住院分裂症患者687例一日处方分析

目的　分析天津市安定医院精神分裂症患者药物使用情况。方法　对总院及分院共687例分裂症患者日医嘱微机查询。结果　(1)在687 例分裂症患者中药物使用频率依次为奋乃静、舒必利、氯氮平、氯丙嗪、维思通、奎地平,换算为氯丙嗪等效剂量后,治疗剂量为13.5~4 012 mg/d,平均(367±250)mg/d。(2)687例患者中516(75.11%)例患者使用经典抗精神病药,185 例(26.92%)使用非典型抗精神病药物,432例(62.88%)为单一用药者,255 例(37.11%)患者配合使用2 种抗精神病药物,而3种或3种以上抗精神病药物配用为0 例,总计53 例(0.08%)患者合并使用抗抑郁剂,106 例(15.43%)合并心境稳定剂。(3)合并心境稳定剂频率依次为锂盐46 例,丙戊酸钠30 例,卡马西平30例。结论　目前天津市安定医院处方方式仍以典型抗精神病药物为主,考虑与患者病程较长,大部分患者仍沿用原老医嘱,且长期住院患者受医保及经济负担影响有关。     

首发精神分裂症早期干预病房中首选药物的状况分析

目的了解首发精神分裂症住院患者在我院早期药物干预情况。方法采用早期干预病房与门诊用药作对比,调查全年患者首次使用抗精神病药(APD)情况,并作1年后应用追踪分析。结果病房组前三位使用的APD分别是维思通、氯氮平、氟哌啶醇,首选全部单种APD治疗,日平均最高剂量为(418.3±107.4)mg,明显高于门诊组(269.6±94.4)mg;病房组安坦预防性用药极少(3.7%),APD合并其他精神药物比例(30.5%)明显低于门诊组(71.8%);总显效率比较病房组60.7%优于门诊组26.9%,两组副反应无显著性差异;1年后追踪首选APD使用率,住院组74.5%明显高于门诊组47.9%,换选药物主要以维思通、氯氮平为主。结论早期干预病房用药合理,疗效较好。作者提倡非典型抗精神病药可作为精神分裂症治疗的首选药物。     

苏州市精神分裂症患者抗精神病药物使用现况调查

目的:调查苏州市精神分裂症患者抗精神病药物使用现况。方法:采用患者药物使用调查表,对苏州市3家精神疾病专科医院的544例住院和门诊精神分裂症患者进行抗精神病药物使用情况调查。结果:使用居前6位的抗精神病药物分别是氯氮平(25.6%)、利培酮(16.5%)、奥氮平(13.9%)、奎硫平(11.4%)、阿立哌唑(9.1%)、氯丙嗪(6.8%)。门诊和住院患者抗精神病药物使用频率存在差异(χ2=37.361,P=0.003)。门诊患者氯氮平、利培酮、奥氮平、奎硫平、阿立哌唑、氯丙嗪、奋乃静、帕利哌酮的使用剂量低于住院患者;舒必利、齐拉西酮、氟哌啶醇使用剂量高于住院患者(P均0.01)。单一抗精神病药治疗的比率(54.4%,293例)高于联合药物治疗(45.6%,246例);单一药物治疗者中84.2%(247例)使用第2代抗精神病药(SGAs);联合用药者中97.8%(241例)主要抗精神病药物及65.0%(160例次)次要药物为SGAs;最常合并使用的药物是镇静催眠药(20.2%)、心境稳定剂(12.2%)、抗胆碱能药(12.1%)、抗抑郁药(7.8%)和β-受体阻断剂(4.3%)。结论:单一用药和选择SGAs是苏州市精神分裂症患者药物治疗的主要方式。     

