Abstract:生物—心理—社会因素共同影响下的精神障碍在我国成年人群中的现患病率高达17.5%， 其中主要是抑郁障碍、焦虑障碍、物质使用障碍等，但临床上对这些疾病的治疗依然以药物为主。虽然 大量研究证实了认知行为治疗(CBT)在多种精神障碍治疗中的一线地位，有关CBT治疗各类精神障碍起 效的神经生物学机制的医学影像学的研究已成为目前研究的热点之一，但国内精神科及心理学领域的专 业人员对于规范的认知行为治疗理论与实践操作普遍缺乏深入的了解，也自然缺乏足够的合格CBT专业 人员在临床工作中为患者提供其所需的CBT。现就CBT的起源、发展、理论模型及临床操作流程做简要 介绍，并结合案例介绍其关键技术，以推动国内更多的同行关注并主动接受CBT培训，以此拓展与提升 国内精神心理卫生服务的能力，更好地服务于患者。

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Abstract:Objective　To explore the efficacy and safety of low frequency repetitive transcranial magnetic stimulation(rTMS) for adolescent patients with first-episode depression. Methods　Totals of 30 adolescent first-episode depression patients with no medication were randomly divided into rTMS group (15 cases) and control group (15 cases). Low frequency rTMS located on right dorsolateral prefrontal cortex (DLPFC)was used in rTMS group for 2 weeks (5 times per week)， compared with sham stimulation in control group. No drug was used during treatment. The efficacy was assessed by Hamilton Depression Scale (HAMD24). Results　(1) There was significant difference between two groups on effective rate(100% vs 0%， P＜ 0.01). (2)There was significant reduction both in HAMD24 total scores and in sub-scale factors’ scores in rTMS group after treatment（ P＜0.05）. But there was no significant differences in control group (P ＞ 0.05). (3) No significant difference was found in incidence of adverse reaction between two groups (P＞ 0.05). Conclusions　Low frequency rTMS can effectively and safely improve adolescent patients with first-episode depression.

Abstract:Objective　To investigate the relationship between serum vitamin D level and acute ischemic stroke caused by large artery atherosclerosis (LAA) and the effects of serum vitamin D on its severity and recent neurological function improvement. Methods　 Totals of 100 acute ischemic stroke patients with LAA within 24 h hospitalized in Department of Neurology， the Fourth Hospital of Baotou were included in test group. NIHSS scores were evaluated before and after 14 days of treatment. 60 healthy controls were enrolled in control group. The serum levels of vitamin D in two groups were measured and compared. Patients were divided into 3 groups according to NIHSS scores: the mild group， moderate group and severe group. And the differences of the serum vitamin D in observation group and control group were compared. According to the level of serum vitamin D， patients were further divided into 3 groups again: the sufficient group， insufficient group and deficiency group. The relationships between serum vitamin D and severity and recent neurological function improvement in patients with LAA were evaluated. Results　The level of serum vitamin D in test group was significantly lower than that in control group［ (13.97±1.32)μg/L vs (21.62±0.89)μg/L；P=0.018］. The level of serum vitamin D in the severe group was significantly lower than that in moderate group and mild group［ (9.21±0.73)μg/L vs (12.24±1.02)μg/L， (15.01±0.98)μg/L；P＜ 0.01］. Serum vitamin D level was negatively correlated with NIHSS score (r=-1.892，P=0.046 ). After 14 days of treatment， ΔNIHSS in sufficient group was significantly higher than that in insufficient group and deficiency group［ (3.93±1.21)μg/L vs (2.96±1.83)μg/L， (2.05±2.06)μg/L； F=5.47，P=0.01］. Conclusions　The level of the serum vitamin D is significantly lower in acute ischemic stroke patients caused by LAA and is closely related to the recent neurological function improvement.

Abstract:Objective　To study the effects of group cognitive behavioral therapy on stigma and medication compliance in patients with bipolar disorder. Methods　Totals of 25 patients with bipolar disorder were divided into study group (16 cases) and control group (9 cases) by paired design. The study group received group cognitive behavioral therapy on the basis of routine treatment. While the control group received routine treatment. Internalized Stigma of Mental Illness scale (ISMI) and Medication Adherence Rating Scale (MARS) were measured in two groups. Results　In stigma， after 10 sessions， stereotype endorsement improved significantly in the study group (P ＜0.05). Alienation， stereotype endorsement， perceived discrimination and total scores of ISMI improved statistically after treatment within the study group (P ＜ 0.05). While within the control group， scores of ISMI and subscales showed no significant differences before and after treatment (P ＞ 0.05). In the medication compliance， there were no significant differences between two groups before and after treatment (P＞0.05). The scores of MARS improved statistically within the study group after treatment (P＜0.05). While within the control group， scores of MARS showed no significant difference before and after treatment (P＞ 0.05). Conclusions　Group cognitive behavioral therapy can reduce stigma， improve medication compliance and promote rehabilitation for patients with bipolar disorder.

Abstract:Objective　 To investigate the improvement of trait coping style after group cognitive behavioral therapy (GCBT) and the effect of trait coping styles on GCBT in patients with mild depression. Methods　 The depressive symptom， anxiety symptom and trait coping style of mild depression patients before and after GCBT and during follow-up were compared in this prospective self-control study. Results　One hundred and two patients with mild depression were recruited. Compared to baseline， the scores of depression symptom， anxiety symptom and trait coping style at 12 weeks， 24 weeks， 36 weeks and 48 weeks declined significantly (P＜ 0.05). Logistic regression analysis showed that baseline anxiety symptom， negative coping style， and attendance rate entered the final equation. Conclusions　GCBT can significantly improve depression symptom， anxiety symptom and trait coping style. And the efficacy can last for a long time for mild depression patients. Baseline anxiety symptom， negative coping style， and attendance rate have significant influence on GCBT.

Abstract:Objective To explore the influence of early emotional trauma on treatment cognitive behavior therapy (GCBT) in mild depression patients. Methods Totals of 102 mild depr eesffseicotn opfa gtireonutps Swheorert rFeocrrmui t(eEdT iInS Rth-iSsF s)t uwdays. uAsleld p taot iiennvtess rtiegcaetiev ecdh isldtahnodoadr dmizaeltdr eGatCmBeTn.t . EHaarlmy ilTtoranu Dmeap Irnesvseinotno rSyc aSleel f( HRAepMoDrt-- 1w7e)e kwsa，s 3u6s ewde eakss ，p r4im8 awrye eokust cdoumrien gi nfo bllaoswe luinpe. ，P aatti e4n tws eweekrse， d8iv wideeedk sin，t o1 2h igwhe eekmso otifo ntraela ttrmauemnta， garso uwpe laln ads lo2w4 tewmoo tgiroonuapl st.r aRumesau gltrso upP baatiseendt so nin t htew om egdroiaunp so fa ellm monetti ocnlianl itcraalu mcuar.e T shtea ntrdeaartdm eanftte er f1fe2c tws eweekrse’ c tormeaptamreedn tb aentwde 4e8n gwreoeukps ’e fffoelclto w(F u=p1.. 3E6a，r lPy =e0m.2o4ti7o)n. aSl itmrapulem ae ffsehcotw aenda lsyisginsi fsihcoawnte din ttheraat cbtiootnh egfrfoeucpt s( Fim=3p.r7o2v，ed P s＜ign0if.i0c5a)n atlnyd a nftoe rs tirgenaitfmicaenntt (ihmipghro evmemoteinont aslp tereadu mbae tgwreoeunp ：twFo= g7r7o.9u8p，s sPh＜ow0ed.0 1n；o lsoiwgn eifmicoatinotn dali fftrearuenmcae g(rto=u1p.1：9F，= P2=2.04.52，3 7P)，＜ d0e.p0r1e)s. sAivlteh osucgohre t hoef low emotional trauma group decreased faster than that of high emontional trauma group significantly (t=-2.54， P=0.013). Conclusions Depression symptom would be significantly improved and lasting after GCBT in all emmilodn tdieopnraels tsriaounm paa itmiepnrtos vree gsalorwdleers.s of the degree of emotional trauma. But at the beginning， patients with high

