多元化治疗对首发精神分裂症患者疗效及认知功能改善的对照研究

目的探讨多元化治疗对首发精神分裂症患者疗效及认知功能改善的效果。方法将80例首发精神分裂症患者随机分为研究组40例（接受多元化治疗）和对照组40例（仅接受药物治疗）,共干预12周。在基线及治疗后第12周末分别进行阳性和阴性综合征量表（PANSS）、韦氏成人智力量表（WAIS．RC）、韦氏记忆量表（WMS）、威斯康星卡片分类测验（WCST）及治疗中需处理的不良反应症状量表（TESS）测定以评定疗效及不良反应。结果治疗后第12周末研究组PANSS总分、WCST的总测验数、持续错误数、随机错误数评分显著低于对照组（P〈0．05,P〈0．01）,WAIS—RC的语言智商量表、操作智商量表、总智商量表、WMS总分评分显著高于对照组（P〈0．05,P〈0．01）。两组TESS评分差异无统计学意义（P〉0．05）。结论多元化治疗可明显改善首发精神分裂症患者的精神症状及认知功能,安全性较高。     

无抽搐电休克对抑郁症患者执行功能和生活质量的影响

目的评价无抽搐电休克治疗（MECT）对抑郁症患者执行功能和生活质量的影响。方法将120例抑郁症患者随机分为研究组（MECT合并非典型药物治疗）60例和对照组（单纯非典型药物治疗）60例,同时取60例健康人作为正常组,分别在入组前、治疗3周及6周后对研究组和对照组进行汉密尔顿抑郁量表（HAMD）评定、威斯康星卡片分类任务（WCST）测验及生活质量调查（SF-36）。对正常组进行威斯康星卡片分类任务（WCST）测定。将研究组和对照组治疗3,6周后的威斯康星卡片分类任务（WCST）测验结果及健康状况调查问卷结果与治疗前比较,研究组和对照组治疗第3周和第6周的生活质量分别进行比较。结果治疗6周后两组HAMD总分较治疗前均有显著下降,差异有统计学意义（P〈0．05）,WCST中的总应答数、完成分类数、正确数、持续错误数均较治疗前明显改善,差异具有统计学意义（P〈0．05）,且治疗3周后研究组在HAMD、WCST方面比对照组改善更为明显,差异具有统计学意义（P〈0．05）。治疗3周后研究组生活质量各因子的分值均明显高于对照组,差异具有统计学意义（t分别为2．23,3．04,4．23,2．56,3．34,2．92,3．65,5．45;P〈0．05）,治疗6周后研究组生理职能（RP）,身体疼痛（BP）,一般健康状况（GH）,社会功能（SF）,精神健康（MH）因子的分值高于对照组,差异有统计学意义（￡分别为2．97,4．37,3．91,5．21,2．93;P〈0．05）。结论合并MECT治疗能快速改善抑郁患者的症状和执行功能,可以更快、更好地改善患者的生活质量。     

奥氮平对精神分裂症认知障碍的疗效及糖、脂代谢的影响

目的 观察奥氮平对精神分裂症患者认知功能障碍的疗效及其对患者糖、脂代谢影响。方法 将60例接受单一奥氮平治疗的精神分裂症患者，采用修订韦氏记忆量表（WMS-RC）评定记忆功能；威斯康星卡片分类测验（WCST）评定执行功功能；PANSS量表评定精神症状；并检测血糖、胆固醇和甘油三脂，分别在治疗前、治疗8周末各进行1次。结果 经过8用的奥氮平治疗后，记忆商数显著提高（P〈0．001）；威斯康星卡片分类测验的总测验次数、持续错误数及随机错误数均显著下降（P〈0，05或P〈0．01）；并且奥氮平对记忆功能、执行功能的改善与阳性症状、阴性症状的下降呈显著正相关。治疗8周末血糖、胆固醇和甘油三脂水平均显著高于治疗前（P〈0．05或P〈0．01）。结论 奥氮平能有效的改善精神分裂症患者的认知功能障碍，但应重视其对患者糖脂代谢的副作用．     

改良电抽搐与抗抑郁剂对抑郁症治疗的比较

目的：分析比较改良电抽搐治疗（MECT）和抗抑郁剂治疗对抑郁症患者的疗效、血清皮质醇浓度和认知功能的影响。方法：将60例抑郁症患者随机分为MECT治疗组和常规抗抑郁剂治疗组。MECT组30例,每周1、3、5治疗,连续4周,以后每周一次维持治疗,共治疗12周。药物组30例．应用抗抑郁剂盐酸文拉法辛治疗,剂量在150mg～225mg／d之间,共治疗12周。所有入组病例．在入组时、治疗1周、治疗4周、治疗12周分别测汉密尔顿抑郁量表（HAMD）和血清皮质醇浓度。两组在入组时和治疗12周进行威斯康星卡片（WCST）评定,结果：HAMD分比较,在治疗1周、4周两组间有统计学差异（P〈0．05）,在第12周末两组间无统计学差异（P〉0．05）。血清皮质醇浓度比较,第1、4周末两组间差异有统计学（P〈0．05）,在治疗12周两组间差异无统计学意义（P〉0．05）。WCST评定在入组时两组间差异无统计学（P〉0．05）,在第12周末两组内均有统计学差异（P〈0．05）,而两组间在治疗12周差异无统计学意义（P〉0．05）。血清皮质醇浓度与汉密尔顿抑郁量表总分,成斯康星卡片分类测验分类测验结果显示的认知功能情况存在相关性．结论：MECT是一种有效的治疗手段,相比较抗抑郁剂而言起效更快,埘认知功能无不良反应,随病情好转对认知功能有改善。血清皮质醇浓度升高程度可能与抑郁症认知功能损害程度相关。     

抑郁症患者和正常人威斯康星卡片分类测验的比较研究

目的：探讨抑郁症患者认知功能障碍的特点。方法：对67例符合ICD－10抑郁症诊断标准的抑郁症患者和44例正常人进行威斯康星卡片分类测验（WCST），并对其中21例经过6周抗抑郁药治疗的患者进行治疗产后比较，观察WCST与HAMD评分变化的关系。结果：抑郁症患者WCST的总测验次数，持续错误数和随机错误数同正常人相比较均有显著差异（P＜0．01），相关分析发现：WCST的总测验次数，持续错误数，随机错误数与年龄，HAMD总分及迟缓，日夜变化两因子分正相关（P＜0．01），正确数和分类数与年龄，HAMD的迟缓因子分成负相关（P＜0．05），WCST在两组按性别及文化程度再分组比较后发现，各组间无显著性差异，对21例患者治疗前后比较发现WCST随病情的好转而改善，而治疗前后WCST的总测验次数、持续错误数，随机错误数的减分率与HAMD减分率正相关（P＜0．05），结论：抑郁症患者存在认知功能缺损，其认知功能缺损与病情的严重程度及抑郁症的迟滞和日夜变化等症状有关，认知功能的降低可能反映病人额叶功能的缺损。     

亚综合征性抑郁患者认知功能初探

目的：探讨亚综合征性抑郁（SSD）患者的认知功能。方法：45例SSD患者，以31例抑郁症患者和28名正常人作为对照。SSD组和抑郁症组均使用抗抑郁剂治疗12个月以上。采用韦氏成人智力量表、临床记忆量表、威斯康星卡片分类测验（WCST）于治疗前后分别评定3组患者的认知状况;采用抑郁自评量表（SDS）评定抑郁症状的严重度。结果：治疗3个月，SSD组和抑郁症组的言语智商、操作智商、总智商、记忆商数均较治疗前明显提高（P〈0.05或P〈0.01）;WCST总应答数显著减少，分类数显著提高（P〈0.01）;两组SDS评分较治疗前显著下降（P〈0.01）。治疗12个月，两组上述认知指标进一步显著改善，SDS评分与对照组相比差异无显著性（P〉0.05）;但两组指向记忆、联想学习、WCST正确百分数、随机错误数与对照组相比仍未恢复正常（P〈0.01）。结论：SSD患者存在认知功能障碍，治疗后症状虽有缓解，但部分认知功能仍不能完全恢复。     

