- P367
拉莫三 嗪与丙戊酸钠治疗双相抑郁的临床对照研究 - A Random and Controlled Study of Lamotrigine and Sodium Valproate for Depression in Bipolar Disorder
Jian-hong Yang 1 , Xin-hua Shen 1 , Min-Cai Qiang 1
1 The Third People's Hospital of Huzhou, Zhejiang, Chinese Mainland
目的 : 评价拉莫三嗪治疗双相障碍 抑郁 发作的效果和安全性。
方法 : 对 107 例双相障碍抑郁 发作患者采用随机、平行分组、对照的方法分别以拉莫三嗪和丙戊酸钠治疗 ， 疗程 8 周 ， 以 汉密尔顿抑郁量表 （ HAMD ） 、 临床疗效总评量表 （ CGI ） 在治 疗前和治疗后第 1 、 2 、 4 、 6 、 8 周末 评价疗效 ， 同时采用治疗时出现的症状量表 （ TESS ） 进行安全性评估 ， 在第 1 、 2 、 4 、 6 、 8 周末及需要 时用 Bech-Rafaelsen 躁狂量表 （ BRMS ） 评定躁狂症状。
结果 : 拉莫三 嗪组和丙戊酸钠组比较 ， 两组有效率分别为 75.5% 和 51.9% ， 治 疗第 6 周和第 8 周末 HAMD 总分和 减分率差异有 统计学意义。治疗组不良反应明显较对照组发生率低。
结论 : 拉莫三 嗪治疗双相障碍抑郁发作疗效优于丙戊酸钠 ， 且前者不良反应较少 ， 安全性高。
关键词 : 双相情感障碍 拉莫三 嗪 抑郁 发作
Objective: to compare the effects and adverse events of lamotrigine and sodium valproate in the treatment of depression in bipolar disorder.
Methods: 87 inpatients were entered into the study by a random, controlled way for 8 weeks. The effects and safety were evaluated by the Hamilton Rating Scale for Depression (HAMD) , Clinical Global Impressions scale (CGI) and TESS at baseline and at the end of weeks 1,2,4 ,6and 8. The Bech-Rafaelsen Mania Rating Scale （ BRMS ） was also administered at the end of weeks 1,2,4 ,6and 8 or when necessary .
Results: The response rates were 75.5% and 51.9% respectively in lamotrigine and sodium valproate group. Significant difference in the efficacy was found between lamotrigine and sodium valproate. There were more adverse effects in sodium valproate group than in lamotrigine .
Conclusion: Lamotrigine has higher efficacy with less side effects to sodium valproate in treatment of depression in bipolar disorder.
Key words: Bipolar disorder, Lamotrigine, Depressive episode
- P368
Maternal Smoking and Alcohol Consumption, and Young Adults' Cannabis Use: A Prospective Study
Mohammad R. Hayatbakhsh 1 , Jake M Najman 1
1 The University of Queensland, QADREC, School of Population Health, Brisbane, Australia
This study examined whether: (1) maternal use of legal drugs (alcohol and tobacco) when a child is 5 and 14 years of age predicts cannabis use in young adults; and (2) this association is explained by possible confounding or mediating factors. Data were from a prospective birth cohort study of mothers and their children in Brisbane , Australia . This study is based on a cohort of 3,176 young adults who participated at the 21-year follow-up of the study and for whom data were available on maternal smoking and alcohol consumption 5 and 14 years after the birth. After controlling for possible confounders, maternal smoking at 14 years was associated with frequent use of cannabis in offspring at 21 years, regardless of maternal smoking at 5 years. Mothers who drank more than one glass alcohol at 5 years and continued at 14 years were more likely to have children who used cannabis in early adulthood. The association between maternal substance use and their offspring's cannabis use was partially mediated by adolescent externalizing behavior and smoking measured at 14 years. Prevention programs that address maternal and adolescent tobacco use and adolescent externalizing behavior should be considered as strategies to reduce cannabis use by young adults.
- P369
澳大利 亚 （ 新南威尔士 ） “ 精神科急症 监护中心 ” 服 务模式评估 - Psychiatric Emergency Care Centres: Evaluating a New Service Model in NSW, Australia
Grant Sara 1 , Anna Hall 1 , Kevin Wolfenden 2
1 InforMH, NSW Health, North Ryde, Australia, 2 NSW Health, North Sydney, Australia
背景 ： 澳大利 亚的精神卫生机构已经并入综合性医院。急诊病房作为精神卫生的前沿科室，则要求建立更好的服务模式。新南威尔士（ NSW ）在 综合医院的急诊科开设了 “ 精神科急症 护理中心（ PECCs ） ” ，即在急 诊科设置 4-6 张精神科床位，并且为患者提供 24 小 时专业人员服务、评估、护理。 目的： 对 “ 精神科急症 护理中心 ” 一年来的工作 进行评估，主要包括以下三方面： 1 、改善 护理质量 2 、提高服 务的可获得性 3 、建立 稳定的服务模式。
方法： 对 7 个 “ 精神科急症 护理中心 ” 进行多方面评估，包括收集临床数据、数据连接、家属访谈，工作人员访谈，临床医疗记录评估、机构巡视。
结果： 有 8222 名 调查对象接受了调查，结果显示 “ 精神科急症 护理中心 ” 使人 们更加便利的接受精神科专业人员的服务，提示风险，获取医疗记录并让家庭成员参与护理。家属及患者都表示出较高满意度，也很少发生严重医疗事故。 “ 精神科急症 护理中心 ” 对患者而言，提高了服务的可获得性，缩短了急诊住院时间， short admissions to associated mental health units were reduced. “ 精神科急症 护理中心 ” 和 “ 急 诊科 ” 工作人 员都表示较高满意度，增加工作的稳定性。患者每天的住院支出与其他急诊住院花费相当。
结论： 对于急诊精神医学而言 “ 精神科急症 护理中心 ” 是一 种可行的服务模式。今后面临的挑战是精神卫生服务同急诊科的分离 ， 这涉及急诊科工作人员的能力和对有明显精神问题的患者的躯体评估。
Background: Australian psychiatry has moved from institutions into general hospitals. Emergency Departments (EDs) are often a front door to mental health care, however better service models for the ED are needed.
NSW is implementing Psychiatric Emergency Care Centres (PECCs) in metropolitan general hospital EDs. These are small (4-6 bed) inpatient units within EDs, providing 24 hour mental health staffing, assessment, and brief inpatient care.
Aim: To evaluate the first year of operation of PECC services against three goals; (1) improving quality of care, (2) reducing delays in service access, and (3) developing a sustainable service model.
Methods: A multimodal evaluation of seven PECC units was conducted. Methods included clinical data collection, data linkage, surveys of PECC consumers and carers, surveys of PECC and ED staff, clinical file review and facility inspections.
Results: Information was collected on 8222 presentations. PECCs appeared to improve access to specialist mental health staff, documentation of risk, access to clinical records and involvement of families in care. Consumers and carers reported high levels of satisfaction. There were few serious incidents. PECCs appeared to reduce delays in accessing mental health beds and to shorten total time in the ED. Short admissions to associated mental health units were reduced. The PECC model appeared sustainable; satisfaction of PECC and ED staff was high, with positive staff retention. Bed day costs were equivalent to other acute inpatient units.
Conclusions: PECC services appear to be a viable model for mental health care in the emergency deparment. Challenges for PECCs include the separation of mental health care from the ED, with implications for ED staff skills and the physical assessment of persons with apparent mental health problems.
- P370
精神科以患者 为受试对象的临床实验所涉及的伦理问题思考 - Ethics Reflection in Clinical Research with Psychiatric Patients
秉玉 曹 1
1 山 东省精神卫生中心 , 山 东省精神卫生中心四病区 , 济南市 , Chinese Mainland
摘要 本文主要探 讨精神科以精神疾病患者作为研究对象的临床实验所涉及的伦理问题。从医学伦理学的角度上分析、讨论了精神病人是否可以作为临床试验的受试对象，精神病人作为临床试验受试者的自愿与非自愿问题以及知情同意等伦理问题，旨在促进精神科医生对精神科科研伦理的关注和重视。 作者姓名：曹秉玉 单位：山东省精神卫生中心 通 讯地址：山东省精神卫生中心四病区
The aim of this paper is to explore the ethical aspects of the psychiatric patients as human subjects in clinical research. Several questions have been addressed ethically in this paper regarding whether the psychiatric patients should be used as human subjects in clinical research; whether the voluntary or non-voluntary participants of the psychiatric patients should be considered and whether the informed consent should be resided in the procedure of clinical research. In conclusion, it's imperative for the psychiatric practitioners to focus on the importance of ethical issues in clinical research.
- P371
对精神科中因强行住院引发伦理问题的探讨 - A Study of the Ethical Problem from Forced Hospitalization in Psychiatric Hospitals
Chen Xu 1 , Tang Maoqin 1
1 Shandong Mental Health Center , Ward 4, Jinan , Chinese Mainland
背景 ： 由于精神科存在着不同于其他 临床科室的特殊性 ， 即精神病患者因疾病自身对他们的影响而失去自知力 ， 多不能接受治疗。这就造成了某些精神病患者被强行送入医院的现象，从而引发了下列伦理问题：强行住院是否尊重病人的权利、是否真的 “ 剥 夺 ” 了病人的自主 权？家属有无权利决定住院或更具体的说是患者的什么人才能决定住院？医生和医疗机构在此应起哪些作用？如何调整医患之间表现在强行住院问题上的矛盾？
方法： 针对上述问题，先客观的分析其产生过程。随着精神病人病情的逐步显现，患者家属认识到送其住院是必需的，为使患者住院治疗，常借助医生的 “ 威 严 ” ，采用 强迫的方式 将其送入院。 这就使患者自然而然的感到是医生强迫他住院的，自己的权利受到 “ 侵犯 ” ，从而引起患者 对医生的仇恨和对治疗的抵触情绪。
结果及结论： 首先，住院治 疗对于精神病（或称之为重型精神病）患者既尊重了其健康权，符合有利无伤的医学伦理首要原则，对他们的 “ 强行 ” 并不是剥 夺他们的自主权，而是由家属或称为法定监护人代为行使。其次，重性精 神疾病病人失去民事行 为能力时，其家属有义务为患者诊治，应依照法律规定的监护人顺序代病人行使病人的部分权利，但这并不等同于患者失去了所有权利，他仍有人的最基本权利。第三，精神科医生在涉及 “ 强行住院 ” 问题时，而应履行告知义务。是否住院应由患者或法定监护人来行使自主权，而不是医生作决定。医疗机构则应依照医学伦理学的基本原则改革现行的有关精神科的医疗规章制度。强调维护精神病患者的权利是精神科医护工作的重中之重 ， 但决不能片面的只强调患者某一权利 ， 而忽略其他权利。
To explore the ethical problem from hospitalzation by force in psychiatric hospital initially and find out its background ,causes and solving methods .It is revealed that the law of mental health should be legislated as soon as possible in order to deal with the similar ethical problems.
Background: Today , with the increasing of mental disease and the unfitting legal system for psychotics, there are more and more ethical problems happened in clinic. Because of the particularity of mental hospital , the most patients with psychosis could not have insight and refuse therapies, then they are often sent to hospitals by force. At the same time, ethical problems are coming, whether the right of the patients is deprived off? whether others have the right to force them hospitalized? What should the doctor do when the patients hospitalized unwillingly? In developed countries, the similar problems were debated drastically, the focuses were that whether the patients have right to refuse therapy? If does the management and treatment by force encroach? and what does legislation deal with it?. The ‘patients' in this paper are the peoples in serious mental diseases, the forced mode in this paper is different with the mode in justice.
Method: To aim directly at the doubts, we should analyse the process. With the states of mental illness worsen, their relatives realize that it is essential to pull them into hospital and treat without their willingness. Thus they take themselves offended for granted and conflicted to the cure naturally. Through the initial survey in several areas of Shangdong Province , it was found that most psychotics thought they were deprived off freedom by psychiatrists and some doctors considered it unnecessary to explain to the guardians and patients. So that, it made them difficult to cooperate to therapy smoothly.
Result and conclusion: At first, inpatient care benefites not only to the psychotics, but also to the families and society, fitting to the chief doctrine of advantageous without hurt. Secondly, being obliged to hospitalize does not mean that they lost the right totally, it is temporarily that the guardians have some rights instead of the patients. Thirdly, the doctors have responsible to inform make the guardians knowing and get authorizing before medical treating. Followed with the social development and peoples' psychiatric changing, the mental medical institutions should reform the rules and regulations.
Emphasizing on sticking up for the patients' rights should be wholly considered .
- P372
证人对人物、地点和事件记忆的精确度 ： 准确的 ， 不 准确的或恰恰是 错误的 ？ - Accuracy of Eyewitness Memory for People, Places and Events: Accurate, Inaccurate or Just Plain False?
Charles Morgan 1
1 Yale University , Psychiatry, New Haven , United States
目的 ： 在 过去的十年中 ， 大量研究证明对强烈应激事件的记忆并不是象照相机的闪光灯定格那样的真实和固定 ， 而是会变化的。这些回顾性研究由于缺乏 事 实依据已经限制了研究结果能多大程度上用于当今的司法实践。目前的研究旨在探讨这个局限性。
方法： 对军队中的 800 名受 试人员进行调查，评估其对强烈应激事件的记忆的准确性。
结果： 证人对地点、事件的记忆和鉴定的准确性随应激程度的增加而下降。而且，各种形式的记忆都会有显著的错误信息。
结论 ： 研究 显示对强烈应激事件的记忆并不是一成不变的 ， 它们和对日常事件的记忆一样容易被修饰。旨在评估创伤相关记忆的司法精神医学评价体系是需要讨论的。
Objectives: Over the past decade numerous studies have provided evidence that memory for highly stressful events is not "flashbulb" in nature, but mutable. The retrospective nature of such studies (and the lack of ground truth) has limited the degree to which these findings may be applied to current forensic practice. The current study was designed to address this limitation.
Method: Accuracy of memory for high stress events was prospectively assessed in 800 paritipants Military personnel.
Results: Eyewitness Identification, Memory for Places and Events were degraded by stress. In addition, a significant effect of misinformation was observed for all types of memory.
Conclusion: The present findings show that memory for high stress events is not imutable and that it is just as vulnerable to modification as are memories for everyday events. Implications for forensic psychiatric evalutions designed to assess trauma-related memories are discussed.
- P373
121 例 严重危害社会的精神障碍者资料分析 - The Analysis of 121 Case Mental Disorder of Endanger Society Seriouly
轶峰 朴 1 , 柏 勋 韩 1
1 广州市民政局精神病院 , 安康医院 , 广州市 , Chinese Mainland
目的 : 探索有 严重危害社会的精神病患者发生危害行为的一般规律 ， 从而有效地防范伤害事件的发生。
方法 : 自制 调查表并收集研究对象的一般人口学的资料、临床特征、危害社会行为特点等内容 ， 回顾性分析其相关资料。结果 精神分裂症占首位 ， 约 90% ， 且 识别率低、未治率高 ； 伤害对象多为与其生活、工作有关系的人员 ， 如妻子 ， 父母 ， 子女及其他亲属。
结论 : 加 强精神 卫生知识的普及以提高对精神疾病的识别率 ， 加快落实以医院为依托、社区防治为主的三级精神病防治康复网络 ， 以提高缓解率、降低复发率、控制肇事率。
关键词 : 精神障碍 精神分裂症 严重危害社会
Object: Investigate the general regulation of mental disorder occur endanger society behavior.
Methods: historical 、 clinical and hurt society behaviors were analyses.
Results: The schizophrenia is share first, about 90%, and identify rate is lower, did not treatment rate is higher ,be hurt object more are his wife 、 parents 、 son 、 daughter and other relatives.
