长期治疗的慢性精神分裂症患者血清脑源性神经营养因子水平的研究

目的探讨血清脑源性营养因子(BDNF)浓度与长期抗精神病药治疗的慢性精神分裂症患者精神病理症状间的关系。方法检测81例慢性精神分裂症患者和45名正常人血清的BDNF浓度,比较2组及各类抗精神病药治疗的患者间血清BDNF浓度的差异;采用阳性和阴性症状量表(PANSS)评定精神病理症状,分析血清BDNF浓度与PANSS评分间的关系。结果①患者组血清BDNF浓度显著低于正常对照[(7.3±2.6)vs(9.9±4.3)ng/mL,P<0.001];②利培酮、氯氮平、典型抗精神病药3组间血清BDNF浓度差异有统计学意义(F=6.25,P<0.01),利培酮组显著低于氯氮平组[(5.1±1.7)vs(7.8±2.7)ng/mL,P<0.05];③患者组中血清BDNF浓度与PANSS阴性症状分呈负相关(r=-0.307,P=0.005)。结论长期抗精神病药物治疗的慢性精神分裂症患者血清BDNF浓度下降,利培酮治疗组显著低于氯氮平治疗组,阴性症状越明显的患者BDNF水平越低。     

精神分裂症患者系统家庭治疗的研究

探讨系统家庭治疗对精神分裂症患者的疗效。对象入组标准:符合中国精神障碍分类与诊断标准第3版的精神分裂症诊断标准;年龄16~60岁;阳性症状和阴性症状量表(PANSS)≥70分;无严重躯体疾病;有1名健康照料者与患者同住;患者及其家属愿意配合。共入组150例,随机分为系统家庭治疗组(以下称治疗组)及对照组,每组各75例。完成2年随访,治疗组为68例,对照组为65例。治疗组男46例,女22例;年龄(31±8)岁;病程(3·7±2·6)年;复发次数(2·8±1·7)次;PANSS总分(78·6±20·3)分;功能缺陷评定量表(DAS)总分(4·0±3·7)分。对照组男40例,女25例;年…     

利培酮对精神分裂症患者血浆高香草酸的影响

目的　探讨利培酮对精神分裂症患者中枢多巴胺代谢产物血浆高香草酸 (pHVA)的影响。方法　 30例精神分裂症住院患者 (患者组 )纳入研究 ,利培酮治疗平均剂量为 (3 2± 1 1)mg/d ,共观察 6周。以阳性和阴性症状量表 (PANSS)评定疗效 ,以高效液相库仑阵列电化学检测法测定患者治疗前后的 pHVA含量。 30例健康志愿者作为对照组 ,检测pHVA水平。 结果　 (1)患者组治疗前 pHVA含量 [(7 9± 4 0 ) μg /L]与对照组含量 [(8 8± 4 1) μg /L]的差异无显著性 (P >0 0 5 ) ,而患者组治疗后 pHVA含量 [(5 3± 2 7) μg/L]明显低于治疗前 (P <0 0 1) ;(2 )治疗前患者组 pHVA与PANSS阳性症状评分 [(2 0 7± 4 1)分 ]存在正相关 (r =0 39,P <0 0 0 1) ,与基线PANSS阴性症状评分 [(19 7± 5 1)分 ]存在负相关 (r =- 0 35 ,P <0 0 1) ;(3)基础pHVA含量及其治疗前后差值[(2 6± 1 3) μg/L]与PANSS阳性症状评分减分值 [(10 8± 4 1)分 ]均分别呈正相关 (r =0 4 8,P <0 0 1;r=0 6 0 ,P <0 0 0 1)。结论　患者组治疗前pHVA可部分反映精神分裂症症状 (尤其是阳性症状 )的严重程度 ,基础 pHVA含量及治疗前后pHVA水平的变化与利培酮治疗阳性症状的疗效相关。     

精神分裂症患者认知功能与精神症状的关系

近几年对精神分裂症患者认知损害与精神症状的关系尚无一致意见 ,我们对此进行研究 ,现将结果报告如下。1　对象和方法均为 2 0 0 2年 7月至 2 0 0 3年 1月在我院住院患者 ,符合中国精神障碍分类与诊断标准第 3版精神分裂症诊断标准 ,阳性与阴性症状量表 (PANSS)总分≥ 6 0分 ,病程≤ 2年 ,年龄16～ 35岁 ;入院前 2周内未服任何抗精神病药。无严重躯体疾病 ,能配合完成认知测验。共 6 0例 ,男 31例 ,女 2 9例 ,平均年龄 (2 5 .4± 5 .7)岁 ,平均受教育 (11.0± 2 .7)年 ,平均病程 (1.2± 0 .8)年。随机分为利培酮组及奎硫平组。奎硫平治疗…     

首发精神分裂症胼胝体的磁共振弥散张量研究

目的 采用磁共振弥散张量成像(DTI)了解首发精神分裂症患者脑部胼胝体的改变及其与临床症状的关系.方法 将首发精神分裂症住院患者60例和正常对照组26例按规定序列作头颅弥散张量成像扫描,测定胼胝体(膝部、体部、压部)FA值,并在入院当天进行PANSS量表评定.结果 病例组胼胝体体部FA值(0.33±0.10)较对照组(0.40±0.11)小,两组比较有差异(F=4.22,P=0.046);病例组男性胼胝体膝部FA值(0.51±0.08)较对照组(0.63±0.10)小,两组比较有差异(F=6.79,P=0.02);病例组女性胼胝体体部FA值(0.33±0.11)较对照组(0.46±0.08)小,两组比较有差异(F=7.08,P=0.014);阳性因子分、阴性因子分与胼胝体体部FA值无相关,而阴性因子分与胼胝体压部FA值(r=-0.38,P=0.04)则显著负相关.结论 首发精神分裂症患者胼胝体FA值减小,提示白质神经纤维的连续性中断,可能是精神分裂症病理基础之一.     

偏执型精神分裂症患者的血一氧化氮水平研究

目的　了解偏执型精神分裂症患者的血一氧化氮水平及其与临床症状间的关系。方法　对 32例偏执型精神分裂症患者的血一氧化氮水平进行了检测 ,采用阳性和阴性症状量表 (PANSS)对其临床精神病理症状进行评定。结果　患者组一氧化氮水平 (6 7.79± 2 3.0 6umol/L)高于对照组 (4 8.78± 16 .0 2umol/L) (t =3.4 6P <0 .0 0 2 ) ,一氧化氮水平与PANSS总分及各因子分未发现相关关系 (r =0 .0 5 5　 0 .0 2 4　 0 .0 17　 0 .0 71　P >0 .0 5 )。结论　偏执型精神分裂症患者的血一氧化氮高 ,并可能是偏执型精神分裂症的病理基础。     

多巴胺D3受体基因多态性与精神分裂症初发期患者抗精神病药疗效关系的研究

目的　探讨多巴胺D3 受体 (DRD3)基因多态性与精神分裂症初发期患者精神症状严重度和抗精神病药疗效是否相关。方法　对 10 9例精神分裂症初发期患者分别进行利培酮治疗 [4 3例 ,3～ 5mg/d ,平均 ( 4 0± 0 5 )mg/d]和氯丙嗪治疗 [6 6例 ,15 0～ 6 0 0mg/d ,平均 ( 339± 87)mg/d],疗程 10周。采用聚合酶链反应 限制性片段长度多态性技术检测其中 10 8例患者 (男 5 2例 ,女 5 6例 )DRD3基因ser9gly多态性。采用阳性和阴性症状量表 (PANSS)评定患者治疗前和治疗第 10周末的精神症状 ,并分析基因型及其他临床指标与PANSS分值和减分率的关系。结果　DRD3ser9gly基因型在各患者组分布频率均符合Hardy Weinberg定律 (P >0 0 5 ) ;基因型在治疗显效和未显著进步组分布频率的差异有显著性 ( χ2 =6 4 4 ,ν=2 ,P <0 0 5 ) ;各基因型亚组临床指标的差异均无显著性 (均P >0 0 5 ) ;基因型与患者治疗前PANSS总分及治疗第 10周末PANSS总减分率、阳性症状减分率的差异均有显著性(均P <0 0 5 )。结论　DRD3基因ser9gly功能多态性可能是精神分裂症初发期患者精神症状严重程度和抗精神病药疗效 (尤其对阳性症状疗效 )的遗传影响因子。     

吸烟对精神分裂症男性患者精神病理症状的影响

目的 分析吸烟对精神分裂症临床精神病理症状的影响,探索精神分裂症患者高比例吸烟的原因.方法 收集慢性精神分裂症吸烟患者(332例)和非吸烟患者(95例)共427例,首次发病(以下简称首发)精神分裂症吸烟患者(22例)和非吸烟患者(41例)共63例,均为男性;使用阳性和阴性症状最表(PANSS)评定其临床精神病理症状.结果 (1)在慢性精神分裂症患者巾,吸烟组PANSS阴性症状分量表中的情感交流障碍得分[(3.9±1.5)分]、被动或淡漠得分[(3.6±1.6)分]及其总分[(24.0.±8.2)分]低于非吸烟组[分别为(4.4.±1.7)分、(4.0±1.7)分和(26.3.±9.5)分;P<0.05];PANSS阴性症状分量表7个条目得分及其总分、一般精神病理分量表总分和PANSS总分与患者每天的吸烟量呈负相关(P<0.05～0.01);阴性症状分量表中的情感交流障碍[比值比(OR)=0.832,95%可信区间(95%CI)=0.691～0.980,P=0.029]和一般精神病理分量表中的紧张(OR=0.534,95%CI=0.363～0.786,P=0.001)进入Logistic模型.(2)在首发精神分裂症患者中,吸烟组在阴性症状分量表中的情绪退缩得分[(2.7±1.3)分]、被动或淡漠得分[(2.7 ±1.3)分]低于非吸烟组[分别为(3.5±1.3)分和(3.5±1.4)分;P<0.05];一般精神病理分量表中的动作迟缓与患者每天的吸烟量呈负相关,自知力缺乏与吸烟量呈正相关(均P<0.05);PANSS一般精神病理分量表中的动作迟缓(OR=0.589,95%CI:0.350～0.989,P=0.045)进入Logistic模型.结论 吸烟对阴性症状的正性作用可能是精神分裂症患者高比例吸烟的原因之一.     

奎硫平治疗精神分裂症对照研究

奎硫平对精神分裂症阳性症状、阴性症状疗效好 ,且无锥体外系反应及催乳素升高 ,患者服药依从性耐受性好[1] 。为验证奎硫平治疗精神分裂症的疗效和不良反应 ,并以氯氮平治疗为对照 ,进行临床观察。1　对象和方法为 2 0 0 1年 6月～ 2 0 0 2年 2月在我院住院的精神分裂症患者 ,符合中国精神疾病分类方案与诊断标准第 2版修订本诊断标准 ,阳性症状与阴性症状量表 (PANSS)评分 >6 0分。奎硫平组 10 0例 ,年龄 (2 9 8± 11 1)岁 ,病程 (19 2±2 9 6 )个月 ,住院次数 (1 7± 1 0 )次 ,初发年龄 (2 8 3± 11 1)岁 ,PANSS治疗前评分 6 1 5 0±…     

家族性精神分裂症患者临床特征分析

目的　研究家族性与散发性精神分裂症患者临床特征的异同。方法　对 2 76例精神分裂症患者用自编项目调查表进行资料统计 ,并对相关因素进行分析。结果　家族性 (Fs)组 (n =5 2 )发病年龄显著小于散发性 (SS)组 (n =2 2 4 ) (P <0 .0 1) ;家族性患者为第一胎者较散发性多 (P <0 .0 5 ) ;散发性组有失眠症状者较家族性组多见 (P <0 .0 5 ) ;家族性组思维联想障碍、情感淡漠、意志减退症状较散发性组多见 (P <0 .0 5 ) ;近期疗效显著较散发组差。结论　家族性精神分裂症起病较早 ,核心症状更突出     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.