沙 , Chinese Mainland, 4 永州精神病医院 , 永州 , Chinese Mainland, 5 娄底市康 复医院 , 娄底 , Chinese Mainland

目的 ： DSM- Ⅳ 为诊断标准 ， 应用二阶段流行病学方法 ， 调查湖南省对立违抗性障碍 （ 简称 ODD ） 的分布特征、患病情况并分析以了解我国中小学生 ODD 的 现状。

方法 ： 一、 对象 ： 本研究样本来自美国中华医学会课题 ， 即《湖南省在校中小学生心理健康状况的流行病学调查》。据湖南省经济文化水平、地域分布及不同地理位置，分层、随机抽湖南省六个地区（郴州、娄底、永州、娄底、长沙、怀化）作为框架地区，每个地区采用 “ 市区 / 农村－学校－班级 ” 抽 样，分级随机抽样。共调查 9495 人，其中男性 5148 人，女性 4347 人，年 龄范围 5-17 岁，平均年龄 10.67+2.93 岁，其中城市 3513 人， 农村 5982 人，城 乡比例为 1 ： 1.70 。

二、 调查方法及工具 : 用儿童精神障碍症状 筛查表筛查，半定式诊断检查表（ K-SADS-PL ） 访谈工具， DSM-IV 为诊断标准对湖南省 9495 名 5-17 岁中小学生调查。调查前对所有调查员进行培训，参加长沙市城区的调查，并对长沙市 418 调查对象分别由两名调查者独立诊断，评估诊断的一致性。对筛查阳性的儿童及随机抽取的对照组，用 K-SADS-PL 访谈，采用 DSM- IV 诊断标准。对疑似智力障碍和学习障碍的儿童进行瑞文智力测试和学习 能力 评定，填写诊断表。质量控制：每个地区抽 10% 的 调查对象进行质控，其中诊断阳性和阴性案例各占质控调查对象的 50% 。共抽 质控人数 917 人。 调查时间为 2005 年 9 月至 2005 年 12 月 31 日， 调查时点： 2005 年 12 月 31 日 24 时 0 分。

结果： 一、 ODD 总时点患病率及各年龄患病率：

ODD 儿童 294 人， 时点患病率为 5.20% ， 11-15 岁年龄段患病率最高，各年龄间患病率差异有显著性（ X2=65.757 ， P=0.000 ）。

二、 ODD 男女患病率：

ODD 男性患病率（ 6.70% ）明 显高于女性（ 3.43% ），差异有高度 显著性（ X2=51.222 ,P=0.000 ），男女性 别比为 2.32:1 。

三、 ODD 城 乡患病率：

城市患病率 为 5.49% ， 农村患病率为 5.03% ，城 乡患病率差异无显著性。城市男女患病率比为 2.36 ， 农村男女患病率比为 1.74 。

四、 ODD 各地区患病率：

ODD 患病率分 别为长沙 5.47% ， 怀化 5.20% ，永州 5.60% ，郴州 4.62% ，娄底 5.47% ，益阳 4.66% 。各地区患病率 间无显著性差异。

五、 ODD 共病：

单纯 ODD （男 152 人，女 76 人）与有合并症者 ( 男 193 人，女 73 人 ) 间性别构成比无显著差异。 ODD 与 ADHD 共病率最高（ 51.88% ）；其次是情 绪障碍（ 48.12% ）、学 习障碍（ 20.68% ）、网 络依赖（ 15.78% ）、抑郁症 / 心境 恶劣障碍（ 12.4% ）、睡眠障碍（ 7.14% ）、抽 动障碍（ 4.89% ）。

结论： ODD 是我国中小学生 较常见的一种行为障碍。 注：本研究得到 CMB 支持， 项目编号为 “Small Grants Program #02-777” ， 项目负责人：费立鹏。

Objective: To explore the characteristics and prevalence of oppositional defiant disorder (ODD) in primary school and middle school in Hunan .

Methods: 9495 cases of students age 5 ～ 17 years old were investigated by two-phase prevalent analysis, children with ODD were screened by the Kiddy Schedule for affective diseases and schizophrenia (K-SADS-PL) and DSM-IV. Conbined Raven' Test and achievement test were used in children with suspicious diagnoses as learning disorder, mental retardation or pervasive developmental disorder. Foxpro 6.0 was used in setting up database. Single variable analyses and multiple-variables analyses were analysed by SPSS 11.5 version for Windows.

Results: The prevalence rate of ODD was 5.20% (male 6.7%,female 3.43% ； urban 5.49%,rural 5.03%) in Hunan , the sex prevalent ratio(male/female) was 2.32:1. There were significant differences between two gender groups(X2=51.222 ， P=0.000) and among all groups with different age(X2=65.757 ， P=0.000). The comorbidities in children with ODD include ADHD, learning disorder, anxiety disorder, depression, dysthymic disorder and so on. The comorbidity of ODD and ADHD is the most common in children with ODD.

