氯氮平和经典抗精神病药的长期治疗对患者体重、糖代谢及血脂的影响

目的 探讨长期应用氯氮平和经典类抗精神病药(APS)对精神分裂症患者体重、血糖和血脂等代谢指标的影响及其可能的相关因素.方法 共调查使用APS≥5年的精神分裂症患者271例,分别测量其身高和体重,检测空腹和餐后2h血糖、空腹血清游离脂肪酸、血清胰岛素和瘦素水平.按药物使用情况将患者分为氯氮平组、经典APS单一治疗组(经典组)或联合用药组进行比较.结果 [1]联合用药组体质量指数、空腹血糖、血甘油三酯和血游离脂肪酸水平均显著高于经典组(P＜0.05);血胰岛素和胰岛素抵抗指数也均显著高于经典组和氯氮平组(P＜0.05).[2]氯氮平组和联合用药组糖耐量降低和2型糖尿病发生率均明显高于经典组(P＜0.05).[3]患者体质量指数与其空腹血糖、血清瘦素、血甘油三酯、胆固醇水平以及与胰岛素抵抗指数均呈正相关(P均小于0.05);患者血清瘦素水平与其血胰岛素水平也呈正相关(P=0.008).[4]多元逐步线型回归分析表明,进入影响空腹血糖水平方程的因素分别为胰岛素抵抗指数、血胰岛素、胆固醇和体质量指数(P＜0.05).结论 单用氯氮平及其与经典抗精神病药联用,均易导致患者肥胖,且易导致患者血糖、血脂、血游离脂肪酸水平升高,并与胰岛素抵抗和糖耐量降低发生相关,可能增加2型糖尿病的发生.     

氯氮平对精神分裂症患者体质量、血脂及胰岛素抵抗的影响

目的:探讨氯氮平对精神分裂症患者体质量(体重)、血脂及胰岛素抵抗的影响。方法:28例氯氮平治疗的精神分裂症住院患者,其中26例完成研究,分别在治疗前和治疗6周末评定阳性与阴性症状量表(PANSS),测量体质量、身高、血糖、血脂、胰岛素及氯氮平药物浓度。结果:与治疗前比较,氯氮平治疗前后体质量指数、三酰甘油水平的增加差异均有显著性(t=-3.181,P=0.004;t=-3.822,P=0.001)。血糖、胆固醇、胰岛素以及胰岛素抵抗等的变化与氯氮平血药物浓度有关。结论:氯氮平可影响精神分裂症患者的体质量指数和血脂水平,氯氮平浓度与胰岛素抵抗有关。     

抗精神病药对男性精神分裂症患者性功能影响的相关性分析

目的 探讨抗精神病药喹硫平、利培酮、氯丙嗪及氯氮平对男性精神分裂症患者性功能影响的差异及相关因素分析.方法 将门诊就诊的男性精神分裂症患者120例,随机分为喹硫平组38例、利培酮组41例、氯丙嗪39例、氯氮平组42例.应用酶联免疫吸附法检测血清泌乳素、放射免疫法检测睾酮水平,检测各组患者治疗前及治疗第12周末的血清泌乳素(PRL)和睾酮水平.分别于基线及治疗第12周末使用简明男性性功能量表、阳性与阴性症状量表(PANSS)评估性功能及精神症状,于治疗第12周末用副反应量表(TESS)评估药物治疗的不良反应.结果 治疗第12周末,利培酮组、氯丙嗪组、氯氮平组的性功能量表总分较治疗前降低(P＜0.05).利培酮组和氯丙嗪组治疗第12周末的血清泌乳素水平高于基线水平[利培酮组:(12±5)ng/ml,(22±6)ng/ml,t=13.92,P＜0.01;氯丙嗪组:(13±6)ng/ml,(19±5)ng/ml,t=8.27,P＜0.01],喹硫平组和氯氮平组无明显变化.利培酮组和氯丙嗪组治疗第12周末的血睾酮水平低于基线水平:利培酮组:(0.77±0.21)ng/ml,(0.27±0.11)ng/ml,t=13.22,P＜0.01;氯丙嗪组:(0.90±0.11)ng/ml,(0.32±0.14)ng/ml,t=11.27,P＜0.01;喹硫平组和氯氮平组无明显变化.影响男性精神分裂症患者性功能的因素有泌乳素、睾酮、年龄及TESS分.结论 抗精神病药物中,利培酮和氯丙嗪易引起血清泌乳素升高和血清睾酮降低,氯氮平具有较多药物不良反应,这些可能造成男性精神分裂症患者的性功能减退.     

