家庭心理干预对首发精神分裂症患者的影响

目的:探讨家庭心理干预对首发精神分裂症患者社会功能及复发率的影响。方法:采用随机抽样方法将84例首发精神分裂症住院患者随机分为干预组和药物组。干预组在药物治疗的基础上,从患者精神症状基本缓解开始实施家庭心理干预。药物组仅接受药物治疗。入组时和治疗9个月、1年后分别进行简明精神病评定量表(BPRS)和社会功能缺陷筛选量表(SDSS)评定。结果:经9个月的家庭心理干预后,干预组BPRS总分及自知力因子分与药物组相比明显降低。1年后两组患者的治愈率、复发率和病残率均以干预组显著较好。结论:家庭心理干预对提高精神分裂症患者疗效,改善其社会功能,防止复发有重要作用。     

综合心理干预在治疗产后抑郁症中的应用

目的 探讨综合心理干预治疗产后抑郁症的疗效.方法 将59例产后抑郁症患者,随机分为综合治疗组和对照组.2组患者均予以抗抑郁药物治疗,综合治疗组在药物治疗同时接受综合心理干预治疗,观察时间为8周.分别在治疗前和治疗8周后采用汉密尔顿抑郁量表(HAMD)进行评定,了解评分的变化.结果 综合治疗组经8周治疗后治愈22例,显著...     

认知领悟治疗和家庭干预对精神分裂症患者治疗中依从性的影响

目的　联合家庭干预和认知领悟治疗法 ,观察其对精神分裂症患者维持治疗中依从性和疗效的影响。方法　将 2 0 0 1年 6月至 2 0 0 1年 12月间入住我院的 118例精神分裂症患者随机分为两组 ,干预组 :药物加家庭干预加认知领悟治疗 ,对照组 :药物加普通心理治疗 ,出院后随访 1年。采用简明精神病评定量表 (BPRS)、社会功能缺陷筛查表 (SDSS)评价疗效 ,观察依从性、复发率和病残率。结果　干预组完全依从性、不依从性、BPRS评分、SDSS评分、治愈率、复发率和病残率较对照组明显改善 ,有统计学差异 (P <0 0 5 )。结论　家庭干预和认知领悟治疗能提高精神分裂症患者维持治疗中的依从性 ,改善预后。     

心理与药物治疗对焦虑障碍疗效的对照研究

目的　探讨心理治疗在焦虑障碍治疗中的作用。方法　将 6 5名焦虑障碍患者随机分为两组 ,A组为心理治疗合并药物治疗组 ;B组为单纯药物治疗组。治疗 6周 ,于治疗前后分别用汉密顿焦虑量表 (HAMA)、临床疗效总评量表中的疗效总评分量表 (CGI GI)评定疗效 ,半年后再随访。结果　A组治疗 6周后HAMA评分下降更明显 ,半年复发率较低。结论　心理治疗合并药物治疗是治疗焦虑障碍的较好方法。     

阿立哌唑对精神病性抑郁的辅助治疗

目的:探讨阿立哌唑联合舍曲林治疗精神病性抑郁的疗效. 方法:62例精神病性抑郁患者随机分为合用组(阿立哌唑联合舍曲林)和单用组(单用舍曲林).治疗8周.以汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)和简明精神病评定量表(BPRS)评定临床疗效. 结果:治疗后两组HAMD、HAMA和.BPRS的评分均显著降低,尤以合用组明显(P<0.01));两组不良反应差异无显著性. 结论:阿立哌唑联合舍曲林治疗精神病性抑郁的疗效优于单用舍曲林,且耐受性好.     

黛力新联合心理干预对丘脑梗死后合并抑郁焦虑状态的影响

目的探讨黛力新联合心理干预对丘脑梗死后合并抑郁焦虑症状的治疗效果。方法采用自评抑郁量表(SDS)、自评焦虑量表(SAS)对140例丘脑梗死患者进行评分及测定,并对合并焦虑抑郁的102例患者分别进行干预,分为对照组(34例)、心理干预治疗组(34例)及药物和心理干预治疗组(34例),分析药物治疗、心理干预对患者愈后的影响。结果丘脑梗死后易合并抑郁焦虑状态,发生率72.9%,严重影响患者的日常生活能力。与干预前相比,经过为期6周的心理干预、药物和心理干预后,心理干预治疗组、药物和心理干预治疗组患者的SAS及SDS评分均明显降低(P0.01);对照组治疗前后的SAS及SDS评分无明显变化(P0.05)。结论丘脑梗死后患者常发生抑郁焦虑症状,药物和心理干预治疗可减轻丘脑梗死后抑郁焦虑症状。     

