江苏盐城市精神分裂症流行病学调查

目的 解盐城市精神分裂症的患率，探讨与其相关的社会心理因素。方法 选1县1城区为框架，对≥15岁2895人进行流行病学调查，采取线索调查和逐户筛选相结合。结果 共检出精神分裂症13例，总患病率4．84‰。时点患病率4．15‰。结论 从心理社会因素看，良好的生活环境，良好的支持系统，和睦的家庭，可增强精神分裂症发病的抵御能力。     

汕头市精神分裂症流行病学调查

采用全国精神疾病流调统一方法，调查了汕头市城乡户口各５００户，１５岁以上总人口３３２０人，查出精神分裂症３１例，现患２６例，总患病率９．３４‰，时点患病率７．８３‰，标化率７．８１‰，高于全国１２地区精神分裂症平均患病率。调查结果发现，经济发达地区精神分裂症患病率高，而经济水平低，无支持系统者有较高的患病率。     

九江市精神疾病及其残疾流行病学调查

目的：了解九江市各类精神障碍患病率及精神残疾和智力残疾状况。方法：采用中国精神障碍分类与诊断标准第3版、精神残疾与智力残疾评定工具，对九江市11个抽样地区进行流行病学调查。结果：共调查市辖区55户，市辖县550户，共调查2636人。在≥15岁人口中，各类精神障碍的时点患病率为24．33‰，终生患病率为27．80‰，精神残疾率为8．94‰，智力残疾率为4．97‰。在≥7岁人口中，精神发育迟滞的时点患病率为3．31‰。在调查的总人口中，精神残疾率为6．83‰，智力残疾率为3．79‰。结论：心境障碍患病率居首位，精神分裂症和精神发育迟滞居2、3位，酒依赖患病率升高，均应列为防治和研究重点。     

沈阳战区精神疾病流行学调查资料分析

应用全国统一调查工具，对沈阳战区陆海空三军进行精神疾病流行学调查，结果表明精神疾病总患病率１．９８７‰，现患病率为１．５２０‰；精神分裂症总患病率１．３６０‰，现患病率１．１２０‰；神经症患病率３．１９７‰。     

1986～2001年某部新兵精神疾病调查

目的；探讨入伍新兵精神疾病的患病率及相关因素。方法：应用新兵精神疾病调查的工具，对1986－2001年某部入伍的所有集训期新兵进行精神疾病的流行病学调查。结果：15年共调查入伍新兵656540名，检查出各类精神疾病共539名，总检出率（时点患病率）为0．82‰。新兵各类精神疾病的时点患病率以精神分裂症（0．29‰）、神经症（0．20‰）和精神发育迟滞（0．10‰）为高。入伍前已患病者占83．1％，入伍后新发病者占16．9％。有明显精神疾病家族史者占28．4％。结论：开展新兵精神疾病调查，在集训期内把患有精神疾病者作退兵处理，对提高兵员质量具有重要意义。     

江苏无锡地区精神疾病流行学调查分析

使用定式调查程序，对无锡地区１０００户６岁以上人群３２０５人进行调查，结果各类精神疾病总患病率为１２．４３‰，其中精神分裂症患病率最高，为５．６２‰，其次是精神发育迟滞为２．９６‰，情感性精神障碍为１．４８‰，心因性精神障碍为１．１８‰，癫痫性精神障碍为０．８９‰和老年性痴呆为０．２９‰。     

90年代首都精神卫生问题的现况与前瞻──北京市1991年精神障碍流行学调查报告

１９９１年北京市１６个区县精神卫生流行学调查显示，全市１５岁及以上３５３８５人中精神病总患病率１１．６７‰，现患病率为１０．０３‰；其中精神分裂症总患病率７．２‰居首位，神经症患病率３５．１８‰，精神发育迟滞６．１０‰。此外，酒依赖为１４．３０‰，药物依赖为２．１８‰。上述数字提示，近１０年来各类精神障碍的患病率有增高趋势。     

中国七个地区精神分裂症流行病学调查

目的动态观察精神分裂症患病率的变化及可能的影响因素。方法于１９９３年在１９８２年调查过的７个地区开展流行病学调查，方法与１９８２年基本相同。结果精神分裂症终生患病率为６．５５‰，时点患病率为５．３１‰，与１９８２年比较有增高趋势（Ｐ＞０．０５）；将经济水平分为上、中、下三等，以下等经济水平者的精神分裂症患病率为高。结论１９９３年出现的精神分裂症患病率变化，可能源于抽样误差，但不排除患者预期寿命延长因素，提示今后在制订精神卫生规划时需予重视     

胜利油田1992年精神疾病流行学抽样调查资料分析

参照１９８２年全国精神疾病流行学调查的设计方案、调查流程和调查工具，１９９２年５月～８月进行了胜利油田精神疾病流行学抽样调查。根据整群分层随机抽样的原则，抽取４０００户居民、１４０７６人（其中≥１５岁者１１８０１人）。调查人口占油田总人口的３．８０％。统计结果，胜利油田各种精神疾病的总患病率为１５．５９‰，时点患病率为１４．３２‰。其中，精神分裂症的总患病率为４．４９‰，时点患病率为３．３０‰；酒精依赖的患病率为７．５４‰；精神发育迟滞的患病率为１．０７‰；神经症的患病率为１．６７‰。资料显示。经济文化水平偏低、地理位置偏僻及６０岁以上人群中，精神疾病的患病率水平相对偏高。     

重视综合医院中抑郁障碍的诊断

1988年美国国立精神卫生研究院(NINH)对五个地区进行流行病学调查，近2万人口的患病率为0．4％-4．8％。1995年澳大利亚调查患病率为13．2‰，1996年香港调查患病率为24‰-52‰，1997年韩国调查患病率为31‰-55‰。但1982年我国在12地区精神疾患流行病学调查时情感障碍的患病率仅0．76‰，1992年在这12地区重复调查患     

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.     

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.     

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.     

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.     

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.     

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.