帕罗西汀联合认知行为疗法治疗强迫症的临床对照研究

目的比较单用帕罗西汀与帕罗西汀联合认知行为疗法对强迫症的临床疗效。方法采用半随机法将符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)强迫症诊断标准的86例患者分为研究组和对照组各43例,两组均给予帕罗西汀治疗,研究组在此基础上给予每周1次的认知行为治疗,均观察12周。于治疗前和治疗后第4、8、12周分别采用耶鲁-布朗强迫量表(Y-BOCS)、汉密尔顿焦虑量表(HAMA)评定临床疗效,于治疗第4、8、12周采用副反应量表(TESS)评定不良反应。结果治疗4周末起两组Y-BOCS总评分均较治疗前低(P均0.01),研究组HAMA评分低于对照组(P0.01),第8周末起研究组Y-BOCS评分低于对照组(P0.05);治疗12周末,研究组强迫行为因子评分低于对照组(P0.05),且研究组总有效率高于对照组(86.05%vs.62.79%,P0.05),研究组和对照组不良反应发生率差异无统计学意义(16.28%vs.20.93%,P0.05)。结论单用帕罗西汀与帕罗西汀联合认知行为疗法均可缓解强迫障碍患者症状,但帕罗西汀联合认知行为疗法的效果优于单用帕罗西汀治疗,尤其对强迫行为的改善更为突出。     

艾司西酞普兰合并认知行为治疗在老年抑郁症治疗中的作用

目的:探讨艾司西酞普兰合并认知行为治疗在老年抑郁症治疗中的作用。方法:将72例老年抑郁症患者随机分为艾司西酞普兰合并认知行为治疗组(研究组,36例)和艾司西酞普兰组(对照组,36例),给予相应的治疗8周。分别于治疗前及治疗1、2、4、6、8周给予汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、临床疗效总评量表病情严重程度量表(CGI-SI)评分;治疗8周以HAMD减分率评价疗效;随访6及12个月观察患者服药的依从性及复发率。结果:研究组和对照组分别有34例和32例完成8周疗程。治疗前两组HAMD、HAMA、CGI-SI评分差异无统计学意义;治疗后两组各时间点HAMD、HAMA、CGI-SI评分较治疗前明显下降(P均<0.01)。治疗1～4周末研究组HAMD、HAMA、CGI-SI评分明显低于对照组(P均<0.01);6～8周两组间各量表评分及疗效比较差异无统计学意义。治疗6及12个月时研究组服药依从率显著高于对照组(χ2=4.942、7.675;P均<0.01);12个月时复发率研究组显著低于对照组(χ2=9.021,P<0.01)。结论:艾司西酞普兰合并认知行为治疗能够更快地改善老年抑郁症患者症状,提高远期服药的依从性,降低复发率。     

艾司西酞普兰合并正念认知治疗对广泛性焦虑障碍患者自尊和应对方式的影响

目的:探讨艾司西酞普兰合并正念认知治疗(MBCT)对广泛性焦虑障碍(GAD)患者自尊和应对方式的影响。方法:采用随机数字法将72例GAD患者分为研究组和对照组各36例;两组均给予艾司西酞普兰治疗,同时给予研究组MBCT;于治疗前和治疗8周后应用汉密尔顿焦虑量表(HAMA)、自尊量表(SES)和简易应对方式问卷(SCSQ)进行评定。结果:治疗后研究组HAMA评分明显低于对照组,SES评分明显高于对照组, SCSQ积极应对评分明显高于对照组,消极应对评分低于明显对照组(P均0.01)。结论:艾司西酞普兰合并MBCT能有效改善GAD患者的焦虑症状、自尊水平和应对方式。     

艾司西酞普兰治疗广泛性焦虑的疗效观察

目的探讨艾司西酞普兰治疗广泛性焦虑的疗效及安全性。方法将64例广泛性焦虑患者随机分为研究组(艾司西酞普兰组)与对照组(文拉法辛组)各32例,分别予艾司西酞普兰与文拉法新治疗,疗程均为6周。分别采用汉密尔顿焦虑量表(HAMA)、临床疗效总评量表-病情严重度(CGI-SI)、艾森贝格抗抑郁剂副反应量表(SERS)于治疗前及治疗第1,46周末进行评定。结果艾司西酞普兰组在治疗后各个时点2,,的HAMA总分、精神性症状分、躯体性症状分、CGI-SI评分均明显下降,与治疗前比较差异有统计学意义(P<0.05或P<0.01)。文拉法新组在治疗后第1周末躯体性症状分与治疗前比较差异有统计学意义(P<0.05),HAMA总分、精神性症状分、CGI-SI评分从治疗后第2周起明显下降,与治疗前比较差异有统计学意义(P均<0.01)。艾司西酞普兰组在治疗后各个时点躯体性症状分均低于对照组,两组比较差异均有统计学意义(P<0.05或P<0.01)。艾司西酞普兰组总有效率为84.28%,显效率为66.67%;与文拉法新组总有效率78.13%、显效率为53.33%比较差异均无统计学意义(P>0.05)。艾司西酞普兰组在治疗第1,周末SERS2总分与文拉法新组比较差异均有统计学意义(P<0.01)。治疗后6周末两组的SERS总分比较差异无统计学意义(P>0.05)。结论艾司西酞普兰治疗广泛性焦虑有良好疗效,起较更快,不良反应轻微。     

度洛西汀合并认知治疗对更年期女性抑郁症患者的疗效比较

目的评价度洛西汀合并认知治疗对更年期女性抑郁症患者的疗效和安全性。方法采用数字随机法将符合ICD-10诊断标准的60例更年期抑郁症患者分为研究组和对照组,各30例。研究组给予度洛西汀合并认知治疗,对照组单用度洛西汀治疗,疗程8周。采用汉密尔顿抑郁量表(HAMD),汉密尔顿焦虑量表(HAMA)评定疗效,副反应量表(TESS)评定不良反应。结果两组治疗8周后HAMD、HAMA评分与治疗前比较差异均有统计学意义(P<0.01),研究组在1、2、4、8周末HAMD、HAMA评分与对照组比较差异有统计学意义(P<0.05或0.01),减分率均高于对照组(P<0.05)。结论度洛西汀合并认知治疗对更年期女性抑郁症患者疗效优于单用度洛西汀。     

文拉法辛联合小剂量多塞平治疗躯体形式障碍的疗效观察

目的探讨文拉法辛联合小剂量多塞平治疗躯体形式障碍的疗效及安全性。方法将64例躯体形式障碍患者随机分为研究组(文拉法辛联合多塞平组)与对照组(文拉法辛组)各32例,分别予文拉法辛联合小剂量多塞平与文拉法辛治疗,疗程均为8周。临床疗效评定分别采用汉密尔顿抑郁量表(HAMD-17)、汉密尔顿焦虑量表(HAMA)、临床疗效总评量表-病情严重度(CGI-SI)及治疗时出现的症状量表(TESS)于治疗前后进行评定。结果研究组在治疗第2,4,6,8周末HAMA总分显著低于对照组,差异有统计学意义(P<0.05)。研究组在治疗第2周末精神性焦虑分低于对照组,差异有统计学意义(P<0.05)。研究组在治疗第2,4周末HAMA减分率均高于对照组,差异有统计学意义(P<0.05)。研究组在治疗第2,8周末HAMD总分显著低于对照组,差异有统计学意义(P<0.05或P<0.01)。研究组在治疗第2,8周末HAMD减分率均高于对照组,差异均有统计学意义(P均<0.01)。研究组总有效率为93.75%与对照组总有效率为87.50%比较,差异无统计学意义(P>0.05),研究组的显效率为75.00%与对照组的50.00%比较,差异有统计学意义(P<0.05)。两组的不良反应均少,在治疗第8周末两组的TESS评分比较差异无统计学意义(P>0.05)。结论文拉法辛联合小剂量多塞平治疗躯体形式障碍疗效优于单用文拉法辛,且无明显不良反应。     

度洛西汀合并认知行为治疗对躯体形式障碍患者的疗效分析

目的 评价度洛西汀合并认知行为治疗对躯体形式障碍患者的治疗效果.方法 将符合CCMD-3诊断标准的60例躯体形式障碍患者随机分为研究组和对照组,研究组给予度洛西汀合并认知行为治疗,对照组只给予度洛西汀治疗.疗程8周.应用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、SCL-90躯体化量表定期评定疗效,治疗中需处理的不良反应症状量表(TESS)评定安全性.结果 治疗8周后,研究组显效率90％,对照组显效率63％,研究组显效率高于对照组(x2=23.89,P＜0.01).治疗第4、6、8周末,研究组SCL-90躯体化因子分、HAMD评分、HAMA评分与对照组比较有显著性差异(P＜0.01).不良反应较轻,两组间比较无显著性差异(P＞0.05).结论 度洛西汀合并认知行为治疗对躯体形式障碍患者的疗效优于单独用度洛西汀治疗.     