Conclusions: The prevalence of ODD is high in china. The study was funded by CMB(Small Grants Program #02-777)

CSP1-7

女性精神分裂症患者 脑白质异常的弥散张量成像研究 - White Matter Abnormalities in Female Schizophrenia Patients Revealed by Diffusion Tensor Imaging

Xiaoqi Huang 1 , Su Lui 2 , Wei Deng 3 , Tao Li 3 , Qiyong Gong 1
1 West Chian Hospital of Sichuan University, Huaxi Magnetic Resonance Research Center, Chengdu, Chinese Mainland, 2 West China Hospital, Department of Radiology, Chengdu, Chinese Mainland, 3 West China Hospital of Sichuan University, Department of Psychiatry, Chengdu, Chinese Mainland

目的 ： DTI 是在 DWI 基 础上发展出来的磁共振成像新技术 ， 主要用于观察脑白质完整性的异常。研究认为精神分裂症患者存在脑白质的联结异常，并且认为这与精神分裂症患者的临床 症状和 认知功能缺损有关。但是长期以来对精神分裂症患者脑结构异常的影像学研究多集中在男性患者。本研究试图采用最新的 VBA 技 术分析弥散张量成像后获得的 FA 图，来探索首发女性精神分裂症患者脑白质的结构异常。

方法： 研究 纳入年龄配对的首发精神分裂症女性患者（年龄 18-33 岁，平均 25.31±6.68 ）和正常 对照者 ( 年 龄 22-33 岁，平均 27.08±5.09) 各 13 名。所有 纳入患者均为初诊的首发病人，诊断符合 CCMD-3 诊断标准；在进行影像检查前未接受过任何精神科治疗。所有 DTI 图像通过自旋回波单次发射 EPI 扫描序列 ，参数如下： TR= 10000 msec, TE= 70.8msec, 翻 转角 = 12 度 , 层厚 = 3mm, FOV = 24 cm×24 cm, 矩 阵 = 128×128, 体素大小 = 3×3×5mm3, b 值 =1000s/mm2 ， NEX=2 。所有的 b=0 图像标准化到蒙特利尔神经研究所（ MNI ）的 标准空间上。然后采用其变形矩阵对 FA 图进行标准化处理， 标准化后的 FA 图采用 FWHM=6 的高斯核 进行空间平滑，以降低空间噪声。最后采用基于体素的两样本 t- 检验进行基于体素的全脑比较。

结果： 根据 统计阈值 t>3.3(p<0.001) 和簇体 积 >100 体素，女性精神分裂症患者与同性 别正常对照者相比双侧前额叶白质（ -12,33,-5, 簇体 积 106; 14,32,-2, 簇体 积 119 ）区域 FA 值明显降低，未发现 FA 值明显升高的区域。

结论： 基于体素的全 脑比较（ VBA ）方法不需要先 验假设信息且避免了手工勾画 ROI 带来的人为偏差，日渐成为影像学研究中的重要方法。但是因为配准等问题不容易获得阳性结果。本研究首次通过对 DTI 图像进行 VBA 分析 证实了女性精神分裂症患者脑白质的异常。此外本研究纳入首发未服药患者可以排除药物以及长期病程对脑结构的影响。

Introduction: Diffusion tensor imaging (DTI) studies reported impaired white matter integrity in schizophrenia, quantified as lower fractional anisotropy (FA). Evidence suggests that male and female schizophrenia patients may have different patterns of structural abnormalities, while past researches mainly focus on male schizophrenia. Present study aims to examine the white matter abnormalities in female patients with first episode drug-naive schizophrenia using a rigorous voxel-based analysis of the diffusion tensor imaging (DTI) data.

Methods: Thirteen female patients experiencing a first episode of schizophrenia (mean age = 25.31±6.68) according to the diagnostic criteria of DSM-IV, and thirteen age matched normal female controls (mean age=27.08±5.09) were recruited. DTI data was acquired using a 3.0T MR scanner by employing a single shot spin echo EPI sequence with 15 directions. Voxel-based analysis was performed using SPM2. Prior to the analysis, FA maps were normalized using the parameters determined from the normalization of the b=0 image followed by smoothing with a 6mm FWHM isotropic Gaussian kernel. Statistical comparisons were performed using two sample t-test between patients and normal controls.

Results: At defined threshold value of t>3.3(p<0.001) and cluster voxel>100, significant reductions of FA value in female patients was found in white matter of bilateral frontal lobe adjacent to the genu of corpus callosum (-12,33,-5, cluster size 106; 14,32,-2, cluster size 119)[fig 1]. No area with significant FA increase was observed in patients group.

Conclusion: Here for the first time we demonstrate abnormal of white matter integrity in female schizophrenia patients by a whole brain voxel based analyses.

CSP1-8

上海精神心理 专科门诊患者轴 Ⅱ 人格障碍患病率共病率调查 - Epidemiological Investigation on the Prevalence and Comorbidity of Personality Disorder of Outpatients in Psycho-counseling Clinics and Psychiatric Clinics in Shanghai

Zeping Xiao 1 , Tianhong Zhang 1 , Lanlan Wang 1
1 Shanghai Mental Health Center , Shanghai , Chinese Mainland

目的 : 调查 DSM-IV 轴 II 人格障碍在上海精神心理 专科门诊 的患病率及与几 类临床常见精神障碍的共病情况 ， 探讨人格障碍作为轴 II 诊断在中国应用的思路与前景。

方法 : 采用系 统抽样法 ， 以人格障碍诊断问卷 （ PDQ4+ ） 为筛查工具对 3075 例就 诊患者进行人格障碍的问卷初筛及轴 Ⅱ 人格障碍 (SCID-II) 的 临床访谈 ， 并收集所有参加研究者的临床诊断情况 ， 进行统计分析。

结果 : （ 1 ） 研究共 发现符合 DSM-IV 轴 II 人格障碍 诊断标准患者共 982 人 ， 上海精神心理 专科门诊人格障碍的总患病率为 31.93% （ 95%CI ： 30.29% ～ 33.58% ）， 其中女性患病率 为 31.09% ， 男性患病率 为 33.01% ， 性 别比较无统计学差异 (P>0.05) ， 平均年 龄 29.90±9.717 ， 年 龄比较有统计学意义 (P<0.01) 。（ 2 ）焦 虑组人格障碍（ C 组）的患病率在各组人格障碍中最高（占 52.14% ），其中回避型（占 8.10% ）和 强迫型（占 7.58% ）人格障碍在 门诊患者中最为常见。（ 3 ）在 门诊三类常见临床疾病（精神分裂症类、心境障碍类、神经症性障碍类）的患者中共患任意一种或多种人格障碍的人数为 776 人，共病率 为 32.66% ，其中 临床诊断为心境障碍类疾病的患者与轴 II 人格障碍共病率最高（占 41.97% ），各 类 常 见临床诊断与各组人格障碍之间的共病有一定的倾向性但并不绝对。（ 4 ） 轴 II 人格障碍 诊断之间的重叠情况较为普遍，在所有符合人格障碍诊断标准的患者中有 44.40% 合并两 种或两种以上人格障碍。

结论 : 轴 II 人格障碍在精神心理 专科门诊患者中有较高的患病率、共病率，与国外的研究结果相近，临床应用中的可行性和必要性值得讨论。

关键词 : 人格障碍 患病率 共病率 精神科 门诊 心理咨 询门诊 DSM-IV 轴 II 诊断 流行病学 调查 .

Objective: To assess the prevalence and comorbidity of personality disorder (PD) in psychiatric and psychological counselling outpatients in Shanghai . Discussion on application avenues and prospect of axis II personality disorders in China .

Method: 3075 subjects were sampled randomly from outpatients in psycho-counselling clinics and psychiatric clinics in Shanghai Mental Health Center . Personality disorders were assessed by questionnaires (Personality diagnostic questionnaire, PDQ4+ ) and interviews(Structured Clinical Interview for DSM—IV Axis II, SCID-II). And the clinical diagnosis of outpatients were collected by reviewing the outpatient records.

Results: （ 1 ） Of those 3075 subjects, 982(31.93% ， 95%CI ： 30.29% ～ 33.58%) samples met criteria for at least one personality disorder. Wherein the prevalence of male and female was 33.01% and 31.09% ， there was no significant difference in the prevalence rate between male and female groups (P>0.05). But the subjects of PD group were more younger than non-PD group(P<0.01). （ 2 ） The cluster C personality disorders(52.14%) were most frequently assigned, wherein avoidant PD(8.10%)and compulsive PD(7.58%) were common in outpatients. （ 3 ） 776 outpatients with common diagnosis (including schizophrenia and other psychotic disorders, mood disorders, neurosis) met criteria for at least one personality disorder, comorbidity rate was 32.66%. Wherein the comorbidity rate of mood disorders with personality disorder was the highest(41.97%). （ 4 ） The diagnosis overlap among axis II personality disorders was common. Of those 982 subjects in PD group, 44.40% outpatients met criteria for more than one personality disorder.

Conclusions: The high frequency and comorbidity of personality disorder in this sample of Chinese outpatients seems similar to the rates found in western countries. The essentiality and feasibility of axis II personality disorders in clinical application deserve to be debated.

Key words: personality disorders, prevalence, comorbidity, outpatient, Psycho-counselling Clinics ， Psychiatric Clinics, DSM-IV, axis II diagnosis, Epidemiological Investigation

CSP2

Chairs: Dongfeng Zhou, Chinese Mainland
Jingping Zhao, Chinese Mainland

CSP2-1

Improving Drug Addiction Treatment in China

Wei Hao 1
1 Mental Health Institute, Second Xiangya Hospital , Central South University , Changsha , Chinese Mainland

Objectives: To illustrate the current situation and problems of drug addiction in China and propose suggestions.

Methods: A descriptive study based on literature searched from Medline and the China National Knowledge Infrastructure database (1996 to 2007) and hand-picked references.

Results: Since the re-emergence of drug addiction in China in the early 1990s, there has been tremendous progress in drug addiction treatments in China , especially treatments for opiate addiction. However, many problems and challenges remain for improvement, including widespread negative attitudes towards drug abuse and drug dependent persons, a lack of evidence-based data on the efficacy of Chinese traditional medicine, and a lack of a comprehensive and integrated system to organize all treatment resources and monitor treatment progress. The authors discuss the challenges that impede effective treatments of drug addiction and some suggestions are proposed. Implementing these suggestions can improve the outcome of treatment of drug dependent persons and benefit the whole society.

Conclusion: China faces substantial drug abuse problems that appear to be worsening with time. Though much progress in drug addiction treatment has been made, improvement in many aspects is urgently needed.

Key words: drug addiction, China , treatment, challenges, efficacy, traditional Chinese medicine, HIV/AIDS

CSP2-2

二甲双胍合并行 为干预治疗抗精神病药物所致体重增加和糖代谢紊 乱的研究 - Study on the Influence of Increased Body Weight and Glycometabolism Disorder Caused by Antipsychotic Medicine when Treating by Dimethyl Biguanide Combined with Behavior Intervention

平 靖 赵 1 , 容 仁 吴 1
1 中南大学湘雅二医院 , 精神 卫生研究所 , 长沙 , Chinese Mainland

目的 : 研究二甲双胍与行 为干预治疗单用或合用治疗抗精神病药物引起的体重增加和糖代谢紊乱的疗效。

方法 : 128 例精神分裂症患者随机分 为二甲双胍 （ 750mg/d ） 与行 为干预治疗合用组 （ A 组 ， 32 例 ） 、二甲双胍 （ 750mg/d ） 单用组 （ B 组 ， 32 例 ） 、行 为干预治疗单用组 （ C 组 ， 32 例 ） 和 对照组 （ D 组 ， 32 例 ） , 均治 疗观察 12 周。 每 组患者于治疗前和治疗后 4 周末、 8 周末及 12 周末 测空腹血糖、胰岛素，量身高、体重、腰围，并计算体重指数（ BMI ）及胰 岛素抵抗指数（ IRI ）。

结果 : （ 1 ）共入 组 128 例病人， 79 例（ 62% ）完成 12 周的研究， A 、 C 两 组的完成率明显低于 B 、 D 两 组，差异有显著性， A 组与 C 组， B 组与 D 组完成率比较差异无显著性。（ 2 ）在 A 、 B 、 C 3 组中，体重、体重指数（ BMI ）、腰 围、空腹血糖、空腹胰岛素、胰岛素抵抗指数（ IRI ）治 疗后均明显降低，治疗后各时点与治疗前比较，差异均有显著性。在 D 组中，体重、 BMI 、腰 围、空腹胰岛素、 IRI 治 疗后均明显升高，治疗后各时点与治疗前比较差异均有显著性。（ 3 ）治 疗 4 周末， A 组与 B 组体重、 BMI 的下降程度相同，而明 显高于 C 组；治疗 8 周末及 12 周末， B 组与 C 组体重、 BMI 的下降程度相同，而明 显低于 A 组；治疗后各时点， A 组与 B 组空腹胰岛素、 IRI 的下降程度相同，而明 显高于 C 组。

结论 : 二甲双胍与行 为干预治疗单用或合用均能有效和安全的减轻抗精神病药物引起的体质量增加和胰岛素抵抗，二甲双胍与行为干预治疗合用减轻体质量的疗效最好，二甲双胍与行为干预治疗缓解抗精神病药物引起的胰岛素抵抗的疗效相同，患者对二甲双胍的依从性优于行为干预治疗。

CSP2-3

矿难后 2 个月及 10 个月 . 创伤后应激障碍的脑功能研究 - The Epidemiology and Neuroimaging Research in Coal Mining Accident Survivors with Posttraumatic Stress Disorder

彩 兰 侯 1 , 凌江 李 2 , 燕 张 2 , 军 刘 2 , 忠 贺 2 , 坤 王 3 , 勇 刘 3 , 高浪 龚 3 , 妮 舒 3 , 猛 梁 3 , 田仔 蒋 3
1 中南大学湘雅二医院精神 卫生研究所 ， 广东省人民医院广东省精神卫生研究所 , 广州 , Chinese Mainland, 2 中南大学湘雅二医院精神 卫生研究所 , 长沙 , Chinese Mainland, 3 中科院自 动化研究所模式识别国家重点实验室 , 北京 , Chinese Mainland

目的 ： 探索急性重性 PTSD （ 矿难后 2 个月 ） 脑功能特点 ， 研究 PTSD 神 经环路发挥重要作用的脑机制。矿难后 10 个月随 访，探讨 PTSD 脑功能变化并进行纵向比较。

方法： 选取 24 名急性重性 PTSD 患者和 24 名 对照者，接受情绪识数 stroop 、症状激 发任务及症状激发的短期记忆提取任务 3 项脑功能检查。矿难后 10 个月，所有 PTSD 患者接受第二次 脑功能检查。

结果： （ 1 ）情 绪识数 stroop ： 矿难后 2 个月， PTSD 患者相比 对照者双侧前扣带回、右侧额下回等脑区激活下降；矿难后 10 个月 PTSD 患者左 侧额叶内侧回、右侧额中回、右侧扣带回及左侧海马旁回激活增强； PTSD 患者 矿难后 10 个月与 矿难后 2 个月前后配 对比较，矿难后 10 个月 PTSD 患者双 侧额上回、双侧额中回、右侧扣带回及左侧海马旁回激活增强。（ 2 ）症状激 发任务：矿难后 2 个月， PTSD 患者相比 对照者，右侧前扣带回、左侧额下回及双侧额中回等部位激活下降，左侧海马旁回激活增强；矿难后 10 个月， PTSD 患者相比 对照者，右侧颞上回（ BA38 ）激活增 强，右 侧颞上回（ BA22 ）、右 侧岛叶等脑区激活下降； PTSD 患者前后配 对比较，矿难后 10 个月右 侧扣带回激活下降。（ 3 ）症状激 发的短时提取任务：矿难后 2 个月， PTSD 患者相比 对照者，右侧额下回、右侧额中回等脑区激活下降；矿难后 10 个月， PTSD 患者相比 对照者，右侧额下回及右侧额中回等脑区激活下降； PTSD 患者 矿难后 10 个月与 矿难后 2 个月 进行配对比较，右侧海马旁回及双侧颞上回激活下降。 (4) 矿难后 2 个月，短 时记忆提取任务相比症状激发任务，右侧海马旁回激活下降；矿难后 10 个月，短 时记忆提取任务相比症状激发任务，左侧海马旁回激活下降。

