106例分裂样精神病患者3～5年随访研究

目的探讨分裂样精神病的临床特征和转归，为分裂样精神病的诊断提供依据。方法对106例首次入院诊断为分裂样精神病的患者进行为期3～5年的随访。结果33例分裂样精神病维持了原诊断，65例改诊为精神分裂症，6例改诊为分裂情感性精神病，2例改诊为心境障碍。分裂样精神病和精神分裂症在临床特征和治疗效果方面有显著性差异。结论分裂样精神病很有必要作为一个独立的疾病单元存在。     

利培酮治疗难治性分裂情感性精神病临床研究

目的探讨利培酮治疗难治性分裂情感性精神病的临床疗效。方法对20例难治性分裂情感性精神病患者给予利培酮治疗,疗程6w．随访6mo。于治疗前及治疗1w,2w,3w,4w,5w,6w末采用简明精神病量表,汉密顿抑郁量表,躁狂评定量表评定临床疗效。结果2例因治疗过程中出现发热性疾病脱落,实际完成18例。治疗2w起各时段．简明精神病量表,汉密顿抑郁量表,躁狂评定量表评分下降明显,与治疗前比较,差异有显著或极显著性（P〈0．05或0．01）。结论利培酮治疗难治性分裂情感性精神病疗效显著,且对患者的社会功能的恢复有良好的促进作用。     

分裂样精神病205例随访调查

对205例分裂样精神病(SFP)进行了5～10年的随访调查,结果显示:91例(44.4％)改诊为精神分裂症,108例(52.6％)维持SFP诊断,6例(3％)改诊为情感性精神病。作者认为通过5～10年的随访调查,仍有52.6％维持SFP诊断,因此,SFP是否可作为一个独立的疾病单元,还有待于进一步研究,     

分裂样精神病2年后再诊断

目的 探讨分裂样精神病的转归及危险因素。方法 对138例入组病人分别于首次诊断、病程6个月及病程2年时进行3次随访调查。出院病人由精神科医师电话随访或根据其门诊记录进行测评,同时采用ICD-10诊断标准进行再诊断。结果 病程6个月时,138例分裂样精神病转归为精神分裂症者93例（67.4%）,转归为心境（情感）类障碍者11例（8.0%）,转归为分裂情感类障碍者3例（2.2%）,转归为器质性精神障碍者1例（0 7.%）;病程2年时,又有13例（14 0.%）精神分裂症转归为分裂情感类障碍,4例（2 9.%）分裂样精神病转归为心境（情感）类障碍。年龄〈45岁、性格内向、慢性起病、起病无诱因、缺乏活力评分较高、阴性症状量表评分较高的分裂样精神病以后可能会转归为精神分裂症;慢性起病、女性、焦虑抑郁评分较高、思维逻辑评分和阳性症状量表评分较低的分裂样精神病以后可能会转归为心境（情感）类障碍;慢性起病、阴性症状量表评分较高的分裂样精神病以后可能会转归为分裂情感类障碍。结论 首次诊断为分裂样精神病的病人在2年内会转归为多种疾病,过分依赖目前诊断标准可能造成误诊,追踪观察对确诊尤为关键。     

精神分裂症与分裂样精神病前躯症状对照分析

为探讨精神分裂症和分裂样精神病前躯症状诊断价值,对80例首次诊断为分裂样精神病,复发后改诊为精神分裂症病人(SC组)与60例维持诊断分裂样精神病的病人(SCF组)的前躯症状进行了比较分析。结果显示:前躯症状的发生率,尤其是不恰当行为、性格改变、讲话离题、躲避亲人或与人疏远、敏感、多疑、怪异想法、无端恐惧、强迫症状等发生率SC组显著高于SCF组。提示精神分裂症与分裂样精神病的前躯症状确有差异。     

老年糖尿病诊断190例分析

本文分析我院 1995～ 2 0 0 0年住院的 190例年龄大于 6 0岁老年糖尿病 (DM)诊断情况 ,特点如下。1　临床资料1.1　一般资料　本组男 10 5例 ,女 85例 ,年龄 6 0～ 84岁 ,病程1个月～ 2 5 a。 型 9例 (4 .7% ) ; 型 181例 (95 .3% )。均符合1985年 WHO糖尿病诊断标准。1.2　 DM诊断原因　因三多一少症状首诊 99例 (5 2 .1% ) ,因并发症首诊 38例 (2 0 .0 % ) ,入院前有糖尿病史 2 9例 (15 .3% ) ,查血糖发现 17例 (8.9% ) ,查尿常规发现 7例 (3.7% )。1.3　并发症 /伴发病　眼部病变 10 9例 (5 7.4% ) ,高血压病 5 5例 (2 8.9% ) ,泌尿…     

奥氮平与氯氮平联合心境稳定剂治疗躁狂症对照研究

目的　比较奥氮平与氯氮平治疗躁狂症的疗效与不良反应。方法　将符合CCMD 3双相情感性精神障碍躁狂相或躁狂发作诊断标准的 78例患者 ,随机分为研究组 (奥氮平联合心境稳定剂组 ) 38例和对照组 (氯氮平联合心境稳定剂组 ) 4 0例 ,分别进行 6w的治疗和观察 ,并于入组时和治疗第 1、2、4、6w末应用BRMS各评定 1次 ,以TESS评定不良反应 ,以Beck -Rafaelsen减分率评定临床疗效。结果　研究组与对照组治疗 6w末躁狂症状均有显著性改善 ,有效率分别为 94 .7%和 92 .5 % ,两组间比较无显著性差异 (P >0 .0 5 ) ,药物不良反应研究组显著少于对照组。结论　奥氮平是一种有效的抗躁狂药物 ,不良反应少且轻     

精神科门诊不同时点病例资料对比分析

目的探讨不同时点精神科门诊就诊结构及治疗状况。方法抽取2006年1月1日～2月10日在我院门诊就诊的480例精神病患者设为研究组,抽取2001年1月1日～2月10日在我院门诊就诊的404例精神病患者设为对照组。统计两组患者的一般资料、疾病诊断及药物治疗状况并进行对比分析。结果两组一般资料均无显著性差异（P〉0．05）;研究组情感性精神病、疑似精神分裂症诊断率显著高于对照组,而分裂样精神病诊断率显著低于对照组（P均〈0．01）;抗精神病药物奋乃静、舒必利选择率显著低于对照组,而阿立哌唑、喹硫平选择率显著高于对照组（P〈0．01）;抗抑郁剂曲唑酮、氟西汀选择率显著低于对照组,而舍曲林、帕罗西汀、西酞普兰选择率显著高于对照组（P〈0．05或0．01）;情绪稳定剂丙戊酸钠选择率显著高于对照组（P〈0．01）;苯二氮革类药物氯硝西泮选择率显著低于对照组（P〈0．01）。结论精神科门诊就诊者情感性精神病及疑似精神分裂症诊断率显著增加,而分裂样精神病诊断率显著下降;新型抗精神病药物及新型抗抑郁剂使用率有明显增加趋势;苯二氮革类药物使用率有显著下降趋势。首诊病程尚无变化,人们对精神疾病的认识依然不足,有关职能部门应进一步加大宣传力度,提高人们对精神疾病的认识能力,以利于早发现、早就医。     

抗环瓜氨酸肽抗体及相关自身抗体在类风湿性关节炎诊断中的应用评价

目的　评价抗环瓜氨酸肽 (CCP)抗体及其相关自身抗体对诊断类风湿性关节炎 (RA)的敏感性和特异性以及在临床上的意义。方法　收集 112例血清标本 ,包括RA 6 4例 ,系统性红斑狼疮 (SLE) 2 0例 ,骨关节炎 (OA) 16例 ,强直性脊柱炎 (AS) 12例 ,正常对照 30例 ,检测抗CCP、抗Sa、抗核周因子 (APF)和类风湿因子 (RF)。结果　 4种自身抗体对诊断RA的敏感性和特异性分别为 :抗CCP 5 1 6 %和 97 9% ;抗Sa 4 6 9%和 10 0 % ;APF 4 8 4 %和 97 9% ;RF 5 6 3%和 83 3% ;敏感性无显著性差异 (P >0 0 5 ) ,抗CCP、抗Sa和APF诊断RA特异性无显著性差异 (P >0 0 5 ) ,但三者均高于RF(P <0 0 1)。RF阳性率在RA患者抗CCP阳性组和阴性组有显著性差异 (P <0 0 1)。而抗Sa和APF则无显著性差异 (P >0 0 5 )。结论　抗CCP是RA的又一个特异性抗体 ,联合检测抗CCP及RF对于RA的诊断与早期诊断具有一定的临床价值。     

