利培酮联合丁螺环酮对精神分裂症阴性症状的疗效

目的探讨利培酮联合丁螺环酮治疗精神分裂症阴性症状的效果及安全性。方法选择符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)精神分裂症诊断标准,以阴性症状为主的精神分裂症女性患者60例,采用"不平衡指数最小分配原则"分为利培酮联合丁螺环酮组(研究组)和单用利培酮组(对照组)各30例,疗程12周。于治疗前和治疗后第4、8、12周末采用阳性与阴性症状量表(PANSS)评定疗效,副反应量表(TESS)评定不良反应。结果研究组和对照组有效率分别为93.30%和73.3%,差异有统计学意义(χ2=6.991,P0.05)。从4周起,研究组PANSS总评分、阴性症状评分及一般精神病理症状评分均低于对照组(P均0.01)。对照组4例月经失调,研究组无1例发生。结论利培酮联合丁螺环酮可能更有利于改善以阴性症状为主的女性精神分裂症患者的阴性症状,同时可减少或消除单用利培酮所致的性功能障碍。     

帕罗西汀合并丁螺环酮治疗抑郁症的对照研究

目的观察帕罗西汀合并丁螺环酮治疗抑郁症的临床疗效及可行性。方法对符合中国精神障碍分类与诊断标准第3版(CCMD-3)抑郁症诊断标准的80例患者随机分为帕罗西汀合并丁螺环酮组和单用帕罗西汀组,每组各40例。采用汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)、副反应量表(TESS)于治疗前及治疗后1、2、4周末分别评定临床疗效及副作用。结果研究组HAMD减分率于2、4周末均明显高于对照组(P<0.05),研究组HAMA减分率自第1周末起即明显高于对照组。两组副反应评分无显著差异,均无严重副反应。结论帕罗西汀合并丁螺环酮治疗抑郁症疗效确切,起效快,副作用较轻,特别适于伴有明显焦虑的抑郁症患者。     

非典型抗精神病药合并丁螺环酮治疗精神分裂症患者的对照研究

目的:探讨非典型抗精神病药(AAPDs)合并丁螺环酮对精神分裂症患者的治疗作用。方法:将85例精神分裂症患者分为研究组(43例)和对照组(42例),两组在单一AAPD常规治疗基础上,研究组及对照组分别加用丁螺环酮及安慰剂,疗程12周。治疗前及治疗4、8、12周后分别给予阳性及阴性症状量表(PANSS)、韦氏成人智力量表(WAIS-R)、韦氏记忆量表(WMS)评分;治疗4、8、12周后给予治疗中出现的症状量表(TESS)评定;以PANSS减分率评价疗效。结果:治疗第8周起两组PANSS总分均较治疗前明显降低(P0.05或P0.01);12周末研究组PANSS总分显著低于对照组(P0.01);总有效率(88.4%)显著高于对照组(71.4%)(P0.05);治疗8周后两组WAIS-R总分、言语量表分、操作量表分及WMS分较治疗前明显增高,研究组改善更明显(P均O.05)。结论:AAPDs合并丁螺环酮较单一AAPDs治疗精神分裂症可获得更好的疗效和认知功能改善,且无增加不良反应。     

米氮平合并丁螺环酮治疗老年抑郁症对照研究

目的探讨米氮平合并丁螺环酮治疗老年抑郁症的疗效及不良反应。方法将70例老年抑郁症患者随机分为米氮平合并丁螺环酮组（研究组）与单用米氮平（对照组）,两组使用米氮平的方法及剂量相同,研究组合并丁螺环酮,疗程6周。于治疗前及治疗后第1、2、4、6周末采用HAMD、TESS评定临床疗效及不良反应。结果治疗6周末,研究组显效率为83%,对照组为63%,研究组显著高于对照组（χ2=12.3,P〈0.01）;两组HAMD减分率随治疗时间延长而逐渐增加,研究组治疗1周末减分率与对照组比较,差异有显著性（P〈0.05）,2周末比较差异有极显著性（P〈0.01）。两组间不良反应差异无显著性（P〉0.05）。结论米氮平合并丁螺环酮治疗老年抑郁症优于单用米氮平,且起效快,更适合老年抑郁症患者。     

丁螺环酮合并氟西汀治疗抑郁症的对照研究

目的探讨丁螺环酮合并氟西汀对抑郁症的疗效以及不良反应。方法将58例抑郁症患者随机分为研究组和对照组，各29例，分别给予氟西汀合并丁螺环酮和氟西汀合并安慰剂，治疗观察时间为8周，采用汉密尔顿抑郁量表（HAMD）和副反应量表（TESS）评定疗效和副反应。结果治疗后两组HAMD评分均有显著降低（均P〈0．05），两组比较HAMD评分差异有统计学意义（P〈0．05），副反应评分差异无统计学意义（P〉0．05）。结论丁螺环酮合并氟西汀治疗抑郁症可增强总体疗效，且不增加副反应。     

