无抽搐电痉挛治疗合并氯氮平治疗难治性精神分裂症及其对记忆力的影响

目的:探讨无抽搐电痉挛治疗(modified electroconvulsive therapy,MECT)合并氯氮平治疗难治性精神分裂症(treatment-refractory schizophrenia,TRS)的疗效及其对记忆力的影响。方法:本研究采用单纯随机对照研究设计,将云南省精神病医院246例符合中国精神障碍分类与诊断标准,并符合难治性精神分裂症条件的住院患者随机分为研究组和对照组,每组123名。研究组为无抽搐电痉挛治疗合并氯氮平治疗,最大剂量为350mg/d;对照组仅单一使用氯氮平治疗,最大剂量为450mg/d,治疗期为8周。分别于治疗前及治疗后第1、4、8周末使用简明精神病量表(Brief Psychiatric Rating Scale,BPRS)和副反应量表(Treatment Emergent Symptom Scale,TESS)分别评定两组患者的精神症状及不良反应。分别于治疗前、治疗1天后、治疗1周后及治疗结束后2周用韦氏记忆量表(Wechsler Memory Scale,WMS)评定两组患者的记忆水平。结果:治疗8周后,研究组BPRS评分低于对照组[(22.34±5.79)vs.(33.97±6.73);P0.001]。研究组显效率高于对照组[(37.40%)vs.(23.77%);P=0.030]。研究组TESS评分低于对照组[(3.12±1.83)vs.(3.68±2.14);P=0.028]。无抽搐电痉挛治疗1天后,研究组记忆商(memory quo-tient,MQ)低于对照组[(76.49±14.16)vs.(82.12±16.53);P=0.004];研究组无抽搐电痉挛治疗1周后MQ与治疗前比较差异无统计学意义[(82.13±14.65)vs.(85.36±16.74);P=0.107]。结论:无抽搐电痉挛治疗合并氯氮平治疗对难治性精神分裂症有效,不良反应少,对患者记忆力影响短暂,随后可恢复。     

双额与单侧顶颞无抽搐电痉挛治疗对精神分裂症患者认知功能的影响

目的比较双额极与单侧顶颞极无抽搐电痉挛治疗对精神分裂症认知功能的影响。方法将58例精神分裂症患者随机分为两组,其中双侧组28例,单侧组30例。一组接受双额极(双侧组)无抽搐电痉挛治疗,另一组接受非优势半球单侧顶颞极(单侧组)无抽搐电痉挛治疗。共给予无抽搐电痉挛治疗8次,应用重复性成套神经心理状态测验手册在治疗前、治疗4次、6次、8次时进行认知功能检测。结果治疗4次时,单侧组和双侧组RBANS总分和治疗前相比均明显降低,差异有显著统计学意义(单侧:t=3.398,P=0.002;双侧:t=4.459,P=0.000),两组间相比无差异。治疗8次时,单侧组和双侧组RBANS总分和治疗前相比增高,单侧组差异有显著统计学意义(t=-3.223,P0.01),双侧组差异无统计学意义;在对视觉空间的影响上,单侧组评分增高,双侧组评分降低,两组之间差异有统计学意义(F=-3.43,P=0.03)。结论 MECT对认知功能的影响与电极安放位置和治疗次数等参数有关,对认知功能的不同成分有不同的影响。     

精神分裂症患者临床特征和无抽搐电痉挛治疗刺激参数对疗效影响

目的探讨无抽搐电痉挛治疗精神分裂症时患者临床特点及刺激参数与疗效的相关性,为无抽搐电痉挛个性化治疗方案的制定提供参考依据。方法共入组58例精神分裂症患者,给予无抽搐电痉挛治疗8次,使用自编临床资料记录表记录患者社会人口学资料、临床特征、无抽搐电痉挛刺激参数等资料,采用阳性和阴性症状量表(PANSS)评估疗效。结果依据治疗结束时PANSS评分减分率65%分为显著好转组(≥65%)和非显著好转组(65%),共有如下因素纳入回归方程:年龄(回归系数为0.13)、性别(回归系数为2.84)、发病年龄(回归系数为-0.18)、MECT峰值强度(回归系数为0.00)、MECT发作时间(回归系数为0.09)、治疗前阴性症状(回归系数为-0.42)、攻击症状(回归系数为-0.95)、PANSS总分(回归系数为0.13)。结论患者年龄大、女性、发病年龄晚、峰值强度大、发作时间长、阴性症状轻、攻击症状轻、病情重的患者无抽搐电痉挛治疗效果好。     

无抽搐电痉挛治疗精神分裂症量效关系及早期预测

目的探讨无抽搐电痉挛治疗精神分裂症治疗数量与疗效的关系。方法 58例精神分裂症患者,接受无抽搐电痉挛治疗8次。采用阳性和阴性症状量表在治疗前、治疗4次、6次、8次结束时评估患者临床症状。规定第4次和第6次PANSS量表减分率≥45%为早期起效,治疗第8次末PANSS量表减分率≥65%为显著好转。结果患者治疗4次时有效率与治疗8次显好率显著相关(χ2=7.18,P=0.01),治疗6次时有效率与治疗8次显好率相关(χ2=5.18,P=0.02)。4次治疗无效的患者组中,6次有效率和8次显好率无关(χ2=0.58,P=0.45)。结论无抽搐电痉挛治疗精神分裂症疗效与治疗次数有关。治疗4次无效时,继续治疗效果无明显增加,建议换用其他治疗方案。     

构建大鼠内囊电毁损痉挛模型

目的：构建一种新的痉挛动物模型以期最大程度地模拟痉挛后的病理生理改变。方法：应用脑立体定位仪，精确地进行深部内囊的损伤定位，采用电毁损内囊的方式制造大鼠痉挛模型。结果：造模后痉挛组大鼠右上肢伸直的幅度与造模前痉挛组、造模前后空白组和假手术组比较明显降低，有统计学意义（P〈0.01）。结论：电毁损内囊可作为大鼠痉挛性瘫痪的一种优选方案。     

不同波宽刺激下无抽搐电痉挛治疗情感障碍患者的疗效及对认知功能的影响

目的:观察无抽搐电痉挛治疗仪DGx模式和LOW0.5模式治疗情感障碍患者的疗效和认知功能的变化。方法:将70例符合国际疾病分类第十版(ICD-10)情感障碍诊断标准的患者随机分为两组,DGx模式组(n=35),LOW0.5模式组(n=35)。用无抽搐电痉挛治疗仪进行治疗6次。治疗前、治疗结束时和治疗后2周分别采用汉密顿抑郁量表(Hamilton Rating Scale for Depression,HAMD)和Young氏躁狂量表(Young Mania Rating Scale,YMRS)进行疗效评定;以韦氏记忆量表(Wechsler Memory Scale,WMS)、威斯康星卡片分类测验(Wisconsin Card Sorting Test,WCST)及持续性操作测验(Continuous Per-formance Task,CPT)评定对认知功能的影响。比较两组患者的疗效和认知功能改变。结果:LOW0.5模式组躁狂和抑郁状态患者显好率均为100%;DGx模式组躁狂状态患者显好率为100%,抑郁状态患者显好率为94.1%。两组相比显好率差异无统计学意义(P0.05)。LOW0.5模式组抑郁状态患者和躁狂患者治疗1天后WMS、WCST、CPT评分均高于DGx组,两组相比差异有统计学意义(P0.05),治疗14天后两组差异无统计学意义(P0.05)。结论:DGx模式和LOW0.5模式治疗情感障碍疗效相当。LOW0.5模式治疗对认知功能的影响程度比DGx模式治疗对认知功能的影响程度轻。     

双额与单侧顶颞抽搐电痉挛治疗精神分裂症急性期疗效的随机对照研究

目的比较双额与单侧顶颞抽搐电痉挛治疗精神分裂症急性期的效果。方法将58例精神分裂症患者随机分为两组,分别接受双额极(双侧组28人)与单侧非优势半球顶颞极(单侧组30人)抽搐电痉挛治疗。共给予抽搐电痉挛治疗8次,在治疗前、治疗4次、6次、8次时分别给予阳性和阴性症状量表(PANSS)评定临床症状。结果双侧组和单侧组患者治疗前后PANSS评分比较显示,双侧组和单侧组治疗后和治疗前相比,PANSS总分均明显降低,有显著统计学差异(单侧组:t=16.65,P=0.001;双侧组:t=19.84,P=0.001);使用重复测量方差分析比较双侧组和单侧组PANSS量表各因子分的组间差异,结果发现阳性量表评分、一般精神病理量表评分治疗后双侧组降低较单侧组明显,差异存在统计学意义(阳性症状:F=7.87,P=0.01;一般精神病理评分:F=7.74,P=0.01)。以PANSS总分减分率≥75%作为痊愈的标准,双侧组痊愈率明显高于单侧组,差异有统计学意义(χ2=4.86,P=0.04)。在起效时间上,双侧组治疗6次症状改善与单侧组治疗8次改善程度相当,双侧组起效更快。结论双额抽搐电痉挛治疗精神分裂症急性期症状与单侧顶颞相比总体效果相当,治愈率更高,对阳性症状和一般精神病理症状效果更好,起效更快。     

重复经颅磁刺激和无抽搐电痉挛治疗抑郁症的初步比较

目的探讨重复经颅磁刺激和无抽搐电痉挛治疗抗抑郁疗效的差异。方法纳入分别接受重复经颅磁刺激治疗(rTMS组)和无抽搐电痉挛治疗(MECT组)的难治性抑郁症患者各30例,采用汉密尔顿抑郁量表在治疗前和治疗结束时评估患者临床症状,比较两组患者的疗效差异。结果 rTMS和MECT均能显著改善患者抑郁症状(rTMS组:t=0.34,P=0.02;MECT组:t=0.23,P=0.00)。rTMS组在汉密尔顿量表睡眠障碍因子分改善方面显著高于MECT组,差异有显著统计学意义(t=7.88,P=0.01),MECT在改善自杀因子方面优于rTMS,差异有显著统计学意义(t=3.87,P=0.00)。结论 rTMS和ECT在短期内均能有效改善抑郁症状,MECT的抗抑郁作用强于rTMS。在改善睡眠障碍方面,rTMS优于MECT;在改善自杀因子方面,MECT组作用更强。     

依托咪酯与丙泊酚对无抽搐电痉挛治疗首次癫痫发作持续时间的影响

目的比较依托咪酯与丙泊酚对无抽搐电痉挛治疗(modified electroconvulsive therapy,MECT)首次癫痫发作时间的影响。方法将患者随机分为依托咪酯组19例和丙泊酚组18例,采用标准的MECT治疗程序进行治疗,比较2组的首次癫痫发作情况。结果依托咪酯组癫痫脑电发作时间为(84.5±50.2)s,丙泊酚组发作时间为(50.0±15.6)s,二组比较有显著性差异(t=2.855,P<0.01)。结论丙泊酚对MECT首次癫痫脑电发作持续时间的抑制作用强于依托咪酯。     

听觉刺激下婴儿痉挛症脑电的相干分析

目的 本通过对婴儿痉挛症（infantile spasms,IS)患儿及正常儿童在安静状态下及喀喇音听觉刺激下脑电的相干值变化的比较，研究这种听觉刺激对脑电所产生的影响及其发生机理，力图尝试从神经电生理角度为婴儿痉挛症关于脑干是其发病责任结构这一假说提供依据；方法 选取婴儿痉挛症患儿10例，正常对照组儿童8例，分别记录其常规及听觉刺激下的脑电信号，并分别计算左右半球的相干值，进行比较；结果 安静状态下，在优势频带（功率谱的峰值频带）上，IS组的半球相干值低于对照组（P＜0．01，P＝0．0072）；而加入喀喇音刺激后，正常组在其优势频带上，半球相干值较其自身安静状态下明显下降（P＜0．01，P＝0．0073），且与相应状态下IS组的半球相干值无明显差异；IS组在加入喀喇音刺激前后无明显差异；而在其他频带上两组则均无明显差异；结论 在听觉刺激下脑电的半球间相干值降低，正常组较IS组变化显，且有理由认为这种影响的强度受脑干功能的控制，并通过脑干对丘脑的控制及丘脑对优势频带的控制而实现的，进一步从侧面验证了IS组患儿脑干机能存在不同程度损害。     

The effects of unilateral and bilateral ECT on verbal and visual spatial memory

Investigated the effects of unilateral left (UL), unilateral right (UR), and bilateral (B) ECT on the performance of right-handed male patients on the Wechsler Memory Scale and two tests of the Williams battery, which provided eight independent measures of verbal memory and two of visual-spatial memory. Patients were tested three times: (1) within 1 week prior to ECT; (2) within 30 minutes after the sixth ECT; (3) 10 days after the sixty ECT. Double blind procedures were maintained carefully. Results showed a significant loss on second testing followed by a significant improvement 10 days later for all ECT groups compared with matched controls. There was some tendency for the UR group to show the least impairment on verbal measures and the UL group to show the least impairment on visual-spatial memory test of the WMS, but most of the differences between UL and UR groups and between each of these and the B group were not significant. The most sensitive test in differentiating among the ECT groups was the brief Verbal Learning subtest of the Williams battery.     

老年无症状性脑梗塞的神经心理学研究

目的：确定老年无症状性脑梗塞（SCI）对于记忆、空间构象、逻辑思维、情感等多方面的影响。方法：应用韦氏记忆量表（WMS）、老年抑郁量表（GDS）、视觉保持测验（VRT）,对61名老年SCI患者的神经心理学改变进行了测量。结果：老年SCI组和对照组WMS测试结果记忆商（MQ)明显降低,其错误分明显提高,老年SCI组情绪抑郁人数也明显高于对照组。结论：老年SCI病人记忆能力、视觉空间能力、注意能力均明显下降,尤以短时记忆、视觉记忆为著。     

Memory impairment in patients with late-onset major depression: the effect of antidepressant therapy

BACKGROUND: Cognitive deficits have been described in patients with major depression (MD), although many aspects remain unsettled. METHOD: During an episode of MD and after remission we used tasks exploring attention, implicit, anterograde and retrograde memory to investigate 48 drug-free patients aged over 50 years without dementia, comparing them with 15 normal volunteer controls (NC). We also evaluated the effect of antidepressant therapy (ADT) with fluoxetine (F) or reboxetine (R) at baseline (T0) and six months later (T6). RESULTS: 42 patients completed the study and 6 dropped out; 33 patients were considered "Remitters" (RP) (17 F pts and 16 R pts). At T0, the entire group of MD patients (MDP) had worse performances than NC in Mini Mental Status Examination (MMSE), Wechsler Memory Scale (WMS) total score (TS), in a few subtests of WMS and in autobiographical memory. RP at T0 had the same impaired tasks and at T6 had significantly improved in MMSE, WMS. TS and many memory tests but they still differed from NC in a few complex tasks requiring more cognitive effort. LIMITATIONS: The effects and differences between F and R must be viewed with caution considering the relatively small sample; only attention and memory were investigated. CONCLUSIONS: Our findings confirm a negative effect of depression on memory with a significant but incomplete improvement after remission and without differences between F and R. We speculate that both a "state" and a "trait" depressive component underlie this memory impairment.     

ADHD儿童脑电生物反馈治疗前后认知功能的比较

目的 :探讨脑电生物反馈治疗 2 0次对注意缺陷多动障碍 (ADHD)患儿认知功能的影响。方法 :对 3 2例符合DSM -IV诊断标准 ,年龄 7-15岁的ADHD患者进行脑电生物反馈治疗 ,治疗前后进行韦氏记忆、数字划消、Stroop、CPT、动态学习能力测试 (DLM)和韦氏智力测试的注意记忆因子测试。结果 :治疗后较治疗前在短时记忆 (韦氏记忆测查中视觉再生、联想记忆、触觉记忆 )、记忆商数 (MQ)、持续注意力 (数字划消中漏划数 ,DLM漏按数 )均有明显改善 (P <0 0 5 ) ;冲动性 (DLM误按数 )下降 (P <0 0 5 ) ;DLM分类提高 (P <0 0 5 ) ;认知加工速度 (Stroop测试色测验时间 )部分改善。结论 :脑电生物反馈治疗 2 0次后 ,视觉短期记忆、认知加工速度、冲动性以及持续注意力提高。听觉短期记忆、言语性工作记忆及选择性注意力的改善不明显     

难治性强迫症与非难治性强迫症认知功能比较研究

目的:比较难治性强迫症与非难治性强迫症认知功能差异。方法:采用韦氏记忆量表(WMS)、数字划销测验、威斯康星卡片分类测验(WCST)评估51例难治性强迫症和59例非难治性强迫症的记忆、注意、执行功能。结果:难治性强迫症的长时记忆较非难治性强迫症差,而两组其它记忆因子分及记商、数字划销测验、威斯康星卡片分类测验分差异无统计学意义。结论:难治性强迫症与非难治性强迫症认知功能无显著性差异。     

The psychometric structure of the Wechsler Memory Scale in comparison to the WAIS-R in a low-IQ clinical population

The psychometric structure of the Wechsler Memory Scale (WMS) and its relationship to the revised Wechsler Adult Intelligence Scale (WAIS-R) were studied in an outpatient population of 103 individuals with low Full Scale IQ scores (M = 71). We found that the age correction of the WMS scores gave memory quotients (WMQ) equivalent to WAIS-R FSIQ scores, but our findings also raised problems of interpretation. If the usual rule of thumb of a 12-point discrepancy between the MQ and the FSIQ were applied, the WMS might be relatively insensitive to memory impairment in this low-IQ clinical population, in which more numerous cases of impairment could be expected. Principal components analysis of the WMS raw scores and three WAIS-R scores included as reference variables yielded five orthogonal factors: Attention/Concentration; Visual Reproductions; New Verbal Learning; Well-learned Semantic Knowledge; and Intelligence. We argue that raw scores on the WMS should be reported to optimize possible diagnostic specificity and to align the WMS with experimental and clinical research in various types of memory functioning and impairment.     

精神分裂症患者短时和瞬时记忆因子与精神症状严重性的关系

目的:探究精神分裂症患者精神症状严重程度对其记忆测试得分的影响。方法:对80例符合DSM-Ⅳ诊断标准的精神分裂症住院患者进行阳性与阴性症状量表(PANSS)、韦氏记忆力测试(Wechsler Memory Scale,WMS)的短时和瞬时记忆(再认、图片、联想、背数4项因子)测评,比较其间是否具有相关性。结果:通过双变量相关分析,精神分裂症患者PANSS阳性症状得分与WMS短时和瞬时记忆总得分具有显著负相关(r=-0.293,P=0.008),精神分裂症患者PANSS总得分与WMS短时和瞬时记忆总得分具有显著负相关(r=-0.285,P=0.010),精神分裂症患者PANSS一般精神症状得分与WMS短时和瞬时记忆总得分具有显著负相关(r=-0.230,P=0.040)。结论:精神分裂症患者精神症状严重程度(尤其是阳性症状得分)对其WMS短时和瞬时记忆测试得分产生显著的影响。     

强迫症患者认知功能与病期的关系

目的：探讨强迫症的认知功能障碍与病期的关系。方法：分别用韦氏记忆测验，数字划销测验和威斯康星卡片分类测验评估25例急性强迫症和36例慢性强迫症患者的记忆、注意和执行功能。结果：急性强迫症患者的记忆测验中记图和数字划销测验中第二阶段失误率显著性较慢性强迫症差，其余两组间记忆测验、划销测验和威斯康星卡片分类测验各量表分无显著性差异。结论：强迫症的认知功能与病期无明显相关。     

"Side effects" of ECT are mainly depressive phenomena and are independent of age

BACKGROUND: The aetiology of reported side effects of electroconvulsive therapy (ECT) is unclear. We examined the interaction of depression and age on adverse neuropsychological and putative side effects of ECT. METHOD: Inpatients (N=81; median age 70 years) with major depression were assessed prospectively pre-ECT, immediately post-ECT and 1-3 years later. Patients were administered the Hamilton Rating Scale for Depression (HRSD), the Global Assessment of Functioning scale (GAF) and neuropsychological tests from the Wechsler Memory Scale. Side effects and total burden scores were rated pre- and post-treatment. RESULTS: HRSD and GAF scores improved with treatment after ECT, but the prevalence and total burden of side effects were unchanged. Side effect burden was related to depression level before and after ECT. Improvement in depression correlated with reduction in side effect burden. There was a significant decline in side effect burden after controlling for change in depression. Patients' scores on neuropsychological measures did not appear to change after ECT or between pre-ECT and follow-up. Re-analysis, allowing for age, chronicity of depression, medication use and development of dementia, did not alter the findings. LIMITATIONS: lack of a control group, lack of information on ECT technique, incomplete data sets and limited neuropsychological testing. CONCLUSIONS: ECT, an effective treatment for depression, does not cause significant side effects or neuropsychological impairment, which are more likely to be depressive phenomena. ECT appears to be safe for old (> or =65 years) and very old (> or =75 years) patients, who do not appear to be more susceptible to adverse effects.     

利培酮联合丙戊酸镁对精神分裂症攻击行为的疗效观察

目的 观察用利培酮联合丙戊酸铗治疗精神分裂症患者攻击行为的疗效和药物副反应。方法 将64例有攻击行为的精神分裂症住院患者随机分为研究组（利培酮联合丙戊酸镁治疗）32例，对照组（单用利培酮治疗）32例。疗程4周。两组于治疗前及治疗第4周末采用简明精神病评定量表，治疗前及治疗第1、2、4周末采用外显攻击行为量表，副反应量表评定疗效与不良反应。结果 两组治疗前与治疗后简明精神病评定量表各因子分差异均有显著性（P〈0．01），治疗后两组问比较差异无显著性（P〉0．05）。两组治疗前后外显攻击行为量表评分差异有显著性（P〈0．01）。治疗第2、4周末两组问比较差异有显著性（P〈0．01）。研究组评分降低更为明显。结论 利培酮联合丙戊酸镁治疗精神分裂症的攻击行为疗效更佳。