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关键词： Trauma   child development   psychopathology   comorbidity   diagnosis  

摘要： Background: Developmental trauma disorder (DTD) has been proposed to describe the biopsychosocial sequelae of exposure to interpersonal victimization in childhood that extend beyond the symptoms of post-traumatic stress disorder (PTSD). Objective: To characterize the psychopathology comorbid with DTD and to determine whether this comorbidity is distinct from, and extends beyond, comorbidities of PTSD. Method: DTD was assessed by structured interview, and probable Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) psychiatric disorders were identified with screening modules on the Kiddie Schedule for Affective Disorders and Schizophrenia, Present/Lifetime version (K-SADS-PL), in a multi-site sample of 236 children (7-18 years old;50% female) referred by paediatric or mental health providers. Results: DTD (N = 80, 34%) and PTSD (N = 69, 29%) were highly comorbid and shared several DSM-IV internalizing disorder and DSM, 5th Edition (DSM-5) dysregulation disorder comorbidities. However, DTD, but not PTSD, was associated with comorbid panic disorder and disruptive behaviour disorders. On a multivariate basis including all probable DSM-IV disorders and DSM-5 dysregulation disorders, DTD was associated with separation anxiety disorder and attention deficit hyperactivity disorder after controlling for PTSD, while PTSD was associated with major depression and generalized anxiety disorder after controlling for DTD. Conclusions: DTD's comorbidities overlap with but extend beyond those of PTSD to include panic, separation anxiety, and disruptive behaviour disorders. DTD warrants further investigation as a potential diagnosis or a complex variant of PTSD in children, similar to the adult symptoms of disturbances of self-organization in the proposed International Classification of Diseases, 11th revision (ICD-11) complex post-traumatic stress disorder subtype.

关键词： 失独父母   创伤后应激障碍症状   相关因素  

摘要： 目的:探讨失独父母的创伤后应激障碍(PTSD)症状随失独年限变化的特点及相关因素。方法:以我国五省十市为调查点,选取373位失独父母开展调查,使用创伤后应激障碍筛查量表(PCL-5)、简版流调中心抑郁量表(CES-D-10)对其心理创伤症状进行评估。结果:失独父母PTSD症状筛查阳性率为57. 1%(213/373),症状B、C、D、E的筛查阳性率分别为77. 7%(290/373)、75. 9%(283/373)、71. 0%(265/373)和68. 6%(256/373)。回归分析表明,家庭经济状况能够负向预测PCL-5和症状D得分,即经济状况越好症状得分越低(β=-0. 13～-0. 10,P <0. 05);孩子去世年龄能够负向预测PCL-5、症状B和D得分,即孩子去世时年龄越小创伤症状得分越高(β=-0. 12～-0. 10,P <0. 05);CES-D得分能够正向预测PCL-5及其子症状得分(β=0. 67～0. 78,P <0. 05)。结论:失独父母创伤后应激障碍症状的筛查阳性率较高,其创伤症状受家庭经济情况、孩子去世的年龄和抑郁症状等因素的影响较为明显。

关键词： Posttraumatic stress disorder   substance use disorder   dual diagnosis   trauma   addiction   alcohol abuse   drug abuse   randomized controlled trial   Seeking Safety   relapse prevention  

摘要： Background: Co-occurring posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are associated with a more severe course and worse outcome than either disorder alone. In Europe, few treatments have been evaluated for PTSD and SUD. Seeking Safety, a manualized, integrated, cognitive-behavioural treatment, has been shown to be effective in studies in the USA. Objective: To test the efficacy of Seeking Safety plus treatment as usual (TAU) in female outpatients with PTSD and SUD compared to Relapse Prevention Training (RPT) plus TAU and TAU alone. Method: In five German study centres a total of N = 343 women were randomized into one of the three study conditions. PTSD severity (primary outcome), substance use, depression and emotion dysregulation (secondary outcomes) were assessed at baseline, post-treatment, as well as at three months and six months post-treatment. Results: Treatment participants attended M = 6.6 sessions (Seeking Safety) and M = 6.1 sessions (RPT). In an intent-to-treat analysis, Seeking Safety plus TAU, RPT plus TAU and TAU alone showed comparable decreases in PTSD severity over the course of the study. Seeking Safety plus TAU showed superior efficacy to TAU alone on depression and emotion regulation and RPT plus TAU was more effective than TAU alone on number of substance-free days and alcohol severity. Minimum-dose analyses suggest additional effects of both programmes among participants who attended at least eight group sessions. Conclusions: With respect to PTSD symptoms, a brief dose of Seeking Safety and RPT in addition to TAU was not superior to TAU alone in women with PTSD and SUD. However, Seeking Safety and RPT showed greater reductions than TAU alone in other domains of psychopathology and substance use outcomes respectively. Future studies should investigate further variables, such as what aspects of each treatment appeal to particular patients and how best to disseminate them.

关键词： 血液检验   贫血诊断   鉴别诊断   价值   探讨  

摘要： 目的:血液检验在贫血诊断与鉴别诊断中的价值探讨.方法:对我院2017年10月至2018年10月90例贫血患者进行研究,根据贫血的类型,分为A组(地中海贫血)和B组(缺铁性贫血)各45例,另选取同期健康体检者45例作为对照组,均行血液检验.结果:A组和B组RBC、RDW高于对照组,MCH、Hb、MCV低于对照组,A组RBC/MCV高于对照组,B组RBC/MCV低于对照组,P<0.05;A组RBC、Hb、MCH、RBC/MCV高于B组,RDW、MCV低于B组,P<0.05.结论:血液检验在贫血诊断及鉴别诊断中具有较高的应用价值,不仅能有效诊断贫血,还能为贫血类型的鉴别诊断提供参考,值得推广应用.

关键词： ICU日记   创伤后应激障碍   ICU记忆   护理  

摘要： 目的探讨ICU日记对ICU患者创伤后应激障碍及ICU记忆的影响。方法选取我院ICU收治的患者79例,随机分为试验组40和对照组39例。对照组予常规ICU护理干预,试验组在对照组的基础上实施ICU日记干预。采用创伤后诊断量表(PDS)及ICU记忆评估工具(ICUMT)在两组从ICU转出3个月后对其进行评价,比较两组PTSD发生率及ICU记忆准确度。结果从ICU转出3个月后,试验组PDS评分低于对照组(P<0.05);试验组ICUMT评分优于对照组(P<0.05)。结论对ICU患者实施ICU日记干预,可有效减少患者ICU创伤后应激障碍的发生,填补ICU住院期间的记忆空白,促进其身心康复。

关键词： 整体护理   躁狂证   治疗依从性   效果分析  

摘要： 目的:探讨整体护理对躁狂证患者治疗依从性的应用效果分析.方法:选取我院自2014年至2018年收治的60例躁狂在患者为研究对象,以简单随机法分为常规组与预见组各30常规组予以常规护理,预见组采用整体护理的方式,比较两组护理后的治疗依从性以及护理满意度.结果:预见组的治疗依从性以及护理满意度均高于常规组,且与常规组的相比分差异有统计学意义,P<0.05.结论:整体护理对于提高躁狂证患者治疗依从性有一定的应用价值,值得推荐.

关键词： Law   Clinical psychology   Gender studies  

摘要： There are millions of adult male offenders currently involved with U.S. corrections system, many of which report a wide range of mental health difficulties and a history of traumatic experiences. Mental health and trauma-related difficulties are important considerations in the treatment and rehabilitation of adult male offenders. The relationship between adverse childhood experiences (ACEs), attachment style, and PTSD symptoms were studied in a sample of adult male participants in a court-ordered diversion program. The sample consisted of 59 men, ranging in age from 19 to 68-years-old, who endorsed a history of at least one prior arrest. Data were collected during a psychoeducational group-therapy class offered at a post-arrest diversion program. Primary study measures included the use of the ACEs questionnaire, Attachment Style Questionnaire (ASQ-40), and the Posttraumatic Stress Disorder Checklist-5 (PCL-5). A priori hypotheses proposed, 1) there is a significant correlation among ACEs, ASQ subscales, and PTSD symptoms, and 2) insecure attachment subscales mediate the relationship between ACEs and PTSD symptoms. Correlation, regression, and mediation analyses evaluated the relationship among ACEs, ASQ subscales and PCL-5 scores. As predicted, ACEs and PTSD symptoms were negatively correlated with secure attachment and positively correlated with insecure attachment. Also as predicted, insecure attachment style (i.e. discomfort from closeness) mediated the relationship between ACEs and PTSD symptoms. Results suggested that the confidence and discomfort with closeness attachment scales shared a significant relationship between and ACEs and PTSD symptoms. These findings suggest that the relationship between ACEs, attachment style, and PTSD symptomatology can further inform conceptualizations and treatments oriented toward improving outcomes for adult male offenders and successful reintegration into their communities.

