Behavioural and emotional disorders in childhood: A brief overview for paediatricians

Mental health problems in children and adolescents include several types of emotional and behavioural disorders, including disruptive, depression, anxiety and pervasive developmental(autism) disorders, characterized as either internalizing or externalizing problems. Disruptive behavioural problems such as temper tantrums, attention deficit hyperactivity disorder, oppositional, defiant or conduct disorders are the commonest behavioural problems in preschool and school age children. The routine Paediatric clinic or Family Medicine/General Practitioner surgery presents with several desirable characteristics that make them ideal for providing effective mental health services to children and adolescents. DSM-5 and ICD-10 are the universally accepted standard criteria for the classification of mental and behaviour disorders in childhood and adults. The age and gender prevalence estimation of various childhood behavioural disorders are variable and difficult to compare worldwide. A review of relevant published literature was conducted, including published metaanalyses and national guidelines. We searched for articles indexed by Ovid, Pub Med, Pub Med Medical Central, CINAHL, EMBASE, Database of Abstracts and Reviews, and the Cochrane Database of Systematic reviews and other online sources. The searches were conducted using a combination of search expressions including "childhood", "behaviour", "disorders" or "problems". Childhood behaviour and emotional problems with their related disorders have significant negative impacts on the individual, the family and the society. They are commonly associated with poor academic, occupational, and psychosocial functioning. It is important for all healthcare professionals, especially the Paediatricians to be aware of the range of presentation, prevention and management of the common mental health problems in children and adolescents.

帕金森病冲动控制障碍发生率及相关影响因素分析

目的总结帕金森病患者冲动控制障碍发生率并筛查其相关危险因素。方法纳入2016年5月至2017年9月中国医科大学附属第一医院收治的201例原发性帕金森病患者,采用冲动控制障碍问卷(QUIP)评估冲动控制障碍;统一帕金森病评价量表第一至四部分(UPDRSⅠ~Ⅳ)分别评估精神、行为和情绪,日常活动,运动功能,治疗相关并发症;Hoehn-Yahr分期评估疾病严重程度;老年抑郁量表(GDS)评估抑郁症状。单因素和多因素前进法Logistic回归分析筛查帕金森病冲动控制障碍相关危险因素。结果共201例帕金森病患者,经QUIP量表筛查出41例冲动控制障碍患者,冲动控制障碍发生率为20.40%,主要表现为强迫性服药占8.46%(17/201)、强迫性饮食占7.46%(15/201)、刻板行为占6.46%(13/201)、强迫性购物占3.98%(8/201)、病理性赌博占1.49%(3/201)、性欲亢进占0.49%(1/201)。Logistic回归分析显示,服药时间长(OR=1.237,95%CI:1.038~1.474;P=0.018)、UPDRSⅣ评分高(OR=1.389,95%CI:1.077~1.790;P=0.011)、抑郁(OR=2.417,95%CI:0.174~0.984;P=0.046)是帕金森病冲动控制障碍的危险因素。结论帕金森病冲动控制障碍发生率较高,服药时间长、治疗相关并发症严重、抑郁是其危险因素,临床可以根据QUIP量表评估冲动控制障碍风险以指导临床用药。

注意缺陷多动障碍共病破坏性、冲动控制及品行障碍的反应抑制和情绪反应

目的了解注意缺陷多动障碍(ADHD)与破坏性、冲动控制及品行障碍(DICCD)在情绪反应中可能存在的神经心理缺陷的特征。方法选择符合美国精神障碍诊断与统计手册第五版(DSM-5)ADHD诊断标准的6～16岁患儿20名,ADHD共病DICCD患儿20名,DICCD患儿20名以及年龄、性别、智力匹配的健康儿童(HC)20名作为对象,选择Golden Stroop测验和情绪Stroop测验对反应抑制和情绪反应进行评估,组间差异采用单因素方差分析,事后分析使用SNK-q检验同质性亚组进行配对比较。结果在Golden Stroop测验中,错误次数(P=0.003)和反应时间(P=0.044)干扰得分组间差异均有统计学意义,进一步Post Hoc分析ADHD组的干扰得分显著高于其余三组。在情绪Stroop测验中,平均反应时间组间差异均有统计学意义(均P<0.05),事后分析ADHD共病DICCD组正性词-色一致平均反应时间低于ADHD组而高于DICCD组,疾病组均高于HC组;ADHD共病DICCD与DICCD组正性词-色不一致、负性词-色一致平均反应时间显著低于ADHD组且高于HC组;DICCD组负性词-色不一致平均反应时间显著低于ADHD组与ADHD共病DICCD组且高于HC组。结论 ADHD的反应抑制缺陷和异常情绪反应均表现为ADHD的核心症状。偏向性情绪刺激可能对于存在冷漠无情特征的DICCD的反应抑制功能具有的负面作用,尤其在处理负性情绪时问题更为突出,而ADHD与DICCD共病更倾向于DICCD的情绪反应特质。

对立违抗性障碍患儿行为特征的初步研究

目的了解对立违抗性障碍(ODD)患者的行为特征。方法应用Achenbach儿童行为量表(CBCL)、教师报告表(TRF)及青少年自我报告表(YSR)对213例ODD儿童和213名正常儿童(对照组)进行评定和比较。结果(1)CBCLODD组的社交情况、学校情况及社会能力总分低于对照组,而退缩、躯体主诉、焦虑/抑郁、社交问题、思维问题、注意问题、违纪行为、攻击性行为、内化性问题、外化性问题和行为问题总分高于对照组(均P<0.01)。(2)TRFODD组的学习努力、行为适当得体、学习效果、快乐、适应能力总分等的评分低于对照组,而退缩、焦虑/抑郁、社交问题、思维问题、注意问题、违纪行为、攻击性行为、内化性、外化性问题评分和行为问题总分高于对照组,差异有统计学意义(P<0.05～0.01)。(3)YSRODD组的焦虑/抑郁、注意问题、违纪问题、攻击性问题、自我身份、外化性问题评分高于对照组(均P<0.05和<0.01)。结论ODD儿童存在更多的行为问题,以攻击、对抗、情绪不稳为主要特征,伴有退缩、焦虑抑郁等内化性问题。