社交焦虑障碍的药物治疗

社交焦虑障碍是常见的焦虑障碍之一.目前临床常用治疗药物主要有选择性5-羟色胺再摄取抑制剂(SSRI)、选择性5-羟色胺和去甲肾上腺素再摄取抑制剂(SSNRI)及苯二氮(艹卓)类药物等.本文综述药物治疗近况.     

帕罗西汀与其他选择性5-HT再摄取抑制药疗效及安全性的meta分析

目的 评价帕罗西汀与其他选择性5-HT再摄取抑制药的疗效及安全性。方法 计算机检索Cochrane图书馆、ISI数据库、中国知网（CNKI）、维普（VIP）、万方数字化期刊数据库,纳入帕罗西汀与其他选择性5-HT再摄取抑制药疗效及安全性随机对照试验（randomized controlled trial,RCT）、系统评价和meta分析文献,对纳入文献的RCTs进行方法学质量评价和meta分析,参考纳入文献的系统评价和meta分析结论。结果 帕罗西汀与其他选择性5-HT再摄取抑制药疗效及安全性对比分析共纳入15个RCTs。2组抗抑郁总有效率差异有统计学意义（OR=1.45,95%CI=1.01~2.09,P=0.04）;治疗2周和6周后HAMD评分差异有统计学意义（MD=-2.04,95%CI=-2.59~-1.49,P<0.000 01;MD=-0.69,95%CI=-1.18~-0.21,P=0.005）;治疗6周后药物不良反应发生率差异有统计学意义（OR=0.88,95%CI=0.78~0.99,P=0.04）。结论 与其他选择性5-HT再摄取抑制药相比较,帕罗西汀的总有效率及起效速度较低,不良反应发生率较高,其不再推荐为一线抗抑郁药。     

盐酸度洛西汀治疗更年期抑郁症疗效评价

盐酸度洛西汀(商品名:奥思平)为5-羟色胺(5-HT)和去甲肾上腺素(NH)平衡和再摄取抑制剂(SNRI),与目前临床使用的5-HT再摄取抑制剂(SSRI)相比,具有更广谱、更快速的抗抑郁疗效,故可获得更高的临床治愈率.盐酸度洛西汀也不同于现有SNRI类药物,具有平衡两种神经递质的作用机制,能使两种神经递质发挥更佳的协同作用,从而快速缓解抑郁情绪和躯体症状.为客观评价盐酸度洛西汀的临床疗效及安全性,现将上海市第一妇婴保健院心理门诊和嘉定区妇婴保健院门诊中使用盐酸度洛西汀治疗更年期抑郁症妇女的情况报告、分析如下.     

SSRI和SNRI类抗抑郁药的不良反应

目的研究SSRI和SNRI类抗抑郁药不良反应的临床表现和处理措施,为临床医师合理用药提供参考。方法收集我院2010年上半年神经内科门诊使用SSRI或SNRI类抗抑郁药出现不良反应的24例抑郁或焦虑病例,分析其具体不良反应临床表现和相应的处理措施。结果 SSRI/SNRI最常见的不良反应是胃肠道反应,其他少见的有精神症状、自主神经功能障碍和椎体外系反应等。结论尽管SSRI和SNRI都是比较安全的抗抑郁药物,临床医师应该注意监测其不良反应,并掌握处理措施。     

维拉佐酮的药理和临床评价

重性抑郁障碍是一种严重的精神障碍,且容易复发。尽管多种药物均可治疗,但仍有许多患者无法获得满意的疗效。维拉佐酮为选择性5-HT再摄取抑制剂和5-HT_(1A)受体部分激动剂,用于治疗重性抑郁障碍。本文就其作用机制、药效学、药动学和临床评价等进行综述。     

创伤后应激障碍的诊断与治疗

创伤后应激障碍(PTSD)是常见、反复发作的慢件精神障碍,常伴有抑郁、焦虑、心身障碍与药物滥用,有较高的自杀率与功能损害.至今,人们对PTSD的概念仍有很多误解,诊断也存在许多困难.近十多年来,PTSD在神经生物学方面有了更多新发现,同时由于认知行为治疗和选择性5-羟色胺再摄取抑制剂(SSRI)的研究进展,以往对PTSD预后的悲观估计已得到改变,临床患者症状完全缓解或大部分消除及功能康复是可期待的.     

妊娠期抗抑郁药物治疗对子代的影响

针对妊娠期抑郁和焦虑的处理非常棘手,选择性5-羟色胺再摄取抑制剂(SSRI)是妊娠期抗抑郁治疗的一线药物。本文综述妊娠期接受抗抑郁药物治疗对子代的影响。     

重性抑郁障碍治疗药 维拉佐酮（vilazodone）

1商品名 Viibryd 2开发与上市厂商 本品由德国默克KgaA公司开发,于2011年6月首次在美国上市。3适应证 本品为5-羟色胺（5-HT）1A部分激动剂和选择性5-羟色胺再摄取抑制剂（SSRI）双重活性药物,是首个吲哚烷基胺类抗抑郁药物,适用于重性抑郁障碍（MDD）成年患者的治疗。     

选择性5-羟色胺再摄取抑制剂引起低钠血症26例报告

选择性5-羟色胺再摄取抑制剂(SSRI)以其疗效与三环类抗抑郁药(TCA)相近,而不良反应明显减少,近十年来,在临床上得到广泛应用;尤其是在门诊治疗中,由于其副反应少,在老年病人中,使用率越来越大,作者在临床工作中,发现26例抑郁症病人使用SSRI类药后引起低钠血症,现报道如下:     

文拉法辛缓释胶囊治疗抑郁和焦虑障碍共病60例

目的 研究文拉法辛缓释胶囊治疗抑郁、焦虑障碍共病的疗效及安全性.方法 将120例抑郁、焦虑障碍共病患者随机均分为文拉法辛缓释胶囊组(研究组)和选择性5-羟色胺再摄取抑制剂组(对照组),进行对照研究,疗程12周,采用汉密顿焦虑量表、汉密顿抑郁量表、药物副作用量表评定临床疗效和不良反应.结果 研究组抗焦虑、抗抑郁作用均较对照组起效快(P＜O.05或P＜O.01),抗焦虑疗效优于对照组(P＜0.05);治疗12周末两组抗抑郁疗效相当.结论 文拉法辛缓释胶囊治疗抑郁、焦虑障碍共病起效快、疗效显著、安全性高、依从性好.     

Impulse Control Disorders and Co-Occurring Disorders: Dual Diagnosis Considerations

ABSTRACT

Impulse control disorders (ICDs) such as pathological gambling frequently co-occur with a broad range of other psychiatric disorders. Relatively little research has investigated the nature of the relationships between ICDs and other psychiatric disorders. Important theoretical and clinical considerations exist regarding how best to conceptualize and treat ICDs within a dual diagnosis framework. Common genetic and environmental contributions have been reported for ICDs and other psychiatric disorders. Clinically, individuals with an ICD and another co-occurring disorder typically fare more poorly than those with either. Data suggest that ICDs frequently go undiagnosed in psychiatric patients. In order to optimize treatment, improved methods for screening individuals for ICDs should be developed and implemented in clinical settings. With increase in the emeregence of empirically validated treatments for ICDs, it is important to investigate their efficacies and tolerabilites in dually diagnosed groups and their effectiveness in general clinical settings.     

Tetracyclines and Neuromuscular Disorders

Tetracyclines are a class of antibiotics which could act as neuroprotective molecules in several neurological disorders, such as Huntington disease, Parkinson disease, stroke and multiple sclerosis. The main biological effects of tetracyclines are the inhibition of microglial activation, the attenuation of apoptosis and the suppression of reactive oxygen species production. The anti-apoptotic effect of tetracyclines involves the mitochondrion, and the major target for neuroprotective effects of tetracyclines lies within the complex network that links mitochondria, oxidative stress and apoptosis.Neuromuscular disorders are due to dysfunction of motor neurons, peripheral nerves, neuromuscular junction, or skeletal muscle itself. Animal studies have shown that minocycline could play neuroprotective effects in amyotrophic lateral sclerosis, but these positive findings have not been replicated in patients. Other neuromuscular disorders which tetracyclines may benefit are Guillain-Barré syndrome and other neuropathies, muscular dystrophies and mitochondrial disorders. However, well-designed double-blind controlled trials are still needed. Further studies are strongly needed to establish the most appropriate timing and dosage, as well as the indications for which tetracyclines could be effective and safe.Here, we review the neuroprotective effects of tetracyclines in animal models, the clinical studies in humans, and we focus on their potential application in patients with neuromuscular disorders.     

The Genetics of Stress-Related Disorders: PTSD,Depression, and Anxiety Disorders

Research into the causes of psychopathology has largely focused on two broad etiologic factors: genetic vulnerability and environmental stressors. An important role for familial/heritable factors in the etiology of a broad range of psychiatric disorders was established well before the modern era of genomic research. This review focuses on the genetic basis of three disorder categories—posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and the anxiety disorders—for which environmental stressors and stress responses are understood to be central to pathogenesis. Each of these disorders aggregates in families and is moderately heritable. More recently, molecular genetic approaches, including genome-wide studies of genetic variation, have been applied to identify specific risk variants. In this review, I summarize evidence for genetic contributions to PTSD, MDD, and the anxiety disorders including genetic epidemiology, the role of common genetic variation, the role of rare and structural variation, and the role of gene–environment interaction. Available data suggest that stress-related disorders are highly complex and polygenic and, despite substantial progress in other areas of psychiatric genetics, few risk loci have been identified for these disorders. Progress in this area will likely require analysis of much larger sample sizes than have been reported to date. The phenotypic complexity and genetic overlap among these disorders present further challenges. The review concludes with a discussion of prospects for clinical translation of genetic findings and future directions for research.Genes and stress are the two most widely acknowledged contributors to psychopathology. The ‘diathesis-stress'' hypothesis has been the leading etiologic model for psychiatric disorders for decades (although alternatives have been proposed, see Boyce, this issue). The essence of this model is that genes and adversity, independently and in combination, increase the liability to disorder, which in turn results once a threshold of sufficient liability is crossed. In this review, I will focus on the ‘diathesis'' (that is, genetic) component as it relates to disorders that are most commonly thought of as stress-related disorders: posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and anxiety disorders. In reality, stress (especially early adversity and later stressful life events) has been identified as a risk factor for a broader range of psychiatric disorders, including bipolar disorder (Gilman et al, 2015) and schizophrenia (Matheson et al, 2013). However, the role of stressful environments and the physiology of stress response systems have been most closely linked to depressive, anxiety, and traumatic stress disorders.The role of genes in psychiatric illness was suggested well before the modern genomic era through family and twin studies. All psychiatric disorders that have been studied by these methods have been reported to be familial and heritable to varying degrees. More recently, molecular genetic studies have begun to identify specific DNA variations associated with neuropsychiatric disorders and related phenotypes. In the sections that follow, I briefly introduce and summarize the methods and study designs used in psychiatric genetics. I will then review in more detail the status of genetic studies of PTSD, MDD, and anxiety disorders, including evidence that the heritable component of these disorders overlaps and is shared to varying degrees with other disorders. Finally, I will discuss prospects for clinical translation of these findings and future directions for research.     

Pathological Gambling,Eating Disorders,and the Psychoactive Substance Use Disorders

Both pathological gambling disease and eating disorders have been conceptualized as addictive diseases, comparable to alcoholism and other drug dependencies. This paper briefly reviews both pathological gambling and the eating disorders, stressing their epidemiology and their overlap with psychoactive substance use and other psychiatric disorders. Common factors in the natural history and treatment of these disorders are also discussed.     

Comorbidity of Addictive and Psychiatric Disorders

No abstract available for this article.     

Oxidative Stress and Psychological Disorders

Oxidative stress is an imbalance between cellular production of reactive oxygen species and the counteracting antioxidant mechanisms. The brain with its high oxygen consumption and a lipid-rich environment is considered highly susceptible to oxidative stress or redox imbalances. Therefore, the fact that oxidative stress is implicated in several mental disorders including depression, anxiety disorders, schizophrenia and bipolar disorder, is not surprising. Although several elegant studies have established a link between oxidative stress and psychiatric disorders, the causal relationship between oxidative stress and psychiatric diseases is not fully determined. Another critical aspect that needs much attention and effort is our understanding of the association between cellular oxidative stress and emotional stress. This review examines some of the recent discoveries that link oxidative status with anxiety, depression, schizophrenia and bipolar disorder. A discussion of published results and questions that currently exist in the field regarding a causal relationship between oxidative and emotional stress is also provided.     

Academy for Eating Disorders International Conference on Eating Disorders

The focus of this meeting was the interface between eating disorders and obesity. A symposium at this meeting dealt with advances in treatment for bulimia nervosa (BN) and binge eating disorder. There were two presentations in this symposium that addressed pharmacological treatments. One reviewed drug treatments for BN, which included reviewing the evidence for the efficacy of tricyclic antidepressants, monoamine oxidase inhibitors and selective serotonin inhibitors in the treatment of BN. All drug studies demonstrated greater reduction in binge eating and purging than with placebo. Other medications studied without evidence of efficacy for BN include opiate antagonists, lithium and anticonvulsants. Two promising agents for BN that require further study are odansitron and topiramate. For binge eating disorder, studies have examined the efficacy of antidepressants (tricyclic antidepressants, selective serotonin re-uptake inhibitors and serotonin/noradrenaline re-uptake inhibitors), antiobesity agents (sibutramine) and antiepileptics associated with weight loss (topiramate), with some evidence of efficacy for these agents.