加用银杏叶制剂治疗慢性精神分裂症的疗效观察

目的了解银杏叶制剂(舒血宁)对慢性精神分裂症阴性症状的疗效和副反应。方法对48例经抗精神病药物治疗疗效不佳的病人，采用舒血宁片合并原抗精神病药物12周的动态观察治疗，用简明精神病评定量表(BPRS)、阴性症状量表(SANS)、副反应量表(TESS)和临床总体印象量表(CGI)评定患者症状变化和副作用。结果舒血宁片对慢性精神分裂症阴性症状有明显疗效，临床有效率为72．9％，BPRS总分，BPRS—ANEC分量表分，SANS总分．SANS五项总评以及CGI严重程度评分均明显下降，而且能减轻原抗精神病药物的副反应。结论舒血宁台并抗精神病药物治疗慢性精神分裂症阴性症状有较好的疗效。     

奎的平、舒必利治疗伴抑郁症状的精神分裂症对照研究

目的了解奎的平对伴有抑郁症状精神分裂症的疗效。方法采用对照研究的方法，将具有抑郁症状的精神分裂症患者46例分两组：其中奎的平组22例，舒必利组24例。于治疗前及治疗后第2、4、6、8周末做简明精神病量表(BPRS)、阴性症状量表(SANS)、汉密顿抑郁量表(HAMD)、临床总体印象量表——疗效总评(CGI-GI)、副反应量表(TESS)评定。结果奎的平对精神病性症状的有效率为72．7％，对抑郁症状的有效率为77．1％，与舒必利相比在抗精神病方面无显著性差异，在抗抑郁方面，奎的平优于舒必利。奎的平的副作用少．于舒必利。结论奎的平对精神分裂症的阳性症状、阴性症状和抑郁症状均有较好的疗效。     

西酞普兰和氯丙咪嗪治疗精神分裂症后抑郁对照研究

目的比较西酞普兰与氯丙咪嗪治疗精神分裂症后抑郁的临床疗效和安全性。方法50例诊断为精神分裂症后抑郁的患者,随机分成两组,分别用西酞普兰与氯丙咪嗪治疗6周。采用汉密尔顿抑郁量表(HAMD)、简明精神病评定量表(BPRS)、阴性症状评定量表(SANS)及副反应量表(TESS),于治疗前和治疗2、4、6周末分别评定疗效和副反应症状。结果西酞普兰组与氯丙咪嗪组HAMD评分差异无显著性。西酞普兰组副反应症状较氯丙咪嗪组少而轻。结论西酞普兰治疗精神分裂症后抑郁的临床疗效好,安全性高,不良反应轻微。     

首发精神分裂症患者临床特点的性别差异

目的:探讨首发精神分裂症患者临床症状及社会功能的性别差异.方法:164例首发精神分裂症患者在治疗前和治疗后12周及1年时分别主定简明精神病评定量表(BPRS),阴性症状评定量表(SANS),功能大体评定量表(GAF),Simpson锥体外系副反应量表(SAEPS)及社会功能缺陷筛选量表(SDSS),结果:男女精神分裂症患者起病年龄,病程,受教育年限及阳性家族史的比例差异无显著性,但女性的已婚率(57.1%),显著高于男性(20.7%),治疗前后阴阳性症状及治疗后SAEPS总分,药物剂量男女差异皆无显著性,治疗前后女性的社会功能(尤其在躯体活动和家庭职能方面)显著优于男性,结论:首先精神分裂症患者的临床特征在治疗前和治疗后一年中无性别差异.但女性的社会功能优于男性.     