关键词： 创伤后应激障碍   多巴胺   D3受体   氯胺酮   异构体   大麻二酚  

摘要： 创伤后应激障碍(post-traumatic stress disorder,PTSD),是一种在接触异常严重创伤后延迟出现并长期存在的精神障碍。PTSD患者常表现出严重的对创伤性线索的高回避、高警觉、高闪回等症状。PTSD与抑郁、焦虑、药物成瘾等诸多精神疾病的共病率可高达50%,使其成为一种重大精神类疾患,引起了社会的广泛关注。PTSD的发病机制比较复杂,目前尚缺乏有效的治疗药物,美国食品药品监督管理局批准的只有5-羟色胺重摄取抑制剂类的抗抑郁药舍曲林和帕罗西汀两种,但也存在针对性差、作用谱窄、有效率不高、不良反应严重等问题,所以亟待发现PTSD发病的新的可能机制和潜在治疗靶点,为有效抗PTSD药物的研发提供新的线索。目前大多数学者认为,脑内神经递质/调质的紊乱是造成PTSD发病的物质基础。其中多巴胺(dopamine,DA)系统和谷氨酸(glutamic acid,Glu)系统的过度激活发挥了至关重要的作用,而最新的研究提示内源性大麻素系统因为参与了应激、情绪及学习记忆的调控也可能在PTSD的发病中占据一席之地。多巴胺D3受体是DA受体的五种亚型之一,被认为与神经精神系统疾病密切相关,有关其单核苷酸多态性(single nucleotide polymorphism,SNP)的研究提示,D3受体的SNP与冲动型精神障碍以及PTSD可能存在相关性。就脑区分布而言,D3受体集中表达在哺乳动物的杏仁核、大脑皮质、伏隔核和嗅结节等脑区,而以上脑区与机体奖赏、决策、运动、焦虑及恐惧等功能密切相关。在功能上,D3受体作为自身受体(突触前受体),对DA神经元的激活状态和突触间隙内DA的浓度具有显著的调节作用。因此,从分布和功能上看,D3受体在抗PTSD方面具有潜在的研究价值。YQA14是本课题组前期研发的高选择性D3受体阻断剂,并已证明在抗药物成瘾和抗精神分裂症中的作用,其是否具有抗PTSD作用引起了我们极大兴趣。氯胺酮是一种非竞争性谷氨酸N-甲基-D-天冬氨酸(N-methyl-D-aspartic acid,NMDA)受体阻断剂,在低于全身麻醉剂量下具有镇静和镇痛效果。一般所说氯胺酮指其R-和S-型异构体按照1:1比例组成的混合物,氯胺酮及其光学异构体的作用效果及作用性质存在一定差异。近年来,氯胺酮的快速抗抑郁作用受到广泛关注,但其在抗PTSD方面的研究却呈现出有效、无效甚至加重PTSD患者的核心症状等相互矛盾的结果,针对氯胺酮的光学异构体的抗PTSD研究也是鲜有报道。所以从氯胺酮的药理学作用及使用情况来看,进行临床前研究以评估氯胺酮及其光学异构体的独立作用非常重要。大麻二酚(cannabidiol,CBD)是大麻中除四氢大麻酚(tetrahydrocannabinol,THC)外的另一种主要成份,安全性高且无精神活性。相关研究提示,CBD能够有效降低应激刺激引起的心血管反应和焦虑,在应激刺激前给与CBD能抑制恐惧记忆的获取和唤起,同时,CBD能阻碍恐惧记忆的再巩固,从而降低实验动物对于恐惧记忆的反应。另外,临床脑影像研究发现CBD可抑制处于不同焦虑水平下患者的杏仁核功能,并降低小鼠杏仁核中c-Fos蛋白的表达,提示CBD可能具有下调杏仁核功能的生物学活性。但到目前为止,CBD对PTSD的作用尚无系统药理学研究报道,对于CBD的给药时机以及作用持续时间等更缺乏系统性的研究,这些都是将其作为抗PTSD药物需要迫切解决的问题。一、研究目的本课题拟针对多巴胺、谷氨酸和内源性大麻素受体作用系统,研究多巴胺D3受体阻断剂YQA14、非竞争性NMDA受体拮抗剂氯胺酮和内源性大麻素系统类药物CBD的抗PTSD作用及其可能的神经生物学机制,为发现作用机制新、药效作用显著的抗PTSD候选药物提供线索依据。二、研究方法基于以上研究目的,我们采用经典的大鼠单程长时刺激(single prolonged stress,SPS)、大鼠时间依赖敏感化(time dependent sensitization,TDS)和小鼠短暂电击法建立了不同的动物PTSD模型,通过旷场实验评价实验动物的自发活动,情景恐惧和高架十字迷宫实验分别评价动物PTSD行为中的恐惧样和焦虑样行为。并以此为基础,分别研究了多巴胺D3受体阻断剂YQA14、非竞争性NMDA受体阻断剂氯胺酮以及内源性大麻素系统类药物CBD抗PTSD的药效学作用及可能的作用机制。三、研究结果1.多巴胺D3受体阻断剂YQA14的抗PTSD作用及其可能机制(1)YQA14抗PTSD的药效学作用:在大鼠SPS模型中,与对照组相比,模型组和给药组动物在旷场实验中的跨格次数和站立次数无显著性差异(P>0.05,P>0.05,n=8),提示造模及给予YQA14不影响实验大鼠的自发活动;与空白对照组相比,模型组大鼠在情景恐惧实

关键词： 血液检验   贫血类型   诊断与鉴定  

摘要： 目的:探讨在贫血诊断与鉴定中血液检验对疾病诊断的临床意义与价值.方法:随机抽查2014年2月～2015年2月在我院检验科检查的100例贫血患者,经检查有62例为缺铁性贫血,38例为巨幼细胞性贫血;巨幼细胞性贫血患者为观察组,缺铁性贫血患者为对照组.观察两种贫血症状的诊断指标:RBC、MCV、Hb、MCH等以及检验中对其的灵敏性和特异性.结果:观察组血液检验鉴定指标RBC、MCV、Hb、MCH等数据统计均与对照组数据比较存在差异,有统计学意义(P<0.05).观察组MCV计数低于对照组,差异显著(P<0.05).两组特异性和灵敏性比较,观察组与对照组血液检查相比无明显差异,无统计学意义(P>0.05).结论:经血液检验在各种贫血诊断与鉴定中临床效果显著,红细胞的相关指标数据鉴定所体现的差异对鉴定不同贫血类型有重要意义,为临床医师诊断及治疗提供数据支持,有效提高正确诊断率.

关键词： 跨代遗传   表观遗传修饰   创伤后应激障碍   慢性社会挫败应激   动物模型   社会挫败   ES干细胞   TS干细胞   XEN干细胞  

摘要： 目的越来越多的研究表明,父辈或祖辈生活环境及生活方式的改变,如营养缺乏或失衡、养育行为、社会压力或恐惧等,对后代的表型/性状的形成至关重要。慢性社会挫败应激又是现代社会发展中常见的社会应激源,因此,对于研究成年雄性模式动物经慢性社会挫败应激后的创伤行为及这些创伤能否跨代遗传具有非常重要的现实意义。方法本研究采用成年雄性C57B16/J小鼠构建立创伤后应激障碍(Posttraumatic stress disorder,PDST)小鼠模型,通过旷场、十字高架实验检测模型小鼠的焦虑样行为;通过糖水偏好和强迫游泳检测模型小鼠的抑郁样行为,并利用独木管竞争和热点占据分析社会等级。并检测这些异常行为学特征是否可以跨代遗传到F1代小鼠。结果经过慢性社会挫败创伤的PDST成年雄性C57小鼠的焦虑、抑郁和社交等相关行为异常。与对照鼠相比有严重的焦虑和抑郁情绪(P<0.05),并且表现为孤立和逃避社交(P<0.05);同时与对照组相比,PDST小鼠处于社会劣势(主要表现为投降,躲避和后退行为)。对F1代的行为检测和等级分析也发现焦虑、抑郁和社交等行为异常,并且某些异常行为存在性别差异。结论成年社会挫败创伤表型在遗传的过程中表现出父系跨代遗传的特点。并且在F1代小鼠中抑郁行为、社交行为等存在性别差异。目前已存在成熟的技术可以从小鼠植入前或植入后胚胎中获得各种类型的干细胞系包括:胚胎干细胞系(ES),外胚层干细胞系(EPI),胚外内胚层干细胞系(XEN)和滋养层干细胞系(TS)。直接培养小鼠胚胎、ES细胞过表达相应的内胚层Marker(GATA6、GATA4、SOX17等)或者培养条件加入维甲酸、激活素A诱导和重编程等三种方法能建小鼠胚外内胚层(XEN)细胞系。但是在早期的研究中,获得的小鼠XEN自我更新能力弱,细胞状态不稳定,只能短暂维持。随着研究的深入,发现小鼠XEN细胞的维持也需要细胞生长因子来维持其干性和增殖。研究发现,由于以前获得的小鼠XEN细胞具有不表达或低表达多能性Marker的缺点。因此,最新的培养体系获得的XEN细胞很好的解决上述的缺点。胚外内胚层前体细胞(PXEN)转录组表达和原始内胚层(Pr E)相似。且PXEN能向XEN转化,但XEN不能转为PXEN。所以现在能稳定的获得小鼠原始的XEN细胞系。迄今为止尚未有灵长类胚外内胚层(XEN)细胞系的建立,严重阻碍了对灵长类早期胚胎发育的研究。我们通过优化小鼠XEN的建系条件,建立了食蟹猴PXEN细胞系(表达相应的多能性Marker:OCT4、REX1和内胚层Marker:GATA6、SOX17等)。