阿戈美拉汀治疗首发抑郁症的临床效果

目的观察阿戈美拉汀治疗首发抑郁症的有效性及安全性。方法将76例首发抑郁症患者按照随机数字表法分为阿戈美拉汀组和氟西汀组各38例,分别以阿戈美拉汀25~50 mg/d和氟西汀20~40 mg/d治疗,两组均治疗6周。分别于治疗前及治疗第1、2、4、6周末采用汉密尔顿抑郁量表17项版(HAMD-17)评定临床疗效,于治疗6周末采用副反应量表(TESS)评定药物的安全性。结果阿戈美拉汀组有效率为86.84%,氟西汀组有效率为84.21%,两组差异无统计学意义(P0.05);在治疗第1、2周末,阿戈美拉汀组HAMD-17总评分及焦虑/躯体化、睡眠障碍因子评分均低于氟西汀组,差异均有统计学意义(P均0.05)。治疗6周末,两组TESS评分比较差异无统计学意义[(2.92±2.11)分vs.(3.42±2.13)分,P0.05]。结论阿戈美拉汀对首发抑郁症的疗效较好、安全性较高,尤其适用于伴有焦虑、失眠的抑郁症患者。     

低频重复经颅磁刺激治疗首发抑郁症的临床对照研究

目的探讨低频重复经颅磁刺激(rTMS)治疗首发抑郁症的疗效及安全性。方法采用随机数字表法将符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)的65例首发抑郁症患者分为rTMS组33例和氟西汀组32例,观察期6周。用汉密尔顿抑郁量表(HAMD-17)、汉密尔顿焦虑量表(HAMA)及副反应量表(TESS)分别评定疗效及不良反应。结果 rTMS组有效率78.8%,氟西汀组有效率84.4%,两组疗效相当(P0.05);在第1周末rTMS组HAMD-17和HAMA评分较氟西汀组低,差异有统计学意义(P均0.05);rTMS组和氟西汀组不良反应发生率分别为12.1%和40.6%,差异有统计学意义(P0.01)。结论 rTMS治疗首发抑郁症的效果与氟西汀相当,但起效较氟西汀快、不良反应发生率低于氟西汀。     

米安色林对首发抑郁症的临床疗效

目的探讨米安色林治疗首发抑郁症的效果及安全性。方法将符合《国际疾病分类(第10版)》(ICD-10)的128例首发抑郁症患者随机分为米安色林组和氟西汀组各64例,疗程8周。用汉密尔顿抑郁量表(HAMD-17)和汉密尔顿焦虑量表(HAMA)评定疗效,副反应量表(TESS)评定安全性。结果米安色林组有效率92.2%,氟西汀组有效率89.1%,两组差异无统计学意义(P0.05)。第2周末,米安色林组HAMD-17及HAMA评分分别为(16.25±2.397)分和(10.92±2.110)分,低于氟西汀组的(17.17±2.758)分和(12.02±2.134)分,差异有统计学意义(P0.05)。米安色林组TESS评分为(4.80±3.80)分,氟西汀组为(5.20±3.65)分,差异无统计学意义(P0.05)。结论米安色林治疗首发抑郁症患者较氟西汀起效快,但疗效及不良反应发生率相当。     

丁螺环酮联合氟西汀治疗抑郁症的疗效分析

目的探讨丁螺环酮联合氟西汀治疗抑郁症的临床疗效。方法选取本院2014年1月至2017年6月符合ICD-10抑郁症诊断标准的186例抑郁症患者,按不同治疗方案随机分成对照组和观察组2组:对照组为氟西汀+安慰剂组(n=93),观察组为氟西汀+丁螺环酮组(n=93),疗程8w。通过Hamilton抑郁量表(HAMD-17项)和不良反应症状量表(TESS)观察治疗前、及治疗后2、4、6、8w 2组患者的临床治疗效果与不良反应。结果 2组患者在治疗前和治疗2w后的HAMD-17项评分相比差异无统计学意义(P0.05),然而从第4周开始,2组HAMD-17项评分相比差异有统计学意义(P0.05)。观察组患者痊愈率(30.11%vs 16.13%,χ~2=5.112,P=0.024)和总有效率(88.17%vs 73.12%,χ~2=6.751,P=0.009)均显著高于对照组患者。从第4周开始,2组患者TESS评分相比(P0.05)。观察组患者与对照组相比失眠发生率显著降低(12.90%vs 24.73%,χ~2=4.258,P=0.039)。结论丁螺环酮可增强氟西汀治疗抑郁症的疗效,同时对改善抑郁症睡眠障碍有显著作用。     