利培酮和氯氮平对体外培养大鼠胰岛分泌功能的影响

目的探讨利培酮与氯氮平对体外培养胰岛分泌功能的影响。方法 利用细胞培养技术,在不同的葡萄糖浓度(3.3 mmoL／L或16.7 mmol／L)和不同作用时间(1 h或4 h)下,以1 μmol／L利培酮或氯氮平分别作用于体外培养大鼠胰岛,用放射免疫法测定培养上清液中胰岛素浓度,并与相应的对照组比较。结果(1)培养液葡萄糖浓度为3.3 mmol／L,作用1 h,利培酮组和氯氮平组胰岛素分泌量与对照组比较,差异无显著性意义(均P>0.05);作用4 h,氯氮平抑制胰岛素分泌[相对胰岛素分泌量为65％(53％-73％)],差异有显著性意义(P<0.05)。培养液葡萄糖浓度为16.7 mmol／L,作用1 h或4 h,利培酮组和氯氮平组胰岛素分泌量与对照组比较,差异无显著性意义(均P>0.05)。(2)培养液葡萄糖浓度为3.3 mmol／L时,氯氮平作用4 h对胰岛素分泌的抑制程度明显低于作用1 h时[相对胰岛素分泌量为88％(77％~137％)],差异有非常显著性意义(P<0.01),其余的差异无显著性。结论 氯氮平抑制离体大鼠胰岛分泌胰岛素,而利培酮对之无影响;二者引起血糖代谢障碍的机制可能不同。     

氯氮平、利培酮对精神分裂症病人血糖-胰岛素稳态的影响及相关因素分析

目的 通过观察精神分裂症病人服用氯氮平或利培酮后糖-胰岛素稳态的变化,探讨抗精神病药物与糖代谢的关系。方法 入组病人符合CCMD-3有关精神分裂症的诊断标准,1月内未服用任何抗精神病药物,排除糖尿病等重大躯体疾病史。共入组63例,分入氯氮平组(n=33)和利培酮组(n=30),治疗8周。治疗前后测身高、体重、腰围、空腹血糖、血清瘦素及胰岛素浓度。结果 (1)药物治疗后8周两组病人空腹血糖均略有下降,在利培酮组此种差异已达统计学意义(P=0.049);(2)两组血清胰岛素浓度及胰岛素分泌指数(HOMA-β cell secretion index,HBCI)均升高(P<0.05),治疗后胰岛素浓度与腰围及瘦素浓度相关;(3)胰岛素抵抗指数(HOMA-insulin resistance,HOMA-IR)升高,胰岛素敏感指数(insulin sensitivity index,ISI)下降,在氯氮平组这些差异达统计学意义(P<0.05)。结论 有必要对服用氯氮平或利培酮病人的糖代谢指标进行监测,避免或减轻药物引起的不良反应,提高病人的生活质量。     

第二代抗精神病药对大鼠血糖、胰岛素和C肽分泌的影响

目的 了解第二代抗精神病药(氯氨平、奥氮平、喹硫平、阿立哌唑)对大鼠体重、空腹血糖、胰岛素和C肽分泌的影响.方法 25只雌性SD(Sprague Dawley,SD)大鼠随机均分成5组.分别给予氯氮平20 mg/(kg·d)、奥氮平5 mg/(kg·d)、喹硫平20 mg/(kg·d)、阿立哌唑5mg/(kg·d)和生理盐水灌胃,共28 d.在第1、7、14、28天分别剪尾采血,测体重及空腹血糖,于第28天测定空腹血浆胰岛素和C肽水平.结果 适应性喂养1周后,5组大鼠的空腹血糖和体重水平差异无统计学意义(P＞0.05).持续灌胃第14及28天,氯氮平、奥氮平和喹硫平组空腹血糖高于空白时照组(P＜0.05);持续灌胃28 d,氯氮平、奥氮平组的体重高于空白对照组(P＜0.05);与未加处理因素前(第1天)相比,氯氮平、奥氮平和喹硫平组体重和空腹血糖随时间的延长而增加(P＜0.05),而阿立哌哇组的变化无统计学意义(P＞0.05).持续灌胃第28天,氯氮平、奥氮平和喹硫平组空腹血浆胰岛素和C肽水平高于空白对照组(P＜0.05);而阿立哌唑组变化不明显(P＞0.05).结论 氯氮平、奥氮平、喹硫平可引起大鼠胰岛素抵抗和血糖代谢异常.     

非典型抗精神病药对男性精神分裂症患者性功能影响的初步分析

目的 探讨喹硫平、利培酮、奥氮平及氯氮平对男性精神分裂症患者性功能影响的差异.方法 将门诊就诊的男性精神分裂症患者145例,分为喹硫平组 30 例、利培酮组 47 例、奥氮平组 31 例及氯氮平组 37 例.检测各组患者血清泌乳素水平.使用简明男性性功能量表、阳性与阴性综合征量表(PANSS)评估性功能及精神症状,用副反应量表(TESS)评估药物治疗的不良反应.共观察8周.结果 治疗第 8 周末,利培酮组的性功能量表总分及因子分均较治疗前降低,奥氮平组的性唤起因子及性功能因子得分有所下降,氯氮平组的性满意度因子及性功能因子得分有所下降.喹硫平组得分无明显变化.利培酮组和奥氮平组治疗第 8 周末的血清泌乳素水平高于基线水平[利培酮组:(12±5)ng/ml,(20±6)ng/ml,t=13.92,P＜0.01;奥氮平组:(13±6)ng/ml,(18±5)ng/ml,t=8.27,P＜0.01],喹硫平组和氯氮平组无明显变化.影响男性精神分裂症患者性功能的因素有泌乳素、年龄及TESS分.结论 常见非典型抗精神病药物对男性精神分裂症患者的性功能影响有所不同.     

氯氮平与利培酮对精神分裂症病人生活质量影响的双盲对照研究

目的观察氯氮平与利培酮对精神分裂症病人生活质量的影响.方法采用双盲对照研究、生活质量综合评定问卷(GQOLI)分析病人生活质量.结果利培酮组的躯体健康维度、心理健康维度及社会功能维度得分明显高于氯氮平组,均有显著性差异(P＜0.01).结论利培酮对精神分裂症病人生活质量的影响优于氯氮平.     

氯氮平和利培酮对首发精神分裂症患者糖代谢影响的研究

目的　探讨氯氮平和利培酮对首发精神分裂症患者糖代谢的影响。方法　 6 8例首发精神分裂症患者随机分为两组 ,分别给予氯氮平治疗 ( 34例 ,氯氮平组 )和利培酮治疗 ( 34例 ,利培酮组 )。两组患者治疗前和治疗后第 4周末做糖耐量试验 ,测定空腹胰岛素、C肽、甘油三酯、胆固醇、瘦素 ,并测量身高、体重 ,计算体重指数 [BMI,体重 (kg) /身高 (m2 ) ]。共观察 4周。结果　治疗第 4周末 ,氯氮平组餐后 1h、2h的血糖值 [分别为 ( 8 6± 1 8)mmol/L和 ( 6 7± 1 1)mmol/L]比治疗前 [分别为( 7 4± 2 2 )mmol/L和 ( 5 8± 1 4 )mmol/L]明显升高 (P <0 0 5 ,P <0 0 1) ,而利培酮组无明显变化。治疗后氯氮平组 ( 2 0 % ,7例 )患者糖耐量减低的发生率高于利培酮组 ( 3% ,1例 ) ,差异有显著性 ( χ2 =3 972 ,P <0 0 5 )。结论　氯氮平对首发精神分裂症患者餐后血糖值的影响大于利培酮     

利培酮治疗的分裂症患者催乳素与胰岛素敏感性相关性的初步研究

目的初步探讨利培酮治疗的分裂症患者催乳素水平与胰岛素敏感性的相关性。方法对符合入组标准的51例服用利培酮治疗的住院分裂症患者记录年龄、利培酮的使用剂量、分裂症病期等一般情况,测量身高、体重,并检测空腹血糖、血清催乳素及胰岛素(FINS)。计算稳态模型的胰岛素抵抗指数(HOMA-IR)和QUICKI胰岛素敏感性指数。依据体重指数(BMI)将患者分为正常体重组(BMI:18.5～23.9)和超重组(BMI≥24kg/m2),使用Pearson相关分析分析血清催乳素与胰岛素敏感性指标的相关性。结果催乳素与FINS、HOMA-IR、QUICKI胰岛素敏感性指数(r=0.149,P>0.05;r=0.134,P>0.05;r=-0.103,P>0.05)均无统计意义的相关性。正常体重组与超重组的催乳素水平无统计学差异(t=0.597,P>0.05)。超重组FINS、HOMA-IR高于正常体重组(t=2.679,P<0.05;t=2.753,P<0.05),超重组QUICKI胰岛素敏感性指数低于正常体重组(t=3.697,P<0.01)。结论服用利培酮治疗的分裂症患者催乳素水平与胰岛素抵抗无统计意义的相关性。     

Physical and Sexual Abuse and Neglect and Eating Disorder Symptoms

For eating-disordered patients with a history of post-traumatic stress, childhood abuse and neglect, and dissociative disorder, eating behavior symptoms may function as a rational response to unmetabolized traumatic experiences. This paper will review trauma-based theory, dissociation, abreactive, and ego-states therapy as they apply to eating disorder patients.     

