痴呆患者心理和行为症状特征以及利培酮疗效的研究

目的　比较痴呆各亚型心理和行为症状 (BPSD)的特征 ,评价利培酮治疗BPSD疗效与安全性 ,探讨血浆同型半胱氨酸(Hcy)水平与BPSD的关系。方法　采用Alzheimer病行为症状评定量表 (BEHAVE AD)、Cohen Masfield激惹性问卷 (CMAI)评定阿尔茨海默病 (AD)、阿尔茨海默病混合型 (MD)、血管性痴呆 (VD)各 3 0例和正常对照组 3 0名的BPSD。 66例痴呆患者应用利培酮 (1 5mg/d)治疗 6周。采用副反应量表 (TESS)评价副反应。采用高压毛细管电泳紫外检测法测定经 2 ,4一二硝基氟苯 (DNFB)衍生后的血浆Hcy水平。结果　AD患者激惹、焦虑与恐惧发生率较高 ,VD患者无目的游荡发生率和严重程度均较低 ,MD患者BPSD症状无特异性。利培酮能明显改善痴呆患者BPSD ,且不损害认知功能 ,副反应主要为轻度嗜睡 ,肌强直 ,震颤。AD、MD和VD患者血浆Hcy浓度均显著高于正常对照组 ,血浆高Hcy水平的痴呆患者BEHAVE AD总分较高。结论　AD、VD患者BPSD症状有特异性 ,MD患者BPSD表现无特异性。利培酮能有效改善痴呆患者BPSD且安全。血浆高Hcy水平在痴患者BPSD的发病机制中可能起重要作用。     

痴呆的行为和精神症状的药物治疗调查

目的：了解抗精神病药治疗痴呆的行为和精神症状（BPSD）的情况。方法：调查443例伴有明显的行为和精神症状、用抗精神病药治疗其行为和精神症状有效的阿尔茨海默病和血管性痴呆患者。结果：常用于治疗BPSD的抗精神病药有奋乃静、利培酮、氟哌啶醇、氯丙嗪、氯氮平、硫利达嗪、舒必利等,其起始剂量与有效剂量均较小,大多单一用药。用药剂量与年龄呈负相关。主要不良反应是锥体外系反应、便秘或排尿困难、嗜睡或步态不稳、吞咽困难等。抗精神病药不良反应发生率为16．0％,典型抗精神病药发生率（18．4％）显著高于非典型抗精神病药（9．6％）。结论：多种抗精神病药治疗BPSD均有效,治疗剂量低。非典型抗精神病药的安全性优于典型抗精神病药。     

利培酮与奋乃静治疗老年期痴呆精神症状的对照研究

目的　比较利培酮与奋乃静治疗老年期痴呆患者精神症状的疗效、不良反应及对认知功能的影响。方法　将符合条件的60例老年期痴呆患者随机分为利培酮组和奋乃静组(各30例)。治疗8周。采用一般情况调查表(自编)、临床疗效评定量表(CGI)、阿尔茨海默病病理行为评分表(BEHAVE AD)、简易智力状态检查(MMSE)及药物不良反应量表(TESS)分别进行疗效、不良反应和认知功能评估。结果　两组临床总体疗效比较:有效率分别为86. 67%和83 .33%,无显著性差异(P>0 .05)。两组BEHAVE AD评分治疗前后比较均有非常显著差异(P<0. 05,P<0 .01),治疗结束后两组间BEHAVE AD评分无显著差异(P>0 .05)。治疗结束后MMSE评分利培酮组较奋乃静组高,有显著差异(t=2 .26,P<0 .05 )。两组不良反应发生率无显著性差异(χ2 =0 .28,P>0 .05)。结论　利培酮与奋乃静对老年期痴呆的精神症状疗效、不良反应相近,但对认知功能的影响优于奋乃静,故利培酮更适合于伴有精神症状的老年期痴呆患者的治疗。     

利培酮维持治疗精神分裂症的长期效果

目的　探讨利培酮维持治疗精神分裂症的效果。方法　对利培酮治疗出院的 57例精神分裂症患者进行 3年随访 ,以总体印象量表 (CGI)、副反应量表 (TESS)及社会功能缺陷量表 (SDSS)评估利培酮维持治疗的社会康复状况 ,临床疗效与药物副反应等 ,并与氯氮平治疗的同类病人 57例进行对照。结果　利培酮组CGI得分中EL :1 72± 0 71 ,较氯氮平组 1 59± 0 59显著性增高 (t=0 99,P <0 .0 5)。利培酮与氯氮平组TESS分别为 1 2 6± 0 87和 1 0 5± 0 85,无显著差异。利培酮与氯氮平组SDSS评分分别为3 1 8± 2 78和 5 2 3± 2 52 (t=2 1 8,P <0 0 0 1 ) ,具有显著性差异。利培酮与氯氮平治疗病人 3年内复发率分别为 2 4 6%和 3 8 6% ,χ2 =3 1 8,P <0 0 0 1 ,再住院率分别为 1 0 6%和 53 1 % ,χ2 =8 3 ,P <0 0 1 ,均具有显著性差异。结论　两种药物治疗出院后的精神分裂症患者 ,以利培酮维持治疗可获得较好疗效而且社会功能康复效果均优于氯氮平组病人     

氯氮平与利培酮对精神分裂症患者体重增加影响的研究

目的探讨新型抗精神病药氯氟平与利培酮对精神分裂症患者体重的影响。方法将60例精神分裂症病人随机分为氯氯平组和利培酮组各30例，对所有患者在用药前、4周和8周时测体重、身高＋计算Quetelet指数，分析其变化。结果氯氮平组体重指数增加明显，治疗前后差异有显著性意义（P〈0．05）。结论氯氯平易导致体重增加，利培酮对体重影响较轻，治疗期间应对使用氯氯平的患者做好饮食指导。     

伴发精神行为症状的高龄痴呆患者应用抗精神病药的安全性分析

目的:分析伴精神行为症状(BPSD)的高龄痴呆患者抗精神病药使用情况。方法:采用回顾性分析方法,根据是否应用抗精神病药治疗,将住院治疗的伴BPSD的80岁以上痴呆患者分为抗精神病药组(56例)和非抗精神病药组(34例),比较两组间安全性。结果:抗精神病药组中血管性痴呆患者的比例(32.1%)明显高于非抗精神病药组(8.8%)(χ~2=6.43,P0.05);不同痴呆类型的患者间奥氮平、喹硫平、利培酮、阿立哌唑、氟哌啶醇的药物剂量比较,差异无统计学意义(P均0.05)。不同痴呆类型间发生不良事件的比较,差异无统计学意义(P均0.05)。结论:应用小剂量抗精神病药治疗伴有BPSD的高龄痴呆患者未升高不良事件发生的风险。     

传统与新型抗精神病药治疗精神分裂症疗效及诊治费用的比较

目的　了解传统与新型抗精神病药治疗精神分裂症患者的疗效及治疗费用情况。方法将 6 0 0例精神分裂症患者按门诊病历号分为两组 ,奇数为传统抗精神病药组 (服用氯丙嗪、氟哌啶醇等 ,折合氯丙嗪的平均剂量为 4 5 0～ 6 0 0mg/d) ,偶数为新型抗精神病药组 (服用氯氮平 4 5 0～ 6 0 0mg/d、利培酮 4 6mg/d、奥氮平 17 5mg/d)。分别在治疗前及治疗后 2 ,8,12 ,5 0周末采用简明精神病评定量表、临床大体印象表和副反应量表进行评定 ;调查两组患者家庭在一年中因诊治该患者所需的直接、间接和隐性费用。结果　 (1)有效率 :传统药组为 70 7% ,新型药组为 70 3% (P >0 0 5 ) ;(2 )诊治费用 :传统药组的总费用为 (10 372 81± 6 86 2 2 )元 ,直接费用为 (2 795 5 5± 84 6 2 4 )元 ,间接费用为(5 712 32± 977 13)元和隐性费用为 (2 0 36 2 5± 881 6 2 )元 ,均多于新型药组 [分别为 (5 196 4 0±4 5 1 6 4 )元、(380 5 2 2± 989 2 2 )元、(12 5 5 4 1± 5 0 3 13)元和 (15 8 4 9± 2 2 71)元 ],差异均有显著性 (P <0 0 5或P <0 0 1)。结论　新型抗精神病药的疗效与传统抗精神病药相似 ,但较后者更经济 ,更适合大多数患者。     

