10省市双相情感障碍患者药物治疗的现况调查

目的了解国内双相情感障碍患者精神药物的治疗现状。方法按一定的抽样比例，选择10个省市46家专科医院或综合医院精神科同时进行药物处方方式的调查。结果（1）在558例双相情感障碍患者中，躁狂相472例（84．6％），抑郁相86例（15．4％）；555（99．5％）例患者接受精神药物治疗。（2）主要治疗药物为心境稳定剂（80．7％），404例（72．8％）患者使用了抗精神病药。（3）躁狂相患者以心境稳定剂（84．7％）和抗精神病药（81．4％）单一或联合治疗为主，抑郁相患者单一或联合使用抗抑郁药的频率较高（80．2％）。（4）联合两种及其以上药物治疗者占80．2％。（5）145例（26．1％）患者合并使用了苯二氮Zhuo类药。结论国内双相情感障碍药物处方方式与国内外的指南推荐方案基本相符；双相障碍抑郁相抗抑郁药使用频率较高，有待于将来的临床实践论证。     

双相障碍不同首选用药间处方方式、不良反应、经济负担、依从性比较

目的比较首选心境稳定剂和首选抗精神病药治疗的双相障碍患者处方方式、不良反应、经济负担及药物治疗依从性等。方法对河北省11个地市39家精神卫生机构中接受心境稳定剂或抗精神病药治疗的240例双相障碍患者,采用自制调查问卷、临床总体印象病情严重程度量表(clinical global impressions scale-severity of illness,CGI-SI)、不良反应量表(treatment emergent symptom scale,TESS)、药物依从性评定量表(medication adherence rating scale,MARS)进行社会人口学、疾病临床特征、处方方式(联合用药情况)、精神类药物花费、不良反应及治疗依从性等方面的调查。结果首选抗精神病药治疗者(抗精神病药组)152例(63.3%),首选心境稳定剂治疗者(心境稳定剂组)88例(36.7%)。抗精神病药组与心境稳定剂组相比,住院患者构成比(90.1%vs.76.1%)、伴有精神病性症状患者构成比(27.0%vs.11.4%)、不良反应发生率(46.1%vs.31.8%)、精神类药物日花费(中位数12.00元vs.8.37元)和总花费(中位数344.61元vs.144.64元)均较高(P0.05)。但两组间药物处方方式、不良反应严重程度、MARS总分无统计学差异(P0.05)。结论河北省双相障碍患者以首选抗精神病药治疗为主,但首选抗精神病药并未减少之后的联合用药,且不良反应发生率及药物经济负担均明显高于首选心境稳定剂治疗者,所以心境稳定剂仍应作为双相障碍主要首选用药。     

2006年我国十省市抗精神病药处方方式的现况调查

目的 调查2006年我国10省市抗精神病药处方方式;分析4年间我国抗精神病药处方方式的变化趋势.方法 按照作者2002年的调查方法,选择10省市41所精神疾病专科医院或综合医院精神科的5898例精神分裂症门诊和住院患者,于2006年5月22-28日使用自制修订的调查问卷进行精神分裂症处方方式的现况调查.结果 (1)5898例患者中,门诊患者为2716例(46.0%);住院患者为3182例(54.0%);男3041例(51.6%),女2803例(47.5%),缺失54例数据.(2)99.1%的患者接受了抗精神病药治疗,使用频率在前7位的药物依次为:氯氮平(31.7%),利培酮(30.5%),舒必利(14.5%),氯丙嗪(10.8%),奋乃静(9.2%)、喹硫平(7.2%),氟哌啶醇(5.8%).换算为氯丙嗪等效剂量后,住院患者平均药物剂量显著高于门诊患者.(3)72.7%的患者使用第2代抗精神病药治疗;第1代抗精神病药的使用频率为38.3%;6.19%的患者接受了长效药物治疗.(4)75.6%的患者接受了单一非长效抗精神病药治疗;24.4%的患者联合使用2种或2种以上抗精神病药.(5)54.1%的患者联合了抗胆碱能药、苯二氮革类、β-受体阻断剂、抗抑郁药和心境稳定剂,主要用于控制不良反应或增效治疗.结论 第2代抗精神病药已经成为我国治疗精神分裂症的主流药物,反映出精神分裂症治疗理念和治疗技术的进展.     

