FT1 - 情感障碍 - Mood or Affective Disorder
Chairs: Fude Yang, Chinese Mainland
Helen Chiu, Chinese Hong Kong

FT1-1

Abstract withdrawn

FT1-2

动物试验 ： 尿皮质醇作为抑郁症的一个可能的治疗因子 - Urocortins as Possible Therapeutic Agents for Depression. Mice Experiments

Gyula Telegdy 1 , Masaru Tanaka 2
1 University of Szeged , Pathophysiology, Szeged , Hungary , 2 University, Pathophysiology, Szeged , Hungary

尿皮 质醇 (1,2 和 3) 是促 肾上腺皮质激素释放激素 (CRH) 家族中的一 员 ， 已经分离出了两个受体 ， CRHR-1 和 CRHR-2. 。 CRH 与 CRH-1 受体 对应；尿皮质醇－ 1 与 CRHR-1 和 CRHR-2 受体 对应；尿皮质醇－ 2 更 倾向于与 CRHR-2 受体 对应，而尿皮质醇－ 3 只与 CRH-2 受体 对应。在改良的鼠强迫 游泳 试验中，测试尿皮质醇 (1,2 和 3) 的抗抑郁作用。 测试的内容包括活动减少、攀爬和游泳行为 (FST) 。尿皮 质醇 1 对所有指标均无作用；尿皮质醇 2 通 过缩短活动减少时间、增加攀爬和游泳时间起到抗抑郁样的作用；尿皮质醇 3 也有 类似作用。从这些研究结果可以得出结论，对应于 CRHR-1 受体的尿皮 质醇 1 无抗抑郁作用，而 对应于 CRHR-2 的尿皮 质醇 2 和 3 可能成 为抗抑郁药的良好候选者。

Urocortins (Urocortin 1,2 and 3) are member of the corticotropin releasing hormone (CRH) family. Two receptors have been isolated CRHR-1 and CRHR-2. CRH is bound to CRH-1 receptor, while urocortin-1 binds to CRHR-1 and CRHR-2. Urocortin 2 binds preferably to the CRHR-2 receptor and urocortin-3 binds exclusively to CRH-2 receptor. Urocortins (UCN 1 , 2 and 3) have been tested in a modified forced swimming test in mice for detection of antidepressant effects. The test involved scoring the immobility, climbing and swimming behavior (FST).

Urocortin 1 had no action on any of the parameter studied in the modified FST. Urocortin 2 elicited an antidepressive-like action by shortening the immobility time, significantly increased the climbing and swimming times.

Urocortin 3 likewise displayed an antidepressive-like action by shortening the immobility time and increasing the climbing and swimming times.

The results conclude that urocortin 1 which binds to CRHR-1 receptor has no antidepressive action, while urocortin 2 and urocortin 3 which binds to CRHR-2 receptor could be a good candidate for developing potent antidepressive agents.

FT1-3

物 质滥用和双相障碍的共病 - Comorbidity between Substance Abuse and Bipolar Disorder

Eugenia Chourdaki 1
1 University Hospital , Department of Psychiatry, Heraklion , Greece

目的 ： 探 讨精神科门诊病人物质滥用和双相障碍共病的发生率。

方法 ： 在 48 个具有 2 年双相障碍病史的 门诊患者中 ， 检查同时符合物质滥用障碍诊断的病人有多少个。采用 DSM IV-TR 作 为诊断标准。采用 Mini 量表、 BPRS 量表、 GAF 和 SF-36 自 评健康问卷评估。病人年龄在 18-65 岁之间。经过血样和尿样检测。

结果： 在 较年轻双相障碍病人中，男性物质滥用障碍发生率要明显高于女性。 22% 的双相障碍病人是 终生物质滥用者，尤其酒精和大麻使用较多，而海洛因和可卡因使用较少。非物质滥用的双相障碍者接受药物治疗者较多。讨论 ： 本研究对象较少。有必要扩大样本、多中心进一步深入研究。

Aim: We want to study the frequency of comorbidity between bipolar disorder and substance abuse in patients who have been examined in psychiatric department as outpatients.

Material: We examined 48 patients with bipolar disorder for two years and we investigated how many of the patients had the diagnosis of substance abuse. The diagnosis was according to DSM IV-TR diagnostic criteria. We used Mini scale, BPRS scale, GAF and self - report scale SF-36 Health Survey. Our patients were between 18 and 65 years old. They had done blood and urine tests.

Results: Men were more often substance abusers than women but it seems that it starts to change in the younger populations. 22% of our bipolar patients were in a lifetime period substance abusers, especially alcohol and cannabis and more seldom heroin and cocaine. The results of pharmacological treatment were better in patients who weren't substance abusers.

Discussion: Our findings are limited in a small population group. There is need to conduct further studies in which the patient's sample will be larger and the design of the studies will include more agents.

FT1-4

脑白介素 -1 引起 肾上腺皮质激活和海马神经生长抑制 ， 促成了慢性轻度应激小鼠出现类抑郁状态 - Chronic Mild Stress Induces a Depressive-like Condition in Mice, Mediated by Brain Interleukin-1-induced Adrenocortical Activation and Hippocampal Neurogenesis Suppression

Raz Yirmiya 1 , Inbal Goshen 1 , Tirzah Kriesel 1 , Tamir Ben-Hur 1
1 The Hebrew University of Jerusalem , Psychology, Jerusalem , Israel

有依据表明炎性 细胞因子白介素 -1 (IL-1) 和抑郁症的病因及病理有 关。本研究采用慢性轻度应激 （ chronic mild stress, CMS ） 的抑郁模型 ， 探 讨在慢性应激所致抑郁中 IL-1 的地位与相 关生物机制。试验鼠暴露于 CMS 5 周后出 现类抑郁症状，如糖水偏爱程度下降、社会探索减少和肾上腺皮质的激活，并伴有海马 IL-1β 水平增高。相反， IL-1 受体 1 型缺失（ IL-1rKO ）小鼠或 转基因鼠（ IL-1 受体抗体 过度表达，大脑受到抑制）未出现任何 CMS 所致的行 为改变或神经内分泌变化。海马神经生长减少（抑郁症发病机制假说之一）可能是 IL-1 参与 CMS 所致抑郁的基 础，因为根据齿状回的 DCX （ doublecortin ） 检测和 BrdU 结合免疫组化检测的结果， CMS 能 显著减少 WT 小鼠神 经生长，但这种情况不发生在 IL-1rKO 小鼠身上。 IL-1rKO 小鼠不出 现抑郁的原因可能是肾上腺皮质激活障碍，因为肾上腺切除后内源性糖皮质肾上腺激素缺乏也可以消除 CMS 的 类抑郁效果。此外，长期给予皮质酮， 4 周后无 论是 WT 小鼠 还是 IL-1rKO 小鼠都出 现行为抑郁且神经生长受阻，提示在 CMS 情况下，皮 质酮是 IL-1 效 应的下游介质。而且，通过渗透微泵给予外源性 IL-1β 达 4 周，即可模 拟 CMS 对行为抑郁和神经发生的影响。在许多疾病状态下大脑 IL-1 都会增加，上述 结果提示， IL-1 增加是 这些疾病状态下抑郁症的发生率高的充分必要条件。因此，减少大脑 IL-1 水平可能是将来抗抑郁治 疗的发展方向之一。

Several lines of evidence implicate the pro-inflammatory cytokine interleukin-1 (IL-1) in the etiology and pathophysiology of major depression. To explore the role of IL-1 in chronic stress-induced depression and in some of its underlying biological mechanisms we used the chronic mild stress (CMS) model of depression. Mice subjected to CMS for 5 weeks exhibited depressive-like symptoms, including decreased sucrose preference, reduced social exploration and adrenocortical activation, concomitantly with increased IL-1 β levels in the hippocampus. In contrast, mice with deletion of the IL-1 receptor type I (IL-1rKO) or mice with transgenic, brain-restricted over-expression of IL-1 receptor antagonist did not display any CMS-induced behavioral or neuroendocrine changes. Reduced hippocampal neurogenesis, a putative mechanism of depression, may underlie IL-1's involvement in CMS-induced depression, because whereas in WT mice CMS significantly reduced neurogenesis, measured by incorporation of BrdU and by doublecortin immunohistochemistry in the dentate gyrus, no such decrease was observed IL-1rKO mice. The blunting of the adrenocortical activation in IL-1rKO mice may play a causal role in their resistance to depression, because removal of endogenous glucocorticoids by adrenalectomy also abolished the depressive-like effects of CMS. Moreover, chronic administration of corticosterone for 4 weeks produced behavioral depression and suppressed neurogenesis both in WT and IL-1rKO mice, suggesting that corticosterone is a downstream mediator of IL-1's effects in the CMS paradigm. Finally, the effects of CMS on both behavioral depression and neurogenesis could be mimicked by exogenous administration of IL-1 β via osmotic minipumps for 4 weeks. These findings indicate that elevation in brain IL-1 levels, which characterizes many medical conditions, is both necessary and sufficient for producing the high incidence of depression found in these conditions. Thus, procedures aimed at reducing brain IL-1 levels may have potent anti-depressive actions.

FT1-5

一 项有关叶酸、维生素 B12 、同型半胱氨酸水平与老年抑郁症相 关性的前瞻性社区研究 - A Prospective Community Study of Folate, Vitamin B12, Homocysteine Levels and Late-life Depression

Jae-Min Kim 1 , Robert Stewart 2 , Sung-Wan Kim 1 , Su-Jin Yang 1 , Il-Seon Shin 1 , Jin-Sang Yoon 1
1 Chonnam National University Medical School , Gwangju , Korea , Republic of, 2 King's College London ( Institute of Psychiatry ), Section of Epidemiology, London , United Kingdom

目的 ： 研究 单碳物质代谢的 核心成分与老年抑郁症的横向和 纵向相关性。

方法 ： 732 名 65 岁以上的韩国人接受了基线评估 ， 其中 631 人无抑郁症状 ， 在 这些无症状的人中 ， 有 521 人接受了 为期两年半的随访。在基线和随访中均测定了抑郁症状和血清叶酸、维生素 B12 、同型半胱氨酸水平。

结果： 基 线水平的抑郁与低维生素 B12 和高同型半胱氨酸水平相 关，但与叶酸水平无关；随访中发生的抑郁与基线时的低叶酸、维生素 B12 水平和高同型半胱氨酸水平相 关；随访中发生的抑郁还与随访期间的维生素 B12 水平降低和同型半胱氨酸水平升高相 关。

结论： 低叶酸、 维生素 B12 水平和高同型半胱氨酸水平与随 访中抑郁的发生相关， 支持 单碳物质代谢与抑郁的病因相关。

Objectives: To investigate cross-sectional and prospective associations between key components of one-carbon metabolism and late-life depression.

Methods: 732 Korean people aged 65+ were evaluated at baseline. Of 631 non-depressed, 521 (83%) were followed after 2.5 years. Depression (GMS) was ascertained, and serum levels of folate, vitamin B12 and homocysteine were assayed at both baseline and follow-up assessments.

Results: Depression at baseline was associated with lower vitamin B12 and higher homocysteine levels but not with folate levels. Incident depression at follow-up was associated with lower levels of folate and vitamin B12 at baseline, and with higher homocysteine levels. Incident depression was associated with a decline in vitamin B12 and an increase in homocysteine levels over the follow-up period.

Conclusion: Lower folate, lower vitamin B12 and raised homocysteine levels predicted incident depression, supporting an aetiological role of one-carbon metabolism.

FT1-6

全球化透视中国女性自杀之谜 - The Riddle of Chinese Female Suicide in a Global Perspective

Moshe Hazani 1
1 Bar Ilan University , Jerusalem , Israel

以往研究 认为中国女性自杀 （ suicide by Chinese women, 简称 SCW ） 的 发生率 （ 1 ） 在某些区域是最高的 ；（ 2 ） 明 显高于男性 ， 世界唯一 ；（ 3 ） 农村女性最高 ， 不同于世界其 它国家。本研究在 这些问题上进一步探讨。首先， SCW 常常 见于抑郁症（同西方国家）。但 SCW 中只有 40% 的 农村自杀女性显示有精神疾病（而一般情况下，平均 63% 女性自 杀同时有精神疾病）。其次， SCW 的 发生率事实上也不是世界上最高的，印度南部女性自杀的发生率更高（ 200 ， 000 ， 000 人以上），并且女性也高于男性。更 为明显的， SCW 常常 归因于贫穷、社会地位低、无望、强制婚姻、虐待、担负农业劳动、缺乏自我价值及一些类似的原因。但在印度南部都市受教育女性显示了最高的自杀发生率；在较不发达的 Uttar Pradesh 自 杀发生率反而较低。这种全球模式下中国女性自杀截然不同的现象很难用文化差异来解释，因为中国乡村的危险因素也同样见于其他国家的乡村。因此 ， 我们还远不能理解 SCW 之 谜。未来研究有必要在比较学和人类学方面进一步展开。

The rate of suicide by Chinese women (henceforth SCW) (1) is said to be the highest in the world, in certain areas; (2) is higher than the rate for men—the only such case in the world; and (3) is highest among rural females, unlike other parts of the world. This paper calls into question the basic premises of most current studies of SCW. First, SCW is often viewed as caused by depression (as is in the West). However, only 40% of young female suicides from rural areas exhibited mental illness (as compared to a 63% average. Second, the rate of SCW is not, in fact, the highest in the world: the suicide rate is higher among women in southern India (population: over 200,000,000), and there too the rate is higher for women than for men. Most significantly, the high rate of SCW is generally attributed to poverty, low social status, hopelessness, forced marriages, abuse, the burden of agricultural labour, a lack of self-worth, and similar factors. Yet in southern India it is urban educated women who exhibit the highest rate; the suicide rate is lower in less-developed Uttar Pradesh. The Chinese inversion of the global pattern can hardly be attributed to cultural differences, because the risk factors in the Chinese village are the same as those in other cultural contexts. Thus we are far from understanding the riddle of SCW. Further research, drawing on comparative and anthropological studies, is clearly necessary

FT2 - 精神病性 障碍 - Psychotic Disorders

Chairs: Zheng Lu, Chinese Mainland
Tarek Okasha , Egypt

FT2-1

不同精神分裂症 亚型与器质性精神病中的妄想痴呆症状 - Some Features of Paraphrenic Disorders in Different Types of Schizophrenia and Exogenous-organic Psychoses

Harutyun Robert Davtyan 1 , Armeniam Association of Psychiatrists
1 'Avan'Clinic of Psychiatry Medical Center , First Men's Department, Yerevan , Armenia

方法 ： 研究 对象包括 50 例精神分裂症患者、 35 例外源性器 质性精神病患者 ， 我们对他们进行了临床病理心理学评估、神经病学相关检测 ， 包括 ： EEG （ 脑电图 ） 、 EchoEG （？） 、神 经 - 眼科学 检查。

