86例精神专科医院护士的症状自评量表调查

目的 了解精神科护士心理压力状况,分析原因,探索对策.方法 采用症状自评量表(SCL-90)对86名精神科护士和100名综合科护士进行调查.结果 精神科护士中躯体化(1.51±0.59)、人际关系(1.74±0.31)、抑郁(1.59±0.65)因子分高于综合科护士(依次为1.37±0.48、1.65±0.51、1.50±0.59,t值依次为2.04、2.07、2.08, P<0.05);躯体化、恐怖、人际关系等因子分较中国常模评分高.精神科中专学历组护士躯体化、恐怖、人际关系因子分评分较大专组和本科组高,年龄40岁以上组躯体化、焦虑、偏执等因子分评分较19～29岁组和30～39岁组评分高,差异均有统计学意义(P<0.05).结论 精神科护士心理压力较综合科护士和一般人群大,年龄越大,心理压力越大,高文化程度者心理压力小于文化程度低者,应根据不同的群体采用不同的对策.     

高原运输军人心理健康现况调查

目的调查驻守高原地区执行运输任务军人的心理健康状况,为提高其心理健康水平提供参考。方法采用简单随机抽样方法,选取驻守高原地区某汽车团的156名军人为研究对象,应用症状自评量表(SCL-90)进行调查。结果高原运输军人躯体化、焦虑、恐怖和精神病性因子评分均高于军人常模,抑郁因子评分低于军人常模,差异均有统计学意义(P均0.01)。躯体化、强迫、抑郁、焦虑、恐怖和精神病性因子评分均高于中国成人常模,差异均有统计学意义(P均0.01)。不同受教育程度的军人SCL-90躯体化、强迫、焦虑、精神病性四个因子评分及总评分比较差异均有统计学意义(P0.05或0.01)。结论高原运输军人心理健康状况总体水平与常模相似,但躯体化、焦虑、恐怖、精神病性症状更明显,受教育程度可能是其影响因素。     

突发灾难事件后维和官兵的心理健康状况

目的 了解突发灾难事件后,维和官兵的心理健康状况.方法 应用症状自评量表(SCL-90)和维和官兵心理健康影响因素调查表,对经历突发灾难事件的维和官兵进行自评.其SCL-90结果与中国军人常模进行比较,维和官兵划分战斗组和非战斗组,两组的SCL-90结果进行对照分析.结果 维和官兵的SCL-90的躯体化、抑郁、焦虑、恐怖和精神病性因子分高于军人常模(P＜0.05);战斗组的SCL-90躯体化、焦虑、恐怖因子分高于非战斗组(P＜0.05),“战友震亡”和“地震”对维和官兵的心理健康影响分别占到94.3％和78.7％.结论 突发灾难事件后维和官兵的心理健康较差,其中战斗队员承受的心理压力更大;“战友震亡”和“地震”是影响维和官兵心理健康最为广泛的两个因素.     

277名护士的心理状况调查

目的 了解临床护理人员的心理状况.方法 对三级乙等综合性医院的277名临床护士选用症状自评量表(SCL-90)和成人版艾森克人格问卷(EPQ)进行调查分析.结果 (1)SCL-90总均分与常模相比较差异无统计学意义(P＞0.05),但忧郁、恐怖两项均分明显高于常模,差异有统计学意义(P＜0.01);偏执的均分低于常模,有显著差异(P＜0.05).(2)15.6%的护士存在中度以上水平的心理问题,表现为忧郁、人际敏感、恐怖、焦虑.(3)EPQ量表各维度分值与常模比较,神经质维度上的得分明显低于常模,内外向和掩饰性两个维度上的得分明显高于常模,差异有统计学意义(P＜0.01).精神质维度上的得分略高于常模,差异无统计学意义(P＞0.05).结论 护士的心理状况与一般人基本相近,部分人员存在一些心理问题,医院领导应引起高度重视.     

未成年犯心理健康状况与犯罪人格特征的相关研究

目的分析未成年犯犯罪人格特征对心理健康的影响。方法金坛市60名未成年犯为研究组,随机抽取89名中学生为对照组。采用SCL-90、中国罪犯心理评估个性分测验(COPA-PI)进行测定。结果未成年犯SCL-90总分、阳性及阴性项目数、躯体化等因子分,与对照组有差异(P0.05-0.001);不同文化程度的未成年犯SCL-90总分及躯体化等因子分有差异(P0.05-0.01);未成年犯COPA-PI戒备因子分低于全国常模(P0.05);不同文化程度未成年犯焦虑因子评分有差异(P0.05);未成年犯COPA-PI的同情等10个因子与SCL-90总分、多项因子分有相关性(P0.05-0.01);COPA-PI的变态心理、外倾、焦虑因子可预测SCL-90的人际敏感、恐怖、抑郁。结论未成年人犯的犯罪个性特征影响其心理健康。     

抗震救灾对救援官兵心理健康的影响及其干预性研究

目的探讨抗震救灾对官兵心理健康的影响及心理干预的效果。方法采用90项症状清单自评量表（SCL-90）对参加抗震救灾的258名官兵进行心理测试,采取针对性心理干预措施,干预后2周复测SCL-90。结果干预前有心理障碍者为35人（13．6％）,干预后为12人（4．7％）,二者差异有统计学意义（χ2=12．383,P〈0．01）;干预前救援官兵SCL-90大部分因子分、总分及阳性项目数显著高于军人常模（P〈0．01～0．05）;干预后除敌对外的各因子分均较干预前显著下降（P〈0．01～0．05）;干预后除忧郁、恐怖因子分略高于常模外,其他因子分均比常模低,且在躯体化、人际敏感、焦虑、偏执、精神病性和阳性项目数上具有显著性差异（P〈0．01-0．05）。影响救援官兵心理健康的主要因素是年龄,其次是职务、民族、文化程度等（均P〈0．01）。结论参加抗震救灾造成救援官兵心理健康不同程度损害,经针对性心理干预后心理健康状况明显好转。     

104名戒毒科护士SCL-90测评结果分析

目的了解戒毒科护士的心理健康状况,并提出相应对策,以提高护理质量。方法采用SCL-90对戒毒科护士进行问卷调查。结果被调查者的SCL-90阳性项目数及躯体化、强迫、焦虑、抑郁及敌对因子分均显著高于国内常模（P〈0．01）。结论戒毒科护士的心理压力明显高于正常人群,应加强对其心理干预。     

新疆维吾尔自治区阿拉尔市金银川街道社区汉族居民心理状况及影响因素调查

目的了解新疆阿克苏地区阿拉尔市金银川街道社区汉族居民心理状况及其影响因素。方法于2013年9月28日-10月10采取整群分层抽样方法抽取新疆阿拉尔市金银川街道社区1000名汉族居民为调查对象,采用症状自评量表(SCL-90)和一般情况调查表进行问卷调查。结果阿拉尔市金银川街道汉族居民SCL-90的躯体化、强迫、人际敏感、抑郁、焦虑、敌对、偏执、精神病因子评分低于全国常模,差异有统计学意义(P0.001);恐怖因子得分与全国常模比较差异无统计学意义(P0.05);女性的强迫、抑郁、敌对等因子得分均高于男性,差异有统计学意义(P0.05)。结论新疆维吾尔自治区阿拉尔市金银川街道社区汉族居民心理健康状况良好;但女性较男性更易发生强迫、抑郁等心理问题。     

幼儿教师心理健康与应对方式调查

目的 了解幼儿教师的应对方式和心理健康状况.方法 以四川集市523例幼儿教师为研究对象,用应对方式同卷(CSQ)和症状自评量表(SCL-90)、非结构式访谈法进行调查.结果 城市幼儿教师、中高职称幼儿教师多采用成熟的应对方式,农村幼儿教师、初级职称幼儿教师多采用不成熟的应对方式.幼儿教师SCL-90得分与全国常模比较,除躯体化、焦虑、恐怖、精神病性四因子得分差异有统计学意义外(P＜0.05),其余各因子得分差异无统计学意义(P＞0.05).城乡幼儿教师在强迫、人际关系敏感、抑郁、焦虑四因子得分差异有统计学意义(P＜0.01);职称比较,除躯体化、强迫、抑郁得分差异有统计学意义外,其余各因子得分差异无统计学意义(P＞0.05).结论 幼儿教师存在一定的心理健康问题,其应对方式有职称、城乡、幼儿园类别差异.     

脑震荡患者心理状况评定(附186例报告)

目的 探讨脑震荡患者的心理状况特征.方法 对186例脑震荡患者进行90项症状自评量表(SCL-90)评定,并与常模(正常人阳件症状均分)比较.结果 腩震荡患者SCL-90总分(137.71±39.48),总均分(1.53±0.44),阳性项目数(32.90±19.41),躯体化症状因子分(1.57±0.52)、强迫症状因子分(1.79±0.50)、焦虑症状因子分(1.50±0.49)、敌对症状因子分(1.63±0.57)、恐惧症状因子分(1.57±0.51)、偏执症状因子分(1.62±0.51)、精神病性因子分(1.49±0.43)明显高于常模(129.96±38.76、1.44±0.43、24.92±18.41、1.37±0.48、1.62±0.58、1.39±0.43、1.48±0.56、1.23±0.41、1.43±0.57、1.29±0.42),差异有统计学意义(P<0.05);人际关系敏感因子分(1.67±0.54)也高于常模(1.65±0.51),但差异无统计学意义(P>0.05).结论 脑震荡可导致患者心理障碍的产生,应早期就对患者进行心理治疗.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Diagnostic Difficulties and Treatment Implications

Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.     

Cognitive Dysfunction Associated with Antiepileptic Drug Therapy

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Carbamazepine Efficacy in Adults With Partial and Generalized Tonic-Clonic Seizures

Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.     

Etiologic and Preventive Aspects of Epilepsy in the Child–Bridging the Gap Between Laboratory and Clinic

Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Predisposing and Causative Factors in Childhood Epilepsy

Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non-febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.