PCI术后谵妄危险因素分析及针对性预防护理对策

目的 探讨急性冠脉综合征(ACS)患者经皮冠状动脉介入术(PCI)后出现谵妄的危险因素并讨论针对性预防护理对策.方法 本研究观察对象为我院2020年1月～2021年1月132例ACS患者,均采用PCI术治疗,评估治疗期间谵妄发生情况,并设为谵妄组与非谵妄组.比较两组患者性别、年龄、合并症等一般资料,通过单因素与多因素分...     

改良电痉挛治疗对精神分裂症患者血清细胞因子及C-反应蛋白水平的影响

目的探讨改良电痉挛治疗(MECT)对精神分裂症患者血清细胞因子及C-反应蛋白水平的影响。方法选取符合《国际疾病分类(第10版)》(ICD-10)中精神分裂症诊断标准的58名精神分裂症患者为MECT组进行MECT治疗,41名未行MECT的患者为药物组,另选取健康人82名为对照组,三组间性别、年龄均相匹配。观察治疗前后血清白介素-1(Interleukin-1,IL-1)、白介素-4(Interleukin-4,IL-4)、白介素-6(Interleukin-6,IL-6)、白介素-10(Interleukin-10,IL-10)和C-反应蛋白(C-reactive protein,CRP)水平变化,采用PANSS量表测评精神症状。结果 1MECT治疗4次后男性血清CRP浓度高于女性,差异有统计学意义(P<0.05);2MECT组治疗4次后、6次后血清CRP浓度高于健康对照组,药物组治疗2周后血清CRP浓度高于健康对照组,差异均有统计学意义(P<0.05);3MECT治疗前后血清IL-1、IL-4、IL-6、IL-10浓度差异无统计学意义(P>0.05),MECT治疗4次后血清CRP浓度高于其他治疗时间点(P<0.05);4MECT组有效率为63.8%,药物组为24.4%,差异有统计学意义(P<0.01)。结论 MECT可能不引起细胞因子的显著变化,但会引起C-反应蛋白的应激性增高,且男性较女性更为敏感。     

首次无抽搐电休克治疗后迟发性谵妄1例

无抽搐电休克治疗(MECT)是在传统电休克治疗基础上配合麻醉技术,是一种快速、安全、高效的治疗方法。MECT虽减少了因抽搐而产生的不良反应,但仍存在头痛、肌肉疼痛、认知功能损害等副作用。本文报告了1例MECT治疗后谵妄(PECTD)的案例,并对PECTD发生的可能机制进行探讨,考虑发作时间过长、双侧电极片放置是本例发生PECTD的可能原因。提示临床工作者加强对PECTD的预防、识别。     

无抽搐电休克治疗对抑郁症患者自伤行为的影响

目的:探讨无抽搐电休克治疗(MECT)对抑郁症患者自伤行为的疗效.方法:采用对照研究设计,根据伴有自伤行为的抑郁症患者是否同意接受MECT的意愿将其分为研究组(共43例)和对照组(共42例);两组患者在服用抗抑郁药治疗的基础上,给予研究组每周3次MECT,共9次,刺激部位为双侧颞叶.治疗前及治疗后6个月采用自伤行为问卷...     

依托咪酯对无抽搐电休克治疗的影响

目的：探讨依托咪酯对丙泊酚诱导麻醉后无抽搐电休克（MECT）治疗运动发作时间不良的精神分裂症患者的疗效。方法：将67例行丙泊酚诱导麻醉下MECT治疗3次后,运动发作时间〈20s的精神分裂症患者随机分为两组,丙泊酚组33例,诱导麻醉仍给予丙泊酚,后续治疗电量较上次递增5％-100％;依托咪酯组34例,诱导麻醉换用依托咪酯,后续治疗电量较上次递增5％。两组均隔日治疗1次,共3次,治疗前及治疗2周,以阳性与阴性症状量表（PANSS）和韦氏记忆量表（WMS）评定其精神状况及记忆水平;比较两组患者运动发作时间、躁动谵妄发生率及疼痛发生率指标。结果：治疗后依托咪酯组运动发作时间、WMS评分、PANSS减分及躁动谵妄发生率均高于丙泊酚组,但疼痛发生率及电量指数显著低于丙泊酚组。结论：依托咪酯可提高丙泊酚诱导麻醉后MECT治疗运动发作时间不良患者的发作时间,减少注射疼痛,且较增加电量延长发作时间的方法有更少的认知损害,但须注意躁动谵妄问题。     

无抽搐电休克治疗老年抑郁症患者的非匹性负波的变化观察

目的观察无抽搐电休克(MECT)治疗前后老年抑郁症(SD)患者的非匹性负波(MMN)的变化。方法应用脑诱发电位仪,对38例SD患者在MECT治疗前后进行MMN和P300检测,观察MECT治疗前后的变化,并与45例正常对照者进行比较。结果与正常对照者相比,SD患者的MMN潜伏期延迟、波幅下降(P<0.05)。SD患者在MECT治疗后,MMN和P300有所恢复(P<0.05)。结论 MMN和P300联合应用可作为MECT治疗SD的有价值的监测指标之一。     

改良电抽搐与抗抑郁药对抑郁症患者血清脑源性神经营养因子影响的对照研究

目的 探讨改良电抽搐治疗(MECT)与抗抑郁药对抑郁症患者血清脑源性神经营养因子(BDNF)的影响.方法 根据性别和年龄相配伍,收集只接受抗抑郁药物治疗(非MECT组)和联合接受MECT治疗的抑郁症患者(MECT组)各24例,检测患者治疗前后和80名正常对照的血清BDNF浓度并作组间比较.结果 治疗前两组抑郁症患者血清BDNF浓度均低于正常对照组(P<0.01);治疗后两组血清BDNF浓度均显著高于治疗前(P<0.01或P＜0.05),MECT组升高幅度明显高于非MECT组(治疗前后均致差分别为20.75和10.10),而两组与正常对照组的差异无统计学意义(F=1.88,P=0.16).两组治疗有效者血清BDNF浓度显著高于治疗前(P<0.01或JP<0.05),治疗无效者治疗前后血清BDNF浓度差异均无统计学意义(P>0.05).结论 MECT和抗抑郁药物治疗均可能通过提高BDNF水平而起到抗抑郁作用.     

改良的电痉挛治疗复苏期护理干预研究

目的 系统观察MECT治疗复苏期患者的临床副反应和相应护理干预措施之效果,丰富该项治疗的护理临床经验.方法 对349例患者共行1 779次MECT治疗,从临床护理角度进行系统观察,将复苏期的各种临床副反应进行记录、分析,采取相应的护理干预,并总结疗效.结果 MECT复苏期,存在烦躁、自主呼吸恢复延时、口腔唾液过多、人工辅助呼吸致胃充气(急性胃扩张)、膈肌痉挛、呕吐、咬肌不松弛等多项副反应,给予恰当护理干预,无不良后果产生.结论 复合麻醉下的ECT复苏期出现的多种临床副反应,只要给予恰当的护理干预,复苏是安全顺利的.     

女性抑郁症患者无抽搐电休克治疗前后的视觉P300观察

目的观察女性抑郁症患者无抽搐电休克(MECT)治疗前后事件相关电位视觉P300的变化。方法对31例女性正常人,33例女性抑郁症患者在MECT治疗前后进行了视觉P300检测,观察MECT治疗前后视觉P300的变化。结果 (1)与正常组比较,患者组治疗前的视觉P300中的靶指标N2和P3潜伏期延迟(P<0.01),靶波幅P3降低(P<0.01)。(2)患者组经过MECT治疗后视觉P300靶潜伏期N2和P3均有所恢复(P<0.05～0.01),但治疗后靶波幅P3明显下降(P<0.01)。结论视觉P300中的P3和N2联合应用可作为评估MECT疗效的指标之一。     

无抽搐电休克治疗对抑郁症患者血清C反应蛋白的影响

目的:探讨无抽搐电休克治疗(MECT)过程中抑郁症患者血清C反应蛋白(CRP)水平的动态变化及其与疗效的关系方法:30例抑郁症患者纳入本研究,分别在MECT前和MECT后第1次、第3次和第5次和最后1次结束后次日清晨空腹抽血检测血清CRP水平。采用汉密尔顿抑郁量表(HAMD)评估MECT的疗效。结果:MECT第1次后CRP水平即出现降低,随着MECT次数的增加CRP水平持续降低并伴随着抑郁症状的改善。抑郁症状缓解者在MECT结束时CRP水平显著降低,女性患者基线CRP水平显著预测MECT的疗效(P0.05)。结论:MECT前后CRP的变化与疗效相关,女性抑郁症患者基线CRP水平能够预测MECT治疗效果,提示MECT可能通过降低炎症因子起作用。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.     

Special Pharmacokinetic Considerations in Children

Summary: Pediatric patients have greater degrees of pharmacokinetic variability and unpredictability than adults. This variability results from the effects of pharmacogenetics, age and growth, prior and current comedication, and disease. Newborns with seizures have the least predictable dosage requirements, and their needs change as drug-eliminating mechanisms mature in the neonatal period. Infants have the highest relative capacities to eliminate antiepileptics of any age group and require the largest relative doses. In addition to age-related trends, children demonstrate the same drug-specific, pharmacokinetic phenomena that adults do, including nonlinear phenytoin elimination, nonlinear valproate binding, and autoinduction of carbamazepine. Intercurrent illness and drug interactions further modify the age-related pharmacokinetic patterns in children and make dosage requirements even more unpredictable. Recent studies have shown that febrile illness can affect drug elimination, sometimes decreasing drug levels by 50% or more. Intermittent treatment with benzodiazepines administered either orally or rectally can be an important adjunct and help minimize this type of problem for children with marginally controlled epilepsy. Intermittent benzodiazepines are also helpful for children who have febrile seizures and who need only occasional antiepileptic protection.