Conclusion: Strengthen universalize the mental hygiene knowledge to identify the case of mental disorder in quickly, speed put into effect the three class mental disorder prevention and treatment network of rely on hospital, prevention and treatment mainly in community, for higher the alleviates, lower the relapse and the endanger society behavior.
Key words: mental disorder schizophrenia endanger society behavior
- P374
Analysis of Sexual Assault against Female Patients with Mental Disorders
曹 延筠 1 , 张 宝 华 2 , 孙 洪 强 3 , 吉 中孚 4
1 北京回 龙观医院 , 22 区 , 北京 , Chinese Mainland, 2 天津市公安局安康医院 , 康 复中心 , 天津 , Chinese Mainland, 3 北京回 龙观医院 , 3 区 , 北京 , Chinese Mainland, 4 北京回 龙观医院 , 北京 , Chinese Mainland
Objective: To explore the characteristics of sexual assault against female mental disorders ．
Methods: Retrospective analysis of related factors of 89 female sexual victims with the help of self-made investigation forms ．
Results: The majority of the sexual victims were young and low educational peasants ． In cases of sexual assault against female mental disorders ， those lost sexual self-defensive ability or reduced sexual self-defensive ability accounted for 71.9 ％， moderate or severe mental retardation were 42.8 ％， schizophrenia on the period of onset accounts for11.2%. 84.3 ％ sexual assault person were familiar with sexual victims. 74.1 ％ applicants for forensic psychiatric expertise were the sexual victims or their relatives.
Conclusion: Those female menta1 disorders should be taught as well as receive training of certain knowledge of sexuality. Treating and guarding the female mental disorder patients should be strengthened and concerned by the whole society ． At the same time, with the development of the society and economy, the more awareness on related laws female mental disorders got, the more punishment on those sexual assault and legal interests of female mental disorders would be received.
Key words: Self-defensive ability against sexual abuse; Mental disorder; Sexual assault; Forensic psychiatric expertise
- P375
简易精神症状自陈量表的编制及信度、效度检验 - Developing of Brief Psychiatric Symptom Self-rating Scale and its Reliability and Validity
北陵 高 1 , 冬凌 吴 1 , 映萍 李 1 , 璐 盛 1 , 学武 李 1
1 深圳市精神 卫生研究所法医精神科 , 深圳市 , Chinese Mainland
目的 ： 本研究 编制了 25 个条目的 简易精神症状自陈量表 ， 以期能为精神医学鉴定提供更为简便而有效的评估工具。
方法 ： 总结近几年来司法鉴定案例中的伪装表现 ， 参阅国外相关测验及文献 ； 编制精神科临床相对少见的精神症状条目 （ 最初 50 个条目 ）； 在正常人和精神病人中 进行初试 （ 50 例 ）， 进行条目的修改与筛选 ， 保留了其中的 25 个条目 ， 构成正式研究 测验。以精神医学鉴定中伪装精神障碍者为研究对象 ，与普通精神科 临床的精神疾病患者及正常人进行比较，分析三组人群在该量表的得分情况，找出伪装与非伪装的划界分，并作判别分析。另外，部分测试对象在间隔 5-15 日后予以重 测；部分测试对象实施 MMPI 和二 项必选数字记忆测验，并与鉴定专家诊断伪装精神症状与否进行信度和效度检验。
结果： ① 伪装组的四个因子分及总分均显著大于精神障碍组及正常人组，精神障碍组的四个因子分及总分均也显著大于正常人组（ P<0.001 ）。②信度：全量表的 Cronbach's α 系数 为 0.91 ；量表的分半信度 为 0.90 ；重 测信度为 0.73 ～ 0.98 ，表明量表具有 较好的内部一致性和稳定性。 ③效度：各因子均与全量表 总分呈高度相关， r 在 0.79 ～ 0.87 之 间；各因子之间为中度相关， r 在 0.50 ～ 0.65 之 间，反映量表的结构效度较为理想。全量表总分与 MMPI 的 Fake 分量表相 关系数为 0.76 ；以 专家评定为校标，量表判定伪装的总准确率为 86.6 ％，表明量表有 较好的实证效度。 ④划界分： 总分大于、等于 13 分 为判定伪装的划界分，判定的总准确率 89.6% ，特异度 91.5 ％，灵敏度 为 79.2 ％。
结论 ： 简易精神症状自陈量表具有良好的信度和效度 ； 是识别伪装的有效评定工具。
- P376
Reliability ， validity and Cut-off Score of Self-Report Scale of Brief Psychopathological Symptoms
Beilin Gao 1 , Dongling Wu 1 , Yingping Li 1
1 Knagning Hospital of Shenzhen, Forensic Psychiatry, Shenzhen, Chinese Mainland
Objective: ① To develop a self-report scale of brief psychopathological symptoms （ SBPS ） ,and to find the cut-off score. ② To examine the reliability and validity of self-report scale of brief psychopathological symptoms （ SBPS ） .
Methods: The subjects with malingering psychiatric symptoms in forensic psychiatry, the patients with mental disorders in general psychiatry and normal sample were tested by SBPS. To compare their differences of dimensional scores and total scores of SBPS, and to find the cut-off score of detecting feigned mental disorder. The reliability and validity of the scale were tested based on three groups of subjects including the cases involved forensic problems, the patients with mental disorders and normal persons. Some of them were retested at 5-15days after first examination. Other subjects of them finished MMPI at same time.
Results: ① The four dimensional scores and total scores of SBPS in malingering group were significant higher than the that of two groups of patients and normal. The four dimensional scores and total scores of SBPS in the group of mental disorders were also significant higher than the normal group （ P<0.001 ） . ② The cut-off of the total score was 13, and the accuracy rate ， the specificity and the sensitivity of SBPS were separately 89.6%, 91.5 ％ and 79.2 ％ for detecting feigned mental disorder. ③ The Cronbach's α coefficients of SBPS was 0.91. The split-half reliability was 0.90. The test-retest reliability ranged from 0.73 ～ 0.98. ④ The correlations between factors scores and the total scores ranged from 0.79 to 0.87. The correlations among the four factors scores were medium correlation, ranged from 0.50 to 0.65. The construct validity was supported by factor analysis. Acceptable internal consistency was obtained for total and dimensional scores. Significant correlation was found between the total scores of SBPS and the fake scores of MMPI (r=0.76). Based on the experts diagnosis, the accuracy rate of SBPS for evaluating malingering was 86.6 ％
Conclusion: SBPS is useful to detect the malingering psychiatric symptoms. The SBPS has acceptable psychometrics properties on reliability and validity.
- P377
简易精神症状自陈量表在精神医学鉴定中的应用 - An Examination of the Self-Report Scale of Brief Psychopathological Symptoms to Detect Malingering in Forensic Psychiatric Subjects
志彪 黄 1 , 北陵 高 1 , 璐 盛 1 , 映萍 李 1 , 学武 李 1
1 深圳市精神 卫生研究所法医精神科 , 深圳市 , Chinese Mainland
目的 ： 将 简易精神症状自陈量表用于司法精神病及精神伤残鉴定中的案例 ， 并予以总结分析应用情况。
方法 ： 对 206 名不同 类型的精神医学鉴定的被鉴定人用该量表进行检测。结果 ： ① 以 该量表总分 13 分 为划界分 ， 206 例被 鉴定人中有 71 例 为伪装或主观夸大 （ 34.5 ％） 。与 专家评定的结果相比，量表评定的假阴性为 19.8 ％；假阳性率 为 1.7 ％； 总准确率为 90.8 ％。②工 伤和交通事故伤残理赔鉴 定案例 伪装比例较高（ 51% ）。③量表 总分及各因子分与二项测验的因子分及总分均呈低度或中度相关（ r ＝－ 0.191 ～－ 0.532 ， P<0.05 ）。④以 专家经验和该测验一致评定的结果对各种案件中的伪装情况进行分析，结果显示，在两种方法评定一致的 187 例中，以工 伤和交通事故伤残鉴定案例伪装或夸大精神伤残的人数比例较高，达一半以上（ 51% ），而刑事案件中的 伪装人数比例最少，仅 14.8% 。民事案件中的 伪装人数较刑事案件高，但比理赔伤残鉴定伪装的情况少，差异具有非常显著性结论：简易精神症状自陈量表对评估伪装精神症状具有良 好的参考价 值。
To examine the self-report scale of brief psychopathological symptoms(SBPS) to detect malingering in forensic psychiatric cases.
Methods: Two hundred and six subjects involved different kinds of forensic problems were tested by SBPS and BFDMT.
Results: ① It was about 71 of 206 cases （ 34.5 ％） were classified to malingering by the cut-off 13 scores of SBPS. Based on the experts evaluation, false negative rate of SBPS was 19.8 ％ and with 1.7 ％ of false positive rate. Total the accuracy rate was 90.8 ％ 。 ② The compensational cases including working injury and traffic accidence had highest rate of malingering (51%). ③ There were low and moderate relationship between total score and factor scores of SBPS and that of BFDMT （ r ＝－ 0.191 ～ － 0.532 ， P<0.05 ） .
Conclusion: SBPS is useful for detecting malingering psychopathological symptoms.
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脑外伤患者伪装认知功能损伤事件相关电位比较分析 - A Comparative Study of Event-related Potentials in Brain Injured Patients with Pretending Cognitive Impairments
树明 丁 1 , 北陵 高 1 , 冬凌 吴 1 , 学武 李 1 , 伟德 梁 1
1 深圳市精神 卫生 研究所法医精神科 , 深圳市 , Chinese Mainland
目的 : 目前国内 虽有一些对伪装智力记忆低下的心理学评估方法做过一些研究 ， 但通常人们认为生理指标更可靠、更精确。因此，有必要寻找不易受主观因素影响、更为客观的指标来反映伪装认知功能损伤的情况。本研究即探讨检测伪装认知功能损伤的神经电生理技术。
方法 : 以 2005 年 10 月～ 2006 年 6 月因工 伤、交通事故或意外伤害所致脑外伤的成年患者（均为右利手），在神经外科治疗终结后，进行精神损伤或伤残鉴定期间进行 ERP 检测。除外听力障碍、显著精神症状影响测试及 完全不配合 测试者，共 193 例完成 测试。同时由 2 名副高 级或以上职称的精神医学鉴定专家，根据临床检查、二项必选数字记忆测验（伪装记忆智力缺损测验）结果及实施实施事件相关电位检测时被试对高低音判断的正确率，将测试对象分成伪装组与非伪装组，其中伪装组 52 例，非 伪装组 120 例， 21 例 难以确定被剔除 ( Kappa=0.89, p<0.001) 。通 过高低音听觉刺激高低概率范式（ oddball ）引 发事件相关电位，并同步记录被试判断高低音的正确率，分析伪装与非伪装认知功能损伤者的事件相关电位相关参数的差异。结果 ① 伪装组对高 、低音判断的正确率 为 79.2±19.8 （％），而非 伪装组高低音判断的正确率为 93.1±9.3 （％），差异具有非常 显著性（ t ＝ 5.195 ， p=0.000 ）。② P300 和后 负慢波的潜伏期均以伪装组短于非伪装组，而 P300 和后 负慢波的波幅则均以伪装组大于非伪装组，但仅后负慢波的潜伏期在二组间的差异达到了显著性（ p ＝ 0.001 ）。③ 伪装组 P300 潜伏期短于非 伪装组，而波幅大于非伪装组，但差异未达到显著性。
结论 : 事件相 关电位对伪装认知功能损伤的诊断具有一定的发展前景。伪装者客观脑电生理反应 ( 潜伏期短，波幅大 ) 与其主 观行为表现（判断高低音的正确率低）的 “ 矛盾 现象 ” 可以作 为伪装认知功能损伤的诊断依据。
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Comparative Analysis on ERP in Head Injury Patients with and without Faking Cognitive Impairment
Shuming Ding 1 , Beiling Gao 1 , Dongling Wu 1
1 Shenzhen Kangning Hospital , Forensic Psychiatry, Shenzhen, Chinese Mainland
Objective: To explore a neuro-electrophysiological technique to detect pretending cognitive impairment.
Methods: The patients with compensational head injury cases were examined by auditory oddball stimulation event-related potential (ERP). At the sometime, to record their the correct rate of differentiating high or low voices in the auditory test. The related parameters of ERP in the test were analyzed between two groups with and without faking cognitive impairment.
Results: ① The Peak latency (PL) of the negative deferred wave post P300 in faking group was significant shorter than non-faking group （ p ＝ 0.001 ） . The amplitudes (AMP) of the negative deferred wave post P300 in faking group were higher than non-faking group, but no significant difference. ② The PL of P300 in faking group was shorter than non-faking group, and the AMP of P300 was higher than non-faking group, but all no significant differences. ③ The correct rate of differentiating high or low voices in faking group was significant lower than non-faking group （ P<0.01 ） .
Conclusion: There are referring value to diagnose faking cognitive impairment by ERP. There are diagnosing value by the contradictory feature between short PL, high AMP and low correct rate of differentiating high or low voices in oddball stimulation test.
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关于皮肤科模仿病的医学法律问题 - Medico Legal Problrms about Ctaneous Pathomimesis
Remi Costagliola 1 , florent Trape 2 , Frederic Laffite 3 , Daniel Rouge 2 , Michel Costagliola 4
1 CHU Rangueil, Service de Médecine Légale, Toulouse, France, 2 CHU Rangueil, Medecine Legale, Toulouse, France, 3 CHU Rangueil, Service de Chirurgie Plastique, Toulouse, France, 4 Clinique du Parc, Chirurgie Plastique, Toulouse, France
模仿病是一 种模拟的病理状态 ， 是对躯体症状的一种错误感知。模仿病通常令医生感到困惑，有时会导致非常严重的后果。皮肤科医生、整形外科医生和医学 - 法律从 业者 可遇到皮 肤科模仿病，诊断很困难。诊断基于反复出现的单一病态表现、患者对于模拟病态有一定认识却拒绝承认、患者不寻求任何获益。临床处理中有必要让患者咨询精神科医生，以明确其精神状态，但是对于这种自我攻击式疾病的治疗并不容易。在医学 - 法律背景下，模仿病患者依据持久的病 态后果欲获得病残赔偿是不可能的，但应让其认识到获得赔偿的医学理由并不充分，这种认识有可能终止患者的自我攻击。本文作者回顾了这种疾病的一些病理学特征和治疗要点，但难题仍需要用多学科的方法加以处理。
Pathomimesis, a false affection with organic symptoms corresponds to a simulated pathology. Often confounding the doctor it sometimes results in very serious sequels. Cutaneous pathomimesis are seen by dermatologist, plastic surjeon, medico legal practicioners and diagnostic is difficult. Diagnosis is based on, the repetitive and monomorphic nature of the manifestation, the patient knowledge of his simulation but his refusal to admit it, the absence of looking for any beneficial effects.
It's necessary to have the patient consult a psychiatrist in order to find his psychiatric profile, but the treatment of this self aggression is not easy.
In a medico-legal context, indemnification for disability due to permanent sequels is impossible but recognition of inaptitude for medical reasons may be proposed. This recognition may put a stop to self aggression.
The authors recall several pathogenic and therapeutic elements for this disease which, although difficult should be managed by a multidisciplinary approach.