抗精神病药治疗精神分裂症引致糖尿病的相关因素分析

目的　探讨抗精神病药物治疗精神分裂症引致糖尿病的相关因素。方法　回顾性调查住院精神分裂症患者中糖尿病的患病情况 ,观察治疗前后血糖的变化 ,比较各种抗精神病药物对糖代谢异常的影响。结果　本组患者中糖尿病的发生率为 7 84 % ;男女性别比较无显著性差异 (P >0 0 5 ) ;病程 <10年与≥ 2 0年组比较及年龄<4 0岁与≥ 4 0岁组比较 ,糖尿病发生率均有极显著性差异 (P <0 0 1)。抗精神病药引发糖尿病的发生率依次为 :氯氮平 (14 16 % )、氯丙嗪 (7 4 1% )、利培酮 (6 5 4 % )和其它 (5 5 8% )。氯氮平组与利培酮组比较 ,糖尿病发生率和空腹血糖均有显著性差异 (P <0 0 5 ) ,餐后 2h血糖亦有极显著性差异 (P <0 0 1)。结论　精神分裂症合并糖尿病与患病年龄、病程有关系 ,5 0岁以上患者发生糖尿病的危险性更大。氯氮平引发糖尿病的发生率明显高于其它抗精神病药物 ,且餐后血糖控制不良。     

文拉法辛治疗精神分裂症伴抑郁症状对照研究

目的:比较抗精神病药合用文拉法辛与单用抗精神病药对精神分裂症阳性、阴性及抑郁症状的影响。方法:经利培酮治疗4周后好转的精神分裂症患者,经汉密尔顿抑郁量表(HAMD)评估伴有抑郁症状的63例患者随机分为两组,单用抗精神病药组(单用组)与抗精神病药合用文拉法辛组(合用组),疗程8周。结果:经治疗后,两组间阳性症状减分率差异无显著性,阴性症状减分率差异有显著性。合用组在治疗第1、2、4、8周末HAMD评分比单用组为低。结论:抗精神病药合用文拉法辛对精神分裂症伴抑郁症状疗效高,有益于阴性症状的改善,对于阳性症状稳定性无明显负面影响。     

利培酮治疗精神分裂症临床观察

我们用利培酮治疗 6 0例精神分裂症 ,并进行临床观察 ,报告如下。1　对象和方法为我中心心理病房 2 0 0 1年住院患者 ,符合中国精神障碍分类与诊断标准第 3版精神分裂症诊断标准 ;入院前 2周均未服抗精神病药 ;阳性症状与阴性症状评定量表 (PANSS)总分≥ 5 5分 ;无器质性疾病。共 6 0例 ,男 2 9例 ,女 31例 ;年龄 16～ 6 0岁 ,平均 (2 8 6± 12 1)岁。利培酮以 1mg/d开始 ,逐步加至 2～ 8mg/d。观察 8周。不合并用其他抗精神病药或其他疗法。可合并抗胆碱药或苯二氮 艹卓 类药。采用PANSS和副反应量表 (TESS)评定疗效和不良反应。疗…     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of legislation of 1935 of interest to the department of Mental Hygiene

Psychiatric Quarterly -