认知矫正治疗前后慢性精神分裂症患者功能磁共振成像的对照研究

目的 探讨认知矫正治疗对精神分裂症患者工作记忆相关脑区活动的影响.方法 对10例病情稳定的慢性精神分裂症患者进行为期6个月的认知矫正治疗,分别于治疗前后进行韦克斯勒记忆量表(WMS)测查及功能磁共振成像(fMRI)测量.结果 (1)WMS测查:治疗后再认[(8.11±4.34)分]和再生[(10.22±3.35)分]以及Benton错误[(3.75±2.92)分]均较治疗前[分别为(5.78±2.95)分、(8.56±3.21)分和(8.00±6.28)分]改善,均P＜0.05.(2)fMRI:治疗前后的反应时和正确率比较,差异无统计学意义(P＞0.05).治疗后在高负荷条件下,背侧前额叶皮质(DLPFC)区域(Brodmann46区)的激活范围(x,y,z=-51,36,15;k=40,t=7.21)小于治疗前的激活范围(x,y,z=-48,24,24,k=154,t=12.72),治疗前后DLPFC区域激活(x,y,z=-24,36,18,k=12,t=3.75)的差异有统计学意义(P＜0.005);在低负荷条件下,治疗前后DLPFC区域激活的差异无统计学意义(P＞0.05).结论 认知矫正治疗能改善精神分裂症患者工作记忆相关脑区的活动.     

多奈哌齐治疗颅脑创伤后记忆和智能障碍的临床观察

目的 观察多奈哌齐治疗96 例颅脑创伤后记忆和智能障碍的疗效.方法 颅脑创伤后记忆和智能障碍患者96例,治疗组给予多奈哌齐片5mg,1次/d, 晚上睡前口服;对照组给予尼莫地平片常规治疗.治疗期为1个月.结果 治疗组患者记忆功能、认知功能改善较为明显, 与对照组比较有明显差异(P ＜ 0.05).结论 多奈哌齐对颅脑创伤后记忆和智能障碍患者早期治疗效果好, 安全性高, 不良反应少, 服用方便.     

神经调节素1基因SNPrs2954041多态性与精神分裂症及其认知功能的关联研究

目的探讨昆明地区汉族人群神经调节素1(NRG-1)基因SNPrs2954041多态性与精神分裂症及认知功能的关系。方法采用聚合酶链反应限制性片段长度多态性(PCR-RFLP)的方法检测141例精神分裂症患者和84名正常对照的NRG-1基因SNPrs2954041多态性;采用韦氏记忆量表(WMS)和威斯康辛卡片分类测验(WCST)评估两组人群的记忆功能和执行功能,并用PANSS量表评定患者的临床症状。结果两组NRG-1基因SNPrs2954041多态性的基因型和等位基因频率差异有统计学意义(2=34.01,P<0.05;2=30.201,P<0.05)。按性别分组后比较,结果仍同前。患者组中各基因型组间认知功能比较结果示:①各基因型组间韦氏记忆量表的理解记忆得分差异有统计学意义(P<0.05),两两比较显示G/G与T/T基因型患者间差异有统计学意义(P<0.05)。②G/G与T/T基因型患者比较,威斯康辛卡片分类测验中的错误数、持续错误数和分类个数差异有统计学意义(P<0.05)。结论NRG1基因SNPrs2954041多态性与精神分裂症存在关联,他也与精神分裂症患者的认知功能相关。     

Return of sexual functioning following penile replant surgery

The penis, scrotum, and testicles of a 31-year-old man were cut off in a fight. Fourteen hours later the penis and one testicle were reattached, but the testicle later had to be removed. By 3 weeks normal urinary function returned but the penis was misshapen. The patient had suicidal intentions. His partner was sexually supportive but afraid to touch the penis. By 10 weeks penile swelling occurred in response to a movie with frank sexual content. By 12 weeks the penile swelling was sufficient for entry but the partner was acutely afraid that her vaginal contractions would tear the scars. The man was concerned because he experienced only mild sexual tensions. Physical examination reassured both, and they gained hope for recovery. At 16 weeks erections were still not full but active intercourse was attempted and he experienced seminal seepage and mild orgasmic sensations; she was relaxed enough to have orgasm. Testosterone was administered at regular intervals from the 19th week on, with immediate improvement of erection. By 32 weeks full erection, ejaculation, and orgasmic functions returned and the couple resumed their normal sexual practices.     