Abstract:抑郁障碍共病失眠障碍的现象在临床中非常普遍。失眠的认知行为治疗（Cognitive Behavioral Therapy for Insomnia，CBT-I）作为一个基于证据的非药物治疗方法已经在治疗失眠障碍中广为 接受。CBT-I也开始应用于抑郁障碍共病失眠障碍，并且获得一些证据的支持，但是尚需要增强CBT-I 治疗抑郁障碍共病失眠障碍患者的依从性，从而提高疗效。

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Abstract:Objective　To investigate the relationship between silent brain infarction (SBI) and firstevent ischemic stroke (FEIS). Methods　A consecutive series of 115 FEIS patients admitted to our hospital who had underwent MRI were included in this retrospective， single center study. Clinical features were compared between patents with and without SBI. The infarcts distribution of SBI and FEIS patients were analyzed. Whether SBI was a potential influence factor of the severity of FEIS was studied. Results　Hypertension and cardiovascular diseases were more common in FEIS accompanied with SBI patients. The distribution concordance of infarcts between SBI and FEIS patients did not influence the severity of FEIS. But patients with more SBI showed larger infarcts of FEIS. Conclusions　SBI is associated with FEIS. Patients with more SBI show more severe clinical symptoms with larger infarcts of FEIS.

Abstract:Objective　To explore the effects of repetitive transcranial magnetic stimulation (rTMS) on the improvement of cognitive function and serum C-reactive protein (CRP) of inpatients with chronic schizophrenia, in order to probe the possible mechanism of rTMS on the cognitive function. Methods　Totals of 60 participants were selected from the inpatients of Tianjin Mental Health Center from January, 2013 to January, 2016. They were paired by the severity of the disease, gender and age. Either patient was treated by real rTMS or sham rTMS for 4 weeks by random in each pair. Positive and Negative Symptom Scale (PANSS) and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were assessed twice (before and after treatment) in all participants. Serum CRP was determined simultaneously. Results　(1) Level of CRP was declined significantly in treatment group (P＜ 0.05), but not in control group; (2) Compared to the baseline, the total score and Negative factor score of PANSS in treatment group were statistically decreased (P＜ 0.05), while there was no change in control group; (3) The total score and the scores of visual span, attention and prolonged memory in RBANS were significantly improved in treatment group (P＜ 0.05), no changes were found in control group; (4)In treatment group, there was the negative correlation between“ Δtotal score of PANSS” and“ Δimmediate memory”,“ Δnegative factor score of PANSS” and“ Δtotal score of RBANS”,“ Δnegative factor score of PANSS” and“ Δprolonged memory” respectively(P＜0.05); (5)There was negative correlation between“ Δtotal score of RBANS”,“ Δscore of immediate memory”,“ Δscore of attention” and“ Δscore of prolonged memory” and“ ΔCRP”(P＜0.05) separately. Conclusions　rTMS could improve cognitive function of patients with chronic schizophrenia, and the possible mechanism may be the remission of inflammatory reaction.

Abstract:Objective　To investigate the prevalence of junior school students’ loneliness and the effect of family environment on it. Methods　 A total of 556 junior school students were investigated using Family Environment Scale (FES-CV) and Emotional-Social Loneliness Inventory (ESLI). Results　In this study， 53.2% of students had emotional isolation， 39.1% had social isolation， 38.5% had emotional loneliness and 33.9% had social loneliness. Boys suffered more isolation and loneliness than girls (P ＜ 0.01). The eight grade students reported more emotional loneliness than those in seven grade (P＜ 0.05). The impact factors of emotional isolation and social isolation included cohesion， intellectual and active-recreational orientation. The impact factors of emotional loneliness and social loneliness included cohesion， conflict， active-recreational orientation and organization. Conclusions　The prevalence of loneliness is common among junior school students. Family environment has important effect on adolescent loneliness.

