双相情感障碍混合发作血清细胞因子水平研究

目的：比较双相情感障碍混合发作与躁狂发作及抑郁发作患者之间血清细胞因子的水平。方法：采用酶联免疫吸附法测定38例双相情感障碍混合发作患者（混合组）、54例躁狂发作患者（躁狂组）、47例抑郁发作患者（抑郁组）及38名正常人（对照组）血清白介素-1（IL-1β）、白介素-2（IL-2）及白介素-6（IL-6）的浓度;混合组患者于治疗前和治疗8周进行Hamilton抑郁量表（HAMD-24）和Young躁狂量表（YMRS）评定。结果：混合组IL-1β浓度显著高于躁狂组及抑郁组（P〈0.01）,但与对照组差异无统计学意义（P〉0.05）。混合组IL-2浓度与躁狂组、抑郁组及对照组之间差异均无统计学意义（P〉0.05）。混合组IL-6浓度显著高于躁狂组、抑郁组及对照组（P〈0.001）。混合组IL-6浓度治疗8周后较治疗前显著下降（t=3.372,P〈0.01）,与对照组比较差异无统计学意义（t=1.823,P〉0.05）。混合组治疗前后IL-6浓度差值与HAMD-24、YMRS减分率之间均无显著相关（r分别=-0.211、-0.100,P均〉0.05）。结论：双相情感障碍混合发作可能存在IL-6诱导的免疫功能异常,有不同于双相情感障碍躁狂发作及抑郁发作的生物学特征。     

双相情感障碍血清尿酸水平研究

目的探讨双相情感障碍患者血清尿酸(uric acid,UA)水平变化及其临床意义。方法纳入双相情感障碍患者126例(躁狂发作77例,抑郁发作49例)、首发精神分裂症患者69例和正常对照126名,测定其血清UA水平,并采用杨氏躁狂量表(Young mania rating scale,YMRS)和汉密尔顿抑郁量表(Hamilton depressionscale,HAMD)评定双相情感障碍患者症状。结果双相情感障碍组血清UA水平[(349.34±107.21)μmol/L]高于精神分裂症组[(319.71±84.48)μmol/L]和对照组[(280.94±71.90)μmol/L],差异有统计学意义(P0.01);躁狂发作患者UA水平高于抑郁发作患者[(366.45±104.01)μmol/L vs.(322.45±107.69)μmol/L],且二者均高于对照组(P0.01);双相情感障碍患者中是否使用精神科药物的亚组间UA水平无统计学差异(P0.05)。双相情感障碍患者血清UA水平与YMRS、HAMD分数线性相关均无统计学意义(P0.05)。结论双相情感障碍患者血清UA水平升高,血清UA水平升高可能是双相情感障碍的一个生物标记物。     

甲状腺功能水平与双相情感障碍相关性的对照研究

目的 探索甲状腺功能与双相情感障碍的相关性.方法 以符合美国精神疾病分类与诊断标准第4版修订本(DSM-Ⅳ-TR)的双相情感障碍诊断标准的患者59例为研究对象,并选取41名健康人作为对照,应用酶联免疫吸附法(ELISA)分别测定所有研究对象的血清甲状腺激素水平,包括TT3、FT3、TT4、FT4及TSH.选用HAMD、HAMA及Bech-Rafaelsen躁狂量表评估患者组临床症状.结果 双相躁狂组中TT4、FT4水平明显高于对照组,FT3水平明显高于抑郁组,差异有统计学意义(P<0.01).双相抑郁组中TT3、FT3水平明显低于对照组,FT4水平则明显高于对照组,差异有统计学意义(P<0.01).按性别分层比较,女性双相躁狂组FT4水平与对照组相比明显升高,差异有统计学意义(P<0.05);女性双相抑郁组TT3明显低于对照组或双相躁狂组,FT4明显高于对照组,FT3则明显低于对照组,差异均有统计学意义(P<0.05),而男性躁狂组中仅TT4水平显著高于对照组(P<0.05).在双相抑郁患者中,HAMD总分与FT4呈负相关(r=-0.34,P=0.03).结论 双相情感障碍患者的甲状腺功能存在一定的改变,不同临床相甲状腺功能改变亦不相同,且这种变化以女性患者明显.     

碳酸锂联合富马酸喹硫平片或丙戊酸镁缓释片治疗双相情感障碍躁狂发作的疗效

目的研究富马酸喹硫平片、丙戊酸镁缓释片分别联合碳酸锂治疗双相情感障碍躁狂发作的疗效。方法将100例双相情感障碍躁狂发作的患者随机、双盲分为对照组和观察组,50例/组,对照组采取丙戊酸镁缓释片联合碳酸锂治疗,观察组采用富马酸喹硫平片联合碳酸锂治疗。将两组双相情感障碍躁狂发作患者的倍克-拉范森躁狂量表(BRMS)评分、阳性和阴性症状量表(PANSS)评分、认知功能、临床效果、不良反应发生情况进行比对。结果观察组患者治疗后的BRMS评分及PANSS评分均低于对照组,差异具有统计学意义(P0.05);治疗后的言语记忆测验(HVLT-R)、持续操作测验(CPT)评分高于对照组,差异具有统计学意义(P0.05);两组的临床总有效率和不良反应发生率无统计学差异(P0.05)。结论在治疗双相情感障碍躁狂发作方面,富马酸喹硫平片联合碳酸锂、丙戊酸镁缓释片联合碳酸锂进行治疗均可取得较好的疗效,安全性较高,但是富马酸喹硫平片联合碳酸锂在改善患者认知功能及临床症状方面效果更好。     

丙戊酸钠与无抽搐电休克治疗中老年双相情感障碍躁狂发作的疗效对比

目的对比丙戊酸钠注射液与无抽搐电休克治疗中老年双相情感障碍躁狂发作的疗效。方法选择我院收治的86例中老年双相情感障碍躁狂发作患者,采用随机数表法将86例患者分为对照组43例和观察组43例,2组均予以常规药物治疗,对照组在常规治疗基础上进行无抽搐电休克治疗,观察组予以丙戊酸钠注射液治疗,治疗2周后使用杨式躁狂评定量表(YMRS)评价症状改善情况,使用连线(TMT)测验与威斯康星卡片分类(WCTS)测验比较2组认知功能改善情况,对比2组预后情况。结果治疗后2组YMRS评分与治疗前相比均降低,治疗后1周2组YMRS评分无明显差异(P0.05);治疗后2周观察组YMRS评分显著低于对照组(P0.05);治疗2周后观察组TMT与WCTS结果均优于对照组(P0.05);观察组住院时间、住院费用、复发次数、约束时间和约束次数均低于对照组(P0.05)。结论在中老年双相情感障碍躁狂发作的治疗中应用丙戊酸钠注射液的效果优于无抽搐电休克治疗,可更好改善患者的症状,缩短住院时间,节省治疗费用,值得临床推广。     

不同发作类型双相障碍患者自知力及服药态度比较

目的比较躁狂发作、抑郁发作及混合状态的双相障碍住院患者出院前的自知力及服药态度,以了解不同发作类型双相障碍的自知力及服药态度在出院前的差异,为出院后制定康复方案提供参考。方法连续入组罗定市第三人民医院2014年5月-2016年12月收治的符合《国际疾病分类(第10版)》(ICD-10)诊断标准的双相障碍住院患者266例,其中躁狂发作116例,抑郁发作94例,混合状态56例。采用汉密尔顿抑郁量表17项版(HAMD-17)、杨氏躁狂评定量表(YMRS)、自知力与治疗态度问卷(ITAQ)及服药态度清单(DAI)在出院当天分别评定精神症状、自知力及服药态度。采用单因素方差分析比较三组HAMD-17、YMRS、ITAQ及DAI评分。结果 HAMD-17、YMRS评分组间比较差异均无统计学意义(P均0.05)。ITAQ、DAI评分组间比较差异有统计学意义(F=6.205、5.481,P=0.002、0.005),两两比较结果显示,抑郁发作组及混合状态组ITAQ、DAI评分均高于躁狂发作组,差异均有统计学意义(P均0.05);抑郁发作组及混合状态组ITAQ、DAI评分比较差异无统计学意义(P均0.05)。结论不同发作类型的双相障碍住院患者出院前的自知力及服药态度存在差异,躁狂发作患者的自知力及服药态度较抑郁发作及混合状态患者差。     

精神分裂症患者与躁狂发作患者父母教养方式对照研究

目的 探讨精神分裂症与双相情感障碍躁狂发作患者的父母教养方式特点.方法 采用父母教养方式评价量表(EMBU)对43例精神分裂症患者及38例双相情感障碍躁狂发作患者父母教养方式(研究组)进行评定,并与38例正常受试者(对照组)比较.结果 与双相情感障碍躁狂发作及正常被试比较,精神分裂症患者组在教养方式上,父母均表现为高惩罚与严厉、高过分干涉和高拒绝与否认(P＜0.05);双相情感障碍躁狂发作患者组教养方式各因子得分虽低于正常对照组,但差异无统计学意义(P＞0.05).结论 精神分裂症患者父母教养方式均存在多方面问题,可能对精神分裂症发病有一定影响.双相情感障碍躁狂发作患者的父母教养方式可能存在一定问题,需要进一步研究.     

双相障碍躁狂发作患者反应抑制能力的研究

目的:探讨双相障碍躁狂发作患者反应抑制能力。方法:对15例双相障碍躁狂发作患者(患者组)在执行Go/Nogo任务的同时进行事件相关电位(ERP)检测;采集前额区、中央区和顶叶区的N2和P3波幅;并与16位性别、年龄及受教育情况相匹配的健康对照者(对照组)比较。结果:患者组前额区Go-N2波幅明显高于对照组(P0.05);Nogo-N2波幅各脑区与对照组相比差异无统计学意义。前额区Go-P3波幅及前额区、中央区的Nogo-P3波幅显著低于对照组(P0.05或P0.01)。结论:双相障碍躁狂发作患者认知控制能力受损,体现在早期冲突觉察监控阶段以冲动性为主,认知控制加工的晚期阶段为认知资源投入不足。     

碳酸锂单用与合并阿立哌唑治疗双相障碍I型躁狂发作患者的随机对照研究

目的:探讨碳酸锂单用及合并阿立哌唑治疗双相障碍I型躁狂发作患者的疗效和安全性。方法:86例门诊双相障碍I型躁狂发作患者被随机分为联合组(碳酸锂+阿立哌唑治疗)和单药组(碳酸锂单药治疗),疗程8周。分别在治疗前、治疗2、4、8周进行杨氏躁狂量表(YMRS)和汉密顿抑郁量表(HAMD)-17项评定,采用治疗中出现的症状量表(TESS)评定不良反应。结果:治疗前两组YMRS评分差异无统计学意义;治疗2、4、8周后联合组YMRS减分值明显高于对照组(P0.05或P0.01);治疗前后两组HAMD均7分;两组TESS评分差异无统计学意义。结论:碳酸锂联合阿立哌唑治疗双相障碍I型躁狂发作较单用碳酸锂起效快,症状改善更明显,且未见不良反应明显增加。     

不同临床相双相障碍患者甲状腺功能的回顾性研究

目的探究双相障碍患者甲状腺功能的临床相和性别差异,以期为双相障碍的诊断和治疗提供参考。方法采用回顾性研究方法,收集河南省精神病医院2015年9月-2018年1月的住院患者甲状腺功能生化指标,包括促甲状腺素(TSH)、三碘甲状腺原氨酸(T_3)、甲状腺素(T_4)、游离三碘甲状腺原氨酸(FT_3)和游离甲状腺素(FT_4),筛选符合《国际疾病分类(第10版)》(ICD-10)诊断标准的双相障碍躁狂发作(双相躁狂)和双相障碍抑郁发作(双相抑郁)患者2 207例,同期选择415例体检人员作为正常对照组,比较不同临床相和不同性别的双相障碍患者甲状腺功能的差异。结果①双相躁狂患者的T_3、FT_3水平高于双相抑郁患者,TSH、T_4水平低于正常对照组;双相抑郁患者的TSH、T_3、T_4、FT_3水平均低于正常对照组(P0. 05或0. 01);②在双相躁狂患者中,男性T_3、FT_3和FT_4水平高于女性,而TSH、T_4水平低于女性,在双相抑郁患者中,男性T_3、FT_3和FT_4水平高于女性,而TSH水平低于女性(P0. 05或0. 01);③在男性患者中,双相躁狂患者的T_3和FT_3水平均高于双相抑郁患者,双相抑郁患者的T_3水平低于正常对照组(P0. 05或0. 01);在女性患者中,双相躁狂患者的T_3和FT_3水平高于双相抑郁患者,双相抑郁患者的T_3、T_4、FT_3水平均低于正常对照组(P0. 05或0. 01)。结论双相障碍患者的甲状腺功能可能存在临床相和性别的差异。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.