偏执型与非偏执型首发精神分裂症患者认知功能及精神症状的比较

目的　探讨偏执型与非偏执型精神分裂症患者认知功能及精神症状的特征。方法　以美国精神障碍诊断与统计手册第 4版诊断标准 ,将 1 64例首发精神分裂症患者分为偏执型组 (1 1 9例 )及非偏执型组 (45例 ) ;分别进行韦氏成人智力量表、韦氏记忆量表、铁槽铁钉测验、利手测验、动作功能测验、手功能协调测验、连线测验A和B、威斯康星卡片分类测验及自编言语流利性测验 1 0项神经心理测查 ,并评定简明精神病评定量表 (BPRS)、修订的阴性症状评定量表 (SANS)、临床总体印象量表、功能总体评定量表 (GAF)。结果　 (1 )认知功能 :偏执型组与非偏执型组各项认知功能的差异均无显著性 (均P >0 0 5)。 (2 )临床症状 :偏执型组与非偏执型组BPRS中的迟滞因子 [分别为 (5 2±1 3)分和 (7 0± 2 7)分 ]、思维障碍 [分别为 (1 3 9± 2 6)分和 (1 2 5± 3 0 )分 ]、SANS总分及各项因子分、GAF评分 [分别为 (37 1± 7 2 )分和 (32 7± 8 1 )分 ]的差异均有非常显著性 (均P <0 0 1 )。结论精神分裂症不同亚型的认知损害不具特征性 ,不能依此作为诊断依据     

氯氮平撤药症状调查

目的：了解氯氮平的撤药症状。方法：对31例服用氯氮平治疗的精神分裂症患者停药1周，分别于停药前后予简明精神病评定量表(BPRS)、副反应量表(TESS)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评定疗效及不良反应。结果：停药后BPRS、TESS、HAMD、HAMA总分均明显高于停药前，停药后有25例(80％)精神症状恶化。结论：氯氮平的撤药症状发生频率高，症状多样。     

精神分裂症住院病人中的抑郁症状

本文对符合现代诊断标准的102例精神分裂症病人,用BPRS及HAMD对其临床症状进行分析。结果表明,有41.2％的病人有抑郁症状(HAMD>17分)。仅用抗精神病药物治疗,随着病情的缓解,BPRS分值下降,HAMD分值亦随之下降(P<0.00),说明这些抑郁症状乃属分裂症本身症状的一部分。本文对精神病后抑郁等临床问题也进行了分析讨论。     

西酞普兰与文拉法辛治疗精神分裂症后抑郁的对照研究

目的 比较西酞普兰与文拉法辛治疗精神分裂症后抑郁症状的疗效和安全性.方法 50例精神分裂症后抑郁患者随机分为2组,分别用西酞普兰和文拉法辛治疗6周.采用汉密尔顿抑郁量表(HAMD),简明精神病量表(BPRS)和副反应评定量表(TESS)于治疗前和治疗1、2、4、6周末分别评定疗效和不良反应.结果 2组治疗后HAMD和 BPRS评分均较治疗前下降(P＜0.01),2组疗效无显著性差异(P＞0.05),2组不良反应发生率无显著性差异(P＞0.05).结论 西酞普兰与文拉法辛治疗精神分裂症后抑郁疗效相当,安全性高,不良反应轻微.     

氯氮平治疗首发精神分裂症临床效应及影响因素分析

目的　探讨氯氮平治疗首发精神分裂症的效能及影响因素对指导临床用药有很大的实用性。　　方法　 3 0例首发精神分裂症病人均按规定剂量给药 ,选用简明精神症状评定量表 (BPRS)、阴性症状评定量表 (SANS)、临床总体印象量表 (CGI)、总体功能评定量表 (GAF) ,在治疗前及治疗第1、2、4、8、1 2周进行临床评定及血药浓度、催乳素 (PRI)检测 ,治疗前威斯康辛卡片分类测验 (WC ST)。　　结果　氯氮平对首发精神分裂症的阳性、阴性症状均有显著的疗效 ,且起效迅速。此外发现血药浓度大于 40 0 μg/L、基础PRL水平低于 1 1 μg/L、WCST检查表现好的患者 ,选用氯氮平治疗有好的疗效。　　结论　氯氮平可作为较好的一线药物 ,广泛应用于首发精神分裂症的治疗     

首发精神分裂症患者认知功能好转的相关因素研究

目的 探讨精神分裂症患者在急性期与慢性期认知功能好转的相关因素。方法 对164例首发精神分裂症患者于治疗前、治疗三个月末和治疗三年末各做一次韦氏成人智力量表、韦氏记忆量表、铁槽铁钉测验、手指敲击试验、动作功能测验、手功能协调测验、连线测验A和B、威斯康星卡片分类测验(WCST)及言语流利性测验10项神经心理测查及BPRS、SANS、功能总体评定量表(GAF)、SIMP-SON药物副反应量表评定。结果 在急性期阴性症状好转程度越大,智力、记忆好转程度越大;在慢性期阴性症状、GAF以及副反应的改善与多种认知功能改善显著相关。结论 精神分裂症患者阴性症状、GAF、药物副反应的改善与认知功能好转有关,但在急性期和慢性期的特征不同。     

精神分裂症伴发抑郁症状及其临床特征

目的 了解急性期住院精神分裂症患者伴发抑郁症状的发生率、临床特征及其相关因素。方法 对符合CCMD-3诊断标准的精神分裂症患者75例，分别于入院3天内评定PA．NSS、HAMD、TESS量表。结果 急性期抑郁发生率为30．7％，抑郁组与非抑郁组性别、婚姻、文化、年龄无显著性差异，抑郁组平均住院次数、偏执型精神分裂症所占比例多于非抑郁组。治疗前汉密顿抑郁量表总分与阴性量表、思维障碍症状群、反应缺乏症状群负相关，与一般精神病理量表、抑郁症状群正相关。结论 精神分裂症抑郁症状急性期较常见、较严重，偏执型精神分裂症更易出现抑郁症状。     

Depression in the long-term course of schizophrenia

Abstract Depressive symptoms are quantitatively and qualitatively among the most important characteristics of schizophrenia. The following contribution reports on the prevalence of depression in 107 patients of the ABC schizophrenia study over 12 years after first hospital admission, looks into a preponderance of depression at certain stages of the illness and the predictive value of depressive symptoms for course and outcome. All but one of the 107 patients experienced one to 10 episodes of depressed mood between index assessment and long-term follow-up. In any month of the observation period about 30–35% of the patients presented at least one symptom of the depressive core syndrome (depressive mood, loss of pleasure, loss of interests, loss of self-confidence, feelings of guilt, suicidal thoughts/suicide attempt). Depressive symptoms are particularly frequent during a psychotic episode at a rate of approximately 50%. There were moderate but statistically significant correlations between the amount of depressive symptoms during a psychotic episode and the frequency of relapses, defined by hospital admissions as well as the total length of inpatient treatment. Depression occurring in the interval was not associated with an increased need for inpatient treatment.     

精神分裂症的抑郁症状及其与疗效的关系

目的了解急性期住院精神分裂症患者伴发抑郁症状的影响因素以及抑郁症状与治疗结果间的关系。方法对符合CCMD-3诊断标准的精神分裂症患者75例,分别于入院3天内及每2周评定PANSS、HAMD、TESS量表,持续8周。结果偏执型精神分裂症、多次住院、年龄较小、受教育的时间较少者易出现抑郁症状。治疗后汉密顿抑郁量表总分与一般精神病理量表、抑郁症状群、TESS正相关。治疗前HAMD评分与治疗8周末PANSS总分减分率正相关。结论精神分裂症不同阶段抑郁症状的发生率不同,急性期精神症状与抑郁症状同时出现时,患者的治疗效果较好。偏执型精神分裂症、多次住院、年龄较小、受教育的时间较少是分裂症患者出现抑郁症状的危险因素。     

Depression during an acute episode of schizophrenia or schizophreniform disorder and its impact on treatment response

The aim of the present study was to examine the relevance of depressive symptoms during an acute schizophrenic episode for the prediction of treatment response. Two hundred inpatients who fulfilled DSM-IV criteria for schizophrenia or schizophreniform disorders were assessed at hospital admission and after 6 weeks of inpatient treatment using the Positive and Negative Syndrome Scale (PANSS) and the Hamilton Rating Scale for Depression (HAM-D). Depressive symptoms showed positive correlations with both positive and negative symptoms at admission and after 6 weeks, and decreased during 6 weeks of treatment. Pronounced depressive symptoms (HAM-D score> or =16) were found in 28% of the sample at admission and in 9% after 6 weeks of treatment. Depressive symptoms at admission predicted a greater improvement of positive and negative symptoms over 6 weeks of treatment, but also more, rather than fewer remaining symptoms after 6 weeks. Both results, however, lost statistical significance when analyses were controlled for the influence of positive and negative symptoms at admission. Therefore, the hypothesis that depressive symptoms are predictive of a favorable treatment response was not supported by the present study.     

老年脑梗死患者恢复期抑郁障碍的临床研究

目的 探讨老年脑梗死患者恢复期抑郁障碍的特点。方法 对87例老年脑梗死患者行汉密尔顿抑郁量表(HAND)和改良爱丁堡-斯堪的那维亚量表(SSS)评定。以HAMD总分20分为界限分为抑郁组和非抑郁组。结果 两组HAMD总分及因子分的差异有统计学意义,抑郁组均高于非抑郁组。两组脑梗死灶数量的差异无统计学意义。两组左侧、右侧及双侧梗死比较无显著性差异。两组SSS总分的差异有统计学意义,抑郁组神经功能缺损程度比非抑郁组严重。HAMD总分和因子分与神经功能缺损程度呈正相关。结论 抑郁是老年脑梗死患者恢复期常见的并发症,且抑郁已达中等严重程度。神经功能缺损严重的病人易产生抑郁障碍。     

Self-experienced vulnerability, prodromal symptoms and coping strategies preceding schizophrenic and depressive relapses.

For the first time, the present study explores pre-episodic disturbances, i.e. self-experienced vulnerability and prodromal symptoms, and related coping strategies preceding schizophrenic and depressive relapses. After complete recovery from the acute episode, 27 patients with recurrent schizophrenic and 24 patients with recurrent depressive episodes were assessed retrospectively for pre-episodic disturbances and related coping strategies with the "Bonn scale for the assessment of basic symptoms-BSABS". All (100%) of the schizophrenic and 23 (96%) of the depressive patients showed pre-episodic disturbances. Patients with schizophrenia showed significantly more often an increased emotional reactivity and certain perception and thought disturbances. Depressive patients reported significantly more often an impaired tolerance to certain stress and disorders of emotion and affect. Sixty-three percent of the schizophrenics and 87% of the depressives reacted to pre-episodic disturbances with coping strategies. The pre-episodic disturbances in patients with schizophrenia could be described in terms of mild psychotic productivity, those in depressives in terms of mild depressive syndrome. Future studies will have to show if these findings can be replicated in first episode or initial prodromal state samples and if the assessment of mild psychotic productivity and mild depressive syndrome can be used for early diagnosis and early intervention in schizophrenia and depression.     

Depressive symptoms in schizophrenia.

OBJECTIVE: The authors assessed the presence and severity of depressive symptoms, as well as their associations with other clinical measures, in a group of mid- to late-life patients with schizophrenia who were not in a major depressive episode or diagnosed with schizoaffective disorder. METHOD: Sixty outpatients with schizophrenia between the ages of 45 and 79 years and 60 normal comparison subjects without major neuropsychiatric disorders, proportionally matched for age and gender, were studied. Depressive symptoms were rated primarily with the Hamilton Depression Rating Scale. Standardized instruments were also used to measure global psychopathology, positive and negative symptoms, abnormalities of movement, and global cognitive status. RESULTS: Depressive symptoms were more frequent and more severe in schizophrenic patients than in normal comparison subjects; 20% of the women with schizophrenia had a Hamilton depression scale score of 17 or more. Severity of depressive symptoms correlated with that of positive symptoms but not with age, gender, negative symptoms, extrapyramidal symptoms, or neuroleptic dose. CONCLUSIONS: Depressive symptoms are common in older patients with schizophrenia. They may be an independent, core component of the disorder or, alternatively, may be a by-product of severe psychotic symptoms.     

Depressive symptoms in stable chronic schizophrenia: prevalence and relationship to psychopathology and treatment

The prevalence and correlates of the depressive syndrome were explored in a population of 120 patients with stable, chronic schizophrenia living in the community. The presence of clinically significant depressive symptoms was defined by a score of 17 or greater on the Beck Depression Inventory. Patients were examined to assess severity of schizophrenic symptoms and medication side-effects. Sixteen of the 120 patients (13.3%) had significant depressive symptoms. Depressive symptoms were significantly correlated with the hostility/suspiciousness (P<0.0001), the positive symptom (P=0.0009) factor of the BPRS and with scores on the Significant Others Scale, a measure of patients' perceived lack of social support (P=0.0004). The association between depression and akathisia approached significance (P=0.007). There was no correlation with demographic variables, alcohol intake, antipsychotic dosage or anticholinergic dosage. Using a scale that rates the subjective aspects of the depressive syndrome, we found no evidence of a relationship between depression and negative symptoms in this population. These results indicate that persistent depressive symptoms in stable patients in the community are related to the degree of persistent positive psychotic symptoms, patient perceptions of social support and, weakly, to the degree of akathisia but not other aspects of antipsychotic treatment.     

Differentiating primary from secondary negative symptoms in schizophrenia: a study of neuroleptic-naive patients before and after treatment

OBJECTIVE: The study examined the primary versus secondary character of negative symptoms in a group of first-episode, neuroleptic-naive psychotic patients before and after they started neuroleptic treatment. METHOD: Forty-seven inpatients with a first episode of schizophrenia or related psychotic disorders were examined for the presence of negative symptoms, psychosis, depression, and parkinsonism at admission to an inpatient psychiatric unit, before receiving neuroleptics, and at discharge an average 3.3 weeks later, after starting neuroleptic treatment. RESULTS: Although patients' mean scores on measures of positive, negative, and depressive symptoms decreased significantly over the treatment period, the mean rating of nonakinetic parkinsonism worsened. The mean rating of akinetic parkinsonism did not change significantly over the treatment period. Negative symptoms at admission were not predicted by positive or depressive symptoms at admission. Residual negative symptoms at discharge were mainly predicted by negative symptoms at admission (i.e., primary symptoms) and to a negligible degree by residual positive and depressive symptoms. Change in negative symptoms over the observation period was predicted to a marginal degree by change in depressive symptoms. CONCLUSIONS: Negative symptoms rated during a first psychotic episode before and after starting antipsychotic treatment are mainly primary in character and should be considered as a direct manifestation of the basic dysfunctions of schizophrenia.     

Distinguishing depression and negative symptoms in unmedicated patients with schizophrenia

Depression can occur in schizophrenia but can be difficult to distinguish from negative symptoms of the illness. To evaluate whether concurrent use of the Hamilton Rating Scale for Depression (HRSD) and the Brief Psychiatric Rating Scale (BPRS) could successfully separate depression and negative symptoms, we examined ratings on 69 unmedicated schizophrenic inpatients. A classical BPRS depression subscale score correlated highly (rho = 0.80) with the HRSD total score. The classical BPRS "negative symptom" subscale score was unrelated to both the BPRS and HRSD depression summary measures. Among individual HRSD items, negative symptoms correlated only with work/activities and retardation. The findings suggest that negative and depressive symptoms may be assessed independently.