喹硫平治疗精神分裂症阴性症状的临床观察

目的 观察喹硫平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80例以阴性症状为主的精神分裂症住院患者随机分为喹硫平组和利培酮组,各40例.分别给予喹硫平和利培酮治疗,疗程共8周.治疗后采用阳性和阴性症状量表(PANSS)、阴性症状评定量表(SANS)、副反应量表(TESS)进行评定.结果 2组总有效率差异无统计学意义(P＞0.05).2组PANSS、SANS评分均较治疗前有显著下降(P＜0.01).喹硫平组不良反应发生率为17.5%低于利培酮组的60.0%,差异有统计学意义(P＜0.01).结论 喹硫平治疗以阴性症状为主的精神分裂症疗效与利培酮相似,但不良反应更少,值得临床推广应用.     

氨磺必利对晚发性分裂症的疗效分析

目的:探讨氨磺必利与喹硫平治疗晚发性分裂症的疗效及安全性.方法:采用随机对照的试验方法,将60例符合CCMD-3诊断标准的首发精神分裂症患者随机分为氨磺必利组和喹硫平组,每组30例.于入院时、治疗2周末、4周末、12周末,采用阳性和阴性症状量表(PANSS)评定疗效.结果:在治疗第2周末和4周末,氨磺必利组阳性症状量表分低于喹硫平组,差异有统计学意义(P＜0.05),在12周末时有非常显著意义(P＜0.01).在治疗的第4周末和12周末,氨磺必利组的PANSS总分低于喹硫平组,差异有统计学意义(P＜0.05).氨磺必利组总体不良反应率为69.32％,与喹硫平组64.15％差异无统计学意义(P＞0.05).结论:氨磺必利总体疗效优于喹硫平,对阳性症状效果更优,两者不良反应均轻微.     

喹硫平联合舍曲林治疗精神分裂症抑郁症状的临床观察

目的喹硫平联合舍曲林治疗精神分裂症抑郁症状的临床观察。方法 2016年11月至2018年5月,选择在我院就诊的108例伴有抑郁症状的精神分裂症患者作为对象,根据就诊顺序按照1∶1比例将其分成对照组(n=54,先就诊,喹硫平治疗)与治疗组(n=54,后就诊,喹硫平+舍曲林治疗),对比观察两组患者治疗前后的PANSS评分及HAMD评分。结果两组患者治疗前的PANSS评分及HAMD评分并无明显差异,没有统计学意义(P>0.05),经不同方案治疗之后,治疗组两项指标评分都低于对照组,数据分析显示,有统计学意义(P<0.05)。结论伴有抑郁症状的精神分裂症,联合喹硫平与舍曲林用药,疗效显著,建议推广。     

喹硫平联合氟西汀治疗难治性抑郁症

目的:了解喹硫平及氟西汀联合治疗难治性抑郁症的疗效.方法:60例难治性抑郁症患者随机分为两组,一组氟西汀治疗,另一组氟西汀联合喹硫平治疗.采用汉密尔顿抑郁量表(HAMD)评分,以HAMD减分率评定疗效.结果:氟西汀组显效率23.3%.有效率40.0%:喹硫平联合氟西汀组显效率50.0%,有效率73.3%,疗效明显优于氟西汀组(P<0.01).两组不良反应均较少.结论:喹硫平及氟西汀联合治疗难治性抑郁症可取得较好疗效,安全性好,不良反应少.对于单用抗抑郁药治疗效果欠佳的抑郁症患者可考虑加用非典型抗精神药物.     

124例精神分裂症患者服用不同第二代抗精神病药物的主观舒适度调查分析

目的 了解服用不同第二代抗精神病药物的精神分裂症患者的主观舒适度.方法 对124例使用不同第二代抗精神病药物的精神分裂症患者测评抗精神病药物治疗中主观舒适度(SWN)简表、阳性与阴性症状量表(PANSS)、药物副反应量表(TESS).结果 氯氮平、奥氮平组患者SWN评分接近,两组差异无统计学意义(P>0.05).利培酮、齐拉西酮及阿立哌唑组患者SWN评分接近,任意两组差异无统计学意义(P>0.05).喹硫平组患者SWN评分最高.前两组中任一组与后四组中任一组间差异有统计学意义(P<0.01),喹硫平组与前五组中任一组间差异有统计学意义(P<0.01).结论 精神分裂症患者服用不同种类第二代抗精神病药物,主观舒适度不同,喹硫平主观舒适度最高.     

阿立哌唑与喹硫平治疗精神分裂症的疗效和安全性

目的 评价阿立哌唑与喹硫平治疗精神分裂症的疗效及安全性.方法 169例符合DSM-Ⅳ(第4版)精神分裂症患者,阿立哌唑组79例,剂量10～30mg·d-1;喹硫平组90例,剂量400～ 750 mg·d-1,疗程均8周.治疗前,治疗第4,8周用阳性和阴性症状量表(PANSS)评价主要疗效.用实验室检查、生命体征、心电图等评价安全性.结果 2组治疗4,8周PANSS总分均较治疗前有显著下降(P均＜0.01),治疗8周末,PANSS总分减分差值及疗效2组间差异无统计学意义.2组药物不良反应发生率分别为25.3％(20/79)和17.7％ (16/90).阿立哌唑组对心率的影响较喹硫平组小;阿立哌唑组甘油三酯水平和心电图QRS间期较治疗前变化明显(P＜0.05).喹硫平组心率、体重、体重指数、血红蛋白、总胆固醇和低密度脂蛋白较治疗前变化明显(P＜0.01).结论 阿立哌唑与喹硫平对精神分裂症疗效相当,两者所致不良反应发生率相近.     

喹硫平治疗老年精神分裂症的对照观察

目的:探讨喹硫平治疗老年精神分裂症的疗效与耐受性、安全性。方法:56例精神分裂症老年患者随机分成两组,喹硫平组28例,用喹硫平100～300 mg/d;奋乃静组28例,用奋乃静12～24 mg/d,疗程均为8周。应用阳性与阴性症状量表(PANSS)评定疗效,应用不良反应量表(TESS)实验室检查及体检评价药物的安全性。结果:治疗2～8周,两组PANSS评分均较治疗前显著下降(P<0.05或P<0.01);两组显效率(χ2=0.38,P>0.05)和有效率(χ2=0.22,P>0.05)差异无统计学意义;喹硫平组不良反应少于奋乃静组,治疗期间奋乃静组合用安坦20例(71.4%),喹硫平组8例(28.6%),差异有非常显著统计学意义(χ2=10.28,P<0.01)。结论:喹硫平治疗老年精神分裂症患者的效果比较理想,且不良反应少而轻,耐受性好。     

帕罗西汀联合喹硫平治疗双重抑郁症的疗效及安全性评价

目的 评价帕罗西汀联合喹硫平对双重抑郁症的临床疗效以及安全性.方法 双重抑郁症患者70例,随机分成对照组和观察组,分别给予帕罗西汀和帕罗西汀与喹硫平联合进行治疗,比较两组治疗效果及安全性.结果 观察组患者的治疗效果明显优于对照组,观察组患者的治疗有效率(85.71％)明显高于对照组(65.71％) (x2 =4.328,P＜0.05).结论 采用帕罗西汀与喹硫平联合对双重抑郁症患者进行治疗的临床疗效显著,具有较高的安全性,值得推广.     

锂盐联合喹硫平与氯氮平应用于双相躁狂发作的药物经济学评价

摘要：目的:对锂盐联合二代抗精神病药喹硫平与氯氮平的治疗方案做药物经济学评价,为双相躁狂发作患者临床合理用药提供参考。方法:选取2015年1月～2019年10月于安徽某三级精神专科医院就诊的双相躁狂患者的病历资料进行回顾性分析。在综合考虑患者治疗前后贝克-拉范森躁狂量表（BRMS）评分以及不良反应发生情况的基础上,对锂盐联合喹硫平与锂盐联合氯氮平这两种治疗方案进行药物经济学评价。结果:锂盐联合喹硫平组共纳入有效病例88例,锂盐联合氯氮平组纳入病例43例。两组药物治疗的缓解率差异无统计学意义（P>0.05）,锂盐联合喹硫平组的不良反应发生率更低。最小成本分析结果显示锂盐联合喹硫平组住院成本低于锂盐联合氯氮平组。敏感性分析结果与基本分析保持一致。结论:锂盐联合氯氮平药物成本低,但是住院总成本显著高于锂盐联合喹硫平组。故锂盐联合喹硫平相对于锂盐联合氯氮平治疗双相情感障碍躁狂发作更具有经济性。     

喹硫平与舒必利改善精神分裂症患者认知功能的比较研究

目的：观察喹硫平与舒必利对精神分裂症患者认知功能的改善情况。方法：将50例初诊或经典抗精神病药物治疗疗效不显著或无法耐受不良反应的精神分裂症患者分为喹硫平（n=25）与舒必利（n=25）两组,进行为期3个月的治疗。治疗前后应用PANSS、MMES分别评定精神症状与认知功能。结果：共39例患者完成3个月的治疗（喹硫平=19,舒必利=20）。与基线比较,喹硫平与舒必利都能明显改善精神分裂症患者的精神症状与认知功能,但两组间精神症状与认知功能改善程度并无差异。结论：喹硫平与舒必利都能明显改善精神分裂症患者的认知障碍,疗效无差异。     

Adding quetiapine to SRI in treatment-resistant obsessive-compulsive disorder: a randomized controlled treatment study

This study aimed to determine the efficacy and tolerability of adding quetiapine to a serotonin reuptake inhibitor in treatment-resistant obsessive-compulsive disorder (OCD). Twenty-one adult treatment-resistant OCD patients were randomized to 16 weeks of augmentation with either quetiapine (n = 11) or placebo (n = 10). Patients with significant comorbidities, including tic-spectrum disorders, were not included. The treatment was well tolerated, with only one premature dropout in each treatment-group. The primary analysis showed that individuals in the quetiapine-treated group showed a 14% mean improvement in baseline Yale-Brown Obsessive-Compulsive Scale scores at study endpoint compared with a 6% improvement in those treated with placebo, but this difference did not reach statistical significance (F<1). Three patients treated with quetiapine met criteria for clinical response, compared to one patient who was treated with placebo. Larger studies are needed to explore the efficacy of second generation antipsychotics, such as quetiapine, when used as adjunct treatment in resistant OCD.     

Cocaine abstinence symptomatology and treatment attrition

Premature termination from outpatient cocaine treatment predicts a number of poor outcomes, including higher rates of relapse and unemployment. This study attempted to predict dropouts from outpatient cocaine treatment, as well as those unable to achieve initial abstinence from cocaine, using two baseline variables that had previously been shown to predict treatment dropout: a measure of the severity of cocaine abstinence symptomatology using the Cocaine Selective Severity Assessment (CSSA) and the initial urine toxicology. Results of logistic regression analyses indicated that those with more intense abstinence symptoms, as measured by the CSSA, were five times more likely to terminate treatment prematurely. When combined with the CSSA, the initial urine did not significantly predict dropouts. The CSSA and the baseline urine were equal in their ability to predict those who would fail in their initial attempts to achieve abstinence. Implications for treatment are discussed.     

Are they being used safely? A retrospective cross‐sectional tertiary health care survey of selective serotonin reuptake inhibitors prescribing practice in Singapore

OBJECTIVES: To determine the prescribing pattern of the SSRIs and to evaluate the safety of current utilization of SSRIs associated with concomitant psychotropic medications in Singapore. METHODS: The average prescribed daily dose (PDD) for each SSRI was calculated and compared with the defined daily dose (DDD). Pearson's chi2 test, one-way analysis of covariance (ANCOVA) and multinomial logistic regression were performed to examine the impacts of variables such as age, gender, patient type and concomitant psychotropic medications on the utilization of SSRIs. Safety issues were discussed by examining the potential metabolic drug interactions between the SSRIs and concomitant psychotropic medications. RESULTS: The most frequently prescribed SSRI was fluoxetine and the PDDs were slightly more than the DDDs for all these SSRIs except fluvoxamine. The SSRIs were mainly prescribed to the patients who were younger, female and outpatients. Psychotropics were more likely concomitantly used with fluvoxamine, sertraline and paroxetine, relative to fluoxetine. CONCLUSION: The prescribing pattern of SSRIs in a tertiary health center in Singapore is generally consistent with the accepted practices, although some safety concerns in terms of metabolic drug interactions were raised. This study provides useful baseline information for further in-depth studies for SSRIs usage both locally and for international comparison.     

Missing data handling in chronic pain trials

In chronic pain trials, proper handling of missing data due to dropout is an important issue because the dropout rate is high and the study conclusion may depend on the method chosen. The intent-to-treat (ITT) principle usually requires imputations for missing data to include the dropouts as well as completers in the statistical analysis. However, a statistical analysis with imputation might lead to a misinterpretation of clinical data. In chronic pain trials, treatment-related dropouts are clinical outcomes themselves. For example, an early dropout due to toxicity usually indicates a treatment failure, as does a dropout due to lack of efficacy. Problems with traditional methods such as last observation carried forward (LOCF) or baseline observation carried forward (BOCF) are identified especially in the chronic pain setting. Alternative methods, such as continuous responder analysis and two-part model analysis, treating dropouts as clinical events, are introduced with an example of osteoarthritis clinical trial data.     

Obsessive-compulsive disorder in the postpartum: open-label trial of quetiapine augmentation

OBJECTIVE: Postpartum nonpsychotic conditions are routinely treated with antidepressant therapy. However, a subset of this population with comorbid obsessive-compulsive disorder (OCD) is treatment-resistant. Optimal response is obtained by augmentation therapy with novel antipsychotics. The objective of this open-label study was to evaluate clinical response to quetiapine augmentation of SSRIs or SNRIs in treatment-resistant OCD in the postpartum. METHODS: Twenty-two postpartum women diagnosed with OCD as per DSM-IV criteria, who did not respond to at least 8 weeks of SSRI or SNRI monotherapy, were offered a trial of quetiapine augmentation for 12 weeks. Response (defined as >50% reduction in scores) was assessed using the Yale Brown Obsessive-Compulsive Scale (YBOCS) and Clinical Global Impressions scale (CGI). RESULTS: Seventeen patients agreed to a trial of quetiapine augmentation. Three withdrew early due to side effects, and 14 completed the 12-week trial. Of these, 11 responded to treatment within 12 weeks, with a mean (SD) response time of 5.9 (2.6) weeks. The mean (SD) baseline YBOCS score of 24.7 (6.8) dropped to a mean of 10.3 (9.0), with a mean reduction of 59.6%. Mean CGI scores at outcome were 1.9 (1.2). The average dose of response was 112.5 mg (76.4 mg). Sedation was the most commonly reported side effect. CONCLUSIONS: Although limited by lack of controls, this is the first study in a postpartum population where the addition of quetiapine to antidepressant therapy has been shown to be effective for treatment-refractory OCD. Quetiapine deserves further controlled study in this context.     

Performance on the Stroop predicts treatment compliance in cocaine-dependent individuals.

Treatment dropout is a problem of great prevalence and stands as an obstacle to recovery in cocaine-dependent (CD) individuals. Treatment attrition in CD individuals may result from impairments in cognitive control, which can be reliably measured by the Stroop color-word interference task. The present analyses contrasted baseline performance on the color-naming, word-reading, and interference subtests of the Stroop task in CD subjects who completed a cocaine treatment trial (completers: N=50) and those who dropped out of the trial before completion (non-completers: N=24). A logistic regression analysis was used to predict trial completion using three models with the following variables: the Stroop task subscale scores (Stroop model); the Hamilton depression rating scale (HDRS) scores (HDRS model); and both the Stroop task subscale scores and HDRS scores (Stroop and HDRS model). Each model was able to significantly predict group membership (completers vs non-completers) better than a model based on a simple constant (HDRS model p=0.02, Stroop model p=0.006, and Stroop and HDRS model p=0.003). Models using the Stroop preformed better than the HDRS model. These findings suggest that the Stroop task can be used to identify cocaine-dependent subjects at risk for treatment dropout. The Stroop task is a widely available, reliable, and valid instrument that can be easily employed to identify and tailor interventions of at risk individuals in the hope of improving treatment compliance.     

Quetiapine augmentation in patients with treatment resistant obsessive-compulsive disorder: a single-blind, placebo-controlled study

Recently, atypical antipsychotics have been used for the management of the patients with refractory obsessive-compulsive disorder (OCD). The aim of the present study was to evaluate the results of quetiapine augmentation to a serotonin reuptake inhibitor (SRI) in the patients with refractory OCD. Fifty-two patients with OCD according to DSM-IV entered 3 months of an open-label phase treatment with a SRI with or without concomitant adjunctive treatment regimen. Of them, 27 patients were refractory OCD. These patients were randomly divided into two groups, SRI plus quetiapine and SRI plus placebo, for an 8-week single-blind phase. The course of OCD was evaluated by Yale-Brown Obsession-Compulsion (Y-BOCS) and Clinical Global Impression-Severity of Illness and Improvement (CGI-SI and I) Scales every other week for 8 weeks. Of the 14 patients in group I, nine (64.4%) showed significant improvement with 60% or greater improvement on the Y-BOCS and one (7.1%) partial improvement with 30% or greater improvement on the Y-BOCS, whereas no improvement was observed in group II. The addition of quetiapine to ongoing SRI therapy has been found to be effective and well-tolerated approach in patients with refractory OCD.     

Factors associated with pretreatment and treatment dropouts among clients admitted to medical withdrawal management

The aims of this study were to identify factors associated with pretreatment and treatment dropouts among individuals accessing an inpatient medical withdrawal management program (Vancouver Detox). Two thousand five hundred sixty-six unique clients, who were referred to Vancouver Detox over two-year period, were assessed. Demographic and drug related variables were analyzed as possible risk factors, and two multivariate logistic regression analyses were conducted. We found that being male, being aboriginal, having no children, no fixed address, alcohol as a preferred substance, and being on methadone maintenance treatment at referral were significantly associated with high pretreatment dropout. Significant risk factors for treatment dropout were: being younger, having HCV infection, having a preferred substance other than alcohol, having opiates as a preferred substance, and being discharged on welfare check issue periods or weekends. These findings may help clinicians and decision-makers to initiate corresponding preventive measures to decrease unnecessary attritions and improve utilization of treatment resources.     

Cognitive impairment,retention and abstinence among cocaine abusers in cognitive-behavioral treatment

Cognitive-behavioral therapy (CBT) depends on adequate cognitive functioning in patients, but prolonged cocaine use may impair cognitive functioning. Therefore, cognitive impairment may impede the ability of cocaine abusers to benefit from CBT. To begin to address this issue, we investigated the relationship between cognitive impairment and two treatment outcomes, therapy completion and abstention. Eighteen carefully screened non-depressed cocaine-dependent patients in a psychopharmacological clinical trial were administered the MicroCog computerized battery to assess cognitive performance at treatment entry. T-tests were used to compare cognitive functioning between completers (patients remaining in treatment at least 12 weeks) and dropouts. The results indicated that treatment completers had demonstrated significantly better cognitive performance at baseline than patients who dropped out of treatment. Cognitive domains that significantly distinguished between treatment completers and dropouts were attention, mental reasoning and spatial processing. This study provides preliminary evidence that cognitive impairments may decrease treatment retention and abstinence in CBT of cocaine dependence.     

Drug information made digestible

This study investigated the characteristics associated with treatment dropout in cocaine-dependent patients. A sample of 102 cocaine-addicted patients (89 male patients and 13 female patients) was assessed at entry to a therapeutic programme in order to collect information on socio-demographic, psychopathological (assessed by SCL-90-R), personality (assessed by MCMI-II), legal and consumption variables (assessed by EuropAsi). The rate of patients who dropped out of the intervention programme was 30.4% (N = 31) of the sample. Dropouts and completers were compared on all studied variables. According to the results obtained, dropouts showed a significantly higher score on the EuropAsi variables related to alcohol consumption, family problems and need for psychological treatment, as well as on the histrionic and antisocial scales of the MCMI-II. Moreover, all patients with histrionic personality disorder dropped out of the treatment. On the other hand, completers showed a significantly higher score on the compulsive scale of the MCMI-II. The implications of these results for further research and clinical practice are commented upon.