氯氮平所致迟发性运动障碍的调查

对长期应用氯氮平治疗的患者进行迟发性运动障碍(TD)调查 ,并以使用典型抗精神病药患者作对照。1　对象和方法系本院住院患者 ,诊断均符合 CCMD- 2 - R标准。研究组至少 1年持续单用氯氮平治疗 ,除外以往使用其它抗精神病药者。对照组以至少 1年以上持续服用典型抗精神病药 ,除外合并使用氯氮平或舒必利者。研究组 5 2例 ,男性 ,平均年龄 (4 3.6± 8.2 )岁 ,总病程 (13.3± 7.34 )年 ,持续服药时间 (4 .2± 2 .3)年 ,药物剂量折合氯丙嗪效价 (35 2± 12 5 ) mg/d。对照组 46例 ,男性 ,平均年龄 (4 5 .3± 7.8)岁 ,总病程(15 .2± 8.4)年 …     

2006年我国十省市抗精神病药处方方式的现况调查

目的 调查2006年我国10省市抗精神病药处方方式;分析4年间我国抗精神病药处方方式的变化趋势.方法 按照作者2002年的调查方法,选择10省市41所精神疾病专科医院或综合医院精神科的5898例精神分裂症门诊和住院患者,于2006年5月22-28日使用自制修订的调查问卷进行精神分裂症处方方式的现况调查.结果 (1)5898例患者中,门诊患者为2716例(46.0%);住院患者为3182例(54.0%);男3041例(51.6%),女2803例(47.5%),缺失54例数据.(2)99.1%的患者接受了抗精神病药治疗,使用频率在前7位的药物依次为:氯氮平(31.7%),利培酮(30.5%),舒必利(14.5%),氯丙嗪(10.8%),奋乃静(9.2%)、喹硫平(7.2%),氟哌啶醇(5.8%).换算为氯丙嗪等效剂量后,住院患者平均药物剂量显著高于门诊患者.(3)72.7%的患者使用第2代抗精神病药治疗;第1代抗精神病药的使用频率为38.3%;6.19%的患者接受了长效药物治疗.(4)75.6%的患者接受了单一非长效抗精神病药治疗;24.4%的患者联合使用2种或2种以上抗精神病药.(5)54.1%的患者联合了抗胆碱能药、苯二氮革类、β-受体阻断剂、抗抑郁药和心境稳定剂,主要用于控制不良反应或增效治疗.结论 第2代抗精神病药已经成为我国治疗精神分裂症的主流药物,反映出精神分裂症治疗理念和治疗技术的进展.     

96例精神药物过量患者资料分析

目的　分析服用过量精神病药物患者的临床相关资料及血药浓度。方法　回顾 1992～2 0 0 0年在上海市精神卫生中心就诊的精神药物过量的精神病患者的临床资料 ,分析疾病诊断、中毒药物的种类及血药浓度等。结果　共分析了 96例精神药物过量患者 ,诊断主要为精神分裂症 (6 5例 )及抑郁症 (2 3例 )。过量精神药物主要为氯丙嗪 (38例 )、氯氮平 (33例 )及苯二氮 卓艹 类 (2 1例 )。氯丙嗪血药浓度为 (1380 4± 1731 5 )ng/ml,氯氮平血药浓度为 (16 80 3± 2 337 4 )ng/ml。 结论　精神病患者中精神药物中毒以精神分裂症患者为主 ,其次为抑郁症患者。过量药物为常用的抗精神病药物氯丙嗪、氯氮平及苯二氮 卓艹 类。过量服药的患者的血药浓度较高 ,平均血药浓度明显高于治疗浓度。对服用这些药物的精神病患者更需要看护并加强对精神药物的管理     

精神药物副反应及其处理

编辑 :本期综合精神药物的副反应及其处理共1 9篇稿件 ,由 1 5个单位 2 8位作者所撰写。 1　抗精神病药致意识障碍涂登峰 :报告 3 2例住院患者 ,使用抗精神病药后引起意识障碍 ,均符合 CCMD- 2 - R意识障碍的诊断标准。其中男 1 9例 ,女 1 3例 ,年龄 2 1～ 6 5岁 ,平均 (3 6± 1 1 )岁 ;使用氯氮平 2 4例 ,氯丙嗪 1 4例 ,舒必利 2例 (部分系合用病例 )。折合氯丙嗪剂量为3 0 0～ 75 0 mg/d,平均 (5 6 0± 6 2 ) mg/d。初次用药量过大 (折合氯丙嗪剂量 >6 0 0 mg/d) 1 7例 ,快速换药1 2例 ,合用抗胆碱能药或三环抗抑郁药 1 2例 ,年老体弱或…     

精神科老年住院患者药物治疗时点调查

目的 了解精神科老年住院患者精神药物及内科药物应用情况.方法 采用一日法对上海市精神卫生中心闵行院区老年住院患者的精神药物及内科药物应用状况进行调查.结果 (1)精神科老年住院患者抗精神病药物使用频度依次为奥氮平(37.1%),氯氮平(26.8%),利培酮(24.7%),以单一药物使用为主(80.4%),部分患者二药联合(19.6%),未发现三类抗精神病药物合用;(2)合并躯体疾病的患者较多,均予相应的降压、降糖、降脂治疗.结论 精神科老年住院患者以非典型抗精神病药物治疗为主,并重视了躯体疾病的诊疗.     

住院精神障碍患者抗精神病药物一日处方调查

目的 了解我院住院精神障碍患者抗精神病药物的使用情况及其用药规律.方法 采用一日法对本院住院精神疾病患者的抗精神药物应用状况进行调查.结果 (1)住院精神疾病种类构成发生了一些变化;(2)两药联用与单药治疗并重;(3)药物以利培酮处方量第一;(4)St精神病药物的使用剂量基本都在推荐的安全剂量之内.结论 目前本院药物使用以非典型抗精神药物为主,抗精神病药物使用合理.     

1986年至2006年间4个年份唐山市精神分裂症住院患者抗精神病药物使用变化趋势

目的 分析近20年精神分裂症住院患者抗精神病药物治疗种类和剂量变化趋势.方法 调查1986年、1996年、2001年和2006年4个年份在唐山市6所精神病院出院的2 718例精神分裂症患者的3 195份住院病历,用专门设计的调查表记录患者的社会人口学资料、疾病特征以及患者出院时药物治疗信息.结果 ①治疗药物的变化:1986年、1996年、2001年和2006年最常使用的抗精神病药物分别是第一代抗精神病药物、氯氮平、氯氮平、除氯氮平外的第二代抗精神病药物,使用率分别为93.8%(396/422)、45%(285/634)、59.9%(557/930)、51.6%(623/1206).2006年氯氮平使用率达35.7%(431/1206).4个年份间患者出院时合并使用2种以上抗精神病药物治疗的比例旱升高趋势(趋势X~2=99.10,P＜0.001),从1986年的10.43%(44/422)渐升至2006年的26.29%(317/1209).②药物剂量变化:4个年份出院时患者服用抗精神病药物的氯丙嗪等效日剂量组间比较差异有统计学意义(Kruskal-Wallis X~2=43.32,P＜0.001),4个年份的出院患者日服药剂量随年份增长而呈下降趋势(Spearman R=-0.13,P＜0.001);抗精神病药的单一治疗日剂量低于合并治疗,差异有统计学意义(Kruskal-Wallis X~2=14.23,P＜0.001).③多元回归分析表明,患者出院时服用抗精神病药物的氯丙嗪等效剂量与抗精神病药物联合治疗(b=163.86,P＜0.001)、住院大数(b:25.76,P＜0.001)呈正相关;与使用第二代抗精神病药物(b=-114.92,P＜0.001)、发病年龄(b=-3.87,P＜0.001)呈负相关.结论 近20年第二代抗精神病药物已逐渐成为抗精神病治疗的主要用药,抗精神病药合并治疗的比例增加.临床实践中应考虑到氯氮平一直保持较高使用率的利弊和合并用药可能带来的药物不良反应.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.