S23 - Psychotherapy for the Chinese: Cultural Consideration

Chairs: Cong Zhong, Chinese Mainland
Wen-Shing Tseng, United States

Chair/Co-Chair: Cong Zhong ( 丛中 ) ( China ) and Wen-Shing Tseng ( 曾文星 )( USA )

Presenters:

(a) Cong Zhong ( 丛中 )( China ) – Application of proverbs in psychotherapy for the Chinese ( 华人心理治疗上成语的运用 )

(b) Zhu Jinfu （ 朱金富 ） ( China ) – Daoistic cognitive therapy: Review of clinical application ( 道学 认知心理治疗的临床运用 )

(c ) Tian Feng ( 田峰 ) ( China ) – Psychotherapy concepts as revealed in Traditional Chinese Medicine ( 中医里的心理治 疗观念 )

(d) Chen Yixin （ 陈一心 ） ( China )—Psychotherapy for the children: Cultural Considerations ( 儿童心理 辅导 ： 文化上的考虑 )

(e) LIN Hong ( 林 红 ) （ China ）－ Child Behavioral Problems: Comparative follow-up study two decades later – Sociocultural comments( 儿童行 为问题 ： 20 年追踪 调查比较 ? － 社会文化上的 讨论 )

S23-1

成语在华人心理治疗中的应用 - Application of Proverbs in Psychotherapy for the Chinese

Cong Zhong 1

1 北京大学医学院 , 北京 , Chinese Mainland

心理治 疗中 ， 最重要的就是要与来访者进行适当而有效的沟通 ， 给来访者一些解释和建议 ， 而这些解释和建议 ， 要力求精炼、有力 ， 并能够配合来访者的文化特征 ， 能够被来访者所接受。成语在心理治疗中的应用就是进行有效沟通的沟通方法之一。 中国文化源 远流长。中国成语，是几千年来，中国人在社 会生活中形成的、共同 拥有的、含义准确、结构固定的词汇用语，是华人文化的突出代表。

一、成 语与华人心理特质的关系

中国成 语是中国文化的结晶，它反映了中国人共同的心理感受，表达了千百年来在不同个体身上重复出现过的共同的生活理念和情感。

1 、成 语与情感表达

2 、成 语与羞耻感

二、在心理治 疗中运用成语的好处

成 语属于日常用语，华人更多时候喜欢使用成语，交谈中使用成语易于沟通、表达和相互理解。在心理治疗会谈中运用成语，对心理治疗有一定的帮助。

三、如何在心理治 疗中应用成语

小 结： 华人在日常生活中，习惯于使用成语， 特 别是在他们遇到烦恼的时候，成语就成为他们解决问题是的哲学指导。病人也是非常熟悉这些成语的。所以，成语，既可以在民间使用，也可以在心理治疗中得以应用。在心理治疗中适当应用成语可以推进与文化相关的沟通。成语展现了拥有者的文化智慧。华语中有成千上万条成语，因此，在心理治疗会谈中，适当地选择和应用成语可以使治疗师以含有文化意义和有效的方式，帮助来访者解决他们遇到的问题。

The essential elements of successful psychotherapy are effective communication. Culturally-relevant communication with the patients is very important. Chinese people customarily use proverbs in their daily lives, particularly in times of distress, as philosophical guides to cope with their problems. Patients are familiar with the use of proverbs. The suitable use of proverbs in psychotherapy will promote culture-relevant communication. Proverbs represent cultural wisdom from authority. So many proverbs exist that proper selection and use of them can help the therapist assist the patient to deal with a wide range of problems in a culturally meaningful and effective way.

S23-2

华人心理治疗上成语的运用 - Daoistic Cognitive Therapy: Review of Clinical Application

JinFu Zhu 1

1 XinXiang Medical Institute, XinXiang , Chinese Mainland

道家 认知治疗自从 1995 年 创建以来。经过 10 余年的 发展 ， 从创意、成型、应用、修改已初步形成一种具有中国文化特色的心理治疗技术 ， 中国学者在焦虑障碍、抑郁障碍及心身疾病等不同领域开展治疗和研究 ， 本文针对不同患者干预的初步评估和体会进 行 总结。从道家认知治疗的选择对象、患者的年龄、受教育程度、道家认知治疗对症状的改善以及患者的药物治疗情况等方面进行了总结和讨论，研究的结果表明：在选择对象时，以中老年受教育年限较长的为好，以情绪症状相对较轻的患者为好，以应激相关的各种神经症、应激相关障碍或心身疾病为好，治疗的时程以 1 － 3 个月 为比较理想；而对于年轻的受教育年限较短的患者，情绪症状比较严重的患者开展道家认知治疗时，相对较差，在道家认知治疗过程中配合药物治疗是十分必要的，当然，个人的领悟力和理解力在治疗中起着关键的作用。

Daoistic Cognitive Psychotherapy has been developed and applied for one decade in China . A group of therapists have carried out this indigenous therapy for Chinese patents suffering from various kinds of psychiatric disorders, such as: anxiety disorders, depression and coronary heart diseases.

Based on the clinical experiences it has illustrated clearly that the Doistic cognitive therapy is particularly useful for the patients who are suffering from psychosomatic disorders, particularly of coronary heart disease. In general, the therapy works better for the patients who are in the middle age or older, have higher education, and less severe emotional symptoms of anxiety or depression. It is effective for patients who are suffering from burden of overwork or overanxious for achievement. In contrast, it is not effective for young patients who are thriving for their success in their personal career and persons who are less educated and do not appreciated the philosophical concepts of Daoism.

Clinical experiences also show that the effectiveness of the therapy will be better if the course of therapy last at least for about ten sessions within the period of one to three months. If it is necessary, medication can be applied to enhance the improvement. Finally, the patient's cognitive ability to comprehend and accept the main point of the philosophical thought of Daoism is the key for the success of the Daoistic cognitive psychotherapy.

S23-3

中医里的心理治疗观念 - Psychotherapy Concepts as Revealed in Traditional Chinese Medicine

Feng Tian 1

1 山西医科大学附属第二人民医院 , 太原 , Chinese Mainland

The basic concepts and principles for healing of the mind as revealed in Chinese traditional medicine is reviewed. The basic principles emphasized are: to maintain tranquilization and calm; keeping the spirit inside of the mind, allowing the vitality (qi) flowing smoothly; adjusting mood by regulating excessive feeling and transfering the feeling, desire, and ambition properly; encouraging adequate relations with others; adjusting mental state according to the seasonal change, and to follow the principle and rhythm of nature.

Keywords: Traditional medicine, concept of healing, healthy mind, Chinese

S23-4

儿童心理辅导：文化上的考虑 - Psychotherapy for the Children: Cultural Considerations

Yixin Chen 1 , Chunyu Ge 2

1 南京 脑科医院 , 南京 , Chinese Mainland, 2 河海大学 , 常州 , Chinese Mainland

目的 ： 阐述儿童心理辅导体会。

方法 ： 从文化的 视角对儿童心理辅导的实践进行总结。

结果 ： 1 、中国家庭的文化特点 ： 结构以核心家庭为主 ， 但孩子半数依赖祖辈抚养 ； 家庭关系常呈现多重三角关系 ； 情绪情感缺乏沟 通 ； 亲子理念以望子成龙根深蒂固。 2 、中国儿童家庭治 疗特点 ： 重视祖辈的资源作用 ； 重视隐藏的家庭结构 ； 用多边结盟保持关系中立 ； 理解父母对 " 专家 " 的期待 ， 以 " 专家的眼光 " 发现父母有帮助儿童改变的能力 ； 坚持资源取向 ， 避免对问题的过度挖掘 ； 巧用改释技巧 ， 淡化对症状的关注 ； 坚持伦理守则 ， 妥善处理领导等转介的个案 ； 家庭治疗技巧的整合应用。

结论 ： 儿童心理 辅导必须重视文化的影响 ， 重视不同文化背景下心理治疗理论与方法的灵活运用。

Purpose: Elaboration of the clinical experiences of psychotherapy for the children in China .

Method: Based on the clinical experiences of psychotherapy with children, that have been carried out in Child Mental Health Center in Nanjing , China , the key points that are needed for consideration from cultural perspectives are to be summarized.

Results: (1) The characteristics of Chinese family need proper attention from cultural perspectives. The Chinese families are stem family by structure. More than half of the children are raised by their grandparents. Thus, family relationship often presents multiple-triangle problems among different generations. Within the family, there are often lack of adequate communication among the members particularly regarding their feeling and emotion. Parents often hold high expectation for their children for academic achievement, which cause tension between the parent-children. (2) For the therapy, it is important to value the role and function of grand-parents as the major resources of support. Pay attention to the hidden structure of the family in term of who are the key members; adequately use of multilateral alliance to maintain the neutrality within the family; comprehend parents' expectation toward the therapists as "experts", but in the same time, utilized parents' ability of helping their own children's. Frequently use the skill of reframing to decrease the attention to the symptom and problems, and focus more on the strength the family have.

Conclusion: Psychotherapy for children needs adequate attention to the cultural factors. The theories and method of family therapy should be flexible to accommodate the culture of the family.

S24 - Research and Treatment for Neurosis

Chairs: Zeping Xiao, Chinese Mainland
Levent Küey , Turkey

S24-1

强迫症患者 COMT 基因表达研究 - Study on the Expression of Gene of COMT in Patients with Obsessive-compulsive Disorder

王 振 1 , 肖 泽萍 1 , 蒋 文 晖 1 , 钱 伊萍 1 , 江 三多 1

1 上海市精神 卫生中心 , 上海 , Chinese Mainland

目的 : 强迫症是以反 复出现的强迫观念 / 行 为为主要临床症状的焦虑障碍 ， 终生患病率达 1 ～ 3 ％， 给患者和家庭带来巨大痛苦 ， 但至今病因未明。已有的研究提示遗传因素在强迫症的发病过程中具有重要作用。近十余年来大量的基因多态研究获得许多有价值的发现，但众多研究结果存在大量不一致，尚未取得突破性进展。本研究尝试从基因表达的角度探讨儿茶酚 - 邻 - 甲基 转移酶（ COMT ）基因表达的 变化与强迫症的关系。

方法 : 采集 35 例 强迫症患者（年 龄： 31.2±12.0 ，女性 16 例）和 31 名健康 对照（年龄： 30.3±5.8 ，女性 14 例）外周静脉血，提取 总 RNA 并 转录为 cDNA, 采用 TaqMan. MGB 探 针法对样本的 COMT 基因表达水平 进行荧光实时定量 RT-PCR 检测（ Quantitative Real Time RT-PCR ）；管家基因 GAPDH 作 为内对照基因标化 COMT 基因的表达水平；采用比 较 Ct 值的方法（ Comparative Ct Method ） 进行相对定量；使用 SDS version 2.0 软件进行基因表达检测数据处理。荧光定量 PCR 的 结果以 Ct 值显示，采用 2-ΔCt 代表基因表达水平，采用公式 2-ΔΔCt 计算表达差异的倍数。 Yale-Brown 强迫量表 (Y-BOCS) 用来 评定患者的症状严重度； SCID-II （ structured clinical interview for DSM-IV ） 强迫型人格障碍分量表用 来 评定患者的强迫型人格障碍（ OCPD ）共病情况。

结果 : 强迫症患者的 COMT 基因相 对表达水平（ 0.034±0.013 ）低于健康 对照组（ 0.046±0.026 ），差异具有 显著性（ t=2.56, df=64, P=0.013 ）；因两例健康 对照的基因表达数据通过分析显示为离散值，予以剔除后两组间差异 仍具有 显著性意义（ t=2.12, df=62, P=0.038 ）；根据 SCID-II 评定结果，将强迫症患者划分为伴 OCPD 组与无 OCPD 组，方差分析显示三组间有显著差异（ F=3.98, df=63, P=0.024 ），两两比 较显示无 OCPD 组强迫症患者与健康对照之间差异具有显著性（ Mean Difference=0.17, P=0.009 ）。将健康 对照患者的平均表达水平作为测量参照 (calibrator) ，根据公式 2-ΔΔCt 计算表达差异倍数显示强迫症患者组比健康对照的 COMT 表达下降 20 ％，而无 OCPD 的 强迫症患者下 调达 30 ％。方差分析 显示，强迫症与健康对照之间的 COMT 基因表达差异可能主要来源与两 组间男性的差异（ P=0.044 ），而两 组女性之间无显著性差异（ P=0.308 ）。未 发现 COMT 基因表达水平与 Y-OBCS 评分间存在显著性相关（ r=0.09, P=0.62 ）。

结论 : 据我 们所知，本研究为首次从基因表达异常角度探讨强迫症的病因，研究结果提示强迫症患者可能存在 COMT 基因表达的异常，与健康 对照相比 COMT 基因表达 显著下调，尤以男性强迫症患者表达下降明显。而且是否伴有强迫型人格障碍也是影响基因表达的重要因素。

Low Expression of Catecholamine-O-methyl-transferase Gene in Obsessive- Compulsive Disorder

Zhen Wang 1 , Zeping Xiao 1 , Wenhui Jiang 1 , Yiping Qian 1 , Sanduo Jiang 1

1 Shanghai Mental Health Center , Shanghai , Chinese Mainland

Objective: Obsessive compulsive disorder (OCD) is a common, severe and chronically debilitating mental illness that affects 1-3% of general population. This disorder is characterized by recurrent obsessions and/or compulsions that are severe enough to be time-consuming or cause marked distress or significant impairment. Although the etiology of this disorder remains largely unknown, numerous family and twin studies indicated that OCD has a strong genetic component. In the recent twenty years, a plenty of gene polymorphism studies achieved important founds but yield contrasting results. In the present study we have examined, for the first time, the gene expression of COMT in peripheral blood of OCD patients.

Methods: Thirty-five OCD patients (mean age: 31.2±12.0, female: 16) and thirty one normal controls (mean age: 30.3±5.8, female:14) were included in this study. Blood samples were obtained from all subjects for and total RNA were extracted. Reverse Transcription was performed using TaqMan reverse transcription reagents with random primers. Real-time quantitative RT-PCR was performed on an ABI Prism 7900 sequence detection system . Housekeeping gene (GAPDH) were used as internal control. The expression data produced were analysed and converted into threshold cycle values (Ct-values) using SDS 2.0. The comparative Ct method ( Δ Ct) was used to measure the relative gene expression. Gene expression level were showed as 2- Δ Ct and the fold change was calculated by the formula 2- ΔΔ Ct. Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to assess severity of OCD and obsessive compulsive personality disorder (OCPD) subscale of SCID-II was used to assess OCPD.

