• P036
  照顧一位因當兵適應障礙出現自殺行為患者之護理經驗 - Nursing of Patient of Solider-experienced Adjustment Disorder–Caused Suicide Attempt
  懇 欣 陳 1
  1 財團法人奇美醫院 , 護理部精神科 , 台南市 , Taiwan , Province of China
  
  本文是描述一位精神官能性憂鬱症個案之護理經驗。個案因當兵時出現適應障礙，而多次出現自殺或自傷的行為，導致家人及部隊感到束手無策。護理期間自 94 年 5 月 18 日至 94 年 7 月 20 日，筆者依據身體、情緒、智能、社會、及靈性等五大層面收集資料，確立個案有潛在危險性暴力行為：朝向自己、個人因應能力失調之健康問題，並參考各學者文獻提供正確的壓力及預防自殺等因應方式，擬定適合個案獨特性的照護行為，促使個案能合乎部隊或是社會環境的期待，亦可提供臨床護理人員照護此類個案之參考。
  
  The study from May 18 to July 20 was to investigate the nursing of a neurotic depression patient of solder-experienced adjustment disorder which caused his self destruction which made his family and corps able to do nothing. The patient of potential risk of violence was ascertained physically, emotionally, intelligently, socially, and spiritually.The accurate coping strategies-based exclusive care was developed after the literatures referred, due to the self adjustment dysfunction and pressure and suicide attempt, to meet Corps' and society's expectations and be a reference for this kind of case.
   
  
• P037
  精神分裂症 8p 基因 NRG-1 的 关联研究及基因相互作用研究 - Association Study of NRG-1 and Gene-Gene Interaction between NRG-1 and ASAH1 Indicate 8p Might Be the Susceptibility Genetic Area of Schizophrenia
  怀惠 张 1 , 东红 崔 2 , 开达 江 2 , 三多 江 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 : 探索位于 8 号染色体短臂 （ 8p ） 的神 经胶质细胞生子因子 1 （ NRG-1 ） 基因与精神分裂症易感性之 间的关系 ； 探索同样位于 8p 的 NRG-1 基因与 ASAH1 基因之 间的相互作用。
  方法 : 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 NRG-1 基因上的 2 个 标签 SNPs （ rs2439322 和 rs16879809 ） 进行检测 ， 使用 EMLD 、 UNPHASED 和 TRANSMIT 统计软件进行连锁不平衡 （ LD ） 、 传递不平衡 （ TDT ） 、基于 单体型的单体型相对危险度分析 （ HHRR ） 及 单体型 TDT 分析。使用阳性和 阴性症状量表（ PANSS ） 评定 254 例精神分裂症患者疾病表型的数量性状，使用 单因素方差分析（ One-Way ANOVA ）、 UNPHASED 软件的 QTPHASE 程序等比 较在 2 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。使用 MDR 软件对 254 个精神分裂症核心家系 NRG-1 基因的 2 个 SNPs （ rs2439322 、 rs16879809 ）和 ASAH1 基因的 3 个 SNPs （ rs3753118 、 rs3753116 和 rs7830490 ）基因分型数据， 进行基因－基因相互作用分析。
  结果 : 1. （ 1 ）位点 rs2439322 － rs16879809 之 间存在弱 LD （ D' =0.178 ， r2=0.024 ）。（ 2 ） 单位点 TDT 分析和 HHRR 分析 结果显示： NRG-1 基因 SNPrs2439322 和 SNPrs16879809 与精神分裂症不存在阳性 关联关系（Ｐ >0.05 ）。（ 3 ） 单体型 TDT 分析 显示：单体型 rs2439322 － rs16879809 与精神分裂症存在阳性 关联（ Χ2=8.72 ， df=3 ，Ｐ <0.05 ），其中 单体型 rs2439322C － rs16879809T 为精神分裂症的风险单体型（Ｐ <0.01 ）。 2. NRG-1 基因与精神分裂症数量性状的 关联分析：研究 NGR-1 基因 2 个 SNPs ，未 发现其不同等位基因、基因型、单体型的患者组之间存在 PANSS 量表 评分差异（Ｐ >0.05 ）。 3. MDR 软件分析结果显示： 4 位点（ rs3753118 、 rs7830490 、 rs2439322 和 rs16879809 ）的模型有 统计学意义（ P<0.05 ），提示 ASAH1 基因的 rs3753118 、 rs7830490 位点与 NRG-1 基因的 rs2439322 、 rs16879809 位点之 间可能存在基因相互作用。
  结论 : 1. 研究 结果提示 NRG-1 基因 单体型 rs2439322 － rs16879809 与精神分裂症 关联， NRG-1 基因可能是中国 汉族人群精神分裂症的位置性易感基因。 2. NGR-1 基因 SNPrs2439322 和 SNPrs16879809 位点与精神分裂症的症状数量性状可能无 关联。 3. NRG-1 基因与 ASAH1 基因可能存在相互作用，并可能和精神分裂症的 发病风险关联。 4. 8 号染色体短臂 较强的连锁信号可能和 NRG-1 与 ASAH1 基因的 联合作用有关。 8 号染色体短臂可能是精神分裂症的易感基因区域，可能含有多个精神分裂症候 选基因。
  
  Objective: To explore the genetic susceptibility of 8p gene NRG-1 in schizophrenia. To explore the gene-gene interaction between NRG-1 and ASAH1 who are all located in 8p.
  Methods: Two tag SNPs (rs2439322 and rs16879809) of NRG-1 in 254 schizophrenia trios were genotyped by using PCR-RFLP, and LD, TDT and HHRR 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. The gene-gene interaction between 2 SNPs (rs2439322 and rs16879809) of NRG-1 and 3 SNPs of ASAH1 (rs3753118, rs3753116 and rs7830490) were analyzed by using MDR software and the NRG-1 and ASAH1 genotyped datas of 254 trios.
  Results: 1.(1) Weak LD was found between rs2439322 and rs16879809 (D'=0.178, r2=0.024). (2) Two SNPs were not observed to be associated with schizophrenia by TDT and HHRR (P>0.05). (3) Haplotype TDT analysis showed the haplotype rs2439322 － rs16879809 was associated with schizophrenia (P<0.05), and identified a risk haplotype rs2439322C － rs16879809T (P<0.01). 2. There was no significant difference of the PANSS score among patients grouped upon different genotypes, alleles and haplotypes of NRG-1 SNPrs2439322 and SNPrs16879809. 3. MDR revealed that the pattern with 4 SNPs (rs3753118, rs7830490, rs2439322 and rs16879809) had statistical significance (P<0.05).
  Conclusions: 1.The NRG-1 rs2439322 － rs16879809 haplotype was associated with schizophrenia, and indicated that NRG-1 might be a positional susceptibility gene of schizophrenia. 2. There might be no relationship between symptom quantitative trait of schizophrenia and NRG-1 gene. 3. There might exist gene-gene interaction between NRG-1 and ASAH1, and it could increase the risk for schizophrenia. 4. The strong linkage signal of 8p might be associated with gene-gene interaction of ASAH1 and NRG-1. 8p might be the susceptibility genetic area of schizophrenia and might exist a number of schizophrenia candidate genes.
   
  
• P038
  情感性精神障碍与气象要素 - Affective Disorders and Meteorological Factors
  晓云 张 1 , 志 颖 冯 2 , 以 扬 解 1 , 金 华 李 2
  1 天津市气象科学研究所 , 天津 , Chinese Mainland, 2 天津市安定医院 , 天津 , Chinese Mainland
  
  目的 : 探 讨情感性精神障碍与气象要素的关系。
  方法 : 用相 关系数检验法对天津市安定医院 1997 ～ 1999 年情感性精神障碍月入院量和同期气象 资料的相关性进行回顾性分析。
  结果 : 情感性精神障碍月入院量与同期日照和气 压有显著意义的相关性。
  结论 : 日照和气 压可能是情感性精神障碍发病的主要气象因素。
  关键词 : 情感性精神障碍 气象要素 抑郁 躁狂 日照
  
  Objective: To study the relationship between affective disorders and meteorological factors.
  Methods: It has been analyzed in review that characteristic of number of affective disorders and meteorological data in hospital from Tianjin AN DING Hospital with correlation coefficient method from January lst,1997 to December 31th,1999.
  Results: The correlation has been proved between affective disorders and air pressure, sunshine-hour and wind speed.
  Conclusion: The mainly meteorological factors of affective disorders may be Sunshine-hour and air pressure.
  Key words: affective disorders; meteorological factors; major depression; mania; sunshine
   
  P039
  782 例 农村首发精神分裂症出院后维持服药调查 - The Investigation 782 Cases Country First Outbreak Schizophrenic Patients Leave Hospital
  道 华 王 1 , 凤仙 程 1 , 缪 金生 2
  1 江 苏建湖第三人民医院 , 江 苏建湖 , Chinese Mainland, 2 江 苏盐城第四人民医院 , 江 苏盐城 , Chinese Mainland
  
  摘要目的 了解 农村 782 例首 发精神分裂症患者出院后维持服药情况和影响维持服药依从性因素 ， 提高患者对维持服药必要性认识。 方法 对 2002—2004 三年 间 ， 首次发病在我院住院的农村患者中 ， 符合 CCMD-3 精神分裂症 诊断 782 例 ， 其中男 383 例 ， 女 399 例 ， 年 龄 18—55 岁。每个患者在出院时将维持服药具体方案一式四份，由县、乡、村三级精防机构及患者家属各执一份。按照预先设计，患者出院后维持服药必须达到 2 年以上，少于 2 年均作 为自行停药。要求每 3 个月由村精防医生向 乡、县精防机构回报一次所辖范围内精神分裂症患者维持服药情况和自行停药的原因。 结果：出院后自行停药 39 例（ 5% ），服 药不足 3 个月 75 例（ 9.6% ），服 药达 6 个月 386 例（ 49.4% ），服 药达 1 年 124 例（ 15.9% ），服 药不足 2 年 84 例（ 10.7% ），服 药 2 年以上 74 例（ 9.4% ）。 自行停 药原因：否认有病拒绝服药 23 例（ 2.9% ），心存 侥幸没有服药必要 292 例（ 37.3% ）， 药物副反应如镇静、体重改变、植物神经功能紊乱、阳痿等 232 例（ 29.7% ），家庭重 视不够、听之任之、不理不问 125 例（ 16% ），社会支持不力、因病失学、失 业、失恋、离异、经济困难等 110 例（ 14.1% ）。 结论：文献提示，维持服药仍为目前预防精神分裂症复发根本措施。加强精神卫生知识宣传和知晓率，精神药物合理使用，选择最佳药物治疗窗口，减轻药物副反应，家庭重视，社会支持，是提高精神分裂症患者出院后维持 服 药依从性的综合措施。
  
  Objective: To know about 782 cases country first outbreak schizophrenic patients leave hospital maintaining dose and compliance factor affecting maintaining dose, elevate the understatement of neediness about maintaining dose.
  Method: 782 cases country first outbreak schizophrenic patients was in our hospital in 2002-2004,when the patient leave hospital, we give his /her family members a project about maintaining dose, the project was also given preventing mental disorder institution of the our county, countryside and village. According this project, every patient must maintaining dose to 2 years when he /she leaving our hospital, subter –2 years is way of self pausing- medicine. The village doctor of preventing mental disorders report the patient`s maintaining dose or self pausing-medicine and their causation to county,countryside mental disorder preventing institutions.
  Results: self pausing- medicine 39 cases(5%); maintaining dose subter –3 month 75 cases (9.6%); maintaining dose to 6 month 386 cases (49.4%), maintaining dose to 1 year 124 cases (15.9%), maintaining dose subter –2 years is 84 cases (10.7%), maintaining dose upwards 2 years was 74 cases .The self pausing-medicine causation: he/she realize their luck no need of maintaining dose was 292 cases (37.3%), because medicine beside responses example sedation ,body- weight getter, self –determination nerves dysfunction, et al 232 cases (29.7%), family regard not enough and pay no attention 125 cases (16%),social support not do best, economic difficulty et al 110 cases (14.1%).
  Conclusion: The maintaining dose at present still was fundamentality measures of preventing relapse of schizophrenia. Strengthen publicize of mental sanitation knowledge, with reason us anti-psychotic drugs, alleviate beside affects of anti-psychotic drugs, give more social and family support, was fundamentality measures of elevating compliance of maintaining dose.
  
  
• P040
  西 酞普兰治疗老年抑郁症的对照研究 - Comparative Study of Citalopram in the Treament of Elderly Depressive Patients
  振宇 郭 1 , 情感障碍
  1 驻马店市精神病医院 , 驻马店市 , Chinese Mainland
  
  目的 ： 探 讨西酞普兰对老年抑郁症的疗效 .
  方法 ： 将 80 例老年抑郁症患者随机分 为西酞普兰组和马普替林组各 40 例 ， 疗程 6 周 ， 在治 疗前及治疗 1 、 2 、 4 、 6 周用 汉密尔顿抑郁量表 （ HAMD ） 评定疗效 ， 并记录不良反应。
  结果 ： 西 酞普兰组从治疗 1 周末 HAMD 评分开始显著下降 ， 而马普替林组从治疗 2 周才 开始显著下降 ； 治疗 6 周西 酞普兰的有效率达 90% ， 马普替林的有效率为 87.5% ， 而西 酞普兰组的不良反应明显低于马普替林组。
  结论 ： 西 酞普兰治疗老年抑郁症疗效好 ， 不良作用少。
  关键词 ： 西 酞普兰 ， 老年抑郁症 ， 马普替林
  
  Objective: To explore the efficacy of citalopram in the treament of elderly depressive patients.
  Method: Eighty elderly patients with depression were randomly divided into citalopram group or maprotiline group for six weeks.Hamilton depressive scale (HAMD) was used to assess the clinical before and after treatment for 1 week 、 2 weeks 、 4 weeks and 6 weeks.At one time side effects were noted.
  Results: The scores of HAMD decreased significantly at the end of the first week in citalopram group, but did at the end of the second week in maprotiline group. The effective rates of citalopram was 90% and that of maprotiline was 87.5% after six weeks of treatment. The adverse reactions of citalopram were lower than that of maprotiline.
  Conclusion: Citalopram is an effective antidepressant with fewer side effects in the treatment of geriatric depression.
  Key words: citalopram, geriatric depression, maprotiline
   
  
• P041
  精神分裂症病人 脑脊液对食蟹猴大脑神经元及毛细血管超微结构的影响 - Effects of Schizophrenic Cerebrospinal Fluid on Macaque's Cerebral Neuron and Capillary at the Ultrastructural Level
  相 兰 王 1 , 晋碚 张 1 , 念 红 关 1 , 钦令 魏 1 , 春霞 洪 1
  1 中山大学附属第三医院 , 精神科 , 广州 , Chinese Mainland
  
  目的 ： 研究精神分裂症病人 脑脊液对食蟹猴大脑神经元和毛细血管超微结构的影响。
  素材 ： （ 1 ） 病人 脑脊液供者 ： 未经治疗的精神分裂症病人。 （ 2 ） 健康 对照脑脊液供者 ： 经知情同意的健康成年志愿者。（ 3 ） 实验动物：健康食蟹猴。
  方法： A. 入 组病人入院后即行脑 CT 检查，进行测量。 B. 留取病人、志愿者 脑脊液 3ml 。 C. 经腰椎穿刺分别在食蟹猴脑脊髓腔内注射大脑结构异常、正常病人或健康志愿者脑脊液，生理盐水，形成实验 1 组、实验 2 组、正常对照组、生理盐水组。 D. 接 种后第 12 周常 规制作食蟹猴大脑灰质电镜标本，以日立 H600 透射 电镜观察。
  结果： （ 1 ）一般 资料：精神分裂症病人 9 名，平均年 龄 29.33 岁，病程： 30~365 天（中位数 90 天）。根据 脑 CT 结果分为脑 CT 异常和正常两 组。（ 2 ）神 经元及内皮细胞病变表现为核肿胀、核染色质凝结、核固缩，神经元病变比例由高至低依次为实验 1 组（ 69.4 ％）、 实验 2 组（ 59.4 ％）、 对照组（ 31.9 ％）、生理 盐水组（ 22.2 ％），差异有 统计学意义的差异（ P<0.01 ）。内皮 细胞病变比例实验 2 组最高（ 36.7 ％）， 实验 1 组次之（ 29.2 ％）， 对照组（ 8.3 ％），生理 盐水组 未 发现，差异具有统计学意义（ P ＝ 0.032 ）。（ 3 ）毛 细血管周围水肿比例由高到低依次为实验 1 组（ 70.8 ％）、 实验 2 组（ 53.3 ％）、 对照组及生理盐水组（ 25 ％），差异有 统计学意义（ P ＝ 0.017 ）。
  结论： （ 1 ）精神分裂症病人 脑脊液可导致食蟹猴大脑神经元超微结构发生明显病理改变，脑结构异常者的影响更为明显和严重；（ 2 ）精神分裂症病人 脑脊液可造成食蟹猴大脑毛细血管超微结构发生血管周围水肿和内皮细胞病变等病理改变；（ 3 ）微血管 环境异常可能在精神分裂症病理机制中具有重要作用。
  
  Objective: This study is designed to investigate effects of schizophrenic cerebrospinal fluid (CSF) on cerebral neuron and capillary of macaque at ultrastructural level.
  Methods: According to their brain computer tomography (CT) presentations, schizophrenics who accepted to participate and gave their informed concent were divided into abnormal and normal brain structures group. Then, CSF of participants and healthy volunteers, and normal saline were separately injected into the macaque' cerebrospinal cavities via lumbar puncture, thus the macaques were divided in turn into Case Group A and B, Healthy Control and Normal Saline group. Hitachi H600 transmission electron microscope was used to observe the cerebral ultrastructures of macaque.
  Results: Significant pathological changes, including nucleus swelling, nuclear chromatin coagulation, nuclear pyknosis, were discovered at macaque's neurons, especially the group received CSF of patients with brain abnormalities. Significant pathologic changes, including peri-capillary edema and pathological changes of endothelial cell of capillaries were discovered at macaque's brain cortex. Case Group A has the higher rate of peri-capillary edema and the lower rate of pathologic changes of endothelial cell than Case Group B, 70.8 ％ : 53.3 ％ and 29.2 ％ : 36.7 ％ respectively.
  Conclusion: Schizophrenic CSF can result in significant pathologically ultrastructural changes of neurons and cerebral capillaries of macaque' brain. CSF of patients with brain atrophy can produce more serious pathological changes than CSF of patients without that. Abnormal microvessel milieus may probably contribute the neuron pathological changes and play an important role in biological mechanism of schizophrenia.
   
