精神分裂症患者出院后2年的复发情况调查

目的:调查精神分裂症患者出院后2年的服药依从性和复发情况以及复发的相关影响因素。方法:选取出院的精神分裂症患者371例,自制调查问卷,回顾性调查出院后第1年及第2年时的复发率、服药认识、依从性、就诊及工作/学习情况;使用Logistic回归分析复发的相关影响因素。结果:患者出院后第1年及第2年复发率分别为32.9%(122例)和40.2%(72例)。出院后第1年复发组与未复发组在对服药的认识、依从性、复诊频率及坚持正常工作/学习比较差异无统计学意义(P0.05);第2年复发组对服药的认识(χ2=17.554)、依从性(χ2=62.514)、复诊频率(χ2=4.131)及坚持正常工作/学习(χ2=9.806)方面均明显差于未复发组(P0.05或P0.001)。Logistic回归分析显示,第1年及第2年对服药认识积极、服药依从性好及能坚持正常工作/学习的患者复发风险更低(OR=0.152~0.376,P0.05或P0.01);而第1年的依从性、服药认识与第2年复发无相关。结论:精神分裂症患者出院后对服药认识积极、依从性好、定期复诊及能坚持正常工作/学习可有效降低复发的风险。     

精神分裂症患者出院后药物治疗依从性的影响因素分析

目的:探讨精神分裂症患者出院后药物治疗依从性及相关影响因素。方法:对175例出院后的精神分裂症患者进行6个月的随访调查,通过电话、入户或门诊随访完成自编《精神分裂症患者药物治疗依从性调查问卷》,分析患者出院后药物治疗依从性及影响依从性的相关危险因素。结果:精神分裂症患者出院后药物治疗依从率仅为61. 1%(107/175例);影响患者出院后药物治疗依从性的危险因素包括缺乏疾病相关知识(OR=2. 319,95%CI:1. 56～3. 07)、药物不良反应(OR=6. 209,95%CI:4. 768～7. 650)、药物种类(OR=1. 931,95%CI:1. 257～2. 605)、对医师的信任较差(OR=2. 855,95%CI:1. 908～3. 801)、门诊不定期复诊(OR=3. 300,95%CI:2. 181～4. 419)及缺乏家庭支持(OR=4. 319,95%CI:2. 935～5. 703)等(P 0. 05或P 0. 001)。结论:精神分裂症患者出院后的药物治疗依从性较差,与缺乏疾病相关知识、药物不良反应、不定期复诊、缺乏家庭支持等影响因素有关。     

精神分裂症恢复期复发影响因素的研究

目的探讨精神分裂症复发的相关影响因素。方法以2012年~2013年河北省石家庄市第八医院诊断为精神分裂症的192名患者为对象,随访3年,了解患者恢复期的复发情况,运用自制的调查问卷收集患者基础资料、临床资料,采用二分类Logistic回归分析精神分裂症复发影响因素。结果192例精神分裂症患者3年内复发93例,复发率48.44%,多因素分析发现男性,家庭支持一般、差,未婚、离婚,偏执型患者,病程1年,有精神病家族史服药不依从是精神分裂症复发的危险因素。尤其是有精神病家族史(OR=4.837,95%CI:2.514~7.326),服药不依从(OR=3.159,95%CI:1.745~4.467)是精神分裂症复发的主要危险因素。结论精神分裂症患者复发受到遗传、服药依从性、家庭环境、疾病的病程、类型等多种因素的影响,应该针对上述因素来降低精神分裂症患者的复发。     

院外精神分裂症患者服药依从性影响因素分析

目的:探讨院外精神分裂症患者服药依从性的影响因素。方法:431例精神分裂症患者出院后按照服药情况分为服药依从性较好(GMC)组和服药依从性较差(PMC)组;对影响服药依从性的个人及家庭因素进行调查和分析。结果:PMC组未婚/离异、文化程度高中以下、家庭关系紧张、未认识服药重要性、药物不良反应发生率明显高于GMC组,服用经典抗精神药率明显低于GMC组(P均0.05)。Logistic回归分析显示文化程度高中以下、家庭关系紧张、药物不良反应、未认识服药重要性、婚姻5个因素是服药依从性的影响因素(OR=11.353、OR=3.857、OR=3.329、OR=2.058、OR=1.788,P均0.05)。结论:院外精神分裂症患者服药依从性的影响因素是文化程度、家庭关系、药物不良反应、对服药的认识及婚姻状况。     

