奎硫平与氯氮平治疗精神分裂症对照研究的Meta分析

目的了解奎硫平与氯氮平治疗精神分裂症的疗效和不良反应差异。方法应用Meta分析对14项研究奎硫平与氯氮平治疗精神分裂症对照研究的文章进行再分析,评价其合并效应量的大小和综合显著性检验。结果①奎硫平治疗前后的自身对照,合并效应量d=3．74,95％CI（0．188,7．29）,综合显著性检验（X^2=7．80,P〈0．01）,提示奎硫平治疗精神分裂症前后症状学变化有非常显著性差异,效应极强。②奎硫平与氯氮平的组间比较,d=-0．108,95％CI（-0．680,0．465）,综合显著性检验（X^2=0．136,P〉0．8）,提示这两种药物的疗效没有显著性差异,差异效应弱。③奎硫平组的低血压不良反应比氯氮平组多,但差异无显著性（X^2=2．77,P〉0．05）,其它的11种不良反应均比氯氮平组少,除了锥体外系不良反应（EPS）没有显著性差异外（X^2=0．720,P〉0．05）,其它均达到显著性差异X^2=16．7—178）,其发生的比值比（OR）合并效应在1．27—10．6倍之间。结论虽然奎硫平与氯氮平在平均8周左右的疗效无显著性差异,但不良反应却有显著不同。。     

国产奎硫平与氯氮平治疗以阳性症状为主的分裂症的对照研究

目的观察国产奎硫平治疗以阳性症状为主的精神分裂症的疗效与副作用。方法将160例（实际完成148例）住院治疗的精神分裂症患者,随机分为国产奎硫平组（实际完成75例）和氯氮平组（实际完成73例）,疗程8周。应用4级临床疗效和阳性症状量表（SAPS）评定疗效,用副反应量表（TESS）观察不良反应。结果治疗8周后,两组SAPS总分、分量表分及总评分都较疗前明显下降,经t检验,差异有显著性;国产奎硫平组有效率90.67%,显效率74.67%,氯氮平组有效率94.52%,显效率76.72%,经χ^2实验,均无显著性差异（χ^2=1.38,P〉0.05）;国产奎硫平起效时间为（15.32±6.28）d比氯氮平平均起效时间（12.89±6.08）d慢,经t检验,有显著性差异（t=2.22,P〈0.05）;奎硫平的不良反应出现率和严重程度较氯氮平组都低,经统计学处理,有显著性差异（P〈0.05）。结论国产奎硫平对精神分裂症阳性症状的疗效较好,与氯氮平相当,副作用较氯氮平少而轻,安全性好,奎硫平具有推广价值。     

阿立哌唑与氯氮平治疗精神分裂症阴性症状对照研究的Meta分析

目的了解阿立哌唑与氯氮平治疗精神分裂症阴性症状疗效的差异。方法应用Meta分析对15项研究阿立哌唑与氯氮平治疗精神分裂症对照研究的文章进行再分析,评价其合并效应量的大小和综合显著性检验。结果①阿立哌唑治疗精神分裂症阴性症状前后的自身对照,合并效应量d=1．77,95％CI（1．65,1．89）,综合显著性检验χ^2=58．7,P〈0．001,提示阿立哌唑治疗精神分裂症阴性症状前后症状学变化有非常显著性差异,效应极强。②阿立哌唑与氯氮平的组间比较,d=0．223,95％CI（0．104,0．342）,综合显著性检验χ^2=4．15,P〈0．05,提示两种药物的疗效有统计学差异,差异效应弱。结论阿立哌唑与氯氮平在治疗精神分裂症阴性症状方面的疗效具有统计学差异（阿立哌唑优于氯氮平）,但差异效应弱。     

奎硫平与氯丙嗪治疗精神分裂症的对照研究

目的验证奎硫平治疗精神分裂症患者的临床疗效与安全性。方法94例精神分裂症患者随机分成2组,奎硫平组48例,氯丙嗪组46例进行临床对照研究,分别给予奎硫平与氯丙嗪治疗8周。采用阳性症状与阴性症状量表（PANSS）评定临床疗效,副反应量表（TESS）记录不良反应。结果两组PANSS评分较治疗前均有显著下降（P均〈0．01）;临床显效率和总有效率奎硫平组为70．8％和87．5％,氯丙嗪组为67．4％和84．8％,两组间疗效比较无显著性差异（P〉0．05）。在阴性因子、认知因子、PANSS总分减分率方面,奎硫平组与氯丙嗪组有显著性差异（P〈0．01）。奎硫平组的各种不良反应发生率较氯丙嗪组低且轻微（P〈0．05）。结论奎硫平组与氯丙嗪组治疗精神分裂症疗效相似,奎硫平不良反应较氯丙嗪少,是1种有效、安全性高的抗精神病药,在改善认知功能和阴性症状方面,奎硫平优于氯丙嗪。     

喹硫平与利培酮对血清催乳素影响的研究

目的了解喹硫平与利培酮对精神分裂症患者的疗效及对血清催乳素的影响。方法对71例符合CCMD-3诊断标准的精神分裂症患者随机分为喹硫平治疗组（33例）与利培酮治疗组（38例）,观察12周,分别于治疗前及治疗后4周、8周、12周予以阳性症状与阴性症状量表（PANSS）,副反应量表（TESS）及血清催乳素测定。结果喹硫平组和利培酮组疗效差异无显著性,两组治疗后4周、8周及12周PANSS总分及各因子分显著下降（P〈0.01）,利培酮组的不良反应高于喹硫平组,主要表现在肌强直、震颤、泌乳（χ^2=5.69,P〈0.01）及闭经（χ^2=6.74,P〈0.01）等不良反应上,利培酮组治疗后4周、8周及12周血清催乳素明显增加（t=13.48,P〈0.01）,而喹硫平组治疗前后无差异。结论喹硫平与利培酮对精神分裂症均有效,但利培酮不良反应大,明显升高血清催乳素,且有较高高血清催乳素不良反应,而喹硫平对血清催乳素影响较少。     

阿立哌唑与奎硫平治疗女性首发精神分裂症的随机、双盲、双模拟平行对照研究

目的 比较阿立哌唑与奎硫平治疗女性首发精神分裂症的疗效和安全性。方法采用随机、双盲、双模拟平行对照的方法,对符合CCMD-3精神分裂症诊断标准的女性首发精神分裂症患者,随机使用阿立哌唑和奎硫平治疗8周。采用阳性症状与阴性症状量表（PANSS）、临床总体印象量表（CGI）评定疗效,采用副反应量表（TESS）评定副反应。结果101例女性首发精神分裂症患者完成了研究,阿立哌唑组50例,奎硫平组51例。治疗8周后,阿立哌唑组显效率为66．0％,有效率为92．0％;奎硫平组显效率为64．7％,有效率为92．2％。两组疗效在统计学上无显著性差异（P〉0．05）。阿立哌唑组总副反应发生率为34．00％,奎硫平组总副反应发生率35．29％,两组间比较在统计学上无显性著差异（P〉0．05）。阿立哌唑组和奎硫平组均出现较多的副反应是嗜睡（16．00％：19．61％）、头昏和昏厥（12％：13．73％）,但两组间比较在统计学上无显性著差异（P〉0．05）。阿立哌唑组恶心呕吐、头痛的发生率比奎硫平组多（14．00％;1．96％,P〈0．05;18．00％：1．96％,P〈0．01）,奎硫平组口干、食欲减退或厌食比阿立哌唑组多（均为15．69％：2．00％,P〈0．05）。两组锥体外系反应不明显,较少引起体重增加和月经紊乱,没有发现溢乳现象。结论阿立哌唑和奎硫平对女性首发精神分裂症疗效相当,副反应轻,而且副反应表现有异同。两种药物均为疗效好、安全性高,对体重和月经影响较小、无溢乳的抗精神病药,有利于提高女性精神分裂症患者服药的依从性。     

