住院精神科病人抗焦虑药物应用调查分析

目的了解住院精神科病人中抗焦虑药的使用情况。方法调查对象为1家三级精神专科医院11月9日至11月25日期间在院的861例精神病人,经查阅住院病历,记录患者的一般资料和当日处方情况,分析抗焦虑药物的使用频度、日均剂量、用药时间及合并用药情况。结果861例住院精神病人有抗焦虑药物处方382例。抗焦虑药物以苯二氮卓类药物为主,有337例,占88%,其中的使用频度居首位75.7%。处方原因主要用于镇静催眠的占93.7%,抗焦虑的占16.8%。联合抗焦虑药物中,非典型抗精神病药多于传统的抗精神病药物,抗抑郁剂与抗焦虑药的联用比率较低,主要是5一羟色胺再摄取抑制剂（SSR I）。结论抗焦虑药物的用药剂量、用药原因是合理的,但不宜长期使用。     

河北省抑郁症患者药物治疗的现况调查

目的了解河北省抑郁障碍患者精神药物的治疗现状。方法使用自制调查问卷,按一定的抽样比例,选择河北省37家专科医院或综合医院精神科进行调查。结果1共调查住院和门诊抑郁障碍病人223例;单一药物治疗97例(43.5%),联合2种及其以上药物治疗124例(55.6%),未用药2例(0.9%);2门诊患者帕罗西汀的使用频度明显高于住院患者(P0.01),其它药物在门诊与住院患者的使用中没有明显差异;三环类抗抑郁剂多虑平、阿米替林住院患者用药剂量明显高于门诊患者(P0.05,P0.01);3合并使用苯二氮类药113例(50.7%),使用频率依次为阿普唑仑、氯硝西泮、劳拉西泮、艾司唑仑;使用剂量在正常范围,持续时间超过60天者占30.8%(43/140);4伴精神病性症状的抑郁症37例(16.6%),伴精神病性症状者治疗多合并精神药物73.0%(27/37)。结论河北省抑郁障碍治疗基本合理,但应注意减少合并用药及缩短苯二氮卓类药物使用时间。     

门诊与住院精神分裂症患者首选药物调查

目的了解首次就诊患者抗精神药物应用现状。方法采用自行设计的调查表,顺序抽取我院每季度第一个月所有精神分裂症患者首次药物使用情况进行调查。结果①334例门诊精神病患者以使用非典型抗精神病药为主,奥氮平使用率最高(29.6%),其次为喹硫平(23.4%)、利培酮(23.1%)、阿立哌唑(14.4%);354例住院患者首选药物多为传统抗精神病药氟哌啶醇注射剂(28.8%),其他为非典型抗精神病药,依次为利培酮(28.5%)、喹硫平(17.8%)、奥氮平(8.8%)、阿立哌唑(6.5%);②住院患者合并使用抗精神病药者多于门诊患者,两者比较有非常显著的差异(χ2=144.91,P<0.01),使用最高的为非典型抗精神病药合并使用氟哌啶醇。门诊合并使用苯二氮卓类药物以及安坦者多于住院患者,两者比较均有非常显著的差异(2χ=6.91,P<0.01)、(2χ=19.5,P<0.01)。结论精神分裂症患者所接受的药物治疗比较规范和合理,非典型性抗精神病药已作为临床医生首选药物;部分医生对抗胆碱能药物和苯二氮卓类药物本身产生的不良反应给患者造成的危害认识不足。     

住院精神分裂症患者应用苯二氮(艹卓)类药物的调查

目的 了解苯二氮（艹卓）类药物(BZD)在精神分裂症患者中的应用情况。方法 采用随机抽样的方式．对300例住院精神分裂症患者应用BZD情况进行分析。结果 35％的病例使用BZD,以应用氯硝安定为多。结论 苯二氮（艹卓）类药物并用抗精神病药物治疗精神分裂症使用率较高,使用时间较长,在临床工作中,应高度重视BZD的依赖性,合理用药。     

