精神分裂症常用药物与用药原则

常用的抗精神病药物传统抗精神病药物为第一代抗精神病药物,又称经典药物或神经阻滞剂,按临床特点分为低效价和高效价两类,分别以氯丙嗪和氟哌啶醇为代表。近年来问世的非经典抗精神病药物,又称为第二代抗精神病药物。不但对幻觉、妄想等阳性症状有效,对情感平淡、意志减退等阴性症状也有一定疗效。其代表药物有利培酮、奥氮平、喹硫平、氯氮平及阿立哌唑等。     

2008年至2010年我院皮肤科抗组胺药物应用分析

目的研究我院抗组胺药的应用状况和发展趋势。方法采用金额排序和应用频度分析法对我院2008年至2010年度抗组胺药的使用情况进行统计分析。结果用药金额及用药频度呈逐年上升趋势,以第二代抗组胺药应用广泛。结论第二代抗组胺药在皮肤病治疗中起重要作用,氯雷他定和西替利嗪目前仍是我院治疗过敏性疾病的首选药物。     

利培酮治疗晚发性精神分裂症的效果观察

利培酮(Risperidone)系苯丙异恶衍生物,为第二代抗精神病药,是一种强5 -HT2A和相对弱的D2 受体拮抗剂[1] ,目前在临床应用中越来越广泛,对其研究也较多,但应用其治疗晚发性精神分裂症的报道甚少。氯丙嗪是195 2年第一个被发现的抗精神病药,是第一代抗精神病药的代表性药物之一,     

深圳市福田区129例慢性精神病患者用药调查分析

目的了解我院参加免费服药补贴精神病患者药物使用情况。方法采用1日法对深圳市福田区精神卫生中心福田区慢性病防治院2010年上半年参加免费服药补贴精神病患者全部用药记录进行调查。结果新型抗精神病药的使用正在逐步扩大,占总人数39.53%,精神疾病首选单药治疗,对于慢性难治性病例可使用合并治疗的用药原则基本保持不变;抗精神病药的使用剂量基本都在推荐的安全剂量之下。结论福田区参加免费服药补贴精神病患者用药基本合理,药物选择多样化、新型化,安全使用精神病药已成为目前临床用药的趋势。     

氯氮平血药浓度与疗效及性别关系研究

目的 探讨不同剂量氯氮平血药浓度与临床疗效及性别差异的关系。方法 以相同剂量氯氮平治疗65例精神分裂症患者。疗效用阳性症状及阴性症状量表(PANNS)进行评定，并测定治疗2周，5周及8周的血药浓度。结果 氯氮平血药浓度与临床疗效有明显关系。与性别差异无关。结论 氯氮平血药浓度的监测有助于指导临床个体化合理用药。     

精神分裂症住院病人用药性别差异情况调查分析

目的:为了解男女精神分裂症患者住院用药情况.方法:对我院精神科封闭病房住院接受抗精神病药物治疗的233例精神分裂症患者不同性别用药进行回顾性分析,其中男性117例,女姓116例.结果:男、女患者精神药物使用频率居首的为氯氮平,居前五位的均为氯氮平,舒必利,利培酮,氯丙嗪,奋乃静;单一抗精神病药物为主;非典型抗精神病药物的使用率超过典型抗精神病药物;服用前五位抗精神病药物的日平均最大剂量女性高:精神药物联合治疗男性高于女性.结论:住院精神分裂症病人在抗精神病药联合治疗上及部分药物的日平均最大剂量有性别差异.     

抗精神病药物联合治疗的有效性及安全性

精神分裂症是最致残和最占用医疗资源的疾病之一,很多患者需要终身进行治疗。长期以来,人们对于抗精神病药物联合治疗的合理性始终存有争议,几乎国内外所有临床治疗指南均推荐单一用药。然而在临床实践中,临床医师往往由于单药不能很好地控制精神症状而使用药物联合治疗。随着联合用药的使用频率越来越高,多种抗精神病药物联合治疗的有效性和安全性也越来越受到关注,联用多种抗精神病药物治疗精神分裂症成为了一个值得探讨的问题。本文综述国内外抗精神病药物联合用药的现状、抗精神病药联合使用的有效性及安全性,以供临床参考用药。     

精神分裂症后抑郁采用舍曲林联合抗精神病药物治疗的症状转归情况分析

目的研究分析精神分裂症后抑郁治疗中抗精神病药物与舍曲林的联合应用效果及影响。方法纳入本院精神科2017年2月-2019年2月期间收治精神分裂症后抑郁患者共107例设为研究对象,开展回顾性治疗研究,根据患者用方案意愿差异性将其分为对照组53例,观察组54例。对照组仅对症接受抗精神病药物单药治疗,观察组接受抗精神病药物舍曲林治疗方案。对比分析患者治疗前后阳性、阴性症状量表评分变化组间差异性、治疗期间各阶段抑郁评分变化、服药依从性、治疗效果差异。结果就诊时,患者各维度阳性、阴性症状量表评分结果对比无显著差异(P0.05);经连续服药4月后,两组各维度阳性、阴性症状评分均有不同幅度改善,且观察组各维度症状评分改善更为明显(P0.05);两组入院及治疗1月后的抑郁评分对比结果无统计学意义,P0.05;相较对照组,观察组自治疗2月起其抑郁症状评分均呈明显逐步下降趋势,且下降幅度显著(P0.05);观察组临床治疗总有效率、服药依从度均明显高于对照组(P0.05)。结论舍曲林与抗精神病药物联合用药方案在精神分裂症后抑郁治疗中的应用,可在实现对患者精神症状有效改善的基础上,通过对其治疗依从性的提升,提升治疗效果,并可对其抑郁症状实现有效缓解,可在临床中结合患者实际症状表现,酌情应用。     

喹硫平与利培酮治疗64例女性精神分裂症的对照研究

喹硫平和利培酮为目前常用的新型非典型抗精神病药,为多种神经递质受体拮抗剂,其对急、慢性精神分裂症的阳性和阴性症状均有效.笔者探讨非典型抗精神病药喹硫平和利培酮在临床应用中的疗效及安全性,对两药进行开放性临床随机对照研究.     

万古霉素治疗新生儿败血症的血药浓度监测与疗效

目的 探讨新生儿败血症病原菌特征,并分析血药浓度监测下万古霉素治疗的疗效,为临床安全用药提供参考。方法 选取2018年1月-2020年12月武汉市江夏区第一人民医院儿科采用万古霉素治疗并进行血药浓度监测的80例败血症新生儿,进行病原菌培养与鉴定,万古霉素给药剂量为10～15 mg/kg,后续根据血药浓度监测结果调整剂量。评价临床疗效,外周血炎症指标水平变化,药物不良反应。结果 共检出病原菌92株,其中革兰阳性菌80株,革兰阴性菌12株。药敏试验显示80株革兰阳性菌对万古霉素敏感率为100.00%。初次监测血药浓度中,仅有25例(31.25%)达到血药浓度最佳推荐值。调整用药剂量后,有52例(65.00%)达到血药浓度最佳推荐值。痊愈51例(63.75%),显效14例(17.50%),有效12例(15.00%),无效死亡3例(3.75%),总有效率为96.25%。相比给药前,患儿给药后的白细胞计数(WBC)、中性粒细胞/淋巴细胞比值(NLR)、超敏C反应蛋白(hs-CRP)、降钙素原(PCT)、白细胞介素-8(IL-8)、血清淀粉样蛋白A(SAA)、巨噬细胞炎症蛋白-2(MIP-2)、高迁移率族蛋白B1(HMGB1)水平下降(P<0.05)。治疗期间发生皮疹6例(7.50%),静脉炎4例(5.00%),无明显耳毒性。结论 万古霉素治疗革兰阳性菌感染的新生儿败血症疗效良好,炎症指标明显下降,对肝肾功能基本无影响。为保障用药安全性和有效性,有必要进行血药浓度监测,适当调整用药剂量。     

Clozapine or Haloperidol in rats prenatally exposed to methylazoxymethanol, a compound inducing entorhinal-hippocampal deficits, alter brain and blood neurotrophins' concentrations

SUMMARY: Rats exposed during prenatal life to methylazoxymethanol (MAM) display in postnatal age structural and behavioral deficits resembling those observed in schizophrenic patients. These deficits are associated with significant changes in brain nerve growth factor (NGF) and brain derived neurotrophic factor (BDNF), particularly in the hippocampus and entorhinal cortex. In the present study, we used the MAM model to investigate in young rats the effect of antipsychotics, Clozapine and Haloperidol, on brain and blood NGF and BDNF presence. Young animals were used because administration of antipsychotics during adolescence is a common feature of intervention. The results showed that administration of Clozapine and Haloperidol causes significant changes in the concentration of NGF and BDNF in the brain and bloodstream of MAM-treated rats. These findings indicate that these drugs may affect the synthesis and release of neurotrophins in the central nervous system and in the blood circulation. In addition, the MAM model can be a useful tool to investigate the biochemical and molecular mechanisms regarding the effects of antipsychotics.     

三种非经典抗精神病药物对分裂症患者血脂影响

目的:探讨非经典抗精神病药物对分裂症患者血脂的影响。方法:随机收集90例住院分裂症患者,服药三种非经典抗精神病药物(氯氮平、利培酮以及阿立哌唑),治疗前后分别检查胆固醇(TC)、高密度脂蛋白(HDL)、甘油三酯(TG)、载脂蛋白A(ApoA)、载脂蛋白B(ApoB)。结果:①治疗后三组血脂的TC、TG、HDL、ApoA项目无统计学差异,而ApoB存在统计学差异(P0.01,)阿立哌唑组氯氮平组利培酮组;②治疗前后血脂各项目配对比较中,TC、HDL、ApoA及ApoB无统计学差异(P0.05),而TG项具有统计学差异(P分别为:0.027,0.000,0.001),治疗后TG升高。结论:氯氮平、利培酮以及阿立哌唑治疗分裂症对载脂蛋白B具有不同程度的影响,三种抗精神病药物治疗中都升高甘油三酯。     

Curvature-adjusted optimal design of sampling times for the inference of pharmacokinetic compartment models

In pharmacokinetics, compartment models are often used to describe the time course of blood concentration after the administration of a drug. In this article, we propose an optimal design criterion for precise estimation of parameters included in the compartment model and illustrate the non-sequential design of sampling times of blood drug concentration data in individual pharmacokinetics. The proposed optimal design criterion minimizes the determinant of the mean-squared error matrix of the parameter estimator that is quadratically approximated by the curvature array. Therefore, the proposed criterion considers the intrinsic and parameter-effects nonlinearity underlying the compartment model, and so is applicable in a pharmacokinetic experiment where the sample size of the blood drug concentration data is quite small.     

The effects of antipsychotic treatment on quality of life of schizophrenic patients under naturalistic treatment conditions: An application of random effect regression models and propensity scores in an observational prospective trial

The study examines the effect of different types of antipsychotic treatment on the health related quality of life (HRQL) of people with schizophrenia under naturalistic outpatient treatment conditions. In a prospective study design, 307 schizophrenic patients were followed over a period of 2.5 years. HRQL, clinical characteristics, and type of antipsychotic medication were assessed five times every 6 months. HRQL was assessed by the SF-36. Random effect regression models were computed for the SF-36 mental (MCS) and physical (PCS) component scores. Propensity scores were included in the regression models to reduce a possible sample selection bias. Monotherapeutic treatment with new atypical neuroleptic drugs had a more positive effect on the mental health related quality of life (MCS) in comparison to treatment with polypharmacological treatment but not with oral conventional antipsychotics. Monopharmaceutical treatment with depot-antipsychotic drugs had a more positive effect on the physical health related quality of life (PCS) in comparison to polypharmacological treatment. Study results indicate that atypical antipsychotic drugs are not superior to conventional antipsychotics with regard to the effect on QOL. However, monopharmaceutical treatment can be assumed to be more effective in improving mental and physical related QOL than polypharmaceutical treatment.     

精神分裂症住院患者并发糖尿病的危险因素研究

目的探讨精神分裂症患者伴发糖尿病的可评估性危险因素。方法回顾性调查符合CCMD-3诊断标准的住院精神分裂症患者中的糖尿病发病情况以及抗精神病药物的使用情况等相关因素,并观察体重、血糖和血脂的变化。结果在230例精神分裂症患者中,并发糖尿病者为22例,其发生与患者年龄、病程、使用抗精神病药物以及体重、血脂和阳性糖尿病家族史有相关性。结论精神病人群,年龄较大、病程较长以及长期使用抗精神病药物均可增加糖尿病的发生率。     

Developmental Toxicity of Lead-Contaminated Sediment to Mallard Ducklings

Sediment ingestion has been identified as an important exposure route for toxicants in waterfowl. The toxicity of lead-contaminated sediment from the Coeur d'Alene River Basin (CDARB) in Idaho was examined on posthatching development of mallard (Anas platyrhynchos) ducklings for 6 weeks. Day-old ducklings received either untreated control diet, clean sediment (24%) supplemented control diet, CDARB sediment (3,449 μg/g lead) supplemented diets at 12% or 24%, or a positive control diet containing lead acetate equivalent to that found in 24% CDARB. The 12% CDARB diet resulted in a geometric mean blood lead concentration of 1.41 ppm (WW) with over 90% depression of red blood cell ALAD activity and over threefold elevation of free erythrocyte protoporphyrin concentration. The 24% CDARB diet resulted in blood lead of 2.56 ppm with over sixfold elevation of protoporphyrin and lower brain weight. In this group the liver lead concentration was 7.92 ppm (WW), and there was a 40% increase in hepatic reduced glutathione concentration. The kidney lead concentration in this group was 7.97 ppm, and acid-fast inclusion bodies were present in the kidneys of four of nine ducklings. The lead acetate positive control group was more adversely affected in most respects than the 24% CDARB group. With a less optimal diet (mixture of two thirds corn and one third standard diet), CDARB sediment was more toxic; blood lead levels were higher, body growth and liver biochemistry (TBARS) were more affected, and prevalence of acid-fast inclusion bodies increased. Lead from CDARB sediment accumulated more readily in duckling blood and liver than reported in goslings, but at given concentrations was generally less toxic to ducklings. Many of these effects are similar to ones reported in wild mallards and geese within the CDARB. Received: 2 September 1999/Accepted: 10 February 2000     

Price adjustment in the hospital sector

We analyse the properties of optimal price adjustment to hospitals when no lump-sum transfers are allowed and when prices differ to reflect observable exogenous differences in costs. We find that: (a) when the marginal benefit from treatment is decreasing and the cost function is the power function, price adjustment for hospitals with higher costs is positive but partial; if the marginal benefit is constant, the price is identical across providers; (b) if the cost function is exponential or it is separable in monetary and non-monetary costs (and linear in monetary costs), price adjustment is positive even when the marginal benefit is constant; (c) higher inequality aversion of the purchaser increases concentration in prices and lowers concentration in quantities; (d) if some dimensions of costs are private information, a higher correlation between the observable and unobservable cost component increases the optimal price for providers whose observable costs are above the average.     

Pharmacologic management of psychosis in the elderly

Antipsychotic medications are the pharmacologic agents of choice for treating psychosis in elderly persons. Age-related physiological changes make older persons more sensitive to the therapeutic and toxic effects of antipsychotics. There is a paucity of controlled studies on the efficacy of antipsychotic medications in older persons. Existing data suggest that atypical antipsychotics are at least as efficacious as and better tolerated than the conventional agents. For elderly persons, important adverse effects of antipsychotics include sedating, anticholinergic, and cardiovascular effects, extrapyramidal symptoms, and tardive dyskinesia. Some atypical antipsychotics appear to carry a risk of metabolic changes. Clinical recommendations include a thorough diagnostic evaluation followed by treatment with atypical antipsychotics at low dosages. It is essential that medication be combined with an appropriate psychosocial intervention in order to optimize its effect. Non-antipsychotic medications may provide useful adjunctive or alternative treatment and should be considered on a case-by-case basis.     

正常妊娠晚期母婴乙型肝炎表面抗体浓度相关性研究

目的定量研究正常妊娠晚期母婴乙型肝炎表面抗体(HBsAb)浓度相关性.方法 152例乙型肝炎表面抗原阴性产妇,分娩前24 h抽静脉血;其新生儿收集脐血.用酶联免疫吸附(ELISA)法检测母血HBsAb;用时间分辨免疫荧光分析(TRF)法测HBsAb定性阳性的母血及其相应脐血的HBsAb浓度.结果 ELISA法检测母血HBsAb阳性率为28.95%(44/152);TRF法测母血HBsAb浓度>10 mU/mL者41例(>10 mU/mL为阳性),与ELISA法相符率为93.18%(41/44),测母血HBsAb阳性对应脐血的HBsAb浓度>10 mU/mL者42例.44例母血HBsAb阳性组中,其相应脐血有68.18%(30/44)HBsAb浓度高于母血.结论正常妊娠晚期HBsAb可通过胎盘主动转运至胎儿体内,脐血中HBsAb浓度与母血呈显著正相关,且遵循妊娠晚期IgG胎盘转运的一般规律.     

Atypical antipsychotic drugs

In recent years several new antipsychotics have come to market in the Netherlands (i.e. risperidone, olanzapine and quetiapine). These compounds are called atypical for their lack of the extrapyramidal side effects typical of older antipsychotics. Clozapine, which was developed earlier, is also an atypical antipsychotic drug. The new antipsychotics have proven to be more effective than the old ones in reducing the negative symptoms and in improving the cognitive deficits of schizophrenia. Moreover, they indeed induce less extrapyramidal side effects than the older antipsychotics. Head-to-head comparisons of the atypical antipsychotics are sparse. Studies comparing low-dose regimens of the typical antipsychotics with the atypical drugs as well as relapse prevention studies are needed before it can be decided whether the atypical drugs can replace the older compounds.