氟西汀联合奥氮平治疗伴自杀意念抑郁症的效果

目的观察氟西汀联合奥氮平治疗伴自杀意念抑郁症的效果,为该疾病的治疗提供参考。方法选取2014年1月-2016年1月新疆维吾尔自治区人民医院收治的70例伴自杀意念抑郁症患者,均符合《精神障碍诊断与统计手册(第4版)》(DSM-IV)抑郁症诊断标准。采用随机数字表法分为研究组和对照组各35例。对照组采用氟西汀治疗,研究组采用氟西汀联合奥氮平治疗,两组均治疗8周。于治疗前后进行汉密尔顿抑郁量表17项版(HAMD-17)和自杀意念自评量表(SIOSS)评定,采用自编不良反应记录表记录两组不良反应发生情况。结果对照组和研究组在不同时间点HAMD-17评分比较差异均有统计学意义(对照组F=204.3,P0.01,研究组F=292.6,P0.01),SIOSS评分在不同时间点比较差异均有统计学意义(对照组F=15.6,P0.01,研究组F=21.8,P0.01)。治疗第2、4、8周末,研究组HAMD-17评分均低于对照组(P均0.01),有自杀意念者的比例和SIOSS评分均低于对照组(P0.05或0.01)。两组不良反应发生率比较差异无统计学意义(χ~2=0.971,P=0.325)。结论与单用氟西汀比较,氟西汀联合奥氮平治疗可能更有助于改善伴自杀意念抑郁症患者抑郁症状和自杀意念。     

小剂量奥氮平联合氟西汀治疗难治性抑郁症的随机对照研究

目的 评价小剂量奥氮平联合氟西汀治疗难治性抑郁症的临床效果.方法 64例难治性抑郁症患者随机分为研究组和对照组,每组32例,研究组患者给予氟西汀合并小剂量奥氮平治疗,对照组患者给予氟西汀单药治疗,两组疗程均为8周.治疗前及治疗后第1、2、4、8周末应用汉密尔顿抑郁量表(HAMD)进行评分并评价疗效,应用治疗中需处理的不良反应症状量表(TESS)及实验室检查评定治疗安全性.结果 治疗后第2周末起,两组患者HAMD评分均显著下降,与治疗前比较差异有统计学意义(P＜0.05),研究组治疗后第1、2、4、8周末HAMD评分显著低于对照组,差异有统计学意义(P＜0.05).研究组临床有效率为46.88％,对照组有效率为21.88％,两组临床有效率比较,差异有统计学意义(P＜0.01).两组患者均无明显不良反应,不良反应发生率无统计学意义(P＞0.05).结论 小剂量奥氮平联合氟西汀治疗难治性抑郁症具有较好的临床疗效.     

帕罗西汀联合重复经颅磁刺激治疗女性更年期抑郁症的对照研究

目的探讨帕罗西汀联合重复经颅磁刺激(r TMS)对女性更年期抑郁症的疗效。方法采用随机数字表法将符合《国际疾病分类(第10版)》(ICD-10)抑郁症诊断标准的72例更年期女性患者分为研究组和对照组各36例,研究组采用帕罗西汀联合r TMS治疗,对照组单用帕罗西汀治疗,采用汉密尔顿抑郁量表17项版(HAMD-17)、汉密尔顿焦虑量表(HAMA)、流调用抑郁自评量表(CES-D)于治疗前及治疗后第2、4、6、8周评定疗效,采用副反应量表(TESS)评定不良反应。结果研究组与对照组有效率分别为94.4%和75.0%,差异有统计学意义(P0.01)。从治疗第1周末开始,研究组HAMD-17、HAMA及CES-D评分与治疗前比较,差异均有统计学意义(P均0.01),从治疗第2周末开始,对照组HAMD-17、HAMA及CES-D评分与治疗前比较,差异均有统计学意义(P均0.01)。治疗后两组同期比较差异有统计学意义(P0.01)。治疗结束时两组TESS评分差异无统计学意义(P0.05)。结论帕罗西汀联合r TMS对女性更年期抑郁症疗效优于单用帕罗西汀,起效较快。     

抑郁症患者的情感强度识别能力及氟西汀治疗的影响

目的探讨抑郁症患者的情感强度识别能力及氟西汀对其的影响,为改善抑郁症患者的情感强度识别能力提供参考。方法于2015年12月-2017年5月在无锡精神卫生中心选取符合《精神障碍诊断与统计手册(第5版)》(DSM-5)诊断标准的抑郁症住院患者56例,采用随机数字表法分为氟西汀组和阿米替林组各28例,分别给予氟西汀和阿米替林治疗,均治疗12周。分别于基线期及治疗4、12周后采用汉密顿抑郁量表17项版(HAMD-17)评定患者抑郁症状,用情感强度识别任务(EIRT)评定患者情感强度识别能力。同期招募28名健康者作为对照组,采用EIRT评定其情感强度识别能力。结果治疗12周后,氟西汀组和阿米替林组HAMD-17评分均低于基线期,差异均有统计学意义(P均0. 01);但两组HAMD-17评分差异无统计学意义(P 0. 05)。在基线期,氟西汀组和阿米替林组EIRT总评分及6个因子评分差异均无统计学意义(P均 0. 05),但均低于对照组(P 0. 05或0. 01);治疗12周后,两患者组EIRT总评分及6个因子评分均高于基线期,氟西汀组EIRT评分高于阿米替林组,差异均有统计学意义(P均0. 05)。结论抑郁症患者可能存在情感强度识别能力受损,氟西汀和阿米替林均能改善抑郁症患者的情感强度识别能力,但氟西汀效果更佳。     

度洛西汀联合认知疗法对首发抑郁症疗效的临床对照研究

目的 探讨度洛西汀联合认知疗法对首发抑郁症的疗效和安全性.方法 将80例门诊首发抑郁症患者采用数字随机法分为度洛西汀联合认知治疗组（A组,n=40）和度洛西汀组（B组,n=40）.A组以度洛西汀联合认知疗法治疗,B组单一服用度洛西汀治疗,疗程8周.采用汉密尔顿抑郁量表（HAMD-17）及副反应量表（ TESS）于治疗前和治疗第2、4、6、8周末分别评定临床疗效和不良反应.结果 治疗2周末两组HAMD-17评分[（17.35±5.51）,（19.59±5.30）]均较治疗前下降（t=8.251、6.193,P＜0.05或0.01）.在治疗2、4、6、8周末,A组HAMD-17评分均较B组低（P＜0.05）.两组患者TESS量表总分差异无统计学意义（t=1.652,P＞0.05）.结论 度洛西汀联合认知疗法对首发抑郁症疗效可能优于单一服用度洛西汀治疗,其副反应程度相当.     

文拉法辛缓释片治疗抑郁症伴躯体疼痛障碍的效果和安全性

目的探讨文拉法辛缓释片治疗抑郁症伴躯体疼痛障碍的效果及安全性,为临床合理用药提供参考。方法选取2016年2月-2017年3月江油市精神病医院收治的100例抑郁症伴躯体疼痛障碍患者,均符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)抑郁症诊断标准,且慢性疼痛等级评价量表(GCP)评分在Ⅰ级以上并有3个月以上的持续性疼痛存在。采用随机数字表法分为观察组和对照组各50例。观察组给予文拉法辛缓释片治疗,对照组给予帕罗西汀治疗,两组均治疗8周。分别于治疗前和治疗第1、2、4、8周末采用汉密尔顿抑郁量表17项版(HAMD-17)、视觉模拟量表(VAS)进行评定,于治疗第1、2、4、8周末采用副反应量表(TESS)评价安全性。结果治疗后,观察组临床治疗总有效率高于对照组,差异有统计学意义(94.00%vs.78.00%,χ~2=5.316,P0.05);治疗第1、2、4、8周末,观察组HAMD-17和VAS评分均较治疗前低(P均0.05),治疗第2、4、8周末,对照组HAMD-17和VAS评分均较治疗前低(P均0.05),治疗后各时点,观察组HAMD-17和VAS评分均低于对照组,差异均有统计学意义(P均0.05),两组TESS评分比较差异均无统计学意义(P均0.05)。结论文拉法辛缓释片较帕罗西汀治疗抑郁症伴躯体疼痛障碍的相对效果更好,二者安全性可能相当。     

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.     

Summary of Legislation of 1933 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -