奥氮平与利培酮治疗首发精神分裂症对照研究

目的 比较奥氮平与利培酮治疗首发精神分裂症的疗效及不良反应。方法 随机将符合CCMD-2R精神分裂症的诊断标准70例患者进入奥氮平或利培酮组接受治疗,分别在治疗0、1、2、4、6、8周评定PANSS和TESS量表,在0、4、8周检查心脑电图和肝肾功能,在0、8周检查血催乳素和空腹血糖。结果 奥氮平与利培酮疗效相当,奥氮平能迅速减轻精神症状,其产生的不良反应少、严重程度轻,很少引起血催乳素变化;利培酮会显著提高血催乳素水平。结论 奥氮平对首发精神分裂症治疗安全有效。     

奎硫平与氯丙嗪治疗精神分裂症的对照研究

目的验证奎硫平治疗精神分裂症患者的临床疗效与安全性。方法94例精神分裂症患者随机分成2组，奎硫平组48例，氯丙嗪组46例进行临床对照研究，分别给予奎硫平与氯丙嗪治疗8周。采用阳性症状与阴性症状量表（PANSS）评定临床疗效，副反应量表（TESS）记录不良反应。结果两组PANSS评分较治疗前均有显著下降（P均〈0．01）；临床显效率和总有效率奎硫平组为70．8％和87．5％，氯丙嗪组为67．4％和84．8％，两组间疗效比较无显著性差异（P〉0．05）。在阴性因子、认知因子、PANSS总分减分率方面，奎硫平组与氯丙嗪组有显著性差异（P〈0．01）。奎硫平组的各种不良反应发生率较氯丙嗪组低且轻微（P〈0．05）。结论奎硫平组与氯丙嗪组治疗精神分裂症疗效相似，奎硫平不良反应较氯丙嗪少，是1种有效、安全性高的抗精神病药，在改善认知功能和阴性症状方面，奎硫平优于氯丙嗪。     

利培酮、氯氮平治疗精神分裂症患者生活质量的长期随访对照研究

目的　探讨长期服用利培酮对精神分裂症患者生活质量的影响作用。方法　对 1997年 7月～ 2 0 0 0年 6月住院服用利培酮或氯氮平治疗达痊愈或显著进步、出院后回归社会达 18个月及以上的 174例精神分裂症患者 (利培酮 89例、氯氮平 75例 )的生活质量进行了分别于 2 0 0 0年 7月和 2 0 0 1年 7月进行了两次追踪随访对照研究。结果　第二次随访利培酮组患者的随访成功率高于氯氮平组 (χ2 =34.11,P <0 .0 0 0 1) ;利培酮组患者的生活质量两次随访结果均极显著高于氯氮平组 ,且利培酮组患者的生活质量较之一年前随访又有新的提高 ,多元逐步回归分析表明 :出院时服用药物剂量和种类是影响患者生活质量的较强因素。结论　利培酮能够提高精神分裂症患者的生活质量 ,远期疗效更突出     

Retroviruses and schizophrenia in Jamaica

Reports of an 18-fold higher incidence of schizophrenia among second-generation Afro-Caribbeans, and especially Jamaican migrants in the United Kingdom were soon called “an epidemic of schizophrenia,” with the inference that a novel virus, likely to be perinatally transmitted, was a possible etiological agent. This intriguing observation led us to explore a possible link with human T-cell lymphotropic virus type one (HTLV-I), because it is a virus that is endemic in the Caribbean Islands, is perinatally transmitted, known to be neuropathogenic, and the cause of a chronic myelopathy (tropical spastic paraparesis/ HTLV-I associated myelopathy). We therefore examined inpatients at the Bellevue Mental Hospital, Kingston, Jamaica and did standard serological tests for retroviruses HTLV-I and HTLV-II and HIV-I and HIV-II on 201 inpatients who fulfilled ICD-9 and DSM III-R criteria for schizophrenia. Our results produced important negative data, since the seropositivity rates for HTLV-I, the most likely pathogen, were no greater than the seropositivity range for HTLV-I carriers in this island population, indicating that HTLV-I and the other retroviruses tested do not play a primary etiological role in Jamaican schizophrenics.     

Antagonism of phencyclidine-induced deficits in prepulse inhibition by the putative atypical antipsychotic olanzapine

Prepulse inhibition (PPI) of the startle reflex provides an operational measure of sensorimotor gating. Deficits in PPI are observed in schizophrenia patients and can be modelled in animals by administration of noncompetitive NMDA antagonists such as phencyclidine (PCP) or dizocilpine (MK-801). Previous studies indicate that the atypical antipsychotic clozapine restores PPI in PCP-treated animals while the typical antipsychotic haloperidol does not. Olanzapine (LY170053) is a novel putative atypical antipsychotic that shares many pharmacological and behavioral properties with clozapine. The present study assessed the ability of olanzapine (0, 1.25, 2.5, 5.0 or 10.0 mg/kg) to antagonize deficits in PPI produced by PCP (1.5 mg/kg) and dizocilpine (0.1 mg/kg). At the two highest doses, olanzapine significantly increased PPI in PCP- and dizocilpine-treated animals without affecting PPI or baseline startle reactivity by itself. These results support the notion that olanzapine is functionally similar to clozapine and may have utility as an atypical antipsychotic agent.     

