合并小剂量奥氮平治疗躯体形式障碍的对照研究

目的探讨合并小剂量奥氮平对躯体形式障碍的治疗作用。方法将97例躯体形式障碍患者随机分成帕罗西汀组48例及帕罗西汀合用奥氮平组49例,于治疗前、治疗后1,2,4,6周末采用汉密尔顿焦虑量表（HAMD）、SCL-90（躯体化、抑郁、焦虑三个因子）评定疗效,用不良反应量表（TESS）在治疗后1,2,4,6周末评定副反应。结果合用小剂量奥氮平组疗效显著,两组间痊愈率（48．98％vs22．92％,P〈0．05）、治疗后2、4、6周末HAMD评分及SCL-903个因子评分差异有显著性。TESS评分两组无明显差异,1年内的复发率无明显差异（8．16％vs10．42％,P〉0．05）。结论合用小剂量奥氮平治疗躯体形式障碍可提高疗效,起效快,但不降低复发率。     

帕罗西汀联合电针经络氧治疗躯体形式障碍的疗效观察

目的观察帕罗西汀联合电针经络氧与单用帕罗西汀治疗躯体形式障碍的临床疗效差别。方法68例躯体形式障碍患者随机分为研究组（帕罗西汀联合电针经络氧治疗）和对照组（单用帕罗西汀治疗）。于治疗前及治疗后第1、2、4周末用症状自评量表（SCL-90）躯体化因子分和汉密尔顿抑郁量表（HAMD）分评定疗效。结果治疗后两组SCL-90躯体化因子分、HAMD总分较治疗前明显较少,差异有显著性（P〈0.01）;4周后,研究组有效率82.4%,对照组52.9%,差异有显著性（P〈0.01）,从第一周末开始,研究组SCL-90中躯体化因子分即明显低于对照组（P〈0.05）、第2周末开始研究组HAMD总分亦明显低于对照组（P〈0.05）。结论帕罗西汀联合电针经络氧比单用帕罗西汀治疗躯体形式障碍起效更快、疗效更佳。     

脑电生物反馈治疗躯体形式障碍的对照研究

目的 研究脑电生物反馈治疗躯体形式障碍的安全有效性.方法 入组54例患者随机分为研究组（帕罗西汀联合脑电生物反馈治疗）和对照组（单用帕罗西汀治疗）,治疗6周;采用症状自评量表（SCL-90）评定疗效,副反应量表（ TESS） 评定不良反应.结果治疗后2组SCL-90躯体化、抑郁、焦虑、恐怖、强迫各因子分较治疗前明显减少,研究组SCL-90躯体化、抑郁、焦虑因子分明显低于对照组（P＜0.05）,2组各时期TESS评分比较差异无统计学意义（P＞0.05）.结论脑电生物反馈治疗联合帕罗西汀治疗躯体形式障碍疗效更为显著,不增加不良反应.     

度洛西汀、米氮平、帕罗西汀与阿米替林治疗伴躯体症状抑郁症的对照研究

目的探讨度洛西汀、米氮平、帕罗西汀与阿米替林治疗伴躯体症状抑郁症的疗效和安全性。方法将符合国际疾病分类第10版（ICD一10）诊断标准的伴躯体症状的抑郁症患者117例,随机分为4组,分别给予度洛西汀、米氮平、帕罗西汀与阿米替林治疗,疗程8周。采用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）和副反应量表（TESS）评定疗效及不良反应。结果4组药物均能迅速起效,第2周末HAMD、HAMA评分较治疗前差异有统计学意义（P〈0．05）,治疗8周后,4组闯疗效无统计学意义（P〉0．05）,4组HAMD、HAMA评分较治疗前有统计学意义（P〈0．01）,4个治疗组不良反应有统计学意义（P．〈0．01）。结论治疗伴躯体症状的抑郁症,四药总体疗效相似,均起效较快,度洛西汀、米氮平和帕罗西汀不良反应相对少,依从性好。提示四种药物均为治疗伴躯体症状的抑郁症一线药物,度洛西汀、米氮平和帕罗西汀值得临床推广。     

米氮平与氟西汀治疗脑卒中后抑郁焦虑障碍对照研究

目的评价米氮平与氟西汀对脑卒中后抑郁焦虑障碍的疗效和副反应。方法53例脑卒中后抑郁焦虑患者随机分为两组,分别以米氮平及氟西汀治疗。疗程6周。于治疗前、治疗后1、2、4、6周末采用汉米尔顿抑郁量表（HAMD）、汉米尔顿焦虑量表（HAMA）、副反应量表（TESS）评定疗效和副反应。结果米氮平组显效率为74．199／6,氟西汀组为50％,差异有显著性（χ^2=3．91,P〈0．05）。米氮平组起效快。两组HAMA总分和HAMD在焦虑／躯体化、睡眠障碍因子分方面差异有显著性（P〈0．05）。米氮平组的不良反应较氟西汀组少而轻。结论米氮平治疗脑卒中后抑郁焦虑障碍起效快、安全、疗效肯定,是临床治疗中可选用的方法之一。     

意象对话技术联合文拉法辛治疗躯体形式障碍研究

目的探讨意象对话技术联合文拉法辛治疗躯体形式障碍的疗效及安全性。方法将60例躯体形式障碍患者随机分为意象对话技术联合文拉法辛治疗组（研究组）和文拉法辛治疗组（对照组）,每组各30例。均进行为期6周的治疗。于治疗前及治疗后2、4、6周末进行HAMA、HAMD、CMI、DSQ及SF-36测评,以HAMD减分率判定临床疗效,以TESS评定不良反应。结果治疗6周末,研究组痊愈9例,显效13例,好转7例,无效1例,总有效率96．67％;对照组痊愈7例,显效9例,好转10例,无效4例,总有效率86．67％,两组间总有效率比较差异具有统计学意义（P〈0．05）。与治疗前比较：在第2,4,6周末HAMA和HAMD研究组和对照组总分及CMI研究组总分明显下降,差异有统计学意义（P〈0．05）。在第2,4,6周末研究组DSQ不成熟防御机制、成熟机制两个因子及SF-366个因子得分差异有统计学意义（P〈0．05）,在第4及6周末对照组不成熟防御机制、成熟机制、生理机能及躯体疼痛几个因子得分差异有统计学意义（P〈0．05）,在第2,4,6周末对照组一般健康状况、社会功能、情感职能及精神健康四个方面得分差异有统计学意义（P〈0．05）。两组间比较：在2,4,6周末两组HAMA、HAMD、CMI、DSQ及SF-36各因子得分比较差异均有统计学意义（P〈0．05）。不良反应轻微。结论意象对话技术联合文拉法辛治疗躯体形式障碍疗效显著,安全性高。     

半夏泻心汤合并帕罗西汀治疗女性躯体形式障碍对照研究

目的 探讨半夏泻心汤合并帕罗西汀治疗躯体形式障碍女性患者的疗效及安全性.方法 将66例躯体形式障碍女性患者随机分为研究组（32例）和对照组（34例）,研究组患者接受半夏泻心汤合并帕罗西汀系统治疗,对照组患者接受帕罗西汀系统治疗,共治疗6周.所有入组患者在基线及治疗后第1、2、4、6周末应用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）和治疗中需处理的不良反应症状量表（TESS）评估疗效和安全性.结果 治疗后第2周末起,研究组患者HAMD评分较基线时显著降低（P＜0.05）,而在治疗后第4周末起,对照组患者的HAMD评分较基线时才有显著降低（P＜0.01）.治疗后第2周末起,研究组患者HAMD评分显著低于对照组（P＜0.01）.治疗后第2周末起,两组患者的HAMA评分均较基线时显著降低（P＜0.05）.治疗后第1周末,研究组患者的TESS评分高于对照组（P＜0.05）,其他时间点两组间TESS评分无显著性差异（P＞0.05）.经6周治疗研究组显效率显著高于对照组（81.25％∶52.94％,X2=8.47,P＜0.05）.结论 半夏泻心汤合并帕罗西汀可有效治疗躯体形式障碍女性患者,起效更快,安全性较高.     

