氯氮平治疗600例精神分裂症临床观察

氯氮平治疗６００例精神分裂症临床观察曹典永以氯氮平单项用药治疗６００例首次住院的患者，符合ＣＣＭＤ－２精神分裂症的诊断标准。患者均为男性，年龄１６～６０岁，平均２０．８岁；病程３～３３年，平均３．５年。其中未分化型４８０例，偏执型１０８例，青春型１２...     

精神分裂症患者脑供血情况初步探讨

本研究报告５０例精神分裂症患者经颅多普勒检查结果，旨在寻找精神分裂症发病的器质性基础。１对象与方法随机抽取５０例符合ＣＣＭＤ－２－Ｒ精神分裂症诊断标准的住院病人作经颅多普勒检查，排除高血压及脑血管疾病。其中男２７例，女２３例；年龄１６～６０岁，平均３...     

碳酸锂治疗情感性精神障碍临床分析

对象为１９９５年４月～１９９７年６月住院的情感性精神障碍（按ＣＣＭＤ－２－Ｒ）患者２０４例，其中男１１７例，女８７例；年龄１６～６９岁，平均３８．３±１３．８岁；病程１月～４６年，平均９．７±９．４年。躁狂症１１１例，双相６０例，抑郁症３３例。以碳酸...     

精神分裂症自知力相关因素研究

按ＣＣＭＤ－２诊断标准，选择１９９７年２～６月期间精神分裂症住院患者５５例进行自知力相关因素研究。其中男２９例，女２６例；年龄１６～５５岁，平均２７±９岁；病程３月～２６年，平均７１±７８月；文化程度，初中２９例，初中以上２６例。按Ｃｒｏｗ标准（Ｂｒ...     

100例精神疾病住院患者用药调查

于１９９７年９月８日对我院精神疾病住院的患者１００例进行精神药物应用情况的调查，其中男６７例，女３３例；年龄１７～７４岁，平均３６．０±１３．２岁；住院１～５５４３天，中位数４５天。按ＣＣＭＤ－２－Ｒ标准诊断为精神分裂症７２例，情感性精神障碍１７例，...     

男性情感性精神障碍的出生季节

男性情感性精神障碍的出生季节孙振晓于相芬有关精神分裂症的出生季节，已有不少报告，而情感性精神障碍国内尚未见报告。作者调查１９９１年１月～１９９５年５月期间，首次住院的男性情感性精神障碍患者２６７例，诊断符合ＣＣＭＤ－２－Ｒ标准，年龄１８～６１岁，平均...     

SCL-90对100例脑卒中后遗症患者的测试

对１９９４年１月～１９９７年６月期间脑卒中后遗症患者１００例作ＳＣＬ－９０测试，以观察其心理状况。其中出血性患者３７例，缺血性患者６３例。男６９例，女３１例；年龄３８～８３岁，平均５５．３±７．５岁；均经ＣＴ或ＭＲＩ检查证实。以年龄，性别，职业，文化...     

未婚精神分裂症女性患者对婚姻的心态

对１９９０年３月～１９９６年６月期间的未婚精神分裂症住院女性患者进行调查，均符合ＣＣＭＤ－２－Ｒ诊断标准。年龄１８～２９岁，平均２２．１±３．８岁；病期４月～６年，平均２１．６±１８．４月；住院１～４次，平均１．３±０．７次。病情均已缓解，共１００例...     

伴有焦虑的抑郁症临床特征

本研究旨在探讨伴有焦虑的抑郁症患者特点。１　对象对１９９５年１月～１９９９年５月期间住院,符合ＣＣＭＤ－２－Ｒ抑郁症诊断标准的患者进行分析。共９９例,其中伴有焦虑症状者（研究组）４８例,不伴有焦虑症状者（对照组）５１例。２　结果研究组男２６例,女２２例;年龄１６～７０岁,平均（３８．１±１４．４）岁。对照组男２７例,女２４例;年龄１７～７２岁,平均（３４．２±１２．９）岁。两组患者的性别,年龄,职业,文化程度和病前性格等均无显著差异;两组患者的有无精神病性症状,单次、反复或双相发作等亦无显著差异…     

29例格林—巴利综合征患者的肌电图改变

现将我院收治的２９例格林－巴利综合征（ＧＢＳ）患者进行常规肌电图、运动神经传导速度（ＭＣＶ）及感觉神经传导速度（ＳＣＶ）检查结果分析如下。资料与方法一、一般资料：本组男２０例，女９例，年龄２～６７岁，平均２９岁。病程５天～２个月，平均０．６个月。本组...     

Evidence for three distinct classes of 'typical', 'psychotic' and 'dual' mania: results from the EMBLEM study

OBJECTIVE: To describe patients included in the European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM) study and to assess and clinically validate the presence of clinical subtypes of patients with acute mania. METHOD: The EMBLEM study is a 2-year prospective, observational study on the treatment and outcome of patients who are treated for a manic or mixed episode. Latent Class Analysis was used to define discrete groups of patients at baseline. RESULTS: Three groups were identified: 'typical mania' (59% of patients); 'psychotic mania' (27%) with more severe mania and presence of psychotic symptoms; and 'dual mania' (13%) with a high proportion of substance abuse. Patient groups differed in age of onset, social functioning and service needs. CONCLUSION: Dual mania represents a distinct and not infrequent subgroup of patients with mania. The exclusion of patients with comorbid substance problems from clinical trials creates a gap in our knowledge on treatment effectiveness.     

The expression of bipolar affective disorders in brain injured patients.

OBJECTIVE: A prospective study was designed to investigate the varied presentations of major affective disorders in patients with organic brain disease. METHOD: Patients admitted to our neuropsychiatry service, with affective and behavioral disturbances, and known neurological disorders, were classified, on phenomenological grounds, into the following groups: 1) elated mania; 2) irritable mania; 3) affective lability with periods of irritability, but without other symptoms pathognomonic for mania; and 4) intermittent psychosis with absent or ambiguous mood changes. RESULTS: A majority of patients in all four groups responded to pharmacotherapy with anti-cycling agents. CONCLUSIONS: It is proposed that these groups represent different expressions of mania in brain injured persons, and that these expressions range through a spectrum of phenomenology, included elated mania, irritable mania, episodic psychosis and explosive organic personality disorder. The DSM-III-R classification of these disorders, and approaches to their clinical management, are discussed.     

利培酮合并碳酸锂治疗急性躁狂临床对照研究

目的：比较利培酮和氯氮平分别合并碳酸锂治疗急性躁狂的疗效和安全性。方法：将符合CCMD－2－R诊断伯68例各型急性躁狂患者,随机分为两组,在使用碳酸锂的基础上分别联合利培酮或氯氮平进行为期8周的治疗。结果：利培酮组在治疗第2、4、8周周末显效率分别为18．8％,71．9％和87．5％,有效率为68．8％、87．5％、93．8％,与氯氮平组相似,但前者第1周周末有效率（28．1％）不及后者（55．6％）。结论：利培酮合并碳酸锂治疗急性躁狂具有与氯氮平合并碳酸锂相似的总体疗效、更安的安全性,但起效稍迟,可作为急性躁狂的一个选择。     

Cross-sectional similarities and differences between schizophrenia, schizoaffective disorder and mania or mixed mania with mood-incongruent psychotic features.

BACKGROUND: The cross-sectional clinical differentiation of schizophrenia or schizoaffective disorder from mood-incongruent psychotic mania or mixed mania is difficult, since pathognomonic symptoms are lacking in these conditions. AIMS OF THE STUDY: To compare a series of clinical variables related to mood and cognition in patient groups with DSM-III-R diagnosis of schizophrenia, schizoaffective disorder, mood-incongruent psychotic mania and mood-incongruent psychotic mixed mania. METHODS: One hundred and fifty-one consecutive patients were evaluated in the week prior to discharge by using the structured clinical interview for DSM-III-R-patient edition (SCID-P). Severity of psychopathology was assessed by the 18-item version of the brief psychiatric rating scale (BPRS) and negative symptoms by the scale for assessment of negative symptoms (SANS). Level of insight was assessed with the scale to assess unawareness of mental disorders (SUMD). RESULTS: There were no differences in rates of specific types of delusions and hallucinations between subjects with schizophrenia, schizoaffective disorder, psychotic mania and psychotic mixed mania. SANS factors scores were significantly higher in patients with schizophrenia than in the bipolar groups. Patients with mixed state scored significantly higher on depression and excitement compared to schizophrenia group and, to a lesser extent, to schizoaffective group. Subjects with schizophrenia showed highest scores on the SUMD indicating that they were much more compromised on the insight dimension than subjects with psychotic mania or mixed mania. CONCLUSION: Negative rather than affective symptomatology may be a useful construct to differentiate between schizophrenia or schizoaffective disorders from mood-incongruent psychotic mania or mixed mania.     

情感性障碍患者脑诱发电位变异与自杀行为的相关性研究

目的探讨情感性障碍患者脑诱发电位(BEP)变异与自杀行为的关系。方法应用国产脑诱发电位仪,记录了41例抑郁症、24例躁狂发作患者和33名正常对照者的3种脑诱发电位。结果与正常对照组相比,抑郁症和躁狂发作组均出现脑诱发电位主成分波幅降低,抑郁症VEP/P2潜伏期延迟[正常对照组(194±19)m s,抑郁症自杀史阳性组(212±22)m s,抑郁症自杀史阴性组(209±17)m s,P<0.01]。两组患者的BEP改变主要与患者有无自杀行为史有关。结论脑诱发电位临床价值得到了初步证实,与自杀行为相关的生物学指标研究中需进一步追踪随访。     

Higher Impulsivity and HIV-Risk Taking Behaviour in Males with Alcohol Dependence Compared to Bipolar Mania: A Pilot Study

To study the association of impulsivity, high-risk behaviours and incidence of HIV infection in patients with alcohol dependence and bipolar mania. This was a cross-sectional hospital-based pilot study and the sample consisted of male patients divided into three groups: 25 patients with alcohol dependence and 25 with bipolar mania as per ICD-10 Diagnostic Criteria for Research and 25 normal controls. Severity of Alcohol Dependence Questionnaire (SADQ) and Young Mania Rating Scale (YMRS) were administered on alcohol dependent and bipolar patients, respectively. All three groups were rated on Barrett’s Impulsivity Scale (BIS) and HIV Risk-taking Behaviour Scale (HRBS). None of the patients tested positive for either HIV 1 or 2. BIS motor impulsivity, BIS total score and HRBS total score were significantly higher in alcohol dependent patients as compared to bipolar mania patients. In the Alcohol dependent group, BIS score significantly correlated with education years, age of onset of alcohol use and SADQ, whereas, HRBS total score significantly correlated with SADQ scores. In the bipolar mania group, BIS significantly correlated with YMRS, and total number of episodes, whereas, there was no significant correlation of HRBS total score with any clinical variable. The findings of this pilot study underscore the link between alcohol use disorder and the impulsive behaviours that can lead to HIV infection, and highlight that those risks are higher for individuals with alcohol dependency than for individuals with bipolar disorder.     

Clinical characteristics of mania, mixed mania, and bipolar depression with psychotic features

This study investigated a series of clinical characteristics, including the level of insight into illness and axis I comorbidity, in 125 patients with bipolar disorder with psychotic features categorized in three groups: 62 patients with mania, 28 patients with mixed mania, and 35 patients with depression. All patients were hospitalized and were assessed in the week preceding discharge. The three groups did not differ in the severity of psychopathology as assessed by the Brief Psychiatric Rating Scale (BPRS). The mania group had a lower level of insight into the social consequences of illness than the other two groups, and compared with the group with depression, they had a lower level of insight of poor attention and of poor social judgment. As to axis I comorbidity, obsessive-compulsive disorder was found to be significantly more frequent in depression than in mania. Patients with depression more frequently reported a history of suicidality than those with mania, whereas they did not significantly differ from patients with mixed mania. Our results suggest that mixed mania as assessed at the time of the patient's discharge differs from mania and from depression with respect to a limited number of features among those examined. However, the overall level of insight into illness significantly discriminated mixed mania from mania, but not from depression.     

Personality features of patients with mixed and pure manic episodes

OBJECTIVE: To test the hypothesis that patients with a mixed manic episode show different personality features than patients with a pure manic episode. METHOD: Sixteen patients with a mixed manic episode (broad criteria) and 26 patients with a pure manic episode were assessed with diagnostic interviews (SCID I/II) as well as instruments for depression, mania and personality. RESULTS: Even after controlling for age as well as depression and mania score at assessment, no differences between the two groups emerged concerning either personality features as assessed with the NEO-five-factor inventory (NEO-FFI) or personality disorders. CONCLUSION: We found no difference between patients with mixed mania and patients with pure mania concerning their personality features. Possible reasons for this are being discussed.     

Prospective study of neuroleptic-induced dystonia in mania and schizophrenia.

OBJECTIVE: The authors' goal was to conduct a prospective study comparing the rate of occurrence of neuroleptic-induced dystonia in a group of consecutively admitted manic and schizophrenic patients receiving typical inpatient treatment from several clinicians. METHOD: All patients met the following criteria: 1) male sex, 2) age between 17 and 45 years, 3) definite diagnosis of mania or schizophrenia according to Research Diagnostic Criteria, 4) no exposure to neuroleptics during the past month, 5) absence of past or family history of a neurodegenerative disorder with extrapyramidal symptoms. All treatment decisions were left to the treating clinicians. Fifty patients with mania and 33 with schizophrenia were included in the study. Most of these patients received high-potency neuroleptics, but the specific neuroleptic used varied in the two groups. RESULTS: Twelve (24%) of the patients with mania and five (15%) of the patients with schizophrenia developed acute dystonia. Manic patients received significantly higher peak doses of neuroleptics during the risk period for dystonia. Stepwise multiple regression analysis revealed that the peak neuroleptic dose and age were most strongly related to the occurrence of dystonia. CONCLUSIONS: This prospective study failed to support the retrospective finding of another study that acute dystonia occurred more often in manic patients than in patients with nonparanoid schizophrenia. The authors conclude that there is a need for carefully controlled prospective studies with larger groups of patients.