Length of hospital stay and associated costs for olanzapine vs. haloperidol in the treatment of schizophrenia relapse in Germany

We examined the number of days spent in hospital due to a relapse of schizophrenia and the associated costs for patients treated with olanzapine or haloperidol. Twenty-one German psychiatric hospitals participated in this retrospective study. Data on the last hospitalisation following a relapse of schizophrenia were documented for equal numbers of patients on olanzapine and haloperidol. Matching for time since diagnosis and severity of symptoms was performed. Data were collected on 136 matched pairs. Total length of time spent in hospital was the same on average for patients in both groups (median about 5 weeks), but olanzapine patients spent nearly 1 week less in the in-patient setting than haloperidol patients, resulting in a saving of Euro 411 per patient. Our findings are consistent with those of randomised clinical trials in concluding that olanzapine is preferable to haloperidol in terms of the direct cost of treating schizophrenia. Andrea Spannheimer Kendle GmbH & Co. GMI KG, Stefan-George-Ring 6, 81929 Munich, Germany, e-mail: spannheimer.andrea@kendle.com     

隐花色素-1基因与精神分裂症核心家系的传递不平衡分析

目的探讨精神分裂症与隐花色素-1（Cryl）基因多态性的关联关系。方法应用聚合酶链反应和限制性片段长度多态性技术对100个精神分裂症核心家系的Cryl基因上的多态性位点rs2300448、rs1921135和rs1056560进行多态性检测；用Genehunter2．1软件包进行传递不平衡分析（TDT），并构建可能的单体型。结果（1）rs2300448多态性位点等位基因G和等位基因A传递给患病子女的频率差异有统计学意义，等位基因G优先传递给患病子女（X^2=4．92，P=0．027），但P值经Bonferroni校正后，差异无统计学意义（Pc=0．054）；rs1056560和rs1921135多态性位点未发现传递不平衡现象（X^2=0．15，P=0．698；X^2=0．56，P=0．456）。（2）单体型rs2300448-rs1056560G—A（X^2=6．76，P=0．009）、rs1921135-rs2300448-rs1056560T—G—C（X^2=4．50，P=0．034）和C—G—A（X^2=6．37，P=0．012）存在传递不平衡现象，但P值经Bonferroni校正后，T—G—C和C—G—A差异均无统计学意义（Pc〉0．05），只有单体型rs2300448-rs1056560G—A差异有统计学意义（Pc=0．036）。结论Cry1基因可能与精神分裂症相关联。     

利培酮治疗与细胞色素P4502D6/C188T酶基因多态性的关联分析

目的　研究利培酮临床效应的个体差异与其代谢酶细胞色素P4 5 0 2D6 (cytochromeP4 5 02D6 ,CYP2D6 )酶基因多态性的相关性。方法　对 88例符合CCMD 3精神分裂症诊断标准的患者和 96例健康对照者作病例 -对照分析。精神分裂症患者给予利培酮治疗 8周 ,用阳性和阴性症状量表 (posi tiveandnegativesymptomscale ,PANSS)评分评价利培酮疗效。采用聚合酶链反应扩增及限制性片段长度多态性 (PCR RFLP)技术对CYP2D6exonⅠ的C188T位点突变进行检测 ,分析利培酮临床效应与其主要代谢酶CYP2D6 /C188T酶基因多态性的相关性。结果　中国上海地区人群的CYP2D6 /C188T突变率(弱代谢型 )为 36 .3% ,病例组和正常对照组间基因型频率总体分布比较无显著差异 (χ2 =1.15 ,df=2 ,P >0 .0 5 ) ,两组间的等位基因频率之间比较也无显著性差异 (χ2 =0 .78,df=1,P >0 .0 5 )。进行性别及有否家族史分组后分析 ,亦无差异存在 ,且CYP2D6 /C188T突变与利培酮临床效应之间并无相关性 (χ2 =1.12 ,df=2 ;χ2 =0 .0 3,df=1,P >0 .0 5 )。结论　未发现中国人CYP2D6 /C188T多态性与利培酮临床效应的个体差异有相关性。     

无抽搐电痉挛治疗精神分裂症的疗效观察分析

目的观察无抽搐电痉挛（Modified Electrocnvulsive therapy，MECT）治疗精神分裂症的疗效及给予次数的关系。方法将60例诊断为精神分裂症的住院患者按治疗次数随机分为两组，进行MECT的临床资料总结分析。结果治疗次数≥6次组，显效率为83．3％，次数〈6次组显效率为76．7％，两者显效率无显著性差异（P〉0．05），每组治疗前后BPRS评分有显著差异，但两组间比较无显著差异（P〉0．05），未发现严重不良反应。结论MECF安全性高，有一定疗效，与治疗次数关系不大。     

Serum levels and clinical response in long-term pharmacotherapy with zuclopenthixol decanoate

Twenty-six patients diagnosed as chronic schizophrenics were given injections of zuclopenthixol decanoate (cis(Z)-clopenthixol decanoate) 200 mg every 3 weeks for at least 6 months. Before treatment and on each day of injection the patients' mental state was assessed by Brief Psychiatric Rating Scale (BPRS), 18 items. A registration of side effects and basal laboratory data was also performed. Blood samples were drawn on each day of injection before injection and 3–7 days after injection (time of maximum concentration). Neuroleptic activity, which was considered equivalent to the concentration of zuclopenthixol, was determined in serum by radio-receptor assay (RRA). Based on amelioration scores ≥50% on the BPRS, 15 patients were characterized as responders and 11 as non-responders. The responder group showed a statistically significant reduction in BPRS score, whereas this was not the case for the non-responders. Apart from a few patients, the serum concentrations showed a low intra-individual variation, but a relatively high inter-individual variation. The responder group had a significantly higher mean preinjection concentration than the non-responder group, whereas no significant difference was found in day 3–7 concentrations. The fluctuation of the serum concentration expressed as the ratio between maximum (days 3–7) and minimum (pre-inj.) was found to be significantly lower for responders than for non-responders. Thus although the present study did not demonstrate a clear relationship between serum level and clinical effect, it indicates that the best antipsychotic effect is obtained with a serum concentration which fluctuates only slightly (the ratio max/min concentration not exceeding 2.1).