情绪稳定剂和苯二氮（艹卓）类药对无抽搐电休克治疗诱导癫痫发作的影响

目的:探讨情绪稳定剂(MSs)和苯二氮艹卓类药(BZs)对无抽搐电休克治疗(MECT)诱导癫痫发作阈值、刺激电量和癫痫发作持续时间的影响.方法:347例接受MECT治疗的精神障碍患者根据用药情况分为MSs组(79例)、BZs组(87例)、合用组(118例)和对照组(63例),采用MECT从低剂量开始滴定刺激电量.记录阈...     

门诊医源性苯二氮(艹卓)类药物依赖患者65例分析

目的调查我院门诊医患治疗关系在苯二氮(艹卓)类药物依赖患者形成中的作用.方法对符合苯二氮(艹卓)类药物依赖的65例病人进行自制项目及非苯二氮(艹卓)类药物替代治疗调查.结果超安全期使用苯二氮(艹卓)类药物治疗原发病,患者可较容易从多家医院或不同医生处获得苯二氮(艹卓)类药物;随时间推移患者对治疗药物依赖的兴趣及对药物不良反应的恐惧均下降;门诊医生对患者的用药及治疗情况难以实质性控制等,促进了医源性苯二氮(艹卓)类药物依赖的产生.结论门诊较为随意的医患治疗关系有利于医源性苯二氮(艹卓)类药物依赖的形成,却不利于其治疗.控制使用苯二氮(艹卓)类药物对原发性疾病治疗的时间是避免导致医源性苯二氮(艹卓)类药物依赖形成的简单而有效的方法.     

门诊医源性苯二氮(艹卓)类药物依赖患者65例分析

目的调查我院门诊医患治疗关系在苯二氮(艹卓)类药物依赖患者形成中的作用.方法对符合苯二氮(艹卓)类药物依赖的65例病人进行自制项目及非苯二氮(艹卓)类药物替代治疗调查.结果超安全期使用苯二氮(艹卓)类药物治疗原发病,患者可较容易从多家医院或不同医生处获得苯二氮(艹卓)类药物;随时间推移患者对治疗药物依赖的兴趣及对药物不良反应的恐惧均下降;门诊医生对患者的用药及治疗情况难以实质性控制等,促进了医源性苯二氮(艹卓)类药物依赖的产生.结论门诊较为随意的医患治疗关系有利于医源性苯二氮(艹卓)类药物依赖的形成,却不利于其治疗.控制使用苯二氮(艹卓)类药物对原发性疾病治疗的时间是避免导致医源性苯二氮(艹卓)类药物依赖形成的简单而有效的方法.     

甲唑安定与抗精神病药合用治疗分裂症

尽管已证明抗精神病药物治疗精神分裂症有效,但有相当一部分患者疗效较差或无效。60年代中期已有用苯二氮(艹卓)类药物治疗精神分裂症的报告,但对其使用仍有争议。甲唑安定是一种新型苯二氮(艹卓)类药物,在生化、电生理及临床使用上与本族药物明显不同,如对治疗惊恐发作、广场恐怖和抑郁症     

美抒玉替代治疗苯二氮(艹卓)类药依赖12例报告

随着苯二氮(艹卓)类药物应用日益增多,由此引起的药物依赖也越来越严重,治疗药物依赖已成为临床工作不容忽视的一个问题.我们应用美抒玉替代治疗苯二氮(艹卓)类药物依赖12例,疗效较好,现分析报道如下.     

中学生有害使用苯二氮类药物调查

目的 :探讨中学生有害使用苯二氮 艹卓 类药物的心理社会因素。　方法 :对 10 9例有害使用苯二氮 艹卓 类药物中学生进行自编调查表及艾森克个性问卷 (EPQ)测定。　结果 :有害使用苯二氮 艹卓 类药物者在为普通学校 ,占 71.5 6 %。EPQ测定有害使用苯二氮艹卓 类药物者P分和N分偏高 ,主要原因有精神压力和同学影响。　结论 :中学生有害使用苯二氮艹卓 类药物与社会、家庭、学校多方面因素有关 ,应引起社会的重视并加以正确引导     

美抒玉替代治疗苯二氮类药依赖12例报告

随着苯二氮(艹卓)类药物应用日益增多,由此引起的药物依赖也越来越严重,治疗药物依赖已成为临床工作不容忽视的一个问题。     

苯二氮类药物治疗精神分裂症

苯二氮艹卓类药物治疗精神分裂症ＳｔｉｍｍｅｌＧＬ喻东山译李文智校常规抗精神病药物对５％～２５％的精神分裂症病人无效，对阴性症状疗效较差，还有５％～２０％的病人不能耐受，由于这些限制，人们已尝试用苯二氮艹卓类药物治疗精神病。一、治疗机制动物研究表明，γ...     

抗焦虑剂撤药症状的神经生化机制

抗焦虑剂(如乙醇、巴比妥类、苯二氮杂(艹卓))停用后常可引起撤药症状,轻者表现为焦虑、烦燥不安、感知障碍,重者表现为谵妄和抽搐发作。撤药症状的出现率及严重程度和持续时间因药物种类不同而有差别。GABA 是哺乳动物 CNS 中重要的抑制性神经递质。能够提高脑内 GABA 浓度的药物具有镇静和抗抽搐作用。现在日益证明,抗焦虑剂主要通过 GABA—苯二氮杂(艹卓)受体的复合体的机制来促进 CNS 中 GABA 的传递。突触后 GABA 受体与特殊的苯二氮杂(艹卓)     

神经症的药物治疗

近年来,在神经症的药物治疗方面已取得重大进展,目前苯二氮(艹卓)类药物是治疗焦虑最有效的一组药物,这类药物比巴比妥类安全,因为它对延髓生命中枢抑制作用较轻,因而想用来自杀是比较困难的。大剂量服用可出现生理性耐受,突然停药会发生撤药综合征,如软弱、神经质、失眠、抽搐及谵妄。出现这些症状的可能比用巴比妥类要小。     

Combined use of ECT and psychotropic drugs: Antidepressives and antipsychotics

Despite overall effectiveness of ECT and psychotropic drugs utilized separately in depressive illness and schizophrenic reactions, there are still a considerable number of patients in both diagnostical categories who are not responsive and treatment resistant. Efforts were spent in the past to combine both treatment approaches for these hard-core treatment resistant patients. This paper reviews previous investigations of the combined use of ECT and psychotropic drugs in the light of research methodology and theoretical framework behind their use. It concludes that although there is no theoretical justification, observed spectacular and long-lasting recoveries in some individual cases of chronic schizophrenia should compel the therapist to try ECT and psychotropic drug combinations. On the other hand, well designed blind controlled studies are needed to demonstrate the value of ECT and psychotropic drug combinations in obtaining faster recovery and longer remission in acute schizophrenia.It advocates the combination of ECT and antidepressives in depressive syndromes in spite of lack of controlled blind studies, merely because of recent theories which conceptualize the depression as a cholinergic dominance. ECT, which produces an instant sympathoadrenal activation, might be helpful to reverse the cholinergic predominance into the adrenergic one to be followed with tricyclic drugs which appear to be working in the same direction but suffering from a lag time before their peak therapeutic effect.     

Seizure activity and safety in combined treatment with venlafaxine and ECT: a pilot study

Some authors have described the combined use of ECT and psychotropic drugs, emphasizing possible interactions and synergisms of this combined therapy. We are unaware of reports of the concurrent use of the new antidepressant venlafaxine with ECT. The goals of our study were to assess the possible effects of venlafaxine on seizure length during ECT and the possible cardiovascular effects of this combined treatment. Nine severely ill, depressed patients were treated simultaneously with bilateral ECT and venlafaxine 150 mg/day and were compared with nine control, depressed subjects taking tricyclic antidepressants (TCA) and ECT. No patients had prolonged seizures and no spontaneous/tardive seizures outside ECT were observed. With regard to mean seizure length, no statistically significant differences were observed between the control group and the venlafaxine group. Neither significant increases in arterial blood pressure nor electrocardiographic recording abnormalities were found in venlafaxine patients when compared with the tricyclic group. Even though the small number of patients used is a significant limitation of this study, we found that combined venlafaxine and ECT appears to be safe when used in depression.     

The use of electroconvulsive therapy in the elderly: a study from the psychiatric unit of a north Indian teaching hospital

