OL1 - Open Lecture 1
Chairs: Juan E. Mezzich, United States
Mingyuan Zhang, Chinese Mainland

OL1-1

全球化 ： 精神病学的 获益和损失 - Globalisation: Gains and Losses for Psychiatry

Norman H. Sartorius 1
1 International Association for the Improvement of Mental Health Programmes, Psychiatry University of Geneva , Geneva , Switzerland

全球化 － 各国 间相互影响的进程将导致世界变为一体 － 给医学和精神病学带来了挑战 ， 希望与风险并存。 理念的相互 渗透 ， 信息共享 将丰富所有国家医学和科学的数据 库 ， 使得精神卫生工作者更有学识 ， 更加了解在世界其他地方获得的经验。这可以帮助他们客观地评估他们的问题和取得 的成 绩，使他们的研究更加有效。这可以帮助他们避免其他人犯的错误，并使他们的成功之路为他人知晓。它可以使人更容易获得在世界其他地方发展出来的现代的药物治疗手段和技术工具，从而便于对精神疾病的诊断和治疗。但是，全球化也给精神卫生服务带来了一些危险因素－这些危险因素大部分源于一个事实：全球化将影响到社会结构，削弱传统的纽带和社区中帮助有困难和生病的人的方式。也许使全球化带来的利益最大化和损害最小化是有可能的：获得这个的一个根本要求是意识到有必要调整精神卫生服务中所用的策略以及调整精神病学知识传播的方式。精神病学的 知 识传播到一个新的地方 ， 在这个地方过去几十年行之有效的一些方式在当今形势下会继续存在的将很少 ， 而很多新的方式 － 在目前可能是很难想像的 － 将会占主导地位。

Globalization – a process of mutual influence of countries which should result in the world becoming one – presents challenges to medicine and psychiatry and holds promise as well as danger for it.

The osmosis of ideas and sharing of information will enrich the data base of medicine and science in all countries and could make mental health workers more knowledgeable and more aware of practices and the experience gained in other parts of the world. It could help them to measure their problems and achievements in an objective way and make their research endeavours more efficacious. It could help them to avoid other people's mistakes and to make their own paths to success known to others. It might make access to modern medications and technological tools developed in other parts of the world easier thus facilitating the diagnostic process and treatment of mental illness. But, globalisation also carries risks for mental health care – most of them stemming from the fact that globalisation will affect the social fabric of society and weaken the traditional ties and ways of helping those in trouble or illness in a community. It is probably possible to maximize gains and minimize losses that globalisation will bring: an essential requirement to achieve this is become aware of the need to adjust strategies used in mental health care and the transmission of knowledge of psychiatry to a new world in which few of the features that were valid in the past several decades will exist in their current form and many new ones -somewhat difficult to imagine at present - will be predominant.

OL1-2

成 瘾障碍中自由意志的神经生物学 - The Neurobiology of Free Will in Addictive Disorders

Nora D. Volkow 1
1 State University of New York , Department of Psychiatry , New York , United States

成 瘾是一种广泛涉及生物学、环境和发展因素的复杂的障碍。应用神经影响学技术联合复杂行为评估模式进行的研究在对成瘾者大脑的神经化学以及功能改变方面取得了非凡的进步。尽管药物的犒赏机制认为和多巴胺大量快速增加有关，恰恰相反，成瘾状态被认为是脑内多巴胺功能显著下降。这种下降和前额叶区包括框前皮质和扣带回功能不良有关。另外，不同研究结果的差异源自于对药物以及药物相关刺激价值的强化，而忽略了其 他 强化因素。抑制控制系 统的功能失调，通过降低成瘾者控制寻求和使用药物的能力，最终导致造成疾病的反复药物摄入。发现通常存在于负责奖赏、动机、记忆和认知控制的大脑回路的平衡被打破，对设计成瘾障碍多管齐下的治疗方案具有很大的意义。

Addiction is a disorder that involves complex interactions between a wide array of biological environmental and developmental variables. Studies employing neuroimaging technology paired with sophisticated behavioral measurement paradigms have led to extraordinary progress in elucidating many of the neurochemical and functional changes that occur in the brains of addicts. Although large and rapid increases in dopamine have been linked with the rewarding properties of drugs, the addicted state, in striking contrast, is marked by significant decreases in brain dopamine function. Such decreases are associated with dysfunction of prefrontal regions including orbitofrontal cortex and cingulate gyrus. In addiction, disturbances in salience attribution result in enhanced value given to drugs and drug-related stimuli at the expense of other reinforcers. Dysfunction in inhibitory control systems, by decreasing the addict's ability to refrain from seeking and consuming drugs, ultimately results in the compulsive drug intake that characterizes the disease. Discovery of such disruptions in the fine balance that normally exists between brain circuits underling reward, motivation, memory and cognitive control have important implications for designing multi-pronged therapies for treating addictive disorders.

