儿童期情感性精神障碍临床特点的对照研究

目的探讨儿童情感性精神障碍的临床特征.方法将54例符合中国精神疾病分类方案与诊断标准第2版修订本中情感性精神障碍、年龄≤16岁的患者(儿童少年组,以下简称儿少组),与随机抽取的同期住院的53例成年情感性精神障碍患者(成人组)的临床特征进行对照分析.结果儿少组缓慢起病者(50%)多于成人组(23%),发病次数[(3.3±4.2)次]多于成人组[(2.3±1.8)次;x2=6.11～9.05,P＜0.05];儿少组情感性精神障碍的核心症状与成人组无本质区别,其中在联想困难、疑病、自杀观念、自杀行为、疲乏、体重下降、食欲下降方面少于成人组(P＜0.01,P＜0.05),焦虑、激越和学习成绩下降多于成人组(P＜0.01);躁狂症精力充沛、精神运动性兴奋、社会功能受损少于成人组(P＜0.05,P＜0.01);儿少组的抑郁发作者有26%、躁狂发作有66%分别伴有行为问题;儿少组的幻听、牵连观念及怪异行为多于成人组(P＜0.05).结论儿童抑郁症和躁狂症伴有较多的行为问题;儿童与成人的情感性精神障碍可能是起病于不同年龄的同一疾病.     

精神分裂症患者机体抗氧化功能指标的实验研究

目的 探讨机体抗氧化能力在精神疾病发病机理中的作用及其临床意义。方法 采用化学比色法检测176例精神分裂症患者血清中SOD、MDA、GSH－Px、VC、VE和NO含量。结果 精神分裂症患者血清中SOD、MDA、NO含量均高于对照组（P＜0．05或0．01）;GSH－Px、VC含均低于对照组（P＜0．01）;VE两者无显著差异（P＞0．05）;精神分裂症家族史阳性者血清中NO高于精神分裂症阴性家族史者（P＜0．05）;精神分裂症患者抗氧化能力含量可因病程、性别、年龄的不同而不同;精神分裂症患者治疗后SOD、MDA低于治疗前（P＜0．01）。结论 精神分裂症患者体内自由基代谢异常可能是精神分裂症发病的生物学因素之一。     

药物自我处置和症状自我监控技能训练对预防精神分裂症复发的作用初探

目的探讨药物自我处置和症状自我监控技能训练对降低精神分裂症患者复发和提高其药物依从性的作用.方法将133例痊愈的精神分裂症患者随机分为技能训练组(以下简称训练组;66例)和对照组(67例).对训练组患者分组进行技能训练,共20周,两组均有64例完成1年随访.每月评定1次简明精神病量表(BPRS),每天以自制的监护人及患者药物依从性评分表进行评分;每2个月测定1次氯氮平血浓度.结果(1)入组时与随访末次评定差值的比较,训练组的BPRS总分[(3.3±13.7)分]、漏服药次数[(-0.9±3.0)次]、监护人药物依从性评分[(-53.0±31.2)分]和氯氮平血浓度[(85.5±44.8)ng/ml],均优于对照组,分别为[(-19.2±21.7)分]、[(-9.5±5.9)次]、[(26.5±24.3)分]和[(199.1±85.0)ng/ml],均P＜0.001;(2)训练组的复发率(12%)和再住院率(3%)低于对照组(分别为52%和38%;P＜0.001);(3)Kaplan-Meier生存分析显示,训练组的复发和再住院累计生存率优于对照组(复发的log-rankx2=25.62,再住院的log-rankx2=25.49,均P＜0.001).结论两种技能训练能降低精神分裂症患者的复发并提高其药物依从性.     

社区精神分裂症患者应用重返社会程式训练的一年随访研究

目的探讨重返社会技能训练程式对于社区精神分裂症患者康复的作用.方法将100例非急性期的社区精神分裂症患者随机分为技能训练组(以下简称训练组;50例,其中脱落5例)和对照组(50例,其中脱落2例).在药物治疗的同时,对训练组进行重返社会技能训练,对照组接受传统精神康复干预,对两组患者随访1年.采用阳性和阴性症状量表(PANSS)和Morning Side康复状态量表(MRSS),在干预前、随访第1,3,6,9,12个月时对患者进行评估;同时监测病情复发率、(再)住院率、(再)就业率.结果 (1)入组时与随访末次评分减分值的比较,训练组PANSS总分[(6.80±11.30)分]、阳性量表[(0.51±3.36)分]、阴性量表[(3.14±5.27)分]、一般精神病理量表[(3.14±5.11)分]和MRSS总分[(13.92±21.08)分]均优于对照组[分别为(-4.33±18.35)分、(-2.93±7.16)分、(-1.23±7.27)分、(-0.16±7.97)分和(-10.09±30.93)分],P＜0.05～0.01;(2)训练组的病情复发率(20%)和(再)住院率(2%)低于对照组(分别为40%和19%;P＜0.05);(3)训练组的(再)就业率(51%)高于对照组(23%;P＜0.01).结论在药物治疗的基础上,重返社会程式可以有效地帮助精神分裂症患者尽早地重返社会.     

重庆地区精神疾病患者Borna病病毒感染的初步报道

目的　研究中国人中是否存在Borna病病毒 (BDV)感染 ,以及探讨BDV感染是否与人类精神疾病有关。方法　收集精神疾病患者 80例 (精神分裂症 5 0例 ,情感性精神障碍 30例 )和健康献血者标本 6 0名。每例采血 10ml,分离外周血单个核细胞 ,提取RNA ;用BDV P2 4基因特异性内外引物进行套式逆转录聚合酶链反应 ,扩增产物经琼脂糖凝胶电泳和特异性探针的Southern印迹杂交检测。结果　 5 0例精神分裂症患者中检出BDV P2 4基因片段 5例 ( 10 % ) ,6 0名健康对照者均未检出 ,两者间的差异有显著性 (P <0 0 5 ) ;30例情感性精神障碍患者中检出 1例 ( 3% ) ,与健康对照者的差异无显著性。结论　重庆地区精神疾病患者中存在BDV感染 ;精神分裂症与BDV感染可能有一定关系     

阿尼西坦改善慢性精神分裂症患者认知功能的临床研究

目的探讨阿尼西坦改善慢性精神分裂症患者认知功能的疗效。方法将64例慢性精神分裂症患者随机分为研究组32例和治疗组32例,分别予以奎的平(350±50)mg/d治疗8周,研究组同时合并阿尼西坦100mg/d,并于治疗前及治疗后分别进行阳性和阴性症状量表(PANSS)、简明精神状态量表(MMSE)、中国修订韦氏成人智力量表(WAIS-RC)、韦氏记忆量表(WMS)及威斯康星卡片分类测定(WCST)等评定,并与正常人组成的对照组进行比较。结果治疗前研究组和治疗组的MMSE、WMS及WAIS-RC均低于对照组,差异有显著性(P〈0.05),提示患者的认知功能有广泛性损害。治疗后研究组MMSE、WCST、WMS、WAIS-RC分数与治疗前比较差异有显著性(P〈0.05),而治疗后治疗组的WCST、WMS、WAIS-RC分数与治疗前比较无显著性差异(P〈0.05)。结论阿尼西坦改善慢性精神分裂症患者的认知功能疗效确切。     

2090例初诊重性精神疾病患者现状分析及早期干预对策建议

目的了解上海市2002年全年在市级精神卫生中心门诊初诊的重性精神疾病患者诊治状况,为及时有效实施监护和干预、减少肇事肇祸的发生提供信息.方法收集全年门诊初诊重性精神疾病患者的就诊资料,按人口学特征和疾病特征进行统计分析.结果全年(2002年1～12月)门诊初诊患者9200例,其中重性精神疾病患者2090例(22.72%),男性925(44.26%)女性1165(55.74%)男女之比为11.26;平均年龄(39.37±16.14)岁;重性精神疾病初诊以精神分裂症为多1101人(52.68%),其次情感性障碍有718人(34.36%).各种病的年龄特征精神分裂症以20～30岁多见(51.68%),情感障碍以41～60岁较多(45.69%),酒依赖41～50岁;疾病的职业分布在业与重性精神疾病初诊关系中发现精神分裂症和情感性精神障碍以工人为多,分别132人(39.88%)和86人(36.29%),而且占所有重性精神疾病初诊病人的比例也相对地高274人(42.15%),技术员和职员其次,精神分裂症职员71人(21.45%),技术员68人(20.54%),情感性精神障碍技术员50人(21.10%),职员46人(19.41%),酒依赖也以工人为多占整个酒依赖的68.97%.人(42.15%),不在业的病种分布精神分裂症以学生和无职业者为多,分别为218人(28.31%)和298人(38.70%);而情感性精神障碍和器质性精神障以离退休多见,分别249人(61.10%)和39人(66.10%);地域分布中各区、县精神分裂症和情感性精神障碍初诊情况,以浦东新区(15.01%)和徐汇区(13.80%)为多,普陀(9.18%)和杨浦(7.75%)其次,而郊区较少.可能与经济状况、就医习惯、宣传力度、地域、人口、交通等因素有关.精神分裂症和情感性障碍的就诊月份分布似乎无明显差异.     

