精神分裂症患者乙型肝炎病毒感染调查

目的:调查精神分裂症患者的乙型肝炎病毒(HBV)感染与肝功能异常情况。方法:对312例精神分裂症住院患者的HBV感染及丙氨酸氨基转移酶(ALT)异常进行流行病学调查,以健康体检者279名为对照。结果:精神分裂症患者的HBV感染率为71.8%,ALT异常率为29.5%,明显高于对照组,精神分裂症患者中两性间HBsAg阳性率以男性显著较高。再次住院患者的HBV感染显著比首次住院患者高。结论:对精神分裂症患者应加强隔离措施,特别是HBsAg阳性的患者,防止交叉感染;加强健康教育,加强饮食营养支持和乙肝疫苗的接种等措施。     

社区精神分裂症患者服药依从性调查及影响因素分析

目的探讨社区精神分裂症患者服药依从性及影响因素。方法对上海市虹口区8个街道社区卫生服务中心登记在册的精神分裂症患者服药依从性情况进行问卷调查,运用二元Logistic回归方法分析影响患者服药依从性的因素。结果入组的2342例社区精神分裂症患者中,服药依从性好者为2159例(占92.2%),服药依从性差者为183例(占7.8%)。Logistic回归分析结果显示起病形式缓慢(OR=2.230,95%CI:1.374～3.619,P=0.001)、自知力不全(OR=6.027,95%CI:1.769～20.533,P=0.004)或缺失(OR=9.306,95%CI:2.146～40.360,P=0.003)、病情严重程度评分 10分(OR=3.229,95%CI:1.765～5.910,P0.001)、就诊方式为未门诊(OR=15.413,95%CI:5.912～40.180,P0.001)、不定期复诊(OR=19.838,95%CI:11.914～33.032,P0.001)、监护情况差(OR=2.156,95%CI:1.402～3.318,P0.001)、近期有心理生活应激事件(OR=9.112,95%CI:2.854～29.085,P0.001)为社区精神分裂症患者服药依从性的不利因素。结论社区精神分裂症患者服药依从性的影响因素包括患者的起病形式、自知力、病情严重程度、就诊方式、复诊及时性、监护情况和近期心理生活应激事件,需针对性采取干预措施以提高社区精神分裂症患者服药依从性。     

中国汉族人泛醌NADH脱氢酶Fe-S蛋白1基因多态性与氯氮平所致代谢综合征的关联研究

目的:探索中国汉族精神分裂症患者人泛醌NADH脱氢酶Fe-S蛋白1(NDUFS1)基因多态性与长期服用氯氮平所致代谢综合征(MS)的关系。方法:收集388例长期服用氯氮平2年的慢性精神分裂症患者临床资料及代谢指标;分为MS组(159例)和非MS组(299例);对NDUFS1基因rs13024804、rs1044120、rs6435330、rs4147713这4个位点进行多态性检测,并进行组间及性别间分析。结果:NDUFS1基因4个位点各等位基因及基因型分布两组间差异无统计学意义;性别分层后发现,两组女性患者中携带rs1044120 T等位基因(GT+TT vs GG,P=0.002,OR=0.25,95%CI:0.10～0.61)、rs6435330 T等位基因(GT+TT vs GG,P 0.001,OR=0.21,95%CI:0.09～0.50)及rs4147713 G等位基因(TG+GG vs TT P=0.002,OR=0.26,95%CI:0.11～0.61)者患MS的危险性下降。男性患者中rs1044120位点T等位基因携带者血浆高密度脂蛋白水平显著高于非携带者[(1.33±1.26) mmol/L vs(1.09±0.48) mmol/L,P=0.034];女性患者中rs6435330位点T等位基因携带者舒张压显著低于非携带者[(71.43±7.134) mmHg vs (74.47±6.419) mmHg,P=0.032]。结论:在中国汉族精神分裂症患者中,NDUFS1基因多态性与氯氮平相关的MS无关联,女性患者中NDUFS1基因多态性与氯氮平相关的MS存在关联。     

社区精神分裂症患者低体重率及相关因素分析

目的探讨精神分裂症患者低体重率及相关社会人口学和临床特征危险因素。方法纳入503例社区精神分裂症患者与323名健康对照,以体质指数小于18.5 kg/m2定义低体重,比较两组低体重率;收集患者组社会人口学资料、临床资料以及实验室检查指标,阳性和阴性症状量表中文版(positive and negative syndrome scale,PANSS)评估患者精神症状,分析患者低体重的相关因素。结果社区精神分裂症患者低体重率为9.9%(50/503),对照组为1.5%(5/323),组间差异有统计学意义(P0.01)。多因素logistic回归分析显示,男性(OR=2.43,95%CI:1.74~3.39)、吸烟(OR=1.50,95%CI:1.21~1.86)、住院次数(OR=1.18,95%CI:1.06~1.31)、PANSS阴性症状因子分(OR=1.09,95%CI:1.04~1.14)是低体重的危险因素(均P0.05)。结论精神分裂症患者体重不足较为常见,远高于健康人群,需要重点关注男性、吸烟、多次住院及阴性症状突出的患者。     

住院精神分裂症患者合并代谢综合征的影响因素

目的分析住院精神分裂症患者合并代谢综合征(MS)的影响因素,为精神分裂症合并MS的早期干预提供参考。方法选取在佛山市顺德区伍仲珮纪念医院住院的207例精神分裂症患者为研究对象,均符合《精神障碍诊断与统计手册(第4版)》(DSM-IV)诊断标准,并根据《中国成人血脂异常防治指南》(2007年) MS诊断标准将患者分为MS组(n=62)和非MS组(n=145)。采用自制调查表收集患者一般资料和抗精神病药物使用情况,并进行腰围、血压、血脂、血糖测定。结果住院精神分裂症患者合并MS的患病率为30. 0%,MS组和非MS组在性别、糖尿病家族史、吸烟史方面比较差异均有统计学意义(P 0. 05或0. 01),Logistic回归分析显示,糖尿病家族史和吸烟史是住院精神分裂症患者合并MS的危险因素(OR=3. 228、2. 689)。结论糖尿病家族史和吸烟史可预测住院精神分裂症患者发生MS的风险。     

住院抑郁障碍患者合并心境稳定剂治疗的调查分析

目的了解住院抑郁障碍患者合并心境稳定剂(MS)的治疗情况,通过对患者的临床特征进行对比分析,探讨抑郁障碍患者合并使用MS治疗的影响因素。方法回顾性分析2016年1月～12月住院治疗的145例抑郁障碍患者的临床资料,对合并或不合并MS治疗的抑郁障碍患者人口学资料和疾病特征进行比较。结果合并MS治疗的患者比例33.8%(49/145)。与未合并MS治疗组相比,合并MS治疗组多伴有精神病性症状(49.0%VS 33.3%,χ~2=4.350,P0.05)。多元回归分析显示,性别(OR=2.656,95%CI:1.162～6.073,P0.05)、自杀(OR=0.456,95%CI:0.214～0.968,P0.05)、精神病性症状(OR=2.327,95%CI:1.068～5.068,P0.05)是抑郁障碍患者药物治疗中联合使用MS的影响因素。结论女性、不伴有自杀、伴有精神病性症状的抑郁障碍患者可能更多的联合心境稳定剂进行治疗。     

住院精神分裂症患者伴发非酒精性脂肪肝相关因素的性别差异

目的 探讨住院精神分裂症患者伴非酒精性脂肪肝（NAFLD）的患病率以及影响因素的性别差异。方法 选取2020年7月1日至2021年6月30日在上海市嘉定区精神卫生中心住院的316例精神分裂症患者为研究对象。采用多因素Logistic回归分析住院精神分裂症患者以及不同性别患者伴NAFLD的影响因素。结果 住院精神分裂症患者的NAFLD患病率为41.1%(130/316)，其中男性患者为42.1%(82/195)，女性患者为39.7%(48/121)。多因素Logistic回归分析显示，女性（OR=2.345,95%CI=1.159～4.743）、体重指数高（OR=1.445,95%CI=1.296～1.610）、甘油三酯高（OR=2.715,95%CI=1.709～4.315）、丙氨酸氨基转移酶（ALT）高（OR=1.019,95%CI=1.002～1.037）、住院时长长（OR=1.099,95%CI=1.040～1.162）、合并糖尿病（OR=2.879,95%CI=1.225～6.768）是住院精神分裂症患者伴NAFLD的危险因素（P<0.05）。多因素Logistic回归分...     

精神分裂症患者出院后药物治疗依从性的影响因素分析

目的:探讨精神分裂症患者出院后药物治疗依从性及相关影响因素。方法:对175例出院后的精神分裂症患者进行6个月的随访调查,通过电话、入户或门诊随访完成自编《精神分裂症患者药物治疗依从性调查问卷》,分析患者出院后药物治疗依从性及影响依从性的相关危险因素。结果:精神分裂症患者出院后药物治疗依从率仅为61. 1%(107/175例);影响患者出院后药物治疗依从性的危险因素包括缺乏疾病相关知识(OR=2. 319,95%CI:1. 56～3. 07)、药物不良反应(OR=6. 209,95%CI:4. 768～7. 650)、药物种类(OR=1. 931,95%CI:1. 257～2. 605)、对医师的信任较差(OR=2. 855,95%CI:1. 908～3. 801)、门诊不定期复诊(OR=3. 300,95%CI:2. 181～4. 419)及缺乏家庭支持(OR=4. 319,95%CI:2. 935～5. 703)等(P 0. 05或P 0. 001)。结论:精神分裂症患者出院后的药物治疗依从性较差,与缺乏疾病相关知识、药物不良反应、不定期复诊、缺乏家庭支持等影响因素有关。     

大面积脑梗死后出血性转化的危险因素分析

目的探讨大面积脑梗死患者急性期发生出血性转化的相关危险因素。方法回顾性分析102例大面积脑梗死患者的基本资料、治疗方法、生化指标等。按是否发生出血性转化分为出血性转化(HT)组25例和非出血性转化(NHT)组77例。对可能与HT相关的因素进行回归分析。结果 HT的发生率为24.51%;HT组总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、纤维蛋白原低于NHT组,差异有统计学意义;HT组脂蛋白a(LPa)高于NHT组,差异有统计学意义。Logistic回归分析显示,TC(OR 2.350,95%CI 1.333～4.143)、LDL-C(OR 2.361,95%CI 1.347～4.138)、LPa(OR 0.965,95%CI 0.947～0.983)、纤维蛋白原(OR 2.397,95%CI 1.133～5.071)是发生出血性转化的独立危险因素(P<0.05)。结论 TC、LDL-C、LPa纤维蛋白原是大面积脑梗死发生出血性转化的独立危险因素。     

首发精神分裂症患者营养状况调查及影响因素研究

目的 调查首发精神分裂症患者的营养不良状况，并分析其影响因素。方法 采用单纯随机抽样法，选取2020年1月至2022年6月于武汉市精神专科联盟机构入院的450例首发精神分裂症患者为研究对象。入院后收集患者的一般资料，根据欧洲营养不良风险筛查2002标准将首发精神分裂症患者分为营养不良组和营养正常组。采用单因素分析和多因素Logistic回归模型分析影响首发精神分裂症患者营养不良的因素。结果 450例首发精神分裂症患者中，营养不良患者占19.11%(86/450)。单因素分析结果显示，两组患者年龄、体重指数、有无配偶、是否合并骨质疏松症和是否拒食比较，差异有统计学意义（t/χ2=5.066、9.608、5.399、4.712、11.102;P<0.05）。多因素Logistic回归分析结果显示，年龄大（OR=1.446,95%CI=1.148～1.823）和拒食（OR=4.306,95%CI=1.865～9.944）是首发精神分裂症患者营养不良的危险因素（P<0.01），而体重指数高（OR=0.871,95%CI=0.782～0.871）是患者营养不良的保护因素（P<0...     

Diagnostic Difficulties and Treatment Implications

Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.     

Cognitive Dysfunction Associated with Antiepileptic Drug Therapy

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.     

Carbamazepine Efficacy in Adults With Partial and Generalized Tonic-Clonic Seizures

Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.     

Etiologic and Preventive Aspects of Epilepsy in the Child–Bridging the Gap Between Laboratory and Clinic

Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Predisposing and Causative Factors in Childhood Epilepsy

Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non-febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.     

Anticonvulsant Drugs and Cognitive Function: A Review of the Literature

Summary: Alterations of cognitive function are separate from disturbances of behavior seen in association with epilepsy. The nature of the cognitive disability may to a certain extent depend on the seizure type. Partial seizures, mainly derived from a temporal lobe focus, impair memory tasks, while generalized seizures seem to have more effect on attentional abilities. A number of studies, reviewed in this paper, suggest that anticonvulsant drugs further impair cognitive function. Maximal impairments are seen in patients receiving polytherapy: rationalization of polytherapy improves cognitive abilities. Studies in children and adults have allowed differentiation of the effects of various commonly used antiepileptic agents. Maximal cognitive deficits are seen with. phenytoin, while phenobarbital and sodium valproate induce moderate disturbances, and carbamazepine seems relatively free from such toxicity. Further research is needed on the interrelationship between types of seizure disorders, types of anticonvulsant medications, and cognitive function.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Treatment Considerations in Anticonvulsant Monotherapy

Summary: The long-standing practice of polypharmacy in treating epilepsy is giving way to use of monotherapy. Monotherapy can improve seizure control as well as reduce the risk of serious idiosyncratic reactions, dose-related side effects, and complex drug interactions. Monotherapy also offers improved compliance and cost-effectiveness. The basis of monotherapy is accurate diagnosis and assessment of the patient's seizure type(s), followed by selection of a single appropriate anticonvulsant drug. Many patients currently treated with multiple anticonvulsants can be successfully converted to monotherapy with a carefully monitored program in which troublesome and redundant drugs are gradually withdrawn from the therapeutic regimen.     

Effects of NMD A- and AMPA-Receptor Antagonists on Different Forms of Epileptiform Activity in Rat Temporal Cortex Slices

Summary: Lowering extracellular magnesium induces different patterns of epileptiform activity in rat hippocampus and entorhinal cortex. Short recurrent epileptiform discharges in the hippocampus are stable over time, whereas seizurelike events (SLEs) in the entorhinal cortex, the subiculum, and the neighboring neocortex develop into late recurrent discharges which are not blocked by clinically employed antiepileptic drugs. We tested the sensitivity of the different epileptiform discharge patterns to. /V-methyl-D-aspartate (NMDA)- and non-NMDA-receptor antagonists. As NMDA-receptor antagonist we used dextrorphan, ket-amine, and 2-aminophosphonovalerate (2APV); as α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA)-receptor antagonist we employed the quinoxaline derivative glutamate 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX). The findings show that the different patterns of epileptiform activity, including the late recurrent discharges, are sensitive to all NMDA-receptor antagonists. However, when dextrorphan was employed to suppress seizure-like events, later recurrent discharges did not develop during the remaining time course of the experiment. CNQX reversibly suppressed recurrent discharges in the hippocampus and SLEs in the entorhinal cortex. However, late recurrent discharges become insensitive to CNQX, even at a high concentration of 60 μM m. This finding suggests a prominent role for NMDA receptors in the generation of late recurrent discharges.