喹硫平联合舒必利治疗难治性精神分裂症的效果观察

目的：观察喹硫平联合舒比利对喹硫平治疗无效的难治性精神分裂症的效果。方法从我院筛选出120例喹硫平无效的难治性精神分裂症患者，随机分为2组，一组采用氯氮平治疗，另一组采取舒必利联合喹硫平治疗，治疗12周后应用阳性和阴性综合征量表（PANSS）和其分量表、临床整体印象-严重程度量表（CGI-S）、临床整体印象-改善量表（CGI-I）和副反应量表（TESS）分别评价2组疗效和不良反应。结果2组总体疗效无明显差异（P＞0.05），喹硫平联合舒比利对改善难治性精神分裂症患者代谢功能、阴性症状及安全性方面优于氯氮平（ P＜0.05）。结论对难治性精神分裂症伴代谢障碍或阴性症状较重者，可尝试喹硫平联合舒比利作为初始治疗方案，以减少使用或替代氯氮平，降低氯氮平的致命风险及对代谢功能的影响。     

小剂量喹硫平治疗广泛性焦虑临床对照研究

喹硫平是多种神经递质受体拮抗剂,小剂量(100～200 mg/d)喹硫平对5-HT和肾上腺素(NE)受体有高度亲和力,在理论上小剂量喹硫平治疗广泛性焦虑症(GAD)是可行的.为评价小剂量喹硫平治疗GAD的疗效,我们将之与疗效较肯定的新型抗焦虑药丁螺环酮进行临床对照研究.     

喹硫平治疗脑器质性精神障碍研究进展

非典型抗精神病药喹硫平临床应用广泛,已批准用于治疗精神分裂症、心境障碍(急性躁狂发作、双相障碍、重度抑郁等)。临床实验已有报道发现喹硫平可用于治疗脑器质性精神障碍,本文主要综述喹硫平治疗痴呆、脑血管病、颅脑损伤所致精神障碍的疗效及安全性,以期为喹硫平的临床使用提供参考依据。     

喹硫平治疗老年期痴呆患者精神行为症状的临床观察

目的探讨喹硫平治疗老年期痴呆患者精神行为症状的临床疗效和不良反应。方法50例老年痴呆患者按入院先后次序分成喹硫平组与阿普唑仑组,并在治疗前及治疗8周后进行评价,采用阿尔茨海默病病理行为评分表（BEHAVE-AD）评价疗效,采用不良反应量表（TESS）及有关实验室检查评价不良反应。结果喹硫平与阿普唑仑对老年期痴呆患者伴发的精神行为症状均有效。喹硫平组有效率为87．5％,阿普唑仑组有效率为66．7％,无统计学差异（χ^2=1．73,P=0．995）。喹硫平治疗8周后BEHAVE—AD总分及各因子分均下降,其中在幻觉、行为紊乱、攻击行为3个因子的得分比阿普唑仑组明显下降。喹硫平的不良反应较阿普唑仑轻,主要的不良反应是嗜睡、头晕和口干。结论喹硫平和阿普唑仑均可用于治疗老年期痴呆的精神行为症状,喹硫平的优势在于治疗老年期痴呆患者的行为和幻觉症状疗效更加明显。     

喹硫平和帕罗西汀单药治疗广泛性焦虑的随机对照研究

目的比较喹硫平单药和帕罗西汀单药治疗广泛性焦虑的疗效及安全性。方法将110例广泛性焦虑障碍患者随机分为喹硫平200mg/d治疗或帕罗西汀20mg/d治疗。疗程6周。用汉密尔顿焦虑量表（HAMA）、临床疗效总评量表严重度（CGI-SI）评定疗效,用副反应量表（TESS）、实验室检查及体重评定安全性。结果喹硫平组55例患者中有51例完成研究,帕罗西汀组55例中53例完成研究。喹硫平组有效率为74.5%,痊愈率为27.3%;帕罗西汀组分别为81.8%、50.9%。两组有效率差异无统计学意义,喹硫平组痊愈率高（χ^2=6.45,P=0.01）。两组HAMA、CGI-SI评分在治疗后均下降;喹硫平组第1周末HAMA总分低于帕罗西汀组;除第1周外,帕罗西汀组量表评分均优于喹硫平组。两组均未发生严重不良事件。喹硫平组嗜睡多见,帕罗西汀组出汗及激越多见;研究结束时,喹硫平组体重增加值高于帕罗西汀组[喹硫平组（M,QR）为1kg（0kg,1kg）,帕罗西汀组为0kg（0kg,1kg）;Z=4.0,P=0.01]。结论喹硫平短期控制广泛性焦虑障碍的症状比帕罗西汀快,但是帕罗西汀6周总体的疗效优于喹硫平。     

