重复经颅磁刺激对注意缺陷多动障碍儿童临床症状及血清脑源性神经营养因子的影响

目的:探讨高频重复经颅磁刺激(rTMS)对注意缺陷多动障碍(ADHD)儿童临床症状及血清脑源性神经营养因子(BDNF)水平的影响.方法:30例ADHD患儿随机分为真、伪刺激组;两组在接受盐酸哌甲酯控释片(18 mg/d)治疗的同时分别给予真、伪高频(10 Hz)rTMS治疗4周,刺激部位为右侧前额叶皮质;治疗前后采用中...     

二十二碳六烯酸对注意缺陷多动障碍儿童临床疗效、血清胶质源性神经营养因子及炎症因子水平的影响

目的:研究二十二碳六烯酸(DHA)对注意缺陷多动障碍(ADHD)儿童临床疗效、血清中胶质源性神经营养因子(GDNF)及炎症因子水平的影响。方法:118例ADHD儿童随机分为研究组(60例)与对照组(58例)。研究组给予盐酸哌甲酯与DHA 300 mg/d,对照组给予盐酸哌甲酯与空白安慰剂,治疗8周。在基线及治疗8周后,采用注意缺陷多动障碍SNAP-IV评定量表(中文版)(SNAP-IV)、美国康纳简易多动症行为评价量表(Conner)评估ADHD儿童病情,记录不良反应;检测两组DHA、GDNF、白介素(IL)-1β、IL-6、肿瘤坏死因子α(TNF-α)水平。结果:8周治疗后,两组SNAP-IV总分、注意缺陷分、Conner学习、心身、多动指数评分下降幅度差异具有统计学意义(P<0.05或P<0.01)。研究组DHA、GDNF水平显著高于对照组及治疗前,而IL-6、TNF-α水平显著低于对照组及治疗前(P<0.05或P<0.01)。研究组ΔDHA与ΔSNAP-IV总分呈负相关;ΔGDNF与ΔTNF-α、Δ注意缺陷分及Δ多动/冲动分呈负相关(P均<0.05)...     

姜黄素对肠易激综合征模型大鼠5-羟色胺和脑源性神经营养因子的影响

目的 从脑肠轴角度明确肠易激综合征(IBS)发病机制,观察姜黄素对IBS的疗效.方法 48只SD大鼠按随机数字表法分为6组:正常组,IBS模型组,姜低组、姜中组、姜高组(造模前分别灌胃给予姜黄素10、20、40 mg/kg),丙咪嗪组(造模前腹腔注射丙咪嗪10 mg/kg),每组各8只.采用大鼠慢急性联合应激模型模拟IBS.糖水消耗试验和内脏敏感性实验检测各组大鼠抑郁样行为和肠道敏感性,高效液相法及Western blotting分别测定大鼠大脑皮层和回肠5-羟色胺(5-HT)及脑源性神经营养因子(BDNF)的表达. 结果 IBS模型组大鼠糖水消耗量明显减少,肠道内脏敏感性明显升高,大脑额叶皮层5-HT、BDNF表达水平降低,回肠黏膜5-HT、BDNF表达水平明显升高,与正常组比较差异均有统计学意义(P＜0.05).给予不同剂量姜黄素后能逆转上述行为学改变及大脑皮层、回肠的5-HT 、BDNF水平变化,其中姜高组与IBS模型组比较差异均有统计学意义(P＜0.05).丙咪嗪组效果与姜高组类似. 结论 IBS大鼠脑肠内5-HT、BDNF表达异常说明IBS的发生存在脑肠改变的物质基础.姜黄素可能是通过调节5-HT、BDNF表达来改善IBS模型大鼠的行为学变化.     

