利培酮治疗难治性精神分裂症临床分析

目的：评价对利培酮对难治性精神分裂症的疗效与副作用。方法：对我住院的难治性精神分裂症３０例换用利培酮治疗２４周。用阳性与阴性症状量表（ＰＡＮＳＳ）评定疗效,用副反应量表（ＴＥＳＳ）及锥体外系副反应量表（ＥＳＲＳ）评定副作用。结果：ＰＡＮＳＳ部分、ＰＡＮＳＳ－Ｇ（一般精神病理）分、ＰＡＮＳＳ－Ｐ（阳性症状）分治疗前后有显著差异。ＰＡＮＳＳ总分及各分量表分均自治疗１２周末起有显著下降,说明自第１２周末开始显效。ＰＡＮＳＳ部分减分率≥２０％者１８例,≥５０％者５例,有效率为６０％。最常见的副作用是ＥＰＳ（６／３０）,但症状多较轻。结论：利培酮对难治精神分裂症有肯定的疗效,副反应轻微。     

丙咪嗪治疗精神分裂症阴性症状的疗效观察

目的 了解丙咪嗪对精神分裂症阴性症状的疗效。方法 采用治疗前后自身对照及设对照组对照方法，以丙咪嗪合并常用抗精神病药物（研究组）与单用抗精神病药物（对照组）对４０例住院精神分裂症病人进行为期８周的对照研究，以ＳＡＮＳ、ＳＡＰＳ、ＴＥＳＳ进行量表评定。结果 两组病人ＳＡＮＳ总分及各分量表分治疗前后均无显著性差异，其余量表评分两组间比较亦均无显著性差异，且研究组有３例在研究期间阳性症状加重而退出研究。     

利培酮对慢性精神分裂症泌乳素的影响

目的探讨非典型抗精神病药利培酮对泌乳素的影响及其与临床疗效的关系。方法采用固定剂量利培酮（６ｍｇ／ｄ）治疗慢性、男性精神分裂症３０例,疗程１２周;在治疗前后评定ＰＡＮＳＳ量表,并用放射免疫法测查血浆中泌乳素（ＰＲＬ）浓度。以１６例健康人为对照。结果治疗后,患者ＰＡＮＳＳ总分及其分量表均显著降低;治疗前患者ＰＲＬ较对照组显著降低,治疗后显著性增高。治疗前后泌乳素差值与ＰＡＮＳＳ阳性症状分量表减分值、减分率显著相关。结论利培酮对精神分裂症血泌乳素水平有明显影响,而且泌乳素水平与临床疗效相关。     

对慢性精神分裂症患者辅以舞蹈治疗的疗效观察

目的 探讨舞蹈治疗对慢性精神分裂症患者的辅助作用。方法 在药物治疗的同时,对３０例慢性精神分裂症患者辅以舞蹈治疗（治疗组）,３０次为一个疗程;采用简明精神病评定量表（ＢＰＲＳ）和阴性症状量（ＳＡＮＳ）表于治疗前后分别进行评定,并与单纯药物治疗的３０例慢性精神分裂症患者（对照组）进行对照。结果 经舞蹈治疗后,治疗组ＢＰＲＳ和ＳＡＮＳ评分中位数分别为２６和１７,均低于治疗前（ＢＰＲＳ和ＳＡＮＳ分别为３     

氯氮平对精神分裂症阴性、阳性症状的疗效分析

用氯氮平治疗表现为阴性、阳性症状的精神分裂症病人１３１例，根据阴性症状量表（ＳＡＮＳ）、阳性症状量表（ＳＡＰＳ）评分分为两组，阴性症状组６１例，阳性症状组７０例。分别在治疗前、治疗后２、４、８周使用简明精神病量表、ＳＡＮＳ、ＳＡＰＳ、临床总体印象量表和副反应量表进行盲式评分。结果显示：氯氮平对两组症状均有较好和同等疗效（Ｐ＜０．０１）。对氯氮平的疗效、作用机制、临床应用、副作用及对难治性病例的疗效进行了讨论。     

