精神在线网 - 2007年WPA上海区域性国际会议暨中华精神病学会学术年会 会议论文汇编
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  • S34 - Clinical Psychopharmacological Study over Past 5 Years in China

    Chairs: Niufan Gu, Chinese Mainland
    Jerrold Rosenbaum, United States

    Clinical trial, psychotropic drugs, therapeutic drug monitoring, metabolic syndrome, antipsychotics, antidepressants, antianxiety drug, China

  • S34-1

    A Randomized Double-blind Multi-center Study Comparing Bupropion SR with Fluoxetine in Chinese Patients with Depression

    Yifeng Shen 1

    1 Shang Mental Health Center , Shanghai , Chinese Mainland

    Purpose: To compare efficacy and safety parameters of 6 weeks' treatment with 300mg/day bupropion SR with that of 20mg/day fluoxetine in Chinese patients with depression.

    Methods: This study was conducted in 4 sites in China , in accordance with the Declaration of Helsinki and the guideline for GCP.

    Eligible patients were within 18-65 years old, with a CCMD-3 diagnosis of Depression and a minimum total score of 18 on HAMD17. After a 1-week run-in period with placebo treatment, patients were randomized to 6 week of double-blind treatment with bupropion SR (300mg/d) or fluoxetine (20mg/d). The initial dose was 150mg bupropion SR or 10mg fluoxetine per day. Patients who completed 6 weeks of treatment entered a 1-week run-out period with the initial dose.

    Efficacy analyses were conducted on ITT population and safety analyses were conducted on the all-patients-treated set. Response was defined as a ≥50% decrease in the HAMD total score from baseline and remission was defined as a HAMD total score ≤8.

    Results: A total of 237 patients entered the double-blind period. Of these, 3 patients in bupropion SR group and 2 patients in fluoxetine group had no post-baseline assessment. The ITT population thus comprised 117 patients in the bupropion SR group and 115 patients in the fluoxetine group. A total of 210 patients completed the study. There were no clinically relevant differences at baseline between the two treatment groups on the basis of demography or disease severity.

    The incidence of withdrawals was low: 8.5% in the bupropion SR group and 10.4% in the fluoxetine group. The proportions of patients who withdrew due to adverse events were 0.85% versus 1.74%. The proportions of patients who withdrew due to lack of efficacy were 3.42% versus 4.35%. There were approximately equal numbers of patients in both treatment groups who were responders (69.23% vs 67.83%) or remitters (35.04% vs 45.22%) at week 6.

    A total of 63.25% of patients in the bupropion SR group and 62.61% of the patients in the fluoxetine group reported TEAEs during the clinical trial with no significant difference (P>0.05). Similarly, there were 52.14% patients in study group experienced adverse reactions and 52.17% in controlled group. Besides, there were no apparent trends within or between treatment groups with respect to laboratory values, ECG, weight, or vital signs.

    Discussion: The study showed clear treatment-related improvements in HAMD scores in both treatment groups during this clinical trial. On the basis of the primary efficacy endpoint, the efficacy of bupropion SR (300mg/d) was similar to fluoxetine (20mg/d). This is in line with results seen in some foreign studies investigating bupropion's efficacy. This study also supported the opinion that bupropion SR had the same tolerability profile as SSRIs.

    On the basis of a summery of 6 randomized, double-blind controlled clinical trials evaluating bupropion SR versus SSRIs for depression in adults, it has been suggested that Bupropion SR and SSRIs (SSRI comparators were fluoxetine, sertraline, and paroxetine) have similar effectiveness; however, bupropion SR was associated with less nausea, diarrhea, somnolence, and sexual dysfunction. The reason of no significant difference in adverse reaction could be found between two groups in study might be in relative small sample.

    In conclusions, this study showed bupropion SR was an effective safe newer antidepressant for Chinese adult patients with depression.

  • S34-2

    分裂症 5HT3D 受体基因多态性与利培酮治疗反应的关系 - Association between 5HT3D Receptor Gene Polymorphisms and Therapeutic Response to Risperidone in Schizophrenic Patients

    Huafang Li 1 , Shunying Yu 1 , Zhiguang Lin 1 , Yiren Weng 1 , Jicheng Jiang 1 , Ye Zhang 1 , Niufan Gu 1

    1 Shanghai Mental Health Center , Shanghai , Chinese Mainland

    Objective: The serotonin type 3 (5-HT(3) receptor is the only ligand-gated ion channel receptor for serotonin (5-HT), and plays an important role in modulating the inhibitory action of dopamine in mesocorticolimbic. A variety of antipsychotics inhibit ion fluxes through 5-HT3 receptors in a noncompetitive manner. As risperidone is a widely used atypical antipsychotic agent, this study aimed to exmaine the relationship between 5HT3D receptor gene polymorphisms and therapeutic response to risperidone in schizophrenic patients.

    Methods: Three hundred eighty-two patients including 204 male and 178 female were recruited from the Shanghai Mental Health Center inwards. All patients met DSM-IV criteria for schizophrenia, and had Clinical Global Impression-Severity of illness (CGI-S) score >=4 at baseline. Patients were treated with 2–6 mg of risperidone, and after 8 weeks treatment, the clinical response were assessed by Clinical Global Impressions–improvement I (CGI–I) scale. CGI–I score >=3 was considered as responder, and CGI–I score <3 as non-responder. Seven tagSNPs (rs6779545, rs7628618, rs939334, rs1467257, rs10937159, rs939335, and rs7613237) selected from CHB(Chinese Han Beijing) database in HAPMAP website and one non-synomoyous SNP(rs6443930) were genotyped by Taqman Assay (ABI) on ABI 7900 or SnaP shot on ABI 3730 in all patients.

    Results: after eight weeks treatment, 203 patients responded to risperidone, while 179 patients did not. There were no differences between the responder group and non-responder group as regards gender and age. No significant difference was found in allele and genotype of rs6779545, rs939334, rs1467257, rs10937159, rs939335, rs6443930 and rs7613237, but rs7628618 was observed to associated to risperidone response(p=0.012). When patients subgrouped to EOS (onset age <=18 years old) and AOS (onset age >18 years old), rs7628618 genotype was found more significantly associated with risperidone response in AOS subgroup(p=0.012), and rs939334 and rs6443930 was found associated with response in EOS subgroup(p=0.0251, 0.015).

    Conclusion: the 5HT3D receptor gene variant may help to predict risperidone treatment efficacy.

  • S34-3

    Serotonin Concentrations May Decrease in the Platelet of Treatment Resistant Depression Patient after the Risperidone Augment

    Xia Li 1 , Jun Cai 1 , Zheng Lu 1 , Hua-fang Li 1 , Gui-hua Pang 1

    1 Shanghai Mental Health Center , Shanghai Jiao Tong University , Shanghai , Chinese Mainland

    Objectives: To explore the platelet serotonin concentration in the treatment-resistant depression patients at baseline and 4 weeks after low dose risperidone as an augment combining with the ongoing antidepressants. At same time, the efficacy of the augmentative strategy was assessed.

    Method: The serotonin concentrations in the 38 patients with treatment-resistant depression were measured before (baseline) and 4 weeks after risperidone was added, at the same point Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) scores were rated as well.

    Results: The seretonin concentrations in the platelets of TRD patients were significant lower than those of responsible depressed patients (99.9 ±118.5ng/10 9 vs 242.8 ±174.4 ng/10 9 , P ＜ 0.01), and positively related to two factors: current episode duration, retardation scores of HAMD. However, 4 weeks after risperidone was added, the serotonin concentrations were nearly significant lower compared to the baseline(p=0.05). The scores of HAMD, HAMA and their factors after risperidone augmentation were significant lower compared to the baseline(p ＜ 0.05). The serotonin concentrations after risperidone augmentation were positive correlated to the current episode duration, retardation scores of HAMD, the total scores of HAMA and the mental anxiety scores of HAMA, while negative correlated to the reductions of HAMD and sleeping factor scores. The reductions of the serotonin concentrations were negative correlated to the episodes while positive correlated to the reductions of retardation scores of HAMD.

    Conclusion: The low platelet serotonin concentration may be one of the biochemical characters in patients with TRD. While patients with treatment-resistant depression response to the augmentative strategy of low dose risperidone combining with antidepressants, the serotonin concentration in the platelet may even lower. The platelet serotonin concentrations may correlate to some symptoms such as anxiety and retardation. There may be correlation between the deductions of the platelet serotonin concentrations and the improvement of the retardation symptoms.

    Key words: Risperidone; Serotonin; Platelet; Treatment-resistant depression

  • S35 – Psychotherapy

    Chairs: Zhuoji Cai, Chinese Mainland
    Edmond H.T. Pi, United States

    S35-1

    Psychogenic Bodyfocusing

    Friedrich Zikes 1

    1 Psychotherapy – life- & social counseling, Vienna , Austria

    Psychogenic Bodyfocusing – method

    ? meaning and understanding of psychogenic and body focused

    ? no new school but a new setting

    ? combinations with several psychotherapeutic schools are possible

    ? access on two levels at the same time -: psyche and cell body

    ? short-therapy setting

    ? priority of high-level compliance

    Psychogenic Bodyfocusing – procedure

    ? first contact – exploration – diagnosis – agreements

    ? starting compliance between partners

    ? patients are dressed in sports outfit or underwear

    ? relaxation to a semi-hypnotic state of alpha-level oscillation

    ? access on two levels according patient`s offer

    ? keeping operation level in spite of body contact

    ? meta language is acceptable, but need to be decoded

    ? imaging and affirmation programmes are instruments of support

    ? steps out of alpha-level-state (8-12Hz)

    Psychogenic Bodyfocusing – an interactive process

    ? priorities of treatment – psyche or body?

    ? use different methods of body manipulation

    ? compliance in context with interacting bio-energetic fields

    ? transactions between different charges of “emotional signature fields”

    ? energetic methods of measurement in terms of mental defence-methods

    ? transfer and counter-transfer in body focused therapies

  • S35-2

    心理治疗在撒哈拉沙漠以南非洲的疗效 - Effectiveness of Psychotherapy in Subsaharan Africa

    Mohammed Said Jidda 1 , Musa Abba Wakil 1 , Abdulaziz Mohammed Olarenwaju 1

    1 Federal Neuropsychiatric Hospital Maiduguri nigeria, Mental Health, Maiduguri, Nigeria

    背景 ： 心理治 疗对精神障碍的疗效在西方世界已经得到确认 ， 但是对非洲人而言 ， 还是一种陌生的治疗方法。

    目的 ： 回 顾在撒哈拉沙漠以南非洲心理治疗疗效的文献。

    方法 ： 在 Medline, PsychINFO, CINAHL 上做系 统的检索 ， 此外还做了引文检 索以及 书本和杂志的检索。选择那些在题目或摘要中描述了在非洲的心理治疗的研究，并对研究的质量进行分类。

    结果： 共 检索了 1261 篇文献； 4 个是病例 报道， 4 个是随机 对照研究，有一个类似实验性研究。在 5 个有相 关资料的研究中， 4 个 显示阳性结果，以及需要对西方的模式进行一些适应。

    结论： 在撒哈拉沙漠以南非洲 对心理治疗疗效的高质量研究还很少，但现有的少量研究大部分肯定心理治疗的疗效。

    Background: Psychotherapy has been shown to be effective in the treatment of mental disorders in the western world but,viewed as an alien method of treatment to Africans.

    Aim: To review litterature on the effectiveness of psychotherapy in Sub-saharan Africa.

    Method: A systematic search of Medline, PsychINFO, CINAHL,were undertakken along with citation searches in addition to text books and journal were used. Studies were selected if psychotherapy treatment in Africa were described in the title or abstract. The study quality was rated.

    Results: The search produced over 1261 articles; 4 were case reports,4 randomised controlled trials and a quasi experimental. Of the 5 with relevant data 4 revealed a positive outcome and, the need for some adaptation of the western model.

    Conclusion: High quality data examining the effectiveness of psychotherapy in Sub-saharan is quite sparse however what few quality data are available reveal mostly positive outcome.

  • S35-3

    采用冠状动脉旁路搭桥术后患者的家庭看护 - Family Caregivers Experiences of Patients with Coronary Artery Bypass Grafting Surgery

    Khosrow Tavakol 1 , Fatemeh Pashashei Sabet 2 , Abdolah Rezaei 2

    1 Nursing Faculty, Isfahan University of Medical Sciences, Health Department, Isfahan, Iran, Islamic Republic of, 2 Isfahan University of Medical Sciences, Isfahan, Iran, Islamic Republic of

    背景 ： 冠状 动脉旁路搭桥术是挽救患者生命的一个有效措施。但术后患者在离院后将会遇到很多问题 ， 日常生活也将随之而改变。他们的健康服务需要可能不能得到很好的满足。照料这些患者的家庭护工有些怎样的经验也需要了解，以便日后向更多的家庭护工宣传。 目的： 本定性研究主要 为了了解照料采用冠状动脉旁路搭桥术的患者的家庭护工在患者手术前后有些怎样的看护经验。

    方法： 采用定性研究 设计。目标样本 10 人，包括 8 个家庭 护工和 2 个 护士。采用深入访谈形式收集信 息， 归纳法分析资料。

    结果： 受 调查者主要在以下几个方面存在共同点如 1 ）担心患者的健康， 2 ）担心患者在家庭、社会和 经济生活方面的困难， 3 ）担心健康小 组与家庭护工之间的关系。

    结论： 家庭 护工是所有不同程度搭桥术患者的有力支助，应该充分肯定家庭护工的作用。

    Introduction: Coronary artery bypass graft Surgery is a Life saving intervention but patients under coronary artery bypass graft who care for them after discharge, will encounter many Issues and changes to their usual daily routine. They may have unmet needs and health Services may not be Sufficiently Seam less or adequate to anticipate and address these needs. little is known about family Caregivers experiences of patient's with Coronary artery bypass grafting Surgery may help health Care teams to meet family caregivers needs.

    Aim: This qualitative. Study explored family Caregivers experiences of patients with Coronary artery bypass at the time before and after patient′s Operation.

    Method: this research is a qualitative design and has done in way of pharmacology. A purposeful Sample of 10 participants was obtained that included 8 family Caregivers and 2 Nurses. Deep Interview has clone for gathering of information and data analysis was done through colizis method.

    Results: The finding of this Study showed Flue principle Concepts have been explored that expresses experiences of participants in research Such as , 1)worry about patients condition 2)disturbance in family , Social and economic life 3) worry a bout ship between health team & the family eave givers

    Conclusion: This finding Showed the important Role of: Family Caregivers to Support patient with corny artery bypass in all Stages Accord to the Findings, Support of family Caregivers Should be a priority.

  • S36 - 东亚地区精神药物处方模式 （ REAP ） 研究 — 抗精神病 药的处方习惯研究专题 - Research on East Asia Psychotropic Prescription Pattern (REAP Study) -Focus on Antipsychotic Drug Prescription in East Asia

    Chairs: Yanling He, Chinese Mainland
    Naotaka Shinfuku , Japan

    从 1999 年起 ， 日本神 户大学国际医学研究中心和新加坡国立大学医学院联手发起了神经精神医学领域的研究。来自中国大陆、香港、日本、韩国、新加坡和台湾等国家和地区的精神科医生、药理学家、流行病学家共同参加了东亚地区抗精神病药物处方习惯的国际合作研究。这个研究简称为 REAP-AP1 ，共 调查了 2399 例住院精神分裂症患者的 处方用药情况。第 12 届世界精神病学大会（横 滨， 2002 年 8 月 24 至 29 日） 报告了这些数据的初步分析结果。三年后又在相同地区进行了类似的研究，称为 REPA-AP2 ，目的是比 较这些国家和地区三年来的处方用药变化情况。本专题会主要报告 REPA-AP2 的 结果，同时对 REPA 的概况做个介 绍并探讨今后如何开展类似的国际合作研究。

    Since 1999, Kobe University School of Medicine International Center for Medical Research and Singapore National University School of Medicine have collaborated to organize research in the field of neuropsychiatry. Psychiatrists, pharmacologists, epidemiologists and researchers from East Asian countries organized an international collaborative research to survey prescription patterns for inpatients with schizophrenia in Mainland China , Hong Kong , Japan , Korea , Singapore and Taiwan . It is briefly called REAP-AP1. The initial analysis of the data involving 2,399 cases was reported at the 12th World Congress of Psychiatry, Yokohama , 24-29 August 2002. Three years later, a similar survey was carried out in the same region as REAP-AP2 to make comparison possible for the prescription patter change along with the time. In this symposium, the results of REAP-AP2 with focus on comparisons will be reported together with an overview of the research and the discussion on the future collaborative research on psychotropic medications in the region.

  • S36-1

    Origin and Development of REAP Study

    Chay Hoon Tan 1 , Mian-Yoon Chong 2 , Gabor S Ungvari 3 , Tianmei Si 2 , Eun Kee Chung 4 , Sim Kang 1 , Shu-yu Yang 5 , Naotaka Shinfuku 6

    1 National University Hospital, Singapore, Singapore, 2 Chang Gung Memorial Hospital-Kaohsiung Medical Center and Chang Gung University, Taiwan, Department of Psychiatry, Shanghai, Chinese Mainland, 3 Chinese University of Hong Kong, Hong Kong, Chinese Hong Kong, 4 Seoul National Mental Hospital, Seoul, Korea, Republic of, 5 Kaohsiung Medical University, Kaohsiung, Chinese Taipai, 6 of Human Sciences, Seinan Gakuin University, Fukuoka, Japan

    Abstract text has not been submitted

  • S36-2

    新旧药之间的选择 ——REPA 研究 - Choosing Among Old and New Antipsychotics: Research on East Asia Psychotropic Prescriptions (Reap)

    Mian-Yoon Chong 1 , Chay Hoon Tan 2 , Gabor S Ungvari 3 , Tianmei Si 4 , Eun Kee Chung 5 , Sim Kang 2 , Shu-yu Yang 6 , Naotaka Shinfuku 7

    1 Chang Gung Memorial Hospital-Kaohsiung Medical Center and Chang Gung University, Taiwan, Department of Psychiatry, Shanghai, Chinese Taipai, 2 National University Hospital, Singapore, ww, Singapore, 3 Chinese University of Hong Kong, Hong Kong, Chinese Hong Kong, 4 Peking University, Beijing, China, Beijing, Chinese Mainland, 5 Seoul National Mental Hospital, Seoul, Korea, Seoul, Korea, Republic of, 6 Kaohsiung Medical University, Kaohsiung, Taiwan, Kaohsiung, Chinese Taipai, 7 School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan, Fukuoka, Japan

    正文 ： 背景及目的 ： 此 项研究是为了对东亚地区抗精神分裂症药物处方模式进行评估 ， 并进一步研究造成各模式之间差别的影响因素。

    方法 ： 在中国大 陆、香港、日本、韩国、新加坡和台湾这六个国家和地区 ， 于 2001 年和 2004 年相 继进行了精神分裂症住院病人处方模式调查研究。用标准诊断记录方式收集数据，包括患者的社会和临床特征 、精神症状、病因、 药物不良反应。比较和分析了抗精神病药处方习惯的趋势和变化。结果：从 31 个中心共采集 2398 例（ 2001 年）、 2136 例（ 2004 年）住院病人，性 别和年龄无显著差异。总体上看，日本病人年龄较大，病程较长。比较这两年的用药情况，发现第二代抗精神病药物（ SGA ）使用有所增加 , 从 45.5% 上升至 64.2% ，相反，第一代 药物使用有所下降，从 67.8% 降至 53.5% 。另外， 复方用药和高剂量用药趋向于减少，分别由 45.7% 降至 26.5% 、 17.9% 降至 6.5% 。有些国家 间的处方模式也不同，日本习惯高剂量及复方用药，新加坡习惯注射高剂量孕激素，中国大陆较多使用氯氮平。多元回归分析显示 SGA 的使用与女性、年 龄较轻、国家、出现幻觉症状和阴性症状有关。

    结论： 本 项研究证明，东亚地区各处方模式之间存在一些共同之处，而且 SGA 使用有增加 趋势。然而，各中心抗精神病药物使用情况是有差别的，这由许多因素引起，其中包括各国卫生保健体系、药物的有效性和药物费用。

    Background/Objectives: This study aims to assess the prescription pattern of antipsychotics for schizophrenia in East Asia , further to analyze factors that could affect these differences.

    Methods: Two consecutive surveys on the prescription patterns for schizophrenic inpatients were conducted in 2001 and 2004 in 6 East Asian countries: China , Hong Kong , Japan , Korea , Singapore and Taiwan . The data were collected using a standardized protocol including patients' social and clinical characteristics, psychiatric symptoms, course of illness, and adverse effects of medications. The trend and change of antipsychotic prescriptions were compared and analyzed.

    Results: samples comprised of 2,398 (2001) and 2,136 (2004) patients from 31 centers, with no significant sex and age differences. In general, Japanese patients were much older and had longer duration of illness. There was a significant increase use of second generation antipsychotics (SGA) (45.5% vs 64.2%) with reciprocal decrease use of first generation antipsychotics (67.8% vs 53.5%) between 2001 and 2004. In addition, decreasing tendency of polypharmacy (45.7% vs 26.5%) and high dosage used antipsychotics (defined by over 1000mg of chlorpromazine equivalent per day; 17.9% vs 6.5%) were also observed. Prescription patterns differed with some countries: Japan had higher dosage and antipsychotic polypharmacy; Singapore had high utilization of depot injections while China had high prescription of clozapine. Multivariate regression analyses showed that females, younger age, country, presence of hallucinations and negative symptoms were related to the use of SGA.

    Conclusions: study demonstrated some common characteristics and an increasing trend of the use of SGA in East Asia . However, the use of antipsychotics differed among centers and was influenced by a variety of factors and among them, the prevailing health care system, the availability of drugs and the costs of drugs.

  • S36-3

    东亚地区抗精神病药物联合研究所面临的挑战 - Future Challenges for Collaborative Research on Psychotropic Medications in East Asia

    Ee Heok Kua 1

    1 National University of Singapore , Singapore , Singapore

    REPA 构思于七年前 ， 它可看作是 东亚地区抗精神病药物处方模式联合研究的里程碑。研究的目的不仅仅止于研究 ， 也是为了提高药物疗效和医疗保健质量。研究获得了关于 整个 东亚地区的处方用药习惯这些非常宝贵的资料。下一阶段， REPA 面 临的挑战包括卫生经济学、成果分析、人种起源研究这几方面。但是有关精神病患者真实的生活资料还是很缺乏的。一些紧迫的问题包括治疗的依从性、费用、家庭支持、心理治疗、反应性的民族差异、精神卫生教育、社区服务等等。通过东亚地区临床医生的共同努力 ， 他们将告诉全世界在我们的诊所和医院里如何为病人服务。

    It was a milestone in East Asian psychiatry when REAP was conceived 7 years ago as a collective enterprise to study antipsychotic prescriptions. The objective in the collaboration was not merely to promote research but also to improve pharmacotherapy and patient care. The results yielded invaluable data on the prescriptive habits in the whole region.

    In the next phase, the exciting challenges for REAP include:

    1 Health economics

    2 Outcome studies

    3 Ethnogenetic research

    There is a paucity of data on the naturalistic or ‘real life' study of psychiatric patients. The pressing issues are treatment adherence, cost, family support, psychological therapies, ethnogenetic differences in response, psychoeducation, community services, etc. The combined effort of clinicians in East Asia will provide important information to the world on how patients are being cared for in our clinics and hospitals.

  • S36-4

    中国大陆地区抗精神分裂症药物处方模式追踪调查 - Following up Investigation Antipsychotic drugs Prescription for Inpatients with Schizophrenia in China

    Tianmei Si 1 , Yanling He 2 , Wei Hao 3

    1 Peking University Institute of Mental Health, Beijing, Chinese Mainland, 2 Shanghai Mental Health Center, Shanghai, Chinese Mainland, 3 Xiangya Hospital, Zhongnan University, Hunan, Changsha, Chinese Mainland

    精神科医生的 处方模式逐渐受到越来越多的新药种类和他们自身接受的大量的培训的影响。为了研究东亚地区抗精神病药物的处方模式和影响因素 ， 我们于 2001 年 7 月、 2004 年 7 月相 继进行了精神分裂症住院病人处方模式调查。这里报告的是 04 年的 调查结果。方法：利用标准诊断方法，在长沙、北京、上海这三个中心调查了从 7 月 1 日至 7 月 31 日期 间接受治疗的精神分裂症病人。收集包括临床特征和药物治疗方面的数据，研究得到北京大学精神卫生研究所药物处方委员会的批准。结果：共调查符合条件的病人 504 例，其中 长沙 102 例、北京 200 例、上海 202 例。女性占 48.2% 。病人年 龄从 13 岁跨至 88 岁，平均年龄为 38.88 岁（标准差为 14.64 岁）。长沙的病例与其余两个地方的相比，具有较轻的年龄和较短的病程。 65% 的病人 为病程超过 5 年的慢性病人，病人住院大 约十个月。 84.5% 的病人社会功能与工作能力受 损。 72.4% 的病人 为阴 性症状， 55.4% 的病人 为阳性症状。四分之三的病人是单一给药， 23.4% 的病人 联合用两种药，有三例患者联合用三种药。在这些处方中， 75.6% 的 药为非典型药物，按给药次数计算，其中氯氮平占 40.3% ，利培 酮占 28.77% ， 喹硫平占 7.14% ，奥氮平占 4.96% 。使用典型 药物的处方占 39.7% ，其中 氯丙嗪占 13.69% ，舒必利占 8.16% ， 奋乃静占 5.36% ， 氯丙嗪平均日用量为 416.3mg-233.4mg ，等等。与 2001 年 调查结果相比， 2004 年中非典型 药物使用增加，日用量也增加了。三个中心的临床资料和处方 模式的不同 显示的结论为：抗精神病药物的处方模式随着经济和药理学的发展不断在改变。

    Background: New medication availability and more education course have the deep influence to the prescription pattern of psychiatrists. In order to study the prescription pattern of psychotropic drugs and analyze the influence factors in East Asia, we conducted the first survey in July, 2001 and this following up survey in July, 2004 on the prescription patter for inpatients with schizophrenia in Asian countries. This is the report of following up survey in July, 2004 from China .

    Methods: Using the standardized protocol, schizophrenic patients who admitted for treatment from 1st to 31st of July 2004, were surveyed at 3 centers in China . Data collected included the clinical characteristics and the antipsychotics treatment of the patients. This research was approved by the Ethical Committee of Medical Research of Peking University Institute of Mental Health.

    Results: 504 cases meeting the inclusion were surveyed from 3 centers, 102 from Changsha , 200 from Beijing and 202 from Shanghai . 48.2% were female. There was a wide age distribution, from 13 to 88 years, with mean age of 38.88 (s.d. 14.64). Changsha had the mean ages younger, and the duration of illness was shorter than Beijing and Shanghai . 65% were chronic patients with more than 5 years duration of illness. Patients had been staying in hospital for nearly ten months. 84.5% patients had impaired social and professional function and 72.4 % experienced the negative symptoms, and 55.4% had the positive symptoms in the past month.

    233.4 mg/day. ± Three quarters patients were treated with one antipsychotics (monopharmacy). 23.4% used two antipsychotics and 3 cases were treated with three kinds of drugs. Among the antipsychotics prescribed, 75.6% were atypical drugs, clozapine(40.3%), risperidone(28.97%), quetiapine(7.14%) and olanzapine(4.96%) by the frequency. 39.7% used typical drugs, chlorpromazine(13.69%), sulpride(8.06%), perphanazine(5.36%), haloperidone(4.56%) and others. Mean chlorpromazine equivalent dose was 416.3 Compared with results from the survey in July 2001, frequency of atypical drugs increased, and the daily dose (CPZ-equivalent dose) of antipsychotics increased also. The patient's clinical profile and antipsychotic prescription from 3 centers showed significant different.

    Conclusion: Antipsychotic prescription pattern is changing with social economic development and understanding the pharmacology of antipsychotics.

  • S36-5

    抗精神分裂症药物处方中的药物剂量问题 ——2001 年与 2004 年相比较 - High and Low Dose Antipsychotic Prescriptions in Schizophrenia- a 2001 and 2004 Comparative Research on East Asia Psychotropic Prescription (REAP) Study

    Sim Kang 1

    1 National University Hospital , Singapore , Singapore , Singapore

    抗精神分裂症 药物处方中的用药剂量问题在东亚国家中研究得尤其多 ， 我们曾经报道过在治疗中使用高剂量者占 17.7% 。在 这项研究中，我们分别调查了高剂 量，低 剂量的使用情况，它们的临床关联性以及这两年间的变化趋势。假设东亚地区在此期间高剂量，低剂量用药情况都是先增后减。方法：在六个国家和地区于 2001 年抽取精神分裂症病人 2399 例， 2004 年抽取 2136 例，高 剂量、低剂量这两种方式都用。结果：两年的数据比较显示，低剂量用药增加，由 24.8% 升至 44% （ P<0.001 ），高 剂量用药下降，由 17.9% 降至 6.5%(P<0.001) 。多元 logistic 回 归分析显示：低剂量用药与年龄增加 (OR 1.02,95%CI 1.01-1.03,P<0.001) ，第一代抗精神病 药物使用减少 (OR 0.65,95%CI 0.53-0.78,P<0.001) 有 关；高剂量用药与年龄较轻 (OR 0.98,95%CI 0.97-0.99,P<0.001) ，第一代抗精神病 药物使用增加 (OR 3.51,95%CI 2.47-4.90,P<0.001) 有 关。同样，在新加坡，低剂量用药趋向增多（ 28.7% 升至 59%,P<0.001 ），高 剂量用药趋向减少（ 20% 降至 6.6%,P=0.002 ）。多元回 归分析显示：低剂量用药与低水平孕激素使用有关 (OR 0.36,95%CI 0.25-0.54,P<0.001) ，高 剂量用药与年龄下降有关 (OR 0.97,95%CI 0.95-0.99,P=0.037) 。 结论 : 精神分裂症 药物治疗中高低剂量用药发生明显变化。因此，我们需要进行药物流行病学研究来更好地纵向评估药物处方模式及其影响因素。

    Background: Low and high dose antipsychotic use in schizophrenia are relatively understudied especially within East Asia. We have previously reported an overall rate of high dose antipsychotic use (17.9%) in schizophrenia. In this follow up study, we seek to examine the use of low (defined as CPZ mg equivalent doses below 300) and high dose (defined as CPZ mg equivalent doses above 1000) antipsychotic use, their clinical correlates as well as determine trend changes between the two time periods (2001 and 2004). We hypothesized that there was an increase and corresponding decrease in the use of low and high dose antipsychotic respectively over time in East Asia .

