躯体化症状为主抑郁症患者的述情障碍

目的:探讨以躯体化症状为主抑郁症患者和以情绪症状为主抑郁症患者述情障碍的差异。方法:50例以躯体化症状为主抑郁症患者(躯体症状组)、50例以情绪症状为主抑郁症患者(情绪症状组)和50名正常健康者(正常对照组)参加研究,采用90项症状自评量表(SCL-90)、汉密尔顿抑郁量表(HAMD)和多伦多述情障碍量表进行评定。结果:躯体症状组SCL-90总分、躯体化、焦虑、人际敏感、恐怖、偏执因子分及HAMD的焦虑/躯体化因子评分均高于情绪症状组(P<0.01或P<0.05),情绪症状组在强迫、抑郁因子评分及HAMD的认知障碍、阻滞、日夜变化、睡眠障碍及绝望因子分高于躯体症状组(P<0.05或P<0.01)。躯体症状组与情绪症状组仅在述情障碍因子II评分差异有统计学意义(P<0.05),而在述情障碍总分及因子分上均高于正常对照组(P<0.05或P<0.001)。结论:以躯体化症状为主和以情绪症状为主抑郁症患者均存在述情障碍,以前者更缺乏识别情绪和躯体感受能力。     

躯体化症状为主的抑郁症心率变异性对照研究

目的：探讨躯体化症状为主的抑郁症患者自主神经系统的特点及抑郁症躯体化表现的发生机制。方法：对30例躯体化症状为主的患者（A组）和30例情绪症状为主的患者（B组）及30例健康正常者（C组）分别进行汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）评定及短时（10min）心率变异性（HRV）分析。结果：A、B、C3组HRV分析指标RR间期标准差（SDNN）分别为（50.84±19.92）ms、（94.93±28.80）ms、（105.77±22.05）ms,A组显著低于C组（t=5.68,P〈0.01）,较B组低（t=3.73,P〈0.05）;3组LF/HF分别为（6.26±2.11）ms、（3.51±2.44）ms、（1.80±1.07）ms,A组显著高于C组（t=6.35,P〈0.01）,较B组高（t=2.50,P〈0.05）;A组HAMD评分（28.30±6.26）分高于B组（24.35±6.69）分,二者差异有显著性（t=3.14,P〈0.05）;A组HAMA评分（22.70±4.92）分显著高于B组（13.05±4.71）分,二者差异有显著性（t=6.17,P〈0.01）;HAMD焦虑/躯体化因子分与HRV指标SDNN、LF、HF、VLF和LF/HF均呈中度相关（r分别为0.49、0.61、0.58、0.50、0.63）（P〈0.05或P〈0.01）。结论：躯体化症状表现为主的抑郁症患者多伴有焦虑,自主神经功能紊乱。     

以躯体症状为主的抑郁症患者的交感神经皮肤反应研究

目的　探讨以躯体症状为主的抑郁症患者的自主神经功能,以寻求此类患者的临床诊断依据。方法　对40例以躯体症状为主的抑郁症患者及3 7例不伴躯体症状的抑郁症患者和3 8名健康人分别进行了交感神经皮肤反应(SSR)测定。结果　以躯体症状为主的抑郁症组SSR测定异常率为75% ,不伴躯体症状的抑郁症患者SSR测定异常率为49% ,两病例组SSR波潜伏期延长明显,波幅降低,与对照组相比存在显著性差异(P <0 . 0 1 )。而以躯体症状为主的抑郁症组与不伴躯体症状的抑郁症组SSR波潜伏期和波幅比较也存在显著性差异(P <0 . 0 1 )。结论　以躯体症状为主的抑郁症患者自主神经功能存在较严重的损害,SSR可判断以躯体症状为主的抑郁症患者的自主神经功能状况,为识别抑郁症提供了较为有效的手段。     

抑郁症患者的皮质醇、甲状腺功能及心率变异性特征对照研究

目的研究抑郁症患者的皮质醇、甲状腺功能及心率变异性特点,探讨其与躯体症状、失眠及性别因素的关系。方法检测60例抑郁症患者和60名正常对照的血清皮质醇(Cortisol,COR)、三碘甲状腺原氨酸(triiodothyronine,T3)、四碘甲状腺原氨酸(tetraiodothyronine,T4)、促甲状腺素(Thyroid stimulating hormone,TSH)水平,当日进行心率变异性检查,进行两组的比较,并按照躯体症状、失眠及不同性别进行分组比较。结果患者组的R-R间期平均标准差(standard deviation of average RR intervals,SDNN)、低频功率(low frequen-cy band,LF)、高频功率(high frequency band,HF)分别为[(34.21±14.31),186.64(846.67,113.87),125.00(839.22,48.50],对照组依次为[(43.86±12.61),375.92(2542.70,233.08),247.51(1547.36,142.33)],前者显著低于后者(均P<0.01)。与对照组相比,患者组COR水平增高[(15.35=6.45)vs.(11.81±6.32),P<0.01],TSH、T3及T4水平无显著差异(P>0.05)。伴躯体症状患者组COR水平显著高于对照组及不伴躯体症状组(P<0.01),SDNN、LF及HF指数均显著低于后两组(P<0.01)。伴失眠的患者组血清COR水平显著高于对照组及不伴失眠组(均P<0.01),SDNN、LF及HF指数均显著低于后两组(均P<0.05)。男性患者组SDNN、LF、HF指数均显著低于正常男性组(均P<0.05);女性患者组血清COR水平显著高于正常女性组(P<0.01),SDNN、LF指数均显著低于正常女性组(均P<0.05)。结论抑郁症HPT轴无紊乱,仅HPA轴及自主神经功能出现紊乱,且HPA轴激素水平及心率变异性与躯体症状、失眠及性别因素有关。     

癌症相关创伤后应激障碍患者心率变异性研究

目的:探讨癌症相关创伤后应激障碍(PTSD)患者的心率变异性(HRV). 方法:采用临床用创伤后应激功能障碍诊断量表(CAPS)对150例癌症患者进行诊断性访谈,并分为PTSD组(37例)和非PTSD组(nPTSD组,30例);应用PTSD自评量表(PCL-C)对两组患者进行评估;采用生理相干与自主神经平衡系统对PTSD组、nPTSD组、健康对照(NC)组(30名)进行短时HRV检测,分析HRV指标与PTSD核心症状的相关性. 结果:与nPTSD组和NC组比较,PTSD组平静状态下R-R间期标准差(SDNN)和高频功率(HF)较显著下降,低频功率(LF)/HF显著升高(P均＜0.001);应激状态下PTSD组SDNN应激差值明显降低,HF和LF/HF应激差值显著增高(P均＜0.001);HRV指标与PTSD核心症状的严重程度显著相关(P均＜0.05). 结论:癌症相关PTSD患者自主神经功能紊乱,其核心症状的严重程度与自主神经功能紊乱显著相关.     

恶劣心境患者述情障碍与自主神经功能的相关研究

目的:探讨恶劣心境患者的人格特质、述情障碍与自主神经功能心理生理反应的相关机制。方法:采用多伦多述情障碍量表中文版(TAS-20-C)及心理健康测查表(PHI)对42例恶劣心境患者组(DD组)、33例重性抑郁症患者组(MD组)及30例健康对照组(NC组)进行述情障碍和心理健康水平和人格特质测定,并分析短时(5min)心率变异性(HRV),评定自主神经功能。结果:DD组TAS-20-C各因子得分及总分显著高于NC组(P<0.01),因子Ⅰ、因子Ⅱ及总分均明显高于MD组(P<0.01或P<0.05);DD组PHI量表躯体化、焦虑、病态人格及疑心因子分明显高于MD组(P<0.01或P<0.05);DD组HRV频谱指标中SDNN、PNN50及HF较MD及NC组均显著下降(P<0.01或P<0.05),LF∕HF较MD及NC组均明显升高(P<0.05);TAS-20-C总分及因子Ⅰ与躯体化、焦虑、病态人格、疑心均相关(︱r︱=0.25～0.38,0.40～0.44,0.47～0.59,0.43～0.42,P<0.01或P<0.05),因子Ⅱ与焦虑及变态人格相关(︱r︱=0.31,0.31,P<0.05);躯体化及焦虑与SDNN、VLF及LF均相关(︱r︱=0.26～0.27,0.39～0.27;︱r︱=0.36～0.28,P<0.05或P<0.01)。结论:恶劣心境患者存在明显的述情障碍,其人格特质可能导致患者焦虑程度更高,伴自主神经功能紊乱。     

伴有抑郁的老年冠心病患者自主神经功能的改变

目的:探讨伴有抑郁老年冠心病患者自主神经功能的改变。方法:根据汉密尔顿抑郁量表(HAMD)、Zung氏抑郁自评量表(SDS)、以及冠状动脉造影结果,将163例住院患者及健康体检者分为冠心病伴抑郁组(48例)、冠心病组(65例)、正常对照组(50例);并行24 h动态心电图检查,分析心率变异各项指标及其与抑郁程度的相关性。结果:与正常对照组相比,冠心病伴抑郁组与单纯冠心病组,时域指标均下降,频域指标中低频功率(LF)、LF/高频功率(HF)值上升。冠心病伴抑郁组的抑郁严重度与24 h正常RR间期标准差(SDNN)呈负相关,与LF/HF之间呈正相关(r=-0.967,r=0.971,P均0.05)。结论:伴有抑郁症状老年冠心病患者自主神经功能改变更明显,并与抑郁程度相关。     

痛风患者自主神经功能障碍及交感皮肤反应特征分析

目的分析痛风患者自主神经功能障碍临床特点及交感皮肤反应特征。方法共纳入25例2017年3月至2018年1月确诊的痛风患者,其中合并痛风石者10例、有自主神经功能障碍症状(有症状)者8例,肌电图进行交感皮肤反应检测。结果痛风组患者表现为以汗腺功能异常为主的自主神经功能紊乱症状。与正常对照组相比,痛风组患者下肢潜伏期延长(Z=-2.136,P=0.033)、波幅降低(Z=-2.959,P=0.003)。有症状组患者下肢波幅分别低于正常对照组(Z=-3.426,P=0.001)和无症状组(Z=-3.308,P=0.001);痛风石组患者下肢波幅低于正常对照组(Z=-3.176,P=0.001)和无痛风石组(Z=-2.301,P=0.021),而无痛风石组下肢潜伏期延长(Z=-2.518,P=0.120)、波幅降低(Z=-2.327,P=0.020)。结论痛风患者自主神经功能存在异常,以下肢损伤为主,尤其合并痛风石或有自主神经功能障碍症状者更为明显,交感皮肤反应可以客观评价自主神经功能状态。     

早年创伤与抑郁症和躯体形式障碍共病的关系

目的:探讨早年创伤经历与抑郁症和躯体形式障碍共病的相关性. 方法:选取58例抑郁症共病躯体形式障碍患者(共病组)和60例单纯抑郁症患者(非共病组)作为研究对象,采用早年创伤间卷简表(ETI-SF)评估早年创伤情况,汉密尔顿抑郁量表(HAMD)评估抑郁的严重程度;运用Mann-Whitney非参数检验和Binary Logistic回归分析早年创伤与抑郁症和躯体形式障碍共病患者的相关性.结果:与非共病组相比,共病组的受教育年限(t=-2.26)、年收入(t=-3.13)均显著低于非共病组(P＜0.05).共病组与非共病组ETI-SF总分(Z=-2.48)、早年躯体创伤(Z=-2.23)及早年情感创伤分量表分(Z=-5.32)差异均具有统计学意义(P＜0.05或P＜0.01).早年创伤问卷总分(B=0.226,OR=1.774;P＜0.05)、躯体创伤分(B =0.327,OR =0.893;P ＜0.05)、情感创伤分(B =0.469,OR=1.627;P ＜0.05)和HAMD总分(B =0.254,SE =0.681;P ＜0.001)进入最终的回归方程. 结论:抑郁症和躯体形式障碍共病患者经历较多早年创伤,其中早年情感虐待经历与抑郁症和躯体形式障碍共病倾向密切相关.     

抑郁症首次发病患者情绪加工特征及抗抑郁剂治疗前后的变化

目的 探讨首次发病(以下简称首发)抑郁症情绪加工特征及抗抑郁剂治疗前后变化与症状改善的关联作用.方法 17例抑郁症首发患者治疗前后及22名对照者完成情绪词识别任务.患者组抗抑郁剂治疗9周,以汉密尔顿抑郁量表(17项,HAMD)评估疗效.结果 (1)患者组治疗有效率为88%,HAMD总分减分率75%.(2)情绪词识别任务:抑郁症组治疗前后正性词遗漏数[分别为(7.4±6.9)个和(4.1±5.3)个]均大于负性词遗漏数[分别为(3.2±3.3)个和(1.8±2.7)个;P＜0.05),治疗后正性词遗漏数小于治疗前(P=0.002),与对照组[(3.0±2.6)个]差异无统计学意义(P=0.44);治疗前后负性词遗漏数[分别为(3.2±3.3)个和(1.8±2.7)个]与对照组[(2.1±2.4)个],以及正负性词错判数与对照组差异均无统计学意义(P＞0.05);正性词平均反应时治疗后[(514±68)ms]短于治疗前[(550±75)ms;P=0.036],负性词平均反应时治疗前后[分别为(540±80)ms和(521±61)ms]差异无统计学意义(P=0.16).(3)治疗前正性词遗漏数与抑郁症状和负性思维评分正相关(r=0.36～0.50,P＜0.05).(4)治疗前后正、负性词遗漏数变化对HAMD分数变化有不同预测作用(r_( chang) ~2=0.45,P=0.002).结论首发抑郁症患者可能存在正性情绪加工缺陷,治疗后可恢复至正常水平;以负性情绪加工占优势的认知结构不因抑郁症状缓解而改变;正负性情绪加工变化与症状改善可能有不同的关联作用.     

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.     

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.     

Sense of coherence as a predictor of subjective state of health: results of 4 years of follow-up of adults

A number of cross-sectional population studies have shown that a strong sense of coherence (SOC) is associated with various aspects of good perceived health. The association does not seem to be entirely attributable to underlying associations of SOC with other variables, such as age or level of education. OBJECTIVE: The aim of the study reported here was to determine whether SOC predicted subjective state of health. METHODS: The study was carried out as a two-way panel mail survey of 1976 individuals with 4 years interval for two collections of data. The statistical method used was multivariate cumulative logistic modeling. Age, initial subjective state of health, initial occupational training level, and initial degree of social integration were included as potential explanatory variables. RESULTS: A strong SOC predicted good health in women and men. CONCLUSIONS: SOC can be interpreted as an autonomous internal resource contributing to a favorable development of subjective state of health. SOC data should, however, be regarded as complementary to and not a substitute for information already known to be associated with increased risk of future ill health.