[Psychometric Evaluation of the Union Physio-Psycho-Social Assessment Questionnaire].

Objective To validate the Union Physio-Psycho-Social Assessment Questionnaire(UPPSAQ-70)and test its validity and reliability.Methods From April,2013 to July,2018,patients were asked to finish the computer evaluation of UPPSAQ-70 and Symptom Checklist 90(SCL-90)in Peking Union Medical College Hospital(PUMCH).Confirmatory factor analysis(CFA)was conducted on the SPSS 17.0,and the number of fixed factors was 8 factors and 3 factors.Amos 23.0 was used to verify the original 8-factor model,8-factor revision model,3-factor model,3-factor revision model,and single-factor model.Each factor of SCL-90 was used as the calibration standard to calculate the correlation coefficient between factors.The retest reliability was tested by the outpatients in PUMCH in July,2018.Results Exploratory factor analysis indicated that the 8-factor revised model included:depression,anxiety and fatigue,sleep,physical discomfort,sexual function,happiness and satisfaction,hypochondria,and social anxiety.The 3 factors revised model included that:psychological,physiological and social dimension.Confirmatory factor analysis indicated that the 8-factor modified model was superior to the 3-factor model and the single-factor model: χ 2=10 410.4,df=1862,RMSEA=0.07,CFI=0.753,and NFI=0.715.With SCL-90 as the standard criteria,except the low correlation coefficient between emotional scale and depression(r=0.600)and anxiety(r=0.520),the correlation coefficients of other symptoms were below 0.5.The chronbach's α between each factor and total score of UPPSAQ-70 was between 0.823 and 0.904,and the Chronbach's α coefficient of the whole scale was between 0.954 and 0.956 after each item was deleted.The retest reliability of the scale of 32 participants Chronbach's α was 0.847.Each item of the scale measured between one week was significantly correlated(P<0.05). Conclusion UPPSAQ-70 is a good scale for evaluating overall health status and is especially feasible in general hospitals.

Causes and outcomes of persistent vegetative state in a Chinese versus American referral hospital.

OBJECTIVE: To compare the etiologies and clinical outcomes of patients in a persistent vegetative state (PVS) between a Chinese and US referral hospital. METHODS: A retrospective, observational study at the Peking Union Medical College Hospital, Beijing, China and Johns Hopkins Hospital, Baltimore, USA (2001-2010) was performed. RESULTS: There were 36 cases of PVS diagnosed. In Beijing, there were 19 cases: mean age 57 years, range 3-86, (42 %) female, with 37 % of patients observed to survive more than 1 year (range >1 month to >28 years, median >6 months). Causes of PVS in Beijing were hemorrhagic stroke (n = 4, 21 %), ischemic stroke (n = 2, 11 %), cardiac arrest (n = 5, 26 %, including 4 with attempted cardiopulmonary resuscitation (CPR)), traumatic brain injury (n = 3, 16 %), and one each of mitochondrial encephalomyopathy, acute disseminated encephalomyelitis, Lennox Gastaut Syndrome, and epilepsy with craniopharyngioma (n = 4, 21 %). In Baltimore, there were 17 cases of PVS: mean age 43 years, range 15-83, 59 % female, with 41 % observed to survive more than 1 year (range >1 month to >10 years, median >3 years). Causes of PVS in Baltimore were ischemic stroke (n = 3, 18 %), cardiac arrest (n = 3, 18 %, including one with attempted CPR), traumatic brain injury (n = 3, 18 %), neurodegenerative conditions (n = 2, 12 %), and hypoxic ischemic encephalopathy due to respiratory arrest (n = 3, 18 %), metabolic derangements (n = 2, 12 %), and meningitis (n = 1, 6 %). CONCLUSIONS: There may be a long survival period for patients with PVS, including in China where resource constraints exist for acute neurologic care. Stroke appears to be the most common underlying cause of PVS in Chinese patients, followed closely by cardiac arrest with attempted CPR. There appear to be more varied causes of PVS in the US referral hospital with a predominance of stroke, cardiac arrest, and traumatic brain injury.

[Clinical study of comparing comorbidity between depression and neurological disorder with depressive disorder].

OBJECTIVE: To compare the clinical traits in comorbidity between depression and neurological disorder with depressive disorder and explore the characteristic of the outpatients with neurological disorder comorbidity in depression. METHODS: According to Diagnosis and Statistic Manual for Mental Disorder-IV (DSM-IV) criteria, outpatients were diagnosed as depressive disorder at Departments of Neurology and Psychology. We used HAMD-17 scale to evaluate the patient's severity. RESULTS: There was no statistical difference in severity of depression in two groups. But the clinical traits showed significant differences between two outpatient groups: the outpatients with neurological disorder comorbidity in depression were elder, had more somatic disorders and a higher retard symptom factor score while the other are relative younger, have less physical disorders and higher the core symptom factor score on the other hand. CONCLUSION: The patients of comorbidity between depression and neurological disorders have unique clinical traits. Thus it will be helpful to improve the identification of diagnosis and choose an appropriate treatment if we know the differences well.

[Clinical traits and treatment outcome for comorbidity of depression and neurological disorders].

OBJECTIVE: To observe the clinical traits and treatment outcome of the comorbidity of depression and neurological disorders. METHODS: For patients diagnosed with depressive disorders based on the diagnostic and statistical manual of mental disorders-IV (DSM-IV) criteria in both outpatients clinics of neurology and psychology. The severity of depression in HAMD-17 scale and quality of life related to outpatients' emotional state and health in Short Form Health Survey (SF-36) were evaluated at the baseline and after a 6-week treatment respectively. RESULTS: Forty-five patients with concurrent depression and neurological disorders and 49 patients with depressive disorders were recruited. The impairs in outpatients with depressive disorder are various degree of both physical health and mental health. The severity of depression and quality of life had a negative correlation. The patients with concurrent depression and neurological disorders were elder and more bodily diseases than those with depressive disorders. According to the SF-36 scores, the patients with concurrent depression and neurological disorders had lower physical function scores (61 and 83, P = 0.044) and higher vitality scores (39 and 29, P = 0.007) than those patients with depression disorders at the baseline. After completing a 6-week treatment, both two groups have the same remission rate and response rate respectively. Bodily pain scores (60 at pre-treatment vs 65 at post-treatment, P = 0.048) changed more obviously in the patients with concurrent depression and neurological disorders. CONCLUSION: More patients with concurrent depression and neurological disorders seek medical consultations at neurological clinics of a general hospital than those with depressive disorders. Their impairment extents of physical health factors were different. And the anti-depressive regimens yield comparable rates of remission and efficacy. If a clinician knows these differences well, the diagnostic and therapeutic levels of the depressive patients will be boosted and their quality of life enhanced.

Fearful imagery induces hyperventilation and dyspnea in medically unexplained dyspnea.

BACKGROUND: Medically unexplained dyspnea refers to a condition characterized by a sensation of dyspnea and is typically applied to patients presenting with anxiety and hyperventilation without underlying cardiopulmonary pathology. We were interested to know how anxiety triggers hyperventilation and elicits subjective symptoms in those patients. Using an imagery paradigm, we investigated the role of fearful imagery in provoking hyperventilation and in eliciting symptoms, specifically dyspnea. METHODS: Forty patients with medically unexplained dyspnea and 40 normal subjects matched for age and gender were exposed to scripts and asked to imagine both fearful and restful scenarios, while end-tidal PCO(2) (PetCO(2)) and breathing frequency were recorded and subjective symptoms evaluated. The subject who had PetCO(2) falling more than 5 mmHg from baseline and persisting at this low level for more than 15 seconds in the imagination was regarded as a hyperventilation responder. RESULTS: In patients with medically unexplained dyspnea, imagination of fearful scenarios, being blocked in an elevator in particular, induced anxious feelings, and provoked a significant fall in PetCO(2) (P < 0.05). Breathing frequency tended to increase. Eighteen out of 40 patients were identified as hyperventilation responders compared to 5 out of 40 normal subjects (P < 0.01). The patients reported symptoms of dyspnea, palpitation or fast heart beat in the same fearful script imagery. Additionally, PetCO(2) fall was significantly correlated with the intensity of dyspnea and palpitation experienced during the mental imagery on one hand, and with anxiety symptoms on the other. CONCLUSIONS: Fearful imagery provokes hyperventilation and induces subjective symptoms of dyspnea and palpitation in patients with medically unexplained dyspnea.

[A multiple center study on depression and anxiety state in the department of neurology].

OBJECTIVE: Inpatients of 15 general hospitals were investigated in order to understand the incidence of depression and anxiety state and the patients'quality of life in the Department of Neurology. METHODS: We used Hospital Anxiety and Depression scale (HADS), 17-item Hamilton Rating Scale for Depression (HAMD), Hamilton Rating Scale for Anxiety (HAMA) and 36-item Short Form Health Survey (SF-36) as tools to evaluate inpatients' emotional state and health related quality of life within 48 hours after admitted and before discharge, respectively. RESULTS: 610 inpatients were finished admitted evaluation, patients showed clinical depressive symptoms and anxiety symptoms were 123 (20.2%) and 161 (26.4%) respectively, in which including 96 showed the both. 405 inpatients finished discharge evaluation, patients showed clinical depression symptoms and anxiety symptoms were 68 (16.8%) and 93 (23%) respectively, in which including 52 showed the both. Regression analysis indicated that health related quality of life was associated with gender, anxiety and depression state. Only 59 (20.8%) patients received drug treatment during they admitted. There were statistic significance decrease of the HAMA and HAMD total scores between treatment group and non-treatment group when discharged; Vitality, role of emotional and mental health were significantly increased at the time of discharge. CONCLUSION: High rate of depression and anxiety state occurred in the department of Neurology. These abnormal emotions affected the quality of life of patients. If a physician treated somatic diseases only, the depressive and anxiety disturbances could not be remission. Thus, more attention should be paid to give adequate treatment if a patient concomitant presented the emotional disturbances in the general hospital.

Intracranial arterial occlusive lesion in patients with Graves' disease.

OBJECTIVE: To investigate the distribution and clinical manifestations of intracranial arterial occlusive lesions (IAOLs), and their correlation with thyroid function. METHODS: We enrolled 7 patients who had Graves' disease (GD) with IAOLs screened and evidenced by transcranial Doppler, then further confirmed with digital substract angiography in 2 patients and magnetic resonance angiography in 5 patients. Brain magnetic resonance imaging (MRI) was performed in all 7 patients. Three patients were followed up. RESULTS: Among 7 patients, 1 was male and 6 were females. The mean age was 32.0 +/- 5.5 (range from 11 to 49) years old. Six of them had symptoms of GD but one was asymptomatic with abnormality of T3, T4, and thyroid stimulating hormone. The lesions of intracranial arteries were symmetrical bilaterally in the internal carotid artery system in 6 patients, as well as asymmetrical in 1 patient Terminal internal carotid artery (TICA) were involved in all 7 patients. Middle cerebral artery (MCA) were involved in 3, anterior cerebral artery in 2, and basilar artery in 1 patient. Net-like collateral vessels and mimic moyamoya disease were observed in the vicinity of the occlusive arteries in 2 patients. All patients presented symptoms of ischemic stroke including transient ischemic attack and/or infarction while IAOLs were found. Three patients had obvious involuntary movements. Brain MRI revealed infarctions located in the cortex, basal ganglion, or hemiovular center in 5 patients. The remaining 2 patients had normal brain MRI. The neurological symptoms were improved concomitant with relief of the thyroid function in 2 patients, while IAOLs were aggravated with deterioration of the thyroid function in 1 patient. CONCLUSION: IAOLs in patients with GD mainly involve intracranial arteries, especially the TICA and MCA, which is similar to moyamoya disease. The neurological symptoms and severity of involved arteries may relieve while the hyperthyroidism is gradually under control.

[Medically unexplained dyspnea in children: a review of 34 cases].

OBJECTIVE: Medically unexplained dyspnea is common in adult and accounts for 14% patients complaining of dyspnea. Its occurrence in children is seldom recognized. In the present paper, 34 children with medically unexplained dyspnea (age 10 to 18 years) seen in Peking Union Medical College Hospital from 1996 to 2002 are reported. METHODS: The diagnosis of medically unexplained dyspnea was clinical: it was based on the presence of dyspnea and other complaints which cannot be explained by an organic disease. The patients answered Nijmegen questionnaire and state and trait anxiety (STAI), and performed hyperventilation provocation test. Twenty sessions of breathing therapy were applied and 13 out of 34 children were followed up after the therapy. RESULTS: Among the children, 75% started to have symptoms at the age of 13 to 16 years, though the age of first episode could be as early as 8 years. In most of the cases, the course was chronic clinically. In addition to marked dyspnea, their clinical profile included symptoms of hyperventilation i.e. blurred vision, dizziness, tingling, stiff fingers or arm. The symptoms of anxiety were less frequent in children and accordingly the level of anxiety evaluated by means of STAI was lower in children compared to adult patients. The precipitating psychological factors appeared to be related to middle school competition. Pressure from exams, reprimand from stern and unsympathetic teachers coupled with high parental expectation could be emotionally damaging to psychologically susceptible children. Thirteen patients were followed up after 2-3 months of breathing therapy with emphasis on abdominal breathing and slowing down of expiration. After therapy, the sum score of the Nijmegen Questionnaire was markedly decreased. Dyspnea and symptoms of hyperventilation were improved. The level of anxiety was minimally modified. CONCLUSION: The cases illustrated the need for careful diagnostic evaluation and treatment because of the high rate of chronicity of the disorder.

[Diagnosis and treatment of medically unexplained dyspnea].

Medically unexplained dyspnea refers to a group of patients presenting marked dyspnea without structural alterations of organs/systems after thorough examinations. This clinically neglected group of patients accounts for about 14% of patients with dyspnea in secondary health care. They appear very difficult to manage clinically. In this paper an organized approach used to diagnose medically unexplained dyspnea is presented. Breathing re-training is recommended as a therapy for those "difficult to treat patients".

Medically unexplained dyspnea: psychophysiological characteristics and role of breathing therapy.

BACKGROUND: Medically unexplained dyspnea occurs commonly in medical settings and remains poorly understood. This study was conducted to investigate the psychophysiological characteristics of medically unexplained dyspnea and the efficacy of breathing retraining for these patients. METHODS: A group of patients with medically unexplained dyspnea were compared to patients with a variety of organic lung diseases and healthy subjects. In another group of patients, the influence of breathing therapy on complaints, anxiety, and breath-holding was evaluated for an average of 1.5 years. RESULTS: Patients with medically unexplained dyspnea reported more intense dyspnea than patients with a variety of organic lung diseases. Additionally, they were anxious and presented a broad range of symptoms in daily life and under challenge, for instance voluntary hyperventilation. More than one third of them qualified for panic disorder. They had shorter breath-holding time at rest, less increase in breath-holding time and higher chances of showing a "paradoxical" decrease of breath-holding time after hyperventilation. A combination of PaO2, forced expiratory volume in one second (FEV1), and anxiety measures distinguished them from organic dyspnea. Breathing retraining profoundly improved their symptoms and decreased the level of state and trait anxiety. Moreover, they better tolerated the voluntary hyperventilation and the symptoms induced were also markedly decreased after therapy. Breath-holding time was prolonged and PetCO2 in a representative group of patients increased. CONCLUSIONS: Patients with medically unexplained dyspnea appear to have the feature of a "psychosomatic" patient: an anxious patient with a wide variety of symptoms of different organ systems that do not have an organic basis. They can be distinguished from organic dyspnea using a small set of physiological and psychological measures. Breathing retraining turns out to be an effective therapy for those "difficult to treat patients".

Cognitive and emotional impairment in obstructive sleep apnea syndrome.

OBJECTIVE: To evaluate the emotional and cognitive status in patients with obstructive sleep apnea syndrome (OSAS), using neuropsychological tests and evoked-related potential (P3). METHODS: Sixteen patients diagnosed of OSAS were tested by Hamilton rating scale for anxiety (HRSA) and Hamilton rating scale for depression (HRSD). Other three groups, OSAS patient group (n = 21), snoring group (n = 21), and control group (n = 21), were administered polysomnography (PSG), auditory evoked event-related potential (P3), and clinic memory test. The results were analyzed using general linear model (GLM) analysis and Post Hoc test. RESULTS: Twelve OSAS patients' scores of HRSA and HRSD were beyond the normal range, 26.42 +/- 4.48 and 22.08 +/- 3.97 respectively. The auditory P3 latency in OSAS group was 363.1 +/- 22.9 ms (Fz), 368.57 +/- 28.03 ms (Cz), in snoring group 336.57 +/- 31.08 ms (Fz), 339.81 +/- 31.76 ms (Cz), in control group 340.8 +/- 28.7 ms (Fz), 338.29 +/- 29.21 ms (Cz). There were significant differences between OSAS group and snoring group, as well as control group (P < 0.05). No significant difference was seen between snoring group and control group. No significant difference was noted in P3 amplitude among three groups. Memory quotient (MQ) reduced in snoring group compared with control group. CONCLUSIONS: Emotional disturbances are common clinical features in OSAS patients. Abnormal auditory P3 latency indicates the cognitive dysfunction in OSAS patients. Nocturnal hypoxaemia may play an important role on it. Snorers should be monitored because of the tendency to develop cognitive impairment.

[Diagnosis and epidemiology of large intracranial artery stenosis].

Extracranial carotid artery occlusive disease is a major cause of ischemic stroke in Caucasians. However, intracranial artery occlusive disease, especially middle cerebral artery (MCA) stenosis is more significant in Asians. The underlying mechanisms of ischemic stroke with intracranial artery occlusive lesions is different from that of extracranial artery it is expected to recognize the pathogenesis and epidemiology of intracranial artery occlusive disease. By digital magnetic resonance angiography (MRA) and transcranial doppler (TCD) instead of traumatic subtract angiography methods for screening diagnosis of intracranial artery stenosis that were developed in recent two decades. In current paper, we summarized the results studied with MRA and TCD in Peking Union Medical College Hospital and Chinese University of Hong Kong with literatures reviews in this field. Two aspects are discussed (1) Methods for diagnosis of intracranial artery stenosis; (2) Epidemiology of intracranial artery stenosis.

[Effect of vitamin E on memory and brain monoaminergic neurotransmitter in chronic episodic hypoxia rat].

OBJECTIVE: To investigate the effect of Vitamin E (VitE) on memory and brain monoaminergic neurotransmitter level in chronic episodic hypoxia (EHYP) rat. METHODS: VitE [50 IU/ (250 g.d) or 5 IU/ (250 g.d)] was given to the EHYP rat model. The memory was evaluated by the passive avoidance test and the levels of monoaminergic neurotransmitter, including norepinephrine (NE), dopamine (DA) and 5-hydroxytryptamine (5-HT), were determined in three different brain regions (including cerebral cortex, hippocampus and striatum) using high performance liquid chromatography and electrochemical detection (HPLC-ECD). RESULTS: The performance on passive avoidance test of EHYP rats was worse than that of controlled rats (P < 0.01). The performance of rats in two different treatment groups was better than that of EHYP rats (P < 0.05), the performance of rats in high-dose group was worse than that of rats in low-dose group (P < 0.05). Compared with controlled rats, levels of monoaminergic neurotransmitters in different brain regions of EHYP rats decreased significantly (P < 0.05). Compared with EHYP rats, level of NE and DA in cerebral cortex and level of monoamine (NE, DA, and 5-HT) in hippocampus and striatum of low-dose treated rats were increased significantly (P < 0.05). Different with low-dose treated rats, only level of monoamine (NE, DA, and 5-HT) in striatum and level of 5-HT in hippocampus in high-dose treated rats were increased significantly (P < 0.05), as compared with the EHYP rats. CONCLUSIONS: vitE can improve memory and increase brain monoaminergic neurotransmitter of EHYP rats. Moreover, the effect of low-dose vitE is better than that of high-dose VitE.

[Relationship of changes in sleep architecture and cognitive function in patients with obstructive sleep apnea syndrome].

OBJECTIVES: To explore the relationship between sleep architecture changes and cognitive impairment in patients with obstructive sleep apnea syndrome (OSAS). METHODS: Thirty-six patients with OSAS and 18 controls were administered polysomnography and neuropsychological tests of visual regeneration, digital symbol, comprehensive memory and digital span. RESULTS: Performances on the visual regeneration test and digital symbol test in patients with OSAS were impaired significantly compared with the control group (P < 0.01). Patients' performance on the visual regeneration test was significantly associated with slow wave sleep duration (r = 0.423, P < 0.05) and that on the digital symbol test was significantly associated with REM sleep duration (r = 0.378, P < 0.05). CONCLUSIONS: Slow wave sleep and REM sleep derivation may play a role in the cognitive impairment in patients with OSAS.