富马酸喹硫平临床应用专家座谈会在珠海市举行

由阿斯利康公司资助的富马酸喹硫平临床应用专家座谈会于2005年12月3日在珠海市举行，国内知名精神病学专家张明园、周东丰、顾牛范、蔡焯基、吴文源、江开达、孙学礼、赵靖平、李凌江、王高华、张晋碚、刘铁榜、赵振环、胡建等出席了会议。与会专家结合国内富马酸喹硫平临床应用现状进行了研讨并达成一定共识：（1）富马酸喹硫平抗精神病作用谱广，对精神分裂症的各种核心症状疗效可靠，属于精神分裂症治疗的一线用药。（2）正确的剂量和用法是取得疗效的关键。     

喹硫平与氟西汀治疗抑郁焦虑共病的对照研究

目的探讨喹硫平与氟西汀对抑郁焦虑障碍共病的疗效和安全性。方法收集抑郁焦虑障碍共病的患者80例,分为喹硫平组和氟西汀组各40例,疗程8周。使用汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）评定疗效,以治疗中出现的症状量表（TESS）评定不良反应。结果喹硫平组有38例、氟西汀组有37例完成8周的研究。治疗8周2组HAMD和HAMA量表减分率无统计学差异,治疗1周末喹硫平组疗效优于氟西汀组。治疗8周后喹硫平组有效率为89.5%（34/38）,氟西汀组为89.2%（33/37）。喹硫平组无转躁患者,氟西汀组1例转躁。喹硫平组头晕的发生率明显多于氟西汀组。结论喹硫平单药治疗抑郁焦虑障碍共病的疗效与氟西汀相当,喹硫平组头晕者较多。     

喹硫平治疗首发老年期精神分裂症对照研究

目的比较喹硫平和奋乃静治疗首发老年期精神分裂症的疗效和安全性。方法将64例首发老年期精神分裂症住院患者随机分为喹硫平和奋乃静组，分别给予喹硫平和奋乃静治疗。疗程8周，采用简明精神病评定量表（BPRS）评定疗效，以副反应量表（TESS）评定药物不良反应。结果喹硫平与奋乃静临床疗效差异无显著性。喹硫平的不良反应以嗜睡、直立性低血压较多，奋乃静锥体外系反应较重。结论喹硫平治疗首发老年期精神分裂症疗效较好，安全性高，有利于长期巩固维持治疗。     

阿立哌唑与喹硫平治疗精神分裂症对照研究

目的比较阿立哌唑与喹硫平治疗精神分裂症的疗效及安全性。方法将120例符合CCMD-3诊断标准的精神分裂症患者根据随机方案分别使用阿立哌唑与喹硫平治疗8周。并在治疗前和治疗后第1、2、4、8周表,采用阳性症状是与阴性症状量表（PANSS）、不良反应量表（TESS）评定疗效及不良反应。结果阿立哌唑组显效率93．30%,有效率81．7％：喹硫平组显效率96．7%,有效率83．3％,两组之间疗效差异无显著性（P〉0．05）;阿立哌唑组的不良反应发生率低于喹硫平组,但差异无显著性;两组药物引起的不良反应均为轻度或中度,患者耐受性较好．不良反应表现有所不同。结论阿立哌唑和喹硫平治疗精神分裂症疗效相当,不良反应轻,但不良反应表现有异同。     

喹硫平治疗双相抑郁的对照研究

目的评价喹硫平治疗双相抑郁的疗效和安全性。方法对双相抑郁采用随机分组、对照的方法,分别以喹硫平、碳酸锂治疗,疗程8周,以HAMD、CGI、TESS在治疗前和治疗后第1、2、4、6、8周末评价疗效和安全性,在第1、2,4、6、8周末及需要时用BRMS评定躁狂症状。结果（1）喹硫平和碳酸锂相比较,两组有效率分别为62．5％和58．3％,治疗第6、8周末HAMD总分和减分率差异无统计学意义（P〉0．05）。（2）治疗组不良反应发生率比对照组少（P〈0．05）。结论喹硫平单药使用可有效治疗双相抑郁,减少诱发躁狂的风险。     

眶颅沟通瘤的手术治疗

目的:探讨眶颅沟通性肿瘤的手术治疗方法。方法:14例病人中6例采用经额眶入路,8例采用经翼点入路进行手术。结果:肿瘤全切除12例,次全切除1例,大部切除1例。所有病人症状体征均明显改善。病理结果:神经鞘瘤3例,脑膜瘤3例,神经纤维瘤1例,间皮源性肉瘤1例,泪腺混合瘤1例,视神经星形细胞瘤1例,巨细胞肉芽肿1例,转移性鳞状上皮基底细胞癌1例,皮样囊肿1例及炎性假瘤1例。结论:上述两种手术入路可提高眶颅沟通性肿瘤的全切率;具备良好的手术技巧,可获得令人满意的治疗效果。     

双骨窗开颅术治疗骑跨上矢状窦硬膜外血肿的临床研究

目的探讨骑跨上矢状窦硬膜外血肿的手术治疗的方法及预后。 方法选择自2000~2013年间在绍兴市中心医院神经外科收治的45例骑跨上矢状窦硬膜外血肿病例的临床资料、手术方式及预后进行回顾性分析。其中23例患者采用上矢状窦旁的单骨窗开颅,窦旁硬脑膜悬吊加明胶海绵填塞止血,22例进行了上矢状窦旁的双骨窗开颅,矢状窦上保留骨桥后硬脑膜悬吊止血。 结果上矢状窦旁的单骨窗开颅组,恢复良好10例,轻度残疾4例,重度残疾4例,植物生存2例,死亡3例。上矢状窦旁的双骨窗开颅组恢复良好15例,轻度残疾5例,重度残疾1例,植物生存0例,死亡1例。两组的治疗效果双骨窗组好于单骨窗组,差异有统计学意义(Z=21.798,P=0.031) 结论骑跨上矢状窦的硬膜外血肿掌握好合适的手术适应证、手术方式,可获得满意的疗效。上矢状窦旁的双骨窗开颅可明显提高手术效果。     

Patients' perceptions of intensive case management

OBJECTIVE: The authors examined patients' perceptions of their case management care and the factors that influenced those perceptions. METHODS: A nine-item patients' perceptions questionnaire was administered to 225 patients with severe psychosis who were enrolled in a randomized controlled trial evaluating the efficacy of intensive versus standard case management. RESULTS: Factor analysis of the responses to the perceptions questionnaire revealed two principal components: quality of care received (including relationship and contact with the case manager) and overall perception of case management. Patients had a better overall perception of intensive case management compared with standard case management, but no significant differences were noted in perceived quality of care. Patients with female case managers had more positive perceptions of the quality of the care they received than those with male case managers. Several clinical and social variables were strongly associated with perceived quality of care but less so with overall perception of case management. CONCLUSIONS: Patients' general perceptions of intensive case management seemed more favorable than patients' general perceptions of standard case management, but no difference was noted in their perceptions of quality of care.     

Characteristics of mental health case management: results of a national survey

In the last several years, state mental health authorities throughout the United States have assigned a high priority to the funding, development, and operation of case management programs. Although the concept of case management has been in existence for over a decade, there is still confusion regarding the definition of case management and the identification of alternative case management approaches. Recognizing this confusion, the Center for Psychiatric Rehabilitation undertook a comprehensive study to determine the state of case management practice today. This article reports on the results of a national survey of case management programs and describes the characteristics of the programs themselves, the case managers, the clients they serve, and the systems within which they operate. Implications of these findings for a definition of case management are discussed.     

Observation psychiatrique : quelle valeur accorder à l’analyse sémiologique de la diffluence du discours du patient ?

The fact that for a given patient, assessing the intensity of a clinical sign is changed according to the diagnostic hypothesis of the clinician, is likely to reduce the semiological value of this clinical sign. This study aims to evaluate the semiological value of the sign “diffluent speech”. Twenty-seven psychiatric residents have conducted a semiological analysis of a filmed clinical case. They were randomly and blindly distributed into three groups. The clinical case was presented either as a case of schizophrenia, either as a case of manic episode, or as a case of borderline personality disorder. The psychiatric residents to whom the case was presented as corresponding to a case of schizophrenia evaluated a higher intensity of the sign “diffluent speech” compared to the psychiatric residents to which the case was presented as corresponding to a borderline personality disorder. To increase the semiological value of the examination of diffluent speech, we propose to distinguish two aspects: abnormalities of the rhythm of the speech and abnormalities of the semantic-pragmatic organization of the discourse.     

The effect of intensive case management on the relatives of patients with severe mental illness

OBJECTIVE: Relatives play a vital role in caring for patients with severe mental illness but receive inadequate support from psychiatric services. Evidence suggests that although intensive case management is directed primarily at patients, relatives may benefit as well. This study examined whether relatives of patients who were receiving intensive case management had more contact with mental health professionals than relatives of patients who were receiving standard case management. It also examined whether relatives of patients receiving intensive case management appraised caregiving less negatively and experienced less psychological distress than relatives of patients receiving standard case management. METHODS: The sample was drawn from the pool of patients participating in the UK700 randomized controlled trial of intensive case management. Prospective data on contact between case managers and the relatives of 146 patients were collected over a two-year period. At a two-year follow-up assessment, relatives of 116 patients were interviewed with the Experience of Caregiving Inventory and the 12-item General Health Questionnaire. RESULTS: Considerably more relatives of patients receiving intensive case management had contact with a case manager during the study period than relatives of patients receiving standard case management (70 percent compared with 45 percent). However, relatives of patients receiving intensive case management did not appraise caregiving less negatively or experience less psychological distress than relatives of patients who were receiving standard case management. CONCLUSIONS: Reducing case managers' caseloads alone will not guarantee adequate support for relatives. Instead, providing more support will need to be an explicit aim, and staff will require specific additional training to achieve it.     

A meta-analysis of the effectiveness of mental health case management over 20 years

OBJECTIVE: Meta-analytical methods were used to investigate the effectiveness of case management and to compare outcomes for assertive community treatment and clinical case management. METHODS: Controlled studies of case management published between 1980 and 1998 were identified from reviews and through database searches. The results were quantitatively combined and compared with results of studies of mental health services without case management. Combined effect sizes and significance levels for 12 outcome domains were calculated. Analysis of homogeneity was used to explore differences between models. RESULTS: Forty-four studies were analyzed; 35 compared assertive community treatment or clinical case management with usual treatment, and nine directly compared assertive community treatment with clinical case management. Both types of case management were more effective than usual treatment in three outcome domains: family burden, family satisfaction with services, and cost of care. The total number of admissions and the proportion of clients hospitalized were reduced in assertive community treatment programs and increased in clinical case management programs. In both programs the number of hospital days used was reduced, but assertive community treatment was significantly more effective. Although clients in clinical case management had more admissions than those in usual treatment, the admissions were shorter, which reduced the total number of hospital days. The two types of case management were equally effective in reducing symptoms, increasing clients' contacts with services, reducing dropout rates, improving social functioning, and increasing clients' satisfaction. CONCLUSIONS: Both types of case management led to small to moderate improvements in the effectiveness of mental health services. Assertive community treatment had some demonstrable advantages over clinical case management in reducing hospitalization.     

Chronic inflammatory demyelinating polyneuropathy associated with membranous glomerulonephritis: case report.

A case of Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) with Membranous Glomerulonephritis (MGN) is reported. This is the second case recorded in the literature and the article compares this case with the other reported case, including immunological implications.     

The case formulation in child and adolescent psychiatry

This article reviews the various definitions of case formulation, differences between diagnosis and case formulation, how case formulation for the child patient differs from the adult patient, and case formulation in the context of residency training, including challenges for residents transitioning from adult psychiatry. It presents a suggested structure for constructing a biopsychosocial formulation that can be applied in a training setting. Several specialized types of psychotherapy formulation are reviewed in more detail. The article concludes with a case example of a child psychiatry resident's case formulation before and after discussion in supervision.     

带状疱疹神经系统并发症14例报告

目的 :报道带状疱疹神经系统并发症。方法 :对 14例病例的临床研究 ,阐述该病的临床特征 ,并结合文献 ,简述其发病机制和治疗。结果 :14例临床症状不同类型的患者包括单独疱疹后神经痛 4例 ,膝状神经节带状疱疹患者 6例 ,带状疱疹性感染性多发性神经炎患者 2例 ,带状疱疹脊随炎患者 1例 ,带状疱疹脑膜炎患者 1例。结论 :带状疱疹可引起多种神经系统并发症 ,治疗的目的是及时阻止或减轻感染向中枢神经系统等其他部位播散的危险性以及预防疱疹后神经痛。