OL1-3

抗氧化 剂对迟发性运动障碍的疗效及可能机制 - Antioxidants and the Therapeutic Implications for Tardive Dyskinesia

Dongfeng Zhou 1
1 Beijing Mental Health Center , Beijing Medical University , Beijing , 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 可能与运 动环路神经毒性过程相关。自由基损伤、神经营养因子缺乏可能在 TD 的病理生理机制中 发挥着重要作用。在本研 究采用自由基俘 获剂，通过动物实验和临床研究探索 TD 可能的治 疗方法，并进一步验证 TD 发生的病理生理机制。

目的 :

（ 1 ） 观察 VitE 对氟哌啶醇诱导的 TD 动物模型异常不自主运动症状的影响；观察 TD 动物模型血清 SOD 活性、 MDA 浓度和基底节部位组织病理学的改变。

（ 2 ） 评估 VitE 和 EGb 对 TD 的 疗效，通过测定治疗前后 SOD 、 Gpx 、 CAT 或 TOC 活性，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抗氧化治疗的机制。

方法 : （ 1 ） 24 只雄性 Sprague-Dawley 大鼠随机分 为 3 组：对照组（生理盐水 + 生理 盐水）、模型组（氟哌啶醇 + 生理 盐水）和 VitE 组（氟哌啶醇 +VitE ），采用口部空嚼运 动评价异常不自主运动的严重程度，运用分光光度法检测血清 SOD 活性和 MDA 浓度。

（ 2 ） 临床研究分 2 部分： 维生素 E 治 疗 TD 的随机双盲 对照研究； EGb-761 治 疗 TD 的随机双盲 对照研究。前者共入组患者 80 例，随机分成治 疗组（ n=40 ）和 对照组（ n=40 ），分 别予维生素 E （ 1200U/ 天）和安慰 剂治疗 12 周；后者共入 组 TD 患者 152 例，随机分成治 疗组（ n=77 ）和 对照组（ n=75 ），分 别予 EGb-761 （ 240mg/ 天）和安慰 剂治疗 12 周治 疗前后分别评定 PANSS 、 SANS 、 AIMS 及 RBANS ，并 测定血浆总抗氧化能力（ TOC ）、血清 MDA 、 BDNF 浓度。

结果 : （ 1 ） 经过 9 周的 处理（注射氟哌啶醇），大鼠血清 SOD 的活性 显著下降， MDA 的 浓度明显升高。 VitE 和 复方中药治疗（共 5 周），不 仅能显著降低 VCM 评分，而且可明显升高模型大鼠血清 SOD 的活力，降低 MDA 的 浓度，该结果与临床研究相符； Nissl 染色的 结果提示，光镜下，未发现各组并在黑质、苍白球部位，细胞形态和密度上的差别； Bax/Bcl2 免疫 组化结果显示，模型组黑质 Bax 阳性 细胞的密度比其它三组要大。

（ 2 ） VitE 和 EGb 均能 显著缓解 TD 的 严重程度； VitE 组和 EGb 组 AIMS 总分减分率均显著高于安慰剂组，分别为 59.0% vs. 7.9% 和 51.9% vs. 5.3% 。

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 ） VitE 能有效提高 SOD 、 GPx 的活性，升高 BDNF 水平（ p<0.05 ），降低血 浆 MDA 浓度（ p<0.05 ）。

（ 4 ） MDA 水平和 AIMS 总分呈显著正相关（ r=0.278, p=0.001 ）。 EGb-761 能 显著降低血清 MDA 水平，升高血 浆 TOC 能力（ p=0.032 ）；安慰 剂组并没有发现这些改变（ p>0.05 ）。 Pearson 相 关分析显示 MDA 水平的降低与 AIMS 总分治疗前后的改变呈正相关 (r=0.198,p=0.09) 。

（ 5 ） VitE 和 EGb-761 均能 显著升高血清 BDNF 水平（ p<0.05 ）。

结论 :

（ 1 ） 自由基 损伤和氧化应激在 TD 的 发病机制中可能起着重要作用。

（ 2 ） VitE 和 EGb-761 能有效 缓解 TD 症状的 严重程度。

（ 3 ） 自由基 损伤和神经营养因子缺乏导致的神经元凋亡、退行性变可能是 TD 发生发展的病生理基础。

关键词 : 迟发性运动障碍 维生素 E 银杏叶提取物 氧化 应激 脑源性神经营养因子

Background: Tardive dyskinesia （ TD ） is a syndrome of late-onset, abnormal and choreoathetoid involuntary movement that develops in some patients who receive chronic neuroleptic medications. However, the pathogenesis still not clear, increasing evidence suggests neuro-excitotoxicity process occurring in motorial circuit may be pathology of TD, free radical damages and neurotrophic factors scarcities might play a role in pathophysiology mechanism. In present study, the patients with TD and animal model received a fixed dose of vitamin E or Extract of Ginkgo Biloba, to investigate the therapeutic implications for tardive dyskinesia.

