Parvalbumin阳性中间神经元缺陷在精神分裂症病理机制中的作用

精神分裂症是一种多发于青壮年的重性精神病, 其原因尚不明确。经典的多巴胺缺陷理论假说在某些方面欠缺解释力; 与此同时, 关于Parvalbumin阳性的中间神经元(后简称PV+神经元)缺陷在精神分裂症病理机制中的作用逐渐明晰, 并引起了越来越多的关注。PV+神经元在绝大部分脑区中是一种快速放电的抑制性神经元, 参与了突触可塑性的调节, 兴奋/抑制平衡的维持和神经发生等。而在精神分裂症中, PV+神经元的异常在患者和动物研究中都被普遍证实, 并发现与 NMDA受体缺陷、gamma波异常和氧化应激存在某些关联。     

Family Therapy and Childhood-Onset Schizophrenia: Pursuing Clinical and Bio/Psycho/Social Competence

Childhood-onset schizophrenia is perceived as more complicated because of its complexity, pervasive duration, and impact on individual and family functioning. Viewing the symptoms of childhood schizophrenia as creating a bio/psycho/social competence within which the therapist and family must interact may help contribute to treatment success. Competent family therapists working within this culture should be knowledgeable about the characteristics of childhood-onset schizophrenia, aware of their own biases towards psychosis, and skillful in its treatment. Guidelines are provided to help therapists identify their attitudes about schizophrenia and understand appropriate skills for treating the disorder.     

Immediate source-monitoring, self-focused attention and the positive symptoms of schizophrenia

Previous research suggests that tendencies to misattribute one's own thoughts to an external source, as assessed by an immediate source-monitoring test, are associated with auditory verbal hallucinations (AVHs). However, recent research suggests that such tendencies are associated instead with symptoms of thought interference. The main aim of the present study was to examine whether such tendencies are differentially associated with different types of thought interference, with AVHs, or with both. It has also been suggested that external misattributions are especially likely to occur with emotionally salient material and if the individual's focus is on the self. These suggestions were also tested. The positive psychotic symptoms of 57 individuals with a diagnosis of schizophrenia were assessed and they then completed the Self-Focus Sentence Completion blank. Immediately after completing each sentence they were asked to indicate to what extent the sentence was their own. The number of sentences that were not rated as completely their own served as their externalisation score. Externalisation scores correlated significantly with the severity of three symptoms: voices commenting, delusions of being controlled, and thought insertion. In a logistic regression analysis, all three of these symptoms were significantly and independently related to externalisation. Externalisation was not associated with either a negative or a neutral self-focus. Thus tendencies to misattribute one's own thoughts to an external source are associated with AVHs and some, but not all, symptoms of thought interference. The importance for externalisation of self-focused attention and of the emotional salience of the elicited thoughts was not supported.     

Mental models and language registers in the psychoanalysis of psychosis: An overview of a thirteen‐year analysis2

The author suggests that the use of mental models and language registers may help an analysis to proceed, especially in psychosis, when the patient has not yet developed a mental space that will allow him/her the functions of knowledge and containment of emotions. Models, according to Bion, are a primitive approach to abstraction and a manifestation of the analyst's reverie that enables him/her to transform sense data into alpha‐elements. Ferrari, in a further development of Bion's theories, hypothesises a relationship between the transference and the internal level of body‐mind communication, and proposes the use of language registers to sustain the psychoanalytic process. The author presents several clinical examples from a thirteen‐year, four‐session‐a‐week analysis of a psychotic analysand who was initially confused, paranoid and altogether unable to bring self‐reflective thought to bear on her overwhelming emotions and had, by the end of the analysis, completely recovered from her psychotic symptoms. The clinical material shows how the technical tools of mental models and language registers helped in the construction of a mental space and spatio‐temporal parameters, permitting the patient to tolerate overwhelming concrete emotions and finally to recognise and work through the emotions of an intense transference.     

Social skills training: The moderating influence of culture in the treatment of Latinos with schizophrenia

Providing effective psychiatric rehabilitation to ethnic minority patients with serious persistent mental illness (SPMI) requires an understanding of the role of cultural values and ethnicity-relevant factors on the course and outcome of severe mental disorders. In this paper, the author identifies some of the cultural factors that are relevant for Latinos with SPMI, and describes how these factors were incorporated into existing rehabilitation modalities. The results of a pilot study designed to test the efficacy of culturally-modified social skills training are presented. The results suggest that the cultural modifications improved Latino patients' ability to learn the material and enhanced their use of these skills in their natural environments. Future research will be aimed at identifying and incorporating these salutary cultural forces into the rehabilitation process of the severely mentally ill.     

Ethnicity/race, paranoia, and psychiatric diagnoses: Clinician bias versus sociocultural differences

Two contradictory assumptions underlie research on race differences in psychiatric diagnoses: (1) the clinician bias (CB) hypothesis, which assumes that Blacks and Whites exhibit symptomatology similarly, but diagnosticians mistakenly judge them differently; and (2) the cultural relativity (CR) hypothesis, which assumes that Blacks and Whites have different modes of expressing psychopathology but diagnosticians are unaware of or insensitive to such cultural differences. The purpose of the present study is to conduct a comparative test of the CB and CR hypotheses focusing on paranoid symptoms. The study examines race differences on the scales of Distrust (DST), Perceived Hostility of Others (PHO), and False Beliefs and Perceptions (FBP) from the Psychiatric Epidemiology Research Interview (PERI), which measure different types of symptoms ranging from relatively ordinary suspiciousness (i.e., mild paranoia) to the severe kind of paranoia often observed in schizophrenia, in relation to rigorous research diagnoses of depression and schizophrenia-like disorders. In effect, the CB and CR hypotheses become the null and alternative hypotheses, respectively, under conditions where the diagnoses are made according to research criteria. The present findings support the CR hypothesis over the CB hypothesis. The implications of these results for the psychiatric misdiagnosis of Black individuals are discussed.     

精神分裂症病人对成人面部表情的辨别

本文对比研究了精神分裂症病人和正常人对成人面部表情辨别的水平,发现精神分裂症病人存在着表情辨别障碍。病程长、以阴性症状为主的病人易出现这种障碍。表情辨别障碍是一种情绪障碍,属阴性症状。     

Schizophrenia and the experience of intersubjectivity as threat

Many with schizophrenia find social interactions a profound and terrifying threat to their sense of self. To better understand this we draw upon dialogical models of the self that suggest that those with schizophrenia have difficulty sustaining dialogues among diverse aspects of self. Because interpersonal exchanges solicit and evoke movement among diverse aspects of self, many with schizophrenia may consequently find those exchanges overwhelming, resulting in despair, the sensation of fusion with another, and/or self-dissolution. In short, compromised dialogical capacities may be a contributing factor to social dysfunction in schizophrenia.     

Freud's theory of paranoid delusion based on the Schreber case contrasted with related theories

The historic importance of Freud's analysis of the Schreber case is acknowledged, even though the theory it expounds is largely disavowed. The theory ascribes the cause of paranoid delusion to homosexual impulses unresolved in infancy or early childhood. This paper summarizes Freud's monograph on Schreber and contrasts his theory with the views of various revisionists. The writers focus on the Freudian concept of projection, which is intended to explain how much meaning can become reversed under the impetus of stress, and the reversal lead to delusional thinking. Based on their work in family therapy, where they observed one form of pathogenic relating termed learning to be possessed, the writers concluded that this form was also based on a type of projection which could culminate in delusional ideation. A relationship between learning to be possessed and H. S. Sullivan's theory of paranoid transformation is described. A learning factor is present in several of the psychological theories advanced to explain delusion, and the factor is akin to if not identical with Freud's concept of projection.Gerald Zuk, PhD, is in private practice at 25316 Pacy Street, Santa Clarita, California 91321-3343. Carmen Zuk, MD, is a child psychiatrist-partner affiliated with the Southern California Permanente Medical Group at its psychiatric clinic in Van Nuys, California. Both may be reached by telephone at (805) 252-7702.