氟西汀合并奥氮平治疗难治性抑郁症的双盲对照研究

目的本研究探讨氟西汀合并奥氮平治疗难治性抑郁症的安全性和疗效。方法采用双盲对照研究,将52例诊断为难治性抑郁症的患者随机分为两组,一组采用氟西汀治疗,一组采用氟西汀合并奥氮平治疗,分别在治疗后第2、4、6、8周末,评定汉密顿抑郁量表(HAMD)和临床总体印象量表(CGI),同时采用Asberg抗抑郁剂副反应量表评定两组的药物副反应。结果氟西汀联合奥氮平治疗难治性抑郁症的疗效要明显优于单一应用氟西汀治疗(P<0.05),药物副反应两组间无明显差异(P>0.05)。结论氟西汀联合奥氮平治疗难治性抑郁症的疗效要明显优于单一应用氟西汀治疗(P<0.05),药物副反应两组间无明显差异(P>0.05)。     

奥氮平联用氟西汀治疗精神分裂症阴性症状的对照研究

目的 探讨奥氮平合并氟西汀治疗精神分裂症阴性症状的疗效和安全性.方法 将59例以阴性症状为主的精神分裂症患者随机分为研究组(奥氮平合用氟西汀治疗,30例)和对照组(单用奥氮平治疗,29例),于治疗前和治疗后第2、4、8、12周末使用阳性和阴性综合征量表(PANSS)和阴性症状量表(SANS)评定两组的疗效,药物治疗中需处理的不良反应症状量表(TESS)评定两组的不良反应.结果 治疗后第2周末研究组PANSS总分、阴性因子分较治疗前降低,差异有统计学意义(P＜0.05),治疗后第4周末研究组PANSS总分、阴性因子分及SANS总分、情感平淡因子分明显低于对照组,差异有统计学意义(P＜0.05,P＜0.01).两组TESS评分体质量改变差异有统计学意义(P＜0.05),余无明显差异.结论 奥氮平合并氟西汀能显著改善精神分裂症患者的阴性症状,且安全性好.     

氟西汀对慢性精神分裂症的辅助治疗作用

目的：探讨抗精神病药合并氟西汀治疗慢性精神分裂症的临床疗效。方法：对60例符合中国精神障碍分类与诊断标准第3版慢性精神分裂症诊断标准患者，在服用原抗精神病药不变的基础上随机分为合用组和对照组，分别给予合用氟西汀和安慰剂，治疗12周。以阳性与阴性症状量表(PANSS)评定临床疗效。结果：两组治疗后PANSS总分均比治疗前有显著降低，合用组阳性症状分有显著下降；两组间治疗后PANSS总分及各因子分差异均无显著性。结论：慢性精神分裂症合用氟西汀辅助治疗作用不大。     

氟西汀合并利培酮治疗难治性抑郁症的对照研究

目的 探讨氟西汀合并利培酮治疗难治性抑郁症的安全性和疗效.方法 将92例难治性抑郁症患者随机分为两组,研究组采用氟西汀合并利培酮治疗,对照组采用氟西汀治疗,分别在治疗后第2、4、8、12周末,评定汉密顿抑郁量表(HAMD)和临床总体印象量表(CGI),同时采用Asberg抗抑郁剂副反应量表评定两组药物的副反应.结果 根据HAMD评分,两组8周末减分率分别为(31.85±12.78)、(19.00±11.88),两组12周末减分率分别为(48.46±20.75)、(29.54±16.85),两组间差异均具有显著性意义(P＜0.05).根据CGI评分,两组8周末评分分别为(2.31±0.95)、(3.15±1.06),两组12周末评分分别为(2.00±1.00)、(2.92±1.19),两组间差异具有显著性意义(P＜0.05).药物副反应两组间无明显差异(P＞0.05).结论 氟西汀联合利培酮治疗难治性抑郁症的疗效好,副反应无明显增加.     

氟伏沙明与氯米帕明治疗躯体化障碍的随机对照研究

目的评价氟伏沙明与氯米帕明对躯体化障碍的临床疗效和不良反应。方法采用随机数字表法将符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)的92例躯体化障碍患者分为两组,分别给予氟伏沙明与氯米帕明治疗。氟伏沙明剂量(227.3±53.8)mg/d,氯米帕明剂量(205.5±32.7)mg/d。观察期8周。采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、副反应量表(TESS)评定疗效和不良反应。结果治疗8周后,氟伏沙明组与氯米帕明组总有效率比较差异无统计学意义(73.91%vs.69.57%,P0.05);两组HAMA、HAMD总评分及躯体性焦虑因子评分均较治疗前低(P0.05或0.01)。治疗2周末,氟伏沙明组HAMA评分及躯体性焦虑因子评分均较氯米帕明组低(P0.05)。两组不良反应发生率比较差异有统计学意义(28.26%vs.60.87%,P0.05)。结论氟伏沙明与氯米帕明治疗躯体化障碍疗效相当,氟伏沙明起效更快,不良反应更少。     

