氯氮平与氯丙嗪治疗精神分裂症的对照研究

为进一步验证氯氮平在治疗精神分裂症中的地位。方法对病程＜５年的１２２例首次住院的精神分裂症患者，采用分层随机法分为两组，分别首选氯氮平和氯丙嗪进行８周治疗。以ＢＰＲＳ、ＳＡＰＳ、ＳＡＮＳ评定疗效，以ＴＥＳＳ评定副反应。结果治疗前后比较，两组ＢＰＲＳ、ＳＡＰＳ分均显著下降（Ｐ＜０．０１），ＳＡＮＳ分氯氮平组显著降低（Ｐ＜０．０１），氯丙嗪组无明显差异（Ｐ＞０．０５）；疗后氯氮平组的ＢＰＲＳ、ＳＡＰＳ、ＳＡＮＳ总分均明显低于氯丙嗪组（Ｐ＜０．０１）；ＴＥＳＳ总分氯氮平组亦低于氯丙嗪组，且无锥体外系副反应。结论氯氮平确是一种十分有效且药物副反应并不多见的抗精神病药。在严密监测血象的情况下，氯氮平实际上可作为一个可供选择的治疗精神分裂症的第一线药使用。     

氯氮平药代动力学影响因素及血药浓度与临床效应的关系

为了探讨吸烟与性别对氯氮平药代动力学及稳态浓度的影响，以及氯氮平、去甲氯氮平稳态浓度与疗效、不良反应的关系，对３０例（吸烟男性１０例，不吸烟男性和女性各１０例）精神分裂症病人进行氯氮平药代动力学研究，对５８例精神分裂症病人于治疗第２、４、６、８周测定氯氮平和去甲氯氮平浓度，并评定简明精神病症状评定量表（ＢＰＲＳ）、阳性和阴性症状量表（ＳＡＰＳ、ＳＡＮＳ）及副反应量表（ＴＥＳＳ），分析血药浓度与疗效、不良反应的相关性。结果显示，吸烟者的氯氮平半衰期、达峰浓度和稳态浓度明显低于非吸烟者（Ｐ＜０．０１）。氯氮平、去甲氯氮平浓度和二者总浓度与ＴＥＳＳ呈显著正相关（Ｐ＜０．０１），与ＢＰＲＳ、ＳＡＰＳ和ＳＡＮＳ无显著相关，但有效组血药浓度高于无效组（Ｐ＜０．０５）。认为氯氮平血药浓度监测有一定临床意义，血药浓度以３５０～６００μｇ／Ｌ为宜     

银杏叶提取物结合氟哌啶醇治疗慢性精神分裂症的双盲对照研究

目的探讨银杏叶提取物结合氟哌啶醇对慢性精神分裂症的治疗作用。方法采用随机、双盲、空白对照法，用银杏叶提取物３６０ｍｇ／ｄ结合氟哌啶醇（０２５ｍｇ／ｋｇ）对１１２例慢性精神分裂症患者进行治疗１２周，在治疗前后评定ＢＰＲＳ、ＳＡＰＳ、ＳＡＮＳ和ＴＥＳＳ量表。结果银杏叶提取物结合氟哌啶醇治疗慢性精神分裂症的疗效比单用氟哌啶醇要好，前者ＢＰＲＳ、ＳＡＰＳ和ＳＡＮＳ量表总分明显降低，而后者仅ＢＰＲＳ量表总分明显降低；同时前者治疗后ＳＡＰＳ量表评分显著低于后者；银杏叶提取物具有减轻氟哌啶醇锥体外系和行为毒性副反应的作用。结论银杏叶提取物可提高抗精神病药治疗慢性精神分裂症的疗效，并减轻抗精神病药副作用。     

脑血管性痴呆与帕金森病神经心理学测验和脑单光子发射计算机断层扫描的对照研究

目的　研究脑血管性痴呆（ Ｖ Ｄ） 与帕金森病（ Ｐ Ｄ） 在神经心理学测验及脑单光子发射计算机断层扫描（ Ｓ Ｐ Ｅ Ｃ Ｔ） 的诊断和鉴别诊断的意义。方法　对３０ 例 Ｖ Ｄ、３１ 例 Ｐ Ｄ 和３０ 名正常老年人（ Ｎ Ａ） 进行神经心理学测验和 Ｓ Ｐ Ｅ Ｃ Ｔ 检查并比较检测结果。结果　神经心理学各项总分 Ｖ Ｄ 组最低［ 除积木测验（ Ｂ Ｄ） 外］ , Ｐ Ｄ 组次之, Ｎ Ａ 组最高;３ 组间差异均有非常显著性（ Ｆ＝ １８６７ ～６３９５ , Ｐ＜００１） 。在 Ｓ Ｐ Ｅ Ｃ Ｔ的检查中, Ｖ Ｄ 除额叶、左丘脑和右枕叶外余各脑区血流灌注均低于 Ｎ Ａ 组（ Ｐ＜００５） , Ｐ Ｄ 则为顶叶、颞叶、基底节和丘脑血流灌注低于 Ｎ Ａ 组（ Ｐ＜ ００５） 。结论　 Ｖ Ｄ 和 Ｐ Ｄ 的神经心理学测验和脑 Ｓ Ｐ Ｅ Ｃ Ｔ各有其特点,这两项检查可作为诊断和鉴别诊断 Ｖ Ｄ 和 Ｐ Ｄ 的辅助手段。     

卡马西平与氯氮平治疗精神分裂症双盲对照研究

用卡马西平、氯氮平对６３例男性精神分裂症进行了为期８周的双盲对照研究，采用ＢＰＲＳ、ＳＡＰＳ、ＳＡＮＳ、ＴＥＳＳ进行评定，结果氯氮平有效率为９４．１２％，卡马西平有效率为７２．４１％，差异有显著意义（Ｐ＜０．０５）。     

哌泊噻嗪、氟哌啶醇癸酸酯与氟奋乃静癸酸酯治疗精神分裂症的对照研究

建桐翁正【摘要】目的验证和比较哌泊噻嗪、氟哌啶醇癸酸酯、氟奋乃静癸酸酯三种长效抗精神病制剂对精神分裂症的疗效及副反应。方法采用多中心、开放随机对照研究，以简明精神病评定量表（ＢＰＲＳ）、阳性症状评定量表（ＳＡＰＳ）、阴性症状评定量表（ＳＡＮＳ）、临床疗效总评量表（ＣＧＩ）和副反应量表（ＴＥＳＳ）、锥体外系副反应量表（ＲＳＥＳＥ）综合评定。结果治疗后哌泊噻嗪组患者的ＣＧＩＳＩ与ＣＧＩＧＩ分值和ＳＡＮＳ量表总分均低于其它两组，差异均有显著性（Ｐ＜０．０５），而ＢＰＲＳ和ＳＡＰＳ量表总分治疗结束时三组间差异无显著性（Ｐ＞０．０５）。ＴＥＳＳ总分和ＲＳＥＳＥ总分在整个治疗过程中均以氟奋乃静癸酸酯组最高，哌泊噻嗪组最低。结论三组中以哌泊噻嗪对精神分裂症的疗效较好，对阴性症状的改善优于氟哌啶醇癸酸酯组和氟奋乃静癸酸酯组，对阳性症状的疗效近似。哌泊噻嗪组副反应较少，安全度较好     

蝮蛇抗栓酶合并抗精神病药治疗精神分裂症对照观察

本研究用蝮蛇抗栓酶并抗精神病药及单用抗精神病药物治疗精神分裂症３０例，结果显示，治疗后两组病人的ＢＰＲＳ总分明显降低（Ｐ〈０．００１）。但两组相比，治疗２周时试验组疗效好于对照组（Ｐ〈０．０５），提示蝮蛇抗栓酶合并抗精神病药治疗可使疗效提早出现。但至第６周两组间疗效无明显差异。本组病人ＳＡＮＳ总分在６周治疗后，也较治疗前有明显下降（Ｐ〈０．０５），尤以意志减退，兴趣丧失，注意力障碍的改善较明显，但     

舒血宁治疗残留型精神分裂症双盲对照研究

采用双盲对照法，对９０例以阴性症状为主的残留型精神分裂症进行舒血宁合并抗精神病药物和单用抗精神病药物治疗观察。结果发现，两组ＢＰＲＳ量表评分和ＳＡＮＳ量表评分有显著差异（Ｐ〈０．０５）。合并舒血宁组对意志缺乏、注意障碍、情感淡漠和兴趣、社交缺乏方面的疗效较明显。其副作用也较对照组轻。     

精神分裂症患者脑脊液促甲状腺激素水平研究

目的比较Ⅰ型与Ⅱ型精神分裂症患者治疗前、后脑甲状腺功能状态及其中枢调节方面的差异。方法电抽搐治疗（ＥＣＴ）Ⅰ型精神分裂症、氯氮平治疗Ⅱ型精神分裂症；在治疗前、后测定促甲状腺激素（ＴＳＨ）含量、简明精神病评定量表（ＢＰＲＳ）、阳性症状评定量表（ＳＡＰＳ）、阴性症状评定量表（ＳＡＮＳ）。结果Ⅰ型精神分裂症患者脑脊液ＴＳＨ值略高于Ⅱ型；ＥＣＴ对Ⅰ型患者脑脊液ＴＳＨ水平有双向调节功能，调节效应好；氯氮平对Ⅱ型患者脑脊液ＴＳＨ水平的调节功能和效应低下；治疗前后脑脊液ＴＳＨ增（减）值Ⅰ型较Ⅱ型大（Ｐ＜００１）。结论提示精神分裂症患者Ⅰ型与Ⅱ型脑甲状腺功能状态及其中枢调节不同     

氯氮平及其联合舒必利治疗精神分裂症的双盲对照研究

目的 比较氯氮平及其联合舒必利治疗精神分裂症的疗效和副反应。方法 ４１例精神分裂症患者,采用随机双盲法进行６周治疗观察,用ＢＰＲＳ、ＳＡＮＳ、临床疗效、ＴＥＳＳ评定疗效和副反应。结果 氯氮平组和氯氮平联合舒必利组ＢＰＲＳ、ＳＡＮＳ评分在治疗末均显著下降（Ｐ〈０．０１）,联合组于疗后３周ＳＡＮＳ７总分即有显著下降（Ｐ〈０．０５）;疗末联合组ＢＰＲＳ、ＳＡＮＳ评分与氯氮平组相比具有显著性差异（Ｐ〈０     

防风通圣散治疗精神分裂症104例临床研究

目的：探讨古方－防风通圣散对精神分裂症的临床疗效,副反应及其作用机理,方法：采用多中心开放随机对照研究,对104例精神分裂症患者用常规抗精神病药加服防风通圣散煎剂结合治疗,与126例单用常规抗精神药治疗的精神分裂症患者对照。以简明精神病评定量表（BPRS）和阳性症状评定量表（SAPS）,阴性症状评定量表（SANS）,临床疗铲总评量表（CGI）和副反应量表（TESS）,锥体外系副反应量表（RSESE）^[1]综合评定。结果：治疗后防风通圣散组（治疗组）患者的CGI－SI与CGI－GI分值和BPRS,SAPS,SANS量表的总分及因子分均低于单用常规抗精神病药治疗组（对照组）患者,差异均有显著性（P＜0．01）,TES总分与RSESE总分在整个治疗过程中均低于对照组,差异有显著性（P＜0．01）,结论：治疗组对精神分裂症的疗效较好;对阳性,阴性症状的改善明显优于对照组,副反应显著较少,安全度较好,调畅各脏腑机能与气机的运动形式,内通外达是其作用的机理。     

One year outcome in first episode schizophrenia

The aim of this study was to identify the predictors of outcome at one year follow-up after the first psychotic episode of schizophrenia. Seventy-nine first-episode schizophrenia patients were assessed monthly with the Brief Psychiatric Rating Scale (BPRS), Scale for Assessment of Positive Symptoms (SAPS), and Scale for Assessment of Negative Symptoms (SANS) after discharge from their first hospitalization. Outcome measures were presence of relapse and rehospitalization, level of global functioning, employment status and severity of symptoms at one year. A total of 33% of the patients had a relapse, and 12.1% were rehospitalized during one year follow-up. Premorbid childhood functionality was worse in patients who had relapse, but there was no correlation between premorbid adjustment scores and BPRS, SANS and SAPS scores at one year. There was no difference in duration of untreated psychosis (DUP) between patients who had relapse and not; however, the patients who had double relapse, had longer DUP than those without relapse. The time period between discharge and rehospitalization was shorter in patients with longer DUP. Functionality in childhood and noncompliance to the treatment independently contributed to the relapse rate. Functionality in late adolescence independently contributed to the Global Assessment of Functioning (GAF) scale score at one year and the GAF score at discharge appeared as a predictor of employment. The results of the present study suggest that treatment compliance and early premorbid adjustment level seem to be important predictors of relapse rate in first episode schizophrenia.     

