Severe mental disorders after prolonged post-traumatic coma

Using observation in a number of patients with severe closed head injuries followed by prolonged coma and of which three are reported in detail, the authors present an analysis of the resulting psychiatric problems. After a brief review of the literature they suggest a central psychopathological "core" common to such head injuries beneath their seemingly diverse symptomatology. This "core" seems to be built up around the following disturbances: 1) Memory disorders; 2) Perceptual problems and difficulties with the association of ideas; 3) Excessive tiredness and concomitant reduction in the powers of concentration.     

酒精中毒致精神障碍患者脑内神经递质功能研究

目的利用脑涨落图仪检测酒精中毒所致精神障碍患者脑内多种神经递质功能,探讨酒精中毒所致精神障碍的发病机制。方法筛选符合《中国精神障碍分类及诊断标准(第3版)》(CCMD-3)酒精所致精神障碍的诊断标准的患者为实验组,健康人员为正常对照组,对两组人员均进行脑涨落图仪检测,比较分析两组人员的检测结果。结果与正常组对比,实验组的9种神经递质功率均降低,差异有统计学意义(P0.05)。实验组的NE相对功率显著低于对照组(P0.05)。实验组的全脑总功率、运动指数和血管舒缩指数均显著低于对照组(P0.05)。结论酒精中毒所致精神障碍患者脑内多种神经递质功能降低,尤其是NE功能降低更为明显,同时还有脑血管舒缩功能障碍。脑涨落图仪能够检测分析脑内神经递质的功能和脑神经细胞的供血情况,对研究酒精中毒所致精神障碍发病机制有帮助。     

多种精神障碍患者睡眠质量的调查

目的 研究精神障碍患者的睡眠特点和规律.方法 以河北省精神疾病流行病学现场抽样调查中符合美国精神障碍诊断与统计手册第4版诊断标准的13种精神障碍患者1874例(患者组)为研究样本.以调查中元任何精神障碍者15 117名为正常对照(对照组),采用匹兹堡睡眠质量指数中国修订版,评定两组最近1个月的睡眠质量,以>7分为有睡眠问题;采用功能大体评定量表评定社会生活功能.结果 (1)患者组有睡眠问题的发生率为48.61%(911例),高于正常人(5.55%,839例;P<0.01),其中以抑郁症者(69.92%)和广泛性焦虑障碍者(58.27%)为重.(2)患者组的睡眠质量问题表现为人睡时间长[(50±60)min]、总睡眠时间短[(7.1±4.3)h;P<0.01],对照组分别为(20±26)min和(8.4±2.4)h;抑郁症、心境恶劣障碍和广泛性焦虑障碍者早醒明显.(3)精神分裂症者[(1.0±1.4)分]和双相障碍者的[(0.7±1.3)分]催眠药物评分较高.(4)抑郁症[(1.8±1.2)分]和双相障碍[(1.6±1.3)分]患者日间功能最差.(5)患者组有睡眠问题者较无睡眠问题者的年龄偏大,教育水平低,功能损害更严重,女性多于男性,丧偶、农民、离退休、病退和家庭妇女有睡眠问题者较多.结论 精神障碍患者睡眠障碍发生率高,表现为人睡困难和总睡眠时间短,其中抑郁症患者最为明显;有睡眠问题受多种因素的影响.     

立体定向术治疗精神障碍11例

目的 探讨立体定向术治疗精神障碍的疗效.方法 回顾性分析经立体定向术治疗的11例精神障碍病人的临床资料,其中难治性强迫症7例,抽动秽语综合征3例,双相情感障碍1例.分析手术前后耶鲁-布朗强迫量表(Y-BOCS)、汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)分值、脑白质纤维束变化及脑葡糖代谢情况.结果 术后6个月病人的各量表分值较术前均明显下降(均P<0.05),无严重并发症.大脑MR/弥散张量成像显示内囊前肢的横行纤维被毁损,大脑18F-FDG PET显示眶额皮质、运动区、运动前区、基底核、丘脑和边缘系统的高代谢区在术后明显降低.结论 立体定向术是治疗难治性精神障碍的有效方法.     

牛肝蕈中毒所致精神障碍30例临床分析

目的：分析牛肝蕈中毒所致精神障碍的临床表现及治疗。方法：对食用牛肝蕈，符合中国精神障碍分类与诊断标准第3版非成瘾物质所致精神障碍诊断标准的30例患者进行临床分析。结果：牛肝蕈中毒所致精神障碍的临床表现为精神分裂样症状，有特殊的“小人”幻视、妄想、兴奋紧张、失眠、行为紊乱等，并对肝脏和血液系统等有损害。精神障碍的程度与食蕈量有关；精神症状越重，所需缓解时间越长。经短程抗精神病药物等相应处理后精神病性症状可消除。结论：过量食用牛肝蕈可影响和损害神经系统，经短程抗精神病药物治疗，精神障碍可在短时间内治愈。     

The Epworth sleepiness scale: relationship to sleep and mental disorders in a sleep clinic

BACKGROUND AND PURPOSE: Both sleep disorders and mental disorders are associated with excessive daytime sleepiness as measured by the Epworth sleepiness scale (ESS). We sought to assess the relationship between the ESS scores and mental disorders in a sleep clinic. METHODS: One hundred sixty-five consecutive new referrals to a sleep clinic completed the ESS prior to their initial visit. Mental disorders (major depression, minor depression, anxiety not otherwise specified, and panic disorder) were diagnosed with the primary care evaluation of mental disorders (PRIME-MD) questionnaire, a reliable and valid instrument. Nearly all sleep diagnoses (95%) were made by polysomnography. RESULTS: The mean ESS for the cohort was 12.3 (standard deviation (SD) 5.1). There was no difference in the mean ESS for those with and without mental disorders (12.8 vs. 12.2, P=0.48) or sleep-disordered breathing (SDB) (12.3 vs. 12.3, P=0.99). ESS scores were not different between patients with a comorbid mental disorder and SDB compared with the presence of a mental disorder or SDB alone (combination: 13.0 vs. mental disorder: 11.5 vs. SDB: 12.2, P=0.70). There was also no relationship between ESS scores and the respiratory disturbance index (RDI) (P=0.63). CONCLUSIONS: We found no relationship between ESS scores and mental disorders among referrals to a sleep clinic. ESS cannot be used to screen for mental disorders among sleep clinic patients.     

101例首次住院气功所致精神障碍患者的5年随访

目的:探讨气功所致精神病性障碍患者的预后.方法:采用门诊检查和访问家属的形式,对101例气功所致精神障碍患者5年以后的状况进行随访.结果:67例(66.34%)稳定,34例复发(33.66%),其中3例残废,80例(79.2%)维持出院论断,18例(17.8%)改诊为其他精神疾病,72例(71.29%)停止精神科治疗,92例(91.1%)缓解期社会功能政党,9例(8.9%)减退,结论:使用CCMD论断的气动所致精神障碍患者怕短期结局比较稳定,停止治疗和继续练功可能导致疾病复发,改诊的原因比较复杂,可能与论断标准有关.     

Treatment of sleep disorders may improve fatigue in multiple sclerosis

Objective

In a previous polysomnographic cross-sectional study we found a significant relationship between sleep disorders and multiple sclerosis (MS) related fatigue. The purpose of this open follow-up observation was to compare the impact of treatment of sleep disorders on MS related fatigue measured with the Modified Fatigue Impact Scale (MFIS).

Methods

Non-randomized follow-up observation: treated versus untreated patients, subgroups according to compliance with sleep medical treatment recommendations (univariate, multivariate analysis, multiple logistic regression). 66 MS patients were followed after polysomnography, 49 patients with relevant sleep disorders and 17 without.

Results

Mean MFIS scores decreased from 41.2 to 26.2 (p = 0.025) in patients with good compliance (GC; n = 18), from 42.4 to 32.1 (p = 0.12) in patients with moderate compliance (MC; n = 12), and from 41.6 to 35.5 (p = 0.17) in non-compliant patients (NC; n = 17). Mean MFIS values increased in patients without sleep disorders from 22.9 to 25.4 (NSD; n = 12, p = 0.56). In multiple logistic regression, treatment of sleep disorders predicted decrease of MFIS-values (GC versus NSD odds ratio 13.4; p = 0.015; 95% confidence interval (CI) 1.7–107.2, MC versus NSD odds ratio 13.8; p = 0.028; 95% CI 1.3–143.3).

Conclusions

Sleep medical treatment may improve MS related fatigue when patients adhere to treatment recommendations.     

痴呆相关性睡眠障碍的发生机制和处理

多数痴呆患者存在不同程度的睡眠障碍。但目前人们对痴呆相关性睡眠障碍的了解甚少。本文综述了痴呆相关性睡眠障碍的临床表现、发病机理和治疗方法。褪黑素治疗和其他一些方法能改善痴呆患者的睡眠障碍。