认知老化、老年大脑可塑性与认知储备

在社会老年人口不断增加的背景下,老化相关研究日益受到重视.先前研究大多集中于4"D"(疾病disease,残疾disa-bility,死亡death和痴呆dementia)人群,目前很多学者开始关注正常老年并对其异质性群体进行深入探索.Rowe和Kahn [1]将老年人群分为三类:成功老龄、常态老龄和病态老龄.部分常态老龄通过生物学、心理学和社会学等干预措施,能够向成功老龄转化,也即可塑性.     

患者健康问卷抑郁症状群量表在综合性医院中的应用研究

目的检验中文版患者健康问卷（patient health questionnaire,PHQ）中抑郁症状群量表（PHQ-9）在综合性医院普通门诊患者中的信度、效度和检出率。方法600例综合性医院普通门诊患者完成中文版PHQ-9和医院焦虑抑郁量表（hospital anxiety and depression scale,HADS）自评,并接受汉密顿抑郁量表（hamilton depression scale,HAMD）的评定,抽取44名患者在完成初次评定后7-14 d内接受PHQ-9重测;抽取96例患者,在完成初次评定后2周内,接受专业研究人员的定式临床精神检查（structured clinical interview for DSM-IV,SCID）。结果PHQ-9内部一致性系数为0.857,条目间的相关系数为0.236-0.718,各条目与量表总分的相关系数为0.588-0.784,先后两次测定总分的相关系数为0.947,PHQ-9总分与HADS总分及抑郁分量表分值和HAMD总分的相关系数范围0.792-0.811,PHQ-9的灵敏度为91%,特异度为97%,Kappa=0.884。检出抑郁症状群98例,占总样本量的16.3%（95%CI：13.4%-19.3%）。结论中文版本PHQ-9在综合性医院普通门诊患者应用中具有良好的信度和效度。     

成功老龄相关因素的研究进展

社会发展与科学进步使人类进入了老龄化时代.近年来,在老年医学领域,成功老龄的研究日益受到关注,其相关因素及早期干预一直是研究的焦点.     

抑郁症患者情绪图片反应特征及杏仁核反应模式的研究

Objective To explore the behavioral and related amygdaiar temporal response to emotional pictures in individuals with major depressive disorder(MDD).Methods Functional magnetic resonance imaging(fMRI)was adopted to examine the neural substrates of emotional pictures processing in 12 first-episode unmedicated MDD subjects(MDD)and 13 healthy controls(HC).Analyses were focused on the temporal dynamics of the blood-oxygen level dependant(BOLD)signal change in the amygdala across blocks of positive,neutral and negative emotional pictures.The crude score to emotional pictures was also recorded.Results(1)The crude score wag(6.6 ±0.2)to positive pictures and(4.7 ±0.1)to neutral pictures in depressed subjects,lower than that in HC(P＜0.01),and(3.4 ±0.3)to negativc pictures in depressed subjects,which was higher than that in HC(2.2±0.2,P＜0.01).(2)The bilateral amygdala showed attenuated and delayed response to the positive pictures.in which the right amygdala showed"group×time"interaction effect to positive pictures(P=0.002).For the negative pictures,there was"group×time"interaction effect in the left amygdala(P=0.008)and group main effect in the right amygdaia(P=0.007),with the attenuated BOLD signal change in MDD group.Conclusions It suggests that amygdala is one of the key neural substrates to the character of the depressed mood or loss of interest in individuals with MDD.Depressed subiects show the attenuated and blunted behavioral and amygdala response to emotional stimuli,which support the hypothesis of the unspecially blunted emotional response in major depressive disorder.     

缩胆囊素-A受体基因多态性与焦虑症的相关性

目的探讨焦虑症(AD)与缩胆囊素-A(CCKA)受体基因多态性的相关性。方法运用PCR技术检测88例AD患者和87例健康对照(NC)组缩胆囊素-A受体基因多态性,并加以对照分析。结果CCKA受体基因的3种基因型(A1/A1、A1/A2和A2/A2),在AD组的分布分别为5%、41%和54%,在NC组分别为1%、44%和55%,两组间无显著性差异(P>0.05);A1和A2等位基因频率,在广泛性焦虑(GAD)组分别为34%、66%,惊恐障碍(PD)组分别为18%和82%,两组间均有显著性差异(P<0.05);A1/A1、A1/A2、A2/A2基因型分布频率,GAD组分别为5%、59%、36%,PD组分别为6%、24%和70%,两组间均有显著性差异(P<0.05)。结论CCKA受体基因多态性与AD之间无显著关联;AD两种亚型间CCKA受体基因多态性有显著性差异。     

医学结局研究用疼痛量表在腰痛患者中的信效度初步研究

目的:评价医学结局研究用疼痛量表(the Medical Outcomes Study Pain Measurement,MOSPM)的信度及效度。方法:58例临床慢性腰背痛患者评定MOSPM,以VAS和SF-36为效度标准进行自评,四周后重测MOSPM。对量表的内部一致性、重测信度和平行效度进行分析。结果:MOSPM标准化后的各条目分与总分的相关系数在0·72~0·94之间,其中疼痛平均程度项(条目6)与总分的相关系数为0·94(P<0·001),Cronbach sα系数为0·97。MOSPM各条目的重测相关系数为0·70~0·92,总分的相关系数为0·86(P<0·001)。MOSPM各条目分与VAS分的相关系数在0·49~0·89(P<0·001)之间,MOSPM总分与VAS分的相关系数为0·85(P<0·001)。SF-36除外生理机能分量表与5个MOSPM条目不相关、精神健康分量表与疼痛频率也不相关外,其余相关均有统计学意义,相关系数在-0·29~-0·92之间(P<0·05)。结论:MOSPM在慢性腰背痛患者中应用具有较好的信度和效度。     

性骚扰问题的初步研究─—附42例资料分析

性骚扰是一个不容忽视的心理卫生及社会问题，本文对上海市心理健康热线中的１６～４０岁女性１００例求询者进行了调查，发现４２例曾有过性骚扰遭遇，年龄大多在３０岁以下（８０．９％）；遭遇对象以陌生人为最多（占４０．８％）；遭遇场所中公共娱乐场所列第一位（占３８％）；受害者为此感到烦恼、不公平的达６９．０５％；对应态度中当即予以警告者仅１１．９％。最后作者就有关性骚扰的概念，社会心理影响及干预处理对策作了讨论，并提出有必要重视和开展这方面研究。     

成功老龄者听觉词汇学习特征初步研究

目的:探索成功老龄者的记忆特征。方法:采用中国老年成套神经心理测验中听觉词汇学习测验评估65岁以上社区老人421名,其中成功老龄(SA)组230名,常态老龄(UA)组137名,轻度认知损害(MCI)组54名。结果:(1)控制年龄、性别、教育程度后,SA 与MCI、UA 与MCI 组间即刻记忆、延迟回忆保持率、倒摄抑制有显著性差异(P<0.01);但三组间学习效应指数、前摄抑制无显著性差异。(2)对三组间七次回忆正确数进行重复测量协方差分析:SA 与UA 组组别及时间与组别交互作用均无显著性差异,但时间*组别变化趋势有显著性差异(P<0.05)。SA 与MCI、UA 与MCI 比较,组别及时间与组别交互作用、变化趋势均有显著性差异(P<0. 05)。结论:(1)延迟回忆可能是鉴别SA 较敏感的指标。(2)UA、MCI 仍具一定的学习能力,为进行成功老龄化干预提供了相关理论依据。     

National field trial of the Chinese classification and diagnostic criteria of mental disorders: comprehensibility, acceptability and applicability.

The Chinese Neurology and Psychiatry Association conducted a national field trial of its Chinese Classification and Diagnostic Criteria of Mental Disorders (CCMD-2) involoviag 26 provinces and municipalities, 80 psychiatric insititutes, and 224 professionals. The results were as follows: (1)95.2% of researchers considered the comprehensibility, of the CCMD-2 diagnstic criteria good. Within the ten major categories, comprehensibility ranged from 85.7% to 100%. (2) Of those surveyed concerning the acceptibility of the CCCMD-2 diagnostic criteria, 85.9% considered them acceptable. In individual classifications, the rate ranged from 74.1% to 95.2%. (3) 1498 cases were tested. The overall applicability rate which indicated the consistency between the CCMD-2 result and the actual clinical diagnoses was found to be 87.6%, (averaging Kappa=0.82, P<0.01), better than those obtained from non-Chinese systems of diagnosis.     

加拿大精神病学学会“惊恐障碍伴或不伴广场恐惧症”临床诊疗指南

本文为加拿大精神病学学会推荐的"惊恐障碍伴或不伴场所恐惧症的临床诊疗指南"的编译稿。