• S16 - 社会文化 变迁与心理适应 - Social and Culture Change and Mental Health Adjustment

  Chairs: Wen-Shing Tseng, United States
  XuDong Zhao, Chinese Mainland

  Zhao Xudong ( 赵旭东 ) ( China ) – Sociocultural change and challenge to the therapists for psychotherapy ( 社会文化 变迁对心理治疗师的挑战 )

  Lin Hong （ 林 红 ） and Wang Yufeng ( 王玉 凤 ) ( China )-Child behavior Problems: Comparative follow-up study twenty years later –sociocultural comments ( 儿童行 为问题 : 20 年后追踪 调查比较 -- 社会文化上的 讨论 )

  Liu Tiebang ( 刘 铁榜 )China ） -- Rapid socioeconomic development and mental Health: Epidemiological findings from Shenzhen ( 社会 经济的快速进展与心理卫生 ： 深圳的流行病学研究 ）

  Zhang Yalin ( 张亚林 ) ( China ) – The protective effects of the traditional Daoism thought for the modern society ( 中国道家思想在 现代社会中的保护作用 )

  Shi Jingyu （ 史靖宇 ） Zhao Xudong （ 赵旭东 ）（ China ）－－ An exploratory study of cross-cultural adaptation of Uygur students from Xinjiang in a Shanghai senior middle school （ 某内地新疆高中班学生跨文化适 应情况调查及其与家庭动力学关系研究 ）

• S16-1

  社会文化变迁对心理治疗师的挑战 - Socio-cultural Change and its Challenges to Mental Health Professionals in China

  XuDong Zhao 1

  1 Chinese-German Friendship Hospital (preparing) Affiliated to TongJi University , Shanghai , Chinese Mainland

  Introduction: China is progressing rapidly. The environment, the contents and styles of the life in China have been changed enormously so that all the people have to readjust their behavioral ways and psychological status.

  Social-cultural changes on the macro-level have induced radical changes in the individual inner psychic life on the micro-level. While the most people are enjoying the satisfaction and happiness of the progress and experiencing individual growth, some people have to pay high price for such a new Great Leap. Behavioral deviations relating to psychopathology have been seen as major causes of some serious social events and emergencies. So, the society has to pay high price, too. Psychological inharmony becomes obstacle in the way to construct a harmonious society. In 2006 ， the Communist Party has written for the first time in its important resolution that the Party would pay much attention to promote the psychological harmony of the people.

  From clinical and cultural perspectives, I'll discuss in this presentation following issues: A. What are the new elements in the daily life in China ? B. What has been changed in Chinese behavioral patterns and psychological life? C. What clinical problems are the Chinese colleagues dealing with in a new era? D. How should we analyze the outstanding phenomena regarding the relationship between modernization and people's adaptation?

  2. Five challenges to cope with We are living in a world where every thing is intertwined. In order to understand problems on individual level, we should begin with the macro environment, and then we could understand the Chinese better. Old stereotypes of Chinese have never fitted the diverse realities. Nowadays' Chinese look still further from such stereotypes than before.

  (1) Changing Ecology, human ecology and ecology of mind: In general, mentality of the contemporary Chinese has been changed and is still changing due to the changes of natural and social environments, so that an art of new “Zeitgeist” has been shaped.

  (2) Behavioral Change in Adaptation: A. Changes related to the living standards: Consciousness of space, self-boundary, privacy, tidiness, cleanness and consumption has changed, so that interpersonal relation and the relation between human being and nature have changed. B. Changed life styles: Hectic tempo in cruel competition makes people under stress constantly. C. The contents of life are increasingly complicated, colorful but also stressful.

  (3) Psychological Features of the young generations: A. Affect and emotional linkage with others ： cooler! B. Cognition ： cleverer! C. Volition & will ： tougher! “Type A behavior” is admired. But holding one's ground is contradictory to the necessary flexibility in a rapidly changing time.

  (4). Phenomena of ambivalence: Individuation and Attachment, dependence; Showing-off, arrogant and narcissistic youth who are lacking of sufficient self-esteem and self consciousness; Pursuit of openness and frankness and being lost in anonymous or virtual world. Internet communication serves as ways to avoid real relationship and responsibility and to express suppressed aggression.

  (5) Imbalance of psycho-somatic relation: The speed of nutrition improvement is faster than the evolutionary adaptation of organisms. Disease-spectrum has changed. Disorders relating to life styles are increasing enormously. We're facing to a challenge to re-balance our body-mind relationship.

  3. Are the Chinese really suffering from “Civilization-diseases”? Based on reseach Cases, the author discusses some outstanding issues, such as unhappiness in prosperity, mental health problems among immigrants and the new riches, changes of family structure and dynamics and their effects on individual psychopathology.

  4. New role and tasks of Chinese psychiatrists: Psychiatry in China is not a favored field in the medical sector and social life. Being confronted with so many old and new problems, Chinese society begins to know its significances. Psychiatrists and other related professionals ought to expand their work scopes and improve service approaches.

• S16-2

  儿童行为问题： 20 年追踪调查比较 ? －社会文化上的讨论 - Child Behavioral Problems: Comparative Follow-up Study Two Decades Later - Sociocultural Comments

  Hong Lin 1 , Yufeng Wang 1

  1 北京大学 , 精神 卫生研究所 , 北京 , Chinese Mainland

  本研究分 别在 1985 ， 1993 和 2003 年 调查了中国北京城市地区学龄儿童行为问题的检出率。研究对象均为同一地区 6 到 14 岁学龄儿童，调查 工具均 为 Rutter 儿童行 为家长问卷，保证了追踪调查的可比性。 2003 年 调查结果表明：行为问题总检出率为 18.2 ％，其中 A 行 为（反社会行为）检出率 5.9%, N 行 为（神经症行为）检出率 8.2 ％。 总的行为问题和 A 行 为检出率男孩（分别为 20.74% 和 7.58 ％）均高于女孩 ( 分 别为 15.00% 和 3.39 ％ ) ，差 别有统计学意义，而不同性别间 N 行 为检出率差异没有显著性。三次调查结果比较发现，学龄儿童行为问题总检出率呈上升趋势（分别为 8.3%, 10.9% 和 18.2% ），特 别是 N 行 为检出率上升尤其明显（分别为 0.6%, 1.9% 和 8.2% ）。近 20 年来社会文化的 变化导致中国北京城市学龄儿童行为问题的上升。

  This study examined behavioral problems in Chinese school children in urban areas of Beijing , China in 1985, 1993 and 2003. For the school children, aged 6 to 14 years, their parents were asked to complete the same instrument of the Rutter Parental Scales for children's behavior problems, so that the obtained data can be compared over the time. The results of the last study carried out in 2003 revealed that: the frequency of the total behavior problem was 18.2%. Among them, 5.9% belong to antisocial (externalizing) behavior; and 8.2 ％ neurotic (internalizing) behavior. By gender, the total behavior problems were higher for boys (20.74%) than girls (15.00%); antisocial behavior was higher for boys (7.58 ％ ) than girls (3.39 ％ ), while the difference of neurotic behavior between them was not significant. In contrast to the previous studies carried out in 1985, and 1993, it illustrated clearly that the total behavior problem was steadily increasing (8.3%, 10.9%, 18.2% respectively); and the main reason for the increase is due to the increase of the neurotic behavior problems (0.6%, 1.9%, 8.2% respectively). The increase of the behavior problems during the past two decades is interpreted as the results of sociocultural changes.
  

• S16-3

  Rapid Socioeconomic Development

  TieBang Liu 1

  1 ShenZhen Mental Health Center Institute, ShenZhen, Chinese Mainland

   Abstract text has not been submitted

• S16-4

  中国传统文化对心理的保护作用 - The Protective Effects of Traditional Chinese Culture for Mind

  YaLin Zhang 1

  1 The Second XiangYa Mental Health Institute, Center South University , ChangSha , Chinese Mainland

  中国 传统文化包括哲学宗教、道德伦理、政治经济、文学艺术、科技教育、语言文字、民间习俗等。本报告将介绍以儒家、道家和释家为代表的圣贤 文化，以鬼、 谚语为代表的世俗文化，中国传统文化中乐观通达的生活态度、和谐统一的价值观念和对立统一的辩证思想。博大、精深、辉煌、悠久的中国传统文化蕴含着巨大的智慧和丰富的营养 ， 护卫和滋养着炎黄子孙的心身。

  The traditional Chinese culture includes philosophy, religion, morality, ethic, politics, economy, literature, art, science and technology, education, language, folk custom, etc. In this report, we will introduce oracle culture typified by Confucianism, Daoism and Buddhism, secular culture represented by ghost and proverb, life attitude of optimism and discernment, value of harmony, unity and dialectic thought of unity of opposites. The traditional Chinese culture, extensive and profound, resplendence and centuries-old, contains immense wisdom and abundant nourishment which safeguard and nourish the mind and body of our Chinese stock.

• S16-5

  某内地新疆高中班学生跨文化适应情况调查及其与家庭动力学关系研究 - An Exploratory Study of Cross-cultural Adaptation of Uygur Students from Xinjiang in a Shanghai Senior Middle School

  JingYu Shi 1 , 旭 东 赵 2

  1 Medical Institute, TongJi University, Shanghai, Chinese Mainland, 2 同 济大学医学院 , 上海 , Chinese Mainland

  目的 ： 调查某内地新疆高中班学生跨文化适应情况 ， 探索其心理健康影响因素 ， 研究不同适应情况的内高班学生家庭动力学特征。

  方法 ： 采用整群抽 样的方法 ， 抽取上海某校内地新疆高中班 ， 共 127 名 维族学生作为调查对象。其中预科 69 名，高一 55 名。女生 55 名， 男生 69 名。平均年 龄 16. 46 （ 15~18 ） 岁。学生问卷由班主任老师发放，各班在统一时间内集体完成。收回有效问卷 124 份。使用症状自 评量表（ scl-90 ）、自 编一般适应情况调查表、系统家庭动力学自评问卷进行评估。

  结果： SCL-90 总分超过 160 分者列 为阳性人 数， , 共 34 例 , 占 总人数的 27.4% ，其 SCL-90 总分 ( 207.68 ±39.98 ) 分。 预科 SCL-90 阳性率 显著高于高一学生（ P<0.01 ）。一般适 应情况调查表结果显示，在来上海的心态、汉语水平、对学校生活和学习条件的评价方面，学生普遍回答是积极正性的。在学习方面， 92.7% 的学生感到学 习有不同程度困难， 60.5% 的学生不感到学 习愉快， 26% 的学生 对自己成绩满意；在家庭方面， 37.1% 的学生 认为成绩偶尔达到或不能达到父母要求， 85.5% 的学生有 对家人担心；在人际关系方面， 41.9% 的学生存在交友困 难。将 SCL-90 总分超过 160 分者 设为心理适应不良组，其余学生为对照组，比较两组学生家庭动力学特征，提示对照组在家庭气氛和个性化两个维度得分高于心理适应不良组（ P<0.05 ），其他 维度得分无明显差异。 SCL-90 总分和各因子分与系统家庭动力学家庭气氛和个性化两个维度成显著性的正相关（ P<0.01 ）。

  结论： 内高班学生 对来上海上学普遍抱积极心态，大多数没有语言交流困难和文化适应困难 , 家庭 动力学特征对于个体心理特征影响明显。

  Objective: To investigate the cross-cultural adaptation of Uygur students from Xinjiang in a Shanghai senior middle school, to explore the factors on their psychological well-being and adaptation and to compare the family dynamics between maladjustment and well adjustment.

  Methods: 127 Uygur students from Xinjiang in a Shanghai senior middle school were asked to finish the self-report symptom inventory ， Symptom checklist-90 ( SCL-90) and the self-report systematic family dynamics inventory and general adaptation questions. Correlation analysis was carried out.

  Results: The positive rate of SCL-90 in these Uygur students from Xinjiang was 27.4%,the positive rate of preparatory Grade one students was significantly higher than that of Grade one students(P<0.01). 92.7% students have difficulties in studying, 41.9% students feel difficult to make friends with classmates, 85.5% students worry about their families. Compared the scores of self-report systematic family dynamics inventory between maladjustment group and control group , maladjustment group had higher Family Atmosphere and Individuality score ( P<0.05). Family Atmosphere and Individuality scores had significant positive correlations with every subscale score of SCL-90( P<0.01) ,the value of correlation rate was from 0.180 to 0.348.

  Conclusion: the students have generally positive attitudes of the studying in Shanghai . The family dynamic factors have important influence to their mental health.

• S17 - 物 质依赖 - Substance Abuse

  Chairs: Betty Tai, United States
  Zhao Ming, Chinese Mainland

• S17-1

  u- 阿片受体基因第一外显子区和 5′ 调控区单核苷酸多态性与海洛因依赖的相关性研究 - Association between Single Nucleotide Polymorphism in First Exon Region and 5′ Regulation Region of U-opium Receptor Gene and Heroin Dependence

  CunMin Zhang 1 , 建 华 李 2 , 秀峰 许 3

  1 The First Affiliated Hospital to KunMing Medical Institute, KunMing, Chinese Mainland, 2 云南省 药物依赖 研究所 , 昆明 , Chinese Mainland, 3 昆明医学院第一附属医院 , 昆明 , Chinese Mainland

  目的 ： 研究云南地区 汉族海洛因依赖者的 u- 阿片受体基因 （ OPRM1 ） 第一外 显子区和 5′ 非 编码区的单核苷酸多态性 （ SNP ） 与海洛因依 赖易感性、临床表型和合并其他药物滥用行为之间的关系。

  方法 ： 采用病例 - 对照研究的方法 ， 采集云南地区 170 名 汉族海洛因依赖者和 124 名 汉族健康人的血样 ， 应用聚合酶链式反应 - 限制性片段 长度多态性 （ PCR-RFLP ） 技 术 ， 检测 OPRM1 -2044C/A 、 -1793T/A 、 17C/T 和 118A/G 多 态性 ， 以进行对照研究。同时，通过遗传研究诊断问卷、海洛因稽延性戒断症状评定量表和自拟问卷，分析海洛因依赖者的临床表型、合并其他药物滥用行为与基因型之间的关系。

  结果：

  1. OPRM1 -2044A 在本研究 对象中的出现率极低，仅在病例组中发现 1 例 杂合子 -2044CA 。未 发现 OPRM1 -1793A 和 17T 等位基因的存在。

  2. OPRM1 118A/G 各基因型在病例 组和对照组间的分布无统计学差异（ P ＝ 0.092 ）；但病例 组 118G 等位基因的 频率明显高于对照组（ P ＝ 0.035 ）。区分性 别后可见男性海洛因依赖者的 118G 等位基因 频率、携带 118G 等位基因的个体数均明 显高于男性对照（ P ＝ 0.031 、 P ＝ 0.038 ），而在女性 组中的差异则无统计学意义（ P ＝ 0.595 、 P ＝ 0.494 ）。

  3. 海洛因依 赖者首次尝试海洛因的年龄、成瘾时间、每日使用次数、每次用量、每日用量、诱发渴求感、稽延症状和持续时间的差异在三种基因型个体、是否携带等位基因 118G 或 A 的基因型个体中均无 统计学意义（ P>0.05 ）。用 药欣快感在各基因型个体间有差异（ P ＝ 0.016 ），携 带等位基因 A 的个体的用 药欣快感高于 未携 带的个体（ P ＝ 0.004 ）。

  4. 海洛因依 赖者中，合并多药滥用在三种基因型个体、是否携带等位基因 118G 或 A 的基因型个体中的分布无差异（ P>0.05 ）。合并或未合并酒依 赖的男性海洛因依赖者的基因型分布不同，携带等位基因 G 的个体合并酒依 赖的比例高于未合并者（ P ＝ 0.035 ）。

  结论：

  1. OPRM1 118A/G 多 态性可能与云南地区男性汉族海洛因依赖的发病有关联，携带等位基因 G 的个体可能更易罹患海洛因依 赖。

  2. OPRM1 118A/G 的基因型可能与云南地区 汉族海洛因依赖者的首次尝试年龄、海洛因使用 量、 诱发渴求感和稽延症状无关。但基因型为 OPRM1 118AA 的个体 较 118AG 和 118GG 的个体可能有更高的用 药欣快感。

  3. 云南地区 汉族男性海洛因依赖者中，携带等位基因 G 的个体可能更容易并 发酒依赖。

  4. OPRM1 -2044C/A 、 -1793T/A 和 17C/T 中 变异等位基因的出现频率极低，提示这三个位点在云南地区汉族人群中可能没有多态性。

  关键词 : 海洛因依 赖 阿片受体基因 m 单核苷酸多态性

• S17-2

  肥胖和药物成瘾者在脑影像学方面的相似性研究 - Similarity of Obesity and Drug Addiction in the Light of Brain Imaging Study

  Jack Wang

  Brookhaven National Laboratory, Upton , United States

  我 们以及其他实验室的证据表明 ， 药物成瘾者和肥胖者的有着相似的脑部通路中断。我们对正常人 和病理性 摄食患者的脑部多巴胺进行了脑影像学研究。对于正常体重的斋戒者，食物的出现会增加纹状体细胞外的多巴胺含量，使进食成为令人不愉快的活动。肥胖者的过度饮食和药物成瘾者的强迫性服药行为都有着相似的控制失效问题。与药物成瘾者相似，我们也发现肥胖患者的纹状体 D2 受体的减少。我 们假定由于易感人群的多巴胺受体减少，使得他们需要寻求增强剂。比如药物成瘾者寻求药物，肥胖者寻求食物，使得原本已经降低的多巴胺敏感性，因暂时性的补充，犒赏通路得以调节。在肥胖者胃内植入刺激物，这种刺激物由于电刺激可导致胃扩张，从而刺激迷走神经 。我 们发现脑部区域（眶额皮质，海马和纹状体）的活化，这些脑部区域包括在成瘾者的药物成瘾区内。这表明食物对于肥胖者和药物对于成瘾者都能各自激发相似的脑部区域。与药物成瘾者不同的是，肥胖者提高躯体感觉皮层的代谢。肥胖者一旦减少受体，嗜食行为同时就会增强，食物作为增强剂就会被过度的消耗。

  There is evidence from our Laboratory and from others that similar brain circuits are disrupted in drug addiction and in obesity. Our imaging studies implicate the involvement of brain dopamine in normal and pathological food intake in humans. In normal body weight fasting subjects, food presentation that could not be consumed was associated with increases in striatal extracellular dopamine, which provides evidence of an involvement of dopamine in non-hedonic motivational properties of food intake. Overeating in obese subjects shares similarities with the loss of control and compulsive drug taking behavior observed in drug-addicted subjects. Similar to drug-addicted subjects, we found reductions in striatal dopamine D2 receptors in obese subjects. We postulated that decreased levels of dopamine receptors predisposed subjects to search for reinforcers; for example, drug-addicted subjects seek the drug whereas obese subjects seek food to temporarily compensate for a decreased sensitivity of dopamine regulated reward circuits. In obese subjects implanted with a gastric stimulator, which induces stomach expansion via electrical stimulation of the vagus nerve, we found brain activated in regions (orbitofrontal cortex, hippocampus and striatum) that involve in drug craving in addicted subjects. This suggests that similar brain circuits underlie the enhanced motivational drive for food and for drugs seen in obese and drug addicted subjects respectively. Different from drug-addicted subjects, obese subjects have increased metabolism in somatosensory cortex. In the case of obesity the reduction in receptors coupled with the enhanced sensitivity to food palatability makes them at risk for food over-consumption as their most salient reinforcer.
  
• S17-3

  大样本人群中使用安非他明的预测因子 - Predictors of Amphetamine Use in a Large Population Sample. 大范围人口样本的大麻使用预测因素 - Predictors of Cannabis Use in a Large Population Sample

  Jake M Najman 1 , Reza M Hayatbakhsh 1 , Rosemary Aird 1 , William Bor 1 , Michael O'Callaghan 1 , Gail M Williams 1

  1 University of Queensland , School of Population Health, Brisbane , Australia

  目的 ： 在世界的很多国家中 ， 安非他明的使用增加。在澳大利 亚，有一成的年轻人报道在过去一年使用安非他 明。尽管有很多原因用以解 释近期安非他明的使用增加了（如海洛因短缺，供给增加），很多人认为安非他明的使用者有一些个人缺陷，而这些个人缺陷与他们决定使用安非他明有关。他们觉得，安非他明的使用者受到情感需要或环境因素的驱动。

  方法： 资料来源于大样本的前瞻性调查（ The Mater- Unversity of Queensland Study of Pregnancy- MUSP ），本 论文调查了使用安非他明的四个方面的预测因素。 1 、社会的（ 贫穷，家庭冲突） 2 、心理的（儿童期的精神障碍可 导致药物滥用） 3 、生物的（生物上的易感性如体重，童年期体 质差等） 4 、 环境的（生活在一个不良的环境中）

  结果： 安非他明使用、 滥用、依赖的具体资料来自于行政部门 CIDI-Auto 。 强有力的 证据表明，安非他明的使用者与非使用者在很多方面存在不同。使用复合的危险因素分数可能是可以用来预测个体会否使用安非他明的。

  结论： 尽管有大量的因素可以用来 预测安非他明的使用，一个包含了所有危险因素信息的多重危险因素模型还是不能辨别出哪些人会是安非他明使用者，哪些是滥用者，而哪些是依赖者。政策需要聚焦于一些人群因素 ， 如可获得性 ， 费用 ， 感受到的使用安非他明 的危 险 ， 而不是个体使用安非他明的特点。

  Objectives: Amphetamine use has increased in a number of countries in the world. In Australia , about one in ten young people report having used amphetamines in the last year. While many reasons have been advanced to explain this recent increased use of amphetamines (e.g. a shortage of heroin, increased supply), many subscribe to the view that amphetamine users have personal deficiencies which are relevant to understanding their decision to use amphetamines. At its simplest level they argue that users of amphetamines are motivated by their emotional needs or social circumstances.

  Methods: Taking data from a large prospective population study (The Mater-University of Queensland Study of Pregnancy—MUSP), this paper examines four categories of predictors of amphetamine use.

  1. Social (poverty, family conflict)

  2. Psychological (child mental health preceding drug use)

  3. Biological (evidence of biological vulnerability such as birthweight and poor health in childhood)

  4. Environmental (living in a “bad” neighbourhood)

  Results: Details of amphetamine use, abuse, and dependence are derived from administration of the CIDI-Auto. There is strong evidence that users of amphetamines differ from non-users in a range of ways. Using a composite risk factor score it is possible to predict the probability of a person using amphetamines.

  Conclusions: While a wide variety of factors predict amphetamine use, even a multiple risk factor model, which combines all the information about risk factors, fails to identify the vast majority of those who use amphetamines or who manifest amphetamine abuse or dependence. Policies need to focus on population factors such as availability, cost, and perceived risk of using amphetamines, rather than the characteristics of the individual using amphetamines.

  目的 ： 1/3 到 1/2 的澳大利 亚年轻人报告过他们曾经 “ 吸食 ” 过大麻 ， 这种非法毒品的使用不仅仅是常见的 ， 一种更重要的意义在于 ， 它是成长的一个 “ 正常 ” 组成部分。关于年轻人为什么要吸食大麻已经是一个陈旧的话题，大多数都强调了个体心理缺陷和毒品使用的社交网络是重要的因素。本文研究了何种程度的大麻吸食是由于个体的 “ 弱点 ” 或社会 / 结构因素导致的。

  方法： 数据来自于大型的 长程前瞻性研究。 21 岁前大麻依赖和滥用的预测指标包括 4 部分： 1. 社会性（ 贫穷、父母亲的婚姻问题等）、 2. 心理学（先于大麻吸食的儿童心理健康和行 为问题）、 3. 生物学（生物学的易感性指 标，如出生体重和童年早期糟糕的健康状态）、 4. 环境（生活在以社会问题和毒品使用为特征的地理区域内）。

  结果： 使用 “ 计算机辅助复合性国际诊断访谈（ CIDI-Auto ） ” 评估大麻吸食情况。可以将那些没有吸食大麻的人从偶尔吸食或者吸食大麻已经造成更多问题的人群中区分出来。毒品使用者的个人品质与那些不使用毒品的个体没有区别，而两者生活的社会和环境背景却差异很大。

  结论： 吸食大麻有 许多预测指标。从制定方针的角度来看， 仍然不确定是否 这些指标已经足够充足以决定需要进行治疗，从而降低非法药物的使用。本文提出这样一个问题 ： 什么是最适当的方针设定以降低大麻导致损害的程度。

  Objectives: With between one third and one half of young Australians now reporting they have “used” cannabis, the use of illicit drugs is not only common but, in an important sense, a normal part of growing up. There are a range of stereotypes about why young people use cannabis, largely emphasising such personal deficiencies as poor mental health and drug using social networks. This paper examines the extent to which cannabis use is a consequence of personal “weaknesses” or social/structural factors.

  Methods: Data are from a large longitudinal prospective study. Predictors of cannabis dependence and abuse by age 21 are grouped into four categories:

  1. Social (poverty, parental marital problems, etc.)

  2. Psychological (child mental health and behaviour prior to cannabis use)

  3. Biological (indicators of a biological vulnerability such as birthweight and poor health in early childhood)

  4. Environmental (living in a geographic area characterised by social problems and drug use).

  Results: Cannabis use is assessed using the CIDI-Auto. It is possible to distinguish those who do not use cannabis from those who are occasional users of cannabis and those whose cannabis use becomes more problematic. While the personal qualities of drug users do not differ from those of non-users, the social and environmental contexts in which they live differ greatly.

  Conclusions: There are a wide number of predictors of cannabis use. From a policy perspective there remains uncertainty about whether these predictors are sufficiently strong to the used in framing treatment decisions to reduce illicit drug use. The paper raises questions about the most appropriate policy settings for influencing the level of cannabis related harms.

• S17-4

  治疗使用中的人种和种族差异：来自 2001-2002 年全国酒精及相关问题流行病学调查的结果 - Racial and Ethnic Differences in Treatment Utilization: Results From the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

  Melinda J Manley 1 , Helen Wu 2 , James Grady 3

  1 Yale University, Epidemiology & Public Health, New Haven, United States, 2 The University of Texas Medical Branch, Obstetrics and Gynecology, Galveston, Texas, United States, 3 The University of Texas Medical Branch, Galveston, Texas, United States

  目的 ： 酒精使用障碍 (AUD) 非常普遍 ， 与 许多公众健康问题有关。不同人种 / 种族的酒精使用障碍患病率不同，但是对治疗使用的差异所知不多。

  方法： 使用 AUDADIS-IV 对 2001-2002 年全国酒精及相 关问题流行病学调查的， DSM-IV 诊断为酒精滥用及依赖（及其他障碍）的 43093 名美国成年人 进行评定，对卡方分析的终生酒精使用障碍（ n ＝ 11843 ），使用未校正方差分析 检验的人种 / 种族均数差，分级对数回归得出的比值比进行交叉列表。

  结果： 不同人 种 / 种族的 AUD 患病率差异 显著，在 11 － 42 ％之 间。 AUD 患者中 4-11 ％ 报告了每次寻求治疗行为。依赖性研究对象的治疗使用更频繁，没有人种 / 种族差异。延迟治疗存在显著的人种 / 种族差异，亚洲人从起病到寻求治疗的时间最短。不同人种 / 种族的 AUD 患者存在 显著的社会人口统计学差异。多变量分析显示终生 AUD 患者的治 疗使用没有人种 / 种族差异。年老，教育水平低，曾结婚，有医疗保障、医疗辅助计划或军队保险，有治疗障碍的终生 AUD 患者更愿 寻求治疗。

  结论： 终生 AUD 患者所有的治 疗使用率都低且延迟，治疗使用的人种 / 种族差异不显著。这些结果需要更多着重于 AUD 患者低治 疗使用率原因的研究，尤其是更易 于 关心的患者。此外 ， 还需要有关治疗相关因子临时排序的纵向研究。

  Objectives: Alcohol use disorders (AUD's) are highly prevalent and associated with a number of public health problems. Differences have been found in the prevalence of AUD's among different racial/ethnic groups, but less is known about differences in treatment utilization.

  Methods: The 2001-2002 National Epidemiologic Survey of Alcohol and Related Conditions (NESARC) surveyed a nationally representative sample of 43,093 U.S. adults. Lifetime and past 12-month DSM-IV diagnoses for alcohol abuse and dependence (and other disorders) were determined using the Alcohol Use Disorder and Associated Disability Interview Schedule DSM-IV version (AUDADIS-IV). Cross-tabulation associations for lifetime AUD's (n=11,843) underwent Chi-square analyses, mean differences by race/ethnicity were tested by unadjusted ANOVA, and odds ratios were derived from hierarchical logistic regression analyses.

  Results: The prevalence of any lifetime AUD varied significantly by race/ethnicity and ranged from 11 to 42%. Among those with an AUD, 4 to 11% of respondents reported every seeking any treatment. Treatment utilization was more frequent among dependent respondents, with no significant differences by race/ethnicity. Significant racial/ethnic differences were found in the extent of delayed treatment, with Asians having the shortest time between disorder onset and treatment seeking. Among those with an AUD significant sociodemographic differences were found between racial/ethnic groups. Multivariate analyses yielded no significant ethnic/racial difference in treatment utilization among those with lifetime AUD. Respondents with lifetime AUD who were older, less educated, previously married, had Medicare, Medicaid or military insurance, and reported any barrier to treatment were more likely to have sought treatment.

  Conclusions: Overall treatment utilization among those with lifetime AUD is low and delayed and racial differences in treatment utilization were not significant. These results call for further investigation focusing on reasons for low AUD treatment utilization, particularly among those with fewer barriers to care. In addition, longitudinal research investigating the temporal ordering of treatment-related factors is needed.

• S17-5

  DC-SIGNR Repeat Region Polymorphisms Are Associated with HCV Transmission in Injecting Drug Users

  Min Zhao 1 , Shunying Yu 1 , Huangliang Liu 2 , Jiang Du 1 , Chengmei Yuan 1 , Dongxiang Wang 1 , Bin Xie 1 , Yiru Fang 1

  1 Shanghai Mental Health Center , Shanghai , Chinese Mainland, 2 Department of Immiology, Miller School of Medicine, University of Miami , Miami , United States

  Background: Injecting drug use has been a risk factor associated with HCV infectious. DC-SIGNR (DC-SIGN related) are cell surface factors that can concentrate HCV and facilitate or augment HCV infectivity. The ability of DC-SIGNR to enhance HCV suggests that they may contribute to HCV parenteral transmission in Injecting drug users (IDUs). We hypothesize that DC-SIGNR repeat region polymorphisms influence HCV transmission in IDUs.

  Objectives: To investigate the role of DC-SIGNR repeat region variants in the susceptibility of HCV in IDUs.

  Methods: DC-SIGNR repeat region are genetyped by PCR in 91 HCV infected and 110 HCV negative IDUs in Shanghai , China .

  Results: 10 genotypes and 5 alleles in DC-SIGNR repeat region are found in our subjects. The 7 repeated allele (70.1%) was the most frenquentely allele, followed by 5, 9, 6, 4 repeared alleles (16.2%, 9.2%, 4%, 0.5%). The frequency of homozygous for DC-SIGNR 7 repeat allele was higher in HCV positive individuals than that in HCV negative individuals (52.5% vs 47.5%; χ 2=4.14, P=0.042). The frequency of DC-SIGNR 7 repeat allele was higher in HCV positive individuals than that in HCV negative individuals (75.3% vs 65.9%; χ 2=4.17, P=0.041).

  Conclusions: DC-SIGNR repeat region polymorphisms are associated with HCV transmission in IDUs. IDUs with DC-SIGNR genotyp 7/7 or 7 repeated allele are susceptible to HCV infection.
  

• S18 - Child & Adolescent Mental Disorders

  Chairs: Wenhong Cheng, Chinese Mainland
  Michel Botbol, France

• S18-1

  社会技能训练项目对儿童注意缺陷障碍的疗效评价 - An Evaluation of a Social Skills Training Program for Children with AGHD

  David Mellor 1 , Carly Ymer 1

  1 Deakin University , Psychology, Burwood , Australia

  目的 ： 评价一种社会技能训练项目对注意缺陷障碍儿童社会适应能力的影响情况。

  方法 ： 14 名 8-12 岁的男孩参与了这个训练项 目 ， 另有 14 名 处于等候序列的儿童作对照。在训练项目开始前和训练结束后 2 周，分 别对所有参加训练者进行社会行为和社会技能方面的评估。评估的变量包括社会技能的质量、社会交往频率、社会知识、社会沟通情况、社会目标的设定和社会经济状况。

  结果： 治 疗组在社会交往频率、负性社会沟通情况方面较对照组有显著提高，在其他方面则无显著差异。

  结论： 不考 虑本研究的局限和混杂的结果，社会技能训练为儿童注意缺陷障碍患者提供了一种可能改善其社会技能和社会经济状况的方法。

  Objective: To evaluate the impact of a social skills training program on the social adjustment of children with ADHD.

  Method: Fourteen boys aged between eight and 12 years participated in the program, and fourteen controls remained on a waiting list. All participants were assessed on various aspects of their social behaviour and social skills before the program began, and two weeks following completion. The variables assessed included quality of social skills, frequency of social interactions, social knowledge, social communication, social goal setting, and sociometric status.

  Results: While the members of the treatment group showed significant improvements in the frequency of social interactions, negative social communication, and social goal setting in comparison to the control group, they did not improve on the other measures more than the controls.

  Conculsions: Despite the limitations of this study, and the mixed findings, social skills training offers potential for improving the social skills and socio-metric status of children with ADHD.

• S18-2

  儿童精神病的治疗情况 - Actualisation of Approaches in Child Psychiatry

  Raymond B Traube 1

  1 SMSP/Sistemica/AESMEAF, Child Psychiatry, Neuchatel , Switzerland

  方法 ： 分析了 过去一年中的 750 例儿童和家庭治 疗病例。

  结果 ： 首先 关注的是儿童在学校或家中的行为。最受推崇的治疗策略是与其他健康、社会和教育学家合作 ， 在门诊或住院条件下来维持孩子个人的资源和家长的能力。采用综合的心理治疗方法对儿童和家庭进行治疗，必要时合并药物也可作为整体治疗体系的一部分，这就是所谓的 “ 针对家庭中儿童的治疗性咨询 ” 。有 时也可以联合使用团体治疗和焦点式短程个别心理治疗。

  结论： 总体来说，儿童精神病学家都受过良好的训练，具备针对患者和社区开展工作的相关技能和经验。我们强调综合治疗模式下儿童精神病学家在多个方面的一致性。作为一名与患者直接相关的心理治疗师，他 本身就是一 种治疗工具；作为精神病学家，他的任务是将神经生物学和药理学结合起来；作合社会精神病学家，他要和整个精神卫生工作体系协作。

  How do we adapt our practice, technique, styles and identity, considering the main needs for children which consult?

  Method: We analyse 750 child and family treatments in the past year.

  Result: The first concern appears the child behaviour, at home and at school. The most appreciated answers appears sustaining child's personal resources and parental competence, with others health, social and educational out and inpatient professionals in outpatient and residential centers. Child and family change with an integrative contextual-behavioural- symbolic psychotherapy, and, when necessary, medication as well network guidance. The main activity results the so-called therapeutic consultations with the child within his family. Some therapeutic interventions are consolidated by group therapy or focal brief individual psychotherapy.

  Conclusion: The child psychiatrist is a high trained practitioner with a relational and social expertise for the patient and the community in a global vision. We stress on the multiple identity of the child-psychiatrist in an integrative model. As psychotherapist in direct relation to the patient, it has to be used as a therapeutic tool itself; as psychiatrist, he integrates the neurobiology and de pharmacology; as social psychiatrist, he collaborates with the whole mental health network.

• S18-3

  湖南省中小学儿童心理障碍的流行病学 - The Prevalence of Mental Disorders among Children of Primary and Middle Schools in Hunan Province

  Xuerong Luo 1 , Zhen Wei 1 , Bingqing Guan 1 , Haishen Yei 1 , Xiuhong Yuan 1 , Zhijun Ning 2 , Jun Ding 1 , Fei Li 1

  1 The Mental Health Institute of Central South University , Changsha , Chinese Mainland, 2 The YongZhi Psychiatric Hospital , Yongzhi, Chinese Mainland

  目的 ： 评估湖南省中小学儿童心理障碍的流行病学。

  方法 ： 湖南省中小学 9495 名年 龄从 5 至 17 岁的儿童通过随机分层取样入组。运用双阶段流行病学设计， 9495 名儿童使用症状量表 测评，对父母、教师、儿童进行结构化访谈（情感障碍与精神分裂症儿童量表， K-SADS-PL ）以 获得信息。疑有心理问题的儿童和对照组均使用 K-SADS-PL 测评。使用 DSM-IV 作 为诊断标准。

  结果： 结果显示湖南省中小学儿童的总体发病率为 18.2% 。 发病率较 1990 年湖南省 发病率高（ 14.89% ）。六个不同区的 发病率没有统计学差异。农村（ 18.8% ）与城市（ 17.2% ） 发病率没有统计学差异。男性发病率（ 23.3% ） 较女性发病率（ 12.2% ）高。注意缺陷多 动障碍是最多见的诊断， 15 岁儿童的发病率最高，达 23.8% 。精神疾病 发病率为 40.5% 。 结论 ： 湖南省中小学儿童心理疾病的 发病率较 1990 年高。

  Objective: To estimate the prevalence of mental disorder children of primary and middle schools in Hunan province.

  Method: 9495 children aged 5-17 yr, were selected by stratified random sampling from primary and middle schools in Hunan province. Using a two-Phase epidemiological design, 9495 children were screened using symptom questionnaire, a structured interview （ Kiddy Schedule for affective diseases and schizophrenia, K-SADS-PL ） were carried out that information from parents, teachers, and children. Children with suspicious mental disorders and controls were interviewed by K-SADS-PL . DSM-IV criteria were used to reach diagnosis.

  Result: The results indicated overall prevalence rate of 18.2% among children of primary and middle schools in Hunan province. The prevalence rate was higher than that in 1990 date of Hunan province(14.89%). There were no significant differences among prevalence rates in six different districts. There was no significant differences between rural district(18.8%) and urban (17.2%). The prevalence rate of male (23.3%) was more than that of the female(12.2%). The attention deficit hyperactivity disorder was the most frequent diagnoses, Maximum prevalence of 23.8% occurred aged 15 year. The psychiatric morbidity was 40.5%.

  Conclusion: Prevalence rates of mental disorders among the children of primary and middle children in Hunan province were found to be higher than that in Hunan 1990 figures.

• S18-4

  美国青少年 Ecstasy （即 “ 摇头丸 ” ）使用与心理障碍的共病 - Comorbidity between Ecstasy Use and Mental Disorders among Adolescents in the United States

  Bin Fan 1 , Xinhua Liu 2 , Cordelia J Fuller 3 , Ping Wu 4

  1 New York State Psychiatric Institute, Child Psychiatry, New York, NY, United States, 2 Columbia University, Biostatistics, New York, NY, United States, 3 Columbia University, Psychiatry, New York, NY, United States, 4 Columbia University, Departments of Psychiatry and Epidemiology, New York, United States

  目的 ： 评价美国青少年中 Ecstasy （ 3,4- 亚甲二氧基甲基苯丙胺 , MDMA ， 即 “ 摇头丸 ” ） 使用与心理障碍的共病形式 ， 调查个体、家庭和社区水平的相关危险和预防因素。

  方法 ： 研究 对具有全国代表性的青少年亚样本 （ 年龄 12-17 ， N=19430 ） 团体进行分析。结果：在 19430 个青少年中， 2.57% （ N=494 人）使用 Ecstasy 。在内化性心理障碍中，惊恐障碍和重症抑郁与 Ecstasy 使用 显著正相关。破环型障碍（尤其是品行障碍）和尼古丁依赖、酒精滥用 / 依 赖一样，也与 Ecstasy 使用相 关。而社交恐惧与 Ecstasy 使用 负相关。研究发现外化性障碍比内化性障碍与 Ecstasy 使用的相 关性更强。年长的青少年（ 16-17 岁）、白种人、居住不稳定、不与亲身的父母亲住在一起、出生于美国、有机会与一些贩卖毒品的人接触、曾经涉及到社会犯罪公正系统中都增加了 Ecstasy 使用的 风险。父母亲不赞同孩子物质使用、青少年不赞同物质使用以及对物质使用存在的风险有所认识与 Ecstasy 使用 负相关。

  结论： 有心理障碍症状的青少年，尤其是那些外化性障碍，更有可能使用 Ecstasy 。 对 Ecstasy 使用危 险因素和预防因素的发现可以提供制定政策的依据，同样也提供给临床医生更多关于预防青少年 Ecstasy 使用的有用信息。教育儿童和父母 亲关于 Ecstasy 使用的不良后果的知 识 ， 可能帮助青少年 ， 防止他们开始 Ecstasy 的使用

  Objective: To assess patterns of comorbidity between Ecstasy (3,4-methylenedioxymethamphetamine, MDMA) use and mental disorders among adolescents in the United States and examine the associated risk and protective factors at the individual, family, and community levels.

  Methods: Analyses are based on the adolescent a subsample (ages 12-17, N=19430), of a nationally representative community survey.

  Results: Among 19430 adolescents, 2.57% (weighted N=494) had used Ecstasy. Among the internalizing disorders, Panic Disorder and Major Depressive Disorder are significantly positively associated with Ecstasy use. Disruptive Disorders (especially Conduct Disorder) are also associated with Ecstasy use, as are Nicotine Dependence and Alcohol Abuse/Dependence. Social phobia, on the other hand, is negatively associated with Ecstasy use. Stronger associations were found with the externalizing disorders than with the internalizing ones. Being an older adolescent (ages 16-17), being white , residential instability, not living with both biological parents, being US-born, having been approached by someone selling drugs, and criminal justice system involvement increase the risk for Ecstasy use. Parental disapproval of child substance use, and adolescents' disapproval and perception of high risks from substance use are negatively related to ecstasy use.

  Conclusion: Adolescents with symptoms of mental disorders - especially externalizing disorders – may be more likely to use Ecstasy. These findings on the risk and protective factors for Ecstasy use may provide policy makers and clinicians with useful information for prevention of Ecstasy use in adolescents. Educating children and parents about the harmful effects of Ecstasy use may help to prevent Ecstasy use initiation by adolescents.

• S18-5

  孤独症患者的弟弟妹妹的发育 ----4 个月到 7 岁 - The Development of Younger Siblings of Children with Autism - From 4 Months to 7 Years

  Nurit Yirmiya 1 , Ifat Gamliel 1

  1 The Hebrew Univeristy of Jerusalem , Psychology, Jerusalem , Israel

  孤独症是一 种复杂的发育障碍 ， 症状包括文字的和非文字交流障碍 ， 社交 - 情 绪功能障碍 ， 还有兴趣和活动显著受限。对孤独症患者亲属的研究表明遗传因素在病因学中占重要地位。研究者进行了前瞻性纵向研究，调查孤独症患者的弟弟妹妹（ SIBS-A ）的早期 发育特点 , 特 别是识别那些将来要被诊断孤独谱系障碍的（ ASD ）或那些将来要出 现与广谱的孤独基因型（ BAP ）相 关的轻 度困 难。目前在耶路撒冷 Hebrew 大学 进行的 SIBS-A 纵向随访研究包括包括现在还在随访的最老的兄弟姐妹。研究分两组，一组是 SIBS-A ， 40 人，另一 组是发育正常儿童的兄弟姐妹（ SIBS-TD ）， 60 人，两 组相匹配，从婴儿期随访至儿童早期。在 4 ， 14 ， 24 ， 36 和 54 月， 7 岁时进行随访评估。在 14-36 月 时，语言功能延迟的情况 SIBS-A 组比 SIBS-TD 更多。在 4 岁半到 7 岁时进行重测。结果表明绝大多数的 SIBS-A 功能良好。 这些兄弟姐妹的发育轨迹还有这些人群的早期识别和干预将来进行讨论。

  Autism is a complex developmental disorder involving difficulties in verbal and nonverbal communication and social-emotional functioning, as well as markedly restricted interests and activities. Strong evidence from research conducted with relatives of children with autism supports the role of genetic factors in its etiology. Thus, researchers have recently initiated prospective longitudinal studies to investigate the early developmental profiles of young siblings of children with autism (SIBS-A), especially to identify those who will later receive a diagnosis of an autism spectrum disorder (ASD) or who will develop the more mild difficulties associated with the broad autism phenotype (BAP). The longitudinal study of SIBS-A currently being carried out at the Hebrew University of Jerusalem includes the oldest siblings studied to date. Two groups, the SIBS-A (n = 40) and a group of siblings of children with typical development (SIBS-TD, n = 60), were matched and followed prospectively from infancy to early childhood. These children were evaluated at the ages of 4, 14, 24, 36, and 54 months and at 7 years. Significantly more SIBS-A compared to SIBS-TD were identified with language delays at the ages of 14 – 36 months. These siblings were retested at ages four and a half and seven years. Findings indicated that most SIBS-A were well-functioning. The developmental trajectories of the siblings will be presented and discussed in relation to early identification and prevention in this high-risk sample.
  

• S19 - 亚太地区的社区精神卫生服务 - Community Mental Health Services in the Asia-Pacific

  Chairs: Helen Herrman, Australia
  Bin Xie, Chinese Mainland

  最近 ， 世界 卫生组织 （ WHO ） 已 经告知各国急需要提供社区卫生服务网络 ， 并再次强调需要在社区给精神疾病患者提供适当的医疗。针对精神疾病患者，社区心理社会康复机构提供更好的医疗，确保更早期的干预，帮助保护患者的尊严，并减少对精神卫生治疗的病耻感。在加强精神卫生服务体系的国际指南的指导下，亚太地区的很多国家已经制定了包括提供现代社区精神卫生服务的卫生政策和指南。然而，社区 精神 卫生发展的不同阶段需要不同的具体执行措施，以使处于不同改革阶段的各国在不同的切入点采取适当的变化。在这次研讨会上，亚太的几个国家将报告目前社区精神卫生服务的发展及主要教训，和未来社区精神卫生服务发展面临的挑战。

  Recently, the World Health Organization (WHO) has signalled the urgent need for countries to provide a network of community mental health services and reinforced the need to provide adequate care for people with mental illness in the community. Community psychosocial rehabilitation facilities provide better care, ensure earlier intervention, help preserve the dignity of mental illness sufferers, and limit the stigma of mental health treatment. Guided by international guidelines to advance mental health service system, many countries in the Asia-Pacific have established health policy and guidelines including the provision of contemporary community mental health care. However, it is recognised that implementation need to be specific to different stages of community mental health development to allow countries at various phases of reform to adopt appropriate changes at different entry points. In this symposium several countries in the Asia-pacific will present the current community mental health service development, and various challenges and key lessons for the future community mental health development in the region will be discussed.

• S19-1

  澳大利亚社区心理卫生发展的挑战与方向 - Challenges and Directions of Community Mental Health Development in Australia

  Chee Ng

  St Vincent's Mental Health Service, Department of Psychiatry, University of Melbourne, Fitzroy, Victoria, Australia

  自 1992 年起 ， 国 际心理健康策略在澳大利亚开始实行 ， 它加速和调整 了心理疾病患者需要中至 长程治疗的去制度化进程。策略规定州政府主要通过立法指导心理卫生的改革和发展特殊的计划以支持这些改革，强调社区为基础的健康照料和对身患心理疾病者权利的尊重。连续的政府均达成一致，继续每五年一轮的心理卫生改革，目前正处于第三轮改革中 2003-2008 。尽管医 疗保健总费用在最近十年中迅速增长，总心理卫生支出仍然维持稳定，不到循环资金的 7% ，在很多州保 证公平获得适当的保健服务仍然是一个挑战。由于对满意的、可获得的服务质量的要求和高期待的增长，心理卫生服务系统面临进一步挑战。其它挑战还包括提供可 靠的、高 标准的心理卫生服务，专家参与和初级卫生保健服务，预防过度转诊，改变鄙视态度和歧视做法。由于经费、服务混合和质量与安全性程序执行的不同，各个州存在多种多样的服务形式。维多利亚已经提供了全面的临床与非临床支持，创新服务的发展，综合社区和精神康复。尽管有创新的主动性和成功的项目，目前仍然存在一种对更广泛的、在国家水平的社区保健系统的需要，以保护心理疾病患者的基本权利，促进高质量的生活。

  Initiated in 1992, The National Mental Health Strategy was implemented in Australia which accelerated and finetuned the process of de-institutionalisation for patients with mental disorders requiring medium and long term care. The Strategy provided State governments broad directions of mental health reform and developed specific plans to support these reforms through developing legislation which emphasises community-based care and the respect of rights of those suffering from mental illness. Consecutive governments have collectively agreed to continue the commitment to mental health reform for each five-year mental health plan, currently in its third cycle 2003-2008. Although total health expenditure has increased rapidly over the last decade, total mental health spending has remained static at less than 7% of recurrent funding and ensuring equity in accessing appropriate care remain a challenge for many States. Mental health service systems face further challenges associated with increased demand and high expectations of readily accessible quality services. Other challenges included providing reliable, high standard mental health care, integrating specialist and primary care services, preventing trans-institutionalisation, and changing stigmatising attitudes and discriminatory practices. Wide variations between the States exist in terms of funding, service mix and implementation of quality and safety procedures. Victoria has provided comprehensive clinical and non-clinical supports, innovative service developments, and integrated community and psychiatric rehabilitation. Although there are innovative initiatives and successful programs, there is still a need for a more comprehensive system of community care supported at a national level that can protect of the basic rights for people with mental illness and promote high quality of life.

• S19-2

  中国社区精神卫生服务的发展历史与目前的国家改革项目 - History of Community Mental Health Services and Current National Reform Program in China

  Jin Liu 1 , Hong Ma 1 , Xin Yu 1 , Mingyuan Zhang 2 , Yanling He 2 , Bin Xie 2 , Yifeng Xu 2 , Lianyuan Cao 3 , Wei Hao 4 , Ming Li 5

  1 National Center for Mental Health, Institute of Mental Health, Beijing University, Beijing, Chinese Mainland, 2 Shanghai Mental Health Center, Shanghai, Chinese Mainland, 3 Beijing Huilongguan Hospital, Beijing, Chinese Mainland, 4 Mental Health Institute, Second Xiang-Ya Hospital, Central South University, Xiang-Ya, Chinese Mainland, 5 Suzhou Guangji Hospital, Suzhou, Chinese Mainland

  中国社区精神 卫生工作起步于 1958 年全国第一次精神 卫生工作会议。在北京、上海、湖南、四川和南京建立防治机构 ， 重点防治重性精神疾病。 70 年代建立了由 卫生、民政和公安联合的精神疾病防治领导小组，开始建立精神病三级防治网。全国比较成功的有北京、上海、山东烟台、大庆模式。 “ 文革 ” 期 间社区精神卫生几乎停止。文革后，几乎只有上海和大庆保留了较为完整的防治网。

  2001 年，第三次全国精神 卫生工作会的召开预示着中国精神卫生工作的加速。 2003 年 3 月， 卫生部组织考察了英国和德国的社区精神卫生。 10 月，在北京召 开了中澳老年 社区精神 卫生会议。在 SARS 结束后，精神卫生开始积极争取进入公共卫生行列。

  2004 年 4 月，中国疾病 预防控制中心和北京大学组织考察了墨尔本社区精神卫生，决定借鉴维多利亚的模式开展中国的新型社区精神卫生服务。

  2004 年 9 月 30 日，精神 卫生项目作为唯一的非传染病项目正式进入国家公共卫生项目。 2004 年 12 月， 获得中央财政专款项目经费 686 万元培 训经费。项目由 CDC 精神 卫生中心具体负责，成立了国家级工作组和澳洲顾问组（主要由墨尔本大学为主的专家担任）。项目目的是探讨建立适合各地情况的医院和社区一体化的重性精神疾 病 连续监管治疗模式，建立重性精神疾病社区防治和康复管理工作机制和网络，最终目的为提供以患者为中心的服务。 2005 全国 30 个省共建示范区 60 个，覆盖人口近 4300 万人。全国分 级培训精神科医生、社区医生、个案管理人员、街道及派出所人员、病人家属 3 万多人次，建立了示范区精神疾病信息管理系 统。 2006 年 获得项目经费 1000 万。各示范区均建立了重性精神疾病 监管治疗网络，各地的重性精神疾病综合防治队伍基本建成。主要服务内容是登记重性精神疾病患者，定期随访有肇事肇祸倾向的患者，为贫困的肇事肇祸患者提供免费药物和住院，免费应急处置肇事肇祸行为。 2007 年 获项目经费 1500 万元 ， 继续在 60 个示范区深入 实施。已联合墨尔本大学、香港中文大学对示范区进行系统的个案管理培训。

  Community mental health in China didn't begin until the first National Mental Health Working Conference in 1958. Prevention and treatment facilities were then built in Beijing , Shanghai , Hunan , Sichuan and Nanjing for psychoses. In 1970s, Mental Disorder Prevention and Treatment Leading Group was organized jointly by Ministries of Health, Civil Affairs and Public Security, and three-level prevention and treatment network for psychoses was formed, with successful examples models of Beijing, Shanghai, Yantai Shandong and Daqing. During Cultural Revolution, community mental health was almost stopped. Only Shanghai and Daqing models survived after Cultural Revolution.

  In 2001, the third National Mental Health Working Conference marked the acceleration of Chinese mental health work. In March 2003, Ministry of Health organized visits of community mental health in UK and Germany . In October 2003, China-Australia Community Geriatric Mental Health Conference was held in Beijing . After SARS, mental health was prepared actively to be included into public health system.

  In April 2004, China CDC and Peking University organized investigation on community mental health in Melbourne , and then decided to use Victorian Model for reference of community-based mental health services in China .

  In Sept. 2004, Mental Health Program was included into national public health programs. In Dec. 2004, Ministry of Finance authorized 6.86 million as training fund. National Center for Mental Health, China-CDC took charge of this program and built national working group as well as Australian consultant group. This program aimed at building hospital and community integrated model for continuing monitoring and management of psychoses, building community work mechanisms and networks for prevention, treatment and rehabilitation of psychoses, and finally providing patient-centered services. In 2005, a total of 60 demonstration areas were built in 30 provinces in China , covering a population of 43 millions. Over 30 thousand people trained, among whom were psychiatrists, community physicians, case managers, community workers, public security staff and family members of patients. National computerized case database was also built. In 2006, this program got the second fund of 10 million RMB. Monitoring and intervention network for psychoses, as well as local comprehensive prevention and treatment team was built in each demonstration area. Main services were to register patients, follow up patients with violence tendency periodically, provide free medication and hospitalization to poor patients with violence tendency, and provided free crisis management to violent behaviours. The budget of 2007 is 15 million RMB, which continuously supports further work in 60 areas. A systematic training on case management has been provided jointly by The University of Melbourne and Chinese University of Hong Kong .

• S19-3

  泰国社区心理卫生服务 - Community Mental Health Services in Thailand

  Apichai Mongkol 1 , Pichet Udomratn 2

  1 Ministry of Public Health, Department of Mental Health, Nonthaburi, Thailand, 2 Faculty of Medicine, Prince of Songkla University, Department of Psychiatry, Hat Yai, Songkhla, Thailand

  泰国社区心理 卫生自 1964 年 开始发展起来。当时 ， 只有一个精神科医师领导的机动的心理卫生团队 ， 他们走进社区 提供心理 卫生服务。在那之后，很多心理卫生服务就发展起来，例如授权公立 / 地区医院、社区医院和 卫生中心的公共卫生人员提供心理健康干预。训练乡村卫生志愿者从事筛选精神病、癫痫、智力缺损的患者，提供初级心理卫生保健，转介他们去第二级获第三级保健处就诊。此外，心理卫生部门在每个省建立 15 个地区心理 卫生中心，以协同其他的公共卫生机构进行心理卫生促进、预防、治疗和康复。 泰国社区心理 卫生保健与其他发达国家不同，是由于人力资源和预算的限制，这导致心理卫生 / 精神科机构很 难扩展到所有乡村。结果，心理卫生服务与公共卫生服务系统结 合并得到 发展，授权所有公共卫生机构提供躯体卫生服务的同时提供心理卫生服务，或者被称之为 “ 整体 ” 服 务。

  我 们社区心理卫生系统成功的关键因素是社区参与、迎合社区需要的干预措施和解决社区每一个问题的团体网络，特别是那些有志于提高社区人民生活质量的强势社区领导者的团体。

  Community mental health in Thailand has been developing since the year 1964. At that time, there was only a mobile mental health team with a psychiatrist as the leader who went out into the community to provide a mental health service. After that, many mental health service models were developed such as empowerment of public health personnel in the general/regional hospitals, community hospitals, and health centers on mental health intervention. The village health volunteers were trained to screen those patients with psychosis, epilepsy and mental retardation as well as provide primary mental health care to the patients and refer them to the secondary and tertiary care levels. Furthermore, the Department of Mental Health established 15 “Regional Mental Health Centers' to coordinate mental health promotion, prevention, treatment, and rehabilitation with other public health facilities in every province.

  Community mental health in Thailand is different from other developed countries due to the limited manpower and budget resources that make expansion of mental health/psychiatric facilities difficult to cover all the country. As a result, a strategy of mental health service integrated with the public health service system has been developed, which empowers all public health care facilities to provide mental health care together with physical health care, or the so-called “holistic” care.

  The key success factors of our community mental health system are community participation, intervention that match the needs of the community, and group networks to solve every problem in the community especially the groups with strong community leaders who have the idea to develop the quality of life of the people in that community.
  

• S19-4

  韩国发展社区心理卫生服务的现状和前景 - Current Situation and Next Steps to Developing Community Mental Health Services of Korea

  Tae-Yeon Hwang 1

  1 WHO Collaborating Center for Psychosocial Rehabilitation and Community Mental Health, Yongin Mental Hospital, Yongin City, Korea, Republic of

  韩国心理卫生服务有几点值得一提。所有机构都可以获得基本的精神科药物 ， 即使某些非典型的药物被美国医疗补助制度所限制。韩国有一套心理卫生政策、计划和法律，在常规基础上不断更新。每年所有的心理卫生资料都会被收集起来，使得收集和评估心理卫生领域的全国性统计成为可能。同时韩国拥有很多心理卫生领域的专家，并且这些专家都接受了充分的训练。

  然而， 韩国目前还没能在每个地区都提供公共心理卫生服务，而且精神病医院的平均住院时间仍然过长。为了减少病人的住院时间，需要更多的过渡居住设施。然而，很多韩国民 众的社会歧 视导致精神疾病患者很难返回社区。

  尽管 韩国有足够心理卫生领域的专家，然而初级心理卫生工作者没有接受到适当的心理卫生教育，导致心理卫生系统与主体卫生保健系统分离。这种心理卫生服务与主流卫生保健系统的分离可能来源于目前对精神疾病的社会歧视。

  韩国正在所有边缘区域发展全面的心理卫生服务系统，政府更多的投资在社区为基础的、公共心理卫生系统，而不非机构为基础的系统。然而，目前，社区为基础的心理卫生保健系统还不够，政府计划再发展另一个 10 年的心理 卫生计划，直到 2017 年。

  韩国下一步发展心理卫生服务将是加强和 促 进社区为基础的公共心理卫生服务，和每个边缘地区和省的监测系统。初级心理卫生系统、教育系统和司法系统地联接也将通过训练和心理卫生的信息发布得到增强。为了在有限的资源下改变心理卫生系统，政府将发展和建立一套高质量高效率的监测和信息系统。最后，将有一个长程的研究项目考察政府心理卫生服务的效力。这样，韩国政府就能使这些让心理疾病患者得到益处的服务得到确认和最佳化。

  Korea 's mental health services have several strengths worth mentioning. Essential psychotropic medicines are available in all facilities, even if some atypical medicines are limited to Medicaid. In Korean primary health care system family physicians do not see mentally ill patients (“few mental health services are integrated in the country's primary health care system” in the Executive Summary) However, Korean government is recently developing its public community mental health system in the public health system which makes close linkage between mental health and health sector.

