精神分裂症与染色体22q11的连锁不平衡研究

目的 探讨染色体22q11泛有素融合降解1型蛋白基因(UFD1L)和腭心面综合征缺失的核定位信号基因(NLVCF)多态性与精神分裂症的关系。方法 在138例吉林省汉族精神分裂症患者及其健康父母双亲的核心家系中，以聚合酶链反应(PCR)和限制性片段长度多态(RFLP)方法对UFDlL基因rs1547931(G／C碱基改变)和NLVCF基因rs1473109(C／T碱基改变)单核苷酸多态性(SNPs)进行检测。应用基于家系的连锁不平衡方法，包括单体型相对风险分析(HRR)，传递不平衡检验(TDT)及Transmit双位点单体型分析，分析基因型数据。结果 (1)HRR显示UFDlL基因rs1547931与精神分裂症有关联(χ^2=4．260，ν=1，P=0．039)，NLVCF基因rs1473109与精神分裂症无关联；(2)TDT显示UFDlL基因rs1547931与精神分裂症有连锁和关联(χ^2=5．333，ν=1，P=0．021)，NLVCF基因rs1473109与精神分裂症无连锁及关联；(3)Transmit双位点单体型分析显示rs1547931-rs1473109单体型与精神分裂症有关联(χ^2=9．723，ν=3，P=0．021)，rs1547931(C)-rs1473109(T)单体型与精神分裂症呈负相关(χ^2=6．607，ν=1，P=0．01)。结论 精神分裂症患者UFD1L基因本身或其附近的基因可能与精神分裂症的易感性相关。     

硫氧还原蛋白结合蛋白基因多态性与精神分裂症的关联分析

目的探索硫氧还原蛋白结合蛋白（TXNIP）基因与精神分裂症的关联关系。方法以182个精神分裂症核心家系为研究对象，应用聚合酶链反应和限制性片段长度多态性技术（PCR-RFLP）对TXNIP基因标签单核苷酸多态性（htSNP）rs9245进行基因分型；使用传递不平衡（TDT）、基于单体型的单体型相对危险度分析（HHRR）检测TXNIP基因与精神分裂症之间的关联关系。结果①患者组、父母组htSNP rs9245位点各基因型的分布均符合Hardy-Weinberg平衡法则（矿值分别为0．68，0．02，df=1，P〉0．05）；②单体型相对风险分析（HHRR）显示htSNP rs9245位点等位基因在患者组和父母组的频数分布为χ^2=3．42，P=0．064；③传递不平衡检验（TDT）分析显示，杂合子父母传递给受累子女与非传递等位基因频率分布为χ^2=3．40，P=0．065，虽然差异未达到显著性，但接近边缘显著性。结论本研究虽未发现TXNIP基因htSNP rs9245与精神分裂症的发生存在关联，但不能排除两者的阳性关联，尚需选择更多SNP及扩大样本量进一步分析。     

肿瘤坏死因子基因与精神分裂症的传递不平衡研究

目的 探讨肿瘤坏死因子-α(TNF-α)基因和肿瘤坏死因子-β(TNF-β)基因与精神分裂症的关系.方法 收集172个广东潮汕地区的精神分裂症核心家系,将172例精神分裂症患者分为偏执型(96例)和非偏执型(76例),用聚合酶链反应-限制性片段长度多态性方法 ,检测所有研究对象的TNF-α的3个多态性位点(-C863A、-G308A、-G238A)和TNF-β+A252G位点的等位基因频率和基因型频率,并进行传递不平衡检验(TDT).结果 (1)单位点TDT检验,TNF-β+A252G位点杂合子父母过多地传递等位基因G给患者(X2=5.49,Pc＜0.05),而TNF-α的3个多态性位点(-C863A、-G308A、-G238A)均未发现传递不平衡.(2)多位点联合进行单体型分析,未显示在精神分裂症核心家系中存在传递不平衡;但在96个偏执型精神分裂症核心家系中,有一种常见单体型[(-863C,-308G,-238G,+252G);X2=7.20,Pc＜0.05]存在偏向传递.结论 在广东潮汕人群中,TNF-α和TNF-β基因与精神分裂症可能存在某些关联,该基因可能是偏执型精神分裂症的易感基因.     

精神分裂症和心境障碍混合家系5-HTR 6基因多态性的关联分析

目的 在中国汉族人群精神分裂症和心境障碍混合家系中探讨五羟色胺6受体（5-HTR6）基因267C／T多态性与精神分裂症、心境障碍的关联性。方法 采用聚合酶链反应一限制性片断长度多态（PCR—RFLP）技术对67例精神病混合家系患者及其父母进行5-HTR6基因267C／T多态性检测,并予以传递不平衡检验（TDT）。结果 患者组与父母组之间,5-HTR6基因267C／T多态性等位基因分布（χ^2=2．70,v=1,P〉0．05）和基因型分布（χ^2=2．97,v=2,P〉0．05）无明显差异,5-HTR6基因267C／T多态性与精神分裂症（χ^2=5．16,P〈0．05）存在关联,但与心境障碍（χ^2=2．17,P〉0．05）无关联。结论 在中国汉族人群中5-HTR6基因或邻近基因可能是精神分裂症易患基因之一,但可能不是心境障碍的易患基因。     

隐花色素-1基因与精神分裂症核心家系的传递不平衡分析

目的探讨精神分裂症与隐花色素-1（Cryl）基因多态性的关联关系。方法应用聚合酶链反应和限制性片段长度多态性技术对100个精神分裂症核心家系的Cryl基因上的多态性位点rs2300448、rs1921135和rs1056560进行多态性检测；用Genehunter2．1软件包进行传递不平衡分析（TDT），并构建可能的单体型。结果（1）rs2300448多态性位点等位基因G和等位基因A传递给患病子女的频率差异有统计学意义，等位基因G优先传递给患病子女（X^2=4．92，P=0．027），但P值经Bonferroni校正后，差异无统计学意义（Pc=0．054）；rs1056560和rs1921135多态性位点未发现传递不平衡现象（X^2=0．15，P=0．698；X^2=0．56，P=0．456）。（2）单体型rs2300448-rs1056560G—A（X^2=6．76，P=0．009）、rs1921135-rs2300448-rs1056560T—G—C（X^2=4．50，P=0．034）和C—G—A（X^2=6．37，P=0．012）存在传递不平衡现象，但P值经Bonferroni校正后，T—G—C和C—G—A差异均无统计学意义（Pc〉0．05），只有单体型rs2300448-rs1056560G—A差异有统计学意义（Pc=0．036）。结论Cry1基因可能与精神分裂症相关联。     

汉族核心家系中强迫症与儿茶酚胺氧位甲基转移酶和单胺氧化酶基因多态性的关联分析

目的 分析儿茶酚胺氧位甲基转移酶(catechol-O-methyltransferase,COMT)基因和单胺氧化酶(monoamine oxidases A, MAOA)基因T941G多态位点与汉族强迫症的关联.方法 应用特异性引物序列聚合酶链反应检测134个强迫症核心家系(患者及其生物学父母)的COMT基因val158met和MAOA基因T941G多态性.采用单体型相对危险度分析(haplotype relative risk,HRR)及传递不平衡检验(transmission disequilibrium test, TDT)进行关联分析.结果 112个和103个核心家系分别进入COMT基因和MAOA基因的TDT和HRR分析.TDT检测McNemar检验(P=0.15)及HRR检测( χ 2=3.58, P=0.06)均不支持COMT val158met多态位点存在传递不平衡; MAOA基因T941G位点的TDT( χ 2=4.78, P=0.04)及HRR分析显示存在传递不平衡( χ 2=7.63, P＜0.01),等位基因T较多地传给下一代(57.22%).结论 本研究提示MAOA基因T941G多态性在汉族人种中可能与强迫症关联,不支持COMT基因val158met多态性与强迫症关联.     

精神病混合家系GRIK2基因多态性的关联研究

目的　在中国汉族人群混合家系中探讨GRIK2基因多态性与精神分裂症、心境障碍是否 关联。方法　采用PCR RFLP技术对GRIK2基因多态性rs6922753(T/C)和rs2227283(G/A)分型,进行 传递不平衡检验(TDT)。结果　(1)rs6922753多态性与精神分裂症(χ2=3.13,P>0.05)或心境障碍 (χ2=3.20,P>0.05)无关联,但在发病年龄≤25岁的患者中与两组疾病均相关联(P<0.05);(2) rs2227283多态性与精神分裂症(χ2=9.85,P<0.01)、心境障碍(χ2=13.50,P<0.01)呈显著关联;(3) 双位点TDT提示单体型TG、CA与精神分裂症、心境障碍相关联(P<0.05)。结论　在中国汉族人群 中GRIK2基因或邻近基因可能是精神分裂症和心境障碍的共同易患基因之一,并可能影响发病年龄。     

SLC25A12基因多态性与孤独性障碍的关联

目的：探讨SLC25A12基因单核苷酸多态性（SNP）与孤独性障碍的遗传关联性。方法：采用聚合酶链式反应和DNA芯片杂交技术，在124个汉族孤独性障碍患儿核心家系中，检测了SLC25A12基因的2个SNP位点（rs2056202，rs2292813），采用传递不平衡检验（TDT）和单倍型的方法进行关联分析。结果：在124个患儿核心家系中，所测得的2个SNP位点的等位基因和基因型的频数分布均符合Hardy-Weinberg平衡检验（χ^2=0.009，P=0.92;χ^2=0.006，P=0.94）。而且这2个SNP处于一个强连锁不平衡区域（D’=0.842，r2=0.566）。对124个核心家系TDT检验，发现带有杂合子基因的父代优先传递给子代的等位基因的传递率和此传递率的置信区间差异无显著性（P〉0.05）;所有样本的2个SNP位点，未发现与孤独性障碍的显著关联。结论：SLC25A12基因可能不是这些汉族家庭儿童孤独性障碍的主要易感基因。     

胱硫醚-β-合成酶基因多态性与精神分裂症核心家系的关联研究

目的:探讨胱硫醚-β-合成酶(cystathionine-beta-synthase,CBS)基因多态性与精神分裂症的关系。方法:采用聚合酶链式反应和DNA测序技术,检测75个精神分裂症核心家系CBS基因T833C、G919A多态性,采用单倍体相对风险度(haplotyperelativerisk,HRR)分析和传递不平衡检验(transmission disequilibrium test,TDT)分析CBS基因多态性与精神分裂症的关系。结果:所有受检者均未发现CBS基因T833C、G919A多态性,但下游8-9内含子33bp处见G→A突变。患者组G→A突变的基因型频率[GG(82.67%),GA(14.67%),AA(2.66%)]与父母组[GG(81.33%),GA(16%),AA(2.67%)]比较差异无统计学意义(χ2=0.29,P>0.05),患者组G→A突变的等位基因频率[G(90%),A(10%)]与父母组[G(89.33%),A(10.67%)]比较差异也无统计学意义(χ2=0.32,P>0.05)。HRR分析未显示G→A突变与精神分裂症有关联(χ2=0.21,P>0.05),TDT分析未见A等位基因在杂合双亲向患病子女的传递中有优势性(χ2=1.80,P>0.05)。结论:CBS基因多态性可能不是精神分裂症的遗传学危险因素。     

精神分裂症伴发2型糖尿病与色氨酸羟化酶基因多态性关联研究

目的：在中国汉族精神分裂症患者中探讨色氨酸羟化酶（TPH）基因A218C（rs1800532）多态性与2型糖尿病共病的关联性。方法：采用聚合酶链反应-限制性片断长度多态（PCR-RFLP）技术在中国汉族人群中对98例伴发2型糖尿病的精神分裂症患者（伴糖尿病组）及109例单纯精神分裂症患者（不伴糖尿病组）进行TPH基因A218C的分型,并进行等位基因及基因型比较。结果：伴糖尿病组与不伴糖尿病组比较,TPH6基因A218C多态性等位基因分布（χ^2=0．00,df=1,P〉0．05）和基因型分布（χ^2=3．78,df=2,P〉0．05）均无显著差异。在男性患者中,伴糖尿病组与不伴糖尿病组基因型分布存在显著差异（χ^2=6．57,df=2,P=0．037）,而等位基因分布（χ^2=1．28,df=1,P=0．26）则无明显差异;在女性患者组中,伴糖尿病组与不伴糖尿病组基因型分布（χ^2=1．54,df=2,P=0．46）和等位基因分布（χ^2=0．02,df=1,P〉0．05）均无显著差异。结论：在中国汉族男性精神分裂症患者中TPH基因A218C多态性与患2型糖尿病存在关联,其可能是男性精神分裂症患者患2型糖尿病的易感基因。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.     

Special Pharmacokinetic Considerations in Children

Summary: Pediatric patients have greater degrees of pharmacokinetic variability and unpredictability than adults. This variability results from the effects of pharmacogenetics, age and growth, prior and current comedication, and disease. Newborns with seizures have the least predictable dosage requirements, and their needs change as drug-eliminating mechanisms mature in the neonatal period. Infants have the highest relative capacities to eliminate antiepileptics of any age group and require the largest relative doses. In addition to age-related trends, children demonstrate the same drug-specific, pharmacokinetic phenomena that adults do, including nonlinear phenytoin elimination, nonlinear valproate binding, and autoinduction of carbamazepine. Intercurrent illness and drug interactions further modify the age-related pharmacokinetic patterns in children and make dosage requirements even more unpredictable. Recent studies have shown that febrile illness can affect drug elimination, sometimes decreasing drug levels by 50% or more. Intermittent treatment with benzodiazepines administered either orally or rectally can be an important adjunct and help minimize this type of problem for children with marginally controlled epilepsy. Intermittent benzodiazepines are also helpful for children who have febrile seizures and who need only occasional antiepileptic protection.