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16 年 间司法精神病鉴定变化趋势的研究 - Study of Change Trend in Jurisdictional Identifications of Mental Diseases for Sixteen Years
忠臣 孙 1 , 鸿志 高 1
1 黑 龙江省公安厅安康医院 , 黑 龙江 , Chinese Mainland
目的 ： 本研究通 过对我院 16 年 间所做的 1661 例司法精神病 鉴定资料的回顾性分析 ， 探讨 16 年来司法精神病 鉴定的变化情况 ， 以适应目前司法精神病鉴定工作发展的需要。
方法 ： 以 1990 ～ 2005 年我院所 鉴定的 1661 例司法精神病 鉴 定案例 为研究对象 ， 以前后八年为分界线 ， 将 1990 ～ 1997 年所 鉴定的 761 例与 1998 ～ 2005 年所 鉴定的 900 例分成前八年 组和后八年组 ， 比较两组在案件类型、鉴定诊断、刑事责任能力的变化情况。
结果 ： ⑴ 人口 资料显示 ： 男性鉴定案例明显多于女性 ， 男女之比为 1.8 ： 1 ； 鉴定案例中以 20 ～ 40 岁的青壮年居多 ， 占全部鉴定案例的 65.20 ％； 文化程度在小学以下的占 53.24 ％， 大 专以上文化程度的仅占 4.10 ％ 。⑵案件 类型：以杀人和伤害所占的比例最高，占全部鉴定案例的 36.33 ％，其余依次 为被强奸（ 17.23 ％）、盗窃（ 8.98 ％）、 强奸（ 8.57 ％）、放火（ 8.50 ％）、 抢劫（ 4.25 ％）、其它（包括流氓、 贪污、诈骗、殴打他人、毁坏公私财物、扰乱公共秩序等）占 16.24 ％。其中，后八年 组强奸案例（ 10.33 ％）明 显多于前八年组（ 7.23 ％），差异有 显著性（ P ＜ 0.05 ） , 其余各案件 类型两组间无显著差异（ P ＞ 0.05 ）。⑶ 鉴定诊断：以精神分裂症所占的比例最高，为 29.50 ％，精神 发育迟滞占 23.02 ％， 脑器质性精神障碍（含癫痫）占 10.48 ％， 应激障碍占 6.83 ％，情感性精神障碍占 4.50 ％， 癔症占 2.45 ％，酒精所致精神障碍占 2.27 ％，其余（包括偏 执性精神障碍、人格障碍、急性短暂性精神障碍及妄想阵发等）占 6.39 ％，无病占 14.56 ％。其中前八年 组精神分裂症和酒精所致精神障碍（ 32.19 ％、 2.76 ％）的比例明 显高于后八年组（ 27.33 ％、 1.78 ％），差异有 显著性（ P ＜ 0.05 ），后八年 组无病诊断（ 18.33 ％）明 显高于前八年组（ 10.78 ％），差异有极 显著性（ P ＜ 0.01 ）。⑷刑事 责任能力判定：前八年组中无刑事责任能力和限定刑事责任能力（ 64.00 ％、 17.87 ％）比例明 显高于后八年组（ 56.33 ％、 12.78 ％），差异有极 显著性（ P ＜ 0.01 ），后八年 组中有刑事责任能力（ 30.89 ％）的比例明 显高于前八年组（ 18.13 ％），差异有极 显著性（ P ＜ 0.01 ）。
结论： 近八年来，司法精神病 鉴定在案件类型、鉴定诊断及责任能力判定等方面都发生了变化，特别是鉴定结论中无精神病的诊断比例和有刑事责任能力的比例明显升高，这些变化表明今后的司法精神病鉴定工作将变得日益复杂。司法精神病鉴定人员应针对这些变化情况，不断提高自身的业务素质和政治素质，坚持原则，坚持实事求是，排除各种干扰，不断总结经验，以适应司法精神病鉴定工作发展的需要。
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During 16 Years the Judicial Neurosis Appraises the Change Tendencythe Research
ZhongChen Sun 1 , HongZhi Gao 1
1 Heilongjiang Province Public Security Department Ankang Hospital, Heilongjiang, Chinese Mainland
Objective: This research through 1,661 examples judicatures neurosis whichdoes to my courtyard during 16 years appraises the material the reviewanalysis, discusses for 16 years judicial neurosis the changesituation, adapts the present judicature neurosis to appraise work theneed to develop.
Method: 1,661 examples judicatures neurosis I the courtyard appraiseswhich by 1,990 ~ in 2005 appraises the case is the research object, before the latter eight years are the separatrices, appraised 1,990 ~in 1997 761 examples 900 examples which appraised with 1,998 ~ in 2005to divide into previous eight years group and the latter eight yearsgroup, compared with two groups in case type, appraisal diagnosis,legal responsibility ability change situation.
Results: (1) The population material demonstrated that, The masculineappraisal case obvious are many to the female, ratio of the male andfemale is 1.8: 1; In the appraisal case is in the majority by 20 ~ 40year-old young adults, occupies completely appraises the case 65.20%; The years of schooling account for 53.24% below the elementary school,the technical college above years of schooling only account for 4.10%.(2) Case type: Kills people the proportion which and the injuryoccupies to be highest, occupies completely appraises the case36.33%, other are in turn is raped (17.23%), steals (8.98%), rapes(8.57%), sets on fire (8.50%), robs (4.25%), other (including hoodlum,embezzlement, cheating, beats other people, destruction public andprivate belongings, harassment public peace and order and so on)occupies 16.24%. Among them, the latter eight years group obviouslyrapes the case (10.33%) to be many to previous eight years group(7.23%), the difference has Remarkable (P < 0.05), other various casestype two groups of not remarkable differences (P > 0.05). (3)Appraisal diagnosis: The proportion occupies which by theschizophrenia is highest, is 29.50%, the spiritual growth sluggishlyaccounts for 23.02%, the brain nature dysphrenia (contains epilepsy)to account for 10.48%, should stir up the barrier to account for6.83%, the emotion dysphrenia accounts for 4.50%, the hysteriasickness accounts for 2.45%, the ethyl alcohol is the result of thedysphrenia to account for 2.27%, other (including biased dysphrenia,personality barrier, acute short dysphrenia and delusion send and soon) to account for 6.39%, not sickness accounts for 14.56%. Previouseight years group schizophrenia and the ethyl alcohol are the resultof the dysphrenia (32.19%, 2.76%) the proportion obviously is higherthan the latter eight years group (27.33%, 1.78%), the difference has remarkable (P < 0.05), the latter eight years group not gets sick thediagnosis (18.33%) obviously to be higher than previous eight yearsgroup (10.78%), the difference has extremely remarkable (P < 0.01). (4)Legal responsibility ability determination: In previous eight yearsgroup the non- legal responsibility ability and the definition legalresponsibility ability (64.00%, 17.87%) the proportion obviously ishigher than the latter eight years group (56.33%, 12.78%), thedifference has extremely remarkable (P < 0.01), in the latter eightyears group has the legal responsibility ability (30.89%) theproportion obviously is higher than previous eight years group(18.13%), the difference has extremely remarkable (P < 0.01).
Conclusion: In the recent eight years, the judicial neurosis appraisedin aspect and so on case type, appraisal diagnosis and responsibilityability determination has all had the change, in the specially writtenthe non- neurosis diagnosis proportion and had the legalresponsibility ability the proportion obviously to elevate, thesechanges indicated the next judicial neurosis will appraise the work tochange day by day complex. The judicial neurosis appraises thepersonnel to be supposed to aim at these change situations,unceasingly improves own service quality and the political quality,persists the principle, persists realistically, removes each kind ofdisturbance, unceasingly sums up experience, adapts the judicialneurosis to appraise work the need to develop.
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P383
Abstract withdrawn
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P384
生命充 满了可能 ， 让灵感引导前进的道路 - Life is Full of Possibilities, Let Inspiration Lead the Way
Hong Chen 1 , Aaron Levi Feil 2
1 World Federation of Chinese Medicine Societies, Beijing, Chinese Mainland, 2 Lobsinger Line, St. Clements, Canada
目的 ： 比 较东西方文化 ， 古代和现代医学 ， 权衡他们从而使 “ 我 们 ” 能做得 “ 远远 ” 好于 这些因素的单独作用。
方法 ： （ 1 ） 原 则 （ 2 ） 采用的方式。 每 个生存着的有生命的事物都是由 组成它本身与环境作用的共同产物。一个动物 ， 或者仅仅是一株植物都会根据他们基因的组成以一种特定的方式 “ 行 动 ” 。如果你把一个特定的 动物或植物放在不同的环境中（诸如：不同的生理、心理或者其他方面），它还是会安照内在 “ 设计 ” 的那 样，但是为了适应新的环境它又会表现得非常不同。 结果： 地理性的文化将不在此 讨论，这样会强调或者忽视任何可能获得的社会方法学，这样都将形成限制或产生相反的作用。取而代之的是，相比于已经实践的医学（或这个事件的其他领域）方法，本 文更 关注于更基本的方法，这样可能更有益。对它们进行优点和缺陷的观察是必须的，同样，也要观察两者同时实施的可能优缺点。
总结： 在古 时候，医学和其他的一些生活方式都是一个非常私人的事情。一个人可能并不知道 “ 为什么 ” 或 “ 怎 么会 ” 服用草 药或做某种形式的练习可以使他们治愈或者治愈他们患有病痛的病人，他们仅仅知道，这样做获得了希望得到的结果。许多治疗者都很有能力，但是他们不能对问题做出充分的回答，许多答案是通过试验和错误发现的，或者他们仅仅是受到教导去这么做，而不去解释这些事情是怎样发生的。对古代原理的研究发现，引起 人 们兴趣的方面在于许多问题都是直接的和在实践中解决的，这些方法以现代的习俗看来，一些技术往往在现在的模式中会被漠视或不能引起注意。古代系统的困难之一在于它是深深植根的，通常不愿意移动变化的，这种停滞不前成为了这些旧方式的杀手。
Objectives: Contrast with western and eastern culture, ancient and modern medicine, balance them so WE can do things FAR greater than each one alone can do.
Methods: (1)PRINCIPALS (2)APPLYING WAYS. Every living thing that exists is the product of its composition, and its environment. An animal, or even a plant will "behave" in particular ways due to its genetic makeup. If you expose an identical animal, or plant into a different environment (physically, psychologically, or otherwise), it will still be the same within the boundries of its initial "design", yet it will be very different due to it′s adaptations in this new backdrop.
Results: geographic culture will not be iscussed, to emphasise, or ignore the methodology of any available society would be limiting, and counterproductive. Instead it would be more beneficial to focus on the more basic aspects of how contrasting approaches to medicine (or any other field for that matter) are done. Their virtues, and drawbacks must be observed, as well as the potential pros and cons of applying them together.
Conclutions: In ancient times medicine and other ways of life were very much an individual thing. A person may not have known WHY, or HOW eating a herb, or doing a form of exercise cured them, or their patients of their ailments, they simply knew that it achieved the desired result. Many healers were quite competant, yet could not provide adequet answers to questions, much of it was discovered through trial and error, or taught to them without explaination as to how these things worked. The intriguing aspect of the principles founded in ancient times is that many problems had direct, and practical solutions that would be difficult to achieve through modern conventions, techniques that would be commonly disregarded, or unnoticed with a modern entality. One of the difficulties with the ancient entality is that it is deeply rooted, and often unwilling to move. Stagnation is the killer of the old ways.
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P385
Neurasthenia? Chronic Fatigue Syndrome?
YuPing Cao 1
1 Mental Health Institute, Second Xiangya Hospital , Central South University , Changsha , Chinese Mainland
Objective: Overlapping symptomatology for neurasthenia and chronic fatigue syndrome(CFS) has been documented in various transcultural studies. The present study was designed to explore the relationships between neurasthenia and personality, life events and the positive rate of serum Epstein-Barr (EB) virus, and to compare these findings with those of CFS.
Method: The level of serum EB virus IgG and IgM of the neurasthenia group and control were determined by using ELISA methods. Blood samples, Eysenck personality questionnaire (EPQ), Symptom Checklist-90 (SCL-90) were taken at baseline and at 4-month follow-up. The Life Event Scale (LES) was used to assess baseline life stress. Blood samples, EPQ and LES were assessed once in the control group. Patients were given routine medication and integrative psychotherapy according to their state of illness.
Results: at baseline and follow-up were compared with those of controls. Results Twenty-seven neurasthenic patients were followed up at 4 months after treatment, and 3 cases were lost due to long distance from hospital. Thirty controls were studied. EPQ scores for neuroticism in the patient sample were significantly higher than that of the control group, scores of extroversion/introversion were obviously lower than that of the control group. Among the neurasthenic sample, scores for neuroticism were significantly lower at follow-up compared to baseline. The total LES and negative scores in the patient sample were significantly higher than that of controls. The SCL-90 total score declined at follow-up compared to baseline. The positive rate of EBV IgG and IgM in patients was significantly higher than that of controls. Scores for neuroticism and the positive rate of serum EBV were two important pathogenic factors distinguishing neurasthenic patients from controls.
Conclusion: Patients with neurasthenia are characterized by neuroticism and introversion, and a higher rate of negative life events. Moreover, the positive rate of EBV in neurasthenic patients is higher, which may be associated with the higher glucocorticoidinduced EBV activation under stress state. Similar results have been found in CFS patients.
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P386
精神病房住院的希腊移民特点 - Characteristics of Psychiatric Hospitalized Immigrants in Greece
Christina Leotsakou 1 , Aikaterini Kalogeropoulou 1 , Andreas Sardis 2 , Ioanna Fotara 1 , Perikles Robotis 1 , Demetrios Gousis 1 , Athanasios Demetriades 1 , Perikles Paterakis 1
1 Dromokaition Psychiatric Hospital, Athens, Greece, 2 Psychiatric Hospital of Attica, Athens, Greece
希腊官方的数据 显示 ， 从 1974 年起希腊已成 为一个移民国家。非官方数据显示从东欧过来的移民约占希腊总人口的 10% 。
目的： 评估移民的精神科住院医疗服务，比较移民与当地人在社会人口统计学和临床特征方面的异同。
方法： 回 顾性调查在 4 年期 间（ 2003-2006 ） 932 人次序 贯入院精神病急诊病房的患者。在此期间反复入院的患者中只调查其第一次入院情况，因此共入组 825 名患者。
结果： 共 49 名 (5.3%) 移民入院，其中女性 29 名，男性 20 名。多数来自 东欧（ 88% ）。住院的女性移民 显著多于男性。与住院的希腊当地患者相比，移民的强制治疗率高、诊断为精神分裂症者少、住院时间短。
结论： 临床印象认为移民的发病率更高在本研究中未获证实。与当地人相比，移民更少利用精神卫生的急诊和住院服务。原因可能是他们表达自己的精神问题存在困难，与医疗部门接触少。这也可能是他们更多地被强制入院的原因。我们不仅要从疾病的角度决定医疗服务和精神疾病诊治 ， 还必须考虑社会文化因素以改善精神卫生服务。
Official Greek data show that from 1974 onward, Greece has become a country of net immigration. According to unofficial data, migrants from Eastern Europe constitute almost 10% of Greek's population.
Objective: To assess psychiatric in-patient care among immigrants, and to compare immigrants and natives with respect to sociodemographic and clinical characteristics.
Methods: We retrospectively examined 932 consecutive admissions -which correspond to 825 patients, when only the first admission of those readmitted was taken into account- over a four-year period (2003-2006) to one acute ward of a Psychiatric Hospital.
Results: 49 (5.3%) admissions, 29 women and 20 men, were migrants mostly from Eastern Europe (88%). Significantly more of the immigrants were women, they had more compulsory treatment, less often a diagnosis of schizophrenia and a shorter length of hospitalization compared to Greek in-patients.
Conclusions: Our clinical impression of a higher frequency referral was not substantiated. Immigrants under-used psychiatric emergency and hospitalization services compared to natives. Greater difficulties in presenting their psychiatric problems and reduced access to care may explain this and may also lead to an overrepresentation of compulsory admissions. Service utilization and psychiatric treatment decisions are not explained merely by illness-related aspects and social and cultural factors have to be recognized in order to prevent disadvantages in psychiatric care.