氟西汀和氯米帕明治疗中性强迫症的对照研究

目的 评价氟西汀和氯米帕明对难治性强迫症的疗效。方法 符合CCMD－2－R强迫症诊断标准的难治性病人共60例,随机分为两组,分别用氟西汀和氯米帕明系统治疗8周。采用耶鲁布郎强迫量表（Y－BOCS）和药物副反应量表（TESS）评价疗效及主要副反应。结果 两药的总体疗效相当;氟西汀对强迫性行为见效快,疗效好,副作用小,尤其是心血管系统及抗胆碱能副反应少,远期效果优于氯米帕明。结论 氟西汀尤其适用于伴有心血管痢疾而又以强迫行为为主的难治性强迫症病人。     

氟西汀、文拉法辛和吗氯贝胺治疗不典型抑郁症的疗效比较

目的比较不同作用机制的抗抑郁剂对不典型抑郁症的疗效和安全性。方法将100例不典型抑郁症随机分为氟西汀组(34例)、文拉法辛组(33例)和吗氯贝胺组(33例),给予相应的药物治疗8周。于治疗前、治疗后1、2、4、8周末应用汉密顿抑郁量表(HAMD,24项)和副反应量表(TESS)评定疗效和安全性;并于治疗前和治疗结束时检测血压、心电图、血常规。结果3组患者治疗前和治疗后1、2周末HAMD评分无显著性差异(P>0.05),第4周和第8周末氟西汀组HAMD评分显著高于文拉法辛和吗氯贝胺组(P<0.05或P<0.01);组内比较,氟西汀组第2周末开始HAMD评分显著下降(P<0.05),而吗氯贝胺与文拉法辛组第1周末HAMD评分显著下降(P<0.05),一直持续至第8周末。吗氯贝胺和文拉法辛组治疗结束时HAMD总分和迟缓因子分的减分显著高于氟西汀组(P<0.01)。氟西汀、文拉法辛和吗氯贝胺组的显效率分别为55.88%、72.73%和72.73%,经2检验文拉法辛和吗氯贝胺组的显效率显著高于氟西汀组(2=8.80和8.80,P均小于0.05)。3组副反应的发生率无显著性差异(P>0.05)。结论文拉法辛与吗氯贝胺对不典型抑郁症的疗效相当,起效迅速,优于氟西汀。     

米氮平治疗抑郁症临床研究

目的：比较米氮平与氟西汀治疗抑郁症的疗效及安全性。方法：将68例抑郁症患者随机分成米氮平组和氟西汀组，治疗6周。采用汉密尔顿抑郁量表(HAMD)、临床疗效总评量表(CGI)评定疗效，采用副反应量表(TESS)评定安全性。结果：米氮平较氟西汀起效快，治疗第1周两组比较差异有显著性，两组TESS评分差异无显著性。结论：米氮平是一种安全、见效快的新型抗抑郁剂。     

氟伏沙明与氯米帕明治疗青少年强迫症的对照研究

目的 比较氟伏沙明与氯米帕明治疗青少年期强迫症的疗效和不良反应.方法 共纳入强迫症患者42例,随机分为氟伏沙明组和氯米帕明组,疗程8周.应用耶鲁-布朗强迫症量表(Y-BOCS)、汉密尔顿焦虑量表(HAMA)评定疗效,治疗中需处理的不良反应症状量表(TESS)评价不良反应.结果 氟伏沙明组治疗总有效率86.4％,氯米帕明组治疗总有效率86.4％,两组比较差异无统计学意义(P＞0.05).两组治疗后第4、8周末Y-BOCS评分、HAMA评分与治疗前比较差异有显著统计学意义(P＜0.01).氟伏沙明组与氯米帕明组不良反应发生率差异有统计学意义(P＜0.05).结论 氟伏沙明对于青少年期强迫症状的治疗是安全有效的.     

抑郁症的药物治疗(二)氟西汀合用氯硝西泮治疗抑郁症对照研究

目的：评价氟西汀合用氯硝西泮对抑郁症的疗效。方法：将氟西汀、氯硝西泮和氟西汀、安慰剂作随机双盲对照治疗50例抑郁症,以汉密尔顿抑郁量表(HAMD)分值为依据,作疗效评定。以不良反应症状量表(TESS)评定副反应。结果：研究组显效时间平均为(12.31±4.65)天,2周末、3周末时减分率与对照组相比有显著差异。两组不同时间TESS总分无显著差异。结论：氟西汀合用氯硝西泮治疗抑郁症,起效早,减少自杀率及某些副反应。     

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.