Aims:

（ 1 ） To investigate the effects of vitamin E treatment on haloperidol-induced orofacial dyskinesia, the serum SOD activity and the MDA concentration and histopathological alterations in the basal ganglia in the TD model animals.

（ 2 ） To evaluate the improvements of vitamin E and EGb on the AIMS in the patients with TD, and To compare the SOD, Gpx, CAT or TOC activity, and MDA, BDNF level between before and after the treatment.

Methods:

（ 1 ） Twenty-four Sprague-Dawley rats were randomly divided into three groups, which include Control （ vehicle + saline ）， Model （ vehicle + haloperidol ）， VitE （ Vitamin E + haloperidol ） . Vacuous chewing movements were assessed during treatment. SOD activities and MDA levels were determined using a standard assay involving spectrophotometric determination, histopathological alterations were observed by using Immunohistochemistry.

（ 2 ） The clinical trials included two parts. a ） Eighty Eligible patients are randomly assigned to receive either vitamin E (1200u/day) (n=40) or placebo (n=40); b ） One hundred and fifty-two patients are randomly assigned to receive either EGb-761 (240mg/day) (n=77) or placebo (n=75 ） . All patients were maintained on a constant, fixed oral dose of antipsychotic medication during the study. The study consists of a 12 weeks of double-blind treatment. Therapeutic effects were evaluated at the baseline and at the end point of research. The SOD, Gpx, CAT or TOC activities, and MDA, BDNF level were measured by using the spectrophotometric determination or ELISA.

Results: （ 1 ） Haloperidol could cause Orofacial dyskinesia in rats, Vitamin E might improve these symptoms (p<0.05), and increase SOD activity and decrease MDA level in serum significantly (p<0.05). Morphological changes of neurons in the substantia nigra and globus pallidus in all groups were not found, but a few Bcl2 positive cells were observed in the substantia nigra and globus pallidus controls. Moreover, Expression of Bax might increase in the TD model rats, VitE might relieve these changes.

（ 2 ） Vitamin E and EGb-761 are markedly effective in reducing the severity of dyskinesia. The results showed that the reduction in AIMS total score from baseline was significantly higher with Vitamin E or EGb-761 treatment compared with placebo (59.0% vs. 7.9% and 51.9% vs. 5.3%).

（ 3 ） Vitamin E might increase the activities of SOD, Gpx and the level of BDNF (p<0.05), and decrease the concentration of MDA (p<0.05) significantly.

（ 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 (p=0.003) and plasma Toc activities increased (p=0.032) markedly after treatment with EGb-761, however, those changes had not been found in placebo group (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 vitamin E and EGb-761.

Conclusions:

（ 1 ） Free radial damage and oxidative stress might play an important role in the pathogenesis of TD.

（ 2 ） Vitamin E and EGb-761 is markedly effective in reducing the severity of dyskinesia in TD.

（ 3 ） Neuronal apoptosis and degeneration were induced by free radical damage and neurotrophic factors deficiencies ， that were underlying pathophysiological mechanism in the development of TD ．

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

OL1-4

21 世 纪精神科医生的认同 - The Identity of the Psychiatrist in the 21st Century

Allan Tasman 1
1 Department of Psychiatry and Behavioral Sciences, University of Louisville , Louisville , United States

上个世 纪精神病学发展迅猛 ， 但与此相伴的是对精神病障碍的理解和干预中对生物 － 心理 － 社会方法的重视减少。举例说， DSM 诊断的变化强调用症状量表来作精神科诊断；神经科学和精神药理的发展强调了躯体的干预；传递系统的变化，以及不充足的精神科医生，使得对病人表现以及治疗的心理侧面的重视减少。该演讲将讨论的是在临床工作中重新重视全面的，生物心理社会理解模式的好处。显然，如果与经验丰富、有心理学头脑、能共情的临床医生建立信任的治疗联盟，治疗的依从性会提高。重视心理因素和发展压力可以更彻底地理解病理心理。此外，科学研究显示， 心理治 疗和药物治疗合并优于单用其中的一种，特别是对于病情严重的病人。演讲中还对近期神经科学的发展中支持生物心理社会框架的文献进行了回顾。此外还将讨论这些对精神科培训的意义。在我们不断地净化、提升我们的职业认同时 ， 精神病学的一个核心任务是把我们人文传统的精华和科学最前沿的发展结合起来。

Scientific advances in psychiatry over the last century have been dramatic, but there has been a concomitant de-emphasis on a biopsychosocial approach to understanding and intervention for psychiatric disorders. For example, the DSM diagnostic changes emphasize symptom checklist approaches to psychiatric diagnosis; neuroscience and psychopharmacology gains emphasize somatic interventions; delivery system changes, and inadequate availability of psychiatrists, diminish attention to the psychological aspects of the patient's presentation and treatment. This lecture will argue for the benefits of a re-emphasis on a comprehensive biopsychosocial model of understanding in the clinical setting, which will encompass a number of positive patient care results. Clearly, compliance with treatment is enhanced when the treatment occurs within the context of a trusting therapeutic alliance with a skilled, psychologically minded, and empathic clinician. Attention to psychological factors and developmental stresses allows for a more thorough understanding of psychopathology. In addition, research studies have demonstrated the superiority of combined psychotherapeutic and psychopharmacologic treatment over one-dimensional interventions, especially for seriously ill patients. Recent neuroscience advances in support of a biopsychosocial frame of reference will be reviewed. Implications for psychiatric training will also be discussed. A key task for psychiatry will be the integration of the best of our humanistic traditions with the latest scientific advances as we continually refine our professional identity.

OL2 - Open Lecture 2
Chairs: Pedro Ruiz, United States
Helen Herrman, Australia

OL2-1

对抑郁症的循证治疗 - Evidence-Based Treatment of Depression

Craig Van Dyke 1
1 Psychiatry, University of California , San Francisco , United States

旧金山加州大学的精神 卫生系发展了对抑郁症进行治疗的一个完整体系。该项目旨在与病人建立合作的关系。它的设计把 循 证医学的知识导入了常规的临床工作中。

抑郁 项目的特点 ：

? 对抑郁症的诊断是用 MINI 精神病 访谈来确定的 ，

? 在日常工作中提供 给病人的是循证医学确定了的一线治疗 ，

? 病人可以从一系列的循 证治疗中进行选择以使依从性最大化 ，

? 提供 给病人循证心理治疗 ， 包括人际关系心理治疗 ， 认知行为治疗 ， 问题解决治疗 ， 正念为基础的认知治疗 ， 病人可以从中学习一些技能 ，

? 提供 给免费的常规病人 ， 家庭教育会议 ， 信息网站 ， 关于抑郁症的纸质材料 ，

? 根据指南的 临床药物治疗持续给患者提供服务。

抑郁 项目的一个核心部分包括常规对所 有患者的 疗效进行追踪。在基线和每隔 12 周 进行 Beck 抑郁量表的 评定。这给临床医生和病人提供了反馈，以便对治疗做进一步的决定，同时还对项目的结果进行评估。对治疗效果不佳的病人有每周一次的会议 ， 该会议遵循的是癌症中心肿瘤委员会的模式 ， 它对临床数据进行回顾 ， 并给临床医生提供可以选择的治疗方案 ， 以提高疗效。

The Department of Psychiatry at the University of California San Francisco developed a comprehensive system of care for major depressive disorder. The program was built to provide a collaborative relationship with patients suffering from this disorder. It was designed to translate evidence-based knowledge into routine clinical care.

The Depression Program features:

? Diagnosis of major depression is confirmed using the MINI psychiatric interview,

? Only evidence-based first-line treatments are offered in routine care,

? Patients may choose from a menu of evidence-based treatments to maximize adherence,

? Evidence-based psychotherapies are provided that transfer specific skill sets to patients including interpersonal psychotherapy, cognitive behavior therapy, problem solving therapy, and mindfulness-based cognitive therapy,

? Free regular patient and family educational meetings, informational website, and written material about depression are provided,

? Guidelines-informed medication management clinics provide ongoing care for patients.

A key part of the Depression Program involves routine outcomes tracking for all patients. A Beck Depression Inventory is collected at baseline and at every 12 week intervals. This allows feedback to the clinician and patient to inform clinical care decisions, as well as provide programmatic outcomes assessment. For patients who fail to respond adequately to treatment there are weekly Conferences, modeled after Cancer Center Tumor Boards, that review clinical data and make suggestions to the treating clinicians about therapeutic alternatives that might improve care.

