长期服用抗精神病药的男性精神分裂症患者骨密度与血清泌乳素的关系

目的:探讨长期服用抗精神病药的男性精神分裂症患者骨密度与血清泌乳素水平(PRL)的关系。方法:将98例长期住院的男性精神分裂症患者按照PRL水平分为PRL升高组(390 m IU/L,66例)和PRL正常组(86~390 m IU/L,32例),测定两组患者的足后跟骨密度T值,并对两组结果进行分析比较。结果:与PRL正常组相比较,PRL升高组骨密度T值明显偏低(t=3.58,P=0.00)。控制年龄因素后,骨密度T值与PRL水平呈负相关(r=-0.101,P=0.043);与体质量指数呈正相关(r=0.199,P=0.012);与病程无显著相关(r=-0.066,P=0.414)。结论:长期服用抗精神病药的男性精神分裂症患者的骨密度与PRL水平呈负相关。     

抗精神病药对男性精神分裂症患者性功能影响的相关性分析

目的 探讨抗精神病药喹硫平、利培酮、氯丙嗪及氯氮平对男性精神分裂症患者性功能影响的差异及相关因素分析.方法 将门诊就诊的男性精神分裂症患者120例,随机分为喹硫平组38例、利培酮组41例、氯丙嗪39例、氯氮平组42例.应用酶联免疫吸附法检测血清泌乳素、放射免疫法检测睾酮水平,检测各组患者治疗前及治疗第12周末的血清泌乳素(PRL)和睾酮水平.分别于基线及治疗第12周末使用简明男性性功能量表、阳性与阴性症状量表(PANSS)评估性功能及精神症状,于治疗第12周末用副反应量表(TESS)评估药物治疗的不良反应.结果 治疗第12周末,利培酮组、氯丙嗪组、氯氮平组的性功能量表总分较治疗前降低(P＜0.05).利培酮组和氯丙嗪组治疗第12周末的血清泌乳素水平高于基线水平[利培酮组:(12±5)ng/ml,(22±6)ng/ml,t=13.92,P＜0.01;氯丙嗪组:(13±6)ng/ml,(19±5)ng/ml,t=8.27,P＜0.01],喹硫平组和氯氮平组无明显变化.利培酮组和氯丙嗪组治疗第12周末的血睾酮水平低于基线水平:利培酮组:(0.77±0.21)ng/ml,(0.27±0.11)ng/ml,t=13.22,P＜0.01;氯丙嗪组:(0.90±0.11)ng/ml,(0.32±0.14)ng/ml,t=11.27,P＜0.01;喹硫平组和氯氮平组无明显变化.影响男性精神分裂症患者性功能的因素有泌乳素、睾酮、年龄及TESS分.结论 抗精神病药物中,利培酮和氯丙嗪易引起血清泌乳素升高和血清睾酮降低,氯氮平具有较多药物不良反应,这些可能造成男性精神分裂症患者的性功能减退.     

首发吸烟精神分裂症患者血清神经元特异性烯醇化酶、认知功能及临床特征研究

目的 研究首发吸烟精神分裂症患者的血清神经元特异性烯醇化酶(NSE)水平、认知功能及临床特征,探索吸烟与精神分裂症的关系.方法 调查70例首发的男性精神分裂症患者的吸烟状况和临床资料,Fagerstrom尼古丁依赖量表(FTND)评定吸烟患者尼古丁依赖程度,词汇流畅、视觉再生、数字广度、连线试验A和B、威斯康星卡片分类测验(WCST)5项神经心理测验评测认知功能,化学发光法检测血清NSE水平.结果 ①首发男性精神分裂症患者吸烟率为57.14%(40/70),75%(30/40)吸烟患者在起病前已吸烟,吸烟患者的发病年龄(24.87±6.45)岁低于非吸烟患者(30.86±7.39)岁(t=3.54,P<0.01);②吸烟与非吸烟患者各认知功能比较无差异;③吸烟患者的血清NSE水平(17.57±8.70)ng/ml高于非吸烟患者(12.68±4.21)ng/ml(t=2.83,P<0.01),并与FTND分呈正相关(r=0.39,P=0.011).结论 吸烟可能是精神分裂症的环境易感因素之一.     