万拉法新与多虑平治疗焦虑症对照研究

目的　比较万拉法新与多虑平治疗焦虑症的疗效与副反应。方法　将 6 8例符合CCMD - 3诊断标准的焦虑症患者 ,随机分为万拉法新治疗 (A)组 34例 ,多虑平治疗 (B)组 34例 ,共治疗 6w。于治疗前及治疗第 2、4、6w末 ,采用HAMA、SAS和TESS评价临床疗效与副反应。结果　万拉法新组治疗 1w后HAMA、SAS评分与治疗前比较有非常显著性差异 (P <0 .0 1;多虑平组治疗 2w后HAMA、SAS评分与治疗前比较有非常显著性差异 (P <0 .0 1;两组间比较除第 1w末有显著性差异 (P <0 .0 5外 ,2、4、6w末差异无显著性 (P >0 .0 5 ) ;万拉法新组副反应明显少于多虑平组 ,两组比较差异有显著性 (P <0 .0 1)。结论　万拉法新治疗焦虑症安全、有效     

Drugs with anticholinergic properties as a risk factor for psychosis in patients affected by Alzheimer's disease

Emerging evidence suggests that psychosis in persons with Alzheimer's disease (AD) may be linked to the cholinergic deficit associated with the disease. This study sought to evaluate whether anticholinergic (ACH) drugs could be a risk factor for psychosis onset. A total of 230 patients affected with probable AD were recruited. Data on behavioral and psychological symptoms were collected using the Neuropsychiatric Inventory, and diagnosis of psychosis was performed. Patients were divided into those who used ACH drugs and those who used non-ACH drugs. Those using ACH drugs (18.3%) were more likely to have psychosis than those using non-ACH drugs (odds ratio (OR)=2.52; 95% confidence interval (CI), 1.27-5.00); this association remained significant even after adjusting for potential confounding variables (OR=2.13; 95% CI, 1.03-4.43). Our data suggest that patients with AD are frequently treated with ACH drugs and that ACH drug intake should be regarded as a potential risk factor for psychosis.     

南海区精神病病人社区防治状况及社区护理干预模式研究

目的了解南海区精神病病人社区防治状况，为探讨更完善的社区护理干预模式提供依据。方法对佛山市南海区17个镇精神病病人分布情况、到精神病防治康复站定期取药情况和政府费用支付比例进行调查。结果南海区17个镇均建立了精神病防治康复站，共有精神病病人6165人，患病率6．05‰。定期到精神病防治康复站取药坚持治疗的病人仅1114人占18.07％，药费由政府资助比例30％-100％小等，其中支付90％以卜的镇有8个。结论政府对精神病社区防治资金投入大，精神病专科医院协作的精神病防治网分布较为全面，为全面建成社区病人、家属及普通人群的精神卫生服务体系提供有利条件。可建立全面的社区护理干预模式：利用各镇的精神病防治康复站和每月的精神病防治日开展对精神病病人、家属和社区人群的教育，纠正其偏见和错误认知，为病人康复创造良好社会环境；加强宣传提高病人服药依从性，对不依从病人进行人户随访和电话随访；由精神病专科陕院派专业人员到各镇指导、协助诊治和规范化管理精神病病人。     

A post hoc analysis of the impact on hostility and agitation of quetiapine and haloperidol among patients with schizophrenia

BACKGROUND: Quetiapine, a drug with a broad pharmacologic profile (similar to that of clozapine), may show benefits for agitation in patients with psychoses. Also, quetiapine may be superior to placebo and either equal or superior to haloperidol in treating this symptom. Available data for other second-generation antipsychotic agents show that quetiapine may have better efficacy in improving agitation compared with haloperidol. OBJECTIVE: This reanalysis of a previously reported pivotal clinical trial assessed whether quetiapine or haloperidol has benefits for the treatment of hostility and agitation among patients experiencing an acute exacerbation of schizophrenia. METHODS: Patients aged 18 to 65 years of either sex and any ethnicity who had a diagnosis of schizophrenia based on the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria and who were experiencing an acute exacerbation were recruited into the study. A priori, data from patients assigned to 4 therapeutically effective quetiapine treatment groups (150, 300, 600, and 750 mg) in a previously reported 6-week, double-blind, placebo-controlled clinical trial were combined and compared with data from patients given haloperidol 12 mg or placebo on an agitation measure derived from the Brief Psychiatric Rating Scale (BPRS). Patients who received at least 2 weeks of treatment who had a baseline assessment and at least 1 postbaseline assessment after the 2 weeks of treatment were included. An analysis of variance with the baseline hostility score and center as covariates was used to assess treatment effects of quetiapine or haloperidol versus placebo for changes in agitation scores. A path analysis was used to separate the direct from the indirect effects (via improvements in psychoses and/or overall psychopathology) on agitation scores of quetiapine relative to haloperidol. RESULTS: A total of 257 patients (193 men, 64 women) were studied. The combined quetiapine groups comprised 175 patients; the haloperidol group, 42 patients; and the placebo group, 40 patients. Quetiapine treatment reduced agitation scores significantly among patients with acute psychoses compared with placebo. A slight reduction in agitation scores was found when haloperidol treatment was compared with placebo, but this difference was not statistically significant. Compared with haloperidol, quetiapine treatment had a direct and significant effect on agitation that was independent of the improvement in psychotic symptoms. CONCLUSIONS: The data in this study suggest that quetiapine treatment has benefits for hostility and agitation among patients experiencing an acute exacerbation of schizophrenia. Furthermore, the path analysis indicated that, relative to haloperidol, quetiapine appeared to have direct effects on agitation that were independent of improvements in psychoses or overall psychopathology, as assessed by the BPRS.     