结果 ： 我 们发现在上述两种疾病 ， “ 妄想痴呆 综合征 ” 的 临床特 征不一 样。在持续性进行性精神分裂症， “ 妄想痴呆 综合征 ” 在妄想 发展的第三阶段才会出现，疾病的过程附属于 “ 马尼安综合征 ” （慢性可卡因中毒 时的症状），随之发生变化。在 55% 的持 续性进行性患者中，存在混合型与幻想虚构的妄想痴呆症状；而相对较少的，在 45% 的患者中，有 较为系统的与扩张性的妄想痴呆症状。在间歇进行性与反复发作性精神分裂症患者，妄想痴呆的症状（ 58% ）更多出 现在疾病的第一阶段，而在经历了 “ 情感 - 幻听症状 ” ， “ 情感 - 精神 错乱症状 ” ， “ 类躁狂 - 抑郁 样发作 ” 后 5 到 10 年的 时间内，妄想痴呆的症状会减少，占 32% 。在 间歇性进行性与反复发作的精神分裂症，症状的变化的模式有如下的特点：即从 “ 躁狂 样情感障碍 ” 发作或者 “ 抑郁 样情感障碍 ” 发作逐渐发展到 “ 情感 - 精神 错乱状态 ” ，或者从前者 发展到以 “ 紧张症状群 ” 为主要表现的过程。

在外源性器 质性精神病伴有妄想痴呆症状的患者，我们进行随访观察发现精神症状的演变首先从情感性症状（包括类躁狂或类抑郁样发作）到情感 - 幻听症状群，再从前者到情感 - 精神 错乱状。妄想痴呆症状的发作具有虚构的特点，或者伴有幻听的症状。

在精神分裂症患者，人格的改 变通常分为内向型，妄想痴呆型。在外源性器质性精神病，人 格改 变总在器质性疾病的基础上出现。

结论： “ 妄想痴呆 综合征 ” 的症状在精神分裂症与外源性器 质性精神病的表现不一样，包括在病程演变、以及疾病症状群模式的转变、主要症状的病理动力学、症状动力学方面的不同。

Methods: We have studied 50 patients with Schizophrenia and 35 patients with exogenous-organic psychoses. Clinical psychopathological, neurological, including EEG, EchoEG, neurophthalmological investigations were done.

Results: We revealed that clinical features of paraphrenic delusions are different in both mentioned psychoses. In continuously progredient schizophrenia paraphrenic syndrome arises in third paraphrenic phase of disease, and the course of disease is strongly subordinated to Magnan's syndromes alternation. In 55 % of cases the paraphrenic syndrome has the course of mixed and fantastic confabulatory paraphrenia.

Comparatively rare, in 45 % cases, the syndrome has the form of systematized and expansive panaphrenia. In paroxysmal progredient and recurrent schizophrenia the studied syndrome arises more often (58 %) during the first manifestation of disease, relatively rare (32 %) five to ten years after the affective-hallucinatory, affective-delirious and maniacal-depressive attacks. In paroxysmal progredient and recurrent schizophrenia the stereotypes of syndrome alternation is characterized by transition from affective maniacal or depressive to affective-delirious and from the last to omneroid-catatonic. In exogenous-organic psychoses with paraphrenic conditions we observed transition from affective (maniacal or depressive) syndromes to affective-hallucinatory and from the last to affective-delirious. Paraphrenic attacks have a course of confabulatory or hallucinatory paraphrenia. In schizophrenia the personality changes basically are taking autic or paraphrenic type. In exogenous-organic psychoses the personality changes precede organic types.

Conclusion: Paraphrenic disorders in schizophrenia and exogenous-organic psychoses are different in the course and stereotype of transmission pathokinesis, syndromokinesis or syndromotaxis of leading syndrome in dynamics.

FT2-2

对精神病早期发作的社会心理急性治疗 ： 美国和欧洲的模式 - Psychosocial Acute Treatment in Early Episode Psychosis: American and European Models

John R Bola 1 , Johan Cullberg 2 , Klaus Lehtinen 3
1 University of Southern California, School of Social Work, Los Angeles, United States, 2 Danderyd Hospital, Stockholm, Sweden, 3 Tampere University Hospital, Tampere, Finland

目的 ： 本 论文回顾了在美国和欧洲对精神分裂症谱系精神病早期发作的社会心理急性治疗。

方法 ： 没有直接用 药物治疗 ， 且已经发表的有实证性评估的社会心理治疗被纳入本研究。我们回顾了理论导向，描述了治疗，比较了治疗方法。

结果： 对在美国的 Soteria, 在瑞士的 Soteria-Bern, 芬 兰的适应需要治疗和瑞典的 Parachute 项目进行了回顾。除了在芬兰，每个项目都发展了一种特别的治疗环境以作为急性住院治疗的备选方案。芬兰的适应需要治疗通过应用基于系统家庭治疗的整合的治疗方法，聚焦于在医院的病房和家庭中创造促进健康的交互环境。 Soteria 项目聚焦于发展基于同伴的社会支持网络。 Soteria-Bern 则更直接地让家庭参与到治疗中。瑞典和芬兰的模式采用了交叉学科的流动危机小组来进行首次接触。

结论： 对于首次发作的精神分裂症谱系病人，每一种治疗方案的 2 年到 5 年的 结局都稍优于对照， 32 ％到 43 ％的意向治 疗病人在治疗的头 2 － 3 年没有服用抗精神病 药，因此减少了药物依赖和药物副作用。急性社会心理治疗的发展者可以考虑整合这些成功的治疗方案中的有用元素。

Objective: This paper reviews psychosocial acute treatments for early episode schizophrenia spectrum psychoses developed in the United States and Europe .

Methods: Psychosocial treatments not immediately medicating all subjects and with published empirical evaluations were included. We review theoretical orientations, describe treatments, compare and contrast the treatment approaches.

Results: Soteria in the United States , Soteria-Bern in Switzerland , the Finnish Need-adapted Treatment and the Swedish Parachute Project are reviewed. Except in Finland , each program developed a special therapeutic milieu as an alternative to acute hospitalization. Finnish Need-adapted treatment focused on creating health promoting interactional environments in hospital wards and families by applying an integrated therapeutic approach build upon systemic family therapy. The Soteria program focused on developing peer-based social support networks. Soteria-Bern more directly involved families in treatment. The Swedish and Finnish models employed an interdisciplinary mobile crisis team for first contact.

Conclusions: Each treatment has been evaluated with comparable to slightly better 2- to 5-year outcomes in treating first-episode schizophrenia spectrum patients. In addition, 32% to 43% of intent-to-treat patients did not receive antipsychotic medications over the first 2-3 years of treatment, thereby reducing medication dependence and side-effect exposure. Developers of acute psychosocial treatments may want to consider incorporating elements of these successful treatment models.

