BJPsych：童年受虐待经历或增加精神障碍发病几率

　　近期《英国精神病学杂志》(The British Journal of Psychiatry)网络版登载的一项研究结果显示，童年时期遭遇的不幸与精神障碍发病风险的显著增加有关。

　　目前，儿童功能性核磁共振成像（functional magnetic resonance imaging，fMRI）主要侧重于对禁固性反应及可查的情感意识加工的研究。本研究着重对前意识表现的情感线索所对应的神经反射进行研究，采用代表愤怒、愉快及中性的前意识情绪面孔作为面具化点探测范本，对18名有受虐经历的儿童与相匹配的23名无受虐经历的儿童进行了点探测范式对照研究。

　　研究发现对代表愤怒及愉快的前意识情绪面孔，探测到有受虐经历的儿童与无受虐经历的儿童相比，右侧杏仁核神经反射增强。杏仁核活化的强度与受试者精神障碍发病年龄呈负相关。

　　研究认为受试者 对正性及负性情绪面孔，甚至对未意识到的刺激所表现出的神经反射增增强与其童年的受虐经历有关。童年的受虐经历或是将来精神障碍发病的一个潜在的神经危险因素。

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Effect of psychosocial interventions on social functioning in depression and schizophrenia: meta-analysis
Background
Psychosocial interventions may contribute to reducing the burden of mental disorders in low- and middle-income (LAMI) countries by improving social functioning, but the evidence has not been systematically reviewed.
Aims
Systematic review and meta-analysis of the effect of psychosocial interventions on social functioning in people with depression and schizophrenia in LAMI countries.
Method
Studies were identified through database searching up to March 2011. Randomised controlled trials were included if they compared the intervention group with a control group receiving placebo or treatment as usual. Random effects meta-analyses were performed separately for depressive disorders and schizophrenia and for each intervention type.
Results
Of the studies that met the inclusion criteria (n = 24), 21 had sufficient data to include in the meta-analysis. Eleven depression trials showed good evidence for a moderate positive effect of psychosocial interventions on social functioning (standardised mean difference (SMD) = 0.46, 95% CI 0.24–0.69, n = 4009) and ten schizophrenia trials showed a large positive effect on social functioning (SMD = 0.84, 95% CI 0.49–1.19, n = 1671), although seven of these trials were of low quality. Excluding these did not substantially affect the size or direction of effect, although the precision of the estimate was substantially reduced (SMD = 0.89, 95% CI 0.05–1.72, n = 863).
Conclusions
Psychosocial interventions delivered in out-patient and primary care settings are effective at improving social functioning in people with depression and should be incorporated into efforts to scale up services. For schizophrenia there is an absence of evidence from high-quality trials and the generalisabilty of the findings is limited by the over-representation of trials conducted in populations of hospital patients in China. More high-quality trials of psychosocial interventions for schizophrenia delivered in out-patient settings are needed.