利培酮治疗精神分裂症2484例临床研究

目的了解利培酮在中国的应用概况.方法在2484名使用利培酮的精神分裂症病人中,采用<临床总体印象量表>(CGI)、<阳性与阴性综合征量表>(PANSS)及不良反应量表,在利培酮治疗8周前后进行评定分析.结果在治疗第8周末继续服用利培酮者占97.02%,其中96.60%服用剂量≤6mg·     

舒血宁注射液合利培酮治疗慢性精神分裂症临床研究

目的：比较利培酮联合舒血宁与利培酮联合安慰剂治疗慢性精神分裂症的疗效和安全性。方法慢性精神分裂症患者82例,随机分为利培酮联合舒血宁治疗组（研究组）和利培酮联合安慰剂治疗组（对照组）,各41例。使用阳性与阴性症状评定量表（PANSS）和精神药物副反应量表（TESS）评定临床疗效和不良反应。治疗前和治疗第4、8、12周末评估PANSS,治疗前和治疗12周末评估TESS。结果研究组有效率46.34%,对照组为21.95%,两组比较差异有统计学意义（P〈0.05）。研究组低血压、心动过速发生率高于对照组,迟发性运动障碍和心电图异常发生率低于对照组（P〈0.05）。结论利培酮联合舒血宁治疗慢性精神分裂症疗效优于单用利培酮,不良反应少。     

Persistent akathisia associated with early tardive dyskinesia

Two psychiatric patients developed moderate or severe oro-facial dyskinesia, and limb dyskinesia, at a relatively young age and within a year of starting antipsychotic drug-treatment. This early appearance of tardive dyskinesia was preceded by akathisia that had developed at the beginning of drug therapy and persisted, despite the reduction of their drug doses to maintenance levels. The possibility that persistent akathisia may herald the early onset of tardive dyskinesia, is discussed.     

Treatment of tardive dyskinesia with choline and tetrabenazine.

A patient with severe tardive dyskinesia due to long-term neuroleptic medication is described. The 2 factors immediately precipitating the onset of the disorder appeared to be the administration of benzhexol hydrochloride and the sudden termination of neuroleptic therapy. the disorder was satisfactorily controlled with choline chloride and a small dose of tetrabenazine. The suggested mechanism of tardive dyskinesia is discussed.     

多巴胺β羟化酶基因G444A多态性可能与慢性精神分裂症患者迟发性运动障碍关联

目的观察广州地区汉族人群中有或无迟发性运动障碍(TD)精神分裂症患者中,多巴胺β羟化酶基因(dopamineβ-hydroxylase gene,DBH)外显子2单核苷酸多态性G444A的分布,并探讨该多态与迟发性运动障碍发生的关系.方法以196例慢性精神分裂症患者(67例伴TD,129例不伴TD)为对象进行病例-对照研究.用聚合酶链反应-限制性片段长度多态性方法分析DgH基因G444A多态性.结果TD组等位基因DBH44G频率显著高于非TD组(x2=12.71,P＜0.001),TD组GG及GA基因型频率也显著高于非TD组(P均＜0.05).结论DBH基因G444A多态性可能与慢性精神分裂症患者TD的发生关联.     

Prospective study of tardive dyskinesia incidence in the elderly.

OBJECTIVES--To investigate the incidence of tardive dyskinesia in elderly individuals beginning treatment with antipsychotic drugs and to identify risk factors for the development of tardive dyskinesia in the elderly. DESIGN--A cohort of previously neuroleptic-naive patients was identified at the time of initiation of antipsychotic drug treatment. Patients were evaluated at baseline and followed up at 3-month intervals for periods ranging from 3 to 119 weeks. SETTING--Subjects were recruited from the psychiatric and geriatric medical services of two medical centers, a geriatric institute, and three nursing homes in the metropolitan area of New York City, NY. PATIENTS--Two hundred fifteen individuals older than 55 years have entered the study thus far. Preliminary data are presented for 160 patients who were followed up for at least 1 month. Their age range was 57 to 99 years (mean, 77 years). Seventy-two percent were women and 87% were white. Sixty-seven percent of patients had a diagnosis of organic mental syndrome and 42% had a psychiatric diagnosis. INTERVENTIONS--A naturalistic, longitudinal, repeated assessment paradigm was employed. Assessments included abnormal involuntary movements, extrapyramidal signs, psychiatric symptoms, and medical and drug treatment histories. MAIN OUTCOME MEASURE--The incidence of tardive dyskinesia was determined using a standardized rating instrument and survival analysis. RESULTS--The incidence of neuroleptic-induced dyskinesia was 31% (95% confidence interval, 20%, 42%) after 43 weeks of cumulative neuroleptic treatment. Psychiatric (as opposed to organic) diagnosis and presence of extrapyramidal signs early in treatment were associated with increased tardive dyskinesia vulnerability.     

Treatment of tardive akathisia with clonidine

Two cases of tardive akathisia, which were misdiagnosed as anxiety originating from a schizophrenic disorder, had been treated with anxiolytics in addition to neuroleptics and anticholinergics. The diagnoses were changed to tardive akathisia, the anticholinergics were discontinued, and the patients were treated with clonidine successfully. In view of the similar effects of clonidine and anticholinergics, the pathophysiology of tardive akathisia must be very similar to that of tardive dyskinesia.     

Tardive dyskinesia and antihistamines.

A case of tardive dyskinesia due to the prolonged administration of antihistamines is reported. Clinical features are discussed, as well as the alleviation of these by haloperidol.     

抗精神病药物合并使用盐酸苯海索的调查分析

盐酸苯海索常用于战轻抗精神病药物所致体外系症状。鉴于目前精神科临床上存在预防性应用和长期合并使用，甚至滥用现象。本文调查分析了抗精神病药物合并使用苯海索的情况，结果显示了氯丙嗪长期各并使用苯海索，增加了锥体外系反应和迟发性运动障碍发生的可能性。由此作者认两预防性或长期合并使用苯海索可产生不良后果。应加以避免。同时还应注意锥体外系副反应和迟发性运动障碍的发生。     

Spectrum of tardive syndromes: clinical recognition and management

Tardive syndrome (TS) refers to a group of delayed onset disorders characterised by abnormal movements and caused by dopamine receptor blocking agents (DRBAs). Classical tardive dyskinesia is a specific type of oro-buccal-lingual dyskinesia. However, TS may exist in other forms--for example, stereotypy, dystonia, and akathisia--and frequently occur in combination. The onset typically is insidious and after reaching its maximum severity it often stabilises. Frequently reported risk factors are age, dose and duration of neuroleptic exposure, the use of conventional DRBAs, and co-existing mood disorders. This review highlights the broad spectrum of TS, not limited to classical tardive dyskinesia, as well as the clues for its recognition. Despite challenges in the treatment of TS, dictated by the different phenomenology, severity of TS and the need for ongoing neuroleptic treatment, the authors provide evidence based recommendations for patient management, which is not restricted to only withdrawal of the offending neuroleptics or the selection of an alternative medication, such as clozapine. In a minority of cases with significant functional disability, symptomatic or suppressive treatments should be considered. Recently, there has been a resurgence of stereotactic pallidal surgery for the treatment of TS. Although the efficacy of both pallidotomy and pallidal deep brain stimulation in dystonia has been encouraging, the evidence is still limited.     

Idiopathic calcification of the basal ganglia.

Idiopathic calcification of the basal ganglia is a rare disorder characterized by neuropsychiatric abnormalities, a movement disturbance of parkinsonian and/or choreoathetoid type and dense calcification of the basal ganglia. We report a 60 year old patient diagnosed as having delusional disorder and tardive dyskinesia who was subsequently found to be suffering from idiopathic calcification of the basal ganglia.     

COMT基因多态性rs4818与精神分裂症及迟发性运动障碍的关联性分析

目的：检测中国北方汉族人群中精神分裂症患者COMT基因多态性rs4818基因型及等位基因频数分布,探讨其与精神分裂症及迟发性运动障碍(TD)发生的关系。方法：以273例并发TD的精神分裂症患者(TD组)、114例未发生TD的精神分裂症患者(非TD组)和286例正常健康人群(正常对照组)为研究对象,采用Taqman探针方法检测COMT基因多态rs4818基因型和等位基因频数的分布。结果：与正常对照组比较,精神分裂症患者rs4818 G/G基因型频数分布差异有统计学意义(χ²=6.186,df=3,P=0.045);与正常对照组比较,TD组患者rs4818 G/G基因型频数分布差异有统计学意义(χ²=6.081,df=3,P=0.048);非TD组患者与正常对照组比较,G等位基因频数分布差异有统计学意义(χ²=4.049,df=2,P=0.044);TD组与非TD组比较,rs4818基因型及等位基因频数分布差异无统计学意义(χ²=0.634,df=2,P=0.426;χ²=0.848,df=3,P=0.654)。结论：COMT基因多态性与精神分裂症的发生有关联,但与精神分裂症TD的发生无关联性。     

Psychoactive drug use in an institution for intellectually handicapped persons.

OBJECTIVE: To study the use of psychoactive drugs for the treatment of long-stay developmentally disabled individuals in an institution in New South Wales. SETTING: Three wards dedicated to the long-term care of developmentally disabled individuals situated on the premises of a large psychiatric hospital. SUBJECTS: All residents (n = 53) of these wards in August 1989. METHOD: All subjects were examined by the author. Charts and medication records were extensively reviewed. Mental retardation was classified by DSM-III-R criteria. Categorisation of problem behaviour was done with the assistance of nurses, who also supplied information on behavioural problems and functional level and completed checklists of self-injurious and stereotypic behaviour. A standardised neurological examination was performed and scales for abnormal involuntary movements completed. RESULTS: The most commonly used drugs were the neuroleptics, with 60.4% of subjects currently receiving one or more neuroleptic drug at relatively large doses. The use of these drugs was not associated with current or past psychiatric illness, but was more closely related with the severity of problem behaviour. Thirty-four per cent of the subjects receiving neuroleptics had dyskinetic movements suggestive of tardive dyskinesia, and 30% had mild tremor. Antidepressant, anxiolytic and sedative drugs were used less commonly. The management of epilepsy was considered to be suboptimal. CONCLUSION: Even though studies over the last two decades have consistently highlighted the problem of overmedication of intellectually handicapped individuals in institutions, the problem does not seem to have been redressed in at least some institutions.     

抗精神分裂症药物诱发迟发性运动障碍与COMT基因多态性的关联性分析

目的:通过分析中国北方汉族人群中精神分裂症患者COMT基因多态性Val158Met 分布,研究COMT基因多态性与精神分裂症及迟发性运动障碍(TD)发生的关系.方法:采集356例并发TD的精神分裂症患者( TD组)、419例不发生TD的精神分裂症患者(非TD组)及471例正常健康人 (正常对照组)的全血样本,提取基因组...     

Approaching long-term neuroleptic treatment of schizophrenia.

Neuroleptic therapy can prevent some acute episodes and may improve the level of function in some cases of chronic schizophrenia. The hazards of tardive dyskinesia require a rigorous design for any long-term use of neuroleptics. The protocol includes narrow indications, demonstrations of efficacy and necessity, and arrangements for surveillance, cooperation, and emergency. Patient instruction improves the precision of medication use and may increase adaptive efforts during episodes.     

An open, randomized, comparative study of efficacy and safety of risperidone and haloperidol in schizophrenia.

Objectives: In the last decade there have been numerous randomized controlled trials comparing the efficacy and safety of second generation antipsychotics and conventional antipsychotics in the treatment of schizophrenia, but most of them have been conducted in the western population. This study compared the efficacy and safety of risperidone versus haloperidol in the Nepalese context, in order to add on to the very few literatures available on this topic in the South East Asia region and compare them. Methods: Patients with the diagnosis of schizophrenia were randomly assigned to receive risperidone 4-6 milligrams (mg) per day and haloperidol 10-20 mg per day, and were followed up for 6 weeks. Assessment were done on the day of the diagnostic interview and days 7, 14, 28 and 42 (end point). During the assessment periods Positive and Negative Syndrome Scale (PANSS) was administered to monitor the progress in psychopathology and Udvalg for Kliniske Undersogelser (UKU) side effects rating scale was applied to rate the treatment emergent adverse effects. Results: Both risperidone and haloperidol were associated with substantial baseline- to- endpoint reduction in symptom severity. After one week of treatment, the improvement in schizophrenia with risperidone was significantly better than haloperidol in terms of PANSS- total Score (-45.4 versus -29.5), negative subscale score (-14.3 versus -6.68) and general psychopathology subscale score (-20.9 versus -13.7). At the end point of the study, the benefit was maintained in total score (-52.1 versus -43.1), though the negative subscale score still showed tendency for greater improvement in psychopathology with risperidone. The side effects profile did not show significant differences except in extrapyramidal symptoms. Thirty-eight percent of risperidone treated patients had to resort to anti-parkinsonian treatment compared to 78% in haloperidol treatment group. Conclusion: Similar to the studies in the western countries, Asia and Indian subcontinent, both risperidone and haloperidol were effective in the reduction of psychopathological symptoms in this group of Nepalese population with the diagnosis of schizophrenia. However, risperidone was quicker and better then haloperidol and risperidone had a better safety profile. This is important, because extrapyramidal side effects of neuroleptics are responsible for non-compliance and increased cost in terms of us of anti-parkinsonian medication. Key words: schizophrenia, antipsychotic, risperidone, haloperidol, positive and negative syndrome scale (PANSS).     

阿立哌唑治疗22例迟发性运动障碍的临床研究

目的：观察阿立哌唑治疗精神分裂症患者迟发性运动障碍（TD）的临床疗效和不良反应.方法：对22例患有迟发性运动障碍的精神分裂症患者在原有药物不变的情况下,加用小剂量阿立哌唑治疗,观察周期12周.22例患者治疗前和治疗第4、8、12周采用异常不自主运动量表（AIMS）评定TD疗效,采用治疗中需处理的不良反应症状量表（TESS）评定不良反应.结果：加用小剂量阿立哌唑前后自身对照比较：AIMS总分较治疗前显著降低,差异有统计学意义（P＜0.05）;随着TD的好转,治疗第4周末,TESS总分开始下降,直到12周末,有统计学意义（P＜0.05）.结论：加用小剂量阿立哌唑治疗TD有效,用药方便、不良反应少且安全可靠,值得在临床上推广应用.     

药源性帕金森综合征的临床分析

目的：探讨药源性帕金森综合征（DIP）的临床特点,与原发性帕金森病的鉴别诊断及治疗体会。方法：对84例临床诊断为药源性帕金森综合征患者的资料进行回顾性分析。结暴：84例患者均有明确的用药史,用药14 d～6年后出现帕金森综合征表现,67．86％在3个月内出现DIP的表现;均双侧肢体对称起病,11例患者以一侧症状较重;临床表现以运动迟缓、肌强直为主;本组患者25％同时出现迟发性运动障碍,10．71％同时合并静坐不能,7．14％同时合并肌张力障碍。异丙嗪、硫必利等药物对症治疗有效。结论：药源性帕金森综合征的临床特点与原发性帕金森病相似,仍有一些特征性的表现可与其相鉴别,两者的治疗不同,药源性帕金森综合征最好的治疗就是预防,给予适当的对症治疗,可改善患者的症状。