结论： PTSD 急性期已存在 脑功能 改 变及记忆功能损害。主要的脑区在前额叶及海马部位。通过纵向比较可以看出 PTSD 患者 脑功能也发生了变化。

关键词： 矿难， PTSD ， fMRI.

CSP2-4

重性抑郁症 脑白质纤维弥散张量成像的初步研究 . 刘海燕 姚志 剑 滕皋 军 武欣 王 丽 杜 经纶 曹燕翔 袁哲星 刘文 - White Matter Integrity in Major Depression: A Diffusion Tensor Imaging Study on Whole Brain

Zhi-jian Yao 1 , Hai-yan Liu 1 , Gao-jun Teng 1
1 Nanjing Brain Hospital of Nanjing Medical University , Department of Psychiatry, Nanjing , Chinese Mainland

目的 ： 抑郁症的病 变涉及多个脑区的变化 ， 其神经联系包括边缘 － 丘脑 － 皮层结构和边缘 － 纹状体 － 皮质 － 丘脑结构两个神经环路 ， 有研究认为环路的异常引起神经整体调节功能异常 ， 抑郁症是具有精神症状的神经疾病。本研究利用弥散张量成像（ diffusion tensor imaging, DTI ）技 术，探索脑白质纤维异常与中青年抑郁症的关联。

方法： 2005 年 3 月－ 2007 年 1 月南京医科大学附属 脑科医院的住院和门诊抑郁症患者 24 例，均符合 CCMD － 3 及 DSM － IV 重性抑郁症 诊断标准， 24 项 Hamilton 抑郁量表 评分 >35 。其中男 15 例，女 9 例；年 龄 23 ～ 55 岁，平均年龄（ 41.88±9.99 ） 岁；受教育年限 5 ～ 15 年，平均（ 10.96±3.08 ）年，均 为右利手； 30 例在性 别、年龄、教育年限上经样本 t 检验，均无显著性差异（ P>0.05 ）的健康志愿者。研究 经南京医科大学医学伦理委员会同意，所有受试者或其家属均签署知情同意书。

应用美国 GE 1. 5 T 超 导型磁共振仪，首先进行常规磁共振平面扫描，未发现异常结构者继续扫描， DTI 采用 SE EPI 序列 轴位扫描，正中矢状位平行前后联合连线为定位线； TR/TE ＝ 1000ms /81.2ms ， FOV ＝ 240mm×240mm ，矩 阵 128 ×128 ， b 值＝ 1000s/mm2 ， NEX 两次， 25 个方向上施加 扩散梯度；每个时间点不间断 30 层图像，层厚 4mm ， 层间隔 0mm ，同 时采集 3D 结构影像数据。利用 DtiStudio 软件重建 FA 图； AFNI 软件中全脑图像手动配准； Statistical Parametric Mapping （ spm ） 2 软件中， FA 图标准化到各自的 3D 图像模板上，后进行基于像素 FA 值的双样本 t 检验统计分析，设 P<0.001 为有显著统计学意义，阈值 >10 个像素。

结果： 经双样本 t 检验，患 者 组在左额中回（ -45 31 28 ;58 像素）；左 额上回（ -26 52 -1 ； 14 像素）；右 额内侧回（ 11 -23 53 ； 38 像素）；左楔前叶（ -17 -54 32 ； 106 像素）；左 颞上回（ -65 -40 18 ； 13 像素）；右扣 带回（ 6 -27 37 ； 10 像素）、等区域的 FA 值低于健康组，差异有显著统计学意义。

结论： 中青年重性抑郁患者存在 脑白质损害现象，同时支持神经环路连接性损伤可能是导致抑郁症发病原因的假设。

Objective: Alternations in the white matter connections of some regions such as cingulated cortex and prefrontal cortex maybe the reason that result in the depression, diffusion tensor magnetic resonance imaging (DTI) is an exciting neuroimaging technique that can be used to visualize and measure the diffusion of water in brain tissue in vivo, this study used DTI to investigate whether the white fiber abnormalities of these regions were present in middle-aged patients with major depression.

Methods: 24 depression middle-aged patients and 30 gender-, age-,and education-matched healthy controls were all underwent whole brain DTI scans. Scans were analyzed using a rigorous voxelwise approach. Results The fractional anisotropy (FA) in the left middle frontal gyrus, the left superior frontal gyrus, the right medial frontal gyrus, the left superior temporal gyrus, the left precuneus and the right cingulate gyrus were significantly lower in patients than in controls (P<0.001).

Conclusions: The white matter abnormalities were also present in middle-aged patients with major depression, and these results support the hypothesis that disrupt connectivity of the nerve circuits among brain regions contribute to the risk of depression.

