自杀行为患者血小板5-HT浓度

目的 通过测定伴自杀行为的精神病患者血小板5-HT浓度,以探讨其5-HT功能与自杀行为的关系。方法 研究组65例(男21例,女44例);疾病对照组60例(男25例,女35例)。采用HAMD及PANSS评定证状。在治疗前及治疗后6周检测血小板5-HT浓度,采用HPLC及电化学检测仪测定浓度。结果 治疗前两组血小板5-HT浓度的差异无统计意义,治疗后两组差异有统计学意义(P为0.012)。自杀1次与自杀至少2次者之间治疗前血小板5-HT的差异有统计学意义(P为0.035)。治疗后HAMD及PANSS评分的变化与血小板5-HT浓度变化之间无显著相关性。结论 精神疾病伴自杀行为者血小板5-HT浓度未见显著下降。自杀至少2次者的浓度明显降低,提示与1次自杀者之间存在异质性。精神症状的变化与血小板5-HT浓度的变化之间无显著相关性。     

精神分裂症患者5-HT2A受体基因相关因素的研究

目的　分析汉族人 5 HT2A受体基因与精神分裂症易感性之间的关系以及影响患者 5 HT2A受体基因的相关因素。方法　 2 6 9例精神分裂症病人 ,310例正常对照 ,用聚合酶链式反应 (PCR)扩增及限制性片段长度多态性 (RFLPs)技术测定其 5 HT2A受体基因型和等位基因。结果　发现含 5 HT2A受体基因的等位基因A2的精神分裂症患者平均发病年龄明显大于含等位基因A1的患者 ,但 5 HT2A受体基因与精神分裂症的易感性、患者的性别、家族史、症状严重度均无显著相关。结论　 5 HT2A受体基因的等位基因A2可明显推迟精神分裂症患者的发病年龄 ,但 5 HT2A受体基因不影响汉族人精神分裂症的易感性、患者的症状严重度 ,患者 5 HT2A受体基因的频率分布也不受患者的性别、家族聚集性的影响     

伴攻击行为的精神分裂症患者不同性别5-羟色胺水平比较

目的比较有攻击行为的住院精神分裂症患者血清5-羟色胺(5-HT)水平的性别差异及其与正常人群的差异,为精神分裂症攻击行为的防范提供科学依据。方法取入院前及入院3天内有攻击行为的精神分裂症患者为研究组,共110例,其中男性62例,女性48例,选取同期来我院的健康体检者为对照组,共73例,其中男性31例,女性42例。采集静脉血制备血浆后用ELISA试剂盒定量测定各组血浆中5-HT水平,分析各组血浆5-HT水平的差异。结果研究组血清5-HT浓度为(849.90±83.56)ng/ml,对照组为(852.15±82.48)ng/ml,差异无统计学意义(P0.05)。有攻击行为的精神分裂症男性患者血清5-HT浓度为(822.91±84.90)ng/ml,女性患者为(696.99±81.80)ng/ml,差异无统计学意义(P0.05)。结论有攻击行为的精神分裂症患者血清5-HT浓度无性别差异,血清5-HT水平与有攻击行为精神分裂症患者无显著相关。     

5-HT6受体基因多态与精神分裂症患病风险的关联分析

目的探讨5-HT6受体基因多态与中国汉族精神分裂症患病风险的关系。方法入组居住在上海及周边地区的汉族精神分裂症患者333例和健康对照365例,通过TaqMan探针SNP基因分型技术对5-HT6受体基因及基因上游7kb区域的标签SNPs rs3790756和rs4912138进行基因分型,并进行统计分析。结果发现SNPs rs3790756和rs4912138的基因型和等位基因频率分布在精神分裂症病例组和健康对照之间差异未达到统计学意义。进一步进行基因型联合分析,rs3790756和rs4912138共组成7种联合基因型,7种联合基因型在病例组和健康对照组间的分布有显著性差异（χ2=13.5,P〈0.05）,其中rs3790756CC和rs4912138AG组成的联合基因型在病例组和对照组中的频率分别为18.3%和27.1%,相对危险度为0.603（P〈0.05）。结论研究提示5-HT6受体基因多态rs3790756和rs4912138组成的CCAG联合基因型可能与精神分裂症的风险降低有关。     

5-HT2C受体与癫痫的关系

5-HT是人体中枢及外周神经系统重要的神经递质，研究发现它涉及感觉、运动和行为等多种生理活动，分为7个亚族，即5-HT1—5-HT7，5-HT2由5-HT2A、5-HT2B、和5-HT2C三部分组成，5-HT2C受体基因定位于Xq24区，由RNA来修饰调节的G蛋白偶联受体，其主要分布在中枢神经系统，除大量分布在脉络丛外（该位置仅有此一种亚型），还广泛分布在嗅核，梨状核，带状核，后夹肌，边缘系统的伏隔核，海马杏仁核和基底神经节的尾状核和黑质。     

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。     

氟西汀治疗精神分裂症伴发抑郁症状的疗效及其与脑脊液5-HT含量变化的研究

目的观察氟西汀治疗精神分裂症伴发抑郁症状的疗效及其与脑脊液5羟色胺(5HT)含量的关系。方法从住院病人中选择符合CCMD3精神分裂症诊断标准,且汉密尔顿抑郁量表(HAMD)评分(17项)≥17分,年龄18～60岁,无严重躯体疾患的患者112例(治疗组)为研究对象,以30例无精神疾病的一般手术者作对照(对照组)。治疗组在原用抗精神病药物治疗的基础上加用氟西汀口服,20mg/d。疗程8周。于治疗前和治疗后第1、2、4、8周末用HAMD量表评定疗效,同时于治疗前和治疗后第8周末行腰椎穿刺抽取脑脊液,用液相色谱法进行脑脊液5HT含量测定。结果治疗组治疗前脑脊液5HT含量为(124±101)μg/L,明显低于对照组的(257±136)μg/L(P<0.01);治疗前5HT含量与HAMD量表总分呈显著负相关(r=-0.625),治疗后第8周末5HT含量增加到(162±78)μg/L,与治疗前比较有统计学差异(P<0.05),但仍低于对照组(P<0.01);治疗后第8周末5HT含量升高值与HAMD量表总分减分率呈高度正相关(r=0.687)。结论氟西汀对精神分裂症伴发的抑郁症状有较好的疗效,随病情的好转,脑脊液5HT含量也升高。治疗期间未发现严重不良反应。     

伴阴性症状的精神分裂症患者5-HT水平对照研究

目的 探讨精神分裂症患者外周血浆5-羟色胺(5-HT)水平是否与其阴性症状严重程度有关。方法 选取符合《国际疾病分类(第10版)》(ICD-10)精神分裂症诊断标准患者共225名,将阳性和阴性症状量表(PANSS)中阴性症状维度评分≥19分且幻听评分4分者纳入研究组(n=125),PANSS阴性症状维度评分19分且幻听评分≥4分者纳入对照组(n=100)。两组分别于入组次日采集静脉血制备血浆后用酶联免疫吸附法(ELISA)测定各组血浆5-HT水平。结果 两组血浆5-HT水平差异无统计学意义(P0.05),PANSS阴性症状维度评分19~25分组与≥26分组患者血浆5-HT水平差异无统计学意义(P0.05)。结论 精神分裂症患者外周血浆5-HT水平与阴性症状无相关。     

精神分裂症患者的记忆与睡眠的特点研究

目的:探讨精神分裂症患者的记忆与睡眠的特点及两者间的相关性。方法:对40例稳定期精神分裂症患者及40名健康人进行多导睡眠监测(PSG),并进行匹兹堡睡眠质量指数量表(PSQI)、多维记忆评估量表(MMAS)评估;对研究组PSG参数与MMAS评分进行相关性分析。结果:研究组PSG、睡眠效率(SE)、慢波睡眠(SWS)值明显低于对照组;REMsol值、微觉醒次数均明显高于对照组;PSQI评分明显高于对照组;研究组汉词回忆前测评分、图画回忆前测评分、汉词配对评分均明显低于对照组,差异有统计学意义(P0.01)。睡眠参数总睡眠时间(TST)、睡眠效率(SE)、SWS与MMAS评分呈明显正相关(P均0.05)。结论:精神分裂症患者存在记忆功能损害、睡眠障碍的现象;睡眠质量的下降与精神分裂症患者记忆、学习功能的损害密切相关。     

杏仁核毁损对甲基苯丙胺大鼠脑内5-HT2A受体的影响

目的探讨杏仁核毁损对甲基苯丙胺（MAP）大鼠脑内5-HT2A受体表达的影响。方法24只SD大鼠分为对照组、模型组、假手术组和手术组，每组各6只；采用腹腔注射MAP制备精神分裂症模型，立体定向毁损杏仁核，采用Sams-Dodd法评定各组动物刻板行为的变化，以PCR技术测定脑组织中5-HT2A受体mRNA的表达。结果杏仁核毁损可明显降低MAP大鼠刻板行为评分（P〈0．05）。各组大鼠额叶、颞叶皮质和中脑均有5-HT2A受体mNRA（61lbp）的阳性表达，且均以额叶皮质表达最为强烈；模型组及假手术组大鼠中脑5-HT2A受体mRNA受体表达的水平明显低于对照组和手术组（P〈0．05）。结论杏仁核毁损可改善MAP大鼠的刻板行为，这可能是通过中脑5-HT2A受体mRNA表达的增高而起作用。     

The relationship between objective sleep variables and subjective sleep estimation in schizophrenia

AIM: Few investigations of sleep structure in schizophrenia have concentrated on the relationship between objective and subjective sleep variables. The aim of this study was to assess objective sleep variables and subjective estimation of sleep duration and sleep quality. METHODS: Polysomnography was performed in 20 chronic patients with schizophrenia during three consecutive nights. After final awakenings subjects answered questions concerning subjective estimations of sleep duration, sleep latency, number of awakenings, and sleep depth. Pearson correlations between ranged subjective reports and objective sleep variables were performed. RESULTS: The results showed a high positive correlation between objective sleep latency and its subjective estimation; a positive correlation between subjective estimation of sleep depth and percentage of slow wave sleep (SWS%); a positive correlation between eye movement (EM) density and subjective estimation of wakefulness during the night; and a negative correlation between EM density and dream reports. CONCLUSION: We concluded that objective sleep variables are related to subjective sleep estimation in schizophrenic patients. In these patients, EM activity in REM sleep is related to the subjective feeling of wakefulness. (Int J Psych Clin Pract 2000; 4:63-67)     

奎硫平治疗精神分裂症的血药浓度与临床效应关系的研究

目的 探讨奎硫平治疗精神分裂症患者的血药浓度与临床疗效的关系及其临床意义。方法 70例住院精神分裂症患者,男38例,女32例;阳性和阴性症状量表(PANSS)总分≥60分,采用个体化给药,剂量范围(250～600)mg/d,疗程8周。在治疗前和治疗第1,2,4,8周末评定PANSS和治疗中需处理的不良反应症状量表。治疗第1,2,4,8周末以高效液相色谱紫外检测法测定奎硫平的血清浓度。结果 在治疗第2,4周末,血药浓度与服药剂量呈正相关(r=0.248和0.347,P<0.05和P<0.01);血药浓度与PANSS减分率呈正相关(r=0.343和0.499,P<0.05和P<0.01)。有效组的血药浓度高于无效组,分别为(320±142)μg/L和(251±109)μg/L(P<0.01)。奎硫平最低有效浓度为250μg/L,有效组(44例)中75％在此浓度以上,无效组(26例)中80％低于此浓度;最低有效剂量为344 mg/d。结论 奎硫平治疗精神分裂症的疗效与血药浓度有相关性,其最低有效阈浓度为250μg/L,血药浓度测定对指导临床用药具有实际意义。     

