非典型抗精神病药治疗阿尔茨海默病患者伴发痴呆综合征和精神病性症状的研究进展

阿尔茨海默病是一种中枢神经系统原发性退行性疾病，其临床特征以痴呆综合征和精神病性症状痴呆综合征和精神病性症状为主，其中痴呆综合征和精神病性症状对患者及照料者有重要影响。针对痴呆综合征和精神病性症状抗精神病药物已成为阿尔茨海默病研究的一大热点，本文对非典型抗精神病药治疗痴呆综合征和精神病性症状研究进展进行综述。     

抗精神病药物致内分泌代谢疾病研究进展

抗精神病药物,特别是第2代抗精神病药物(secondgeneration antipsychotics,SGAs)自问世以来,极大地改善了抗精神病治疗的有效性和耐受性,对精神分裂症尤然。但是,随着抗精神病药物的广泛应用,SGAs对内分泌和代谢系统的影响也越来越突出,包括体重增加、血糖升高、血脂代谢异常、催乳素(PRL)水平升高等。导致体重增加和高血糖症已经在抗精神病药治疗的患者得以证实,美国食品和药品管理局(FDA)要求所有SGAs的说明书必须警示其有无诱发高血糖症、糖尿病的风险。现将近年来抗精神病药物与内分泌代谢性疾病之间的关系作一综述,旨在提高临床医师对本病的认识水平。     

综合性医院老年住院患者抗精神病药物使用状况的临床分析

目的了解综合性医院老年住院患者抗精神病药物使用情况及其对生理心理的潜在影响。方法选择2008年11月在我院老年病各科住院的、年龄≥58岁患者280例,随访2年,调查分析患者抗精神病药物的使用情况。结果共32例患者使用了抗精神病药物,年龄均≥80岁,绝大部分患者服用非经典抗精神病药物。痴呆患者占46.9%,痴呆是老年住院患者使用抗精神病药物的主要疾病。抗精神病药物的使用主要与急性谵妄或精神病性症状、焦虑抑郁、痴呆相关的精神行为症状等有关。43.8%的患者连续服用≥1年,56.3%的患者合用镇静催眠药。结论痴呆、谵妄、焦虑抑郁症状是综合性医院老年住院患者应用抗精神病药物的重要因素,其联合用药多,需警惕非经典抗精神病药对老年人的不良影响。     

情感护理疗法对有阴性症状精神分裂症患者的治疗作用

抗精神病药物对控制精神分裂症患者精神症状、缓解病情起重要作用。但是，对有情感淡漠、思维贫乏、意志缺乏、行为懒散、退缩等阴性症状为主的精神分裂症患者，单纯抗精神病药物治疗作用甚微。为此，笔者对34例精神分裂症患者尝试情感护理疗法，收到了明显的效果。现报告如下。     

动态心电图在抗精神病药物治疗上的应用价值

应用抗精神病药物会使心电图表现异常,其导致患者猝死的报道也屡见不鲜[1-2]。由于抗精神病药物服用时间较长,常规心电图已不能很好地满足临床监测需求,而动态心电图在临床上已较为普及,本文对服用抗精神病药物患者的心电图和动态心电图检查结果进行分析,现报道如下。     

抗精神病药物不加重阿尔茨海默病患者认知功能下降

与以往的研究结果相反，英国学者最近的研究结果显示，抗精神病药物确实不促进阿尔茨海默病患者的认知功能下降。尽管如此，医师在给阿尔茨海默病患者处方抗精神病药时还应谨慎。     

纳洛酮抢救抗精神病药物急性中毒昏迷催醒疗效观察

目的探讨纳洛酮救治抗精神病药物急性中毒昏迷的疗效。方法回顾性对照研究抗精神病药物急性中毒昏迷患者使用纳洛酮治疗的催醒疗效,纳洛酮治疗组38例,常规治疗 纳洛酮静注.对照组36例,仅常规治疗。按GCS评分又将两组昏迷患者分为轻型、中型和重型。结果纳洛酮治疗组在轻、中、重各型的昏迷时间与对照组的比较,差异有统计学意义(P<0.01)。结论纳洛酮抢救抗精神病药物急性中毒昏迷催醒的疗效显著,安全性好。     

急性心肌梗死患者并发精神症状临床分析（附7例报告）

目的：探讨急性心肌梗死（AMI）并发精神症状的原因和治疗方法。方法：回顾分析7例AMI并发精神症状患者的临床资料、诊断和治疗方法。结果：所有患者均给以规范的冠心病二级预防治疗。病例1、3给以心境稳定剂,心理疏导、亲人安慰关怀,症状很快缓解;病例4转脑外科治疗;病例5予以小剂量镇静剂联合心理辅导;病例2、6、7给以小剂量抗精神病药物治疗。所有患者出院前均恢复正常。出院后1,3,6月随访患者无精神症状发生。结论：急性心肌梗死并发精神症状在常规冠心病治疗基础上给予心理治疗及抗精神病药物治疗预后良好。     

4种非典型抗精神病药物对精神分裂症患者心电图的影响

非典型抗精神病药物对精神分裂症的阴、阳性症状均有效，且副作用少，目前在国内外使用较多的是奥氮平、利培酮、奎硫平及氯氮平。2006年1～12月，我们观察了上述药物对精神分裂症患者心电图的影响，现报告如下。     

抗组胺药物防治哮喘的研究进展

组胺是与哮喘发作有关的重要炎症介质，但传统的抗组胺药物在哮喘防治中的作用不大。第二代抗组胺药物对H1受体有高选择性、副作用少，而且具有抗炎作用，促使人们重认识抗组胺药物在防治哮喘中的作用。     

Prevalence of antiphospholipid antibodies in psychiatric patients users and non‐users of antipsychotics

Past reports have suggested that antiphospholipid (aPL) antibodies may emerge as a response to antipsychotics treatment, as a high prevalence of aPL antibodies in antipsychotics users has been observed. However, no control group of non‐medicated psychiatric patients was included in these reports. In a cross sectional study we determined the prevalence of aPL antibodies in 333 psychiatric inpatients. We compared the proportions of positive aPL antibodytests between users and non‐users of antipsychotics with adjustments for potential confounders. The proportion of antipsychotics users carrying at least one aPL antibody ranged from 10·8% to 27·0% compared with 6·8% to 27·2% in non‐users (P = 0·24, P = 0·24) depending on the method of detection of lupus anticoagulant (LA). The prevalence of LA detected by dilute Russell viper venom time or partial thromboplastin time‐LA was not different between antipsychotics users and non‐users (8·1% vs. 5·4%, P = 0·53 and 18·4% vs. 18·2%, P = 0·22), as well as the prevalence of IgM and IgG anti‐β2‐glycoprotein‐I antibodies, IgM and IgG anti‐cardiolipin antibodies(3·8% vs. 2·0%, P = 0·75, 0·0% vs. 0·0%, P = not applicable, 1·1 vs. 1·4%, P = 0·91, 2·7% vs. 3·4%, P = 0·71). In conclusion, aPL antibodies were frequently found in patients with psychiatric diseases and no significant increase in the prevalence of aPL antibodies was observed in antipsychotics users.     

Psychiatric medication-induced obesity: treatment options

A majority of psychiatric medications are known to generate weight gain and ultimately obesity in some patients. The authors undertook a comprehensive literature review in order to provide a better understanding of novel treatment options in regards to alleviating weight gained by use of antidepressants, antipsychotics, and mood stabilizers. There are no agents for management of this weight gain approved by the Food and Drug Administration (FDA), and existing studies on options are mainly uncontrolled, small-scale projects with limited power to produce coherent conclusions. There is a clear need for larger studies on existing options, and future psychotropics without these side-effects are currently in the pipeline.     

Psychiatric medication induced obesity: an aetiologic review

A majority of psychiatric medications are known to generate weight gain and ultimately obesity in some patients. There is much speculation about the prevalence of weight gain and the degree of weight gain during acute and longitudinal treatment, but consensus shows that weight gain is prominent. The present review looked at the aetiology and cause of weight gain associated with psychotropic use and presents hypotheses as to why patients gain weight on antipsychotics, mood stabilizers and antidepressants. It is found that most psychotropic medications induce some weight gain, and clinicians are encouraged to utilize active interventions to alleviate the weight gain in order to prevent more serious obesity related comorbidities.     

Psychiatric medication-induced obesity: a review

A majority of psychiatric medications are known to generate weight gain and ultimately obesity in some patients. There is much speculation about the prevalence of weight gain and the degree of weight gain during acute and longitudinal treatment with these agents. There is newer literature looking at the aetiology of this weight gain and the potential treatments being used to alleviate this side‐effect. We found solid evidence that weight gain is often associated with the mood stabilizers, and antipsychotics and antidepressants. Only few weight neutral or weight loss producing psychotropics are available, and weight gain, outside of an immediate side‐effect, may generate secondary side‐effects and medical comorbidity. Weight gain may cause hypertension, diabetes, osteoarthritis, sedentary lifestyle, coronary artery disease, etc. Given the likelihood of inducing weight gain with psychotropic medications and the longitudinal impact on physical health, a thorough literature review is warranted to determine the epidemiology, aetiology and treatment options of psychotropic‐induced weight gain.