低血糖症状误认为精神分裂症症状1例

正1病例患者,女性,57岁。以"自语、自笑、生活懒散、疑心被窃24年"2015年5月6日入院。本次入院诊断:精神分裂症;2型糖尿病。患者24年前无明显诱因出现自言自语,无故发笑,烦躁易怒,打骂人,大喊大叫,经常把许多垃圾捡拾到家中,家人劝说不听,疑心村里人欺负自己和家人,总说村民偷了家中东西,说别人欠了她的钱等。先后服用奋乃静、利培     

综合性康复治疗对精神分裂症阴性症状的增效作用

以阴性症状为主的精神分裂症的治疗是长期困扰精神科的一个棘手问题,虽然国内在康复治疗方面作了许多工作,但多是单一的行为治疗模式,尚缺乏综合性系统性康复研究。为此,我们进行了综合性康复治疗措施的对照观察。现将结果报道如下：     

综合治疗对缓解期精神分裂症的作用

目的:比较单用抗精神病药与抗精神病药联合心理社会康复治疗,对缓解期精神分裂症患者临床症状和疾病家庭负担的疗效. 方法:137例缓解期精神分裂症患者分为综合组65例,对照组72例.综合组在药物治疗的同时给予综合干预治疗,每个月1次,共12次;对照组单用药物治疗.采用阳性与阴性症状量表(PANSS)和疾病家庭负担量表(FBS),在治疗前和治疗12个月进行临床症状和疾病家庭负担评定. 结果:治疗12个月,综合组PANSS总分、阴性症状及一般精神病理症状评分值均低于对照组(P均<0.01);综合组FBS评分中的家庭娱乐活动、家庭关系、家庭成员躯体健康及家庭成员心理健康4个维度分值及总分均低于对照组(P均<0.05). 结论:综合治疗对于缓解期精神分裂症患者的精神症状和疾病家庭负担有着积极的作用.     

精神分裂症患者对治疗依从性的相关因素分析

作者探讨了影响精神分裂症患者对治疗依从性的相关因素。现将结果报告于后。1　对象与方法1 1　对象　本组共 35 9例精神分裂症患者 ,均符合CCMD- 3精神分裂症的诊断标准 ,其中男性 185例 ,女性 174例 ;年龄 14～ 6 2岁 ,平均 (2 4± 11 5 6 )岁 ,其中年龄≤ 30岁 10 8例 ,>30岁 2 5 1例 ;已婚 193例 ,未婚 16 6例 ;初中文化以下87例 ,初中 131例 ,高中及以上 14 1例 ;家庭关系良好 14 3例(39 8% ) ,一般 135例 (37 6 % ) ,较差 81例 (2 2 6 % )。1 2　方法　采用自编有关因素调查表 ,内容包括年龄、家庭关系、服药数量、精神症状等方面…     

以精神分裂症样症状为突出表现的低血糖1例报道

患者,男,47岁,农民。因发作性精神异常15d于2009年5月13日就诊。患者就诊前15d上午约11时于田间劳作时突然停下,不与家人招呼独自回家,且衣着不整,不洗手脚,回家途中大唱京剧（具体唱词不清,患者平常从不唱京剧）;患者回家途中不走正路而行走于田间,踩坏他家禾苗而不顾,不理会他人,不听劝阻,但无谩骂和攻击行为,少语,常独自发笑,无抽搐及晕厥;患者返家后能正常进食,食量大,     

城乡精神分裂症患者的临床特征比较

为进一步加深对城乡精神分裂症的临床特征的认识，本文就此作一对照分析于后。     

精神分裂症与性有关的精神症状

与性有关的精神病性症状在精神分裂症病人中是较常见的。其出现频率有多高,以什么症状多见,与病人的性别、婚姻、诊断分型等因素存在着什么关系的报道甚少。现将我们调查的资料报告如下。     

宁心汤对难治性精神分裂症治疗的增效作用

目的：对自制中药制剂宁心汤联合齐拉西酮治疗难治性精神分裂症的疗效和安全性进行比较。方法：60例难治性精神分裂症患者随机分为研究组（宁心汤联合齐拉西酮治疗）和对照组（单用齐拉西酮治疗）,每组30例。观察12周。采用阳性和阴性症状量表（PANSS）和治疗中出现的症状量表（TESS）,在治疗前和治疗2、4、8、12周分别评定临床疗效和安全性。结果：治疗12周,研究组显效率63.3%显著高于对照组的36.7%（P〈0.05）;两组PANSS总分及各因子评分治疗后均显著下降（P均〈0.01）,以研究组降低更为显著（P〈0.05或〈0.01）。两组TESS评分比较差异均无统计学意义（P〉0.05）。结论：宁心汤对难治性精神分裂症的治疗有较好的增效作用,无明显不良反应。     