Key words: Depression ； Diffusion tensor imaging ； White matter ； Fractional anisotropy

CSP2-5

新婚夫妻暴力 预防性心理干预对家庭暴力态度的前瞻性研究 - The Propective Study of the Attitudes on Domestic of Psychological Preventive Intervention of Spousal Violence to Newly-married Couples

邹韶红 韶 红 邹 1 , 张亚林 亚林 张 1
1 中南大学湘雅二医院 , 精神 卫生研究所 , 长沙 , Chinese Mainland

目的 ： 通 过对新婚夫妻暴力的重点 人群 进行预防性心理干预 ， 旨在降低对家庭暴力持认可的态度

方法 ： 采取横断面 调查及前瞻性研究。于 2005 年 11 月～ 2006 年 2 月在 长沙市 5 个市 辖区中抽取 2 个市 辖区 ， 再在每个市辖区民政局婚姻登记机构处对领取结婚证愿意接受婚前暴力调查研究的新婚登记夫妻进行调查。调查对象仅限于初婚的夫妻。经样本估算后，实际有效调查 317 对。从 317 对新婚夫妻中筛选出 93 对夫妻暴力重点人群，随机分为研究组（ 42 对）和对照组（ 51 对）。研究组主要接受关于夫妻暴力的健康心理教育及预防夫妻暴力发生的心理辅导训练，对照组不接受任何干预。两组分别在干预前接受自编的夫妻暴力调查问卷、简易应对方式问卷（ SCSQ ）、艾森克人格 问卷（ EPQ ）、社会支持 评定量表（ SSRS ）、儿童期虐待 问卷（ CTQ-SF ）的 评定。在干预后 6 个月接受夫妻暴力 调查问卷的评定。研究组完成 25 对，对照组完成 37 对。

结果：

1. 研究前两 组的年龄、性别、受教育程度、职业、经济收入、同居史、饮酒史、吸烟史、赌博史、居住条件、儿童期目睹家庭暴力及各种量表的评分差异均无显著性（ P>0.05 ）。

2. 对家庭暴力态度的变化。干预前两组对家庭暴力态度的比较，差异无显著性（ P>0.05 ）；随 访 6 月后研究 组对家庭暴力持 “ 可以 ” 和 “ 看情况 ” 的 态度者 15 人（ 30% ）低于 对照组 43 人（ 58.1% ）（ P<0.01 ）。随 访 6 月后，研究 组对家庭暴力持 “ 可以 ” 和 “ 看情况 ” 的 态度者 25 人（ 50.0% ）明 显下降到 15 人 (30.0%) ，但差异无 显著性（ P>0.05 ）。

结论： 预防性心理干预改善了新婚夫妻对家庭暴力的态度，对家庭暴力持 “ 可以 ” 和 “ 看情况 ” 态度者明显减少，持 “ 不可以 ” 态度者明显增多。预防性心理干预是 有效的。

关键词 夫妻暴力， 预防，前瞻性研究，干预，表现形式

Object: To evaluate psychological preventive intervention of high-risk spousal violence groups for prevention of the attitudes on domestic.

Methods: By using cross-sectional survey and prospective study, two of the five catchment areas in Changsha city were randomly selected. Totally 317 newly-married couples in Changsha city were interviewed. 93 high-risk couples were screened from 317 newly-married couples were randomly assigned to research group and control group. For the research group, session about psychological education of SV and counseling about prevention of SV were given. For the control group, no not intervention was received. A self-designed SV questionnaire, Neurosis and Psychosis Screening Scale, the self-report Eysenck's Personality Questionnaire (EPQ), Simplified Coping Style Questionnaire (SCSQ), Social Supporting Rating Scale (SSRS), and Childhood Trauma Questionnaire-28 item Short Form (CTQ-SF) were administered in two groups before intervention. After follow-up six months, a self-designed SV questionnaire and Short Marital-Adjustment and Prediction Test (SMAPT) were administered again. Total 25 couples of research group completed follow up study while 37 couples in control group completed.

Results: 1. There was no difference on age, gender, education levels, employment, economic status, cohabitation history, alcohol abuse, drinking frequency, smoking, gambling, habitation condition, witnessing DV, childhood abuse, and scores of every scales between two groups. 2. There was no difference on attitudes on domestic violence before intervention. To compare attitudes on domestic violence between two groups after follow-up six months, the viewpoints of acceptance DV, acceptance under some circumstances of research group were significantly lower than control group （ P<0.01 ） . After follow-up six months, the viewpoints of acceptance DV, and acceptance under some circumstances of research group is lower but did not have statistical significantly （ P>0.05 ） . The total scores of SMAPT of intervention group was significantly higher than that of control group after follow-up （ P<0.01 ） .

Conclusions: Psychological preventive intervention of SV was effective on the attitudes on SV. The viewpoints of acceptance DV, acceptance under some circumstances decreased significantly, but denying SV rising significantly. Preventive intervention was effective.

