精神分裂症患者病耻感调查及相关因素分析

目的了解精神分裂症患者的病耻感状况以及其相关因素。方法 2011年1月至3月间抽取95名精神分裂症患者,采用自编一般情况量表及内在耻感问卷及病耻感经历问卷进行调查。同时以阳性症状量表(SAPS)及阴性症状量表(SANS)、社会支持量表(SSRS)、生活质量量表(WHOQOL-BREF)对其评定。结果 (1)内在耻感量表:疏离因子2.29(sd=0.49),刻板因子2.07(sd=0.44),歧视因子2.15(sd=0.45),退缩因子2.19(sd=0.46),总量表分2.17(sd=0.38);内在耻感量表中各因子分超过中点值2.5分的病例比例为:疏离因子44.2%,刻板因子14.7%,歧视因子25.3%,退缩因子32.6%,调整后的内在耻感量表总分20.0%,超过2.5者提示有较强内在病耻感;(2)病耻感经历量表:病耻感体验因子2.50(sd=0.59),介于"很少发生"与"有时发生"之间;歧视经历因子1.71(sd=0.39),介于"从不发生"到"很少发生"之间,总量表分2.08(sd=0.39)介于"很少发生"与"有时发生"之间;病耻感经历量表中各因子分超过中值3分的病例比例为:受试者病耻感经历各因子及总分超过中点值3分的百分比为:病耻感体验因子24.2%(n=23),歧视经历因子1.1%(n=1),病耻感经历总分1.1%(n=1),超过3分者提示病耻经历较多;(3)以内在耻感总分作为因变量回归分析,提示与内在耻感显著相关的因素为学历、病期、职业、社会支持中的对支持的利用度分量表及生活满意度量表中的心理领域等。结论 (1)精神分裂症患者中存在较高水平的病耻感;(2)患者文化、社会支持和生活质量是其内在耻感的主要相关因素。     

精神分裂症患者合并强迫症状临床分析

据估计,7.8%~46.6%的精神分裂症患者有强迫症状[1~3],我们对此进行研究,报告如下。1对象和方法为2003年1月至2005年6月我院首发精神分裂症患者,符合中国精神障碍分类与诊断标准第3版(CCMD-3)诊断标准。共61例,男42例,女19例;年龄18~41岁;精神分裂症41例,分裂样精神病13例,分裂情感性精神病7例。平均病程(18.5±21.8)个月;连续使用抗精神病药≤12周;排除酒依赖、物质滥用和躯体疾病。使用阳性症状量表(SAPS)、阴性症状量表(SANS)、临床疗效总评量表(CGI)和Hamilton抑郁量表(HAMD),美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)轴I,以及…     

惠州市81例使用氯胺酮人员的心理状况调查

目的 探讨分析使用氯胺酮人员的心理状况.方法 采用抑郁自评量表(SDS)、焦虑自评量表(SAS)、症状自评量表(SCL-90)对惠州市81例使用氯胺酮人员进行心理健康分析,并与常模比较;进一步分析比较使用氯胺酮人员性别、职业、婚姻状况、文化程度及吸毒方式之间的心理健康的差别.结果 所有使用氯胺酮人员的SDS、SAS、SCL-90各因子评分均比常模高(P＜0.001);男性SAS及SCL-90中的偏执因子分比女性高(P＜0.05);高中以上文化程度的使用氯胺酮人员在SCL-90中的抑郁和焦虑因子分比初中文化的高(P＜0.05),但与小学文化的无显著性差别;有职业的使用氯胺酮人员的人际关系因子分比无职业的高(P＜0.1).结论 使用氯胺酮人员有明显的心理障碍,尤其是抑郁及焦虑广泛存在,在强制性戒氯胺酮时,可给予适当的药物,同时加强心理干预.     

