国产齐拉西酮与氟哌啶醇注射液治疗精神分裂症急性激越症状的对照研究

目的 评价国产齐拉西酮注射液治疗精神分裂症急性激越症状的疗效和安全性.方法 将231例精神分裂症患者随机分为齐拉西酮组(115例)和氟哌啶醇组(116例),进行多中心随机单盲对照研究.患者入组后即给予齐拉西酮注射液10～20 mg或氟哌啶醇注射液5～10 mg肌内注射,4～6 h后可重复使用.齐拉西酮每日总量不超过40 mg,氟哌啶醇每日总量不超过30 mg,每日注射均不超过3次,疗程均为3 d.于治疗前、治疗第2,6,24,48,72小时采用阳性和阴性症状量表(PANSS)、阳性和阴性症状量表兴奋因子(PANSS-EC)、治疗时需处理的不良反应量表、锥体外系副反应量表评定疗效及副反应.结果 治疗第72小时,齐拉西酮组的PANSS-EC总分明显降低,PANSS-EC减分率为(68±25)%,临床总有效率为47.8%;氟哌啶醇组PANSS-EC减分率为(65±23)%,临床总有效率为37.1%;两组的差异均无统计学意义(P均＞0.05).齐拉西酮组的不良反应发生率为37.4%,氟哌啶醇组的不良反应发生率为50.0%,两组的差异无统计学意义(P＞0.05).氟哌啶醇组锥体外系的发生率明显高于齐拉西酮组,差异有统计学意义(P＜0.05).结论 国产齐拉西酮注射液治疗精神分裂症的急性激越症状有明显疗效,不良反应少.     

齐拉西酮与氟哌啶醇注射液治疗急性精神分裂症对照研究

目的:评价齐拉西酮注射液治疗急性精神分裂症的疗效和安全性. 方法:将120例精神分裂症患者随机分为齐拉西酮组和氟哌啶醇组,进行随机单盲对照研究.疗程3 d.采用简明精神病评定量表(BPRS)、Bech-Rafaelsen躁狂量表(BRMS)、治疗中出现的症状量表(TESS)及锥体外系反应量表(RSESE)分别评定疗效和不良反应. 结果:治疗后两组BPRS及BRMS评分均显著降低,两组间减分率及显效率的差异均无统计学意义.齐拉西酮组不良反应发生率明显低于氟哌啶醇组(P＜0.01). 结论:齐拉西酮注射液对急性精神分裂症治疗效果与氟哌啶醇注射液相当,而不良反应少于氟哌啶醇.     

齐拉西酮与氟哌啶醇注射液治疗精神分裂症急性激越症状的临床对照研究

目的评价齐拉西酮与氟哌啶醇注射液治疗精神分裂症急性激越症状的临床疗效和安全性。方法采用最小不平衡指数法将94例具有急性激越症状的精神分裂症患者分为齐拉西酮组和氟哌啶醇组各47例。齐拉西酮组给予齐拉西酮注射液,起始剂量为10~20mg,根据病情需要4~6h后可重复使用,最大剂量不超过40mg/d;氟哌定醇组给予氟哌定醇注射液,起始剂量为5~10mg,4~6h后可重复使用,最大剂量不超过30mg/d。均臀大肌深部注射,疗程3天。采用阳性与阴性症状量表兴奋因子(PANSS-EC)评定疗效,采用副反应量表(TESS)评定副反应。结果齐拉西酮组与氟哌啶醇组PANSS-EC减分率差异无统计学意义[(45.29±13.84)%vs.(47.56±14.49)%,t=0.068,P0.05]。齐拉西酮组与氟哌啶醇组临床总有效率差异无统计学意义(53.19%vs.48.94%,χ2=0.072,P0.05)。齐拉西酮组与氟哌啶醇组不良反应发生率差异有统计学意义(29.8%vs.49.8%,χ2=9.035,P0.05)。结论齐拉西酮注射液治疗精神分裂症急性激越症状的效果与氟哌啶醇相当,安全性优于氟哌啶醇。     

