• 【寻求减肥手术的人的夜间饮食综合症和暴食症: 患病率和相关特征。】 复制标题 收藏 收藏
    DOI:10.1016/j.soard.2006.03.014 复制DOI
    作者列表:Allison KC,Wadden TA,Sarwer DB,Fabricatore AN,Crerand CE,Gibbons LM,Stack RM,Stunkard AJ,Williams NN
    BACKGROUND & AIMS: OBJECTIVE:To assess the prevalence of night eating syndrome (NES) and binge eating disorder (BED) and their related behavioral and psychological correlates in persons who sought bariatric surgery. RESEARCH METHODS AND PROCEDURES:A consecutive series of 215 persons with extreme obesity (82% women, 70% European American) completed the Weight and Lifestyle Inventory and a semistructured interview as part of a pre-surgery behavioral/psychological assessment. Diagnoses for NES and BED were based on graded diagnostic criteria. RESULTS:Percentages of participants who met diagnostic criteria for NES by interview were 1.9% for the strictest definition and 8.9% across all definitions of NES. After interview, full DSM-TR criteria for BED were met by 4.2%; an additional 1.4% reported binge eating at least once per week. Self-reported prevalence of NES and BED were higher. Those with NES or BED had significantly more symptoms of depression and a greater history of psychological complications than the remaining sample. DISCUSSION:The prevalence rates of NES and BED among this population of bariatric surgery candidates were lower than expected based on previous reports. Findings and hypotheses regarding lowered prevalence rates are discussed.
    背景与目标:
  • 【注意缺陷多动障碍可能与中枢脑源性神经营养因子活性降低有关: 临床和治疗意义。】 复制标题 收藏 收藏
    DOI:10.1016/j.mehy.2006.06.025 复制DOI
    作者列表:Tsai SJ
    BACKGROUND & AIMS: :Attention-deficit hyperactivity disorder (ADHD) is a common childhood psychiatric disorder. Despite intensive research efforts, the aetiology of ADHD remains unknown. Current evidence suggests that the aetiology of ADHD is heterogeneous, comprising of multiple factors. Recently, it has been proposed that brain-derived neurotrophic factor (BDNF), a member of the neurotrophic factor family, may be implicated in the pathogenesis of ADHD. This hypothesis is supported by recent genetic studies in ADHD. Drawing on findings from studies into the drugs for ADHD relating to central BDNF expression, hyperactivity in BDNF knockout mice, BDNF effects in midbrain dopaminergic function and the close association between BDNF and the dopamine transporter (an important molecule for ADHD pathogenesis), it is proposed here that decreased central BDNF, particularly in the midbrain region, may play an important role in the pathogenesis ADHD. This hypothesis may have some implications for clinical findings in ADHD (for example, the co-morbidity between ADHD and major depression), and provide a new direction for the development of medication for ADHD treatment.
    背景与目标: : 注意力缺陷多动障碍 (ADHD) 是一种常见的儿童精神疾病。尽管进行了大量研究,但ADHD的病因仍然未知。目前的证据表明,ADHD的病因是异质的,由多种因素组成。最近,有人提出,神经营养因子家族的成员脑源性神经营养因子 (BDNF) 可能与ADHD的发病机理有关。该假设得到了ADHD最近的遗传研究的支持。根据对ADHD药物的研究结果,该药物与中枢BDNF表达,BDNF基因敲除小鼠的活动过度,BDNF在中脑多巴胺能功能中的作用以及BDNF与多巴胺转运蛋白 (ADHD发病机理的重要分子) 之间的密切联系有关,在这里提出降低中枢BDNF,特别是在中脑区域,可能在ADHD的发病机理中起重要作用。该假设可能对ADHD的临床发现 (例如,ADHD与重度抑郁症之间的合并症) 具有一定的意义,并为ADHD治疗药物的发展提供了新的方向。
  • 【自闭症谱系障碍儿童的医学调查。】 复制标题 收藏 收藏
    DOI:10.1111/j.1365-2214.2006.00630.x 复制DOI
    作者列表:Cass H,Sekaran D,Baird G
    BACKGROUND & AIMS: :Few well-constructed studies have systematically evaluated medical investigation protocols for children with autistic spectrum disorders. This is in large part due to the heterogeneous nature of the population and changing diagnostic frameworks. This review outlines the studies that have directed investigation strategies to date, and discusses how these might be applied in the clinical situation. The importance of listing the conditions that may be present on the basis of the specific clinical presentation, and using a thorough history and examination to generate a pre-test probability of the target disorders is emphasized if tests are to be useful in directing therapy or broader management approaches.
