物理治疗在难治性精神分裂症中的应用进展

难治性精神分裂症的物理治疗包括电休克疗法、重复经颅磁刺激、磁痉挛治疗及深部脑 刺激等神经调控技术，现概述这些物理治疗方法的定义、疗效及不良反应，为今后进一步优化难治性精 神分裂症的物理联合治疗策略提供支持。     

难治性精神病外科治疗效果评价

目的综合评价难治性精神病外科治疗的临床效果及手术对难治性精神病人的神经生理、记忆、智能的影响。方法采用脑立体定向技术对临床确诊的难治性精神病精神分裂症选杏仁核、扣带回、内囊前肢等脑内不同靶点进行单靶点或多靶点联合毁损,对部分患者进行了手术前后医学心理、神经电生理检查对照分析,同时对难治性精神分裂症患者进行了手术前后BPRS及各因子分析对照。结果难治性分裂症通过BPRS及各因子分析,其中BPRS、ANDP、ACTV、HOST手术前后对照具有显著的差异性（P〈0．01）,综合疗效评定：痊愈2例;显进64例;进步41例;无效20例。结论脑立体定向技术对临床确诊的难治性精神病靶症状疗效是肯定的,手术对患者记忆、智能及脑电图无明显影响。     

基于难治性精神分裂症脑神经机制的潜在治疗靶点及疗效预测研究进展

精神分裂症病理机制不明,即使经充分有效治疗后,仍有30% 以上的患者由于疗效欠佳 发展为难治性精神分裂症,造成重大疾病负担。现从难治性精神分裂症治疗现状、神经病理机制、潜在 治疗靶点及疗效预测等方面进行综述,希望能够为难治性精神分裂症的病理机制研究及治疗提供参考。     

精神分裂症幻听症状神经机制的研究进展

<正>幻听是精神分裂症最常见的症状之一,其出现频率高于任何其他类型幻觉,可作为临床诊断、判断精神分裂症严重程度以及治疗效果的重要依据之一。揭示幻听的神经机制,不仅具有显著临床意义,还有助于探讨精神分裂症的病理生理机制。本文将从神经影像学、电生理、遗传学等方面对其做一系列综述。1神经影像学研究精神分裂症患者影像学检查通常并不表现出脑结构异常,但随着科学技术发展,不断涌现的脑成像新技术及数据     

基于认知任务的近红外光谱成像技术在抑郁症中的研究进展

抑郁症确切的病理生理学机制尚不清楚,近红外光谱脑功能成像技术是近年来新兴的一种基于血流动力学原理的非侵入式功能神经影像学技术,广泛应用于精神科,具有辅助诊断抑郁症的临床价值。此外,近红外光谱成像可以与其他神经调控物理治疗结合以检测大脑皮层的血流动力学及氧合状态变化,有望为相关技术参数设定及疗效预后提供有利指导。     

反应性神经刺激治疗难治性癫痫的新进展

迷走神经刺激(VNS)、深部脑刺激(DBS)等神经调控技术在既往难治性局灶性癫痫治疗中发挥了重要作用, 而近些年来以闭环刺激为主的反应性神经刺激系统(RNS)也逐渐投入临床, 并在2013年作为难治性癫痫的辅助疗法获得美国食品药品监督管理局(FDA)批准使用。本文现围绕RNS的发展历程、临床应用、抗癫痫作用机制及今后的研究方向综述如下, 以期加深临床工作者对这一技术的了解。     

晚发性精神分裂症

本文对晚发性精神分裂症的概念由来、临床特征、流行学、危险因素、脑成像、神经心理学缺损，治疗等进行了讨论。     

精神分裂症神经电生理的研究进展

精神分裂症是一种病因不明、预后欠佳的复杂重性精神疾病,目前诊断精神分裂症主要依据临床症状,电生理及影像学特征不能作为诊断依据,但大量研究结果提示,精神分裂症患者脑结构和功能异常是发病的病理生理基础。随着脑成像技术的发展,特别是当前功能神经影像学已成为精神分裂症研究的热点之一,多种设备联合检测技术的运用,使精神疾病的研究将进入了多学科和多模态的发展阶段［1］。功能神经影像学主要包括脑电图（EEG ）／脑电地形图（BEAM ）及诱发电位、多导睡眠图（PSG）、脑电超慢涨落图（EFG ）、脑磁图（M EG ）及磁源性成像（MSI）、功能磁共振成像（fMRI）、正电子发射计算机断层显像（PE T ）和单光子发射计算机断层成像（SPECT ）,均从不同角度研究大脑的功能［2］。fMRI、PET及SPECT 检测均依赖局部脑血流,是神经元活动的间接反应,受时间分辨率不高等因素的限制。EEG／BEAM 、诱发电位、PSG、EFG、M EG 及MSI均属于神经电生理检测方法。EEG／BEAM 具有可长时间连续监测和成本低廉等优势,在精神分裂症的研究中具有重要价值;PSG 能够准确检测精神分裂症患者睡眠障碍的严重程度;EFG 是一种用于精神科的新技术,具有广阔前景;M EG的时间、空间分辨率高,干扰少,具有无法比拟的优势［2－3］。目前,精神分裂症神经电生理的相关研究较少,现对此复习文献并综述如下。     

难治性精神分裂症的研究进展

精神分裂症是以思维、情感、行为等方面的障碍以及精神活动的不协调为主要表现的一组精神病.WHO1992年公布的资料显示其年发病率为7‰～14‰,病情迁延反复发作.有资料显示仍有30%～60%的患者在充分的药物治疗后仍然缺乏反应或仅有部分反应,迁延为难治性精神分裂症,导致临床治愈率低,预后差,给患者本人及其家庭带来极大痛苦和负担.本文介绍了难治性精神分裂症的概念、流行病学及临床特征、难治性精神分裂症的诊断,重点介绍了难治性精神分裂症的治疗,包括药物治疗和非药物治疗措施及进展,关注到难治性精神分裂症患者的社会心理康复的综合治疗问题.但难治性精神分裂症的神经生物学机制仍不明了,难治性精神分裂症对临床医生将仍然是一个挑战.     

脑深部电刺激治疗难治性抑郁障碍临床疗效及机制研究进展

脑深部电刺激是难治性抑郁障碍的新兴治疗手段之一。本文概述了脑深部电刺激治疗难治性抑郁障碍的诸多潜在靶点,归纳了相关临床研究的结果。这些靶点包括胼胝体下扣带回,伏隔核,腹侧内囊和腹侧纹状体区域,内侧前脑束等区域。在这些研究的基础上,本文结合相关基础研究,在突触可塑性、神经电生理、神经环路及神经递质等层面进一步讨论了脑深部电刺激发挥治疗效果可能的机制,并对其进一步推广的应用潜力做出评估和展望。结合现有临床研究结果和神经生物学机制的多靶点联合刺激可能是提高脑深部电刺激治疗难治性抑郁障碍的重要发展方向。     

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.