无抽搐电休克合并氯丙咪嗪治疗难治性强迫症对照研究

目的探讨无抽搐电休克治疗难治性强迫症的疗效及安全性.方法 39例经氯丙咪嗪(＞150mg/d)治疗8周效果差的强迫症患者,分为两组.一组加用无抽搐电休克治疗,每周3次共10次,期间氯丙咪嗪减量;另一组继续服用原有氯丙咪嗪治疗.进行临床疗效、Y-BOCS、TESS评定并作比较.结果合用无抽搐电休克治疗组显效率71.43%,与单用氯丙咪嗪组(5.56%)相比有非常显著性差异.疗程结束时两组Y-BOCS评分有非常显著性差异.TESS评分无差异.结论并用无抽搐电休克治疗难治性强迫症有效、安全.     

帕罗西汀联合小剂量舒必利对女性抑郁症疗效及安全性的影响

目的 探讨帕罗西汀联合小剂量舒必利静滴治疗女性抑郁症患者的临床疗效和安全性.方法 将62例女性抑郁症患者随机分为两组,研究组给予帕罗西汀合并舒必利静滴治疗,对照组则仅给予帕罗西汀治疗,疗程为8周,仅在疗程前2周合并舒必利静滴治疗.采用汉密尔顿抑郁量表(HAMD)评定临床疗效,不良反应症状量表(TESS)评定不良反应情况.结果 治疗8周末两组HAMD评分下降,差异有统计学意义(P＜0.01),显效率差异无统计学意义(P＞0.05),但研究组起效较快;两组TESS评分差异无统计学意义(P＞0.05),不良反应均较轻微.结论 帕罗西汀联合小剂量舒必利静滴治疗女性抑郁症起效快,安全性高.     

帕罗西汀单用与帕罗西汀合并喹硫平对强迫症疗效的对照研究

目的探讨帕罗西汀合并喹硫平治疗强迫症的疗效。方法50例强迫症患者随机分为帕罗西汀组和帕罗西汀合并喹硫平组,疗程8周。采用强迫症量表(Y-BOCS),汉密尔顿焦虑量表(HAMA),汉密尔顿抑郁量表(HAMD),评定疗效。结果治疗结束时两组Y-BOCS,HAMA,HAMD的评分均显著下降,而合并喹硫平组更明显。结论帕罗西汀合并喹硫平治疗强迫症可以提高疗效。     

舍曲林合并奎硫平治疗难治性强迫症对照研究

目的:探讨舍曲林合并奎硫平治疗难治性强迫症的疗效和安全性。方法:64例难治性强迫症患者随机分为舍曲林合并奎硫平组和单用舍曲林组,疗程8周。采用Yale-Brown强迫症量表(Y-BOCS),汉密尔顿焦虑量表(HAMA)评定疗效,用治疗中出现的症状量表(TESS)评定安全性。结果:治疗后合用组的显效率为56.3%,单用组的显效率为25.8%,两组比较差异有统计学意义(χ2=6.021,P=0.014);两组治疗后Y-BOCS、HAMA评分以合用组下降更明显(P<0.05或P<0.01);两组TESS评分差异无统计学意义(P>0.05)。结论:舍曲林合并小剂量奎硫平治疗难治性强迫症可提高疗效,安全性较好。     

利培酮合并帕罗西汀治疗强迫症疗效分析

目的：探讨利培酮合并帕罗西汀治疗强迫症的疗效。方法：40例强迫症患者随机分为利培酮合并帕罗西汀组和帕罗西汀组,治疗8周。采用强迫症量表(Y-BOCS)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评定疗效。结果：治疗结束时两组Y-BOCs、HAMA、HAMD的评分均显著降低,更以合用利培酮组明显。结论：利培酮合并帕罗西汀治疗强迫症可以增加疗效。     

无抽搐电休克与喹硫平联合氟伏沙明治疗难治性强迫症的疗效比较

目的对比无抽搐电休克(MECT)与喹硫平联合氟伏沙明治疗难治性强迫症(OCD)的疗效及安全性。方法50例难治性强迫症患者随机分为2组各25例,观察组给予MECT联合氟伏沙明治疗,对照组给予喹硫平联合氟伏沙明治疗,疗程12周。2组均于治疗前及治疗后第4、8、12周末采用耶鲁-布朗强迫量表(Y-BOCS)、17-项汉密顿抑郁量表(HAMD-17)及汉密顿焦虑量表(HAMA)各评分1次,以减分率评定临床疗效,用副反应量表(TESS)评定不良反应。结果 12周末观察组显效率64%,对照组显效率60%,2组比较差异无统计学意义(P0.05),TESS评分亦无显著差异(P0.05)。结论MECT与喹硫平联合氟伏沙明治疗难治性强迫症的疗效相当,安全性好。     

氯氮平合并无抽搐电休克治疗难治性精神分裂症的对照研究

目的 评价氯氮平合并无抽搐电休克(MECT)治疗难治性精神分裂症的疗效和安全性.方法 将60例难治性精神分裂症患者随机分为研究组和对照组,分别给予氯氮平合并无抽搐电休克、氯氮平治疗,疗程12周,采用阳性与阴性症状量表(PANSS)及治疗中出现的症状量表(TESS)评定疗效和不良反应.结果 研究组显效率为43.3%,有效率为76.7%;对照组显效率16.7%,有效率53.3%,两组显效率和有效率均有显著性差异(P<0.05).PANSS总分及各因子分从治疗4～6周起两组即有显著性差异(P<0.05或P<0.01);两组副反应比较差异无显著性(P>0.05).结论 氯氮平合并无抽搐电休克治疗难治性精神分裂症疗效优于单用氯氮平,且显效快,副作用少,安全性高,是治疗难治性精神分裂症的较好选择.     

无抽搐电休克合并舍曲林治疗难治性抑郁症的对照研究

目的探讨舍曲林合并无抽搐电休克治疗(modified electroconvulsivetherapy,MECT)难治性抑郁症的临床疗效及安全性。方法将43例难治性抑郁症患者随机分为两组,研究组(2l例)在原用抗抑郁剂舍曲林的基础上加用MECT治疗。对照组(22例)仍使用原有抗抑郁剂舍曲林。所有患者进行汉密尔顿抑郁量表(HAMD)、副反应量表(TESS)评定并作比较。结果研究组显效率为71.43%,明显高于对照组的9.09%(P<0.01)。两组TESS分值无差异。结论抗抑郁剂并用无抽搐电休克治疗难治性抑郁症有效、安全。     

帕罗西汀联合无抽搐电休克治疗难治性抑郁症的临床研究

目的 评价帕罗西汀联合无抽搐电休克（MECT）治疗难治性抑郁症的疗效及不良反应.方法 将符合入组标准的80例患者随机分为联合治疗组（研究组）和帕罗西汀组（对照组）,共观察6周,分别于治疗前和治疗后第1、2、4、6周末采用汉密尔顿抑郁量表（HAMD）评定临床疗效,采用治疗中需处理的不良反应症状量表（TESS）评定不良反应.结果 治疗结束时研究组有效率显著高于对照组（分别为65.0％和42.5％,P＜0.01）.研究组治疗后第1周末起HAMD评分显著降低（P＜0.05）,而对照组治疗后第2周末起HAMD评分显著降低（P＜0.05）;治疗后第2周末起HAMD评分研究组低于对照组（P＜0.05）.两组总体不良反应发生率比较无显著性差异（P＞0.05）,在头痛、性功能障碍方面比较差异有统计学意义（P＜0.05）.结论 帕罗西汀联合MECT治疗难活性抑郁症疗效显著,起效快,优于单用帕罗西汀治疗.     

奥氮平对老年抑郁症的增效作用

目的：探讨帕罗西汀联合小剂量奥氮平治疗老年抑郁症的疗效和安全性。方法：将96例老年抑郁症患者随机分为研究组和对照组,研究组采用帕罗西汀合并奥氮平治疗,对照组用帕罗西汀治疗,治疗12周。两组分别在治疗2、4、8、12周,采用汉密尔顿抑郁量表（HAMD）、临床疗效总评量表（CGI）评定疗效,用治疗中出现的症状量表（TESS）评定不良反应。结果：研究组HAMD评分降分率显著较大,CGI评分显著较低,两组TESS评分相仿。结论：帕罗西汀联合小剂量奥氮平治疗老年抑郁症的疗效好,不良反应无明显增加。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of Legislation of 1933 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -