选择性5-羟色胺再摄取抑制剂与性功能障碍

性功能改变，尤其是性欲减退或性欲缺乏，可能是抑郁症的症状之一。因此，经抗抑郁治疗后，性功能障碍(SD)亦应逐渐恢复。但有报道部分抗抑郁药如单胺氧化酶抑制剂(MAOI)、三环类抗抑郁药(TCA)、选择性5-羟色胺再摄取抑制剂(SSRI)类等，会引起SD或使之恶化。抗抑郁药最常见的SD症状有：勃起障碍，性欲减退，性唤起困难，高潮延迟或     

广泛性焦虑障碍的神经生物学机制

广泛性焦虑障碍(GAD)的神经生物学机制尚不清楚，神经影像学和神经递质研究提示某些特定脑区的功能异常，GABA／苯二氮革复合体、5-HT、去甲肾上腺素一氟化氮、胆囊收缩素和下丘脑-垂体-肾上腺轴等功能紊乱均可能与GAD的发病有关。     

当地新闻对远距离地震所致非破坏性震感的过度报道促发儿童焦虑障碍的病例报告

概述：地震是世界上许多地区比较常见的自然灾害,但地震对心理健康影响的研究还很有限。经历地震的人往往遭受重大损失,患精神障碍的风险增加。然而,规模不大、非破坏性地震现象所致精神障碍的患病率还是未知的。本文报告了一名就诊于精神科门诊的10岁女孩,她出现严重影响功能的焦虑症状已2周,其诱因是经历了一场较远地区的地震,而在当地仅有非破坏性震感,媒体却过度报道。她的情况不符合任何特定的焦虑相关障碍,因此最合适的诊断是精神障碍诊断与统计手册第五版(Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, DSM-5)非特异性分类中的“其它特定焦虑障碍”。经过一种苯二氮?类药物和一种选择性5-羟色胺再摄取抑制剂的治疗,患者的症状4周后消失。     

广泛性焦虑障碍的神经生物学机制

广泛性焦虑障碍 (GAD)的神经生物学机制尚不清楚 ,神经影像学和神经递质研究提示某些特定脑区的功能异常 ,GABA/苯二氮复合体、 5 HT、去甲肾上腺素　一氧化氮、胆囊收缩素和下丘脑—垂体—肾上腺轴等功能紊乱均可能与GAD的发病有关。     

西酞普兰治愈心脑血管病所致抑郁焦虑障碍

西酞普兰系5-羟色胺再摄取选择性抑制剂，国内外已广泛应用于抑郁症的治疗，国内对器质性抑郁焦虑状态的治疗报道并不多见。现将我们所观察的1例心脑血管疾病所致的抑郁焦虑障碍介绍如下。     

社交焦虑障碍药物治疗的循证研究进展

社交焦虑障碍（social anxiety disorder）,又称社交恐惧症（social phobia）,是最常见的精神疾病之一,年发病率为7．1％,终生患病率为12．1％。15％-20％的社交焦虑障碍患者同时存在重性抑郁和酒精滥用＂0。研究已经证明了选择性5-羟色胺再摄取抑制剂（selective serotonin reuptake inhibitors,SSRIs）、     

惊恐障碍80例临床观察

为探讨惊恐患者的临床特点及发病的相关因素 ,我们对80例惊恐障碍进行观察 ,报告如下。1　对象和方法为 1998年 6月～ 2 0 0 1年 6月收住本院开放式精神科病房的惊恐障碍患者 ,共 80例。符合中国精神障碍分类与诊断标准第 3版诊断标准。采用回顾性研究。使用自行设计的调查表 ,项目包括 :发病年龄、性别、职业、文化程度、病前性格、发病诱因、病程、家族史、临床表现、首诊医院、治疗情况及随访半年资料。统计方法使用相对百分率 (% )计算。2　结果一般情况 :80例中男 37例 ,女 4 3例。发病年龄 17～ 6 8岁 ,平均 (4 5 6± 17 1)岁。体力…     

选择性5-羟色胺再摄取抑制剂对骨骼系统的影响

本文对5-HT的中枢和外周作用、肠源性5-HT介导低密度脂蛋白受体相关蛋白5(LRP5)的骨骼效应、SSRIs对骨骼系统的影响及其机制作一综述。     

选择性5-羟色胺再摄取抑制剂的较少见不良反应

本文对选择性5-羟色胺再摄取抑制剂引起抗利尿激素不适当分泌综合征、出血、锥体外系症状、撤药综合征、5-HT综合征及对妊娠及哺乳的影响作一综述。     

Multidimensional effects of sertraline in social anxiety disorder

Clinical trials of social anxiety disorder (SAD) have largely focused on the effect of treatment on symptoms of fear and avoidance, while neglecting the third clinically relevant dimension, physiological arousal. Data were combined from two previously reported placebo-controlled trials of sertraline in the treatment of moderate-to-severe generalized SAD. Efficacy was evaluated using the Brief Social Phobia Scale (BSPS). Three hundred forty-six subjects were randomized to 12-13 weeks of treatment with sertraline and 273 subjects to placebo. Following treatment, significant improvement was noted in favor of sertraline on the full BSPS (P < .001), as well as on each of the individual BSPS subscales: fear (P = .001); avoidance (P < .0001); and physiological arousal (P < .0001). Of the physiological symptoms assessed, the treatment advantage with sertraline was maintained for blushing (P < .003) and palpitations (P < .03), but not for trembling and sweating. These results confirm the efficacy of treatment with a selective serotonin reuptake inhibitor (SSRI), sertraline, across the spectrum of fear, avoidance, and physiological arousal in generalized SAD (GSAD). Among common physiological symptoms in this population, blushing and palpitations appear more treatment responsive than trembling and sweating to acute treatment with sertraline.     

Pharmacotherapy of social anxiety disorder.

Over the last few years, a number of medications have demonstrated their efficacy in the acute treatment of social anxiety disorder. At present, selective serotonin reuptake inhibitors probably constitute the first line treatment, based on their safety, tolerability, and efficacy in the treatment of social anxiety disorder and common comorbid conditions. Data from single trials suggest that clonazepam, bromazepam, and gabapentin may have efficacy similar to the serotonin reuptake inhibitors, but further studies are needed to confirm these findings. The monoamine oxidase inhibitor phenelzine appears to be at least as efficacious as these other agents, but should be reserved for cases that fail to respond to these safer medications. Among the reversible inhibitors of monoamine oxidase A, brofaromine may also be an effective drug, while moclobemide appears to be less potent.Future research directions should include delineating ways to achieve remission (as opposed to response); developing strategies for augmenting partial responders and treating nonresponders to first line approaches; studying the long-term response to medication and prevention of relapse when medication is discontinued; clarifying ways to integrate psychosocial and pharmacological treatment approaches; developing predictors of which patients do best with which treatments; and the treatment of social anxiety disorder in children and adolescents.     

Effects of selective serotonin reuptake and dual serotonergic-noradrenergic reuptake treatments on memory and mental processing speed in patients with major depressive disorder

Patients with major depressive disorder (MDD) usually suffer from altered cognitive functions of episodic memory, working memory, mental processing speed and motor response. Diverse studies suggest that different antidepressant agents may improve cognitive functions in patients with MDD. The aim of this work is to study the effects of serotonergic reuptake inhibitors (SSRIs) and serotonergic-noradrenergic reuptake inhibitors (SNRIs) treatments to improve the performance on memory tasks and mental processing speed in MDD. Seventy-three subjects meeting criteria for major depressive disorder were assessed with the Hamilton depression rating scale and a neuropsychological battery. The subjects were medicated with escitalopram (n = 36) or duloxetine (n = 37) for 24 weeks. At the end of the trial, the subjects were assessed again with the same neuropsychological battery used prior to the treatment. Both treatments improved importantly the episodic memory and to a lesser extent, working memory, mental processing speed and motor performance. Our results suggest that cognition is partially independent from improvement in clinical symptoms. Both groups achieved remission rates in the HAM-D-17 after 24 weeks of treatment, but SNRI was superior to SSRI at improving episodic and working memory. Our work indicates that the superiority of SNRI over the SSRI at episodic memory improvement is clinically relevant.     

The short- and long-term effect of duloxetine on painful physical symptoms in patients with generalized anxiety disorder: Results from three clinical trials

Generalized anxiety disorder (GAD) is associated with painful physical symptoms (PPS). These post hoc analyses of previous trial data assessed PPS and their response to duloxetine treatment in GAD patients. Studies 1 and 2 (n = 840) were 9- to 10-week efficacy trials; study 3 (n = 887) was a relapse prevention trial comprising a 26-week open-label treatment phase and a 26-week double-blind, placebo-controlled treatment continuation phase. Mean baseline visual analog scale scores (VAS, 0–100; n = 1727) ranged from 26 to 37 for overall pain, headache, back pain, shoulder pain, interference with daily activities, and time in pain while awake. In studies 1 and 2, improvement on all VAS scores was greater in duloxetine-treated than in placebo-treated patients (p ≤ 0.01). In study 3, pain symptoms worsened in responders switched to placebo compared with those maintained on duloxetine (p ≤ 0.02). In conclusion, duloxetine was efficacious in the short- and long-term treatment of PPS, which are common in GAD patients.     

Clinical features and treatment outcome in Japanese patients with social anxiety disorder: chart review study

The lifetime prevalence of social anxiety disorder (SAD) is high at 3-13%, but there have been only limited reports investigating the clinical features of this disorder in a large number of Japanese patients. The authors have conducted a retrospective, chart review study of 52 patients with SAD and obtained the following results. (i) The proportion of SAD in first visit outpatients at the Department of Psychiatry, Niigata University Medical and Dental Hospital, Niigata, Japan, was 1.04%. The male : female ratio was 1:0.73, so male patients appeared to be more common in the sample. (ii) With regard to subtype, generalized type (73% of the patients) was more common than non-generalized type (27%). (iii) The mean age of onset was 18.6 +/- 7.8 years, and there was a trend towards onset of disease at a younger age in the generalized type compared to the non-generalized type. (iv) The most common chief complaint was anxiety and tension in front of others (40.4%). (v) Pharmacotherapy resulted in improvement in 63.5% of the patients. Treatment by fluvoxamine and alprazolam resulted in high response rates of more than 70%.     

SSRI 治疗首发为抑郁发作的双相障碍患者对自杀风险的相关因素分析

目的 探讨双相障碍首次抑郁发作使用SSRI类抗抑郁剂治疗后,出现自杀风险的相关因素.方法 回顾性记录177例以抑郁发作为首次发作形式的双相抑郁障碍患者人口学资料和临床特征,并比较它们在没有出现自杀组和出现自杀组之间的差异,采用逐步Logistic回归方法进行分析,受试者工作特征曲线(ROC)与Hosmer-Lemeshow分别评估危险因素模型的准确度和拟合优度.结果 没有出现自杀风险患者154例,出现自杀风险患者23例.出现自杀风险的患者组中饮酒史、心境障碍家族史、有易激惹症状、绝望感和伴随精神病性症状的比例高于未出现自杀风险的患者组(均P<0.05).进一步回归分析显示,使用SSRI类抗抑郁剂治疗而导致自杀风险的相关因素为:易激惹(OR=4.04,95%CI:1.40-11.67,P<0.05),有精神病性症状(OR=6.23,95%CI:1.41-27.56,P<0.05).ROC为0.71.Hosmer-Lemeshow为0.58.结论 易激惹症状、精神病性症状是双相障碍首次抑郁发作予SSRI治疗出现自杀风险的潜在预测因素.     

