书讯

由卫生部疾病预防控制局、中国疾病预防控制中心精神卫生中心和中华医学会精神病学分会和北京大学精神卫生研究所牵头编写的《中国精神障碍防治指南》丛书已部分完成，将在2007年7月由北京大学医学出版社出版，包括：精神分裂症防治指南（舒良主编）、抑郁障碍防治指南（江开达主编）、双相障碍防治指南（沈其杰主编）、老年期痴呆防治指南（张明园主编）和儿童注意缺陷多动障碍（郑毅主编）。     

Seroquel

阿斯利康公司宣布，FDA已批准其抗精神病药物Seroquel（quetiapine）作为锂（1ithium）或丙戊酸（divalproex）的辅助药用于治疗双相情感障碍，它是唯一获准治疗情感障碍中的抑郁症和躁狂症的单用药治疗产品。双向情感障碍，又称踩狂抑郁症，被认为是最为严重的精神疾病之一。据研究，全球有0．4％～6％的人患有该病。     

Seroquel

阿斯利康公司宣布，FDA已批准其抗精神病药物Seroquel（quetiapine）作为锂（1ithium）或丙戊酸（divalproex）的辅助药用于治疗双相情感障碍，它是唯一获准治疗情感障碍中的抑郁症和躁狂症的单用药治疗产品。双向情感障碍，又称踩狂抑郁症，被认为是最为严重的精神疾病之一。据研究，全球有0．4％～6％的人患有该病。     

喹硫平治疗双相情感障碍的疗效观察

目的探讨喹硫平治疗双相情感障碍的I临床疗效。方法选取我院在2010年1月至2012年12月收治的双相情感障碍患者60例，将所有患者随机分为观察组和对照组，观察组患者单独应用喹硫平治疗，对照组患者联合应用喹硫平和碳酸锂治疗，对两组患者的疗效进行比较。结果观察组和对照组总有效率分别为83．3％、86．7％，两组比较无明显差异P〉O．05；不良反应的比较，观察组不良反应的发生率（10．0％）明显小于对照组（23．3％），且P〈O．05。结论单独应用喹硫平和喹硫平与碳酸锂联合应用治疗双相情感障碍患者的疗效相当，但单独应喹硫平的安全性高，值得临床推广。     

喹硫平和氯丙嗪合并丙戊酸钠治疗双相情感障碍躁狂发作的对照研究

目的探讨喹硫平和氯丙嗪合并丙戊酸钠治疗双相情感障碍躁狂发作患者的疗效及副反应。方法将94例双相情感障碍躁狂发作患者分为喹硫平组51例;氯丙嗪组43例,进行为期6周的疗效及副反应比较。采用躁狂量表（BRMS）、副反应量表（TESS）分别于治疗前和治疗第1、2、4、和6周末时进行评定。结果治疗结束时,两组BRMS评分较治疗时均显著减低（P〈0．05）;临床总有效率喹硫平组82．3％,氯丙嗪组83．7％;两组疗效差异无显著性。喹硫平组的不良反应较氯丙嗪组少。结论喹硫平治疗双相情感障碍躁狂发作的疗效肯定,不良反应较少,安全性高,适合临床应用。     

丙戊酸盐治疗双相情感障碍的研究进展

作为心境稳定剂,丙戊酸盐治疗各型双相情感障碍均有一定的疗效。近年来对各型双相情感障碍患者进行的临床研究证实：丙戊酸盐能改善躁狂症状;联合镇静药物治疗可有效改善抑郁症状;联合抗抑郁药物预防抑郁发作的疗效优于锂盐。丙戊酸盐与其他心境稳定剂联合治疗快速循环型双相情感障碍患者时可能更有益,也更适用于非快速循环型双相情感障碍患者的长程治疗。     

儿童和青少年抑郁障碍的精神药理学

重症抑郁障碍（MDD）和心境恶劣障碍（DD）在儿童和青少年中是较常见的，其比率分别约为2％-8％。抑郁障碍通常对学校，社会和家庭造成损害，而且，患有抑郁症的年轻人在自杀，出现双相情感障碍，药物滥用，行为问题，嗜烟和早孕等方面有很高的危险性，这些障碍很易复发，有过一次MDD发作的儿童在5年内70％具有第2次发作的危险。而患有DD的年轻人在5年内出现MDD发作的机率约为70％。上述内容旨在强调目前需解决如下问题：（1）对患有急性抑郁症的年轻人的有效治疗；（2）复发的预防；（3）预防高危人群（例如有心境障碍高发家族史的儿…     

拉莫三嗪治疗双相情感障碍的研究进展

拉莫三嗪作为心境稳定剂治疗双相情感障碍已经应用于临床。在2013年最新的CANMAT指南中新增了拉莫三嗪单药或联合其他药物的治疗方案,提示目前应用拉莫三嗪治疗双相情感障碍已受到广泛关注。本文综述了近几年拉莫三嗪在治疗双相情感障碍各亚型中的临床研究、安全性及应用前景,为双相障碍的治疗提供新观点及新思路。     

1994-2005年国内文献中苯妥英钠临床监测的计量研究

目的：探讨苯妥英钠（phenytoinsodium，DPH）临床监测的研究现状、发展动向及趋势。方法：检索1994—2005年DPH的临床监测文献，采用文献计量学方法，取文献量、应用频次、构成比等量化指标，对12年间DPH临床监测文献的刊物学科及年代分布、单位类型及地域分布、研究内容及方向等进行统计。结果：年平均发文9．3篇，刊物学科分布以医学刊物和药学刊物为主；《中国医院药学杂志》等8家杂志载文3篇以上；血药浓度治疗窗及给药方案研究的文献构成比为82．9％，是普遍关注的课题；DPH临床监测的主要方法依次为：FPIA（44．4％）、HPLC（33．3％）、UV（13．7％）。结论：DPH的临床监测已在我国有条件的单位普遍开展，收集整理该领域科研文献，定量分析、综合评价其基本信息，有助于把握该学科领域的研究现状、发展动向及趋势。     

双相情感障碍及其治疗药物--心境稳定剂

生活中常有抑郁与兴奋,七情六欲乃正常反应,但是,如若某些情绪持续存在,则为心境障碍。双相情感障碍是心境障碍的一种临床类型,旧称躁狂抑郁症．呈现躁狂和抑郁,或交替发作的临床症状。双相情感障碍的药物治疗,除要求安全有效外,还需要不致促发情感转相,并能预防反复发作。本文介绍治疗双相情感障碍的药物——心境稳定剂,并兼述其他临床治疗措施。     

Current concepts in the validity,diagnosis and treatment of paediatric bipolar disorder

Despite ongoing controversy, the view that paediatric bipolar disorder is rare or non-existent has been increasingly challenged not only by case reports but also by systematic research. This research strongly suggests that paediatric bipolar disorder may not be rare but that it may be difficult to diagnose. Since children with bipolar disorder are likely to become adults with bipolar disorder, the recognition and characterization of childhood-onset bipolar disorder may help identify a meaningful developmental subtype of bipolar disorder worthy of further investigation. As recommended by Robins and Guze [American Journal of Psychiatry (1970), 126, 983-987], a psychiatric disorder may be considered a valid diagnostic entity if it can be shown to have differentiating features, evidence of familiality, specific treatment responsivity and a unique course. The goal of this article is to review our work and the extant literature within this framework to describe the evidence supporting bipolar disorder in children as a valid clinical diagnosis.     

蚓激酶国内研究文献回顾

目的研究百奥蚓激酶临床观察、研究的文献,分析其临床用药的安全性、有效性。方法检索国内医学文献数据库,收集1994年1月～2009年6月期间有关蚓激酶的文献报道54篇,对每篇文献的发表期刊、年限、第一作者、回顾性研究文献、临床观察性文献、观察病例数、患者年龄、性别、疾病病程、用药疗程、合并用药情况、观察指标、结果和有效率、不良反应发生情况等资料进行统计分析。结果共纳入54篇文献,27篇关于治疗急性脑梗死的文献、13篇治疗其他心血管疾病的文献、10篇治疗糖尿病并发症的文献、4篇治疗其他疾病的文献。结论蚓激酶是一种临床疗效肯定、不良反应小、可靠性强的降纤药品。     

国内期刊医疗器械风险管理研究文献计量学分析

目的：深入了解我国关于医疗器械风险管理的研究进展与实际应用。方法：利用中文期刊全文数据库（CNKI）与中文科技期刊数据库（VIP）检索出的相关文献,采用文献计量学方法对国内医疗器械风险管理文献的时间分布、期刊分布、作者分布及文献涉及的内容等方面进行研究,并就我国的药品医疗器械风险管理现状进行归纳与分析。结果：我国对医疗器械风险管理的研究呈增长趋势,现已形成核心作者群,各级医疗机构和药监部门是文献的主要来源;具体的研究内容基本可以分为四大类,以问题和建议类、论著类居多。结论：我国在该领域的相关工作刚刚起步,尚缺乏系统化,法规和技术等亟待完善。     

认知心理干预对双相障碍抑郁患者的疗效

目的 探讨认知心理干预对双相障碍抑郁患者的临床疗效.方法 采用随机数字法将符合《美国精神病学会精神障碍诊断与统计手册(第三版)》制定的诊断标准的82例双相障碍患者分为观察组42例和对照组40例,观察组采用认知心理干预治疗.采用世界卫生组织生存质量测定量表(WHOQOL-BREF)评定临床症状及生存质量、采用汉密尔顿抑郁量法评定临床疗效.结果 干预8周后观察组与对照组总有效率为95.2％和82.5％,差异有统计学意义(P＜0.05).两组干预后WHOQOL-BREF 4个领域评分与干预前比较差异有统计学意义(P＜0.05),两组间比较差异也有统计学意义(P＜0.05).结论 认知心理干预可以对双相障碍抑郁患者产生较好的恢复作用、增强康复效果和提高生存质量.     

Melatonin sensitivity to dim white light in affective disorders.

Both dim and bright light has been shown to suppress the nocturnal secretion of the pineal hormone melatonin. Early reports suggests that an abnormal response to light occurs in patients with bipolar affective disorder, where as patients with major depressive disorder respond similarly to controls. It has been suggested that this abnormal sensitivity of the melatonin response to light could be a trait marker of bipolar affective disorder. However reports lack consistency. Hence, we investigated the melatonin suppression by dim light (200 lux) in patients with bipolar affective disorder, seasonal affective disorder and major depressive disorder. Results suggest that a supersensitive melatonin suppression to light in bipolar affective disorder (p < .005), and seasonal affective disorder (p < .05), whereas patients with major depressive disorder display similar suppression to controls. The supersensitivity may be a mechanism where by phase-delayed rhythms, are resynchronised to a new circadian position. Conversely, an abnormality may exist in the pathway from the retina to the suprachiamatic nucleus.     

人乳头瘤病毒在中国大陆女性的型别分布的Meta分析

目的 分析人乳头瘤病毒(human papillomavirus,HPV)型别在中国大陆女性中的分布特征.方法 检索万方数据库、中国期刊全文数据库、中国生物医学文献数据库收录的2009年1月至2016年1月我国女性大样本、一般人群的HPV型别相关研究,进行筛选、评估和数据提取,采用Meta分析法进行评价.结果 纳入31篇文献;HPV感染型别各地方一致,均在HPV16、HPV52、HPV58出现峰值,其中HPV16占所统计的19种HPV型别的9.77％～41.63％,HPV52占3.43％～28.68％,HPV58占5.29％ ～ 14.36％;HPV68、HPV6、HPV 11、HPV43只在个别地方出现峰值;其余几种HPV未见明显峰值.结论 中国大陆女性HPV感染型别以HPV16、HPV52、HPV58为主,HPV型别的分布存在明显的地区差异.     

