上海青浦区流浪乞讨肇事肇祸精神病患者风险评估及相关因素分析

目的探讨上海市青浦区流浪乞讨肇事肇祸精神病患者的风险度及相关影响因素。方法选取上海市青浦区精神卫生中心住院的流浪乞讨精神病患者59例,基线评估一般资料,分别在入院时及入院后第4、8周末采用阳性和阴性综合征量表(PANSS)、外显攻击行为量表(MOAS)及精神病人安全风险评估表评估精神症状及安全风险。结果流浪乞讨肇事肇祸精神病患者风险评估高风险达100%,有明显攻击行为者占81.4%,多在精神症状支配下发生;患者以规范药物治疗少,文化程度低,男性为主,其中精神分裂症者居多。入院后第4、8周末PANSS、MOAS、风险评估总分及各因子分均较入院时降低(P<0.05);入院后第8周末PANSS、风险评估总分及各因子分均较入院后第4周末降低(P<0.05),入院后第8周末MOAS总分及言语攻击、自身攻击因子分均较入院后第4周末降低(P<0.05)。结论流浪乞讨精神病患者肇事肇祸风险高,攻击行为主要与其精神症状相关,药物规范治疗可以改善相关症状并减少风险。

Stress and sleep:a survey based on wearable sleep trackers among medical and nursing staff in Wuhan during the COVID-19 pandemic

Backgroud COVID-19 pandemic has significantly affected the sleep health of local medical and nursing staff.Aim We used wearable pulse oximeters to monitor and screen the medical and nursing staff working in hospitals designated for COVID-19 in the Wuhan area.This study aimed to establish a reliable basis to provide sleep intervention for the medical and nursing staff.Methods Thirty medical and nursing staff members with symptoms of insomnia were instructed to wear medical ring-shaped pulse oximeters to monitor their sleep overnight.We also used the Insomnia Severity Index(ISI)and the Chinese version of the Self-Reporting Questionnaire(SRQ-20)to evaluate the severity of insomnia and mental health status,respectively,for each participant.Results Among the 30 participants,only 26 completed the screening.Ten cases(38.5%)demonstrated moderate to severe sleep apnoea-hypopnea syndrome(SAHS)when using an oxygen desaturation index^15 times/hour as the cut-off value.Participants with comorbid moderate to severe SAHS had significantly higher ISI and SRQ scores(p values 0.034 and 0.016,respectively)than those in the insomnia group.Correlation analysis revealed that ISI was positively correlated with total sleep time(TST)(r=0.435,p=0.026),and negatively correlated with deep sleep(r=-0.495,p=0.010);furthermore,patient SRQ scores were positively correlated with TST,sleep efficiency(SE)and REM(rapid eyes movement)sleep%(r=0.454 and 0.389,0.512;p=0.020,0.050 and 0.008,respectively).Stepwise logistic regression indicated that SRQ-20 and sex were risk factors for insomnia with comorbid SAHS,and their OR values were 1.516 and 11.56(95%Cl 1.053 to 2.180 and 1.037 to 128.9),respectively.Conclusion Medical and nursing staff with insomnia showed clear signs of comorbid sleep apnoea attributable to stress.The wearable pulse oximeters accurately monitored the participants'breathing when asleep.

双因素视角下个案管理社区干预对精神分裂症患者的效果

目的评价"问题取向"与"优势视角"双因素视角下的延续性个案管理社区干预,对精神分裂症患者精神症状及生活质量的影响。方法 140例社区精神分裂症患者随机分为研究组和对照组,各70例,对研究组应用双因素视角下的个案管理模式进行干预,对照组患者接受常规随访和康复指导。比较干预前后两组患者在精神症状、自知力、生活质量及家庭负担状况等方面的差异。结果基线期两组患者阳性与阴性症状量表(PANSS)、自知力与治疗态度问卷(ITAQ)、生活质量量表(SQLS)、家庭疾病负担量表(FBS)的评分差异均无统计学意义(P值均>0.05)。干预6个月及随访1年后,研究组患者PANSS总分、阳性因子及一般病理分、SQLS、FBS评分低于对照组,ITAQ评分高于对照组,组间差异均有统计学意义(P值均<0.05)。结论应用"问题取向"与"优势视角"双因素延续性个案管理社区干预,能提供更为全面和多层次的康复服务,有效缓解精神分裂患者的精神症状,改善其生活质量。

