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1.
噻奈普汀治疗抑郁症的临床对照研究   总被引:2,自引:0,他引:2  
目的:了解噻奈普汀治疗抑郁症的疗效和安全性。方法:对71例抑郁症患者进行噻奈普汀和阿米替林治疗的对照研究。噻奈普汀组36例,阿米替林组35例,疗程6周。采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评定疗效,用副反应量表(TESS)评定不良反应。结果:噻奈普汀有效率86.1%,显效率63.9%;阿米替林组分别为85.7%和62.9%;两组差异无显著性。噻奈普汀的不良反应较阿米替林少而轻。结论:噻奈普汀治疗抑郁症有效,不良反应少而轻,可在临床使用。  相似文献   

2.
噻奈普汀与阿米替林治疗抑郁症的对照研究   总被引:2,自引:0,他引:2  
目的:验证噻奈普汀(Tianeptine)治疗抑郁症的临床疗效和安全性。方法:研究对象符合CCMD-2-R中抑郁发作的诊断标准,经安慰剂清洗3-7天后,被随机分入噻奈普汀治疗组和阿米替林治疗组,治疗剂量分别为37.5mg/日和150mg/日,疗程为6周。疗效评价采用汉密尔顿抑郁量表(HAMD,17项),蒙哥马利抑郁量表(MADRS),汉密尔顿焦虑量表(HAMA)和临床疗效总评量表(CGI),安全性评价采用不良反应清单(AMDP-5),于治疗前、治疗后第1、2、4、6周各评定一次,实验室检查包括血液常规、肝肾功能和ECG等。结果:共入组26例,噻奈普汀和阿米替林组各13例。根据HAMD减分率评价(减分率≥25%为有效),6周末噻奈普汀组的HAMD总分平均下降73%,而阿米替林组为48%,判别有显著意义(P=0.029)。两药的起效时间均在第2周。噻奈普汀的抗焦虑作用在第一周末即有显著效果,6周末的HAMA总分平均下降68%,显著高于阿米替林组的33%(P=0.0196)。噻奈普汀的不良反应较阿米替林少而轻,结论:噻奈普汀具有肯定的抗抑郁和抗焦虑作用,6周末的临床疗效优于阿米替林,安全性高。  相似文献   

3.
路优泰与氟西汀治疗抑郁症对照研究   总被引:1,自引:0,他引:1  
目的:探讨路优泰对抑郁症患者的疗效及安全性. 方法:将40例抑郁症患者随机分为路优泰组和氟西汀组,治疗6周.采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)和副反应量表(TESS)评定疗效和不良反应. 结果:路优泰有效率为85%,对抑郁及伴随的焦虑症状作用明显,不良反应少而轻. 结论:路优泰抗抑郁疗效肯定,与氟西汀相当,安全性好.  相似文献   

4.
丁螺环酮与氟西汀联合治疗抑郁症临床研究   总被引:5,自引:1,他引:4  
目的:探讨丁螺环酮与氟西汀联合治疗抑郁症的疗效。方法:抑郁症患者65例,随机分成两组,分别用丁螺环酮联合氟西汀治疗(联用组)和单用氟西汀治疗(单用组),疗程6周。采用汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)评定疗效,用不良反应量表(TESS)评定不良反应。结果:治疗6周后联用组HAMD和HAMA评分显著低于单用组;在第2、第6周末联用组的治疗有效率显著高于单用组。两组不良反应相仿。结论:丁螺环酮联合氟西汀治疗抑郁症有良好的疗效。  相似文献   

5.
西酞普兰与氟西汀治疗老年抑郁症对照研究   总被引:1,自引:0,他引:1  
目的 比较西酞普兰和氟西汀治疗老年抑郁症的疗效及安全性.方法 将54例老年抑郁症患者随机分为西酞普兰组和氟西汀组,分别给予西酞普兰和氟西汀治疗,疗程6周.采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)及副反应量表(TESS)评定疗效和副反应.结果 2组总体疗效相当,显效率分别为82.3%和75.6%.但2周末时HAMD评分及减分率、HAMA评分2组间差异有显著性,说明西酞普兰起效较快.2组不良反应均较轻,安全性好.结论 西酞普兰是一种安全有效的抗抑郁药,能用于老年抑郁症患者.  相似文献   

6.
噻奈普汀与帕罗西汀治疗抑郁症的对照研究   总被引:2,自引:0,他引:2  
目的 比较噻奈普汀(商品名达体朗)与帕罗西汀治疗抑郁症的有效性和安全性。方法 将68例符合CCMD-2-R诊断标准的抑郁症患者,随机分为噻奈普汀组与帕罗西汀组,治疗6周。用汉密顿抑郁量表(HAMD)评定疗效,用副反应量表(TESS)评定副反应。结果 治疗6周后噻奈普汀组和帕罗西汀组的有效率分别为77%和82%,二者比较差异无显著性。治疗6周后两组HAMD总分及焦虑躯体化因子分,治疗前后比较差异均有显著性,两组间比较差异无显著意义。噻奈普汀组主要不良反应是嗜睡、口干等,与帕罗西汀组相比,差异无显著性。结论 噻奈普汀是安全、有效的抗抑郁药物。  相似文献   

7.
目的 比较帕罗西汀和氟西汀治疗伴焦虑症状的抑郁症的临床疗效及副反应。方法 符合CCMD - 3抑郁症的诊断标准 ,并且汉密尔顿焦虑量表评分 >14分的门诊及住院患者 5 8例 ,随机分为两组 ,为期 6周的治疗 ,于治疗前及治疗后第 1、2、4、6周末用汉密尔顿抑郁量表 (HAMD)、汉密尔顿焦虑量表 (HAMA)评定疗效 ,以不良反应症状量表 (TESS)观察副作用。结果 帕罗西汀和氟西汀治疗伴焦虑症状的抑郁症的显效率分别为 85 19%和 81 4 8% ,无显著差异。两组的HAMD减分率亦相当 (P >0 0 5 )。两组的HAMA减分率有显著差异 (P <0 0 5 )。两组的副反应相当 ,且均较轻。结论 帕罗西汀和氟西汀对伴焦虑症状的抑郁症的疗效均显著 ,抗抑郁效果两药相当 ,抗焦虑效果前者优于后者。两者副反应均较轻。  相似文献   

8.
目的:探讨氟西汀联合齐拉西酮治疗难治性抑郁症的疗效和安全性. 方法:76例难治性抑郁症患者随机分为合用组(氟西汀联合齐拉西酮)39例,单用组(单用氟西汀)37例.疗程8周.于治疗前及治疗2、4、8周分别用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)及治疗中出现的症状量表(TESS)评定疗效及不良反应. 结果:两组HAMD、HAMA评分较治疗前均显著下降(P<0.05或P<0.01),以合用组在治疗各周降分更为明显(P<0.05或P<0.01).两组药物不良反应相仿. 结论:氟西汀联合齐拉西酮治疗难治性抑郁症的疗效明显优于单用氟西汀,安全性较高.  相似文献   

9.
西酞普兰与氟西汀治疗抑郁症对照研究   总被引:30,自引:10,他引:20  
目的:验证西酞普兰治疗抑郁症的疗效及安全性。方法:按前瞻性,随机、单盲法将56例抑郁症患者分为西酞普兰组与氟西汀组。疗程6周。在疗前、治疗1、2、6周用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评定疗效,用副反应量表(TESS)、实验室检查及体检评价安全性。结果:两组总体疗效相当。但2周末时HAMD评分及减分率、HAMA评分两组问差异有显著性,说明西酞普兰起效较快。两组不良反应均较轻,安全性好。结论:西酞普兰是一种安全有效的抗抑郁药,耐受性及依从性好。  相似文献   

10.
氟西汀合并奥氮平治疗难治性抑郁症对照研究   总被引:15,自引:4,他引:11  
目的探讨小剂量奥氮平合并氟西汀治疗难治性抑郁症的疗效和不良反应。方法将74例难治性抑郁症患者随机分为2组,研究组在氟西汀(20mg/d)治疗的同时合并应用奥氮平(5~10mg/d);对照组仅用氟西汀(20mg/d)治疗,两组作4周的持续治疗观察,于入组前及入组后第1、2、4周末分别用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)及副反应量表进行评定。结果两组在治疗后第2、4周末,HAMD、HAMA总分及减分率的差异有统计学意义,两组间有效率的差异也有统计学意义。研究组和对照组分别有48.5%和38.9%出现不良反应,差异无统计学意义。结论小剂量奥氮平在难治性抑郁症的治疗中有增效作用,优于单用氟西汀,且安全性较好,在临床上可以作为治疗难治性抑郁症的一个备选方案。  相似文献   

11.
Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.  相似文献   

12.
Diagnostic Difficulties and Treatment Implications   总被引:1,自引:0,他引:1  
Robert J. Gumnit 《Epilepsia》1987,28(S3):S9-S13
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.  相似文献   

13.
Cognitive Dysfunction Associated with Antiepileptic Drug Therapy   总被引:7,自引:5,他引:2  
Eileen P.G. Vining 《Epilepsia》1987,28(S2):S18-S22
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.  相似文献   

14.
B. J. Wilder 《Epilepsia》1987,28(S2):S1-S7
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.  相似文献   

15.
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.  相似文献   

16.
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.  相似文献   

17.
Dextromethorphan: Cellular Effects Reducing Neuronal Hyperactivity   总被引:5,自引:1,他引:4  
G. Trube  R. Netzer 《Epilepsia》1994,35(S5):S62-S67
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.  相似文献   

18.
Hepatic Considerations in the Use of Antiepileptic Drugs   总被引:5,自引:4,他引:1  
Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.  相似文献   

19.
Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.  相似文献   

20.
Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.  相似文献   

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