盐酸文拉法辛缓释片联合舒肝解郁胶囊治疗伴躯体症状抑郁症的临床对照研究

目的比较盐酸文拉法辛缓释片联合舒肝解郁胶囊与单用盐酸文拉法辛缓释片治疗伴躯体症状抑郁症的效果及安全性。方法选择符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)的抑郁症伴躯体症状患者60例,按就诊时间和入院顺序单双号分为研究组和对照组各30例。两组均服用盐酸文拉法辛缓释片,研究组在此基础上加用舒肝解郁胶囊治疗,疗程6周,在治疗第2、4、6周对患者进行汉密顿抑郁量表17项版(HAMD-17)及副反应量表(TESS)评定。结果治疗第6周末,研究组显效率高于对照组(86.67%vs.73.33%,χ2=6.125,P0.05);两组HAMD-17评分差异有统计学意义[(7.36±3.41)vs.(11.14±3.25),t=4.59,P0.01];两组HAMD-17焦虑/躯体化因子评分差异有统计学意义[(4.64±1.11)vs.(1.57±1.45),t=6.324,P0.01];两组TESS评分差异无统计学意义[(3.47±0.85)vs.(3.96±1.23),t=1.12,P0.05]。结论盐酸文拉法辛缓释片联合舒肝解郁胶囊治疗伴躯体症状抑郁症较单用盐酸文拉法辛缓释片起效更快,更快改善躯体症状,不增加药物的不良反应。     

舍曲林联合喹硫平对强迫症的疗效分析

目的评价舍曲林联合喹硫平治疗强迫症的疗效及安全性。方法采用Excel将96例符合《国际疾病分类(第10版)》(ICD-10)诊断标准的强迫症患者随机分为研究组和对照组各48例。研究组采用舍曲林联合喹硫平治疗,对照组单用舍曲林治疗,两组均治疗8周,于治疗前后采用耶鲁布朗强迫症状量表(Y-BOCS)和汉密尔顿焦虑量表(HAMA)评定疗效,采用药物不良反应量表(TESS)评估不良反应。结果治疗后,研究组总有效率高于对照组(95.83%vs.68.75%,P0.05);研究组Y-BOCS和HAMA评分均低于对照组,差异有统计学意义[(8.4±1.6)分vs.(15.4±2.1)分、(6.5±1.1)分vs.(10.8±1.2)分,P均0.05];研究组与对照组不良反应发生率差异无统计学意义(6.25%vs.8.33%,P0.05)。结论舍曲林联合喹硫平治疗强迫症疗效优于单用舍曲林,安全性相当。     

舍曲林联合乌灵胶囊对抑郁症的临床疗效观察

目的观察舍曲林联合乌灵胶囊对抑郁症的临床疗效。方法将2014年3月-2015年3月在天水市复退军人精神病疗养院住院和门诊就医的130例符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)中抑郁发作的患者按照随机数字表法分为研究组和对照组各65例,研究组以舍曲林联合乌灵胶囊治疗,对照组单用舍曲林治疗,均治疗6周。采用汉密尔顿抑郁量表17项版(HAMD-17)和汉密尔顿焦虑量表(HAMA)评定疗效;采用副反应量表(TESS)评定不良反应,分别于治疗前及治疗后1、2、4、6周末各评定一次。结果研究组有效率为92.3%,对照组为80.0%,两组差异有统计学意义(P0.05)。从治疗第1周末开始,两组HAMD-17、HAMA评分均较治疗前低(P均0.01),两组同一治疗时点比较,研究组评分低于对照组(P0.05);研究组服用艾司唑仑的时间短于对照组(P0.05)。结论舍曲林联合乌灵胶囊治疗抑郁症较单用舍曲林效果好,且失眠、焦虑不安的发生率更低。     

文拉法辛与舍曲林对女性抑郁症患者认知功能的影响

目的 比较文拉法辛与舍曲林对女性抑郁症的疗效和认知功能的影响.方法 将符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)抑郁发作诊断标准,汉密尔顿抑郁量表(HAMD-17)评分≥17分的64例女性抑郁症患者采用随机数字法分为文拉法辛组和舍曲林组,分别给予文拉法辛(剂量75～225 mg/d)和舍曲林(剂量50 ～ 200mg/d)治疗8周.两组在治疗前后分别给予HAMD-17、威斯康星卡片分类测验(WCST)、连线测试(TMT)、Stroop测验.同时对32例相匹配的健康对照组进行神经心理测试.结果 ①治疗8周后文拉法辛组和舍曲林组的显效率(84.4％ vs.81.3％)、HAMD-17分[(7.53±5.13)vs.(7.22±5.26)]比较差异无统计学意义(P＞0.05),但两组HAMD-17评分均低于治疗前(P＜0.05).②与治疗前比较,文拉法辛组WCST总数、持续错误数下降,TMT-A、TMT-B、Stroop成绩好转(P＜0.05);舍曲林组WCST各项指标治疗前后变化无统计学意义(P＞0.05),TMT-A、TMT-B、Stroop成绩好转(P＜0.05).③治疗后两组的认知功能仍差于正常对照组(P＜0.05).结论 文拉法辛与舍曲林治疗女性抑郁症的疗效相当,但文拉法辛在改善认知方面优于舍曲林,可能更适合女性抑郁症患者;女性抑郁症患者的认知障碍在抑郁症状缓解后依然存在.     

氨磺必利合并舍曲林治疗老年期抑郁症的对照研究

目的探讨氨磺必利联合舍曲林对老年期抑郁症的治疗作用。方法采用随机开放对照研究,将符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)的60例老年期抑郁症的患者随机分为研究组(氨磺必利联合舍曲林治疗组)与对照组(单纯舍曲林治疗组),分别在治疗前及治疗后第2、4、6、8周末,采用汉密尔顿抑郁量表(HAMD)、临床总体印象量表(CGI-GI)评定疗效,采用Asberg抗抑郁剂副反应量表(SERS)评定两组的药物副反应。结果研究组HAMD评分在治疗后2周末、4周末、6周末以及8周末与治疗前比较差异有统计学意义(P0.05或0.01);研究组CGI-GI总评分在治疗4周末、6周末以及8周末与治疗前比较差异有统计学意义(P均0.01);治疗后第4、6、8周末,研究组CGI-GI总评分与对照组比较差异有统计学意义(P0.05或0.01);对照组CGI-GI总评分在治疗8周末与治疗前比较差异有统计学意义(P0.01)。治疗后第8周末,对照组SERS评分与研究组比较[(5.4±2.8)分vs.(4.7±2.6)分],差异无统计学意义(P0.05)。结论氨磺必利联合舍曲林对老年期抑郁症的疗效优于单一应用舍曲林治疗,安全性好。     

舍曲林联合归因训练对脑卒中后抑郁及神经功能康复的影响

目的探讨舍曲林联合归因训练对脑卒中后抑郁及神经功能康复的影响。方法共78例脑卒中后抑郁患者,随机分为研究组和对照组,研究组给予舍曲林联合归因训练,对照组单用舍曲林治疗,疗程8周。在治疗前及治疗的第2、4、6、8周末用汉密尔顿抑郁量表(Hamilton depression rating scale,HAMD)和美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)分别评定抑郁症状和神经功能康复情况。结果经重复测量方差分析显示,患者HAMD总分的时间主效应、分组主效应以及时间与分组交互效应均有统计学意义(P0.05)。其中研究组在2、4、6、8周末HAMD总分均明显低于对照组[(18.25±4.27)vs.(20.81±4.63),(15.94±3.47)vs.(18.12±4.51),(12.85±3.12)vs.(16.54±3.70),(10.42±3.66)vs.(13.09±3.59)],差异有统计学意义(P0.05);研究组与对照组HAMD总分在各个时点均较治疗前降低(P0.01)。治疗8周后研究组有效率(以HAMD减分率评价)高于对照组(77.5%vs.52.6%),差异有统计学意义(P0.05)。两组NIHSS总分的时间主效应有统计学意义(P0.01),分组主效应、时间与分组交互效应无统计学意义(P0.05)。研究组与对照组NIHSS总分在各个时点均较治疗前降低(P0.01)。结论舍曲林联合归因训练可明显缓解脑卒中后抑郁患者的抑郁症状,但归因训练对患者神经功能改善不明显。     

盐酸文拉法辛缓释片联合舒肝解郁胶_省略_疗伴躯体症状抑郁症的临床对照研究

目的比较盐酸文拉法辛缓释片联合舒肝解郁胶囊与单用盐酸文拉法辛缓释片治疗伴躯体症状抑郁症的效果及安全性。方法选择符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)的抑郁症伴躯体症状患者60例,按就诊时间和入院顺序单双号分为研究组和对照组各30例。两组均服用盐酸文拉法辛缓释片,研究组在此基础上加用舒肝解郁胶囊治疗,疗程6周,在治疗第2、4、6周对患者进行汉密顿抑郁量表17项版(HAMD-17)及副反应量表(TESS)评定。结果治疗第6周末,研究组显效率高于对照组(86.67%vs.73.33%,χ2=6.125,P<0.05);两组HAMD-17评分差异有统计学意义[(7.36±3.41)vs.(11.14±3.25),t=4.59,P<0.01];两组HAMD-17焦虑/躯体化因子评分差异有统计学意义[(4.64±1.11)vs.(1.57±1.45),t=6.324,P<0.01];两组TESS评分差异无统计学意义[(3.47±0.85)vs.(3.96±1.23),t=1.12,P>0.05]。结论盐酸文拉法辛缓释片联合舒肝解郁胶囊治疗伴躯体症状抑郁症较单用盐酸文拉法辛缓释片起效更快,更快改善躯体症状,不增加药物的不良反应     