自我护理能力实施量表中文版在精神分裂症患者中的信效度

目的:评价自我护理能力实施量表(ESCA)中文版在精神分裂症患者中的信度和效度。方法:抽取150例精神分裂症患者进行ESCA初测,进行初步的项目分析;正式施测阶段抽取300例精神分裂症患者,7 d后对其中30例进行重测,计算克朗巴赫α系数、重测信度评价量表内部一致性;采用探索性因子分析方法考评量表结构效度;相关分析来评价量表的效标效度。结果:条目一总分相关法及决断值法对条目的区分度进行分析后,组成35个条目的新量表,经最大方差旋转法旋转后提取4个因子,4个因子累计解释的方差为42.38%;ESCA与日常生活能力评定量表、护士用住院病人观察量表相关系数分别为0.59,0.63;Cranach'sα系数为0.88,重测信度为0.65。结论:ESCA中文版具有较好的信度和效度,用于精神分裂症患者自我护理能力的研究需要反复修订。     

家庭负担访谈问卷中文简化版评估精神障碍患者家庭成员的照料负担（英文）

背景:在制定慢性精神障碍患者管理计划时需要解决的一个重要问题就是照料者的负担,但是迄今为止,国内还没有可靠的方法来评估上述负担。目标:评估家庭负担访谈问卷(Family Experience Interview Schedule,FEIS)中文简化版在国内住院精神障碍患者的照料者中使用的信度和效度。方法:我们翻译114项条目的英文版FEIS,并回译。然后用中文版评估606名住院精神障碍患者的主要照料者。排除9项社会人口学变量和9项超过15%的受访者都不能回答的条目后,我们随机选取一半样本问卷对剩余的96项进行了探索性因子分析,并根据因子分析的结果选择最终简化版量表包含的项目。利用另一半样本数据,通过相关性分析、验证性因子分析和内部一致性方法来评估最终简化版量表的信度和效度。结果:最终的中文版量表由28个条目组成,包括五个维度:(a)患者的暴力行为;(b)患者的自杀倾向;(c)照料者的抑郁和焦虑症状;(d)照料者的日常生活受扰乱;(e)照料者对医疗服务的满意度。这五个维度解释了总方差的50.5%。验证性因子分析发现该五因子模型是合理的[χ2/df=2.94,p0.001,拟合优度指数[GFI]=0.85,比较拟合指数[CFI]=0.85,近似均方根误差[RMSEA]=0.08]。每个条目和对应的因子之间的相关系数均在0.5以上。整个量表的Cronbachα系数为0.76,五个维度的Cronbachα系数在0.71和0.84之间。结论:28项FEIS简化中文版评估的家庭负担五个维度具有良好的内部一致性,因此,可以用来评估国内重性精神障碍患者照料者的家庭负担的各个维度。还需要进一步工作来评估该量表的重测信度和随时间而改变的灵敏度。     

利培酮合并阿美戈拉汀治疗以阴性症状为主精神分裂症患者的对照研究

目的:探讨利培酮合并阿美戈拉汀对慢性精神分裂症患者阴性症状的疗效。方法:将102例以阴性症状为主的慢性精神分裂症患者随机分为研究组(利培酮合并阿美戈拉汀治疗,52例)和对照组(单用利培酮治疗,50例),并给予相应的治疗,疗程6个月。治疗前后给予阳性与阴性症状量表(PANSS)中的阴性症状分量表(NEG)、费城老年中心信心量表(PGC)、WHO生存质量测定量表简表(WHOQOL-BREF)评估。结果:研究组及对照组分别有46例及45例患者完成观察;研究组阴性症状的有效率(86.96%)显著高于对照组(62.22%)(χ~2=5.65,P0.05);治疗后NEG总分及情感迟钝、情绪退缩、情感交流障碍、被动或淡漠和社交退缩因子分明显低于对照组(P均0.05);WHOQOL-BREF的生理领域、心理领域、社会关系领域评分显著高于对照组(P均0.05);PGC总分、激越、自己年龄的态度、孤独与不满维度评分两组间差异有统计学意义(P均0.05)。结论:利培酮合并阿美戈拉汀能显著改善慢性精神分裂症患者的阴性症状,提高主观幸福感和生存质量。     

冗思反应量表中文版在抑郁障碍患者中的运用结果分析

目的 评价冗思反应量表中文版(RRS-C)在抑郁障碍患者中的信、效度.方法 212例抑郁障碍患者完成了RRS-C和流调中心抑郁量表(CES- D),分析RRS-C的Cronbach'sα系数、条目间平均相关系数、总分和各因子的相关系数,并采用验证性因子分析考察其三因子结构.结果 RRS-C总量表的Cronbach's α系数为0.88,三因子的Cronbach's α系数在0.67～0.84;总量表的条目间平均相关系数为0.26,量表总分和各因子间的相关系数在0.71～0.94,各因子条目间平均相关系数在0.29～0.32;验证性因子分析指标(CFI=0.913;GFI=0.905;x2/v＜2;RSMEA=0.072)均符合测量学要求.结论 RRS-C在抑郁障碍患者中有良好的信、效度,可应用于我国抑郁障碍患者冗思特征的测评.     

Morisky问卷评价精神分裂症恢复期患者服药依从性的信度和效度

目的:评价Morisky问卷对精神分裂症患者服药依从性的信度和效度。方法:采用便利取样法选取125例精神分裂症恢复期患者进行Morisky问卷调查,7 d后对其中30例患者进行Morisky问卷重测,计算Cronbach'sα系数及重测信度,评价量表的信度;采用探索性因子分析方法考评量表结构效度。结果:采用条目-总分相关法及决断值法对条目的区分度进行分析,问卷的4个条目皆达显著水平,符合选题标准,可以保留。问卷总Cronbach'sα系数为0.78,7 d后重测信度为0.84。经最大方差旋转法旋转后提取1个因子,累计解释的方差为52.25%,4个条目的因子负荷0.65~0.78之间。结论:Morisky问卷在精神分裂症恢复期患者服药依从性中有较好的信度及效度。     

心理干预改善网络成瘾患者症状的对照研究

目的 探讨心理干预对网络成瘾患者症状的干预效果.方法 将153例网络成瘾患者随机分为研究组(78例)和对照组(75例),研究组接受有针对性的心理干预,对照组不接受心理干预,共3个月,并在基线及干预后应用上网情况调查表(IUQ)、抑郁自评量表(SDS)、焦虑自评量表(SAS)评定疗效.结果 干预后,研究组的IUQ各因子评分以及SDS、SAS评分较基线时均有显著性降低(P＜0.05),对照组的各项量表评分均无显著性变化(P＞0.05).在干预后,干预组的IUQ各因子评分以及SDS、SAS评分均显著低于对照组(P＜0.05).结论 心理干预可有效改善网络成瘾患者的焦虑抑郁症状,减少网络滥用行为.     

首发精神病患者快感缺失水平与认知功能的关系

目的探讨首发精神病患者快感缺失水平及其与认知功能的关系,分析其认知功能的影响因素。方法选取2016年12月-2019年3月在广州医科大学附属脑科医院就诊的符合《精神障碍诊断与统计手册(第5版)》(DSM-5)诊断标准的首发精神病患者143例。采用阳性和阴性症状量表(PANSS)评定患者的精神症状,以其中N2情绪退缩和N4被动/淡漠社交退缩评价患者的快感缺失水平,(N2+N4)评分4分定义为快感缺失组,(N2+N4)评分≤4分定义为无快感缺失组;采用汉密尔顿抑郁量表24项版(HAMD-24)和精神分裂症认知功能成套测验(MCCB)评定患者的抑郁情绪和认知功能。比较快感缺失组和无快感缺失组临床症状和认知功能的差异,采用多元线性回归分析患者认知功能的影响因素。结果快感缺失组PANSS阴性症状评分、一般精神病理症状评分及总评分均高于无快感缺失组,差异均有统计学意义(P均0.05);青少年快感缺失组患者MCCB的工作记忆、成年快感缺失组患者的信息处理速度、注意/警觉性、词语学习评分均低于于无快感缺失组(P均0.05)。多元线性回归分析结果显示,青少年亚组快感缺失评分及未治疗期是工作记忆的影响因素(P0.05)。结论快感缺失水平高的患者精神症状更严重,认知功能损害更重,快感缺失是青少年工作记忆的影响因素之一。     

酒精依赖的基于基因和基于通路的全基因组关联研究（英文）

背景:信号通路中风险基因的构成可能可以解释酒精依赖风险基因协同的神经生物学作用。目的:识别酒精依赖的风险基因和风险基因通路。方法:我们采用基因富集(gene-set-rich)分析方法对酒精依赖进行了基于通路的全基因组关联分析(GWAS)。在包括1409名欧裔美国人(European-American,EA)酒精依赖者和1518名EA健康对照者的探索性样本人群中检测了近一百万个基因标志物。此外,将681名非裔美国人(African-American,AA)病例和508名AA健康受试者作为重测样本。结果:我们发现了几个与酒精依赖显著相关的可重复的全基因组风险基因和风险通路。在多重比较Bonferroni校正后,"细胞-细胞外基质相互作用"通路(EA样本中p2.0E-4)和该通路中PXN基因(编码桩蛋白paxillin)(EA样本中p=3.9E-7)是最有可能的酒精依赖的危险因素。在EA样本(0.015≤p≤0.035)和AA样本(0.025≤p≤0.050)中还有两条富含酒精依赖相关基因的可重复的通路:"Na+/Cl-依赖性神经递质转运体"通路和"其他聚糖降解"通路。结论:一些基因和生物信号传导过程可能与酒精依赖的风险相关,本研究的发现为此提供了新的证据。     

Neuropsychiatric symptoms as a predictor of caregiver burden in Alzheimer’s disease

Aims

Patients with Alzheimer’s disease need assistance and supervision of their daily activities. They survive for protracted periods of time, placing an extensive burden of care on the caregiver prior to the patient’s death. The present study addressed the predictive value of behavior-related burden on Alzheimer’s disease caregivers.

Participants

82 patients with probable Alzheimer’s (73.7 ± 8.1 years), and their primary caregivers (59.6 ± 14.8 years, 81.5% women), were assessed.

Methods

Cognitive impairment, neuropsychiatric symptoms, and dementia severity were assessed with Mini Mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), and Clinical Dementia Rating (CDR), respectively. Caregivers were given Zarit’s Burden Interview and Carer Activity Inventory.

Results

Neuropsychiatric symptoms like delusions, hallucinations, restlessness, anxiety, euphoria, disinhibition, unusual motor behavior, sleep disturbances, and appetite alterations were the best caregiver burden predictors (NPI r = 0.482, p < 0.001). No correlation with cognition, disease stage, or negative neuropsychiatric symptoms (depression and apathy) was found.

Conclusion

Increased caregiver burden was related to increased levels of patient behavioral disturbance. Of these symptoms, hallucinations, unusual (motor) behavior, and abnormal behavior at nighttime were the most significant. No correlation with neuropsychiatric symptoms such as apathy and depression was found. This may have relevance to appropriate interventions for caregivers.     

Controlled trial of the effectiveness of community rehabilitation for patients with schizophrenia in Shanghai,China

Background

The ‘Sunshine Soul Park’ is a network of social welfare institutions that provides communitybased rehabilitation services for individuals with mental illness.

Aims

Assess the effectiveness of the rehabilitation services provided at the ‘Sunshine Soul Park’ on the psychotic symptoms and social functioning of individuals with schizophrenia and, based on these findings, provide a theoretical model of community-based rehabilitation.

Methods

Sixty individuals with schizophrenia in the Huangpu District of Shanghai volunteered for the rehabilitation training program provided at six ‘Sunshine Soul Park’ community centers that involves day treatment, medication monitoring, biweekly rehabilitation training, and other recreational, social, and intellectual activities. A matched control group was recruited from individuals with schizophrenia registered on the Huangpu District registry of the ‘Severe Mental Illness Prevention and Rehabilitation System’. All participants continued their medication without change for the full year of follow-up. Both groups were assessed at baseline, and 3, 6, and 12 months after enrollment using the Insight and Treatment Attitude Questionnaire (ITAQ), Social Disability Screening Schedule (SDSS), Generic Quality of Life Inventory-74 (GQOLI-74), and Positive and Negative Syndrome Scale (PANSS).

Results

In the intervention group the ITAQ, SDSS, GQOLI-74, and PANSS scores showed statistically significant improvement compared to baseline at each follow-up assessment. Moreover, the trend in improvement in the interventions group is significantly faster than that in the control group.

Conclusions

The ‘Sunshine Soul Park’ rehabilitation training program enhances patients’ knowledge about their disorder and improves their social functioning and quality of life. Further studies to assess methods for up-scaling this intervention to other areas of China are warranted.     

Small-world brain networks in schizophrenia

Summary

Over the last decade the combination of brain neuroimaging techniques and graph theoretical analysis of the complex anatomical and functional networks in the brain have provided an exciting new platform for exploring the etiology of mental disorders such as schizophrenia. This review introduces the current status of this work, focusing on the topological properties of human brain networks – called ‘small-world brain networks’ – and on the disruptions in these networks in schizophrenia. The evidence supporting the findings of reduced efficiency of information exchange in schizophrenia both within local brain regions and globally throughout the brain is reviewed and the potential relationship of these changes to cognitive and clinical symptoms is discussed. Finally we propose some suggestions for future research.Schizophrenia is a severe mental disorder characterized by positive symptoms (delusions, hallucinations and other thought disturbances), negative symptoms (apathy, social withdrawal and other behaviors), cognitive impairments, and emotional dysregulation. Despite more than a century of research, the pathophysiological mechanisms that result in schizophrenia remain unknown, presumably because of the incredible complexity of the human brain.[1] The intensive study of the structure and function of complex systems in nature – ‘network science’[2] – may provide insights that can be applied to the study of the brain and, thus, improve our understanding of mental disorders like schizophrenia. Network science describes the topological properties of complex networks in terms of the characteristics of ‘small-world architecture’, ‘centrality,’ ‘hierarchy,’ ‘modularity,’ and ‘distribution of network hubs’. When applied to the brain, these hypothesized small-world properties may enable the cortical network to process information globally and locally with maximal efficiency. This article briefly reviews the current understanding of the small-world network of the brain and then focuses on recent studies about the relationship between disruptions of the small-world brain network and schizophrenia.     

Brief Chinese version of the Family Experience Interview Schedule to assess caregiver burden of family members of individuals with mental disorders

Background

Caregiver burden is an important issue that needs to be addressed when developing management programs for persons with chronic mental illnesses, but there is, as yet, no reliable way for assessing this in China.

Aim

Assess the validity and reliability of a brief adapted Chinese version of the Family Experience Interview Schedule (FEIS) among caregivers of inpatients with mental disorders in China.

Methods

We first translated and back-translated the original 114-item FEIS and administered it to 606 primary caregivers of psychiatric inpatients. After excluding 9 items about sociodemographic variables and 9 items that over 15% of respondents were unable to answer, we conducted an exploratory factor analysis using a random half of the sample on the remaining 96 items and, based on the results of the factor analysis, selected the items to be included in the final shortened scale. Correlation analysis, confirmatory factor analysis, and internal consistency measures were used to assess the reliability and validity of the final scale using data from the second half of the sample.

Results

The final scale included 28 items that loaded on five dimensions: (a) patients’ violent behavior; (b) patients’ suicidal tendency; (c) caregivers’ depression and anxiety; (d) disruption of caregivers’ daily routines; and (e) caregivers’ satisfaction with health services. These five dimensions explained 50.5% of the total variance. Confirmatory factor analysis found reasonable fit of this 5-factor model (χ² /df=2.94, p<0.001, goodness-of-fit index [GFI]=0.85, comparative fit index [CFI]=0.85, root-mean-square error of approximation [RMSEA]=0.08). The correlation coefficients between each item and the corresponding factor were all above 0.5. The Cronbach α coefficient of the entire scale was 0.76 and that for the five dimensions varied between 0.71 and 0.84.

Conclusion

The five dimensions of family burden assessed by the 28-item brief Chinese version of FEIS have good internal consistency and, thus, appear to assess valid dimensions of family burden in Chinese caregivers of persons with serious mental illnesses. Further work is needed to assess the test-retest reliability of this scale and its sensitivity to change over time.     

