A型肉毒毒素局部注射对成年面肌痉挛患者生存质量的影响

目的探讨A型肉毒毒素(BTXA)局部注射治疗对成年偏侧面肌痉挛(HFS)患者生存质量的影响。方法给予108例HFS患者BTXA痉挛部位肌内注射治疗,于治疗前、治疗后3个月、6个月时应用Cohen分级标准进行痉挛程度及疗效评价,应用生存质量量表(QOL-BREF)、抑郁自评量表(SDS)、焦虑自评量表(SAS)进行问卷调查。结果治疗后3个月、6个月时Cohen分级较治疗前明显下降;治疗后3个月、6个月时显效率及总有效率分别为90.1%、100%及83.3%、96.3%。治疗后3个月、6个月时QOL-BREF生理、心理、社会关系领域的评分较明显高于治疗前,差异有统计学意义(P<0.05)。治疗后3个月、6个月时SDS评分较治疗前明显降低,42.6%有抑郁情绪的患者治疗3个月、6个月降至13.9%、15.7%;治疗后3个月、6个月时SAS评分较治疗前明显降低;57.4%有焦虑情绪的患者治疗后3个月、6个月降至20.4%、24.1%。差异有统计学意义(P<0.05)。结论 A型肉毒毒素治疗HFS安全有效,并能明显改善患者生存质量和情绪。     

A型肉毒毒素对偏侧面肌痉挛和良性特发性眼睑痉挛患者焦虑/抑郁状态的影响

目的探讨偏侧面肌痉挛和良性特发性眼睑痉挛患者伴发焦虑/抑郁状态的情况,以及A型肉毒毒素局部注射治疗对患者焦虑/抑郁的影响。方法共纳入偏侧面肌痉挛(hemifacial spasm,HFS)患者90例和良性特发性眼睑痉挛(benign essential blepharospasm,BEB)患者90例,所有患者均进行BTX-A局部肌肉注射治疗,在注射前、注射后2个月采用焦虑自评量表(SAS)及抑郁自评量表(SDS)进行测评。比较HFS和BEB患者注射前后SAS和SDS分值的变化。结果(1)HFS患者治疗前SAS及SDS标准分的平均值分别为41.25±6.35、42.25±7.57,其中女性患者SAS评分比男性患者高(43.56±6.10、40.17±8.36,P=0.031),SDS评分比男性患者高(45.48±7.31、40.25±6.46,P=0.008),治疗后患者SAS及SDS评分分别为30.12±4.35(P=0.000)、30.58±4.89(P=0.000),与治疗前比具有统计学差异;(2)BEB患者治疗前SAS及SDS评分分别为58.90±10.61,58.78±9.89;其中女性患者SAS评分比男性患者高(60.89±9.11、56.45±8.75,P=0.017),SDS评分比男性高(60.12±8.35、57.90±7.93,P=0.011);治疗后SAS及SDS评分分别为38.17±3.67(P=0.000)、38.12±4.15(P=0.001),与治疗前比具有统计学差异。结论很多HFS和BEB患者伴发焦虑/抑郁状态,且女性较男性更明显,BTX-A治疗后可改善患者的焦虑/抑郁症状。     

心理干预对癫患者焦虑抑郁情绪的影响

目的:探讨心理干预对癫患者焦虑抑郁情绪的影响。方法:对163例成人癫患者在抗癫治疗的同时实施为期3个月的心理干预;采用中文版Zung焦虑自评量表(SAS)及抑郁自评量表(SDS)分别于干预前、干预后1个月和3个月进行评定。结果:163例癫患者实施心理干预后焦虑和抑郁情绪改善显著,并随干预时间延长而显著下降。与干预前比较,干预1周,SAS及SDS评分与干预前差异无统计学意义(P=0.469、0.272);干预1个月和3个月,SAS及SDS评分与干预前比较差异有显著统计学意义(F=15.196、16.207,P均<0.001)。结论:癫患者焦虑抑郁情绪明显;心理干预能够显著改善患者焦虑抑郁情绪;干预时间越长,效果越好。     

心理干预对恶性肿瘤患者焦虑、抑郁状态及生活质量的影响

目的 探讨心理干预对恶性肿瘤患者焦虑抑郁状态及生活质量的影响.方法 将205例恶性肿瘤患者随机分为对照组和心理干预组,对照组采用常规放疗、化疗及最佳支持治疗,心理干预组在常规治疗基础上对患者进行心理干预,治疗前后采用焦虑自评量表(SAS),抑郁自评量表(SDS)和EORTC-QLQ-C30量表对患者进行焦虑抑郁状态及生活质量的测定.结果 两组患者入院时SDS及SAS评分比较无统计学差异(P＞0.05),心理干预组第6周SDS及SAS评分均明显低于对照组,差异有统计学意义(P＜0.05),心理干预后可改善癌症患者生活质量,较干预前差异有统计学意义(P＜0.05).结论 心理干预能够改善恶性肿瘤患者焦虑抑郁情绪,提高生活质量,有利于患者的康复.     

