佛山顺德区有肇事肇祸倾向重性精神疾病患者社区个案管理效果的干预12个月随访

目的:探讨社区个案管理对佛山市顺德区有肇事肇祸倾向的重性精神疾病患者社会功能、生活质量和家庭负担的影响。方法:将有肇事肇祸倾向的重性精神疾病患者分成干预组和对照组,对干预组实施个案管理模式,而对照组仅维持原来的社区随访服务。用简明精神病量表(BPRS)、社会功能缺陷筛查量表(SDSS)、Morning Side康复状态量表(MRSS)、生活质量量表和家庭负担会谈量表(FIS)评定两组患者的精神症状、社会功能、生活质量和家庭负担,并计算两组患者的肇事肇祸率。结果:在干预12个月后,干预组BPRS评分[(32.51±4.03)和(34.18±4.46)]、SDSS评分[(7.51±2.90)和(7.99±4.16)]、MRSS评分[(56.09±20.61)和(58.74±22.30)]和FIS量表评分[(35.20±10.31)和(37.28±14.24)]显著低于对照组(P0.05或P0.01),而干预组生活质量量表评分(13.32±4.75)显著高于对照组[(12.58±4.97)(P0.05)];干预组的肇事肇祸率(12.6%)显著低于对照组(18.2%,P0.05)。结论:对有肇事肇祸倾向的重性精神疾病患者实施个案管理,能有效改善患者的精神症状,降低肇事肇祸率,改善社会功能和生活质量,减轻患者的家庭负担。     

社区医生督导对重性精神障碍患者服药依从性和疗效的影响

目的探讨社区医生督导对重性精神障碍患者的服药依从性及治疗效果的影响。方法选取于2013年2月2日至2015年2月1日期间居住于同一社区的重性精神障碍患者175例,对所有患者进行六级危险性评估,依据临床表现对所有患者作四级管理分类,并根据管理分类,为每位患者制定个性化社区医生督导方案。2年后,收集所有患者服药依从率、症状好转率、社区集体康复活动参与率、肇事肇祸率等资料,并与2年前进行对比。结果与管理前相比,患者服药依从率从59.1%上升到70.2%;社区集体康复活动参与率从27.3%上升到70.1%;肇事肇祸率从44.4%下降到11.4%,差异具有统计学意义(P0.01)。结论应用社区医生督导能有效提高重性精神障碍患者的服药依从性和疗效,对提高患者医疗效果有着积极作用。     

湖南省严重精神障碍患者肇事肇祸行为的影响因素分析

目的 探讨严重精神障碍患者肇事肇祸的主要影响因素。方法 在湖南省严重精神障碍信息管理系统中筛选出2019年11月～2020年10月期间有肇事肇祸行为的患者489例作为研究组,随机抽取无肇事肇祸行为的患者489例作为对照组,共978例患者作为研究对象。采用χ2检验及二元逐步Logistic回归分析肇事肇祸行为的影响因素。结果 男性、中青年(18～44岁、45～60岁)、文化程度低、户别为城镇、自知力缺乏、服药不规律、不参加社区康复服务是患者发生肇事肇祸行为的危险因素,差异均有统计学意义(P0.05)。结论 应重点关注自知力缺乏、服药不规律、男性、18～60岁、文化程度低、户别为城镇、不参加社区康复服务的严重精神障碍患者,采取针对性措施,降低肇事肇祸行为发生率。     

心理健康教育多元家庭治疗在严重精神障碍患者康复中的效果评价

目的观察心理健康教育多元家庭治疗模式在严重精神障碍患者康复中的效果。方法采用随机数字表法将100例居家治疗的严重精神障碍患者分为干预组和对照组,两组患者均在给予药物治疗的同时分别采用心理健康教育多元家庭治疗模式和常规社区管理模式进行干预,分别于干预前、干预12个月时采用阴性和阳性症状量表(PANSS)、个人与社会表现量表(PSP)、社会功能缺陷筛选量表(SDSS)对患者进行评估。结果与干预前比较,干预组PANSS、PSP、SDSS量表总分及各分量表评分差异均明显降低(P0.05);干预结束时,干预组与对照组比较,PANSS、PSP、SDSS量表总分及各分量表评分差异均明显降低(P0.05);入院率显著低于对照组。结论心理健康教育多元家庭治疗模式可改善严重精神障碍患者的社会功能,对严重精神障碍的康复具有积极作用。     