Efficacy and Effectiveness of Child and Adolescent Psychotherapy and Pharmacotherapy

Decades of intervention research have produced a rich body of evidence on the effects of psychotherapies and pharmacotherapies with children and adolescents. Here we summarize and critique that evidence. We review findings bearing on the efficacy of psychosocial treatments and medications under controlled experimental conditions. We also report evidence, where available, on the effectiveness of both classes of treatment with clinically referred youth treated in real-world clinical contexts. In general, the large body of evidence on efficacy contrasts sharply with the small base of evidence on effectiveness. Addressing this gap through an enriched research agenda could contribute importantly to linking scientific inquiry and clinical practice—to the benefit of both ventures. This is one element of a multifaceted agenda for future research and for synthesis of research, which will require the interplay of multiple disciplines related to child and adolescent mental health.     

Physical and Sexual Abuse and Neglect and Eating Disorder Symptoms

Abstract

For eating-disordered patients with a history of post-traumatic stress, childhood abuse and neglect, and dissociative disorder, eating behavior symptoms may function as a rational response to unmetabolized traumatic experiences. This paper will review trauma-based theory, dissociation, abreactive, and ego-states therapy as they apply to eating disorder patients.     

Presence and severity of anorexia and bulimia among male and female Omani and non-Omani adolescents

OBJECTIVE: The population of Oman is a heterogeneous mix of nationalities providing a natural setting for studying the cross-cultural differences in the presence and severity of eating disorders as well as an opportunity for evaluating the performance of measurement instruments for these disorders. METHOD: Disordered eating screening instruments (the Eating Attitude Test and the Bulimic Investigatory Test) were administered to Omani teenagers, non-Omani teenagers, and Omani adults. RESULTS: On the Eating Attitude Test, 33% of Omani teenagers (29.4% females and 36.4% males) and 9% of non-Omani teenagers (7.5% of males and 10.6% females) showed a propensity for anorexic-like behavior. On the Bulimic Investigatory Test, 12.3% of Omani teenagers showed a propensity for binge eating or bulimia (13.7% females and 10.9% males). Among the non-Omani teenagers, 18.4% showed a tendency toward bulimia, with females showing a slightly greater tendency than males. In contrast, barely 2% of Omani adults showed either a presence of or a severity of disorderly behavior with food. CONCLUSION: Omani teenagers scored significantly higher than other ethnic groups and Omani adults. This finding is discussed in the light of emerging evidence from many parts of the world suggesting that cultural transition, compounded by demographic constraints, plays a significant role in abnormal eating attitudes.     

Relationship Between Sluggish Cognitive Tempo and Age and IQ in Preschool and School-Age Children and Adolescents with Autism and with ADHD

Journal of Autism and Developmental Disorders - Relationships between sluggish cognitive tempo (SCT) and age and IQ were investigated in children with autism and/or ADHD covering broader age and IQ...     

Synaptic plasticity and learning and memory: LTP and beyond.

Long-term potentiation (LTP) of synaptic activity is by far the most popular and widely researched model of synaptic plastic changes that might occur during learning. Numerous recent reports, however, have not found a correlation between the inducibility of LTP in the hippocampus and the ability of animals to learn hippocampus-dependent tasks. For example, some experiments with gene deletion (knockout) mice strains have shown that in some strains LTP is not inducible in the dentate gyrus, in area CA3, or CA1, but the animals are still able to learn spatial tasks. This apparent mismatch has rejuvenated the discussion concerning whether LTP is a good model for mechanisms that underlie memory formation in the nervous system. This review analyzes the conditions under which LTP is induced or learning takes place and suggests reasons for the mismatches that can occur and what we can learn from them. High-frequency stimulation protocols and in vitro assays cannot be seen to resemble natural firing patterns or conditions found in the brain. More physiological experimental conditions, especially in vivo recording in awake animals, could lead the way to the development of improved models of learning mechanisms that better correlate with learning abilities of animals.