Chairs: Ihsan Salloum , United States
Yanfang Chen, Chinese Mainland
Juan E. Mezzich, United States

National and regional classifications in psychiatry have assumed increasing important role as efforts at developing these systems to better reflect local realities have evolved. The issue of harmonization with the International Classification of Mental Disorders is particularly pertinent as the process of development of ICD-11 Classification of Mental Disorders (Mental Health Chapetr-5) has begun. This symposium will present three major national and regional systems, the Chinese Classification of Mental Disorders, 3rd Ed. (CCMD-3), the French Classification for Child and Adolescent Mental Disorders, and the Latin American Guide for Psychiatric Diagnosis (GLADP). It will also examine the role of regional adaptation in psychiatric classification.

•  S01-1

Place of Regional Adaptations on International Diagnosis

Ihsan Salloum

University of Miami Miller School of Medicine, Miami , United States

This presentation will review communality and differences between International Classification of Mental Disorders and National and Regional classifications. It will examine their role, potential discourse and dialectic between these complementary, but potentially divergent systems and it will discuss emerging integrative diagnostic models.

•  S01-2

French Classification For Child And Adolescent Psychiatry

Michel Botbol

Judicial Protection of the Youth Governmental Agency, Paris , France

Operational since 1983, the French Classification of Child and Adolescent Mental Disorders (CFTMEA) is the classification of reference for all French Child psychiatrists who are very attached to it because they find there the clinical and therapeutic way in which they recognize themselves and in which they were (and continue to be) trained.

Validated through multicentric studies, it currently remains used in the whole of the medico-administrative documents in circulation in France and takes part in the existing evaluations aiming at knowing the activity of the public services of Child Psychiatry and to plan their evolution. The CFTMEA is glossarised; it is articulated with the classification of the handicaps such as it was elaborate starting from the Woods principles, and comprises a table of conversion with the ICD10. A data-processing expert system was built on this classification, testifying to the rigour and the reproducibility of its step. The CFTMEA is deliberately built according to a hierarchical architecture built on two quite distinct axis. It thus favours an overall catching of the disorders which it classifies, seeking in priority to establish a structural diagnosis; this structural diagnosis includes personality characteristics and is referred to psychodynamic psychopathology. CFTMEA is thus not pretending to be atheorical; on the contrary it clearly affirms the theory on which it is based, allowing it to remain closer to the clinical steps which are never atheorical when they do not limit themselves to simple symptomatic descriptions.

•  S01-3

The Latin American Guide for Psychiatric Diagnosis (GLADP)

Miguel R. Jorge

Federal University of Sao Paulo ; Paulista School of Medicine, Sao Paulo , Brazil

The Latin American Guide for Psychiatric Diagnosis (GLADP) proposes regional adaptation of ICD-10 to Latin American realities and it proposes comprehensive diagnostic guidelines, including a multiaxial format, a structured, and a narrative component. Since its publication, the GLADP has generated wide interest in its use. This presentation will discuss the structure of the GLADP. It will also review GLADP-related educational, dissemination, and research efforts.

•  S01-4

Chinese Classification and Diagnostic Criteria of Mental Disorders Version 3 (CCMD-3): Preset and Future

Yanfang Chen

Section on Classification, Diagnostic Assessment and Nomenclature WPA, Beijing , Chinese Mainland

The aim of publishing Chinese Classification and Diagnostic Criteria of Mental Disorders Version 3 (CCMD-3, CSP 2001) was to resolve the controversy existed in previous version of CCMD, and to integrate into the international classification and diagnostic system, particularly the ICD-10, and also to enhance the reliability and validity of the classification and diagnostic criteria of mental disorders in China . This presentation will publish the results of investigation on using CCMD-3 in China and the suggestion and comments on the present state and the future of CCMD system in the part of Chinese psychiatrists.

•  S02 - 跨文化精神病学的国 际观点 - International Perspectives on Cross Cultural Psychiatry

Chairs: Ahmed Okasha, Egypt
Tarek Okasha , Egypt
XuDong Zhao, Chinese Mainland

当我 们的社会变得越来越多样化、世界发展进化为一个地球村时 ， 将文化融入医学和精神病学的需要就变得愈发的迫切和重要。世界范围内的国际旅游、移民正变得越来越便捷，通信技术的发展增强了来自不同文化和社会体系的人们之间的交流与融合。因此，卫生和精神卫生的职业医生越来越多地 需要治 疗与自己背景不同的患者。虽然现代精神病学扎根于神经科学和心理学，然而目前的成就增强了精神病学与多种社会学与文化的结合。理解患者的经历对于提高诊断和治疗的精确性是至关重要的。更清楚地理解文化的概念及其与医学和精神病学的整合不仅可以增强临床医生的文化敏感性，而且可以提高他们对于诊断的敏感性、在决定治疗处方时能更适合患者的社会背景。毫无疑问，文化对于精神疾病的症状表现，症状的理解以及在每种文化下不同的传统治疗方式都有显著地影响。理解症状的表现对于达到正确的诊断是必需的部分。我们生活的时代是一个精神病学的实践 和需要我 们帮助的患者以及我们将来的患者不断增加的重要时期。这个世纪详细描述心理动力学机制的著名纯行为反射学理论中，没有一项能够充分地描述人类在健康与疾病时的思想。神经突触是我们新的希望，它从生物学角度回答了思维的复杂性，就如同它的实际性和便利性，对于提供所有的回答和解决方法显得过于简单。现在是时间进行反思了，也许我们的文化遗产会有所帮助。对于仔细看待不同文化的贡献还有另一种原因，创造条件使得职业医生更好地理解。我们所有人需要知道其他文化的现实。每一种文化对于发展我们复杂和多维度的学科都有潜在的贡献。理解其他 文化的 贡献同样能够减少某些我们对于其他文化的误解。本专题讨论将会讨论发展中国家精神卫生发展的全球化，文化相关综合征以及它们在世界范围内成人中的不同表现。此外 ， 有个演讲将会聚焦于中国儿童和青少年跨文化精神病学 ， 也会有一个演讲是关于躯体障碍和医学无法解释的躯体症状的阿拉伯观点。

As our societies become more diverse and the world evolves into a global village, the need to integrate culture into medicine and psychiatry becomes more critically important. Worldwide, increasing ease in international travel and migration and advances in information technology has enhanced interaction and intermingling of people from different cultural and social systems. As a result, practitioners of the health and mental health professions are increasingly being called on to treat patients from backgrounds very different from their own. Although modern psychiatry is grounded in both neuroscience and psychology, there have been recent efforts to enrich psychiatry by integrating it into various sociological and cultural materials. Understanding the context of the patient's experience is critical for enhancing greater precision in diagnosis and treatment. A clearer understanding of the concept of culture and its integration into medicine and psychiatry not only can increase clinicians' cultural sensitivity, but also can sharpen their diagnostic acumen and aid in the formulation of treatment plans more congruent with the patient's cultural background. There is no doubt that culture has a marked influence on the presentation of psychiatric symptoms, the understanding of theses symptoms and the different methods of traditional therapies used in each culture. Understanding the presentation of the symptomatology is an essential and integral part of reaching a proper diagnosis. We live in a time in which the practice of psychiatry and the future of our patients and an increasing number of people who need our help at a very crucial stage. None of the famous theories of this century, from pure behavioral reflexology to elaborate psychodynamic formulations, have proved sufficient to describe the human mind in health and disease. Our new hopes in the synapse, as the biological answer to the complexities of the mind, pragmatic and convenient as they can be, are too simplistic to provide all the answers and solutions. It is time for reflection and perhaps our cultural heritage can help. There is another reason to look more carefully at the contributions of different cultures, the creation of conditions for a better understanding among professionals. All of us need to know the realities of other cultures. Each culture has the potential for some contribution to the advancement of our complex and multidimensional discipline. Knowing the contributions of another culture can also help by decreasing some of the misunderstandings we have regarding other cultures This symposium will discuss the effect of globalization on mental health in developing countries as well as cultural bound syndromes and their different presentations around the world in adults. Also a presentation will focus on Cross Cultural Psychiatry in Children and Adolescence from a Chinese perspective as well as a presentation on somatoform disorders and medically unexplained somatic symptoms from an Arab perspective.

•  S02-1

全球化对发展中国家精神卫生的冲击 - The Impact of Globalization on Mental Health in Developing Countries

Ahmed Okasha 1

1 Institute of Psychiatry, Ain Shams University , Cairo , Egypt

全球化可以定 义为逐渐分隔个体和社会的传统界限加速倒退的过程。这个过程既有负性又有正性的结果 ， 而且可能产生胜利者或是失败者。全球化有希望给与世界即时通信，快速和便捷的旅行方式，更多的科技，跨国文化交流和全球化的方式处理环境事件。事实上，全球化已经到来，几种不同的危机已经显现：领导危机（财富集中到越来越少的人手中，以至于全世界 3 个最富有的富翁 资产超过了 48 个最 贫穷国家的 GDP 总值）；民主危机（ 13 亿人生活在每天收入不到 1 美元的情况之下）； 经济危机（将近 15 亿人得不到清洁的饮用水， 10 亿人生活在条件十 分 简陋的住房内）；精神危机（许多人太过贫穷以至于只有通过面包的形式他们才能看见上帝），而且，最后但不是最少见的，道德危机（每天有 4 万儿童因 营养不良和疾病而死）。在精神病学中，全球化最重要的一面是采用合理的方式分配精神卫生服务，提供平等的治疗和为我们的患者建立平等的疗效，无论这些患者来自世界的哪个部分。迄今为止，全球化已从多个方面影响了精神病学的临床实践，不幸的是这些方面并不包括从世界范围内提供支持或是获得精神卫生服务的权利，使用精神卫生服务者的种族和文化差异的增加导致了对于精神疾病的态度和信念的宽泛。在发达 国家中，移民的增加使得与移民相 关的精神障碍发生增加。在快速发展的发展中国家中，社会经济的改变以及生活事件导致了精神障碍发生的增加。在所有国家中，科技技术的发展使得获取卫生保健服务的信息增加，导致了需求的增加。最终，全球化推动了精神科培训的全球化协议增加，精神卫生政策以及保护精神疾病患者的人权。全球化也导致了对于社会资产概念及其对人群精神卫生的影响进行彻底地调查。在 2002 年，世界精神病学 协会会员大会一致通过了一项关于精神卫生和全球化的声明（ 5 ）。 这项声明号召所有的世界精神病学协会成员提升公众与政府的意识，那 就是只有当 发展健康与福利成为国家经济政策发展以及设计与管理国际经济体系的中心任务时；精神卫生已成为公共卫生的一部分时全球化的效果才会有选择性。这项声明号召精神病学家要处于积极设计政策的地位，形成国家联盟，在国际间进行游说争取更为合理的精神卫生服务资源和质量的分配，并且保证让政府知道精神卫生和人权全球化的涵义。这项声明呼吁他们提倡给与精神疾病公平合理的治疗 ， 给与所有人社会公平与公正 ， 向患者提供最好的治疗以及与其对应的科学知识和道德原则。

Globalization may be defined as a process in which the traditional boundaries separating individuals and societies gradually and increasingly recede. The process has clearly both negative and positive results and is likely to create both losers and winners. Globalization has promised to grant the world instant communication, fast and efficient means of travel, a widened access to technology, cross border cultural interaction and globalized approaches to environmental issues.

In fact, globalization, as it has been implemented to this very day, highlights several crises of different natures: a leadership crisis (where wealth is allowed to be concentrated in fewer and fewer hands so that the world's three richest individuals have assets exceeding the gross domestic product of the poorest 48 countries); a democratic crisis (where 1.3 billion people live on incomes of less than 1$/day); an economic crisis (where nearly 1.5 billion people have no access to clean water, and 1 billion live in miserably substandard housing); a spiritual crisis (where many people are so poor that they can only see God in the form of bread), and, last but not least, a moral crisis(where 40 thousand children die each day from malnutrition and disease.

In psychiatry, the most important aspect of globalization is delivering mental health services in an equitable pattern, providing equal treatment and establishing equal outcome to our patient population, no matter which part of the world they come from . So far, globalization has affected psychiatric clinical practice in a multitude of ways, which unfortunately do not include a worldwide provision or access to mental health care services, increased ethnic and cultural diversity of service users has led to a wider range of attitudes and beliefs in relation to mental illness.

Increased ethnic and cultural diversity of service providers has led to a wider range of approaches and beliefs in relation to mental health care. In developed countries, increased rates of inward migration have led to increases of migration-associated mental disorders. In rapidly developing countries, socioeconomic changes and life events have led to increases in rates of mental disorders. In all countries, the development of technology has led to increased information on a range of health care services, resulting in increased demand.

Finally, globalization has contributed to an increased emphasis on the implementation of international protocols In psychiatric training, mental health policy and the protection of human rights of mental patients. It has also resulted into a thorough examination of the concept of social capital and its influence on the mental health of populations.

In 2002, the WPA General Assembly in Yokohama endorsed a consensus statement on globalization and mental health (5). This statement called upon all WPA components to raise public and government awareness that the effects of globalization will be optimized only when improvements in health and well-being become central objectives of national economic policies and of the design and management of the international economic system; and that mental health is part of public health. It called upon psychiatrists to be in a position to actively shape policy, to form national alliances, to lobby internationally for a more equitable distribution of resources and quality of care, and to ensure that governments are aware of the implications of globalization on human rights and mental health. It appealed to them to advocate for fair and equal treatment of the mentally ill, for social justice and equity for all, and to serve patients by providing the best therapy available consistent with accepted scientific knowledge and ethical principles.

  S02-2

文化相关综合征：对传统精神病学的挑战 - Culture-Bound Syndromes: A Challenge to Traditional Psychiatry

Pedro Ruiz 1

1 Department of Psychiatry & Behavioral Sciences University of Texas Medical School at Houston , Texas , United States

在 过去的二十年中 ， 发达的全球化过程产生了全世界范围内大量的移民。然而这种移民进程 ， 发展中国家要比工业国家激烈的多。 这些移民不仅带来了他们发展社会经济的欲望 ， 同样也带来了他们的规范、传统、语言和宗教信仰 ； 那就是他们的文化。举例来说，在美国目前的居民中有 1000 万人属于不同的 种族。 在欧盟， 类似的现象同样在发生。无论如何，这些移民同样带来和描述了精神状态的临床表现，这些并不适合精神障碍的传统分类体系；那就是文化相关综合征。本演讲回顾了最为常见和相关的文化相关综合征，希望能够帮助来自传统国家的精神卫生专家更好地理解这些文化相关综合征的含义。

培 训目标： 1 、理解在少数民族中文化相 关综合征的含义。 2 、提高 传统精神卫生专家的诊断技巧。

During the last two decades, a very strong globalization process has produced an extensive migration process all over the world. This migration process, however, is more intense from developing or evolving countries to industrialized nations. These migrants not only bring with them their desire to improve socioeconomically, but also their norms, heritage, language, and religion; that is, their culture.

In the United States , for instance, there are currently 100 million of persons who belong to different ethnic groups who reside in this country. In the European Union, something similar is also happening. In any case, these migrants also bring and depict clinical manifestations of mental conditions that do not fit the norms defined by the traditional systems of classification of mental disorders; that is, culture-bound syndromes. In this presentation a review of the most common and relevant culture-bound syndromes will be presented with the hope of helping mental health professionals from traditional countries to understand better the meaning of these culture-bound syndromes.

Educational objectives:

1. Understand the meaning of culture-bound syndromes among ethnic minority groups.

2. Improve the diagnostic skills of traditional mental health professionals.

•  S02-3

心身疾病和医学上无法解释的体征；一种阿拉伯的观点 - Somatoform Disorders and Medically Unexplained Physical Symptoms; An Arab Perspective

Tarek A. Okasha 1

1 Institute of Psychiatry, Faculty of Medicine Ain Shams University , Cairo , Egypt

我 们的社会正在变得越来越多样化 ， 世界发展进化为一个地球村 ， 将文化融入医学和精神病学的需要就变得愈发的迫切和重要。在阿拉伯文化中，与医生进行人道主义者的互动是十分宝贵的，这要比他或她的技术能力或是科学知识更为重要。互动的人道主义本质取 决于医生 对待患者及其家庭的方式，以及延伸至医生表达对他们的尊重和接纳当地的文化规范。这种社会比个人中心更倾向以家庭为中心，比自主更倾向于相互依赖。毫无疑问的是文化对精神症状的表现，对这些症状的理解以及在各种文化下使用不同的传统治疗方法有着显著地影响。由于精神卫生设施的不足 ， 就必须由全科医师帮助诊断和治疗那些无法解释躯体症状的精神疾病 ， 这也是医学生精神科训练的必需部分。本演讲将着重对西方社会与传统社会之间对于阿拉伯文化下躯体形式障碍的诊断差异进行回顾。

As our societies become more diverse and the world evolves into a global village, the need to integrate culture into medicine and psychiatry becomes more critically important. In Arab the culture, the humanitarian interaction with a doctor is valued as much, if not more, than his or her technical ability or scientific knowledge. The humanitarian nature of this interaction depends on the way the doctor deals with the patient and his or her family and the extent to which the doctor expresses respect for, and acceptance of local cultural norms. The society is more family centered than it is individual centered and there is interdependence rather than autonomy. There is no doubt that culture has a marked influence on the presentation of psychiatric symptoms, the understanding of theses symptoms and the different methods of traditional therapies used in each culture. Due to understaffed mental health facilities, it is essential that the general practitioner help in the diagnosis and management of psychiatric disorders under the title of unexplained somatic symptoms which is an essential part of the undergraduate psychiatric training. In this talk the main differences between traditional and western societies will be reviewed with special emphasis on the diagnosis of somatoform disorders in the Arab culture.

•  S02-4

变化中的数据：中国的独生子女家庭与精神卫生服务 - Data in Changing: One Child Family and Mental Health Service in China

Wenhong Cheng 1

1 Shanghai Mental Health Center , Department of Child and Adolescent Psychiatry, Shanghai , Chinese Mainland

过去 60 年里 ， 中国的社会 经济与文化结构发生了显著的变化 ， 这种变化可以分为几个阶段。在这种独特的社会变革之中，家庭的结构同样改变甚多，包括父母对独生子女的态度。在中国社会中，儿童与青少年的精神健康变得日益重要。我们比较了不同社会发展阶段中家庭的经济、文化与价值观特点，并回顾在这样的变化中儿童与青少年精神卫生问题的流调数据。我们将介绍如今中国目前的儿童与青少年精神卫生服务，并展望今后的发展方向。

From the last 60 years, social economic and culture structure in Chinese society has changing, such kind of change could be divided by several stages. Under this unique social changing background the family structure has also changing a lot, including parents' attitude towards one child policy. Child and adolescent's mental health becomes more and more important in Chinese society. We compare economic, culture and value characters of family among different stages of social development, and review some epidemiological data on child and adolescent mental health with that change. We introduce the child and adolescent mental health service in China today, and give some views on developing service in the future in China .

•  S03 - Psychotherapy of OCD

Chair: Yanchun Yang, Chinese Mainland

主席 : 杨彦春教授 ， 张海英教授

•  S03-1

强迫障碍的认知模式与成人依恋及心理治疗的关系 - The Cognitive System, Adult Attachment and Correlation with Exposure Respond Prevention Therapy of Obsessive Compulsive Disorder

Yanchun Yang 1

1 Department of Psychiatry, West China Hospital, Sichuan University, 成都 , Chinese Mainland

本文重点研究了 强迫症的 认知系统 ， 将强迫症的认知系统分为三级认知系统。包括 ： 侵入性思维、对侵入性思维的认知歪曲以及对自我应对能力的认知歪曲 ， 结合回避性负强化使强迫症的症状循环不止 ， 难于治疗。本文探讨了强迫症认知系统形成与早年依恋模式的相关系。早年的依恋类型如何影响到强迫症患者的认知应对和认知模式的发展，不良的应对焦虑的强迫行为如何使焦虑得以暂时缓解。在此基础上，提出了改良式暴露反应预防的认知行为治疗。使原来的暴露反应预防在治疗中有进一步的应用和提高疗效。改良式暴露反应预防作为强迫症特殊的心理干预技术如何打 破 强迫症 内部的 认知模式及与现实的功能不良的恶性循环 ， 达到缓解症状 ， 增进适应的目的 ， 进一步拓展现今强迫障碍的心理治疗研究焦点。

This article explore the cognitive system and adult attachment, and provide the evidence of modified ERP(Exposure Respond Prevention) of obsessive compulsive disorders. We have found the dysfunctioned cognitive schema at the three levels. They are include intrusive thought, cognitive responding to intrusive thought and cognitive coping of behavior. These dysfunctioned cognitive system has been related with attachment types of adult which was developed in the childhood of life. ERP is accepted as one of effective psychotherapyies for OCD., But there are a lots of patients with OCD withdrawn from this psychotherapy, it make us to think about solving the problem of anxiety arouse during ERP. Based on the theory of cognitive behavior ,This paper explore the modified ERP treatment of OCD, and stop the cycle of symptoms and behavior ,and make the patients with OCD can conduct exposure to situations provoking symptoms of OCD guandually and finally, they got suffering of symptoms relieved and maintain long effection.

•  S03-2

强迫症的依恋关系及述情障碍研究 - Adult Attachment, Alexithymia and Clinical Symptoms of Patients with Obsessive-Compulsive Disorder and Exploration of Pathopsychological Model in OCD

HaiYing Zhang 1

1 Shanghai Mental Health Center , Shanghai , Chinese Mainland

研究目的 ： 探 讨强迫症的成人依恋关系状况及其与临床症状严重程度的相关性 ； 探讨强迫症的述情障碍状况与临床症状严重程度的相关性 ； 探讨依恋关系与述情障碍的相关性 ； 从心理学因素对强迫症发病的心理机制进行探讨 ， 通过成人依恋关系的研究 ， 了解早年环境对于强迫症发病的影响 ， 并进一步通过对患者述情障碍的研究 ， 了解强迫症患者在情感识别 ， 情感描述及表达方面存在的特征 ， 二者是如何相互作用并在强迫症发病中如何发生作用的。

研究方法 ： 符合 纳入标准的强迫症患者 95 例 ， 对照 331 名 ， 完成多 伦多述情障碍量表 （ TAS-20 ） 中文版 ， 亲密关系经历量表 (ECR) 中文版 ， 自 编并评定结果 ， 强迫症患者另需完成 Y-BOCS 量表。将各量表的 评分结果建立数据库，采用 SPSS11.5 软件包，进行统计分析。

结果： 1. 强迫症 组与对照组的依恋类型有显著性差异 (P<0.001), 强迫症 组的不安全依恋类型显著高于对照组；且在依恋相关焦虑维度上，强迫症组明显高于对照组（ P<0.05 ）；在 强迫症 组中，不同的依恋类型其 Y-BOCS 评分无显著性差异（ P>0.05 ） ; 而依恋相 关焦虑和依恋相关回避维度分与 Y-BOCS 评分呈显著正相关 (P<0.05) ；依恋相 关焦虑和回避维度得分与文化程度呈显著负相关 (P<0.05) ； 强迫症 组男女的依恋相关焦虑，差异无显著性（ P 〉 0.05 ） , 依恋相 关回避纬度分男性明显高于女性，差异有显著性（ P 〈 0.001 〉， 对照组中的依恋相关焦虑纬度分及依恋相关回避纬度分男女差异无显著性 (P>0.05) 。

2. 强迫症患者多 伦多述情障碍量表总分及各因子分高于对照组 (P<0.05), 总分及 F2,F3 因子分与 Y-BOCS 分无相 关性 , 仅 F1 因子分有弱相 关性 (r=0.217,P=0.035); 强迫症 组男女间各因子分及总分差异无显著性 (P>0.05), 而 对照组 F2 因子 ,F3 因子及 总分男性高于女性，具有显著性性差异 (P<0.001); 述情障碍 总分及各因子分均与文化程度呈显著性负相关， P 〈 0.05 ；述情障碍 TAS-20 总分及因子 2 ，因子 3 的得分与 强迫症症 状的 严重程度 Y-BOCS 分无相 关性， P 〉 0.05 ； 仅因子 1 的得分与 强迫症症 状的 严重程度 Y-BOCS 分有相 关性， P 〈 0.05 ，相 关系数为 0.217 。

3. 依恋相 关焦虑和依恋相关回避得分与述情障碍量表总分及各 因子分呈 显著正相关（ P<0.001) ，不同依恋 类型的述情障碍总分及各因子分具有显著性差异，其中，恐惧型最高，其次为焦虑型和拒绝型，安全型最低，且具有统计学意义（ P<0.05 ）。

结论： 强迫症患者不安全依 恋 类型居多，且强迫症患者存在明显的述情障碍，表现为情感识别，情感描述及外向性思维方面。本研究关于强迫症的病理心理模型的探索结论如下： 1. 强迫症具有不安全依 恋的基本特征， 这一特征可能是焦虑障碍谱系疾病的共同心理基础； 2. 部分 强迫症患者存在一 种特定的情感识别，情感表达缺陷的心理特质，可能与遗传有关，使强迫症患者 在 处理早年依恋焦虑时，常采用理性符号和象征性认知的方式； 3. 强迫症患者通 过行为学习和条件化是强迫症状反复和维持的主要原因； 4. 强迫症 发病的病理心理机制与遗传，早年生活事件及特定的认知，应对方式及行为强化有关； 5. 对于强迫症患者，认知行为治疗为主的心理治疗仍然是主要的方法，良好的治疗性关系的建立，作为精神动力学取向的心理治疗，是患者学习情感识别，情感表达及修复早年不安全依恋关系的有效手段。

关键词： 强迫症 成人依恋 亲密关系经历量表 述情障碍 多 伦多述情障碍量表 Y-BOCS 病理心理模型

Objective: The objective of this study was to test a hypothesized model of associations between adult attachment, alexithymia and clinical symptoms of patient with obsessive-compulsive disorder. Alexithymia , a construct involving a deficit in the ability to identify and describe emotions, is thought to develop as a result of childhood interactions with caregivers. We wished to determine how the alexithymia and attachment style worked in OCD. What's more, we wished to explore the pathopsychological model in OCD and gain enlightenment of psychotherapy in OCD. Method: Three hundred and thirty one undergraduates and ninety five patients, aged 18-65, completed questionnaire measures of adult attachment style, alexithymia, Yale-Brown Obsessive-Compulsive Scale and common information.

Result:

1. There were significant differences in the styles of adult attachment between patients and control group(P<0.001). The cases of insecure attachment ( including anxious, avoidant, fearful and rejecting) in case group were significant more than in control group). There was a significant positive correlation between anxious and avoidant dimensions related attachment and the scores of the Y-BOCS(P<0.05).

2. The total score and the scores of F1, F2 and F3 of the TAS-20 were significantly higher in the OCD than in the control group(P<0.05) , while the total score and the scores of F2 and F3 of the TAS-20 were not correlated to the score of the Y-BOCS. However, there was a weakly positive correlation between the score of F1 and the score of the Y-BOCS( r=0.217, P=0.035).

3. The scores of anxious and avoidant dimensions related to attachment were significantly positively related to the total score and the scores of factors' scores (P<0.001). There were significant differences among all styles of adult attachment, among which the score of the fearful style was the highest, the scores of the anxious and rejecting styles were higher than of the secure style(P<0.05).

Conclusion: The OCD patients with more insecure adult attachment have significant alexithymia, especially capacities of feeling identify, description and coupled with a tendency towards externally orientated and concrete thinking. Our results are consistent with the proposition that alexithymia develops in response to interaction with primary caregivers that also influence infant and adult attachment. Associations between adult attachment and symptoms of OCD may be due in part to disturbances in affect regulation.

Chairs: Wenyuan Wu, Chinese Mainland
Lawrence Park , United States

•  S04-1

护士个人、社会特征与其心境状态之间的联系 - Association between Mood Status of Nurses with Personal and Social Characteristics

Saeid Pahlavanzadeh 1 , Akbar Hasanzadeh 2 , Mohammad Mehdi Roostazadeh 3 , Mohamoud Nasiri 4

1 Isfahan University of Medical Sciences, Nursing Faculty, Psychiatric Nursing, Isfahan, Iran, Islamic Republic of, 2 Isfahan University of Medical Sciences, Health Faculty, Isfahan, Iran, Islamic Republic of, 3 Isfahan University of Medical Sciences, Al- Zahra Hospital, Isfahan, Iran, Islamic Republic of, 4 Isfahan University of Medical Sciences, Psychiatric Nursing, Isfahan, Iran, Islamic Republic of

目的 ： 所有的人在本 质上是趋向快乐和愉快的。然而有些情况使人感到悲伤。看护是一项压力很大的职业。因而，对影响护士心境的个人及环境因素的研究显得非常重要。在这项研究中，我们试图确定护士的心境状态，并研究其个人、社会特征与心境 状 态之间的关系。

方法： 这是一项描述性 - 分析性研究。在 Isfahan 医科大学附属 Al-Zahra 医院不同病房（例如 ICU 、 CCU 、内科、外科 … ）工作的 490 名 护士完成了问卷，这个问卷包括护士的个人及社会信息和 Zung 抑郁自 评量表两个部分组成。用方差分析和 Mantel-Hanzel 方法 对数据进行分析。

结果： 统计分析发现护士的心境状态与性别、病房、收入、睡眠满意度、工作满意度、夫妻交流情况、两种休闲方式（看书和家庭聚会）有显著性关系。

结论： 考 虑到治愈病人和其他来访者所获得的幸福感重要性和影响力，对护士及其管理者来说，非常有必要让自己充分了解心境和相关因素之间的关系，如果必要，可以选择适当的政策来避免令人不快的结果。

Objectives: All of us tend to happy and pleasure intrinsically. However, there are some situations that make someone feel sad. Nursing is a stressful profession .Thus, effect of different factors of nurses and their environment, on nurses mood, seems to have enough importance to study. In this study we intend to determine mood status in nurses and the relationship between personal and social characteristics and mood status.

