文拉法辛合并抗精神病药治疗精神分裂症阴性症状

以文拉法辛合并抗精神病药治疗以阴性症状为主的精神分裂症患者,报告如下.     

文拉法辛治疗精神分裂症伴抑郁症状对照研究

目的:比较抗精神病药合用文拉法辛与单用抗精神病药对精神分裂症阳性、阴性及抑郁症状的影响。方法:经利培酮治疗4周后好转的精神分裂症患者,经汉密尔顿抑郁量表(HAMD)评估伴有抑郁症状的63例患者随机分为两组,单用抗精神病药组(单用组)与抗精神病药合用文拉法辛组(合用组),疗程8周。结果:经治疗后,两组间阳性症状减分率差异无显著性,阴性症状减分率差异有显著性。合用组在治疗第1、2、4、8周末HAMD评分比单用组为低。结论:抗精神病药合用文拉法辛对精神分裂症伴抑郁症状疗效高,有益于阴性症状的改善,对于阳性症状稳定性无明显负面影响。     

文拉法辛对慢性精神分裂症的辅助治疗作用

对我院以阴性症状为主的慢性精神分裂症住院患者予抗精神病药合并小剂量文拉法辛治疗,报告如下.     

阿立哌唑治疗精神分裂症阴性症状Meta分析

目的探讨阿立哌唑与其他抗精神病药治疗精神分裂症阴性症状的疗效差异。方法用Meta分析对24项阿立哌唑与其他抗精神病药治疗精神分裂症阴性症状文章进行再分析,评价其合并效应量大小和综合显著性检验。结果阿立哌唑治疗前后的自身对照,提示阿立哌唑治疗精神分裂症阴性症状疗效明显,效应极强（χ2=15.32,P〈0.01）;与其他抗精神病药比较差异无显著性。结论阿立哌唑治疗精神分裂症阴性症状疗效显著,与其他抗精神病药差异无显著性,但差异效应因药物不同而异。     

文拉法辛合并舒必利治疗精神分裂症对照研究

目的:探讨文拉法辛合并舒必利治疗精神分裂症的疗效和安全性。方法:将68例精神分裂症患者随机分为研究组与对照组,研究组给予文拉法辛合并舒必利治疗,对照组用利培酮治疗,疗程8周,用阳性与阴性症状量表(PANSS)、简明精神病评定量表(BPRS)以及治疗中出现的症状量表(TESS)评定疗效和安全性。结果:治疗8周研究组总有效率为88.24%,对照组为67.65%,两组比较差异有统计学意义(P<0.05)。治疗后两组PANSS及BPRS评分均有明显下降(P<0.05或P<0.01),研究组下降更显著(P<0.05)。结论:文拉法辛合并舒必利治疗精神分裂症阴性与阳性症状疗效可靠,不良反应小。     

维思通与其它抗精神病药物治疗精神分裂症阴性症状对照研究的Meta分析

目的了解维思通与其它抗精神病药物对精神分裂症阴性症状疗效的差异.方法应用Meta分析对22项研究维思通与其它抗精神病药物治疗精神分裂症阴性症状进行再分析,评价其综合显著性差异和效应大小.结果①维思通治疗前后的自身对照综合检验Z=49.718,自由度44,P＜0.05;ESd=2.45,这两项结果表明维思通对阴性症状疗效明显、可靠.②维思通与非维思通抗精神病药物的比较综合检验Z=8.684,自由度44,P＞0.05;ESd=0.449.③维思通与氯氮平的比较综合检验Z=7.111,自由度28,P＞0.05;ESd=0.479.④维思通与舒必利的比较综合检验Z=2.444,自由度8,P＞0.05;ESd=0.196.⑤维思通与典型抗精神病药物的比较综合检验Z=4.873,自由度8,P＞0.05;ESd=0.523.结论维思通对精神分裂症阴性症状疗效明显,与其它抗精神病药物虽然没有显著性差异,但差异的效应因药物不同而异.     

盐酸文拉法辛对以阴性症状为主的精神分裂症患者听觉P300的影响

目的 研究盐酸文拉法辛对以阴性症状为主的精神分裂症患者听觉P300的影响,为临床治疗阴性精神分裂症提供理论基础。方法 60例以阴性症状为主的精神分裂症患者为对照组,服用抗精神病类药物进行治疗,60例以阴性症状为主的患者为研究组,使用抗精神病药物合并文拉法辛缓释片治疗。分别于治疗前及治疗后第5周末,对两组患者进行听觉P300检测以及阳性和阴性综合征量表（PANSS）评定。结果 研究组治疗后潜伏期P2、N2、P3均显著低于治疗前（P〈0.05）,其中N2、P3亦低于对照组（P〈0.01）,研究组治疗后波幅P3均高于对照组和同组治疗前（P〈0.01）;对照组治疗后潜伏期P2低于治疗前,波幅P2高于治疗前（P〈0.05）。研究组治疗后PANSS总分及阴性因子、阳性因子评分均低于对照组和同组治疗前（P〈0.01）。结论 盐酸文拉法辛可提高以阴性症状为主精神分裂症患者的认知功能,改善其听觉P300各项指标。     

文拉法辛联合氯丙嗪对精神分裂症阴性症状的改善作用

目的 探讨文拉法辛联合氯丙嗪治疗精神分裂症阴性症状的临床疗效.方法 将118例精神分裂症患者随机分为对照组与观察组,对照组患者接受氯丙嗪口服,观察组患者接受文拉法辛联合氯丙嗪口服,疗程8周.采用简明精神病量表（BPRS）及阴性症状量表（SANS）评估临床疗效,采用副反应量表（TESS）评估不良反应.比较2组临床疗效及不良反应发生率的差别.结果 治疗后8周,观察组BPRS总分及各项评分显著低于对照组（P＜0.05）;治疗后8周,2组SANS评分均显著下降（P＜0.05）,但观察组SANS评分显著优于对照组（P＜0.05）;观察组与对照组不良反应发生率比较差异无统计学意义（P＞0.05）.结论 文拉法辛联合氯丙嗪治疗精神分裂症可显著改善阴性症状,不良反应小.     

氯氮平联合美金刚治疗精神分裂症阴性症状对照研究

目的:探讨氯氮平联合美金刚治疗精神分裂症阴性症状的疗效及安全性. 方法:将64例以阴性症状为主的慢性精神分裂症患者随机分成两组,每组32例,两组在服用原有抗精神病药(氯氮平)的基础上,研究组联合美金刚治疗,对照组联合安慰剂治疗,观察12周.于治疗前、治疗8周及12周采用阳性与阴性症状量表(PANSS)、阴性症状量表(SANS)评定临床疗效. 结果:治疗8周及12周时研究组和对照组PANSS总分、阴性因子分及SANS总分较治疗前显著下降(P＜0.05或P＜0.01)),研究组较对照组下降更为显著(P＜0.05或P＜0.01). 结论:氯氮平联合美金刚治疗与单用氯氮平相比,可显著缓解精神分裂症患者的阴性症状.     

西酞普兰与文拉法辛治疗精神分裂症后抑郁的对照研究

目的 比较西酞普兰与文拉法辛治疗精神分裂症后抑郁症状的疗效和安全性.方法 50例精神分裂症后抑郁患者随机分为2组,分别用西酞普兰和文拉法辛治疗6周.采用汉密尔顿抑郁量表(HAMD),简明精神病量表(BPRS)和副反应评定量表(TESS)于治疗前和治疗1、2、4、6周末分别评定疗效和不良反应.结果 2组治疗后HAMD和 BPRS评分均较治疗前下降(P＜0.01),2组疗效无显著性差异(P＞0.05),2组不良反应发生率无显著性差异(P＞0.05).结论 西酞普兰与文拉法辛治疗精神分裂症后抑郁疗效相当,安全性高,不良反应轻微.     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of legislation of 1935 of interest to the department of Mental Hygiene

Psychiatric Quarterly -