利培酮与无抽搐电休克治疗难治性精神分裂症近期疗效对照研究

目的评价利培酮和无抽搐电休克对难治性精神分裂症的疗效和副反应。方法将住院的难治性精神分裂症60例,随机分为两组,分别应用利培酮和无抽搐电休克治疗,观察12周。用PANSS量表评定疗效,用TESS量表评定药物副反应。结果利培酮治疗组(在2周内逐渐停用原有抗精神病药)从治疗第6周起PAN-SS量表总分、PANSS量表一般精神病理分和阳性症状分开始下降,第8周起全面下降,各治疗时段TESS评分不大于3,观察期末评定有效率为56.67%,显效率为13.33%。MECT组(将原有抗精神病药减量至2/3-1/2)自治疗第4周起PANSS量表总分、PANSS量表一般精神病理分和阳性症状分开始下降,观察期末,有效率为63.33%,显效率为20%,但TESS评分较高。结论上述两种方法对难治性精神分裂症均有较理想治疗效果。     

无抽搐电休克治疗难治性精神分裂症临床观察

目的:了解无抽搐电休克治疗(MECT)对难治性精神分裂症的疗效与不良反应。方法:对39例难治性精神分裂症患者在原服用抗精神病药基础上合并MECT治疗,分别于合并治疗前后采用阳性与阴性症状量表(PANSS)及副反应量表(TESS),韦氏记忆量表(WMS)评定疗效及不良反应。结果:合并MECT后PANSS评分明显降低(P<0.01),WMS评分在治疗结束后1d明显降低,1周及2周时恢复。结论:MECT对难治性精神分裂症有效,不良反应少。     

无抽搐电休克治疗——无抽搐电休克对难治性精神分裂症的增效作用

目的：探讨无抽搐电休克治疗（MECT）对难治性精神分裂症的疗效和安全性。方法：76例难治性精神分裂症患者随机分为合用组（药物联合MECT）和单用组（单用药物治疗），每组各38例。合用组自药物治疗3周起增加MECT，疗程12周。采用阳性与阴性症状量表（PANSS）和治疗中出现的症状量表（TESS）评定疗效和不良反应;韦氏记忆量表（WMS）评定MECT对记忆力的影响。结果：合用组总有效率84.2%和显效率55.3%显著高于单用组的60.5%和31.6%（χ^2=4.34，5.33;P均〈0.05）;两组PANSS总分及各因子分均较治疗前有显著下降（P均〈0.01），以合用组显著低于单用组（P〈0.01或P〈0.05）;WMS评分与治疗前比较差异无显著性（P〉0.05）。两组不良反应发生率和TESS评分差异无显著性（P〉0.05）。结论：MECT对难治性精神分裂症有较好的增效作用，不良反应少。     

无抽搐电休克合并奥氮平治疗难治性精神分裂症对照研究

目的探讨无抽搐电休克治疗（MECT）合并奥氮平（悉敏）对难治性精神分裂症的疗效及安全性。方法将63例难治性精神分裂症患者随机分为研究组和对照组,分别予以MECT合并奥氮平和单用奥氮平治疗。观察期为12周。分别采用阳性和阴性症状量表（PANSS）、韦氏记忆量表（WMS）及副反应量表（TESS）评定疗效及安全性。结果（1）治疗2周末,MECT合并奥氮平组PANSS量表总分及阳性症状分较前明显下降（P〈0．05）,治疗4周末,奥氮平合并MECT组PANSS量表总分及阳性症状分较单用奥氮平组明显下降（P〈0．01）,治疗12周后,两组PANSS量表总分、阳性症状分、阴性症状分均较治疗前有显著性下降（P〈0．01）;（2）总有效率两组分为67．74％和62．50％,组间比较无差异（P〉0．05）;（3）奥氮平合并MECT组在MECT治疗期间WMS分明显下降（P〈0．01）,但在MECT结束治疗后4～8周恢复,与单用奥氮平组相比无显著性差异（P〉0．05）;（4）两组均未见严重的不良反应。结论MECT合并奥氮平治疗难治性精神分裂症疗效肯定,安全性好,快速控制阳性症状的疗效优于单用奥氯平。     

不同疗程无抽搐电休克治疗难治性精神分裂症疗效观察

目的观察不同疗程无抽搐电休克（MECT）治疗难治性精神分裂症（TRS）的疗效。方法将69例难TRS患者随机分为三组,对照组21例,采用传统的氯氮平治疗;短疗程组25例,采用氯氮平合并MECT≤8次;长疗程组23例,采用氯氮平合并MECT〉8次。观察三组样本的起效速度,采用简明精神病量表（BPRS）观察三组样本的评分变化、有效率,采用治疗时出现的症状量表（TESS）、韦氏记忆量表（WMS）评价样本的副反应,分别在MECT治疗开始后1,2,4,8,12周评定。结果短疗程组、长疗程组起效时间均短于对照组（t=11．31、9．54,P均〈0．01）,长疗程组、短疗程组之间的差异无统计学意义（t=1．35,P〉0．05）;MECT治疗开始后各观察时段两实验组有效率均高于对照组（P均〈0．01）,但两实验组之间的MECT开始后备时段BPRS评分差异无统计学意义（P均〉0．05）;三组之间各观察时段TESS评分、WNS评分无显著性差异（P均〉0．05）,两实验组MECT治疗1周末WNS评分与治疗前比较的差异有统计学意义（t=3．61,P〉0．05）。结论与传统的药物治疗TRS比较,合并MECT起效更快,有效率更高;但疗效并非随MECT治疗次数而增加;且短时观察有认知损害,但能迅速恢复;其远期疗效尚需进一步研究。     

无抽搐电休克治疗难治性精神分裂症的临床研究

目的 了解无抽搐电休克治疗（MECT）对难治性精神分裂症（TRS）的疗效与不良反应。方法 对78例TRS患者在原服用抗精神病药物基础上合并MECT治疗,分别于合并治疗前后采用阳性与阴性症状量表（PANSS）、副反应量表（TESS）、韦氏记忆量表（WMS）评定疗效及不良反应。结果 合并MECT后省PANSS评分明显降低（P〈0.01）WMS评分在治疗结束后1d明显降低,1周及2周时恢复。结论 MECT对TRS有效,不良反应少。     

氯氮平合并无抽搐电休克治疗难治性精神分裂症的对照研究

目的 评价氯氮平合并无抽搐电休克(MECT)治疗难治性精神分裂症的疗效和安全性.方法 将60例难治性精神分裂症患者随机分为研究组和对照组,分别给予氯氮平合并无抽搐电休克、氯氮平治疗,疗程12周,采用阳性与阴性症状量表(PANSS)及治疗中出现的症状量表(TESS)评定疗效和不良反应.结果 研究组显效率为43.3%,有效率为76.7%;对照组显效率16.7%,有效率53.3%,两组显效率和有效率均有显著性差异(P<0.05).PANSS总分及各因子分从治疗4～6周起两组即有显著性差异(P<0.05或P<0.01);两组副反应比较差异无显著性(P>0.05).结论 氯氮平合并无抽搐电休克治疗难治性精神分裂症疗效优于单用氯氮平,且显效快,副作用少,安全性高,是治疗难治性精神分裂症的较好选择.     

无抽搐电休克对难治性精神分裂症的增效作用

目的:探讨无抽搐电休克治疗(MECT)对难治性精神分裂症的疗效和安全性。方法:76例难治性精神分裂症患者随机分为合用组(药物联合MECT)和单用组(单用药物治疗),每组各38例。合用组自药物治疗3周起增加MECT,疗程12周。采用阳性与阴性症状量表(PANSS)和治疗中出现的症状量表(TESS)评定疗效和不良反应;韦氏记忆量表(WMS)评定MECT对记忆力的影响。结果:合用组总有效率84.2%和显效率55.3%显著高于单用组的60.5%和31.6%(χ2=4.34,5.33;P均<0.05);两组PANSS总分及各因子分均较治疗前有显著下降(P均<0.01),以合用组显著低于单用组(P<0.01或P<0.05);WMS评分与治疗前比较差异无显著性(P>0.05)。两组不良反应发生率和TESS评分差异无显著性(P>0.05)。结论:MECT对难治性精神分裂症有较好的增效作用,不良反应少。     

不同频次无抽搐电休克治疗难治性精神分裂症对照观察

目的探讨不同频次无抽搐电休克治疗(MECT)对难治性精神分裂症(TRS)的临床疗效及安全性。方法将80例难治性精神分裂症患者随机分为两组,一组给予1周一次MECT治疗(研究组n=40),另一组给予1周2次MECT治疗(对照组n=40);观察12周,于治疗前及治疗第2周、4周、6周、8周、12周末采用阳性与阴性症状量表(PANSS)评定临床疗效,不良反应量表(TESS)评定不良反应。结果两组PANSS总分均较治疗前有下降(P0.05);对照组治疗第2、4周末PANSS评分较研究组低,差异有统计学意义(P0.05),但治疗12周末PANSS评分对比无明显差异(P0.05);治疗12周末,研究组有效率76.67%,对照组有效率73.33%,两组无显著性差异(P0.05)。两组不良反应发生率差异无统计学意义(P0.05)。结论 MECT对TRS有效,一周两次MECT的疗效和不良反应不优于一周一次。     

无抽搐电休克联合氯氮平治疗难治性精神分裂症临床观察

目的探讨无抽搐电休克(MECT)联合氯氮平对难治性精神分裂症的临床疗效。方法选取符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)难治性精神分裂症断标准的患者91例,采用随机数字表法分为观察组(n=46)和对照组(n=45),给予对照组单纯氯氮平25mg,每天睡前服用,观察组在此基础上接受MECT治疗。于治疗前后采用阳性和阴性症状量表(PANSS)评定临床疗效,采用症状量表(TESS)评定不良反应。结果治疗12周后,观察组和对照组总有效率比较差异有统计学意义(91.3%vs.71.1%,P0.05);观察组治疗后的PANSS总评分为(32.7±3.8)分,不良反应发生率为15.2%,低于对照组的(56.6±4.5)分和37.8%,差异有统计学意义(P0.05)。结论 MECT联合氯氮平对难治性精神分裂症疗效和安全性均优于单用氯氮平。     

Maintenance electroconvulsive therapy (ECT) for treatment-resistant disorganized schizophrenia

Patients who have not responded to recommended antipsychotic medications should be considered for electroconvulsive therapy (ECT). However, there has been controversy about the standardized methods of continuation and maintenance ECT in the management of treatment-resistant schizophrenia. We describe a patient with a serious case of disorganized schizophrenia who had not responded well with any typical and atypical antipsychotic drug for seven years, but responded remarkably to acute ECT. Continuation ECT was necessary to sustain a positive therapeutic response. The patient showed dramatic improvement from 70 to 20 in the 18-item Brief Psychiatric Rating Scale (BPRS) score (71% reduction) after acute ECT and continuation ECT. Using maintenance ECT, she was able to live in the custody of her parents after 7-years hospitalization. This case report suggests that continuation and maintenance ECT benefits patients with serious cases of refractory schizophrenia.     

Severe self-injurious behavior associated with treatment-resistant schizophrenia: treatment with maintenance electroconvulsive therapy

A 35-year-old man with schizophrenia associated with a 10-year history of repetitive and often severe self-injurious behaviors was treated successfully with maintenance electroconvulsive therapy. Initially his condition did not respond to multiple psychotropic agents (including a year-long trial of clozapine), 27 hospitalizations, two courses of bilateral electroconvulsive therapy, and supportive psychotherapy with partial hospitalization. After the initiation of maintenance electroconvulsive therapy, this patient was able to tolerate residential placement and begin a work therapy program with only one instance of self-injurious behavior in the past 17 months.     

Combined electroconvulsive therapy and clozapine in treatment-resistant schizophrenia.

1. To assess the efficacy and safety of combining electroconvulsive therapy (ECT) and clozapine in patients with treatment-resistant schizophrenia, the authors reviewed use of this combination in four treatment-resistant schizophrenic inpatients and one inpatient with schizophrenia who was intolerant of clozapine doses needed to control her psychosis. 2. The combination of clozapine and bilateral ECT was modestly effective in two treatment-resistant patients and markedly effective in three patients. There was significant overall improvement in patients' Clinical Global Impression (CGI) and Global Assessment of Functioning (GAF) scores (p < 0.005 and p < 0.0004, respectively), however in patients where marked symptomatic improvement was noted, effects were not sustained. 3. One of the patients that showed dramatic yet transient improvement followed by relapses received maintenance ECT but relapsed despite this. 4. The authors saw no adverse effects in connection with the combination of ECT and clozapine. 5. Supplementing clozapine with a course of bilateral ECT appears to be safe and is effective in some patients with refractory schizophrenia, however its beneficial effects may be short-lived. The long-term impact of ECT on the course of schizophrenia in patients incompletely responsive to clozapine is not fully elucidated.     

无抽搐电休克对难治性抑郁症患者多导睡眠图的影响

目的探讨无抽搐电休克(MECT)疗法对难治性抑郁症(TRD)患者多导睡眠图(PSG)的影响。方法应用PSG仪监测30例TRD患者在MECT治疗前和治疗14次后PSG的变化,并与30名正常对照者进行比较。结果与正常对照者相比,TRD患者的睡眠总时间(TST)减少、睡眠潜伏期(SL)延迟、觉醒时间(AT)增加、快眼动睡眠时间(RT)增多、快眼动睡眠潜伏期(RL)缩短、S1和S2增加以及慢波睡眠(SWS)减少。TRD患者在MECT治疗后,出现TST增加、SL缩短、AT减少、RT减少及SWS增加,但RL无明显变化。结论 TRD患者的PSG指标在MECT治疗后有所改善。     

难治性抑郁症患者无抽搐电休克治疗前后注意偏向的变化

目的:探讨难治性抑郁症患者注意偏向的特点及无抽搐电休克治疗(MECT)前后的变化。方法:对28例难治性抑郁症(研究组)患者在MECT前和MECT后2、4、6、8周进行情绪图片刺激的点探测任务测试,同时选择与研究组性别、年龄及文化程度相匹配的28名健康人作为对照组,比较研究组治疗前后以及与对照组之间反应时和注意偏向分的差异。结果:研究组的平均反应时尽管MECT后较MECT前有显著缩短(P<0.05),但始终长于对照组(P均<0.05)。研究组对负性情绪图片刺激的注意偏向分尽管在MECT后显著降低(P<0.05)且后4次测量结果之间差异无统计学意义(P>0.05),但仍明显高于对照组(P<0.05)。结论:难治性抑郁症患者对负性情绪图片存在注意偏向,MECT对这种偏向可能具有改善作用。     

利培酮与氯氮平治疗难治性精神分裂症对照研究

目的 比较利培酮与氯氮平治疗难治性精神分裂症的疗效和副反应。方法 将符合入组条件的病人随机分为2组,分别服用利培酮和氯氮平治疗12周,用PANSS和TESS评定疗效和副反应情况。结果 利培酮组总有效率为62.9％,氯氮平组为60.0％,经统计学处理无显著性差异(P>0.05)。结论 利培酮对难治性精神分裂症的疗效与氯氮平相当,副作用轻,易被病人接受。     

不同疗程无抽搐电休克治疗难治性精神分裂症的对照研究

目的比较不同疗程无抽搐电休克治疗（EMCT）对难治性精神分裂症TRS的疗效与副反应。方法将102例难治性精神分裂症患者随机分为两组,一组给予12次MECT治疗（实验组n=52）,另一组给予8次MECT治疗（对照组n=50）;观察两组样本的有效率、阳性与阴性症状量表（PANSS）总分、治疗相关症状量表（TESS）总分、韦克斯勒记忆量表（WMS）总分变化。结果两组有效率在MECT治疗4次末、8次末、12次未表现出统计学差异（P均＞0.05）,各组组内前后比较也未表现出统计学差异（P均＞0.05）;PANSS总分在各测量时点组间差异不显著（P均＞0.05）,但第4次、8次、12次评分与入院时相比差异有统计学意义（P均＜0.05）;TESS总分各时点测量组间差异无显著性,但在第8次时与入组时比较差异具显著性（P＜0.01）;WMS各测量时点组间及各组与入组时比较均无显著性意义（P均＞0.05）。结论不同疗程MECT对TRS的短期疗效、副反应的影响无差别;MECT对TRS有效、安全;应当进一步研究MECT的作用机制。     

Efficacy of electroconvulsive therapy in treatment-resistant schizophrenia: a prospective open trial

There is a lack of controlled trials examining the effectiveness of electroconvulsive therapy (ECT) combined with olanzapine or risperidone in treatment-resistant schizophrenia (TRS). The authors conducted a prospective, open, controlled trial of ECT in TRS in a long-term psychiatric rehabilitation unit in Hong Kong. Thirty patients with TRS from an inpatient psychiatric rehabilitation unit participated in this study. All subjects were resistant to a host of antipsychotic medications given singly or in different combinations. In addition, they were also resistant to or they refused clozapine treatment. Fifteen patients completed a course of ECT consisting of 8-20 sessions. Fifteen patients who refused ECT formed the control Subjects were assessed at baseline, 1 week, 1 month, and 2 months after their last ECT. Assessment instruments included the Brief Psychiatric Rating Scale (BPRS), Hamilton Depression Rating Scale (HDRS), Scale for the Assessment of Negative Symptoms (SANS), Global Assessment Scale (GAS), Clinical Global Impression (CGI), CGI Severity of Illness [CGI(SOI)], CGI Global Improvement [CGI(GI)], Nurses' Observation Scale for Inpatient Evaluation (NOSIE-30), and occupational therapists' rating of the subjects' functioning with respect to work (OT-W), social (OT-S), and leisure (OT-L) activities. In comparison with the control group, the ECT group showed statistically significant improvement only in the GAS and CGI at each posttreatment evaluation. There was a trend for ECT to reduce positive and negative symptoms, although the rate of improvement did not reach statistically significant levels. ECT augmentation of risperidone and olanzapine is of marginal efficacy compared to reports of the greater augmentation of these antipsychotics with other agents.