S49 - 焦 虑障碍 1 - Anxiety Disorder 1

Chairs: Henry Chung, Chinese Mainland
Mingyuan Zhang, Chinese Mainland

S49-1

Liebowitz 社交焦虑量表在中国的应用 - The Application of Leibowitz Social Anxiety Scale in China

Yanlin He

Shanghai Mental Health Center , Shanghai , Chinese Mainland

目的 : 回 顾 Liebowitz 社交焦 虑量表 （ LSAS ） 在中国的 应用和评价 ， 为更好使用该量表并提高对社交焦虑症 （ SAD ） 的 认识提供资料。

方法 ： 通 过中国期刊全文数据库 ， 中文科技期刊数据库 （ 维普资讯网 ） 和万方数据资源系统 ， 以 LSAS 为关键词检索 ， 获得相关文献 14 篇。除去 1 篇重 复，纳入分析 13 篇。

结果： LSAS 在中国的 应用主要有 3 方面文献：① LSAS 中文版在中国 SAD 患者中 应用的品质 研究 3 篇。均 报告 LSAS 在中国社交焦 虑症患者中的评估有很好的信度和较好的判别效度和治疗效度，与 HAMA 和 CGI 高度相 关。三项研究均比较了自评和他评两种方式评定结果，一项研究显示无明显差异，另两项研究显示两者高度相关，但其中一项比较病例组自评均分高于他评均分，差异有显著性。何等和潘等分别以 LSAS 总分 38 和 35 为分界值来判断 SAD ，其敏感性和特异性分 别为 83 ％和 8l ％，及 81 ％和 77 ％。②用于 发现不同人群中具有社交焦虑症状者有 3 篇。 2 篇用 LSAS 来 筛查门诊精神分裂症、住院精神分裂症和抑郁症患者中的社交焦虑共病 比例。在 门诊精神分裂症患者中以 LSAS>27 分来判 别 SAD 的符合率 为 90.77% ，假阳性率 为 9.23 ％，假 阴性率为 5.93 ％。③用于各 种治疗前后社交焦虑症状严重程度的评定有 7 篇。用于 评估 SAD 的帕 罗西汀治疗、万拉法新治疗和认知行为集体治疗，以及慢性精神分裂症社会适应的综合康复和社交自信训练。一般的疗效划分以 LSAS 的减分率 ≥75% 为临床痊愈 , 50% ～ 74% 为显著进步 , 25% ～ 49% 为好转 , ≤25% 为无效；或前两类合并，即 LSAS 的减分率 ≥50% 为显著有效。对精神分裂症患者社交训练和综合训练均能降低有社 交焦 虑症状者的 LSAS 评分，但标准差都比较大，表明数据的离散度高。

结论： LSAS 在中国社交焦 虑症患者中的应用有很好的信度效度。国内研究建议的分界值（ 35 ， 38 ）均高于国外 报道的分界值（ 22.5-30 分）。 LSAS 对社交焦虑症状的变化敏感 ， 是较好的治疗效果评价指标。

Aims: To provide information for better use of Leibowitz social Anxiety Scale (LSAS) and better recognition of social anxiety disorder (SAD) in China by reviewing the Chinese literature of the use and evaluation of LSAS.

Methods: Searching the Chinese literature database of CNKI, VIP information and Wanfang data) using key word of Leibowitz Social Anxiety Scale /LSAS, fourteen research articles were emerged. All together 13 were analyzed, a duplicate one was eliminated.

Results: The researches on use of LSAS were mainly in three areas. a) There were three papers reported the psychometric properties of LSAS Chinese version at assessment of Chinese patients with SAD. In general, it has good reliability and good discrimination validity and treatment sensitivity. The total score of LSAS is highly co-related to the scores of HAMA and CGI. The score of self-rating and doctor rating were co-related in two of the studies, one showed no significant difference at means between the two but another showed that self-rating of SAD group had higher means score of LSAS than doctor-rating with significant statistical difference. The third study reported no difference in mean score between self-rating and doctor-rating. It was found that factor scores of social intercourse and speak at public were higher among female than female of both SAD and normal groups, whereas only in normal group man had higher score of being observed and eating and drink in public than woman. b) Another three studies applied LSAS as a screening instrument to identify comorbidity of social anxiety among outpatient and inpatient with schizophrenia and inpatient with depression. In screening SAD from outpatient with schizophrenia by LSAS total score of >27 as cutoff point, the consistent rate to clinical diagnose according to DSV-IV was 90.77%, False positive rate was 9.23% and False negative rate was 5.93%. c) LSAS was used as treatment effect index for social anxiety symptom in seven papers of six studies. Three of the six studies used antidepressants for SAD, one of the six studies used group cognitive behavioral therapy for SAD and two of the six use rehabilitation and social skill training for schizophrenia patient. The clinical effectiveness was commonly categorized according to the decrease of LSAS score ≥75% as clinical recovery, ≥50 ～ 74%% as remarkable improvement, 25% ～ 49% as improvement and ≤25% as no improvement. The results showed that the remarkable improve rate for SAD in these studies of antidepressant treatment was between83.4 ％ -85.7 ％ and of group cognitive behavioral therapy was 50%. Rehabilitation and social skill training for schizophrenia patient can decrease LSAS score for those with social anxiety symptoms but with relative large standard deviation.

Conclusions: LSAS has a good reliability and validity applied for Chinese SAD patients. The sensitivity and specificity are different with different cutoff point of LSAS total score of 35 or 38 as suggested, which are higher that reported in other countries (22.5-30 分 ） . LSAS has good treatment sensitivity and can be used as a good treatment effective measurement.

S49-2

帕罗西汀治疗社交焦虑障碍的随访研究 - The Follow-up Study on Social Anxiety Disorder Treat by Paroxetine

Zheng Lu

Tongji Hospital , Tongji Universitiy, Shanghai , Chinese Mainland

目的 : 探 讨帕罗西汀治疗社交焦虑障碍的长期疗效。

方法 : 用帕 罗西汀治疗社交焦虑障碍患者 58 例 ， 其中男 25 例 （ 43.1% ）， 女 33 例 （ 56.9% ）， 年 龄 19—64 岁 ， 平均 （ 35.67±12.84 ） 岁。帕罗西汀剂量和治疗时间不定，并在 18 个月和 30 个月后 进行随访研究；以 Liebowitz 社交焦 虑量表（ LSAS ）、 汉密尔顿焦虑量表（ HAMA ）、 临床疗效总评量表（ CGI ） 评定临床疗效。

结果 : 1 、入 组时及治疗 18 、 30 个月 时患者职业状况未见明显差异。 2 、治 疗后第 18 个月及第 30 个月的 LSAS 总分均低于入组时，差异有非常显著性（ p<0.01 ）。 LSAS 各因子分 评分变化趋势与 LSAS 总分相类似，均明显低于入组时，差异有非常显著性（ p<0.01 ）。 3 、治 疗后第 18 个月和第 30 个月 HAMA 总分和 CGI-SI 分 值在均有明显的下降，其差异具有非常显著性（ p<0.01 ）。 4 、在 58 例患者中，有 30 例 长期维持药物治疗， 28 例患者在 药物治疗后一段时间因各种原因停止治疗。维持组和停药组患者随访前及治疗第 18 、 30 个月 LSAS 总分及其因子分均无显著差异。 5 、非条件 logistic 回 归分析显示长期疗效可能与病程和文化程度密切相关。

结论 : 帕 罗西汀治疗社交焦虑症有效 ， 维持用药对能持续改善患者临床症状。

Objective: To investigate the long-term efficacy of paroxetine in treatment patients with social anxiety disorder.

Methods: Used paroxetine in 58 patients diagnosed for social anxiety disorder, 25(43.1%) patients were male and 30(56.9%) patients were female, the average age of them were (25.67±12.84) years. Paroxetine dosage and duration was uncertain. The Liebowitz Social Anxiety Scale (LSAS), the Hamilton anxiety scale( HAMA ), the Clinical Global Impression scale (CGI) were administered at 18th and 30th month.

Results: 1.The occupation status of patients at the baseline and 18th and 30th month were no significant difference. 2. The total score and subscores of LSAS were very much improved at 18th month and 30th month compared with baseline. 3. The total score of HAMA and CGI-SI were also very much improved at 18th month and 30th month compared with baseline. 4. Within the 58 patients 30 were maintained the 30 months' therapy, 28 patients were dropped out for some reasons. There were no difference between these two kinds of patients in the total score and subscores of LSAS at baseline, 18th and 30th month. 5. Non-conditional Logistic Regression Analysis showed that long-term efficacy had close relationship with course of diseases and the years of accepting education.

Conclusion: These data suggest paroxetine has efficacy in the treatment of social anxiety disorder, maintenance therapy can get sustaining improvement of clinical symptoms.

S49-3

伴与不伴焦虑的抑郁症 2 年随访 - The Two Years Follow-up Study on Major Depression Disorder Companion or Without Anxiety

Shenxun Shi 1 , Mingyuan Zhang 1 , Wenyuan Wu 1 , Tianxin Zhou 1 , Zheng Lu 1 , Baolong Zhao 1 , Zhengwan Qu 1 , Shengqi Chen 1 , Yilan Liu 1 , Ming Tao 1 , Huichun Li 1 , Ming Li 1 , Ning Zhang 1 , Shanwen Liu 1 , Xueli Sun 1 , Jingping Zhao 1 , Yunping Yang 1 , Jing Wei 1

1 Huanshan Hospital , Shanghai , Chinese Mainland

目的 : ： 探索抑郁症 长期预后状况和影响因素。

方法 ： 前瞻性、多中心、 开放性、长期随访研究。观察项目： 1. 流行病学 资料（年龄、性别、婚姻、躯体疾病等情况）。 2. 目前 临床症状（焦虑和抑郁症状群、自杀状况）。 3. 合并焦 虑。评估工具： 1. 诊断标准 DSM-IV 和 SDS-L 诊断清单。 2. 症状 评定 HAMD, HAMA 。 3. 疗效观察 CGI, HAMD, HAMA, SDSS 。 4. 不良反 应 TESS 。研究 时间： 2002 年 6 月 -2006 年 6 月。

结果： 总共收集 604 例，两年各 时点随访到人数 3 个月 477 例， 6 个月 436 例， 12 个月 300 例， 24 个月 152 例。 3-6 个月 转躁率均为 0.8% ， 12-24 个月均 1.2% 。 复发率 3 个月 6.3% ， 6 个月 11.2% ， 12 个月 13.0% ， 24 个月 21.1% 。男女性 别之间没有显著差异。 首 发抑郁症与反复发作 抑郁症在 6 个月（ 8.1%VS15.0% ， χ2=5.097 ， P=0.024 ）和 24 个月（ 15.0%VS30.6% ， χ2=5.010 ， P=0.025 ）比 较差异有显著性。有无精神疾病家族史患者的 6 月 复发率（ 21.7%VS9.4% ， χ2=7.964 ， P=0.019 ）比 较差异有显著性。有无抽烟的 6 月 复发率比较（ 21.7%VS10.2% ， χ2=5.787 ， P=0.055 ）差异有 显著性。本次发病有无诱因的 6 月 复发率比较（ 15.2%VS8.2% ， χ2=4.484 ， P=0.034 ）差异有 显著性。服药依从性在 3 月（ 3.2%VS23.5% ， χ2=44.581 ， P=0.000 ）、 6 月（ 9.0%VS22.2% ， χ2=8.981 ， P=0.011 ）比 较复发率差异有显著性。入组时有无自杀念头在 12 个月的 复发率比较（ 19.9%VS5.0% ， χ2=14.525 ， P=0.000 ）差异有 显著性。

入 组时有无精神病性症状，有无躯体疾病，有无喝酒，有无焦虑症状（以 HAMA 总分 ≥14 分 为界），焦虑严重程度，抑郁症状严重程度（以 HAMD 总分 17-24 分、 25-34 分和 35 分以上 为界划分轻、中、重三个程度），本次发病形式，性格内向、中性、外向，文化程度，婚姻 ，目前年 龄 40 岁以前与 40 岁以后，起病年龄 20 、 30 、 40 岁之间对两年各时点复发率没有显著差异。

结论： 抑郁症需要 长期药物治疗降低复发率，自杀企图和行为、抽烟、家族史、诱因、反复发作、服药依从性是抑郁症复发的危险因素。

Objective: Previous studies showed that patients suffering from depression accompanied with anxiety, suicide idea, comorbidity were refractory to medical treatment with drugs. But there are few studies about these accompanied condition related with recurrence of depression. The purpose of this study was to observe which fact is connected with recurrence of depression in China .

Method: This was a prospective, multi-center, long-term follow up study. The scales of HAMD, HAMA , CGI, TESS were used to evaluate the efficacy and adverse events. The epidemiological data were collected at same time.

Results: Six hundred and four patients were enrolled at beginning, but some subjects dropped out on different points within two years. We had 477 patients on the three month, 436 ones on the six month, 300 subjects on one year and only 152 persons on the end. The rate of transfer bipolar in this study only was 0.8% in 3 and 6 month, 1.2% in one and two year. The recurrent rates on 3, 6, 12 and 24 months were 6.3%, 11.2%, 13.0%, and 21.1% separately. There was no significant difference in gender.

We found that the recurrent rate of 6 and 24 months were significant between patients with first episode and patients with recurrent episodes (8.1%VS15.0% ， χ 2=5.097 ， P=0.024, and 15.0%VS30.6% ， χ 2=5.010 ， P=0.025). Patients with family history of mental disorders, with marked induced factors and smoking history had obviously higher recurrent rate of 6 month (21.7%VS9.4% ， χ 2=7.964 ， P=0.019, 15.2%VS8.2% ， χ 2=4.484 ， P=0.034 and21.7%VS10.2% ， χ 2=5.787 ， P=0.055 ). The compliance of drug taking was significant with the recurrent rates of 3 month (3.2%VS23.5% ， χ 2=44.581 ， P=0.000) and 6 month (9.0%VS22.2% ， χ 2=8.981 ， P=0.011). Patient with suicide attempt was significantly related with the recurrent rate of 12 month (19.9%VS5.0% ， χ 2=14.525 ， P=0.000).

However we did not find that patient with psychotic symptoms, medical conditions, history of drinking, anxiety symptom (HAMA≥14 score), different degree of depression (HAMD total score 17-24, 25-34 and more than 35), form of episode this time, degree of education, married state, 40 years old at present and the age of onset at 20, 30 and 40 years old had significant differences within any point of the two years.

Conclusions: According to these results we suggested that preventing recurrence from depression, taking medicine long time is first. Attempt of suicide, smoking, history of mental disorders, repeated episodes, induce factor and lower compliance of drug taking are risk factor of recurrence in patients with depression.

S49-4

帕罗西汀对门诊抑郁症患者生命质量的影响 - The Quality of Life in Depressed Outpatients: 6-month Follow-up Study in Shanghai, China

Jianlin Ji 1 , Xingbao Cheng 2 , Wenyuan Wu 3 , Chongshun Wang 3 , Yijue Shi 3 , Feng Sheng 3

1 Department of Psychological Medicine, Zhongshan Hospital, Shanghai, Chinese Mainland, 2 Public Health School, Shanghai, Chinese Mainland, 3 Fudan University, Shanghai, Chinese Mainland

目的 : ： 研究 门诊抑郁症患者的生命质量 （ QOL ） 及其抗抑郁治 疗后生命质量的改善与疗效。

方法 ： 多中心合作研究 ， 180 例符合抑郁症 诊断标准患者给予帕罗西汀治疗 6 月 ， 采用 HAMD-17 、 HAMA 和 SF-36 分 别在治疗前、治疗 3 月和 6 月 评价。

结果 ： 1 ） 门诊抑郁症患者的 生命 质量较低 （ QOL 评分 <50 分 ）， 尤其 <30 岁者 ； 2 ） 合并焦 虑症状抑郁症组患者的 QOL 总分 （ 41.04 ） 明 显低于单纯抑郁症组 （ 48.36 ）， 特 别在生理功能 （ PF ） 、活力 （ VT ） 、社会功能 （ SF ） 和精神健康 （ MH ） 等方面两 组差异显著 （ P<0.05 ）； 3 ） 抗抑郁治 疗后 QOL 评分显著提高 ， 6 月后 >70 分 (P=0.00) ， 以 <30 岁者和合并焦虑症状者改善更为明显。

结论 ： 抑郁症患者生命 质量有明显降低 ， 抗抑郁药物治疗能显著提高其 QOL 水平和 缓解抑郁和焦虑症状。

Objectives: Depression is one most of common mental disorders in primary care and most of depressed patients have obvious impaired on the quality of life (QOL), which is concerned as a key issue in treatment and rehabilitation of depression. Many new antidepressants (e.g.SSRIs, SNRI and NaSSA) are chosen as the first line treatments of depression in China now and have a definite anti-depressive effect. However, few clinical trials concern the QOL among depressed patients. This study aims to compare the QOL in depressed outpatients with anti-depressant before and after treatment with 3 and 6-month follow-up.

Methods: It is a multi-center collaborative clinical trial conducted in 7 general hospitals and one mental health center in Shanghai , and there are 180 cases selected from these centers, who met the diagnostic criteria of major depression in accordance with the DSM-IV. The patients are treated with paroxetine (10-20mg/day) for 6 months and assessed with HAMD, HAMA and SF-36 at baseline, 3-month and 6-month after treatment.

Results: 1 ） Before treatment, the QOL scores of all depressed cases are below of 50 scores ， particularly among young cases （ aged less 30 years ） and the patients who comorbided anxiety symptoms. 2 ） The sub-scores of role-emotional and mental health are very lower than the others among young group and the depressed patients comorbided anxiety symptoms. 3) After treatment with antidepressant, the QOL score among all cases increases significantly and is over 70 score (compared to baseline, p=0.00), especially among young group and comorbided anxiety group. 4) Paroxetine is an effective anti-depressant which let 59% of cases are free of depressive symptoms (HAMD<8 score) and 88% of cases are free of anxiety symptoms ( HAMA <8 score) after 6-month treatment.

Conclusion: The depressed patients have an obvious low level of QOL, particularly in the young cases and who comorbided anxiety. Anti-depressants have been widely used in clinical practice in China , and convinced the effectiveness and safety. This study shows that paroxetine as one of SSRIs is able to be improved so significantly the depressed outpatients' QOL levels and to increase remission rate and response rate, especially in the early 3-month treatment.

S49-5

Emotional Distress and Resiliency in Chinese Americans after the September 11, 2001 Attack: The Role of Primary Health Care in Mental Health

Henry Chung

Student Health, Psychiatry, Shanghai , Chinese Mainland

背景 ： 2001 年 9 月 11 日 纽约的世界贸易大厦攻击事件发生距离纽约中国城不足 2 公里 ， 这里作为纽约城一个重要的区域聚集了超过 100 ， 000 的 亚裔居民和工人。据我们所知，此次研究是攻击事件发生近 5 个月后的首次 对社区居民抽样的有关抑郁情绪症状的回顾性研究。

方法： 通 过简单抽样，中国城 2 个主要社区中的 555 名接受初 级健康保健服务或社会服务成年居民在惨剧发生 5 个月后，接受了 2 页长的典型抑郁情绪症状的调查问卷。他们被问及在灾难发生后 2 周内症状是否 产生，然后对有症状者进行了单独调查有关于当时存在什么样的症状。分析了各年龄组症状出现的频率以及症状恢复状况。

结果： 以至少具有 4 个抑郁症状 为切点， 59% 的回答者被 认为符合标准。 5 个月后，很多回答者都达到恢 复，只有 17% 仍然 处在抑郁困扰中；然而，超过 50% 仍 报告了至少一项的持续症状。 40-60 年 龄组的回答者显示出最易受到打击。

讨论： 结果显示出华裔美国居民的情绪恢复力。研究发现年龄较大者更易受到打击意味着年龄较大的移民对健康权力、心理健康和社会服务有更多计划。用这些有限的资料以及其他一些研究证明亚洲人和亚裔美国人在抑郁症状上显示出不成比例的影响，论述者将讨论使用初级保健和心理卫生综合模型进行心理健康问题的初级和刺激预防的重要性。

Background: The September 11, 2001 attacks at the World Trade Center in New York City was less than 2 miles away from Chinatown in New York City, a vital urban enclave that is estimated to have more than 100,000 residents and workers of Asian ethnicity. To our knowledge, this was the first retrospective examination of symptoms of emotional distress in a sample of community residents approximately 5 months after the attack.

Methods: Through convenience sampling, 555 local adult residents who received either primary care health services or social services at two prominent community agencies in Chinatown 5 months after the tragedy were given a 2 page survey of typical emotional symptoms of distress. They were asked about whether the symptoms were present in the 2 weeks after the attack and then a separate survey on what their current symptoms were (if any). Analyses were performed on frequency of symptoms and “recovery” from symptoms by age groupings.

Results: Using an initial cut point of having at least 4 symptoms of distress, 59% of respondents were considered troubled. After 5 months, many respondents “recovered” and only 17% were still troubled; however, over 50% still reported at least having one persistent symptom. Those in the 40-60 age group appeared to be the most vulnerable.

Discussion: The results demonstrate emotional resilience in Chinese American residents. Findings of greater vulnerability to an older cohort has implications for older immigrants and planning for access to health, mental health and social service planning. Using this limited data and other studies demonstrating the disproportionate impact of depression symptoms on Asians and Asian Americans, the presenter will discuss the critical importance of primary and secondary prevention of mental health problems using primary care and mental health integration models.

S50 - 儿童行 为障碍的诊断与防治 - Diagnosis and Treatment of Behavior Disorder in Child

Chairs: Lanting Guo, Chinese Mainland
Yi Zheng, Chinese Mainland

主席 ： 郭 兰婷教授 ， 郑毅教授

讲演者小组 ： 郭兰婷教授 ， 郑毅教授 ， 苏林雁教授 ， 王玉 凤教授 ， 黄颐副教授

小 结 ：

目的 ： 以儿童行 为问题这一大类儿童期最常见心理问题为中心 ， 结合讲演者本人的临床实践和科学研究、国内外同行的最新研究情况 ， 重点讲述刻板行为、冲动行为、 ADHD 等疾病的 临床特征、诊断和治疗 ， 为亚太地区精神科医生展现中国儿童精神科的临床和科研水平 ， 提供相互交流的平台和机会 ， 为进一步扩大学术交流范围 ， 不断提高国内儿童精神科学术水平奠定基础。

内容 ： 1 、儿童刻板性运 动障碍及其强迫谱系障碍的临床特点与治疗 ： 讲演者四川大学华西医院心理卫生中心郭兰婷教授。主要介绍儿童强迫谱系障碍的定义、包 括的疾病， 讲演者在临床特征、心理治疗和药物治疗等方面的临床研究结果。

2 、中国儿童注意缺陷多 动障碍防治指南要点介绍：讲演者首都医科大学附属北京安定医院郑毅教授。重点介绍中国最新出台的儿童 ADHD 防治指南中 ADHD 的 评估和诊断步骤、标准化治疗、预防重点以及推广实施等内容。

3 、儿童冲 动控制障碍的评估和诊断：讲演者中南大学湘雅二院精神卫生研究所苏林雁教授。讲演者结合本人及其团队的研究，介绍儿童冲动控制障碍的定义、评估工具、诊断标准等内容。

4 、儿童注意缺陷多 动障碍功能磁共振研究与诊断意义：讲演者北京大学第六医院 王玉 凤教授。讲演者介绍本人及其团队长期、深入对 ADHD 所做的功能磁共振研究 结果及其诊断学上的应用和前景。

5. 儿童行 为障碍病因学的双生子研究：讲演者四川大学华西医院心理卫生中心黄颐副教授。讲演者介绍本人及其团队目前进行的儿童行为障碍的双生子研究，探讨了遗传因素和环境因素的相互作用在行为障碍发生中的机制。

S50-1

儿童刻板性运动障碍及其强迫谱系障碍的临床特点与治疗 - The Clinical Phenomenological Characteristics and Treatment in the Children with Obssisseve-compulsive Disorders

Lanting Guo 1

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

儿童 强迫 谱系障碍是一组行为障碍 ， 包括强迫症 ， 咬手指甲、吸吮手指、舔口唇、拔头发等刻板性运动障碍 ， 抽动障碍和 ADHD 等疾病。 临床的表现形式多种多样，因患者的心理发育和语言表达不成熟，给临床诊断带来一定困难。这组疾病具有重复、刻板、不能随意控制等共 同的 临床特征，亲属中相同疾病的患病率较高。他们也存在一些共同的神经生化改变。选择性五羟色胺再摄取抑制剂和三环类抗抑郁剂氯米帕明对于强迫谱系障碍有效。认知治疗 (cognitive therapy) 和行 为治疗 (behavior therapy) 是主要的心理治 疗方法。

作者同 时报告临床病例，探讨患者的临床特点以及在家庭、学校、心理发育等方面的危险因素。

Obssisseve-compulsive spectrum disorders is a group of disorders in childhood which include the obssisseve-compulsive disorders, stereotypic movement disorders (such as suckle fingers, licking lips and trichotillomania), tic disorders and ADHD. The patients frequently demonstrate complex clinical phenomenologic characteristics. Pediatric patients frequently demonstrate poor insight into the nature of their behavebeor, which in association with their limited verbal expression may make the diagnosis more difficult. Repetition, rigidity and un-volition are the features shared by obssisseve-compulsive spectrum disorders. Family studies indicate that the disorder is highly familial. The obssisseve-compulsive disorders also share some sameness in neuropathology. The symptoms are responsive in general to selective serotonin reuptake inhibitors and clomipramine. Cognitive therapy and behavioral interventions are the mainstay of treatment but with more variable success. The author also go in to report the cases in their clinical practice and to examine the clinical features and the risk factors in family, school, development and psychology associated with the obssisseve-compulsive spectrum disorders in children.

S50-2

中国儿童注意缺陷多动障碍防治指南研究进展 - Essentials of Chinese Guidelines for ADHD Prevention and Treatment

Yi Zheng 1

1 Beijing Anding Hospital , Capital Medical University , Beijing , Chinese Mainland

注意缺陷多 动障碍 （ ADHD ） 是儿童中最常 见的精神障碍。但是在中国，这些儿童很少首先来看精神科医生，也很少能得到合适的诊断与治疗。因此，一部 ADHD 防治指南 对所有相关人员都是非常重要的。中国 ADHD 防治指南主要包括以下一些 规则和建议： (1). ADHD 的 诊断需要符合 DSM-IV 诊断标准； (2). ADHD 的 评估需要从父母及其他有关人员中直接获得在多个环境中 ADHD 的核心症状表 现、发病年龄、症状持续时间、和功能缺损的程度； (3). 治 疗计划应该遵循个体化、系统化、和综合治疗原则； (4). 中枢 兴奋剂和选择性中枢去甲肾上腺素受体激动剂作为主要推荐药物； (5). 临床医生因该规律性系统地随访诊疗的效果； (6). 特殊干 预技术应该被联合使用，包括：父母的教育和咨询，学校咨询与干预，特殊目标症状的药物治疗与管理，以及适当的个别心理治疗。

ADHD is one of the most common mental disorders among children. In fact, few of ADHD children to visit Psychiatrist firstly and get suitable diagnosis and treatment in China . So the Guidelines for ADHD Prevention and Treatment should be very important to all related personnel. From 2003 an expert group have been striving for editing Chinese ADHD guidelines including visiting international correlate group. The essentials of Chinese ADHD guidelines consist of a series of regulation and recommendation. (1).The diagnosis of ADHD requires that a child meet DSM-IV criteria of ADHD. (2).The assessment of ADHD requires evidence directly obtained from parents or caregivers regarding the core symptoms of ADHD in various settings, the age of onset, duration of symptoms, and degree of functional impairment.(3). The treatment plan should be individualized, systematized and multipled. (4).Stimulant and Atomoxetine are regarded as main recommended medication in children and adolescent with ADHD. (5).The clinician should periodically provide a systematic follow-up for the child with ADHD. (6).Specific intervention techniques should be combined including Parent education and consultation; School consultation and interventions; Medication management for specific target symptoms; Psychosocial treatments and behavioral management; Individual psychotherapy where indicated.

S50-3

注意缺陷多动障碍儿童冲动行为的影响因素和神经影像学研究进展 - Resent Findings from Psychological Influential Factors and Neuroimaging Studies in Attention Deficit Hyperactivity Disorder with Impulsivity

Linyan Su 1 , Yaoguo Geng 1 , Fei Li 1 , Fenglin Cao 1 , Xueping Gao 1

1 Mental Health Institute of the Second Xiangya Hospital , Central South University , Changsha , Chinese Mainland

目的 : 探索 8~12 岁 ADHD 儿童冲 动行为的影响因素与功能性影像学特征。

方法 : 39 名 ADHD 冲 动儿童、 31 名 ADHD 非冲 动儿童及 45 名 对照组儿童及其父母分别完成冲动量表 （ BIS ） 、 Achenbach 儿童行 为调查表 （ CBCL ） 、儿童焦 虑性情绪障碍筛查表 (SCARED ) 、儿童抑郁障碍自 评量表 （ DSRSC ） 、 Piers-Harrris 儿童自我意 识量表 （ PHCSCS ） 、儿童孤独量表 （ CLS ） 、儿童社会期望量表 （ CSD ） 、儿童青少年 时间管理倾向量表 （ TMD ） 和威斯康星卡片分 类测验 （ WCST ） 的 评估。以 GOSTOP 冲 动测量软件中的注意及冲动控制为任务，对 10 例 ADHD 伴冲 动男童、 7 例不伴冲 动男童及 9 对照组男童进行脑功能成像。

结果 : 冲 动组儿童有更多的外化性行为，焦虑、抑郁情绪、孤独感；有较低的社会期望、自我意识、时间管理倾向；社会期望、 WCST 的非持 续性错误数和时间管理倾向总分对冲动行为有预测作用，可以解释冲动行为变异的 47% 。

执行 GO 任 务时，对照组儿童的激活区域主要是额极等区域； ADHD 儿童不冲 动组是小脑、扣带回； ADHD 冲 动组是内侧苍白球、岛叶。执行 STOP 任 务对照组儿童的激活区域主要为额上回、额中回； ADHD 儿童不冲 动组为额中回；冲动 ADHD 组为钩回、扣带回。冲动 ADHD 儿童的激活的 脑区远少于其他两组。

结论 : ADHD 儿童的冲 动行为与其认知、情绪和行为特点有关；社会期望、 WCST 的非持 续性错误数和时间管理倾向总分可部分预测 ADHD 儿童的冲 动行为。可能额极（前额区）在冲动控制起重要作用。冲动的 ADHD 儿童大 脑功能相对低下，以额极 明 显。

关键词： ADHD ，冲 动，心理机制，功能性核磁共振

Objective: To explore the psychological influential factors of attention deficit hyperactivity disorder with and without impulsivity for 8~12 years-old children.And the specific brain functional areas associated with impulsivity by functional MRI.

