托吡酯与氟哌啶醇治疗Tourette综合征疗效的对照研究

目的 探讨托吡酯单一治疗Tourette综合征(TS)的疗效和安全性。方法 将53例TS患者按病例编号分为研究组(35例)和对照组(18例)。研究组予托吡酯(50-150 mg/d)治疗;对照组予氟哌啶醇(1.5-6 mg/d),共治疗24周。研究组3例脱落,对照组2例脱落。采用耶鲁抽动症整体严重度量表(YGTSS)、治疗中需处理的不良反应症状量表(TESS)于治疗前、治疗第8,24周末对两组进行评估。结果(1)治疗第8周末研究组有效率为72％,高于对照组(38％;Z=-3.284,P=0.001)。研究组YGTSS总分[(28.06±14.45)分]低于对照组[(40.00±20.90)分;P<0.05];减分率[(48.10±22.80)％]高于对照组[(33.17±31.90)％;但P>0.05]。治疗第24周末,研究组有效率为81％,高于对照组(56％;Z=-4.808,P<0.001)。研究组YGTSS总分[(24.96±16.28)分]低于对照组[(36.50±21.08)分;P<0.05];减分率[(52.90±24.49)％]高于对照组[(34.63±32.58)％;P<0.05]。(2)第8周末研究组TESS分[(2.69±3.02)分]低于对照组[(6.25±4.06)分;P<0.01];第24周末研究组TESS分[(1.69±1.79)分]低于对照组[(2.69±3.02)分;P<0.01]。结论 托吡酯能有效改善TS的运动、发声抽动和综合损伤效应,副作用相对较轻。     

奎硫平治疗Tourette综合征对照研究

目的:探讨奎硫平治疗Tourette综合征(TS)的疗效和安全性。方法:将24例TS患者随机平分为奎硫平(50～600mg/d)组和氟哌啶醇(2～12mg/d)组,治疗8周。采用耶鲁抽动症状严重程度量表(YGTSS)、副反应量表(TESS)于治疗前和治疗2、4、8周末进行评估。结果:两组YGTSS减分率相仿,奎硫平组TESS分较低。结论:奎硫平能有效改善TS症状,不良反应较轻。     

阿立哌唑治疗Tourette综合征对照研究

目的探讨阿立哌唑治疗Tourette综合征(TS)的疗效和安全性。方法将82例TS患者按入组顺序分为研究组和对照组后分别予阿立哌唑(5～30mg/d)和氟哌啶醇(6～16mg/d)治疗8周。采用耶鲁抽动严重程度总体量表(YGTSS)、副反应量表(TESS)于治疗前、治疗第2、4、8周末对两组进行评估。结果研究组和治疗组在治疗第2、4、8周末两组YGTSS总分均较治疗前明显下降,差异均有统计学意义(t值为13.60～13.89和15.37～16.66,P均小于0.001)。两组间治疗前和治疗的第2、4、8周末YGTSS总分和减分率的差异均无统计学意义(总分差异主效应F=0.41,P=0.80;减分率差异主效应F=0.38,P=0.77),治疗的第2、4、8周末研究组TESS分低于对照组(秩和检验P均小于0.05)。结论阿立哌唑治疗TS的疗效与氟哌啶醇相当,且副作用较轻。     

阿立哌唑与氟哌啶醇治疗儿童抽动障碍的对照研究

目的比较阿立哌唑与氟哌啶醇治疗儿童抽动障碍的疗效和安全性。方法将68例5～16岁抽动障碍患儿随机分为两组,每组34例,分别给予阿立哌唑(5～20 mg/d)与氟哌啶醇(2～8 mg/d)治疗,采用耶鲁综合抽动严重程度量表(Yale Global Tic Severity Scale,YGTSS)、副反应量表(treatment emergent symptomscale,TESS)于治疗前、治疗第2、4、8周末评估疗效和安全性。结果从治疗第2周末起阿立哌唑组和氟哌啶醇组YGTSS总分均下降,减分率无明显差异,治疗8周后,阿立哌唑组和氟哌啶醇组治疗总体有效率分别为79%和73%,差异无统计学意义。而在2,4,8周阿立哌唑组TESS分[(2.53±2.95)vs.(12.26±10.58),(1.95±2.06)vs.(7.58±5.26),(1.36±1.85)vs.(4.68±2.06)]明显低于氟哌啶醇组,均P﹤0.05。结论阿立哌唑能有效改善儿童抽动障碍,疗效与氟哌啶醇相当,而且副反应小,适合儿童治疗。     

利培酮治疗Tourette综合征对照研究

目的：探讨利培酮与氟哌啶醇、泰必利治疗Tourette综合征(TS)的疗效和安全性。方法：将90例TS随机分为3组，分别以利培酮、氟哌啶醇、泰必利治疗8周。在治疗前及治疗4周末、8周末分别进行耶鲁综合抽动严重程度量表(YGTSS)评分，用减分率评定疗效。结果：治疗8周末3组的YGTSS总抽动分、总发声抽动分、全部损伤因子分及严重程度分均显著小于治疗前，但氟哌啶醇不良反应大，脱落率高。结论：3种药物对TS疗效相当，利培酮不良反应小，脱落率低，安全性好。     

胃复安控制抽动秽语综合征及改善认知功能的研究

目的 探讨胃复安控制抽动秽语综合征（Tourette　Syndrome,TS）抽动及改善认知功能的有效性、安全性。方法 50例TS患者随机分入胃复安组或氟哌啶醇组,两组治疗前后的结果经YGTSS量表、Asberg副反应量表、韦氏智力检测进行评估。结果 胃复安、氟哌啶醇组TS的抽动程度YGTSS量表分治疗后均明显降低,组间比较胃复安组疗效更优。临床疗效的有效率均为92％。韦氏智力检测显示:治疗后的智商均有显著增加,而记忆商仅胃复安组显著增加。副反应Asberg量表分胃复安组低于氟哌啶醇组。结论胃复安能有效控制TS抽动,改善认知功能,副反应轻微,特别是无锥体外系副反应。     

利培酮与氟哌啶醇治疗儿童抽动障碍的对照研究

目的:比较利培酮与氟哌啶醇治疗儿童抽动障碍的疗效和安全性。方法:将52例6~14岁抽动障碍患儿随机分为利培酮组和氟哌啶醇组;分别予以相应的药物治疗8周;于治疗前及治疗2、4、8周末采用耶鲁综合抽动严重程度量表(YGTSS)、治疗中出现的症状量表(TESS)评估疗效和安全性。结果:共有46例患者完成8周的治疗;治疗第2周末利培酮组(24例)YGTSS总分明显高于氟哌啶醇组(22例)[(57.71±15.45)分vs.(47.34±18.13)分],有效率明显低于氟哌啶醇组(29.17%vs.59.09%)(P均0.05);治疗第4、8周末两组间YGTSS总分和有效率差异无统计学意义;治疗第2、4、8周末利培酮组TESS分明显低于氟哌啶醇组(P均0.01)。结论:利培酮治疗儿童抽动障碍的疗效与氟哌啶醇相当;虽然起效较慢,但不良反应小,适合儿童治疗。     

利培酮治疗难治性Tourette综合征对照观察

目的:探讨利培酮治疗难治性Tourette综合征(TS)的疗效和安全性。方法:对141例难治性TS患者,随机分为利培酮组(71例)和对照组(70例),进行8周的利培酮开放、对照研究。利培酮组以利培酮单药治疗,对照组以氟哌啶醇等单一或联合治疗。采用耶鲁抽动症状严重程度量表(YGTSS)Achenbach儿童行为量表(CBCL)、治疗中出现的症状量表(TESS),于治疗前、治疗4、8周对两组进行临床疗效及安全性评估。结果:两组症状均有改善。治疗第4周利培酮组有效率56.3%,明显高于对照组32.9%(χ2=8.212,P<0.01);利培酮组YGTSS总分(39.97±15.62)分较对照组(49.84±13.91)分显著为低(P<0.01)。治疗8周时利培酮组有效率为71.8%,明显高于对照组51.4%(χ2=6.357,P<0.05);利培酮组YGTSS总分(17.20±11.24)分明显低于对照组(24.97±10.74)分(P<0.05);减分率(76.55±14.73)%明显高于对照组(66.86±14.28)%(P<0.01)。治疗4周和8周,两组的CBCL总分均显著减少(P<0.05)。治疗4周和8周,利培酮组TESS分显著低于对照组(P<0.01)。结论:利培酮对难治性TS疗效肯定,不良反应较轻。     

利培酮合并氯丙咪嗪治疗难治性Tourette综合征对照研究

目的利培酮联用氯丙咪嗪治疗Tourette综合征(TS)的临床疗效。方法55例TS患者随机分成利培酮组(对照组)和利培酮联用氯丙咪嗪组(试验组),分别治疗8周,采用YGTSS(耶鲁综合抽动严重程度量表)于治疗前后分别进行测试。结果8周后试验组的YGTSS总分较对照组有明显的下降(P<0.05),试验组的有效率为87.51%,对照组的有效率为66.66%,差异有显著性。(χ2=9.46,P=0.023<0.05)。结论利培酮联用氯丙咪嗪治疗难治性TS疗效肯定。     

丙戊酸钠,肌苷,氟哌啶醇联合治疗难治性Tourette综合征

丙戊酸钠、肌苷、氟哌啶醇联合治疗难治性Ｔｏｕｒｅｔｅ综合征赵春玉赵宝东李洁刘向志作者单位：１２１００１锦州医学院附属第一医院神经内科（赵春玉李洁刘向志）；锦州医学院基础学院（赵宝东）我院锥体外系病专科门诊，采用丙戊酸钠、肌苷与氟哌啶醇联合治疗Ｔｏｕｒ...     

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.     

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.     

Clobazam for Treatment of Intractable Epilepsy: A Critical Assessment

Summary: Clobazam (CLB), a 1,5-benzodiazepine, is a remarkably effective add-on drug for individual patients with refractory partial epilepsy. CLB has an excellent safety record. As with all benzodiazepines used for treating epilepsy, sedation and withdrawal effects, together with the development of tolerance, limit its usefulness. Recent efforts to prevent or reverse tolerance with intermittent administration of CLB or periodic injection of a benzodiazepine antagonist, flumazenil, are encouraging and justify further investigations.     

La passion de Torquemada et le terrorisme islamique : quelques points de comparaison

This original research compares the doctrinal, psychopathological and operational standpoints of the 15th century Spanish Inquisition (Torquemada) with those of radical Islamism from 1988 to 2005 (Al-Qaeda). The following are reviewed: (a) the main texts codifying the procedure for conducting the criminal investigation of a Holy Office trial (Directorium inquisitorum); (b) the life and work of the grand inquisitor Tomás de Torquemada (1420–1498); (c) the psychopathological relations between passion (passionate psychoses, passionate idealism, paranoid personality) and fanaticism; (d) “the madmen, the enlightened and the criminals” of Islamic terrorism; (e) the cognitive and emotional motives for engagement in the jihadist radicalization of young people; (f) the common principles of monotheistic fanaticism (Inquisition, Al-Qaeda) and the particular dogmas of Islamic terrorism in our time; (g) the operating modes of the Inquisition and the Jihadist holy war. The author concludes that the rigour and seriousness of the inquisitorial judicial procedure, which was precise, individual and personalized, contrasts with the revolutionary pamphlets of Al-Qaeda, which only provide broad guidelines for the modus operandi of the fight against infidels, who are usually random victims.     

Claustration et collectionnisme : réflexions à propos d’un cas de syndrome de Diogène avec vols kleptomaniaques et vengeurs

Social withdrawal is a pathognomonic behaviour that is consistently associated with mental illnesses. Compulsive hoarding can also be interpreted as a pathological behaviour, even when it does not involve kleptomania. Diogenes syndrome (DS) was first described in 1975, and is characterized by both behaviours - social withdrawal and compulsive hoarding. Even though it is often the manifestation of a psychiatric condition, its aetiology is diverse. The most frequent ones are however: dementia, schizophrenia and mental retardation. In this study, we describe an atypical case presenting with DS. Il consists of a young man, seen in a forensic setting, who had been diagnosed with kleptomania in the past, presents with compulsive hoarding, and whose recent thefts were fuelled by revenge. Finally, to our knowledge, the way social withdrawal is viewed is seldom taken into account. We analyse its implication on social withdrawal.     

Neurological soft signs and schizophrenia: a review of current knowledge

Schizophrenia is a frequent and disabling disorder emerging during adolescence or early adulthood. The identification of underlying processes has been hampered by the complex clinical expression and the probable etiological heterogeneity. The frequency of neurological soft signs (NSS) in patients with schizophrenia and their presence early in life (during the first two years) in high risk subjects support the hypothesis that schizophrenia is a "brain disease" reflecting pre- or perinatal insults during development. The growing interest for NSS has lead to multiple studies that are often difficult to compare. The objective of this review is to summarize the current knowledge on NSS, methodological issues and the future perspectives.     

Lacan, lecteur de Minkowski : l'approche structurale

The notion of structure occupies a predominant place in the theory of Lacan. He indicates that was developed from the work of Minkowski. In fact, through his phenomeno-structural approach, Minkowski does not limit himself to purely observable phenomena, but attempts to determine the underlying structure. He refers to the comprehensive phenomenology and psychopathology, and this method provides him with clinical finesse and another means of determining a diagnosis. Thus Lacan has used this as a basis for his approach to structure to develop a theory regarding the individual. This implies that the structure of the individual is based on his relation to language. From this concept, he then develops the clinical structures of neurosis, psychosis, and perversion. These structural landmarks also have an effect on the course of treatment.