牛黄宁宫片联合氨磺必利治疗精神分裂症的临床研究

目的探讨牛黄宁宫片联合氨磺必利治疗精神分裂症的临床疗效。方法选取2017年2月—2017年11月在武威市红十字精神病院进行诊治的94例精神分裂症患者,根据用药差别分为对照组和治疗组,每组各47例。对照组口服氨磺必利片,0.4 g/次,1次/d;治疗组在对照组基础上口服牛黄宁宫片,6片/次,3次/d。两组均连续治疗2个月。观察两组的临床疗效,比较两组治疗前后PANSS评分、HAMD评分、GQOLI-74评分、血清学指标的变化情况。结果治疗后,对照组和治疗组的总有效率分别是80.85%、95.74%,两组比较差异具有统计学意义(P0.05)。治疗后,治疗后,两组PANSS评分、HAMD评分较治疗前均显著降低,GQOLI-74评分显著升高,同组治疗前后比较差异有统计学意义(P0.05);治疗后,治疗组PANSS评分、HAMD评分低于对照组,GQOLI-74评分高于对照组,两组比较差异有统计学意义(P0.05)。治疗后,两组血清神经元特异性烯醇化酶(NSE)、S100β蛋白、白细胞介素-1β(IL-1β)、高迁移率族蛋白B1(HMGBl)水平均较治疗前显著降低,但胶质源性神经营养因子(GDNF)水平均显著增高,同组治疗前后比较差异有统计学意义(P0.05);治疗后,治疗组NSE、S100β蛋白、IL-1β、HMGBl低于对照组,GDNF水平高于对照组,两组比较差异有统计学意义(P0.05)。结论牛黄宁宫片联合氨磺必利治疗精神分裂症具有较好的临床疗效,可有效改善患者症状体征,提高患者生活质量,调节血清学指标,具有一定的临床推广应用价值。     

丙戊酸镁与喹硫平联合治疗双向情感障碍的临床观察

目的分析丙戊酸镁与喹硫平联合治疗双向情感障碍(bipolar disorder,BP)的效果。方法选取2017年1月至2020年2月本院收治的150例BP患者,随机分为实验组与对照组,各75例。对照组采用丙戊酸镁治疗,实验组采用丙戊酸镁联合喹硫平治疗,比较两组临床疗效、BRMS、PANSS、HAMD-17、TESS评分。结果实验组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。治疗后,两组BRMS、PANSS、HAMD-17评分差异有统计学意义(P<0.05)。结论丙戊酸镁联合喹硫平治疗BP患者,能显著改善患者临床症状,减轻患者负面情绪,用药安全性较高,治疗效果显著。     

Identification of psychopathological course trajectories in schizophrenia

Course trajectory analyses have been performed primarily for treatment response in acute episodes of schizophrenic disorders. As yet, corresponding data for the long-term course are lacking. Within a multicenter prospective observational study, 268 patients with schizophrenia were assessed at discharge from hospital and followed up after 6, 12, 18, and 24 months. A latent class growth analysis was performed on the scores from the Positive and Negative Syndrome Scale (PANSS). A two-class conditional latent class model showed the best data fit (Entropy: 0.924). The model divided the sample into a group with amelioration in all PANSS subscales (60%) and a group with stable positive/negative and deteriorating general psychopathology symptoms (40%). Global functioning (GAF score), gender, age, living situation and involuntary admission predicted course trajectory class membership. The model was predictive of significant differences between the two groups in health care service costs and quality of life. The results underline the heterogeneous course of the illness, which ranged from amelioration to deterioration over a 2-year period. Statistical models such as trajectory analysis could help to identify more homogenous subtypes in schizophrenia.     

系列康复治疗对住院慢性精神分裂症患者个人和社会功能疗效

目的:研究系列康复治疗对住院慢性稳定期精神分裂症患者的个人和社会功能的疗效。方法:将符合入组标准的120例住院慢性稳定期精神分裂症患者随机分为两组,干预组每周接受系列康复治疗2次,共治疗12周。在干预前、干预4周,干预8周及干预12周对2组患者分别采用个人和社会功能量表中文版(PSP)及阳性和阴性症状量表(PANSS)进行评估。结果:两组患者在康复治疗前量表及各项因子评分差异均无统计学意义(P0.05);在康复治疗第8周至12周结束时,两组在扰乱及攻击行为的评分差异有显著的统计学意义(P0.05),精神症状因子评分差异存在统计学意义(P0.05);系列康复治疗对干预组患者的治疗效果也存在随着时间变化的趋势,特别是个人关系和社会关系、自我照料、扰乱及攻击行为,以及精神症状的时间主效应存在统计学意义(P均0.01)。结论:系列康复治疗有助于改善住院慢性稳定期精神分裂症患者的个人和社会功能及残留的部分精神症状;其中,自我照料、扰乱及攻击行为和精神症状、阴性症状改善明显。     

De novo cost-utility analysis of oral paliperidone in the treatment of schizoaffective disorder

ObjectivesThe aim of this analysis is to compare costs and effectiveness of paliperidone ER vs. placebo in the treatment of schizoaffective disorder (SAD) in the Czech Republic based on pooled clinical trial data.MethodsA de novo micro-simulation model was developed to assess the cost-utility analysis of paliperidone vs. placebo as there is lack of clinical data comparing paliperidone to other interventions. There are no studies primarily evaluating the efficacy of treatment of SAD with other antipsychotics. The model estimated effectiveness and costs of patients with SAD every week during 24-week time horizon. The effectiveness was defined as improvement of a patient's PANSS score where utilities were assigned to each modelled PANSS score. Based on the patient level data a linear mixed-effects model was used to estimate the regression equations of percentage decrease of PANSS score from the baseline. Utilities were computed using a regression function of patients' age, sex and PANSS score, which was adapted from a clinical study of patients with schizophrenia as there are no QoL data on SAD patients. Among relevant costs, reflecting the payer's perspective, costs of pharmacotherapy, concomitant medications and outpatient care were considered.ResultsThe average ICER of paliperidone compared to placebo reached 28,935 EUR/QALY. The probability of paliperidone being cost-effective compared to placebo was 99.5%.ConclusionsTreatment of SAD with paliperidone results in acceptable ICER and high probability of being cost-effective compared to placebo. Thus, it can be considered as a cost-effective treatment of patients with SAD in the Czech Republic.     

精神分裂症患者前瞻性记忆及其与睡眠的关系分析

目的分析精神分裂症患者前瞻性记忆及其与睡眠的关系。方法在2015年5月19日~2017年5月19日期间选取100例睡眠质量较差的精神分裂症患者作为本次研究对象,为观察组,另选取同期100例睡眠质量较好的精神分裂症患者作为对照组,且实施回顾性分析,了解受检者临床资料、PSQI评分、PANSS评分以及WCST和SCWAT实验。结果观察组患者睡眠总分、WCST持续性正确数、WCST错误数、STROOP反应时间、STROOP遗漏数高于对照组(P0.05),WCST完成分类数、WCST正确数、EBPM评分、TBPM评分低于对照组(P0.05),同时进行因变量和自变量分析,可发现PSQI日间功能障碍、WCST完成分类数、教育程度均属于自变量,EBPM、TBPM为因变量(P0.05)。结论精神分裂症患者的睡眠质量可影响前瞻性记忆,临床中需依据患者的文化程度提高其认知功能,降低夜间障碍,可提高患者的睡眠质量,改善前瞻性记忆。     

A latent variable approach in simultaneous modeling of longitudinal and dropout data in schizophrenia trials

Dropouts impact clinical trial outcome analyses. Ignoring missing data is not an acceptable option when planning, conducting or interpreting the analysis of a clinical trial. Treatment related efficacy and safety data observed in the trial may not always be sufficient in explaining the dropouts' mechanism. Nevertheless, these dropout data may carry important treatment-related information and present as an outcome by itself. Traditional analyses involve the use of the time-to-event approach assuming that the dropouts' hazard is solely related to the efficacy or safety profiles observed in a study. A latent variable approach was developed to generalize this approach and to implement a more flexible dropout hazard function in a schizophrenia trial. This unobserved latent variable was used to jointly model the longitudinal efficacy data and dropout profiles across treatments. The analysis provides a framework to model informative dropouts simultaneously with primary efficacy outcomes and make intelligent decisions in drug development.     