  
• P042
  抑郁症静息状 态的功能核磁共振成像研究 - A Functional MRI Study in Patients with Depression at of Resting State
  Li Wang 1 , Zhi-jian Yao 2 , Gao-jun Teng 3
  1 南京医科大学附属 脑科医院 , 精神科 , 南京 , Chinese Mainland, 2 南京医科大学附属 脑科医院 ， 精神科 ； 东南大学临床医学院 , 南京 , Chinese Mainland, 3 东南大学附属临床医学院 , 南京 , Chinese Mainland
  
  目的 ： 既往将 PET 、 SPECT 利用于抑郁症静息状 态的研究已显示抑郁症存在特定脑神经环路 （ 边缘系统 - 纹状体 - 皮 层 - 丘 脑 ） 的异常。本研究将功能核磁共振利用于抑郁症静息状态研究，旨在进一步探明抑郁症的脑功能异常。
  方法： 27 名来自南京 脑科医院的重症抑郁患者与 27 名年 龄、性别、利手、文化程度等均与患者匹配的正常受试者参加研究。应用 GE Signa NV/ i 1. 5 T 超 导型磁共振仪，进行常规磁共振 T1WI 、 T2WI 扫描。而后用 GRE-EPI 序列采集静息 BOLD 数据，
  参数： TR/TE ＝ 3000ms /40ms ， FOV=240mm×240mm ， matrix ＝ 64×64 ， 连续扫描 27 层，层厚＝ 4 mm 。 图像数据经转化格式后用 SPM5 进行时间、空间标准化，校正头动并映射到标准脑，经滤波、去线性漂移，用 ReHofMRI1.0 生成 Reho 图，将 Reho 图标准化，最后用 spm2 进行配对 t 检验。将所获得的局部一致性对比有显著性差异脑区的 MNI 坐 标转换为 Talairach 坐 标，查看解剖位置。 结果：与对照组相比，抑郁组静息状态局部一致性增强的脑区主要位于：左额中回（－ 27 ，－ 12 ， 45 ； 11 像素； BA6 ）、右 额中回（ 27 ， 33 ， 23 ； 17 像素； BA9 ）、右 额下回（ 39 ， 38 ， 4 ； 95 像素； BA46 ）、右 颞上回（ 50 ， 13 ，－ 28 ； 11 像素； BA38 ）、左前扣 带回（－ 21 ， 30 ， 18 ； 22 像素； BA32 ）、右后扣 带回（ 24 ，－ 30 ， 37 ； 25 像素； BA31 ）、右 脑岛（ 36 ，－ 2 ， 17 ； 54 像素； BA13 ）、左豆状核（－ 21 ， 1 ， 17 ； 29 像素）、右豆状核（ 24 ， 0 ， 17 ； 54 像素）、左屏状核（－ 30 ，－ 2 ， 11 ； 29 像素）、右屏状核（ 30 ， 12 ， 16 ； 54 像素）、左尾状核（－ 9 ， 23 ，－ 4 ； 14 像素）；正常 对照组并未显示较抑郁组更强的局部一致性。
  结论： 本研究局部一致性增高的 脑区进一步证实了抑郁症神经环路的存在，并认为该神经环路在静息状态下具有很高的局部一致性。这些脑区也构成了抑郁症的默认状态网络，该默认状态网络存在异常；将局部一致性方法利用于抑郁症静息状态研究很有意义。
  
   
• P043
  阿立 哌唑与利培酮治疗精神分裂症患者依从性的对照研究 - A Controlled Study on Compliance of Schizophrenia Treated with Aripiprazole and Risperidone
  陶 建青 1 , 梁 佳 1 , 曾 强 1 , 康 红 1
  1 广西壮族自治区人民医院 , 心理康 复中心 , 南宁市 , Chile
  
  目的 : 探 讨阿立哌唑治疗精神分裂症患者的依从性。
  方法 : 把符合ＣＣＭＤ -3 诊断标准的精神分裂症患者 120 例 , 随机分成两 组 , 分 别给予阿立哌唑和利培酮治疗 12 周 , 采用阳性症状 阴性症状量表 ( ＰＡＮＳＳ ) 评定疗效 , 副反 应量表ＴＥＳＳ评价其副反应。比较两组的服药依从性。
  结果 : 治 疗 12 周后两 组疗效差异不显著 (P>0.05), 阿立 哌唑组有效率 90%,; 维思通组有效率 88.3%, 但阿立 哌唑组药物 完全依从占 65.5%, 显著高于利培酮组的 45.2%; 阿立 哌唑组不依从占 3.4%, 则显著低于利培酮组的 22.9%. 两 组依从性差异显著 (P<0.05) 。阿立 哌唑组以兴奋激越、头昏或头痛等副反应为主 , 维思通组以锥体外系等副反应为主 结论 阿立 哌唑对治疗精神分裂症疗效和利培酮 , 且安全性相 对较高 , 能更好地提高治 疗的依从性。
   
  
• P044
  安非他 酮治疗抑郁障碍的对照研究 - Comparative study on Bupropion in Treatment of Depressive Disorder
  张 天 亮 1
  1 山 东精卫中心 , 济南 , Shandong Province Mental Health Center , Jinan 250014, China
  目的： 比 较安非他酮与西酞普兰治疗抑郁症的疗效和安全性。
  方法： 采用平行 对照的方法，符合入组标准的门诊抑郁症患者随机分为两组，每组 45 例，分 别以盐酸安非他酮片 150mg ～ 450mg/ 日， 氢溴酸西酞普兰片 20mg ～ 40mg/ 日治 疗 8 周，以 汉密尔顿抑郁量表（ HAMD ） 评定疗效，副反应量表（ TESS ） 评定安全性。结果：安非他酮和西酞普兰组的有效率分别为 82.2 ％和 75.6 ％，两 组差异无显著性意义（ P>0.05 ）；不良事件 发生率分别为 52.7 ％和 58.1 ％，两 组差异无统计学意义（ P>0.05 ）。
  结论 ： 安非他 酮是安全有效的抗抑郁药。
  关键词 : 安非他 酮 西 酞普兰 抑郁障碍
  
  Objective: To evaluate the efficacy and safety of bupropion in depressed patients in comparison to citalopram.
  Method: Adopting parallel comparative method, 90 depressed outpatients in accordance with clinical depressive standards were randomly divided into two groups (45 patients each). One group was given bupropion hydrochloride tablets 150~450mg per day, and the other group citalopram hydrobromide tablets 20~40mg per day. Two groups were treated for a period of 8 weeks. The efficacy was assessed by Hamilton depression rating scale (HAMD) and the safety by treatment emergent symptom scale (TESS).
  Results: The response rates of two groups (bupropion v.s. citalopram) were 82.2% and 75.6% respectively, which had no remarkable differences between them (p>0.05); Adverse reactions observed in 52.7% and 58.1% of patients in the two groups respectively, were of no statistical significance (p>0.05).
  Conclusion: Bupropion is an effective and safe antidepressant 。
   
  
• P045
  盐酸安非他酮治疗抑郁与焦虑障碍的临床观察 - Bupropion Hydrochloride for Clinical Treatments of Depression and Anxiety Disorder
  韩春美 韩勇 1
  1 山东省精神卫生中心 Shandong Province Mental Health Center , Jinan 250014, China
  目的 ： 安非他 酮是继 5-HT 再 摄取抑制剂和 5-HT 和去甲 肾上腺素再摄取抑制剂等新型抗抑郁药之后的又一新型抗抑郁药物。它的主要机制为抑制多巴胺和去甲肾上腺素 的回吸收，增加两方面的 递质功能，改善单胺类递质功能，从而发挥治疗抑郁症和焦虑症的作用。现将安非他酮治疗抑郁症 30 例和焦 虑症 20 例 门诊患者的疗效作以下临床分析和讨论。
  结果： 本文服用安非他 酮治疗抑郁症和焦虑症的临床观察，结果中，发现它是治疗抑郁症和焦虑症的有效药物 [5,6] ，甚至 优于其他新型抗抑郁药物。治疗 30 例抑郁症中，痊愈率可达 80% ， 对双相情感障碍中抑郁发作更有效， 10 例中 9 例痊愈，且无 转化为躁狂发作的现象，其他三环抗抑郁药和新型抗抑郁药常有诱发躁狂发作。甚至发展为难治性或快速循环型情感障碍，所以服用安 非他 酮过程中不须服大剂量抗躁狂药物，甚至只用小剂量碳酸锂即可 [6] 。在副作用方面，很少出 现恶心、头胀、嗜睡及抗胆碱等心率增快等副作用，所以作者提出，双相情感障碍的抑郁发作时，安非他酮可作为首选药物。
  安非他 酮在治疗慢性焦虑症，尤其焦虑症伴抑郁情绪的病人及抑郁焦虑症患者可作为首选药物 [5] 。本文治 疗 20 例焦 虑症中有效率为 100% ，病期减慢的治病效果 较好，有的病人可合并未安色林（晚），可有抗焦虑又有抗失眠作用。
  其治 疗剂量问题，内源性抑郁须剂量较大，一般 225-450mg/d 为适，若剂量偏大达不到痊愈，剂量过大 可出 现紧张性焦虑等副反应。心因性抑郁，神经性抑郁（循环心境）。恶劣心境的等和焦虑症，应服剂量较小，一般在 300mg/d 以内，服用 过程注意对睡眠的影响，甚至只放在早上和中午服用。
  
  Bupropion is a new type of antidepressants, along with SSRIs, SNRIs, etc, which belongs to NDRI antidepressants. Its main action mechanism is to inhibit reuptakes of dopamine (DA) and norepinephrine (NE), and improve monoamine neurotransmitter functions, so it is active in treatment for depression and anxiety disorders. This paper is to clinically analyze and discuss its curative efficacy on out-patients with depression (n=30) and /or anxiety disorders (n=20). The result showed that bupropion is an effective drug in treatment of depression and anxiety disorders, being even more active than other kinds of antidepressants. Of the 30 patients with depression, the curative rate reach 80 percent and bupropion is a more effective therapy for depression attack in bipolar affective disorders, with 9 being fully cured in 10 subjects and no occurrence of transition from depression to manic attacks, which usually are intrigued by TCAs and other class antidepressants, and even develop into refractory or fast cycling affective disorder. Therefore, no high dose of antimanic drugs or only a little dose of lithium carbonate is required in treatment by bupropion. Due to adverse reactions being seldom occur, such as nausea, distention of head, lethargy and increasing heart rate, bupropion is regard as the first choice for patients with depression attacks in bipolar affective disorder and also for those with chronic anxiety disorder, especially accompanied by depression mood or depression/anxiety disorder. The cure rate among the 20 patients with anxiety disorder can reach 100 percent. Bupropion also has the anti-anxiety and anti-insomnia effect with concomitant use of mianserine (taking at night). As far as dose is concerned, high dose is needed for endogenous depression, about 225~450mg/d. But excessive dose may lead to tension-anxiety and full-recovery may not be reached. The dose for psychic depression, nervous depression (Cycle mood) and dysthymia should be low, commonly not above 300mg/d. Meanwhile, attention should be paid to its effect on sleep and sometimes bupropion is even taken only in the morning or at noon, in stead of in the evening.
  
  
• P046
  齐拉西酮对心脏 QTc,QTd 的影响 - Effects of Cardiac QTc and QTd Change Induced by Ziprasidone
  长友 孙 1 , 丹 王 2 , 国 辉 李 2 , 博 兰 2 , 云峰 李 2 , 清川 胡 2
  1 孝感市康 复医院 , 孝感市 , Chinese Mainland, 2 孝感市康 复医院 （ 孝感 432000 ） , 孝感 , Chinese Mainland
  
  目的 : 观察齐拉西酮治疗精神分裂症时的心脏不良反应。
  方法 : 对 32 例服用 齐拉西酮的精神分裂症患者在服药前及服药后不同剂量时间监测心电图观察 QTc,QTd 的 变化。结果 服用 齐拉西酮后部分病例心电图 QTc,QTd 有不同程度 变化 ， 其 QTc,QTd 的延 长和增加与剂量呈正相关。结论 齐拉西酮的心脏不良反应主要在于 QTc 的延 长，不宜与抗心律失常Ⅰ类，Ⅲ类药联用，应在推荐剂量范围内应用，应用期间定期监测心电图。
  
  Object: To research the cardiovascular side effects of ziprasidone in the treatment of schizophrenia.
  Methods: Monitor the QTc,QTd interval on electrocardiogram (ECG) of 32 Schizophrenia patients from pre- to post-treatment of ziprasidone in different dosage and time.
  Results: QTc, QTd on ECG in partial case changes in varying degree after takes ziprasidone, its QTc,QTd interval prolongation is dose dependent.
  Conclusions: Cardiovascular side effects of ziprasidone lies in QTc interval prolongation. In addition we suggest caution using ziprasidone with I and II kind of Anti- cardiac arrhythmia medicines, should apply it in the recommendation dosage scope and monitor ECG. regularly.
   
  
• P047
  阿立 哌唑对精神分裂症患者生活质量的影响 - Comparative Study of Influence of Aripiprazole on Life Quality in Schizophrenic Patients
  铭 李 1 , 宁 强 武 1 , 云峰 李 1
  1 湖北省孝感市康 复医院 , 孝感 , Chinese Mainland
  
  目的 : 比 较阿立哌唑与氯氮平对精神分裂症患者生活质量的影响。
  方法 : 对 60 例精神分裂症患者随机分 为二组 ， 分别予阿立哌唑、氯氮平治疗 6 个月。用阳性症状与 阴性症状量表 （ PANSS ） 评定精神症状 ， 用世界卫生组织编制的生活质量量表 （ WHOQOL100 ） 评估生活质量。 结果 阿立 哌唑对阳性症状、一般精神病理和 PANSS 总分改善与氯氮平相似 ， 对阴性症状改善明显优于氯氮平。阿立哌唑对生活质量方面除精神支柱外均非常明显地提高 ， 且在生理领域、心理领域和独立性领域明显优于氯氮平。
  结论 : 阿立 哌唑更有利于改善精神分裂症患者的生活质量。
  
  Objective: To compare the quality of life in schizophrenic patients treated with aripiprazole and clozapine.
  Methods: 60 schizophrenic patients were treated with aripiprazole or clozapine randomly for 6 months. The symptoms of schizophrenia was assessed with the positive and negative symptoms scale (PANSS), the quality of life was measured with WHO quality of life scale (WHOQOL100).
  Results: The degree of the improvement of positive symptoms, general psychiatric pathology and the total score of PANSS in aripiprazole group was similar with clozapine group, but the degree of the improvement of negative symptoms in aripiprazole group was higher than clozapine group. Aripiprazole can significantly improve every aspects of patient's life quality except domination, and aripiprazole was superior to clozapine in improvement of schizophrenic patients quality of life in aspect of physiology, psychology and independence.
  Conclusion: Aripiprazole is favorable for schizophrenic patients to improve quality of life.
   
