神经心理测验预测首发精神分裂症的近期预后

目的：筛选与首发精神分裂症近期预后有关的神经心理测查指标。方法：对１６４例首发精神分裂症患者随机给予氯丙嗪或氯氮平治疗,于治疗前分别作韦氏成人智力量表、韦氏记忆量表、铁槽铁钉测验、手指敲击测验、利手测验、动作功能测验、手功能协调测验、连线测验、连线测验Ｂ、威期康辛卡片分类测验（ＷＣＳＴ）及语言流畅性测验等１１项刘经心理测查各１次,并作ＢＰＲＳ、ＳＡＮＳ、功能总体评定量表（ＧＡＦ）各１次,治疗１２周     

氯氮平的血药浓度与临床效应关系的研究

本研究旨在进一步研究不同时间氯氮平的血药浓度与临床效应的关系，对住院前至少两两周未用过抗精神病药的精神分裂症病人，入组后即服药，两周内加至治疗量。分别于治疗前，治疗后４周末，８周末和１２周末进行ＢＰＲＳ，ＳＡＮＳ评定，４周末，８周霜，１２周末空腹１２小时后次日晨取血检测血药浓度，同时评定ＴＥＳＳ得分。结果发现ＢＰＲＳ总分，ＣＧＩ和ＧＡＦ总分在第４周末，ＳＡＮＳ总分在第８周末明显减低。在第４周末、８     

家庭干预对首发精神分裂症近期与远期疗效影响的对照研究

目的 探讨家庭干预对首发精神分裂症的近期与远期疗效的影响。方法 对符合ＣＣＭＤ－２的５０例首发精神分裂症住院病人（Ａ组）进行为期８周的积极家庭干预及出院后维持干预，与采取传统方式治疗的５０例首发精神分裂症病人对照（Ｂ组），用ＢＰＲＳ、ＳＡＮＳ、ＣＧＩ量表评定其临床疗效，并进行２年随访。结果 经８周住院治疗，Ａ、Ｂ两组ＢＰＲＳ总分、ＳＡＮＳ总分、ＣＧＩ－ＳＩ、ＣＢＧＩ－ＧＩ减分有显著差异，Ａ组疗效好     

精神分裂症免疫指标与精神症状的关系

为探讨精神分裂症精神病理与免疫指标的相关性、评估抗精神病药对免疫指标的影响及其与疗效的关系，用固定剂量氟哌啶醇治疗５０例慢性精神分裂症患者１２周，在治疗前后测查Ｔ细胞亚群和白细胞介素２（ＩＬ－２）分泌细胞，并采用简明精神病评定量表（ＢＰＲＳ）、阳性症状评定量表（ＳＡＰＳ）和阴性症状评定量表（ＳＡＮＳ）进行评定。结果显示，治疗前ＣＤ３阳性细胞（ＣＤ＋３）、ＣＤ４阳性细胞（ＣＤ＋４）、ＣＤ４／ＣＤ８阳性细胞比值（ＣＤ４／ＣＤ８）和ＩＬ－２分泌细胞均明显低于正常人，治疗后ＣＤ＋４呈显著性增高；治疗前ＣＤ４／ＣＤ８与ＳＡＰＳ总分呈显著负相关，ＢＰＲＳ、ＳＡＰＳ和ＳＡＮＳ减分率与治疗前ＣＤ＋３细胞数均呈显著正相关，ＳＡＮＳ减分率与治疗前ＣＤ＋４细胞数亦呈正相关。研究表明，抗精神病药在改善患者精神症状的同时，也使其免疫功能得到改善；临床症状改善程度与治疗前的免疫功能状态相关。     

氯氮平治疗首发精神分裂症的疗效与血浆催乳素浓度

探讨氯氮平对首发精神分裂症的疗效，副反应及对催乳素水平的影响。共有３０例首发精神分裂症患者入组，用ＢＰＲＳ、ＳＡＮＳ观察疗效，以ＴＥＳＳ记录副反应。ＰＲＬ测定采用酶联免疫法。用ｔ检验，Ｆ检验、相关杂质分析进行分析比较。结果氯氮平对阳性，阴性症状均有良好的治疗效果。对ＰＲＬ水平基本无影响，ＰＲＬ水平与副反应无相关联系。本研究提示氯氮平的作用机理可能与多种受体有关。     

氯氮平与氯丙嗪治疗精神分裂症的对照研究

为进一步验证氯氮平在治疗精神分裂症中的地位。方法对病程＜５年的１２２例首次住院的精神分裂症患者，采用分层随机法分为两组，分别首选氯氮平和氯丙嗪进行８周治疗。以ＢＰＲＳ、ＳＡＰＳ、ＳＡＮＳ评定疗效，以ＴＥＳＳ评定副反应。结果治疗前后比较，两组ＢＰＲＳ、ＳＡＰＳ分均显著下降（Ｐ＜０．０１），ＳＡＮＳ分氯氮平组显著降低（Ｐ＜０．０１），氯丙嗪组无明显差异（Ｐ＞０．０５）；疗后氯氮平组的ＢＰＲＳ、ＳＡＰＳ、ＳＡＮＳ总分均明显低于氯丙嗪组（Ｐ＜０．０１）；ＴＥＳＳ总分氯氮平组亦低于氯丙嗪组，且无锥体外系副反应。结论氯氮平确是一种十分有效且药物副反应并不多见的抗精神病药。在严密监测血象的情况下，氯氮平实际上可作为一个可供选择的治疗精神分裂症的第一线药使用。     

氯氮平台并利培酮与氯氮平治疗精神分裂症阴性症状的对照研究

目的 比较氯氮平合并利培酮与氯氮平对精神分裂症阴局限性症状的疗效。方法 ６０例长期住院的精神分裂症患者，分别接受氯氮平合并利培本呼氯氮平治疗，疗程８周，用ＢＰＲＳ，ＳＡＮＳ，ＳＡＰＳ，ＴＥＳＳ评定疗效和副反应。结果 氯氮平合并利培酮组在治疗后４周、８周ＳＡＮＳ评分较治疗前均有显著差异（Ｐ〈０．０１）；氯氮平组在治疗后８周ＳＡＮＳ评分与治疗前比较也有显著差异（Ｐ〈０．０５）。两组在治疗后４周、８周时     

精神分裂症d－芬氟拉明激发的神经内分泌反应与临床症状的关系

目的探讨ｄ－芬氟拉明（ｄ－ＦＦ）激发的神经内分泌反应与精神分裂症临床症状的关系。方法把１５例精神分裂症患者在氯氮平治疗前、后行ｄ－ＦＦ激发试验，同时以简明精神病评定量表（ＢＰＲＳ）、阳性症状量表（ＳＡＰＳ）、阴性症状量表（ＳＡＮＳ）评定精神症状。结果混合型患者治疗前基础皮质醇（ＣＯＲ）值、治疗后ｄ－ＦＦ激发的ＣＯＲ值及治疗前、后ｄ－ＦＦ激发的催乳素（ＰＲＬ）值均显著高于阳性型。症状评分与激素反应有一定的相关关系。结论提示精神分裂症的发生可能与中枢５－羟色胺／多巴胺（５－ＨＴ／ＤＡ）功能失平衡有关。     

首发精神分裂症的认知功能与阴,阳性症状和抗精神病药物效应的关系

目的 探讨首发精神分裂症认知功能与阴、阳性症状和抗精神病药物效应的关系。方法 对７８例精神分裂症患者给予氯丙嗪或氯氮平治疗,于治疗前及治疗１２周末各作一次Ｗｉｓｃｏｎｓｉｎ卡片分类测验（ＷＣＳＴ）、韦氏成人智力量表（ＷＡＩＳＲ）、韦氏记忆量表（ＷＭＳ）、语言流利性测验等。另外,４５例正常人也做了上述测验。结果 首发精神分裂症患者存在广泛的认知功能障碍,上述则查结果均较正常对照组差,尤以ＷＣＳＴ明显     

以阴性症状为主的精神分裂症患者认知功能与局部脑血流的 …

目的 动态观察药物对局部脑血流量（ｒＣＢＦ）的影响,探索以阴性症状为主的精神分裂症患者潜隐的局部脑功能异常。方法 对２１例符合Ａｎｄｒｅａｓｏｎ阴性精神分裂症标准的患者（以下简称患者组）于氯氮平治疗前后进行威斯康星卡片分类测验（ＷＣＳＴ）和单光子发射计算机断层扫描（ＳＰＥＣＴ）检查,以４０名正常人为对照组（其中２８名为ＷＣＳＴ对照组,１２名为ＳＰＥＣＴ对照组）。结果 患者组氯氮平治疗前后ＷＣＳＴ的     

氯氮平治疗难治性精神分裂症的效能及相关因素

为探讨氯氮平（ＣＬＺ）治疗难治性精神分裂症的效能及相关因素，将符合研究标准的患者共４９例进行为期６周ＣＬＺ治疗。结果显示，ＣＬＺ起效快，不仅对阳性症状有效，对阴性症状也有效。对可能影响ＣＬＺ疗效的因素进行多元回归分析发现，如下因素依次对疗效产生积极的影响：（１）治疗前简明精神病评定量表的焦虑抑郁因子分高；（２）治疗前阴性症状量表的注意障碍因子分高而思维贫乏因子分低；（３）治疗前阳性症状量表的阳性思维障碍因子分低；（４）本次治疗前的住院次数少；（５）家族史阴性；（６）首次住院年龄大。提示氯氮平对难治性精神分裂症不失为有效和相对安全的药物。     

Clozapine augmented with risperidone in the treatment of schizophrenia: a randomized, double-blind, placebo-controlled trial

OBJECTIVE: The authors evaluated the efficacy and safety of augmenting clozapine with risperidone in patients with treatment-resistant schizophrenia. METHOD: In a randomized, double-blind, placebo-controlled 12-week trial, 40 patients unresponsive or partially responsive to clozapine monotherapy received a steady dose of clozapine combined with either placebo (N=20) or up to 6 mg/day of risperidone (N=20). Patient psychopathology was assessed at 2-week intervals with the Brief Psychiatric Rating Scale (BPRS) and the Scale for the Assessment of Negative Symptoms (SANS), among other measures. Movement disorders were assessed with the Simpson-Angus Rating Scale. RESULTS: From baseline to week 6 and week 12, mean BPRS total and positive symptom subscale scores were reduced significantly in both groups, but the reductions were significantly greater with clozapine/risperidone treatment. Reductions in SANS scores were also significantly greater with clozapine/risperidone treatment than with clozapine/placebo. The adverse event profile for clozapine/risperidone treatment was similar to that for clozapine/placebo. Simpson-Angus Rating Scale scores were lower with clozapine/risperidone treatment throughout the trial but increased to approach those of clozapine/placebo treatment at week 12. Clozapine/risperidone treatment did not induce additional weight gain, agranulocytosis, or seizures compared with clozapine/placebo treatment. CONCLUSIONS: In patients with a suboptimal response to clozapine, the addition of risperidone improved overall symptoms and positive and negative symptoms of schizophrenia. The combination appears to be safe and well tolerated. Augmentation of clozapine with risperidone may provide additional clinical benefit for patients who are nonresponsive or only partially responsive to clozapine alone.     

Lithium addition to neuroleptic treatment in chronic schizophrenia: a randomized,double-blind,placebo-controlled,cross-over study

We studied the effect of lithium addition to neuroleptic treatment in chronic schizophrenia, for which contradictory results have been produced in previous studies. Twenty-one chronic schizophrenic inpatients received lithium in a study with randomized, double-blind, placebo-controlled, cross-over design consisting of 8 weeks each of treatment with lithium capsules and identical placebo capsules. The total Brief Psychiatric Rating Scale (BPRS) scores at week 8 of the lithium treatment were improved significantly compared with those at week 8 of the placebo treatment. Of the BPRS subscales, however, only anxiety-depression improved, whereas none of the subscales for anergia, thought disturbance, activation and hostile-suspiciousness improved. There was no significant difference between the total Scale for the Assessment of Negative Symptoms (SANS) scores at any time during lithium and placebo treatment. These results suggest that the addition of lithium to neuroleptic treatment improves anxiety-depression in chronic schizophrenia.     

文拉法辛联合氯氮平治疗精神分裂症阴性症状的疗效

目的 观察文拉法辛缓释片合并氯氮平治疗精神分裂症阴性症状的疗效和不良反应.方法 采用单纯随机化法,将107例精神分裂症患者分为研究组（文拉法辛缓释片＋氯氮平）和对照组（氯氮平＋安慰剂）.于治疗前、治疗第2、4、8周末以阳性和阴性症状量表（PANSS）和阴性症状量表（SANS）评定疗效,于治疗第2、4、8周末以药物副反应量表（TESS）评定不良反应.结果 治疗4、8周末,研究组PANSS总分和阴性因子分与对照组比较,差异有统计学意义（P〈0.05）;研究组SANS总分和部分因子分与对照组比较,差异有统计学意义（P〈0.05）.治疗后第2、4、8周末,研究组TESS评分均明显低于对照组,差异有统计学意义（P〈0.05）.结论 文拉法辛缓释片治疗精神分裂症安全有效,协同氯氮平治疗精神分裂症阴性症状可增加疗效.     

万拉法新与氯丙咪嗪治疗精神分裂症后抑郁对照研究

目的 验证万拉法新治疗精神分裂症后抑郁的疗效及安全性。方法 对65例精神分裂症后抑郁患者随机入组,分别以万拉法新与氯丙咪嗪治疗6周。采用汉密尔顿抑郁量表(HAMD)、简明精神病量表(BPRS)、阴性症状量表(SANS)评定临床疗效,采用副反应量表(TESS)评定副反应。结果 万拉法新组与氯丙咪嗪组治疗前后HAMD、BRPS、SANS评分及减分率比较均无显著性差异(P>0.05)。万拉法新组的副反应较氯丙咪嗪组少而轻,但各有1例精神病症状恶化。结论 万拉法新治疗精神分裂症后抑郁的疗效确切,但极个别病例精神病症状恶化。     

奎的平与氯氮平治疗以阴性症状为主的精神分裂症对照研究

目的　比较奎的平与氯氮平对以阴性症状为主的精神分裂症的疗效和副反应。方法　对 72例以阴性症状为主的精神分裂症住院患者 ,随机分别用奎的平与氯氮平治疗 ,疗程 12周 ;于治疗前及治疗后 1、2、4、8、12周末用阴性症状量表 (SANS)、简明精神病量表 (BPRS)评定临床疗效 ,用副反应量表 (TESS)评定药物副反应。结果　奎的平组与氮氮平组治疗前后SANS、BPRS总分及减分比较差异无显著性 (P >0 0 5 ) ,各组治疗后SANS、BPRS总分与治疗前比较差异有极显著性 (P <0 0 1) ,奎的平在兴趣社交缺乏因子方面的疗效优于氯氮平 (P <0 0 5 ) ;奎的平组的副反应较氯氮平组少而轻。结论　奎的平对以阴性症状为主的精神分裂症有肯定的疗效 ,在某些方面优于氯氮平 ,安全性较高     

氯氮平和利培酮治疗精神分裂症患者比较研究

目的 评价氯氮平和利培酮治疗精神分裂症的疗效和副作用。方法 将40例精神分裂症患者随机分为氯氮平组和利培酮组(氯氮平组20例,利培酮组20例),于治疗前和治疗12周末各作一次韦氏成人智力量表、韦氏记忆量表、威斯康星卡片分类测验、言语流利性测验、连线测验A、简明精神症状评定量表(BPRS)、TESS副反应量表。结果 治疗12周末氯氮平组显著改善BPRS评分,利培酮组显著改善迟滞、思维障碍、敌对猜疑因子分,但氯氮平组较利培酮组敌对猜疑因子分减分率高。两组之间副反应评分有显著性差异,利培酮组明显低于氯氮平组,其余各项无显著性差异。结论 氯氮平较利培酮治疗敌对猜疑效果好,但利培酮较氯氮平副作用小,安全性较高。     

