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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  • P264
    老年期与非老年期焦 虑症临床对照研究 - Clinical Control Study on Anxiety Disorder between Gerontic and Non-gerontic Patients
    欢 高 1 , Ying Wen Liu 2 , 春平 廖 1 , Biological Psychiatry
    1 深圳市康宁医院 , 深圳市 , Chinese Mainland, 2 Shenzhen Kangning Hospital, Shenzhen City, Chinese Mainland

    目的 ： 探 讨老年期焦虑症的临床特征及疾病相关因素。
    方法 ： 对符合 CCND-3 诊断标准的焦虑症患者 79 例 ， 其中 39 例首 发年龄 ≥60 岁为老年期组 ， 40 例首 发年龄 ＜ 60 岁为非老年组。对两组一般临床资料进行对照分析，并在入院时及治疗后第 2 、 4 、 6 周 评定 HAMA 及 HAMD 量表，比 较两组疗效。结果： 79 例中老年 组共 39 例，其中男 14 例，女 25 例；年 龄范围 60-78 岁。非老年组共 40 例，其中男 15 例，女 25 例；年 龄范围 17-50 岁。首次发作例数、病前性格与家族史、起病诱因比较 P ﹥ 0.05 。老年 组伴有躯体疾病者明显高于非老年组，两者比较 P ﹤ 0.01 。老年 组焦虑激越，自杀意念，疑病的出现率明显高于非老年组，两者比较 P ﹤ 0.01 。而心境焦 虑，运动性不安，肌肉紧张及植物神经症状等方面两者比较 P ﹥ 0.05 。治 疗前 HAMA 总分两者比较 P ﹤ 0.01 ， 说明老年组的焦虑症状较重。治疗前 HAMD 总分老年组明显高于非老年组，两者比较 P ﹤ 0.01 。 说明老年期焦虑症伴有抑郁症状较重。治疗第 2 、 4 、 6 周 HAMD 总分老年组 明 显高于非老年组。而 HAMD 减分率两 组比较 P ﹥ 0.05 ， 说明两组治疗抑郁症状均较有效。老年组主要以百优解、赛洛特、瑞美隆、怡诺思、喜普妙治疗，共有 13 例（ 33.3 ％）起始 剂量为推荐剂量的一半；而非老年组为 4 例（ 10 ％）。两者比 较 P ﹤ 0.05 。而最 终治疗剂量两组差别不大，一般均要达到常规治疗剂量。
    结论： 老年 组在焦虑激越，自杀意念，疑病的出现率明显高于非老年组。老年组治疗前 HAMA 总分较高，与非老年组比较 P ﹤ 0.01 。因此要充分重 视老年焦虑症患者的焦虑症状，在药物的选择方面要注意其特殊性，并且在治疗初期要合并 一些 较快起效的抗焦虑药。而 HAMA 减分率两 组比较 P ﹥ 0.05 ， 说明两者对抗焦虑治疗均有效。老年组与非老年组在治疗前 HAMD 总分比较 P ﹤ 0.05 ，治 疗后第 2 周、第 4 周、第 6 周比 较亦有显著性差异， HAMD 减分率与此一致。治 疗 6 周后 总有效率老年组为 61.5 ％，非老年 组为 85.0 ％。两者比 较 P ﹤ 0.05 。 这表明老年期焦虑症的治疗效果较非老年期焦虑症要差，且起效较慢。这符合老年焦虑可能趋向慢性病程，治疗效果差的观点。老年组抗焦虑药的初始剂量较非老年组低，但最终治疗剂量与非老年组相差不大，均达到了常规治疗剂量。由于老年 人通常伴有躯体疾病及老年人的生理改 变，以及对药物的耐受性问题使老年焦虑症的治疗问题变得较复杂。所以建议治疗老年期焦虑症从最低有效剂量开始用药。用药需小心谨慎，缓慢加药，但最终需用常规剂量。另外，本研究中治疗老年期焦虑症的药物均为新型抗抑郁、焦虑药，与传统抗焦虑药相比，其不良反应少，更易耐受。
     
  • P265
    弓形虫抗体阳性和 阴性的精神分裂症患者临床症状比较 - Comparison of the Clinical Symptoms between Antitoxoplasma-Seropositive and Seronegative Patients with Schizophrenia
    惠玲 王 1 , 晓萍 王 2
    1 武 汉大学人民医院 , 精神 卫生中心 , 武 汉 , Chinese Mainland, 2 武 汉大学人民医院 , 武 汉 , Chinese Mainland

    目的： 弓形虫 隐性感染被认为是精神分裂症的候选病因之一。本研究在以前研究的基础上，进一步分析精神分裂症患者精神症状与弓形虫抗体水平之间的关系，以深入了解弓形虫感染与精神分裂症这一重性精神疾病的关系。
    方法： 以 酶 联免疫吸附法检测 600 例精神分裂症患者血清弓形虫 IgG 抗体水平 , 比 较抗体阳性组和阴性组患者阳性与阴性症状量表（ PANSS ） 评定结果。
    结果： 600 例精神分裂症患者中弓形虫 IgG 抗体阳性的 82 人，占 13.7% 。弓形虫抗体阳性与 阴性的患者在年龄、受教育程度、性别构成、居住地区及精神障碍家族史、病程等方面的差异均无显著性意义。但弓形虫抗体阳性的精神分裂症患者阳性分量表分和兴奋、夸大、敌对性、刻板思维、紧张、装相和作态、不寻常的思维内容、注意障碍、意志障碍、冲动控制缺乏等条目上的得分高于抗体阴性组患者；而前者阴性分量表分和情绪退缩、被动 / 淡漠社交退 缩、 交 谈缺乏自发性和流畅性、先占观念、主动回避社交等条目上的得分低于后者； Logistic 回 归分析，兴奋、敌对性、刻板思维、不寻常思维内容、注意障碍等五个条目与弓形虫 IgG 抗体阳性有 关。
    结论： 弓形虫感染可能影响精神分裂症的部分症状，有弓形虫感染的精神分裂症患者 倾向于兴奋紊乱、荒谬和认知症状。由于样本例数有限，上述结果还需要进一步研究验证。今后还有必要观察精神分裂症患者治疗过程中精神症状的变化、弓形虫抗体水平的动态变化及其相互关系 ， 以探索弓形虫感染与精神分裂症之间的病因学联系及可能的机制。

    Objective: To investigate the relationship between Toxoplasma infection and schizophrenia by comparing and analyzing the clinical symptoms between the antitoxoplasma-seropositive and seronegative patients with schizophrenia.
    Methods: Six hundred cases of first-episode schizophrenia were examined the serum reactivity to IgG antitoxoplasma antibody by Enzyme Linked Immunosorbent Assay (ELISA). And the clinical symptoms of the patients were scored by use of the Positive and Negative Syndrome Scale (PANSS).
    Results: Compared to IgG-seronegative schizophrenia, IgG-seropositive schizophrenia group was higher in the positive subscale score, the score of the following items including excitement, grandiosity, hostility, stereotyped thinking, tension, mannerism and posturing, unusual thought content, poor attention, disturbance of volition, poor impulse control; and was lower in the negative subscale score and the score of emotional withdrawal, passive/apathetic social withdrawal, lack of spontaneity and flow of conversation, preoccupation and active social avoidance. Logistic regression analysis revealed that the items of excitement, hostility, stereotyped thinking, unusual thought content and poor attention are correlated with IgG seropositivity.
    Conclusion: Toxoplasma infection may be related with some of the symptoms of schizophrenia. Further prospective study is necessary to verify the findings.
    Key words: Schizophrenia Toxoplasmosis Antibody Clinical Symptoms
     
  • P266
    酪氨酸 羟化酶基因微卫星多态性与精神分裂症患者伴发糖代谢异常的关联分析 - Association Analysis between Tyrosine Hydroxylase Gene Microsatellite Polymorphism and Schizophrenic with Abnormal Glucose Metabolism
    松 陈 1 , 高 华 王 2
    1 武 汉大学人民医院 , 精神 卫生中心 , 武 汉 , Chinese Mainland, 2 武 汉大学人民医院 , 武 汉 , Chinese Mainland

    目的 ： 精神分裂症患者中糖尿病的 发病率显著高于普通人群 ， 研究显示精神分裂症患者及其一级亲属均对 2 型糖尿病易感 ， 提示精神分裂症和糖尿病之 间可能有共同的遗传因素参与 ， 有一部分精神分裂症患者身上可能存在糖尿病的易感基因。本研究试图在具有特殊遗传背景的精神分裂症患者中，探讨酪氨酸羟化酶基因第一内含子 TCAT 微 卫星多态性（ HUMTH01 ）与 该人群发生糖代谢异常的相关性。
    方法： 以口服葡萄糖耐量 试验的结果将精神分裂症患者分为糖代谢异常组和糖代谢正常组，两组患者在年龄、性别、病程、体重指数、腰臀比、吸烟史、服用的药物上予以配对，共 33 对。检测空腹血糖（ FPG ）、空腹血清胰 岛素（ FIns ）、 总胆固醇（ TC ）、甘油三 酯（ TG ）、高密度脂蛋白胆固醇（ HDL-C ）、低密度脂蛋白胆固醇（ LDL-C ）、胰 岛素抵抗指数（ IRI ）和胰 岛素敏感指数（ ISI ）。采用聚合 酶 链反应和 12% 非 变性聚丙烯酰胺凝胶电泳对所有患者进行 HUMTH01 基因型分型。
    结果： （ 1 ） 测得 5 种等位基因和 11 种基因型。（ 2 ）病例 组 TC 、 TG 、 LDL-C 、 FPG 、 FIns 、 IRI 高于 对照组，而 ISI 低于 对照组。（ 3 ）两 组之间等位基因和基因型分布的差异无统计学意义（ P ＞ 0.05 ），但将 TH9 等位基因 视为暴露因素，其它等位基因均被视为非暴露因素，发现病例组 TH9 等位基因的 频率 明 显高于对照组，差异具有显著性（ 27.3 ％ VS12.1 ％， X2 ＝ 4.790 ， P ＜ 0.05 ， OR ＝ 2.719 ， 95 ％ CI ＝ 1.087 ～ 6.798 ）。（ 4 ）病例 组携带有 TH9 等位基因者 FIns 、 IRI 高于未携 带者， ISI 低于未携 带者（均 P<0.05 ）。 对照组中无论是否携带 TH9 等位基因，各 项指标的差异均无显著性（ P ＞ 0.05 ）。
    结论： HUMTH01 多 态性中 TCAT 重 复 9 次（ TH9 ）可能与精神分裂症患者 发生胰岛素抵抗相关，从而可能与该群体罹患 2 型糖尿病有 关。本研究有可能为精神分裂症的个体化治疗提供理论依据 ， 预防 糖尿病高危患者在抗精神病 药物治疗过程中出现 2 型糖尿病或原有的糖尿病加重。

    Objective: To explore the relationship between a tetranucleotide polymorphic microsatellite localised in the first intron of the tyrosine hydroxylase gene (HUMTH01) and schizophrenic with abnormal glucose metabolism.
    Method: Using 1:1 matched case-control study, 33 paires of patients were included. Fasting glucose (FPG) 、 fasting insulin (FIns) 、 serum lipids 、 insulin resistance index (IRI) and insulin sensitivity index (ISI) in the abnormal glucose metabolism group (case group) and the normal glucose metabolism group (control group) were analyzed. Genotyping of HUMTH01 was undertaken with polymerase chain reaction (PCR) and 12% native polyacrylamide gel electrophoresis.
    Results: (1) TC 、 TG 、 LDL-C 、 FPG 、 FIns and IRI levels were remarkably higher in the case group than that in the control group; ISI, contrariwise, was lower in the case group (P<0.05). (2) The frequency of allele TH9 was higher in the case group than that in the control group (27.3 ％ VS12.1 ％， X2 ＝ 4.790 ， P ＜ 0.05 ， OR ＝ 2.719). (3) In the case group subjects carrying allele TH9,as compared to those not, had higher FIns and IRI and lower ISI levels (P<0.05).
    Conclusion: 9 repetitions of the core motif TCAT of The HUMTH01 microsatellite is associated with insulin resistance in schizophrenic, thus it may be related to type 2 diabetes in patients with schizophrenia.
     
  • P267
    利培 酮对女性精神分裂症患者血清催乳素和雌二醇的影响 - Effect of Risperidone on Plasma Level of Prolactin and Estradiol of Female Patients with Schizophrenia
    晓萍 王 1 , 红丽 李 1
    1 武 汉大学人民医院 , 武 汉 , Chinese Mainland

    目的 ： 探 讨利培酮对女性精神分裂症患者血清催乳素 (PRL) 和雌二醇 (E2) 的影响及相 关因素分析。
    方法 ： 研究 对象为住院的女性精神分裂症或分裂样精神病患者。采用自身对照研究 ， 于治疗前和治疗 4 周后早晨 7 点空腹抽血 ， 采用全自 动化学发光免疫分析系统测定 PRL 和 E2 的 浓度 ， 并同时评定阳性和阴性症状量表 （ PANSS ） 、 临床总体印象评价量表 （ CGI ） 判断患者的精神症状。 观察时间为 4 周。
    结果： （ 1 ）利培 酮治疗 4 周后，患者的 PANSS 量表 总分、阳性症状分量表、阴性症状分量表和一般精神病理分量表得 分均下降（ p<0.01 ），有效率达 90.63% 、 显效率 68.76% 。（ 2 ）治 疗后，所有入组患者的血清 PRL 均明 显升高（ 0.28-16.88 倍）。（ 3 ）患者的年 龄、病程和血清 PRL 的升高 值呈显著正相关（ p<0.01 ）；有生育史患者的血清 PRL 的升高 值显著高于无生育史的患者（ p<0.01 ）。（ 4 ）治 疗后 E2 的 浓度呈双向变化，有的升高，有的下降。治疗前基础 E2 浓度低的患者，治疗后 E2 的 浓度升高；而治疗前基础 E2 浓度高的患者，治疗后 E2 的 浓度反而下降。（ 5 ）治 疗前后 E2 的 变化值和 PRL 的 变化值没有相关性（ p>0.05 ）。
    结论： （ 1 ）利培 酮对女性精神分裂症患者的治疗是有效的。（ 2 ）利培 酮治疗 4 周后，患者的血清 PRL 均明 显升高，但升高程度的差异性较大。（ 3 ）年 龄大、病程长、有生育史的患者服用利培酮后 PRL 的升高程度更明 显。（ 4 ）利培 酮治疗后，女性患者的 E2 的 变化不能单用 PRL 的升高来解 释。

    Objective ： To investigate the effect of Risperidone on Plasma Level of Prolactin and estradiol of female patients with schizophrenia or schizophreniform disorder.
    Methods: 31 cases met the CCMD-3 criteria for schizophrenia were treated with Risperidone respectively for 4 weeks ． The serum PRL and E2 were measured before and after treatment. The PANSS 、 TESS and related lab tests were evaluated to access the treatment effectiveness and side effects ．
    Results: Age and course of disease are significantly direct correlation with the change of Prolactin. Patients who have children is easier to occur the advance of Prolactin. And the change of E2 is bidirection after treatment.
    Conclusion: Age 、 course of disease and childbearing history are correlation with the change of Prolactin. And, the change of E2 could not be explain with the advance of Prolactin.
    Key words: Risperidone; female patients with schizophrenia; Prolactin; estradiol
     
  • P268
    氯氮平和利培酮对大鼠脂肪细胞 GLUT4 的影响 - Effects of Clozaping and Risperidone on Glucose Transporter 4 in Periph Tissue in Rats
    惠玲 王 1 , 晓津 徐 1
    1 武 汉大学人民医院 , 武 汉 , Chinese Mainland