影响抑郁症患者精神专科门诊治疗的相关因素研究

目的探讨影响抑郁症患者在精神专科门诊治疗的相关因素,为提高治疗依从性提供科学依据。方法采用简明精神病量表（BPRS）和自制问卷调查79例精神专科医院门诊就诊的抑郁症患者,分析影响在专科治疗的因素,进行健康指导,采取预约复诊或电话回访随访1年。结果63．29％的抑郁症患者首诊选择非精神科诊治;53．16％的患者未到精神科就诊的原因是不知道患抑郁症;首诊于精神专科的患者诊断、首次连续治疗时间、用药、疗效均明显优于首诊于非精神科患者（P〈0．01）;系统健康教育后治疗依从性提高,差异有统计学意义（P〈0．01）。结论对医护人员、患者及家属开展积极有效的精神卫生知识宣传与普及是提高早期诊断、早期治疗、提高疗效、防止复发的关键。     

Acute psychosis. Functional versus organic

Acute psychosis is a true emergency and is a manifestation of multiple organic and functional disorders. The emergency medicine physician's role in dealing with the acutely psychotic patient is to control the patient's behavior, to delineate the etiology of the psychosis, and to provide appropriate initial treatment and disposition. When making initial contact with the psychotic patient, behavioral control can be accomplished through supportive, physical, or pharmacologic interventions. Judicious use of rapid tranquilization permits rapid control of these patients when supportive and other nonpharmacologic therapies fail. Initial examination is directed at identifying immediate life-threatening organic disorders and promptly treating them. Historical data, mental status examination, physical examination, and appropriate radiologic and laboratory investigations give information that assist in delineating functional from organic psychosis. Most acute organic psychoses, with the exception of some drug intoxications that clear in the Emergency Department, require medical or surgical admission. Acute functional psychotic patients who are a danger to themselves or others, who are without a reliable social support system, or who present with their first psychotic episode require admission to the psychiatric service for further evaluation and treatment.     

Motor proficiency in children with psychosis

Twenty-one children, aged 8 to 11 years, whose disorders were diagnosed as childhood psychosis, were tested by using the Bruininks-Oseretsky Test of Motor Proficiency. In addition, two reflex tests, one righting reaction, and a test for muscle tone were administered. The children showed large variations in all motor skill scores, which ranged from average to far below average. Total test battery scores indicated all children but one scored at or below the first percentile of the standardized sample. Delayed reflex integration and delayed mature righting reactions were observed and in some cases were associated with low motor test scores. Hypotonicity was observed in 12 of the 21 children. Results indicate that for children with psychoses, early intervention is important and carefully planned motor and reflex integration programs should be applied.     

The physical health of young people experiencing first‐episode psychosis: Mental health consumers’ experiences

Young people experiencing first‐episode psychosis taking antipsychotic medications often develop comorbidities such as obesity and cardiometabolic abnormalities at an earlier age than young people in the general population. Therefore, it is important to explore the healthcare needs and experiences of this group of consumers. This paper reports research conducted to obtain an informed understanding of young people's health literacy, physical healthcare needs, and interest and knowledge about their physical health. Grounded theory methodology was used to guide the research. Semistructured interviews were conducted with 24 young consumers aged between 18 and 35 years who were case managed by one metropolitan community mental health service. The results describe the journey of young people from the time of diagnosis, to when they developed an awareness of the need to improve their physical health and the impact of physical health issues on their overall health and well‐being. Six categories emerged from the data: (i) initial responses when diagnosed with first‐episode psychosis; (ii) focus of care on treating first‐episode psychosis; (iii) lack of education on antipsychotic medications; (iv) adverse effects from taking antipsychotic medication; (v) increased awareness of the need for good physical health; and 6) importance of social support in the community. The findings highlight the importance for health professionals improving young people's health literacy and addressing physical health and well‐being as part of first‐episode psychosis programmes. Young people require improved health education on the importance of maintaining healthy lifestyle in relation to their overall health and well‐being.