Consideration on two cases of dystonia-parkinsonism.

We describe two sporadic cases of dystonia-parkinsonism at different stages of disease progression. The two girls, first seen at the ages of 10 and 12 years, have been followed for 9 and 2 years respectively. In both patients L-dopa 60 mg + carbidopa 6 mg brought about a swift remission of symptoms, which persists to date. All examinations, including CT and MR brainscans, were normal. The CSF and urine levels of HVA and 5HIAA were low in one case and normalized with treatment. This finding might provide a fairly valid predictive index of responsiveness to L-dopa.     

多巴反应性肌张力障碍10例分析

目的认识多巴反应性肌张力障碍的临床特征,以期早期诊治,并加深对该病的认识。方法对10例DRD患者进行临床分析。结果10例患者,男3例,女7例,发病年龄4~28岁,平均12岁,首发症状均为肌张力障碍,下肢起病者8例,上肢起病2例,全部病人均有晨轻暮重的现象,给予美多巴62.5~125mg/d治疗有显著疗效。结论DRD是一种较为罕见的遗传性运动障碍疾病,小剂量多巴制剂有显著、持续疗效,早期治疗效果好,需与其他肌张力障碍相鉴别。     

心肺复苏后肌阵挛(附2例临床报告)

目的:探讨心肺复苏后肌阵挛的分类、诊断、治疗原则及预后。方法:报道两例心肺复苏后肌阵挛病例并综合已有的文献研究。结果:两例分别明确诊断为急性症状性肌阵挛和慢性症状性肌阵挛,并根据其不同的病理生理机制,给予相应的治疗,两例均存活且临床症状得到控制。结论:心肺复苏后肌阵挛应根据不同的分类及病理生理机制,采取有针对性的措施控制症状,并尽快改善中枢神经系统缺血缺氧损伤,合并癫痫与否对于治疗及预后有参考意义。     

恩他卡朋对帕金森病大鼠的疗效

目的:观察恩他卡朋与左旋多巴/苄丝肼(美多芭)联用对帕金森病大鼠的治疗作用。方法:6-羟多巴(6-OHDA)毁损内侧前脑束(MFB)建立SD大鼠PD模型。成模大鼠腹腔注射不同剂量的美多芭与恩他卡朋,观测大鼠旋转圈数和持续时间。结果:单用恩他卡朋不能诱导PD大鼠旋转。采用美多芭(6.25、12.5mg·kg-1)和不同剂量的恩他卡朋(10、5、0mg·kg-1)联用的PD大鼠,旋转圈数明显增加、旋转时间也明显延长;恩他卡朋的剂量越大,旋转运动的持续时间越长,但出现旋转反应高峰的时间向后推迟。结论:足量的恩他卡朋可以加强左旋多巴的疗效,半量的恩他卡朋疗效欠佳。     

Effectiveness of nilvadipine in two cases of chronic schizophrenia

Abstract Nilvadipine is a calcium channel inhibitor used commonly for the treatment of cerebrovascular insufficiency. We observed two patients with schizophrenia whose psychiatric symptoms and tardive dyskinesia improved after the addition of nilvadipine to their antipsychotic drug regimen. The total score of the brief psychiatric rating scale (BPRS) in case 1 fell from 56 to 42 after 8 weeks on nilvadipine; while that of case 2 fell from 44 to 32. The total score of the abnormal involuntary movement scale (AIMS) in case 2 decreased from 12 to 7. No adverse effects occurred during treatment. Nilvadipine may thus offer a new approach to the adjunctive treatment of schizophrenia.     

Comparative efficacy of two oral sustained-release preparations of L-dopa in fluctuating Parkinson's disease. Preliminary findings in 20 patients

Summary 20 patients with Parkinson's disease and a fluctuating response to chronic treatment with conventional L-dopa preparations participated in an open randomized trial comparing two sustained-release L-dopa preparations (Madopar HBS, Sinemet CR4). While a majority (15 patients, 7 on Madopar HBS and 8 on Sinemet CR4) showed a favourable response after 2 months of slow-release L-dopa treatment the clinical benefit remained stable in only 2 patients on Madopar HBS and 3 patients on Sinemet CR4 over the entire follow-up period of 12 months. Reasons for treatment failure were increased peak-dose or biphasic dyskinesias or prolonged off-periods. This preliminary study failed to demonstrate clinically significant advantages of one slow-release principle over the other.     

Effect of L-dopa on dementia-related rigidity

L-dopa 100 mg plus benserazide 25 mg versus placebo were given 3 times daily to 14 consecutive patients with dementia and rigidity. The treatment was crossed over to the alternative therapy after a 7-day period. Despite a mean 60% raise in CSF-HVA during L-dopa administration, no patient responded to the treatment. These data suggest that dementia-associated rigidity differs, at least, pharmacologically from parkinsonian rigidity.     

对左旋多巴长期治疗帕金森病的评价

很多研究证明长期应用左旋多巴(L-dopa)治疗帕金森病(PD),可明显改善PD患者的症状,而且应该在PD的早期应用适量的左旋多巴进行治疗,以改善患者的早期症状。长期应用左旋多巴治疗PD与长期应用多巴胺受体激动剂对疾病导致的病死率相同。长期应用多巴胺受体激动剂治疗PD的疗效与长期应用左旋多巴相同,前者并未显示出优越性。     

Stability of treatment outcome in short-term psychiatric care. A six-month follow-up of a controlled study of patient involvement

The general trend of avoiding and shortening in-patient treatment raises the question of the stability of treatment gains made during hospitalization. A 6-month follow-up was made for patients treated on a short-term psychiatric ward. The origin was a controlled study of two models of patient involvement in treatment planning. Patients benefiting most from a cooperation procedure during hospitalization were those with socio-psychological treatment objectives and those treated in a Basic Activation Group on the ward. The superior outcome for these patients was not stable during the period of follow-up, resulting in an incongruence between in-hospital and post-hospital adjustment. Furthermore, these patients at time of follow-up showed an increased confidence in the staff of the ward and a decrease in the rated importance of their social network. It is suggested that this is the result of dependency reactions and a separation process from the therapeutic milieu of the ward which were not resolved at time of discharge. Greater concern should be invested in formulating the treatment contract in an out-patient context in order to place the emphasis on the real life situation of the patient.     

Single fibre EMG in 6 cases of botulism

ABSTRACT- In 6 cases of mild botulinum intoxication, conventional EMG and single fibre EMG (SFEMG) were performed on admission to our ward (about 15 days after ingestion of the toxin) and 4, 8 and 14 weeks after admission.
In 4 cases, conventional EMG resulted in abnormal findings; and they normalized 4 weeks later. On the first examination, SFEMG revealed in all cases but one the occurrence of potential pairs with abnormal jitter (above 50 μs). The % of the potential pairs with abnormal jitter ranged in different cases from 17% to 44%. Some of the potential pairs with abnormal jitter showed blockings; the occurrence of blockings was not strictly related to jitter value. Mean jitter value and % of potential pairs with abnormal jitter became progressively reduced with increasing time after intoxication. Nevertheless, in 4 cases slightly abnormal findings were still present after 4 months.
The data obtained in the basal condition are in agreement with those reported by others. SFEMG findings relate fairly well to conventional EMG data and clinical status. SFEMG has proved to be a very sensitive method for studying the neuromuscular transmission defect in botulism and in obtaining further information on the course of the syndrome.     

Elective mutism.

Eleven children who had received a diagnosis of elective mutism upon admission to the children's psychiatric clinic, were followed up 8--18 years later. The average age upon admission was 9 1/2 years, and at the time of follow-up, 23 years. Nine of the children came from homes with a strong familial shyness and reservation, and eight lived in social isolation. Six were particularly overprotected. Six came from discordant family constellations. All were diagnosed neurotic, eight specified as compulsion-neurosis. All were of normal intelligence. Six children received extensive individual psychotherapy (four upon admission to the clinic, two by way of out-patient treatment). We were unable to offer similar treatment to the remaining five. During the course of treatment three of the admitted patients improved, the fourth and the two ambulatory patients remained unchanged after up to 4 years of therapy. The follow-up study showed the three unchanged patients and the five who had received treatment, now were cured of the symptom; improvement took place in connection with a change of environment. The five who had not received treatment were better adjusted than those who had been separated from home for several years, at a vulnerable age. The importance of early prophylactic intervention is emphasized.     

显微手术夹闭与血管内介入栓塞治疗颅内破裂动脉瘤的疗效分析

目的 对手术夹闭和血管内介入治疗颅内破裂动脉瘤的疗效作初步分析.方法 对2008年1月-2009年12月在重庆医科大学附一院神经外科治疗的破裂动脉瘤患者进行随访,获得随访信息的病例共109例,病人术前状态采用Hunt-Hess分级评分,其中采用显微神经外科开颅手术79例,Ⅰ-Ⅱ级69例(87.3％),Ⅲ-Ⅴ级10例(12.7％),血管内介入治疗30例,Ⅰ-Ⅱ级26例(86.7％),Ⅲ-Ⅴ级4例(13.3％).出院时手术夹闭组Hunt-Hess分级Ⅰ-Ⅱ级69例全部预后良好,Ⅲ-Ⅴ级10例,6例预后良好,4例预后不良(1例死亡),平均住院恢复时间(22.7±3.2)天;介入栓塞组Hunt-Hess分级Ⅰ-Ⅱ级26例全部预后良好,Ⅲ-Ⅴ级4例,2例预后良好,2例预后不良(1例死亡),平均住院恢复时间(13.4±3.4)天.随访时间3个月～2年.结果 手术夹闭组预后良好76例(96.2％),不良3例(3.8％),其中死亡2例(2.5％),瘫痪1例(1.3％);介入栓塞组预后良好28例(93 3％),不良2例(6.7％),其中死亡1例(3.4％),瘫痪1例(3.4％).影像学上,手术夹闭组79例随访63例(79.7％),其中稳定59例(93.7％);介入栓塞组30例病例随访21例(70％),其中稳定19例(90.5％).差异无统计学意义(P=0.625).结论 本研究手术夹闭和介入栓塞两种治疗方法间近期临床效果及随访结果统计学均无显著差异.手术治疗组的完全夹闭率较介入栓塞组的完全栓塞率高,而介入栓塞组平均住院恢复时间明显低于手术夹闭组.     

The children of the Lundby study as adults: A salutogenic perspective

In this study, 100 patients consecutively admitted to four child psychiatric inpatient wards in Finland were prospectively followed 12 months after discharge from short-term inpatient treatment. It turned out that 50 patients were discharged back to their previous residence and to outpatient treatment, 40 patients were admitted to long-term inpatient treatment and 10 patients were placed in some institution. The child's antisocial behaviour on admission was the strongest determinant for long-term treatment or placement at the 12 month follow-up. Other predictors of long-term treatment or placement in an institution included a high total score in teacher's behaviour ratings, being referred by a psychiatric agency and living in a semi-rural area. No statistically significant relationship was found in the child's age, gender, parents' education level or occupation, family characteristics, total life events, parent's ratings of total behaviour, total life events, parent's ratings of total behaviour, CGAS ratings by a clinician or a wide range of treatment variables.     

The clinical course of children treated in a short-term inpatient programme

Forty-six children admitted to short-term, usually 4–6-week child psychiatric inpatient treatment were evaluated from multiple perspectives on admission, at discharge, and at 5-month, one-year, and 3-year follow-ups. The majority of the patients showed an improvement in functioning over the course of the 3-year follow-up. However, the 3-year stability of parent, teacher and clinical ratings of the child was very high. Furthermore, the majority of children had a high level of symptoms at follow-ups. Conduct problems had the highest stability and predicted the poorest outcome. The results stress the importance of long-term follow-up of children discharged from child psychiatric tertiary sevices. In many of these cases, the problems were persistent chronic problems that require continued monitoring and evaluation over many years. Short-term hospitalization should be seen as a pathway to further assistance rather than a complete form of treatment.     

Cross-linguistic transfer effects of verb-production therapy in two cases of multilingual aphasia

Background: Verb retrieval is challenging for monolingual and multilingual speakers with aphasia. Previous research on bilingual aphasia shows equivocal results of cross-linguistic transfer and inhibition.

Aims: This study explores the impact of verb-production treatment in the treated and untreated languages of two bilingual speakers with aphasia. The main goals were to explore treatment effects, possible cross-linguistic transfer effects and to investigate possible inhibition of the untreated languages.

Methods & Procedures: The participants were one trilingual speaker (Portuguese-Ronga-Norwegian) with nonfluent aphasia and one bilingual speaker (English-Norwegian) with fluent aphasia. They received two types of treatment: communication-based therapy and Semantic Feature Analysis. Treatment was conducted in Norwegian, a late-acquired language for both speakers. Treatment effects were measured in action naming tasks and narrative tasks in the treated language as well as the untreated languages.

Outcomes & Results: Overall, the participants responded positively to the verb production treatments. This was demonstrated at the lexical level and also in discourse production, especially in the treated, but also in the untreated languages. No inhibition of the untreated languages was found.

Conclusions: The data provide evidence for positive effects of verb-retrieval treatment provided in sentence contexts in a late-learned weaker language of multilingual speakers with aphasia. The treatments did not lead to an unwanted inhibition of the untreated language, which is an important finding for clinicians as well as for researchers. The results provide evidence for a shared conceptual network of the languages in bilingual speakers, supporting current models of bilingual language processing.     

No effect of orthographic neighbourhood in treatment with two cases of acquired dysgraphia

Background: Studies on the nature of processing within the spelling system have provided evidence for interactivity, where activation between levels of processing flows bidirectionally. In particular, activated letters at the level of the graphemic buffer feed activation back to the lexicon. As a consequence lexical neighbours are activated, which in turn reactivate the graphemic buffer, supporting target selection and leading to an effect of orthographic neighbourhood size in spelling. As a consequence of this feedback, treating words with many neighbours may be more beneficial, and generalisation may be more likely to occur.

Aims: The current study aimed to further examine this interactivity, and in particular the role of orthographic neighbourhood size in both treatment effects and generalisation, in the treatment of two individuals with acquired dysgraphia. Two phases of copy and recall treatment were conducted to investigate if orthographic neighbourhood size modulates treatment effects: in the first phase, treated words had no orthographic neighbours, in the second phase, treated words had many neighbours. Untreated control sets were used to investigate the influence of neighbourhood size on potential generalisation across items.

Main Contribution: Results showed that treated items improved, however neighbourhood size did not significantly influence the size of the treatment effect for either participant, and no clear evidence was found for generalisation to untreated items.

Conclusions: It is argued that (1) the amount of feedback from the buffer to the lexicon was reduced in the participants in this study, and consequently the treated items provide insufficient activation to orthographic neighbours or (2) the effect of feedback from neighbours is small compared to effects of treatment, resulting in similar results for treated words with and without neighbours.

This study informs the relationship between spelling impairment and effects of treatment. Furthermore, the absence of generalisation emphasises the importance of choosing functionally relevant items for treatment.     

功能性垂体腺瘤的伽玛刀治疗

目的 评估伽玛刀（γ-刀）治疗对功能性垂体腺瘤的治疗效果。方法 对132例功能性垂体腺瘤病人,用1.5T磁共振和γ-plan计算机联网定位,LekaseⅡ,伽玛刀实施放射外科手术,肿瘤直径4-37mm,平均14mm,处方剂量11-35Gy,平均26.4Gy。结果 本组病例随访35-57个月,获随访118例（89.4%),肿瘤消失78例（66.1%),缩小32例（27.1%),肿瘤增大1例;激素值恢复正常74例（62.7%)。较术前下降26例（22.0%)。临床症状改善108例（91.5%),症状加重6例（5.1%)。结论 γ-刀是治疗功能性垂体腺瘤安全、有效的一种方法,但要严格掌握适应证,否则γ-刀治疗后有可能加重症状,产生并发症。     

气功相关精神障碍患者82例随访对照分析

目的：对气功所致精神障碍与气功相关的精神分裂症的临床特点差异进行探讨。方法：收集在1990年至2000年间连续入院患者中与气功相关的精神病性障碍患者82例,其中住院时诊断为气功所致精神障碍46例,精神分裂症36例。收集两组病例的人口统计学、临床表现等资料并作5年以上随访。结果：气功所致精神障碍（气功组）与精神分裂症（分裂症组）比较,在性别、婚姻、年龄、接受教育年限、起病年龄及病程方面差异均有显著性（P均〈0．001）。获得68例5年以上的随访资料,其中气功组38例,分裂症组30例。至随访结束,气功组中84％（32例）、分裂症组中57％（17例）维持原诊断,二者差异有显著性（P〈0．001）。气功组的精神障碍缓解程度达89％（34例）,而分裂症组的缓解程度仅33％（10例）,差异有显著性（P〈0．001）。气功组的社会功能也明显优于分裂症组（P〈0．01）。结论：气功所致精神障碍与气功相关的精神分裂症是两种不同类型的疾病,根据临床特点,二者可以鉴别。     

门诊青少年焦虑障碍患者团体认知行为治疗的3个月随访研究

目的:评估门诊焦虑障碍青少年团体认知行为治疗(GCBT)的有效性。方法:对儿童青少年门诊就诊的70例13～18岁焦虑障碍青少年采用随机抽样方法,分为GCBT组和等待对照(WLC)组。GCBT组接受为期8周、每周1次、每次120 min的GCBT治疗。在治疗前填写自制一般情况问卷,治疗前、治疗8周后、治疗结束3个月后用儿童焦虑性情绪障碍筛查表(SCARED)进行测试。结果:GCBT组共34例完成研究,3个月后的随访有17例参加。WLC组共22例完成8周随访。与WLC组相比GCBT组治疗后青少年焦虑障碍患者SCARED总分及广泛性焦虑、躯体化、社交焦虑、分离性焦虑因子分呈显著性下降(t=6.24,P0.01;t=4.58,P0.01,t=4.31,P0.01,t=4.17,P0.01)。治疗结束后3个月随访发现患者SCARED总分及广泛性焦虑、躯体化、社交焦虑、分离性焦虑因子分呈明显下降趋势(F=11.26,P0.01;F=11.38,P0.01;F=11.01,P0.01;F=20.02;P0.01)。结论:GCBT能有效缓解门诊焦虑障碍青少年的焦虑情绪。     

Multisystemic Treatment of Serious Behaviour Problems in Youth: Sustainability of Effectiveness Two Years after Intake

Background:  Multisystemic Treatment (MST) is an intensive home- and community based intervention for youths with serious behaviour problems. The aim of this study was to examine the effectiveness of MST compared to 'regular services' (RS) two years after intake to treatment. In particular, our goals were to investigate whether MST was successful at preventing placement out of home, and to examine reductions in behaviour problems in multi-informant assessments.
Method:  Participants were 75 adolescents who were randomly assigned to MST or Regular Child Welfare Services (RS) at 3 sites across Norway. Data were gathered from youths, caregivers and teachers.
Results:  MST was more effective than RS in reducing out of home placement and behavioural problems.
Discussion:  The sustainability of treatment effects was evident, supporting the MST approach to the treatment of serious behavioural problems in youth. Site differences and the moderating effects of age and gender are discussed.