精神分裂症异质性及其中枢去甲肾上腺素功能初步研究

本文采用高压液相色谱（ＨＰＬＣ）对４２例阳性精神分裂症、２５例阴性精神分裂症及１０例健康对照组进行了脑脊液中去甲肾上腺素（ＮＥ）及其代谢产物３－甲基－４－羟基苯乙二醇（ＭＨＰＧ）的测定，同时引入ＮＥ相对代谢率（ＭＨＰＧ／ＮＥ）加以比较，研究结果提示：６７例精神分裂症脑脊液中ＭＨＰＧ明显低于正常对照组，４２例阳性精神分裂症脑脊液中ＮＥ及ＭＨＰＧ亦明显低于正常对照组，同时还发现，阴性精神分裂症相对代谢率ＭＨＰＧ／ＮＥ也明显低于阳性精神分裂症．本文针对以上结果、结合ＮＥ与多巴胺（ＤＡ）的相互关系进行了讨论，同时分析了精神分裂症的异质性问题。     

精神分裂症中枢—5羟色胺代谢的再探讨

了解性别因素对精神分裂症中枢５—羟色胺（５—ＨＴ）代谢的影响。方法应用高效液相色谱（ＨＰＬＣ）对３０例男性精神分裂症、３７例女性精神分裂症、２１例男性对照组、９例女性对照组脑脊液中５—ＨＴ及其代谢产物５—羟吲哚乙酸（５—ＨＩＡＡ）进行测试。结果男、女病例组及男、女对照组四组间５—ＨＴ、５—ＨＩＡＡ水平显著不同（Ｆ＝４．２６５，Ｐ＝０．０１７；Ｆ＝５．８９６，Ｐ＝０．００４）；同时还揭示男性精神分裂症５—ＨＩＡＡ显著低于男性正常对照组（ｑ＝４．０７７２，Ｐ＜０．０１）和女性精神分裂症５—ＨＩＡＡ显著低于女性正常对照组（ｑ＝４．６２１，Ｐ＜０．０１），但未见有病例组５—ＨＴ和５—ＨＩＡＡ的性别差异，亦未见有正常对照组的性别差异。结论不论男性还是女性精神分裂症其５—ＨＩＡＡ均低于相应对照组，表明精神分裂症有５—ＨＴ代谢低下。     

酚噻嗪类药物对精神分裂症中枢NE和5－HT代谢的调节作用

作者应用高效液相色谱电化学检测器对３９例精神分裂症患者脑脊液中的ＮＥ及其代谢产物ＭＨ－ＰＧ、５－ＨＴ及其代谢产物５－ＨＩＡＡ进行了测试，比较酚噻嗪类药物治疗前后ＮＥ、５－ＨＴ及其代谢产物浓度的变化，结果发现：ＮＥ、５－ＨＴ及其代谢产物浓度治疗后呈现双向性变化，变化方向与其基础浓度有关。基础浓度较低者治疗后显著增高（正向调节）；反之，显著降低（负向调节）．正向调节组和负向调节组基础浓度有显著差异，但治疗后浓度趋向于一致。揭示酚噻嗪类药物对ＮＥ、５－ＨＴ代谢具有明显双向调节作用并对此进行了简要讨论。     

中枢5－HT相对代谢率与精神分裂症临床特征分析

应用高压液相色谱（ＨＰＬＣ）对符合ＣＣＭＤ－２精神分裂症诊断标准的６７例患者脑脊液中５－ＨＴ、５－ＨＩＡＡ进行了测试，并以５－ＨＩＡＡ／５－ＨＴ作为相对代谢率，并以其中位数为界值分为高５－ＨＩＡＡ／５－ＨＴ比值组和低５－ＨＩＡＡ／５－ＨＴ比值组，结果发现，低比值组的ＢＰＲＳ阳性症状显著高于高比值组，而ＢＰＲＳ及其阴性症状和非特异症状两组无显著差异。相关分析发现，５－ＨＩＡＡ与ＢＰＲＳ及其阳性症状呈显著负相关，５－ＨＩＡＡ／５－ＨＴ与ＢＰＲＳ的阳性症状呈显著负相关，提示５－ＨＴ代谢低下与阳性症状有关。     