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P387
父母 评定的 ADHA 症状 ： 在 马来西亚的马来西亚儿童和中国儿童的不同症状机能 - Parent Ratings of ADHD Symptoms: Differential Symptom Functioning Across Malaysian Malay and Chinese Children
Rapson Gomez 1
1 University of Ballarat, School of Behavioural & Social Sciences & Humanities, Ballarat , Australia
本研究 评价了在马来西亚的马来西亚儿童和中国儿童 ADHA 症状的不同症状机能 （ DSF ） 。 马来西亚父母（ N=571 ）和中国父母（ N=254 ）完成了破坏行 为评定量表，该量表列出了 DSM-IV 的 ADHD 症状。用 MIMIC （ multiple indicators multiple causes ） 结构模型来评价 DSF 。尽管在一个注意不集中（ IA ）和二个多 动－冲动（ HI ）症状中 发现 DSF ，而且 马来西亚儿童的 IA 潜在因素的 评分比中国儿童高，但是所有这些差异的作用是较低的，因此这表明它们不能对这些不同种族文化的研究组 ADHD 的症状 变异提供相当好的支持。 ADHD 症状的跨文化差异的研究 结果值得讨论。
This study examined differential symptom functioning (DSF) in ADHD symptoms across Malay and Chinese children in Malaysia . Malay (N = 571) and Chinese (N = 254) parents completed the Disruptive Behavior Rating Scale, which lists the DSM-IV ADHD symptoms. DSF was examined using the multiple indicators multiple causes (MIMIC) structural equation modeling procedure. Although DSF was found for one inattention (IA) and two hyperactivity-impulsivity (HI) symptoms, and Malay children had higher scores than Chinese children for the IA latent factor, all these differences had low effect sizes, thereby suggesting fairly good support for invariance of the ADHD symptoms across these ethno-cultural groups. The implications of the findings for cross-cultural invariance of the ADHD symptoms are discussed.
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P388
中医心理治 疗 122 例分析 - A Study of 122 Cases Analysis with Psychotherapy of Traditional Chinese Medicine
少校 闫 1 , 义壮 邹 1
1 北京回 龙观医院 , 北京 , Chinese Mainland
目的 ： 了解中医心理治 疗诊断、治疗详细情况。
方法 ： 为历代中医书籍和现代期刊中记录的中医心理治疗案例共 122 例 ， 分 别从案例年代、性别、年龄、疗程、致病因素、中医疾病诊断、中医心理治疗方法、合并治疗方案、现代诊断、现代治疗分类以及有无违背伦理学原则等 11 个方面 进行统计。 结果 ： 案例年代从唐代以前至近现代时期均有 ， 其中男女比例相当 ， 年龄从 0-50 岁 ， 疗程从 1 天至 1 年以上。有 58 例（ 47.54% ）在治 疗当天病情就获得缓解，一个月之内缓解的占 68% 。共有 59 例 发病与情志刺激有关，其中， “ 忧 ” 、 “ 思 ” 致病 为最多，分别为 10.66% 和 11.48% 。疾病 诊断多为癫狂、郁证等精神科疾病以外的内科杂症（心身疾病），占 55.74% ，在精神疾病中，以郁 证为最多，约占总数的 1/5 。心理治 疗方法中使用最多的依次是情志相胜法（ 19.67% ）、暗示解惑法（ 14.75% ）、激情 疗法（ 12.30% ）、 劝说开导法（ 9.84% ）、 顺情从欲法（ 8.20% ）、和行 为诱导法（ 9.02% ）等，有 31.97% 的案例合并 药物或针灸治疗。按现代诊断分别为神经症（ 16.39% ）、 应激相关障碍（ 10.66% ）和 癔症（ 8.20% ）。有近一半（ 46.72% ）的案例所使用的心理治 疗方法，与现代心理治疗的某些理论一致，如支持治疗、行为治疗、认知治疗等，另有一些属于中医独特的治疗方法，如情志相胜治疗。共有 22 例（ 18% ）的案例中使用了有悖于 伦理的方法。
结论： 中医心理治 疗是一种有效的短程心理治疗，主要适用于神经症、应激相关障碍、癔症等精神障碍，具有明显的中国文化特色，值得挖掘和推广。
关键词 ： 中医 心理治 疗 情志相 胜法
Objective: To explore the information of diagnosis and treatment of psychotherapy of TCM.
Method: The record of 122 cases receiving psychotherapy of TCM were obtained from the literatures at ancient time and current magazines, and 11 aspects including occurring era, gender, age, course, causative factors, TCM diagnosis, TCB psychotherapy, concomitant treatment strategy, current diagnosis, current therapy classification and whether breaching ethic rules, were evaluated.
Results: The cases occurred from Tang Dynasty to current time, with age range from 0 to 50 years old and course from 1 day to more than 1 year, 58% of which got relieved at the first day of treatment, and 68% relieved within 1 month. The 59 patient onsets resulted from emotional stimulation, especially “YOU (Anxiety)” and “SI (Thought)” occupying 10.66% and 11.48% respectively. The diagnosis of the diseases mainly included psychosomatic diseases except psychiatric diseases such as Dian, Kuang, Depressed syndrome, etc., occupying 55.74%. The maximum of the mental diseases was depressed syndrome, occupying 1/5. The mostly applied psychotherapies included Emotion Inter-resistance Therapy, (19.67%), Suggestive Explanation Therapy (14.75%), Intense emotion Therapy (12.30%), Persuasion and Release Therapy (9.84%), Smoothing emotion and desire Therapy (8.20%), Behavioral Induction Therapy (9.02%), etc., and 31.9% of cases were accompanied with drug or acupuncture therapy. The current diagnosis included neurosis (16.39), stress-related disorder (10.66%) and hysteria (8.20%). The nearly half of psychotherapies applied (46.72%) were consistent with some theories of modern psychotherapy, such as Supportive Therapy, Behavioral Therapy, Cognitive Therapy, etc., and some therapies such as Emotion Inter-resistance Therapy belonged to unique treatments of TCM. Among all cases, 22 cases (18%) might breach the ethic rules.
Conclusion: Psychotherapy of TCM was an effective short-term psychotherapy, and was mainly applied for some mental disorders including neurosis, stress-related disorder, hysteria, etc., which had obvious Chinese culture distinctness and deserved development and extension.
Key Words: Traditional Chinese Medicine (TCM) Psychotherapy Emotion Inter-resistance Therapy
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新疆 维吾尔族与汉族抑郁症患者临床特征的性别差异 - The Sex Study of Clinical Characteristics between Ethnic Uigur and The Chinese in Depression
L V Shuyun 1 , B I Likezi 1 , A Yixiamu 1
1 Xinjiang Mental Health Center, Xinjiang, Chinese Mainland
目的 ： 探 讨文化和性别因素对抑郁症的影响。
方法 ： 符合 CCMD-3 抑郁 发作诊断标准共 263 例 ， 按民族性 别分 4 组进行一般情况、 SCL-90 、 HAMD 、 MMPI 评定。
结果 ： 不同民族不同性 别间都存在着差异 ， 民族差异大于性别差异。维族女性与其它组差异最多。
结论 ： 文化和性 别因素都对抑郁症有影响 ， 文化影响大于性别影响 ， 文化和性别可以相互影响甚至可以对抑郁症产生叠加影响。
关键词 : 维吾尔族 汉族 抑郁症 性 别
Objective: To investigate the affect in culture and sex factor in depression.
Methods: There were 263 patients which conformed to the diagnostic standard of depressive episode according to CCMD-3 .To be separated in four groups in order to assess them in ordinary condition, SCL-90, HAMD and MMPI.
Results: There have differences in different nation and sex. The differences of nation are higher than sex. The women of Uigur are more higher than others.
Conclusion: Culture and sex factor rea affect the depression and the culture factor are higher than the sex. Culture and sex can affect each other and they can affect together in depression.
Key words: Uigur; Hanzu; Depression; Sex
- P390
Globalisation: Gains and Losses for Psychiatry
Norman H. Sartorius 1
1 International Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
Globalization – a process of mutual influence of countries which should result in the world becoming one – presents challenges to medicine and psychiatry and holds promise as well as danger for it.
The osmosis of ideas and sharing of information will enrich the data base of medicine and science in all countries and could make mental health workers more knowledgeable and more aware of practices and the experience gained in other parts of the world. It could help them to measure their problems and achievements in an objective way and make their research endeavours more efficacious. It could help them to avoid other people's mistakes and to make their own paths to success known to others. It might make access to modern medications and technological tools developed in other parts of the world easier thus facilitating the diagnostic process and treatment of mental illness. But, globalisation also carries risks for mental health care – most of them stemming from the fact that globalisation will affect the social fabric of society and weaken the traditional ties and ways of helping those in trouble or illness in a community. It is probably possible to maximize gains and minimize losses that globalisation will bring: an essential requirement to achieve this is become aware of the need to adjust strategies used in mental health care and the transmission of knowledge of psychiatry to a new world in which few of the features that were valid in the past several decades will exist in their current form and many new ones -somewhat difficult to imagine at present - will be predominant.
- P391
Cognitive Remediation Therapy for Chronic Inpatients with Schizophrenia, a Controlled and Randomized Study
Tan Shuping 1 , Zou Yizhuang 1 , Til Wykes 2 , Clare Reeder 2 , Yang Fude 1 , Qu Ying 2 , Zhou Dongfeng 3
1 Research Center, Beijing Huilongguan Hospital, Beijing, Chinese Mainland, 2 Department of Psychology, Institute of Psychiatry, Kings College, De Crespigny Park, London, United Kingdom, 3 Institute of Mental Health, Peking University, Beijing, Chinese Mainland
Background: Psychological therapy, such as Cognitive Remediation Therapy (CRT), has been reported to be effective in improving both cognitive and social performance. Is this therapy having similar effect in Chinese context? Aim: To confirm the cross-cultural utility of CRT, the present study carried out.
Methods: 104 inpatients with a diagnosis of schizophrenia were randomized to receive 40-sessions of pencil-paper CRT therapy plus usual treatment or a therapeutic contact matched Musical and Dancing Therapy (MDT) plus usual treatment over a six-months period. Pre and post treatment, cognitive function using a battery of cognitive measurement, clinical symptoms using PANSS and social function using NOSIE were evaluated.
Results: 44 of CRT group and 46 of MDT group had complete data at the end of the study. Cognitive measurements in cognitive flexibility and memory achieved a significant improvement in CRT. Some measurements in cognitive flexibility had got improving in MDT, but there was significant advantage of cognitive improving in CRT to MDT. Some factors of social function exhibited a significant improving in CRT not MDT after treatment. There was a positive correlation between improvement of cognitive function and social function. But the improvement of cognitive function was not the predictor of social function change.
Conclusion: CRT is an effective and promising therapy on improving cognitive function and social outcome for patient with schizophrenia, and it has a cross-cultural valid.
- P392
精神病患者的社会保障 - Social Safeguard for Patients with Mental dDsorder
He Bin 1 , Hu Wuchang 1 , Wu Hongjun 1 , Xiaoyu Jiang 1 , Hui Ye 1 , 九江市第五人民医院
1 Jiujiang No. 5 People's Hospital, Jiujiang, Chinese Mainland
精神疾病 严重威胁着人类健康 ， 导致了巨大的家庭和社会负担。据ＷＨＯ的有关研究，我国仅精神分裂症的疾病负担就已经占疾病总负担的 1. ３％。另一 种严重的精神疾病－抑郁症，已经在中国疾病总负担中排名第二。我国目前有 95% 的精神病患者散落在社会， 带来诸如社会歧视、精神病患者犯罪等问题，给社会造成相当的损害。
同 时，我们还要认识到，目前我国精神病患者社会地位低，缺乏社会保障，家庭负担重，严重制约了我国精神病患者的治疗、康复和回归社会。本文在此结合我们工作中的实际以及国内近年来的一些有关文献，对精神病患者的社会保障问题进行探讨。以期引起大家的重视。
1. 我国目前精神病患者的主要 费用负担方式
2. 我国精神病患者目前社会支持的不足与 风险 ①家庭支持仍然是主要支持②社会保障的不足③医 疗机构的困境
3. 我 们的期盼
①加 强政府投入，健全精神病患者的社 会保障，保障其就医、康 复、就业、生活的权利。
②加大 对困难群体的社会救助，拓宽社会慈善救助渠道。对贫困精神病患者由政府提供免费药物治疗。
③使精神 卫生医疗机构完成角色回归：医疗服务的提供者、健康知识的宣传者、社区康复的指导者、先进技术的研究者。
④早日完成制 订同时兼顾精神病患者、家属、普通人群和精神卫生医疗机构及其从业者利益的精神卫生法，保障精神病患者的权益，依法惩治歧视、虐待、遗弃精神病患者的行为。
⑤ 每位中 国公民，无 论出身贫富，无论家住省城或县市，都可以享受同等质素的精神医疗照顾。
- P393
选择性 5 － 羟色胺再摄取抑制剂（ SSRIs ）和多巴胺抑制 剂（ DIs ） 联合治疗青少年强迫症的经济效益 - Economical Benefits of SSRI-S and DI-S Co-administrative Treatment among the Adolescents with OCD
Maruke G. Yeghiyan 1 , Kachatur V. Gasparyan 1 , Armen F. Soghoyan 1
1 Yerevan State Medical University, Psychiatry and Medical Psychology Department, Yerevan, Armenia
背景： 青少年 强迫症需要相 对高剂量的 SSRIs 长程治疗。近期的研究开始提出 SSRIs 和 DIs 的 联合治疗。我们早期的研究证实了氨磺必利 Amisulpirid 和西 酞普兰合用与两者单用或其他 SSRIs 单一治疗相比较的疗效。研究目的是证实 SSRIs 和 DIs 合用的 经济效益。
方法： 我 们在开发式研究中观察 25 位患有中度或重度 强迫症的 青少年（年 龄 13 － 16 岁），所有患者接受为期 8 周 20 － 60mg/d 的西 酞普兰治疗单一治疗无效的患者使用两种药物的联合治疗。比较两种疗法的
结果： 耶 鲁一布朗强迫症量表及相关数据。
结果： 氨磺必利和西 酞普兰合用的经济效益高于 SSRIs 单一疗法。讨论 ： 所得结果可能与以上疗法的早期疗效有关。需要进一步研究验证这些结论。
Background: Adolescent's OCD typically requires long term treatment with comparably high dosage of SSRI -s. Recent studies are mentioning early onset of co-administrative use of SSRI-s and DI -s.
In our previous study we identified that the effectiveness of Amisulpirid and Citaloprame co-administration in comparison with monotherapy with one of them or with other SSRI's. Aims of the study is to identify the economical benefits of SSRI-s and DI-s co-administration.
Methods:
? In open study we observed 25 adolescents (13-16 years old) with moderate and severe OCD.
? All patients during the 8 weeks received Citaloprame in dosage range 20-60 mg/per day.
? Co-administrative use of two drugs in-patients without response to monotherapy.
? Comparison of results of two therapeutic approaches: Y-BOCS and relative source.
Results: We conclude that Amisulpiride (DI-s) action in association with Citaloprame (SSRI-s) increasing economical benefits in comparison with SSRI-s monotherapy.
Discussion: Most probably outcome results are related to early onset of activity when above mentioned approach is used. Further study are warranted to confirm these results.