阿尔茨海默病患者红细胞超氧化物歧化酶与载脂蛋白ε4等位基因的相互关系

目的探讨阿尔茨海默病(AD)患者的外周血氧化应激与载脂蛋白(apo)Eε4等位基因的相互关系.方法分别测定25例散发性AD患者(AD组)、20例血管性痴呆(VD)患者、22名正常人(正常组)的红细胞超氧化物歧化酶(SOD)、血浆一氧化氮(NO)浓度及apoE等位基因频率.结果AD组的SOD活性[U/mg血红蛋白]为1080±351,明显高于正常组[(818±330)U],P＜0.05;NO浓度的差异无显著性.根据apoEε4等位基因进行分层后,不携带ε4组间SOD活性差异有显著性,AD组高于正常组(P＜0.05).AD患者的SOD活性与临床痴呆分级量表(CDR)呈显著性负相关(r=-0.480,P＜0.05),与BLESSED痴呆量表分呈显著性负相关(r=-0.522,P＜0.01),正常组的SOD活性与年龄呈显著性负相关(r=-0.430,P＜0.05).结论与痴呆严重程度有关的氧化应激可能参与AD患者的病理生理变化,并可能受ε4等位基因的影响.     

对精神疾病患者就诊途径的调查

作者对精神疾病患者就诊途径进行了调查 ,现报告于后。1　对象与方法1.1　调查对象　为 1999年 8月～ 2 0 0 0年 8月首次入院的精神疾病患者 ,共计 2 6 0例。其中 ,男 15 8例 ,女 10 2例 ,平均年龄 (34 .7± 10 .9)岁 ,大专以上文化 16例 ,中专 19例 ,高中 78例 ,初中 81例 ,小学以下 6 6例 ,城市 172例 ,农村 88例 ,平均病程 (85 .4± 41.7)天。诊断为精神分裂症 12 5例、分裂样精神病 9例、偏执性精神病 3例、情感性精神障碍 38例、酒精所致精神障碍 9例、颅脑创伤所致精神障碍 8例、癫疒间 所致精神障碍 10例、阿尔茨海默病 3例、气功所…     

文拉法辛对抑郁症患者脑脊液5-HT和NE的影响及其与疗效的关系

目的观察文拉法辛对抑郁症患者脑脊液5-羟色胺(5-HT)和去甲肾上腺素(NE)含量的影响及其与疗效的关系。方法选择符合中国精神障碍分类与诊断标准第3版(CCMD-3)中抑郁症诊断标准的患者126例(患者组),并选择48例无精神疾病的一般手术者作对照(对照组),患者组单用文拉法辛治疗8周,于治疗前和治疗后第1、2、4、6、8周末用汉密顿抑郁量表(HAMD)评定疗效,并于治疗前和治疗后第8周末用液相色谱法检测脑脊液5-HT和NE含量,将治疗前的5-HT、NE含量与对照组进行对比,比较患者组治疗前后的5-HT、NE含量并与HAMD量表总分进行相关分析。结果患者组治疗前脑脊液5-HT和NE含量分别为(136±112)μg/L和(421±125)μg/L,均低于对照组的(249±141)μg/L和(673±158)μg/L(P均小于0.01);治疗前5-HT、NE含量与HAMD量表总分均呈显著负相关(r为-0.689和-0.761),治疗后第8周末5-HT和NE均增加,分别为(154±99)μg/L和(449±128)μg/L,均显著高于治疗前(P均小于0.01),NE含量与对照组无显著差异(P>0.05),但5-HT含量仍低于对照组(P<0.05)。第8周末的5-HT、NE含量升高值与HAMD量表减分率均呈高度正相关(r为0.724和0.661)。结论文拉法辛治疗抑郁症,随精神症状的好转,脑脊液5-HT和NE含量均显著升高,且与HAMD量表减分率均呈高度正相关。     

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.     

Special Pharmacokinetic Considerations in Children

Summary: Pediatric patients have greater degrees of pharmacokinetic variability and unpredictability than adults. This variability results from the effects of pharmacogenetics, age and growth, prior and current comedication, and disease. Newborns with seizures have the least predictable dosage requirements, and their needs change as drug-eliminating mechanisms mature in the neonatal period. Infants have the highest relative capacities to eliminate antiepileptics of any age group and require the largest relative doses. In addition to age-related trends, children demonstrate the same drug-specific, pharmacokinetic phenomena that adults do, including nonlinear phenytoin elimination, nonlinear valproate binding, and autoinduction of carbamazepine. Intercurrent illness and drug interactions further modify the age-related pharmacokinetic patterns in children and make dosage requirements even more unpredictable. Recent studies have shown that febrile illness can affect drug elimination, sometimes decreasing drug levels by 50% or more. Intermittent treatment with benzodiazepines administered either orally or rectally can be an important adjunct and help minimize this type of problem for children with marginally controlled epilepsy. Intermittent benzodiazepines are also helpful for children who have febrile seizures and who need only occasional antiepileptic protection.