Methods: Thirty nine ADHD children with impulsive(Impulsive group),31 ADHD without impulsive (Non-impulsive group ) and 45 controls(control group ) were evaluated with BIS, CBCL, SCARED, DSRSC,PHCSCS, CLS, CSD, TMD and WCST. Ten boys from control group, 7 boys from Non-impulsive group and 9 impulsive group were tested by functional MRI when they were playing GOSTOP impulsivity paradigm.

Results: 1 ． Children of Impulsive group showed more externalizing behaviors, higher anxious mood and depressive mood and more loneliness significantly, and lower social desirability, self- concept, time management dispositionthan than Non-impulsive group and Control group. Social desirability, non-persistence errors of WCST and the total score of time management disposition can predict the occurrence of impulsivity and explain about 47% variation.

2. When playing go task the main actived regions of the control group were frontal pole; the Non-impulsive group were cerebellum, cingulate gyrus; the Impulsive group were medial globus pallidus, insula. When playing stop task the main actived regions of the control group were superior frontal gyrus, cingulate gyrus; the Non-impulsive group were middle frontal gyrus; the Impulsive group were uncus, cingulated gyrus. Actived regions of the Impulsive group were less than the other two groups.

Conclusion: Impulsivity of ADHD children concerned with the characteristics of cognition, emotion and behavior. Social desirability, non-persistence errors and the total score of time management disposition can predict the occurrence of impulsivity.

The frontal pole maybe significant role in neuromechanisms of impulsivity. ADHD with impulsive children showed low brain activation compared with other two groups, especially the frontal pole.

Key words: ADHD ， impulsivity ， influential factors, functional MRI

S50-4

Contribution IV to the symposium "Diagnosis and Treatment of Behavior Disorder in Child"

Yufeng Wang, Chinese Mainland

Abstract text has not been submitted

S50-5

儿童注意缺陷多动障碍与品行障碍的双生子研究 - A Population Twin Study of Childhood Attention Deficit and Hyperactivity Disorder and Conduct Disorder Behavior in a Chinese Sample

Yi Huang 1 , Tao Li 2 , Fruhling Rijsdijk 3 , Yingcheng Wang 1 , Xiaohong Ma 1 , Xin Gao 1 , Xiaowei Zhang 1 , Yun Xiang 1 , Xueli Sun 1 , Xiehe Liu 1 , David Collier 3

1 Mental Health Center, West China University, Sichuan University, 北京 , Chinese Mainland, 2 Mental Health Center, West China University, Sichuan University, Department of Psychological Medicine, Institute of Psychiatry, King's College, London, United Kingdom, 3 Department of Psychological Medicine, Institute of Psychiatry, King's College, London, United Kingdom

背景 既往的研究 证实注意缺陷多动障碍和品行障碍紧密相关 ， 注意缺陷多动行为 （ HYPER ） 与品行 问题行为 （ COND ） 存在 遗传病因学联系 , 二者可能是同一 遗传背景的不同表现型。本文研究了这一联系的内在机制 : 即 遗传因素（ additive genetic factors ） , 共同的 环境因素以及个体特异性环境因素的相互作用。方法 收集了来自西南双生子登 记系统的 133 对双生子 ，采用困 难和长处量表测量行为表型 (SDQ) ，运用 Mx 软件计算相同变量双生子间、不同变量双生子间以及同一变量双生子内部的表型相关性。采用结构方程模型进行了双生子两变量模型的拟合，基于最大释然值选择出最佳的模型。结果 HYPER 与 COND 表型的相 关性为 0.44 (95% CI: 0.09, 0.27), 遗传因素在表型相关性中占 70% 。两 变量模型拟合发现 HYPER 与 COND 的 遗传相关性为 0.76 (95% CI: 0.31, 1) ，个体特异性的 环境因素相关性为 0.28 (95% CI: 0.02, 0.51). 结论 三 种不同的遗传因素直接影响注意缺陷多动障碍与品行障碍的相关性 : 一 种是仅与注意缺陷多动行为有关遗传因素；第二种是仅与品行问题行为有关，第三种是同时影响注意缺陷和多动行为以及品行问题行为的遗传因素。本研究提示大多数影响注意缺陷多动障碍的环境因素并不影响品行问题行为。

Introduction: Previous work has demonstrated associations between attention deficit and hyperactivity disorder and conduct disorder. As both behaviors of attention deficit and hyperactivity disorder (HYPER) and conduct disorder (COND) are influenced by genetic factors, one explanation for the association is that they are the pleiotropic manifestations of the same underlying genetic factors. The present paper examines three possible causes of the association: additive genetic factors, common environmental factors and individual-specific environmental factors.

Method: One hundred and thirty three twin pairs from the Southwestern China Twin Registry were examined with the Strength and difficulties questionnaire (SDQ) and the Wechsler Intelligence Scale for Children-Revised. The cross-twin within-variable, within-twin cross-variable and cross-twin cross-variable correlations were calculated. Using structural equation modelling, bivariate models were fitted. The best fitting model was chosen, based on likelihood and parsimony.

Results: The observed phenotypic correlation between HYPER and COND was 0.44 (95% CI: 0.09, 0.27), with genetic factors accounting for about 70% of the observed correlation. Bivariate model fitting quantified the genetic correlation between HYPER and COND at 0.76 (95% CI: 0.31, 1) and the individual-specific environmental correlation at 0.28 (95% CI: 0.02, 0.51). ′

Conclusions: In children, three different genetic factors may exist: one that solely affects the liability to HYPER, one that has only an effect on COND and one that influences both HYPER and COND. Our results suggest that most of the environmental factors that increase the risk of HYPER do not influence COND.

S51 - 痴呆照料者的心理教育 - Psychoeducation for the Caregivers of Dementia

Chairs: Jitendra Trivedi , India
Shifu Xiao, Chinese Mainland

现在正在经历着人口的转变 ， 特别是在发达国家 ， 越来越多的人寿命延长 ， 步入老年期。据联合国预计 2000 年至 2050 年，全球超 过 65 岁者将达到 11 亿多。仅发达国家痴呆患者将从 1350 万增至 3670 万 ( 联合国世界人中展望： 1996 年 ) 。

痴呆患者、与其共同生活者和照料者的生活 质量下降。多数照料者承受着情感和社会的压力，有时是身体和经济上的负担 (zarit et.al.1986, George & Gwyther, 1986) 。我中心 进行的一项关于痴呆者主要家庭成员 “ 照料 负担 ” 的研究表明，他 们在身体和精神上、日常生活和外在支持上有着很大的压力 (Indra Mohan et al.2003) 。

关于家庭中职业性关系的历史性回顾表明，当今家庭照料者的状况没有得到足够的重视 (Radha Shanker & Kiran Rao:2005) 。 过去 20 年中， 这一情况在概念性框架上产生了重要的转变，随之进行了许多关于家庭心理教育的 随机 对照性研究，它们对治疗性干预有着系统性的设计。无数的综述证实了这一方法的有效性 (Dixon L.B & Lehman A.F:1995,Fadden G.B/:1998) 。 这次工作坊将讨论痴呆照料者的心理教育问题。它侧重于关于痴呆者生活、行为问题和认知 (ABC) 的教育。同 时也将讨论照料者负担的问题和如何识别早期征兆。

There has been a demographic transition, especially in developing countries, therefore more and more people are surviving to an old age. According to United Nations projections between the years 2000 and 2050 the number of individuals ‘over 65' shall exceed 1.1 billion worldwide. Number of individuals with dementia in developed countries alone will increase from 13.5 million to 36.7 million. (United Nations, World Population Prospects: 1996 Revision).

The quality of life of the patients of Dementia and the people living with and caring for them is negatively affected. Most caregivers experience emotional, social and sometimes physical and financial burdens (Zarit et. al. 1986, George & Gwyther, 1986). A study of ‘burden of care' on key relatives of patients of dementia at our centre revealed a high burden of care in areas of physical and mental health, caregivers routines and external support (Indra Mohan et al.2003) A historical review of family professional relationships suggests that the early attempts to meaningfully acknowledge the contribution of family carers have not received due attention in contemporary practice. (Radha Shanker & Kiran Rao: 2005). The past 20 years have been characterized by a major shift in the conceptual framework, followed by rigorous research in the form of randomized controlled trials of formal family psychoeducation which represents a collective designation for interventions that combined the imparting of information with therapeutic element. The efficacy and effectiveness of this approach has been demonstrated in numerous reviews (Dixon L.B & Lehman A. F: 1995, Fadden G.B/: 1998).

The proposed workshop will address issues related to psychoeducation to the caregivers of dementia. The focus will be on educating about Activities of daily living, Behavioural problems & Cognition (ABC) in dementia. It will also address issues on educating the caregivers about the burden of care and how the caregivers may identify early warning signs.

S51-1

对工作坊的介绍 - Introduction to the Workshop

Jitendra Kumar Trivedi

King George Medical University , Department of Psychiatry, Lucknow , India

由于人口 结构的改变 ， 痴呆的患病率大幅增加。由于预期寿命延长 ， 老年人口增加。

对照料者进行心理教育是处理痴呆的最重要措施之一。控制的症结在于非药物治疗 ， 而照料者的参与对治疗是至关重要的。病人的心理教育包括教给治疗者关于疾病，管理和预后的信息。 必 须以照料者能够理解，而又科学、正确的方式来传授这些知识。在讨论疾病时，对照料的考虑必须关注到社会经济状况，文化程度和文化因素。

南 亚的国家尽管有很多不同，但有一个相似的问题，那就是老年人口增加，痴呆的负担增加。本工作坊关注的是精神卫生工作者在给家庭照料者进行心理教育时碰到的各种问题。演讲者将把焦点集中在工作人员在与照顾者讨论疾病的不同侧面时如何克服他们所碰到的困难。

Dementia is a disorder that is growing in prevalence largely due to the changing constitution of the population. There is a growing population of the elderly due to the increasing life expectancy.

Psychoeducation of the caregiver is one of the most important measures in the management of dementia. The crux of management lies on non pharmacological treatment, and the participation of the caregivers is crucial to treatment. Psychoeducation of the patients involves giving the caregiver information about the illness, management and prognosis. The information has to be given in a manner that is comprehensible and scientifically correct. Care has to be taken about the socio-economic status, literacy and cultural factors while discussing the disease.

The South Asian Countries although different have a similar problem with increasing population of the elderly and increasing burden of dementia. The current workshop will focus on the different array of problems faced by the mental health care workers in giving psychoeducation to the caregivers. The speakers will focus on how the health care professionals may overcome the difficulties that they face while discussing the different aspect of the illness with the caregivers.

S51-2

提高对痴呆的急性和慢性行为问题的警觉性（与痴呆的突然和长期行为改变有关的问题） - Creating Awareness about the Acute and Chronic Behavioral Problems in Dementia (Issues Related to Abrupt and Long Term Behavioral Changes in Dementia)

Charles Pinto

Nair Hospital , Psychiatry, Mumbai , India

许多照顾者要持续面对 3-15 年的生理和社会心理需求。当痴呆 进展时 ， 照料者必须持续地调整照料情况 ， 应对困难行为。痴呆行为和心理症状（ BPSD ）是相 对普遍的，但是照料者的耐受情况也是比较差的（ Shaji 等， 2004 ）。照 顾一个痴呆患者的压力使得照料者的健康和情绪出现问题的危险性较高。照料者可能是非正式（家庭： 80 ％）或正式的（雇佣或 专业： 20 ％）（美国大众 统计局， 1994 ），但是他 们需要关于痴呆，特别是 BPSD 的心理教育，以及它 对患者和照顾者的影响，而且它可以培训照顾者，使得他们可以更好地应对，处理被照顾者的那些挑战性的行为 。 BPSD 是痴呆中 问题最大，也最有破坏性的一面，痴呆患者有 83% 会出 现这种情况，而且这也是照顾痴呆者中负担很大的一部分（ Pinto C 等， 2000 ）。 BPSD 是痴呆 带来的各种心理反应，精神症状和行为。 IPA BPSD 任 务组， 1996 ， BPSD 可以出 现在症状开始时，照料者需要学习和监察痴呆的迹象，症状和行为诱因（ Costa 等， 96 ），以及在痴呆病程中出 现的焦虑，抑郁，精神病，激越表现及改变了的生理节律如睡眠。 BPSD 现在可以通过 NPI 和 BEHAVE-AD 等量表来 进行评估和定量。

对这些早期识别并通过药 物和行 为干预可以减少患者和照顾者的痛苦和压力 (Desai AK and Grossberg GT 2001) 。本演 讲将重点介绍通过我们在 Memory 医院 对病人和照顾者开展的工作中总结出来的策略。

References 参考文献

Shaji KS Qualititative Research Study of Dementia in Kerala. 10/66 Dementia Research Group 2004 Pinto C., Deshpande N., Panikker D. & Vas, C. J. (2000). JAPI, 48, 386-389.

Costa, P.T., Jr., T.F. Williams, M. Somerfield, et al. 1996. “Early Identification of Alzheimer's Disease and Related Dementias.” Clinical Practice Guidelines, Quick Reference Guide for Clinicians, No 19. Rockville , Md. : U.S. Department of Health and Human Services. AHRQ Publication No. 97-0703.

Desai A K and Grossberg G T. BPSD Management Algorithm JCP 2001

Many caregivers face 3 to 15 years of continuous exposure to physical and psychosocial demands. As Dementia progresses, caregivers must continually monitor the care recipient, cope with difficult behaviors. Behavioral and Psychological Symptoms of Dementia (BPSD) relatively common and poorly tolerated by caregivers (Shaji et Al 2004). The stress of caring for a person with a dementia puts the caregiver at higher risk for health and emotional problems. Caregivers may be Informal (Family 80%) or Formal (Paid or Professional 20%) US General Accounting Office 1994 but they require Psycho education about dementia specially BPSD and its effects on Patient and Caregivers and it trains caregivers to cope better and manage challenging behaviors of their care receivers.

BPSD are the most problematic and disrupting aspects of Dementia and present in Approximately 83% of demented patients accounting for a greater part of the burden of Caring in Dementia (Pinto C et al 2000) BPSD are A heterogeneous range of psychological reactions, psychiatric symptoms and behaviours resulting from the presence of dementia IPA Task Force on BPSD, 1996, BPSD may occur at onset with Carers having to Learn and monitor for signs, symptoms, and behavioral triggers of dementia (Costa et al 96) and during the course of Dementia and manifests as Anxiety, Depression, Psychosis, Activity related like Agitation and Altered Circadian rhythms like sleep. BPSD can now be assessed and quantified by scales like NPI and BEHAVE-AD

Early recognition of these and management by Drug and Behavioral Interventions can reduce both patient and Carer Distress ( Desai AK and Grossberg GT 2001). The presentation will highlight the strategies to be followed drawing from the experience of handling patients and their Carers at our Memory Clinics

References:

Shaji KS Qualititative Research Study of Dementia in Kerala. 10/66 Dementia Research Group 2004 Pinto C., Deshpande N., Panikker D. & Vas, C. J. (2000). JAPI, 48, 386-389.

Costa, P.T., Jr., T.F. Williams, M. Somerfield, et al. 1996. “Early Identification of Alzheimer's Disease and Related Dementias.” Clinical Practice Guidelines, Quick Reference Guide for Clinicians, No 19. Rockville , Md. : U.S. Department of Health and Human Services. AHRQ Publication No. 97-0703.

Desai A K and Grossberg G T. BPSD Management Algorithm JCP 2001

S51-3

提高照料者对痴呆临床表现的警觉性（解释与照料者有关的疾病表现） - Creating Awareness about the Clinical Manifestations of Dementia in the Caregivers (Explaining the Disease Manifestations Pertinent for Caregivers)

Pronob Kumar Dalal

Department of Psychiatry, C.S.M.Medical University , Lucknow , India

随着 预期寿命的增长 ， 痴呆的患病率也增高。这是一个与疾病明显相关的疾病 ； 60 － 65 岁者的的患病率是 1% ， 75-79 岁者为 6 ％， 95 岁或以上者为 45 ％ 。

尽管其患病率上升 ， 家庭及照 顾者对它的警觉性却是有限的。对大部分的患者来说 ， 痴呆的症状进展缓慢 ， 经常是要有几年。早期表现－通常是记忆问题－常常是轻微的，难以很快发现。病人和照顾者意识不到这是疾病表现，而把其视为年纪增加带来的变化。照料者通常在痴呆已经进展到晚期了才把病人带来治疗。

对病人和照顾者进行痴呆的心理教育对其管理是很重要的。非药物治疗的手段在对痴呆的管理中得到了重视，而这些需要对照顾者进行培训。传授给关于痴呆的知识是对痴呆进行管理的第一步。精神卫生护理工作者在向患者及其照顾者解释关于痴呆的表现和预后时常常碰到很多困难。在讨论疾病时，精神卫生专业人员要注意避免使用医学术语，顾及其文化信仰，根据患者的情况来传授信息。 这些问题将在工作坊中进行讨论 ， 包括痴呆不同阶段的临床表现。

The prevalence of dementia is increasing with the increasing life expectancy. It is a disease which is strongly associated with age; 1% of those aged 60-65, 6% of those aged 75-79, and 45% of those aged 95 or older suffer from the disease.

Despite the increasing prevalence there is limited awareness among the family and caregivers. In most cases, the symptoms of dementia progress gradually, often over a period of several years. The early signs - usually memory problems - are normally subtle and may not be immediately obvious. The patients and the caregivers are unaware about the illness and often attribute the changes to normal ageing. The caregivers often bring the patients for treatment when dementia has progressed to an advanced stage.

Psychoeducation about dementia to the patient and the caregiver is important in its management. Non pharmacological methods are often emphasized in the management of dementia, and most of these require training the caregivers. Giving the information about the illness forms a first step in the management of dementia. The mental health care workers often face difficulties in trying to explain the manifestations and prognosis of dementia to the patients as well as the caregivers. Avoiding medical jargon, being sensitive to the cultural beliefs and customizing the information to the individual patient are among the important considerations that a mental health professional should take while discussing the illness.

During the workshop all these issues will be discussed. Including the clinical manifestations of dementia in the different stages.

S51-4

讨论照顾者和病人面对的困难（与照料者管理病人中的困难及照顾负担相关的问题） - Discussing the Difficulties Faced by the Caregivers and the Patients (Issues Relating to Difficulties in Management of Patient and Burden of Care in the Caregivers)

Indra Mohan

Psychiatric Registrar, Department of Psychiatry, Royal Perth Hospital , Perth , Australia

痴呆病人及与他 们居住在一起 ， 照料他们的人的生活质量受到了负面的影响。大部分的照顾者感受到情感 ， 社会的负担 ， 有时候还有躯体和经济负担 (Zarit 等 , 1980; George and Gwyther, 1986) 。痴呆病人在疾病 开始后在日常生活上更加依赖；在一些复杂的活动，如找东西，出门或进屋均需要帮助。在印度，大部分的痴呆病人继续与家人呆在一起，由家人来照料他们。任何形式的机构照顾均不普遍。照顾痴呆的人在经济上是不利的。社会支持明显不足，核心亲属发现他们是孤立的 (Shaji 等 , 2003) 。我 们将讨论照顾中存在的各种困难，处理这些问题存在的障碍，以及减轻这些问题的方法。

References 参考文献

1.Zarit, S. H., Todd, P.A. and Zarit, J.M. Subjective burden of husbands and wives as caregivers: a longitudinal study. The Gerontologist, 1986; 26:260-266.

2. George, L. K. & Gwyther, L. P. Caregiver well-being: A multidimentional examination of family caregivers of demented adults. The Gerontologist, 1986; 26(3): 253-259.

3. Shaji, K.S., Smitha, K., Lal, K.P. and Prince M.J. (2003): Caregivers of people with Alzheimers disease: a qualitative study from the Indian 10/66 Dementia

The quality of life of the patients of dementia and the people living with and caring for them is negatively affected. Most caregivers experience emotional, social, and sometimes physical and financial burdens (Zarit et al., 1980; George and Gwyther, 1986). Patients of dementia are more dependent in daily living activities than before onset of illness; most assistance is needed in complex activities like finding things or moving outside or inside the house. In India most dementia patients continue to stay with their families, where family members look after all their needs. Institutional care in any form is not prevalent. Caregiver looking after a patient with dementia is associated with a financial disadvantage. Social support is conspicuous by its absence and the key relative finds oneself isolated (Shaji et al., 2003).We would discuss various difficulties in caregiving and hurdles in management including ways to alleviate the problems.

References

1.Zarit, S. H., Todd, P.A. and Zarit, J.M. Subjective burden of husbands and wives as caregivers: a longitudinal study. The Gerontologist, 1986; 26:260-266.

2. George, L. K. & Gwyther, L. P. Caregiver well-being: A multidimentional examination of family caregivers of demented adults. The Gerontologist, 1986; 26(3): 253-259.

3. Shaji, K.S., Smitha, K., Lal, K.P. and Prince M.J. (2003):

Caregivers of people with Alzheimer ? s disease: a qualitative study from the Indian 10/66 Dementia

S52 - 灾 难心理保健 — 恢 复和康复 - Disaster Mental Health- Recovery and Rehabilitation

Chairs: Russell D'Souza, Australia
Zhuoji Cai, Chinese Mainland

这个专题讨论会提供关于灾难心理卫生的见解 ， 包括自然和人为灾难。在这个专题讨论会中的发言者都是经历了最近的海啸灾难恢复工作的专家 ， 它的冲击在不同的领域 ， 喀什米尔地震和神户地震。 这个专题讨论会会发表一些教训 ， 从那些经历 ， 比 如 对策 ， 需要特定的地方性的背景 ， 需要和资源。需要避免对于创伤的病态的自然地反映。尽管悲痛的人们会不时地体验心理学症状，他们不一定需要心理的或精神病学专家的咨询。需要一套评估和治疗安排程序以确保能够监测少数严重的异常的悲伤反应是接受高水平的精神病治疗或心理学服务的适当帮助的保证。

This symposium will offer an insight into the disaster mental health including Natural and Human disasters. Speakers in this symposium have had experience with disaster recovery work after the recent disasters as the Tsunami and its impact in the different regions, The Earth quake of Kashmir the Kobe Earthquake.

This symposium will address some of the lessons learnt from these experiences such as Strategies need to be tailored to the local context, needs and resources Need to avoid pathologising natural reactions to trauma Although grieving people may at times experience psychological symptoms they do not always require help from counseling psychological or psychiatric professionals A need for assessment and referral procedures to ensure that the minority with more severe or abnormal grief reaction are ensured of receiving appropriate help from higher level psychiatric therapeutic or psychological services.

S52-1

海啸之后 — 灾难恢复经验 - Post Tsunami: The Sri Lankan Disaster Recovery Experience

Carlyle Perera

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

讲演者在斯里兰卡南部海啸灾难后进行了访问。这些活动利用恰当的资源从临床评估和治疗到教育和培训提供了一系列的康复服务。大量的需要和有限的资源 ， 在这样一种处境下 ， 精神卫生康复问题浮现 ， 我们讨论这些参加和随后的心理学反应的检查方法。

The presenter took part in a number of visits following the Tsunami disaster at South of Srilnaka. These attendances offered a range of recovery services from clinical assessments and treatments to teaching and training of appropriate resources. In situations where lage needs presented with very limited resources the mental health recovery issues that presented and ways that these were attended and a hind site examination of the psychological response s will be discussed.

S52-2

了解亚洲海啸发生后灾难精神病症状的发生率 - Disaster Psychiatry Pathologies Understanding the Morbidity from the Asian Tsunami Disaster

Suresh Sundram

South Asian Forum on Mental Health & Psychiatry Australia and Melbourne University , Parkville , Australia

讲演者在斯里兰卡南部海啸灾难后进行了访问 。 这些活动利用恰当的资源从临床评估和治疗到教育和培训提供了一系列的康复服务。 当前的精神病 发病率将会被讨论 ， 并试图了解它们的病理学特点和不同于一般创伤性事件的特点会被探索和说明模型会被考虑来理解灾后的表现。

The presenter took part in a number of visits following the Tsunami disaster at North of Srilnaka. These attendances offered a range of recovery services from clinical assessments and treatments to teaching and training of appropriate resources.

A view of the impending psychiatric morbidity that presented will be discussed and understanding the these pathologies and their presentations which differed from conventional traumatic events will be explored and explanatory models will be considered to under stand the post disaster presentations.

S52-3

了解亚洲海啸后的灾难精神病症状的发病率 - Disaster Psychiatry Pathologies Understanding the Morbidity from the Asian Tsunami Disaster

Suresh Sundram

South Asian Forum on Mental Health & Psychiatry Australia and Melbourne University , Parkville , Australia

讲演者在斯里兰卡北部海啸灾难后进行了访问。这些人从临床评估和治疗到教育和培训恰当的资源 ， 提供了一定范围的康复服务。 当前的精神病 发病率将会被讨论 ， 并探讨对其病理学和他们不同于一般的创伤性事件的特点的理解 ， 以及创伤后表现的解释模型。

The presenter took part in a number of visits following the Tsunami disaster at North of Srilnaka. These attendances offered a range of recovery services from clinical assessments and treatments to teaching and training of appropriate resources.

A view of the impending psychiatric morbidity that presented will be discussed and understanding the these pathologies and their presentations which differed from conventional traumatic events will be explored and explanatory models will be considered to under stand the post disaster presentations.

S52-4

克什米尔地震后的心理卫生 - The Mental Health Response to the Kashmir Earth Quake

Haroon Rashed Chaudhry

WPA Zonal Representative Zone 15, Dingley, Australia

演 讲者领导了一个心理卫生的专家队伍来治疗巴基斯坦克什米尔地震受害者。将讨论他们表现出的迫切的精神病发病率 ， 并探讨如何理解这些症状和他们的表现不同于一般的创伤性事件 ， 以及创伤后表现的解释模型。

The presenter lead a team of mental health professional to treat the victims of the earth quake in the Kashmir region of Pakistan. A view of the impending psychiatric morbidity that presented will be discussed and understanding the these pathologies and their presentations which differed from conventional traumatic events will be explored and explanatory models will be considered to under stand the post disaster presentations. And needs

S52-5

Hanshin Awaji 大地震十年反思 - The Great Hanshin Awaji Earthquake-Reflexion after Ten Years

Naotaka Shinfuku 1

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

文章回 忆了神 坂大地震的灾 难性体验和导致的心理卫生问题。将回顾十年的恢复过程 ， 其中的教训能帮助未来的灾害处置。

This presentation will recall the disaster experience of the Great Hanshin Awaji Earth quake and with it the mental health morbidity that resulted. The decade lang recovery process will be reflected on and lessons understood that can help future disasters will be revisted

S53 - The Report on Personality Disorder

Chairs: Zeping Xiao, Chinese Mainland
Larry Siever, United States

S53-1

中国边缘型人格障碍相关影响因素的研究 - Study on the Related Risk Factors of Borderline Personality Disorder in China

兰兰 王 1

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

目的 : 调查上海市精神卫生中心门诊就诊者中边缘型人格障碍的相关影响因素。

方法 : 对 BPD 的相 关影响因素进行现况调查。采用人格诊断问卷 （ PDQ-4+ ） 及美国精神障碍 诊断与统计手册第四版 （ DSM- Ⅳ） 对上海市精神卫生中心 3075 名 门诊患者进行调查 ， 诊断出边缘型人格障碍患者 178 名 ， 对所有患者进行儿童期创伤史研究 ； 并对检出 的 BPD 患者 进行父母教养方式、家庭环境等研究 .[ 结果 ]1 、 BPD 儿童期 创伤经历 ： BPD 患者在情感虐待、躯体虐待、性虐待、情感忽 视、躯体忽视及总体虐待程度 （ 总分 ） 显著高于精神科门诊中非人格障碍患者。 2 、 BPD 父母 养育方式： BPD 患者的父母 养育方式与中国常模相比存在较多显著差异，父亲在情感温暖理解、过度保护方面远低于对照，而在惩罚、严厉，拒绝、否认方面远高于对照；母亲在情感温暖、理解方面远低于对照，而在拒绝、否认，惩罚、严厉方面远高于对照。 3 、 BPD 家庭 环境：患者家庭的亲密度、情感表达、独立性、成功性、文化 性、 娱乐性、道德宗教观、组织性等方面均显著低于中国常模；而矛盾性方面显著高于常模。 4 、 BPD 儿童期 创伤与不恰当的父母养育方式和不良的家庭环境显著相关。 5 、 BPD 的影响因素： 经 Logistic 回 归分析，性别、年龄，情感虐待、躯体虐待、情感忽视是影响 BPD 患病与否的 关键因素。

结论 : 边缘型人格障碍与儿童期创伤经历、不良的家庭环境及父母养育方式显著相关。儿童期创伤经历与不良的家庭环境及父母养育方式显著相关。精神科门诊中女性患者、儿童期有过情感虐待、躯体虐待、情感忽视经历 ， 年纪较轻的患者罹患边缘型人格障碍的风险 性更高

Objective: to study the related risk factors of borderline personality disorder(BPD) in Chinese particular cultural and social background.

Methods: A cross-sectional investigation of related risk factors of patients with borderline personality disorder were conducted at Shanghai Mental Health Center . The Personality Diagnostic Questionnaire-4+( PDQ-4+) and the Fourth Edition of Diagnostic and Statistical Manual of Mental Disorder (DSM- Ⅳ ) were used to identify the patients with BPD among the 3075 outpatients. Then Childhood trauma questionnaire(CTQ-SF) were administrated to all. Thirdly, the patients with borderline personality disorder were assessed on parents' rearing style and family environment by EMBU(Egma Minnen av Bardndosnauppforstran) and FES-CV.

Results: 1. Childhood trauma history: the patients with BPD had significantly higher scores of emotional abuse, physical abuse, sex abuse, emotional neglect and physical neglect than the non-personality disorder patients. 2. The parental rearing style: comparing with the Chinese norm, the scores of emotional warmth / comprehension of BPD group were lower; the scores of punishment/rigorousness and rejection /deny of BPD group were higher; The differences were significant. 3. Family environment: comparing with Chinese norm, the scores of intimacy/ affection expression/ independence/ success/ culture/ entertainment/ morality and religion/sense of organization of BPD group were lower; the scores of contradictory were higher.4. Correlation analysis revealed that the childhood trauma history of BPD was correlated with the unhealthy parents' rearing style and family environment. 5. Logistic regression analyses revealed that gender (female), emotional abuse, physical abuse, emotional neglect are the risk factors for BPD.

Conclusion: There was significant relationship between the childhood trauma history, unhealthy parents' rearing style, bad family environment and BPD.The outpatients who suffered the four risk factors: female, emotional abuse, physical abuse, emotional neglect, would encounter more possibility of being BPD than others

S53-2

心理咨询门诊人格障碍的流行病学调查与评估 - Epidemiologic Investigation and Assessment on Personality Disorders of Outpatients in Psychological Counseling

Tianhong Zhang 1 , Zeping Xiao 1 , Lanlan Wang 1 , Yunfei Dai 1

1 Shanghai Mental Health Center , Shanghai , Chinese Mainland

目的 ： 调查人格障碍在心理咨询门诊的患病率及分布特征 ； 讨论心理咨询门诊人格障碍的评估方法 ；

方法 ： 采用系 统抽样法 ， 随机抽取了 2006 年 5 月至 2006 年 10 月就 诊与上海市心理咨询中心的 1511 例咨客 ， 应用人格障碍诊断问卷 （ PDQ4+ ） 对 1402 例入 组被试进行筛查 ， PDQ4+ 结果阳性的 986 例和 10% 结果阴性的被试用轴 Ⅱ 人格障碍临床访谈 (SCID-II) 进行盲法评估。

结果 ： 人格障碍在心理咨 询门诊咨客中的患病率为 38.4% ， PDQ4+ 的 总分及各分量表得分均显著高于正常人群常模 (P<0.001) ； 各分量表在 P70 、 P75 百分位的得分已达到或高出原量表划界分 ； PDQ4+ 各分量表分及 总分在各大类临床诊断分组比较中差异极显著 （ P<0.001 ）； 因子分析 结果提示 PDQ4+ 结构效度与人格障碍的类群理论构想基本吻合。

讨论 ： 人格障碍在心理咨 询门诊有较高的患病率 ， 与国外调查结果接近。 PDQ4+ 应用于心理咨询门诊能反映出咨客和普通人群的病理性性格差异，能体现 DSM －Ⅳ 轴Ⅱ人格障碍 的 类群理论构想 , 具有一定的 临床应用价值。

Objective: To assess the prevalence and comorbidity of personality disorder in Psychological Counseling department in Shanghai .

Method: 1402 subjects were sampled randomly from Shanghai Psychological Counseling Center . Personality disorders were assessed by questionnaires and interviews.

Results: Of those 1402 subjects, 539(38.4%) samples met criteria for at least one personality disorder and the cluster C personality disorders were most frequently assigned. The subscales for different type of personality disorders of PDQ4+ were higher than normal sample in China(P<0.001) ； The results of percentile showed that excepting antisocial factor, scores of other factors in 70 ～ 75 percentile point reached or over reached the cut off scores of PDQ4+. The Abstracted factors by factor analysis were very consistent with what originally proposed in the theory of personality disorder.

Conclusions: The frequency of personality disorder in this sample of Chinese outpatients seems similar to the rates found in western countries. PDQ4+ can reflect personality deviation between psychological counseling clients and normal sample in China . It also basically matches the designed questionnaire construct which based on the diagnosis of personality disorders by DSM －Ⅳ axis Ⅱ .

Key words: personality disorders, prevalence, outpatient in psychological counseling ， personality diagnostic questionnaire

S53-3

DSM-IV 边缘型人格障碍诊断的道德特性及其与中国精神科和 CCMD-III 的关联 - The Moral Nature of the DSM-IV Borderline Personality Diagnosis and its Implications for Chinese Psychiatry and the CCMD-III

Louis C Charland 1

1 University of Western Ontario, Philosophy, Psychiatry, and Faculty of Health Sciences, London , Canada

目的 ： 澄清 DSM-IV 中 边缘型人格障碍的科学框架。

方法 ： 对 DSM-IV 边缘型人格障碍的诊断用词和诊断标准进行哲学分析。

总结 ： DSM-IV 边缘型人格障碍的诊断代表的道德意义多于医学的状态 ， 这可能也是为什么这一诊断没有进入 CCMD-III 的原因之一 ， 注 释者争论并反对把反常和不稳定的行为医学化。

讨论 ： 道德上的考量在 DSM-IV 人格障碍的 讨论中和对它们的经验有效性的辩论中并没有扮演很大的角色。但是哲学的思考揭示：一些 B 类的人格障碍更偏重于道德而非医学状态。尤其是，哲学分析揭示声名狼藉的 “ 边缘型人格障碍 ” 实际上代表的是道德意义而非医学状态。这样的发现提出了一个严重的问题，边缘型人格障碍以及其他的一些 B 类人格障碍应当怎样治疗，由谁来治疗。同时，它也确认了哲学研究和分 析可以 对精神病学和心理学产生重要的贡献。实际上，目前中国精神障碍分类（ CCMD-III ）不包括 边缘型的诊断，除了一些可能的排除原因，我们的结论可能也是原因之一。

Purpose: To clarify the scientific status of the DSM-IV Borderline Personality Diagnosis.

Method: Philosophical analysis of the diagnostic terms and criteria for the DSM-IV Borderline Diagnosis.

Conclusion: The DSM-IV Borderline Diagnosis represents a moral rather than a medical condition. This may be one of the reasons why it is not included in the CCMD-III, where commentators have argued against medicalizing emotionally deviant and unstable behavior.

Discussion: Moral considerations do not appear to play a large role in discussions of the DSM IV personality disorders and debates about their empirical validity. Yet philosophical analysis reveals that some of the Cluster B personality disorders, in particular, may in fact be moral rather than medical conditions. In particular, philosophical analysis reveals that the notorious ‘Borderline Personality Disorder' diagnosis may in fact represent a moral rather than a medical condition. This finding has serious consequences for how this and some of the other Cluster B Personality Disorders should be treated, and by whom. At the same time, it confirms the importance of what philosophical research and analysis can contribute to psychiatry and psychology. The fact that the current Chinese Classification of Mental Disorders (CCMD-III) excludes the Borderline Diagnosis, as well as some possible reasons for that exclusion, will also be considered in light of this conclusion.

S53-4

度洛西汀治疗边缘性人格障碍的疗效与安全性的预试验研究 - Efficacy and Tolerability of Duloxetine in the Treatment of Borderline Personality Disorder (BPD): A Pilot Study

Silvio Bellino 1 , Erika Paradiso 1 , Monica Zizza 1 , Federica Crisà 1 , Filippo Bogetto 1

1 Service for Personality Disorders, Unit of Psychiatry, Department of Neurosciences, University of Turin , Torino , Italy

目的 ： 万拉法新作 为五羟色胺 （ 5-HT ） 和去甲 肾上腺素 （ NE ） 的双回收抑制 剂 （ SNRI ）， 已 显示治疗边缘性人格障碍 （ borderline personality disorder, BPD ） 有效。并被美国精神 协会指南指定为治疗 BPD 情感不 稳和冲动行为的一线用药。度洛西汀作用机理与万拉法新相似，但对 5-HT 及 NE 系 统的作用更均衡，目前有许多探讨其 治 疗抑郁症的研究，结果显示度洛西汀对抑郁症患者的躯体疼痛症状具有显著的疗效。然而度洛西汀治疗 BPD 的研究目前尚未 见报道。这个预初试验旨在评估度洛西汀治疗 BPD （符合 DSM-IV-TR 标准）的疗效与安全性。

方法： 被 试服用度洛西汀（ 60-120mg/d) 治 疗 12 周。采用的量表有： 临床总体印象量表 - 严重程度项（ CGI-S ）、 简明精神评定量表（ BPRS ）、 汉密顿抑郁量表和焦虑量表（ HDRS ， HARS ）、社会和 职业功能评定量表 (SOFAS) 、 BPD 严重指数（评估边缘性精神病理严重程度）、躯体症状问卷（评估躯体不适症 状）。分 别在基线、 4 周末和 12 周末 进行上述量表的评估。每次随访时采用药物剂量记录和治疗紧急症状表（ DOTES ） 记录不良反应。根据各量表评分变化进行数据分析统计。

结果： 预试验结果显示， 11 位被 试的 CGI-S 、 BPRS 、 HDRS 、 SSI 均分 显著下降； BPD 指数 总分和 “ 冲 动 ” 、 “ 愤怒爆发 ” 项目分显著下降。出现的不良反应有恶心、头痛、眩晕和失眠，程度为轻 - 中度。

结论： 本研究 结果显示，度洛西汀耐受性好，治疗 BPD 患者的 总体症状、抑郁症状、躯体不适和冲动控制障碍均有效。

Objectives: Venlafaxine, a dual serotonin and norepinephrine reuptake inhibitor (SNRI), has been shown to be efficacious in treating borderline personality disorder (BPD) and is indicated by American Psychiatric Association Guidelines for BPD as a first-line treatment for affective dysregulation and impulsive-behavioural symptoms. Duloxetine, an antidepressant with a similar mechanism of action but a more balanced effect on the noradrenergic and serotonergic systems, has been widely studied for the treatment of patients with major depressive disorder, showing a marked effect on painful physical symptoms associated with depression. However, no data have been published yet concerning duloxetine in BPD patients. This pilot study has been performed to assess the efficacy and tolerability of duloxetine in the treatment of patients meeting DSM-IV-TR criteria for BPD.

Methods: Patients were treated with 12-weeks duloxetine (60-120 mg/day) and repeatedly tested at baseline, after 4 and 12 weeks with: the Clinical Global Impression Scale-Severity item (CGI-S); the Brief Psychiatric Rating Scale (BPRS); Hamilton Rating Scales for Depression and Anxiety (HDRS, HARS); the Socio-Occupational Functioning Assessment Scale (SOFAS); the BPD-Severity Index concerning the severity of borderline psychopathology; the Somatic Symptom Inventory (SSI) for somatic complaints. Side effects were collected at each visit using the Dose Record and Treatment Emergent Symptom Scale Side (DOTES).

Statistics were performed by analyzing data concerning assessment scales with the analysis of variance for repeated measures.

Results: Preliminary findings concerning 11 patients indicate a significant reduction on CGI-S, BPRS, HDRS and SSI mean values, BPDSI global score and items “impulsivity” and “outbursts of anger”. Side effects were mild-to moderate in strength and included nausea, headache, dizziness and insomnia.

Conclusions: These data suggest that duloxetine is a well-tolerated agent and can be efficacious in treating global and depressive symptoms, somatic complaints and impulsive dysregulation of BPD patients.

S53-5

2005 至 2006 年间 50 例边缘型人格障碍的综述 - A Review of 50 Border Line Personality Disorder Cases Recorded in 2005-06

Asis Krishna Acharya 1

1 Calcutta Pavlov Hospital , Pshyiatry, Kolkata , India

目 标 ： 边缘型人格障碍是精神科急诊 最常 见的人格障碍之一。虽然它会被漏诊或在最初几次访谈中未能识别 ， 同时在不同国家和设置下 ， 它有不同的发生模式、呈现方式、年龄和性别分布 ， 但在全球化的背景下 ， 越来越多的边缘型人格障碍的案例被报道。

方法 ： 笔者所在加 尔各答 诊所共有 50 例 边缘型人格障碍患者纳入分析 ， 诊断标准为 DSM-TR 。 边缘型人格障碍占所有就诊患者的 0.1% 。

结果： 男性患者占 22 例，女性 28 例，年 龄从 22 到 47 岁不等，平均年龄 35 岁。 Mode is 33 years (4no.) and mean is 35.6 years. 据 DSM-4 所描述的 9 项标准中 1) 疯狂地努力以避免真实或想象中的抛弃 2) 不 稳定的人际关系 3) 身份紊乱 4) 冲 动最为常见，另外男女患者共有的特点包括人际关系的持续不稳定，不恰当的自我意象，长时间的冲动和情绪不稳定及自伤行为 ( 割腕和砍手腕 ) ，女性患者的自 杀行为突出 (34%) ， 长期感到空虚或厌烦，性冲动，物质依赖和莽撞驾驶，后者在男性中多见 (60% 以上 ) ；情 绪不稳定，明显者达到躁狂程度或轻微精神症状 ( 男性中突出 ) ， 对亲密关系者不恰当的愤怒和强烈的不愉快在女性中多见。患者中由伴侣带来就诊的占 55% ，接着 为父母 (33%) 和 亲戚及他人，未见朋友前来陪诊。伴侣为主要受害者，其次为伴侣一方的父母或孩子及自己的父母。 48% 患者婚姻出 现问题，分居或离异。 3 名女性患者和一名男性患者离婚。未婚者达 38 名。多数患者 经济状况下滑，拥有工作的患者中 60% 工作表 现不佳。

结论： 边缘型人格障碍患者的家庭、经济状况和生活质量均呈下滑表现。

Objectives: Borderline personality disorder is one of the commonest pernonality disorder found in busy psychiatry clinic. Although it is underdiagnosed or remain undiagonosed in first few visits. It`s pattern of occurance, presentation style, age and gender variation differs in different countries and settings. In globalised world more and more BPD cases are likely to be registered.

Methods: A total number of 50 BPD cases diagonesed in authors clinic in a metropolitan city of calcutta were taken for analysis. Diagonosis was based on DSM-4-TR diagn. criteria. BPD cases accounts for nearly 0.1% of all cases attended.

Results: There were 28 female and 22 male. Age distribution is 22 years to 47 years with a median average of 35 years. Mode is 33 years (4no.) and mean is 35.6 years. Among nine contexts desribed in DSM criteria 1) franatic efforts to avoid real or imagined abandonement 2) unstable and intenserpersonal relationship 3) identitydisturbance and 4) imulsivity are the most commonly observed additonal features obseved in both sexes apart froma pervasive instability in relationship, sef-image improperly built, impusivity and marked affective instability for a long period of time. Self mutilating (wrist slashing and cutting) behavior and suicidalbehaviors were prominent in female (34%). Chronic feeling of emptyness or feeling bore or empty and impulsivity in the area of sex, subsance abuse and reckless drive was observed more in males(over 60%). Affective instability, maked reactivity of mood expressing in a mania or mini pshychosis were maked in males predominantly. Inappropiate anger and intense displeasure for other close members were noted in females mainly. BPD patents were mostly brought by their spouses(55%), folled by parents 33% and by other relatives and others. Friends were not available in the scene.sufferers are mainly spouses, then in-law parent or in law daughter and in-law son, and own parents.marriage was zeoporised in 48% of both sexes by desrsion,separation or divorce.3 female and one male was divorced.no. of married were 38. Financial status in majority of cases were detoriated and employment was in under scale in 60% of employed BPD cases.

Coclusions: In borderline persality disorder patients, there is a detoriatation in famalial, financial, and qualityof life.

S54 - 焦 虑障碍 -2 - Anxiety Disorder 2

Chair: Mingyuan Zhang, Chinese Mainland

S54-1

门诊和住院焦虑障碍患者共病人格障碍的状况研究 - Investigation of Out-patients and In-patients of Anxiety Disorders Co-morbidity with Personality Disorders

Jianjun Huang 1

1 Beijing Anding Hospital , Beijing , Chinese Mainland

目的 ： 了解焦 虑障碍与人格障碍的共病率 ， 探讨焦虑障碍和人 格障碍的共病因素、内在 联系、临床特点、预后等因素。

方法 ： 在北京安定医院及北京友 谊医院中筛查出符合 DSM- Ⅳ 轴 Ⅰ 焦虑障碍的患者 ， 应用 DSM- Ⅳ 轴 Ⅰ 障碍定式临床检查 （ SCID— Ⅰ） 做焦 虑障碍的定性评估 ， 轴 Ⅱ 障碍定式临床检查 （ SCID— Ⅱ） 评估其共病的人格障碍 ， 根据是否共病人格障碍分为共病组和非共病组。两组患者在入组时均进行汉密尔顿焦虑量表（ HAMA ）、 汉密尔顿抑郁量表 (HAMD) 、焦 虑自评量表（ SAS ）、抑郁自 评量表（ SDS ）、疾病 严重程度（ CGI-SI ）、社会功能缺陷（ SDSS ）及自制 调查表的评定，在随访时 再次 进行 SAS 、 SDS 、 CGI-SI 、 SDSS 及自制 调查表的评估。

结果： 1) 整体 样本中 16 例 为 2 种或 3 种焦虑障碍同时共病，占样本量的 12.6 ％。焦 虑与人格障碍共病组发病年龄早（ 20 岁 vs.30 岁， P<0.05 ），病程 长（ 24 个月 vs.12 个月， P<0.01 ）。就 诊于北京安定医院的焦虑障碍患者共病率高于北京友谊医院（ 80 ％ vs.63 ％， P<0.05 ）。 2 ）所取焦 虑障碍的样本与人格障碍的整体共病率为 73.2 ％，其中与一 种人格障碍的共病率为 43.3 ％，与两 种人格障碍的共病率为 15.7 ％，最多可同 时共病 8 种人格障 碍；与焦 虑障碍共病的前 5 位人格障碍 亚型依次为强迫型、回避型、消极型、偏执型和抑郁型； 70.0 ％的人格障碍 类型来自 C 组，各焦虑障碍亚型与人格障碍的共病率依次是社交焦虑障碍共病率 88.0 ％、 GAD 共病率 69.6 ％、 PAD 共病率 为 77.8 ％、 PTSD 共病率 为 81.8 ％， OCD 的共病率 为 76.9 ％，；共病两 种或三种焦虑障碍亚型的焦虑障碍与人格障碍的共病率为 81.3 ％。 3 ）共病 组疾病严重程度更重，焦虑、抑郁水平更高，社会功能更差，治疗依从性差；两组疾病的变化与转归有明显差异，非共病组以好转居多（ 73.3 ％），共病 组预 后差（ 41.3% 病情无 变化或恶化），对治疗满意度低（ 41.3% 对治疗不满意）；随访发现二者都能获得较多的家庭支持，但在单位社会和亲朋好友支持方面，非共病组较共病组得到的支持多。随访发现共病组患者较非共病组更多的使用两种及以上抗焦虑抑郁药或合并使用其他抗精神病药（ P<0.05 ）；共病 组患者较非共病组更多的选择多家医疗机构及多名医生，在 6 个月内是否住 过院以及 6 个月内的治 疗费用方面，两组无明显差异。 4 ） Logistic 回 归分析发现社会功能缺陷和焦虑程度越重，发病年龄越早、对治疗越不满意的焦虑障碍患者，其共病人格障 碍的 风险性越大。

结论： 焦 虑障碍与人格障碍的共病率高，人格障碍对焦虑障碍影响较大，使得疾病特点更加复杂，在接诊焦虑障碍患者时，应对其人格障碍给予充分的评估和处理。

Objective: to get the co-morbidity rates of Anxiety Disorders and Personality Disorders and to explore the co-morbidity factors ,clinical features ,prognosis.

Methods: The Structured Clinical Interview for DSM-- Ⅳ (SCID) was used to determine Axis I and Axis II diagnoses, 127 out-patients and in-patients anxiety disorders came from Beijing Anding Mental Hospital and Beijing Youyi General Hospital . The sample was divided into two groups by whether co-morbidity with Personality Disorders, the cases of each group acquired assessment of HAMA 、 HAMD 、 SAS 、 SDS 、 CGI-SI 、 SDSS as well as self-made questionnaires in the first interview, and SAS 、 SDS 、 CGI-SI 、 SDSS and self-made questionnaires were still need to assess at 6 months follow-up interview.

Result: 1 ） Among the whole sample, 16 cases were diagnosed two or three anxiety disorder subtypes, which account for 12.6% of the whole sample; the onset age of co-morbidity group are earlier than non-comorbidity group (20years vs.30years P<0.05) ， course of disease are longer (24months vs.12months,P<0.01) ， the co-morbidity rate of patients from Anding Hospital is higher than Youyi Hospital(80 ％ vs.63 ％， P<0.05). 2).Total Co-morbidity Rate of Anxiety Disorder and Personality Disorder is 73.2 ％， and 43.3% Anxiety Disorder co-morbidity with one Personality Disorder,15.7%with two Personality Disorders, and at most eight Personality Disorders are diagnosed for one patient. The former five Personality Disorders comorbiditied are Obsessive-compulsive Personality Disorder, Avoidant Personality Disorder, Paranoid Personality Disorder and Depressive Personality Disorder. 70%Personality Disorders come from C cluster, ie. Anxious/phobia cluster. The co-morbidity rate of subtypes of Anxiety Disorder with Personality Disorders as followers: GAD 69.6 ％ ,Social phobia Disorder 88.0 ％ , Panic Disorder77.8 ％ , PTSD81.8 ％ , OCD76.9 ％ ,the co-morbidity rate of two or three Anxiety Disorders with Personality Disorder is 81.3 ％ . 3)The symptoms of co-morbidity group were more severe, worse social function, higher degree of anxiety and depression ,worse prognosis(41.3%deteriorate),lower satisfaction level (41.3% un-satisfaction ), lower support system, use more anti-anxiety or anti-depression and more than two anti-psychological drugs(P<0.05);The patients of co-morbidity group prefer more than one medical agents and doctors; but the cost during the following 6 months was not different greatly.4 ） Logistic regression analysis indicates that the worse social function and anxiety ,and the earlier onset age ,and the lower level satisfaction , the higher risk of co-morbidity with Personality Disorder.

Conclusion: The high co-morbidity rate of Anxiety Disorder with Personality Disorder influence the Anxiety Disorder greatly, Personality Disorders should be paid attention to and assessed sufficiently when confronted with Anxiety Disorders.

S54-2

抑郁症与焦虑障碍患者的心脏血液循环动力学特征研究 - The Study of Dynamic of Blood Circulation of Heart on Major Depression and Anxiety Disorder Patient

Ming Tao

Xinhua Hospital in Zhejiang Province , Shanghai , Chinese Mainland

背 景 : 抑郁症与焦 虑障碍患者常常伴随有各种心脏事件的发生 ， 其心脏事件的发生率远远高于无情绪障碍的人群 [1] ， 其心 脏事件发生的危险程度也高于普通人群一倍以上 [2] 。因而 认为抑郁与焦虑障碍可能是心脏事件发生的一个重要的独立危险因素。然而，现有的临床研究较多地关注各种抗抑郁药物治疗中患者心脏电生理方面的变化，关于抑郁与焦虑状态下心脏及血液循环系统自身的血流动力学改变尚缺乏详实的研究资料。

目 的 : 心 脏血流动力学改变不仅是心脏事件发生的最终结果，同时也是促使心脏血液循环效率降低、应对外周循环变化的贮备能力减少，诱发严重心脏事件发生的因素之一。临床上抑郁症与焦虑障碍所伴随的循环系统生理变化不尽相同，为此，分别监测抑郁与 焦 虑状态下患者的心脏血流动力学变化有助于客观地评估二者的循环系统生理变化的差异及抗抑郁药物对其影响的程度。

方 法 (1) 、方案 设计 采取多中心随机抽 样病例对照试验；研究开始于 1996 年 4 月，按 预试验阶段、干预试验阶段及主体研究阶段三部分进行，至 2006 年 5 月完成， 样本资料分别来源于杭州、绍兴、湖州等地的综合医院精神科及专科医院。

(2) 、 样本资料 共完成 32468 例抑郁症和的 临床资料评估与血液循环动力学测试，剔除有心脑血管病史的患者 5067 例，治 疗期间出现心电图有临床意义改变的患者 2265 例，使用 SSRI 以外 药物治疗或合并二种抗抑郁药治疗的患者 10844 例；从中 选择符合 CCMD-3 的抑郁症 诊断标准，且无显著焦虑 (HAMA>14) 的患者 1007 例作 为抑郁症组；选择符合 CCMD-3 焦 虑症诊断标准（包括惊恐发作和广泛性焦虑），同时要求 HAMA>14 ，且 HAMD<17 的患者 866 例作 为焦虑障碍组。

(3) 、 测量指标 临床诊断采用 CCMD-III 诊断标准，抑郁症状与焦虑症状的评估采用 HAMD 和 HAMA ，一般生理指 标包括血压、心电图、血电解质， X 线胸片等，心脏血液动力学采用浙江大学求是公司医学仪器研究所研制的血液循环动 力学信息 检测仪（简称 CD ）。

(4) 、分析方法 研究 样本的检测指标分别与常模进行比较，与正常对照组比较以及治疗前后自身比较。

结 果 : （ 1 ）抑郁症与焦 虑障碍的循环系统动力学特征：抑郁或焦虑状态下的循环系统能耗参数（ 1.362±0.322 ） 较症状缓解后及正常对照组显著增高（ t=2.566~4.212, p=0.013~0.0001 ）；效率参数（ 0.248±0.392 ） 较症状缓解后及正常对照组显著降低（ t=2.586~4.124, p=0.012~0.0001 ）；

（ 2 ）抑郁症的循 环系统动力学特征：抑郁状态 下的心 脏循环动力学改变较外周更明显，主要为患者的心脏左室舒张期末压力（ LDP=9.3329±3.0992 ）、迷走神 经反馈系数（ VFC=0.0370±0.0322 ）等参数分 别较抑郁缓解后、常模均值和正常对照组显著升高（ t=2.585~66.993, P<0.05 ）；左室舒 张末期容量（ LDV=112.2753±41.3346 ）、左室机械效率（ LME=0.2049±0.0591 ）和交感神 经反馈系数（ SFC=0.4194±0.0776 ）等参数分 别较抑郁缓解后、常模均值和正常对照组显著降低（ t=2.996~20.414, P<0.05 ）。

（ 3 ）焦 虑障碍的循环系统动力学特征：外周循环系统的动力学改变更显著，主要为患者的收缩期动脉压、中动脉弹性模量、心脏射血阻抗等分别较症状缓解后及正常对照组升高（ t=2.411~3.530, p=020~0.001 ）

结 论 : 抑郁症与焦 虑障碍均存在显著的血液循环动力学改变，主要表现为循环系统的能量消耗增加，机械效率降低；其中焦虑状态下外周的循环动力学改变更显著，以收缩期血压升高、动脉弹性模量及心脏射血阻抗增高为主；抑郁状态下心脏的动力学改变较明显，主要以左室舒张末期容量（ LDV ）下降，左室舒 张末期压力（ LDP ）上升， LDV/LDP 比 值下降，左心室的顺应性下降，心脏工作处于低效能状态，尤其是左心室工作效能降低，且参数的变化程度与病情、治疗效果相关。

S54-3

几种主要诊断工具在焦虑障碍诊断中的比较 - Concordant Analysis for Anxiety Disorders of Three Diagnostic Interview Instruments - SCID, MINI and CIDI

Yanlin He

Shanghai Mental Health Center , Shanghai , Chinese Mainland

目的 ： 了解 CIDI 、 MINI 和 SCID 三 种精神科诊断工具对焦虑障碍的诊断一致性及优缺点。

方法 ： 以上海市精神 卫生中心门诊、住院病人及社区居民为调查对象。同一对象由不同调查人员分别采用 CIDI 、 MINI 和 SCID 三 种精神科诊断工具进行诊断检查。进行一致性（ Kappa ）分析， 计算各诊断工具的敏感性和特异性。

结果： 共 调查 303 人。三 种诊断工具之间以及有无诊断者之间花费时间差异均有统计学意义。

三 种诊断工具有无焦虑障碍诊断 Kappa 为 0.61 ，其中 强迫症（ OCD ） 0.65 ，惊恐障碍（ PD ） 0.31 ，社交焦 虑症（ SAD ） 0.23 ，广泛性焦 虑（ GAD ） 0.03 ； MINI 诊断与原始诊断比较：有无焦虑诊断 Kappa 为 0.49 ，其中 OCD0.69 ， SAD0.41 ， PD0.23 ， GAD0.21 ； CIDI 与原始 诊断比较：有无焦虑障碍诊断 Kappa 为 0.39 (DSM) / 0.46 (ICD) ，其中 OCD0.40 (DSM) / 0.46 (ICD) ， PD0.16 ， SAD0.05 （ DSM ） / 0.05 (ICD) 。

MINI 与 SCID 比 较， Kappa0.58 。其中 OCD0.61 ， SAD0.55 ，余均小于 0.4 。若以 SCID 为标准， MINI 对焦虑障碍的诊断灵敏度 0.62 ，特异度 0.92 ，阳性 预测值 0.82 ， 阴性预测值 0.81 ，效率 0.82 。

SCID 与 CIDI 比 较， Kappa0.05 (DSM) / 0.06 (ICD) 。各焦 虑障碍诊断类别均小于 0.2 。若以 SCID 为标准， CIDI 的 DSM 焦 虑障碍诊断灵敏度 0. 25 ，特异度 0.80 ，阳性 预测值 0.31 ， 阴性预测值 0.75 ，效率 0.65 。 MINI 与 CIDI 焦 虑障碍诊断结果比较， Kappa 为 0.41 (DSM) / 0.44 (ICD) 。其中 OCD 为 0.54 (DSM) / 0.53 (ICD) ，余均小于 0.3 。

结论： ①三 种工具中， CIDI 花 费时间最长。 ②焦 虑障碍诊断与临床原始诊断的一致性以 SCID 最高，其次 MINI,CIDI 最低。焦 虑谱系中各类诊断的一致性以强迫症较好，其他类别均不甚理想。 ③ MINI 与 SCID 间的诊断一致性优于 MINI 与 CIDI 和 SCID 与 CIDI 。同 样 ， 各类别诊断的一致性不理想 ， 相对较好的是强迫症。

Objectives: To figure out the diagnostic concordance for anxiety disorders among three psychiatric diagnostic interview instruments (SCID, MINI and CIDI) and concordance between instrumental diagnoses and original clinical diagnoses. To evaluate the advantage and disadvantage of each instrument and to provide evidence for diagnostic instrument election and application for future use.

Methods: Inpatients and outpatients in Shanghai Mental Health Center and community residents were included as the subjects. All subjects were administered 3 interviews of CIDI, SCID and MINI by independent interviewer. We use the Cohen's kappa coefficient for the concordance comparison and student-t test for the length of interview comparison.

Results: A total of 303 subjects with 150 outpatients (49.5%), 99 inpatients (32.7%) and 54 community residents (17.8%) were interviewed. The differences in time consuming among three interviews and between with and without diagnosis were statistically significance. Concordant analysis between instrumental diagnoses and original clinical diagnoses showed that Kappa values of SCID diagnoses of anxiety disorder and clinical diagnoses was 0.61, that of MINI was 0.49 and that of CIDI was 0.39 for DSM diagnostic criteria and 0.46 for ICD diagnostic criteria. More detailed analyses showed that concordance of SCID and MINI diagnosis of OCD was good (0.65, 0.69), but relatively low for PD (0.31, 0.23), SAD (0.23, 0.41) and GAD (0.03, 0.21). But concordance of CIDI diagnosis for all of the four specific diagnoses were not satisfied for both DSM diagnoses or ICD diagnoses. SCID & MINI Kappa values were only moderately good for lifetime (0.63) and current anxiety disorders (0.58), except OCD (0.61) and social anxiety disorder (0.55), agreement was relatively low (<0.40) for panic disorder (0.15), and generalized anxiety disorder (0.37). If set SCID diagnoses as gold standard, the sensitivity of MINI for DSM diagnoses of anxiety disorder was 0.62, specificity was 0.92, PPV 0.82, NPV 0.81, efficiency 0.83.

SCID & CIDI Kappa values for anxiety disorders were 0.05 if took DSM diagnoses or 0.06 if took ICD diagnose into account. If set SCID diagnoses as gold standard, the sensitivity of CIDI for DSM diagnoses of anxiety disorder was 0.25, specificity was 0.80, PPV 0.31, NPV 0.75, efficiency 0.65.

MINI & CIDI Kappa value for anxiety diagnoses between the two tools was 0.41 (DSM) /0.44 (ICD), with moderate for OCD (0.54 for DSM and 0.53 for ICD), but low for others (<0.4).

Conclusions: a) CIDI takes longest time among the three even for normal people with no diagnosis. b) SCID is better concordant with clinical diagnoses that MINI and CIDI. c) Concordance between MINI and SCID is better than that between MINI and CIDI, and that between SCID and CIDI. OCD is better diagnosed by all three instruments concordant to each other and to clinical diagnosis than other diagnoses of anxiety spectrum disorders.

S54-4

广泛性焦虑右侧额叶、小脑和海马等功能异常：视觉任务 fMRI 研究 - The Abnormal Prefrontal ， Hippocampus and Cerebellum of Right Hemispihere in Generalized Anxiety Disorder: A Visual Task fMRI Study

Qingwei Li 1

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

Objective: to observe the related cerebral functional locations during processing affective pictures in patients with generalized anxiety disorder (GAD) and to explore its possible psychopathological mechanisms.

Methods: Nine patients met with the criterion of GAD (GAD group) and nine healthy matched controls (control group) were scanned in Marconi MRI 1.5 T. BOLD-EPI signals of all subjects were collected during paying attention to pictures of IAPS. BOLD-EPI data were analyzed by AFNI. All subjects were measured by Hamilton anxiety scale ( HAMA ), state-trait anxiety inventory （ STAI ） and valence assessment of IAPS pictures.

Results: (1) GAD group showed higher scores of HAMA （ 27.7±5.8 ） 、 STAI-trait （ 43.0±14.4 ） and STAT-state(40.6±5.8) than control groups, respectively （ 1.8±1.3 ） , （ 30.0±8.3 ） and (32.4±5.2)(P<0.05-0.01) ； Scores of valence of the three kinds of IAPS pictures between the GAD group and control group had no significant difference (P>0.05). (2) GAD group showed that right precentral gyrus （ t=5.009 ） , right hippocampus （ t=5.345 ） , right lingual gyrus （ t=4.584 ） were activated stronger than those of control group, but right frontalgyrus （ t= － 5.095 ） , left paracentral gyrus （ t= － 5.358 ） , right middle temporal gyrus （ t= － 5.074 ） , right fusiform gyrus （ t= － 8.833 ） , left middle occipital gyrus （ t= － 8.100 ） , right middle occipital gyrus （ t= － 5.570 ） right tonsil of cerebellum （ t= － 4.654 ） were weaker than those in control group(P<0.001).

Conclusion: The abnormal brain functional locations of GAD mainly presented in right hemisphere, especially right middle frontal gyrus, right tonsil of cerebellum, right hippocampus and occipital lobe.

S54-5

河北省广泛焦虑症的流行病学调查（栗克清，孙秀丽，崔利军 等） - Epidemiological Survey on Generalized Anxiety Disorder in Hebei Province

Keqing Li 1 , Xiuli Sun 1 , Lijun Cui 1

1 Hebei Mental Health Center, Hebei, Chinese Mainland

目的 : 了解广泛焦 虑症的患病率及人口学特点。

方法 : 采用随机抽 样方法 ， 调查河北省 18 岁以上人群 24000 人 ， 调查筛选工具 采用改 编后的一般健康问卷 12 项 (GHQ-12) ， 以《 DSM- Ⅳ -TR 轴 Ⅰ 障碍定式临床检查》 (SCID-I/P) 病人版 为调查的诊断工具。

结果 : 广泛焦 虑症 ( 均 为现患病例 ) 的 时点患病率为 7.69‰(95%CI 6.50-8.88‰) ， 女性 10.42‰ ， 男性 4.97‰ ， 女性明 显高于男性 （ u =4.49 ； p<0.01 ） 。 20-29 岁患病率较低 (3.17‰) ， 50-59 岁患病率较高 (15.56‰) ； Logistic 回 归分析显示，危险因素有：年龄 50-59 岁；保护性因素有：男性，年龄 20-29 岁，年收入 10001-40000 元。

结论 : 广泛焦 虑症是一种十分常见的精神疾病 , 应列为社区精神卫生保健工作的重点疾病。

Objective: To investigate the prevalence of generalized anxiety disorder in Hebei province and the impact of relative factors on it.

Methods: Sum total of 24,000 random samples at ages over 18 were selected among the crowd and data were collected. The tools of the revised edition of the General Health Questionnaire (GHQ-12) for the investigation, Structured Clinical Interview for DSM- Ⅳ -TR Axis I Disorders-Patient Edition (SCID-I/P) for diagnosis.

Results: The prevalence rate of generalized anxiety disorder was 7.69‰(95%CI 6.50-8.88‰).There was a significant difference on the current prevalence between10.42‰ in female population and4.97‰ in male, and the former was more than the later (u=4.48 ； p<0.01). Logistic analysis showed that risk factors to the disease was ages of 50-59. On the other hand, factors to avoid the disease were male, ages of 20-29 and the family average annual income ranged 20,001-40,000 RMB.

Conclusions: Generalized anxiety disorder has become common disease. The prevalence rate of showed a tendency to increase, so it should be listed as one of the major mental disorders for prevention ,treatment and research.

S55 - 抑郁障碍的功能影像研究 - Functional Neuroimaging Study on Depression Disorder

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

功能 脑影像技术的发展 ， 使得探讨精神病人特定脑区的结构影像、血流 / 代 谢及血氧激活信号改变特征成为现实 ， 这些结构与功能影像学资料是疾病病因机制及治疗机制研究的重要部分。本专题会着重 探 讨抑郁障碍的功能脑影像学研究 ， 为大家提供相关研究思路的交流平台。

S55-1

难治性抑郁症局部脑葡萄糖代谢的初步研究 - Regional Cerebral Glucose Metabolic Abnormalities in Treatment-Resistant Depression: A Preliminary Study

ZhiGuo Wu 1 , 贻儒 方 2 , 斌 谢 2 , 晓光 孙 3

1 Shanghai Mental Health Center, Shanghai, Chinese Mainland, 2 上海市精神 卫生中心 , 上海 , Chinese Mainland, 3 上海交通大学医学院附属仁 济医院临床核医学科 , 上海 , Chinese Mainland

研究目的 : 探索 难治性抑郁症局部脑葡萄糖代谢模式 ， 并探讨抑郁症在脑通路水平上的异常功能改变。

材料和方法 : 选取符合 ICD-10 诊断标准以及 Thase 等定 义的难治性抑郁判断标准的 8 例 难治性抑郁症患者和 8 例性 别、年龄相匹配的健康受检者 ， 收集一般人口学资料和临床资料 ， 并进行静息态正电子发射计算机断层 /18F- 氟代脱氧葡萄糖 （ PET/FDG ） 扫描 ， 利用参数统计图 （ SPM2 ） 方法分析比 较两组间局部脑代谢差异。

结果 : 结果显示难治性抑郁症患者局部脑区葡萄糖代谢活动呈现降低或增高的异常改变。病例组受检者 FDG 代 谢较对照组显著降低 (p ＜ 0.001) 的 脑区有左侧额中回 （ Brodmann 9/46 区 ） 和 顶下小叶 （ Brodmann 40 区 ）； 右 侧额中回 （ Brodmann 9 区 ） 、 额下回 （ Brodmann 45/47 区 ） 、后部 颞叶皮质的颞上回和颞中回 （ Brodmann 21/22 区 ）； 边缘系统代谢降低的区域见于左侧背侧前扣带回 （ Brodmann 32 区 ） 。 病例 组受检者代谢增高的脑区见于运动皮质、旁边缘系统和皮质下脑区 (p ＜ 0.001) 。分 别包括 ： 左侧中央前回和中央后回 (Brodmann 4 区 ) 和右 侧额内侧回 (Brodmann 6 区 ) ； 右 侧前颞叶的颞上回 （ 颞极 ， Brodmann 38 区 ） 和右 侧岛叶 ； 双侧小脑 （ 左侧小脑山顶和右侧小脑蚓部 ） 。另外，还发现病例组左侧额叶额中回和额下回白质代谢显著增高。

结论 : 难治性抑郁症患者存在旁边缘系统代谢增高和皮质代谢降低的交互性代谢改变模式，支持抑郁症边缘系统－皮质功能紊乱假说；患者小脑代谢水平增高，提示抑郁状态下小脑功能亢进；额叶白质高代谢水平提示有必要对难治性抑郁症潜在的脑结构异常改变进行深入研究。

Objectives: The aim of the present study was to investigate regional cerebral glucose metabolic abnormalities in treatment-resistant depression (TRD), and further explore the dysfunctional neural pathways for depression.

Methods: Relative regional cerebral glucose metabolism was measured with fluorine-18 deoxyglucose(18F-FDG) positron emission tomography(PET) scan in 8 patients with treatment-resistant unipolar depression and 8 age-matched healthy controls under resting conditions. PET data of the two groups was compared by using Statistical Parametric Mapping (SPM2) analysis.

Results: Both abnormally significant decreasing and increasing cerebral regions were found in patients with TRD. Decreases in cortex included left middle frontal gyrus (Brodmann's area 9/46) and inferior parietal (Brodmann's area 40), and right middle frontal gyrus (Brodmann's area 9), inferior frontal gyrus (Brodmann's area 45/47), right posterior temporal cotex (Brodmann's area 21/22) and left dorsal anterior cingulate (Brodmann's area 32) (p<0.001). Increases in right medial frontal (Brodmann's area 6), precentral and postcentral gyrus (Brodmann's area 4), paralimic regions including right anterior temporal (Brodmann's area 38) and insula, bilateral cerebellum, and left frontal white matter (p <0.001) were also identified.

首发抑郁症患者静息态 fMRI 研究 - The Abnormal Brain Activity in First Episode Depression by Resting fMRI

DaiHui Peng 1 , 开达 江 2 , 贻儒 方 2 , 翔宇 龙 3 , 玉峰 臧 3

1 Shanghai Mental Health Center, Shanghai, Chinese Mainland, 2 上海市精神 卫生中心 , 上海 , Chinese Mainland, 3 北京 师范大学 , 北京 , Chinese Mainland

目的 ： 通 过静息态功能磁共振了解抑郁症患者基础状态的自发脑活动特征。

方法 ： 16 例首 发抑郁症患者 （ ICD-10 标准 ） 与 16 例健康 对照者在静息状态下接受 5 分 12 秒功能磁共振 扫描。以汉密尔顿抑郁量表（ HAMD ） 评估患者症状严重程度。以 ReHo 软件对影像数据进行局部脑区的功能一致性分析（获取各局部脑区一致性数值 “ReHo” ：反映 脑功能区的自发神经活动一致性）；对病例组 -- 对照组的 ReHo 值进行 t 检验。对患者脑功能区局部一致性 ReHo 值与其 HAMD 量表 总分及因子分进行 pearson 相 关分析。

结果： 1 、抑郁症患者 组左侧丘脑、左侧小脑、左内外侧上颞叶与枕叶的神经自发活动局部一致性减低（ P<0.005 ）； 2 、抑郁症患者 组的上述所有差异脑区 ReHo 值与 HAMD 量表 总分无相关性（ P>0.05 ）； 3 、抑郁症患者 组的左侧丘脑 ReHo 值与其 HAMD 量表睡眠障碍因子分及体重因子分相 关，相关系数分别为 0.56 与 0.58 （ P<0.05 ）；患者 组的左外侧上颞叶 ReHo 值与偏向性认知障碍因子分相关，相关系数为 0.04 （ P<0.05 ）；患者 组的左内侧上颞叶 ReHo 值与焦虑躯体化因子分及偏向性认知障碍因子分相关，相关系数分别为 0.04 与 0.04 （ P<0.05 ）。

结论： 1 、通 过静息态 fMRI--ReHo 法， 发现首发抑郁症患者异常脑功能区包括：左侧丘脑、左侧上颞叶、左侧小脑、枕叶，患者这些区域自发活动减弱。 2 、左 侧丘脑自发活动降低可以部分反映抑郁症体重变化与睡眠障碍的脑神经反常活动基础。 3 、左内外 侧上颞叶自发活动降低可以部分反映抑郁症抑郁情绪及情绪认知障碍的脑神经反常活动基础。

Object: To explore the differences of regional brain activity in resting state in depressed vs healthy participants in this research, using functional magnetic resonance imaging (fMRI).

Methods: Sixteen participants diagnosed with major depressive disorder (ICD-10) and 16 controls were scanned during resting state. To detect spontaneous hemodynamic responses across the whole brain, by using a novel method based on regional homogeneity (ReHo). And to analyze the relationship between ReHo and HAMD in depression group by pearson analysis.

Results: Depressed patients exhibited significantly lower KCC than controls in the left thalamus, uvulae, super temporal and the lobe cortex （ P<0.005 ） . The HAMD scores was not significantly correlated with the KCC in these areas (p>0.05). In depression group, the ReHo of left thalamus was related to sleep factor and weight factor, the values of relation were 0.56 and 0.58 （ P<0.05 ） . The ReHo of left super lateral temporal was related to the factor of bias mood processing, and the value was 0.04 （ P<0.05 ） . And the ReHo of left super wall temporal was related to the factors of anxiety and bias mood processing, the values were all 0.04 （ P<0.05 ） .

Conclusions: The results indicated abnormal activity may exit in a resting state of depression in the left thalamus, uvulae, super temporal and the lobe cortex. The ReHo may be potentially a reference in understanding the distinct brain activity in resting state of depression.

S55-3

矿难所致创伤后应激障碍流行病学及神经影像学研究 - The Epidemiology and Brain Functional and Structural Mechanism in Coal Mining Survivors with PTSD after Two and Ten Months

彩 兰 侯 1 , 凌江 李 1 , 燕 张 1 , 坤 王 2 , 勇 刘 2 , 高浪 龚 2

1 中南大学精神 卫生研究所 , 长沙市 , Chinese Mainland, 2 中科院自 动化研究所模式识别国家重点实验室 , 北京 , Chinese Mainland

目的 ： 调查矿难后创伤后应激障碍的发生率及相关因素 ； 纵向研究重性 PTSD 脑功能和脑结构特点 ， 研究 PTSD 神 经环路发挥重要作用的脑机制。

方法 ： 24 名急性重性 PTSD 患者和 24 名 对照者 ， 接受情绪识数 stroop 、症状激 发任务及症状激发的短期记忆提取任务 3 项脑功能检查 ， 以及三维成像 （ 3D ） 及弥散 张量成像 （ DTI ） 检查。矿难后 10 个月随 访。

结果： （ 1 ） 矿难后创伤后应激障碍急性期发生率为 50% ，低年 龄组发生率明显高于高年龄组；矿难后 10 个月 发生率为 30.6% （ 2 ）情 绪识数 stroop ： 矿难后 2 个月， PTSD 患者相比 对照者，双侧前扣带回、右侧额下回等脑区激活下降；矿难后 10 个月， PTSD 患者相比 对照者，左侧额叶内侧回、右侧额中回、右侧扣带回及左侧海马旁回激活增强； PTSD 患者 矿难后 10 个月与 矿难后 2 个月前后配 对比较，矿难后 10 个月 PTSD 患者双 侧额上回、双侧额中回、右侧扣带回及左侧海马旁回激活增强；矿难后 10 个月，按照症状恢 复程度发现恢复好的患者左侧额叶内侧回、右侧前扣带回、双侧额上回及右侧额下回激活强于恢复差的患者。（ 3 ）症状激 发任务：矿难后 2 个月， PTSD 患者相比 对照者，右侧前扣带回、左侧额下回及双侧额中回等部位激活下降，左侧海马旁回激活增强；矿难后 10 个月， PTSD 患者相比 对照者，右侧颞上回（ BA38 ）激活增 强，右 侧颞上回（ BA22 ）、右 侧岛叶等脑区激活下降； PTSD 患者前后配 对比较，矿难后 10 个月 PTSD 患者右 侧扣带回激 活下降； 矿难后 10 个月，按照症状恢 复程度发现恢复好的患者双侧额上回、双侧额中回、双侧颞横回、左侧颞中回、右侧颞下回等脑区激活强于恢复差的患者。（ 4 ）症状激 发的短时提取任务：矿难后 2 个月， PTSD 患者相比 对照者，右侧额下回、右侧额中回等脑区激活下降；矿难后 10 个月， PTSD 患者相比 对照者，右侧额下回及右侧额中回等脑区激活下降； PTSD 患者 矿难后 10 个月与 矿难后 2 个月 进行配对比较，右侧海马旁回及双侧颞上回激活下降；矿难后 10 个月，按照症状恢 复程度发现恢复好的患者右侧海马旁回激活低于恢复差的患者。（ 5 ） 矿难后 2 个月， 脑形态学显示 PTSD 患者左 侧额中回灰质密度低于对照组；矿难后 10 个月， PTSD 患者双 侧海马旁回及右侧额中回灰质密度低于对照组； PTSD 患者 矿难后 10 个月与 矿难后 2 个月 进行配对比较，右侧海马旁回、左侧扣带回、左侧额下回、左侧额叶内侧回、左侧岛叶等脑区灰质密度增高。（ 6 ） 矿难后 2 个月， DTI 结果显示， PTSD 患者左 侧前扣带回、右侧扣带回、左侧胼胝体下回、右侧额中回及左侧海马旁回等脑区 FA 值高于对照组。

结论： 矿难后创伤后应激障碍发生率高。 PTSD 主要病 变脑区在前额叶及海马部位。 PTSD 患者 执行记忆提取任务时 ，表 现明显的脑激活不足。前额叶功能的恢复可以作为 PTSD 预后或疗效的指标。 PTSD 患者急性期、慢性期皆有 脑结构变化，结果也存在矛盾之处，其意义还需要进一步的明确。

关键词： 矿难， PTSD ， 发生率， fMRI

S55-4

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

Ning Ma 1 , 凌江 李 2 , 立文 谭 2 , 则宣 李 2 , 张燕 张 2 , 妮 舒 3 , 高浪 龚 3 , 春 兰 杨 3

1 Mental Health Institute, Center South University , ChangSha , Chinese Mainland, 2 中南大学精神 卫生研究所 , 长沙市 , Chinese Mainland, 3 中国科学院自 动化研究所 , 北京 , Chinese Mainland

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

方法 ： 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 进行评定。入组后进行 3D 和 DTI 扫描。患者给予文拉法辛治疗并进行半年随访观察，随访结束时复查。

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，但未达正常人水平；患者组治疗前的理解和再认测验分数低于正常，治疗后接近正常人水平；患者和正常人两组的 LES 负性分和总分之间差异显著。 2. 发作期抑郁症患者右侧额内侧回和同侧颞极、双侧壳核 / 苍白球和双侧小脑的灰质密度较正常人低；治疗后右侧额上回、双侧中央 前回、双 侧颞极、双侧壳核 / 苍白球和双侧小脑的灰质密度仍较正常人低。未见患者治疗前后灰质密度差异有显著性的脑区。 3. 发作期抑郁症患者左侧额上回，双侧额中回和双侧前扣带回白质的分数各向异性（ FA ） 值较正常人低；治疗后双侧额上回和额中回，右侧额下回白质 FA 值较治疗前增高，左侧额中回白质 FA 值仍较正常人低，而右侧颞中回和颞上回白质 FA 值高于正常人。

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

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

Methods: Twenty seven first-episode treatment-na?ve young adult with MDD and twenty eight age and gender-matched healthy controls were assessed using 17-item HAMD ， HAMA ， and WMS. MRI scan were obtained ordering to 3D and DTI, and detected again after six months antidepressant (Venlafaxine) treatment.

Results: 1. HAMD and HAMA scores in post-treatment patients were significantly lower than those in pre-treatment (P ＝ 0.000), however still higher than those in healthy controls (P ＝ 0.01). Understanding and recognition tests scores were lower significantly in pre-treatment patients compared with healthy controls (P ＝ 0.001, P ＝ 0.04), and were similar between post-treatment patients and controls (P>0.05). 2. 3D MDD patients showed significantly lower gray matter density than healthy controls in right medial frontal gyrus, right temporal pole, bilateral putamen and globus pallidus, bilateral cerebellum. After treatment, gray matter density in right superior frontal gyrus, bilateral precentral gyrus, temporal pole, putamen and globus pallidus, and cerebellum in patients were still significantly lower than controls. No brain regions were found with significantly different gray matter density between pre- and post-treatment patients. 3. DTI Compared with controls, MDD patients exhibited significant decreased fractional anisotropy (FA) values in left superior frontal gyrus, bilateral middle frontal gyrus and bilateral anterior cingulate. FA values in bilateral superior and middle gyrus, right inferior frontal gyrus increased after treatment. However, FA values in left middle gyrus in post-treatment patients were still lower than controls. Furthermore, FA values in right middle and superior temporal gyrus were significantly higher than controls.

Conclusions: 1. Decreased gray matter density in right medial frontal gyrus, right temporal pole, bilateral putamen and globus pallidus, bilateral cerebellum may be the neuropathological substrate of MDD rather than a result. 2. White matter microstructure abnormalities of prefrontal lobe and anterior cingulate presented early in the course of MDD. And the white matter abnormalities in MDD could be reversed after the symptoms remission.

S56 - 儿童精神障碍 药物治疗现状与进展 - Current Status and Tendency of Psychopharmaceutical Treatment in Children and Adolescent with Mental Disorders

Chairs: Yi Zheng, Chinese Mainland
Lanting Guo, Chinese Mainland

S56-1

非典型抗精神病药治疗儿童少年精神分裂症的对照研究 - A Comprehensive Study of Atypical Antipsychotics in Treatment of Child and Adolescent Schizophrenia

Jing Liu

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

目的 : 探 讨非典型抗精神病药物对儿童少年精神分裂症的疗效与安全性特点。

方法 : 本研究分 为三个部分 ： ① 、前瞻性随机、双盲、 对照研究利培酮和喹硫平疗效和安全性 ， 观察时间为 8 周。将 140 例儿童少年精神分裂症患者随机分 为两组。观察 PANSS 量表、 TESS 量表和 实验室指标变化，并进行血药浓度检测和对比。 ②、病例回 顾性研究维思通和奥氮平对精神分裂症儿童少年糖代谢及脂代谢的影响，共有 47 名（ 26 名 单独使用利培酮， 21 名 单独使用奥氮平入组。对比治疗前、治疗后 4 周及 8 周的血糖、血脂、体重 变化。 ③、前瞻性随 访 42 例儿童青少年精神分裂症使用利陪 酮长效针剂进行 12 周治 疗的患者。观察疗效和不良反应。

结果 : ①、 利培 酮和喹硫平对儿童少年精神分裂症疗效较好，副反应总体较轻微，二者疗效相当 ， 喹硫平副反应比利培酮轻。血药浓度与日剂量、疗效有一定相关性并可为临床诊疗提供参考依据。 ②、短期利培 酮、奥氮平治疗对精神分裂症儿童少年糖代谢、脂代谢均无显著影响。 ③、利培 酮长效针剂治疗儿童青少年精神分裂症安全有效，不良反应少，有利于提高患儿的依从性和生活质量。

结论： 非典型抗精神病 药治疗儿童少年精神分裂症疗效好，副反应少，特别是对代谢的影响不大。但儿童处于生长发育阶段还应注意长期观察和监测体重、血糖、血脂、内分泌等指标变化。

关键词 : 儿童和青少年；非典型抗精神病 药；临床效应；不良反应

Objective: To evaluate the effectiveness, safety of atypical antipsychotics for the treatment of child and adolescent schizophrenia.

Method: The study was divided to three parts: ① ,a prospective, random, double-blind and control study through 8 weeks. 140 child and adolescent patients with schizophrenia were divided into two groups and treated with risperidone and quetiaping respectively. The efficacy was evaluated with the PANSS, the safety was evaluated with the TESS, and the serum concentration of risperidone and quetiapine was determined with HPLC ultraviolet detection assay. ② ,To compare the results of weight, glucose and lipid of 0, 4, 8 weeks in patients with childhood schizophrenia treated only by risperidone or olanzapine. ③ ,42 Child and Adolescent schizophrenia patients were treated by Long-acting risperidone for 12 weeks. PANSS, TESS, CGI-SI, HRQOL, were used to evaluate the efficiency and side effects.

Results: ① ,Risperidone and quetiapine was effective and safe for the child and adolescent schizophrenia patients. Both of the two drugs were therapeutic equivalence and quetiapine showed a better side effect profile. The correlation between the serum concentration and dosage and clinic effect may provide referred data for clinic. ② , Short-term risperidone or olanzapine treatment had no significant effects on metabolism of glucose and lipid in patients with childhood schizophrenia. ③ , Long-acting Risperedone is safe and effective in the treatment of Child and Adolescent schizophrenia.

Conclusion: The results of this study encourage us to believe that many more Child and Adolescent patients will benefit from the advantages of atypical antipsychotics. At the same time, We should monitor the weigh index, BG, blood fat,PRL and so on for a long time.

Key word: atypical antipsychotics; child and adolescent; clinical effect; side effect

S56-2

盐酸托莫西汀和盐酸哌甲酯治疗符合 DSM-IV 标准的注意缺陷多动障碍的门诊儿童患者疗效和安全性的随机双盲对照试验 - A Randomized, Double-Blind Comparison, Safety and Efficacy Trial of Atomoxetine Hydrochloride and Methylphenidate Hydrochloride in Pediatric Outpatients with DSM-IV Attention-Deficit/Hyperactivity Disorder-Report on Chinese Pediatric Outpatients

Yufeng Wang

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

目的 ： 验证经过约 8 周的双盲治 疗后 ， 托莫西汀对注意缺陷多动障碍 （ 简称 ADHD ） 症状的改善不 亚于哌甲酯。

方法 ： 采用多中心、随机、双盲 对照研究 ， 对 6-16 岁之间 ， 符合 DSM-IV 中 ADHD （ 任何 亚型 ） 的诊断标准的中国门诊儿 童患者 ， 给予盐酸托莫西汀胶囊 （ 0.8 mg/kg/day 到 1.8 mg/kg/day 每日一次口服 ） 或 盐酸哌甲酯胶囊 （ 0.2 mg/kg/day 到 0.6 mg/kg/day 每天 2 次口服 ） 。 经 8 周治 疗后，比较两组根据 ADHDRS-IV-Parent: Inv （注意缺陷多 动障碍评定量表 -IV- 父母版：研究者 实施和评分）量表分所获得的有效率；同时比较 Conners 父母 问卷修订版 - 简版（ CPRS-R: S ） 评分和注意缺陷多动障碍严重程度临床总体印象量表（ CGI-ADHD-S ） 评分。

结果： 两 组的有效率无统计差异（ 托莫西汀 组 78.6% ， 哌甲酯组为 80.3% ）。

结论： 托莫西汀在改善 ADHD 上与 哌甲酯疗效相当。

Objectives: To test the hypothesis that atomoxetine is noninferior to methylphenidate in improving Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms.

Methods: A multicountry, multicenter, randomized, double-blind study, subjects 6 to 16 years of age at Visit 1 who met DSM-IV diagnostic criteria for ADHD (any subtype), received double-blind treatment either with atomoxetine (0.8 mg/kg/day to 1.8 mg/kg/day, given once daily as oral capsules ) or methylphenidate(0.2 mg/kg/day up to 0.6 mg/kg/day, given twice daily as oral capsules) for an acute treatment period of approximately 8 weeks, followed by a discontinuation phase of approximately 1 week Assessment was based on a comparison of response rates derived from the Attention-Deficit/Hyperactivity Disorder Rating Scale-IV-Parent Version: Investigator-Administered and Scored (ADHDRS-IV-Parent:Inv) scale. Secondary efficacy variables included ADHDRS-IV-Parent:Inv Total and subscale scores; subscores of the the Conners' Parent Rating Scale-Revised: Short Form (CPRS-R:S) and the Clinical Global Impressions-Attention-Deficit/Hyperactivity Disorder-Severity (CGI-ADHD-S) scale.

Results: Results of the primary efficacy analysis indicated that 78.6% of atomoxetine-treated subjects in China responded to treatment, compared with 80.3% of those on methylphenidate. Secondary efficacy analyses demonstrated that both atomoxetine and methylphenidate were associated with clinically meaningful and statistically significant improvements in ADHD symptoms, including attention and hyperactivity/impulsivity. Scores for both treatment groups were comparable throughout the acute treatment period.

Conclusion: Atomoxetine provides similar efficacy to methylphenidate in the improvement of ADHD symptoms.

S56-3

专注达与利他林治疗注意缺陷多动障碍临床疗效的比较 - Comparison of Clinical Effects of Concerta and Ritalin for ADHD

Yasong Du

Shanghai Mental Health Center , Shanghai , Chinese Mainland

目的 ： 比 较专注达与利他林治疗儿童 ADHD 的 疗效和安全性。

方法 ： 上海心理咨 询中心儿少部就诊 ADHD 患儿 ， 按照患者意愿分 别使用专注达与利他林治疗 ， 随访 2 周、 4 周 观察疗效 （ Conners 量表和 DSM-IV 诊断标准 ） 和安全性 （ 血压、心律、主观不适等 ） 。

结果 ： 治 疗两周后 ， 专注达组 Conners 量表学 习问题、多动指数两个指标与治疗前有显著改善 (P<0.01) ， 治 疗四周后 ， 两组在品行因子、学习问题因子、冲动 - 多 动因子和多动指数上都显著好转 (P<0.05) ； 治 疗四周后 ， 两种药物均在注意缺陷分量表的得分显著好转 (P<0.05) ， 服用 专注达和利他林组不良反应发生率没有显著差异 (P ＞ 0.05) 。

结论 ： 专注达疗效确切 ， 使用安全。

关键词 ： 注意缺陷多 动障碍 ； 专注达 ； 疗效

Objective: To compare the curative effect and safety of Concerta and Ritalin .

Subjects and method: Children suffered from attention deficit and hyperactivity disorder (ADHD) came to Shanghai mental counseling center for help. According to their agreement, Concerta and Ritalin were prescribed. Curative effect （ Conners rating scale and DSM-IV diagnostic criteria for ADHD ） and safety （ blood pressure, heart rate and adverse events ） were followed up in the next 2 and 4 weeks after given the medicine.

Results: After 2 weeks' treatment, the scores of study problem and hyperactivity index in Conners rating scale were significantly improved in the group of Concerta (P<0.01). After 4 weeks' treatment, the scores of conduct and study problem, compulsive-hyperactivity and hyperactivity index were significantly improved in two groups(P<0.05). The score of attention deficit was significantly improved in two group (P<0.05) after 4 weeks' treatment. There were no difference between two groups in the incidence of adverse events (P ＞ 0.05).

Conclusion: Concerta was effective and safe to treat children with ADHD.

Key words: ADHD ， Concerta ， curative effect

S56-4

西酞普兰治疗儿童青少年抑郁症临床观察 - Citalopram in Treatment of Major Depression in Child and Adolescent

Linyan Su

2nd Affiliated Hospital of Middle South University , Changsha , Chinese Mainland