电子社区管理对精神分裂症患者出院后康复的影响

目的:探讨电子社区管理对出院后恢复期精神分裂症患者康复的影响。方法:将临床"痊愈"出院的精神分裂症患者206例按出院顺序交替分为研究组102例和对照组104例;两组患者均给予抗精神病药维持治疗及常规出院指导,研究组在此基础上实施电子社区管理,观察1年。采用症状自评量表(SCL-90)、Momingside康复状态量表(MRSS)、服药依从性量表在入组时和1年后分别进行测评,评价患者的心理健康、服药依从性及复发率。结果:经电子社区管理1年后,研究组SCL-90各项评分(t=2.31~5.72)、MRSS各项评分(t=2.19~5.15)均明显低于对照组(P0.05或P0.01);服药依从性高于对照组(χ2=12.67,P0.01),复发率(28.43%)低于对照组(42.30%)(χ2=4.33,P0.05)。结论:电子社区管理能显著提高出院后精神分裂症患者的服药依从性、改善社会功能及降低疾病的复发率。     

抑郁症和双相障碍患者服药依从性及相关因素 分析的多中心横断面研究

目的 对门诊抑郁症/ 双相障碍患者的服药依从性现状进行调查,探索服药依从性的影 响因素。方法 采用多中心连续入组的方法,选取首都医科大学附属北京安定医院、南京脑科医院、昆 明医学院附属第一医院、广州市精神病医院、哈尔滨医科大学附属第一医院、第四军医大学附属西京 医院等6 家三级甲等精神专科医院或综合医院精神科为研究中心,对2015 年10 月至2016 年3 月就诊 于各中心的门诊抑郁症/ 双相障碍患者进行访谈,对服药依从性和相关因素等主要观察指标进行统计 分析。结果 共收集有效资料1 206 份,其中758 例（62.85%）服药依从性较差;双相/ 抑郁患者中依从 性差分别为56.49%（296/524）和67.74%（462/682）。服药依从性好与差的两组患者在年龄、教育程度、疾 病诊断、2 年内发作次数、本次发作病程、抑郁严重程度、自知力、就诊医院类型等方面差异有统计学意 义（P＜ 0.05）。多因素分析显示,本科以下学历患者（OR=0.719,95%CI：0.542～0.953,P＜ 0.05）、2 年内 发作2 次以上的患者（OR=0.424,95%CI：0.251～0.716,P ＜ 0.01）及中重度抑郁发作的患者（OR=0.444, 95%CI：0.327～0.603,P＜ 0.01）服药不依从风险较低;于综合医院就诊的患者不依从风险低于精神专 科就诊患者（OR=0.328,95%CI：0.241～0.447,P＜ 0.01）;抑郁症患者服药不依从的风险高于双相障碍患 者（OR=1.659,95%CI：1.205～2.284,P＜ 0.01）。结论 抑郁症和双相障碍门诊患者服药依从性不佳,相 关因素包括疾病种类、当前发作的严重程度、既往发作次数、就诊医院类型、教育程度等,有必要采取措 施提升抑郁症和双相障碍患者对药物治疗的依从性。     

家庭护理干预对稳定精神分裂症患者病情的影响

目的 探讨家庭护理干预对稳定精神分裂症患者病情的影响.方法 对临床痊愈出院的精神分裂症263例随机分为研究组(132)例和对照组(131)例,出院后2组均给予抗精神病药物维持治疗和护理,研究组在此基础上实施家庭护理干预,观察一年.采用简明精神病评定量表(BPRS)、服药依从量表于入组时、3个月、6个月、1年后进行评定.结果 1年后,研究组BPRS总分、服药依从性明显好于对照组,差异有显著性(P<0.01);研究组的复发率(21.9%)低于对照组(33.5%),差异有显著性(χ2=3.95,P<0.05).结论 家庭护理干预对稳定精神分裂症患者病情有重要意义.     

抑郁症患者院外服药依从性的相关因素及其对复发的影响

目的分析抑郁症患者院外服药依从性的相关因素及其对抑郁症复发的影响。方法选取2011年7月至2014年7月之间出院抑郁症患者135例进行随访。调查内容主要包括一般人口学资料、住院治疗与出院后服药相关情况、家庭和社会支持情况、复发情况等。实际共得到120例调查资料,按照遵照医嘱服药或是自行减药、断续服药、停药将其分为依从组和非依从组,其中依从组56例,非依从组64例。结果 (1)依从组和非依从组患者在性别、年龄上的差异无统计学意义(P0.05),在受教育程度和婚姻情况上的差异具有统计学意义(P0.05);(2)120例患者中,有76例出现复发,44例未见复发。依从组中复发15例,占26.7%,非依从组中复发61例,占93.8%,差异具有统计学意义(P0.05)。(3)Logistic回归分析得出,影响抑郁症服药依从性的直接因素主要有文化程度、家庭对服药的态度、用药维持时间、用药剂量、工作能力、复发情况。结论加强宣传遵照医嘱服药重要性,注重改善家庭环境,提高医疗质量是提高抑郁症患者院外依从性,降低复发率的关键。     

精神分裂症患者出院后维持服药观察及影响因素分析

目的:调查精神分裂症患者出院后2年内维持服药情况,探讨影响维持服药的各种因素.方法:随访293例精神分裂症患者出院后停药情况,以停药前服药时间为指标探讨可能影响维持服药的因素.结果:出院后1年内停药129例,停药率为44.79%(95%CI:39.05～50.53%),2年内总停药175例,停药率为60.76%(95%...     