齐拉西酮注射液与氟哌啶醇注射液治疗精神分裂症急性激越症状的对比研究

目的验证甲磺酸齐拉西酮注射液治疗精神分裂症急性激越症状的临床疗效和安全性。方法将64例具有急性激越症状的精神分裂症患者随机分为齐拉西酮组（研究组,32例）和氟哌啶醇组（对照组,32例）,进行开放式临床对照研究,患者入组后即给予臀大肌深部注射齐拉西酮注射液10mg或氟哌定醇注射液5~10mg,6~8小时后可重复使用;甲磺酸齐拉西酮和氟哌啶醇每日总量均不超过30mg,每日注射不超过3次,疗程3天。采用阳性和阴性症状量表（PANSS）、阳性与阴性症状量表兴奋因子（PANSS-EC）、临床总体印象量表（CGI）评分评价疗效;采用药物不良反应量表（TESS）、锥体外系副反应量表（SAS）评价副反应。结果治疗72小时后,齐拉西酮组和氟哌啶醇组的PANSS-EC总分均明显减低,齐拉西酮组PANSS-EC减分率为（47.79±12.94）%,氟哌啶醇组为（47.79±11.49）%,差异无统计学意义（t=0.063,P〉0.05）。齐拉西酮组临床总有效率为46.9%;氟哌啶醇组为40.6%,差异无统计学意义（χ2=0.063,P〉0.05）。齐拉西酮组不良反应发生率为28.1%,氟哌啶醇组65.6%,差异有统计学意义（χ2=9.035,P〉0.05）。结论甲磺酸齐拉西酮治疗精神分裂症的急性激越症状疗效明显,耐受性良好。     

齐拉西酮注射液治疗精神分裂症急性兴奋临床研究

目的观察齐拉西酮注射液治疗精神分裂症患者急性兴奋的疗效和安全性。方法将急性精神分裂症兴奋患者71例分为两组,治疗组36例予齐拉西酮肌内注射,对照组35例予氟哌啶醇肌内注射,患者入组后即给予齐拉西酮注射液10mg或氟哌啶醇注射液5-10mg肌内注射,4-6h后可重复使用,齐拉西酮及氟哌啶醇每日总量均不超过40mg/d,观察疗程均为3天。采用阳性和阴性症状量表（PANSS）中兴奋因子（PANSS-EC）的变化评定临床疗效,副反应量表（TESS）评定不良反应。于治疗前、治疗第2、6、24、48、72小时分别评定PANSS-EC,副反应量表（TESS）,治疗前及治疗结束时分别评定血、尿、生化常规及心电图。结果治疗72小时,齐拉西酮组的PANSS-EC总分明显降低,PANSS-EC减分率为（71±27）%,临床总有效率为52.7%;氟哌啶醇组的PANSS-EC减分率为（67±24）%,临床总有效率为45.7%,两组的差异均无统计学意义（P均〉0.05）;齐拉西酮组总的不良反应发生率41.7%,氟哌啶醇组为54.3%,两组的差异无统计学意义（P〉0.05）;齐拉西酮组的心脏不良反应发生率19.4%,氟哌啶醇组为14.3%,两组的差异无统计学意义（P〉0.05）;氟哌啶醇组的锥体外系的发生率明显高于齐拉西酮组,差异有统计学意义（P〈0.05）。结论齐拉西酮注射液治疗精神分裂症急性兴奋疗效肯定,安全性高。     

齐拉西酮合并氟哌啶醇治疗偏执型精神分裂症临床研究

目的:探讨齐拉西酮合并氟哌啶醇治疗偏执型精神分裂症的疗效及安全性. 方法:齐拉西酮合并小剂量氟哌啶醇治疗偏执型精神分裂症30例,采用阳性与阴性症状量表(PANSS)、治疗中出现的症状量表(TESS)评定疗效及不良反应,疗程6周. 结果:齐拉西酮合并小剂量氟哌啶醇治疗偏执型精神分裂症显效率86.7%,有效率96.7%,无明显锥体外系反应. 结论:齐拉西酮合并小剂量氟哌啶醇治疗偏执型精神分裂症疗效好,不良反应少.     

阿立哌唑与氟哌啶醇治疗精神分裂症对照研究

目的:比较阿立哌唑与氟哌啶醇治疗精神分裂症的疗效和不良反应。方法:将116例精神分裂症患者随机平分为阿立哌唑组和氟哌啶醇组。疗程8周。采用阳性与阴性症状量表(PANSS)及副反应量表(TESS)在治疗前及治疗1、24、、8周末分别评定疗效和不良反应。结果:两组治疗后PANSS评分均显著减少(P<0.01)。治疗8周末阿立哌唑组减分率59.7%,阳性症状减分率67.9%,阴性症状减分率52.8%,有效率69.0%;氟哌啶醇组分别为41.3%,68.3%,4.1%和58.6%。不良反应阿立哌唑组少于氟哌啶醇组。结论:阿立哌唑治疗精神分裂症阳性症状疗效与氟哌啶醇相似,治疗阴性症状和一般精神病理症状优于氟哌啶醇,不良反应少,可作为治疗精神分裂症的一线用药。     

国产齐拉西酮与氟哌啶醇注射液治疗急性躁狂发作的对照研究

目的评价国产齐拉西酮注射液治疗急性躁狂发作患者的急性激越症状的疗效和安全性。方法64例伴有激越行为的急性躁狂患者随机分成两组,齐拉西酮组和氟哌啶醇组各32例,入组后即给予齐拉西酮注射液10～20mg或氟哌啶醇注射液5～10mg肌内注射,4～6h可重复使用。齐拉西酮每日总量不超过40mg,氟哌啶醇每日总量不超过30mg,每日注射均不超过3次,疗程均为1周。于治疗前、治疗后24h、48h、72h及1周末采用PANSS的兴奋因子量表评定疗效,用不良反应症状量表（TESS）评定安全性。结果两组对兴奋激越症状均能快速起效,疗效相当,各时点两组间比较无显著性差异,两组不良反应的发生率差异无统计学意义,氟哌啶醇组锥体外系不良反应的比例明显高于齐拉西酮组,两组的差异有统计学意义（P〈0.05）。结论国产齐拉西酮注射液治疗急性躁狂发作患者的急性激越症状有明显疗效,不良反应少。     

利培酮口服液合并氯硝西泮片治疗精神分裂症急性激越的对照研究

目的:比较利培酮口服液合并氯硝西泮片与氟哌啶醇肌内注射治疗精神分裂症急性激越症状的疗效及不良反应。方法:60例精神分裂症急性激越症状患者,按1:1比例随机分入利培酮口服液(2～6mg/d)合并氯硝西泮片(2～8mg/d)组(利培酮组)或氟哌啶醇肌注(5～20mg/d)组(氟哌啶醇组)治疗,疗程7d。采用阳性和阴性症状量表(PANSS)、阳性和阴性症状量表兴奋因子(PANSS-EC)、病人合作程度评定表、修改版外显攻击行为量表(MOAS)、临床疗效总体评定量表(CGI)评定疗效,采用治疗中出现的症状量表(TESS)、静坐不能评定量表(BAS)、锥体外系副反应量表(SAS),不良事件和实验室检查评定安全性。结果:在治疗7d后,利培酮组和氟哌啶醇组PANSS-EC评分分别为(11.1,3.6)分和(12.9,5.2)分,较治疗前均明显进步(P<0.01),两组间PANSS-EC和PANSS总分差异无统计学意义(P>0.05);利培酮组在阳性因子分、MOAS、合作程度改善方面均优于氟哌啶醇组(P<0.05);肌强直、静坐不能的发生率显著低于氟哌啶醇肌注组(P<0.01)。结论:利培酮口服液合并氯硝西泮片治疗精神分裂症急性激越症状与氟哌啶醇肌内注射疗效相当,在某些方面优于氟哌啶醇肌内注射。     

氯普噻吨注射液与氟哌啶醇注射液治疗急性期精神分裂症的对照研究

目的 比较氯普噻吨注射液与氟哌啶醇注射液治疗急性期精神分裂症的疗效和副作用。方法 71例患者随机分为氯普噻吨组（n=33）及氟哌啶醇组（n=38）进行治疗,分别在治疗前及治疗后采用阳性与阴性症状量表（PANSS）,临床总体印象量表（CGI）及不良反应量表（TESS）评定其疗效及药物不良反应。结果 氯普噻吨注射液对控制急性精神分裂症的兴奋、躁动疗效与氟哌啶醇注射液相当,统计学无显著意义（P〉0．05）,但锥体外系不良反应较氟哌啶醇注射液少。结论 氯普噻吨注射液与氟哌啶醇注射液治疗急性精神分裂症的疗效相当而不良反应较少。     

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 -