精神在线网 - 2007年WPA上海区域性国际会议暨中华精神病学会学术年会 会议论文汇编
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  • P081
    冲 击疗法治疗癔病性失眠 - Flooding Therapy in Hysteria Insomnia
    涛 戴 1
    1 山西省大同市第六人民医院 , 精神心理科 , 大同市 , Chinese Mainland

    王某 ， 女 ，４５ 岁 ， 小学文化 ， 家庭妇女 ， 已婚 ， 汉族 ， 病历号 03311 。自 觉身上有个东西作祟三个月，因此感到着急、紧张、伴失眠，近三日加重。
    该患于三个月前生气后，觉得身上有个东西作怪，游走不定。在背上时似有重物在压，在胸前时便觉得气憋呼吸不畅，有时又有疼痛的感觉。后经大仙诊治，说是孙悟空和一个李大仙同时存在，患者于是又觉得孙悟空在肚子里乱窜，且用手还能摸到。后又经另一大仙诊治说其实不是孙悟空是狐狸精，于是又觉得是狐狸精在周身乱窜，全身疼痛，尤其臀部和阴部为甚。患者感到外阴部奇痒烧灼感，整日用冷毛巾垫着。患者 感到着急 紧张同时失眠。入院前三日，症状加重整夜难眠，还能听到那个东西同她说话， “ 我就不走 ” ！ “ 我就不回去 ” 等声音。 经综合科医院全面体检未发现躯体疾患，遂来我院就诊。
    素健，幼年 发育与常儿一样，小学毕业，成年后务农，２２岁经人介绍与现夫结婚，婚后感情和，生育二女一男。平素少与人交往，心眼小爱生闷气。家族史无特殊记载。 体 查：神经系统无特殊发现。
    精 检：意识清楚，接触好，能自述症状说到身上附着的东西时，感到着急，紧张，害怕，询问大夫究竟是什么东西，能否把它赶走，说让它折磨得整夜整夜地睡不着，受不了。求治心切，认为身上跟着东西，自知力部分存在。无智能障碍。
    实验室检查：脑电图：正常 心理ＣＴ提示：精神病性障碍 81.20% 焦 虑性障碍： 18.46% ＳＣＬ－ 90 ：
    躯体化 2.7 恐怖 0.8 强迫 1.2 人 际敏感 1.1 抑郁 1.8 焦 虑 2.0 敌意 1.1 妄想 2.3 精神病 0.8 其它 1.2 诊断：癔症（附体障碍）
    治 疗 :
    经用静滴小剂量冬非合剂一周和口服奋乃静 , 日高量 28mg, 附体妄想消除 , 但患者的睡眠没有改善 , 曾于睡前 给罗拉、三唑仑、肌注安定，冬非合剂等，效果不佳。最理想时睡眠 2 小 时，经发现该患者 白天有打盹 现象，每天３－５次，每次十分钟左右，考虑患者睡眠节律紊乱，抑制与兴奋失调，拟应用冲击疗法进行治疗。考虑到患者年龄和用药的情况，采用白天冲击的办法，夜间正常入睡，具体做法如下：
    第一次冲 击：白天让家人陪同，不让病人上床睡觉，打盹的时候，采用呼唤、吃零食等办法避免入睡，中午２点患者出现稍不提醒便打盹，家属请示医生，嘱只睡二十分钟，叫醒，夜间九点，嘱病人上床睡觉，于１１点入睡，夜间３点醒来，再未入睡。 第二次冲 击：考虑第一次冲击夜间睡眠欠佳，嘱第二次，坚决不能打盹、入睡。傍晚６点，患者感到瞌睡，站在地上 眼皮都抬不起，陪 视人便拉着她在地上走，同时开大电视音量。九点上床后，马上入睡，至次日晨约４时醒来。
    第三次冲 击：患者一天中出现几次打盹现象，但困倦程度远不如前，夜间九点上床，约半小时后入睡，次晨５点多醒来。一周后，睡眠规律恢复正常，白天精神状况良好，夜间睡眠每日保持在６－８小时，持续一周后办理出院。出院后一月随访，在家中恢复的情况更好。白天能料理家中事务，基本恢复了病前状况，病人非常满意。
    冲 击疗法属于行为疗法的一种，它的原理在于让被试持久地暴露在刺激因素面前，惊恐反应终究将自行耗尽。这位患者入睡困难是大脑 皮 层未达到足够抑制的表现，如果让其持续强烈地兴奋，也可能物极必反，产生抑制，这正符合冲击疗法的原理。冲击疗法是用来治疗恐怖症的，后来被心理学家扩展为治疗强迫症，顽固性睡眠障碍等。本例患者经冲击疗法起到了药物所达不到的作用。
    参考文献： 张亚林著 . 行 为疗法 . 贵阳 : 贵州教育出版社 ,1999.6
     
  • P082
    北京某 综合医院普通外科急诊外伤病人中酒应用现况调查 - To Investigate the Prevalence of Alcohol Use to the Traumatic Patient from Trauma Emergency Room
    梅 刘 1
    1 北京大学医学部 , 北京 , Chinese Mainland

    目的： 了解某 综合医院普通外科急诊某一时段外伤病人中的酒应用情况，为提高综合医院外科急诊对酒应用的识别及相应处理提供依据。
    方法： 连续 10 周工作日（除外 “ 十一 ” 的 7 天假期）， 对北医三院外科急诊室在 19 点到 22 点之 间来诊的 14 岁及以上的外伤病人进行 AUDIT 量表及 调查问卷的调查，用 SPSS 11.5 统计软件对数据进行统计学分析。
    结果： (1) 连续 10 周的 调查期间，共有 187 例外 伤病人 来 诊，有 126 人接受 调查入组，占总数的 67.4% 。入 组病人中 92.9% 的人能在受 伤后 6 小 时内就诊； (2) AUDIT 量表 总分在 7 分及以上的 21 人 (16.7%) ，男性是高危因素， AUDIT 量表分 ≥16 分的有 8 人（ 6.3% ）； AUDIT 量表分 =0 （即滴酒不沾者）的占 总数的 36.5% ，在女性中所占比例 较大； (3) 入 组的病人中有 15 人（ 11.9% ）在受 伤前 6 小 时内有饮酒行为，其中有 6 人（ 40% ）有狂 饮行为， AUDIT 量表分 ≥7 分的和 ≥16 分的在有 饮酒行为组的比例明显高于无饮酒行为组。 (4)126 人中有 9 人（ 7.1% ）存在 间断性大量饮酒（简称 HED ）模式，其中 44.4% 的人受 伤前有狂饮，而受伤前有狂饮的病人中有 66.7% 存在 HED ； (5) 有常 见躯体疾病的有占 11.9% ， 80% 的人年 龄﹥ 42 岁。
    结论： 本研究提示，受 伤前大量饮酒与 HED 饮酒模式均是外伤的高危因素。男性是危险性及有害性饮酒的高危因素。 AUDIT 量表在 筛查危险性及有害性饮酒问题上具有推广应用价值。关键词 ： 外伤　急诊室　酒应用 综合医院

    Objective: To investigate the prevalence of alcohol use to the traumatic patient from the general surgical emergency room of a general hospital during a period of time in a day. It protended some evidence to recognize alcohol use among traumatic patients in general hospital.
    Method: The survey sample was all traumatic patients older than 14-year old who came to the general surgical emergency room of Third Hospital of Peking University during 19:00 to 22:00,limited to 10-week duration of investigation. They were administered AUDIT and a questionnaire. SPSS Ver.11.5 software package was used for the statistics.
    Results: (1) Within the 10-week investigation, there were 187 traumatic patients, and 126 of those accepted our investigation entering the group, the percent is 67.4%. 92.9% of the group entered the emergency room (ER) in 6 hours after injured; (2) In the group, there 21 persons (16.7%) whose AUDIT score were more than 7 and risks were more pronounced for male. 6.3% scored 16 or more. Teetotaller is 36.5% in the group and female is more; (3)In the 126 cases, 15 （ 11.9% ） used alcohol in 6 hours before trauma and 40% of those were binge drinking. Those AUDIT score 7 or more and 16 or more in alcohol-used group were obviously more than those in non-alcohol-used group; (4) In the group, 9 (7.1%) were HED drinkers and 44.4% of those were binge drinking before trauma. 66.7% of those binge drinking before trauma were HED drinkers; (5) Of the 126 person, 11.9% had common physical disease and 80% aged more than 42.
    Conclusion: As this study showed, Binge drinking and HED is higher risk of trauma. Male is higher risk of hazardous and harmful drinking. AUDIT is worth applied in the similar studies with screening hazardous and harmful drinking.
    Key words: Trauma Emergency room Alcohol use General hospital
     
  • P083
    认知心理干预方法对甲状腺切除病人 . 术前焦虑及术后恢复的影响 - The Effects on Thyroid Tumor Patients' Preoperative Anxiety and Postoperative Recovery with Cognitive Psychological Intervention Methods
    乐英 孙 1 , 华孟 石 2 , 石 华孟
    1 温州医学院 , 心身医学科 , 温州市 , Chinese Mainland, 2 温州市鹿城精神病医院 , 精神科 , 浙江省温州市 , Chinese Mainland

    目的 ： 探 讨认知心理干预方法对甲状腺切除手术病人术前焦虑及术后身体恢复的影响。
    方法 ： 100 例甲状腺切除手 术病人随机编入实验组 （ 接受研究者制定的认知心理干预 ） 和对照组 （ 接受所在病区的一般心理护理 ）， 并测定其术前焦虑、心率、收缩压以及与术后身体恢复有关的各项指标。结果：实验组手术前夜焦虑及术后不良反应显著低于对照组，（ p ﹤ 0.05 ）。
    结论： 本研究采用的 认知心理干预方法在缓术前焦虑、加速术后身体恢复等方面效果优于一般心理护理。
    关键词 认知心理干预 手 术病人 焦 虑 手 术后恢复

    0bjective: To study the effects of reducing preoperative anxiety and accelerating recovery on thyroid tumor patients.
    Method: 100 patients were observed, 50 in experimental group(accept cognitive psychological intervention) and 50 in control group(accept routine psychological care). Preoperative anxiety, frequency of heartbeat, blood pressure and index of postoperative recovery were monitored.
    Result: In experimental group, patients' anxiety at the evening before operation and postoperative adverse reaction were reduced more than the control group.
    Conclusion: The cognitive psychologieal intervention acceptted by experimental patients were better in reducing preoperative anxiety and accelerating postoperative recovery than routine psychologicl care.
    Key words: Cognitive psychological intervention Surgical patient Anxiety Postoperative recovery
     
  • P084
    国 产西酞普兰联用多塞平治疗广泛性焦虑障碍的开放性研究 - Citalopram Combined with Doxepin in Treating Generalized Anxiety Disorder GAD
    建明 童 1 , 成文 刘 1 , 正春 杨 1
    1 四川省自 贡市精神卫生中心 , 自 贡 , Chinese Mainland

    目的 : 通 过国产西酞普兰和多塞平低效量联用的开放性治疗 ， 探讨对广泛性焦虑障碍的效果及安全性 .
    方法 : 以西 酞普兰 20 ㎎ /d （ 原服有 SSRIS 者 药物剂量保持不变 ） 加用多塞平 （ 75 ～ 125 ） ㎎ /d ， 并与同期接受文拉法辛治 疗者对照。选择 HAMA 评定治疗前，治疗后 1,2,4,6W 分 值变化， GAS 评定 6W 治 疗效果， TESS 评定治疗过程中不良反应发生率。
    结果 : 2 组完成 6W 治 疗者 50 例和 30 例，脱落率分 别为 10.7% 和 9% ， P ＞ 0.05 。 6W 有效率均 为 100% ， P ＞ 0.05 。 HAMA 评定中，精神性焦虑因子减分差值在 4 ～ 6W 时出现了显著和非常显著性意义。靶症状结合因子减分差值分析中，联用组的失眠、记忆 / 注意障碍和呼吸系 统症状在 4 ～ 6W 时较文拉法辛组改善更为明显， p ＜ 0.05 ～ 0.01 。不良反 应中联用组有较 高的口干，便秘及体重增加 现象。结论 : 西 酞普兰等 SSRIS 与多塞平 联用对 GAD 显示出了与 SNRIS 的相同效果，且安全性 较高。因治疗成本不足文拉法辛 1/3 ， 对低收入病员群体是一种更为实际的治疗方法。

    Objective: To explore the clinical effects and safety by combined citalopram with doxepin in the treatment of GAD.
    Methods: The combination group was treated by citalopram (dose:20mg.d) and doxepin (dose: 75~125mg.d), the other group was treated with venlafaxine, we will assess the scores by HAMA ; assess the clinical effects by GAS; assess adverse reactions by TESS.
    Results: After 6 weeks, there were 50 and 30 patients completed the treatment,the lost rate were 10.7% and 9%, effective rate was 100%, P>0.05. Assessed by HAMA , the psychosis anxiety factors showed conspicuous meanings. The target symptoms factors showed that the adverse reactions in combination group were that they would have more dry mouths, constipation or weight increased, but compared to the venlafaxine group,the symptoms of insomnia, dysmnesia. attention dysfunction and respiratory system were improved a lot. (P<0.05~0.01).
    Conclusion: During the treatment of GAD, citalopra combined with doxepin shows the same clinical effects as the SNRIs do ， even more safer, but the treating cost will be less than 1/3 of the venlafaxine. It is a more practical way in treatment for the patients of lower income.

  • P085
    认知疗法对子宫次切除术患者情绪和性生活的影响 - Effects of Cognitive Therapy in Preoperative on Patient with Partial Hysterectomy and Postoperative Mental Recovery
    华孟 石 1 , 乐英 孙 2
    1 浙江省温州市鹿城精神病医院 , 司法 鉴定室 , 温州市 , Chinese Mainland, 2 浙江省温州医学院附属一医 , 手 术室 , 温州市 , Chinese Mainland

    目的 ： 探 讨术前认知疗法对子宫次切除术患者术后心理康复的影响 .
    方法 ： 248 例子 宫次切除术患者随机编入研究组 （ 接受认知疗法和常规术前访视 ） 和对照组 （ 仅接受常规术前访视 ）， 术前和术后测定其 HAMD 、 HAMA 、 SAS 、 SDS 、 SCL-90 。
    结果 ： 研究 组术后抑郁、焦虑分值显著低于对照组 ，（ p ﹤ 0.05 ） 。研究 组术后性生活满意度高于对照组。
    结论 ： 术前认知疗法加常规术前访视对子宫次切除术患者术后心理康复效果优于仅接受常规术前访视患者 . 关键词 认知疗法 手 术病人 子 宫次切除术 心理恢 复

    Objective: To study the effects of cognitive therapy in preoperative on patient with partial hysterectomy and postoperative mental recovery.
    Method: 248 patients were randomly divided into two group, 124 in experimental group (accept cognitive therapy and routine psychological care). 124 in control group(accept routine psychological care). Preoperative and postoperative HAMDHAMA SAS 、 SDS 、 SCL-90 were monitored.
    Result: In experimental group, patients' anxiety and depression in postoperative were reduced more than the control group （ p ﹤ 0.05 ） .
    Conclusion: The cognitive therapy acceptted by experimental patients with partial hysterectomy were better in reducing postoperative anxiety and depression than routine psychologicl care.
    Key words: Cognitive therapy Surgical patient partial hysterectomy mental recovery
     
  • P086
    矿难后 2 个月及 10 个月 . 创伤后应激障碍的发生率及相关因素研究 - The Brain Functional and Structural Mechanism in Coal Mining Survivors with PTSD after Two and Ten Months
    彩 兰 侯 1 , 凌江 李 2 , 燕 张 2 , 卫辉 李 2
    1 中南大学湘雅二医院精神 卫生研究所 ， 广东省人民医院广东省精神卫生研究所 , 广州 , Chinese Mainland, 2 中南大学湘雅二医院精神 卫生研究所 , 长沙 , Chinese Mainland

    目的 ： 调查矿难后 2 个月及 10 个月 创伤后应激障碍 （ posttraumatic stress disorder, PTSD ） 的 发生率及相关因素。
    b> 方法 ： 矿难后 2 个月 ， 首先采用 创伤后应激障碍清单 （ PTSD Checklist-Civilian Version, PCL-C ） 调查矿难幸存者 PTSD 的 发生率。随后按照 PCL-C 评分，选取 48 名幸存者（包括 24 名重性 PTSD 患者及 24 名非 PTSD 对照 ） 进行包括矿难前后一般情况、 PTSD 症状、焦 虑抑郁状况、艾森克人格问卷（ EPQ ）及 韦氏记忆等详细评估。矿难后 10 个月 进行随访。
    结果： 矿难后 2 个月，所有 112 名生 还矿工中有 104 名（ 92.9% ）接受了 调查，矿难后 2 个月 PTSD 的 发生率为 50% ；分 别选取的 24 名重性 PTSD 患者和非 PTSD （ Non-PTSD ） 对照在 PTSD 症状分析、焦 虑抑郁、个性及记忆功能方面都有显著的差别；逐步回归分析显示状态焦虑、矿难后恢复上班情况、 Beck 抑郁 问卷（ BDI ） 总分、神经质、矿难发生时所在位置、井下工龄进入回归方程。矿难后 10 个月，随 访到了 112 名幸存者中的 85 名，符合 PTSD 诊断标准的占 30.6% ；上述 48 名幸存者中有 18 名 PTSD 患者、 23 名 Non-PTSD 对照接受随访，与矿难后 2 个月相比， PTSD 患者在 PTSD 症状、焦 虑症状、及韦氏记忆方面有明显改善，抑郁症状无显著差别；逐步回归分析显示，状态焦虑改善、矿难后恢复上班情况、积极应对、情感平衡、井下工龄是 PTSD 症状减 轻的因素。
    结论： 矿难后 PTSD 的 发病率高、症状严重，对幸存矿工的心理及职业影响很大，需要及时干预与治疗。状态焦虑、矿难后恢复上班晚、 BDI 、神 经质、矿难发生时所在位置最危险、井下工龄短是 PTSD 发生的危险因素。积极应对是 PTSD 恢 复的积极因素之一。
    关键词 ： 创伤后应激障碍 ， 矿难 ， 幸存者 ， 发生率 ， 影响因素

    Objective: We sought to characterize the brain responses and structure of patients with acute severe and chronic PTSD, and investigate the neurocircuit of PTSD.
    Methods: 24 individuals with acute severe PTSD resulting from the mining accident and 24 subjects exposed to the accident without PTSD underwent functional magnetic resonance imaging (fMRI) while performing the emotional counting stroop, the symptom provocation and trauma related short-term memory recall paradigms. Three dimension imaging (3D) and DTI examinations were followed. PTSD patients received fMRI and MRI tests for the second time at ten months after the accident.
    Results: (1) During the emotional counting stroop, PTSD subjects showed diminished responses in bilateral anterior cingulate gyrus, right inferior frontal gyrus, etc, compared with Non-PTSD controls at two months after the accident. PTSD subjects showed enhanced responses in left medial frontal gyrus, left parahippocampal gyrus compared with Non-PTSD controls at ten months after the accident. When PTSD subjects at ten months were compared with at two months by paired t-test, bilateral superior frontal gyrus, bilateral middle frontal gyrus, right cingulate gyrus, left parahippocampal gyrus had enhanced responses. (2) During symptom provocation paradigm, PTSD subjects showed diminished responses in right anterior cingulate gyrus, left inferior frontal gyrus and bilateral middle frontal gyrus, and enhanced left parahippocampal gyrus response compared with Non-PTSD controls at two months. PTSD subjects showed enhanced right superior temporal (BA 38) response and diminished responses in right superior temporal gyrus (BA 22), right insula compared with Non-PTSD subjects at ten months. By paried t-test, PTSD patients at ten months showed diminished right cingulate gyrus response compared with PTSD patients at two months. (3) During the short-term memory recall paradigm, PTSD group showed diminished responses in right inferior frontal gyrus in comparison with controls at two months. PTSD group showed diminished responses in right inferior frontal gyrus and right middle frontal gyrus compared with Non-PTSD subjects at ten months. By paried t-test, PTSD subjects at ten months showed diminished right parahippocampus gyrus compared with PTSD patients at two months. (4) The brain morphologic showed that the Gray Matter Density (GMD) of left middle frontal gyrus was significantly lower than the controls at two months. The brain morphologic showed that the GMD of bilateral parahippocampal and right middle frontal gyrus were significantly lower than the controls at ten months. The brain morphologic showed that the GMD of right parahippocampal and left cingulate gyrus were significantly higher than at two months. (5) The DTI results showed PTSD patients at two months had significantly higher fractional anisotropy values in the left anterior cingulate gyrus, and left parahippocampal gyrus.
    Conclusions: Our findings suggest that neurophysiological alterations, memory performance deficit have developed in acute severe PTSD. By longitudinal research, we found the brain function and structure made changes. Some brain regions recovered, but some didn't. In all, the brain areas such as frontal lobe and hippocampus may importantly contribute to the PTSD neurocircurity. Trauma influenced PTSD patients chronically.
    Key words: coal mining accident, acute severe PTSD, fMRI, 3D, DTI
     
  • P087
    運用認知治療護理一位慢性精神分裂病患者併有焦慮情緒之經驗 Applying Cognitive-behavioral Therapy to a Patient with Chronic Schizophrenia and Comorbid Anxiety Disorder
    珊 孟 謝 1
    1 財團法人奇美醫院 , 護理部精神科 , 樹林街二段 442 號 , Taiwan, Province of China

    本文乃運用認知治療護理一位日間病房慢性精神分裂病患者併有焦慮情緒之經驗。護理期間為 94 年 5 月 18 日 至 94 年 12 月 31 日 。個案除了殘餘精神症 狀干擾之外，對於生活壓力事件及人員的分離 產生焦慮情緒，其原因往往來自於負向 、災難化思考及扭曲的認知，導致人際關係緊張及生活適應不良。住院期間經整體性護理評估歸納出健康問題核心，乃為焦慮。筆者以尊重、真誠的態度，予以長時間陪伴，採行認知治療模式及重建因應壓力技巧促使有不同的省思及改變，使其能了解以往負面思考模式，並且願意嘗試及學習新的因應方法且培養對自我負責的態度，進而增進生活適應。

    The purpose of this article is to describe a nursing experience at daycare with a patient who suffers from chronic schizophrenia and comorbid anxiety disorder. Cognitive-behavioral therapy was conducted through the period from 2005-05-18 to 2005-12-31 . Growing anxiety was easily developed toward stressful life events and even separation from working staff, possibly due to negative thoughts and distorted cognition, which lead to impoverished interpersonal relationships and adjustment deficits. After comprehensive assessments we summed up the patient's core problem to be free-floating anxiety. During the therapeutic process the author accompanied the patient constantly with respect and sincere attitude, and utilized cognitive-behavioral model to help the patient reform effective coping skills, promote alternative thinkings, understand and attenuate negative thinkings, develop positive attitude and sense of responsibility, and reinforce adjustment to life.
     
  • P088
    The Control Study of the Patients between the Gerontic and Non-gerontic with Anxiety Disorder
    Huan Gao 1 , Wenying Liu 1 , Chunping Liao 1
    1 Shenzhen Kangning Hospital , Shenzhen City , Chinese Mainland

    Objective ： To investigate the clinic characters and factors of disease association.
    Methods ： 79 patients with anxiety disorder according to the CCMD-3 enter into the study,39 patients were belong to the gerontic group (age≥60 years), 40 patients were belong to the non-gerontic group (age ＜ 60 years). The clinic datum of the two groups were analyzed. The HAMA and HAMD of the patients in the end of second week, fourth week and sixth week were rated and compared.
    Results ： There were 14 male and 25 female in the gerontic group patients.The age was from 60 years old to 78 years old. There were 15 male and 25 female in the non-gerontic group patients.The age was from 17 years old to 50 years old. Personality, family history and inducing factors also were P ﹥ 0.05. The agitation,suicide idea were notable more common the gerontic group than the non-gerontic group was P ﹤ 0.01.Between the two groups in the anxiety, restlessness, muscle tension and autonomic nerve symptoms was P ﹥ 0.05.The mean total score of HAMA were 20.9±6.4, 13.9±6.9 respectively was P ﹤ 0.05. It means that the anxiety is more severe in gerontic group. The total score of HAMD of the gerontic group was notably higher than that of the non-gerontic group was P ﹤ 0.01.It means that the gerontic anxiety patients have severe depressive symptoms. The total score of HAMD in the gerontic group were higher than those of the non-gerontic group at the second,fourth,sixth week. Between the two groups in the reduction rate was P ﹥ 0.05.It means the treatment were effective in both groups.
    Conclusion ： The gerontic patients with anxiety disorder have more physical uncomfortableness, hypochondriasis idea more intense, more impairment of the cognition, more irritable, mood fluctuate greatly. The agitation,suicide idea and hypochondriasis more higher in the gerontic patients than those of non-gerontic patients. We should try our best to relieve these symptoms. the total score of HAMDat the baseline was P ﹥ 0.05. While notable difference existed after the treatment of two,four and six week. The effect rates were 61.5 ％ , 85.0 ％ in the gerontic and non-gerontic group after six week treatent. The difference is notable. It means that the effect of treatment was worse in the gerontic patients and the effect is slower too.
     
  • 089
    社交恐怖 倾向者的弱刺激抑制 - Prepulse Inhibition in Social Phobia Tendencies
    Naoyasu Motomura 1
    1 National Mental Support Center for School Crisis, Ikeda , Japan

    背景 ： 在惊跳反射中的弱刺激抑制 现象 （ PPI ） 在精神分裂症和 强迫症患者中是 减少或者消失的。本研究 调查了社交恐惧倾向者中惊跳反射的 PPI 。
    对象和方法： 研究根据社交恐惧量表（ SPS ）将 28 个大学生分 为高社交焦虑组（ N=8 ）和低社交焦 虑组（ N=20 ）。 对这些研究对象进行 S1 和 S2 的双耳听 觉刺激，采用由 NIHONSANTEC 研制的听 觉刺激和 EMG 系 统。 S1 刺激 为 80dB ， 100Hz 纯音，刺激时程为 50msec ， r/f 为 1msec 。 S2 刺激 为 110dB ， 1000Hz 白噪音，刺激 时程为 50msec ， r/f 为 1msec 。 总共有 4 种类型的 ISI （ 0,100, 500, 1000mec ），参加者收听了 16 种类型的试验。 EMG 放置在右 侧轮匝肌， PPI 使用 NIHONSANTEC EMG 系 统计算。 结果和结论： 高社交焦 虑组 100msec ISI 的 PPI 相比于低社交焦 虑组减少。这些结果提示 PPI 现象在社交焦虑倾向者中与信息加工相关。

    Background: Prepulse inhibition (PPI) phenomenon in startle reflex is diminished or disappeared in patients with schizophrenia and obsessive compulsive disorders. In the present study we studied PPI of startle reflex in social phobia tendency subjects.
    Subjects and method: Twenty-eight university students were classified into high social anxiety group (N=8) and low social anxiety group (N=20) by use of social phobia scale. (SPS). To these subjects, S1 and S2 auditory stimuli were presented binaurally. We used the Auditory stimuli and EMG system, developed by NIHONSANTEC. S1 stimuli were 80dB, 100Hz pure tone and duration of the stimuli was 50msec, r/f 1msec. S2 stimuli were 110dB and 1000Hz white noise. Duration of the stimuli was 50msec and r/f was 1msec. There were 4 types of ISI (0,100, 500, 1000mec) and subjects listened 16 trials. EMG was setted in right orbicular muscle and PPI was calculated by use of NIHONSANTEC EMG system.
    Results and conclusions: PPI of 100msec ISI was reduced in high social anxiety group compared with low social anxiety group. These results suggest that PPI phenomenon is related with information processing in social anxiety tendencies.
     
  • P090
    The Effect of Ziziphi Spinosae Decoction on Anxiety Model Rats Behavior and Serum Neuropeptide Y
    Jin-bao Wang 1 , Heng-fen Li 1 , Ji-meng Liu 1 , Zheng Xie 1
    1 The Second Affiliated Hospital of Xin Xiang medical university, Xinxiang, Chinese Mainland

    Objective: To investigate the curative effect and mechanism of Ziziphi Spinosae Decoction on anxiety.
    Methods: 1. After anxiety rat model were produced by vacant bottle stimulus method ,each group were correspondently supplied with Ziziphi Spinosae Decoction,etc. 2. Apply open-field test to observe the rat behavior variation. 3. Detected serum NPY concentration and alanine aminotransferase (ALT) level.
    Results: 1. Center grille entrance number and detention time of Zizyphi Spinosi Decoction group(SZRT) and diazepam group (ADZ) were significantly increaded （ P ﹤ 0.05 ） after medicine intervention .2.Serum neusopeptide Y concentration of SZRT and ADZ dropped to blank control group level, obviously lower than anxiety control group and normal sodium group （ P ﹤ 0.05 ） . 5. Serum ALT level of ADZ was obviously higher than other groups （ P ﹤ 0.01 ） .
    Conclusions: Ziziphi Spinosae Decoction has ability to obviously improve anxiety behavior ,and the is safe, the anxiety model rats have high levels of neuropeptide Y, the neuropeptide Y concentrion was dropped to normal after Ziziphi Spinosae Decoction intervention, It is supposed that neuropeptide Y might be one of the Ziziphi Spinosae Decoction antianxietic effect mechanism.
    Key Words ： Anxiety ； Neuropeptide Y ； Ziziphi Spinosae Decoction ； Model Rat ； Effective.
     
  • P091
    强迫症影 响生活 质量的研究 - A Study of Impact on Quality of Life in Obsessive-Compulsive Disorder
    曹 中昌 1
    1 济宁市精神病防治院 , 精神科 , 济宁 山 东 , Chinese Mainland

    目的 : 　探 讨强迫症对生活质量的影响。
    方法 : 　采用 TDL 生活 质量量表评估强迫症患者的生活质量。
    结果 : 强迫症 组 TDL 量表的身体方面、心理方面、社会方面、尽 职的能力、自我健康意识及总分均显著地低于对照组 （ P ＜ 0.05 ）， 病情 严重者生活质量更低。
    结论 : 强迫症降低患者的生活 质量。

    Objective: To explore the impact on quality of life in obsessive-compulsive disorder.
    Methods: TDL life quality scale were used to assessed TDL-QOLAS of OCD patients.
    Results: Physical aspect ， psychological aspect ， social function ， duty capability ， self health consciousness and total score of TDL-QOLAS in patients with OCD was lower than in controls,severe patients even more.
    Conclusions: QOL of OCD patients was significantly worse than that of normal controls.
     
  • P092
    学 龄前儿童的行为抑制表现是儿童中期社交焦虑障碍的特异性预测因子 ： 一项为期 5 年的随 访研究 - Behavioral Inhibition in Preschool Children At Risk is a Specific Predictor of Middle Childhood Social Anxiety: A Five-Year Follow-up
    Jerrold F Rosenbaum 1 , Dina Hirshfeld-Becker 1 , Joseph Biederman 1 , Aude Henin 1
    1 Massachusetts General Hospital, Psychiatry, Boston, United States

    目的 ： 面 对陌生人时的行为抑制表现 （ BI ） 表示个体具有特定的气 质倾向 ， 在面对不熟悉的人或环境时 ， 更倾向于表现出恐惧、沉默或抑制。这种行为抑制表现被认为是焦虑障碍的一个危险因素。在本前瞻性长程研究中，我们比较了学龄前有或无行为抑制表现儿童，其儿童中期时精神疾病的发生情况。
    . 方法： 基 线时的样本纳入了 284 名 21 个月到 6 岁的儿童，其中包括有焦虑风险的儿童（父母患有惊恐障碍和 / 或抑郁症）及其 对照（父母无心境或重性焦虑障碍）。 所有研究 对象均按年龄特异性试验程序进行了 BI 评定。 5 年后，我 们随访到了 215 名 (76.5%) 儿童，其平均年 龄是 9.6 岁， 并用 结构式的诊断访谈对他们进行了再次评估。
    结果： BI 可特异性的 预测社交焦虑的发生。伴或不伴 BI 儿童的社交焦 虑 (DSM-IV 社交恐惧或 DSM-III-R 回避障碍 ) 的 终生患病率分别是 28% 和 14% ( 比数比 [OR] = 2.37; 95% 可信区 间 [CI]: 1.10-5.10) 。 在基 线正常的儿童中， BI 可 显著预测新的社交恐惧的发生（伴或不伴 BI 儿童中，社交恐惧的 发生率分别为 22.2% 和 8.0% ， OR = 3.15 ， 95% CI: 1.16-8.57 ）。其他焦 虑障碍与 BI 无明 显相关性。
    结论： BI 可能是儿童中期 继发社交焦虑的素质因素。目前有 BI 表 现的儿童需监测其社交焦虑症状，且可以进行预防性的认知行为治疗。

    Objectives: Behavioral inhibition (BI) to the unfamiliar represents the temperamental tendency to exhibit fearfulness, reticence, or restraint when faced with unfamiliar people or situations. It has been hypothesized to be a risk factor for anxiety disorders. In this prospective longitudinal study, we compared the psychiatric outcomes in middle childhood of children evaluated at preschool age for BI.
    Methods: The baseline sample consisted of 284 children ages 21 months to 6 years, including offspring at risk for anxiety (children of parents with panic disorder and/or major depression) and comparison offspring of parents without mood or major anxiety disorders. They had been assessed for BI using age-specific laboratory protocols. We reassessed 215 of the children (76.5%) at 5-year follow-up at a mean age of 9.6 years using structured diagnostic interviews.
    Results: BI specifically predicted onset of social anxiety. The rate of lifetime social anxiety (DSM-IV social phobia or DSM-III-R avoidant disorder) was 28% versus 14% (odds ratio [OR] = 2.37; 95% confidence interval [CI]: 1.10-5.10) in inhibited versus noninhibited children. BI significantly predicted new onset of social phobia among children unaffected at baseline (22.2% vs 8.0% in inhibited versus noninhibited children (OR = 3.15, 95% CI: 1.16-8.57). No other anxiety disorders were associated with BI.
    Conclusions: BI appears to be a temperamental antecedent to subsequent social anxiety in middle childhood. Children presenting with BI should be monitored for symptoms of social anxiety and may be good candidates for preventive cognitive behavioral strategies.
     
  • P093
    印度 乡村医院门诊青少年精神障碍的研究 - Study of Adolescent Mental Disorders Attending a Rural Hospital Clinic in India
    Asis Acharya 1
    1 Calcutta Pavlov Hospital , Kolkata , India

    目 标 ： 人的一生中 ， 青少年是一个重要的 阶段。它是从童年到成年的一个过渡。当这一过渡平稳无事时，最有可能形成稳定平衡的人格，从而成为有责任感和成熟的个体。当发生严重混乱、家庭破裂、重要家庭成员去世、搬 家、地方或政治上的 压迫及受全球化变迁的影响，青少年可能受到严重干扰、变得混乱，倾向于成为不通情达理的人。在这一短暂的时间中，青少年面临着许多快速的变化，如身体上的变化、性欲的产生及其它激素和生理的改变、职业的选择和上大学等等，所有这些发生在当一个孩子成为男孩或女孩之时。在这动荡的阶段中，会形成一个真正的身份或产生身份危机或困惑。青少年的模式及精神障碍可以成为全球化社会精神卫生的一个敏感标识。
    方法： 在笔者所在的 midapore 诊所，它是距离城市 124 公里的一个中心 乡镇。入组患者为 2004-06 年 间 13 到 20 岁的青少年，共有 132 例，包括 75 例男性和 57 例女性。采用 ICD-10 进行评估，尽管怀孕和自杀倾向问题少见，但这两项还是单独列出。
    结果： 青少年障碍主要 为各种形式的焦虑障碍、创伤后应激障碍、情感障碍 ( 从 恶劣心境到抑郁障碍 ) 、 经前烦躁、社会化和非社会化的行为障碍、逃学、恐吓、女孩和一些男孩受到的性虐待、物质依赖少见、未见酒精依赖。一名 20 岁女性患者有自杀倾向、反社会人格倾向和边缘人格障碍。还包括梦游症、癫痫、攻击和冲动控制障碍、精神发育迟滞和其它发育障碍。
    结论 ： 需要 识别青少年中的行为和精神障碍 ， 同时进行早 期干 预以避免今后全面性的精神障碍。早期识别也有助于预防自杀。

    Objectives: Adolescence is an important period in the life-cycle of human being. It`s a period of transition from childhood to an adult person. When the transision is smooth and uneventful a smooth and balanced personality and a responsible, mature person is the likely outcome. When there are severe turmoil, broken home, death of a key famaily member,change of house, locality or political opression, or shifting in this erra of globalisation, adolescence may be turbid, crucial, disturbed and can yield to not so sensible persons, as erlier. Rapid myarid of changes hits the adolescence (adls)in a short span. Bodily changes sexual abrubt change with hormonal & other physiological changes and career selection, going to college etc. All happpens in the child turned boy or girl in a rapid transition. There may be a real identity formation or may be an identity crisis or confusion in the turmoil state. Patterns of adls. Mental disorder could be a sensible marker of socities mental health on the show of globalisation.
    Methods: In the authors clinic at midnapore,a district headqrts. town-124 k.m away from city, all the patients belonging to the age group 13-20 were analysed during the year 2004-06. There were altogether 132 such cases with 75 male & 57 female teen agers. Their diagnosis as per ICD_10 cliteria were evaluated. Problems of teen ager pregnancy in girls & suicidal trends were seperately enlisted, although their no. were few.
    Results: main adolsent disorders found were thus various forms of anxiety, socil anxiety disorder, p.t.s.d, o.c.d, mood disorders from dysthymia to depressive disorder, pre-menstrual dysphoria, conduct disorders both socialised and unsocialised, truancy, bullying in school, sexual abuse in girl as wellas in a few boys. Substance use disorder are few,alchol related disorders none.suicidal attempt, anti social personalty trends and 1 border line personality disorder in a 20 year`s female was noted. Somnabulism, epilepsy, and agressive behavior,and diff. impulse control behavior were marked. Mentalretardation and other devolptmental disorders were also noted.
    Conclusions: Behavior and mental disordes in adolescence need to be identefied and managed early to prevent full-blown mental disorders. awereness of adls. Disordes will also helps to prevent suicide.

  • P094
    电子游戏成瘾儿童的心理和行为特征的研究 - Psychiatric and Behavior Problems of Children with Video Games Dependence
    Zhong-meng Guo 1 , Sheng-jun Zou 1 , Kan Li 1
    1 Jiangxi Mental Hospital , Nanchang , Chinese Mainland

    摘要 : 目的 探 讨电子游戏成瘾儿童的心理 、行 为的特点。
    方法 : 采用症状自 评量表 （ SCL-90 ） 和 Achenbach 儿童行 为量表 （ CBCL ） 分 别对 32 例 电子游戏成瘾儿童 （ 成瘾组 ） 和 32 例正常儿童 （ 对照组 ） 进行评定。
    结果 : 成 瘾组 SCL-90 中的人 际关系敏感、焦虑、偏执、敌对及精神病性五个因子分高于对照组 （ P<0.05 ） ; 成 瘾组 CBCL 量表中的学校情况、退 缩、焦虑 / 抑郁、社交 问题、违纪行为、攻击行为、外向性行为得分以及行为问题总分均高于对照组 （ P<0.05 ） 。
    结论 : 电子游戏成瘾儿童存在较多的心理和行为问题。
    关键词 : 儿童精神病学 ； 电子游戏 ； 成瘾 ； 行为问题 ； 病例对照研究

    Objective: To investigate psychiatric and behavior problems of children with video games dependence.
    Methods: 32 video games dependent children and 32 normal children were assessed with Symptom Check List-90(SCL-90) and Achenbach Childrens Behavior Check List(CBCL).
    Results: The scores of interpersonal sensitivity, anxiety, paranoid ideation, hostility and psychotism were higher in the study group than in control (P<0.05); School status, withdraw, anxiety/depression, social problems, delinqent problems, extroversive behavior problems and the total score of CBCL were also higher in the study group.
    Conclusion: Video games dependent children have more psychiatric and behavior problems.
    Key words: child psychiatry; video games; dependence; behavior problem; case-controlled study
     
  • P095
    Increased Serum Level of Soluble Interliukin6 Receptor in Tourette' Syndrome
    Yuhang Cheng 1 , Yi Zheng 1
    1 Beijing Anding Hospital, Capital Medical University, Clinical Laboratory Center, Beijing, Chinese Mainland

    Background ： The hypothesis that common infection can modulate the onset and course of tic disorder in pediatric population is longstanding. Interleukin 6 (IL-6) performs a prominent role during disease and has been described as both a pro- and anti-inflammatory cytokine. A key feature in the regulation of IL-6 responses has been the identification of a soluble interleukin 6 receptor (sIL-6R), which forms a ligand–receptor complex with IL-6 that is capable of stimulating a variety of cellular responses including proliferation, differentiation and activation of inflammatory processes.
    Objective: To study the relationship between serum level of sIL-6R and Tourette's syndrome.
    Method: Using enzyme-linked immuno-sorbent assay (ELISA), serum level of sIL-6R was measured in 67 patients with Tourette's syndrome, aged 8-18years or 54 schizophrenia patients, aged 7-17years, and 61 age-matched control subjects.
    Results: Serum level of sIL-6R was significantly higher in TS patients than in healthy controls (t=0.000) and in schizophrenia patients (P=0.000). While there were no significant differences in sIL-6R between schizophrenia patients and control subjects(t=0.053).
    Conclusion: Elevated sIL-6R levels have been described in TS patients. Which infers that sIL-6R performs an important role in the regulation of IL-6 responses and consequently disease progression. There is immune dysfunction in TS patients, which may be mediated though IL-6. an inflammatory process propagated by systemic and local cytokine synthesis that might involve the central nervous system.
     
  • P096
    成 长经历与青少年心理问题的潜在性及缓解对策 - The Potential Relationship between Growing Experience and Mental Disorder in Adolescent and the Relief Strategy
    启康 孙 1 , 双 鹤 陆 1
    1 上海市 复兴高级中学 , 上海 , Chinese Mainland

    前言 我 们都知道在孩子的成长过程中 ， 多少会遇到一些挫折 ， 但是往往做大人们以为事情过去了或是简单的处理了就行了。却很少想到这种影响会对孩子的今后成长带来不利，有的甚至会影响其终生。笔者根据临床心理咨询的实践发现，学生常见的学习困难、行为偏差、情绪障碍等三大心理问题，大多与来访者在幼儿及少年时期的成长环境（经历）相关。
    例如一位由家 长陪同来访的高中学生告诉我，他的思路十分混乱，看不进书，心里总是害怕。而他的家长也说常常发现他有自己打耳光的现象，还不停地使劲
    擦面孔， 经了解远在少年时期曾受过性侵犯的人格侮辱，一直不敢说，直到现在家长发现了怪异行为时才追问出来。可见，心理障碍的形成有一个较长时间的潜伏期，它根植于早年经历，显现于青年或成年之后。
    为此笔者认为虽然无法改变他们过去的经历，但是可以帮助他们学会倾诉以缩短潜伏期；虽然无法改变过去的环境，但是可以现在建造良好环境，以缓解他们心理问题，早日走出阴影。本论文是笔者就有关上述问题作了近 8 年研究的 结果。
    关键词 成 长经历 心理 问题 潜在性 缓解
    研究的目的
    1 ． 青少年心理 问题潜在性的表现情况
    2 ． 青少年心理 问题缓解的对策和有效途径
    研究的方法
    观察法 深度 访谈法 团体辅导法
    研究的 过程
    1 ． 观察个别表现，了解（扑捉）内心需求
    2 ． 心理健康知 识引导，促进青少年学会自我倾诉
    3 ． 环境辅导渗入，给予必要的社 会心理 环境支持
    研究的 结果
    1 ． 学生懂得了成 长环境（经历）对自己精神健康的重要性
    2 ． 85% 的学生 开始重视并愿意回顾自己的成长过程中的种种问题，以早日走出过去的阴影。
    3 ． 学生 们的心理品质有了明显提升
    研究的 结论
    1 ． 心理健康知 识引导是促进青少年学会倾诉，缩短潜伏期的重要因素 。
    2 ． 学校 — 家庭 — 社区的良好 环境塑造是青少年心理品质提升并对心理问题得以缓解的有效途径。
    3 ． 本研究的社会价 值
     
  • P097
    The Potential Relationship between Growing Experience and Teen-age Mental Problems and the Measures to Solve Them
    Qikang Sun 1 , Shuanghe Lu 1
    1 Shanghai Fu Xing Senior High School, Shanghai, Chinese Mainland

    As we all know, there will be many frustrations in children's growing experience. However, parents always think it will be all right as it passed or be handled simply, but never consider about the bad influence on children's later development, sometimes it would last in their whole life. The author discusses in the clinic psychological consultation practice, and finds that the three familiar mental problems in students –learning difficulty; behave aberration; emotional disorder – are mostly correlative to their growing environment (experience) in infancy and youth.
    For Example, there was a senior student who came to visit me with his parents. He told me that he was woolly-headed, disable to read, and always scared. His parents described that he often slapped himself in the face, as well as scraped his face forcibly. It was found out later that he has been sexually insulted and encroached in his youth age. He dared not to talk about it until his strange behaviors were found by his parents. So I learned that the form of mental disorder has a long latent period, it maybe start in childhood but appear on youth or adult or even later. The author points out that, even though we could not change their experiences, we could help them learn to confide so as to shorten the latent period; even though we could not change their past environments, we could create better environments now to relieve their problems. The article talks about the results through eight years' research.
    Key Words: Growing experience, mental problems, Potential, relieving
    Purposes:
    1. Teen-age mental problem's potential exhibitions
    2. Teen-age mental problem's relieving countermeasure and effective approaches
    Methods: Observation, depth interview, group tutorship
    Processes:
    1. Observe individual behavior, comprehend innermost needs
    2. Offer Instructions for mental health knowledge, encourage them to confide in mental counseling
    3. Offer environmental and social support
    Results:
    1. Students learned the importance of growing experience to their mental health
    2. 85% students attached importance to their problems in experience, and willing to look back at them
    3. With all-round and various behavior training, their mental qualities have been improved

     
  • P098
    对尼泊尔受武装冲突的儿童进行以学校为基础的社会心理干预的效果 ： 一项随机对照研究的结果 - Efficacy of a School-based Psychosocial Intervention for Children Affected by Armed Conflict in Nepal: Results of a Randomized Controlled Trial [ISRCTN48004304]
    Nagendra P Luitel 1 , Mark J.D. Jordans 2 , Brandon A. K. Kohrt 2 , Wietse A Tol 2 , Ivan H Komproe 3 , Joop TVM de Jong 4
    1 Transcultural Psychosocial Organization, Lazimpat, Kathmandu, Nepal, 2 Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal, 3 Healthnet/ Transcultural Psychosocial Organization, Amsterdam, Netherlands, 4 Vrije Universiteit Medisch Centrum, Amsterdam, Netherlands

    关于在非西方国家 ， 对受到武装冲突影响的儿童进行社会心理干预的效果如何 ， 我们知道很少 ， 尽管目前这类干预已经被广泛的应用 ， 本研究的目的在于填补这项空白。
    本研究采用随机 对照设计 ， 通过实施 15 次系列的以学校 为基础的集体心理干预 ， 评价心理干预的疗效。正文中描述了试验的设计 ， 还包括 ： 取样方法 ， 测量工具的使用 ， 如何在前期的试验中 ， 找到一个适合当地使用的评价调查对象社会心理健康状况的量表及方法。 研究
    结果 ： 我 们探讨了基线值 （ T1 ） 与干 预后测量值 （ T2 ） 之 间的不同 ， 特别注意了量表中症状学指标与一些弹性指标的不同 ， 164 位儿童接受了 15 次系列心理干 预 ， 161 位儿童作 为对照组 ， 在研究结束后接受心理干预。这项随机对照的干预试验提示，心理干预组的儿童在日常功能、是否对生活充满希望、社会行为、抑郁情绪都较对照组有改善，但是心理干预并不能改善创伤后应激障碍相关的症状（ PTSD ）。最后 ， 我 们提出了在将来进行进一步心理干预的方法与建议。

    Very little is known about the efficacy of psychosocial services for children affected by armed conflict in non-Western settings, even though such interventions are increasingly popular. This study was aimed at addressing this gap by assessing the efficacy of a school-based 15-session psychosocial group intervention through a Cluster Randomized Controlled Trial design. The presentation covers the design of the study, including (a) sampling, (b) instrumentation and development of adapted and locally designed tools for measuring psychosocial wellbeing through a qualitative pre-phase, (c) study results. Results of baseline (T1) and post-intervention (T2) differences are discussed, with attention to both symptomatology and resiliency measures. 164 children received the 15 session intervention, meanwhile 161 children were waitlisted for the intervention. The randomized control trial of this intervention found that the treatment group improved on daily functioning, hopefullness, prosocial behavior, and depression. However, the intervention did not improve posttraumatic stress symptoms (PTSD). Finally, recommendations for future implementation of this intervention are made.
     

  • P099
    尼泊 尔 儿童士兵与非武装儿童精神健康状况的 对照研究 - Mental Health Status of Child Soldiers Compared with Children Never Associated with Armed Groups in Nepal
    Brandon A. K. Kohrt 1 , Mark J.D. Jordans 1 , Sujen Maharjan 2 , Suraj Koirala 1 , Ivan H Komproe 3 , Carol M Worthman 4
    1 Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal, 2 Transcultural Psychosocial Organization, Kathmandu, Nepal, 3 Healthnet/ Transcultural Psychosocial Organization, Amsterdam, Netherlands, 4 Emory University, Department of Anthropology, Atlanta, United States

    内容 ： 儿童士兵被 认为是需要特殊心理干预的脆弱群体 ， 但是 ， 迄今为止 ， 还没有关于儿童士兵与非武装相关儿童之间的对照研究。
    目的 ： 探 讨儿童士兵与受政治暴力影响但与武装军队没有联系的社区儿童相比 ， 是否承受更多的精神应激。
    研究 设计 ： 采用配 对的病例对照研究方法 ， 比较儿童士兵与非武装军队相关的社区儿童 ， 两组之间有的人口学特征具有可比性。
    研究地点 ： 儿童士兵主要来自于在尼泊 尔 11 个行政区 ， 所以 处于这些行政区的社区被选作对照的抽样社区。
    对象 ： 根据估 计 ， 大约有 404 个儿童士兵 ， 我 们联系到了其中的 227 个 ， 其中有 142 个同意参加本 项研究 ， 我们根据性别、受教育水平、民族、居住地对这 142 个儿童士兵 进行配对 ， 选取对照。
    主要的 评定工具 ： 受试者抑郁自评量表、儿童焦虑相关的情绪障碍筛查量表、儿童创伤后应激评定量表、能力与困难问卷、躯体受侵犯量表、儿童希望度量表、日常功能受损情况量表。
    结果 ： 据 统计 ， 与非武装相关儿童相比 ， 儿童士兵在抑郁情绪、焦虑情绪、创伤后应激障碍、高警觉性、躯体受侵犯、社会日常功能受损方面有较高的发生率 ， 差异具有显著性。（ p<0.01 ） 对儿童士兵的人口学数据与儿童的精神健康状况采用线性回归分析显示， “ 住在尼泊 尔 东区 ” 对与儿童的精神健康状况是一个保护因素；住在尼泊尔东区的儿童士兵与非武装关联的尼泊尔西区社区儿童相比，具有较健康的精神状态。
    结论： 研究提示，在受政治暴力影响的地区，与非武装 关联的儿童相比，儿童士兵有较差的精神健康状况。然而，干预措施应该是具有区域特异性的，不能笼统地认为儿童士兵作为一个群体，比非武装关联的儿童有更好的精神健康状况。

    Context: Child soldiers are considered a vulnerable group with special needs for mental health intervention. However, to date there has been no empirical studies comparing child soldiers and children not associated with armed groups.
    Objective: To determine if child soldiers in Nepal have greater mental health distress than community children exposed to political violence who have not associated with armed groups.
    Design: A matched case-control study design was employed to compare child soldiers and children in the community who had never associated with armed groups with comparable demographics.
    Setting: In Nepal , eleven districts with the highest estimates of child soldiers returned to the community were selected as study sites.
    Participants: From an estimated 404 child soldiers, 227 were contacted and 142 participated. Child soldiers were matched with 142 never associated community children on sex, education level, ethnicity, and region of residence.
    Main Outcome Measures: Participants completed Depression Self Rating Scale, Screen for Child Anxiety Related Emotional Disorders, Child Posttraumatic Stress Scale, Strength and Difficulties Questionnaire, Physical Aggression Questionnaire, Child Hope Scale, and a measure of impaired daily functioning.
    Results: Child soldiers report higher depression, anxiety, posttraumatic stress, physical aggression, hyperactivity, and impairment in daily functioning than never associated children do (p < 0.01). Linear regression of mental health status against demographics and status as a child soldiers reveals that residing in eastern districts of Nepal is protective against mental health problems; child soldiers in eastern districts display better mental health status that never associated children in western districts.
    Conclusions: This research suggests that in areas affected by political violence, child soldiers generally have poorer mental health status than children not associated with armed groups. However, interventions should be region-specific rather than assumptions that child soldiers as a category have poorer functioning than community children do.
     

  • P100
    新型抗精神病 药在儿童分裂症中的临床应用 - The Use of NAD in Treatment of Children Schizophrenia Patients
    含秋 李 1
    1 广州市精神病医院 , 门诊部 , 广州市 , Chinese Mainland

    目的 ： 了解新型抗精神病 药 （ new generation atypical drug ， NAD ） 在儿童分裂症中的 应用。

    方法： 对广州市脑科医院的儿童精神科门诊使用 NAD 的 66 例儿童分裂症患者 进行分析。
    结果： NAD 已 较为广泛地应用于儿童精神分裂症。
    结论 ： NAD 总体来说对儿童分裂症疗效较好 ， 副反应小 ， 安全性高。
    关键词 ： 新型抗精神病 药 儿童分裂症

    Objective: To study the use of NAD in treatment of children schizophrenia patients.
    Method: Exploring the condition of children schizophrenia patients in outpatient ， Analysis the use of NAD.
    Result: NAD has been widely used in children schizophrenia outpatients.
    Conclusion: It suggested that NAD are effective and safe in the treatment of children schizophrenia patients.
    Key words: New antipsychiatric drugs; Children schizophrenia
     
  • P101
    南非 Mthatha 地区 对智能障碍患者的性侵犯 - Sexual Assaults on the Mentally Impaired in Mthatha Area of South Africa
    Banwari Lal Meel 1 , Ram Prakash Kaswa 1
    1 Walter Sisulu University, Forensic Medicine, Mthatha, South Africa

    背景 ： 在南非 ， 保 护儿童已经被视为一个重要的行动。尽管承诺维护儿童的权益，但是很多还仍旧停留 在保 护智能障碍患者的安全性上。 目的： 确定 2001 年至 2005 年期 间加入 Sinawe 中心的智能障碍患者中受到性侵犯的流行率。
    方法： 这是对 2001 年至 2005 年期 间加入 Sinawe 中心的患者的 记录进行的回顾。这是该地区惟一一个对受到性侵犯者进行处理的中心，隶属于 Nelson Mandela 大学医院。登 记所有智能障碍的性侵犯受害者。
    结果： 研究期 间，共有 1268 人在受到性侵犯后 进入 Sinawe 中心，其中 32 人 为严重智能障碍。在这 32 人中， 28 人（ 87.5 ％）在 18 岁以下， 23 人（ 72 ％）在 15 岁以下，男性 2 人， 29 人（ 90.6 ％）被 发现为近亲。 6 人（ 18.7 ％） 为正在治疗中的癫痫患者。一人为 13 岁已经怀孕。 4 人 为 HIV 筛检阳性。结局：加入 Sinawe 中心的性侵犯受害者中，超 过 2 ％ 为智能障碍。

    Background: Protection of children has been identified as a priority for action in South Africa . Despite a commitment to uphold children's rights, much has still to be done for the safety of mentally impaired.
    Objective: To ascertain the prevalence of sexual assault on the mental impaired who attended the Sinawe Center from 2001 to 2005.
    Methods: This is a record review of attendees to the Sinawe Center between 2001 and 2005. It is the only center in this area that deals with sexually assaulted persons and is attached to Nelson Mandela Academic Hospital . All mentally impaired victims of sexual assaults were recorded in the register.
    Results: There were 1268 who attended the Sinawe Centre following sexual assault during the study period, of whom 32 were profoundly mentally impaired. Of this 28 (87.5%) were below the age of 18 years. Twenty three (72%) victims were below the age of 15 years. Two were males. A close relative was implicated in 29 (90.6%) of the cases. Among them were 6 (18.7%) epileptics who were on treatment. One was 13 years old and pregnant. Four were HIV positive on screening.
    Conclusion: Over 2% of the sexual assault victims attending the Sinawe Centre were mentally impaired.
     
  • P102
    网 络过度使用倾向中学生的人格特征 - The Personality Characteristic of Middle School Students Involved in Internet Overuse
    宇 金 1 , 雁 林 苏 2 , 林 枫 曹 2
    1 中南大学湘雅二医院精神 卫生研究所 , 中山大学公共 卫生学院妇幼系 , 广州 , Chinese Mainland, 2 中南大学湘雅二医院 , 精神 卫生研究所 , 长沙 , Chinese Mainland

    目的 ： 探 讨网络过度使用 （ internet overuse, IOU ） 倾向中学生的人格特征。素材和方法：采用 Beard 修 订， Young 编制的 “ 网 络成瘾诊断问卷 ” （至少 4 分，但未达到网 络成瘾标准者为 IOU 倾向）、青少年时间管理倾向量表及修订艾森克个性问卷对 2620 名中学生 进行调查，使用 SPSS11.0 统计软件对资料进行 t 检验和卡方检验。
    结果： 在 调查对象中， IOU 倾向者有 313 人，占 11.95% ，其中男生（ 224 人）多于女生（ 89 人）。 IOU 倾向组中学生的时间价值感、时间监控观、时间效能感及时间 管理 倾向总分均显著低于正常组（ t=2.56~4.52, P<0.01 ）。 IOU 倾向组中学生精神质和神经质量表的得分显著高于正常组，掩饰性得分显著低于正常组（ t=-5.35 ， -9.02 ， 7.47 ， P<0.01 ）；两 组内外倾维度得分差异无统计学显著性（ t=0.77 ， P>0.05 ）。 IOU 倾向组学生中男生掩饰性得分高于女生，女生神经质得分高于男生，差异有统计学显著性（ t=2.27 ， -2.47 ， P= 0.02 ）。
    结论： 中学生网 络过度使用倾向者具有时间管理差、精神质倾向、神经质倾向及纯朴性的人格特征，并有性别差异。

  • P103
    Child and Adolescent Mental Health Survey in Chengdu Area: The Prevalence of DSM-IV Disorders
    Yi Huang 1 , Xueli Sun 2 , Yanchun Yang 2 , Shujun Liu 2 , Yun Xiang 2 , Mingjing Gu 2 , Xin Gao 2 , Shusen Zhang 2 , Guoying Zhang 2 , Haixiang Sun 2
    1 Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan,P R China, Chinese Mainland, 2 Mental Health Center, West China Hospital, Sichuan University, Chengdu, Chinese Mainland

    Objectives: To describe the prevalence of DSM-IV disorders and comorbidity in a large population-based sample of Chinese children and adolescents.
    Method: Using a one-phase design, 4844 children were assessed using the Development and Well-Being Assessment (DAWBA), a structured interview with verbatim reports reviewed by clinicians so that information from parents, teachers, and children was combined in a manner that emulated the clinical process. The authors' analysis examined comorbidity and the influence of teacher reports.
    Results: The overall prevalence of DSM-IV disorders was 12.5% (95% confidence interval 8.8-10.1%), but 2.1% of children were assigned "not otherwise specified" rather than operationalized diagnoses. After adjusting for the presence of a third disorder, there was no longer significant comorbidity between anxiety and conduct disorder or attention-deficit/hyperactivity disorder (ADHD), or between depression and oppositional defiant disorder. A comparison of the disorders in children with and without teacher reports suggested that the prevalence of conduct disorders and ADHD would be underestimated in the absence of teacher information.
    Conclusions: Roughly 1 in 12 children have at least one DSM-IV disorder, involving a level of distress or social impairment likely to warrant treatment. Comorbidity reported between some childhood diagnoses may be due to the association of both disorders with a third. Diagnoses of conduct disorder and ADHD may be missed if information is not sought from teachers about children's functioning in school.

  • P104
    Time Perception Deficit in Children with ADHD
    Binrang Yang 1 , Raymond C.K Chan 2 , Xiaobing Zou 3 , Jing Jin 4 , Jianning Mai 5 , Jing Li 6
    1 ShenZhen children's hospital/Sun Yat-sen University, ShenZhen, Chinese Mainland, 2 Institute of Psychology, Chinese Academy of Sciences, Beijing, Chinese Mainland, 3 The Third Affiliated Hospital, Sun Yat-Sen University, GuangZhou, Chinese Mainland, 4 School of Public Health, Sun Yat-Sen University, Guangzhou, China, GuangZhou, Chinese Mainland, 5 Guangzhou Children′s Hospital, GuangZhou, Chinese Mainland, 6 ZhuHai Maternal and Child Health Hospital, ZhuHai, Chinese Mainland

    Objectives: Time perception deficit has been demonstrated in children with ADHD by using time production and time reproduction tasks. However, the impact of motor demand has not yet fully examined in previous studies. The current study aimed to investigate the pure time perception in Chinese children with ADHD by using a duration discrimination task.
    Methods: A battery of tests specifically capturing for time perception, and other related ability such as inhibition, attention, and working memory was administered to 40 children with ADHD and 40 demographically matched healthy children.
    Results: Repeated measure MANOVA indicated that children with ADHD showed significantly higher discrimination thresholds than healthy controls and there was an interaction effect between group and durations. Pairwise comparison indicated that children with ADHD were less accurate in discriminating durations at either target duration. Working memory (Corsi blocks task) was related to discrimination threshold at the duration of 800 milliseconds after controlling for FIQ in ADHD group, but it did not survive the Bonferroni correction. The results indicated that children with ADHD may have a perceptual deficit of time discrimination. They needed a greater difference between comparison and target intervals to discriminate the short, median and long durations reliably.
    Conclusions: This study provides further support for a generic time perception deficit, probably due to a dysfunctional fronto-striato-cerebellar network involved in this capacity, especially the presence of deficits in basic internal timing mechanisms. 

  • P105
    中 专学生网络使用情况与社会心理因素的关系分析 - Internet Use and Psychosocial Factors of Technical Secondary School Students
    Kong-xiang Zhu 1 , Shi-qing Zhong 1 , Ke-zhen Song 1
    1 Linyi City Vaterents Hospital, Department of Psychiatry, Linyi, Chinese Mainland

    中 专学生网络使用情况与社会心理因素的关系分析朱 孔香 （ 1 ） 钟士庆 （ 2 ） 宋克珍 （ 3 ） 吕锋 （ 1 ） 梁家国 （ 1 ） 青少年网 络成瘾和网络使用过度已成为当今社会人们关注的焦点 ， 探讨青少年网络使用的影响因素 ， 以便为正确地引导青少年使用网络提供理论依据。采用自制一般情况调查表，网络成瘾量表（ IAII ）、症状自 评量表（ SCL-90 ）， 对 231 名中 专学生进行测查。 应用 SPSS11.0 统计软件进行一般性统计学描述、 Pearson 相 关分析和多元线性回归分析。测查前对网络成瘾量表进行了分析，结果显示：量表的内部一致性 Cronbachα 系数 为 0.9239 ，各条目与量表的相 关性为 0.305-0.734 之 间，均有统计学显著性意义 . 网 络成瘾量表评定得分在 50 ～ 79 分，判断 为网络成瘾倾向 16 人，占 总数的 6.98 ％，其中男 13 人、女 3 人。得分 30 ～ 49 ，判断 为网络使用过度 33 人，占 总数的 14.41 ％，其中男 18 人、女 15 人。 30 分以下，判断 为正常使用者 180 人，占 总人数的 78.60 ％。 单因素相关分析结果显示：网络成瘾量表得分与男性、计算机专业相关、与 SCL-90 各因子之 间均成正相关，均有统计学显著性差异 , 表明学生性 别、所学专业及其心理健康状况对其网络使用情况有重要的影响。多因素分析结 果 显示：精神病性因子、学生性别、敌对性及所学专业依次是影响网络使用的危险因素，差异均有统计学显著意义，综上所述中专学生网络使用情况与社会心理因素关系密切，预防网络成瘾应从性别、专业和个体的心理特点出发。这一结果为心理工作者解决青少年网络成瘾提供了理论依据。因此学校和家庭应为青少年营造轻松和谐的生活氛围，减少他们的心理压力，以利于他们心身的健康成长。作者单位：山东省临沂市荣军医院　　 276005

    Internet addiction and excessive use of the network in today's society have become the focus of people's attention. Discusses the influence factors of young people network use, in order to provide the theory basis for correctly guide young people to use network. With Commonly data questionary, Internet Addition Impairment Index (IAII), Symptom Checklist 90(SCL-90), 231 technical secondary school students were investigated. Use SPSS 11.0 statistical for a general description, Pearson correlation and multiple linear regression analysis. Before Investigation we carried out analysis for IAII , the results showed: The scale inside compatibility Cronbach α modulus is 0.9239 , every entry and the scale correlativity are between 0.305-0.734 , has Statistics notable difference. IAII scores in 70 ~ 79, the judgment of Internet Addiction 16, the total 6.98%. Scores of 30-49, judgment for the use of excessive network of 33, accounting for 14.41% of the total. Pearson correlation analysis showed that IAII score was notably related to males 、 computer specialty and 10 factors score of SCL-90. The multivariate linear returns the analysis showed that psychoticism, males, Hostility and computer specialty were risk factors for internet addiction. In summary ， internet addiction is closed associated with males, computer specialty and mental health. The result provides a theoretical basis for psychological workers. Therefore schools and families should be easy for young people to create a harmonious living environment and reduce the psychological pressure on them, facilitate their psychosomatic healthy growth.

  • P106

    Abstract withdrawn

     

  • P107
    青少年人格特 质与教育过程之间的关系 - Relation between Personality Traits and Educational Progression in Adolescents
    Mahin Aminolroayie Yamini 1 , Abbas Attari 1 , Maryam Alebrahim 1
    1 Behavioral Sciences Research Center , Isfahan , Iran , Islamic Republic of

    目的 ： 人格是 对个体可见行为和他 / 她主 观报告自 我 经历的总体描述性标签。人格和教育的成功性相互影响。本研究的目的在于调查青少年人格特征和教育成功性之间的关系。
    方法： 在 这个描述 - 分析的研究中， 对 shahrekord （伊朗一大学）指 导学校中的 275 个女孩采用艾森克人格 问卷（ EPQ ） 进行评价。她们教育的成功性以最后一个学年中的平均成绩来评定。数据采用 SPSS 采集，并 进行 spearman 和 pirson 检验进行分析。
    结果： 一半的学生得到超 过 18 的学科平均分。他 们中 66% 有 较大的外向性， 68.9% 有 严重的精神质， 61.9% 说谎以及 58.4% 神 经质。教育平均分与外 向性、精神 质直接相关。
    结论： 更成功的教育伴随着更高的外向性，更成功的受教育者在精神 质和说谎分上的得分更高。

    Purpose: Personality has generally been used as a global descriptive label for a person's observable behavior and his/her subjectively reportable inner experience. Personality and Educational successfulness can effect each other. The aim of this study is survey of relation between personality characteristic of adolescents with Educational successfulness.
    Method: In this descriptive- analytic study, 275 girls in a guidance school in shahrekord were evaluated by Eysenk Personality Questionnaire (EPQ).
    Their successfulness in education were determined by mean scores in last academic year.
    Data collected with SPSS and analysed with spearman and pirson Test.
    Results: The half of students had academic mean score above 18. They demonesterated 66% severe Extravertion, 68.9% severe psychoticism, 61.9% lying and 58.4% neuroticism. Educational mean score had direct relation with extroversion and direct relation with psychoticism cunclusion: Higher education successfulness is with higher exteravertion, psychoticism and lying in high degree.
     

  • P108
    COMT val/met 多 态性和汉族抽动秽语综合症认知灵活性关系研究 - A Relationship Study between COMT val/met Polymorphism and Cognitive Flexibility in Tourette Syndrome in the Han Nationality
    卫东 季 1 , 田友 郭 2 , 闯 杨 3 , 兰婷 郭 4
    1 1 四川大学 华西医院心理卫生中心 2 上海市 长宁区精神卫生中心 , 上海 , Chinese Mainland, 2 深圳大学 , 深圳市 , Chinese Mainland, 3 浙江温州医学院 , 温州 , Chinese Mainland, 4 四川大学 华西医院心理卫生中心 , 成都 , Chinese Mainland

    目 标 ： 了解 COMT val/met 多 态性和汉族抽动秽语综合症患者认知灵活性之间关系。
    素材和方法 ： 采用聚合 酶 链扩增技术对 86 个 汉族抽动秽语综合症核心家系儿茶酚胺一氧位一甲基转移酶 met/val 基因多 态性进行分析 ， 了解等位基因从杂合子父母向子代传递和非传递的频率 ， 用遗传传递不平衡检验分析上述基因多态性和抽动秽语综合症之间是否存在连锁不平衡 。 2. 用 Stroop 测验 (Stroop test) 、威斯康辛卡片 测验 (Modified Wisconsin Card sorting test) 对抽动秽语综合症患者进行测试，并和 51 名健康儿童 进行比较，了解抽动秽语综合症认知灵活性特点，观察上述多个功能基因多态性对抽动秽语综合症患者认知灵活性的影响。
    结果和结论： 1. 儿茶酚胺一氧位一甲基 转移酶 met/val 基因多 态性和抽动秽语综合症之间未存在连锁不平衡。 2.GTS 组内 COMTmet/met 纯合子个体 WCST 持 续错误数少于 val/val 纯合子个体，携带 val 等位基因个体在延 迟记忆得分、 StroopC 错误数和威斯康辛卡片持续错误数上和非携带 val 个体有 显著性差异 3.COMTval 等位基因 对抽动秽语综合症患者认知灵活性有负性影响。

  • P109
    利培 酮对儿童分裂症维持治疗的 2 年随 访研究 - Maintenance Therapy with Risperidone in Children with Schizophrenia: A Two-year Follow-up Study
    Huanzhong Li 1 , Zeai Li 1 , Xiaosi Li 1
    1 The Ahui Mental Health Center, Hefei, Chinese Mainland

    目的： 对经利培酮治疗达痊愈的儿童分裂症患者进行 2 年的随 访研究，探讨其维持治疗的剂量、疗效及安全性。
    方法： 对所有经利培酮治疗达痊愈的儿童分裂症患者随机分成两组，一组为干预组，每月定期随访，坚持治疗量即维持量的原则，另一组为非干预组，进行自然随访；两组均定期评估临床病情、常规检查和不良反应。结果：共入组 42 例，脱落 4 例，完成随 访 38 例，其中干 预组 24 例，非干 预组 14 例，两 组在年龄、性别、文化程度、家庭环境上 差异无 显著性 (p>0.05) 。 2 年期 间共复发 8 例（ 复发率为 21.1% ），干 预组 2 例，非干 预组 6 例，两 组差异有显著性（ χ2=6.44 ， P<0.05 ）。
    结论： 利培 酮对儿童分裂症的维持治疗应尽可能的以治疗量维持更长的时间，即维持量 = 治 疗量，可以减少复发风险，不良反应并未显著增加。

    Objective: To explore the effectiveness and safety of risperidone in maintenance treatment of children schizophrenia ．
    Methods: All 42 children with schizophrenia getting recovery by risperidone were divided two group, continued maintenance therapy with risperidone and were followed up for 2 years.
    Results: During two years the total relapse rates were 21.1%, two patients relapse in controlled group (n=24) versus 6 patients in naturalistic follow-up group(n=14) （ χ 2=6.44 ， P<0.05 ） . There were no significant difference in the rates of extra pyramidal symptoms and regularly test impairments.
    Conclusion: It is suggested that the dosage of maintenance treatment of risperidone in children schizophrenia be not decreased soon or more as far as possible, which can reduce the rate of relapse.
    Key words: Schizophrenia ； Children; Risperidone ； Maintenance Treatment.
     
  • P110
    Enhanced Functional Connectivity in Attention Deficit Hyperactivity Disorder in Flanker Task with fMRI
    嫚秋 隋 1
    1 清 华大学 , 清 华大学玉泉医院 , 北京 , Chinese Mainland

    Background: Dorsal anterior cingulate cortex (dACC) has been focused on in the pathophysiology of attention deficit hyperactivity disorder (ADHD) as a critical area in attentional processing. It is necessary to investigate the abnormality of functional connectivity pattern of dACC to further our understanding of the pathophysiology of ADHD.
    Methods: We employed an arrow flanker task combined with slow even-related functional MRI (fMRI) to explore the brain activations related to ADHD, especially perform the functional connectivity (FC) analysis of dACC on children with ADHD.
    Results: The interference control paradigm produced markedly greater activation of the bilateral basal ganglia, insular cortex, occipital cortex and cerebellum in normal controls than in patients in both types of trials. In congruent trials, boys with ADHD showed hypofunction in bilateral SMA as well as bilateral PFC (BA 10) than comparison subjects; in incongruent trials, ADHD patients showed hypofunction in bilateral dACC than normals, yet the bilateral PFC (BA 10) showed greater activation in ADHD boys than in normals. Boys with ADHD showed significantly enhanced functional connectivity between dACC and left angular gyrus, fusiform gyrus, posterior cingulated, inferior parietal lobule, supplementary motor area, inferior frontal gyrus, and right parahippocampal gyrus, superior temporal gyrus than normal boys during the flanker task.
    Conclusions: Our data support the hypothesis that the dACC is dysfunctional in ADHD. Boys with ADHD showed lower activation in frontostriatal circuitry yet enhanced functional connectivities between dACC and some regions to respond to an inhibitory challenge. Such functional pattern may suggest that children with ADHD need greater effort as well as alternative strategy to complete the same task as the normal controls do.
    Key words: ADHD, fMRI, functional connectivity, anterior cingulated cortex, flanker task

  • P111 Weiss 功能缺 损量表 （ Weiss Functional Impairment Rating Scale ） 的信度和效度 - Reliability and Validity of the Weiss Functional Impairment Rating Scale
    Margaret D. Weiss 1 , Brian L. Brooks 2 , Grant L. Iverson 2 , B. Lee 2 , R. Dickson 2 , Christopher Gibbins 1 , Michael Wasdell 2
    1 British Columbia's Children's Hosptial, ADHD Clinic, Vancouver, Canada, 2 British Columbia's Children's Hosptial, Vancouver, Canada

    目的 ： 研究 Weiss 功能缺 损量表 （ Weiss Functional Impairment Rating Scale ， WFIRS ） 在 ADHD 患儿中的信度和效度。
    方法 ： WFIRS-P 量表含 50 条条目 ， 由父母 评定 ， 包括家庭 ， 学习 / 学校 ， 生活技能 ， 儿童自我概念 ， 社会活 动和危险活动等 6 个 维度 （ domain ） 。 每 个条目采用 Likert 4 分制 计分法，相加后得各维度量表分和总分。本研究在加拿大完成，样本来源于接受阿托西汀（ atomoxetine ）治 疗的 6-11 岁共 209 名 ADHD 患儿，其中 150 例完成 为期 3 月的治 疗。评估内容为：均值评定，敏感性变化，内部连贯性，同时效度 ( 参照 GAF) 、区 别效度 ( 参照 ADHD-RS 和 CHIP-CE) 和因素 结构。
    结果： WFIRS-P 量表 总分的基线平均值为 53.9 (SD =20.7) ，治 疗 3 月后 为 30.9 (SD = 18.5) 。从 40% 到 47% 的 转换百分比的效应尺度变化值大 (≥0.7) 。 Cronbach's alphas 系数范 围为 0.75 到 0.94 。 WFIRS-P 和 GAF 的 Pearson 相 关系数在基线和 3 月分 别为 -0.29 和 -0.59 ， WFIRS-P 和 ADHD-RS 的相 关系数在基线和 3 月分 别为 0.44 和 0.71 ， WFIRS-P 和 CHIP-CE 维度在基线和 3 月分 别为 -0.32 到 -0.65 和 -0.54 到 -0.72 。初 步的因子分析提示， 学 习和学校维度量表应分为学习成功和学校行为 2 组因子。
    结论： WFIRS-P 简单易行，能很好的评定 ADHD 患儿的功能 损害特征。

    Objective: To examine the reliability and validity of the Weiss Functional Impairment Rating Scale Parent Report (WFIRS-P) in children with ADHD.
    Method: The WFIRS-P is a 50-item parent-rated measure of functioning across 6 domains: Family, Learning/School, Life Skills, Child's Self-Concept, Social Activities, and Risky Activities. Each item is rated using a 4-point Likert scale and then summed to provide domain and total scale scores. The sample consisted of 209 children, ages 6 to 11 years, diagnosed with ADHD, who were treated by pediatricians; 150 completed this 3-month Canadian study of atomoxetine. Mean ratings, sensitivity to change, internal consistency, concurrent (GAF) and discriminant validity (ADHD-RS and CHIP-CE), and factor structure were evaluated.
    Results: The mean WFIRS-P total score at baseline was 53.9 (SD = 20.7) and at 3 months was 30.9 (SD = 18.5). Percent change ranged from 40 to 47% and effect sizes of change were large (≥ .7). The Cronbach's coefficient alphas ranged from .75 to .94. The Pearson's correlations between the WFIRS-P and the (1) GAF were -.29 at baseline and -.59 at 3 months, (2) ADHD-RS were .44 at baseline and .71 at 3 months, and (3) CHIP-CE domains ranged from -.32 to -.65 at baseline and -.54 to -.72 at 3 months. A preliminary factor analysis suggested that “Learning and School” would split into 2 factors: academic success and school behavior.
    Conclusions: The WFIRS-P has strong psychometric properties and offers a short, easy to use and to score measure of functional impairment in children with ADHD.
     
  • P112
    阿托西汀治 疗加拿大 ADHD 患儿 3 月的症状 变化和功能结局 - Change In ADHD Symptoms and Functional Outcomes in Canadian Children During 3 Months of Atomoxetine Treatment
    Ruth A Dickson 1 , Grazyna Jackiewicz 2 , Sohail Khattak 3 , William Gilchrist 4 , Stanley Szombathy 5 , Elizabeth Brunner 6 , Bobbie Lee 7
    1 Eli Lilly Canada Inc.; University of Calgary, Psychiatry, Toronto, Canada, 2 Stamford Medical Center, Niagra Falls, Canada, 3 The Kids Clinic, Whitby, Canada, 4 private practice, Oshawa, Canada, 5 Okanagon Clinical Trials, Kelowna, Canada, 6 Eli Lilly Inc. Canada, Toronto, Canada, 7 Eli Lilly Canada Inc., Toronto, Canada

    背景 ： 注意缺陷与多 动障碍 （ ADHD ） 患儿常有功能、情 绪和生活质量多方面改变 ， 有必要对其进行多领域的系列研究以利于更好的了解其治疗结局。
    目的 ： 使用阿托西汀 （ ATX ） 治 疗 ADHD 患儿 3 月 ， 研究患儿的症状改 变和功能结局及健康有关的生活质量改变的相关性。
    方法 ： 本研究 为开放性试验 ， 共纳入符合 DSM-IV 诊断标准的加拿大门诊 ADHD 患儿 212 名 ， 年 龄 6-11 岁。研究用工具为 ： 父母用 ADHD 评定量表第四版 （ ADHD Rating Scale-IV-Parent: Inv ， ADHDRS), 父母用儿童版健康和疾病 测查表 (the Child Health and Illness Profile-Child Edition-Parent Rated ， CHIP-CE), 父母用 Weiss 氏功能 损害量表 （ Weiss Functional Impairment Rating Scale–Parent Report ， WFIRS-P) 。采用配 对 t- 检验比较基线和治疗 3 月后 变化， Pearson 相 关分析用以研究各变量之间的相关关系。
    结果： 共有 70.8%(150/212) 的病例完成本研究。治 疗 3 月后基 线水平 ADHDRS 量表 总分的平均改变分值为 -23.0(p<.001 ；基 线为 41.2) ； WFIRS-P 量表 总分平均改变分值为 -0.48(p<.001 ；基 线为 1.10) 。 AHDHRS 量表和 WFIRS-P 量表的 总分改善存在中度正相关（ r= 0.40, p< .001 ）。基 线水平 CHIP-CE 量表的 4 、 5 维度量表分高于常模 1 个 标准差。治疗 3 月后，所有量表均 值较基线水平都有所改善，（均 p<.001) ，其中 4 个量表恢 复到常模 1 个 标准差内。 CHIP-CE 维度量表和 ADHDRS 量表分 值改善呈轻度到中度正相关。
    结论： ATX 治 疗 3 月后 ADHD 症状和更多量表 评分均 得到改善，各量表的 变化有轻度到中度相关性。

    Background: Children with attention deficit/hyperactivity disorder (ADHD) often experience functional, emotional and quality of life issues; studies of serial changes in multiple domains are essential to better understanding treatment outcomes.
    Objective: To investigate the relationship of changes in functional outcome and health-related quality of life (QoL) measures to changes in ADHD symptoms in children treated with atomoxetine (ATX) for 3 months.
    Methods: This open-label ATX study enrolled 212 Canadian outpatients aged 6–11 meeting the DSM-IV criteria for ADHD. This study used the ADHD Rating Scale-IV-Parent: Inv (ADHDRS), the Child Health and Illness Profile-Child Edition-Parent Rated (CHIP-CE), and the Weiss Functional Impairment Rating Scale–Parent Report (WFIRS-P). Paired T-tests assessed changes from baseline to 3 months and Pearson correlations assessed relationships between these changes.
    Results: 70.8% (150/212) patients completed the study. At 3 months, mean change from baseline in ADHDRS Total scores was -23.0 (p<.001; baseline 41.2); mean change in WFIRS-P total scores was -0.48 (p<.001; baseline 1.10). Improvements in AHDHRS total scores and WFIRS-P were moderately correlated, r= 0.40, p< .001. At baseline, 4 of 5 CHIP-CE domains were greater than 1 standard deviation (SD) from the norm. At 3 months, all mean scores improved (all p<.001) and 4 were within one SD of the norm. Correlations of improvements in CHIP-CE domain scores and the ADHDRS were small to moderate.
    Conclusions: Improvements occurred not only in ADHD symptoms, but also in broader measures during 3 months of ATX-treatment; correlations of changes in these measures were small to moderate.
     
  • P113
    托莫西汀治 疗 : ADHD 、学 业、认知和功能的相互关系 - Atomoxetine Treatment: Correlations of ADHD, Academic, Cognitive, and Functional Outcomes
    Margaret Weiss 1 , Bobbie Lee 2 , Atilla Turgay 3 , Samuel Chang 4 , Hubert White 5 , Lori Davis 6 , Michael Wasdell 7 , Alan Yoshioka 8 , Ruth A Dickson 2
    1 Children's and Women's Health Centre of British Columbia, Mental Health Research Unit, Vancouver, Canada, 2 Eli Lilly Canada, Scarborough, Canada, 3 University of Toronto and Scarborough Grace Hospital, Scarborough, Canada, 4 Foothills Medical Centre, Department of Psychiatry, Calgary, Canada, 5 Janeway Children's Health and Rehabilitation Centre, St. John's, Canada, 6 Davis Biostatistics Inc., Barrie, Canada, 7 Fraser Health, Surrey, Canada, 8 AY's Edit, Toronto, Canada

    目的 ： 评价学业、认知和功能性与采用托莫西汀 （ ATX ） 治 疗的注意缺陷多动障碍 （ ADHD ） 儿童症状 变化之间的关系。
    方法 ： 本研究 涉及 105 个 8-11 岁符合 DSM-IV-TR 中 ADHD 诊断标准的加拿大患者 ， 他们之前没有采用过药物治疗 ADHD 。 这些病人采用 ATX 进行 1 年左右的 开放式治疗。本研究采用了 ADHD 评估量表 IV- 家 长版： Inv （ ADHDRS ）， Woodcock-Johnson? 成就 测试（ WJ III ）， 执行功能的行为评定目录 ? （ BRIEF ），儿童行 为评定系统和 Weiss 家 长报告功能损害评定量表 (WFIRS-P) 。基本的分析采用了 Pearson 相 关系数，
    分析了： ADHDRS 总分、 WJ III 中 扩展性阅读、数学和写作分量表原始分在基线到 1 年之 间变化。结果：在 1 年完成者中 (n=72) ， ADHDRS 和 WJ III 都有所改 进，但是这些测量值从基线开始变化的相关性很小并且没有显著差异 (r=?.066, p=.600) 。在 ADHDRS 、 BRIEF (r=.664, p<.001) 和 WFIRS-P (r=.520, p<.001) 中出 现了中度到高度的相关性。
    结论： 1 年 ATX 的治 疗是有效的、安全的、可以被很好地耐 受。尽管学 业上的成就和 ADHD 的核心症状都有改善， 这个变化在一年时不是显著相关的；相比之下，核心症状和一些其他测量值，包括： BRIEF 和 WFIRS-P 显示出显著的相关性。

    Objective: To assess the relationship of changes in academic, cognitive, and functional measures to changes in attention-deficit/hyperactivity disorder (ADHD) symptoms in children treated with atomoxetine (ATX).
    Methods: This study enrolled 105 Canadian patients aged 8–11 meeting DSM-IV-TR criteria for ADHD and previously untreated with medication for ADHD. Patients were treated with open-label ATX for up to 1 year. The study used the ADHD Rating Scale IV-Parent:Inv (ADHDRS), Woodcock-Johnson? Tests of Achievement (WJ III), Behavior Rating Inventory of Executive Function? (BRIEF), Behavior Assessment System for Children, and Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P). The primary analysis utilizes Pearson's correlation coefficient between changes from baseline to 1 year in the ADHDRS total score and in the combined raw scores of the broad reading, math, and writing subtests of the WJ III.
    Results: Among 1-year completers (n=72), improvement occurred in both the ADHDRS and WJ III, but the correlation of change from baseline between these measures is small and not statistically significant (r=?.066, p=.600). Moderate to high correlations with changes in ADHDRS are observed in the BRIEF (r=.664, p<.001) and WFIRS-P (r=.520, p<.001).
    Conclusion: One-year ATX treatment is efficacious, safe, and well tolerated. Although academic achievement and core ADHD symptoms both improve, the changes at 1 year are not significantly correlated, in contrast to significant correlations found between changes in core symptoms and some other measures including the BRIEF and WFIRS-P.
     
  • P114
    西安地区注意缺陷多 动障碍与 HLA-DRB1 基因的相 关性研究 - Association Study between HLA-DRB1 and ADHA in Xian
    Yaping Wang 1
    1 The Second Affiliated Hospital ,School of Medicine, Xi'an Jiaotong University , Xi'an , Chinese Mainland

    目的 : 探 讨注意缺陷多动障碍 （ Attention deficit hyperactivity disorder, ADHD ） 患儿 HLA-DRB1 基因多 态性的分布特征 ， 了解 ADHD 病例 组 与正常 对照组中 HLA-DRB1 位点等位基因 频率分布上的差异。
    方法 : 采用病例 对照的研究方法 ， 应用 PCR-SSOP 技 术对 54 例 ADHD 病例 组及 66 例正常 对照组儿童进行 HLA-DRB1 等位基因多 态性分析。
    结果 : 在 ADHD 病例 组及对照组中 ， HLA-DRB1 位点共 检出 13 个等位基因 ， 基因 频率分别为 0.92-13.89℅ 及 0.75-18.18℅ ； DR1 及 DR12 在两 组中的分布有统计学上的显著性差异 ， 对照组中 DR12 （ 15.91℅ ） 明 显高于 ADHD 病例 组 （ 4.63℅ ）， RR 为 3.8973 ； DR1 在 AHHD 病例 组为 7.41℅ ， 在 对照组为 0.76℅ ， RR 为 0.0954 。
    结论 : ① 西安地区 ADHD 患儿及正常 对照儿童 HLA-DRB1 为点上等位基因的遗传信息体现了国人的主要特征。具有一定的代表性。 ② DR12 可能 为 ADHD 的保 护基因， DR1 可能 为 ADHD 的易感基因或与易感基因相 连锁。
     
  • P115
    注意缺陷多 动障碍治疗模式的现状及影响治疗模式 - Status of ADHD Treatment Mode and Multiple Factor of Analysis of Impacting the Choice of Treatment Mode
    志 强 赵 1 , 毅 郑 1
    1 首都医科大学附属北京安定医院 , 北京 , Chinese Mainland

    目的 : 探 讨注意缺陷多动障碍（ Attention Deficit Hyperactivity Disorder ， ADHD ）治 疗模式的现状及影响治疗模式选择的相关因素，指导 ADHD 治 疗模式的正确选择。
    方法 : 来源于 2006 年 1 月 19 日 至 2006 年 6 月 1 日 北京安定医院儿科 门诊 ADHD 患者。符合 DSM-IV 诊断标准，男性 33 例，女性 17 例，年 龄 6 ～ 18 岁，自由选取治疗模式。 (1) 依据治 疗模式进行分组：分为西药治疗组和其它组，分别为 26 例和 24 例。 (2) 依据是否已治 疗过分组：分为首次治疗组和已治疗组，分别为 33 例和 17 例。 (3) 依据 ADHD 分型分 组：分为混合型组和注意缺陷为主型组，分别为 42 例和 8 例。采用自然 观察法，多因素调查与相关分析和综合评估治疗模式选择的影响因素。
    结果 : (1) 目前治 疗现状：发现问题时患儿年龄平均为 4.5 岁，最初诊治时年龄为 8.55±3.14 岁，本次就诊时患儿年龄为 10.20±3.33 岁，第一次选择西药治疗的年龄为 10.46±3.15 岁，第一次选择中药治疗的年龄为 8.33±2.73 岁，最初治疗与发现问题时间间隔 3.34±3.25 年；西 药治疗 52% ，中 药治疗 40% ，无治 疗 8% 。
    (2) 影响就 诊时治疗模式选择的因素是患儿年龄和有无信息来源， P 值分别为 0.004 和 0.020 ， OR 值分别为 1.382 和 0.156 。
    (3) 影响首次治 疗患儿的治疗模式选择的因素是患儿年龄和有无信息来源， P 值分别 0.038 和 0.034 ， OR 值分别为 1.322 和 0.131 。
    (4) 影响 ADHD 混合型患儿治 疗模式选择的因素是有无信息来 源和 发现问题人， P 值分别为 0.009 和 0.013 ， OR 值分别为 0.081 和 0.116 。
    结论 :
    (1) 目前 ADHD 治 疗模式的选择不科学。
    (2) 影响 ADHD 治 疗模式选择的因素：患儿年龄和有无信息来源。
    (3) 没有介 绍治疗模式的相关知识，或者讲解不清，导致首次治疗与已治疗过的在治疗模式的选择上没有区别。
    (4) 父母 对 ADHD 亚型的忽视，导致不同亚型间在治疗模式的选择上没有区别
    (5) 加 强科 学的宣 传，正确地指导 ADHD 治 疗模式的选择，是 ADHD 预后的关键因素，对家庭和社会有显著的影响。

    Objective: To approach Status of ADHD treatment mode and multiple factor analysis of impacting the choice of treatment mode, to guild correct choice of treatment mode in patients with ADHD.
    Methods: 50 patients with ADHD were selected and met diagnostic criteria of DSM-IV, which were from outpatient pediatic clinic in Beijing anding hospital ， from 19 Jan in 2006 to 1 Jun in 2006.By applying naturalistic observation method, status of ADHD treatment mode was evaluated and impacting factor about choice of ADHD treatment mode was attained based on multiple factor investigation 、 multiple factor correlation analysis and synthesis evaluation.
    Results:
    (1) Status of ADHD treatment mode ： Western medicine was 52 percent, Chinese medicine was 40 percent and no select treatment mode was 8 percent.
    (2) Factors of impacting the choice of treatment mode were patient's age and if information source, P=0.004 and P=0.020, OR=1.382 and 0.156.
    (3) Impacting factors were patient's age and if information source, P=0.038 and P=0.034, OR=1.322 and 0.131, when patient was treated first time.
    (4) Impacting factors were if information source and person who discovered child's symptoms, P=0.009 and P=0.013, OR=0.081 and 0.116.
    Conclusions:
    (1) At present choice of treatment mode lacked norm.
    (2) Age of patients and if information source were factors that influenced choice of ADHD treatment mode.
    (3) Doctors didn't introduce correlation knowledge about treatment mode, or explain distinctly, so as to have no difference in choice of treatment mode between first time therapy and finished therapy.
    (4) Parents ignored ADHD subtypes so as to have no difference in choice of treatment mode among different subtypes.
    (5) It is critical factor of ADHD rehabilitation that strengthens reasonable propaganda and guide choice of ADHD treatment exactly.
  • P116
    Adolescent Problem Behaviors Predicting DSM-IV Diagnoses of Multiple Substance Use Disorder: Findings of a Prospective Birth Cohort Study
    Mohammad R. Hayatbakhsh 1 , Jake M. Najman 1
    1 The University of Queensland, QADREC, School of Population Health, Brisbane, Australia

    This study investigated prospective associations between adolescent psychopathology and problem behaviors and substance use disorders (SUD) in early adulthood and whether these associations are confounded by other factors. Data were from a prospective study of 2429 Australian young adults from birth to the age of 21 when data on SUD were collected. Adolescent psychopathology and problem behaviors were assessed at 14 years via Youth Self Report on eight sub-scales of emotional and behavioral problems. The risk for any type of SUD in young adults was predicted by somatic, thought, attention, delinquency, and aggression problems. In multivariate analyses, attention problems, delinquency, and aggression were associated with both single and multiple SUD in early adulthood, with delinquent behavior being strongest predictor. The results suggested that substance use prevention programs should target adolescents with early symptoms of psychopathology and problem behavior.
     
  • P117
    轻度认知功能障碍老年人和阿尔茨海默病认知电位标志研 - Study to Cognitive Potentials Impatient with Mild Cognitive Impairment
    路英智 宗文斌　任清涛 白素云 1
    1 山 东省淄博市精神卫生中心 , 淄博 , Chinese Mainland

    目的 ： 探 讨轻度认知功能障碍老年人 (MCI) 和阿 尔茨海默病 （ AD ） 患者的多 项认知电位特点。
    方法 ： 应用美国 Niclet spirit 脑诱发电位仪 ， 对 36 例 MCI 、 30 例 AD 和 45 名正常老年人作了事件相 关电 位 （ P300 ） 、 关联性负变 （ CNV ） 、失匹性 负波 （ MMN ） 和 脑干听觉反应 （ ABR ） 检测。
    结果 ： MCI 和 AD 患者的 P300 、 CNV 、 MMN 和 ABR 均有多 项指标异常。 (P300-P3 波幅： NC 组 3.4±1.3uv,MCI 组 2.0±1.4uv,AD 组 2.1±1.4uv,P<0.01 ； CNN-RT 时间；正常组 358.1±104.0ms,MCI 组 475.9±165.9ms,AD 组 988.9±376.9ms,P<0.01 ； MMN 潜伏期： NC 组 190.9±24.5ms,MCI 组 192.7±23.9ms ； AD 组 206.7±28.9ms,P<0.05.ABR- 波 III 波幅： NC 组 0.36±0.15uv,MCI 组 0.32±0.13uv ； AD 组 0.19±0.07uv,P<0.01) 。与正常人 组比较， AD 患者的 认知电位异常程度较 MCI 患者更 为明显。
    结论： 多 项认知电位检测可以综合反映 MCI 和 AD 患者的 认知功能，有助于 AD 患者的早期 诊断。

    Objective: To investigate the characteristics of multi-congitive potentials of patients with mild cognitive impairment (MCI) and Alzheimers disease.
    Methods: The event related potentials (P300) contigent negative variation(CNV), mismatched negativity(MMN) and auditory brain stem response (ABR) were examined in 2 groups of patients with MCI, AD and normal aged controls by a Nicolet Spirit BEP instrument.
    Results: P300, CNV, MMN and ABR were all found abnormal characteristics in both group of patients with MCI and AD. （ P300—P3 amplitude ：
    NC3.4±1.3uv, MCI2.0±1.4uv, AD2.1±1.4uv, P<0.01.CNN-RT:NC358.1±104. 0ms, MCI475.9±165.9ms, AD998.9±376.9ms, P<0.01;MMN latency:NC 190.9±24.5ms, MCI192.7±23.9ms; AD206.7±28.9ms, P<0.05.ABR-III amplitude: NC0.36±0.15uv, MCI0.32±0.13uv, AD0.19±0.07uv, p<0.01 ） . Compaired with aged controls, AD group showed more severe than those of MCI group.
    Conclusion: Multi-cognitive potentials are of value in assessing the cognitive functions of patients with AD, Therefore can be used for diagnosing the disease ahead of time.
     
  • P118
    印度 乡村痴呆照料的特点 - Profile of Dementia Care in a Rural District of India
    Asis Krishna Acharya 1
    1 calcutta Pavlov Hospital , Psychiatry, Kolkata , India

    . 目的 ： 痴呆有多 种类型。不同的社会，不同的国家，城市和农村处理痴呆的方式各有不同。在农村地区，痴呆病人在家中，医院或老年人之家被照料。研究的目的是评估并建立起最基本的照料系统，统一的共识和指南。
    方法： 在 2003-2005 年之 间， 112 名 Midnapore 医学院医院的病人被 评估。共有 67 女性和 45 名男性。年 龄分布在 52-84 岁，中位数为 68 ，均数 为 72 岁。诊断标准为 ICD-10 ，根据 临床特征和影像学资料来诊断。主要的症状有： 1. 记忆力或判断力受损； 2. 激越和攻 击； 3. 尿便失禁； 4 ， 执行功能受损，如个人照料，行走和处理钱财有困难。
    结果： 阿 尔茨海默病占大多 数（女性中有 48 名，男性中有 36 名），接下来是血管性痴呆，混合性痴呆，少数 脑外伤后痴呆。有一例 AIDS 痴呆，一例路易体痴呆。 92% 的痴呆病人住在家里， 5% 的因 为有攻击或合并躯体疾病住在医院里， 2% 的住在老人之家， 1% 的住在 为精神障碍老人而设的护理院。 80% 的病人由配偶，儿子或媳 妇照料。 10% 的由女儿或女婿照料。 2% 的由 孙辈照料。当问到将来他们如何选择照料者时， 78% 的人希望由配偶照料， 12% 希望由儿子， 4% 希望由女婿， 4% 希望由 孙辈照料， 2% 希望住在医院里。
    结论 ： 应鼓励痴呆在社区中得到照料 ， 那里需要训练和治疗。

    Objectives: Dementia of various categories are found in a community. Their type and management varies from soceity to soceity, from country to country and also from rural to urban communities. In a rural disrict area they are being cared in their own houses, in hospitals and in old aged home.current profile of dementia care in such a remote disrict is evaluated to build a consensus and a guideline that may be universaly minimum in a care delivery system.
    Methods: A total no. of 112 dementia cases detected in midnapore medical college hospital were noted during the period of 2003-05. There were 67 female & 45 males. They were in the age range of 52 to 84years of age with a median age of 68 and mean age of 72 years. They were diagosed as per ICD-10 diagnostiT criteria and were diagnosed mainly on clinical and radio-imaging investigations. There main presnting complaint were 1) lack of memory and judgement, 2)agitation and agression, 3) incontinence of urine and faeces, 4) incapble of exucutive function like personal care,walking,and difficulty in financial handling.
    Results: Among the all diagnosed cases dementia of alzheimer`s type was majority( 48 in female and 36 in male), follwed by vasculer(Va)dementia, mixed vas. and alzheimer`s type, and a few post head injury/trauma dementia. there was one AIDS dementia in amale and a dementia with lewy bodies in a female patient with some features of parkinson`s disease. of all the dementia cases 92% were at home,5% were in hospital for some agression or physical co-morbidity, 2% were kept in old aged home and 1% in a nushing home meant for caring mentally ill patients. 80% were being looked after by their spouse, son &son -in -law in his or her own house.10% were cared by their daughters or in -laws son. 2% were cared by their grand children. when asked about what might be their choice of care in future' 78% wanted to be cared by their spouses, 12% by their son, 4% by their son-in-laws, 4% by their grand children, 2% only opted for a care in hospital or in a govt. home.When asked about future care of them to their care givers 64% opted for a hospital or govt. home,32% opted for a home care as it is, 4% was in favour of terminal care by a hosp.
    Conclusions: Dementia care in cmmunity should be encouraged and training & treatment is needed here.
     
  • P119
    轻度 Alzheimer 病持 续性注意功能的相关性研究 - Correlativity Studies for Ccontinuous Attention Function of Mild Alzheimer Disease
    国 强 田 1
    1 浙江省 绍兴市第七人民医院 , 精神科 , 浙江省 绍兴市 , Chinese Mainland

    目的 ： 了解 轻度 Alzheimer 病患者注意 损害情况及其相关因素。
    方法 ： 对 79 例 轻度 Alzheimer 病患者在入 组时、入组治疗六周后及 100 例正常人 进行了连续操作试验 （ CPT ） 测试 ， 以 MMSE 和 AD 病理行 为评分表 （ BEHAVE-AD ） 评定病情 ， 并对测试结果、病程、病情严重度、年龄等进行回归分析。
    结果 ： Alzheimer 病患者的所有 CPT 指 标均高于正常对照组 ， 入组治疗六周后略有好转 ， 但仍比正常人高 ， 入组时 CPT 结果与病程、精神行为症状有关。
    结论 ： Alzheimer 病人注意 损害广泛而严重 ， 注意损害与病程、精神行为症 状有 关。

    Objective: Know condition ang relevance factor that mild Alzheimer disease patients' at attention function damage.
    Methods: Have been in progress continuous performance test(CPT) for 79 cases Patients When becoming a member of a group, after 6 weeks and 100 cases of contrast group, use MMSE znd BEHAVE-AD estimate that state of illness, and, age etc. carries out regression analysis on to testing result, course of disease, be seriously ill.
    Results: AD patient's all CPT index is without exception higher than regular contrast group, have a bit taking a turn for the better after treat 6 weeks, than regular, person is still high but, CPT result is connected with course of disease and BPSD.
    Conclusion: AD attention function damage is Broad but grave, Be connected with course of disease and BPSD.
    Keywords: Attention function ； Continuous performance test ； CPT ； Alzheimer disease; BPSD
     
  • P120
    老年期精神障行 为障碍患者的睾酮变化 - The Blood Testosterone Level in Senior Behavior Psychological Disorder Patients
    耀祖 胡 1 , 艳 黎 2 , 海 标 叶 2 , 彬 李 2
    1 广 东佛山市第三人民医院 , 老年科 , 佛山市 , Chinese Mainland, 2 佛山市第三人民医院 , 老年科 , 佛山市 , Chinese Mainland

    目的 ： 探 讨老年期精神障行为障碍患者的睾酮 （ T ） 变化。
    方法 ： 设痴呆组与非痴呆组。早上抽取空腹静脉血 ， 使用电化学发光免疫分析仪测定血清 Ｔ 。数据使用 SPSS 10.0 软件分析。
    结果 ： 痴呆 组 男性平均 (4.33±2.51)nmol/L ， 女性 统平均 (0.26±0.48)nmol/L 。非痴呆 组 男性平均 (5.04±4.40) nmol/L ，女性平均 (0.11±0.08) nmol/L 。两 组之间的差异不显著， P ＞ 0.05 。但 组内性别之间有显著性差异， P ＜ 0.001 。阿 尔茨海默病（ AD ）与血管性痴呆（ VD ） 组间差异不显著。
    结论 ： 血清 Ｔ 明 显减少可能是促发老年期精神行为障碍的危险因素之一。

    Objective: To explore the change of testosterone on geriatric mental and behavioral disorder.
    Methods: All patients were divided into two groups: dementia group and control group. The serum testosterone was detected on electrochemistry immune analysis instrument. The data analyze on SPSS for 10.0.
    Results: the scores of the testosterone: 4.33±2.51 for male and 0.26±0.48 for female on dementia group, 5.04±4.40 for male and 0.11±0.08 for female on control group respectively. There have no difference on two groups (p>0.05) ， greatly difference line in one groups (p<0.001). The difference on Alzheimer's disease and vascular dementia is no significantly.
    Conclusion: The decline of serum testosterone may be a risk factor of geriatric mental and behavior disorder.
     
  • P121
    用《 认知伪装甄别测验》探测模拟认知损害 - The Detection of Simulated Cognitive Impairment with the CMST
    灶火 程 1 , 振和 周 1 , 国 桢 袁 1 , 兴 储 1 , 晓琴 周 1
    1 江 苏省无锡市精神卫生中心 , 中国无 锡 , Chinese Mainland

    目的 ： 评价《认知伪装甄别测验》探测模拟认知损害的有效性。
    方法 ： 模 拟组 40 名健康成人在 测验中伪装有认知损害 ， 对照组 40 名健康成人要求尽最大能力完成 测验。
    结果 ： 模 拟组的测验成绩比对照组低 1-2 个 标准差 （ P<0.001 ） 。按四 种评判标准判断，对照组所有被试均被判为真诚，特异性 100% ，而模 拟组的阳性命中率分别为 82.5% （得分模式）、 77.5% （最低分）、 52.5% （划界分）和 37.5% （概率分），加 权敏感性分别为 90.0% 、 87.5% 、 71.25% 和 50% 。判 别分析显示 6 指 标组合或分测验分的归类正确率均为 97.5% 。
    结论 ： 《 认知伪装甄别测验》对模拟伪装具有较好甄别能力。

    The aim of this study was to evaluate effect of Cognitive Malingering Screening Test (CMST) used to detect simulated cognitive impairment. Forty normal adults (Simulative group) tried their maligning best to complete the CMST under directions. Forty normal subjects (Control group) tried their best to complete the CMST under dirctions. Results showed that the average performance of simulative group was 1.0-2.0 standard deviations less than that of control group. According to four judgment standards, all subjects in the control group were classified as honesty, with specificity of 100%, while positive hit rate of the simulative group was 82.5% (performance model), 77.5% (the lowest performance ), 52.5%( cut-off score),and 37.5% (chance level) ， with weighed sensitivity of 90.0%, 87.5%, 71.25% and 50%. Discriminant function analyses using the two scores or six scores derived from the CMST as predictors of group membership resulted in a 97.5% correct classification rate. A drawn conclusion by above results, the CMST continues to show promise as a measure of detecting malingering cognitive impairment.
  • P122
    认知伪装甄别测验在劳动能力鉴定中的应用 - Application of Cognitive Malingering Screening Test in Labor Disability Evaluation
    国 桢 袁 1 , 灶火 程 1 , 建 军 姚 1 , 霞 张 1 , 振和 周 1
    1 江 苏省无锡市精神卫生中心 , 中国无 锡 , Chinese Mainland

    目的 : 考 查《认知伪装甄别测验》对认知伪装的甄别能力。
    方法 : 用《 认知伪装甄别测验》对 123 名接受 劳动能力鉴定的病人、 35 名 脑损害病人和 263 名正常人 进行个别测试。结果 鉴定组的数字迫选分低于对照组 2.6 个 标准差、低于脑损害组 0.8 个 标准差，图符迫选分低于对照组 2.2 个 标准差、低于脑损害组 0.3 个 标准差；按概率分标准，鉴定组有 32 人（ 26.0% ）判 为伪装，按划界分标准，鉴定组有 69 人（ 56.1% ）判 为伪装，按得分模式评判 ， 鉴定组有 41 人（ 33.3% ）判 为伪装；判别分析显示六指标组合对鉴定组与对照组的归类正确率为 91.2% ， 对鉴定组与脑损害组的归类正确率为 68.4% ，其中数字 1-10 和数字 11-20 是两个最敏感的指 标。
    结论 : 《 认知伪装甄别测验》对伪装认知损害有较好的甄别能力。

    Objective: To evaluate effect of Cognitive Malingering Screening Test to detect malingered cognitive impairment.
    Methods: The Cognitive Malingering Screening Test (CNST) was administered 123 adults received disability assessment (Disable group), 35 patients with brain damage (Damage group), and 263 normal adults ( Normal group).
    Results: On the Digital Forced-choice Test, the average performance of disable group was 2.6 or 0.8 standard deviations worse than that of normal group or damage group. On the figure Forced-choice Test, the disable group was 2.2 or 0.3 standard deviations worse than the normal group or damage group. On the base of chance level, there were 32 (26.0%) malingers in the disable group. According to cut-off standard, 69 (56.1%) persons in the disable group were judged as malingers. In the light of performance model, 41 (33.3%) disable adults were recognized as malingers. A discriminant function analysis using six test scores resulted in 91.2% correct classification of the disable group and normal group, and 68.4% correct classification of the disable group and damage group, Digital item1-10 and Digital item11-20 were the most effective indicators.
    Conclusion: The Cognitive Malingering Screening Test is useful instrument in detecting feigned cognitive impairment.
     
  • P123
    心理干 预和情感 - 多感 觉刺激干预方案应用于阿尔采木病的康复 - Psycho-interventions and Emotional Multisensorial Stimulation Protocol Applied to Alzheimer′s Cases Recovery
    Luis Maria Sanchez 1 , Maria Agustina Leites 1 , Liliana Alba Portillo 1 , Gisela Anahi Martinez 1 , Estefania Daiana Ferrari 1 , Teresa Lin Lou 2 , Juan Gomez Salgado 3 , Maria Alejandra Jalife 1 , Silvana Raquel Sastre 1
    1 Neural Net Lab/ Science & Technology Faculty/University of Entre Rios, Psycho-neuro-biology, Concepción del Uruguay, Argentina, 2 Non-Chirurgical interventions-Sediva, Concepcion del Uruguay, Argentina, 3 Mental Health Nursing- Medical Faculty- University of Huelva, Huelva, Spain

    目的 ： 总结将基于社会心理学理论的心理干预方案应用于慢性进行性痴呆 （ 阿尔采木病 ）， 帮助患者康复的临床实践经验。
    方法 ： 这项可操作性的干预方法是根据阿尔采木病的社会心理变化过程制定的。本病通常首先经历心理应对功能的丧失 ， 随后患者的注意力会固定 ， 认为自己即将死亡 ， 进而导致与感觉相关的 “ 再 认机制 ” 障碍 ， “ 再 认机制 ” 与患者日常生活能力、思考能力相 关。以上这些过程就会产生众所周知的行为异常、记忆、认知缺陷。当这种感觉认知体系阻滞过程随着时间的延续持续进展时，会导 致神 经元接受外界刺激被阻滞，进而造成神经元的突触消失。
    与以上病理改 变过程相对应，干预的方案在痴呆的开始阶段就开始了。干预方案首先进行注意力与自尊加强阶段（前期刺激），随后对患者进行大量的视觉、听觉刺激，同时辅助给与嗅觉、味觉的刺激，促使脑部进行 “ 放 电 ” ， 这些脑部 “ 放 电 ” 会使患者在心理上 获得满意感。
    结果： 这个干预方案被应用于 29 例病人， 这其中包括年龄 84 岁的老年女性，该患者在 2002 年被 诊断为 “ 阿 尔采木病 4 期 ” ，有失 语、失认、共济失调、持续的帕金森样的震颤运动、整体感觉系统功能障碍以及括约肌功能障碍。也 包括一例年 龄 49 岁妇女， 2002 年被 诊断为 “ 阿 尔采木病 3 期 ” ，感 觉认知系统有多种功能障碍，但没有失语。
    对于被诊断为阿尔采木病 2 期的患者，我 们的干预方案效果令人满意，但对于大多数处于疾病 3 期、 4 期的病人来 讲，干预只是部分有效。
    结论： 干 预方案的效果还是令人满意的，干预时间从几周到 4 个月不等，但必 须有家庭成员的参与支持以及经济支持。因为我们的国家有 1/3 的人生存在 贫困线以下，我们卫生资源有限，对患者干预的过程需要其家庭成员的帮助。总的来讲 ， 通过干预可以使患者恢复到阿尔采木病之前的社会功能状态。

    Purpose: to report experiences in applying a protocol based on the psychosocial theory of the chronic progressive dementia (alzheimer) to recovery alzheimer′s cases.
    Method: the protocol is the operative counterpart of the psychosocial theory of this dementia, that begin generally associated with painful losses with coping deficit, and a latter fixation of the attention in its own death′s desire, which trigger failures in the recognition mechanism associated to senses, that is essential for all activities of the dairy life and also to think. This produce the well know behaviors abnormalities, including memory and recognition failures. When this sensorial recognition system′s blockade is extended in time cause the stimulation blockade of the evolved neurons, then the loss of synapse an so on. Correspondingly the protocol began with the identification of the painful trigger of the dementia′s process, an attention and auto esteem enhanced step (pre stimulation), followed by a massive stimulation of all those charged in their brains as satisfactory events in an audio and visual presentation with the complementation of olfactory, taste and smell stimuli, and at last a new installation of an extolling dairy labor in its residence.
    Results: the protocol has been applied at present to 29 cases, from a woman of 84 yo. diagnosed as alzheimer phase IV in 2002 with aphasia, agnosia, apraxia, continuos repetitive oscillating and like-parkinson movements, dysfunction of all sensorial recognition system, without sphincters control, to a 49 yo. woman diagnosed as alzheimer phase III in 2002 with diverse dysfunctionalities of sense recognition system, but without aphasia. Up to phase II the alzheimer recovery experiences were complete and satisfactory, but partial in most of the phase III or IV′s cases.
    Conclusion: The developed protocol seems to be widely satisfactory, with results in few weeks to about four months, with a strong family participation and financial support′s dependence, in order to we are working in a country with 1/3 of people under de poverty level. In any case the recovery persons returns to que previous alzheimer state.
     
  • P124
    Alzheimer 病精神行 为症状及其治疗 - Investigation on Psychiatric and Behavioural Symptoms and Treatment in Alzheimer's Disease
    沐 楠 1 , 符 卫仙 1
    1 广州市精神病医院 , 老年精神科 , 广州 , Chinese Mainland

    目 标 ： 探 讨 Alzheimer 病 （ AD ） 患者有治 疗价值的精神行为症状发生情况以及精神药物的使用现状 ， 从老年精神科专业角度积累痴呆伴发的精神行为症状精神药物治疗经验。
    素材和方法 ： 本院老年精神科住院的 AD 病患者 ， 诊断标准参照中国精神障碍分类与诊断标准 （ 第三版 ） 。采用研究者自己设计的调查表 ， 详细收集患者资料。
    结果 ： 共收集 82 例 , 平均年 龄 71.63±11.17 岁 ， 病程 3.76±3.20 年。 MMSE 评分 ： 13.24±6.67 分。 1 、 BPSD 的情况： 82 例患者入院精神 检查 26.8% 有幻 觉。查出 39.0% 有妄想。 查出 65.9% 有情感障碍 ,47.6% 有激越、攻 击行为。 2.4% 自 杀自伤行为。 68.3% 有睡眠障碍。 2 、精神 药物使用的情况：包括抗精神病药、抗抑郁药、情感稳定剂、镇静催眠药物的使用率。 81.40% 患者使用乙 酰胆碱酯酶抑制剂。 3 、 出院 疗效 82 例住院痴呆患者出院 疗效好转 95.12% 。
    结论： 1 、 AD 患者的精神和行 为症状很常见。以睡眠障碍（ 68.8% ）和情感障碍 (65.3%) 最常 见。 2 、老年精神科使用多 种类精神药物种类处理 BPSD ， 临床实践证明有效。 3 、 87.97% 的 AD 住院患者使用促智 药物。

    Objective: To investigate the characteristics of psychiatric and behavioural symptoms in Alzheimer's disease （ AD ） and the usage of psychotropic drugs.

    Methods: We collected the data in detail about psychiatric and behavioural symptoms in dementia (BPSD) and the usage of psychotropic drugs in 82 cases of AD by the scale we designed.
    Results: MMSE score: 13.24±6.671 ,1.BPSD: the rate of occurance of hallucination 、 delusion 、 affective symptoms 、 agitation and aggressive behaviour and sleep disorder. 2.Psychotropic drugs :the rate of usage: Antipsychotic Medications 、 Antidepressant Medication 、 Mood Stabilizers 、 Benzodiazepines and Nonbenzodiazepine Hypnotics and Cognitive Enhancers.
    Conclusions: 1.Psychiatric and behavioural symptoms are common in Alzheimer's disease. Sleep disorder and affective symptoms are the most .2 、 Many kinds of psychotropic drugs were often used to treat BPSD in Department of Geriatric Psychiatry and they are effective.
     

  • P125
    教導弱智母親因應過動兒自傷行為之護理經驗 - Nursing Experience of Instructing Mildly Mentally Handicapped Mother Who Had Hyperactive Child of Self-destructive Behavior
    怡 蔚 高 1
    1 財團法人奇美醫院 , 護理部精神科 , 台南市 , Taiwan , Province of China

    本篇為照護一位注意力不足過動症合併重度智能障礙的個案 ， 處於單親及低社會經濟家庭中 ， 面臨主要照顧者患有輕度智能障礙之護理經驗。因主要照顧者缺乏完善的支持系統、充足的撫育資訊以及正確的學習環境，導致對個案的躁動與自傷行為皆以暴力因應。護理期間為 94 年 5 月 31 日至 94 年 7 月 23 日，筆者依據五大層面護理評估為指引，發現個案有營養 狀況改變：少於身體所需、家庭因應能力失調之健康問題，並透過社交技巧訓練策略來 教導主要照顧者學習過動兒的相關撫育技巧，改善其暴力因應方式並進而發展出親子間的良性互動。經由護理措施介入後 ， 主要照顧者可使用合宜的技巧因應 ， 並主動討論對個案行為改變之察覺 ， 觀察個案自傷行為伴隨主要照顧者合適的因應技巧而有顯著下降趨勢。

    This case was to care for the low income single parent of mild mental retardation who nursed a child of attention deficit hyperactivity disorder complicated with severe mental retardation attention.The main caregiver lacked a good support system, sufficient nurturance information, and accurate learning environments, which led to her violence toward her child of self-injurious and agitated behaviors.The changes in the nutritient status were asserted by the 5 aspects-based nursing assessment from May 31 to July 23, 2005: insufficient supply- and family coping ability dysfunction-caused health problems. Moreover, social skills trainings were offered to guide the nurturance skills which improved the competence in coping with violence toward the child and developed parent-child positive interaction.
     

  • P126
    Brain Volume Changes of Patients with Alzheimer's Disease in Two years: a Case Control Study
    Tao Wang 1 , Wang Tao 1 , Li Xia 1 , Hao Jin 1 , Chen Kemin 1 , Xiao Shifu 1
    1 Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Geriatric Psychiatry, Shanghai, Chinese Mainland

    Objective: To study the brain volume changes of patients with Alzheimer's disease with 3 dimensional MRI in two years.
    Methods: White matter, gray matter, hippocampal, amygdala, entorhinal cortex (EC), perirhinal cortex (PC), cornu temporale, corpus callosum, uncus distance etc. were measured with 3D-MRI. 3D-SPGR-T1 weighted images were acquired with the GE 1.5T EXCITE HD MR Imaging System and the 8NVHEAD_A COIL. The scanning parameters were TE/TR 1.6/7.7, FOV 24.0cm×24.0cm, Thickness 0.5mm, Space 0.7mm, Slad 230mm, Matrix 256×256, NEX 1.00.
    Results: 23 AD and 23 normal controls (NC) were examined with 3D-MRI at the baseline. There were no significant difference of age (71.78±7.88 vs 71.13±7.83, P=0.78) and gender between the two groups. There were significant differences of the total EC VOL (AD vs NC: 2.52±0.86 vs 3.67±0.54, P<0.01), the total PC VOL (AD vs NC: 2.19±0.62 vs 3.39±0.51, P<0.01) and the total hippocampus VOL (AD vs NC: 3.23±0.75 vs 3.98±0.38, P<0.01). Of those finished baseline examination, 21 subjects (10AD and 11NC) completed 2 year follow-up examination. The significant differences of the total EC VOL ((AD vs NC: 1.79±0.56 vs 2.76±0.50,P<0.01), the total PC VOL ((AD vs NC: 1.77±0.59 vs 2.76±0.41,P<0.01) and the total hippocampus VOL ((AD vs NC: 2.80±0.80 vs 3.59±0.38,P<0.01) still remained. The most salient shrinkage was observed in hippocampus. The standardized annually VOL shrinkage rate was 11% for AD and 5% for NC, and there was significant difference between two groups.
    Conclusion: The present study confirmed that the AD patients has obviously brain atrophy compared to normal controls. The shrinkage rate of hippocampus can be used as marker for diagnosis and progress of Alzheimer's disease.
    Key words: Alzheimer's disease, 3D-MRI, Brain Volume
     

  • P127
    Using Cerebrospinal Fluid Beta-amyloid (1-42), Total-tau and Phospho-tau to Diagnose Alzheimers Disease and Vascular Dementia
    Haibo Xue 1 , Xiao Shifu 1 , Sun Yun 1 , Zhang Mingyuan 1
    1 Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Geriatric Psychiatry, Shanghai, Chinese Mainland

    Objective: to use cerebrospinal fluid levels of beta-amyloid (1-42), total-tau and phospho-tau to diagnose Alzheimers disease.

    Methods: Cerebral spinal fluid levels of beta-amyloid (1-42) (A β 1-42), total-tau (Tau) and phospho-tau (Ptau) of patients with, Alzheimer's disease (AD) and Vascular Dementia (VaD) and normal controls were measured with ELISA method. Statistical analysis includes description, one-way ANOVA, Least Significant Difference (LSD), and Receiver Operating Characteristic (ROC) curve.
    Results: 30 AD, 10 VaD and 10 normal subjects were recruited in the study. The CSF level of A β 1-42 in AD group （ 542.96±237.5ng/L ） was lower than VaD group (682.5±129.12ng/L, P=0.083) and significantly lower than normal controls (744.2±211.15ng/L,P=0.014). The CSF level of Total tau in AD group (295.26±189.73ng/L) was significantly higher than normal controls (79.8±13.75ng/L, P=0.001) and VaD group (172.2±116.36, P=0.038). The CSF level of P-tau in AD group (45.22±22.59ng/L) was significantly higher than normal group (23.91±7.4ng/L, P=0.004) and higher than VaD group (31.02±16.29ng/L, P=0.051). The sensitivity and specificity by using A β 1-42, T-tau and P-tau to diagnose AD were ranged 60%~96.7% and 70%~100%. When the tests were combined to differentiate AD and VaD, the sensitivity and specificity of the tests could reach 86.6% and 90% respectively.
    Conclusion: Cerebrospinal fluid beta-amyloid (1-42), Total tau and phospho-tau are useful biomarkers for Alzheimer's disease, and can be used to differentiate AD and VaD.
    Key words: Alzheimer's disease, cerebrospinal fluid, beta-amyloid (1-42), phospho-tau

  • P128
    阿 尔茨海默病、血管性痴呆 与 轻微认知功能损害血脂浓度检测 - Blood Lipid Concentrations Detection of Alzheimer′s Disease, Vascular Dementia and Mild Cognitive Impairment
    牟尼 唐 1 , 崔 马 1 , 老年痴呆
    1 广州市精神病医院 , 广州市 , Chinese Mainland

    目的 ： 检测阿尔茨海默病 （ AD ） 、血管性痴呆 （ VD ） 与 轻微认知功能损害 (MCI) 的血脂 浓度 ， 探索其与认知功能损害的关系。
    方法 ： 痴呆、 MCI 患者和正常老人来源于广州市城 乡社区及养老院老年期痴呆流行病学调查。痴呆诊断采用 DSM- Ⅳ 的 标准 ， AD 、 VD 诊断分别采用 NINCDS/ADRDA 和 NINDS/AIREN 的 标准。
    结果 ： AD164 人 ,VD58 人 , 可疑痴呆 79 人 , 正常 对照 232 人。 AD 轻度 51 例、中度 51 例、重度 62 例 ， VD 轻度 22 例、中度 15 例、重度 21 例。血 浆胆固醇浓度（ mmol/L ）： AD （ 5.11±1.34 ）、 VD （ 5.19±1.47 ）、 MCI （ 5.63±1.12 ）、正常 组（ 5.60±1.37 ）；血 浆甘油三脂浓度（ mmol/L ）： AD （ 1.72±1.13 ）、 VD （ 2.00±1.22 ）、 MCI （ 1.98±1.39 ）、正常 组（ 2.23±1.52 ） , 差异均有 显著性（ P<0.01 ）。不同程度 AD 患者的胆固醇和甘油三脂 浓度（ mmol/L ）： 轻度痴呆（ 5.65±1.35 ）、（ 2.28±1.59 ），中度（ 4.86±1.41 ）、（ 1.42±0.64 ），重度（ 4.86±1.15 ）、（ 1.52±0.79 ），差异均有 显著性（ P<0.01 ）。不同程度 VD 患者的胆固醇和甘油三脂 浓度的差异无显著性（ P>0.05 ）。
    结论： AD 患者血 浆胆固醇和甘油三脂浓度较 VD 、 MCI 及正常 组低，中重度 AD 患者血 浆胆固醇和甘油三脂浓度较轻度者低 。

    Objective: Detecting lipid concentration of AD, VD with MCI and exploring their correlation with cognitive dysfunction.
    Methods: Subjects were recruited from dementia epidemiological investigation in Guangzhou . Dementia diagnosis was based upon DSM-IV criteria, AD and VD were diagnosed according to NINCDS/ADRDA or NINDS/AIREN criteria.
    Results: 164 AD, 58 VD, 79 suspected dementia, and 232 normal control were included in the study. Plasma cholesterol concentration and triglyceride concentration in four groups were significantly different (P<0.01), in AD group lower than others. Significantly difference was found as cholesterol and triglyceride concentrations of AD patients with varying degree (P<0.01), in moderate or severe ones lower than in mild ones.
    Conclusion: Plasma cholesterol and triglyceride concentrations of AD were lower than VD, MCI and normal elderly, which of moderate to severe AD patients were lower than mild ones.
     
  • P129
    阿 尔茨海默病人 脑体积变化的 2 年随 访对照研究 - Follow-up Research on Brain Volume in Alzheimers Disease Patients
    涛 王 1 , 霞 李 1 , 晶 郝 2 , 克敏 陈 2 , 世富 肖 1
    1 上海交通大学医学院附属上海精神 卫生中心 , 老年科 , 上海 , Chinese Mainland, 2 上海交通大学医学院附属瑞金医院 , 影像科 , 上海 , Chinese Mainland

    目的 ： 研究阿 尔茨海默病 （ Alzheimer's Disease ， AD ） 人 脑体积变化的特征。
    素材和方法 ： 依据 DSM- Ⅳ 阿 尔茨海默病 诊断标准确定 AD 以及正常 对照老人。应用 3D-MRI 测量白质、灰质、海马、杏仁体 、内嗅皮 质、旁嗅皮质、颞角、胼胝体、钩间距等指标。 3D-SPGR-T1 加 权成像应用 GE 1.5T EXCITE HD MR 成像系 统和 8NVHEAD_A 线圈。扫描参数为 TE/TR 1.6/7.7 ， FOV 24.0cm×24.0cm ， Thickness 0.5mm ， Space 0.7mm ， Slad 230mm ， Matrix 256×256 ， NEX 1.00 。在 GE 后 处理工作站上对 3D-MRI 资料进行后处理和统计及标准化。
    结果： 基 线共入组 23 例 AD ，其中男 9 例，女 14 例； 23 例正常 对照老人，其中男 11 例，女 12 例。两 组平均年龄分别为 71.78±7.88 和 71.13±7.83 （ P=0.78 ），性 别无显著差异。两组比较后提示在内嗅皮质总体积 (2.52±0.86 和 3.67±0.54 ， P<0.01) 、旁嗅皮 质总体积 (2.19±0.62 和 3.39±0.51 ， P<0.01) 和海 马总体积 (3.23±0.75 和 3.98±0.38 ， P<0.01) 等指 标上有显著差异。 2 年后完成 3D-MRI 随 访的有 10 例 AD ，其中男 3 例，女 7 例； 11 例正常 对照者，其中男 5 例，女 6 例。两 组平均年龄分别为 72.30±10.56 和 69.00±8.19 （ P=0.43 ），性 别无显著差异。两组比较后提示在内嗅皮质总体积 (1.79±0.56 和 2.76±0.50,P<0.01) 、旁嗅皮 质总体积 (1.77±0.59 和 2.76±0.41,P<0.01) 和海 马总体积 (2.80±0.80 和 3.59±0.38,P<0.01) 等指 标上仍有明显差异。海马体积年萎缩率在两组之间有显著差异，正常对照组为 5.69% ，而阿 尔茨海默病人 组达 10.53% 。
    结论： 内嗅皮 质、旁嗅皮质和海马等与记忆、智能密切相关的部位，阿尔茨海默病人的萎缩较正常对照显著。海马的年萎缩率可以作为诊断阿尔茨海默病 或者 评价其进展的可靠指标。
    关键词 : 阿 尔茨海默病 3D-MRI 脑体积
     
  • P130
    氟西汀 对老年性脑卒中后抑郁及神经功能缺损康复的临床研究 - Clinical Study of Fluoxetine on Neurological Functional Impairment and Post-Stroke Depression in Old Patients
    BoQuan Yang 1 , Juefang Zhao 1
    1 The Taizhou Central Hospital, Taizhou, Chinese Mainland

    Objective: To evaluate the clinical effect of fluoxetine on neurological functional impairment and post-stroke depression (PSD) in old patients.
    Method: Eighty old patients with stroke were randomly divided into therapy group (40 cases) and control group (40 cases). Control group received psychotherapy after stroke management, while therapy group had been treated with fluoxetine 20 mg/d for 2 、 4 、 8 weeks in addition to above treatment.All cases were assessed with HAMD and clinical neural function-defect assessment set (SSS) before and after treatment.
    Results: The incidence of PSD was 41%.HAM