认知行为疗法对惊恐障碍的辅助治疗作用

目的：观察文拉法辛缓释剂联合认知行为疗法对惊恐障碍的治疗效果。方法：60例惊恐障碍患者分为研究组和对照组,每组各30例。研究组给予文拉法辛缓释剂联合认知行为治疗,对照组只给予文拉法辛缓释剂治疗。观察12周。采用汉密尔顿焦虑量表（HAMA）、临床疗效总评量表-病情严重度（CGI-SI）在治疗前及治疗2、4、8和12周时评定疗效;以治疗中出现的症状量表（TESS）评定药物的不良反应。结果：两组治疗后HAMA及CGI-SI评分较治疗前均显著降低（P〈0.05或P〈0.01）,以研究组较对照组更为显著（P〈0.05或P〈0.01）。两组不良反应少而轻微。结论：文拉法辛缓释剂联合认知行为疗法治疗惊恐障碍效果优于单纯药物治疗。     

认知行为疗法加药物治疗对首发精神分裂症的疗效观察

目的探析认知行为疗法联合药物治疗对首发精神分裂症患者的疗效及生活质量的影响。方法前瞻性选取2015年1月~2016年12月期间精神科门诊和住院部收治的120例精神分裂症患者,采用随机抽签法将其分为2组,对照组给予喹硫平药物治疗并给予常规心理治疗,研究组在此基础上给予行为认知疗法,对比分析两组患者治疗效果及生存质量改善情况。结果经6月(24周)治疗后,两组患者各项评分均明显低于治疗前(P0.01),阴性症状、总分组间比较差异有显著统计学意义(P0.01);研究组HAMD、HAMA评分较治疗明显降低,PSP评分较治疗前明显增高,组内和组间比较差异有显著统计学意义(P0.05);研究组复发率18.33%明显低于对照组的43.33%(χ2=8.7919,P=0.0030)。结论认知行为疗法配合药物治疗能有效改善精神分裂症患者的精神症状,缓解抑郁、焦虑,恢复其自尊和自知力,促进生存质量的提高,同时提高患者服药依从性,预防复发,临床应用价值高。     

艾司西酞普兰联合正念认知疗法对广泛性焦虑障碍患者临床症状和生活质量的效果

目的观察艾司西酞普兰联合正念认知疗法(MBCT)对广泛性焦虑障碍患者临床症状和生活质量的效果,为广泛性焦虑障碍的治疗提供参考。方法选择72例就诊于天津市安定医院、符合《国际疾病分类(第10版)》(ICD-10)广泛性焦虑障碍诊断标准的患者,采用随机数字表法分为研究组和对照组各36例,研究组给予艾司西酞普兰联合MBCT,对照组单用艾司西酞普兰治疗,于治疗前和治疗8周后采用汉密尔顿焦虑量表(HAMA)、焦虑自评量表(SAS)和健康调查简表(SF-36)进行评定。结果治疗8周后,两组HAMA和SAS评分均较治疗前低,差异均有统计学意义(P均0. 01),研究组HAMA和SAS评分均低于对照组,差异有统计学意义(P均0. 01);治疗后研究组SF-36各因子评分及总评分均较治疗前高,差异均有统计学意义(P均0. 01),对照组SF-36除社会功能、心理健康因子外,其他各因子评分及总评分均较治疗前高,差异有统计学意义(P均0. 01),治疗后研究组SF-36各因子评分及总评分均高于对照组,差异均有统计学意义(P 0. 05或0. 01)。结论与单用艾司西酞普兰相比,艾司西酞普兰联合MBCT可能更有助于改善广泛性焦虑障碍患者的临床症状和生活质量。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of Legislation of 1933 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -