老年期痴呆患者家属生存质量及其影响因素分析

目的探讨老年期痴呆患者家属生存质量及其影响因素。方法采用一般情况调查表、健康状况问卷（SF-36）、社会支持评定量表（SSRS）、简易智力状态检查（MMSE）、AD病理行为评分表（BEHAVE-AD）对老年期痴呆（AD和VD）患者和其家属进行评定,并与正常老人的家属和老年护理病人的家属进行比较。结果住院痴呆患者家属SF-36总分及因子分比正常对照组和老年护理组的家属评分低,但较门诊痴呆组家属评分高,均有显著性差异（P〈0．01～0．05）。单因素分析发现不同性别、年龄、文化程度、婚姻状况、工作情况、性格、病程、与患者的关系及有无躯体疾病之间SF-36总评分均具有非常显著性差异（P〈0．01）;逐步回归分析显示影响痴呆患者家属生存质量的因素依次为患者痴呆的严重程度,精神行为症状,与患者的血源关系,性别及获得的社会支持。结论老年期痴呆患者家属生存质量较差,影响因素是多方面的,应引起高度重视。     

住院老年痴呆患者监护人的心理状态及其影响因素

目的探讨住院老年痴呆患者监护人的心理状态及其影响因素。方法采用一般情况调查表、症状自评量表（SCL-90）、社会支持评定量表（SSRS）、简易智力状态检查（MMSE）及AD病理行为评分表（BEHAVE-AD）对住院老年痴呆患者及门诊老年痴呆（AD和VD）患者和其监护人进行评定，并与正常老人的监护人和老年非痴呆患者的护理人员进行比较。结果住院痴呆患者监护人SCL-90总分及因子分比正常对照组和老年非痴呆患者护理组评分高，但较门诊痴呆组评分低，均有显著差异（P〈0．01-0．05）。单因素分析发现不同性别、年龄、文化程度、婚姻状况、工作情况、性格、病程、与患者的关系及有无躯体疾病之间SCL-90总评分均具有非常显著差异（P〈0．01）：逐步回归分析显示影响监护人心理状态的因素依次为患者痴呆的严重程度、精神行为症状、与患者关系、性别及社会支持。结论住院老年痴呆患者监护人的心理状态较差，影响因素是多方面的，应引起社会高度重视。     

奥氮平治疗老年期痴呆行为和精神障碍对照研究

目的：探讨奥氮平对老年期痴呆患者的行为和精神症状的疗效及不良反应。方法：80例老年期痴呆患者随机分为奥氮平组38例和奎硫平组42例,疗程8周。采用阿尔茨海默病病理行为评定量表（BEHAV,AD）及治疗中出现的症状量表评定疗效和不良反应。结果：治疗后两组BEHAV—AD评分均显著下降（P〈0．05或P〈0．01）;以奥氮平组BEHAV—AD总分及行为紊乱、抑郁、焦虑评分降低明显（P〈0．05）。结论：奥氮平对老年期痴呆的行为和精神障碍患者安全有效,适合临床应用。     

喹硫平与氟哌啶醇治疗老年期痴呆精神行为症状的对照研究

目的比较喹硫平与氟哌啶醇治疗老年期痴呆患者精神行为症状（BPSD）的疗效、副反应及对认知功能的影响。方法将符合条件的60例老年期痴呆患者随机分为喹硫平组和氟哌啶醇组（各30例）,治疗2个月。采用一般情况调查表（自编）、临床疗效评定量表（CGI）、阿尔茨海默病病理行为评分表（BEHAVE—AD）、简易智力状态检查（MMSE）、药物副反应量表（TESS）进行疗效、副反应和认知功能评估。结果两组有效率分别为85．67％和83．33％,无显著性差异（P〉0．05）。两组BEHAVE—AD评分治疗前后比较均有显著差异（P〈0．05,P〈0．01）,治疗结束后两组间BEHAVE—AD评分无显著差异（P〉0．05）。治疗结束后MMSE评分喹硫平组较氟哌啶醇组高,有显著差异（t=2．24,P〈0．05）。两组锥体外系副反应发生率比较有显著性差异（x2=6．91,P〈0．01）。结论喹硫平与氟哌啶醇对老年期痴呆精神行为症状疗效相似,但副反应小,对认知功能的影响优于氟哌啶醇,故喹硫平更适合于伴有精神行为症状的老年期痴呆患者的治疗。     

焦虑症患者的生活质量及相关因素分析

目的 探索焦虑症患者的生活质量及相关因素。方法 对60例符合CCMD-3诊断标准的焦虑症患者进行一般情况调查、汉密顿焦虑量表（HAMA）、汉密顿抑郁量表（HAMD）、健康状况调查问卷（SF-36）评定。结果除生理机能一项外,焦虑症患者SF-36各维度的评分均显著低于常模（P〈0．01）。患者HAMD评分和SF-36各维度评分呈显著负相关（P〈0．05或P〈0．01）。伴有抑郁症状的焦虑症患者,其SF-36的躯体疼痛、一般健康状况、精力、社会功能、情感职能、精神健康6个维度得分显著低于不伴抑郁症状的患者（P〈0．05或P〈0．01）,其HAMA评分显著高于不伴抑郁症状的患者（P〈0．01）。结论 焦虑症患者的生活质量低于一般正常人群,伴有的抑郁症状的焦虑症患者其生活质量受损更加严重。     

护理干预对抑郁症患者生活质量的影响

目的：观察护理干预对抑郁症患者生活质量的影响。方法：90例抑郁症患者随机分为研究组和对照组各45例。两组均给予帕罗西汀治疗,研究组同时接受8周的护理干预。采用汉密尔顿抑郁量表（HAMD）、焦虑自评量表（SAS）及抑郁自评量表（SDS）评价疗效;采用MOS健康状况调查表（SF-36）评价生活质量。结果：经8周护理干预,研究组HAMD、SAS及SDS评分均较对照组显著降低（P〈0．05或P〈0．01）。出院后6个月,以研究组SF-36各项评分（除躯体疼痛评分显著低于人院时外）均显著高于人院时（P〈0．05或P〈0．01）;两组间比较,以社会功能、精神健康、躯体疼痛及总分差异具有显著性（P〈0．01）。结论：护理干预不仅能缓解抑郁症患者的症状,而且能提高生活质量。     

奥氮平与氟哌啶醇治疗女性精神分裂症患者的对照研究

目的比较奥氮平与氟哌啶醇治疗女性精神分裂症患者的疗效及安全性。方法将符合条件的100例住院女性精神分裂症患者随机分为奥氮平组和氟哌啶醇组,共治疗3个月,采用PANSS、TESS、健康状况问卷（SF-36）进行疗效、不良反应和生活质量评估,同时检测血清泌乳素水平。结果两组治疗前后PANSS评分均有显著性差异（P〈0．01）,治疗结束后阴性症状评分奥氮平组明显低于氟哌啶醇组,有显著差异（P〈0．01）;奥氮平组在生理机能、生理职能、生命活力、社会功能、情感职能5个因子分及生活质量总评分均明显高于氟哌啶醇组（P〈0．05）;治疗结束后奥氮平组泌乳素水平显著低于氟哌啶醇组（P〈0．01）。结论奥氮平治疗女性精神分裂症疗效好,安全性高,生活质量优于氟哌啶醇。     

老年期痴呆家属生活质量的探讨

目的:探讨老年期痴呆家属的生活质量。方法:应用36题健康状况调查问卷(SF-36)评定71名老年期痴呆家属的生活质量并与80名健康者(对照组)进行比较。结果:老年期痴呆家属组在SF-36某些维度均显著低于对照组(P<0.05或P<0.01);病程>5年、伴有躯体疾病以及患者的直系亲属SF-36的某些维度评分分别显著低于病程<5年、无躯体疾病以及患者的旁系亲属。结论:老年期痴呆家属的生活质量下降且与患者病情及亲属关系有关。     

长期住院慢性精神分裂症患者生活质量及影响因素分析

目的 探讨长期住院的慢性精神分裂症患者的生活质量及影响因素。方法 采用阳性症状和阴性症状量表（PANSS）、治疗不良反应量表（TESS）、健康状况调查问卷（sF一36）以及自编患者一般情况调查表（人口学资料、病期、住院时间、临床用药、目前状态、躯体疾病）,对2012年8月～2013年8月的163例慢性精神分裂症住院患者进行评定,并与82名健康志愿者进行对照分析。结果 精神分裂症患者SF-36生活质量各维度评分均低于对照组,两组间差异有统计学显著意义（P〈0．01）;患者的生理机能与药物不良反应呈负相关（r=-0.290,P〈0．01）;躯体疼痛与患者的阳性症状（r=-0．144,P〈0．05）及阴性症状（r=-0．199,P〈0．05）呈负相关;一般健康状况与患者的阴性症状（r=-0．193,P〈0．05）及一般精神病理症状（r=-0．219,P〈0．01）呈负相关;精力与患者的阴性症状（r=-0．342,P〈0．01）及一般精神病理症状（r=-0．186,P〈0．05）呈负相关;社会功能与药物不良反应（r=-0．173,P〈0．05）呈负相关;情感职能与患者的阳性症状（r=-0．201,P〈0．05）呈负相关;精神健康与阴性症状（r=-0．214,P〈0．01）及一般精神病理症状（r=-0．168,P〈0．05）、药物不良反应（r=-0．194,P〈0．05）呈负相关。结论 长期住院的慢性精神分裂症患者的生活质量低下,影响因素是多方面的,包括患者的精神状态、药物疗效、不良反应等。     

奥氮平与氯丙嗪对精神分裂症患者生活质量影响的对照研究

目的比较奥氮平（悉敏）与氯丙嗪对精神分裂症患者生活质量的影响。方法将符合标准的100例住院精神分裂症患者随机分为奥氮平组和氯丙嗪组，共治疗3个月。采用阳性与阴性症状量表（PANSS），不良反应量表（TESS）、健康状况问卷（SF-36）分别进行疗效，不良反应和生活质量评估，并对影响生活质量的诸因素进行多元逐步回归分析。结果两组治疗前后PANSS评分均有显著差异（P〈0．01），治疗结束后阴性症状评分奥氮平组明显低于氯丙嗪组，且有显著差异（P〈0．01）。生活质量比较：奥氮平组在生理机能、生理职能、生活活力、社会功能和情感职能5个因子分及生活质量总分均明显高于氯丙嗪组（P〈0．05），且治疗前后评分有显著差异。多因素逐步回归分析亦显示影响患者生活质量的主要因素依次为精神症状、药物、不良反应和病程。结论奥氮平治疗精神分裂症疗效好，安全性高，生活质量优于氯丙嗪。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.