背景 精神分裂症患者远期疗效不理想的可能因素之一是住院治疗与社区精神卫生服务间缺乏连贯性.目的 评估医院-社区一体化康复模式对精神分裂症患者康复的疗效.方法 在上海市长宁区 10 家社区卫生服务中心参与医院-社区一体化康复计划的 90 例精神分裂症患者作为干预组,从长宁区社区普通管理的门诊精神分裂症患者中随机抽取 52 例患者作为对照组.由不了解患者分组情况的医生在入组(基线)和12个月后采用阳性与阴性症状量表(Positive and Negative Syndrome Scale,PANSS)、Morningside康复状态量表(Morningside Rehabilitation Status Scale,MRSS)评估患者情况.同时在上述两个时点采用家庭负担会谈量表(Family Burden Scale,FBS)、抑郁自评量表(Self-rating Depression Scale,SDS)、焦虑自评量表(Self-rating Anxiety Scale,SAS)和社会支持评定量表(Social Support Rating Scale,SSRS)评估患者法定监护人(绝大部分是与患者同住的家属)的情况.结果 入组时,PANSS评估结果显示两组的临床状况相仿,但是MRSS评估结果表明干预组的社会功能明显不如对照组.干预 1 年后研究组的临床症状和社会功能的改善程度均比对照组显著.1年中,研究组有3 例(3.3%)住院,而对照组有 6 例(11.5%)(Fisher确切概率法,p=0.074).无论是入组时还是1年后,两组监护人之间在感到的负担、抑郁、焦虑以及自我报告的社会支持等的差异均无显著性,但是干预组患者监护人的抑郁和焦虑症状在1年后得到改善.结论 医院-社区一体化康复模式能促进精神分裂症患者临床症状和社会功能的改善.今后需要进一步开展这一项目,来提高参与一体化康复模式的患者比例,并为患者家属提供更好的心理社会支持服务.
作者：陶华；宋兰君；牛昕；李学海；张琼婷；崔佳；陈浩；符争辉；方文莉 刊期： 2012年第03期
背景 在国内,学生的人口学特征及负性生活事件与其心理健康的关系尚未得到充分的研究.目的 评估中学生中各种生活应激事件的发生率,确定与中学生自我感知的心理健康问题密切相关的人口学特征和生活事件的类型.方法 采用分层随机抽样的方法进行横断面调查,抽取上海市 2 个区 4 所中学共 1818 名学生,应用 2 种自评问卷进行评估:长处与困难问卷(Strengths and Difficulties Questionnaire,SDQ)学生版和用于评估11项负性生活事件的简易版青少年生活事件量表(Adolescent Self-rating Life Events Checklist,ASLEC).结果 中学生报告的常见负性生活事件为学习压力(74%),受到批评(66%),家庭冲突(29%)以及受人欺负、歧视或人际关系紧张(26%),但是这些事件的发生率因学生的性别、学校类型以及所处城郊位置不同而有所差异.同样,不同组别的学生其生活事件所致心理应激水平、心理困难总分以及社会行为水平亦有所不同.多因素线性回归分析表明,评估前 6 个月内心理困难的独立预测因素依次为(按照重要性先后顺序):过去一年内负性生活事件所致的应激总评分高,受人欺负、歧视或人际关系紧张,没有发生亲人死亡,男性,学校位于郊区,以及未患重病或残疾.社会行为水平的独立预测因素依次为负性生活事件所致的应激总评分高,学校位于城区,女性,普通中学(与重点中学比),受人欺负、歧视或人际关系紧张,没有发生亲人死亡,初中(与高中比).结论 与中学生的应激和社会行为相关的众多因素之一是负性生活事件.进一步需要开展前瞻性研究以阐明中学生应激与负性生活事件的因果关系,开展并验证人群特异性的干预方法以减轻应激、增加适应性社会行为.
作者：周琳琳；范娟；杜亚松 刊期： 2012年第03期
背景 认知矫正治疗(Cognitive Remediation Therapy,CRT)是一种很有希望的、新的非药物治疗方法,能够减少精神分裂症患者的认知缺损.但未在国内得到充分的验证.目的 探讨认知矫正治疗对慢性精神分裂症患者认知功能、社会功能及自知力的疗效.方法 将126例病情相对稳定的慢性精神分裂症住院患者随机分成干预组和对照组.干预组接受行认知矫正治疗,对照组接受常规的工娱治疗,两组在治疗频度和治疗持续时间一致,均为每周5次,共3个月.于治疗前及治疗末分别采用威斯康星卡片分类测验(Wisconsin Card Sorting Test,WCST)评估认知功能,采用住院慢性精神分裂症患者社会功能评定量表(Scale of Social Skills of chronic schizophrenia Inpatients,SSSI)评估社会功能以及采用自知力与治疗态度问卷(Insight and Treatment Attitude Questionnaire,ITAQ)评估自知力.结果 研究过程中有 4 例患者脱落,干预组 60 例、对照组 62 例终进入结果分析.治疗 3 个月后,两组的WCST测评结果均较治疗前显著改善,而干预组的WCST各指标的改善均比对照组明显.两组在 3 个月治疗后的SSSI总分均显著改善,但改善程度在两组间无显著性差异;两组的ITAQ总分也均有提高,但干预组的改善程度比对照组更明显.结论 在药物治疗的基础上,为期3个月的认知矫正治疗对改善慢性精神分裂症住院患者的认知功能及自知力比常规的工娱治疗更为有效.
作者：吕红波；李玉英；李峰；焦歆益；师雯；郭康林；刘鹏飞 刊期： 2012年第03期
背景 氧化应激是一种神经毒性因素,可能会促使急性精神病的发生.目的 评估旅途精神病(travel-induced psychosis)与氧化应激的关系.方法 对乘坐长途火车诱发的 21 例旅途精神病住院患者,在其入院时采用简明精神病评定量表(Brief Psychiatric Rating Scale,BPRS)评定精神症状,入院次日清晨测定其血清超氧化物歧化酶(super oxide dlsmutase,SOD)活性和丙二醛(malondialdehyde,MDA)含量;待患者精神病性症状缓解后(通常为小剂量抗精神病药治疗后 2~6天),再次进行上述检测.选取性别、年龄匹配的 21 名健康志愿者为对照组,比较患者与对照者的血清SOD活性和MDA含量.结果 入院时患者的血清SOD活性和MDA含量均高于对照组.精神症状缓解后,患者的BPRS评分、血清SOD活性和MDA含量均显著下降,但后两者仍高于对照组.入院时患者的BPRS总分与SOD活性呈正相关(r=0.32,p=0.164),与MDA含量也呈正相关(r=0.34,p=0.126),但均无统计学意义.治疗后BPRS总分的下降与SOD活性的下降弱相关(r=0.28,p=0.217),也与MDA含量的下降也呈弱相关(r=0.29,p=0.211).结论 研究结果提示,氧化应激的神经毒性作用与旅途精神病的发生直接相关.这或许能够帮助我们理解其他急性精神病性障碍(如精神分裂症)的发生.
作者：龚毅；赵若连；杨保春 刊期： 2012年第03期
Consultation-liaison psychiatry (CLP) was first established in China after liberation in 1949. It has developed more rapidly over the last two decades but, despite major regional differences in the level of CLP, the overall practice of CLP in the country remains quite basic, largely limited to case-based consultation with other medical departments. There is little ongoing collaboration between departments of psychiatry and other departments, and medical students and non-psychiatric clinicians rarely get training in CLP.
作者：季建林；叶尘宇 刊期： 2012年第03期
One of the most common challenges in biomedical and psychosocial research is missing data, which occurs when respondents refuse to provide answers to sensitive questions and when study subjects are lost to follow-up during the repeated assessments of longitudinal trials.This paper is the first in a 3-part series focusing on this important topic; it describes different types of missing data and their differential effects on model estimates, focusing on study design strategies that can be used to prevent or minimize missing data and, thus, maintain the scientific integrity of the research.The second paper in the series will discuss implementation strategies to manage and reduce missing data while conducting the study, and the third paper will discuss analytic strategies for dealing with missing data after completion of data collection.
作者： 刊期： 2012年第03期
Quietly, with little apparent notice from even the strongest advocates for global mental health, China is undertaking the world's largest – and arguably most important – mental health services demonstration project, a project focused on providing comprehensive care for persons with severe mental illnesses.As Professor Ma indicates in her short report,[1] the ‘686 Project' was launched as part of China's commitment to rebuild its public health infrastructure following the SARS epidemic, and has now moved beyond the initial pilot phase into a process of scaling up community mental health services throughout the country.China is currently moving toward passage of its first national mental health law, so the project has profound implications for mental health policy in the country.It will also provide useful models for the development of mental health policies in other countries with limited mental health personnel.
作者： 刊期： 2012年第03期
Moving from an institutional model of mental health care to a community oriented system of care has long been recognized as desirable because of the improved health and social outcomes generally achieved by avoiding institutionalization, and the enhanced stimulation possible in the community.But providing local comprehensive community care is a complex task, and while it is relatively straightforward to plan and implement small-scale demonstration projects, it is very challenging to undertake systematic implementation of such projects across a whole country.National implementation of a community mental health service network across a country as large, populous, and geographically and socially diverse as China is a vast undertaking.The many challenges include political engagement, public and professional support, mobilization of financial and human resources, dedicated training tailored to specific roles, quality assurance, supervision, and monitoring.[1]
作者： 刊期： 2012年第03期