双相障碍抑郁发作患者急性期治疗有效后3年的再入院率及影响因素分析

目的分析双相障碍抑郁发作患者急性期治疗有效后3年的再入院率及影响因素。方法采用便利抽样法,选取2015年9月至2018年9月在首都医科大学附属北京安定医院住院且急性期治疗有效的315例双相障碍抑郁发作患者为研究对象。收集患者的人口学资料、病史、临床特征等资料。随访3年,追踪再入院情况,采用Cox比例风险模型分析双相障碍抑郁发作患者急性期治疗有效后3年再入院的影响因素。结果共289例患者完成随访,其中39.45%(114/289)的患者治疗后3年内再次入院。多因素Cox回归分析结果显示,总发作次数多是患者治疗后3年再入院的危险因素(HR=1.081,95%CI:1.040~1.124,P<0.01),基线治疗方式为心境稳定剂/抗精神病药是患者治疗后3年再入院的保护因素(HR=0.471,95%CI:0.321~0.692,P<0.01)。结论发作次数多、急性期使用心境稳定剂/抗精神病药物联合抗抑郁药治疗是双相障碍抑郁发作患者急性期治疗有效后3年内再入院的危险因素,临床需给予足够的重视并进行相应的干预。     

双相障碍抑郁发作的治疗进展

双相障碍抑郁发作 (以下简称双相抑郁 )具独特的临床特点[1] ,这类患者特别是发病年龄小的患者更易出现精神病性症状 ,自杀风险更高 ,共患物质滥用的比例较高 ,平均寿命较短于其他抑郁障碍患者 ,临床治疗常因此而较为棘手。在治疗上 ,双相抑郁与其他抑郁的差异主要在于单纯抗抑郁药治疗诱发躁狂的风险高 ,需要联用心境稳定剂[2 ] 。鉴于国内关于双相抑郁治疗的文献较少 ,而国外近年来对此多有探讨(检索Medline数据库近 5年的文献 ) ,故对此予以复习。一、药物治疗众多治疗原则及文献均认为 ,心境稳定剂是治疗的基础[1,3 ,4] 。对于伴精神病…     

不同起病年龄双相障碍患者的特征和用药比较

目的:研究不同起病年龄段双相障碍患者的特征和用药情况。方法:利用电子病历系统，收集住院双相障碍患者的人口学资料、临床资料和用药情况，将患者按起病年龄分为早发型、中间型和晚发型，比较3组的人口学特征、临床特征和用药差异。结果:共纳入双相障碍患者8 184例，其中早发型1 575例(19.24%),中间型5 383例(65.77%),晚发型1 226例(14.98%)。早发型年龄更小，男性和未婚比例更高，病程和住院时间更长，混合状态的比例更高(P<0.05)。早发型使用两种心境稳定剂联合抗精神病药的比例较高，药物组合以锂盐+丙戊酸盐+喹硫平/奥氮平为主(P<0.05)。晚发型使用1种心境稳定剂联合抗精神病药的比例较高，药物组合以丙戊酸盐+喹硫平/奥氮平为主(P<0.05)。晚发型联用抗抑郁药的比例较高(P<0.05)。结论:不同年龄起病的双相障碍患者在人口学特征、临床特征和用药上均存在显著差异，双相障碍的起病年龄应引起重视。     

单相抑郁与双相抑郁的药物选择

研究显示,双相抑郁与单相抑郁患者对药物的治疗反应存在着相当的差异,表现出一定的异质性.单相抑郁的标准治疗是抗抑郁药,单用抗抑郁药效果不佳时联合心境稳定剂可能增加疗效;而双相抑郁的标准治疗是心境稳定剂,误用抗抑郁药可能导致病情恶化.     

