奥氮平治疗老年期难治性精神分裂症临床分析

目的：评价奥氮平治疗老年期难治性精神分裂症的疗效与安全性. 方法：用奥氮平治疗老年期难治性精神分裂症患者62例.疗程16周.采用阳性与阴性症状量表（PANSS）评价临床疗效,副反应量表（TESS）评价不良反应. 结果：PANSS总分、阳性症状、阴性症状及一般精神病理分在治疗前后差异有显著性.有效率为58.1%,显效率为32.3%,未见严重的不良反应. 结论：奥氮平对老年期难治性精神分裂症安全有效,服用方便.     

利培酮联合氯氮平治疗难治性精神分裂症临床研究

目的探讨利培酮联合氯氮平治疗难治性精神分裂症的疗效及安全性。方法对40例难治性精神分裂症患者,给予利培酮联合氯氮平治疗8周、12周。采用阳性与阴性症状量表、副反应量表评定临床疗效及不良反应。结果利培酮联合氯氮平治疗难治性精神分裂症的显效率为42.5%,有效率为57.5%。有效剂量利培酮为1mg~4mg/d,氯氮平为100mg~350mg/d,不良反应轻微且发生率低,均可耐受,经对症处理后均可缓解或消失。结论利培酮联合氯氮平治疗难治性精神分裂症疗效显著,安全性高,依从性好,可作为难治性精神分裂症的治疗方法。     

利培酮治疗难治性精神分裂症20例资料分析

目的 了解利培酮对难治性精神分裂症的疗效、副反应及处理。方法 对我院1998年单一用利培酮治疗的20例难治性精神分裂症进行疗效、治疗剂量、出现的副反应及处理的回顾性分析。结果 利培酮治疗日量为5.23±1.82mg,治疗显效率为10％,有效率为40％,总有效率50％,副反应发生率为60％。结论 利培酮是治疗难治性精神分裂症安全有效的抗精神病药,锥体外系发生率虽较高,但症状轻微,安坦治疗有效,无其它严重副反应。可作为治疗难治性精神分裂症的首选药物。     

精神分裂症物理治疗机制及其神经成像研究进展

近年来,脑影像成像技术飞速发展,极大地推动了临床神经精神疾病的研究进展。多模态脑成像技术已经发现精神分裂症患者存在广泛的功能连接异常。包括电抽搐治疗、经颅磁刺激治疗在内的物理治疗已经应用于临床,特别是对难治性精神分裂症的治疗。但是这些物理治疗的作用机制尚不明确。本文就精神分裂症物理治疗机制及脑成像研究方面进行了文献综述。综合多种无创的神经成像方法可以纵向研究物理治疗对难治性精神分裂症起效机制,对于指导临床治疗方案的制定及疗效评价均有重要的科学意义及临床价值。     

喹硫平合并利培酮治疗难治性精神分裂症

目的探讨喹硫平合并利培酮对难治性精神分裂症的疗效和安全性。方法共68例难治性精神分裂症标准的患者，疗程12周，分别在治疗前及治疗后进行阳性与阴性症状量表（PANSS）和不良反应症状量表（TESS）评定。结果治疗12周后总有效率为76．5％。PANSS阳性、阴性及一般精神病理总分治疗前后均有显著差异（P〈0．01），TESS评分治疗前后无显著性差异（P〉0．05）。结论喹硫平合并利培酮对难治性精神分裂症有较好的临床效果，且安全性较高。     

利培酮和氯氮平治疗难治性精神分裂症对照观察

目的　了解利培酮和氯氮平对难治性精神分裂症患者疗效。方法　对１３５ 例难治性精神分裂症患者按ＣＣＭＤⅡＲ 标准确诊后,随机分成两组,用利培酮和氯氮平各治疗６ 个月,在治疗前及治疗后２ 、４、６ 个月用ＢＰＲＳ、ＳＡＮＳ、ＳＤＳＳ、ＣＧＩ量表评定疗效。结果　在治疗难治性精神分裂症利培酮有效率３５－３ ％ ,氯氮平有效率３１－３％ ,量表显示二药对难治性精神分裂症疗效相似,利培酮主要以不良反应为轻度静坐不能,震颤,急性肌张力障碍,氯氮平为嗜睡,头晕,恶心,呕吐,流涎。结论　传统的神经阻滞剂治疗难治性精神分裂症无效时,非典型抗精神病药尤其利培酮可作为理想的药物。     

氯氮平对难治性精神分裂症靶症状疗效的观察

有报道氯氮平对一般精神分裂症的疗效与氯丙嗪相似,而对难治性精神分裂症的疗效则优于氯丙嗪。也有报道氯氮平对慢性精神分裂症和偏执型精神分裂症的疗效与氯丙嗪无显著性差异。这里可能存在氯氮平对难治性精神分裂症不同症候群的疗效差异。为探讨氯氮平对难治性精神分裂症的疗效和靶症状,作者对21例用氯丙嗪治疗无效的精神分裂症给予氯氮平治疗,现将结果报告分析如下。     

氯氮平合并安度利可治疗难治性精神分裂症对照研究

目的：了解氯氮平合并安度利可治疗难治性精神分裂症的疗效和不良反应。方法：68例难治性精神分裂症随机分为合用组和单用组，治疗前及治疗1、2、4、6个月末进行简明精神病评定量表(BPRS)和副反应量表(TESS)评定疗效及不良反应。结果：总疗效合用组明显高于单用组。结论：氯氯氮平合并安度利可治疗难治性精神分裂症疗效较好，不良反应较少。     

难治性精神分裂症的研究进展

精神分裂症是以思维、情感、行为等方面的障碍以及精神活动的不协调为主要表现的一组精神病.WHO1992年公布的资料显示其年发病率为7‰～14‰,病情迁延反复发作.有资料显示仍有30%～60%的患者在充分的药物治疗后仍然缺乏反应或仅有部分反应,迁延为难治性精神分裂症,导致临床治愈率低,预后差,给患者本人及其家庭带来极大痛苦和负担.本文介绍了难治性精神分裂症的概念、流行病学及临床特征、难治性精神分裂症的诊断,重点介绍了难治性精神分裂症的治疗,包括药物治疗和非药物治疗措施及进展,关注到难治性精神分裂症患者的社会心理康复的综合治疗问题.但难治性精神分裂症的神经生物学机制仍不明了,难治性精神分裂症对临床医生将仍然是一个挑战.     

氯氮平合并丙戊酸钠治疗难治性精神分裂症疗效及相关因素观察

目的 探讨氯氮平合并丙戊酸钠治疗难治性精神分裂症的疗效及其它相关因素。方法 抽取64例难治性精神分裂症患者给予氯氮平≥400mg/日,合并丙戊酸钠≥800mg/日治疗3个月,用简明精神病量表(BPRS)及药物副反应量表(TESS)评定疗效及副作用,并对其它相关因素进行分析。结果 发现氯氮平合并丙戊酸钠治疗难治性精神分裂症阳性、阴性症状均有效,总有效率为56.25％,尤其对女性及<22岁的患者疗效好,对激活因子及敌对猜疑因子疗效较佳,副作用轻。结论 氯氮平合并丙戊酸钠可作为治疗难治性精神分裂症,尤其是女性及<22岁患者较理想的方法。     

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 -