脑卒中后抑郁与损伤部位的关系研究

目的：探讨脑卒中后抑郁与脑损伤部位的关系,为采取针对性的预防干预措施提供依据。方法符合临床诊断标准的脑卒中患者进行MRI检查,对MRI确诊为脑卒中的患者进行精神检查,抑郁症诊断标准符合《中国精神障碍分类与诊断标准（ CCMD-3）》,并进行汉密尔顿抑郁量表（ HAMD 24项）评定。结果136例脑卒中患者发生抑郁症59例占43．38％;其中轻度抑郁症状33例占24．26％,病程（9．0±6．2）个月;中度抑郁症状15例占11．03％,病程（2．0±3．2）个月;重度抑郁症状11例占8．09％,病程（16．0±4．3）个月;在多因素水平筛选PSD危险部位,其中额叶、颞叶、胼胝体病灶回归系数（B）分别为1．364、1．417、2．231;优势比（OR）值分别为2．212、3．451、1．985（OR＞1, P ＜0．05）。结论额叶、颞叶、胼胝体部位与脑卒中抑郁症的发生显著相关,是PSD发生的危险因素;病变部位与抑郁程度和病程相关。     

脑卒中后癫痫的临床分析

目的探讨脑卒中后癫痫的临床表现、特点及发病机制和治疗原则。方法回顾分析近3年我院754例脑卒中患者中46例继发患者的卒中部位、癫痫发作特点、类型和治疗方法。结果脑卒中后癫痫发生率为6．1％（46／754）,其中早发癫痫39例占5．2％（39／754）,迟发癫痫7例占0．9％（7／754）;46例继发癫痫中,皮层病灶继发癫痫占78．2％（36／46）,皮层下病灶继发癫痫占21．8％（10／46）。早发癫痫中全身发作30例,部分性发作9例;迟发癫痫中全身发作2例,部分性发作5例。皮层病灶继发癫痫较皮层下病灶继发癫痫多见,差异有显著性（P〈0．05）。并发癫痫患者预后较无癫痫患者差。结论腑卒中后癫痫皮层病灶多见,早发癫痫以全身发作为主,迟发癫痫以部分发作为主。早期控制癫痫发作有利患者康复。     

34例脑卒中后抑郁性精神障碍患者临床分析

目的：分析脑卒中后发生抑郁性精神障碍患者的临床特征。方法：对118例脑血管病中的34例患者进行临床分析。结果：脑卒中（脑梗死或脑出血）后有34例患者发生抑郁性精神障碍,经正规抗抑郁治疗症状有不同程序的改善,治疗前后用抑郁量表（HAMD）分析评定差异有显著性（P〈0．01）。结论：脑卒中后抑郁性障碍患者应用氟西汀或帕罗西汀与传统的抗抑郁症相比较疗效肯定。     

喹硫平治疗帕金森病合并精神障碍的疗效观察

目的探讨喹硫平治疗帕金森病（PD）合并精神障碍的疗效及不良反应。方法收集PD合并精神障碍患者共78例。所有患者均伴有精神行为异常1个月以上,其中以阳性症状为主要表现者42例,以阴性症状为主要表现者36例。78例患者随机分为两组,治疗组40例,对照组38例。治疗组在调整抗帕金森药物的基础上加用喹硫平50～400mg／d,观察8周;对照组仅予以调整抗帕金森药物的治疗。治疗前后以统一帕金森病评定量表（UPDRS）评定运动功能;以阳性症状和阴性症状量表（PANSS）评定精神障碍程度及疗效;以副反应量表（TESS）评定不良反应。结果两组患者治疗后PANSS评分均比治疗前减少,以治疗组减少程度较大,两组差异有统计学意义（P〈0．01）;两组患者治疗后UPDRS评分均比治疗前减少,两组差异无统计学意义（P〉0．05）;治疗组不良反应少,未出现严重不良反应。结论喹硫平治疗PD合并精神障碍的疗效肯定,不良反应少,安全性强,值得临床应用和推广。     