Abstract:Objective　To investigate the correlation between renal insufficiency and prognosis of acute ischaemic stroke patients with non-valvular atrial fibrillation. Methods　Totals of 266 acute ischaemic stroke patients with non-valvular atrial fibrillation in Neurology Department， Xuan Wu Hospital between January 2013 and January 2015 were included. Estimated glomerular filtration rate (eGFR) was estimated by revised Modification of Diet in Renal Disease (MDRD) equation. Renal inadequacy is defined as eGFR＜60 ml/(min·1.73 m2). There were 36 cases in renal inadequacy group and 230 cases in renal adequacy group. The followed-up duration lasted for 1 year. The association between eGFR and poor stroke outcomes was evaluated by multivariate analysis. Results　(1) The proportion of patients older than 65 years in renal inadequacy group was bigger than renal adequacy group［ 94.4%(34/36) vs 70.0%(161/230)，P=0.002］. (2)There was statistical difference between renal inadequacy group and renal adequacy group on rate of outcome events (50.5% vs 29.6%，P=0.021). (3)Multivariate logistic regression analysis showed that eGFR ＜ 60 ml/(min·1.73 m2) was an independent risk factor for the occurrence of endpoint events within 1 year after acute cerebral infarction. The worse renal function was， the higher incidence of poor stroke outcomes would be(OR=1.485，P ＜ 0.05). Conclusions　The renal function would become worse with the growth of age in acute ischemic stroke patients with non-valvular atrial fibrillation. Renal insufficiency is an independent risk factor for the occurrence of endpoint events in acute cerebral infarction patients with non-valvular atrial fibrillation.

Abstract:Objective　To survey the quality of life of patients with headache in the northern part of Xinjiang. Methods　Adults in the Bortala Mongol Autonomous Prefecture and Barkol Kazak Autonomous County were randomly selected. The headache and quality of life were measured by the EPI sampling technique established by WHO. Results　Totals of 252 participants were involved. In the past one year， 99 patients (39.3%) suffered from headache， including 19(7.5%) ones with migraine， 28(11.1%) with tension headache， 6(2.4%) with chronic headache and 46(18.3%) under unclear diagnosis. Compared with the non-headache group， the total score of quality of life of the headache group was lower［ (27.25±3.72) vs (29.01±3.68)，P ＜ 0.01］， which was manifested in aspects of health status， daily living ability， self-esteem and economic source. Logistic multiple regression analysis showed that gender and occupation affected the quality of life of patients with headache. Conclusions　 The prevalence rate of headache in the northern area of Xinjiang Province is 39.3%， and the patients’ quality of life is poor. Gender and occupation are main factors influencing the quality of life of the patients with headache.

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Abstract:现从近年来工作同盟的主要评估工具出发，分别从患方、医师以及治疗效果3个角度综述 与工作同盟的关系研究。其中，患者自身的素质水平如精神病性症状严重、自知力低下、认知与社会功 能受损严重，患者和医师都倾向于做出低水平的工作同盟评估；医师良好的沟通技巧、安全的依恋模式， 或者在治疗过程中患者表现出更显著的依从性和症状改善，双方评定出更高水平的工作同盟；与治疗效 果有关的依从性、症状改善、生活质量与社会功能也都与工作同盟有着不同的关系。

Abstract:紧张症是一种伴随多种内科及神经系统疾病的严重的运动障碍综合征，在精神科住院患者 中较为常见。在过去的一个多世纪中，紧张症一直以来都被视为精神分裂症的一个亚型。但随着DSMICD 诊断系统的改版，不仅取消了精神分裂症的分型，而且赋予了紧张症独立的编码。此举既增加了诊 断的操作性和一致性，亦对治疗具有指导意义。

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Abstract:阿尔茨海默病(AD)是一种常见的神经系统退行性疾病，也是最常见的痴呆类型，但目前 AD仍缺乏有效的早期诊断手段。近年来，越来越多的研究表明，AD患者在疾病进程早期就表现出明显 听力障碍。因此，听力功能异常的检测有望成为AD早期诊断手段之一，现就AD与听力障碍的关系、其 潜在的病理学机制及听力功能检测在AD中的应用做一综述。

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