长春西汀联合氟西汀治疗脑卒中后抑郁症的研究

目的观察长春西汀联合氟西汀治疗脑卒中后抑郁症的临床疗效,初步探讨其作用机制。方法选择临床确诊为脑卒中后抑郁症患者120例,采用随机对照方法,分为长春西汀联合氟西汀治疗组（观察组）与氟西汀治疗组（对照组）,每组60例,疗程4周。治疗前及治疗2、4周后通过神经功能缺损评分（NIHSS）以及汉密尔顿抑郁量表（HAMD）评定疗效。采用荧光分光光度计法测定血清单胺类递质的水平。结果治疗2、4周末,观察组和对照组经HAMD及NIHSs评分比较,治疗前两组评分均下降（P〈0．05）;且观察组低于对照组（P〈0．05）。观察组总体疗效优于对照组（P〈0．05）。治疗前两组血清NE、DA、5-HT含量差异无统计学意义;治疗2、4周末,与治疗前相比,两组血清NE、DA、5-HT含量均有升高（P〈0．05）,且观察组高于对照组（P〈0．05）。在用药安全性上,两组中治疗前后均未出现明显不良事件。结论长春西汀联合氟西汀治疗脑卒中后抑郁症能显著提高脑卒中后抑郁症患者的疗效,且无明显不良反应。作用机制可能与提高血清单胺类神经递质水平有关。     

文拉法辛缓释片对癫痫伴抑郁障碍患者血清DA、5-HT和炎症因子水平影响

目的探讨文拉法辛缓释片治疗对癫痫性抑郁障碍患者血清DA、5-HT和炎症因子水平的影响。方法收集2013年1月~2015年12月期间我院收住的癫痫性抑郁障碍患者92例,按照随机数字表法随机分为观察组46例与对照组46例。在抗癫痫药物治疗的基础上,对照组加用盐酸氟西汀胶囊治疗,观察组加用文拉法辛缓释片治疗,两组疗程均为8周。观察比较两组患者治疗前后血清DA、5-HT和炎症因子水平。结果 (1)治疗前后两组患者的HAMA和HAMD评分差异均无统计学意义(P0.05);且治疗后两组患者的评分均较治疗前明显降低(P0.05);(2)与治疗前相比,治疗后两组患者血清DA和5-HT水平明显升高,IL~(-1)β和IL-4水平明显降低(P0.05);且与对照组相比,治疗后观察组患者的血清5-HT水平明显升高,IL~(-1)β和IL-4水平明显降低(P0.05);(3)两组均未见严重药物不良反应。结论文拉法辛缓释片治疗癫痫性抑郁障碍患者疗效显著,与氟西汀相当,其可能通过升高5HT水平、降低IL~(-1)β和IL-4水平来发挥作用。     

音乐运动疗法联合文拉法辛缓释片治疗产褥期抑郁患者的随访观察

目的分析音乐运动疗法联合盐酸文拉法辛对产褥期抑郁症患者的效果。方法选取2015年2月～2018年8月我院收治的56例产褥期抑郁症患者,简单随机化分组,对照组(28例)给予盐酸文拉法辛缓释片治疗,观察组(28例)给予音乐运动疗法联合盐酸文拉法辛缓释片治疗,比较两组汉密尔顿抑郁量表评分(HAMD)、血浆白介素-6(IL-6)、促肾上腺皮质激素释放激素(CRH)、5-羟色胺(5-HT)水平和不良反应发生情况。结果观察组治疗1周后、治疗2周后、治疗4周后、治疗8周后HAMD评分均低于对照组(P0.05);观察组治疗8周后血浆IL-6、CRH水平低于对照组,5-HT高于对照组(P0.05);观察组虚弱/疲倦、消化系统、出汗不良反应发生率(7.14%、14.29%、17.86%)与对照组(10.71%、10.71%、14.29%)相比无明显差异(P0.05);观察组失眠发生率(7.14%)低于对照组(32.14%)(P0.05)。结论音乐运动疗法联合盐酸文拉法辛更能改善产褥期抑郁症患者的抑郁情绪,改善神经、内分泌指标,减少失眠发生。     

文拉法辛对抑郁症患者脑脊液5-HT和NE的影响及其与疗效的关系

目的观察文拉法辛对抑郁症患者脑脊液5-羟色胺(5-HT)和去甲肾上腺素(NE)含量的影响及其与疗效的关系。方法选择符合中国精神障碍分类与诊断标准第3版(CCMD-3)中抑郁症诊断标准的患者126例(患者组),并选择48例无精神疾病的一般手术者作对照(对照组),患者组单用文拉法辛治疗8周,于治疗前和治疗后第1、2、4、6、8周末用汉密顿抑郁量表(HAMD)评定疗效,并于治疗前和治疗后第8周末用液相色谱法检测脑脊液5-HT和NE含量,将治疗前的5-HT、NE含量与对照组进行对比,比较患者组治疗前后的5-HT、NE含量并与HAMD量表总分进行相关分析。结果患者组治疗前脑脊液5-HT和NE含量分别为(136±112)μg/L和(421±125)μg/L,均低于对照组的(249±141)μg/L和(673±158)μg/L(P均小于0.01);治疗前5-HT、NE含量与HAMD量表总分均呈显著负相关(r为-0.689和-0.761),治疗后第8周末5-HT和NE均增加,分别为(154±99)μg/L和(449±128)μg/L,均显著高于治疗前(P均小于0.01),NE含量与对照组无显著差异(P>0.05),但5-HT含量仍低于对照组(P<0.05)。第8周末的5-HT、NE含量升高值与HAMD量表减分率均呈高度正相关(r为0.724和0.661)。结论文拉法辛治疗抑郁症,随精神症状的好转,脑脊液5-HT和NE含量均显著升高,且与HAMD量表减分率均呈高度正相关。     

文拉法辛与帕罗西汀治疗首发抑郁症对照研究

目的:评价文拉法辛与帕罗西汀治疗首发抑郁症的疗效、生存质量与不良反应. 方法:106例首发抑郁症患者随机平分为文拉法辛组和帕罗西汀组,每组53例.两组分别给予文拉法辛与帕罗西汀治疗,疗程8周.采用汉密尔顿抑郁量表(HAMD)、健康状况问卷(SF-36)及治疗中出现的症状量表(TESS)评定疗效、生存质量及不良反应. 结果:治疗后两组HAMD评分均较治疗前有显著降低(P<0.01);治疗2周,以文拉法辛组显著较低(P<0.01);两组中的重度抑郁患者(HAMD>24分)治疗后HAMD评分仍以文拉法辛组显著为低(P<0.01);治疗8周,两组SF-36总分及各因子分均显著高于治疗前(P<0.01);但两组间比较差异无统计学意义(P>0.05). 结论:文拉法辛能显著改善患者的生存质量,起效快,对重度抑郁症的疗效明显.     

文拉法辛与氟西汀门诊治疗伴躯体症状的抑郁症对照研究

目的比较文拉法辛与氟西汀的抗抑郁效果及不良反应。方法随机将60例符合CCMD-3情感性精神障碍(抑郁发作)诊断标准的患者分为文拉法辛组(30例)和氟西汀组(30例)。疗程6周。在0、1、2、4、6周评定汉密尔顿抑郁量表(HAMD,17项),并评定疗效、记录出现的不良反应。结果文拉法辛组从疗后第1周HAMD评分开始显著下降,而氟西汀组从疗后第2周HAMD评分才显著下降;治疗6周后,文拉法辛的临床治愈率显著高于氟西汀(分别为66.7%和36.7%)。两组患者的不良反应相似,差异无显著性(P>0.05)。结论文拉法辛较氟西汀起效快,临床治愈率高。     

长春西汀对抑郁症的辅助治疗作用

目的：探讨文拉法辛联合长春西汀对复发性抑郁症的疗效和不良反应。方法：复发性抑郁症患者78例，按就诊及确诊顺序编号，单号为合用组（文拉法辛联合长春西汀）;双号为单用组（单用文拉法辛）。疗程4周。采用汉密尔顿抑郁量表（HAMD）和治疗中出现的症状量表（TESS）评定疗效和不良反应。结果：两组HAMD评分均较治疗前显著下降（P〈0.01）;治疗4周，以合用组HAMD评分显著低于单用组（P〈0.01或P〈0.05）。两组不良反应差异无显著性（P〉0.05）。结论：文拉法辛联合长春西汀治疗抑郁症的效果优于单用文拉法辛，长春西汀对复发性抑郁症有辅助治疗作用。     

文拉法辛缓释片治疗抑郁症临床对照观察

目的:评价文法拉辛缓释片治疗抑郁症的疗效与安全性。方法:将73例抑郁症患者随机分为文拉法辛缓释片组37例,氟西汀组36例。疗程8周。以汉密尔顿抑郁量表(HAMD)和治疗中出现的症状量表(TESS)评定。结果:文拉法辛缓释片组与氟西汀组均有显著疗效,不良反应均少。结论:文拉法辛缓释片治疗抑郁症疗效确切,安全性好。     

氟西汀、文拉法辛和吗氯贝胺治疗不典型抑郁症的疗效比较

目的比较不同作用机制的抗抑郁剂对不典型抑郁症的疗效和安全性。方法将100例不典型抑郁症随机分为氟西汀组(34例)、文拉法辛组(33例)和吗氯贝胺组(33例),给予相应的药物治疗8周。于治疗前、治疗后1、2、4、8周末应用汉密顿抑郁量表(HAMD,24项)和副反应量表(TESS)评定疗效和安全性;并于治疗前和治疗结束时检测血压、心电图、血常规。结果3组患者治疗前和治疗后1、2周末HAMD评分无显著性差异(P>0.05),第4周和第8周末氟西汀组HAMD评分显著高于文拉法辛和吗氯贝胺组(P<0.05或P<0.01);组内比较,氟西汀组第2周末开始HAMD评分显著下降(P<0.05),而吗氯贝胺与文拉法辛组第1周末HAMD评分显著下降(P<0.05),一直持续至第8周末。吗氯贝胺和文拉法辛组治疗结束时HAMD总分和迟缓因子分的减分显著高于氟西汀组(P<0.01)。氟西汀、文拉法辛和吗氯贝胺组的显效率分别为55.88%、72.73%和72.73%,经2检验文拉法辛和吗氯贝胺组的显效率显著高于氟西汀组(2=8.80和8.80,P均小于0.05)。3组副反应的发生率无显著性差异(P>0.05)。结论文拉法辛与吗氯贝胺对不典型抑郁症的疗效相当,起效迅速,优于氟西汀。     

阿戈美拉汀对围绝经期抑郁症患者内分泌、神经递质水平及睡眠质量的影响

目的探究阿戈美拉汀对围绝经期抑郁症患者的内分泌激素、神经递质水平及睡眠质量的影响。方法选取我院联合平顶山市第二人民医院2018年3月～2020年5月期间收治的115例围绝经期抑郁症患者作为主要研究对象,根据随机数字表法分为观察组和对照组,对照组57例患者采用帕罗西汀联合安慰剂治疗,观察组58例患者采用帕罗西汀联合阿戈美拉汀治疗,观察对比两组患者临床疗效,以及治疗前后的内分泌激素水平[卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)水平]、神经递质水平[多巴胺(DA)、去甲肾上腺素(NE)]和匹兹堡睡眠质量指数量表(PSQI)评分。结果观察组患者临床总有效率为96.55%高于对照组的80.70%,差异具有统计学意义(P0.05);治疗后,观察组患者E2、DA、和NE水平高于对照组(P0.05);治疗后观察组患者的PSQI各项评分及总分均低于对照组(P0.05)。结论阿戈美拉汀联合帕罗西汀治疗围绝经期抑郁症患者临床疗效确切,可显著改善患者睡眠质量和抑郁症状,考虑可能与改善患者血清E2、DA和NE水平相关。     

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.     

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.     

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.