帕罗西汀合并氯氮平治疗精神分裂症的阴性症状

目的探讨氯氮平合并帕罗西汀治疗精神分裂症的阴性症状的疗效。方法以阴性症状为主、单用氯氮平的住院精神分裂症病人58例，随机分成研究组和对照组，分别加用帕罗西汀和安慰剂治疗，疗程12周，使用阳性症状与阴性症状量表（PANSS）和副反应量表（TESS）评定，在治疗前和治疗4、8、12周末备评定一次。结果研究发现两组疗效相比较，两组疗效相仿（P〉0．05）。两组治疗前后PANSS总分、阴性因子分评分比较，显效时间均在用药8周后。12周末研究组PANSS总分、阴性因子分明显低于治疗前，而且两组间比较发现研究组阴性因子分比对照组明显降低，提示存在显著差异（P〈0．01）。结论帕罗西汀合并氯氮平能够显著改善精神分裂症的阴性症状。且少有副反应。     

氯氮平联合美金刚治疗精神分裂症阴性症状对照研究

目的:探讨氯氮平联合美金刚治疗精神分裂症阴性症状的疗效及安全性. 方法:将64例以阴性症状为主的慢性精神分裂症患者随机分成两组,每组32例,两组在服用原有抗精神病药(氯氮平)的基础上,研究组联合美金刚治疗,对照组联合安慰剂治疗,观察12周.于治疗前、治疗8周及12周采用阳性与阴性症状量表(PANSS)、阴性症状量表(SANS)评定临床疗效. 结果:治疗8周及12周时研究组和对照组PANSS总分、阴性因子分及SANS总分较治疗前显著下降(P＜0.05或P＜0.01)),研究组较对照组下降更为显著(P＜0.05或P＜0.01). 结论:氯氮平联合美金刚治疗与单用氯氮平相比,可显著缓解精神分裂症患者的阴性症状.     

帕利哌酮合用艾司西酞普兰对精神分裂症患者BDNF及阴性症状的影响

目的探讨帕利哌酮舍用艾司西酞普兰对精神分裂症患者血清脑源性神经营养因子（BDNF）浓度及阴性症状的影响。方法将84例以阴性症状为主的精神分裂症患者随机分为研究组（帕利哌酮合用艾司西酞普兰）与对照组（单用帕利哌酮）,治疗12周。于治疗第0、4、8、12周监测血清BDNF浓度,同时采用阳性与阴性症状量表（PANSS）和副反应量表（TESS）评定疗效和不良反应。结果①两组有效率分别为85．7％和64．3％,经比较差异有统计学意义（χ^2=4．29;P〈O．05）;②疗后8、12周,两组BDNF浓度较治疗前升高,但研究组BDNF浓度升高较对照组明显（t=2．0814,2．4719;P〈0．05）;③两组PANSS总分和各阴性因子均较治疗前减少（P均〈0．05）,但研究组PANSS总分及各阴性因子分差异较对照组差异有统计学意义（t=2．059,2．014,P〈0．05）;④两组药物不良反应比较无显著差异。结论帕利哌酮合用艾司西酞普兰可明显提高BDNF浓度,改善精神分裂症的阴性症状。     

阿立哌唑合并帕罗西汀治疗男性精神分裂症阴性症状的临床研究

目的对比阿立哌唑合并帕罗西汀与单用阿立哌唑治疗男性以阴性症状为主的精神分裂症的疗效和安全性。方法将符合入组标准的60例男性精神分裂症患者随机分为阿立哌唑合并帕罗西汀组（研究组）和阿立哌唑纽（对照组）,观察8周。共完成研究60例,研究组30例,对照组30例,采用阳性和阴性综合征量表（PNASS）分别评定基线和治疗后组内组间总分、各分量表分的变化以及不良反应。结果治疗后第4、8周末,两组患者的PANSS总分及阴性症状分均较治疗前显著降低（P〈0．05,P〈0．01）,治疗后第8周末,研究组PANSS总分及阴性症状分显著低于对照组（P〈0．05）。研究组总有效率为80％,对照组总有效率为47％,两组有效率比较差异有统计学意义（P〈0．05）。两组不良反应均轻微。结论阿立哌唑合并帕罗西汀能明显改善精神分裂症患者的阴性症状,且副反应较少。     

齐拉西酮合并艾司西酞普兰治疗以阴性症状为主的精神分裂症对照研究

目的 探讨齐拉西酮合并艾司西酞普兰治疗以阴性症状为主的精神分裂症的疗效和安全性。方法 将86例以阴性症状为主的精神分裂症患者随机分为研究组（齐拉西酮合并艾司西酞普兰治疗）和对照组（单用齐拉西酮治疗）,各43例。于治疗前及治疗后第2、4、8、12周末采用阳性和阴性综合征量表（PANSS）和阴性症状量表（SANS）评定两组的疗效,治疗中需处理的不良反应症状量表（TESS）评定两组的不良反应。结果 治疗后第2周末起研究组PANSS总分及阴性症状因子分较治疗前下降（P〈0.05）,研究组治疗后第2周末起PANSS总分及阴性症状因子分低于对照组（P〈0.05）。治疗后第4周末研究组SANS总分、情感平淡、注意障碍因子分低于对照组（P〈0.05）。两组不良反应发生率比较无显著性差异（P〉0.05）。结论 齐拉西酮合并艾司西酞普兰治疗以阴性症状为主的精神分裂症起效快、疗效好,且未增加不良反应。     

音乐节奏训练对慢性精神分裂症患者疗效和社会功能影响的研究

目的评价音乐节奏训练对精神分裂症患者临床症状的改善及对社会功能恢复的作用。方法将90例慢性精神分裂症患者随机分为研究组及对照组,研究组在原来药物治疗的基础上合并无错化学习模式的音乐节奏训练3个月。对照组在原来药物治疗的基础上合并普通工娱治疗3个月。在治疗前后用阳性和阴性综合征量表（PANSS）、个人和社会功能量表（PSP）评估患者临床症状和社会功能变化。结果研究组PANSS总分、阴性症状、一般精神病理、反应缺乏因子、激活因子及抑郁因子评分均较治疗前下降（P〈0.05）,对照组仅PANSS阴性症状评分较治疗前下降（P〈0.05）;治疗后研究组PANSS总分、阴性症状、反应缺乏因子评分低于对照组（P〈0.05）。研究组治疗后PSP总分较治疗前显著升高（P〈0.05）,治疗后研究组PSP总分高于对照组（P〈0.05）。结论音乐节奏训练对慢性精神分裂症阴性症状及社会功能的改善作用优于普通工娱治疗。     

利培酮合并西酞普兰治疗精神分裂症阴性症状的疗效观察

目的探讨利培酮合并西酞普兰治疗精神分裂症阴性症状的疗效及安全性。方法将70例以阴性症状为主的精神分裂症患者随机分为研究组与对照组各35例,其中研究组给予利培酮合并西酞普兰,而对照组仅单用利培酮,两组疗程均为12周,采用PANSS评定临床疗效,TESS评定不良反应,于治疗第4、8、12周分别评定一次。结果两组治疗后PANSS总分、各因子分均较治疗前显著降低。研究组阴性因子分在第4周时较治疗前显著降低,而对照组阴性因子分则在第8周时降低,且第8、12周时研究组阴性因子分显著低于对照组。两组间TESS评分值在治疗期间无显著性差异。结论利培酮合并西酞普兰治疗精神分裂症阴性症状较单用利培酮疗效好,且不增加不良反应。     

氯氮平合并帕罗西汀治疗精神分裂症阴性症状临床研究

目的　观察氯氮平合并帕罗西汀治疗精神分裂症阴性症状的疗效和副作用。方法　将 66例女性慢性精神分裂症患者平均分为研究组 (氯氮平加帕罗西汀 )和对照组 (氯氮平加安慰剂 )。在治疗前、治疗后 4、8、12周末分别以阳性症状和阴性症状量表(PANSS)和副反应量表 (TESS)评定疗效和副作用。同时测定氯氮平与去甲氯氮平的血浓度。结果　治疗 8周后研究组PANSS总分、阴性因子分比治疗前明显降低 ,且阴性因子分值显著低于对照组 ,氯氮平及去甲氯氮平血浓度明显升高。治疗后 4、8、12周末TESS评分 ,研究组均低于对照组 ,且治疗后低于治疗前 ,均有显著性差异。结论　氯氮平合并帕罗西汀能明显改善精神分裂症患者的阴性症状 ,且副作用减少。     

利培酮合用米氮平治疗精神分裂症阴性症状的研究

目的　探讨米氮平治疗精神分裂症阴性症状的疗效和安全性。方法　将 86例以阴性症状为主的住院精神分裂症患者随机分为研究组对对照组 ,分别给予利培酮合用米氮平及单用利培酮治疗 ,疗程 12周 ,用PANSS、TESS评定疗效和安全性。结果　疗后 4周两组PANSS总分、阳性因子分、阴性因子分及 8、12周末两组PANSS总分和各因子分与疗前比较差异有显著性 (P <0 0 5或P <0 0 1)。治疗后 8、12周两组间比较PANSS总分及阴性因子分差异有显著性 (P <0 0 5或P <0 0 1)。结论　米氮平治疗精神分裂症阴性症状疗效较好 ,副作用少。     

盐酸文拉法辛对以阴性症状为主的精神分裂症患者听觉P300的影响

目的 研究盐酸文拉法辛对以阴性症状为主的精神分裂症患者听觉P300的影响,为临床治疗阴性精神分裂症提供理论基础。方法 60例以阴性症状为主的精神分裂症患者为对照组,服用抗精神病类药物进行治疗,60例以阴性症状为主的患者为研究组,使用抗精神病药物合并文拉法辛缓释片治疗。分别于治疗前及治疗后第5周末,对两组患者进行听觉P300检测以及阳性和阴性综合征量表（PANSS）评定。结果 研究组治疗后潜伏期P2、N2、P3均显著低于治疗前（P〈0.05）,其中N2、P3亦低于对照组（P〈0.01）,研究组治疗后波幅P3均高于对照组和同组治疗前（P〈0.01）;对照组治疗后潜伏期P2低于治疗前,波幅P2高于治疗前（P〈0.05）。研究组治疗后PANSS总分及阴性因子、阳性因子评分均低于对照组和同组治疗前（P〈0.01）。结论 盐酸文拉法辛可提高以阴性症状为主精神分裂症患者的认知功能,改善其听觉P300各项指标。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.