First 150 years of catatonia:Looking back at its complicated history and forward to the road ahead

Karl Ludwig Kahlbaum(1828-1899)was the first to conceptualize and describe the main clinical features of a novel psychiatric illness,which he termed catatonia in his groundbreaking monograph published 150 years ago.Although Kahlbaum postulated catatonia as a separate disease entity characterized by psychomotor symptoms and a cyclical course,a close examination of his 26 cases reveals that most of them presented with motor symptom complexes or syndromes associated with various psychiatric and medical conditions.In his classification system,Kraepelin categorized catatonic motor symptoms that occur in combination with psychotic symptoms and typically have a poor prognosis within his dementia praecox(schizophrenia)disease entity.Because of the substantial influence of Kraepelin’s classification,catatonia was predominantly perceived as a component of schizophrenia for most of the 20th century.However,with the advent of the psychopharmacotherapy era starting from the early 1950s,interest in catatonia in both clinical practice and research subsided until the early 2000s.The past two decades have witnessed a resurgence of interest in catatonia.The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition,marked a paradigmatic shift by acknowledging that catatonia can occur secondary to various psychiatric and medical conditions.The introduction of an independent diagnostic category termed“Catatonia Not Otherwise Specified”significantly stimulated research in this field.The authors briefly review the history and findings of recent catatonia research and highlight promising directions for future exploration.

Operational definitions and measurement of externalizing behavior problems:An integrative review including research models and clinical diagnostic systems

Measurement of externalizing disorders such as antisocial disorders,attentiondeficit/hyperactivity disorder or borderline disorder have relevant implications for the daily lives of people with these disorders.While the Diagnostic and Statistical Manual of Mental Disorders(DSM)and the International Classification of Diseases(ICD)have provided the diagnostic framework for decades,recent dimensional frameworks question the categorical approach of psychopathology,inherent in traditional nosotaxies.Tests and instruments develop under the DSM or ICD framework preferentially adopt this categorical approach,providing diagnostic labels.In contrast,dimensional measurement instruments provide an individualized profile for the domains that comprise the externalizing spectrum,but are less widely used in practice.Current paper aims to review the operational definitions of externalizing disorders defined under these different frameworks,revise the different measurement alternatives existing,and provide an integrative operational definition.First,an analysis of the operational definition of externalizing disorders among the DSM/ICD diagnostic systems and the recent Hierarchical Taxonomy of Psychopathology(HiTOP)model is carried out.Then,in order to analyze the coverage of operational definitions found,a description of measurement instruments among each conceptualization is provided.Three phases in the development of the ICD and DSM diagnosis systems can be observed with direct implications for measurement.ICD and DSM versions have progressively introduced systematicity,providing more detailed descriptions of diagnostic criteria and categories that ease the measurement instrument development.However,it is questioned whether the DSM/ICD systems adequately modelize externalizing disorders,and therefore their measurement.More recent theoretical approaches,such as the HiTOP model seek to overcome some of the criticism raised towards the classification systems.Nevertheless,several issues concerning this model raise mesasurement challenges.A revision of the instruments underneath each approach shows incomplete coverage of externalizing disorders among the existing instruments.Efforts to bring nosotaxies together with other theoretical models of psychopathology and personality are still needed.The integrative operational definition of externalizing disorders provided may help to gather clinical practice and research.