Antidepressant-Induced Mania with Concomitant Mood Stabilizer in Patients with Comorbid Substance Abuse and Bipolar Disorder

ABSTRACT

Antidepressant use in the treatment of bipolar disorder is controversial due the risks of affective switching and cycle acceleration. Studies of non-comorbid samples suggest that the risk can be mitigated with the use of a concomitant mood stabilizer. However, the majority of patients with bipolar disorder will experience a comorbid substance use disorder and little is known about these individuals because they are typically excluded from clinical trials. Patients entering a substance abuse treatment program who had a history of bipolar disorder were interviewed to evaluate antidepressant-induced affective switching with and without concomitant mood stabilizer. Among 41 comorbid participants, the total lifetime antidepressant-induced switch rate was 76%. The switch rate was 56% for patients taking a mood stabilizer and an antidepressant concomitantly. There was no difference between patients with bipolar I and bipolar II disorders.     

我国肿瘤科临床药师的发展现状

目的了解我国肿瘤科临床药师工作的开展状况,为不断拓展临床药学工作提供参考。方法检索有关肿瘤科临床药师工作文献52篇,采用文献计量学方法分析文献的发表时间、期刊、研究内容、研究方法等分布特点。结果不同年度时间段,有关文献量呈逐渐上升趋势。文献分布在26种生物医学期刊,其中《中国药房》、《中国医院药学杂志》、《医药导报》、《中国药学杂志》、《中国药师》为刊载临床药师工作相关文献的核心期刊;文献中研究方法主要以综述和实践报告为主,其中临床药师实践类文献2010年以后明显增多。结论自2000年以来,我国肿瘤科临床药师工作取得了一定进步,但肿瘤科临床药师实践工作仍处于探索阶段,有待进一步探索建立临床药师有效培养路径及其药学服务考核评价体系。     

Brain structural abnormalities at the onset of schizophrenia and bipolar disorder: a meta-analysis of controlled magnetic resonance imaging studies

A number of structural brain imaging studies and meta-analytic reviews have shown that multiple subtle brain abnormalities are consistently found in schizophrenia and bipolar disorder. Several studies suggest that schizophrenia and affective psychoses share a largely common pattern of brain abnormalities. Aim of the present study was to compare, by means of a meta-analytic approach, brain structural abnormalities, as detected by Magnetic Resonance Imaging (MRI), found at the onset of schizophrenia and bipolar disorder in order to address the question of the specificity of brain abnormalities across diagnostic groups. Forty-five studies were identified as suitable for analysis. In both schizophrenic and bipolar patients significant overall effect sizes were demonstrated for intracranial, whole brain, total grey and white matter volume reduction as well as for an increase of lateral ventricular volume at disease onset. Thus, the available literature data strongly indicate that some brain abnormalities are already present in first-episode schizophrenia or bipolar disorder and that there is a significant overlap of brain abnormalities in affective and non-affective psychotic disorders at the onset of the disease. However, whole grey matter volume deficits and lateral ventricular enlargement appear to be more prominent in first-episode schizophrenia whereas white matter volume reduction seems more prominent in bipolar disorder. The common vs specific trajectories of brain pathomorphology in schizophrenia and bipolar disorder are discussed.     

Lamotrigine in mood disorders

Lamotrigine is an anticonvulsant drug with good efficacy and safety in the treatment of epilepsy. There is now substantial evidence that lamotrigine is also useful in treating resistant depression, rapid cycling bipolar affective disorder, depressive episodes in bipolar affective disorder and in the maintenance phase or prophylaxis of bipolar affective disorder. There are possible roles in managing mood changes in borderline personality disorder, reducing chronic pain and treating schizoaffective disorder. The general range of doses found effective in affective disorders is from 50 to 300 mg daily. Clinical use seems to involve a titration of dose upwards over several weeks until the desired effect is obtained. However, further definitive double-blind, randomised controlled trials against gold standard treatments are required. Lamotrigine has a preferable side-effect profile compared to standard agents for bipolar affective disorder such as lithium or carbamazepine. Further research is certainly warranted and, given its tolerability, could point to lamotrigine as the treatment of choice for some affective disorders.