听神经瘤病人抑郁与焦虑状况调查及影响因素分析

目的调查听神经瘤病人的抑郁与焦虑状况并分析其相关影响因素。方法以62例行开颅听神经瘤切除术的病人为研究对象,分别于术前1 d、出院前1 d及出院后6个月,应用Zung抑郁自评量表(SDS)和Zung焦虑自评量表(SAS)评估病人的抑郁及焦虑状况,自制调查表记录人口学特征和疾病特征,面神经功能分级采用House-Brackmann(H-B)分级法。结果病人处于抑郁、焦虑状态在术前、出院前与出院后6个月的例数分别为13例(20.9%)、24例(38.7%)和15例(30.0%,15/50)。术前住院时间长、合并慢性疾病、中青年病人术前容易出现抑郁、焦虑。病人的性别、年龄、面神经功能H-B分级影响出院前及术后6个月抑郁、焦虑的发生率。结论听神经瘤病人手术前后抑郁、焦虑发生率均较高。女性、中青年、面神经功能障碍严重者可能为术后发生抑郁、焦虑的高危病例,应引起重视,必要时给予心理干预或药物治疗。     

综合干预对精神分裂症患者亲属抑郁与焦虑情绪的影响

目的:探讨综合干预对精神分裂症患者亲属抑郁、焦虑情绪的影响。方法:对114位精神分裂症患者家属进行综合干预6个月;干预前、干预3及6个月后分别采用抑郁自评量表(SDS)和焦虑自评量表(SAS)对入组者的抑郁、焦虑情绪进行评估,分析影响其抑郁、焦虑情绪的因素。结果:干预前患者亲属SDS和SAS评分明显高于国内常模(t=12.10,t=10.81;P均0.001);女性亲属SDS和SAS评分明显高于男性亲属(t=3.35,P=0.001;t=2.32,P=0.022);无固定职业的患者亲属SDS和SAS评分明显高于有固定职业的患者亲属(t=2.00,P=0.048;t=2.06,P=0.042);不同教育程度的患者亲属的SDS和SAS评分比较差异有统计学意义(F=3.18,P=0.046;F=3.24,P,0.043);但不同亲属关系的患者亲属间SDS和SAS评分比较差异无统计学意义。干预3个月后及6个月后,患者亲属的SDS和SAS评分较基线有明显下降(P均0.05),但与国内常模相比,差异仍有统计学意义(P均0.05)。结论:精神分裂症患者家属有明显的抑郁、焦虑情绪,并与其性别、受教育程度和职业状况有关。综合干预能有效改善精神分裂症患者家属的焦虑、抑郁情绪。     

规范的华法林抗凝治疗对心源性脑栓塞患者心理状态及生活质量的影响

目的比较规范的华法林抗凝和抗血小板治疗对心源性脑栓塞患者心理及生活质量的影响。方法连续纳入心源性脑栓塞患者201例,其中华法林抗凝组107例,抗血小板治疗组94例。采用焦虑自评量表(SAS)、抑郁自评量表(SDS)和SF-36健康调查量表评价两组患者第3 d及第1、3、6、9、12个月时的焦虑、抑郁、生活质量水平。结果抗凝组第12个月的SAS、SDS评分显著低于第3 d(t=10. 142,t=9. 704;均P 0. 001)。与抗血小板组比较,抗凝组第3、6、9、12个月SAS和SDS评分显著下降(均P 0. 001)。与起病第3d比较,抗凝组SF-36健康调查量表第12个月PCS、MCS评分显著升高(t=-32. 426,t=-33. 549;均P 0. 001);抗血小板组第12个月MCS评分差异无统计学意义(t=-0. 613,P=0. 541),PCS评分显著升高(t=-25. 994,P 0. 001)。与抗血小板组比较,抗凝组第3、6、9、12个月MCS评分均显著升高(均P 0. 01)。结论规范的华法林抗凝治疗、定期在抗凝门诊就诊能显著改善心源性脑栓塞患者的焦虑、抑郁情绪,有利于生活质量提高。     

黛力新联合心理干预对丘脑梗死后合并抑郁焦虑状态的影响

目的探讨黛力新联合心理干预对丘脑梗死后合并抑郁焦虑症状的治疗效果。方法采用自评抑郁量表(SDS)、自评焦虑量表(SAS)对140例丘脑梗死患者进行评分及测定,并对合并焦虑抑郁的102例患者分别进行干预,分为对照组(34例)、心理干预治疗组(34例)及药物和心理干预治疗组(34例),分析药物治疗、心理干预对患者愈后的影响。结果丘脑梗死后易合并抑郁焦虑状态,发生率72.9%,严重影响患者的日常生活能力。与干预前相比,经过为期6周的心理干预、药物和心理干预后,心理干预治疗组、药物和心理干预治疗组患者的SAS及SDS评分均明显降低(P0.01);对照组治疗前后的SAS及SDS评分无明显变化(P0.05)。结论丘脑梗死后患者常发生抑郁焦虑症状,药物和心理干预治疗可减轻丘脑梗死后抑郁焦虑症状。     

心理干预对精神分裂症患者经期情绪障碍影响的研究

目的 了解精神分裂症患月经期的情绪障碍问题及心理干预时情绪障碍的影响，从而解决女性病人治疗中的疑难问题。方法 对我院126名住院的女性精神分裂症病人分别进行经期和非经期的焦虑自评量表SAS和抑郁自评量表SDS的测定，然后将126名病人随机分成干预组和对照组各63名，干预组进行2个月的心理干预，对照组不进行上述干预，其他治疗相同。第3个月再分别对两组病人进行经期和非经期的焦虑自评量表和抑郁自评量表的测定。结果 (1)精神分裂症病人经期SAS、SDS量表分均较非经期高，经统计学检验两差异显；(2)干预组经心理干预后无论经期还是非经期SAS、SDS量表分与对照组比较差异显；(3)干预组自身前后量表分比较差异显。结论 精神分裂症患月经期存在明显的焦虑、抑郁，易引起病情波动，针对女性病人内分泌变化进行心理干预有一定疗效。     

海洛因依赖者的生活事件与情绪问题调查

目的 探索海洛因依赖患者的生活事件发生情况和焦虑、抑郁情绪问题,以及生活事件与焦虑、抑郁情绪的相关性.方法 采用生活事件量表(LES)、焦虑自评量表(SAS)和抑郁自评量表(SDS)对139名吸毒者进行测评.结果 根据生活事件量表(LES)、焦虑自评量表(SAS)和抑郁自评量表(SDS)评定结果,76.26%受试者经历...     

Factors associated with satisfaction with care among patients with epilepsy

OBJECTIVE: The purpose of the work described here was to determine those variables associated with satisfaction with care among patients with epilepsy. METHODS: We interviewed patients followed at a tertiary epilepsy center. Predictor variables included age, gender, race, education, income, insurance, seizure frequency, and Quality of Life in Epilepsy-10 inventory (QOLIE-10) results. Target variables were the subscales of the Short Form Patient Satisfaction Questionnaire (PSQ-18). We used univariate analysis to identify those variables significantly associated with the subscales and multiple linear regression to determine those independently significant. RESULTS: The study population comprised 193 patients. Lower education and better QOLIE-10 scores were independently associated with general satisfaction with care. The mental health scale was associated with general satisfaction with care. Lower educational level was the only variable independently associated with patient satisfaction with communication, the financial aspect of care, and time spent with physician. CONCLUSION: Lower educational level and better quality of life are the main variables associated with higher general satisfaction with care among patients with epilepsy.     

Treatment with rituximab in patients with polyneuropathy with anti-MAG antibodies

Journal of Neurology -     

Surgical Outcome in Patients with Epilepsy with Occult Vascular Malformations Treated with Lesionectomy

Summary: Purpose: This retrospective study reports the long-term surgical outcome of patients with medically refractory epilepsy and vascular malformations who were treated with lesionectomy. A detailed analysis of surgical failures had been performed in an attempt to define predictors of surgical success and failure.
Methods: Fifteen patients with medically intractable epilepsy and angiographically occult vascular malformations (AOVMs) were treated surgically with lesionectomy at Duke University Medical Center. Lesionectomy consisted of removal of the AOVM and surrounding hemosiderin-stained brain only, without the use of electrocorticography (ECoG) to guide resection.
Results: Eleven (73%) patients are seizure free after lesionectomy. Three showed no significant improvement, and one patient died, presumably after a seizure. Age of onset, duration of seizures, age at resection, and gender did not affect outcome. All patients with neocortical AOVMs in whom EEG findings correlated with the site of the lesion were seizure free after lesional resection. Treatment failures were associated with the presence of multiple intracranial lesions, poorly localized or diffuse EEG findings, discordant positron emission tomography (PET) imaging, or with a lesion in close proximity to the limbic system.
Conclusions: Lesionectomy, with removal of surrounding hemosiderin-stained brain, can be considered the procedure of choice in carefully selected patients with epilepsy with occult vascular malformations.     

Children with ADHD and motor dysfunction compared with children with ADHD only

The purpose of this study was to identify group differences in children with attention-deficit-hyperactivity disorder and motor dysfunction (ADHD-MD) and ADHD only, and to evaluate the medication responsiveness of ADHD-MD. Sixty-three children (49 males and 14 females; mean age 9 years 10 months, SD 2 years 10 months) underwent a triple blind, placebo-controlled crossover study evaluating two dose levels of methylphenidate (0.3 mg/kg and 0.5 mg/kg [corrected], twice daily) and placebo. Forty-nine trials were completed. Nineteen were children with ADHD-MD, 44 had ADHD only. Behavior and functioning were assessed at home and at school. Treatment effects were assessed using the Abbreviated Symptom Questionnaire for Parents and Teachers. Children with ADHD-MD were more likely to have severe ADHD-combined type and other neurodevelopmental and behavioral problems. Both groups of children had a linear dose response to medication (placebo, low, high) and there was no evidence of a group by dose interaction or an overall group effect at home or school. The lack of group effect suggests that these children responded to medication like the other subgroups.     

Chronic headache with vasospasm treated with nimodipine

Journal of Neurology -