托吡酯治疗酒依赖临床疗效观察

目的观察托吡酯治疗酒依赖的临床疗效与安全性。方法采用随机双盲对照研究方法对符合入组标准的78例酒依赖患者分为单一服用托吡酯组和安慰剂治疗组,疗程24周。在入组前和入组后2、4、8、12、24周末进行酒精依赖疾患识别测验（Alcohol Use Disorder Test,AUDIT）,强制性饮酒问卷（The Obsessive Compulsive Drinking Scale,OCDS）,症状自评量表（SCL-90）,副反应量表（TESS）评定,治疗结束对两组总体疗效进行对比。结果托吡酯组在戒酒总体疗效、对酒渴求程度、异常心理状态改善等方面明显优于安慰剂组,治疗中出现一些轻度药物副反应,随治疗进展逐渐缓解。结论托吡酯对戒酒治疗疗效肯定,能有效改善饮酒行为,降低酒依赖程度,加强心理防御机制,同时药物不良反应轻,持续时间较短,提高患者治疗依从性,降低复饮率,对酒依赖的治疗安全有效。     

坦度螺酮合并心理干预对酒依赖的疗效

目的 探究并分析坦度螺酮合并心理干预治疗酒依赖患者的临床疗效.方法 选取我院自2009年7月-2011年7月收治的酒依赖患者74例,将其作为临床研究对象.随机分为A、B两组,每组各37例,A组患者单纯采用坦度螺酮治疗,即为对照组;B组患者采用坦度螺酮治疗的同时合并心理干预.观察两组患者的治疗效果,随访患者3～6个月,观察并记录患者的戒酒效果.结果 B组患者的焦虑及抑郁值较A组小,复饮人数较A组少（t =6.1175,6.7212;x2=5.6381,P＜0.05）,均具有统计学意义.结论 对酒依赖患者采用坦度螺酮合并心理干预的治疗方案效果显著.     

西酞普兰治疗酒依赖伴抑郁临床疗效观察

目的观察西酞普兰治疗酒依赖伴抑郁患者临床疗效。方法将40例符合酒依赖伴发抑郁患者随机分为研究组和对照组,在临床常规戒酒治疗同时,研究组合用西酞普兰,疗程12周,并于入组、治疗第2、4、6、8、12周进行相关量表评定对比疗效。结果两组汉密尔顿抑郁量表(HAMD)比较自第2周出现统计学差异(P0.05),自第4周至疗程结束比较有极显著性差异(P0.001);两组强制性饮酒问卷(OCDS)及酒精依赖疾患识别测验(AUDIT)比较自第4周开始出现统计学差异(P0.05),自第8周至治疗结束比较有极显著差异(P0.001)。结论西酞普兰能有效治疗酒依赖伴发的抑郁症状,迅速改善情绪,降低饮酒欲望,强化酒依赖治疗效果。     

阿坎酸治疗酒依赖的12周多中心随机双盲对照研究

目的:评价阿坎酸治疗酒依赖的疗效和安全性。方法:本研究采用随机、双盲、安慰剂对照的多中心临床试验设计。研究对象是符合美国精神障碍诊断与统计手册第4版(DSM-IV)酒依赖诊断标准的门诊或者住院患者。共入组230例,一组(n=116)用阿坎酸(体质量60 kg,1332 mg/d;≥60kg,1998 mg/d)治疗,另一组(n=114)接受安慰剂治疗,连续治疗12周。以累计戒酒天数(CAD)与校正累积戒酒持续时间(CCAD)、每次访视的复饮率、首次复饮时间作为评价疗效的主要指标。以饮酒次数、饮酒量、可视渴求量表评分、血γ-谷氨酰转移酶水平为评价疗效的次要指标。根据生命体征、实验室及心电图检查、不良事件报告评价安全性。结果:阿坎酸组与安慰剂组在累计戒酒天数[(43.7±34.7)d vs.(38.9±35.8)d]、校正累积戒酒持续时间[(52.0±41.3)%vs.(46.3±42.6)%]、每次访视的复饮率以及首次复饮时间分布等主要疗效评价指标均无统计学差异(均P0.05)。但在治疗12周后,阿坎酸组患者饮酒量的等级为戒除和小于5标准杯/d的比例(88.1%vs.78.7%)高于安慰剂组,可视渴求量表分[(2.6±2.3)vs.(3.3±2.9)]低于安慰剂组(均P0.05)。阿坎酸组和安慰剂组的不良事件发生率差异无统计学意义(22.6%vs.19.3%,P0.05)。阿坎酸组最常见的不良反应是腹泻和皮疹,与安慰剂组相比腹泻发生率(4.9%vs.3.2%)和皮疹发生率(3.9%vs.2.1%)无统计学差异(均P0.05)。结论:阿坎酸对减少酒依赖患者饮酒量、降低渴求等方面的疗效优于安慰剂,并且安全性良好。     

纳曲酮临床应用及其免疫调节机制研究进展

纳曲酮是一种阿片受体拮抗剂,对免疫系统具有调节作用.早期纳曲酮被用来治疗阿片类药物依赖,最近用来治疗肥胖、瘙痒、多发性硬化症、多囊卵巢综合症、肿瘤、酒精和尼古丁成瘾.最近研究证明纳曲酮具有抗麻醉和治疗纤维肌痛和克罗恩病的作用,超低剂量纳曲酮可以增强麻醉作用.     

盐酸曲唑酮治疗酒依赖稽延性戒断症状100例临床研究

目的 探讨盐酸曲唑酮治疗酒依赖稽延性戒断症状的有效性和安全性.方法 采用随机、双盲、安慰剂对照的方法把100例符合纳入和排除标准的患者分成盐酸曲唑酮组和安慰剂组.每个患者均口服盐酸曲唑酮或安慰剂每日3次,每次1片,疗程均为8周.8周内按时分别进行汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)、匹兹堡睡眠质量指数...     

奥氮平合并丁螺环酮治疗精神分裂症阴性症状对照研究

目的:探讨奥氮平合并丁螺环酮治疗精神分裂症阴性症状的疗效及安全性。方法:68例精神分裂症随机分为两组,研究组奥氮平合并丁螺环酮治疗,对照组用奥氮平合并安慰剂治疗共8周。治疗前及治疗后4、8周末分别用阳性和阴性症状量表(PANSS)评定临床疗效,用副反应量表(TESS)评定不良反应。结果:治疗后8周末阴性症状分与对照组比较差异有统计学意义(P0.05)。8周末研究组阴性症状减分有效率41.2%,对照组有效率14.7%,研究组有效率显著高于对照组(χ~2=5.9,P0.05)。不良反应均较轻,两组间比较差异无统计学意义。结论:奥氮平合并丁螺环酮治疗精神分裂症阴性症状的疗效优于单独应用奥氮平治疗,副作用无增加。     

加巴喷丁治疗酒依赖的临床疗效

目的 观察加巴喷丁治疗酒精依赖的临床疗效。方法 选取2018年2月~2019年2月我院收治的酒依赖患者82例,采用随机数字表法分为加巴喷丁组和安慰剂组,每组41例。加巴喷丁组予加巴喷丁胶囊治疗,安慰剂组予无药物成分的模拟胶囊治疗,比较两组治疗前和治疗后2、4、8、12周强制性饮酒问卷（OCDS）、宾夕法尼亚酒精渴求量表（PACS）及副反应量表（TESS）评分。结果 治疗后2周,加巴喷丁组OCDS、PACS评分与安慰剂组比较,差异无统计学意义（P＞0.05）;治疗后4、8、12周,加巴喷丁组OCDS评分、PACS评分低于安慰剂组[（52.64±1.56）分vs（53.68±1.86）分、（18.62±5.22）分vs（24.34±5.65）分]、[（49.31±1.32）分vs（51.62±1.93）分、（15.14±4.15）分vs（23.92±4.86）分]、[（46.52±1.43）分vs（51.62±1.93）分、（14.71±5.67）分vs（23.92±4.86）分],差异有统计学意义（P＜0.05）;治疗后4、8、12周,两组TESS评分比较,差异无统计学意义（P＞0.05）。结论 加巴喷丁可有效减少饮酒行为,降低渴求度,且耐受性好,不良反应轻微。     

氯氮平、丙戊酸纳、卡马西平治疗躁狂症84例对照分析

本文对 84例躁狂症分别以氯氮平 ,丙戊酸纳 ,卡马西平治疗。对照其疗效及副作用。治疗 6周后结果显示 :氯氮平有效率 97.0 % ;丙戊酸纳有效率 80 .7% ;卡马西平有效率 5 4 .1 % ;3者相比差异非常显著。氯氮平的副作用主要为心血管及血液系统较多 ,丙戊酸纳和卡马西平主要为消化道的副作用。     

帕罗西汀对海洛因依赖者的抑郁焦虑症状的治疗研究

目的:评价帕罗西汀对海洛因依赖者的抑郁及焦虑症状的治疗效果.方法:对103例符合诊断标准的海洛因依赖并伴焦虑抑郁者,分别应用帕罗西汀和丁螺环酮进行治疗,疗程为4周.采用HAMA及HAMD两种量表进行评定疗效 ,用TESS量表对不良反应进行评定.结果:帕罗西汀组治疗后与治疗前的HAMA及HAMD评分比较,有显著性差异(P＜0.01);两组间从治疗第1周末起,各时点HAMD评分有显著性差异(P＜0.05);两组间HAMA评分在治疗第1、2周末有显著性差异(P＜0.05),在第3、4周末无显著性差异(P＞0.05);两组间各时点TESS评分无显著性差异(P＞0.05).结论:帕罗西汀在显著改善海洛因依赖者抑郁症状的同时,其改善焦虑症状的疗效与抗焦虑药物丁螺环酮相当,疗效显著,副作用小.     

Web-Based Cognitive Behavioral Self-Help Intervention to Reduce Cocaine Consumption in Problematic Cocaine Users: Randomized Controlled Trial

Background

Web-based self-help programs that reduce problematic substance use are able to reach hidden consumer groups in the general population. These programs are characterized by their low treatment threshold and nonrestrictive intervention settings. They are also cost effective, making them of interest to both low-income and high-income industrialized countries with ever-increasing health costs.

Objective

To test the feasibility and effectiveness of an anonymous, fully automated, Web-based self-help intervention as an alternative to outpatient treatment services for cocaine users.

Methods

A total of 196 cocaine-using participants were recruited through various online and offline media for a randomized controlled trial. Participants in the intervention group received interactive cognitive behavioral modules and a consumption diary to reduce cocaine use, whereas participants in the control group received online psychoeducative information modules. Web-based follow-up assessments were conducted after 4 weeks, 6 weeks, and 6 months. Treatment retention was examined and compared between the intervention and control groups. Severity of cocaine dependence was the main outcome measure. Secondary outcomes were cocaine craving, depression symptoms, and alcohol and other substance use.

Results

This Web-based intervention attracted older and more educated participants than existing outpatient treatment programs for which cocaine is the primary substance of abuse. Participants in the intervention group showed greater treatment retention compared with the control group (P = .04). Low response rates at the follow-up assessments restricted the explanatory power of the analyses. At the follow-up assessments, the severity of cocaine dependence did not differ between the intervention and control groups (P = .75). Furthermore, there were no differences in cocaine craving, depression, or alcohol and other substance use. Using the consumption diaries, the average number of cocaine-free days per week did not change significantly, whereas the weekly quantity of cocaine used decreased equally in both groups (P = .009).

Conclusions

For cocaine users with low dependence severity, a fully automated Web-based cognitive behavioral self-help intervention is a feasible alternative with limited effectiveness in outpatient treatment services. However, this type of intervention may attract specific user groups that are rarely reached by existing outpatient treatment and may help them to control their cocaine consumption anonymously.

Trial Registration

ISRCTN93702927; http://www.controlled-trials.com/ISRCTN93702927 (Archived by WebCite at http://www.webcitation.org/6CTMM10MR)     

Naltrexone in the treatment of alcohol dependence.

BACKGROUND: Although naltrexone, an opiate-receptor antagonist, has been approved by the Food and Drug Administration for the treatment of alcohol dependence, its efficacy is uncertain. METHODS: We conducted a multicenter, double-blind, placebo-controlled evaluation of naltrexone as an adjunct to standardized psychosocial treatment. We randomly assigned 627 veterans (almost all men) with chronic, severe alcohol dependence to 12 months of naltrexone (50 mg once daily), 3 months of naltrexone followed by 9 months of placebo, or 12 months of placebo. All patients were offered individual counseling and programs to improve their compliance with study medication and were encouraged to attend Alcoholics Anonymous meetings. RESULTS: There were 209 patients in each group; all had been sober for at least five days before randomization. At 13 weeks, we found no significant difference in the number of days to relapse between patients in the two naltrexone groups (mean, 72.3 days) and the placebo group (mean, 62.4 days; 95 percent confidence interval for the difference between groups, -3.0 to 22.8). At 52 weeks, there were no significant differences among the three groups in the percentage of days on which drinking occurred and the number of drinks per drinking day. CONCLUSIONS: Our findings do not support the use of naltrexone for the treatment of men with chronic, severe alcohol dependence.     

神经衰弱治疗中的安慰剂效应

目的 :观察神经衰弱治疗中的安慰剂效应及其程度。方法 :符合 CCMD- 2 - R和 ICD- 1 0神经衰弱诊断标准的门诊患者 ,经过为期 1 - 6周的药物清洗期后 ,首先接受 1周的导入期治疗 ,仍然符合入组标准的患者进入正式的为期 1 2周的安慰剂治疗。治疗中不合并抗抑郁药物治疗。结果 :共纳入 1 0 5例患者 ,平均年龄 38.2± 1 6.0岁 ,平均病程 4.7± 5.3年。安慰剂治疗显著降低汉米尔顿抑郁量表、汉米尔顿焦虑量表、临床总体印象量表的评分 ,1 2周的治疗中无疗效的反跳现象。以 1 7项 HRSD总分在治疗 1 2周后降低 50 %或者以上者为治疗有效的标准 ,安慰剂治疗的有效率为 34.3%。结论 :神经衰弱患者的治疗中存在显著的安慰剂效应。     

拉米夫定治疗慢性乙型肝炎2年临床疗效

目的 研究拉米夫定治疗慢性乙型肝炎的临床疗效和安全性。方法 选取72例慢性乙型肝炎病人,第一阶段为随机、双盲、安慰剂对照的研究共12周,分为拉米夫定组（n=54）和安慰剂组（n=18）;第二阶段为开放研究,所有病人均服用拉米夫定100mg/d至104周。观察指标包括临床症状、肝功、乙型肝炎病毒（HBV）血清标志物、HBV DNA和病毒YMDD变异等。结果 拉米夫定治疗12周时,HBV DNA阴转率显著高于安慰剂组（61％对6％,P＜0.01）,ALT持续复常率也高于安慰剂组（65％对11％,P＜0.05）;治疗52周时,两组病人总的HBV DNA阴转率为785,ALT持续复常率为39％,HBeAg阴转率和血清转换率分别为8.2%和6.1%;治疗104周时,两组病人总的HBV DNA阴转率36％,ALT持续复常率为33％,HBeAg阴转率和血清转换率分别为12.2%和6.1%。两组病人总的YMDD变异率在52周时为13.7%,104周时为39.7%。第一阶段拉米夫定和安慰剂组不良瓜在的差异不显著（P＞0.05）,治疗期间未发生与药物有关的严重不良反应。结论 拉米夫定100mg/d可以迅速降低血清HBV DNA和ALT水平,安全性良好。但应严密监测以及时发现YMDD病毒变异引起的HBV DNA反跳。     

Budesonide Turbuhaler delivered once daily improves health-related quality of life and maintains improvements with a stepped-down dose in adults with mild to moderate asthma.

BACKGROUND: Budesonide inhalation powder administered via Turbuhaler (budesonide Turbuhaler, AstraZeneca LP, Wilmington, DE) is proven efficacious and safe in the treatment of mild to severe asthma. OBJECTIVE: To evaluate the effect of once-daily budesonide Turbuhaler on health-related quality of life (HRQL) in adults with mild to moderate asthma. METHODS: In this double-blind, parallel-group study, 309 asthmatic patients between 18 and 70 years of age were randomized to receive once-daily treatment with budesonide 200 or 400 microg or placebo for 6 weeks. Patients initially receiving 400 microg budesonide had their dose reduced to 200 microg (400/200-microg group), and patients receiving 200 microg (200/200-microg group) or placebo continued to receive their assigned doses for a 12-week maintenance phase. HRQL was evaluated using the Asthma Quality of Life Questionnaire at randomization, week 6, and week 18. RESULTS: Compared with placebo, patients initially receiving 400 and 200 microg budesonide Turbuhaler demonstrated significantly greater HRQL scores at week 6 (P < or = 0.001 and P < or = 0.010, respectively) that were maintained at week 18 (P < or = 0.001). Clinically important (> or = 0.5 unit) improvement in Asthma Quality of Life Questionnaire overall at week 18 was demonstrated by 55% and 43% of patients in the 400/200-microg and 200/200-microg budesonide Turbuhaler groups, respectively. Conclusions: In patients with mild to moderate asthma, once-daily budesonide Turbuhaler 200 and 400 microg demonstrates statistically significant and clinically important improvements in HRQL that can be maintained with a low dose of 200 microg.     

Clinical effects of a standardized soy extract in postmenopausal women: a pilot study

OBJECTIVE: This double-blind, randomized study was aimed at evaluating comparatively, in postmenopausal women, the activity of a standardized soy extract (SOYSELECT) and placebo when given alone or in combination with conjugated equine estrogens (CEE) on early climacteric symptoms. Lipid profile, pituitary hormones, osteocalcin and endothelin levels, and vaginal and endometrial parameters were also evaluated. DESIGN: Participants in the control group were given placebo, and participants in the treated group were given 400 mg/day of a standardized soy extract, corresponding to 50 mg/daily of isoflavones. After 6 weeks of treatment, CEE was also then given to each participant at a dose of 0.625 mg/day for 4 weeks. At the end of this period, soy and placebo treatment were suspended, and, until the end of the study (week 12), participants were administered 10 mg/day of medroxyprogesterone acetate in association with CEE (0.625 mg/day). RESULTS: When compared with pretreatment data, on week 6 of the study, a significant (p < 0.01) reduction in the mean number of hot flushes per week was observed in participants who were receiving the standardized soy extract, whereas a more marked relief was observed in both soy and placebo groups during CEE administration. Concurrently, the severity of hot flushes, assessed by means of the Greene climacteric scale, was also reduced in the soy group participants (p < 0.001, by paired t-test). No soy-related changes were observed on vaginal cytology, endometrial thickness, uterine artery pulsatility index, or metabolic and hormonal parameters tested. Finally, CEE-related changes on genital tract, uterine vascular compartment, and pituitary hormones were not modified by soy treatment. CONCLUSIONS: SOYSELECT may be a safe and efficacious therapy for relief of hot flushes in women who refuse or have contraindications for hormone replacement therapy.     

对酒依赖者的注意-操作能力测试

目的:了解酒依赖患者注意损害情况及其相关因素.方法:对39例酒依赖患者在入院时、入院治疗六周后及45例正常人进行了连续操作试验(CPT)测试,并对测试结果进行回归分析.结果:酒依赖者的所有CPT指标均高于正常对照组,入院治疗六周后有所好转,但仍比正常人高,入院时CPT结果与血液乙醇浓度、年龄及饮酒年限有关.结论:酒依赖者注意损害广泛而严重,注意损害与饮酒有关.