OL2-2

基于内心基本 实际模式的一种新的心理治疗方式 - A New Psychotherapy Method Based on the Elementary Pragmatic Model of the Mind

Piero De Giacomo 1 , Francesco Margari 1 , Wanda Santamato 1 , Andrea De Giacomo 2 , Rita Masellis 2
1 University of Bari Italy, Bari, Italy, 2 Dipartimento di Scienze Neurologiche e Psichiatriche, Università degli Studi di Bari, Bari, Italy

心理治 疗干预是基于过去三十年发展出来的交互作用和改变的精神模式。它是基于逐步增加的复杂的互动的五个水平。 这个模式将在本次大会上介绍 (De Giacomo P. 1992; L'Abate & De Giacomo, 2003) 。 这个提出的干预模式是基于行为主义原则以及基于一个强大的心理影响的作用，对个体或整个家庭都有影响。心理治疗干预中语句 的 选择起源于一个计算机程序，该程序基于一个在 90 个 语句中进行的三步操作程序。这 90 个 语句对人类内心的功能有着良好的理解。基于基本实际模式的干预作为一个衍生元素能够被运用于普通精神科访谈中 ， 同时给与诊断和药物处方 ， 服务于 “ 最 优化的精神科访谈 ”(De Giacomo & coll. 1997) 。

Psychotherapy interventions are based on a mental model of interactions and changes that has been developed over the last thirty years. It is based on five levels of interactions of increasing complexity. The model (De Giacomo P. 1992; L'Abate & De Giacomo, 2003) will be presented at the congress. The interventions it gives rise to are based on behavioral prescriptions and on the presentation of sentences with a strong psychological impact, posed to individuals or to the whole family. The choice of the sentences to be used in the psychotherapy interventions is derived from a computer program based ona three-step operation conducted on 90 sentences found to be particularly signficant for gaining a better understanding of the function of the human mind. Interventions based on the Elementary Pragmatic Model can also be used in the context of the general psychiatric visit as a further element, together with diagnosis and pharmacological prescriptions, serving to “optimize the psychiatric visit” (De Giacomo & coll. 1997)

References:

- De Giacomo P. : Finite Systems and Infinite Interactions: The Logic of Human Interactions and its application to psychotherapy. Ed. Bramble Company, Connecticut , USA , 1992.

- De Giacomo P., Rutigliano G., Margari F.: Ottimizzazione della visita psichiatrica, Franco Angeli Ed. Milano, 1997.

- L'Abate, L., & De Giacomo, P.: Intimate relationships and how improve them: Integration of theoretical models with prevention and psychotherapy. Westport , CT : Praeger 2003.

OL2-3

抑郁和焦 虑共病 ： 共性与区别 - The Comorbidity of Depression and Anxiety: Commonalities and Distinctions

Levent Küey 1
1 WPA Southern Europe Zonal Representative and Istanbul Bilgi University , Istanbul , Turkey

采用描述性或 归类性的方法对精神障碍进行诊断与分类 ， 无法回避的重要问题是饱受争议与关注的精神疾病共病现象。因此 ， 分析抑郁状态和焦虑状态相互区分和共有的特征不仅从概念的角度具有重要意义 ， 从临床角度出发也具有重要意义。

概念模型采用疾病一元 论的观点 ， 认为抑郁症和焦虑症分别具有不同特性 ， 是相互独立的疾病体。另外，概念模型同时也代表归属与分类的方式，即将这两类疾病的亚型也分列出来。

临床上，焦虑与抑郁共病很普遍，很难将它们完全分开。两者关系的描述有多种多样：完全不同的两个疾病、共病、症状重叠、相同症状、共同的人格特征与心理应激经历。根据这些不同的描述，可讨论两者共病的相关问题。正是如此，两者共病的状态可分为以下几类： ①各自独立的、相互区分的 临床实体； ②共病状 态，两个疾病的诊断标准都同时符合； ③符合其中一个 诊断标准，伴有另一个疾病的症状，但未达到另一个疾病的诊断标准； ④焦 虑抑郁混合状态，同时符合两个疾病的阈下症状标准； ⑤存在相 关的人格特征和心理应激经历。有研究者认为，从疾病角度两者的区别较突出，而从症状学、人格特征及心理应激的角度，两者的共性较明显。 不管从什 么角度出发，最重要的是抑郁和焦虑状态两者紧密相关。两者共病的研究一定程度上还存在方法学的问题，这些解释不能够充分显示临床观察到的焦虑抑郁的紧密联系。尽管焦虑症与抑郁症紧密关联，存在不少共性，但两者显然不是同一的疾病，也不会相互转换。两者的区别应是相对的，不是绝对的。

在此，我将回 顾当前关于抑郁和焦虑状态共病的观点，展示我的研究结果。之后，将重点阐述两者共病对临床工作的意义和将来的研究方向。

Descriptive / categorical approach in the classification and diagnosis of mental disorders had reached a point where the dilemma of comorbidity became a crucial matter of concern and controversy. The shared and discriminating features of depressive states and anxiety states have both conceptual and clinical importance, in this respect.

Conceptual models represent either a dimensional approach, where in a unitary perspective, depression and anxiety are considered as constructs in a continuum holding various psychopathological features, or a categorical/typological approach, where a separatist perspective proposes several subtypes in both diagnostic categories.

In clinical practice, the common co-existence of these two states makes it difficult to keep them as complete distinct entities. The related dilemma of comorbidity may be discussed in the context of different levels of description: distinct disorders, comorbid disorders, overlapping syndromes, shared symptoms, and common personality traits and psychosocial stress. So, depending on the level of description these conditions may be reviewed (i) as independent two distinct clinical entities; (ii) as comorbid conditions, concomitantly meeting threshold criteria of both disorders; (iii) as one having the primary diagnosis associated with the other syndrome not meeting threshold criteria; (iv) as mixed states where both conditions have concomitant sub-threshold symptoms; (v) as related personality traits and psychosocial stresses. Researches in this field had shown that, the distinction is more prominent at the level of disorders, where the overlap becomes more prominent at the levels of symptomatology and personality traits and psychosocial stress.

Whatever the level of discussion, the central finding is that depressive and anxiety states are strongly correlated with one another. Although to some extent, methodological problems may be responsible for their co-occurrence; these explanations are insufficient to reveal the strong observed correlation between anxiety and depression. Despite the strong correlation and commonalities, anxiety and depression are clearly not identical or transposable constructs. The differences between these two states are best viewed as relative, rather than absolute. This presentation after reviewing the current state of the art on the comorbidity of depressive states and anxiety states and the results of a research undertaken by the author will focus on the implications for clinical practice and future research.

OL2-4

有 关人格障碍神经生物学的新 展望 ： 个体化治 疗的含义 - New Perspectives on Neurobiology of Personality Disorders: Implications for Individualized Treatment

Larry Siever 1
1 Mount Sinai School of Medicine, Department of Psychiatry , New York , United States

有 关人格障碍的神经生物学研究得益于对于这类疾病的自然本质以及它们气质基础更为深刻的理解 以及目前能 够被运用于该领域的神经科学工具的发展。许多人格障碍新的研究策略或展望都来自于实验室。

一个有可能的方向是在确定 这类疾病的潜在维度以及潜在易感基因的媒介 “ 表型 ” 。 这类媒介或 “ 内部表型 ” 包含 实验室试验和特殊临床特征维度和样本有关儿茶酚胺和五羟色胺相关的基因型。此外 ， 功能性和神经化学影像被运用于详细描述脑回路系统 , 通常包括前皮 层和边缘结构 （ 杏仁核等 ）， 而这部分与边缘型人格障碍的情绪反应以及分裂型人格障碍的类精神病性症状相关。

认知功能指数能够与分裂症谱系中分裂型人格障碍的潜在基因型相联结。基因易感性因 素的 临床表达将同样取决于环境以及样本所受到的由环境刺激所致的神经生物学系统的影响。诸如早年的虐待和被忽视将被提及并且它们是如何与日后的人格障碍相联系也将被讨论。

最 终 ， 媒介表型 ， 候选基因 ， 特殊的社会心理前因 ， 人口统计学和文化特征可能都会在针对个体独有的弱点和强度上因人施治的个体化治疗的选择中起作用。

OL3 - Open Lecture 3
Chairs: Byron J. Good, United States
Nada L Stotland, United States

OL3-1

精神障碍和分娩 ： 跨文化和公共 卫生的角度 - Mental Disorder and Childbirth: Transcultural and Public Health Perspectives

John Cox 1
1 Royal College of Psychiatrist, London , United Kingdom

千禧年的 发展目标把对婴儿发展的理解和精神障碍对分娩妇女的影响几乎放在了公共卫生关注的中心位置上 － 特别是在发展中国家。 根据作者在此 领域三十多年的临床和科研工作背景 ， 该论文将概述在此领域的相关研究 ， 特 别强调的是社会文化视角 ， 以及近期的国际信息 ， 这些信息表明很多损害婴儿发展的原因 （ 包括母亲抑郁 ） 是可以改善的。 推荐 对产前和产后的障碍进行筛查 ， 包括在孕期识别有发展产后精神病高危因素的妇女。 将 简述对初级保健工作者 ， 精神科医生和产科医生培训的建议 ， 该论文将对爱丁堡产后抑郁量表的使用以及局限性进行讨论。 对这些普遍而又使人失去能力的状态的充分理解只有在生物 － 心理 － 社会的框架中才能达到 ， 这还包含着这些事件对病人和健康工作者个人意义的理解。

The Millenium Development Goals have placed the greater understanding of infant development and the impact of mental disorder on childbearing women near to the centre of public health concerns - particularly in developing countries.

Against the background of the author ? s clinical and research work in this field for over three decades, the paper will summarise relevant studies in this field, with particular emphasis on the sociocultural perspectives, and the recent international data indicating that many of the causes of impaired infant development (including maternal depression) could be ameliorated. Screening for ante- and postnatal disorder is advocated, including the identification of women during pregnancy at high risk of developing a puerperal psychosis.

The implications for the training of primary care workers, as well as psychiatrists and obstetricians, will be outlined, and the paper will include a discussion of the uses and limitations of the Edinburgh Postnatal Depression Scale.

The full understanding of these common and disabling conditions can only occur within a bio-psychosocial framework, which also includes an understanding of the personal meanings of these events for both the patient and the health practitioner.

OL3-2

躯体形式障碍的跨文化因素 - Transcultural Aspects of Somatoform Disorders

Ahmed Okasha 1
1 Institute of Psychiatry, Cairo , Egypt

躯体形式障碍近来被描述 为 “ 现代精神医学界最具有争议和挑战的领域 ” ， 然而全国范 围的精神卫生调查以及亟待解决的需求调查一般不会将其纳入研究 ， 也没有准确的疾病负担估计。最早的医疗记录来自两大文化中心：埃及和美索不达米亚。在古埃及精神障碍被认为是躯体疾病而不是躯体形式障碍。由于定义的多样性，关于躯体形式障碍的患病情况报道有很大的差异。今天我们将就此进行讨论。

1988 年 Kleinman 对该类疾病进行了最有效的定义 “ 躯体化 ” ：躯体化是指将心理社会 应激通过躯体来表达。 我 们对该疾病有一些限制性的诊断标准，例如注重计算症状个数，而忽略了考虑该疾病的其他方面，如行为、认知特点、人格特质，以及最特征性的临床症状：他们行为表现让人感觉好象解剖学是不存在的。

躯体症状的 类型和发生频率随文化不同而有差异。有人认为亚洲人或其他非西方人群比欧洲人或美国人更易于通过躯体化方式来表达应激，而该观点受到北美地区高患病率的挑战，在英国、西班牙、尼日利亚及其他一些地区的初级护理中心的研究也得出相似结果。 ICD-10 中 对躯体形式 障碍的定 义普遍适用于不同文化。神经科学对意识领域研究的发展必将对 “ 躯体化 ” 、 “ 躯体形式 ” 等 陈旧的术语给出明确定义，并用特定的神经生理知识和神经认知机制来阐释该行为模式和患者的主观感受。

今天的演 讲中我将和大家讨论 “ 躯体形式障碍的跨文化因素 ” 。

Somatoform disorders have been described recently as “one of the most controversial and challenging areas of modern Psychiatry" they are not usually included in national surveys of mental health and unmet needs, and accurate estimates of burden have not been established. The earliest recorded sources of medicine emanate from the two great centers of culture: Egypt and Mesopotamia . Mental disorders were somatic not somatoform in ancient Egypt.There was no stigma. The multiplicity of definitions has led to wide variation in the prevalence of somatoform disorder which will be discussed in the presentation. The most useful definition of somatization was given by Kleinman (1988): Somatization is the somatic idiom of psychosocial distress We have many restrictive diagnostic criteria e.g. Focus on symptom counting, failure to include other aspects of this disorder such as behavior, cognitive attribution and personality, The lowest commonest denominator for these clinical problems is that they tend to behave “as though anatomy did not exist”. Type and frequency of somatic symptoms may differ across cultures e.g. The high prevalence in North America challenges the notion that Asians or other ‘non- western' groups are more prone to somatize their distress than Europeans or Americans, similar findings have been made in primary care in Britain , Spain , Nigeria and elsewhere, Furthermore, the ICD-10 concept of somatoform disorders was generally appropriate for use across cultures. Advances of neuroscience into the territory of consciousness may eventually render concepts and terms such as somatization and somatoform obsolete and replace them with specific knowledge about the neuro-physiological and neuro-cognitive mechanisms underlying such behavior and subjective experience. The presentation will discuss “Transcultural Aspects of Somatoform Disorders”.

OL3-3

Development of Cultural Psychiatry: China as an Example

Wen-Shing Tseng 1
1 University of Hawaii , School of Medicine , Department of Psychiatry, Honolulu , United States

It is a common knowledge among contemporary clinicians that it is vitally important to provide culturally competent psychiatry care for patients of diversified ethnic-cultural background. This is true for any societies, whether the society is composed of homogenous or hetrogenous ethnic groups, with ethnic minorities or migrants or not. Because our life and mental health problems are intensively shaped by the culture within which we were living in. Every society around the world is exposed to cultures from outside and there is socioculture change within constantly. From clinical point of view, how to emphasize and include cultural psychiatry as a part of the overall picture of general psychiatry is a contemporary new tasks for modern psychiatry.

In order to promote cultural psychiatry in China , there are several basic issues that need to be dealt with. The basic orientation of general psychiatry needs to be broad and not to be restricted merely as biological and descriptive psychiatry. It needs to include psychologically oriented psychiatry which will address the mental life of the patients beyond symptoms, diagnosis, and medication. The patient needs to be regarded as a person who has psychology, personal and family history, and emotional problems that need to be managed psychologically.

