心境稳定剂在精神疾病治疗中的应用

目前临床上常用的心境稳定剂包括锂盐、抗惊厥药物和非典型抗精神病药物。此外,现还新上市了一些具有潜在心境稳定作用的药物或辅助用药。本文概要介绍主要心境稳定剂及其在精神疾病治疗中的应用。     

Considerations in the treatment of anxiety disorders: a pharmacoeconomic review

Anxiety disorders are a group of common mental disorders that impose a significant economic burden on the healthcare system and society. For this review of published literature on the pharmacoeconomics of treating anxiety disorders, various studies of the cost, resource use and the economic outcomes of pharmacological treatment were examined. Numerous studies have been published that document how the excessive costs associated with anxiety disorders, especially panic disorder, result from a combination of factors including under-recognition and misdiagnosis of the problem by primary healthcare providers, high medical resource utilisation including unnecessary or inappropriate diagnostic tests and high levels of medical help-seeking behaviour by patients. Little information has been available on the economic effects of pharmacotherapy for anxiety disorders but recent studies have shown that selective serotonin re-uptake inhibitors (SSRIs) are associated with a shift in medical resource utilisation (lower rates of emergency department and laboratory visits) which can potentially result in decreased healthcare expenditures. Facilitating an increased awareness among primary healthcare providers of the anxiety disorders and utilising appropriate diagnostic and treatment strategies can benefit patients while providing more efficient and effective healthcare spending leading to an overall reduction in the burden of disease.     

丙戊酸盐治疗双相情感障碍的研究进展

作为心境稳定剂,丙戊酸盐治疗各型双相情感障碍均有一定的疗效。近年来对各型双相情感障碍患者进行的临床研究证实：丙戊酸盐能改善躁狂症状;联合镇静药物治疗可有效改善抑郁症状;联合抗抑郁药物预防抑郁发作的疗效优于锂盐。丙戊酸盐与其他心境稳定剂联合治疗快速循环型双相情感障碍患者时可能更有益,也更适用于非快速循环型双相情感障碍患者的长程治疗。     

Recent developments in the treatment of bipolar disorders

Recently, many new therapeutic options have become available for the treatment of bipolar disorder. Most of these options are agents originally developed to treat other conditions, such as anticonvulsants and antipsychotics. Some older agents have also been rediscovered or reformulated. New drug combinations and treatment strategies have enabled a more comprehensive treatment of the spectrum of bipolar symptoms, as well as bipolar disorder complicated by a range of comorbidities, to be targeted. A growing range of novel therapeutic options for the treatment of bipolar disorder is under investigation. This paper summarises some of the data regarding these potential therapeutic options.     

丁螺环酮联合奋乃静治疗焦虑症70例疗效观察

目的观察丁螺环酮联合奋乃静用于焦虑症的临床价值。方法丁螺环酮联合奋乃静,治疗符合CCMD-3焦虑症诊断标准的患者,以HAMA、SAS作为主要疗效评价指标,以不良事件,评价安全性。结果经8周治疗后,临床痊愈60%,显进10%,进步30%,总显效率（痊愈＋显进）70%,有效率100%。结论丁螺环酮联合奋乃静治疗焦虑症效果好,不良反应小,患者依从性好。     

Evaluation of vilazodone for the treatment of depressive and anxiety disorders

Introduction: Major Depressive Disorder (MDD) and General Anxiety Disorder (GAD) significantly contribute to the global burden of disease. Vilazodone, a combined serotonin reuptake inhibitor and 5-HT1A partial agonist, is an approved therapy for the treatment of MDD and which has been further investigated for GAD.

Areas covered: This article covers the pharmacokinetics and pharmacodynamics of vilazodone and provides an evaluation of the clinical usefulness of vilazodone for the treatment of MDD and anxiety disorders. A literature search was performed using PubMed/MEDLINE, Web of Science and the Cochrane Library.

Expert opinion: Studies have shown that vilazodone is significantly superior to placebo. However, vilazodone cannot as yet be recommended as a first-line treatment option for MDD as it is unclear whether the drug’s dual mechanism of action provides greater efficacy than prevailing treatment options. Moreover, more phase IV studies are needed to establish its efficacy and long-term safety in larger and more diverse populations. Although vilazodone may have an additional advantage for the treatment of anxiety symptoms in MDD, here also additional studies are required to confirm its efficacy over and above SSRI alternatives and other antidepressant treatments. Therefore, presently, vilazodone should be considered as a second- or third-line treatment option for MDD and GAD.     

Lamotrigine in mood disorders

SUMMARY

Lamotrigine is an anticonvulsant drug with good efficacy and safety in the treatment of epilepsy. There is now substantial evidence that lamotrigine is also useful in treating resistant depression, rapid cycling bipolar affective disorder, depressive episodes in bipolar affective disorder and in the maintenance phase or prophylaxis of bipolar affective disorder. There are possible roles in managing mood changes in borderline personality disorder, reducing chronic pain and treating schizoaffective disorder.

The general range of doses found effective in affective disorders is from 50 to 300?mg daily.

Clinical use seems to involve a titration of dose upwards over several weeks until the desired ! effect is obtained.

However, further definitive double-blind, randomised controlled trials against gold standard treatments are required.

Lamotrigine has a preferable side-effect profile compared to standard agents for bipolar affective disorder such as lithium or carbamazepine. Further research is certainly warranted and, given its tolerability, could point to lamotrigine as the treatment of choice for some affective disorders.     

Lymphocyte adenylate cyclase activity in immunosuppressed patients

Summary In order to determine whether alterations of adenylate cyclase are involved in the immunosuppressive effect of glucocorticoid/cyclosporin treatment we measured basal, prostaglandin E₁-, and forskolin-stimulated cAMP production in lymphocyte membranes from kidney transplant patients undergoing glucocorticoid and/or cyclosporin A treatment. Healthy volunteers and hemodialysis patients with immunosuppression due to uremia served as controls.Whereas adenylate cyclase activity was similar in healthy and uremic controls, basal and stimulated activity were increased threefold in patients with immunosuppressive medication.We suggest that an activation of adenylate cyclase might be involved in the immunosuppressive effects of glucocorticoids and/or cyclosporin A.     

The comorbidity of substance use disorders and eating disorders in women: Prevalence,etiology, and treatment

Substance use disorders often co-occur with eating disorders in female populations. This review addresses the prevalence and etiology of this comorbidity in women. Thirteen peer-reviewed journal articles are reviewed. Conclusions are drawn concerning prevalence rates, theory, and implications for treatment. Current research supports distinct etiologies and growth trajectories for both disorders. Thus, comorbidity presents with unique challenges, and often, worse outcomes. Though comorbidity rates are high, little research has been done concerning treatment. Given the high prevalence rates of these comorbid disorders, a specific treatment needs to be developed that targets both disorders simultaneously.     

围绝经期妇女焦虑症心理治疗研究进展

随着社会竞争日益激烈,妇女承受的生理、心理、社会压力越来越大,致使部分女性提早进入围绝经期,出现较为严重的围绝经期焦虑症。围绝经期焦虑症患病率较高,诊断率和治疗率均很低,临床更易误诊为器质性疾病,严重影响妇女的家庭生活和工作。因此,大力发展社区心理治疗,主动与区精神卫生中心合作,形成心理疾病防控网络,可更好地提高妇女在围绝经期的社会功能,促进社区妇女健康,推动社区围绝经期焦虑症心理治疗的迅速发展。     

Adjunctive topiramate in the maintenance treatment of bipolar disorders: an open-label study

SUMMARY

Objective: A considerable number of patients with bipolar disorder fail to respond completely to mood stabilizers. The anti-epileptic topiramate shares some pharmacological actions with carbamazepine and valproate. We therefore explored the efficacy and tolerability of topiramate in the prophylaxis of bipolar disorder.

Methods: Fifty-six patients receiving outpatient treatment for bipolar affective disorder who had been on mood stabilizers, and had relapsed at least once in the past 12?months, were treated with topiramate in an add-on design and were evaluated for 1?year. Patients were assessed biweekly for the first 3?months and every month thereafter.

Results: Fifty out of 56 patients completed the 1-year study, which indicated that adjunctive topiramate was associated with a significant reduction of new manic and depressive episodes compared to the past 12?months. The most common adverse effects were reduced appetite, fatigue and somnolence.

Conclusions: This was an open-label, uncontrolled study involving retrospective evaluation of episodes prior to the initiation of treatment, and the use of more than one mood stabilizer in a few patients. However, these preliminary observations of adjunctive topiramate as a maintenance treatment encourage further investigations, especially with controlled trials, for its long-term effect.     

氟西汀与阿米替林双盲对照治疗16例抑郁障碍病人

目的：评价国产氟西汀对抑郁症的疗效及安全性。方法：用国产氟西汀和阿米替林随机双盲对照治疗严重抑郁障碍病人共１６例。氟西汀组８例（男性４例，女性４例，年龄５１±ｓ１５ａ），口服氟西汀２０ｍｇ，ｑｄ；阿米替林组８例（男性３例，女性５例，年龄５１±１６ａ），口服阿米替林７５ｍｇ，ｂｉｄ。疗程６ｗｋ。结果：２组病人治疗后ＨＡＭＤ，ＨＡＭＡ，ＳＤＳ评分均显著下降，但２组间比较无显著差异。２组病人的显效率均为７５％。治疗后ｗｋ１，２，６末ＴＥＳＳ评分值氟西汀组均低于阿米替林组。结论：国产氟西汀疗效同阿米替林相当，但副作用较轻微。     

Screening for bipolar disorders in patients with alcohol or substance use disorders: performance of the mood disorder questionnaire

Background

Screening properties of the Mood Disorder Questionnaire (MDQ) to detect bipolar disorder (BD) in patients with substance use disorders are unknown.

Methods

403 treatment seeking patients with a substance use disorder completed the MDQ and subsequently 111 MDQ positives and 59 MDQ negatives were assessed with the Structured Clinical Interview for DSM-IV to diagnose BD. In addition, given the overlap with BD symptoms, the presence of borderline personality disorder (BPD), antisocial personality disorder (APD) and attention deficit/hyperactivity disorder (ADHD), were assessed using the Diagnostic Interview Schedule and the Structured Interview for DSM-IV Personality.

Results

Of the 170 patients with a SCID interview, 35 patients (20.6%) met criteria for a lifetime diagnosis of BD. Twenty-three patients (62.8%) with BD had a positive MDQ score and 47 of the 135 patients (34.8%) without BD had a negative MDQ score resulting in a weighted sensitivity of .43, a weighted specificity of .57, a positive predictive value of .21, a negative predictive value (NPV) of .80 and an area under the curve of .50. The area under the curve of the MDQ to detect BPD, APD, ADHD and any externalizing disorder ranged from .55 (APD) to .63 (ADHD).

Conclusions

The MDQ is not a suitable screening instrument for the detection of BD or other externalizing disorders but it could be used for ruling out the presence of BD in treatment seeking substance use disorder patients.     

坦度螺酮与丁螺环酮治疗广泛性焦虑症的疗效和安全性比较研究

目的评价坦度螺酮治疗广泛性焦虑症的有效性和安全性。方法用随机化、双盲、双模拟、多中心、阳性药平行对照研究方法。共入组符合研究方案的病例236例,坦度螺酮组117例,丁螺环酮组119例。试验药的剂量为每日30-60mg,对照药的剂量为每日15-30 mg。结果两组病人的主要疗效指标HAMA评分在治疗结束时与基线比较均显著减低(P相似文献   

The pharmacological treatment of anxiety disorders in children and adolescents

As the recognition of paediatric and adolescent anxiety disorders improves, so does the number of recommended treatments. Newer medications (chiefly serotonergic antidepressants) have emerged as the pharmacological treatment of choice and have largely replaced benzodiazepines and tricyclic antidepressants (TCAs) for these disorders. This review will focus on placebo-controlled and open-label studies concerning the treatment of anxiety in children and adolescents, comparing data from newer antidepressant medications (plus buspirone) with data on TCAs and benzodiazepines in this population. There are few randomised, placebo-controlled trials of medications for anxiety in children and adolescents, with most data coming from open-label trials and case series. Moreover, there are no studies comparing pharmacological versus behavioural treatments. Most recent data concerning the efficacy of selective serotonin reuptake inhibitors suggests that these agents will be effective and safe in the treatment of paediatric anxiety disorders. The potential side effect profiles of these newer agents also makes them an attractive first choice for anxiety when compared to the benzodiazepines or TCAs, each of which poses its own potentially serious adverse effects. More research is needed in the area of psychopharmacological treatments for paediatric and adolescent anxiety, not only to substantiate the current beliefs that serotonergic agents are effective and safe but to pinpoint the factors that might predict responses to particular agents or classes of medications. Future investigations should focus on treatments which have already proven effective for adult anxiety disorders (both medications and psychotherapies), given the apparent links between paediatric and adult anxiety disorders.     

脑深部电刺激在运动障碍性疾病中的临床应用

脑深部电刺激(DBS)作为神经调控的主要手段,目前已广泛应用于药物难治性帕金森病、特发性震颤、肌张力障碍、Meige综合征、躯干前曲症、不宁腿综合征、抽动秽语综合征等运动障碍性疾病治疗,为运动障碍性疾病提供了全新的治疗方法。本文综述DBS的临床应用进展。     

Pharmacogenetics in affective disorders

Pharmacogenetics will be of substantial help in the field of affective disorders pharmacotherapy. The possible definition of a genetic liability profile for drug side-effects and efficacy will be of great help in treatments that need weeks to months to be effective. During the last few years, a number of groups have reported possible liability genes. The efficacy and time of onset of selective serotonin reuptake inhibitors have been associated with a polymorphism in the promoter region of the transporter (SERTPR) in many independent studies, while variants at the tryptophan hydroxylase gene, 5-HT2a receptor and G-protein beta3 have been associated with them in pilot studies. Lithium long-term prophylactic efficacy has been associated with SERTPR, TPH and inositol polyphosphate 1-phosphatase variants, though in unreplicated samples. A number of further candidate genes were not associated with these treatments. In conclusion, both acute and long-term treatments appear to be, at least to some extent, under genetic influence and preliminary data have identified possible liability genes.