氯硝西泮静点合并帕罗西汀治疗焦虑症的临床研究

目的 氯硝西泮静点合并帕罗西汀治疗焦虑症的疗效.方法 将100例焦虑症患者随机分为研究组和对照组,分别给予氯硝西泮静点合并帕罗西汀治疗及单纯帕罗西汀组治疗4周.用汉米尔顿焦虑表(HAMA)、治愈率、副反应量表(TESS)评定疗效.结果 研究组HAMA评分在治疗第2d明显低于对照组(P＜0.01),第7d、第15d HAMA评分差异逐渐缩小,4周后两组无显著差异.副反应发生率在第2d研究组较早出现,第7d减轻,15d,4周后二组无明显区别.结论 氯硝西泮静点合并帕罗西汀的治疗起效快,抗焦虑的效果明显.     

Risperidone Combined with Paroxetine in the Treatment of Treatment Resistant Depression.

目的 探讨利培酮合并帕罗西汀治疗难治性抑郁症的效果.方法 将56例难治性抑郁症患者随机分成两组,分别给予利培酮合并帕罗西汀(合用组)和单用帕罗西汀(单用组)治疗12周,以汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)评定临床疗效,以副反应量表(TESS)和相关检查评定不良反应.结果 治疗结束时两组HAMD和HAMA的评分均明显降低,以舍用组疗效显著且快(t=3.6688,3.8299;P＜0.01).结论 利培酮合并帕罗西汀治疗难治性抑郁症的疗效优于单用帕罗西汀,且耐受性好.     

认知应对疗法联合帕罗西汀治疗广泛性焦虑障碍的随机对照试验

目的:探讨认知应对治疗(CCT)联合帕罗西汀对广泛性焦虑障碍(GAD)的短期临床疗效、社会功能以及认知功能的影响。方法:选取符合美国精神障碍诊断统计手册第5版(DSM-5)诊断标准的70例GAD患者,按随机数字表法分为CCT联合帕罗西汀组35例(31例完成)、帕罗西汀组35例(32例完成)。两组患者分别在基线期以及治疗4周后完成焦虑自评量表(SAS)、汉密顿焦虑量表(HAMA)、社会功能缺陷量表(SDSS)评估、事件相关电位P300检查、MATRICS共识认知成套测验(MCCB)成套认知测验。结果:经过4周治疗后,CCT联合帕罗西汀组在SAS评分、HAMA评分、SDSS评分低于帕罗西汀组(P<0.05),P300波幅、MCCB评分注意/警觉性、推理解决问题能力、社会认知领域显著高于帕罗西汀组(P<0.05),CCT联合帕罗西汀组的总显效率(51.6%)显著高于帕罗西汀组(25%)。结论:认知应对治疗联合帕罗西汀对GAD患者的治疗在短期内起到增效或协同作用,能够有效提高患者的社会功能,对患者的认知功能具有一定的改善作用。     

帕罗西汀、劳拉西泮治疗广泛性焦虑症临床观察

目的:验证帕罗西汀与劳拉西泮治疗广泛性焦虑症的临床疗效及副反应.方法:采用随机分组的方法,将符合CCMD-3诊断标准的80例广泛性焦虑症分为帕罗西汀组(40例),劳拉西泮组(40例),疗程6周,用焦虑自评量表(SAS)、Hamilton焦虑量表(HAMA)和副反应量表(TESS)评定疗效和副反应.结果:帕罗西汀与劳拉西泮疗效相当,治疗第2、4、6周两组SAS、HAMA及HAMA因子分的减分比较差异有统计学显著性,副反应两药相当,帕罗西汀的主要副反应为口干、头疼、头晕和恶心.结果:帕罗西汀治疗广泛性焦虑症安全、有效,副反应轻微.     

中药联合帕罗西汀治疗广泛性焦虑障碍的临床疗效

目的研究加味甘麦大枣汤联合帕罗西汀治疗广泛性焦虑障碍的临床疗效。方法收集广泛性焦虑障碍患者80名,分别采用帕罗西汀(西医)、加味甘麦大枣汤联合帕罗西汀(中西医结合)治疗12周,治疗前后采用汉密尔顿焦虑量表(H am iltonA nx iety Scale,HAMA)进行疗效评估,采用副反应量表(T reatm en t Em ergen t Sym ptom Scale,TESS)评定药物不良反应。结果①治疗前西医组与中西医结合组HAMA量表评分无显著差异(P>0.05)。中西医结合组HAMA量表评分第2周、第4周、第8周、第12周末得分明显低于西医组,差异有统计学意义(P<0.05);②中西医结合组的显效性(94.7%)和有效性(97.4%)均高于西医组(分别为86.5%,91.9%);③两组不良反应轻微,差异无统计学意义(P>0.05)。结论加味甘麦大枣汤联合帕罗西汀治疗广泛性焦虑障碍优于单独使用帕罗西汀治疗,不良反应轻微。     

帕罗西汀合并加巴喷丁治疗躯体形式障碍对照研究

目的探讨帕罗西汀合并加巴喷丁治疗躯体形式障碍的疗效及安全性。方法 86例躯体形式障碍患者随机分为两组,研究组帕罗西汀合并加巴喷丁进行治疗,对照组单用帕罗西汀,疗程8周。治疗前及治疗后2、4、6、8周末分别应用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、症状自评量表(SCL-90)躯体化因子评定临床疗效,用副反应量表(TESS)评定不良反应。结果治疗后2、4、6、8周末研究组HAMD、HAMA、SCL-90躯体化因子评分与对照组有显著性差异(P0.01)。8周末研究组显效率76.74%,对照组显效率55.81%,研究组显效率高于对照组(χ2=4.214,P0.05)。不良反应均较轻,两组间比较无显著性差异。结论帕罗西汀合并加巴喷丁治疗躯体形式障碍的疗效优于单独应用帕罗西汀,且疗效出现较早,副作用无明显增加。     

认知行为疗法合并帕罗西汀治疗重度抑郁的对照研究

目的:评价认知行为疗法合并帕罗西汀治疗重度抑郁的疗效和安全性。方法:将符合国际疾病分类(ICD-10)重度抑郁发作诊断标准的66例患者随机分为两组,研究组(n=34)给予认知行为疗法合并帕罗西汀治疗,对照组(n=32)给予帕罗西汀治疗,疗程12周。于治疗前和治疗后2、4、6、8、12周采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、临床总体印象疗效总评量表病情严重程度(CGI-SI)、不良反应量表(TESS)评定疗效和不良反应。结果:治疗前研究组和对照组的HAMD、HAMA评分差异无统计学意义(t=-0.88,0.93;P0.05)。治疗12周后,两组HAMD、HAMA评分均低于治疗前(研究组t=40.26,-27.29;P均0.01;对照组t=19.11,70.85;P均0.01);研究组6、8、12周HAMD、HAMA评分均低于对照组(t=-2.82,-2.84,-3.41;P均0.05;t=-2.14,-3.01,-3.34;P均0.05);研究组有效率高于对照组(χ2=4.799,P0.05);研究组不良反应发生率低于对照组(χ2=4.855,P0.05)。结论:认知行为疗法合并帕罗西汀治疗重度抑郁疗效较好,安全性高。     

帕罗西汀合用劳拉西泮治疗广泛性焦虑的随机对照研究

目的 评价帕罗西汀治疗广泛性焦虑早期合用劳拉西泮的临床疗效和副反应.方法 采用随机对照法,对符合CCMD-3诊断标准的64例广泛性焦虑症进行随机入组,其中对照组32例,帕罗西汀治疗8周;研究组32例,帕罗西汀合用劳拉西泮治疗8周(其中劳拉西泮2～4周末停药).采用汉密顿焦虑量表(HAMA)、焦虑自评量表(SAS)和副反应量表(TESS)评定疗效和副反应.结果 研究组在1周末SAS和HAMA总分、SA因子分的减分比较差异有显著性(P＜0.05),治疗2、4、8周末SAS和HAMA总分、SA因子分、PA因子分较治疗前减分显著(P＜0.01);治疗8周末评定总体疗效两组相近,两组间副反应差异无显著性(P＞0.05),主要副反应为口干、头晕或头痛、恶心或食欲下降、嗜睡、乏力.结论 帕罗西汀治疗广泛性焦虑早期合用劳拉西泮症状改善早、起效快、依从性好.     

度洛西汀与帕罗西汀治疗首诊广泛性焦虑症的对照研究

目的探讨度洛西汀与帕罗西汀治疗首诊广泛性焦虑症的临床疗效、安全性。方法将首诊的广泛性焦虑症患者随机分为两组,研究组口服度洛西汀治疗,对照组口服帕罗西汀治疗,观察8周疗效。于治疗前及治疗1周、2周、4周、8周末采用汉密尔顿焦虑量表(HAMA)和焦虑自评量表(SAS)评定临床疗效,副反应量表(TESS)评定不良反应。结果两组治疗8周末总有效率分别为度洛西汀组89.8%、帕罗西汀组87.2%。治疗1周末两组汉密尔顿焦虑量表总分均较治疗前有显著下降(P0.05或0.01),但研究组较对照组下降更显著(P0.05),随治疗时间的延续评分均呈持续性下降;两组治疗后汉密尔顿焦虑量表、焦虑自评量表总分均较治疗前有显著下降(P0.01);服药初期帕罗西汀不良反应较度洛西汀明显严重,影响治疗的依从性。结论度洛西汀治疗广泛性焦虑疗效与帕罗西汀相当,起效更快,安全性、依从性方面优于帕罗西汀。     

针对性心理干预合并药物治疗对心脏神经症患者的疗效研究

目的 比较针对性心理干预合并药物治疗与单一药物治疗对心脏神经症患者的临床疗效及安全性.方法 将54例心脏神经症患者随机分为研究组和对照组各27例,对照组采用单一药物治疗,研究组在此基础上针对症状特点开展针对性心理干预.使用汉密尔顿焦虑量表(HAMA),汉密尔顿抑郁量表(HAMD)和副反应量表(TESS)于治疗初和治疗后2,4,6,8,12周进行临床疗效及安全性评定对比.结果 与治疗前比较对照组第6周HAMA、HAMD出现改善(t=2.31,P＜0.05;t=5.24,P＜0.01),研究组则在第2周出现明显改善(t=2.33,P＜0.05;t=6.35,P＜0.01),并且治疗各周改善程度明显优于对照组(t=3.17,4.73,6.08,6.07,5.90;P＜0.01,t=5.70,15.32,14.81,14.55,15.10;P＜0.01);两组在治疗第2周开始TESS值均出现升高,对比无显著差异(t=0.47,P＞0.05),但研究组自第4周开始降低,而对照组继续升高,两组自第4周开始对比有明显差异(t=7.56,14.53,36.97,71.28;P＜0.01).结论 针对性心理干预合并药物治疗心脏神经症安全、快速、高效,优于单一药物治疗.     

Playing the genome card

Abstract

In the 1990s, prominent biologists and journalists predicted that by 2020 each of us would carry a genome card, which would allow physicians to access our entire genome sequence and routinely use this information to diagnose and treat common and debilitating conditions. This is not yet the case. Why not? Common and debilitating diseases are rarely caused by single-gene mutations, and this was recognized before these genome card predictions had been made. Debilitating conditions, including common psychiatric disorders, are typically caused either by rare mutations or by complex interactions of many genes, each having a small effect, and epigenetic, environmental, and microbial factors. In such cases, having a complete genome sequence may have limited utility in diagnosis and treatment. Genome sequencing technologies have transformed biological research in many ways, but had a much smaller effect than expected on treatments of common diseases. Thus, early proponents of genome sequencing effectively “mis-promised” its benefits. One reason may be that there are incentives for both biologists and journalists to tell simple stories, including the idea of relatively simple genetic causation of common, debilitating diseases. These incentives may have led to misleading predictions, which to some extent continue today. Although the Human Genome Project has facilitated biological research generally, the mis-promising of medical benefits, at least for treating common and debilitating disorders, could undermine support for scientific research over the long term.     

Mind the gap: Disclosure of dietary supplement use to hospital and family physicians

ObjectiveWe aim to compare patients’ perspectives on communication with their hospital physicians (HPs) and primary care physicians (PCPs) on patients' dietary and herbal supplements (DHS) use.MethodsWe conducted a cross-sectional prospective study among in-patients using structured questionnaires on DHS use. Multivariate logistic regression models assessed variables influencing doctor-related reasons for patients' nondisclosure of supplement use.ResultsOf 452 DHS users identified, 133 (29.4%) used herbs and 319 (70.6%) used non-herbal supplements. DHS users reported that PCPs were more aware of DHS consumption than HPs (70.1% vs. 34.1%, P < 0.0001). PCPs initiative to detect supplement use was higher compared with HPs (P < 0.0001). Doctor-related reasons for non-disclosure of DHS use were more prominent in a hospital setting. Multivariate logistic regression model suggested association between older patient age and doctor-related non-disclosure (p = 0.03). DHS use was recorded in only 33 patients medical files.ConclusionsDoctor-patient communication concerning DHS use is significantly poorer during hospitalization compared with primary-care settings. A significant barrier for in-hospital disclosure is doctor-related.Practice implicationsContinuity of care between community and hospital physicians regarding patients' DHS use should be improved due to the safety implications of such use. Educating physicians on DHS and improving communication could bridge this gap.     

血液密度测量及其在基础医学和临床中的应用

本文介绍了血液密度测量的主要方法及面临的主要问题 ,并详细讨论了血液密度测量技术在基础医学和临床中的应用     

Attitudes toward integration of complementary and alternative medicine in primary care: perspectives of patients, physicians and complementary practitioners

OBJECTIVE: Our study explored the attitudes of patients toward complementary and alternative medicine (CAM) use, their family physicians' role regarding CAM, and models for CAM referral and treatment. We compared patients' perspectives regarding integration of CAM into primary care with attitudes of primary care physicians (PCPs) and CAM practitioners. METHODS: We conducted a comprehensive literature review and focus group discussions to develop a questionnaire, which we gave to three groups: a random sample of patients receiving care at an academic family medicine clinic and PCPs and CAM practitioners employed in the largest health maintenance organization in Israel. RESULTS: A total of 1150 patients, 333 PCPs, and 241 CAM practitioners responded to our questionnaire. Compared with PCPs, patients expected their family physician to refer them to CAM, to have updated knowledge about CAM, and to offer CAM treatment in the clinic based on appropriate training. When asked about CAM integration into medical care, more patients expected to receive CAM in a primary care setting compared to PCPs' expectations of prescribing CAM (62% vs. 30%; p=0.0001). Patients, CAM practitioners, and PCPs expected family practitioners to generate CAM referrals in an integrative primary care setting (85.6% vs. 82.4% vs. 62.6%; p<0.0001). Patients supported CAM practitioners providing CAM treatments in the primary care setting, regardless of whether the practitioner held a medical degree (MD). Also, more patients than PCPs or CAM practitioners expected their family physician to provide CAM (28.2% vs. 14.5% vs. 3.8%; p<0.0001). CONCLUSION: Patients, PCPs, and CAM practitioners suggested that family physicians play a central role in CAM referral and, to a lesser extent, that they actually provide CAM treatment themselves. PRACTICE IMPLICATIONS: PCPs need to be aware of their present and future role in informed referral to CAM and, to a lesser degree, in providing CAM in integrative primary care clinics. With the increasing use of CAM, patients may expect their family physician to be more knowledgeable, skillful, and have a balanced approach regarding CAM use. In addition, practitioners should learn how to communicate effectively and better collaborate with CAM practitioners to the benefit of their patients.     

The Anatomical Record continues to replace wonder with knowledge through first-hand experience of acupuncture

A group of original papers is assembled for this thematic-papers issue on traditional Chinese medicine (TCM). The idea for a thematic-papers issue came from Associate Editor and Guest Editor, Jicheng Li. Jicheng's idea was to introduce concepts and studies of TCM to the editorial board of The Anatomical Record and the Journal's readership. Thus, nine papers are published that deal with biomarkers, animal models, or treatments of TCM syndromes. Uniquely, Jicheng's effort culminated in acupuncture treatment of the editorial board members by a licensed physician of TCM. We learned, first-hand by Dr. Weixue Wang, about this ancient and vibrant holistic philosophy and medical practice. Our pleasure is to share the topic and our experience with you.     

躁狂症中西医结合辩证分型治疗对照观察

目的　观察躁狂症的中西医结合辩证分型治疗的疗效。方法　随机将符合 CCMD— 2— R的躁狂症 1 2 8例分为两组 ,中西医结合治疗组 6 5例 (为 A组 )用龙胆泻肝汤加中小剂量碳酸锂治疗。单纯碳酸锂治疗组为对照组 6 3例 (为 B组 )。用 BRMS,CGI-S量表观察 4周的疗效 ,TESS量表观察副反应。结果　 2周后两组 BRMS减分率分别为 4 7.5 3% ,2 7.36 %。 4周后两组减分率分别为 75 % ,5 5 .6 1 % ( t=2 .35 ,P<0 .0 5 )均有显著差异。 4周末 TESS量表分值比治疗第一周A组较明显小于 B组 ( χ2 =3.95 ,P<0 .0 1 )。结论　中西医结合辩证分型治疗躁狂症的疗效快而好 ,副反应少 ,值得推广     

Modeling an integrative oncology program within a community-centered oncology service in Israel

Objective

Describing the processes that preceded the opening of an integrative oncology program (IOP) within the oncology service (OS) of the largest health maintenance organization in northern Israel.

Methods

The groundwork towards initiation of the IOP was based on three key elements (1) Interviews with patients, practitioners and directors were performed in order to explore perspectives regarding complementary medicine integration (CM) within the OS; (2) review of research data on CM efficacy and safety in cancer care; (3) critical comparative analysis of seven models of IOPs in Israel, Europe, and the U.S.

Results

Ninety-three interviews included 24 patients, 34 conventional practitioners, 9 medical directors, and 26 CM-trained practitioners. The interviews revealed that there is a need for CM in the OS, aimed towards improving patients’ well-being during chemotherapy and advanced disease. An integrative oncology score (IOS) was formulated based on 6 themes considered promoters of successful integration.

Conclusions

Integration of CM within an oncology service should address patients’ needs and research knowledge and be built upon mandatory practitioners’ communication.

Practice implications

IOP modeling necessitates in-depth study aimed at revealing the OS needs and expectations, adjusting research data to the OS clinical challenges, and tailoring an appropriate model of integrative care.