抗精神病药物在老年精神病患者中的合理应用情况

目的 探讨抗精神病药物在老年精神病患者中的合理应用情况.方法 对2010年及2011年恩施市两家医院的门诊和急诊＞60岁患者的电子处方进行回顾分析,统计抗焦虑及抗抑郁药物用药种类.结果 2010年门诊处方32 9434张,2011年374 875张;2年中5-羟色胺再摄取抑制剂(SSRI).具有较高的处方频率,且2011年较2010年更高;三环类抗抑郁药(TCAs)具有较低的处方频率,且2011年较2010年进一步降低.2011年4 424张SSRIs处方中28.80％联用一种及以上的药物;187张TCAs处方中65.78％联用一种及以上药物.在与SSRIs联用的药物中以镇静催眠药物频率最高,其次是脑功能激活药和钙离子拮抗药.该院2年期间帕罗西汀用量较大,超过规定剂量,其他抗焦虑及抑郁药物使用合理.结论 医生应根据患者的特点结合药物的特点和自身的经验进行综合分析和考虑,达到真正的抗精神病药物的合理应用.     

老年精神病患者使用典型与非典型抗精神病药物处方变化分析

为了观察老年精神病患者使用药物现状,分析典型药与非典型处方变化情况,本文抽取2003～2005年3年处方3500张,按照处方同种药品进行归类、统计、分析、比较每种药品每年有多少老年病人服用,及典型与非典型药归成二大类进行分析比对,观察老年精神病患者用药趋势和未来用药发展方向。     

住院精神病患者猝死11例临床分析

猝死系指直至死前24小时无死亡迹象的非预期突然死亡。1985年7月至2003年9月，我院共有11例精神病患者出现猝死。现分析如下。     

抗精神病药物对心电图的影响

目的探讨精神分裂症患者应用新型抗精神病药物及典型抗精神病药物后心电图变化的差异情况。方法600例精神分裂症患者分别使用阿立哌唑、利培酮、氯氮平、氯丙嗪治疗,分别于第一、二、三月复查心电图。结果使用新型抗精神病药物三月后患者心电图改变显著,低于使用典型抗精神病药物患者（P〈0．05）;心电图改变与性别、年龄无关,与使用药物剂量有关。结论新型抗精神病药物导致心电图异常率较典型抗精神病药物低,临床使用具有较高的安全性。     

抗精神病药物致继发性闭经88例临床分析

2002年6月～2003年12月，我们对山东省精神卫生中心使用抗精神病药物发生继发性闭经的患者进行了回顾性分析。现报告如下。     

303例住院患者精神科药物使用及日付药费情况分析

目的了解住院精神分裂症和心境障碍患者使用传统精神药物和新型精神药物及日付药费情况.方法 2005年4月25日22时对新疆精神卫生中心303例符合CCMD-3中国精神障碍分类与诊断标准(第三版)的精神分裂症和心境障碍患者用自编调查表,登记患者的姓名、性别、族别、年龄、诊断、当日使用口服精神药物的种类、剂量、合并用药情况以及药费情况.结果非典型抗精神病药和新型抗抑郁药物在临床使用占主导地位,心境障碍每日药费高于精神分裂症患者.结论精神科药物使用发生了很大变化,心境障碍中新型抗抑郁药物有取代三环类、四环类抗抑郁药的趋势.     

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。     

住院精神病患者发生危险行为因素的分析与对策

精神病患者发生危险行为(例如：外走、冲动、伤人、损物及自杀、自伤等)，危及自身及他人的生命安全，是精神科护理的重要问题。为了减少危险行为的发生，提高护理水平，我们对104例发生危险行为且造成不良后果的住院精神病患者进行了调查分析，并提出了防范措施。现报告如下。     

老年住院患者发生谵妄的研究进展

谵妄是老年患者住院期间常见而严重的综合征,对患者、家庭和社会均带来严重的影响。本文就老年住院患者发生谵妄的流行病学、危险因素、发病机制、评估标准以及预防和治疗的新进展进行综述。     

