试论《黄帝内经》中的精神病学

通过探讨《黄帝内经》理论,对中医精神病学的定义和范围提出了个人见解。并从精神活动的生理基础、病因病机、诊断命名、治疗方法、预防思想等几个方面,对《黄帝内经》中有关精神病学的理论进行归纳分析。

精神病人死亡原因临床分析

1一般资料我院2003年6月3日至2009年6月3日共收治3013例精神疾病患者,其中死亡23例,死亡率为0.76%。23例死亡患者中,男性17例,女性6例;年龄33～65岁,平均（39.65±12.36）岁;婚姻状况：已婚18例,未婚2例,离婚3例;住院时间：2～3542天,平均（69.86±1712.36）天。有精神病家族史者5例,占21.74%。

颅脑损伤后躁狂型精神障碍“痰迷心窍”证治体会

目的:探讨颅脑损伤后躁狂型精神障碍的中医病机,并结合病例谈临证体会。方法:根据颅脑损伤后躁狂型精神障碍的临床特征,参阅中医典籍,笔者认为颅脑损伤后躁狂型精神障碍属于中医狂(躁)范畴,其病机为"痰迷心窍"。结论:颅脑损伤后躁狂型精神障碍患者,中医病机以"痰、热"为标,神明受扰,治以豁痰开窍,宁心安神,临证选用温胆汤合酸枣仁汤加减,疗效明确,并避免了氯丙嗪、氟哌啶醇等西药副反应。

首发精神障碍症的病毒性脑炎16例临床分析

目的探讨精神障碍为首发症状的病毒性脑炎的临床特点,以便早期诊断和治疗。方法对精神障碍为首发症状的16例病毒性脑炎的临床表现、脑脊液、脑电图和脑MRI资料进行回顾性分析。结果呈急性或亚急性发病,主要早期表现为发热、头痛、意识障碍、精神行为异常、抽搐发作和智能减退。常规脑脊液检查异常率43.6%,早期脑电图检查异常率75.0%,脑MRI检查异常率62.5%。结论精神障碍可以是病毒性脑炎的首发症状,常伴有意识障碍、精神运动性兴奋或抑制、抽搐发作和智能障碍,结合脑电图和脑CT,MRI检查可以作出早期诊断和治疗。

中医辨证治疗产褥期抑郁症60例

产褥期抑郁症是指产妇在分娩后出现情绪低落、精神抑郁为主要症状的病症,是产褥期精神综合征中最常见一种类型。本病一般在产后一周开始出现症状,产后4～6个月逐渐明显,平均持续6～8周,

枣百宁神汤治疗精神分裂症116例

目的统计枣百宁神汤对精神分裂症的临床疗效、副反应及其作用机理。方法采用多中心开放随机对照研究，对116例精神分裂症患者用常规搞精神病药加服枣百宁神汤煎剂结合治疗，与128例单用常规抗精神病药治疗的精神分裂症患者对照。以简明精神病评定量表（BPRS）和阳性症状评宁量表（SAPS）、阴性症状评定量表（SANS）、临床疗效总评量表（CGI）和副反应量表（TESS）、锥体外系副反应量表（RSESE）^[1]综合评定。结果治疗后枣百宁神汤组（治疗组）患者的CGI-G1分值和BPRS、SAPS、SANS量表的总分及因子分均低于单用常规抗精神病药治疗组（对照组）患者，差异均有显著性（P〈0．01）。TESS总分与RSESE总分在整个治疗过程中均低于对照组，差异有显著性（P〈0.01）。结论治疗组对精神分裂症的疗效较好；对阳性、阴性症状的改善明显优于对照组，副反应显著较少，安全度较好。调畅各脏腑机能与气机的运动形式，内通外达是其作用机理。

大庆市城区精神分裂症患者配偶生活质量调查

目的探讨大庆市城区精神分裂症患者配偶的生活质量状况及性别等差异。方法对1526例符合CCMD-3[1]精神分裂症诊断标准的精神分裂症患者的配偶进行生活满意度量表调查分析。结果患者配偶性别比较有显著差异,P〈0.05。患者配偶不同文化程度比较除初中与高中比较无差异（P〉0.05）外,其余各项比较均有显著差异,P〈0.001;且文化程度越高,差异越显著。不同病程患者配偶比较显示：15年内各组比较及与16年以上各组比较有显著差异,P均〈0.01;16年以上各组比较无显著差异,P均〉0.05。结论精神分裂症患者配偶的生活质量状况明显偏低,应引起全社会的关注,开展家庭教育和早期心理干预有望提高其生活质量。

缓解期精神分裂症患者的生活质量调查

精神分裂症是一种较常见的精神科疾病,多发病于青壮年,病程多迁延,社会功能损害较重,致残率较高。在人群中患病率为0.5%～1%,其终生患病率约为1.3%[1]。

急性脑梗死后抑郁状态临床分析

抑郁是卒中后常见的并发症,由于其影响患者神经功能恢复及生活质量,所以越来越受到人们的重视。本文通过对162例急性脑梗死患者一些因素调查分析,探讨急性脑梗死患者抑郁发生的相关因素,便于临床防治。

