度洛西汀联合喹硫平治疗躯体化障碍的临床研究

目的探讨度洛西汀联合喹硫平治疗躯体化障碍的疗效及安全性。方法 100例躯体化障碍患者随机分为研究组(度洛西汀联合喹硫平组)和对照组(度洛西汀组),疗程8周。用症状自评量表(SCL-90)、汉密尔顿抑郁、焦虑量表(HAMD、HAMA)评定严重程度,用副反应量表(TESS)评定不良反应;用SCL-90躯体化因子分和HAMD量表减分率评定疗效。结果1治疗8周后,两组SCL-90各因子分、HAMD及HAMA分均呈下降趋势;研究组HAMD、HAMA、SCL-90躯体化、强迫、抑郁、焦虑及偏执因子分均较对照组下降显著(P0.05或0.01)。研究组和对照组有效率分别为81.6%和64.0%,差异有统计学意义(P0.05)。2研究组和对照组不良反应发生率分别为42%和36%(P0.05),TESS评分为[(5.21±3.60)vs.(4.80±3.80),P0.05]。结论度洛西汀联合喹硫平治疗躯体化障碍疗效优于单用度洛西汀,且安全性好。     

度洛西汀合并小剂量氨磺必利治疗躯体形式障碍的临床对照研究

目的 评价度洛西汀合并小剂量氨磺必利对躯体形式障碍患者的疗效.方法 将52例躯体形式障碍患者随机分为研究组（予度洛西汀合并氨磺必利治疗）和对照组（予度洛西汀治疗）,每组各26例,共观察6周.采用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）、症状自评量表（SCL-90）躯体化因子量表、治疗中需处理的不良反应症状量表（TESS）于治疗前及治疗后第1、2、4、6周末分别评定疗效及安全性.结果 治疗6周后,研究组显效率76.92％,对照组显效率57.69％;研究组有效率92.31％,对照组80.77％.研究组显效率、有效率与对照组比较无显著性差异（P＞0.05）.SCL-90躯体化因子、HAMD、HAMA评分在治疗后第2、4、6周末研究组低于对照组（P＜0.05）.研究组药物不良反应发生率为38.46％,对照组为34.62％,两组药物不良反应发生率比较差异无统计学意义（P＞0.05）.结论 合并小剂量氨磺必利较单用度洛西汀可加快躯体形式障碍患者症状的消失,并能提高疗效,而且未增加药物不良反应.     

萨提亚模式家庭治疗对躯体形式障碍患者疗效的影响

目的评价萨提亚模式家庭治疗对躯体形式障碍患者疗效的影响。方法将符合《国际疾病分类(第10版)》(ICD-10)诊断标准的48例躯体形式障碍患者随机分为研究组和对照组,研究组给予度洛西汀合并萨提亚模式家庭治疗,对照组只给予度洛西汀治疗,共观察8周。采用家庭亲密度与适应性量表(FACES II-CV)对家庭亲密性和适应性进行测量;用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、症状自评量表(SCL-90)分别评定抑郁、焦虑症状和主观身体不适感。结果①治疗8周后,研究组和对照组显效率分别为87.5%和58.3%;有效率分别为100%,和83.3%,两组比较差异有统计学意义(P0.05)。②治疗8周后研究组与对照组FACES II-CV评分[(8.1±6.9)vs.(17.7±9.1)]比较差异有统计学意义(P0.05)。③治疗第6、8周末,研究组与对照组SCL-90躯体化因子分、HAMD评分、HAMA评分比较差异有统计学意义(P0.01)。结论合用萨提亚模式家庭治疗可能会改善躯体形式障碍患者的家庭亲密性和适应性,提高对躯体形式障碍的疗效。     

度洛西汀与氟西汀改善躯体形式障碍患者症状及社会功能效果的对照研究

目的 探讨度洛西汀与氟西汀对改善躯体形式障碍患者症状及社会功能的效果.方法 将134例躯体形式障碍患者随机分为研究组（度洛西汀系统治疗）和对照组（氟西汀系统治疗）,共治疗8周.在基线及治疗后第1、2、4、8周末采用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）、社会功能缺陷量表（SDSS）及治疗中需处理的不良反应症状量表（TESS）评定疗效及不良反应.结果 研究组患者在治疗后第1周末起HAMD及HAMA量表评分均显著低于基线时（P＜0.05）,而对照组治疗后第2周末起HAMD及HAMA量表评分均显著低于基线时（P＜0.05）;治疗后第1、2、4、8周末研究组HAMD及HAMA量表评分均低于对照组（P＜0.05）.研究组治疗后第4周末起SDSS量表评分显著低于基线时（P＜0.05）,而对照组治疗后第8周末SDSS量表评分显著低于基线时（P＜0.05）.治疗后第4、8周末研究组SDSS量表评分均低于对照组（P＜0.05）.两组均未出现严重不良反应.结论 度洛西汀可有效、快速的改善躯体形式障碍患者的抑郁、焦虑症状及社会功能,效果优于氟西汀.     

度洛西汀合并认知治疗对更年期女性抑郁症患者的疗效比较

目的评价度洛西汀合并认知治疗对更年期女性抑郁症患者的疗效和安全性。方法采用数字随机法将符合ICD-10诊断标准的60例更年期抑郁症患者分为研究组和对照组,各30例。研究组给予度洛西汀合并认知治疗,对照组单用度洛西汀治疗,疗程8周。采用汉密尔顿抑郁量表(HAMD),汉密尔顿焦虑量表(HAMA)评定疗效,副反应量表(TESS)评定不良反应。结果两组治疗8周后HAMD、HAMA评分与治疗前比较差异均有统计学意义(P<0.01),研究组在1、2、4、8周末HAMD、HAMA评分与对照组比较差异有统计学意义(P<0.05或0.01),减分率均高于对照组(P<0.05)。结论度洛西汀合并认知治疗对更年期女性抑郁症患者疗效优于单用度洛西汀。     

中药熏蒸疗法联合度洛西汀治疗躯体化障碍患者的临床观察

目的观察中药熏蒸疗法联合度洛西汀治疗躯体化障碍患者的临床疗效。方法选取2017年11月～2020年6月沈阳市精神卫生中心就诊的躯体化障碍患者62例纳入研究,随机分为对照组(30例)和研究组(32例),研究组给予中药熏蒸+度洛西汀治疗,对照组仅给予度洛西汀治疗,治疗时间共6周,在治疗前后通过症状自评量表(SCL-90)和汉密尔顿焦虑量表(HAMA)评价治疗效果。结果治疗前,两组的SCL-90、HAMA评分无明显差异(P0.05);治疗6周后,两组的SCL-90、HAMA评分均低于治疗前,差异有统计学意义(P0.05)。治疗后研究组的SCL-90、HAMA评分均低于对照组,差异有统计学意义(P0.05)。结论中药熏蒸疗法联合度洛西汀可更有效改善躯体化障碍患者的临床症状,具有患者体验舒适、接受性好、副作用小等优势,值得在临床推广应用。     

度洛西汀合并阿立哌唑治疗躯体形式障碍的临床对照研究

目的 观察度洛西汀合并阿立哌唑治疗躯体形式障碍的临床疗效.方法 将80例躯体形式障碍患者随机分为度洛西汀合并阿立哌唑组(研究组)和度洛西汀组(对照组),均进行6周系统治疗和观察,分别于治疗前、治疗后第1、2、4、6周末采用汉密尔顿抑郁量表(HAMD)总评分及其焦虑/躯体化因子评分进行疗效评定.结果 两组HAMD总分及焦虑/躯体化因子评分在治疗后第1、6周末有显著性差异(P＜0.05),在治疗后第2、4周末有极显著差异(P＜0.01).两组治疗后各阶段的临床显效率比较均有显著性差异(P＜0.05).两组患者总体副反应发生率无显著性差异(P＞0.05).结论 度洛西汀合并小剂量阿立哌唑治疗躯体形式障碍具有起效快、疗效好、不良反应少等优点.     

度洛西汀合并小剂量奥氮平对抑郁症患者的治疗作用

目的:探讨度洛西汀合并小剂量奥氮平治疗抑郁症的疗效。方法:采用随机双盲对照研究,将105例抑郁症患者随机分为研究组52例(度洛西汀合并小剂量奥氮平治疗),对照组53例(单用度洛西汀治疗);疗程8周。于治疗前及治疗后采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)及治疗中出现的症状量表(TESS)评定疗效及不良反应。结果:研究组和对照组显效率分别为94.0%和62.7%,以研究组疗效显著(t=2.37,P<0.05)。两组HAMD、HAMA治疗后各次评分均较治疗前显著下降(t=2.66～3.76,P均<0.01);以研究组降分显著(t=2.54～3.68,P<0.01或P<0.05)。两组不良反应相当(χ2=0.08,P>0.05)。结论:度洛西汀合并小剂量奥氮平治疗抑郁症疗效优于单一用药。     

帕利哌酮对文拉法辛治疗躯体形式障碍的增效作用研究

目的探讨小剂量帕利哌酮对文拉法辛治疗躯体形式障碍的增效作用及安全性。方法将年龄在23～56岁之间符合CCMD-3躯体形式障碍诊断标准的患者58例随机分为对照组(文拉法辛组)及研究组(文拉法辛合并帕利哌酮组)各29例,治疗8周。于治疗前、治疗2、4、8周末分别应用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)及症状自评量表(SCL-90)评价疗效,应用副反应量表(TESS)评定不良反应,将两组结果加以分析、比较。结果治疗第2周末开始研究组HAMD及SCL-90抑郁因子分明显低于对照组(P<0.05);第4周末开始研究组HAMA及SCL-90躯体化、焦虑因子分明显低于对照组(P<0.05)。两组各时期TESS评分无显著差异(P>0.05)。治疗8周末研究组有效率为82.8%,对照组有效率为65.5%,两组间差异有显著性意义(P<0.05)。结论小剂量帕利哌酮对文拉法辛治疗躯体形式障碍的增效作用明显且安全,控制抑郁症状更加迅速。     

度洛西汀联合奥氮平治疗躯体形式障碍患者的临床分析

目的:探讨度洛西汀联合小剂量奥氮平治疗躯体形式障碍患者的疗效和安全性。方法:120例躯体形式障碍患者随机分为研究组即度洛西汀联合小剂量奥氮平组和对照组即单用度洛西汀组,各60例疗程6周。治疗前后以汉密尔顿焦虑量表(HAMA)、密尔顿抑郁量表(HAMD)的疑病条目、阿森斯失眠量表(AIS),临床疗效总评量表(CGI)进行疗效评估,以治疗时出现的症状量表(TESS)评估用药的安全性。结果:治疗第2周,研究组HAMA和CGI-GI评分显著低于对照组(P均0.01)。治疗第6周,两组显效率基本接近,对照组的疑病观念的残留率高于研究组(P0.05)。两组第2、4、6周的HAMA评分均显著低于治疗前(P0.01)。第1周及第6周,对照组的治疗脱落率显著高于研究组(P均0.05)。治疗第1周末,对照组的恶心呕吐以及失眠的发生率显著高于研究组(P0.05)。结论:度洛西汀联合小剂量奥氮平治疗躯体形式障碍较单用度洛西汀,具有疗效好、起效快、恶心呕吐不良反应少,脱落率低的优点。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Special Pharmacokinetic Considerations in Children

Summary: Pediatric patients have greater degrees of pharmacokinetic variability and unpredictability than adults. This variability results from the effects of pharmacogenetics, age and growth, prior and current comedication, and disease. Newborns with seizures have the least predictable dosage requirements, and their needs change as drug-eliminating mechanisms mature in the neonatal period. Infants have the highest relative capacities to eliminate antiepileptics of any age group and require the largest relative doses. In addition to age-related trends, children demonstrate the same drug-specific, pharmacokinetic phenomena that adults do, including nonlinear phenytoin elimination, nonlinear valproate binding, and autoinduction of carbamazepine. Intercurrent illness and drug interactions further modify the age-related pharmacokinetic patterns in children and make dosage requirements even more unpredictable. Recent studies have shown that febrile illness can affect drug elimination, sometimes decreasing drug levels by 50% or more. Intermittent treatment with benzodiazepines administered either orally or rectally can be an important adjunct and help minimize this type of problem for children with marginally controlled epilepsy. Intermittent benzodiazepines are also helpful for children who have febrile seizures and who need only occasional antiepileptic protection.