首发与复发精神分裂症患者空间认知功能的差异研究

目的探讨首发与复发精神分裂症患者空间认知功能的差异。方法对30例精神分裂症首次发作患者（首发组）、32例复发精神分裂症患者（复发组）进行视觉空间旋转任务的测定,测量其错误数和反应时,并与30名健康志愿者的结果进行比较。结果（1）与对照组（8．6±2．7）％相比,首发组（26．8±8．4）％、复发组（35．3±9．6）％错误率均显著升高,且首发组错误率低于复发组,差异有统计学意义（P〈0．05）。（2）与对照组（722．5±76．8）ms相比,首发组（801．2±85．1）ms、复发组（863．1±87．2）ms反应时显著延长,且首发组反应时显著短于复发组（P〈0．05）。（3）首发、复发组错误率、反应时正镜像差异消失（P〉0．05）。（4）线性回归分析发现,对照组正镜像错误率、反应时均随着旋转角度递增呈线性递增函数（P〈0．01）;首发、复发组正镜像错误率、反应时均没有随着旋转角度递增呈线性递增函数（P〉O．05）。结论首发、复发精神分裂症患者视觉空间认知功能均受损,更多受损发生在镜像转化为正像的平面外旋转,且复发患者受损程度大于首发患者。提示空间认知功能受损可能为一种更严重的继发性高级认知功能障碍。     

首发抑郁症患者自我旋转任务下诱发电位P500研究

目的 探讨抑郁症的自我旋转能力及其脑电生理机制,进一步了解抑郁症空间认知能力的损害.方法 对23例首发抑郁症患者和22名健康对照者进行自我旋转任务下的事件相关电位测定,检测被试者的神经心理学表现和P500的潜伏期、波幅.结果 与对照组相比,患者组左手和右手的错误率均升高[(28±5)％vs.(24±4)％,P＜ 0.05; (26±4％) vs.(24±3％),P＜0.05],而且左手和右手的反应时也均较对照组延长[(1193.79±53.32)ms vs.(742.62±15.21)ms,P＜ 0.05;(1105.57±51.61)ms vs.(732.10±16.53)ms,P＜ 0.05];患者组左手错误率升高值、反应时延长值均大于右手(P＜0.05).患者组左手、右手的P500波幅均降低[(5.22±2.41)μV vs.(8.28±3.11)μV,P＜0.05; (6.79±3.24)μV vs.(8.29±3.41)μV,P＜ 0.05],左右手潜伏期均较对照组延迟[(551.37±45.27)ms vs.(508.22±28.22)ms,P＜0.05; (542.74±46.73) ms vs.(507.52±31.48)ms,P＜0.05];患者组的左手波幅降低值、潜伏期延迟值均大于右手(P＜0.05).结论 首发抑郁症患者自我旋转能力受损提示其信息加工的速度与深度均受损,左手受损程度大于右手,提示左右手加工的生物学机制可能不同.     

青年和中年精神分裂症患者心理旋转信息加工系统研究

目的 探讨年龄因素对精神分裂症患者心理旋转信息加工系统的影响.方法 对78例精神分裂症患者,按不同年龄段将其分成两组,青年组38例,中年组40例,和76名(青年组36名,中年组40名)健康被试进行心理旋转任务的测定,测量其错误数和反应时.结果 (1)与对照组[(15.2±5.8)％]相比,患者组错误率升高[(42.8±7.6)％,P＜0.05].在对照组内,青年组正像和镜像错误率均低于中年组,差异有统计学意义(P＜0.05);在患者组内,青年组与中年组相比差异无统计学意义(P＞0.05).(2)与对照组[(744.3±93.1)ms]相比,患者组反应时升高[(947.8±97.8)ms,P＜0.05].在对照组内,青年组正像和镜像反应时均短于中年组,差异有统计学意义(P＜0.05);在患者组内,青年组与中年组相比差异无统计学意义(P＞0.05).(3)线性回归分析发现,对照组青年、中年组正镜像错误率、反应时均随着旋转角度递增呈线性递增函数(P＜0.001);患者组无此线性关系.结论 精神分裂症患者心理旋转信息加工机制受损,且年龄效应消失,其中青年受损程度大于中年患者.提示大脑神经系统的中年化在一定程度上能对心理旋转信息加工系统起保护作用.     

老年抑郁症患者面孔知觉早期加工的事件相关电位研究

目的 采用事件相关电位技术,探讨老年抑郁症患者面孔识别(区分面孔还是非面孔)和面孔结构信息早期加工的脑电生理机制.方法 被试者包括19例老年抑郁症患者(患者组)及17名健康老年人(对照组).要求被试者观看图片并计数蝴蝶(靶刺激)呈现次数,其他图片(包括面孔、非面孔)为非靶刺激.记录32导脑电波.结果 (1)患者组非靶刺激诱发的P＜,1＞[(3.9±0.8)μV]和N170波幅[(-10.1±1.1)μV]均低于对照组[P<,1>:(6.8±0.8)μV;N170:(-14.4±1.1)μV;P＜0.05～0.01];(2)患者组和对照组均产生显著的N170效应(Nd170)以及N170翻转效应(倒立面孔图像时的N170变化),但患者组右侧颢枕区的N170效应[(-5.8 4±0.9)μV]弱于对照组[(-8.8±0.9)μV,P＜0.05],翻转效应的组间差异则无统计学意义(P＞0.05);(3)患者组靶刺激的P＜,3＞潜伏期[(400 ±10)ms]长于对照组[(368±10)ms;P＜0.05].结论 老年抑郁症患者可能存在面孔基本水平(区分面孔还是非面孔)早期识别的损害,而对面孔结构信息的早期加工则保持相对完整.     

首发抑郁症患者心理旋转任务的事件相关电位研究(英文)

背景抑郁症患者的心理旋转意象能力受损,但与此相关联的异常脑电生理机制仍不清楚。目的比较抑郁症患者与健康对照完成心理旋转任务时的事件相关电位(event-related potentials,ERPs)的差异。方法对32例住院或门诊首发抑郁症患者和29名对照进行心理旋转任务的ERP测定,给予不同旋转角度的测试刺激。测定4个脑区的ERPs(PZ、CZ、P3和P4)。测量指标包括错误数、反应时以及P500潜伏期和波峰值。结果与对照组相比,患者组完成心理旋转任务的反应时显著延长[689(98)ms 比 569 (55)ms; t=4.36, p0.001],错误率显著升高[30.2%(11.4%)比20.3%(7.2%); t=3.61, p=0.015],且在所有4个旋转角度均有差异。完成心理旋转任务时的事件相关电位测定发现,抑郁症患者在4个脑区的总P500潜伏期有所增加,但无统计学意义,而P500波峰值显著降低。患者组与对照组错误率、反应时、P500潜伏期及波峰值均随着旋转角度(0°~180°)的递增而呈逐渐增加。对照组平均ERP波形在700ms处出现一个正波峰,而在患者组未见。结论本研究证实了既往研究利用心理旋转任务评定抑郁症患者认知功能缺陷的有效性。本研究发现心理旋转任务诱发的事件相关电位的电生理指标,特别是P500及P700波峰值,可能是抑郁症的潜在生物学标记。需要前瞻性研究测定上述指标在抑郁症病程中的变化,以证实其有效性。     

小脑损伤患者28例注意网络功能受损的特点

目的 研究小脑损伤患者注意网络功能受损的特点.方法 应用注意网络测验,对28例小脑损伤患者和31名健康对照进行注意网络功能的测试.结果 与对照组相比,小脑损伤患者定向效率减低[病例组、对照组分别为(36.32±30.58)、(54.39±22.17)ms],差异有统计学意义(Z=-2.309,P＜0.05);执行控制受到损害[(160.05±83.25)、(93.42±37.41)ms],差异有统计学意义(Z=-3.500,P＜0.01);警觉效率[(35.14±45.59)、(28.81±26.09)ms]与总平均反应时[(797.14±94.11)、(739.90±97.90)ms]的差异无统计学意义.病例组的总平均错误率(6.57%±9.84%)明显高于对照组(3.38%±5.42%,Z=-2.119,P＜0.05).结论 小脑参与了注意网络的认知功能;小脑病变可选择性损害注意网络的定向和执行控制功能,而警觉功能相对保持正常.     

