产妇产后初期抑郁状况、影响因素及干预措施

目的分析产妇产后初期(产后第7天)抑郁状况,探讨相关影响因素及干预措施。方法选取2016年7月-2017年12月在泸县妇幼保健院分娩的85例产妇为研究对象,于产后第7天采用爱丁堡产后抑郁量表(EPDS)评定产妇抑郁状况,对EPDS筛查阳性者进行产后抑郁影响因素问卷调查,并予以相应的心理干预,比较其干预前后EPDS评分。结果 EPDS评分9分者共46例(54.12%),其中存在产后抑郁倾向者25例(29.41%)、产后抑郁者21例(24.71%)。EPDS阳性者产后初期出现抑郁症状的因素主要有:孕期知识掌握不足(47.83%)、家庭/社会支持不足(47.83%)、无法适应产后角色或(和)自身改变(43.48%)。阳性者干预前后EPDS评分比较差异有统计学意义[(16.26±5.34)分vs.(12.24±4.15)分,t=12.528,P=0.021]。结论产妇产后初期抑郁发生率较高,其影响因素较多,尽早采取心理干预措施可能有助于改善产妇的抑郁情绪。     

产后抑郁症与社会心理因素

目的：经前不适、社会支持和心理应激对产后抑郁症发生的影响。方法：对88例产妇评定Edinburgh产后抑郁量表（EPDS）、社会支持评定量表（SSRS）、艾森克人格问卷（EPQ）。结果：产后抑郁症发生率为17％；产后抑郁症的既往经前不适率比正常对照组的明显为高；EPDS总分与SSRS的客观支持呈显著负相关性；产后抑郁症的住房拥挤率比正常对照组明显为低。结论：有经前不适史的产妇易感产后抑郁症；产后抑郁症病人感到客观支持减少是抑郁的结果；产妇在小家庭受到的照顾不如大家庭周到。     

成年男性服刑人员神经质人格、人际关系敏感与社会支持的关系

目的了解成年男性服刑人员的神经质人格、人际关系敏感和社会支持的现状以及三者之间的关系,为对其进行有针对性的心理健康教育提供参考。方法于2017年5月-10月随机抽取山东省某市周边两所监狱中的244名成年男性服刑人员,采用症状自评量表(SCL-90)、艾森克人格问卷(EPQ)和社会支持评定量表(SSRS)调查其人际关系敏感状况、神经质人格特征和社会支持情况。结果①男性服刑人员EPQ神经质维度评分、SCL-90人际关系敏感评分、SSRS评分与全国常模比较,差异均有统计学意义(t=-7.86～16.54,P均0.01)。②依次检验回归系数显示,成年男性服刑人员的人际关系敏感对社会支持的影响通过神经质人格实现[加入中介变量前(β=-0.164,P=0.034);加入后,(β=-0.237,P=0.133)]。结论成年男性服刑人员的神经质人格较为典型,人际关系较为敏感;神经质人格在社会支持和人际关系敏感中起中介作用。     

母亲产后抑郁对喂养方式及子代体重增加量影响的队列研究

目的比较产后抑郁母亲与正常对照组对子代喂养方式的差异,明确产后抑郁是否对子代的体重增加有所影响。方法分别在西南医科大学附属医院、泸州市中医院、泸州市江阳区妇幼保健院和泸州市妇女儿童医院对住院待产的产妇进行筛查,对符合入组标准的48例产妇在产后第4、8、12周,使用爱丁堡产后抑郁量表(EPDS)和婴幼儿喂养方式及体重增加量调查表进行评定,将在首次评定时EPDS评分≥13分的被试归入产后抑郁组(n=14),将EPDS评分13分者归入对照组(n=34),比较两组人口学资料、EPDS评分、喂养方式及其婴儿体重增加量等方面的差异。结果产后第12周,产后抑郁组婴儿体重增加量高于对照组(Z=-2.612,P=0.009)。各随访时间点,产后抑郁组平均每日非母乳喂养的比例均高于对照组(Z_(4周)=-2.652,Z_(8周)=-3.591,Z_(12周)=-2.822,P均0.05)。产后抑郁组平均每日非母乳喂养的次数(Z_(4周)=-2.403,Z_(8周)=-3.666,Z_(12周)=-2.834,P均0.05)和非母乳喂养量(Z_(4周)=-2.289,Z_(8周)=-3.347,Z_(12周)=-2.609)均高于对照组。产后抑郁组当月用于婴儿食品等消耗品的支出均高于对照组(Z_(4周)=-3.404,Z_(8周)=-4.130,Z_(12周)=-3.859,P均0.05)。结论截止产后第12周,产后抑郁母亲的子代较少接受母乳喂养,但喂养方式的差异并未影响子代体重的增加。     

综合护理干预对产后抑郁产妇的影响及抑郁与焦虑量表评价效果分析

目的探究与分析综合护理干预对产后抑郁产妇的影响。方法选取我院自2012-05—2015-05収治的120例产后抑郁产妇,采取随机数字表法分为基础护理组与综合护理干预组,每组各60例,对比2组产妇抑郁及焦虑量表评分及子宫复旧情况。结果常规护理干预组护理后抑郁自评量表及焦虑自评量表评分较护理前相比均明显降低(t=2.90,P0.05;t=2.88,P0.05)。综合护理干预组护理后抑郁自评量表及焦虑自评量表评分较护理前相比均明显降低(t=3.45,P0.05;t=3.67,P0.05)。综合护理干预组护理后抑郁自评量表及焦虑自评量表评分较常规护理组护理后相比降低更加显著(t=4.23,P0.05;t=3.93,P0.05)。综合护理干预组产后2周、产后3周三径之和较常规护理组相比均明显减少(t=2.34,P0.05;t=3.21,P0.05;t=3.45,P0.05)。综合护理干预组3周内子宫复旧至正常的比例明显高于常规护理组(2χ=4.93,P0.05)。结论对产后抑郁产妇给予综合护理干预可显著改善焦虑及抑郁情绪,促进子宫复旧,值得推广与应用。     

产后抑郁症患者HPA轴激素、甲状腺功能及性激素的水平分析

目的探讨产后抑郁患者下丘脑-垂体-肾上腺(HPA)轴激素、甲状腺功能及性激素的水平及其意义。方法选取产后6～7周经我院精神科门诊检测评估为产后抑郁的产妇100例作为抑郁组、100例同期产后未发生抑郁的产妇作为对照组;检测对比两组的HPA激素、甲状腺激素、性激素水平;并分析抑郁组患者各项激素水平与爱丁堡产后抑郁量表(EPDS)评分的关系。结果抑郁组患者的CHR、ACTH水平高于对照组(P0.05),抑郁组患者的CORT水平低于对照组(P0.05);抑郁组患者的TSH水平低于对照组(P0.05),抑郁组患者的TG-Ab、TPO-Ab、FT3、FT4水平与对照组比较,无统计学意义的差异(P0.05);抑郁组患者的E2水平低于对照组(P0.05),抑郁组患者的PRL、P值高于对照组(P0.05);抑郁组患者的E2、TSH、CORT水平与EPDS评分负相关(P0.05),抑郁组患者的PRL、CHR、ACTH测定值与EPDS评分正相关(P0.05)。结论产后抑郁患者自身激素水平异于正常产妇,调节产后激素水平可能有利于改善产后抑郁。     

产后抑郁的影响因素调查及个体心理干预效果

目的探讨产后抑郁的影响因素及个体心理干预效果,为产后抑郁的防治提供参考。方法选择2016年2月-2018年2月在泸县妇幼保健院妇产科分娩、爱丁堡产后抑郁量表(EPDS)评分≥9分且符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)产后抑郁症诊断标准的产妇62例,采用自制影响因素调查问卷进行调查,分析产妇发生抑郁症状的主要影响因素。采用随机数字表法将62例产妇分为对照组和观察组各31例,对照组给予常规心理疏导,观察组给予个体化心理干预,均干预7天。干预前和干预后,采用EPDS和汉密尔顿抑郁量表17项版(HAMD-17)评定产妇抑郁症状。结果 62例产妇产后抑郁的影响因素中,受分娩疼痛、激素变化影响出现情感脆弱(30.65%)的比例最高,其次为难以做好母亲角色转变(24.19%)和难以适应分娩后自身变化(17.74%)。干预后,观察组EPDS和HAMD-17评分均低于对照组,差异均有统计学意义[(13.26±4.36)分vs.(17.63±3.56)分,(14.02±6.13)分vs.(25.32±5.54)分,t=14.272、12.526,P均0.05]。结论产后抑郁的心理因素较多,个体化心理干预对产后抑郁的改善效果优于常规心理疏导。     

重复经颅磁刺激与抗抑郁药物联合治疗对产后抑郁患者认知功能及哺乳的影响

目的分析单用重复经颅磁刺激、抗抑郁药物及其联合治疗产后抑郁的临床效果。方法将120例产后抑郁患者随机分为A(氟西汀治疗)、B(重复经颅磁刺激治疗)、C组(氟西汀+重复经颅磁刺激治疗)各40例,比较三组治疗效果及认知功能改善情况,分析不同疗法对患者产后泌乳的影响。结果 (1)治疗10周,B、C组分类数高于A组(t=13.514、37.104,P均0.05),RE低于A组(t=4.593、6.115,P均0.05),C组PE、RE均低于B组(t=2.252、7.140,P均0.05),其分类数高于B组(t=32.109,P0.05);(2)治疗10周,B、C组汉密尔顿抑郁量表评分(HAMD)、爱丁堡产后抑郁量表(EPDS)量表评分降低幅度高于A组(t=4.775、9.984、4.604、9.549,P均0.05),C组降低幅度又高于B组(t=4.715、4.686,P均0.05);(3)治疗10周,B、C组睡眠质量各维度评分降低幅度高于A组(t=24.464、35.332、14.039、30.454、18.617、51.600、19.000、44.308,P均0.05),C组降低幅度高于B组(t=12.181、18.895、43.544、26.167,P均0.05);(4)C组泌乳量少所占比例低于A组(χ~2=5.591,P0.05),泌乳量多所占比例高于A组(χ~2=3.887,P0.05)。结论采用重复经颅磁刺激联合抗抑郁药物治疗产后抑郁症患者,可明显改善患者认知功能、睡眠质量及抑郁症状,且对产后泌乳影响小。     

人际心理治疗及认知行为治疗对产后抑郁障碍的疗效和社会支持的影响

目的:探讨人际心理治疗(IPT)及认知行为治疗(CBT)对产后抑郁障碍(PPD)的疗效及社会支持的影响。方法:60例PPD患者随机分为IPT组和CBT组,并分别接受相应的治疗,为期12周。治疗前后分别进行爱丁堡产后抑郁量表(EPDS)及社会支持量表评定。结果:治疗后两组EPDS评分明显低于治疗前(P均0.01),且两组间差异无统计学意义(P0.05)。治疗前两组间社会支持量表评分总分比较差异无统计学意义(P0.05);治疗后两组社会支持量表总分及分量表评分均较治疗前显著增加(P均0.01),且IPT组社会支持量表总分及各分量表评分均显著高于CBT组(P均0.05)。结论:IPT及CBT治疗PPD的疗效相当,但IPT可更好地改善PPD患者的社会支持。     

社会心理支持系统对产后抑郁的影响

目的：探讨孕妇学校学习、导乐分娩、分娩镇痛及产后访视联合应用的社会心理支持系统对产后抑郁的影响。方法选择从2013年1月-2014年1月建卡,孕期坚持在我院正规产检、分娩并进行产后访视,无产科合并症及并发症的初产妇共200例,采用焦虑自评量表(SAS)、抑郁自评量表(SDS)、爱丁堡孕产期抑郁量表(EPDS)及社会支持量表(SSRS)分别对是否接受社会心理支持系统进行孕期及分娩期生理及心理指导的两组孕妇进行调查。结果接受社会支持系统的初产妇(观察组)在第一产程及产后42天的SAS、SDS评分低于未接受社会支持系统的初产妇(对照组)(P<0.05),产后42天观察组EPDS评分低于对照组、SSRS及婚姻满意度评分高于对照组(P<0.05)。结论孕妇学校学习、导乐分娩、分娩镇痛及产后访视的社会心理支持系统可缓解孕期、分娩及产后焦虑,降低产后抑郁的检出率。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of legislation of 1935 of interest to the department of Mental Hygiene

Psychiatric Quarterly -