我院2006-2009年抗精神病药使用分析

目的 对我院抗精神病药物的使用数据进行分析,通过了解抗精病药在我院的使用情况,以对我院抗精神病药物的规范化管理提供合理、科学的依据.方法 对我院2006年-2009年使用的抗精神病药物的金额、用药频度及日均费用情况进行汇总和统计分析.结果 从用药金额角度分析,四年期间我院抗精神病药用药额度程上升趋势,其中非典型抗精神病药所占比例程逐年上升的趋势,而典型抗精神病药用药所占比例程下降趋势;舒必利为用药频度最高的药物;利培酮是用药金额最大的药物.结论 4年来我院抗精神药的应用与现代治疗需要的变化基本一致.     

纳洛酮合并抗精神病药治疗难治性精神分裂症临床观察

为探讨纳洛酮对难治性精神分裂症患者的治疗效果，对３２例难治性患者在原来抗精神病药不变的情况下合并纳洛酮肌注，进行２周自身对照研究，结果显示，以ＢＰＲＳ和ＰＡＮＳＳ评定临床有效率分别为３０％和２６．７％，对ＢＰＲＳ中幻听，关心身体健康症状的临床有效率分别为７３．３％和４０％，除２例因出现高血压而中断治疗外，未见其它严重副反应，揭示纳洛酮对难治性精神分裂症，尤其是伴有幻听症状者，有较好的治疗效果。     

中日门诊精神分裂症病人的抗精神病药物使用

精神分裂症是一种常见的重性精神病.抗精神病药是最重要的治疗方法,不同抗精神病药的疗效、副作用存在差异,不同地区[1-2]与国家[3-4]的抗精神病药的处方模式广泛受到重视.本文针对中日两国门诊精神分裂症病人抗精神病药处方的比较分析,并做进一步的探讨.     

所谓“被精神病”

<正>刘教授的文章说,所谓被精神病,是指把正常人错误诊断为精神病,被送入精神病院,进行强制治疗。这一说法可以讨论。其实,被精神病在我看来并不限于正常人,也包括神经症病人、人格障碍者等,一句话,非精神病病人     

典型与非典型抗精神病药对首发精神分裂症患者脑电图的影响

目的:观察典型与非典型抗精神病药对首发精神分裂症患者脑电图的影响。方法:采用双盲随机对照研究,161例首发精神分裂症患者随机入组,典型组82例,非典型组79例,对典型与非典型抗精神病药于初始剂量25mg治疗后1-2天进行脑电图描记。结果:非典型抗精神病药氯氮平引起的脑电改变主要是慢波增多,典型抗精神病药氯丙嗪引起的脑电改变主要是α波失律。结论:非典型抗精神病药氯氮平与典型抗精神病药氯丙嗪对首发精神分裂症患者脑电图的影响方式和作用强度是不同的,氯氮平的影响大于氯丙嗪。     

抗精神病药所致静坐不能调查分析

目的 探讨静坐不能有发生率及其与住院时间、年龄和药物剂量的关系。方法 采用Simpson氏锥体外系反应量表对120例住院病人进行评定。结果 静坐不能的发生率为15.8%,各种抗精神病药物中以氯丙嗪为最高（27.5%）,出现静坐不能的患者中有63%发生于服药2周内,年龄与静坐不能的发生无明显关系。抗精神病药物剂量越大。静坐不能的发生率越高。结论 用氯丙嗪治疗或抗精神病药物剂量较大的病人在用药2周内易发生静坐不能,必须加强观察。     

抗精神病药物合并使用盐酸苯海索的调查分析

盐酸苯海索是精神科常用于减轻抗精神病药物所致锥外系症状的药物。目前精神科临床应用中存在预防性应用，长期事并使用，甚至滥用的情况。本文调查分析了抗精神病药物合并使用苯海索的情况，讨论苯海索长期合并使用中的不良后果，提出了避免苯海索预防性使用和长期合并合作，同时注意迟发性运动障碍发生。     

非典型抗精神病药对首发精神分裂症患者记忆功能的影响

目的:探讨奥氮平、利培酮和阿立哌唑三种非典型抗精神病药对首发精神分裂症患者认知功能的影响。方法:91例首发精神分裂症患者通过多中心随机分配,奥氮平组(n=27)、利培酮组(n=37)和阿立哌唑组(n=27),在治疗前和12周后完成如下测评:阳性与阴性症状量表(Positive and Negative Syndrome Scale,PANSS)、韦氏记忆量表-第三版(Wechsler Memory Scale,WMS-Ⅲ)的空间广度测验、霍普金斯词汇学习测验-修订版(Hopkins Verbal Learning Test-Revised,HVLT-R)。结果:①治疗12周后,三组PANSS评分均较治疗前显著降低(P<0.001),三组间PANSS减分率的差异无统计学显著性。②空间广度方面,阿立哌唑组治疗后的顺行得分和总分(8.48±2.26,15.59±3.61)较治疗前(7.52±1.72,14.11±3.63)显著增加(P<0.05),奥氮平组和利培酮组前后比较差异均无统计学显著性(P>0.05)。③HVLT-R得分方面,奥氮平组和利培酮组治疗后即刻回忆数、回忆总数和再认得分较治疗前显著增加(P<0.05～0.01),阿立哌唑组治疗后HVLT-R的所有得分均较治疗前显著增加(P<0.05～0.01),三组患者即刻回忆数、回忆总数和再认的改善值比较差异均无统计学显著性(P>0.05)。结论:阿立哌唑对首发精神分裂症患者记忆功能的改善在一定程度上优于奥氮平和利培酮。     

经典与非经典抗精神病药对流浪乞讨精神分裂症患者临床疗效对比

目的探讨经典与非经典抗精神病药对流浪乞讨精神分裂症患者临床疗效及安全性的影响。方法将我院救治的324例流浪乞讨精神分裂症患者随机分为研究组和对照组各162例,研究组使用各型非经典抗精神病药,对照组使用各型经典抗精神病药。两组均按常规治疗剂量用药。疗程12周,使用阳性与阴性症状量表(PANSS)和副反应量表(TESS)于治疗初,治疗2,4,6,8,12周对临床疗效及各种副反应情况进行评定。观察过程中因其它情况致脱落病例按随机原则补充新病例。结果治疗初两组PANSS无显著差异,均表现出严重精神症状,研究组自2周时开始改善(t=6.78,P<0.01),持续改善至疗程结束(t=26.59,P<0.01)。对照组自6周时出现改善(t=6.89,P<0.01),各周分值改善程度均明显差于研究组(t=6.96,13.53,14.55,21.76,24.24;P<0.01)。研究组TESS于观察各周明显优于观察组(t=7.10,15.56,10.52,18.54,20.23;P<0.01)。结论非经典抗精神病药治疗流浪乞讨精神分裂症患者的临床疗效好安全性高,明显优于经典抗精神病药。     

住院精神分裂症患者抗精神病药联合使用合理性的病例分析

目的:分析精神分裂症成年住院患者入院后抗精神病药联合使用的比例、具体联用的抗精神病药及其合理性。方法:2012年6月-2013年3月对2009年至2011年入住北京大学第六医院,符合美国精神障碍诊断和统计手册第4版(DSM-IV)诊断标准的精神分裂症成年患者171例,记录其人口学资料、所服抗精神病药、服用时间及出院情况。通过检索Pub Med,对抗精神病药的合理联用(有证据支持者)和通过查询Micromedex○R 2.0数据库,确定为重度违反该数据库(Micromedex○R 2.0为美国Thomson Healthcare按临床应用的需求制作的综述型事实数据库)的联用(可以致死和/或需要医疗干预的抗精神病药联用)对抗精神病药风险联用进行界定。而抗精神病药的不合理联用则是所有抗精神病药联用去除合理联用和风险联用者。结果:本组病例住院后接受抗精神病药联合治疗者占49.7%(85/171),其中合理联合使用占12.9%(11/85),不合理联合使用占68.2%(58/85),风险联用为18.8%(16/85)。结论:精神分裂症成年患者住院治疗期间抗精神病药联合使用常见,联用风险值得关注。     

The SNAP-25 gene may be associated with clinical response and weight gain in antipsychotic treatment of schizophrenia

The synaptosomal-associated protein of 25 kDa (SNAP-25) is an essential component of the core complex that mediates presynaptic vesicle trafficking. Thus, SNAP-25 is directly involved in the release of neurotransmitters. Quantitative alterations of SNAP-25 expression have been reported in brain regions and cerebrospinal fluid (CSF) of schizophrenics and in haloperidol treated rats. This observed altered expression may be influenced by genetic variants of SNAP-25. We hypothesized that polymorphisms of the SNAP-25 gene (sites DdeI, MnlI and TaiI in the 3'UTR) are associated with antipsychotic drug response and induced weight gain. A sample of 59 patients with prior suboptimal response to antipsychotic treatment and diagnosed with DSM-IV schizophrenia or schizoaffective disorder was examined. Patients were administered clozapine, haloperidol, olanzapine or risperidone for up to 14 weeks. Clinical response was defined as the difference between the baseline and the endpoint total scores on the Positive and Negative Syndrome Scale (PANSS). Weight was assessed at baseline and at study endpoint. ANOVA revealed that the MnlI and TaiI polymorphisms were associated with response (F[2,53] = 4.57, p = 0.01 and F[2,52] = 3.53, p = 0.03) and with weight gain (F[2,52] = 4.28, p = 0.01 and F[2,51] = 3.38, p = 0.04). When covariates were included, the MnlI polymorphism remained significantly associated with changes of PANSS scores, but not with weight gain. The DdeI polymorphism was not associated with response or weight gain. These findings suggest that SNAP-25 gene variants affect clinical response in patients with prior poor response to antipsychotics. Weight changes do not seem to be associated with polymorphism of the SNAP-25 gene, however, replication in independent samples is warranted.     

Neurocognitive effects of atypical and conventional antipsychotic drugs in schizophrenia: A naturalistic 6-month follow-up study

The present study aimed to assess the neurocognitive effects of atypical and conventional antipsychotic drugs on neurocognition under naturalistic treatment conditions. Eighty-two patients with schizophrenia underwent a comprehensive neuropsychological assessment both at baseline during inpatient treatment and 6 months after discharge from hospital (follow-up). From this sample, we selected two subgroups of patients, which had either a continuous atypical (n = 33) or conventional (n = 16) antipsychotic medication. Twenty-seven out of 40 healthy controls were also retested to control for practice effects. Both patient groups showed a moderate and significant improvement in global cognitive functioning. The repeated measurement ANOVAs revealed no differential treatment effects for all neuropsychological domains. These results remained after controlling for potential confounders between groups. Administering antipsychotic medications in an individually optimized manner seems to have the potential to improve some aspects of neurocognition in schizophrenia, regardless of the kind of antipsychotic medication.     

1 White blood cell ultrastructure before and during antipsychotic therapy in schizophrenia

The Winter Meeting of the Anatomical Society of Great Britain and Ireland was held at Royal Holloway College, Egham, from 6 to 8 January 2004. It included a symposium on ‘Functional anatomy of the human brain’. The following are abstracts of communications and posters presented at the meeting.     

Adequate antipsychotic treatment normalizes serum nerve growth factor concentrations in schizophrenia with and without cannabis or additional substance abuse

Neurotrophins such as nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) are important for the development and maintenance of neuron function. Neurodevelopment is thought to be impaired in schizophrenia, and vulnerable schizophrenic brains may be more sensitive to toxic influences. Thus, cannabis as a neurotoxin (and other substances) may be more harmful to schizophrenic brains than to non-schizophrenic brains, when used chronically. In a previous study we demonstrated an earlier disease onset and significantly higher serum NGF concentrations in drug-naïve schizophrenic patients with previous long-term cannabis abuse than in schizophrenics without cannabis abuse or cannabis abusers without schizophrenia. We therefore investigated whether this difference is still observed after treatment. Serum NGF measured in 114 treated schizophrenic patients (schizophrenia alone, n = 66; schizophrenia plus cannabis abuse, n = 42; schizophrenia plus multiple substance abuse, n = 6) no longer differed significantly among those groups and from the control groups (healthy controls, n = 51; cannabis controls, n = 24; multiple substance controls, n = 6). These results were confirmed by an additional prospective study in 28 patients suffering from schizophrenia (S) or schizophrenia with cannabis abuse (SC). Previously elevated serum NGF levels in the drug-naïve state, also differing between the groups (S: 83.44 ± 265.25 pg/ml; SC: 246.89 ± 310.24 pg/ml, S versus SC: p = 0.03) dropped to 10.72 ± 14.13 pg/ml (S) and 34.19 ± 38.96 pg/ml (SC) (S versus SC, p > 0.05), respectively, after adequate antipsychotic treatment. We thus conclude that antipsychotic treatment leads to recovery of neural integrity, as indicated by renormalized NGF values.     

Cognitive behaviour therapy in patients with schizophrenia who are not prescribed antipsychotic medication: A case series

Objectives . Cognitive behaviour therapy (CBT) as an adjunct to medication has been shown to improve symptom management in patients with schizophrenia. However, little is understood about the value of CBT for people who are not prescribed antipsychotic medication. Design . A post hoc case series design was used to examine the outcome data of three participants selected from a randomized controlled trial for CBT for schizophrenia. The participants were included if they had received CBT and were not prescribed antipsychotic medication during active treatment. Results . The three patients improved on outcome measures of psychopathology, depression, or negative symptoms, some to a clinically significant degree. Conclusions . CBT is a feasible treatment for people with schizophrenia who are not prescribed antipsychotic medication. It may be a valuable alternative to medication in treating symptoms of schizophrenia.