我院精神药物使用现状分析

调查我院精神药物使用情况现状 ,报告如下1　临床资料调查 2 0 0 2年间我院就医患者的处方 4 370张 ,了解一般资料及所用药物资料。所用精神药物中单一用药 2 82 5例 ,占 6 4 6 % ,前 10位中依次为氯丙嗪 (2 5 0 % ) ,阿米替林(19 8% ) ,氯氮平 (16 4 % ) ,舒必利 (15 2 % ) ,奋乃静(13 1% ) ,多虑平、氟哌啶醇、碳酸锂、氟奋乃静和三氟拉嗪。联合用药 10 5 2例 ,占 2 4 1% ,其中居前 3位的是 ,氯氮平 +舒必利 ,阿米替林 +舒必利 ,氯丙嗪 +阿米替林 ,联用 3种及以上精神药物 10 5例。有 185 2例联用了苯海索 ,占 4 2 4 %。2　讨论单一…     

县精神病医院精神药物使用状况调查

调查我院精神药物使用现状,报告如下. 1 临床资料 调查2004年间我院门诊就诊患者处方5 465张.其中精神药物单一用药3 563例(65.2%),前10位依次为氯丙嗪(30%),氯氮平(18.5%),舒必利(14.1%),阿米替林(13.5%),奋乃静(13.2%)及氟哌啶醇、多塞平、碳酸锂,氟奋乃静和三氟拉嗪.联合用药1 306例(23.9%),居前3位的是氯氮平 舒必利,氯丙嗪 阿米替林,氯氮平 碳酸锂.     

无抽搐电休克治疗致窦性心动过缓者的药物使用研究

目的　研究无抽搐电休克(MECT)引起窦性心动过缓患者的药物使用情况。方法　将∧康摹⊙芯课蕹榇さ缧菘?MECT)引起窦性心动过缓患者的药物使用情况。方法　将MECT通电后出现窦性心动过缓,频率低于50次/min的患者为窦缓组,高于 50 次/min的患者为对照组,每组各22例。对两组MECT前3天用药的方式,频度,剂量进行调查和比较。结果　(1)窦缓组和对照组,单一用药分别为9例(41%)和17 例(77%),联合用药分别为 13 例(59%)和 5 例(23%),差异有非常显著性(χ2 值=11.08,P <0.01)。(2)两组使用频度在前5位的药物依次为:氟哌啶醇(29%),SSRI类(22%),氯氮平(20%),氯丙嗪(18%),舒必利(16%)。(3)精神药物使用剂量:窦缓组为 150~1 750 mg/d,平均(573±483)mg/d;对照组为 50~1 150 mg,平均(322±235)mg,差异有非常显著性(t =4.99,P <0.001)。结论　临床在MECT治疗前宜单一用药,小剂量维持,避免大剂量或联合用药,防止出现窦性心动过缓。     

首发首诊住院分裂症患者精神药物使用情况调查

目的 了解首发首诊住院分裂症患者精神药物的使用情况。方法 自2000年全部首次住院病例中，选择符合CCMD-2-R精神分裂样精神病标准者673例。结果 首选单一用药者587例(92．15％)，常用药物依次为氟哌啶醇占64．52％，氯氮平占14．76％，氯丙嗪占7．69％，舒必利占2．83％，其他药物的使用率均不足1％，首选联合用药者50例(7．85％)，最常见的是氯氮平联合舒必利占4．71％，合用安坦者510例(80．06％)。结论 对初治分裂症的首选用药，仍以经典抗精神病药为主，不应联合用药，必要时可舍用增效剂，氯氮平不宜做为首选用药。     

精神药物副反应及其处理

编辑 :本期综合精神药物的副反应及其处理共1 9篇稿件 ,由 1 5个单位 2 8位作者所撰写。 1　抗精神病药致意识障碍涂登峰 :报告 3 2例住院患者 ,使用抗精神病药后引起意识障碍 ,均符合 CCMD- 2 - R意识障碍的诊断标准。其中男 1 9例 ,女 1 3例 ,年龄 2 1～ 6 5岁 ,平均 (3 6± 1 1 )岁 ;使用氯氮平 2 4例 ,氯丙嗪 1 4例 ,舒必利 2例 (部分系合用病例 )。折合氯丙嗪剂量为3 0 0～ 75 0 mg/d,平均 (5 6 0± 6 2 ) mg/d。初次用药量过大 (折合氯丙嗪剂量 >6 0 0 mg/d) 1 7例 ,快速换药1 2例 ,合用抗胆碱能药或三环抗抑郁药 1 2例 ,年老体弱或…     

并用抗震颤麻痹药临床调查

我们对本院用抗震颤麻痹药物的情况进行调查 ,结果报告如下。1　对象和方法系 2 0 0 0年内在我院女病区住院的精神分裂症患者 ,符合中国精神疾病分类方案与诊断标准第 2版修订本诊断标准 ,共 112例。其中服用安坦 79例 (70 5 % ) ,年龄 2 2～ 5 0岁 ,平均 (36 0± 12 0 )岁 ;总病程 4个月～ 2 7年 ,平均 (13 6±4 3)年 ;住院 2个月～ 2 1年 ,平均 (5 1± 3 3)年。服用氯丙嗪 2 7例 ,氯氮平 5例 ,奋乃静 11例 ,氟哌啶醇 7例 ,舒必利 6例 ,氯氮平并用奋乃静 4例 ,氯氮平并用氯丙嗪 19例。安坦每日剂量为 4ｍｇ者 32例 ,6ｍｇ者 13例 ,8ｍ…     

利培酮、氯氮平和氟哌啶醇治疗精神分裂症的疗效比较结果

目的　比较利培酮、氯氮平和氟哌啶醇的疗效和不良反应。方法　将符合CCMD - 2 -R诊断标准的精神分裂症患者 ,根据入院顺序分别进入利培酮组、氯氮平组和氟哌啶醇组 ,并观察 8周。以PANSS和TESS量表评定药物的疗效和不良反应。结果　利培酮组、氯氮平组和氟哌啶醇组的PANSS量表总分、阴性分量表、一般精神病理学分量表评分均下降 ;利培酮组和氯氮平组减分较氟哌啶醇组明显 (分别P <0 0 1,P <0 0 5 ) ,TESS量表的评分也与氟哌啶醇组有显著性差异 (分别P <0 0 1,P <0 0 5 ) ;利培酮组、氯氮平组和氟哌啶醇组肝功能、心电图检查结果 ,组间差异有非常显著意义 (P <0 0 1) ;利培酮组不良反应少于氯氮平组和氟哌啶醇组。结论　利培酮、氯氮平和氟哌啶醇均具有较强的抗精神病作用 ,利培酮的安全性相对较好。     

精神药物的副反应

编辑 :本期我刊继续综合发表 1 5篇有关精神药物副反应方面的稿件 ,由 1 4个单位 2 1位作者所提供。欢迎继续来稿 ,但内容必须真实可靠 ,所报告的副反应是颇为罕见或前未有过报道的。1　氯氮平致低血压性休克战晓梅、李冬波、刘守波 :氯氮平可引起低血压性休克。患者女性 ,3 1岁 ,既往 6次住院 ,均诊断精神分裂症 ,曾口服奋乃静、氟哌啶醇、利培酮等药物。既往健康 ,无药物过敏史 ,体检正常。给予氟哌啶醇肌注 5 mg,每日 2次 ;氯氮平口服 5 0 mg,每晚 1次 ;1周后停氟哌啶醇。氯氮平逐渐加量至 3 5 0 mg/d,6周后减至 2 75 mg/d。约 5月后某日…     

氯氮平引起恶性症状群2例报告

复习国内外有关资料,单用氯氮平引起恶性症状群(NMS)的报告较少见,下面把我院所遇到2例报告如下:例1陈某,女性,33岁,因疑人迫害,自语自笑8年,神志不清,肌肉强直12小时于1990年6月18日第5次住院,诊断:(1)精神分裂症(同前4次),(2)恶性症状群?最先两次住院用过舒必利、氯丙嗪、氟哌啶醇等治疗达痊愈,第4次住院用过氯氮平(最大量300mg/日)。出院后继用氯氮平(300mg/日)维持治疗。1990年6     

氯氮平、氟哌啶醇和氯丙嗪对慢性精神分裂症患者糖、脂代谢及体质量的影响

目的 探讨氯氮平、氟哌啶醇和氯丙嗪对慢性精神分裂症患者的糖、脂代谢和体质量的影响。方法 对服用氯氮平（89例，氯氮平组），服用氟哌啶醇（87例，氟哌啶醇组）及服用氯丙嗪（83例，氯丙嗪组）治疗的慢性精神分裂症患者于治疗前后的不同时间进行血糖、胰岛素、血脂及体质量测定，并做相关因素分析。结果 氯氮平组治疗第90天和第180天空腹血糖异常（空腹血浆血糖〉7.0mmo/L）的发生率分别为8％及24％，氟哌啶醇组分别为1％和2％，氯丙嗪组分别为1％及4％。治疗第90天氯氮平组和氯丙嗪组的空腹及餐后2h血糖浓度均较治疗前升高，治疗第180天的血糖浓度高于第90天，氟哌啶醇组各时点的变化则不明显；差异均有统计学意义（P均〈0．01）。治疗第90天，氯氮平组的体质量平均高于治疗前5．5％，氯丙嗪组高于治疗前4．8％；治疗第180天两组分别高于治疗前9．1％和7．4％；氟哌啶醇组则无明显变化；三组间的差异有统计学意义（P〈0．01）。三组患者治疗第180天的胰岛素浓度均高于治疗前，差异均有统计学意义（P均〈0．01），但三组间的差异无统计学意义（P〉0．05）。氯氮平组和氯丙嗪组的胆固醇和甘油三酯浓度均高于治疗前，差异均有统计学意义（P均〈0．01），氟哌啶醇组则无明显变化。治疗第180天氯氮平组和氯丙嗪组患者血糖、胰岛素、血脂浓度与体质量均有一定相关性（r=0．23-0．39）；氯氮平组的血糖、体质量、血脂代谢还与血药浓度呈显著性相关（r=0．28-0．62），差异均有统计学意义（P〈0．05或〈0．01）。结论 氯氮平和氯丙嗪治疗影响慢性精神分裂症患者的糖、脂代谢及体质量。     

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.     

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.     

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.     

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.     

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.