抑郁症患者和正常人威斯康星卡片分类测验的比较研究

目的：探讨抑郁症患者认知功能障碍的特点。方法：对67例符合ICD－10抑郁症诊断标准的抑郁症患者和44例正常人进行威斯康星卡片分类测验（WCST），并对其中21例经过6周抗抑郁药治疗的患者进行治疗产后比较，观察WCST与HAMD评分变化的关系。结果：抑郁症患者WCST的总测验次数，持续错误数和随机错误数同正常人相比较均有显著差异（P＜0．01），相关分析发现：WCST的总测验次数，持续错误数，随机错误数与年龄，HAMD总分及迟缓，日夜变化两因子分正相关（P＜0．01），正确数和分类数与年龄，HAMD的迟缓因子分成负相关（P＜0．05），WCST在两组按性别及文化程度再分组比较后发现，各组间无显著性差异，对21例患者治疗前后比较发现WCST随病情的好转而改善，而治疗前后WCST的总测验次数、持续错误数，随机错误数的减分率与HAMD减分率正相关（P＜0．05），结论：抑郁症患者存在认知功能缺损，其认知功能缺损与病情的严重程度及抑郁症的迟滞和日夜变化等症状有关，认知功能的降低可能反映病人额叶功能的缺损。     

精神分裂症患者的认知功能障碍

目的：探讨精神分裂症患者认知功能障碍的特点及以及比较威斯康星卡片分类测验（WCST）与色、数、形测验的一致性。方法对31例精神分裂症及25名正常人进行WCST、韦氏记忆量表（WMS）、简式中国修订版韦氏成人智力量表（WAIS－RC）及色、数、形判断能力的测验,结果：精神分裂症组的各种测验成绩均显著低于对照组,差异有显著性（P＜0．05或P＜0．01）。结论1,精神分裂症患者有较广泛的认知功能损害;2WCST与色、数形测验结果具有一致性。     

以阴、阳性症状为主的精神分裂症患者威斯康星卡片分类测验的比较研究

目的探讨精神分裂症患者认知功能障碍的特点。方法对２３例以阴性症状为主的精神分裂症、３０例以阳性症状为主的精神分裂症和２８名正常人进行了威斯康星卡片分类测验（ＷＣＳＴ）。结果显示以阴性症状为主的精神分裂症患者的总测验次数、持续错误数和非持续错误数明显高于以阳性症状为主的精神分裂症患者和正常人，差异有显著性（Ｐ＜０．０５）。同时发现，ＷＣＳＴ的以上测验指标在两组患者之间差异亦有显著性（Ｐ＜０．０５）。相关分析显示，以阴性症状为主的精神分裂症患者的Ａｎｄｒｅａｓｅｎ阴性症状量表总分与简明精神病评定量表的迟滞因子分和持续错误数呈显著正相关（ｒ分别为０．４３７２和０．４５５１）。结论提示精神分裂症患者存在执行功能障碍，其中阴性症状可能与额叶功能缺陷有关。     

老年精神分裂症患者认知功能与社会功能研究

目的探讨老年精神分裂症患者的认知功能及社会功能损害情况。方法采用一系列标准化神经心理测验工具：韦氏记忆测验（WMS）、威斯康星卡片分类测验（WCST）、简易智力状态检查（MMSE）和日常生活能力量表（ADL），测定45例老年精神分裂症患者（研究组）的认知功能和社会功能，并与42例正常老年人（对照组）作对照。结果研究组在WMS中的经历、定向、1→100、100→1、累加、再认、记图、再生、联想、触摸、理解、背数等项成绩均差于对照组（P均〈0．05或0．01）。WCST研究组总正确数和分类次数均小于对照组，而总错误数、持续错误数和持续反应数均高于对照组（P均〈0．01）。MMSE成绩研究组显著低于对照组（P〈0．05），ADL研究组显著高于对照组（P〈0．05）。结论老年精神分裂症患者存在突出的认知功能和社会功能损害。     

精神分裂症患者机体抗氧化功能指标的实验研究

目的 探讨机体抗氧化能力在精神疾病发病机理中的作用及其临床意义。方法 采用化学比色法检测176例精神分裂症患者血清中SOD、MDA、GSH－Px、VC、VE和NO含量。结果 精神分裂症患者血清中SOD、MDA、NO含量均高于对照组（P＜0．05或0．01）;GSH－Px、VC含均低于对照组（P＜0．01）;VE两者无显著差异（P＞0．05）;精神分裂症家族史阳性者血清中NO高于精神分裂症阴性家族史者（P＜0．05）;精神分裂症患者抗氧化能力含量可因病程、性别、年龄的不同而不同;精神分裂症患者治疗后SOD、MDA低于治疗前（P＜0．01）。结论 精神分裂症患者体内自由基代谢异常可能是精神分裂症发病的生物学因素之一。     

海洛因依赖者记忆力与氧化应激的关系

目的：探讨男性海洛因依赖者（MPHD）记忆力改变及其与氧化应激的关系。方法：对140例MPHD及75名健康者对照进行韦氏记忆量表（WMS）评估和氧化应激指标血清一氧化氮（NO）、丙二醛（MDA）、超氧化物歧化酶（SOD）、维生素C（VC）及总抗氧化能力（T-AOC）的检测。结果：MPHD组WMS的测验成绩显著差于对照组（P〈0．05）；MPHD组血清MDA水平高于对照组（P〈0．05），T-AOC、VC、SOD水平低于对照组（P〈0．05或P〈0．01）；随戒断时间延长，MPHD组的记忆商数（MQ）有升高的趋势（P〉0．05），血清MDA含量有下降的趋势（P〈0．01），T-AOC、SOD含量有升高的趋势（P〈0．05）。MPHD组血清NO及MDA水平与WMS多个因子呈负相关（P〈0．05或P〈0．01），T-AOC、VC及SOD水平与WMS多个因子呈正相关（P〈0．05或P〈0．01）。结论：海洛因依赖者存在明显的记忆力损害与氧化抗氧化反应失衡；其记忆力损害可能与氧化应激有关，血清NO、MDA、SOD、VC、T-AOC可能是与记忆力密切相关的氧化应激指标。     

长期住院男性精神分裂症患者认知功能调查

目的：探讨长期住院男性精神分裂症患者的认知功能。方法：采用数字划消测验、空间广度测验评定57例男性长期住院精神分裂症患者（患者组）和57名正常对照者（正常对照组）的认知功能。结果：患者组在数字划消测验的完成时间、漏划个数以及空间广度测验的总分、顺行得分、逆行得分上明显差于正常对照组（t=8．21,t=3．47,t=4．72,t=2．36,t=5．88;P〈0．05或P〈0．001）。相关分析显示,患者的病程、服药时间与数字划消测验的完成时间呈显著正相关（r=0．41,P〈0．01;r=0．30,P〈0．05）。结论：长期住院男性精神分裂症患者的认知功能明显受损,且与患者的病程和服药时间相关。     

精神分裂症患者利培酮治疗前后认知功能的研究

目的　了解利培酮治疗对精神分裂症病人认知功能的影响 ,及认知功能与阳性和阴性症状的关系。方法　对 30例精神分裂症或分裂样精神病患者 ,在利培酮治疗前后进行威斯康星卡片分类测验 (WCST)。结果　治疗后WCST总测验次数、持续错误数、非持续错误数均少于治疗前 ,有显著性差异 ,P <0 .0 1或P <0 .0 5。PANSS总分的改善与WCST总测验次数、持续错误数呈正相关 ;阳性症状量表分的下降与WCST总测验次数、持续错误数、非持续错误数呈正相关 ,与正确反应数呈负相关 ;而阴性症状量表分的下降与WCST的各项指标之间无明显相关关系。结论　经利培酮治疗后 ,精神分裂症病人在症状改善的同时 ,认知功能也有明显提高 ,且认知功能的提高与阳性症状的改善存在着明显相关性 ,而与阴性症状的改善关系不大 ,提示两者可能存在异质性。     

奥氮平对精神分裂症认知障碍的疗效及糖、脂代谢的影响

目的 观察奥氮平对精神分裂症患者认知功能障碍的疗效及其对患者糖、脂代谢影响。方法 将60例接受单一奥氮平治疗的精神分裂症患者，采用修订韦氏记忆量表（WMS-RC）评定记忆功能；威斯康星卡片分类测验（WCST）评定执行功功能；PANSS量表评定精神症状；并检测血糖、胆固醇和甘油三脂，分别在治疗前、治疗8周末各进行1次。结果 经过8用的奥氮平治疗后，记忆商数显著提高（P〈0．001）；威斯康星卡片分类测验的总测验次数、持续错误数及随机错误数均显著下降（P〈0，05或P〈0．01）；并且奥氮平对记忆功能、执行功能的改善与阳性症状、阴性症状的下降呈显著正相关。治疗8周末血糖、胆固醇和甘油三脂水平均显著高于治疗前（P〈0．05或P〈0．01）。结论 奥氮平能有效的改善精神分裂症患者的认知功能障碍，但应重视其对患者糖脂代谢的副作用．     

儿茶酚氧位甲基转移酶基因多态性与抑郁症认知功能的关联性研究

目的探讨儿茶酚氧位甲基转移酶（COMT）基因多态性与抑郁症认知功能及其严重程度的关系。方法采用病例一对照研究。应用聚合酶链反应（PCR）及聚丙烯酰胺凝胶电泳（PAGE）方法．检测抑郁症患者（患者组）和健康志愿者（对照组）COMT基因多态性分布。患者组评定24项汉密尔顿抑郁量表（HAMD-24）、威斯康星卡片分类测验（WCST）、中国韦氏成人记忆量表（WMS—RC）、连线A、B测验。结果COMT等位基因与基因型频率在患者组和对照组内均有显著性差异（Χ^2检验,P均〈0．01）,在两组间无显著性差异（Χ^2检验,P均〉0．05）;患者组COMT等位基因、基因型之间在WCST、WMS—RC和连线A、B测验无显著性差异（F检验,P均〉0．05）,但在HAMD-24认识障碍因子分上均有显著性差异（F检验,P均〈0．05）;患者组基因型A／A与认识障碍（r=-0．210,P=0．036）、绝望感（r=-0．331,P=0．001）均呈负相关;等位基因A与绝望感呈负相关（r=-0．220,P=0．028）;等位基因G与认识障碍（r=0．210,P=0．036）、绝望感（r=0．331,P=0．001）均呈正相关。在WCST测验中,等位基因G与持续错误数呈正相关（r=0．341,P=0．000）;在WMS—RC测验中,等住基因G与数字广度（倒背）呈负相关（r=-0．327,P=0．001）。结论提示COMT基因多态性与抑郁症患者的疾病严重程度及认知功能的改变存在相关性。     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.     

Clobazam for Treatment of Intractable Epilepsy: A Critical Assessment

Summary: Clobazam (CLB), a 1,5-benzodiazepine, is a remarkably effective add-on drug for individual patients with refractory partial epilepsy. CLB has an excellent safety record. As with all benzodiazepines used for treating epilepsy, sedation and withdrawal effects, together with the development of tolerance, limit its usefulness. Recent efforts to prevent or reverse tolerance with intermittent administration of CLB or periodic injection of a benzodiazepine antagonist, flumazenil, are encouraging and justify further investigations.     

La passion de Torquemada et le terrorisme islamique : quelques points de comparaison

This original research compares the doctrinal, psychopathological and operational standpoints of the 15th century Spanish Inquisition (Torquemada) with those of radical Islamism from 1988 to 2005 (Al-Qaeda). The following are reviewed: (a) the main texts codifying the procedure for conducting the criminal investigation of a Holy Office trial (Directorium inquisitorum); (b) the life and work of the grand inquisitor Tomás de Torquemada (1420–1498); (c) the psychopathological relations between passion (passionate psychoses, passionate idealism, paranoid personality) and fanaticism; (d) “the madmen, the enlightened and the criminals” of Islamic terrorism; (e) the cognitive and emotional motives for engagement in the jihadist radicalization of young people; (f) the common principles of monotheistic fanaticism (Inquisition, Al-Qaeda) and the particular dogmas of Islamic terrorism in our time; (g) the operating modes of the Inquisition and the Jihadist holy war. The author concludes that the rigour and seriousness of the inquisitorial judicial procedure, which was precise, individual and personalized, contrasts with the revolutionary pamphlets of Al-Qaeda, which only provide broad guidelines for the modus operandi of the fight against infidels, who are usually random victims.     

Claustration et collectionnisme : réflexions à propos d’un cas de syndrome de Diogène avec vols kleptomaniaques et vengeurs

Social withdrawal is a pathognomonic behaviour that is consistently associated with mental illnesses. Compulsive hoarding can also be interpreted as a pathological behaviour, even when it does not involve kleptomania. Diogenes syndrome (DS) was first described in 1975, and is characterized by both behaviours - social withdrawal and compulsive hoarding. Even though it is often the manifestation of a psychiatric condition, its aetiology is diverse. The most frequent ones are however: dementia, schizophrenia and mental retardation. In this study, we describe an atypical case presenting with DS. Il consists of a young man, seen in a forensic setting, who had been diagnosed with kleptomania in the past, presents with compulsive hoarding, and whose recent thefts were fuelled by revenge. Finally, to our knowledge, the way social withdrawal is viewed is seldom taken into account. We analyse its implication on social withdrawal.     

Neurological soft signs and schizophrenia: a review of current knowledge

Schizophrenia is a frequent and disabling disorder emerging during adolescence or early adulthood. The identification of underlying processes has been hampered by the complex clinical expression and the probable etiological heterogeneity. The frequency of neurological soft signs (NSS) in patients with schizophrenia and their presence early in life (during the first two years) in high risk subjects support the hypothesis that schizophrenia is a "brain disease" reflecting pre- or perinatal insults during development. The growing interest for NSS has lead to multiple studies that are often difficult to compare. The objective of this review is to summarize the current knowledge on NSS, methodological issues and the future perspectives.     

Lacan, lecteur de Minkowski : l'approche structurale

The notion of structure occupies a predominant place in the theory of Lacan. He indicates that was developed from the work of Minkowski. In fact, through his phenomeno-structural approach, Minkowski does not limit himself to purely observable phenomena, but attempts to determine the underlying structure. He refers to the comprehensive phenomenology and psychopathology, and this method provides him with clinical finesse and another means of determining a diagnosis. Thus Lacan has used this as a basis for his approach to structure to develop a theory regarding the individual. This implies that the structure of the individual is based on his relation to language. From this concept, he then develops the clinical structures of neurosis, psychosis, and perversion. These structural landmarks also have an effect on the course of treatment.