文拉法辛联合小剂量多塞平治疗躯体形式障碍的疗效观察

目的探讨文拉法辛联合小剂量多塞平治疗躯体形式障碍的疗效及安全性。方法将64例躯体形式障碍患者随机分为研究组(文拉法辛联合多塞平组)与对照组(文拉法辛组)各32例,分别予文拉法辛联合小剂量多塞平与文拉法辛治疗,疗程均为8周。临床疗效评定分别采用汉密尔顿抑郁量表(HAMD-17)、汉密尔顿焦虑量表(HAMA)、临床疗效总评量表-病情严重度(CGI-SI)及治疗时出现的症状量表(TESS)于治疗前后进行评定。结果研究组在治疗第2,4,6,8周末HAMA总分显著低于对照组,差异有统计学意义(P<0.05)。研究组在治疗第2周末精神性焦虑分低于对照组,差异有统计学意义(P<0.05)。研究组在治疗第2,4周末HAMA减分率均高于对照组,差异有统计学意义(P<0.05)。研究组在治疗第2,8周末HAMD总分显著低于对照组,差异有统计学意义(P<0.05或P<0.01)。研究组在治疗第2,8周末HAMD减分率均高于对照组,差异均有统计学意义(P均<0.01)。研究组总有效率为93.75%与对照组总有效率为87.50%比较,差异无统计学意义(P>0.05),研究组的显效率为75.00%与对照组的50.00%比较,差异有统计学意义(P<0.05)。两组的不良反应均少,在治疗第8周末两组的TESS评分比较差异无统计学意义(P>0.05)。结论文拉法辛联合小剂量多塞平治疗躯体形式障碍疗效优于单用文拉法辛,且无明显不良反应。     

小剂量帕利哌酮对难治性抑郁症的增效影响

目的研究小剂量帕利哌酮对抑郁症患者的影响。方法选取符合《国际疾病分类(第10版)》(ICD-10)抑郁发作诊断标准的60例抑郁症患者,采用住院号末位奇偶数随机分成两组,奇数组为研究组、偶数组为对照组,研究组用艾司西酞普兰联合帕利哌酮,对照组用艾司西酞普兰联合安慰剂治疗,于用药前、治疗1、2、4、8周末用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评定疗效,采用副反应量表(TESS)评定不良反应。结果治疗8周后,两组HAMD评分[(4.31±2.11),(9.21±2.87)],HAMA评分[(3.54±1.21),(10.31±1.06)]均较治疗前下降,研究组HAMD及HAMA评分均低于对照组。两组不良反应差异无统计学意义(P0.05)。结论小剂量帕利哌酮对抑郁症的治疗有增效作用。     

度洛西汀联合喹硫平治疗躯体化障碍的临床研究

目的探讨度洛西汀联合喹硫平治疗躯体化障碍的疗效及安全性。方法 100例躯体化障碍患者随机分为研究组(度洛西汀联合喹硫平组)和对照组(度洛西汀组),疗程8周。用症状自评量表(SCL-90)、汉密尔顿抑郁、焦虑量表(HAMD、HAMA)评定严重程度,用副反应量表(TESS)评定不良反应;用SCL-90躯体化因子分和HAMD量表减分率评定疗效。结果1治疗8周后,两组SCL-90各因子分、HAMD及HAMA分均呈下降趋势;研究组HAMD、HAMA、SCL-90躯体化、强迫、抑郁、焦虑及偏执因子分均较对照组下降显著(P0.05或0.01)。研究组和对照组有效率分别为81.6%和64.0%,差异有统计学意义(P0.05)。2研究组和对照组不良反应发生率分别为42%和36%(P0.05),TESS评分为[(5.21±3.60)vs.(4.80±3.80),P0.05]。结论度洛西汀联合喹硫平治疗躯体化障碍疗效优于单用度洛西汀,且安全性好。     

度洛西汀合并认知行为治疗对躯体形式障碍患者的疗效分析

目的 评价度洛西汀合并认知行为治疗对躯体形式障碍患者的治疗效果.方法 将符合CCMD-3诊断标准的60例躯体形式障碍患者随机分为研究组和对照组,研究组给予度洛西汀合并认知行为治疗,对照组只给予度洛西汀治疗.疗程8周.应用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、SCL-90躯体化量表定期评定疗效,治疗中需处理的不良反应症状量表(TESS)评定安全性.结果 治疗8周后,研究组显效率90％,对照组显效率63％,研究组显效率高于对照组(x2=23.89,P＜0.01).治疗第4、6、8周末,研究组SCL-90躯体化因子分、HAMD评分、HAMA评分与对照组比较有显著性差异(P＜0.01).不良反应较轻,两组间比较无显著性差异(P＞0.05).结论 度洛西汀合并认知行为治疗对躯体形式障碍患者的疗效优于单独用度洛西汀治疗.     

帕罗西汀与文拉法辛治疗躯体化障碍的对照研究

目的探讨帕罗西汀与文拉法辛治疗躯体化障碍的疗效及安全性。方法将60例躯体化障碍患者随机分为帕罗西汀组(n=30)和文拉法辛组(n=30),治疗6周。用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)及副反应量表(TESS)评定疗效及不良反应。结果治疗后两组疗效及不良反应相仿。结论帕罗西汀治疗躯体化障碍是安全和有效的。     

文拉法辛合并小剂量舒必利治疗抑郁障碍的对照研究

目的探讨用文拉法辛并小量舒必利治疗抑郁障碍的疗效与副反应。方法将32例单相抑郁患者和32例双相障碍抑郁患者分别随机分成2组，分别接受文拉法辛合并小剂量舒必利治疗（研究组）及单用文拉法辛治疗（对照组），共治疗6用。用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）及犬体评定量表（CGI—CI）评估疗效，用副反应量表（TESS）评估治疗不良反应。结果在单相抑郁患者中，研究组在第2、4、6周末的HAMD、HAMA和CGI评分均显著少于对照组，且均有显著性差异（P〈0．05）。在双相障碍抑郁患者中，研究组在第2、4、6周末的HAMD、HAMA和CGI评分均显著少于对照组，且均有显著性差异（P〈0．05）。研究组与对照组在不良反应方面比较无显著性差异（P〉O．05）。结论文拉法辛合并小量舒必利治疗单相抑郁或双相障碍抑郁患者具有疗效好，起效快，副反应较少特点。     

文拉法辛缓释片治疗抑郁症的临床疗效及安全性评价

目的评价文拉法辛缓释片治疗抑郁症的临床疗效及用药安全性。方法将符合纳入标准的68例病人根据就诊时间随机分成观察组与对照组各34例,分别给予盐酸文拉法辛缓释片及盐酸阿米替林进行治疗。应用汉密尔顿抑郁量表(HAMD)及汉密尔顿焦虑量表(HAMA)对2组治疗前后的疗效进行评价,应用副反应量表(TESS)对不良反应进行评价。结果观察组显效率显著高于对照组,差异有统计学意义(P<0.05);观察组总有效率高于对照组,但差异无统计学意义(P>0.05)。观察组治疗后同期HAMD及HAMA评分均比对照组明显降低,差异有统计学意义(P<0.05或P<0.01);观察组不良反应类型及严重程度第2周与第6周末时同对照组相比差异有统计学意义(P均<0.05),观察组第4周末同对照组相比差异有统计学意义(P<0.01)。结论应用文拉法辛缓释片治疗抑郁症的疗效确切,依从性良好,具有较高的安全性。     

文拉法辛治疗焦虑抑郁共病对照研究

目的：探讨文拉法辛与帕罗西汀治疗焦虑抑郁共病障碍的疗效及安全性。方法：73例焦虑抑郁共病障碍患者随机分为研究组35例和对照组38例。分别给予文拉法辛和帕罗西汀治疗8周。于治疗前后分别采用汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）及治疗中出现的症状量表（TESS）评定疗效和不良反应。结果：两组抗抑郁显效率（χ2=0.69,P〉0.05）和抗焦虑显效率（χ2=0.90,P〉0.05）相仿。两组HAMD、HAMA治疗后均显著下降（P〈0.05或P〈0.01）。不良反应均轻微（P〉0.05）。结论：文拉法辛与帕罗西汀治疗焦虑抑郁共病障碍疗效肯定,安全性高,依从性好。     

度洛西汀合并小剂量氨磺必利治疗躯体形式障碍的临床对照研究

目的 评价度洛西汀合并小剂量氨磺必利对躯体形式障碍患者的疗效.方法 将52例躯体形式障碍患者随机分为研究组（予度洛西汀合并氨磺必利治疗）和对照组（予度洛西汀治疗）,每组各26例,共观察6周.采用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）、症状自评量表（SCL-90）躯体化因子量表、治疗中需处理的不良反应症状量表（TESS）于治疗前及治疗后第1、2、4、6周末分别评定疗效及安全性.结果 治疗6周后,研究组显效率76.92％,对照组显效率57.69％;研究组有效率92.31％,对照组80.77％.研究组显效率、有效率与对照组比较无显著性差异（P＞0.05）.SCL-90躯体化因子、HAMD、HAMA评分在治疗后第2、4、6周末研究组低于对照组（P＜0.05）.研究组药物不良反应发生率为38.46％,对照组为34.62％,两组药物不良反应发生率比较差异无统计学意义（P＞0.05）.结论 合并小剂量氨磺必利较单用度洛西汀可加快躯体形式障碍患者症状的消失,并能提高疗效,而且未增加药物不良反应.     

丁螺环酮与文拉法辛在广泛性焦虑症患者中的血药浓度及疗效的比较

目的探讨丁螺环酮与文拉法辛在广泛性焦虑症患者中的血药浓度及疗效对比。方法研究选取2013年6月~2016年6月期间在我院接受治疗的100例广泛性焦虑症患者作为对象。随机将患者分为丁螺环酮组、文拉法辛组。比较两组患者汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)及焦虑自评量表(SAS)评分,血药浓度与治疗效果间的关系,有效率及不良反应。结果两组患者经药物治疗后HAMA、HAMD及SAS评分均有下降(P0.05);文拉法辛组患者HAMA、HAMD及SAS评分均低于丁螺环酮组(P0.05)。两组患者治疗后精神性焦虑及躯体性焦虑评分较治疗前明显降低(P0.05);文拉法辛组患者治疗后精神性和躯体性焦虑评分均明显低于丁螺环酮组(P0.05)。两组患者的临床疗效和血药浓度均无明显相关性,且不良反应发生率无明显差异(P0.05)。结论文拉法辛与丁螺环酮治疗广泛性焦虑症均有较好的治疗效果,不良反应较低,但是文拉法辛抗焦虑治疗的效果优于丁螺环酮。     

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.     

Summary of Legislation of 1933 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -