阿立哌唑联合多奈哌齐对精神分裂症患者认知功能、糖脂代谢和血清炎症因子的影响

目的探讨阿立哌唑联合多奈哌齐对精神分裂症患者认知功能、糖脂代谢和血清炎症因子的影响。方法按照入院顺序抽签后随机将120例精神分裂症患者分为观察组和对照组,观察组患者给予阿立哌唑联合多奈哌齐治疗,对照组患者给予阿立哌唑联合多奈哌齐模拟片治疗,比较两组治疗效果。结果观察组患者治疗后PANSS评分显著低于对照组(P0.05),TMT-A、DST、VFT水平显著高于对照组(P0.05);观察组患者治疗后FBG、2h PBG、TG、TC水平均显著低于对照组(P0.05);且观察组患者治疗后血清TNF-α、IL-6、IL-10水平均显著低于对照组(P0.05)。结论阿立哌唑联合多奈哌齐可有效改善精神分裂症患者临床症状、认知功能和炎症因子水平,对糖脂代谢影响小,可作为优选治疗方案。     

文拉法辛联合阿立哌唑治疗难治性抑郁症的临床疗效及对认知功能的影响

目的 探讨文拉法辛联合阿立哌唑治疗难治性抑郁症的临床疗效及对认知功能的影响.方法 将128例难治性抑郁症患者随机分为对照组与观察组,对照组患者给予文拉法辛口服,观察组给予文拉法辛联合阿立哌唑治疗,疗程8周.比较2组临床疗效、认知功能及药物不良反应的差别.结果 治疗8周后观察组汉密尔顿抑郁量表（HAMD）各项评分显著低于对照组（P〈0.05）;观察组认知功能威斯康星卡片分类测验（WCST）正确反应数及完成分类数评分显著优于对照组（P〈0.05）;2组不良反应无显著差别（P〈0.05）.结论 文拉法辛联合阿立哌唑治疗难治性抑郁症可显著提高临床疗效、改善认知功能,且不增加不良反应.     

阿立哌唑联合奥拉西坦对精神分裂症患者认知功能的影响

目的观察阿立哌唑与奥拉西坦联合治疗对精神分裂症患者认知功能的影响,为精神分裂症认知损伤的治疗提供临床证据。方法采用随机数字表法将98例符合《国际疾病分类(第10版)》(ICD-10)诊断标准的精神分裂症患者分为研究组(阿立哌唑10~30 mg/d联合奥拉西坦1 600~2 400 mg/d)和对照组(阿立哌唑10~30 mg/d)各49例,进行为期8周的随机对照研究。在治疗开始前与治疗结束时(第8周末)采用阳性和阴性症状量表(PANSS)进行临床疗效评定,采用MATRICS共识认知成套测验(MCCB)评定认知功能。结果治疗8周末,两组MCCB和PANSS评分较治疗前均有改善,差异均有统计学意义(P均0.05);研究组在语义流畅性、连线测验、符号编码、持续操作、情绪管理五项指标的评分低于对照组,差异均有统计学意义(P均0.05)。结论阿立哌唑联合奥拉西坦与单用阿立哌唑对精神分裂症疗效相当,但前者对精神分裂症认知功能损害的疗效优于单用阿立哌唑。     

阿立哌唑合并氯氮平对精神分裂症患者生活质量的影响

目的:探讨阿立哌唑合并氯氮平对精神分裂症患者生活质量的影响. 方法:将78例经急性期治疗达临床痊愈及显著进步的复发性精神分裂症患者按治疗方案分为研究组(38例)和对照组(40例),分别给予阿立哌唑合并低剂量氯氮平及氯氮平单药维持治疗.分别在维持治疗前、6及12个月时采用生活质量综合评定问卷(GQOLl-74)对两组患者生活质量进行评定和比较. 结果:维持治疗6及12个月时,两组GQOLl-74总分较维持治疗前显著提高,且研究组更显著(P＜0.01或P＜0.001);研究组的躯体功能、社会功能维度评分以及心理功能维度中自尊评分明显高于对照组(P ＜0.05或P＜0.01). 结论:阿立哌唑合并低剂量氯氮平维持治疗的精神分裂症患者生活质量优于单用氯氮平.     

阿立哌唑联合艾司西酞普兰对首发精神分裂症患者认知功能及社会功能的疗效

目的探讨阿立哌唑联合艾司西酞普兰对首发精神分裂症患者认知功能及社会功能的临床效果。方法将140例首发精神分裂症患者随机分为观察组和对照组,各70例,对照组给予阿立哌唑治疗,观察组给予艾司西酞普兰联合阿立哌唑治疗。治疗前及治疗6个月后,采用阳性和阴性症状量表(PANSS)、威斯康星卡片分类测验(WCST)、社会功能缺陷筛选量表(SDSS)评估患者临床症状、认知功能、社会功能。结果治疗前两组患者上述量表评分组间无明显差异(P0.05);治疗6个月后观察组PANSS各项评分明显低于对照组,WCST量表中的完成分类数、正确应答数、概念化水平百分比评分明显高于对照组,持续性错误数明显低于对照组,SDSS量表中的社会性退缩、家庭外活动、家庭内活动、家庭职能、个人生活自理、对外界兴趣评分均明显低于对照组,上述差异均有统计学意义(P0.05)。结论阿立哌唑联合艾司西酞普兰能更有效地缓解首发精神分裂症患者精神病性症状,改善其认知功能与社会功能。     

阿立哌唑对精神分裂症生活质量研究Meta分析

目的：研究阿立哌唑对精神分裂症患者生活质量的影响。方法：用Meta分析对7项关于阿立哌唑与其他抗精神病药影响精神分裂症患者生活质量比较分析的文献进行Meta分析。结果：在躯体功能、心理功能和社会功能维度3方面,阿立哌唑治疗前与治疗后组内比较的效应依次为-1.93、-2.61、-1.96,95%可信区间（CI）依次为（-3.51,-0.34）、（-4.16,-1.07）、（-3.76,-0.15）,阿立哌唑组与对照组治疗后组间比较效应依次为1.03、0.70、1.00,95%CI依次为（0.51,1.91）、（-0.14,1.53）、（-0.03,2.03）。结论：阿立哌唑改善精神分裂症患者生活质量明显,对躯体功能维度的改善优于对照药。     

心理治疗联合阿立哌唑治疗精神分裂症患者阴性症状的疗效

目的探讨阿立哌唑联合心理治疗对精神分裂症患者阴性症状的效果。方法采用随机数字表法,将2017年9月～2018年9月我院精神科收治的80例精神分裂症患者随机分组,对照组单用阿立哌唑治疗(n=40),观察组联用心理治疗(n=40)。用阳性和阴性综合征量表总分及阴性症状评分、疾病严重程度评分、抑郁症状评分、生活质量评分及认知功能评分对两组患者进行比较。结果两组治疗前,PANSS总分、阴性症状评分、疾病严重程度评分、抑郁症状评分、生活质量评分无差异(P0.05),治疗后12周,两组患者的各评分均有改善,且观察组优于对照组(P0.05);两组治疗前,认知功能量表评分无差异(P0.05),治疗后,两组患者持续错误数、随机错误数评分均有降低,总正确数、完成分类数评分均有升高,但观察组改善更为显著(P0.05)。结论阿立哌唑联合心理治疗可显著减轻精神分裂症患者的阴性症状和抑郁,改善疾病严重程度、提高生活质量,增强认知功能。     

阿立哌唑与利培酮治疗精神分裂症的对照研究

目的比较阿立哌唑与利培酮治疗精神分裂症患者的疗效、不良反应及生活质量的影响。方法将68例精神分裂症患者,随机分为阿立哌唑组（研究组）和利培酮组（对照组）,每组34例,分别给予阿立哌唑与利培酮治疗8周,采用阳性和阴性综合征量表（PANSS）评定疗效,治疗中需处理的不良反应症状量表（TESS）评定不良反应,以生活质量综合评定问卷（GQOLI-74）评定生活质量。结果两组治疗后第4、8周末PANSS量表总分及各因子分与治疗前比较均显著降低（P〈0．01）。两组不良反应均较轻微,研究组不良反应发生率61．8％,对照组不良反应发生率70．6％,两组不良反应总发生率差异无统计学意义（P〉0．05）。研究组不良反应主要为失眠,且多于对照组（P〈0．05）,对照组在口干、静坐不能、肌强直、体质量增加、泌乳、月经异常、血糖升高不良反应方面多于研究组（P〈0．05,P〈0．01）。治疗后第8周末与治疗前比较两组GQOLI-74总分、躯体健康、心理健康及社会功能均显著升高（P〈0．01）。结论阿立哌唑与利培酮治疗精神分裂症疗效相当,不良反应小,均可提高患者生活质量。     

齐拉西酮与阿立哌唑治疗首发女性精神分裂症的对照研究

目的 比较齐拉西酮与阿立哌唑治疗首发女性精神分裂症的临床疗效及安全性分析.方法 选择首发女性精神分裂症患者96例,随机分为齐拉西酮组和阿立哌唑组各48例.治疗3个月后比较两组患者的阳性和阴性综合征量表（PANSS）、阴性症状评定量表（SANS）、简明精神症状量表（BPRS）及治疗中需处理的不良反应症状量表（TESS）评分.结果 治疗后3个月两组PANSS、SANS、BPRS与治疗前比较,均有显著下降（P＜0.01）.治疗后3个月两组总有效率齐拉西酮组为91.7％,阿立哌唑组为87.5％.齐拉西酮组总不良反应发生率（29.2％）显著低于阿立哌唑组总不良反应发生率（50.0％）（P＜0.05）.齐拉西酮组的失眠、头痛头晕发生率少于阿立哌唑组（P＜0.05）.结论 齐拉西酮与阿立哌唑治疗首发女性精神分裂症疗效相当,且效果均显著.齐拉西酮安全性优于阿立哌唑.     

阿立哌唑联合认知干预对精神分裂症患者认知功能的影响

目的探讨阿立哌唑联合认知干预对精神分裂症患者认知功能的影响。方法将92例精神分裂症患者随机分为阿立哌唑联合认知干预组(研究组,n=46)和阿立哌唑组(对照组,n=46),疗程12周,采用PANSS评估患者的精神症状,WCST、CPT、TMT、CF、HVLT-R及WMS-Ⅲ评估患者的认知功能,TESS评估患者的不良反应。结果治疗12周末两组PANSS各项评分较治疗前均显著降低(P0.01),而研究组阴性症状分、一般症状分及总分较对照组显著降低(P0.05或0.01),阳性症状分较对照组则无明显变化(P0.05)。两组WCST、CPT、TMT、CF、HVLT-R及WMS-Ⅲ评分较治疗前均明显改善(P0.01),且研究组较对照组改善更加明显(P0.05或0.01)。两组患者TESS量表总分差异无统计学意义(P0.05)。结论阿立哌唑联合认知干预对改善精神分裂症患者的认知功能可能优于单用阿立哌唑治疗。     

Factors associated with satisfaction with care among patients with epilepsy

OBJECTIVE: The purpose of the work described here was to determine those variables associated with satisfaction with care among patients with epilepsy. METHODS: We interviewed patients followed at a tertiary epilepsy center. Predictor variables included age, gender, race, education, income, insurance, seizure frequency, and Quality of Life in Epilepsy-10 inventory (QOLIE-10) results. Target variables were the subscales of the Short Form Patient Satisfaction Questionnaire (PSQ-18). We used univariate analysis to identify those variables significantly associated with the subscales and multiple linear regression to determine those independently significant. RESULTS: The study population comprised 193 patients. Lower education and better QOLIE-10 scores were independently associated with general satisfaction with care. The mental health scale was associated with general satisfaction with care. Lower educational level was the only variable independently associated with patient satisfaction with communication, the financial aspect of care, and time spent with physician. CONCLUSION: Lower educational level and better quality of life are the main variables associated with higher general satisfaction with care among patients with epilepsy.     

Treatment with rituximab in patients with polyneuropathy with anti-MAG antibodies

Journal of Neurology -     

Surgical Outcome in Patients with Epilepsy with Occult Vascular Malformations Treated with Lesionectomy

Summary: Purpose: This retrospective study reports the long-term surgical outcome of patients with medically refractory epilepsy and vascular malformations who were treated with lesionectomy. A detailed analysis of surgical failures had been performed in an attempt to define predictors of surgical success and failure.
Methods: Fifteen patients with medically intractable epilepsy and angiographically occult vascular malformations (AOVMs) were treated surgically with lesionectomy at Duke University Medical Center. Lesionectomy consisted of removal of the AOVM and surrounding hemosiderin-stained brain only, without the use of electrocorticography (ECoG) to guide resection.
Results: Eleven (73%) patients are seizure free after lesionectomy. Three showed no significant improvement, and one patient died, presumably after a seizure. Age of onset, duration of seizures, age at resection, and gender did not affect outcome. All patients with neocortical AOVMs in whom EEG findings correlated with the site of the lesion were seizure free after lesional resection. Treatment failures were associated with the presence of multiple intracranial lesions, poorly localized or diffuse EEG findings, discordant positron emission tomography (PET) imaging, or with a lesion in close proximity to the limbic system.
Conclusions: Lesionectomy, with removal of surrounding hemosiderin-stained brain, can be considered the procedure of choice in carefully selected patients with epilepsy with occult vascular malformations.     

Children with ADHD and motor dysfunction compared with children with ADHD only

The purpose of this study was to identify group differences in children with attention-deficit-hyperactivity disorder and motor dysfunction (ADHD-MD) and ADHD only, and to evaluate the medication responsiveness of ADHD-MD. Sixty-three children (49 males and 14 females; mean age 9 years 10 months, SD 2 years 10 months) underwent a triple blind, placebo-controlled crossover study evaluating two dose levels of methylphenidate (0.3 mg/kg and 0.5 mg/kg [corrected], twice daily) and placebo. Forty-nine trials were completed. Nineteen were children with ADHD-MD, 44 had ADHD only. Behavior and functioning were assessed at home and at school. Treatment effects were assessed using the Abbreviated Symptom Questionnaire for Parents and Teachers. Children with ADHD-MD were more likely to have severe ADHD-combined type and other neurodevelopmental and behavioral problems. Both groups of children had a linear dose response to medication (placebo, low, high) and there was no evidence of a group by dose interaction or an overall group effect at home or school. The lack of group effect suggests that these children responded to medication like the other subgroups.     

Valproate is associated with new-onset oligoamenorrhea with hyperandrogenism in women with bipolar disorder.

BACKGROUND: Preliminary evidence suggests that valproate is associated with isolated features of polycystic ovarian syndrome (PCOS), while contradictory data support an association between epilepsy and PCOS. The development of PCOS features after initiation of valproate was therefore examined in women with bipolar disorder using a standardized definition of PCOS. METHODS: Three hundred women 18 to 45 years old with bipolar disorder were evaluated for PCOS at 16 Systematic Treatment Enhancement for Bipolar Disorder sites. A comparison was made between the incidence of hyperandrogenism (hirsutism, acne, male-pattern alopecia, elevated androgens) with oligoamenorrhea that developed while taking valproate versus other anticonvulsants (lamotrigine, topiramate, gabapentin, carbamazepine, oxcarbazepine) and lithium. Medication and menstrual cycle histories were obtained, and hyperandrogenism was assessed. RESULTS: Among 230 women who could be evaluated, oligoamenorrhea with hyperandrogenism developed in 9 (10.5%) of 86 women on valproate and in 2 (1.4%) of 144 women on a nonvalproate anticonvulsant or lithium (relative risk 7.5, 95% confidence interval [CI] 1.7-34.1, p = .002). Oligoamenorrhea always began within 12 months of valproate use. CONCLUSIONS: Valproate is associated with new-onset oligoamenorrhea with hyperandrogenism. Monitoring for reproductive-endocrine abnormalities is important when starting and using valproate in reproductive-aged women. Prospective studies are needed to elucidate risk factors for development of PCOS on valproate.     

血管内栓塞治疗未破裂脑动静脉畸形并发癫痫患者的预后分析

目的分析血管内栓塞治疗未破裂脑动静脉畸形(CAVM)并发癫痫患者的预后情况。方法选择2013年3月至2017年6月收治的符合诊断标准的CAVM并发癫痫发作患者49例为研究对象,分析血管内栓塞治疗后患者的临床症状、生活质量(QOLIE-31)改善情况。结果患者经血管内栓塞治疗后,QOLIE-31各项指标(除了药物影响)评分均明显提高,高于治疗前(P0.05);Spetzler-Martin分级与Engel分级的I~II级例数多于治疗前(P0.05),同时Spetzler-Martin分级I~II级生活质量评分(76.04±18.33)分明显高于III~V级的(65.65±16.76)分(P0.05);Engel分级I~II级的生活质量评分(75.25±17.78)分明显高于III~V级的(66.23±13.22)分(P0.05);血管内栓塞比例80%的生活质量总评分(78.37±18.87)分明显高于栓塞比例80%的(64.16±16.92)分(P0.05);术后患者的头疼症状中重度例数明显低于治疗前(P0.01);患者的NIHSS评分和MRS评分均明显低于治疗前,头疼症状的生活质量评分高于治疗前(均P0.05)。结论血管内栓塞能明显改善未破裂脑动静脉畸形并发癫痫患者的头疼症状、癫痫发作情况、神经功能缺损,提高血管内栓塞比例能够提高患者生活质量。