A Single-Blind, Crossover Comparison of the Pharmacokinetics and Cognitive Effects of a New Diazepam Rectal Gel with Intravenous Diazepam

Summary: Purpose: The objective of this study was to compare the pharmacokinetics and cognitive effects of a new diazepam (DZP) rectal gel (Diastat®) with intravenously administered DZP.
Methods: Twenty healthy volunteers were enrolled in a single-blind, randomized, double-dummy, two-period, crossover study. Subjects received either 15 mg of DZP rectal gel or 7.5 mg of DZP by intravenous infusion. Blood samples for DZP and desmethyldiazepam analysis were obtained before the dose and from 3 min to 240 h after the dose. Heart rate and blood pressure were measured over the first 24-h period. Subjects also completed five repetitions of a neuropsychological test battery over the first 8-h period.
Results: Diazepam rapidly appeared in plasma after rectal administration, exceeding 200 ng/mL within 15 min and reaching an initial maximum of 373 ng/ml at 45 min and a second maximum of 447 ± 91.1 ng/ml at ∼70 min. The absolute bioavailability of DZP rectal gel was 90.4%. Subjects receiving intravenous DZP were less alert and performed less efficiently on the WAIS Digit Symbol test 6 min after the dose. Subjects receiving DZP rectal gel performed less well on the WAIS Digit Span test 1 h after the dose and required more time to complete the Letter Cancellation and Grooved Pegboard tests 1 and 2 h after drug administration.
Conclusions: Diastat® displayed rapid, consistent absorption and was well tolerated. Alterations in cognition were mild and dissipated within 4 h of drug administration. This new rectal drug-delivery system offers an easy, safe, and bioavailable method to administer DZP.     

Triazolam-induced changes in alcoholic thought processes

 This study was designed to examine and contrast cognitive effects (explicit memory and access to semantic knowledge) of the benzodiazepine Halcion (triazolam) in ten normal volunteers and ten cognitively unimpaired detoxified alcoholics. The two groups were indistinguishable from one another under placebo conditions on all measures of cognitive functioning. Under Halcion test conditions (0.375 mg PO), both groups were about equally impaired in their recall of to-be-remembered information. However, alcoholics, were more likely to recall information that they were not asked to remember (intrusion errors) on all measures of explicit remembering. Alcoholics also generated relatively uncommon (low frequency) responses from semantic memory, rather than common, categorically related associations in response to stimuli such as types of vegetables, flowers, and fruit following the administration of Halcion, but were not different from normal volunteers in the types of responses generated under placebo conditions. These findings suggest that a drug challenge that simulates many of the effects of acute alcohol administration induces alcoholics to think and remember differently (qualitatively) from normal volunteers. Received: 7 July 1997 / Final version: 22 September 1997     

Immunoglobulins, cognitive status and duration of illness in alzheimer''s disease

Immunologic changes have been reported in the dementing illnesses of mid and late life. The results of two studies of drug-free males meeting research diagnostic criteria for primary neuronal degeneration of the Alzheimer's type suggest that serum IgG levels decrease with the progression of dementia. Serum IgG levels were inversely correlated with duration of illness and the levels of psychiatric symptomatology. Performance on the mini-mental status examination was positively associated with serum IgG concentrations.     

伴迟发性运动障碍的慢性精神分裂症患者认知功能研究

目的:了解伴迟发性运动障碍(TD)的慢性精神分裂症患者认知功能的损害情况。方法:以82例伴TD的(TD组)、70例不伴TD的慢性精神分裂症患者(非TD组)为研究对象,两组一般情况相匹配,选用韦氏记忆测验(WMS)、威斯康星卡片分类测验(WCST)及连线测验(TMT)进行认知功能评定。结果:①两组在WMS方面比较无统计学差异。②两组在WCST方面比较,TD组错误应答数、选择错误率、错误思考时间、持续应答数及概念化水平百分数成绩均显著差于非TD组。③两组在TMT方面比较,TD组PartB耗时数显著长于非TD组,而两组PartA耗时数无显著差异。结论:伴TD的慢性精神分裂症病人存在明显的认知功能损害,且可能涉及额叶皮层。