中文版五条目杜克大学宗教指数量表的内部一致性和重测信度(英文)

背景:杜克大学宗教指数量表(DUREL)是一个应用广泛的宗教性评估量表,包含五个条目。目的:评估DUREL中文修订版的内部一致性、信度和因子结构。方法:宁夏回族自治区是中国西北部的一个省,其人口的34%是信奉伊斯兰教的回族。我们利用概率比例规模的抽样方法,在20个基本抽样单位中随机选出了有合适居民的3981户。3054户完成了筛查访谈并随机选出了一名成年家庭成员;2425名受访者完成了调查(包括DUREL),平均在2.5天后,188名随机选中的被试再次完成了该调查。结果:全体样本中五个条目的内部一致性(Cronbach'sα)为0.90;在依据民族、城市与农村居住地、和文化程度中位数之上下分层的被试亚组中,其值为0.70到0.90。全样本中总分的重测信度(组内相关系数)为0.87;其值在不同被试亚组中为0.63到0.90。在随机的一半样本中,探索性因子分析确定为单一因子(特征根=4.21),解释总变异的84%。在另外一半的样本中,验证性因子分析证实了单维模型;使用五条目计分的一个因子模型的模型拟合指标是可以接受的(比较拟合指数[CFI]和塔克-刘易斯指数[TLI]0.99;近似误差均方根[RMSEA]=0.105;χ2=70.49,df=5),但是将条目1和条目2(分别评估组织和个体的宗教活动)的相关作为第六个观察变量添加后,模型拟合度有改善(CFI和TLI0.99;RMSEA=0.046;χ2=14.32,df=4)。结论:中文版DUREL是一个评估宗教性的可信有效措施,可以用于评估中国受访者的宗教性/信仰与身心健康之间的关系。正如其他研究者建议,我们的因子分析结果表明总分是该量表提取的最好指标,而不是原作者建议的三个维度的评分。     

Metformin for treatment of clozapine-induced weight gain in adult patients with schizophrenia: a meta-analysis

Background

Long-term use of clozapine for individuals with schizophrenia carries a high risk for developing metabolic abnormalities, especially clozapine-induced weight gain. Previous studies suggest that metformin can decrease clozapine-induced weight gain, but the sample sizes of most of these studies are relatively small.

Methods

We identified randomized controlled trials (RCTs) published prior to December 15, 2015 about the use of metformin to treat clozapine-induced weight gain in adults with schizophrenia by searching several English-language and Chinese-language databases. Two independent researchers did the screening and data extraction. We used Revman 5.3 to conduct the meta-analyses, assessed the risk of bias (RoB), and assessed the strength of the evidence using the Cochrane Grades of Recommendation, Assessment, Development, and Evaluation (GRADE).

Results

Six studies with a pooled sample of 207 treatment-group patients and 207 control-group patients were included —— three double-blind, placebo-controlled RCTs and three RCTs that did not use placebo controls and were not blinded. The meta-analysis found that compared to the control condition, patients receiving metformin experienced significantly greater reductions in body weight (mean difference [MD]=-2.89 kg, 95% CI: -4.20 to -1.59 kg) and body mass index (BMI) (MD=-0.81, 95% CI: -1.16 to -0.45), but there was no significant difference between the groups in the prevalence of side effects. Based on the GRADE scale, the strength of the evidence for the change in weight outcome was ‘moderate’ and that for the change in BMI outcome was ‘high’, but the strength of evidence about differences in side effects between groups was ‘low’ or ‘very low’.

Conclusions

Adjunctive treatment with metformin appears to be effective for treating clozapine-induced weight gain and elevations in BMI in adult patients with schizophrenia. However, the quality of the evidence about the safety of this treatment is low, follow-up time in the available studies is relatively short, and half of the studies did not employ blinded assessment of outcome measures. Larger studies with placebo controls that follow patients for at least 24 weeks and that make blinded assessments of a range of relevant outcome measures (weight, BMI, blood lipids, insulin resistance, etc.) are needed to confirm these results.     

Psychometric Properties of a Short Korean Version of the Revised Obsessive Intrusion Inventory

Objective

The Revised Obsessive Intrusion Inventory (ROII) is a 52-item scale that evaluates obsessional intrusive thoughts. The aim of the present study was to validate a short, 20-item Korean version of the ROII (ROII-20).

Methods

Of the 1125 participants who completed the ROII-20, 895 participants completed the scale to examine the factor structure of the scale. A subgroup of these participants (n=53) completed the scale twice to determine test-retest reliability. To establish external validity, 230 participants completed the scale and other questionnaires.

Results

Exploratory factor analyses suggested a hierarchical model comprising two higher order factors of autogenous obsessions (resulting from aggressive thoughts and sexual thoughts) and reactive obsessions (resulting from thoughts about contamination, thoughts about accidents, and thoughts about dirt). Confirmatory factor analyses supported this model. The results indicated good internal consistency and test-retest reliability. External validity was supported by relationships with obsessive-compulsive symptoms and general distress.

Conclusion

The ROII-20 presents good psychometric properties and may be considered as a promising instrument for measuring obsessional intrusions.     

One-Year Open-Label Study of Entacapone in Patients with Advanced Parkinson Disease

Background and purpose

A carboxy-O-methyl transferase inhibitor entacapone has been introduced as an adjuvant drug for Parkinson disease (PD) patients. Although clinical trials reported beneficial role of entacapone, a long-term trial over 3 years failed to show significant effect. The goals of this study were to evaluate the clinical benefit and the efficacy of entacapone in an open clinical practice.

Methods

After the completion of a double-blind placebo-controlled entacapone study, 149 patients from 4 centers were included. Antiparkinsonian medications were optimized by the judgment of the neurologists in charge. The clinical global impression (CGI) scale was obtained at 6 months and 1 year after the initiation of entacapone treatment.

Results

Of the 149 patients, 117 patients chose to try entacapone in an open-label fashion. Sixty-nine (59%) patients completed the 1-year trial. Twenty-nine patients discontinued entacpaone before 6 months, and 19 between 6 months and 1 year during trial. Twelve patients out of 48 patients discontinued entacapone because of its poor efficacy. The CGI scale was 3.9 (±1.5) at the beginning of the trial, 4.3 (±1.1) at 6 month, and 3.8 (±1.3) at 1 year, respectively. The CGI scale of those who discontinued between 6 month and 1 year was 3.4 (±1.7), which was worse, but insignificantly, than that of the continuer.

Conclusions

The dropout at 1 year of our study was very high at 41%. Even though entacapone is indicated for advanced PD patients with motor fluctuation, the fluctuators commonly have dyskinesia and mental symptoms, which can become more troublesome with entacapone. In the patients with advanced PD, the clinical efficacy and side effects should be carefully considered in a long-term use of entacapone.     

Depersonalisation/derealisation symptoms in vestibular disease

Background

Depersonalisation is a subjective experience of unreality and detachment from the self often accompanied by derealisation; the experience of the external world appearing to be strange or unreal. Feelings of unreality can be evoked by disorienting vestibular stimulation.

Objective

To identify the prevalence of depersonalisation/derealisation symptoms in patients with peripheral vestibular disease and experimentally to induce these symptoms by vestibular stimulation.

Methods

121 healthy subjects and 50 patients with peripheral vestibular disease participated in the study. For comparison with the patients a subgroup of 50 age matched healthy subjects was delineated. All completed (1) an in‐house health screening questionnaire; (2) the General Health Questionnaire (GHQ‐12); (3) the 28‐item depersonalisation/derealisation inventory of Cox and Swinson (2002). Experimental verification of “vestibular induced” depersonalisation/derealisation was assessed in 20 patients and 20 controls during caloric irrigation of the labyrinths.

Results

The frequency and severity of symptoms in vestibular patients was significantly higher than in controls. In controls the most common experiences were of “déjà vu” and “difficulty in concentrating/attending”. In contrast, apart from dizziness, patients most frequently reported derealisation symptoms of “feel as if walking on shifting ground”, “body feels strange/not being in control of self”, and “feel ‘spacey'' or ‘spaced out''”. Items permitted discrimination between healthy subjects and vestibular patients in 92% of the cases. Apart from dizziness, caloric stimulation induced depersonalisation/derealisation symptoms which healthy subjects denied ever experiencing before, while patients reported that the symptoms were similar to those encountered during their disease.

Conclusions

Depersonalisation/derealisation symptoms are both different in quality and more frequent under conditions of non‐physiological vestibular stimulation. In vestibular disease, frequent experiences of derealisation may occur because distorted vestibular signals mismatch with the other sensory input to create an incoherent frame of spatial reference which makes the patient feel he or she is detached or separated from the world.