阿立哌唑与氯氮平治疗精神分裂症Meta分析

目的：了解阿立哌唑与氯氮平治疗精神分裂症的疗效和不良反应差异。方法：应用Meta分析对17项研究阿立哌唑与氯氮平治疗精神分裂症对照研究的文章进行再分析,重新评价其疗效和不良反应。结果：阿立哌唑组治疗前后的自身对照,合并效应量d=3.62,95%CI（0.607,6.63）,综合显著性检验χ^2=8.52,P〈0.01,提示阿立哌唑治疗精神分裂症前后症状学变化差异有显著性,效应极强;阿立哌唑组与氯氮平组之间组间比较,d=0.043,95%CI（0.013,0.153）,综合显著性检验χ2=4.65,P〈0.05,提示这两种药物的疗效差异有统计学意义,差异效应很弱;阿立哌唑组的失眠,头痛不良反应显著较比氯氮平组多,（χ^2=27.95,P〈0.001;χ^2=15.54,P〈0.001）,氯氮平组的流涎、白细胞减少、嗜睡、体质量增加、便秘、心动过速、头晕等不良反应均显著较比阿立哌唑组为多（χ^2=39.11~360.60,P均〈0.001）。结论：阿立哌唑在平均8周左右的疗效显著优于氯氮平,不良反应却有显著不同。     

阿立哌唑与氯氮平治疗精神分裂症阴性症状对照研究的Meta分析

目的了解阿立哌唑与氯氮平治疗精神分裂症阴性症状疗效的差异。方法应用Meta分析对15项研究阿立哌唑与氯氮平治疗精神分裂症对照研究的文章进行再分析,评价其合并效应量的大小和综合显著性检验。结果①阿立哌唑治疗精神分裂症阴性症状前后的自身对照,合并效应量d=1．77,95％CI（1．65,1．89）,综合显著性检验χ^2=58．7,P〈0．001,提示阿立哌唑治疗精神分裂症阴性症状前后症状学变化有非常显著性差异,效应极强。②阿立哌唑与氯氮平的组间比较,d=0．223,95％CI（0．104,0．342）,综合显著性检验χ^2=4．15,P〈0．05,提示两种药物的疗效有统计学差异,差异效应弱。结论阿立哌唑与氯氮平在治疗精神分裂症阴性症状方面的疗效具有统计学差异（阿立哌唑优于氯氮平）,但差异效应弱。     

阿立哌唑与氯氮平治疗精神分裂症阴性症状对照研究的Meta分析

目的探讨阿立哌唑治疗精神分裂症阴性症状的疗效和不良反应的差异。方法应用Meta分析对10项阿立哌唑与氯氮平治疗精神分裂症阴性症状对照研究的文章进行再分析，评价其合并效应量大小和综合显著性检验。结果（1）阿立哌唑自身对照比较的治疗效应极大，合并效应量Y合并=-1．77，95％CI（-2．10，-1．43，Х^2=11．87，P〉0．05；（2）阿立哌唑与氯氮平在第2周末和治疗后组间的比较疗效没有显著差异，差异效应偏小，分别为Y合并=-0．01，95％CI（-0．17，0．14），Х^2=1．43，P〉0．05；Y合并＝-0．07，95％CI（-0．21，0．08），Х^2=7．88，P〉0．05；（3）阿立哌唑的不良反应显著少于氯氮平。结论阿立哌唑与氯氮平对阴性症状的疗效相仿，但阿立哌唑副作用少。     

阿立哌唑治疗精神分裂症对照研究的Meta分析

目的 探讨阿立哌唑与其他抗精神病药治疗精神分裂症的疗效和不良反应的差异.方法 用Meta分析对12项阿立哌唑与其他抗精神病药治疗精神分裂症对照研究的文章进行再分析,评价其合并效应量大小和综合显著性检验.结果 阿立哌唑治疗前后的自身对照,合并效应量d=2.64,95%CI为(2.33,2.96),综合显著性检验x2=16.55,P＜0.05,提示阿立哌唑治疗精神分裂症前后症状学变化有非常显著性差异,效应极强.阿立哌唑与对照药物在第2周末和治疗结束后的组间比较,分别为y合并=-0.08,95%CI为(-0.20,0.05),x2=1.15,P＞0.05;y合并=-0.07,95%CI为(-0.19,0.06),x2=1.00,P＞0.05.提示两组疗效相当,差异无统计学意义.阿立哌唑的恶心呕吐和失眠比对照组多,头昏头痛、便秘及视力模糊比对照组少,但两者之间均无统计学意义,其他不良反应均显著少于对照组(x2=8.88～19.89,P＜0.01).结论 阿立哌唑与对照组的疗效相当,不良反应明显不同.     

阿立哌唑与利培酮对精神分裂症患者血清催乳素影响的Meta分析

目的：探讨阿立哌唑与利培酮对精神分裂症患者血清催乳素（PRL）影响的差异。方法：应用Meta分析对7项阿立哌唑与利培酮对精神分裂症患者血清PRL影响对照研究的文章进行再分析,评价其合并效应量大小和综合显著性检验。结果：阿立哌唑组自身对照血清PRL水平差异效应极小,y合并=-0.08,95%CI（-0.25,0.06）,χ2=2.20,P〉0.05;利培酮组治疗后血清PRL水平显著高于治疗前,差异效应极大,d=3.06,95%CI（0.22,6.21）,χ2=85.90,P〈0.01。治疗4周和治疗结束后阿立哌唑组血清PRL水平显著低于利培酮组,差异效应极大,分别为d=-0.72,95%CI（-0.89,-0.49）,χ2=18.39,P〈0.05;y合并=-1.07,95%CI（-1.25,-0.88）,χ2=4.87,P〉0.05。阿立哌唑组月经紊乱、溢乳现象显著少于利培酮组。结论：阿立哌唑对精神分裂症患者血清PRL水平影响较小。     

阿立哌唑与氯氮平治疗首发精神分裂症对照研究

目的比较阿立哌唑与氯氮平治疗首发精神分裂症的疗效及安全性。方法将63例首发精神分裂症患者随机分为阿立哌唑组(n=32)和氯氮平组(n=31)进行治疗,疗程8周。采用PANSS量表和TESS量表评定疗效和不良反应。结果两组疗效差异无显著性(P>0.05),阿立哌唑不良反应显著少于氯氮平(P<0.01)。结论阿立哌唑与氯氮平治疗首发精神分裂症均有效,前者不良反应少,安全性高。     

阿立哌唑治疗精神分裂症阴性症状Meta分析

目的探讨阿立哌唑与其他抗精神病药治疗精神分裂症阴性症状的疗效差异。方法用Meta分析对24项阿立哌唑与其他抗精神病药治疗精神分裂症阴性症状文章进行再分析,评价其合并效应量大小和综合显著性检验。结果阿立哌唑治疗前后的自身对照,提示阿立哌唑治疗精神分裂症阴性症状疗效明显,效应极强（χ2=15.32,P〈0.01）;与其他抗精神病药比较差异无显著性。结论阿立哌唑治疗精神分裂症阴性症状疗效显著,与其他抗精神病药差异无显著性,但差异效应因药物不同而异。     

度洛西汀治疗老年抑郁症对照研究的Meta分析

目的探讨度洛西汀治疗老年抑郁症的疗效和不良反应的差异。方法应用Meta分析对10篇度洛西汀治疗老年抑郁症对照研究的文章进行再分析,评价其合并效应量大小并进行显著性检验。结果 1度洛西汀自身对照比较的治疗效应极大,合并效应量d=4.59,95%CI(3.01,6.17),χ2=21.5,P0.01;2度洛西汀与氯氮平在第2周末和治疗后组间比较,疗效差异无统计学意义(P0.05),差异效应偏小,分别为Y合并=-0.04,95%CI(-0.19,0.11),χ2=3.86,P0.05;Y合并=0.01,95%CI(-0.14,0.17),χ2=3.06,P0.05;3两组不良反应差异无统计学意义(P0.05)。结论度洛西汀治疗老年抑郁症疗效好,不良反应少。     

阿立哌唑与氯氮平治疗精神分裂症对照研究

目的:探讨阿立哌唑与氯氮平对首发精神分裂症患者的临床疗效及安全性。方法:对64例精神分裂症患者随机分为两组,分别给予阿立哌唑与氯氮平治疗,疗程8周。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:两组疗效差异无显著性(P>0.05),阿立哌唑不良反应显著少于氯氮平(P<0.01)。结论:阿立哌唑是一种安全有效的抗精神病药。     

阿立哌唑与小剂量氯氮平治疗难治性精神分裂症对照研究

目的探讨阿立哌唑合并小剂量氯氮平治疗难治性精神分裂症的疗效和安全性。方法将40例难治性精神分裂症患者随机分为A组(阿立哌唑合并小剂量氯氮平,n=20)和B组(单用氯氮平,n=20)。于治疗前和治疗第4、8、12周末采用阳性与阴性症状量表(PANSS)评定临床疗效;使用副反应量表(TESS)评定不良反应,并进行对比分析。结果 2组治疗后PANSS总分较治疗前明显降低,A组显著低于B组,差异有统计学意义。2组治疗12周末有效率分别是80%、50%,差异有统计学意义(χ2=3.95,P<0.05)。2组不良反应比较差异有统计学意义(P<0.05)。结论阿立哌唑合并小剂量氯氮平治疗难治性精神分裂症疗效好,不良反应少且依从性好。     

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.     

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.     

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.