森田疗法在神经症治疗中的应用

目的　观察森田疗法对神经症的治疗作用。方法　观察研究组 (使用系统森田治疗方法 )和对照组 (药物治疗组 ) 8周 ,用汉密顿焦虑量表 ( HAMA)和汉密顿抑郁量表 ( HAMD)评定临床疗效。结果　森田组和对照组疗效无明显差异 ,森田组服用抗抑郁药和抗焦虑药物剂量低于对照组 ( P<0 .0 5 )。结论　森田疗法对神经症有明显的治疗作用 ,并可减低抗抑郁和抗焦虑药物剂量。     

Partial sleep deprivation therapy combined with sertraline induces more rapid improvements in quality of life items in major depressive disorder

BACKGROUND: Total or partial sleep deprivation was showed to have rapid antidepressive effects in depression. Sleep deprivation therapy in major depression constitutes insufficient antidepressive treatment response and depressive symptoms reoccur after one night of recovery. Combination of antidepressant medication with sleep deprivation therapy is generally indicated. These combination therapies were found more favorable overall therapeutic effect than antidepressive monotherapy. METHODS: In this study, we examined the Quality of Life changes with the antidepressive therapy using partial sleep deprivation plus sertraline and sertraline monotherapy in patients with major depressive disorder. Thirteen patients received six partial sleep deprivation therapies in addition to sertraline, that sleep schedule in deprivation nights started at 11:00-12:00 p.m. to 03:00 a.m. and 11 patients treated with sertraline monotherapy as a control group. Quality of Life was evaluated with the WHOQOL-100, depression and the accompanying anxiety were also assessed at baseline and at the end of the 4th week. RESULTS: Patients treated with combination therapy improved significantly and more rapidly. Rapid improvement in quality of life in major depressive disorder was showed in patients treated with combination of late partial sleep deprivation and sertraline. LIMITATIONS: Small sample size, the lack of placebo group and short duration of the study are the main limitations. CONCLUSIONS: In clinical practice, QOL improvement can be accelerated using combination of partial sleep deprivation with the sertraline therapy.     

Search for biological correlates of depression and mechanisms of action of antidepressant treatment modalities. Do neuropeptides play a role?

Dysregulation of the monoaminergic systems is likely a sufficient but not a necessary cause of depression. A wealth of data indicates that neuropeptides, e.g., NPY, CRH, somatostatin, tachykinins and CGRP play a role in affective disorders and alcohol use/abuse. This paper focuses on NPY in etiology and pathophysiology of depression. Decreased peptide and mRNA NPY were found in hippocampus of both the genetic, e.g., the FSL strain, and environmental rat models of depression, e.g., chronic mild stress and early life maternal separation paradigms. Rat models of alcoholism also show altered NPY. Furthermore, NPY is also reduced in CSF of depressed patients. Antidepressive treatments tested so far (lithium, topiramate, SSRIs, ECT and ECS, wheel running) increase NPY selectively in rat hippocampus and in human CSF. Moreover, NPY given icv to rat has antidepressive effects which are antagonized by NPY-Y1 blockers. The data support our hypothesis that the NPY system dysregulation constitutes one of the biological underpinnings of depression and that one common mechanism of action of antidepressive treatment modalities may be effects on NPY and its receptors. In a novel paradigm, early life maternal separation was superimposed on "depressed" FSL and control rats and behavioral and brain neurochemistry changes observed in adulthood. The consequences were more deleterious in genetically vulnerable FSL. Early antidepressive treatment modulated the adult sequelae. Consequently, if these data are confirmed, the ethical and medical question that will be asked is whether it is permissible and advisable to consider prophylactically treating persons at risk.     

S—腺苷蛋氨酸治疗抑郁症

目的：观察新型天然抗抑郁药Ｓ－腺苷蛋氨酸的抗抑郁作用及其不良反应。方法：采用该药开放性治疗各种抑郁性障碍３１例。采用Ｈａｍｉｌｔｏｎ抑郁量表和临床总体印象评定临床疗效。结果：全部病人（包括脱落病人）的有效率为７２．４％。疗程分析发现该药起效较快，在治疗第四天量表评分业已有显著下降。第二周时已较基线分下降了５２％。因子分析发现，该药对主观焦虑因子效果不佳，对其它各因子均有显著效果。该药不良反应轻微，无一例因药物不良反应导致治疗中断。结论：Ｓ－腺苷蛋氨酸是一种安全有效的天然抗抑郁药物     

Primary hyperparathyroidism, psychiatric manifestations, diagnosis and management

Mental manifestations of primary hyperparathyroidism simulate a wide spectrum of psychiatric disorders. Definitive surgical treatment results in long-lasting full recovery. The 2 cases presented demonstrate this. The clinical diagnostic and therapeutic aspects of primary hyperparathyroidism, with an emphasis on neuropsychiatric manifestations, are discussed. Early diagnosis of hypercalcemia can prevent unnecessary and potentially harmful treatment with antidepressive, anxiolytic or antipsychotic drugs, which can further depress the cognitive state of the patients, and can aggravate the mental symptoms.     

以头晕为主诉的无症状性脑梗死患者焦虑状态的临床分析

目的:探讨以头晕为主诉的无症状性脑梗死(ACI)患者的情绪状态及临床体验并观察抗焦虑/抑郁治疗的疗效.方法:对98例ACI患者采用汉密尔顿焦虑抑郁量表进行筛查,并根据ICD-10的诊断标准做出诊断后,给予抗焦虑/抑郁药物治疗和支持性心理治疗,以治疗前后的汉密尔顿焦虑量表(HAMA)的减分率和临床症状缓解程度来评定疗效.结果:处于焦虑状态的ACI患者,医检证实均有脑血管系统的轻微病损,头晕史0.5～7年,有心悸、气短、眩晕发作、失眠等自诉躯体症状,67.55%伴有高血压;经帕罗西汀和支持性心理治疗,100%显效,临床症状缓解.结论:以头晕为主诉的ACI患者,若经改善脑血流循环治疗无效者,则应实施抗焦虑/抑郁药物治疗和支持性心理治疗,可望获得良好疗效.     

多虑平、罗拉联合治疗焦虑、抑郁症状的疗效观察

目的 探讨多虑平、罗拉联合治疗对焦虑、抑郁症状的临床疗效。方法 将72例患者随机分为实验组和对照磐,观察时间为8周,并进行疗效评定。结果 治疗1周内开始见效。总有效率为94．4％,其中痊愈55.6％,显著好转27．8％,好转11．1％。以对焦虑症状的疗效最为显著,其次为抑郁改善。结论 提示二者联用效果显著。     

Possible contribution of epiphyseo-adrenocortical relations to antidepressive effect of imipramine

Chronically administered of imipramine decreases, while the depressogen reserpine increases, the level of plasma corticosterone in rats. The only effect of reserpine is antidepressive. Epiphysectomy stimulates the endocrine response to reserpine and attenuates the antireserpine effect of imipramine. This may be caused by antidepressive effect of epiphyseal factors. Translated fromByulleten' Eksperimental'noi Biologii i Meditsiny, Vol. 125, No. 6, pp. 626–627, June, 1998     

Electroconvulsive stimulations prevent chronic stress-induced increases in L-type calcium channel mRNAs in the hippocampus and basolateral amygdala

Although affective disorders have high prevalence, morbidity and mortality, we do not fully understand disease etiopathology, nor have we determined the exact mechanisms by which treatment works. Recent research indicates that intracellular calcium ion dysfunction might be involved. Here we use the chronic restraint stress model of affective disorder (6 h restraint per day for 21 days) in combination with electroconvulsive stimulations to examine the effects of stress and an effective antidepressive treatment modality on L-type voltage gated calcium channel subunit mRNA expression patterns in the brain. We find that stress tended to upregulate Ca_v1.2 and Ca_v1.3 channels in a brain region specific manner, while ECS tended to normalise this effect. This was more pronounced for Ca_v1.2 channels, where stress clearly increased expression in both the basolateral amygdala, dentate gyrus and CA3, while stress only upregulated Ca_v1.3 channel expression significantly in the dentate gyrus. ECS effects on Ca_v1.2 channel expression were generally specific to stressed animals. Our findings are consistent with and extent previous studies on the involvement of intracellular calcium ion dysfunction in affective disorders. Selective modulation of neuronal L-type voltage gated calcium channels appears to be a promising target for the development of novel antidepressive treatment modalities.     

文拉法辛与氟西汀治疗首发抑郁症对照观察

目的探讨文拉法辛与氟西汀治疗首发抑郁症的疗效和安全性。方法将56例首发抑郁症患者随机分为两组,分别给予文拉法辛和氟西汀治疗8周。结果文拉法辛与氟西汀均具有良好的抗抑郁作用,疗效差异无显著性(t=0.86,P0.05)。结论文拉法辛和氟西汀都是治疗抑郁症较理想的药物。     

Hypothalamic-pituitary-adrenocortical axis dysregulation in patients with major depression is influenced by the insertion/deletion polymorphism in the angiotensin I-converting enzyme gene

The Dex/CRH test is one of the most reliable neuroendocrine function tests for hypothalamic-pituitary-adrenocortical (HPA) system dysregulation in depression. Persistent overdrive of HPA system activity after successful antidepressant treatment predicts an enhanced risk for relapse of a depressive episode. As the renin-angiotensin system has been shown to play a role in HPA system activity, we investigated the impact of the angiotensin converting enzyme (ACE) gene insertion (I)/deletion (D) polymorphism, which determines ACE plasma concentrations, on HPA system dysregulation. We performed repeated combined Dex/CRH tests in 115 patients suffering from major depression. Dex/CRH test results were related to the I/D polymorphism within the ACE gene, which was assessed by PCR. Genotype frequencies were comparable to those in the general population (I/I 16.8%, I/D 59.3%, D/D 23.9%). D/D genotypes showed a higher cortisol stimulation during the first Dex/CRH test after admission than homozygous I-allele carriers (repeated measurement ANOVA: P=0.034). Cortisol area under the curve values were highest in those with the D/D genotype (mean+/-SEM [nmol/l*75 min]: 12700+/-2220), intermediate in those with the I/D genotype (9570+/-1000), and lowest in those with the I/I genotype (5160+/-1000; ANOVA: P=0.04). After successful antidepressive treatment and attenuation of HPA system overdrive these differences were no more detectable. The HPA axis stimulating properties of higher ACE and consecutively higher AT-II and/or lower substance P concentrations may be crucial factors for the HPA system hyperactivity during major depressive episodes.     

Chronotherapeutics: An alternative treatment of juvenile depression

Chronotherapeutic treatments, such as bright light therapy, sleep deprivation and sleep phase advance have successfully been established for the treatment of adults with seasonal and major depression. Today, sleep deprivation is supposed to be the fastest acting antidepressant we know of. Combined with bright light therapy, the antidepressive effect can be sustained. Notwithstanding, the effect of sleep deprivation and bright light therapy has not yet been studied in adolescents suffering from juvenile depression. However, because of its growing prevalence rates and the insufficient outcomes of established treatments, such as medication and psychotherapy, alternative treatments of juvenile depression are urgently needed. Furthermore, a high percentage of patients suffer from sleep disorders. Along with their large positive impact on sleep patterns and antidepressive effects, chronotherapeutics are thought to be powerful interventions for patients with juvenile depression. The present study investigates the additional benefit of sleep deprivation combined with bright light therapy, as compared to mere bright light therapy. We hypothesize that both therapies have a positive impact on depressive symptoms and sleep parameters, but that a combined therapy enhances and sustains outcomes.     

Lithium + L-tryptophan compared with amitriptyline in endogenous depression

Endogenously depressed in-patients were treated for four weeks with either lithium + L-tryptophan (N = 22) or amitriptyline (N = 21) in an open study. Before and weekly during treatment the patients were evaluated by means of Hamilton rating scale, and blood samples were collected for determination of serum concentration of lithium, or amitriptyline and nortriptyline. Both groups responded significantly and the two treatments were not significantly different in antidepressive efficacy. No significant correlation could be demonstrated between clinical improvement and steady-state serum drug levels. From this study it appears that lithium combined with L-tryptophan may be effective in the treatment of endogenous depression.     

Neuropsychological Correlates of Major Depression: A Short-term Follow-up

The present study investigated neuropsychological correlates of major depression and their course following treatment. We investigated 41 patients with major depression according to DSM-III-R criteria, who do not fulfil criteria of Alzheimer's disease, with a standardised clinical interview, different self- and observer-rating depression scales, and a comprehensive neuropsychological examination, and 27 subjects were reinvestigated 4.5 weeks after the first assessment. We found deficits in all cognitive domains with a predominant decline in tasks of cognitive flexibility and fluency. Patients who respond to antidepressive treatment showed a significant improvement in executive functions at the followup examination. Our data support the hypothesis that cognitive disorders in major depression may be associated with a frontostriatal dysfunction.     

金丝桃属植物药理作用研究进展

本文主要综述了藤黄科金丝桃属植物的抗抑郁、抗肿瘤、抗病毒、镇痛、抗菌、抗炎等多种药理活性及其相关的作用机制。     

Apparent supersensitivity of platelet 5-HT receptors in lithium-treated patients

An increased 5-HT-induced platelet aggregatory response was seen in bipolar and unipolar patients who were being treated with lithium prophylactically. The responses were not related to the patients' lithium levels or affective morbidity. The results are discussed with reference to the action of antidepressive treatments on 5-HT receptor systems in the platelet and the CNS.     

抑郁症睡眠障碍、负性自动思维对疗效的影响

目的探讨抑郁症睡眠障碍、自动思维对疗效的影响。方法应用汉密尔顿抑郁量表(HAMD-24),匹兹堡睡眠质量问卷(PSQI),在治疗前及治疗后4周对75名抑郁症患者进行2次评定,并对其中40名患者于治疗前施测自动思维问卷(ATQ-30)。结果①通过4周治疗,抑郁-睡眠障碍组(简称A组)和抑郁-非睡眠障碍组(简称B组)HAMD总分及各因子分均显著下降(P<0.01),但A组的PSQI得分仍显著高于B组(8.20±2.278,6.70±2.229);(P<0.01);②疗前抑郁-自动思维高分组(简称C组)与抑郁-自动思维低分组(简称D组)HAMD总分(27.38,17.55);(P<0.05)和绝望(28.38,17.13);(P<0.01)平均秩次有显著差异,疗后C组绝望因子的平均秩次仍显著高于D组(26.00,18.14);(P<0.05)。结论抑郁症睡眠障碍和不良自动思维影响着疾病的严重程度和抗抑郁治疗的疗效。     

Sleep-related chronobiological markers of affective illness

Sleep EEG and neuroendocrine disturbances have been described in the acute phase of affective illness. The question arises as to whether these biological marker disturbances are state- or trait-related. This important issue can be addressed by evaluating changes in sleep EEG and neuroendocrine parameters from a chronobiological approach before and after antidepressant treatment. Among the circadian variables explored in affectively ill patients are REM sleep and slow wave sleep, as well as circadian secretion of plasma GH, cortisol, ACTH and prolactin. Our studies show that depressed patients mainly of the unipolar type secrete more GH and cortisol during the circadian period than control subjects do. GH hypersecretion appears mainly during wakefulness while cortisol hypersecretion is observed during the 24 h space. Temporal disorganization of hormonal secretion is also present since an advance of the quiescent period of the ACTH-cortisol rhythm as well as pre-sleep GH spikes were described in our depressed unipolar patients before treatment. After antidepressive treatment, these chronobiological anomalies tend to normalize, as state biological markers. These observations are giving support to the phase-advance hypothesis of depression.