Keywords: spousal violence, prevention, intervention, pattern

CSP2-6

山 东省 18 岁及以上人群精神疾病流行病学调查 - Epidemiological Investigation on Mental Disorders over 18 in Shangdong Province

张敬悬 Zhang 1 , 卢传华 唐 济生 刘 兰芬 邱慧敏 王松波 王 爱贞 张韶东 江永 华 胡伯文 赵长英 曹学 义
1 山 东省精神卫生中心 , 济南市 , Chinese Mainland 目的 ： 调查山东省 18 岁及以上城乡人口精神疾病的患病率。

方法 ： 采用多 阶段分层整群系统随机抽样方法在全省五个地区 （ 包括城市和农村 ） 进行抽样 ， 实际抽取 18 及 18 岁以上人口 23987 人 ， 实际完成 GHQ-12 问卷调查 22664 人 （ 94.48% ）， 1323 人被抽中的 调查者未完成调查 ， 主要原因为因躯体疾病不能填表 66 人 ， 因精神疾病不能填表 67 人 ， 拒 绝调查 446 人 ， 该户一直没人住 160 人 ， 该户有人但选出的被试一直没找到 576 人 ， 其他 14 人 ， 共 纳入资料分析 22793 人。主要研究工具有 GHQ-12 、 DSM-IV 和 SCID-P 。 24 名精神科 护士和 60 名精神科医生培 训 4 周后参加 调查，并进行一致性测验，现场调查 3 个月完成。 结果 在 18 岁及以上城乡人群中，精神疾病的患病率为 17.66% （ 95%CI ： 17.16%-18.15% ）。各 类精神疾病的患病率分别为：双相障碍 0.21% ，重性抑郁障碍 1.52% ，心境 恶劣障碍 1.81% ，未特定抑郁障碍 1.91% ， 缘于躯体状况的心境障碍 0.12% ，精神分裂症 0.82% ，其他精神病性障碍 0.12% ，酒精使用障碍 5.27% ， 镇静催眠抗焦虑剂使用障碍 0.06% ，焦 虑障碍 5.11% ，躯体形式障碍 0.21% ，适 应障碍 0.04% ，其他 轴 1 诊断 0.11% ，精神 发育迟滞 0.23% ，老年性痴呆 0.13% 。

结论： 与国内浙江省的研究 结果一致，山东省 18 岁及以上人群精神疾病的患病率为 17.66% 。按此推算山 东省 18 岁及以上人群中有各类精神疾病患者 1347 万人（ 95%CI ： 1309-1384 万人）。精神 卫生问题已成为我国非常重要的公共卫生问题和非常突出的社会问题。

CSP2-7

A Epidemiological Investigation of Mental Disorders of the People Aged 18 Years and above in Shandong Province

Jingxuan Zhang 1 , Chuanhua Lu 1 , Jisheng Tang 1 , Lanfen Liu 1 , Huimin Qiu 1 , Songbo Wang 1 , Aizhen Wang 1 , Shaodong Zhang 1 , Yonghua Jiang 1 , Bowen Hu 1 , Changying Zhao 1 , Xueyi Cao 1
1 Shandong Mental Health Center , Jinan City , Chinese Mainland

Objective: To investigate the prevalence rate of mental disorders of the people aged 18 years and above of Shandong province.

Method: 23987 persons aged 18 years and above were sampled from five areas of Shandong province by multi-stage cluster random sampling. 22664 （ 94.48% ） persons completed the survey questionnaires. 1323 persons did not completed the survey questionnaires, the reasons non-completed survey were not finding the sampled persons (576 cases), refusing (446 cases), and no person living in the sampled home (160 cases), not able to completed the questionnaires (123 cases) due to mental or body disorders, and the other reasons (14 cases). The main survey tools were General Health Questionnaire （ GHQ-12 ） , DSM-IV and SCID-P. 24 nurses and 60 psychiatrists trained for 4 weeks before survey completed the investigation costing 3 months.

Result: The prevalence rate of mental disorders of the people aged 18 years and above of Shandong province was 17.66%(95%CI ： 17.16%-18.15% ） , The prevalence rates of different mental disorders were 0.21% of bipolar disorders, 1.52% of major depressition ， 1.81% of dysthymia disorders ， 1.91% of depressive disorders not classified elsewhere ， 0.12% of mood disorders due to body's diseases ， 0.82% of schizophrenia ， 0.12% of other psychotic disorders ， 5.27% of alcohol abuse disorders ， 0.06% of sedatives or hypnotics abuse disorders ， 5.11% of anxiety disorders ， 0.21% of somatoform disorders ， 0.04% of adjustment disorderss ， 0.11% of other disorders of DSM-IV axis I ， 0.23% of mental retardation ， and 0.13% of dementia 。

Conclusion: It is the same as the results of the epidemiological study of mental disorders in Zhejiang province, the prevalence rate of mental disorders of the people aged 18 years and above of Shandong province is 17.66% (95%CI ： 17.16%-18.15% ） , according to that there are about 13.47 millions people aged 18 years and above with different mental disorders in Shandong province (95%CI:. 13.09-13.84 millions people ） . The mental health problems are becoming very important public health problems and important social problems in our country.

CSP2-8

酸性神 经酰胺酶 ASAH1 基因与精神分裂症易感性研究 - The Study of Genetic Susceptibility to ASAH1 Gene in Schizophrenia

怀惠 张 1 , 东红 崔 2 , 开达 江 2 , 三多 江 2 , 紫青 朱 2
1 上海交通大学附属上海市精神 卫生中心 ， 上海市杨浦区精神卫生中心 , 上海市 , Chinese Mainland, 2 上海交通大学附属上海市精神 卫生中心 , 上海市 , Chinese Mainland

目的 ： 探索基因芯片 筛查出的在精神分裂症患者中异常表达的酸性神经酰胺酶基因 （ ASAH1 ） 与精神分裂症易感性 间的关系。

方法 ： 应用基因表达谱芯片对 6 例精神分裂症患者和 6 名健康 对照进行分析 ， 筛查易感基因。应 用聚合 酶 链反应和限制性片段长度多态性技术对 254 个精神分裂症核心家系 ASAH1 基因上的 3 个 SNPs （ rs3753118 、 rs3753116 和 rs7830490 ） 进行检测，计算连锁不平衡（ LD ）、 传递不平衡（ TDT ）及 单体型 TDT 。使用 PANSS 量表 评定 254 例精神分裂症患者疾病表型的数量性状，比 较在 3 个 SNPs 位点具有不同基因型、不同等位基因、不同 单体型的患者的 PANSS 量表 评分。

结果： 1. ASAH1 基因芯片研究：符合差异表达基因的有 31 条（数据此 处未报道），其中 ASAH1 基因表达水平在 6 例精神分裂症患者、 7 次 试验中均低于健康对照。 2. ASAH1 基因 传递不平衡分析：（ 1 ） rs3753116 － rs7830490 存在 强 LD （ D'=0.851 ， r2=0.369 ）， rs3753118 － rs3753116 存在中等 强度 LD （ D'=0.495 ， r2=0.165 ）， rs3753118 － rs7830490 存在弱 LD （ D'=0.196 ， r2=0.029 ）。（ 2 ） ASAH1 基因 rs3753118 、 rs3753116 和 rs7830490 与精神分裂症存在阳性 关联， TDT Χ2 值分别为： 5.18 （ P=0.023 ）； 4.44 （ P=0.035 ）； 4.14 （ P=0.042 ）。（ 3 ） 单体型 rs3753118 － rs7830490 和 rs3753118 － rs3753116 － rs7830490 与精神分裂症存在阳性 关联（ Χ2 值分别为 8.45 ， df=3 ，Ｐ <0.05 ； Χ2 ＝ 15.86 ， df=7 ，Ｐ <0.05 ）， 单体型 rs3753118T － rs7830490A 和 rs3753118T － rs3753116G － rs7830490A 为精神分裂症的风险单体型 (P<0.05) 。 3. ASAH1 基因与精神分裂症数量性状的 关联分析：（ 1 ） rs3753118 位点 3 种基因型间患者的阳性症状分存在显著性差异 (P<0.05) ； rs3753116 位点 3 种基因型间患者的 PANSS 总分和阴性症状分存在显著性差异 (P<0.05) 。（ 2 ） rs3753118 Ｃ -rs3753116 Ｇ 单体型和 rs3753118 Ｃ -rs3753116 Ｇ -rs7830490 Ａ 单体型对应的 PANSS 总分和阴性量表分明显高于系统默认的参照单体型（Ｐ <0.05 ）。

结论： ASAH1 基因与精神分裂症 连锁， ASAH1 基因可能是中国 汉族人群精神分裂症的易感基因。 ASAH1 基因上可能存在着精神分裂症的症状数量性状位点。

Objective: To explore the genetic susceptibility of ASAH1 gene in schizophrenia. ASAH1 gene was detected by Cui's microarray and was significantly down regulated in all schizophrenia patients.

Methods: Microarray analysis was used to detect gene expression profiles of leucocytes in six schizophrenic patients and six normal controls. Three SNPs (rs3753118, rs3753116 and rs7830490) of ASAH1 in 254 schizophrenia trios were genotyped by using PCR-RFLP, and the LD, TDT and haplotype TDT were analyzed by using EMLD, UNPHASED and TRANSMIT softwares. PANSS was used to quantify the phenotypes of schizophrenia. One-Way ANOVA and the QTPHASE of UNPHASED2.4 were used to compare the PANSS score between different genotypes, alleles and haplotypes.

Results: 1. Microarray analysis: 31 genes expression altered when the ratio of Cy5/Cy3 signal was more than 1.5 or less than 0.7 (we didn't report these dates here), and ASAH1 expression levels were significantly decreased in all patients compared to healthy controls. 2. TDT analysis: (1) Strong LD was found between rs3753116 and rs7830490 (D' =0.851, r2=0.369), mild LD was found between rs3753118 and rs3753116 (D' =0.495, r2=0.165), and weak LD between rs3753118 and rs7830490 (D' =0.196, r2=0.029). (2) SNP rs3753118, rs3753116, rs7830490 were observed to be associated with schizophrenia by TDT (X2=5.18, P=0.023; X2=4.44, P=0.035; X2=4.14, P=0.042). (3) The haplotype rs3753118-rs7830490 and rs3753118-rs3753116-rs7830490 were associated with schizophrenia (P<0.05). 3.Association analysis between ASAH1 gene and symptom quantitative trait: (1) There were significant difference of the Positive score among patients grouped upon genotypes in rs3753118, and the total PANSS score and Negative score were significant different among patients grouped upon genotypes in rs3753116 (P<0.05). (2) The total PANSS score and the Negative score of patients with rs3753118C-rs3753116G haplotype, with rs3753118C-rs3753116G-rs7830490A haplotype, were higher than that of reference haplotype (P<0.05).