5-羟色胺转运体基因与注意缺陷多动障碍及其相关症状的关联分析

目的　探讨5- 羟色胺转运体( 5 -HTT)基因启动子区多态性与注意缺陷多动障碍(ADHD)及其相关症状的关系。方法　抽取1 39例ADHD患儿及1 1 5名正常对照,用Achenbach儿童行为调查表(CBCL)来评定患者的临床症状;采用聚合酶链式反应(PCR)、聚丙烯酰胺凝胶电泳结合银染技术,检测ADHD患者和对照组基因型和等位基因的频率。结果　患者组5- HTT启动子区多态性( 5- HTTLPR)的基因型和等位基因的频率与对照组相比无显著性差异(P >0. 0 5) ;但发现S/S基因型个体社会退缩、躯体主诉两行为分量表评分高,S/S基因型个体与S/L +L/L基因型个体间社会退缩、躯体主诉两分量表分有显著性差异(P <0 . 0 5)。结论　本研究结果不支持5- HTTL- PR与ADHD存在关联,但ADHD的某些内化性症状与5 -HTTLPR可能存在关联。     

团体归因治疗与选择性5-羟色胺回收抑制剂对血浆脑源性神经营养因子的作用

目的:比较团体归因治疗(ARGT)与选择性5-羟色胺回收抑制剂(SSRI)对抑郁症、焦虑症、强迫症患者血浆脑源性神经营养因子(BDNF)的作用.方法:采用ARGT与SSRI对照的前瞻性干预研究设计,根据就诊顺序将129例门诊患者(其中抑郁症45例、焦虑症45例、强迫症39例)分至ARGT组63例(其中抑郁症21例、焦虑...     

脑源性神经营养因子血清浓度与双相障碍关系横断面研究

背景近年来发现,脑源性神经营养因子（brain-derived neurotrophic factor,BDNF）的血清浓度与双相障碍症状关系的研究结果不一致。目的检验BDNF血清浓度与双相障碍的关系,并讨论双相障碍家族史在两者关系中的作用。方法检测了228例双相障碍患者和153名健康对照者的BDNF血清浓度,采用杨氏躁狂量表和汉密尔顿抑郁量表（17项）评估患者的躁狂或抑郁症状,将杨氏躁狂量表评分≥20分定义为躁狂发作,共计85例;将汉密尔顿抑郁量表评分≥17分定义为抑郁发作,共计14例;将杨氏躁狂量表评分〈20分并且汉密尔顿抑郁量表评分〈17分定义为缓解期,共计129例。结果患者组平均（标准差）BDNF血清浓度低于健康对照组[18．75（8．98）ng／d比23．72（5．60）．g／ml,t=6．09,P〈0．001】,且各个亚组（躁狂组、抑郁组和缓解期组）与健康对照组BDNF血清浓度的差异均有统计学意义。躁狂发作期与缓解期之间的BDNF血清浓度差异有统计学意义,其余各亚组间的差异无统计学意义。在多元线性回归模型中控制各个因素后,发现仅有杨氏躁狂量表评分与BDNF血清浓度呈正相关（标准回归系数=0．17,P=0．011）。结论双相障碍患者的BDNF血清浓度低于健康对照组,BDNF血清浓度与躁狂症状存在正相关,与是否存在家族史并不相关。     

5-羟色胺转运体基因多态与共患学习困难的儿童注意缺陷多动障碍的相关性

目的探讨共患学习困难(LD)的注意缺陷多动障碍(ADHD)患儿与5-羟色胺转运体(5-HTT)基因连锁多态区(5-HTTLPR)和第2内含子17 bp数目可变的顺向重复(stin2.VNTR)的关联关系。方法对126例共患LD的ADHD患儿和198例不共患LD的ADHD患儿的5-HTTLPR和stin2.VNTR两种多态进行检测,并采用传递不平衡检测(TDT)和单体型分析方法进行关联分析。结果(1)TDT检测:5-HTTLPR多态的S等位基因在共患LD的ADHD和ADHD混合型(ADHD-C)核心家系中优先传递(X2=5.831和5.281,P=0.015和0.020);所有家系均未观察到stin2.VNTR多态中的任何等位基因有传递不平衡现象(均P>0.05);(2)单体型分析:5-HTT基因与共患LD的ADHD和ADHD-C相关联(X2=11.391和13.343,v=3,P=0.010和P=0.004);单体型L／12在共患LD的ADHD和ADHD-C核心家系中传递较少(X2=10.317和8.948,v=1,P=0.001和0.003),而单体型L／10在共患LD的ADHD核心家系中传递较多(X2=4.065,v=1,P=0.044)。结论5-HTT基因可能与共患LD的ADHD相关联,其中主要为共患LD的ADHD-C亚型。     

注意缺陷多动障碍的功能神经成像研究

本文就功能神经成像技术如PET、SPECT、fMRI对注意缺陷多动障碍患者的大脑代谢和局部脑血流及神经生化的研究进行综述，结果提示ADHD所涉及的脑区为前额叶、顶叶、颞叶、扣带回，纹状体，基底节等区域。另外也表明注意缺陷障碍的成人的功能神经影像方面不同于儿童。     

脑源性神经营养因子与精神分裂症

脑源性神经营养因子BDNF在精神分裂症发病中的作用得到了越来越广泛的关注。目前研究发现,BDNF与精神分裂症发病机制假说、分裂症动物模型的建立及分裂症治疗均存在相关性。通过综合评价该领域近年来的实验结果,对BDNF与精神分裂症的关系作一综述。     

脑源性神经营养因子与癫痫研究进展

癫痫发作后 ,脑内BDNF的表达升高 ,其在时间和地域分布上有一定规律 ,这与其维持神经元存活和再生的功能紧密相关 ;BDNF对癫痫动物模型的痫性发作有阻止作用 ;痫性发作后 ,BDNF的表达受到多种分子的影响     

伴与不伴学习困难的注意缺陷多动障碍患儿认知特点的比较

目的　探讨伴与不伴学习困难 (LD)注意缺陷多动障碍 (ADHD)患儿认知特点的异同。方法　运用韦氏儿童智力量表 (C WISC)、韦氏记忆量表、数字划消测验、Stroop测验和瑞文标准推理测验 ,对 66例仅患ADHD患儿 (ADHD组 )和 2 9例合并LD的ADHD患儿 (ADHD +LD组 )的智力、记忆力、注意力及执行功能进行比较。结果　 (1 )ADHD组的平均年龄 [(9 5± 2 0 )岁 ]小于ADHD +LD组[(1 1 3± 2 3)岁 ] ,差异有显著性 (P <0 0 5) ;(2 )ADHD组在C WISC中仅注意 /不分心因子分 [(1 0 2±1 3)分 ]高于ADHD +LD组 [(96± 1 3)分 ] ,差异有显著性 (P =0 0 2 8) ,其余各项测验结果两组间的差异均无显著性 (P >0 0 5)。结论　ADHD +LD组注意 /不分心因子受损更严重 ,其余认知模式与ADHD组相似。     

学习障碍患儿血清BDNF水平的研究

目的探讨学习障碍血清脑源性神经营养因子(BDNF)水平的变化,及其与学习障碍病理基础的关系。方法患者组为22例未治疗过且不共患其他疾病的学习障碍患儿,对照组为16例年龄性别匹配正常儿童,以瑞文标准推理测验(SPM)测定智商,BDNF采用酶联夹心免疫吸附法检测。结果LD患者血清BDNF浓度为:平均(4.603±3.620)ng/ml高于对照组(1.843±0.728)ng/ml(t=3.326,P=0.003<0.01)。边缘智商组(4.523±4.618)ng/ml,与正常对照组比较差异有非常显著性(P=0.008<0.01)。结论学习障碍患儿血清BDNF浓度高于正常儿童,边缘智商者升高更明显。     

Effect of methylphenidate treatment on appetite and levels of leptin,ghrelin, adiponectin,and brain-derived neurotrophic factor in children and adolescents with attention deficit and hyperactivity disorder

Objectives. We aimed to explore whether the use of methylphenidate relates leptin, ghrelin, adiponectin, and brain-derived neurotrophic factor (BDNF). In addition, the relationship between methylphenidate-related weight loss in attention deficit hyperactivity disorder (ADHD) patients and these biomolecules were evaluated. Methods. Thirty ADHD patients receiving methylphenidate and 20 healthy controls were included. Leptin, ghrelin, adiponectin, and BDNF levels were measured at baseline and after two-month treatment in both groups. Results. At baseline, leptin, ghrelin, adiponectin, and BDNF levels were similar in the ADHD and control groups. The most common adverse events occurring in the ADHD group after a 2-month treatment period included loss of appetite (70%) and weight loss (66.7%). A significant difference was found in body weight, BMI, and CGI scores of the ADHD patients after the treatment. While post-treatment ghrelin and adiponectin levels were significantly higher in the ADHD group, BDNF level was significantly lower. Post-treatment decrease in leptin levels was not significant. Conclusions. Leptin and BDNF were not associated with poor appetite and/or weight loss due to methylphenidate treatment. However, ghrelin and adiponectin might be biomolecules that play a role in underlying neurobiological mechanisms of methylphenidate-related appetite or weight loss.     

Attention deficit hyperactivity disorder and mild learning disabilities: a case study

The pervasive use of ‘challenging behaviour’ as an explanatory concept has precluded the development of alternative ways of construing the actions of people with learning disabilities. Moreover, possession of a challenging behaviour label has facilitated the segregation of individuals into specialist service provision. The present case study illustrates how an inclusive account can be developed using concepts from mainstream psychological activity. The development of alternative accounts also has implications for the design of interventions. It is argued that the process of developing alternative accounts may ultimately result in the redundancy of ‘challenging behaviour’ as an explanatory concept.     

Altered serum levels of vascular endothelial growth factor and glial-derived neurotrophic factor but not fibroblast growth factor-2 in treatment-naive children with attention deficit/hyperactivity disorder

Abstract

Background and aim: Recent evidence suggests that growth factors might be involved in the pathophysiology of attention deficit hyperactivity disorder (ADHD). The aim of this study was to determine whether serum levels of brain-derived neurotrophic factor (BDNF), glial-derived neurotrophic factor (GDNF), neurotrophin-3 (NT-3), nerve growth factor (NGF), fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF) were altered in children with ADHD.

Methods: Serum levels of BDNF, GDNF, NT-3, NGF, VEGF and FGF-2 were analyzed in 49 treatment- naive children with ADHD and age, gender matched 36 healthy controls using enzyme-linked immunosorbent assay. ADHD symptoms were scored by Du Paul ADHD Rating Scale and Strengths and Difficulties Questionnaire.

Results: We found that serum VEGF levels were significantly lower (p?<?0.001) and GDNF levels were significantly higher in ADHD group compared to control group (p?=?0.003). However, we found no correlations between ADHD symptoms and serum VEGF or GDNF levels. Furthermore, we observed no significant alterations in serum BDNF, NT-3, NGF, FGF-2 levels in children with ADHD.

Conclusion: To our knowledge, the present study is the first to examine serum VEGF and FGF-2 levels in children with ADHD. Our results indicate that VEGF and GDNF might be involved in the etiology of ADHD. Further studies are required to determine the role of growth factors in the etiology and consequently in the treatment of ADHD.     

Discrimination between attention deficit hyperactivity disorder and reactive attachment disorder in school aged children