双相情感障碍躁狂发作患者攻击行为 与执行功能的相关性

目的 探讨双相情感障碍躁狂发作患者攻击行为与执行功能之间的相关性。方法 采用 修订版外显攻击行为量表（MOAS）对2018 年6 月—2019 年2 月在山东省精神卫生中心门诊就诊或者住 院治疗的164例双相情感障碍躁狂发作患者攻击行为进行评定，MOAS评分≥5分为攻击组，MOAS＜5分 为非攻击组。用威斯康星卡片分类测验（WCST）评估受试者的执行功能，用贝克-拉范森躁狂量表（BRMS） 评估受试者的临床症状。结果 双相情感障碍躁狂攻击组患者BRMS总分［（25.78±4.32）分］高于非攻击组 ［（24.69±4.29）分］（P＜0.05），攻击组WCST正确数［（42.52±7.23）分］、分类数［（7.61±3.48）分］低于非攻 击组［（44.29±9.14）、（8.06±2.12）分］；错误数［（43.03±8.43）分］、持续错误数［（29.08±5.55）分］、非持 续错误数［（26.84±5.78）分］均高于非攻击组［（41.32±8.18）、（28.58±7.22）、（25.03±5.80）分］，差异有统 计学意义（P＜ 0.05），双相情感障碍躁狂患者MOAS 评分与WCST错误数、持续性错误数、非持续性错误 数呈正相关（P＜ 0.05），与分类数呈负相关（P ＜ 0.05）。结论 双相情感障碍躁狂患者攻击行为与执行 功能存在相关性，执行功能受损可能与双相情感障碍躁狂攻击行为的发生机制有关。     

人性化护理对抑郁症患者护理满意度和病情的影响

目的探讨人性化护理对抑郁症患者护理满意度和病情的影响。方法将103例住院抑郁症患者随机分成研究组和对照组，研究组采用基础护理与人性化护理，对照组采用基础护理。在治疗后8周末采用自编病房护士服务质量调查表调查患者对护理质量的满意程度，在入组时与治疗后第8周末采用抑郁自评量表（SDS）评定患者的病情。结果研究组护理满意度高于对照组（P〈0．05）；两组治疗后第8周末SDS评分均低于入组时（P〈0．05）；治疗后第8周末研究组SDS评分低于对照组（P〈0．05）。结论对抑郁症患者实施人性化护理可以提高患者对护理的满意度，改善患者的抑郁情绪。     

阿戈美拉汀联合rTMS对首发抑郁症认知功能的影响

目的探讨阿戈美拉汀联合rTMS治疗首发抑郁症的疗效及认知功能的影响。方法将90例首发抑郁症患者用EpiCalc 2000随机分为两组,各45例,在阿戈美拉汀治疗基础上,研究组给予rTMS治疗,对照组给予伪刺激治疗。分别于治疗第0、1、2、4周末采用汉密尔顿抑郁量表(HAMD-17)评定疗效、用韦氏智力测验(WAIS)中数字符号、数字广度、韦氏记忆量表(WMS)、威斯康星卡片分类测验(WCST)、连线测验(TMT)、词语流畅性测验(VFT)评定认知功能。结果在治疗后第1、2、4周末研究组HAMD评分明显低于对照组;4周末研究组有效率高于对照组;4周末研究组WCST非持续错误数、VFT重复数较治疗前减少,对照组TMT-A提笔次数较治疗前减少。与对照组比较,研究组治疗后第4周末WCST持续错误数、TMT连线时间较少,VFT总数较高,以上均有统计学差异(P0.05)。结论 rTMS联合阿戈美拉汀治疗首发抑郁症安全、快速、有效,并改善认知功能。     

喹硫平及其联合丙戊酸钠治疗双相情感障碍躁狂发作认知功能损害的对照研究

目的 应用神经心理学方法 评估双相障碍躁狂发作认知损害特点,并探讨丙戊酸钠对双相躁狂认知损害的治疗作用.方法 64例双相躁狂患者随机分为两组:丙戊酸钠联合喹硫平治疗组33侧(联合治疗组),单用喹硫平治疗组31例(单药治疗组),两组于治疗前与治疗6周末均给予威斯康星卡片分类测验( WCST)、言语记忆测验(HVILT-R)、持续操作测验(CPT)、扬氏躁狂评定量表(YMRS)、临床总体疗效量表(CGI- S)评定.对照组为30名健康人.结果 (1)两个患者组治疗前WCST操作的完成分类数、错误应答数、持续应答数、持续错误数以及HVILT-R、CPT的操作分均低于对照组,差异有统计学意义(P＜0.01),两个患者组间的差异无统计学意义(P＞0.05).6周治疗后两个治疗组WCST和HVILT-R的操作分仍低于对照组,差异有统计学意义(P＜0.01).CPT的操作得分三组间差异无统计学意义(P＞0.05);(2)治疗后与治疗前比较,联合治疗组WCST的完成分类数增加,错误应答数、持续错误数减少,差异有统计学意义(P＜0.01).单一治疗组的完成分类数增加、错误应答数减少,差异有统计学意义(P＜0.01).两个治疗组的HVLT—R操作分与治疗前的差异无统计学意义(P＞0.05).CPT操作分与治疗前比较明显提高,差异有统计学意义(P＜0.01).结论 双相障碍躁狂发作时存在执行功能、学习和记忆能力、注意力等神经认知领域损害;病情稳定后,执行功能和言语记忆功能损害仍持续存在;6周的丙戊酸钠联合喹硫平或单一喹硫平治疗均能有效地改善双相躁狂患者的部分认知功能.     

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.     

Dextromethorphan: Cellular Effects Reducing Neuronal Hyperactivity

Summary: Dextromethorphan is a dextrorotary morphinan without affinity for opioid receptors, commonly used as an antitussive medication. During the past 5 years, interest in the compound and its demethylated derivative, dextrorphan, has been revived because additional neuroprotective and an-tiepileptic properties were found in in vitro studies, animal experiments, and a few clinical cases. Both morphinans are able to inhibit N -methyl-D-aspartate (NMDA) receptor channels and voltage-operated calcium and sodium channels with different potencies. The inhibition of the NMDA receptor is believed to be the predominant mechanism of action responsible for the anticonvulsant and neuroprotective properties of the compounds.     

Pediatric Epilepsy Surgery

Summary: The use of implantable arrays of epidural electrodes has made it possible to carry out extraoperative electrocorticography (ECoG) and functional localization in the awake child. This has permitted cortical excisions that are determined by criteria similar to those obtained during surgical procedures performed under local anesthesia in adults. In addition, the method also permits simultaneous ECoG and video monitoring during the child's symptomatic seizures, providing additional important localizing information that is impractical to obtain in operations under local anesthesia. We report our experience with 75 children, ages 5 months to 15 years, whom we have managed with epidural electrode arrays. The method of extraoperative ECoG is described and illustrative cases are presented to demonstrate its feasibility and utility in children. In addition, we call attention to gliomas as a common cause of chronic focal seizures in children. Of 49 children undergoing resection and followed for from 1 to 14 years (mean of 5.8 years), 32 (65%) are either seizure free or have had a significant reduction in seizure frequency that has unambiguously improved their quality of life. The results are analyzed further by relating the surgical outcome to each of the pathologic entities that caused the seizures. This analysis reveals the variety of neurological conditions that commonly cause intractable focal seizure disorder in children and distinguishes those pathologic entities in which the seizure disorder is apt to respond to surgical intervention from those that will not.     

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.     

Un nouveau cadre conceptuel de travail pour une psychiatrie revisitée ? Introduction à deux articles de E. Kandel

In two articles which appeared in the American Journal of Psychiatry and that were subsequently translated for Évolution Psychiatrique, E. Kandel examines the bases for a reinterpreted psychiatry that is prepared to confront the major challenge of the 3rd millenium: that of insight into the mind and brain. This requires a major reorganization of the discipline, which involves a reinvestment of the scientific approach and a critical  assessment of the data provided by psychoanalytical psychiatry and cognitive neurosciences. Seven concepts have therefore been proposed for interactive re-examination: consciousness, the unconscious, memory, emotion, development, desire, impulse. The dynamic relations existing between genetics and the environment allow one to see how evolutions are possible from actions at different levels, both psychotherapeutic and pharmacological. Imaging and other techniques provide additional objective information to the process of human interaction which remains the basis of psychiatry. A common framework for psychiatry and the neurosciences, a reconsideration and renewal of the psychoanalytical approach are both possible and necessary.     

Opioids and the developing organism: A comprehensive bibliography, 1984–1988

A comprehensive bibliography of the literature concerned with opioids and the developing organism for 1984-1988 is presented. Utilized with companion papers (Neurosci. Biobehav. Rev. 6:439-479; 1982; 8:387-403; 1984), these articles cover the clinical and laboratory references beginning in 1875. For the years 1984, 1985, 1986, 1987, and 1988, a total of 877 citations were recorded. A series of indexes accompanies the citations in order to make the literature more accessible. These indexes are divided into clinical and laboratory topics, and subdivided into such topics as the type of opioid explored and the general area of biological interest (e.g., physiology).     

La biologie et le futur de la psychanalyse : un nouveau cadre conceptuel de travail pour une psychiatrie revisitée

The American Journal of Psychiatry has received a number of letters in response to my earlier “Framework” article (1). Some of these are reprinted elsewhere in this issue, and I have answered them briefly there. However, one issue raised by some letters deserves a more detailed answer, and that relates to whether biology is at all relevant to psychoanalysis. To my mind, this issue is so central to the future of psychoanalysis that it cannot be addressed with a brief comment. I therefore have written this article in an attempt to outline the importance of biology for the future of psychoanalysis.     

Facteurs de risque environnementaux à la schizophrénie

Schizophrenia is currently a major concern, its prevalence being estimated at around 1% and its social consequences being severe. The elucidation of the pathophysiology of the disease is difficult due to the great variability of clinical expressions, the instability of the clinical symptoms during the evolution and the absence of reliable biological markers. The existence of a familial aggregation in schizophrenia is well known, the risk of presenting the disease for first-degree relatives of patients being 5 to 10 times higher than the risk observed in the general population. The genetic component was further confirmed by twin and adoption studies. Although the concordance for the disease is higher (40 to 70%) among monozygotic twins as compared with dizygotic twins (15%) it does not reach 100%, which implies that environmental factors modulate the effects of the genotype. However, the role of these factors and especially their interaction with genetic factors remain unclear but the implications of some specific environmental factors are well documented by recent research data. The current literature on sex differences in schizophrenia is consistent. Several studies have suggested that male and female patients may differ in age at the onset and expression of clinical symptoms. Complications during pregnancy or birth-giving may increase the risk of developing schizophrenia later in life. The major complications are oxygen deprivation during pregnancy, bleeding, maternal malnutrition or infection (exposure to influenza, for example). A low birth weight is associated with an increased risk of schizophrenia. Psychoses are more common among people living in an urban environment and among those born during winter months. Schizophrenia is probably more prevalent in people who are living promiscuously, are subject to toxic abuse, poor nutrition and stress but here more precise data are needed. Moreover, immigrants have a higher risk of developing psychotic disorders. In addition, head traumas are associated with an increased risk of schizophrenia. Though they are contentious, some studies suggest that substance abuse (cannabis use in European countries) is related to the development of schizophrenia, especially in people with genetic vulnerability. Moreover, substance misuse may worsen the symptoms. If the environment is sufficiently stressful, people with a high genetic vulnerability will develop some degree of mental illness, including schizophrenia. Conversely, a less stressful or a protective environment may decrease the risk of its onset in persons with a predisposition to schizophrenia.