Efficacy of low glycemic index treatment in epileptic patients: a systematic review

Low glycemic index treatment (LGIT) is one of the new kinds of ketogenic diet (KD), designed to simplify the implementation of the KD. To date, several studies have attempted to determine the efficacy of LGIT in patients with epilepsy; however, their results are debatable. This study aims to retrieve all the LGIT studies to shed light on LGIT efficacy in epileptic patients. Electronic literature databases including MEDLINE/PubMed, Web of Science, Scopus, EMBASE were searched in July 2017. Interventional or observational studies exploring the efficacy of LGIT were included in the study. The National Heart, Lung, and Blood Institute quality assessment tool was used for the quality assessment of included studies. Two hundred and eighteen records were retrieved through a literature search. Following the screening process, eight studies were included. According to the ratings of the quality assessment tool, four studies were classified as good and four were categorized as fair. The result of the current study reveals that LGIT has a beneficial effect in patients with intractable epilepsy. However, more high-quality studies are required to determine the efficacy of LGIT in patients with intractable epilepsy.     

Efficacy,safety, and tolerability of the low glycemic index treatment in pediatric epilepsy

Purpose: To report the efficacy, safety, and tolerability of the low glycemic index treatment (LGIT) in pediatric epilepsy. Methods: A retrospective chart review was performed on patients initiating the LGIT at the Massachusetts General Hospital between January 2002 and June 2008. Demographic and clinical information including seizure type, baseline seizure frequency, medications, blood chemistries, side effects, and anthropometrics were collected. Initiation of the LGIT was done in an outpatient setting. Patients were educated by a dietitian to restrict foods with high glycemic index and to limit total daily carbohydrates to 40–60 g. Change in seizure frequency was assessed at 1‐, 3‐, 6‐, 9‐, and 12‐month follow‐up intervals. Results: Seventy‐six children were included in the study. Eighty‐nine percent had intractable epilepsy (≥3 antiepileptic drugs). A greater than 50% reduction from baseline seizure frequency was observed in 42%, 50%, 54%, 64%, and 66% of the population with follow‐up available at 1, 3, 6, 9, and 12 months, respectively. Increased efficacy was correlated with lower serum glucose levels at some time points, but not with β‐hydroxybutyrate (BOHB) changes or ketosis status at any time point. Only three patients reported side effects (transient lethargy). Blood urea nitrogen (BUN) was elevated in approximately one‐third of follow‐up laboratory studies. No significant changes were seen in body mass index (BMI) or BMI z‐score at any follow‐up interval. The most cited reason for treatment discontinuation was the restrictiveness of the diet, in 18 patients (24%). Conclusion: The LGIT was associated with reduced seizure frequency in a large fraction of patients, with limited side effects.     

