协作干预措施在颈动脉闭塞性脑梗死介入治疗中的应用效果

目的 探讨协作干预措施在颈动脉闭塞性脑梗死(CAOCI)介入治疗中的应用效果。方法 收集2019年3月至2021年5月于首都医科大学附属北京世纪坛医院接受颈动脉介入治疗的106例CAOCI患者的临床资料,根据是否采取协作干预措施将患者分为常规组和协作组,每组53例。比较两组患者干预前后的心理状态[焦虑自评量表(SAS)、抑郁自评量表(SDS)评分]、自我效能感、自我管理水平、神经功能[美国国立卫生研究院卒中量表(NIHSS)评分]、生活能力[改良Rankin量表(mRS)评分],以及出院前与术后6个月的生活质量、血脂指标[甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平]。比较两组患者干预措施相关的并发症发生情况。结果 干预后,协作组患者的SAS、SDS评分均低于常规组患者,自我效能感评分高于常规组患者,自我管理水平量表中各维度的评分均高于常规组患者,NIHSS、mRS评分均低于常规组患者(P﹤0.05)。术后6个月,协作组患者世界卫生组织生活质量测定量表-100(WHOQOL-100)中的各维度评分及总分均高于常规组患者,TG、TC、LDL-C水平均低于常规组患者(P﹤0.05)。两组患者均未出现干预措施相关并发症。结论 协作干预措施能够改善CAOCI患者的心理状态,减轻神经功能损伤,提高患者生活能力,辅助改善患者的预后。

阿立哌唑联合帕罗西汀对难治性老年抑郁症患者血清Hcy、Cor、BDNF水平的影响

目的分析阿立哌唑联合帕罗西汀对难治性老年抑郁症患者血清Hcy、Cor、BDNF水平的影响。方法选择2018年1月至2019年12月常熟市第三人民医院收治的100例难治性老年抑郁症患者,按照随机数字表法分为对照组和研究组,每组各50例。对照组患者采用帕罗西汀治疗,研究组患者在对照组治疗的基础上联合阿立哌唑治疗,两组患者均治疗12周。比较治疗12周后两组患者的治疗效果;比较治疗前及治疗4周、8周、12周后两组患者的HAMD-17、SFRS评分及治疗前、治疗12周后血清Hcy、Cor、BDNF水平。结果治疗12周后,研究组患者治疗总有效率为94.00%,高于对照组患者的80.00%;与治疗前比,治疗4周、8周、12周后两组患者HAMD-17、SFRS评分均呈下降趋势,且各时间点研究组低于对照组;治疗12周后两组患者血清Hcy、Cor水平降低,且研究组低于对照组;血清BDNF水平升高,且研究组高于对照组(均P<0.05)。结论阿立哌唑联合帕罗西汀可提高血清BDNF水平,降低血清Hcy、Cor水平,改善患者神经功能,缓解患者临床症状,提高抗抑郁效果。

精神卫生立法需要着眼于未来(英文)

The forum article by Professor Xie [1] raises the broad issue of whether mental health legislation in China needs to respond to the existing realities of the community mental health services system.Given the lack of community mental health resources in China,the burden of caring for persons with mental illnesses has traditionally been borne by families and by psychiatric hospitals.As China introduces its first national mental health legislation the concern is

精神病学与电影:从神奇的画面中我们可以学到什么?（英文）

概述:电影是一种社会形态的载体,它可展示精神疾病的各个不同方面。由于电影的戏剧性和污蔑性的描述,它有时会传播有关精神疾病的消极影响,给病人带来痛苦。与消极影响相比,虽然它也会有一些正面和鼓舞人心的故事,但却是少之又少。在此,我们将描述电影对精神病学的双重影响。

Group psychological intervention for maternal depression: A nested qualitative study from Karachi, Pakistan

AIM To understand the experience of maternal depression, the factors implicated in accessing health, and the acceptability of the psychosocial intervention. METHODS The participants were recruited from the paediatrics outpatient department of Civil Hospital Karachi, Pakistan. The study started in December 2009 and completed in December 2010. Women with maternal depression, aged 18-44 years with children aged 0-30 mo who had received nutritional supplements, and participated in the intervention programme [called Learning through Play(LTP) plus] were included in the study. Qualitative interviews were conducted with 8 participants before the intervention and 7 participants after the intervention. A semi structured topic guide was used to conduct the interviews.RESULTS Framework analysis procedures were used to analyse the qualitative data. Four themes emerged:(1) the women's contextual environment: Interpersonal conflicts, lack of social support and financial issues being the major barriers in assessing healthcare;(2) women's isolation and powerlessness within the environment: Sense of loneliness was identified as a restricting factor to access healthcare;(3) the impact of the intervention(LTP-Plus): Women felt "listened to" and seemed empowered; and(4) empowered transformed women within the same contextual environment: The facilitator provided a "gardening role" in nurturing the women resulting in a positive transformation within the same environment. The women's homes seemed to be more happy homes and there was a positive change in their behaviour towards their children.CONCLUSION Findings informed the further development and testing of culturally-appropriate psychosocial intervention(LTP^+) for addressing maternal depression.

The Simple Science of Sanity, Certainty, & Peace-of-Mind—Empowering ‘Intent’ Detoxifies Psychosis

CHILDHOODS MATTER.Human beings have a prodigious capacity to learn.The language we absorb at our mother’s knee is vastly complex,supple,subtle and continually in flux-but vital for social skills.And also crucial,for that ever elusive target for which we all strive,PEACE-OF-MIND.Those of us born into confident peaceable families,unsurprisingly,face the adult world with confidence and delight.We use language to grow solid,reliable,TRUSTWORTHY social networks—which we accept without a second thought.We presume that this is normal,healthy,and the rightful desert of every human being ever born—which it is.

Anti-voltage-gated potassium channel complex antibody-mediated limbic encephalitis:a case report of a 53-yearold man admitted to intensive care psychiatric unit with psychotic mania

Limbic encephalitis represents a cluster of autoimmune disorders,with inflammation in the medial temporal lobe characterised by subacute onset of neuropsychiatric symptoms such as anxiety,affective symptoms,psychosis,short-term memory impairment as well as faciobrachial and grand mal seizures.We aim to present a case of a 53-year-old man with positive anti-voltage-gated potassium channel(VGKC)complex antibodies who initially presented with symptoms of psychotic mania.Six weeks post-psychiatric symptomatology,he presented with neurological symptoms such as faciobrachial jerking and tonic-clonic seizure.The patient had no previous psychiatric history and was initially treated with psychotropic medications.Our experience emphasises the fact that limbic encephalitis is not easy to identify as most patients initially present with psychiatric symptomatology than neurological symptoms.Furthermore,immunological and laboratory testing takes a rather long time to determine the diagnosis.What is more,few psychiatrists consider autoimmune nature of the neuropsychiatric presentation.Therefore,it is important to consider autoimmune encephalitis in patients with new-onset psychosis or mania who also present with neurological symptoms at some stage of their illness.Characteristic indicators of autoimmune encephalitis include neurological symptoms such as facial twitching,seizures,confusion and cognitive decline.

Sensation/novelty seeking in psychotic disorders:A review of the literature

The evaluation of personality traits is important for the better understanding of the person suffering from psychosis and for treatment individualization. However literature on patients' personality and character in such disorders is limited. The aim of this review was to summarize the literature on sensation/novelty seeking(SNS), a trait which is biologically based and highly heritable and is associated with dopamine activity, and refers to a person's tendency to seek varied, novel, complex, and intense sensations and experiences. A total of 38 studies were included in this review, involving 2808 patients and 2039 healthy controls. There is consistent evidence that this trait is independentlyassociated with alcohol and substance abuse in patients with schizophrenia and related disorders. The estimation of SNS would help clinicians to identify patients at risk for abuse. There is also some evidence that higher SNS levels may relate to medication non-adherence and seem to increase the risk of patients' aggressive and violent behavior, but studies are scarce. SNS was found not to be related to suicidality, whereas in the fields of patients' quality of life and psychopathology results are contradictory, but most studies show no possible association. Several studies suggest that SNS is lower in psychotic patients compared to controls, whereas most yield no differences. The evidence for this trait as a potential endophenotype of schizophrenia is weak. SNS may be implicated in psychotic disorders' course and prognosis in several ways and should be always inquired for. This trait can be reliably measured with the use of easily applicable self-rated instruments, and patients' accounts could inform clinicians when planning management and delivering individualized treatment.

Perception and Attitude of Employers towards Employees with AUD in an Emerging Economy: A Qualitative Enquiry

Background: The disease, addiction to chemical substances or drugs such as alcohol (ethanol, C2H5OH) is still not accepted as a diagnostic nosology by many in Ghana. Many consider addiction as a moral challenge, rather than a medical condition. This perception is propagated even in the Ministry of Health’s Occupational Health and Safety (OHS) policy document which punishes symptoms of substance use disorders. This study seeks to explore the perception and attitude of employers towards employees with alcohol use disorders (AUD) and to ascertain the level at which employee assistance programs (EAPs) are implemented in organizations. Methods: To infer outcomes, the study adopted the qualitative approach. In-depth interviews and observations which describe the perceived attitudes of employers (using HR managers as proxy) towards employees with AUD of some selected hospitals (private and public) in the Greater-Accra Metropolis. The interview was conducted face-to-face using an interview guide, which included open-ended questions. The structure of the guide helped the researchers to observe the participants and the conversations were also audio-taped after seeking the consent of the participants. On average, the interview lasted between 45 and 60 minutes. Results: Findings from the 10 interviews revealed that a number of factors such as biological, environmental, social and psychological accounted for AUD among employees regardless of the nature of their work. Although the HR managers had knowledge on the possible causes of AUD, some of them explained that they could not identify alcohol use in their organisations. The few that admitted to AUD at their workplace reported that alcohol use did not have any effect on their productivity and most of these workers were temporal or causal workers, hence were not perceived as permanent staff. In spite of prevalence of AUD in some hospitals, it was interesting to know that majority of these facilities had no EAPs and the few that had policies on AUD were not implementing them. Conclusions: This paper focused on some aspect of HR managers’ perceived attitude toward an aspect of their employees’ mental wellbeing which is AUD in a work setting. However, there are other pertinent issues that are crucial to employee total wellbeing that can be addressed in future research.

Psychiatry Is Bereft-It Lacks a Workable Philosophy for Consciousness-Herewith a Three Pronged Escape Plan

PHILOSOPHY and PSYCHIATRY are unusual bedfellows.Medical students,already hard pressed for time,are generally thrust into the melee of mental disorders,having spent years focussing on first dissecting and then prodding human bodies,which too often leaves little room for evaluating theories about human nature,especially with respect to“Intent”or Free Will.The present writer was unusual in that having spent two years in pre-clinical medical training,he devoted a full university year to pursuing philosophical studies in up to 20 different university departments.Thus he entered his teaching hospital with a working knowledge of Hume,Kant,Sartre,Wittgenstein,Buber and others.This is not a clinical paper-it focuses on the reasoning behind psychiatric precepts-so it is perhaps inevitable that today’s prevailing ideology is shown to be grievously wanting-a case of decidedly unphilosophical,even anti-philosophical,medical practice.The notion of there ever being a“scientific”theory of psychiatry has already been discounted in a series of earlier papers-which leaves us with the responsibility for choosing the best possible option,from an infinite number of theoretical models available.The paper provides a whistle-stop tour of how mental disease looks if you start with a confident and consistent look at that pinnacle of human attributes-consciousness.It doesn’t presume to say what consciousness is,but it does assume that it has a function,like every other human asset.Indeed by cutting corners,evaluating what has worked over 60 years in psychiatry,the result is as straightforward a picture of sanity as one can reasonably expect.As such,it leaves the reader with little wriggle room-there is enough clarity here,for you to accept or reject the main proposition.However,since the flaws described tend to be lethal,acceptance entails action.Now read on.

绿色通道措施对大动脉闭塞性急性缺血性脑卒中患者临床疗效与预后的影响

目的探讨绿色通道措施对大动脉闭塞性急性缺血性脑卒中(AIS)患者临床疗效与预后的影响。方法收集2019年3月至2021年6月首都医科大学附属北京世纪坛医院收治的120例大动脉闭塞性AIS患者的临床资料,其中,将2019年3月至2020年5月采用常规急救措施的患者作为对照组,将2020年6月至2021年6月采用绿色通道措施的患者作为观察组,每组60例。比较两组患者的救治过程各阶段用时,包括预检分诊时间、发病至就诊时间(ODT)、入院至静脉溶栓时间(DNT)、发病至静脉溶栓时间(ONT)、就诊至取得知情同意时间、计算机断层扫描(CT)完成时间、住院时间。比较两组患者不同时间[治疗前(入院检查时)、出院前及出院后6个月]的生活自理能力(Barthel指数评分)、神经功能[美国国立卫生研究院卒中量表(NIHSS)评分]。比较两组患者治疗前、治疗后1 d的血清标志物[C反应蛋白(CRP)、同型半胱氨酸(Hcy)、血管内皮生长因子(VEGF)]水平,动脉血流速度指标[舒张期流速(Vd)、收缩期峰值流速(Vp)]。比较两组患者出院前、出院后6个月的生活质量[世界卫生组织生活质量测定量表简表(WHOQOL-BREF)评分]。结果观察组患者的预检分诊时间、ODT、DNT、ONT、就诊至取得知情同意的时间、CT完成时间及住院时间均明显短于对照组患者,差异均有统计学意义(P<0.01)。治疗后1 d,观察组患者的CRP、Hcy水平均低于对照组患者,VEGF水平高于对照组患者,Vd、Vp均快于对照组患者,差异均有统计学意义(P<0.05)。出院前、出院后6个月,观察组患者的Barthel指数均高于对照组患者,NIHSS评分均低于对照组患者,差异均有统计学意义(P<0.05)。出院后6个月,观察组患者WHOQOL-BREF中的躯体症状、躯体功能、心理功能、社会关系、总生存质量维度的评分均高于对照组患者,差异均有统计学意义(P<0.05)。结论绿色通道措施能够加快大动脉闭塞性AIS患者的抢救进程,提高患者生活能力,减轻神经功能损伤程度,改善患者生活质量。

Sleep Paralysis - Cultural Significance and Its Management

Sleep paralysis (SP) is a benign,transient episode of immobility and it lasts a few seconds to a few minutes.It can occur while falling asleep or on awakening.It is a condition of unknown etiology and all the skeletal muscles are almost ‘paralyzed’.It leads to an inability to speak or move but individual remains conscious.This review summarizes the existential clinical literature on sleep paralysis most relevant to practitioners;also summarizes the many historical and artistic manifestations of SP in different cultures.It also throws light on the available Arabic literature and others as per the aim of the review.For this review,literature search using engines was carried out,and review papers and original research articles were analyzed.We start with a review which summarizes the collection of symptoms,prevalence rate,risk factors and etiological theories,characteristics and classification of the SP over the past years up to the present time,also the management in the form of psychotherapy and pharmacotherapy as well as the cultural significances in different countries.SP plays an important role in the genesis and maintenance of many supernatural beliefs such as nocturnal alien abductions,demonic and ghost attacks in individuals with intact reality testing.

Emotion regulation in bipolar disorder: Are emotion regulation abilities less compromised in euthymic bipolar disorder than unipolar depressive or anxiety disorders?

Objective: This study investigated the profile of emotion dysregulation in Bipolar Disorder (BD) and compared it to Unipolar Depression, Anxiety, and Healthy control groups. Methods: 148 euthymic patients diagnosed with BD (n = 48), Unipolar Depressive disorder (n = 50), Anxiety disorder (n = 50), and a Healthy Control (HC) group (n = 48) were evaluated using the Difficulties in Emotion Regulation Scale (DERS). The DERS yields a total score in addition to scores on six subcomponents believed to encapsulate the emotion dysregulation construct. Results: Compared to the healthy control group, all clinical groups (BD, Unipolar Depression, and Anxiety) reported significantly greater overall difficulties in emotion regulation (Total DERS) and difficulties specific to the DERS subcomponent measures: Goals, Impulse, and Strategies. The profile of emotion dysregulation was virtually identical for the Unipolar Depression and Anxiety groups, with BD demonstrating emotion regulation difficulties intermediate between controls and the two clinical groups. Specifically, emotion regulation in the BD group was significantly less compromised in the domains of acceptance of emotions, emotional awareness, and emotional clarity compared to the depression and anxiety groups. Conclusions: Emotion regulation abilities among people with euthymic BD were significantly less compromised than Unipolar Depression and Anxiety groups with regards to emotional awareness, acceptance of emotions, and understanding of emotions. However, emotion regulation abilities pertaining to engagement in goal directed behaviour, impulse control, and access to emotion regulation strategies were similarly compromised across all three clinical groups. This profile might help enrich extant adjunct psychological interventions for BD by enlisting emotion regulation strategies with the aim of decreasing the relapse rate that characterises BD.

A Juvenile Sex Offender with Attention Deficit Hyperactivity Disorder

Background:Attention deficit hyperactivity disorder(ADHD)is a neurodevelopmental disorder manifesting in early life.These children are more vulnerable to sexual abuse as victims and offenders.Here we describe a teenager with previously undiagnosed ADHD presenting with an alleged act of sexual offending.Case report:According to the 14-year-old accused,he has engaged in penetrative anal intercourse with another school colleague.He also divulged past such incidents involving a teenage male relative and insertion of foreign bodies by him to his anus repeatedly.On assessment the accused had features of inattention such as difficulty in sustaining attention,failing to finish work and features of impulsivity such as difficulty waiting for his turn and intruding on others.He was diagnosed with ADHD according to DSM 5 clinical criteria which were supported by the Sinhalese adaptation of the Swanson,Nolan and Pelham questionnaire.The assessment of the non-verbal intelligence was in the normal range,but his school performance was far below the average.Discussion:Undiagnosed ADHD contributes to academic impairment and inappropriate sexual behaviour.It is possible that the described adolescent’s impulsiveness and inattention contributed to his academic failure and risky sexual behaviour.Early detection and proper management of this disorder may have reduced the risk of such behaviour in him.

Comparison of horse and cow milk on sleep disorders in children with attention deficit hyperactivity disorder:a double-blind randomized clinical trial study

Approximately 25%–50%of children with attention deficit hyperactivity disorder have sleep problems.The aim of this study is to compare the effect of horse milk with conventionally-fed cow’s milk on sleep disorders in children with attention deficit hyperactivity disorder.In this randomized double-blind crossover study,30 patients with attention deficit hyperactivity disorder were randomly selected and divided into two groups.All patients underwent a 45-day period of horse milk consumption and a 45-day period of cow milk consumption and they continued their drug treatment.A one-week interval between two periods of milk consumption was considered as the washout period.The severity of sleep disorder in the studied patients was determined based on the short form of the Children’s Sleep Habits Questionnaire(CSHQ).Twenty-two(73.3%)male and eight(26.7%)female patients were included in this study.The mean age of the patients was 8.9 years.Our results showed that horse milk consumption improved the CSHQ score.For the group of patients consuming horse milk prior to cow milk,reductions of total CSHQ(P-value=0.001)and subscale 1(P-value<0.001)scores were significant.For the group of patients consuming cow milk first,in addition to the total CSHQ(P-value<0.001),subscale 3(P-value=0.001)and 4(P-value=0.009)dropped significantly.On the other hand,the results indicated that cow milk consumption increased the CSHQ score.Specifically,for the group of patients consuming horse milk first,the total CSHQ(P-value=0.001),subscale 3(P-value=0.016),and subscale 4(P-value=0.010)increased significantly.The mean values of the first,second,third,and fourth subscales of CSHQ before and after the washout period were not significantly different between the two groups.According to the study,consuming horse milk was significantly better than cow milk in improving the total score of CSHQ in children with attention deficit hyperactivity disorder.

Left Temporal Lobe Arachnoid Cyst Presenting with Symptoms of Psychosis

Arachnoid cysts are uncommon benign neurological tumors,and having presentation like schizophrenia,which has been reported in association with this cyst.The presence of psychiatric disturbances of arachnoid cyst has not been clearly mentioned in the literature.Even though,the appearance of some of the references that focuses on a possible link between arachnoid cysts and psychotic symptoms.Here we present a case report of a 35-year-old man,characterized by the insidious onset of psychotic symptoms of varying intensity such as multiple physical assaults on people with stone.Due to organic suspicion one cannot exclude the possibility that the lesion played a significant role in this psychiatric presentation.

精神药物在新型冠状病毒肺炎患者中的使用建议

随着新型冠状病毒肺炎(简称新冠肺炎)疫情的蔓延,部分精神障碍患者感染2019新型冠状病毒(2019-nCoV),以及新冠肺炎患者在疾病的发展和治疗中继发严重的精神症状,均影响了新冠肺炎的系统治疗,因此需要积极治疗新冠肺炎的同时维持或开始使用精神药物进行治疗,以控制精神症状。由于新冠肺炎患者的躯体基础状况较差,因此对精神药物的耐受性变差,精神药物和新冠肺炎治疗药物联合应用存在一定的相互作用风险。本文中汇总了现有的数据和防治指南,对新冠肺炎患者使用精神药物的耐受性情况、精神药物与其他药物的相互作用以及在特殊人群中使用的注意事项进行详细介绍,希望能为一线医生提供参考。

重大突发传染病(新型冠状病毒肺炎)防控期间精神障碍诊治流程和路径专家建议

重大突发传染病,如新型冠状病毒肺炎疫情,严重威胁公众健康。中国绝大多数精神病医院或综合医院精神科病房实施封闭式管理,在防治传染性疾病方面都较为薄弱,难以有效应对疫情。在当前新型冠状病毒肺炎疫情严峻情形下,中华医学会精神医学分会牵头中国精神医学领域主要学会和(或)协会,组织专家制定《重大突发传染病(新型冠状病毒肺炎)防控期间精神障碍诊治流程和路径专家建议》,供相关医疗机构参照执行。本专家建议分精神病医院和综合医院精神科两部分,从门诊、住院和居家管理3个方面提出了详细的诊治流程和路径,具有很好的操作性和指导价值,对于预防精神卫生医疗机构院内感染发生和保障精神障碍患者医疗安全具有重要意义。