两种自评问卷筛查综合医院诊断抑郁障碍患者的既往躁狂症状

目的 探索两种躁狂症状问卷在综合医院门诊ICD-10诊断的抑郁障碍是否筛查出既往有躁狂症状,及两个问卷识别躁狂症状的差异及其与临床特征的关系.方法 连续评估同济大学附属同济医院精神科门诊符合ICD-10诊断的抑郁障碍102例,调查工具包括自编问卷、中文版心境障碍调查问卷(Chinese version mood disorder questionnaire,CV-MDQ)、中文版32项轻躁狂症状清单(Chinese version 32 items hypomania check list,CV-HCL-32),CV-MDQ≥7分为既往躁狂症状阳性,CV-HCL-32≥14分为既往轻躁狂症状阳性.结果 1.内部一致性检验显示,CV.MDQ的Cronbach's α值为0.808,P<0.01,CV-HCL32的Cronbach's α值为0.916,P<0.01.2.11例患者(10.8%)在CV-MDQ报告躁狂症状阳性,14例(13.7%)在CV-HCL-32报告躁狂症状阳性,两问卷判别躁狂或轻躁狂的一致性有显著差异(Kappa=0.227,P<0.05).3.CV-HCL-32阳性组的首发年龄、总病程、本次病程、复发次数的中位数(35.0岁,60.0月,12.0月,2.5次)与阴性组(50.5岁,22.0月,6.0月,1.0次)差异具有显著性(Z=-2.065,-2.102,-2.180,-2.168,均P<0.05),年龄、性别、文化程度差异无显著性(P>0.05);CV-MDQ阳性组与阴性组间差异无显著性(P>0.05).结论 CV-MDQ和CV-HCL-32可在综合医院门诊ICD诊断为抑郁障碍患者中检出一定比例既往有躁狂或轻躁狂症状,但CV-HCL-32是否较CV-MDQ更适用于筛查双相Ⅱ型障碍值得探索.

Abstract：

Objective To explore the prevalence of self reposed mania/hypomania symptoms of depressive disorders and the difference between the two self-rating symptoms questionnaires in setting of psychiatric clinic of a general hospital.Methods 102 outpatients who were diagnosed with depressive disorders by ICD-10 in department of psychiatry of Tongji Hospital of Tongji University were continuously investigated and fulfilled the Chinese Version mood disorder questionnaire(CV-MDQ)and the Chinese Version 32 items hypomania check list(CVHCL-32).The positive mania symptoms were elevated with at least seven positive mania items reported by the CVMDQ.The positive hypomania symptoms were elevated with at least fourteen positive hypomania items reported by the CV-HCL-32.Results The internal consistency(Cronbach alpha)of the CV-MDQ was 0.808(95% CI=0.767～0.845,P<0.01).The internal consistency(Cmnbach alpha) of the CV-HCL-32 was 0.916(95% CI=0.898～0.930,P<0.01).11 patients(10.8%) reported positive mania symptoms by the CV-MDQ.14 patients (13.7%)had been reported positive hypomania symptoms through the CV-HCL-32.The ability of discriminating mania or hypomania between the two scales was significantly different(Kappa=0.227,P<0.05).Compared to the patients who were reported negative hypomania symptoms by the CV-HCL-32.the 11 patients with positive hypomania symptoms by the CV-HCL-32 had much earlier age in first episode(35.0 vs 50.5,z=-2.065,P<0.05),much longer months in total disease course(60.0 vs 22.0,z=-2.102,P<0.05)and present episode (12.0 vs 6.0,z=-2.180,P<0.05),and much higher frequency of relapse(2.5 vs 1.0,z=-2.168,P<0.05),but no significant differences at age,gender and education.No significant differences appeared between CV-MDQ positive and negative group.Conclusion Mania or hypomania symptoms may be screened by CV-MDQ and CV-HCL-32 from the outpatients with depressive disorders who are diagnosed by ICD-10 in general hospital.whether CV-HCL-32 is superior to CV-MDQ when screening bipolar Ⅱ disorder is worthly further study.     

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.     

社区老年人有氧能力的现况调查

目的评估社区老年人的有氧能力,并探索其与运动耐力的关系。方法对来自上海市静安区的87名社区老年人进行心肺运动试验,并根据运动负荷试验的结果将其分为3组:阴性组、未达标准组和可疑阳性组。计算3组的峰值摄氧量占该个体最大摄氧量预测值的百分比(VO_2peak/VO_2maxPred)、无氧阈值占该个体最大摄氧量预测值的百分比(VO_2AT/VO_2maxPred)、无氧阈值与峰值摄氧量的比值(VO_2AT/VO_2peak),比较3组老年人的有氧能力。结果 3组的性别、年龄及体质量指数差异均无统计学意义(P 0.05)。3组VO_2peak/VO_2maxPred(F=4.730,P=0.011)、VO_2AT/VO_2maxPred(F=3.888,P=0.024)差异有统计学意义,其中,未达标准组和可疑阳性组的VO_2peak/VO_2maxPred值均显著低于阴性组(P0.05),可疑阳性组的VO_2AT/VO_2maxPred值显著低于阴性组(P0.05)。3组间VO_2AT/VO_2peak差异无统计学意义(F=0.906,P=0.408)。结论社区老年人有氧能力的下降可能与运动耐力下降及潜在心血管疾病有关;作为评估不同个体有氧代谢能力的指标,VO_2peak/VO_2maxPred较VO_2AT/VO_2maxPred更为敏感。     

用药态度和主观感受对社区精神分裂症患者服药依从性的影响

目的调查分析社区精神分裂症患者的一般人口学资料、用药态度、主观舒适度、焦虑、抑郁等相关主观感受因素对患者服药依从性的影响。方法选取2020年6—12月在社区诊断为精神分裂症的570例患者,设计问卷,收集问卷并分析患者的一般人口学资料和主要人际关系(家庭关系、医患关系),采用Morisky量表(MAQ)调查患者服药依从性,采用用药态度量表调查患者服药态度,采用焦虑自评量表(SAS)、抑郁症状快速检查-自我报告(QIDS-SR16)调查患者负性情绪,采用主观舒适度量表和阳性和阴性症状量表(PANSS)调查患者的主观舒适和精神症状,最后探讨上述指标与服药依从性之间关系。结果服药依从性好的患者为227例(39.82%),依从性差的患者为343例(60.18%)。服药依从性与患者工作状况、医患关系、SWN量表、SAS量表、QIDS-SR16量表、PANSS量表评分均有相关性,差异具有统计学意义(P<0.05)。Logistic回归分析显示,患者服药依从性与患者工作状况、DAI量表分、SAS量表分具有明显相关性(P<0.05)。结论患者负性主观感受是影响服药依从性的主要因素之一。建立良好的医患关系,积极关注和处理患者的焦虑抑郁、用药态度等主观感受性指标,为患者制定个性化的心理干预方案,消除或减轻恢复期患者的负性情绪体验,能提高患者服药依从性,这对于精神分裂症患者的康复和预后具有积极影响。     

惊恐障碍的事件相关电位研究

惊恐障碍(panic disorder,PD)的病因和发病机制有多种解释角度。从认知心理学角度,越来越多的研究推断患者存在认知功能缺陷,整合外界信息输入的能力受损,将此作为PD发病机制的重要方面。随着电生理技术的发展,事件相关电位(event—related potentials,ERP)以其毫秒级的时间分辨率和相对的空间分辨率,成为反映大脑信息处理过程的重要手段,为PD患者认知受损的发病机制假说提供了一些证据。现对其研究进展作一简要综述。