利培酮合并氯硝西泮治疗急性期精神分裂症的对照研究

目的 评估利培酮合并氯硝西泮治疗急性期精神分裂症的疗效和不良反应.方法 将符合精神分裂症CCMD-3诊断标准的64例精神分裂症患者随机分为两组,分别以利培酮合并氯硝西泮治疗或氟哌啶醇单独治疗,疗程28 d.以阳性与阴性症状量表（PANSS）评估疗效,以副反应量表（TESS）评估不良反应.结果 利培酮合并氯硝西泮组治疗急性期精神分裂症与氟哌啶醇组相比总体疗效相当,利培酮合并氯硝西泮组PANSS兴奋激越因子减分在第1周末（P＜0.05）优于氟哌啶醇组.利培酮合并氯硝西泮组不良反应小.结论 利培酮合并氯硝西泮治疗急性期精神分裂症疗效肯定,起效较快,不良反应小.     

氟西汀合并丁螺环酮治疗抑郁症的对照研究

目的　探讨氟西汀合并丁螺环酮治疗抑郁症的有效性及可行性。方法　采用随机对照研究方法 ,入组病例符合CCMD 2 R抑郁症的诊断标准 ,氟西汀合并丁螺环酮 30例为研究组 ,单用氟西汀 30例为对照组 ,用HAMD、HAMA、TESS量表评价疗效及副反应。结果　研究组HAMD减分率自第 2周末开始明显高于对照组 (P <0 .0 5 ) ,HAMA减分率自第 1周末即显著高于对照组 (P <0 .0 1) ,显效率 80 % ,有效率93 3%均高于对照组 ,副反应评分 ,研究组则高于对照组 ,尤其是第 1周明显 ,但无严重副反应 ,不影响治疗。结论　氟西汀合并丁螺环酮治疗抑郁症效果好 ,起效快 ,是可行的治疗方法 ,副作用不影响治疗     

氨磺必利与利培酮治疗青少年精神分裂症的对照研究

目的 探讨氨磺必利治疗青少年精神分裂症的疗效和安全性.方法 68例青少年精神分裂症患者随机分为氨磺必利治疗组（研究组）和利培酮治疗组（对照组）,于治疗前和治疗后第8周末,采用阳性和阴性综合征量表（PANSS）、卡尔加里精神分裂症抑郁量表（CDSS）评定临床疗效,治疗中需处理的不良反应症状量表（TESS）评定药物的不良反应.结果 治疗8周后两组有效率分别为87.5％和78.8％,差异无统计学意义（x^2=0.858,P＞0.05）;研究组PANSS阴性症状量表减分和CDSS量表减分明显高于对照组（P＜0.05）;研究组在静坐不能、心血管不良反应、体质量增加、血清泌乳素升高方面不良反应的发生率明显低于对照组（P＜0.05）.结论 氨磺必利与利培酮治疗青少年精神分裂症总体疗效相当,但在改善阴性症状及抑郁症状方面优于利培酮.     

国产奎的平治疗难治性精神分裂症症临床分析

目的：评价奎的平对难治性精神分裂症的疗效与副反应。方法：对住院的难治性精神分裂症60例换用奎的平治疗24周。用阳性和阴性症状量表（PANSS）评定疗效,用副反应量表（TESS）及锥体外系副反应量表（ESRS）评定副反应。结果：PANSS总分、PANSS－G（一般精神病理）分、PANSS－P（阳性症状）分、PANSS－N（阴性症状）分治疗前后有显著意义,PANSS总分及各分量表分均自12周末起有显著下降,说明自12周末形始显效。PANSS总分减分率≥20％者36例,≥50％者10例,有效率为60％,显效率为16．67％,最常见的副反应是体重增加（18／60）,结论：奎的平对难治性精神分裂症有肯定的疗效,副反应轻微。     

丁螺环酮合并西酞普兰治疗伴躯体症状抑郁症的疗效观察

目的 探讨丁螺环酮合并西酞普兰治疗伴躯体症状抑郁症的疗效和安全性.方法 对60例伴躯体症状抑郁症患者随机分为研究组与对照组,研究组采用丁螺环酮合并西酞普兰治疗,对照组用西酞普兰治疗,治疗8周,两组分别在治疗2、4、6、8周采用汉密尔顿抑郁量表(HAMD)、临床疗效总评量表(CGI)评定疗效,以副反应症状量表(TESS)评定不良反应.结果 与对照组相比,研究组HAMD评分减分率显著增大,CGI评分显著降低,两组TESS评分相当.结论 丁螺环酮合并西酞普兰治疗伴躯体症状的抑郁症疗效较单用西酞普兰好,安全性较好.     

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.