  
• P048
  抑郁症患者治 疗前认知状态对抗抑郁疗效的预示作用 - Baseline Cognitive State as an Predictor of Response in Patients with Depression
  冬萍 饶 1
  1 广州市精神病医院 , 广州市 , Chinese Mainland
  
  目的 ： 了解抑郁症患者治 疗前认知状态对抗抑郁治疗效果的预示作用。
  方法 ： 研究 对象为广州市精神病医院门诊及住院的 171 名抑郁症患者。入 组者符合国际疾病分类第 10 版的抑郁 发作诊断标准。采用威斯康新卡片分类测验 （ WCST ）（ 48 张 ） 、连线测验 （ A 、 B ） 、 词语流畅性测验 （ 动物 ） 等分别评定抑郁症患者治疗前的认知功能。采用抗抑郁药达有效治疗量治疗 6 周，治 疗前后分别采用 17-HAMD 评定抑郁症状严重程度。采用 HAMD 评分的减分率评定疗效。
  结果： 入 组 171 例，脱落 44 例，完成治 疗者 127 例。有效 组 63 例，部分有效 组 42 例，无效 组 22 例； 连线测验 A 、 B 操作 时间和词语流畅性测验动物总数及 WCST 分 类数、总错误数、持续错误数、随机错误数，三组差异均无统计学意义 (P>0 ． 05) 。
  结论 ： 不同 疗效的抑郁症患者治疗前认知功能无明显差异 ， 治疗前认知状态对抗抑郁疗效可能无预示作用。
  
  Objective: To investigate prediction of treatment response in depressed patients from baseline cognitive state.
  Methods: 171 subjects were recruited at the Guangzhou psychiatric hospital. WCST(48), trail making tests (A, B) and verbal fluency test (animals) were made to assess the cognitive function in depressed patients. They were received single conventional antidepressants with effective therapeutic dose for 6 weeks. Severity of depressive symptoms was assessed using 17-HAMD. Operation definitions of antidepressant response were classified according to 17-HAMD scores.
  Results: Of 171 cases, 127 cases including 63 responders, 42 partial-responder and 22 nonresponders completed the trial. No significant difference regarding operation time of trail making test A with B, scores of verbal fluency test, scores of total trials, preservative errors and random errors in WCST were found among three groups.
  Conclusion: Baseline cognitive function in patients with depression was not an efficient predictor of treatment response.
   
  
• P049
  阿立 哌唑治疗老年精神分裂症 28 例 临床观察 - Clinical Study of Ariprirazole in the Treatment of Schizophrenia with Late Onset
  伟 刘 1
  1 山西省 临汾市荣军康复医院 , 精神科 , 临汾市 , Chinese Mainland
  
  目的 ： 探 讨阿立哌唑对老年精神分裂症治疗的疗效及安全性。
  方法 ： 采用 门诊开放性研究 ， 对 28 例符合 CCMD—3 精神分裂症或分裂 样精神病的老年患者采用阿立哌唑 10—20mg/d 治 疗 ， 采用 PANSS 评价临床疗效 ， 采用 TESS 血生化指 标和心电图的改变评价安全性。疗程观察 6 周。
  结果： 1 ）治 疗 2 周后， PANSS 阳性、 阴性症状分和总分均显著下降（ P<0.05 ）；治 疗 6 周后 PANSS 各分 值与基线水平差异显著 (P<0.001) ； 2) 经 6 周治 疗 , 基本痊愈 6 例 , 显著进步 + 进步 18 例 , 无效 4 例 ,3) 治 疗过程中 , 所以患者 TESS 总分最大值 (2.0±2.3), 其中 12 例 评分一直为 0 ； 6 周 观察中未发现有体重显著增加和心电图的明显改变。
  结论 ： 阿立 哌唑能有效缓解老年精神分裂症的精神病性症状 ， 安全性高 ， 适合于老年精神分裂症患者的治疗
  Objective: To investigate the efficacy and safety of Aripirazole in the treatment of Schizophrenia patients with late onset.
  Method: Twenty—egeight patients in the study met the diagnostic cyiter for Schizophrenia described in the CCMD-3. The dosage of Aripirazole ranged 10~20/d. To assess the efficacy and side effects by using Positive and Negative Symptoms Scale(PANSS), Treatment Emergent Symptoms Scale (TESS) and the changes of biochemical index and electrocardiogram.
  Result: 1)The positive, negative sub-scores and total score were significantly decreased(p ＜ 0.05 ＝ after 2week treatment. After 6-week treated, the PANSS scores were significantly lower than baseline (p ＜ 0.001 。 2 、 After 6-week treated, 6patients were cured and 18 patients were improved, the symptoms of 4 patients were aggravated. 3 、 Duration of the treatment, the TESS average score was 2.0±2.3, 12 patients had never observable side effects. IN this study, We had not found weight gain and abnomalities in electrocardiogram.
  Conclusion: Aripiprazole is safe and effective in the management of psychotic symptoms in old out patients with Schizophrenia.
   
  
• P050
  喹硫平与氯丙嗪对女性精神分裂症患者生活质量的影响 - The Quality of Life in Female Schizophrenic Patients Treated with Quetiapine or Chlorpromazine
  梅 雪 郭 1
  1 山西省 临汾市荣军康复医院 , 精神科 , 临汾市 , Chinese Mainland
  
  目的 ： 比 较国产喹硫平与氯丙嗪对女性精神分裂症患者生活质量的影响。
  方法： 对 30 例服用 喹硫平及 30 例服用 氯丙嗪的女性精神分裂症患者用生活质量综合评定问卷（ GQOLI ）、阳性与 阴性症状量表（ PANSS ）、副反 应量表（ TESS ） 进行评定。结果：喹硫平组的躯体健康纬度、心理健康纬度及社会功能纬度得分高于氯丙嗪组，均有显著性差异。
  结论： 喹硫平治疗有利于女性精神分裂症患者提高生活质量。
  
  Objective: to compare the quality of life in female schizophrenic patients treated with quetiapine or chlorpromazine.
  Method: The female patients treated with schizophenia who were treated by quetiapine (n=35) or chlorpromazine (n=35) were evaluated with general quality of life inventory (GQOLI) ， positive and negative syndrome scale (PANSS) and treatment emergent symptom scale (TESS).
  Results: The quetiapine group had better results in physical function, mental health and social function than chlorpromazine group.
  Conclussions: Quetiapine is beneficial to improve the living qualities of the femal patients with schizophrenia.
   
  
• P051
  抑郁症与正常人群的心理防御机制的 对照研究 - A Control Study of the Psychological Defense Mechansim in Patients with Depression
  筠 马 1 , 轶琛 李 1
  1 华中科技大学同济医学院附属精神病医院 , Wuhan , Chinese Mainland
  
  目的 ： 探 讨抑郁症患者的心理防御机制 .
  方法 ： 采用防御机制 问卷对 30 名抑郁症患者与 30 名正常人 进行测试 ， 并两组对照研究
  结果 ： 〈 1 〉抑郁症患者不成熟的防御机制及其投射 . 潜意 显现 . 抱怨 ， 幻想 ， 退 缩得分明显高于正常对照组 ， 差异有显著性 (p<0.01, 或 p<0.05) 〈 2 〉抑郁症 组患者成熟防御机制得分明显低于正常对照组 ， 差异有显著性 (p<0.01, 或 p<0.05)
  结论 : 抑郁症患者均采用不成熟防御机制如投射 , 潜意 显现 , 抱怨 , 幻想 , 退 缩的特定的防御方式。
  
  Objective: To study the defense of patients with depression.
  Method: 30 patients with depression, 30 healthy controls were accessed with DSQ (defense mechansim questionnaire).
  Results: (1) Patients with depression had higher scores immature style, projection, acting out, complaining, fantasy, regression than healthy control (p<0.01,or p<0.05). (2) The one groups with depression had lower scores mature style than healthy controls (p<0.01,orp<0.05).
  Conclusion: Patients with depression used specific defense style, such as projection, acting out, complaining, fantasy, regression.
   
  
• P052
  精神分裂症 认知功能损害与干预 - The Cognitive Function Impairment in Schizophrenic Patients and its Intervention
  Hou HaiRong 1
  1 The Rehabilitation Hospital of Linfen City , Shanxi Province, Linfen City , Shanxi province, Chinese Mainland
  
  目的 ： 了解精神分裂症的 认知功能损害的病理机制、临床表现及危害 ， 采取多种 干 预措施使精神分裂症病人的认知功能损害 ， 得到较好的控制和改善 ， 尽量使精神分裂症病人的认知功能保持完整。
  方法 ： 使用 CCMD—3 中国精神障碍精神分裂症的 诊断标准 ， 注意观察精神分裂症的认知功能损害的临床表现。如 ： 1 、注意障碍包括 ：① 注意分散。②注意 专注与转移困难。 ③ 选择性注意障碍。 ④ 觉醒度降低。 2 、 记忆障碍： ①即 时记忆。 ②近事 记忆。 ③ 远事记忆。 3 、抽象思 维障碍。精神分裂症的认知功能障碍，主要表现为执行功能困难，难以形成、制定、完善和执行计划，难以处理和解决问题，定势转换困难，错误纠正能力降低，难以执行目标性任务 。 4 、信息整合障碍。精神分裂症患者不能充分的利用已有知 识与缩短信息加工过程。精神分裂症患者的记忆力、注意力、周密计划和运动敏感能力的速度减慢，错误较多。
  结果： 对精神分裂症病人，采取多种干预。如： 1 、早期 发现，早期治疗，预防复发，是防治精神分裂症认知功能损害的关键。 2 、注重控制 阴性症状，认知症状，不使症状残留。 3 、首 选非典型抗精神病药。 4 、 严格控制使用辅助用药。 5 、 认知矫正治疗。 6 、 坚持开展工娱疗活动。 7 、 发挥医院 —— 社区 —— 家庭三 级防治网的优势。 8 、加 强全社 会的 关注，加大政府投入。
  结论： 对精神分裂症病人进行全面的多方位干预。 1 、可以避免出 现认知功能损害。 2 、即使出 现认知功能损害也是比较轻微，可以恢复的。 3 、 对于一些认知功能损害严重的病人，可以使认知功能部分恢复，延缓病人的衰退，有利于提高病人的生活质量，有利于病人重返社会。
  关键词 : 精神分裂症 认知功能 干 预
  
  Objects: To get to know the pathological mechanism of the cognitive function impairment of schizophrenia and its clinical manifestation, and to take interventional strategies to prevent their cognitive function from deterioration.
  Methods: Using the diagnostic criteria of schizophrenia in the CCMD-III, the author observed the clinical manifestations of the cognitive function impairment of schizophrenia, such as 1) attention disorder; 2) memory impairment; 3) abstract thinking disorder; and 4) The integration of information disorder, in which the patients can not make good use of their knowledge representing with impairment of their memory, attention and vigilance while making more mistakes.
  Results: Multiple interventions should be taken for a schizophrenia, including 1) Early detection, early treatment and prevention from recurrence, which are the key points of the treatment for these patients; 2) Focusing on the negative symptoms and cognitive manifestation; 3) Atypical antipsychotics are the first choice; 4) Lessen the adjuvant drugs strictly; 5) Cognitive function modification; 6) Insisting on the occupational and recreation treatment; 7) Bring into full play the function of the hospital-community-family three-tier health net work; 8) Strengthen the society concern and enlarge government investment on these areas.
  Conclusions: Conducting all-around intervention in schizophrenic patients benefits them by avoiding to develop cognitive function impairment, making the cognitive function impairment milder and reversibly, and partially recover the patients' cognitive function, which will be helpful for their community re-entry.
  Key words: schizophrenia cognitive function intervention

• P053
  气功所致精神障碍与急性反 应性精神病对照研究 - Comparison of Mental Disorder by Deep Breath Exercise and Acute Reactive Psychosis
  Qingping Wei 1 , Longshan Hu 1
  1 Zigong Mental Health Center , Zigong , Chinese Mainland
  
  目的 : 为了进一步探讨气功所致精神障碍和急性反应性精神病的临床特点 ， 有利于这两种精神障碍今后诊断、鉴别诊断和治疗。
  方法 : 对我院 1989-2006 年住院治 疗的 26 例气功所致精神障碍 （ 研究 组 ） 和 59 例急性反 应性精神病 （ 对照组 ） 的临床特点进行对照研究。结果 发现这两组疾病有如下特点： 1. 均 为精神因素所致，研究组精神因素与练气功有关；对照组与严重生活事件有关。 2. 两 组患者病前性格，以敏感多疑、神经质为主。 3. 研究 组和对照组有精神病家族史者分别为 19.2% 、 23.7% 。 4. 两 组均可出现精神分裂症任何精神病性症 状，其内容与他 们各自的精神刺激内容有关。 5. 两 组治疗方案相同，均为脱离不良环境，进行心理和抗精神病药物等治疗。 6. 两 组多数为急性和亚急性起病，经治疗均在一月内精神症状完全消失；少数慢性起病者在 4 个月以内恢 复正常。 7. 研究 组出现幻觉和妄想与鬼神有关的例数明显多于对照组。
  结论 : 两 组发病与精神因素、不良性格、家族史有关，均可出现精神分裂症任何症状，其精神症状内容与各自的精神因素有关，治疗方案相同、疗效好、预后好；不同的地方是研究组出现幻视、幻听、被控制感和行为紊乱明显多于对照组。
  Objects: To determine the clinical characteristics of mental disorder by deep breath exercise and acute reactive psychosis, provide scientific foundation for diagnosis, differential diagnosis and treatment of the two diseases.
  Methods: 26 patients with mental disorder by deep breath exercise (control group) and 59 patients with reactive psychosis (study group) in our hospital from 1989 to 2006 were reviewed and compared in clinical characteristics.
  Results: 1. Both were caused by mental factors. 2. Patients in both groups have characters as sensitive, suspiciousness and nervousness. 3. The ratio of mental disease family history is 19.2% in the study group while 23.7% in the control group. 4. All psychiatric symptoms of schizophrenia which were impacted by mental stimulation can be found in both groups. 5. The treatment prescriptions were identical in the two groups. Both included be free from unhealthy environment, psychotherapy and antipsychotic therapy. 6. Most onset of the disease in both groups was acute or subacute, while all patients were restored and can work and live normally in 1 month after therapy. Still a few patients with chronic onset can restore in 4 months. 7. Illusion and delusion were more common in study group than in control group.
  Conclusion: Onset of the disease was related to mental factors, unhealthy characters, and family history. All psychiatric symptoms of schizophrenia which were impacted by mental stimulation can be found in both groups. The treatment prescriptions were identical, therapeutic and prognoses were well in the two groups. Visual hallucination, hearing hallucination, feeling of being controlled, incongruity of affect and conduct disorder were more common in study group than in control group.
  
  
• P054
  安非他 酮与文拉法辛治疗抑郁障碍的对照研究 - The Comparative Study of Bupropion and Venlafaxine in Treatment of Depressive Disorders
  潘惟 华 1 温琳 李海英
  1 青岛精神卫生 中心 , 青岛 , Qingdao Mental Health Center of Shandong Province, Qingdao 266034,China
  目的 : 研究比 较安非他酮与文拉法辛对抑郁症的疗效和不良反应。
  方法 : 100 例符合中国精神障碍分 类与诊断标准第三版 （ CCMD-3 ） 的各型抑郁 发作患者 ， 随机分为两组 ， 安非他酮组 (300mg/d ～ 450mg/d ） 50 例 ； 文拉法辛 组 （ 50mg/d ～ 250mg/d ） 50 例 ； 疗程均为 6 周。以 汉密尔顿抑郁量表（ HAMD ）、 汉密尔顿焦虑量表（ HAMA ） 进行疗效评估，以治疗中需处理的不良反应、血常规、生化分析、心电图等进行安全性评估。结果 安非他 酮组的有效率为 82% ，文拉法辛 组为 72% ，差异无 统计学意义（ P ＞ 0.05 ）。安非他 酮组 HAMD 分数下降大于文拉法辛，差异有 统计学意义（ P ＜ 0.01 ）。安非他 酮组的不良反应发生率为 20% ，文拉法辛 组为 42% (p ＜ 0.01) ，安非他 酮组的口干、心动过速、性功能障碍较文拉法辛组少见。
  结论 : 安非他 酮与文拉法辛治疗抑郁障碍有效 ， 安非 他 酮组的不良反应及疗效均优于文拉法辛。
  关键词 : 安非他 酮 文拉法辛 抑郁障碍
  
  Objective: To compare the efficacy and side effect of bupropion and venlafaxine in the treatment of depression.
  Methods: 100 patients diagnosised as depression according to CCMD-3 were included. They were randomly devided into two groups. One group was given bupropion, the other was given venlafaxine for six weeks. The efficacy was measured with Hamilton depression scale (HAMD), Hamilton anxiety scale( HAMA )and the safety was assessed with side effect 、 blood routine 、 electrocardiogram and so on.
  Results: The response rate was 82% in bupropion and 72% in venlafaxine group （ P ＞ 0.05 ） . The HAMD scores in bupropoin group decreased more than that in venlafaxine group(p ＜ 0.01).The rate of side effect was 20% in bupropion group and 42% in venlafaxine (p ＜ 0.01).There were less dry mouth 、 tachycardia and ED in bupropion group than that in venlafaxine group.
  Conclusion: It is effective that both bupropion and venlafaxine in treating depression, with fewer side effects and more efficacy in bupropion group.
  Key words: bupropion ； venlafaxine ； depressive disorders
   
  
• P055
  盐酸氟西汀与盐酸度洛西汀肠溶胶囊治疗抑郁症的 . 随机、双盲双模 拟、多中心临床试验 - A randomized, Double-blinded, Double-mimic, Multi-centre Clinical Trial for Fluoxertine Hydrochloride and Dutoxetine Hydrochloride Enteric Capsule in Treating Depression
  成 阁 高 1 , 刚 王 2 , 秀峰 许 3 , 世平 谢 4 , 庆荣 谭 5 , 波 杜 6 , 能能 程 7
  1 西安交通大学医学院第一附属医院心理 卫生中心 , 陕西西安 , Chinese Mainland, 2 首都医科大学附属北京安定医院 , 北京 , Chinese Mainland, 3 昆明医学院第一附属医院 , 云南昆明 , Chinese Mainland, 4 南京 脑科医院 , 江 苏南京 , Chinese Mainland, 5 第四 军医大学西京医院 , 陕西 , Chinese Mainland, 6 河北省精神 卫生中心 , 河北保定 , Chinese Mainland, 7 复旦大学药学院 , 上海 , Chinese Mainland
  
  目的 : 评价度洛西汀肠溶胶囊治疗抑郁症的疗效和安全性。方法 采用随机、双盲双模 拟、氟西汀平行对照、剂量固定的多中心研究。受试者分别口服度洛西汀肠溶胶囊 60 mg/d 或氟西汀胶囊 20 mg/d, 共 观察 6 周。采用 汉密尔顿抑郁量表 (HAMD) 17 项总分减分值作为主要疗效指标 , 以 汉密尔顿焦虑量表 (HAMA) 和 临床疗效总评量表 (CGI) 评分作为次要疗效指标 , 采用副反 应量表 ( TESS) 、 实验室检查、心电图、生命体征和体格检查等观察药物的安全性。结果 共收集意向性治 疗 ( ITT) 抑郁症患者 238 例 , 度洛西汀 组 117 例和氟西汀 组 121 例。符合方案患者 ( PP) 228 例 , 度洛西汀 组 111 例 , 氟西汀 组 117 例。根据 PP 样本 , 治 疗 6 周后 , 度洛西汀 组和氟西汀组 HAMD 17 总分减分值分别为 (15.4±5.0) 分及（ 15.6±5.6 ）分 , 与基 线相比均存在显著性差异 ( P < 0. 01) , 但 组间无统计学差异 ( P > 0. 05) ; 度洛西汀 组在有效率、临床治愈率及 CGI 、 HAMA 评分上与氟西汀组比较均无统计学差异 ( P > 0. 05) ; ITT 结果与 PP 相似。两 组不良反应的症状和发生率也无统计学 差异 ( P > 0. 05) 。
  结论 : 度洛西汀 肠溶胶囊治疗抑郁症的疗效、安全性以及治疗抑郁症伴焦虑的疗效均与盐酸氟西汀相似 , 是一 种安全有效的抗抑郁药。
  
  Objective: To evaluate the efficacy and safety of Duloxetine hydrochloride enteric capsule in the treatment of depression.
  Methods: A randomized, double-blinded, double-dummy, fluoxetine-controlled, multicenter clinical trial was conducted. Patients were assigned to two groups (Duloxetine 60mg/d or fluoxetine 20mg/d) and received six weeks treatment. The primary efficacy indicator was the decreased score of Hamilton depression (HAMD) rating scale 17, and the secondary efficacy indicator was the Hamilton anxiety ( HAMA ) rating scale and clinical global impression(CGI). Treatment emergent symptom scale, laboratory examinations, ECG, vital signs and physical examinations were used to evaluate safety of the medicine.
  Results: 238 treat patients were enrolled in this trial, with 117 in the Duloxetine group and 121 in the fluoxetine group. Among them, the per protocol (PP) sample was 228 patients (Duloxetine group 111,v.s. fluoxetine group 117). Based on the PP sample, the HAMD17 decreased score of Duloxetine group was 15.4±5.0 six weeks after treatment, while fluoxetine group was 15.6±5.6,and there were no significant differences between the two groups (P > 0. 05). Besides, there were no significant differences in response rate (P > 0. 05), remission rate (P > 0. 05), CGI and HAMA . Safety analysis suggested that no significant differences were found in symptoms and frequency of side effects between the two groups.
  Conclusion: Duloxetine hydrochloride tablet is an effective and safe antidepressant. It has similar effect and safety compared with fluoxetine in the treatment of depression.

• P056
  鲁西南农村自杀现状急诊室医务人员访谈分析 - Investigation and Analysis of In-depth Individual Interview on Current Status and Trends of Suicide Behaviors among Docters and Nurses of Energercy Room in South Western Rural Areas in Shandong Province
  Zhonghua Su 1 , Qunfang Liu 1 , Huimin Gao 1
  1 The 2th Affiliated Hospital of Jining Medical College, Jining, Chinese Mainland
  
  目的 ： 了解 鲁西南农村地区自杀现状及近年的变化趋势 ， 为自杀预防和干预提供依据。
  方法 ： 研究 对象是二级或以上医院急诊室的医务工作人员 （ 包括医生和护士两类 ）， 采用随机方便抽样的方法 ， 抽取济宁市三个县城内六家医疗卫生机构作为访谈现场 ， 采用自编个体深入访谈提纲 ， 对 27 名急 诊室医务人员进行面对面的深入访谈。
  结果 ： （ 1 ） 93.6 ％（ 25/27 例 ） 的受 访者认为近年自杀者人数明显下降。 （ 2 ） 74.1 ％（ 20/27 例 ） 的 认为服用农药自杀者比例下降 ， 服用 " 安定 类 " 镇静催眠药物自杀比例上升。（ 3 ） 66.7 ％（ 18/27 例）的受 访者认为老年人多服用农药自杀，年轻人多服用 " 安定 类 " 催眠 药物自杀。（ 4 ） 70.4 ％（ 19/27 例）的受 访者称现在自杀抢救成功率高于从前。（ 5 ）自 杀降低的原因：生活富裕（ 77.8 ％， 21/27 例）；外出打工或 经商，没有机会生气打架（ 66.7 ％， 18/27 例）； 农药使用减少（ 66.7 ％， 18/27 例）；思想 观念转变（ 37.0 ％， 10/27 例）。（ 6 ） 对自杀者精神状态的认识： 37.0 ％（ 10/27 例）的 认为有些自杀者可能存在某种精神疾病， 63.0 ％（ 17/27 例）的 认为自杀者没有心理问题或是自讨苦吃。前者中， 100 ％（ 10/10 例）的不知道自 杀者患有何种确切的精神疾病，仅是怀疑而已。结论：（ 1 ） 21 世 纪鲁西南农村地区自杀率下降，自杀相关行为亦有改变，但确切原因尚需定量研究证实；（ 2 ） 农村急诊室医务人员精神疾病的识别率和诊断率较低，需加强精神卫生知识教育。
  关键词 ： 个人深入 访谈 ； 定性研究 ； 自杀
  
  Objective: To understand the current status and trends of suicide behaviors in south westen rural areas in Shandong Province, so as to develop suitable strategy on suicide prevention.
  Methods: Six Hospitals lied in three conty towns respectively was selected investigation fields by random-convennience sampling. Twenty seven medical staffers (14 docters and 13 nurses) came from the emegercy room of the above hospital were conducted face-to-face interview by using self-developed interview schedule. The materials was analyzed by coding and classify.
  Results: (1) Of the interviewees, 93.6% (25 cases) reported that the numbers of suicidual outpatients came to seek medical helps had declined, while 6.4% (2 cases) reported no change; (2) 74.1% (20 cases) reported the proportion of suicidual outpatients by drinking pestcides had decreased, and that by taking tranquillizer such as diazepam had increased; (3) 70.4% (19 cases) though that the success rate of first aid for the suicidual outpatients were higher than before; (4) For the causes of the decline on the suicidual rate in recent years, 77.8% (21 caes ) attributed to inprove of peasants' life, 66.7% (18 cases) to the decrease of family diputes, and 66.7% (18 cases) to decrease of pestcide use; (5) 37.0% (10 cases) were suspicious that certain outpatients conducted suicide had mental disorder, while 63.0% (17 cases) though no mental disorder.
  Conclusion: (1) The rate of suicide in south-western rural areas in Shandong Province had been declined, and the styles of suicide had been changed. The precise causes of the changes should be to comfirmed by the coming quantative inverstagtions and longistitual investagtions. (2) The discrimination and diagnose abilities of the medical staffers in energercy room on mental disorders have be lower still. The mental health education should be strengthened among them.
  Key words: In-depth individual interview, Qualitative study, Suicide
  
• P057
  国外双相抑郁治 疗进展介绍 - A Introduction of the Development in the Treatmrnt of Bipolar Depression Overseas
  马 燕桃 1 , 于 欣 1 , 双相情感障碍
  1 北京大学精神 卫生研究所 , 北京 , Chinese Mainland
  
  目的 ： 双相抑郁 ， 特 别是难治性抑郁的治疗 ， 临床医生经常缺乏有循证依据的选择。笔者在美国访问期间，了解由美国国立精神卫生中心 (NIMH) 进行的竞争性随机使用拉莫三嗪， inositol 和 维思通作为抗抑郁剂附加剂治疗难治性双相抑郁的研究 [1] ，旨在介 绍国外双相抑郁治疗领域的最新研究成果。该研究是全球首个关于双相抑郁治疗策略的系统研究。
  方法： 搜索双相抑郁治 疗的近 10 年的研究 进展，介绍和拉莫三嗪相关的研究成果。
  结果： 该研究结果发现三组间在治愈率方面没有组间显著差异。不过拉莫三嗪合并治疗组治愈率为 23.8%, 而 inositol 和 维思通治疗组分别为 17.4% and 4.6% 。和另外两 组相比，拉莫三嗪治疗组抑郁评分和临床总体印象评分更低，而社会功能总体评估相对更好 [1] 。
  讨论： 最新 结果证实拉莫三嗪（ LMG ） 较 inositol 和 维思通在提高难治性双相抑郁疗效方面有优越性 [1] 。拉莫三 嗪可能具备成为理想的情感稳定剂的特征。
  Claus et al [2] 的 LMG 合并 赛乐特治疗双相抑郁双盲试验证实 LMG 的抗抑郁 疗效，其对 SSRI 类药物的增效作用可能加快抗抑郁的疗效。多项维持期治疗研究肯定了该药对长期抗抑郁效果显著优于安慰剂 [3,4] 。拉莫三 嗪没有显示出可以抗躁狂或预防躁狂复发 [5] 。多 项和安慰剂对照双盲研究表明拉莫三嗪对双相抑郁急性期，快速循环型或难治性抑郁治疗有效，不增加转躁狂风险 [6,7,8,9] 。 Calabrese et al[6] 的大 样本随机双盲对照试验显示双相 I 型抑郁 LMG 治 疗组和安慰剂对照组相比转躁狂率没有组间差异，说明拉莫三嗪不仅带有抗抑郁特性，与其它抗抑郁剂相比，对快速循环型预防也有效。 Bowden [10] 总结了 8 个安慰 剂对照临床试验 1800 例病人， 证实拉莫三嗪耐受好，副作用等同于安慰剂，常见不适为头痛。拉莫三嗪不引起情绪不稳，无性功能障碍，体重增加，撤药综合征。极少严重副作用。少见严重皮疹发生 ( 发生率 0.1%) 。美国食品和 药物管理局（ FDA ） 2003 年批准拉莫三 嗪作为成人双相 I 型情感障碍 维持治疗用药。已有临床治疗指南将其列为治疗双相抑郁急性期治疗一线药物，或初始治疗无效者的附加用药 [11,12] 。
  
  Motivation: To introduce the development of treatment of bipolar depression in abroad.
  Method: A literature search was performed in using online English databases, including Pub Med, Ovid, Medline, and Treadwell Library using the following terms: Bipolar Depression, Treatment, and Lamotrigine.
  Result: More than thirty articles were included, which cover topics including trials of Lamotrigine monotherapy or adjunctive therapy in treating bipolar depression.
  Discussion: Lamotrigine has been proved to have the superiority in improving the antidepressant effect in treating bipolar depression compared with risperidone or lithium. A pilot study of Lamotrigine in treating Chinese patients with bipolar depression is on-going.
  
• P058
  缺陷型与非缺陷型精神分裂症的 C 型行 为特点 - The C Type Behavior Characteristic of Deficit and Nondeficit Forms of Schizophrenia
  庆丰 吴 1 , 国 军 谢 1
  1 广 东省佛山市第三人民医院 , 佛山 , Chinese Mainland
  
  目的 ： 探 讨缺陷型与非缺陷型精神分裂症与 C 型行 为的关系。
  方法 ： 将符合 CCMD-3 精神分裂症 诊断标准的男女患者各 45 名 纳入研究 ， 分别于治疗前和治疗 8 周后 对 患者 进行 BPRS 量表、 SAPS 量表、 SANS 量表 评定和患者自行进行 C 型行 为量表测定。并根据缺陷型精神分裂症的定义和治疗前的 SAPS 、 SANS 评分将患者分为缺陷型 (30 例 ) 和非缺陷型（ 60 例）两 组。
  结果： 无 论治疗前后，缺陷组的焦虑、抑郁、理智、控制分较非缺陷组低，社会支持分较非缺陷组高；与治疗前相比，治疗后缺陷组与非缺陷组的焦虑分（ 26.25±3.69 和 41.03±7.67 ）、抑郁分（ 24.83±3.93 和 40.61±6.07 ）均降低，控制分（ 16.50±2.54 和 19.91±4.21 ）、社会支持分（ 19.50±2.78 和 17.33±2.39 ）均升高。治 疗后缺陷组精神症状缓解不全（ BPRS ＞ 35 ）， 阴性症状改善不明显。
  结论： 缺陷 组与非缺陷组有不同的 C 型行 为特征 .
  
  Objective: To detect the relationship between deficit and nondeficit forms of schizophrenia with the C type behavior.
  Methods: 90 patients, who met CCMD-3 criteria schizophrenia,were enrolled in the study. BPRS, SAPS, SANS, C type behavior were measured before treatment and 8 weeks after treatment. The patients were divided into deficit group(30)and nondeficit group(60).
  Results: Compared with nondeficit group, anxiety, depression,reason and control scores were lower, social support scores were higher in deficit group both pretreatment and posttreatment. Compared with pretreatment, anxiety(26.25±3.69 and 41.03±7.67) and depression(24.83±3.93 and 40.61±6.07) scores descended, control (16.50±2.54 and 19.91±4.21) and social support (19.50±2.78 and 17.33±2.39)scores increased in posttreatment both deficit and nondeficit group; However, posttreatment psychotic symptom had obvious (BPRS ＞ 35) in deficit group,negative symptom had no visible change.
  Conclusion: Deficit and nondeficit forms of schizophrenia have different C type behavioral character.
  
