• 【2001-2014年,青少年和年轻人接受丁丙诺啡和纳曲酮治疗阿片类药物使用障碍的趋势。】 复制标题 收藏 收藏
    DOI:10.1001/jamapediatrics.2017.0745 复制DOI
    作者列表:Hadland SE,Wharam JF,Schuster MA,Zhang F,Samet JH,Larochelle MR
    BACKGROUND & AIMS: Importance:Opioid use disorder (OUD) frequently begins in adolescence and young adulthood. Intervening early with pharmacotherapy is recommended by major professional organizations. No prior national studies have examined the extent to which adolescents and young adults (collectively termed youth) with OUD receive pharmacotherapy. Objective:To identify time trends and disparities in receipt of buprenorphine and naltrexone among youth with OUD in the United States. Design, Setting, and Participants:A retrospective cohort study was conducted using deidentified data from a national commercial insurance database. Enrollment and complete health insurance claims of 9.7 million youth, aged 13 to 25 years were analyzed, identifying individuals who received a diagnosis of OUD between January 1, 2001, and June 30, 2014, with final follow-up date December 31, 2014. Analysis was conducted from April 25 to December 31, 2016. Time trends were identified and multivariable logistic regression was used to determine sociodemographic factors associated with medication receipt. Exposures:Sex, age, race/ethnicity, neighborhood education and poverty levels, geographic region, census region, and year of diagnosis. Main Outcomes and Measures:Dispensing of a medication (buprenorphine or naltrexone) within 6 months of first receiving an OUD diagnosis. Results:Among 20 822 youth diagnosed with OUD (0.2% of the 9.7 million sample), 13 698 (65.8%) were male and 17 119 (82.2%) were non-Hispanic white. Mean (SD) age was 21.0 (2.5) years at the first observed diagnosis. The diagnosis rate of OUD increased nearly 6-fold from 2001 to 2014 (from 0.26 per 100 000 person-years to 1.51 per 100 000 person-years). Overall, 5580 (26.8%) youth were dispensed a medication within 6 months of diagnosis, with 4976 (89.2%) of medication-treated youth receiving buprenorphine and 604 (10.8%) receiving naltrexone. Medication receipt increased more than 10-fold, from 3.0% in 2002 (when buprenorphine was introduced) to 31.8% in 2009, but declined in subsequent years (27.5% in 2014). In multivariable analyses, younger individuals were less likely to receive medications, with adjusted probability for age 13 to 15 years, 1.4% (95% CI, 0.4%-2.3%); 16 to 17 years, 9.7% (95% CI, 8.4%-11.1%); 18 to 20 years, 22.0% (95% CI, 21.0%-23.0%); and 21 to 25 years, 30.5% (95% CI, 30.0%-31.5%) (P < .001 for difference). Females (7124 [20.3%]) were less likely than males (13 698 [24.4%]) to receive medications (P < .001), as were non-Hispanic black (105 [14.8%]) and Hispanic (1165 [20.0%]) youth compared with non-Hispanic white (17 119 [23.1%]) youth (P < .001). Conclusions and Relevance:In this first national study of buprenorphine and naltrexone receipt among youth, dispensing increased over time. Nonetheless, only 1 in 4 commercially insured youth with OUD received pharmacotherapy, and disparities based on sex, age, and race/ethnicity were observed.
