妊娠及哺乳期精神障碍的药物治疗

精神药物的不良反应不仅对患者带来影响，而且可通过胎盘、乳汁使胎儿或新生儿出现不良反应，如过度镇静、锥体外系反应、中毒，严重时可致畸形，因此，为了母婴的健康，对这类患者进行精神科药物治疗时应尽量考虑周全，权衡治疗的利弊。现就妊娠期及哺乳期精神药物的应用做一综述，以供临床医生参考。     

住院精神病患者490例精神药物使用一日调查

自从抗精神病药氯丙嗪应用于临床以来,治疗精神疾病的新型药物层出不穷,目前,临床使用的精神药物有近2∞种,精神药物在精神疾病的治疗中起着极其重要的作用.精神药物一般分为以下几类:抗精神病药、抗抑郁药、情感稳定剂、抗焦虑药/镇静催眠药等.随着新型的精神药物的不断研制开发,将对精神疾病的治疗带来广阔的前景.为近一步了解精神药物的使用现状,本研究对本院住院精神病患者精神药物的一日使用情况进行了调查.     

C-反应蛋白检测在骨科患者抗感染治疗中的意义

目的:探讨C-反应蛋白(CRP)动态检测在骨科患者抗感染治疗中的意义。方法:使用特种蛋白检测仪(ARRAY),动态检测78例患者的C-反应蛋白在应用抗生素前后的变化。结果:患者的CRP含量因有无合并感染及应用抗感染药物的不同而存在差异。CRP的含量男女有差异,构成比无性别差异。结论:动态检测C-反应蛋白,对判断感染情况及临床治疗效果有一定价值。     

精神药物副反应的观察分析与护理

目前治疗精神疾病主要以精神药物应用为主。精神药物有效地促进患者的精神康复 ,然而几乎所有精神药物都存在不同程度的副反应。不同的药物所导致的副反应不尽相同 ,因此熟知药物及其副反应特点 ,对临床精神药物副反应进行仔细的观察分析 ,采用有效的护理措施 ,减轻药物副反应对患者造成的心理及躯体不适 ,提高患者服药治疗的依从性 ,在精神科护理中有重要意义。1　临床资料与方法1 1　一般资料　我病区 2 0 0 1年 5月～ 2 0 0 2年 2月住院精神病人 110人。均为男性 ,年龄 13～ 70岁 ,平均 (2 5 2 3±13 5 6 )岁。病程最短 3天 ,最长 41年 …     

功能性胃肠病的性别和年龄等因素

1.性别与流行病学功能性胃肠病多见于女性。功能性消化不良女性患者多出现胃排空延迟及水负荷实验耐受力下降。有证据支持,IBS受月经周期影响,女性患者在整个周期中消化道症状较健康女性重。2.性别与生物学因素FGID最好被视为一种由脑肠轴调节异常引起的生物心理社会疾病。该病导致了内脏痛感知、自主神经功能和内脏刺激中枢加工处理的改变。3.性别与心理因素在许多FGID相关研究中都进行了心理评估,其性别差异见表2。多数研究显示,门诊治疗的FGID患者存在精神疾病及心理压抑的比例较高(40%和60%)。4.性别与治疗反应心理治疗:英国的研…     

前方牵引联合快速扩弓矫治前牙反颌的头影测量分析

目的研究前方牵引联合快速扩弓矫治反颌的临床疗效。方法从临床收集乳牙期、替牙期、3-12岁无先天性颅颌面畸形，之前未接受过任何正畸治疗的骨性Class III错颌67例患者，采用前方牵引联合快速扩弓进行治疗。分别对治疗前后的头颅侧位片进行定点测量，然后取均值以减小误差。分三个方面比较：同一年龄组内不同性别的治疗前后效果差异；不考虑年龄因素，不同性别在治疗前后效果差异；不考虑性别，不同年龄在治疗效果差异。结果比较不同年龄组的男女性别差异时发现：除了3—6岁组的颌平面occlusal plan to PH有显著性差异外，其余未见显著性差异。结论垂直向的显著性变化常见于3～6岁；除了前面高ANS—Me，在9—12岁未见显著性垂直向改变；这些垂直向的变化，比如FMA、GoGn—SN、面轴角、ANS—Me尽管是反颌改善的部分机制，但对面中分发育不足的反颌没有直接的益处；在不同年龄组，未见显著性性别差异，仅在3—6岁组可见牙合平面的旋转方向存在性别差异。     

抗抑郁药的药效学性别异质性研究进展

抑郁症存在高患病率、高致残率和高自杀率的特点,严重影响患者的生活质量。药物治疗为该病的首选治疗方式,在临床治疗过程中,抗抑郁药物的药效学存在着明显的性别差异,可能与男女之间的大脑结构、性格、激素水平存在差异有关,但具体原因和机制尚未有统一结论。本文对抗抑郁药物的药效学性别异质性及其产生原因进行综述。     

精神科药物的正确认识和使用

自从1952年,第一个精神药物氯丙嗪被发现和应用以来,精神药物治疗经历了一个飞速发展的时期.此后,各种精神药物不断涌现,为患者的治疗提供了帮助.然而,目前人们仍对精神药物怀着各种各样的疑问.本文就精神药物的概念、分类、作用机制及合理使用进行阐述,以提高人们对精神药物的正确认识.     

帕金森病的性别差异及其原因探讨

流行病学调查发现帕金森病(Parkinson disease,PD)的发病存在性别差异,大多数研究认为男性更易罹患PD.Wooten等[1]对来自世界各地经Medline引用的统计资料进行荟萃分析,结果显示男性较女性患PD的风险明显要高.本研究拟将PD按性别、发病年龄分层,探讨雌激素在PD发病中的作用;同时将遗传、环境毒物接触、头外伤等因素对男女PD的影响进行比较,以期发现PD性别差异的原因.     

堵耳效应在纯音听阈测试中的影响

目的探讨不同性别年龄的听力损失患者在纯音听阈测试时,堵耳效应对纯音骨导测试的影响,浅谈临床测试中的体会。方法对54例不同年龄、不同性别的听力损失患者,按国际GB7583-87规定的上升法进行测试,以骨振器震动颅骨给声。结果各组间比较有显著性差异（F=860.667,P〈0.001,两两比较均P〈0.001）;男女性别间堵耳效应差异无统计意义（t=0.606～0.921,P〉0.05）。结论骨导听阈取决于双耳耳蜗的听敏度,堵耳效应主要集中在1000Hz以下的低频,无性别差异。     

Biological basis of sex differences in drug abuse: preclinical and clinical studies

The recent focus on drug abuse in women has brought attention to numerous differences between women and men. In this review, we discuss both preclinical and clinical findings of sex differences in drug abuse as well as mechanisms that may underlie these differences. Recent evidence suggests that the progression to dependence and abuse may differ between women and men; thus, different prevention and treatment strategies may be required. Similar sex differences in drug sensitivity and self-administration have been reported in laboratory animal studies. Females appear to be more vulnerable than males to the reinforcing effects of psychostimulants, opiates, and nicotine during many phases of the addiction process (e.g. acquisition, maintenance, dysregulation-escalation, relapse). Male and female animals differ in their behavioral, neurological, and pharmacological responses to drugs. Although the role of sex in the mechanisms of drug action remains unclear, preclinical and clinical studies indicate that ovarian hormones, particularly estrogen, play a role in producing sex differences in drug abuse. Future research is necessary to provide information on how to design more effective drug abuse treatment programs and resources that are sex specific. Electronic Publication     

Gender-based differences in the toxicity of pharmaceuticals--the Food and Drug Administration's perspective

Women experience more adverse reactions to treatment with therapeutic drugs than men. Theories proposed to explain this include overdosing, different pharmacokinetics and pharmacodynamics, women are more likely to report adverse events than men, or women take more medications than men. Food and Drug Administration (FDA) Office of Women's Health (OWH) funds research to promote including women in clinical trials and understanding the biology of sex-related differences in the safety of FDA-regulated products. Including women in clinical trials advances the understanding of drug efficacy and safety in women by providing information on drug dosing, pharmacokinetics, and pharmacodynamics. A Baysian statistical analysis of sex differences in adverse events showed that although about the same number of adverse events were reported for men and women, those reported for women were more serious. One example of a sex difference in the toxicity of pharmaceuticals is the drug-induced cardiac arrhythmia, torsades de point. OWH funded studies in animals and humans to investigate the mechanism behind this sex difference. These studies demonstrated that shortening the QT interval increases the risk of developing torsades and that androgens protect against torsades by slowing cardiac repolarization and prolonging the QT interval. Understanding the mechanisms behind other reported sex-related differences in adverse drug effects requires additional research. The preliminary studies conducted to date suggest that this sex-related difference is likely to be a multifactorial problem requiring information from several fields of study. Ideally, individuals at risk for developing an adverse event should be identified prior to therapeutic intervention. The OWH plans to fund more studies to investigate the role of hormonal variations on drug metabolism and drug-drug interactions. Animal and in vitro model systems are needed to fully understand the mechanism of how gender influences drug toxicity.     

Sex differences in the subjective tolerability of antipsychotic drugs

In recent years, research efforts have been directed to better characterize the subjective experience of taking psychotropic drugs. This study investigated the sex difference in the subjective tolerability of antipsychotic drugs. Participants were recruited from patients under the care of psychiatric services serving geographical catchment areas in Croydon (UK), Verona (Italy), Amsterdam (Netherlands), and Leipzig (Germany). Clinically unstable patients with a clinical diagnosis of schizophrenia and a research diagnosis of schizophrenia, established using the Item Group Checklist of the Schedule for Clinical Assessment in Neuropsychiatry, were enrolled. Antipsychotic subjective tolerability was rated by means of the Liverpool University Neuroleptic Side Effect Rating Scale. During the recruitment period, 245 men and 164 women with schizophrenia were recruited. In both sexes, the most frequently reported side effects were difficulty in concentrating, tiredness, and weight gain; these side effects occurred in approximately 50% of men and in up to 70% of women. Extrapyramidal and anticholinergic reactions were reported more often by women, whereas men reported sexual problems more often. After background group differences were controlled for, sex was the strongest determinant of the subjective tolerability of antipsychotic drugs. We therefore conclude that sex differences in the subjective tolerability of antipsychotic drugs should be taken into account in the pharmacological management of patients with schizophrenia. Studies should no longer consider men and women as a homogeneous group, given that the subjective tolerability of antipsychotic drugs substantially differs between sexes.     

5-羟色胺递质相关基因多态性对抗精神病药物作用影响的研究进展

神经递质5-羟色胺(5-HT)是许多抗精神病药物体内效应环节。5-HT相关基因合成酶色氨酸羟化酶、5-HT转运体、5-HT受体及5-HT效应相关G蛋白耦合受体中的一些高频变异基因型具有5-HT能抗精神病药物疗效优势,有的表现为基因型特异的安全反应性。它们从一个侧面反映了遗传因素对抗精神病药物作用的影响。与此同时,由于同类研究源于不同种族人群,涉及疾病病因与药物疗效评价复杂性,以及研究中的基因型分组方法可能隐含未知遗传异质性的影响等原因,关于特定多态变异对药物作用影响的同类研究结果有时存在较大差异。探讨这些问题有利于抗精神病药物遗传药理学研究的发展,提高抗精神病药物的疗效与安全性。     

The effect of sex/gender on cardiovascular pharmacology

Cardiovascular diseases differ between men and women as do outcomes after therapeutic interventions. Management of these diseases, however, is generally guided by evidence from trials conducted predominantly in men, with few studies focused on women alone. Our goal is to review the sex/gender differences in cardiovascular therapies, which show many areas of uncertainty regarding women due to their small enrolment in clinical trials; thus, in some cases, firm conclusions about efficacy in women are difficult to obtain. Nevertheless, female gender appears to suffer from more adverse drug effects [ADE] than the male gender. For example, women are significantly more likely to experience drug-induced QT-prolongation and torsade de pointes arrhythmia and many other types of ADE. The major sex-specific differences present in pharmacokinetics, especially for the major drug metabolizing enzymes, the cytochromes P450 family, but also for phase II reactions such as glucuronidation, are discussed. Pharmacodynamic mechanisms underlying sex/gender differences are not clearly elucidated yet; however, this highlights the need for more studies focusing on women in order to optimize sex/gender-specific therapy and, therefore, improve clinical outcomes in women with cardiovascular diseases.     

A GENS-based approach to cardiovascular pharmacology: impact on metabolism, pharmacokinetics and pharmacodynamics

Pharmacological outcomes depend on many factors, with many of them being sexually dimorphic. Thus, physiological gender/sex (GENS) differences can influence pharmacokinetics, pharmacodynamics and, thus, bioavailability and resulting in efficacy of treatment, meaning GENS differences should be an important consideration in therapeutics. In particular, drug response can change according to different hormonal environments. Therefore, GENS-specific differences have a particular clinical relevance in terms of drug delivery, especially for those substances with a narrow therapeutic margin. Since adverse effects are more frequent among women, safety is a key issue. Overall, the status of women, from a pharmacological point of view, is often different and less studied than that of men and deserves particular attention. Further studies focused on women's responses to drugs are necessary in order to make optimal pharmacotherapeutic decisions.     

我院精神类基本药物处方分析

目的:为我院精神类基本药物合理用药和管理提供参考。方法:采用世界卫生组织推荐的用药频度和药物利用指数(DUI)分析方法,对我院2011年1-12月共15070张精神类基本药物处方进行回顾性分析。结果:我院精神类基本药物使用频率较高的依次是艾司唑仑片、咪达唑仑注射液、阿普唑仑片;有6种精神药品的DUI值均≤1.0。结论:我院精神类基本药物应用基本合理,但仍需加强个别药品使用的监控,进一步促进其合理应用。     

Effects of psychotropic drugs on seizure threshold.

Psychotropic drugs, especially antidepressants and antipsychotics, may give rise to some concern in clinical practice because of their known ability to reduce seizure threshold and to provoke epileptic seizures. Although the phenomenon has been described with almost all the available compounds, neither its real magnitude nor the seizurogenic potential of individual drugs have been clearly established so far. In large investigations, seizure incidence rates have been reported to range from approximately 0.1 to approximately 1.5% in patients treated with therapeutic doses of most commonly used antidepressants and antipsychotics (incidence of the first unprovoked seizure in the general population is 0.07 to 0.09%). In patients who have taken an overdose, the seizure risk rises markedly, achieving values of approximately 4 to approximately 30%. This large variability, probably due to methodological differences among studies, makes data confusing and difficult to interpret. Agreement, however, converges on the following: seizures triggered by psychotropic drugs are a dose-dependent adverse effect; maprotiline and clomipramine among antidepressants and chlorpromazine and clozapine among antipsychotics that have a relatively high seizurogenic potential; phenelzine, tranylcypromine, fluoxetine, paroxetine, sertraline, venlafaxine and trazodone among antidepressants and fluphenazine, haloperidol, pimozide and risperidone among antipsychotics that exhibit a relatively low risk. Apart from drug-related factors, seizure precipitation during psychotropic drug medication is greatly influenced by the individual's inherited seizure threshold and, particularly, by the presence of seizurogenic conditions (such as history of epilepsy, brain damage, etc.). Pending identification of compounds with less or no effect on seizure threshold and formulation of definite therapeutic guidelines especially for patients at risk for seizures, the problem may be minimised through careful evaluation of the possible presence of seizurogenic conditions and simplification of the therapeutic scheme (low starting doses/slow dose escalation, maintenance of the minimal effective dose, avoidance of complex drug combinations, etc.). Although there is sufficient evidence that psychotropic drugs may lower seizure threshold, published literature data have also suggested that an appropriate psychotropic therapy may not only improve the mental state in patients with epilepsy, but also exert antiepileptic effects through a specific action. Further scientific research is warranted to clarify all aspects characterising the complex link between seizure threshold and psychotropic drugs.     

The influence of sex on pharmacokinetics

Biologic differences exist between men and women that can result in differences in responses to drugs. Both pharmacokinetic and pharmacodynamic differences between the sexes exist, with more data on pharmacokinetic differences. On average, men are larger than women. Body size differences results in larger distribution volumes and faster total clearance of most medications in men compared to women. Greater body fat in women (until older ages) may increase distribution volumes for lipophilic drugs in women. Total drug absorption does not appear to be significantly affected by sex although absorption rates may be slightly slower in women. Bioavailability after oral drug dosing, for CYP3A substrates in particular, may be somewhat higher in women compared to men. Bioavailability after transdermal drug administration does not appear to be significantly affected by gender; nor does protein binding. Renal processes of glomerular filtration, tubular secretion, and tubular reabsorption appear to be faster in men compared to women whether considered on a mg/kg basis or total body weight basis. Algorithms to estimate glomerular filtration rate incorporate sex as a factor; some also include weight. For hepatic processes, drugs metabolized by Phase I metabolism (oxidation, reduction, and hydrolysis via cytochrome P450's 1A, 2D6, 2E1), Phase II conjugative metabolism (glucuronidation, conjugation, glucuronyltransferases, methyltransferases, dehydrogenases) and by combined oxidative and conjugation processes are usually cleared faster in men compared to women (mg/kg basis). Metabolism by CYP2C9, CYP2C19, and N-acetyltransferase, appear to be similar in men and women (mg/kg). Clearance of p-glycoprotein substrates appear to be similar in men and women. In contrast, total clearance of a number of CYP3A substrates appear to be mildly or moderately faster (mg/kg) in women compared to men. The clinical significance of reported differences warrants consideration. Clearance reported on a per kg basis directly addresses organ or enzyme clearance. The difference in size between men and women means translating these results to clinical dosage rates should include an adjustment for body size. Unfortunately, this is not standard. Reports of sex differences that persist after considering weight may warrant further dosage adjustments. In addition, investigations are often performed in healthy fasting individuals yet medications are prescribed to patients with confounding influences of disease, co-medications, diet, and social habits. The relative role of sex on pharmacokinetics as compared to genetics, age, disease, social habits and their potential interactions in the clinical setting is not yet fully known but should be routinely considered and further studied.