Nicardipine improves motor tics

Calcium channel blockers can act on dopaminergic systems, and some reports suggest that they could be useful for the treatment of several movement disorders. In order to assess the efficacy of nicardipine in tics disorders we performed a prospective open non-controlled study which included 10 previously untreated patients. Our results suggest that nicardipine could be a useful and safe treatment for tics.     

新型抗精神病药物对肝功能的影响及帕利哌酮的优势

目的探索新型抗精神病药对肝功能的影响,以及帕利哌酮与其他新型抗精神病药相比是否具有优势。方法采用病例回顾研究方法,收集2010年1月-2014年2月北京回龙观医院新入院精神分裂症患者91例,均符合《国际疾病分类(第10版)》(ICD-10)诊断标准。给予单一或联合新型抗精神病药系统治疗,于治疗前后检测血清丙氨酸转氨酶(ALT)、门冬氨酸转氨酶(AST)、谷氨酰转肽酶(GGT)、血清总胆汁酸(TBA)、总胆红素(T-BIL)、直接胆红素(D-BIL)、间接胆红素(I-BIL)、白蛋白/球蛋白(A/G)水平。结果使用新型抗精神病药物治疗后肝功能异常率为14.28%。用药后ALT、GGT、TBA水平增加,ALT、TBA异常率增加,差异有统计学意义(P0.05)。T-BIL、D-BIL、I-BIL水平下降,I-BIL异常率下降,差异有统计学意义(P0.05)。方差分析显示,帕利哌酮组、利培酮组和其他组三组间血清ALT水平差异有统计学意义(F=3.664,P=0.03),多重比较显示,帕利哌酮组分别与其他两组血清ALT水平差异有统计学意义(P0.05)。结论新型抗精神病药物对肝功能的影响主要体现在对肝细胞实质的影响。帕利哌酮与其他新型抗精神病药相比对肝脏的安全性更好。     

The management of tics

A tic is a stereotyped repetitive involuntary movement or sound, frequently preceded by premonitory sensations or urges. Most tic disorders are genetic or idiopathic in nature, possibly due to a developmental failure of inhibitory function within frontal‐subcortical circuits modulating volitional movements. Currently available oral medications can reduce the severity of tics, but rarely eliminate them. Botulinum toxin injections can be effective if there are a few particularly disabling motor tics. Deep brain stimulation has been reported to be an effective treatment for the most severe cases, but remains unproven. A comprehensive evaluation accounting for secondary causes, psychosocial factors, and comorbid neuropsychiatric conditions is essential to successful treatment of tic disorders. © 2008 Movement Disorder Society     

Use of levetiracetam to treat tics in children and adolescents with Tourette syndrome.

Some drugs currently used to treat tics in pediatric patients have drawbacks, including the risk of side effects. New therapeutic options with better safety profiles are needed. Levetiracetam is an antiepileptic drug with atypical mechanisms of action that might be beneficial for this indication. We evaluated the effects of levetiracetam on motor and vocal tics, behavior, and school performance in children and adolescents with tics and Tourette syndrome (TS). Sixty patients, < or =18 years of age, with tics and TS were enrolled in this prospective, open-label study. The initial starting dose of levetiracetam was 250 mg/day. The dosage was titrated over 3 weeks to 1,000 to 2,000 mg/day. Clinical outcomes were assessed with the Clinical Global Impression Scale, Yale Global Tic Severity Scale, and Revised Conners' Parent Rating Scale. Behavior and school performance were also recorded. All 60 patients showed improvements based on all of the scales used, and 43 patients improved with regard to behavior and school performance. Levetiracetam was generally well tolerated. Three patients discontinued treatment because of exaggeration of preexisting behavioral problems. Levetiracetam may be useful in treating tics in children and adolescents. Given its established safety profile, levetiracetam is a candidate for evaluation in a well-controlled trial.     

Insight in persons with schizophrenia: effects of switching from conventional neuroleptics to atypical antipsychotics

The primary aim of our study is to evaluate the level of insight during the switch from a classical antipsychotic drug to a atypical neuroleptic. Twenty-two schizophrenic patients were admitted to the study, 9 were male and 13 were female. Standardized questionnaire were: Scale for Assessment of Negative Symptoms (SANS), Scale for Assessment of Positive Symptoms (SAPS), Brief Psychiatric Rating Scale (BPRS) and Schedule for Assessing the three components of Insight (SAI). All patients were receiving haloperidol at time of recruitment. Eight patients were switched to clozapine, 3 to risperidone and 11 to olanzapine. The global function, measured with BPRS, increased after administration of atypical antipsychotics. The positive and negative symptoms were reduced. The level of insight was increased after the administration of the atypical antipsychotics. The cognitive effect of the atypical antipsychotics changed the level of insight and augmented the compliance.     

Atypical antipsychotic drugs: Part 1

This column on atypical antipsychotics is the first of two parts. Part I consists of a review of foundational information and a discussion on clozapine and risperidone. Part II will address olanzapine, quetiapine, and ziprasidone.     

四种非典型抗精神病药对血清催乳素和血脂的影响

目的探讨四种非典型抗精神病药对精神分裂症患者血脂和血清催乳素（PRL）的影响,以及血清PRL水平与药物疗效的关系。方法118例精神分裂症患者分为4组,分别予以喹硫平（29例）、氯氮平（30例）、奥氮平（30例）和利培酮（29例）治疗12周。于治疗前及治疗4、8及12周末予以阳性与阴性症状量表（PANSS）评定,测定血总胆固醇（TC）、甘油三脂（TG）高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、阿朴脂蛋白A—I（ApoA-1）、阿朴脂蛋白-B（Apo—B）及血清PRL浓度。结果（1）喹硫平组TG、HDL在12周末有显著升高（P〈0．05）,氯氮平组Apo—B在4、12周末有显著升高（P〈0．05）、LDL在8、12周末有显著升高（P〈0．05）,利培酮组除TG外其余血脂指标在8、12周末有显著升高（P〈0．05）,奥氮平组TG、HDL、LDL、ApoA-1、Apo—B在12周末有显著升高（P〈0．05）,TC在8与12周有显著升高（P〈0．05）。（2）利培酮组治疗8、12周后血清PRL明显升高（P〈0．01）。（3）氯氮平组和利培酮组PANSS一般病理分的减分率分别与PRL、LDL有显著相关;氯氮平组PRL与LDL有显著相关。结论利培酮、奥氮平、喹硫平和氯氮平均影响血脂代谢;氯氮平疗效与血清催乳素及LDL有关,利培酮疗效与LDL有关。     

In the Aftermath of CATIE: How Should Administrators Value Atypical Antipsychotic Medications?

The wide scale use of expensive atypical antipsychotic medications has led to a dramatic increase in the proportion of direct costs schizophrenia being allocated for medications. Although there is evidence that the atypical antipsychotic, clozapine, may lead to cost savings in patients with refractory schizophrenia the cost-effectiveness of the other atypical antipsychotics remains in question. We therefore reviewed the published, long-term randomized, prospective cost-effectiveness treatment studies that compared an atypical to a typical antipsychotic. There were serious methodological problems with all. In general, those that were based on efficacy trials showed an advantage for atypicals while those based on effectiveness studies found the opposite. It appears that to the extent that studies mimic “real world” conditions they fail to support the cost-effectiveness of the atypical antipsychotics.     

典型和非典型抗精神病药合并碳酸锂治疗双相情感障碍躁狂发作的对照研究

目的探讨典型和非典型抗精神病药物合并碳酸锂治疗双相情感障碍躁狂发作患者的疗效。方法将94例双相情感障碍躁狂发作患者分为典型抗精神病药物组（43例）和非典型抗精神病药物组（51例）,进行为期8周的疗效比较。采用Bech-Rafaelsen躁狂量表（BRMS）、临床大体印象量表（CGI）、副反应量表（TESS）以及药物依从性量表分别于入组前和入组第1、2、4、6和8周末时进行评定。结果治疗结束时,两组BRMS评分较入组时均显著减低（P〈0．01）;临床总有效率：典型抗精神病药物组83．7％,非典型抗精神病药物组82．3％;两组疗效差异无显著性。非典型药物组的不良反应较典型组少,药物依从性较典型组高。结论非典型抗精神病药物治疗双相情感障碍躁狂发作的疗效肯定,不良反应较少,安全性高,依从性好,适合临床应用。     

Aripiprazole: a new atypical antipsychotic with a different pharmacological mechanism

Aripiprazole is a new atypical antipsychotic with a mode of action that is distinct from currently available antipsychotic drugs. In phase III comparative clinical studies, aripiprazole 15–30 mg/day was at least as effective as haloperidol and risperidone in short term treatment of acute exacerbation of schizophrenia but superior to haloperidol in long term maintenance therapy. Consistent with an atypical profile, aripiprazole is effective against positive, negative and cognitive symptoms of schizophrenia and has a favourable side effect profile with the incidence of extrapyramidal symptoms (EPS) comparable to placebo. It is also devoid of side effects such as clinically significant hyperprolactinaemia, hypercholesterolaemia and cardiotoxicity, and has a low propensity for weight gain. Symptom relief is achieved without significant sedation. These clinical data suggest its usefulness in psychosocial rehabilitation, as well as in long-term prevention of schizophrenic relapse. Recent results from a multicentre, open-label study in a general psychiatric setting provide the first evidence that aripiprazole is also effective under naturalistic conditions. However, only post-marketing experience will show whether the positive results of these controlled trials can be replicated in everyday practice.     

New onset of idiopathic bilateral ear tics in an adult

Tic disorders are commonly considered to be childhood syndromes. Newly presenting tic disorders during adulthood are uncommon and mostly described in relation to an acquired brain lesion or as incidental tics, particularly in context with other neurological or psychiatric diseases. Tic disorder involving the ears is extremely uncommon with only few studies in English literature. In the present case, we describe an adult patient with new-onset idiopathic tics disorder involving both ears, causing social embarrassment. In addition, our patient had recent onset of the tics without any childhood or family history of tic disorders. The single most important component of management is an accurate diagnosis. At the same time, tics should be differentiated from other movement disorders such as chorea, stereotypy, and dystonias.     

Amisulpride-induced tardive motor and phonic tics

OBJECTIVE: To report a patient with tardive tics possibly induced by the atypical neuroleptic drug amisulpride. CASE REPORT: A 55-year-old woman developed motor and phonic tics after a prolonged treatment with amisulpride. Tics improved and finally disappeared after amisulpride withdrawal. CONCLUSIONS: Tardive motor and phonic tics should be considered as a possible adverse effect of amisulpride.     

非典型抗精神病药物对老年患者心脏功能的影响

目的 探讨非典型抗精神病药物对老年精神病患者心脏功能的影响.方法 对入院的33例老年精神病患者在治疗前、治疗第4,8周分别进行血清肌钙蛋白（cTn）、肌红蛋白（MB）、B型钠尿肽（BNP）、心肌酶谱（CK、CKMB、LDH、AST）及心率校正QT间期（QTc）检测,并比较治疗前后各指标变化.结果 QTc治疗前后均正常范围.LDH异常率由治疗前36.36％下降到治疗后15.15％,差异接近统计学水准（P=0.057）.其他各指标在治疗前后虽存在部分异常,但差异并无统计学意义（P＞0.05）.治疗前LDH显著高于治疗后第4,8周,差异有统计学意义（P＜0.05）,而第4,8周间LDH比较差异无统计学意义（P＞0.05）; cTn、MB、BNP、CK、CKMB、AST在治疗前后差异无统计学意义（P＞0.05）.QTc在治疗第4,8周较治疗前显著延长,差异有统计学意义（P＜0.01）,而第4周、第8周QTc比较差异无统计学意义（P＞0.05）.结论 非典型抗精神病药物在治疗初期通过控制兴奋症状有助于改善老年精神病患者部分心脏功能指标,但对QTc有延长作用.因此,临床实践中需注意心脏相关指标的监测,尤其在治疗初期.     

Obsessive-compulsive disorder with and without tics in a clinical sample of children and adolescents

The purpose of this study was to discriminate subtypes of obsessive-compulsive disorder (OCD) in a clinical sample of children and adolescents. Sixty OCD patients were assessed in two outpatient psychiatric clinics; 15 patients had a lifetime history of tics and 45 patients had no tic history. Interviews were conducted with the patients and their parents by a child psychiatrist using the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). The symptom checklist of the CY-BOCS was used to categorize obsessions and compulsions. Discriminant function analysis was used to compare the two groups in their symptomatology. There was no difference between the two groups in seven obsession categories. However, there was a significant difference between the two groups in seven compulsion categories. Ordering, hoarding, and washing compulsions were more common in those with no tic history. The results indicate that tic-related OCD may be differentiated from non-tic-related OCD early in life by the presence or absence of certain compulsive symptoms.     

Deep slow nasal respiration with tight lip closure for immediate attenuation of severe tics

BackgroundSevere intractable tics, which are associated with Tourette syndrome and chronic tic disorder (TS/CTD), severely affect the quality of life. Common less-invasive treatments are often unable to attenuate tics with deep brain stimulation currently being the only effective treatment. We aimed to assess the anti-tic effect of deep slow nasal respiration with tight lip closure using patients with TS/CTD.MethodsWe retrospectively analyzed 10 consecutive patients (9 men, 1 woman; 23–41 years old). We instructed the patients to perform the procedure for 120 s and to obtain a video recording of before and during the procedure. The videos were used to count tics and determine lip competency or incompetency. The counted tics were rated using the modified Rush Video Rating Scale.ResultsCompared with before the procedure, there were significantly lower frequencies of motor and phonic tics, as well as video scored, during the procedure. Eight patients presented with lip incompetency before the procedure and none after the procedure (P = 0.041). There were no side effects associated with the procedure.ConclusionOur findings indicate that deep slow nasal respiration with tight lip closure ameliorates tics in patients with TS/CTD. In accordance with our results, lip opening and oral breathing could be causes of tics, in addition to heritability. Therefore, this novel procedure could improve tics. Furthermore, our findings could contribute toward the development of tic treatments and elucidate their pathophysiology regarding the reward system, hypersensitivity, autonomic nerves, and nasal airway.     

降糖药联合行为干预治疗非典型抗精神病药所致代谢综合征的研究

目的 验证降糖药二甲双胍与行为干预联合治疗非典型抗精神病药所致代谢综合征的疗效.方法 将抗精神病药所致体质量增加≥10%的128例精神分裂症患者随机分为四组:二甲双胍(750 mg/d)联合行为干预组(以下简称A组,32例);二甲双胍(750 mg/d)组(以下简称B组,32例);行为干预联合安慰剂组(以下简称C组,32例);安慰剂对照组(以下简称D组,32例);治疗观察期均为12周.结果 A、B、C组患者治疗后的体质量、BMI、空腹血糖、空腹胰岛素及IRI均明显低于治疗前(P(0.05);D组患者的体质量、BMI、腰围、空腹胰岛素、IRI治疗后均明显高于治疗前(P<0.05).结论 二甲双胍与行为干预单一或联合治疗均能有效减轻非典型抗精神病药所致的代谢综合征,二甲双胍联合行为干预的疗效最好.