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1.
Summary: Purpose: To determine the incidence of psychiatric disorders before and after surgical treatment for partial epilepsy and to document the effectiveness of their treatment.
Methods: Fifty consecutive patients treated surgically for focal epilepsy (44 temporal and six frontal) were evaluated by established neuropsychiatric methods before surgery and over a mean period of 2 years after surgery. The patients with interictal dysphoric disorders, with or without psychotic episodes, were treated with tricyclic antidepressant medication alone or combined with serotonin selective reuptake inhibitors and, if necessary, with the addition of risperidone.
Results: Before surgery, 25 (57%) of the 44 patients with temporal lobe epilepsy had dysphoric disorders. After surgery, 17 (39%) of the 44 patients experienced either de novo psychiatric complications (six psychotic episodes, six dysphoric disorders, and two depressive episodes) or exacerbation of preoperative dysphoric disorder (three patients). Eight previously intact patients of the 19 (42%) developed dysphoric disorders after surgery that were significantly related to recurrence of seizures. All psychiatric complications occurred in the first 2 months after surgery, except for the six patients intact before surgery, who had a recurrence of seizures. A significant predictor of ultimate excellent psychiatric outcome was complete absence of seizures after surgery. All postoperative psychiatric complications remitted on treatment with psychotropic medication in the compliant patients.
Conclusions: An exceptional psychiatric morbidity is associated with the months after temporal lobectomy. Possible pathogenetic mechanisms are discussed. Antidepressant drugs are very effective in treating the psychiatric disorders of chronic epilepsy; their use in conjunction with the surgical treatment of epilepsy appears to be crucial for the overall positive outcome of a significant number of patients.  相似文献
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Cytokine imbalance in the pathophysiology of major depressive disorder   总被引:9,自引:0,他引:9  
OBJECTIVE: A substantial body of evidence indicates that dysregulation of the immune system is associated with Major Depressive Disorder (MDD). Because most cytokines have pleiotropic effects, we measured various subsets of cytokines to examine the association between immune response and MDD. METHODS: Forty-eight hospitalized MDD patients and 63 normal controls were recruited. We measured in vitro monocytic (IL-6 and tumor necrosis factor (TNF)-alpha), Th1 (interferon (IFN)-gamma and interleukin (IL)-2), Th2 (IL-4), and Treg (transforming growth factor (TGF)-beta1) cytokine production as well as IL-2/IL-4 and IFN-gamma/IL-4 ratios for both groups. Depressive symptoms were assessed by Hamilton Depression Rating Scale. Patients were evaluated before and after 6 weeks of antidepressant treatment. RESULTS: At admission, IL-6, TNF-alpha, TGF-beta1 production, and IFN-gamma/IL-4 ratio were significantly higher, whereas IFN-gamma, IL-2, and IL-4 were significantly lower in MDD patients. After treatment, IL-6 and TGF-beta1 production were significantly lower than before treatment. CONCLUSION: We suggest that activation of monocytic proinflammatory cytokines, and inhibition of both Th1 and Th2 cytokines may be associated with immunological dysregulation in MDD. TGF-beta1 may be associated with the regulation of monocytic cytokines as well as Th1 and Th2 cytokines in MDD.  相似文献
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Depressive Illness in Patients with Epilepsy: A Review   总被引:8,自引:8,他引:2  
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BACKGROUND: One of the most consistent morphologic findings in postmortem studies of brain tissue from depressed patients is a decrease in the number of glia in the prefrontal cortex. However, little is known about the mechanisms that contribute to this decrease in cell number. METHODS: To address this question, we subjected adult rats to chronic stress, a vulnerability factor for depression, and measured cell proliferation as a potential cellular mechanism that could underlie glial reduction in depression. RESULTS: We found that exposure to chronic unpredictable stress (CUS) for 15 days significantly decreased cell proliferation in neocortex by approximately 35%. This effect was dependent on the duration, intensity and type of stress, and was region-specific. Analysis of cell phenotype demonstrated that there was a decrease in the number of oligodendrocytes and endothelial cells. Finally, using a CUS paradigm that allows for analysis of anhedonia, we found that chronic antidepressant administration reversed the decrease in cortical cell proliferation, as well as the deficit in sucrose preference. CONCLUSION: These findings are consistent with the possibility that decreased cell proliferation could contribute to reductions in glia in prefrontal cortex of depressed subjects and further elucidate the cellular actions of stress and antidepressants.  相似文献
5.