伴述情障碍的精神分裂症患者的抑制控制

目的:研究伴述情障碍的精神分裂症患者的抑制控制功能。方法:对50例符合入组标准的伴述情障碍的精神分裂症患者以及年龄、性别、受教育程度相匹配的50名精神分裂症患者实施Stroop色词测验。结果:与对照组相比,伴述情障碍的精神分裂症患者Stroop色词测验卡片C反应时长于对照组(t=3.104,P0.01)、正确阅读数低于对照组(t=-2.882,P0.01);卡片A反应时、正确阅读数差异均无统计学意义(t=1.285,-0.995;P0.05),卡片B反应时与对照组差异无统计学意义(t=1.81,P0.05),正确阅读数差异无统计学意义(t=-1.247,P0.05)。与对照组相比,伴述情障碍的精神分裂症患者干扰量高于对照组(t=2.264,P0.05)。结论:伴述情障碍的精神分裂症患者相对非述情障碍的精神分裂症患者存在更严重的抑制控制功能损害,临床工作中应给予针对性的认知干预,将有助于促进康复。     

Could PANSS be a useful tool in the determining of the stages of schizophrenia? A clinically operational approach

Staging in schizophrenia might be an important approach for the better treatment and rehabilitation of patients. The purpose of this study was to empirically devise a staging approach in a sample of stabilized patients with schizophrenia. One hundred and seventy patients aged ≥18 years (mean = 40.7, SD = 11.6) diagnosed by DSM-5 criteria were evaluated with the Positive and Negative Syndrome Scale (PANSS). Principal components analysis (PCA) with varimax rotation was used. The model was examined in the total sample and separately across a hypothesized stage of illness based on three age groups and between the two sexes. The PCA revealed a six factor structure for the total sample: 1) Negative, 2) Positive, 3) Depression and anxiety, 4) Excitement and Hostility, 5) Neurocognition and 6) Disorganization. The separate PCAs by stage of illness and sex revealed different patterns and quality of symptomatology. The Negative and Positive factors were stable across all examined groups. The models corresponding to different stages differed mainly in terms of neurocognition and disorganization and their interplay. Catatonic features appear more prominent in males while in females neurocognition takes two forms; one with disorganization and one with stereotype thinking with delusions. This study suggests that the three arbitrary defined stages of illness (on the basis of age) seem to reflect a progress from a preserved insight and more coherent mental functioning to disorganization and eventually neurocognitive impairment. Sexes differ in terms of the relationship of psychotic features with neurocognition. These results might have significant research and clinical implications.     

喹硫平联合无抽搐电休克治疗首发精神分裂症疗效观察

目的：探讨喹硫平联合无抽搐电休克治疗首发精神分裂症患者的临床疗效及安全性。方法将72例首发精神分裂症患者按入院单双号分为两组,均予以富马酸喹硫平治疗,观察组在此基础上联合无抽搐电休克治疗,观察8周。采用阳性与阴性症状量表评定临床疗效,副反应量表评定不良反应。结果观察组总有效率为94.4%,对照组为58.3%,观察组显著高于对照组(P <0.05)。治疗1周末起,两组阳性与阴性症状量表总分均较治疗前显著降低(P <0.01),观察组显著低于对照组(P <0.01)。观察组不良反应主要表现为记忆障碍、一过性头疼、头晕等,治疗1周后可缓解;对照组主要表现为锥体外系反应,便秘、口干、体质量增加,且发生率显著高于观察组(P <0.05)。结论喹硫平联合无抽搐电休克治疗首发精神分裂症疗效显著,起效快,安全性高,优于单用喹硫平治疗。