丙戊酸钠对精神分裂症攻击行为的治疗作用

目的：了解丙戊酸钠对精神分裂症患者攻击性行为的治疗作用。方法：对21例有攻击性行为的长期住院精神分裂症患者在原有抗精神病药的基础上加用丙戊酸钠进行为期6周的治疗，在治疗前及治疗后第6周用简明精神病评定量表(BPRS)、外显攻击行为量表修订版(MOAS)进行评定。结果：治疗前后BPRS各因子分差异无显著性。但治疗后MOAS评分显著降低。结论：丙戊酸钠辅助治疗精神分裂症的攻击性行为安全有效。     

丙戊酸钠对精神分裂症的辅助治疗作用

目的：探讨丙戊酸钠合并抗精神病药治疗伴有冲动和攻击行为的精神分裂症的疗效。方法：对42例精神分裂症患者随机分成两组，一组加用丙戊酸钠(合用组)，另一组仍用原抗精神病药物(单用组)，治疗4周。采用阳性症状和阴性症状量表(PANSS)、副反应量表(TESS)评定两组精神症状变化和不良反应。结果：合用组治疗1周后及治疗结束时PANSS量表总分、阳性症状、精神病理症状的评分比单用组明显为低。结论：伴冲动和攻击行为的精神分裂症患者以丙戊酸钠合并抗精神病药物治疗，起效快，可增加疗效。     

丙戊酸钠与碳酸锂治疗躁狂发作对照研究

目的：比较丙戊酸钠与碳酸锂治疗躁狂发作的疗效和不良反应。方法：对80例躁狂发作患者随机均分为丙戊酸钠组和碳酸锂组，在治疗前，治疗2、4、8周末分别用Bech-Rafaelsen躁狂量表(RBRMS)和临床疗效总评量表(CGI)及副反应量表(TESS)评定疗效和不良反应。结果：丙戊酸钠组治疗2周后BRMS总分，及各因子分比治疗前明显降低，且显著低于碳酸锂组，两组治疗8周BRMS总分各因子分均显著低于治疗前，差异显著。治疗2、4、8周末TESS评分，丙戊酸钠组显著低于碳酸锂组，差异有显著性。结论：丙戊酸钠治疗躁狂发作疗效好，起效快，不良反应小。     

丙戊酸镁缓释片对精神分裂症暴力攻击行为的疗效观察

目的:探讨丙戊酸镁缓释片联合抗精神病药治疗精神分裂症暴力攻击行为疗效及安全性.方法:将64例有暴力攻击行为的精神分裂症患者随机分为两组,丙戊酸镁缓释片联合抗精神病药组(合用组)32例,单用抗精神病药组(单用组)32例治疗4周.采用简明精神病量表(BPRS)、外显攻击行为量表(MOAS )和治疗中出现的症状量表(TESS...     

丙戊酸钠改善精神分裂症患者认知功能障碍的对照研究

目的 探讨丙戊酸钠改善精神分裂症患者认知功能障碍的疗效.方法 将80例精神分裂症患者随机分成研究组(40例)和对照组(40例),研究组患者使用新型抗精神病药合并丙戊酸钠系统治疗,对照组患者单用新型抗精神病药物系统治疗,共治疗8周.全部病例在治疗前后分别进行阳性和阴性综合征量表(PANSS)、韦氏成人智力量表(WAIS-RC)、韦氏记忆量表(WMS)、威斯康星卡片分类测验(WCST)进行疗效评定,应用治疗中需处理的不良反应症状量表(TESS)评定不良反应.结果 与基线时比较,两组在治疗后第4、8周末PANSS总分及各因子分均有明显降低(P＜0.05),研究组治疗后第8周末PANSS总分及各因子分均显著低于对照组(P＜0.05).治疗后第8周末,两组WMS、WAIS-RC、WCST评分与基线时比较,除即刻记忆评分外其余各项评分差异均有统计学意义(P＜0.05),两组间比较,除即刻记忆评分外其余各项评分均有显著性差异(P ＜0.05,P＜0.01).结论 丙戊酸钠对精神分裂症患者的认知功能障碍有明显改善效果.     

