惊恐障碍的表现及治疗

惊恐障碍又称为惊恐症，是一种急性的焦虑性障碍。根据美国精神卫生研究院流行病学规划区的调查(ECA)，惊恐障碍的终生患病率是1．6％，女性明显高于男性(根据天津市的调查，女性患者高于男性患者的10倍多)。本病的病因尚未明确，遗传、体内的生化(乳酸盐、神经递质和受体)变化、人脑的某些部位(如脑干、边缘系等)、脑电生理和心理机制均可能与惊恐发作的产生有关；但迄今对于本症的病因尚无统一、明确和公认的观点。     

惊恐障碍的临床表现与治疗策略

目的：探讨惊恐障碍的常见临床表现及治疗策略。方法：对国外近期对惊恐障碍的研究文献进行综述。结果：惊恐障碍的常见表现为高度恐惧、人格解体、现实解体，以及心脏、神经系统、胃肠道系统、呼吸系统的躯体症状，并容易引起误诊。目前常用的药物为高效苯二氮Ｚｈｕｏ类，抗抑郁剂及其他制剂。同时可以配合认知行为治疗。结论：该病临床表现包括精神及躯体症状，容易引起误诊，可予以药物及心理治疗。     

惊恐障碍不期而至

林女士算得上是个新潮人物,早就有了私家车,工作、生活因此倍感方便,还常常有一种自豪感和满足感。但是,从去年开始,她突然对开车产生了莫名的恐惧感。三次惊魂心感不解有一次晚上在开车回家的路上,她突然感到有点头晕,继而心快速跳了起来,头上直冒冷汗。林女士马上将车子就近停了下来,双手无力地放在方向盘上,阵阵莫名恐惧油然而生,非常担心就此一命归天。她连忙打电话给丈夫, 丈夫心急如焚地赶了过来,驾车送林女士到附近的一所医院挂急诊。医生检查后,没有发现什么问题。     

赛乐特治疗惊恐障碍临床观察

惊恐障碍（PD）又称间歇发作性焦虑，临床表现为严重焦虑的反复发作，多伴有濒死感、将发疯感或将失控感等。赛乐特的主要成分是盐酸帕罗西汀，是强力、高度选择性的五羟色胺再摄取抑制剂（SSRI），具有抗抑郁和抗焦虑双重作用。笔者对2005年7月-2006年7月来我院治疗的42例PD患者以赛乐特治疗，观察其有效性和安全性。     

电针与帕罗西汀治疗惊恐障碍的临床疗效

目的 比较电针疗法与帕罗西汀片治疗惊恐障碍的疗效和安全性。方法 将59例随机分为电针组(30例)和帕罗西汀组(29例),疗程为4周。在治疗前及治疗1、2、4、8周时采用焦虑自评量表(SAS)、汉密尔顿抑郁量表(HAMA)、疗效指数(CGI-EI)、Barthel指数(BI)量表评定疗效和不良反应。结果 电针组总有效率为86.66%,帕罗西汀组为82.76%,两组疗效差异无统计学意义;疗效指数及起效时间两组间有显著差异,电针组起效时间短、不良反应少。结论 两种方法治疗惊恐障碍疗效相当,但电针疗法起效时间短、疗效指数高、不良反应少。     

惊恐障碍的病因及治疗进展

惊恐障碍是一种临床常见的精神障碍,严重影响患者的生活质量。其发病机制目前尚未有定论,治疗方案也不十分成熟。本文综述了惊恐障碍的发病机制及治疗的研究进展,其发病与生物、心理、社会等因素密切相关,治疗主要采用药物治疗、认知行为治疗以及综合治疗。     

米氮平结合认知行为疗法治疗惊恐障碍

目的 评价米氮平结合认知行为疗法治疗惊恐障碍的临床疗效、治疗依从性和复发、复燃情况.方法 73例惊恐障碍患者随机分成两组,研究组口服米氮平30mg/晚,合并认知行为治疗;对照组单纯口服米氮平30mg,晚,疗程为12周.采用汉密尔顿焦虑量表(HAMA)评定疗效,分别于治疗前、治疗后第2,4,8.12周末各评定1次;1年后随访.结果 治疗第12周末,研究组显效率91.9%(34/37),有效率100%(37/37);对照组显效率69.4%(25/36),有效率88.9%(32/36);两组间显效率、有效率比较分别为:X2=5.932,P=0.015;X2=4.349,P=0.037;治疗第4、8、12周末,两组间HAMA总分差异非常显著(P<0.001);1年后随访,研究组有4例擅自减药或停药,对照组有11例擅自减药或停药,两组间治疗依从性比较:X2=4.357,P=0.037;两组间复发、复燃比较:研究组复发2例;对照组复发4例,复燃4例,X2=4.365,P=0.037.结论 米氮平合并认知行为疗法治疗惊恐障碍比单用米氮平治疗惊恐障碍的近期和远期疗效均更好,起效更快,依从性更好,复发率更低.     

文拉法辛治疗惊恐障碍疗效分析

目的 对比分析文拉法辛治疗惊恐障碍的治疗效果.方法 随机设观察组(44例)和对照组(40例),并对两组进行汉密尔顿焦虑量表(HAMA)、临床总体印象量表(CGI)、不良反应量表(TESTS)和国内统一四级疗效评定和比较.结果 两组间HAMA治疗前和治疗后4周末均P＞0.05,治疗后1周末和2周末均P＜0.01;治疗后4周末与治疗前两组HAMA均降分明显,均P＜0.01.两组疗效构成比的比较,P＞0.05.结论 文拉法辛具有快速、有效和不良反应相对轻微的特点,治疗依从性较好,可以作为治疗惊恐障碍的首选药物.     

帕罗西汀合并认知行为疗法治疗惊恐障碍

目的观察帕罗西汀合并认知行为疗法对惊恐障碍的治疗效果。方法对符合CCMD-11～R诊断标准的28例惊恐障碍患者给每晨饭后20-40mg的帕罗西汀连续治疗6个月,同时给予认知行为治疗,按临床疗效判定标准定期评定。结果1个月显效者占21．4％,好转占64．3％,无效占14．3％;3个月显效者占71．4％,好转占28．6％,半年时显效者占85．7％,好转者占14．3％。21．4％患者在治疗中出现轻微的副作用,随时间延长而消失。结论帕罗西汀合并认知行为治疗能明显缩短疗程,减少医疗开支,安全性高,依从性好。     

文拉法辛与帕罗西汀治疗惊恐障碍的疗效研究

目的：比较分析文拉法辛与帕罗西汀治疗惊恐障碍的疗效、不良反应。方法分别采用汉密尔顿焦虑量表及抗抑郁药不良反应评定量表,分析2013年2月～2014年10月就诊我院的77名惊恐障碍,随机分为文拉法辛组、帕罗西汀组,评估患者用药前后焦虑情绪变化及不良反应情况,观察两种药物治疗惊恐障碍的疗效及主要不良反应。结果惊恐障碍患者用药8周前后,两组总有效率（91．8％,91．4％）及无效率（8．1％,8．5％）,患者焦虑情绪缓解明显,但两组比较效果无显著差别。两种药物不良反应以胃肠道不适,头晕、乏力为主。两组不良反应发生率无显著差别（21．6％,20．0％）。结论惊恐障碍患者服用文拉法辛、帕罗西汀后焦虑情绪缓解明显,不良反应较轻。     

Epidemiology of Panic Disorder

International community surveys generally agree that panic disorder occurs in adults with a lifetime prevalence of up to 3 per cent and a 6-month or 1-year prevalence of about 1 per cent. Although all sociodemographic groups are affected, panic disorder is most prevalent in women, people under the age of 50 years, people who are divorced or separated and those who live in an urban area. Aetiological factors include familial and genetic aspects, and developmental variables, such as parental loss and separation during childhood, stressful life events and social environmental difficulties. A major problem associated with panic disorder is risk of suicide. © 1997 John Wiley & Sons, Ltd.     

Drug Treatment of Panic Disorder

Abstract: Drug treatment of panic disorder is reviewed with focus on recent controlled studies. The efficacy of alprazolam, a triazolobenzodiazepine, and imipramine, a tricyclic antidepressant, has consistently been demonstrated, but there is reasonable evidence that other benzodiazepines or antidepressants might also be effective if equipotent doses are used. Most controlled studies demonstrate drug efficacy on several psychopathological symptoms, including the core symptom panic attacks. Limited evidence indicates that alprazolam may be more efficacious in treating panic attacks than avoidance behaviour, and the reverse when imipramine is concerned. Drug efficacy appears to be most consistently documented in moderately to severely ill panic patients. The benzodiazepines are better tolerated than antidepressants in terms of patient acceptance, and the improvement sets in faster with benzodiazepines. In the presence of depressive symptoms considered secondary to panic attacks and/or agoraphobia, both types of drugs appear efficacious. Difficulty discontinuing high-dose benzodiazepine treatment remains the most important side effect of the treatment but sedation can, like anticholinergic side effects of the tricyclic antidepressants, be troublesome, thereby diminishing patient compliance. The role of newly developed antidepressants with a more specific mode of action and milder side effects awaits evaluation in controlled trials.     

The Place of Selective Serotonin Reuptake Inhibitors in the Treatment of Panic Disorder

Panic disorder is a frequently chronic condition with extensive patterns of psychiatric comorbidity. Optimum pharmacotherapy with traditional agents is limited by side effects, long-term tolerability, and other problems. Recent research findings support the characterization of panic disorder as an illness involving derangements of central serotonergic function. Selective serotonin reuptake inhibitors could become first-line treatment of the disorder, as they seem to have fewer side effects than tricyclic antidepressants and benzodiazepines.     

Suspected Causal Association Between Cocaine Use and Occurrence of Panic

Aim: To estimate a suspected causal association between cocaine use and the occurrence of panic. Methods: Data are from an epidemiologic sample of school-attending youths enrolled in primary school who were traced, rerecruited, and assessed via standardized interviews in young adulthood during 2000–2002. A total of 1,692 young adults comprised the analysis sample. Occurrences of panic and cocaine use were assessed in young adulthood, via standardized item sets from the Diagnostic Interview Schedule. A brief assessment of panic experiences had also been made when the youths were in early adolescence. Results: With statistical adjustment for important covariates, we found a modestly excess occurrence of panic attack-like experiences among those who had used cocaine at least once, relative to occurrence among young people who never had used cocaine (estimated odds ratio, OR = 1.9; p = .014 before exclusion of 288 with early onset panic attack-like experiences; p = .005 after this exclusion). Discussion: The main finding of this study was an association linking cocaine use and panic attack-like experiences, which was more modest than was observed in study samples that included older adults.     

耳硬化症的HRCT表现

目的明确耳硬化症的高分辨率CT（HRCT）表现，评价HRCT的应用价值。方法收集经手术病理证实为耳硬化症13例，所有病例均行水平位及冠状位HRCT扫描。结果13例共26耳显示异常。①仅前庭窗异常12耳，表现为前庭窗扩大或狭小；②主要累及耳蜗周围迷路骨质8耳，表现为耳蜗骨迷路边缘不整，呈条片状密度减低或呈双环状改变；③耳蜗、前庭窗同时受累6耳。结论高分辨率CT能清晰显示耳硬化症病变的范围及程度，提供详细的术前诊断信息，为临床制定合适的手术计划提供了帮助。