“686项目”示范市(州)2011年抗精神病药物采购数据的地区分析

目的:了解"686项目"示范市(州)2011年抗精神病药物采购种类及费用在各地配置使用情况,比较抗精神病药物使用的地域性差异。方法:对2011年"686项目"示范市(州)药品采购资料,分析东部、中部、西部和东北四大地区抗精神病药物使用情况。结果:西部地区抗精神病药物采购经费(596.35万元)明显高于东部(476.88万元)、中部(287.46万元)及东北地区(299.06万元)。东北地区长效抗精神病药物费用支出占总费用的比例(30.35%),明显高于东部(5.82%)、中部(2.19%)及西部(4.04%)。结论:本项目中抗精神病药物选用偏好上存在地域差异。     

我院2006-2009年抗精神病药使用分析

目的 对我院抗精神病药物的使用数据进行分析,通过了解抗精病药在我院的使用情况,以对我院抗精神病药物的规范化管理提供合理、科学的依据.方法 对我院2006年-2009年使用的抗精神病药物的金额、用药频度及日均费用情况进行汇总和统计分析.结果 从用药金额角度分析,四年期间我院抗精神病药用药额度程上升趋势,其中非典型抗精神病药所占比例程逐年上升的趋势,而典型抗精神病药用药所占比例程下降趋势;舒必利为用药频度最高的药物;利培酮是用药金额最大的药物.结论 4年来我院抗精神药的应用与现代治疗需要的变化基本一致.     

天津市城镇职工基本医疗保险精神分裂症患者抗精神病药的使用情况及其医疗费用

目的:掌握天津市城镇职工医保精神分裂症患者抗精神病药物使用情况及其医疗费用,为临床决策提供参考。方法:本研究数据来源于2008-2010年天津城镇职工基本医疗保险参保人30%随机抽样。在2008-2009年间至少有1次精神分裂症诊断,首次诊断时使用抗精神病药且之后持续参保12个月的患者被纳入研究。描述抗精神病药使用类型和个数,并对医疗费用进行分析。结果:接受抗精神病药治疗的1739例精神分裂症患者作为研究样本。患者纳入研究时,1461例(84.0%)使用单一抗精神病药治疗;747例(43.0%)使用第一代抗精神病药,813例(46.8%)使用第二代抗精神病药,179例(10.2%)同时使用第一代和第二代两种抗精神病药。在随访12个月内,1387例(79.8%)患者坚持使用与首次药物处方同类型的抗精神病药物。患者年人均医疗费用为(12498.9±14575.2)元,其中仅使用第二代抗精神病药患者的年人均医疗费用低于仅使用第一代抗精神病药的患者[(9064.1±13209.8)元vs.(11928.6±13767.4)元,P0.001],此外12个月期间使用过第一代和第二代抗精神病药患者的年人均医疗费用为(18821.8±15702.7)元。结论:精神分裂症患者在药物治疗时以使用单一抗精神病药为主;第一代和第二代抗精神病药均处于重要地位;在接受药物治疗过程中,大部分患者坚持使用与首次处方同类型的抗精神病药。相比使用第一代抗精神病药的患者,使用第二代抗精神病药患者的总医疗费用较低。     

中国十省市第一代及第二代抗精神病药使用现况调查

目的:调查中国十省市第一代及第二代抗精神病药治疗精神分裂症的使用现况,并初步分析其相关因素。方法:选择2006年全国第2次精神药物处方方式调查中,符合国际疾病和相关健康问题分类第十版(ICD-10)精神分裂症诊断标准,并且接受单一、非长效抗精神病药治疗的4232例患者为研究对象,收集一般资料、临床症状及抗精神病药物使用情况等数据。结果:第二代抗精神病药使用比例明显高于第一代抗精神病药(70.8%vs.29.2%,P0.01)。使用频率居前6位的药物依次是利培酮(31.1%)、氯氮平(24.0%)、舒必利(10.3%)、氯丙嗪(9.7%)、奋乃静(8.4%)和喹硫平(5.9%)。与使用第二代药物的患者相比,使用第一代药物的患者年龄较大,男性比例较高,有家族史的比例较大,病程较长,家庭收入较低,就诊次数较少,发作次数较多(均P0.05);使用第二代药物的患者中妄想幻觉状态、言语行为紊乱、言语活动增多及攻击症状出现的比例高于使用第一代药物的患者(均P0.05),而阴性症状出现的比例较低(P0.01)。Logistic回归分析显示,江西(OR=1.29)和四川(OR=1.08)、年龄大(OR=1.02)、发作次数多(OR=1.03)、从事农业劳动(OR=1.21)的患者更倾向于选择第一代抗精神病药(均P0.01)。结论:第二代抗精神病药在我国精神分裂症患者的治疗中占主导地位。     

住院精神科病人抗焦虑药物应用调查分析

目的了解住院精神科病人中抗焦虑药的使用情况。方法调查对象为1家三级精神专科医院11月9日至11月25日期间在院的861例精神病人,经查阅住院病历,记录患者的一般资料和当日处方情况,分析抗焦虑药物的使用频度、日均剂量、用药时间及合并用药情况。结果861例住院精神病人有抗焦虑药物处方382例。抗焦虑药物以苯二氮卓类药物为主,有337例,占88%,其中的使用频度居首位75.7%。处方原因主要用于镇静催眠的占93.7%,抗焦虑的占16.8%。联合抗焦虑药物中,非典型抗精神病药多于传统的抗精神病药物,抗抑郁剂与抗焦虑药的联用比率较低,主要是5一羟色胺再摄取抑制剂（SSR I）。结论抗焦虑药物的用药剂量、用药原因是合理的,但不宜长期使用。     

门诊与住院精神分裂症患者首选药物调查

目的了解首次就诊患者抗精神药物应用现状。方法采用自行设计的调查表,顺序抽取我院每季度第一个月所有精神分裂症患者首次药物使用情况进行调查。结果①334例门诊精神病患者以使用非典型抗精神病药为主,奥氮平使用率最高(29.6%),其次为喹硫平(23.4%)、利培酮(23.1%)、阿立哌唑(14.4%);354例住院患者首选药物多为传统抗精神病药氟哌啶醇注射剂(28.8%),其他为非典型抗精神病药,依次为利培酮(28.5%)、喹硫平(17.8%)、奥氮平(8.8%)、阿立哌唑(6.5%);②住院患者合并使用抗精神病药者多于门诊患者,两者比较有非常显著的差异(χ2=144.91,P<0.01),使用最高的为非典型抗精神病药合并使用氟哌啶醇。门诊合并使用苯二氮卓类药物以及安坦者多于住院患者,两者比较均有非常显著的差异(2χ=6.91,P<0.01)、(2χ=19.5,P<0.01)。结论精神分裂症患者所接受的药物治疗比较规范和合理,非典型性抗精神病药已作为临床医生首选药物;部分医生对抗胆碱能药物和苯二氮卓类药物本身产生的不良反应给患者造成的危害认识不足。     

中国精神卫生服务模式改革的重要方向:686模式

本文全面介绍了"中央补助地方重性精神疾病管理治疗项目"实施7年来的主要内容和效果.该项目以崭新的"医院社区一体化"服务模式覆盖了全国160个市(州)的680个区县,实际覆盖人口3.3亿.共登记建档了28万例重性精神病患者,随访20万例次,提供免费药物治疗累计9.4万例次,免费收治患者1.24万人次.2006年1月至2011年4月的统计显示,随访患者病情维持稳定的比例从基线的67.0%增加到第5年的90.7%;所管患者的肇事率从基线的4.8%下降到0.5%;肇祸率从基线时的1.5%下降到0.同时将精神卫生服务半径从医院外展至平均74公里,培训多功能服务团队人员38.2万人、52.5万人次.其中专科医生1万人,占我国精神科医师的50%;约7万人参与686,其中精神专科医护人员与其他参与人员之比为1:7.25,7年来间接地将精神卫生服务队伍扩大了7倍.     

住院精神病人8年临床资料分析

目的了解我院住院精神病人的临床特点,为精神卫生防治提供科学依据。方法采用回顾性调查方法,对8年出院的病历资料进行调查,并与我市相同年份的GDP进行相关分析。结果女性多于男性,农村人口占多数(69.24%),初中及以下文化程度偏多73.57%,婚姻状态较差。各种诱因导致精神障碍发生率为(33.83%)。精神分裂症占首位(50.34%),神经症占第2位(11.36%),情感性精神障碍占第3位(10.48%)。治疗单一用药占(64.96%),抗精神病药物使用频度最高的是氯氮平(20.07%),其次利培酮(18.70%);抗抑郁药物使用频度最高的是帕罗西汀(9.90%),其次米氮平(3.66%),好转率(85.01%)。我市人均GDP与住院各类精神病人数之间成正相关。结论随着时代的发展,我市住院精神病人数有增加趋势,尤其是神经症病人数增加明显,提示加强心理卫生工作非常必要。     

抗精神病药物配伍联用品种与剂量关系的图谱分析

目的对抗精病药物配伍联用品种与剂量关系的图谱进行分析评价。为临床合理用药提供参考。方法回顾350例已出院的精神病患者的用药情况,用图谱进行统计分析。结果总共涉及的治疗方案有31种。其中,单用1种抗精神病药治疗方案有13种172例(49.15%);联用2种药的方案有19种139例(39.72%);联用3种药的方案有10种38例(10.85%);联用4种药的方案有1种1例(0.28%)。抗精神病药物二联用药例数居前5位的为喹硫平56例(34.26%),氯氮平48例(30.80%),利培酮45例(28.47%),奥氮平41例(26.07%),阿立哌唑36例(22.17%)。结论随着联用品种类增加,平均用药剂量成逐步减少,用量少于单用剂量,符合配伍使用基本原则。     

住院精神病人的精神药物调查

为了解基层医院对精神药物的使用情况，对本院住院病人的精神药物医嘱进行了调查．结果显示，用药种类21种。用药频度抗精神病药72．92％、抗震颤麻痹药28．17％、抗焦虑药12．29％、抗躁狂药5．89％、抗抑郁药3．60％。单用精神药占34．97％，2种合用61．43％，3药合用3．60％，表明本院精神药物种类有限、抗精神病药使用频度较高、合用药问题较突出。     

Secular change in menarche in women in Madrid

The age at menarche was estimated by recollection in 1617 women between the ages of 18 and 60 in Madrid and a nearby suburb, Pinto. The population of Pinto is working-class and the Madrid group, taken from residential neighbourhoods , belongs to the upper middle class. In both groups we found a diminution in average age at menarche, from 14.04 to 13.02 years in Madrid and from 14.55 to 13.16 years from about 1935 to about 1965 in Pinto. These changes have been more intense in the group which is less well-off economically, where living conditions have varied much more drastically.     

Intestinal helminthiasis in school children in Haiti in 2002

A survey on intestinal helminths in school children was conducted in Haiti in 2002. This first nationwide study involving the entire country was stratified by department according to urban and rural zones using the cluster method. Focusing on elementary school children (n=5792; age range 3 to 20 years), it involved 26 urban and 49 rural schools randomly selected. Stools were preserved in formalin and examined by the Ritchie technique. Thirty-four per cent of stools (1981/5792) tested positive for intestinal helminths with the following parasites identified: Ascaris lumbricoides (27.3%), Trichuris trichiura (7.3%), Necator americanus (3.8%), Hymenolepsis nana (2%), Taenia sp. (0.3%) and Strongyloides stercoralis (0.2%). The helminth prevalence was higher in rural (38.4%) compared to urban areas (30%). There was no significant difference in prevalence by sex and age. The importance of geohelminths changed from one department to another with the highest prevalence found in the Southern department of Grande Anse (73.7%) and the lowest prevalence in the Center department (20.6%). Five out of the country's nine departments had a similar prevalence varying from 25.5% to 28.2%. Intestinal helminthic polyparasitism was observed in a percentage of infested school children comprise between 3.4% and 28.6% according in relation to the geographical area. A program to fight against geohelminths in school children should be initiated as a public health priority. Albendazole is the drug of choice. Frequency of drug distribution should be based on the prevalence of geohelminths in each department.     

Experience in adult population in dengue outbreak in Delhi

A dengue outbreak has recently hit the Indian capital. We studied the clinical profile of adult patients. Five hundred and sixty patients of dengue infection were admitted in a specially created ward according to the criteria laid down by WHO. Haematemesis (28.28%), epistaxis (26.78%) and malena (14.28%) were some of the common presentations. Similarly lymphadenopathy, especially cervical (30.89%), palatal rashes (26.96%) and hepatomegaly (23.75%) were the most commonly encountered findings on physical examination. Most of the cases were of dengue fever with haemorrhage and only 2.5% cases were classified under dengue haemorrhagic fever or dengue shock syndrome. The average hospital stay was 3.4 days but only 9.8 hours in the eleven patients who died, suggesting their late arrival in preterminal situation giving little time for resuscitation. Thrombocytopenia was not a feature and only 12.85% patients had platelet count less than 70,000/cmm. Most of the patients who were admitted with thrombocytopenia, showed normalization in their platelet counts in next few days. Serological examination demonstrated evidence of recent dengue infection in 41.17% patients. Few patients required blood or platelet concentrate transfusion. Eleven patients died, three due to DIC, one of intracranial haemorrhage and seven due to massive gastric haemorrhage. Rest of the patients recovered completely. Thus we can conclude that recent outbreak in Delhi was of dengue fever with haemorrhage and mortality was very low in patients who came early to the hospital.     

Changes in the hypothalamic nuclei in in experimental allergy

Summary In rabbits subjected to prolonged sensitization and in which the Arthus phenomenon was induced there was a marked reaction of the hypothalamic nuclei. Staining by Gomori's method indicated a cellular swelling, loss of granules, and protoplasmic vacuolization in the supraoptic nucleus. There was a considerable increase in the size of the cross-sectional area of the cells. The same effects were much less well shown in the paraventricular nucleus. These results show that marked signs of increased neurosecretion developed in the animals at the height of the Arthus phenomenon.(Presented by Active Member AMN SSSR V. V. Parin) Translated from Byulleten Éksperimental'noi biologii i Meditsiny, Vol. 55, No. 4, pp. 110–113, April, 1963.     

Cerebellar noradrenergic systems in aging: studies in situ and in in oculo grafts

Age-related changes in noradrenergic function in the rat cerebellum were examined using electrophysiological and electrochemical techniques. Sprague-Dawley and Fischer 344 rats showed subsensitivity to norepinephrine (NE) locally applied onto cerebellar Purkinje neurons. The modulatory actions of NE on Purkinje cell-evoked activity was also examined. In young rats NE preferentially inhibits spontaneous activity more than evoked excitations when compared to control. These modulatory actions of NE are not seen in senescent Fischer 344 rats. The intrinsic vs. extrinsic influences determining the loss of efficacy to NE were examined using three groups of rats with in oculo cerebellar grafts. The first group had young grafts grown in young hosts and these grafts showed a potent response to perfused NE. The second group, old grafts in old hosts, showed a diminished responsiveness to NE with respect to the first group. The third group consisted of young grafts in old hosts. These grafts demonstrated a responsiveness to NE that was indistinguishable from those in the first group. The integrity of the presynaptic NE fibers was examined in the grafts using electrochemical techniques. No difference in the release of NE was observed in the old grafts. Taken together, these results suggest a loss of postsynaptic NE function that is intrinsically determined. The change in NE modulation could influence information processing within the aged cerebellar cortex. This deficit could underlie behavioral changes seen in senescence.