童年创伤、早期适应不良图式与述情障碍关系的研究进展

述情障碍是指个体在情感体验、情感识别和情感表达中存在困难和不足，是精神疾病的影响因素之一。童年创伤、早期适应不良图式等社会心理因素与述情障碍的发生密切相关。本文对童年创伤、早期适应不良图式与述情障碍的关系进行综述，以深入探究相关心理因素在述情障碍中的作用机制，为后续的心理治疗和干预提供新的方向。     

述情障碍的神经影像学研究进展

述情障碍是一种表达和识别情绪困难的人格特征，这种人格特征与多种精神障碍关系密 切，影响精神障碍治疗的疗效，增长患者治疗的疗程并增加自杀风险。目前，述情障碍的发生机制并不 明确，病因不明和诊断缺乏客观指标是临床诊治亟需解决的问题。正电子发射计算机断层显像、磁共 振成像等影像学技术是研究述情障碍的重要客观手段。本文综述了述情障碍与大脑半球、边缘系统及 其他脑区的神经影像学进展，旨在为述情障碍的评估干预提供参考。     

述情障碍国内研究进展

重点回顾国内述情障碍的研究进展,多伦多述情障碍量表（TAS）在不同人群中的应用及相关研究.对目前国内述情障碍研究现状进行综述并提出今后研究方向.     

恶劣心境障碍危险因素研究进展

恶劣心境障碍是一种常见的、但易被临床忽视的情感障碍,其与重性抑郁障碍的关系更是众说纷纭.目前对恶劣心境障碍的研究较少,临床上对其概念和分类缺乏统一的认识,因此探讨恶劣心境障碍可能的病因机制具有重要意义.现将国内外为对恶劣心境障碍临床特征及生物心理社会危险因素如述情障碍、生活事件、免疫因子等相关研究作一综述.     

述情障碍的神经机制

述情障碍又称“情绪表达不能”，临床表现为识别和描述自己情绪的困难、幻想减少、移情能力不完善、躯体化倾向和目标行为中的实用性思维等。另外，还常伴有抑郁、焦虑和愤怒等消极情绪，以及不能应对紧张情境、人际关系淡漠和社会适应力差等表现。目前理论上普通倾向于认为可能是情绪加工与调节的功能紊乱导致了述情障碍。本文主要关注述情障碍产生的神经机制，并对现有研究做一综述。     

精神分裂症共情障碍的神经机制研究进展

正共情是社会认知的重要组成部分,在人际交往中非常重要。既往研究提示精神分裂症患者存在严重的共情障碍,这种障碍直接导致其社会功能的严重受损~([1-2])。目前,精神分裂症共情障碍的神经机制还未完全明确,故揭示其神经机制有助于为共情障碍干预提供理论依据。本文将从神经电生理学、神经影像学以及遗传学研究3个方面来对精神分裂症共情障碍的神经机制进行简要综述。     

述情障碍与抑郁关系的研究进展

述情障碍以不能识别情感、描述情感、不能与他人交流情感、缺乏幻想和外向性思维为特点。有的学认为述情障碍是一种稳定的人格特质，是抑郁症的易感因素，也有的学认为述情障碍是抑郁症的一种状态反应。本旨在对有关述情障碍与抑郁之间关系的研究献进行综述。     

多伦多述情障碍量表对大学生和医务人员的评定

“述情障碍”对精神科临床和心身疾病有一定现实意义,在正常的人群中有一定的比例。本文以多伦多述情障碍量表对302例大学生117例医务人员进行评定,被试均系健康人。结果平均总分为男性64.65±7.50.女性66.94±8.34。本文所得某些数字可作为文化较高者的常模。     

述情障碍的执行功能研究

目的 通过对述情障碍者的额叶执行功能研究,探讨述情障碍可能的神经机制.方法 纳入正常人群述情障碍者33例和对照组30名,采用Stroop色词测验,数字广度和数字符号测验比较2组的执行功能.结果 述情障碍组在Stroop色词测验中C项的反应时低于对照组[(19.93±0.95)s vs s(24.49±1.27)s, t=2.83, P＜0.01],干扰抑制效应明显长于对照组[(9.55±0.86)s vs (5.59±0.61)s, t=3.75, P＜0.001].述情障碍组与对照组间数字广度(顺/反)记忆数和数字符号测验得分的差异也有统计学意义(P＜0.05).结论 述情障碍存在额叶执行功能障碍,额叶损害可能是述情障碍的神经机制之一.     

小组心理护理对躯体形式障碍患者述情障碍的影响

目的:研究小组心理护理对躯体形式障碍患者述情障碍的疗效. 方法:将符合入组标准的躯体形式障碍患者63例随机分为试验组32例和对照组31例,分别对两组患者进行常规药物治疗和护理,且对试验组进行小组心理护理.对完成研究的试验组30例患者和对照组30例患者进行多伦多述情障碍量表(TAS)和临床疗效总评量表(CGI)的测试. 结果:①重复测量的方差分析发现干预因素对TAS因子Ⅰ、因子Ⅱ和因子Ⅳ存在主效应(F=4.291 ～5.844,P＜0.05);时间因素对TAS因子Ⅰ、因子Ⅱ、因子Ⅲ和因子Ⅳ均存在主效应(F=31.283～99.974,P＜0.01);干预因素和时间因素对TAS因子Ⅰ、因子Ⅱ和因子Ⅳ存在交互作用(F =7.815～12.541,P＜0.01).②逐步回归分析显示干预前TAS各因子分数和小组心理护理对TAS因子Ⅰ、因子Ⅱ、因子Ⅳ减少值具有显著的预测作用(Beta值=4.572～13.199,P＜0.01).③试验组疗效(76.7％)优于对照组(50％);多因素Logistic回归分析显示,对躯体形式障碍患者临床疗效影响从大到小的因素分别是:小组心理护理、TAS因子Ⅰ、TAS因子Ⅱ和TAS因子Ⅳ(OR =9.721～1.237). 结论:小组心理护理能够改善躯体形式障碍患者的述情障碍和临床疗效.     

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.     

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.     

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.     

Anticonvulsant Drugs and Cognitive Function: A Review of the Literature

Summary: Alterations of cognitive function are separate from disturbances of behavior seen in association with epilepsy. The nature of the cognitive disability may to a certain extent depend on the seizure type. Partial seizures, mainly derived from a temporal lobe focus, impair memory tasks, while generalized seizures seem to have more effect on attentional abilities. A number of studies, reviewed in this paper, suggest that anticonvulsant drugs further impair cognitive function. Maximal impairments are seen in patients receiving polytherapy: rationalization of polytherapy improves cognitive abilities. Studies in children and adults have allowed differentiation of the effects of various commonly used antiepileptic agents. Maximal cognitive deficits are seen with. phenytoin, while phenobarbital and sodium valproate induce moderate disturbances, and carbamazepine seems relatively free from such toxicity. Further research is needed on the interrelationship between types of seizure disorders, types of anticonvulsant medications, and cognitive function.     

Effects of NMD A- and AMPA-Receptor Antagonists on Different Forms of Epileptiform Activity in Rat Temporal Cortex Slices

Summary: Lowering extracellular magnesium induces different patterns of epileptiform activity in rat hippocampus and entorhinal cortex. Short recurrent epileptiform discharges in the hippocampus are stable over time, whereas seizurelike events (SLEs) in the entorhinal cortex, the subiculum, and the neighboring neocortex develop into late recurrent discharges which are not blocked by clinically employed antiepileptic drugs. We tested the sensitivity of the different epileptiform discharge patterns to. /V-methyl-D-aspartate (NMDA)- and non-NMDA-receptor antagonists. As NMDA-receptor antagonist we used dextrorphan, ket-amine, and 2-aminophosphonovalerate (2APV); as α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA)-receptor antagonist we employed the quinoxaline derivative glutamate 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX). The findings show that the different patterns of epileptiform activity, including the late recurrent discharges, are sensitive to all NMDA-receptor antagonists. However, when dextrorphan was employed to suppress seizure-like events, later recurrent discharges did not develop during the remaining time course of the experiment. CNQX reversibly suppressed recurrent discharges in the hippocampus and SLEs in the entorhinal cortex. However, late recurrent discharges become insensitive to CNQX, even at a high concentration of 60 μM m. This finding suggests a prominent role for NMDA receptors in the generation of late recurrent discharges.     

Treatment Considerations in Anticonvulsant Monotherapy

Summary: The long-standing practice of polypharmacy in treating epilepsy is giving way to use of monotherapy. Monotherapy can improve seizure control as well as reduce the risk of serious idiosyncratic reactions, dose-related side effects, and complex drug interactions. Monotherapy also offers improved compliance and cost-effectiveness. The basis of monotherapy is accurate diagnosis and assessment of the patient's seizure type(s), followed by selection of a single appropriate anticonvulsant drug. Many patients currently treated with multiple anticonvulsants can be successfully converted to monotherapy with a carefully monitored program in which troublesome and redundant drugs are gradually withdrawn from the therapeutic regimen.     

The influence of comorbid depression on seizure severity

PURPOSE: To determine the relation between depressive symptoms and seizure severity among people with epilepsy. METHODS: A postal questionnaire was used to survey a nationwide community sample about seizures and depression. The Seizure Severity Questionnaire (SSQ) assessed the severity and bothersomeness of seizure components. The Centers for Epidemiological Studies-Depression scale categorized levels of depression. RESULTS: Respondents categorized as having current severe (SEV, n = 166), mild-moderate (MOD, n = 74), or no depression (NO, n = 443) differed significantly in SSQ scores (all p < 0.0001). People with SEV or MOD reported significantly worse problems than did those with NO depression for overall seizure recovery (mean, 5.3, 4.9, 4.5, respectively); overall severity (5.0, 4.5, 4.2); and overall seizure bother (5.3, 4.8, 4.4) (all p < 0.005). Cognitive, emotional, and physical aspects of seizure recovery also were rated worse among people with SEV than with NO depression (all p < 0.05). Symptoms of depression were significantly correlated with higher levels of all components of generalized tonic-clonic seizure severity (r = 0.33-0.48; all p < 0.0001), and partial seizures (r = 0.31-0.38; all p < 0.01). CONCLUSIONS: Clinically depressed people with epilepsy reported higher levels of perceived severity and bother from seizures, as well as greater problems with overall seizure recovery than did nondepressed people experiencing similar types of seizures. The pervasive influence of depressive symptoms on reports of seizure activity suggests that people with epilepsy should be screened for depression. These data highlight the importance of detecting and treating depression among people with epilepsy.     

Dextromethorphan: Cellular Effects Reducing Neuronal Hyperactivity

Summary: Dextromethorphan is a dextrorotary morphinan without affinity for opioid receptors, commonly used as an antitussive medication. During the past 5 years, interest in the compound and its demethylated derivative, dextrorphan, has been revived because additional neuroprotective and an-tiepileptic properties were found in in vitro studies, animal experiments, and a few clinical cases. Both morphinans are able to inhibit N -methyl-D-aspartate (NMDA) receptor channels and voltage-operated calcium and sodium channels with different potencies. The inhibition of the NMDA receptor is believed to be the predominant mechanism of action responsible for the anticonvulsant and neuroprotective properties of the compounds.