齐拉西酮与利培酮治疗首发精神分裂症疗效的对照研究

目的探讨齐拉西酮治疗精神分裂的疗效及安全性。方法将符合CCMD-3诊断标准的60例首发精神分裂症患者随机分为两组,分别给予齐拉西酮和利培酮治疗8周,采用PANSS、CGI、TESS、体格检查及实验室检查评定疗效和安全性。结果实验组和对照组的有效率分别为76.36%和75.68%,治愈率分别为53.43%和51.08%;两组患者PANSS量表总分治疗后2、4、6、8周与治疗前比较差异有显著性（P〈0.01）,两组之间比较无统计学差异（P〉0.05）。齐拉西酮不良反应显著少于利培酮（P〈0.05）。结论齐拉西酮对精神分裂症与利培酮同样有效,在改善阴性症状方面起效快,不良反应轻微,是一种安全有效的新型抗精神病药物。     

奎硫平治疗首发精神分裂症对照研究

目的:对比奎硫平与氯氮平治疗首发精神分裂症的疗效和安全性.方法:分别以奎硫平与氯氮平治疗首发精神分裂症各30例,采用阳性症状与阴性症状量表(PANSS)、副反应量表(TESS),在治疗前及治疗后第1、2、4、6、8周末分别评定疗效及不良反应.结果:奎硫平有效率86.7%,显效率76.7%;氯氮平有效率80.0%,显效率66.7%.两组治疗后与治疗前的PANSS评分比较差异有显著性性,奎硫平不良反应少于氯氮平.结论:奎硫平治疗精神分裂症疗效好,不良反应较氯氮平轻微,病人服药依从性良好.     

Common mental disorders and disability pension award: Seven year follow-up of the HUSK study

Objective

Rates of disability pension (DP) awards remain high in most developed countries. We aimed to estimate the impact of anxiety and depression on DPs awarded both for mental and for physical diagnoses and to estimate the relative contribution of sub case-level anxiety and depression compared with case-level symptom loads.

Methods

Information from a large cohort study on mental and physical health in individuals aged 40-46 (N=15,288) was linked to a comprehensive national database of disability benefits. Case-level and sub case-level anxiety and depression were defined as scores on the Hospital Anxiety and Depression Scale of ≥8 and 5-7, respectively. The outcome was incident award of a DP (including ICD-10 diagnosis) during 1-7-year follow-up.

Results

DP awards for all diagnoses were predicted both from case-level anxiety [HR 1.90 (95% CI 1.50-2.41)], case-level depression [HR 2.44 (95% CI 1.65-3.59] and comorbid anxiety and depression [HR 4.92 (95% CI 3.94-6.15)] at baseline. These effects were only partly accounted for by adjusting for baseline somatic symptoms and diagnoses. Anxiety and depression also predicted awards for physical diagnoses [HR 3.26 (95% CI 2.46-4.32)]. The population attributable fractions (PAF) of sub case-level anxiety and depression symptom loads were comparable to those from case-level symptom loads (PAF anxiety 0.07 versus 0.11, PAF depression 0.05 versus 0.06).

Conclusion

The long-term occupational impact of symptoms of anxiety and depression is currently being underestimated. Sub case-level symptom loads of anxiety and depression make an important and previously unmeasured contribution to DP awards.     

精神疾病患者血清睾酮和雌二醇水平研究

目的：了解首发精神分裂症和情感性精神障碍患者血清睾酮和雌二醇的变化。方法：以放射免疫法对首次发病的５４例精神分裂症患者和３７例情感性精神障碍患者血清中睾酮和雌二醇进行测定,并与正常健康者作对照。结果：男性精神分裂症患者者血清雌 二醇浓度显著高于对照组男性,女性情感性精神障碍患者血清睾酮浓度显著高于对照组和精神分裂症组女性。治疗后女性患者血清雌二醇浓度显著下降,对睾酮浓度影响不大。结论：精神分裂症和     

Transnational stability of gender differences in schizophrenia?

Summary Gender-specific analyses of the multinational WHO-Determinants of Outcome-Study (including 1,292 cases from 10 countries) demonstrate the transnational stability of major findings on gender differences in schizophrenia: Male patients have an earlier mean age at onset in all countries. In female patients, the distribution of the age at onset shows a second peak after age 40 years. No gender differences on nuclear symptoms of schizophrenia can be detected, but on uncharacteristic symptoms, particularly some aspects of the illness behaviour, differences appear. This investigation supports the transcultural validity of gender differences found in the German ABC-Schizophrenia-Study and in the Danish-German Psychiatric Case Register studies.     

The study of geographic differences in the prevalence of disability among Taiwanese population

The present study analyzes data of the governmental reported general population and population of persons with disabilities from 2002 to 2009, to describe the disability prevalence and to test the overtime change with particular focused on the geographic differences in Taiwan. In average, the disability prevalence was 42.06‰ (range = 31.06‰-80.04‰ in different areas) of the general population during the past 8 years. We found that the disability prevalence in general population (R² = 0.991; p < 0.001), disability prevalence in men (R² = 0.992; p < 0.001) and in women (R² = 0.991; p < 0.001) were significantly increased in curve tests of the study. The disability number were more populous in north or west urban areas (such as Taipei County, Taipei City, Taoyuan County, Taichung County, Kaohsiung City), however, those areas of higher disability prevalence were more likely to locate in east and central remote areas (such as Taitung County = 80.04‰; Yunlin County = 71.95‰; Hualien County = 71.59‰; Chiayi County = 63.51‰ and Yilan County = 59.91‰). The study highlights that the uneven distribution of disability prevalence will bring challenges of health and social welfare services for this group of population. We suggest the authorities should scrutinize the disparity of disability prevalence in different geographic area to examine the equality of social welfare resources distribution in Taiwan.     

利培酮与氯氮平治疗首发精神分裂症对认知功能的影响

目的 比较利培酮和氯氮平对首发精神分裂症患者认知功能的影响。方法 将符合入组标准的首发精神分裂症患者77例随机分为利培酮组与氯氮平组,分别进行8周系统治疗,用阳性与阴性症状量表(PANSS)、韦氏成人智力量表(WAIS-RC)、数字划销试验(CT)和临床记忆量表(CMS)进行检查,评估其疗效和对认知功能的影响。结果 脱落4例,73例患者在8周治疗后PANSS总分明显下降(P<0.01),两组之间差异无显著性(P>0.05)。利培酮组的WAIS-RC、CT、CMS总分均明显高于氯氮平组,差异有显著性(P<0.05～0.01)。结论 利培酮对首发精神分裂症患者认知功能的影响明显好于氯氮平。     

Neuroanatomic substrates of sex differences in language dysfunction in schizophrenia: a pilot study

OBJECTIVE: This pilot study investigated whether our previous findings of disrupted normal sexual brain dimorphisms in language-associated regions in schizophrenia were linked with our previously reported sex differences in language dysfunction in schizophrenia. METHOD: Nineteen adults with schizophrenia and 15 normal comparisons were tested on phonology, semantics and grammar and underwent structural MRI. RESULTS: Among males, left hippocampal and left planum temporale (PT) abnormalities were associated with phonological, semantic and grammar deficits, accounting for 17-52% and 27-33%, respectively, of variance in diagnostic group differences. Anterior cingulate gyrus was significantly associated with semantics. Among females, right Heschl's Gyrus (HG) and left PT were significantly associated with phonology, right HG with semantics and grammar and right hippocampus with semantics. CONCLUSIONS: These preliminary findings suggest disrupted sexual brain dimorphisms in schizophrenia are associated with sex-specific language deficits, and left hippocampal abnormalities, in particular, contribute to language dysfunction among men. Abnormalities in right cortical temporal regions showed stronger associations with language dysfunction among females.     

A 5-year prospective study of predictors for disability pension among patients with major depressive disorder

Holma IAK, Holma KM, Melartin TK, Rytsälä HJ, Isometsä ET. A 5‐year prospective study of predictors for disability pension among patients with major depressive disorder. Objective: There is a scarcity of prospective long‐term studies on work disability caused by depression. We investigated predictors for disability pension among psychiatric patients with MDD. Method: The Vantaa Depression Study followed up prospectively 269 psychiatric in‐ and out‐patients with DSM‐IV MDD for 5 years with a life chart, including 230 (91.3%) patients belonging to labour force. Information on disability pensions was obtained from interviews, patient records and registers. Results: Within 5 years, 20% of the patients belonging to labour force at baseline were granted a disability pension. In multivariate analyses, the significant baseline predictors for granted disability pension were age ≥50 years (HR = 3.91, P < 0.001), subjective inability to work (HR = 2.14, P = 0.008) and introversion (HR = 1.08, P = 0.049). When follow‐up variables were included, the predictors were age more than 50 (OR = 6.25, P < 0.001), proportion of time spent depressed (OR = 14.6, P < 0.001), number of comorbid somatic disorders (OR = 1.47, P = 0.013) and lack of vocational education (OR = 2.38, P = 0.032). Conclusion: Of psychiatric patients with depression, one‐fifth were granted a disability pension within 5 years. Future disability pension can be predicted by baseline older age, personality factors, functional disability, lack of vocational education and comorbid somatic disorders. Longitudinally, accumulation of time spent depressed appears decisive for pensioning.     

Clinical symptoms and regional cerebral blood flow in schizophrenia

This study examined the relationship between clinical symptoms and regional cerebral blood flow (rCBF) in schizophrenic patients using single photon emission computed tomography (SPECT). The subjects were 26 medicated schizophrenic patients diagnosed according to DSM-III-R criteria. Clinical symptoms were assessed using the Scale for the Assessment of Negative Symptoms (SANS), selected items for the Positive and Negative Syndrome Scale (PANSS), and the scale for Schneider's first rank symptoms. Resting rCBF was measured using N-isopropyl-p-[I-123] iodoamphetamine (I-123 IMP) SPECT, and relative rCBF distribution was evaluated in nine regions of interest in each hemisphere. Factor analysis of symptom ratings indicated four separate syndromes: psychomotor poverty, alienation (hallucination and disturbance of the self), delusion, and disorganization. Stepwise multiple regression analysis showed the psychomotor poverty syndrome to be correlated with decreased rCBF in bilateral superior frontal areas and increased rCBF in the left thalamus and right basal ganglia. The disorganization syndrome was correlated with increases rCBF in bilateral anterior cingulates and decreased rCBF in bilateral midolle frontal areas. The alienation syndrome was shown related to increased rCBF in the right inferior frontal area and parietal area. Dysfunction in distinctive neural networks involving various prefrontal areas would thus appear to underlie these syndromes in schizophrenia.     

舒必利和氯氮平维持性治疗精神分裂症的两年随访结果

目的：比较舒必利和氯氮平对精神分裂症的维持治疗的疗效及复发。方法：对出院后坚持使用舒必利和氯氮平维持治疗的精神分裂症病人进行了疗效评定，并随访2年。结果：舒必利对精神分裂症阴性症状的改善和社会功能的恢复好于氯氮平，且副作用亦少。结论：舒必利维持治疗是改善精神分裂症阴性症状和预防复发比较理想的药物，值得推荐。     

Correlations between sadness-induced cerebral activations and schizophrenia symptoms: An fMRI study of sex differences

Background

The functional neuroimaging studies of emotion processing in schizophrenia have revealed variable results attributed partly to differential symptomatology and sex of tested patients. The aim of the present study was to investigate the relationship between cerebral activations during exposure to emotional material and schizophrenia symptoms in men versus women.

Method

Fifteen men and 10 women with schizophrenia, equivalent in terms of age, medication and experienced symptomatology, underwent functional MRI during viewing sad and neutral film excerpts. Data were analyzed using Statistical Parametric Mapping Software (SPM2).

Results

Across all the patients there was a significant inverse relationship between negative symptoms and activations in the right prefrontal cortex during processing of sad versus neutral stimuli. In men, activations during sad versus neutral stimuli in the prefrontal, temporal and anterior cingulate cortex, as well as the caudate and cerebellum, were positively correlated with negative symptoms. In women, there were inverse correlations between positive symptoms and activations in the hippocampus, parietal and occipital cortex during the same condition.

Conclusion

Present results confirmed association of prefrontal hypofunction with negative symptoms in schizophrenia. More interestingly, the results revealed a diametrically different pattern of symptom-correlated brain activity in men and women with schizophrenia, suggesting that the processing of sadness is mediated via neurophysiological mechanism related to negative symptoms in men and the mechanism related to positive symptoms in women.     

奥氮平治疗首发精神分裂症1年随访

目的了解奥氮平长期治疗首发精神分裂症的疗效、不良反应等。方法采用自然观察研究方法,结合全病程管理模式对研究对象进行1年随访观察。136例符合国际疾病分类第十次修订本(ICD-10)精神分裂症或分裂样精神障碍研究用诊断标准的首发患者纳入研究,给予可变剂量的奥氮平治疗。采用阳性和阴性症状量表(PANSS)评估疗效,副反应量表(TESS)评估治疗的不良反应。PANSS减分率≥50%为有效。结果治疗第2个月末有效率为50%(65/129),第3、6、8、12个月末的有效率分别为57%(71/125)、63%(70/69)、71%(73/103)、75%(70/93)。101例治疗有效的患者中随访期间有17例复发。1年末43例脱落,脱落率为31.6%。奥氮平的平均持续治疗时间为(9.7±3.8)个月(1～12个月)。不良反应发生率≥10%的有:体重增加、嗜睡、便秘、口干、静坐不能、震颤、活动减退、头晕、视物模糊等。结论奥氮平长期治疗首发精神分裂症有效,也存在体重增加等不良反应。     

Cannabis and schizophrenia: results of a follow-up study

A total of 39 schizophrenic patients with a history of current cannabis abuse at index admission was compared with a control group of schizophrenics without substance abuse matched for age, gender, and year of admission. At follow-up after 68.7 ± 28.3 months, 27/ 39 cases and 26/39 controls could be investigated. 8/27 cases (30%) had continued cannabis abuse, 6/27 (22%) had become alcohol abusers. Only one patient of the control group had started abusing alcohol. Patients with previous cannabis abuse had significantly more rehospitalizations, tended to worse psychosocial functioning, and scored significantly higher on the psychopathological syndromes “thought disturbance” (BPRS) and “hostility” (AMDP). These results confirm the major impact of cannabis abuse on the long-term outcome of schizophrenic patients. Received: 16 December 1997 / Accepted: 19 November 1998     

基于需求的出院随访对精神分裂症患者的随访效果

目的探讨基于需求的出院随访对精神分裂症患者出院随访完成率、满意率和门诊复诊率的影响。方法选取2017年3月-5月在四川省精神卫生中心准备出院的200例慢性精神分裂症患者为研究对象,按照随机数字表法分为对照组和观察组各100例。出院后1月内,对照组采取通用出院电话随访,观察组通过出院随访需求问卷调查后实施个性化出院随访。出院随访后的1周内,由第三方管理咨询公司电话调查两组患者出院随访完成率和满意率;出院随访后1月内,分析两组患者门诊复诊情况。结果对照组出院随访完成率为80%,满意率为80%,门诊复诊率为11%;观察组分别为93%、93%、22%。两组出院随访完成率、满意率和门诊复诊率比较差异均有统计学意义(P0. 05或0. 01)。结论实施基于需求的个性化出院随访可能有助于提高精神分裂症患者出院随访完成率、随访满意率和门诊复诊率。     

Sex/gender differences in the brain and cognition in schizophrenia

The early conceptualizations of schizophrenia have noted some sex/gender differences in epidemiology and clinical expression of the disorder. Over the past few decades, the interest in differences between male and female patients has expanded to encompass brain morphology and neurocognitive function. Despite some variability and methodological shortcomings, a few patterns emerge from the available literature. Most studies of gross neuroanatomy show more enlarged ventricles and smaller frontal lobes in men than in women with schizophrenia; finding reflecting normal sexual dimorphism. In comparison, studies of brain asymmetry and specific corticolimbic structures, suggest a disturbance in normal sexual dimorphism. The neurocognitive findings are somewhat consistent with this picture. Studies of cognitive functions mediated by the lateral frontal network tend to show sex differences in patients which are in the same direction as those observed in the general population, whereas studies of processes mediated by the corticolimbic system more frequently reveal reversal of normal sexual dimorphisms. These trends are faint and future research would need to delineate neurocognitive differences between men and women with various subtypes of schizophrenia (e.g., early versus late onset), while taking into consideration hormonal status and gender of tested participants.     

利培酮与奥氮平治疗首发精神分裂症的1年随访研究

目的评价利培酮与奥氮平治疗首发精神分裂症的疗效与不良反应。方法本研究为开放性，平行对照，药物剂量可调整的临床试验。采用自然观察研究方法，结合全病程管理模式对研究对象进行1年随访研究。分别有131例和136例首发精神分裂症患者被分入利培酮组和奥氮平组。利培酮组剂量为3—6mg，平均（3．8±1．3）mg，奥氮平组剂量为10—20mg，平均（12．9±5．6）mg。疗效主要统计指标为阳性和阴性症状评定量表（PANSS）的总分值及有效率，持续治疗时间。PANSS减分率≥50％定义为有效。次要统计指标为复发率、复发时间及药物不良反应。用副反应量表（TESS）评估药物不良反应。结果12月末时，利培酮组有85例患者（64．9％）完成随访，奥氮平组为93例（68．4％），两组差异无统计学意义（P〉0．05）。治疗终点利醅酮和奥氮平组有效率分别为62．6％和69．8％，差异无统计学意义（P〉0．05），随访中其他时点（2、3、6、8个月）两组有效率差异亦无统计学意义。12个月末利培酮组和奥氮平组的复发率（14．5％、12．5％）、持续治疗时间（9．5±3．8月、9．7±3．8月）、复发时间（4．0±2．9月、5．1±2．8月）等差异均无统计学意义（均P〉0．05）。不良反应方面，利培酮组锥体外系反应比例高于奥氮平组，奥氮平组体重增加比例高于利培酮组。结论利培酮与奥氮平治疗首发精神分裂症1年疗效均好，利培酮组锥体外系反应发生较多，奥氮平组体重增加较多。     

A five-year follow-up study of older long-stay clients with intellectual disability using the Disability Assessment Schedule

The emphasis on community care means closure of the long-stay institutions for people with intellectual disability. Studies have indicated that older people with intellectual disability in particular may not be adequately cared for because of poor monitoring of their changing needs and inadequate provision of services. The use of rating instruments to monitor changes, and to predict outcome or needs in this population may help to improve care by assisting with planning and projection of service requirements. In 1991, all residents of a long-stay hospital for people with intellectual disability were assessed using the Disability Assessment Schedule (DAS). Five years later, the 1991 scores of the older residents (aged > 50 years) were reviewed and compared under three outcome groups: in-patients, discharged and deceased. Furthermore, all older people resident in the hospital in 1996 were reassessed using the DAS. Out of the 144 older clients resident in 1991, five years later, 78 were still in-patients, 38 had been discharged into the community and 28 were deceased. In 1991, the deceased group had the greatest problems with continence and symbolic behaviour, while the discharged group had the greatest problems with self-help, vision, hearing, communication, social interaction, echolalia and repetitive speech. In comparison with 1991, the 1996 DAS scores of older residents showed that there were increasing problems with vision, hearing, communication, behaviour and symbolic activities. The present study suggested that the DAS is a useful instrument for monitoring change and predicting outcome in older people with intellectual disability.     

Opioid abuse and hospitalization rates in patients with schizophrenia

Background: Substance abuse worsens the course of schizophrenia, but it is not known whether or not there are differences between specific substances concerning their association with the hospitalizations of patients with schizophrenia. Aims: The primary aims of this study were to examine the possible associations between amphetamine, cannabis, and opioid abuse, and the risk of hospitalizations among patients with schizophrenia. Methods: The study population consisted of 146 patients with ICD-defined schizophrenia from two different geographical sites in Finland, and it included both inpatients and outpatients. Data were collected retrospectively from the patients’ medical files. Substance abuse was defined as either harmful use or dependence according to ICD-10. Results: The cumulative prevalence of substance abuse was 10.9% (16/146) for cannabis, 8.9% (13/146) for amphetamine, and 4.1% (6/146) for opioids. Among patients with schizophrenia and abuse of any substance, the number of hospitalizations was about 1.5-fold when compared to those without substance abuse. The incidence rate ratio for hospitalizations was 2.9 (95% CI 2.47–3.63) for opioids, 2.0 (1.71–2.41) for amphetamine, and 1.6 (1.33–1.84) for cannabis, when compared with no abuse of each substance. The risk of hospitalizations was significantly higher for opioids when compared with amphetamine (p < 0.001) or cannabis (p < 0.001). Conclusions: Harmful use or dependence of opioids among patients with schizophrenia is associated with significantly higher risk of hospitalizations than either harmful use or dependence of amphetamine or cannabis.