Methods: This is a descriptive– analytical study, that 214 nurses who work in the different wards(such as ICU, CCU, medical, surgical,…) of Al-Zahra hospital of Isfahan Medical Sciences University answered a two parts questionnaire consisted of personal and social data and Zung self rating depression scale. Data were analyzed with ANOVA and Mantel-Hanzel.

Results: Findings resulted from Statistical analysis showed that there are significant relationships between mood status and sex, ward, income, sleep satisfaction, job satisfaction , spouse communication and two types of spending leisure time (book study and family meeting).

Conclusions: With regard to the importance and the impact of happiness in recovery of patients and other clients, it is necessary for nurses and managers to have a complete knowledge about effects of related factors to nurses mood and, if necessary, choose appropriate policy to avoid unpleasant results of it.

•  S04-2

Abstract Withdrawn

•  S04-3

The Antidepressant Treatment of Patients with Chest Pain and Comorbid Depression but with Negative Coronary Angiography

Anlin Zheng 1 , Yun Huang 1 , Wenhang Qi 2

1 Huadong Hospital , Shanghai , Chinese Mainland, 2 Ruijin Hospital , Shanghai , Chinese Mainland

Objectives: Patients with chest pain and comorbid depression while with negative coronary angiography results were treated in order to observe correlation between improvement of depression and chest pain, and to observe efficacy, onset of effect and safety of different treatment in this double-blinded study.

Method: 123 patients with chest pain and comorbid mild to moderate depression/anxiety, and whose diagnoses of coronary heart disease had been ruled out through coronary angiography, were randomly allocated to 3 groups: Fluoxetine (F), 41 patients; Placebo (P), 40 patients; Fluoxetine+Olanzapine (F+O), 42 patients. The length of treatment was 4 weeks. Before treatment and at 1 week and 2 weeks of treatment respectively, HAMD, HAMA and chest pain self-evaluation scale were measured to observe onset time of effect, differences in effectiveness and correlation of depression/anxiety with chest pain.

Results: F+O had the best response in depression and anxiety as well as chest pain. F came second, and P was the worst. F+O demonstrated the fastest onset of effect, as early as 1 week of treatment. Decrease rates were 54.1% for both HAMD and HAMA scores and 63.1% for chest pain self-evaluation scores. After 4 weeks of treatment, decrease rates were 78.1% and 78.3% for HAMD and HAMA scores respectively. There are statistical significance between P and F in terms of HAMD scores (20.9% vs 66.3%, P<0.05) and HAMA (22.9% vs 66.5%, P<0.05). F showed effectiveness after 2-4 weeks. Also, at 4 weeks, chest pain scores decrease significantly correlated to HAMD (r=0.867, P<0.001) and HAMA (r=0.854, P<0.001) scores decrease. No severe adverse event was observed during treatment.

Conclusion: For patients with chest pain as well as comorbid depression/anxiety and whose diagnoses of coronary heart disease were ruled out through coronary angiography, antidepressive and anxiolytic treatment improved depression/anxiety symptoms as well as chest pain. The treatment was safe as well. Among the 3 groups, combination of short-term small-dose olanzapine with flouxetine appeared to provide better and faster effects than fluoxetine alone. There was statistically significant correlation between improvement of depression/anxiety and chest pain.

•  S04-4

乳癌存活患者家庭功能和心理应激关系：一项 3 年前瞻性研究 - Relationship between Family Functioning and Psychological Distress in Breast Cancer Survivors: A 3-Year Prospective Study

Toshinari Saeki 1 , Miki Takaishi 1 , Shigeto Yamawaki 1 , Shinichi Inoue 1 , Tomoyuki Mantani 1 , Susumu Tazuma 1 , Hitoshi Okamura 2 , Tsuyoshi Kataoka 2

1 Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan, 2 Graduate School of Health Sciences, Hiroshima University, Hiroshima, Japan

目的 ： 乳癌与心理异常存在明 显的共病现象 ， 有证据表明家庭功能在其中起到了重要作用。本研究主要目的是探讨家庭因素对乳癌存活者心理状况的影响。

方法： 100 名乳腺癌 I 期或 II 期行乳癌切除 术后患者，患者为广岛大学附属医院自 1999 年 10 月至 2000 年 3 月的病人。患者及其丈夫均 签署了知情同意书。共 74 名患者完成了行乳癌切除 术后 3 个月随 访（第一阶段），共 63 名患者行乳癌切除 术 3 年后尚生存（第二 阶段）。第一和第二阶段存活者分别进行 Z 氏抑郁自 评量表， Z 氏焦 虑自评量表，多伦多述情障碍 20 个条目量表以及家庭功能 问卷（ FAD ）。

结果： 多元回 归分析表明，第一阶段 6 项 FAD 量表中 1 项与第二阶段中抑郁和焦虑症状显著相关。

结论： 本研究 结果提示，乳癌生存患者在第一阶段的异常 家庭功能表 现预示第二阶段异常心理状况的出现，心理干预可以促进家庭成员间的情感反应，并能促进乳癌存活患者保持心理良好状态。

Objectives: Considerable psychological morbidity associated with breast cancer has been documented, and there is some evidence to indicate that family functioning plays an important role for such morbidity. The purpose of the study was to identify family factors related to psychological distress among breast cancer survivors.

Methods: 100 ambulatory patients after mastectomy for stage I or II localized breast cancer were drawn consecutively from the outpatient population of the Mammary Gland Dispensary of Hiroshima University Hospital during the 6-month period from October 1999 to March 2000. Written consent was obtained after the patients and their husbands had been fully informed of the purpose of the longitudinal study. 74 patients participated in the study at more than three months after mastectomy (Time 1) and 63 survivors were followed up three years later (Time 2). The survivors completed the Zung Self-rating Depression Scale, the Zung Self-rating Anxiety Scale, the 20-item Toronto Alexithymia Scale, and the Family Assessment Device (FAD) at Time 1 and Time 2.

Results: Multiple regression analysis showed that Affective Responsiveness, one of 6 domains of perceived family functioning assessed by the FAD, at Time 1 significantly correlated with both depression and anxiety among survivors at Time 2.

Conclusions: The findings of the present study suggested that inappropriate affective responsiveness in the family could predict later psychological distress among breast cancer survivors, and that psychosocial interventions that could improve affective responsiveness among family members might contribute to promoting breast cancer survivors' psychological well-being.

•  S04-5

综合性医院精神科门诊专科和非专科医师对抑郁症的识别比较研究 - A Compared Study on the Recognition of Depression in Psychiatric Clinics of General Hospitals

Zheng Lu 1

1 Tongji Hospital ， Tongji University, Department of Psychiatry, Tongji, Chinese Mainland

蔡 军 李玉珊 施慎 逊 史以珏 王崇 顺 蒋有倩 季建林 朱 荣申 韩宏毅 丁素菊 陆峥 朱俊娟

目的 : 比 较综合性医院精神科门诊中专科和非专科医生对抑郁症的不同识别情况 ， 了解综合性医院中抑郁症的特点 ， 分析影响抑郁症识别的相关因素。

方法 : 对就诊于上海市 9 所 综合性医院精神科门诊的 680 例初 诊患者使用复合式国际诊断检查 (CIDI) 抑郁部分 进行筛查 ， 并进行专家复核 ， 与首诊医师诊断进行比较 ， 共收集抑郁症患者 297 例 ， 并 对这些患者进行汉密顿抑郁量表 24 项 （ HAMD24 ） 、 汉密顿焦虑量表 （ HAMA ） 的 评估 ， 利用 “ 上海市 综合医院精神科门诊非专科医师基本情况调查表 ” 对非专科医师进行调查。

结果 : (1)680 例初 诊患者中 ， 专科医师正确识别 337 例 ， 非 专科医师正确识别 216 例 ， 两者 对抑郁症的识别率具有显著性差异 （ χ 2=30.73, P=0.000 ）； (2) 专科医师对抑郁症的识别能力高于非专科医师 ， 专科医师组和 CIDI 复核诊断的一致性高 ， Kappa 值为 0.774 ， 非 专科医师与 CIDI 复核诊断的一致性偏低 ， Kappa 值为 0.439 ； (3) 综合医院门诊抑郁症患者具有中等以上的抑郁症状 ， 伴有普遍的睡眠障碍、焦虑、躯体化等临床特点 ； (4) 非 专科医师从事精神科工作的年限和每年接受精神科知识培训的时间的长短 ， 对抑郁症的识别有显著影响 （ P<0.05 ） 。

结论 : 综合医院精神科室中的非专科医师接受精神卫生专科知识培训不足 ， 对抑郁症的识别能力不如专科医生 ， 需加强对综合医院精神卫生科室服务质量的管理。

Objective ： The study is designed to evaluate the different recognition of depression by psychiatrists and non-psychiatrists, and to illuminate the clinical manifestation of depression in general hospitals, then make a more detailed analysis of related influential factors.

Methods ： 680 candidates first consulting psychiatric clinics were screened by the investigators using Composite International Diagnostic Interview (CIDI) findings tool on their first visit day. And the findings were compared with the diagnosis making by psychiatrists or non-psychiatrists. Altogether 297 cases were defined with depression, which were divided into psychiatrists treated group and non-psychiatrists treated group. Then the cases were assessed with Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA). A self-made questionnaire was used to assess the non-psychiatrists' ability in the recognition of depression.