• P059
  米氮平与 SSRIs 对难治性抑郁症患者的疗效及生存质量的对照研究 - A Controlled Study on the Effect and Quality Life about Mirtazapine versus SSRIs in the Treatment of Treat-resistant Depression
  孙群星 星 1
  1 驻马店市精神病院门诊部 , 河南 驻马店市 , 驻马店市 , Chinese Mainland
  
  目的 ： 观察米氮平与 SSRIs 对治疗难治性抑郁症患者的疗效及生存质量的影响。
  方法 ： 采用入院 顺序分层随机法 ， 将 80 例 难治性抑郁症患者平均分为研究组 （ 米氮平 ） 和对照组 （ SSRIs ）， 在治 疗前、治疗后 1 、 3 、 6 、 12 月末分 别用汉密尔顿抑郁量表 （ HAMD ） 、 总体疗效量表 （ CGI ） 和副反 应量表 （ TESS ） 评定疗效和副作用 ,WHOQ0L—BREF 量表衡量患者的生存 质量 , 分析量表中各 领域的计分。
  结果 ： 治 疗 1 月后研究 组 HAMD 总分及各因子分比治疗前明显降低 (p<0.01) ， 且治 疗因子分显著低于对照组 (p<0.05) 。 SSRIs 组副作用比米氮平组多。 经 12 个月治 疗，研究组的生理领域、心理领域、社会关系领域、环境领域的分值分别为 71.13±5.73 ， 93.37±11.43 ， 94.31±12.77 ， 93.61±11.35 ， 对照组的生理领域、心理领域、社会关系领域、环境领域的分值分别为 69.31±8.37 、 77.12±10.54 、 78.72±12.52 、 77.65±11.45 。治 疗后两组患者生存质量较治疗前均有显著改善（ P<0.01 ），在心理 领域、社会关系领域和环境领域等三方面，米氮平优于 SSRIs （ P<0.01 ）。
  结论 ： 米氮平治 疗难治性抑郁症疗效确切 , 且 对生存质量的改善更彻底。
  关键词 : 难治性抑郁症 米氮平 SSRIs 疗效 生存 质量
   
  
• P060
  Comparative and Study the Influence of Mirtazapine and SSRIs on Efficacy and Quality of Exist in Treatment-Refractory Depression
  Zhen Qi Ding 1 , Yu Xing Zhu 1 , Ai Rong Zhang 1
  1 HeNan Sen Zhumadian Mental Hospital, Zhumadian, Chinese Mainland
  
  Objective: To investigate the influence on efficacy and quality of exist of mirtazapine and SSRIs in treatment-refractory depression.
  Methods: Being used the vendom control study. 80 treatment-redfractory depression were divided into study group (mirtazapine) and control group(SSRIs). Effects and side effects were assessed with HAMD and CGI and TESS respectively, WHOQ0L-BREF instruments were used to evaluate the patients quality of life before and after drug abministration, by menas of analyzing the scores in every domains. Before and after 1 、 3 、 6 、 12 months treatment.
  Results: Compared with before treatment, the todal scores of HAMD and the scores of every factor were signficantly decreased after 1-month treatment with study group and the score of treatment factors was significantly lower than that of contrast group (p<0.01), the tess scores of study group were lower than that of contrast group (p<0.01). The side effects were more in SSRIs group those in mirtazapine group. 12 months after treatment, the scores of physical realm, psychological realm, social relationship, and environment in mirtazapine group were 71.13±5.73 ， 93.37±11.43 ， 94.31±12.77 ， 93.37±11.35; and the scores of physical halth, psychological realm, cocial relationship, and environment in SSRIs group were 69.31±8.37 、 77.12±10.54 、 78.72±12.52 、 77.65±11.45. And the scores of four domains in WHOQ0L-BREF instruments had been improved significantly in to groups (p<0.01) In the damains of Psychological realm, social Relation ship and Environment, mirtazapine was superior to SSRIs (p<0.01).
  Conclusion: The study suggests that mirtazapine is effective in the treatment of treatmene-refractory depression and to exist the improvement of the quantity more thoroughly.
   
  
• P061
  阿立派 唑合并丙米嗪治疗难治性抑郁症的临床研究 - A Study of Aripiprazole Combined with Lmipramine in the Treatment of Treatment Resistant Depression
  孙群星 星 1
  1 驻马店市精神病院门诊部 , 河南 驻马店市 , 驻马店市 , Chinese Mainland
  
  目的 ： 观察阿立派唑合并丙米嗪治疗难治性抑郁症的疗效和副作用。
  方法 ： 采用入院 顺序分层随机法 ， 将 80 例 难治性抑郁症患者平均分为研究组 （ 阿立派唑 + 丙米 嗪 ） 和对 照 组 （ 丙米嗪 + 安慰 剂 ）， 在治疗前、治疗后 4 、 8 、 12 周末分 别用汉密尔顿抑郁量表 （ HAMD ） 、 总体疗效量表 （ CGI ） 和副反 应量表 （ TESS ） 评定疗效和副作用。
  结果 ： 治 疗 4 周后研究 组 HAMD 总分及各因子分比治疗前明显降低 ， 且治疗因子分显著低于对照组 ， 治疗后 4 、 8 、 12 周末 TESS 评分 ， 4 周末研究 组高于对照组 ， 8 、 12 周末两 组无显著差异。
  结论 ： 阿立派 唑合并丙米嗪治疗难治性抑郁症疗效确切。
  关键词 : 难治性抑郁症 阿立派 唑 丙米 嗪
   
  
• P062
  A Clinical Study on Guetinpine Combined with Imipramimum in Treatment-refractory Depression
  Yong Liu 1
  1 HeNan Sen Zhumadian Mental Hospital, Zhumadian, Chinese Mainland
  
  Objective: To observe the efficacy and side effects of guetiapine combined imipramimum in the treatment of treatment-refractory depression.
  Methods: Being used the vendom control study, 60 treatment-redfractory depression were divided into strdy gooup (aripiprazole and imipramimum) and control group (imipramimum and comfort). Effects and side effects were assessed with HAMD and CGI and TESS respectively before and after 4 、 8 、 12 weeks tyeatinent.
  Results: compared with befere treatment, the todal scores of HAMD and the scores of every factor were signficantly decreased after 4-week treatment with aripiprazole and imipramimum and the score of treatment factors was significantly lower than that of control group. The tess scores of study group were lower than that of control group. After 4 、 8 、 12 weeks treatment. and the scores of TESS. The control group were lower than that the study group in 4-week. There was no significant significantly in 8 、 12weeks.
  Conclusion: The study suggests that aripiprazole combined with imipramimum is effective in the treatment of treatmene-refractory depression.
  Key words: Treatment-refractory depression aripiprazole imipramimum.
   
  
• P063
  抑郁症患者治 疗前后关联性负变研究 - Study of Contingent Negative Variation of before and after treatment in Patients with Depression
  俊祥 成 1 , 军辉 平 1 , 英 王 2
  1 河南省精神病院 , 新 乡市 , Chinese Mainland, 2 新 乡医学院研究生 , 新 乡市 , Chinese Mainland
  
  目的 : 　研究抑郁症患者治 疗前后认知功能的变化特点 ， 同时探讨关联性负变 (CNV) 与神 经心理学测验之间的关系。
  方法 : 将 45 例 18~60 岁抑郁症患者 , 在入院当日和西 肽普兰治疗 8 周后 进行采用视觉诱发电位系统完成事件相关电位伴随负变化及韦氏记忆量表 (WMS-RC) 、 韦氏成人智力量表 (WAIS-RC) 测试检测 , 并与 30 例健康人作 为对照组 ， 所有数据均采用 SPSS11.5 统计软件包统计数据处理 ， 统计处理采用 χ 2 检验、 t 检验、 Pearson 相 关分析。结果 实验组关联性负变早反应波潜伏期 (CNVm1PL) 、 关联性负变晚反应波幅 (CNVm2amp) 治 疗前和治疗后比较有显著性差异 (P<0.05); 实验组关联性负变早反应波潜伏期、关联性负变晚反应波潜伏期、关联性负变晚反应波波幅治疗前与对照组比较有显著性差异 (P<0.05); 关联性负变早反应波、关联性负变晚反应波潜伏期治疗后与对照组比较有显著性差异 (P>0.05) 。治 疗前语言智商与 CNVM1 潜伏期呈正相 关关系 (P<0.05) 。治 疗后短时记忆、记忆商数、作业智商、全智商与 CNVM1 潜伏期呈正相 关关系（ P<0.05 ）；短 时记忆、记忆商数与 CNVM1 波幅呈正相 关关系（ P<0.05 ）； 记忆商数、作业 智商、全智商与 CNVM2 波幅呈 负相关关系（ P<0.05 ）。
  结论 : 抑郁症患者 发作期存在明显认知功能损害 , 治 疗后随着临床症状的缓解 , 其 认知功能得到部分改善，但不能短期内恢复到正常水平。 抑郁症患者 韦氏记忆和韦氏智力测试与关联性负变多个指标间存在相关 , 提示 关联性负变可作为抑郁症患者伴发认知功能障碍的有效评定工具。
  
  Objective: To explore the characters of cognitive function in depressed patients, and to examine the correlations between neuronpsychology and contingent negative variation (CNV).
  Methods 45 depressed patients were enrolled as study group, which were assessed at baseline and after SSRIs therapy 8 weeks. contingent negative variation (CNV) of ERPs and Wechsler memory scale (WMS-RC) as well as Wechsler adult intelligence scale (WAIS-RC) were measured in all subjects, meanwhile 30 normal persons matched as control group. All the data were analyzed with SPSS software package. The normal distributed numerical data were analyzed with t-test and linear Pearson correlation analysis and the enumeration data were analyzed with Chi-square test.
  Results: Compared with before treatment, the CNVm1PL and CNVm2amp in study groups showed significant differences after treatment (P<0.05). There were significant differences in CNVm1PL 、 CNVm2PL and CNVm2PL before treatment in study group compared with control group. Compared with control group, the CNVM1PL and CNVM2PL had significant differences after treatment (P>0.05). There were positive correlations between the latencies of P300 and LTM, STM and PIQ before treatment in study group (P<0.05) and the latencies of N400 showed positive correlations with IQ (P<0.05) meanwhile the latencies of MMN presented negative correlations with LTM (P<0.05) but there were positive correlations between the latencies of CNVM1 and VIQ (P<0.05). The latencies of CNVM1 were positively correlated with STM, MQ, PIQ and IQ (P<0.05) and the amplitudes of CNVM1 were positively correlated with STM and MQ (P<0.05). There were negative correlations between the amplitude of CNVM2 and MQ, PIQ, IQ (P<0.05).
  Conclusions: It suggests that depressed patients have significant cognitive deficits in period of onset and the cognitive function can be partly proved in terms of the improvement of clinical symptoms, but the most cannot be normal in short times. There are significant correlations between neuropsychological tests and CNV many indexes of in depressed patients. It suggests that latency of CNV are markers of cognitive function of patients with depression.
   
  
• P064
  Application of Filial Therapy in Child Psychological Counseling
  Wan Guobin 1
  1 Shenzhen Maternity & Child Healthcare Hospital , Child Psychiatry, Shenzhen, Chinese Mainland
  
  Objective: To explore the effects of filial therapy in child psychological counseling.
  Methods: parent was trained to manage the filial therapy and then, did home play sessions with their children 30minutes a week ． Checklist of the empathy in adult-child interaction(MEACI) and Portor parental acceptance scale (PPAS) were filled before and 8 weeks after the therapy.
  Results: Total scores of PPAS ， and scores of feelings, uniqueness, autonomus and love unconditionally to child is increased . Empathy in adult-child interaction improved obviously in parent-child play session after filial the therapy.
  Conclusion: Filial therapy can be applied to child psychological counseling 。
   
  
• P065
  阿立 哌唑与利培酮治疗儿童青少年精 神分裂症 对照研究 - Comparative Study between Aripiprazode and Risperidone in the Treatment of Schizophrenia in Children and Adolescents
  茹 卜 1 , 小 扬 顾 1 , 金 荣 孙 1 , 昕 储 1 , 仁 丽 叶 2
  1 扬州五台山医院 , 扬州市 , Chinese Mainland, 2 安徽省皖南医学院 , 芜湖 , Chinese Mainland
  
  目的 ： 目前国内外使用阿立 哌唑治疗儿童青少年精神分裂症的经验报 道 较少 ， 因此本研究在取得患者家长同意后分别使用阿立哌唑与利培酮治疗儿童青少年精神分裂症 ， 比较阿立哌唑与利培酮治疗儿童青少年精神分裂症的临床疗效和安全性。
  方法 ： 2 检验和 t 检验。 c 将 120 例儿童青少年精神分裂症的住院患者随机分 为两组 ， 分别用阿立哌唑与利培酮治疗 8 周。采用阳性与 阴性症状量表（ PANSS ）、 临床总体印象量表 (CGI) 和副反 应量表 (TESS) 评定疗效及不良反应，在治疗前和治疗第 2 、 4 、 6 、 8 周末各 评定 1 次，同 时检测血常规、肝功能和心电图，并观察治疗前后体重、月经的变化以及有无泌乳现象。数据进行进 行
  结果： （ 1 ）阿立 哌唑组和利培酮组治疗儿童青少年精神分裂症后第 4 、 6 、 8 周的 PANSS 分 较治疗前相比差异均有显著性（ P 均 <0.01 ）。（ 2 ）阿立 哌唑组治疗 2 周末 PANSS 总分、阴性症状评分均有明显下降（ P<0.05 ）。 (3) 阿立 哌唑和利培酮治疗儿童青少年精神分裂症治疗 8 周的 疗效相当（ P>0.05 ），阿立 哌唑组和利培酮组的显效率分别为 83.2% 和 82.7% 。 (4) 阿立 哌唑组的副反应发生率明显低于利培酮组（ P<0.05 ） , 尤其是 锥体外系反应（震颤、静坐不能、肌强直）、体重增加、月经紊乱的发生率显著低于利 培 酮组（ P<0.005 ）。
  结论： 阿立 哌唑是一种安全有效、见效快、不良反应轻的治疗儿童青少年精神分裂症的药物，阿立哌唑儿童青少年精神分裂症阳性、阴性症状与利培酮同样有效，但不良反应更少，依从性较好，值得推广使用。
  
  Objective: At this time,there are few reports about experiences of using aripiprazode in the treatment of schizophrenia in children and adolescents all over the world, so the study has schizophrenic inpatients divided into aripiprazode group and risperidone group randomly to treat after we have obtained the permition of parents, in order to compare the efficiencies and safeties of aripiprazode with risperidone's in the treatment of schizophrenia in children and adolescents. To detectthren clinical efficacy and side effect of aripiprazode and risperidone in the treatment of schizophrenia in children and adolescents.
  Method: 120 schizophrenic inpatients have been divided into aripiprazode group and risperidone group randomly to treat for 8 weeks. Before and after treatment for 2, 4, 6, 8 weeked, Positive and negative symptom scale(PANSS) 、 clinical global impression(CGI) and treatment emergent symptom scale(TESS) were used to evaluate the efficacy and side effects respectively before treatments and during the process of treatments per two weeks,as well as examine blood routine test liver function and EKG, meanwhile observe the change of weight and menses and whether have appearence of 2 and test. c after treatment. The date is examined by
  Results: （ 1 ） The PANSS scores in both aripiprazode group and risperidone group decresed significantly for the treatment of schizophrenia in children and adolescents after treated for 4,6,8 weeks(P<0.01).(2)Aripiprazode group more efficient for both the total PASS scores and the negative symptom scores obviously decrease (P<0.05) after treated for 2 weeks.(3) Aripiprazode was as effective as risperidone for the treatment of schizophrenia in children and adolescents (P>0.05), the ret of improvement was similar in aripiprazode group and risperidone group(83.2% vs 82.7%).(4) Aripiprazode produced fewer side effects extrapyramidal side effect （ tremor 、 athsia 、 dystonia ） ,gain weight, disorder of mensturation than risperidone (P<0.005).
  Conclusion: Aripiprazode is a safe and effective drug for schizophrenia in children and adolescents with more rapid onset of action. Aripiprazode has similar efficacy to risperidone inrelieving the positive and negative symptoms of schizophrenia in children and adolescents,but with less side effects thana risperidone ,superior compliance.It is worthy to be recommended for clinical treatment.
   
  
• P066
  慢性精神分裂症患者 认知功能的研究 - A Comparative Study of Cognitive Ability between Chronic Schizophrenia Patients and Normal People
  Jin-Rong Sun 1 , Zao-Huo Cheng 2 , Wei-Wei Sha 1 , Zhao-Sheng Ding 1 , Zheng-Dong Chen 1 , Xiao-Yang Gu 1 , Ru Bo 1 , Yu-Mei Zhang 1 , Hong-Hui Zhou 1 , Xin Chu 1
  1 Yangzhou Wutaishan Hostipal, Yangzhou, Chinese Mainland, 2 Wuxi Mental Health Institution, Wuxi, Chinese Mainland
  
  目的 ： 探 讨慢性精神分裂症患者认知能力的特点。
  方法 ： ① 样本 58 例符合 CCMD-3 精神分裂症 诊断标准 ， 病程持续 ≥5 年的患者和 63 例正常人 ， 所有受 试者测试前都征得本人或监护人的知情同意。 ②工具：采用 华文认知能力量表 ( 简称 CCAS) 包含 10 个分 测验，数字广度、汉词配对、数理运算 、言 语类推、快速组词、空间广度、图符配对、巧拼积木、图形类推、快速编码，测试是个别测验； ③ 评估标准：成绩以量表分表示，测验总成绩以离差商数（智商）表示，分数越高认知能力越好，并比较组间差异。结果：所有被试均进入结果分析，慢性精神分裂症患者 CCAS 测得的总智商低于正常人（ 49.60±13.22 ， 97.27±18.34 ， P<0.01 ），各 项分测验得分也低于正常人（ P<0.01 ）且得分与病程呈 负相关 (P<0.01) 。 结论：慢性精神分裂症患者存在认知能力缺陷 , 其 认知能力缺损与病程有关。
  关键词： 慢性精神分裂症； 认知 能力； 华文认知能力量表
  
  Objective: To explore the cognitive ability in chronic schizophrenia patients.
  Method: 63 normal people and 58 schizophrenia patients who met the CCMD-3 and course of diseases were over 5 years, all participants or the guardians were apprised what happened. The Scale was Chinese Cognitive Ability Scale (CCAS), which has 10 subtests, such as Digit Span, Chinese Word Matching, Numeral Operation, Verbal Analogy, Word Stem Completion, Spatial Span, and Picture—Symbol Matching, Build Block, Pattern Analogy, Quick Coding. The grade was the score of the scale. The total result was the intelligence quotient (IQ), the score was much more the cognitive function was more good, and to comparer the differences of them.
  Results: All participants were analyzed. Comparing with mean IQs chronic schizophrenia patients （ FIQ= 49.60 ±13.22 ） were less than normal groups （ FIQ=97.27 ±18.34 ） (P<0.01). And the score of all the subtests were less than normal groups (P<0.01). The scores and course of diseases were negative correlation (P<0.01).
  Conclusion: The cognitive ability in chronic schizophrenia patients were damaged, and the damage correlation with the course of diseases.
  Key word: Chronic Schizophrenia ; Cognitive Ability, Chinese Cognitive Ability Scale (CCAS)
  
  
• P067
  齐拉西酮与氯氮平对首发精神分裂症患者生活质量影响 - Comparative Study on the Influence of Ziprasidone and Clzapine on Quality of Life in Schizophrenic
  Yu Ling Wang 1 , Hua Guo 1 , Yong Liu 1
  1 Henan Zhumadian Psychiatric Hoapital, Zhumadian, Chinese Macao
  
  目的 ： 探 讨齐拉西酮治疗对首发精神分裂症患者生活质量的影响。
  方法 ： 以 齐拉西酮与氯氮平治疗精神分裂症各 40 例作 对照研究 ， 采用简明精神病评定量表 （ BPRS ） 不良反 应量表 （ TESS ） 评定疗效及副反应 ， WHOQ 0L —BREF 量表衡量患者的生活 质量。结果 最后一次 评定，齐拉西酮组 BPRS 总分降至 15.62±4.37 ，与治 疗前比较有显著性差异（ P<0.01 ）； 氯氮平组 BPRS 总分降至 16.02±4.63 ，与治 疗前比较有显著性差异（ P<0.01 ）。两 组间疗效无显著性差异（ P>0.05 ）。 氯氮平组副作用较齐拉西酮组多。经 6 个月治 疗，齐拉西酮组的身心健康、心理健康、社会关系、环境因素 的分 值分别为 72.43±4.53 ， 94.87±10.55 ， 96.31±12.37 ， 95.43±10.12 ， 氯氮平组的身心健康、心理健康、社会关系、环境因素的分值分别为 69.81±5.37 、 79.72±11.84 、 80.72±11.42 、 77.74±10.56 。两 组患者生活质量较治疗前均有显著改善（ P<0.01 ），在心理健康、社会 关系和环境因素等三方面，齐拉西酮优于氯氮平（ P<0.01 ）。
  结论 ： 首 发精神分裂症患者在提高生活质量方面 ， 齐拉西酮优于氯氮平 ， 有利于精神分裂症的远期康复。
  关键词 : 齐拉西酮 氯氮平 分裂症 生活 质量
  
  Objective: To investigate the influence on quality of life of Ziprasidone in schizophrenia
  Methods: 40 schizophrenic patients were treated with sisperidone as the controlled group. The Brief Psychiatric Rating Scale (BPRS), while the adverse events were determined by the treatment emergent symptoms scale (TESS), WHOQ 0L -BREF instruments were used to evaluate the patients quality of life before and after drug abministration.
  Results: for the last assessment ,The scores of BPRS decrease to 15.62± 4.37 in Ziprasidone group, was significantly lower than the beginning (p<0.01); the scores of BPRS decrease to 16.02± 4.63 in clozapine group, was significantly lower than the beyinning (p<0.01); Two groups showed similar effects, with no significance. The side effects were more in clozapine group than those in guetiapine group. 6 months after treatment, the scores of physical health, psychological health, social relationship, and environment in Ziprasidone group were 72.43±4.53 ， 94.87±10.55 ， 96.31±12.37 ， 95.43±10.12; and the scores of physical halth, psychological health, cocial relationship, and environment in clozapine group were69.81±5.37 、 79.72±11.84 、 80.72±11.42 、 77.74±10.56. and the scores of four domains in WHOQ 0L -BREF instruments had been improved significantly in to groups (p<0.01) In the damains of Psychological health, social Relation ship and Environment, Ziprasidone was superior to clozapine (p<0.01).
  Conclusion: Ziprasidone has more advantage than Cozapine to improve guality of life in schizophrenic and would be helpful to patients longterm rehabilitation.
  Keywords: Ziprasidone Clozapine Schizophrenic Quality of life
   
  
• P068
  阿立派 唑与奎硫平治疗老年期分裂症的对照研究 - Aripiprazole versus Quetiapine in the Treatment of Schizophrenia in the Old Age
  金波 崔 1
  1 天津市安定医院 , 天津 , Chinese Mainland
  
  目的 ： 探 讨阿立哌唑与奎硫平治疗老年期分裂症患者的疗效及副作用。
  方法 ： 将 60 例住院老年期精神分裂症患者随机分成阿立 哌唑组 （ 30 例 ） 和奎硫平 组 （ 30 例 ）， 治 疗 8 周后 进行对照研究。用 BPRS 量表和 TESS 量表 评定疗效和副作用。采用简明精神病量表（ BPRS ） 评定临床疗效，分别在疗前和疗后 2 、 4 、 6 、 8 每周末分 别评定分值一次。经治疗后减分率 >70% 为显效， 30% ～ 70% 为有效， <30% 为无效；根据两组病例疗前与疗后 2 、 4 、 6 、 8 周的 BPRS 减分情况来判定起效 时间及疗效变化；采用副反应 量表（ TESS ） 评定用药过程中出现的各类副反应；应用 χ2 检验、 t 检验进行资料的统计分析。
  结果： 疗效评价： 8 周治 疗后，阿立哌唑组：显效 9 例，有效 14 例，无效 7 例；奎硫平 组显效 10 例，有效 14 例，无效 6 例。 经 χ2 检验，两组无显著差异（ P ＞ 0.05 ）。 疗后 8 周，阿立 哌唑组减分率为 51.01% ，奎硫平 组为 49.67%, 两 组 BPRS 减分情况相仿， 经 t 检验评定结果两组无显著差异（ P ＞ 0.05 ）；阿立 哌唑和奎硫平的 BPRS 量表在 疗后 2 、 4 、 6 、 8 周分 别与疗前比较，经 t 检验有显著差异（ p<0.01 ），表明两 药对治疗老年 期精神分裂症均有 较好疗效；两组的 BPRS 分 值在治疗 2 周内均已起效（ p<0.01 ），随着治 疗时间延伸，其效果亦同步上升，两组起效时间及疗效基本相仿，比较结果无显著差异（ P ＞ 0.05 ）。副反 应分析：两组的 TESS 评分比较相近且较小，但两组的副反应存在差异，阿立哌唑组不良反应有头疼、恶心、失眠、激越、焦虑和轻度的 EPS ， 较奎硫平组多。奎硫平组不良反应有口干、嗜睡、体位性低血压、比阿立哌唑组多。
  结论： 显示阿立哌唑、奎硫平在治疗老年期精神分裂症方面均为安全有效的抗精神病药，虽然副作用各有异同，但较少引起 EPS 、内分泌改 变以及体重增加是两药共同的特点。
  
  Objective: To compare the efficacy and safety of Aripiprazole and quetiapine in the treatment of schizophrenia in old age.
  Methods: In this 8-week study, 60 patients with schizophrenia in old age were assign randomly into aripiprazole group(N=30) and quetiapine group(N=30). The Brief Psychiatric Rating Scale and the Treatment Emergent Side effect Scale were used to assess the efficacy and the safety. 1)
  Results: 1.Efficacy Assessment: After 8-week treatment , the improvement of the BPRS score in the afipiprazole group was 51.01%,compared with the quetiapine group was 49.67%. The total score improvements were no significant between the two groups(P ＞ 0.05,t-test); In both aripiprazole group and quetiapine group ,BPRS total scores at 2, 4, 6, 8 week had significant improvement than the score at the baseline; The efficacy and the time to response were similar, there were no significant difference between the two groups(P ＞ 0.05);2. Assessmet Of Side Effect In the both groups, TESS scores suggest that the two drugs had few side effect. But there were difference in the two groups of side effect.
  Conclusions: The results suggest that both aripiprizole and quetiapine have efficacy for the treatment of schizophrenia in old age, and they are also safe for these patients.
   
  
• P069
  山 东省 18 岁及以上人群睡眠质量流行病学研究 - Sleep Quality Investigation of the People Aged 18 Years and above of Shandong Province
  Jingxuan Zhang 1
  1 Shandong Mental Health Center , Jinan City , Chinese Mainland
  
  目的 ： 调查山东省 18 岁及以上城乡人口睡眠质量现状、睡眠障碍的发生率。探讨睡眠障碍与生命质量和心理健康水平的关系和精神疾病诊断之间的关系。
  方法： 采用多 阶段分层整群系统随机抽样方法进行抽样分布抽样，实际抽取 18 及 18 岁以上人口 23987 人， 实际完成问卷调查 22664 人（ 94.48% ）。主要研究工具有：匹斯堡睡眠 质量指数，一般健康问卷 ，生命 质量量表，简易应对方式问卷， 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 分析 显示： 18 岁及以上城乡人群的平均睡眠时间为 7.86±1.43 小 时。睡眠质量指数为 3.42±3.57 。女 3.67±3.79 ，男 3.13±3.26 （ t=11.39 ， p < .01 ）； 18-59 岁 2.97±3.25 ， ≥60 岁 5.27±4.16 （ t=34.32 ， p < .01 ）； 农村 3.46±3.61 ，城市 3.30±3.43 （ t=3.03 ， p < 0.01 ）。以 PSQI 总分 >7 为有睡眠障碍， 22664 人中有 2973 人有睡眠障碍， 发生率为 13.12% 。男女分 别为 10.31% 和 15.50% （ χ2=133.01 ， p < .0001 ）。 ≥60 岁人群为 26.68% ， 18-59 岁人群为 9.80% （ χ2=895.56 ， p < .0001 ）。无睡眠障碍 组与睡眠障碍组的 GHQ-12 （ 21.22±2.64 ， 24.54±4.15 ）、生命 质量（ 13.53±2.35 ， 15.89±2.82 ）有 显著差异（ p <.01 ）。 5410 例完成了 SCID-P 的 检查， 2624 例有精神障碍 诊断。无精神障碍者中睡眠障碍的发生率 9.44% ，有精神障碍 诊断者为 41.20% （ χ2=2052.92 ， p < .01 ）。心境障碍 为发生率 55.42% ，精神分裂症和其它精神病性障碍 37.43% ，物 质使用障碍 11.02% ，焦 虑障碍 51.13% ，躯体形式障碍 36.67% ， 进食障碍 71.43% ，智力障碍 13.64% （ χ2=378.08 ， p < 0.0001 ）。
  结论： 山 东省 18 岁及以上人群的睡眠质量指数为 3.42±3.57 （山 东常模），睡眠障碍的发生率为 13.12% ，据此推算山 东省 18 岁及以上人群中有睡眠障碍患者约 988 万人。有睡眠障碍者其生命 质量、心理健康水平较差。精神障碍患者存在睡眠障者高达 41.20% 。
  
  Objective: To investigate the sleep quality, prevalence of sleep disorders, and the prevalence in different groups of the people aged 18 years and above of Shandong province, To analyze the relationship between sleeping disorders and the quality of life, general mental health levels and mental disorders.
  Method: 23987 persons aged 18 years and above were sampled from Shandong province by multi-stage cluster random sampling. 22664 （ 94.48% ） persons completed the survey questionnaires. The main survey tools were Pittsburgh Sleep Quality Index （ PSQI ）， General Health Questionnaire （ GHQ-12 ）， Quality of Life Questionnaire, Simplified Coping Style Questionnaire, DSM-IV and SCID-P. 24 nurses and 60 psychiatrists trained for 4 weeks before survey completed the investigation in homes costing 3 months.
  Result: The average score of sleep duration of 22664 cases who completed questionnaires was 7.86±1.43 hours, and their average score of PSlQI was 3.42±3.57, . female 3.67±3.79, male3.13±3.26 (t=11.39,p<0.001), people aged 18-59 years 2.97±3.25, people aged 5.27±4.16 (t=34.32, p < 0.001). If a person whose total score of PSQI was more than 7, we thought that he or she met diagnostic criteria of sleep disorders, then there were 2973 persons meeting sleep disorder criteria, The prevalence of sleep disorder was 13.12%, male 10.31%, female 15.50% （ χ 2=133.01 ， p < 0.001 ） ; people aged 60 years and above 26.68%, people aged 8-59 years 9.80% （ χ 2=895.56 ， p < .0001 ） 。 There were significant relationship between sleep disorders and mental disorders, quality life, coping style, mental health levels and body health levels. 2624 cases met different mental disorders diagnostic criteria of DSM- Ⅳ . The prevalence of sleep disorders of 2624 people with mental disorders was 41.20%.
  Conclusion: The Norm of PSQI of the people aged 18 years and above of Shandong province was 3.42±3.57 ， the prevalence of sleep disorders was 13.12% ， according to that there are about 98.83 millions people with sleep disorders in Shandong province.
   
  
• P070
  The Effect of Acute Stress, Chronic Stress on Cental Nerve Neuropeptide Y, Adenylcyclase in Rats
  Ji Meng Liu 1
  1 The Second Affiliated Hospital of Xin Xiang Medical University , 新 乡 , Chinese Mainland
  
  Objective: To investigate the effect of acute stress and chronic stress on ethology and neuropeptide Y 、 adenylcyclase of brain in rats.
  Methods: Twenty-four male SpragueDawley were randomly divided into normal control groups 、 acute stress groups 、 chronic stress groups, with eight in each group,acute and chronic stress models were separately produced by forced swimming and empty bottle stimulation. open-field was used to observe the number of times in entry the central grille 、 detention time. The number of outer grille.the number of times in modifying. The number of intestinal discharge pills. Immunohistochemistry was used to test neuropeptide Y 、 adenylcyclase in Cortex of frontal lobe, hippocampusCA3, striatum of brain in rats.
  Results: neuropeptide Y in Cortex of frontal lobe, striatum was markedly higher in two stressed groups than that in normal control group,and was markedly high in hippocampusCA 3 in chronic stress groups, but it was not changed in acute stress groups. Adenylcyclase in in Cortex of frontal lobe, hippocampusCA3, striatum was lower in chronic stress groups than that in normal control groups. but Adenylcyclase in striatum was high in acute stress groups, Adenylcyclase in Cortex of frontal lobe, striatum in acute stress groups was separately related with the detention time, the number of times in modifying in open-field test.
  Conclusion: the forced swimming and empty bottle stimulation which are ideal stress ways in emotional disorder models can lead to emotional disorder. neuropeptide Y and adenylcyclase are concernd with emotion, adenylcyclase in Cortex of frontal lobe, striatum play an important role in the physiological regulation of acute stress emotion.
   