脑卒中后癫痫的临床特征及其预后分析

目的探讨脑卒中后继发癫痫的临床特征及其预后。方法对脑卒中后继发癫痫76例患者的发生率、发作时间、发作类型、与卒中类型及病灶部位的关系与预后等临床特征进行总结分析,同时随机抽取同期住院无癫痫发作的70例脑卒中患者（对照组）,观察两组的临床疗效和神经功能缺损（NFD）评分变化。结果①脑卒中后癫痫发生率11．1％（76／682）,其中早发性癫痫59．2％（45／76）,迟发性癫痫40．8％（31／76）;②皮层病灶继发癫痫60．5％（46／76）,皮层下病灶继发癫痫39．5％（30／76）,两者比较差异有统计学意义（P〈0．01）;③局限性运动性发作40例（52．6％）,其中早发性发作14例,迟发性发作26例;全身强直阵挛性发作31例和癫痫持续状态5例（47．4％）中,早发性发作26例,迟发性发作10例。（4）出血性卒中继发癫痫占61．8％（47／76）,缺血性卒中占38．2％（29／76）,两者比较差异有统计学意义（P〈0．01）;⑤癫痫组显著进步率明显低于对照组（P〈0．01）,癫痫组神经功能缺损评分均差于对照组（P〈0．05）。结论脑卒中后癫痫皮层病灶多见,早发癫痫以全身发作为主,迟发癫痫以部分发作为主。脑卒中继发癫痫患者的治疗效果差于对照组,抗癫痫治疗有利于神经功能康复。     

动态血糖监测系统在血糖控制良好的老年2型糖尿病患者中的应用

目的观察动态血糖监测系统（CGMS）在糖化血红蛋白这标（HbAIC≤7％）的老年2型糖尿病患者的应用。方法采用CGMS对50例空腹血糖≤7．0mmol／L,餐后2h血糖≤10mmol／L,糖化血红蛋白≤7．0％的老年2型糖尿病患者进行连续3d的血糖监测,分析血糖动态变化信息。结果50例患者中,有11例（占22％）发生了无症状性低血糖,血糖值为3．0～3．8mmol／L;6例（占12％）发生有症状性低血糖,血糖值为2．1～3．8mmol／L。在17例无症状和有症状性低血糖患者中,有10例（占20％）患者低血糖发生于凌晨1：00～4：00。25例（占50％）餐后2h血糖〉11．1mmol／L,其中8例发生早餐后高血糖,血糖值11．2～14．6mmol／L;6例发生午餐后高血糖,血糖值11.8～15．6mmol／L;11例发生晚餐后高血糖,血糖值12-3～16．0mmol／L。结论对于应用空腹血糖、餐后2h、糖化血红蛋白来判定血糖控制良好的老年2型糖尿病患者,通过全天多点血糖监测,了解任意时间的血糖情况,作为临床治疗方案调整的基础,达到精细化降糖目的。     

利培酮治疗脑梗死所致精神障碍的疗效及安全性研究

目的：探讨利培酮治疗脑梗死所致精神障碍的疗效及安全性。方法回顾性分析了采用利培酮治疗的入住我院的189例脑梗死所致精神障碍患者的临床资料。分析患者治疗效果及安全性。结果①本组患者治疗后 PANSS总得分、阳性症状、阴性症状及精神病理评分均显著小于治疗前（P＜0.05～0.01）;②本组患者在治疗过程中,出现副反应例数为39例,副反应发生率为20.63％（39／189）。结论利培酮治疗脑梗死所致精神障碍的疗效显著,副反应均经简单处理后均能显著缓解直至消失,应在临床上进行推广。     

预见性护理在老年慢性心力衰竭患者治疗中的应用

目的观察预见性护理在老年慢性心力衰竭患者治疗中的应用价值。方法在110例老年慢性心力衰竭治疗中实施预见性护理．包括基础护理、心理护理、监测病情、配合抢救、健康宣教等．观察预见护理的临床应用价值。结果治疗依从性达98．2％（108／110），胸闷、气促等临床症状缓解率达93．6％（103／110）．对护士的服务态度满意度达97．3％（107／110），无护理并发症发生及护理投诉。结论实施预见性护理可提高老年慢性心力衰竭患者的治疗依从性和症状缓解率，提高护理满意度。     

超选择碘化油动脉化疗栓塞治疗支气管肺癌的效果

目的探讨超选择碘化油动脉化疗栓塞治疗支气管肺癌的效果。方法搜集2002年1月至2011年12月57例经病理证实的中晚期支气管肺癌,确认肿瘤供血动脉后行超选择支气管动脉化疗栓塞治疗,治疗后1个月记录患者临床症状、肿瘤大小改变情况及并发症发生情况。结果本组患者中支气管肺癌右侧支-肋共干占14．0％（8／57）,双侧支气管动脉供血占5．3％（3／57）,左、右支气管动脉共干占5．3％（3／57）,肋间动脉参与供血占7．0％（4／57）,胸廓内动脉参与供血占1．8％（1／57）;57例患者均成功实施了碘化油动脉化疗栓塞治疗,患者术后临床症状减轻,部分消失,肿瘤供血动脉阻断,肿瘤发生缺血坏死,瘤体缩小。治疗后完全缓解率为66．7％（38／57）,总有效率为84．2％（48／57）,无变化为10．5％（6／57）,进展为5．3％（3／57）。结论超选择碘化油动脉化疗栓塞疗法可以明显缓解症状,提高患者的生存质量,是治疗支气管肺癌的有效方法。     

脑卒中后继发癫痫临床分析

目的探讨脑卒中后继发癫痫临床症状特点及与卒中类型关系。方法对897例脑卒中患者的卒中类型、卒中后癫痫发病率、发作时间及治疗效果进行回顾性研究。结果脑卒中癫痫发病率为8．7％（78／897）,其中以蛛网膜下腔出血发生率最高,其次为脑出血,脑梗死后癫痫发生率最低。早发性癫痫54例（69．2％）,治疗效果好;迟发性癫痫24例（30．8％）,治疗效果相对较差。结论癫痫是老年人卒中常见的并发症,发病率与卒中性质相关,经正规抗癫痫治疗后总体预后较好。     

Neuropsychiatric disorders following vascular brain injury

Several neuropsychiatric disorders such as mood, anxiety and psychotic disorders occur following cerebrovascular lesions. Post-stroke depression is the most common of these disorders and, along with post-stroke anxiety, has been shown to inhibit physical and cognitive recovery. Antidepressants have been shown to effectively treat post-stroke depression and to have a positive impact on rehabilitation efforts in patients suffering from this disorder. Much less is known about the potential impact of psychiatric conditions on recovery after stroke. Controlled trials will be able to adequately determine the effectiveness of treatment for these disorders.     

突发性聋患者睡眠质量与心理健康状况相关性分析

目的 分析突发性聋患者睡眠质量与心理健康状况的相关性,探讨突发性聋患者进行睡眠、心理健康干预的依据.方法 采用方便抽样方法选取2011年6月至2013年6月在耳鼻咽喉头颈外科住院治疗的突发性聋患者220例,参照《症状自评量表（SCL-90）》测定指标/标准确定有无心理健康问题,根据结果分观察组和对照组,各110名;应用《一般情况调查表》、《匹兹堡睡眠质量指数量表（PSQI）》评测被调查者的PSQI得分,比较两组睡眠质量情况.结果 观察组78％（86/110）发生睡眠障碍,明显高于对照组14％ （15/110）,差异有统计学意义（P＜0.05）.结论 关注睡眠障碍与负性情绪对突发性聋患者带来的负面影响,为患者提供有效心理干预的依据,从而提高睡眠质量,促进身心健康.     

儿科护士心理健康状况调查及干预对策探讨

目的了解儿科护士的心理健康状况,并对其产生的原因进行分析,提出相应的干预对策。方法采用SCL-90症状自评量表对6所二级甲等以上医院的儿科病房护士108名和普通病房护士110名进行问卷调查,并进行对比分析。结果儿科病房护士的总均分及阳性项目数均高于普通病房护士,差异有统计学意义（P〈0.05）。各因子分中除恐怖与精神病性2个因子分外,其余因子得分儿科病房护士明显高于普通病房护士,差异均有统计学意义（P〈0.05）。结论与普通病房护士比较,儿科病房护士显示出较多的心理问题,常见的心理障碍为焦虑、抑郁及强迫。管理者及护理人员自身应采取切实有效的措施,维护和促进儿科护士的心理健康,进一步提高护理质量。     

Long-term efficacy of risperidone long-acting injectable in bipolar disorder with psychotic features: a prospective study of 3-year outcomes