头发、血浆皮质醇水平变化与抑郁症的相关性研究

目的探讨头发、血浆皮质醇水平在抑郁症发病过程中的特点及抗抑郁治疗前后的变化。方法纳入抑郁症患者47例和正常对照47名。抑郁症组给予选择性5-羟色胺再摄取抑制剂治疗4周,分别于治疗前、治疗4周后检测头发、血浆皮质醇水平,分别采用汉密尔顿抑郁量表17项(Hamilton Depression Rating Scale-17,HAMD-17)和汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)评估抑郁症状和焦虑症状的严重程度及疗效。对照组不予干预,于入组时检测头发、血浆皮质醇水平。结果抑郁症组治疗前头发皮质醇水平高于对照组[(17.42±12.40)nmol/L vs.(10.22±8.00)nmol/L,P0.01],血浆皮质醇水平两组间无统计学差异(P0.05)。抑郁症组治疗后HAMD-17总分[(10.60±4.57)vs.(24.00±4.86)]和HAMA总分[(6.30±4.86)vs.(15.78±5.45)]较治疗前均降低(P0.01),治疗后头发皮质醇水平较治疗前增高[(30.53±25.75)nmol/L vs.(16.02±11.77)nmol/L,P0.05],血浆皮质醇水平治疗前后差异无统计学意义(P0.05)。治疗后达到临床痊愈的患者治疗前血浆皮质醇水平高于非临床痊愈的患者[(27.47±14.48)nmol/L vs.(18.30±7.11)nmol/L,P0.05]。抑郁症组治疗前血浆皮质醇水平与HAMD-17中的胃肠道症状因子分呈正相关(r=0.335,P=0.023),与HAMD-17总分及其他因子的相关性均无统计学意义(P0.05)。结论抑郁症患者头发皮质醇水平高于正常对照,经抗抑郁药治疗后头发皮质醇水平较治疗前升高。治疗前血浆皮质醇水平高的患者可能对抗抑郁药治疗更敏感,可获得更好的临床疗效。     

性激素联合艾司西酞普兰治疗围绝经期抑郁症的对照研究

目的探讨艾司西酞普兰联合性激素治疗围绝经期抑郁症的疗效。方法将60例围绝经期抑郁症患者随机分为研究组(30例)和对照组(30例),对照组用性激素治疗,研究组选用性激素联合艾司西酞普兰治疗,疗程共8周,在治疗前后采用汉密尔顿抑郁量表17项(HAMD-17)评定抑郁症状、WHO生存质量评定量表简表(WHOQOL-BREF)评定生存质量。结果两组基线时各项指标均无统计学意义(P0.05)。治疗8周后两组HAMD-17评分[(6.7±1.9),(10.8±5.5)]比较及与治疗前[(25.2±5.2),(24.5±6.5)]比较差异均有统计学意义(P均0.01),临床疗效总有效率分别为90%、76.7%,差异有统计学意义(P0.05)。治疗8周后两组WHOQOL-BREF各因子评分与治疗前比较差异有统计学意义(P0.05);治疗8周后两组WHOQOL-BREF生理领域[(14.24±2.81)vs.(11.31±2.37)]和心理领域评分[(15.66±2.04)vs.(12.12±1.84)]比较差异有统计学意义(P0.05)。结论性激素联合艾司西酞普兰治疗能够有效改善围绝经期抑郁症状,提高其生存质量。     

舍曲林联合小剂量奥氮平对抑郁焦虑共病患者的疗效

目的观察舍曲林联合小剂量奥氮平对抑郁焦虑共病的疗效、安全性及其对患者睡眠质量的影响,为抑郁焦虑共病的治疗提供参考。方法纳入2019年10月-2020年8月在甘肃省天水市第三人民医院和天水市复退军人精神病疗养院门诊就诊、符合《国际疾病分类(第10版)》(ICD-10)抑郁发作和广泛性焦虑障碍诊断标准的121例患者为研究对象,按照随机数字表法分为研究组(n=61)和对照组(n=60),研究组采用舍曲林联合小剂量奥氮平治疗,对照组采用舍曲林治疗,观察期8周。于治疗前和治疗后第1、2、4、6、8周采用汉密尔顿抑郁量表17项版(HAMD-17)和汉密尔顿焦虑量表(HAMA)评定病情严重程度,采用匹兹堡睡眠质量指数量表(PSQI)评定睡眠质量,采用副反应量表(TESS)评定药物不良反应。结果治疗后,两组HAMD-17、HAMA和PSQI评分均低于治疗前,差异均有统计学意义(P均0.05);治疗后各时点,研究组HAMD-17、HAMA和PSQI评分均低于对照组,差异均有统计学意义(P均0.05)。结论舍曲林联合小剂量奥氮平与单一舍曲林对抑郁焦虑共病的治疗均有效,但联合用药在改善焦虑和失眠症状方面的效果更好、安全性更高。     

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 -