  
• P071
  不同治 疗模式住院精神分裂症患者的照料者精神负担的对照研究 - A comparative Study on Psychological Burden of Schizophrenic Caregiver at Open and Closed Ward
  海兵 秦 1
  1 昆明医学院第一附属医院 , 昆明 , Chinese Mainland
  
  目的 ： 探 讨开放式管理模式、封闭式管理模式住院精神分裂症患者的住院期间患者照料者的精神负担及其相关因素。
  方法 ： 采用疾病家庭 负担量表 (FBS) 、社会支持量表 (SS) 、 亲属应激量表 （ RSS ） 、世界 卫生组织生存质量测定量表简表 （ WHOQOL-BREF ） 等 对患者的照料者精神状况进行调查评估 ， 应用单因素方差分析和逐步线性回归分析的方法来分析患者的照料者精神负担的相关影响因素。
  结果 ： 影响照料者 应激水平最主要因素是其家庭负担 ， 其家庭负担越重 ， 应激水平越高 ； 患者出院时精神分裂症病人的生存质量、日常生活能力严重程度 ， 是增加病人照料者应激水平的重要因素。
  结论 ： 照料精神分裂症患者 ， 是一 项心理、生理备受折磨的工作 ， 住院精神分裂症患者的照料者精神负担在不同治疗模式之间无明显差异。
  关键词 : 精神分裂症 ； 精神 负担 ； 开放式管理 ； 封闭式管理
  
  Objective: To investigate psychological burden of the caregivers of the schizophrene and find correltional cause in schizophrene at open and closed ward 。
  Methods: The psychological burden of the caregivers of the schizophrene were assessed with RSS 、 FBS 、 SS 、 WHOQOL-BREF, etc. One-way analysis of variance, (One-way ANOVA) and Multivariate regression analysis were used to analysis them correlative factor.
  Reasults: The most factor that inflenced the stress of the caregivers was the family burden,the more heavy family burden,the higher stress of the caregivers;the severity of the schizophrenia quality of life and the activity of daily life could enhance the stess of the caregivers.
  Results: The most factor that inflenced the stress of the caregivers was the family burden,the more heavy family burden,the higher stress of the caregivers;the severity of the schizophrenia quality of life and the activity of daily life could enhance the stess of the caregivers.
  Conclusion: Looking after the schizophrene was a ridden job. There was not a significant difference on psychological burden of schizophrenic caregiver between open eard and closed ward.
  Key words: schizophrenia ； psychological burden ； open ward ； closed ward
   
  
• P072
  5 － HT1B 受体基因 G 861C 、 A-161T 位点多 态性与基诺族酒依赖相关性研究 - Association Study of 5 － HT1B Receptor Gene G 861C , A-161T Locus Polymorphism and Alcohol Depedence in Jino Ethnic Group
  培 凯 李 1 , 建 华 李 2 , 秀峰 许 1
  1 昆明医学院第一附属医院 , 昆明 , Chinese Mainland, 2 云南 药物依赖研究所 , 昆明 , Chinese Mainland
  
  目的 ： 探 讨云南省基诺族人群中 5-HT1B 受体基因 G 861C 、 A-161T 位点多 态性与酒依赖的相关性。
  方法 ： 采用聚合 酶 链反应 － 限制性片段长度多态性 （ PCR-RFLP ） 方法 检测云南省西双版纳地区基诺族酒依赖患者 （ 84 名 ） 和健康 对照人群 （ 50 名 ） 5-HT1B 受体基因 G 861C 、 A-161T 位点 单核苷酸多态性 ， 计算和比较两组间基因型和等位基因的频率。
  结果 ： （ 1 ） 在云南省基 诺族人群中 ， 5-HT1B 受体基因 861 多 态性位点基因型以 GG 型 为多见 ， 酒依赖和正常对照的 GG 型 频率分别为 30.9 ％ 、 44 ％； 等位基因 频率以 G 为常见 ， 其频率在酒依赖和正常对照中分别为 52.4 ％ 、 58 ％； 基因型 频率和 等位基因 频率在酒依赖患者与正常对照中差异不具有统计学意义 （ P>0.05 ） 。 (2) 在云南省基 诺族人群中， 5-HT1B 受体基因 161 位点基因型分布 频率以 AA 型多 见，酒依赖人群和正常对照分别为 70.2 ％、 88 ％，在所 选正常对照中未发现 TT 型 纯合子，酒依赖中 TT 纯合子的比例为 6 ％，两 组间基因型差异及纯合子频率均具有统计学意义（ P<0.05 ）。按有无 T 等位基因 赋值后二者差异仍存在显著性；等位基因频率以 A 等位基因多 见，酒依赖人群中 T 等位基因明 显高于正常人群， T 等位基因在两个人群中的 频率分别为 17.9 ％、 6 ％，差异具有 统计学意义（ P<0.05 ）。
  结论： （ 1 ） 5-HT1B 受体基因 G 861C 多 态分布在云南省基诺族酒依赖人群和正常对照中无差异性， 5-HT1B 受体基因 G 861C 多 态性与基诺族酒依赖的发生无相关性。（ 2 ） 5-HT1B 受体基因 A-161T 多 态分布在基诺族酒依赖人群和正常对照中存在显著差异性， 5-HT1B 受体基因 161T 多 态性可能与基诺族酒依赖的发生有相关性。
  关键词 : 酒依 赖 5-HT1B 受体基因 单核苷酸多态性 相 关性研究
  
  Objective: To investigate the relationship between the 5-HT1B RECEPTOR gene G 861C , A-161T genotype, allele and alcohol dependence in Jinuo population of Yunnan province in China.
  Methods: Polymerase chain reaction-restriction fragment length polymorphism (PCR-RELP) was used to detect 5-HT1B gene G 861C , A-161T single nucleotide polymorphism in alcohol dependence group (n=84) and control group (n=50) in Jinuo population of Yunnan province. The frequencies of genotype and allele in two groups were calculated and compared.
  Results: (1) In Jinuo population of Yunnan province. The GG genotype of 5-HT1B G 861C was more common. The frequency in alcohol dependence and control group were 30.9% and 44%. Allele G was more common. The frequency in two group were 52.4% and 58%. There was no significant difference between alcohol dependant group and control group both at the genotype and allele level. (2) In Jinuo population of Yunnan province. The AA genotype of 5-HT1B A-161T was more common. The frequency in alcohol dependence and control group were 70.2% and 88%. TT homozygote frequency in alcohol dependence was 6%. But it was not found in control group. The allele A was more common both in two group. And frequency of allele T in alcohol group is higher than in control group. The frequencies of allele T in two group were 17.9% and 6%. The difference was significant between two groups both at genotype and allele.
  Conclusion: (1) The difference between alcohol dependence and control group at 5-HT1B receptor gene G 861C was not significant in Jinuo population of Yunnan province. There was no relationship between 5-HT1B receptor gene C 861G polymorphism and alcohol dependence in this population. (2) There was significant difference of distribution of 5-HT1B receptor gene A-161T polymorphism between alcohol dependant group and control group in Jinuo population of Yunnan province. This results support an association between 5-HT1B receptor A-161T polymorphism and alcohol dependence.
  Key words: Alcohol dependence, 5-HT1B receptor gene, Single nucleotide polymorphism (SNP), Association study
  
• P073
  国 产氟西汀和奋乃静合用对精神分裂症认知功能障碍的疗效研究 - A Clinical Study of Fluoxetine Hydrochloride Capsules and Fentazin Tablets in the Treatment of Cognitive Impairment of Remission in Patients with Schizophrenia
  开庆 邹 1 , 麒麟 蒋 1
  1 四川省雅安市精神病医院 , 雅安市 , Chinese Mainland
  
  目的探 讨国产氟西汀和奋乃静合用对精神分裂症患者认知功能障碍的治疗作用。方法对 63 例精神分裂症患者，随机分 为研究组（ 32 例）和 对照组（ 31 例）分 别给予国产氟西汀和奋乃静合用组和单独用奋乃静治疗组治疗 12 周，并于治 疗前、治疗 4 周和治 疗 12 周后用 韦氏成人智力量表（ WAIS ）、 韦氏记忆量表（ WMS ）、威斯康星卡片分 类测验（ WCST ）副反 应量表（ TESS ） 进行评分分析。结果治疗后两组认知功能有显著性差异。结论国产氟西汀和奋乃静合用对改善精神分裂症患者的认知功能障碍有益。
  
  Objective: To discuss the therapeutic effects of Fluoxetine Hydrochloride Capsules and Fentazin Tablets in the treatment of cognitive impairment of remission inpatients with schizophrenia.
  Methods: 63 remission inpatients who met CCMD-3 for schizophrenia were randomly assigned to the observational group (n=32) and the control group (n=31). The observational group was treated with venlafaxine and the control group with comfort for 12 weeks. They were studied with WAIS 、 WMS 、 WCST 、 and TESS before 、 6 weeks after treatment and 12 weeks after treatment.
  Results: There were significant differences between the two groups on the cognitive function after treatment.
  Conclusion: Fluoxetine Hydrochloride Capsules and Fentazin Tablets proves to be effective in the treatment of cognitive impairment of remission inpatients with schizophrenia
   
• P074
  WHO-AIMS 评估湖南省精神卫生资源的报告 - WHO-AIMS Report on Mental Health System in Hunan Province of People′s Republic of China
  燕 张 1 , 凌江 李 1 , 则宣 李 1
  1 中南大学湘雅二院精神 卫生研究所 , 长沙市 , Chinese Mainland
  
  目的 : 充分了解湖南省精神 卫生资源基本信息和精神卫生服务发展的劣势 ， 促进、发展和完善湖南省精神卫生服务体系。 方法 : 应用世界卫生组织提供的评估工具 —— （ The World Health Organization Assessment Instrument for Mental health Systems ） 评估湖南省精神卫生服务体系现状。
  结果 : 应用 WHO-AIMS 评估工具从精神卫生政策规划立法框架、精神卫生服务机构、初级卫生保健、精神卫生资源、宣传以及与其他部门的合作、监督体系和支持研究工作等六个方面全面评估了湖南省精神卫生服务体系的基本情况。具体如下： 1 ）湖南省精神 卫生政策、规划比较完善，精神卫生立法还在进行中； 2 ）尽管社区精神 卫生工作已经纳入精神卫生发展规划 , 但仍以大型 监管式的精神病院为核心 , 社区康 复机构较少，康复设施缺乏； 3 ）湖南省精神 卫生财政经费大部分投入精神病医院，社区工作很少。政府卫生健康方面财政开支中 2% 投入精神 卫生体系，这其中的 61% 是投入大型的精神病医院。在近 5 年里，精神病院的床位增加了 2% ； 4 ）湖南省的精神 卫生服务机构网络是不建全的，有 64 家精神科 门诊， 36 家 卫生系统精神病专科医院， 13 家民政系 统精神病专科医院和 15 家 综合医院的精神专科，针对青少年的医疗服务机构较少，而且暂时没有公安系统精神病专科医院和日间医院； 5 ）精神 卫生资源是不足的，在湖南省 每 100,000 人中有 1.4 个精神科医 师 , 3.2 个精神科 护士和 1.5 个工人， 暂时没有社区工作者和职业治疗师； 6 ）精神 卫生的初级卫生保健、与其他部门的合作、精神卫生知识公共教育宣传、监督体系、信息反馈体系以及支持研究工作等还需进一步的发展。
  结论： WHO-AIMS 是一个全面 细致的精神卫生资源评估工具，通过研究 WHO-AIMS 收集到的精神 卫生资源的基本信息，全面了解了湖南省精神卫生工作现状，明确了工作中的强势和劣势，特别是精神卫生预防、康复、社区服务及专业咨询等还十分薄弱。这些信息明确了发展完善精神卫生服务体系的重点，为以后精神卫生工作制定政策、规划和财政分配等指明了方向。促进我省尽快完善和加强以医疗机构为骨干、社区为基础、家庭为依托的精神疾病防治康复工作。
  
  Objective: To improve the mental health system and to provide a baseline for monitoring the change.
  Method: The World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) was used to collect information on the mental health system in Hunan province.
  Results: Hunan Province has its own mental health policy and plans, in which the community-based mental health service model is especially stressed besides principles, aims, organization and leadership, intervention for key populations, treatment and rehabilitation for mental disorders. Though community as basis and family as depending unit are being increasingly improved and strengthened for establishing the system of prevention & treatment and rehabilitation, the developing of such system is considerably delayed relatively. At present, 2% of health care expenditures by the government health department are directed towards mental health, 61% of which has been spent on mental hospitals and the beds in mental hospitals have been increased by 2% in the last five years in Hunan Province . The network of mental health facilities is not complete in Hunan Province . Few facilities are devoted to children and adolescents. Human resources in mental health care are not sufficient. The total number of human resources working in mental health facilities or private practice per 100,000 population is 6.1. The breakdown according to profession is as follows: 1.4 psychiatrist, 3.2 nurses and 1.5 other health or mental health workers. The monitoring of mental health services must be improved. A formally defined set of items that ought to be collected by all mental health facilities should be established. Public education and awareness campaigns on mental health should be strengthened. Also training courses for staff need to be developed.
  Conclusion: We collected this information is to improve mental health systems.The consistent agreement is to strengthen the community mental health system and subsequently further improve the rehabilitation of the patients based on community.
   
  
• P075
  拉莫三 嗪治疗双相抑郁的最新进展 - A Review of Lamotrigine in Treatment of Bipolar Depression
  马 燕桃 1 , 于 欣 2
  1 北京大学第六医院精神 卫生研究所 , 北京 , Chinese Mainland, 2 北京大学精神 卫生研究所 , 北京 , Chinese Mainland
  
  目的 ： 介 绍拉莫三嗪在双相抑郁治疗领域的最新进展。
  方法 ： 查阅拉莫三嗪治疗双相抑郁的临床资料 ， 搜索 Pub Med, Ovid, Medline, Treadwell 和 Cochrane 数据 库。关键词：双相抑郁，治疗，拉莫三嗪。比较研究设计和方法。
  结果： 1999 年 Calabrese et al[1] 大 样本随机双盲对照试验首先报告了双相 I 型抑郁 LMG 治 疗组和安慰剂对照组相比转躁狂率没有组间差异，说明拉莫三嗪带有抗抑郁特性；与其它抗抑郁剂相比，对快速循环型预防有效。 2002 年 Claus et al [2] 的 LMG 合并 赛乐特治疗双相抑郁双盲试验证实 LMG 在急性期有抗抑郁 疗效，提出其对 SSRI 类药物的增效作用可能加快抗抑郁剂显效。还有多项和安慰剂对照双盲研究表明拉莫三嗪治疗急性期双相抑郁，快 速循 环型或难治性抑郁有效，不增加转躁狂风险 [3,4,5,6] 。 维持期治疗的多项研究报告了该药在长期抗抑郁效果上显著优于安慰剂 [7,8] 。拉莫三 嗪没有显示出可以抗躁狂或预防躁狂复发 [9] 。有 关安全性， Bowden [10] 总结了 8 个安慰 剂对照临床试验 1800 例病人， 证实拉莫三嗪耐受好，副作用约等同于安慰剂，常见不适主诉为头痛。拉莫三嗪不引起情绪不稳，无性功能障碍，体重增加，撤药综合征。极少严重副作用。少见严重皮疹发生 ( 发生率 0.1%) 。最新 报告是 2006 年由美国国立精神 卫生中心 (NIMH) 进行的大规模，多中心协作的竞争性随机使用拉莫三嗪， inositol 和 维思通作为抗抑郁剂附加剂治疗难治性双相抑郁的研究 [11] ， 该研究是全球首个关于双相抑郁治疗策略的系统研究 (STEP-BD) 。研究 发现三组间在治愈率方面没有组间显著差异。不过拉莫三嗪合并治疗组治愈率为 23.8%, 而 inositol 和 维思通治疗组分别为 17.4% and 4.6% 。和另外两 组相比，拉莫三嗪治疗组抑郁评分和临床总体印象评分更低，而社会功能总体评估相对更好。该研究指出拉莫三嗪（ LMG ） 较 inositol 和 维思通在提高难治性双相抑郁疗效方面有优越性 [11] 。
  讨论： 临床医生对双相抑郁的药物治疗常面临困难的选择。美国食品和药物管理局（ FDA ） 2003 年批准拉莫三 嗪作为成人双相 I 型障碍 维持用药 [12] 。中国双相障碍治 疗指南将其列为治疗双相抑郁急性期治疗一线药物，或初始治疗无效者的附加用药 [13] 。拉莫三 嗪可能成为治疗双相抑郁的理想的情感稳定剂。
  
  Motivation ： To review the recent development of Lamotrigine in treating bipolar depression.
  Method ： A literature search was performed in using online English databases, including Pub Med, Ovid, Medline, Treadwell and Cochrane Library using the following terms: Bipolar Depression, Clinical Trial, and Lamotrigine.
  Result ： More than twenty trials were included, most of which found Lamotrigine has the superiority in improving the antidepressant effect in treating bipolar depression compared with placebo or lithium while the tolerability is good. An analysis of different designs and methods of included trials is performed.
  Discussion ： Lamotrigine may be the available stabilizer in treatment of bipolar depression.
   
  
• P076
  二个 汉族精神分裂症多发家系 GRM3 基因相 关多态性位点 - A Linkage Analysis Between Schizophrenia and GRM3 Gene
  Xi-jia Xu 1 , Xiao-gang Chen 1 , Jin-song Tang 1 , 精神 遗传
  1 NanJing Brain Hospital, NanJing, Chinese Mainland
  
  目的 ： 了解代 谢型谷氨酸受体 3 亚型 （ GRM3 ） 基因与精神分裂症的 连锁关系。
  方法 ： 选取二个汉族精神分裂症多发家系 ， 采集到这二个家系中共 54 个个体 ， 其中 9 个受累个体的血 样 ， 选取 GRM3 基因附近 3 对微卫星标记引物 D7S2555 、 D7S644 、 D7S2481 ， 对上述基因分型的结果采用 Genehunter2.1 软件对这二个家系 GRM3 基因相 关多态性位点进行两点和多点非参数连锁分析。
  结果 ： 这 3 个微 卫星标记在两点及多点非参数连锁分析中均能提供较多的信息 ( 信息 满意度值〉 0 ． 25) ； D7S644 两点非参数分析 LOD 值 （ NPL ） 为 0.953 （ P=0.095 ）， 多点非参数分析 NPL 为 1.471 （ P=0.064 ）， 其余 2 对微卫星标记位点的两点和多点非参数分析 NPL 值均未达到验证性连锁的阈值 （ NPL=1 ． 2 ） 。
  结论 ： GRM3 基因位点可能与精神分裂症存在相 关。
  
  Objective: To investigate the linkage relationship between GRM3 gene locus and schizophrenia.
  Methods: Altogether 54 subjects from two families were recruited, including 9 patients and their relatives. The subjects were interviewed with Dignostic Interview for Gentic Studies (DIGS) and Family Interview for Genetic Studies （ FIGS ） . All enrolled patients fulfilled the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM- Ⅳ ) diagnosis of schizophrenia. Three microsatellite polymorphisms from GRM3 gene region were determined after the polymerase chain reaction. Nonparametric linkage analysis was performed with Genehunter software version 2.1.
  Result: The two-point NPL score of D7S644 was 0.953 （ P=0.095 ） ,the multipoint NPL score of D7S644 was 1.471 （ P=0.064 ） . The NPL score of the other two microsatellite markers did not reach 1.2,which was the liminal value of indicative linkage.
  Conclusion: The data suggest GRM3 gene may be associated with schizophrenia.
  
  
• P077
  亚慢性氯胺酮处理对 SD 大鼠行 为及神经生物影响 - Subchronic Application of Ketamine-induced Changes in Rat Behaviour and Neurobiology
  嘉 西 徐 1 , 生物精神病学
  1 南京医科大学附属 脑科医院 , 精神科 , 南京 , Chinese Mainland
  
  目的 : 以 NMDA 受体拮抗 剂氯胺酮为工具药 ， 予 SD 大鼠 亚慢性氯胺酮给药 ， 制作分裂症药理学动物模型 ， 通过测评模型的行为及神经生物学的改变 ， 探讨该模型的表现效度和结构效度。
  方法 : 成年雄性 SD 大鼠 ， 随机分 为试验组和对照组。试验组大鼠分别给予氯胺酮 5 、 30 、 60mg/kg/d, 连续腹腔给药氯胺酮 5 天 ， 第 6 天 开始连续给予生理盐水 10 天 ； 对照组大鼠连续给生理盐水 15 天。 进行高架迷宫、社会交往试验、强迫游泳试验、 Morris 水迷 宫、注意定势转移试验等行为学测试。采用库仑阵列分析各组间内侧前额叶和海马组织匀浆中 DA 、 Glu 及其代 谢产物水平，并分析它们的利用率。采用免疫组化分析各组间前额叶和海马 CA1 区 PV 和 PTEN 蛋白表达。 统计处理采用方差分析。结果 社会交往 试验中，各组大鼠在活动水平和社会交往时间上无显著差异，但亚麻醉剂量氯胺酮组（ 30mg/kg 、 60mg/kg ）在非攻 击性行为百分比上显著低于对照组；亚麻醉剂量氯胺酮组在强迫游泳试验中不动时间延长、在 Morris 水迷 宫测试逃避潜伏期和目标象限停留时间上和对照组存在显著差异、在注意定势转移 EDS 阶段连续 6 次完成操作任 务所需要的次数明显多于对照组大鼠。递质分析显示，亚麻醉剂量氯胺酮组内侧前额叶和海马 DA 和 DOPAC 水平低于 对照组、 Glu 水平高于 对照组、 GABA 水平低于 对照组、 Glu 利用率与 对照组比较有显著性差异。免疫组化显示，亚麻醉剂量氯胺酮组内侧前额叶和海马的 PV 灰度 值高于对照组，而 PTEN 灰度 值各组间比较对照组比较差异无统计学意义。
  结论 : (1) 亚慢性亚麻醉剂量氯胺酮处理 SD 大鼠能部分模 拟分裂症阴性症状，认知损害和神经生物学损害； (2) 利用 氯胺酮制作的分裂症 SD 大鼠模型具有一定的表 现效度和结构效度 。
  
  Objectives: SD rats are repeated injection of NMDA receptor antagonist ketamine as pharmacological animal model of schizophrenia. Through testing the changes of behaviour and neurobiology in this model, the face validity and construction validity of the model are investigated.
  Methods: Adult male SD rats were randomly assigned to normal control group, 5 、 30 、 60mg/kg/d ketamine group.Animals were injected with ketamine i.p.. The rats were assessed by the Elevated Plus-Maze test ， the Social Interaction test, the Forced Swimming test, the Morris Water Maze test and the Attentional set shifting test. The release of the neurotransmitters (DA, Glu) and their metabolites in homogenates obtained from the medialfrontal cortex, hippocampus was assessed by CoulArray, and to calculate the utilization ratios. Parvalbumin and PTEN protein expression were assessed in the medial frontal cortex and hippocampus CA1. Data was analyzed using ANOVA.
  Results: In the Social interaction test, no differences were observed in the activity and time spent in the social interaction.But the percentage of non-aggressive behaviours of subanesthetic-dose ketamine groups were significantly lower than normal control group. Compared with control group, subanesthetic-dose ketamine groups were observed significant deviant in the immobility time, escape latency and time spended in aimed- quadrant and the number of trails to reach the criterion of six consecutive in EDS.In the subanesthetic-dose ketamine groups, the level of neurotransmitters (DA, DOPAC, GABA) in the medial frontal cortex and hippocampus CA1 were significantly lower than that of the control, but the level of Glu in these brain regions were significantly higher than that of the control. The subanesthetic-dose ketamine groups have exhibited a lower utilization lever when compared with the saline control group. There was significantly highed Parvalbumin immunoreactivity in the subanesthetic-dose ketamine groups rats but not in the saline control group, no differences were observed in PTEN immunoreactivity withins groups.
  Conclusions: (1)The SD rat treated with subchronic and subanaesthetic-dose ketamine can partly model the negative symptoms ， the cognitive impariment and the neurobiology impariment of schizophrenia.(2) Ketamine SD rat model of schizophrenia has some face validity and construction validity.
   
  
• P078
  兰释治疗难治性强迫症 20 例 临床分析 - Clinical Analysis on Fluvoxamine in the Treatment of 20 Refractory OCD Patient
  振海 赵 1
  1 北京回 龙观医院 , 北京 , Chinese Mainland
  
  入 组标准 :(1) 符合 CCMD-3 中 强迫症 诊断标准 , 经过氯丙咪嗪和至少 1 种 SSRI 类药物的独立足量足疗程 （ 12 周 ） 治 疗 ， 疗效不理想 ； (2) Yale - Brown 强迫量表 （ Y － BOCS ） 评分 > 16 分 , 排除其他精神障碍 继发性强迫症状 , 脑器质性继发强迫症状 ； 共入组 20 例 ： 男 12 例、女 8 例 , 平均年 龄 (31±9) 岁 ； 平均病程均为 (36±18) 个月。
  1.2 　方法 给药方案 : 停用原 药物一周 ， 兰释初始剂量为 50mg qd, 2 周内据其 疗效加至 150 ～ 300mg/d, 平均 剂量 （ 175±85 ） mg/d ， 研究期 间均不合用其他精神药物 , 对失眠者可合并用小剂量苯二氮卓类药物 , 观察 12 周。
  1.3 疗效评定 : 采用 Yale － Brown 量表于 疗前和疗后每 6 周 评定 1 次。 临床疗效是在 12 周末根据 Y-BOCS 减分率 评定 , 即 ≥75% 为痊愈、 50% ～ 74% 为显著进步、 25% ～ 49% 为进步、 <25% 为无效 ， 4 级评定临床疗效。
  1.4 统计学处理 : 资料采用 t 检验。
  2 结果
  2.1 临床疗效比较 : 痊愈 7 例 , 显著进步 5 例 , 进步 3 例 ， 无效 5 例 ， 有效率 75 ％， 显效率 60 ％ 。
  2.2 Y － BOCS 量表 评分比较 :
  疗前 ： 24.2±5.1 六周末 ： 17.8±4.3 十二周末 ： 12.1±3.2 经 t 检验 ， 治疗前与治疗后六周 Y － BOCS 评分有显著性差异 （ t ＝ 3.71 ， p<0.01 ）
  治 疗前与治疗后十二周 Y － BOCS 评分有显著性差异 （ t ＝ 7.78 ， p<0.01 ）
  2.3 副反 应 ： 　有 4 例出 现了副作用 ， 恶心 3 例次 ， 口干 2 例 , 失眠 1 例次 , 在 坚持服药后两周内副反应自行消失。
  3 讨论 强迫症是一 种难于治疗而预后较差的疾病 , 致残率 较高 ,54 % ～ 61 % 的病例逐 渐发展 ;24 % ～ 33 % 的病例呈波 动病程 ;11 % ～ 14 % 的病例有完全 缓解的间歇期 ， 常有中度及重度社会功能障碍 [1] 。 强迫症的 发生与脑内 5 - HT 功能低下有 关 , 兰释是 一 种 5-HT 再 摄取抑制剂 (SSRI) , 其能有效地抑制神 经元从突触间隙中摄取 5 - HT, 增加 间隙中可供实际利用的这种神经递质 , 可提高 脑内 5 - HT 的功能，达到治 疗强迫症的目的。
  近年来的研究 [4] 发现谷氨酸能神经直接通路 ( 额叶眶部 → 纹状体 → 苍白球的内侧部 → 黑 质的网状复合物部 → 丘 脑 → 额叶眶部 ) 参与了 强迫症的 发病机制，强迫症患者的直接通路功能高于间接通路 ( 额叶眶部 → 纹状体 → 苍白球外侧部 → 丘 脑底核 → 黑 质的网状复合物部 → 丘 脑 → 额叶眶部 ) 。 σ 受体是 1976 年 发现的，是有活性的内织网蛋白 [5] ， σ1 受体在海 马 的 齿状回、面神经核和多个丘脑和下丘脑的神经核中最丰富 [6] ，它通 过调节 NMDA (N- 甲基 -D- 天冬氨酸 ) 来 调节谷氨酸能系统，而 SSRI 药物中兰释对 σ-1 受体的 亲和力最强 [7] ， 对谷氨酸能神经作用较强，推测兰释能抑制谷氨酸能神经直接通路或增强间接通路功能，从而发挥更好的抗强迫作用；同时兰释也是美国粮食药物管理局已批准的可治疗儿童和青少年强迫症的三种药物之一 [8] 。
  本研究表明 该药对难治强迫症效果较好，有效率 75 ％， 显效率 60 ％，而且笔者用此 药治疗首发强迫症也取得了较好的疗效，值得作为强迫症的首选治
   
  
• P079
  高冲 动性 ADHD 儿童 Go/Nogo 任 务中的自我调控：事件相关电位 N2 分析 - The Self-regulation in Go/Nogo Task of High Impulsive Children with Attention Deficit Hyperactivity Disorder: The Analysis of ERPs N2
  劲松 张 1
  1 上海交通大学医学院 , 新 华医院 , 上海 , Chinese Mainland
  
  目的 : 本研究比 较高冲动性 ADHD 儿童与正常儿童的 ERPs 的 N2 成分的差异性 变化，探讨高冲动性 ADHD 儿童的自我 调控脑神经心理机制。
  方法 : 高冲 动组和正常对照组各 15 人，用 Go/Nogo 模式 进行事件相关电位 ERPs 研究。 结果（ 1 ） Go 的正确按 键反应时间，高冲动组比对照组长；高冲动组的错误按键反应时明显快于正确按键。对照组的正确率 (%) 高于高冲 动组。（ 2 ） 对照组的 N2 波幅 Nogo>Go ，在 Cz 、 Fz 、 Pz 、 FCz 和 CPz 点上的差异有 统计学意义。（ 3 ） 对照组右半球 C4 的 N2 波幅大于 C3 。高冲 动组的左右半球波幅差异均无统计学意义。（ 4 ） 对照组的 Nogo-N2 波幅大于冲 动儿童对应点上的 Nogo-N2 波幅，尤其在 Fz 和 FCz 。 (5) ADHD 儿童 额叶尤其右侧的激活性低。结论 额叶、中央区是大脑执行抑制功能的重要部位，右侧额叶的参与更多；正常儿童的脑自我调控功能能随冲动控制任务而提高，右脑优势显著。高冲动 ADHD 儿童存在 额叶功能缺陷 ， 特别是右半球的功能。
  
  Purpose: To study the self-regulation neuropsychological mechanism of high impulsive ADHD children.
  Methods: The Go/Nogo model was adopted in the Event related Potentials (ERPs) test.
  Results: (1) The mean correct Go-RT of the ADHD group is significantly longer than control group; The correct rate of control group is significant higher. (2) The average N2 amplitude of control group is Nogo>Go on Cz 、 Fz 、 Pz 、 FCz and CPz. (3) Right N2 amplitudes are larger than left sites. But there is no significant lateralized of N 2 in ADHD. (4) The Nogo-N2 amplitude of control is larger than ADHD, especially significant at Fz and FCz. (5) The activation of the frontal lobe, especially the right, is lower in high ADHD children.
  Conclusions: The right frontal is involved much more in behavioral control and dominating the behavioral control. The ADHD has deficiency at frontal lobe function, especially the right frontal lobe.
   
  
• P080
  艾司西 酞普兰与舍曲林治疗抑郁症的对照研究 - A Comparative Study between Ascitalopram and Sertraline in the Treatment of Depression
  Hai-bo Yang 1
  1 The Mental Health Center of Daqing, Daqing, Chinese Mainland
  
  目的 : 比 较艾司西酞普兰与舍曲林治疗抑郁症的疗效和安全性。
  方法 : 将 70 例抑郁症病人随机分艾司西 酞普兰组 36 例 ， 舍曲林 组 34 例 ， 共治 疗 6 周 ， 采用 汉密尔顿抑郁量表 （ HAMD ） 评定临床疗效 ， 副反应量表 （ TESS ） 评定副反应。
  结果 : 艾司西 酞普兰组显效率 76.4% ， 舍曲林 组的显效率 74.9% ， 两 组间比较差异无显著性。治疗前后 HAMD 评分比较两者均有显著差异 ， 艾司西酞普兰舍曲林组在 1 、 2 周 HAMD 减分与舍曲林 组比有显著性差异。两组副反应 TESS 评分比较在个别项目上差异有显著性。
  结论 : 艾司西 酞普兰与舍曲林治疗抑郁症均有良好的疗效。其中艾司西酞普兰起效早、副反应轻，是治疗抑郁症的良好药物。
  关键词 : 艾司西 酞普兰 ； 舍曲林 ； 抑郁症
  Objective: To evaluate the efficacy and safety of ascitalopram and sertraline.
  Methods: 36patients with depression were divided into treating group with ascitalopram,34patients with same symptom were divided into controlled group with sertraline.Clinical progress was examined with HAME—17, and TESS.
  Results: There was no significant difference in the efficacy between two groups （ P>0.05 ） 。 But the effectual time of ascitalopram was lower remarkably than that of sertraline group.At every week,therewere no significant differences in TESS between two groups.
  Conclusions: In the treatment of depression,ascitalopram and sertralineall had good curative effects. ascitalopram took effects quickly and had light side effects.
  Key words: ascitalopram; sertraline; depression

第一页 第二页 第三页 第四页 第五页 第六页 第七页 第八页 第九页