Mood Spectrum Model:Evidence reconsidered in the light of DSM-5

AIM: to investigate studies conducted with the Mood Spectrum Structured Interviews and Self-Report versions(SCI-MOODS and MOODS-SR).METHODS: We conducted a review of studies published between 1997 and August 2014. The search was performed using Pubmed and Psyc INFO databases. Analysis of the papers followed the inclusion and exclusion criteria recommended by the PRISMA Guidelines, namely:(1) articles that presented a combination of at least two terms, "SCI-MOODS" [all fields] or "MOODS-SR" [all fields] or "mood spectrum" [all fields];(2) manuscript in English;(3) original articles; and(4) prospective or retrospective original studies(analytical or descriptive), experimental or quasi-experimental studies. Exclusion criteria were:(1) other study designs(case reports, case series, and reviews);(2) non-original studies including editorials, book reviews and letters to the editor; and(3) studies not specifically designed and focused on SCI-MOODS or MOODS-SR.RESULTS: The search retrieved 43 papers, including 5 reviews of literature or methodological papers, and 1 case report. After analyzing their titles and abstracts, according to the eligibility criteria, 6 were excluded and 37 were chosen and included. The SCI-MOODS and the MOODS-SR have been tested in published studies involving 52 different samples across 4 countries(Italy, United States, Spain and Japan). The proposed mood spectrum approach has demonstrated its usefulness mainly in 3 different areas:(1) Patients with the socalled "pure" unipolar depression that might manifest hypomanic atypical and/or sub-threshold aspects systematically detectable with the mood questionnaire;(2) Spectrum features not detected by other instruments are clinically relevant, because they might manifest in waves during the lifespan, sometimes together, sometimes alone, sometimes reaching the severity for a full-blown disorder, sometimes interfering withother mental disorders or complicating the course of somatic diseases; and(3) Higher scores on the MOODSSR factors assessing "psychomotor disturbances","mixed instability" and "suicidality" delineate subtypes of patients characterized by the more severe forms of mood disorders, the higher risk for psychotic symptoms,and the lower quality of life after the remission of the full-blown-episode.CONCLUSION: The mood spectrum model help researchers and clinicians in the systematic assessment of those areas of psychopathology that are still neglected by the Diagnostic and Statistical Manual of Mental Disorders 5classification.

Diagnostic challenges in alcohol use disorder and alcoholic liver disease

Alcohol use disorders represent a heterogeneous spectrum of clinical manifestations that have been defined by the Diagnostic and Statistical Manual of Mental Disorders-5. Excessive alcohol intake can lead to damage of various organs, including the liver. Alcoholic liver disease includes different injuries ranging from steatosis to cirrhosis and implicates a diagnostic assessment of the liver disease and of its possible complications. There is growing interest in the possible different tools for assessing previous alcohol consumption and for establishing the severity of liver injury, especially by noninvasive methods.

NATIONAL FIELD TRIAL OF THE CHINESE CLASSIFICATION AND DIAGNOSTIC CRITERIA OF MENTAL DISORDERS: COMPREHENSIBILITY, ACCEPTABILITY AND APPLICABILITY

The Chinese Neurology and Psychiatry Association conducted a national field trial of its Chinese Classification and Diagnostic Criteria of Mental Disorders (CCMD-2) involov-ing 26 provinces and municipalities, 80 psychiatric institutes, and 224 professionals. The results were as follows: (1)95.2% of researchers considered the comprehensibility of the CCMD-2 diagnstic criteria good. Within the ten major categories, comprehensibility ranged from 85.7% to 100%. (2) Of those surveyed concerning the acceptibility of the CCCMD-2 diagnostic criteria, 85.9% considered them acceptable. In individual classifications, the rate ranged from 74.1% to 95.2%. (3) 1498 cases were tested. The overall applicability rate which indicated the consistency between the CCMD-2 result and the actual clinical diagnoses was found to be 87.6%, (averaging Kappa = 0.82,P<0.01), better than those obtained from non-Chinese systems of diagnosis.

整合视听连续执行测试与DSM-Ⅳ诊断注意缺陷多动障碍的对照研究

【目的】 通过整合视听连续执行测试 (integratedvisualandauditorycontinuousperformancetest ,IVA CPT)与DSM Ⅳ诊断儿童注意缺陷多动障碍 (attentiondeficithyperactivitydisorder ,ADHD)的对照研究 ,探讨IVA CPT的应用价值。 【方法】 对专科门诊 13 0例ADHD儿童同时行IVA CPT和DSM Ⅳ诊断 ,统计分析结果 ,对比、评价其临床意义。 【结果】 DSM Ⅳ和IVA CPT对ADHD的阳性检出率分别为 67.69%和 5 9.2 3 % ,经 χ2 相关分析两者呈正相关 ,χ2 相差分析差异不明显 ;对ADHD临床分型的诊断两方法同样呈正相关和相差不明显。 【结论】 IVA

双极性指标与DSM-Ⅴ标准在筛检双相障碍患者中的识别效能比较研究

目的比较双极性指标与DSM-Ⅴ在筛检双相障碍患者中的识别效能。方法选取2012年6月~2013年12月本院门诊及住院治疗的120例抑郁发作患者作为研究对象,分别采用双极性指标（BPX）、精神障碍诊断与统计学手册第五版（DSM-Ⅴ）、疾病和有关健康问题的国际统计分类第十次修订本（ICD-10）进行评估,以ICD-10临床诊断为标准,比较BPX、DSM-Ⅴ筛查的灵敏度、特异度、准确度、阳性预测值、阴性预测值,采用多因素Logistic回归分析对双相障碍的危险因素进行分析。结果 BPX筛查的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为84.62%、82.98%、83.33%、57.89%、95.12%,DSM-Ⅴ筛查的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为38.46%、96.81%、84.17%、76.92%、85.05%。不典型抑郁、自杀企图史、既往情感发作总次数≥4次、病情完全缓解是双相障碍患者的高危因素。结论双极性指标在筛查双相障碍患者中具有良好的灵敏度与特异度,有助于提高双相障碍患者的识别率。

Connectivity differences between adult male and female patients with attention deficit hyperactivity disorder according to resting-state functional MRI

Attention deficit hyperactivity disorder（ADHD） is a pervasive psychiatric disorder that affects both children and adults. Adult male and female patients with ADHD are differentially affected, but few studies have explored the differences. The purpose of this study was to quantify differences between adult male and female patients with ADHD based on neuroimaging and connectivity analysis. Resting-state functional magnetic resonance imaging scans were obtained and preprocessed in 82 patients. Group-wise differences between male and female patients were quantified using degree centrality for different brain regions. The medial-, middle-, and inferior-frontal gyrus, superior parietal lobule, precuneus, supramarginal gyrus, superior- and middle-temporal gyrus, middle occipital gyrus, and cuneus were identified as regions with significant group-wise differences. The identified regions were correlated with clinical scores reflecting depression and anxiety and significant correlations were found. Adult ADHD patients exhibit different levels of depression and anxiety depending on sex, and our study provides insight into how changes in brain circuitry might differentially impact male and female ADHD patients.

Role of Transcranial Direct Current Stimulation in the Management of Post-Stroke Depression

Study Objectives: Stroke is a major neurological disease significantly threatening the human health and life with a high morbidity, disability, and mortality. Post-stroke depression (PSD) is one of the common complications of stroke. PSD has been a major factor hindering the recovery of neurological functions and daily activities in stroke patients and is closely related to the social avoidance and increased mortality of stroke patients. Although antidepressant drug treatment has improved during the last decades, symptoms in about 20% of the patients are not in remission two years after initiation of pharmacological intervention. Nowadays, non-invasive brain stimulation;techniques;transcranial direct current stimulation (tCDS) has gained an important interest in the treatment of many neuropsychiatric disorders which might be of some help in treatment of PSD. The goal of the current study is to evaluate the beneficial short term role of tDCS on post-stroke depression. Study Design: This was a randomized double blind placebo-controlled clinical trial included forty hemiparetic patients with post-stroke depression from outpatient clinic of Faculty of Physical Therapy, Cairo University, in the period between June 2018 to June 2019. All patients diagnosed as having a PSD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Depression was evaluated by Hamilton Depression Rating Scale (HAM-D) pre and post treatment and quality of life was evaluated by the Stroke Specific Quality Of Life scale (SS-QOL). Patients were assigned randomly into two groups: the study group A and the control group B. Both groups received antidepressant medication in addition to physical therapy program. Group A received tCDS for 30 minutes, three times per week for one month, while the group B received sham transcranial direct current stimulation. Results: Active tDCS was significantly superior to sham with significant improvement in depression and Stroke Specific Quality Of Life in treated group in comparison to group B, p = 0.000. Conclusion: tDCS was effective for post- stroke depression and might be a favorable option for treating post-stroke patients.

《精神疾病诊断和统计手册》第5版双相障碍伴混合特征的专家问卷调查

目的:评价我国精神科医师对《精神疾病诊断和统计手册》第5版中双相障碍伴混合特征的态度和观点以及临床适用性。方法:通过网络调查问卷,调查214名精神病学相关医疗人员,汇总专家建议,进行分析。结果:多数专家肯定了混合特征这一标注的确立,特别是对于抑郁障碍有不同意义。但是调查结果显示认为将典型的躁狂发作症状(50%)和典型的抑郁发作症状(63.55%)列为伴混合特征症状的反向症状合理的比例偏低。抑郁背景上,易激惹、激越、冲动、想的事情太多、对外界特别敏感较为常见,在躁狂背景上,自伤、自责、自卑较为常见。结论:相反症状组合在一起,可能会因为相互修饰出现新的症状,而不是两个相反症状的简单组合。

双相障碍的诊治与研究——机遇与挑战

双相障碍临床表现复杂、病程多变,常导致临床识别不足、诊断不确定以及治疗困难。由此,学界开展了一系列研究,探索该病的特征与本质,并在循证医学的基础上践行有关诊断标准的修正以及治疗理念的纠正。该文从概念与诊断、神经生物学研究进展以及心境稳定剂治疗等方面对双相障碍的探索现状和前景进行评述。

整合视听持续测试诊断不同年龄段注意缺陷多动障碍患儿的临床应用

目的探讨整合视听持续测试(IVA-CPT)对不同年龄段注意缺陷多动障碍(ADHD)诊断的临床应用价值。方法以美国精神障碍诊断和统计手册第4版(DSM-Ⅳ)为参照,对309例临床怀疑ADHD患儿进行IVA-CPT诊断,并按年龄将患儿分为6.0～6.9岁组、7.0～7.9岁组、8.0～8.9岁组、9.0～9.9岁组、10.0～10.9岁组、11.0～11.9岁组和12.0～15.0岁组,共7组,分别进行临床诊断评价,对比、评价IVA-CPT诊断不同年龄段ADHD临床价值。结果以DSM-Ⅳ为参照标准,IVA-CPT诊断ADHD各组的特异度不超过52.9%;7.0～7.9、8.0～8.9岁组敏感度最高(84.6%、85.4%),6.0～6.9、9.0～9.9岁组次之(76.9%、79.5%),10.0岁以上组敏感度最低(57.1%、61.5%、60.0%)。IVA-CPT与DSM-Ⅳ二种诊断方法对ADHD的阳性检出率比较,按年龄分组后二种诊断方法的ADHD的检出率之间无显著性差异(Pa>0.05);6.0～6.9岁组及10岁以上组在注意缺陷型,多动/冲动型,混合型二种诊断方法的符合率均<50%;7.0～7.9、8.0～8.9、9.0～9.9岁组符合率>60%,二种方法对分型诊断之间符合率的比较存在显著性差异(Pa<0.01)。二种方法在注意缺陷型诊断中符合率最高。结论IVA-CPT对7.0～8.9岁ADHD诊断价值较高,对较小及较大儿童还要结合临床行DSM-Ⅳ量表或其他量表评分,综合评定。IVA-CPT在分型诊断中建议只用于注意缺陷型的测定,对多动/冲动型的诊断需谨慎。

东莞市儿童孤独症谱系障碍早期筛查识别的应用

目的:探究ASD三级筛查在东莞市6~36个月婴幼儿中的应用价值,了解孤独症谱系障碍(autism spectrum disorder,ASD)患病情况,以便对其采取早期康复措施。方法:选取6~36个月常住人口活产出生儿童2000例为研究对象,应用ASD警示指标作检查进行初级保健筛查,初筛阳性儿童运用中文简化版改良婴幼儿孤独症筛查量表(Modified Checklist for Autism in Toddlers,M-CHAT)作检查进行一级筛查,一筛阳性儿童运用孤独症行为量表(Autism Behavior Checklist,ABC)、儿童孤独症评定量表(Childhood Autism Rating Scale,CARS)进行二级筛查协助诊断ASD,二筛阳性儿童为高度疑似ASD,由儿童康复专家医生运用诊断工具美国精神疾病诊断分类手册第5版(Diagnostic and Statistical Manual of Mental Disorders V,DSM-V)标准进行诊断分级。结果:共筛查东莞市2000例适龄儿童,依据筛查标准,初筛阳性率为3.8%(76/2000),一筛阳性率51.32%(39/76),二筛阳性率69.23%(27/39),最终经DSM-V标准确诊27例ASD患儿,患病率为13.50‰,其中男21例,女6例,男性患病率为1.88%,显著高于女性的0.68%(P<0.05),不同确诊年龄、出生地的ASD患病率比较,差异无统计学意义(P>0.05)。经神经心理发育测评发现,27例ASD患儿中7例量表均分≥85分的智力发育正常患儿,10例84~70分的智力偏低患儿,8例69~35分为智力轻中度低下的患儿,2例≤34分的智力重度低下患儿,确诊年龄<18个月的患儿大运动评分显著低于确诊年龄≥18个月的患儿(P<0.05)。结论:依据ASD三级筛查新模式,东莞市2000名适龄儿童ASD患病率为13.5‰,略高于多数报道中的10‰,该筛查模式有助于ASD患儿的早发现、早干预、早治疗。