精神分裂症患者生活质量与非理性信念的关系研究

目的分析探讨精神分裂症患者生活质量与非理性信念的关系,为认知行为治疗提高患者的生活质量提供理论指导。方法选取符合DSM—IV中精神分裂症诊断标准的医院门诊和住院患者共200例,采用世界卫生组织生存质量测定量表简表（wHOQOL—BREF）和非理性信念量表（IBS）对患者进行测评,收回有效问卷182例,分析患者生活质量与非理性信念的相关性。结果患者生活质量总分及4个因子分与非理性信念的低挫折耐受呈负相关（r分别为-0．348,-0．405,-0．309,-0．256,-0．394;P〈0．01）,与概括化评论呈负相关（r分别为-0．357,-0．401,-0．325,-0．295,-0．413;P〈0．01）。低挫折耐受和概括化评论可以作为总体生活质量和心理因子的预测指标（F分别为21．231,21．015;P〈0．01）;概括化评论可以作为总体生活质量及生理、社会关系、环境因子的预测指标（F分别为15．292,12．020,9．011;P〈0．01）。结论精神分裂症患者的非理性信念影响患者的生活质量的各个层面,非理性信念中的低挫折耐受和概括化评论可作为患者生活质量的预测指标。     

Relationship between hostility and subjective sleep quality

While hostility and sleep disturbance are the potential risk factors for health problems and disease, few studies have examined the relationship between the two factors. The present study was performed to investigate the relationship between hostility and sleep problems assessed both subjectively and objectively in a nonclinical sample. Sixty-one healthy subjects were enrolled in this study. Hostility was measured according to the Cook–Medley hostility scale. Subjective sleep quality was evaluated according to the global score of the Pittsburgh Sleep Quality Index. Objective sleep was evaluated using actigraphy. A multiple regression analysis revealed that a higher level of hostility was significantly associated with the global score of the Pittsburgh Sleep Quality Index and that a higher level of depression was not associated with the global score of the Pittsburgh Sleep Quality Index. Objective sleep measures were not found to be associated with hostility. Confirming the robust relationship between poor sleep and hostility would have several important treatment implications for preventing health problems.     

精神分裂症患者氯丙嗪治疗前后血小板聚集功能观察

目的 探讨精神分裂症患者血小板聚集功能及氯丙嗪治疗对血小板聚集功能的影响。方法 对３３例首次住院的男性精神分裂症患者氯丙嗪治疗前后进行ＢＰＲＳ评定及肾上腺素致聚下的血小板聚集功能检测,并与５５名正常对照相比较。结果 精神分裂症患者血小板１分钟聚集率（ＰＡＲ１）、５分钟聚集率（ＰＡＲ５）显著高于对照组（Ｐ〈０．０５,Ｐ〈０．０１）;用氯丙嗪治疗１个月后,患者临床症状缓解,ＢＰＲＳ评定分值下降（Ｐ〈０．０１）,血小板聚集功能ＰＡＲ１无显著性改变（Ｐ〉０．０５）,ＰＡＲ５明显升高（Ｐ〈０．０１）。结论 精神分裂症患者血小板聚集功能增强;氯丙嗪治疗可导致血小板的激活状态。     

Decreased platelet peripheral-type benzodiazepine receptors in persistently violent schizophrenia patients

Peripheral-type benzodiazepine receptors (PBR) have been shown to be sensitive to stressful conditions. This study aimed to explore a possible association of platelets PBR binding with aggressive behavior and homicidal history in schizophrenia patients. The authors compared [³H] PK 11195 binding to platelet membrane among 11 currently aggressive schizophrenia patients, 15 schizophrenia patients with homicidal history, 14 nonaggressive schizophrenia patients, and 15 healthy volunteers. Subjects were assessed for aggressive behavior, psychopathology, anxiety, anger, and emotional distress using standardized instruments. We found that currently aggressive patients had significantly lower (−30%) platelet PBR density (B_max), and scored significantly higher on hostility, anxiety, state anger, and emotional distress compared to homicidal and nonaggressive schizophrenia patients and healthy controls. Predominance of positive or negative symptoms, homicidal or suicidal attempt history, emotional distress levels, and conventional or atypical antipsychotic therapy is not associated with the expression of platelet PBR binding sites. Significant negative correlations emerged between PBR density and scores for aggressive behavior, hostility and anxiety. Thus, decreased platelet PBR density in aggressive schizophrenia patients is associated with higher scores for overt aggression, hostility and anxiety, but independent of illness subtype, homicidal and suicidal attempt history, distress level and type of antipsychotic treatment.     

Sleep quality and cognitive impairments in remitted patients with schizophrenia in Nigeria

BackgroundDespite the ubiquity of sleep disturbance in schizophrenia, it has generally been overlooked as a potential contributor to cognitive impairments. The main aim of this study was to find out if impaired sleep quality contributes to cognitive impairments in patients with a diagnosis of schizophrenia who are in remission.MethodsThe study was conducted at the University College Hospital, Ibadan and State Hospital, Ibadan, Nigeria. The Pittsburgh Sleep Quality Index (PSQI) and Screen for Cognitive Impairment in Psychiatry (SCIP) were applied in this cross-sectional study, to all consecutive and consenting remitted outpatients with schizophrenia (N = 130). Other instruments such as Hamilton Depression Rating Scale (HDRS), the Positive and Negative Syndrome Scale (PANSS), sociodemographic and clinical measures were also applied.ResultsThere were 130 participants made up of 69 females (53.1%) and 61males(46.9%). The mean age of the participants was 38.5 ± 9.1 years. The prevalence of poor sleep quality in remitted patients with schizophrenia was 56.9%. Sleep quality was significantly negatively correlated with Verbal Learning Test-Immediate (VLT-I) (r(128) = -.18, P = .044) and Verbal Learning Test-Delayed (VLT-D) (r(128) = -.18, P = .037). The variables that independently predicted cognitive functioning were the VLT-I, odds ratio (OR) 0.66; 95% confidence interval ((CI) 0.49-0.88) and education (OR) 0.61;(CI) 0.40- 0.92).ConclusionPoor subjective sleep quality measured by the PSQI is linked to cognitive impairment in remitted patients with schizophrenia. We suggest that sleep quality in remitted patients with a diagnosis of schizophrenia should receive better attention by physicians.     

伴失眠的缓解期抑郁症患者客观睡眠质量与认知功能的关系

目的 探讨伴失眠的缓解期抑郁症患者客观睡眠质量与认知功能的关系。方法 在北京回龙观医院筛选缓解期抑郁症患者47例,采用失眠严重程度指数量表（ISI）和匹兹堡睡眠质量指数量表（PSQI）前四项计算的睡眠效率对患者进行分组,最终伴失眠组22例,不伴失眠组25例。通过多导睡眠监测（PSG）评定患者客观睡眠情况,采用重复性成套神经心理状态测验（RBANS）评定患者认知功能。建立回归模型探究伴失眠的缓解期抑郁症患者客观睡眠质量与认知功能的关系。结果伴失眠与不伴失眠的缓解期抑郁症患者RBANS即刻记忆因子评分差异有统计学意义（t=-2.102,P<0.05）。伴失眠组的睡眠效率（Z=-2.113,P<0.05）、N3期占比（Z=-3.175,P<0.01）和N3期持续时间（Z=-3.196,P<0.01）均小于不伴失眠组,夜间总清醒时间（Z=-2.058,P<0.05）、N1期占比（Z=-2.399,P<0.05）和N1期持续时间（Z=-2.463,P<0.05）均多于不伴失眠组。伴失眠组REM期占比增加与注意功能的改善相关（β=0.953,95%CI:0...     

精神分裂症的睡眠脑电图研究进展

精神分裂症是一组病因未明的精神疾病,多起病于青壮年,常有感知、思维、情感、行为等多方面的障碍和精神活动不协调,病程多迁延［1］。睡眠障碍往往是精神分裂症的先兆症状和伴随症状,睡眠质量的好坏也常常影响病情的转归［2］。多导睡眠图（Polysomnogram ,PSG ）是评估睡眠质量的重要手段,可以用来探讨药物、心理治疗、物理治疗等治疗手段对睡眠的影响［3］。既往研究对精神分裂症患者睡眠脑电图的改变进行了探讨,主要包括睡眠结构、慢波睡眠（SWS ）、睡眠纺锤波、K 复合波和睡眠δ波,希望找到精神分裂症患者睡眠参数的改变与神经生理学、精神病理学之间的关系,继而确定睡眠脑电图改变与精神分裂症之间的相关性,找到精神分裂症的生物学标记,为精神分裂症的诊断和治疗提供依据。