OBJECTIVES: There are very little data on elderly patients receiving electroconvulsive therapy (ECT) in India. This study was a preliminary attempt at characterizing the clinical and demographic profile of elderly subjects (>or=60 years) who received ECT in the psychiatric department of a teaching hospital in north India. METHODS: A retrospective case-note review was carried out to identify patients 60 years or older who had received ECT over an 8-year period at the Postgraduate Institute of Medical Education and Research, Chandigarh, India. Several details about their demographic and clinical profile, indications for ECT, response patterns, and adverse effects were extracted. RESULTS: Over the 8 years, 373 patients received ECT, of which 56 (15%) were 60 years or older. Complete records were available for only 50 of these patients. The majority (96%) had depression. The index depressive episode for which ECT was used was severe in 91.6% of the subjects, and 68% had not responded to adequate psychotropic treatment before ECT. Comorbid medical illnesses were present in 66% of cases and were associated with significantly higher risk of cognitive side effects. However, side effects were usually mild; there were no serious untoward events caused by ECT. About 80% to 90% showed some response to treatment. Those who had received inadequate antidepressant treatment before ECT were significantly more likely to respond to ECT. CONCLUSIONS: Elderly with depression constitute a substantial proportion of those receiving ECT in India. Use of ECT in this population seemed to be mainly restricted to those who were very severely ill and poorly responsive to medications. Electroconvulsive therapy seemed to be a safe and effective treatment in such situations. However, particular care may be required in the subgroup with comorbid physical problems that may be more vulnerable to cognitive adverse effects.     

Effects of polypharmacy on outcome in patients with schizophrenia in routine psychiatric treatment

Längle G, Steinert T, Weiser P, Schepp W, Jaeger S, Pfiffner C, Frasch K, Eschweiler GW, Messer T, Croissant D, Becker T, Kilian R. Effects of polypharmacy on outcome in patients with schizophrenia in routine psychiatric treatment. Objective: Evaluating the effects of different types of psychotropic polypharmacy on clinical outcomes and quality of life (QOL) in 374 patients with schizophrenia and schizoaffective disorder in routine care. Method: Psychotropic regimen, clinical outcomes, and QOL were assessed before discharge and after 6, 12, 18, and 24 months. Data were analyzed by mixed‐effects regression models for longitudinal data controlling for selection bias by means of propensity scores. Results: At baseline 22% of participants received antipsychotic monotherapy (APM) (quetiapine, olanzapine, or risperidone), 20% more than one antipsychotic drug, 16% received antipsychotics combined with antidepressants, 16% antipsychotics plus benzodiazepines, 11.5% had antipsychotics and mood stabilizers, and 16% psychotropic drugs from three or more subclasses. Patients receiving APM had better clinical characteristics and QOL at baseline. Patients receiving i) antipsychotics plus benzodiazepines or ii) antipsychotics plus drugs from at least two additional psychotropic drug categories improved less than patients with APM. Conclusion: Combinations of antipsychotics with other psychotropic drugs seem to be effective in special indications. Nevertheless, combinations with benzodiazepines and with compounds from multiple drug classes should be critically reviewed. It is unclear whether poorer outcomes in patients with such treatment are its result or its cause.     

Succinylcholine drug interactions during electroconvulsive therapy.

Electroconvulsive therapy (ECT) is frequently described as being almost free of absolute contraindications. However, drug interactions with succinylcholine pose potential hazards to which this paper calls attention. In addition to its neuromuscular-blocking action, succinylcholine has other acetylcholine-like effects. Drugs which inhibit cholinesterase activity or which inhibit acetylcholine release or synthesis may produce prolonged respiratory paralysis when combined with succinylcholine. The increasing longevity of the population receiving chemotherapy for physical ailments implies that greater numbers of these patients may also become candidates for ECT and therefore be at risk for adverse drug interactions with succinylcholine. Of particular importance to the psychiatrist are the various psychotropic drugs that have been reported to interact with succinylcholine. Precautions in using drug combinations and treatment of complications are described.     

半量电抽搐与全量电抽搐治疗的随机对照研究

一般认为电抽搐治疗(ＥＣＴ)治疗时过强的电刺激会造成认知功能等的损害[1],因此ＥＣＴ治疗时往往要求电量设定在恰好略高于抽搐预值的一点上。我院最新引进的美国生产的ＥＣＴ治疗机醒脉通要求的刺激电量是根据年龄设定的,刺激量一般是抽搐预值的25倍,而我们认为按其设定的半量即抽搐阈值的125倍进行ＥＣＴ治疗,在理论上是完全行得通的,为此我们将60例病人随机分成两组进行全量和半量刺激进行临床对照研究。1　资料与方法11　一般资料　将1999年3月1日至1999年8月30日接受ＥＣＴ治疗的病人按照治疗的先后顺序随机分成两组,一组为半量组,另…     

Efficacy and Safety of ECT for Behavioral and Psychological Symptoms of Dementia (BPSD): A Retrospective Chart Review

ObjectiveMuch of the functional disturbance in patients with dementia reflects the presence of noncognitive behavioral and psychological symptoms of dementia (BPSD). Agitation is among the most distressing symptoms for patients, clinicians, and caregivers. Currently no pharmacotherapy has clearly been shown to be of value for this condition. This study used a chart review method to examine the safety and efficacy of electroconvulsive therapy (ECT) for patients with dementia receiving ECT for agitation.MethodsA retrospective chart review was conducted of patients with dementia presenting with symptoms of aggression or agitation and who received ECT treatments. Aggression and agitation were measured by pre- and post-ECT Pittsburg Agitation Scale (PAS) scores. Detailed history of the use of psychotropic medications as well as other clinically relevant variables was analyzed.FindingsSixty elderly patients (45 women and 15 men, 75% female, mean age 77.5 ± 8.0 years) were included in the analysis. Most patients were treatment resistant to multiple psychotropic medications prior to ECT (mean number 6.1±1.5). The baseline PAS total was 9.3 ± 3.7 and it decreased significantly after three (2.5±2.8) and six (1.5±2.3) ECT treatments. No significant ECT-related medical complications were observed except transient confusion. A decrease in the number of psychotropics prescribed along with an increase in the GAF score was observed after the ECT treatment course.ConclusionECT was safe in this sample of patients who had co-morbid medical conditions. ECT was associated with the following observations: 1) a reduction in agitation; 2) a reduction in psychotropic polypharmacy; and 3) an improvement in global functioning level. Further research evaluating the effects of ECT in the setting of dementia is warranted.     

A study into predictors for the speed of response to electroconvulsive therapy

The efficacy of electroconvulsive therapy (ECT) has been firmly established in the treatment of depression. However, prediction of the speed of response to ECT is an issue that needs to be further explored. This study aims to examine the presence of predictors for the speed of response. In a retrospective chart review using 57 patients suffering from major depression who received ECT, the relation of several patient and ECT variables with the speed of response was explored. Response was defined as a drop of at least 35% in Hamilton rating scale of depression (HRSD) score from baseline after 3 or 4 ECT sessions. Patients received ECT with an aged-based stimulus dosage in a clinical setting. Multiple regression analysis showed that high baseline HRSD score and high seizure energy index (SEI) were significantly and independently associated with a rapid response. In a regression model, baseline HRSD score and SEI can be used to predict the speed of response to ECT. Rapid responders to ECT achieved remission significantly more often than slow responders did. SEI can be modified by the clinician. This offers the possibility to optimize ECT treatment.     

General anesthesia and long term psychotropic treatments]

Anesthesists often ask for withdrawal of psychotropic treatment a few days before surgery. Usually they do not differentiate among the various classes of psychotropic drugs. Some drugs, including MAO inhibitors and reserpine-like agents, can induce or precipitate accidents; however, this does not occur with other types of antidepressants, neuroleptics and minor tranquilizers. The authors review the psychiatric risks related to such withdrawals; these risks are to be considered. They report that in 8,210 ECT under general anesthesia (among which 5,688 were done without psychotropic withdrawal) there was no occurrence of severe accidents.     

Predictors for the efficacy of electroconvulsive therapy: chart review of a naturalistic study

BACKGROUND: Several variables have been suggested that can predict the efficacy of electro-convulsive therapy (ECT) in patients suffering from depression. The results of studies into these predictors for ECT efficacy are not consistent. METHOD: In a retrospective chart review of patients suffering from major depressive disorder and bipolar disorder according to DSM-IV criteria who have been given ECT in a psychiatric hospital in the Netherlands, predictors for ECT efficacy were explored. Information was gathered for predictors including sex, age, diagnosis, presence of psychosis, duration of index episode, medication treatment failure prior to ECT, medication during ECT course, and ECT variables. ECT was given twice weekly from November 1997 to June 2002. The 17-item Hamilton Rating Scale for Depression (HAM-D) was applied at baseline and weekly during the course. RESULTS: Seventy-three patients suffering from unipolar or bipolar depression were given ECT in the study period, with 56 patients (77%) meeting antidepressant treatment history form criteria for medication treatment failure. With remission defined as a reduction of depressive symptoms of at least 60% from baseline and a HAM-D end score of less than 8, 48 patients (65.8%) remitted. Forward stepwise logistic regression analysis selected only duration of index episode as a significant predictor for ECT efficacy. Medication treatment failure was not found to be a significant predictor. The concurrent use of psychotropic medication during ECT did not influence the efficacy. CONCLUSION: Duration of index episode was the only variable found to significantly predict the efficacy of ECT.