齐拉西酮联合喹硫平治疗精神分裂症患者急性期兴奋激越的临床研究

目的观察齐拉西酮联合喹硫平治疗精神分裂症患者急性期兴奋激越的临床疗效。方法将120例精神分裂症急性期兴奋激越患者随机分为对照组和观察组,每组60例。对照组给予富马酸喹硫平片口服治疗,观察组在对照组基础上加服盐酸齐拉西酮胶囊,两组均持续治疗4周。比较两组治疗效果及安全性。结果治疗4周后,观察组较对照组阳性与阴性症状量表(PANSS)评分、疗效总评量表-病情严重程度(CGI-SI)评分、PANSS兴奋激越因子(PANSS-EC)评分均明显降低(P0.05),血清血清脑源性神经营养因子(BDNF)、胶质源性神经营养因子(GDNF)、神经生长因子(NGF)水平明显升高(P0.05)。治疗4周后,两组不良反应总发生情况比较无显著差异(P0.05)。结论齐拉西酮联合喹硫平治疗伴兴奋激越症状的精神分裂症,可有效改善患者血清BDNF、GDNF、NGF水平,有效缓解精神分裂症状及兴奋激越症状,且未明显增加不良反应。     

齐拉西酮与利培酮治疗急性期精神分裂症疗效对照分析

目的齐拉西酮治疗急性期精神分裂症的疗效及不良反应。方法选择60例急性期精神分裂症患者随机分为2组各30例,治疗组口服齐拉西酮,对照组口服利培酮,观察4周,于治疗前及治疗第1、2、4周末,采用阳性和阴性症状量表(PANSS),治疗时出现的副反应量表(TESS)评定疗效和不良反应。结果治疗4周末,两组总有效率为80%和83.3%,2组疗效相当,无显著性差异(P>0.05)。常见不良反应,治疗组主要为椎体外系不良反应(EPS)、嗜睡、恶心。对照组主要为EPS、泌乳、体质量增加、性功能减退。发生率较治疗组有明显差异(P<0.05)。结论齐拉西酮与利培酮治疗急性期分裂症疗效均较显著,齐拉西酮不良反应小于利培酮。     

齐拉西酮与氯氮平治疗女性难治性精神分裂症对照研究

目的 探讨齐拉西酮治疗女性难治性精神分裂症的疗效及安全性.方法 将80例女性难治性精神分裂症患者随机分为齐拉西酮治疗组40例,氯氮平治疗组40例,疗程均为8月.治疗前及治疗第2、4、6、8月,采用阳性和阴性症状量表(PANSS)评定临床疗效,用副反应量表(TESS)及有关实验室检查评定不良反应.结果 阳性和阴性症状量表(PANSS)评定治疗第2、4、6、8月末与治疗前比较均有统计学意义(P＜0.05),两组间比较均无统计学意义(P＞0.05);齐拉西酮组主要不良反应为恶心、轻度静坐不能、嗜睡、震颤、头痛等;氯氮平组为流涎、体重增加、嗜睡、头晕、恶心呕吐、心肌劳损等.齐拉西酮不良反应发生率为2.8%,明显低于氯氮平的19.7%,差异有统计学意义,且不良反应程度轻.结论 齐拉西酮治疗女性难治性精神分裂症疗效与氯氮平相当,不良反应较氯氮平轻,服药依从好,可作为女性难治性精神分裂症的首选药物.     

齐拉西酮、氯氮平治疗的卫生经济学比较

目的:比较齐拉西酮和氯氮平在治疗难治性精神分裂症时的卫生经济学。方法:将85例难治性精神分裂症患者随机分为齐拉西酮组43例,氯氮平组42例,疗程6个月。采用阳性与阴性症状量表(PANSS)、治疗中出现的症状量表(TESS)进行评定;调查住院2年内因患精神分裂症所花费成本及治疗恢复后所获得的收入,进行比较。结果:两组疗效相当,但齐拉西酮组不良反应明显少于氯氮平组(P<0.01)。齐拉西酮组的直接费用比氯氮平高,平均工作时间较氯氮平组长,效益比值明显比氯氮平组大(P<0.01)。结论:齐拉西酮治疗难治性精神分裂症疗效与氯氮平相当,不良反应较氯氮平轻,服药依从好,总的经济价值高于氯氮平。     

齐拉西酮与利培酮治疗精神分裂症对照分析

目的:探讨齐拉西酮治疗精神分裂症的疗效和安全性。方法:将80例精神分裂症患者随机分为齐拉西酮组和利培酮组,每组40例。疗程8周。用阳性与阴性症状量表(PANSS)和治疗中出现的症状量表(TESS)评定临床疗效和不良反应。结果:治疗8周后,齐拉西酮组显效率和有效率分别为65.0%和85.0%,利培酮组分别为67.5%及87.5%,两组疗效相当;两组治疗后PANSS总分和各因子分均较治疗前有明显下降,但两组间比较差异无显著性。不良反应总发生率齐拉西酮组显著低于利培酮组。结论:齐拉西酮治疗精神分裂症有较好的疗效,与利培酮相当,不良反应比利培酮更少。     

国产齐拉西酮与氟哌啶醇注射液治疗精神分裂症急性激越症状的对照研究

目的 评价国产齐拉西酮注射液治疗精神分裂症急性激越症状的疗效和安全性.方法 将231例精神分裂症患者随机分为齐拉西酮组(115例)和氟哌啶醇组(116例),进行多中心随机单盲对照研究.患者入组后即给予齐拉西酮注射液10～20 mg或氟哌啶醇注射液5～10 mg肌内注射,4～6 h后可重复使用.齐拉西酮每日总量不超过40 mg,氟哌啶醇每日总量不超过30 mg,每日注射均不超过3次,疗程均为3 d.于治疗前、治疗第2,6,24,48,72小时采用阳性和阴性症状量表(PANSS)、阳性和阴性症状量表兴奋因子(PANSS-EC)、治疗时需处理的不良反应量表、锥体外系副反应量表评定疗效及副反应.结果 治疗第72小时,齐拉西酮组的PANSS-EC总分明显降低,PANSS-EC减分率为(68±25)%,临床总有效率为47.8%;氟哌啶醇组PANSS-EC减分率为(65±23)%,临床总有效率为37.1%;两组的差异均无统计学意义(P均＞0.05).齐拉西酮组的不良反应发生率为37.4%,氟哌啶醇组的不良反应发生率为50.0%,两组的差异无统计学意义(P＞0.05).氟哌啶醇组锥体外系的发生率明显高于齐拉西酮组,差异有统计学意义(P＜0.05).结论 国产齐拉西酮注射液治疗精神分裂症的急性激越症状有明显疗效,不良反应少.     

阿立哌唑治疗伴激越的精神分裂症对照研究

目的:研究阿立哌唑治疗伴激越的精神分裂症患者疗效与不良反应。方法:75例伴激越的精神分裂症患者随机分为阿立哌唑组(40例)和奥氮平组(35例),治疗6周。应用阳性和阴性症状量表(PANSS)、兴奋分量表(PEC)和治疗中出现的症状量表(TESS)评定疗效及不良反应。结果:两组治疗后PANSS总分和PEC分均显著低于治疗前(P<0.05或P<0.01)。两组疗效差异无显著统计意义,两组不良反应均轻微。结论:阿立哌唑能显著改善伴激越的精神分裂症患者的症状。     