Results: The COMT gene expression level, normalized by GAPDH, were significantly decreased in OCD group ( t=2.12, df=62, p=0.038) compared with health control subjects. According to the OCPD subscale of SCID-II , OCD patients were divided into two subgroup. One-way ANOVA showed that there was significant different among two subgroups and normal controls （ F=3.98, df=63, P=0.024 ） . Post Hoc testing revealed that OCD without OCPD has a lower expression of COMT than normal controls(P=0.009) while no significant between OCD with OCPD and normal controls. According to the formula 2- ΔΔ Ct, OCD patients showed 20% decrease of COMT expression than normal controls. Correlative analysis showed that there was no significant correlation between COMT expression and OCD severity(r=0.09, P=0.62).

Conclusion: The present study reported, for the first time, abnormal COMT gene expression in OCD patients. OCD group showed significant decrease on COMT expression when compare with normal controls. With or without OCPD may affect the COMT expression level.

Keywords: COMT gene expression, obsessive-compulsive disorder, OCPD

S24-3

焦虑症患者前额叶、海马磁共振质子波谱成像的研究 - Magnetic Resonance Pectroscopy Imaging Study on Prefrontal Lobe and Hippocampus in Anxiety Patients

华良 禹 1

1 浙江大学医学院 , 浙医二院 , 杭州 , Chinese Mainland

目的 : 利用磁共振 质子波谱成像技术 （ 1H-MRS ） 探 讨焦虑症患者前额叶和海马的脑功能变化特点。方法 应用 1.5-Tesla 超 导磁共振扫描仪行 1H-MRS 检查，检测 12 例焦 虑症患者和 10 例健康 对照者前额叶、海马脑 N －乙 酰天门冬氨酸（ NAA ）、胆碱（ Cho ）、肌酸（ Cr ）三 种代谢物水平，计算 NAA/Cr 和 Cho/Cr 比 值，进行比较分析。结果 焦 虑症组右侧前额叶 NAA 、 NAA/Cr 高于正常 对照组 , 差异具有 统计学意义（ P<0.05 ）；焦 虑症组左侧海马 Cho 、 NAA/Cr 、 Cho/Cr 显著高于正常对照组，差异具有统计学意义（ <0.05 ）。

结论 : 焦 虑症患者左右额叶及海马代谢功能存在不对称性，焦虑症患者的前额叶和海马有可能参与了该病的病理生理过程，焦虑症患者可能存在右侧前额叶神经元活性增强，左侧海马神经细胞膜磷脂代谢增快。

Objective: To investigate the possible alterations of brain function in prefrontal lobe and hippocampus in anxiety there uses proton magnetic resonance spectroscopy (1H-MRS).

Method: A 1.5-T nuclear magnetic resonance machine was used to test 12 patients and 10 comparison subjects. The NAA, Cho and Cr were measured and ratios of NAA/Cr and Cho/Cr were determined. Spectral data were analyzed by using SPSS11.0 software.

Result: The NAA and NAA/Cr ratios in right prefrontal lobe in patients with anxiety were higher than those in normal controls （ P<0.05 ） ; In left hippocampus, the Cho 、 NAA/Cr 、 Cho/Cr ratios in patients with anxiety were higher than that in controls （ P<0.05 ） .

Conclusion: These results provide neurochemical evidence suggesting asymmetric brain metabolic function in prefrontal lobe and hippocampus of anxiety patients and the involvement of the prefrontal lobe and hippocampus region in the pathogenesis of anxiety disorder. There might be increased neuronal vitality in right prefrontal lobe and enhanced metabolism of membrane in left hippocampus in anxiety patients.

S24-4

214 例不同性别惊恐障碍患者临床症状比较 - Comparison of Clinical Symptom between Different Genders of 214 Patients with Panic Disorder

Yuhua Zhan 1

1 中国医科大学盛京医院 , 心理 门诊 , 沈阳 , Chinese Mainland

目的 ： 比 较不同性别惊恐障碍病人临床症状 ， 了解差异。

方法 ： 对综合医院心理门诊连续 214 例首 诊为惊恐障碍的病人的临床症状进行对照比较。

结果 ： 男性主要症状排序 为心悸、头昏、害怕即将死亡、气促 / 窒息感、出汗、喉 头梗阻。女性主要症状排序为心悸、震颤 / 发抖、气促 / 窒息感、出汗、喉 头梗塞、恶心和头昏。在头晕、震颤 / 发抖、害怕即将死亡和恶心症状上存在症状差别，

结论： 惊恐障碍不同性 别有不同临床特点 .

Objective: To compare the clinical symptoms between different genders of patients with panic disorder.

Methods: Compare the clinical symptoms of 214 out-patients with panic disorder who firstly came to our psychological clinical service of general houspital.

Result: The present symptoms sort of male is ： palmus, dizziness, dread in ext, anhelation, apopnixis, diaphoresis, obstruct of throat; and that of female is palmus, tremb or shiver, anhelation or apopnixis, diaphoresis, obstruct of throat, nausea and dizziness. The significant sexual differences were found in four kinds of symptoms: diaphoresis, tremb or shiver, dread in ext, nausea.

Conclusion: There may be distinctions between male and female patients with panic disorder.

S24-5

集体心理治疗对住院神经症的疗效分析 - A Comparative Analysis about the Effectiveness of Group Psychotherapy to Hospitalized Neurosis

Qing Ye 1 , Denghua Tang 1 , Xiaoyang Gu 1 , Ru Bo 1 , Yumei Zhang 1 , Xing Chu 1

1 Wutaishan Hospital of Yangzhou , Jiangsu , Chinese Mainland

目的 ： 探 讨集体心理治疗对神经症住院治疗中的有效性。

方法 ： 用集体心理治 疗合并帕罗西汀 （ 85 例 为研究组 ） 和单用帕罗西汀 （ 82 例 为对照组 ） 治疗 ， 于入组时、治疗 8 周后分 别用症状自评量表 （ SCL-90 ） 、焦 虑和抑郁自评量表 （ SAS 、 SDS ） 、社会功能缺陷 筛选量表 （ SDSS ） 评定病人。

结果 ： 研究 组治疗 8 周后 ， 病人 显效率 67.1% ， 对照组显效率 34.1% ， 两 组差异有显著性 （ P ＜ 0.01 ）， SCL-90 、 SAS 、 SDS 总分两组差异有显著性 （ P ＜ 0.05 ）， SDSS 评分也显著低于对照组 （ P ＜ 0.05 ） 。

结论 ： 集体心理治 疗可以有效改善神经症患者症状 ， 而且对增强社会功能 ， 提 高生活 质量均有较好的效果。

关键词 : 集体心理治 疗 神 经症 帕 罗西汀

Objective: To study the effectiveness of the group psychotherapy to hospitalized neurosis.

Method: 167 patients with neurosis were randomly divided into two groups. Compared with the 85 cases of patients were treated with group psychotherapy (group A) and 82 cases (group B) were treated with only paroxetine. To compare two results with SCL-90, SAS, SDS, and the Social Disability Screening Schedule (SDSS) were used after 8 weeks.

Results: After 8 weeks, the efficiency of group A is 67.1%, group B is 34.1%, the total scores of SCL-90, SAS, SDS, and SDSS of group A decreased significantly.

Conclusion: It is suggested that group psychotherapy is definite efficacy on treatment of neurosis in hospital. It shows better effect in improving the symptom and the condition of social function.

Key Words: group psychotherapy neurosis paroxetine

S24-6

A Study off Platelet Serotonin Concerntration in Patients with Anorexia Nervosa

Jue Chen 1 , Mingdao Zhang 2 , Zeping Xiao 2 , Zheng Zou 1 , Anorexia Nervosa

1 Shanghai Mental Health Center , Psychosomatic Department, Shanghai , Chinese Mainland, 2 Shanghai Mental Health Center , Shanghai , Chinese Mainland

Objective: To explore the pathophysiological mechanism in patients with anorexia nervosa from the angles of serotonin.

Methods: 1.A cross-sectional investigation and assessement of clinical features were conducted to 44 patients as follows: general state examination, symptom evaluation using clinical scales including HAMD, HAMA and Y-BOCS, and investigation on eating disorders with relavent scales including EAT-26 、 EDE 、 EDI-II. 2. High performance liquid chromatography (HDLP) was applied in the measurement of platelet serotonin concentration, and case-control study was designed to probe into the biochemistrial pathogenesis among 44 patients and 34 normal controls.

Results: 1.Platelet serotonin levels of AN [ （ 376.28±244.51 ） ng /10E9platelet] were significantly lower than those of healthy controls [ （ 765.94±163.33 ） ng /10E9 platelet] （ P<0.01 ） .2.The average age of onset in Anorexia Nervosa of Restricting Type (RAN) was earlier than that of Binge-Eating/Purging Type (BAN) （ 17.1±3.3 ）（ P<0.01 ） . Total scores of EDE , EDI and Y-B0CS in BAN patients were higher than that in RAN patients （ P<0.05 ） . 3. There was no significant difference of platelet serotonin levels between subgroups of RAN and BAN （ P>0.05 ） , and both of them were significantly lower than those of healthy controls （ P<0.01 ） .

Conclusions: 1.This study support the hypothesis of serotoninergic hypoactivity in AN, which is found in both of RAN and BAN patients. 2. BAN patiens have more severer disordered eating behaviors and pathopsychology than RAN patients.

This study was the first national study on the biochemistrial pathogenesis in patients with anorexia nervosa.

S25 - Social Psychiatry 1

Chairs: Wenyuan Wu, Chinese Mainland
Dominic Lee, Chinese Hong Kong

S25-1

山东省 18 岁及以上人群生命质量流行病学研究 - Epidemiological Study on Quality of Life in People Aged 18 Years and over in Shandong Province

唐 济生 Tang 1 , 张敬悬 Zhang 1 , 卢传华 邱慧敏 刘 兰芬 王松波 王 爱贞

1 山 东省精神卫生中心 , 济南市 , Chinese Mainland

目的 ： 调查山东省 18 岁及以上城乡人口生命质量现状。探讨生命质量与心理健康水平、躯体健康水平、睡眠质量、应对方式和精神疾病诊断之间的关系。

方法 ： 采用多 阶段分层整群系统随机抽样方法进行抽样 ， 实际抽取 18 及 18 岁以上人口 23987 人 ， 实际完成问卷调查 22664 人 （ 94.48% ） 。主要研究工具有生命 质量量表、 PSQI 、 GHQ-12 、 简易应对方式问卷及 DSM-IV 和 SCID-P 。 24 名精神科 护士和 60 名精神科医生培 训 4 周后参加 调查，并进行一致性测验，现场调查 3 个月完成。

A Quality of life investigation of the people aged 18 years and above of Shandong Province

Jisheng Tang 1 , Jingxuan Zhang 1 , Chuanhua Lu 1 , Huimin Qiu 1 , Lanfen Liu 1 , Songbo Wang 1 , Aizhen Wang 1

1 Shandong Mental Health Center , Jinan City , Chinese Mainland

Objective: To investigate the quality of life of the people aged 18 years and above of Shandong province, To analyze the relationship between the quality of life and sleeping disorders, general mental health levels, body health levels and mental disorders.

Method: 23987 persons aged 18 years and above were sampled from Shandong province by multi-stage cluster random sampling. 22664 （ 94.48% ） persons completed the survey questionnaires. The main survey tools were Quality of Life Questionnaire(QLQ), Pittsburgh Sleep Quality Index （ PSQI ）， General Health Questionnaire （ GHQ-12 ）， Simplified Coping Style Questionnaire, DSM-IV and SCID-P. 24 nurses and 60 psychiatrists trained for 4 weeks before survey completed the investigation costing 3 months.

Result: 22527 persons aged 18 years and above completed the QLQ fully. The average score of QLQ was 13.84±2.55, female 13.89±2.53, male 13.77±2.57 (t=3.59,p<0.001),people aged 18-59 years 13.58±2.47, people aged 60 years and above 14.89±2.59 （ t=30.54,p<0.001),people in rural 13.85±2.66,people in urban 13.80±2.19 （ t=1.49 ， p>0.05 ） .There were significant difference of the scores of QLQ in the groups of different works, levels of education, status of marriage, and areas. The scores of questionnaires were significant positive correlation between QLQ and PSQI, GHQ-12, mental disorders, negative coping style, and body health levels, and there was negative correlation between QLQ and positive coping style, 2624 cases met different mental disorders diagnostic criteria according to DSM- Ⅳ /SCID-P, among them 2583 persons completed QLQ fully, the average score of QLQ of them was 15.96±3.13, mere higher than the average score of the people not with mental disorders (13.56±2.33)(t=37.64,p<0.0001).

Conclusion: The Norm of QLQ of the people aged 18 years and above of Shandong province was 13.84±2.55. The levels of quality of life was correlation with ages, sex, works, education, and sleep quality, mental health levels, body health levels, and metal disorders, and other factors.

S25-3

大學生日常生活、網路使用行為與憂鬱傾向之相關性調查 - A Study of the Relationship between Internet Use and Depression among College Students in Taiwan

雅馨 葉 1 , 家興 林 2 , 旭英 董 3 , 怡君 戴 1 , 連盛 黃 1

1 董氏基金會 , 心理衛生組 , 台北市 , Taiwan, Province of China, 2 國立台灣師範大學 , 教育心理與輔導學系 , 台北市 , Taiwan, Province of China, 3 國立成功大學 , 教育研究所 , 台南市 , Taiwan, Province of China

目的 ： 本研究在了解台灣大學生憂鬱程度分布、日常生活現況、及其網路使用行為與憂鬱程度的相關性。

方法 : 本研究以台灣地區大學及獨立學院在學大學生為對象 ， 採立意抽樣法 ， 進行問卷調 查。調查進行期間為 2006 年 4 月至 5 月，有效問卷為 6543 份，其中男生佔 47.6 ％，女生佔 52.4 ％。問卷回收資料採用 SPSS10.0 中文版進行描述統計分析，計算大學生憂鬱情緒程度、網路使用行為等變項之次數分配與百分比，最後以多元線性迴歸分析法探討網路使用行為與憂鬱程度之關係。

結果： 1.24.3% 的台灣大學生有嚴重憂鬱情緒需專業機構協助，專業協助是指學校諮商中心、民間協談機構或醫療機構等；女生比男生憂鬱。 2. 九成以上大學生 每次上網持續時間至少 2-3 小時，近五分之一大學生 每次上網持續 5 小時以上，而男生 每次上網持續時間高於女生。此外，有 26.7 ％的大學生 每週上網 29 小時以上，男生 每週上網總時數高於女生。 3. 以 每次上網持續時間及上網總時數最多的選項交叉分析後發現，憂鬱情 緒嚴重者 每次上網持續時間較長，每週上網總時數、每週使用網路溝通及非溝通功能總時數也都比較長，而且經常或總是因上網而翹 課的比例也稍多。

結論： 迴歸分析發現 每週上網總時數越多的大學生越有憂鬱傾向，花越多時間在網路非溝通功能的大學生越憂鬱，但是使用溝通功能時數的多寡對憂鬱情 緒的預測不明顯。當網路已成為大學生活不可或缺的一部分，對大學生的輔導工作而言，一方面可以強化網站上非溝通功能的資訊 內容，例如幫助大學生認識各種擺脫壓力與憂鬱的方法以及實際問題解決技巧的提供；另一方面，也可以巧妙的將互動機制設計於網站中，善用網路即時互動的特性，其實也不失 為另一種引導他們走出憂鬱情緒的方法。

S25-4

Abstract Withdrawn

S25-5

高中学生人格障碍的社区干预研究 - Community-based Intervention Study of Personality Disorder among Senior High School Students in Beijing

Yueqin Huang 1

1 Institute of Mental Health, Peking University , Peking , Chinese Mainland

目的 : 通 过社区干预试验 ， 建立社区青少年人格障碍的心理健康教育的干预模式 ， 并进行效果评价。

方法 : 应用系列的流行病学研究社区干预试验的方法 ， 按照 ICD-10 和 DSM-IV 的 标准 ， 采用人格诊断问卷第四版 （ PDQ-4 ） 、国 际人格障碍检查表 （ IPDE ） 、父母 养育方式问卷 （ EMBU ） 和一般情况 问卷 ， 调查北京市高中生样本及其父母 ， 进行精神卫生健康教育的社区干预 ， 包括给学生及其家长和教师发放健康教育手册、教师专题访谈、学生健康教育讲座 ， 经过三年随访 ， 评价干预措施的效果。采用现代流行病学单因素和多因素的分析方法分析资料。

结果 :

（ 1 ）横断面比 较：干预前高一时 PDQ-4 量表 总分和各组量表分干预组与非干预组差异无统计 学意 义，干预后高三时干预组明显低于非干预组；高一时和高三时干预组与非干预组人格偏离现患率差异均无显著性。

（ 2 ） 单因素分析：高一与高三人格偏离和人格障碍的 OR 分 别为 1.54 和 1.46 。

（ 3 ）多因素分析：干 预组和非干预组 Logistic 回 归分析总体人格障碍的危险因素有父母关系不良、父母的否认拒绝型和过度保护型养育方式； A 、 B 、 C 组人格障碍分析的结果类似。

（ 4 ）新 发率比较：干预组人格偏离新发率为 3.4% ，低于非干 预组新发率 4.0% ；但差异无 显著性。干预组人格障碍的发病率为 0.8% ，低于非干 预组新发率 1.1% ；但差异无 显著性。

（ 6 ）干 预前后纵向比较：干预组和非干预组 PDQ-4 量表分三年后均明 显下降，成组和配对比较差异均有高度显著性。高一阴性至高三维持阴性组中干预组三年前后 PDQ-4 量表 总分的差值明显大于非干预组三年前后差值。

（ 7 ）分 组和分型纵向比较：在各组人格偏离现患率中干预组 C 组和偏执型、自恋型、边缘型人格偏离的新发率低于非干预组，干预效果较好。

结论 : 成功地建立了青少年心理健康教育的干 预模式并评价了干预效果，证实社区人群预防人格障碍发生的青春期心理健康教育的干预模式对青少年是行之有效的，可以促进高中生 群体精神 卫生水平的提高。

Objective: To establish an intervention model of mental health education for adolescents in community.

Method: Using epidemiological study, 10039 senior high school students were investigated with Personality Disorder Questionnaire-fourth edition (PDQ-4), EMBU, General Information Questionnaire, and International Personality Disorder Examination (IPDE) to diagnose PD according to the criteria of ICD-10 and DSM-IV. The subjects were followed up for three years to observe the dynamic change of personal disorder and to evaluate the effect of intervention measure of mental health education. The single and multivariate analysis methods were applied for data processing.

Results: 1) PDQ-4 scores of the intervention group were significantly lower than those of the non-intervention group. 2) PDQ-4 scores and incidence rates of PD at the third grade were significantly lower than those at the first grade. The ORs of personality dysfunction and PD were 1.54 and 1.46. 3) Logistic regression analysis yielded risk factors of overall PD including poor parental relationship, parental rejection and over-protection. 4) The incidence rate of personality dysfunction was 3.4% in the intervention group, and 4.0% in the non-intervention group. The incidence rate of PD was 0.8% in the intervention group, and 1.1% in the non-intervention group, but no statistical differences were found among them. 5) The mean score of PDQ-4 in intervention group was significantly lower than that in non-intervention group. The PDQ-4 score showed significant decline during three years. But the prevalence rates had no statistical difference between intervention and non-intervention groups. 6) the prevalence rates of personality dysfunction significantly decreased after three years. 7) The incidence rates of cluster C, as well as paranoid, narcissistic and borderline PD were statistically decreased by intervention.

Conclusions: The model of intervention to personality disorder is successful. The mental health education during adolescence contributes to promotion of mental health for adolescents.

S25-6

An Epidemiological Survey of Alcohol Use Disorders in a Tibetan Population

万 军 郭 1 , Lanzi Gongga 2 , Ouzhu Luobu 2

1 四川大学 华西医院精神科 , 成都 , Chinese Mainland, 2 University of Tibet, Medical School, 拉 萨 , Chinese Mainland

Aims: As part of a larger study on alcohol use disorders, we performed an epidemiological survey in order to detect the prevalence of alcohol use disorders in the Tibetan population.

Methods: A sub-group of the population of Tibet from the suburban counties of Lhasa was sampled by using stratified-cluster-random sampling strategy. The Alcohol Use Disorders Identification Test (AUDIT) questionnaire, the Severity of Alcohol Dependence Questionnaire (SADQ) and 12-item version of General Health Questionnaire (GHQ12) were used to obtain epidemiological data on alcohol use disorders and to assess the severity of ‘problem drinking' and general mental health status.

Results: The AUDIT is a reliable and valid screening tool for both alcohol abuse and dependence. The cut-off points were set to be 10 and 13 of the AUDIT scores as a diagnostic discriminator of alcohol abuse and alcohol dependence, respectively, with both sensitivity and specificity >0.85. Among all 3171 participants, the prevalence of alcohol abuse was 2.7% (Female: 2.0%; Male: 6.2%), alcohol dependence 13.5% (Female: 7.6%; Male: 25.4%) and alcohol use disorders 16.2% (Female: 9.6%; Male: 31.6%). Age and sex were the main factors affecting an individual's alcohol use and their general mental health status.

Conclusion: The AUDIT could be used as a screening tool in the Tibetan population to identify individuals with alcohol use problems. The epidemiological data of alcohol use disorders documented in this project would be useful for future work leading to more firm causal inferences or interpretations related to this prevalent health problem in Tibet .

Key words: Alcohol use disorders, epidemiological survey, Tibet

This work was supported by a grant from the Department of Science and Technology , Sichuan , China

S26 - 中挪在精神科人 权和伦理学方面的合作 - Sino-Norwegian Cooperation on Human Rights and Ethical Dilemmas in Psychiatry

Chairs: Ma Hong, Chinese Mainland
Eline Thorleiffsson, Chinese Mainland

2003 年中 华医学会精神病学分会 （ CSP ） 和挪威医学会 （ NMA ） 决定在精神科人 权和伦理学方面进行合作。 2006 年中国医 师协会精神科医师分会 （ CPA ） 加入了 这一项目。

至今已 经举办了四次培训班。来自中国各地的 50 到 60 位代表参加了 这几次培训。针对中国和挪威的案例，在临床、伦理学和人权方面进行了深入探讨。该项目还包括两国人员间的学习互访，包括访问精神卫生机构。

虽然两国的精神卫生服务体系不同，但是都面临着类似的人权和伦理困境。这是很容易引起情绪波动甚至冲突的敏感话题。所以合作双方坦陈自己的缺点并且避免偏见和强硬态度是 很重要的 。 对培训班的评估表明大多数参会代表对培训满意。很多人表示他们可以在临床工作中应用所学到的内容。 案例 给了参会者们反思自己的实践和态度的机会。中国和挪威之间的合作已促进了双方从实践和经验方面互相学习。

Chinese Society of Psychiatry (CSP) and the Norwegian Medical Association (NMA) decided in 2003 to cooperate on human rights and ethical dilemmas in psychiatry. In 2006 the Chinese Psychiatrist Association (CPA) joined the project.

Four workshops have been held. Fifty to 60 participants representing all the regions in China have attended each of the workshops. The participants have discussed clinical, ethical and human rights issues based on cases from China and Norway . The project has also included mutual study visits to each country. The study visits have included visits to psychiatric institutions. Although the psychiatric health care systems in the two countries are different, both countries face similar human rights and ethical dilemmas. This is topics that can easily cause emotions and even conflicts. It is important that the collaborating parties are open on their own shortcomings and that they avoid prejudices and paternalistic attitudes.

The evaluations have suggested that the majority of the participants have been content with the workshops. Many have reported that they can apply what they learnt, in clinical settings. The cases gave the participants an opportunity to reflect on their own practice and attitudes. The collaboration between China and Norway has stimulated the parties to learn from each others practice and experience.

S26-1

合作项目的背景 - Background of Cooperative Program

Dongfeng Zhou 1 , Eline Thorleifsson 2 , Bj?rn Oscar Hoftvedt 2 , Xin Yu 2

1 Peking University Institute of Mental Health, Beijing, Chinese Mainland, 2 Mental Health Institute, Second Xiang-Ya Hospital, Central South University, Changsha, Chinese Mainland

国 际上对中国的精神卫生现状长期缺乏 了解。当 2000 年美国哥 伦比亚大学亚洲司法杂志发表关于中国精神病学政治滥用文章后 ， 引起了国际上的关注。由于中国还没有国家精神卫生法，同时精神病学学科发展水平地域差异极大，因此在全国不同地区不同级别的医院里，在精神卫生服务中，专业人员遵守医学伦理学和保护患者权益的情况差别较大。因此，亟待提高精神科临床医师们的有关知识，继续医学教育是一个主要的途径。

挪威的国家精神 卫生法历史久远，在人权与伦理学方面做了许多工作，尤其对人员培训有丰富的经验。从 2003 年始，挪威外交部 给挪威医学会拨专款与中华医学会精神病学分会合作开展人员培训。到 2006 年，中国医 师协会精神科医师分会参与此合作项目。

The world knew little about mental health status in China for a long period of time. When a paper regarding political abuse of psychiatry in China was published on Columbia Journal of Asian Law in 2000, human rights in China was attended internationally. Since China hasn't had national mental health law yet, and there is great disparity of development of psychiatry in different areas, principles of medical ethics and protection of patients' rights in mental health services are followed differently in various levels of psychiatric hospitals in different areas. Therefore, it's urgent for psychiatrists to improve relevant knowledge, and continuing medical education is a main way of reaching this objective.

Norway had its first national mental health act in 1848, has been doing lots of work in protection of human rights and ethics, and is especially experienced in training. Since 2003, Norwegian Ministry of Foreign Affairs has provided financial support to Chinese Society of Psychiatry to conduct trainings for psychiatrists. In 2006, Chinese Psychiatrist Association joined this cooperative program.

S26-2

对培训的组织 - Organization of Training

Ma Hong 1 , Bj?rn Oscar Hoftvedt 2 , Xie Bin 3 , Jin Liu 1 , Eline Thorleifsson 2 , Dongfeng Zhou 1 , Xin Yu 1 , Hongyu Tang 1 , Yifeng Xu 3 , Wei Hao 2 , Xiaoping Wang 2 , Ming Li 2 , Yang Gao 1

1 Peking University Institute of Mental Health, Beijing, Chinese Mainland, 2 Mental Health Institute, Second Xiang-Ya Hospital, Central South University, Changsha, Chinese Mainland, 3 Shanghai Mental Health Center, Shanghai, Chinese Mainland

目的 ： 探 讨通过固定人群培训建设专业立法宣讲队伍的可行性。

方法 ： 选择 50 名来自全国各省有相 关背景的、正在从事司法精神病鉴定或者从事医疗纠纷处理的人员参加。进行连续 3 年的培 训。讲员来自中挪双方，事先集体备课。互动式教学为主，集中授课与家庭作业相结合，讲演比赛提供标准幻灯片并鼓励学员发挥。第 3 次培 训有数名学员主动针对一个有纠纷的案例进行了角色扮演。

结果： 两年培 训已经有 7 人参加了立法宣 传试讲，其中 4 人基本达到能准确理解中国精神 卫生法（草案）和顺畅演讲。

结论： 固定人群培 训可以在短期内为我国培养出一支专业知识丰富，同时具有讲解能力的立法宣传队伍。

Objective: To explore the feasibility of establishing a professional legislative advocacy team by training a specific group of people.

Methods: Chose 50 trainees who had relevant background and had been engaging in forensic psychiatric appraisals or handling medical dissension to participate 3-year consecutive trainings. Trainers from both China and Norway had collective preparation for lessons beforehand. The whole training process was based on interactive teaching, integrative focused lessons and assignment as well as provision of standardized slides for teaching competition and encouraging trainees to bring their individual talent into play. Role play of an medical dissension was performed voluntarily by several trainees.

Results: During the past two years' training, seven people had participated in the teaching trial of legislative advocacy, and four of them had basically reached the standard of correctly understanding Chinese mental health legislation (protocol) and could give fluent speeches.

Conclusion: By training a specific group of people, it can help cultivate a legislative advocacy team with professional knowledge and capability of speeches.

S26-3

中挪精神卫生立法、伦理与人权合作项目 . II 项目内容 - Sino-Norwegian Cooperative Program on Mental Health Legislation, Ethical Dilemmas and Human Rights in Psychiatry. Part Two: Contents of the Program

Xie Bin 1 , Ma Hong 2 , Eline Thorleifsson 3 , Bj?rn Oscar Hoftvedt 3 , Dongfeng Zhou 2 , Xin Yu 2 , Hongyu Tang 2 , Yifeng Xu 1 , Jin Liu 2

1 Shanghai Mental Health Center, Shanghai, Chinese Mainland, 2 Peking University Institute of Mental Health, Beijing, Chinese Mainland, 3 Mental Health Institute, Second Xiang-Ya Hospital, Central South University, Changsha, Chinese Mainland

合作 项目的内容大致上可以分为 3 个模 块 ：

模 块 I 的目 标是介绍精神科领域的伦理、人权与立法的基础概念和基本原则。这包括知情同意、自愿与非自愿入院、保密以及保护患者的隐私和自主权。教师与学员之间在提供的案例基础上就不同国家间的社会与文化差异进行了深入讨论。

模 块 II 的目 标是让参与者思考如何在日常工作中履行相关国内外准则予法律条款，并保护患者的权益。经常会邀请律师、法官以及其他相关专业人士参与教学讨论以提供不同视角的观点。该模块中最具价值的就是案例讨论。

模 块 III 的目 标是根据国际公认的准则和中国精神卫生服务现状建立一个平台，以完善起草中的全国性精神卫生法并讨论一些已经颁布的地方精神卫生条例。

根据 对该项目的不同检验和评估，其内容的安排在实现上述目标方面获得了成功。

The contents of this program could be roughly clarified into 3 modules as follows: Module I was aimed to introduce the basic concepts and fundamental principles of ethics, human rights, and legislation in the field of psychiatry. Such include informed consent, voluntary and involuntary admission, confidentiality, and protection of patient's privacy and autonomy, etc. The social and cultural differences between different countries were discussed among participants and the teachers in detail, usually based on the presentation of cases.

Module II was aimed to let participants think about implementation of the national and international principles and legal provisions into their daily practice and how to protect the patient rights. Layers, judges and other relevant professionals were usually invited to take part in teaching or discussion activities for providing different view of opinions. Case discussion was mostly valuable in this module. Module III was aimed to provide a useful platform for polishing the ongoing drafted national mental health legislation and for discussing some enacted local legislation, according to the international accepted principles and the situation of Chinese mental health service. According to the different tests and evaluations about this program, the arrangements of the contents are generally successful in achieving the goals.

S26-4

合作项目的结果和意义 - Results and Consequences of Cooperative Program

Jialong Yi 1 , Dongfeng Zhou 2 , Eline Thorleifsson 1 , Bj?rn Oscar Hoftvedt 1 , Xie Bin 3 , Ma Hong 2 , Xin Yu 2 , Hongyu Tang 2 , Yifeng Xu 3 , Jin Liu 2

1 Mental Health Institute, Second Xiang-Ya Hospital, Central South University, Changsha, Chinese Mainland, 2 Peking University Institute of Mental Health, Beijing, Chinese Mainland, 3 Shanghai Mental Health Center, Shanghai, Chinese Mainland

该合作项目是在中国首次对精神卫生立法、精神科人权和伦理学进行的培训。在此前 ， 大学虽然有伦理学课程 ， 但是没有精神病学的伦理学课程。各地执行伦理规范的情况也非常不统一。 以 连续培训的方式逐步从学习过渡到试讲，为全国范围内的大规模精神卫生立法宣传培养了讲员和宣传员。 参加培 训的有精神病院高层管理人员，使得中国的精神卫生机构越来越多地建立开放病房，能较好执行自愿和非自愿治疗所应当遵守的伦理学规定，推动了我国精神卫生领域在保护患者权益方面的进步。 参加培 训的年轻精神科医师提高了伦理学水平和处理与法律有关问题的能力 ， 对解决实际问题有很大的帮助。 推 动了国内精神卫生立法工作的进展，在 3 年内 陆续出台了 4 部精神 卫生地方法规，对国家精神卫生立法也有很好的推动作用。 加深了国 际上对中国精神卫生现状和进步情况的了解，使国外同行更愿意与中国同行进行有关学术交流与合作。

This cooperative program was the first training on mental health legislation, human rights and ethics in psychiatry in China . Before this program, though there is ethical course in colleges and universities, ethics in psychiatry is not included. In addition, disparity in following principles of ethical standards in different areas does exist. By consecutive training model, the trainees experienced transition of roles as learners to speakers, which helps to train speakers and advocators for large scale advocacy for mental health legislation nationwide. Some trainees were administrators at psychiatric hospitals. When they went back to work, they set up more and more open wards, and they are following ethical principles towards voluntary and involuntary treatment more closely. This also improves protection of patients' rights in mental health field in China . The young trainees have improved their understanding of ethics and the ability to solve relevant legal problems, which is helpful for dealing with practical problems. This program contributed to progress of mental health legislation in China . In the past 3 years, 4 local mental health acts have been enacted, and national mental health legislation has been pushed forward. Finally, this program deepened understanding of situation and advancement of mental health by the world, and helped international colleagues become more likely to cooperate with Chinese people to have academic exchange and joint programs.

S27 - 亚洲文化下的心理社会康复 ： 学习西方模式、发展亚洲模式 - Psychosocial Rehabilitation in Asian Cultures: Learning from the Western Model and developing an Asian Model

Chairs: Tae-Yeon Hwang, Korea , Republic of
Francis Lu , United States

在 WPA 地区会 “ 全球化与精神 卫生 ” 的主 题之下 ， 我们将讨论如何在亚洲的文化背景之下采用西方的心理社会康复方式。三位分别来自韩国、日本和中国的讲者将展示如何在各自领域实施心理社会康复计划，以及如何根据本地的实际情况对原本的计划进行修正。最后一名发言人 ， Chee Ng 博士将于大家分享 对亚洲精神卫生专业人员进行心理社会康复培训的经验以及在其他亚洲国家推广澳大利亚心理社会康复计划的可行性。

Under the theme of the WPA Regional Meeting, ? Globalization and Mental Health′, we will discuss adoption of Westernized PSR to Asian culture. Three speakers from Korea , Japan , and China will present the actual practice of PSR programs in their field and how they adopt and modify the original program to their local situation. The last speaker, Dr. Chee Ng will speak his experience of training PSR to Asian MH professionals and feasibility of dissemination of Australian PSR in other Asian countries

Korea : Tae-Yeon Hwang

Development of Model PSR programs in Korea

China : Dr. Xue Zhi Qiang

Development of community psychological rehabilitation in Shanghai

Japan : Dr. Junichiro Ito Cultural Accommodation of ACT to Japan

Australia : Dr. Chee Ng

Training programs in PSR: applications for Asia-Pacific.

S27-1

在韩国发展心理社会康复（ PSR ）项目 - Development of Model PSR programs in Korea

Tae-Yeon Hwang 1

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

精神残疾者面 临众多的挑战 ， 包括社会、个人、精神病、就业和资金等方面。他们还需要在发展技能获的帮助，以满足日常生活的需求，实现生活独立的目标。因此韩国的精神卫生专业人员借鉴源自欧美的西方模式发展出自己的心理社会康复计划。 纽约的泉水屋模式在 1986 年被 Taiwha 医院所采 纳，并在首尔的市区开张。精神病院的精神康复中心热衷于发展许多 PSR 计划用于帮助慢性精神病患者恢复机能。借鉴自加州大学洛杉矶分校的社会技能训练模式被一家精神病院采用并与 1990 年代早期在全国范 围内被推广。在 1995 年 颁布精神卫生法后，大量受过训练 的精神 卫生专业人员加入到迅猛发展的社区精神卫生中心中，如今全国又超过 140 家社区中心。所有的社区中心都提供 PSR 计划，包括生活自主技能锻炼、心理教育、家庭教育、职业康复项目，这些源自西方的 PSR 计划模式已经有了多个韩国版本。 以医院 为基础的 PSR 计划也在精神病院得到发展。一个例子是 Gyeonggi 道的 Yongin 精神康 复中心。他们从 1991 年起 开始了独特的职业康复模式，帮助慢性精神疾病出院患者回归社区，并帮助他们就业以获得生活自主。 西方 PSR 模式的本地化在 韩国获得了成功 ， 现在可以对这些韩国的 PSR 计划作一 个 评论。

Peoples with psychiatric disability are challenged by wide variety of needs that include social, personal, psychiatric, vocational and financial aspects. They also need assistance in developing skills to meet demands of daily living and grow toward independent living that mental health professionals of Korea have developed psychosocial rehabilitation learning from Western Model developed in United States and Europe . Fountain House model of New York was adopted in 1986 that Taiwha FH was opened in downtown Seoul . Psychiatric rehabilitation centers in Mental Hospitals were enthusiastic to develop many PSR program for recovery of functioning of people with chronic mental illness. Social Skills training was adopted by one mental hospital from UCLA module and disseminated nationwide in early 1990. After promulgation of Mental Health Act in 1995, trained mental health professionals contributed to rapid increasing number of community mental health centers, which are now more than 140 nationwide.

All the CMHCs are providing PSR programs for the consumers such as independent living skills training, psychoeducation, family psychoeducation, vocational rehabilitation program, which are modified from Western Model that there are many Korean Model PSR programs. Hospital-based PSR program was also developed in mental hospitals. One example is Yongin Psychiatric Rehabilitation Center in Gyeonggi Province . Unique vocational rehabilitation model started in 1991 and it contributed to discharge people with chronic mental illness into the community and assist independent living of them with their jobs.

Local accommodation of Western Model of PSR was successful in Korea and now we can observe many Korean Model of PSR program.

S27-2

Development of Community Psychological Rehabilitation in Shanghai

Xue Zhi Qiang

Shanghai Hongkou District Mental Health Center , Shanghai , Chinese Mainland

目的 ： 1 、促 进精神疾病患者心理社会康复、回归社区。 3 、探索上海社区中 开展精神疾病心理社会康复的有效模式。

方法： 1 ， 2005 年 试点对社区精神疾病患者进行社会技能训练的方法，该方法为北京首都医科大学安定医院翁永振教授从美国引进开发。我们培训了社区卫生服务中心的精神科专职医师，并且组建了数十支训练队伍。 2 ，在中国 传统文化中，病人往往与家属一起生活。所以我们从社区康复病人和他们的家属中征集精神卫生志愿者， 为其他病人和家庭服务。 3 ，我院一名 专家前往澳大利亚墨尔本学习社区精神疾病团队服务的模式，并且多人参加了国家疾控中心组织的墨尔本社区精神卫生专家个案管理员培训班，从而在我区开始建立以社区卫生服务中心精神病防治医师为骨干的个案管理员队伍。 4 ，我 们建立了社区精神卫生的主动式社区治疗团队。团队成员包括了精神科医师、护士、志愿者、心理治疗师、社区民警、居委会、全科医师、精神障碍自助团体 等。在个案管理 员针对各病人制定的个体服务计划基础上，团队成员提供以下服务：免费服药（上海市政府提供）、社区心理咨询、社会技能训练、健康教育、紧急住院、日间康复站看护等。

结果 / 效益 评估 : 1 ， 该项目使得我区政府部门对社区精神卫生工作加大了财政和行政上的支持，例如于 2006 年 组建了虹口区心理卫生学会，为基层社区精神卫生工作者提供专业指导。 2 ，社区精神 卫生服务队伍服务队伍加强，服务理念转为病人需求为导向，服务目标从疾病治疗转向心理社会康复。 3 、近几年，我 们加强了对社区居民的心理健康教育，形式有现场咨询、地 方 电视台、海报和版面巡展以及报纸。 4 ，在我 们努力下，我区在过去两年内没有精神病患者的肇事肇祸事件发生。 5 ，从我 们的部分研究数据显示通过个案管理服务精神疾病患者能够改善精神症状和社会功能，降低药物副反应等。结论 : 通 过整合社会资源尤其是政府、警察、家属等，在上海能够推广和提高针对社区精神疾病患者的心理社会康复服务。我们在针对精神障碍患者的主动式社区治疗服务中取得了进展。

Object:

1. To improve the mental disorder patients' social psychological rehabilitation and back to community.

2. To explore the effective mode of psychosocial rehabilitation in Shanghai .

Method:

1. we try the intervention method on community mental disorder patients' psychosocial rehabilitation from 2005, a social skill training program which introduced from USA by professor Weng of Beijing Capital Medical University. we trained the community doctors which are the GPs specializing in community mental health, and organized some teams of social skills training.

2. According to Chinese culture, patients are used to live with some family members. So some mental health volunteers are recruited from community patients and their families, who service for other patients and families according.

3. An expert of our hospital visited Melbourne to learn the community mental health service teams, and some staff members received the training on case manager specializing in community mental health given by some experts from Melbourne . We had organized case manager teams.

4. we tried to organize ACT teams specializing in community mental health service. The members included psychiatrists, nurses, volunteers ， psychological therapists, community polices, the staff of residents' committee, GPs, mental disorders' self-help groups, etc. Base on the Individual Service Plan given by case managers, the teams give the following services such as free drug given by Shanghai government, health education, community psychological counseling, the social skill training, emergency hospitalization, daytime rehabilitation stations, etc.

Outcome:

1. The government of our district support community mental health development by finance, administration and establishing the Hongkou district mental health association in 2006, which gave the community mental health staff professional directions.

2. The staff of community mental health services was strengthened in members and service ideas directed by patients need. Our focus object shifted from medical treatment to psychosocial rehabilitation.

3. During recent years, we enhanced mental health education to community residents by field counseling, local TV, printed sheet and newspapers.

4. For our efforts, none of the patients caused trouble during the last 2 years.

5. Based on some data, we found that the mental disorder could ameliorate in psychiatric symptoms, social function and decrease the side effect form drug for case management.

Conclusion: It can extend the PSR services for the community psychosis patients and improve its quality in Shanghai , integrating with the kinds of social sources especially as government ， police and family members. We made progress in ACT for mental disorder patients in Shanghai .

S27-3

在日本文化中实施 ACT 的文化融合问题 - What Are the Cultural Accommodation Issues when We Implement ACT in Japanese Culture?

Junichiro Ito 1

1 Japan National Institute of Mental Health, Tokyo , Japan

自主社区治 疗 (ACT) 以多学科 团队的形式向重性精神病 (SMI) 患者提供全面支持 ， 这被公认是有实证基础的模式。 日本的第一个 ACT 团队 (ACT-J) 起始于 2003 年日本 NIMH 的一个研究 计划。当 ACT-J 计划以 DACTS 评分的良好再现而被建立时，其通过降低重性疾病患者住院天数的良好结局显示出该项目的效果。 近年来，受到 ACT-J 的刺激，日本的一些 诊所和精神卫生中心都设立了 “ACT 团队 ” ，他 们试图开展社区精神卫生体系。在实施 ACT 的 过程中，我们必须考虑调整计划以适应我们的文化和体系，虽然保持计划原有的结构与运作是必需的。 当我 们试图开展 ACT 时，精神卫生历史、预算以及教育体系等诸多方面的差异，当然会影响计划的动机、结构、功能和管理体系。 当然，在我看来 试图在亚洲国家建立 ACT 时理解 ACT 的根本使命和思想体系是最重要的。如果 ACT 的工作人 员相要发展以人为中心的服务而非以疾病为中新的服务，那么理解康复的概念就尤其关键。 强 调康复的重要必须是全球性的标准。

Assertive Community Treatment (ACT) provides comprehensive supports for people with severe mental illness (SMI) by multidisciplinary outreaching team, which is well known as one of the Evidenced Based Practices.

The first ACT team in Japan (ACT-J) has started at Japan NIMH as a research project since 2003. ACT-J project has shown us an effectiveness of its program by showing a good outcome of decreasing hospitalization days for people with SMI in Japan when the team was established with good enough fidelity score measured by DACTS. In recent years, being stimulated by ACT-J, some clinics and mental health centers in Japan have established “ACT teams” and they have tried to develop the community based mental health systems. In the process of implementing ACT, we should consider to accommodate the program to our own culture and systems although we know the importance of high fidelity structure and function.

The differences of the history of mental health, the budgeting, and the educational system etc., of course must influence the motivation, structure, function, and management systems when we try to start ACT.

However, understanding the fundamental mission and philosophy of ACT is the most important thing I think when we try to establish ACT in Asian countries. Especially understanding the concept of RECOVERY must be the key for the ACT staff, who want to develop the person-centered services instead of illness-centered services. The importance of RECOVERY must be a global standard.

S27-4

PSR 培训项目：在亚太地区的应用 - Training Programs in PSR: Applications for Asia-Pacific

Chee Ng

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

精神 卫生改革已经表明大量的精神卫生问题可以在社区得到处理 ， 这使得心理社会康复与回归社会得到最优化。毫无疑问 ， 训练有素的工作人员的短缺依然是一个挑战 ， 目前 日益需要受 过培训的工作人员在社区处理精神卫生问题。通过与地区伙伴合作，我们已经开展了专门的训练项目，通过专门教育以及接触心理社会服务模式来帮助精神科医师、护士以及合作的健康工作人员提高能力与专门技能。在此基础上，亚洲 - 澳大利 亚精神卫生和 POST 项目提供的计划的目标是在那些资源短缺的地区改善精神卫生服务。通过地区性的国家合作，培训项目相互发展并且在计划时纳入了各类专家的意见，包括临床、管理、政府和社区等方面，以促进扩大容量以及发展地区性培训中心。为了有效地将最新的知识转入应用 ， 在培训与项目执行方面的国际性合作 与 协作关系对于促进更好的精神卫生服务以及心理社会服务是必不可少的。

Mental health reforms have shown that large proportion mental health problems can be treated at a community level which can optimize psychosocial rehabilitation and social reintegration. Nonetheless, shortage of trained staff remains a challenge and there is a need to increase number of staff trained to assess and treat mental health problems in the community. Specific training programs have been developed in collaboration with regional partners to enhance capacity and specialist skills that provides specialist training and exposure to psychosocial models of care for psychiatrists, nursing and allied health staff in mental health. Building on this, programs delivered by Asia-Australia Mental Health and POST Program aim to improve mental health care in the region including where resources are lacking. In collaboration with regional countries, training programs are mutually developed and are designed for a range of expertise including clinical, managerial, governmental and community roles that promotes capacity building and the development of local training centres. In order to effectively translate current knowledge to useful applications, international collaboration and cooperative links in training and implementation programs are essential to promote better mental health care, and psychosocial service delivery.

S28 - 研究前沿 - Research Frontier

Chairs: Jizhong Huang, Chinese Mainland
Jingping Zhao, Chinese Mainland

S28-1

精神分裂症，代谢综合征和糖尿病：了解精神病患者的代谢隐患 - Schizophrenia, the Metabolic Syndrome, and Diabetes: Understanding the Implications of Metabolic Health in Psychiatric Patients

Dan W Haupt 1

1 Washington University School of Medicine, Department of Psychiatry, St. Louis , United States

精神分裂症患者心 脏代谢紊乱的危险因素多于一般人群 ， 这可能与较高的心血管疾病的发病率有关。另外 ， 抗精神病药物的使用 ， 使原本存在的心脏代谢的危险因素变得更加复杂。肥胖、糖尿病和代谢综合征与心脏疾病的危险因素相互作用，前者可由抗精神病药物引发，也可因抗精神病药物的使用更加严重。改善精神分裂症患者的健康结局需要综合性药物监管，尽量减少心脏代谢疾病的发生。

Schizophrenia patients tend to have more cardiometabolic risk factors than the general population, likely contributing to their greater rates of cardiovascular morbidity. In addition, antipsychotic medications can worsen preexisting cardiometabolic risk factors. Obesity, diabetes, and the metabolic syndrome are interrelated risk factors for heart disease that can originate from or be exacerbated by antipsychotic treatment. Improving health outcomes in schizophrenia patients will require integration of pharmacologic management with attention to minimizing cardiometabolic risk.

S28-2

急性精神应激对 SD 大鼠部分脑区 BDNF 、 CREB 表达的影响 - The Effects of Mental Stress on Expression of BDNF and CREB in Some Brain Regions of Sprague-Dawley Rats

Gongying Li 1

1 Hospital of Jining Medical College , Shandong , Chinese Mainland

目的 ： 研究精神 应激后部分脑区内 BDNF 、 CREB 蛋白及 mRNA 表达的 时序性变化 ， 探讨 BDNF 对精神应激的保护作用及其机制。

方法 ： 采用旁 观电击大鼠应激模型 ， 将雄性 SD 大鼠随机分 为精神应激组 （ PS 组 ） 、生理应激组 （ PH 组 ） 、空白对照组 （ Control 组 ） 。以旷场实验、高架十字迷宫实验评估大鼠焦虑行为，用免疫组织化学、原位杂交技术，观察精神应激后多个脑区内 BDNF 、 CREB 蛋白及 mRNA 不同 时点的表达。

结果：

1 ． 旷场实验：外周格数、中央格数、以及修饰数， PH 组均低于 PS 组， PS 组低于正常对照组；高架十字迷宫实验：开放臂次数以及开放臂时间 PH 组最低， PS 组居 中，正常 对照组最高。

2 ．精神 应激后即刻，各脑区 BDNF 蛋白及 mRNA 表达均明 显下调，灰度值明显高于对照组；精神应激后 0.5h 、 1h BDNF 蛋白及 mRNA 表达 开始恢复，但少于对照组；精神应激后 2h 各 脑区 BDNF 蛋白及 mRNA 表达恢 复至对照组水平（ VTA 区 BDNF mRNA 表达除外），无差异 显著，精神应激后 6h BDNF 蛋白及 mRNA 表达 继续增高，明显高于对照组（ VTA 区 BDNF mRNA 表达除外）；精神 应激后 24h BDNF 蛋白及 mRNA 表达达最高，明 显高于对照组（ VTA 区 BDNF mRNA 表达除外）； VTA 区 BDNF mRNA 表达至精神 应激后 24 h 低于 对照组， VTA 区 BDNF 蛋白和 mRNA 表达二者不一致。

3 ． 应激后即刻， PH 组 BDNF 蛋白及 mRNA 在各 脑区呈高表达，心理应激组呈低表达， PH 组灰度值明显低于心理应激组。应激后 24h 时， BDNF 蛋白表达除 CA3 区、 BDNF mRNA 表达除 PAG 区外， BDNF 蛋白和 mRNA 在其余各 脑区表达仍是 PH 组高于 PS 组。

4 ． 应激后即刻， PS 组 P-CREB 及 CREB mRNA 表达 较对照组明显减少；随后二者表达逐渐增多，精神应激后 24h 时， PS 组 P-CREB 及 CREB mRNA 表达 较对照组明显增多。

5 ．精神 应激后即刻、精神应激后 24h 各 脑区 BDNF 蛋白与 P-CREB 灰度 值相关（ P 均＜ 0.05 ），精神 应激后即刻、 24h BDNF mRNA 与 CREB mRNA 灰度 值相关（ P 均＜ 0.05 ），二者存在 时空相关性。

结论： 旁 观电击大鼠应激模型能产生明显的精神应激； BDNF 对精神应激有保护作用，其参与了机体精神应激状态下的 “ 异 稳态平衡 ” ， BDNF 保 护作用的发挥可能是通过 CREB 路径 实现的。

Objectives: To study the pattern of changes of brain-derived neurotrophic factor (BDNF) and cAMP response element binding protein(CREB) gene expression in some brain regions after mental stress, and to further explore the protective effects and mechanisms of BDNF on the mental stress.

Methods: We applied the Communication Box to establish animal model of mental stress ,and assessed the rats anxiety behavior through the Open field test and elevated plus maze test, then used both in situ hybridization and immunohistochemistry techniques to measure the expressions of both BDNF and CREB in some brain regions, such as CA1,CA3, dentate gyrus (DG)of hippocampus, prefrontal cortex (PF) ， central amygdaloid nuclei (AG), shell of accumbens nucleus (NAC), periaqueductal gray (PAG), ventral tegmental area (VTA) and Dorsomedial hypothalamic nucleus (DM).

Results: 1. The expression of both BDNF protein and BDNF mRNA were significantly decreased at the oh after mental stress, the gray intensity of BDNF protein and mRNA in mental stress group were very significantly higher than that of control group; Then both BDNF protein and mRNA have restored at 0.5h, 1h after mental stress, but still lower than the control level; There were no significant difference in almost regions(other than the BDNF mRNA in VTA region) between mental stress group and control group at 2h after mental stress; The expression of BDNF protein and mRNA continuously increased at 6h after mental stress(other than the BDNF mRNA in VTA region), and above the level of control group; Then reached to the peak at 24h after stress. The expression of BDNF mRNA of mental stress group was still lower than the level of control group in VTA at 24h after stress.2.At the 0h after stress, the expression of BDNF protein and mRNA were higher in all brain regions in physiological stress group, but lower in mental stress group, the gray intensity were significantly lower in former group than that in later group;At the 24h, the expression were also similar in majority regions except BDNF protein in CA3 and BDNF mRNA in PAG. 3. At the 0h after stress, the expression of P-CREB and CREB mRNA in mental stress group were significantly decreased than that in control group, but at the 24h , the both levels were significantly increased. 4. The gray intensity of BDNF were significantly correlated with that of P-CREB at both 0h and 24h after stress, and the BDNF mRNA were also significantly correlated with the CREB mRNA,and the BDNF and CREB have spatio-temporal associativity. Conclusions:The Communication Box model could induce obvious mental stress, BDNF could bring about protective effects on mental stress, which were involved in the hetermeostasis of mental stress,the protective effects of BDNF were realized may be through CREB pathway.

S28-3

急性期精神分裂症返回抑制时间进程的初步研究 - Pilot Study of Inhibition of Return in Acute Schizophrenia

登堂 刘 1

1 上海市精神 卫生中心 , 上海市 , Chinese Mainland

目的 ： 探 讨急性期精神分裂症返回抑制时间进程的基本属性。

方法 ： 30 名健康志愿者及 41 例符合 ICD-10 精神分裂症 诊断标准的急性期患者分别接受线索 - 靶子 实验。靶子位置的 2 个水平分 别为线索化位置和非线索化位置。线索开始呈现到靶子开始呈现的时间间隔（ SOA ）的 9 个水平分 别为 300ms,400ms, 500ms, 600ms, 700ms, 800ms,1200ms,1500ms 和 2500ms 。 记录被试的反应时和错误率。

结果： （ 1 ） 经重复测量方差分析，发现分组因素的主效应显著（ P=0.000 ），健康 对照组的平均反应时（ 365ms ）短于精神分裂症患者的平均反 应时（ 521ms ）。靶子位置的主效 应显著（ P ＝ 0.000 ），靶子在 线索化位置的反应时（ 458ms ） 长于非线索化位置的反应时（ 428ms ）。 SOA 主效 应不显著。两因素或三因素交互作用均不显著（ P>0.05 ）。（ 2 ）健康 对照组在所有 SOA 水平上靶子在 线索化位置的反应时均长于非线索化位置的反应时（ P 均 <0.01 ）。（ 3 ）精神分裂症患者在所有 SOA 水平上靶子在 线索化位置的反应时均长于非线索化位置的反应时， SOA 为 400ms ， 700ms 和 2500ms 时的差异有显著性（ P<0.05 ）； SOA 为 600ms ， 800ms ， 1200ms 和 1500ms 时的差异有非常显著性（ P<0.01 ）；而 SOA 为 300ms 和 500ms 时的差异无显著性（ P>0.05 ）。

结论： 急性期精神分裂症患者的返回抑制延 迟出现， SOA600ms 以后出 现稳定的返回抑制。 基金 项目：上海市精神疾病临床医学中心重点项目（ K-04-2 ）；上海市 卫生局科研课题项目（ 024036 ）和上海市 优秀青年医学人才培养计划项目。 作者 单位： 1 、上海市精神 卫生中心 200030 ； 2 、 复旦大学附属华山医院精神医学科 200040 ； 3 、 华东师范大学心理学系。 通信作者 ： 徐一峰 （ hyyyyb@online.sh.cn ） .

S28-4

负性图片重复刺激对抑郁症患者脑活动影响的 fMRI 研究 - Impact of Repetitive Aversive Picture Stimulation on brain activity of Depression disorder: A fMRI study

Qingwei Li 1

1 Tongji Hospital , Tongji University , Psychosomatic Medicine, Shanghai , Chinese Mainland

Objective: Depression patients show the character of intolerance and persisting strength to negative stressful events. Beck cognitive model also hint depression patients express induced and strengthened learned hopelessness and despair by negative stressful events. This study was to primarily explore the possible mechanisms processing negative emotion in depression.

Methods: Group-designed case-control study. 10 depression patients met with the depression criterion of DSM- Ⅳ were outpatient of Tongji Hospital , while 10 healthy people from the community around the hospital. All subjects were right handedness and written informed consent were get. The task is designed as Block, which included 5 ones and‘ ＋ 'as baseline. The uniform 16 pictures selected from International affective Picture System were randomly arranged in every block. Each picture presented 3 seconds and one block 48 seconds. The baseline between two consecutive block presented 24 seconds. The whole task spanned 7 min and 36 seconds showed by E-prime software. The pictures were passively looked at. BOLD-EPI was collected by Marconi 1.5T MRI. All subjective were also evaluated using HAMD and AFNI was applied to analyze functional data.

Results: Two groups had no statistical difference in sex, age, marital status(p>0.05). Depression group showed higher scores of HAMD(27.7±5.8) than control groups(1.8±1.3)(P<0.05) ； Scores of valence of the IAPS pictures between the depression and control group had no significant difference (P>0.05). ⑵ Comparing the activity in the pre- and post- repetitive stimulation ， depression group showed stronger activity in right medial prefrontal gyrus;right cingulate gyrus ； Healthy groups showed no difference between the pre- and post- stimulation.

Conclusion: Depression patients showed the abnormal right medial prefrontal gyrus and right cingulate gyrus. It inferred the abnormal tendency on habituation during processing negative information in depression patients.

S28-5

恢复期老年抑郁症认知损害：从神经心理学测量到结构和功能磁共振研究 - Convalescence Agedness Depression Cognitive Impairment

Yonggui Yuan 1 , 张志珺 , 宇 辉 , 施咏梅 , 柏峰 , 钱云 , 尤加永 , 刘文

1 Nanjing Medical University , Nanjing , Chinese Mainland

研究背景 ： 老年抑郁症 (Geriatric depression, GD) 在 60 岁以上老年人群患病率高达 15% ， 60% 伴有 认知损害。本课题组的前期研究已证实， GD 患者 轻度认知损害（ MCI ）的 发生率为 46.7% （ 28/60 ），随 访 2 年后伴 MC 者 发展为痴呆者占 14.3% （ 4/28 ）， 显著高于不伴 MCI 者 [3.1% （ 1/31 ） ] 。 Bhalla 等 对 56 例 晚发性抑郁症患者随访 1 年后 发现，尽管抑郁症状已完全缓解，但 45% 患者仍存在 认知损害（主要包括视空间能力减退、信息处理速度减慢以及延迟回忆能力差），但确切机理尚未深入探讨。

目的： 本研究 结合应用神经心理测试与多模态神经影像技术探讨恢复期老年抑郁症 (RGD) 患者神 经认知特征、全脑灰质体积、白质纤维完整性和静息状态以及图片情节记忆提取任务时脑结构与功能的改变及其相关性。

方法： 采用 记忆和非记忆神经认知测试量表对 19 例 RGD ( 患者 组 ) 和 16 例正常老年人 ( 对照组 ) 进行神经心理学测试，量表包括简明智能状态检查（ MMSE ）、听 觉词语记忆测验延迟回忆（ AVMT ）、 Rey-Osterrich 复杂图形测验（ CFT ）、言 语流畅性测验（ VFT ； 动物类别）、画钟测试、符号数字转换测试、中文修订版的连线测试 A 、 B 和数字广度 测验。采用优化的基于体素的形态分析法（ OVBM ）和弥散 张量成像 (DTI) 技 术分别测定比较 RGD 患者和正常老人全 脑灰质体积改变以及白质纤维 (WM) 的完整性，并采用 fMRI 技 术分别测定比较静息状态下以及图片情节记忆 提取任 务状态下 RGD 患者与正常老年人 脑功能的差异。影像学检查未发现明显脑部结构异常后使用 SPM2 ( Statistical Parametric Maps, SPM) 软件进行图像处理。

结果： 1 、 RGD 患者的情 节记忆功能 [ 听 觉词语记忆测试（ AVMT ）的即刻回 忆和延迟回忆、 Rey 复杂图形延迟回忆）和执行功能（连线测验）均显著低于正常老人。

2 、 OVBM 结果显示， RGD 患者右 侧额上回 (BA6) 、右 侧颞中回（ BA21 ）和右 侧扣带回的灰质体积显著低于正常老年人，而左侧颞上回（ BA38 ）、左 侧扣带回 (BA24) 和双 侧扣带回后部（ BA23 ）的灰 质体积显著高于正常老年人（ P<0.001 ，未校正，体 积阈值 >50mm3 ）。

3 、 DTI 结果显示， RGD 患者在下列 脑区的分数各向异性（ FA ） 值显著低于正常老年人对照组 : 右 额上回，左额下回，左颞中回，右顶下小叶，右枕中回，左侧舌回，右侧壳核和右侧尾状核（ P<0.001 ，未校正，体 积阈值 >60mm3 ）。

4 、静息 fMRI 结果显示：与正常老年人相比， RGD 患者局部一致性（ ReHo ）降低的 脑区主要有双侧楔前叶（ BA7 ）、双 侧额上回（ BA11 ）、左 侧枕中回（ BA19 ）、右 侧颞中回（ BA21 ）、左 侧额中回（ BA9 ）、右 侧颞上回（ BA38 ）、右 侧中央后回（ BA5 、 2 ）和右 侧梭状回（ BA20 ）；局部一致性（ ReHo ）升高的 脑区主要有右侧苍白球、左侧钩回（ BA20 ）、右 侧额上回（ BA6 ）、左 侧壳核、双侧中央后回（ BA40 、 2 和 BA2 ）（ P<0.005 ，未校正，体 积阈值 >270mm3 ）。

5 、 图片情节记忆提取相关 fMRI 结果显示：（ 1 ）看新 图片时 RGD 患者 较正常老年人显著激活的脑区有左侧扣带回 (BA32) 、左 侧海马回 (BA34) 、左 侧颞上回 (BA39) ，正常老年人 较 RGD 患者 显著激活的脑区有左侧额中回 (BA46) 、左 侧额下回 (BA10) 、右 侧尾状核体部和左侧尾状核尾部；（ 2 ）在看旧 图片时 RGD 患者 较正常老年人显著激活的脑区有右侧额中回 (BA46) 和右 侧颞上回 (BA38) ，正常老年人 较 RGD 患者 显著激活的脑区有右侧旁中央小叶 (BA31) 和左 侧尾状核尾部（ P<0.005 ，未校正，体 积阈值 >270mm3 ）。

结论： 恢 复期老年抑郁症患者存在情节记忆功能和执行功能障碍；额叶、颞叶和扣带回的灰质体积减少和多个部位（额上回、壳核和尾状核）脑白质纤维的完整性破坏可能是情节记忆功能和执行功能障碍的生物学基础；在静息状态下 ， 额叶、颞叶和楔前叶的局部一致性（ ReHo ） 显著降低，而在观看新旧图片时，额叶、颞叶、海马区脑功能代偿性增强可能是恢复期老年抑郁症的神经影像学特征性标记。

S29 - Symposium of Substance Use Disorders of WPA 2007

Chairs: Jing Li, Chinese Mainland
Lin Lu, Chinese Mainland
Nora D. Volkow, United States

主席 ： 陆林教授 ， 李静教授 精神活性物 质滥用是全球性公害 , 很多国家从多个角度 开展了对精神活性物质滥用问题的科学研究 , 以期解决 这一世界性的难题。我国也不例外。海洛因是我国物质滥用者使用最多的成瘾物质。当今 , 全球毒品 滥用的突出趋势之一就是苯丙胺类中枢神经兴奋剂 (amphetamine-typestimulants,ATS) 的消 费急剧增加 , 尤其 东亚和东南亚国家 , 滥用者占全球 ATS 滥用者的 2/3 。在我国 ,ATS 的 种类主要是冰毒和 “ 摇头丸 ” 。 2005 年 1 月至 7 月，全国 缴获冰毒 2,182 千克、 摇头丸 37 万余粒、易制毒化学品 137 吨 , 与 2004 年同期相比 , 冰毒 缴获量、摇头丸缴获量、易制毒化学品缴获量分别上升了 9. 5% 、 54% 、 280% 。 20 世 纪 90 年代以来 , 甲基苯丙胺已成 为世界上流行最快、滥用最为广泛的中枢兴奋剂。根据国际禁毒署的统计 , 全球 滥用 人数已超 过 3,000 万人。据 2005 年《中国禁毒 报告》 , 吸食苯丙胺 类毒品和氯胺酮的人数已经占现有吸毒人数的 9. 5% 。新型毒品将成 为 21 世 纪主导毒品的趋势已越来越明显。

这类新型毒品是相对于鸦片、海洛因、大麻等传统毒品而言的一类毒品。它具有不需要种植 , 在化学 实验室里就可以合成的特点。根据毒品化合物的基本结构取代基位置和化合物的不同 , 新型毒品具有不同的 药理、毒理学性质 , 可分 为四类 : 第一 类以中枢兴奋作用为主 , 包括甲基苯丙胺、甲基卡西 酮、哌醋甲酯等 ; 第二 类以致幻作用为主 , 包括 4 - 溴 - 2,5 - 二甲氧基苯丙胺、 2,5 - 二甲氧基 - 4- 甲基苯丙胺、 氯胺酮 ( 俗称 “K” 粉 ) 等 ; 第三 类兼具兴奋和致幻作用 , 代表物 质是 3,4 - 亚甲二氧基甲基苯丙胺 (MDMA, 我国俗称 “ 摇头丸 ”) 、 3,4 - 亚甲二氧基乙基苯丙胺 (MDEA) 等 ; 第四 类是以抑制食欲为主 , 包括苯甲 吗啉、苯双甲吗啉、二乙胺苯丙酮、芬氟拉明及其右旋异构体右旋芬氟拉明等。

精神活性物 质的滥用可以导致成瘾，形成依赖。药物依赖是指药物和机体相互作用引起的身体和心理改变 , 为了再度追求药物引起的欣快感和避免停药后的痛苦戒断症状 , 而 长期反复地、持续地以 强迫性自我 给药为特征的脑疾病。大量研究表明 , 神 经递质系统如多巴胺递质系统、 5-HT 递质系统、谷氨酸递质系统和信号传递途径如 AC-cAMP-PKA-CREB 、 NO-cGMP 、 Ca2+-CaM-CaMK-CREB 等参与了 药物 ( 特 别是吗啡类 ) 依 赖性的形成。进年来在分子、细胞和神经系统的水平上都发现， NAcc －相 关回路中存在着由持续性药物刺激引发的神经适应性改变，从而被许多研究者认为是理解成瘾问题的关键所在。

目前我国 对于药物依赖的治疗主要是替代治疗、对症治疗和社会心理治疗。美沙酮门诊维持治疗也在逐步的开展。然 而，如何防止成 瘾复吸 , 一直是困 扰医学界的一个难题。药物疗法可以缓解戒断症状、抑制渴求、减少觅药行为 , 是治 疗成瘾的主要方法之一。另外，社会心理干预有益于使滥用者获得身心全面康复，并为最终回归社会和预防复吸奠定基础。

药物成瘾是一个亟待解决的社会医学问题。由于药物成瘾机制尚未完全明确，药物依赖患者的治疗仍在探索之中。随着科学技术的发展，尤其是基因敲除技术等先进技术的广泛应用与发展，人们已经从基因水平对药物依赖的机制做更加深入的研究，而治疗方法也会日趋完善。

S29-1

陆林教授，中国药物依赖性研究所所长 - Incubation of Drug Craving: From Molecular to Clinical. 北京大学中国药物依赖性研究所 - Role of ERK in Cocaine Addiction

Lin Lu 1

1 National Institute on Drug Dependence, Peking University , Department of Neuropharmacology, Beijing , Chinese Mainland

摘要 : 细胞外信号调节激酶 （ ERK ） 信号 转导途径参与突触可塑性以及学习和记忆的细胞过程。

在于可卡因的 奖赏和复吸有关的脑区如伏核和杏仁核 ， 这一途径可以被可卡因或可卡因相关线索激活 ， 而阻断 ERK 的激活可以减弱可卡因的精神运 动敏化作用和奖赏效应。最近的研究显示伏核 ERK 参与 药物线索相关记忆的巩固和再巩固过程，而且戒断后，在由线索诱发的可卡因觅药行为过程中（可卡因潜伏渴求），杏仁核的 ERK 呈 时间依赖性增高。 ERK 在可卡因行 为效应中的作用，可能包括由下游的转录因子介导基因表达的长时程改变，以及即时控制可卡因觅药行为的可被快速诱导的突触传递过程。

关键词　 ： 药物成瘾，细胞外信号调节激酶，可卡因， 多巴胺，谷胺酸， 记忆巩固，奖赏，复吸

Cocaine addiction is characterized by compulsive drug-taking behavior and high rates of relapse. Recent theories argue that this addiction is due to drug-induced maladaptive neuroadaptations in cellular mechanisms underlying normal learning and memory. Extracellular signal-regulated kinase (ERK) signaling is known to be involved in cellular processes underlying learning and memory. Evidence from rodent studies indicates a role of ERK in cocaine psychomotor sensitization, cocaine reward, consolidation and reconsolidation of memories for cocaine cues, and time-dependent increases in cocaine seeking after withdrawal (incubation of cocaine craving). ERK's role in these behaviors involves long-term stable alterations in synaptic plasticity that results from repeated cocaine exposure, as well as, rapidly induced changes in synaptic transmission events that acutely control cocaine-seeking behaviors. Pharmacological manipulations that decrease cocaine- or cocaine cue-induced ERK activity may be considered for cocaine addiction treatment.

Keywords: Drug addiction, extracellular signal-regulated kinase, dopamine, extinction, glutamate, reconsolidation, reward, reinstatement, relapse

S29-2

中国的新型毒品依赖和治疗摘要 , 四川大学华西医院心理卫生中心 - New Type Drugs Addiction and Treatment in China

Jing Li 1

1 Mental Health Center , West China Hospital of Sichuan University , Chengdu , Chinese Mainland

目前国内 滥用新型毒品的人数呈快速上升趋势 ， 新型毒品依赖已经成为一个紧迫的社会问题 ， 日益受到关注。报告总结了近 5 年来国内 关于新型毒品依赖的流行病学、 基 础、临床和防治的研究现况。分析新型毒品的使用种类、使用方法，滥用人群特征及流行趋势，总结了其神经和机体毒性的动物实验研究，具体临床症状表现、急性中毒救治策略，并探讨系统的治疗和防治策略。

The population of new type drug addict in China increasing rapidly recent years and related issues such as public health, criminals, young people affairs has resulted in concerns about increasing harms to individuals and the community. This report concludes the domestic research status of new type drugs addiction on epidemiology, basic, clinical and prevention in China . Types of drug, methods of abuse, feature of abusers and spreading trends are discussed while animal studies of neurotoxicity and physical toxicity, specific clinical symptoms, emergency medical treatment for acute poisoning and explores systematic treatment and prevention strategies are summarized.

S29-3

郝伟教授，中南大学湘雅二院教授卫生研究所 - Improving Drug Addiction Treatment in China. Drinking and Drinking-Related Problems in China

Hao Wei 1

1 Mental Health Institute, Second Xiangya Hospital, Central South University, and WHO Collaborating Center for Drug Abuse and Health, 长沙 , Chinese Mainland

中国是 经济发展最快的人口大国。近年来 ， 中国的酒消耗量及相关危害增加明显 ， 自从 2002 以来 ， 中国的啤酒 产量成为全球第一。不过，如果以纯酒精计算，白酒的消耗量仍是啤酒的四倍，成人人均饮酒量为每年 5.4 升 纯酒精。在南方许多省区，自酿酒的消耗占整个酒消耗量的 14.9% 。

中国人男性 较女性较多选择高度白酒，饮酒频度与饮酒量较高，因而与饮酒相关的问题发生率也较高。根据 WHO 保守估 计，在 1990 年，中国的酒相 关的死亡为 11.4 万，根据一 项 WHO 资助的 研究， 15 岁以上男性、女性三月饮酒率分别为 63.8% 和 18.3% ，整体三月 饮酒者比例为 43.5% 。

饮酒问题主要表现为急性酒中毒相关的问题，包括暴力、犯罪、经济问题、家庭问题等。饮酒相关的远期问题主要表现为躯体精神问题，公共卫生问题以及社会问题，已成为人们关注的重点之一，但这方面的研究甚少。

目前，我国 颁布了有关法律、管理条例，以降低酒相关危害，例如通过加税来降低消耗（特别是对高度白酒）、针对专卖、广告管理、酒后驾车等法律与管理条例。但仍需要对自酿酒的管理、酒销售地点与时间的管理等。我国目前还没有针对酒滥用 的 预防项目与计划，需要政府的协调机构来协调制定、实施、评估的政策与立法的工作，以减少酒的危害。

关键词： 饮酒、饮酒相关问题、酒政策、立法、流行病学

China is the most populate and fast advance country of the world. In recent years, the alcohol consumption and related harms are increasing steadily. China has been now the largest beer-producing country in the world since 2002. However, 2001 spirits consumption was four times than beer in pure ethanol. The per capita consumption (15+ adult) was about 5.4 liters. The unrecorded alcohol consumption accounts for about 14.9% of total alcohol consumption in some areas in southern China .

Chinese males prefer to distilled spirits and drink more frequently and in more amount than female counterpart, and have more drinking-related negative consequences. It was conservatively estimated by WHO in 1990 in China alcohol was responsible for 114 000 deaths. In a WHO sponsored study in general population aged 15 and above, the proportions of 3-month drinkers were 63.8%, 18.3% and 43.8%, for males, females and the total sample, respectively. Given this pattern of drinking, harms associated with intoxication episodes are typically predominated. These harms include violence, crime, economic problems to the drinker and to others, especially impacts on family. In addition, long term problems such as medical, psychological public health and social consequences are concerned. Nevertheless, only a few studies are available to document these issues in China .

At present, some relevant policies and legislations in China have been issued to reduce the drinking-related problems in China , including taxation to limit consumption levels (esp. for high ethanol degree beverages), specific licensing of alcohol outlets, minimum-age sale limits, advertisement regulation and drinking-driving countermeasures. However, there are still no governmental controls directed at licensing of outlets or licensing hours, no regulation of alcohol promotions, no special regulation on unregistered beverages. Furthermore, there is no national prevention program for reducing the drinking-related harm in China . Finally, there is no government sector taking a leading position on the development ， implementation and evaluation of alcohol policy or legislation.

Key words: drinking, drinking-related disease, alcohol policy, legislation, epidemiology

S29-4

临床期及亚临床期物质成瘾的疫苗治疗 - The Psychopathology and Treatment of Addiction. Preclinical and Clinical Aspects of Vaccination for Addiction

Thomas R Kosten 1

1 Baylor College of Medicine, Division of Alcohol and Addictive Disorder, Houston , United States

抗体 疗法 , 通 过积极的预防接种或被动转移单克隆抗体是预防毒品对中枢神经系统的影响 . 禁毒抗体减少欣快感 , 减少 药物分布到大脑 ； 以及通 过抗体的屏障能力减少了药物在大脑里 ， 跨越血脑屏障的药物清除 , 药物的分散 . 因 为抗体留在循环系统 , 他 们没有明显的中枢神经系统副作用 . 可卡因 , 海洛因 , 甲基苯丙胺及尼古丁 动物主动免疫的药物 - 蛋白 结合疫苗以及一个可卡因和 3 个尼古丁疫苗第二 阶段人体试验已通过测试 . 可卡因 , 冰毒 , 尼古丁和苯 环的被动免疫 , 高 亲和力的单克隆抗体在实验动物模型进行了测试 . 抗体有两个迫切的 临床应用药物治疗 : 治 疗吸毒过量以及减少复吸病人 . 其主要治 疗比传统的小分子激动剂和拮抗剂优益的是治疗特异性 , 没有成 瘾性 , 极少副作用 , 长期使用杜绝毒品滥用 . 免疫 疗法也联合其它抗成瘾药物 , 并加 强行 为疗法 . 目前免疫 疗法已显示效果 , 但需提高抗原和抗体的特异性 .

关键词 : 疫苗 ; 药物依赖 ; 尼古丁

Antibody therapy through active vaccination or passive transfer of monoclonal antibodies is designed to prevent drugs of abuse from entering the central nervous system. Anti-drug antibodies reduce rush, euphoria, and drug distribution to the brain primarily by the binding capacity of the antibody, as well as through a pharmacokinetic antagonism, which reduces the amount of drug in the brain, the rate of clearance across the blood brain barrier, and the volume of drug distribution. Because the antibodies remain in the circulatory system, they have no apparent central nervous system side effects. Active immunization with drug-protein conjugate vaccines has been tested for cocaine, heroin, methamphetamine and nicotine in animals, with one cocaine and three nicotine vaccines in phase 2 human trials. Passive immunization with high affinity monoclonal antibodies has been tested for cocaine, methamphetamine, nicotine and phencyclidine in preclinical animal models. Antibodies have two immediate clinical applications in drug abuse treatment: to treat drug overdose and to reduce relapse to drug use in addicted patients. Their major therapeutic benefits over conventional small molecule agonists and antagonists are specificity of the therapies, lack of addiction liability, minimal side effects, and long-lasting protection against drug use. Immunotherapies can also be combined with other anti-addiction medications and enhance behavioral therapies. Current immunotherapies already show efficacy, but improved antigen design and antibody engineering promise highly specific and rapidly developed treatments for both existing and future addictions.

Key Words: vaccine; drug dependence; nicotine

S30 - Classification and Diagnostic Instrument of Mental Disorders towards more Science and more Practice

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

We compile Rating Test for Health and Diseases (RTHD) mainly in order to meet China 's current needs of clinical psychiatry and mental health, research and teaching activities. RTHD serves as an investigative instrument for epidemiological survey, mental illness or mental health consoling, as well as for psychiatric and medical examination of the patient ? s health problems. The diagnosis of RTHD is based on three classifications and diagnostic criteria of mental disorders, i.e., the 10th edition of International Classification of Disease (ICD-10) by the World Health Organization (WHO), Diagnostic and Statistical Manual (DSM-IV) by American Psychiatric Association (APA), and Chinese Classification and Diagnostic Criteria for Mental Disorders version 3 (CCMD-3) by Chinese Society of Psychiatry. After the informal edition of the RTHD publishing in 2001, the first edition is further improved through practical applications. The RTHD includes RTHD-Research version (RTHD-R), RTHD-Clinical version (RTHD-C), RTHD-People self rating version (RTHD-P). The RTHD may satisfy requirements of people from different classes. The general public can make self-assessment by RTHD software and acquire medical advice of physical symptoms and psychological problems. Psychiatric professionals can not only make their own assessment through the clinical diagnosis, but also get the computer logical diagnosis based on the diagnostic criteria of those three diagnostic system mentioned above, and treatment recommendations. The work is a systematic engineering, which is continuously improving in practice. We will have introduction of RTHD both in theory and in practice at this symposium.

S30-1

Principles and Methods of Classification and Diagnosis

Juan E. Mezzich 1

1 International Center for Mental Health, Mount Sinal School of Medicing, New York University, New York, United States

1.The key concepts in classification and diagnosis.

1) Classification as the nosological and taxonomic organization of diseases of disorders

2) Diagnosis

(1)Traditional concept involving identification of disorders.

(2)New concept as comprehensive understanding and formulation

3) The meanings of diagnosis

(1) A fundamental concept for clinical care and public health

(2) A formulation and a process or activity

(3) Etymology of diagnosis

Elucidation a disorder

To diagignoskein: understanding of the person, reflecting the meaning of health as wholeness.

2.Domains in diagnostic models

1) Patient's main illness

2) Panel of all illnesses present

3) All health problems (illnesses, dysfunctions, stressors, etc.)

4) Whole health status (health problems and positive health indicators, e.g. functioning, strengths, supports, quality of life)

3.Descriptive tools

1) Standardized typologies (classical vs. prototypical)

2) Dimensional and configurable scales

3) Narratives (to address meaning, values and particularities)

4) Unilevel and multilevel schemas

4.Architecture of diagnosis

5.Evaluators in diagnostic models

1) Clinician (the conventional expert)

2) Patient (the protagonist, informationally and ethically)

3) Family (crucial support group)

4) Community members (teachers, social workers, etc.)

Diagnostic vealdity concepts

1) Etiopathogenic validity: identifying faithfully the nature of diseases, “ carving nature at its joints”.

2) Clinical validity: diagnosis as the informational base for prediction and care. This notion is growing in acceptance.

Recent WPA Developments

1) Updated WPA Position on International Classification and Diagnosis (April 2006)

(1) Full collaboration with WHO and national and regional associations to develop ICD-11 and related diagnostic systems

(2) Key anticipated tasks:

The best possible classification of mental diaorders

Designing the most useful integrative diagnostic model

(3) Engagement of the WPA Classification Section, other scientific sections, member societies, and other WPA components in this process.

2) Establishment of the WPA Institutional Program on Psychiatry for the Person: From Clinical Care to Public Health.

It includes a clinical diagnostic Project aimed at contributing to the emerging nosological and integrative diagnostic tasks.

3) WPA Classification Section proceeding to engage the WPA member societies to strengthen their classification and Diagnosis Sections and involve them in the above mentioned processes

6. Major current tasks in international diagnosis Delineating WPA Person-centered Integrative Diagnosis (PID)

1) emerging PID concept: Description of the positive and negative aspects of health, interactively, within the person's life context

2) It would include the best possible classification of mental and general health disorders (expectedly ICD-11 and its national and regional adaptations)

3) As well as the description of other health-related problems (e.g., disabilities) and positive aspects of health (e.g., adaptive functioning, protective factors, quality of life) attending to the totality of the person (including dignity, values and aspirations).

S30-2

The Challenge and Opportunity of Comorbidity

Ihson M. Salloum 1

1 Research and Training Addiction Medicine Services, Western Psychiatric Institute and Clinic of the University of Pittsburgh , Pittsburgh , United States

1.Definition of Comorbidity (Feinstein A.R. 1970)

2. Medical-psychiatric comorbidity if children is a neglected area

3.Comorbid conditions may interact at different levels and impact on

1) the emergence

2) Manifestation

3) Recognition

4) Treatment

5) Course

6) Outcome of the conditions involved

2. Early patterns may be similar to adulthood comorbidity

3. The role of core psychopathological mechanisms underlying comorbid condition need to be elucidated

4. Comorbid disorders calls for formulation of integrated models of care

5. The challenge of clinical comorbidity cannot be ignored

1) Comorbidities are the rule in regular clinical care

2) Comorbidities are global health problem.

3) comorbidities are associated with increased morbidity, mortality, and overall economic and humanitarian burden.

4) Comorbidities still require intensive studies.

S30-3

Analysis on Modified DSM-IV Multiple Axial Diagnosis for Patients with Both Physical and Mental Symptoms

Zhong Chen 1 , Cenlin Xiao 2 , Yanfang Chen 2

1 Shandong Provincial Center of Mental Health, Jinan , Chinese Mainland, 2 Beijing Huilonggaun Hospital , Beijing , Chinese Mainland

Objective: The purpose of this study was to investigate the suitability of the Rating Test for Health and Diseases Research version (RTHD-R), the modified DSM-IV axial diagnostic system with seven axes, for the diagnosis of patients with both physical and mental symptoms.

Method: One author using The RTHD-R independently re-diagnosed 35 patients with both physical and mental symptoms in DSM-IV Case Book, according to the DSM-IV and modified DSM-IV axial diagnostic system with seven axes. The other using The RTHD-R independently re-diagnosed those patients, according to the DSM-IV and DSM-IV axial diagnostic system with five axes, then compared their diagnosis each other, furthermore compared their diagnosis with those made by the authors of DSM-IV Case Book.

Results: The results of the patients rated by modified DSM-IV axial diagnostic system (i.e., RTHD seven axial diagnostic system) will be published in details at the symposium.

S30-4

Multiaxial Diagnosis for Menopausal Patients with Depression

Chunling Xiao 1 , Yanfang Chen 1 , Xin Wang 2

1 Beijing Hui Long Guan Hospital , Beijing , Chinese Hong Kong, 2 Jinan Railway Hospital , Jinan , Chinese Mainland

Objective: Assess the applicability of the seven-axial diagnosis system of the Rating Test for Health and Disease and its logic verdict system (RTHD-LVS) among Menopausal Patients with Depression.

Methods: The seven axes of the RTHD for 66 patients who met ICD-10 criteria of Menopausal Depression were assessed.

Results: All 66 patients had the Axis I (mental disorder) primary diagnosis of Menopausal Depression; 45(68.2%) had a comorbid syndrome of anxiety. Axis II (personality traits): 7 were introverted, 7 extroverted and 52 between introverted and extroverted traits (i.e., middle personal traits). Axis III (general medical conditions): All 66 patients were during their menopausal phase and with abnormal menstrution. some had physical symptoms, such as with neurological endocrine symptoms (68.2%). Axis Ⅳ (bio-psychosocial stressors) ： 42(63.6%) had experienced important negative life events within one year of premorbidity. Axis V (social functioning) ： 56 had grossly inadequate functioning at the time of their worst impairment, and 55 had poor or grossly inadequate functioning on the interview. Axis VI (global assessment of present state): 42(63.6%) had experienced no effects and 19(28.8%) had become worse. Axis VII (relationship between axes): 42(63.6%) had experienced important negative life events within one year of premorbidity. It is showed as [X4—( 2)→X1]. That means the mental disorder more or less related with the negative life events. All 66 patients were in their Menopausal phase. It is showed as [X3—( 3)→X1]. That means the mental disorder certainly caused by physical conditions.

Conclusion: It is feasible to employ the seven axes of the RTHD to provide a comprehensive assessment of patients with Menopausal Depression. However, this needs to be assessed with other types of patients.

S30-5

A Psychiatric Epidemiological Study in Rural China

Dominic T S Lee 1

1 The Chinese University of Hong Kong, Shatin, Hong Kong, Chinese Hong Kong

Objective: There is a lack of psychiatric epidemiological data on rural China , even though China 's rural population has very high suicide rates. This study measured the 12-month prevalence of common mental disorders among the rural population of Shandong province.

Method: A total of 1,401 rural residents from 48 villages were recruited using stratified multi-stage cluster sampling. The respondents were first interviewed with the CIDI. Those who were identified as probable cases, and an equal number of randomly selected CIDI non-cases, were re-interviewed using a validated Chinese psychiatric diagnostic interview.

Results: The overall 12-month prevalence rate of common mental disorders was 6.0%. The prevalence of major depressive disorder was similar between male and female respondents.

Conclusions: Compared to a decade ago, the prevalence of mental disorders in Chinese rural population has risen substantially. More studies are needed to examine the relation between gender and depression in Chinese populations.

S31 - 抑郁症与合并躯体疾病 - Depression and Co-morbid Medical Disorders

Chairs: Michelle B. Riba, United States
Norman Sartorius, Switzerland
Yifeng Xu, Chinese Mainland

抑郁症是一 种在初级保健系统中高发病率的疾病。在糖尿病和某些类型的冠心病中 ， 抑郁是增加患病与死亡的危险因素。抑郁会影响对药物治疗的依从性，改变生活，比如锻炼和生活质量。重要的影响因素包括躯体疾病、疼痛、残疾的严重程度，社会支持水平和既往精神病史。伴有躯体疾病，尤其是诸如终末期肾病之类的疾病，自杀率会更高。由于抑郁症和与躯体疾病在症状与治疗上存在重叠 ， 使得初级保健机构在筛查与评估方面存在困难。本专题会将讨论抑郁症合并躯体疾病的复杂情况 ， 并提出一些临床上的处理方法。

Depression is highly prevalent in chronic medical diseases and therefore, in primary care practice. Depression is a risk factor for increased morbidity and mortality in diseases such as diabetes and types of coronary artery disease. Depression impacts on adherence to medication, modifications in life style such as exercise, and quality of life. Factors that are important modifiers include severity of physical illness, pain, disability, level of social support and previous psychiatric history. Suicide rates are generally higher in those patients with physical illness and with certain specific disorders such as end-stage renal disease. There is often an overlap of symptoms between depression and the underlying physical condition or its treatments that make screening and evaluation difficult for the primary care clinician. This symposium will address some of the very complex aspects of depression and co-morbid medical disorders and will offer some ways to manage clinical issues.

S31-1

澳大利亚初级卫生保健系统中的抑郁与共病躯体疾病：一项抑郁症状的诊断、处理与结局的队列研究 - Depression, Co-morbid Medical Disorders and Functioning in Australian Primary Care: The DIAMOND Study

Helen Herrman 1 , Jane Gunn 2 , Kelsey Hegarty 2 , Grant Blashki 2 , Dimity Pond 2 , Michael Kyrios 2 , Patty Chondros 2

1 University of Melbourne, Carlton, Australia, 2 University of Melbourne, Monash University and Newcastle University, Carlton, Australia

目的 ： 描述抑郁症状的 诊断、处理与结局 (DIAMOND) 的 队列研究的基线发现 ， 重点是合并的躯体疾病与社会功能情况。 DIAMOND 是一 项持续 3 年的前瞻性研究。 调查澳大利亚公共卫生系统中被确诊抑郁症状的患者的特点、服务与治疗使用情况、以及健康结 局。

背景： 抑郁症在全球范 围内的初级保健患者中十分普遍（大约 10% ）。 对许多人而言，这是一种慢性的、反复发作性的疾病，伴有健康状况不良、残疾、高死亡率以及健康保健使用率增高。目前的结局研究主要针对专科机构，而作为提供大量医疗保健服务的初级医疗机构中的数据却很匮乏。以往的研究排除了合并物质滥用的病例。长期保健的 “ 合作 ” 模式使的在不同机构 间的转诊变得十分昂贵和困难。

方法： 随机招募的 30 名全科医 师筛查了 18000 位患者的抑郁症状（ 每位 医 师 600 名病人，随机 选自该医师过去 12 个月所 诊断的病人）。 “ 可能的抑郁症 ” 患者在基 线、第 3 、 6 、 9 、 12 、 24 和 36 周 评估抑郁、健康状况、生活质量、伴侣虐待、社会支持、生活事件以及对治疗的依从性。 结果：队列中纳入了 791 名伴有抑郁症状的患者。 564 (71.3%) 是女性； 49% (356/726) 符合 DSM-IV 抑郁 发作 12 个月的 标准， 10% (75) 符合 DSM-IV 恶劣心境的标准； 153 (21%) 合并物 质滥用； 142 (18%) 伴有疼痛症状； 202 (26%) 合并焦 虑症状； 543 (69%) 合并慢性躯体健康 问题。

结论： 讨论基线处的发现结果，并讨论在初级保健系统中整合心理与躯体治疗。

Objective: Describe the baseline findings of the Diagnosis, Management and Outcomes Depressive Symptoms (DIAMOND) Cohort Study, with particular reference to medical disorder co-morbidity and social functioning. The DIAMOND study is a prospective, 3-year cohort study of the characteristics, service and treatment use and health outcomes of patients identified with depressive symptoms from Australian general practice.

Background: Depression is common in primary care patients worldwide (approximately 10%). It is a chronic and relapsing disorder for many people, associated with poor health, disability, and higher mortality and health care use. Outcome studies are conducted mainly in tertiary settings, with little data from primary care where most care is provided. Previous research excludes those with co-morbid substance abuse. Chronic care ‘collaborative' models remain expensive and difficult to translate between settings.

Methods: 30 general practitioners (GPs), randomly selected, were recruited. 18000 patients were screened for depressive symptoms (600 per GP, randomly selected if seen by the GP in the last 12 months), and ‘probably depressed' patients recruited and assessed at baseline, and at 3, 6, 9, 12, 24 and 36 months for depression, health status, QOL, partner abuse, substance abuse, social support, life events and adherence to treatment.

Results: The cohort consists of 791 patients with depressive symptoms. 564 (71.3%) are female. 49% (356/726) met DSM-IV 12-month criteria for major depressive disorder and 10% (75) met DSM-IV criteria for dysthymia. 153 (21%) had a co-morbid substance use problem; 142 (18%) had co-morbid panic syndrome; 202 (26%) had co-morbid anxiety syndrome; 543 (69%) had a co-morbid chronic physical health problem.

Conclusions: Baseline results will be presented and the implications discussed for integrated treatment of mental and physical health problems in primary care.

S31-2

首发重性抑郁症患者脑灰质密度和白质微结构的磁共振研究 - MRI Study on the Brain Gray Matter Density and White Matter Integrity in First-Episode Major Depressive Disorder

Ma Ning

Institute of Mental Health, Peking University , Beijing , Chinese Mainland

目的 ： 使用三 维结构磁共振 （ 3D ） 和弥散 张量成像 （ DTI ） 相 结合的技术探讨首发重性抑郁症患者是否存在脑灰质密度和白质微结构的改变。

方法 ： 应用汉密尔顿抑郁量表 （ HAMD ） 和 汉密尔顿焦虑量表 （ HAMA ） 对 27 例首 发未治疗过的年轻成年重 性抑郁症患者及 28 例正常人 进行评定 ， 要求 HAMD 评分患者 ≥24 分 ， 正常人 ≤7 分。研究 对象入组后进行 3D 和 DTI 扫描。扫描后患者给予文拉法辛治疗并进行半年随访观察，随访结束时再次进行上述量表评定和记忆测验以及 3D 和 DTI 扫描。

结果： 1. 抑郁症患者的 HAMD 和 HAMA 评分治疗后较治疗前明显下降（ P ＝ 0.000 ），但未达正常人水平（ P ＝ 0.01 ）。 2. 发作期抑郁症患者右侧额内侧回和同侧颞极、双侧壳核 / 苍白球和双侧小脑的灰质密度较正常人低；治疗后右侧额上回、双侧中央前回、双侧颞极、双侧壳核 / 苍白球和双侧小脑的灰质密度仍较正常人低。未见患者治疗前后灰质密度差异有显著性的脑区。 3. 发作期抑郁症患者左侧额上回，双侧额中回和双侧前扣带回白质的分数各向异性（ FA ） 值较正常人低；治疗后双侧额上回和额中回，右侧额下回白质 FA 值较治疗前增高，左侧额中回白质 FA 值仍较正常人低，而右侧颞中回和颞上回白质 FA 值高于正常人。

结论： 1. 右 侧额内侧回和颞极，双侧壳核 / 苍白球和小脑的灰质密度降低可能是抑郁症发生的神经病理基础，而非抑郁症的后果。 2. 前 额叶和前扣带回白质纤维整合性失常在抑郁症发病早期即已存在 ， 这种失常随着临床症状缓解后部 分恢 复。

Object: The aim was to explore the brain gray matter density and white matter integrity abnormalities in first-episode MDD, by using three dimensions MRI (3D), and diffusion tensor imaging (DTI) techniques.

Methods: Twenty seven first-episode treatment-na?ve young adult with MDD and twenty eight age and gender-matched healthy controls were assessed using 17-item HAMD and HAMA . HAMD scores were requested≥24 in patients and ≤7 in controls. Then, MRI scan were obtained ordering to 3D and DTI. We assessed patients like above again after six months antidepressant (Venlafaxine) treatment.

Results: 1. HAMD and HAMA scores in post-treated patients were significantly lower than those in pre-treated (P ＝ 0.000), however still higher than those in controls (P ＝ 0.01). 2. 3D MDD patients showed significantly lower gray matter density than controls in right medial frontal gyrus, right temporal pole, bilateral putamen and globus pallidus, bilateral cerebellum. After treatment, gray matter density in right superior frontal gyrus, bilateral precentral gyrus, temporal pole, putamen and globus pallidus, and cerebellum in patients were still significantly lower than controls. No regions were found with significantly different gray matter density between pre- and post-treated patients. 3. DTI Compared with controls, MDD patients exhibited significant decreased FA values in left superior frontal gyrus, bilateral middle frontal gyri and bilateral anterior cingulate. FA values in bilateral superior and middle gyri, right inferior frontal gyrus increased after treatment. However, FA values in left middle gyrus in post-treated patients were still lower than controls. Furthermore, FA values in right middle and superior temporal gyri were significantly higher than controls.

Conclusions: 1. Decreased gray matter density in some brain regions may be the neuropathological substrate of MDD rather than a result. 2. White matter microstructure abnormalities may present early in the course of MDD, which could be reversed after the symptoms remission.

S31-3

孕期抑郁症治疗 - Treatment of Depression during Pregnancy

Nada L Stotland

American Psychiatric Association, Chicago , United States

抑郁症在育 龄女性中十分常见 ， 超过 10% 的孕期 妇女罹患抑郁症。如果未经治疗 ， 抑郁症会对母亲与胎儿造成不良影响 ， 这可以是通过限制自我照顾如锻炼、营养和对分娩前看护的依从性产生的间接影响 ， 也可以是直接的。因此对此类女性进行有效的治疗十分必要。抗抑郁药物，主要是选择性 5-HT 再 摄取抑制剂，已经成为抗抑郁治疗的主要工具，但最近的研究已经对胎儿和新生儿的影响提出质疑：持续肺高压， 肢体抽 动，和出生体重下降都被报道过。另一方面，母孕期抗抑郁药物疗效的不连续造成了 60% 或更高的 复发风险。本报告将总结已经出版的研究并分析它们的方法，包括对于严重抑郁的标准、治疗剂量以及治疗的时间。报告还将涉及针对母孕期抑郁女性的临床治疗指南。

Depression is common among women of child-bearing age and affects 10% or more of pregnant women. If untreated, depression can have significant negative effects on both mother and fetus, both indirectly, by diminishing self-care such as exercise, nutrition, and adherence to prenatal care, and perhaps directly as well. Therefore it is important that these women be effectively treated. Antidepressant medication, selective serotonin reuptake inhibitors in particular, have become a central tool in the treatment of depression, but recent studies have raised questions about their safety for the developing fetus and newborn: persistent pulmonary hypertension, jitteriness, and decreased birth weight have been reported. On the other hand, discontinuing effective antidepressant medication during pregnancy entails a 60% or more risk of relapse. This presentation will summarize the published studies and analyze their methodology, including correction for severity of depression and dosage and length of treatment. The presentation will conclude with clinical guidelines for the management of the many women faced with depression during pregnancy.

S32 - Cognitive Rehabilitation in Schizophrenia

Chairs: Dongfeng Zhou, Chinese Mainland
Yizhuang Zou, Chinese Mainland
Siu Wa Tang, Chinese Hong Kong

The symposium is focused on new technique to improve cognitive function of schizophrenia, such as rTMS, cognitive remediation therapy and cognitive behaviour therapy. The project is sponsored by Beijing Science and Technology committee.

S32-1

New Trend of Cognitive Rehabilitation in Schizophrenia

Til Wykes 1

1 Institute of Psychiatry, Department of Psychology, London , United Kingdom

Background: Cognitive difficulties are prevalent in people with a diagnosis of schizophrenia and are associated with poor long term functioning.

Aim: To establish the effectiveness of cognitive remediation therapy (CRT) on cognitive difficulties experienced by people with schizophrenia.

Method: Both early onset and chronic participants with a diagnosis of schizophrenia, a social behaviour problem and a cognitive difficulty were all randomised to 40 sessions of cognitive remediation in separate single blind RCTs. The principal outcomes were working memory, cognitive flexibility and planning which were measured at post treatment and follow-up.

Results: The effects in each study were slightly different for instance for more chronic participants there were durable improvements in working memory (advantage of 1 ? 33 points (95% CI 0.428, 2 ? 159) standardized effect size 0 ? 34), but for younger participants there were changes in cognitive flexibility. Functioning improvements were pr