116例癫痫性精神障碍临床分析

癫痫是一种常见病,欧美国家调查资料其患病率为4％,我国六城市流行病学调查癫痫患病率为4.6％。为探讨癫痫性精神障碍的临床表现,我们对116例癫痫性精神障碍的临床资料进行分析。     

66例癫痫性精神障碍的临床分析

目的:探讨癫痫性精神障碍的临床表现及治疗。方法:对66例癫痫性精神障碍患者临床资料进行回顾性研究。结果:癫痫性精神障碍症状以类精神分裂症为主,经卡马西平合并氟哌啶醇治疗痊愈59.10%,显著24.24%,好转13.63%,无效3.03%。结论:癫痫性精神障碍时癫痫发作减少,规范治疗癫痫性精神障碍效果显著。     

癫痫性精神障碍90例临床分析

目的：探讨癫痫性精神病的临床表现及其预后,方法：回顾性调查1995年以来的住院病人资料,所有病人符合CCMD－2－R癫痫 精神障碍诊断标准,共90例,结果：癫痫性精神障碍的表现形式,多种多样,以类精神分裂样表现,人格改变为主,结论：长期有效的抗痫治疗,有助于癫痫性精神障碍的预防。     

癫痫性精神障碍52例临床分析

癫痫性精神障碍是指一组复发性脑异常放电所致的精神障碍。在临床上可分为二类;一类为发作性的精神异常,另一类为慢性精神分裂症样障碍、人格改变及智能障碍等。本文收集了我院1988～1997年间收治住院的癫病性精神障碍患者,按CCMD—2—R诊断标准进行再诊断,符合该诊断标准者52例,现就其临床资料报道如下。1临床资料1．1一般资料52例中,男30例（57．7％）,女22例（42．3％）;年龄16－60岁。有精神病家族史4例（7．7％）,有癫痛家族史5例（9．6％）。1．2癫病发作癫痛始发年龄,最大44岁,最小2岁,平均（1．25±11．92）岁。首次…     

128例癫痫性精神障碍预后分析

本文对１２８例癫痫性精神障碍的临床疗效、预后进行了回顾性分析，结果显示，起病年龄小、发病频数多、精神症状持续时间长者预后差。癫痫发作造成器质性精神症状者预后更差。     

癫痫性精神障碍的临床诊治

我们往往可以见到，有些精神科医生在遇到既有癫痫又有精神导演的患者时，立即作出癫痫性精神障碍的诊断。这些精神异常的表现与癫痫究竟有没有关系?是癫痫引起了精神异常呢，还是精神病患者伴发了癫痫?似乎没有什么书籍或文献可供临床参考。为此，作者查阅了近年的有关资料，结合自己多年的临床实践，作此文以供读者参阅。     

16例癫痫所致精神障碍临床分析

对癫痫所致精神障碍患者临床资料进行分析，现将结果报告如下。 1对象和方法 为我院癫痫所致精神障碍住院患者。共16例，男12例，女4例；精神障碍始发年龄17-50岁，平均27．8岁。首次癫痫发作至发生精神障碍时间0．5-0．7年，有11例精神障碍出现在癫痫大发作显著减少或消失后，5例精神障碍与大发作先后或交替出现。9例病因不明，2例有脑外伤史，3例有脑炎史，1例作过颅脑减压术（诊断不明）。2例有阳性家族史。16例均无明显神经系统体征。3例脑电图为弥漫性异常，阵发性加重，伴棘波、尖波综合发放；1例颞区偏胜。     

癫痫伴发精神障碍71例临床分析

癫痫伴发精神障碍７１例临床分析福建医学院附属第二医院（３６２０００）杨东华福建省泉州市第三人民医院胡永寿，翁信会为探讨癫痫伴发精神障碍的临床表现，现将收集７１例患者进行临床分析，其结果报导如下。１对象与方法本文对１９８９年以来就诊的癫痫患者４５９例的...     

癫癎性精神分裂症样精神病的临床资料分析

目的探讨癫疴性精神分裂症样精神病的临床特征和预后。方法69例瘢疴性精神分裂症样精神病患者的。临床资料进行回顾性分析。结果癫疴性精神分裂症样精神病患者86．96％为缓慢起病,精神病性症状出现于癫疴发作11.9年之后,88．4％的患者在癫疴发作控制和发作减少之后出现精神病性症状,76．8％患者的异常脑电图恢复正常或得到改善。临床精神症状以思维障碍和幻听为主。33％的患者有智能低下。结论良性病程,不呈精神分裂症性衰退,愈后无精神分裂症的残留症状。     

Transient psychosis in a girl with epilepsy and continuous spikes and waves during slow sleep (CSWS)

A normally developed and healthy 6-year-old girl suffered the onset of epilepsy with generalized tonic-clonic seizures and atypical absences. Initially the EEG showed epileptiform activity over the temporal and parietal regions, later there were episodes of bilateral synchronous spike-wave activity with a frequency of 1.5–2.5 Hz. After a few months, deterioration of cognitive and behavioural functions appeared and gradually increased with the development of a fullblown disintegrative psychosis that went on for several months. Sleep EEG recordings showed the characteristic abnormality described as continuous spikes and waves during slow sleep. Later there was a remarkable improvement of neuropsy chiatric functions but a second outbreak of psychosis seems to have left the girl, who is now 9 years of age, with severe mental impairment.     

合用精神药物对无抽搐电休克治疗指标的影响

目的探讨合用精神药物对无抽搐电休克治疗指标的影响,为无抽搐电休克并药物治疗提供参考依据。方法收集无抽搐电休克治疗患者第一次电休克治疗发作的主要指标(抽搐时间,简称T;抽搐指数,简称SEI;抑制指数,简称PSI)和治疗前一天所用的主要精神药物种类及剂量;然后根据合用药物情况进行T、SEI、PSI值的比较,计算T、SEI、PSI值与药物剂量之间的相关系数。结果苯二氮卓艹类药物对T、SEI值有明显影响,且药物剂量与T、SEI值呈负性相关;锂盐对T、SEI值无明显影响;氯丙嗪组的T、SEI值明显大于氯氮平组;合用精神药物对提示本次治疗成败PSI值均无明显影响。结论在常规剂量条件下,各类精57神药物对无抽搐电休克发作效果无重大影响,治疗前可以不必考虑停药或减药;苯二氮卓艹类药物对治疗电量的控制有一定关系,对使用较大剂量苯二氮卓艹类药物的患者,可以考虑使用较大的电量。     

Long-term outcome of clozapine use for psychosis in parkinsonian patients.

A retrospective analysis was carried out on 39 parkinsonian patients on clozapine treatment >/=24 months for psychosis. The cohort had a mean age of 76 years and an average clozapine dose of 47 mg/day over 60 months of clozapine use. Of 39 patients, 13 (33%) patients were eventually admitted to nursing homes, 6 (46%) of whom died over a period of 5 years. The overall 5-year mortality rate in this cohort was 44% (17/39). Of 39 patients, 33 (85%) had continued partial/good response and 5 (13%) had complete resolution of psychosis. None discontinued clozapine due to motor worsening. Among patients who responded early on, the long-term efficacy of clozapine for psychosis was sustained. The risk of nursing home placement and mortality among parkinsonian patients treated with clozapine for psychosis in this geriatric cohort was better than that reported previously. Our data are more consistent with recently published long-term outcome data suggesting an improvement in the prognosis of parkinsonian patients with psychosis with the use of atypical antipsychotic agents such as clozapine.     

神经外科患者癫痫反复发作处理分析

目的 探讨神经外科患者出现癫痫反复发作的临床特点、处理原则与方法.方法 回顾性分析沈阳军区总医院神经外科自2011年1月至6月收治的9例癫痫反复发作患者的临床资料,分析其加重的原因、发作特点及治疗方法和结果.结果 9例患者中3例合并胶质瘤、1例蛛网膜囊肿、1例海绵状血管瘤、1例脑软化灶;7例有癫痫病史,2例既往无癫痫病史;7例为额叶癫痫,2例颞叶癫痫.癫痫发作加重的原因:减药3例,新诊断的脑肿瘤2例,手术(颅内电极置入术)1例,原因不明3例.癫痫发作类型包括部分性发作与全面性发作,发作频率从间隔3min至间隔数小时发作一次.患者经给予多种抗癫痫药物联合用药治疗,包括口服与注射给药,癫痫得到控制,其中添加左乙拉西坦口服有较好的疗效.结论 神经外科患者出现癫痫反复发作多呈药物难治性,发作不易控制,其处理应使用对部分性癫痫发作有较好疗效的多种抗癫痫药物联合用药,剂量应高于常规初始剂量,包括静脉注射及肌注给药,以尽快控制癫痫发作.左乙拉西坦因口服吸收快、起效迅速及有较好的抗癫痫作用,对癫痫反复发作有较好的疗效.     

Predictors of psychosis remission in psychotic disorders that co-occur with substance use

OBJECTIVE: To examine rates and predictors of psychosis remission at 1-year follow-up for emergency admissions diagnosed with primary psychotic disorders and substance-induced psychoses. METHOD: A total of 319 patients with comorbid psychosis and substance use, representing 83% of the original referred sample, were rediagnosed at 1 year postintake employing a research diagnostic assessment. Remission of psychosis was defined as the absence of positive and negative symptoms for at least 6 months. Likelihood ratio chi-square tests and multivariate logistic regression were the main means of analysis. RESULTS: Of those with a baseline diagnosis of primary psychotic disorder, 50% were in remission at 1 year postintake, while of those with a baseline diagnosis of substance-induced psychosis, 77% were in remission at this time point. Lower Positive and Negative Syndrome Scale (PANSS) symptom levels at baseline, better premorbid functioning, greater insight into psychosis, and a shorter duration of untreated psychosis predicted remission at 1 year in both diagnostic groups. No interaction effects of baseline predictors and diagnosis type were observed. A stepwise multivariate logistic regression holding baseline diagnosis constant revealed the duration of untreated psychosis (odds ratio [OR] = 0.97; 95% confidence interval [CI] = 0.95, 0.997), total PANSS score (OR = 0.98; 95% CI = 0.97, 0.987), Premorbid Adjustment Scale score (OR = 0.13; 95% CI = 0.02, 0.88), and Scale to Assess Unawareness of Mental Disorders unawareness score (OR = 0.84; 95% CI = 0.71, 0.993) as key predictors of psychosis remission. CONCLUSIONS: The association of better premorbid adjustment, a shorter duration of untreated psychosis, better insight into psychotic symptoms, and lower severity of psychotic symptoms with improved clinical outcome, reported previously in studies of schizophrenia, generalizes to psychosis remission in psychotic disorders that are substance induced.     

Vulnerability to psychosis associated with hallucinogen use

Ninety-five patients hospitalized for acute psychosis were reviewed with respect to hallucinogen use and family history of mental illness. Sixty-three percent of admissions had used hallucinogens to some degree within 3 years of the index admission. Drug users were predominantly male, although no age or diagnostic differences with the nondrug group were found. The incidence of hospitalized first degree relatives was approximately 30% and equal for both drug and nondrug groups. Male drug users and female nondrug users were more likely to have had first degree relatives hospitalized. For male psychotics only, lower degrees of drug use were associated with a greater number of hospitalized first degree relatives. For female psychotics only, drug use was positively associated with full scale IQ. The findings suggest sex differences in vulnerability to psychoses associated with hallucinogen use.     

Psychotropic drug prescription in Nigeria

A study of prescribing practice in three psychiatric institutions in Nigeria revealed high frequency of polypharmacy liberal routine use of antiparkinsonian agents and daily multiple administration of drugs. In the treatment of depression and schizophrenia older and better known oral neuroleptics were preferred to newer ones, but there was apparent tendency for depressives to be under-treated and long-acting depot preparations were seldom administered to schizophrenics. Several aspects of drug use were similar to those observed elsewhere, particularly in the Anglo-American practice - an observation presumed explicable in terms of common psychiatry training background. The need for clinicians to comply with acceptable pharmacokinetic principles of drug treatment is stressed.