    背景与目标: : 很少有精心构建的研究系统地评估了自闭症谱系障碍儿童的医学调查方案。这在很大程度上是由于人口的异质性和不断变化的诊断框架。这篇综述概述了迄今为止指导研究策略的研究,并讨论了如何将这些策略应用于临床情况。如果要在指导治疗或更广泛的治疗方法中有用,则强调了根据特定临床表现列出可能存在的条件并使用全面的病史和检查来产生目标疾病的预测试概率的重要性。管理方法。
  • 【对象偏好对自闭症儿童任务表现和刻板印象的影响。】 复制标题 收藏 收藏
    DOI:10.1016/s0891-4222(96)00046-7 复制DOI
    作者列表:Morrison K,Rosales-Ruiz J
    BACKGROUND & AIMS: The relationship between preferred objects associated with stereotypy, stereotypic behavior, and accuracy of responding during a counting task by a child with autism was analyzed. Object preference was determined by presenting the child with different sets of objects and asking him to choose one. His choices were then rank ordered into three groupslow, medium, and high preference objects. Counting performance within each of the three object groups was then analyzed in a multi-element design, alternating preference groups. Teaching with high-preference objects occasioned more stereotypic behavior and less accurate counting than teaching with medium- and low-preference objects. Thus, there exists the possibility that teaching may be less successful with certain teaching materials, especially if those materials evoke high rates of incompatible behaviors.

    背景与目标: 分析了与自闭症儿童在计数任务中与刻板印象相关的首选对象,刻板行为和响应准确性之间的关系。对象偏好是通过向孩子展示不同的对象集并要求他选择一个来确定的。然后将他的选择排序为三个慢,中和高偏好对象。然后,在多元素设计 (交替的偏好组) 中分析了三个对象组中每个对象组的计数性能。与中低偏好对象的教学相比,高偏好对象的教学产生了更多的刻板行为和更不准确的计数。因此,存在使用某些教材进行教学可能不太成功的可能性,尤其是如果这些教材引起高度的不相容行为。
  • 【压痛点和纤维肌痛症状变量之间的关系: 证据表明纤维肌痛不是临床上的离散疾病。】 复制标题 收藏 收藏
    DOI:10.1136/ard.56.4.268 复制DOI
    作者列表:Wolfe F
    BACKGROUND & AIMS: OBJECTIVE:To investigate the relation between measures of pain threshold and symptoms of distress to determine if fibromyalgia is a discrete construct/ disorder in the clinic.

    METHODS:627 patients seen at an outpatient rheumatology centre from 1993 to 1996 underwent tender point and dolorimetry examinations. All completed the assessment scales for fatigue, sleep disturbance, anxiety, depression, global severity, pain, functional disability, and a composite measure of distress constructed from scores of sleep disturbance, fatigue, anxiety, depression, and global severity-the rheumatology distress index (RDI).

    RESULTS:In regression analyses, the RDI was linearly related to the count of tender points (r2 = 0.30). Lesser associations were found between the RDI and dolorimetry measurements (r2 = 0.08). The RDI was more strongly correlated with the two measures of pain threshold than any of the individual fibromyalgia symptom variables. In partial correlation analyses, all of the information relating to symptom variables was contained in the tender point count, and dolorimetry was not independently related to symptoms.

    CONCLUSION:Tender points are linearly related to fibromyalgia variables and distress, and there is no discrete enhancement or perturbation of fibromyalgia or distress variables associated with very high levels of tender points. Although fibromyalgia is a recognisable clinical entity, there seems to be no rationale for treating fibromyalgia as a discrete disorder, and it would seem appropriate to consider the entire range of tenderness and distress in clinic patients as well as in research studies. The tender point count functions as a 'sedimentation rate' for distress, and is a better measure than the dolorimetry score.