住院老年精神病患者肺炎106例临床分析

目的分析住院老年精神病患者罹患肺炎的临床特点,为临床早期诊治提供帮助。方法回顾性分析北京回龙观医院2006年—2009年在院的老年精神病患者肺炎的临床资料,总结其特点。结果患有肺炎的住院老年精神病患者42%临床表现不典型,81.1%合并有基础疾病,病死率为15.9%。结论罹患肺炎的住院老年精神病患者病情复杂,有其自身的特点,临床医师要密切观察病情,早发现、早诊治。     

Delirium in elderly general medical inpatients: a prospective study

Background: More than 49% of all US hospital days are spent caring for patients with delirium. There are few Australian data on this important condition. The aim of the study was to determine the prevalence and incidence of delirium in older medical inpatients in a metropolitan teaching hospital, the incidence of known risk factors and current practice in identifying and managing patients at risk of this condition. Methods: Patients aged 65 years or more, and admitted to a general medical unit, were eligible for study inclusion. Participants were screened with an Abbreviated Mental Test Score (AMTS) and chart review. Confusion Assessment Method was used to diagnose delirium if confusion was documented or AMTS <8. Barthel Index (BI), demographics, delirium risk factors and management were recorded. Results: Prevalent delirium was diagnosed in 19 of 104 (18%) and incident delirium in 2 of 85 (2%) participants. Pre‐existing cognitive impairment and admission AMTS <8 were strongly associated with prevalent delirium (P‐values <0.01). Age >80 years, Barthel Index ≤50, use of high‐risk medications and electrolyte disturbance were also associated with prevalent delirium. Prevalent delirium was not recognized by the treating unit in 4 of 19 cases (21%). Five of 104 (4.8%) of participants had a formal cognitive assessment on admission. One of 19 patients (5.3%) with prevalent delirium had an orientation device in their room. Conclusion: Pre‐existing cognitive impairment and admission AMTS are strong predictors of delirium. Despite this, formal cognitive assessment is not routinely carried out in elderly medical patients. Recognition of delirium may be improved by routine cognitive assessment in elderly medical patients.     

某医院2005~2014年老年住院患者死亡原因分析

目的 分析近10年老年住院患者死亡原因及变化趋势。方法 收集2005~2014年解放军总医院老年病房(包括老年心血管内科、神经内科、呼吸内科、消化内科、肿瘤内科等)≥60岁住院死亡患者1130例的疾病分类报表,其中男性1067例,女性63例,年龄(87.24±6.76)岁,按照年龄分为4组,60～69岁组32例,70～79岁组86例,80～89岁组578例,≥90岁组434例,分析不同年龄组患者死亡原因、顺位情况及变化趋势。结果 近10年老年住院患者死亡原因前三位系统疾病依次为肿瘤426例(33.7%)、呼吸系统疾病375例(33.19%)和循环系统疾病191例(16.90%),下呼吸道感染(32.12%)、肺癌(12.04%)和冠心病(9.03%)是前三位单病种疾病,肿瘤、呼吸系统疾病分别是<90岁和≥90岁患者死亡的首位原因。近5年死亡患者中>90岁组构成比显著升高(χ²＝34.70,P<0.001)。结论 肿瘤、呼吸和循环系统疾病是我院老年住院患者死亡的三大系统疾病,尤其要重视下呼吸道感染、肺癌和冠心病的综合防治。     

Psychiatric diagnosis in the elderly referred to a consultation‐liaison psychiatry service in a general geriatric hospital in Japan

Aim: Because depression is a common disorder in later life, elderly patients with delirium can be misdiagnosed as having depression. This study aimed to compare psychiatric diagnoses in the elderly made by referring doctors and psychiatrists. Method: Consecutive non‐psychiatric inpatients aged 65 years or older that were referred to a consultation‐liaison (C‐L) psychiatry service of a general hospital in Japan were enrolled. An attending psychiatrist recorded the physical and psychiatric diagnoses of the referring doctors, reason for referral, psychotropic medication and sociodemographics. The psychiatrist recorded the psychiatric diagnosis after discussion with another psychiatrist in the C‐L psychiatry service. A researcher categorized the diagnoses of the referring physicians and psychiatrists as F0 (organic brain syndrome), F1 (mainly alcoholism), F2/3 (mainly depression) and F4/5 (neurosis/insomnia) using The International Classification of Mental and Behavioural Disorders, Tenth Revision (ICD‐10). The degree of agreement between doctors' and psychiatrists' diagnoses was estimated for each F category using kappa statistics. Results: Of the 192 referred inpatients, 172 were enrolled (79 [45.9%] men; mean age 81.6 ± 7.8 years). Concordance of diagnosis between doctors and psychiatrists was achieved for F0, F1, F2/3 and F4/5, resulting in kappa statistics of 0.47, 0.27, 0.28 and 0.32, respectively. The psychiatrists in this survey diagnosed 12 cases of delirium and four cases of psychoactive substance‐use disorders in 23 cases of depression diagnosed by the referring doctors. Conclusion: The referring doctors in this survey had an insufficient level of diagnostic accuracy for psychiatric disorders. Delirium and psychoactive substance‐use disorders were often misdiagnosed as depression. Geriatr Gerontol Int 2012; 12: 304–309.     

The course of delirium in older medical inpatients

OBJECTIVES: To describe the clinical course and outcomes of delirium up to 12 months after diagnosis, the relationship between the in-hospital clinical course and post-discharge outcomes, and the role of dementia in both the clinical course and outcomes of delirium. DESIGN: Prospective cohort study. SETTING: Medical wards of a 400-bed, university-affiliated, primary acute care hospital in Montreal. PATIENTS: Cohort of 193 medical inpatients aged 65 and over with delirium diagnosed at admission or during the first week in hospital, who were discharged alive from hospital. MEASUREMENTS AND MAIN RESULTS: Study outcomes included cognitive impairment and activities of daily living (standardized, face-to-face clinical instruments at 1-, 2-, 6-, and 12-month follow-up), and mortality. Dementia, severity of illness, comorbidity, and sociodemographic variables were measured at time of diagnosis. Several measures of the in-hospital course of delirium were constructed. The mean numbers of symptoms of delirium at diagnosis and 12-month follow-up, respectively, were 4.5 and 3.5 in the subgroup of patients with dementia and 3.4 and 2.2 among those without dementia. Inattention, disorientation, and impaired memory were the most persistent symptoms in both subgroups. In multivariate analyses, pre-morbid and admission level of function, nursing home residence, and slower recovery during the initial hospitalization were associated with worse cognitive and functional outcomes but not mortality. CONCLUSIONS: Among patients with and without dementia, symptoms of delirium persist up to 12 months after diagnosis. Quicker in-hospital recovery is associated with better outcomes.     

Is the Use of Antihypertensives and Sedatives a Major Risk Factor for Colorectal Cancer?

Not much attention has been given to drug use and risk of colorectal cancer. We investigated the issue in an 18-year prospective cohort study of 5249 Copenhagen men aged 40–59 years. Potential confounders included were tobacco smoking, alcohol consumption, coffee drinking, physical activity, and social class. Colon cancer was diagnosed in 51 men, rectal cancer in 42 (all adenocarcinomas). Estimated from a Cox proportional hazards regression equation, use of antihypertensive medicine was highly significantly associated with risk of colon cancer; relative risk (95% confidence limits) was 3.5 (1.6–7.5) (p = 0.001). Frequent use of minor tranquilizers or sleeping pills was also associated with a highly significantly increased risk of colon cancer; relative risk was 3.2 (1.6–6.6) (p = 0.002). In contrast, there was no such association with rectum cancer. We suggest that use of antihypertensive medicine and use of minor tranquilizers or sleeping pills may be strong risk factors for colon cancer.     

Delirium among elderly general medical patients in a New Zealand hospital

Background: Overseas studies suggest that delirium is a common and serious health problem of hospitalized elderly. There is very little information in New Zealand. Aims: To study prospectively the frequency and effect of delirium on a cohort of elderly general medical patients. Methods: Over 2 months, 317 patients were admitted to general medical wards; 70% were aged 65 years and above. These patients were screened for delirium. Comparisons were made between the delirious and non‐delirious patients. Results: Fifty‐six of the 216 patients screened had delirium. The prevalence and incidence of delirium were 23.4 and 5.7%, respectively. Thirty‐one per cent of delirious patients had a previous history of dementia; 48% of delirious patients had multiple precipitants, most commonly infections. Delirium was associated with higher complication rates – 94 versus 39% in the non‐delirious patients – and a doubling in the length of hospital stay. Over 50% of delirious patients required increased supports on discharge with a general trend towards higher frequency of institutionalization. The presence of delirium was associated with increased use of neuroleptic medications, special nursing care, cot sides and restraints. A non‐significant trend towards increased mortality was seen in the delirious group. Conclusions: Delirium is a common health problem in elderly patients, associated with multiple adverse outcomes. This study highlighted the prognostic importance of diagnosing delirium. Recommendations included improved health professional education, development of guidelines including rational use of neuroleptic medication and measures to improve follow up for these patients.     

The prognostic significance of subsyndromal delirium in elderly medical inpatients

OBJECTIVES: To determine the prognostic significance of subsyndromal delirium (SSD) presentations. DESIGN: Cohort study. SETTING: University-affiliated primary acute care hospital. PARTICIPANTS: One hundred sixty-four elderly medical inpatients who did not meet Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R) criteria for delirium during the first week after admission were classified into three mutually exclusive groups. The first group, prevalent SSD, included those who had two or more of four core symptoms of delirium (clouding of consciousness, inattention, disorientation, perceptual disturbances) at admission. The second group, incident SSD, included those who did not meet criteria for prevalent SSD but displayed one or more new core symptoms during the week after admission. The third group had no prevalent or incident SSD. The three groups were followed up at 2, 6, and 12 months. MEASUREMENTS: Outcomes (length of stay, symptoms of delirium (Delirium index), cognitive (Mini-Mental State Examination) and functional status (instrumental activities of daily living), and mortality) were compared using univariate techniques and multivariate regression models that adjusted for age, sex, marital status, living arrangements before admission, comorbidity, clinical and physiological severity of illness, and dementia status and severity. RESULTS: Patients with prevalent SSD had longer acute care hospital stay, increased postdischarge mortality, more symptoms of delirium, and a lower cognitive and functional level at follow-up than patients with no SSD. Most of the findings for incident SSD were similar but not statistically significant. Patients with prevalent or incident SSD had risk factors for DSM-defined delirium. CONCLUSION: SSD in elderly medical inpatients appears to be a clinically important syndrome that falls on a continuum between no symptoms and DSM-defined delirium.     

奥氮平与氟哌啶醇治疗老年谵妄的随机对照研究

目的探讨非典型抗精神病药物奥氮平与传统抗精神病药物氟哌啶醇治疗老年谵妄的疗效和安全性。方法收集在我院住院的老年谵妄患者196例,随机分为奥氮平组(80例)、氟哌啶醇组(76例)和对照组(40例),3组分别治疗7 d,治疗前后用简明精神病评定量表、临床总体印象量表严重程度评定疗效,用副反应量表评定不良反应和安全性。结果奥氮平组、氟哌啶醇组和对照组治疗的显效率分别为83.75%、80.26%和27.5%,差异有统计学意义(P0.01),奥氮平与氟哌啶醇组比较,差异无统计学意义(P0.05)。奥氮平组不良反应发生率为18.75%,氟哌啶醇组为55.26%,2组比较差异有统计学意义(P0.01)。结论奥氮平治疗谵妄患者疗效与氟哌啶醇相当,但副作用少,耐受性好,且安全有效,可替代传统抗精神病药用于谵妄治疗。     

82例初治痰涂片阳性老年肺结核患者的近期临床观察

目的 探讨初治痰涂片阳性老年肺结核患者的疗效、对抗结核药物的耐受性及左氧氟沙星的有效性和安全性。方法 将82例初治痰涂片阳性老年肺结核患者按4：3分为治疗组和对照组进行6个月的临床观察（强化期2个月，巩固期4个月）。治疗组选用可乐必妥，按2HLEV／4HLE方案给药；对照组用吡嗪酰胺，按2HLEZ／4HLE给药。结果 治疗组和对照组2个月痰菌阴转率分别为72．7％和63．3％（P＞0．05），治疗6个月痰菌阴转率分别为88．6％和83．3％（P＞0．05），胸部X线病灶吸收分别为86．4％和86．7％（P＞0．05），空洞闭合率分别为30．0％和24．1％（P＞0．05），药物副反应发生率分别为25．5％和51．4％（P＜0．05）。结论 老年人肺结核治愈率较低，药物副反应发生率高，左氧氟沙星对老年人肺结核安全有效。