We aimed to determine whether it is possible to discriminate between children with attention deficit hyperactivity disorder (ADHD) and children with reactive attachment disorder (RAD) using standardized assessment tools for RAD. The study involved 107 children: 38 with a diagnosis of RAD and 30 with ADHD were recruited through community child and adolescent mental health services (CAMHS) and specialist ADHD clinics. In addition, 39 typically developing children were recruited through family practice. Clinicians were trained to use a standardized assessment package for RAD using a DVD with brief follow-up support. Discriminant function analysis was used to identify the items in the standardized assessment package that best discriminated between children with ADHD and children with RAD. Clinicians’ ratings of RAD symptoms were reliable, particularly when focusing on eight core DSM-IV symptoms of RAD. Certain parent-report symptoms were highly discriminatory between children with ADHD and children with RAD. These symptoms included “cuddliness with strangers” and “comfort-seeking with strangers”. A semi-structured interview with parents, observation of the child in the waiting room and teacher report of RAD symptoms aided diagnostic discrimination between the groups. Clinical diagnosis of RAD can be made reliably by clinicians, especially when focusing on eight core RAD symptoms. Clear discrimination can be made between children with RAD and children with ADHD.     

注意缺陷多动障碍患儿血清儿茶酚胺类递质的测定

目的探讨注意缺陷多动障碍（ＡＤＨＤ）可能的精神生化机制。方法采用高效液相色谱法，测定了经哌醋甲酯治疗后的６４例ＡＤＨＤ男性患儿和３０名正常男性儿童的血清儿茶酚胺类递质及其代谢产物水平。结果ＡＤＨＤ患儿血清去甲肾上腺素（ＮＥ）水平和ＮＥ／３－甲氧－４－羟苯乙二醇（ＭＨＰＧ）比值（２７±１８）低于正常儿童（１５２±５７），血清高香草酸水平（３．９±２．９μｇ／Ｌ）高于正常儿童（０．８±０．３μｇ／Ｌ）；经哌醋甲酯治疗有效者血清ＭＨＰＧ水平（１３±１０μｇ／Ｌ）高于无效者（８±５μｇ／Ｌ）；智力发育不平衡组血清ＮＥ水平（８４±４３μｇ／Ｌ）低于智力发育平衡组（８９±５８μｇ／Ｌ）；根据美国精神障碍诊断统计手册第３版修订本，将病情分为轻度、中度和重度，重度ＡＤＨＤ患儿血清ＮＥ水平（８２±４５μｇ／Ｌ）明显低于轻度（１０５±５９μｇ／Ｌ）。结论ＡＤＨＤ可能是多巴胺能和去甲肾上腺素能两种递质系统失调或失衡的结果。     

托莫西汀治疗儿童注意力缺陷多动障碍研究进展

为探讨托莫西汀对儿童注意力缺陷多动障碍(ADHD)的疗效,本文对托莫西汀治疗儿童ADHD的研究进行综述。通过阐述ADHD发病机制和治疗方案,总结托莫西汀治疗儿童ADHD的效果和安全性,并与哌甲酯、安慰剂治疗的效果进行比较,为ADHD临床治疗提供参考。     

注意缺陷多动障碍与家庭因素

近年来,儿童注意缺陷多动障碍（ADHD）的研究在国内外受到广泛关注.美国儿科协会临床指南指出学龄儿童ADHD的患病率为4％～12％,是一种最常见的儿童心理行为疾病[1].我国选用DSM-Ⅳ的注意缺陷多动障碍诊断标准,近年调查学龄儿童检出率为3.94％～6.3％[2-4],调查数据普遍低于国外的数据,但总体呈上升趋势.儿童ADHD核心症状为注意力不集中、多动与冲动,它的病因目前仍不清楚,一般认为是由遗传和环境因素引起的一种心理行为性疾病.近年经许多回顾研究表明,ADHD儿童的不良行为与家庭环境因素和养育方式等具有一定的相关性,现在对此作一综述.关键词：注意缺陷多动障碍;家庭环境;教养方式;依恋     

利培酮治疗注意缺陷障碍对照观察

目的:观察小剂量利培酮治疗注意缺陷障碍(ADHD)的疗效和安全性,方法:前瞻性研究,以利他林作为对照,采用康纳多动症评定量表及不良反应症状量表(TESS)评定,观察4周,结果:利培酮有效率为77%,利他林为78%,未见锥体外系副反应,结论:利培酮与利他林的疗效相似,小剂量使用时安全有效.