Effect of flupenthixol on depression with special reference to combination use with tricyclic antidepressants

In an open, uncontrolled trial flupenthixol was administered to 45 patients with endogenous depression. The drug was markedly effective in eight patients, effective in nine patients, fairly effective in 12 patients, and ineffective or aggravating in 16 patients. Four patients showed transient manic symptoms. Dosage was 1–3 mg daily. In 36 patients flupenthixol was used in combination with previously administered tricyclic antidepressants, and in nine patients it was used alone. Clinical effect was quickly apparent. It appeared within 1 week in 63% and within 2 weeks in 93 % of subjects. Side-effects were observed in 13 patients: insomnia, five patients; slight extrapyramidal symptoms, nine patients. Sedative-hypnogenic effects were rarely seen. In 71 % of 17 patients in whom the drug was found to be markedly effective or effective, flupenthixol's influence on psychomotor retardation was particularly strking. Other clear benefits were relief of depressive mood, psychic anxiety, and agitation. It is recommended that flupenthixol is given, as supplementary medication, to patients (1) whose depressive symptoms other than psychomotor retardation have already improved with current tricyclic antidepressants, and (2) in whom, before antidepressant medication, psychomotor retardation is a principal feature.     

Lithium augmentation in psychotic depression refractory to combined drug treatment

In this retrospective study the authors determined the efficacy of lithium added to a combined antipsychotic-antidepressant drug regimen in 21 psychotically depressed patients who had been refractory to combined drug treatment. Response to lithium was then compared with response rates of 15 patients to ECT, the established treatment for nonresponsive delusional depression. Lithium was effective in eight of nine patients with bipolar depression but in only three of 12 patients with unipolar depression; ECT was effective in nine of 15 patients with unipolar depression. Lithium augmentation appeared to be a realistic treatment alternative for refractory bipolar patients but was disappointing in unipolar patients.     

Intolerance to visceral distension in functional dyspepsia or irritable bowel syndrome: an organ specific defect or a pan intestinal dysregulation?

Functional gastrointestinal disorders (FGID) are characterized by visceral hypersensitivity that could be specific to a region of the gut or reflect a diffuse pan-intestinal disorder. Sensory thresholds to distension at two visceral sites in patients with different FGIDs were determined. According to Rome II criteria, 30 patients from three groups were studied: patients with (i) functional dyspepsia (FD) or (ii) irritable bowel syndrome (IBS), and (iii) patients with concomitant symptoms of FD and IBS. Pain thresholds to balloon distension were determined in stomach and rectum. In FD patients, gastric intolerance to balloon distension was found in 91% patients; rectal hypersensitivity was documented in 18% patients. In IBS patients, rectal hypersensitivity was seen in 75% patients; while gastric hypersensitivity was never found. In patients with concomitant symptoms of FD + IBS, gastric and rectal intolerance to distension were present respectively in 82 and 91% patients. In the whole group, visceral intolerance to distension was documented at one site in 90% patients and at both sites, i.e. stomach and rectum, in 33% patients. Visceral intolerance to distension can be pan-intestinal in patients with multiple sites of symptoms, but appears organ-specific in patients exhibiting a specific site of symptoms.     

Clinical Study of Thirteen Patients with Spinal Cord Infarction

BackgroundA concept of sensory tracts in the spinal cord has been established in relation to a dorsolateral pathway which is located in the posterior part of the lateral column and conveys the deep sense.MethodsThe clinical status at onset, neurological symptoms, and magnetic resonance imaging (MRI) findings in 13 patients of spinal cord infarction were studied.ResultsThe clinical status was acute in 11 patients and subacute in 2 patients. Palsy of the extremities was noted in 11 patients. Segmental sensory disturbance was shown in all patients. One patient showed disturbance of all senses and paraplegia, which indicated transverse myelopathy. In the other 12 patients, 11 patients showed impairment of pain sense although joint position sense was preserved, excluding 1 patient whose sensory disturbance showed dysesthesia alone. In these 11 patients, soft touch and vibration senses were impaired in 7 patients. Abnormality of spinal cord MRI was detected 7 patients. The lesions were located in the cervical cord in 3 patients, cervical to thoracic cord in 1 patient, and thoracic cord in 3 patients.ConclusionsIn the 11 patients in whom pain sense was impaired and joint position sense was preserved, involvement of the anterior spinal cord artery (ASCA) was the mainstay. Impairment of vibration sense was accompanied in 7 patients in patients of ASCA infarction. It was speculated that impairment of vibration sense can occur in patients with ASCA infarction whose ischemia spread to the dorsolateral pathway in the posterior part of the lateral column.     

Concentration of catecholamines and indoleamines in the cerebrospinal fluid of patients with vascular parkinsonism compared to Parkinson's disease patients

Summary The concentration of catecholamines and indoleamines in the cerebrospinal fluid of patients with vascular parkinsonism (VP) was compared to that in patients with Parkinson's disease (PD) and controls. Compared to the controls, the concentration of tyrosine was significantly higher, and the concentration of L-dopa and 3-O-methyldopa (3-OMD) was significantly lower in both VP and PD patients. The balance between the 3-OMD/L-dopa and dopamine (DA)/L-dopa ratios was changed in favor of 3-OMD/L-dopa in both VP patients and PD patients suggesting the preservation of a compensatory mechanism. All these changes were less marked in VP patients than in PD patients. A remarkable finding was that in contrast to PD patients the concentration of DA and norepinephrine (NE) was significantly higher in VP patients than in the controls. The decrease in the concentration of 5-hydroxytryptamine (5-HT) was significantly greater in VP patients than in PD patients. In PD patients, the concentration of DA, NE, and 5-HT showed significant correlation with the severity of motor symptoms. In VP patients, the concentration of 5-HT alone showed significant correlation with the severity of motor symptoms and cognitive dysfunction. These findings suggest that VP patients may have similar disturbances in the DA synthesis pathway as PD patients, but differ from PD patients in that the concentrations of DA and NE are elevated and the decrease in the 5-HT concentration is greater in VP patients.     

A Controlled Study of the Effect of Sodium Valproate on Photosensitive Epilepsy and Its Prognosis

The effect of sodium valproate on photosensitive epilepsy was studied. The range of flash rates of intermittent photic stimulation to which patients were sensitive (photosensitive range) was tested prior to treatment, and the reliability of this measure established by repeated tests on 70 patients. The photosensitive range was measured on 50 patients prior to and during treatment with sodium valproate. In 27 patients photosensitivity was abolished and in a further 12 patients photosensitivity was significantly reduced. A group of 167 patients followed without treatment did not show significant improvement over a 7 year period. Sixteen patients had drug treatment withdrawn, and in 7 months their photosensitive range had returned to its predrug level.     

Prolonged stationary colonic motility recording in seven patients with severe constipation secondary to antidepressants

The aim of this study was to determine whether the colonic motor profile of seven patients with constipation secondary to antidepressants differed from the motility of seven patients with idiopathic constipation and seven healthy volunteers. All constipated patients had very severe constipation. Colonic manometric recordings were performed for 24 h. The number of high amplitude propagating contractions (HAPC) was lower in the two groups of constipated patients than in controls. No HAPC were observed in 5/7 patients with constipation secondary to antidepressants and in 1/7 patients with idiopathic constipation. The overall area under the curve (AUC) in the left colon was lower in the two constipated patient groups than in controls. AUC increased after a 1000-kcal standard meal given at noon in controls but not in the two groups of constipated patients. In conclusion, in patients with constipation secondary to antidepressants, the overall AUC was as poor as in patients with idiopathic constipation, and no colonic response to eating was observed. Moreover, the number of HAPC was more markedly decreased in patients with constipation secondary to antidepressants than in patients with idiopathic constipation.     

2011年四川省在库重性精神疾病分析

目的了解四川省重性精神疾病的基本情况,旨在为四川省重性精神疾病社区管理治疗工作提供技术指导。方法依据国家公共卫生服务均等化重性精神疾病管理治疗服务规范及工作规范和国家数据收集分析系统的要求制定工作方案,开展全省精神卫生机构、疾病预防控制机构及社区卫生服务中心和乡镇卫生院相关人员技术培训,按照工作方案的要求于2010年7月在全省范围内启动重性精神疾病摸底调查,资料完整者录入国家数据收集分析系统,再将2011年12月末四川省各市州录入国家重性精神疾病数据收集分析系统的数据导出进行统计分析。结果截止2011年12月末,四川省共调查出重性精神疾病119313例,同意并实施网络管理的重性精神疾病54700例,管理率为45.85%。本次显示四川省重性精神疾病患者经济状况处于当地贫困线以下为61.77%;文盲和半文盲为31.87%,小学文化为37%;农村重性精神疾病为80.8%,城市无业人员为5.46%;重性精神疾病未婚率为31.01%,离婚率为4.21%;重性精神疾病患者间断服药和不服药者分别为27.9%和33.5%;重性精神疾病患者危险行为发生率为21.56%,其中肇事、肇祸发生率为7.84%。结论我省重性精神疾病患者社会、经济地位十分低下,对社会、家庭的危害及潜在危险极大,需进一步探索和改变现有的管理治疗模式,以维护社会的和谐稳定。     

Treatment of myoclonus with pheneturide.

Twenty-one patients with various forms of myoclonus are presented. Phenacemide was given to five patients with considerable benefit to three, but with serious toxic effects in two. Another acetylurea derivative, pheneturide, was given to 19 patients and was well tolerated. Myoclonus was completely or substantially controlled in 12 patients.     

The clinico-radiological spectrum of Dyke-Davidoff-Masson syndrome in adults

Dyke-Davidoff-Masson syndrome (DDMS) is characterized by cerebral hemiatrophy, seizure, contralateral hemiplegia/hemiparesis, and mental retardation. In this study, clinical and radiological investigations of seven patients who were diagnosed with DDMS as adult age were evaluated and discussed. Seven patients (four male, three female) were included. The mean age ± SD of the patients was 46 ± 21 years. Clinical presentation of six patients was epileptic seizure. One patient was presented with head trauma due to a fall. Two patients had complex partial seizures, three patients had generalized tonic-clonic seizures (GTC), and one had GTC and myoclonic seizure. Mental retardation was in five patients. A congenital cause was detected in one patient in the etiologic investigation and acquired causes in two patients. In four patients, the etiology was not identified. We observed left-hemisphere involvement in four patients and right-hemisphere involvement in three patients. Brain imaging was performed by CT only in four patients and by MRI only in three patients. All patients were diagnosed with DDMS at adulthood. Atrophy in basal ganglia was detected in five patients, and atrophy in brain stem in four patients. Calvarial thickening was observed in four patients. Three patients had hyperpneumatization in mastoid cells. Sinus hyperpneumatization, including the paranasal and frontal sinuses, was seen in six patients. DDMS can also be diagnosed in adulthood symptomatically (mild–severe) or asymptomatically in adulthood. As a result, DDMS is a syndrome with wide clinical and radiological spectra that can be variably symptomatic at different stages of life.     

肝移植后肾功能损害58例相关因素分析

回顾性分析解放军107中心医院肝胆外科58例肝移植患者围手术期肾功能的变化情况,以探讨肝移植患者围手术期肾功能损害的相关因素及治疗、预防经验。58例患者中男48例,女10例,年龄14~65岁,平均38岁。其中终末期良性肝病40例,肝脏恶性肿瘤18例。肝肾联合移植2例,二次肝移植2例。全部患者中,移植前肌肝超过正常值者40例,50例患者术前已应用利尿药物。移植后死亡8例,总生存率86%,10例患者肌酐持续增高,尿量进行性减少,给予连续性肾脏替代疗法治疗。其中2例在连续性肾脏替代疗法治疗过程中肾功能逐渐恢复正常,2例患者肾功能逐渐恢复正常后因合并肝功能衰竭、严重肺部感染而死亡,另6例患者因肾功能损害进一步加重,分别合并肺部感染、心功能衰竭、腹腔感染而死亡。可见,肾脏功能损害的有效处理及预防对于肝移植手术成功率具有重要意义。     

Immediate and long-term results of carotid endarterectomy

We review the long-term results of carotid endarterectomy in 200 consecutive patients operated on from 1980 to 1987. The patients were part of an ongoing study using duplex scanning to assess the status of the carotid bifurcation before and after endarterectomy. The average follow-up for the patients was 31 months. The indications for surgery were transient ischemic attacks in 87 (43.5%) and stroke in 36 (18%) patients; 77 patients (38.5%) were asymptomatic. In 176 sides (88%), the degree of stenosis exceeded 50% in terms of diameter reduction. The perioperative stroke rate was 2.3% in patients with transient ischemic attacks, 2.8% in patients with strokes, and 1.3% in asymptomatic patients. There was one perioperative death (0.5%). There were five occlusions of the internal carotid artery, one during the perioperative period and four after discharge; in three patients the occlusion was associated with the development of a stroke. There was a restenosis rate of 19.7% secondary to myointimal hyperplasia; such lesions did not appear to contribute to new ischemic events during or after their development. The mean stroke incidence after the decision was made for carotid endarterectomy was 2.8%/yr in the patients with transient ischemic attacks, 6.2%/yr in the patients with stroke, and 0.65%/yr in the asymptomatic patients. The annual death rate was 6% for the entire group, 5.5%/yr in the patients with transient ischemic attacks, 9.2%/yr in the patients with stroke, and 4.6%/yr in the asymptomatic patients.     

Surgical treatment of adult patients with thalamic tumors with the aid of tractography,fMRI, transcranial electrical stimulation and direct electrical stimulation of the subcortical white matter

The aim of investigation was to assess treatment outcomes in adult patients with thalamic tumors, operated on with the aid of tractography (DTI) and monitoring of motor evoked potentials (MEPs) generated due to transcranial electrical stimulation (TES) and direct electrical stimulation (DES) of the subcortical white matter.38 subsequent patients with thalamic tumors were operated on using tractography (DTI)-integrated neuronavigation, transcranial electrical stimulation (TES) and direct electrical stimulation (DES). The volumetric method was used to calculate pre- and postoperative tumor volume.Total tumor resection (100%) was performed in 18 (47%) patients, subtotal in 9 (24%) (mean extent of resection ?89.4%) and partial in 11 (29%) patients (mean extent of resection ?77.18%). The mean extent of resection for all surgical patients was 86.5%.Two (5.2%) patients died postoperatively. Preoperative hemiparesis was present in 18 (47%) patients. Postoperative hemiparesis was observed in 11 (29%) patients of whom only in 5 (13%) new paresis was noted due to surgical intervention. In patients with hemiparesis significantly more frequently larger tumor volume was detected preoperatively. Low mean normal fractional anisotropy (nFA) values in the internal capsule were observed statistically significantly more frequently in patients with preoperative hemiparesis as compared to the internal capsule of the unaffected hemisphere. Transcranial electrical stimulation helps to predict postoperative paresis of extremities. Direct electrical stimulation is an effective tool for intraoperative localization of the internal capsule thus helping to avoid postoperative deficit.In patients with tumor grade I and II the median time to tumor progression was 36 months. In the case of patients with grades III and IV it was 14 months. The median survival time in patients with grades I and II it was 60 months. In patients with grades III and IV it was 18 months. Basing on our results, patients with glioma grade I/II according to WHO classification are the best candidates for surgical treatment of thalamic tumors. In this group of the patients more often resection is radical, median time to progression and survival time are longer than in patients with gliomas grade III and IV. Within a 7-year follow-up none of the patients with GI/GII grade glioma died.     

A comparison of monotherapy with lamotrigine or carbamazepine in patients with newly diagnosed partial epilepsy.

Monotherapy with lamotrigine or carbamazepine was evaluated in a multicentre open trial of patients aged 2 years and above with newly diagnosed partial epilepsy. A total of 417 patients were randomised to treatment with lamotrigine, while 201 patients received carbamazepine. Following a dose escalation period of 6 weeks, maintenance therapy (Weeks 7-24) was adjusted according to response. Efficacy was similar with both treatments (65% with lamotrigine, 73% with carbamazepine, P=0.085). Efficacy was assessed by the proportion of patients seizure free during the last 16 weeks of treatment; all subjects who remained in the study for at least 18 weeks after the week 4 visit were included in the analysis. More patients receiving lamotrigine completed the study (81%), compared with those receiving carbamazepine (77%). This difference was primarily due to discontinuation as a result of adverse events, reported by 34 (8%) of those treated with lamotrigine but 26 (13%) of those treated with carbamazepine. The proportion of patients who experienced adverse events in the lamotrigine group was lower (218 patients, 52%) compared with the carbamazepine group (120 patients, 60%). The proportion of patients with adverse events considered to be drug related was lower in the lamotrigine group (132 patients, 32%) compared with the carbamazepine group (83 patients, 41%). Somnolence was the only adverse event reported at an incidence of greater than 5% and where there was a difference of 5% or more between treatment groups (4% lamotrigine, 11% carbamazepine patients). The small subsets of elderly patients (aged 65 years or over) and paediatric patients (aged 2-12 years) also showed better tolerability to lamotrigine than to carbamazepine. In conclusion, monotherapy with lamotrigine is as effective as carbamazepine in patients with newly diagnosed partial epilepsy. Patients were able to tolerate lamotrigine better than carbamazepine, so more patients receiving lamotrigine were able to remain on therapy.     

West syndrome in Thailand: a hospital-based survey.

The prevalence of West syndrome in Thailand had not been studied. During January 1997 to December 1999, at the Department of Pediatrics, Ramathibodi Hospital, Bangkok, Thailand, of the total 628 first seen epileptic patients, aged 0-15 years, 31 patients (4.9%) with West syndrome were encountered. Sixteen were males. The mean age at presentation was 9.7 months (range 4-32 months) and at seizure onset was 5.7 months (range 2-11 months). Twenty-two patients had typical spasms, four each had generalized tonic seizures and focal seizures prior to the onset of infantile spasms, and another patient had myoclonic seizures. Nineteen patients were classified as symptomatic. Electroencephalogram revealed hypsarrhythmia in six patients, multifocal independent epileptiform discharges in 24 patients, and focal epileptiform discharges in four patients. Abnormal brain-imaging findings were demonstrated in six of the 11 patients investigated. Vigabatrin was given to 17 patients whereas one patient was given valproate. Others who had been severely retarded were given phenobarbital in combination with benzodiazepine. Six patients were lost to follow-up. Of the remaining patients, the duration of follow-up ranged from 7 to 44 months (mean 28 months). Infantile spasms disappeared in 11 patients, persisted in six patients, and changed to other form in eight patients. The developmental outcome was apparently normal in five, slightly delayed in four, moderately delayed in ten, and severely delayed in eight patients.     

Quality of life assessment in MND: development of a social withdrawal scale.

A scale to measure 'social withdrawal,' was developed specifically for use with MND patients. Scale design was based upon patient-focused interviews which were used to explore patients' concerns. The impact the condition had upon their social interactions with others was salient for all patients and affected their overall quality of life. Using issues raised by patients, a 23-item scale was generated to specifically and quantitatively measure social withdrawal and this scale was psychometrically evaluated. The scale was administered to a sample of 23 patients at varied stages of progression of MND, and to a control group of patients with arthritis with similar levels of physical disability. For MND patients withdrawal from the community was found to be closely related to severity of physical symptoms and depression. Specific patients were identified who are particularly susceptible to withdrawal and depression. Comparison of the pattern of withdrawal in the MND and arthritis patient groups suggested that there may be differences between the factors governing social withdrawal in different patient populations.     

Platelet aggregation response in schizophrenia and prostaglandin E1

Platelet aggregation response to various stimulants was examined in 18 unmedicated schizophrenic patients, 13 medicated patients, and 13 control subjects. Platelet aggregation response to epinephrine decreased only in unmedicated schizophrenic patients. Clinical improvement in seven patients after neuroleptic medication was significantly correlated with an increase in platelet aggregation response to arachidonic acid, and nonsignificantly to epinephrine, dopamine, and serotonin. The inhibitory effect of prostaglandin E1 on platelet aggregation response to adenosine diphosphate was investigated in seven unmedicated schizophrenic patients, six medicated patients, and eight controls. The inhibitory effect of prostaglandin E1 on platelet aggregation response to adenosine diphosphate was significantly reduced in all unmedicated schizophrenic patients. Neuroleptic medication had some effect in normalizing aberrant sensitivity to prostaglandin E1 in those patients, although acute medication induced an adverse reaction in the controls.     

A型肉毒毒素治疗眼睑及面肌痉挛的临床分析

目的观察A型肉毒毒素治疗偏侧面肌痉挛、眼睑痉挛的临床疗效,探讨眼睑及面肌痉挛的病因。方法应用A型肉毒毒素对105例眼睑及偏侧面肌痉挛患者行面部肌肉局部多点注射,对治疗前后的病情分级进行对比,分析治疗效果。结果71例面肌痉挛者完全缓解35例(49.3%),明显缓解34例(47.8%),无效2例(2.8%)。34例眼睑痉挛者,22例完全缓解,12例明显缓解,总有效率达98%。起效时间数小时至7d,缓解时间3～8个月,局部不良反应轻微、短暂,无全身反应及过敏反应,其中2例引起面肌萎缩。4例MRA中3例检出有椎动脉、小脑后下动脉、小脑前下动脉变异,并造成对面神经的压迫。结论A型肉毒毒素局部肌肉多点小剂量注射,可有效控制眼睑痉挛及偏侧面肌痉挛,部分眼睑及面肌痉挛的病因为血管压迫。     

Magnetic resonance imaging in multiple sclerosis: investigation of brain and spinal cord lesions

Magnetic resonance imaging (MRI) of the brain was performed on forty-five patients with multiple sclerosis (MS), using T1-weighted inversion recovery and T2-weighted spin echo images, and the results were compared with X-ray computed tomography (CT). Some of the 45 MS patients were also examined by neurophysiological studies (visual evoked potentials and auditory brainstem responses) to compare with the brain MRI findings. MRI showed demyelinating plaques of the brain in 20 (74%) of 27 patients with brain symptoms, 11 (61%) of 18 patients without symptoms and 31 (69%) of all 45 patients. In 27 patients with brain symptoms, MRI was able to detect brain lesions in 6 (86%) of 7 acute stage patients and 14 (70%) of 20 non-acute stage patients. Furthermore, MRI was able to detect brain lesions in 21 (70%) of 30 clinically definite MS patients and 10 (67%) of 15 clinically probable MS patients. X-ray CT was performed on all 45 patients and was able to detect brain lesions in 9 (33%) of 27 patients with brain symptoms and 1 (6%) of 18 patients without symptoms. Visual evoked potentials were evaluated in 31 patients, and showed abnormalities in 1 (11%) of 9 patients without symptoms of optic neuritis and 100% of 22 patients with symptoms. Auditory brainstem responses were evaluated in 19 patients, and showed abnormalities in 1 (11%) of 9 patients without brainstem symptoms and 3 (30%) of 10 patients with symptoms. MRI of the brain was markedly superior to X-ray CT, visual evoked potentials and auditory brainstem responses in detecting clinically unsuspected lesions.(ABSTRACT TRUNCATED AT 250 WORDS)     

Impairment in visual and spatial perception in schizophrenia and delusional disorder

The Judgment of Line Orientation Test, a visuospatial processing task, was administered to normal subjects, to schizophrenic patients and to patients with delusional disorder. Significantly better performance was seen in the normal subjects than in the schizophrenic and delusional patients. Delusional patients, in turn, showed better performance than the schizophrenic patients.