中国精神分裂症患者不同家庭干预措施效果比较的meta分析

目的对中国精神分裂症患者采取家庭干预的研究文献进行综合回顾和系统评价, 比较不同条件下家庭干预效果的差异。方法在中国知网、维普、万方、中国生物医学文献数据库四大中文数据库及OVID Medline、Science Direct、Web of Science、EBSCO四大英文数据库中, 检索各数据库建库至2015年1月为止使用社会功能缺陷筛选量表(SDSS)、简明精神病(科)量表(BPRS)、阳性与阴性症状量表(PANSS)研究中国精神分裂症患者家庭干预效果的文献, 以标准化加权均数差( SMD)作为效应量, 采用meta分析比较不同干预时间、不同干预类型、对不同病程和不同严重程度的精神分裂症患者的家庭干预效果差异。 结果共纳入57篇符合标准的文献。SDSS、PANSS分析结果显示:① 干预时间越长干预效果越好( P < 0.0001、 P=0.0025);② 单独家庭干预比多个家庭合并单独家庭干预的效果更明显( P < 0.0001、 P=0.0131);③ 干预对于病情较重患者效果较好( P < 0.0001、 P=0.0280)。SDSS量表还显示家庭干预对于病程短的患者效果更好( P < 0.0001)。 结论家庭干预更适合病程较短的精神分裂症患者, 干预应实施较长时间; 单独家庭干预更有利于患者阴性症状的改善和社会功能的康复, 且对于病情较轻患者的阴性症状改善效果更好。     

Antipsychotic Trials in Schizophrenia from India: A Systematic Review and Meta-analysis

Ethnic and regional variations have been found in the pharmacological treatment response. Though many efficacy studies have been conducted in India for antipsychotic treatment modalities of schizophrenia, there is a lack meta-analytic data of the existing literature from India. This study aimed to conduct a systematic review and meta-analysis of the antipsychotic treatment trials of schizophrenia in the Indian context. All controlled trials from India evaluating the clinical efficacy of antipsychotics in patients with schizophrenia were evaluated and 28 trials were included in the metanalysis. Effect sizes were computed using Cohen''s ‘d’ and risk of bias was evaluated. Meta analysis revealed superiority of first generation antipsychotics over placebo (mean effect size of 1.387, confidence interval of 1.127 to 1.648). Second generation antipsychotics were marginally better than first generation antipsychotics (effect size 0.106, confidence intervals 0.009 to 0.204). There was improvement in the methodology of the trials over time (Kendall tau=0.289, P=0.049), though no statistically significant increase in trial duration and sample size was noted. There is lack of data on long term efficacy of antipsychotic in schizophrenia from India. First generation antipsychotics have demonstrated benefits over placebo in patients with schizophrenia in the Indian context, though marginally lesser than second generation ones.     

Problems in remembering to carry out future actions in first-episode schizophrenia: Primary or secondary impairment?

Prospective memory (PM) is the ability to remember to carry out intended actions in the future. Empirical evidence suggests that PM deficits exist in individuals with chronic schizophrenia. However, it is unclear whether PM deficits in first-episode schizophrenia exist independently from other neuropsychological deficits. Moreover, prior research using patients with first-episode has been limited to small inpatient samples. We aimed to clarify the nature and extent of PM deficits in individuals with first-episode schizophrenia, using a large outpatient sample. Participants were 91 clinically stable outpatients with first-episode schizophrenia and 83 healthy controls. PM was assessed using both a subjective self-reported checklist and a laboratory-based task capturing time- and event-based PM. A battery assessing verbal and visuo-spatial working memory, as well as executive functions was also administered. ANOVA analyses showed that patients with first-episode schizophrenia performed significantly poorer than healthy controls in time- and event-based PM. Stepwise linear regression analyses suggested that cognitive flexibility predicted time- and event-based PM; and working memory predicted event-based PM. Subgroup analyses showed that “cognitive-preserved” patients with first-episode schizophrenia tended to perform poorer in time-based PM deficit than healthy controls who were matched in IQ and other neuropsychological functions. Overall, our results provide substantial evidence to support that time-based PM deficits in first-episode schizophrenia are apparent and not entirely attributable to other neuropsychological deficits. PM may constitute a neuropsychological marker for schizophrenia.     

阿立哌唑与利培酮治疗精神分裂症患者的疗效及不良反应

目的:观察阿立哌唑、利培酮治疗精神分裂症患者的疗效、不良反应及安全性。方法:将60例符合CCMD-3诊断标准的精神分裂症患者随机分为两组,分别给予患者阿立哌唑、利培酮治疗8周,于治疗前以及治疗2、4和8周采用阳性与阴性症状量表(PANSS)评定患者的疗效,不良反应量表(TESS)评定患者的不良反应。结果:两组患者治疗的疗效相当。利培酮组患者的锥体外系反应、内分泌以及体重增加多于阿立哌唑组。结论:阿立哌唑治疗精神分裂症患者的疗效与利培酮相似,但不良反应更少。     

The Covid-19 infection: An opportunity to develop systematic vitamin D supplementation in psychiatry

Psychiatric patients are at risk of hypovitaminosis D and Covid-19-related mortality. In addition to the mental health benefits, vitamin D supplementation may be potentially effective in preventing severe forms of Covid-19 infections. Vitamin D supplementation is not necessary and is not reimbursed in France for this indication. A monthly supplementation of 50,000 IU may be sufficient in most cases. Double the dose is recommended for obese patients. The risk of renal lithiasis is not increased at these doses, even when supplemented in a patient without vitamin D deficiency. The Covid-19 crisis is an opportunity to disseminate vitamin D supplementation in psychiatric patients, as it has been shown to be effective in other respiratory diseases such as mild upper respiratory tract infections and influenza.     

慢性精神分裂症患者合并肺部感染临床资料分析

目的：探讨慢性精神分裂症患者合并肺部感染的临床特征。方法对162例慢性精神分裂症合并肺部感染患者的临床资料进行回顾性分析。结果162例肺部感染者，其中节段性肺炎124例，慢性肺部感染38例。急性肺炎以中青年，精神病病程＜3 a居多，感染部位以右肺中叶和左肺舌叶为主，对症治疗后均痊愈；慢性感染以中老年多见，精神病病程＞3a，感染部位以两肺下叶、肺底及脊柱两旁慢性感染为主，对症治疗后痊愈率为71．1％，临床症状消失率为28．9％。结论精神分裂症患者合并肺部感染率较高，临床症状不典型，应制定有效的预防和控制对策，减少感染的发生。     

Le « soi territorial » : propositions théoriques à partir d’une compréhension phénoménologique de la schizophrénie

ObjectivesThis theoretical paper discusses the integration of a “territorial self” alongside the minimal and narrative selves most commonly described by contemporary phenomenology and used by phenomenological psychopathology.MethodsWe start from the schizophrenic experience and the tools for understanding it, in order to highlight some limitations in the use of vocal communication within the clinical system to evoke phenomena that are a priori pre-linguistic.ResultsThis theoretical path, which requires an openness to clinical observation and intersubjectivity, leads to nosographic and therapeutic implications that seem useful to us from a phenomenological perspective.DiscussionFrom a nosographic standpoint, we discuss the (non-systematic) crossovers between the schizophrenic experience and the psychotic experience; whereas, from a therapeutic standpoint, the proposal of the territorial self allows us to insist on the fact that the clinical relationship is characterized as much by an analysis of experience and a discussion about it as it is by a joint practice and an experiential experience requiring a common ground.ConclusionsThe “territorial self” proves to be a fruitful and heuristic theoretical proposal, enriching nosographic debates in the field of psychosis, and contributing to a reflection on the practice of psychotherapy.     

Target specific effects of direct current stimulation in schizo-obsessive disorder: A case report

Transcranial direct current stimulation (tDCS) is a type of non-invasive brain stimulation technique that is explored as an add-on treatment for the alleviation of symptoms across the diverse symptom domains in neuropsychiatric disorders. In psychiatry, data is emerging on the effects of tDCS as an add-on treatment in schizophrenia as well as obsessive-compulsive disorder (OCD). But despite high prevalence, the effectiveness of tDCS in co-morbid schizophrenia and OCD is lacking. This case report for the first time examines the clinical utility with target-specific effects of the add-on tDCS in a patient diagnosed with schizo-obsessive disorder.     

Le problème de l’analyse des troubles de la pensée dans le discours avec la personne schizophrène : proposition méthodologique

ObjectiveWe are designing the beginnings of a methodology for the analysis of discursive disorders that will have the particularity of helping to pinpoint the discontinuous sequences that are most likely to signal the presence of thought disorders. We anticipate the development of a modeling system based on principles of pragmatic linguistics and formal semantics, which, applied to carefully selected discontinuous discourse sequences, will have a good chance of revealing the nature of the underlying thought disorders.MethodWe proceed to the analysis of the experimental literature in cognitive psychopathology that aims at identifying the cognitive processes, in this case related to semantic memory and executive functions, which are believed to define thought disorders. We confront this paradigm with other approaches in cognitive psychology and the philosophy of language that explore the language of thought. The combined theoretical and empirical findings allow us to arrive at a set of conjectures that anticipate the pragmatic and semantic properties of discourse transactions that are likely signs of disorders.ResultsWe compare these conjectures with the results of a previous study on the discovery of four “proven” types of discontinuous sequences; and we show which of these sequences can thus be considered as symptomatic of thought disorders. In continuity, we analyze some of these sequences by testing some principles of semantic modeling in order to identify the nature of the disorders and thought operations underlying the relevant discontinuous sequences.DiscussionWe show that discursive thought disorders should not be considered simply as an expression of a dysexecutive syndrome but also as a device that is likely to affect more complex thought operations, such as the inferences involved in the representation system of the conversational context, in the meaning calculus of the utterances, and in the speaker's meaning calculus. Improving the heuristics of formal systems for recognizing discourse disorders and interpreting thought disorders on the basis of more appropriate and accurate semantic modeling may lead to the development of more discriminating and effective diagnostic tools.ConclusionThe format of the formal systems that we have created will allow us to represent the interlocutory structure of the disorder in its natural context of expression with increasing precision, and should lead to the development of computerized tools to assist in diagnosis. Finally, the increased precision of formal modeling applied to communication disorders should also allow us to test the hypothesis according to which certain discursive configurations are based on thought disorders (in a broad sense) whereas others reveal cognitive dysfunctions that have to do, rather, with the conditions of possibility of discourse.