丙戊酸钠对精神分裂症伴攻击行为的辅助疗效观察

目的探讨丙戊酸钠对精神分裂症伴攻击行为患者治疗的辅助疗效。方法对60例符合条件的精神分裂症患者随机分成两组，一组应用利培酮加丙戊酸钠（研究组），另一组单用利培酮（对照组），进行8周治疗观察，采用简明精神病评定量表（BPRS）进行评定。结果加用丙戊酸钠者的疗效显著较好。结论对精神分裂症伴攻击行为的患者以丙戊酸钠合并抗精神病药物治疗可以增加疗效。     

丙戊酸钠对精神分裂症幻听症状的辅助疗效

目的：探讨丙戊酸钠对精神分裂症患者的幻听症状有无辅助治疗作用。方法：将病人随机分为两组，一组氯丙嗉合合并丙戊酸钠治疗8周，另一组不合并丙戊酸钠治疗。用简明精神病评定量表（BPRS）、阳性症状评定量表（SAPS）、临床疗效总评量表（CGI）及副反应量表（TFSS）综合评定。结果：氯丙嗪合并丙戊酸钠治疗组疗后BP民分、单项幻觉分，以及SAPS总分、幻觉分、幻听分均低于不合并治疗组，尤以1、2周末明显。结论：丙戊酸钠可加快精神分裂症病人幻听症状的消除，且对幻听伴随的焦虑、激越、怪异行为、敌对猜疑等症状亦有一定的疗效。     

氯氮平治疗迟发性运动障碍疗效分析

目的：探讨氯氮平对迟发性运动障碍(TD)的疗效。方法：以氯氮平治疗TD患者32例，剂量为200—600mg／d，疗程24周。用不自主运动量表(AIMS)及阴性症状量表(SANS)评定。以AIMS减分率评定疗效，并随访半年。结果：痊愈7例，显著好转5例，好转9例，无效11例；显效率37．5％。无效组年龄显著高于显效组和好转组；疗前无效组AIMS评分显著高于显效组和好转组。结论：氯氯平对TD有一定疗效，随着年龄的增长及症状的加重，疗效减退。     

喹硫平联合丙戊酸钠治疗双相障碍躁狂的临床疗效及安全性分析

目的 探讨喹硫平联合丙戊酸钠治疗双相障碍躁狂的临床疗效及安全性分析.方法 将本院诊治的126例双相障碍躁狂患者随机分为对照组与观察组,对照组患者给予喹硫平单药治疗,观察组给予喹硫平联合丙戊酸钠口服治疗,疗程8周.采用Beck-Rafaelsen躁狂量表（BRMS）及阳性和阴性症状量表（PANSS）评分来评估临床疗效,比较2组不良反应发生率.结果 治疗后4周及8周,观察组BRMS及PANSS评分均显著低于对照组（P〈0.05）;治疗后8周观察组痊愈率及有效率均显著高于对照组（P〈0.05）;观察组与对照组不良反应发生率无显著差别（P〉0.05）.结论 与喹硫平单药治疗相比,喹硫平联合丙戊酸钠治疗双相障碍躁狂可显著提高临床疗效,且不增加不良反应.     

氯氮平合并丙戊酸钠治疗难治性精神分裂症的疗效分析

目的：探讨氯氮平合并丙戊酸钠治疗难治性精神分裂症的疗效。方法：抽取64例难治性精神分裂症患者给予氯氮平≥400mg/日，合并丙戊酸钠≥800mg/日，治疗3个月，用简明精神病量表（BPRS）及药物副反应量表（TESS）评定疗效及副作用，并对其它相关因素进行分析。结果：发现氯氮平合并丙戊酸钠治疗难治性精神分裂症阳性，阴性症状均有效，总有效率为56．2％，尤其对女性及＜22岁的患者疗效好，对激活因子及敌对猜疑因子疗效亦佳，副作用轻微，结论：氯氮平合并丙戊酸钠是治疗难治性精神分裂症（尤其是对女性及＜22岁患者）较为理想的方法。     

