未成年精神疾病患者使用新型抗精神病药物的分析

深入研究新型抗精神病药物应用于未成年精神疾病中效果。方法:对医院2019年10月-2020年10月内137例未成年精神疾病患者抗精神病药物治疗进行研究。结果:均合理应用药物,使用频率前三位为利培酮、氯氮平、奥氮平,三种药物联合应用率较低,一种药物单独应用率较高。结论:新型抗精神病药物治疗需要保证合理性,这样才能确保治疗效果。

132例社区重性精神疾病患者死亡原因分析及干预措施

目的为了解社区重性精神疾病患者死亡的原因,从而采取有针对性干预措施达到降低病人死亡率,延长生命的目的。方法对收集本辖区建档立卡已录入省重性精神疾病信息系统并随访管理的,在2011年8月至2013年7月间死亡的患者132例死亡原因进行统计分析。结果资料显示死亡原因:躯体疾病87例(65.9%),意外17例(12.9%),自杀15例(11.4%),并发症13例(9.8%)。结论采取针对性干预措施可预防和降低社区重性精神疾病患者的死亡率。

Prevalence of depression and anxiety in patients with chronic digestive system diseases: A multicenter epidemiological study

AIM To investigate the prevalence of depression and anxiety in patients with chronic digestive system diseases.METHODS A total of 1736 patients with chronic digestive systemdiseases were included in this cross-sectional study, including 871 outpatients and 865 in-patients. A selfdesigned General Information for Patients of the Department of Gastroenterology of General Hospitals questionnaire was used to collect each patient's general information, which included demographic data(including age, sex, marital status, and education) and disease characteristics(including major diseases, disease duration, principal symptoms, chronic pain, sleep disorder, and limited daily activities).RESULTS The overall detection rate was 31.11%(540/1736) for depression symptoms alone, 27.02%(469/1736) for anxiety symptoms alone, 20.68%(359/1736) for both depression and anxiety symptoms, and 37.44%(650/1736) for either depression or anxiety symptoms. Subjects aged 70 years or above had the highest detection rate of depression(44.06%) and anxiety symptoms(33.33%). χ2 trend test showed: the higher the body mass index(BMI), the lower the detection rate of depression and anxiety symptoms(χ2trend = 13.697, P < 0.001; χ2trend = 9.082, P = 0.003); the more severe the limited daily activities, the higher the detection rate of depression and anxiety symptoms(χ2trend = 130.455, P < 0.001, χ2trend = 108.528, P < 0.001); and the poorer the sleep quality, the higher the detection rate of depression and anxiety symptoms(χ2trend = 85.759, P < 0.001; χ2trend = 51.969, P < 0.001). Patients with digestive system tumors had the highest detection rate of depression(57.55%) and anxiety(55.19%), followed by patients with liver cirrhosis(41.35% and 48.08%). Depression and anxiety symptoms were also high in subjects with comorbid hypertension and coronary heart disease. CONCLUSION Depression and anxiety occur in patients with tumors, liver cirrhosis, functional dyspepsia, and chronic viral hepatitis. Elderly, divorced/widowed, poor sleep quality, and lower BMI are associated with higher risk of depression and anxiety.

A comparison of the clinical, demographic and psychiatric profiles among patients with erosive and non-erosive reflux disease in a multi-ethnic Asian country

AIM:To examine the clinical spectrum of gastroesophageal reflux disease (GERD) and compare erosive (ERD) with non-erosive (NERD) in terms of clinical, demographic and psychiatric profiles. METHODS: Patients with reflux symptoms were enrolled and stratified to NERD and ERD after endoscopy (LA classification). Patients with ERD presenting with dyspepsia were included. Patients on proton pump inhibitors (PPI) or H2 receptor antagonists before endoscopy were excluded. Demographic data, Helicobacter pylori(H pylori) status and presence of minor psychiatric morbidity (based on General Health Questionnaire-28) were analyzed. RESULTS: Among 690 patients screened, 533 were eligible for analysis (male to female ratio: 3:2; Chinese: 75.4%; Malay: 9.8%; Indian: 14.8%). Clinical spectrum of GERD: N: 40.5%; A: 46%; B: 9.2%; C: 2.1%; D: 0.6%; Barrett's esophagus: 1.7%. Compared to patients with NERD, patients with ERD were significantly older (45 vs 39.4 years), more likely to be male (64.4% vs 53.7%), tended to smoke (19.6% vs 9.7%), less likely to have minor psychiatric morbidity (26.4 vs 46.7%) and were more likely to respond to PPI (79.7 vs 66.8%). There was also a trend towards a higher BMI (24.5 vs 23.5). Race, alcohol consumption and H pylori status were not significant. On multivariate analysis, age and presence of minor psychiatric morbidity remained with significant differences. CONCLUSION: The majority of patients who have typical symptoms of GERD have NERD or mild erosive reflux disease. Compared to patients with erosive reflux disease, patients with NERD were younger and had a higher prevalence of minor psychiatric morbidity.

Neurotoxicity and Biomarkers of Lead Exposure: a Review

Appropriate selection and measurement of lead biomarkers of exposure are critically important for health care management purposes,public health decision making,and primary prevention synthesis.Lead is one of the neurotoxicants that seems to be involved in the etiology of psychologies.Biomarkers are generally classified into three groups:biomarkers of exposure,effect,and susceptibility.The main body compartments that store lead are the blood,soft tissues,and bone;the half-life of lead in these tissues is measured in weeks for blood,months for soft tissues,and years for bone.Within the brain,lead-induced damage in the prefrontal cerebral cortex,hippocampus,and cerebellum can lead to a variety of neurological disorders,such as brain damage,mental retardation,behavioral problems,nerve damage,and possibly Alzheimer’s disease,Parkinson’s disease,and schizophrenia.This paper presents an overview of biomarkers of lead exposure and discusses the neurotoxic effects of lead with regard to children and adults.

Simple pain measures reveal psycho-social pathology in patients with Crohn's disease

To determine whether pain has psycho-social associations in adult Crohn’s disease (CD) patients.METHODSPatients completed demographics, disease status, Patient Harvey-Bradshaw Index (P-HBI), Short Form Health Survey (SF-36), Short Inflammatory Bowel Disease Questionnaire (SIBDQ), and five socio-psychological questionnaires: Brief Symptom Inventory, Brief COPE Inventory, Family Assessment Device, Satisfaction with Life Scale, and Work Productivity and Activity Impairment Questionnaire. Pain sub-scales in P-HBI, SF-36 and SIBDQ measures were recoded into 4 identical scores for univariate and multinomial logistic regression analysis of associations with psycho-social variables.RESULTSThe cohort comprised 594 patients, mean age 38.6 ± 14.8 years, women 52.5%, P-HBI 5.76 ± 5.15. P-HBI, SF-36 and SIBDQ broadly agreed in their assessment of pain intensity. More severe pain was significantly associated with female gender, low socio-economic status, unemployment, Israeli birth and smoking. Higher pain scores correlated positively with psychological stress, dysfunctional coping strategies, poor family relationships, absenteeism, presenteeism, productivity loss and activity impairment and all WPAI sub-scores. Patients exhibiting greater satisfaction with life had less pain. The regression showed increasing odds ratios for psychological stress (lowest 2.26, highest 12.17) and female gender (highest 3.19) with increasing pain. Internet-recruited patients were sicker and differed from hardcopy questionnaire patients in their associations with pain.CONCLUSIONPain measures in P-HBI, SF-36 and SIBDQ correlate with psycho-social pathology in CD. Physicians should be aware also of these relationships in approaching CD patients with pain.

Media Influence Over the Transformation of Stigma Toward Depression in Japan

in Japan, the number of depression patients has markedly increased over the last 10 years, and depression is now a major social concern. Moreover, there are concerns that patients with depression are not always seeking the treatment they need, in part due to the stigma associated with the illness. Despite of increasing public awareness of depression, the stigma has not lessened, but has changed in form. Previous studies report that depression which was once viewed as a special psychiatric illness is now viewed as a ＂common＂ mental illness. The author, too, believes that the nature of the stigmatization has changed in recent years to become more complex and ultimately continues to present a barrier to treatment for people with depression. This study aims to explore how the stigmatization has changed by examining one specific aspect in society that may have contributed to this change, namely, the media＇s portrayal of depression. The author presents and discusses clear examples of how the Japanese media＇s portrayals of depression have changed, particularly over the last 20 to 30 years, and discusses how media influence could have contributed to the shifts in stigmatization, with reference to labeling theory and growing social isolation.

陈致宇:心理问题,贵在早期干预

陈致宇主任医师、杭州市第七人民医院副院长。擅长难治性精神分裂症、情感性精神障碍、心理疾病的早期干预、急性焦虑症、睡眠障碍的诊治。杭州市精神疾病重点学科带头人,浙江毒理学会神经精神药物与依赖专委会主任委员,浙江康复医学精神康复专委会副主任委员,首届优秀精神科医师,浙江省医学会精神病分会副主任委员,浙江省司法精神病咨询委员会委员,浙江省心理咨询师指导老师。专家门诊时间：每周一上午特需门诊时间：

Schizophrenia:a classic battle ground of nature versus nurture debate

Much has been learned about the etiology and pathogenesis of schizophrenia since the term was first used by Eugene Bleuler over a century ago to describe one of the most important forms of major mental illness to affect mankind.Both nature and nurture feature prominently in our understanding of the genesis of the overall risk of developing schizophrenia.We now have a firm grasp of the broad structure of the genetic architecture and several key environmental risk factors have been identified and delineated.However,much of the heritability of schizophrenia remains unexplained and the reported environmental risk factors do not explain all the variances not attributable to genetic risk factors.The biggest problem at present is that our understanding of the causal mechanisms involved is still in its infancy.In this review,we describe the extent and limits of our knowledge of the specific genetic/constitutional and non-genetic/environmental factors that contribute to the overall risk of schizophrenia.We suggest novel methods may be required to understand the almost certainly immensely complex multi-level causal mechanisms that contribute to the generation of the schizophrenia phenotype.

Human endogenous retrovirus W env increases nitric oxide production and enhances the migration ability of microglia by regulating the expression of inducible nitric oxide synthase

Human endogenous retrovirus W env(HERV-W env) plays a critical role in many neuropsychological diseases such as schizophrenia and multiple sclerosis(MS). These diseases are accompanied by immunological reactions in the central nervous system(CNS). Microglia are important immunocytes in brain inflammation that can produce a gasotransmitter – nitric oxide(NO). NO not only plays a role in the function of neuronal cells but also participates in the pathogenesis of various neuropsychological diseases. In this study, we reported increased NO production in CHME-5 microglia cells after they were transfected with HERV-W env. Moreover, HERV-W env increased the expression and function of human inducible nitric oxide synthase(hi NOS) and enhanced the promoter activity of hi NOS. Microglial migration was also enhanced. These data revealed that HERV-W env might contribute to increase NO production and microglial migration ability in neuropsychological disorders by regulating the expression of inducible NOS. Results from this study might lead to the identification of novel targets for the treatment of neuropsychological diseases, including neuroinflammatory diseases, stroke, and neurodegenerative diseases.