新生儿缺氧缺血性脑病的脑脊液单胺类物质改变

为明确单胺神经递质代谢在新生儿缺氧缺血性脑病（ＨＩＥ）发病过程中的改变及意义，以及Ｇｌｕ与单胺物质改变的关系，我们应用高效液相色谱（ＨＰＬＣ）法测定了１１例ＨＩＥ患儿和对照组８例患儿ＧＳＦ中Ｔｒｐ５－ＨＴ，５－ＨＩＡＡ，ＨＶＡ，ＭＨＰＧ，Ｇｌｕ和ＧＡＢＡ等，结果显示ＨＩＥ组５－ＨＩＡＡ，ＨＶＡ高于对照组，且其ＨＩＡ含量与呼吸复苏时间呈正相关，未发现５－ＨＩＡＡ或ＨＶＡ与Ｇｌｕ之间的相关性。表明ＨＩ     

中枢5—HT相对代谢率与精神分裂症临床特征分析

应用高压液相色谱对符合ＣＣＭＤ－２精神分裂症诊断标准的６７例患者脑脊液中５－ＨＴ、５－ＨＩＡＡ进行了测试，并以５－ＨＩＡＡ 作为相对代谢率，并以其中位数为界值分为高５－ＨＩＡＡ／５－ＨＴ比人且和低５－ＨＩＡＡ／５－ＨＴ比值组，结果发现，低比值组的ＢＰＲＳ阳性症状显著高于高比值组，而ＢＰＲＳ及其阴性症状和非特异症状两组无显著差异。相关分析发现，５－ＨＩＡＡ与ＢＰＲＳ及其阳性症状呈显著负相关，５－ＨＩ     

中枢5—HT相对代谢率与精神分裂症相关因素分析

了解中枢５－ＨＴ代谢与精神分裂症的关系。用ＨＰＬＣ测定６７例精神分裂症患者脑脊液中５－ＨＴ及５－ＨＩＡＡ，计算５－ＨＩＡＡ／５－ＨＴ比值，比值高者年龄明显较大，其阴性症状型与阳性症状型的构成比明显不同于比值低者，５－ＨＩＡＡ／５－ＨＴ比值高低与阴阳性症状有明显关系。     

酚噻嗪药物对精神分裂症中枢NE和5——HT代谢的调节作用

作者应用高效液相色谱电化学检测器对３９例精神分裂症患者脑脊液中的ＮＥ及其代谢产物ＭＨ－ＰＧ、５－ＨＴ及其代谢产物５－ＨＡＡ进行了测试，比较酚噻嗪类药物治疗前后ＮＥ、５－ＨＴ及其代谢产物浓度的变化。结果发现：ＮＥ、５－ＨＴ及其代谢产物浓度治疗后呈现双向性变化，变化方向与其基础浓度有关。基础浓度较低者治疗后显著增高；反之，显著降低。正向调节组和负向调节组基础浓度有显著差异，但治疗后浓度趋向于一致。提示     

电针对慢性应激抑郁模型大鼠脑单胺类神经递质的影响

目的　探讨电针刺激百会、印堂穴对慢性应激抑郁模型大鼠脑内单胺类神经递质的影响及治疗抑郁症的机理。方法　将２４ 只ＳｐｒａｇｕｅＤａｗｌｅｙ 雄性大鼠随机分为对照组、抑郁模型组、抑郁模型加电针组和抑郁模型加阿米替林组,每组６ 只。用高效液相电化学法测定大鼠脑内单胺类神经递质及其代谢产物的含量,比较含量的比值。结果　抑郁模型组大鼠脑皮层５羟色胺（５ＨＴ）／５羟吲哚乙酸（５ＨＩＡＡ） 、纹状体多巴胺（ＤＡ）／３,４二羟基苯乙酸（ＤＯＰＡＣ） 分别为０－５０ ±０－１７,１０－３７ ±１－４０,低于对照组（ 分别为０－８８±０－２５ ,１２－３６ ±１－５０）,Ｐ＜ ０－０５ ;皮层去甲肾上腺素（ＮＥ）／５ＨＴ（２－８８ ±１－００） 高于对照组（１－７３±０－４０） ,Ｐ＜ ０－０５。电针刺激百会、印堂穴可使模型大鼠脑皮层５ＨＴ／５ＨＩＡＡ 与ＮＥ／５ＨＴ恢复正常（Ｐ＜０－０５） ,对纹状体ＤＡ／ＤＯＰＡＣ 的降低无影响（ Ｐ＞ ０－０５）。结论　提示电针刺激百会、印堂穴通过降低皮层５ＨＴ的代谢,提高５ＨＴ能神经的活性,并协调ＮＥ 与５ＨＴ之间的平衡来发挥抗抑郁作用。     

利培酮治疗难治性精神分裂症临床分析

目的：评价对利培酮对难治性精神分裂症的疗效与副作用。方法：对我住院的难治性精神分裂症３０例换用利培酮治疗２４周。用阳性与阴性症状量表（ＰＡＮＳＳ）评定疗效,用副反应量表（ＴＥＳＳ）及锥体外系副反应量表（ＥＳＲＳ）评定副作用。结果：ＰＡＮＳＳ部分、ＰＡＮＳＳ－Ｇ（一般精神病理）分、ＰＡＮＳＳ－Ｐ（阳性症状）分治疗前后有显著差异。ＰＡＮＳＳ总分及各分量表分均自治疗１２周末起有显著下降,说明自第１２周末开始显效。ＰＡＮＳＳ部分减分率≥２０％者１８例,≥５０％者５例,有效率为６０％。最常见的副作用是ＥＰＳ（６／３０）,但症状多较轻。结论：利培酮对难治精神分裂症有肯定的疗效,副反应轻微。     

The neuroendocrinology of stress and the pathophysiology and therapy of depression and anxiety

Clinical and preclinical studies have gathered substantial evidence that stress response alterations play a major role in the development of major depression, panic disorder, and post-traumatic stress disorder. The stress response, the hypothalamic pituitary adrenocortical (HPA) system and its modulation by corticotropin-releasing hormones (CRH),corticosteroids,and their receptors, and the roles of natriuretic peptides and neuroactive steroids are described. We review the role of the HPA system in major depression, panic disorder, and post-traumatic stress disorder and its possible relevance for treatment. Impaired glucocorticoid receptor function in major depression is associated with an excessive release of neurohormones such as CRH, to which a number of signs and symptoms characteristic of depression can be ascribed. In panic disorder, a role of central CRH in panic attacks has been suggested. Atrial natriuretic peptide (ANP) is causally involved in sodium lactate-induced panic attacks. Furthermore, preclinical and clinical data on its anxiolytic activity suggest that nonpeptidergic ANP receptor ligands may be potentially useful in the treatment of anxiety disorders. Post-traumatic stress disorder is characterized by a peripheral hyporesponsive HPA system and elevated CRH concentrations in the CSF. This dissociation is probably related to an increased risk of this disorder. We further review recent data that describe an important role of GABA(A)-receptor modulatory,3 alpha-reduced neuroactive steroids in major depression, anxiety, and its treatment. Antidepressants are effective in both depression and anxiety disorders and have major effects on the HPA system,especially on glucocorticoid and mineralocorticoid receptors. Normalization of HPA system abnormalities is a strong predictor of the clinical course, at least in major depression and panic disorder. Currently,CRH-R1 or glucocorticoid receptor antagonists and ANP receptor agonists are being studied and may provide future treatment options more closely related to the pathophysiology of these disorders.     

Polymorphisms of DRD4 and DRD3 and risk of avoidant and obsessive personality traits and disorders

We investigated whether polymorphisms of the dopamine D4 receptor (DRD4) and polymorphisms of the dopamine D3 receptor (DRD3) were associated with personality disorder symptomatology rather than with personality traits such as novelty seeking. DNA was obtained from 145 depressed patients in a clinical trial. These patients were assessed for the presence of personality disorder symptoms and disorders. The 2-repeat allele of the DRD4 exon III polymorphism was associated with increased rates of avoidant and obsessive personality disorder symptomatology. The T,T genotype of the DRD4 -521 C>T polymorphism was also associated with increased rates of avoidant and obsessive personality disorder symptomatology. The Gly9,Gly9 genotype of the DRD3 Ser9Gly polymorphism was associated with increased rates of obsessive personality disorder symptomatology. None of these three polymorphisms were associated with novelty seeking or other temperament traits on the Temperament and Character Inventory. Our results suggest that genetic polymorphisms of DRD4 and DRD3 may well be associated with personality traits, and that conflicting findings to date may arise from the problem of phenotype definition.     

沙盘游戏疗法在地中海贫血患儿心理干预中的应用

本文目的是对沙盘游戏疗法在地中海贫血患儿心理干预中的应用进行综述,以期为地中海贫血患儿的心理康复提供参考。地中海贫血是以珠蛋白生成障碍为主要特征的遗传性疾病,由于长期输血治疗,患儿存在较多的心理和行为问题。沙盘游戏疗法作为一种有效、实用的儿童心理治疗方法,对提高地中海贫血患儿的康复效果、改善生存质量有重要的临床意义。     

癫痫共病抑郁的机制及临床诊疗

本文目的是探讨癫痫共病抑郁的可能机制及临床诊疗。癫痫是一种常见的、慢性的、致残性的神经疾病,癫痫患者生活质量下降,存在明显的负性情绪,常伴发各种精神疾病。癫痫与抑郁具有共同的神经生物学基础,可能存在共同的发病机制。本文从癫痫共病抑郁的发病机制、临床诊断及治疗方面予以总结归纳。     

Efficacy and Effectiveness of Child and Adolescent Psychotherapy and Pharmacotherapy

Decades of intervention research have produced a rich body of evidence on the effects of psychotherapies and pharmacotherapies with children and adolescents. Here we summarize and critique that evidence. We review findings bearing on the efficacy of psychosocial treatments and medications under controlled experimental conditions. We also report evidence, where available, on the effectiveness of both classes of treatment with clinically referred youth treated in real-world clinical contexts. In general, the large body of evidence on efficacy contrasts sharply with the small base of evidence on effectiveness. Addressing this gap through an enriched research agenda could contribute importantly to linking scientific inquiry and clinical practice—to the benefit of both ventures. This is one element of a multifaceted agenda for future research and for synthesis of research, which will require the interplay of multiple disciplines related to child and adolescent mental health.     

Seclusion and restraint and prediction of violence

The authors studied the use of seclusion and restraint on an inpatient unit in a state psychiatric hospital. Of 69 randomly selected inpatients, 51% experienced seclusion or restraint at least once. More psychotic than nonpsychotic patients required seclusion or restraint. However, neither psychosis/nonpsychosis nor voluntary/involuntary admission status predicted the likelihood of violent threats or actions. Patients experiencing seclusion and restraint showed a nonsignificant trend toward longer mean length of stay in the hospital. The frequency of patient behavior leading to seclusion or restraint appeared to be directly related to the stimulation caused by the presence of many staff members and other patients.     

Comparison of trigeminal and spinal modulation of pain and nociception

Modulation of pain and nociception by noxious counterstimulation, also called "diffuse noxious inhibitory controls" or DNIC-like effect, is often used in studies of pain disorders. It can be elicited in the trigeminal and spinal innervation areas, but no study has previously compared effects in both innervation areas. Therefore, we performed a study comparing DNIC-like effects on the nociceptive flexion reflex (NFR) and the nociceptive blink reflex as well as the respective pain sensations. In 50 healthy volunteers, the blink reflex elicited with a concentric electrode and the NFR were recorded before and after immersion of the contralateral hand in cold water. Responses were recorded as the subjective pain sensation and the reflex size. The cold water immersion of the contralateral hand elicited a reduction of both subjective pain sensation and reflex amplitude following the stimulation of both reflexes. However, there were no strong correlations between the individual reductions of both subjective pain sensation and reflex amplitude for both reflexes, and neither when results of the two reflexes were compared with each other. The dissociation between DNIC-like effects on pain and on nociception, which had been found previously already for the NFR, implies that both effects need to be studied separately.