10省市抗精神病药使用现况的调查

目的调查中国10省市精神药物治疗精神分裂症的使用现状.方法按人均国内生产总值将各省分为五个经济发展等级,以一定的抽样比例,选择10个省市的46家精神疾病专科医院或综合医院精神科的4 779例住院和门诊精神分裂症患者,于2002年5月20～24日用自制调查问卷进行精神分裂症药物治疗的现况调查.结果 (1)在4 779例患者中,门诊为1 969例(41.20%),住院为2 810例(58.80%).与门诊患者比较,住院患者中的男性患者比例高、年龄大、病程长、公费医疗比例高(均P<0.01).(2)使用频率在前六位的药物依次是氯氮平、利培酮、舒必利、氯丙嗪、奋乃静和氟哌啶醇.换算为氯丙嗪等效剂量后,治疗剂量为12.5～4 125 mg/d,平均(365±253)mg/d.其中住院患者的使用剂量[(409±274)mg/d]高于门诊患者[(300±201)mg/d;F=223,P<0.01].(3)2 617例次(54.99%)使用典型抗精神病药,2 940例次(61.78%)使用非典型抗精神病药(包括氯氮平在内).312例接受长效抗精神病药.3 523例(74.03%)接受单一抗精神病药治疗,1 236例(25.97%)联合使用2种及其以上抗精神病药.(4)常见的合并治疗药物有抗胆碱能药、β-受体阻断剂、苯二氮NFDA3类药、抗抑郁药和心境稳定剂.结论国内精神分裂症药物处方方式逐渐以非典型抗精神病药占主流,经济负担和患者的症状表现对精神药物的处方方式影响较大.     

心境稳定剂联合新型抗精神病药物在双相障碍中的应用

众多研究显示双相障碍的治疗趋向采用心境稳定剂（锂盐和丙戊酸钠）联合新型抗精神病药物（利培酮、奥氯平、喹硫平、齐拉西酮）治疗．可增加疗效且不良反应无明显增加。本文就心境稳定剂联合新型抗精神病药物治疗双相障碍的疗效及不良反应作一综述。     

双相障碍在新世纪的挑战(下)

4　治疗BPD病因不明 ,治疗主要是对症的 ,原则上应包括心理支持 ,减少生活应激等综合措施 ,但一线治疗仍是药物治疗。本病因症状多样 ,病程复杂 ,治疗难度远比 MDD大。BPD药物治疗有以下特点 :1用药品种多 ,包涵常用的各类精神药物 ,如抗精神病药、抗抑郁药、抗焦虑药、心境稳定剂等 ;2药物组合多 ,往往是两三种药联合 ,如心境稳定剂 ( MS)和MS之间联合 ,MS与抗精神病药、抗抑郁药之间的联合 ;3MS为主其它药为辅 ,并贯穿全治疗过程 ;4急性治疗和维持治疗相结合 ,即不仅急性治疗而且应预防复发。4.1　药物治疗概况　抗精神病药 :锂广…     

Neuroimaging in epilepsy in tropics

Epilepsy is a major public health problem in many tropical countries. Also, some of the tropical diseases are major contributors to the higher prevalence of epilepsy in these countries. The etiologic factors responsible for epilepsy in these countries are quite different from those in the developed world. This article discusses the etiologic factors and neuroimaging of epilepsy in light of the conditions in these tropical countries.     

癫痫与抑郁关系的研究进展

抑郁是癫痫患者中常见的精神障碍,严重地影响了患者的生活质量。传统的观点认为癫痫患者因为存在着诸多社会学问题易出现抑郁倾向,癫痫和抑郁是单向的联系,但大量的研究已经证明癫痫和抑郁之间存在双向的联系,一种异常状态的存在可能易转化为另一种异常状态的发展。癫痫和抑郁存在着共同的发病机制。本文主要就癫痫和抑郁的双向联系以及抗抑郁药物在癫痫患者中的应用进行阐述。     

Sudanophilic lipid accumulation in astrocytes in periventricular leukomalacia in monkeys

Summary Sudanophilic lipid accumulation is a characteristic feature of periventricular leukomalacia (PVL) of infants. At least two types of lipid-containing cells have been identified, one being the macrophage, the other the pre-myelin glial cell. A third type of lipid-containing cell has been seen in two monkeys with spontaneous PVL. Electron microscopically this cell appears to be an astrocyte. This probably represents a reaction of the astrocyte to hypoxia and may be the equivalent of the hypertrophic astrocytes found in human infants.Supported in part by NIH grant HDO 8633 and the Regional Primate Research Center Grant RR-00166     

Increase in cathepsin D activity in rat brain in aging

Cathepsin D-like activity in homogenates of five brain areas of 3-month-old and 24-month-old Fischer 344 rats was measured. With hemoglobin as substrate at pH 3.2, more than 90% of the activity was inhibited by pepstatin. In each area studied, activity was more than twice as high in the old rat brain: 140-160% higher in the cortex, cerebellum, pons-medulla, and striatum and 90-100% higher in the hippocampus and spinal cord. The greatly increased metabolic capacity in the absence of an increase in protein turnover may have a role in age-related pathological degeneration in the brain.     

Characteristics of nociceptors in the periodontium--an in vitro study in rats

Recent studies have indicated that nociceptors can be classified into various types according to their physiological properties. These studies have clarified that the frequency distribution of various nociceptor types is different among body sites and animal species. In the present study, we investigated the physiological properties of rat's periodontal nociceptors in an in vitro jaw-nerve preparation. Responses were recorded from functional single filaments in the inferior alveolar nerve. To determine the nociceptor type, calibrated von Frey filaments, heat, and bradykinin (BK) stimuli were used. We found five subtypes of nociceptors in the periodontal ligaments of the lower incisor: Adelta-high threshold mechanonociceptors (Adelta-HTM, n=28), Adelta-mechanoheat nociceptors (Adelta-MH, n=6), Adelta-polymodal nociceptors (Adelta-POLY, n=26), C-high threshold mechanonociceptors (C-HTM, n=3) and C-polymodal nociceptors (C-POLY, n=4). Most nociceptors were Adelta-innervated, while only a small number of C-innervated nociceptors were found. The present results suggest that periodontal nociceptors transmit mainly fast pain, and may thus play a role in rapid detection of injure-related stimuli during mastication.     

Gender in Voice Perception in Autism

Deficits in the perception of social stimuli may contribute to the characteristic impairments in social interaction in high functioning autism (HFA). Although the cortical processing of voice is abnormal in HFA, it is unclear whether this gives rise to impairments in the perception of voice gender. About 20 children with HFA and 20 matched controls were presented with voice fragments that were parametrically morphed in gender. No differences were found in the perception of gender between the two groups of participants, but response times differed significantly. The results suggest that the perception of voice gender is not impaired in HFA, which is consistent with behavioral findings of an unimpaired voice-based identification of age and identity by individuals with autism. The differences in response times suggest that individuals with HFA use different perceptual approaches from those used by typically developing individuals.     

Defects in Bioenergetic Coupling in Schizophrenia

Synaptic neurotransmission relies on maintenance of the synapse and meeting the energy demands of neurons. Defects in excitatory and inhibitory synapses have been implicated in schizophrenia, likely contributing to positive and negative symptoms as well as impaired cognition. Recently, accumulating evidence has suggested that bioenergetic systems, important in both synaptic function and cognition, are abnormal in psychiatric illnesses such as schizophrenia. Animal models of synaptic dysfunction demonstrated endophenotypes of schizophrenia as well as bioenergetic abnormalities. We report findings on the bioenergetic interplay of astrocytes and neurons and discuss how dysregulation of these pathways may contribute to the pathogenesis of schizophrenia, highlighting metabolic systems as important therapeutic targets.     

Ethnic disparities in problem behaviour in adolescence contribute to ethnic disparities in social class in adulthood

BACKGROUND: It is important for prevention of social class disparities to know how ethnic disparities in social class arise among migrant children. We contribute to this understanding by examining the role of problem behaviour in adolescence. METHODS: Prospective observational study with 753 Dutch native and 217 Turkish migrant adolescents (11-18 year) followed for 10 years. Internalising and externalising problems were assessed in adolescence and employment status and occupational level were assessed in adulthood. The difference in odds ratios (OR) before and after adjustment for internalising and externalising problems was an indication of the predictive value of disparities in internalising and externalising problems for the development of social class disparities. RESULTS: A total of 135 (62%) of the Turkish and 602 (80%) of the Dutch adults were employed. Internalising and externalising problems were not associated with employment status. Of the employed, 65 (48%) Turkish and 179 (30%) Dutch adults worked in low-level occupations (p < 0.0001). Internalising and externalising problems were associated with both ethnicity and occupation. The OR for low-level occupation for Turkish adults was 1.78 (1.19-2.65), indicating ethnic disparities. Adjustment for internalising problems lowered the OR with 36% to 1.50 (0.97-2.31), and adjustment for externalising problems lowered it with 8% to 1.72 (1.15-2.57). Findings were similar for men and women and did not vary by age. CONCLUSIONS: Ethnic disparities in occupational level in adulthood could partly be attributed to disparities in mental health between Turkish migrants and Dutch natives in adolescence. Prevention of ethnic disparities in mental health at young age may therefore also contribute to the prevention of occupational differences in adulthood.     

Progress in neuroprotection in Parkinson's disease

Slowing or aborting the progress of neurodegeneration in Parkinson's disease (PD) remains the most important unmet need of this disorder. There are several recent developments in trial design and also in drugs under investigation for possible neuroprotective effect. Emphasis has been placed on clinical as opposed to imaging end-points and these include change in a clinical rating scale, e.g. United Parkinson's disease Rating Scale (UPDRS), or time to additional therapy. The introduction of the delayed-start, or wash-in, trial design adds an additional dimension to drug evaluation for neuroprotection. Compounds that have been recently tested in clinical trial include the monoamine oxidase-B inhibitor rasagiline, the anti-apoptotic agents TCH346 and CEP1347, and the promitochondrial agent creatine. The dopamine agonists have been evaluated for a neuroprotective effect using imaging end-points. Perhaps the most important and simplest concept for neuroprotection has been the theory that early dopaminergic support for the degenerating dopaminergic system per se provides significant long-term clinical benefit for PD patients.     

Changes in parasympathetic system in medulla oblongata in male pigs in the course of tachycardia-induced cardiomyopathy

Background

Autonomic imbalance constituting a fundamental feature of heart failure (HF) has been assessed mainly at the periphery. Changes in the functioning of autonomic centers in the brain remain unclear. We investigated the molecular elements of parasympathetic system, i.e. α7 nicotinic acetylcholine receptor (α7nAChR) and enzymes metabolizing acetylcholine (acetylcholinesterase, AChE, choline acetyltransferase, ChAT) in medulla oblongata (MO) of male pigs with chronic tachycardia-induced cardiomyopathy.

Methods

The mRNA levels of AChE, ChAT, α7nAChR and X-box binding protein 1 (spliced form, XBP1s) in MO were analyzed using qPCR, AChE and ChAT activities using spectrophotometry, proteasome activity using fluorometry, and the protein level of α7nAChR using Western blotting.

Results

The development of systolic HF was accompanied by an increase in circulating catecholamines, a decrease in the AChE and α7nAChR mRNA in MO, an increase in AChE activity (all p < 0.05), and no change in either the mRNA or activity of ChAT. Both circulating catecholamine levels and AChE activity were inversely related to systolic function of left myocardial ventricle (p < 0.05). The level of α7nAChR protein in MO and its cytoplasmatic fraction were higher in pigs with moderate and severe HF as compared to the other animals (p < 0.01). There was no difference in proteasome activity in MO between diseased and healthy animals, whereas the XBP1s mRNA decreased during HF progression (p < 0.05).

Conclusions

Molecular elements of parasympathetic system are changed within the medulla oblongata during the progression of systolic non-ischemic heart failure in male pigs, indicating a functional link between MO and heart in HF.