儿童青少年精神障碍患者睡眠不足及相关因素

目的 探讨儿童青少年精神障碍患者睡眠不足的现况及相关影响因素。方法 选取2021年2月-6月就诊于阜阳市第三人民医院且符合《国际疾病分类（第10版）》（ICD-10）精神分裂症、抑郁障碍、童年情绪障碍诊断标准的131例儿童青少年患者为研究对象,采用自制调查问卷收集患者的一般人口学资料、睡眠情况、生活情况、家庭和学校情况等信息,比较睡眠充足组和睡眠不足组人口学资料的差异,采用Spearman法分析患者睡眠不足的相关因素。结果 ①在131例儿童青少年精神障碍患者中,93例（71.0%）存在睡眠不足,睡眠不足组与睡眠充足组在疾病类别（χ²=8.798,P=0.012）、近6个月内被打（χ²=3.427,P=0.035）或被骂（χ²=4.145,P=0.031）以及一年内遭受网络欺凌（χ²=4.187,P=0.041）方面,差异均有统计学意义。②在睡眠不足的患者中,77例（82.8%）存在入睡困难,69例（74.2%）存在夜间多醒。③儿童青少年精神障碍患者睡眠不足与近6个月内有被骂经历（r=0.210,P=0.037）或被打经历（r=0.145,P=0.023）以及一年内遭受网络欺凌（r=0.179,P=0.041）呈正相关。结论 儿童青少年精神障碍患者睡眠不足的发生风险较高,且与抑郁障碍、有被打和被骂经历、经受过网络欺凌相关。     

儿童青少年时期精神障碍的遗传学研究Ⅱ

儿童和青少年时期除易患成年期精神疾病外，有些精神障碍易在这一年龄段中发生，如脆性X综合征、神经性厌食和神经性贪食、注意缺陷与多动障碍、Tourette’S综合征、儿童孤独症和反社会人格障碍等。本文拟就近年来注意缺陷与多动障碍、Tourette’S综合征、儿童孤独症和反社会人格障碍等的遗传学研究进展概述如下。     

儿童青少年精神障碍研究进展与学科发展

儿童青少年精神卫生服务能力与社会需求不匹配的矛盾日益突出。本文目的是系统阐述儿童青少年精神障碍研究现状和学科发展方向,包括儿童青少年精神障碍的流行病学、病因与发病机制、诊断进展、治疗进展以及学科发展。儿童青少年精神障碍发病率高,如果未得到有效治疗,甚至会延续到成年期,给患者、家庭和社会带来沉重的负担。目前,儿童青少年精神障碍的病因和发病机制尚未完全阐明,可能与遗传、环境、压力性事件等众多复杂因素相关,诊断根据以症状学为主,缺少客观指标。治疗方面,虽然治疗手段并不单一,且均有一定效果,但仍有部分患儿治疗效果欠佳,需要多学科综合干预,并加强遗传影像学、新药物靶点、智慧医疗及脑科学等研究,更好地满足儿童青少年精神卫生服务的社会需求。     

儿童青少年精神障碍患者问题性网络使用发生率及危险因素分析

目的:新冠肺炎疫情流行期间,问题性网络使用(problematic internet use, PIU)发生率较前明显升高。本研究拟探讨儿童青少年精神障碍患者PIU的发生率及危险因素。方法:选取精神分裂症、抑郁障碍、童年情绪障碍儿童青少年患者,收集一般人口学资料及临床数据,采用中文版杨氏网络成瘾量表(IAT)评估患者PIU的严重程度。结果:PIU组与非PIU组患者在疾病类别、自身健康水平、体育锻炼、每周早饭次数、入睡困难、夜间多醒、师生关系、家庭经济情况、遭受网络欺凌、自杀意念及自杀行为等方面存在统计学差异(P<0.05)。相关分析显示,精神障碍患儿共病PIU与较差的健康水平,较少的体育锻炼及每周早饭次数,较差的师生关系、睡眠质量及家庭经济状况,遭受过网络欺凌、既往存在自杀意念或行为等方面差异有统计学意义(P<0.05)。二元Logistic回归分析发现,较差的自身健康水平、较差的师生关系是精神障碍患儿伴PIU的危险因素。结论:与不伴PIU的精神障碍患儿相比,伴PIU的患儿表现出更多的不良生活方式、睡眠质量欠佳、较多的行为障碍。而PIU的解决可能有效缓解精神障碍儿童的病情程...     

无抽搐电休克治疗在儿童青少年精神障碍患者中的应用

对MECT在儿童青少年精神障碍患者中应用作以综述,介绍了儿童青少年患者MECT治疗的历史情况,国内外的研究现况以及儿童青少年患者MECT治疗的风险、适应证、禁忌证和展望。     

儿童青少年抑郁症自杀及相关影响因素研究

目的 探讨儿童青少年抑郁症患者中自杀相关影响因素.方法 选取2018年1月至2019年12月就诊于河北省第六人民医院的389例儿童青少年抑郁症患者作为研究对象,其中自杀组171例,非自杀组218例.对两组间的一般情况与临床特征进行比较,并采用Logistic回归方法对青少年儿童抑郁症伴自杀的影响因素进行分析.结果 自杀...     

突发公共卫生事件下成都市某综合医院儿童青少年精神障碍患者疾病变化趋势分析

背景 儿童青少年时期是个体心理健康发育的关键阶段,在面对突发公共卫生事件时,儿童青少年的心理应对能力较弱,极易出现各种心理问题。目的 了解突发公共卫生事件下某综合医院心理卫生中心儿童青少年住院患者的疾病构成比变化趋势,为以后类似突发公共卫生事件下儿童青少年心理健康研究与干预实践提供参考。方法 选取2018年1月1日—2022年12月31日于四川大学华西医院心理卫生中心住院且出院主诊断为《国际疾病分类（第10版）》（ICD-10）中精神分裂症、分裂型障碍和妄想性障碍、抑郁障碍、双相情感障碍、焦虑障碍、创伤后应激障碍任一诊断的儿童青少年患者为研究对象（n=6 613）。回顾性收集患者的病历资料,根据入院时间将患者分为两组：新冠肺炎疫情大流行前（2018年1月1日—2019年12月31日）和新冠肺炎疫情大流行期间（2020年1月1日—2022年12月31日）。采用趋势χ²检验考查疾病构成比变化趋势。结果 与新冠肺炎疫情大流行前相比,新冠肺炎疫情大流行期间,儿童青少年住院患者的年龄更小、住院天数更短、女生占比更高（t=10.743、4.082,χ²=29.092,P均<0.01）。新冠肺炎疫情大流行期间,抑郁障碍、双相情感障碍、焦虑障碍构成比均呈上升趋势（χ²_趋势=11.058、67.333、17.276,P均<0.01）,精神分裂症、分裂型障碍和妄想性障碍构成比呈下降趋势（χ²_趋势=219.924,P<0.01）。亚组分析显示,6~14岁患者中,双相情感障碍构成比呈上升趋势（χ²_趋势=18.207,P<0.01）,15~19岁患者中,双相情感障碍和焦虑障碍构成比均呈上升趋势（χ²_趋势=57.339、19.011,P均<0.01）;男生抑郁障碍和双相情感障碍构成比均呈上升趋势（χ²_趋势=21.729、11.380,P<0.01）,女生双相情感障碍和焦虑障碍构成比均呈上升趋势（χ²_趋势=54.830、14.377,P均<0.01）。结论 与新冠肺炎疫情大流行前比较,新冠肺炎疫情大流行期间,儿童青少年住院患者中女生多于男生,患者年龄偏小、住院时间偏短,抑郁障碍、双相情感障碍、焦虑障碍构成比均上升。     

儿童青少年脑外伤所致精神障碍远期调查及其与成年人的比较分析

目的探讨儿童青少年脑外伤后4～10年远期器质性精神障碍的发生率及其与成年人的差异。方法对深圳市39家医院的脑外伤病例进行系统抽样,采用自编的《颅脑外伤后精神障碍状况调查手册》对抽样的105例脑外伤儿童青少年患者的精神障碍进行随访调查,并与同期调查的570例成人脑外伤患者进行比较。由二名副主任及以上职称的精神科医师面检筛查阳性者,并按照CCMD-3脑外伤所致精神障碍的诊断标准明确诊断。结果 20.0%(21/105)儿童青少年在调查时符合脑外伤所致精神障碍的诊断,包括:行为(人格)改变12.38%(13/105),智能损害8.57%(9/105),脑外伤后综合征6.67%(7/105),抑郁综合征1.90%(2/105)。重型脑外伤所致精神障碍发生率显著高于中型和轻型(2=8.08,P0.05;2=20.43,P0.01)。儿童青少年组颅脑外伤所致远期精神障碍总发生率明显较成人组低(2=6.49,P0.05),主要是智能损害和抑郁综合征发生率低于成人组(2=6.84,P0.05;2=6.02,P0.05)。结论儿童青少年脑外伤对精神损伤的远期影响较成人好。     

SSRIs在儿童及青少年精神障碍中的应用

目的：了解选择性5—羟色胺回收抑制剂(SSRI)类在儿童及青少年精神障碍中的应用。方法：对儿童精神科门诊使用SSRIs的75例患者进行回顾性分析。结果：SSRIs已广泛应用于治疗多种儿童及青少年精神障碍。结论：SSRIs对部分儿童及青少年精神障碍疗效较好,安全性高。     

首次住院儿童青少年精神障碍患儿父母压力调查及干预研究

目的 调查首次住院儿童少年精神障碍患儿父母的心理压力状况,并通过干预指导,改善父母心理状况.方法 采用心理身体紧张松弛测试表(PSTRI)和自编问卷的方法 ,对121例患儿父母的心理压力及对精神障碍相关知识了解程度进行了调查,并对其实施有针对性地干预指导.结果 通过干预,患儿出院时其父母心理压力状况明显优于患儿入院时,有显著性差异(X2=147.02,P<0.01);患儿父母在精神疾病基本知识、药物治疗知识、护理知识、促进康复知识、预防知识掌握上,入院时与出院时相比具有显著性差异(X2=144.39～171.68,P<0.01).结论 首次住院的儿童少年精神障碍患儿父母心理压力普遍较重,对其进行有针对性地干预指导,可有效改善父母心理状况,有助于精神障碍患儿的治疗及减少复发.     

Cost variation in child and adolescent psychiatric inpatient treatment

Publicly available costs data for child and adolescent psychiatric inpatient services do not allow links to be made with patients’ needs and outcomes. Without this information commissioners may reduce the role of inpatient services on the basis of budgetary impacts alone. This study estimates the support costs before, during and after an inpatient admission and explores the associations between costs, needs and outcomes. A detailed prospective cohort study of eight child and adolescent units was undertaken in which participants were assessed at referral, admission, decision to discharge and 1 year later. Mean admission costs were ￡24,120, although the range was wide. Associations were found between costs and patients’ global impairment, age and exclusion status. Support costs after admission were similar to pre-admission costs, but there was some evidence to suggest that services were better targeted. Moves in England to develop national tariffs for inpatient psychiatric episodes should be based on the likely cost of the episode of treatment rather than costs per day, and good commissioning requires more information on the predictors of such costs.     

Child and adolescent psychiatric disorders in a public service over seventy years

The entire sample of N=45554 patients attending the child and adolescent psychiatric service of the Canton of Zurich, Switzerland between 1921 and 1990 was analyzed with regard to age, sex, and diagnoses. Data were based on annual reports of the institution for the period between 1921 and 1978. From 1979 onwards, electronically stored data on each patient were available. ICD-9 diagnoses were applied between 1979 and 1987. The ICD-10 system was introduced in 1988. The total administrative prevalence rate varied between 0.15 and 0.40 percent with an increasing trend over time. On the average, boys outnumbered girls by a sex ratio of 2:1. The age distribution showed peaks at 8 to 9 years and during adolescence. The distributions of the most common diagnoses showed remarkable differences over time. It is assumed that changes in diagnostic categories rather than changes in true prevalence rates play a major role in the latter trend.     

Deaths among child and adolescent psychiatric patients

Of 1,206 patients treated during the period 1970-1980 in a department of child psychiatry in a large city in Sweden 24 (2%) (14 boys and 10 girls) had died by the end of 1981. Twenty-one of these (88%) died of "injuries following external violence and poisoning", of whom 15 (63%) were suicides. Twenty subjects (83%) had grown up in surroundings characterised by one or more psychosocial stress factors. The study indicates a possible link between psychosocial background factors and deaths from "injuries following external violence and poisoning".     

The premature demise of public child and adolescent inpatient psychiatric beds : Part II: challenges and implications

Psychiatric disorders are the leading reason for hospitalization among 5–19 year olds. Current data, however, suggest there are fewer than necessary available services for children and adolescents requiring intensive, inpatient psychiatric care. Children and adolescents with behavioral health problems, the majority of whom do not receive appropriate treatment, have increased risk of school failure, family disruption, out-of-home placements, poor employment opportunities, and poverty in adulthood. This paper will examine the challenges inherent in serving children and adolescents with serious emotional disturbances, avenues of financing for treatment and services, and various loci of intervention for high-risk children, including inpatient settings and systems of care. The goals of this paper are to illustrate the complexities of working with children and adolescents most in need of intensive psychiatric services, to explore how inpatient services “fit” into existing treatment approaches, and to discuss the efficacy of downsizing or closing inpatient psychiatric units for this population.     

The child and adolescent track in the forensic fellowship

Exposure to child and adolescent forensic issues is limited in general psychiatry residency and child and adolescent psychiatry residency programs. There is no Graduate Medical Education Program for child and adolescent forensic psychiatry that is approved by the American Council on Graduate Medical Education (ACGME). Forensic psychiatry residency directors can create a child-focused forensic training opportunity that meets the needs of the ACGME program in forensic psychiatry. By creating didactic, clinical, and research experiences relevant to child and adolescent forensic psychiatric issues, this much-needed training can be provided to qualified psychiatrists.     

Retrospective chart review of catatonia in child and adolescent psychiatric patients

Ghaziuddin N, Dhossche D, Marcotte K. Retrospective chart review of catatonia in child and adolescent psychiatric patients. Objective: Identify the frequency of catatonia among at‐risk children and adolescents receiving psychiatric treatment. Method: Subjects were children and adolescents (<18 years), who had received psychiatric treatment at a University Hospital during 2004–2009, and were diagnosed with disorders with known risk for catatonia or displayed symptoms suggestive of catatonia. Approval was obtained from the Investigational Review Board (IRB). The first 101 (n = 101) subjects were selected among 570 subjects identified by psychiatric diagnoses: any pervasive developmental disorder, psychosis‐NOS (Not Otherwise Specified), intermittent explosive disorder, mental retardation, catatonia and neuroleptic malignant syndrome. Subjects met study‐defined criteria for catatonia, if they had three or more of the following symptoms: unexplained agitation/excitement, disturbed or unusual movements, reduced movements, repetitive or stereotyped movements, or reduced or loss of speech. Results: Eighteen (17.8%) subjects, among a group suspected to be at a higher risk for catatonia, met the study‐defined criteria for this syndrome. However, only two subjects had been diagnosed by their treatment providers. Higher rates of intellectual disability and aggression were found among the group that met study‐criteria. Conclusion: We concluded that catatonia is under recognized and undertreated among children and adolescents receiving psychiatric treatment.     

A retrospective and explorative study of hypokalemia in psychiatric disorders: a beta2-receptor related phenomenon

Summary Since the serum potassium level is under beta₂-adrenergic influence, we studied serum potassium values on admission in psychiatric patients. Data are reported on 683 patients from nine major diagnostic groups. Among these nine groups significant differences were found concerning the mean serum potassium level and incidence of hypokalemia. Significant differences existed between the alcohol withdrawal and attempted suicide groups compared to the dysthymic, bipolar manic, schizophrenic and nonschizophrenic psychosis groups. Like alcohol withdrawal, attempted suicide is assumed to be a hyper-adrenergic state. Although the relative contribution of factors like nutritional state, aldosterone, insulin, and beta₂-receptor density or sensitivity is unclear, the catecholamine-potassium relationship deserves further study.An abstract of this study will be published as a letter to the editor in the J Clin Psychiatr     

Childhood and adolescent onset psychiatric disorders, substance use, and failure to graduate high school on time

We examined the joint predictive effects of childhood and adolescent onset psychiatric and substance use disorders on failure to graduate high school (HS) on time. Structured diagnostic interviews were conducted with a US national sample of adults (18 and over). The analysis sample included respondents with at least 8 years of education who were born in the US or arrived in the US prior to age 13 (N = 29,662). Psychiatric disorders, substance use and substance use disorders were examined as predictors of termination or interruption of educational progress prior to HS graduation, with statistical adjustment for demographic characteristics and childhood adversities. Failure to graduate HS on time was more common among respondents with any of the psychiatric and substance use disorders examined, ranging from 18.1% (specific phobia) to 33.2% (ADHD-combined type), compared with respondents with no disorder (15.2%). After adjustment for co-occurring disorders, significant associations with failure to graduate on time remained only for conduct disorder (OR = 1.89, 95% CI 1.57-2.26) and the three ADHD subtypes (Inattentive OR = 1.78, 95% CI 1.44-2.20, Hyperactive-Impulsive OR = 1.38, 95% CI 1.14-1.67, and Combined OR = 2.06, 95% CI 1.66-2.56). Adjusting for prior disorders, tobacco use was associated with failure to graduate on time (OR = 1.97, 95% CI 1.80-2.16). Among substance users, substance use disorders were not associated with on-time graduation. The findings suggest that the adverse impact of childhood and adolescent onset psychiatric disorders on HS graduation is largely accounted for by problems of conduct and inattention. Adjusting for these disorders, smoking remains strongly associated with failure to graduate HS on time.     

Linkage studies of psychiatric disorders

Summary Linkage analysis has been successful in identifying the genetic basis of numerous Mendelian diseases. These successes were due in part to the rapid developments in molecular biology, which have yielded a plethora of informative genetic markers. Although there is strong evidence that the manifestation of schizophrenia and bipolar affective disorders is controlled by genes, no evidence for linkage has been established. For psychiatric disorders, the most important limiting factor is likely to be the lack of single loci with very large effects that occur with any relevant frequency. The difficulties of linkage studies in psychiatric disorders are discussed with reference to non-psychiatric genetic diseases for which linkage to genetic markers has been successful. Recommendations for collecting information to clarify the patterns of transmission of the psychiatric disorders are described.     

儿童少年期躁狂症临床特点的对照分析

目的：探讨儿童少年期躁狂症的临床特点。方法：将符合CCMD－2－R诊断标准的30例儿童少年期躁狂症患者（观察组）,与随机抽取的同期住我院的42例成人躁狂症患者（对照组）的临床特征作对照分析。结果：儿童少年期躁狂症患者的早期症状复杂且不典型;临床误诊率高,与典型躁狂症状无本质区别,但观察组在注意力不集中,行为增多并有破坏性多于对照组,而思维联想加快少于对照组。结论：儿童少年期躁狂症有其自身的特点。