癫癎患者生活质量的研究

目的探讨成年癫癎患者生活质量状况及其影响因素.方法实验组86例癫癎患者,对照组59名健康自愿受试者.用世界卫生组织生存质量量表中文版简表(Q0 L-BREF)、癫癎患者生活质量量表(QOLIE-31)评定生活质量;用症状自评量表评价心境健康;分析各种影响因素的作用.结果实验组生活质量在心理领域得分比对照组低(P＜0.05);除精力/疲乏领域外的各领域均有50%以上实验组QOLIE-31得分低于平均水平;实验组的抑郁、焦虑分均比对照组明显增高(P＜0.0001);影响QOLIE总分的三个因素按作用大小依次是抑郁、焦虑和用药种数.结论癫癎患者生活质量下降,心境健康恶化;对总体QOLIE影响最大的因素是抑郁、焦虑和用药种数.     

成年癫(癎)患者的抑郁情绪相关因素及生活质量研究

目的 调查成年癫(癎)患者抑郁的患病率及可能的危险因素;评价各种危险因素对癫(癎)伴发抑郁患者生活质量的影响.方法 采用Beck抑郁问卷(BDI)及癫(癎)患者生活质量量表-31(QO-LIE-31 中文版),并自制一般情况调查表对患者进行测查.用χ2检验、t检验及Logistic多元回归分析.结果 在120例成年癫(癎)患者中47.5%伴发抑郁.负性影响癫(癎)患者伴发抑郁的因素为发作频率,而正性影响因素根据影响程度的大小依次为职业和对癫(癎)相关知识的掌握情况.结论 癫(癎)患者抑郁发生率高且受多种因素的影响.积极控制癫(癎)发作、为癫(癎)患者提供更多的就业机会及对癫(癎)患者做好相关知识宣传、增加患者对癫(癎)相关知识的掌握程度是改善癫(癎)患者生活质量的重要因素.     

抑郁、焦虑对癫(癎)患者健康相关生存质量的影响

目的 调查癫(癎)患者健康相关生存质量和情绪健康状况,探讨各种因素对患者生存质量的影响.方法 使用世界卫生组织(WHO)生存质量量表中文版简表(QOL-BREF)附加癫(癎)生存质量量表(QOLIE)-31(中文版)、抑郁自评量表(SD5)、焦虑自评量表(SAS)进行生存质量和心境健康状况调查.多元逐步回归分析各种因素对生存质量的影响.结果 癫(癎)患者(n=141)在WHOQOL-BREF的生理、心理领域得分(分别为12.7±1.8、12.4 4-1.9)比常模下降(15.1±2.3、13.9±1.9,t=11.75、8.625,P<0.05);有抑郁情绪者占57.4 % ,有焦虑情绪者占39.7 % .合并抑郁、焦虑情绪的癫(癎)患者在除外QOLIE-31药物的影响领域的生存质量各个领域得分均减低;多元逐步回归结果显示,影响QOLIE总分的3个因素按影响作用大小依次是焦虑、抑郁和病程.结论 合并抑郁、焦虑情绪障碍,病程长是癫(癎)患者生存质量下降的重要因素.     

拉莫三嗪对癫癎患者生活质量影响的研究

目的:评价拉莫三嗪对癫癎患者生活质量的影响.方法: 采用多中心、前瞻性的研究方法,对新诊断癫癎患者应用拉莫三嗪治疗,并在基线期及用药6个月后,采用QOLIE-31、MOS SF-36量表、数字符号转换测验、HAMD抑郁量表和女性专用调查问卷对患者进行生活质量评价.结果: 共纳入新诊断癫癎患者282例.MOS SF-36量表的8个项目得分在用药后均有显著提高(P<0.01);QOLIE-31问卷中"对癫癎的担心","情绪"、"活力","认知","药物不良反应"、"社会功能"及"总体自身健康评价"项目得分在用药后均有显著提高(P<0.01).用药后,患者Hamilton抑郁量表平均3.65分,显著低干基线期6.42分(P<0.01);数字符号转换测验得分在用药后与基线期比较有显著提高(P<0.01).结论: 拉莫三嗪初始单药治疗能在一定程度上改善新诊断癫癎患者的生活质量.     

焦虑、抑郁情绪对癫(癎)患者生活质量的影响

目的 探讨焦虑、抑郁情绪对癫(癎)患者生活质量的关系.方法 应用生活质量综合评定问卷(GQOLI)、Zung焦虑自评量表 (SAS)及Zung抑郁自评量表 (SDS)对60例癫(癎)患者(癫(癎)组)及60名健康自愿者(对照组)进行评定,并对生活质量与焦虑、抑郁作相关分析.结果 癫(癎)患者的生活质量总分及躯体功能、心理功能、社会功能、物质生活4个维度分均明显低于对照组(P＜0.01),而SAS及SDS评分则均明显高于对照组(P＜0.01);生活质量总分及躯体功能、心理功能、社会功能、物质生活4个维度分均与SAS及SDS评分呈显著性负相关.结论 癫(癎)患者的生活质量较差,焦虑、抑郁情绪明显;其生活质量与焦虑、抑郁情绪密切相关.     

西藏农村地区惊厥性癫(癎)患病率初步调查

目的 初步调查西藏农村地区惊厥性癫(癎)患病率、治疗缺口及患者生活质量.方法 利用统一的调查表,对西藏拉萨市墨竹工卡县工卡镇和扎西岗乡、昌都地区芒康县曲孜卡乡进行整群逐户问卷调查.结果 共调查14 822人,确诊惊厥性癫(癎)患者37例,患病率0.25%,其中活动性癫(癎)患者35例(94.59%),患病率为0.24%.调查前1周内接受西药正规治疗者1例,治疗缺口为97.1%.癫(癎)患者生活质量评定量表-31(QOLIE-31)总评分平均为(42.15±17.63)分,其中各分项得分中发作担忧得分最低[(22.59±20.31)分]、药物影响的评分最高[(85.83±18.59)分].年龄、职业、文化程度、经济状况、起病年龄、发作次数为QOLIE-31低评分的影响因素(P＜0.05).结论 西藏农村地区惊厥性癫(癎)患病率为0.25%,西药治疗缺口大,主要以藏医藏药治疗为主,对西药治疗癫(癎)的了解很少,生活质量评分低.探索藏西医结合防治癫(癎)、提高当地医护人员的癫(癎)防治知识及公众的健康意识迫在眉睫.     

藏族全面性强直阵挛性癫(癎)患者生活质量及其影响因素的调查

目的调查藏族地区全面性强直阵挛性癫癎患者生活质量及其影响因素。方法应用癫癎患者生活质量评定量表-31(QOLIE-31)对126例确诊为全面性强直阵挛性癫癎的藏族患者进行生活质量评定,并对影响其生活质量的因素进行分析。结果QOLIE-31总评分为(48.58±17.29)分,分项中对发作担忧评分最低[(32.92±22.97)分],药物影响的评分最高[(77.11±20.98)分]。单因素分析显示:不同性别、职业、婚姻状况、年龄、文化程度的生活质量评分差异有统计学意义(均P<0.05);而不同发作频率、治疗与否评分差异无统计学意义。多因素分析表明,年龄、起病年龄、职业、文化程度、经济状况、发作次数是影响藏族全面性强直阵挛性癫癎患者生活质量的因素(均P<0.05);其中年龄、职业影响生活质量多个方面,而病程、婚姻状况、性别不是影响因素。结论藏族全面性强直阵挛性癫癎患者的生活质量差;职业、经济状况、文化程度、年龄、起病年龄、发作频率是影响生活质量的因素;年龄、职业影响生活质量的多个方面。     

成年癫癎患者合并抑郁障碍的临床研究

目的研究成年癫癎患者合并抑郁障碍的主要影响因素。方法应用24项汉密尔顿抑郁量表进行测评,并对癫癎合并抑郁障碍的相关危险因素进行分析。结果癫患者抑郁障碍发生率显著高于对照组。就业状况、病程、使用抗癫癎药物治疗方式、难治性癫、合并其他疾病为癫患者合并抑郁障碍的相关危险因素。结论癫癎合并抑郁障碍的发病率高。早期诊断及治疗癫合并抑郁障碍对提高患者临床疗效及生活质量有重要意义。     

焦虑、抑郁情绪对癫患者生活质量的影响

目的 探讨焦虑、抑郁情绪对癫(癎)患者生活质量的关系.方法 应用生活质量综合评定问卷(GQOLI)、Zung焦虑自评量表 (SAS)及Zung抑郁自评量表 (SDS)对60例癫(癎)患者(癫(癎)组)及60名健康自愿者(对照组)进行评定,并对生活质量与焦虑、抑郁作相关分析.结果 癫(癎)患者的生活质量总分及躯体功能、心理功能、社会功能、物质生活4个维度分均明显低于对照组(P＜0.01),而SAS及SDS评分则均明显高于对照组(P＜0.01);生活质量总分及躯体功能、心理功能、社会功能、物质生活4个维度分均与SAS及SDS评分呈显著性负相关.结论 癫(癎)患者的生活质量较差,焦虑、抑郁情绪明显;其生活质量与焦虑、抑郁情绪密切相关.     

左乙拉西坦添加治疗对青年癫(癎)患者生活质量影响的研究

目的 评价新型抗癫(癎)药物左乙拉西坦添加治疗青年难治性部分性癫(癎)患者的疗效,以及对患者生活质量的影响.方法 30例诊断明确的部分性发作青年患者随机分为左乙拉西坦组和吡拉两坦组,计算左乙拉西坦治疗第12周末时治疗有效率;依据癫(癎)生活质量量表-31分别评价两组患者在左乙拉西坦剂量维持期(12周)和开放性治疗期(12周)的生活质量.结果 治疗第12周末时,左乙拉西坦组治疗有效率(43.75%,7/16)高于吡拉两坦组(35.72%,5/14;Fisher精确概率法:P=0.031),生活质最明显改善(与基线比较:t=3.905.P=0.001).治疗第24周末时,两组患者生活质量较治疗前均显著改善(左乙拉西坦组:t=4.940,P:0.021;吡拉西坦组:t=2.575.P=0.023).结论 左乙拉两坦作为抗癫(癎)药的添加治疗药物,能够显著减少青年难治性部分性癫(癎)患者的发作频率,快速有效地提高患者生活质量.     

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.     

Summary of Legislation of 1933 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -