国产奎硫平与氯丙嗪治疗精神分裂症的

目的 验证奎硫平治疗精神分裂症的疗效及安全性.方法 将221例精神分裂症患者随机分为奎硫平组(114例)和氯丙嗪组(107例),进行多中心双盲双模拟对照研究,两药治疗剂量均为200～800 mg/d,疗程8周.疗效指标包括阳性和阴性症状量表(PANSS)、简明精神病评定量表(BPRS)、临床总体印象量表(CGI).不良反应指标为不良反应量表(TESS)及有关实验室检查.结果 治疗结束时,两组PANSS和BPRS评分较入组时均显著减低(P<0.01);PANSS减分率奎硫平组为(65.9±27.8)%,氯丙嗪组为(66.5±26.4)%;临床总有效率奎硫平组68.1%,氯丙嗪组69.6%;两组疗效差异无显著性.奎硫平组的不良反应较氯丙嗪组少,其中活动减少、震颤、扭转痉挛、静坐不能、口干、视物模糊、便秘、头晕的发生率显著少于氯丙嗪组(P<0.01或0.05).结论 国产奎硫平治疗精神分裂症的疗效与氯丙嗪相似,某些不良反应较氯丙嗪轻而少;是一种有效、耐受性好的抗精神病药.     

奎硫平与氯丙嗪治疗精神分裂症的对照研究

目的验证奎硫平治疗精神分裂症患者的临床疗效与安全性。方法94例精神分裂症患者随机分成2组,奎硫平组48例,氯丙嗪组46例进行临床对照研究,分别给予奎硫平与氯丙嗪治疗8周。采用阳性症状与阴性症状量表（PANSS）评定临床疗效,副反应量表（TESS）记录不良反应。结果两组PANSS评分较治疗前均有显著下降（P均〈0．01）;临床显效率和总有效率奎硫平组为70．8％和87．5％,氯丙嗪组为67．4％和84．8％,两组间疗效比较无显著性差异（P〉0．05）。在阴性因子、认知因子、PANSS总分减分率方面,奎硫平组与氯丙嗪组有显著性差异（P〈0．01）。奎硫平组的各种不良反应发生率较氯丙嗪组低且轻微（P〈0．05）。结论奎硫平组与氯丙嗪组治疗精神分裂症疗效相似,奎硫平不良反应较氯丙嗪少,是1种有效、安全性高的抗精神病药,在改善认知功能和阴性症状方面,奎硫平优于氯丙嗪。     

奎硫平治疗精神分裂症对照研究

目的：探讨奎硫平治疗精神分裂症的疗效及安全性。方法：将90例精神分裂症患者随机平分为奎硫平组和氯丙嗪组各45例进行双盲对照研究，以简明精神病评定量表(BPRS)、阳性症状量表(SAPS)、阴性症状量表(SANS)、副反应量表(TESS)及有关实验室检查评定疗效及安全性。结果：治疗结束时两组患者的BPRS、SAPS、SANS评分较人组时均显著降低，两组相比则相仿。奎硫平组不良反应发生率少于氯丙嗪组。结论：国产奎硫平治疗精神分裂症的疗效与氯丙嗪相当，不良反应较少，是一种安全、有效的抗精神病药：     

奎硫平治疗女性精神分裂症患者的疗效

目的探讨奎硫平与传统抗精神病药物氯丙嗪对女性精神分裂症患者疗效及不良反应的差异。方法上海市精神卫生中心的女性精神分裂症住院患者105例,采用随机对照、开放性研究。奎硫平组48例,氯丙嗪组57例,治疗8周。以阳性与阴性症状量表(PANSS)评估疗效,以治疗中出现不良症状量表(TESS)评估不良反应。同时检测血糖、催乳素等生化指标。结果1.以PANSS量表作为评估指标,奎硫平与氯丙嗪的总体疗效相当(P>0.05)。2.不良反应方面:TESS量表评估显示氯丙嗪较奎硫平引起肌强直、震颤、扭转痉挛、静坐不能等椎体外系副反应发生率高,引起胆碱能系统不良反应:口干、视物模糊、便秘、鼻塞发生率高(P<0.05);奎硫平对血清催乳素水平无明显影响;奎硫平对血糖、体重影响较氯丙嗪小(P<0.05)。结论奎硫平对女性精神分裂症疗效与传统抗精神病药物氯丙嗪相当,不良反应较小。     

奎硫平与洛沙平治疗精神分裂症对照研究

目的:评价奎硫平与洛沙平治疗精神分裂症的疗效及不良反应。方法:对60例精神分裂症首次住院患者,随机平分为奎硫平组和洛沙平组,疗程6周。采用阳性与阴性症状量表(PANSS)及简明精神病评定量表(BPRS)评定疗效,用副反应量表(TESS)评定不良反应。结果:奎硫平组有效率93.3%,洛沙平组90.0%,两组疗效相仿。不良反应以奎硫平组显著较轻(P<0.05)。结论:奎硫平治疗精神分裂症的疗效优于洛沙平,不良反应较轻。     

奎硫平与利培酮治疗老年期精神分裂症的对照研究

目的　比较奎硫平与利培酮治疗老年期精神分裂症的临床疗效与安全性。方法　将68 例住院老年期精神分裂症患者,随机分成两组,分别给予奎硫平与利培酮治疗,疗程8 周。采用阳性症状量表和阴性症状量表(PANSS)评定疗效,用副反应量表(TESS)评定不良反应。结果　治疗8 周后PANSS总分较治疗前显著下降奎硫平组有效率91.2%,显效率为76.5%,利培酮组分别为88.2%和73.5%,两组比较差异无显著性(P>0.05)。奎硫平组不良反应少而轻。结论　奎硫平与利培酮治疗老年期精神分裂症患者疗效相当,奎硫平不良反应较轻,安全性好。     

奎硫平与利培酮治疗精神分裂症的对照研究

目的验正奎硫平治疗精神分裂症的疗效及安全性。方法将121例精神分裂症患者随机分为奎硫平组（61例）与利培酮组（60例）,并进行对照研究,两药治疗剂量分别为200—800mg／d,2～5mg／d,疗程8周。采用阳性和阴性症状量表（PANSS）、简明精神病评定量表（BPRS）、治疗中出现的症状量表（TESS）进行评定及有关实验室检查。结果治疗结束时,两组PANSS和BPRS评分较入组时均显著减低（P〈0．01）,PANSS减分率奎硫平组为（65．7±28．1）,利培酮组为（66．4±27．3）,临床总有效率奎硫平组为70．5％,利培酮组为73．3％;两组疗效差异无显著性。奎硫平组的不良反应较利培酮组少,其中活动减少、震颤、扭转痉挛、静坐不能、口干、视物模糊、便秘、头晕的发生率显著少于利培酮组（P〈0．01或0．05）。结论国产奎硫平治疗精神分裂症的疗效与利培酮相当,部分不良反应较利培酮轻而少,是一种有效、耐受性较好的新型抗精神病药。     

奎硫平与氯丙嗪对精神分裂症患者疗效及生活质量影响的对照研究

目的　探讨奎硫平、氯丙嗪对精神分裂症患者疗效及生活质量的影响。方法　对符合CCMD 2 R精神分裂症诊断标准的患者随机给予奎硫平 (4 0例 )、氯丙嗪 (37例 )治疗 6个月 ,采用阳性与阴性症状量表(PANSS)、副反应量表 (TESS)、世界卫生组织编制的生活质量量表 (WHOQOL 10 0 )观察疗效、副反应和生活质量的变化。结果　奎硫平组PANSS总分、阴性症状分低于氯丙嗪组 ,阳性症状分两组间差异无显著性 ,奎硫平组生活质量除精神支柱外均明显改善 ,在生活领域、心理领域、独立性领域、社会关系领域均较氯丙嗪组有显著改善。结论　奎硫平组生活质量优于氯丙嗪组。     

奎硫平与氯丙嗪治疗精神分裂症的对照研究

目的评价奎硫平与氯丙嗪治疗精神分裂症的疗效及不良反应。方法将60例精神分裂症患者随机分为两组,每组各30例,研究组给予奎硫平治疗,对照组给予氯丙嗪治疗,疗程12周。采用PANSS量表及副反应量表（TESS）评定临床疗效和不良反应。结果奎硫平组与氯丙嗪组治疗前PANSS量表阴性症状分、阳性症状分、总分差异无显著性（P〉0.05）。各组治疗后PANSS量表评分与治疗前比较差异有显著性（P〈0.05或P〈0.01）。奎硫平的不良反应较氯丙嗪轻。结论奎硫平治疗精神分裂症疗效显著、安全、经济,疗效虽然与氯丙嗪相当,而前者不良反应相对较轻,安全性更好,对临床选择用药具有一定的借鉴作用。     

奎硫平治疗精神分裂症患者的疗效及生活质量影响

目的:探讨奎硫平与氯丙嗪对精神分裂症患者的疗效及生活质量的影响。方法:对62例精神分裂症患者,随机使用奎硫平和氯丙嗪治疗,疗程3个月。采用阳性与阴性症状量表(PANSS)评定疗效,采用治疗中出现的症状量表(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:两组均有显著疗效,奎硫平可显著提高生活质量。两组间无显著差异(P>0.05)。氯丙嗪组不良反应比奎硫平组多。结论:奎硫平和氯丙嗪对精神分裂症疗效相当,奎硫平不良反应较少,对提高患者生活质量的效果明显优于氯丙嗪。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.