精神分裂症与瑞文测验

应用瑞文标准推理测验测查50例精神分裂症患者的智力情况,所得总分明显低于正常对照组,各分组(A、B、C、D、E)得分,以 E 组最低,其顺序为 A>B>C>D>E 组。提示精神分裂症在知觉辨别力、图形比较、图形想象能力方面保持较好。在图形推理系列关系、图形的套合、组合、互换等抽象思维方面则有程度不等的损害。     

精神分裂症患者血清性激素水平及其与临床特征的相关性

目的:探讨精神分裂症患者血清性激素水平变化及其与精神症状、认知功能的相关性。方法:检测84例精神分裂症患者(病例组)治疗前后血清泌乳素(PRL)、睾酮(T)及雌二醇(E2)水平,并与42例非精神分裂症患者(对照组)比较;分析病例组血清性激素水平与阳性与阴性症状量表(PANSS)评分、数字符号测验、数字广度、语义流畅性测验评分的相关性。结果:病例组治疗前后血清PRL、T水平明显高于对照组(P均0.05);与治疗前比较,治疗后血清PRL明显升高、T明显降低(P均0.05)。女性病例组治疗前后血清E2浓水平明显低于对照组(P均0.05)。病例组血清PRL、T及E2水平与PANSS总分、及各认知功能测验评分无相关(P均0.05),血清T水平与PANSS中兴奋性、冲动控制障碍评分呈正相关(r=0.26,r=0.33;P均0.05)。结论:精神分裂症患者血清性激素水平异常,但与其病情和认知功能改变不相关;但血清T水平可能适用于其临床兴奋、冲动的风险评估。     

儿童精神分裂症认知功能研究

目的:探讨儿童精神分裂症患者的认知功能及与临床症状的关系. 方法:60例未经治疗的儿童首发精神分裂症患者(研究组)和30名健康学龄儿童(对照组),采用中国韦氏儿童智力量表(C-wIsc)、临床记忆量表和瑞文标准推理测验进行认知功能评定;研究组以阳性症状量表(SAPS)和阴性症状量表(SANS)进行临床评估. 结果:研究组总智商(FIQ)评分(97.2±15.6)分,言语智商(VIQ)(100.4±12.6)分和操作智商(PIQ)(90.5±15.3)分显著低于对照组的(115.3±13.7)分,(119.2±11.8)分和(110.6±14.8)分(P均=0.000).研究组等值记忆商MQ评分(70.5±15.2)分显著低于对照组(105.9±13.8)分(P均<0.001).研究组瑞文标准推理测验标准分中位数为5分,对照组为3分(X<'2>=6.44,P<0.05).研究组IQ、MQ及瑞文标准推理测验与SAPS阳性症状评分无显著相关,但与某些SANS阴性症状评分显著相关(r=-0.36,-0.42;P<0.05或P<0.01). 结论:儿童精神分裂症患者存在认知功能障碍,表现为智力发展不平衡、记忆障碍以及执行功能障碍;临床记忆及瑞文标准推理测验缺损与阴性症状严重程度有一定的关系,但与阳性症状无关.     

立体定向手术对阿片类药物依赖病人近期智力水平的影响(附24例分析)

目的观察立体定向手术对阿片类药物依赖者智力水平的影响情况。方法24例接受手术治疗的阿片类药物依赖病人，分别于手术前、后采用瑞文测验一联合型图册法检测其智力水平，统选知觉辨别、类同比较、比较推理、系列关系、抽象推理五单元分别施测，比较手术前、后智力变化。结果手术前智商（IQ）均数为79.46，术后近期IQ均数为85.92，术后IQ平均提高6.46。多数病人智力水平有不同程度地提高。结论立体定向手术对阿片类药物依赖者核心智力近期无不良影响，手术治疗成瘾性脑病不会损害病人智力。     

儿童期精神分裂症患者认知功能研究

目的:探索儿童期精神分裂症患者认知功能情况。方法:对15名年龄≤16岁以妄想为主要症状的精神分裂症患者(患者组)及15名正常匹配儿童(对照组)进行认知功能测验(包括听觉词汇学习、数字广度、数字符号及瑞文标准推理测验)。结果:患者组在听觉词汇学习、数字广度、数字符号及瑞文标准推理测验成绩均较对照组差。其中,知觉辨别的效应值最大为-2.10,其次为比较推理-1.68、抽象推理-1.59、即刻记忆-1.50、数字符号-1.44、系列关系-0.85、数字广度(倒背、正背)分别为-0.77,-0.58、类同比较-0.30、延迟记忆保持率的效应值为0.32。结论:儿童期精神分裂症患者在智能、逻辑推理、记忆功能、注意功能、执行功能等方面均有不同程度的损害。     

沙盘游戏联合感觉统合治疗对儿童注意缺陷多动障碍的效果

目的探讨沙盘游戏治疗儿童注意缺陷多动障碍(ADHD)的临床疗效。方法本研究对象为我院2019年1月~2021年1月80例ADHD患儿,随机分为两组,对照组采用常规感觉统合治疗,观察组在常规治疗基础上联合沙盘游戏治疗,共干预12周。治疗前后采用Conners的儿童行为量表(PSQ)评估患儿行为及情绪状况,采用联合型瑞文测验(CRT)评估患儿各项能力。结果两组治疗后PSQ量表中品行、心身障碍、焦虑、冲动、学习、多动评分均显著降低,且治疗后观察组各项评分显著低于对照组(P<0.05);两组治疗后CRT量表类同比较、比较推理、系列关系、知觉辨别、抽象推理、智商数评分均显著升高,且治疗后观察组各项评分显著高于对照组(P<0.05)。结论沙盘游戏联合感觉统合治疗ADHD能显著改善患儿行为及情绪状况,提高类同比较、知觉辨别等能力。     

脑外伤后伤残鉴定患者二项必选数字记忆测验与瑞文测验成绩的相关分析

目的 探讨以二项必选数字记亿测验(BFDMT)的得分来反映瑞文标准推理测验(以下简称为琐文测验)成绩真实程度的可能性。方法 对以例脑外伤后伤残鉴定的患者进行BFDMT和瑞文测验，以BFDMT总分划界分区分出前无伪装，并以得分高低划分成5个不同程度组，比较伪装组与非伪装组及不同程度组间BFDMT得分与瑞文测验成绩的差异及其相关性。结果 (1)伪装组琐文测验各因子分、总分及智商值均低于非伪装组(P＜0．01)；(2)不同程度伪装组间瑞文测验的总分和智商值差异有非常显著性(P＜0．01)，且BFDMT得分越低，瑞文测验成绩越差；(3)BFDMT的困难条目分、容易条目分及总分与瑞文测验各因子分、总分及智商值均呈显著正相关(P＜0．05—P＜0．01)，两个测验总分的相关性为0．743。结论 BFDMT得分高低在一定程度上能够反映被试者瑞文测验成绩的真实程度。     

精神分裂症患者认知功能与社会功能的相关性

目的探讨精神分裂症恢复期患者认知功能对社会功能的影响。方法对80例精神分裂症恢复期患者采用瑞文标准测验（CRT）、韦氏成人智力量表（WAIS）、威斯康星卡片测验（WCST）,分别与社会功能缺陷量表（SDSS）进行多重线性回归分析。结果经逐步回归分析显示,WCST中变量（正确反应数、持续错误数、分类数）、WAIS中言语量表分、CRT中瑞文总分进入回归方程,拟合的回归方程均有统计学意义。其中瑞文总分、言语量表分与SDSS呈线性负相关关系,持续错误数与SDSS呈线性正相关关系;比较WCST、CRT、WAIS与SDSS的相关性,回归模型的拟合最好的为WCST。结论精神分裂症患者的认知功能与社会功能有显著相关性,正确的评测及改善认知功能对提高患者的社会功能有重要意义,WCST提供了一个有效预测精神分裂症患者社会功能的重要方法。     

二甲双胍对奥氮平治疗后肥胖伴闭经的精神分裂症患者性激素水平及月经的影响

目的观察二甲双胍在奥氮平治疗后肥胖患者降重过程中,性激素的变化及闭经恢复情况。方法奥氮平治疗后肥胖伴闭经的精神分裂症患者随机分为两组,维持原奥氮平治疗方案不变;对照组(n=32)仅予生活方式干预,二甲双胍组(n=31)尚予加用二甲双胍(1500mg/d),为期6月。测定治疗前、治疗后性激素5项,包括催乳素(PRL)、黄体生成素(LH)、卵泡刺激素(FSH),雌二醇(E2)、睾酮(T),以及体质量指数(BMI),随访月经恢复情况。结果治疗后,二甲双胍组LH增高(P0.05),PRL、T、BMI下降(均P0.05),差异有统计学意义,FSH、E2无显著变化(P0.05);对照组性激素5项、BMI较治疗前无显著差异(均P0.05)。治疗后,二甲双胍组LH高于对照组,PRL、T、BMI低于对照组,差异有统计学意义(均P0.05)。二甲双胍组月经恢复率(35.5%)高于对照组的(3.1%),差异有统计学意义(P0.05)。结论二甲双胍在降低奥氮平治疗后肥胖患者体重同时,对部分性激素水平有影响,并可部分改善闭经。     

万拉法新对抑郁症患者血清性激素的影响

目的 探讨万拉法新对抑郁瘟患血清性激素的影响。方法 用放免法测定42例抑郁症患治疗前和治疗后1、6周末血清催乳素(PRL)、促滤泡成熟激素(FSH)、促黄体生成素(LH)、睾酮(T)、雌二醇(E2)，并与30例健康对照。结果 抑郁症组男性LH、E2和女性PRL、FSH与对照组比较明显升高。治疗后1、6周末男性患PRL、T、E2和女性PRL、T有显差异。结论 抑郁症患存在下丘脑—垂体—性腺轴内分泌异常，万拉法新可引起抑郁症患性激素分泌变异。     

抑郁症患者的性激素分析

目的　研究抑郁症患者垂体促性腺激素及外周性激素的功能状态,探讨性激素水平改变与性有关症状和药物治疗的关系。方法　采用放射免疫法测定３０ 例（ 男１１ 例,女１９ 例） 抑郁症患者血清促卵泡激素（ Ｆ Ｓ Ｈ） 、黄体生成素（ Ｌ Ｈ） 、催乳素（ Ｐ Ｒ Ｌ） 、睾丸酮（ Ｔ） 、雌二醇（ Ｅ２） 等激素水平,并与２０ 例（ 男女各１０ 例） 正常人对照。结果　试验组男性 Ｌ Ｈ 和女性 Ｆ Ｓ Ｈ、 Ｒ Ｐ Ｌ 明显高于对照组,其他性激素水平两组间无显著性差异。药物治疗前后男性患者 Ｐ Ｒ Ｌ、 Ｔ、 Ｅ２ ,女患者 Ｐ Ｒ Ｌ、 Ｔ 等激素分泌改变非常显著。结论　提示抑郁症患者性腺轴存在功能失调。性有关症状与性激素水平改变无关。抗抑郁治疗可导致性激素分泌紊乱。     

绝经后妇女脑梗死患者性激素变化与胰岛素抵抗的关系

目的：为探讨绝经后妇女脑梗死患者性激素水平变化及与胰岛素抵抗的关系。方法：对３３例绝经１年以上妇女脑梗死患者（Ａ组）与２１例绝经１年以上无脑梗死健康妇女（Ｂ组）的血清雌二醇（Ｅ２）、促卵泡刺激素（ＦＳＨ）、促黄体生成素（ＬＨ）、睾酮（Ｔ）、血浆葡萄糖（Ｇ）、血浆胰岛素（ＩＮＳ）及胰岛素敏感指数（ＩＳＩ）进行检测。结果：Ａ组Ｅ２水平较Ｂ组明显降低,ＦＳＨ、ＬＨ、Ｔ水平显著增高。相关分析发现,Ｅ２与ＩＳＮ是显著负相关,而Ｅ２与ＩＳＩ呈显著正相关;Ｔ与ＩＮＳ呈显著正相关,与ＩＳＩ是显著负相关。结论：绝经后妇女脑梗死患者存在严重的性激素失调,且与胰岛素抵抗并存,可能参与绝经后妇女脑梗死发生和发展。     

Estrogen positive feedback on LH secretion in transsexuality

In order to test the hypothesis whether there is variation in hormonal levels or response to hormonal manipulation that could permit a distinction between heterosexuals and transsexuals, we designed the following protocol: Six male-to-female (m-to-f) transsexuals, six heterosexual control females and six female-to-male (f-to-m) transsexuals were given estradiol benzoate (E2B) (4.5 micrograms/kg/12 hr) for five days. In the female population, E2B treatment was initiated on day 5 of the menstrual cycle. In all the subjects blood luteinizing hormone (LH) and follicle stimulating hormone (FSH), estradiol-17 beta (E2) and testosterone (T) levels were measured twice daily. Additionally, LH and FSH responses to LHRH (100 micrograms iv) stimulation prior to and on day 5 of the E2B treatment were evaluated. In the m-to-f transsexuals, T levels decreased sharply and progressively during estrogen treatment, along with a fall in LH and FSH levels. The magnitude of the LH and FSH responses to LHRH stimulation also decreased following estrogen administration. In the heterosexual female controls and in the f-to-m transsexuals, estrogen administration increased LH levels to a minimum of 100% above initial values from day 3 onwards. Interestingly, the magnitude of the LH increase in the f-to-m transsexuals was greater than that of the heterosexual female controls. In both groups, LHRH stimulation resulted in a greater LH response compared to that prior to estrogen treatment. Our present observations, based on blood hormonal levels and responses to hormonal manipulations do not permit a distinction between heterosexual females and f-to-m transsexuals. There was no convincing evidence for the existence of a positive estrogen feedback on LH secretion in m-to-f transsexuals. These results contradict some of the reported hypotheses concerning hormonal alterations in these individuals.     

成年男性癫痫患者血清性腺激素水平的变化

目的： 探讨癫痫发作和ＡＥＤｓ 治疗对垂体一性腺激素平衡的影响。方法： 利用ＲＩＡ法测定了诊断明确的７３ 例成年男性癫痫患者血清ＬＨ、ＦＳＨ、Ｐ、Ｅ２、Ｔ水平, 并比较了ＡＥＤｓ 治疗组与未治疗组和健康对照组病人的血清性腺激素水平。同时,观察了其中的３１ 例癫痫患者癫痫发作前后血清性腺激素水平的变化。结果：癫痫发作前后血清性腺激素水平无明显差异。ＡＥＤｓ 明显影响血清性腺激素水平。在所有ＡＥＤｓ 治疗中, 血清Ｅ２ 水平明显升高, ＬＨ水平明显减低, Ｔ／Ｅ２ 的比较明显低于正常对照和病人对照组, 在ＡＥＤｓ 单一和联合治疗组中有３９．７％ 的病例性功能低下。结论： 癫痫发作不影响血清性腺激素水平。ＡＥＤｓ明显影响性激素平衡和性功能     

Effects of Carbamazepine on the Hypothalamic-Pituitary-Gonadal Axis in Male Patients with Epilepsy: A Prospective Study

The effects of carbamazepine (CBZ) monotherapy on serum sex hormone levels and on pituitary responsiveness to various stimuli were evaluated in a prospective study with 21 male patients with epilepsy. The serum levels of testosterone (T), free testosterone (FT), sex hormone binding globulin (SHBG), estradiol (E2), luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), and dehydroepiandrosterone sulfate (DHEAS) were assayed, and the free androgen index (FAI) values were calculated for each patient before and after 2-month CBZ treatment. The pituitary PRL, LH, and FSH responses to luteinizing hormone-releasing hormone (LH-RH), thyrotropin-releasing hormone (TRH), and metoclopramide (MC) were also measured before and after CBZ treatment. The baseline serum hormone and SHBG levels were measured and the FAI values calculated in 16 healthy male control subjects of similar age. The mean E2 level was higher in patients before CBZ treatment than in control subjects, and untreated patients had greater variances for FAI values, PRL levels, and LH levels than control subjects. No other significant differences were found between untreated patients and control subjects. The FAI values and DHEAS levels of patients decreased during 2-month treatment with CBZ. The PRL response to MC was higher after CBZ treatment than before. The baseline levels of other hormones and SHBG, as well as the LH and FSH responses to LH-RH, remained unaltered. The results indicate that during the first 2 months of CBZ treatment the androgen balance in male epileptic patients changes: Serum DHEAS levels and FAI values decrease, although FT levels remain unchanged. The clinical relevance of these hormonal changes is obscure.     

奥氮平对精神分裂症患者认知功能障碍的改善作用

目的探讨奥氮平对精神分裂症患者认知功能的改善作用。方法使用新韦氏记忆量表(WMSRC)、威斯康星卡片分类测验(WCST)、阳性症状与阴性症状量表(PANSS)、标准化的精神分裂症认知功能成套测验(MCCB)对患者的认知功能进行综合评定。结果治疗8周后,患者的记忆商数较治疗前有显著提高(P0.05);患者总测试次数、随机错误数、持续错误数均显著性下降(P0.05);但分类完成数、正确数无显著性变化(P0.05);患者治疗前后语言记忆及数字序列间存在显著差异(P0.01);治疗前后其迷宫、视觉记忆、空间广度及持续操作测试结果存在显著差异(P0.05),治疗前后患者连线及情绪管理检测结果差异无统计学意义(P0.05);阴性及阳性症状减分值、PANSS总分减分值与患者记忆商数增加值间呈显著正相关关系(P0.05或P0.01);患者PANSS总分减分值和一般病理性症状减分值与随机错误数减分值及阳性/阴性症状减分值与持续错误数减分值间均存在显著正相关关系(P0.05);治疗期间均未出现严重的不良反应。结论奥氮平可以显著改善精神分裂症患者的认知功能障碍,值得临床推广应用。     

抗精神病药对男性精神分裂症患者垂体-性腺轴的影响

目的:研究氯丙嗪、利培酮、奎硫平及奥氮平对男性精神分裂症患者垂体性腺轴的影响。方法:88例首发男性精神分裂症患者随机分为氯丙嗪组、利培酮组、奎硫平组及奥氮平组,检测治疗前、治疗4周及8周血清促卵泡素(FSH)、黄体生成素(LH)、催乳素(PRL)、睾酮(T)的水平变化。结果:氯丙嗪组治疗8周后,血清PRL水平显著高于治疗前。利培酮组在治疗4周及8周后PRL水平均显著高于治疗前,治疗8周后T及LH水平显著低于治疗前。奎硫平组在治疗4周及8周后血清PRL、LH、T水平与治疗前比较差异均无显著性。奥氮平组治疗4周后PRL水平显著高于治疗前,治疗8周后即与治疗前差异无显著性。结论:奎硫平对垂体性腺轴激素水平无明显影响。     

Basal plasma hormone levels in depressed perimenopausal women

Background: An association between abnormal changes in reproductive endocrine function during the perimenopause and the onset of depression in some women has been suggested but remains controversial.

Methods: We examined basal plasma hormone levels in two samples of women with well characterized, first onset depression (major or minor) during the perimenopause and matched comparison groups of asymptomatic women. Results were compared by analysis of variance.

Results: No significant diagnosis-related differences were observed in plasma hormone measures of the following: follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), estrone (E1), total (T) or free testosterone (FT), or the E2/LH ratio. We did identify significantly lower morning plasma dehydroepiandrosterone (DHEA) and its sulphated metabolite DHEA-S (but not cortisol) levels in the depressed women compared to the non-depressed comparison group. Women with hot flushes (regardless of the presence of depression) were significantly older than women without flushes, had significantly higher plasma levels of FT, LH and FSH, and had significantly lower E2/LH ratios.

Conclusions: Women with first onset depression during the perimenopause are not distinguished from controls on the basis of basal hormone measures of ovarian estrogens, testosterone, or gonadotropins. However, perimenopause-related changes in E2 may interact with low levels of DHEA in some women to increase their vulnerability to develop depression. In contrast to perimenopause-related vasomotor symptoms, depression during the perimenopause is not associated with a simple hormone deficiency state. The relatively low levels of E2 and E1 in the depressed women may have met statistical significance in a much larger and homogenous sample.     

Neuroendocrine aspects of primary endogenous depression VIII. Pituitary-gonadal axis activity in male patients and matched control subjects

To determine the extent of hypothalamo-pituitary-gonadal (HPG) axis dysfunction in endogenous depressed men, we measured nocturnal and diurnal serum luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone (T), and estradiol (E2) concentrations, and their responses to gonadotropin releasing hormone (LHRH) and dexamethasone administration, in 16 Research Diagnostic Criteria primary, definite endogenous male depressives and 16 individually matched male normal controls. Compared to their controls, the patients showed no differences in basal nocturnal or diurnal gonadotropin or gonadal steroid hormone concentrations, and no differences in hormone concentrations either post-LHRH or post-dexamethasone. Age was negatively correlated with baseline serum T in the patients but not in the controls, and it was modestly positively correlated with baseline serum LH in both groups of subjects. In the patients, the presence of DSM-III melancholia was modestly negatively correlated with baseline and post-LHRH concentrations of both LH and FSH and was positively correlated with baseline serum T, but it bore no relation to serum E2. None of the other subject characteristics or specific dimensions of depressive symptomatology were significantly related to the HPG axis measures. The HPG axis measures also were unrelated to pre- and post-dexamethasone cortisol concentrations in both groups of subjects. The results of this study suggest that, in contrast to the hypothalamo-pituitary-adrenal cortical and thyroid axis abnormalities frequently found in endogenous depressives, HPG axis function in male depressives is relatively normal.