抑郁症患者心理旋转能力的初步研究

目的探讨抑郁症患者与健康人心理旋转能力的差异性。方法对30例抑郁症患者和28例健康人进行心理旋转任务测定。测量其错误率和反应时。结果 (1)与对照组相比,患者组错误率正像显著性升高,镜像显著性降低,正像和镜像反应时均显著性升高(P<0.05)。(2)与对照组相比,患者组正像不同旋转角度中只有0°、30°错误率无显著性差异(P>0.05),60°、90°、120°、150°、180°错误率显著性升高(P<0.05);镜像0°、30°、90°无显著性差异(P>0.05),60°、120°、150°、180°错误率显著性降低(P<0.05)。患者组正像和镜像所有角度的反应时均显著性长于对照组(P<0.05)。(3)两组错误率、反应时正像都在0°至180°呈线性递增,而镜像却是非线性的。结论抑郁症患者心理旋转能力受损,其正像严重受损,而镜像得到了补偿,提示正像和镜像旋转能力可以相互转化,心理旋转能力受损可作为诊断抑郁症的临床辅助指标。     

抑郁症首次发病患者情绪加工特征及抗抑郁剂治疗前后的变化

目的 探讨首次发病(以下简称首发)抑郁症情绪加工特征及抗抑郁剂治疗前后变化与症状改善的关联作用.方法 17例抑郁症首发患者治疗前后及22名对照者完成情绪词识别任务.患者组抗抑郁剂治疗9周,以汉密尔顿抑郁量表(17项,HAMD)评估疗效.结果 (1)患者组治疗有效率为88%,HAMD总分减分率75%.(2)情绪词识别任务:抑郁症组治疗前后正性词遗漏数[分别为(7.4±6.9)个和(4.1±5.3)个]均大于负性词遗漏数[分别为(3.2±3.3)个和(1.8±2.7)个;P＜0.05),治疗后正性词遗漏数小于治疗前(P=0.002),与对照组[(3.0±2.6)个]差异无统计学意义(P=0.44);治疗前后负性词遗漏数[分别为(3.2±3.3)个和(1.8±2.7)个]与对照组[(2.1±2.4)个],以及正负性词错判数与对照组差异均无统计学意义(P＞0.05);正性词平均反应时治疗后[(514±68)ms]短于治疗前[(550±75)ms;P=0.036],负性词平均反应时治疗前后[分别为(540±80)ms和(521±61)ms]差异无统计学意义(P=0.16).(3)治疗前正性词遗漏数与抑郁症状和负性思维评分正相关(r=0.36～0.50,P＜0.05).(4)治疗前后正、负性词遗漏数变化对HAMD分数变化有不同预测作用(r_( chang) ~2=0.45,P=0.002).结论首发抑郁症患者可能存在正性情绪加工缺陷,治疗后可恢复至正常水平;以负性情绪加工占优势的认知结构不因抑郁症状缓解而改变;正负性情绪加工变化与症状改善可能有不同的关联作用.     

精神分裂症首次发病患者治疗早期神经认知功能改变的对照研究

目的 探讨精神分裂症首次发病患者治疗早期神经认知功能受损的程度和范围.方法 采用成套神经心理测验工具,包括连线测验A、颜色连线测验、《韦克斯勒记忆量表(第3版)》空间广度测验、《韦克斯勒量表(第3版)》(WAIS-Ⅲ)符号搜索和数字符号、霍普金斯词汇学习测验-修订版(HVLT-R)、简易视觉空间记忆测验-修订版(BVMT-R)、沟槽钉板测验和定步调听觉连续加法测验(PASAT)测试77例16 ～ 28岁的精神分裂症首次发病患者(病例组)和80名健康者(对照组)的学习和记忆、精细动作、信息处理速度以及执行功能,采用SPSS16.0统计软件包对所有数据进行统计学分析.结果 共有21项评价指标的效应值＞0.80(P ＜0.001),整体受损效应值在0.47 ～3.41个标准差;病例组沟槽钉板测验完成时问[利手(84.77±31.55)s,非利手(97.95 ±42.30)s]均显著长于对照组[(59.00±7.57)s,ES =3.41,F=43.28;(66.84±10.74)s,ES =2.90,F=35.75;P均＜0.001],连线测验A[(50.88 ±27.45)s]、颜色连线1完成时间[(54.59±25.62)s]和颜色连线2完成时间[(117.38±52.66)s]显著长于对照组[(27.25±8.49)s,ES=2.78,F=42.66;(29.64±9.49)s,ES =2.63,F=58.82;(66.34±15.06)s,ES =3.39,F=60.51;P＜0.001],PASAT尝试数[(36.43±9.88)个]和正确数[(31.11±11.09)个]显著低于对照组[(46.85±3.42)个,ES=-3.04,F=72.52;(44.15 ±5.08)个,ES=-2.57,F=81.10;P均＜0.001],WAIS-Ⅲ数字符号得分[(59.81 ±15.11)分]显著低于对照组[(91.13±10.87)分,ES=-2.88,F=179.33,P＜0.001],病例组BVMT-R测试各项得分显著低于对照组(P＜0.050).结论 精神分裂症首次发病患者神经认知功能全面受损.     

SSRI类药物对抑郁症患者esRAGE水平及血糖的影响

目的 探讨SSRI类药物对抑郁症患者血清内源性分泌型糖基化终产物受体(esRAGE)水平及血糖的影响.方法 采用SSRI类药物对28例抑郁症患者进行为期6周的治疗,分别在治疗前和治疗6周后,用酶联免疫法测定抑郁症患者血清中esRAGE浓度和血糖水平,并与34例正常对照者比较.结果 (1)抑郁症组治疗后esRAGE浓度[(0.56±0.17)ng/ml]高于治疗前[(0.49±0.21)ng/ml],但均低于正常对照组[(0.66±0.10)ng/ml],组间比较差异有显著统计学意义(P＜0.001).(2)抑郁症组治疗后空腹血糖[(4.91±0.50)mmol/L]低于治疗前[(5.38±0.39)mmol/L],差异有显著统计学意义(P=0.000),但与正常对照组空腹血糖[(5.08±0.41)mmol/L]比较差异无统计学意义(P=0.172).(3)Pearson相关分析显示,esRAGE与空腹血糖成中等程度负相关(P＜0.05).结论 SSRI类药物能升高抑郁症患者的esRAGE水平,同时降低血糖水平.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.     

Special Pharmacokinetic Considerations in Children

Summary: Pediatric patients have greater degrees of pharmacokinetic variability and unpredictability than adults. This variability results from the effects of pharmacogenetics, age and growth, prior and current comedication, and disease. Newborns with seizures have the least predictable dosage requirements, and their needs change as drug-eliminating mechanisms mature in the neonatal period. Infants have the highest relative capacities to eliminate antiepileptics of any age group and require the largest relative doses. In addition to age-related trends, children demonstrate the same drug-specific, pharmacokinetic phenomena that adults do, including nonlinear phenytoin elimination, nonlinear valproate binding, and autoinduction of carbamazepine. Intercurrent illness and drug interactions further modify the age-related pharmacokinetic patterns in children and make dosage requirements even more unpredictable. Recent studies have shown that febrile illness can affect drug elimination, sometimes decreasing drug levels by 50% or more. Intermittent treatment with benzodiazepines administered either orally or rectally can be an important adjunct and help minimize this type of problem for children with marginally controlled epilepsy. Intermittent benzodiazepines are also helpful for children who have febrile seizures and who need only occasional antiepileptic protection.