家庭教育改善首发精神分裂症患者预后的作用

作者对首发精神分裂症患者给予家庭教育,旨在了解家庭教育对其预后的影响作用。     

早期干预对首发精神分裂症预后的影响

目的：了解早期干预对首发精神分裂症复发的影响。方法：对30例首发精神分裂症患者，病期在3个月以内知的，在住院期间配合积极家庭干预及出院后继续干预（干预组）并与30例首发精神分裂症患者，病期在3个月以上治疗条件相仿，无家庭干预（对照组）进行对照。对两组的复发率进行比较。结果：干预组疗效明显好于对照组，干预组复发率明显少于对照组（P＜0.05）。结论：积极的家庭干预能促进服药的依从性，减少复发率，促进康复。     

利培酮治疗首发精神分裂症患者的疗效分析

作者对利培酮治疗首发精神分裂症患者的疗效进行了观察 ,现将结果报道于后。1　对象与方法1.1　对象　为本院 1999年 3月～ 8月的门诊和住院患者。入组标准 :①符合ＣＣＭＤ - 2 -Ｒ中精神分裂症的诊断标准 ,且病程不超过 5年 ;②年龄 16～ 5 0岁 ;③ＢＰＲＳ总分≥ 4 0 ;④既往采用抗精神病药物的连续治疗时间不超过 8周 ;⑤无严重的躯体疾病者。1.2　给药方法　入组前未经抗精神病药物治疗者直接给药 ;曾服用过抗精神病药物需停原药 3天 ,再开始利培酮治疗。利培酮剂量为 1ｍｇ/ｄ开始 ,以后据病情逐渐加量 ,直到疗效满意 ,最大剂量不超过…     

利培酮治疗首发精神分裂症的临床疗效观察

目的：观察利培酮治疗首发精神分裂症的疗效，副反应及最佳剂量。方法：首次使用可变剂量的利培酮治疗首发精神分裂症8周，使用阳性和阴性症状量表（PANSS）及不良反应症状量表（TESS）分别评定疗效和副反应。结果：全部病例完成8周治疗。治疗前后PANSS减分率比较，差异有极显著性（P＜0．001），显效率为81．63％，有效率达95．92％，起效时间在第2－4周，最佳剂量≤4mg/d，低剂量组（≤4mg/d)PANSS减分率大于高剂量组（＞4mg/d)，较多见副反应为EPS（20．41％），结论：低剂量利培酮（≤4mg/d)治疗首发精神分裂症安全，有效，病人依从性好。     

思瑞康治疗女性首发精神分裂症患者的疗效及安全性观察

目的 探讨思瑞康对女性首发精神分裂症患者的疗效及安全性.方法 对48例女性首发精神分裂症患者进行为期16周的思瑞康开放性治疗试验.治疗前及治疗后第4、8及16周末采用阳性和阴性症状量表（PANSS）及临床疗效总评疾病严重度量表（CGI-SI）评价疾病的严重程度;不良反应量表（TESS）评估药物不良反应;Sampson氏锥体外系不良反应量表（SAS）评价不良反应症状;利用自编的月经调查问卷每4周调查1次月经情况;治疗前、治疗结束时分别测定体重及血清催乳素（（PRL）水平.结果 ①治疗16周后PANSS总分值较治疗前明显下降,差异有极显著性（P＜0.001）,阳性和阴性症状量表分值较治疗前均明显下降（P＜0.05）;②各治疗时段PANSS总分、阳性因子分、阴性因子分均较前一次明显下降（P＜0.05）;③疗后CGI-SI分值与疗前相比明显下降,差异有极显著性（P＜0.001）;④36例患者PANSS减分率≥75%;⑤SAS评分疗前、疗后无显著性差异;⑥治疗后体重中度增加,与治疗前相比差异有显著性（P＜0.01）;⑦患者疗前、疗后血清PRL水平差异无显著性（P=0.307）;⑧月经周期、月经量及行经时间与用药前比较均无明显改变;⑨整个治疗期间未发生严重的不良反应.结论 思瑞康剂量达500～800mg/d时,能有效控制精神症状,对阳性、阴性症状均有效;发生锥体外系不良反应的危险性较小;对月经影响不明显,是较为理想的新型抗精神病药物.     

利培酮治疗首发精神分裂症临床观察

对我院应用利培酮治疗首发精神分裂症进行分析。1　对象和方法为我院 1999年 5月至 2 0 0 3年 2月门诊及住院患者 ,符合中国精神障碍分类与诊断标准第 3版精神分裂症诊断标准。共 184例 ,男 99例 ,女 85例 ;3例因经济原因、2例因迁移脱落 ,179例患者完成治疗。以利培酮治疗 ,起始剂量 0 5～ 1mg/d ,逐步加量 ,平均剂量 4 5mg/d。疗程 8周。以简明精神病评定量表 (BPRS)和副反应量表 (TESS)在治疗前及治疗 1、2、4、8周进行评定。实验室检查包括血常规 ,肝功能 ,心电图 ,胸透等。统计采用SPSS软件作t检验。2　结果经利培酮治疗 ,179例…     

神经心理测验预测首发精神分裂症的近期预后

目的：筛选与首发精神分裂症近期预后有关的神经心理测查指标。方法：对１６４例首发精神分裂症患者随机给予氯丙嗪或氯氮平治疗,于治疗前分别作韦氏成人智力量表、韦氏记忆量表、铁槽铁钉测验、手指敲击测验、利手测验、动作功能测验、手功能协调测验、连线测验、连线测验Ｂ、威期康辛卡片分类测验（ＷＣＳＴ）及语言流畅性测验等１１项刘经心理测查各１次,并作ＢＰＲＳ、ＳＡＮＳ、功能总体评定量表（ＧＡＦ）各１次,治疗１２周     

奥氮平治疗首发精神分裂症的疗效分析

目的 评价奥氮平治疗首发精神分裂症的疗效及安全性。方法 用奥氮平治疗首发精神分裂症32例,疗程8周;用简明精神病评定量表(BPRS)和副反应量表(TESS)评定疗效及副反应。结果 完成8周治疗的32例首发精神分裂症患者,显效18例(56.2％)、有效11例(34.4％)、无效3例(9.4％),总有效率为90.6％,副作用轻微,无明显心血管系统不良反应。结论 奥氮平治疗首发精神分裂症安全有效。     

小剂量利培酮对首发精神分裂症的疗效观察

目的：探索小剂量利培酮对首发精神分裂症的疗效和副反应。方法：33例患者给予小剂量利培酮（A组）,并以中等剂量的利培酮（B组,34例）和氨氮平（C组,30例）治疗进行对照。结果：A组第8周末阳性和阴性症状量表（PANSS）部分和各项目积分比疗前均显著下降（P均＜0．001）;生效时间在第2－4周,和C组相似,但比B组晚。疗程中3组间PANSS总分的减分率以及治疗后的总有效率均无显著差异。A组的不良反应症状量表（TESS）总分显著低于其它两组。结论：小剂量利醅酮对首发精神分裂症是一种有效、安全、经济、实惠的治疗方案。     

不同预后的首发精神分裂症患者免疫球蛋白及补体成分的研究

为了解不同预后的首发精神分裂症患者免疫球蛋白及补体成分 (Ｃ)的特点 ,我们进行了以下研究。对象　 (1)患者组 :共 33例精神分裂症患者 ,均系 1998年 10月至 1999年 8月在我科未接受过抗精神病药治疗的首发住院患者 ,均符合中国精神疾病分类方案与诊断标准第 2版修订本的精神分裂症标准 ,简明精神病评定量表 (ＢＰＲＳ)总分 >38分。 33例在住院治疗后按ＢＰＲＳ评分分为显效组(减分率≥ 5 0 % )和非显效组 (减分率 <5 0 % )。①显效组 :17例 ,其中男 9例 ,女 8例 ;平均年龄 (33± 12 )岁 ;平均病程 (6±2 )月 ;治疗前ＢＰＲＳ评分为 (5 1 …     

A prospective 2-year follow-up study of neurocognitive functioning in patients with first-episode schizophrenia

To investigate the temporal stability, or progressivity, of neuropsychological (NP) impairment in schizophrenia, 50 patients with first episode (FE) schizophrenia and 50 healthy controls were given a battery of tests at the outset of the study and after a two-year interval. Both patient and control groups were balanced with respect to age, gender, education and parental socioeconomic status. Summary rating scales for semantic memory (SEM), visual memory (VIM), verbal learning (VBL), visual-motor processing and attention (VSM) and abstraction/flexibility (ABS) were constructed. FE schizophrenics showed improvement in VBL, stability of function in SEM, VSM and ABS and absence of improvement in VIM. While performance in VSM and VIM is influenced by medication status, SEM seems to be trait-related and stable; VBL, however, seems to be state-related. Our data suggest that there is no proof for the assumption of progressive deterioration in NP functioning during the first few years of illness.     

首发精神分裂症患者近期疗效的影响因素

目的系统了解首发精神分裂症患者近期疗效(住院治疗约70~90天)的影响因素。方法采用前瞻性研究方法,应用简明精神病评定量表、阴阳性症状评定量表、社会支持评定量表、生活事件问卷、大体功能评定量表等工具,对符合CCMD-3诊断标准的114例住院精神分裂症患者进行评估。结果首发精神分裂症患者近期疗效的主要影响因素为:家庭社会支持、注意障碍、意志减退、病前职业功能水平、思维贫乏、情感淡漠及起病的快慢。结论为改善精神分裂症病人的预后,应加强心理社会干预措施的改进与研究。     

Outcome in males with first-episode schizophrenia: 7-year follow-up

Abstract

Family, twin, and segregation analytic studies indicate a complex genetic contribution to panic disorder with an estimated heritability of 48%. Angiotensin-converting enzyme (ACE) degrades substance P, which has been implicated in anxiety-related behaviour. ACE has been suggested as a potential risk factor in the pathogenesis of panic attacks. A functional insertion deletion (I/D) polymorphism in the ACE gene was suggested to be associated with panic disorder in a potentially gender-specific way (). The present study aimed to replicate this finding and thereby to further elucidate the role of ACE gene variation in the pathomechanism of panic disorder. The ACE I/D polymorphism was genotyped in a sample of 102 German patients with panic disorder with or without agoraphobia as well as a healthy German control group matched with regard to age and sex (n = 102). In the male subgroup (n = 43) of panic patients a significant association of the ACE I allele (P = 0.0474) and genotypes containing the I allele (P = 0.0195), respectively, was observed. The present results provide further support for a potentially male-specific role of the less active ACE I allele in the pathogenesis of panic disorder, possibly by altering substance P levels.     

Thalamic volumes in patients with first-episode schizophrenia

OBJECTIVE: The thalamus, a highly evolved sensory and motor gateway to the cortex, has been implicated in the pathophysiology of several illnesses, including schizophrenia. Several studies have suggested thalamic volume differences in patients with schizophrenia, although only a few studies have examined thalamic structure in new-onset patients. METHOD: The authors used magnetic resonance imaging to measure thalamic volumes in previously untreated patients with first-episode schizophrenia (N=16) relative to those of healthy comparison subjects (N=25). The age range of the patients and comparison subjects was 15 to 45 years of age. Thalamic volumes in the right and left hemispheres were segmented and analyzed, both separately and as total thalamic volume, by a rater blind to clinical data. The thalamus was further segmented into regions that roughly reflected individual thalamic nuclei. Analysis of covariance was used to control for intracranial volume. RESULTS: Right, left, and total thalamic volumes of the patients with schizophrenia were significantly smaller than those of the comparison subjects. Significantly smaller volumes were found in the left central medial subdivision of the patients as well as a smaller volume in the right central medial subdivision that approached significance. These regions primarily comprised the dorsomedial nucleus, a thalamic nucleus thought to be an important component of aberrant circuitry in schizophrenia. Significant volume differences were also seen in the left anterior, right anterior, and right posterior medial subdivisions. CONCLUSIONS: These findings suggest significant thalamic volumetric differences between patients with newly diagnosed schizophrenia and healthy comparison subjects. Future analysis of individual thalamic nuclei may reveal important, specific relationships between thalamic abnormalities and schizophrenia.     

Neurocognitive functioning in patients with first-episode schizophrenia

To assess the course of neuropsychological (NP) impairment in schizophrenia, 71 patients with first episode (FE) schizophrenia and 71 healthy controls were given a comprehensive battery of NP tests at index assessment, after a 2-year and after a 5-year follow-up period. By means of the z-score standardization, summary scores for verbal intelligence (VBI), spatial organisation (SPT), verbal fluency (VBF), Verbal learning (VBL), semantic memory (SEM), visual memory (VIM), delay/retention rate (DEL), short-term memory (STM), visuomotor processing and attention (VSM) and abstraction/flexibility (ABS) were constructed. FE schizophrenia patients showed a worse performance compared to controls in all areas investigated, most pronounced in VSM, SEM and VBL. In the majority of cognitive domains, an improvement was found over the 5-year follow-up period without differences between the two groups. However, in VBF patients slightly deteriorated whilst controls improved and in memory functions patients improved less compared to controls. When controlling for relevant confounders, neither conventional nor atypical neuroleptics showed a deleterious influence on NP performance, except on VBF. Our data suggest that NP impairment is already present at the onset of the illness and remains stable over the early course of schizophrenia.     

Obsessive-compulsive disorder in patients with first-episode schizophrenia

OBJECTIVE: The aim of the present study was to determine the rate of obsessive-compulsive disorder (OCD) in patients with first-episode schizophrenia. METHOD: Fifty patients consecutively hospitalized with first-episode psychosis who met DSM-IV criteria for schizophrenia spectrum disorders were assessed for OCD. The instruments used were the Structured Clinical Interview for DSM-IV, Schedule for the Assessment of Positive Symptoms (SAPS), Schedule for the Assessment of Negative Symptoms (SANS), and Yale-Brown Obsessive Compulsive Scale. RESULTS: Seven (14%) of the 50 schizophrenic patients met DSM-IV criteria for OCD and scored significantly lower than schizophrenic patients without OCD on the formal thought disorder subscale of the SAPS and the flattened affect subscale of the SANS. CONCLUSIONS: OCD is relatively frequent in patients with first-episode schizophrenia and may have a "protective" effect on some schizophrenic symptoms, at least in the early stages of the disease.     

Reduced plasma antioxidants in first-episode patients with schizophrenia

Recent findings suggest that free radical-mediated pathological processes may underlie membrane deficits that have been observed in schizophrenia. We have previously demonstrated that both total antioxidant status (TAS) and individual antioxidants were significantly reduced in plasma of chronic schizophrenic patients, on and off haloperidol. To test whether reductions in plasma antioxidants are independent of treatment or illness progression, levels of plasma antioxidants were evaluated in 43 patients at first-episode of psychosis, 31 patients meeting DSM-IV criteria for schizophrenia or schizoaffective disorder (reconfirmed after 6 months) and 12 patients with primary mood (bipolar or depressive (BP/D)) disorder, at neuroleptic-naive baseline as well as 40 age- and sex-matched normal controls (NC). The major plasma antioxidants albumin, uric acid and bilirubin were all significantly lower in the first-episode schizophrenic, but not in the BP/D patients, than in normal controls. Factors that can affect these antioxidants-age, gender, diet and smoking-were examined. Body mass index (BMI) was significantly lower in patients, but was not correlated with plasma albumin and bilirubin; there was a trend for a correlation with uric acid in schizophrenic patients. Lower antioxidant levels were independent of smoking status of patients. The present data suggest that a defect in the antioxidant defense system (AODS), which may lead to oxidative damage, occurs early in the course of illness and is independent of treatment effects.     

首发精神分裂症患者持续缓解的预测因素分析

目的:探讨首发精神分裂症患者1年持续缓解的临床与认知预测因素。方法:44例首发精神分裂症患者给予抗精神病药治疗1年,并在基线期采集患者人口学和临床资料,同时采用阳性与阴性症状量表(PANSS)评估疾病症状以及霍普金斯词语学习测验中文修订版(HVLT-R)、Stroop词色测验、彩色连线测验、词语流利测验中文版(VFT:VFL和VFC)评估认知功能;在治疗后4、8、12、24、36周和1年时随访,从第8周末至1年期间,历次访视PANSS量表8个核心条目评分均≤3分者被视为持续缓解(持续缓解组),其他患者视为病情波动(病情波动组)。结果:42例患者完成1年随访,其中24例(57.1%)患者持续缓解;与病情波动组(18例)比较,持续缓解组具有未治疗精神病期(DUP)较短、阴性症状较轻、阳性症状较重、HVLT-R和VFC得分较高的特点(P0.05或P0.001)。多元Logistic回归分析表明持续缓解的患者具有DUP短(OR:0.791,95%CI:0.629~0.995;P=0.003)、阴性症状分低(OR:0.775,95%CI:0.609~0.987;P=0.012)及阳性症状分高(OR:1.706,95%CI:1.040~2.800;P=0.004)是持续缓解的独立预测因素。结论:DUP短、阴性症状较轻、阳性症状较重是首发精神分裂症患者持续缓解的独立预测因素。     

Psychopathology and treatment responsiveness of patients with first-episode schizophrenia

One hundred and four male patients hospitalized for the first time with the diagnosis of first-episode schizophrenia were comprehensively assessed on admission and discharge. Psychopathology, treatment response, and remission rates were evaluated (based on the Positive and Negative Syndrome Scale (PANSS), severity of symptoms only). On admission, the most frequently observed symptoms were lack of judgment and insight (87.6%), suspiciousness/feelings of persecution (82.3%), delusions (77%), poor attention (70%), disturbance of volition (65.4%), conceptual disorganization (64.7%), and active social avoidance (64%). Except for delusions and hallucinations, the positive items of the PANSS correlated significantly with negative symptoms, and conceptual disorganization correlated with the greatest number of negative symptoms. Individual negative symptoms were present in about half the patients. At discharge, the most frequent symptoms were again lack of judgment and insight (in 55.7%), and for negative symptoms they were blunted affect (22.1%), emotional withdrawal (21.2%), and passive/apathetic social withdrawal (19.5%). The positive symptoms of suspiciousness/feelings of persecution and grandiosity persisted in 20.6% of patients. On average, all symptoms were significantly reduced 44 days after admission. The negative symptoms improved less, compared with the positive ones. At discharge there was a high rate of responders (response defined as minimal 30% reduction of total PANSS): 73% and 74% of patients fulfilled the criteria for remission. On admission, the responders (n = 76) had significantly higher scores of most symptoms, both positive and negative ones than nonresponders (n = 28).