    背景与目标: 目的 : 研究疼痛阈值的测量与痛苦症状之间的关系,以确定纤维肌痛是否是临床中的离散结构/疾病。
    方法 : 在门诊风湿病中心1993年的627名患者1996年接受了压痛点和度日检查。全部完成乏力,睡眠障碍,焦虑,抑郁,整体严重程度,疼痛,功能障碍的评估量表,以及由睡眠障碍,乏力,焦虑,抑郁,和全球严重程度-风湿病困扰指数 (RDI)。
    结果 : 在回归分析中,RDI与压痛点的计数呈线性关系 (r2 = 0.30)。在RDI和测年测量之间发现较小的关联 (r2 = 0.08)。与任何单个纤维肌痛症状变量相比,RDI与两种疼痛阈值的相关性更强。在偏相关分析中,与症状变量有关的所有信息都包含在压痛点计数中,并且度量法与症状没有独立关系。
    结论 : 压痛点与纤维肌痛变量和困扰呈线性关系,并且没有与非常高的压痛点相关的纤维肌痛或窘迫变量的离散增强或扰动。尽管纤维肌痛是可识别的临床实体,但似乎没有理由将纤维肌痛作为一种离散性疾病进行治疗,并且在临床患者以及研究中考虑整个范围的压痛和困扰似乎是合适的。招标点计数起遇险的 “沉降率” 的作用,并且比dolorimetry评分更好。
  • 【使用红色光谱中的发光二极管灯进行光活化消毒: 牙周炎患者在维护中的临床和微生物短期发现。一项随机对照的裂口临床试验。】 复制标题 收藏 收藏
    DOI:10.1007/s10103-012-1225-x 复制DOI
    作者列表:Mongardini C,Di Tanna GL,Pilloni A
    BACKGROUND & AIMS: :Eradication or suppression of pathogens is a major goal in periodontal therapy. Due to the increase in antibiotic resistance, the need of new disinfection therapies is raising. Photodynamic therapy (PDT) has demonstrated anti-infective potential. No data are available on the use of light-emitting diode (LED) lights as the light source in PDT. The aim of this study was to investigate the microbiological and clinical adjunctive outcome of a new photodynamic LED device, compared to scaling and root planing in periodontitis patients in maintenance [supportive periodontal therapy (SPT)]. In this masked, split-mouth design study, 30 treated chronic periodontitis subjects (mean age, 46.2 years; 13 males) in SPT were included. Two residual interdental sites with probing pocket depth (PPD) ≥ 5 mm in two opposite quadrants, with positive bleeding on probing (BOP) and comparable periodontal breakdown, were selected. PPD, BOP and subgingival microbiological samples for real-time PCR analysis (Carpegen® PerioDiagnostics, Carpegen GmbH, Münster, Germany) were recorded at baseline and 1 week after treatment. Scaling and root planing was performed under local anesthesia. Randomly one of the sites was selected to receive adjunctive photodynamic therapy by inserting a photosensitizer (toluidine blue O solution) and exposing it to a LED light in the red spectrum (Fotosan, CMS Dental, Copenhagen, Denmark), according to the manufacturer's instructions. After 1 week, 73 % of the control sites and 27 % of the test sites were still BOP+. These differences compared to baseline values and in-between groups were statistically significantly different (p < 0.001). Mean PPD decreased from 5.47 mm (±0.68) to 4.73 mm (±0.74, p < 0.001) in control sites and from 5.63 mm (±0.85) to 4.43 mm (±1.25, p < 0.001, test vs control p = 0.01) in the test group. Microbiologically, higher reductions of relative proportions of red complex bacteria were observed in test sites (68.1 vs. 4.1 %; p = 0.01). This study showed that adjunctive photodynamic treatment by LED light may enhance short-term clinical and microbiological outcome in periodontitis subjects in SPT.
    背景与目标: : 根除或抑制病原体是牙周治疗的主要目标。由于抗生素耐药性的增加,新的消毒疗法的需求正在增加。光动力疗法 (PDT) 已显示出抗感染潜力。没有关于在PDT中使用发光二极管 (LED) 灯作为光源的数据。这项研究的目的是研究一种新型光动力LED设备的微生物学和临床辅助结果,与牙周炎患者在维持 [支持性牙周治疗 (SPT)] 中的牙周炎患者进行结垢和牙根平整相比。在这项蒙面的裂口设计研究中,包括30名接受治疗的SPT慢性牙周炎受试者 (平均年龄46.2岁; 13名男性)。选择了两个相对象限中探查袋深度 (PPD) ≥   5毫米的两个残留齿间部位,探查出血 (BOP) 阳性,牙周分解相当。用于实时PCR分析的PPD,BOP和龈下微生物样品 (Carpegen®在基线和治疗后1周记录PerioDiagnostics,Carpegen GmbH,m ü nster,德国)。在局部麻醉下进行了缩放和根刨除。根据制造商的说明,通过插入光敏剂 (甲苯胺蓝O溶液) 并将其暴露于红色光谱的LED光 (Fotosan,CMS Dental,哥本哈根,丹麦),随机选择其中一个部位接受辅助光动力疗法。1周后,73% 对照部位和27% 试验部位仍为BOP +。这些差异与基线值和组间比较在统计学上有显著差异 (p <0.001)。在对照组中,平均PPD从5.47毫米 (± 0.68) 降至4.73毫米 (± 0.74,p <0.001),在试验组中从5.63毫米 (± 0.85) 降至4.43毫米 (± 1.25,p <0.001,测试vs对照p = 0.01)。在微生物学上,在测试部位观察到红色复合细菌相对比例的较高降低 (68.1对4.1%; p = 0.01)。这项研究表明,通过LED光辅助光动力治疗可能会增强SPT牙周炎受试者的短期临床和微生物学结果。
  • 【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:
  • 【Hla-g * 14bp插入和自闭症谱系障碍儿童行为障碍的KIR2DS1-HLAC2复杂影响。】 复制标题 收藏 收藏
    DOI:10.1016/j.neuroscience.2017.06.012 复制DOI
    作者列表:Guerini FR,Bolognesi E,Chiappedi M,Ghezzo A,Manca S,Zanette M,Sotgiu S,Mensi MM,Zanzottera M,Agliardi C,Costa AS,Balottin U,Clerici M
    BACKGROUND & AIMS: :Activating KIR-HLA-C ligand complexes and HLA-G∗14bp insertion/deletion (+/-) polymorphism were associated to Autism Spectrum Disorders (ASD) and were suggested to correlate with inflammation during fetal development. We evaluated whether HLA-G∗14bp(+/-) and KIR-HLA-C complexes are associated with cognitive and behavioral scores and EEG profile in 119 ASD children (58 from Sardinia, 61 from Peninsular Italy). KIR2DS1-C2; KIR2DS2-C1; KIR2DL1-C2; KIR2DL2-C1; KIR2DL3-C1 and HLA-G∗14bp(+/-) were molecularly genotyped by Single Specific Primer PCR and gel electrophoresis. Univariate linear model analysis adjusted for age, gender and provenience showed statistically higher scores of Childhood Autism Rating Scale (CARS) and Autistic Core Behavior in KIR2DS1-C2+/HLA-G∗14bp+ASD children (43.7±1.5, p=0.03; 3.3±0.1, p=0.03, respectively). These results suggested a synergistic polygenic association of KIR2DS1-HLAC2+/HLA-G∗14bp+ pattern with behavioral impairment in ASD children.
    背景与目标: : 激活KIR-hla-c配体复合物和hla-g ∗ 14bp插入/缺失 (+/-) 多态性与自闭症谱系障碍 (ASD) 相关,并被认为与胎儿发育过程中的炎症相关。我们评估了119名ASD儿童 (58名来自撒丁岛,61名来自意大利半岛) 的hla-g * 14bp(+/-) 和KIR-hla-c复合物是否与认知和行为评分以及脑电图谱相关。KIR2DS1-C2; KIR2DS2-C1; KIR2DL1-C2; KIR2DL2-C1; KIR2DL3-C1和hla-g * 14bp(+/-) 通过单特异性引物PCR和凝胶电泳进行分子分型。调整年龄,性别和出血率的单变量线性模型分析显示,KIR2DS1-C2/hla-g * 14bp ASD儿童的儿童自闭症评分量表 (CARS) 和自闭症核心行为得分在统计学上更高 (43.7 ± 1.5,p = 0.03; 3.3 ± 0.1,p = 0.03)。这些结果表明,ASD儿童的KIR2DS1-HLAC2/hla-g ∗ 14bp模式与行为障碍具有协同的多基因关联。
  • 【在ALS4-like运动神经元疾病患者中评估的SETX错义变异谱。】 复制标题 收藏 收藏
    DOI:10.1007/s10048-012-0347-4 复制DOI
    作者列表:Arning L,Epplen JT,Rahikkala E,Hendrich C,Ludolph AC,Sperfeld AD
    BACKGROUND & AIMS: :Mutations in the senataxin (SETX) gene can cause amyotrophic lateral sclerosis 4 (ALS4), an autosomal dominant form of juvenile onset amyotrophic lateral sclerosis, or result in autosomal recessive ataxia with oculomotor apraxia type 2. Great caution regarding the possible disease causation, especially of missense variations, has to be taken. Here, we evaluated the significance of all previously reported SETX missense mutations as well as six newly identified variations in 54 patients suspected of having ALS4. Yet, epidemiologic and in silico evidence indicates that all newly identified variations and two previously published ALS4-related missense variations (C1554G and I2547T) are most likely non-pathogenic, demonstrating the problems of interpretation of SETX missense alleles in the absence of functional assays.
    背景与目标: : senataxin (SETX) 基因的突变可导致肌萎缩性侧索硬化症4 (ALS4),这是一种常染色体显性遗传形式的少年性肌萎缩性侧索硬化症,或导致常染色体隐性遗传性共济失调并伴有动眼失用2型。对于可能的疾病原因,尤其是错义变异,必须谨慎行事。在这里,我们评估了所有先前报道的SETX错义突变以及54例怀疑患有als4的患者中新发现的六个变异的重要性。然而,流行病学和计算机证据表明,所有新发现的变异和两个先前发表的ALS4-related错义变异 (C1554G和I2547T) 最有可能是非致病性的,证明了在缺乏功能测定的情况下解释SETX错义等位基因的问题。
  • 【青少年内在化和外在化症状作为创伤暴露类型和创伤后应激障碍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。
  • 12 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。

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