度洛西汀合并认知治疗对更年期女性抑郁症患者的疗效比较

目的评价度洛西汀合并认知治疗对更年期女性抑郁症患者的疗效和安全性。方法采用数字随机法将符合ICD-10诊断标准的60例更年期抑郁症患者分为研究组和对照组,各30例。研究组给予度洛西汀合并认知治疗,对照组单用度洛西汀治疗,疗程8周。采用汉密尔顿抑郁量表(HAMD),汉密尔顿焦虑量表(HAMA)评定疗效,副反应量表(TESS)评定不良反应。结果两组治疗8周后HAMD、HAMA评分与治疗前比较差异均有统计学意义(P<0.01),研究组在1、2、4、8周末HAMD、HAMA评分与对照组比较差异有统计学意义(P<0.05或0.01),减分率均高于对照组(P<0.05)。结论度洛西汀合并认知治疗对更年期女性抑郁症患者疗效优于单用度洛西汀。     

奥氮平对伴有焦虑的抑郁症的治疗作用

目的:观察西酞普兰合并小剂量奥氮平治疗伴有焦虑的抑郁症患者的临床疗效和安全性。方法:将68例伴有焦虑的抑郁症患者随机分为两组,研究组给予西酞普兰合并奥氮平治疗,对照组给予西酞普兰治疗,疗程均为8周。采用汉密尔顿抑郁量表(HAMD)及汉密尔顿焦虑量表(HAMA)评定临床疗效,治疗中出现的症状量表(TESS)评定不良反应。结果:治疗8周末两组HAMD及HAMA评分均显著性下降(P均<0.01)。研究组起效较快,显效率高于对照组(P<0.05),两组不良反应均较轻微。结论:西酞普兰合并奥氮平对伴有焦虑的抑郁症起效快,疗效肯定,安全性高,依从性好。     

度洛西汀联合小剂量奥氮平治疗抑郁症的临床疗效和不良反应观察

目的探讨度洛西汀联合小剂量奥氮平治疗抑郁症患者的临床疗效,观察其不良反应的发生情况。方法随机将89例抑郁症患者随机分为实验组(度洛西汀与小剂量奥氮平联合用药)及对照组(度洛西汀单药),实验组45例,对照组44例,治疗8周,应用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)对治疗前及治疗后两组患者抑郁情况进行评分,比较两组评分差异,同时观察两组患者不良反应的发生。结果对照组治疗有效率为77.3%,实验组治疗有效率88.9%,差异有统计学意义(P0.05)。从治疗的第1周开始,两组HAMA及HAMD评分不断减低,较治疗前显著下降(P0.05);两组间比较,实验组HAMA及HAMD治疗后评分下降程度显著高于对照组(P0.05)。治疗期间两组患者药物不良反应情况相比,差异无显著性(P0.05)。结论度洛西汀联合小剂量奥氮平治疗抑郁症较单药治疗效果显著,且安全可靠。     

重复超低频经颅磁刺激对首发抑郁症患者的早期疗效及认知功能影响的初步分析

目的探讨度洛西汀联合逍遥丸治疗首发抑郁症的疗效及安全性。方法将120例首发抑郁症患者随机分为研究组60例,对照组60例,分别给予度洛西汀联合逍遥丸与单用度洛西汀治疗,治疗8周。在治疗前与治疗后的第2、4、8周分别采用汉密尔顿抑郁量表(HAMD17)、汉密尔顿焦虑量表(HAMA)、临床疗效总评量表(CGI)进行疗效评定;用治疗时出现的症状量表(TESS)评定不良反应。结果研究组和对照组有效率分别为85%和70%,两组比较差异有统计学意义(χ2=3.871,P<0.05);两组治疗后的第2、4、8周HAMD17和HAMA评分及CGI评分比较,差异均具有统计学意义(P<0.01),研究组在治疗4、8周末HAMD17和HAMA评分下降较对照组显著,两组间比较差异有统计学意义(P<0.05和P<0.01);不良反应方面,研究组发生厌食和失眠的不良反应明显少于对照组,两组间比较差异均有统计学意义(P<0.05)。结论度洛西汀联合逍遥丸治疗抑郁症的疗效比单用度洛西汀更显著,能提高临床有效率,且不良反应少,安全性高。     

度洛西汀与西酞普兰治疗伴疼痛症状抑郁症的对照研究

目的比较度洛西汀与西酞普兰治疗伴疼痛症状的抑郁症的疗效及安全性。方法60例伴疼痛症状的抑郁症患者随机分为度洛西汀组(n=30)和西酞普兰组(n=30),治疗8周。用汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)和副反应量表(TESS)评定疗效及不良反应。结果治疗后两组HAMD评分及HAMA评分均较治疗前显著下降(P均<0.01),度洛西汀组HAMD总分及全身症状分较西酞普兰组下降显著(P<0.05或P<0.01),且度洛西汀组起效较快;两组不良反应差异无统计学意义(P>0.05)。结论度洛西汀与西酞普兰治疗伴疼痛症状的抑郁症均有效,但以度洛西汀起效快,疗效更好。     

度洛西汀合并认知行为治疗对躯体形式障碍患者的疗效分析

目的 评价度洛西汀合并认知行为治疗对躯体形式障碍患者的治疗效果.方法 将符合CCMD-3诊断标准的60例躯体形式障碍患者随机分为研究组和对照组,研究组给予度洛西汀合并认知行为治疗,对照组只给予度洛西汀治疗.疗程8周.应用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、SCL-90躯体化量表定期评定疗效,治疗中需处理的不良反应症状量表(TESS)评定安全性.结果 治疗8周后,研究组显效率90％,对照组显效率63％,研究组显效率高于对照组(x2=23.89,P＜0.01).治疗第4、6、8周末,研究组SCL-90躯体化因子分、HAMD评分、HAMA评分与对照组比较有显著性差异(P＜0.01).不良反应较轻,两组间比较无显著性差异(P＞0.05).结论 度洛西汀合并认知行为治疗对躯体形式障碍患者的疗效优于单独用度洛西汀治疗.     

氟伏沙明合并逍遥丸治疗抑郁症的临床观察

目的探讨氟伏沙明合并逍遥丸治疗抑郁症的疗效及安全性。方法将126例抑郁症患者随机分为研究组63例,对照组63例,分别给予氟伏沙明合并逍遥丸与单用氟伏沙明治疗,疗程8周。在治疗前及治疗后的第2、4、8周分别采用汉密尔顿抑郁量表(HAMD17)、汉密尔顿焦虑量表(HAMA)、临床疗效总评量表(CGI)进行疗效评定;用不良反应量表(TESS)评定不良反应。结果研究组痊愈41例,有效13例,有效率85.7%;对照组痊愈37例,有效7例,有效率71.0%,两组间有效率差异有统计学意义(χ2=4.013,P<0.05);与治疗前比较,两组治疗后的第2、4、8周HAMD17、HAMA及CGI评分比较,差异均具有统计学意义(P<0.01),研究组在治疗后4、8周末HAMD17和HAMA评分下降较对照组显著,两组间比较,差异具有统计学意义(P<0.05和P<0.01)。两组不良反应比较,研究组发生厌食和失眠的不良反应明显少于对照组,两组间比较差异均有统计学意义(P<0.05);结论氟伏沙明合并逍遥丸治疗抑郁症的疗效优于单用氟伏沙明,能提高临床有效率,且不良反应少,安全性高。     

低频重复经颅磁刺激联合度洛西汀治疗难治性抑郁症的疗效

目的探讨低频重复经颅磁刺激(rTMS)联合度洛西汀对难治性抑郁症的疗效。方法将符合CCMD-3抑郁症诊断标准,至少应用两种不同作用机制抗抑郁药足量、足疗程治疗无效的43例患者随机分为研究组(n=22例)和对照组(n=21例)。研究组给予低频(≤1Hz)rTMS联合度洛西汀治疗,对照组单用度洛西汀治疗,观察6周。2组分别于治疗前和治疗2、4、6周末应用汉密尔顿抑郁量表(HAMD)评定疗效,采用症状量表(TESS)评定2组不良反应。结果 2组在治疗6周后HAMD评分较治疗前均有显著下降(P<0.05),研究组在治疗2、4、6周HAMD总分显著低于对照组(P<0.05或P<0.01)。2组不良反应发生率比较差异无统计学意义(P>0.05)。结论低频rTMS合并度洛西汀治疗难治性抑郁症显效快,早期能显著改善患者重度抑郁情绪,疗效优于单一用药,不良反应发生率低,安全性高。     

度洛西汀合并重复经颅磁刺激治疗老年抑郁症的对照研究

目的分析度洛西汀合并重复经颅磁刺激治疗老年抑郁症的临床疗效。方法采用数字随机法将68例符合ICD-10抑郁发作诊断标准的老年抑郁症患者分为研究组和对照组各34例,研究组给予度洛西汀合并重复经颅磁刺激治疗,对照组给予度洛西汀合并伪刺激治疗,共6周。于治疗前及治疗1、2、4及6周末采用汉密尔顿抑郁量表评定临床疗效。结果治疗6周末,研究组和对照组总有效率分别为97.40%和78.10%,差异有统计学意义(P<0.05)。治疗前及治疗后1、2、4、6周末两组患者HAMD评分差异均有统计学意义(P<0.01),但两组间比较,差异则无统计学意义(P>0.05)。研究组发生不良反应25例(73.5%);对照组发生不良反应23例(67.6%),两组不良反应发生率差异无统计学意义(P>0.05)结论度洛西汀合并重复经颅磁刺激可提高老年抑郁症治疗的有效率。     

度洛西汀与西酞普兰治疗抑郁症的临床对照研究

目的探讨度洛西汀与西酞普兰治疗抑郁症的疗效与不良反应。方法将符合中国精神障碍分类与诊断标准第三版(CCMD-3)的住院及门诊46例抑郁症患者,随机分为度洛西汀组22例和西酞普兰组24例,共治疗8周。采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)和治疗中出现的症状量表(TESS)评定疗效及不良反应。结果治疗第1周末度洛西汀组HAMD评分较西酞普兰组下降明显(P0.05),提示度洛西汀起效快于西酞普兰;治疗6周末度洛西汀组有效率为95.45%,西酞普兰组为91.66%,两组疗效相当(χ2=0.247,P0.05);两组不良反应均较轻微。结论度洛西汀和西酞普兰均为治疗抑郁症安全有效的药物,但度洛西汀较西酞普兰起效快,可作为临床治疗抑郁症理想药物的选择。     

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.