首发未服药精神分裂症患者血浆非酶抗氧化物浓度分析

目的探讨首发未服药精神分裂症患者血浆非酶抗氧化物水平及其与临床特征间的关系。方法测定55例首发未服用抗精神病药精神分裂症患者和42名正常对照的血浆非酶抗氧化物水平,包括白蛋白、总胆红素浓度和尿酸浓度;采用阳性和阴性症状量表(positive and negative symptoms scale,PANSS)评定精神症状。结果患者组血浆白蛋白和尿酸浓度明显低于对照组[(44.72±3.42)g/Lvs(46.70±3.43)g/L,(3.11±1.00)×102μmoL/Lvs(5.00±1.01)×102μmoL/L,P均小于0.05];以阳性症状为主的患者血浆总胆红素浓度明显高于以阴性症状为主的患者[(12.48±3.86)μmoL/L vs(10.27±1.78)μmoL/L,P=0.04];男性患者尿酸浓度明显高于女性患者[(3.54±1.21)×102μmoL/L vs(2.88±0.76)×102μmoL/L,P=0.01];对照组男女性之间上述3个指标的差异均无统计学意义(P>0.05);相关分析仅发现对照组血浆白蛋白、尿酸与年龄相关(r=-0.39,P=0.01;r=-0.40,P=0.01)...     

抗精神病药所致迟发性运动障碍患者血浆超氧化物歧化酶、过氧化氢酶、谷胱甘肽过氧化酶活性及丙二醛浓度的改变

目的探讨抗精神病药所致迟发性运动障碍(TD)患者体内自由基代谢状况与TD的关系。方法测定119例TD(TD组)、46例非TD(非TD组)慢性精神分裂症患者及44名正常人(对照组)血浆超氧化物歧化酶(SOD)、谷胱甘肽过氧化酶(Gpx)、过氧化氢酶(CAT)活性及丙二醛(MDA)浓度,并在TD组中选取46例一般状况与非TD组、对照组匹配的患者进行三组间方差分析;生化指标与异常不自主运动量表(AIMS)总分间的相关性采用直线相关分析。结果(1)对照组血浆SOD活性[(98±11)×103U/L]、Gpx活性[(143±31)×103U/L]高于TD患者[44例,SOD(85±15)×103U/L,Gpx(101±29)×103U/L]及非TD组[SOD(93±16)×103U/L,Gpx(117±39)×103U/L];对照组MDA浓度[(2.6±1.5)mmol/L]低于TD患者[44例,(13.5±8.8)mmol/L]及非TD组[(7.3±6.5)mmol/L],差异均有统计学意义(均P<0.05);(2)TD患者(44例)血浆SOD活性、MDA浓度与非TD组间的差异均有统计学意义(均P<0.05);(3)AIMS总分与SOD、MDA均有显著相关(r=-0.225,r=0.225,均P<0.05)。结论TD患者的血浆抗氧化酶、脂质过氧化物异常,自由基代谢障碍可能与TD关系密切。     

精神分裂症伴发迟发性运动障碍的血清S100B蛋白浓度研究

目的 比较伴发和未伴发迟发性运动障碍(tardive dyskinesia,TD)的慢性精神分裂症患者血清S100B蛋白的浓度,探索S100B蛋白在TD发生中的作用.方法 采用酶联免疫吸附法检测95例伴发TD(TD组,n ＝ 40)与未伴发TD(非TD组,n ＝ 55)的慢性精神分裂症患者和40名正常对照的血清S100B蛋白浓度,比较3组间的差异;采用阳性和阴性症状量表(positive and negative syndrome scale,PANSS)评定精神病理症状,采用异常不自主运动量表(abnormal involuntary movement scale,AIMS)评定TD严重程度,分析血清S100B蛋白浓度与精神病理症状、TD严重程度的关系.结果 TD组、非TD组和对照组的血清S100B蛋白浓度分别为(0.17 ± 0.04)μg/L、(0.15 ± 0.02)μg/L和(0.10 ± 0.03)μg/L,3组的差异有统计学意义(F ＝ 53.07,P ＜ 0.01),前两者均明显高于对照组(P ＜ 0.01),且TD组高于非TD组(P ＜ 0.01).TD组血清S100B蛋白浓度与AIMS总分正相关(r ＝ 0.52,P ＜ 0.01).结论 TD患者血清S100B蛋白浓度较非TD患者还高,而且与TD严重程度正相关,提示胶质细胞功能异常可能在TD发生、发展过程中可能起一定作用.     

首次躁狂发作未服药患者血清尿酸水平的研究

目的:探讨首次躁狂发作未用药患者血清尿酸(UA)水平及其临床影响因素。方法:检测105例首次躁狂发作未用药患者(患者组)和105名健康对照者(对照组)血清UA水平,同时采用杨氏躁狂量表(YMRS)评估躁狂症状严重程度。结果:患者组血清UA水平[(371.17±103.63)μmol/L]显著高于对照组[(301.10±78.40)μmol/L](P0.01);高尿酸血症(HUA)发生率(35.2%,37例)显著高于对照组(8.5%,9例)(P0.01);患者组男性[(399.20±99.35)μmol/L]和对照组男性[(329.62±76.34)μmol/L]之间、患者组女性[(333.80±100.71)μmol/L]与对照组女性[(263.06±64.23)μmol/L]之间血清UA水平差异有统计学意义(均P0.01)。相关分析显示血清UA水平与YMRS评分无相关(P0.05)。结论:首次躁狂发作未用药患者血清UA水平升高,但其与躁狂病情无关。     

精神分裂症患者迟发性运动障碍与血清尿酸浓度关系探讨

目的比较伴有迟发性运动障碍(TD)与不伴TD的精神分裂症患者、正常对照血清尿酸水平,探索尿酸在TD发生机制中可能的作用。方法采用Simpson迟发性运动障碍专用量表进行筛选,共入组TD患者30名(TD组),非TD患者32名(非TD组),健康对照组33名,收集患者性别、年龄、病程、用药时间、体重等相关信息;分别采用阳性和阴性症状量表(PANSS)评定精神病理症状,异常不自主运动量表(AIMS)评定患者TD症状的严重程度;采用全自动生化仪测定三组血清尿酸水平,比较组间差异,并分析TD患者血清尿酸水平与AIMS总分间的关系。结果三组血清尿酸水平(正常组:338.97±81.29umol/l,TD:222.2±69.53umol/l,非TD组:270.46±89.89umol/l)间存在显著差异(F=14.94,P0.05)。TD患者血清尿酸水平与AIMS评分呈负相关(r=-0.391,P0.05)。结论尿酸可能参与了TD的病理生理过程     

伴发迟发性运动障碍的精神分裂症患者血清脑源性神经营养因子水平的对照研究

目的 探讨外周血清脑源性神经营养因子(brain derived neurotrophic factor,BDNF)浓度与精神分裂症伴发的迟发性运动障碍(tadrive dyskinesia,TD)的关系.方法 收集精神分裂症伴发TD患者61例、不伴发TD的患者78例,以及正常对照102名.用酶联免疫吸附法检测BDNF水平,采用不自主运动量表(abnormal involuntary movement scale,AIMS)评估TD的严重程度,阳性和阴性症状量表(positive and negative symptom scale,PANSS)评估患者精神症状.结果 TD组、非TD组和对照组的BDNF水平分别为(9.35±1.60)μg/L、(10.12±2.03)μg/L、(12.27±2.7)μg/L,3组的差异有统计学意义(F=37.8,P<0.01);两两比较显示,TD组和非TD组均低于对照组(P<0.01),而TD组又低于非TD组(P<0.05).使用典型和非典型抗精神病药物患者之间的BDNF水平差异无统计学意义(P>0.05).TD组BDNF水平与AIMS总分、年龄、总病程负相关(r分别为-0.24、-0.32、-0.22,P均小于0.05),而在非TD组BDNF水平与上述因素均无相关(P>0.05).结论 精神分裂症伴发TD患者外周BDNF浓度下降,且其水平与异常运动严重程度相关,提示BDNF可能在TD的病理生理中发挥作用.     

慢性精神分裂症男性患者血浆一氧化氮及其合成酶活性的临床研究

目的探讨慢性精神分裂症男性患者血浆一氧化氮(NO)浓度及其合成酶活性与患者认知功能和临床症状之间关系。方法于2020年1—10月在连云港地区精神专科医院(连云港市第四人民医院、赣榆区康复医院、东海县精神病医院、灌云县精神病医院)选取96例慢性精神分裂症男性患者作为患者组,同期在连云港市招募年龄18~60岁的88例健康男性作为对照组,进行血浆NO浓度和原生型一氧化氮合酶(cNOS)、诱导型一氧化氮合酶(iNOS)活性检测,采用重复性成套神经心理状态评定量表(RBANS)对所有研究对象测量认知功能,采用阳性与阴性症状评定量表(PANSS)对患者组进行精神症状评估。结果患者组的NO水平高于对照组[(53.1±16.7)μmol/L比(48.0±16.8)μmol/L],差异有统计学意义(P=0.017);患者组的cNOS活性低于对照组[(1.3±0.5)U/ml比(1.6±0.5)U/ml],差异有统计学意义(P<0.001)。两组的iNOS活性比较,差异无统计学意义[(1.7±0.5)U/ml比(1.6±0.7)U/ml,P=0.160]。患者组的RBANS总分及5个分量表评分显著低于对照组(均P<0.01)。在患者组中,NO浓度与体重指数(BMI)(r=0.353,P<0.001)、病程(r=0.257,P=0.012)、PANSS阳性症状分(r=0.331,P=0.001)、PANSS一般病理分(r=0.204,P=0.047)呈正相关,而与发病年龄(r=-0.320,P=0.001)、RBANS中的言语功能评分(r=-0.281,P=0.005)呈负相关。患者组的cNOS和iNOS活性与临床特征、PANSS评分及RBANS评分无明显相关性(均P>0.05)。患者组的低NO浓度组[(39.6±10.6)μmol/L]较高NO浓度组[(66.2±9.5)μmol/L]在言语功能[(76.1±11.3)分比(68.5±14.3)分]方面差异有统计学意义(P<0.05)。结论慢性精神分裂症男性患者认知功能明显受损,血浆NO及其合成酶活性存在异常,且血浆NO与患者的临床特征存在关联性,提示氧化应激机制在精神分裂症病理生理机制中可能起到一定作用。     

双相障碍躁狂发作治疗前后血清尿酸水平分析

目的探讨双相障碍躁狂发作治疗前后血清尿酸(uric acid UA)水平的变化及意义。方法双相障碍躁狂发作79例(患者组),采用Young氏躁狂量表评定治疗前后躁狂症状严重程度,观察周期8周,并检测治疗前后血清UA水平。纳入77名正常健康人作为对照(对照组)。结果患者组治疗前血清UA水平[(369.28±107.59)umol/L]高于对照组[(301.77±76.04)μmol/L]明显升高(P0.01);治疗后血清UA水平[(331.94±94.58)μmol/L]下降(P0.01),但仍显著高于健康对照组(P0.01)。相关分析显示:治疗前血清UA水平与治疗前躁狂量表评分无关(r=0.11,P=0.37),治疗后血清UA水平与治疗后躁狂量表评分正相关(r=0.28,P=0.02)。结论双相障碍躁狂发作患者可能存在嘌呤代谢紊乱,躁狂急性期UA水平升高,临床症状改善后UA水平下降。     

