精神分裂症患者乙型肝炎病毒感染调查

目的:调查精神分裂症患者的乙型肝炎病毒(HBV)感染与肝功能异常情况。方法:对312例精神分裂症住院患者的HBV感染及丙氨酸氨基转移酶(ALT)异常进行流行病学调查,以健康体检者279名为对照。结果:精神分裂症患者的HBV感染率为71.8%,ALT异常率为29.5%,明显高于对照组,精神分裂症患者中两性间HBsAg阳性率以男性显著较高。再次住院患者的HBV感染显著比首次住院患者高。结论:对精神分裂症患者应加强隔离措施,特别是HBsAg阳性的患者,防止交叉感染;加强健康教育,加强饮食营养支持和乙肝疫苗的接种等措施。     

社区精神分裂症患者服药依从性调查及影响因素分析

目的探讨社区精神分裂症患者服药依从性及影响因素。方法对上海市虹口区8个街道社区卫生服务中心登记在册的精神分裂症患者服药依从性情况进行问卷调查,运用二元Logistic回归方法分析影响患者服药依从性的因素。结果入组的2342例社区精神分裂症患者中,服药依从性好者为2159例(占92.2%),服药依从性差者为183例(占7.8%)。Logistic回归分析结果显示起病形式缓慢(OR=2.230,95%CI:1.374～3.619,P=0.001)、自知力不全(OR=6.027,95%CI:1.769～20.533,P=0.004)或缺失(OR=9.306,95%CI:2.146～40.360,P=0.003)、病情严重程度评分 10分(OR=3.229,95%CI:1.765～5.910,P0.001)、就诊方式为未门诊(OR=15.413,95%CI:5.912～40.180,P0.001)、不定期复诊(OR=19.838,95%CI:11.914～33.032,P0.001)、监护情况差(OR=2.156,95%CI:1.402～3.318,P0.001)、近期有心理生活应激事件(OR=9.112,95%CI:2.854～29.085,P0.001)为社区精神分裂症患者服药依从性的不利因素。结论社区精神分裂症患者服药依从性的影响因素包括患者的起病形式、自知力、病情严重程度、就诊方式、复诊及时性、监护情况和近期心理生活应激事件,需针对性采取干预措施以提高社区精神分裂症患者服药依从性。     

慢性精神分裂症患者伴发代谢综合征的危险因素分析

目的:探讨慢性精神分裂症患者伴发代谢综合征(MS)的危险因素、患病率及与血清脑源性神经营养因子(BDNF)水平的关系。方法:采用横断面研究方法,收集入组者一般人口学资料及临床资料,检测入组者血糖、血脂及血清BDNF水平。采用中华医学会糖尿病学分会(CDS)的标准诊断,将病程≥5年的慢性精神分裂症患者分为MS组及非MS组,分析慢性精神分裂症患者伴发MS的危险因素。结果:共有298例慢性精神分裂症患者入组,其中44例(14.7%)伴发MS纳入MS组;254例入非MS组。两组一般人口学资料比较差异无统计学意义(P>0.05)。MS组阳性与阴性症状量表(PANSS)中阴性症状因子分明显低于非MS组(P<0.05);血清BDNF水平明显高于非MS组(P<0.01)。二分类Logistic回归分析显示,血清BDNF水平增高是慢性精神分裂症患者伴发MS的危险因素(OR=1.658,P=0.005);阴性症状因子是伴发MS的保护性因素(OR=0.941,P=0.027)。结论:血清BDNF水平升高是慢性精神分裂症患者伴发MS的危险因素。     