60例酒精所致精神障碍临床用药分析

目的：了解酒精所致精神障碍临床药物使用情况。方法对我院60例酒精所致精神障碍患者使用抗精神病药、心境稳定剂、抗焦虑药、镇静催眠药、维生素类及各类辅助治疗药物的使用情况及精神药物的副反应进行分析。结果抗精神病药以利培酮使用最多,心境稳定剂主要是丙戊酸钠,镇静催眠药以苯二氮卓类药物居多,维生素类主要是维生素B1。药物副反应主要是椎体外系反应,过度镇静。结论治疗酒精所致精神障碍主要使用苯二氮卓类药物治疗戒断症状及改善睡眠,合并小剂量抗精神病药或心境稳定剂治疗,同时补充维生素B1,其他辅助药物以护肝药物居多。     

门诊首发精神分裂症首次用药情况分析

目的 了解门诊首发精神分裂症患者首次用药情况.方法 采用自行设计的调查表对1995年1月～10月、2000年1月～10月及2005年1月～10月在门诊首次治疗的首发精神分裂症患者用药及一般资料进行调查.结果 1995年共有158例,其中单用抗精神病药物(APD)142例(89.87%),以氯氮平为首;联合用APD16例(10.13%),以氯氮平联合舒必利为首;预防性应用安坦18例(11.39%);合用苯二氮卓类药物(BZD)20例(12.66%).2000年共有180例,其中单用APD133例(73.98%),以利培酮为首;联用APD47例(26.11%),以氯氮平联合舒必利为首;预防性应用安坦23例(12.78%);合用BZD46例(25.56%).2005年共有198例,其中单用APD189例(95.46%),以阿立哌唑为首;联合用APD9例(4.54%),以氯丙嗪联合阿立哌唑为首;预防性应用安坦17例(8.59%);合用BZD109例(55.05%).结论 目前门诊首发精神分裂症患者首次治疗时单用APD以阿立哌唑为首选,不主张预防性应用安坦,慎用BZD.     

慢性失眠症药物治疗临床分析

目的:通过对慢性失眠症患者药物治疗疗效临床分析,为失眠症患者有效、安全治疗提供理论参考.方法:选取2018年8月-2020年6月在本院门诊就诊符合ICSD—3诊断标准,且连续药物治疗1年以上的128例慢性失眠症患者做为研究对象,按照治疗慢性失眠症患者服药种类进行分组,利用 自制调查表和PSQI量表评分,采用SPSS17.0统计软件进行分析,应用Spearman相关分析.结果:123例完成研究(服用苯二氮卓类药物70人,服用非苯二氮卓类药物53人).慢性失眠症患者服用苯二氮卓类药物和非苯二氮卓类药物1年后总睡眠时间比较,差异无统计学意义(X2=0.78,P=0.68);服用苯二氮卓类药物组1年后睡眠质量更差,差异有统计学意义(X2=62.92,P＜0.001).应用Spearman相关分析发现服用苯二氮卓类药物与年龄、性别、文化程度,病程等无相关性,与睡眠质量呈负相关(r=-0.703,P＜0.01).结论:失眠患者服用苯二氮卓类药物时间越长其睡眠质量越差.     

Drug of Choice for Outpatient and Inpatient Patients with Schizophrenia

目的 了解首次就诊患者抗精神药物应用现状.方法 采用自行设计的调查表,顺序抽取我院每季度第一个月所有精神分裂症患者首次药物使用情况进行调查.结果 ①334例门诊精神病患者以使用非典型抗精神病药为主,奥氮平使用率最高(29.6％),其次为喹硫平(23.4％)、利培酮(23.1％)、阿立哌唑(14.4％);354例住院患者首选药物多为传统抗精神病药氟哌啶醇注射剂(28.8％),其他为非典型抗精神病药,依次为利培酮(28.5％)、喹硫平(17.8％)、奥氮平(8.8％)、阿立哌唑(6.5％);②住院患者合并使用抗精神病药者多于门诊患者,两者比较有非常显著的差异(x2=144.91,P＜0.01),使用最高的为非典型抗精神病药合并使用氟哌啶醇.门诊合并使用苯二氮卓类药物以及安坦者多于住院患者,两者比较均有非常显著的差异(x2=6.91,P＜0.01)、(x2=19.5,P＜0.01).结论 精神分裂症患者所接受的药物治疗比较规范和合理,非典型性抗精神病药已作为临床医生首选药物;部分医生对抗胆碱能药物和苯二氮卓类药物本身产生的不良反应给患者造成的危害认识不足.     

昆沪两地住院精神病人使用精神药物比较

目的　了解不同地区住院精神病人使用精神药物的情况。方法　采用 1日法对昆明的 2 61例住院精神病人的一般情况、诊断和治疗情况进行调查 ,并与 1 997年上海的调查结果进行比较。结果　两地精神分裂症仍居诊断首位 ,单用 1种精神药物上海明显高于昆明 ;联用 3种或 3种以上药物者昆明明显高于上海 ( P<0 .0 0 1 ) ;精神药物使用频度前 4位两地相比完全相同 ,两地氯氮平使用频度皆为首位 ;抗抑郁药物氯丙咪嗪、氟西汀的使用昆明明显少于上海 ( P<0 .0 0 1 ) ;昆明组治疗方案偏少 ;两地用药平均剂量均偏小 ,联用抗胆碱能药者两组无明显差异 ( P>0 .0 5 ) ,合并使用苯二氮 艹卓类药物值得注意。结论　提示两地精神药物的使用总体趋势基本一致 ,但仍有不同之处 ,可能与人们对精神疾病及药物的认识和地域的经济有关     

右佐匹克隆联合奥氮平治疗难治性失眠症的临床疗效研究

目的 探讨治疗难治性失眠症的有效方法.方法 采用随机对照方法,将120例难治性失眠症患者随机分为右佐匹克隆联合奥氮平组和右佐匹克隆组,治疗4周.采用匹兹堡睡眠质量指数(PSQI)及药物副作用量表评定临床疗效和副作用.结果 右佐匹克隆联合奥氮平组在治疗第4周时PSQI总分、汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)、临床显效率明显优于单用右佐匹克隆组(t=4.416,6.612,6.758;P＜0.01;x2=7.434,P＜0.01).结论 右佐匹克隆联合奥氮平治疗难治性失眠症安全有效.     

米氮平与帕罗西汀治疗难治性抑郁的对照试验

目的:观察米氮平对难治性抑郁的疗效和不良反应。方法:将符合入组标准的80例患者随机分成米氮平组和帕罗西汀组各40例。于治疗前和治疗第1、4、8周末采用汉密尔顿抑郁量表(HAMD)17项评定疾病严重程度和疗效,采用不良反应量表(TESS)评定药物不良反应,采用生活质量综合评定问卷(WHO.QOL-100)评定生活质量。结果:(1)米氮平组痊愈13例,显著进步13例,进步10例,显效率57.5%;帕罗西汀组痊愈8例,显著进步9例,进步13例,显效率42.5%;两组间显效率比较χ2=4.07,P=0.044。(2)治疗1周时,米氮平组与帕罗西汀组之间HAMD总分的差异有统计学意义,但是在治疗8周末差异没有统计学意义。(3)治疗8周末,米氮平组WHOQOL心理领域、社会关系、环境因素因子分均高于帕罗西汀组,差异有统计学意义。(4)在不良反应方面,食欲增加、性功能障碍和睡眠障碍的发生率组间差异有统计学意义,但是均较轻微。结论:与帕罗西汀相比,米氮平治疗难治性抑郁症起效快,疗效好,安全性好,且能显著改善患者的生存质量。     

Review of the results from clinical studies on the efficacy, safety and tolerability of mirtazapine for the treatment of patients with major depression.

Mirtazapine is a presynaptic alpha-2 antagonist that has dual action by increasing noradrenergic and serotonergic neurotransmission. The enhancement of serotonergic neurotransmission is specifically mediated via 5-HT1 receptors because mirtazapine is a postsynaptic serotonergic 5-HT2 and 5-HT3 antagonist. In addition, mirtazapine has only a weak affinity for 5-HT1 receptors and has very weak muscarinic anticholinergic and histamine (H1) antagonist properties. As a consequence of its unique pharmacodynamic properties, mirtazapine is an effective, safe and well-tolerated addition to the antidepressant armamentarium. Mirtazapine is well absorbed from the gastrointestinal tract following oral administration, and it is extensively metabolized in the liver to four metabolites via demethylation and hydroxylation, followed by glucuronide conjugation. The unconjugated desmethyl metabolite is pharmacologically less active than the parent compound. Mirtazapine lacks auto-induction of hepatic isoenzymes. Although mirtazapine is a substrate of P450 isoenzymes 1A2, 2D6 and 3A4, in vitro studies show that it is not a potent inhibitor or inducer of any of these enzymes. Mirtazapine has been evaluated in a worldwide clinical development program involving approximately 4500 patients. Controlled clinical trials involving almost 2800 mirtazapine-treated patients have demonstrated the compound to be effective for the treatment of moderate-to-serve major depression. Mirtazapine was consistently superior to placebo, and equivalent in efficacy to the tricyclic antidepressants amitriptyline, doxepin and clomipramine, but with an improved tolerability profile. Mirtazapine has shown a rapid onset of action in patients with predominantly severe depressive illness in a comparative study against fluoxetine. Mirtazapine has a unique tolerability profile, since the specific postsynaptic 5-HT2 and 5-HT3 receptor blockade of mirtazapine provides early antidepressant effects without causing unwanted serotonin-related side-effects. Transient somnolence, hyperphagia and weight gain are the most commonly reported adverse events, which may be attributed to the antihistaminic (H1) activity of mirtazapine at low doses. Somnolence, the most commonly reported side-effect, appears to be less frequent at higher dosages. Mirtazapine also demonstrates important anxiolytic and sleep-improving effects, which may be related to its pharmacodynamic properties. In addition, mirtazapine does not appear to be associated with sexual dysfunction. Mirtazapine has shown no significant cardiovascular adverse effects at multiples of 7 to 22 times the maximum recommended dose. Mirtazapine is a unique addition to the antidepressant armamentarium as first-line therapy in patients with major depression and symptoms of anxiety/agitation or anxiety/somatization or complaints of insomnia and as a useful alternative in depressed patients who do not adequately respond to or are intolerant of tricyclic antidepressants or serotonin-specific reuptake inhibitors.     

米氮平与马普替林治疗抑郁症对照研究

目的 评价米氮平与马普替林治疗抑郁症的疗效和不良反应.方法 将符合CCMD-3诊断标准的60例抑郁症住院和门诊患者,随机平分为两组,分别给予米氮平和马普替林治疗,疗程6周.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)评定疗效和不良反应.结果 米氮平与马普替林治疗抑郁症的疗效接近,但前者起效更快,不良反应少于后者.结论 米氮平是一种安全、有效的新一代抗抑郁药,可以作为治疗抑郁症的第一线抗抑郁药使用.     

米氮平合并认知治疗对脑卒中后抑郁的疗效对照

目的 探讨米氮平合并认知治疗对脑卒中后抑郁的疗效.方法 对72例脑卒中后抑郁患者用米氮平治疗,部分病例合并认知治疗进行临床对照研究;采用汉密尔顿抑郁量表(HAMD)进行疗效评定.结果 两组均有效,合并认知治疗组起效快(P<0.05),疗效好.结论 米氮平合并认知治疗对治疗脑卒中抑郁疗效较好.     

米氮平与马普替林治疗老年抑郁症临床对照研究

目的探讨米氮平对老年抑郁症的疗效和安全性。方法将62例抑郁症患者随机分为两组,分别予米氮平与马普替林治疗,疗程6周。于治疗前和治疗后1、2、4、6周末分别用汉密尔顿抑郁量表（HAMD）和副反应量表（TESS）评定疗效及不良反应。结果米氮平组显效率为76.7%,马普替林组为75.9%,两组比较差异无显著性（P〉0.05）,但米氮平起效快,不良反应轻微。结论米氮平与马普替林治疗老年抑郁症疗效相当,但米氮平起效快,不良反应少,安全性高。     

Epidemiology of dermatophytic infections in Rome, Italy: a retrospective study from 2002 to 2004.

In the present study, we determined the incidence of dermatophyte species causing superficial mycoses among outpatients referred to the Department of Dermatology of the "La Sapienza" University of Rome between 2002 and 2004. Of the 3160 subjects studied, 1275 (40.3%) were positive for fungal infection, but only 252 (19.7%) of these had infections caused by dermatophytes. The dermatophyte most frequently isolated was Microsporum canis. Our epidemiological data were compared with those obtained previously by other authors in the same geographic area. For the first time we described an inversion of the T. rubrum/T. mentagrophytes ratio, the latter being more frequently encountered. We also observed the emergence of M. audouinii.     

The association among depressive symptoms,smoking status and antidepressant use in cardiac outpatients

Both depression and smoking are highly prevalent and related to poorer outcomes in cardiac patients. In this study, the authors examined the association between depressive symptoms and smoking status, described the frequency and type of antidepressant use, and prospectively tested the effects of antidepressant use in smokers on smoking status and psychosocial outcomes. Participants comprised 1,498 coronary artery disease (CAD) outpatients who completed a baseline survey which assessed depressive symptoms, current medications, and smoking status. A second survey was mailed 9 months later that assessed depressive symptoms, anxiety, insomnia and smoking status. Results showed that current and former-smokers had significantly greater depressive symptoms than non-smokers. Ten percent of patients were taking antidepressants, most frequently SSRIs, with significantly more smokers on antidepressants than former and non-smokers. At follow-up, smokers on antidepressants were less likely to have quit, had greater anxiety, depressive symptoms and insomnia than smokers not using antidepressants. This study demonstrated that smokers and quitters with CAD had greater depressive symptoms and use of antidepressants than non-smokers, but that the antidepressants utilized may not be optimizing outcomes.     

Insomnia in the elderly: a review for the primary care practitioner

The elderly are known to have a high prevalence of insomnia. Causes of insomnia include: medical, psychiatric, and drug issues; circadian rhythm changes; sleep disorders; and psychosocial factors. The elderly frequently use sleeping aids. Risks associated with elderly patients' use of hypnotic drugs are attributable to concomitant comorbid conditions, use of multiple medications, altered pharmacokinetics, and increased central nervous system sensitivity to these drugs. Treatment options for insomnia include behavior modification and pharmacotherapy. The choice of hypnotics is based on matching the nature of the insomnia to the hypnotic agent. Benzodiazepine receptor agonists are common hypnotics prescribed for insomnia in the elderly. The ideal agent has rapid onset, duration of action that lasts through the night but no residual daytime effects, and no adverse effects. The longer-acting agents have been shown to result in a higher risk of falls and hip fractures in the elderly. This relationship is not apparent with short-acting agents. Zaleplon, the newest benzodiazepine receptor agonist, has the shortest half-life of available agents. Studies have demonstrated that zaleplon is effective in improving sleep latency, duration, and sleep quality in the elderly. Zaleplon does not appear to cause rebound insomnia, residual sedation, or adversely affect psychomotor function. The key for the healthcare professional is finding the appropriate treatment or treatment combination, including behavioral modification and pharmacotherapy. When hypnotics are indicated, the most appropriate short-acting agent should be considered.     

An epidemiological survey of dermatomycoses in Japan, 2002]

An epidemiological survey of dermatomycoses and the causative fungus flora of dermatophytoses in Japan for 2002 was made on a total number of 72,660 outpatients who visited 14 dermatological clinics throughout Japan. The results were as follows: 1) Dermatophytosis was the most prevalent cutaneous fungal infection (7,994 cases) seen in these clinics, followed by candidiasis (755 cases) and then Malassezia infections (220 cases). 2) Among dermatophytoses, tinea pedis was the most frequent (4,813 cases: male 2,439, female 2,374), then in decreasing order, tinea unguium (2,123 cases: male 1,093, female 1,030), tinea corporis (497 cases: male 281, female 216), tinea cruris (299 cases: male 249, female 50), tinea manuum (248 cases: male 144, female 104) and tinea capitis including kerion (14 cases, male 6, female 8). 3) Tinea pedis and tinea unguium are seen to increase in summer season, among the aged population and among males in each clinic. When compared to the previous surveys (1992 and 1997) by clinical form, t. unguium patients increased from 1.9% of total outpatients in 1992, to 2.0% in 1997, then to 2.9% in 2002. 4) As the causative dermatophyte species, Trichophyton rubrum was the most frequently isolated among all dermatophyte infections except tinea capitis. 5) T. rubrum was isolated from 63.3%(1,431/2,262) of tinea pedis lesions, followed by Trichophyton mentagrophytes (36.6%, 829/2,262), and also 88.8% (325/366) of t. corporis, 95.4% (185/194) of t. cruris and 85.6% (462/540) of t. unguium. 6) Cutaneous candidiasis was seen in 755 cases (1.0%) of 72,660 outpatients. Intertrigo (347 cases) was the most frequent clinical form, followed by erosio interdigitalis (103 cases) and diaper candidiasis (102 cases). It has a tendency to affect the aged being complicated with topical predisposing factors. 7) Cutaneous Malassezia infections and other superficial fungal infections are seen in 220 cases, without any characteristic features by gender or clinical form.