    目的 : 了解 氯氮平和利培酮对大鼠血糖 （ FPG ） 、血 浆胰岛素 （ FINS ） 、胰 岛素敏感指数 (ISI) 以及脂肪 细胞上葡萄糖转运蛋白 （ GLUT ） 4 表达的影响 ， 探 寻非典型性抗精神病药物影响大鼠糖代谢的机制。
    方法 : 18 只雄性 SD 大鼠随机均分成 氯氮平组、利培酮组和空白对照组 ， 分别将氯氮平片按 20mg.kg-1.d-1 、利培 酮片按 2mg.kg-1.d-1 的 剂量溶于蒸馏水中给大鼠灌胃 ， 空白对照组直接蒸馏水灌胃 ， 共 28 天。在第 1 、 14 、 28 天分 别剪尾采血，测 FPG 、 FINS ， 计算 ISI ，在第 28 天 处死大鼠后分离副睾脂肪垫，经超速冷冻离心后获得脂肪细胞内外膜，用 Western-blot 法分 别测大鼠脂肪细胞内外膜上 GLUT4 的含量。
    结果 : 适 应性喂养后，各组大鼠的 FPG 、 FINS 、 ISI 水平均接近（ P>0.05 ）。持 续灌胃 14 天后， 氯氮平组大鼠的 FPG 水平高于空白 对照组（ P<0.05 ）； 氯氮平组大鼠的 ISI 水平低于空白 对照组，差异有显著性（ P<0.05 ）。灌胃 28 天 时，氯氮平组的 FPG 、 FINS 均高于空白 对照组差异有显著性（ P<0.05 ）， ISI 水平低于 对照组且差异有显著性（ P<0.05 ） , 利培 酮组与空白对照组相比差异无显著性。各组大鼠脂肪细胞内外膜上的葡萄糖转运蛋白的量均较空白对照组下降 ，但差异不明 显。
    结论 : 短期服用 氯氮平即影响外周组织细胞对葡萄糖的吸收和利用，但胰岛素的分泌功能未受影响。长期服用氯氮平的大鼠体内产生胰岛素抵抗，外周组织 GLUT4 的表达降低， 氯氮平可能既影响胰岛素的分泌功能又同时减少了外周组织对葡萄糖的吸收利用从而影响了糖代谢的正常进行。利培酮对血糖和血浆胰岛素的影响无论短期或是长期都没有氯氮平明显 ， 提示利培酮的作用可能与之不同。

    Objective: To compare the different effect of clozapine and risperidone on FPG 、 FINS 、 ISI and glucose transporter 4(GLUT4) in adipose tissue in rats.
    Methods: There are 18 SD rats in 3 groups, the rat of clozapine group was intragastric administrated 20mg/kg/d, the rat of risperidone group was intragastric administrated 2mg/kg/d, the blank group were intragastric administrated with liquor natrii chloridi isotonicus over 28 days. To detect the glucose 、 insulin and ISI of rat on day1, day14, day28. To detect the GLUT4 in adipose cell with western-blot.
    Results: On day 14, the glucose level in clozapine group were higher than that in blank group (p<0.05), the ISI level in clozapine group was litter lower than that in risperidone group (p>0.05). On day 28, the glucose level and insulin level in clozapine group were higher than that in blank group (p<0.05), the ISI level in clozapine group was lower than that in blank group (p<0.05). The GLUT4 in adipose cell in clozapine group and risperidone group were lower than that in blank group.
    Conclusions: Clozapine inhibits GLUT4 of rat, but risperidone does not do,which shows that different atypical antipsychotic drugs may disturb glucose metabolism by different paths.
    Key words: atypical antipsychotic ; insulin resistance ; glucose transporter 4 ; clozapine ; risperidone
  • P269
    COMT 基因多 态性与伴发暴力行为分裂症的关联分析 - Association Study of COMT Gene Polymorphism and Schizophrenia with Aggressive Behaviours
    Wen-ying Liu 1 , Yun-fei Zhou 1 , Huai-an Wu 1 , Huan Gao 1
    1 Shenzhen Kangning Hospital , Shenzhen, Chinese Mainland

    目的 ： 探 讨儿茶酚胺甲基转移酶 （ COMT ） 基因多 态性与有无伴发暴力行为的分 裂症之 间的关系。
    方法 ： 采用暴力行 为量表 (OAS) 的 4 个分量表 总分相加得出总量表分。用聚合酶链反应 （ PCR ） 和限制性片断 长度多态性 （ RFLP ） 技 术 ， 检测 109 例伴 发暴力行为分裂症和 64 例未伴 发暴力行为分裂症患者 COMT 基因型 ， 并分 别比较伴发暴力行为分裂症和未伴发暴力行为分裂症组之间的 COMT 基因多 态性差异。结果：符合中国精神障碍分类与诊断标准第三版（ CCMD-3 ）和美国精神病学会精神障碍 诊断与统计手册第四版（ DSM-IV ）精神分裂症 诊断标准。共 173 例，分 为无伴发暴力行为组 (OAS=0) 和伴 发暴力行为组 (OAS>0) ：其中无伴 发暴力行为分裂症组共 109 例，男 61 例 , 女 48 例；平均年 龄（ 27.62±7.45 ） 岁 , 平均文化程度（ 8.96±2.53 ）年，病程（ 5.21±4.32 ）年。伴 发暴力行为分裂症组共 64 例，男 43 例 , 女 21 例 ; 平均年 龄（ 26.69±8.93 ） 岁 , 平均文化程度（ 9.21±2.41 ）年，病程（ 4.89±2.85 ）年。两 组一般资料无显著性差异。伴发暴力行为分裂症和无伴发暴力行为分裂症的观察值和期望值吻合度良好，均符合 Hardy-weinberg 遗传平衡法则（ P>0.05 ）。将 109 例伴 发暴力行为分裂 症和 64 例无伴 发暴力行为分裂症经卡方检验发现，两组的 COMT 基因型和等位基因 频率的总体分布无显著性差异。将 7 例 A/A 基因型 组、 74 例 A/G 基因型 组和 92 例 G/G 基因型分裂症 组的暴力行为症状分经方差分析发现，三组分裂症组暴力量表中言语攻击行为分、对物品的攻击行为分、对自身躯体的攻击行为分、对他人的攻击行为分和暴力量表总分无显著性差异。
    结论： 伴 发暴力行为分裂症和未伴发暴力行为分裂症组之间的 COMT 基因 频率分布无显著性差异。不同 COMT 基因型 强迫症的言 语攻击行为分、对物品的攻击行为分、对自身躯体的攻击行为分、对 他人的攻 击行为分和攻击行为总分无显著性差异；推测有无伴发暴力行为分裂症与 COMT 基因多 态性无关联。

    Objective: To explore the relationship between COMT gene polymorphism and schizophrenia with or without aggressive behaviours.
    Method: 109 schizophrenia with aggressive behaviours and 64 schizophrenia without aggressive behaviours were recruited into the study. The gene polymorphism of COMT in all subjects was genotyped directly with polymerase chain reaction (PCR) and restriction fragment Length polymorphism (RFLP) technique, and to compare the differences of COMT polymorphism between schizophrenia with and without aggressive behaviours.
    Results: The patients met diagnosis standards in ICD-10 and diagnostic & statistical manual-IV (DSM-IV) for schizophrenia. The 173 cases of grouped schizophrenics were divided into schizophrenia with and without aggressive behaviours groups:In the 109 schizophrenia without aggressive behaviours group averagely aged （ 27.62±7.45 ） yrs, there were 61 males and 48 females. In the 64 schizophrenia with aggressive behaviours group averagely aged （ 26.69±8.93 ） yrs, there were 43 males and 41 females. Between the general data of the two groups （ P>0.05 ） . Goodness of fit between observed and expected values of genes of COMT were good in schizophrenia with and without aggressive behaviours groups, and the value contribution was consistent with Hardy-Weinberg principle （ P>0.05 ） . In the chi-square criterion, there were significant differences in the distribution of COMT genotypic and Alleles frequency between schizophrenia with aggressive behaviours group (109 cases) and schizophrenia without aggressive behaviours group (64 cases). There were no significant differences among A/A 、 A/G and G/G genetype schizophrenia in the following items: verbal aggression, aggression towards properties, self-aggression, and physical aggression towards people and OAS total scores.
    Conclusion: There were no significant differences in the distribution of COMT genotypic and Alleles frequency between schizophrenia with and without aggressive behaviours group.Genetype schizophrenia in the following items: verbal aggression, aggression towards properties, self-aggression, and physical aggression towards people and OAS total scores （ P>0.05 ） . There may were no significant association in COMT gene polymorphism between schizophrenia with and without aggressive behaviours.
     
  • P270
    精神分裂症高 发家系 13q 的 连锁分析 - A Linkage Analysis of Pedigree with High Incidence of Schizophrenia on 13q
    罗 炯 1 , 董 芳 1 , 胡 正茂 2 , 姜 涛 1 , 聂 长杰 1 , 黄 青 1 , 凌 四海 1 , 夏 昆 2 , 王 传跃 1
    1 首都医科大学附属北京安定医院 , 北京 , Chinese Mainland, 2 中南大学医学 遗传学国家重点实验室 , 长沙 , Chinese Mainland

    目的 ： 采用精神分裂症高 发家系 ， 通过部分基因组扫描和连锁分析 ， 在中国人群中验证精神分裂症易感基因是否与 13q 连锁。
    方法 ： 收集精神分裂症高 发家系 4 个 ， 对家系正常成员使用遗传学研究家属会谈表 （ Family Interview for Genetic Study, FIGS ） 访谈筛查 ， 对家属提供的有明确精神疾病史者和筛查出的可疑精神分裂症患者 ， 使用遗传学研究诊断检查手册 （ Diagnostic and Interview for Genetics Study, DIGS ） 访谈诊断。采集家系成员外周血，提取 DNA 。在 13q14-13q33 选取 Perkin-Elmer 公司 试剂盒（ ABI PRISMTM linkage mapping set version 2 ）中的 7 个微 卫星标记（ D13S263 、 D13S156 、 D13S170 、 D13S265 、 D13S159 、 D13S158 、 D13S173 ）。 对这些位点进行多重 PCR 扩增。扩增产物在 ABI 3100 测序仪上进行毛细管电泳，采用 3100 Date Collection 软件自动收集电泳图象并转换为数字信号文件 ， GeneScan Analysis 3.0 软件进行分子量内标校正和扩增片段大小分析。采用 Genotyper 3.7 软件进行各位点上各样本基因分型。采用 Designer 软件检验亲子关系，生成连锁分析所用的 X.pre 和 X.par 文件。采用 GENEHUNTER2.1 软件进行单点和多点的参数、非参数连锁分析，其中参数连锁分析假设不同的遗传模式分别计算。连锁分析的阈值采用 Lander 等 1995 年提出的 验证性连锁阈值，参数连锁分析 LOD 值大于 1.0 ，或非参数 连锁分析 LOD 值（ NPL 值）大于 1.2 为阳性结果。
    结果： 单 点非参数 连锁分析发现，连续 5 个位点（位于 13q22.1-13q33.1 ） 结果为阳性， D13S156 、 D13S170 、 D13S265 、 D13S159 、 D13S158 位点 NPL 值分别为 1.40 、 2.25 、 2.06 、 1.71 和 1.39 。多点非参数 连锁分析得到约 50cM 的阳性区域。 单点参数连锁分析， D13S156 显性遗传模式下 LOD 值为 1.02 ； D13S265 显性遗传模式下 LOD 值为 1.27 ， 隐性遗传模式下 LOD 值为 1.64 。多点参数 连锁分析，假设隐性遗传模式，得到 10cM 余的阳性区域。
    结论： 13q22.1-13q33.1 可能存在精神分裂症的易感基因， 该区域值得扩大家系数目及精细扫描进一步研究。

    Objective: To explore the genetic susceptibility loci on 13q of schizophrenia based on genome scan and linkage study in Chinese pedigrees.
    Methods: 4 multiplex schizophrenia pedigrees were collected. Interview and diagnosis were done at homes of patients with DIGS （ Diagnostic and Interview for Genetics Study ） . Blood samples were collected from families and genomic DNA was extracted.7 microsatellite markers in ABI PRISMTM linkage mapping set version 2 on 13q14-13q33 were evaluated, including D13S263, D13S156, D13S170, D13S265, D13S159, D13S158 and D13S173. Linkage analyses were carried out by GENEHUNTER 2.1 software. We set parametric LOD scores of 1.0, or NPL scores of 1.2 as the thresholds linkage, which was recommended by Lander in 1995.
    Results: The results of single point-point nonparametric linkage analyses are positive at 5 consecutive locus. The NPL score are 1.40, 2.25, 2.06, 1.71 and 1.39 at D13S156, D13S170, D13S265, D13S159, and D13S158 respectively. A 50cM positive region was observed by multipoint nonparametric linkage analyses. Single-point LOD of 1.02 and 1.27 were observed at D13S156 and D13S265 with parametric linkage analyses under the dominant model, and single-point LOD of 1.64 were observed at D13S165 under the recessive model. A 10cM positive region was observed by multipoint parametric linkage analyses under the recessive model.
    Conclusions: The evidence for linkage of schizophrenia to 13q14-13q33 is worth pursuing, using more samples. It is hoped that detailed mapping studies might help to narrow the range of potential location in this region in the search for candidate genes for schizophrenia.
     
  • P271
    An Association Study of the Polymorphism of Cytosolic PLA2 Family Genes and Schizophrenia with Ligase Detection Reaction
    Yaqin Yu 1 , Qiong Yu 1
    1 Jilin University, Epidemiology and Statistics, Changchun, Chinese Mainland

    Objective: To investigate a genetic association between the polymophism of cytosolic phospholipase A2(cPLA2) family genes and schizophrenia by detecting SNPs of cPLA2 family genes with the bioinformatics and the molecular genetics.
    Methods: A total of 201 family trios of Chinese Han descent, consisting of fathers, mothers, and affected offspring with schizophrenia, were recruited for the genetic analysis. 10 SNPs were chosen on cPLA2 family genes including PLA2G4A 、 PLA2G4C 、 PLA2G4D 、 PLA2G4E 、 PLA2G4F and PLA2R1. SNPs were genotyped using PCR-based LDR analysis.
    Results: The goodness of fit test showed that genotype frequency distributions of all subjects were not deviated from the H-W equilibrium. TDT analysis showed that the probability of the two different alleles from heterozygous parents didn't deviated from 50% at these 10 SNPs (P>0.05). The analysis for clinical subgroups showed that rs156631, rs2307279, rs2162886, rs891014, rs1668589, rs3828323 and rs3749117 were associated with schizophrenia. Analysis for haplotype transmission showed that the rs2162886-rs981014 haplotype systems did not associated with schizophrenia (P>0.05). The COA test and COG test showed a disease association for the rs2162886-rs1668589, rs891014-rs1668589 and rs2307279-rs7542180 combinations. Seven SNPs, including rs2307279 、 rs1356410 、 rs2162886 、 rs891014 、 rs1668589 、 rs3749117 and rs3828323, were associated with some positive symptoms of schizophrenia. The rs2162886 and rs891014 were associated with Character before illness of schizophrenia.
    Conclusions: Many loci in the cPLA2 family genes were associated with schizophrenic.
     
  • P272
    Association Analysis between a Functional Polymorphism of CYP2E1 Gene and Alcohol Use Disorders in a Tibetan Population
    万 军 郭 1 , Gongga Lanzi 2 , Ouzhu Luobu 3
    1 四川大学 , 华西医院精神科 , 成都 , Chinese Mainland, 2 Medical School, University of Tibet, Medical School, 拉 萨 , Chinese Mainland, 3 Medical School, University of Tibet, 拉 萨 , Chinese Mainland

    Background: A number of studies shown that the possible association between the functional *C1/*C2 polymorphism in the 5'-flanking region of cytochrome P450 2E1 (CYP2E1) gene and drinking behavior though the results are inconsistent. In this study, we performed a case-control study in order to investigate the relationship between the CYP2E1*c1/c2* polymorphism and alcohol use disorders, and the potential influence of the CYP2E1*c1/*c2 polymorphism on the severity and dimensions of alcohol use disorders in this population.
    Methods: 340 Tibetan farmers with Alcohol Use Disorders Identification Test (AUDIT) score ≥10 and 315 matched control subjects with AUDIT score ≤5 were enrolled in this study. The CYP2E1*C1/*C2 polymorphism were determined by using PCR-RFLP method.
    Results: The frequency of the CYP2E1*c2 allele was significant higher in subjects with alcohol use disorders (16.2%) than controls (10.8%), with the P value of 0.005 and OR of 1.60 (95% CI: 1.15-2.21). There was also significant difference in genotype frequencies between two groups (x2=8.75, P=0.01). Compared to control group, subjects with alcohol use disorders have higher frequencies of genotypes with at least one copy of allele c2 (28.5% v.s 18.7%; x2=8.65, P=0.003; OR=1.73). We also found that the association of CYP2E1*c2 allele with higher risk of alcohol use disorders was much stronger in males than in females with OR of 2.30. The involvement of CYP2E1*c2 allele with the increased alcohol consumption was observed in males with alcohol use disorders only.
    Discussion: The present study confirmed that the positive association between CYP2E1*c2 allele and alcohol use disorders, and the amount of alcohol consumption in the Tibetan population, especially in males. Further study are warranted to explore the interaction among genes involve with ethanol metabolism (e.g. ADH genes and ALDH genes), and to identify other susceptibility genes which may responsible for addiction behaviors.
    Key words: Alcohol use disorders; CYP2E1 gene; Association; Tibetan
    This work was supported by a grant from the Department of Science and Technology , Sichuan , China .
     