儿童注意缺陷多动障碍整合视听连续执行测试研究

目的:探讨整合视听连续执行测试整合视听连续执行测试(IVA-CPT)对儿童注意缺陷多动障碍(ADHD)的诊断价值。方法:对门诊怀疑ADHD的99例儿童同时采用精神障碍诊断与统计(DSM-IV)和IVA-CPT进行诊断,并比较两组的检测结果。结果:精神障碍诊断与统计和IVA-CPT对ADHD的阳性检出率分别是72.73%和63.64%,χ2检验两者具有相关性,相差分析差异不明显,对ADHD分型的诊断同样具有相关性,相差不明显。结论:整合视听连续执行测试对ADHD的诊断具有客观的应用价值。

女性性功能障碍的诊断

女性性功能障碍(female sexual dysfunction,FSD)根据精神障碍诊断下统计手册第4版(DSM-Ⅳ)标准主要分为:性欲障碍、性唤起障碍、性高潮障碍和性交疼痛。2013年5月DSM-Ⅴ正式发布,主要变化包括将性厌恶归为焦虑症,改变了女性性高潮障碍的定义,合并性欲障碍和性唤起障碍为性兴趣/唤起障碍,合并性交疼痛和阴道痉挛为生殖器-盆腔疼痛/插入障碍。妇科医生应能够做出女性性功能障碍基本诊断,将重点放在发现器质性病变以及对阴道痉挛患者的治疗,而对性欲障碍、性唤起障碍和性高潮障碍患者仍建议转诊至心理科治疗。

人格障碍诊断与评估的研究进展

《精神疾病诊断与统计手册》第一版(the first edition of Diagnostic and Statistical Manual of Mental Disorders,DSM-1)正式提出人格障碍的诊断;DSM-3开创性地提出了用一个系统的框架来理解人格障碍,并提出了多轴诊断策略、类别诊断标准;之后的DSM系统关于人格障碍的诊断沿用了DSM-3的策略与标准。2013年出版的DSM-5,在沿用以往的人格障碍诊断标准的同时提出了人格障碍替代模式(alternative model for personality disorders,AMPD),表明了人格障碍诊断和评估新的发展方向。AMPD强调用标准A即自我及人际功能损害来预测人格障碍的严重性,用标准B即病理性人格特质来鉴别不同的人格障碍类型。标准A的内容可追溯到心理动力学的概念,比如Kernberg人格组织模型中提到的自体与客体的区分与整合。AMPD提出了分别用于评估人格功能损害程度、病理性人格特质的人格障碍评估工具:人格功能水平量表(Level of Personality Functioning Scale,LPFS)、DSM-5人格量表,并进行了信度和效度检验。基于Kernberg人格组织模型的人格障碍评估工具人格组织结构化访谈问卷被证明与LPFS有良好的相关性。

Validity of Chinese Version of the Composite Internationa Diagnostic Interview-3.0 in Psychiatric Settings

Background： The Composite International Diagnostic Interview-3.0 （CIDI-3.0） is a fully structured lay-administered diagnostic interview for the assessment of mental disorders according to ICD-10 and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition （DSM-IV） criteria. The aim of the study was to investigate the concurrent validity of the Chinese CIDI in diagnosing mental disorders in psychiatric settings. Methods： We recruited 208 participants, of whom 148 were patients from two psychiatric hospitals and 60 healthy people from communities. These participants were administered with CIDI by six trained lay interviewers and the Structured Clinical Interview for DSM-IV Axis I Disorders （SCID-I, gold standard） by two psychiatrists. Agreement between CIDI and SCID-I was assessed with sensitivity, specificity, positive predictive value and negative predictive value. Individual-level CIDI-SCID diagnostic concordance was evaluated using the area under the receiver operator characteristic curve and Cohen＇s K. Results： Substantial to excellent CIDI to SCID concordance was found for any substance use disorder （area under the receiver operator characteristic curve [AUC] = 0.926）, any anxiety disorder （AUC = 0.807） and any mood disorder （AUC = 0.806）. The concordance between the CIDI and the SCID for psychotic and eating disorders is moderate. However, for individual mental disorders, the CIDI-SCID concordance for bipolar disorders （AUC = 0.55） and anorexia nervosa （AUC = 0.50） was insufficient. Conclusions： Overall, the Chinese version of ClDI-3.0 has acceptable validity in diagnosing the substance use disorder, anxiety disorder and mood disorder among Chinese adult population. However, we should be cautious when using it for bipolar disorders and anorexia nervosa.

美国《精神障碍诊断与统计手册》第5版跨界症状量表在消化系统恶性肿瘤患者精神症状评估中的应用

目的:探讨美国《精神障碍诊断与统计手册》第5版(DSM-5)跨界症状量表在消化系统恶性肿瘤患者精神症状评估中的应用价值。方法:运用DSM-5跨界症状量表、广泛性焦虑量表(GAD-7)及9项患者健康问卷(PHQ-9)对243例住院治疗的消化系统恶性肿瘤患者进行评估和分析。结果:DSM-5跨界症状量表评估显示142例(58.44%)出现精神症状,>40%的患者出现≥2种精神症状;精神症状出现的频率依次是焦虑(27.16%)、抑郁(25.10%)、躯体症状(25.10%)、躁狂症状(24.69%)、睡眠问题(21.40%)及物质使用(11.11%);焦虑症状出现率大于GAD-7评估结果(18.52%),抑郁症状出现率与PHQ-9评估相似(25.11%);有精神症状组对疾病了解程度明显多于无精神症状组(χ^2=6.651,P<0.05)。结论:消化系统恶性肿瘤患者出现精神症状的比率高,抑郁、焦虑、躯体症状、睡眠问题为主要症状,精神症状出现可能与其对疾病的了解程度有关。

儿童神经发育障碍的诊断——ICD-11和DSM-5解读

解读世界卫生组织《国际疾病与相关健康问题统计分类》第11版和《精神疾病诊断与统计手册》第5版,并参考近10年的相关文献,将常见的神经发育障碍性疾病的诊断进行归纳分类,旨在为临床诊断提供参考依据,以便与国际接轨。

CCMD-3和DSM-Ⅳ对注意缺陷多动障碍诊断的比较研究

【目的】比较美国精神障碍诊断与统计手册第4版(Diagnostic and Statistical Manual of Mental Disorder,th ed,DSM-Ⅳ)和中国精神障碍分类及诊断标准(Chinese Classification of Mental Disorders,Third Edition,CCMD-3)在诊断注意缺陷多动障碍(attention deficit and hyperactive disorder,ADHD)上的异同。【方法】以172例由高年资精神科医生诊断为ADHD的门诊患儿为研究对象,由家长填写由两个诊断标准制成的量表,按照两个诊断标准对患儿进行诊断和分型。【结果】172例患者中,162例符合DSM-Ⅳ诊断标准,而所有样本均符合CCMD-3诊断标准;对同时符合两个诊断标准的注意缺陷为主型或混合型的156例患儿进行两量表分型的吻合度检验显示中等吻合度(Kappa=0.587),McNemar检验显示两个诊断分型的差异有统计学意义(P=0.000);对两个量表注意缺陷为主型和混合型的构成比比较显示CCMD-3中混合型的构成比高于DSM-Ⅳ(P=0.023);CCMD-3的条目阳性率比DSM-Ⅳ高,两者均在学习问题描述的条目阳性率高。【结论】CCMD-3较DSM-Ⅳ在诊断ADHD上更为宽松,且更多的将患儿判定为混合型;就诊患儿中注意缺陷症状较多动冲动症状更为明显。