Results ： （ 1 ） The psychiatrists had much more efficiency in the recognition of depression than the non-psychiatrists in general psychiatric practice ( χ 2=30.73, P=0.000).(2 ） The agreement between psychiatrists' diagnosis and CIDI findings is consistent (Kappa=0.774), while for non-psychiatrists and CIDI, the result is much more lower.(Kappa=0.439). (3)The common characteristics of depressed patients in general hospitals are: they have moderate depressive syndrome, accompanied with sleeping problems, anxiety, somatization disorders. (4)The work time and the training for the management of mental disorders are relevant to the recognition of depression, which are the main factors in judging the non-psychiatrists' ability to cope with mental disorders..

Conclusion ： The non-psychiatrists' ability to recognize depression in psychiatric department of general hospitals is insufficient, which suggests that it is important to emphasize the management of the staffs in psychiatric settings in general hospitals.

•  S04-6

Abstract Withdrawn

Chairs: Shenxun Shi, Chinese Mainland
Yuhua Cui, Chinese Mainland

•  S05-1

雌激素对妇女围绝经期与绝经期抑郁障碍的影响 - Estrogen Action in Perimenopausal and Postmenopausal Women With Depressive Disorder

Xuewen Yu 1

1 Hospital of Xi`an Jiaotong University , Xi'an , Shaanxi , Chinese Mainland

目的 ： 探 讨了围绝经期与绝经期抑郁障碍妇女的雌激素水平以及用雌激素治疗妇女围绝经期与绝经期抑郁障碍的效果。

方法 ： 采用磁 酶 联免疫技术检测了 30 例 围绝经期和绝经期抑郁障碍妇女血清雌激素、卵泡刺激素、黄体生成素水平。设 30 例正常 对照。并用雌激素（单用组 31 例）或 联合应用抗抑郁药物（联合组 30 例）治 疗围绝经期和绝经期抑郁障碍妇女，用 HAMD 量表 评估抑郁症状的治疗效果；用 KMI 量表 评估围绝经期和绝经期症状的治疗效果。。观察 8 周。

结果： 围绝经期与绝经期抑郁障碍妇女血清雌激素水平明显低于正常围绝经期及绝经期妇女 (P<0.05) 。治 疗后两组 HAMD 总分均明显下降 (P<0.001) ； 联合组和单用组的减分率分别为 70.53% 和 58.24% ，两 组比较有显著性差异 (P<0.05) 。 联合组和单用组的总有效率分别为 93.33% 和 80% ， 联合组高于单用组，但无统计学意义（ P>0.05 ）。治 疗后两组 KMI 评分均明显下降，差异非常显著 (P<0.001) ； 联合组和单用组的减分率（ 73.99% 和 70.66% ）、 联合组和单用组的总有效率（ 96.67% 和 93.33% ）也无明 显差异 (P>0.05) 。

结论： 围绝经期与绝经期抑郁障碍的发生与 雌激素水平的降低有 关，因此采用雌激素治疗围绝经期与绝经期抑郁障碍可以取得良好的效果。受雌激素水平的影响，在原来抗抑郁药物的基础上，联合应用雌激素对提高疗效的作用更明显。

Objective: To investigate concentration of estrogen, FSH and LH in serum and the effects of estrogen therapy (ET) on antidepressant response in perimenopausal and postmenopausal women with depressive disorder.

Methods: Serum levels of estrogen, FSH and LH were measured by magnetism-ELISA. Thirty subjects received estrogen at 2.5mg/day for two week, with an decrease to 1.25mg/day at week 3 for a 8-week trial, and thirty-one subjects received the combination of estrogen and antidepressant at 20mg. The 17 item Hamilton Depression Rating Scale (HDRS) and Kupperman (KMI) were administered to all patients at baseline and 8-week thereafter.

Results: The serum level of estrogen was lower in women with depressive disorder than in the healthy women (p<0.05). No difference was found for FSH and LH between two groups. Both groups showed a significant reduction in HDRS and KMI scores at the end of the 8-week trial. The women receiving estrogen with antidepressant (70.53% for decreased HDRS score rate)showed significantly greater improvement compared to the women receiving estrogen only (58.24% for decreased HDRS score rate). There was no significant difference between the two treatment groups for total effective rate of improving depressive disorder and perimenopausal and postmenopausal symptoms.

Conclusions: Perimenopausal and postmenopausal depressive disorder is correlated with serum estrogen level. Estrogen may play a effective role in antidepressant for perimenopausal and postmenopausal women with depressive disorder. But the combination of antidepressant and estrogen is the best solution for the treatment of perimenopausal and postmenopausal depressive disorder, and the therapy must be individual.

•  S05-2

女性精神障碍患者受性侵害的特征 - Analysis of Sexual Assault against Female Patients with Mental Disorders

Yanjun Cao 1

1 Beijing Huilongguan Hospital , Beijing , Chinese Mainland

目的 : 探 讨司法精神病鉴定中女性精神障碍患者受性侵害案件的特点 ， 为预防此类事件的发生及维护这类妇女群体的权利提供参数。

方法 : 采用自 编 性侵害 调查问卷对 89 例女性性侵害案例从一般 资料、与强奸人的关系、疾病诊断、性自我防卫能力、申请鉴定者与被鉴定人的关系等方面进行回顾性分析。

结果 : 年 龄分布在 14 至 30 岁之间占 77.5 ％； 文化程度中小学以下占 78.6 ％， 其中 57.3 ％ 为文盲 ； 职业中农民 57 例 ， 占 64 ％， 无 业 26 名 ， 占 29.2 ％； 鉴定结论诊断为精神发育迟滞者占 60.7% ， 表明精神 发育迟滞是申请鉴定的女性性侵害案件的主要精神疾病病种 ； 鉴定结论为性自我防卫能力丧失或削弱者为 71.9 ％， 均 为精神发育迟滞和精神分裂症患者 ， 其中中度以上精神发育迟滞占 42.8 ％， 发作期精神分裂症患者占 11.2% ； 性侵害者与受性侵害者 认识或熟悉占 84.3 ％， 甚至是 亲戚 ， 表明大部分犯罪嫌疑人与受性侵害者认识 ， 使受性侵害者放松了警惕 ， 加之多数女性精神病人的性自我防卫能力削弱 ， 才使犯罪嫌疑人有机可乘 ； 本调查中有 3 例是被网友 强奸 ， 因此年 轻女性对于陌生人应该提高警惕 , 提高自我防范意 识。由受性侵害者家属或本人提出鉴定要求者共占 74.1 ％， 远高于由办案单位提出的比例，说明人们的法制观念、自我保护意识均有了提高。

结论 : 性侵害者大多数是青少年 妇女、农民或无业、文盲、有精神障碍者。其中，中度以上精神发育迟滞和发作期精神分裂症的性自我防卫能力削弱，甚至消失，容易受到性侵害。提示有必要加强社会支持系统，切实维护女性精神障碍患者的合法权益，减少或避免女性精神障碍患者受到性侵害。同时，随着社会的发展，人们的法制观念、自我保护意识均有了提高。这有利于严厉惩治犯罪嫌疑人，保护女性的合法权益。另外，随着网络的发展，交网友成为年轻人的时尚，网友见面遭受性侵害是新的现象，且具有隐蔽性强的特点。提示 ， 女性精神障碍患者的监护人应加强看管 ， 避免因此 受到性侵害。

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.

•  S05-3

雌激素受体 β 亚型 (ERβ) 基因 SNPs 与产后抑郁的关联研究 - Study of Relation of Single Nucleotide Polymorphisms of Estrogen Receptor Beta (ERβ) Gene With Postpartum Depression

Yuefen Tang 1

1 Huashan Hospital of Fudan University , Shanghai , Chinese Mainland

目的 ： 假 设产后抑郁存在遗传易感性基因 ， 探讨雌激素受体 β 亚型 (Estrogen Receptor Beta ， ER β ) 基因与 产后抑郁的关系。

方法 ： 对于在前部分临床研究 中的 产后抑郁者和非抑郁者分别随机抽取静脉血 68 例和 93 例 ， 采用聚合 酶 链反应 － 限制性酶切多态性 （ PCR-RFLP ） 的方法 进行 ER β 的 2 个 SNPs(rs1256030 和 rs3020444) 基因分型。采用病例 - 对照关联分析和两点单体型关联分析获得产后抑郁遗传易感性。

结果： 1.ERβ 基因 rs3020444 （ T/C ）多 态 “T/T” 基因型与 产后抑郁关联，导致产妇患产后抑郁的风险是对照组的 2.91 倍（ P<0.05 ）；病例 组 “T” 等位基因 导致产妇患产后抑郁的风险是对照组的 2.72 倍（ P<0.05 ）。未 发现 rs1256030 （ C/T ）的等位基因或基因型与 产后抑郁存在关联 , 但病例 组由于出现过多的杂合子 C/T 而偏离了 H-W 平衡。 2. 基于 rs1256030 （ C/T ）和 rs3020444(T/C) 的 单体型 “C-C” 对产后抑郁具有保护作用， OR= 0.312 [0.104 - 0.942] ， P=0.039 。

结论： ERβ 基因有可能参与了 产后抑郁的发病。但需要扩大样本进一步验证。

Objectives: Given the susceptible genetic gene for postpartum depression, to investigate the relationship of ER β gene with postpartum depression.

Methods: 68 cases (depressed women postpartum) and 93 control (non-depressed women postpartum) selected from the 746 subjects who had joined the preceding clinical test were genotyped by ER β gene two SNPs (rs1256030 and rs3020444) with PCR-RFLP. Case-control association and two-point haplotype association with postpartum depression were performed.

Results: 1.The genotype “T/T” according to ER β gene rs3020444 （ T/C ） polymorphism was found to be associated with postpartum depression. The case who had the “T/T” genotype developed postpartum depression 2.91 times the control （ P<0.05 ） . The case who had the “T” allele developed postpartum depression 2.72 times the control （ P<0.05. We couldn't find the rs1256030 （ C/T ） alleles or genotypes were associated with postpartum depression, but the case group deviated the H-W because of two much of C/T genotype. 2.The haplotype “C-C” based on rs1256030 （ C/T ） and rs3020444 （ T/C ） polymorphisms had a protective effect on postpartum depression, OR=0.312[0.104-0.942] ， P=0.039.

Conclusions: ER β gene may join in the pathogenesis of postpartum depression. But a large sample is needed to testify the finding.

•  S05-4

孕期家庭暴力与新生儿谷氨酸、 r - 氨基丁酸神经递质及血浆皮质醇的相关研究 - Correlation between Domestic Violence in Pregnancy and Glutamate,r-aminobutyric Acid Neurotransmitters and Plasma Cortisol Llevels in Neonatals

Yong Zhang 1 , 张 亚 林 1 , 邹 韶 红 1 , 张 向 辉 1 , 曹 玉 萍 1

1 中南大学湘雅二院精神 卫生研究所 , 精研所 , 长沙 , Chinese Mainland

目的 : 通 过孕产妇在孕期遭受家庭暴力与新生儿谷氨酸、 r - 氨基丁酸神 经递质及血浆皮质醇的相关性研究 ， 初步探讨家庭暴力对新生儿神经生化和内分泌的影响。

方法 : 选择无躯体及精神疾病的住院待产妇 ， 采用孕产妇受虐评估问卷 （ AAS ） 完成家庭暴力 筛查 ， 实际符合条件者家庭暴力组产妇 （ DV ） 56 名 ， 非家庭暴力 组产妇 （ N-DV ） 107 名。分娩 时采集其新生儿脐静脉血 3 毫升，抗凝、离心后，取血 浆低温冷冻备用。采用库仑阵列电化学高效液相法检测血浆谷氨酸（ Glu ）和 r - 氨基丁酸（ GABA ）神 经递质含量，血浆皮质醇（ Cortisol ）含量采用放免法 测定。数据录入及统计分析采用 SSPS13.0 统计软件分析。 结果 1 ） DV 组与非 DV 组产妇在年龄、婚龄、孕周、受教育程度、职业等一般人口学资料方面差异不显著 (P ＞ 0.05) ； DV 组与非 DV 组新生儿出生体重、身长差异不显著（ z=-1.84, z=-0.90 P ＞ 0.05 ）。 2 ）孕期 经历精神虐待者 49 人（ 87.5% ）躯体虐待者 2 人（ 3.6% ），近一年 经历性虐待者 29 人（ 51.8% ） 3 ） DV 组 与非 DV 组比较， DV 组新生儿血浆谷氨酸、 r - 氨基丁酸神 经递质水平高于非 DV 组（ 752.1±169.2pmol/l ， 403.4±134.3pmol/l ）、（ 727.5±183.6pmol/l ， 351.3±146.9pmol/l ），血 浆皮质醇水平高于非 DV 组（ 490.6±86.1ug/l ， 391.5±107.8ug/l ），差异具有 显著性（ t=14.40, t=14.26, t=5.99,P <0.001 ）。 4 ） Spearman 相 关分析发现，谷氨酸、 r - 氨基丁酸神 经递质水平与精神虐待严重程度呈显著正相关（ r=0.65 ， r=0.64 ， P <0.01 ），与性虐待程度呈 显著正相关（ r=0.47 ， r=0.42 ， P <0.01 ），与躯体虐待未 发现相关关系；皮质醇含量与精神虐待严重程度呈显著正相关（ r=0.49 ， P <0.01 ），与性虐待程度呈正相 关（ r=0.27 ， P <0.01 ），与躯体虐待未 发现相关关系。 5 ）回 归分析发现，孕期精神虐待是新生儿谷氨酸、 r - 氨基丁酸神 经递质及血浆皮质醇水平变化的预测变量之一。

结论 : 孕期家庭暴力可能会 导致新生儿部分兴奋性和抑制性氨基酸神经递质及内分泌的改变。

关键词 : 家庭暴力；新生儿；氨基酸神 经递质；血浆皮质醇

Objective: To explore the correlate between domestic violence in pregnancy and Glutamate 、 r-aminobutyric acid neurotransmitters and plasma Cortisol levels in neonatals.

Methods: By cross-sectional survey and domestic violence interview with Abuse Assessment Survey(AAS),56 abused pregnants were screened, and 107 non-abused pregnants were normal controls. 3ml blood in umbilical vein of neonatal were collected immediately after delivery, extracting plasma to keep for detect. Accumulation of Glu 、 GABA neurotransmitters in plasma were assayed by high performance liquid chromatography with electrochemical detection on samples,levels of plasma Cortisol were detecteded by immunoradiometric assay. All variables of two groups were compared, Chi-square, t/z-test, spearman correlation, liner regression analysis were adopted.

Results: 1) No statistically significant differences were found between two groups on mean age, marital age,gestational weeks, education levels, occupation, and birth weight, body length of neonatals (P ＞ 0.05). 2)In DV group, there were 49 women(87.5%) experienced psychological abuse, 2 women(3.6%) experienced physical abuse in pregnancy ， and 29 women (51.8%) experienced sexual abuse in the past year. 3)By comparision, our study reported that higher levels of Glu 、 GABA neurotransmitters in DV neonatal plasma than normal controls （ 752.1±169.2pmol/l, 403.4±134.3pmol/l ） 、 （ 727.5±183.6pmol/l, 351.3±146.9pmol/l ）（ t=14.40, t=14.26, P <0.001 ） ,and higher levels of plasma Cortisol in DV neonatal plasma than normal controls （ 490.6±86.1ug/L, 391.5±107.8 ug/L ）（ t=5.99, P <0.001 ） .4) Spearman correlation analysis showed significantly positive correlation between severity of psychological abuse and levels of Glu 、 GABA neurotransmitters and Cortisol （ r=0.65,r=0.64,r=0.49,P <0.01 ） ,and positive correlation between severity of sexual abuse and levels of Glu 、 GABA neurotransmitters and Cortisol （ r=0.47,r=0.42,r=0.27,P <0.01 ） .5) Regression analysis showed severity of psychological abuse may predict levels of Glu 、 GABA neurotransmitters and plasma cortisol in neonatals.

Conclusion: Domestic violence in pregnancy may vary some excitatory and inhibitory amino acid neurotransmitters and endocrine in neonatals.

KeyWords: Domestic Violence ; Neonatal; Amino Acid Neurotransmitter; Plasma Cortisol

  S05-5

重性抑郁症女性患者不明确识别动态面部表情的 fMRI 研究 - Recognition of Dynamic Emotional Facial Expression in Major Depressive Patients: An fMRI Study

Zhijian Yao 1 , 皋 军 滕 2 , 经纶 杜 3 , 世平 谢 4 , 燕翔 曹 3 , 丽 王 3 , 海燕 刘 3 , 文 刘 3 , 宁 张 3

1 Nanjing Medical University, Department of Psychiatry, Nanjing, Chinese Mainland, 2 东南大学临床医学院 , 南京 , Chinese Mainland, 3 南京医科大学 脑科医院 , 南京 , Chinese Mainland, 4 南京医科大学 脑科医院 , 精神科 , 南京 , Chinese Mainland

目的 ： 本研究利用事件相 关设计的功能 MRI 及 隐性任务实验范式探讨抑郁症患者非注意状态下这种认知模式的相关神经机制。

方法 ： 按入 组标准筛选 15 符合 CCMD-3 及 DSM-IV 诊断标准的首发、未服药重性女性抑郁患者以及年龄和受教育程度等与之相匹配的 15 例女性正常 对照。以中国面部表情视频系统中的动态喜悦、 悲 伤及中性表情片段作为情绪刺激，以性别判断为显形任务，而情绪识别作为隐性任务，利用 1.5T 功能核磁共振成像系 统检测受试者完成任务时的脑部反应，并记录行为学结果（包括反应时间和识别一致率）。扫描结束后，请受试者对所看到的动态表情的表情类型、愉悦度和唤醒度做评判。图像数据经 SPM2 软件处理和统计分析，获得脑区激活图。行为学数据和扫描后评测数据采用 SPSS11.5 统计分析。

结果： 不明确 识别喜悦情感（识别性别）时，与正常对照相比，抑郁症患者活动增高的脑区包括，顶叶皮质（右顶下小叶， BA40 ）。不明确 识别悲伤情感， 与正常 对照相比，抑郁症患者活动增高的脑区包括枕叶皮质（左梭状回， BA19 ）、 顶叶皮质（右中央前回， BA2 ；右楔前叶， BA7 ）、 颞叶皮质（左颞上回， BA13 ；左 缘上回， BA40 ）、 边缘叶（左海马旁回， BA36/28 ；右海 马旁回， BA30 ；左后扣 带回， BA29 ）、皮 质下区（右豆状核，外侧苍白球；丘脑）以及中脑等。在不明确识别中性表情条件下，与正常对照相比，抑郁症患者活动增高的脑区有额叶皮质（右额内侧回， BA6 ；左 额中回， BA6 ；右中央前回， BA4 ；左中央前回， BA6 ）、 顶叶皮质（左中央后回， BA2 ；右中央后回， BA3 ；右 顶上小叶， BA7 ）、 颞叶皮质（右颞中回， BA39 ）以及皮 质下区（左尾状核尾部；右岛叶， BA13 ；双 侧丘脑）。

结论： 研究 结果进一步证实抑郁症患者在非注意状态下存在负性认知偏移，其相应的脑区激活范围、程度增加；在非注意状态下，患者完成相同负性工作任务时，注意调节活动明显较正常人加强。患者在注意状态下是否存负性偏移有待进一步研究。

•  S06 - 东亚的精神疾病分类 ： 过去、现在和未来 - Psychiatric Classification in East Asia: Past, Present and Future

Chairs: Naotaka Shinfuku , Japan
Yizhuang Zou, Chinese Mainland

二 战前后很多年来 ， 亚洲的精神科医生采用传统的以经验为基础的精神疾病分类法。

操作性的 诊断系统如 ICD 和 DSM 在上个世 纪 80 年代被引入 亚洲的临床实践。在 1990 年，日本 许多高年资的精神科医师还不愿意采用操作性的诊断标准。他们认为操作性的诊断肤浅、死板而且不能触及病人的精神病理学。 但是 ICD 和 DSM 在很多精神科医 师尤 其是年 轻的医师中获得了支持。

这有很多促成的原因。 比如以下一些因素：

1) 评估者间信度高

2) 有助于 团体讨论

3) 增 进国际合作

4) 对于定性研究必不可少

5) 对于官方报道是必需的

目前在 东亚的许多国家， ICD-10 和 DSM-4 已 经变成了分类和诊断的标准工具。 我 们也知道在不久的将来将发展 ICD-11 and DSM-5 而且我 们希望在将要面世的 ICD 和 DSM 的版本中 纳入亚洲的观点。 在 这种情况下应及时与亚洲精神病学界的领导者们组织一个关 于精神疾病分 类的专题会

参加者 们将共同学习到

1) 东亚国家精神疾病分类的简短的历史发展

2) ICD 和 DSM 的使用范 围

3) 操作性系 统的优点

4) 操作性系 统的缺点

5) 地区特殊的精神科 问题不足以被目前的诊断分类涵盖

6) 对新版本的建议

我 们希望能有来自中国、日本韩国的演讲 同 样 N Sartorius 教授将 总结演讲并就未来的诊断分类如何代表亚洲的观点提出建议 本 专题会还欢迎来自台湾、香港和其他亚洲国家关于这个问题的其他观点。

For many years before and after the Second World War, Asian psychiatrists used traditional and experience based psychiatric classification.

Operational diagnostic systems such as ICD and DSM were introduced to Asia for clinical practices in 1980's. In 1990, many senior psychiarists in Japan were still reluctant to the use of operational diagnoses. They criticised operational diagnoses as superficial, conventional and not reaching the psychopathology of patient.

However, ICD and DSM gained supports of many psychiatrists particulary among young psychiatrists.

There were many contirbuting factors.

To name a few:

1) High inter-reliability

2) Useful for team approach

3) Increase of international collaboration.

4) Indespensable for quality research

5) Necessary for official report.

At present, ICD-10 and DSM-4 have become standard tool for classification and diagnoses in many countires in East Asia .

Also, we are aware of the possible development of ICD-11 and DSM-5 in the near future and we hope that Asian views will be taken into consideration in the coming versions of ICD and DSM.

In this context, it is considered timely to organize a symposium on psychiatric classifiction with the participation of leaders of Asian psychiatry.

The participants will study among others

1) Brief historical development of psychairic classification in countries of East Asia

2) Extent of the use of ICD and DSM.

3) Advantages of operational systems.

4) Desadvatages of opertional systems.

5) Country sepcific psychiatric problems not sufficiently covered by present classification. 6) Suggestions to the new versions.

We expect to have presentations from China , Japan and Korea .

Also, Prof. N Sartorius will summarize the presentation and will make suggestions on how Asian views be better represented by future diagnostic classification.

The symposium will welcome additional views from Taiwan , Hong Kong and other Asian countires on the issue.

•  S06-1

日本的精神疾病分类 - Psychiatric Classification in Japan

Naotaka Shinfuku 1

1 Seinan Gakuin University, Department of Humand Science, Fukuoka city, Japan

日本的精神科医 师很长时间一 直用克雷丕林的 诊断分类。当操作性诊断系统在上个世纪 80 年代被引入日本 时 ， 高年资的精神科医师不愿意采用 ， 他们评价操作性的系统诊断肤浅、死板。但是 ICD 和 DSM 受到了年 轻精神科医师的欢迎，被当作是一个通用的诊断工具。他们认为操作性的诊断系统比某些时候收到权威影响的传统系统更加可靠。 现在日本的年轻精神科医师采用操作性的诊断系统作为可靠的专业人士交流工具。 作者将提出日本精神科医 师对于起草 ICD-11 和 DSM-5 的 观点

For long years, Japanese psychiatrists used Kraepelin model of classificatiion. When operational diagnostic systems were intorduced into Japan in 1980 ? s, senior psychiatrists were rather reluctant.They commented the operational systems as superficial and conventional. However, DSM and ICD were welcomed by young psychiatrists as universal diagnostic tools. They found operational diagnostic systgems more reliable than traditional systems which sometimes were influenced by authorities.

Now Japanese young psychiatrists use operational diagnoses as relaible communication tools among professional.

The author will present views of Japanese psychaitrists toward the preparation of ICD-11 and DSM-5.

S06-2

中国的精神障碍分类 - Classification of Mental Disorders in China

Yizhaugn Zou 1

1 Beijing Huilongguan Hospital , Beijing , Chinese Mainland

中医 （ TCM ） 在大概公元前 300 年或更早就定 义了精神障碍。 “ 癫 ” 、 “ 狂 ” 和 “ 痫 ” 指精神病、躁狂和 癫痫。情绪障碍被命名为 “ 情志 ” 障碍，包括极度的喜悦、 愤怒、悲伤、担忧、惊恐和焦虑，这些与身体脏器心、肝、肺、脾和肾的异常功能和障碍有关。在中医中， “ 伤寒 ” 或 传染病、酒精或是药物同样也能导致精神障碍。现代西方精神病学直到 20 世 纪早期才进入中国，欧洲、美国和俄国精神疾病理论和分类影响了一代中国精神科医师。 中国 现在的精神病学分类是在上个世纪 50 年代由国内 专家一致形成的。中国精神障碍分类第一版 (CCMD-I) 始于 1985 年，包括了精神分裂症和双相障碍的操作性 标准，接着在 1989 年和 2001 年相 继出版了 CCMD-II and 。 现在 CCMD-III 已在中国 临床上得到广泛应用。 2006 年中 华医学会精神病学分会学术年会上进行了一项东亚精神疾病分类的研究（ Reaclap ）。研究 对象包括了来自全国的 192 位精神科医 师。结果显示其中 94.8% 的人使用 CCMD-III 或是 ICD-10 ，只有 5.2% 的人使用 DSM-IV 。大 约 88% 的被 调查者认为分类系统最重要的目的是为了不同医师之间的交流，只有 22% 的人 认为是为了促进医师和病人之间的交流。接近 75% 的人 认为不管是什么种族 / 文化， 现在的分类系统在他们的实践中是有用而且可靠的。

Traditional Chinese Medicine(TCM) defined of mental disorder in about 300BC or earlier. “Dian”, ”Kuang” and ”Xian” were indicated psychotic features, mania and epilepsy. Emotional disorders were named as “Qingzhi” disorders, listed as the extreme of happy, angry, sad, worry, panic and anxiety, which were related to the abnormal function and disorder of heart, liver, lung, spleen and kidney of physical organs. In TCM, “Shanghan” or infectious, alcohol or medication could cause mental disorders as well. The modern western psychiatry came to China until early of 20's century, European, American and Russia psychiatry theory and classification affected generations of Chinese psychiatrists. Chinese modern classification of psychiatry was formed in 1950's by national expert's consensus. The first version of Chinese classification of Mental Disorders (CCMD-I) was initiated in 1985 include operational criteria of schizophrenia and bipolar disorder, then CCMD-II and CCMD-III published in 1989 and 2001. Now CCMD-III is widely used in clinical practice in China . A study of East Asia Psychiatric classification (Reaclap) was conducted during the Annual Meeting of the CSP in 2006. The valid subjects included 192 psychiatrists from all over China . The results indicated 94.8% subjects used CCMD-III or ICD-10, while only 5.2% subjects used DSM-IV. About 88% subjects believed that the most important purpose of classificatory is for reliable inter-clinician communication, only 22% thought for facilitate communication between clinician and patient. Nearly 75% people thought present classifications were useful and reliable in their practice regardless ethnicity/culture.

S06-3

目前韩国精神疾病分类中的问题 - Current Issues on Psychiatric Classification in Korea

Y S Kim 1 , Jong-Ik Park 2

1 Seoul National University College of Medicine, Department of Psychiatry and Behavioral Science and Institute of Behavioral Medicine, Seoul, Korea, Republic of, 2 Kangwon National University College of Medicine, Department of Psychiatry, Chunchon, Kangwon-Do, Korea, Republic of

用来 诊断精神疾病的 ICD-10 和 DSM-VI 目前都用于 临床、教育、研究和医疗费用的偿付中。但是在韩国的精神科医师中，当前诊断系统的有效性和适度性一直有争议。因为在表达躯体化和抑郁方面存在文化差异，这引起了某些困难。 基于 Graham Mellsop 教授 编制的一个问卷进行 了 Reaclap 研究（ 关于东亚精神疾病分类的研究）。在 2007 年 1 月 1 日至 5 月 31 日之 间通过电子邮件或是面对面的访谈收集数据。从 66 位男性和 30 位女性精神科 专家和精神科住院医师那里收集了 96 份 问卷，年龄从 25 岁至 63 岁。 初 步分析 结果显示了一些临时的意见。 1) DSM-IV 尽管 对于某些障碍无法分类，但仍然为教育和科研提供了有用的诊断标准。 2) 由于主要的教科 书都是针对 DSM-IV 的，因此大部分精神科医 师在为了从国家健康保险公司获得医疗费用的偿付而被迫使用 ICD-10 之前，在培 训时是很少能有机会使用的。 3) 在 临床中与精神疾病分类有关的文化问题有时会使韩国精神科医师遇到麻烦。 4) 为了改善对于诊断系统中某些基于文化方面的理解需要亚洲精神科医师之间的合作

Both the ICD-10 and DSM-VI for psychiatric diagnosis are currently used in practice, education, research, and for the reimbursement of medical fees. However, the usefulness and appropriateness of the current diagnostic system has been debated among Korean psychiatrists because of cultural differences in the expression of somatization and depression, an issue that raises some difficulties.

Based on a questionnaire developed by Prof. Graham Mellsop, the Reaclap (Research on East Asia Psychiatric classification) survey was conducted. Data were obtained via e mail or face-to-face interviews between 1 January and 31 May 2007. Ninety-six questionnaires were collected from 66 male and 30 female psychiatrists and psychiatric residents. Their ages ranged between 25 and 63 years.

精神疾病分类的未来 - Future of Psychiatric Classification

Norman Sartorius

Univeristy of Geneva , Geneva , Switzerland

国 际疾病分类正在预备第 11 版的修 订工作。 在 5 年之内修 订版将递交给世界卫生议会以获得通过 ， 但是修订工作现在就开始了。这些工作包括 1) 系 统回顾自从第 10 版以来医学是否有了重大 发现因而需要改变分类的科学证据。 2) 建立一个网 络，可以向对分类有兴趣并且能够根据经验提供与分类有关信息的专家和组织咨询 3) 向那些参与 ICD 工作并且被 纳入处理分类问题的合作中心的机构咨询。分析与精神和神经障碍有关的章节将采用以上提到的信息资源以及从处理 ICD 相 关问题的 WHO 项目中收集到的资料。很多重要的问题已经出现，并且将在编制新版本的过程中来处理。这些问题包括在 ICD 11 中采用 纬度方法、确保 ICD 和各国的 专家分类 ( 特 别是那些由业内其他同行制定的 ) 协调的最好办法、分类版本的分类数和类型以及其他问题。本演讲将讨论对于这些问题可能的答案和选择

The International Classification of diseases is being prepared for its 11th Revision. The revision will be submitted to the World Health Assembly for approval in 5 years time but work on the revision is starting now. This will include 1) a systematic review of scientific evidence to establish whether in the time since the 10th revision there have been major discoveries in medicine requiring a change of the classification 2) the establishment of a network of consultation with experts and organizations that have an interest in the classification and could provide information from experience relevant to the classification 3) the consultation with institutions that have participated in the work on the ICD and have been designated as collaborating centres to deal with matters of the classification. The chapters dealing with mental and neurological disorders will be examined using the sources of information mentioned above as well as data that has been accumulated in WHO projects dealing with matters relevant to the ICD. Numerous important questions have already arisen and will have to be dealt with in the process of developing the new revision. They include questions about the use of dimensional approaches in the ICD 11, about the best way to ensure harmony between the ICD and the national specialist classification (in particular those produced by other professions) about the number and type of versions of the classification and so forth. The presentation will discuss possible answers to these questions and options that are likely to be before the bodies entrusted with the development of the revision.

S07 - 精神病医 师的能力 — 教育和培 训 - Competencies for Psychiatrists - Education and Training

Chairs: Russell D'Souza, Australia
Hongyu Tang, Chinese Mainland

这个专题讨论会目的在于强调一般意义上的精神科医师的培训和能力。它集中了美国、澳大利亚和印度在培训和教育领域较为擅长的专家 ， 这会提示一些基本的能力 ， 以及不同区域各种各样的需求 ， 包括资源的有效性。在这个领域 ， 当前美国和澳大利亚已经开始的改革和努力会被详细的说明。

This symposium is meant to high light the training and competencies for psychiatrists in general It brings together experts in the area of education and training from USA , Australia and India and this will offer an insight to the underpinnings of competencies together with the varied requirements of various regions including the availability of resources. The reforms and current initiatives in this area being embarked on in USA and Australia will be elaborated.

S07-1

核心能力：一个潜在的世界范围内的培训模型 - Core Competencies: A Potential Worldwide Model of Training

Pedro Ruiz 1

1 American Psychiatric Association, Houston , United States

在西方的 许多国家 ， 精神病学毕业生的培训经历了较多的变化 ， 尤其是在美国。这些变化最初开始于美国、加拿大和英国，但是他们期望（这种变化）很快传播到世界上大多数工业化国家中。现在这种积极的变化很大程度上影响到教育课程和教学方法上。它的结果是改变了世界上所有国家的毕业生培训计划。另外，它也为发展中国家提供了一系列的新奇而有创造力的应用。在本文中，我们必须为愿意引进这些新的培训模型作为他们精神病学毕业生计划的地区提供帮助。

在此，目前美国能力模型的六个核心区域会被完全的呈 现和讨论。比较乐观的，对这种新的教育模型的学习 会允 许这个专题讨论会的参加者体验这个新的教育概念，并思考在自己国家的实行。 教育目的：

1 ． 理解和新的能力模型和概念；

2 ． 了解当前六个核心能力在西方国家的 问题；

3 ． 基于六个核心能力，考 虑在发展中国 家的 课程变化。

Graduate Psychiatric Training is currently undergoing major changes in most of the countries of the Western hemisphere, especially in the United States . These changes are primarily originating in the United States , Canada and the United Kingdom , but they are expected to soon spread out among most of the industrialized nations across the world. These positive changes that are nowadays very much influencing the didactic curriculums, the method of teaching, and the outcome of its implementations have revolutionized the graduate training programs of all countries around the world. Additionally, it offers a series of novel and very creative applications in developing or evolving nations as well. In this context, it is imperative that we assist countries for evolving areas of the world that want to entertain the introduction of these new models of training in their graduate training programs in psychiatry.

In this presentation, the core six areas of the competency model currently in practice in the United States will be fully presented and discussed. Hopefully, the learning of this new educational model will permit the participants of this symposium to be exposed to this new educational concept and, perhaps, to consider its implementation in their own countries. Educational Objectives

1. To understand the core competency model and its conceptualization.

2. To be exposed to the six core competencies currently issue in the Western hemisphere.

3. To consider changes in the curriculum of evolving countries based on the core competency model.

Literature Reference

1. Ruiz P: Recent Advances in Graduate Psychiatric Training. World Psychiatry, 2(1): 57-60, 2003.

2. Ruiz P: Systems-Based Practice Core Competencies. In S.C. Scheiber, T.A.M. Kramer, S.E. Adamowski (eds.): Core Competencies for Psychiatric Practice: What Clinicians Need to Know. Washington , D.C. , American Psychiatric Publishing, Inc., 2003, pp. 109-118.

S07-2

发展中国家的精神病医师核心能力 - Core Competencies for Psychiatrists in Developing Countries

Russell F D'Souza 1

1 Clinical Trials Research & Bipolar, Northern Psychiatry Research Centre, the Department of Psychiatry of The Melbourne University, Department of Psychological Medicine Monash University, Melbourne, Australia

发展中国家有庞大的需要和有限的资源。这些地区常常是一百万人口中只有一位精神科医师。随着精神科医师趋向于大都市地区 ， 这种情况进一步恶化。对于这种处境，一些地区的精神科医师资源因为这些专业人才向发达国家移民而进一步缺失。从治疗工作的经验和与发展中国家精神科医师的讨论，这个演讲讨论流行的处境和条件，这会要求精神科医师不仅要具有多样的卫生专业技能，还要求他们应用他们的能力和经常利用丰富 的 团队的第二意见和监督。作者在细致检查和咨询之后，得到了核心能力的列表，这是发展中地区精神科医师必须知道，应该知道并且乐于知道的： 学 习目标：

1 ． 当前的精神科医 师人口比

2 ． 发展中国家的工作条件和需要 量

3 ． 核心能力： 发展中地区精神科医师必须知道，应该知道并且乐于知道的

Developing countries have in comm0on large needs and very limited resources. Often these regions have 1 psychiatrist for a million population. This is further aggravated with distribution squired to metropolitan areas. To this situation some regions experience further loss of psychiatrist resource from the migration of these professionals to developed regions. From the experience of attending working and discussing with developing country psychiatrist this lecture will discuss the situation and conditions that prevail this will require psychiatrists not only to have knowledge of multiple health professionals skills but will also be required to use these competencies and often with out the luxuries of teams second opinion and supervision. The author after detailed examination and consultation has arrived with a list of core competencies that developing region psychiatrist must know, should know and would be nice to know.

Learning objectives

1. The current status of psychiatrist population ratios

2. Working conditions and requirements in developing countries

3. Core competencies that a Psychiatrist must know, should know and would be nice to know

S07-3

精神科医师能力 — 澳大利亚的教育和培训 - Competencies for Psychiatrists – Education and training in Australia

Bruce Singh 1

1 Melbourne University , Melbourne , Australia

在 过去的几年里 ， 作为他们培训的组织基础 ， 精神科医师能力越来越被人们重视。在这个讨论中 ， 我将描述澳大利亚和新西兰精神科医师皇家协会完成这些变化的步骤 。

There has been an increasing trend to focus on competencies for psychiatrists as the basis for organization of their training in the past few years. In this talk I will describe the steps taken by the Royal Australian and New Zealand College of Psychiatrists (RANZCP) to implement such changes.

S07-4

精神科医师能力 — 印度的教育和培训 - Competencies for Psychiatrists – Education and Training in India

Mohandas Warier 1

1 South Asian Forum International on Mental Health & Psychiatry, Dingley, Australia

这个报告将描述印度精神科医师培训的摘 要。精神科医 师的培训基于地方上的需求 ， 由具有普遍形式的核心培训能力的大 学管理。 这些方面会在这个演讲中详细描述。

This lecture will map the traing and syllabus for Psychiatrist training in India . The traing of psychiatrists conducted in Universities competencies based on the requirements locally together with competencies that are universal form the core training. These areas will be elaborated in this lecture

S07-5

精神科医师能力 — 莫纳什大学为国际精神科医师提供的联谊计划 - Competencies for Psychiatrists – Monash University Fellowship Program for International Psychiatrists

Saji Damadoran 1

1 Monash University, Dingley, Australia

这个演讲会讨论有莫纳什大学 ， 心理学、精神病学和精神药理学院精神病学系发展的一个计划。这个创新的计划提供精神病学的特殊区域的精神科医师培训和教育，发展全球精神病学的有用资源，是一个被 WPA 区域在 发展中国家的精神病学应用的资源，恰当的培训具有令人铭记的目的，是构建能力和加强社区的精神卫生和健康。

This lecture will discuss a program that has been developed by the Department of Psychiatry of the School of Psychology , psychiatry and Psychological Medicine, Monash University . This innovative program offers psychiatrist training and education in specialty areas of Psychiatry which is an useful resource in the advancement of psychiatry globally and is a resource that is used by the WPA Section on psychiatry in dev eloping countries that has the enshrine objective of appropriate training that is part of building capacity and enhancing mental health and well-being in the community.

第一页 第二页 第三页 第四页 第五页 第六页