Ⅰ型与Ⅱ型精神分裂症的血液流变学改变

目的 探讨精神分裂症病人的血液流变学变化。方法 对１００例精神分裂症，５０名健康对照组作血液流变学检测的前瞻性研究。结果 精神分裂症的全血粘度，红细胞沉降率，血沉方程Ｋ值、纤维蛋白质均高于正常人（Ｐ〈０．０５）。Ｉ型精神分裂症的纤维蛋白原、全血度、特别是低切粘度显著高于Ⅱ型精神分裂症（Ｐ〈０．００１）。结论定期检查血液流变学性质，有助于阐明明精神分理解症的发病因素，疾病分型，指导临床用药，监测复发     

52例老年期抑郁症的血液流变学对照分析

目的为了探讨老年期抑郁症的血液流变学变异。方法对５２例女性老年期抑郁症（患者组）和４８例健康老年人（对照组）的血液流变学进行了检测,并对其中１２例患者于治疗后进行了复测。结果患者组在全血比低切粘度、红细胞聚集指数、红细胞压积和还原比粘度等显著高于对照组（Ｐ〈０．０５或Ｐ〈０．０１）。其次,患者组经治疗后血液流变学各项指标较治疗前均有不同程度的降低（Ｐ〉０．０５）。结论老年期抑郁症患者存在着血液变学     

喹硫平治疗心境障碍的作用机制

双相情感障碍，简称双相障碍（BPD），是针对单相情感障碍（重性抑郁）而言。DSM—Ⅳ和ICD-10将二者并列为两种主要心境障碍。顾名思义，双相兼有心境变高和变低两极性特点，是心境在正常，高涨（躁狂），低落（抑郁）之间往返摆动。DSM—Ⅳ将双相障碍又分为若干个亚型，这在诊断上是一个重要变更，突出表现在分出了双相Ⅰ型和双相Ⅱ型，基本区别是前者一般以躁狂发作严重；后者以抑郁发作严重，躁狂发作较轻，且家族史中阳性率高，发作次数多，对治疗反应差。流行病学资料显示，双相Ⅰ型发病率为0．5％～2．4％，双相Ⅱ型发病率为0．2％-5．0％。双相障碍是精神科常见病，多发病，具有较高同病率（焦虑障碍，酒依赖，药物依赖）与较高死亡率（特别是在抑郁相或者混合状态）特点。目前有关躁狂症状的治疗已有很大进展；而抑郁症状则被认为治疗困难，传统抗抑郁药物或心境稳定剂疗效均不佳。美国最近一项研究发现，喹硫平除对躁狂症状（单药或喹硫平＋锂盐／双丙戊酸钠）或精神分裂症疗效明确外，还能控制抑郁症状，从而提高患者生活质量。因此，喹硫平是目前唯一被FDA批准单药既可用于治疗双相躁狂急性发作，     

急性脑血栓形成不同时期——氧化氮含量的变化

探讨急性脑血栓形成不同时期一氧化氮（ＮＯ）含量的变化。测定３０例急性脑血栓形成患者发病不同时期血清中ＮＯ、ＳＯＤ、ＭＤＡ的含量。另选２８例性别、年龄组成相似的健康人作为正常对照。结果表明，脑血栓形成期，ＮＯ、ＳＯＤ含量显著降低（Ｐ〈０．０５），ＭＤＡ含量显著增高（Ｐ〈０．０１）；脑水肿期，ＮＯ含量较前显著增高（Ｐ〈０．０１）达正常水平（Ｐ〉０．０５），ＳＯＤ含量进一步降低（Ｐ〈０．０５），ＭＤＡ是     

反复发作躁狂症与双相情感障碍躁狂相的临床特征对照分析

本文对反复发作躁狂症与双相情感障碍躁狂相的临床特征进行了对照分析 ,现将结果报道于后。1　资料与方法本文资料来源于 1997年 1月～ 1999年 12月的住院患者 ,其中反复发作躁狂症共 32例 (Ⅰ组 ) ,随机抽取同期住院的双相情感障碍躁狂相 32例 (Ⅱ组 ) ,两组病例均符合ＣＣＭＤ- 2 -Ｒ中相应的诊断标准 ,并对两组的临床特征进行了对照分析。2　结　　果2 .1　一般资料　在Ⅰ组中男性 12例少于Ⅱ组 2 3例 (χ2 =7.6 5 ,Ｐ <0 .0 5 )。发病年龄Ⅰ组为 (2 3.2 8± 8.91)岁 ,Ⅱ组为(2 5 .34± 10 .0 1)岁 ,两组间差异无统计学意义 (ｔ =2 .0 6 …     

氯氮平、氯丙嗪并用卡马西平撤药引起抽搐1例报告

氯氮平、氯丙嗪并用卡马西平撤药引起抽搐１例报告安徽省合肥市精神病医院（２３０００１）董毅患者，男，２３岁。诊断双相情感障碍（躁狂相）。既往无脑器质性疾病和抽搐发作史。入院后服氯氮平（４００ｍｇ／日）、氯丙嗪（２００ｍｇ／日）及卡马西平（０．８ｇ／日）...     

双相情感障碍混合发作血清细胞因子水平研究

目的：比较双相情感障碍混合发作与躁狂发作及抑郁发作患者之间血清细胞因子的水平。方法：采用酶联免疫吸附法测定38例双相情感障碍混合发作患者（混合组）、54例躁狂发作患者（躁狂组）、47例抑郁发作患者（抑郁组）及38名正常人（对照组）血清白介素-1（IL-1β）、白介素-2（IL-2）及白介素-6（IL-6）的浓度;混合组患者于治疗前和治疗8周进行Hamilton抑郁量表（HAMD-24）和Young躁狂量表（YMRS）评定。结果：混合组IL-1β浓度显著高于躁狂组及抑郁组（P〈0.01）,但与对照组差异无统计学意义（P〉0.05）。混合组IL-2浓度与躁狂组、抑郁组及对照组之间差异均无统计学意义（P〉0.05）。混合组IL-6浓度显著高于躁狂组、抑郁组及对照组（P〈0.001）。混合组IL-6浓度治疗8周后较治疗前显著下降（t=3.372,P〈0.01）,与对照组比较差异无统计学意义（t=1.823,P〉0.05）。混合组治疗前后IL-6浓度差值与HAMD-24、YMRS减分率之间均无显著相关（r分别=-0.211、-0.100,P均〉0.05）。结论：双相情感障碍混合发作可能存在IL-6诱导的免疫功能异常,有不同于双相情感障碍躁狂发作及抑郁发作的生物学特征。     

消栓灵治疗脑梗塞260例临床观察

本文应用消栓灵治疗脑梗塞２６０例，与同时应用维脑路通治疗脑便塞２５０例比较，结果显示：治疗组总有效率为８６％，对照组为７６％，两组疗效比较，治疗组明显优于对照组（Ｐ〈０．００５），治疗组治疗后血液流变学参数与治疗前比较除红细胞压积下降Ｐ〈０．０５外，余均为Ｐ〈０．０１。说明消栓灵是治疗脑梗塞比较理想的药物。     

情感性障碍单双相分类及其临床特征的30年随访研究

为探讨情感性障碍单双相分类问题，对８３例情感性障碍各亚型进行了３０年随访研究，结果：双相占７５．９％，单相躁狂１３．３％抑郁症（单霜抑郁＋反复抑郁）占１０．８％。比较了单双相临床特征。作者认为：（１）单相躁在双相情感性障碍之后的第二位，将单相躁狂视为情感性障碍的一个亚型是适宜的；（２）对首次入院、首次发病者，建议在情感性障碍诊断后暂不定相，而以某种发作表示，待明确后再定临床相；（３）国际疾病分类第     

拉莫三嗪治疗超快速循环性双相Ⅱ障碍有效一例

1病例 女，46岁，门诊号750446。主诉话多、兴奋和情绪低、想死交替17年，既往诊断双相障碍。1993年因躁狂发作而住院（双相Ⅰ型障碍），最近发作抑郁比躁狂发作重，抑郁表现，想跳井、上吊、撞火车寻死，认为自己是家里累赘，怕自己牵连家人。躁狂发作时自感舒服，家里人觉得她说话多。每月14天抑郁，10天躁狂，其余几天心境正常。一月转一次。服氯氮平100mg／d，碳酸锂0．5g／d。2个月前诊断为超快速循环双相Ⅱ型障碍。     

重性抑郁障碍或双相障碍患者抑郁发作伴随躁狂症状的临床特征

目的:了解重性抑郁障碍(MDD)或双相障碍抑郁发作患者出现躁狂症状的频率和程度。方法:对52例经简明国际神经精神访谈(MINI)、符合《美国精神障碍诊断与统计手册》第4版(DSMIV)重性抑郁障碍或双相障碍抑郁发作的患者,采用情感障碍评估量表(ADE)评估患者本次抑郁发作中出现的躁狂症状。结果:52例患者中有36例重性抑郁障碍,16例为双相障碍抑郁发作。至少有1条躁狂症状的患者达86.5%(n=45),至少有3条躁狂症状的患者占32.7%(n=17),而没有任何躁狂症状的患者仅占13.5%(n=7)。结论:抑郁发作患者大多存在不同程度的躁狂症状,及时识别这些症状,对诊断与治疗有指导意义。情感障碍评估量表是一个值得应用的评估情感发作的工具。     

双相情感障碍血清尿酸水平研究

目的探讨双相情感障碍患者血清尿酸(uric acid,UA)水平变化及其临床意义。方法纳入双相情感障碍患者126例(躁狂发作77例,抑郁发作49例)、首发精神分裂症患者69例和正常对照126名,测定其血清UA水平,并采用杨氏躁狂量表(Young mania rating scale,YMRS)和汉密尔顿抑郁量表(Hamilton depressionscale,HAMD)评定双相情感障碍患者症状。结果双相情感障碍组血清UA水平[(349.34±107.21)μmol/L]高于精神分裂症组[(319.71±84.48)μmol/L]和对照组[(280.94±71.90)μmol/L],差异有统计学意义(P0.01);躁狂发作患者UA水平高于抑郁发作患者[(366.45±104.01)μmol/L vs.(322.45±107.69)μmol/L],且二者均高于对照组(P0.01);双相情感障碍患者中是否使用精神科药物的亚组间UA水平无统计学差异(P0.05)。双相情感障碍患者血清UA水平与YMRS、HAMD分数线性相关均无统计学意义(P0.05)。结论双相情感障碍患者血清UA水平升高,血清UA水平升高可能是双相情感障碍的一个生物标记物。     

A manic episode as a result of information about breast cancer diagnosis in a patient suffering from bipolar affective disorder

The paper describes a patient who suffered from bipolar affective disorder for 22 years and the following manic episode appeared after getting information about a diagnosis of breast cancer. During mania the patient presented delusions of being healthy which caused a marked delay in introducing the necessary treatment of the tumour. Besides, we discuss different authors' views about the possibility of evoking manic episodes by psychological factors. Same authors agree, that such an event may happen but others do not. This matter requires further studies, but any doctor who takes care of a patient with bipolar affective illness should always remember about the possibility of being evoked manic episode by harmful stress events.     

Resting energy expenditure in manic episode

Objective:  We aimed to assess the resting energy expenditure in bipolar I disorder, manic episode patients.
Method:  Forty-two bipolar I disorder, manic episode patients that were treated in the inpatient psychiatry clinic of Trakya University Hospital and had met the necessary study criteria were included along with 27 controls. DSM-IV criteria and the Bech-Rafaelsen Mania Rating Scale were used to evaluate patients' diagnosis and severity of the manic episodes. The indirect calorimetry device was used to measure resting energy expenditure values.
Results:  Resting energy expenditure values of manic patients were found to be higher than those of the controls. Controls showed significant correlations between body mass index and resting energy expenditure, but manic patients did not exhibit similar correlations. There was also no relation between Bech-Rafaelsen Mania Rating Scale scores and resting energy expenditure values in manic patients.
Conclusions:  We found significantly increased resting energy expenditure values in bipolar I disorder, manic episode patients. These findings suggest a possible clinical use of resting energy expenditure for evaluation of bipolar I disorder manic episode and also suggest resting energy expenditure as a possible biological marker.     

齐拉西酮合并碳酸锂治疗双相情感障碍躁狂发作的疗效及安全性

目的评价齐拉西酮合并碳酸锂治疗双相情感障碍躁狂发作的疗效及安全性。方法将2018年2月~2019年3月期间我院收治的70例双相情感障碍躁狂发作患者分成对照组和研究组,每组35例。对照组单用碳酸锂治疗;研究组联合碳酸锂与齐拉西酮治疗。对比观察两组患者的临床疗效。结果研究组总有效率97.1%(34/35)高于对照组85.7%(30/35)(P<0.05);研究组治疗后血清神经递质指标优于对照组(P<0.05);研究组2例出现不良反应低于对照组的7例(P<0.05);6个月后,研究组0例复发,对照组3例复发,研究组复发率低于对照组(P<0.05)。结论齐拉西酮合并碳酸锂治疗双相情感障碍躁狂发作的疗效显著,且不良反应少,复发率低。     

Decreased S100B serum levels after treatment in bipolar patients in a manic phase

BackgroundPrevious studies have suggested that patients with bipolar disorder might have brain damage. The aim of this study was to investigate the serum levels of brain injury biomarkers and S100A10 in bipolar patients in a manic phase, and evaluate the changes in S100B, neuron specific enolase (NSE), heat shock protein 70 (HSP70) and S100A10 after treatment.MethodWe consecutively enrolled 17 bipolar inpatients in a manic phase and 30 healthy subjects. Serum brain injury biomarkers and S100A10 were measured with assay kits. All patients were evaluated by examining the correlation between brain injury biomarkers and Young Mania Rating Scale (YMRS) scores.ResultWe found significantly decreased S100B levels only in bipolar manic patients after treatment (p = 0.002), but S100B levels were not significantly different from those in healthy controls (p > 0.05).ConclusionOur results indicate there were decreased S100B serum levels in bipolar patients in a manic phase after treatment and that increased serum S100B levels might be a possible indicator of transient disruption of the blood–brain barrier in bipolar patients in a manic phase.     

单相抑郁与双相障碍住院患者地塞米松抑制试验的对照研究

目的 通过地塞米松抑制试验(DST)了解单相抑郁和双相障碍患者在不同情绪状态下的下丘脑-垂体-肾上腺轴功能改变情况. 方法对38例单相抑郁住院患者和63例双相障碍住院患者(双相障碍Ⅰ型19例,双相障碍Ⅱ型44例;双相障碍抑郁发作者33例,双相障碍躁狂发作者18例,双相障碍混合发作者12例)进行DST,其中17例单相抑郁、35例双相障碍患者在治疗4周后再次行DST,比较各组DST脱抑制率差异.结果 治疗前,单相抑郁的DST脱抑制率(36.8%)与双相障碍(14.3%)、双相障碍Ⅰ型(10.5%)、双相障碍Ⅱ型(15.9%)以及双相障碍抑郁发作(15.2%)之间比较差异有统计学意义(P<0.05);双相障碍Ⅰ型(10.5%)与双相障碍Ⅱ型(15.9%)之间,双相障碍抑郁发作(15.2%)、双相障碍混合发作(16.7%)和双相障碍躁狂发作(11.1%)两两比较差异均无统计学意义(P>0.05).治疗后,DST脱抑制率在上述各组间差异无统计学意义(P>0.05).治疗后单相抑郁的DST脱抑制率随着病情改善而降低,但较治疗前差异无统计学意义(P>0.05),双相障碍的DST脱抑制率在治疗前后比较差异无统计学意义(P>0.05).结论在疾病期,单相抑郁的DST脱抑制率高于双相障碍;双相障碍的DST脱抑制率与临床分型、发作类型、病情无关.     

丙戊酸钠与无抽搐电休克治疗中老年双相情感障碍躁狂发作的疗效对比

目的对比丙戊酸钠注射液与无抽搐电休克治疗中老年双相情感障碍躁狂发作的疗效。方法选择我院收治的86例中老年双相情感障碍躁狂发作患者,采用随机数表法将86例患者分为对照组43例和观察组43例,2组均予以常规药物治疗,对照组在常规治疗基础上进行无抽搐电休克治疗,观察组予以丙戊酸钠注射液治疗,治疗2周后使用杨式躁狂评定量表(YMRS)评价症状改善情况,使用连线(TMT)测验与威斯康星卡片分类(WCTS)测验比较2组认知功能改善情况,对比2组预后情况。结果治疗后2组YMRS评分与治疗前相比均降低,治疗后1周2组YMRS评分无明显差异(P0.05);治疗后2周观察组YMRS评分显著低于对照组(P0.05);治疗2周后观察组TMT与WCTS结果均优于对照组(P0.05);观察组住院时间、住院费用、复发次数、约束时间和约束次数均低于对照组(P0.05)。结论在中老年双相情感障碍躁狂发作的治疗中应用丙戊酸钠注射液的效果优于无抽搐电休克治疗,可更好改善患者的症状,缩短住院时间,节省治疗费用,值得临床推广。     

Sex difference in symptomatology of manic episode

Objective

Studies addressing sex differences in the symptoms and course of bipolar affective disorder had been investigated across different phase of bipolar affective disorder. There are few studies in manic phase that have reported inconsistent results. Therefore, we investigated sex difference in symptom presentation of manic episode.

Methods

A total of 150 male and 50 female subjects meeting criteria for manic episode according to International Statistical Classification of Diseases, 10th Revision Diagnostic Criteria for Research, giving written informed consent, were included for the study. Those with comorbid major medical or psychiatric disorders were excluded. All the patients were assessed on Scale for Manic States.

Results

Multivariate analysis of variance using all the items of Scale for Manic Symptoms showed significant sex difference (Pillai's Trace F_20,179 = 5.154, P < .001), with large effect size (η² = .365). In men, there was significantly higher motor activity, psychosis, grandiosity, contact, and humor, whereas mood lability, depressed mood, guilt, suicide, anxiety, and dress scores were higher in women. Discriminant analysis showed that 84% of men and 72% of women could be correctly classified using the Scale for Manic Symptoms. Stepwise logistic regression analysis showed anxiety, guilt, and dress positively predicted female sex and the model explained 24% to 36% of variance.

Conclusion

Symptom presentation of mania differs across sex and a predominance of anxiety and depressive symptoms was found in women, whereas increased psychomotor activity was prevalent in men.