氯氮平对慢性难治性精神分裂症的疗效与5—羟色胺2A受体基 …

目的 探讨与氯氮平对慢性难治性精神分裂症疗效有关的５－羟色胺２Ａ（５－ＨＴ２Ａ）受体基因的基因型及其他相关因素。方法 抽取１０４例慢性难治性精神分裂症患者,给予氯氮平≥４００ｍｇ／ｄ治疗２个月。治疗前后用阴性和阳性症状量表（ＰＡＮＳＳ）评定氯氮平疗效,按ＰＡＮＳＳ的减分率≥３０％和≤３０％将氯氮平治疗的患者分为有效组和无效组,用聚合酶链反应扩增及限制性片段长度多态性（ＰＣＲ－ＲＦＬＰｓ）技术测定患     

氯氮平对精神分裂症阴性,阳性症状的疗效分析

用氯氮平治疗表现为阴性、阳性症状的精神分裂症病人１３１例，根据阴性症状量表（ＳＡＮＳ）、阳性症状量表（ＳＡＰＳ）评分分为两组，阴性症状组６１例，阳性症状组７０例。分别在治疗前、治疗后２、４、８周使用简明精神病量表、ＳＡＮＳ、ＳＡＰＳ、临床总体印象量表和副反应量表进行盲式评分。结果显示：氯氮平对两组症状均有较好和同等疗效（Ｐ＜０．０１）。对氯氮平的疗效、作用机制、临床应用、副作用及对难治性病例的疗效     

氟哌啶醇对精神分裂症超氧化物歧化酶的作用

目的：探讨精神分裂症自由基代谢酶超氧化物歧化酶（ＳＯＤ）在氟哌啶醇治疗前后的变化。方法：用固定剂量氟哌啶醇治疗４６例慢性精神分裂症患者１２周，在治疗前后应用放射免疫法测定血ＳＯＤ含量，并评定ＢＰＲＳ、ＳＡＰＳ和ＳＡＮＳ量表。结果：治疗前ＳＯＤ值与ＳＡＰＳ总分正相关（Ｐ〈０．０５）。治疗后，治疗前高ＳＯＤ组明显降低，而低ＳＯＤ组明显增高（Ｐ均〈０．０５）。阴性型亚组中，治疗前ＳＯＤ值与治疗前后ＳＡＮ     

氯氮平台并利培酮与氯氮平治疗精神分裂症阴性症状的对照研究

目的 比较氯氮平合并利培酮与氯氮平对精神分裂症阴局限性症状的疗效。方法 ６０例长期住院的精神分裂症患者，分别接受氯氮平合并利培本呼氯氮平治疗，疗程８周，用ＢＰＲＳ，ＳＡＮＳ，ＳＡＰＳ，ＴＥＳＳ评定疗效和副反应。结果 氯氮平合并利培酮组在治疗后４周、８周ＳＡＮＳ评分较治疗前均有显著差异（Ｐ〈０．０１）；氯氮平组在治疗后８周ＳＡＮＳ评分与治疗前比较也有显著差异（Ｐ〈０．０５）。两组在治疗后４周、８周时     

维思通与氯氮平治疗慢性精神分裂症的临床对照研究

目的 探讨维思通和氯氮平治疗慢性精神分裂症的临床疗效及副反应。方法 对９６例符合ＣＣＭＤ－２－Ｒ中精神分裂症诊断标准，病程≥５年，ＰＡＮＳＳ总分≥６０分的住院患者并随机分为维思通组（ｎ＝５１例）和氯氮平组（ｎ＝４５例）。研究期限为９周。两组均采用药物固定剂量法，维思通组每日４ｍｇ，氯氮平组每日３７５ｍｇ。分别于研究前、后评定两次ＰＡＮＳＳ量表。以研究前后减分２０分为有效果限值；利用副反应清单比较了     

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.