稳心颗粒联合帕罗西汀与单用帕罗西汀治疗焦虑障碍的疗效观察

目的探讨稳心颗粒联合帕罗西汀与单用帕罗西汀治疗焦虑障碍的临床疗效。方法 86例焦虑障碍患者,随机分为对照组和观察组,各43例。对照组患者单用帕罗西汀治疗,观察组患者采用稳心颗粒联合帕罗西汀治疗,比较两组患者治疗前后负性情绪改善情况、临床疗效以及不良反应发生情况。结果治疗前,两组患者汉密尔顿焦虑量表(HAMA)评分、汉密尔顿抑郁量表(HAMD)评分比较,差异无统计学意义(P>0.05);治疗第2、4、8、12周末,两组患者HAMA评分、HAMD评分均低于治疗前,且观察组患者HAMA评分、HAMD评分低于对照组,差异具有统计学意义(P<0.05)。观察组患者总有效率为97.67%,显著高于对照组的83.72%,差异具有统计学意义(P<0.05)。两组患者治疗第1、2、4、8、12周末副反应量表(TESS)评分比较,差异无统计学意义(P>0.05);两组患者治疗第2、4、8、12周末TESS评分均低于治疗第1周末,差异具有统计学意义(P<0.05)。结论稳心颗粒联合帕罗西汀治疗焦虑障碍疗效理想,能够迅速缓解临床症状,改善患者的焦虑、抑郁等负性情绪,且安全性高,值得临床应用。

THE EFFECTS OF COMBINING APPLICATION OF DIAGNOSIS AND TREATMENT TECHNOLOGIES OF ERP AND PSYCHIC REHABILITATION INTERVENTION ON REHABILITATION OF SCHIZOPHRENIA

Objective:To explore the effects of combining application of diagnosis and treatment technologies of Event Related Potentials(ERP)and Psychic Rehabilitation Intervention(PRI)on rehabilitation of schizophrenia.Methods:PRI and ERP were used in schizophrenia rehabilitation in this research.232 patients were divided into study group(SG)and control group(CG),and the rehabilitation effects were compared.Results:(1)After the implementation of the PRI,more score of the Brief Psychiatric Rating Scale(BPRS)was reduced on SG than the score on CG;more decreased scores of insight and on Social Disability Screening Schedule(SDSS),and more increased scores of treatment compliance questionnaire scores were observed on SG,comparing with CG(P<0.05 or 0.01).(2)After the implementation of the PRI,more decreased factor scores of Symptom Checklist 90 were observed on SG patients family members(P<0.05 or 0.01).(3)PRI significantly improved the patients’social functions,family members’relationship and prevented the recurrence of schizophrenia.(4)Improved P2,P3 amplitudes were also detected on SG compared with CG(P<0.05).Conclusions:(1)PRI interventions may improve schizophrenia patients’social function.(2)ERP may be used to evaluate the schizophrenia patients’rehabilitation,and is worth being popularized.

大学生工作记忆广度训练迁移效应的行为学与影像学研究

目的:探讨工作记忆广度训练对n-back任务的迁移效应及脑机制。方法:首先在60例大学生中开展随机对照实验,训练组(n=30)接受自适应性训练,对照组(n=30)接受低难度反复练习,比较两组训练前后2-back任务的差异。接下来在60例接受自适应性训练的大学生中,根据2-back任务改善中位数分为高迁移组(n=30)和低迁移组(n=30),比较两组训练前后全脑激活的差异。结果:与训练前比较,训练组训练后2-back任务正确率显著增加(F=21.45,P<0.001),正确率增加量为(0.15±0.18);对照组训练后正确率增加量为(0.03±0.17),差异无统计学意义(F=0.99,P=0.327)。与低迁移组比较,高迁移组训练后右侧纹状体激活显著增加(校正后P=0.028),纹状体激活变化与2-back任务正确率变化呈显著的正相关关系(R^2=0.084;F=5.21,P=0.025)。结论:工作记忆广度训练效果可迁移到n-back任务,纹状体在迁移过程中发挥重要作用。

长期住院男性精神分裂症患者认知功能5年随访及与阴性症状相关分析

目的了解男性长期住院精神分裂症患者5年随访认知功能变化及阴性症状对其影响。方法选取精神分裂症男性患者160名,采用重复性成套神经心理状态测验(RBANS)及阳性和阴性症状量表(PANSS)对患者基线期及随访5年后进行测评。使用SPSS17.0进行统计学分析。结果语言功能、视觉广度随访5年后比基线期评分降低,阴性症状、一般精神病理随访5年后比基线期升高(P≤0.05);阴性症状、一般精神病理与RBANS量表各因子分呈负相关关系(P≤0.05);阴性症状对语言功能及视觉广度有预测效应(P≤0.05),可分别解释语言功能及视觉广度方差变异的23.7%及19.2%。结论长期住院精神分裂症患者随访5年后认知功能减退,阴性症状、一般精神病理加重,阴性症状是语言功能及视觉广度的预测因子。

基于随机森林法的精神分裂症患者病情复发的预测

目的通过随机森林法分析精神分裂症门诊患者的病情复发的影响因素,建立精神分裂症患者病情复发的预测模型。方法搜集精神分裂症患者门诊记录、住院信息、社区随访记录等信息,将数据进行结构化处理,利用Python处理分析数据,建立病情复发的预测模型。结果具有统计学意义的影响因素是年就诊次数、生活刺激事件、自我护理能力、技能学习能力(P<0.05)。经过随机森林分析,年就诊次数、生活刺激事件、自我护理能力、技能学习能力是预测模型中的重要权衡因素。复发预测模型具有46.41%的命中率,准确率84.4%,覆盖率91.23%。结论预测模型能够有效预测精神分裂症患者病情复发情况并且提供预警信息。