帕利哌酮与氟哌啶醇治疗精神分裂症的双盲对照研究

目的 比较帕利哌酮与氟哌啶醇治疗精神分裂症的疗效和安全性.方法 将60例精神分裂症患者随机分为帕利哌酮组和氟哌啶醇组各30例,按双盲法,分别予帕利哌酮和氟哌啶醇单一口服治疗,观察8周.治疗前及治疗后第1、2、4、6、8周末使用简明精神病评定量表(BPRS)、锥体外系副反应量表(SAS)、静坐不能评定量表(BARS)及治疗中需处理的不良反应症状量表(TESS)评定,并测生命体征,基线和治疗结束时进行实验室检查,包括血常规、尿常规、血生化、心电图.观察疗效及不良反应.结果 帕利哌酮组与氟哌啶醇组患者的精神症状均明显改善(F =201.49,P＜0.001),两组之间有效率比较无显著性差异(x2=0.1617,P=1.00).帕利哌酮组静坐不能(Z =2.52,P=0.013)及锥体外系副反应(Z=2.02,P=0.044)均明显少于氟哌啶醇组.实验室检查显示除催乳素水平升幅帕利哌酮组较氟哌啶醇组高(x2=5.08,P=0.04)外,其余均无明显差异.结论 帕利哌酮与氟哌啶醇治疗精神分裂症疗效相当,副反应轻.     

棕榈酸帕利哌酮对精神分裂症患者生活质量的影响

目的探讨棕榈酸帕利哌酮对精神分裂症患者生活质量的影响。方法将98例患者分成研究组(棕榈酸帕利哌酮)和对照组(奥氮平),研究组口服三天帕利哌酮,无过敏即予棕榈酸帕利哌酮注射;首次150mg,间隔8天100mg,之后每月一次,剂量75~150mg;对照组口服奥氮平,剂量5mg~30mg,分别在治疗前与治疗后4、8、12、16周末采用阳性与阴性症状评定量(PANSS)、临床总体印象量表(CGI)评定精神症状与疗效的变化;生活质量和满意度自评问卷(Q-LES-Q)评定生活质量和满意度;副作用量表(TESS)、实验室、血生化、体质量评价安全性。结果两组各时点PANSS、CGI、Q-LES-Q评分与治疗前比较均有显著性差异(P0.05或P0.01),PANSS、CGI组间比较差异无显著性(P0.05);Q-LES-Q治疗后组间比较差异有显著性(P0.05或P0.01),实验室、血生化无差异,体重、催乳素组间比较有差异。结论棕榈酸帕利哌酮对精神分裂症疗效、副反应与奥氮平相当;对体重及催乳素影响较奥氮平轻,对生活质量和满意度优于奥氮平。     

帕利哌酮缓释片与利培酮治疗精神分裂症的对照研究

目的讨论帕利哌酮缓释片对精神分裂症的治疗效果及对患者社会功能的影响。方法采用随机数字表将84例精神分裂症患者分为帕利哌酮缓释剂组和利培酮组,各42例,分别使用帕利哌酮缓释剂和利培酮片治疗,疗程均为8周。两组均在治疗前及治疗第2、4、8周末采用阳性与阴性症状量表(PANSS)评定疗效,副反应量表(TESS)评定不良反应,在治疗前和8周末采用个人和社会功能量表(PSP)评定社会功能恢复状况。结果PANSS评定:两组在治疗前后差异均有统计学意义(P均0.05),同时两组在8周末差异有统计学意义(P0.05)。TESS评定:两组药物的副反应差异无统计学意义(P0.05)。PSP量表评定:两组治疗前后及两组之间相比差异有统计学意义(P0.05),并且帕利哌酮缓释片优于利培酮。结论帕利哌酮缓释片和利培酮治疗精神分裂症阳性及阴性症状均有效。但帕利哌酮缓释片起效相对迅速,不良反应少且轻微,对于精神分裂症患者的整体社会功能改善具有明显的效果。     

帕利哌酮缓释片治疗复发精神分裂症疗效与社会功能评定

目的 探讨帕利哌酮缓释片对复发精神分裂症疗效及社会功能的影响。方法 选取38例复发精神分裂症患者使用帕利哌酮缓释片持续治疗4周,于治疗前及治疗后第4周末采用阳性和阴性综合征量表（PANSS）、个人和社会功能量表（PSP）及治疗中需处理的不良反应症状量表（TESS）评定并比较患者的精神症状、社会功能和不良反应。结果患者治疗后第4周末PANSS各因子分、总分及PSP各因子分较治疗前均降低（P〈0.01）;PSP总分较治疗前升高（P〈0.01）。总不良反应发生率42%。结论 帕利哌酮缓释片可有效改善复发精神分裂症患者的精神症状、个人及社会功能,且不良反应轻。     

随机对照研究比较喹硫平与氟哌啶醇治疗精神分裂症的疗效

目的研究喹硫平对精神分裂症患者认知功能及生活质量的改善作用。方法将62名住院或门诊的急性期精神分裂症患者随机分为两组,分别给予喹硫平（n=32）和氟哌啶醇（n=30）治疗,随访16周。分别在基线、第8周、第12周和第16周用阳性与阴性综合征量表（PANSS）、生活质量和满意度自评问卷（Q-LES-Q）、持续性操作测验（CPT）、威斯康星卡片分类测验（WCST）以及成人韦氏智力量表（WAIS）中的数字广度项目盲法评定精神症状、生活质量和满意度以及认知功能。采用重复测量的方差分析比较两组结果。结果喹硫平组有17例完成16周的随访,氟哌啶醇组为14例。喹硫平组与氟哌啶醇组各时点PANSS评分均比基线改善,组间无明显差异。喹硫平组的4个时点平均（标准差）Q-LES-Q得分改善[分别为：49.0（8.1）分,51.2（7.0）分,54.3（10.6）分,54.1（10.3）分,F=11.70,P〈0.001],而氟哌啶醇组无明显改善[分别为：49.5（7.8）分,51.3（8.0）分,50.0（8.7）分,50.5（8.9）分;F=0.33,P=0.701]。在第16周时喹硫平组Q-LES-Q得分高于氟哌啶醇组（t=2.27,P=0.026）。第8周至第16周,喹硫平组WCST完成分类数、CPT的反应时间、WAIS数字广度评分与基线比均明显改善,而氟哌啶醇组的不同时点间评分无明显差异。结论虽然根据PANSS结果,急性精神分裂症患者用喹硫平和氟哌啶醇治疗的疗效相当,但是持续用喹硫平治疗16周者比持续用氟哌啶醇治疗者的生活质量更好,认知缺陷更少。     

重复经颅磁刺激联合帕利哌酮缓释片治疗精神分裂症的对照试验

目的比较重复经颅磁刺激联合帕利哌酮缓释片与单用帕利哌酮缓释片治疗精神分裂症患者的疗效、安全性和社会功能恢复,为临床选择治疗方案提供参考依据。方法选择符合条件的88例精神分裂症患者,随机分成研究组和对照组,治疗时间为4周。在治疗前和治疗后第1周、第2周、第4周末,用阳性与阴性症状量表(PANSS)及减分率评定疗效,治疗时出现的症状量表(TESS)评定不良反应,个体和社会功能量表(PSP)评定患者的社会功能。结果治疗后,与各组治疗前比较,两组PANSS总分及阴性症状分和阳性症状分、PSP均有明显改善,具有统计学意义(P0.05);组间比较,第2周和第4周末PANSS总分和阴性症状分、PSP评分比较差异有统计学意义(P0.05)。至治疗终点,观察组治疗有效率优于对照组(P0.05),两组间TESS评分差异无统计学意义(P0.05)。重复经颅磁刺激和帕利哌酮缓释片都是安全有效、可以耐受的。结论与单一使用帕利哌酮缓释片相比,重复经颅磁刺激联合帕利哌酮缓释片治疗能取得更好的疗效,改善阴性症状和提高社会功能,;同时副反应方面无明显差异。     

帕利哌酮缓释片与齐拉西酮治疗精神分裂症对照研究

目的：比较帕利哌酮缓释片与齐拉西酮治疗精神分裂症的疗效与安全性。方法：99例精神分裂症患者随机分为帕利哌酮组48例和齐拉西酮组51例,分别给予帕利哌酮缓释片和齐拉西酮治疗6周。采用阳性与阴性症状量表（PANSS）、个人与社会功能量表（PSP）和治疗中出现的症状量表（TESS）作为评价指标。结果：治疗2周及6周后,两组PANSS评分均低于治疗前（P均〈0．05）;组间比较,以帕利哌酮组PANSS评分显著低于对照组（P均〈0．05）。与治疗前比较,帕利哌酮组个人与社会功能改善显著[PSP评分治疗前和治疗后分别平均（49．85±7．64）分和（60．32±8．24）分];而齐拉西酮组改善不明显[PSP评分分别平均（48．92±5．40）分和（（53．38±6．90）分],组间比较,差异有显著性（P〈0．001）。帕利哌酮缓释片的主要不良反应为锥体外系不良反应、失眠、便秘、泌乳素升高,齐拉西酮主要为心电图QTc间期延长、失眠、头痛、恶心等。结论：帕利哌酮缓释片治疗精神分裂症的疗效和改善社会功能方面均优于齐拉西酮。     

阿立哌唑联合认知干预对精神分裂症患者认知功能的影响

目的探讨阿立哌唑联合认知干预对精神分裂症患者认知功能的影响。方法将92例精神分裂症患者随机分为阿立哌唑联合认知干预组(研究组,n=46)和阿立哌唑组(对照组,n=46),疗程12周,采用PANSS评估患者的精神症状,WCST、CPT、TMT、CF、HVLT-R及WMS-Ⅲ评估患者的认知功能,TESS评估患者的不良反应。结果治疗12周末两组PANSS各项评分较治疗前均显著降低(P0.01),而研究组阴性症状分、一般症状分及总分较对照组显著降低(P0.05或0.01),阳性症状分较对照组则无明显变化(P0.05)。两组WCST、CPT、TMT、CF、HVLT-R及WMS-Ⅲ评分较治疗前均明显改善(P0.01),且研究组较对照组改善更加明显(P0.05或0.01)。两组患者TESS量表总分差异无统计学意义(P0.05)。结论阿立哌唑联合认知干预对改善精神分裂症患者的认知功能可能优于单用阿立哌唑治疗。     

帕利哌酮缓释片与利培酮改善老年精神分裂症患者社会功能的对照研究

目的:探讨帕利哌酮缓释片对老年期精神分裂症患者社会功能的改善。方法:107例老年期精神分裂症患者被随机分为帕利哌酮组54例和利培酮组53例,分别于基线及180 d时采用个人和社会功能量表(PSP)从社会中有用的活动、个人和社会的关系、自我照料、干扰和攻击行为4个维度进行社会功能评估;随访结束时进行药物满意度问卷(MSQ量表)调查。结果:两组在治疗终点时PSP评分与基线相比均有显著提高(P0.01),帕利哌酮组比利培酮组社会功能改善更明显,差异具有统计学意义(P0.01)。治疗后,帕利哌酮组药物满意率为70.4%,明显高于利培酮组(39.6%)(χ~2=10.22,P=0.001)。结论:帕利哌酮缓释片能够明显改善老年精神分裂症患者的社会功能,提高患者的生活质量和药物治疗满意度。     

帕利哌酮对儿童精神分裂症患者阴性症状的效果

目的探讨帕利哌酮对儿童精神分裂症患者阴性症状的效果。方法选取2015年6月~2017年5月来本院诊治精神分裂症患儿60例,随机分为帕利哌酮组和阿立哌唑组,各30例,帕利哌酮组给予帕利哌酮治疗,阿立哌唑组给予阿立哌唑治疗,分析所有患者的临床疗效、阴性症状评定量表(SANS)评分、个人社会功能量表(PSP)评分、副反应量表(TESS)评分。结果两组患儿治疗2周后帕利哌酮组患儿SANS五项因子(思维贫乏、情感平淡或迟钝、意志缺乏/情感淡漠、兴趣缺乏/社交缺乏及注意损害)评分开始明显降低,PSP评分开始明显升高,阿立哌唑组治疗后4周SANS评分开始明显降低和PSP评分开始明显升高,帕利哌酮组改善程度好于阿立哌唑组,差异有统计学意义(P0.05);两组患儿治疗前、治疗后2、4、8周TESS评分均无明显差异(P0.05)。结论与阿立哌唑相比,帕利哌酮能更好的改善儿童精神分裂症的阴性症状和社会功能,起效快、安全性高。     

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 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.     

Anticonvulsant Drugs and Cognitive Function: A Review of the Literature

Summary: Alterations of cognitive function are separate from disturbances of behavior seen in association with epilepsy. The nature of the cognitive disability may to a certain extent depend on the seizure type. Partial seizures, mainly derived from a temporal lobe focus, impair memory tasks, while generalized seizures seem to have more effect on attentional abilities. A number of studies, reviewed in this paper, suggest that anticonvulsant drugs further impair cognitive function. Maximal impairments are seen in patients receiving polytherapy: rationalization of polytherapy improves cognitive abilities. Studies in children and adults have allowed differentiation of the effects of various commonly used antiepileptic agents. Maximal cognitive deficits are seen with. phenytoin, while phenobarbital and sodium valproate induce moderate disturbances, and carbamazepine seems relatively free from such toxicity. Further research is needed on the interrelationship between types of seizure disorders, types of anticonvulsant medications, and cognitive function.     

Effects of NMD A- and AMPA-Receptor Antagonists on Different Forms of Epileptiform Activity in Rat Temporal Cortex Slices

Summary: Lowering extracellular magnesium induces different patterns of epileptiform activity in rat hippocampus and entorhinal cortex. Short recurrent epileptiform discharges in the hippocampus are stable over time, whereas seizurelike events (SLEs) in the entorhinal cortex, the subiculum, and the neighboring neocortex develop into late recurrent discharges which are not blocked by clinically employed antiepileptic drugs. We tested the sensitivity of the different epileptiform discharge patterns to. /V-methyl-D-aspartate (NMDA)- and non-NMDA-receptor antagonists. As NMDA-receptor antagonist we used dextrorphan, ket-amine, and 2-aminophosphonovalerate (2APV); as α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA)-receptor antagonist we employed the quinoxaline derivative glutamate 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX). The findings show that the different patterns of epileptiform activity, including the late recurrent discharges, are sensitive to all NMDA-receptor antagonists. However, when dextrorphan was employed to suppress seizure-like events, later recurrent discharges did not develop during the remaining time course of the experiment. CNQX reversibly suppressed recurrent discharges in the hippocampus and SLEs in the entorhinal cortex. However, late recurrent discharges become insensitive to CNQX, even at a high concentration of 60 μM m. This finding suggests a prominent role for NMDA receptors in the generation of late recurrent discharges.     

The influence of comorbid depression on seizure severity

PURPOSE: To determine the relation between depressive symptoms and seizure severity among people with epilepsy. METHODS: A postal questionnaire was used to survey a nationwide community sample about seizures and depression. The Seizure Severity Questionnaire (SSQ) assessed the severity and bothersomeness of seizure components. The Centers for Epidemiological Studies-Depression scale categorized levels of depression. RESULTS: Respondents categorized as having current severe (SEV, n = 166), mild-moderate (MOD, n = 74), or no depression (NO, n = 443) differed significantly in SSQ scores (all p < 0.0001). People with SEV or MOD reported significantly worse problems than did those with NO depression for overall seizure recovery (mean, 5.3, 4.9, 4.5, respectively); overall severity (5.0, 4.5, 4.2); and overall seizure bother (5.3, 4.8, 4.4) (all p < 0.005). Cognitive, emotional, and physical aspects of seizure recovery also were rated worse among people with SEV than with NO depression (all p < 0.05). Symptoms of depression were significantly correlated with higher levels of all components of generalized tonic-clonic seizure severity (r = 0.33-0.48; all p < 0.0001), and partial seizures (r = 0.31-0.38; all p < 0.01). CONCLUSIONS: Clinically depressed people with epilepsy reported higher levels of perceived severity and bother from seizures, as well as greater problems with overall seizure recovery than did nondepressed people experiencing similar types of seizures. The pervasive influence of depressive symptoms on reports of seizure activity suggests that people with epilepsy should be screened for depression. These data highlight the importance of detecting and treating depression among people with epilepsy.     

Une phénoménologie de la dépendance à l'alcool. Une expérience primordiale de la « nostrité »

The phenomenological approach to alcoholism interestingly focuses on specific dynamics of interpersonal relationships displaying the founding of the Self from a primary “us” and its original basis in the human feast. Priorities for treatment intervention recommend to involve social setting and relationships of the patients, reaching their active participation to a motivational and long term group treatment, underlying the specific therapeutic effect of world exchanges. Biopsychosocial determination of alcoholism could be primarily based on components of interpersonal relationships. Regarding social background, drinking is one of the most famous supports for the achievement of the feast, a founding marker of present time. Taking an existential point of view, the feast appears as the heart of mankind because it presents a primary “us”, a plural state which indicates the beginning and founding of the Self from the others. During the feast, we regularly have to reach our Self from the “us” while avoiding two main dangers, drunkenness, an increase in the dizziness of upright verticality, and addiction, an opposite vertical surrender to alcohol and falling into in the alcoholic relapse, both situations imply a spatial domination and the disappearance of others. Treatment programs of alcohol addicts need to integrate the necessity of reaching the existential basic trust from the support of a group to the appropriation of the community which can be defined as an original “usness”.