脑清通颗粒治疗肝痰瘀型高血压的疗效观察

高血压是临床常见疾病之一,具有较高的发病率,严重影响患者的身体健康。中医属于眩晕和头痛范畴,而肝痰瘀型高血压是一种常见的中医分型,临床常给予西药治疗,效果并不很理想[1]。笔者结合多年临床工作经验,对肝痰瘀型高血压患者应用脑清通颗粒治疗,取得较好效果,报告如下。1资料与方法     

高血压脑出血术后痰瘀腑实证血浆代谢组学的检测分析

目的从代谢组学层面寻找高血压脑出血术后痰瘀腑实证的本质以及通腑泻热活血合剂治疗作用机制。方法采用氢谱磁共振(1 H-NMR)CPMG脉冲序列检测12例高血压脑出血患者的术前及术后第1、3、7、12天血浆样本,每例患者采集5个血浆样本,本实验共收集60个血样本,所有患者的术前、术后第1天、术后第3天、术后第7天、术后第12天各为1组,分为5组,所有患者术后第3天开始服用通腑泻热合剂。对不同组之间代谢产物含量的变化,采用主成分分析(principal components analysis,PCA)、偏最小二乘判别分析(PLS-discriminant analysis,PLSDA),对比观察5组血浆中的磁共振波谱差异情况,分析相应的代谢产物积分值变化情况。最终选择对本次实验贡献值最大的代谢物,将此代谢物和自身前后进行比对,随后运用统计学方法进行检验,对比不同组别之间的血浆代谢物变化差异。结果患者术前、术后第1天、术后第3天、术后第7天、术后第12天中5组血浆代谢谱在对比中出现差异,且具有统计学意义(P0.05),在模式识别和主成份进行分析中,结果表明高血压脑出血术后第3天痰瘀腑实证形成,服用通腑泻热合剂前后具有可区分性、可比较性;术前组和术后第1天组患者血浆中差异较大的特异性代谢物6个:丙氨酸、异亮氨酸、α-酮戊二酸、糖蛋白、前列腺素、极低密度脂蛋白。术后第1天组和术后第3天组中患者血浆中差异较大的特异性代谢物6个:γ-氨基丁酸、α-酮戊二酸、甜菜碱、丝氨酸、前列腺素E1、脂蛋白;术后第3天组和术后第12天组中患者血浆中差异较大的特异性代谢物6个:N-乙酰糖蛋白、α-葡糖糖、胆碱、肌醇、亮氨酸、谷氨酰胺。术后第7天组和术后第12天组中患者血浆中差异较大的特异性代谢物2个:N-乙酰糖蛋白、乳酸。结论当高血压脑出血术后痰瘀腑实证形成,服用通腑泻热活血合剂可以改善脑出血后患者体内脂肪含量,更可以改善血糖代谢,稳定细胞膜等,促进已损伤细胞修复。     

痰热清治疗小儿感染性惊厥96例临床观察

小儿感染性惊厥是儿科常见而重要的急症,我院在2010-10-2012-02用痰热清针剂治疗小儿感染性惊厥96例,取得显著疗效,现报道如下.1 资料与方法1.1 一般资料 我院在2010-10 2012-02对96例小儿感染性惊厥患者随机分为痰热清治疗组(治疗组)和安定针和鲁米那针常规抗感染治疗组(对照组),每组各48例.上述患者均有不同程度的抽搐,伴随外感发热症状,血常规白细胞计数、中性粒细胞计数及分类均升高.治疗组48例,男30例,女18例;年龄0.5～14岁,平均5.6岁.高热惊厥28例,脑炎8例,中毒性菌痢4例,中毒性脑病8例,病程1～6 d,平均3.8d.     

深部脑刺激戒断阿片类药物精神依赖1例临床报道(附3个月随访结果)

目的在立体定向射频毁损手术的研究基础上,进行了1例深部脑刺激(deep brain stimulation,DBS)戒断阿片类药物精神依赖手术,探讨一种既能起到有效治疗作用,而又减少副损伤的外科治疗方法。方法药物依赖患者,男性,24岁,吸食海洛因等多种毒品成瘾5年,反复戒毒5次无效。在阿片脱毒术脱毒后,行双侧伏隔核DBS电极植入术,立体定向MRI定位,植入Medtronic 3387刺激电极及脉冲发生器。术后定期进行疗效随访,以及副作用、心理学量表和症状量表等评估。结果患者术后即停止吸毒,通过3个月的临床观察,至今无复吸现象。临床证实该方法较射频毁损方法微刨、副反应小,心理学量表(WMS、WEIS-RC和MMPI)评估未发现有记忆、智力和人格等方面影响。术后患者饮食较术前明显好转,体重增加,吸烟量明显减少;症状自评量表(SCL90、SAS和SDS)评估提示多因素均有明显改善。结论应用DBS外科方法戒断阿片类药物精神依赖,取得短期满意疗效。     

Electron microscopy of oligodendroglia in severe mental illness

Qualitative electron microscopy was performed to verify whether brain pathology in schizophrenia and bipolar disorder is associated with alterations of oligodendroglial cells and myelinated fibers. Ultrastructural signs of apoptosis and necrosis of oligodendroglial cells were found in the prefrontal area 10 and the caudate nucleus in both schizophrenia and bipolar disorder. Damage of myelin sheath lamellae, with the formation of concentric lamellar bodies, were detected in both brain structures in schizophrenia. There was also a significant decrease in the area of the nucleus and the volume density of mitochondria in oligodendrogliocytes in the caudate nucleus and in the prefrontal cortex in schizophrenia, as compared to normal controls. Volume density of heterochromatin was significantly increased (+14%) in the caudate nucleus in schizophrenia. The density of concentric lamellar bodies (as an indicator of damage of myelinated fibers) was dramatically increased (4.5-fold) in the caudate nucleus in schizophrenia, as compared to controls, and was positively correlated with volume density of heterochromatin. Multiple regression analysis and analysis of covariance demonstrated that these changes could not be explained by the effects of postmortem delay, age, neuroleptic medication, or gender. Pathology of oligodendroglia might be an essential feature of severe mental disorders.     

Characteristics of primary care visits for individuals with severe mental illness in a national sample

Individuals with severe mental illness (SMI) are at risk for inadequate general medical and preventive care, but little is known about their visits for primary care. We performed a cross-sectional analysis of primary care physician visits from the National Ambulatory Medical Care Survey (NAMCS) 1993–1998 and compared visit characteristics for patients with and without SMI. SMI was defined from ICD-9 diagnoses and medications. Primary care visits for patients with SMI were more likely to be return visits, were longer, and were more likely to have scheduled follow-up than for patients without SMI. Obesity, diabetes, and smoking were reported approximately twice as frequently in visits for patients with SMI compared to patients without SMI. The percent of visits with preventive counseling and counseling targeted at chronic medical conditions was similar for both groups. Likely appropriate to their complex needs, patients with SMI using primary care tend to have more return visits, longer time with the physician and are more often scheduled for follow-up care; their preventive counseling appears similar to non-SMI visits.     

Eight-year follow-up of olanzapine therapy in a previous treatment-refractory schizophrenic patient: a case report

The introduction of atypical antipsychotic drugs during the 1990s represented a great step forward in the treatment of schizophrenia and other psychoses. These drugs might more effectively prevent relapse because of their effectiveness against a wider range of schizophrenic symptoms, as well as their improved tolerability, which leads to improved medication compliance. Olanzapine, a thienobenzodiazapine, is an antipsychotic drug with high affinity for the serotonergic receptors 5-HT 2 and 5-HT 6 and high affinity for dopaminergic receptors, mainly D2, D3 and D4, and with a lower propensity to cause extrapyramidal symptoms or increasing prolactin levels. The long-term efficacy and safety of olanzapine for treating treatment-refractory schizophrenia is still being investigated. The authors present a case of a 43-year-old man suffering from chronic treatment-resistant schizophrenia with both positive and negative symptoms, who was successfully treated with olanzapine for 8 years. (Int J Psych Clin Pract 2002; 6: 211-214 )     

Performance-based assessment of functional skills in severe mental illness: results of a large-scale study in China

Performance-based assessments of everyday living skills have been shown to be highly correlated with cognitive functioning in schizophrenia and bipolar disorder, as well as being predictive of deficits in real-world outcomes such as independent living and employment. In this study, we expand our assessments of impairments in everyday living skills to China, evaluating people with schizophrenia, bipolar disorder, and major depression, and comparing their performance to that of healthy controls. Samples of people with schizophrenia (n = 272), bipolar disorder (n = 61), major depression (n = 50), and healthy controls (n = 284) were examined with the Chinese version of the UCSD performance-based assessment, brief version (UPSA-B). Performance was compared across the groups and the association between age, gender, educational attainment, marital status, and UPSA-B scores was evaluated. When the performance on the UPSA was compared across the groups, with education as a covariate, significant effects of both diagnosis (F = 86.3, p < .001) and education were found (F = 228.3, p < .001). Sex and age did not contribute significantly when age and education were considered. Post-hoc comparisons revealed that total UPSA-B scores were lowest in the schizophrenia patients, followed by the patients with major depression. Patients with bipolar disorder did not differ from the healthy comparison subjects on overall performance. Scores for all groups were lower than previously reported in western samples (e.g., HC mean = 64). While diagnostic differences in UPSA-B scores are similar to those previously seen in western samples, the education effect is considerably more substantial. These data suggest that in developing countries educational attainment may be strongly associated with levels of adaptive outcomes and the utilization and interpretation of functional capacity measures be adjusted accordingly.     

Identification of primary polydipsia in a severe and persistent mental illness outpatient population: A prospective observational study

Studies to date have only investigated primary polydipsia in hospitalized psychiatric patient populations, where rates range from 3% to 25%. The objective of the present study was to determine the occurrence of primary polydipsia in a psychiatric outpatient population, and to determine the perceptions of outpatients with self-induced water intoxication regarding reasons for drinking excess fluids, health risks, and insight into their behavior. All 115 psychiatric outpatients from a Community Outreach Program in Kingston, Ontario, were invited to participate in this study. Of these, 89 (77.4%) were enrolled. Data collection included chart reviews, structured interviews, weight measurements, and urine collection. The incidence of primary polydipsia was found to be 15.7%. One-half of the polydipsic people presenting with medical complications suggestive for water intoxication had cigarette smoking as a strong correlate. There were interesting answers to the self-induced water intoxication questionnaire. These showed a lack of knowledge related to the normal quantity of fluids necessary daily and about healthy behaviors. Excessive drinking occurs in psychiatric patient populations outside of institutional/hospital settings. Patients have limited awareness of the severity and possible complications from their problem. Given the prevalence of polydipsia, more effort should be put into identifying and treating this problem.     

Isolated nocturnal auditory hallucinations: a case report

Sleep-related hallucinations (hypnagogic and hypnopompic) are transient and occur in normal individuals. Rarely, they are prominent and distressing and are associated with diverse conditions including narcolepsy. We report a case of prominent hypnopompic auditory hallucinations — which gradually became continuous and distressing with characteristics of schizophrenia-like hallucinations — that responded to a low dose of olanzapine.     

Polydipsia,hyponatremia and rhabdomyolysis in schizophrenia: A case report

The prevalence of polydipsia among patients with schizophrenia is 6%-20%. Around 10%-20% of patients with polydipsia may develop hyponatremia and even complicated with rhabdomyolysis. Here we presented a 40-year-old man with schizophrenia, who had received paliperidone 15 mg/d for more than one year, and polydipsia was noted. In Jan, 2014, he developed hyponatremia (Na 113 mEq/L) with consciousness disturbance. After 3% NaCl (500 cc/d) intravenous supplement for three days, the hyponatremia was corrected, but rhabdomyolysis developed with a substantial elevation in the level of creatine kinase (CK) to 30505 U/L. After hydration, the CK level gradually decreased to 212 U/L. Both the hyponatremia itself and quick supplementation of NaCl can cause rhabdomyolysis. If rhabdomyolysis is not recognized, insufficient hydration or water restriction for polydipsia may further exacerbate the rhabdomyolysis with a lethal risk. In this case, we highlight the possible complication of rhabdomyolysis with polydipsia-induced hyponatremia. In addition to monitoring the serum sodium level, the monitoring of CK is also important; and switching of antipsychotic may improve the polydipsia.     

中国北方两地居民对常见精神疾病知晓情况的调查

目的了解北京市和河北省1007名城乡居民对常见精神疾病相关知识的知晓情况。方法采用分层随机抽样的方法,抽取北京市10个居委会和河北省武安市下属10个村庄的居民作为调查对象,拟调查1000人,实际调查1007人,其中城市居民503人,农村居民504人。使用"公众对自杀的态度问卷"了解城乡居民对自杀的态度及对常见精神疾病,即精神分裂症、抑郁症及酒依赖相关知识的知晓情况。结果在调查的1007人中,听说过精神分裂症、抑郁症、酒依赖的城乡居民分别为770例(76%)、677例(77%)、729例(72%)。在听说过精神分裂症的人中50%认为无助是精神分裂症的常见症状;32%认为震颤是精神分裂症的常见症状;49%认为精神分裂症通过心理治疗可以治愈。在听说过抑郁症的人中54%认为古怪行为是抑郁症的常见症状。在听说过酒依赖的人中38%认为兴趣缺乏是酒依赖的常见症状。结论北京市和河北省1007名城乡居民对常见精神疾病知识的知晓率低,需加强精神疾病知识的宣传。