FT2-3

利 兹 “ 庄家 ” 结果调查 - Leeds Outcomes Stakeholder Survey - LOSS Study

Clive E Adams 1 , Vinaya Bhagat 2 , Nishant Bhagat 2 , Pranathaman Bhoopathi 1 , Vanessa Pinfold 3 , Hany El-Sayeh 4 , Yahya Takriti 2 , Jun Xia 1
1 University of Leeds, Cochrane Schizophrenia Group, Leeds, United Kingdom, 2 Aire Court Community Unit, Lingwell Grove, Leeds Mental Health Teaching NHS Trust, Leeds, United Kingdom, 3 Rethink, London, United Kingdom, 4 Briary Wing, Harrogate District Hospital, Harrogate, United Kingdom

背景知 识 ： 有很多 评价药物对精神分裂症疗效的随机对照研究 ， 这些研究给我们提供的信息有不同程度的 偏倚 ， 大多数的研究都提到了自身研究的缺陷 ， 但是 还不知道这种由于研究本身的偏倚造成的真实信息损失严重到何种程度的时候 ， 临床医生、研究者、 “ 服 务的接受者 ” （ 患者 ） 以及他 们的照顾者会认为研究的结果是没有意义的。由于不知道以上这些重要的 “ 庄家 ” 是怎 样看待这些随机对照研究的，对资料进行荟萃分析的人也不能根据资料的实际有用程度作出取舍。为了估计在临床医生、研究者、 “ 服 务使用者 ” （患者）看来， 这些研究实际可以被接受的信息损耗程度，我们设计了本研究。

方法： 通 过使用邮寄或者电子邮件传递调查问卷进行研究，使用 2006 年 3 月的 预试验调查问卷（ March 2006 Piloted questionnaire ），只 询问一个问题：在一个关于精神分裂症的随访研究中，询问有关研究对象脱落的问题。样本量及对象： 100 名来自 Yorkshire Deanery 精神科医生、 100 名从事精神分裂症研究的研究者（他 们的电子邮件地址是面向大众公开的）、 100 名 经过反复思考选取的 “ 服 务使用者 ” （ RETHINK service users ）。

结果： 我 们首次在卫生领域进行了此类研究，主要的评价指标是在不同的调查对象看来，可以接受的在治疗精神分裂症药物研究 中脱落的病人数目。 这种粗略的估计可以帮助研究这解释研究的结果 ， 尤其是当研究的 “ 信息 损耗 ” 超出了 预先估计值。

Background: There is variable attrition from randomised controlled trails (RCTs) evaluating treatments for the people with schizophrenia. Though most of these studies mention high attrition rates as a weakness, it is unclear at what degree of loss from such studies clinicians, researchers and service users or their carers begin to consider the results meaningless. Those undertaking systematic reviews do not have empirical data upon which to make decisions regarding the utility of such data as perceived by important stakeholders.

Aim: To derive estimates for subjectively acceptable attrition rates in schizophrenia RCTs as viewed by three different groups of stakeholders (clinicians, researchers and service users).

Method: Postal/e-mail survey – March 2006 Piloted questionnaire asking a single question regarding loss to follow up in a schizophrenia trial. Sampling frame – 100 consultant psychiatrists from Yorkshire Deanery; 100 schizophrenia trialists whose e-mail is publicly available; 100 RETHINK service users.

Outcome: This study is the first of its kind in health care. The main outcome measure will be a broad estimate of the acceptable level of drop-outs in schizophrenia drug trials as viewed by the different groups of stakeholders. This crude estimate will help encourage caution when interpreting results of trials where attrition exceeds this estimate.

FT2-4

老年抑郁型与双相分裂情感性精神病 - Geriatric Depressive and Bipolar Schizoaffective Disorders

Xiaolei Y Baran 1 , Robert C Young 1
1 Cornell Institute of Geriatric Psychiatry, New York Presbyterian Hospital , White Plains , New York , United States

背景知 识 ： 在回 顾以前的关于老年分裂情感性精神障碍的相关研究后 ，（ baran young 2006 ）， 我 们发现双相障碍型分裂情感性精神病在这些病人很常见。根据这些初步的研究经验，我们扩大样本进一步研究，并提出假设：老年抑郁型分裂情感性精神病与双相型分裂情感性精神病相比，在自杀企图与先前的治疗方案这两个方面存在差异。

方法： 我 们回顾性的研究了年龄大于 60 岁、 1996-2000 年期 间、在某所大学教学医院精神科就诊并根据 DSM-IV 被 诊断为 “ 分裂情感性精神病 ” 患者的病 历纪录。排除物质依赖、患急性躯体疾病、精神发育迟滞得患者。 根据 DSM-IV 诊断标准将患者分为抑郁型或者双相型分裂情感性精神病。

结果： 符合研究入 组标准的 109 位患者大部分是女性（ 71.4% ）、白人（ 72.5% ）、双相型分裂情感性精神病患者（ 73.4% ）。抑郁型分裂情感性患者有更多比例的自 杀史（ 41.4% ），抗抑郁治 疗史（ 51.7% ），或者 ECT 治 疗史（ 17.2% ），而双相型分裂情感性精神病患者以上各 项分别是 20.0 %, Fisher p = 0.045; 20 %, p = 0.002; and 5 %, p = 0.054 。与抑郁型患者相比（ 3.4 %, p = 0.005 ），双相型患者更多接受 锂盐的治疗（ 27.5% ）。与双相型患者相比，抑郁型患者（ 20.7% ）有更多精神分裂症患者（ 7.5 %, p = 0.079 ）的家族史。

结论： 这些从扩大的样本研究中得出的结论证明双相型分裂情感性精神病在老年患者中更常见，在抑郁型与双相型分裂情感性精神病患者中存在着明显的临床差异，这些差异的存在为今后关于疾病临床特征的研究、医疗干预以及结果的研究提供了依据。

Background: In a preliminary sample from a retrospective chart review of geriatric inpatients with schizoaffective disorder (Baran &Young 2006), we found that bipolar type was prevalent among these patients. We studied an expanded sample and hypothesized, based on initial findings, that histories of suicide attempt and of prior treatment would differ between elders with depressive and bipolar schizoaffective disorders.

Methods: Charts of patients aged >60 years older admitted to a university teaching hospital psychiatric service (1996-2000) with a discharge diagnosis of schizoaffective disorder by DSM-IV were reviewed. Patients were excluded who had active substance abuse, acute medical illness, or mental retardation. Patients were characterized as depressive or bipolar type according to DSM-IV criteria.

Results: The 109 patients who met criteria for the study were predominantly female (71.4 %), Caucasian (72.5 %) and bipolar type (73.4 %). More depressive type patients had history of suicide attempt (41.4 %) and antidepressant (51.7 %) or ECT treatment (17.2 %) compared to bipolar type patients (20.0 %, Fisher p = 0.045; 20 %, p = 0.002; and 5 %, p = 0.054, respectively). Bipolar patients more often had history of lithium treatment (27.5%) compared to depressive patients (3.4 %, p = 0.005). Depressive patients tended to have more family history of schizophrenia (20.7 %) compared to bipolar patients (7.5 %, p = 0.079).

Conclusions: These findings from an expanded sample provide further evidence that bipolar type can be prevalent among geriatric schizoaffective inpatients, and that clinically meaningful differences exist between bipolar and depressive types. These subtypes may be useful in further studies of clinical features, interventions and outcomes.

FT2-5

长期使用苯二氮卓类药物的临床和社会决定因素以及对中国精神分裂症患者生活质量的影响 - Clinical and Social Determinants of Long-term Use of Benzodiazepines and its Impact on Quality of Life of Chinese Schizophrenia Patients

Yu-Tao Xiang 1 , Gabor Sandor Ungvari 2
1 The Chinese University of Hong Kong, Psychiatry, Hong Kong, Chinese Hong Kong, 2 The Chinese University of Hong Kong, Hong Kong, Chinese Hong Kong

目的 ： 至今 还没有研究调查中国精神分裂症门诊病人苯二氮卓类药物 （ BZDs ） 的 处方模式。本研究调查中国香港和北京的 BZD 处方的频率和社会人口学和临床的相关性。

方法： 香港和北京的 550 例 临床稳定的精神分裂症门诊病人被随机选择，经标准化的评估工具被访谈。基本的社会人口学和临床数据和精神科药物处方在诊断访谈时被收集。

结果： 总样本中 151 例（ 29.9 ％）病人使用 BZDs ；香港和北京 样本分别是 25.1 ％和 34.8 ％。 BZDs 的使用是伴随性 别、职业状况、自杀史、较少使用氯氮平、更多使用典型抗精神病药（ APs ）、更高 剂量的 APs 、阳性症状的 严重度、锥外系副反应（ EPS ）和失眠。在多重 logistic 回 归分析中，抑郁症状的严重度、研究地点、性别、职业状况、较少使用氯氮平和自杀史保持和 BZDs 的 显著相关。

结论： 虽然两个样本的人种和临床特征基本一致，但是香港和北京之间 BZD 处方的频率有明显差别，提示社会文化和经济因素以及精神科训练和实践在决定 BZDs 使用中起作用。两个研究地点的 BZDs 处方都不符和目前的推荐标准。

Aims: To date there have been no studies investigating prescription patterns of benzodiazepine agents (BZDs) in Chinese outpatients with schizophrenia. This study examined the frequency and socio-demographic and clinical correlates of BZD prescription in Hong Kong (HK) and Beijing (BJ), China .

Methods: Five hundred and five clinically stable outpatients with schizophrenia were randomly selected and interviewed in HK and BJ using standardized assessment instruments. Basic socio-demographic and clinical data and psychotropic drug prescriptions were collected at the time of a diagnostic interview.

Results: One-hundred and fifty one (29.9%) patients were prescribed BZDs in the whole sample; 25.1% and 34.8% of the HK and BJ samples, respectively. Use of BZDs was associated with sex, employment status, history of suicide, less use of clozapine, more frequent use of typical antipsychotics (APs), higher doses of APs, severity of positive symptoms, extrapyramidal side effects (EPS) and insomnia. In multiple logistic regression analysis, severity of depressive symptoms, study site, sex, employment status, less use of clozapine and history of suicide remained significantly associated with BZDs.

Conclusion: Although the ethnic and clinical characteristics of the two samples were nearly identical, there was a wide variation in the frequency of BZD prescriptions between HK and BJ suggesting that socio-cultural and economical factors as well as traditions of psychiatric training and practice all played a role in determining the use of BZDs. Prescribing BZDs in neither site was in line with current recommendation.

FT3 - 基 础研究 - Basic Research
Chairs: Fujun Jia, Chinese Mainland
Charles R Marmar, United States

FT3-1

LORETA 显示分裂型人格障碍和精神分裂症同胞有 P300 异常 - P300 abnormality in Schizotypal Personality Disorder and Siblings of Schizophrenia Revealed by LORETA

Hiroto Hokama 1 , Wang Jijun 2 , Lin Hongquan 3 , Akira Toyozato 4 , Hiroshi Miyazato 4 , Tsuyoshi Kondo 5
1 Ryukyu University, School of Medicine, Department of Neuropsychiatry, Nishihara, Okinawa, Japan, 2 Shanghai Mental Health Center, Shanghai, Chinese Mainland, 3 Guangxi Medical University, The Sixth Affiliated Hospital, Department of Neurology, Guangxi, Chinese Mainland, 4 Okinawa-Chuo hospital, Okinawa, Japan, 5 Ryukyu University, School of Medicine, Department of Neuropsychiatry, Nishihara, Japan

事件相 关电位 P300 的减少是精神分裂症最 强有力的生物 学 发现之一 ， 该现象同时也存在于有精神分裂症高发风险的人群中 ， 包括分裂型人格障碍和精神分裂症的一级亲属。然而 . 这些不同的人群是否有相同的 P300 异常却不得而知。本研究用 LORETA (low resolution brain electromagnetic tomography) 对这两组分裂症的高危人群进行了 P300 异常的 检测。第一组为 9 例由分裂型人格障碍 问卷 (SPQ) 筛选出来的分裂型人格障碍大学生，第二组为 10 例分裂症同胞。与性 别 / 年 龄相匹配的正常人群相比，这两组高危人群的 P300 减少，分裂型人格障碍人群的左 侧优势半球颞区的 P300 皮 层电流密度减少，而分裂症同胞则右侧额叶区 P300 皮 层电流密度减少。这些结果提示分裂症的症状学及遗传学高危人群存在 P300 减少 ， 且可能存在有不同 P300 神 经通路的失调。

The reduction of P300 component of Event-Related Potentials in schizophrenia is one of the robust biological findings of schizophrenia. It is also known to exist among subjects at high risk for schizophrenia, including Schizotypal Personality Disorder (SPD) subjects and the first-degree relatives of schizophrenia. However, whether the different groups of high risk subjects have the same or different neural origins of P300 abnormality has not yet been explored. The present study examined P300 abnormality in two high risk groups of schizophrenia with LORETA (low resolution brain electromagnetic tomography). The first group was consisted of nine SPD subjects recruited from university students using Schizotypal Personality Questionnaire (SPQ). The second group was consisted of ten siblings of schizophrenic patients. ERPs were recorded using oddball paradigm. In both high risk groups, P300 was reduced as compared to their sex/age matched normal controls. Reduction of P300 cortical current density was observed in temporal region with left dominancy in SPD subjects. The siblings of schizophrenia showed reduction of P300 cortical current density in the right frontal region. These results suggest that P300 reduction in both symptomatological and genetic high risk groups of schizophrenia might have different origin of disturbance in the neural circuitry for P300 generation.

FT3-2

不同磁共振成像 （ MRI ） 方法 对精神分裂症患者白质异常的比较研究 - Comparison of in vivo MRI Methods for Detection of White Matter Abnormalities in Schizophrenia

Kelvin O Lim 1 , Bryon A. Mueller 1 , Jeffrey R. Wozniak 1 , Ryan L. Muetzel 1 , Peter J. Fried 1
1 University of Minnesota , Psychiatry, Minneapolis , United States

目的 ： 加 权灰阶反转成像 （ T2R ） 方法可 对大脑髓质周围水分进行选择性成像 ， 其横向弛豫时间 (T2~10ms) 明 显短于细胞内外水分 (T2~65ms) 和 脑脊液 (T2 ＞ 500ms) ， 其数据采集是 应用一种新型的多回声、多断层、线性组合方法。该项研究直接比较三种成像方法，即弥散张量成像 (DTI) 、磁化 转移成像 (MTI) 和加 权灰阶反转成像 (T2R) ， 对精神分裂症白质异常研究的敏感性和特异性。