苯丙胺类兴奋剂所致精神障碍患者肇事肇祸的相关因素

目的探索苯丙胺类兴奋剂(ATS)所致精神障碍患者肇事肇祸的相关因素,为ATS所致精神障碍患者制定相关干预措施提供参考。方法纳入符合《国际疾病分类(第10版)》(ICD-10)苯丙胺类兴奋剂所致精神障碍诊断标准的患者105例。分为肇事肇祸组和无肇事肇祸组。收集患者的一般人口学资料和临床资料,采用社会支持评定量表(SSRS)对患者的社会支持情况进行评定,通过单因素分析和多因素Logistic回归模型探索患者出现肇事肇祸的相关因素。结果肇事肇祸组SSRS总评分[(24.10±6.59)分vs.(28.94±5.59)分,t=3.364,P=0.001]、客观支持评分[(5.50±1.96)分vs.(8.20±2.13)分,t=5.183,P0.01]、对支持的利用度评分[(4.60±2.26)分vs.(6.28±1.90)分,t=3.435,P=0.001]均低于无肇事肇祸组,差异均有统计学意义。多因素Logistic回归分析结果显示,男性(OR=6.061,P=0.014)是ATS所致精神障碍患者发生肇事肇祸的危险因素,高社会支持水平(OR=0.873,P=0.018)是ATS所致精神障碍患者发生肇事肇祸的保护因素。结论男性和低社会支持的ATS所致精神障碍患者发生肇事肇祸的可能性较大。     

雅安市社区在管严重精神障碍患者现状研究

目的了解雅安市社区在管严重精神障碍患者的现况,为改进雅安市严重精神障碍管理治疗工作提出可行性建议。方法采用分层随机抽样的方法,抽取雅安市纳入社区管理的严重精神障碍患者1 002例,采用重性精神疾病管理随访表调查患者规范管理情况、服药情况、居家稳定情况以及肇事肇祸情况。结果完成有效问卷803份,雅安市社区在管严重精神障碍患者规范管理率为93. 03%(95%CI:91. 30%~94. 80%),服药率为65. 13%(95%CI:61. 80%~68. 40%),规律服药率为50. 44%(95%CI:47. 00%~53. 90%),居家稳定率为90. 78%(95%CI:88. 80%~92. 80%)。肇事肇祸发生率为4. 61%(95%CI:3. 20%~6. 10%)。结论雅安市严重精神障碍患者规范管理率、规律服药率达到国家标准,服药率尚未达到国家标准,居家稳定率较高,肇事肇祸率较低。     

心理干预对首发精神分裂症康复期患者疗效影响分析

目的探索心理干预对康复期精神分裂症患者的疗效与影响。方法研究对象为在我院精神1、2科住院治疗的首发精神分裂症患者,出院前1月对干预组患者实施心理干预,对照组按正常治疗出院。出院时进行阳性和阴性症状量表(PANSS)、大体评定量表(GAS)评分。干预组出院后进行定期的电话和上门随访;对照组一般门诊随访。在3个月,6个月,1年时再分别对两组患者做PANSS、GAS、康复状态评定量表(MRSS)、社会功能缺陷筛选量表(SDSS)测定。结果干预组PANSS、MRSS、SDSS分值逐步下降,GAS分值升高,与对照组比较差异有显著性;干预组服药依从性、自觉门诊随访率显著高于对照组,再住院率低于对照组(P<0.01)。结论对首发精神分裂症患者康复期进行心理干预可以提高临床疗效,改善阳性症状,提高社会功能并能增加服药的依从性,减少复发。     

精神分裂患者长期住院与社区康复治疗对照研究

目的探讨精神分裂症长期住院与社区康复治疗两组患者疗效、社会功能缺陷以及对社会的影响、卫生经济学指标有何差异。方法以住院治疗慢性精神分裂症患者300例及在社区康复站治疗300例进行为期一年的观察，采用BPRS、PANSS、SDSS量表，自编肇事肇祸危险性评估量表及生活质量和总体幸福感量表分别对两组患者进行评分。结果两组BPRS、PANSS减分率、总有效率差异无显著性意义。治疗组SDSS在治疗第3、6月下降，与治疗前有显著性（P〈0．05）；第9、12月又上升，与治疗前差异无显著性意义；对照组则一直下降，与治疗前比较差异有非常显著性意义（P〈0．01）。治疗组肇事肇祸危险性评估分值少于对照组（P〈0．05）。对照组家属生活满意度及总体幸福感明显好于治疗组（P〈0．01）。对照组平均每月医疗费用明显低于治疗组（P〈0．01）。结论开展社区康复治疗对慢性精神分裂患者可以达到理想的疗效；较好的社会功能，较低的肇事肇祸率，减轻家庭及政府的经济负担，提高家属及患者的生活质量。     

社区服药无缝连接管理模式对精神分裂症患者社会功能和生活质量影响

目的观察社区服药无缝连接管理模式对精神分裂症患者社会功能和生活质量的影响,为提高精神分裂症患者社区管理质量提供参考。方法将符合入组标准50对精神分裂症患者分为研究组与对照组,研究组实施服药无缝连接管理,对照组实施常规社区管理。分别在基线、干预后6个月和干预后1年行患者社会功能缺陷(SDSS)及生活质量(QOL-BRIEF)评估。结果基线时研究组和对照组SDSS评分无统计学意义(7.1±2.9vs 6.9±2.3);干预后6个月实验组SDSS评分显著低于对照组(5.1±2.4 vs 6.3±2.3,t=2.66,P=0.009);干预后1年实验组SDSS评分仍然显著低于对照组(4.4±2.0 vs 6.0±2.4,t=3.50、P=0.001);干预后1年研究组WHOQOLBRIEF量表在躯体功能维度(13.8±1.6)、心理功能维度(15.0±2.4)、社会关系维度(15.1±2.4)及环境维度(14.9±2.1)评分显著高于对照组(11.7±1.3、12.6±1.2、12.5±2.1、12.16±1.55,P0.001)。结论社区服药无缝连接管理模式对精神分裂症患者的社会功能和生活质量改善显著优于常规社区管理。     

精神病康复防治网络对男性复员退伍军人精神分裂症患者管理及康复效果的影响

目的探讨精神病康复防治网络对男性复员退伍军人精神分裂症患者管理及康复效果的影响。方法将烟台市散居在乡的274名男性复员退伍军人精神分裂症患者纳入精神病康复防治网络,于2007年1月-2012年12月进行为期6年的追踪随访。分别于纳入防治网络前、纳入防治网络3年后、6年后以阳性和阴性症状量表(PANSS)、社会功能缺陷筛选量表(SDSS)、自知力与治疗态度问卷(ITAQ)、肇事肇祸危险性评估量表对其管理和康复效果进行评定。结果防治网络实施3年及6年后,患者的PANSS各项目评分及总分、SDSS总分、ITAQ评分与纳入防治网络前比较差异有统计学意义(P0.01);无4级和5级肇事肇祸危险性患者出现。结论精神病康复防治网络可能有利于改善男性复员退伍军人精神分裂症患者的症状,提高社会功能,降低危险性。     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Diagnostic Difficulties and Treatment Implications

Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.     

Cognitive Dysfunction Associated with Antiepileptic Drug Therapy

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Carbamazepine Efficacy in Adults With Partial and Generalized Tonic-Clonic Seizures

Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.     

Etiologic and Preventive Aspects of Epilepsy in the Child–Bridging the Gap Between Laboratory and Clinic

Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.     

Predisposing and Causative Factors in Childhood Epilepsy

Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non-febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

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.