围绝经期抑郁症的中医治疗研究进展

抑郁症是围绝经期女性常见的精神疾病之一，而传统，中医治疗围绝经期抑郁症中受到越来越大的关注。本文对中医药治疗围绝经期抑郁症的研究进展作一综述。     

瘦素与围绝经期抑郁症的关系及研究进展

围绝经期（perimenopausal period）是女性抑郁症高发期,常表现为情绪低落、心绪紊乱等抑郁症状,且发病基础尚不明确,亟待寻求好的治疗手段。瘦素是一种由脂肪组织分泌的激素,在新陈代谢和神经保护方面均发挥功能。近年来,瘦素被报道对围绝经期抑郁症具有一定的改善作用,且瘦素与雌激素的合成及分泌关系密切。因此瘦素可能成为治疗围绝经期抑郁症的潜在分子靶点。本文针对瘦素与围绝经期抑郁症的关系及相关研究进展进行综述。     

激素替代治疗围绝经期抑郁症疗效观察

目的探讨激素替代治疗围绝经期抑郁症患者的临床疗效。方法将2018年12月~2019年12月本院接收的104例围绝经期抑郁症患者通过电脑随机分为两组,每组52例患者。常规组予以单纯抗抑郁药物治疗,研究组予以抗抑郁药物治疗+激素替代治疗。比较两组的效果。结果研究组临床疗效高于常规组(P<0.05);研究组用药之后第4周、第8周以及第12周时的汉密尔顿抑郁量表(HAMD)评分均低于常规组(P<0.05);研究组用药之后的雌二醇、卵泡刺激素、孕酮以及黄体生成素的改善情况明显优于常规组(P<0.05);研究组与常规组不良反应差异无统计学意义(P>0.05)。结论和单纯抗抑郁药物治疗相比,给围绝经期抑郁症患者加用激素替代治疗,可进一步减轻其抑郁症状,改善其激素水平,增加治疗效果,而且不增加不良反应。     

社区围绝经期女性心理问题及干预

目的总结社区妇女围绝经期心理问题及干预的护理体会。方法对社区围绝经期妇女患者采取针对性的个体干预措施如下：健康教育、心理干预、生物反馈疗法、生活方式干预和激素替代疗法（HRT）。结果通过对社区妇女围绝经期患者实施科学、有效的护理干预,减轻了围绝经期女性症状,提高了生活质量。结论对社区围绝经期女性患者实施护理干预,能提高患者的自我保健意识,降低心理障碍对身心健康带来的影响,收到较好效果。使其处于最佳心身状态,轻松、安全地渡过围绝经期。     

围绝经期综合征的心理支持干预效果分析

目的 探讨心理治疗治疗围绝经期综合征的疗效。方法 对46例围绝经期综合征患者分别采用心理治疗合并药物治疗（治疗组，n=25）和单纯用药物治疗（对照组，n=21），于治疗前及治疗8周末采用症状自评量表（SCL-90）评定疗效。结果 治疗组治疗后的躯体化、人际关系、抑郁、敌对因子分降低程度显著高于对照组，差异有显著性（P〈0．05）。结论 心理疗法对围绝经期综合征有治疗作用。     

文拉法辛治疗围绝经期抑郁症患者的对照研究

本研究以文拉法辛联合雌激素治疗围绝经期抑郁症患者,并与单用雌激素进行比较,报告如下。1对象和方法为我院2008年6月至2009年12月门诊或住院患者。均为女性;年龄45～60岁;符合世界卫生组织围绝经期定义,Kupperman绝经指数（KMI）≥17分;     

围绝经期综合征的心理支持干预效果分析

目的 探讨心理治疗治疗围绝经期综合征的疗效.方法 对46例围绝经期综合征患者分别采用心理治疗合并药物治疗(治疗组,n=25)和单纯用药物治疗(对照组,n=21),于治疗前及治疗8周末采用症状自评量表(SCL-90)评定疗效.结果 治疗组治疗后的躯体化、人际关系、抑郁、敌对因子分降低程度显著高于对照组,差异有显著性 (P＜0.05).结论 心理疗法对围绝经期综合征有治疗作用.     

正念疗法治疗抑郁症的研究进展

抑郁症的非药物治疗手段是药物治疗的一种有效补充，正念疗法是近年开展较多的一种 心理治疗方法，现通过归纳总结近几年国内外正念及其相关疗法的内涵、作用机制，对正念疗法在抑郁 症患者中的应用研究现状进行综述，为将来进一步的研究和临床应用提供指导和支持。     

数字疗法在精神科的临床应用与发展

数字疗法（digital therapeutics,DTs）是指利用计算机、智能手机和可穿戴设备等电子设备,通过软件程序和互联网技术,对疾病或症状进行评估、干预的一类非药物治疗方法,目前已证实其对多种精神障碍疾病存在良好的治疗效果。数字疗法能够改善睡眠障碍人群的失眠问题,增强注意力缺陷多动障碍患者的注意力和工作记忆能力,同时还能治疗抑郁症、焦虑症等疾病。数字疗法在未来将向个性化治疗、通俗化治疗、碎片化治疗、娱乐化治疗等方向发展,具有广阔的发展前景。     

围绝经期抑郁症诊治分析

围绝经期抑郁症是指初次发病于围绝经期，以情绪低落、焦虑不安、失眠为主要症状的疾病，发病年龄多在45～55岁，祖国医学称为郁症。自2005-01～2009-01，我院应用中西医结合的方法进行治疗并与单纯西医治疗进行对比，现报告如下。     

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.     

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.     

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.     

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.