抑郁症患者心理治疗的临床研究

目的 通过对照的方法,对抑郁症患者使用单纯抗抑郁药物治疗和药物合并心理治疗的疗效进行比较,探讨心理治疗在抑郁症患者治疗中的作用.方法 选取抑郁症患者120例,随机分成两组.对照组60例,男女各半,年龄18～65岁,平均(38.9±2.53)岁;心理治疗组60例,男女各半,年龄19～67岁,平均(39.7±3.12)岁.两组患者均给予帕罗西汀(商品名赛乐特)20mg/d,对照组单纯用药物治疗,心理治疗组药物加心理治疗,疗程8周.分别于第0周(基线)、干预后第2周、第4周、第8周使用汉密顿抑郁量表(HAMD)和抑郁自评量表(SDS)进行评分.结果 药物合并心理治疗组的治疗效果优于对照组(P＜0.05),且治疗时间越长,两组的疗效差异越明显.结论 心理治疗对抑郁症患者的康复有积极的作用,药物治疗合并心理治疗较单纯药物治疗更有利.     

Lithium for irritability in Post-Traumatic stress disorder

Irritability is often a problem for patients with Post-Traumatic Stress Disorder (PTSD). We describe two cases that illustrate the use of lithium in the treatment of veterans with PTSD who complained of serious problems with irritability or angry outbursts. These cases are discussed in the context of evidence that lithium may be useful in other patients with disorders of impulse control. The evidence linking disorders of anger and impulse control to a dysregulation in neurotransmitter regulation, particularly in serotonergic pathways, supports a psychopharmacologic approach to treatment. These findings should lead to further study of the role of lithium in the treatment of this symptom complex in patients with PTSD.     

促甲状腺素释放激素类似物YM14673对小鼠学习记忆的影响

采用小鼠跳台法评价促甲状腺素释放激素类似物ＹＭ１４６７３（ｉｐ１ｍｇ·ｋｇ－１）对正常成年小鼠被动回避学习记忆成绩的影响．结果表明ＹＭ１４６７３对东莨菪碱，氯霉素和乙醇造成的小鼠记忆获得，巩固及再现障碍均有明显的改善作用．     

氟西汀与阿米替林治疗105例抑郁障碍病人的双盲对照试验

目的：评价国产氟西汀的抗抑郁作用及安全性。方法：采用随机、双盲对照、多中心研究，分为国产氟西汀组５７例（男性２２例，女性３５例；年龄４０±ｓ１３ａ），口服氟西汀２０ｍｇ，ｑｄ，阿米替林５７例（男性２７例，女性３０例；年龄４０±１４ａ），口服阿米替林７５ｍｇ，ｂｉｄ，疗程６ｗｋ。结果：氟西汀治疗抑郁障碍的疗效与阿米替林相当，总有效率分别为８５％及９２％（Ｐ＞０．０５）；氟西汀组的主要副作用有口干、便秘、恶心、心动过速等，但较之阿米替林程度轻且发生率低。结论：氟西汀的抗抑郁作用与阿米替林相当，副作用少，服用方便。     

Familial Sneddon's syndrome

We report the familial occurrence and apparent autosomal dominant inheritance of Sneddon's syndrome with variable clinical expression. The proband, a 40-year-old woman, presented with livedo reticularis and progressive neurological deterioration following a stroke. The diagnosis was confirmed by cerebral angiogram and skin biopsy, both showing the characteristic findings. Two of the patient's sisters were reported to have been similarly affected in the past. Her mother, two additional siblings and five of her seven children exhibited various vasospastic skin phenomena. Familial aggregation of this disorder may be common and a genetic basis may be involved in its pathogenesis.     

氟西汀与阿米替林双盲对照治疗抑郁障碍病人16例

目的：评价国产氟西汀治疗抑郁障碍的疗效和副作用。方法：采用国产氟西汀和阿米替林双盲对照治疗１６例抑郁障碍病人。氟西汀组８例（男性３例，女性５例，年龄４５±ｓ１４ａ），用氟西汀２０ｍｇ，ｐｏ，ｑｄ。阿米替林组８例（男性３例，女性５例，年龄４４±１３ａ），用阿米替林７５ｍｇ，ｐｏ，ｂｉｄ。疗程６ｗｋ。结果：治疗后２组病人的ＨＡＭＤ，ＨＡＭＡ，ＳＤＳ评分均显著下降，显效率均为１００％，２种药物在疗效和副作用方面未有显著差异。结论：国产氟西汀是满意的新型抗抑郁剂。     

Digital movement analysis,a new objective method of measuring tardive dyskinesia and drug-induced parkinsonian tremor: acceptability,reliability and validity

Digital movment analysis (DMA) is a new instrumental approach to assessing oral tardive dyskinesia (TD) by means of digital image processing of a video signal, tracking five paper dots placed around the patient's mouth. A total of 40 schizophrenic patients, 30 with and 10 without TD, were examined twice (with a 3-month interval) with this new device. The patients were further examined with two TD rating scales: the St. Hans Rating Scale for extrapyramidal syndromes (SHRS) and the Abnormal Involuntary Movement Scale (AIMS).The schizophrenic patients accepted the instrumental assessment without any anxiety or resistance. The internal relibility of the apparatus was high, with correlation coefficients of 0.80–0.99. The DMA TD values correlated with the SHRS and AIMS scores with correlation coefficients of 0.48–0.73 indicating an acceptable, although not strong, concurrent validity. Fluctuations occurred from the first to the second examination independent of medication. For these fluctuations no correlation was found between DMA values and rating scores. Finally, the DMA device was able to detect perioral tremor as a sign of parkinsonism.It has been concluded that DMA is a useful supplement to classical TD rating, although further validity evaluation is warranted.     

MHPG and heart rate as correlates of nonresponse to drug therapy in panic disorder patients

Little is known about biological predictors of treatment response in panic disorder (PD). In the present study heart rate, blood pressure, plasma cortisol and plasma MHPG were investigated at baseline in a sample of 44 PD patients as possible predictors for nonresponse to treatment. We used a strict definition of nonresponse to find patients who did not respond at all after 12 weeks of treatment with brofaromine or fluvoxamine. Patients were considered nonresponders when they fulfilled two criteria: they did not show a 50% reduction of agoraphobic avoidance and they still experienced panic attacks at endpoint. The variables that differed significantly between the groups were used to predict nonresponse to drug therapy. Using this strict definition of nonresponse, 15 patients (32.6%) were considered nonresponders. These patients were characterised by a higher plasma MHPG concentration and a higher heart rate at baseline. These variables were subsequently used to predict nonresponse.     

帕罗西汀对抑郁模型大鼠不同脑区环磷酸腺苷反应元件结合蛋白的影响

目的探讨帕罗西汀在不同用药时间对抑郁模型大鼠海马、前额叶皮质环磷酸腺苷反应元件结合蛋白（CREB）磷酸化（p-CREB）及总蛋白（t-CREB）水平的影响。方法成年雄性SpragueDawley大鼠36只，随机分为6组：对照组、抑郁模型组（以下简称模型组）、抑郁模型＋用药1d组（以下简称用药1d组）、抑郁模型＋用药1周组（以下简称用药1周组）、抑郁模型＋用药2周组（以下简称用药2周组）和抑郁模型＋用药4周组（以下简称用药4周组），每组各6只。抑郁模型的制作为强迫大鼠游泳4周，每天1次，每次15min。帕罗西汀的剂量为10m∥kg体质量，灌胃给药，时间分别为1d和1，2，4周，每天1次，于每次游泳前用药。采用Westernblot法检测各组大鼠海马及前额叶皮质的p-CREB和t-CREB水平。结果（1）模型组及用药1d、1周组大鼠海马p-CREB水平明显低于对照组（P〈0．01），用药2，4周组大鼠海马p-CREB水平与对照组的差异无统计学意义（P〉0．05）；模型组及各用药组海马t-CREB水平与对照组的差异无统计学意义（P〉0．05）。（2）模型组及用药1d和1，2周组大鼠前额叶皮质p-CREB水平均明显低于对照组（P〈0．05），用药4周组与对照组的差异无统计学意义（P〉0．05）。模型组及用药1d、1周组大鼠前额叶皮质t-CREB水平与对照组的差异无统计学意义（P〉0．05），用药2，4周组大鼠前额叶皮质t-CREB水平均明显高于对照组（P〈0．05或P〈0．01）。结论慢性强迫游泳导致大鼠海马及前额叶皮质CREB活性降低，长期使用帕罗西汀可逆转此效应，提高抑郁大鼠前额叶皮质的CREB水平。