  • P273
    5 － HT 受体基因与中国精神分裂症患者利培 酮治疗反应的关联分析 - No Association between Response of Risperidone Treatment and 5-HT6 Receptor Gene Variants in Chinese Schizophrenia Patients
    Shunying Yu 1 , Huafang Li 1 , Zhiguang Lin 1 , Jicheng Jiang 1 , Yiren Weng 1 , Ye Zhang 1 , Dongxiang Wang 1 , Yiping Qian 1 , Niufan Gu 1
    1 Shanghai Mental Health Center, Shanghai, Chinese Mainland

    目的 ： 利培 酮是目前广泛应用的一种 非典型抗精神病 药物 ， 它对 5 － HT6 受体有高 亲和性。有关 5 － HT6 受体基因多 态与非典型抗精神病药物的治疗反应的关联研究的结果不尽一致。本研究旨在中国汉族精神分裂症患者中探讨 5 － HT6 受体基因多 态与利培酮治疗反应之间的关系。
    方法： 从上海市精神 卫生中心住院病人中入组了 379 例精神分裂症患者，包括了 204 例男性患者和 175 例女性患者，平均年 龄为 39.51 +-13.75 岁。所有入组患者符合 DSM-IV 精神分裂症 诊断标准，并且治疗前的 CGI － S 评分大于等于 4 。所有患者 给予利培酮 2 － 6mg ，在治 疗 8 周后，使用 CGI － I 评估临床疗效， CGI–I score >/3 被 认为是利培酮治疗有效者， CGI–I score <3 被 认为是利培酮治疗无效者。所有患者取外周血提取 DNA ，通 过 Taqman SNP Genotyping Assays (ABI) 对从 Hapmap Website 中的 CHB （中国人）数据中挑 选的两个 tagSNP(rs4912138 and rs3790756 ) 进行基因分型。
    结果： 过 8 周的利培 酮治疗， 204 例患者属于利培 酮治疗有效者， 175 例患者属于利培 酮治疗无效者。利培酮治疗有效者组和无效者组两组在年龄性别方 面无差异。 rs4912138 和 rs3790756 的基因型分布在两 组中符合 Hardy-Weinberg 平衡 规律。不论是 rs4912138 和 rs3790756 的基因型 还是等位基因，利培酮治疗有效组和无效者组之间均无显著性差异。由于 rs4912138 和 rs3790756 处于一个 LD block （ D'= 0.963 ）中，我 们进行了单体型分析，三个单体型被发现，但在两组间亦无显著性差异。
    结论 ： 我 们的研究结果不支持在中国汉族精神分裂症中 HTR6 基因的 变异与利培酮治疗反应有关。

    Objectives: Risperidone is a widely used atypical antipsychotic agent and have high affinities for 5-HT6 receptor. The association between the polymorphism in 5-HT6 receptor gene and response to atypical antipsychotics have yielded conflicting findings. This study aims to examine the relationship between tagSNPs of 5-HT6 receptor gene and the response of risperidone treatment in Chinese Han patients with schizophrenia.
    Methods: Three hundred seventy-nine patients including 204 male and 175 female (mean age 39.51 +/-13.75 years) were recruited from the Shanghai Mental Health Center inwards. All patients met DSM-IV criteria for schizophrenia, and had Clinical Global Impression-Severity of illness (CGI-S) score >/4 at baseline. Patients were treated with 2–6 mg of risperidone, and after 8 weeks treatment, the clinical response were assessed by Clinical Global Impressions–improvement I (CGI–I) scale. CGI–I score >/3 was considered as responder, and CGI–I score <3 as non-responder. DNA was extracted from peripheral blood lymphocytes. Two tagSNPs (rs4912138 and rs3790756 ) were selected from CHB(Chinese Han Beijing) database in HAPMAP website, and genotyped by Taqman SNP Genotyping Assays (ABI) on ABI 7900 in all patients.
    Results: after eight weeks treatment, 204 patients responded to risperidone, while 175 patients did not. There were no differences between the responder group and non-responder group as regards gender and age. Genotypes of the markers did not deviate from Hardy-Weinberg equilibrium in either the responder or non-responder group. No significant difference in both allele and genotype of rs4912138 and rs3790756 was observed in responder and non-responder group. As the two SNPs are in a LD block (D'= 0.963), haploytpe analysis was performed, and three haploytpe was found, but no significant difference was found between two groups.
    Conclusion: our results did not support that the genetic variation of the HTR6 gene play a role in response to risperidone treatment at least in Chinese patients with schizophrenia.
  • P274

    Abstract withdrawn


  • P275
    Homeostatic Modulation of Brain Activity after Alprazolam Challenge in Resting Human
    Haihong Liu 1 , Yihui Hao 1 , Xuan Ouyang 1 , Zhening Liu 1 , Tianzi Jiang 2 , Lin Xu 3
    1 Institute of Mental Health, Second Xiangya Hospital, Central South University, Changsha, Chinese Mainland, 2 National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, Chinese Mainland, 3 Laboratory of Learning and Memory, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Chinese Mainland

    Objective: Functional MRI studies demonstrated a default mode of brain function (Shulman, et al., 1997), and suggested that the human brain is intrinsically organized into dynamic, anticorrelated functional networks (Fox, et al., 2005). The brain neural activity may be homeostatically modulated by pharmacological challenge in resting human.
    Method and materials: Nine healthy, right-handed adults (aged 21-34; 4 men, 5 women) were underwent two resting state (motionless with eyes closed) functional MRI scans before and after administration of 0.8 mg tablets of alprazolam 90 minutes later. Functional images were acquired on a 1.5T GE MRI scanner (Liu et al., 2006) and preprocessed by using SPM2 in normative steps (Jiang et al., 2004). Individual map was analyzed by using Regional homogeneity (ReHo) approach (Zang et al., 2004), and the sum of whole brain ReHO value for each individual was calculated. Group difference was measured by paired t test performed on individual ReHo maps in a voxel-by-voxel manner.
    Results: The sum of whole brain ReHo value shows no significant difference between these two groups (p=0.724), but decreased and increased ReHo were showed in distributed areas after alprazolam administration (p<0.05). Brain regions with decreased ReHo include bilateral posterior cingulate and left anterior gyrus. Brain regions with increased ReHo include bilateral cuneus, middle occipital, parahippocampal, postcentral gyrus and paracentral lobule, and left middle temporal, precentral gyrus, superior and inferior parietal lobe, and right medial frontal gyrus and anterior lobe of cerebellum.
    Discussion: 1. Although the whole brain activity was maintaining its homeostasis, decreased and increased regional neural activities were showed after alprazolam administration; the increased activity is distributed more extensive than the decreased. 2. Decreased ReHo in cingulated cortex may be related to the anxiolytic effect of alprazolam. Increased ReHo in distributed areas suggested that alprazolam might increase the temporal synchrony of BOLD signal within brain regions. 3. Effect of alprazolam on muscular movement of blood vessels may confound the results.
     

  • P276
    伴有 执行功能障碍的精神分裂症患者双重任务工作记忆前额叶激活模式 - The Activation Model of the Prefrontal Cortex in Schizophrenia Accompanied by Dysexecutive Syndromes during the Double Working Memory Tasks: A fMRI Study
    大 兴 吴 1 , 长连 谭 2 , 莉蓉 颜 3 , 德文 胡 3 , 湘 王 1 , 树桥 姚 1
    1 中南大学湘雅二医院医学心理研究中心 , 长沙 , Chinese Mainland, 2 中南大学湘雅二医院放射科 , 长沙 , Chinese Mainland, 3 国防科技大学机 电工程与自动化学院 , 长沙 , Chinese Mainland

    目的 : 探 讨伴 有 执行功能障碍的精神分裂症患者执行双重工作记忆时大脑前额叶激活特征。
    方法 : 用功能磁共振成像技 术观察 11 例伴有 执行功能障碍的精神分裂症患者和 13 名正常人 , 威斯康星卡片分 类测验评估额叶执行功能。
    结果 : 精神分裂症 组 WCST 成 绩、工作记忆反应时明显比正常组差 . 精神分裂症患者激活明 显有双侧前额叶背外侧区和右侧腹外侧等 ， 比正常组范围大。精神分裂症组减正常组，差异的激活区有左右前额背外侧区、腹外侧区、额内侧回，左右岛叶 ( 额盖 ) 、右眶 额回等区域，以右额叶为主。正常组减精神分裂症组只有左背外侧区有差异。
    结论 : 伴有 执行功能障碍的精神分裂症患者前额皮质区在双重任务工作记忆中激活异常。

    Objective: Aimed to investigate the different pattern of prefrontal cortex (PFC) activities in the phonological and spatial double working memory(WM) tasks between schizophrenia (Sch) inpatients accompanied by dysexecutive syndromes and normal healthy subjects.
    Methods: Functional magnetic resonance imaging (fMRI) was performed on 11 Sch accompanied by dysexecutive syndromes and 13 normal groups. The subjects were asked to conduct the double WM task visually presented on the screen. Function of PFC was assessed by Wisconsin Card Sorting Test(WCST).
    Results: The reaction time had delayed and WCST result had lowed when patients were being taken the double WM and WCST task than normal group.There were significant activition in bilateral DLPFC and the ventrolateral prefrontal cortex (VLPFC) when patients were taken double tasks, which were broader than normal subjects. When compared control with SCH in double tasks, there were significant activition only in left DLPFC, but also when compared SCH with control, there were broader significantly activition in bilateral DLPFC, VLPFC, medial frontal gyrus (MFG), insula and right orbito-prefrontal cortex (OPFC), right prefrontal cortex is dominantly activated.
    Conclusion: These findings suggested that prefrontal cortex of Sch patients accompanied by dysexecutive syndromes had some functional activation deficits.
    This research was supported by NSFC(30100054, 30570609).
     

  • P277
    缺陷型及非缺陷型精神分裂症 执行功能障碍的 fMRI 初 步 研究 - Evidence for Abnormal Executive Function in Deficit and Nondeficit Schizophrenia - A Preliminary fMRI Study
    湘 王 1 , 长连 谭 2 , 莉蓉 颜 3 , 亚军 李 2 , 卫军 司徒 2 , 大 兴 吴 1 , 德文 胡 3 , 树桥 姚 1
    1 中南大学湘雅二医院 , 医学心理学研究中心 , 长沙 , Chinese Mainland, 2 中南大学湘雅二医院 , 放射科 , 长沙 , Chinese Mainland, 3 国防科技大学 , 机 电工程与自动化学院 , 长沙 , Chinese Mainland

    Objective: To compare the differences in brain activity patterns in deficit and nondeficit schizophrenia under parametric increasing WM load, and investigate the executive function impairment and mechanism in deficit and nondeficit schizophrenia.
    Methods: 6 schizophrenic patients with deficit syndrome, matched nondeficit schizophrenic patients and healthy comparison subjects were studied in a parametric fMRI design of N-back task. One-way ANOVA was used to examine the WM-load-dependent changes of activity in brain regions (executive function related area).
    Results: The results showed significant WM load-depended increases left prefrontal and posterior parietal cortex in controls. In patients with schizophrenia, there was less activity voxels in prefrontal cortex, but more significant activity in subcerebral structures. The nondeficit patients showed more obvious activity in dorsolateral prefrontal regions (DLPFC) and right prefrontal cortex than normal subjects. However, the deficit patients showed significant hypofrontality with less active areas and weaker activity in prefrontal lobe.
    Conclusion: We conclude that schizophrenia have significant prefrontal lobe dysfunction and abnormal executive function. Moreover, there were differences between deficit and nondeficit patients in their activity patterns of prefrontal lobe and underlying neural mechanism. Deficit schizophrenia may have characteristic impairment of prefrontal lobe, whereas nondeficit schizophrenia showed relatively hyperfrontality and neurophysiological inefficiency.
    Key words: deficit schizophrenia, nondeficit schizophrenia, fMRI, n-back test
     

  • P278
    Initial Analysis of the Dysfunction of the Facial Emotion Discrimination in Male Patients with Schizophrenia
    Yu Chen 1 , Zhijian Yao 1 , Shiping Xie 1
    1 Nanjing Brain Hospital of Nanjing Medical University, Department of Psychiatry, Nanjing, Chinese Mainland

    Objective: To explore the characteristic of the dysfunction of the facial emotion discrimination in male patients with schizophrenia and the relationship between the dysfunction and the symptom severity.
    Method: Chinese Facial Expression Video System(CFEVS) and Positive and Negative Syndrome Scale(PANSS) were applied to test the dysfunction of facial emotion discrimination and the symptom severity of 42 male schizophrenic inpatients and 37 normal controls which were matched in age and education level.
    Results: The male patients with schizophrenia performed worse than normal controls in response time and accuracy rate, especially in neutral emotional faces; and the accuracy rate was correlated with the severity of positive symptoms.
    Conclusion: Male patients with schizophrenia have deficits in the discrimination of emotional facial expressions which were non-progressive and were correlated with positive symptoms
     

  • P279
    男性重性抑郁症患者 识别动态面部表情情绪偏向性的 fMRI 研究 - The fMRI Study in Male Patients with Depression in Emotional Deviation to Recognize the Living Facial Expression
    燕翔 曹 1 , 志 剑 姚 2 , 世平 谢 1 , 皋 军 滕 3
    1 南京医科大学附属 脑科医院 , 精神科 , 南京 , Chinese Mainland, 2 南京医科大学附属 脑科医院 ， 精神科 ； 东南大学临床医学院 , 南京 , Chinese Mainland, 3 东南大学临床医学院 , 南京 , Chinese Mainland

    目的 ： Beck （ 1976 ） 提出抑郁症患者存在 负性认知模式 ， 但这种负性认知产生的神经基础尚不明确。面部表情识别是了解情绪加工的重要手段之一，可有效地探讨抑郁症负性认知的加工特点及神经基础。既往相关研究多采用静态面部表情，而动态面部表情明确识别的神经基础尚需进一步探讨；亦有研究指出，男性和女性情绪识别的神经基础存在差异。故本研究旨在利用事件相关设计的功能核磁共振 成像技 术探讨男性抑郁症患者明确识别动态面部表情的相关脑区，进而探讨抑郁症情绪加工的特点及其神经基础。
    方法： 按入 组标准筛选 12 例符合 CCMD-3 及 DSM-IV 抑郁症 诊断标准的重性男性患者及与之年龄和受教育程度相匹配的 12 例男性正常 对照。以中国面部表情视频系统中的动态喜悦、悲伤及中性表情片段作为情绪刺激，利用 1.5T 功能核磁共振成像系 统检测受试者识别不同动态面部表情时的脑部反应。功能 MRI 原始 图像数据经转化格式， SPM 进行时间、空间标准化，校正头动并映射到标准脑；在全脑平均化后进行配对 t 检验统计分析，设定 p<0.001 。激活范 围阈值设定为 10 个像素。将所 获得具有显著性差异脑区的 MNI 坐 标转换为 Talairach 坐 标，获得兴趣脑区激活图。结果：（ 1 ） 组内比较：与识别喜悦相比，抑郁症患者组识别悲伤表情激活右边缘叶（海马回、钩回）（ BA34 ）、左海 马回（ BA19 ）、右前扣 带回（ BA32 ）、右 侧体神经膝、右中央后回（ BA3 ）、右中央前回（ BA4 ）、右 额中回（ BA6 ）、右丘 脑、左丘脑、右楔前叶（ BA31 ）、左 钩回（ BA28 ），而正常 对照组则激活左中央前回（ BA6 ）、右壳核。（ 2 ） 组间比较：与正常对照相比，抑郁症患者明确识别喜悦情感（识别喜悦表情－识别中性表情）时活动增加的脑区有右枕中回（ BA37 ）、左 额中回（ BA6 ）、左 顶下回（ BA40 ）、左中央前回（ BA6 ）、左中央后回（ BA2 ）而活 动降低的脑区有左颞上回（ BA38 ）、左 颞中回（ BA21 ）、右 额下回（ BA10 ）。明确 识别悲伤情感（识别悲伤表情－识别中性表情）时活动增加的脑区包括右额中回（ BA6 ）、左扣 带回（ BA31 ），右梭状回（ BA20 ）、右中央后回（ BA2 ）。但正常 对照较抑郁症患者在悲伤情绪的识别中未发现显著激活脑区。
    结论： 抑郁症患者明确 识别动态面部表情的神经基础与正 常 对照存在差异，表现为需要更多脑区参与情绪刺激的识别，尤其在悲伤情绪识别中，情绪相关脑区活动增加明显。
     

  • P280
    Diffusion tensor imaging and magnetic resonance imaging of corpus callosum in first-episode schizophrenia
    Hui Yi Hao 1 , Zhening Liu 1 , Haihong Liu 1 , Lihua Tan 1 , Fan Kang 1 , Lin Xu 1
    1 Institute of Mental Health, Second Xiangya Hospital, Central South University, Psychiatry, Changsha, Chinese Mainland

    Objective: Structural magnetic resonance imaging and diffusion tensor imaging studies demonstrate that both morphology and anisotropy of corpus callosum are abnormal in schizophrenia. In this study, we integated these two techniques to observe whether both abnormalities are concurrent in the corpus callosum and whether these anomalies are crosscorrelation in five subregions of the corpus callosum in first-episode schizophrenics (FES), which maybe clarify whether the number or coherence of anxonal fibres are abnormal.

    Methods: We scanned twenty FESs (12 men, 8 women) and sixteen normal controls (8 men, 8 women) with high-resolution 3D magnetization prepared rapid gradient echo images and diffusion-weighted images. After being preprocessed such as segment, normalization, and smoothing by spm2, the area values were measured in normalized 3D images. Fractional anisotropy (FA) and apparent diffusivity coefficient (ADC) images were established by calculating the diffusion-weighted images according to the formula which Basser et al had developed and FA and ADC values of the five subregions of the CC of each participant were also obtained. Furtherly, we made correlation analysis on the area, FA and ADC values between patients and normal controls.
    Results: There were no significant differences in FA and ADC of all five subregions in the CC between patients and controls. The significant difference for groups was found in the isthmus, with the results that the schizophrenics had a smaller isthmus size than the normal controls. Whereas the others subregions showed no significant differences. And no correlation between area and FA and ADC were observed in each subregion.
    Conclusion: The reduction of area in isthmus of the CC may suggest that a reduction of fibers crossing this region in schizophrenia. Size abnormality rather than diffusion anisotropy change may suggest the number instead of coherence of axonal fibres or the degree of mylination was the abnormal factor in FESs.
     
  • P281
    A Resting State Functional Magnetic Resonance Imaging Study of Major Depression
    Li Wang 1 , Zhi-jian Yao 2 , Gao-jun Teng 3
    1 Nanjing Brain Hospital of Nanjing Medical University, Department of Psychiatry, Nanjing, Chinese Mainland, 2 Nanjing Brain Hospital of Nanjing Medical University, Department of Psychiatry, Clinical Medical College of Southeast University, Nanjing, Chinese Mainland, 3 Clinical Medical College of Southeast University, Nanjing, Chinese Mainland

    Objective: To explore the brain dysfunction of major depression disorders （ MDDs ） in resting state.
    Methods: 27 MDDs patients and 27 controls matched with age and educational level and gender experienced fMRI scanning in resting state. Imaging data were acquired using a 1.5 T GE system at Nanjing Brain Hospital , and were preprocessed using SPM5 、 AFNI 、 SPM99. Regional homogeneity （ ReHo ） approach was used. Paried t-test was performed by SPM2(statistical parametric mapping).
    Results: Compared to the controls, MDDs patients showed increased ReHo regions in the bilateral middle frontal gyrus （ -27, -12, 45/27, 33, 23; 11/17 voxels; BA6/BA9 ） , right inferior frontal gyrus （ 39, 38, 4; 95 voxels; BA46 ） , right superior temporal gyrus （ 50, 13, -28; 11 voxels; BA38 ） , left anterior cingulate （ -21, 30, 18; 22 voxels; BA32 ） , right posterior cingulate gyrus （ 24, -30, 37; 25 voxels; BA31 ） , right insula （ 36, -2, 17; 54 voxels; BA13 ） , left lentiform （ -21, 1, 17; 29 voxels ） , right lentiform （ 24, 0, 17; 54 voxels ） , bilateral claustrum （ -30, -2, 11/30, 12, 16; 29/54 voxels ） , left caudate （ -9, 23, -4; 14 voxels ） . The controls didn't show significantly higher ReHo regions than depressed group.
    Conclusion: Increased ReHo regions of depressed group confirmed that MDDs had the abnormality of default mode network. ReHo approach may be a potentially useful method in exploring the pathophysiology of MDDs.
     
  • P282
    男性精神分裂症患者情 绪识别障碍与执行功能障碍关系的初步研究 - The Preliminary Study of Emotion Identity Disorder and Executive Functional Disorder in Male Schizophrenic Patients
    Yu Chen 1 , Zhijian Yao 1 , Yanxiang Cao 1 , Jinglun Du 2 , Qibao Chen 2 , Shiping Xie 2
    1 南京医科大学附属 脑科医院 , 精神科 , 南京 , Chinese Mainland, 2 南京医科大学附属 脑科医院 , 南京 , Chinese Mainland

    目的 ： 近年来有研究 发现精神分裂症患者存在情绪识别障碍 ， 主要表现为情绪面孔识别障碍。神经影像学研究表明额叶参与情绪的加工过程，额叶损伤患者会出现对面孔情绪的辨别障碍。精神分裂症患者执行功能与情绪加工认知过程是否存在联系国内尚无相关报道。本研究拟从行为学水平探讨男性精神分裂症患者情绪识别功能与执行功能之间的关系，进而为情绪－认知关系的深入研究提供线索。
    方法： 选择 41 例精神分裂症男性住院患者以及年 龄、受教育年限与之相匹配的 33 例正常 对照，采用中国面部表情视频系统（ CFEVS ）作 为刺激实验材料比较两组面部表情识别功能，采用威斯康星卡片分类测验、 Stroop 字色干 扰测验、言语流畅性测验进行执行功能评定。使用 SPSS13.0 软件包进行统计分析。
    结果： ①男性精神分裂症患者情 绪面孔识别测试及执行功能测试结果均比正常组差，两者均与病程无关； ② 识别中性情绪（咀嚼、无表情面孔）正确数与 WCST 完成第一分 类所需应答数、 Stroop 彩色文字 阅读（ C ）和彩色文字 颜色阅读（ CW ） 时间呈负相关；识别喜悦、悲伤情绪正确数和总正确数与 Stroop(C) 和 (CW) 时间呈负相关，与 Stroop(C) 和 (CW) 正确数以及言 语流畅性总分呈正相关； ③ 识别表情总反应时间与言语流畅性测验总分呈负相关。
    结论： 本研究采用本土化的 动态视频刺激材料，在男性精神分裂症患者研究中发现存在明确的面部表情识别功能障碍，与国内外相关研究结论一致。其特征为以识别中性表情障碍为主，与执行功能障碍均发生在疾病早期，两者严重程度呈平行关系； Stroop 测验及言语流畅性测验可作为精神分裂症情绪识别障碍的生态学标记。本研究为精神分裂症的病理心理学机制提供行为 学研究依据。
  • P283
    The Abnormal Brain Activity in First Episode Depression by Resting fMRI
    Daihui Peng 1 , Kaida Jiang 1 , Yiru Fang 1 , Xiangyu Long 2 , Yufeng Zang 3
    1 Shanghai Mental Health Center, Shanghai, Chinese Mainland, 2 Beijing Normal University, Beijing, Chinese Mainland, 3 Beijing Normal University, Beijng, Chinese Mainland

    Object: To explore the differences of regional brain activity in resting state in depressed vs healthy participants in this research, using functional magnetic resonance imaging (fMRI).
    Methods: Sixteen participants diagnosed with major depressive disorder (ICD-10) and 16 controls were scanned during resting state. To detect spontaneous hemodynamic responses across the whole brain, by using a novel method based on regional homogeneity (ReHo). And to analyze the relationship between ReHo and HAMD in depression group by pearson analysis.
    Results: Depressed patients exhibited significantly lower KCC than controls in the left thalamus, uvulae, super temporal and the lobe cortex （ P<0.005 ） . The HAMD scores was not significantly correlated with the KCC in these areas (p>0.05). In depression group, the ReHo of left thalamus was related to sleep factor and weight factor, the values of relation were 0.56 and 0.58 （ P<0.05 ） . The ReHo of left super lateral temporal was related to the factor of bias mood processing, and the value was 0.04 （ P<0.05 ） . And the ReHo of left super wall temporal was related to the factors of anxiety and bias mood processing, the values were all 0.04 （ P<0.05 ） .
    Conclusions: The results indicated abnormal activity may exit in a resting state of depression in the left thalamus, uvulae, super temporal and the lobe cortex. The ReHo may be potentially a reference in understanding the distinct brain activity in resting state of depression.
    Key words: depression, first episode; fMRI; resting state; ReHo
     
  • P284
    Neural Substrates for Explicit Recognition of Dynamic Facial Expressions in Male Major Depressed Patients by fMRI
    Yan-xiang Cao 1 , Zhi-jian Yao 2 , Shi-ping Xie 1 , Gao-jun Teng 3
    1 Affiliated Nanjing Brain Hospital of Nanjing Medical University, Department of Psychiatry, Nanjing, Chinese Mainland, 2 Affiliated Nanjing Brain Hospital of Nanjing Medical University, Department of Psychiatry, Clinical Medical College of Southeast University, Nanjing, Chinese Mainland, 3 Clinical Medical College of Southeast University, Nanjing, Chinese Mainland

    Objective: To explore neural correlates for the explicit recognition of dynamic facial expression in male major depressed patients using event-related functional magnetic resonance imaging.
    Methods: 12 Chinese nationality right-handed patients with major depression and 12 volunteers underwent blood oxygen level dependent (BOLD) fMRI while recognizing happy, sad, neutral emotional faces videos. Major depression and healthy individuals were matched for age, sex and educational levels.
    Results: (1) In comparison with healthy, major depression showed increased activation in right middle occipital gyrus(BA37), left middle frontal gyrus(BA6), left inferior parietal gyrus(BA40), left precentral gyrus(BA6), left postcentral gyrus(BA2) and decreased activation in left superior temporal gyrus(BA38), left middle temporal gyrus(BA21) and right inferior frontal gyrus (BA10)when explicit recognition of happy faces. (2) In comparison with healthy, major depression showed increased activation in right middle frontal gyrus(BA6), left cingulated gyrus(BA31), right fusiform gyrus(BA20) and right postcentral gyrus(BA2) and decreased activation in no suprathreshold clusters when explicit recognition of sad faces.
    Conclusion: This study indicates that the neural correlates of major depression for explicit recognition of dynamic facial expression is different with healthy. Depressed showed that increased activity in neural regions for the response to dynamic facial expression stimuli when compared with healthy individuals ， especially for sad stimuli.
     
  • P285
    Neural Correlates of Implicit Recognition of Dynamic Facial Expression in Major Depression: A fMRI Study
    Zhijian Yao 1 , Gaojun Teng 2 , Jinglun Du 3
    1 Nanjing Medical University, Department of Psychiatry, Nanjing, Chinese Mainland, 2 Southeast University, Clinical Medical School, Nanjing, Chinese Mainland, 3 Nanjing Brain Hospital, Nanjing, Chinese Mainland

    Objective: To explore neural correlates for implicit recognition of emotion of dynamic facial expressions in major depression using event-related functional magnetic resonance imaging scanning.
    Methods: 15 Chinese nationality female inpatients with major depression (HAMD Scores > 35) and matched with age, educational level, right handed female volunteers underwent blood oxygen level dependent (BOLD) fMRI scanning while recognizing the gender of happy, sad, neutral emotional faces and fixation cross videos. Data was analynised by SPM2, (p<0.001; threshold >10 voxels).
    Results: During implicit happy emotion task (recognizing gender), Contrasted with recognition of gender of neutral faces, depressed patients showed increased activation in the parietal lobule (BA40). During implicit sad emotion tasks, compared to healthy controls, depressed patients showed increased activation in the left fisiform(BA19), right precuneus (BA7), left superior temporal gyrus (BA13/40), bilateral parahippocampus (BA36/28), left postcigulate gurus (BA29), left caudate, left lentiform nucleus, left thalamus and bilateral middle temporal gyrus.
    Conclusion: This present study results indicates that the extension of the major depressed patients brain activation is increased during implicit recognition task of emotion, and showes a bias for negative emotion recognition. Depressed patients have to pay more attention to complete implicit task.
     