    Methods: High and low dose prescription use for a sample of 2136 patients with schizophrenia from six countries and territories ( China , Hong Kong , Korea , Japan , Taiwan , Singapore ) were evaluated in 2004 and compared with those of 2399 patients in 2001.

    Results: Overall, data comparisons between 2001 and 2004 showed a significant increase in low dose (24.8% to 44.0%, p<0.001) antipsychotic use and decrease in high dose (17.9% to 6.5%, p<0.001) antipsychotic use. Using a multiple logistic regression model, low dose antipsychotic use was associated with increased age (OR 1.02, 95%CI 1.01-1.03, p<0.001), less use of first generation antipsychotic (OR 0.65, 95%CI 0.53-0.78,p<0.001) and high dose was associated with younger age (OR 0.98, 95%CI 0.97-0.99, p=0.035), increase in first generation antipsychotic use (OR 3.51, 95%CI 2.47-4.90, p<0.001). In Singapore , a similar trend prevailed from 2001 to 2004 for low (28.7% to 59.3%, p<0.001) and high dose (20.0% to 6.6%, p=0.002) antipsychotic use. Multiple regression analyses revealed that low dose use was associated with less depot use (OR 0.36, 95%CI 0.25-0.54, p<0.001) and high dose use was associated with decreased age (OR 0.97, 95%CI 0.95-0.99, p=0.037).

    Conclusions: Significant positive trend changes were found in the prescription of low and high dose antipsychotic in schizophrenia, thus lending support to the usefulness of such pharmcoepidemiology studies to evaluate longitudinal prescription patterns as well as the factors impacting such patterns.

  • S37 - Depression: Treatment Advances and Implications for Care

    Chairs: Jerrold Rosenbaum, United States
    Jonathan Worth, United States
    Taoyuan Xu, Chinese Mainland

    Purpose – to compare and contrast what is learned about the etiology, diagnosis and treatment of depression from the fields of psychopharmacology, neurotherapeutics and psychotherapy.

  • S37-1

    Neurotherapeutics: Past, Present and Future

    Lawrence Park , United States

    Abstract text has not been submitted

  • S37-2

    Pharmacotherapeutic Approaches for the Depressed Patient: First Line and Next Step Treatments

    Jerrold Rosenbaum, United States

    Abstract text has not been submitted

  • S37-3

    Effective Psychotherapies for Depression: Evidence-Based Approaches and Novel Applications

    Timothy Petersen, United States

    Abstract text has not been submitted

  • S37-4

    The Collaborative Care Model to Improve Recognition and Treatment of Depression in the Medical Settings

    Albert Yeung, United States

    Abstract text has not been submitted

  • S37-5

    Contribution V to the Sympsium "Depression: Treatment Advances and Implications for Care"

    Liang Shu, Chinese Mainland

    Abstract text has not been submitted

  • S38 - 精神科医师培训 - Psychiatry Training Program

    Chairs: Xin Yu, Chinese Mainland
    Enrique Bobles, United States

  • S38-1

    亚洲地区精神科医师的培训与专业人员发展 - Professional Development and Training of Psychiatrists in Asia

    N Sartorius

    International Association for the Improvement of Mental Health Programmes, Geneva , Switzerland

    多数 亚洲国家中精神科医师 （ 包括其他精神卫生工作人员 ） 占整个人口的比例都很低 ， 而他们在国家中扮演的角色却需要精神卫生服务发展完善、人员充足。因 此有必要 为他们设计一种不同于欧洲以及其他工业化发达国家的培训项目。而这还不是关键。在发达与发展中国家，毕业后继续教育与研究生教育的比重很小，这使得精神科医师很难担负起领导精神卫生服务发展，满足国内需求与现状的职责。本文将关注那些需要加强的课程 ， 以使毕业生能够更好地应对公众的需求。

    The ratio psychiatrists/population is low in most Asian countries and the roles of psychiatrists (and of other mental health workers) would therefore have to be different from the roles that these professionals have in countries in which the mental health services are well developed and adequately staffed. To make this possible it would be necessary to design their training in a manner different from that prevailing in European and other highly industrialized and developed countries. This however is not the case. Graduate and postgraduate training are still constructed in a very similar way in developed and developing countries and, as consequence psychiatrists only rarely assume leadership in the development of a model of mental health care that would correspond to the needs and conditions in their countries. The presentation will focus on elements of curricula that would need to be strengthened in order to make graduates better able to respond to the needs of their populations.

  • S38-2

    精神科 “ 双基 ” 培训在中国各地的实践 - Psychiatric Basic Training in China

    Yifng Xu

    Shanghai Mental Health Center , Shanghai , Chinese Mainland

    “ 双基 ” 的内容是 “ 基本知 识 ” 和 “ 基本技能 ” ， 这本来是一位医师从事某个专业必须掌握的基本内容 ， 但是由于我国的医学教育和住院医师培训体系的不完善 ， 基层医师对这两项内容的掌握程度普遍较差 ， 精神科也不例外 ， 而且情况 比其他学科相比更加糟糕。 为了改变这种状况，中国卫生部组织 了一个主要 针对基层精神科医生的专科培训项目，由北京大学精神卫生研究所等四个培训中心具体执行培训任务。

    项目从 2002 年 开始，每年一期，由四个培训中心各执行 1 个班， 每班培 训高年住院医师以上的医生约 50 人，全年培 训约 200 人。 2003 年由于 SARS 而中断，到今年 9 月共 举办 5 期 19 个班，培 训总人数约 1000 人。

    项目从开始就与中国精神科专科医师培训体系的建立同步，其培训经验直接被运用到制定中国精神科专科医师培训大纲和培训教材的编写之中。

    “ 规范 ” 和 “ 系 统 ” 是 该项目的操作指导。我们力图建立起一个能够被广泛接受的精神 障碍全程 处理的流程模式和步骤框架，同时特别注意针对每一个步骤的具体细节进行培训，使受训者系统地掌握基本知识，规范地操作基本技能。

    在 执行过程中我们发现，基层精神科医生的专业态度和基本技能的缺陷，比基本知识的缺乏更为突出。因此我们逐渐将培训的重点转向态度和技能。在内容上，由原来的讲课多于实习，演变成目前临床技能实习和观摩占 70% 。在教学方法上，以 现场观摩专家查房、录像分析与讨论、角色扮演、病房实习为主，讲大课为辅。具体的方法是：围绕临床实际病例的完整处理过程进行培训，将临床诊疗过程的每一个步骤和细节分拆教学， 然后整合成 规范化的完整过程。另外还增加了临床法律和伦理问题的课程。

    从 2005 年的第三期 开始，各培训中心将培训地点选择在二线城市，与当地的目标医院共同举办项目，这样不仅扩大了本项目的影响，更重要的是培养新的培训基地和教师队伍，也为目标医院带来了社会效益。

    The ‘basic training' includes basic skills and basic knowledge which should be implemented in the phase of psychiatric residency training. However, due to the lack of systemic training curriculum of psychiatric residency training in China , most of Chinese psychiatrists are trained in a sort of ‘master-apprentice' way, which results in a disparity in terms of qualification and practice capacity. In order to improve this situation, the Ministry of Health initiated a training program targeting doctors working in provincial psychiatric hospitals. The training program is undertaken by four prestigious psychiatric institutions in Beijing , Shanghai , Hunan , and Sichuan . The program started in 2002. It is an annual training program which includes four workshops, 50 trainees per workshop. Until now, more than one thousand doctors were recruited. Meanwhile the training curriculum for psychiatrist is in drafting process and the experience from the ‘basic training program' is much helpful for the development a more focusing and more practical curriculum. We keep trying to set up a paradigm which stresses the standardization and systemization. A framework which includes every detail in the diagnosis and management of psychiatric disorders is repeatedly practiced so that the participants can learn how to interview the patient and structure the therapeutic strategy What we have learnt from the training program is that the trainees are much worse in the attitude and skills than that of basic knowledge. To improving the professional attitude and skills, we try to integrate more practice into the workshop rather than lectures. The practice consists of grand round, observation of teaching videos, role play, and group discussion in psychiatric ward. Vignette analysis provides a good example of making clinical diagnosis, establishing management plan, and dealing with other issues such as ethical and legal issues. The workshops now extend to smaller cities and co-organize with local psychiatric hospitals. Therefore it brings a more in depth impact to the local psychiatric institution and more training opportunities for doctors from remote areas.

  • S38-3

    如何将心理治疗整合到精神科医师培训课程中 - How to Integrate the Psychotherapy Training into Psychiatry Training Program

    Wen-Shing Tseng 1

    1 University of Hawaii , School of Medicine , Department of Psychiatry, Honolulu , United States

    虽然近年来生物精神医学 ， 包括精神药物学 ， 有显著的发展 ， 对精神医疗有明显的改进 ， 特别是对严重 性的精神疾病 ， 可是仍然很有需要推展心理治 疗 ， 特别是对轻度性的精神疾病或患一般心理问题的病人。有经验与远见的专家们都肯定现代精神医学需要广泛且整合性的包含 “ 生物 - 心理 - 社会与文化 ” 取向。在精神科医 师培训课程中需要有相当的份量针对并分配于心理治疗的训练，这样每位受训的精神科医师都可以学习到如何针对所有病人去执行所需的心理治疗。这是对任何社会都是一样的要求与看法，而本报告将就中国的情况为例子来讨论。

    为了提供适当的心理治疗的训练，首先要有一些基本而重要的条件。即：精神医学的取向要超越 ( 现象 ) 描述性的精神医学而富有心理取向的 动态性精神医学。除了描述性地针对病人所表现的症状、病情、分类诊断与药物治疗以外，还得能就 “ 人 ” 的角度去了解并把握病人，包括：个人的生活、心理状 态，及如何去协助并处理心情上的问题。同样很重要的基本条件就是，精神医学的培训要有明确的、整体性的系统，按年有计划性、成长性的进行，并且有充分的培训的课程。不仅是带教的医院，普通的医院也该如此，才算是正规的提供了住院医师的培训。

    由于心理治 疗是很重要而复杂的临床知识与经验，配合着整体的培训课程，至少要有三分之一到二分之一的时间分配于心理治疗的培训，并且按年而有 逐 步性的安排培 训的要点与内容。以最短的三年培训期间为例来说，头一年最好要注重如何有深度的了解人的心理与人格发展、行为的性质、病理的动态性原理、以及心理治疗会谈的基本原则与要领。接着，第二年就得注重学习：心理治疗的基本学理，各种不同模式的心理治疗，包括分析性、认知 - 行 为性、人际性治疗 （如：家庭、婚姻与群体治 疗）。至于第三年就得学习心理治疗高度的知识与学理，并且懂得如何能熟练的操作长期性、短期性的治疗治疗，对各种不同精神病理与性格的治疗要领，如何考虑文化与哲学思想上的因素，以及如何品审治疗的效果等。

    因 为心理 治 疗的施行，不但要有知识，强调学理的了解，还得学习实际上的技巧与要领，因此，心理治疗的培训要以多样形式来进行，并且学理知识与实际经验并重。培训的课程通常每周要包括：就题讲解与讨论的专题讨论会、个案讨论会、以及督导。精神科医师要学习如何治疗住院的严重病人，但也必得学习如何诊治门诊的轻度病人，经验如何治疗各种不同病情与性格的病患者，更也要学习如何适当地配合心理与药物的治疗，有效地医疗病人。

    总归说来，每个精神科医师都要在其培训过程里接受心理治疗的训练。这样，每个精神科医师，除了懂得如何开药治疗病人以外，还能提供 每 个病人所需的心理上的 辅导与治疗。也就是说，心理治疗不是接受特别训练的心理治疗师才可以施与的特殊疗法，而是每个精神科医师都需懂得操作的基本医疗方法。如何建立有系统培训的观念，培养所需的教师，如何更改培训的制度，是要逐年去改进的迫切课题。

    In spite of the recent remarkable advance in biological psychiatry, including psychopharmacology, improving tremendously the psychiatric care of patients, particularly for those suffering from major psychiatric disorders, there is still a great need to promote psychotherapy for caring of patients suffering from minor psychiatric disorders or emotional problems. Most of the competent clinicians agree that modern psychiatry needs to be biological-psychological-sociocultural oriented and comprehensive in nature. Furthermore, there is a need of emphasis of psychotherapy training as a significant part of the training program so that each psychiatrist trained will know how to provide psychological therapy for patients. This is true for most societies but discussion will be geared mainly for the situation in China as example.

    In order to provide adequate psychotherapy training, there are several major premises. The psychiatry needs to be dynamically oriented, beyond descriptive orientation. Knowing how to comprehend a patient as a person with personal life and how to work on emotional matter is very important beyond focusing merely on patient's symptoms, diagnosis and medication descriptively. Equally important is that there is a need to have a systematic training program available for the residents in training. During the course of training, there needs to be a clearly defined stage and program of training with identified goals for each year to advance progressively.

    Integrated with such systematically developing training program, there is a need to have a sufficient part of time devoted to the training of psychotherapy, at least one third to half of the total training time. The emphasis of training needs to be progressive yearly. Let us take three year period of training as example. For the first year , it is suggested to focus on comprehensive and in depth understanding of human mind, the nature of human behavior, life development, and the principle and skill of psychiatric interview. For the second year, emphasis needs to be concentrated on the understanding of: the basic principle of psychotherapy; different models of psychotherapy, including analytic, cognitive-behavior, and interpersonal therapy (such as family, couple or group therapy); and practice of long-term as well as short-term psychotherapy. For the third year, the stress can be laid on the advanced knowledge and experiences of psychotherapy, therapy for patients of various pathology, including evaluation of psychotherapy, culture and philosophical aspects of psychotherapy.

    Because of the nature of the psychotherapy, which need address not only the knowledge of theory, but also the actual clinical experiences, the teachings need to be carried out in multiple formats simultaneously. This includes the didactic teaching of various topics, case-conference, and clinical supervision. The trainees need to experience psychotherapy of inpatients, outpatients, for patients of various psychopathology.

    The final goal of the training is to make every psychiatrist know how to carry out psychotherapy in addition to pharmacotherapy or other forms of treatment. In another word, psychotherapy is not for specialists to carry out but for every psychiatrist to perform.

  • S39 - 社交焦 虑症的研究现状 （ 归属焦虑障碍 ） - Current Research Situation in Social Anxiety

    Chairs: Wei Zhang, Chinese Mainland
    Dominic Lee, Chinese Hong Kong

    主席 ： 张伟 社交焦 虑障碍自 1985 年 Leibowitz 提出以来 ， 就有学者 预言它将是 21 世 纪最常见的心理障碍之一。据美国国立共病率研究中心（ NCS ） 调查结果表明，社交焦虑障碍终身患病率（ 13.3 ％）是 仅次于抑郁症（ 17.4 ％）、酒依 赖（ 14.1 ％）的第三位常 见病。社交焦虑障碍通常起病年龄在 13—24 岁之间，平均 20 岁左右，平均病程 20 年，只有 1/4 的患者随年 龄增长而后缓解。病程的慢性化、症状的痛苦、社会功能的损害严重 影响患者的生存、生活 质量。近年来，国内外学者从多个角度对社交焦虑障碍进行了研究，但仍存在不少须待进一步研究的地方。

    1 、 SAD 常被 过低诊断，许多情况下社交焦虑障碍要早于其他精神疾病的出现，但通常是和其他疾病发生共病后才被发现。估计只有不到四分之一的患者接受了正确的诊断和适当的治疗。而大量证据表明，社交焦虑障碍的早期发现和治疗可预防病程的慢性化、改善患者的社会功能。

    2 、社交焦 虑障碍共病率高， 80 ％的 SAD 至少与一 种其它精神障碍共病， 50%SAD 与 GAD ， PD 共病； 85.2% 与物 质滥用共病； 33% 的 SAD 同 时 符合重型抑郁的 诊断； 59%-67.8% 与人格障碍共病，且伴有人格障碍的社交焦 虑障碍出现抑郁情绪，焦虑和功能受损较与其他共病更严重。共病加重了疾病的严重程度和疾病负担，严重影响患者的生命质量。 Wittchen 等（ 1996 年）采用社会功能 问卷调查了社交焦虑障碍的生活质量，结果表明在情绪表达、社会功能和生命活力三方面明显受损， 50 ％的患者 严重或明显损害。但共病的作用机制尚未明了，是否具有相同的遗传背景、起病因素须待进一步研究。

    3 、社交焦 虑障碍病因不清，据研究心理社会因素占 2/3 ， 遗传因素占 1/3 。但社交焦 虑障碍 的病理心理机制仍不清楚，不同的学者从多个角度 进行了研究，但未能完全解释病理心理机制。 4 、社交焦 虑障碍患者对治疗反应不一，预后不一，是否存在不同亚型仍需进一步研究。

    此次适逢国 际精神病学年会，有机会拟就下列内容向国际同行进行交流学习。

    1 、 张伟教授：社交焦虑障碍的中国现状及流行病学调查

    2 、 张新凯教授：中国社交焦虑障碍物的心理治疗方法

    3 、吴薇莉教授：社交焦 虑障碍的病理心理机制研究及初步分型

    4 、 龚启勇教授：社交焦虑障碍的功能脑影像研究

    期望通 过上述的专题报告促进对社交焦虑障碍的关注与研究。

  • S39-1

    中国社交焦虑障碍的现状及流行病学调查 - Epidemiology Survey on Social Anxiety Disorder in China

    伟 张 1

    1 四川大学 华西医院心理卫生中心 , 成都 , Chinese Mainland

    社交焦 虑障碍患病率高，是继重型抑郁 (17.4%) 和酒精依 赖 (14.1%) 之后的第三常 见精神障碍，且共病率高， 80 ％与 轴Ⅰ共病， 59.0 ％－ 67.8 ％与 轴Ⅱ共病。起病年龄多在 13—24 岁，平均 20 岁左右，平均病程 20 年左右，一般不能自我 缓解，约 25 ％的患者随年 龄增长缓解，发病率女性（ 59% ） 显著高于男性（ 41% ），社会功能缺陷，疾病 负担严重，不到 1/4 的患者接受了正确的 诊断和适当的治疗。 2004 年 张伟等对成都市 11-24 岁 2279 名学生采用 SCID －Ⅰ定式一 对一检查，发现患病率 8.15 ％，共病率 30.87 ％，共病患者中心境障碍 73.91 ％，焦 虑障碍 58.70 ％，物 质使用障碍 10.87 ％； 发现生长环境、家庭经济情况、父母教养方式、人格因素、遗传等是其危险因素。阳性家族史率 11.21% 。随后 对社交焦虑障碍一级亲属的研究发现，社交焦虑障碍一级亲属社交焦虑的状况比正常对照组的一级亲属更加明显；社交焦虑障碍患者性格更倾向于精神质、内向、情绪不稳定，社交焦虑障碍的一级亲属与正常相比性格更加倾向于内向；社交焦虑研究组及其一级亲属的心理健康状况偏差；社交焦虑患者性格内向，容易表现出在公共场所讲话时更加焦虑，其情绪不稳定容易在社交中感到焦虑和害怕；社交焦虑患者的一级亲属内向的性格引起在各个社交场合中的焦虑害怕。目前正在进行社交焦虑障碍患者的功能脑影像、电生理、药理遗传学及治疗方案优化的研究。

    Social anxiety disorder have high prevalence rate. Following is the third common mental disorders after major depression (17.4%) and alcohol dependence (14.1%), and the disease has a high rate of 80% and a total of axis I disease, 59.0% -67.8% and axis II comorbidity. More rapid onset age 13 -24 years old, with an average age of 20 or so, the average duration was 20%, generally not self-mitigation, About 25% of patients with age growth eased, the incidence of women (59%) was significantly higher than that of males (41%), social dysfunction, a serious disease burden, less than 1 / 4 of the patients receiving the correct diagnosis and appropriate treatment. In 2004, such as Chengdu, 2,279 11-24 -year-old students using SCID - I scheduled one-on-one check - found prevalence rate 8.15%, a total of 30.87% rate of the disease, patients were comorbidity with mood disorder 73.91%, Anxiety Disorders 58.70%, substance use disorders 10.87%; found that the growth environment, family economic situation, Parenting styles, personality factors such as their genetic risk factors. Positive family history of the rate of 11.21%. Then right a social anxiety disorder relatives, the study found. a social anxiety disorder social anxiety of relatives of the situation than the normal control group of relatives of a more obvious; Patients with social anxiety disorder personality more inclined to spiritual quality, introverted and emotional instability, social anxiety disorder and relatives of a normal compared to the more inclined to character; Social Anxiety Study Group and relatives of a mental health deviation; Patients with social anxiety introverted personality, easily displayed in public places is more speech anxiety, emotional instability easily felt in social anxiety and fear; Patients with social anxiety to the relatives of a lead character in various social occasions anxiety fear. Ongoing social anxiety disorder patients with functional brain imaging, and electrophysiology, genetics and pharmacological treatment plan optimization studies.

  • S39-2

    社交焦虑障碍的认知行为集体治疗方法与初步结果 - Social Anxiety Disorder of Cognitive Behavioral Group Therapy with Preliminary Results

    XinKai Zhang 1

    1 Shanghai Mental Health Center , Shanghai , Chinese Mainland

    目的 : 探 讨认知行为集体治疗 （ CBGT ） 方法治 疗社交焦虑障碍 （ SAD ） 的具体方法与治 疗效果。

    对象和方法 : 上海市心理咨 询中心就诊的 SAD 患者中自愿参加 CBGT 者 ， 符合 DSM-IV 关于 SAD 的 诊断标准 ， 性别年龄不限 ； 记录患者的一般资料及病史资料 ， 包括咨询号、姓名、性别、年龄、职业、文化、婚姻、家族史、病程、起病年龄、诱发因素、病前性格、既往治疗情况等及 MMPI 测试 ； 参加集体治疗的 SAD 者治 疗期间均未服用治疗 SAD 药物 ， 如即往用过药者需经两周的药物清洗期 ， 其中 6 例因睡眠不好于夜 间睡前不定时服用小剂量安定类药物助眠。 CBGT 的 实施：每个治疗集体（小组） 6-8 人，由一名心理治 疗师主持治疗 8 周， 每周日上午 2.5 小 时。内容包括：患者自我病情介绍、认知重建 （ 认别自己的自动负性想法和核心信念），恐惧对象分级，放松训练，社交技巧训练，系统暴露和现场暴露治疗。每次治疗后有家庭作业。治疗前进行 LSAS 量表（ Liebowitz 社交焦 虑评定量表）评定；每次治疗前进行作业检查；其中内容可根据学员反馈情况作适当调整。疗效评定由其它两位心理治疗师进行，主要评定工具为 LSAS 。 计总分、恐惧因子分、回避因子分，统计分析用配对 T 检验方法。

    结果 : 符合入 组条件的 58 例中 诊断为 SAD-I 型 25 例、 II 型 23 例、 III 型 10 例，男 34 例、女 24 例，性 别比 1.42:1 ，年 龄 16-48 岁（ 25.95±6.10 岁），病程 6 个月 -19 年（ 7.17±4.75 年），起病年 龄 11-34 岁（ 18.81±4.56 岁），初中文化 6 例、高中 / 中 专 20 例、大 专以上 32 例，未婚 37 例、已婚 20 例、离异 1 例，精神疾病家族史 4 例， 诱发因素原因不明者 20 例，有心理社会因素者 30 例，躯体疾病加心理社会因素者 5 例；病前个性 51 例 为内向、 1 例外向、 6 例中 间型；既往用过药物治疗者 24 例，心理治 疗者 8 例， 药物合并心理治疗者 26 例。 LSAS 量表 评分：总分治疗前后 75.89±28.82 和 47.00±23.71 （ t=12.60 ， p<0.01 ）；恐惧因子分治 疗前后 39.28±13.12 和 25.39±12.42 （ t=8.267 ， p<0.01 ）；回避因子分治 疗前后 36.39±16.44 和 22.17±13.29 （ t=8.067 ， p<0.01 ），均有 统计学显著性差异。

    结论： CBGT 治 疗 SAD 有很好的 疗效，尤其对 SAD 的回避行 为效果似更显著，值得推广。

    Objective: To investigate cognitive behavioral group therapy (CBGT) efficacy for treating social anxiety disorder (SAD ) and the specific treatment methods.

    Targets and methods: Shanghai psychological counseling centers for treatment in patients with SAD voluntary CBGT, meet DSM-IV diagnosis of SAD standards, sex irrespective of age; Records of the patients general information and history information, including advisory, name, sex, age, occupation, culture, marriage, family history, course of illness, age of onset, inducing factor, premorbid personality, grandfather, and so on and treatment of MMPI; participate in group therapy treatment of SAD during the treatment of SAD did not take drugs, If that is used to the drug subject to a two-week drug washout period. Six cases of sleep well at night before bed without taking regular small doses of drugs Zhumian stability. CBGT implementation: each treatment group (Group) 6-8, and from a psychological therapists presided over eight weeks of treatment, every Sunday at 2.5 hours. Include: self-disease patients, the cognitive restructuring (identification of negative automatic thoughts and core beliefs). fear object classification, relaxation training, social skills training, and on-site system exposed exposure treatment. After each treatment a family operation. Before treatment LSAS Scale (Liebowitz Social Anxiety Rating Scale) evaluation; each treatment operation before inspection; content feedback from trainees under the circumstances make appropriate adjustments. Clinical assessment by the other two psychological therapists, the main tool for assessing LSAS. Total score, the fear factor, the factor scores evaded, statistical analysis using paired T test.

    Results: The results meet the entry conditions of the Group of 58 cases were diagnosed as SAD-25 patients with type I, type II in 23 cases, Type III 10 cases, 34 were male and female 24 cases, the sex ratio was 1.42:1. aged 16 -48 years (25.95 ± 6.10 years), duration of six months -19 (7.17 ± 4.75), onset age 11 -34 years (18.81 ± 4.56 years), junior middle school education six cases, the high school / secondary school in 20 cases, college or 32 cases, unmarried 37 cases, 20 cases of married, divorced one cases, family history of mental illness four cases. unknown factors induced 20 cases, psycho-social factors, and 30 cases physical disease plus psycho-social factors were five cases; Personalized disease before 51 cases of introverted, an exception to, the middle-six cases; always used the drug treatment, 24 cases Psychological treatment eight cases, drug therapy with 26 patients. LSAS scores : scores before and after treatment 75.89 ± 28.82 and 47.00 ± 23.71 (t = 12.60, p "0.01); fear factor scores before and after treatment 39.28 ± 13.12 and 25.39 ± 12.42 (t = 8.267 , p. "0.01); evading factor scores before and after treatment 36.39 ± 16.44 and 22.17 ± 13.29 (t = 8.067 , p. "0.01), both statistically significant differences.

    Conclusions: The treatment of SAD CBGT had good results, especially for the avoidance behavior SAD effect seems even more markedly, worth promoting.

  • S39-3

    Contribution III to the Symposium "Current Research Situation in Social Anxiety"

    Weili Wu, Chinese Mainland

    Abstract text has not been submitted

  • S39-4

    Contribution IV to the Symposium "Current Research Situation in Social Anxiety"

    Qiyong Gong, Chinese Mainland

    Abstract text has not been submitted

  • S40 - 难治性抑郁障碍生物学机制及其临床特征 - The Biological Mechanisms and Clinical Features of the Treatment-resistant Depression

    Chairs: Xueli Sun, Chinese Mainland
    Haroon Rashed Chaudhry , Australia

    据 统计 ， 难治性抑郁障碍为抑郁障碍的 30% ， 在本次会 议上所讨论的 “ 难治性抑郁 ” 是指采用两 种或两种以上不同类型的抗抑郁剂足疗程、足剂量地治疗后仍不能取得明显疗效的病例。难治性抑郁造成患者临床症状的久治不愈，造成抑郁障碍的慢性化趋势增加，造成患者的自杀率增加，值得高度重视。本次会议将就两年来对于难治性抑郁的临床、神经生化、脑影像学结果进行报道和讨论。

    According to statistics, refractory depression takes 30% of depression.In this meeting we discussed the “refractory depression” refers to the cases for which we used two species or two or more antidepressants of different chemical structure, after adequate dose , the full course of treatment ， and the therapeutic effect is still valid or little . It is noteworthy that refractory depression causes the clinical symptoms easy to relapse, causing increasing trend of chronic depression, causing increasing suicide rate of patients.. The meeting will report and disscuss the clinical symptoms, neurobiochemical and brain imaging results of refractory depression in our two years' research.

  • S40-1

    难治性抑郁的优化治疗方案研究 - The Study on the Optimized Treatment Plan to the Treatment-resistant Depression

    静 李 1

    1 四川大学 华西医院心理卫生中心 , 成都 , Chinese Mainland

    以文拉 发新作为基本治疗药物 ， 以甲状腺素、电抽搐治疗、非典型抗精神病药物、认知治疗作为辅助治疗手段 ， 对 400 例 难治性抑郁障碍患者分组进行治疗 ， 均取得明显疗效。治疗中有以下几点值得注意： ①文拉 发新对于难治性抑郁障碍的治疗比其它种类的抗抑郁剂对于难治性抑郁的治疗疗效更为明显，在此基础上，其优化方案依次是文拉发新 + 电疗；文拉法新 + 认知治疗；文拉法新 + 碳酸 锂治疗；文拉法新 + 甲状腺素治 疗以及文拉发新 + 非典型抗精神病 药物治疗。 ②以往 难治性抑郁障碍首选抗抑郁剂的种类、治疗的足够时间以及对于患者的心理干预均有密切关系，值得注意。 ③ 对于抑郁患者的抗抑郁剂治疗，在剂量足够的情况下，疗程应在 6-8 周。 ④ 在 规范治疗的情况下 ， 多数患者可以取得满意的治疗效果。

    Venlafaxine as a basic therapeutic medicine, thyroxine, electroconvulsive therapy, atypical antipsychotics and cognitive therapy as a means of treatment, 400 patients with refractory depression treated, we have achieved significant effect. The following points are worthy of note in the treatment: ① Compared with other types of antidepressants,venlafaxine has more obviously therapeutic effect. On this basis,the optimized programs one by one are venlafaxine + electrotherapy,venlafaxine + cognitive therapy,venlafaxine + lithium carbonate therapy,venlafaxine + thyroxine treatment, as well as venlafaxine+atypical antipsychotic treatment. ② It is noteworthy that previous types of antidepressant of first choice, sufficient treating time and the psychological intervention to patients are closely related. ③ Treatment using antidepressants should last 6 -8 weeks,at circumstances of sufficient dose. ④ In the case of standarized treatment, the majority of patients can achieve a satisfactory therapeutic effect.

  • S40-2

    难治性抑郁的神经内分泌研究 - The Study on the Neuroendocrine of the Treatment-resistant Depression

    学礼 孙 1

    1 四川大学 华西医院心理卫生中心 , 成都 , Chinese Mainland

    采用多中心、前瞻性、分 层、随机对照研究和队列研究设计相结合的临床研究方法。根据纳入、排除标准，共收集 1092 例。于用 药前采集静脉血，对纳入对象进行 HPA 轴和 HPT 轴相关生化指标检验，同时对入组对象进行临床指标评定。结果显示： ⒈抑郁症患者神 经内分泌异常率达到 59.4% ；⒉抑郁症患者 临床特征与不同神经内分泌轴具有相关性以下几点值得注意； ① HPA 轴异常组抑郁症患者多伴有激越症状； ② HPT 轴异常组抑郁症患者体重改变不明显，多伴有睡眠障碍、迟纯症状和焦虑症状，常出现自杀观念； ③ HPG 轴异常组抑郁 症患者多 发于年龄偏大的女性，躯体症状多明显； ④ HPA 轴和 HPT 轴均异常组抑郁症患者多伴有体重减轻和明显自责和迟滞症状； ⑤正常 组抑郁症患者多发于青少年，快感缺失症状明显。抑郁症以神经内分泌轴改变进行分型值得注意。 ⒊不同神 经内分泌轴改变的抑郁症对抗抑郁药物的反应下几点值得注意： ① HPA 轴异常组抑郁症患者对达体朗、舍曲林、阿米替林、帕罗西丁、西酞普兰、米氮平以及 SNRI 类药物治疗优于其他药物； ② HPT 轴异常组抑郁症患者对氟西丁、丙米嗪、氯丙米嗪以及 SNRI 类药物疗效优于其他药物； ③ HPG 轴异常组抑郁症患者选用舍曲 林、 SNRI 类药物以及激素的替代治疗疗效优于其他类药物； ④ HPA 轴和 HPT 轴同时异常的抑郁症患者选用 SNRI 类药物疗效优于其他类药物。

    This study was a prospective hierarchies random control study, executed in several centers. 1092 patients entered the study. The venous blood was collected before overdose. Neuroendocrine axle biochemistry detection were implemented, so as clinic index evaluation. Data management was performed by the department of medical statistics of Public Health school, Sichuan University . Results: 1. The depression patients in neuroendocrine abnormity make up 59.4% of the total. 2. Correlation of clinical features and neuroendocrine diversity of depression patients. ① Agitate symptom often existed in HPA axle abnormal group. ② The weight diversity was not obvious suffered HPT axle abnormal depression frequently, Sleep disorder and anxiety often exist in HPT axle abnormal group. ③ Elder women suffered HPG axle abnormal depression frequently, The symptom of somatic often exist in HPG axle abnormal group. ④ Self-reproach and delay symptom often existed in the HPA axle and HPT axle abnormal group. ⑤ The adolescent fuffered the normal neuroendocrine group, Patients of the normal neuroendocrine group were often combined with anhedonia. Antidepressant response to depression of different neuroendocrine abnormity is different, 3.So as following can be seriously regarded. ① The depression patients in HPA axis abnormity have better response to fluoxetine 、 imipramine 、 clomipramine and SNRI rather than other antidepressants. ② The depression patients in HPT axis abnormity have better response to fluoxetine 、 imipramine 、 clomipramine and SNRI rather than other antidepressants. ③ The patients in HPG axis abnormity have better response to sertraline 、 SNRI and hormone replacement therapy rather than other antidepressants. ④ The depression patients in both HPA and HPT axis abnormity have better response to SNRI rather than other antidepressants.

  • S40-3

    难治性抑郁症影像学研究 - Summary of the Key Technologies R&D Program in MRI

    Qiyong Gong 1 , Ke Zou 1

    1 四川大学 华西医院医学影像科 , 成都 , Chinese Mainland

    从 2005 年 8 月至 2006 年 10 月 9 日 ， 共有 77 人参加了本 课题影像学的磁共振研究。包括非难治性抑郁症患者 50 人， 难治性抑郁症患者 27 人。其中 37 人参加了随 访扫描。所有患者都对本研究知情同意且没有磁共振扫描的禁忌指征。所有患者都通过美国 GE 公司生 产的 3.0T 磁共振成像系 统 （ 8 通道 头部线圈）完成以下扫描序列：三维结构相 3D T1 ；波 谱；静息功能态；磁化转移；弥散张量成像；脑血流；斜位 T2 和任 务刺激。目前，波谱研究发现难治性抑郁症患者右侧海马 NAA/Cr 增 强，使得 双 侧海马 NAA/Cr 左高右低 这一在正常对照体现的特性在难治性抑 郁症患者消失。 关于 DTI ，我 们发现相对于正常对照，抑郁正患者的左侧顶叶，额叶和扣带前回 FA 值降低；与治疗前相比，额叶、颞叶、扣带前回以及海马等处治疗后 FA 值增高的患者反映出较好的疗效；扣带前回的 FA 值与抑郁症状的严重程度呈正相关。关于局部脑血流，我们发现难治性抑郁症患者双侧额叶血流降低，没有发现血流增加的脑区；而非难治性抑郁症患者左侧额叶和左侧颞枕区血流降低，边缘系统血流增加。关于 FMRI ，我 们发现情绪图片对难度较低的任务影响更为明显。这些研究结果说明额叶，顶叶，颞叶的改变与抑郁症关系密切，也映证了额叶 - 边缘环路在抑郁症病理生理中的重要地位。相对于非难治性患者，难治性抑郁症患者有独特的影像学表现，它们到底能否作为判断预后的指标需要进一步研究。

    A total of 77 patients with major depression （ MD ） participated in the MRI study from August, 2005 to October, 2006, including 50 non- treatment-resistant depression (nTRD) patients and 27 treatment- resistant depression (TRD) patients. Thirty-seven patients participated in the follow-up scan. All subjects were provided written informed consent after detailed explanation of the study and without mental indwelling. MRI examinations were conducted on a 3.0-Tesla MRI scanner (Signa, GE Medical Systems) for all the subjects using a standard 8-channel phase array head coil to obtain the following sequences: 3D T1; magnetic resonance spectroscopy (MRS); resting state functional MRI; magnetization transfer ratio; diffusion tensor imaging (DTI); FAIR; T2 mapping and functional MRI(fMRI). So far, MRS study found NAA/Cr of the left hippocampus was significantly higher than that of the right hippocampus in controls, while no such significant difference was found in TRD patients. As for DTI, decresed FA values were found in the left parietal lobe, left frontal lobe and left anterior cingulate cortex in depressed patients compared with normal controls; Compared with baseline, patients who responded to treatment showed increased FA values in the frontal lobe, temporal lobe, anterior cingulate cortex and the hippocampus after a 6-week treatment; the FA value in the anterior cingulate cortex correlated positively to the severity of depressive symptoms. About FAIR, decreased cerebral blood flow (CBF) were found in bilateral frontal blood in TRD patients and no regions showed increased CBF; instead, nTRD patients showed decreased CBF in the left frontal lobe and tempo-occipital region and increased CBF in the limbic system. For fMRI study, we found that emotional pictures had greater impact on the easier task. These results suggest that there is close relationship between changes of the frontal lobe, parietal lobe and temporal lobe and MD. They also suggest that the frontal-limbic circuits play an important role in the pathophysiology of depression. Compared with nTRD patients, TRD patients showed unique MRI manifestations. Whether can they be prognostic indicator needs further study.

  • S40-4

    难治性抑郁症的相关因素 - The Study on the Related Factors of the Treatment-resistant Depression

    Xiufeng Xu 1

    1 昆明医学院附属医院精神科 , 昆明 , Chinese Mainland

    难治性抑郁质的关注 ， 特别是那难治性抑郁概念的把握有待进一步商榷。提高抑郁障碍的治愈率应该注意抑郁障碍的生物学分型、抗抑郁剂的作用机制、以及患者病因及患者机理判别的个别化问题 ， 特别应该注意的是医学多学科的合作与配合的问题。

    We should furtherly disscuss and concern the nature of refractory depression , especially the concept of refractory depression.In order to raise the cure rate of depression,we should pay attention to the biological type of depression, the mechanism of antidepressants,the individualized causes and specific mechanism.And special attention should be paid to the issue on multidisciplinary medical cooperation and coordination.

  • S41 - 抑郁障碍治 疗的新概念 - New Conceptualization for the Treatment of Major Depressive Disorder

    Chairs: Mark Rapaport, United States
    Yiru Fang, Chinese Mainland

    本 专题会的目的是就当前公认的抑郁症概念、治疗和关于对一线治疗产生阻抗的抑郁症患者的处理策略等发起讨论。第一个演讲聚焦于抑郁症概念的变化 ， 将回顾抑郁谱系障碍的概念 ， 这种概念的延伸可能导致治疗模式的改变。第二篇论文中我们将讨论抑郁症药物治疗发展的革新，包括当前正在开发的新药的种类和进行大型国际性试验的新方法，后者对于确保新药的有效性和安全性来说是必不可少的。第三篇论文中我们将就发展难治性抑郁症的治疗新策略进行讨论，包括介绍 NIMH 提供 资助的 STAR-D 研究以及最近一些探索 难治性抑 郁症新治 疗方法的研究。

    The goal of this symposium is to stimulate discussion about the currently accepted concepts of major depressive disorder, its treatment and strategies for taking care of patients whose depression is resistant to initial treatment approaches. The first lecture will focus in on the changing conceptualization of major depressive disorders. This presentation will review the concept of depressive spectrum disorders and how this expansion of the concept of depressive disorders may lead to modifications in treatment patterns. In the second presentation we will discuss innovations in drug development for depressive disorders. There will be discussions of the types of compounds that are currently under development and also innovative approaches to performing large international trials that are necessary to insure the compound is both efficacious and safe. In the third presentation we will discuss the development of new strategies to address treatment-resistant depression. This talk will include both a review of data from NIMH-funded STAR-D study as well as other recent studies investigating novel approaches for treating resistant depression.

  • S41-1

    抑郁障碍新概念：对治疗的启示 - Reconceptualizations of Depressive Disorder: Implications for Treatment

    Mark Hyman Rapaport

    Cedars-Sinai Medical Center , Department of Psychiatry and Biobehavioral Sciences, Los Angeles , United States

    在全球范 围内为精神障碍创立一个公认的描述性疾病分类标准对于患者和科研而言具 有重大的意 义。这已经使得全球的临床医生和研究者们对于抑郁症的概念有了共同的理解。然而 ， 这种启发式的模型不应被当作教条 ， 而只能被看作是延展抑郁症概念的铺路石。本文将回顾最近一些令人振奋的新发现，这些发现与生物学研究发现迥然不同。研究数据提示抑郁症只不过是组成抑郁谱系障碍这个更广的概念的一个部分。重点介绍和讨论有关抑郁谱系障碍的临床和流行病学研究数据。最后听众将会更加深入的了解抑郁症的异质性特点，以及对抑郁障碍这个谱系及其可能的治疗方法开展更广泛的研究的必要性。

    Development of a commonly accepted descriptive nosology for psychiatric disorders worldwide has been a tremendous benefit for patients and for research. It has enabled clinicians and researchers throughout the world to share a common understanding of what is meant by major depressive disorder. However, this heuristic model should not be codified but rather used as a stepping stone for more extensive exploration of the concept of major depressive disorder. This presentation we will review some of the more recent exciting but disparate findings from biological studies of depressive disorders. We will also discuss data suggesting that major depressive disorder is only one component of a larger continuum of depressive spectrum disorders. In particular, clinical and epidemiological data about depressive spectrum disorders will be discussed and presented. By the end of the presentation the audience should have more comprehensive understanding of heterogeneity of depressive disorders and why it may be reasonable to pursue more extensive research investigating the spectrum of depressive disorders and potential treatments.

  • S41-2

    抑郁症药物研发革新 - Innovations in Drug Development of Depressive Disorder

    Amin Kalali

    Medical and Scientific Services, Quintiles CNS Therapeutics, San Diego , United States

    抑郁症 药物研发作为一项特殊的挑战 ， 有着非常高的试验失败率 （ 已记录在案 ） 。这些挑战来自诊断、患者的异质性、安慰剂的反应和受试者的结局管理等方面。

    这使得学院派和工业派的科学家们去寻求试验失败的原因，同时从方法学上进行改进。

    近十年来，中枢神 经系统临床试验的方法学相对滞后，但在不久以前，各方都在集中力量来改善这种情况。革新包括更多的使用集中数据、评估患者和纯化患者群的技术，更新的统计模型以及结局管理方法。同时主要转变还包括进行全球化的临床试验和在监管局领导下招募全球化受试者，而不仅仅局限于美国或者欧 洲的 试验中心。

    报告将回顾抑郁症药物研发领域的革新，探讨这些革新对研究者、临床医师和患者的影响。

    在 报告结束时，听众将了解抑郁症药物研发所面临的挑战和迎接挑战可能的解决方法。

    Drug development in the field of depression has its own particular set of challenges, and there has been a documented high rate of failed trials in this field. Some of these challenges include diagnostic issues, patient heterogeneity, placebo response, and our subjective outcome measures.

    This has stimulated a search by both academic and industry scientists to investigate the causes of failed trials and to try and develop improved methodologies.

    It is true to say that CNS clinical trial methodologies had remained relatively stagnant for decades but in the more recent past, there has been a concerted effort by various stakeholders to improve this situation. Some of these innovations include more use of technology in gathering data and assessing patients, refining patient populations, different study designs, and newer statistical models and outcome measures. There has also been a major shift to global clinical trials rather than just US and EU centric trials, as well as global submissions to regulatory authorities.

    This presentation will review the areas that have witnessed innovation in drug development of depressive disorders, and discuss how these innovations may impact, researchers, clinicians and patients.

    At the end of this presentation the audience will have learnt of the challenges facing drug development in the field of depression and some of the possible innovative solutions that have been developed to meet these challenges.

  • S42 - 泰国青少年与暴力 专题谈论会 - A Symposium on Adolescence and Violence in Thailand

    Chairs: Siriwan Grisurapong , Thailand
    Yasong Du, Chinese Mainland

    世界范 围的研究证据显示暴力在每个年龄层中都有所增加。鉴于其对躯体健康与精神健康的严重影响 ， 不少亚洲国家制定了一些特殊政策与干预措施以控制各种类型的暴力。然而，在青少年领域 中所作的工作甚少。 为了认识针对青少年暴力的新方法，我们将泰国的经验汇总起来并加以总结。在研讨会上提出此项内容的目的是为了将此作为一种操作模式在亚洲国家与地区以及其他地区中共享。

    目的：

    1 、促 进使用多种途径干预青少年暴力的认识提高与政策形成。

    2 、提供青少年暴力干 预启动的知识与技能。

    3 、促 进不同政策 - 社会 - 经济环境干预者间互相讨论、分享与学习。

    4 、鼓励青少年暴力干 预中的深入探索、研究与合作。

    预期结果：

    1 、 泰国干 预青少年暴力的经验可反映出亚洲国家的情况，并作为亚洲国家的范例为其他国家提供经验。

    2 、 来自不同文化与 环境的干预者可获得第一手的协助资料，分享在干预青少年暴力中的经验，并随着经验的累积提高不同干预者制定政策与项目执行的有效性。

    World wide evidence-based studies demonstrated that violence has increased its intensity in every population age group. Due to its profoundly effect on physical and mental health, several Asian countries have initiated some specific policies and interventions to respond to each type of violence. However, very little effort had been focused on adolescent age group. In order to identify some innovative ways to deal with violence in adolescence, experience and findings from Thailand had been gathered to draw some lessons learned. This session has been proposed to bring this issue to the arena so that experience can be shared for a practice model among countries in the Asian region and elsewhere.

    The session aims to: 1. Promote understanding and policy formulation on how to respond to issues of violence in adolescence in a variety way.

    2. Provide knowledge and transfer skills in initiating some intervention in adolescence.

    3. Promote discussion, sharing and learning among participants with different politico-socio-economic circumstances.

    4. Encourage for further explorations, actions and collaboration establishment in responses to violence in adolescent age group.

    Expected output / results:

    1. Thai responses to violence in adolescence can reflect and be an example of Asian experience for countries in other regions

    2. Participants from different cultures and circumstances will be beneficial from obtaining first hand information and sharing of skill and experience in dealing with violence among adolescence, and with this enrichment will be able to improve effectiveness of their policies and program implementation.
  • S42-1

    泰国社会经济与健康体系及其与青少年暴力间关系介绍 - Introduction of Thai Socioeconomic and Health Systems and its Relation to Adolescent and Violence Issues

    Siriwan Grisurapong

    Mahidol University , Faculty of Social Sciences and Humanities, Salaya , Thailand

    泰国是 东南亚的热带国家 ， 拥有 6160 万人口 ， 其中 20% 居住在城市 ， 共分 为 4 个区域 76 个省。 95% 人口是泰国人，几乎 100% 的人口都是佛教徒。近 30 年来 该国一直处在军事统治之下，至 1992 年才由一个民主政府管 辖。该国人均 GDP 为 6400 美金（ 2001 数据）。 1997 年前 该国人均 GDP 均有 每年 7-8% 的持 续增长，而在该年该地区遭受了严重的经济下滑，泰国也不例外。 自 20 世 纪 60 年代以来，泰国 经济持续增长，这种进步拥有强大的基础，并体现在经济与社会发展的各项指标中。尽管收入的分配并不均衡，但是证据显示所有社会经济组织与所有区域的人均收入与家庭收入均有显著提高 。 这使得泰国预期生存年龄增长为 68.9 岁，是该地区中最高的。或许我们可以用更有说服力的指标 —— 人 类发展指数来衡量这些增长，这是一项综合评估指标，它从 1975 年的 0.612 不断增加 为 2001 年的 0.768 。 此外， 经济增长使得泰国在社会与健康领域获得显著进步，获得这些进步的关键在于国家的疾病预防与治疗体系深入到了国家的各个角落。体系的发展使得多项指数明显下降，如新生儿死亡率从 1970 年的 74 例 /1000 名新生儿下降 为 2001 年 24 例 /1000 名新生儿， 5 岁以下死亡率从 1970 年的 102 例 /1000 名新生儿下降 为 2001 年 28 例 /1000 名新生儿。与此同 时， 1985-2001 年 间的产妇死亡率为 44 例 /100,000 名 产妇。通过覆盖率近乎 100% 的疫苗注射，大幅度降低三度 营养不良的发生，以及干预其他影响健康的因素如提供健康饮用水与合适的卫生设施，泰国实现了多种疾病传播的显著减少。然而 ， 近几十年中暴力发生在显著增加 ， 尤其是在青少年中。尽管只有很少数据能证明其严重性 ， 但一些事例证明了其存在。

    Thailand , a tropical country of Southeast Asia , has a population of about 61.6 million with 20% of it residing in the urban areas. The country is divided into 4 regions and 76 provinces. Ethnically 95% of the population is Thai and almost 100% of Buddhist faith. For almost 3 decades, the country was under military rule and it was in 1992 that a democratic government took office. The country has a GDP per capita (PPP US $) of 6400 (2001 figure), and had seen a sustained growth of 7-8% up until 1997. This was the year when the region saw a severe economic downturn, Thailand being no exception.

    From the 1960s on, Thailand saw a sustained growth in economy. This progress was broad based and finds expression in almost all indicators of economic and social development. Although income gains have not been shared equitably, but evidence suggests that there was a sharp increase in per capita and household income in all socio-economic groups and all regions. (HDR 99). This has resulted in addition to life years with the overall life expectancy at birth being 68.9 years, one of the highest in the regions. Better reflective, perhaps, of the comprehensiveness of these gains across different sectors is the Human Development Index which comprehensively measures, life expectancy, has increased steadily from 0.612 in 1975 to 0.768 in 2001.

    Besides economic growth there was marked improvements in social sectors and health. A key to these improvements is the development of a national system of preventative and curative health care that penetrates all the corners of the kingdom. (HDR 99) The development of decentralized system has made it possible to achieve sharp reductions in many indicators like Infant Mortality Rate which dropped from 74 in 1970 to 24 per thousand live births in 2001 and under five Mortality Rate of 102 in 1970 to 28 per thousand live births in 2001. (HDR 99) Maternal mortality ratio, during the same time, that is, 1985-2001 was 44 per 100,000 live births. Significant reductions in the modes of transmission of many diseases has also been achieved. This has been mainly made possible through nearly 100% immunization coverage, significant reductions in 3rd degree malnutrition and access to other factors which affect health, like provision of safe drinking water and proper sanitation. However, increasing of violence had been remarked during these decades, particularly in the adolescent age group. Although there is very little data to demonstrate its severity, anecdotal evidence confirm its existence.

  • S42-2

    泰国青少年犯罪影响因素 - Factors Affecting Committed Crimes among Thai Juveniles

    Suree Kanjanawong 1

    1 Mahidol University , Faculty of Social Sciences and Humanities, Salaya , Thailand

    本研究的目的在于探 讨 (1) 犯罪原因 （ 2 ） 解决青少年犯罪的方法。数据来源（ 1 ）通 过使用问卷，选取 200 名来自于名 为 Ban Mutita 、 Ban Karuna 、 Ban Ubekka 以及 Ban Pranee 的青少年 职业教育中心监管所的违法青少年， (2) 通 过进一步访谈，选取 4 名在上述中心的 违法青少年， (3) 通 过使用集中团体技术，选取来自上述中心的 10 名政府工作人 员包括社会工作者与临床心理治疗师。并使用频数，百分比，算数平均数，标准差对合格数据进行描述。 结果如下： (1) 社会与 环境原因：多数青少年犯罪者的教育水平为初中或小学，基本在同一水平；父母的婚姻状况为分居或离婚；居住在贫民区；在无限制的教育方式下成长；父母关系恶劣 (2) 个人原因：多数青少年犯罪者都 为累犯，大多数是与其同 伴 进行以获得财物为目的的犯罪；大约一半的人抵制上学，对学习成功感到乏味与无望；他们的期望大多数是金钱与享受；遵守家长、教师与同伴间规范水平为中等；自我控制力为中等。心理调查显示这些青少年犯罪者敏感，有攻击性，退缩，缺乏自信。他们在适应、协调人际关系、独立上存在困难，并由自卑感。

    The objectives of the study were to study (1) causes of committed crime and (2) measures to solve the committed crime among juvenile delinquents. Data were collected from (1) two hundred juvenile delinquents in the custody of The Juvenile Vocational Training Center, named Ban Mutita, Ban Karuna, Ban Ubekka, and Ban Pranee by using questionnaires, (2) four selected juvenile delinquents from the said Center by using in-depth interview, and (3) ten government officials including social workers, and clinical psychologists who are working in the Juvenile Vocational Training Center by using focus group technique. Frequency distribution, percentage, arithmetic mean and standard deviation were used to describe quantitative data.

    The results from the study are as follows; (1) Social and environmental causes: the educational levels of most of the juvenile delinquents are secondary school and primary school at almost the same rate; parent's marital statuses are separate or divorce; their residents are in slum areas; being brought up with permissive type of child rearing; the relationship between parents is poor (2) Personal causes: most of the juvenile delinquents had ever committed crime before, mostly on property's crime with his friends; about one-half of them reject their schooling, boring or no hope with learning success; an expectation of their outcome mostly in terms of money or enjoyment; a comply to subject norms including parents teachers, and peers are in the moderate level. Self-control is moderate. Psychological reports reveal that these juvenile delinquents are sensitive, aggressive, regressive, and low self-esteem. They also have problems with adjustment, making relationships with other, dependency, and inferiority feeling.

  • S42-3

    利用宗教解决青少年性暴力：佛教案例 - Faith-based Advocacy on Adolescent Sexual Violence: A Case of Buddhism

    Luechai Sringernyuong

    Mahidol University , Faculty of Social Sciences and Humanities, Salaya , Thailand

    和世界其他地方一 样 ， 青少年生殖与性健康问题 （ ARSH ） 在泰国日益 严重。近年来婚前性行为，未成年怀孕、流产，艾滋病病毒感染与艾滋病，暴力与毒品等问题正令人担忧的不断增多。尽管我们已尽力解决上述危机，但离成功尚远。本研究是 UNESCO 支持的，在泰国 Nakorprathom 省 开展的一项利用宗教促进青少年性与生殖健康的研究。其目的在于倡议利用佛教解决青少年性与生殖健康相关问题。该研究包括需求评估、募集社 会 资金、培训、工作坊与结果评估。本研究在该省的 3 个区内 开展，在 ARSH 的 进展与复杂性，佛教解决 ARSH 的相 关性与重要意义上提供了许多有价值的内容。最为重要的经验是如何动员宗教领袖、学校教师与儿童以及社区领导。

    Elsewhere alike, adolescent reproductive and sexual health problems (ARSH) have been rising in Thailand . Premarital sex, teenage pregnancy, abortion, HIV/AIDS, violence and drugs are among the problems worryingly increasing during the recent years. Although a lot of efforts have been done to solve the crises but success is still far-reaching. This study is part of a UNESCO's support project on Faith-based Advocacy on Adolescent and Sexual Reproductive Health carried out in Nakorprathom Province central of Thailand . Its aims concentrate on promoting Buddhism as a means to solve adolescent's sexual and reproductive health-related problems. Activities of the project comprise needs assessment, social capital mobilization, training workshop and outcome evaluation. The study took place in 3 districts of this province. The project provides many valuable lessons in regard to the dynamics and complexity of ARSH and the relevance and significance of Buddhism principles in solving ARSH problems. An important lesson learned is the practical aspects of how religious leaders, school teachers and children, and community leaders could be mobilized.

  • S42-4

    暴力及其对青少年精神健康的影响：测量与意义 - Violence and its Impact to Adolescent Mental Health: Measurement and Implication

    Siriwan Grisurapong

    Mahidol University , Faculty of Social Sciences and Humanities, Salaya , Thailand

    一 项由 WHO 组织多国家参与的关于性暴力 （ GBV ） 的研究 发现 44-51% 年 龄在 15-19 岁的泰国青少年 在他 们一生中至少经历过一次 GBV 。 许多科学研究发现青少年在遭遇 GBV 后会出 现一些心理障碍，如创伤后应激障碍（ PTSD ）、抑郁症与一些行 为障碍。但是泰国至今仍未有研究去证实 GBV 对青少年的心理影响状况，以及健康机构的干预措施应当如何提供给他们。 一 项研究被用来调查青少年遭受 GBV 的 严重程度，包括调查他们作为当事人或见证人。并调查 GBV 与一些心理障碍包括 创伤后应激障碍（ PTSD ）、抑郁症与焦 虑症的相关性。 2004 学年泰国 东北部某省城市中 2 个中学的学生被有目的的 选择作为样本，共有 466 名学生参加，他 们的年龄为 14-17 岁，分别为 10-12 年 级的学生。一项自评问卷被随机分发给他们来筛选他们暴露于暴力的情况，并使用生活事件量表、儿童 PTSD 症状量表、儿童抑郁症量表与儿童青少年症状 检查表等心理量表来揭示他们的心理状况。结果显示几乎半数的学生见证过恐吓与殴打， 1/5 的学生曾 亲身经历过。 1/5 的学生曾 见过别人被武器威胁和性虐待， 3-8% 曾被打和遭受性虐待。 3/4 的学生 PTSD 总分在临界点之上， 1/3 的学生的抑郁与焦 虑总分在临界点之上。遭受暴力与 PTSD 的相 关性研究发现两者相关系数为 0.31 。 尽管有 关青少年的健康调查未显示出 性暴力 对青少年心理创伤的影响 ， 我们依然应当采取一些干预措施去支持那些在 GBV 后出 现心理障碍的青少年 ， 尤其是作为一项以学校为基础的性与生殖健康项目。

    A WHO multi-countries study on gender-based violence (GBV) found that 44-51% of Thai adolescent aged 15-19 years had some experience on GBV at least once in their life time. A lot of scientific studies found that adolescent exposed with GBV demonstrated some psychological distress such as Post traumatic Stress Disorder (PTSD), Depression and some behavioral problems. But no effort to identify psychological impact of adolescent exposed to GBV or health service interventions that should be provided to them had been conducted in Thailand yet.

    A research had been conducted to identify the extent to which adolescent are exposed to GBV as either victims or witnesses and its association with some psychosocial dysfunctions including Posttraumatic Stress Disorder (PTSD), Depression and Anxiety. Data collection was carried out during the academic year 2004. Student in 2 middle schools in an urban area of a province in the Northeast of Thailand has been purposively selected as the target group. A self-reported questionnaire has been administered to 466 student aged range from 14-17 years in grade 10-12 who were randomly selected to screen for exposure of violence and the psychosocial scales by using Life Events Scale, child PTSD Symptom Scale, Child Depression Scale and Youth Pediatric Symptom checklist. The results demonstrated that almost half of students had witnessed in threatening, slapping / hitting / punching and beating whereas one-fifth experienced such violence by themselves. One-fifth of students had witnessed threatening by using weapons and sexually abuse whereas 3-8% experienced in being beaten and sexually abused. Three-fourth of students had PTSD scores above the cut-off point. One-third of student had depression and anxiety scores above the cut-off point. Test of correlation showed that exposure to violence had significantly correlated with PTSD at 0.31.

    Since the health programs for adolescent tend to fail to address gender or sexual coercion and its psychological trauma to children. There should be some interventions to support adolescent with psychological distress from GBV, particularly as a school-based sexual and reproductive health programs.

  • S42-5

    泰国青少年约会暴力 - Dating Violence among Thai Adolescence

    Penchan Sherer

    Mahidol University , Faculty of Social Sciences and Humanities, Salaya , Thailand

    本研究采用具有代表性的研究 设计来调查约会暴力的发生与严重性。 研究 对象为 1269 名男性与女性青少年 ， 其中 47.29 % 为高中生 ,44.90% 为职校生 ， 7.7% 为校外人员 ， 年龄在 14 － 19 岁之间。结果显示泰国青少年遭受不 同 类型约会暴力的发生率颇高。 695 名曾参加 约会的研究对象中， 49.2% 的男性与 46.7% 的女性曾被他 们的伴侣恐吓， 65.8% 的男性与 59% 的女性曾被 对方虐待， 41.9% 的男性与 41.2% 的女性曾遭受躯体虐待， 43.2% 的男性与 46.7% 的女性曾被性虐待，此外 49.2% 的男性与 46.7% 的女性受 过言语与情感虐待。在遭受约会对象暴力后 50.2% 男性与 57.2% 的女性曾 寻求帮助。 职校生与校外人员遭受暴力威胁以及躯体与性虐待的发生率都显著高于高中生。同伴人际关系与泰国青少年约会暴力的发生间有密切相关 性。青少年的伙伴 关系很简单，但是却有很重要的影响。无论何种与朋友的日常活动似乎对约会暴力都有负性影响。这意味着朋友间正性的日常行为包括学校作业、娱乐与体育锻炼可减少泰国青少年约会暴力的发生。 健康管理者可将此作 为基线信息用于制定合理的青少年健康发展政策。应当由以学校与社区为基础的机构来为学生提供必要的健康服务。健康服务应当包括职业指导项目与指导体系，拨款给社区健康与社会服务工作者来确保学生在犯罪前就能得到适当的健康服务。学生应能获得职业健康与咨询服务的信息 ， 以及知道他们该如何获得这些信息。针对高中生的综合性 暴力 预防应向高中生提供解决与伴侣关系问题的交流工具与知识。任何评估与干预都应当包括增进青少年对什么应在青少年期优先发展的理解 ， 以及提高青少年做出决断的能力。

    The study used a cross-sectional survey design to explore the incidence and severity of violence in dating relationships and to examine the variables related to the perpetuation of abuse in dating relationships among Thai adolescents.

    The sample in this study consisted of 1,269 male and female adolescents from high school ( 47.29 %), vocational school (44.90%)and out of school (7.7%), aged between 14-19 years. The results indicated that a high percentage of Thai youths experience various forms of dating violence in their relationships. Of the 695 participants who dated, 49.2% of the males and 46.7% of the females had been threatened by their partners, 65.8% of the males and 59% of the females had been relationally abused, 41.9% of the males and 41.2% of the females had been physically abused, 43.2% of the males and 46.7% of the females claimed that they had been sexually abused by their partners, while 49.2% of the males and 46.7% of the females reporting being verbally or emotionally abused. Of those who experienced a problem or have concerns about their violent dating relationships, 50.2% of the males asked for help. While 57.2% of the females asked for help.

    The incidence rates of both threaten abuse, physical and sexual violence among adolescents from out of school and vocational school were significantly higher than those from the high school. Interpersonal relationships with peers has a strong association with dating violence among the Thai youth. The relationships with the partners have low loadings in this model, but it seems that the importance of the relationship is some what more influential. The routine activities with friends, seem to negatively influence dating violence – no matter what kind of activity is involved. This means that association with friends around positive routine activities that involve school assignments, entertainment and sport, may have a positive influence on lowering dating violence among the Thai youths.

    The findings can be used as baseline information for health administrators in developing appropriate health policy in the area of adolescent health. Necessary health services for students should be provided in school-based and community based settings. Services should include professional counselling programs and referral systems to appropriate health and social service providers in the community to ensure that students can access appropriate health care before seeking assistance in the criminal justice systems or social service agencies. Students should be provided with information about available professional health and counselling services and information about how they can gain access to these services. Comprehensive violence prevention programs are needed for high school students to provide important communication tools and knowledge for resolving relationship problems. Any assessment and intervention should include understanding of developmental priorities during adolescence and support for adolescents' decision-making skill.
  • S43 - 精神病 协会亚洲分会 - Asian Federation of Psychiatric Associations

    Chairs: Naotaka Shinfuku , Japan
    Dongfeng Zhou, Chinese Mainland

    这个专题讨论会重点介绍起始于开罗 （ 2005 ） WPA 会 议 ， 并在 2007 巴基斯坦拉合 尔 WPA 区域性会 议 —— 发展中国家精神病国际会议上形成的精神病协会亚洲分会。 这是亚洲地区的精神科第一次走到一起 ， 以实现促进精神卫生与健康的共同目标。 最后将 讨论最近出现的亚洲精神科杂志以及给这个地区带来的机遇。

    This symposium will high light the inauguration of AFPA at the WPA Congress at Cairo in 2005 and finally launched in 2007 February at the WPA Section on Psychiatry in Developing countries international conference at Lahore Pakistan . The broad directions of and vision of the first time Asiian psychiatry becomes united for the important direrction of the enhanced mental health and well-being of all Asia .

    The recent Inaguration of the Asian Journal of Psychiatry and its opportunities to the various regions of Asia will be disscssed

  • S43-1

    AFPA'S— 亚洲精神病学杂志 — 她的承诺和机会 - AFPA'S – Asian Journal of Psychiatry- Its Promises and the Opportunities

    Russell D'Souza 1

    1 Asian Federation of Psychiatric Association, Melbourne , Australia

    本 报告会介绍 AFPA 的 结构 ， 以及联合这个州所有地区以实现加强亚洲精神病学和精神卫生的共同目标。亚洲精神病学杂志，它的结构，他的要求，他的目标和机 会， 预见重要的精神病学杂志成功的因素

    This presentation will out line the formation of AFPA and the uniting of all the regions of this vast continent for a united cause of enhancing Asian mental health and Psychiatry. The Asian Journal of Psychiatry its formation, its mandate, its objectives and the opportunities that promise to see the making of a significant Journal of Psychiatry

  • S43-2

    AFPA— 台湾精神卫生现状和未来挑战 - AFPA- Taiwan's Mental Health Current Status and Future Challenges

    Ming-jen Yang

    Asian Federation of Psychiatric Associations, Melbourne , Australia

    本 报告概括了作为台湾东亚 AFPA'S 的精神病学群体一 员的精神卫生的地位和资源。还将讨论未来挑战和前景 ， 以及达到这些指标的计划。

    This presentation will out line the Taiwan a member of the AFPA's East Asian psychiatry group's mental health capacity and resources. Future challenges and vision together with plans to achieve these indicators will be disscussed

  • S43-3

    SAARC 精神病学分会目前状态和未来的方向及挑战 - SAARC Psychiatric Federation Current Status and Future Directions and Challenges

    Subba Reddy

    President SAARC Psychiatric Federation, Melbourne , Australia

    本 报告介绍由 8 个成 员国的地区性精神病合作组织 ， SAARC 南 亚协会区域性的成立。将讨论诸如印度精神病协会，南亚国际论坛之类的组织以及其它所有国家在精神卫生与精神医学建设中扮演的角色。也会讨论未来挑战和确定的可能方向。

    This presentation will out line the inauguration of the SAARC South Asian Association for Regional Cooperation psychiatric Federation with the 8 countries members. The outcomes in the ahead of mental health and psychiatry capacity building the roles played by organizations such as the Indian Psychiatric Society, the South Asian Forum International and its chapters in all the SAARC countries will be discussed. Future challenges and positive possible direction will also be discussed.

  • S43-4

    中国的心理卫生和精神病学 — 未来的方向和挑战 - Mental Health and Psychiatry in China – Future Directions and Challenges

    Dongfeng Zhou

    President Chinese Society of Psychiatry, Beijing , Chinese Mainland

    本 报告概括了中国精神卫生的成就。他的角色在 WPA 的 16 区 ， 和 AFPA 的 东亚区。讨论中国社会精神病学的挑战和未来以及中国心理卫生和健康的提高。

    This presentation will out line the achievements in the are of mental health in China . Its role in zone 16 of the WPA. And the East Asian region of AFPA. The challenges and future directions for the Chinese Society of Psychiatry and the enhanced mental health and well-being of China will be discussed

  • S43-5

    东盟精神卫生 — 现状和挑战 - ASEAN Mental Health: Current Status and Challenge

    Pichet Udomratn 1

    1 ASAEN Psychiatric Federation, Songkhla , Thailand

    ASEAN 是 东南亚政治、经济和社会群体的东南亚国家联盟 ， 成立于 1971 年。 东盟除印度尼西亚、马来西亚、菲律宾、新加坡和泰国５个创始成员国外，文莱、越南、老挝、缅甸和柬埔寨５国先后加入该组织，使东盟由最初成立时的５个成员国发展到目前的１０个成员国。东盟１０国人口约５ .2 亿，东盟位于东南亚的心脏地带，均为热带气候，但在政治、宗教、语言和人种上差别巨大。目前在东盟大约有 2200 名精神病学家。 东盟精神病和心理卫生联盟是亚洲较早的区域性精神病协会，在泰国曼谷成立于 1981 年， 东盟精神病和心理卫生联盟在 2006 年通 过东盟加三模式已经走出本地区与中国、韩国和日本联系起来，并且在 2007 年 东盟精神病和心理卫生联盟作为创立者加入了 AFPA 。 尽管我 们的联盟在过去的 26 年取得了 许多成就，但是许多挑战依然存在。因此，东盟精神卫生的未来不会依赖联盟或者任何单个国家的精神 病 协会或者任何东盟地区的精神病学家，而主要依赖统一东盟地区所有普的精神病学家来开启一个新的提高人民的精神健康之路。

    Reference: Udomratn P, Deva MP. ASEAN psychiatry : past, present, and future : ASEAN J Psychiatry 2007 ; 8(1) : 35-39.

    The term ASEAN refers to the political, economic and social grouping of Association of South East Asian Nations formed in 1971. Initially, ASEAN composed of 5 countries i.e. Indonesia , Malaysia , Philippines , Singapore , and Thailand . Later, ASEAN has enlarged its membership to form a larger group of 10 countries of south east Asia that now include Brunei, Cambodia, Laos, Myanmar and Vietnam. Together ASEAN has a population of about 520 million people with a wide range of GNP and incomes. The ASEAN region is geographically situated at the heart of south east Asia and has a generally tropical climate but is extremely diverse in political, religious, linguistic and ethnic origins. There are about 2,200 psychiatrists in the ASEAN countries at present. The AFPMH (ASEAN Federation for Psychiatry and Mental Health), the oldest regional psychiatric association in Asia, was formed in 1981 in Bangkok, Thailand .The AFPMH, has gone beyond the region to forge links with China, Korea, and Japan in 2006 through the ASEAN Plus Three Partnership, and in 2007 the AFPMH joined as a founder member of the newly formed Asian Federation of Psychiatric Association (AFPA). Although, our federation has achieved many successes during the past 26 years but many challenges still remain. Thus, the future of ASEAN mental health does not depend on the federation or any single national psychiatric association or any psychiatrist in the ASEAN region but relies heavily on the unity and commitments of all psychiatrists within the ASEAN to open up a new way to improve the mental health of our people.

    Reference: Udomratn P, Deva MP. ASEAN psychiatry : past, present, and future : ASEAN J Psychiatry 2007 ; 8(1) : 35-39.

  • S44 – Psychoanalysis

    Chairs: Yanchun Yang, Chinese Mainland
    HaiYing Zhang, Chinese Mainland

  • S44-1

    叙说与诠释 — 叙事治疗中的建构过程 - Narrative and Hermeneutics — The Constructive Process in Narrative Therapy

    Chenhai Zhu 1

    1 Fudan University , Social Work, Shanghai , Chinese Mainland

    叙事治 疗是从现象学视角 ， 由咨询师与当事人协作 ， 在其选择和述说的生命故事中 ， 找出遗漏的片段 ， 从而 “ 产生或辨识了不同的故事 ， 让他实行新的意义 ， 带给他想要的可能性 ” 的 过程 （ White & Epston, 2001 ） 。叙事的目 标之一是把人类经验中的分散成分整合成一个前后一致的整体（ McAdams, 1985 ），同 时它也帮助把未经加工的经验组织成更易于接受的叙说形式。 Halliday （ 1973 ）曾指出， 语言具有三个不同的功能：观念的功能（ ideational function ）、交互的功能（ interpersonal function ）与文本的功能（ textual function ），而意 义在这三个层面中交汇、传递与建构。其中，观念是叙事的核心，交互方式提供了叙事的背景，而文本则是叙事的主 要 载体。叙事治疗的实质在于，解构那些受社会论述、负向力量及权力结构所支配的故事，通过问题外化的方式，协助其消除问题所依赖的观念，创造出所谓符合自身生活意义的 “ 独一无二的叙 说 ” 。 然而，在 诠释学的框架下，理解本身并不具有客观有效性，理解不仅是主观的，而且还受制于决定它的所谓 “ 前理解 ”…… 这便构成了海德格尔所谓 “ 理解的循 环 ” （海德格 尔， 1987 ）。在叙事治 疗中，也存在相同的困境，当倾听、诠释与重构文本时，咨询师无法超越自身的历史性，这又如何保证意义建构与治疗本身不会成为又一个异化的力量呢？ 对此，伽达默尔的解决 方式是肯定成 见（ Vorurteil ）的合法性，从而明确否定了人可以根据某 种特殊的客观立场，超越现实境遇对文本加以理解。他又进一步指出，成见构成了解释者与解释对象的特殊视界（ Horizont ），它属于人的前判断，即 对意义和真理的预期。视界不是封闭的、孤立的，而处于不断的运动变化之中。叙事文本中含有作者原初的视界，它与解释者的当下视界间存在着各种的差距，而理解的过程，就是达成 “ 视界融合 ” 的 过程，也是意义建构的过程。最终过去和现在、主体和客体、自我与他者都融为一体，构成一个无限的、开放的统一的整体（伽达默尔， 1999 ）。 由此，在叙事治 疗中，情境、协作与会话是不可或缺的三大要素。咨询与治疗的首要目的是为当事人提供一个安全的、有利于其意义建构的情境，促使他们以新的眼光发现与理解自己的故事，协作与会话则贯穿于咨询始末，是最终达成重构的重要手段。事实上，没有知识 / 观念可以独立于背景或解释者，而从会话中所产生的协商一致的观点，构成了感知和解释未来文本的方式（ Josselson, 1995 ）。 参考文献 1 、麦克 ? 怀特、戴维 ? 艾普斯 顿 (2001): 《故事 ? 知 识 ? 权力 —— 叙事治 疗的力量》，心灵工坊 : 台北 2 、 马丁 ? 海德格 尔 (1987) ：《存在与 时间》，三联出版社 : 北京 3 、 汉斯－格奥尔格 ? 伽达默 尔 (1999) ：《真理与方法 ( 上卷 ) 》，上海 译文出版社 : 上海 4 、 Halliday, M. A. K. (1973): Explorations in the functions of language. London : Edward Arnold 5 、 Josselson, R. (1995): Narrative and Psychological understanding, Psychiatry, 58, 330-343 6 、 McAdams, D. P. (1985): Power, intimacy, and the life story: Personological inquiries into identiry. New York : Guilford Press.

  • S44-2

    中国人的俄迪浦斯三角 - The Chinese Oedipus Triangle

    Tianbu Zhang 1

    1 Shaanxi Provincial Peoples' Hospital, Xi'an , Chinese Mainland

    俄狄浦斯 现象是每个文化背景下的精神分析学家探讨本土文化不可忽略的研究主题。对一个文化群体的俄狄浦斯现象进行研究 ， 可以从三个层面入手。 1 ． 临床心理动力学治疗或精神分析的案例，可以显著呈现个体潜意识中的俄狄浦斯冲突。 2 ． 文学 经典作品：作为经典的文学作品，其能够被世代相传，往往是因为这些作品被大多数人的情感所共鸣。换言之，是它触动了这个文化背景中人们的集体潜意识中的某些重中要的情节。 3 ． 神 话和传说。神话故事能启示的是人们精神世界里最为深处的那些潜意识的内含。它世代流传的过程，就是用故事来承载和传达存在于心 灵深 处的某些相同的潜意识情感与认识。流传所经的各代人们，都在用自己的语言和感受对内心潜意识进行解读。

    本文首先 对俄狄浦斯这一基本概念的提出和发展作了概述。

    本文的第二部分 综述了几位华人精神分析学者对中国神话和传说的分析。

    本文第三部分，作者 对中国文学名著《水浒传》和典型人物宋江和李逵做了分析。

    本文第四部分，作者列 举讨论了四个临床精神动力学治疗的案例，来呈现典型的俄狄浦斯情节和俄狄浦斯情景

    本文的第五部分，作者指出心理治 疗中设置的意义，在临床心理治疗关系上犹如在治疗的医患双方的内心建立一个三角关系

    总结：中 国人的内心世界里，在内在自我 认同的形成中有 Oedipus 三角 关系冲突的心理特点。文化作为一种集体超我的形式影响着 Oedipus 三角 关系的转归 . 在 Oedipus complex 水平上解决内心三角冲突的的方式，中国人与西方人有些差异 . 在 Oedipus situation 水平上的三角冲突，中国人与西方人相同。提示我 们从临床上理解神经症患者的心理表现可能中西有别 ， 人格障碍患者的心理表现可能一样。

    The phenomena of Oedipus couldn't be ignored by the psychoanalysts who want to explore their native culture. we could study the Oedipus phenomena in a certain cultural background from the following three dimensions . 1. Cases of clinical psychodynamic psychotherapy or psychoanalysis, from which the individual unconscious Oedipus conflict appears significantly. 2. Literary masterpieces: as classic literary works, which have been passed on from generation to generation, usually they can arouse most people ‘s emotional resonance. In other words, it touches some important complex in people ? s collective subconscious of this cultural background . 3. Myth stories and legends: They show the deepest unconscious content in people's spiritual world .In the process of spreading, it conveys and bears the same unconscious feelings and understandings in the deep soul. People of all generations would interpret the inner unconscious with their own languages and feelings.

    Firstly , the article gave a brief introduction on the coming out and development of the basic concept- Oedipus.

    The second part of this paper summarized some analysis on Chinese myths and legends by some Chinese scholars.

    In the third part of this paper, I analysed the Chinese classical literature "The Water Margin" and two typical figures Song Jiang and Li Kui.

    In the fourth part, the author discussed four clinical cases of psychodynamic psychotherapy ,which revealed typical Oedipus complex and situation.

    In the fifth part, the author pointed out that in clinical psychotherapy, the significance of treatment setting was like establishing an internal triangular relationship among the therapist and patient.

    Conclusion: In the inner world, Chinese people have the internal characteristics of Oedipus triangular relationship while developing their self-identification. (As a form of group superego Culture has impact on the triangular relationship.) On the level of Oedipus complex ,there are some differences between Chinese and Westerners in resolving the internal triangular conflicts . But on the level of Oedipus situation ,Chinese and Westerners have the same triangular conflicts. So we should keep in mind that in clinical psychotherapy,there might be some difference between Chinese and Westeners in understanding the neurotic patients'psychological performance, but might be the same for the personality disorder patients.

  • S44-3

    Abstract Withdrawn

  • S45 - Session withdrawn

  • S46 - 精神科的 认知功能影像学研究 - Cognition Study on Psychiatry by Functional Neuroimaging

    Chairs: KaiDa Jiang, Chinese Mainland
    Lingjiang Li, Chinese Mainland

    认知功能研究逐渐为各国精神科领域的研究者所重视 ， 多种精神疾病的认知功能缺损是其重要的临床特征。功能影像学技术与方法为认知功能障碍的神经基础研究提供了新的途径。本专题会着重交流认知功能的功能影像学研究进展。

    主席 ： 李凌江 江 开达

  • S46-1

    首发重性抑郁症患者情绪处理障碍和认知功能损害的脑功能机制 - The Brain Functional Pathological Mechanism on Emotional Processing Bias and Cognition Dysfunction in First-episode Major Depressive Disorder

    Ning Ma 1 , 凌江 李 2 , 立文 谭 2 , 军 刘 3 , 忠 贺 3 , 田仔 蒋 4

    1 Mental Health Institute,Center South University, ChangSha, Chinese Mainland, 2 中南大学精神 卫生研究所 , 长沙 , Chinese Mainland, 3 中南大学湘雅二医院放射科 , 长沙 , Chinese Mainland, 4 中国科学院自 动化研究所 , 北京 , Chinese Mainland

    目的 ： 使用血氧依 赖水平功能磁共振 （ BOLD-fMRI ） 技 术 ， 探讨首发重性抑郁症患者情绪处理障碍和认知功能损害可能的脑功能病理机制。

    方法 ： 应用汉密尔顿抑郁量表 （ HAMD ） 、 汉密尔顿焦虑量表 （ HAMA ）， 韦氏记忆量表理解和再认分测验对 27 例首 发未治疗过的年轻成年重性抑郁症患者和 28 例正常人 进行测评。 fMRI 检查，依次为情绪计数 Stroop （ ecStroop ）、情 绪面孔、情绪图片和提取四个任务。扫描后患者给予文拉法辛治疗并随访观察半年，随访结束时再次进行上述量表评定和记忆测验及 fMRI 检查。

    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 ）；患者 组治疗前的理解和再认测验分数低于正常人（ P ＝ 0.001 ， P ＝ 0.04 ），治 疗后 接近正常人水平（ P>0.05 ）。 2. fMRI （ 1 ） ecStroop 任 务：抑郁症患者和正常人双侧扣带回和前额叶均有激活。发作期患者右侧扣带回和左侧颞中回激活较正常人低，左侧小脑激活较后者高；患者治疗前后，治疗后和正常人之间比较未见激活差异显著性的脑区。（ 2 ）情 绪面孔任务：抑郁症患者和正常人面对悲伤面孔时视皮层和海马旁回的激活都高，右侧前额叶激活都低。发作期患者右侧后扣带回和左侧岛叶激活较正常人高，双侧前额叶，左侧顶下小叶和梭状回，右侧钩回和海马旁回激活较正常人低。治疗后右侧前额叶和左侧颞叶、双侧视皮层、左侧基底神经节的激活较治疗前增高，并且双侧前额叶，右侧扣带回及颞叶的激活较正常人高。（ 3 ）情 绪图片任务：抑郁症患者负性图片较正性图片对双侧杏仁核和左侧钩回激活高；对左侧额中回，右侧扣带回前部和后部，右侧顶叶，双侧岛叶的激活低。发作期患者双侧前额叶和左侧钩回激活较正常人低。治疗后右侧额中回和同侧后扣带回，左侧丘脑的激活较治疗前增高；但右侧额中回和双侧顶叶部分区域的激活较正常人低。（ 4 ）提取任 务：抑郁症患者负性图片较正性图片对双侧前额叶和左侧顶叶，左侧前扣带回激活高；正常人左侧前扣带回和右侧额内侧回在负性图片时激 活低。 发作期患者双侧前额叶和顶叶，双侧视皮层的激活较正常人高。治疗后双侧前额叶和视皮层的激活较治疗前降低；但双侧前额叶，右侧角回和右侧视皮层的激活较正常人高。

    结论： 1. 边缘叶功能异常增强和额顶叶功能减退可能是抑郁症负性情绪的脑功能病理基础。 2. 双 侧前额叶和扣带回，顶叶和视皮层功能异常可能是抑郁症认知功能损害的脑功能病理基础。 3. 脑功能异常是一种可逆性变化，在临床症状缓解后部分恢复。

  • S46-2

    轻度认知障碍老年人脑功能代偿现象的磁共振研究 - Brain Functional Compensation in Mild Cognitive Impairment: Evidences from Both Structural and Functional MR Imaging

    Feng Bo 1 , 志珺 张 2 , 辉 宇 2 , 咏梅 施 2 , 亮 王 3 , 万林 朱 4 , 玉峰 臧 5

    1 China Municipal Hospital Affiliatted to Southeast University, NanJing, Chinese Mainland, 2 东南大学附属中大医院神经内科 , 南京 , Chinese Mainland, 3 北京理工大学 , 北京 , Chinese Mainland, 4 浙江大学数学系 , 杭州 , Chinese Mainland, 5 北京 师范大学认知神经科学与学习国家重点实验室 , 北京 , Chinese Mainland

    目的 : 运用 结构和功能核磁共振 （ fMRI ） 对比研究轻度认知障碍 （ MCI ） 老人与健康老人 脑结构及其功能差异 ， 探讨 MCI 脑功能代偿机制。方法 应用基于像素的形态测量方法（ VBM ） 测定 14 例 MCI 老人和 15 例健康老人灰 质体积差异，并用 fMRI 检测特定难度的情节记忆 提取任 务相关激活脑区的功能。结果 结构影像 显示： MCI 组比健康老人灰质体积显著降低，主要位于双侧额上回、左侧额中回、右侧额下回、双侧颞上回、右侧颞下回、右侧海马旁回、左侧扣带回后部、左侧楔前叶；功能影像显示： MCI 组与健康老人任务表现相同，前者激活降低的脑区主要是海马旁回；增强激活的脑区主要是：前额叶前侧、背外侧、右侧颞上回、右侧颞下回、枕叶皮层。结论 在 MCI 组老人内侧颞叶记忆系统结构萎缩、功能下降， MCI 组动员额外脑区激活代偿颞叶内侧记忆系统的损害。

    关键词 : 轻度认知障碍；基于像素的形态测量法；功能核 磁共振；情 节记忆提取；脑代偿功能

    Objective: The study used structural and functional magnetic resonance (MR) imaging to investigate differences between mild cognitive impairment (MCI) and normal aging, and to explored brain functional compensation in MCI.

    Methods: The voxel-based morphometry (VBM) method was applied on the 3D structural MR images to evaluate the difference in brain regional gray matter volume between MCI and normal aging groups. Brain responses, during a suitable episodic memory recognition task, were also examined and compared between the two groups.

    Results: Compared to normal aging, the MCI subjects had greater atrophy in the bilateral superior and right middle and inferior frontal gyrus, the bilateral superior and right inferior temporal gyrus, and the medial temporal lobe. In addition, the MCI subjects showed significant activation in the bilateral frontal cortex, the right superior and inferior temporal gyrus, the right precuneus and the bilateral occipital cortex when undertake the visual episodic memory recognition task.

    Conclusions: The structional MR imaing comfirmed the gray matter atrophy in memory related brain regions. Furthermore, MCI subjects performed the suitable episodic memory recognition task via recruiting the additional brain regions of the ventrolateral and dorsolateral prefrontal cortex, the right superior and inferior temporal cortex and the occipital cortex, suggesting that the additional effort of MCI subjects' indicated the compensation for memory related brain regions deficits.

    Keywords: mild cognitive impairment; voxel-based morphometry; functional magnetic resonance imaging; episodic memory recognition; compensation

  • S46-3

    语言熟悉性在中英文认知脑功能基础中的重要性分析 - Significance of Language Proficiency in Chinese-English Language Perception

    GuiFeng Hao 1 , 志珺 张 2 , 家波 史 3 , 宁 陈 3 , 钢 侯 3

    1 China Municipal Hospital Affiliatted to Southeast University, NanJing, Chinese Mainland, 2 东南大学附属中大医院神经内科 , 南京 , Chinese Mainland, 3 南京医科大学附属 脑科医院精神科 , 南京 , Chinese Mainland

    目的 ： 应用组块设计功能磁共振成像技术 ， 在体研究语言熟悉性对汉