方法： 受 试者包括 22 例慢性精神分裂症患者（ 13 例女性）和 24 例年 龄相匹配的健康人（ 13 例女性），年 龄介于 21-57 之 间，平均年龄为 38.4 ，使用 CON=40.2 MRI 扫描仪 （型号 Siemens Trio, 8 通道 线圈 ) T1 加 权使用 MP-Rage 序列（磁化准 备快速采集梯度回波三维成像） , TR/TE 2530/3.65ms, 1mm 各向同性 质子密度成像采用 TSE 序列 , TR/TE 8550/14ms, 1x1x2mm 弥散加 权成像 : TR/TE 8500/90, 64 层 , 2mm isotropic, 30 directions Field: GRE, TR/TE 700/4.62&7.08, 64 slices, 2mm isotropic 磁化 转移成像采用 3D GRE 序列 , TR/TE 31/3.85ms, 2x1x2mm 加 权灰阶反转成像采用 2D SE 序列 , 每 层均平行于听眦线 TR/TE=1290/8, 1310/33, 1390/110, 共 连续采集 12 层 , 2x2x8mm 。 图像处理方法： 磁化 转移率以像素值为基础进行计算，即磁化转移得出的图像像素值和无磁化转移的图像像素值之差除以无磁化转移图像的像素值。弥散张量的计算是在经涡流矫正后的图像上进行的，接着标量图采用结合了多种 FSL 软件中的方法的自主软件进行变形的矫正。经三种 加 权灰阶反转成像采集的数据通过组合获得对髓鞘中水的分数的估计，它被定义为髓鞘中的水除以总的水的信号。白质 ROI 的定 义：采用 T1 和 质子图像经组织分割后得到的白质的蒙相来选择应用于白质评价的体素。在额部和上部区域的白质进行组间差异的评价。额部区域被定义为经过胼胝体膝部前缘并与 AC-PC 连线垂直的冠状面以前的区域，胼胝体上区被定于为在正中层面经过胼胝体上缘与 AC-PC 平行的平面以上的区域。蒙相被 应用于原始采集得到的数据，用于计算的体素至少涵盖了用于计算局部平均值的白质的 50% 。

结果： 2 组受试者平均年龄无显著差 异。 应用独立样本 t 检验对 2 组间的 6 组数据进行比较：各向异性分数、平均弥散率、辐射弥散张量、轴向弥散张量、磁化转移率和髓质成分。初步研究结果显示，同对照组受试者相比，精神分裂症患者额叶白质各向异性分数减低和平均弥散张量增高，与其他一些研究报道相一致。 2 组间 MTR 和 T2R 数据无差异。

结论： 本研究 结果重复了之前研究使用弥撒张量方法所发现的精神分裂症患者白质异常的表现，扩大样本量有可能发现 MTR 和 T2R 数据的 组间差异。进一步研究方向包括，对分析其他感兴趣区、进行以像素为基础的比较分析、以及比较首发精神分裂症患者 同与之性 别、年龄想匹配的健康对照人群之间的差异。

Objectives: Previous MRI studies have found white matter abnormalities in subjects with schizophrenia. Imaging methods that have been used to examine white matter composition in schizophrenia include diffusion tensor imaging (DTI), magnetization transfer imaging (MTI), and T2 relaxography (T2R). DTI measures the self diffusion of water molecules and provides a measure of tissue microstructure organization based on the spatial diffusion profile. MTI provides a measure of protons bound to large molecules and has been used as a measure for myelin damage. T2R selectively images myelin-bound water based on the dramatically shorter transverse relaxation time (T2~10ms) relative to intra/extra cellular water (T2~65ms) and CSF (T2>500ms). Differences between patients with schizophrenia and control subjects have been observed with all three imaging methods, however no direct comparison between all three methods has been reported. We are conducting a neuroimaging study of patients with schizophrenia and age matched controls in which the three modalities (DTI, MTI, T2R) are collected on each subject. T2R data is collected using a novel multi echo, multi slice, linear combination method that allows for multi-slice collection.

Methods:

Participants

? 22 Chronic Schizophrenia (13 male)

? 24 Age-Matched Controls (13 male)

? Ages 21-57, mean age SZ=38.4, CON=40.2

MRI Scans (Siemens Trio, 8 channel Coil)

? T1: MP-Rage, TR/TE 2530/3.65ms, 1mm isotropic

? PD: TSE, TR/TE 8550/14ms, 1x1x2mm

? DTI: TR/TE 8500/90, 64 slices, 2mm isotropic, 30 directions

? Field: GRE, TR/TE 700/4.62&7.08, 64 slices, 2mm isotropic

? MT: 3D GRE, TR/TE 31/3.85ms, 2x1x2mm

? T2R: 2D SE, AC-PC aligned,

TR/TE=1290/8, 1310/33, 1390/110, 12 consecutive slices, 2x2x8mm

Image Processing Methods: The magnetization transfer ratio (MTR) was computed on a voxel-wise basis, as the difference between the data without and with MT, divided by the value without MT. The diffusion tensor was computed from the eddy current corrected volumes, and the scalar maps were then distortion corrected using custom software incorporating multiple FSL routines7. Data from the three T2R acquisitions were linearly combined to obtain estimates of the myelin water fraction (MWF), defined as the myelin water divided by the total water signal.

Definition of the White Matter ROIs: A white matter mask derived from tissue segmentation created from the T1 and PD images was used to select voxels to include in the white matter evaluation. White matter in frontal and superior regions was evaluated for group differences. The frontal region is defined as anterior to the coronal plane located at the anterior extent of the genu and perpendicular to the AC-PC line and the supracallosal region is defined as superior to the AC-PC aligned plane located at the superior extent of the corpus callosum at the midline. The masks were translated to the original acquisition, and voxels estimated to be at least 50% white matter were included in the computation of the regional averages.

Results: There was no significant difference in the mean age of the two groups. Independent groups t-tests were used to compare mean values between groups (schizophrenia vs. control) on six measures:

? Fractional Anisotropy

? Mean Diffusivity

? Radial Diffusion

? Axial Diffusion

? Magnetization Transfer Ratio

? Myelin Fraction

These preliminary results show reduced FA and increased MD in frontal and superior white matter in subjects with schizophrenia relative to controls, in line with published results from other studies. No significant differences were observed in the MTR and T2R data.

Conclusions: These results reproduce previous reports of DTI detected abnormalities in white matter in schizophrenia. Inclusion of additional subjects may reveal group differences in the MTR and T2R data. Future plans include analyses of additional regions of interest, voxel based analyses, and comparisons of first episode schizophrenics to age and gender matched controls.

Acknowledgments: This work is supported by NIH MH060662-05, 5P41RR008079-13, NIH NCRR M01-RR00400 and the MIND Institute.

FT3-3

对抑郁症患者进行简易 - 脉冲式 电休克治疗过程中的脑电图变化研究 - Electroencephalography Changes Following Brief-Pulse Electroconvulsive Therapy in Patients with Depression

Kenichi Matsumura 1 , Masako Matsuda 2 , Akihisa Akahane 1 , Osamu Kanno 1 , Shinichiro Nanko 1
1 Teikyo University School of Medicine, Department of Psychiatry, Tokyo , Japan , 2 Teikyo University School of Medicine, Tokyo , Japan

日本自 2002 年引入能 产生简易脉冲式电流的电休克机器。简易脉冲式电休克 （ BP-ECT ） 引起的 认知损伤比传统的使用正弦波刺激的电休克 （ C-ECT ） 轻微得多 。 这就产生了一个问题：事实上是否 BP-ECT 对脑功能的影响较轻微或者比 C-ECT 更 轻。因此，我们通过对脑电图 (EEG) 的 观察来研究 BP-ECT 对脑功能的影响。研究对象为 19 例抑郁症患者， 13 例患者 (68%) 在 EEG 上表 现为广泛性慢波活动，尖波或慢波爆发。在几周到 3 个月内 这些 EEG 变化消失。 13 例病人中， 7 例 (37%)EEG 显示为广泛性慢波活动。所有患者都有认知混乱的表现。其余 7 例患者 EEG 上表 现为慢波爆发， 4 例 显示为尖波活动， 6 例患者有更多的改 变。以往的研究报道提示大多数 C-ECT 治 疗的病人都有 EEG 的改 变 。 这些变化在 98% 的 C-ECT 病例中 3 个月内恢 复，其余 2% 则留下不可逆的 EEG 改 变。 I 相反， BP-ECT 治 疗的患者 3 月内 EEG 变化均可恢复，没有产生不可逆的脑电图改变。因此，可以推断 BP-ECT 对脑功能的影响小，比 C-ECT 轻微。

In Japan , machines which deliver a brief-pulse current for electroconvulsive therapy (ECT) was introduced in 2002. Cognitive impairments caused by Brief-Pulse ECT （ BP-ECT ） are milder and lesser in degree than those caused by Conventional ECT （ C-ECT ） which use sine-wave stimuli. This raises a question of whether the influence of BP-ECT on brain functions are actually milder and/or lesser than those of C-ECT .Thus, we investigated the influence of BP-ECT on brain functions by electroencephalography (EEG). Subjects were 19 patients with depression. 13 patients (68%) showed EEG changes which consisted of generalized slow-wave activity, spike or slow wave bursts. These EEG changes disappeared in a few weeks to 3 months. Among 13 patients, 7 showed (37%) generalized slow wave activity in EEG. All of them revealed symptoms of cognitive disturbances. Other 7 patients showed slow wave bursts, while 4 patients showed spike activity in EEG.. Build up change was observed in 6 patients. In previous paper, majority of the patients showed EEG changes after C-ECT.In 98% of the patients, these changes recovered within 3 months. In the other 2% of the patients, irreversible EEG changes were observed. In contrast, EEG changes after BP-ECT recovered within 3 months and no irreversible EEG changes were observed in all subjects.Thus, it can be concluded that the influence of BP-ECT on the brain functions may be milder and lesser than that of C-ECT.

FT3-4

不断 进行的 GABAA 受体 _2 基因重 组与阳性选择可能是精神分裂症的潜在病因 - Ongoing Recombination and Positive Selection in GABAA Receptor _2 Gene Underlying Schizophrenia Etiology

Hannah Hong Xue 1 , Applied Genomics Center
1 Hong Kong University of Science and Technology, Biochemistry, Hong Kong, Chinese Hong Kong

与精神分裂症相 关的 GABAA- β 2 受体基因的两个独立的 产物 ， 在精神分裂症患者以基因型依赖的模式呈下调表达。本研究揭示了该基因人类特异性的丙氨酸插入突变、在灵长类动物中变异少而在人群中有多种变异的特点以及位于该精神分裂症相关基因非编码区的一个调节元件。从等位基因以及单体型出现的高频率现象以及模拟效应均有利的证明了阳性选择的存在。这些被阳性选择的区域，与一个主动性结合位点在基因区域上有重叠，这一点通过我们的实验室技术得到了证实。这种阳性选择保留了 β2 基因的 长片段， 增加了 GABAA 受体 ATP 偶 联的电敏感度。这种正在不断进行的基因重组是这个遗传区域存在人群差异的基础，使得在精神分裂症患者与正常对照之间存在分子遗传学标志性的差异位点，为精神分裂症病因学分子进化学方面的研究提供了一个佐证。

Two alternatively-spliced products of the schizophrenia-associated GABAA receptor β2 gene (GABRB2) having different current-run-down properties were differentially down-expressed in schizophrenics in a genotype-dependent manner. The present study revealed a human-specific Alu-insertion and a contrast between low primate-divergence and high population-diversity, as well as regulatory elements in this schizophrenia-associated non-coding region. Positive selection was evident from high frequencies of derived alleles and haplotypes, and supported by simulation. The region under positive selection is overlapped with an active recombination hot-spot, experimentally demonstrated in the present study. The selection-favored long-form β 2 increased GABAA receptor electrophysiological ATP-sensitivity. This ongoing recombination-selection, attributable to human population genetic variations in the region, left different signatures in schizophrenics and controls, providing a window to molecular-evolutionary aspects of schizophrenia etiology.

FT4 - 其它 1 - Others Topics 1

Chairs: Tiebang Liu, Chinese Mainland
Enrique Camarena Robles, Mexico

FT4-1

大学生双相情感障碍状况 调查 - Screening for Bipolar Disorder in the University Students

Seung-Oh Bae 1 , Jung-Goo Lee 2 , Tae-Hyon Ha 3 , Young-Hwa Sea 4 , Su-Hee Park 4 , Won-Myong Bahk 5 , Bo-Hyun Yoon 4 , KBF (Korean Bipolar Forum)
1 Damyang Chansarang Hospital, Neuropsychiatric, Damyang, Chonnam, Korea, Republic of, 2 Dong Suh Mental Hospital, Neuropsychiatric, Masan, Kyungnam, Korea, Republic of, 3 Seoul National University Bundang Hospital, Neuropsychiatric, Seongnam, Gyeonggj, Korea, Republic of, 4 Naju National Hospital, Neuropsychiatric, Naju, Chonnam, Korea, Republic of, 5 The Catholic University, Psychiatry, Seoul, Korea, Korea, Republic of

目的 ： 了解 韩国版心境障碍问卷 （ K-MDQ ） 临床应用情况 ， 通过心境障碍问卷对大学生双相 I 型、双相 II 型、双相障碍、 NOS 进行筛查 ， 了解大学生人群双相障碍谱系疾病的发病率。

方法 ： 根据 2005 年 韩国国家统计办公室人口学标准选择 1234 名研究 对象 ， 自 2006 年 11 月 1 日到 2007 年 1 月 31 使用 韩国版心境障碍问卷对上述对象进行双相障碍谱系的疾病筛查 ， 其中 671 名研究 对象符合 K-MDQ 中至少七 项阳性症状 ， 对其中 74 名研究 对象再次进行 SCID 评定。

结果 ： 在研究 对象中 ， 有 54.4% 的学生 (N=671) 至少符合 K-MDQ 的 7 条阳性症状 ; 2.8% 的学生 (N=35)K-MDQ 评估结果为阳性 ， 平均症状得分是 （ 6.9±3.1 ） 。管理或法学院学校学生、男性、寄宿、 乡下学生的 K-MDQ 得分 较高；大学二年纪学生以及基督教徒 K-MDQ 得分 较低，研究结果具有统计学差异。进一步根据功能损害严重度进行分析比较，低损害程度及中等损害程度的两组人群在 K-MDQ 得分上无 显著差异。接受 SCID 访谈的 74 名学生，有 12 名 诊断双相谱系障碍，使用 K-MDQ 诊断双相谱系障碍的发病率为 2.8% 。

结论： K-MDQ 问卷对于筛查在校大学生双相谱系障碍是一个非常好的工具； 2.8% 的阳性 检出率证实多数韩国大学生患有双相谱系障碍。

Objective: This study tested the clinical application of the Korean version of Mood Disorder Questionnaire (K-MDQ), a screening instrument for bipolar I disorder, bipolar II disorder and bipolar disorder, NOS and assess the prevalence of bipolar spectrum disorder in the college population.

Method: 1234 subjects matched demographically to the 2005 Korea National Statistical Office were selected and surveyed from November 1, 2006, to January 31, 2007, using the Korean version of Mood Disorder Questionnaire (K-MDQ) to screen for bipolar spectrum disorder. Also 74 of 671 subjects reported seven of more positive symptoms in K-MDQ were interviewed with SCID (Structured Clinical Interview for DSM-IV).

Results: Among the all population, 54.4% (N=671) of them reported seven of more positive symptoms in K-MDQ and 2.8%(N=35) of them reported MDQ-positive. The mean symptom score of K-MDQ was 6.9±3.1. And variables such as college of management and law, man, self-boarding, rural area were associated with higher score of K-MDQ and sophomore and christian were associated with lower score of K-MDQ statistically. But no differences between minimal impairment group and moderate impairment group in symptom score of K-MDQ according to severity of functional impairment. Of the 74 subjects interviewed with SCID, 12 subjects were diagnosed bipolar spectrum disorder. The prevalence of bipolar spectrum disorder using K-MDQ was 2.8%.

Conclusions: The Korean version of Mood Disorder Questionnaire screening is a useful screening instrument for bipolar spectrum disorder in korean college students. The positive K-MDQ screen rate of 2.8% suggests that many korean college students may suffer from bipolar spectrum disorder.

Key Words: K-MDQ, College student, Bipolar spectrum disorder, SCID, Prevalence.

FT4-2

教育性干预对 2 型糖尿病人及其家庭的生活 质量影响 - Impact of an Educational Intervention on Quality of Life in Patients with Type 2 Diabetes and their Families

Miki Takaishi 1 , Toshinari Saeki 2 , Kazufumi Ishida 3 , Keiko Daikoku 3 , Sachiko Hiraoka 3 , Susumu Tazuma 2 , Shigeto Yamawaki 1
1 Hiroshima University, Psychiatry & Neurosciences, Graduate School of Biomedical Sciences, Hiroshima, Japan, 2 Hiroshima University Hospital, General Medicine, Hiroshima, Japan, 3 Hiroshima General Hospital, Diabetes Metabolism Internal Medicine, Hiroshima, Japan

目的 : 在日本几乎没有研究 关注教育性干预对 2 型糖尿病人及其家庭的影响。当前研究的目 标是调查教育性干预计划对 2 型糖尿病人及其家庭成 员生理、心理、社会因素以及生活质量的影响。

方法 ： 从 门诊人群中连续纳入 2 型糖尿病人参加 为期两周的教育性干预计划 ， 该计划由 Hiroshima 总院糖尿病代谢内科的一个多学科团队 （ 医生 ， 护士 ， 有资格的糖尿病教育者 ， 营养学家 ， 药剂师 ） 提供 14 次干 预。病人及其家属都被告知本研究的目的并签署知情同意书。在干预计划前后，被试及其家庭成员完成 Zung 自 评抑郁量表 (SDS) ， Zung 自 评焦虑量表 (SAS) ，被 试还要求完成糖尿病生活质量量表 (DQOL) 以及 the Problem Areas In Diabetes mellitus (PAID) scale 。同 时，被试的家庭功能在治疗前通过家庭评估程序 (FAD) 测定。这项研究被 Hiroshima 总院以及 Hiroshima 大学 伦理委员会同意。

结果： 从 2006 年 9 月到 2007 年 5 月 为期 9 个月里， 41 个病人中有 38 人以及 22 个家庭成 员入组本研究。病人的 DQOL 分 值显著升高 (t=-3.548, p=.001), 病人 PAID 分 值 (t=3.281, p=.002) 及 SAS 分 值 (t=2.787, p=.008) 以及家庭成 员的 SAS 分 值 (t=3.128, p=.005) 在干 预计划后显著降低。

结论： 本研究的 结果提示教育性干预计划可能提高病人的糖尿病相关生活质量以及情感抑郁和焦虑和家庭的焦虑。有多学科团队进行的教育性干预可能不单单对血糖控制有正性影响，而且对糖尿病人以及其家庭成员的许多心理社会因素有正性影响。由于样本量比较小 ， 家庭功能对 HbA1c 水平的可能相 关性仍需要进一步研究。

Objectives: Very little research in Japan has focused on how an educational intervention affects patients with type 2 diabetes and their families. The present study aimed to investigate the impact of an educational intervention program on physical, psychological, and social factors as well as quality of life in patients with type 2 diabetes and their family members.

Methods: Ambulatory patients with type 2 diabetes were drawn consecutively from the inpatient population participated in a two-week educational intervention program consisted of 14 sessions by a multi-disciplinary team (doctors, nurses, certified diabetes educators, dietitians, pharmacists) at the department of diabetes metabolism internal medicine, Hiroshima General Hospital. Written consent was obtained from the patients and their family members who had been fully informed of the purpose of the study. Before and after the intervention program, the subjects and their family members completed the Zung Self-rating Depression Scale (SDS), the Zung Self-rating Anxiety Scale (SAS), and the subjects also completed the Diabetes Quality of Life (DQOL) and the Problem Areas In Diabetes mellitus (PAID) scale. Furthermore family functioning of the subjects was assessed by the Family Assessment Device (FAD) before the program. This study was approved by the Institutional Review Board and the Ethics Committee of Hiroshima General Hospital and Hiroshima University .

Results: During the 9-month period from September 2006 to May 2007, 38 out of 41 patients and 22 family members were enrolled in the study. DQOL score was significantly increased (t=-3.548, p=.001), and PAID score (t=3.281, p=.002) and SAS score of the patients (t=2.787, p=.008) as well as SAS score of the family members (t=3.128, p=.005) were significantly decreased after the intervention program.

Conclusions: The findings of the present study suggested that the educational intervention program might improve patients' diabetes-related quality of life and emotional distress and anxiety as well as family's anxiety. An educational intervention by a multi-disciplinary team may have positive influence not only on glycemic control, but also on several psychosocial factors among patients with diabetes and their family members. Because of the limitations of small sample size, further research is needed to assess the possibility of family functioning as a related factor with the level of HbA1c.

FT4-3

Abstract withdrawn

FT4-4

香港老年 华人的认知功能损害筛查 - Screening Cognitive Impairment among Elderly Chinese in Hong Kong

Wei-Qun Vivian Lou 1 , Kee Lee Chou 2 , Iris Chi 3
1 The Chinese University of Hong Kong, Social Work, Hong Kong, Chinese Hong Kong, 2 Lingnan University, Politics and Sociology, Hong Kong, Chinese Hong Kong, 3 University of Southern California, School of Social Work, California, United States

按年 龄和性别分层 ， 随机抽取 1540 名香港社区 华人 ， 调查认知功能损害的患病率。采用简短可携带式智能状态量表（ Short Portable Mental Status Questionnaire ， SPMSQ) 作 为筛查工具，将受访者分为正常、轻度、中度和重度认知功能损害四组。根据教育程度校正后，轻、中和重度认知功能损害的患病率分别为 17.6% 、 3.8% 和 1.7% 。与 ADL 量表中的基本生活自理能力相比， 认知功能有损害的老人在 IADL 量表中的高 级生活自理能力（如服药、烹饪、购物和打电话等）的受损更重。香港社区的研究显示，认知功能损害老年人群中女性和 80 岁及以上者更常见，这与中国西部的研究结果相 似。同 应用其他筛查工具的研究相比， SPMSQ 量表 对轻度认知功能损害更敏感，在社区人群的早期检测和制订服务方案中有其优势。

The prevalence of cognitive impairment was determined in a random age- and sex-stratified sample of 1540 community dwelling Hong Kong Chinese, aged 65 years and over. The Short Portable Mental Status Questionnaire (SPMSQ) was used as the screening instrument that differentiates four categories of the respondents – intact, mild, moderate and severe cognitive impairment. The overall education-adjusted prevalence was 17.6% of mild, 3.8% of moderate, and 1.7% of severe group. Compared to basic self care function as accessed by ADL, cognitive impaired elderly showed greater difficulties in higher level of self care tasks as accessed by IADL, such as taking medicine, cooking, shopping, and making the telephone. Similar to statistics in Chinese studies and in the west, cognitive impairment among elderly living in the community in Hong Kong was more common among females and those who aged 80 or above. Compared to studies using other screening tools, SPMSQ is sensitive to mild cognitive impairment, which showed advantages for early detection and service planning at community level.

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