奎硫平辅助治疗抑郁症的临床疗效及安全性研究   总被引:6,自引:0,他引:6  
目的探讨奎硫平合并抗抑郁药治疗抑郁症的疗效及安全性。方法将60名抑郁症患者随机分为合并奎硫平治疗组和对照组,合并奎硫平治疗组在原抗抑郁药物治疗的基础上合并使用奎硫平,对照组继续使用原抗抑郁药物,疗程为4周。入组时及入组第1、2、3、4周末对患者进行汉密顿抑郁量表(HAMD-17)、汉密顿焦虑量表(HAMA)、副反应量表(TESS)评定。结果合并奎硫平组共完成25例,1例在加用50mg奎硫平后出现双下肢水肿,故退出研究。1例在治疗过程中出现严重精神病性症状,在治疗第1周由研究者中止研究。2例在第2周脱落,1例在第四周时脱落。治疗第1周末起两组HAMD、HAMA总分差异有统计学意义(P〈0.01),合并奎硫平组低于对照组。研究组总有效率为83.3%,痊愈与显效占56.7%,对照组分别为50%和20%。研究组与对照组疗效存在显著差异。研究组出现不良反应共13例(43.3%),1例因服用50mg奎硫平后出现双下肢水肿而退出研究,其余均为可疑或极轻到中度。对照组共12例(40%)出现不良反应。结论奎硫平合并抗抑郁药治疗抑郁症是1种有效且相对安全的治疗方法。  相似文献
6.
S. Prendiville  K. Gale 《Epilepsia》1993,34(2):381-384
Summary: Fluoxetine was evaluated for anticonvulsant effects in a rat model of focally evoked complex partial seizures (CPS) secondarily generalized. Fluoxetine was administered intraperitoneally (i.p.) 1 h before seizures were induced by focal intracerebral application of the GABAA receptor antagonist, bicuculline methiodide (118 pmol) unilaterally into a discrete epileptogenic site in the deep prepiriform cortex ("area tempestas," AT) of rats. Significant dose-dependent protection from clonic motor seizures was obtained after 5-, 10-, and 20-mg/kg doses of fluoxetine, with 50% protection occurring after the 5-mg/kg dose. Suppression of electrographic seizure activity was concomitant with suppression of motor seizures. These observations support and extend previous findings of other investigators who showed that fluoxetine exerts anticonvulsant actions against maximal electroshock (MES) convulsions and audiogenic convulsions in genetically seizure-prone rodents.  相似文献
7.
Interactions Between Anticonvulsant and Psychoactive Drugs   总被引:5,自引:5,他引:1  
8.
Non-Monoamine Oxidase Inhibitor Antidepressants and Epilepsy: A Review   总被引:3,自引:3,他引:2  
Michael Trimble 《Epilepsia》1978,19(3):241-250
The literature dealing with the convulsant effects of the antidepressant drugs of the non-monoamine oxidase inhibitor variety is reviews. It is concluded that most of these drugs do lower the seizure threshold and may precipitate seizures even at normal therapeutic doses. The pathophysiology of antidepressant-induced seizures is discussed, and attention is drawn to biochemical differences in those antideprssants that have the least epileptogenic potential or may even be anticonvulsant. The clinical difficulties regarding administration of antidepressant drugs to epileptic patients are mentioned, and some practical advice is offered.  相似文献
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