One year outcome in first episode schizophrenia

The aim of this study was to identify the predictors of outcome at one year follow-up after the first psychotic episode of schizophrenia. Seventy-nine first-episode schizophrenia patients were assessed monthly with the Brief Psychiatric Rating Scale (BPRS), Scale for Assessment of Positive Symptoms (SAPS), and Scale for Assessment of Negative Symptoms (SANS) after discharge from their first hospitalization. Outcome measures were presence of relapse and rehospitalization, level of global functioning, employment status and severity of symptoms at one year. A total of 33% of the patients had a relapse, and 12.1% were rehospitalized during one year follow-up. Premorbid childhood functionality was worse in patients who had relapse, but there was no correlation between premorbid adjustment scores and BPRS, SANS and SAPS scores at one year. There was no difference in duration of untreated psychosis (DUP) between patients who had relapse and not; however, the patients who had double relapse, had longer DUP than those without relapse. The time period between discharge and rehospitalization was shorter in patients with longer DUP. Functionality in childhood and noncompliance to the treatment independently contributed to the relapse rate. Functionality in late adolescence independently contributed to the Global Assessment of Functioning (GAF) scale score at one year and the GAF score at discharge appeared as a predictor of employment. The results of the present study suggest that treatment compliance and early premorbid adjustment level seem to be important predictors of relapse rate in first episode schizophrenia.     

The relationship of clozapine and haloperidol treatment response to prefrontal,hippocampal, and caudate brain volumes

OBJECTIVE: The study was designed to assess the predictive relationship between brain structure volume and positive and negative symptom response to clozapine and haloperidol. METHOD: Partially responsive outpatients with schizophrenia who participated in a 10-week, parallel-group, double-blind comparison of clozapine and haloperidol and who had an available magnetic resonance imaging scan were included in the current study. Prefrontal gray and white matter, hippocampal, and caudate volumes were manually measured. The Scale for the Assessment of Negative Symptoms (SANS) and the Brief Psychiatric Rating Scale (BPRS) were used to assess symptom changes. The Simpson-Angus Rating Scale was used to assess extrapyramidal symptoms. RESULTS: Twenty-two patients randomly assigned to clozapine and 23 patients assigned to haloperidol met study entry criteria. There were significant interactions between treatment and right prefrontal gray matter volume for BPRS total score and SANS total score. There were no significant treatment-by-brain structure interactions for BPRS positive symptom items. Right prefrontal gray matter volume was also related to differential treatment effects for the BPRS subscales of anxiety/depression and hostility and the Simpson-Angus Rating Scale akathisia item. CONCLUSIONS: These results suggest that there is a differential interaction among clozapine and haloperidol, brain structure, and treatment response. Partially responsive patients with larger brain volumes may be more likely to experience the benefits of clozapine treatment, but they may be more vulnerable to side effects and experience a subsequent worsening of their symptoms when treated with haloperidol.     

Stability of positive and negative symptom constructs during neuroleptic treatment in schizophrenia.

To assess the structural stability of positive and negative symptom ratings, we rated 40 schizophrenic inpatients on the Brief Psychiatric Rating Scale (BPRS) and the Scale for the Assessment of Negative Symptoms (SANS) at medication-free baseline and after 4 weeks of neuroleptic treatment. Positive symptom variables consisted of six BPRS items, and the negative symptom variables consisted of the five SANS subscale global scores. On principal components analysis, a three-factor, oblique-rotated solution resulted, with a negative symptom factor, a positive symptom factor, and an unstable behavioral agitation factor. The pre- and posttreatment factor loading patterns were similar. The findings suggest that BPRS-positive symptom items and the SANS measure distinct clinical dimensions and that the construct is stable, as demonstrated by minimal structural change with time.