低频重复经颅磁刺激联合草酸艾司西酞普兰治疗广泛性焦虑障碍的临床对照研究

目的探讨低频重复经颅磁刺激(r TMS)联合草酸艾司西酞普兰对广泛性焦虑障碍(GAD)的临床疗效及安全性。方法采用随机数字表法将符合《国际疾病分类(第10版)》(ICD-10)广泛性焦虑障碍诊断标准的60例患者分为研究组和对照组各30例,研究组采用低频r TMS(1Hz)刺激右侧前额叶背外侧部联合草酸艾司西酞普兰治疗,对照组单用草酸艾司西酞普兰治疗,观察期6周。分别在治疗前和治疗后1、2、4、6周采用汉密尔顿焦虑量表(HAMA)、焦虑自评量表(SAS)评定疗效,于治疗后第1、2、4、6周采用副反应量表(TESS)评定不良反应。结果治疗后各时点两组HAMA、SAS评分均较治疗前低(P均0.01),从第1周末开始,研究组HAMA、SAS评分均低于对照组,差异均有统计学意义(P均0.05)。治疗6周后,研究组有效率高于对照组(86.67%vs.63.33%,χ~2=4.356,P0.05),且两组TESS评分比较差异无统计学意义[(2.33±0.96)分vs.(2.13±0.90)分,P0.05]。结论低频r TMS联合草酸艾司西酞普兰对GAD疗效可能优于单用草酸艾司西酞普兰。     

草酸艾司西酞普兰合并艾地苯醌对脑卒中后抑郁的临床疗效观察

目的探讨草酸艾司西酞普兰合并艾地苯醌治疗脑卒中后抑郁的效果及安全性。方法将符合《国际疾病分类(第10版)》(ICD-10)脑卒中后抑郁症诊断标准的47例患者随机分为研究组(n=25)和对照组(n=22),给予研究组草酸艾司西酞普兰合并艾地苯醌治疗,给予对照组草酸艾司西酞普兰治疗。分别于治疗前和治疗后第1、2、3月采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、简易精神状态量表(MMSE)及副反应量表(TESS)评定疗效和不良反应。结果治疗前两组HAMD、HAMA、MMSE评分差异均无统计学意义(P0.05),治疗3个月后研究组HAMA和HAMD评分低于对照组,MMSE评分高于对照组,研究组总有效率(84.00%)高于对照组(59.09%),差异均有统计学意义(P0.05)。结论草酸艾司西酞普兰合并艾地苯醌治疗脑卒中后抑郁的效果优于单独应用草酸艾司西酞普兰。     

草酸艾司西酞普兰联合拉莫三嗪治疗儿童癫痫合并抑郁症的疗效及安全性

目的探讨草酸艾司西酞普兰联合拉莫三嗪(LTG)治疗儿童癫痫合并抑郁症的疗效与安全性。方法将82例癫痫合并抑郁症患儿随机分为观察组与对照组,各41例,对照组予以LTG治疗,观察组予以LTG联合草酸艾司西酞普兰治疗8周。比较两组抗癫痫疗效,并评价汉密尔顿抑郁量表24项(HAMD-24)和不良反应症状量表(TESS)评分。结果观察组的治疗总有效率显著高于对照组的(95.12%vs 78.05%,P0.05);治疗2、4、6、8周后,观察组的HAMD-24评分显著低于对照组(P0.05),但两组TESS评分及不良反应率无明显差异(P0.05)。结论草酸艾司西酞普兰联合LTG能够有效控制儿童癫痫发作并改善抑郁症状,安全性好。     

舒肝解郁胶囊合并草酸艾司西酞普兰对抑郁症患者焦虑、抑郁状态疗效临床研究

目的探讨舒肝解郁胶囊合并草酸艾司西酞普兰对抑郁症患者的效果。方法 2015年5月~2016年12月在我院门诊就诊的抑郁症患者50人,依照给药方式不同分为试验组25例与对照组25例。对照组给予草酸艾司西酞普兰10mg/次口服,1d/次。试验组:给予草酸艾司西酞普兰10mg/次口服,1d/次,同时加服舒肝解郁胶囊,2粒/次,2次/d,早晚各1次,两组疗程均为6周。用焦虑自评量表SAS、抑郁自评量表SDS作为评价焦虑抑郁状态程度,用日常生活能力评定表(ADL)为患者评估日常生活能力。并观察记录服药期间出现的不良反应。结果治疗后试验组和对照组的SAS和SDS评分均有明显下降。试验组在治疗4周、6周后其SAS、SDS均低于对照组(P0.05);两组患者在治疗4周、6周后日常生活能力评分均低于治疗前,且试验组治疗6周的评分优于对照组,差异有统计学意义(P0.05)。用药期间两组不良反应发生率无统计学差异(P0.05)。两组用药后均无血、尿常规、肝、肾功能无明显变化。结论舒肝解郁胶囊合并草酸艾司西酞普兰可更好的改善抑郁症患者的抑郁、焦虑症状和日常生活能力,安全性好。     

草酸艾司西酞普兰联合喹硫平治疗抑郁症合并高血压患者的疗效与安全性

目的探讨草酸艾司西酞普兰联合喹硫平治疗抑郁症合并高血压患者的疗效与安全性。方法本院2018年5月～2019年5月收治的86例抑郁症合并高血压患者,随机分为常规组(草酸艾司西酞普兰片治疗)、研究组(草酸艾司西酞普兰片联合喹硫平片治疗),各43例。比较两组的疗效和安全性。结果研究组整体疗效高于常规组(P0.05);研究组治疗后24h收缩压、24h舒张压均低于常规组(P0.05);研究组治疗后第2周、第4周、第8周HAMD汉密尔顿抑郁量表评分低于常规组、(P0.05);不良反应总发生率两组无明显差异(P0.05)。结论草酸艾司西酞普兰片与喹硫平联合治疗可以减轻抑郁症合并高血压的患者的抑郁程度、降低血压,而且不良反应少。     

草酸艾司西酞普兰对腹腔镜子宫肌瘤剥除术后患者焦虑抑郁及性生活质量的影响

目的探讨草酸艾司西酞普兰对腹腔镜子宫肌瘤剥除术(LM)后患者焦虑抑郁状态及性生活的影响。方法收集2015年2月~2017年2月我院收治的LM术后伴焦虑抑郁状态患者74例,随机分为观察组与对照组,各37例。对照组予以常规心理学干预,观察组在对照组的基础上加用草酸艾司西酞普兰口服。12周后比较两组患者治疗前后汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、女性性功能评价表(BISF-W)评分。结果两组治疗后HAMA、HAMD评分均显著降低,且观察组显著低于对照组(P0.05);两组治疗后BISF-W各项评分均显著提高,且观察组显著高于对照组(P0.05)。结论草酸艾司西酞普兰可减轻LM患者术后焦虑抑郁状态,改善性生活质量。     

草酸艾司西酞普兰联合氨磺必利治疗抑郁症的效果和安全性研究

目的探讨氨磺必利联合草酸艾司西酞普兰治疗抑郁症的有效性和安全性。方法采用随机数字表法将符合《国际疾病分类(第10版)》(ICD-10)抑郁症诊断标准的78例抑郁症患者分为草酸艾司西酞普兰组(对照组,n=40)和草酸艾司西酞普兰联合氨磺必利组(研究组,n=38),疗程8周。于治疗前和治疗后第2、4、6、8周末采用汉密尔顿抑郁量表17项版(HAMD-17)评定疗效,采用副反应量表(TESS)评定安全性和不良反应。结果治疗2周后,两组HAMD-17总评分比较差异有统计学意义(P0.01)。治疗4周后,研究组HAMD-17焦虑躯体化因子评分、体重因子评分、阻滞因子评分及总评分均较对照组低(P0.05或0.01)。两组总有效率差异有统计学意义(χ2=2.734,P0.01)。研究组与对照组口干、恶心、呕吐及便秘的发生率差异有统计学意义(P0.01)。结论在抑郁症的临床治疗过程中,相对于单用草酸艾司西酞普兰,联合用药可能会更有效地改善躯体症状,减轻早期消化道不良反应,加快起效时间。     

盐酸文拉法辛和草酸艾司西酞普兰治疗抑郁症的对照研究

目的 比较盐酸文拉法辛和草酸艾司西酞普兰治疗抑郁症患者的疗效和安全性.方法 69例抑郁症患者随机分为盐酸文拉法辛组和草酸艾司西酞普兰组.盐酸文拉法辛治疗剂量150～225 mg/d,草酸艾司西酞普兰治疗剂量10～20 mg/d,采用汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)以及副反应评定量表(TESS)评定疗效和不良反应,观察时间为期8周.结果 两组药物在治疗终末期疗效以及不良反应差异没有统计学意义(P＞0.05).在治疗第6周末草酸艾司西酞普兰组HAMD/HAMA总评分低于盐酸文拉法辛组(P＜0.05).结论 盐酸文拉法辛与草酸艾司西酞普兰对抑郁症患者均有较好的疗效,安全性一致,但是后者起效更快.     

草酸艾司西酞普兰联合经颅磁刺激对青壮年卒中后抑郁的治疗研究

目的 探讨经颅磁刺激(rTMS)联合草酸艾司西酞普兰治疗青壮年卒中后抑郁(PSD)的治疗效果。方法 选取2021年6月至2023年7月就诊于保定市第一中心医院与河北省第六人民医院的的青壮年PSD患者共106例,随机分为草酸艾司西酞普兰治疗组(38例)、草酸艾司西酞普兰联合高频rTMS治疗组(32例)及草酸艾司西酞普兰联合低频rTMS治疗组(36例),经过4 w治疗后采用汉密尔顿抑郁量表17 (HAMD-17)及患者健康问卷-9 (PHQ-9)观察各组治疗效果及抑郁症状改善情况。结果经治疗后,各组HAMD-17量表评分较治疗前均有降低;除单纯草酸艾司西酞普兰治疗组外,其余两组PHQ9量表抑郁评分较治疗前均有降低。总体来说,草酸艾司西酞普兰联合rTMS治疗组评分均低于非联合治疗组,差异有统计学意义(P<0.05),但高频rTMS治疗组与低频rTMS治疗组之间差异不明显(P>0.05)。结论 草酸艾司西酞普兰联合rTMS能够降低青壮年PSD患者HAMD-17评分及PHQ-9评分,改善抑郁症状。     

西酞普兰联合心理干预对抑郁症患者症状及认知功能的疗效

目的观察草酸艾司西酞普兰联合心理干预治疗对抑郁症患者的临床疗效及认知功能的影响。方法选取2014年6月到2016年12月我院收治的64例抑郁症患者,随机分成两组,其中对照组32例采用草酸艾司西酞普兰治疗,研究组32例在药物治疗基础上联合心理干预,为期2个月。观察对比两组患者治疗前后抑郁焦虑改善情况及认知功能改变。结果两组患者治疗前焦虑抑郁及认知功能评分组间差异不明显(P0.05)。治疗后两组患者抑郁、焦虑评分均降低,认知功能相关评分均升高,差异具有统计学意义(P0.05);且与对照组比较,治疗后研究组焦虑抑郁情绪及认知功能改善程度更明显(P0.05)。结论草酸艾司西酞普兰联合心理干预能更有效的改善抑郁症患者的焦虑抑郁情绪及认知症状,值得临床推广应用。     

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.     

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.     

Sense of coherence as a predictor of subjective state of health: results of 4 years of follow-up of adults

A number of cross-sectional population studies have shown that a strong sense of coherence (SOC) is associated with various aspects of good perceived health. The association does not seem to be entirely attributable to underlying associations of SOC with other variables, such as age or level of education. OBJECTIVE: The aim of the study reported here was to determine whether SOC predicted subjective state of health. METHODS: The study was carried out as a two-way panel mail survey of 1976 individuals with 4 years interval for two collections of data. The statistical method used was multivariate cumulative logistic modeling. Age, initial subjective state of health, initial occupational training level, and initial degree of social integration were included as potential explanatory variables. RESULTS: A strong SOC predicted good health in women and men. CONCLUSIONS: SOC can be interpreted as an autonomous internal resource contributing to a favorable development of subjective state of health. SOC data should, however, be regarded as complementary to and not a substitute for information already known to be associated with increased risk of future ill health.