心理干预合并小剂量氯米帕明治疗早泄的对照研究

目的探讨心理干预合并小剂量氯米帕明治疗早泄的效果。方法将33例符合CCMD-3诊断标准的早泄病人随机分成单用氯米帕明治疗组与合并心理干预组。于治疗前、治疗后3周及6周进行性功能状况和TESS评定。结果两组疗效均显著;治疗后3周及6周的性功能状况评分与治疗前相比,其差异有显著性,合并组效果更好且持久。TESS评分两组无明显差异。结论氯米帕明能明显延长射精潜伏期,可用于治疗早泄,若合并心理干预则可提高疗效。     

小剂量抗精神病药联合心理疗法治疗躯体化障碍的疗效观察

目的观察小剂量抗精神病药联合心理疗法治疗躯体化障碍的临床效果。方法选取2015-05—2016-08我院诊治的躯体化障碍患者70例,采用随机数字法分为对照组(n=35)和观察组(n=35)。对照组采用心理疗法治疗,观察组联合小剂量利培酮治疗,比较2组临床疗效及安全性。结果观察组治疗后2周、4周、6周及8周HAMA17评分、HAMA评分,均显著低于对照组(P0.05);观察组不良反应发生率为8.57%,与对照组的11.43%比较差异无统计学意义(P0.05)。结论躯体化障碍患者在心理疗法基础上联合小剂量抗精神病药治疗效果理想,安全性较高,值得推广应用。     

综合干预对农村精神分裂症患者预后的影响

目的 探讨生物-心理-社会综合干预对农村社区精神分裂症患者预后的影响。方法 将符合入组标准的300例农村社区精神分裂症患者分为干撷组和对照组(每组各150例)。两组均服小剂量抗精神病药(折合氯丙嗪剂量为<300 mg/d),其中干预组同时接受生物-心理-社会综合干预及个案管理;于入组时和随访每半年时评定1次社会功能缺陷筛选量表(SDSS)、简明精神病评定量表(BPRS)、疾病严重程度量表(SI)、疾病总体进步量表(GI),3年共7次。结果 (1)入组时干预组与对照组相比,BPRS、SI、GI、SDSS评分的差异均无显著性(P>0.05);(2)综合干预1年时,干预组各量表的评分均低于对照组,差异有显著性(均P<0.01),并持续到随访结束。(3)随访结束时,干预组在掌握精神卫生知识、规律就医、接受精神科治疗、恢复工作能力等方面均好于对照组(均P<0.01)。结论 生物-心理-社会综合干预使农村社区精神分裂症患者的复发率明显降低。     

阶段性心理社会干预对精神分裂症的疗效

目的：探索分阶段的心理社会干预对首发精神分裂症患者的疗效。方法：采用随机抽样对48例首发精神分裂症住院患者随机平分为研究组和对照组。对照组接受常规药物治疗。研究组同时给予分阶段特殊的心理社会干预9个月，1年后随访。使用修改版的简明精神病评定量表（BPRS）及社会功能缺陷筛选量表（SDSS）评定疗效及预后。结果：研究组的BPRS总分及自积压力因子分与对照组相比明显降低。1年后随访，其治愈率，复发率及病残率均以研究组显著较好，SDSS总分也有明显降低。结论：阶段性心理社会干预对精神分裂症患者在提高疗效，改善社会功能，以及防止精神症状复发方面具有明显作用。     

A prospective study of postictal psychoses with emphasis on the periictal type

PURPOSE: To assess prospectively episodes of postictal psychosis. METHODS: We followed 108 consecutive patients with temporal lobe epilepsy, who were divided into three groups: those without psychotic episodes (n=87, N group), those with interictal psychosis (n=13, IIP group), and those with postictal psychosis (n=8, PIP group). The first episode of postictal psychosis, which was defined as a psychotic episode that occurred within 1 week after the end or within 3 days before the beginning of seizure clusters, was assessed with the Brief Psychiatric Rating Scale (BPRS) and Social Dysfunction and Aggression Scale (SDAS) during the observation period. RESULTS: The duration of illness was significantly different between the N and PIP groups (p=0.004) and between the N and IIP groups (p=0.039). The average initial BPRS score (obtained 3.0 days after the end of the seizure cluster) was 19.7, and then decreased to 5.8 after 1 week, and finally normalized at 1.5 after 1 month. A statistically significant decrease in BPRS scores was found between the initial assessment and those obtained after 1 week (p=0.011). Those who had psychotic episodes without a lucid interval tended to have episodes more often than monthly, and experienced additional seizure recurrence even during the psychotic episodes. Two patients exhibited a frank manic phase, and three patients showed excessively aggressive behavior, as determined by the SDAS. CONCLUSIONS: Postictal psychosis should be subdivided into the nuclear type, with an established clinical picture as an indirect aftereffect of seizure activity, and the atypical periictal type, which is a direct manifestation of limbic discharge.     