An open trial of paroxetine for the "offensive subtype" of taijin kyofusho and social anxiety disorder

The taijin kyofusho (TKS) offensive subtype is thought to be a culture-bound syndrome similar to social anxiety disorder (SAD). In Western countries, such patients would be diagnosed as having delusional disorder, somatic subtype, or body dysmorphic disorder. Recently, open trials for the TKS offensive subtype and a randomized controlled trial for body dysmorphic disorder demonstrated that selective serotonin reuptake inhibitors (SSRIs) might be as effective in TKS as in SAD. This study investigated the efficacy of the SSRI paroxetine in patients with the TKS offensive subtype, both on anxiety and fears, as well as insight. This study was a 12-week open trial using paroxetine in 22 patients with TKS. Subjects were diagnosed based on the original diagnostic criteria for the TKS offensive subtype. Insight regarding TKS symptoms was assessed by the 11th supplement subscale "Insight into obsessions and compulsions" of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). The Liebowitz Social Anxiety Scale (LSAS), the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI), Rosenberg's Self-Esteem Scale, and the Interpersonal Distrust subscale of the Eating Disorder Inventory were also administered. Offensive anxiety was assessed by the original TKS offensive anxiety subscale (0-3 points). The primary efficacy variable was the Clinical Global Impression scale (CGI) global improvement item. Nineteen patients completed the study. Forty-seven percent (9/19) were responders to the drug treatment (scoring 2 or less on the CGI). Last observation carried forward (LOCF) analysis (N=22) demonstrated a statistically significant reduction in LSAS total score and offensive anxiety in TKS, and the insight scale score of the Y-BOCS also significantly improved. Interpersonal distrust showed a trend toward improvement.     

Potential involvement of NET polymorphism in serotonin/norepinephrine reuptake inhibitor response in panic disorder

Background: This is a pilot study assessing the impact of polymorphisms of serotonin transporter (5-HTT; 5-HTTLPR (S/L)) and norepinephrine transporter (NET; rs2242446 (T/C)) genes on selective serotonin reuptake inhibitors (SSRIs) and serotonin/norepinephrine reuptake inhibitors (SNRIs) response in Korean panic disorder (PD) patients. Methods: PD patients were treated with SSRI (n?=?18) or SNRI (n?=?6) for 4 weeks. Panic Disorder Severity Scale (PDSS) was rated to evaluate the treatment response. Wilcoxon signed-rank test was used to compare PDSS scores before and after medication (SSRI or SNRI) as well as to compare those according to genotypes. Mann–Whitney U test was used to compare those between the two groups (SSRI or SNRI). Results: Both SSRI and SNRI treatments for 4 weeks significantly reduced PDSS scores. We assessed the impact of rs2242446 on this effect of SSRI and SNRI. The scores were significantly decreased after 4 weeks in the SSRI-treated group regardless of genotypes of rs2242446, whereas they were significantly decreased in the SNRI-treated group with only non-C carrier (TT) of rs2242446. On 5-HTTLPR we could not analyse because 22 patients had SS genotype. Conclusions: These results suggest that NET polymorphism may affect the SNRI response in Korean PD patients.     

Evidence of a progressive motor dysfunction in Mucopolysaccharidosis type I mice

Selective serotonin re-uptake inhibitors are increasingly used for the treatment of adolescents with behavioural disorders. However, the effect of this class of drugs during this sensitive period of brain development has not been extensively investigated. In this study we examine the effect of subchronic treatment with the selective serotonin re-uptake inhibitor, fluoxetine (10 mg/kg/day, i.p.) throughout adolescence (postnatal day 28-60) on learning and memory in the rat. Learning and memory were assessed at two time points: during adolescence, while the animals were being treated with fluoxetine and in young adulthood, 40 days after the termination of fluoxetine treatment. Fluoxetine treated rats were compared to a saline injected control group with respect to spatial navigation in the water maze, object recognition and object-in-place recognition memory. Additionally open field behaviour was examined. In adolescent rats fluoxetine treatment impaired water-maze probe trial performance and object recognition at intertrial intervals of 15 and 60 min, while leaving object-in-place recognition memory unaffected. In the open field the fluoxetine treated animals displayed reduced exploratory activity and higher levels of anxiety. Training the animals to a new platform position in young adulthood showed that the rats that had been treated with fluoxetine during adolescence were significantly slower to acquire this new spatial information. Adolescent fluoxetine treatment had no effect on cell proliferation in dorsal dentate gyrus and subgranular zone in young adulthood. This calls for further studies examining the long-term effects of this class of antidepressants on adolescent brain development and behaviour.