齐拉西酮与利培酮治疗精神分裂症的对照研究

目的 评价齐拉西酮治疗精神分裂症的疗效和安全性.方法 选择90例精神分裂症患者随机分为齐拉西酮组(139.6±23.5)mg/d和利培酮组(5.8±0.6)mg/d,疗程为8周.采用阳性与阴性症状量表(PANSS)、临床总体印象量表(CGI- S)和不良反应症状量表(TESS),分别于入组时(基线)、治疗后第2、4、6、8周末分别评定疗效和不良反应.结果 两组PANSS总分、阳性症状分、一般病理分从第2周末起较治疗前下降(P＜0.05);两组PANSS阴性症状分在第4周末起较治疗前下降(P＜0.05);两组CGI-S总分第2周末开始各时点较治疗前下降(P＜0.05);齐拉西酮组临床总有效率为75％,利培酮组为78.4％,两组间疗效差异无统计学意义(P＞0.05).齐拉西酮组、利培酮组不良反应发生率分别为26.6％(12/45)和51.1％(23/45),差异有统计学意义(P＜0.01);利培酮组体质量增加(1.1±1.3)kg,齐拉西酮组体质量减少(1.4±1.5)kg,在锥体外系有关的副反应、血细胞、肝功能、心电图异常及自主神经系统不良反应方面利培酮组明显高于齐拉西酮组,差异有统计学意义(P＜0.01).结论 齐拉西酮对精神分裂症的疗效等同于利培酮,而不良反应全面优于利培酮.     

齐拉西酮治疗首发精神分裂症对照研究

目的 比较齐拉西酮与利培酮治疗首发精神分裂症的疗效与安全性.方法 分别以齐拉西酮与利培酮治疗首发精神分裂症各40例,采用阳性与阴性症状量表(PANSS)及治疗中出现的症状量表(TESS)评定疗效及不良反应,在治疗前及治疗第2、4、8周末各评定1次.结果 齐拉西酮有效率95%,显效率82%,利培酮有效率87%,显效率77%.齐拉西酮不良反应少于利培酮.结论 齐拉西酮和利培酮对精神分裂症的疗效相当,但齐拉西酮不良反应较少.     

齐拉西酮片联合氯氮平治疗难治性精神分裂症疗效及对认知功能的影响

目的旨在观察齐拉西酮片联合氯氮平治疗难治性精神分裂症疗效及对认知功能的影响。方法选择2016年9月～2017年9月我院收治的120例难治性精神分裂症患者,将患者随机分为对照组、观察组。对照组患者采用氯氮平治疗,观察组在对照组的基础上使用齐拉西酮片。比较两组患者的疗效和认知功能。结果观察组总临床有效率明显优于对照组(93.33%vs 80.00%)(χ2=4.615,P=0.032);与治疗前做比较,治疗第4周末时观察组与对照组患者的PANSS总分以及阳性症状、阴性症状、一般病理得分均有下降,且在治疗第12周末,各项评分均有显著下降(P0.05);与对照组比较,治疗第12周末观察组的PANSS总分及各因子分下降幅度更大(P0.05)。与治疗前相比,治疗后观察组患者的WAIS-RC各评分明显上升(P0.05),观察组患者治疗后知识、相似性、数字广度、图画填充、记忆商数评分均优于对照组(P0.05);治疗期间观察组与对照组患者的不良反应率无明显差异(P0.05)。结论齐拉西酮片联合氯氮平治疗可以改善难治性精神分裂症患者的认知功能,临床疗效显著且安全性较高。     

The neuroendocrinology of stress and the pathophysiology and therapy of depression and anxiety

Clinical and preclinical studies have gathered substantial evidence that stress response alterations play a major role in the development of major depression, panic disorder, and post-traumatic stress disorder. The stress response, the hypothalamic pituitary adrenocortical (HPA) system and its modulation by corticotropin-releasing hormones (CRH),corticosteroids,and their receptors, and the roles of natriuretic peptides and neuroactive steroids are described. We review the role of the HPA system in major depression, panic disorder, and post-traumatic stress disorder and its possible relevance for treatment. Impaired glucocorticoid receptor function in major depression is associated with an excessive release of neurohormones such as CRH, to which a number of signs and symptoms characteristic of depression can be ascribed. In panic disorder, a role of central CRH in panic attacks has been suggested. Atrial natriuretic peptide (ANP) is causally involved in sodium lactate-induced panic attacks. Furthermore, preclinical and clinical data on its anxiolytic activity suggest that nonpeptidergic ANP receptor ligands may be potentially useful in the treatment of anxiety disorders. Post-traumatic stress disorder is characterized by a peripheral hyporesponsive HPA system and elevated CRH concentrations in the CSF. This dissociation is probably related to an increased risk of this disorder. We further review recent data that describe an important role of GABA(A)-receptor modulatory,3 alpha-reduced neuroactive steroids in major depression, anxiety, and its treatment. Antidepressants are effective in both depression and anxiety disorders and have major effects on the HPA system,especially on glucocorticoid and mineralocorticoid receptors. Normalization of HPA system abnormalities is a strong predictor of the clinical course, at least in major depression and panic disorder. Currently,CRH-R1 or glucocorticoid receptor antagonists and ANP receptor agonists are being studied and may provide future treatment options more closely related to the pathophysiology of these disorders.     

Polymorphisms of DRD4 and DRD3 and risk of avoidant and obsessive personality traits and disorders

We investigated whether polymorphisms of the dopamine D4 receptor (DRD4) and polymorphisms of the dopamine D3 receptor (DRD3) were associated with personality disorder symptomatology rather than with personality traits such as novelty seeking. DNA was obtained from 145 depressed patients in a clinical trial. These patients were assessed for the presence of personality disorder symptoms and disorders. The 2-repeat allele of the DRD4 exon III polymorphism was associated with increased rates of avoidant and obsessive personality disorder symptomatology. The T,T genotype of the DRD4 -521 C>T polymorphism was also associated with increased rates of avoidant and obsessive personality disorder symptomatology. The Gly9,Gly9 genotype of the DRD3 Ser9Gly polymorphism was associated with increased rates of obsessive personality disorder symptomatology. None of these three polymorphisms were associated with novelty seeking or other temperament traits on the Temperament and Character Inventory. Our results suggest that genetic polymorphisms of DRD4 and DRD3 may well be associated with personality traits, and that conflicting findings to date may arise from the problem of phenotype definition.     

沙盘游戏疗法在地中海贫血患儿心理干预中的应用

本文目的是对沙盘游戏疗法在地中海贫血患儿心理干预中的应用进行综述,以期为地中海贫血患儿的心理康复提供参考。地中海贫血是以珠蛋白生成障碍为主要特征的遗传性疾病,由于长期输血治疗,患儿存在较多的心理和行为问题。沙盘游戏疗法作为一种有效、实用的儿童心理治疗方法,对提高地中海贫血患儿的康复效果、改善生存质量有重要的临床意义。     

癫痫共病抑郁的机制及临床诊疗

本文目的是探讨癫痫共病抑郁的可能机制及临床诊疗。癫痫是一种常见的、慢性的、致残性的神经疾病,癫痫患者生活质量下降,存在明显的负性情绪,常伴发各种精神疾病。癫痫与抑郁具有共同的神经生物学基础,可能存在共同的发病机制。本文从癫痫共病抑郁的发病机制、临床诊断及治疗方面予以总结归纳。     

Seclusion and restraint and prediction of violence

The authors studied the use of seclusion and restraint on an inpatient unit in a state psychiatric hospital. Of 69 randomly selected inpatients, 51% experienced seclusion or restraint at least once. More psychotic than nonpsychotic patients required seclusion or restraint. However, neither psychosis/nonpsychosis nor voluntary/involuntary admission status predicted the likelihood of violent threats or actions. Patients experiencing seclusion and restraint showed a nonsignificant trend toward longer mean length of stay in the hospital. The frequency of patient behavior leading to seclusion or restraint appeared to be directly related to the stimulation caused by the presence of many staff members and other patients.     

Modulators and inhibitors of gamma- and beta-secretases

Most gene mutations associated with Alzheimer's disease point to the metabolism of amyloid precursor protein as a potential cause. The beta- and gamma-secretases are two executioners of amyloid precursor protein processing resulting in amyloid-beta. Significant progress has been made in the selective inhibition of both proteases, regardless of structural information for gamma-secretase. Several peptidic and nonpeptidic leads were identified for both targets.