万拉法新与氯丙咪嗪治疗精神分裂症后抑郁对照研究

目的 验证万拉法新治疗精神分裂症后抑郁的疗效及安全性。方法 对65例精神分裂症后抑郁患者随机入组,分别以万拉法新与氯丙咪嗪治疗6周。采用汉密尔顿抑郁量表(HAMD)、简明精神病量表(BPRS)、阴性症状量表(SANS)评定临床疗效,采用副反应量表(TESS)评定副反应。结果 万拉法新组与氯丙咪嗪组治疗前后HAMD、BRPS、SANS评分及减分率比较均无显著性差异(P>0.05)。万拉法新组的副反应较氯丙咪嗪组少而轻,但各有1例精神病症状恶化。结论 万拉法新治疗精神分裂症后抑郁的疗效确切,但极个别病例精神病症状恶化。     

Risperidone in the treatment of disorders with a combined psychotic and depressive syndrome--a functional approach.

In vitro receptor-binding profiles and in vivo pharmacological studies have shown risperidone to be a potent mixed serotonin-S2 dopamine-D2-like receptor antagonist. While anti-D2 activity may relate to the antipsychotic potency of neuroleptic drugs, an antidepressive efficacy of substances with anti-S2 activity has been suggested. In an open pilot-study, ten patients with schizodepressive disorders or a DSM-III-R diagnosis of psychotic major depressive episodes were treated with risperidone (2-10 mg/d) for six weeks. Weekly psychopathological evaluation was performed, including BPRS, SANS, SAPS, VAS scales, and AIMS and UKU for the assessment of side-effects. Generally, the psychotic syndrome (BPRS, SANS and SAPS) decreased markedly in all patients; seven patients also showed a clinically significant improvement of depressive symptoms (BPRS). Except for two patients who needed biperiden because of extrapyramidal side-effects, the tolerance of risperidone was good. The antipsychotic and antidepressive properties of risperidone shown in our pilot study are promising enough to merit full double-blind controlled trials for further evaluation of its therapeutic value in this broad spectrum of psychiatric disorders.     

万拉法新与舒必利辅助治疗精神分裂症阴性症状的比较研究

目的 比较万拉法新与舒必利辅助治疗精神症阴性症状的效果。方法 使用万拉法新、舒必利分别作为氯氮平的辅助用药,对84例以阴性症状为主的分裂症患者进行对照研究,以简明精神量表(BPRS)、阴性症状量表(SANS)、汉密尔顿抑郁量表(HAMD)和副反应量表(TESS)进行评定。结果两组有效率分别为73.79％、76.19％,无显著性差异,治疗4周后BPRS、SANS、HAMD和TESS比较有显著性差异(P<0.05),治疗8周后HAMD差异非常显著(P<0.01),BPRS有显著性差异(P<0.05),而SANS和TESS无显著性(P>0.05)。万拉法新的主要不良反应为口干、出汗、恶心及头痛等症状,一般不须处理。结论 在服氯氮平的基础上,用万拉法新作为治疗精神分裂症阴性症状的辅助药,比舒必利更安全、副反应小。     

Electroconvulsive therapy in first-episode schizophrenia

Knowledge about the efficacy of electroconvulsive therapy (ECT) on schizophrenia comes from chronic patients and little known on young, first-episode patients. The aim of this study is to evaluate short-term and long-term efficacy of ECT in patients with first-episode schizophrenia.In the first phase of the study, 90 hospitalized, first-episode patients with schizophrenia were enrolled; psychopathology was evaluated with Brief Psychiatric Research Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS), and Scale for the Assessment of Negative Symptoms (SANS) on admission and discharge. Antipsychotics were first-line treatment for most of the patients, but medication for nonrespondent catatonic patients and patients who had violent behaviors were treated with ECT. The patients who met the remission criteria were intended to a 1-year follow-up after discharge. BPRS, SAPS, and SANS were monthly recorded during the follow-up. Differences in clinical characteristics, relapse, and rehospitalization rates were analyzed in patients with or without ECT treatment.Thirteen patients were treated with ECT. They were low educated and were more likely nonparanoid subtypes (catatonic, disorganized). The ECT group had higher BPRS scores on admission and their hospitalization period was longer than the antipsychotic group. On the contrary, BPRS and SAPS scores of the ECT group were lower at discharge. The ECT group presented shorter follow-up duration than the antipsychotic group during the follow-up period. In conclusion, the efficacy of ECT was very satisfactory in acute term in first-episode schizophrenia, but the same efficacy was not continuous during the 1-year follow-up.     

A double-blind, placebo-controlled trial of extract of Ginkgo biloba added to haloperidol in treatment-resistant patients with schizophrenia.

BACKGROUND: Many studies have indicated that excess free radical formation may be involved in the pathogenesis of patients with schizophrenia. Some investigators suggested that the use of free radical scavengers might provide improvement in schizophrenia. The aim of this study was to determine the effectiveness and to evaluate the side effects of extract of Ginkgo biloba (EGb) plus haloperidol in chronic, treatment-resistant inpatients with schizophrenia. METHOD: One hundred nine patients meeting DSM-III-R criteria for schizophrenia completed a double-blind, placebo-controlled, parallel-group study of EGb plus haloperidol. Fifty-six of the patients were randomly assigned to receive a fixed dose of 360 mg/day of EGb plus a stable dose of haloperidol, 0.25 mg/kg/day, and 53 were assigned to receive placebo plus the same dose of haloperidol for 12 weeks. Patients were assessed using the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Negative Symptoms (SANS), and the Scale for the Assessment of Positive Symptoms (SAPS) at baseline, week 6, and week 12 and the Treatment Emergent Symptom Scale (TESS) for side effects at week 12. RESULTS: There was a significant reduction in both groups in BPRS total score after 12 weeks of treatment (p < .05). However, a significant reduction in total SAPS and SANS scores was noted in the EGb group (p < .05), but not in the placebo group. There was a lower SAPS total score in the EGb group than in the placebo group at the end of 12 weeks of treatment (p < .05). Of those treated with EGb plus haloperidol, 57.1% were rated as responders as compared with only 37.7% of those receiving placebo plus haloperidol when assessed by the SAPS (chi2 = 4. 111, p = .043). After 12 weeks of treatment, TESS subscore 1 (behavioral toxicity) and subscore 3 (symptoms of nerve system) were significantly decreased in the EGb group compared with the placebo group (p < .05). CONCLUSION: EGb treatment may enhance the effectiveness of antipsychotic drugs and reduce their extrapyramidal side effects.     

奎的平与氯氮平治疗以阴性症状为主的精神分裂症对照研究

目的　比较奎的平与氯氮平对以阴性症状为主的精神分裂症的疗效和副反应。方法　对 72例以阴性症状为主的精神分裂症住院患者 ,随机分别用奎的平与氯氮平治疗 ,疗程 12周 ;于治疗前及治疗后 1、2、4、8、12周末用阴性症状量表 (SANS)、简明精神病量表 (BPRS)评定临床疗效 ,用副反应量表 (TESS)评定药物副反应。结果　奎的平组与氮氮平组治疗前后SANS、BPRS总分及减分比较差异无显著性 (P >0 0 5 ) ,各组治疗后SANS、BPRS总分与治疗前比较差异有极显著性 (P <0 0 1) ,奎的平在兴趣社交缺乏因子方面的疗效优于氯氮平 (P <0 0 5 ) ;奎的平组的副反应较氯氮平组少而轻。结论　奎的平对以阴性症状为主的精神分裂症有肯定的疗效 ,在某些方面优于氯氮平 ,安全性较高     

美多巴及舒必利治疗精神分裂症阴性症状的对照研究

目的探讨美多巴、舒必利治疗精神分裂症阴性症状的效果。方法用美多巴、舒必利分别合并抗精神病药物及单用抗精神病药物对各３０例住院精神分裂症病人进行１３周的对照研究，用阴性症状量表（ＳＡＮＳ）、简明精神病量表（ＢＰＲＳ）、副反应量表（ＴＥＳＳ）于治疗前后评定。结果美多巴、舒必舒利与单用抗精神病药物对阴性病状治疗有效率分别为５０％、５３３％和２０％。结论美多巴、舒必利合并抗精神病药均能提高对阴性症状的疗效，提示精神分裂症存在生物学异质性。