精神科门诊长期使用苯二氮类药物的病人的状况

目的了解长期应用苯二氮(廾卓)类药物的精神科门诊病人的状况,便于在精神科更好管理和使用苯二氮(廾卓)类药物.方法我们对安徽省精神卫生中心2004.10.1～2005.3.31门诊就诊的连续使用苯二氮(廾卓)类药物≥1.5年的门诊病人,随机整群抽取66名进行前瞻性调查,并分析所得.结果长期应用苯二氮(廾卓)类药物精神科门诊病人中神经症、癔症病人占45.5%,分裂症、躁郁症占42.4%;40～59岁占47.0%,老年人(≥60岁)占28.8%;女性病人占66.7%;病程中应用过1～2种苯二氮(廾卓)类药物占81.8%,剂量≤2片/d占95.5%;苯二氮(廾卓)类药物停药失败的首要原因66.7%是停用药后失眠.精神科门诊长期应用苯二氮(廾卓)类药物病人主要是神经症、癔症、分裂症、躁郁症病人,女性、40～59岁占多数,老年人亦占相当部分,精神科门诊病人要停用苯二氮(廾卓)类药物首先需解决的问题是停药之后如何应对失眠.     

精神科门诊长期使用苯二氮[艹卓]类药物的病人的状况

目的：了解长期应用苯二氮[艹卓]类药物的精神科门诊病人的状况，便于在精神科更好管理和使用苯二氮[艹卓]类药物。方法：我们对安徽省精神卫生中心2004．10．1～2005．3．31门诊就诊的连续使用苯二氮[艹卓]类药物≥1．5年的门诊病人，随机整群抽取66名进行前瞻性调查，并分析所得。结果：长期应用苯二氮[艹卓]类药物精神科门诊病人中神经症、癔症病人占45．5％，分裂症、躁郁症占42．4％；40～59岁占47．0％，老年人（≥60岁）占28．8％；女性病人占66．7％；病程中应用过1～2种苯二氮[艹卓]类药物占81．8％，剂量≤2片／d占95．5％；苯二氮[艹卓]类药物停药失败的首要原因66．7％是停用药后失眠。精神科门诊长期应用苯二氮[艹卓]类药物病人主要是神经症、癔症、分裂症、躁郁症病人，女性、40～59岁占多数，老年人亦占相当部分，精神科门诊病人要停用苯二氮[艹卓]类药物首先需解决的问题是停药之后如何应对失眠。     

社区门诊失眠患者镇静催眠药使用情况调查分析

目的了解社区门诊失眠患者镇静催眠药的使用现状及合理性。方法对2009年1月1日—6月30日杭州市企业退休人员门诊医疗服务中心定海路门诊部接诊的237例失眠患者的门诊病历进行回顾性调查分析。结果社区门诊中60岁以上的失眠患者占失眠总人数的88.6%,以70～79岁者居多,占55.3%。<60岁的患者中以女性居多。社区门诊失眠患者苯二氮艹卓类药物的使用率为99.6%(236/237),唑吡坦类药物的使用率为0。其中18.1%(43/237)的失眠患者长期连续使用苯二氮艹卓类药物10年以上。结论社区门诊失眠患者镇静催眠药的使用率较高,以使用苯二氮卓艹类药物为主,社区门诊患者在镇静催眠药的使用上存在一些不合理之处,需要引起社区医师的重视。     

社区门诊失眠患者镇静催眠药使用情况调查分析

目的 了解社区门诊失眠患者镇静催眠药的使用现状及合理性.方法 对2009年1月1日-6月30日杭州市企业退休人员门诊医疗服务中心定海路门诊部接诊的237例失眠患者的门诊病历进行回顾性调查分析.结果 社区门诊中60岁以上的失眠患者占失眠总人数的88.6%,以70～79岁者居多,占55.3%.＜60岁的患者中以女性居多.社区门诊失眠患者苯二氮()类药物的使用率为99.6%(236/237),唑吡坦类药物的使用率为0.其中18.1%(43/237)的失眠患者长期连续使用苯二氮()类药物10年以上.结论 社区门诊失眠患者镇静催眠药的使用率较高,以使用苯二氮()类药物为主,社区门诊患者在镇静催眠药的使用上存在一些不合理之处,需要引起社区医师的重视.     

精神科门诊失眠患者就诊前苯二氮类药物自行应用情况调查分析

目的调查精神科门诊失眠患者就诊前苯二氮类药物的使用情况。方法采用自编问卷形式对240例失眠患者就诊前苯二氮类药物自行应用情况进行问卷调查。结果 240例患者中就诊前自行应用苯二氮类药物者209例,使用率为87.1%,各年龄段失眠患者中女性比例高于男性,97.6%药物来源于家人、亲戚和朋友的援助和传递,2.4%自行在药店和基层私人诊所少量购买。结论应加强对苯二氮类药物的管理和正确使用的宣传教育,失眠者应到正规医院门诊实行个体化合理治疗,避免盲目用药。     

苯二氮(艹卓)类药物对老年慢性失眠患者吞咽功能的影响

目的:评价苯二氮(草)类药物对老年慢性失眠患者吞咽功能的影响.方法:通过自身对照的方式,对49例服用苯二氮(草)类药物治疗慢性失眠的老年患者,分别于停药前及停药后检测洼田饮水试验.结果:在停用苯二氮(草)类药物后,洼田饮水试验的等级较服药期间改善(p＜0.05).结论:苯二氮(草)类药物加重老年慢性失眠患者吞咽障碍.     

佐匹克隆的药理与临床应用

失眠是一种常见的症状 ,调查发现成年人中失眠的发生率在５ %～４５ %之间 ,在老年人中更加普遍。失眠严重影响人们的生活、工作及身心健康。２０世纪６０年代以前 ,临床上主要用巴比妥和非巴比妥类药物治疗失眠症 ,从６０年代起 ,苯二氮类 (ＢＺＳ)药物由于较巴比妥和非巴比妥类药物副作用小 ,疗效明显 ,逐渐替代了它们 ,是目前临床上治疗失眠应用最多的镇静催眠药。但是 ,由于苯二氮类药物的耐药性、依赖性和成瘾性等副作用 ,使人们着眼于对新的非苯二氮类药物进行研究。佐匹克隆 (ｚｏｐｉｃｌｏｎｅ，ＺＯＰ) ,化学名为６—(５—…     

半个世纪的争议——苯二氮()类药物临床应用50年

上个世纪50年代,苯二氮(艹卓)类药物进入临床使用,由于此类药物高效、安全、耐受性良好,目前苯二氮(艹卓)类药物已成为抗焦虑和失眠领域应用最广泛的药物。根据统计,全球有超过5000万人服用苯二氮(艹卓)类药物。苯二氮(艹卓)类药物目前仍是失眠和抗焦虑的一线治疗药物。 然而,由于许多原因,苯二氮(艹卓)类药物只是用于短期的抗焦虑及失眠的治疗,这是因为人们担心长期使用     

门诊苯二氮（艹卓）类药物应用分析

目的 了解我院门诊苯二氮（艹卓）类药物（BZD）的使用情况,评价其合理性.方法 对我院2009年1月1日至12月31日使用苯二氮（艹卓）类药物的门诊处方共17 185张进行统计与分析.结果 苯二氮（艹卓）类药物广泛应用于精神科和心理科门诊,主要联合用药处方有苯二氮（艹卓）类与抗抑郁药7011张（40.80%）,苯二氮（艹卓）类与抗精神病药物6149张（35.78%）,不合理用药处方占所统计总处方数的1.32%.结论 苯二氮（艹卓）类药物在我院门诊的使用是基本合理的,但亦存在少数不合理用药现象,是造成苯二氮（艹卓）类药物滥用的主要原因.     

小剂量氯氮平治疗苯二氮(艹卓)类药物滥用相关性失眠

目的:探讨小剂量氯氮平治疗苯二氮类药物滥用相关性失眠的疗效和安全性。方法:应用小剂量(41.48±26.27mg/d,12.5～100mg/d)氯氮平治疗35例苯二氮类药物滥用相关性失眠患者,于治疗前、治疗后第2、4周末,分别采用匹茨堡睡眠质量指数(PSQI)中文定式问卷评定疗效、副反应量表(TESS)评定副反应,停药后随访4周。结果:使用小剂量氯氮平治疗前后PSQI评分有显著性差异(P<0.001)。主要不良反应为轻度口干、轻微流涎、乏力、嗜睡等。停药4周后反弹性失眠少。结论:在监测血象的前提下,使用小剂量氯氮平治疗苯二氮类药物滥用相关性失眠是一种快速、有效的方法,较为安全,     

精神病专科医院300例住院患者中应用苯二氮（艹卓）类药物情况分析

目的：探讨精神病专科医院住院患者应用苯二氮(艹卓)类药物的使用情况。方法：随机选取我院300例住院患者作为研究对象,通过住院精神病患者调查表分析住院精神病患者使用苯二氮(艹卓)类药物的整体情况。结果：我院精神病住院患者使用苯二氮(艹卓)类药物人数为110例、占比36.7%。药物共有4种,其中使用氯硝西洋的69例、占比62.7%;使用艾司唑仑的3例,占比2.7%;精神分裂症患者中使用苯二氮(艹卓)类药物83例,占比75.6%。结论：精神病专科医院住院患者应用苯二氮(艹卓)类药物能够起到一定作用,但不宜过度使用。     

阿普唑仑治疗精神疾病142例

阿普唑仑为新型苯氮类药物,其化学名为8-氯-1-甲基-6-苯基-4H-1,2,4-三唑[4,3-α][1,4]苯并氮(艹卓)。用该药治疗142例(男55,女87,平均年龄37±SD13岁)精神疾病(抑郁症、神经衰弱、 焦虑症、癔症、精神分裂症及强迫行为等)日剂量 自0.8-1.2mg开始,1wk内增至最高量(2±0.58mg),治疗4wk,总有效率达91％,其中显效率为50.7％。主要副反应为嗜睡、头晕及失眠等。 对照组40例(男15,女25,平均年龄39±SD12岁)用阿米替林治疗,日剂量自50-100mg开始2wk左右增至最高用量(198±12.5mg)治疗4wk。2组疗效无显著差异。     

Drug-use behavior and correlates in people with schizophrenia

This study examined how illicit drugs were accessed, reasons for drug use, prevalence of emotional, physical, and sexual abuse, psychiatric symptomatology, level of functioning, and the relationship of these factors to substance use in 25 schizophrenia outpatients. To identify unique substance-use behaviors or correlates, this information was compared to 25 substance-abusing outpatients with major affective disorders, and 30 people with schizophrenia alone. Patients largely financed their drug habits with money given by immediate family members, and reported using drugs primarily for social reasons. While all three groups reported high levels of physical, sexual, and emotional abuse, a relationship between emotional abuse and substance use was observed only for people with schizophrenia. There were no differences between the two schizophrenia groups in psychiatric symptoms or level of functioning. The treatment implications of these findings are discussed.     

救助站和精神专科医院精神病患者的临床比较

目的研究救助站和精神专科医院的精神病患者的临床特征和一般资料的差异。方法采用自制调查表及BPRS量表对来自救助站的患者260例(住院90例,门诊170例),精神专科医院患者260例(住院90例,门诊170例)进行比较。结果来自救助站的精神病患者教育水平低,外地人员多,未婚或离婚多,无业多,有15%资料不详,疾病种类排序上也与精神专科医院有不同。住院患者以冲动敌对,攻击行为和不服从管理为多,住院时间较短,疗效以好转或稍改善为主,而未入院者以阴性衰退,情感淡漠为主。用药上,住院患者中救助站和精神专科医院无明显差异。但非住院患者中,救助站与精神专科医院患者有差异。结论救助站精神病患者为一个特殊群体。少了社会与家庭的关注。其临床特征与基神专科医院精神病患者有显著差异,其对社会及自身的危害较大,应引起高度重视。     

Burden of illness and health care resource utilization in adult psychiatric outpatients with attention-deficit/hyperactivity disorder in Europe

Objective: To assess the burden of illness and health care resource utilization of adult nonpsychotic psychiatric outpatients with attention-deficit/hyperactivity disorder (ADHD) in Europe.

Methods: This was a multicountry, cross-sectional, observational study where unselected routine patients from clinical psychiatric outpatient settings were screened and assessed for ADHD. Patients were evaluated using the Clinical Global Impressions of Severity (CGI-S) scale, the Sheehan Disability Scale (SDS), and the EuroQol-5 Dimensions questionnaire. Data on comorbidities, functional impairment, and health care resource utilization were captured.

Results: The study enrolled 2284 patients, of whom 1986 completed the study. The prevalence of ADHD was 17.4%, of whom 46.0% had a previous ADHD diagnosis. Patients with ADHD had a high clinical burden with psychiatric comorbidities, especially depression (43.0%) and anxiety disorders (36.4%). Substance abuse (9.2% vs. 3.4%) and alcohol abuse (10.3% vs. 5.2%) were more common in the ADHD cohort vs. the non-ADHD cohort. Only 11.5% of the patients with ADHD had no other psychiatric disorder. Various measures indicated a significantly poorer level of functioning for patients with ADHD than without ADHD, as indicated by higher scores for CGI-S (3.8 vs. 3.3) and SDS (18.9 vs. 11.6) and higher percentages of debt (35.5% vs. 24.3%) and criminality (13.8% vs. 6.1%). Lastly, the health care resource utilization was considerable and similar between adult psychiatric outpatients diagnosed and not diagnosed with ADHD.

Conclusions: Although care was taken when choosing the sites for this study, to make it representative of the general outpatient adult psychiatric population, caution should be advised in generalizing the findings of our study to the general ADHD or psychiatric outpatient population. This was an observational study, thus no inference on causality can be drawn. Having ADHD imposes a considerable health and social burden on patient and health care resource utilization comparable to other chronic psychiatric disorders.     

Use of naltrexone in the treatment of alcohol use disorders in patients with concomitant major mental illness

We report the use of naltrexone for treatment of alcohol use disorder in patients with major psychiatric illness. We reviewed the records of 72 mentally ill outpatients treated with naltrexone for alcohol use disorders at a community mental health center. The psychiatric diagnoses included major depression (n = 37), schizophrenia (n = 17), bipolar illness (n = 11), schizoaffective disorder (n = 7), and gender identity disorder (n = 4). Sixty-one patients (85%) had histories of psychiatric hospitalization. Total retention in naltrexone treatment for at least eight weeks was 81.9%: 5 (6.9%) were lost to follow-up, and 8 (11.1%) discontinued the medication because of side effects, primarily nausea. Patients showed good clinical response to naltrexone, with 82% reducing their drinking by at least 75%, and only 17% relapsing at eight weeks. We conclude that naltrexone is useful in the treatment of dually-disordered patients. The hypothesis that clinical response to naltrexone is facilitated by active alcohol drinking during treatment is discussed.     

Double-blind clinical assessment of alprazolam, a new benzodiazepine derivative, in the treatment of moderate to severe anxiety

This four-week, double-blind, placebo-controlled clinical trial assessed the new benzodiazepine derivative alprazolam (Xanax) treatment of moderate to severe anxiety characteristic of anxiety neurosis. Sixty-two outpatients participated; 8 per cent of those taking drug and 52 per cent of those taking placebo discontinued participation due to side effects or lack of efficacy. The mean total daily alprazolam dose was 1.35 mg taken in divided doses. Alprazolam significantly improved scores on five anxiety rating scales--Hamilton Anxiety Rating Scale, Physician's Global Impressions, Target Symptoms Record, Self-Rating Symptom Scale, and Patient's Global Impressions. Alprazolam patients experienced no clinically significant changes in vital signs and laboratory values; they reported drowsiness as the most frequent side effect. We conclude that alprazolam is an effective and safe anxiolytic agent.