集体心理干预对精神分裂症患者的康复作用

目的 探讨集体心理干预对恢复期精神分裂症患者的康复作用。方法 将200例恢复期住院精神分裂症患者随机分成两组,对其中的100例进行集体心理干预(干预组),并与对照组(未干预)比较。采用BPRS、IPROS、SDS及SAS于干预前和干预后3个月时进行量表评定。结果 干预组在干预后3个月时患者的社会功能缺陷程度明显降低,IPROS总分与干预前比较有非常显著性差异(P<0.01),BPRS总分较干预前有极显著性差异(P<0.001),同时患者的焦虑、抑郁情绪亦均有明显的减轻,SAS及SDS标准分与干预前比较均有非常显著性差异(P均<0.01);而对照组除BPRS总分较前有显著性差异外(P<0.05),其余各量表均无显著性差异(P均>0.05)。两组在干预后各量表评分比较均有非常显著性差异(P均<0.01)。结论 临床上对恢复期精神分裂症患者实施集体心理干预,能帮助患者减轻心理障碍,提高社会适应能力。     

家庭干预对首发精神分裂症患者辅助治疗的随访研究

目的:探讨家庭干预对首发精神分裂症患者预后的影响。方法:将90例首发精神分裂症患者随机分为抗精神病药物合并家庭干预组(干预组,45例)及单用抗精神病药物组(对照组,45例),进行为期1年的随访研究。采用家庭亲密度和适应性量表(FACESⅡ-CV)、家庭功能量表(FAD)、简明精神病评定量表(BPRS)、阳性症状评定量表(SAPS)及阴性症状评定量表(SANS)评估患者家庭状况和精神症状。结果:随访结束后,干预组家庭亲密度和适应性及家庭功能改善明显(P<0.01);干预组FACESⅡ-CV中的实际亲密度、理想亲密度因子评分显著高于对照组[(66.7±12.2)分、(57.7±10.4)分、(68.4±10.6)分、(55.8±9.7)分,P均<0.01],干预组FAD中的沟通、角色、情感反应、情感介入、行为控制及总的功能因子评分显著低于对照组(P均<0.05);两组BPRS、SAPS及SANS评分均较入组时有明显下降(P均<0.01),随访期干预组BPRS和SANS评分显著低于对照组[(19.6±10.7)分、(21.8±12.5)分、(16.7±6.4)分、(18.8±7.2)分,P均<0.01];多元逐步回归分析显示患者精神症状预后与基线期精神症状严重程度呈正相关,与基线期家庭功能及发病年龄呈负相关(t=2.65,-2.49,-2.79,P均<0.05)。结论:对精神分裂症患者进行家庭干预,可增加患者家庭亲密度和适应性,提高家庭功能,改善疾病预后。     

旅途精神病患者血清超氧化物歧化酶活性及丙二醛水平(英文)

背景 氧化应激是一种神经毒性因素,可能会促使急性精神病的发生。目的 评估旅途精神病(travel-induced psychosis)与氧化应激的关系。方法 对乘坐长途火车诱发的21例旅途精神病住院患者,在其入院时采用简明精神病评定量表(Brief Psychiatric Rating Scale,BPRS)评定精神症状,入院次日清晨测定其血清超氧化物歧化酶(super oxide dlsmutase,SOD)活性和丙二醛(malondialdehyde,MDA)含量;待患者精神病性症状缓解后(通常为小剂量抗精神病药治疗后2~6天),再次进行上述检测。选取性别、年龄匹配的21名健康志愿者为对照组,比较患者与对照者的血清SOD活性和MDA含量。结果 入院时患者的血清SOD活性和MDA含量均高于对照组。精神症状缓解后,患者的BPRS评分、血清SOD活性和MDA含量均显著下降,但后两者仍高于对照组。入院时患者的BPRS总分与SOD活性呈正相关(r=0.32,p=0.164),与MDA含量也呈正相关(r=0.34,p=0.126),但均无统计学意义。治疗后BPRS总分的下降与SOD活性的下降弱相关(r=0.28,p=0.217),也与MDA含量的下降也呈弱相关(r=0.29,p=0.211)。结论 研究结果提示,氧化应激的神经毒性作用与旅途精神病的发生直接相关。这或许能够帮助我们理解其他急性精神病性障碍(如精神分裂症)的发生。     

全程干预对首发精神分裂症患者的影响

目的:探讨全程综合性干预对首发精神分裂症患者社会功能及生活质量的影响。方法:将116例首发精神分裂症患者随机分为干预组和药物组各58例,其中脱落7例。两组均接受抗精神病药治疗,干预组同时接受全程综合干预措施1年。采用简明精神病评定量表(BPRS)、住院病人护士观察量表(NOSIE-30)、社会功能缺陷量表(SDSS)和生活质量综合评定问卷(GQOLI)分别于入组时及干预结束时进行评估。结果:入组时,两组所有量表评分差异均无显著性;干预结束时,干预组的BPRS、NOSIE-30中的总消极因素及SDSS评分均明显低于药物组;而NOSIE-30总分、总积极因素及GQOLI评分均明显高于药物组。结论:全程综合性干预措施有助于改善首发精神分裂症患者的精神症状,促进其社会功能的恢复,提高其生活质量。     

Relapse of paranoid psychotic state in methamphetamine model of schizophrenia.

The study of the clinical course of methamphetamine (MAP) psychosis yields insights into the biological aspect of the relapse of the paranoid psychotic state with hallucination in schizophrenia. A series of MAP psychosis studies in Japan conducted over a period of more than four decades revealed three types of clinical courses of MAP psychosis after discontinuation of MAP: transient type, prolonged type, and persistent type. Identification of the latter two indicates a lasting change in the brain that produces and maintains a schizophrenia-like paranoid psychotic state without MAP. The characteristic course seen in the transient type is acute recurrence of the psychotic state after a long remission period, almost identical to the initial episode, due to reuse of MAP or to psychological stressors. Such lasting vulnerability of the brain to schizophrenia-like psychotic symptoms may be caused by a lasting sensitization of the brain to the psychotogenic action of MAP resulting from its chronic abuse. Experimental studies using animals sensitized to MAP-induced stereotypy suggest that lasting enhancement of MAP-induced dopamine release in the striatum and nucleus accumbens is related to the development and expression of brain vulnerability to schizophrenic symptoms.     

Acute antipyschotic efficacy and side effects in schizophrenia: association with serotonin transporter promoter genotypes

BACKGROUND: The serotonin transporter (5-HTT) plays an important role in serotonergic neurotransmission. In the present study, we investigated the effects of the 44 bp insertion/deletion polymorphism in the promoter region of 5-HTT gene (5-HTTLPR) on symptomatology of psychosis and clinical response to antipsychotic drugs. METHODS: In total 56 patients acutely treated with haloperidol or risperidone either for the first episode of schizophrenia, schizophreniform or schizoaffective disorders, or for the relapse of these psychotic disorders after tapering their maintenance treatment, were genotyped for the 5-HTTLPR L and S alleles and for the new A/G functional variant within the L alelle (La/g). Psychopathological symptoms were assessed with the Brief Psychiatric Rating Scale (BPRS) and with Clinical Global Impression (CGI) twice: at 8-12 days after the first dose of antipsychotic and after 4 weeks. Extrapyramidal side effects were assessed with the Simpson-Angus Extrapyramidal Side Effects Scale (EPS), the Barnes Akathisia Scale (BARS) and the Abnormal Involuntary Movement Scale (AIMS). RESULTS: Age, body mass index (BMI), illness duration, drug type and dosage were considered as covariates when analysing association with genetic variants as they were associated with baseline or final BPRS and CGI scores and/or extrapyramidal side effects. 5-HTTLPR was not associated with baseline and final BPRS and CGI scores or with the CGI% reduction. However, the 5-HTTLPR S allele was associated with a lower improvement in BPRS scores (P=0.022) and this effect was even stronger after pooling subjects with S or Lg containing alleles (P=0.006). We did not observe any effect of 5-HTTLPR on acute antipsychotics side effects. CONCLUSION: Present result supports a contribution of serotonin system to neuroleptics efficacy for the treatment of schizophrenia. The analysis of the La/g functional variant may significantly improve the predictive power of 5-HTTLPR genotyping and represent a step further towards the development of the personalized antipsychotic treatment.     

A pilot study evaluating the effectiveness of individual inpatient cognitive-behavioural therapy in early psychosis

Background: Recent research indicates that cognitive-behaviour therapy (CBT) can be effective in ameliorating persistent positive symptoms in chronic psychotic patients. The effectiveness of CBT in acute and recent-onset psychosis has been little explored, although a recent pilot study indicated that CBT could significantly improve recovery in acutely psychotic inpatients. Method: Short-term individual CBT was compared to supportive counselling/psychoeducation (SC) as an adjunct to standard inpatient hospital care and medication in 21 inpatients experiencing a recent-onset acute schizophrenic episode. Results: Both groups showed significant reductions in Brief Psychiatric Rating Scale (BPRS) scores following treatment, although there were no group differences. Time to discharge did not differ significantly between the groups, although there was a greater variance for the SC patients. Two-year follow-up showed no significant differences between the groups, although the number of patients who relapsed, the number of relapses and the time to recurrence of psychotic symptoms was lower in the CBT group than the SC group. Interestingly, the time to readmission was shorter in the CBT group. Conclusions: CBT and SC are acceptable treatments for recent-onset acutely psychotic inpatients. A larger randomised controlled trial over multiple hospital sites is warranted. Accepted: 11 December 1998