帕罗西汀联合奥氮平改善以怕冷为主的躯体形式障碍临床观察

目的观察帕罗西汀联合奥氮平治疗以怕冷为主的躯体形式障碍的临床疗效。方法采用随机分组的方法,将60例以怕冷为主的躯体形式障碍患者分为2组,每组30例,治疗组给予帕罗西汀20mg.d-1,联合奥氮平5mg.n-1,对照组只给予帕罗西汀20mg.d-1;两组总疗程均为6周。治疗前及治疗后第1、2、4、6周采用症状自评量表(SCL-90)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)作为评定指标。结果两组治疗后SCL-90、HAMD、HAMA评分均较治疗前下降,差异有显著性(P<0.01)。治疗组治疗1周末开始见效,而对照组在第4周末才显效。结论帕罗西汀联合奥氮平治疗以怕冷为主的躯体形式障碍较单用帕罗西汀疗效好,起效快,安全性高,依从性好。     

度洛西汀与氟西汀治疗老年期抑郁症的比较观察

目的比较度洛西汀与氟西汀治疗老年期抑郁症的疗效和安全性。方法将70例老年期抑郁症患者随机分为度洛西汀组（35例）和氟西汀组（35例）,并进行为期6周的治疗观察。分别在治疗的第1、2、4和6周末,采用汉密顿抑郁量表评定其疗效,治疗中出现的症状量表及实验室检查评价安全性。结果两组治疗后HAMD评分均明显低于治疗前,差异有统计学意义（P〈0．01）;治疗后1周末,度洛西汀组HAMD量表总分、焦虑／躯体化、阻滞及睡眠障碍因子评分均较氟西汀组低,且差异有统计学意义（P〈0．05）;治疗结束时,上述指标的组间差异则无统计学意义;经过6周的治疗,有效率和治愈率度洛西汀分别为82．9％和68．6％,氟西汀组分别为80％和65．7％,差异无统计学意义（P〉0．05）;安全性评定两组比较差异无统计学意义（P〉0．05）。结论度洛西汀治疗老年抑郁症有效而安全,且起效时间早于氟西汀。     

舍曲林合并奥氮平治疗躯体形式障碍的临床对照研究

目的观察舍曲林合并奥氮平治疗躯体形式障碍的临床疗效特点。方法将符合入组标准的75例患者随机分为舍曲林合并奥氮平组（研究组）与舍曲林组（对照组），均进行6周系统治疗和观察，分别于治疗前、治疗后第1、2、4、6周末采用汉密顿抑郁量表（HAMD）总评分及其焦虑／躯体化因子和睡眠因子评分加以评定疗效。结果两组HAMD总分在疗后第1、2、6周末有显著性差异（P〈0．05），在疗后第4周末有极显著差异（P〈0.01）；在HAMD因子方面，两组焦虑／躯体化评分在疗后第1、2周末有极显著差异（P〈0．01），在疗后第4周末有显著差异（P〈0．05）；睡眠障碍评分在疗后第1、2、4周末有极显著差异（P〈0．01），在第6周末有显著差异（p〈0．05）。两组显效率在疗后第1、2、4周末有极显著性差异（P〈0．01），在疗后第6周末有显著差异（P〈0．05）。两组患者总体副反应发生率无显著性差异（P〉0．05）。结论舍曲林合并小剂量奥氮平治疗躯体形式障碍不仅起效较快，能迅速改善睡眠及焦虑／躯体化症状，而且明显提高疗效和患者的治疗依从性，却又并不明显增加药物副反应，因此推荐该方法临床试用。     

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.     

Summary of Legislation of 1933 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -