抗精神病药引起心电图异常临床分析

目的：探讨抗精神病药对心脏的影响。方法：自编调查表，回顾性分析我院426例服用抗精神病药的住院患者的心电图变化及影响因素。结果：426例患者中165例出现心电图异常，发生率38．7％；以ST—T异常及心率异常为多见。结论：在服用抗精神病药治疗过程中，心电图监测非常必要。     

常见抗精神病药对心电图的影响

了解抗精神病药对于心电图的影响。分析１９９１年至１９９３年住院的１０６１例病人在服用抗精神病药前后的心电图变化。心电图异常共３１７例，各种药物所致心电图异常率无明显差异。氯丙嗪剂量与心电图异常率有明显差异。异常以心肌劳损及心律失常较多。应用抗精神病药时应定期随访心电图。     

住院精神病人猝死对照研究

目的：探讨影响住院精神病患者猝死的因素及特征。方法：采用回顾性查阅病历的方法登记近十年20例猝死患者，并与同期住院的非死亡患者（20例）作对照，定量观察猝死前一个月抗精神病药的平均日剂量及不良用药方式，躯体营养状况恶化率，心电图异常率。结果：猝死患者的躯体营养状况恶化率及心电图异常率均显著高于对照组（P＜0．01或P＜0．05），抗精神病平均日剂量比较无显著性差异（P＞0．05），但不良用药方式成为诱发猝死的重要因素。结论；正确使用抗精神病药，减少对心肌的不良影响，加强躯体状况的改善，对减少猝死发生率有一定的积极意义。     

门冬氨酸钾镁治疗抗精神病药引起心电图异常的疗效观察

目的 探讨门冬氨酸钾镁对抗精神病药物引起心电图异常的疗效。方法 对60例应用抗精神病药出现心电图异常的患者随机分为治疗组（30例）和对照组（30例），治疗组应用门冬氨酸钾镁治疗，对照组应用能量合剂＋10％氯化钾治疗，并在治疗后14d、28d分别进行血清钾、镁的测定。结果 治疗组治疗后血清钾、镁都有明显升高，心电图改善的有效率与对照组比较有显著性差异。结论 门冬氨酸钾镁能有效改善抗精神病药引起的心电图异常。     

长期抗精神病药物治疗对患者糖脂代谢的影响

目的 调查长期抗精神病药物治疗对精神分裂症患者糖脂代谢的影响.方法 调查持续使用24个月或以上抗精神病药的精神分裂症患者315例,收集一般人口学资料,测查身高、体质量、血糖、血脂等指标,进行12导联心电图检查,分析糖脂代谢状况及相关因素.结果 血糖异常率14.0％,血糖异常组BMI、总病程高于血糖正常组,差异有统计学意义（t分别为-3.459,-2.369;P＜0.05）;血脂异常率49.2％,血脂异常组患者BMI和使用非典型抗精神病药的比例高于血脂正常组,差异有统计学意义（t=-2.734,x2=18.061;P＜0.01）;心电图异常率26.2％,血脂异常组患者心电图ST-T改变发生率12.4％高于血脂正常组5.6％,差异有统计学意义（x2=4.068,P＜0.05）.结论 抗精神病药长期治疗相关的糖脂代谢紊乱问题严重,并可导致心电图缺血性改变.     

舒福宁治疗抗精神病药所致心电图异常疗效观察

目的：验证中成药舒福宁治疗抗精神病药所致的心电图异常在临床上的疗效。方法选择既往心电图正常，而服用抗精神病药后有心电图改变的住院病人30例，采用治疗前后自身对照方法进行。结果舒福宁对抗精神病药所致的异常心电图确有治疗效果，治疗前后比较，有显著性差异。结论舒福宁疗效显著，作用稳定、持久、且温和、无毒副作用。     

3种非典型抗精神病药对精神分裂症患者心电图的影响

目的:探讨3种非典型抗精神病药对精神分裂症患者心电图的影响。:方法:将270例精神分裂症患者随机分成3组,分别给予利培酮、阿立哌唑和齐拉西酮治疗,于治疗前和治疗2、4、8周进行心电图检查。结果:利培酮组、阿立哌唑组和齐拉西酮组的心电图异常率分别为27.8%、26.7%和22.2%。其中利培酮组与阿立派唑组女性异常率显著高于男性(P<0.05)。心电图改变主要为T波改变、窦性心动过速、窦性心动过缓、室性期前收缩、不完全右束支传导阻滞。结论:3种非典型抗精神病药对精神分裂症患者心电图均有影响,但轻而可逆。     

抗精神病药物所致心电图异常

了解抗精神病药对于心电图的影响。分析１９９３年至１９９５年全部住院病人１１６７例在抗精神病药前后的心电图变化。心电图异常共３２８例，各种药物所致心电图异常率无明显差异。大部分病例的异常出现在２周之内。Ｔ与ＳＴ改变的发生率在〉４０岁者较〈４０岁者多。应用抗精神病药时应定期随访心电图。     

抗精神病药导致心跳呼吸骤停5例临床分析

对5例使用抗精神病药发生心跳呼吸骤停进行临床分析。结果显示：与患躯体状况、联合用药、药物剂量有关，均有心电图改变及低血钾。作认为躯体状况差，精神症状活跃的患，宜慎用抗精神病药，避免大剂量联合使用，且须定期复查心电图及电解质，密切观察病情。     

舒福宁治疗抗精神药所致心电图异常疗效观察

目的 验证中成药舒福宁治疗抗精神病药所致的心电图异常在临床上的疗效。方法 选择既往心电图正常,而服用抗精神病药后有心电图改变的住院病人３０例,采用治疗前后自身对照方法进行。结果 舒福宁对抗精神病药所致的异常心电图确有治疗效果,治疗前后比较,有显著性差异。结论 舒福宁疗效显著,作用稳定、持久、且温和、无毒副作用。     

抗精神病药致首发精神疾病QTc 间期变化的相关 因素分析

目的 调查抗精神病药致首发精神疾病QTc间期延长的影响因素.方法 对服用稳定剂量抗精神病药治疗1月的309例首发精神疾病患者进行回顾性调查,收集人口学资料、空腹血糖、血压、血脂等生化指标、心电图资料,以QTc≥440ms作为QTc间期延长的标准,分析QTc间期延长的状况及其相关因素.结果 QTc间期延长的发生率为10.6%.药物治疗组QTc间期均值大于基线期,差异有统计学意义(P<0.05);药物联合电休克治疗组以及药物联合脑电治疗组QTc间期与基线期相比,差异无统计学意义(P>0.05).单一抗精神病药治疗组QTc间期与基线期差异无统计学意义(P>0.05);而抗精神病药联用以及抗精神病药联用抗抑郁药/心境稳定剂组QTc间期均值大于基线期,差异有统计学意义(P<0.05).抗精神病药等效氯丙嗪剂量<1000mg/d组别QTc间期与基线期相比差异有统计学意义(P<0.05).抗精神病药剂量与QTc间期没有相关性.女性是QTc间期延长的风险因素(OR=3.26,95%CI=1.050~10.094),其他因素未进入回归方程.结论 首发精神疾病患者抗精神病药治疗期间QTc间期延长存在性别差异,女性发生QTc间期延长的风险是男性的3.26倍.药物联用延长的QTc间期并未达到异常值.抗精神病药剂量与QTc间期没有相关性.除了性别因素外,其他指标不是QTc间期延长的风险因素.     

参松养心胶囊对氯氮平所致难治性精神分裂症患者心电图和心肌酶改变的影响

目的：探讨参松养心胶囊对氯氮平所致难治性精神分裂症患者心电图和心肌酶改变的影响.方法对102例心电图和心肌酶正常的难治性精神分裂症患者进行研究,随机分为氯氮平联合参松养心胶囊治疗的观察组(52例)和氯氮平单独治疗的对照组(50例),分别于治疗前和治疗8周后评估阳性与阴性症状量表(PANSS)评分、检测心电图和心肌酶变化,包括肌酸激酶(CK)和肌酸激酶同工酶MB 亚型(CK－MB).结果(1)两组患者疗效和严重不良事件比较差异均无统计学意义(P ＞0．05);(2)两组患者共出现33例心电图异常,对照组21例(42．0％),观察组12例(23．1％),差异有统计学意义(P ＜0．05),其中窦性心动过速最常见,分别出现16例(32．0％)和8例(15．4％),差异有统计学意义(P ＜0．05),心电图异常的发生与疗效无相关性;(3)与治疗前相比,两组患者治疗后均出现 CK 和 CK－MB升高(P ＜0．05),且观察组低于对照组,差异均有统计学意义(P ＜0．05).结论参松养心胶囊能够减轻氯氮平所致的难治性精神分裂症患者心电图异常和心肌酶升高.     

氯丙嗪、氯氮平、利培酮对心电图的影响

目的探讨新型与传统的抗精神病药物在临床治疗中对心电图(ECG)的影响。方法对符合要求的325名入住本院的精神分裂症患者按照所服用的药物分为氯丙嗪等6组,在服药前、服药后1月、服药2月进行定期的心电图检查并进行比较。结果服药后二月ECG之间存在显著性差异;服药2月ECG的药物组间存在显著性差异,氯氮平 利培酮组的异常率最低、氯氮平组最高;单用药组与合并用药组间无统计学差异;性别与药物对ECG的影响因素较大。结论氯丙嗪、氯氮平、利培酮对ECG均有一定程度的影响,用药期间应注意加强ECG检查。     

精神疾病患者猝死前心电图分析

目的：探讨精神疾病患者猝死前心电图特征及其相关影响因素。方法：将临床诊断为心脏性猝死的49例患者作为猝死组；随机抽出同期住院的60例患者作为对照组。比较两组患者心电图特征，人口学资料以及临床特征。结果：猝死组心电图异常发生率显著高于对照组（P〈0．05），主要表现为窦性心动过速、室性期前收缩、QT间期延长、T波改变、ST段低平、U波或TU融合波、左束支传导阻滞（LBBB）。猝死组氯氮平使用率显著高于对照组（P〈0．05）。两组使用氯氮平者心电图异常率明显高于未使用氯氮平者（P〈0．05或P〈0．01）。猝死组高龄，兴奋状态，低血钾，肌酸激酶升高，心脑血管疾病的发生率均显著高于对照组（P均〈0．05）。结论：精神疾病患者猝死前大多心电图异常，多呈非特异性改变。高龄、使用氯氮平以及某些临床征象可能成为患者猝死的危险因素。     

A case of risperidone overdose in early schizophrenia: a review of potential complications.

Deliberate drug overdose is a frequent occurrence in patients with schizophrenia. Typical antipsychotic medications can be lethal at doses 5 times the recommended therapeutic range. Clozapine, an atypical antipsychotic, can be toxic at doses 4 times a moderate dose. Little is known about the lethal effects of the novel antipsychotic risperidone, despite the fact that it is now one of the most widely prescribed antipsychotics in North America. To date, only 1 death attributable to risperidone overdose has been reported. The case presented here documents adverse cardiac effects in a 28-year-old man who intentionally ingested 24 mg of risperidone--4 times the recommended dose. A potential drug interaction with fluvoxamine and the role of active metabolites are discussed.     

痴呆的行为和精神症状的药物治疗调查

目的：了解抗精神病药治疗痴呆的行为和精神症状（BPSD）的情况。方法：调查443例伴有明显的行为和精神症状、用抗精神病药治疗其行为和精神症状有效的阿尔茨海默病和血管性痴呆患者。结果：常用于治疗BPSD的抗精神病药有奋乃静、利培酮、氟哌啶醇、氯丙嗪、氯氮平、硫利达嗪、舒必利等,其起始剂量与有效剂量均较小,大多单一用药。用药剂量与年龄呈负相关。主要不良反应是锥体外系反应、便秘或排尿困难、嗜睡或步态不稳、吞咽困难等。抗精神病药不良反应发生率为16．0％,典型抗精神病药发生率（18．4％）显著高于非典型抗精神病药（9．6％）。结论：多种抗精神病药治疗BPSD均有效,治疗剂量低。非典型抗精神病药的安全性优于典型抗精神病药。     

Abnormal neurological signs at the onset of psychosis

INTRODUCTION: The objective of this investigation was to determine whether abnormal neurological signs (ANS) are present at the onset of psychosis, prior to the initiation of antipsychotic treatment, and to examine the effect of 6 weeks of antipsychotic treatment on these signs. METHODS: We examined 29 first-episode schizophrenic patients admitted at an Army Medical Center within 10 days of psychosis onset, using the Neurological Evaluation Scale and the 18-item Brief Psychiatric Rating Scale (BPRS) and compared them to controls. RESULTS: All of the subjects had neurological signs indicating problems in sensory integration, motor coordination, and sequencing of complex motor acts. No psychotic subject had fewer than two abnormal neurological signs. When compared to age and sex matched groups of normal controls and nonpsychotic psychiatric controls, the psychotic group had a significantly higher incidence of neurological signs. At baseline, the severity of neurological signs was associated with elevated BPRS total, positive, and negative symptom scores. The change in clinical symptoms was positively correlated with a change in neurological signs. DISCUSSION: These findings indicate that some neurological signs are present at the onset of psychosis, and that these signs may be altered by treatment. These abnormal neurological signs reflect an underlying brain function abnormality and may be useful in differential diagnosis, prognosis, and treatment selection.     

Clinical features of patients with obsessive-compulsive disorder showing different pharmacological responses]

BACKGROUND: Although selective serotonin reuptake inhibitors (SSRIs) are the mainstay of pharmacological treatment for obsessive-compulsive disorder (OCD), some OCD patients do not show improvement. Sometimes, the addition of a low-dose atypical antipsychotic, such as risperidone, or olanzapine, to ongoing SSRI treatment has been shown to be effective. However, there are patients who still show no response after trials with this augmentation therapy. In the present study, we examined the clinical features of OCD patients who showed different responses to pharmacological treatment. SUBJECTS AND METHOD: Fifty OCD patients were divided into three groups according to their pharmacological responses: responders to SSRI (group A: n= 25), responders to SSRI with an atypical antipsychotic (group B: n= 15), and non-responders to both SSRI and SSRI with an atypical antipsychotic (group C: n= 10). We examined the clinical features such as age, sex, age of onset, duration of illness, types of obsessive-compulsive symptoms, severity, improvement after treatment, insight into disease, depression, comorbidity, involving family members in compulsive or ritualistic behavior, and the level of social adaptation of each OCD group. RESULTS: Twenty five patients showed a good response to SSRI monotherapy, 15 showed a response to antipsychotic augmentation, and 10 were non-responders to both SSRI and SSRI with an atypical antipsychotic. Significantly lower insight levels were observed only in group B and higher depressive levels in group C. OCD patients who were refractory to SSRI monotherapy showed comorbidity at a significantly higher frequency. OCD patients in group A showed significantly greater improvement, and group B showed inferior social adaptation after treatment. There were no significant differences in age, sex, age of onset, duration of illness, severity, involving family members in compulsive or ritualistic behavior, and social adaptation before treatment in the three OCD groups. CONCLUSION: There were differences in the clinical features of OCD patients who showed different responses to pharmacological treatment. Our results suggest that OCD is clinically and biologically heterogeneous. It may be important to divide OCD patients into subgroups for future studies.     

The role of the irritative zone and of the number and distribution of calcifications in the severity of epilepsy associated with intracranial calcifications

OBJECTIVE: To determine the influence of the location of the irritative zone, and the number and the distribution of the intracranial calcifications in the severity of epilepsy associated with intracranial calcifications. METHOD: We studied 47 patients with epilepsy and intracranial calcifications, 24 with normal (Group A) and 23 with abnormal interictal EEGs (Group B), a control group (n=21) with abnormal interictal EEGs and normal CT-scans (Group C). Clinical, electroencephalographic and neuroradiological features were compared among groups. RESULTS: Temporal lobe interictal EEG abnormalities were found in 23/24 Group B patients, and in all Group C patients. Most Group B and Group C patients presented temporal lobe seizure symptomatology, whereas in most Group A patients symptomatology was rolandic (p=0.0001). Epilepsy was more severe in Group B and Group C patients than in Group A patients (p=0.0001 and p=0.0054). No relationship was found between the number of calcifications and epilepsy severity. CONCLUSION: An irritative zone at the temporal lobe is more relevant in determining the severity, symptomatology and frequency of seizures than the number and location of calcifications.     

利培酮对心电图的影响

目的研究利培酮引起心电图改变的特征及其与服药时间、剂量之间的关系,并与氯氮平引起的心电图改变作比较.方法对符合CCMD-2-R诊断标准的精神分裂症、分裂样精神障碍患者,在服药前、服药后4周、8周分别作心电图检查,记录服药剂量与心电图改变的情况,并在利培酮组与氯氮平组之间作显著性检验.结果利培酮引起的心电图改变主要为窦性心动过速、T波变化,其程度及发生率均低于氯氮平,一般不影响治疗.并且与服药天数、剂量大小有一定的关系.结论利培酮可引起心电图的改变,其程度及发生率低于氯氮平.