中国汉族人泛醌NADH脱氢酶Fe-S蛋白1基因多态性与氯氮平所致代谢综合征的关联研究

目的:探索中国汉族精神分裂症患者人泛醌NADH脱氢酶Fe-S蛋白1(NDUFS1)基因多态性与长期服用氯氮平所致代谢综合征(MS)的关系。方法:收集388例长期服用氯氮平2年的慢性精神分裂症患者临床资料及代谢指标;分为MS组(159例)和非MS组(299例);对NDUFS1基因rs13024804、rs1044120、rs6435330、rs4147713这4个位点进行多态性检测,并进行组间及性别间分析。结果:NDUFS1基因4个位点各等位基因及基因型分布两组间差异无统计学意义;性别分层后发现,两组女性患者中携带rs1044120 T等位基因(GT+TT vs GG,P=0.002,OR=0.25,95%CI:0.10～0.61)、rs6435330 T等位基因(GT+TT vs GG,P 0.001,OR=0.21,95%CI:0.09～0.50)及rs4147713 G等位基因(TG+GG vs TT P=0.002,OR=0.26,95%CI:0.11～0.61)者患MS的危险性下降。男性患者中rs1044120位点T等位基因携带者血浆高密度脂蛋白水平显著高于非携带者[(1.33±1.26) mmol/L vs(1.09±0.48) mmol/L,P=0.034];女性患者中rs6435330位点T等位基因携带者舒张压显著低于非携带者[(71.43±7.134) mmHg vs (74.47±6.419) mmHg,P=0.032]。结论:在中国汉族精神分裂症患者中,NDUFS1基因多态性与氯氮平相关的MS无关联,女性患者中NDUFS1基因多态性与氯氮平相关的MS存在关联。     

社区精神分裂症患者低体重率及相关因素分析

目的探讨精神分裂症患者低体重率及相关社会人口学和临床特征危险因素。方法纳入503例社区精神分裂症患者与323名健康对照,以体质指数小于18.5 kg/m2定义低体重,比较两组低体重率;收集患者组社会人口学资料、临床资料以及实验室检查指标,阳性和阴性症状量表中文版(positive and negative syndrome scale,PANSS)评估患者精神症状,分析患者低体重的相关因素。结果社区精神分裂症患者低体重率为9.9%(50/503),对照组为1.5%(5/323),组间差异有统计学意义(P0.01)。多因素logistic回归分析显示,男性(OR=2.43,95%CI:1.74~3.39)、吸烟(OR=1.50,95%CI:1.21~1.86)、住院次数(OR=1.18,95%CI:1.06~1.31)、PANSS阴性症状因子分(OR=1.09,95%CI:1.04~1.14)是低体重的危险因素(均P0.05)。结论精神分裂症患者体重不足较为常见,远高于健康人群,需要重点关注男性、吸烟、多次住院及阴性症状突出的患者。     

住院精神分裂症患者合并代谢综合征的影响因素

目的分析住院精神分裂症患者合并代谢综合征(MS)的影响因素,为精神分裂症合并MS的早期干预提供参考。方法选取在佛山市顺德区伍仲珮纪念医院住院的207例精神分裂症患者为研究对象,均符合《精神障碍诊断与统计手册(第4版)》(DSM-IV)诊断标准,并根据《中国成人血脂异常防治指南》(2007年) MS诊断标准将患者分为MS组(n=62)和非MS组(n=145)。采用自制调查表收集患者一般资料和抗精神病药物使用情况,并进行腰围、血压、血脂、血糖测定。结果住院精神分裂症患者合并MS的患病率为30. 0%,MS组和非MS组在性别、糖尿病家族史、吸烟史方面比较差异均有统计学意义(P 0. 05或0. 01),Logistic回归分析显示,糖尿病家族史和吸烟史是住院精神分裂症患者合并MS的危险因素(OR=3. 228、2. 689)。结论糖尿病家族史和吸烟史可预测住院精神分裂症患者发生MS的风险。     

住院抑郁障碍患者合并心境稳定剂治疗的调查分析

目的了解住院抑郁障碍患者合并心境稳定剂(MS)的治疗情况,通过对患者的临床特征进行对比分析,探讨抑郁障碍患者合并使用MS治疗的影响因素。方法回顾性分析2016年1月～12月住院治疗的145例抑郁障碍患者的临床资料,对合并或不合并MS治疗的抑郁障碍患者人口学资料和疾病特征进行比较。结果合并MS治疗的患者比例33.8%(49/145)。与未合并MS治疗组相比,合并MS治疗组多伴有精神病性症状(49.0%VS 33.3%,χ~2=4.350,P0.05)。多元回归分析显示,性别(OR=2.656,95%CI:1.162～6.073,P0.05)、自杀(OR=0.456,95%CI:0.214～0.968,P0.05)、精神病性症状(OR=2.327,95%CI:1.068～5.068,P0.05)是抑郁障碍患者药物治疗中联合使用MS的影响因素。结论女性、不伴有自杀、伴有精神病性症状的抑郁障碍患者可能更多的联合心境稳定剂进行治疗。     

住院精神分裂症患者暴力行为危险因素研究

目的:探讨住院精神分裂症患者发生暴力行为的危险因素。方法:以外显行为攻击量表(MOAS)评分≥5分为界将220例住院精神分裂症患者分为暴力组(62例)和非暴力组(158例);对两组的人口学及临床资料进行收集、比较;采用多元Logitic回归分析探讨住院精神分裂症患者发生暴力行为的危险因素。结果:与非暴力组比较,暴力组患者更年轻、内向型人格比率低、既往有暴力行为史、有敌对情绪、被害妄想、兴奋易激惹的比率高(P<0.05或P<0.01);多元Logistic回归分析显示,既往暴力行为史(OR=2.169,95%CI:1.095～4.296)、有敌对情绪(OR=2.561,95%CI:1.117～5.869)、非内向人格特征(OR=1.496,95%CI:1.021～2.191)和被害妄想(OR=3.800,95%CI:1.592～9.070)进入方程。结论:既往暴力行为史、有敌对情绪、人格特征和被害妄想是住院精神分裂症患者发生暴力行为的危险因素。     

住院精神分裂症患者伴发非酒精性脂肪肝相关因素的性别差异

目的 探讨住院精神分裂症患者伴非酒精性脂肪肝（NAFLD）的患病率以及影响因素的性别差异。方法 选取2020年7月1日至2021年6月30日在上海市嘉定区精神卫生中心住院的316例精神分裂症患者为研究对象。采用多因素Logistic回归分析住院精神分裂症患者以及不同性别患者伴NAFLD的影响因素。结果 住院精神分裂症患者的NAFLD患病率为41.1%(130/316)，其中男性患者为42.1%(82/195)，女性患者为39.7%(48/121)。多因素Logistic回归分析显示，女性（OR=2.345,95%CI=1.159～4.743）、体重指数高（OR=1.445,95%CI=1.296～1.610）、甘油三酯高（OR=2.715,95%CI=1.709～4.315）、丙氨酸氨基转移酶（ALT）高（OR=1.019,95%CI=1.002～1.037）、住院时长长（OR=1.099,95%CI=1.040～1.162）、合并糖尿病（OR=2.879,95%CI=1.225～6.768）是住院精神分裂症患者伴NAFLD的危险因素（P<0.05）。多因素Logistic回归分...     

精神分裂症患者出院后药物治疗依从性的影响因素分析

目的:探讨精神分裂症患者出院后药物治疗依从性及相关影响因素。方法:对175例出院后的精神分裂症患者进行6个月的随访调查,通过电话、入户或门诊随访完成自编《精神分裂症患者药物治疗依从性调查问卷》,分析患者出院后药物治疗依从性及影响依从性的相关危险因素。结果:精神分裂症患者出院后药物治疗依从率仅为61. 1%(107/175例);影响患者出院后药物治疗依从性的危险因素包括缺乏疾病相关知识(OR=2. 319,95%CI:1. 56～3. 07)、药物不良反应(OR=6. 209,95%CI:4. 768～7. 650)、药物种类(OR=1. 931,95%CI:1. 257～2. 605)、对医师的信任较差(OR=2. 855,95%CI:1. 908～3. 801)、门诊不定期复诊(OR=3. 300,95%CI:2. 181～4. 419)及缺乏家庭支持(OR=4. 319,95%CI:2. 935～5. 703)等(P 0. 05或P 0. 001)。结论:精神分裂症患者出院后的药物治疗依从性较差,与缺乏疾病相关知识、药物不良反应、不定期复诊、缺乏家庭支持等影响因素有关。     

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.