The broadening of the scope and orientation of general psychiatry needs to start from the training of young psychiatrists. There is a need to establish formal, regular, and adequate training program for the residents while they are under training. The human psychology and the knowledge and skill of providing psychotherapy need to be the requirement for every psychiatry residents under training. Psychotherapy should be not an extra task for training for certain psychiatrists. Every clinicians needs to know how to provide psychological care of the patients that they care. By becoming psychologically-oriented psychiatry, it will give a room for the cultural psychiatry to grow.

To pay special attention how to provide care for the ethnic minorities is necessary, but it is not enough for cultural psychiatry. The scope of cultural psychiatry needs to be broad beyond minorities or immigrants with focus on every person, including the majority of the people. It is based on the notion that the life of every person within a society subject to his/her culture.

In China , there are numerous subjects that have been persuaded. The subject of: culture and personality, family and marriage under change, adjustment to rapidly industrialized and urban society, adjustment to foreign cultures, provision of culture-relevant care, including psychotherapy, development of community oriented mental health care, dealing with stigma against mental illness are some of the examples that deserve continuous study in the future with further expansion.

OL3-4

亚洲精神卫生系统改变中心理医院的作用 - The Role of the Mental Hospital in Changing Mental Health Systems in Asia

Byron Good 1
1 Harvard Medical School , Department of Social Medicine, Boston , United States

神 经精神病学和心理卫生服务的全球强大力量改变了我们对当代精神卫生服务中心理医院的作用的想法。这些包括有时候矛盾的历史变化 ： 神经生物学和精神药 理的 进步 ， 以社区为基础的社会心理干预的新方法的发展 ， 对人权的新的允诺和对精神病人的人性化照顾 ， 结合消费者的强大的革新变化 ， 临床医生 ， 政策支持者 ， 对精神卫生服务进行财政支持系统的变化 ， 对从严重的精神疾病中康复的潜力的新的乐观态度。作为全球近 40 年 “ 去机构化 ” 努力的 结果，现在取得了广泛一致的观点，即应该首先在社区中提供精神卫生服务，精神病服务的 “ 避 难所 ” 模式 应该被整合到社区的医院模式所取代，并紧密地与各种社区服务相结合。该讲座将讨论这个新的观点在当代亚洲国家中给精神卫生服务和精神卫生政策所带来的挑战。

这个讲座 将回 顾对去机构化的四种 “ 表述 ” ： 1) 把服 务从避难所转到社区的积极表述，从 “ 拘禁所 ” 到 “ 希望 ” ； 2 ） “ 去机构化 ” 导致忽视和 “ 重新机构化 ” 的灰暗的表述； 3 ）在不同的 亚洲地区有各具特色的机构化和去机构化形式的文化表述； 4 ） 让人回想起在美国和西方国家中去机构化的复杂历史。这些表述方式将会引起对当代亚洲国家中心理医院的作用的疑问 ， “ 去机构化 ” 的形式可能会吸收一些低收入的社会 ， 这些社会正竭力于增加医院的床位数 ， 以及将来亚洲心理医院的积极模式。

Powerful global forces within neuropsychiatry and mental health care have transformed our thinking about the role of the mental hospital in contemporary mental health services. These include sometimes contradictory historical changes: advances in neurobiology and psychopharacology, the development of new approaches to community-based psychosocial interventions and rehabilitation, a new commitment to human rights and humane care for the mentally ill, powerful reform movements joining consumers, clinicians, and policy advocates, changing systems of financing mental health services, and a new optimism about the potential for ‘recovery' from major mental illness. As a result of nearly 40 years of ‘deinstitutionalization' efforts globally, a broad consensus has emerged that mental health services should be provided primarily in the community, and that the ‘asylum' model for psychiatric services should be replaced with a model of the hospital as integrated into the community and closely linked to diverse community services. This talk will address the relevance and challenge of this new consensus for mental health services and mental health policy in contemporary Asian countries. The talk will review four ‘narratives' of deinstitutionalization: 1) the positive narrative of moving care from the asylum to the community, from ‘confinement' to ‘hope'; 2) the dark narratives of ‘deinstitutionalization' leading to neglect and ‘reinstitutionalization'; 3) a cultural narrative of distinctive forms of institutionalization and deinstitutionalization in diverse regions of Asia; and 4) a reminder of the complex history of deinstitutionalization in the United States and Western countries. These narratives will be used to raise questions about role the mental hospital in contemporary Asian countries, what form ‘deinstitutionalization' is likely to take in low income societies which have been struggling to increase the number of hospital beds, and positive models for the future of mental hospitals in Asia .

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