精神分裂症的阴性症状与脑血灌流量的相关研究

目的探讨精神分裂症患者脑血灌流量与阴性症状的关系。方法应用单光子发射计算机断层技术研究阴性症状为主和非阴性症状为主的精神分裂症患者各２５例的脑血灌流量，并与２１例正常对照组比较。结果发现两个研究组均存在额叶、颞叶及基底节脑血灌流量降低，但两组检测结果无差异；相关研究显示患者脑血灌流量与身高呈正相关性。结论精神分裂症的阴性症状与脑血灌流量降低无相关性。     

复方地西泮与地西泮抗焦虑的多中心双盲对照研究

为比较复方地西泮片与地西泮片的镇静、催眠、抗焦虑效果及安全性，对２０６例病例随机入组，疗程３周。结果：（１）用复方地西泮治疗可明显减少地西泮用量，疗效更好；（２）观察组（复方地西泮片）总有效率５０．４％，显著高于对照组（地西泮片）的２２．８％；（３）汉米尔顿焦虑量表（ＨＡＭＡ）及抑郁量表（ＨＡＭＤ）总分于治疗后均明显减低，观察组的减分幅度显著大于对照组；（４）ＨＡＭＡ和ＨＡＭＤ混合因子分析结果显示，两药均可改善睡眠障碍、焦虑、抑郁心境、植物神经及全身症状，复方地西泮片对前二组症状的疗效显著优于地西泮片；（５）不良反应量表记录两组治疗不良反应均轻微，且发生率低。观察组偶见倦、头痛等，均不影响治疗。提示复方地西泮片是一种安全、有效的抗焦虑新药。     

Age-related correlations in patient symptom management strategies in schizophrenia: An exploratory study

The role that symptom management strategies play in the remediation of schizophrenia with age has been largely neglected. The aim of this study is to examine whether there are age-related alterations in symptom management strategies. A total of 86 schizophrenic outpatients (age range 19–69 years) were queried about management strategies for 29 symptoms. Of the nine strategies employed ‘social diversion’ was significantly associated with increased age and ‘acceptance’ and ‘fighting back’ showed positive and negative trends with increased age, respectively. These age-associated differences in management strategies are hypothesized to represent an interaction of trial and error procedures unique to the disorder intertwined with life-span changes.     

探索性眼球运动检查在精神分裂症诊断中的价值

目的 探讨探索性眼球活动测验在精神分裂症诊断中的价值。方法 对61名精神分裂症患者和56名正常对照进行了探索性眼球活动检查。记录凝视点数(NEF)和反应性探索分(RSS)；计算敏感度、特异度、阳性预测值。结果 精神分裂症患者的NEF和RSS均显著低于正常对照。NEF和RSS的敏感度、特异度、阳性预测值较好。结论 探索性眼球活动测验在精神分裂症诊断中有一定的辅助价值。     

CSF levels of diazepam-binding inhibitor correlate with REM latency in schizophrenia,a pilot study

CSF diazepam-binding inhibitor-like immuno-reactivity (DBI-LI) and polysomnography were studied in 28 drug-free male schizophrenic (DSM-III-R) patients. They underwent a three-night polysomnography evaluation and a lumbar puncture. CSF DBI-LI correlated positively with REM latency, the REM latency/2^d nonREM period ratio and stage-4% sleep, and negatively with stage-1% sleep. CSF DBI-LI did not correlate significantly with duration of sleep or sleep latency. CSF DBI-LI during haloperidol treatment did not correlate significantly with sleep EEG measures. The results of this first study of the relationship between endogenous DBI and sleep in humans suggest that physiological effects of DBI other than interactions with the BZD/GABA_A receptor complex may explain its positive effects on sleep. However, the absence of similar sleep data in normal subjects precludes us from establishing a specific relationship between DBI and sleep in schizophrenia.     

Presynaptic dopamine in schizophrenia

Presynaptic dopamine (DA) transmission has been measured in schizophrenia using different paradigms aimed at providing estimates of the integrity or the activity of the presynaptic dopaminergic neuron. RESEARCHERS HAVE MEASURED: (1) DA synthesis capacity with [(18) F]DOPA, a measure of the activity of dopa decarboxylase, (2) DA release with studies measuring the impact of a DA releasing stimulant challenge on the binding of a D(2) receptor radiotracer, (3) D(2) baseline occupancy by DA, a measure of baseline intrasynaptic DA, assessed by the changes in binding of D(2) radiotracer induced by DA depletion, and (4) the DA and the vesicular monoamine transporters, to assess the integrity of presynaptic terminals. The relationship between DA release and D(2) receptor occupancy at baseline by DA has also been assessed in the same patients. Overall, these different imaging modalities have converged to show a dysregulation of presynaptic dopaminergic activity in schizophrenia, leading to excessive DA release in the striatum, particularly in the projection to the associative striatum, an area of integration between cognitive and limbic cortical inputs. Excessive striatal presynaptic DA is linked to the emergence of acute psychotic symptoms and to their response to treatment in schizophrenia. Understanding the etiology of this dysregulation and its consequences on the rest of the circuitry is important for future drug development.     

Neurochemical correlates of cortical GABAergic deficits in schizophrenia: selective losses of calcium binding protein immunoreactivity

Deficits in a variety of different neurochemical species are consistent with a loss of cortical gamma-aminobutyric acid (GABA)ergic interneurons in schizophrenia. As well as neurochemical markers that indicate all neurons using GABA as a transmitter, and which include GABA uptake sites and glutamate decarboxylase, deficits of certain neuropeptides and calcium binding proteins coexisting with GABA have been reported. These abnormalities are indicative of losses specific to certain subtypes of GABAergic neurons. The calcium binding proteins in particular demonstrate selective deficits; we find losses of parvalbumin- and calbindin-, but not calretinin-immunoreactive cells in the prefrontal cortex in schizophrenia. These selective reductions in the density of parvalbumin- and calbindin-containing neurons could reflect functional loss of expression in intact cells or alternatively a deficit in the density of certain GABAergic neuronal subtypes. The latter interpretation is consistent with a neurodevelopmental pathogenesis involving neuronal damage at a time prior to the expression of these protective calcium-binding proteins. In this review we discuss the evidence for altered GABAergic transmission in schizophrenia.     

精神分裂症患者探究性眼球轨迹运动的研究

目的探讨精神分裂症患者眼球轨迹运动功能障碍的特异性方法应用眼球轨迹运动标记记录仪测试精神分裂症偏执型患者２６例，抑郁症患者３６例，正常人３５名。经判别式分析获得正分为精神分裂症性障碍，获得负分为非精神分裂症性障碍。结果精神分裂症组平均获得２．０７６分，抑郁症组和正常人组平均分别获得０．２６７分和０．５３８分。该研究对精神分裂症患者诊断的敏感性为８４．６％，特异性为７１．１％。精神分裂症患者与正常人的眼球注视点和认知性探究分差异有显著性（Ｐ＜０．０５），眼球注视总距离、眼球注视平均距离以及反应性探究分差异有非常显著性（Ｐ＜０．０１）。结论眼球轨迹运动很可能是精神分裂症患者所具有的特定生物学指标     

探索性眼球活动试验在精神分裂症诊断中的价值

目的　用新仪器验证探索性眼球活动试验在精神分裂症诊断中的价值。方法　给 113名精神分裂症患者和 5 2名正常对照者 ,进行探索性眼球活动检查。测定凝视点数 (NEF)和反应性探索分(RSS) ,计算敏感度、特异度和阳性预期值。结果　精神分裂症患者和正常对照组的NEF和RSS有极显著差别 (P <0 .0 0 0 1)。NEF和RSS的敏感度和特异度都较好 ,阳性预期值很好。结论　探索性眼球运动可以作为精神分裂症的辅助诊断指标。进行过此项眼球活动检测 ;并排除有冲动攻击行为、不合作、明显衰退 ,或患有影响眼球活动的疾病。正常对照组为建筑民工、本院职工、及医学院校学生 ,共 5 2人 ;其中男性 39人 ,女性 13人 ,平均年龄(34.1± 9.1)岁。正常对照组均排除有精神异常史或精神病家族史 ,以及有影响眼球活动的疾病。1 2　检查方法1 2 1　让受试者舒服地坐在椅子上 ,眼看前方的小屏幕。双眼与屏幕的距离为 2 5cm ,使其眼光从屏幕左边移向右边的夹角为 33°。1 2 2　在屏幕上先显示第一个S形图样 (S1) ,持续15s。请受试者仔细观察。仪器自动记录 15s内的凝视点 ,并予计数 ,作为凝视点数 (NEF)。1 2 3　在屏幕上再分别显示第二个和第三个S形图样 (S2 、S3)。这两个图形与第一个图形都略有差别。每个图形持续 15s。请受试     

急、慢性精神分裂症患者血浆兴奋性和抑制性氨基酸含量的研究

目的探讨精神分裂症可能的发病和衰退机理。方法利用日立８３５型快速氨基酸分析仪，测定和分析３０例住院精神分裂症患者（急性１５例，慢性１５例）的血浆谷氨酸（Ｇｌｕ）、牛磺酸（Ｔａｕ）、γ氨基丁酸（ＧＡＢＡ）、甘氨酸（Ｇｌｙ）的含量变化，并与对照组（健康志愿者１０例）比较。结果（１）血浆Ｇｌｕ和ＧＡＢＡ含量患者组（８３±２４μｍｏｌ／Ｌ，５６±１７μｍｏｌ／Ｌ）显著低于对照组（１２６±５７μｍｏｌ／Ｌ，９０±１７μｍｏｌ／Ｌ），而血浆Ｔａｕ和Ｇｌｙ含量两组间差异无显著性；（２）慢性患者的血浆Ｇｌｕ和ＧＡＢＡ含量（９３±３１μｍｏｌ／Ｌ，６６±２２μｍｏｌ／Ｌ）高于急性患者（６９±１９μｍｏｌ／Ｌ，４９±１１μｍｏｌ／Ｌ），存在随病程迁延而增高的趋势；（３）３０例患者血浆ＧＡＢＡ的含量与阴性症状（ｒ＝０．４７０，Ｐ＜０．０１）和社会功能缺陷（ｒ＝－０．５６７，Ｐ＜０．０１）的严重程度呈显著性相关。结论精神分裂症可能与Ｇｌｕ能和ＧＡＢＡ能神经系统功能低下有关。中枢神经系统Ｇｌｕ和ＧＡＢＡ严重的功能失调可能导致精神分裂症慢性衰退的结局。     

Language lateralization in female patients with schizophrenia: an fMRI study

Gender differences in schizophrenia are among the most consistently reported findings in schizophrenia research. However, the biological substrate underlying these gender differences is still largely unknown. Differences in language lateralization between men and women may underlie some gender differences in schizophrenia.

In previous functional imaging studies, language lateralization was found to be decreased in male schizophrenia patients as compared to healthy males, which was due to enhanced language activation of the right hemisphere as compared to the healthy males. It could be hypothesized that decreased language lateralization in schizophrenia is gender specific, i.e. decreased lateralization in male patients and normal lateralization in female patients.

To test this hypothesis, language activation was measured in 12 right-handed female patients with schizophrenia and 12 healthy females, and compared to findings in 12 male patients and 12 male controls of an earlier study.

Language lateralization was significantly lower in the female patients (0.44) as compared to the female controls (0.75), which was due to increased activation of the right-sided language areas (patients: 19 voxels; controls: 8 voxels), while left hemisphere activation was similar in patients and controls. When these data are compared to the male patients and controls, both patient groups had lower lateralization than their healthy counterparts, but there was no difference between male and female patients. In both sexes, decreased lateralization resulted from increased right hemispheric language activation, which suggests a failure to inhibit nondominant language areas in schizophrenia. These findings indicate that lower language lateralization in women is not likely to underlie gender differences in schizophrenia.     

A diazepam binding inhibitor (DBI)-like neuropeptide is detected in human brain

Diazepam binding inhibitor (DBI), a 11,000 MW neuropeptide, which coexists with GABA and elicits proconflict responses in the rat, has been purified and partially sequenced from rat brain. We now report purification and characterization of a DBI-like neuropeptide from human brain. Its molecular weight and pharmacological profile is identical to that of rat DBI but differs in the amino acid composition and immunologically. The tryptic fragments of human DBI differ from rat DBI in the HPLC elution profile and in the amino acid sequence. Using high affinity specific human DBI antibodies, the distribution of DBI-like immunoreactivity in bioptic samples of human brain appeared to be similar to that of DBI found in rat brain. DbI-like immunoreactivity was also found in spinal fluid of human volunteers. The cerebrospinal fluid content of this peptide might be used as a probe to study whether spinal fluid DBI content changes in neuropsychiatric disorders.     

Deficit in decision making in catatonic schizophrenia: an exploratory study

Catatonic schizophrenia can be distinguished from paranoid schizophrenia by prominent behavioral and motor anomalies. As demonstrated in recent imaging studies, behavioral symptoms may be related to dysfunction in the ventral prefrontal cortex. However, the neuropsychological correlates of ventral prefrontal cortical dysfunction remain unclear. In an exploratory study, we investigated eight patients with catatonic schizophrenia and compared them with 19 patients with paranoid schizophrenia and 26 healthy subjects. The Iowa Gambling Task (IGT) and the Object Alternation Task (OAT) served as measures of ventral prefrontal cortical function. In addition, other prefrontal cortical tests such as a visual working memory task, a Go-NoGo task, and the Wisconsin Card Sorting Test, as well as attentional tasks, were included in the test battery. Catatonic patients showed significant deficits in the IGT characterized by an inability to shift from the initial preference for high-risk cards to a more advantageous strategy with low-risk cards. Moreover, catatonic patients showed significant deficits in the OAT. In conclusion, our preliminary results suggest a specific deficit in catatonic schizophrenia in those neuropsychological measures that are associated with ventral prefrontal cortical function.     

探索性眼球活动与精神分裂症患者临床症状的相关性研究

目的 探讨探索性眼球活动与精神分裂症患者临床症状的相关性.方法 选取2017年01月～2018年12月本院收治的58例精神分裂症患者作为此次研究的观察主体.入院后,对患者的反应性探索(RSS)、凝视点数(NEF)进行检测,同时在患者接受为期6周的抗精神病治疗后,追踪分析RSS、NEF与阳性与阴性症状量表(PANSS)评...     

Effects of intravenous diazepam on high-frequency oscillations in EEGs with CSWS

High-frequency oscillations (HFOs) associated with continuous spike-waves during slow-wave sleep (CSWS) are speculated to be linked to the disturbance of higher brain function. We intended to investigate the generative mechanisms of HFOs in CSWS by clarifying the effects of intravenous injection (IV) of diazepam (DZP), an agonist for the gamma-aminobutyric acid A (GABA_A) receptor in the GABAergic interneuron system, in patients who had previously been treated with IV DZP. The subjects were three patients with epilepsy with CSWS. For each patient, EEG data before and after IV DZP were separated into consecutive 5-min sections. Time–frequency power spectral analysis was performed on the spikes of each section, and peak-power and frequency of detected high-frequency spectral spots were compared before and after IV DZP. Spectral spots with peak-frequencies at 85.9–121.1 Hz in the ripple band were revealed in all three patients. Although the amplitudes of the spikes largely returned to the baseline levels 20–25 min after IV DZP, the recovery of the peak-power levels of HFOs lagged behind that of the spike amplitudes, and the power levels of HFOs were lower than the baseline data within 25 min after the injection of DZP. No consistent changes were found regarding the spectral frequencies of HFOs. The dissociation of the effect of IV DZP in terms of recovery when comparing spike-amplitudes and the power of HFOs may correspond to an already suggested difference in the pathophysiological mechanisms that generate the spikes and HFOs.     

Regional cerebral blood flow in patients with schizophrenia

Summary Regional cerebral blood flow was evaluated using Tc99m-HMPAO SPECT in 10 medicated patients with schizophrenia and 9 healthy volunteers. There were no prefrontal regions in the patient group with lower regional indices than in the control group. However, in the left hippocampal region, relative blood flow was significantly increased in the patient group compared with the control group. Furthermore, there was a relative increase in blood flow in the left basal ganglia of the patient group. A negative correlation coefficient was calculated between the relative blood flow in the left middle prefrontal cortex and the severity of the blunted affect, as well as between the relative blood flow in the left basal ganglia and the severity of the anhedonia-asociality. These findings indicate that prefrontal hypoactivity is not invariably present in all schizophrenics and that left basal ganglial hyperactivity may be associated with the effects of antipsychotic treatment and clinical improvement. Moreover, the left hippocampal hyperactivity may correspond to left limbic dysfunction in schizophrenia.     