Low glycemic index treatment for seizures in Angelman syndrome

Purpose: The low glycemic index treatment (LGIT) is a high fat, limited carbohydrate diet used in the treatment of epilepsy. The purpose of this study was to assess the efficacy and tolerability of the LGIT for the treatment of refractory seizures in pediatric patients with Angelman syndrome. Methods: A pediatric Angelman syndrome cohort with refractory epilepsy was treated with the LGIT and followed prospectively over 4 months. Parents recorded a daily seizure log for a minimum of 1 month prior to the start of treatment as well as throughout the LGIT trial. Electroencephalography (EEG) and neuropsychological assessments (Scales of Independent Behavior‐Revised and the Vineland Adaptive Behavior Scales‐2nd Edition were obtained for each subject at both baseline and 4‐month follow‐up time points. Clinical evaluations of subjects were completed by a neurologist and dietitian at the time of enrollment, as well as following both the first and fourth months of dietary therapy. At each time point, blood for laboratory chemistries was drawn and anthropometric measures were obtained. Key Findings: Six children (mean age 3.3 years, range 1.1–4.8) with genetically confirmed Angelman syndrome initiated the LGIT, and completed the trial with no significant adverse events. Cohort averages for indices of seizure severity were as follows: age of 1.6 years at seizure onset, 3 lifetime antiepileptic drugs tried (range 1–6), and baseline seizure frequency of 10.1 events/week (range: 0.4–30.9). All subjects had a decrease in seizure frequency on the LGIT, with five of six exhibiting >80% seizure frequency reduction. All posttrial EEG studies showed improvement and three of four children with epileptiform activity on his or her baseline EEG had no discharges present on follow‐up EEG. Developmental gains were noted by parents in all cases, although few of these neurocognitive gains were statistically significant on neuropsychological assessment. Significance: This is the first prospective study assessing the LGIT for epilepsy. Our results indicate that this dietary therapy is highly effective in treating Angelman syndrome–related seizures. The diet was well tolerated by subjects as evidenced by five of six subjects remaining on the LGIT after completion of the trial. Beyond the prospective trial window, all five subjects who remained on the diet had >90% seizure reduction after 1 year of LGIT therapy. Despite the small sample size in this prospective study, the results indicate a potentially higher degree of efficacy of the LGIT for the Angelman syndrome population than that observed in the general epilepsy population. Although this study is too small to make definitive recommendations, these results suggest that the LGIT is a promising treatment option for Angelman syndrome–related epilepsy.     

Low glycemic index treatment for epilepsy in tuberous sclerosis complex

Retrospective chart review of 15 patients with tuberous sclerosis complex (TSC) who initiated the low glycemic index treatment (LGIT) for epilepsy management at Massachusetts General Hospital over a five-year period. Prior to dietary therapy, this cohort (average age: 8.5 years) had tried an average of 5.8 anti-epileptic drugs with incomplete seizure control. At 6 months on the LGIT, 7/15 (47%) patients experienced >50% reduction in seizure frequency.     

High and low dose thiothixene treatment in chronic schizophrenia

Forty hospitalized treatment-resistant schizophrenics were randomly assigned to high (40 mg.) or low (10 mg.) daily oral doses of thiothixene. Differential effects were predicted on measures of CNS arousal, performance tests, clinical ratings, and perceptual-cognitive training. The high dose showed effects consistent with antipsychotic activity. The low dose showed some changes indicating activating properties. Side effects on high dose included several instances of EPS: akathisia and tremor, and transient CNS stimulation. Low dose produced persistent CNS stimulation: excitement and insomnia. The differentiation of "turbulence" from "activation" is of clinical importance. Methodological problems of sample size, lost performance and EEG data, fixed dose level, and refractory patients probably account for the paucity of statistically significant dose differences.     

Body mass index among Japanese inpatients with schizophrenia

BACKGROUND: Many studies have emphasized the high frequency of obesity in schizophrenic patients. However, the characteristics of the Body Mass Index (BMI) distribution in Japanese schizophrenic patients remain unknown, and the aim of this study was to clarify these characteristics in a Japanese schizophrenic inpatient population. METHODS: The subjects were 273 inpatients (males: 141, females: 132) with schizophrenia. The patient BMI distribution was compared with normal control data obtained from the 2003 Japanese National Health and Nutrition Survey. RESULTS: The mean patient BMI was 23.0 +/- 4.3, and the BMI showed a normal distribution. The proportion of patients who were obese, of normal weight and underweight was 30.8%, 53.1%, and 16.1%, respectively. No statistical evidence of a higher frequency of obesity was found in male patients, compared to normal controls, but a higher frequency of underweight patients and a lower frequency of normal-weight patients were apparent in most decades of age. In female schizophrenia patients, a higher prevalence of obesity occurred in patients aged 50-59 years old, compared to controls. A higher rate of underweight elderly patients and a lower rate of normal-weight patients aged 40 to more than 70 years old were also apparent. CONCLUSIONS: The results suggest that not only obesity but also weight problems related to an underweight condition occur more frequently in Japanese schizophrenic inpatients than in normal controls. The deviation of the BMI distribution in Japanese schizophrenic inpatients may have a relationship with higher mortality and sudden death in schizophrenia.     

Body mass index in persons with schizophrenia.

BACKGROUND: Schizophrenia has been associated with several health concerns and risks. Overall mortality among persons with schizophrenia has been shown to be about twice that of the general population. There is growing concern that persons with schizophrenia may also be at risk for being overweight or obese, compared with the general population. To examine this possibility, the author compared the distribution of body mass index values (BMI = kg/m2) in people with schizophrenia with that of the Canadian population as a whole. METHOD: Weights and heights were obtained for 183 patients receiving treatment in a hospital-based program for persons with schizophrenia. These BMI values were compared with the results of Statistics Canada's 1996-1997 National Population Health Survey (NPHS), which provided average BMI values for the general population. RESULTS: The average BMI in the study sample was 29.02, with the average for men being 28.49 (range 15.55 to 49.22, SD 6.25) and the average for women, 30.02 (range 19.30 to 45.71, SD 6.45). This is compared with the NPHS average BMI of 26.3 for men and 24.3 for women. The prevalence of obesity (BMI > 30) in the sample was 42.08%, 3.5 times that of the Canadian average of 12% and 2.8 times that of the 15% prevalence in Manitoba. In this sample, 26.78% had a BMI in the acceptable range, in contrast to the 48% of those in the NPHS who had a weight appropriate to their height. CONCLUSIONS: This analysis provides evidence that the BMI distribution of the sample population is different from that of the national population as represented in the NPHS data. The data indicate that patients with schizophrenia are significantly heavier than the general population.     

Association of schizophrenia with low maternal body mass index, small size at birth, and thinness during childhood

BACKGROUND: Nutritional factors in early life may contribute to the neurodevelopmental deficit in schizophrenia. This study explores the influence of maternal body size, size at birth, and childhood growth on future risk for schizophrenia. SUBJECTS AND METHODS: This population-based cohort study comprised births at Helsinki University Central Hospital in Helsinki, Finland, from 1924 to 1933. Prospective data from birth and school health records of 7086 individuals were collected and linked to the Finnish Hospital Discharge Register. RESULTS: Schizophrenia or schizoaffective disorder had been diagnosed in 114 individuals. A lower late-pregnancy maternal body mass index (BMI) increased the risk (odds ratio [OR], 1.09 per kilogram/meter(2); 95% confidence interval [CI], 1.02-1.17) for schizophrenia among the offspring. The risk of schizophrenia increased with low birth weight (OR, 1.48 per kilogram; 95% CI, 1.03-2.13), shortness at birth (OR, 1.12 per centimeter; 95% CI, 1.03-1.22), and low placental weight (OR, 1.22 per 100 g; 95% CI, 1.04-1.43). Schizophrenia cases were thinner than comparison subjects from 7 to 15 years of age. In a joint model comprising late-pregnancy maternal BMI, body size at birth, and childhood BMI, childhood BMI was an independent predictor of schizophrenia, whereas other factors exhibited attenuated effects. CONCLUSION: Indicators of intrauterine and childhood undernutrition are associated with an increased lifetime risk of schizophrenia.     

Treatment of refractory catatonic schizophrenia with low dose aripiprazole

ABSTRACT: This case report concerns a 54-year-old woman with catatonic schizophrenia, characterized by treatment resistance to pharmacotherapy with olanzapine, risperidone and flunitrazepam, and electroconvulsive therapy (ECT). In this case, olanzapine and risperidone and flunitrazepam did not improve her catatonic and psychotic symptoms, and induced extrapyramidal symptoms. The effects of ECT did not continue even for a month. However, treatment with low-dose aripiprazole dramatically improved the patient's psychotic symptoms and extrapyramidal symptoms. The mechanisms underlying the effects of low-dose aripiprazole in this case remain unclear, but unlike other antipsychotics aripiprazole is a dopamine D2 partial agonist. In this regard, our results suggest that aripiprazole has numerous advantages, especially in cases of stuporous catatonia and a defective general status such as the present case.     

小剂量利培酮对首发精神分裂症的疗效观察

目的：探索小剂量利培酮对首发精神分裂症的疗效和副反应。方法：33例患者给予小剂量利培酮（A组）,并以中等剂量的利培酮（B组,34例）和氨氮平（C组,30例）治疗进行对照。结果：A组第8周末阳性和阴性症状量表（PANSS）部分和各项目积分比疗前均显著下降（P均＜0．001）;生效时间在第2－4周,和C组相似,但比B组晚。疗程中3组间PANSS总分的减分率以及治疗后的总有效率均无显著差异。A组的不良反应症状量表（TESS）总分显著低于其它两组。结论：小剂量利醅酮对首发精神分裂症是一种有效、安全、经济、实惠的治疗方案。