非典型抗精神病药物联合双心境稳定剂治疗躁狂发作的比较

目的评价非典型抗精神病药物联合双心境稳定剂（丙戊酸钠缓释剂和碳酸锂）治疗躁狂发作的疗效与安全性。方法将69例躁狂发作患者随机分为研究组（n=34）和对照组（n=35）。研究组应用碳酸锂、丙戊酸钠缓释剂以及非典型抗精神病药物治疗6周,对照组应用丙戊酸钠缓释剂联合非典型抗精神病药物,应用Beck-Rafaelsen躁狂评定量表（BRMS）评估病情严重程度。结果治疗后研究组BRMS分值明显下降（基线为27.7±7.8,第6周6.0±3.4）,对照组BRMS分值也下降（分别为28.5±5.5,7.8±2.1）,但是研究组从第2周末起BRMS分值改善比对照组明显。研究组第6周末痊愈率高于对照组（分别为51.4%、28.5%,χ2=5.0,P=0.03）。不良反应发生率无明显差异。结论非典型抗精神病药物联合双心境稳定剂（丙戊酸钠缓释剂联合碳酸锂）比非典型抗精神病药物联合一种心境稳定剂（丙戊酸钠缓释剂）控制躁狂发作效果好。     

褪黑素治疗迟发性运动障碍的随机对照研究

目的 观察褪黑素治疗慢性精神分裂症患者迟发性运动障碍(TD)的临床疗效和不良反应.方法 选择76例有迟发性运动障碍的精神分裂症住院患者,按照入组顺序用随机数字表将患者分为褪黑素治疗组(以下简称褪黑素组,39例)和对照组(37例).褪黑素组患者每晚服用褪黑素1次(9 mg/次),对照组患者只维持常规治疗;观察期均为12周.76例患者治疗前和治疗第4,8,12周末盲法采用异常不自主运动量表(AIMS)评定TD疗效,采用治疗中需处理的不良反应症状量表(TESS)评定不良反应.结果 治疗第4,8,12周末,对照组患者AIMS总分较治疗前的差异均无统计学意义(配对t检验,P均>0.05);褪黑素组患者AIMS总分均较治疗前显著降低,差异有统计学意义(配对t检验,P均<0.05),治疗第12周末舌部、上肢的TD症状较治疗前显著降低,差异均有统计学意义(配对t检验,P均<0.05).治疗第8,12周末两组AIMS总分差异有统计学意义(t检验,P<0.05).褪黑素组和对照组治疗各时点TESS总分与治疗前比较,褪黑素组患者治疗第4,8,12周末较治疗前均显著降低,差异均有统计学意义(配对t检验,P均<0.05);而对照组及两组间的差异均无统计学意义(t检验,P均>0.05).结论 褪黑素治疗慢性精神分裂症患者TD有效,对舌和上肢的症状效果明显,无不良反应.     

拉莫三嗪与丙戊酸钠治疗双相抑郁的对照研究

目的评价拉莫三嗪治疗双相障碍抑郁发作的效果和安全性。方法对107例双相障碍抑郁发作患者采用随机、平行分组、对照的方法分别以拉莫三嗪和丙戊酸钠治疗,疗程8周,以汉密尔顿抑郁量表(HAMD)、临床疗效总评量表(CGI)在治疗前和治疗后第1、2、4、6、8周末评价疗效,同时采用治疗时出现的症状量表(TESS)进行安全性评估,在第1、2、4、6、8周末及需要时用Bech-Rafaelsen躁狂量表(BRMS)评定躁狂症状。结果拉莫三嗪组和丙戊酸钠组比较,两组有效率分别为75.5%和51.9%,治疗第6周和第8周末HAMD总分和减分率差异有统计学意义。治疗组不良反应明显较对照组发生率低。结论拉莫三嗪治疗双相障碍抑郁发作疗效优于丙戊酸钠,且前者不良反应较少,安全性高。     

Risperidone for severe tardive dyskinesia: a 12-week randomized, double-blind, placebo-controlled study

BACKGROUND: Risperidone has been reported to alleviate the severity of tardive dyskinesia, but without placebo control, the possibility of spontaneous tardive dyskinesia remission after discontinuing original conventional antipsychotics cannot be excluded. This 12-week randomized, double-blind, placebo-controlled study investigated the effect of risperidone on severe tardive dyskinesia. METHOD: Forty-nine DSM-IV schizophrenia patients with severe tardive dyskinesia were enrolled in the study. After a 4-week washout period, the subjects were randomly assigned to treatment with either risperidone or placebo. The risperidone dose was started at 2 mg/day and gradually increased to 6 mg/day over 6 weeks; the 6-mg/day dose was maintained for the remaining 6 weeks of the study. The subjects were evaluated every 2 weeks with the Abnormal Involuntary Movement Scale (AIMS) and the Extrapyramidal Symptom Rating Scale. The final mental status was assessed with the Brief Psychiatric Rating Scale. RESULTS: Twenty-two subjects in the risperidone group and 20 subjects in the placebo group completed the study; the mean baseline AIMS total score for all subjects was 15.9 +/- 4.6. At the end of the study, the mean AIMS total score decrease was 1.1 +/- 4.8 in the placebo group and 5.5 +/- 3.8 in the risperidone group (p <.05). Fifteen subjects (68%) in the risperidone group and 6 subjects (30%) in the placebo group were responders (p <.05). The risperidone responders had a mean AIMS total score decrease of 7.5 +/- 2.1. More significant tardive dyskinesia improvement among the risperidone group was noted from the eighth week and was mainly demonstrated in the buccolinguomasticatory a rea rather than in choreoathetoid movement of the extremities (p <.001). CONCLUSIONS: Risperidone, 6 mg/day, can improve tardive dyskinesia more significantly than discontinuing antipsychotics in patients with severe tardive dyskinesia, especially in the orofacial areas.     

迟发性运动障碍与急性锥外系反应

目的：探讨抗精神病药所致的迟发性运动障碍（ＴＤ）的相关因素。方法：用不自主运动量表（ＡＩＭＳ），锥体外系副反应量表（ＲＳＥＳＥ）评定确认ＴＤ、急性锥体外系副反应（ＥＰＳ）存在，建立对照组。对所得临床资料进行统计学分析。结果：ＴＤ组年轻男性多，总服药时间长，服药剂量高，高效价药使用多，既往ＥＰＳ次数多，情感性精神障碍患者服药剂量比精神分裂症患者明显低。ＴＤ严重程度与各临床变量无显著相关性，ＡＩＭＳ≤     

Cytochrome P-450 2D6*10 C188T polymorphism is associated with antipsychotic-induced persistent tardive dyskinesia in Chinese schizophrenic patients

Typical antipsychotic treatment had been postulated to be a risk factor for the susceptibility to tardive dyskinesia (TD). The cytochrome P-450 debrisoquine/sparteine hydroxylase (CYP2D6) metabolizes a majority of antipsychotics and exhibits various phenotypes on enzymatic activities from poor metabolizers to ultrarapid metabolizers. The various phenotypes are encoded by polymorphic genetic variants on the CYP2D6 gene. Although several studies had explored the association between the CYP2D6*10 C188T polymorphism, which encodes the phenotype intermediate metabolizers, and TD in Orientals, the findings were inconclusive. In the present study, we examined the relationship between the CYP2D6*10 C188T polymorphism and the TD occurrence in 216 Chinese schizophrenic patients (113 patients with TD and 103 patients without TD) and explored the correlation between the TD severity assessed by the Abnormal Involuntary Movement Scale (AIMS) and each C188T genotype in the 113 TD patients. Using logistic regression analysis, we found a modest association (p = 0.045) between TD and C188T genotypes. This positive finding was only observed in male patients (p = 0.001), but not in females. Our findings also support the correlation between AIMS scores and C188T polymorphism within the TD group after adjusting for confounding effects with the multiple regression analysis (p = 0.033). We concluded that the CYP2D6*10 C188T polymorphism may be associated with the susceptibility to the occurrence of TD induced by typical antipsychotics, especially in male patients, and may also be correlated with AIMS scores in TD patients.     

迟发性运动障碍与抗精神病药物治疗关系的研究

目的观察迟发性运动障的发生与长期应用抗精神病药物的关系。方法选取北京回龙观医院长期住院的患者,符合CCMD-3精神分裂症的诊断标准,抗精神病药剂量恒定维持治疗6个月。排除器质性疾病及其它神经精神疾患。先用Simpson迟发性运动专业量表进行全院患者筛选,最终选出合乎要求病例109例,再用AIMS量表评定,依据患者用药情况分为三组,典型抗精神病药组（包括氯丙嗪、奋乃静、氟哌啶醇、安棕酯）、氯氮平组、利培酮组,使用SPSS10.0,采用独立样本t检验、单因素方差分析,分析三组药物与TD的相关性。结果利培酮组的AIMS总分显著低于典型抗精神病药组（p=0.032）,与氯氮平组无显著差异（P=0.275）。结论利培酮组,氯氮平组致TD症状的严重程度偏低,或对TD症状有一定抑制或治疗作用。     

A multicentre comparative trial of sodium valproate and carbamazepine in adult onset epilepsy. Adult EPITEG Collaborative Group.

The long-term efficacy and safety of sodium valproate and carbamazepine in adult outpatients with newly diagnosed primary generalised or partial and secondarily generalised seizures were compared in a randomised, open, multicentre study at 22 neurology outpatient clinics. Patients were randomised to oral sodium valproate (Epilim EC enteric coated 200 mg tablets twice daily, n = 149) or oral carbamazepine (100 mg twice daily increasing to 200 mg twice daily in week 2, n = 151) and followed up for three years. If clinically necessary, dosages were regularly increased until seizures were controlled or toxicity developed. Sodium valproate and carbamazepine controlled both primary generalised and partial seizures equally effectively overall. Significantly more patients on sodium valproate than carbamazepine (126/140 (90%) v 105/141 (75%), p = 0.001) remained on randomised treatment for at least six months. Skin rashes occurred significantly more often in carbamazepine recipients than in sodium valproate recipients (11.2% v 1.7%, p < 0.05) and carbamazepine was associated with a higher withdrawal rate because of adverse events (15% v 5% on sodium valproate) in the first six months of treatment. There was no difference between the drugs in the rate of withdrawal because of poor seizure control at any stage, regardless of seizure type. At the end of the three year trial period, over 70% of the available patients were still on randomised treatment or had recently stopped treatment after achieving full seizure control. Sodium valproate and carbamazepine were both associated with a high degree of overall seizure control regardless of seizure type and both have good long-term tolerability in adult patients with newly diagnosed epilepsy. Recommendations are made for a higher initial dosage regime for sodium valproate in partial seizures.     

长期抗精神病药治疗撤药时的运动障碍

目的：调查撤药出现的运动障碍（ＷＥ－Ｄ）是否为迟发性运动障碍（ＴＤ）的早期征象。方法：７１例精神分裂症病人停药２周,于停药前及停药后第２周末评定迟发性运动障碍量表（Ｓｉｍｐ－ｓｏｎ量表）及阴性症状量表,收集临床资料,并随访半年。结果：无ＴＤ组病人年龄、病程显著低于ＷＥ－Ｄ组及ＴＤ组病人;ＷＥ－Ｄ组与ＴＤ组病人间年龄、病程、抗精神病药治疗持续时间、平均剂量及阴性症状间无显著差异。结论：ＷＥ－Ｄ可能是ＴＤ的一个早期表现或为一隐匿性运动障碍