精神分裂症患者重复违法情况调查

目的 调查精神分裂症患者重复违法的情况,探讨精神分裂症患者重复违法的原因.方法 采用非配比成组对照研究方法,以重复违法者为研究组,第一次违法者为对照组.用自编调查问卷对北京市某医院2005～2007年的167份精神障碍鉴定病历进行回顾性调查.结果 在调查的鉴定案例中,29.9％的精神分裂症患者出现重复违法行为.重复违法相关因素方面,研究组28.0％无人监护,高于对照组的12.8％,差异具有统计学意义(x2=5.63,P＜0.05).用药方面,研究组和对照组差异具有统计学意义(Z=2.64,P＜0.01).无人监护是首次违法后出现重复违法情况的危险因素(OR=2.64),持续用药是重复违法的保护因素(OR =0.28).结论 司法鉴定后的精神分裂症患者重复违法比例较高,无人监护是首次违法后出现重复违法情况的危险因素,持续用药和间断用药是重复违法的保护因素.     

Diagnostic Difficulties and Treatment Implications

Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.     

Cognitive Dysfunction Associated with Antiepileptic Drug Therapy

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.     

Carbamazepine Efficacy in Adults With Partial and Generalized Tonic-Clonic Seizures

Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.     

Etiologic and Preventive Aspects of Epilepsy in the Child–Bridging the Gap Between Laboratory and Clinic

Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Predisposing and Causative Factors in Childhood Epilepsy

Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non-febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Treatment Considerations in Anticonvulsant Monotherapy

Summary: The long-standing practice of polypharmacy in treating epilepsy is giving way to use of monotherapy. Monotherapy can improve seizure control as well as reduce the risk of serious idiosyncratic reactions, dose-related side effects, and complex drug interactions. Monotherapy also offers improved compliance and cost-effectiveness. The basis of monotherapy is accurate diagnosis and assessment of the patient's seizure type(s), followed by selection of a single appropriate anticonvulsant drug. Many patients currently treated with multiple anticonvulsants can be successfully converted to monotherapy with a carefully monitored program in which troublesome and redundant drugs are gradually withdrawn from the therapeutic regimen.     

Anticonvulsant Drugs and Cognitive Function: A Review of the Literature

Summary: Alterations of cognitive function are separate from disturbances of behavior seen in association with epilepsy. The nature of the cognitive disability may to a certain extent depend on the seizure type. Partial seizures, mainly derived from a temporal lobe focus, impair memory tasks, while generalized seizures seem to have more effect on attentional abilities. A number of studies, reviewed in this paper, suggest that anticonvulsant drugs further impair cognitive function. Maximal impairments are seen in patients receiving polytherapy: rationalization of polytherapy improves cognitive abilities. Studies in children and adults have allowed differentiation of the effects of various commonly used antiepileptic agents. Maximal cognitive deficits are seen with. phenytoin, while phenobarbital and sodium valproate induce moderate disturbances, and carbamazepine seems relatively free from such toxicity. Further research is needed on the interrelationship between types of seizure disorders, types of anticonvulsant medications, and cognitive function.     

Effects of NMD A- and AMPA-Receptor Antagonists on Different Forms of Epileptiform Activity in Rat Temporal Cortex Slices

Summary: Lowering extracellular magnesium induces different patterns of epileptiform activity in rat hippocampus and entorhinal cortex. Short recurrent epileptiform discharges in the hippocampus are stable over time, whereas seizurelike events (SLEs) in the entorhinal cortex, the subiculum, and the neighboring neocortex develop into late recurrent discharges which are not blocked by clinically employed antiepileptic drugs. We tested the sensitivity of the different epileptiform discharge patterns to. /V-methyl-D-aspartate (NMDA)- and non-NMDA-receptor antagonists. As NMDA-receptor antagonist we used dextrorphan, ket-amine, and 2-aminophosphonovalerate (2APV); as α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA)-receptor antagonist we employed the quinoxaline derivative glutamate 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX). The findings show that the different patterns of epileptiform activity, including the late recurrent discharges, are sensitive to all NMDA-receptor antagonists. However, when dextrorphan was employed to suppress seizure-like events, later recurrent discharges did not develop during the remaining time course of the experiment. CNQX reversibly suppressed recurrent discharges in the hippocampus and SLEs in the entorhinal cortex. However, late recurrent discharges become insensitive to CNQX, even at a high concentration of 60 μM m. This finding suggests a prominent role for NMDA receptors in the generation of late recurrent discharges.