药物治疗40例抑郁症的临床分析

抑郁症（Depression）是躁狂抑郁症的一种发作形式。以情感低落、思维迟缓以及言语动作减少、迟缓为典型症状。抑郁症严重困扰患者的生活和工作，给家庭和社会带来沉重的负担，约15％的抑郁症患者死于自杀。世界卫生组织、世界银行和哈佛大学的一项联合研究表明，抑郁症已经成为中国疾病负担的第二大病病。引起抑郁症的因素包括：遗传因素、体质因素、

综合治疗难治性抑郁症22例

目的观察奎硫平合并舍曲林治疗难治性抑郁症的疗效和不良反应。方法将45例难治性抑郁症患者随机分为研究组（奎硫平合并舍曲林）和对照组（舍曲林）。疗程8周。于治疗前及治疗2、4、8周分别用汉密尔顿抑郁量表（HAMD）、临床疗效总体量表（CGI）和副反应量表（TESS）评定疗效和不良反应。结果治疗4周研究组HAMD总分及各因子分比治疗前明显降低,并显著低于对照组,TESS评分两组无显著差异。结论奎硫平合并舍曲林治疗难治性抑郁症疗效确切。

Age-related symptom and life quality changes in women with irritable bowel syndrome

AIM:To explore age-related changes in symptoms and quality of life(QoL) of women with irritable bowel syndrome(IBS).METHODS:Two-hundred and fifty-four female adult outpatients with IBS attending the Department of Gastroenterology at the First Affiliated Hospital of Nanjing Medical University between January,2008 and October,2008 were approached.Patients with a history of abdominal surgery,mental illness or those who had recently taken psychotropic drugs were excluded.A physician obtained demographic and abdominal symptom data.All patients were asked to complete the Zung Self-Rated Anxiety and Depression Scale(SDS/SAS) and the IBS-specific QoL questionnaire.The patients were divided into six groups according to age,in 10-year increments:18-27 years,28-37 years,38-47 years,48-57 years,58-67 years and 68-75 years(maximum 75 years).Age-related differences of abdominal pain or discomfort were analyzed using ranksum tests.Differences in SDS/SAS and IBS-QoL scores between age groups were analyzed using one-way analysis of variance.Pearson's correlations evaluated potential associations between IBS symptoms,psychological factors and QoL in each age group.RESULTS:There were no differences in the distribution of IBS subtypes between age groups(χ2 = 20.516,P = 0.153).Differences in the severity of abdominal pain/discomfort with age were statistically significant(χ2 = 25.638,P < 0.001);patients aged 48-57 years,58-67 years or 68-75 years had milder abdominal pain/discomfort than those in the younger age groups.The severity of anxiety or depressive symptoms did not differ between age groups(SDS,χ2 = 390.845,P = 0.110;SAS,χ 2 = 360.071,P = 0.220).Differences of IBSQoL scores were statistically significant between age groups(χ2 = 1098.458,P = 0.011).The scores of patients in the 48-57-year group were lower than those in the 18-27-year and 28-37-year groups(48-57-year group vs 18-27-year group,74.88 ± 8.76 vs 79.76 ± 8.63,P = 0.021;48-57-year group vs 28-37-year group,74.88 ± 8.76 vs 79.04 ± 8.32,P = 0.014).The scores in the 68-75-year group were lower than those in the 18-27-year,28-37-year and 38-47-year groups(68-75-year group vs 18-27-year group,71.98 ± 9.83 vs 79.76 ± 8.63,P = 0.003;68-75-year group vs 28-37-year group,71.98 ± 9.83 vs 79.04 ± 8.32,P = 0.002;68-75-year group vs 38-47-year group,71.98 ± 9.83 vs 76.44 ± 8.15,P = 0.039).Anxiety and depression were negatively correlated with QoL in all age groups(SDS and QoL:18-27-year group,r =-0.562,P = 0.005;28-37-year group,r =-0.540,P < 0.001;38-47-year group,r =-0.775,P < 0.001;48-57-year group,r =-0.445,P = 0.001;58-67-year group,r =-0.692,P < 0.001;68-75-year group,r =-0.732,P < 0.001.SAS and QoL:18-27-year group,r =-0.600,P = 0.002;28-37-year group,r =-0.511,P < 0.001;38-47-year group,r =-0.675,P < 0.001;48-57-year group,r =-0.558,58-67-year group,P = 0.001;r =-0.588,P < 0.001;68-75-year group,r =-0.811,P < 0.001).A negative correlation between abdominal pain severity and QoL was found in patients aged more than 58 years(58-67-year group,r =-0.366,P = 0.017;68-75-year group,r =-0.448,P = 0.048),but not in younger patients(18-27-year group,r = 0.080,P = 0.716;28-37-year group,r =-0.063,P = 0.679;38-47-year group,r =-0.029,P = 0.812;48-57-year group,r =-0.022,P = 0.876).CONCLUSION:Factors affecting QoL should always be treated in IBS,especially emotional problems in young adults.Even mild abdominal pain should be controlled in elderly patients.

略论张锡纯心脑共主神明说

略论张锡纯心脑共主神明说程如海（湖北省中医药研究院武汉４３００７３）关键词心；脑；神明；张锡纯关于神志活动的归属，有“心主神明”与“脑主神明”两说，并引发了学术争鸣。而张锡纯认为心脑共主神明，试粗论之。１心脑共主神明的生理及其联系张氏认为：“人之神明...