    背景与目标:
  • 【重度抑郁症儿童和青少年的气质和性格特征: 一项病例对照研究。】 复制标题 收藏 收藏
    DOI:10.1016/j.comppsych.2012.10.009 复制DOI
    作者列表:Zappitelli MC,Bordin IA,Hatch JP,Caetano SC,Zunta-Soares G,Olvera RL,Soares JC
    BACKGROUND & AIMS: OBJECTIVES:To evaluate temperament and character traits using the Junior Temperament and Character Inventory (JTCI) in children and adolescents with major depressive disorder (MDD) in comparison with healthy control subjects (HC), and to verify if comorbidity with disruptive behavioral disorders and being currently depressed influence JTCI scores. METHODS:A case-control study comprising 41 MDD children/adolescents matched to 40 HC by gender and age (8-17years). All participants were assessed diagnostically with the Kiddie Schedule for Affective Disorders and Schizophrenia - Present and Lifetime (K-SADS-PL). Temperament and character traits were measured with the parent and child versions of JTCI, and depression was evaluated with the Children's Depression Rating Scale (CDRS). RESULTS:According to child and parent data, MDD subjects had significantly higher scores on harm avoidance and novelty seeking, and lower scores on reward dependence, persistence, self-directedness and cooperativeness compared with HC. According to parent data only, MDD subjects significantly differed from HC on self-transcendence (lower spirituality scores and higher fantasy scores). Comorbidity with disruptive behavioral disorders exerted influence on almost all dimensions, in general increasing the mean differences between MDD and HC subjects. Also, being currently depressed did not influence the results, except for reward dependence according to parent data. LIMITATIONS:The cross-sectional nature of the study and its limited sample size. CONCLUSIONS:MDD children/adolescents have a different temperament and character profile compared to HC subjects. This study supports previous findings of trait-like characteristics of harm avoidance and self-directedness.
    背景与目标:
  • 【青少年内在化和外在化症状作为创伤暴露和创伤后应激障碍类型的前瞻性预测指标的测试。】 复制标题 收藏 收藏
    DOI:10.1002/jts.21751 复制DOI
    作者列表:Haller M,Chassin L
    BACKGROUND & AIMS: :The present study utilized longitudinal data from a high-risk community sample (N = 377; 166 trauma-exposed; 202 males; 175 females; 73% non-Hispanic Caucasian) to test pretrauma measures of adolescent internalizing and externalizing symptoms as unique prospective predictors of type of trauma exposure and PTSD over and above the influence of correlated family adversity (a composite of family conflict, stress, and parental psychopathology). Data were analyzed with logistic and multinomial logistic regressions. Results indicated that females, but not males, with higher levels of internalizing (OR = 2.91) and externalizing (OR = 2.37) symptoms during adolescence were significantly more likely to be exposed to assaultive violence (over and above family adversity). In fact, males with higher levels of internalizing symptoms were significantly less likely to be exposed to assaultive violence (OR = 0.54). Neither internalizing nor externalizing symptoms uniquely predicted exposure to traumatic events that did not involve assaultive violence. Among trauma-exposed participants, the unique association between internalizing symptoms and later PTSD yielded an odds ratio of 1.79 (p = .07) over and above the influences of family adversity, type of trauma exposure, and gender. Assaultive violence exposure fully mediated the association between females' externalizing symptoms and future PTSD. Findings may help inform the prevention of both assaultive violence exposure and PTSD.
    背景与目标: : 本研究利用了来自高风险社区样本的纵向数据 (N = 377; 166创伤暴露; 202男性; 175女性; 73% 非西班牙裔高加索人) 测试青少年内在化和外在化症状的创伤前措施,作为创伤暴露类型和创伤后应激障碍的独特前瞻性预测因子,超越相关家庭逆境 (家庭冲突、压力和父母心理病理学的组合) 的影响。数据采用logistic和多项logistic回归分析。结果表明,女性而不是男性,在青春期具有较高水平的内在化 (或 = 2.91) 和外在化 (或 = 2.37) 症状的女性更容易遭受攻击性暴力 (超过家庭逆境)。事实上,具有较高水平内化症状的男性暴露于攻击性暴力的可能性显著降低 (OR = 0.54)。内部化或外部化症状都不能唯一地预测暴露于不涉及攻击性暴力的创伤事件。在创伤暴露的参与者中,内在化症状与后来的PTSD之间的独特关联产生了1.79的优势比 (p = .07),超出了家庭逆境,创伤暴露类型和性别的影响。攻击性暴力暴露充分介导了女性外在症状与未来创伤后应激障碍之间的关联。研究结果可能有助于预防攻击性暴力暴露和PTSD。
  • 4 Skin picking disorder. 复制标题 收藏 收藏

    【皮肤采摘障碍。】 复制标题 收藏 收藏
    DOI:10.1176/appi.ajp.2012.12040508 复制DOI
    作者列表:Grant JE,Odlaug BL,Chamberlain SR,Keuthen NJ,Lochner C,Stein DJ
    BACKGROUND & AIMS: :Although skin picking has been documented in the medical literature since the 19th century, only now is it receiving serious consideration as a DSM psychiatric disorder in discussions for DSM-5. Recent community prevalence studies suggest that skin picking disorder appears to be as common as many other psychiatric disorders, with reported prevalences ranging from 1.4% to 5.4%. Clinical evaluation of patients with skin picking disorder entails a broad physical and psychiatric examination, encouraging an interdisciplinary approach to evaluation and treatment. Approaches to treatment should include cognitive-behavioral therapy (including habit reversal or acceptance-enhanced behavior therapy) and medication (serotonin reuptake inhibitors, N-acetylcysteine, or naltrexone). Based on clinical experience and research findings, the authors recommend several management approaches to skin picking disorder.
    背景与目标: : 尽管自19世纪以来,医学文献中已经记录了皮肤采摘,但直到现在,在DSM-5讨论中,它才被视为DSM精神疾病。最近的社区患病率研究表明,皮肤采摘障碍似乎与许多其他精神疾病一样普遍,据报道患病率从1.4% 到5.4% 不等。对皮肤采摘障碍患者的临床评估需要进行广泛的身体和精神检查,从而鼓励采用跨学科的方法进行评估和治疗。治疗方法应包括认知行为疗法 (包括习惯逆转或接受增强行为疗法) 和药物 (5-羟色胺再摄取抑制剂,N-乙酰半胱氨酸或纳曲酮)。根据临床经验和研究结果,作者推荐了几种皮肤采摘障碍的管理方法。
  • 【海地地震后的精神病理学: 一项基于人群的创伤后应激障碍和严重抑郁症研究。】 复制标题 收藏 收藏
    DOI:10.1002/da.22007 复制DOI
    作者列表:Cerdá M,Paczkowski M,Galea S,Nemethy K,Péan C,Desvarieux M
    BACKGROUND & AIMS: BACKGROUND:In the first population-based study of psychopathology conducted in Haiti, we documented earthquake-related experiences associated with risk for posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) 2-4 months following the 2010 Haiti earthquake. METHODS:A population-based survey was conducted of 1,323 survivors randomly selected from the general nondisplaced community, internally displaced persons camps, and a community clinic. Respondents were from the Nazon area of Port-au-Prince, ∼20 miles from the epicenter. RESULTS:Respondents (90.5%) reported at least one relative/close friend injured/killed, 93% saw dead bodies, and 20.9% lost their job post-earthquake. The prevalence of PTSD (24.6%) and MDD (28.3%) was high. History of violent trauma was associated with risk of PTSD and MDD (adjusted odds ratio [AOR] 1.4, 95% confidence interval [CI], 1.0-1.9; AOR, 1.7, 95% CI 1.3, 2.2, respectively). Low social support (AOR, 1.7, 95% CI 1.2, 2.3; AOR 1.4, 95% CI 1.0, 1.9, respectively) increased risk of PTSD and MDD among women. Suffering damage to the home increased risk of MDD in males (AOR 2.8, 95% CI 1.5, 5.5). Associations between being trapped in rubble, major damage to house, job loss, and PTSD; and participation in rescue/recovery, friends/family injured/killed, and MDD varied based on prior history of violent trauma. CONCLUSIONS:Addressing mental health in a post-earthquake setting such as Haiti will require focusing resources on screening and treatment of identified vulnerable groups while targeting improvement of post-earthquake living conditions. Investment in sources of social support for women may make help mitigate the vulnerability of women to PTSD and MDD.
    背景与目标:
  • 【MDMA (± 3,4-亚甲二氧基甲基苯丙胺) 辅助心理治疗治疗耐药性慢性创伤后应激障碍 (PTSD) 的随机对照试验研究。】 复制标题 收藏 收藏
    DOI:10.1177/0269881112464827 复制DOI
    作者列表:Oehen P,Traber R,Widmer V,Schnyder U
    BACKGROUND & AIMS: :Psychiatrists and psychotherapists in the US (1970s to 1985) and Switzerland (1988-1993) used MDMA legally as a prescription drug, to enhance the effectiveness of psychotherapy. Early reports suggest that it is useful in treating trauma-related disorders. Recently, the first completed pilot study of MDMA-assisted psychotherapy for PTSD yielded encouraging results. Designed to test the safety and efficacy of MDMA-assisted psychotherapy in patients with treatment-resistant PTSD; our randomized, double-blind, active-placebo controlled trial enrolled 12 patients for treatment with either low-dose (25 mg, plus 12.5 mg supplemental dose) or full-dose MDMA (125 mg, plus 62.5 mg supplemental dose). MDMA was administered during three experimental sessions, interspersed with weekly non-drug-based psychotherapy sessions. Outcome measures used were the Clinician-Administered PTSD Scale (CAPS) and the Posttraumatic Diagnostic Scale (PDS). Patients were assessed at baseline, three weeks after the second and third MDMA session (end of treatment), and at the 2-month and 1-year follow-ups. We found that MDMA-assisted psychotherapy can be safely administered in a clinical setting. No drug-related serious adverse events occurred. We did not see statistically significant reductions in CAPS scores (p = 0.066), although there was clinically and statistically significant self-reported (PDS) improvement (p = 0.014). CAPS scores improved further at the 1-year follow-up. In addition, three MDMA sessions were more effective than two (p = 0.016).
    背景与目标: : 美国 (20世纪70年代1985年) 和瑞士 (1988-1993) 的精神科医生和心理治疗师合法使用MDMA作为处方药,以提高心理治疗的有效性。早期报告表明,它在治疗创伤相关疾病中很有用。最近,第一个完成的MDMA辅助心理治疗PTSD的初步研究取得了令人鼓舞的结果。旨在测试MDMA辅助心理治疗在治疗耐药的PTSD患者中的安全性和有效性; 我们的随机,双盲,活性安慰剂对照试验招募了12名患者接受低剂量 (25 mg,加12.5 mg补充剂量) 或全剂量MDMA (125 mg,加62.5 mg补充剂量)。MDMA在三个实验课程中进行,并散布在每周的非基于药物的心理治疗课程中。使用的结果指标是临床医生管理的PTSD量表 (CAPS) 和创伤后诊断量表 (PDS)。在基线,第二次和第三次MDMA疗程 (治疗结束) 后三周以及2个月和1年随访时对患者进行评估。我们发现MDMA辅助心理治疗可以在临床环境中安全施用。未发生与药物相关的严重不良事件。尽管有临床和统计学上显着的自我报告 (PDS) 改善 (p = 0.066),但我们没有看到CAPS评分的统计学显着降低 (p = 0.014)。在1年的随访中,CAPS评分进一步提高。此外,三个MDMA会话比两个更有效 (p = 0.016)。
  • 【惊恐障碍患者应激性生活事件,应对方式,症状严重程度和健康相关生活质量的性别差异。】 复制标题 收藏 收藏
    DOI:10.1097/NMD.0000000000000696 复制DOI
    作者列表:Kim JE,Song IH,Lee SH
    BACKGROUND & AIMS: :Although affective disorders have been known to have sex differences in the associated clinical characteristics and quality of life (QOL), sex differences among patients with panic disorder (PD) have remained relatively unexplored in Korea. We examined the sex differences in different types of stressful life events (SLEs), coping styles, symptom severity, and health-related QOL (HRQOL) in patients with PD. Data from 291 female and 254 male participants diagnosed with PD were analyzed using a structured clinical interview following the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria. Females with PD reported more SLEs including separation issues, physical illness or disability, and pregnancy-related problems than males. They also reported lower levels of confrontation and help-seeking coping strategies and higher levels of agoraphobia in symptom severity than males. The HRQOL of females with PD was significantly lower than male in physical functioning of HRQOL. This study suggests that the patient's sex is relevant to the assessment and treatment of PD.
    背景与目标: : 尽管已知情感障碍在相关的临床特征和生活质量 (QOL) 方面存在性别差异,但在韩国,恐慌症 (PD) 患者之间的性别差异仍未得到探索。我们检查了PD患者不同类型的压力生活事件 (sle),应对方式,症状严重程度和健康相关QOL (HRQOL) 的性别差异。根据《精神障碍诊断和统计手册》第4版标准,使用结构化临床访谈分析了291名被诊断为PD的女性和254名男性参与者的数据。患有PD的女性报告的SLEs比男性更多,包括分离问题,身体疾病或残疾以及与怀孕有关的问题。他们还报告说,与男性相比,对抗和寻求帮助的应对策略水平较低,而广场恐惧症的症状严重程度较高。PD女性的HRQOL在HRQOL的身体功能方面显着低于男性。这项研究表明,患者的性别与PD的评估和治疗有关。
  • 【比较评估成人ADHD和边缘性人格障碍的人格特质和人格病理的维度模型。】 复制标题 收藏 收藏
    DOI:10.1177/1087054712464391 复制DOI
    作者列表:Koerting J,Pukrop R,Klein P,Ritter K,Knowles M,Banzhaf A,Gentschow L,Vater A,Heuser I,Colla M,Roepke S
    BACKGROUND & AIMS: OBJECTIVE:This pilot study was a comparison of dimensional models assessing personality traits and personality pathology in a clinical sample of adults diagnosed with ADHD and adults diagnosed with borderline personality disorder (BPD), and a nonclinical control sample of healthy adults. METHOD:Personality traits were assessed using the NEO-Personality Inventory-Revised (NEO-PI-R) and dimensional personality pathology with the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ). RESULTS:Adults with ADHD and BPD produced higher Emotional Dysregulation/Neuroticism and Dissocial Behavior scores than controls. For the Extraversion/Inhibitedness scale, adults with BPD produced significantly lower scores than adults with ADHD and controls. On the Conscientiousness/Compulsivity domains, Conscientiousness scores were lower for both disorders, whereas low Compulsivity values were specific to adult ADHD. CONCLUSION:Our results suggest that patients with adult ADHD and BPD have distinguishable profiles of personality traits and personality pathology.
    背景与目标:
  • 【SLC22A3基因多态性与甲基苯丙胺使用障碍之间的关联。】 复制标题 收藏 收藏
    DOI:10.1111/j.1530-0277.2006.00215.x 复制DOI
    作者列表:Aoyama N,Takahashi N,Kitaichi K,Ishihara R,Saito S,Maeno N,Ji X,Takagi K,Sekine Y,Iyo M,Harano M,Komiyama T,Yamada M,Sora I,Ujike H,Iwata N,Inada T,Ozaki N
    BACKGROUND & AIMS: BACKGROUND:Methamphetamine (MAP) is one of the most frequently used illegal substances in Japan, and family and twin studies have suggested that genetic factors contribute to psychostimulant dependence, including MAP dependence. Organic cation transporter 3 (OCT3) has been reported to be involved in the disposition of MAP as well as MAP-induced behavioral changes in animals. Moreover, SLC22A3 (which encodes OCT3) is a candidate gene for MAP dependence because it is located within a chromosomal region associated with substance dependence. METHODS:Using 96 healthy control subjects, linkage disequilibrium (LD) within the SLC22A3 was investigated, and 5 single-nucleotide polymorphisms (SNPs) were selected as haplotype tag SNPs to search for an association with MAP dependence. Single-marker analyses and haplotype analyses of these SNPs were performed in 213 subjects with MAP dependence and 443 healthy controls. RESULTS:SLC22A3 polymorphisms were not significantly associated with MAP dependence in any of the single-marker and haplotype analyses. When subjects with MAP dependence were divided into polysubstance and single-MAP users, genotype and allele frequency of SNP2 (p=0.024, p=0.011, respectively), allele frequency of SNP3 (p=0.037), and haplotypic frequencies for these 2 SNPs (p=0.0438) differed significantly between groups. CONCLUSIONS:These results suggest that polymorphisms of SLC22A3 are related to the development of polysubstance use in Japanese patients with MAP dependence.
    背景与目标:
  • 【Pellegrini-Stieda病: 一种异质性疾病,与胫骨副韧带骨化/钙化不同义-解剖学和影像学研究。】 复制标题 收藏 收藏
    DOI:10.1007/s00256-006-0174-5 复制DOI
    作者列表:Mendes LF,Pretterklieber ML,Cho JH,Garcia GM,Resnick DL,Chung CB
    BACKGROUND & AIMS: OBJECTIVE:Ossification/calcification around the medial femoral condyle has been known as Pellegrini-Stieda (PS) disease for almost 100 years. Little attention has been given to magnetic resonance (MR) imaging characteristics. Our purpose is to demonstrate the anatomy in the medial femoral compartment and imaging findings of PS disease, determining the sites and patterns of ossification. DESIGN AND PATIENTS:In a cadaveric study seven specimens were dissected to show the anatomic relations of the tibial collateral ligament (TCL) and the tendon of the ischiocondylar part of the adductor magnus muscle, in the medial femoral epicondyle. In order to determine the nature of ossification/calcification in PS disease, MR imaging and radiographic findings in nine patients were analyzed by two observers with attention to the specific site, shape, and orientation of the ossification and its relationship to the tibial collateral ligament (TCL) and adductor magnus tendon. Available clinical history was recorded. A classification system addressing different sites and patterns of ossification was developed. RESULTS:The anatomic study showed that the TCL and the adductor magnus tendon insert at different sites in the medial femoral condyle and there is no continuation; however, some fibers of the posterior bundle of the TCL overlap the anterior aspect of the adductor magnus tendon. The imaging study showed that shape, orientation, and location of the abnormal calcification and ossification were similar on radiographic and MR imaging analysis. Ossification had an inferior orientation in six cases, a superior orientation in two cases, and both in one case. Four patterns of ossification were noted: (I) a beak-like appearance with an inferior orientation and femoral attachment was present in five cases; (II) a drop-like appearance with an inferior orientation, parallel to the femur, was evident in one case; (III) an elongated appearance with a superior orientation, parallel to the femur, was seen in two cases; and (IV) a beak-like appearance with an inferior and superior orientation, attached to the femur, was seen in one case. The ossification was present in the TCL in six cases, in the adductor magnus tendon in two cases, and in both in one case. The coronal plane was best in detecting and categorizing the ossification. CONCLUSION:Our data indicate that ossification in PS disease is not confined to the TCL but may also involve the adductor magnus tendon. In some cases, it can be related to the anatomic proximity (overlap) of the fibers of these two structures. PS disease should not be regarded as synonymous with ossification of the TCL. The ossification may be classified into four types. No clinical differences among these types appear to exist.
    背景与目标:
  • 【注意力缺陷/多动障碍患者的药物使用与高等教育入学考试成绩之间的关联。】 复制标题 收藏 收藏
    DOI:10.1001/jamapsychiatry.2017.1472 复制DOI
    作者列表:Lu Y,Sjölander A,Cederlöf M,D'Onofrio BM,Almqvist C,Larsson H,Lichtenstein P
    BACKGROUND & AIMS: Importance:Individuals with attention-deficit/hyperactivity disorder (ADHD) are at greater risk for academic problems. Pharmacologic treatment is effective in reducing the core symptoms of ADHD, but it is unclear whether it helps to improve academic outcomes. Objective:To investigate the association between the use of ADHD medication and performance on higher education entrance tests in individuals with ADHD. Design, Setting, and Participants:This cohort study observed 61 640 individuals with a diagnosis of ADHD from January 1, 2006, to December 31, 2013. Records of their pharmacologic treatment were extracted from Swedish national registers along with data from the Swedish Scholastic Aptitude Test. Using a within-patient design, test scores when patients were taking medication for ADHD were compared with scores when they were not taking such medication. Data analysis was performed from November 24, 2015, to November 4, 2016. Exposures:Periods with and without ADHD medication use. Main Outcomes and Measures:Scores from the higher education entrance examination (score range, 1-200 points). Results:Among 930 individuals (493 males and 437 females; mean [SD] age, 22.2 [3.2] years) who had taken multiple entrance tests (n = 2524) and used ADHD medications intermittently, the test scores were a mean of 4.80 points higher (95% CI, 2.26-7.34; P < .001) during periods they were taking medication vs nonmedicated periods, after adjusting for age and practice effects. Similar associations between ADHD medication use and test scores were detected in sensitivity analyses. Conclusions and Relevance:Individuals with ADHD had higher scores on the higher education entrance tests during periods they were taking ADHD medication vs nonmedicated periods. These findings suggest that ADHD medications may help ameliorate educationally relevant outcomes in individuals with ADHD.
    背景与目标:
  • 【睡眠-呼吸障碍,心律失常和恐慌症。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Trajanovic NN,Rasool MS,Voloh I,Shapiro CM
    BACKGROUND & AIMS: :Sleep-disordered breathing often presents as a cardiac or psychiatric problem. Such presentation may lead to suboptimal diagnostic and therapeutic decisions. The authors present a case in which a patient's condition improved only after the primary disorder was diagnosed and properly managed.
    背景与目标: : 睡眠呼吸障碍通常表现为心脏或精神问题。这种表现可能导致诊断和治疗决策不理想。作者提出了一个案例,其中只有在诊断并正确处理了原发性疾病后,患者的病情才有所改善。
  • 【阿托莫西汀的神经相关性可改善患有注意力缺陷/多动障碍的未成年人的抑制控制和视觉加工。】 复制标题 收藏 收藏
    DOI:10.1002/hbm.23683 复制DOI
    作者列表:Fan LY,Chou TL,Gau SS
    BACKGROUND & AIMS: :Atomoxetine improves inhibitory control and visual processing in healthy volunteers and adults with attention-deficit/hyperactivity disorder (ADHD). However, little is known about the neural correlates of these two functions after chronic treatment with atomoxetine. This study aimed to use the counting Stroop task with functional magnetic resonance imaging (fMRI) and the Cambridge Neuropsychological Test Automated Battery (CANTAB) to investigate the changes related to inhibitory control and visual processing in adults with ADHD. This study is an 8-week, placebo-controlled, double-blind, randomized clinical trial of atomoxetine in 24 drug-naïve adults with ADHD. We investigated the changes of treatment with atomoxetine compared to placebo-treated counterparts using the counting Stroop fMRI and two CANTAB tests: rapid visual information processing (RVP) for inhibitory control and delayed matching to sample (DMS) for visual processing. Atomoxetine decreased activations in the right inferior frontal gyrus and anterior cingulate cortex, which were correlated with the improvement in inhibitory control assessed by the RVP. Also, atomoxetine increased activation in the left precuneus, which was correlated with the improvement in the mean latency of correct responses assessed by the DMS. Moreover, anterior cingulate activation in the pre-treatment was able to predict the improvements of clinical symptoms. Treatment with atomoxetine may improve inhibitory control to suppress interference and may enhance the visual processing to process numbers. In addition, the anterior cingulate cortex might play an important role as a biological marker for the treatment effectiveness of atomoxetine. Hum Brain Mapp 38:4850-4864, 2017. © 2017 Wiley Periodicals, Inc.
    背景与目标: : 阿托莫西汀改善健康志愿者和患有注意力缺陷/多动障碍 (ADHD) 的成年人的抑制控制和视觉处理。然而,对于长期使用阿托莫西汀治疗后这两种功能的神经相关性知之甚少。这项研究旨在使用功能磁共振成像 (fMRI) 和剑桥神经心理测试自动电池 (CANTAB) 的计数Stroop任务来研究ADHD成人与抑制性控制和视觉处理相关的变化。这项研究是一项为期8周,安慰剂对照,双盲,随机临床试验的阿托莫西汀在24名未用药的ADHD成人中进行的试验。我们使用Stroop fMRI计数和两种CANTAB测试研究了与安慰剂治疗的对应物相比,托莫西汀治疗的变化: 用于抑制控制的快速视觉信息处理 (RVP) 和用于视觉处理的延迟匹配 (DMS)。阿托莫西汀降低了右下额回和前扣带回皮层的激活,这与RVP评估的抑制性控制的改善有关。此外,阿托莫西汀增加了左前肌的激活,这与DMS评估的正确反应的平均潜伏期的改善有关。此外,治疗前的扣带回激活能够预测临床症状的改善。用阿托莫西汀治疗可以改善抑制控制以抑制干扰,并可以增强视觉处理以处理数字。此外,前扣带回皮层可能是阿托莫西汀治疗效果的生物学标记。Hum Brain Mapp 38:4850-4864,2017。©2017威利期刊公司
  • 【低水平激光治疗后颞下颌疾病患者口面功能的评估。】 复制标题 收藏 收藏
    DOI:10.3109/00016357.2012.749517 复制DOI
    作者列表:Gökçen-Röhlig B,Kipirdi S,Baca E,Keskin H,Sato S
    BACKGROUND & AIMS: OBJECTIVE:To evaluate the effect of low-level laser therapy on occlusal contact area, occlusal pressure and bite force in temporomandibular disorder patients. PATIENTS AND METHOD:Twenty patients (14 women, six men, mean age 33.1 ± 3.8 years) diagnosed with myofascial pain according to the Research Diagnostic Criteria for Temporomandibular Disorder (RDC/TMD) participated in the study. Twenty healthy individuals, matched in age and gender, served as a control group. Low-level laser was applied to the mastication muscles three times per week, for a total of 10 sessions. The mandibular mobility range was evaluated. The maximum bite force, occlusal contact area and occlusal pressure were measured bilaterally with a dental pre-scale before and after treatment. All variables were analyzed descriptively. Changes in the masticatory muscle tenderness, mandibular movements, maximum bite force, occlusal contact area and occlusal pressure were compared by paired-sample Student's t-tests. RESULTS:There was a significant increase in the pressure pain threshold of the examined muscles. Mandibular movements were significantly improved in all patients. There was also a significant decrease in pain by palpation after laser exposure. However, no significant change was found in the maximum bite force, occlusal contact area or occlusal pressure after the treatment and also the values after the treatment were still significantly lower than those of the healthy individuals. CONCLUSION:This particular type of LLLT is effective at relieving pain but does not provide physical improvement.
    背景与目标:
  • 【社交焦虑症的认知疗法: “自我关注的注意和安全行为实验” 对治疗过程的影响。】 复制标题 收藏 收藏
    DOI:10.1017/S1352465813000672 复制DOI
    作者列表:Schreiber F,Heimlich C,Schweitzer C,Stangier U
    BACKGROUND & AIMS: BACKGROUND AND AIMS:Several studies have shown that cognitive therapy is an effective treatment for social anxiety disorder (SAD). However, it remains unclear which of the complex interventions are associated with an anxiety reduction during the course of treatment. The aim of this study was to examine the impact of the intervention referred to as the "self-focused attention and safety behaviours experiment" on treatment outcome. METHOD:This study was part of a randomized controlled trial including 16 sessions of either individual cognitive therapy (CT) or interpersonal therapy (IPT) for SAD. Of particular importance, a concomitant time-series analysis was used to investigate the impact of the self-focused attention and safety behaviours experiment on subsequent social anxiety (1, 2, 3, and 4 weeks after the intervention) in 32 patients with SAD, who are receiving cognitive treatment. RESULTS:The results revealed a significant reduction of social anxiety after the self-focused attention and safety behaviours experiment during the subsequent month of treatment. CONCLUSION:The findings of the current study confirm current cognitive theories of SAD and demonstrate the importance of interventions that target self-focused attention and safety behaviour in cognitive therapy for SAD.
    背景与目标:

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