无抽搐电休克对精神分裂症患者血清脑源性神经营养因子的影响

目的探讨改良电抽搐治疗(MECT)对精神分裂症(SZ)患者血清脑源性神经营养因子(BDNF)的影响。方法采用酶联免疫吸附法对80例SZ患者(患者组)在MECT前后和77例正常人(正常组)进行血清BDNF水平检测,研究MECT对精神分裂症患者BDNF水平的影响。结果 MECT前,患者组血清BDNF水平[(9.7±2.1)ng/ml]显著低于正常组[(12.4±3.2)ng/ml](t=6.2,P0.01)。MECT后,患者组血清BDNF水平[(11.9±3.3)ng/ml]显著升高,与MECT前比较有显著差异(t=-4.8,P0.01),与正常组无显著差异(t=0.9,P0.05)。结论 SZ患者可能存在血清BDNF水平低下,MECT可以提高患者血清BDNF水平。     

精神分裂症患者改良电休克治疗前后血清胶质源性神经营养因子水平的变化

目的:探讨改良电休克治疗(MECT)对精神分裂症(SZ)患者血清胶质源性神经营养因子(GDNF)水平的影响。方法:采用酶联免疫吸附法,对48名正常人(对照组)和70例SZ患者(患者组)在MECT前后进行血清GDNF水平检测。结果:MECT前,患者组血清GDNF水平[(34.98±20.36)ng/ml]显著低于对照组[(78.23±40.57)ng/ml](t=6.821,P0.001)。MECT后,患者组血清GDNF水平[(79.88±36.10)ng/ml]显著升高,与MECT前比较有显著差异(t=-10.64,P0.01),与对照组差异无统计学意义(t=-0.232,P0.05)。结论:SZ患者可能存在血清GDNF水平低下,MECT可能通过提高GDNF水平起作用。     

非典型抗精神病药对男性精神分裂症患者性功能影响的初步分析

目的 探讨喹硫平、利培酮、奥氮平及氯氮平对男性精神分裂症患者性功能影响的差异.方法 将门诊就诊的男性精神分裂症患者145例,分为喹硫平组 30 例、利培酮组 47 例、奥氮平组 31 例及氯氮平组 37 例.检测各组患者血清泌乳素水平.使用简明男性性功能量表、阳性与阴性综合征量表(PANSS)评估性功能及精神症状,用副反应量表(TESS)评估药物治疗的不良反应.共观察8周.结果 治疗第 8 周末,利培酮组的性功能量表总分及因子分均较治疗前降低,奥氮平组的性唤起因子及性功能因子得分有所下降,氯氮平组的性满意度因子及性功能因子得分有所下降.喹硫平组得分无明显变化.利培酮组和奥氮平组治疗第 8 周末的血清泌乳素水平高于基线水平[利培酮组:(12±5)ng/ml,(20±6)ng/ml,t=13.92,P＜0.01;奥氮平组:(13±6)ng/ml,(18±5)ng/ml,t=8.27,P＜0.01],喹硫平组和氯氮平组无明显变化.影响男性精神分裂症患者性功能的因素有泌乳素、年龄及TESS分.结论 常见非典型抗精神病药物对男性精神分裂症患者的性功能影响有所不同.     

吸烟的首发精神分裂症患者脑源性神经营养因子与精神症状认知功能关系的对照研究

目的探讨吸烟与非吸烟首发精神分裂症患者临床症状、认知功能与BDNF的相关性。方法符合美国精神障碍诊断与统计手册第四版(DSM-Ⅳ)诊断标准的首发精神分裂症住院患者81例,其中吸烟27例,非吸烟54例。采用阳性和阴性症状量表(PANSS)、威斯康星卡片分类(WCST)、重复性神经心理测查系统(RBANS)评估精神症状和认知功能,采用酶联免疫吸附法检测血清BDNF水平。结果吸烟组PANSS总分、阴性症状分、一般精神病理症状分均高于非吸烟组(t=2.5,2.0,2.0,P均0.05),吸烟组的正确应答数显著高于非吸烟组,吸烟组错误应答数显著低于非吸烟组(t=2.02,-2.26,P均0.05)。吸烟组患者血清BDNF水平为(8.8±4.6)μg/L,非吸烟组为(9.2±4.3)μg/L,两组比较差异不显著,无统计学意义(t=0.38,υ=83,P0.05);吸烟患者BDNF与患者总病程、PANSS总分、一般精神病理症状分呈显著正相关(r=0.66,0.54,0.54,P均0.05);与RBANS词汇回忆、故事回忆、图形回忆、编码测验分值、延时记忆因子呈显著负相关(r=-0.48,-0.45,-0.45,-0.53,P均≤0.05);非吸烟患者BDNF与PANSS中阳性症状分呈显著正相关(r=0.27,P0.05)。结论吸烟精神分裂症患者BDNF水平与精神症状可能存在相关性。     

男性慢性精神分裂症患者骨密度与性激素的相关研究

目的:探讨长期住院治疗的男性慢性精神分裂症患者的骨密度及性激素水平以及相关影响因素。方法:对63例长期住院的男性精神分裂症患者(患者组)和53名正常男性(正常对照组)采用定量CT检测其骨密度水平,采用化学发光法检测血清泌乳素、雌二醇和睾酮水平,并对两组检测结果进行分析比较。结果:与正常对照组相比,患者组骨质疏松发生率(χ2=14.941)、泌乳素水平(Z=-9.253)较正常对照组升高(P均0.001);骨密度(t=3.923)及雌二醇水平(Z=-7.872)较正常对照组降低(P均0.001);睾酮水平组间比较差异无统计学意义(P0.05)。Pearson相关分析显示两组骨密度水平与泌乳素水平显著负相关(r=-0.367,r=-0.725;P0.01)。结论:长期住院的男性慢性精神分裂症患者的骨密度及雌二醇水平明显降低,泌乳素水平明显升高;骨密度水平与泌乳素水平显著相关。     

抗精神病药物对龋齿发生的危险因素的影响分析

目的比较长期服用抗精神病药的住院精神分裂症患者(简称服药人群)和健康人群的龋齿发生因素如唾液氟离子浓度(F-浓度)、唾液流速以及唾液p H值的差异,研究服药人群龋病高发的主要影响因素,探讨早期干预龋病的措施。方法采用病例对照的研究方法,服药组80例为2012年5月-2013年10月在上海市杨浦区精神卫生中心住院的符合《国际疾病分类(第10版)》(ICD-10)诊断标准的精神分裂症患者,对照组40例为普通健康人群。收集并测定其唾液F-浓度、流速以及p H值。运用独立样本t检验,非参数检验Spearman相关分析进行分析。结果 1服药组唾液F-浓度(1.86±2.23)mmol/L低于对照组(4.40±6.27)mmol/L;服药组唾液流速(1.46±0.97)ml/min低于对照组(1.99±0.51)ml/min;服药组p H值(6.30±0.39)低于对照组(7.09±0.34),差异均有统计学意义(P均0.05)。2服药组和对照组唾液之流速和p H值均呈正相关(r=0.459,P0.05);服药组和对照组唾液流速和F-浓度呈负相关(r=-0.415,P0.05);唾液p H值和F-浓度呈负相关(r=-0.496,P0.05)。结论服药人群中较低的唾液F-浓度、唾液流速以及唾液p H值可能是该人群龋齿高发的主要影响因素,其中唾液流速与F-浓度是需重点干预的环节。     

长期住院男性精神分裂症患者睾酮水平与认知功能的关系

目的探讨男性长期住院精神分裂症患者血清总睾酮水平与认知功能的关系。方法使用化学发光免疫分析仪检测80例长期住院男性精神分裂症患者和40例对照的血清总睾酮水平。通过数字划销(DCT)、范畴流畅、空间广度(SS)、连线A、木块图、连续定步调听觉测验检测患者组的认知功能。结果血清总睾酮水平与DCT呈显著正相关(r=0.261,P0.05),与SS呈显著负相关(r=-0.240,P0.05)。向后法回归分析在剔除其他影响因素后仍然发现血清总睾酮水平可以显著预测患者在DCT(β=0.240,P=0.028)和SS(β=-0.207,P=0.047)上的表现。结论男性长期住院精神分裂症患者血清总睾酮水平升高时,反映空间记忆和注意方面的认知功能反而下降。     