Bipolar disorder (BD) with psychotic features is a difficult-to-treat form of the illness that is associated with a poor prognosis. We hypothesized that treatment with adjunctive risperidone long-acting injectable (RLAI) is well-tolerated and efficacious in treating patients with psychotic BD. Ten patients with BDI or BDII with psychotic features who were refractory to earlier treatments were prescribed adjunctive open-label RLAI 25-62.5 mg q twice weekly. The patients were followed prospectively for 3 years. The severity of mood and psychotic symptoms was measured using clinical rating scales, and information regarding relapses, hospitalizations, extra-pyramidal symptom, weight gain, and other side effects was also gathered. Young Mania Rating Scale scores, Montgomery Asberg Depression Rating Scale scores, psychosis rating scale scores, and the numbers of mood episodes and hospitalizations were reduced during 3 years of RLAI therapy compared with an equivalent pretreatment period. Only three patients experienced relapses with psychotic symptoms. Functional outcomes were also improved, with substantial numbers of previously disabled patients able to return to gainful employment and independent living. RLAI was associated with minimal extra-pyramidal symptom, modest weight gain, and few other side effects. Adjunctive RLAI can be considered as a treatment option in patients with psychotic BD.     

Kynurenine pathway in psychosis: evidence of increased tryptophan degradation

The kynurenine pathway of tryptophan degradation may serve to integrate disparate abnormalities heretofore identified in research aiming to elucidate the complex aetiopathogenesis of psychotic disorders. Post-mortem brain tissue studies have reported elevated kynurenine and kynurenic acid in the frontal cortex and upregulation of the first step of the pathway in the anterior cingulate cortex of individuals with schizophrenia. In this study, we examined kynurenine pathway activity by measuring tryptophan breakdown, a number of pathway metabolites and interferon gamma (IFN-gamma), which is the preferential activator of the first-step enzyme, indoleamine dioxygenase (IDO), in the plasma of patients with major psychotic disorder. Plasma tryptophan, kynurenine pathway metabolites were measured using high-performance liquid chromatography (HPLC) in 34 patients with a diagnosis on the psychotic spectrum (schizophrenia or schizoaffective disorder) and in 36 healthy control subjects. IFN-gamma was measured using enzyme-linked immunosorbent assay (ELISA). The mean tryptophan breakdown index (kynurenine/tryptophan) was significantly higher in the patient group compared with controls (P < 0.05). IFN-gamma measures did not differ between groups (P = 0.23). No relationship was found between measures of psychopathology, symptom severity and activity in the first step in the pathway. A modest correlation was established between the tryptophan breakdown index and illness duration. These results provide evidence for kynurenine pathway upregulation, specifically involving the first enzymatic step, in patients with major psychotic disorder. Increased tryptophan degradation in psychoses may have potential consequences for the treatment of these disorders by informing the development of novel therapeutic compounds.     

奥氮平与利培酮治疗冰毒所致精神障碍的临床对照研究

目的观察奥氮平与利培酮治疗甲基苯丙胺(冰毒)所致精神障碍的疗效和不良反应。方法对我科2011年1月至2012年12月收治的98例符合中国精神疾病分类方案与诊断标准第三版(CCMD-3)诊断为冰毒所致精神障碍的患者,随机分为2组:奥氮平组49例和利培酮组49例,采用阳性与阴性症状量表(PANSS)和不良反应量表(TESS)评定患者的疗效和不良反应。结果奥氮平组有效率为93.8%,利培酮组有效率为89.7%。两组疗效比较差异无统计学意义(P>0.05)。两组不良反应发生率比较差异有统计学意义(P<0.05),主要表现在锥体外系不良反应及镇静。结论奥氮平、利培酮均能有效改善冰毒所致的精神病性症状,疗效显著。但奥氮平不良反应发生率低,安全性好。     

氯胺酮所致精神障碍的临床特点分析

目的:探讨氯胺酮所致精神障碍的临床特点。方法:对41例氯胺酮所致精神障碍患者的临床资料进行分析。结果:患者多为男性未婚青年。氯胺酮滥用时间为21.8±s17.8月,滥用剂量为0.4 g·次-1±s0.2 g·次-1,吸食频度为9.5次·月-1±s8.5次·月-1,滥用方式全部为鼻吸。患者均有多物质滥用的经历。临床诊断主要依据确切的氯胺酮滥用史和临床表现,临床类型以精神病性障碍多见,占85.4%(35/41)。依赖者的耐受性增加不明显,戒断症状出现较迟且较轻,心理依赖呈中等程度;精神病性障碍者的主要表现为:幻听、被害妄想、易激惹、兴奋和行为异常等。患者的治疗效果较好。结论:氯胺酮所致精神障碍以精神病性障碍多见,应加以重视。     

Mood responses of remitted schizophrenics to methylphenidate infusion

To investigate the mood response of schizophrenic subjects to psychostimulant challenge, 29 neuroleptic-treated subjects (22 with schizophrenia and 7 with schizoaffective disorder) in clinical remission received two infusions, one with methylphenidate 0.5 mg/kg and the other with normal saline, under double-blind conditions. Twenty-five of these subjects were withdrawn from neuroleptics and given a second set of double-blind infusions. Infusion mood responses were classified as euphoric, neutral, mixed or dysphoric. Subjects were also rated as either psychotic symptom activators to the infusion or no change in psychotic symptoms. Overall response by mood category was as follows: 35.2% euphoric, 50% neutral, 5.6% mixed and 9.3% dysphoric. Mood responses were not correlated with sex, methylphenidate plasma levels or diagnostic distinctions between schizophrenia and schizoaffective disorder. Although they occurred infrequently, dysphoric and mixed mood responses were associated with high rates of psychotic activation. Comparing subjects on and off neuroleptics, subjects on neuroleptics had more euphoric responses than the same subjects off neuroleptics. This increased number of euphoric responses in subjects taking neuroleptics compared to off neuroleptics suggests that neuroleptic treatment status may be an important factor in assessing psychostimulant use in schizophrenia patients.     

29例毒品所致精神障碍的临床资料分析

目的了解毒品所致精神障碍的临床表现及转归。方法对滥用毒品,符合中国精神障碍分类与诊断标准第三版精神活性物质所致精神障碍诊断标准的患者29例作临床资料分析。结果毒品所致精神障碍的临床表现多为类精神分裂症症状,有幻觉、妄想、行为紊乱、行为怪异等,并对心脏、肾、肝脏等有损害。脱离毒品及解毒、对症、支持等相应处理可消除精神病性症状。结论毒品影响或损害了滥用者的神经系统,经及时脱离毒品以及对症治疗,精神病性症状均在短时间内消失。     

Source monitoring improvement in patients with schizophrenia receiving antipsychotic medications

Rationale The absence of a relationship between cognitive deficit treatment response and positive symptom treatment response is often assumed, and few data have shed light on this issue. Most of these data have been collected using standard neuropsychological measures, which are ill-designed to assess the types of neurocognitive disturbances associated with psychotic symptoms. This study investigates the effect of treatment on source monitoring performance and its relation to the reduction of certain psychotic symptoms associated with the inability to identify self-generated mental events, known as "autonoetic agnosia". Objectives To determine whether risperidone, olanzapine, and haloperidol were differentially effective in reducing autonoetic agnosia and whether changes in this aspect of cognition were related to reduction of specific symptoms of psychosis. Methods From a cohort of 49 patients diagnosed with schizophrenia by DSM-IV criteria and randomly assigned to double-blind treatment with risperidone, olanzapine, or haloperidol, 16 patients were identified with symptoms believed to reflect autonoetic agnosia ("target symptoms") as assessed with the Schneiderian Symptom Rating Scale, and then evaluated during a baseline period, and then at 1, 2, and 3 weeks. Autonoetic agnosia was assessed as the ability of a patient to distinguish self-generated words from both experimenter-generated words and pictorially presented words. Results Analysis of patients from all treatment groups found a significant reduction in the number of "target" Schneiderian symptoms. Discrimination for items from the self-generated and heard sources significantly improved with treatment, as did the number of self-generated items that patients remembered as coming from the heard source ("self-hear errors"). The correlation between improvement in recognition of self-generated items and reduction in target Schneiderian symptoms after 2 weeks of treatment suggested a modest relationship between symptom improvement and changes in autonoetic agnosia. Conclusions While the differences between medications were not statistically significant, antipsychotic medication in general was associated with improvements in symptoms and cognitive deficits that may underlie autonoetic agnosia. Improvement of autonoetic agnosia was a weak predictor of positive symptom improvement in a limited sample.