• S08 - 精神康复 - Psychiatric Rehabilitation

  Chairs: Tiebang Liu, Chinese Mainland
  Tae-Yeon Hwang, Korea , Republic of

• S08-1

  娱乐治疗：为严重精神疾病患者创造目的意识 - Therapeutic Recreation: Creating a Sense of Purpose for Consumers with a Serious Mental Illness

  Lorna Moxham 1 , Shane A Pegg 2 , Matthew Johnson 3

  1 Central Queensland University, Nursing and Health Studies, Rockhampton, Australia, 2 University of Queensland, Tourism and Management, Ipswich, Australia, 3 Rockhampton Hospital, Mental Health, Rockhampton, Australia

  众所周知 ， 如果患者缺乏目的意 识 ， 精神疾病的康复就会非常困难。使用康复范例作为基础 , 并且 认定康复者拥有 “ 有效的自我意 识 ” ， 对患者从事有积极意义、目的和方向的活动作用重大。本文讨论娱乐治疗（ TR ）的作用， 这项计划的研究者包括科研员和临床医师，研究对象来源于澳大利亚昆士兰地区的精神卫生服务机构。干预研究证实， TR 有助于增 强患者的控制能力， 减少病耻感和提高自尊心。

  It is well known that without a sense of purpose recovery from a mental illness is very difficult. Using the Recovery paradigm as a foundation and given that one of the points on the Recovery star is "Active Sense of Self" it is vital that consumers are engaged in programmes and activities that facilitate meaning, purpose and direction.

  This paper examines a therapeutic recreation (TR)programme that was collaboratively delivered by mental health academics and clinicians at a regional mental health service in Queensland Australia.

  Results of this intervention research project demonstrated that active invlovement in a TR programme increased consumers locus of control, aidded in the reduction of stigma and had markedly positive effects on their self esteem.

• S08-2

  让患者回到社区居住：希望抑或烦恼 ? - Hopes and Worries of Deinstitutionalized Patients: Were They Fulfilled?

  Georgios D Giaglis 1 , Barbara Michailidou 1 , Georgios F Angelidis 1

  1 Psychiatric Hospital of Petra , Olympus, Katerini , Greece

  目的 ： 在 Petra Olympus 精神病院 （ PHPO ） 的慢性病房 关闭后 ， 调查过去住在慢性病房内患者的想法和希望 ， 同时评估这些想法的可信度。

  方法 ： 在病房 关闭前后 ， 分别有 33 例 （ 其中有 69.7% 的男性患者 ， 占全部患者的 75.8% ） 和 49 例 （ 其中有 69.4% 的男性患者 ， 占全部患者的 73.4% ） 患者接受了半定式 访谈 ， 他们的回答都被记录。

  结果 ： 尽管多达 81.8% 的患者大体 满意 PHPO 的服 务 ， 但仍然有 66.7% 的患者 对搬出医院的慢性病房持积极态度 ， 12.1% 的患者既不 赞成也不反对 ， 21.2% 的患者表示反 对。 75.8% 的患者 对回到社区居住表现出足够的知识，其中 68.0% 的患者知 识较为详尽。回到社区居住 1 年后， 69.4% 的患者 对新的居住环境的持积极态度， 22.4 % 的患者 态度中立， 8.2% 的患者持反 对态度 [x2(2)=3.674, p=0.159] 。新 环境的改善最主要体现在住房条件、营养、独立性、精神疾病的照顾和社会关系方面。

  结论： 本研究 证实了患者最初对于回到社区居住的积极态度可能是正确的，大部分患者清楚的表示，他们更喜欢回到社区居住后新的居住状况。

  Objectives: The evaluation of views and hopes of the formerly institutionalized patients of the Psychiatric Hospital of Petra Olympus (PHPO) after the closing of its chronic wards and the assessment of the extent to which these views were confirmed.

  Methods: 33 patients (69.7% males – 75.8% psychotic) were interviewed before and 49 patients (69.4% males – 73.4% psychotic) after the closing of the hospital using a semi-structured procedure; their answers were recorded.

  Results: Although a total of 81.8% of the patients declared satisfied in general from the PHPO, 66.7% of them had a positive, 12.1% a neutral and 21.2% had a negative initial attitude towards their relocation away from the chronic wards of the hospital. 75.8% showed adequate knowledge about the deinstitutionalization plan, while only 68.0% had detailed knowledge regarding their relocation. One year after the deinstitutionalization, 69.4% of the patients had a positive attitude towards their new living conditions, 22.4 % were neutral and only 8.2% were negative about it [x2(2)=3.674, p=0.159]. The housing conditions, nutrition, independence, psychiatric care and social relationships were the most important aspects that were considered improved in their new environment.

  Conclusions: The initial positive attitudes of the patients towards deinstitutionalization seem to be verified. The majority expressed a clear preference to their new living status compared to before deinstitutionalization.

• S08-3

  针对精神病患者的娱乐治疗：内容介绍和疗效评估 - Formualation and Evaluation of a Therapeutic Recreation Programme for Clients with a Mental Illness

  Lorna J Moxham 1

  1 Central Queensland University , Nursing and Health Studies, Rockhampton, Australia

  在精神病患者的康 复过程中 ， 自我价值是一项综合性的感觉。增强患者对自我价值的认同 ， 让患者对未来产生期望 （ 康复的中心内容 ） 的方法之一是让患者从事有意义的活动 ， 正因为如此 ， 娱乐治疗就是在以活动为原则的基础上建立的。本文将介绍娱乐治疗计划（包括急性和以社区为基础的精神卫生健康服务）的内容，同时评估娱乐治疗的疗效。结果显示，参加康复计划患者的自尊心和控制力都将增强。

  It is well known that a sense of self worth is integral to the Recovery of people with a mental illness. One way to enhance a persons self worth and engender Hope, a central tenent of Recovery, is by getting clients to engage in activities that are meaningful. As such, activity based programmes need to be grounded in principles of therapeutic recreation. This paper will present the formulation and evaluation of a therapeutic recreation programme within an acute and communiyt based mental health service. Outcome data will be presented which will focus on how self esteem and loci of control can be enhanced by involvements in a rehabilitation programme such as this.

• S08-4

  药物自我处置和症状自我监控技能训练对精神分裂症疗效的随访研究 - The Follow-up Study of Medicine Self-Disposition and Symptom Self-Control Skill Training for Schizophrenia

  军 蔡 1 , 紫青 朱 1 , 国 荣 孟 1 , 寒 刘 1

  1 上海市精神 卫生中心 , 上海市 , Chinese Mainland

  目的 ： 探 讨药物自我处置和症状自我监控技能训练对精神分裂症的远期疗效。

  方法 ： 上海市社区在册精神分裂症患者。前 4 周内 训练组患者接受集中性训练 ， 教材选自 Liberman 编写的《社会独立生活技能》。其中药物自我处置程式包括 4 部分：掌握抗精神病 药作用的有关知识、学会正确管理自己的方法和评估自己所服药物的作用、识别并处置药物副作用及学会与医务人员商讨解决与用药相关的问题；症状自我监控程式也包括 4 部分： 识别病情复发的先兆症状、监控复发先兆症状、处置持续症状及拒绝饮酒和吸毒等。每周上课 2 次， 每次 课约 90 分 钟，期间休息 2 次。由 1 名精神科医 师负责授课。对照组患者除不参加技能训练外，余下各项治疗均与训练组相同。 4 周后 继续对两组患者随访 24 周。采用阳性和 阴性症状量表（ PANSS ）和自知力与治 疗态度问卷（ ITAQ ）在入 组时、训练期末各测评一次；随访期内每 12 周 测评 1 次。 结果：训练组和对照组症状改善比较：两组患者入组时的 PANSS 评分差异无显著性。自第 16 周末起， 训练组患者的 PANSS 总分、阴性量表分和一般精神病理量表分与对照组比较，差异有显著性。随访结束时，两组患者 PANSS 阳性量表分无 显著性差异。训练组和对照组自知力的比较：我们用自知力与治疗态度问卷（ ITAQ ）来 评定患者的自知力。入组时的训练组与对照组的 ITAQ 评分差异无显著性差异（ p>0.05 ）。随 访结束时，训练组的 ITAQ 分 值明显高于对照组，有非常显著性差异。复发和再住院：训练组 5 例 复发（ 6% ）， 对照组 9 例 复发（ 11% ）， 2 例再住院（ 3% ）。 训练组的复发率和再住院率均低于对照组，但两组之间无显著性差异（ Fisher 精确概率， p>0.05 ）。

  结论： 模式化技能 训练作为一种康复治疗手段，有益于精神分裂症患者疗效的长期保持。

  Objective: explore the future effect of medicine self-disposition and symptom self-control skill training for schizophrenia

  Method: 164 schizophrenia patients were included.patients were randomly divided into two groups, training group and control group.the education was delivered to training group for 4 weeks.then both groups were observed and evaluated for 24 weeks. Positive and negative symptom scale （ PANSS ） and Insight and Treatment Attitude Questionnaire （ ITAQ ） were used to assessment for both group patients.

  Result: The total score of PANSS , negative symptom scale score and general psychopathology score in training group was significantly greater than that in control group after the end of the 16th week;self-knowledge in training group was better than that in control group after the end of the 28th week.relaps rate in training group was less than that in control group .but the difference between two groups was not significant.

  Conclusion: skill traning ,as a treatment method for preventing patients from relapsing , can maintain the effect for schizophrenia patients.

• S08-5

  对社区慢性精神分裂症患者家庭行为干预的近期效果 - The Short Term Efficacy of Family Behavioral Intervention in Chronic Schizophrenias from Community

  志 强 薛 1 , 少平 张 2 , 慧 钧 周 2 , 建芳 周 1

  1 上海市虹口区精神 卫生中心 , 防治科 , 上海市 , Chinese Mainland, 2 上海市虹口区精神 卫生中心 , 上海市 , Chinese Mainland

  目的 : 探 讨家庭行为干预对社区 慢性精神分裂症患者的近期效果。

  方法 : 抽取上海市虹口区社区慢性精神分裂症患者 48 例 （ 干 预组 28 ， 对照组 20 ）， 两 组年龄、性别、受教育程度、病程等匹配 (p>0.05) ； 对干预组进行 11 月的家庭行 为干预 ； 在基线收集一般资料 , 并在基 线和随访使用 ITAQ 、 PANSS 、 MRSS 、 GHQ 、 FIS 。 评定。

  结果 : 1, 干 预组和对照组之间在基线各量表评分比较除了 FIS 评分差异有显著性（ p<0.05 ），其他各 项差异均无统计学意义（ p>0.05 ）。 2 ，基 线与随访时各量表减分值比较，干预组 PANSS 总分（ 3.79±3.72 ）、 阴性量表（ 1.29±1.90 ）、一般精神病理量表（ 1.86±2.24 ）、 MRSS （ 1.81±0.96 ）和 GHQ(2.29±3.54) 均 优于对照组 [ 分 别为 (-0.21±0.61) 、 ( 0.07±0.30) 、 ( 0.10±0.62) 、 ( -0.10±1.37) 、 ( -1.10±2.36)] ， p>0.01 ；其他各 项减分值差异无统计学意义， p>0.05 。

  结论 : 家庭行 为干预有利于改善社区慢性精神分裂症患者的精神症状 ， 提高心理健 康水平和康 复状态以及降低家庭照料负担。

  Objective: To explore the short term efficacy of family behavioral intervention in chronic schizophrenia from community.

  Methods: A total of 48 patients with chronic schizophrenias in Hong Kou district were drew and randomly assigned into intervention group for 28 and control group for 20. The intervention group received family behavioral intervention about for 11 months. General information of two groups was collected at baseline. At baseline and following point, all patients were examined with ITAQ, PANSS, MRSS, GHQ and FIS.

  Results: 1, there were no difference in all examinations at baseline except FIS. According to the reduction scorers of PANSS, positive, general psychopathology subscale, MRSS and GHQ, the intervention group demonstrated better improvement than control group （ 3.79±3.72 vs. -0.21±0.61;. 1.29±1.90 VS. 0.07±0.30; 1.86±2.24 VS. 0.10±0.62; 1.81±0.96 VS. -0.10±1.37; 2.29±3.54 VS.-1.10±2.36, respectively P<0.01 ） .

  Conclusions: Family behavioral intervention contribute to the reduction of psychiatric symptoms and family burden, the improvement of psychological health and rehabilitation for chronic schizophrenias in community.

• S09 - 精神文生公共政策发展的全球化和经验交 - Globalization, Psyquiatry and Mental Health. Globalization and Experiences Interchange on Public Policies Development for Mental Health

  Chairs: Enrique Camarena Robles, Mexico
  Desen Yang, Chinese Mainland

  世界 经济全球化不能单用上世纪中期国际货物、服务和资金的流通屏障大大减少来解释 ， 还要归功于技术的改变。与这些变化相关的是互联网对增进全球信息交流和经济交易的作用已经非常显著，它将由于潜在的使用者和所有技术知识在未来变得更加重要， 在 1990 年，不到一百万人口接触互 联网。到 2004 年， 这个数字已经升至 7 亿 8 千 5 百万， 2000 年到 2004 年的增 长速度达到 120% 。尽管如此，在整个世界人口中 这个比率仍然很低。在 6 千 4 百 5 十 亿地球居民中，只有 12.5% 的人 获得了这种服务，而且各个国家间的差异很大。美国拥有世界上最多的 使用者， 总共为 2 亿 7 百万，使用率达 70% ，而在中国 仅 6% 的人口使用互 联网，尽管在使用人数上（ 8 千万）它的排名是第二的。更多的 设备和更多的使用者都还远远不够。

  制定公共精神 卫生领域方面的政策非常困难，因为这需要对精神卫生领域以及管理这个领域的相关法律和规则有很深的认识。找到对这两方面都很精通的人并不容易。另一方面，我们知道世界卫生组织对各个国家发展精神卫生的指导要求是要与每个国家的经济、人口和科技资源相适应。这些资源在非洲、拉丁美洲和欧洲国家中的差异非常大。在这些地方工作过的人都知道现在首先要做的事是商讨目前的形势以制定一个专门的规则，因为首先可能一个专门为了我们的目标而制定的条例可能早已经存在，其次我们可以避免重复劳动（我们经常可以找到为解决同一个问题而制定了两条不同的规则，得出的结论也是一致的）。

  对于先前的任务，在不同的网站上查阅目前的国际规定使得这项工作变得简单。如此一来，一个拉丁美洲国家就可以效仿与其情况相似的国家的规定了。除此以外，为了在不同的网络中纳入这些现存、完整的规则，使用者和患者将有权使用当地的法律法规来保护他们的计划、知识和权利。电子媒体作为全球化的一个现象，是我们开展这项工作的一个主题。

  The world's economic globalization is not being explained just because of the dramatic reduction, since the middle of last century, of barriers for the international flow of goods, services and capitals, but by technological changes. In connection with such changes, the internet's role in the global communications expansion and the multiplication of economic transactions have been extraordinary, and it will become more important in the future due to the users potential and the overall technological learning.

  In 1990, less than one million persons were connected to internet. In 2004, this figure raised to 785 millions with a rate of growth, for the period from 2000 to 2004, of 120 %. Notwithstanding, the penetration rate among the world's population is still low. Only 12.5 % of the 6.45 billions of the planet's inhabitants have access to such service, and the differences among countries are enormous. In the United States , which has the largest amount of users in the world (207 millions), the penetration goes up to 70 %, while in China only 6 % of the population have access to the net, even though it occupies the second place as far as the number of users is concerned (80 millions). More equipment and more users will never be sufficient.

  In order to enter the society of knowledge it will imply facing cultural and educational barriers as well as the need to overcome the distrust feeling toward using technology to make business or for the improvement of personal knowledge in general.

  The task of developing field politics on public mental health is a very difficult and arduous one. It is difficult as it requires a deep knowledge of the mental health field and also, of the law and regulations governing this area with particular features. It is not easy to find people with such knowledge in both areas. In the other hand, we know that the WHO's guidelines related to what has to be done in the world's countries to improve the mental health of their population, should be deemed and adapted to the economical, human and technological resources of each country. There are big differences among the African, Latin American and European countries in respect to these resources. Each and all of us who have worked in these areas, know that the first thing to do is to consult the current normativity in order to develop an specific regulation, and this is so because in the first place, a document specifically prepared for our purposes may already exist, and in the second place, we avoid to duplicate efforts (it is quite frequent to find two different rules dealing with the same problem and concluding the same) while preparing our rule.

  For the previous task, to consult the current international documents shown in the various nets, facilitates the job. Thus, a Latin American country having equal or similar conditions, may have rules which can be duplicated in other country having such similar conditions. Additionally, to include these existing and completed rules in the various nets, it allows users and patients to have access to local laws and rules for their contemplation, knowledge and defense of their rights. The electronic media dividends as part of the globalization phenomenon, is the subject we pretend to deal with in this work.

• S09-1

  精神病学的诊断系统和分类的全球化中悬而未决的任务 - The Pending Tasks in the Globalization of the Diagnosis Systems and their Classification in Psychiatry

  Francisco de la Pe?a Olvera 1

  1 Instituto Nacional de Psiquiatría RFM, México, Mexico

  介 绍 ： 自从 DSM 和 ICE 的最近一次修 订以来 ， 人们一直在努力消除精神疾病诊断系统和分类全球化中的悬而未决的任务和局限性 ， 尤其在儿童人群中。

  目的 ： 概括精神疾病 诊断、分类和全球化中的主要问题。 方法学 ： 用 plumbed 和其他互 联网软件系统检索具有最高医学证据的关于诊断和分类的文献 ， 进行系统综述。

  结论 ： 在 DSM 和 ICE 的分 类中仍然存在差异 ， ICE 是一个全球广泛接受的分 类方法 ， 但一些国家只使用 DSM ， DSM 诊断分类法比 ICE 更广泛 见于出版文献中。一些贫困国家例如非洲和拉丁美洲国家没有参与分类系统诊断标准的制定，因此分类系统中缺乏同一性。这两个诊断分类系统都存在很多缺陷，最重要的是：它们的诊断标准都基于对症状学的描述而缺乏病因学资料；另一个很大的缺 陷是： 诊断的分类学 方法把精神病理学的考量排除在外。在儿科人群的 诊断缺陷尤其大而妨碍了建立一个全球诊断系统。

  讨论： 我 们需要继续努力建立一个统一的世界精神病学分类系统，所有的国家都要参与其中，同时也需要对精神疾病的病因学做进一步的调查，以超越目前使用的现象学分类方法。

  Introduction: Since the last modification of the DSM and the ICE many efforts had been made to go over the limitations and the pending tasks in the globalization of the diagnosis systems and their classification in psychiatry, especially in pediatric population.