Mental illness in England,in Scotland and in Scots living in England

Summary Beginning from the observation that Scots living in England have much higher rates of mental hospital admission than do the English, several hypotheses are proposed to account for this. Much of the excess in rates of mental illness is accounted for by those diagnosed as having alcohol-related disorders and behaviour and personality problems. The results of an examination of offical statistics in the two countries enabled some explanations to be offered. It was found that rates of admissions to mental hospitals are higher in Scotland than in England but not as high as those found among Scots migrants who have a much higher rate of readmission to hospitals than either of the other groups. In fact, if first admissions only are considered the rates of admission in Scotland are not only higher than rates for English natives but also higher than for Scottish migrants. It seems that Scots living in England are somewhat less likely to become mental patients than Scots in Scotland but that once they do achieve this status they are very much more likely to be readmitted on subsequent occasions. It was concluded that there might be two fairly distinct groups of migrants from Scotland to England who have different backgrounds, different reasons for migrating and different psychological characteristics. On the one hand there are stable, economically motivated migrants who move south for definite employment related reasons and who show few psychological symptoms. While on the other hand there is a group of migrants who perhaps have psychological problems and who move more in hope than expectation without definite prospects and who account for the high rates of mental hospital admission found in Scottish migrants.     

Prostacyclin release in the coronary circulation during sustained stimulation in in vitro and in in vivo experimental systems

Prostacyclin release from rat isolated perfused hearts and from dog coronary circulation was studied by measuring immunoreactive 6-keto-PGF1 alpha (6-keto-PGF1a) in heart perfusate and in plasma obtained from the great cardiac vein respectively. Continuous infusion of arachidonic acid at constant concentration in isolated perfused hearts induced an increased prostacyclin release. This release showed a rapid peak within 10 min and a subsequent decrease. Low-flow ischemia induced an increased perfusate concentration of 6-keto-PGF1a but, considering the decreased flow, prostacyclin release was actually reduced. During the whole period of ischemia (60 min) prostacyclin release was constant. In open-chest anesthetized dogs 6-keto-PGF1a concentration in the great cardiac vein was increased after ligation of the left anterior descending coronary artery. A prolonged period of coronary occlusion (4.5 hours) resulted in a progressive rise of prostacyclin release. 6-keto-PGF1a determinations in the femoral vein and in the aorta did not show relevant variations during the observation period.     

癫痫与抑郁关系的研究进展

抑郁是癫痫患者中常见的精神障碍,严重地影响了患者的生活质量。传统的观点认为癫痫患者因为存在着诸多社会学问题易出现抑郁倾向,癫痫和抑郁是单向的联系,但大量的研究已经证明癫痫和抑郁之间存在双向的联系,一种异常状态的存在可能易转化为另一种异常状态的发展。癫痫和抑郁存在着共同的发病机制。本文主要就癫痫和抑郁的双向联系以及抗抑郁药物在癫痫患者中的应用进行阐述。     

神经介入：回眸2022

<正>2022年,国际上公布了多项大型神经介入领域的随机对照试验（randomized controlled trial,RCT）结果,在血管内治疗（endovascular treatment,EVT）急性大血管闭塞（large vessel occlusion,LVO）适应证的扩展、药物治疗、管理,症状性颅内动脉粥样硬化性狭窄（symptomatic intracranial atherosclerotic stenosis,sICAS）治疗,无症状性颈动脉狭窄治疗,     

Neuroimaging in epilepsy in tropics

Epilepsy is a major public health problem in many tropical countries. Also, some of the tropical diseases are major contributors to the higher prevalence of epilepsy in these countries. The etiologic factors responsible for epilepsy in these countries are quite different from those in the developed world. This article discusses the etiologic factors and neuroimaging of epilepsy in light of the conditions in these tropical countries.