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关键词： 血液检验   贫血   诊断   鉴别   应用价值  

摘要： 目的探讨血液检验在贫血诊断与鉴别诊断中的价值。方法选取我院2014年10月～2017年10月收治的经血常规检查确诊为贫血的80例患者作为研究对象,根据贫血类型不同将所有贫血患者分为地中海贫血组(n=40)和缺铁性贫血组(n=40)。同时选取同期来院的40例健康体检者设为健康对照组。检测三组的血细胞,分析各组患者血液中的红细胞计数(RBC)、红细胞平均血红蛋白(MCH)、血红蛋白(Hb)、红细胞体积分布宽度(RDW)、红细胞平均体积(MCV)以及RBC/MCV比值。结果地中海贫血组患者和缺铁性贫血组患者的MCV、MCH指标均明显低于健康对照组,差异有统计学意义(P<0.05)。地中海贫血组患者的RBC/MCV、RBC指标均明显高于缺铁性贫血组和健康对照组,差异有统计学意义(P<0.05)。缺铁性贫血组患者的RDW指标均明显高于地中海贫血组和健康对照组,其RBC、Hb指标均明显低于其他两组患者,差异有统计学意义(P<0.05)。结论检测贫血患者血液中的MCH、RDW、MCV以及RBC/MCV比值等指标对贫血疾病的诊断与鉴别有较高的应用价值。

关键词： 事故灾难   PTSD   影响因素   心理韧性  

摘要： 目的探讨事故灾难后民众创伤后应激障碍(PTSD)和抑郁状况及其影响因素。方法 2015年10—12月,采用整群取样的方法选取天津经济技术开发区21家企业的2 456名员工,运用PTSD平民版筛查问卷(PCL-C),简版流调中心抑郁量表(CES-D-10)和简版心理韧性量表(CD-RISC-10)进行调查。结果 PTSD、抑郁、二者共病检出率分别为20.09%、28.29%、14.36%,男性的PTSD检出率以及PTSD和抑郁的共病检出率明显高于女性(22.37%vs17.27%,χ~2=9.37,P <0.01; 15.87%vs 12.50%,χ~2=5.33,P <0.05),抑郁检出率无性别差异(χ~2=1.12,P> 0.05)。logistic回归分析显示,影响PTSD、抑郁和二者共病的因素分别为身体受伤(OR=2.430,P <0.01; OR=1.863,P <0.05; OR=1.903,P <0.05)、爆炸造成严重损失(OR=1.343,P <0.01;OR=1.464,P <0.001; OR=1.513,P <0.001)、心理韧性(OR=0.335、0.274、0.275,Ps <0.001)。结论身体受伤、爆炸造成严重损失是PTSD和抑郁的风险因素,而心理韧性是PTSD和抑郁的保护因素。

关键词： 双相情感障碍   抗精神病药   临床疗效   HAMD-17  

摘要： 目的分析抗精神病药治疗双相情感障碍的临床有效性,为临床治疗提高参考。方法选取我院在2015年8月—2016年8月收治急性发作期双相情感障碍患者116例为研究对象,随机分为观察组和对照组各58例,对照组患者实施常规药物治疗,观察组患者在此基础上采取抗精神病药治疗,记录两组患者治疗前后症状评分变化,分析两组患者治疗效果。结果治疗后,两组患者HAMD-17、CGI-SI评分均显著降低(P<0.05),观察组患者HAMD-17评分(12.84±5.63)显著低于对照组(16.98±6.25)(P<0.05),观察组患者CGI-SI评分(2.10±0.85)低于对照组(2.16±0.87),但差异无统计学意义(P>0.05)。在治疗中,观察组2例出现恶心呕吐,1例体重增加,1例头晕,对照组患者2例出现恶心,两组患者未见心电图、血常规、肝肾功能改变。结论抗精神病药治疗双相情感障碍有很好的效果,能够稳定患者心境,在治疗中,需要慎重合理选择抗精神病药。

关键词： 新精神活性物质   核磁共振技术   合成大麻素类   合成卡西酮类   哌嗪类   苯乙胺类   氯胺酮及苯环利定类   芬太尼类  

摘要： 新精神活性物质结构多变,对照品难以获得,目前常用的气质联用和液质联用技术在结构的确证上存在一定的局限性,导致禁毒实战中对新精神活性物质的快速鉴定受到限制。核磁共振技术是解析未知物结构最有效的手段,特别适合于结构变异迅速的新精神活性物质的快速分析确证鉴定。本文综述了核磁共振技术在合成大麻素类、合成卡西酮类、哌嗪类、苯乙胺类、氯胺酮及苯环利定类和芬太尼类新精神活性物质结构筛查中的应用,发现各类新精神活性物质均有各自基本一致的特征母体结构和相应的NMR信号,可以为快速鉴定新精神活性物质的结构类别提供科学证据。并对扩散排序谱以及液核联用技术在新精神活性物质的应用前景进行展望,为新精神活性物质的筛查工作提供新的思路。

关键词： 双相情感障碍症   躁狂   抑郁   丙戊酸钠   富马酸喹硫平   治疗结果  

摘要： 目的探讨丙戊酸钠联合富马酸喹硫平治疗双相障碍躁狂症的临床疗效。方法选取丰城市第四人民医院精神内科2014年9月—2017年9月收治的双相障碍躁狂症患者90例,随机分为对照组和试验组,各45例。对照组患者给予富马酸喹硫平治疗,试验组在对照组基础上联合丙戊酸钠治疗。比较两组患者治疗前后精神状态[贝克-拉范森躁狂量表(BRMS)、汉密尔顿抑郁量表(HAMD)及简明精神病量表(BPRS)评分],观察两组患者治疗期间不良反应发生情况(头痛、厌食、嗜睡、腹泻)。结果治疗前两组患者BRMS、HAMD及BPRS评分比较,差异无统计学意义(P>0.05);治疗后试验组患者BRMS、HAMD、BPRS评分低于对照组(P<0.05)。治疗期间试验组患者各不良反应发生率低于对照组(P<0.05)。结论丙戊酸钠联合富马酸喹硫平治疗双相障碍躁狂症的临床疗效确切,可有效减轻患者躁狂、抑郁程度,缓解精神障碍症状,且安全性高,利于患者康复。

关键词： Primary motor abnormalities   Schizophrenia   Nonschizophrenic nonaffective psychoses   NSNAP   MRI   Intermediate phenotype  

摘要： Primary motor abnormalities (PMA), as found in patients with schizophrenia, are quantitatively and qualitatively distinct markers of motor system abnormalities. PMA have been often referred to phenomena that are present across schizophrenia-spectrum disorders. A dysfunction of frontoparietal and subcortical networks has been proposed as core pathophysiological mechanism underlying the expression of PMA. However, it is undear at present if such mechanisms are a common within schizophrenia and other psychotic disorders. To address this question, we review recent neuroimaging studies investigating the neural substrates of PMA in schizophrenia and so-called "nonschizophrenic nonaffective psychoses" (NSNAP) such as schizophreniform, schizoaffective, brief psychotic, and other unspecified psychotic disorders. Although the extant data in patients with schizophrenia suggests that further investigation is warranted, MRI findings in NSNAP are less persuasive. It is unclear so far which PMA, if any. are characteristic features of NSNAP or, possibly even specific for these disorders. Preliminary data suggest a relationship between relapsing-remitting PMA in hyper-/hypokinetic cycloid syndromes and neurodegenerative disorders of the basal ganglia, likely reflecting the transnosological relevance of subcortical abnormalities. Despite this evidence, neural substrates and mechanisms underlying PMA that are common in schizophrenia and NSNAP cannot be clearly delineated at this stage of research. PMA and their underlying brain circuits could be promising intermediate phenotype candidates for psychotic disorders, but future multimodal neuroimaging studies in schizophrenia and NSNAP patients and their unaffected first-degree relatives are needed to answer fundamental transnosologic questions. (C) 2017 Elsevier B.V. All rights reserved.

关键词： Psychotic illness   Neuromotor abnormality   Psychological symptoms   Mutant mouse models   Developmental models   Network dysfunction  

摘要： Limitations in access to antipsychotic-naive patients and in the incisiveness of studies that can be conducted on them, together with the inevitability of subsequent antipsychotic treatment, indicate an enduring role for animal models that can inform on the pathobiology of neuromotor abnormalities in schizophrenia and related psychotic illness. This review focusses particularly on genetically modified mouse models that involve genes associated with risk for schizophrenia and with mechanisms implicated in the neuromotor abnormalities evident in psychotic patients, as well as developmental models that seek to mirror the trajectory, phenomenology and putative pathophysiology of psychotic illness. Such abnormalities are inconsistent and subtle in mice mutant for some schizophrenia risk genes but more evident for others. The phenotype of dopaminergic and glutamatergic mutants indicates the involvement of these mechanisms, informs on the roles of specific receptor subtypes, and implicates the interplay of cortical and subcortical processes. Developmental models suggest a criticality in the timing of early adversity for diversity in the relative emergence of psychological symptoms vis-a-vis neuromotor abnormalities in the overall psychosis phenotype. These findings elaborate current concepts of dysfunction in a neuronal network linking the cerebral cortex, basal ganglia. thalamus and cerebellum. Both findings in model systems and clinical evidence converge in indicating that any distinction between 'psychomotor' and 'neuromotor' abnormality is artificial and arbitrary due to a unitary origin in developmentally determined systems/network dysfunction that underlies the lifetime trajectory of psychotic illness. (C) 2017 Elsevier B.V. All rights reserved.

摘要： Purpose: People with severe mental illness (SMI) can benefit from meeting the recommended guidelines on physical activity;yet meeting these guidelines for this population is challenging in practice. We examined the difference between outpatients with SKI that meet and do not meet physical activity guidelines in relation to barriers to physical activity in domain areas that are theoretically-informed from determinant areas of physical activity behaviour change. We aimed to identify clinical and demographic variables of less active people with SMI and domains where less active people with SMI have heightened barriers to physical activity. Methods: A self-report survey comprised of clinical and demographic variables, a brief 3-item measure of physical activity (3Q), and the Determinants of Physical Activity Questionnaire (DPAQ) was administered to a sample of outpatients with SMI (N = 105) in Ireland. Results: The findings show 72% of the sample did not meet recommended physical activity guidelines. No differences between active and less active participants were found in relation to demographic and clinical variables measured. Participants that did not meet physical activity guidelines reported stronger barriers in the areas 'Beliefs in the consequences of physical activity' and 'Motivation and goals to physical activity' (P <= 0.001). Discussion: This is the first study to use the DPAQ tool to examine the differences between active and inactive people with SMI in relation to physical activity barriers, with clear implications for tailoring intervention specifically for less active people with SMI.

关键词： 非典型抗精神病药物   代谢障碍   心血管疾病  

摘要： 非典型抗精神病药可引起体重增加、糖尿病、高血脂、代谢综合征等不良反应,并进一步成为诱发心血管疾病的危险因子,本文对此作一论述.

关键词： Treatment outcome   Posttraumatic stress disorder   Prolonged exposure   Supportive counselling   Randomized controlled trial   Task-shifting  

摘要： Background: There is a dearth of empirical evidence on the effectiveness of pharmacological and non-pharmacological treatments for adolescents with posttraumatic stress disorder (PTSD) in developing countries. The primary aim of the study is to examine the effects of prolonged exposure therapy compared with supportive counseling for adolescents with PTSD delivered by nurses trained as counselors. Methods/design: A single-blind randomized clinical trial comprising 90 adolescents with PTSD using a permuted block design will be utilized. Nurses previously naive to prolonged exposure and supportive counselling will be trained to provide these treatments at the adolescents' high schools. Data collection will last from March 2014 to December 2017 and annually thereafter, dependent on the availability of funding. Participants will receive seven to fourteen 60 min sessions of prolonged exposure treatment (n = 45) or supportive counselling (n = 45). All assessments will be conducted before treatment at mid-treatment, immediately after treatment completion, at 3-, 6-, and 12-month follow-up, and annually thereafter. It is hypothesized that PE-A will be superior to SC in reducing PTSD symptoms at post-treatment as measured by the CPSS-I administered by an independent evaluator. It is further hypothesized that PE-A treatment gains will be maintained at 3-, 6- and 12-month follow-ups and annually thereafter. Discussion: While early indications are that PE-A is an effective treatment for PTSD in adolescents, this study will help determine the effectiveness of PE-A in a South African, community setting (school-based) when task-shifted to nurses, as compared to SC.