D4受体基因与精神分裂症的关联研究

目的 探讨上海地区汉族人D4受体基因与精神分裂症的易感性、患者的性别、发病年龄、家族史以及症状严重度之间的关系。方法 抽取38例精神分裂症病人作研究,以76例正常人作对照。用聚合酶链式反应（PCR）扩增技术测定所有研究对象的D4基因型和等位基因。结果 发现D4受体基因与精神分裂症的易感性相关联,而与患者的性别、发病年龄、家族史以及症状严重度均无关联;发现正常对照组D4受体基因与性别相关联。结论 D4受体基因可影响精神分裂症患者的易感性,但不改变患者的发病年龄以及症状严重度,D4受体基因多态性的频率分布不受患者的性别及家族聚集性的影响;正常人群中D4受体基因多态性的频率分布存在性别差异。     

帕罗西汀与地西泮治疗广泛性焦虑症的临床对照研究

目的　评价帕罗西汀治疗广泛性焦虑症的临床疗效和副反应。方法　对 5 6例符合CCMD - 3诊断标准的广泛性焦虑症患者 ,分别应用帕罗西汀 (2 8例 )、地西泮 (2 8例 )进行治疗 ,疗程 4周。采用焦虑自评量表 (SAS)、Hamilton焦虑量表 (HAMA)和副反应量表 (TESS)评定疗效和副反应。结果　帕罗西汀与地西泮对广泛性焦虑症的疗效差异无显著性 (P >0 .0 5 )。治疗第 4周末两组SAS、HAMA以及HAMA因子分的减分比较差异有非常显著性 (P <0 .0 1)。副反应两药相似 ,帕罗西汀的主要副反应为口干、头痛、头晕和恶心。结论　帕罗西汀治疗广泛性焦虑症有效 ,副反应轻微     

Phylogenetic distribution of bicuculline-sensitiveγ-amino-butyric acid (GABA) receptor binding

Bicuculline-sensitive [³H]GABA receptor binding was studied in membrane fractions prepared from vertebrate whole brain or invertebrate cephalic ganglia. In tissue not treated with Triton X-100, a significant amount of bicuculline-displaceable [³H]GABA binding was detected in the brains of all vertebrates studied, with the hagfish brain binding over twice as much [³H]GABA as the spiny dogfish, the next oldest species. All other vertebrates bound similar amounts of [³H]GABA, being one-third to one-fourth that observed in the hagfish. In contrast, after Triton treatment, the hagfish displayed the least amount of bicuculline-sensitive [³H]GABA binding and, under those conditions, the amount of binding observed increased in an evolutionary fashion. No measurable bicuculline-sensitive GABA receptor binding was noted in any invertebrate studied. These results suggest that bicuculline-sensitive GABA receptors are present in the brains of all vertebrates and that during the course of evolution there developed a Triton-sensitive substance(s) whose presence modifies the kinetic properties of this receptor site.     

Nefazodone in the adjunctive therapy of schizophrenia: an open-label exploratory study

Compared to conventional antipsychotic medications, atypical antipsychotic medications demonstrate greater central serotonin (5HT2) receptor antagonism than dopamine type 2 (D2) receptor antagonism. Nefazodone, an antidepressant medication, exhibits 5HT2 receptor antagonism; we therefore wondered if its addition to stable regimens of antipsychotic medication would increase antipsychotic efficacy, independently of a primary effect on mood, through the mechanism of augmented 5HT2 receptor antagonism. In a pilot investigation, we administered nefazodone (400 mg/d) for 6 weeks as an open-label adjunct to antipsychotic medication in 10 patients with chronic schizophrenia. The patients were moderately depressed at baseline but did not meet criteria for major depressive episode. The Brief Psychiatric Rating Scale (BPRS) and Montgomery-Asberg Depression Rating Scale scores showed statistically significant and clinically robust improvements with nefazodone treatment, which were maintained at follow-up evaluation 2 weeks after the end of nefazodone treatment. There were no adverse events. These results suggest that nefazodone may be a safe and effective adjunct to antipsychotic medications in schizophrenia and that augmentation of 5HT2 antagonism may prove to be a viable strategy for "boosting" antipsychotic efficacy and for treating depressive symptoms in schizophrenia.