  Even though there are no mental health professionals in schools, community mental health centers recently began to provide outreach mental health services and consultation service to schools.

  Korea has a mental health policy, plan and legislation, which are updated on a regular basis. Comprehensive mental health data has been gathered every year, which makes it possible to collect and evaluate national statistics in the area of mental health. Also Korea has a lot of mental health professionals and these professionals receive adequate training. But, Korea does not have a public community mental health services in every catchment area yet, and the average length of stay in mental hospitals is still too long. In order to reduce the length of stay, more residential facilities are needed. However, social stigma against by many of the people in Korea makes it difficult to reintegrate people with mental disorders into the community Even though there are sufficient mental health professionals in Korea, primary health care workers do not receive an adequate mental health education, which results in the separation of the mental health system from the main health care system. This separation in provisions of mental health services from the mainstream health care system might contribute to the current social stigma against mental illness. Korea is quickly developing a comprehensive mental health service system in each catchment area and the government has invested in a community-based, public mental health system rather than in an institution-based system. However, at this time, the community-based system of mental health care is not sufficient that the government plans to develop another 10-year mental health plan, up to the year 2017. The next steps in further developing the mental health services in Korea will be to strengthen and improve community-based, public mental health services, as well as the monitoring system in each catchment area and province. Also, linkages with the primary health care system, the education system, and the judicial system should be strengthened through trainings and distribution of information about mental health. In order to transforming a mental health system with limited resources, the government should develop and establish a monitoring and information system of good quality and efficiency. Finally, there should be a program of long-term, ongoing research that examines the effectiveness of the country's mental health services. This way, Korea can identify and maximize those services that are producing improvements and benefits to people with mental disorders.

• S20 - Globalization and Suicide in ASEAN: Sharing Good Practice for Suicide Prevention

  Chairs: Pichet Udomratn , Thailand
  Jianlin Ji, Chinese Mainland

  According to the WHO, there have been more than five million suicide deaths worldwide in this century. Large increases in suicide rates have been seen in the last decade not only in the West but also the East, especially in those Asian countries which were affected by the 1997 economic crisis. This crisis started in Thailand before spreading to Indonesia and other countries. The rising suicide rates have been of growing concern for the communities and governments in the ASEAN countries. Many suicide prevention strategies have been implemented in Thailand , Malaysia , Singapore and Philippines . In this symposium, participants will learn about various interventions including the early detection and treatment of mental disorders, increases in access to mental health services, increases in mental health literacy and public education, reduction in access to means, media strategies, and crisis support service from a multi-disciplinary team.

  Results of national suicide prevention programmes of each country will be discussed. However, it is important to emphasize that suicide prevention activities should be carefully targeted, adapted appropriately to local needs and properly evaluated to improve the evidence base for good practice. Suicide prevention remains a challenging and complex task, which is likely to benefit from a consistent, sustained and collaborative approach across all levels of government and community.

• S20-1

  Suicide and Suicide Prevention in Thailand

  Apichai Mongkol 1 , Pichet Udomratn 2

  1 Ministry of Public Health, Department of Mental Health, Nonthaburi, Thailand, 2 The Psychiatric Association of Thailand, Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand

  The suicide rate in Thailand has been a major public health concern in the country for some time as it dramatically increased from 4 per 100,000 in 1994 to 8.1 per 100,000 in 1998 and peaking at 8.6 per 100,000 in 1999 after the Asian economic crisis which had initially started in Thailand in 1997. There were so many suicide cases reported in the newspapers and on television that the Ministry of Public Health (MOPH) made suicide reduction a priority requiring urgent activation and suicide prevention programme was implemented by the Department of Mental Health. Many activities were carried out such as a public education on “suicide and mental disorders” especially major depression, training GPs to increase detection and give appropriate treatment to those who suffer from mental disorders, training village health volunteers (VHV) to use simple screening test to detect the high risk group of suicide patients so that they can refer these patients for early treatment, and monitoring the suicide rate closely every three months at all levels.

  Since then, the suicide rate dropped from 8.4 per 100,000 in 2000 to 7.1 per 100,000 in 2003 and lastly to 5.7 per 100,000 in 2006.

  However, some obstacles and challenges have been found. In the northern region of Thailand especially in Lamphun, Chiangmai, Chiangrai, and Phayao provinces the suicide rate although it had decreased from 2000 to 2006, still had a high overall rate. Further deep investigation should be explored and assessed particularly male population , so that more specific interventions can be implemented.

• S20-2

  Suicide in Singapore: The National Response

  Hong Choon Chua 1

  1 Department of General Psychiatry ,Institute of Mental Health and Woodbridge Hospital , Singapore , Singapore

  According to the World Health Organization, there have been more than 5 million suicide deaths worldwide in this century alone.In Singapore , about one person will commit suicide daily. Suicide accounts for about 2.4% of all deaths in Singapore . This rate is higher than deaths caused by traffic accidents.However,this rate is lower than other Asian countries.

  In Singapore , there are slightly more adolescent females between the ages of 15 to 19 years who die from suicide. Suicide is among the top three causes of death among young people aged 15 to 35 years. In the past, suicide among the elderly accounted for more than 50% of total suicides.With improvement in healthcare and with the development of community services for older Singaporeans, this rate has come down.

  Local studies have also shown that teens in Singapore commit suicide due to relationship or family problems,or study stress. Adult suicides are mainly related to financial and marital problems while suicides in the elderly are more related to health problems and the perception of being a burden to the family. Suicide can be prevented but there is a great need for coordinated and comprehensive suicide prevention initiatives.

  In Singapore , various organizations have programmes in place to take care of people at risk and their families. At the Institute of Mental Health , our mental health professionals make risk assessments and provide counseling to at-risk persons and their families where necessary. IMH's community psychiatry programme provides support to distressed patients who are living in the community.With this support from a multi-disciplinary team, patients have an avenue to turn to for assistance.

  The Institute of Mental Health also collaborates with the Health Promotion Board through the Mind Your Mind programme to provide training to general practitioners on how to identify and manage suicidal patients.Voluntary welfare organizations (VWOs) such as the SOS, CareCorner counseling centers, Family Service Centers and other Ministries all run help lines and counseling services for persons in distress.

• S20-3

  Managing Suicidal Patients: A Malaysian Experience

  Hussain Habil 1

  1 Department of Psychological Medicine, University Malaya, Kuala Lumpur , Malaysia

  Any patient who wish to end their life must be considered to be undergoing psychiatric emergency and deserve special attention. It is no more true that suicide is a western disease. Base on recent study it showed that death due to suicide is gaining momentum in many Asian countries including Malaysia . Even though for quite sometime our number of parasuicide and suicide cases has increased steadily in Malaysia , an awareness in giving right management to them is still minimal. The topic on management of suicidal patients has on many occasions, been confined to certain services where people have an interest in a related subject. Unfortunately their numbers are still very small . Even if one took a look at health care setting throught-out Malaysia , awareness pertaining to suicide management was still not recocgnised at the same level as other health related disorders. Indeed many doctors still feel uncomfortable to manage their patients who openly express suicidal ideation. They are either ignore for good the risk of these patients to commit suicide or some of them might ridiculing patients and fail to offer appropriate help.

  In acknowledging the above problems, this article is meant to highlight program whereby doctors and supporting staff could become more aware of suicidal patients and the proper way of handling these patients. The main emphasis is to help reduce suicide cases in the hospital and also to prevent reattempting suicide among parasuicide cases.

• S20-4

  Suicide in the Philippines

  Dinah Pacquing-Nadera 1

  1 Philippines Psychiatric Association, Manila , Philippines

  The Philippines is cited to have the lowest male (2.5) and female suicide rates (1.7 per 100,000) in the Western Pacific Region. Many attribute this to the Filipinos' grounding in the Catholic faith, natural resiliency, and gregariousness as a people and as a nation. “Connectedness” as being preventive for suicide is a concept that needs no proof in the Philippines . Filipinos are known for close family ties, extended family structure, and a nation of texters, the Philippines being called the texting (SMS) capital of the world.

  Amidst this reportedly low rate, there is a general perception of an increasing trend in suicide through print and broadcast coverage. With a heightening awareness of suicide, one senses an urgency of a public health problem. Alas, the interpretation of a “perceived increase” needs to be based on “actual data”.

  This paper presents suicide data gathered from different studies. The purpose is to take an objective look at suicide reporting in different settings and draw implications to what suicide trends in the Philippines is. A second look at available rates and ratios, a peek into the actual reporting process of suicide in a medico-legal setting, an analysis of media reporting, and an examination of the process through which suicide figures seem to get lost in hospital statistics, are presented in this paper. This will hopefully shed light to a practical approach to generating the much needed reliable data for a national suicide rate. In addition, this will enable more appropriate interpretation of current suicide data. In the end, availability of factual data to cite the real magnitude of the problem may entice the necessary support needed for a national suicide prevention plan.
  

• S21 - 非典型抗精神病 药物的疗效、代谢副反应和将来的新药 - Atypical Antipsychotics: Efficacy, Metabolic Side Effects and New Drugs on Horizon

  Chairs: Hua Jin , United States
  Liang Shu, Chinese Mainland

  当今社会所有的医学疾病中精神障碍是属于最常 见和最易致残的。对于精神病性障碍潜在病生机制的不断了解 ， 促进了有特定药理学 特性的 药物发展。这个专题讨论会将根据最新的荟萃分析来总结不同的非典型抗精神病药疗效的最新发现。这些非典型抗精神病药独特的受体结合谱和药代动力学特点导致了易于产生代谢和其他副反应如体重增加、糖尿病、高血脂、高泌乳素血症和心血管风险。这些副反应可能不只引起对抗精神病药物治疗的不依从性，还会导致严重的医疗后果。大家将讨论为了处理某一特定障碍来选择一种非典型抗精神病药的方法、监测代谢和其他长期副反应的方法以及探讨非典型抗精神病药相关代谢副反应的潜在机制的方法。这个专题会还将综述抗精神病药 Bifeprunox, 临床试验的结果，在 FDA 的 综述中 Bifeprunox 是一 种部分多巴胺激动剂

  Psychiatric disorders are among the most common and disabling of all the medical disorders found in society today. An increasing appreciation of the pathophysiologic mechanisms underlying psychotic disorders has fueled the development of agents with identifiable pharmacologic properties. This symposium will summarize the newest findings of efficacy of different atypical antipsychotics based on updated meta analysis. The distinct receptor-binding profiles and pharmacodynamic properties of these atypical antipsychotics result in unique propensities for causing metabolic and other side effects such as weight gain, diabetes, hyperlipidemia, hyperprolactinemia; and cerebravascular risk. These adverse effects may not only lead to nonadherence to antipsychotic therapy but also cause serious medical consequences. The faculty will discuss ways to choose an atypical antipsychotics for management of a particular disorders, to monitor metabolic and other long-term side effects, and to address potential mechanisms of those atypical antipsychotics related metabolic side effects. This symposium will also review the clinical trial results of Bifeprunox, which is a partial dopamine agonist antipsychotic agent under FDA review.

• S21-1

  非典型抗精神病药：基于新近研究证据的功效和效能比较 - Atypical Antipsychotics: Comparison of Efficacy and Effectiveness Based on New Study Evidence

  John M Davis 1

  1 University of Illinois , Department of Psychiatry, Chicago , Illinois , United States

  荟萃分析结合了来自双盲、随机对照研究的证据。 根据最大差 值比较 ， 氯氮平 比第一代抗精神病 药更有效 ， 且显著优于安慰剂。 氨磺必利、奥氮平和利培 酮比第一代抗精神病药更有效 ， 而喹硫平、阿立哌唑、齐拉西酮与第一代抗精神病药的疗效相似。 氯氮平、奥氮平、氨磺必利和利培酮对于阴性症状和情感症状比第一代抗精神病药更有效。 第一代和第二代抗精神病 药在不良反应上存在差异。 与第一代抗精神病 药相比 ， 利培酮和氨磺必利引起更多的催乳素升高 ， 而许多第二代抗精神病药即使引起催乳素升高 ， 程度也很低。 奥氮平和 氯氮平引起的体重增加幅度更大 ， 而喹硫平和利培酮引起的体重增加与第一代抗精神病药类似。 在 EPS （ 锥体 外系不良反 应 ） 上 ， 同样存在差异。 第二代抗精神病 药中不同的药物其疗效和不良反应的存在差异 ， 因此 ， 作者认为 ， “ 第二代 ” 不是相同性 质的一类 ， 将这些药物简单笼统地分为一类 ， 会模糊其真正的差别。 不是所有的患者都会有所有的不良反 应。因此对于具体的一个患者 ， 治疗应该个体化 ， 以期获得最大利益并尽可能减少明显的不良反应。 在服用 这些药物的精神分裂症患者中 ， 作者比较了药物的效能 （ 剂量 ） 与其阻断 D2/D3 受体作用的 关系。结果发现，抗精神病药临床作用与其对颞叶皮质 D2/D3 受体的阻断作用高度相 关，而与纹状体的阻断低度相关。 相反， EPS 与 纹状体 D2/D3 受体的阻断相 关。 5HT2 受体与两者作用无 关。

  The evidence from double-blind randomized-controlled studies was combined in a meta-analysis. Clozapine is more effective than first-generation antipsychotics by the largest margin of difference of any antipsychotic and clearly superior to placebo. Amisulpride, olanzapine and risperidone are more efficacious than first-generation antipsychotics whereas quetiapine, aripiprazole, ziprasidone have about the same degree of efficacy as first-generation antipsychotics. Clozapine, olanzapine, amisulpride, and risperidone are differentially more effective than first-generation drugs on negative and affective symptoms. There are differences in side effect profiles between the different first- and second-generation antipsychotics. Risperidone and amisulpride cause more prolactin elevation than first-generation drugs and many second-generation drugs cause minimal if any prolactin elevation. Olanzapine and clozapine cause greater degrees of weight gain but some weight gain occurs with quetiapine and risperidone as well. There are EPS differences as well. As efficacy differences and side effect differences occur between different members of second-generation antipsychotics, the author suggest that this class is not a homogeneous class and the simplification in lumping these drugs as a class obscures real differences. Not all patients have every side effect. Treatment should be individualized for each patient to get the maximal benefit with the minimal significant side effects. The authors correlated the potency (dose) of the drugs to blockade of D2/D3 receptors as measured in schizophrenic patients taking these drugs. There was an excellent correlation of clinical antipsychotic activity to temporal cortical D2/D3 receptors, and a low correlation of striatal blockade. In contrast EPS was correlated to striatal D2/D3 blockade. 5HT2 was not correlated to either action.

• S21-2

  非典型抗精神病药的代谢不良反应、可能的作用机制、监测与干预 - Metabolic Side Effects of Atypical Antipsychotics, Potential Mechanisms, Monitoring and Intervention

  Hua Jin 1 , Sundar Mudaliar 2 , Dilip V. Jeste 2

  1 University of California, Department of Psychiatry, San Diego, United States, 2 University of California, San Diego Healthcare System, San Diego, United States

  自从非典型抗精神病 药 （ AAPs ） 出 现后 ， 这些药物被越来越多地 用于治 疗患有各种精神障碍和严重行为障碍的患者。 在 过去的十年中 ， 临床医生和研究人员已经逐渐发现 ， 使用 AAPs 可能与代 谢不良反应相关 ， 包括体重增加、高脂血症和葡萄糖耐受不良。 最近的一些研究提示 ， 患有 严重精神疾病的患者死亡年龄最多比普通人群早 30 年 ， 其中心 脏病是这些患者的主要死亡原因。 体重增加是 这些患者心脏病和早期死亡的一个主要危险因子。 本 讲演将回顾不同 AAPs 治 疗某一特定疾病、其并发症、肥胖风险、代谢不良反应后果、以及可能与这些代谢不良反应相关的作用机制。 此外 ， 也将 讨论如何监测与 AAP 相 关的代谢和其他长期不良反应 ， 以及可能的预防措施。

  Since the introduction of atypical antipsychotics (AAPs), these medications have been increasingly used for the management of patients with a variety of psychotic disorders and severe behavioral disturbances. In the past decade there has been a growing concern among clinicians and researchers that use of AAPs may be related to adverse metabolic effects, including weight gain, hyperlipidemia and glucose intolerance. Recent studies suggested that people with severe mental illness die up to 3 decades earlier than the general population and heart disease is a leading cause of death in these patients. One of the major risk factors for heart disease and early death is weight gain in these patients. This presentation reviews different AAPs for management of a particular disorder, their complications and risk of obesity and metabolic consequences as well as potential mechanisms related to these metabolic side effects. In addition, how to monitor AAP related metabolic and other long-term side effects and possible preventive interventions will also be discussed.

• S21-3

  即将问世的新型抗精神病药：多巴胺受体部分激动剂 - New Antipsychotic Medications on the Horizon: Dopamine Partial Agonists

  Mark Hyman Rapaport 1

  1 Cedars-Sinai Medical Center, UCLA, Department of Psychiatry, Los Angeles , CA , United States

  目前已有一 种多巴胺受体部分激动剂 —— 阿立 哌唑 ， 获得美国食品与药品管理局 （ FDA ） 和全球多个管理当局批准用于治 疗精神分裂症。 无 论对于精神分裂症 ， 还是急性双相障碍 ， 阿立哌唑用于治疗急性精神病 ， 已为大家广泛接受。 第二个多巴胺受体部分激 动剂拥有明显不同的离体药效学和药代动力学特性 ， 目前正在接受美国 FDA 和其他一些管理当局的 审查。 这种化合物 ——Bifeprunox ， 与多巴胺 D2 受体有高 亲和力 ， 但对 5HT2 受体系 统无亲和力。 Bifeprunox 与 5HT1 受体系 统有亲和力。 本 讲演中 ， 我们将复习多巴胺受体部分激动剂与许多传统和非典型抗精神病药的差别。 我 们也将展示一些最近的来自 Bifeprunox 两个 剂量组 （ 30 毫克 / 日和 40 毫克 / 日 ） 与安慰 剂和利培酮 （ 6 毫克 / 日 ） 对照的急性临床试验的数据。 在 讲演的最后 ， 与会者将了解多巴胺受体部分激动剂在治疗急性精神障碍患者时 ， 可能具有的价值。

  At this time there is one dopamine partial agonist, Aripiprazole, that has been approved for the treatment of schizophrenia by the US Food & Drug Administration and a variety of worldwide agencies. It is a well-established medication for the treatment of acute psychosis associated with both schizophrenia and acute bipolar disorder. A second dopamine partial agonist that has a distinctly different ex vivo pharmacodynamic and pharmacokinetic profile is currently under review by the FDA in the United States and other regulatory agencies. This compound, Bifeprunox, has a high affinity for the D2 receptor but does not have affinity for the 5HT-2 receptor system. Bifeprunox does have affinity for the 5HT-1 receptor system. In this presentation, we will review the differences between dopamine partial agonists and more traditional typical and atypical antipsychotic medications. We will also present some recent data from a placebo-controlled acute trial of two doses of Bifeprunox 30 mg/day and 40 mg/day versus placebo and Risperidone 6mg/day. By the end of the presentation the audience will know about the potential role that dopamine partial agonists may have as treatments for patients with acute psychotic disorders.

• S22 - 亚洲儿童与青少年精神卫生问题 - Child and Adolescent Mental Health in Asia

  Chairs: Norman Sartorius, Switzerland
  Yufeng Wang, Chinese Mainland

  此 讨论会将作为 2007 年 9 月 21 日 举行的世界精神病学联合会区域性会议 / 中国精神病学年会的一部分 ， 目的是提醒与会者 关注儿童与青少年精神卫生方面的需要 ， 并为各国从事儿童与青少年精神卫生工作的人员提供方法技术上的支持。 讨论会先由精神卫生发展联合会 （ AIMHP ） 主席 Norman Sartorius 教授主持并致 开场白 ， 接下来有 四位到会者 发表陈述。 首先 发表陈述的是 WPA 上一任主席兼理事会委 员 Ahmed Okasha 教授。他将 报告 2002 至 2005 年 间 WPA 全球儿童精神 卫生工作总体项目的动因和最终成果。 第二位 陈述者是上一任国际儿童与青少年精神病学职业联盟联合会 （ IACAPAP ） 主席 Myron Belfer 教授。他将指 导安排目前和符合未来发展需要的儿童与青少年精神卫生工作。此论文将针对儿童与青少年的需要和目前世界卫生组织、世界精神卫生联合会及 IACAPAP 对世界范围内该问题的共同管理指导情况发表演说，此外还包括处理具体相关问题的若 干提 议。 第三位 陈述者是汉城国立大学医学院名誉教授 Kang-E Michael Hong 教授，他将指出社会的迅速 发展和家庭结构的改变对亚洲儿童精神卫生状况的影响。该讲演将集中阐述迅速发展的工业化社会和引入开放市场经济体系造成的家庭结构的改变和生育减少所带来的儿童精神健康问题。 第四位 陈述者是上海精神卫生中心儿少科副主任程文红教授，她将具体描述中国国内儿童精神卫生医疗的发展状况。

  This Symposium will be organized in Shanghai on 21 September 2007 in the framework of the World Psychiatric Association Regional Conference/Chinese Society of Psychiatry Annual Congress. Its objective is to raise the awareness of the participants about the mental health needs of children and adolescents and to provide them with materials that they might use in the development of child and adolescent mental health programmes in their countries.

  The symposium will be chaired by Professor Norman Sartorius, President of the Association for the Improvement of Mental Health Programmes (AIMHP), who will make introductory remarks. These will be followed by four presentations.

  The first of these, by Professor Ahmed Okasha, Immediate Past President of the World Psychiatric Association and member of the WPA Council, will describe the origin and main results of the Presidential WPA Programme on Global Child Mental Health conducted in the years 2002 – 2005.

  The second presentation, by Professor Myron Belfer, Immediate Past President of the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP), will deal with present and future mental health needs of children and adolescents. This paper will address the needs of children and adolescents and present the results of the worldwide survey conducted jointly by the World Health Organization, the World Psychiatric Association and IACAPAP. The paper will also propose possible ways of dealing with those problems.

  The third presentation, by Professor Kang-E Michael Hong, Professor Emeritus, Seoul National University College of Medicine, will deal with the impacts of rapid social and family changes on the mental health of children in Asia . The presentation will focus on child mental health problems associated with rapid social changes due to industrialization, with the introduction of open market economical system, with changes of family structure and the reduction of the number of children in a family. These changes brought about confusion and crisis in childrearing practices resulting in child abuse and neglect, reactive attachment disorder, problems of discipline - over or under control, conduct problems, and many other disorders.

  The fourth presentation, by Professor Cheng Wenhong, Deputy Director of the Child Department of the Shanghai Mental Health Centre, will address the situation in China and focus on the development of mental health care in the country.

  This Symposium was made possible with the support of an unrestricted educational grant by Eli Lilly and Company
  

• S22-1

  WPA 全球儿童精神卫生总体工作 - Presidential WPA Programme on Global Child Mental Health

  Ahmed Okasha 1

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

  此演 讲将介绍一项前所未有的工程 ， 它提高了全世界近一半人口的精神卫生状况。童年期精神障碍在世界范围内得到了认识、诊断和治疗。有三个工作要完成： 1 、 认知工作：主要涉及进一步探求儿童精神卫生问题，根据不同文化、流行病学特征 、 卫生服务组织分订出不同水平的精神问题，编订相关诊疗手册、指导方针和实用小册子并出版发行； 2 、 预防工作：主要涉及调查有关 PTSD 、抑郁、行 为问题、 ADHD 、精神病、自 杀、癫痫及智力发育迟滞的预防措施，拓展一级预防的观念，讨论童年期精神障碍的危险因子和保护因子，讲述儿童缺陷问题（例如听觉和视觉缺陷），并且通过回顾不同的养育方式； 3 、 卫生服务的发展、管理和治疗主要涉及与医疗相关的如儿科医生等其他医疗工作者、父母亲的养育，更注重症状表现的评估而不是疾病障碍本身，在医生的治疗和外界的支持间权衡，更强调父母及老师所给 予的支持的重要性。 这项工程为期三年的实践成果包括：出版发行了关于儿童精神卫生的著作，建立了相关的个人和公共网站，为儿童精神卫生的从业者和抚育者编订了认知、预防、早期识别、诊断及治疗相关的手册指南，国际公认的促进儿童精神发育和大脑活跃的指导方针。有关当前疾病流行状况和促进世界各地儿童精神卫生事业发展的资料也将出版。

  The lecture will address the unprecedented program which will enhance the Mental Health of almost half the population of the world. Childhood mental disorders are underrecognized, underdiagnosed and undertreated worldwide. It was decided that there will be three taskforces as follows: Taskforce on Awareness: will be mainly concerned with: Further information about child mental health issues, addressing child problems at different levels from different cultures , epidemiology and service organizers, producing the required manuals, guidelines and a booklet regarding awareness and its distributions, Taskforce on Prevention :will be mainly concerned with : Search for preventive measures of some disorders as PTSD, depression, conduct, ADHD, psychosis, suicide, epilepsy and mental retardation, widening the concept of the term primary prevention , to discuss the risk factors and protective factors of childhood disorders , and address problems of children with deficits (e.g. hearing and visual impairments, etc.) , and also review different parenting styles, Taskforce on Service Development, Management and Treatment will be mainly concerned with: The involvement of pediatricians and other parties , interventional medications for severe disorders, parental support , evaluate symptoms rather than disorders, problems like over prescription Vs under prescription and the importance of parents and teachers in service provision. Childhood mental health polices and services will be addressed.

  The program will, in the course of the three years of its duration, produce outputs in the form of: publication of critical reviews of the literature on child mental health , a functional network of individuals and institutions committed to the achievement of the program objectives, manuals and guidelines concerned with awareness, prevention , early recognition and detection and treatment of mental disorders in childhood for health professionals and others concerned with child care and upbringing, internationally accepted guidelines for activities promoting child mental health and development of a healthier brain for our children .A data base containing information about the current epidemiological situation and about policies and programs relevant to the promotion of child mental health in different parts of the world will be published.

• S22-2

  目前和未来儿童青少年精神卫生需求：全球状况回顾 - Present and Future Mental Health Needs of Children and Adolescents: A Global Review

  Myron Belfer 1

  1 IACAPAP, Geneva , Switzerland

  了解当前儿童与青少年精神障碍的 负担之巨大程度是一项富有挑战的工作。缺乏资料，缺乏了解，顶着追求个体和社会对儿童精神疾病的偏见。尽管在治疗上取得了很大进步，然而在各国家和地区大范围的儿童和青少年中只有少数能够得到卫生服务而大部分还存在问题。我们积极努力地去获得客观资料并整理出 文化相 关以及损伤程度相关的资料。由 WHO 和 WPA 协作绘制的世界卫生组织儿童和青少年精神卫生资源地图是个很好的例子。 WPA 全球儿童精神 卫生工作总体项目为医疗工作的发展贡献了有重大意义的资料，提高了疾病认知，提供了治疗和预防的新方法。此全球项目的成果现已广泛应用于儿童精神卫生服务事业的发展。 近期全球化的工作焦点都集中在 “ 中毒的 ” 环境对精神健康的影响上。这对儿童与青少年精神卫生状况的调查和临床医疗工作提出了新的挑战。这些对儿童精神健康的关注将如何利用家庭和国家的力量，从劳动力和性别的角度迫使他们在这样的环境下 成 长呢？

  Understanding the magnitude of the burden of child and adolescent mental disorders is a challenge. Lack of data, lack of understanding, and stigma detract from gaining a true picture of the consequences for the individual and society of child mental illness. Despite the many gains made in treatment and a focus on improving access, it is apparent that the countries and regions with the highest proportion of children and adolescents have the fewest services and most problematic access. New initiatives are attempting to gain more objective data and placing the data in a context that appreciates culture and the degree of impairment. The WHO Atlas of Child and Adolescent Mental Health Resources, developed by the World Health Organization in collaboration with the World Psychiatric Association, is an example of such an initiative.

  The World Psychiatric Association Presidential Global Program on Child Mental Health has made a significant contribution to the development of materials useful to promote awareness, and disseminate information on modern forms of treatment and prevention. The Global Program products are now being widely distributed to impact the program development to close the gap in services offered for child mental health and enhance advocacy efforts.

  Most recently global concern is focusing on the detrimental impact of “toxic” environments on mental health. This focus presents new challenges to child and adolescent mental health researchers and clinicians. How will all those interested in child mental health address the needs of children displaced from their homes and countries, exploited for labor and sex, and forced to grow up in environments that undermine family cohesion?

• S22-3

  社会的飞速发展和家庭结构的改变对亚洲儿童精神健康的冲击 - Impacts of Rapid Social and Family Changes on the Mental Health of Children in Asia

  Michael Hong

  Seoul National University , Seoul , Korea , Republic of

  在 过去的几十年里 ， 几乎所有的亚洲国家都经历了不同程度和范围的激烈的经济 - 政治 - 社会 变革 ， 我们称之为 “ 现代化 ” 。 现代化包含工业化和城市化两部分，传统的家 庭 观念被打破，引进许多西方的价值观念。 “ 西方化 ” 意味着民主、 资本主义、个人主义、人权平等和选择自由。 这些改变带来了亚洲部分地区人民生活水平的进步，表现在物质水平、卫生条件、营养、教育以及体质改善等方面，相应地儿童与青少年精神健康问题日益凸现，包括精神发育、情感及行为障碍、儿童受虐和被忽略、校园暴力、行为不良以及自杀等，还包括其他一些亚临床精神问题。 基于 临床观察和流行病学实验研究成果、心理病理机制和过程，我们将探讨冲击和影响下的儿童精神卫生问题，提出精神发育、生物学和行为学的一些观点。 作者提出最重要的一个致病因子是 变革的速度而不是内容。在过去的 30 到 40 年 间亚洲国家的现代化被 “ 压缩化 ” 加快 发展了，这在西方国家至少要经历 200 到 300 年。起阻碍作用的致病因素是 传统价值观、家庭结构体系的核心瓦解，离婚率急剧升高，起到的负面影响则是儿童问题危机。 作者提出在大多数 亚洲国家存在儿童抚养问题危机，主要依据以下观察： ①避孕和意外 怀孕 ②逃避和拒 绝抚养，虐待儿童，遗弃幼童 ③不恰当的早期 抚养 ④不恰当的 / 不 够充分的教育，过度保护和过度控制 ⑤性 别角色和态度改变 ⑥ 对智力发展拔苗助长以及学习成绩的压力 作者 还提出了以下几种现象，它们与亚洲国家的儿童精神健康有着密切关联： ①家庭体系核心化和令人担 忧的离婚率猛增 ②家庭成 员中儿童数量的减少 ③ 职业妇女做母亲及妇女解放运动的兴起 ④父母 亲抚养孩子经验不足 ⑤学校 对学习成绩的过分强调合潜在的竞争压力 ⑥ 传统价值观在现代化的冲击中发生明显的变化 ⑦所 谓 “ 专家 ” 和 “ 权威人士 ” 对孩子抚养和教育的观点众说纷纭 ⑧全球化新潮及多 种文化共存的问题，虚拟世界的出现，发达国家 IT 、 BT 工 业引发新型精神病理现象如 “ 网 络成瘾 ” 和极端的社会隔 绝 根据 这些发现，如何干涉和预防发展中国家的儿童精神健康问题，我们将从精神发育、生物 学、行 为学观点进行阐述。针对加强２１世纪未来儿童早期抚养和母婴质量的评价及其重要，我们需要新的指导方针，新的范例，在这个复杂变化的世界，提倡更好地给予儿童精神上的健康，方法也许是新老结合的或者东西方结合的。

  During the past few decades, almost all countries in Asia went through drastic economical-political-social changes, so called "modernization", although the extent and speed of changes might vary. Modernization involves industrialization, urbanization, breakdown of traditional family system and introduction of western ideology, "Westernization", in value orientation, meaning democratization, capitalism, individualism, human/gender equal right and freedom of choices.

  While these changes certainly brought about improvements in many areas of Asian peoples ? life, such as standards of living, sanitation, nutrition, education and physical health, they seem to be accompanied by disconcerting increase of mental health problems in children and adolescents, including developmental, emotional and behavioral disorders, child abuse and neglect, school violence, delinquency and suicide, and many other reactive sub-clinical mental health problems.

  Clinical observations and epidemiological-empirical studies are presented, psycho-pathogenic mechanisms and processes are formulated, and the impacts and implications on the mental health of children are discussed in developmental, ecological and ethological perspectives.

  The author suggests that one of the most critical pathogenic factor would be the rapidness and swiftness rather than the contents of changes, due to ‘compressed' modernization accomplished within the last 30-40 years in most Asian countries, which had been accomplished gradually over 200-300 years in western countries. Important mediating pathogenic processes are the breakdown of traditional value orientation, nuclearization of family system and sharp increase of divorces with subsequent weakening of major support system, and crises and problems of child rearing.

  The author suggests that there are crises and grave problems in child rearing in most Asian countries, based on the following observations; 1 Avoidance of pregnancy and increase of unwanted children, 2 Avoidance and refusal of child rearing and increasing child abuse and neglect including abandonment of young children, 3 Confusion and inappropriateness in early child rearing,4 Inappropriate/ inadequate discipline ; over-protection and over-control, 5 Changes in gender roles and attitudes 6 Preoccupation with intellectual capability and endless pressure on scholastic achievement.

  The author also presents the following phenomena which must have significant implications on the mental health of children in many countries in Asia . 1 Nuclearization of the family system and alarming increase of divorce, 2 Reduction of the number of children in a family, 3 Rising number of working mothers and women ? s equal right movement, 4 Lack of opportunity for parents to learn how to raise a child, 5 Steep competition and exclusive emphasis on scholastic achievement in school, 6 Marked changes in value orientations from traditional to modern ones, 7 Confusing and often contradictory advices by "experts" and "professionals" on child rearing and child education, 8 New tides of globalization and confounding co-existence of multi-cultures in most countries and emergences of virtual world, IT and BT industry in some advanced countries, resulting in new forms of psychopathology such as ‘internet addiction' and extreme social isolation.

  Implications of these findings in terms of interventions and prevention for mental health children in developing countries are discussed in developmental, ecological and ethological points of view. The critical importance of early child rearing and the quality of mother-infant attachment for the future mental health of our children of 21st century is emphasized and needs for new guidelines and new paradigms are advocated in order to bring up children with good enough mental health in this complex and ever changing world, perhaps by integrating the Old and the New as well as the East and West.
  
• S22-4

  儿童与青少年精神卫生：中国国内形势回顾分析 - Mental Health of Children and Adolescents: A Review of the Situation in China

  Wenhong Cheng

  Child Department of Mental Health Center in Shanghai , Shanghai , Chinese Mainland

  中国于上世 纪六十年代起开展儿童与青少年精神卫生服务工作 ， 七十年代曾一度中断 ， 到八十年代才又继续发展。近二十年来，儿童与青少年精神卫生服务工作突飞猛进，但在中国社会巨大变革影响下仍然存在很多方面的问题，其中包括儿童与 青少年精神疾病的流行和医 疗资源的缺乏。当今儿童与青少年精神健康问题日益显现，不同水平的精神卫生医疗服务却缺乏完善。疾病需要和社会支持两者间存在着巨大的鸿沟。我们将介绍主要存在的问题和儿童青少年精神障碍的流行状况，以及当今国内的精神卫生政策，并展望中国儿童青少年精神卫生工作的未来发展。

  Child and adolescent mental health service began from 1960s in China , which was interrupted at 1970s and is developing from 1980s. Recent 20 years, child and adolescent mental health service is improving significantly, but still has problems coming from different aspects in huge changing Chinese society, which includes increasing prevalence and problems of child and adolescent mental illness, and deficiency of medical and social resources. Child and adolescent mental health problem becomes more and more obvious today; mental health services on different levels are not matched well and enough. Gap between needs from society and mental health service is huge. We introduce main problem and prevalence of child and adolescent mental disorders and mental health service and policy in China today, we also give our view on how to improve child and adolescent mental health in China in the future.

   

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