- P394
双相情感障碍与抑郁症患者功能失 调性态度的对照研究 - Control Study to Dysfunctional Attitudes of Depression and Bipolar Disorder
Qing-tao Bian 1 , Ke-bing Yang 1 , Chun-qiu Li 1
1 Beijing Huilongguan Hospital , Beijing , Chinese Mainland
目的 ： 探 讨双相情感障碍与抑郁症患者功能失调性态度的特征及两者之间的相互关系。
方法 ： 使用功能失 调性状况评定表 （ Dysfunctional Attitudes Scales, DAS ） 对缓解期的 66 例双相情感障碍及 56 例抑郁症患者 进行评定 ， 并与 60 名正常人 进行对照。
结果 ： 0.05 ）；（ 2 ） 抑郁症 组的 DAS 总分及各项因子分 ， 双相情感障碍组的 DAS 总分及脆弱性、完美化、依赖性因子分均高于正常人对照组 ， 差异有显著性或非常显著性 (P > （ 1 ） 抑郁症 组、双相情感障碍组与正常对照组之间的性别、年龄、受教育年 限差异无 显著性 （ P<0.05 或 P<0.01) 。（ 3 ）抑郁症 组 DAS 总分，以及脆弱性、吸引 / 排斥、完美化、依 赖性、自主性态度和认知哲学等因子分值高于双相障碍组，差异有显著性或非常显著性 (P<0.05 或 P<0.01) 。
结论： （ 1 ）部分抑郁症及双相情感障碍患者可能存在明 显的功能失调性认知态度；（ 2 ）抑郁症患者的功能失 调性态度有可能重于双相障碍患者。
关键词 : 抑郁症；双相情感障碍；功能失 调性态度；认知心理学
- P395
利培 酮对首发精神分裂症患者代谢的影响 - Effects of Risperidone for the Metabolism in First Episode Schizophrenia
Jian-xin Zhang 1 , Feng-yan Zhu 1 , Yan-ying Song 1
1 Beijing Huilongguan Hospital, Beijing, Chinese Mainland
目的 : 观察未经过药物治疗的首发精神分裂症病人服用利培酮治疗后对血糖、血脂的影响。
方法 : 共入 组 62 例未 经治疗的首发精神分裂症患者，服用利培酮（ 2-6mg ）治 疗，观察期为 12 周，分 别于入组前、服药 4 周末、 8 周末、 12 周末采用阳性症状和 阴性症状量表（ PANSS ） 评定精神症状，用酶法测定血糖（ GLU ）、血脂（ 总胆固醇 (TC) 、甘油三 酯 (TG) 、高密度脂蛋白 (HDL) 、低密度脂蛋白 (LDL) ）水平。
结果 : TC 、 TG 浓度在治疗第 4 周、第 8 周、第 12 周末与治 疗前比较，经配对 t 检验差异有显著性（ P<0.01 ）。 TG 浓度在治疗第 12 周末与第 8 周末比 较， HDL 浓度在治疗第 8 周末与治 疗前比较， . LDL 浓度在治疗第 12 周末与治 疗前比较，经配对 t 检验差异均有显著性（ P<0.05 ）。 TC 、 TG 、 HDL 、 LDL 浓度其他各时 段 组间比较及 GLU 浓度各时段组间比较经配对 t 检验差异均无显著性（ P>0.05 ）。
结论 : 62 例未 经治疗的首发精神分裂症患者经利培酮治疗 12 周后 总胆固醇和甘油三脂水平明显升高，血脂障碍与利培酮治疗之间有密切的联系，利培酮对血糖没有明显影响。
关键词 : 利培 酮 首 发精神分裂症 血脂 血糖
Objective: To observe the relationships between the metabolism and risperidone for the drug-na?ve first episode schizophrenia patients.
Methods ： During a 12-week period, fasting blood samples for serum lipid profiles and blood glucose were collected from 62 first episode schizophrenic drug-naive patients. The Positive and Negtive Syndrome Scale (PANSS) was used to measure therapeutic efficacy and the serum lipid profiles and blood glucose were detected by enzymatic determination at baseline and end of 4-week 、 8-week 、 12-week. After a 12-week treatment with risperidone the blood samples of the 62 schizophrenic patients were assessed again.
- P396
从校园大屠 杀到大学生自杀 ： 全球化时代美国和中国的成长之痛和大学生精神健康危机 - From Campus Massacre to College Suicides: Growing Pains and College Mental Health Crisis in U.S. and China in the Era of Globalization
Xiaolu Hsi 1
1 MIT Medical, Massachusetts Institute of Technology, Mental Health Department, Cambridge, United States
校园 枪击和大学生自杀在统计上并不常见 ， 这些在今天的新闻中却显著成了头版 ， 甚至在学生、父母、教育工作者和一般公众的头脑中也占据了显著位置。不幸的是，美国并不是唯一卷入这样的悲剧中的国家。在当今的中国，大学生自杀率至少与其他许多国家一样高。我们是否面临着全球大学生处于心理社会危机的状况？如果不是，怎样解释大洋两岸这样的悲剧涌现和校园对精神健康服务的需求激增现象？如果是，我们需 要知道写什 么？怎样去理解这个棘手和复杂的现象？在美国和中国，哪些心理社会因素造成了这个现象的激增？如果有，那么全球化在其中扮演了什么角色？因为本文作者在美国生活和工作，也定期在中国授课，为了美国和中国的青少年和大学生的精神健康，本文试图对这些重要的问题进行讨论。
Statistically uncommon as the tragedies of campus shootings and college suicides are, they feature prominently in the news today and even more prominently in the psyche of students, parents and educators as well as general public. U.S. is not, unfortunately, the only country that is inflicted with such tragedies. College suicides have occurred at least at the same rate in China today as many other countries. Are we confronted with a psycho-social crisis amongst our college-age youth globally? If not, what could account for what appears to be a surge in not only in such tragedies, but also in utilization and the need to expand the on-campus mental health services on both sides of the ocean? If so, what do we know and how do we understand this difficult and complex phenomenon? What are some of the contributing psycho-social factors for such a surge in U.S. and in China ? What, if any, role does globalization play in this? This paper will attempt to discuss these important questions for adolescent and college mental health both in U.S. and in China as the writer lives and works in one (U.S.) and teaches regularly in the other (China).
- P397
美国学 术性门诊诊所的结果测定 ： 一年的数据 - Outcomes Measurement in an Academic US Outpatient Clinic: One-year Data
Jonathan Liu Worth 1 , Mark Blais 1 , Matthew Baity 1 , John Herman 1
1 Massachusetts General Hospital, Department of Psychiatry, Boston, Massachusetts, United States
2005 年 ， 麻省 总院精神医学部开始了一项成果评估项目。本研究收集的是我们门诊诊所中 2005 年 9 月至 2006 年 10 月期 间的数据。门诊病人在入组时和第 13 周随 访时完成测定。病人完成的是 Schwartz 结果问卷 (SOS-10) 和病人自 评 10 项 “ 一般 ” 结果测定。临床医生完成总体功能量表 (GAF) 和 复合功能量表。共有 1545 个 对象进行了初始评估（占所有评估的 90% ）， 1295 个 对象完成了评估（ 84% ）。 553 个 对象进入随访评估（ 36% ）， 371 个 对象完成了随访评估（ 68% ）。病人的平均年 龄为 42 岁（年龄范围 18-94 岁）。 54% 为女性。 80% 为白种人。 42% 为大学以上文化程度。病人的结果测定均有改善 (SOS & GAF r=.35, n=1256, p<.000) 。 这些发现得到所有样本和一个更同质的抑郁病人亚组样本的支持。不论治疗模式如何，对于抑郁病人的发现是相似的：心理治疗 (n= 53) ， 药物治疗 (n= 105) ，合并治 疗 (n= 105) 。 ANOVA 发现在 p<.05 水平具有 显著意义 ( 对照原始的 SOS 分 值 ) 。多 种治疗合并有其优势。获得了 258 个工作人 员和 85 个受 训者的 SOS 随 访数据。对照抑 郁病人 组，两组的 SOS 原始分 值和治疗模式结果均没有显著差异。美国的精神健康服务付费方越来越需要结果测定。在学术性门诊实践中，已经证实 SOS-10 是一个低 负担的能满足结果测定需要的工具。
In 2005 the Massachusetts General Hospital Department of Psychiatry started an outcomes assessment program. This reports on data collected between September 2005 and October 2006 at our outpatient clinics. Outpatients completed measures at intake and at 13-week follow-up intervals.
Patients completed the Schwartz Outcome Scale (SOS-10), a patient-rated 10-item “generic” outcome measure. Clinicians completed the Global Assessment of Functioning (GAF), a composite measure of functioning.
There were 1545 initial evaluations (90+% of all evaluations); 1295 (84%) had complete data. There were 553 follow-up evaluations (36%); 371 (68%) had complete data.
Patients' mean age was 42 years (range 18-94). 54% were Female. 80% were Caucasian. 42% were College graduates and further education.
Patients improved on both outcome measures (SOS & GAF r=.35, n=1256, p<.000). These findings hold for both the entire sample and a more homogeneous sub-sample of depressed patients. For depressed patients the findings were similar , regardless of treatment mode: Psychotherapy (n= 53), Pharmacotherapy, (n= 105), Combined treatment (n= 31). ANOVA was significant at p<.05 (controlling for initial SOS score). There was an advantage for combined multimodal treatments.
SOS follow-up data were available for 258 staff & 85 trainees. There was no significant difference in outcomes after controlling for initial SOS score and mode of treatment, with same finding for the depressed sample.
Outcome measurement is increasingly being required by payors of mental health services in the US . The SOS-10 has proven to be a low burden instrument capable of meeting outcome measurement needs in an academic outpatient practice.
- P398
启 维治疗老年精神分裂症的临床观察 - A Clinical Study of Quetiapine in the Treatment of Elderly Schizophrenics
Fangyu Chen 1 , Zhong Xia 1 , Lei Chen 1
1 Wuhu 4th People's Hospital, Wuhu , Chinese Mainland
目的 ： 探 讨启维治疗老年精神分裂症的疗效和安全性。
方法 ： 启 维治疗老年精神分裂症 23 例 ， 以阳性症状与 阴 性症状量表 （ PANSS ） 评定疗效 ， 以不良反应症状量表 （ TESS ） 评估安全性。
结果 ： 启 维治疗老年精神分裂症显效率 69.56% ， 有效率 86.95% ， 起效 时间 2 周。有效治 疗剂量为 378.26±105.34mg/d ， 不良反 应轻。
结论 ： 启 维对老年精神分裂症有较好的疗效和安全性。
关键词 : 启 维 ； 老年精神分裂症
Objective: To study the efficacy and safety of quetiapine in the treatment of elderly schizophrenics.
Method: 23 elderly schizophrenics were treated with quetiapine for 6 weeks. The positive and negative symptoms scale (PANSS) was used for assessment of the efficacy and the treatment emergent symptoms scale(TESS)for side effects.
Results: The efficacy rate was 86.95% and 69.56% marked improvement at the end of study. The clinical response appeared in 2 weeks, the optional dose of 378.26±105.34mg/d. Common side effects were mild.
Conclusion: Quetiapine is effective and safe in the treatment of elderly schizophrenics.
Key words: Quetiapine; Elderly schizophrenia
- P399
台湾私立和公立医院在 费用调节下使用非典型抗精神病药情况 - Usage in Atypical Antipsychotics between Public and Private Hospitals Upon Expenditure Regulation in Taiwan
Hsien-Jane Chiu 1 , Tsuo-Hung Lan 1 , Tsung-Ming Hu 1 , Shuen-Zen Liu 2 , Ching-Han Chao 1 , Ching-juei Chang 3 , Churn-Shiouh Gau 4
1 Yu-Li Hospital, DOH, Psychiatry, Hualien, Taiwan, Province of China, 2 National Taiwan Univeristy, Accounting, Taipei, Taiwan, Province of China, 3 Cathay General Hospital, Psychiatry, Taipei, Taiwan, Province of China, 4 National University, Pharmacy, Taipei, Taiwan, Province of China
目的 ： 过去十年 ， 全世界范围内可见治疗精神分裂症的处方更多的趋向于从第一代抗精神病药 (FGA) 转为第二代抗精神病药 (SGA) 。然而，由于 SGA 带来的经济负担越来越重，通常一些国家通过执行新的健康保健政策来削减无限制的健康保健费用。我们试图利用台湾健康保险数据库来探索在执行医院价格调节政策后公立医院和私立医院之间的非典型抗精神病药处方模式变化关系。
方法： 2003 年 7 月，台湾健康保 险开始执行新的医院价格调节政策。回顾过去的文献，精神科医师的抗精神病药处方模式可以反映出第一代抗精神病药 (FGA) 向第二代抗精神病 药 (SGA) 的 转变情况。将 2002 年至 2004 年台湾健康保 险数据库中精神分裂症患者使用 FGA 的 总费用和 SGA 的 总费用进行比较，发现存有差异，此差异说明新的健康政策间接影响到精神科医师的临床处方决定。在国家健康研究学会的许可下，在数据库中不记名发现有 40000 多名确 诊为精神分裂症的患者。本研究所有的统计计算使 用 SAS 9.1 版本。使用 简单线性回归模型来比较公立医院和私立医院之间 SGA 使用模式的差异。
结果： 大体上看， 2002 年至 2004 年期 间，台湾治疗精神分裂症的 SGA 处方比例在门诊保健中显著减少了 20%-50% ，在住院保健中减少了 25%-52% 。然而，以私立基金医院和公立基金医院或精神保健学会 进行分组，我们发现从 2003 年 7 月 执行新的医院价格调节政策后在住院保健中两组的 FGA 处方比例差异增大，分别是私立医院从 75% 降到 60% ，公立基金医院或精神保健学会 则从 45% 降到 25% 。在住院保健中两 组的 SGA 处方比例差异 没有明 显的变化。然而，在门诊保健中两组之间 SGA 使用模式的差异具有 统计学意义 (p 值 < 0.0001) 。
结论： 基于 2002-2004 年台湾健康保 险数据库的资料，治疗精神分裂症的 FGA 处方比例持续降低。然而，医院价格调节政策实施对公立医院和私立医院的精神科医师的处方行为的影响实际上是不同的。基于对这些分析的观察 ， 提示可能比较私立机构而言 ， 公立机构的精神科医师处方行为更不易受到保险公司付费政策变化的影响。
Objectives: The trend of more prescriptions from first generation antipsychotics (FGA) to second generation antipsychotics (SGA) to treat schizophrenia has been observed all over the world in the past ten years. However, because of an increasing economic burden from SGA, a new implementation of health care policy to slow down the unlimited expending of health care is also common in some countries. We tried to utilize the Taiwan Health Insurance Database to explore the relationship between atypical antipsychotics prescription pattern change after the implementation of hospital price regulation policy between public and private hospitals.
Methods: The new policy of hospital price regulation in Taiwan Health Insurance has been implemented since July in 2003. From the past publications reviewed, the antipsychotics shifting from first generation antipsychotics (FGA) to second generation antipsychotics (SGA) could be reflected upon psychiatrists' prescribing pattern. By comparing the total expenses on FGA and SGA in the schizophrenic populations embedded in Taiwan Health Insurance Database from year 2002 to year 2004, the difference can be identified to elucidate the indirect effect of a new health policy on psychiatrists′ clinical decision to prescribe. There are more than 40000 subjects with confirmed schizophrenia diagnosis included in this database with anonymous identity under the permission of use from National Institute of Health Research. All statistics calculated here is performed by using SAS 9.1 version. Simple linear regression model is applied to compare the difference in SGA usage pattern between public and private hospitals.
Results: In general, the proportion of SGA prescription to treat schizophrenia in Taiwan decreases significantly from 20% to 50% in outpatient care, and from 25% to 52% in inpatient care, during the period between year 2002 to year 2004. However, after subgrouping into private-funded and government-funded hospital or institutes of mental health care, the difference of proportion of FGA prescription in inpatient care between these groups widened after the implementation of hospital price regulation policy in July 2003 from 75% to 60% vs. from 45% to 25% for private-funded and government-funded hospitals or institutions individually. The difference of proportion of SGA prescription in inpatient care after the implementation of hospital price regulation policy in July 2003 between these two groups did not show a lot of changes comparatively. However, the difference of SGA usage pattern in outpatient care reached the statistically significant level (p value < 0.0001).
Conclusions: The proportion of FGA continuously went down in the prescriptions of schizophrenia based on Taiwan Health Insurance Database 2002~2004. However, the prescription behavior of psychiatrists indeed differs between public and private hospitals to respond to the impact from the implementation of hospital price regulation policy. Based on the observations of these analyses, it might imply that the prescription behavior of psychiatrists in public institutions seems to more reluctant to the change of payment policy change from insurance company compared to colleagues staying in the private institutions.
- P400
氟西汀治 疗老年性脑卒中后抑郁和神经功能缺损的临床研究 - A Study the Efficacy of Fluoxetine in the Treatment of Old Patients and Neurologic Functional with Post-stroke Depression
BoQuan Yang 1 , GuoJie Jing 1 , Juefang Zhao 1
1 The Taizhou Central Hospital of Zhejiang Province, Taizhou, Chinese Mainland
目的 ： 探 讨氟西汀治疗老年性脑卒中后抑郁 （ PSD ） 疗效和神经功能缺损康复的研究。
方法 ： 将 80 例患者随机分 为治疗组和对照组各 40 例 ， 对照组给予脑卒中常规治疗及心理治疗 ， 治疗组在此基础上加用氟 西汀 20 mg/d 连续口服 8 周 ， 治 疗前及治疗后 8 周作 汉密尔顿抑郁量表 （ HAMD 17 项 ） 和神经功能缺损评分量表 （ SSS ） 评估。结果： PSD 发生率 41% ，两 组治疗前后比较均有显著性差异（ P<0.05 ），两 组间治疗组疗效比较明显优于对照组（ P<0.01 ）；
结论： 氟西汀治 疗脑卒中后抑郁有良好疗效、副作用少 , 而且有利患者神 经功能缺损的康复，值得临床推广。
关键词 脑卒中后抑郁 ， 氟西汀 ， 心理治疗
Objective: To study the efficacy of fluoxetine in the treatment of old patients depression symptoms,cognitive impairment and neural functional impairment of post-stroke depression(PSD).
Method: Eighty old patients with PSD were randomly divided into fluoxetine and control group with psychotherapy and therapy group with fluoxetine. Subject were assessed with the HAMD and the chinical neural function –defect assessment set(SSS) after treatment for eight weeks.
Results: The incidence of depression after stroke was 41%. The score of fluoxetine group had greatly lower than that of control one. The therapy group is obvious to surpass the control group while the two group were effective.
Conclusion: The result suggested fluoxetine is effective in the treatment of old patients with PSD with little side effect and is worth popularizing.
Key words: post-stroke depression Fluoxetine psychotherapy
- P401
Randomized Double-blind Placebo-controlled Research on Effect of Fluoxetine for Persistent Somatoform Pain Disorder
Yanli Luo 1
1 Tongji Hospital of Tongji University, Psychosomatic, Shanghai, Chinese Mainland
Objectives: To verify the efficacy and safety of fluoxetine in treating persistent somatoform pain disorder (PSPD).
Methods: In this 8-week, randomized double-blind placebo-controlled study, 80 patients with a ICD-10 diagnosis of PSPD were randomly assigned to receive fluoxetine (Prozac) 20mg per day or placebo. Some psychological scales including Medical Outcomes Study Pain Measurement (MOSPM) ， Hamilton Depression Scale (HAMD17) and Hamilton Anxiety Scale (HAMA), Treatment Emergent Symptom Scale (TESS) were used to assess analgesic effect and safety of fluoxetine, and the possible analgesic mechanism of fluoxetine was analyzed preliminary.
Results: No significance of demographic and clinical features between fluoxetine and placebo groups. MOSPM total score and factor scores decreased in both groups, and difference of analgesic effect between two groups was statistically significant, analgesic effect was related with treatment time, and patients with depression or/and anxiety have better analgesic effect. Adverse effect of fluoxetine is seldom.
Conclusions: Fluoxetine has better effect than placebo in treating PSPD and has good safety, its analgesic effect maybe related with antidepressive and antianxious effect.
- P402
对 Isfahan 医科大学和 Gom 神学院 1381 名抑郁女生的比 较 - A Comparison between Depression of Girls Students in Isfahan Medical Universities and Gom Divinity Unit 1381
Mohammad Rastegari 1
1 Nursing Faculty, Health Department, Isfahan , Iran , Islamic Republic of
目的 ： 本研究的目 标是比较 Isfahan 医科大学和 Gom 神学院两 组住宿女生的抑郁状况和抑郁程度。
方法 ： 本研究是横断面的描述性 调查。通过让医科大学和神学院的女学生完成 beck 抑郁 问卷来获得信息。用 SPSS 和 T- 检验进行数据分析。
结果 ： 我 们发现在医科大学女生中 52% 情 绪在正常范围内 ， 29.5% 有 轻度抑郁 ， 15.4% 有中度抑郁 ， 3% 达到了重度抑郁并需要接受医学上的治 疗。神学院的女生则有 54% 为正常， 28% 有 轻度抑郁。同样也有 15.5% 为中度抑郁，而 2% 的学生达到了重度抑郁并需要治 疗。 Student t- 检验 (03.284) 和 p=0.001 显示出两组之间有显著差异。
讨论： 因 为受调查的医学生和神学院学生均对社会的生理和心理健康方面有影响作用，所以她们需要有一个积极的情绪状态。因此教育资金管理者在学生入学时、学习期间、甚至在毕业后都应该特别注意到这个问题。两组受试者之间情绪的显著差异提示神学院的学生具有较高的心理学情绪，显示出精神性对学生心理需要的影响。
关键词 ： 抑郁 医学生 申雪院学生 宿舍
Aim: the aim of this research was comparison between depression status of girls students in Isfahan medical universities an gom divine unit depression degree in two group of girls who was in their dormitories of medical science university and divine unity.
Method: This study was cross sectional descriptive survey. The information were gathered baste on beck depression questionnaire for both medical girl students their residential hall. And divinity students, SPSS and t- test were used to analyze the data.
Result: The findings showed that medial science 52% of students were in normal range, 29.5% had mild depression and 15.4% moderate one and 3% severe depression how need to receive medical treatment findings revealed normal status and mild depression in 54.6% and 28% of divinity girl students respectively. Also 15.5% had moderate depression while 2% sever depression which need to treat.
Student t- test (03.284) and p=0.001 showed a significant difference between two groups. Discussion: Since both investigated medical and divinity students have an influential role in physical and psychological aspects of community health respectively, having an effective mood is necessary for them Educational stakeholders, therefore should pay particular attention to them in terms of their admission, during their studies and even after graduation. The signification difference between the scure of participants mood revealed a higher psychological mood in the divinity students, showing the in flounce of spirituality on the students psyclogical needs.
Key words: Depression, medical students, divinity and students, dormitory.
- P403
使用气流理 论治疗和预防躯体和精神卫生问题 - Use Chi Flow Theory to Cure and Prevent Physical and Mental Health Problems
Hong Chen 1 , Aaron Levi Feil 2
1 World Federation of Chinese Medicine Societies, Beijing , Chinese Mainland, 2 Lobsinger Line, St. Clements , Canada
目的 ： 我 们身体常见 （ 或甚至不常见 ） 的问题可以通过仔细审视我们的心灵和意念而被治疗或预防。
方法 ： 根据气流理 论 ， 针灸师和太极功都尝试不同的方法清除气的淤塞 ， 促进气循环 ， 以防止精神和身体的互相伤害。这些方法可能有所不同 ， 但是精神方面仍然是维持躯体健康的永恒主题。
结果 ： 气 ， 如果没有足 够的气流 / 循 环 ， 将在相应的器官表现为一种疾病。根据这个逻辑 ， 即使躯体治疗后 ， 疾病将最终重现。这是由于气的淤塞没有被清除以及意念 / 心灵没有改 变它的习惯，引导更多的气到相同的淤塞的经络 （据 说身体在睡眠时愈合更快，这是因为意念放开，允许气在更自然的方式下流动）。可选择的是意念可能受到躯体伤害或气导致疾病的影响。如果身体的某部分受到痛苦，它将中断气流，重新引导气通过其它的经络，最终导致气淤塞在有关思想和情感的经络上。
结论： 许多中医的主要理论里，大多数的健康问题是由于不同经络上气的淤塞造成。意念引导气，也受它的影响。使用气流理论可以治疗和预防躯体和精神卫生问题。
Objectives: Common (or even the less common) problems with our bodies can be cured, or prevented by taking a closer look into our hearts, and minds.
Methods: According to Chi flow theory, Accupuncturists, Tai Chi all practice different ways of removing Chi blockages, and try to promote Chi circulation that would prevent the mind and body from harming each other. The methods may differ, but the mental aspect is still a constant theme to maintain physical health.
Results: Chi, and if there is not enough Chi flow/circulation,it will manifest as an illness in corresponding organs. According to this logic, the illness will eventually return even after a physical remedy was used. This is due to the Chi buildup not being removed, as well as the mind/heart not changing it′s habits, and directing more Chi to the same blocked channels (it is said that the body heals faster during sleep due to the fact that the mind lets go, and allows Chi to flow in a more natural manner). Alternatively, the mind can be influenced by physical injury, or disease through Chi. If one part of the body is afflicted, it will disrupt Chi flow, redirecting it through other channels, eventually causing Chi blocks in places that coinside with channels that deal with thought, and emotion.
Conclution: In many principals of Chinese Medicine, most health problems are caused by Chi blockages in various channels, the mind directs Chi, and is also influenced by it. Using Chi flow theory can cure and prevent physical and mental health problems.
- P404
体育 锻炼对大学生心理健康的促进作用 - Effects of Physical Exercise on Mental Health of Undergraduates
学林 李 1 , 桂英 姚 2 , 丽敏 王 2
1 东北农业大学 , 哈 尔 滨 , Chinese Mainland, 2 哈 尔 滨医科大学 , 哈 尔 滨 , Chinese Mainland
目的 ： 探 讨体育锻炼对大学生心理健康的积极影响 ， 为促进大学生心理健康提供依据。
方法 ： 采用分 层整群抽样的方法于 2007 年 4 月 对 600 名高校本科生 （ 大四除外 ） 运用症状自 评量表 （ SCL-90 ） 、自尊量表 （ SES ） 、自 编体育锻炼调查问卷进行了统一问卷调查。以 SCL-90 的 9 个因子包括躯体化、 强迫、人 际关系、抑郁 、焦 虑、敌对、恐怖、偏执、精神病性中的任一个因子分 ≥3 作 为评定有无心理问题（即中等程度以上）的标准。数据采用 Epidata 录入 ，运用 SPSS13.0 软件进行统计分析。
结果： ①大学生心理 问题检出率为 13.5% ；不同体育 锻炼频率的大学生心理问题检出率有差异 (1.9% ， 11.6% ， X2=6.798 ,P<0.01) 。②体育 锻炼次数 3 次以上 / 周的大学生在 总分、躯体化、强迫、抑郁、焦虑、恐怖、偏执、精神病性的得分明显低于少于 3 次 / 周的学生（ P<0.05 ）；体育 锻炼 30 分 钟以上 / 次的学生抑郁、恐怖因子分低于少于 30 分 钟以下者（ P<0.05 ）。③体育 锻炼 30 分 钟以上 / 次的大学生的自尊水平明 显高于锻炼 30 分 钟以下者。 ④体育 锻炼的频率与心理健康呈显著正相关（ r = 0.109, P<0.01 ）；体育 锻炼时间与自尊水平呈正相关（ r = 0.095, P<0.01 ）。⑤ logistic 回 归分析：体育锻炼频率与自尊水平为心理健康的保护性因素（ β ﹤ 0 ， P<0.01 ）。多元 线形回归显示：体育锻炼时间对个体自尊水平有显著影响（ F=5.319 ， P<0.01 ）。
结论： 体育 锻炼可以维护大学生自尊水平、促进大学生心理健康。高校应在加强 体育 锻炼频率和时间上注重学生的心理素质的培养，促进大学生身心的全面发展。
关键词 : 体育 锻炼 ； 大学生 ； 心理健康
Objective: To explore the effect that physical exercises have on the mental health , it will contribute to improve the mental health education of undergraduates.
Methods: 600 undergraduates were surveyed with symptom checklist-90 (SCL-90) and The Self-Esteem Scale and a self administered questionnaire about physical exercises.
Results: Physiology exercise frequency and self-esteem suggested great contribution to psychological health （ P<0.01 ） , and different period 所 of exercise duration are likely to have a positive effect in psychological health through enhancing the self-esteem.
Conclusion: Physical exercise has positive effect on the self-esteem and the mental health.
Key word: Physical exercise ; Undergraduates; mental health
- P405
人 际信任量表用于中国大学生的信效度研究 - The Reliability and Validity of Interpersonal Trust Scale
茂芹 唐 1 , 佳 简 2
1 山 东精神卫生中心 , 济南 , Chinese Mainland, 2 山 东大学 , 济南 , Chinese Mainland
目的 ： 探 讨人际信任量表的信度和效度。
方法 ： 驻济四所高校的 1155 名本科 1 ～ 4 年 级大学生分别接受人际信任量表、症状自评量 表及青少年生活事件量表的自 评 ， 其中 206 名大学生 10 天后重 测 ， 评定人际信任量表的内部一致性、重测信度、内容效度及结构效度和效标效度。
结果 ： 人 际信任量表的 Cronbach's α 系数 为 0.9136 ， 重 测信度系数为 0.784 （ P<0.01 ） , 效度指 标达心理测量学的标准。
结论 ： 人 际信任量表可作为我国心理学研究人际信任的有效工具。
关键词 : 人 际信任 量表 信度 效度
Objective: To explore the reliability and validity of Interpersonal Trust Scale.
Methods: 1155 college students came from four universities in Ji'nan were administrated Interpersonal Trust Scale 、 Symptom Checklist 90 (SCL-90) and Adolescent Self-Rating Life Events Check List (ASLEC). The internal reliability, test-retest, construct validity and criteria validity were examined.
Results: The Cronbach's α coefficients of The Interpersonal Trust Scale was 0.9136 and the test-retest reliability was 0.784 （ P<0.01 ） . The scale also maintained the validity for psychometric properties.
Conclusion: The Interpersonal Trust Scale could be used for our later research or practical works.
Key words: interpersonal trust scale reliability validity
- P406
乳腺 肿瘤患者情绪状况与生存质量调查及影响因素分析 - A Study on Survey of Mental States and Quality of Life of Patients with Breast Tumours and the Influencing Factors
敏俊 江 1
1 上海市精神 卫生中心 , 上海 , Chinese Mainland
目的 ： 了解乳腺良 恶性肿瘤患者治疗过程中情绪状况、社会支持的变化及治疗前后的生存质量状况。评价手术及辅助治疗对乳腺良恶性肿瘤患者情绪状况及生存质量的影响。研究手术及辅助治疗前后乳腺良恶性肿瘤患者生存质量变化的影响因素。探讨乳腺癌患者的抑郁焦虑情绪、社会支持及其他因素对生存质量的影响。
方法： 本研究采用欧洲癌症治 疗研究组织生活质 量核心量表 EORTC QLQ-C30 、 SCL-90 、 HAMA 、 HAMD 、社会支持量表（ SSI ） 对 88 例乳腺 肿瘤患者手术前和手术后六个月分别进行问卷调查。采用面访和电话随访问卷的方法调查其情绪状况、社会支持、生存质量及其影响因素。采用多元线性回归分析患者生存质量的影响因素。
结果： ⑴手 术前：乳腺良恶性肿瘤患者手术前的 SCL-90 、 HAMA 、 HAMD 、 QLQ-C30 测评结果差异没有统计学意义（ p>0.05 ）。⑵手 术前后：乳腺良恶性肿瘤患者的 SSI 测评结果差异均没有统计学意义（ p>0.05 ）。乳腺良性 肿瘤患者手术 前后的 HAMA 、 HAMD 评分具有统计学差异（ p<0.05 ），手 术后 HAMA 、 HAMD 评分均低于手术前。乳腺恶性肿瘤患者手术前后的 HAMD 评分具有统计学差异（ p<0.05 ），手 术后 HAMD 评分低于手术前。 ⑶手 术后：乳腺恶性肿瘤患者的 HAMA 、 HAMD 评分高于乳腺良性肿瘤患者（ p<0.05 ）。乳腺 恶性肿瘤患者手术后六月的生存质量低于乳腺良性肿瘤患者，社会功能、整体生存质量、疲乏、疼痛、失眠以及经济困难比较，差异具有统计学意义（ p<0.05 ）。⑷影响因素分析：情 绪状况、居住状况、家庭收入、其他躯体疾病、麻醉方式、 乳腺癌既往史、主 观支持情况是影响乳腺良性肿瘤患者生存质量的主要因素。情绪状况、婚姻状况、居住状况、医疗保险、其他躯体疾病、乳腺癌既往史、放疗和免疫指标、社会支持情况是影响乳腺恶性肿瘤患者生存质量的主要因素。
结论： 乳腺 恶性肿瘤患者手术后六月的情绪状态、生存质量均较乳腺良性肿瘤患者差。影响乳腺良恶性肿瘤患者术后生存质量的因素不同，有必要对其分别进行有针对性的心理社会干预和疏导，以改善和提高他们的生存质量。
Objective: To describe the mental states, social support, and quality of life of patients with breast tumours before and after the therapy, access the influence of the therapy, and explore the influencing factors of quality of life
Methods: Eighty-eight female breast tumour patients were investigated by using European Organization for Research and Treatment of Cancer EORTC QLQ-C30, SCL-90, HAMA, HAMD, Social Support Inventory (SSI) before and six months after surgery. Their mental states, social support, quality of life and the influencing factors were explored by interview and telephone follow-up. The influencing factors of quality of life were analysed by linear regression ( stepwise method).
Results: ⑴ before surgery: The scores of SCL-90, HAMA , HAMD, QLQ-C30, SSI were not statistically different between patients with breast cancer and those with breast benign tumours. ⑵ before and after surgery: The scores of HAMA and HAMD after surgery were lower than those before surgery in breast benign tumour patients. The scores of HAMA after surgery were lower than those before surgery in breast cancer patients. ⑶ six months after surgery: Breast cancer patients'scores of HAMA and HAMD were higher than those of breast benign tumour patients. Breast cancer patients' qualities of life were worse than those of breast benign tumour patients. Their scores of social function, total quality of life, fatigue, pain, insomnia and economy difficulty were statistically different. ⑷ Influencing factors: The influencing factors of breast benign tumour patients' quality of life were emotion states, inhabitation states, family income, somatic diseases, anaesthesia, breast cancer history and subjective support. The influencing factors of breast cancer patients' quality of life were emotion states, marriage, inhabitation states, medical insurance status, somatic diseases, breast cancer history, radiotherapy, estrogen receiver and social support.
Conclusion: Breast cancer patients'mood states and quality of life are worse than patients with breast benign tumours in six months after surgery. The influencing factors are different between patients with breast cancer and breast benign tumours, and therefore it is necessary to implement different psychosocial intervention approaches to improve their quality of life.
- P407
西安市普通市民精神 卫生知识知晓率调研分析 - Investigation and Analysis of Xi'an General Public Awareness of Mental Health Knowledge
建国 师 1 , 园园 罗 1
1 西安市精神 卫生中心 , 西安市 , Chinese Mainland
目的 : 普及精神 卫生知识 ， 防止心理障碍和精神疾病的发生 ， 提高心理健康水平。
方法 : 本研究采用 问卷法对西安市普通市民精神卫生知识知晓率进行调研分析 ， 采取随机抽样设计 ， 收回有效问卷 2552 份。
结果 : 研究 结果表明 ： 基本知晓率为 27.00% ， 部分知 晓率为 46.39% ， 较少知晓率为 26.61% 。知 晓率与性别、年龄、职业以及受教育程度有关。
结论 : 市民的精神 卫生知识知晓程度并不高，特别是儿童精神疾病和精神障碍的具体表现等知识缺乏，有待进一步加强宣传普及工作。
Objective: To popularize mental health knowledge to prevent the psychological barriers and the incidence of mental illness and improve mental health.
Methods: This study used questionnaires to investigate into the awareness of xi'an general public mental health knowledge. The study taked random sampling design, and recovered 2,552 valid questionnaires.
Results: The results showed that basic awareness was 27.00%, some awareness of 46.39%, less awareness of 26.61%. Awareness was in connection with gender, age, occupation and education degree.
Conclusion: The extent of public knowledge about mental health was not high, particularly a lack of knowledge about children's mental diseases and mental disorders. We need to strengthen the outreach work further.
- P408
儿童运 动与脑执行功能的神经心理研究 - Neuropsychology Research on Children Movement and Brain Execution Function
星 季 1
1 上海交通大学医学院附属新 华医院 , 儿童与青少年保健科 , 上海 , Chinese Mainland
目的 : 不同的运 动是否对脑发展不同的作用 ？ 本有研究通过对于乒乓运动员和游泳运动员的事件相关电位和连续作业测试的研究 ， 以大脑执行功能为主要着眼点探讨不同类型运动对于脑功能发展是否存在不同的影响。 方法 选取小学 1 、 2 年 纪的乒乓运动员 41 名和游泳运 动员 43 名 ， 智力正常。 ERP 研究采用 Go/Nogo 范式 ， 对两组被试的 Fz 、 FCz 、 Cz 、 CPz 、 F3 、 F4 导联的 N2 绝对波幅和相对幅值进行成组比较。行为学研究采用视觉 CPT ，同 时结合 Stim2 记录的行为学数据，对于被试的正确率、反应时间进行组间比较。结果 1 、两 组之间基线水平稳定， IQ 值（ t=0.6964 ， P=0.4884>0.05 ）和年 龄均无明显差异。 2 、行 为学数据：游泳组和乒乓组在总体准确率上存在差异，乒乓组总体准确率为 0.92 ，游泳 组总体准确率为 0.88 ，两 组数据经反正弦平方根变换后进行 t 检验（ t=2.1678 ， P ＝ 0.0334<0.05 ）差异具有 显著性。 3 、 ERP 数据： 对于六个导联的 ERP 数据 进行平均叠加后，在两组之间没有发现明显差异。 结论 乒乓组在执行任务的总体正确率上要优于游泳组，而在反应时间上则要慢于游泳组。 N2 幅 值两组间没有明显差 异。
讨论： 在 执行测试任务的过程中，乒乓组完成任务的效率要高于游泳组，并且这种高效率并不是以动用更多的脑资源为代价的。当时并没有明确的事实说明这两种运动对于脑功能的发展存在明显的优劣之分。
- 409
述情障碍 对应激产生的作用及模型 - The Effect of Alexithymia on Stress Generation: Mediator Modeling
Wenhui Yang 1 , Shuqiao Yao 1 , Zhening Liu 1
1 Central South University, The Medical Psychological Research Center, Changsha, Chinese Mainland
目的： 1 ）探 讨述情障碍在应激产生中的作用，并在普通人群中验证述情障碍的应激产生假设，即述情障碍是否作为一种特质使个体经历更多应激性生活事件。 2 ）探明述情障碍 导致应激产生的机制。
方法： 309 名大二、大三学生完成多 伦多述情障碍 20 个条目量表， 应对方式问卷，大学生心理应激量表。
结果： （ 1 ）述情障碍高、中、低分三 组之间心理应激量表总分、社交、负性事情和生活琐事分量表得分 差异具有 显著性 (p<0.05) 。（ 2 ）述情障碍高、中、低分三 组之间应对方式各因子分差异具有显著性（ P<0.01 ）。（ 3 ）述情障碍、心理 应激和应对方式各变量之间相关显著。 其中述情障碍与心理 应激量表显著性正相关 (r=0.12~0.27 ， P<0.05) ，与 应对方式量表中解决问题和求助成熟型应对方式显著性负相关 ( r=-0.28~-0.36, P<0.01) ，与不成熟型 应对方式自责、幻想、退避和合理化显著性正相关 (r=0.27~0.40,P<0.01) 。而心理 应激量表与成熟型应对方式显著性负相关（ r=-0.11~-0.30 ， P<0.01 ）；与不成熟型 应对方式显著性正相关 (r=0.11~0.38,P<0.05) 。 (4) 通 过竞争性模型比较，述情障碍应激产生模型为应对方式完全中介模型，模型的拟合指数 χ2/df=2.24 ， GFI=0.97 ， IFI=0.96 ， CFI=0.96 ， RMSEA=0.064, 均在理想范 围内，路径系数均具有显著意义（ P<0.01 ）。
结论： （ 1 ）述情障碍 导致个体经历更多应激性生活事情，是一种导致个体应激产生的素质特征。（ 2 ）述情障碍 导致应激产生增加是通过不良应对方式为中介变量，改变不良应对方式可 能有利于减少述情障碍个体 经历与其个人特质和行为方式相关的应激性生活事情 .
Objective: (1) To determine the effect of alexithymia on stress generation, and to test the stress generation hypothesis that alexithymia as a trait predisposes individuals to stressful life events in normal people; (2) To explore the mechanism in mediating between alexithymia and stress generation.
Methods: 309 undergraduate students of grade two and three completed TAS-20, Coping Style Questionnaire, and China College Students Psychological Stress Scale(CCSPSS).
Results: (1) Significant differences among low, intermediate and high alexithymia groups on the CCSPSS and its social interactions, negative affairs and daily hassles subscales, and on six factors of coping scale （ problem-solving ， self-blaming ， seeking help ， fantasy ， avoidance ， and rationalization ） .(2) TAS-20 was associated with the CCSPSS and its learning, life, social interactions, negative affairs, life events and daily hassles subscales((r=0.12~0.27,P<0.05); associated with immature coping style(self-blaming, fantasy, avoidance and rationalization r=0.27~0.40,P<0.01),and with mature coping style( problem-solving and seeking help, r=-0.28~-0.36, P<0.01). The CCSPSS and its social interactions, negative affairs, and daily hassles subscales negatively associated with mature coping styl （ r=0.11~0.30,P<0.01 ） ,and positively with immature coping style (r=0.11~0.38,P<0.05) .(3) Through competitive model comparing, the fit alexithymia–stress generation model is a complete mediating model performed by coping style, and the indices including X2/df(2.24) ， GFI(0.97) ， IFI(0.96) ， CFI(0.96) ， and RMSEA(0.064) all met the criteria for adequacy of fit.
Conclusion: （ 1 ） Individuals with alexithymia experience more stressful life events, which suggested alexithymia as a trait predisposes individuals to stressful events. （ 2 ） The effect of alxithymia on stress generation is mediated by coping style. Improving immature coping style may reduce stressful life events that are due to individuals' characteristics and behaviors.
- P410
罗夏测验客体关系相关变量在不 同精神疾病中的特点 - The Difference of Variables Related with Object Relations in Rorschach Test in Evaluating Different Mental Disorders
红军 彭 1 , 宪璋 孟 2 , 婵娟 杨 3 , 英 龙 4
1 广州市 脑科医院 , 广州 , Chinese Mainland, 2 暨南大学医学院附属第一医院 , 心理精神科 , 广州 , Chinese Mainland, 3 广州市 脑科医院 , 精神科 , 广州 , Chinese Mainland, 4 广州市民政局精神病医院 , 精神科 , 广州 , Chinese Mainland
目的 ： 探 讨罗夏测验中与客体关系相关的变量在不同精神疾病中评分特点 ， 以及治疗前后评分变化。
方法 ： 符合 CCMD-3 的分裂症 ( 偏 执型 ) 病人 32 例 ， 躁狂症病人 31 例 ， 抑郁症 （ 单相 ） 病人 30 例 ， 及正常 对照组 32 例 ， 治 疗前及治疗后 2 月分 别给予罗夏测验综合系统及自主同一性量表 （ MOA ） 记分 ， 治疗前及后 2 月分裂症 组及抑郁症组分别给予 PANSS 及 汉密尔顿抑郁量表评分。
结果 ： 所 选取的指标中 H （ 人 类回答及人类部分回答 ） 与 SA （ 分离自主的相似活 动 ） 、 SA 与 SX( 与性有 关的反应 ) 、 MC （ 恶意控制 ） 与 (2) （ 成 对反应或影像 ） 、 DI （ 毁 灭性不平衡 ） 与 (2) 存在 显著相关 （ P<0.05 或 P<0.01 ） 。 M( 运 动反应 ) 、 A （ 动物反应）、 (2) 、 AG （攻 击）、 SX 、 R （反 应数）各指标对于区分不同精神疾病均有意义；分裂症治疗前后， M (P<0.001) 、 R(P<0.05) 分存在 显著差异。抑郁症治疗前后， M (P<0.001) 、 A (P<0.001) 、 AG(P<0.05) 分存在 显著差异。
结论 ： 罗夏测验中部分变量与客体关系相关 ， 该变量对于区分不同精神疾病有一定的意义。
Objective ： To explore the difference of variables related with object relations in Rorschach test in evaluating different mental disorders.
Methods ： 32 schizophrenia patients 、 30 depression patients 、 and 31mania patients were taken in Guangzhou Brain Hospital , and 32 people in control group were taken, Patients taken must meet the CCMD-3 diagnosis criterion, Patients in different groups were evaluated twice by Rorschach scale 、 MOA 、 PANSS 、 Hanmilton Depression scale before theorapy and two months later after theorapy.
Results ： there were significant correlation between H （ human reaction ） and SA （ Separate, autonomous parallel axtivity, ） 、 SA and SX(Sex reaction) 、 MC （ Malevolent control ） and (2) (Two reaction) （ P<0.05 或 P<0.01 ）
Conclusion ： Some Variables in Rorschach test are relational with object relations level really, and the difference of their scales in different mental disorders perhaps were significant in distinguishing different types of mental disorders
- P411
罗夏测验自主同一性量表 (MOA) 的信度、效度研究 - A Study in Reliability and Validity for Mutuality of Autonomy Scale (MOA) in Rorschach Test
红军 彭 1 , 宪璋 孟 2 , 英 龙 3
1 广州市 脑科医院 , 广州 , Chinese Mainland, 2 暨南大学医学院附属第一医院 , 精神心理科 , 广州 , Chinese Mainland, 3 广州市民政局精神病医院 , 广州 , Chinese Mainland
目的 ： 探 讨罗夏测验自主同一性量表在中国人群中的信度、效度。
方法 ： 符合 CCMD-3 的分裂症 ( 偏 执型 ) 病人 32 例 ， 躁狂症病人 31 例 ， 抑郁症 （ 单相 ） 病人 30 例 ， 及正常 对照组 32 例 ， 各 组分别进行自主同一性量表 （ MOA ） 记分 , 对照组一月后再次 MOA 评分 ， 两不同记分者对同一记录分别作 MOA 记分 ； 病人组入组时均作 MOA 记分。
结果 ： 正常 组 MOA 七等 级及总相关系数为 0.78 － 0.98 （ P<0.01 ） ， 两 记分者评分一致率在 0.75-0.95, 总一致率为 0.91 ； MOA 七 变量可提出三个因素 （ DA 、 SI 、 SA ）； MC 、 OE ； RA 、 DI ）， 各因子 负荷量均在 0.50 以上。七 变量按三分法及七 分法均能有效的区分被 试是否有精神病。
结论： 罗夏测验自主同一性量表在中国人群中有较好的信度、效度。
关键词 : 罗夏测验自主同一性量表； 信度； 效度
Objective: Exploring the reliability and validity of object relations MOA scale.
Methods: 32 schizophrenia patients, 30 depression people, 31mania patients were taken into groups, and 32 people in control group were taken, Patients taken must meet the CCMD-3 diagnosis criterion, Patients in different groups were evaluated by MOA, the control group were evaluated again after a month.; two different surveyors evaluated the reactions of the same control group to Rorschach card.
Results: There was a significant correlation between the two evaluations ， the correlation coefficient are between 0.78 and 0.98(P<0.01); Two different surveyors evaluated the same control group and the coherence frequency between 0.75and 0.95, the total coherence frequency is 0.91. the seven variables of MOA can reduce to three factors （ DA 、 SI 、 SA ； MC 、 OE ； RA 、 DI ） ; the three variables reduced by the seven variables of MOA and the seven ones can distinguish the people with mental disorders from the normal ones.
Conclusion: Mutuality of Autonomy Scale(MOA) in Rorschach Test has good reliability and validity in Chinese people.
Key words: Mutuality of Autonomy Scale(MOA) in Rorschach test ； reliability ； validity
- P412
精神科慢性病房護理站空氣品質改善案 - Improvements for Air Quality in the Chronic Psychiatric Nursing Station
寧 宛 馬 1
1 財團法人奇美醫院 , 護理部精神科 , 台南市 , Taiwan , Province of China
本專案旨在改善精神科慢性病房護理站之空氣品質 ， 所謂空氣品質即指空氣中 CO2 濃度。運用美製 CO2 監測器量測，發現本護理站 8am 至 10am 時段， CO2 濃度明顯大於 1000 ppm 。以問卷測量護理人員對空氣的感受， 100 ﹪認為空氣品質為差及非常差。分析主要原因為：病患於護理站前點煙、護理站回風口無法有效循環、抽風機及空調關閉、新鮮空氣流量不足、中央空調主機定時關閉等因素等因素。專案小組運用：?修訂點菸規則 ? 裝置病房區回風網 ? 修訂抽風機及空調及空調使用原則 ? 改變新鮮空氣路徑 … 增設冰水主機設備及改變中央空調主機使用原則等策略，結果：護理站 8am~10am CO2 濃度小於 1000ppm 。白班 8 小時濃度平均 值自 896ppm 降至 780ppm ，且護理人員對空氣質素的感受，一般及好的感受評量提升至 71% 。
This project was aimed at improving the chronic psychiatric nursing stations air quality, air CO2 concentration. Using U.S.-made CO2 monitoring device, we found that he CO2 concentrations achieved greater than 1,000 ppm the nursing station during 8am and 10am sessions,. A questionnaire survey of nurses on the air quality, all (100%) nurses think that the air quality is worse and worst. We found the main reasons including patients light cigarette in front of the nursing station, the nursing station blocked air-flow for effective recycling, inadequate flow of fresh air, central air conditioning shut down regularly and other factors. The group used: amended rules , installing wind re-entry mesh, wind amendment FAN and modifying air conditioning and air-conditioning operating rules, exchanging of fresh air routes, additional ice mainframe equipment to change the principles of the use of mainframe strategy. The result: CO2 concentrations in nursing station during 8am~10am decreased to less than 1000 ppm. In 8-hour day shift, the average concentration decreased from 896ppm to 780ppm. Nurses report the air quality was good and the general satisfactory upgraded to 71%.
- P413
病人健康 问卷抑郁量表 (PHQ-9) 在社区老年人群中的信度与效度初 步分析 - The Preliminary Analysis of Reliability and Ralidity of the Patient Health Questionnaire (PHQ-9) in Community Old People
徐 勇 1
1 上海精神 卫生中心 , 上海 , Chinese Mainland
目的 : 检验病人健康问卷抑郁量表 （ PHQ-9 ） 在老年人中的信度与效度。
方法 : 应用 PHQ-9 对社区 622 名老年人 进行评定 ， 进行同质性信度研究 ； 1 周后 对随机抽取的 61 名老人 进行再次评定 ， 进行重测信度研究 ； 从 622 名老人中抽取 195 名 进行定式精神检查 （ SCID- Ⅰ） 抑郁量表 评定 ， 进行 PHQ-9 的效度研究。 结果 :PHQ-9 内部一致性系数 Cronbach′а 系数 为 0.8325 ，条目 间的相关系数为 0.233-0.523 ，各条目与量表 总分的相关系数为 0.451-0.693 。 61 名老人重 测 PHQ-9 信度系数 0.934 ， PHQ-9 的灵敏度 为 88% ，特异度 为 99% 。
结论 : PHQ-9 在我国社区老年人群中也具有良好的信度与效度 , 并且条目 简洁，操作方便，易于掌握和节省时间，值得在临床，尤其是基层社区卫生中心推广使用。
- P414
精神疾病相 关法律问题研究 - On Legal Problems Associated with Mental Disorder
莎 丽 王 1
1 新 乡医学院第二附属医院 , 新 乡 , Chinese Mainland
当前，精神病人的入院程序和住院期 间意外伤害事件引发的法律问题，已成为精神卫生法学研究的焦点。 1 ．精神疾病患者入院的法律 纠纷，主要确立监护人的时间和精神疾病确诊的时限不明造成的。 建 议：（１）规定疑似精神病人有责任和义务前往或被接至精神病院或精神科诊断，一经确诊为精神病就应治疗。如果精神病人病情严重又丧失或部分丧失自知力，则应保护或强制入院，监护人由此确立；（２）精神疾病的确诊应该有确定的时限，可参考《上 海市精神 卫生条例》对强制入院 72 小 时的确诊时间规定。 2 ．精神病人住院期 间的意外伤害，既包括患者本人受到伤害，也包括患者肇事造成他人的伤害。这些伤害引发的法律问题，主要围绕精神病医院对精神病患者是否有监护义务来展开。医院到底是否应该承担住院精神病人的监护责任问题，通常精神科专业人士都认为精神病院对住院病人不存在监护责任，而法学工作者则普遍认为精神病院与精神病人的法律关系应当是监护与被监护的关系。 使用 “ 保 护 ” 一 词将有利于明确医院的义务以及确立医院的法律责任。精神病医院应严格履行 “ 善良管理人合理注意的保 护义务 ” ，住院期 间的意外伤害是对医院的管理下，医院对此有防范的义务，该义务应该建立在合理注意的基础上，这样更符合精神病医院的工作性质和法律要求。精神卫生问题不仅仅是医疗卫生问题，更是一个突出的社会问题。精神卫生涉及到诸多的法律问题，从医学和法学结合的视角研究精神疾病引发的相关法律问题，对于维护精神病患者、精神卫生工作者的权益，保障社会的稳定具有重大意义。
Now, the legal dispute originated from mental disorder patients' admission procedure and patients' accidents during the period of hospital stay had been focal points in both psychiatry realm and jurisprudence realm. 1.It caused the legal dispute originated from mental disorder patients' admission procedure that time of establishing guardian was indefiniteand time limited which setting for psychiatrist to make a final diagnosis was indefinite. Suggestions: （１） It should be regulated that suspect mental disorder patients had accountabilities and liabilities to go to or be taken over mental hospitals or psyche departments for final diagnosis, and they should be treated immediately once they were diagnosed mental disease. If patients' condition were serious and they were loss of the whole or part insight, they should be defended or forced to be hospitalized, and guardians be established. （２） The final diagnosis of mental disorders should have definitive latitude, which can refer to 《 Rules of Mental health in Shanghai 》 which regulates 72 hours for final diagnosis. 2 ． The patients' accidents during the period of hospital stay include patients' received harm and others' injuries caused by patients. Legal problems initiated from those harms surrounded that whether psychiatric hospital had guardianship duty to psychopath and whether hospitalization signified guardianship duty to psychopath had transferred to psychiatric hospital partly.Whether hospital should assume the guardianship responsibility or not, usually psych-department specialists consider hospital have not guardianship responsibility, but jurisprudence workers widespread consider the relationship of psychiatric hospitals have the total guardianship responsibility.
- P415
北京地区部分医学生与非医学生 对癔症的知识和态度的比较 - Comparison of the Attitudes to Hysteria between Medical and Non-medical Undergraduates in Beijing
韩 雪 1 , 黄 庆 英 1 , 马 弘 1 , 于 欣 1
1 北京大学精神 卫生研究所 , 北京 , Chinese Mainland
目的 ： 调查并比较北京地区部分医学生及非医学生对于癔症的了解程度以及对于癔症患者的态度。
方法 ： 设计大学生调查问卷 ， 随机抽取北京大学医学部本科生 179 名以及北京第二外国 语学院和北京大学非医学专业本科生共 189 名 进行统一问卷调查 ， 并对结果进行分析。
结果 ： 接受 调查的大学生中 ， 93.9 ％ 的医学生听 说过癔症 ， 而 71.4 ％ 的非医学生根本没有听 说过此病 ， 二者存在显著统计学差异 （ χ 2 ＝ 163.705 ， p<0.01 ）； 大部分大学生没有接触 过患癔症的患者 ； 对于给定典型癔症病例 ， 69.3 ％ 的医学生会想到是 癔症可能 ， 而 81.9 ％ 的非医学生不会想到此病 ， 二者差异具有 统计学意义 （ χ 2 ＝ 97.999 ， p<0.01 ）； 对于典型病例 ， 62.9 ％ 的医学生 选择到精神科就诊 ， 而 62.2 ％ 的非医学生 选择看中医或者神经科 ； 83.8 ％ 的医学生 认为女性患者多发 ， 而超过 50 ％ 的非医学生 认为与性别无关 ； 医学生中认为年轻人易患的较多 ， 而非医学生中认为与年龄无关的人较多 （ χ 2 ＝ 7.038 ， p<0.05 ）； 认为白领阶层易患癔病的医 学生多于非医学生 ， 而 认为体力劳动者易患或者认为此病与职业无关的非医学生明显多于医学生 （ χ 2 ＝ 9.945 ， p<0.01 ）； 接受 调查的大学生中 ， 有 1.4 ％ 觉得 “ 癔病 ” 是个褒 义词 ， 而分别有 78.7 ％ 的医学生和 60.3 ％ 的非医学生 觉得 “ 癔病 ” 是个中性 词 ， 而认为 “ 癔病 ” 是 贬义词的非医学生比例明显高于医学生 （ χ 2 ＝ 15.916 ， p<0.01 ）； 接受 调查的医学生和非医学生中 ， 分别有 60.9 ％ 和 39.8 ％ 认为神经质的人易患癔症 ， 分别有 37.4 ％ 和 46.8 ％ 认为生活不顺利的人易患 ， 13.4 ％ 的非医学生 认为道德水准不高的人易患 ， 而医学生中只有 1.7 ％ 这样认为 ， 存在显著的统计学差异 （ χ 2 ＝ 26.453 ， p<0.01 ）； 觉得癔症患者和正常人一样的医学生和非医学生比例分别为 54.9 ％ 和 50.8 ％， 而 觉得癔症患者讨厌的分别为 42.9 ％ 和 46.5 ％； 分 别有 41 ％ 和 37 ％ 的医学生和非医学生 对癔症患者感到同情 ， 也有相当一部分人 （ 14.6 ％ 的医学生和 19.6 ％ 的非医学生 ） 选择敬而远之。
结论 ： 北京地区的部分大学生 对于癔病的认识存在不足 ， 且有相当部分学生对于癔症患者存有偏见甚至歧视 ， 这个情况在非医学生中尤为突出 ， 所以大学生加强精神疾病相关知识的普 及教育可能是有必要的。
Objective: To investigate the understanding of hysteria among undergraduates in Beijing , and to compare the attitudes to hysteric patients between medical and non-medical students.
Method: The questionnaire designed to explore the knowledge of hysteria and how hysteria is perceived was administered to undergraduates randomly sampled at Peking University Health Science Center and Beijing International Studies University . The data was analyzed with SPSS 11.5 Software Packet. Results: Most medical students had heard of hysteria (93.9%), while most non-medical students hadn't (71.4%). The difference was statistically significant ( χ 2 ＝ 163.705, p<0.01). When presented with a typical case of hysteria, more medical students gave an impression of hysteria than non-medical students (69.3% vs. 18.1%, P<0.01). Most medical students (62.9%) recommended visiting a psychiatrist, while most non-medical students (62.2%) preferred visiting a Chinese traditional practitioner or neurologist. Around 83.8% medical students stated hysteria was more prevalent in female, whereas more than half of non-medical students thought gender did not matter regarding the prevalence rate of hysteria. Comparing to non-medical students, more medical students considered that young people ( χ 2 ＝ 7.038 ， p<0.05) and white-collars ( χ 2 ＝ 9.945 ， p<0.01) were more vulnerable to hysteria. Concerning the meaning of term “hysteria”, more non-medical students looked “hysteria” in derogatory sense than medical students ( χ 2 ＝ 15.916 ， p<0.01). Almost half of the students disliked hysteric patients, and many of them would keep far away from the patients.
Conclusions: In Beijing , undergraduates have limited knowledge of hysteria, and hold prejudice and discrimination to hysteric patients, especially among non-medical students. The findings highlight the necessity of health promotion education of mental health among college students.
- P416
慢性 应激对大鼠的行为及海马 BaxmRNA 和 Bcl-2mRNA 表达的影响及文拉法辛 对其干预作用的研究 - Effect of Chronic Stress on the Change of Behavior and the Expressions of mRNA of Bcl-2 and Bax in Hippocampus and the Interventional Effect of Venlafaxine of the Rats
Zheng-jun Xiao 1 , Yi-ming Wang 2
1 扬州大学医学院附属扬州五台山医院心理科 , 扬州市 , Chinese Mainland, 2 贵阳医学院附属医院心理科 , 贵阳 , Chinese Mainland
目的 : 观察慢性应激对大鼠的行为及海马 BaxmRNA 和 Bcl-2mRNA 表达的影响和抗抑郁 药 文拉法辛 对其干预作用。
方法 ： 选择 48 只 SD 大鼠 ， 随机分 为 3 组 ， 即正常对照组 ， 单纯应激组 , 应激药物组 , 每 组 16 只。采用慢性 轻度不可预见性的应激结合孤养给予大鼠应激。单纯应激组及应激药物组大鼠共接受 21d 各 种不同的应激。刺激同时应激药物组灌胃给药， 1 次 /d ， 剂量 15mg/kg ， 单纯应激组蒸馏水灌胃，共 21d 。采用敞箱 实验和糖水消耗实验观察大鼠行为改变。用逆转录聚合酶链反应（ RT-PCR ） 检测海马组织凋亡相关基因 Bax 和 Bcl-2 的 mRNA 基因表达情况。
结果： ① Open-field 行 为得分和糖水消耗实验：单纯应激组大鼠旷场行为得分和糖水消耗量与正常对照组比较明显降低（ P ＜ 0.01) ；与 单纯应激组比较，文拉法辛能增加慢性应激大鼠旷场行为得分和糖水消耗量（ P ＜ 0.01) 。② RT-PCR 检测 Bcl-2mRNA 和 BaxmRNA 发现：单纯应激组与正常对照组比较，单纯应激组海马 BaxmRNA 基因表达明 显升高， Bcl-2mRNA 基因表达明 显降低（ P ＜ 0.01); 与 单纯应激组比较，文拉法辛可降低应激大鼠海马 BaxmRNA 基因表达 , 升高 应激大鼠海马 Bcl-2mRNA 基因表达（ P ＜ 0.01) 。
结论： 慢性 应激可使大鼠的行为表现出抑郁状态，使海马 BaxmRNA 基因表达升高 , Bcl-2mRNA 基因表达降低，而文拉法辛可 显著改善应激大鼠的异常行为，并对海马 BaxmRNA 和 |