  • P286
    抑郁症治 疗前后静息状态脑功能变化的自身对照研究 - Control Study of the Brain Function of Depression Patient in Hypnotic State before and after Treatment
    志 剑 姚 1 , 皋 军 滕 2 , 丽 王 3 , 海燕 刘 3 , 燕翔 曹 3 , 经纶 杜 3 , 欣 武 4 , 宗 鸿 李 5 , 文 刘 5 , 宁 张 4
    1 南京 脑科医院 , 精神科 , 南京 , Chinese Mainland, 2 东南大学 , 临床医学院 , 南京 , Chinese Mainland, 3 南京医科大学 , 南京 , Chinese Mainland, 4 南京医科大学附属 脑科医院 , 南京 , Chinese Mainland, 5 南京医科大学附属 脑科医院 , 放射科 , 南京 , Chinese Mainland

    目的 ： 本 实验利用功能性 MRI 研究重症抑郁患者治 疗前后静息状态脑功能状态的变化 ， 旨在探讨重症抑郁的脑功能异常及可能机制。
    方法 ： 按入 组标准筛选 12 例符合 DSM － IV 诊断标准的抑郁患者 （ 男 6 例 ， 女 6 例 ， 均 为右利手 ， 平均年龄 41.75±9.76 岁 ）； 性别、受教育年限均 1 ： 1 匹配的健康 对照者 12 名 ； 两 组年龄 （ t=0.371 ， P=0.71 ） 无 显著性差异。应用 GE Signa NV/ i 1. 5 T 超 导型磁共振仪，采用 GRE-EPI 序列采集静息 BOLD 数据， TR ＝ 3000ms ， TE ＝ 40ms ，矩 阵＝ 64×64 ， 连续 27 层，层厚＝ 4 ㎜。原始 图像数据经转化格式， SPM 进行时间、空间标准化，校正头动并映射到标准脑；经滤波、去线性漂移，用 ReHofMRI1.0 生成 reho 图；在全脑平均化后进行统计分析，设定 p<0.005 ，不校正， 阈值 >10 个像素。将所 获得的两组的 reho 图进行双样本 t 检验、治疗前后进行匹配 t 检验，具有显著性差异的脑区 MNI 坐 标转换为 Talairach 坐 标，查看其解剖位置。
    结果： 抑郁症 组治疗前较正常组额下回（ 50,19,24/-48,13,19;BA9/ BA44 ）、左豆状核（ -21,5,-8 ）、左屏状核（ -33,-3,-7 ）、左 颞下回（ -59,-10,-35;BA20 ）局部一致性减低。而右 颞中回（ 45,4,-33;BA21 ）局部一致性增 强。治 疗后患者较正常组右颞下回（ 56,-7,-20;BA20 ）、后扣 带回（ 24,-33,38/-6,-36,43;BA31 ）、右 侧丘脑腹外侧核（ 18,-14,9 ）、左楔前叶（ -27,-42,41;BA7 ）、右 颞上回（ 56,-3,-5;BA22 ）局部一致性减低；而右 侧枕叶中回（ 21,-76,-1;BA18 ）局部一致性增 强。患者治 疗后较治疗前左额上回（ -21,49,-20;BA11 ）、左 颞中回（ -36,-7,-25;BA21 ）、左海 马回（ -12,-13,-25;BA34 ）局部一致性减低；而左 侧语言中枢（ -12,-49,2;BA19 ）、右 颞下回（ 50,-7,-22;BA20 ）、左楔前叶（ -15,-47,44;BA7 ）、右后扣 带回（ 3,-42,35;BA31 ）、左海 马回（ -33,-22,-29;BA36 ）局部一致性增 强。
    结论： 本 实验发现参与抑郁症默认网络脑区的局部一致性异常（额下回、后扣带回、基底节区等脑区局部一致性降低，反应患者相关脑区功能的协调性减低，经治疗后可增高 。抑郁症治 疗前后的局部一致性对比提示抑郁症静息状态的研究可用于指导临床治疗。
     
  • P287
    Treatment Response of the Resting State Brain Function in Major Depression ： a Self-case Control fMRI Study
    Zhijian Yao 1 , Gaojun Teng 2 , Li Wang 3 , Haiyan Liu 3 , Yanxiang Cao 3
    1 Nanjing Brain Hospital of Nanjing Medical University, Department of Psychiatry, Nanjing, Chinese Mainland, 2 Southeast University, Clinical Medical School, Nanjing, Chinese Mainland, 3 Nanjing Medical University, Nanjing, Chinese Mainland

    Objective: To explore treatment response of the brain function in major depression disorders(MDDs) at resting state using functional MRI.
    Methods: 12 MDDs patients and 12 controls, which matched with age and educational level and gender, experienced fMRI scanning at resting state. Imaging data were acquired using a 1.5 T GE system at Nanjing Brain Hospital , and analyzed by SPM2 and Regional homogeneity （ ReHo ） approach.
    Results: Compared to the controls, pre-treatment MDDs patients showed decreased ReHo regions in the bilateral inferior frontal gyrus (50,19,24/-48,13,19; BA9/BA44), left lentiform (-21,5,-8), left claustrum (-33,-3,-7), left inferior temporal gyrus (-59,-10,-35; BA20), but right middle temporal gyrus (45,4,-33; BA21) ReHo was increased; post-treatment MDDs patients showed decreased ReHo regions in the right inferior temporal gyrus (56,-7,-20; BA20), bilateral posterior cingulate gyrus (24,-33,38/-6,-36,43; BA31), right ventrolateral nuclei of thalamus (18,-14,9), left precunus (-27,-42,41; BA7), right superior temporal gyrus (56,-3,-5; BA22). but right middle occipital gyrus (21,-76,-1; BA18) ReHo was increased. Compared to the pre-treatment group, post-treatment MDDs patients showed decreased ReHo regions in the superior frontal gyrus (-21,49,-20;BA11), left middle temporal gyrus (-36,-7,-25; BA21), left hippocampus (-12,-13,-25; BA34); but left lingual gyrus (-12,-49,2; BA19), right inferior temporal gyrus (50,-7,-22; BA20), left precunus (-15,-47,44; BA7), right posterior cingulate gyrus(3,-42,35; BA31), left hippocampus (-33,-22,-29; BA36) ReHo were increased.
    Conclusion: The present study indicates that decreased ReHo regions of default mode network in depression can be recovered after effective treatment. ReHo approach may be a potentially useful method in exploring the pathophysiology of MDDs.
     
  • P288
    恢 复过程中老年期抑郁症患者的前额叶近红外光谱分析研究 - Prefrontal Lobe Function in Remitted Geriatric Depression: A Multichannel Near-infrared Spectroscopy Study
    丽莎 赵 1
    1 首都医科大学附属北京安定医院 , 北京 , Chinese Mainland

    中文摘要目的 ： 采用 28 通道的近 红外光谱分析 （ NIRS ） 技 术 ， 探讨处于恢复过程中的老年期抑郁症 （ GD ） 患者在 执行词语流畅性测验时前额叶的激活特点。方法 : 12 例 处于恢复过程中的 GD 患者和 12 例性 别、年龄和教育程度相匹配的健康志愿者。患者在入组时符合 DSM － 4 有 关重度和中度抑郁发作或复发的标准诊断，首次发病年龄 ≥60 岁，均服用 SSRIs 类抗抑郁药物治疗，未经 ECT 治 疗。对入组患者随访，在其病情恢复过程中，接受正式 NIRS 测查。所有被试者为右利手，经过实验室检查没有发现严重的躯体疾病，并且所有被试者经 MMSE 检测排除痴呆。通过 NIRS 系 统监测被试者在执行 VFT 任 务过程中，前额叶氧合血红蛋白和脱氧血红蛋白浓度的变化，从而反映前额叶认知任务相关的激活效应。采用组块设计的 VFT 作 为认知激活任务。结果 : 在健康老年人和 处于恢复过程中的 GD 患者， VFT 能 够激活双侧前额叶，未发现半球单侧化激活效应；处于恢复过程中的 GD 患者在 VFT 任 务过程中，左侧前额叶激活效应较对照组减弱 ; 尽管在健康老年人和 处于恢复过程中的 GD 患者， NIRS 显示了不同的激活模式，但 VFT 测验的成绩不存在显著性的组间差异。结论 : 处于恢复过程中的 GD 患者存在 VFT 相 关的功能性左侧前额叶功能减退 , 微血管功能失 调和多巴胺系统异常也许在 GD 的病理生理学机制中起重要作用。 关键词 : 老年人；抑郁障碍；近 红外光谱技术；前额叶

    Aim: Using a multichannel near-infrared spectroscopy (NIRS) to study the effect of verbal fluency task (VFT) on the prefrontal lobe activation in remitted geriatric depressive patients.
    Methods: This study was conducted on 12 patients with remitted geriatric depressive disorder and 12 healthy volunteers matched for sex ， age and education. At the time of being selected, these patients were diagnosed according to the DSM-IV criteria about the moderate or severe depressive episode or relapse. The age at onset of the first depressive episode in these patients was over 60 years. All of them were in remission by the time the formal study began and were medicated with a selective serotonin reuptake inhibitor. None of them had a history of electroconvulsive therapy. All subjects were assessed as being right-handed. None of them had major physical diseases requiring regular visits to physicians, as assessed by laboratory tests. None of the participants suffered from dementia as assessed by the Mini-Mental State Examination. A 28-channel near-infrared spectroscopy (NIRS) imaging system was employed to monitor the concentration changes of Oxy-Hb and Deoxy-Hb in the bilateral prefrontal cortex of all subjects during cognitive tasks. It could reflect prefrontal cognition-dependent activation. A block designed verbal fluency task (VFT) was used as cognitive tasks.
    Results: ⑴ The performance of the VFT leads to activation in prefrontal brain areas of the patients with remitted geriatric depressive disorder and the healthy old people, but failed to find lateralized activation. ⑵ Activation of the left prefrontal cortex during the VFT was significantly less in patients as compared with controls. ⑶ The task performances of the VFT were not significantly different between the two groups although activation patterns were distinct respectively.
    Counclusion: There is the VFT-relative functional left hypofrontality in remitted geriatric depressive patients. Microvascular dysregulation and the dysfunction of dopamine in the prefrontal cortex may play important roles in the pathophysiology of elderly geriatric depression.
    Key words: Aged; Depressive disorder; Near-infrared spectroscopy; Prefrontal lobe
     
  • P289
    重性抑郁症患者明确 识别动态面部表情的 . 功能核磁共振成像研究 - Recognition of Dynamic Emotional Facial Expression in Major Depressive Patients: An fMRI Study
    Jing-lun Du 1 , Zhi-jian Yao 1 , Shi-ping Xie 1 , Gao-jun Teng 1 , Wen Liu 1 , Ning Zhang 1 , Hui-fen Qiao 1 , Su-ruan Guo 1
    1 Nanjing Brain Hospital, Nanjing Medical University, Psychiatry Department, Nanjing, Chinese Mainland

    目的 ： 利用事件相 关设计的功能核磁共振成像技术探讨汉族女性抑郁症患者明确识别动态面部表情情感的神经基础。
    方法 ： 利用 1.5T 功能核磁共振成像系 统检测 15 例 汉族女性重性抑郁症患者和 15 例性 别、年龄及教育程度与患者组相匹配的正常对照组明确识别动态悲伤和喜悦的脑部反应 ， 并比较两组间脑激活区的差异。表情图片选自中国面部表情视频系统（ CFEVS ）。 图像数据经 SPM2 软件处理和统计分析，获得脑激活图。
    结果： 1. 与健康受 试者相比，抑郁症患者明确识别动态喜悦表情时活动增 高的 脑区包括枕颞交界处（左颞中回， BA19 ）、 顶叶皮质（右顶下小叶， BA40; 左中央后回， BA7 和 5 ；右中央前回， BA7 和 5 ；右前楔叶， BA7 ；），而活 动降低的脑区包括顶叶皮质（右顶上小叶， BA7 ；左 顶上小叶， BA7 ）等 脑区。
    2. 与健康受 试者相比，抑郁症患者明确识别动态悲伤表情时活动增高的脑区包括枕叶皮质（右枕中回， BA18 ；）、 顶叶皮质（左中央后回， BA5 ；左楔前叶， BA7 ；），而活 动降低的脑区为额叶皮质（左额中回， BA10 ；）。
    结论： 本研究旨在利用功能核磁共振成像技 术探讨抑郁症患者与正常对照明确识别动态喜悦和悲伤表情的相关脑区的差异，进一步探讨抑郁症患者有意识加工情绪性刺激的神经基础，得出以下结论：
    1. 在明确加工条件下，抑郁症患者和正常 对照在加工正性情绪方面无差异，但在感知动态喜悦表情的面部运动方面存在差异，表现为抑郁症患者在明确条件下感知面部运动能力降低。
    2. 在明确加工条件下 ， 抑郁症患者 识别悲伤表情时都表现为情绪产生相关脑区活动增强 ， 而情绪调节相关脑区活动减弱。

    Objective: To explore neural correlates for the explicit recognition of dynamic facial expression videos in female major depressed patients using event-related functional magnetic resonance imaging.
    Methods: Fifteen Chinese nationality right-handed patients with major depression and fifteen age and educational levels matched healthy right-handed adult female volunteers underwent blood oxygen level dependent (BOLD) fMRI while recognizing the emotional type of happy, sad and neutral emotional faces and fixation cross videos. Dynamic images were selected from Chinese facial expression videos system (CFEVS). fMRI data were processed by SPM2 software.
    Results: (1) In comparison with healthy comparison participants, major depression showed increased activation in left middle temporal gyrus(BA19), right inferior parietal lobule(BA40), left postcentral gyrus(BA7,BA5), right postcentral gyrus(BA7,BA5) and right precuneus(BA7), and decreased activation in bilateral superior parietal lobule(BA7) when explicit recognition of happy faces.
    (2) In comparison with healthy comparison participants, major depression showed increased activation in right middle occipital gyrus(BA18), left postcentral gyrus(BA5), left precuneus(BA7) and right hippocampus and decreased activation in middle frontal gyrus when explicit recognition of sad faces.
    Conclusion: (1) In the explicit processing, patients with major depression are not different from healthy comparison participants in processing of positive emotion, but different in the perception of facial motions of happy expressions. Patients with major depression show attenuated ability to percept facial motion in the explicit processing.
    (2) In the explicit processing, recognition of sad faces in patients with major depression elicits increased activation in emotion production-related brain regions and decreased activation in emotion regulation-related brain regions.
  • P290
    抑郁症患者 认知功能的治疗变化 - Change of the Cognitive Function Depressive Patients after Treatment
    贵云 徐 1 , 情感障碍
    1 广州市精神病医院 , 广州市 , Chinese Mainland

    目的 ： 了解抑郁症患者在治 疗过程中认知功能的变化及不同疗法认知功能变化有无差异。
    方法 ： 研究 对象为广州市精神病医院门诊及住院的抑郁症患者。入组者分别采用 TCA （ a ） 、 SSRIs （ b ） 、万拉法新 （ c ） 、万拉法新合并 组 （ d ）， 以有效治 疗量治疗 6 周。治 疗前后分别采用 17-HAMD 评定抑郁症状严重程度及采用威斯康新卡片分类测验（ WCST ）（ 48 张）、连线测验（ A 、 B ）、 词语流畅性测验（动物）等分别评定认知功能。
    结果： 有 112 例患者 纳入研究， 89 例完成。治 疗后 WCST 分 类数、总错误数、持续错误数、非持续错误数的得分、词语流畅性测验动物总数明显高于治疗前，治疗后连线测验 A 、 B 操作 时间少于治疗前，差异均有统计学意义（ P<0.05 ）。不同 药物治疗组病例数： a 组 10 例、 b 组 51 例、 c 组 14 例， d 组 14 例。 d 组治疗前后 WCST 分 类数增加值、总错误数减少值均大于 b 组，其差异有统计学意义（ P 均 <0.05 ），其它 项目的差异无统计学意义（ P 均 >0.05 ）。
    结论 ： 抑郁症患者抗抑郁治 疗后认知功能明显改善 ， 万拉法新合并组改善程度较 SSRIs 治 疗组明显。

    Objective: To investigate change of the cognitive function in depressed patients in post-treatment.
    Methods: Subjects were recruited at the Guangzhou psychiatric hospital. They were respectively treated by TCA (a), SSRIs (b), venlafaxine (c), Venlafaxine merger (d), with effective therapeutic dose for 6 weeks. WCST(48), trail making tests (A, B) and verbal fluency test (animals) were respectively made to evaluate the cognitive function before and after treatment.
    Results: There were 112 patients included in the study, 89 cases completed. Post-treatment in comparison with pre-therapy, scores of total trials and preservative errors and random errors in WCST, scores of verbal fluency test and trail making test A or B were all significantly higher (P<0.05). Four groups included respectively 10 cases, 51 cases, 14 cases, 14 cases, After treatment increased categories and reduced total number of errors in WCST were significantly greater in d groups than in b group(P<0.05).
    Conclusions: After antidepressant treatment the cognitive function of patients with depression was significantly improved and in venlafaxine merger group more significant than in SSRIs treatment group.
     
  • P291
    精神分裂症的社区康 复干预与疗效研究 - Effects of Community Rehabilitation Intervention on Patients with Schizophrenia
    咏 文 李 1 , 利 会 徐 1 , 华 樊 1 , 亮 高 1
    1 北京市朝阳区第三医院 , 北京 , Chinese Mainland

    目的 : 探索一 种新的 ， 在社 区中易于推广、操作的社区精神康 复服务模式。
    方法 : 用随机数字表将社区中的精神分裂症患者分 为干预组和对照组。干预组病人接受一个月由 Liberman 等教授制定的《回 归社会技能训练》程式 ， 训练后 ， 精神科医生每两周随访病人一次 ， 并进行个体康复指导。随访期为 18 个月。 采用 PANSS 量表，社会功能缺陷 筛选量表（ SDSS ）等 进行评定，并统计两组的就业率及复发率。在试验初期进行为期六周的集体家属教育；对照组不接受任何的干预措施。
    结果 : 1 共有 50 例患者入 组，干预组、对照组各 25 例； 2 干 预组患者在 PANSS 阳性、 阴性症状 分量表 评分和总分均低于对照组，两组比较有显著性差异； 3 干 预组的 SDSS 量表 评分显著低于对照组； 4 干 预组再就业率为 36%, 而 对照组仅为 4% ，干 预组的复发例数和再住院例数均为 1 例，达到了 预期目标。结论 : 社区康 复干预对改善精神症状，恢复社会功能有很好的疗效，可明显降低复发率、再住院率 , 提高就 业率。

    Objective: Investigating new and effective psychiatric rehabilitation service delivery model which can be used easily in community.
    Method: The patients with schizophrenia were grouped into intervention group and control group by random digits table. "The community reentry module" established by Liberman was used in intervention group. In intervention group, every nine patients were in one group and trained by "The community reentry module" for one month. The patients were interviewed by psychiatrists every two weeks. Individual rehabilitation instruction was given. The time of follow –up was eighteen months. The scale of PANSS and SDSS were used. The rate of recurrence, rehospitalization and employment was researched. Families in intervention group were educated for six weeks at the beginning. The control group was not given any intervention.
    Result: 1. 50 samples were included in the study and assayed. Among the samples, there were 25 patients in intervention group, and the others were in control group. 2. The total, positive and negative of PANSS score in intervention group were significantly lower than control group. 3. The SDSS score in intervention group was significantly lower than control group at the medium-term of intervention. 4. Employment rate in intervention group was 36% and control group was 4%. The number of recurrence and rehospitalization were one respectively, achieving intended goal.
    Conclusion: Community rehabilitation intervention can improve psychiatric symptom, recover social function, decrease recurrence and rehospitalization rate, increase employment rate. Key words: community rehabilitation; schizophrenia; effects
     
  • P292
    首 诊于内科门诊与专科门诊的精神障碍患者临床对比研究 - A Comparative Study in First-Diagnosis Outpatients with Psychiatric Disorders between Medicine Clinic and the Specialism
    Na Wang 1 , Han-hua Chen 2 , Ru-qin Luo 2
    1 Wuchang Railway Hospital, Wuhan, Chinese Mainland, 2 Wudong Railway Psychiatric Hospital, Wuhan, Chinese Mainland

    目的 ： 对首诊于内科门诊与专科 （ 精神科或心理科 ） 门诊的精神障碍患者的临床资料进行对比研究　
    方法 ： 对 124 例首 诊于内科门诊的精神障碍患者 （ 研究组 ） 与 142 例首 诊于专科的精神障碍患者 （ 对照组 ） 的基本临床资料 ， 就诊情况以及医生的诊治进行分析比较 ， 有关数据统计分析 ， 采用卡方检验。　
    结果 ： 　两 组在性别、年龄、文化程度、精神障碍类别上比较 ， 差异 存在 显著性 ， 女性、中年、文化程度高者以及抑郁症、焦虑症、躯体形式障碍者更倾向于首诊内科。研究组确诊年限长，而且内科医生的诊治存在缺陷。
    结论： 精神障碍患者首 诊于内科门诊的原因较多，而提高内科医生对精神障碍的识别水平，建立联络会诊精神病学会减少误诊率，缩短确诊时间。

    Objective: To compare the clinical data of the first-diagnosis psychiatric outpatients in medicine clinic and the specialism （ psychosis or psychology specialism ） .
    Methods: clinical data ， diagnosis and therapy of doctor were compared between 124 patients in medicine clinic （ study group ） and 142 patients in the specialism （ contrast group ） . The data analysis was performed with chi-square test.
    Results: There were significant differences in sex ， age, level of education and psychiatric disorders. female ， midlife ， high level of education ， depressive disorders ， anxiety disorders and somatoform disorders tend to see physician for the first time. Physician of study group spent longer time in correct diagnosis. Besides, diagnosis and therapy of physician had some defect.
    Conclusion: There are many reasons why outpatients with psychiatric disorders go to see physician for the first time. If the capacity of physician is promoted in distinguishing mental disorders and liaison consultation psychiatry is established, we will decrease the rate of error diagnosis and shorten the time of providing exact diagnosis.
     
  • P293
    神 经症患者就诊行为研究 - The Study on Medical Care Seeking Behavior among Neurosis Patients
    恒永 关 1 , 克 强 王 1
    1 河北省 荣军医院 , 保定 , Chinese Mainland

    目的 ： 探 讨神经症患者的就诊行为。
    方法 ： 所有病例均来自 2005 年 10 月 1 日至 2006 年 9 月 30 日在我院 门诊就诊的部分患者 ， 均符合 CCMD-3 关于神经症的诊断标准。自编神经症患者就诊行为调查表，包括性别、年龄、职业、诊断、病程、曾经就诊医院、就诊次数、就诊费用等。按就诊顺序由首诊医生填写调查表，结束后对资料进行统计分析。
    结果： 共 调查符合标准的患者 568 例，男 156 例（ 27.46% ），女 412 例（ 72.54% ）。年 龄 16~82 岁，平均（ 43.63±21.56 ） 岁，其中 ≤25 岁 80 例， 26~35 岁 87 例， 36~45 岁 165 例， 46~55 岁 173 例， ≥56 岁 63 例。以 36~55 岁者居多，占 59.51% （ 338 例）。病程 3 月 ~42 年，平均（ 8.69±25.36 ）年， ≤1 年者 124 例， 1~2 年者 132 例， 2~3 年者 235 例， ≥3 年者 77 例。 恐怖症 16 例（ 2.82% ） , 焦 虑症 186 例（ 32.75% ） , 强迫症 86 例（ 15.14% ） , 躯体形式障碍 260 例 (45.77%), 神 经衰弱 14 例（ 2.46% ） , 其他神 经症 6 例（ 1.06% ），以焦 虑症和躯体形式障碍为主（ 78.52% ）。在就 诊精神科前，首诊于综合医院非精神科的 490 例患者中有 70 例（ 14.29% ）患者曾被确 诊为神经症，而其余 420 例患者被 诊断为其它疾病。首诊于精神科者 78 例（ 13.73% ） ,490 例（ 86.27% ）首 诊于综合医院非精神科，在 2~3 家医院就 诊者 380 例（ 66.90% ） ， 3 家以上医院就 诊者 110 例（ 19.37% ）。求助于迷信者 162 例（ 28.52% ）。就 诊 1 次者 67 例（ 11.80% ）， 2~3 次者 206 例（ 36.27% ）， 3 次以上者 295 例（ 51.94% ），其中有 18 例（ 3.17% ）患者超 过 10 次。就 诊原因：自认为是精神疾病者 72 例（ 12.68% ），听人介 绍者 268 例（ 47.18% ），久治不愈无奈者 154 例（ 27.11% ），家人 认为有问题 55 例（ 9.68% ），其他 19 例（ 3.35% ）。 文盲 167 例（ 29.40% ），小学 195 例（ 34.33% ），中学 146 例（ 25.70% ），中 专及以上 60 例（ 10.56% ）。其中小学及文盲者占 63.73% （ 362 例）。
    2.5 居住地分布：来自 农村者占 72.54% （ 412 例），城市 27.46% （ 156 例），以 农村居多。病前性格：内向者 217 例（ 38.23% ），外向者 115 例（ 20.25% ），中性者 167 例（ 29.40% ）， 强迫性格者 69 例（ 12.15% ）。
    2.7 对 260 例躯体形式障碍患者再分析：女性占 196 例（ 75.38% ），男性 64 例（ 24.62% ），小学及文盲者占 202 例（ 77.69% ），初中以上者 58 例（ 22.31% ），来自 农村者 182 例（ 70.00% ），城市 72 例（ 30.00% ），在性 别、文化程度、居住地等方面比较均有统计 学差异（ P<0.05 ）。年 龄 20~82 岁，平均（ 40.65±21.36 ） 岁，就诊次数 2~18 次，平均（ 6.85±5.68 ）次， 112 例（ 43.08% ）患者曾 经求助于迷信。以农村中年女性、文化程度偏低者居多。对就诊超过 3 次的患者再分析：共 295 例，女性 231 例（ 78.31% ） , 男性 64 例 (21.69%), 小学及文盲者占 222 例（ 75.25% ），初中以上者 73 例（ 24.75% ），来自 农村者 190 例（ 64.41% ），城市 105 例（ 35.59% ），在性 别、文化程度、居住地等方面比较均有统计学差异（ P<0.05) 。其中 诊断为躯体形式障碍 198 例 (67.12%), 焦 虑症 38 例 (12.88%) ，二者占 80% 。 说明躯体形式障碍患者更容易反复就医。家庭收入情况：年收入＜ 2 千元者 75 例， 2 千 ~5 千者 376 例， 5 千 ~1 万元者 70 例，＞ 1 万者 47 例。病人花 费情况：花费＜ 1 千者 102 例（ 17.96% ）， 1 千 ~2 千者 165 例（ 29.05% ）， 3 千 ~5 千者 213 例（ 37.50% ）， 5 千 ~1 万者 78 例（ 13.73% ），＞ 1 万者 10 例（ 1.76% ）。
    结论： 提高精神 卫生知识的普及率，加强综合医院医生对神经症的识别率十分重要。
     
  • P294
    夫妻躯体施暴者的社会心理因素 Logestic 回 归分析 - Psychosocial Factors of Somatic Violence Couples: A Logistic Regression Analysis
    福 幸 赵 1 , 幸 福 赵 1
    1 南京医科大学附属无 锡精神卫生中心 , 无 锡市 , Chinese Mainland

    目的： 探 讨夫妻躯体施暴者的社会心理学因素，寻找干预的预测指标。
    方法： 采用病例 对照研究，对 156 例社区夫妻暴力躯体施暴者和 44 例正常 对照组用社会人口学指标、社会支持力量表、父 母 养育方式量表、儿童期虐待问卷、艾森克人格问卷、反社会人格症状问卷、症状自评量表、应付方式问卷、家庭功能问卷进行评定。并对夫妻暴力躯体施暴行为多种因素进行 Logestic 回 归分析。
    结果： Logestic 回 归分析，显示夫妻关系，父亲惩罚、严厉的养育方式，内外向性格，嗜烟，主观社会支持和情感介入有统计学意义。
    结论： 夫妻 关系，父亲惩罚、严厉的养育方式，嗜烟，内外向性格，社会支持和情感介入是夫妻暴力躯体施暴行为最显著的预测指标。
    关键词 ： 夫妻暴力 ； 社会心理因素 ； Logestic 回 归

    Objective: To investigated the psychosocial factors of the physical domestic violence on male perpetraters and pProvide help to interfering with family violence further.
    Methods: The case-control association study was used. 156 male samples who had couple violent behavior in community were tested by the demographic data, Social Support Questonnaire(SSQ), Egm Minnen av Bardnosnaupp-forstran (EMBU), CTQ-SF,EPQ, Antisocial Personality disorder Symptoms(APDS), Coping Style Questionnair(CSQ), SCL-90, Fmamily Asessment Device (FAD) were compared with those of 44 normal paired controls derived from the community sample. The factors of the male physical domistic violence were examined by Binary Logestic.
    Results: Binary Logestic Regression suggested that the marital relationship, the punishment and firm of fathers in EMBU, the smokers, the EPQ-E, the subjective social support and the affective Involvement in Family Functioning were statistically different.
    Conclusions: The marital relationship, the punishment and firm of fathers in EMBU, the smokers, the EPQ-E, the subjective social support and the affective Involvement in Family Functioning are the statistically signs for the physical domestic violence on male perpetraters.
    Key words: Couple violence ， psychosocial factors ， Logestic Regression
     
  • P295
    Effects of Homocysteine on Apoptosis and Expression of NF- κ B in Substantia Nigra Induced by 6-OHDA
    Min Liu 1
    1 Mental Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Chinese Mainland

    Objectives: To study the effects of homocysteine (Hcy) on apoptosis and expression of nuclear factor kappa B (NF- κ B) in substantia nigra induced by 6-hydroxy dopamine (6-OHDA) in vivo.
    Methods: 100 rats were divided into 4 groups. 6-OHDA focally administrated to induce PD, 2-h later Hcy or 0.9% Nacl was administrated in the ipsolateral substantia nigra (SN). Immolunohistochemical technique was used to observe the number of nigra apoptosis and the changes of the expression of NF- κ B during the development of rat Parkinson's disease (PD) model on the hour 4, day l, 2, 7 and 14 after injection.
    Result: The number of substantia nigral apoptosis induced by 6-OHDA showed significantly increasing after treatment with Hcy compared with the controls (P<0.01).Also the expression of NF- κ B was increased significantly.
    Conclusions: Focal infusion of Hcy into the substantia nigra increased the vulnerability of the dopaminergic neurons to 6-OHDA-induced apoptosis; it seemed likely that the endangering effect of Hcy is due to activating NF- κ B.
     
  • P296
    网 络成瘾对家庭的影响 - Family Experiences Regarding Coherency to Internet
    Khosrow Tavakol 1 , Fatemeh Pashaee 1 , Health Group
    1 Nursing Faculty of Medical Sciences in Isfahan , Health Department, Isfahan , Iran , Islamic Republic of

    前言 ： 尽管日益 发展的高科技给家 庭生活 带来诸多便利 ， 但是高科技对家庭也有不利因素 ， 从一方面而言因特网具有很多有利的特征 ， 但过度应用网络则会导致家庭成员网络成瘾。
    方法 ： 家庭成 员的经历通过非量化的方式评估 ， 而是为对生活经历的描述。
    结果 ： 我 们对 3 个方面 进行了评估 （ 各项评分总分为 60 分 ）： 1 ） 动机 ； 2 ） 合并症 ； 3 ） 生活方式的改 变。
    讨论 ： 网 络成瘾可导致家庭破裂以及生活方式的改变 ， 这些情况值得精神科及家庭健康护理专业人员的重视。
    关键词 ： 家庭 相 关性 因特网

    Introduction: althought today extensive growth of technology induce welfare and accesiblity for families, but it is one of threaten agent for families, from one aspect the unique characteritise of Internet is useful, and over using form internet is caused to internet addiction in family members.
    Methods: The subject of this study is acquired experiences of members of family that is n,t measurable by quantitave and rmethod is applied for description this experiences.
    Result: Finding of this research were classified in 60 codes an three main concept consist of:
    1) motivetors (directors)
    2) Complication
    3) Change of life style
    Discussion: Dependent member of family after tend to internet are tolerated complication like to disruption of family discipline and inappropriate change of life style that this problem is considerable for psychiatric and family health nurses.
    Keywords: Family- Coherency- Internet
  • P297
    试用 PSWQ-PW 量表 鉴别广泛性焦虑的 ROC 分析 - Use Penn State Worry Questionnaire –Past Week (PSWQ-PW) to Identify Individuals with Generalized Anxiety Disorder: A Receiver Operating Characteristic Analysis
    Qingwei Li 1
    1 Tongji Hospital , Tongji University , Psychosomatic Medicine, Shanghai , Chinese Mainland

    目的 : 评价 Penn 最近一周担 忧状态问卷 （ Penn State Worry Questionnaire –Past Week ， PSWQ-PW ） 国内人群中 GAD 鉴别筛选的灵敏度和特异度。
    方法 : 101 名被 试完成 PSWQ-PW 自 评 ， 并接受根据 CCMD- Ⅲ 进行的精神状况检查。 结果 PSWQ-PW 总分 GAD 组 60.2±12.7 ， 其它精神障碍 47.0±12.3 ， 健康个体 35.8±7.9 ； 三 组具有显著差异 ； ROC 曲 线 AUC 为 0.844 （ 95 ％ CI ＝ 0.76-0.93 ， P ＝ 0.00 ）， 以 55 分 为界值 ， 灵敏度为 0.75 ， 假阳性率 为 0.09 。
    结论 : PSWQ-PW 具有 较好的 GAD 鉴别能力。

    Object: to evaluate the sensitivity and specificity of the Penn State Worry Questionnaire –Past Week （ PSWQ-PW ） during identifing individuals with generalized anxiety disorder.
    Method: 101 subjects completed self-scale with PSWQ-PW and were examined by doctors in psychiatry according to CCMD- Ⅲ .
    Results: The total scores was 60.2±12.7 in GAD ， 47.0±12.3 in other mental disorders ， 35.8±7.9 in healthy ； and the difference among them was significant. The AUC of ROC was 0.844 （ 95 ％ CI=0.76-0.93 ， P=0.00 ） . If taken score 55 as dividing line, the sensitivity was 0.75 and specificity 0.09.
    Conclusion: PSWQ-PW has better ability to identify individuals with generalized anxiety disorder.
     
  • P298
    人格、 应付方式、负性情绪与冠心病关系的研究 - A Study on the Relation between Personality, Coping Strategy, Negative Emotion and the Incidence of Coronary Heart Disease
    兴蓉 赵 1 , 俊云 白 2 , 秀峰 许 2
    1 昆明医学院第一附属医院 , 昆明 , Christmas Island, 2 昆明医学院第一附属医院 , 昆明 , Chinese Mainland

    目 标 ： 随着生物 - 心理 - 社会医学模式的 发展 ， 人们逐渐认识到单纯的药物及介入治疗并不能完全有效地防止冠心病的发生与发展 ， 许多研究已证明心理社会和行为的危险因素在冠心病的发生发展中起到重要作用 ， 其中人格、应付方式、负性情绪等被证实为重要的影响因素。本研究检验了 D 型人格量表的效度和信度，同 时拟通过对冠心病患者与普通健康人群相关量表测评结果 的比 较，来探讨人格、应付方式、负性情绪与冠心病的关系，为冠心病的心理行为干预提供理论依据。
    素材和方法：收集昆医附一院心内科冠心病住院病人 203 例 为病例组，并在普通健康人群中随机抽取 199 例 为对照组，采用 D 型人格量表 (Type D Scale-14 ， DS14) 、 A 型行 为问卷、 NEO 五因素 问卷（ NEO-FFI ）、 应付方式问卷、汉密尔顿抑郁量表（ HAMD ）、 汉密尔顿焦虑量表（ HAMA ） 进行评估，检验 D 型人格量表的效度和信度，并用 t 检验、卡方检验、简单相关分析、多元逐步回归分析、二项分类 Logistic 回 归分析等 方法来探 讨这些心理社会因素与冠心病的关系。
    结果：
    1. D 型人格与冠心病：
    1.1 DS14 信、效度 检验：因子分析得到 NA 和 SI 两个因子，共解 释了 50.16% 的 变异量，各个条目的因素负荷均＞ 0.5 ； 总量表、 NA 维度和 SI 维度的 Cronbach's α 系数分 别为 0.857 、 0.859 和 0.761 ，重 测相关系数分别为 0.782 、 0.810 、 0.834 ；以 NEO-FFI 为效标检验，表明 DS14 具有 较好的聚合效度和区分效度。
    1.2 冠心病 组的 D 型人格比例、 DS14 总分、 NA 维度评分高于对照组。
    1.3 D 型人格者 应付方式中 “ 解决 问题 ” 维度评分较非 D 型人格者低， “ 幻想 ” 、 “ 退避 ” 、 “ 合理化 ” 、 “ 自 责 ” 维度评分较非 D 型人格者高， “ 求助 ” 维度评分两者差异无统计学意义。
    1.4 冠心病 组中 D 型人格者合并抑郁、焦 虑的比例和程度多于非 D 型人格者。
    1.5 NEO-FFI 各 维度评分： D 型人格者 “ 神 经质 ” 维度评分较非 D 型人格者高， “ 外向性 ” 、 “ 严谨性 ” 、 “ 顺同性 ” 维度评分较非 D 型人格者低。
    2. A 型行 为与冠心病：冠心病组 A 型行 为比例高于对照组， A 型行 为问卷总分和各维度评分与对照组差异无统计学意义。
    3. 冠心病 组与对照组的 NEO-FFI 各 维度评分比较结果：冠心病组 “ 开放性 ” 维度低于对照组， “ 严谨性 ” 维度高于对照组， “ 神 经质 ” 、 “ 外向性 ” 和 “ 顺同性 ” 维度两组差异无统计学意义。
    4. 应付方式与冠心病：冠心病组应付方式各维度评分与对照组差异无统计学意义。
    5. 负性情绪与冠心病：
    5.1 冠心病患者合并抑郁者占 14.3 ％，合并焦 虑者占 20.7 ％。
    5.2 对影响冠心病患者抑郁和焦虑状态的多元逐步回归分析提示： D 型人格中的 NA 维度与冠心病患者的抑郁状态呈正相关。
    6. 对冠心病患病的多因素的二项分类 Logistic 回 归分析提示： DS14 评分的 OR 值大于 1 ，提示其 为冠心病患病的危险因素； NEO-FFI 中的 “ 开放性 ” 维度的 OR 值小于 1 ，提示其 为冠心病患病的保护因素。
    结论：
    1. DS14 中文版具有 较好的信度和效度，特点为简短、操作性强、患者负担小，可作为我国冠心病患者和健康人群 D 型人格的 测量工具。但个别条目还需根据中国人特点进一步修订完善。
    2. D 型人格是冠心病患病的危 险因素，它包含了清晰的负性情感和社交抑制两个特质； D 型人格者 较多运用消极的应付方式，较少运用积极的应付方式；更多体验焦虑和抑郁；表现为高神经质和低顺同性、外向性、严谨 性等特征。 D 型人格中的 NA 维度是冠心病患者抑郁状态的影响因素。
    3. A 型行 为问卷在本研究中未发现与冠心病相关。 4. DS14 评分为冠心病患病的危险因素， NEO-FFI 中的 “ 开放性 ” 维度为冠心病患病的保护因素。
    关键词 : 冠心病 D 型人格 A 型行 为 应付方式 抑郁 焦 虑 NEO-FFI
     
  • P299
    Effects of Bilateral Lesions of Habenula on Heroin Self-administration in Rats
    Yuhong Wang 1 , Fuqiang Zhang 1 , Shuaien Tang 1 , MiaoJun Lai 1 , Wei Hao 1
    1 The 2nd Xiangya Hospital of Central South University, Mental Health Institute and WHO Collaborating Center for Drug Abuse and Health, Changsha, Chinese Mainland

    Rationale: The mesolimbic dopamine system has been proved to be the key neural substrates underlying the rewarding effects of drugs of abuse. Habenula, a major relay station conveying information between the limbic forebrain and midbrain, mediates the negative feedback from forebrain dopamine-rich and limbic structures onto midbrain dopamine-secreting cells. Previous studies provided evidence that the habenula appears to be vulnerable to damage following chronic administration of most of abused drugs. The role of habenula in mediating the acute rewarding effects of abused drugs is unclear.
    Objectives: The present experiments examined the effects of bilateral electric lesion of the habenula on the acquisition and maintenance of IV heroin self-administration, in order to investigation the possible role of the habenula in heroin reward.
    Methods: Sprague Dawley rats received bilateral electric(1.0mA,15s) or sham lesions of the habenula prior to (acquisition) or after (maintenance) IV heroin self-administration training. Self-administration training was conducted under a FR1 schedule in a daily 4h session. Each active nose-poke resulted in a 0.05mg IV heroin infusion. A progressive schedule (PR-34) was also used to evaluate the relative relative strength by measuring the “ breaking point”.
    Results: Pre-training lesions of habenula caused a higher baseline level of heroin infusions in both the FR1 and the PR-34 schedule compared with the sham controls. Post-training lesions of habenula had no effects on the re-establishment of heroin self-administration under the FR1 schedule and also no effects on the “breaking point” under the PR-34 schedule.
    Conclusions: The results indicated that the acquisition of heroin self-administration depend on the integrity of the habenula. But the habenula is not critically involved in maintaining the heroin self-administration once the behavior has been acquired. These findings suggest that the habenula is only involved in the learning system in controlling the acquisition of heroin self-administration.
    K eywords: Heroin, Habenula, Self-administration, Reward.
    Supported by the National Natural Science Foundation of China: 30670676, 30370522, 30500180 and the National Basic Research Programe of China: CB2003515404, CB2003515403
     
  • P300
    整形美容 术诱发精神障碍 26 例分析 - Mental Disorders after Plastic Surgery, Analysis of 26 Cases
    锐 付 1
    1 湖北省 荆门市第三人民医院心理科 , 荆门市 , Chinese Mainland

    1 对象与方法
    我院 1992~2004 年期 间的整形美容手术病人中 ， 手术后而诱发精神障碍者 26 例 （ 其中隆鼻 13 例 ， 隆胸 7 例 ， 取痣 4 例 ， 抽脂 2 例 ）， 以中国精神障碍分 类与诊断标准 —CCMD-3 重新 诊断。其中男 1 例，女 25 例。年 龄 19~35 岁，平均（ 26.8±5.0 ）。已婚 12 例，未婚 14 例。有精神病家族史 4 例。性格内向型 20 例，外向 6 例，急性一周内起病 18 例， 亚急性 1~6 月内起病 6 例，慢性 2 例。就 诊时病程 2 天 ~3 年，平均（ 5.7±4.1 ）月。
    2 结果
    临床现有失眠多梦 22 例，躯体不适 21 例，情 绪底落 19 例，焦 虑、坐立不安 12 例，哭笑无常、乱 语 5 例， 恶心呕吐 3 例，四肢无力 3 例。
    以中国精神障碍分 类与诊断标准 —CCMD-3[1] 临床诊断为躯体化障碍 14 例，焦 虑症 6 例，抑郁症 3 例， 癔症 3 例。 14 例 门诊治疗， 12 例住院治 疗，均给予心理治疗为主。 5 例心理治 疗 1 次即症状消失， 12 例心理治 疗 2~5 次， 9 例心理治 疗 9~14 次。均 获痊愈。
    3 讨论
    本 组病例有以下特点 ：女性居多，性格内向，起病 较急，临床表现为躯体不适、焦虑、抑郁症状突出，经过认知领悟疗法（让患者认识到整形美容手术只能部分改变外表容貌，更多应是内心接纳自己普通不太丑陋的外表，增加更多的兴趣爱好活动，改变自我内向性格变的更为开朗。）躯体不适、焦虑、抑郁等症状消失快，能接纳自我外表，均无再次复发。从此组病例看来，整形美容手术的术前心理咨询不可忽视。不少前来整形者认为： “ 自己外表的缺陷或不完美的部位，通 过整形美容术会变的完美无暇 ” ，因而 给予了整形美容术过高的期望，而整形美容手术实际上只能部分改善不完美的外表，且 大多求助于整形美容手 术者自我本身完美欲过高，故完美欲过高者术前不做心理咨询 , 术后较易出现心理障碍，严重者便出现精神障碍，但经过正规心理治疗，症状可消失，预后良好。
     
  • P301
    Compared Study of Group Psychotherapy in College Students With Internet Addiction
    维芳 郑 1
    1 浙江温州市民康医院 , 浙江省温州市 , Chinese Mainland

    Objective: To explore the efficacy of group psychotherapy in college students with internet addiction.
    Methods: 1481 college students were selected with cluster sampling method. 61 can be defined as internet addiction disorder (IAD) by whose scores of Young's internet addiction questionnaires were ≥ 5 and they were divided into the treatment group(30) and the control group(31) randomly. Treatment group was received group psychotherapy once a week during 8 weeks and followed up at the 3th, 6th months after treatment. The efficacy was evaluated at different time point.
    Results: After treatment for 8 weeks,the scores of Young's internet addiction questionnaires and SCL-90 of treatment group were lower than itself before treatment and control group significantly.The percentage of individuals whose scores of Young's internet addiction questionnaires ≥ 5 in treatment group is 46.7%,which lower than itself before treatment and control group(90.3%) after 8 weeks.Compare with the scores of Young's internet addiction questionnaires and SCL-90 and the percentage of IAD, there are not significant difference between 8 weeks, 3th and 6th month after treatment.
    Conclusions: Group psychotherapy is effect for IAD and the efficacy is sustained.
     
  • P302
    认知心理治疗对酒精所致精神障病人康复的影响 - Using CBT in Rehabilitation in Alcoholic Patients
    杨 森 1
    1 黑 龙江省鸡西矿业集团精神病院 , 鸡西 , Chinese Mainland

    目的 ： 分析探 讨认知心理治疗对酒精所致精神障碍病人康复的影响和治疗效果。
    方法 ： 将我院 2000 年以来 ， 在本院住院治 疗 ， 符合 CCMD － 3 诊断标准 ， 诊断为酒精所致精神障碍的病历 ， 提取采用认知心理治疗方法和未采用认知心理治疗方法的各 40 份病例 ， 共 计 80 份。按事先 设计项目进行逐项登记， 80 份病例均 为男性，将 80 份病 历分为二组，一组为采用认知心理治疗组，另一组为未采用认知心理治疗组。采用认知心理治疗组 40 例病 历，均分别不同给予 10 － 20 次个 别心理治疗，每周一次。向病人讲述酒精所致精神障碍的发病机制，从生物学角度向病人讲述酒精与发病的关系和酒精对人体的影响，使病人掌握了酒精对人体的影响与发病的关系的有关知识。
    结果： 80 例酒精所致精神障碍病人在未采用 认知心理治疗前，有 79 例病人不知道自己患的是一 种病，也不清楚疾病与酒有关，只有 1 例病人 认为可能与酒有关， 90 ％以上病人 对自己复饮而再次入院而感到忏悔，甚至认为前途无望。采用认知心理治疗组病人经过认知心理治疗后，均能主动配合治疗，复饮间隔时间比未采用认知心理治疗方 法的病人 间隔时间长。未采用认知心理治疗组有 60 ％病人在出院 1 个月内 复饮； 80 ％病人在出院 2 个月内 复饮；全组 40 份病人在出院 3 个月内全部出 现复饮现象。而采用认知心理治疗组只有 20 ％病人在出院 3 个月内出 现复饮；有 80 ％病人超 过 6 个月以上才出 现复饮现象，个别病例可超过 1 年以上。
    结论： 酒精所致精神障碍病人在常 规药物治疗过程中同时经过认知心理治疗，可使病人自我控制能力增强，使复饮间隔时间明显延长，提高了治疗效果，能够增强病人治愈的自信心，使病人认识到自己患的是一种病。是由于酒精作用而致病的。我院近年来对酒精所致精神 障碍病人 实施认知心理治疗方法，取得了良好的治疗效果，通过几年来的临床实践证明，认知心理治疗对病人的康复起到了很好的作用，明显提高了康复水平。
     
  • P303
    老年抑郁症与 脑卒中后抑郁障碍比较 淮安市第三人民医院 - The Comparion of Depressive Disorders Post Brain Stroke and Depression in Senior Patients
    华 汤 1
    1 江 苏省淮安市第三人民医院 , 老年精神科 , 淮安 , Chinese Mainland

    40 例老年抑郁症与 40 例 脑卒中后抑郁障碍进行临床抑郁症状比较，发现脑卒中后的抑郁症状除有较典型的抑郁症状外，还存在较明显谵妄症状，两组比较有显著的差异并分析了两组症状的异同点。

    Objective: To compare depressive symptoms post brain stroke with depression in senior patients.
    Method: 40 cases of depressive symptoms post brain stroke and depression in senior patients were investigated and analysed respectively.
    Result: The patients post brain stroke had more significant typical depressive symptoms and delirium symptoms than depression in senior patients.
    Conclusion: The patients post brain stroke had more depressive and delirium symptoms.
    Key word: depressive disorders post brain; depression in senior patients
  • P304
    认知行为疗法对精神分裂症后抑郁的疗效分析 - Analysis on Curative Effect of Cognitive-behavior Therapy in Treating Depression after Schizophrenia
    天 龙 王 1 , 平 程 1 , 家 胜 祝 1 , 忠烈 郑 1 , 心理治 疗
    1 咸宁学院精神病学研究所 , 咸宁市 , Chinese Mainland