  Objectives: The main purpose of this presentation is to overview the main pending tasks in the diagnosis classification and its globalization.

  Methodology: A systematic review of the literature around diagnosis classification was done in plumbed and other internet software systems selecting those with the highest medical evidence.

  Results: There is still a gap between DSM and ICE classifications, the ICE is a worldwide accepted taxonomy but some countries only use the DSM, the DSM diagnosis classification is used widely in the scientific publications, more than the ICE diagnosis system. There is a lack of participation of poor countries like those in Africa and Latin-American, in the establishment of the diagnosis criteria in the classification systems and a consequent lack of identification in the taxonomy system. Both actual diagnosis classification systems have many limitations; one of the most important is that their criteria are based in phenomenological descriptions and not in etiological aspects; another big limitation is the categorical approach to the diagnosis that keep out the dimensional more explicit view of psychopathology. There are big limitations, especially with pediatric population's diagnoses in the establishment of a global diagnosis system.

  Discussion: There is a need to continue the efforts to a unique world psychopathology classification system in which all the countries participate and also a need to make more investigation around the etiology of mental illnesses in order to go over the actual phenomenological taxonomy.

• S09-2

  精神科领域中交流控制论全球化的发展 - The Development of the Globalization in the Communication Cybernetics in the Field of Psychiatry

  Alejandro Soto Chilaca

  Instituto Nacional de Psiquiatría RFM, México, Mexico

  网 络和相关信息技术的发展是不可避免的 ， 并且有不同的技术和社会含意。近十年内网络和它预计的效果与医学各个方面的实践都有联系 ， 包括精神医学 ， 例如邮件的使用 ； 对补充信息有用的方面提供了面对面会议和监视过程。 “ 计算机临床 ” ，正如他 们所知，提出了增加传统病人管理的多种可能；包括非所有病 人 拥有机密性及治疗关系相关技术的途径之内的所有问题是不可避免的通过它的使用发生改变，然而对提供在线卫生服务的精神科医师又是必需的，不仅如此而且，主要机遇是提供高质量的跨国精神服务特别对于农村人口。另一方面，精神科领域的信息爆炸给精神科执业医师带来更高的要求。对于这些精神科医师而言获得这些信息是一项繁重的任务，他们必须同时熟悉临床与研究工作，因此在医学继续教育和在临床实践中推广循证医学得过程中需要使用手提电脑提供帮助。最后，在对患者的心理 教育中使用网 络是一种有效而必需的工具，当然评估这些信息的数量与质量十分重要，而网上服务与干预还需要正式评估。作为精神科医师 ， 我们必须保持有效的信息交流 ， 并且调整自己适应这个变化的世界对我们的角色与技能的要求 ， 以使我们能够更好地完成专业使命。

  The growth of internet and related information technologies is inevitable and has diverse technical and social implications. The web and its projected effects in this decade have implications for he practice of all forms of medicine, including psychiatry, like de use of email; the one which is useful for supplementing information provided in face-to-face sessions and for monitoring progress. ‘Cyberclinics', like they are known, present many possibilities to augment traditional patient management; problems include not all patients having access to the technology and issues relating to confidentiality, and the therapeutic relationship is inevitably altered through its use, however is essential for psychiatrists to become involved in online health care, for to get, major opportunities for to provide high quality psychiatric care across the countries and especial for rural populations. On the other hand the information explosion in psychiatry, has placed enormous demands upon the practicing psychiatrist. Obtaining access to this information is even more onerous for the psychiatrist, who must maintain a familiarity with clinical psychiatry and investigation, in this part the use of hand-held computers to assist is relevant to continuing medical education and embedding evidence-based medicine in clinical practice. Finally the use of internet in the psychoeducation for our patients is a tool efficient and necessary however is important to evaluate the overload and quality of information, sites and interventions on the internet need to be formally evaluated. As psychiatrists, we must remain effective communicators of information and adjust to a changing world with new roles and skills that permit us to best serve our professional mission.

• S09-3

  Transcultural Factors and Globalization in the Suicide in Latin-American

  Jesus Del Bosque Garza , Mexico

  Abstract text has not been submitted

   

• S09-4

  Globalization and Experience Changes in the Development the Publics'' Politics in Mental Health

  Enrique Camarena Robles, Mexico

  Abstract text has not been submitted

• S10 - 全球化与精神 卫生 —— 欧洲的 观点 - European Perspective in Globalization and Mental Health

  Chairs: Levent Küey , Turkey
  Ma Hong, Chinese Mainland

  在欧洲地区既有一些世界上最 发达 ， 最完善的精神卫生系统 ， 同时也有一些国家的精神卫生服务仍旧处于发展阶段。由于过去二十年中政治与社会心理的变化，出现了许多新的挑战和机遇。一些国家资源相对匮乏，对建立完善系统的强烈需求，以及对精神医学与精神科医师的挑战仅仅是上述挑战中的一部分。其间，随着整个欧盟版图的调整，人们期待一种新的改变，即从整个欧盟的角度来处理精神卫生问题。

  这个由 WPA 欧洲地区代表 组织的 “ 欧洲区域 专题会 ” 的目 标是从欧洲的角度来讨论全球化对精神卫生问题的影响。

  The European Region includes some of the world ? s well developed and better established mental health systems as well as a number of countries in the process of developing their mental health refoms. With the political and psychosocial transitions in the last two decades, there has been a significant emergence of new challenges and opportunities. Some countries with relatively low resources, and new dynamics for the well established ones, and new challenges for the role of psychiatry and the psychiatrist in the region are just some of these challenges. Meanwhile, with the increasing regulatory strength of the European Union a new transitional period is expected regarding the mental health issues on a European basis.

  This “European Region Symposium” organized by the WPA European Region Zonal Representatives aims to discuss the impact of globalization on mental health issues from a European perspective. After the presentation by Marianne Kastrup ( Denmark ) on the issues of concern in mental care in the Nordic region, Michel Botbol ( France ) will discuss the new French mental health plan, and put a crucial question forward: Is it a way to bridge the gap between tradition and globalization? Armen Soghoyan ( Armenia ) will review the transition in mental health issues in Eastern Europe, and finally, Levent Küey ( Turkey ) will review the data on the treatment gap in Europe and present the basic principals of Helsinki Mental Health Declaration.

• S10-1

  北欧地区精神卫生医疗的问题 - Globalization and Mental Health Issues of Concern in Mental Care in the Nordic Region

  Marianne Kastrup 1

  1 Centre Transcultural Psychiatry, Copenhagen , Denmark

  At the WHO European Conference on Mental Health held in Helsinki 2005 a main focus was the identification of European values for mental health. Repeatedly, the values: equality, fairness and solidarity were mentioned as values that the European region can adhere to.

  The Northern European Region supports wholly the values mentioned above, and the region is characterised with its longstanding tradition to a welfare model with emphasis on public services. In many welfare societies, the overall aim has been to have a mental health service that provides free and equal access to care irrespective of sex, age, social status or ethnic background.

  But the consequences of globalization increasingly colors the scene and today, we know that exposure to extreme stress have psychological consequences, and that severe social adversities may influence mental health, and that the consequences are to some extent similar independent of cultural background. This fact has vast public health consequences also in the Northern European region and deserves increased public attention today

  The question is however to what extent the above thoughts and aspirations have been implemented for the vulnerable marginalised populations.

  In my presentation I intend to discuss the interweaving of these factors seen in the perspective of ethnic minorities, including refugees, as the prototype of a population that is facing increasing social adversities in many European countries with the inherent increased risk of developing mental problems. The paper will discuss Northern European strategies to empower marginalized, vulnerable groups and work for reintegration into society for those suffering of mental disorders.

• S10-2

  法国精神卫生计划：如何填补传统与全球化之间的鸿沟？ - Will the new French Mental Health Plan Bridge the Gap between Tradition and Globalization?

  Michel Botbol 1

  1 Judicial Protection of the Youth Governmental Agency, Paris , France

  French Psychiatry is currently facing crucial changes calling into question much of what was considered its most specific characteristics and traditions. These changes induce a radical splitting between 1) what is still the common profile of most French psychiatrists still referred to this specific tradition, 2) the new model imposed by stakeholder and policy maker who want French psychiatry to merge a more global profile referred to Anglo-Saxon classic evidence-based literature on epidemiology, treatments, public health organisation, and education. This paper will draw the current profile of French psychiatry (on manpower issues, education issues, legal and scientific issues), and present the recent steps taken by the new mental health program to deal with this splitting.

• S10-3

  Contemporary Mental Health Situation in Eastern Europe

  Armen Soghoyan 1

  1 Yerevan State Medical University , Yerevan , Armenia

  Psychiatric services in Eastern Europe still suffer from difficulties of transitional stage and practically they are condensed expression of attitude towards economy and human rights in these countries.

  Main reforms, although relatively, are performed in large centers, but in peripheral services these processes are very slow. Governments of all countries in our region direct much more resources to emergency services and to solving of general public daily essential problems. In such situations vulnerable social groups, including people with mental disorders, are affected. It can be noticed that processes of globalization could act as panacea in solving this problems, because main difficulties which we see in our countries come from the past and they are attributes of previous political and economic overcentralized models, whereas globalization opens new perspectives and doors.

  We have to consider, it is very important that non-governmental organizations, especially those which have international and global significance, participate in finding solutions for these issues. From this point of view it is necessary to create a widespread professional network between the specialists from Eastern Europe and their colleagues from countries with advanced Mental Health system.

  To achieve this goals we prioritizing conferences, professional meetings, seminars, joint research and training programs.

• S10-4

  欧洲的治疗差异，赫尔辛基精神卫生宣言的基本原则 - The Treatment Gap in Europe and the Helsinki Mental Health Declaration

  Levent Küey 1

  1 WPA Southern Europe Zonal Representative and Isatnbul Bilgi University , Istanbul , Turkey

  Mental disorders, psychosocial problems, and comorbidity of physical diseases and mental disorders in the community constitute a major public health problem across the world and in Europe . Besides their high prevalence rates these disorders and sub-threshold cases diminish quality of life and cause high disability. Considering the low rates of consultation of the patients with mental disorders, and even when consulted, the high rates of misdiagnosis and under treatment create a further burden on the health level of the society and health delivery systems. On the other hand, primary care health setting enhances the possibility of early detection, treatment and rehabilitation of mental disorders and related psychosocial problems. Hence, the relation between the primary care health team and the psychiatrists gains a crucial importance in this respect. It is a well documented fact that the treatment gap in Europe is a challenge for the mental health systems in many countries in this region. Helsinki Mental Health Declaration is an answer to this challenge. This presentation will intend to discuss the dimensions of the problem and possible solutions.

• S11 - 女性与精神 卫生 - Women and Mental Health II

  Chairs: Shenxun Shi, Chinese Mainland
  John Cox, United Kingdom

• S11-1

  The Preventive Impaction of Group Psychotherapy on the Prenatal Anxiety and Depression

  Shenxun Shi 1

  1 Shanghai Huashan Hospital , Shanghai , Chinese Mainland

  Objective: The purpose of this study was to explore the preventive impaction of group psychotherapy on the prenatal anxiety and depressive mood.

  Method: 800 pregnant women from 3544 ones with 16-20 weeks were randomly distributed into two groups, intervention group with group psychotherapy and controlled group with regular follow-up from March 2005 to February 2006. Tools of Eysenck Personality Questionnaire (EPQ), Hospital Used Anxiety and Depression Scale (HAD), Life Events Scale (LES) and Questionnaire of Risk-Related Factors according to published papers of postpartum depression were used to assess each woman in six times including baseline, 24, 28, 32 36 and 40 weeks during pregnancy except EPQ only used at baseline. The score of 9 with A or D of HAD scale was defined as cut-off score for anxiety and depressive symptoms in this study.

  Results: 386 of the 800 women were assigned into the intervention group and 414 into the control group. There was significant difference between two groups with the prevalence of prenatal anxiety (P=0.038) and no significant differences between two groups with the prevalence of anxiety and depressive symptoms in the second and third trimesters totally. The average A score of HAD scale in the intervention group was 2.38 obviously lower than that of 2.94 in the controlled one on the 38-40 week of pregnancy (t=3.02, P=0.003). We also found that 166 women attending the course in the third trimester had 3.6% prevalence of depressive symptom significant lower than that of 8.5% in the controlled group (P=0.031). People attending classes ≥3 times had 2.48 the average A score of HAD scale on the 38-40 week with pregnancy, it was significant lower than that of 2.94 in persons only participating ≤2 times women (P=0.040). We found that those women whose husbands attending the class had a significantly lower A score of HAD scale on the 38-40 week of pregnancy comparing with only women attending the course and controlled group (F=0.009).

  Conclusions: The results in this study showed that group psychotherapy intervention during pregnancy had significantly preventing effect on the prevalence of anxiety and depressive symptoms in women with pregnancy. Husband education was very important to prevent women with pregnancy from anxiety and depressive symptoms occurrence.

• S11-2

  孕期集体心理干预对产后焦虑、抑郁的影 - The Effect of Group Psychotherapy in Women with Pregnancy on Postpartum Anxiety and Depression

  Yuefen Tang

  Huashan Hospital of Fudan University , Shanghai , Chinese Mainland

  目的 ： 探 讨孕期集体心理干预能否减少产后焦虑、抑郁的发生。

  方法 ： 采用 RCT 设计。于 2005.3-2006.2 在中国福利会上海国 际和平妇幼保健院部分连续整群抽样 800 例 怀孕 16-20 周的孕 妇，随机被分配至干预组（ n=386 ）和 对照组（ n=414 ）。干 预组 在常 规孕妇保健的基础上给予集体心理干预（ 5 次孕 妇＋ 1 次丈夫） 课程，以小组集体讨论和授课结合的形式进行。对照组常规孕妇保健。所有参加本研究对象分娩前每月随访一次，至产后 3 天、 42 天和 3 月。孕期采用 综合性医院用焦虑抑郁量表（ Hospital Anxiety and Depression Scale, HAD ） 评估焦虑抑郁，产后增加爱丁堡产后抑郁量表（ Edingburgh Postpartum Depression Scale ， EPDS ）。采用 2004 年 汉化版 SCID-I(Structured Clinical Interview For DSM-IV-TR Axis I Disorders, Research Version) 分 层盲法 SCID 临床诊断。采用 ITT 原 则分析资料。

  结果： （ 1 ）一般情况：根据入 组标准在 3544 个孕 妇中随机获得 800 个研究 对象中，孕期随访 764 人 (95.5%) ， 产后 3 天随 访 759 人 (94.9%), 产后 42 天随 访 756 人 (94.5%) ， 产后 3 月随 访 746 人 (93.3%) 。本研究中失 访 54 人 (6.7%) 。

  （ 2 ）根据 HAD 评估，在符合方案数据集中，孕妇心理干预可以明显减轻产后的焦虑情绪；但 根据 HAD 或 EPDS 评估 , 未能 发现干预对产后抑郁情绪具有效果。孕妇接受心理干预课 4 次以上 时，其丈夫接受心理干预对她们的产后焦虑存在干预作用（ F=4.035 ， P=0.045 ）

  （ 3 ）根据 HAD 或 EPDS 划分界 值（ HAD 的 A 分或 D 分 ≥9 分， EPDS ≥13 分），未能 发现心理干预对产后三个时点的焦虑或抑郁症状具有干预作用。

  （ 4 ）采用 SCID 诊断产后抑郁症，我们发现产后三个时点抑郁障碍的发生率（调整发生率） 干 预组分别为 4.04% 、 14.92% 、 7.85% ， 对照组分别为 3.61% 、 18.12% 、 5.39% ，两 组差异比较没有统计学意义。

  结论： 孕期集体心理干 预对预防产后焦虑情绪具有作用。如何有效预防产后抑郁有待进一步研究探讨。

  Objectives: To test the effectiveness of a prenatal group psychological intervention in reducing the incidence of anxiety and depression in postpartum periods.

  Methods: Using a randomized controlled trial design for the study. 800 pregnant women at 16-20 weeks gestation were selected parted-continuly from The International Peace Maternity & Child Health Hospital of China Welfare Institute in Shanghai . All the women were randomly aollotted to the intervention group(n=386) or control group(n=414).The intervention involved six 90-minute group sessions (five sessions for pregnant women + one session for husband). All the sessions was held by combining group discussion with knowledge introduction. Both of the two groups attended the normal hospital education equally. All the subjects were evaluated by HAD （ Hospital Anxiety and Depression Scale ） once a month prenatally, and EPDS （ Edingburgh Postpartum Depression Scale ） additionally at 3 days, 42 days, 3 month postpartum. SCID-I Chinese version 2004 (Structured Clinical Interview For DSM-IV-TR Axis I Disorders, Research Version) clinical interviews would be blindly hold at different level across to HAD and EPDS scores. Analysis of the mental health outcomes, by intention to treat, was adjusted for the correlated structure of the data.

  Results: (1) Among the 800 subjects randomly selected from 3544 pregnant women according to inclusion criteria, 764(95.5%) women were followed up at the end of pregnancy, 759(94.9%) women at 3 days postpartum,756(94.5%)women at 42 days postpartum. 746(93.3%)women at 3 months postpartum. 54(6.7%)women were lost totally.

  (2)According to HAD, in the PP dataset, we find the intervention can weaken the anxious emotion in postpartum periods. However, there was no efficacy on depressive emotion whether according to HAD or EPDS. The education on husband can help those women who recept more than 4 sessions of intervention prevent the anxious emotion in postpartum.

  (3) According to HAD or EPDS cut-off （ HAD A or D item≥9 scores ， EPDS ≥13 scores ） , the intervention couldn't play role on the anxious symptoms or depressive symptoms at any time-point postpartum.

  (4) By SCID interview, the prevalence of major depressive disorder was 4.04% at 3 days postpartum 、 14.92% at 42 days postpartum and 7.85% at 3 months postpartum in the intervention group; and 3.61% 、 18.12% 、 5.39% in the control group. There was no significant difference between the two groups at each time-point postpartum.

  Conclusions: The prenatal psychological intervention can prevent postpartum anxious emotion. But how to prevent postpartum depression needs to be continuly studied.

• S11-3

  Psychiatric Medications and Pregnancy

  Hong Deng

  Huaxi hospital, Sichuan University, Psychiatry Department, Chengdu, Sichuan, Chinese Mainland

  To explore the risk and the benefit of psychiatric medicine of pregnancy, we conducted a pilot study. 46 reproductive aged psychosis patients with different diagnosis were recruited in this study, including: schizophrenia, bipolar and OCD. All of them had planed pregnancies. Some of them take medicine throughout the whole process of pregnancy; others stopped the medicine during the whole or part of the process of pregnancy. We observed the patients mental states throughout the whole process of pregnancy and a period after the delivery, as well as the incidence of abortion, other perinatal syndromes, birth defects and earlier development. Our primary result shows no congenital malformation was found no matter taking medicine or not. However the number of relapse is more in patients who stopped medicine.

• S11-4

  印度独生子女母亲的精神障碍问题 - Mental Disorder Among Mothers of Single Issue in India

  Asis Acharya 1

  1 Calcutta Pavlov Hospital , Pshyiatry, Kolkata , India

  目的 ： 妇女精神卫生应该是全球化时代的一个敏感的指示器。独生子女母亲遭受各种压力 ， 有时处在情感危机中 ， 一生有不安全的感觉。

  方法 ： 一年期 间来加尔各答市一家精神病院的精神科门诊看病的 164 名母 亲被纳入。入组标准 包括有超 过 10 岁的一个儿 子或女儿的母 亲。她们的年龄在 30 － 60 岁，平均年龄 45 岁。另外的 164 名母 亲的对照组也被筛选，她们有多个子女，匹配的年龄和社会状况。按照 ICD － 10 诊断标准的精神障碍在研究组中被分析。然后，作为比较的对照组母亲被单独列表的诊断评估。

  结果： 在独生子女母 亲中更多类型和不同的诊断分类被发现。心境（情感）障碍（抑郁发作，复发性抑郁障碍，双相情感障碍－目前轻度或中度抑郁发作），恐惧性焦虑障碍，其它的焦虑障碍，适应障碍，躯体形式障碍，人格障碍和物质滥用障碍在独生子女母亲组中被过度地注意到。两组间妄想性障碍和精神分裂症 的率相同。儿童虐待和忽 视史在独生子女母亲组中被较少发现。焦虑障碍，强迫障碍和恐惧性焦虑障碍在研究组和对照组出现的例数是 37,11,8 相 对 28,7 和 6 。抑郁障碍在独生子女母 亲组中被发现 42 例，多子女母 亲组中 23 例。人格障碍如 边缘性人格障碍（情感不稳边缘型），表演型人格障碍在研究组母亲中被发现更多 (3&2) 。在 对照组中它们的发生是零。适应障碍在研究组中被发现有更高的率。

  结论： 一些附加的 压力和情感负担在独生子女母亲中起作用。她们似乎易患不同的焦虑相关障碍，抑郁和适应障碍，而多子女可能作为 一个保 护因素。

  Objectives: Women`s mental health could be a sensetive indicator in the erra of globalisation. Mothers of single son or daughter are exposed to various stress,are in emotional crisis at times, and are in a sense of insecurity during their life time.

  Methods: 164 mothers seen in psychiatry o.p.d of a calcutta city mental hopital during one calender year were taken into.inclusion criteria includes one issue mother who have a son or a daugter more than 10 years of age.they were in the age group of 30-60 years, with an median age of 45.A control group of another 164 mothers were also screened who have multiple children and closely maches the same age and social status.mental disordes as per ICD-10 diag. cliteria was then analysed in the study group. separate list of diagnosis were evaluated later for the control gr. mothers,those were kept for comparism.

  Results: More types and different diagnostic categories were found in single child mothers.mood(affective) disorders(Depressive episode,recurrent depressive disorder,bipolar affective disorder-current episode mild or moderate depression), phobic anxiety disorders, other anxiety disorders, adjustment disorders, somatoform disorders, personality disorders and substance abuse disorder were noted in excess in single child mother group. delusional dis. and schizophrenia were found in equal rates in both the groups.history of child abuse and child neglect were noted less in single child mother gr.Anxiety disorders,obsessive compulsive disorder and phobic anxiety disorders no. of occurance in the study and control groups were-37, 11, 8 versus 28, 7, and 6. Altogether depressive disorder were marked in 42 motthers in one child gr. and 23 in many child mother`s gr. Gross personality disorder like border line personality disorder (emotionaly unstable-borderline type), histrionic personality disorders are found more (3&2) in study gr. mothers. their incidence were nil in control gr.Adjustment disorders were found in significantly higer rate in study mothers group.

  Conclusions: Some additional stress and emotinal burden works in single child mother who seems to be vulnerable to diff. anxiety related diorders, depression and adjusment disorders whereas multiple children might have a protective factor to guard them from within.

• S11-5

  A Study of Defense Style and the Related Changes of Serum Levels of Cytokines in Women with Depression

  Jianyin Qiu 1 , Shenxun Shi 2

  1 Shanghai Jiaotong University Mental Health Center, Shanghai, Chinese Mainland, 2 Fudan University Medical School, Huashan Hospital, Shanghai, Chinese Mainland

  Objective: The study aims to analyze the features of life events and defense style of women with depression, and to explore the related changes of serum levels of cytokines.

  Methods: 87 women with depression were recruited and assessed. By using instruments as self-designed investigation questionnaire, Life Event Scale (LES), Defense Style Questionnaire (DSQ), HAMD-24, and HAMA , the features of life events and defense style were analyzed. Using ELSIA method, serum levels of IL-1 β , IL-6, TNF- α , IFN- γ were evaluated in 40 first-episode, drug-naive women with depression, and 41 healthy controls. The association between serum levels of cytokines and defense style was analyzed.

  Results: 74 (87.12%) patients reported the life events during the past one year. Women with depression used more defenses as autistic fantasy and regression. First-episode patients used more unmature defenses than recurrent patients (P<0.05). The defense style was significantly related to clinical symptoms and severity of depression (P<0.05). The first-episode, drug-naive female depressive patients had significant lower serum level of INF- γ (P<0.01). The total score of LES was positively correlated with IL-6 level (P<0.05). The defense of regression was negatively related with levels of IL-6 、 INF- γ and TNF- α (P<0.05).

  Conclusions: Life events were common in women with depression during the past one year. Defense style was significantly associated with clinical symptoms and the severity of depression, which reflected the deficit in stress coping. Women with depression had a lower cellular immunity activating response, and defense style was significantly correlated serum levels of cytokines.

  Key Words: life event, defense style, cytokine

• S12 - 抑郁与慢性躯体疾病 - Depression and Chronic Medical Diseases

  Chairs: Gerhard Schuessler , Austria
  Qijia Shi, Chinese Mainland

  慢性躯体疾病的患者共病心理 问题的比例较高，最常见的是焦虑与抑郁。 这种共病现象的病因十分复杂。越来越多的证据显示这些共病的患者问题更多，功能丧失更严重；对一些疾病而言，共病心理疾病的患者死亡率高于非共病患者。在回顾最新的资料后 ， 将讨论 COPD 的 结果 ： 这是同吸烟和空气污染有关的全球性疾病。治疗干预是必需的。

  Patients with medical-especially chronic-diseases show a high comorbidity with psychological disorders; Anxiety and Depression are very common.

  There are complex aetiological features of this comorbidity. Evidence is increasing that comorbid patients have more problems and higher functional losses and (for some disease) a higher mortality compared to medical patients without psychological disorder. Following a review of the stat-of-art, results of COPD are presented: a global disease connected with smoking and air pollution. Therapeutic interventions are necessary.

• S13 - 跨文化精神医学 - Cross-Culture Psychiatry

  Chairs: Albert Yeung, United States
  Yifeng Xu, Chinese Mainland

• S13-1

  Psychological Status of Young Migrants from Three Gorges to Zhejiang Province, China

  Jianmin Zhang 1 , Martin Prince 2 , Zhangmu Wu 1 , Robert Stewart 2

  1 Tongde Hospital of Zhejiang Province, Hangzhou, Chinese Mainland, 2 Institute of Psychiatry, King's College London, Section of Epidemiology, Department of Health Service and Population Research, London, United Kingdom

  Background: Large-scale population migration has occurred in China as part of the Three Gorges Dam project (estimated 1.2 million people). Mental health consequences have not been researched. The objectives of this study were to compare mental health measures in young adult migrants to Zhejiang Province with indigenous young adults, and to investigate factors associated with mental disorder in the migrant group.

  Methods: A community survey was carried out in Zhejiang Province , using random and replacement sampling of migrant and indigenous adults aged 16-24 in 15 counties. Face to face interviews were carried out from March to April 2007, including the Patient Health Questionnaire (PHQ). The following outcomes were derived from this instrument and compared between the two groups: i) any mental disorder; ii) common mental disorder (CMD: major and other depressive disorder, panic disorder and other anxiety disorder, somatoform disorder); iii) alcohol abuse.

  Results: The analyzed sample consisted of 700 migrant and 678 indigenous young adults. The point prevalence for any mental disorder was 19.3% in the migrant group and 15.3% in the indigenous group (p=0.053). Respective prevalence rates for CMD were 7.9% and 3.1% (p<0.001), and for alcohol abuse were 9.3% and 11.9% (p=0.13). The association between migrant status and CMD persisted after adjustment for socio-demographic factors, family income, social support and life events.

  Conclusions: Migrant status was associated with a higher prevalence of CMD but not alcohol abuse. Ongoing analysis will further investigate correlates of mental disorder in the migrant group.

  Key words: Three Gorges, Migration, CMD, Alcohol Abuse, Risk Factors

• S13-2

  对门诊华裔美国人抑郁症患者的识别和治疗 - Recognition and Treatment of Depressed Chinese Americans in a Medical Clinic

  Albert Yeung 1 , Lauren Fisher 1 , Wan-Chen Weng 2 , Yantao Ma 3 , Maurizio Fava 1

  1 Massachusetts General Hospital, Psychiatry, Boston, United States, 2 Boston University, Psychology, Boston, United States, 3 Beijing University, Institute of Psychiatry, Beijing, Chinese Mainland

  目的 ： 探索在初 级卫生保健系统中使用协同管理方法 （ CM ） 识别和治疗华裔美国人抑郁症患者的有效性。

  方法 ： 使用患者健康 问卷 (PHQ-9) 中文版 对 2004 年 3 月至 2005 年 12 月在初 级卫生保健门诊就诊的华裔抑郁症患者进行筛查。使用衔接访谈量表 (EIP) 对 PHQ-9≥15 的患者 进行访谈， EIP 用以 联系精神科诊断和适合患者文化背景的协商式治疗方法。入组抑郁症患者从初级卫生保健医生或精神科医生获得药物治疗，并随机接收电话医疗或常规医疗保健服务。治疗结局由不知情的评估者分别于治疗 6 周、 3 个月和 6 个月 时应用 17-HAMD 、 CGI 和社会功能量表 (SF-12) 进行评估。

  结果： 共有 60 名 华裔美国人（ 72% 为女性，平均年龄为 50±15 ）抑郁症患者 纳入研究； 35 例（ 58% ）患者随机接受了 电话医疗保健服务。截至研究结束， 16 例（ 27% ）患者 获缓解（ 17-HAMD 减分率＞ 50% ）， 25 例（ 42% ）患者 获痊愈（末次评估 17-HAMD 评分＜ 7 ）， 20 例（ 33% ）患者失 访。

  结论： 本研究 证实了在初级卫生保健体系中使用 CM 方法治 疗华裔美国人抑郁症患者的可行性和有效性。 CM 有可能成 为改善少数族裔移民抑郁症患者治疗状况的一个解决办法。

  Objective: To examine the effectiveness of recognizing and treating depressed Chinese Americans in primary care using Collaborative Management (CM).

  Method: Between March 2004 to December 2005, depressed Chinese American patients in a primary care clinic were identified through screening using the Chinese version of Patient Health Questionnaire (PHQ-9). Patients who screened positive (PHQ-9≥15) were interviewed using the Engagement Interview Protocol (EIP), designed for communicating psychiatric diagnoses and for negotiating treatment options attuned to patients' cultural viewpoints. Enrolled depressed patients received medications treatment from their primary care physicians or from a psychiatrist, and were randomized to receive either telephonic care management or usual care. Treatment outcomes were evaluated by blind assessors at 1.5, 3, and 6 months using the 17-item Hamilton Rating Scale for Depression (HAM-D), the Clinical Global Impression Scale (CGI), and the Social Functioning Scale (SF-12).

  Results: Sixty depressed Chinese Americans (72% female, mean age 50±15) were enrolled into the study; and 35 (58%) of them were randomized to receive telephonic care management. At the end of the study, 16 (27%) patients achieved remission (> 50% reduction of initial HAM-D score), 25 (42%) patients showed response to treatment (HAM-D score < 7 at last assessment), and 20 (33%) patients were lost to follow-up.

  Conclusions: This study demonstrated the feasibility and effectiveness of using CM to treat depressed Chinese Americans in primary care. CM may be a solution for reducing under-treatment of depression among ethnic minority immigrants.

• S13-3

  从加拿大原住民的视角看双亲对依恋的敏感性 - A Canadian Aboriginal Perspective on Parental Sensitivity for Attachment

  Raymond Neckoway 1 , Keith Brownlee 1

  1 Lakehead University , School of Social Work , Thunder Bay , Canada

  依恋理 论是源于西欧地区的一种理论 ， 聚焦于研究母婴关系中的情感因素 ， 被认为是儿童健康发育的基础。由于被认为具有普遍性也应用于针对加拿大土著家庭的跨文化研究。然而，原住民文化强调将传统和仪式做为发展亲子关系的基础。由于原住民双亲倾向于受不同的哲学思想和世界观的影响，因此并不清楚依恋理论是否同原住民的亲子关系一致或者不一致，以及这种以西方文化为基础的理论能否最好的反映原住民的亲子关系和教养方式。在本文中，我们将讨论针对加拿大边远地区原住民社区的研究和一项城市原住民学前教育计划，重点聚焦于双亲对儿童需要的敏感性和被研究者认为何谓敏感性教养方式。结果显示整体文化价值观和传统习惯是构成亲子关系的一个重要部分，而且原住民双亲在如何理解儿 童的行 为和发育方面存在显著差异。更为特别的是，一种完全不同的世界观构成了对儿童内心世界的理解和解释。本研究提示，将依恋理论应用于加拿大原住民群体甚或其他拥有迥异于西方世界观的群体值得进一步讨论。

  Attachment theory is a Western Eurocentric based theory that focuses on the emotional aspects of the mother-infant relationship is and is considered foundational for healthy child development. It is applied across cultures with Canadian Aboriginal families because it is presumed to be universal. However, Aboriginal culture stresses traditions and ceremonies as a foundation for developing relationships with the child. Given that Aboriginal parents tend to be guided by different philosophical and world view perspectives, it is not clear whether attachment theory is consistent or inconsistent with Aboriginal parenting and whether this Western based theory would best inform parenting and parenting programs when working with Aboriginal parents. In this presentation we will discuss our research with remote Canadian Aboriginal communities as well as an urban Aboriginal Head-Start program, with a focus on sensitivity to a child's needs and what the participants considered as sensitive parenting. The results revealed that general cultural values and dictums formed an important part of the parent child relationship and that there appeared to be important differences in how Aboriginal parents approach an understanding of child behaviour and development. In particular, the understanding and interpretation of the inner world of the child is constructed from a different world view. The implications for applying attachment theory with Canadian indigenous populations and perhaps other populations that do not follow a Western based world view will be discussed.

• S13-4

  38 个国家中公众对精神疾病患者的态度 - Public Attitudes toward People with Mental Health Problems in 38 Countries

  Heather L Stuart 1

  1 Queen's University, Community Health & Epidemiology and Psychiatry, Kingston , Canada

  精神疾病患者的康 复和回归社会是当今社会面临的一大挑战。尽管每个社会都会有对精神疾病的羞耻感 ， 仅有很少的研究对公 众的 态度进行了直接的比较 ， 而那少数的几项研究也局限于两三个国家中。本研究所使用的数据来源于世界价值观调查（第三波），比较了 38 个国家 对精神健康问题人群的公众态度。其次，比较了社会接纳程度和由世界银行定义的国家经济发展水平之间的关系。结果发现不同国家的公众态度差异很大 ， 低收入国家显示有更大程度的社会接纳。

  Stigma poses a major challenge for the recovery and social integration of people with mental health problems. Although stigma toward the mentally ill appears to be a feature of every society, few studies have made direct empirical comparisons of public attitudes, and those that have, have been restricted to a small number of countries (2 or 3). This study uses data from the World Values Survey (3rd Wave) to compare public attitudes toward people with mental health and related conditions in 38 countries. Secondly it examines the relationship between country level social tolerance and level of economic development as defined by the World Bank. Findings confirm that stigmatizing attitudes vary widely from country to country with low income countries generally showing greater levels of social tolerance.

• S14 - WPA 审查委员会关于伦理道德问题研讨 - WPA Review Committee Concerns on Ethical Issues

  Chairs: Donna Stewart, Canada
  Xin Yu, Chinese Mainland

  本次 专题主要围绕与精神疾病相关的四个伦理道德问题。其中一些主题是针对 WPA 常 务委员会的指控 ， 另外一些重要问题是针对审查委员会以及全世界的精神科医生。这些主题包括：文化影响、综合精神病学的重要性、儿童性虐待、医患性关系、以及精神科研究领域中的其他伦理道德问题。

  This symposium will focus on four ethical issues related to psychiatry. Some of these topics have been the source of complaints to the WPA Standing Review Committee, while others are topics of vital concern to the WPA Review Committee and psychiatrists across the world. The topics range from the impact of culture, the importance of integrative psychiatry, child sexual abuse, physician-patient sexual relations and ethics in psychiatric research.

• S14-1

  国家社会实践调查委员会对儿童性虐待、医患性虐待调查 - The Review Committee Survey on National Society Practices Relating to Child Sexual Abuse and Doctor-Patient Sexual Abuse

  Donna E Stewart 1

  1 University Health Network, University of Toronto , Women's Health, Toronto , Canada

  目的 ： 马德里宣言及修订本是 WPA 精神疾病的 伦理道德标准。这次讲座主要是对在 WPA 会 员国中开展的儿童性虐待和医患性虐待政策调查结果进行汇报讨论。马德里宣言中对于儿童性虐待和医患性虐待都是严令禁止的。

  方法： 对 105 个国家的 128 个 WPA 成 员团体通过电子邮件方式对儿童性虐待和医患性虐待进行调查。

  结果： 关于儿童性虐待，所有的会员国都制定相关法律禁止对儿童性虐待，但是有 18% 的国家没有要求医生 报告儿童性虐待情况；有 45% 的成 员团体认为自己会员已经了解儿童性虐待；多数国家建议进一步加强相关教育。关于医患性虐待， 87% 的国家 报告制定有相关的法律；有 47% 的国家 认为自己的成员对医患性虐待有了很好了解；所有参加调查的国家均认为应该加强相关方面的教育。

  结论： 本次的 调查结果说明在 WPA 的会 员国中应该进一步加强对儿童性虐待、医患性虐待相关法律的宣传，培训，教育。

  Purpose: The Declaration of Madrid (DOM) and its revisions are the WPA's standards on ethics in Psychiatry. This presentation will discuss the results of a survey on Child Sexual Abuse (CSA), and Psychiatrist-Patient Sexual Relations (PPSR) policies by the WPA member societies. Both CSA and PPSR are prohibited by DOM.

  Methods: E-mail surveys on CSA and PPSR were sent to 128 WPA member societies in 105 countries.

  Results: Responses represent all world regions. With regard to CSA, all member countries have laws against this, but 18% of countries do not require physicians to report CSA. Only 45% of member societies feel their members are well informed on CSA, and most recommend further education.

  With regard to Psychiatrist-Patient Sexual Relations, 87% of countries or societies have laws or policies against this. Only 47% of societies feel their members are well informed about PPSR and 100% feel further education would be helpful.

  Conclusion: The results of this survey show the need for better advocacy, policies, sanctions and education related to CSA and PPSR in many countries and member societies in WPA.

• S14-2

  精神疾病中伦理道德问题：文化价值，普遍原则 - Ethics in Psychiatry: Cultural Values, Universal Principles

  Ahmed Okasha 1

  1 Institute of Psychiatry, Ain Shams University , Research and Training in Mental Health, Cairo , Egypt

  在所有文化和社会中将各 种信念 ( 信仰 ) 按照 统一的道德标准贯彻实施是不现实的。知情同意、非自愿住院、保密原则在一些传统或者东方社会中都未得到认可 ， 而这部分国家人口已占到世界人口的 2/3 。自主决定 权和以家庭为中心的决定权是东西方社会文化最大差异。精神卫生服务中管制护理以及第三方的加入不仅改变了原有的医患关系，同时也泄露了一些信息。治疗联盟和科研中的知情同意权作为一项基本人权，在 WPA 的 马德里宣言以及特别指南中已加以强调。如何能加快不同种族患者信念的转变 ? 无 论我们是否接受，精神疾病与法律之间的对决已经导致了人们观念上的冲突，一面是健康的价值 , 另外一面是自由、正直、和自主的价 值。传统文化中更多强调社会整合，而不是自主权，这 就意味着家庭，而非个体，构成了社会 单元。在这些文化氛围中，依赖是如此懦弱却又普遍存在，很少被人当作异己的现象。当依赖的意义大于成功时，个体对于他人而言就会变的非常重要。如何避免在实践过程中不忽视地方价值？如何保证对地方文化的尊重不会被当作超越道德伦理界限，侵犯患者权利的借口？本次讲座的主题是文化差异的多样性不应当影响伦理道德的实施。

  The belief of the universality of implementing similar ethical codes in all cultures and societies is a mirage. Informed consent, involuntary admission and confidentiality are not so empowering in some traditional and Eastern societies, representing two thirds of the World population. Autonomy versus family centered decision is one of the main connectors of differences between Western and Eastern Societies. The influence of managed care and the third party in mental health services have changed not only Doctor-patient relationship, but also the disclosure of information. Informed consent in therapeutic alliances and research became a basic human right and has been emphasized in the WPA declaration of Madrid and its specific guidelines.. In what ways does acculturation change the beliefs of patients of various ethnicities? Whether we like it or not, the encounters between psychiatry and law keep bringing us back to our conflicting conceptions of the value of health on the one hand and the value of liberty, integrity and autonomy on the other.In traditional cultures, social integration is emphasized more than autonomy; that is, the family, not the individual, is the unit of society. Dependence is more natural and infirmity is less alien in these cultures. When affiliation is more important than achievement, how one appears to others becomes vital and shame. How can we practice without showing disrespect or disregard for local values? On the other hand, how can we ensure that respect for the local culture does not become a pretext for bypassing ethical guidelines, to the detriment of the patients' rights? The presentation will discuss that diversity of cultural differences should not affect a universal pattern of implementing Ethics taking the cultural context into consideration.

• S14-3

  用整和精神医学的观点看待个体出生 - The Birth of the Person: Towards an Integrative Psychiatry

  John Cox 1

  1 Royal College of Psychiatrist, London , Canada

  本 论文主要以围产期精神病学的一些国际研究进展和临床经验 ， 同时还有本人目前从事的关于个体价值和来源的相关研究为基础。

  近年来 婴幼儿大脑研究新进展和围产期精神疾病的遗传学研究进展提示我们 ， 了解并且掌握这些状况必须从多元论和交互作用的视角来看待问题。这种方法是否依据了循证医学原理来探索精神疾病病因可能还存在一定争议，但仅仅局限于一元论，单从生物学角度或者是社会学角 度了解精神疾病都是不全面的。 进一步提高科研和临床能力明确精神疾病病因，从社会文化视角将左右大脑半球功能结合起来考虑，将会更加有利于个人、家庭、护理工作者。

  我以在 WPA 中提出的相 关提议作为本次讲座的总结，这些提议包括 “ 整体医学 ” ， “ 整体精神病 ” ，同 时将这些观点用于团队工作和社区治疗中。

  This conceptual paper is based on international research and clinical experience in perinatal mental health, as well as my present preoccupation with values and where they come from.

  Recent advances in knowledge of infant brain development and new genetic studies of perinatal mental disorder suggest that the causes and management of these conditions can only be grasped with reference to Pluralistic Explanatory Models (Engel, Kendler) and an interactive perspective ( Buber,Tournier, Bowlby). It will be argued that this approach has also an evidence base for understanding the causes of most other mental disorders.

  It is inadequate to consider only narrow monistic theories of mental disorder restricted to biological or social mechanisms alone but to develop further the research and clinical competencies to determine causal beliefs and sociocultural perspectives that hold together the left and right brain, and which make sense to the individual, the family and the health care worker.

  I conclude with an account of initiatives within WPA relevant to these issues including the Medicine of the Person*, and the Institutional programme ‘Psychiatry of the Person', as well as the implications of these approaches for team working and the therapy of the community.

  * John Cox, Alastair V. Campbell . and Bill (K.W.M) Fulford ( Editors ) 2006 Medicine of the Person: Faith, Science and Values in Health Care Provision. Jessica Kingsley Publishers, London and Philadelphia .

• S14-4

  精神科研究中的伦理问题 - The Ethics of Psychiatric Research

  Donna E Stewart

  University Health Network, University of Toronto , Women's Health, Toronto , Canada

  Abstract text has not been submitted

• S15 - 减少 亚洲抑郁症的疾病负担 - Reducing the Burden of Depression in Asia

  Chairs: Norman Sartorius, Switzerland
  Zeping Xiao, Chinese Mainland

  正文 ： 近年来 ， 许多国家都发表了很多有关抑郁症发生率增加的报导 ， 包括原本认为抑郁症极为少见的亚洲国家。 本主 题讨论会将介绍有关亚洲抑郁症情况的研究结果。

  In recent years a number of alarming reports about the frequency of depressive disorders and its increase has been published in many countries including countries in Asia where depression was considered to be rare. The symposium will provide results of studies that have helped to assess the nature and magnitude of problems related to depressive diseases in Asia .

• S15-1

  菲律宾综合医疗机构中抑郁症的识别和处理情况 - Depression among Patients in General Health Care: Their Detection and Management - A Philippine Experience

  Lourdes Ladrido-Ignacio 1

  1 University of the Philippines , Psychiatry, Ermita Manila , Philippines

  正文 : 在菲律 宾开展的一些研究包括来自不同机构的患者 ， 如社区初级和综合医疗机构的咨询者、受灾社区的居民、三级医院的慢性病 （ 如结核 ） 患者等。其中一项研究是关于 2006 年菲律 宾综 合医院中抑郁症患者情况的， 该研究了解了抑郁症的社会和经济负担情况。这些研究结果与世界范围内的研究结果一致，均提示抑郁症是一个重要的公共卫生问题。而且，对菲律宾来说，形势更为严峻，因为这里精神卫生资源短缺，尤其是人力资源严重不足。菲律宾有 8 千 7 百万人口，只有 400 个精神科医生，（精神科） 护士更喜欢到国外工作，社会工作者终日忙于帮助穷人的社区事务（而无暇顾及精神卫生工作）。市区居民的精神卫生问题和精神疾病由精神科医生处理。但是对大多数人来说 ， 尤其是生活在乡村的居民 ， 精神科医生只能培训社区医生来为他们服务。文中将 介 绍我们现有的培训经验。

  Studies on the Philippines have been conducted among patients consulting primary and general health care clinics in several Philippine communities as well as those communities affected by disasters, and among those in tertiary hospitals suffering from chronic medical problems like tuberculosis. The social and economic cost of depression among these patients was documented in a study among patients seen in the Philippine General Hospital in 2006.

  These studies are consistent with worldwide findings that provide evidence to the fact that depression is a major public health problem. This situation is a major concern in the Philippines where there is severe shortage of resources for mental health services, especially in manpower. The Philippines has a population of 87 million. There are only 400 psychiatrists, a majority of nurses prefer to work overseas, and social workers are immersed in community programs especially for poverty alleviation.

  The management of mental health problems and mental disorders are undertaken by psychiatrists in the urban centers. However for the majority of the population especially in rural areas, psychiatrists have undertaken the role of trainors for community health workers, i.e., general health workers, so that they are able to detect and manage these problems at their level of care. The experience we have had so far in undertaking this training will be described in the paper.

• S15-2

  中国抑郁症的经济花费 - Economic Costs of Depression in China

  Yanling He 1

  1 Shanghai Mental Health Center , Shanghai , Chinese Mainland

  正文 : 背景 ： 最近 ， 中国的一 项调查显示 ， 北京市抑郁障碍的年患病率为 2.5 ％， 上海 为 1.7 ％ 。 这些疾患可导致功能残疾、非正常死亡，严重的还会影响到患者的家庭。

  目的： 评估中国抑郁障碍的经济花费。

  方法： 抑郁障碍的 经济花费包括直接花费和间接花费。为了获得直接经济花费的资料，课题组在中国 5 个城市的 8 个医 疗机构对 505 名抑郁障碍的患者及其照料者 进行了访谈。抑郁症相关的自杀率则来自公开发表的文献。用人力资本核算的方式来评估间接经济花费。流 行病学的数据来自 现有文献。

  结果： 以 2002 年的物价核算，中国抑郁症的 总的经济花费是 513.7 亿人民币（或 62.64 亿美元），直接的经济花费是 80.9 亿人民币（或 9.86 亿美元），约占抑郁症总花费的 16 ％。 间接经济花费是 432.8 亿人民币（或 52.78 亿美元），约占抑郁症总花费的 84 ％。

  结论： 在中国，抑郁症的花 费很高。采取有效的治疗手段以缩短抑郁发作的时间（或防止发作）、降低自杀率，将显著降低抑郁障碍的经济负担。政府决策者应该认真考虑增加对精神卫生机构的投入。

  Background: A recent survey in China indicated the 12-month prevalence rate of depressive disorders was 2.5% in Beijing and 1.7% in Shanghai . These disorders may result in disability, premature death, and severe suffering of those affected and their families.

  Aims: This study estimates the economic consequences of depressive disorders in China .

  Methods: Depressive disorders can have both direct and indirect costs. To obtain direct costs, the research team interviewed 505 patients with depressive disorders and their caregivers in eight clinics/hospitals in five cities in China . Depression-related suicide rates were obtained from published literature. The human capital approach was used to estimate indirect costs. Epidemiological data were taken from available literature.

  Results: The total estimated cost of depression in China is 51,370 million Renminbi (RMB) (or US $6,264 million) at 2002 prices. Direct costs were 8,090 million RMB (or US$ 986 million), about 16% of the total cost of depression. Indirect costs were 43,280 million RMB (or US$ 5,278 million), about 84% of the total cost of depression.

  Conclusions: Depression is a very costly disorder in China . The application of an effective treatment—reducing the length of depressive episodes (or preventing episodes) and reducing suicide rates—will lead to a significant reduction in the total burden resulting from depressive disorders. Government policymakers should seriously consider further investments in mental health services.

• S15-3

  提高亚洲抑郁症的诊疗水平： 5 个亚洲国家的处方情况 - Improving Care for People with Depression in Asia: Prescription Practices in Five Asian Countries

  Naotaka Shinfuku 1

  1 Seinan Gakuin University , School of Human Sciences, Fukuoka , Japan

  正文 : 作者在文中将介 绍 REAP( 东亚精神科药物处方结构研究 ) 研究中有 关抗抑郁药处方情况的 研究 结果。 REAP 是一 项区包括 5 个 亚洲国家和地区的域性合作项目，具体有中国、韩国、日本、中国台湾和新加坡，所有地区均采用统一的研究程序，研究时间是 2003 年 10 月到 2004 年 3 月。 最 终有 5 个国家和地区的 20 个医 疗机构的 1898 个被 试进入研究。入组标准是，接受 ATC-DDD 列出的 56 种抗抑郁药清单中任一种抗抑郁药治疗的抑郁症患者。部分研究结果如下：

  1) 回 顾这 1898 个 处方， 56 种抗抑郁药中的 26 种在亚洲均有使用。

  2) 抗抑郁 药主要用于 F3 编码的心境障碍（ 61.6% ），但也用于 F4 编码的神经症性障碍（ 17.1% ） 、 F2 编码的精神分裂症 (13.1%) 和其他精神障碍。

  3) 70% 的患者使用 SSRI 和 SNRI 类药物。

  4) 帕 罗西汀是最常用的药物 (22.4%) ，其次是氟西汀。

  5) 在不同国家常用抗抑郁 药的种类有所不同。 作者将就改善 亚洲抗抑郁药处方情况的具体方法和途径进行讨论。

  The author will present the outcome of REAP (Research on East Asia Prescription Pattern of Psychotropic) survey on antidepressants. REAP carried out a regional collaborative research in 5 countries and areas in Asia: China , Korea , Japan , Taiwan and Singapore using the unified research protocol from October 2003 to March 2004. In total, a number of 1,898 valid entries were collected from 20 medical institutions of five countries and area. Inclusion criteria were the patients receiving 56 antidepressants listed as antidepressants by ATC-DDD ( WHO Collaborating Center for Drug Statistic Methodology).

  Some of its findings are as follows.

  1) The review of 1,898 prescription showed that twenty-six antidepressants were prescribed in Asia out of fifty six.

  2) Antidepressants were prescribed mostly for F3 Mood disorders (61.6%) but also for F4 Neurotic disorders (17.1%),F2 Schizophrenia disorders (13.1%) and for other categories.

  3) SSRI and SNRI were prescribed for about 70% of patients.

  4) Paroxetine was the most frequently prescribed (22.4%) followed by fluoxetine.

  5) The list of the commonly used antidepressants differed country by country.

  The author will discuss the ways and means to improve prescription of antidepressants in Asia .

• S15-4

  日本预防自杀的国家级社区干预策略 - The National Community Intervention Trial to Prevent Suicide in Japan

  Shuichi Awata 1

  1 Sendai City Hospital , Division of Neuropsychistry & Center for Dementia, Sendai , Japan

  正文 ： 为了研究日本据高不下的自杀率 ， 一项名为 “ 新型社区干 预模式 —— 多模式自 杀预防项目 ” 的国家 级自杀预防研究于 2006 年 开始实施 . 。 该项目计划在所有人群中开展自杀预防活动，包括初级预防：对公众和关键人物开展教育；二级预防：确定高危人群，对其进行干预；三级预防：为因自杀而丧失亲人的人群提供帮助。本研究旨在论证在城市范围内大样本人群中实施这个 “ 自 杀综合干预措施 ” 的可行性。

  方法： 本研究描述了在日本仙台市 实施和推广该项目的过程及结果。

  结果： 2002 年在仙台市某居民区的老年人群中 开展了预防自杀和抑郁的综合干预项目，并且逐步推广至整个城市。研究显示， 2002-2005 年老年人自 杀率呈现下降趋势。市政领导机构在上述成绩的鼓舞下制定了相关政策， 将 这一项目作为公益事业推广开来， 2006 年国会的抵制自 杀法案的通过，以及非政府组织的 “ 向自 杀人群提供帮助 ” 活 动，更进一步推动了政府的这项举措。

  结论： 综合自杀干预模式适用于百万人口的大城市。该项目目前已经在 7 个地区展 开，因此，今后还将对上述七个地区的自杀率变化情况进行长期监测。

  Objective: In order to address Japan 's enduring high suicide rate, a national suicide prevention study entitled “A novel community intervention trial of multimodal suicide prevention program in Japan (NOCOMIT-J)” was launched in 2006. The program is designed to prevent suicide in all generations and includes primary prevention measures for educating the public and key personnel, secondary prevention measures for identifying and providing interventions for high-risk individuals, and tertiary prevention measures for providing care to people bereaved by suicide. The present study investigates the feasibility of undertaking such a comprehensive suicide prevention program in an urban city with a large population. Method: The present study describes the process of implementing and propagating the program and the course of events in Sendai city.

  Results: A comprehensive program for preventing suicide and depression among the elderly was implemented in a residential district of Sendai city in 2002 and has gradually propagated to the entire city. As a result, from 2002 to 2005, a decreasing trend in the suicide rate in later life was observed. Municipal authorities were encouraged by the success of the elderly suicide prevention program and established a policy to implement NOCOMIT-J as a public enterprise. The action of the municipality was facilitated by the passing of an anti-suicide law by the National Diet in 2006 as well as by the movement of nongovernmental citizens' groups to provide care to people bereaved by suicide.

  Conclusion: A comprehensive program for preventing suicide might be feasible in an urban city with a population of 1000,000. The intervention trial was started in 7 regions; therefore, further long-term monitoring of changes in the suicide rate in all generations is scheduled to be conducted in these regions.

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