奎硫平和利培酮治疗精神分裂症的比较研究

目的　以利培酮为对照 ,探讨奎硫平治疗精神分裂症的疗效和副作用。方法　将 79例符合CCMD 3诊断标准的精神分裂症病人随机分为两组 ,分别给予奎硫平和利培酮治疗 8周。采用阳性症状和阴性症状量表 (PANSS)评定临床疗效 ,副反应量表 (TESS)评定副反应。结果　治疗 8周后的疗效近似 (P >0 0 5 ) ;奎硫平组和利培酮组的显效率差异无显著性 (P >0 0 5 ) ;奎硫平组的副反应发生率低于利培酮组 ,但差异无显著性 (P >0 0 5 )。利培酮组锥体外系副反应和内分泌改变的发生均明显高于奎硫平组 (P <0 0 5 )。结论　奎硫平和利培酮对精神分裂症的疗效相当 ,副作用较小。     

奎硫平与氯丙嗪治疗女性精神分裂症的比较分析

目的比较奎硫平与氯丙嗪治疗女性精神分裂症的临床疗效及安全性。方法将68例住院女性精神分裂症患者分为奎硫平组与氯丙嗪组各34例进行临床比较分析。奎硫平剂量为500—800mg,／d,氯丙嗪为250～600mg／d,共治疗8周。分别采用PANSS、CGI及TESS评定疗效及安全性。结果治疗8周后,两组患者的PANSS、CGI评分均明显下降,差异有显著性（P〈0．01）,两组间比较PANSS、CGI评分差异无显著性（P〉0．05）。奎硫平组不良反应发生率低于氯丙嗪组,差异有显著性（P〈0．05）。结论奎硫平治疗女性精神分裂症的精神病性症状有效,安全性、依从性好。     

奎硫平与利培酮治疗精神分裂症的对照研究

目的验正奎硫平治疗精神分裂症的疗效及安全性。方法将121例精神分裂症患者随机分为奎硫平组（61例）与利培酮组（60例）,并进行对照研究,两药治疗剂量分别为200—800mg／d,2～5mg／d,疗程8周。采用阳性和阴性症状量表（PANSS）、简明精神病评定量表（BPRS）、治疗中出现的症状量表（TESS）进行评定及有关实验室检查。结果治疗结束时,两组PANSS和BPRS评分较入组时均显著减低（P〈0．01）,PANSS减分率奎硫平组为（65．7±28．1）,利培酮组为（66．4±27．3）,临床总有效率奎硫平组为70．5％,利培酮组为73．3％;两组疗效差异无显著性。奎硫平组的不良反应较利培酮组少,其中活动减少、震颤、扭转痉挛、静坐不能、口干、视物模糊、便秘、头晕的发生率显著少于利培酮组（P〈0．01或0．05）。结论国产奎硫平治疗精神分裂症的疗效与利培酮相当,部分不良反应较利培酮轻而少,是一种有效、耐受性较好的新型抗精神病药。     

喹硫平与利培酮治疗老年精神分裂症对照研究

目的探讨喹硫平对老年首发精神分裂症的临床疗效及安全性。方法6例首发老年精神分裂症患者随机分成两组,分别给与喹硫平与利培酮治疗8周,用阳性和阴性症状量表（PANSS）和副反应量表（TESS）评定疗效和不良反应。结果两组疗效相当（P〉0．05）,喹硫平不良反应显著少于利培酮（P〈0．05）。结论喹硫平对老年精神分裂症安全有效。     

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.     

Sense of coherence as a predictor of subjective state of health: results of 4 years of follow-up of adults

A number of cross-sectional population studies have shown that a strong sense of coherence (SOC) is associated with various aspects of good perceived health. The association does not seem to be entirely attributable to underlying associations of SOC with other variables, such as age or level of education. OBJECTIVE: The aim of the study reported here was to determine whether SOC predicted subjective state of health. METHODS: The study was carried out as a two-way panel mail survey of 1976 individuals with 4 years interval for two collections of data. The statistical method used was multivariate cumulative logistic modeling. Age, initial subjective state of health, initial occupational training level, and initial degree of social integration were included as potential explanatory variables. RESULTS: A strong SOC predicted good health in women and men. CONCLUSIONS: SOC can be interpreted as an autonomous internal resource contributing to a favorable development of subjective state of health. SOC data should, however, be regarded as complementary to and not a substitute for information already known to be associated with increased risk of future ill health.