    目的 ： 探 讨认知行为疗法对精神分裂症后抑郁的治疗效果。
    方法 ： 对象为 2004 年 9 月至 2005 年 12 月在我院住院患者 ， 均符合中国精神障碍分 类与诊断标准第 3 版 （ CCMD-3 ） 精神分裂症 诊断标准 ， HAMD 评分 ＞ 18 分。入 组患者共 128 例，随机分 为研究组（西酞普兰合并认知行为治疗， 64 例）与 对照组（西酞普兰治疗， 64 例）。两 组所服抗精神病药物种类基本匹配，治疗量按效价比折算成氯丙嗪等值量，研究组为 （ 365.7±121.3 ） mg/d ， 对照组为（ 358.4±126.6 ） mg/d 。两 组在以上各项及婚姻、教育方面比较差异均无显著性（ P 均＞ 0.05 ）。在 维持原用抗精神病药剂量不变的情况下入组，分别给予西酞普兰合并认知行为治疗和西酞普兰治疗。对研究组病例进行 2 次 / 周的 认知行为干预，每次 30 ～ 45 分 钟。其方法为：（ 1 ）与患者建立良好的治 疗协作关系；（ 2 ）全面了解患者的病史及心理社会因素。（ 3 ）了解患者的个性特征，探 讨其非理性的功能失调性思维、情绪和信念，通过深入的心理互动，运用放松治疗、认知治疗、生物反馈治疗和行为治疗，提高心理应对技巧及适应能力；（ 4 ） 讲解有关精神分裂症的知识，帮助患者正确认识精神疾病，鼓励患者增强自信心，消除自责自卑的心理；（ 5 ）与家庭成 员进行沟通，讲解精神分裂症的临床表现、治疗方案、复发先兆、常见不良反应的处理及心理治疗的必要性，使家属成为患者的支持和监督者。临床疗效评定采用汉密尔顿抑郁量表（ HAMD ）、阳性和 阴性症状量表（ PANSS ） 进行评定。结果：研究组 4 、 6 、 8 周末及随 访 1 年后 HAMD 评分较对照组显著改善（ P ＜ 0.05 ＝；入 组前及 8 周末 PANSS 总分及各因子分两组比较无明显差异（ P ＞ 0.05 ），但随 访 1 年后 PANSS 总分及各因子分研究组明显低于对照组，差异有显著性（ P ＜ 0.05 ～ 0.01 ＝；研究 组的复发率为 23.3% （ 14/60 ）， 对照组的复发率为 41.9% （ 26/62 ），两 组比较差异有显著性（ P ＜ 0.05 ）。研究 组复发率低，依从性好。
    结论： 认知行为疗法对精神分裂症后抑郁疗效确切，有利于回归社会。
     
  • P305
    Evaluation of Efficacy of Cognitive Behavior Therapy in Treatment of Post-Schizophrenia Depressive
    Tian-long Wang 1 , Ping Cheng 1 , Jia-sheng Zhu 1 , ZHong-lie Theng 1 , 心理治 疗
    1 咸宁学院精神病学研究所 , Xianning, Chinese Mainland

    Objective: To evaluate the clinical efficacy of cognitive behavior therapy(CBT)on the patients with Post-schizophrenia depressive ．
    Methods: 128 patients with post-schizophrenia depressive were randomly divided into citalopram treatment plus CBT group(study group ， n=64) and citalopram treatment group without CBT (control group ， n=64) ． The efficacy was measured with Hamilton depression scale(HAMD)and the Positive and Negative Symptoms Scale(PANSS) ．
    Results: The score of HAMD was better in study group than in control group after treatments for 4 ， 6 ， 8 weeks and 1 year follow up ． The total score and factor scores of PANSS of both groups before and after treatments for 8 weeks were not significantly different (P ＞ 0.05) ． However ， the total scroe and factor scores of PANSS were lower in study group than in control group after a year, and the total score and factor scores of PANSS of both groups before and after treatments for a year were significantly different (P<0.05~0.01) ． The study group had lower rates of recurrence and good compliance than the control group ．
    Conclusions ： CBT is effective for post-schizophrenia depressive and condusive for the patients to return to the society ．
    Key words: Cognitive behavior therapy ； Post-schizophrenia depressive
     
  • P306
    亲子游戏治疗在儿童心理辅导中的应用 - The Application of Parent-child Game Therapy in Mental Counseling for Children
    国斌 万 1
    1 深圳市 妇幼保健院 , 儿童心理科 , 深圳 , Chinese Mainland

    目 标 ： 探 讨亲子游戏治疗在儿童心理辅导中的作用。材料和方法：按照美国北德州大学游戏治疗中心 Landreth 所建立的 亲子游戏治疗模式，对两所幼儿园的 20 名儿童的家 长进行为期八周、每周一次、每次 90 分 钟的亲子游戏治疗培训，并要求家长每周在家与孩子进行 30 分 钟的亲子游戏。在治疗前和结束后所有参与培训的家长分别填写父母接纳量表。所有参与家庭在治疗前和 6 个家庭在治 疗后对家庭亲子游戏过程录像 20 分 钟以上，由一名研究者对亲子游戏中父母对儿童的同理心进行评分。另外，在治疗培训结束后由一名研究者对 16 个孩子的父母 进行访谈。结果和结论：游戏治疗结束后，父母接纳量表总分（ 140.7±15.11 与 162.3±9.39 ）和无条件的 爱（ 36.3±6.63 与 40.4±7.80 ）、感受（ 32.5±6.45 与 42.85±4.38 ）、差异性（ 30.20±5.35 与 34.35±4.74 ）和独立性（ 41.65±4.64 与 44.7±3.94 ）四个因子的 评分均比治疗前提高，差异达到统计学意义水平（ P<0.05 ），其中在 总分和感受与差异性因子评分的提高达到高度统计学意义的水平（ P<0.01 ）。 说明亲子游戏治疗能够改变父母对孩子的态度，提高对孩子的接纳程度，尤 其是能 够提高对孩子内心的感受和情感体验、孩子之间存在个体差异上的接纳程度。录像资料分析发现，与治疗前比较，治疗结束后的亲子游戏中，父母对孩子的接纳性交流、容许孩子自我导向和对孩子行为的关注程度上的评分均增加。治疗结束后，接受访谈的父母认为亲子游戏对改善亲子关系、对孩子的成长、对父母本人以及对家庭关系等都有不同程度的积极作用，部分或基本达到参加亲子游戏培训的目标和期望水平。亲子游戏治疗对于提高父母对孩子的接纳程度，改善亲子关系具有积极作用，对于儿童情绪问题和行为问题具有一定的治疗效果。
     
  • P307
    绘 画治 疗在情绪障碍中学生的临床应用 - Drawing Therapy Applied in Middle School Student of Emotion Disorder
    润德 潘 1 , 心理治 疗
    1 广西 龙泉山医院 , 心理科 , 柳州市 , Chinese Mainland

    目的： 探 讨绘画治疗在有情绪障碍的中学生的应用。
    方法： 采用房 - 树 - 人 测验方法对 6 名来心理咨 询的中学生进行治疗，提供 A4 白 纸一张、一支铅笔，然后告诉来访者，请用铅笔在白纸上任意画一幅包括房子、树木、人物在内的画，想怎么画就怎么画，没有时间 限制，均由来 访者独立完成，然后对绘画资料进行分析。
    结果： 6 例均在 11-22 分 钟内完成了房树木人测验。绘画结束后，请来访者讲述绘画的顺序，咨询师对画中的房、树木、人物等进行询问。通过对绘画的形式和内容进行分析，画面大于 2/3 纸的 4 例，小于 1/2 纸的 1 例。画的位置：居中 3 例，左 侧 1 例，上部 2 例。
    方向： 房子正面 5 例， 侧面 1 例；人 6 例均 为正面， 1 例房 顶过大， 6 例均画了 门窗， 4 例画了烟囱， 1 例烟囱冒烟， 2 例在 门前画了弯曲的路； 1 例 树干左侧弯曲， 1 例 树干有伤疤；画人正面像 4 例， 侧面像 1 例，躺着 2 例， 4 例不画五官， 3 例 为画火柴人。提示 6 例中学生有心理 创伤，情绪化的倾向、情绪低落，逃避人际关系，防御、心理失衡等。
    结论 ： 使用 绘画治疗 ， 可以更好地了解这中学生情绪冲突原由 ， 在心理咨询过程中起到了很好的效果。
    关键词 ： 绘画治疗 中学生 情 绪障碍

    Object: To explore drawing therapy applied in middle school student of emotion disorder.
    Method: The 6 middle school students of emotion disorder. Were tested by applied drawing therapy, then their picture were analyzed.
    Result: The pictures were analyzed in form and content, it shows these students were emotional and avoidance interpersonal.
    Conclusion: Drawing therapy can provide cause of emotion disorder in middle school student.
    Keywords: drawing therapy middle school student emotion disorder
     
  • P308
    The Dark Ring
    Hong Chen 1 , Jie Ya Chen 2
    1 World Federation of Chinese Medicine Societies, Beijing, Chinese Mainland, 2 Haidian third Experimental Primary School, Beijing, Chinese Mainland

    Objectives: Use psychotherapies to cure an complicated mental problem.
    Methods:
    1) Dr. Montessori educational therapy.
    2) Dr. Chen Hong's psychotherapies
    Dr.Chen Hong:
    Man could understand the some creatures' soul and smoothed the wounds they had found there. What about the patients' soul?
    Ms. Chen Hong:
    Skeleton key-united for humanbeings. The key for all locks of soul. The small step for me, the huge step for the world The fact that I was cured means many patients could be cured.
    Dr.Chen Hong:
    Yeah, many patients.
    Ms. Chen Hong:
    Put the past behind you before you can move on. Give people hope,all the past can't make up,so facing future actively is bright.I have a dream.
    Dr.Chen Hong:
    Great! Your long term wealth.... short term however... that needs some work, step by step.
    Result:
    1) Ms.Chen Hong's general data was that her parents gave her an informal childhood and she was terribly hurt before ten, she got personality disorder, autism,depression, anxiety, insomnia, neurasthenia, affective disorders. Her extra-husband had schizophrenia, her extra-mother-in-law had schizophrenia too. Her daughter is ten. She divorced twice.
    2) Related affairs Her personal freedom was restricted for 2 years, raped by a criminal and was infectioned by condylomata acuminata,was insulted, was kidnapped, sexual abused for 2 years, deprived of the right to work,disenfranchised for 13 years.
    3) The observation and other's reflection: Lack of intimate relation; Social support systems had been changed.
    Conclusions: The situation above was dark,but her suroundings thought she had good family, her parents were both proffessors. She had good education. Nobody cared of her. She was living in the dark ring for 23 years,suffered from many pains. She was cured in 2007, It is a tough work but it succeed!
     
  • P309
    不同抗精神病 药的长期治疗对患者体质量 , 糖代 谢及血脂的影响 - Chronic Treatment of Different Antipsychotics Affected the Patients' Body Weight, Metabolism of Glucose and Lipids
    Cong-jie Wang 1 , Zhi-jun Zhang 1 , Jing Sun 1
    1 Huai an No.3 People's Hospital, Huai an, Chinese Mainland

    [ 摘要 ] 目的 ： 调查和探讨长期抗精神病药 （ APS ） 治 疗对精神分裂症患者的体质量改变 ， 以及对患者血糖和血脂等代谢改变的影响 , 及其可能 发生机制。方法： 共 调查 308 例精神分裂症患者 , 其中使用 APS 治 疗时间 ≥5 年的患者 271 例 , 分 别测量其身高和体质量 , 抽取空腹肘静脉血等。 APS 应用方法主要分为单用经典 APS 、 单用氯氮平和二者联合用药三种。用比色法检测患者空腹血清游离脂肪酸，用放射免疫法测定患者 血清胰 岛素和瘦素。
    结果： 1. 三 组方差分析示， 二者 联合用药者体质量指数、空腹血糖、血甘油三酯和血游离脂肪酸水平均显着高于单用经典 APS 患者；且二者 联合用药者的血胰岛素和胰岛素抵抗指数也分别显着高于单用经典 APS 患者和 单用氯氮平患者。
    2.X2 检验示 , 单用氯氮平和联合用药者 , 发生糖耐量降低和罹患 2 型糖尿病比例均 显著高于单一使用经典 APS 治 疗的患者 (P 值均 <0.05) 。
    3. 相 关分析示： 患者体 质量指数的改变与患者空腹血糖、血清瘦素、血甘油三酯和胆固醇水平，以及与胰岛素抵抗指数均呈显着正相关；患者血清瘦素水平 的 变化与患者血胰岛素水平也呈显着正相关 , 而与胰 岛素抵抗指数（ HOMA-IR ） 趋向正相关（ P=0.058 ）。
    4. 多元逐 步 线型回归分析示， 进入影响空腹血糖水平方程的因素分别为胰岛素抵抗指数、血胰岛素、胆固醇和体质量指数，标化偏回归系数分别为 1.97,-1.65,0.11,-0.083,P 值分别为 0.000 ， 0.000 ， 0.001 和 0.015 ； R2=0.829 。
    结论： 氯氮平与经典 APS 联合应用 , 以及 单用氯氮平均易增加患者发生肥胖，且易导致患者血糖、血脂、血游离脂肪酸水平显着升高，并增加胰岛素抵抗，乃至引起糖耐 量降低，甚至 导致 2 型糖尿病。


    Objectives: To investigate and explore how the chronic treatment of different antipsychotics (APS) impacted on body weight, fasting blood glucose and serum lipids in schizophrenic patients, and explore the possible mechanisms of its onset..
    Methods: 308 cases of schizophrenic patients were investigated. The high, body weight, fasting and post 2-hour blood glucose in 271 of 308 cases that duration of treatment was more than 5 years were measured. The methods of antipsychotics used were single-use typical APS, single-use clozapine, and co-use of them. Serum free fatty acids (FFA) were tested by colorimetry. Serum insulin and leptin were measured with radioimmunoassay.
    Results: (1). The body weight, fasting blood glucose, blood glyceride and serum FFA level in the patients of co-using typical APS with clozapine were markedly higher than that in patients with single-use typical APS and only using clozapine, respectively. Serum insulin levels and HOMA-IR in co-use group were also remarkably higher than that in patients with single-use APS and single-use clozapine. (2). The ration of suffering impaired glucose tolerance(IGT) and type 2 diabetes mellitus in patients with single-use clozapine and co-use group were significantly more than that in patients with single-use typical APS. (3). The changes of body weight were positively correlation with fasting blood glucose, serum leptin level and HOMA-IR. And serum leptin levels were also positively correlation with serum insulin levels. (4). Multiple linear regression analysis indicated that all variables entered into the fourth multivariate model if their associations with FBG met the 0.05 significance level for entry into the model, using stepwise procedure, were HOMA-IR, serum insulin, serum cholesterol, and BMI. R2=0.83.
    Conclusions: Single-use of clozapine and its combination with typical antipsychotics both easily induced obesity, elevations of fasting blood glucose, serum lipids and serum FFA. And it may increase insulin resistance, even induced IGT and type 2 diabetes mellitus.
    Key words: antipsychotics; body weight; metabolism of glucose; serum lipids
     
  • P310
    Psychotherapy for the Children: Cultural Considerations
    Yixin Chen 1 , Chunyu Ge 2
    1 Nanjing Medical University Affiliated Psychiatric Hospital , Nanjing , Chinese Mainland, 2 Huhoo University , Nanjing , Chinese Mainland

    Purpose: Elaboration of the clinical experiences of psychotherapy for the children in China .
    Method: Based on the clinical experiences of psychotherapy with children, that have been carried out in Child Mental Health Center in Nanjing , China , the key points that are needed for consideration from cultural perspectives are to be summarized.
    Results: (1) The characteristics of Chinese family need proper attention from cultural perspectives. The Chinese families are stem family by structure. More than half of the children are raised by their grandparents. Thus, family relationship often presents multiple-triangle problems among different generations. Within the family, there are often lack of adequate communication among the members particularly regarding their feeling and emotion. Parents often hold high expectation for their children for academic achievement, which cause tension between the parent-children. (2) For the therapy, it is important to value the role and function of grand-parents as the major resources of support. Pay attention to the hidden structure of the family in term of who are the key members; adequately use of multilateral alliance to maintain the neutrality within the family; comprehend parents' expectation toward the therapists as "experts", but in the same time, utilized parents' ability of helping their own children's. Frequently use the skill of reframing to decrease the attention to the symptom and problems, and focus more on the strength the family have.
    Conclusion: Psychotherapy for children needs adequate attention to the cultural factors. The theories and method of family therapy should be flexible to accommodate the culture of the family.

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