前循环TIA患者血清总胆红素水平与ABCD2评分

目的探讨动脉粥样硬化(AS)性前循环短暂性脑缺血发作(TIA)患者血清总胆红素(T.Bil)水平与其ABCD2评分的相关性。方法收集前循环TIA患者133例进行ABCD2评分,根据评分分为低危亚组、中危亚组和高危亚组,收集其血清T.Bil水平资料,比较三组间血清T.Bil平均水平,分析血清T.Bil水平与ABCD2评分的相关程度及其临床意义。结果 TIA患者血清T.Bil水平较对照组显著降低,差异有统计学意义(P<0.05)。Kruskal-Wallis H检验显示,三组间血清T.Bil平均水平差异有统计学意义(P=0.004),高危亚组[(7.59±2.05)μmol/L]低于中危亚组[(9.45±3.08)μmol/L],中危亚组低于低危亚组[(11.53±2.26)μmol/L](均P<0.05)。经Spearman秩相关系数检验,血清T.Bil水平与ABCD2评分呈负相关(r=-0.269,P=0.002)。结论 TIA患者血清T.Bil水平随ABCD2评分的增高而降低,并与ABCD2评分呈负相关。     

双相Ⅰ型障碍抑郁发作患者血清尿酸水平及其影响因素

目的调查双相I型障碍抑郁发作患者血清尿酸(UA)水平及其影响因素。方法采用横断面研究,选取双相I型障碍抑郁发作患者(患者组)68例和健康人群(对照组)68例。采用全自动生化仪检测血清UA水平,采用汉密尔顿抑郁量表(HAMD)评定患者抑郁严重程度。结果患者组高尿酸血症(HUA)检出率高于对照组,差异有统计学意义(20.6%vs.7.4%,P0.05);患者组血清UA水平与对照组比较差异有统计学意义[(310.31±83.35)μmol/L vs.(282.47±78.30)μmol/L,P0.05],患者组男性UA水平高于女性[(344.40±100.45)μmol/L vs.(296.10±71.59)μmol/L,P0.05]。相关分析显示:UA水平与性别和精神病家族史呈负相关(r=-0.28、-0.27,P均0.05);与甘油三酯水平呈正相关(r=0.34,P0.01)。逐步多元回归分析显示,性别、阳性精神疾病家族史对血清UA水平有明显影响(P均0.01)。结论双相I型障碍抑郁发作患者UA水平增高,并与性别、精神疾病家族史相关。     

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.     

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.     

Introduction: Goals

Summary: Epilepsy is characterized by recurrent seizures. Many epilepsies with focal seizures as well as convulsive generalized seizures respond satisfactorily to antiepileptic drugs (AEDs) that reduce repetitive firing (e.g., phenytoin, carbamazepine, and valproate) or that augment GABA_A-mediated inhibition (e.g., phenobarbital and benzodiazepines). A number of drugs presently under development, such as NMDA receptor antagonists, loreclezole, losigamone, meth-ysticine, and dextromethorphan, are promising in acute animal models of otherwise drug-resistant convulsant activity. As a result of recent studies in both experimental models and surgically resected human epileptic brain, the prospects for development of AEDs have significantly improved. Several new AEDs recently have reached the commercial market or are in experimental or clinical trials. A comparative presentation of the standing of the new AEDs with respect to their efficacy and side effects is necessary, but still very difficult. Because initial experience with new AEDs is restricted to populations with severe drug-resistant epilepsy, the crucial question whether potential new AEDs can alter prognosis is not yet definitively answered. There is a clear need to compare the effects of standard AEDs and new AEDs in naive patients and over longer follow-up periods. Moreover, because of the strong desire to develop antiepileptic therapy that directly treats the primary etiology of a given epileptic syndrome , or modifies the neurobiological processes that cause recurrent seizures, better experimental epilepsy models for chronic epilepsy and further clinical studies are necessary to increase the knowledge on the pathophysiology of distinct epileptic syndromes. In this respect, studies on the differences between responders and nonresponders to a given AED treatment are extremely valuable.