首发精神分裂症患者抗精神病药物治疗与代谢相关指标变化的关系

 目的：观察奥氮平和阿立哌唑治疗前后,首发精神分裂症患者体重指数、瘦素及生长激素刺激肽的变化。方法：共99例门诊或住院的首发精神分裂症患者,随机选用奥氮平或阿立哌唑治疗,均单一用药。分别于治疗前、4周末、8周末及24周末测定体重指数,并进行瘦素和生长激素刺激肽测定,以阳性和阴性症状量表(PANSS)评定病情变化及疗效。结果：经奥氮平或阿立哌唑治疗后精神分裂症患者的血清瘦素水平均有不同程度的升高,并与体重指数呈正相关,且这种变化在治疗初期（4周末）即已显现,并持续至24周末。治疗后生长激素刺激肽与治疗后体重指数的相关性仅在阿立哌唑组观察到（r=-0.291,P<0.05）。结论：首发精神分裂症患者经奥氮平或阿立哌唑治疗,持续存在不同程度的瘦素水平升高;奥氮平组体重指数与血清瘦素水平的相关性较显著,而阿立哌唑组则与生长激素刺激肽水平的相关性较显著;阿立哌唑对体重指数的影响可能通过生长激素刺激肽的作用来实现。     

阿立哌唑对接受奥氮平治疗的精神分裂症患者血清胰岛素样生长因子的影响

目的探讨合并阿立哌唑对接受奥氮平治疗的精神分裂症患者血清胰岛素样生长因子1水平的(IGF-1)的影响及其意义。方法接受奥氮平治疗的精神分裂症患者随机分为阿立哌唑组(合并阿立哌唑10mg/d,n=30)和对照组(单一奥氮平治疗(n=30),测定治疗前及治疗后4、8周时体质量指数(BMI)、总胆固醇(TC)、甘油三酯(TG)、IGF-1水平。结果①阿立哌唑组治疗4,8周时的IGF-1均较治疗前显著增高(t=2.114,2.641;P均0.05);对照组则无显著变化;②阿立哌唑组治疗8周时BMI、TG显著下降(t=3.262,2.315;P0.01,0.05);对照组治疗4周、8周末时BMI(t=2.267,2.160;P均0.05)、TG(t=2.077,2.410;P均0.05)均较治疗前升高,TC则于8周时升高(t=2.632,P0.05);③阿立哌唑组治疗8周时的IGF-1变化值与BMI、TG变化值负相关(r=-0.474,-0.364;P均0.05)。结论合并阿立哌唑可增高接受奥氮平治疗的精神分裂症患者IGF-1水平,并可能与其降低患者体质量、血脂的作用有关。     

奥氮平与阿立哌唑治疗精神分裂症的疗效及对生活质量影响的对照研究

目的探讨奥氮平与阿立哌唑对首发精神分裂症患者的治疗疗效及生活质量的影响。方法 81例首发精神分裂症患者随机分为奥氮平组(n=41)与阿立哌唑组(n=40),分别以奥氮平与阿立哌唑治疗8周。于治疗前、治疗8周末采用阳性与阴性症状量表(PANSS)及生活质量综合评定问卷(GQOLI)评定疗效与生活质量,采用副反应量表(TESS)评定不良反应。结果两组PANSS评分治疗8周末均有显著下降(P0.05或0.01),两组间无统计学意义;GQOLI总分及各维度评分治疗前与治疗8周末比较均有显著差异(P0.01),两组间无统计学意义。结论奥氮平与阿立哌唑治疗首发精神分裂症疗效相当,均可明显提高患者的生活质量。     

阿立哌唑对奥氮平治疗精神分裂症患者胰岛素抵抗的影响

目的观察合并阿立哌唑对奥氮平治疗的精神分裂症患者胰岛素抵抗的影响。方法首发精神分裂症患者随机分为2组,研究组(n=40)在使用奥氮平治疗的同时合并阿立哌唑(10mg/d),对照组(n=40)单一使用奥氮平治疗。分别于治疗前、治疗后6周测定体质量指数(BMI)、空腹血糖(FPG)、胰岛素(INS),以稳态模型评估的胰岛素抵抗指数(HOMA-IR)评估IR。结果①治疗后研究组、对照组BMI、FPG、INS、HOMA-IR均较治疗前增高(t=2.234~5.152,P0.05或0.001);②研究组治疗前后BMI、INS、HOMA-IR的变化值显著低于对照组(分别t=2.329、2.667、3.076,P0.05或0.01);③两组BMI变化值与HOMA-IR的变化值均有显著相关性(分别r=0.339、0.423,P0.05、0.01)。结论阿立哌唑可改善奥氮平所导致精神分裂症患者的胰岛素抵抗,并可能与其对体重增加的改善作用有关。     

奥氮平对精神分裂症患者血清视黄醇结合蛋白4的影响

目的探讨奥氮平对精神分裂症患者血清视黄醇结合蛋白4(RBP4)的影响。方法首发、未经药物治疗的精神分裂症患者随机分组,分别接受奥氮平(n=34)、阿立哌唑(n=28)治疗,测定治疗前及治疗后4、8周时体质量指数(BMI)、总胆固醇(TC)、甘油三酯(TG)、RBP4水平。结果①奥氮平组治疗8周时的RBP4较治疗前显著增高(t=2.891,P0.01);阿立哌唑治疗组无显著变化;②奥氮平组治疗4、8周时的BMI(t=2.499,3.468;P0.05或0.001),治疗8周时的TC、TG均较治疗前显著升高(t=2.599,2.463;P0.05);阿立哌唑组则无显著变化;③奥氮平组治疗8周时的RBP4水平与BMI有显著的相关性(r=0.372,P0.05)。结论奥氮平治疗可显著增高精神分裂症患者血清RBP4水平。     

阿立哌唑与奥氮平治疗老年期首发精神分裂症的临床分析

目的比较阿立哌唑与奥氮平治疗老年期首发精神分裂症的疗效和安全性。方法 60例老年期精神分裂症患者随机分为阿立哌唑组和奥氮平组,分别给予阿立哌唑和奥氮平治疗。疗程8周。采用阳性和阴性症状量表(PAN SS)评定疗效,采用副反应量表(TESS)评定治疗后不良反应。结果在阴性症状方面,治疗2周后,阿立哌唑组即有明显改善(t=2.210,P0.05),且与奥氮平组相比较有统计学差异(t=2.021,P0.05),而在阳性症状方面,奥氮平组改善优于阿立哌唑组(t=2.016,P0.05),但在治疗4、6、8周后,两组总体疗效相当,但阿立哌唑组在阴性症状方面改善较奥氮平组有显著性差异(t=3.302,P0.01)。在副反应方面,阿立哌唑组副反应较少。结论阿立哌唑治疗老年期首发精神分裂症疗效好,阴性症状改善优越,安全性高,可推广使用。     

合用阿立哌唑及单用利培酮对精神分裂症体质量的影响

目的:对比利培酮与阿立哌唑合用及单用利培酮对精神分裂症患者体重及体重指数(BMI)的影响。方法:将符合入组标准的70例精神分裂症患者随机分为阿立哌唑合并利培酮组(合用阿立哌唑组)及单用利培酮组(单一利培酮组)。两组各入组35例,在基线及4周末、8周末,用阳性和阴性症状量表(PANSS)评定疗效,并进行体重及体重指数(BMI)的测定。结果:共完成65例,合用阿立哌唑组31例,单一利培酮组34例。治疗4周末及8周末,两组PANSS评分差异均无统计学意义;治疗后两组间有明显的变化,单一利培酮组体重及BMI值均增加明显(P0.05);组间变化值的比较,合用阿立哌唑组BMI值均较单一利培酮组低(t=2.61,P0.05)。结论:合用阿立哌唑能够明显减轻利培酮对体质量的影响。     

国产奥氮平与阿立哌唑治疗精神分裂症的临床研究

目的 探讨国产奥氮平、阿立哌唑对精神分裂症的疗效及副反应.方法 61例患者随机分为两组,分别用国产奥氮平或阿立哌唑治疗.采用PANSS、TESS量表和CGI四级疗效标准评定疗效和副反应.结果 国产奥氮平组与阿立哌唑组8周末的疗效无显著性差异,但国产奥氮平组第2周末的疗效优于阿立哌唑组,国产奥氮平组副反应主要为体重增加,而阿立哌唑组副反应主要为静坐不能和震颤,两药副作用不同.结论 国产奥氮平与阿立哌唑的疗效相当,均安全有效,但国产奥氮平起效较快,两药副作用不同,可供不同人群选用.     

阿立哌唑与奥氮平治疗慢性精神分裂症对照研究

目的 以奥氮平为对照,比较阿立哌唑治疗慢性精神分裂症的疗效及安全性。方法 将104例慢性精神分裂症患者随机为研究组和对照组各52例,分别予以阿立哌唑和奥氮平治疗8周,采用阳性与阴性症状评定量表（PANSS）、简明精神症状量表（BPRS）和副反应量表（TESS）在治疗前及治疗后第1、2、4、6、8周末分别评定疗效及不良反应。结果 阿立哌唑组显效率75．25％,总有效率81．79％;奥氮平组显效率73．76％,总有效率80．12％,二者疗效相当,差异无显著性。不良反应发生率阿立哌唑组56．34％;奥氮平组为68．28％,二者比较差异有显著性（P〈0．05）。结论 阿立哌唑与奥氮平治疗慢性精神分裂症疗效相当,阿立哌唑副反应较奥氮平少而轻,是一种安全有效的抗精神病药物。     

利培酮、阿立哌唑对女性精神分裂症腹部脂肪沉积的影响及瘦素的关系

目的探讨利培酮、阿立哌唑治疗后,女性精神分裂症患者腹部脂肪沉积的变化情况及其与血清瘦素水平的关系。方法首次治疗的女性精神分裂症患者随机分组,分别接受利培酮(n=26)、阿立哌唑(n=23)治疗,疗程8周。于基线、4周、8周时采用CT分别测定腹部内脏脂肪(VA)、皮下脂肪(SA)面积、内脏脂肪/皮下脂肪比值(VA/SA),同时观察血清瘦素水平的变化情况。结果①利培酮组4,8周时VA(分别t=2.704、7.130,P0.05、0.001)、VA/SA(分别t=5.244、6.034,P均0.001)均较基线增高,8周时SA增高(t=3.132,P0.01);阿立哌唑组VA、SA、VA/SA在4周、8周时的改变均不显著(P均0.05);②利培酮组8周时瘦素水平较基线显著升高(t=2.838,P0.01),4周时则无显著变化(P0.05);阿立哌唑组4、8周时瘦素水平均较基线无显著变化(P均0.05);③两组基线及4,8周时的瘦素水平均与SA正相关(r=0.414~0.535,P0.05~0.01);利培酮组8周时的瘦素水平与VA/SA正相关(r=0.527,P0.01)。结论利培酮可致女性精神分裂症腹部脂肪沉积、以腹部内脏脂肪最为明显,并与瘦素的增高有关,而阿立哌唑对此影响较小。     

Asymmetry of the internal connections of the striate cortex of the cat in the projection zone of the center of the field of vision

Studies were carried out on the organization of the internal connections of the striate cortex in cats in the projection zone of the center (0–5°) of the field of vision by microintophoretic application of horseradish peroxidase to electrophysiologically identified orientational columns. The area containing neurons showing retrograde labeling in most cases extended in the mediolateral direction. Labeled cells were located in the upper (II, III) and lower (V, VI) layers of the cortex, and the shapes and orientations of the areas containing labeled neurons in these layers coincided. Spatial asymmetry was detected in the distribution of labeled neurons relative to the orientational column studied. Labeled cells were located predominantly medial to the columns, regardless of the distance from the projection of the area centralis. Considering the visuotopical map of field 17, the asymmetry detected here provides evidence that neurons in orientational columns have more extensive connections with neurons of the peripheral part of the cortex. An asymmetrical distribution of “silent” zones around the receptive fields of neurons in orientational columns is suggested, and that these appear to receive influences from the periphery of the visual field. Laboratory of Visual Physiology and Laboratory of Central Nervous System Morphology, I. P. Pavlov Institute of Physiology, Russian Academy of Sciences, 6 Makarov Bank, 199034 St. Petersburg, Russia. Translated from Fiziologicheskii Zhurnal imeni I. M. Sechenova, Vol. 82, No. 12, pp. 23–29, December, 1996.     

Effects of the lesion of the postcommissural part of the septum on the behavior of the rat.

The effects of the lesion of the postcommissural part of the septum on behavior of the rat has been studied. Results may be summarized as follows. An increase in the exploratory behavior in the open field which decreases rapidly; a decrease in the number of defecations in this test and a decrease in time leaving a dark environment for exploration. In the shuttle box test, no facilitation of the acquisition, but a permanent and quite significant increase in the intertrial activity has been found. We conclude that the lesions tend to decrease the emotivity of the subjects. An interpretation on the basis of the species -- specific defensive reactions explains the transitory and permanent effects of the lesions on the spontaneous activity.     

The development of the ligament of the head of the femur

The hip joints of 30 human male and female fetuses and stillborns between 20 mm and 350 mm crown-rump length were studied by light microscopy. The ligament of the head of the femur developed in situ as a condensation of mesenchyme at the end of the second month of intra-uterine life (IUL), and was vascularized by branches of acetabular vessels early in the fourth month. In the majority of fetuses older than 5.5 months IUL, vessels in the ligament passed a short way into the femoral head within cartilage canals, to supply a small region around the fovea capitis. The remainder of the head was supplied by vessels in canals from around the upper part of the neck. The ligament changed from predominantly cellular to fibrous during the last 4 months of IUL. This increase in strength suggested significant mechanical functions in utero: limitation of adduction-flexion and opposition to postero-superior dislocation were the most likely.     

Counterpointing the functional role of the forebrain and of the brainstem in the control of the sleep-waking system

This paper reviews the lifetime contributions of the author to the field of sleep-wakefulness (S-W), reinterprets results of the early studies, and suggests new conclusions and perspectives. Long-term cats with mesencephalic transection show behavioral/polygraphic rapid eye movement sleep (REMS), including the typical oculo-pupillary behavior, even when the section is performed in kittens prior to S-W maturation. REMS can be induced as a reflex. Typical non-rapid eye movement S (NREMS) is absent and full W/arousal is present only after a precollicular section. The isolated forebrain (IF) rostral to the transection exhibits all features of W/arousal and NREMS [with electroencephalographic (EEG) spindles and delta waves], arousal to olfactory stimuli, and including the appropriate oculo-pupillary behaviors. These features also mature normally after neonatal transection. REMS is absent from the IF. After deprivation there is NREMS pressure and rebound in the IF, but the decerebrate cat only shows pressure for REMS. Most IF reactions to pharmacologic agents are within expectations, except for the tolerance/withdrawal effects of long-term morphine use which are absent. In contrast, these effects are supported by the brainstem (i.e. seen in the decerebrate cat). In cats with ablation of the telencephalon, or diencephalic cats, delta waves are absent in the thalamus. EEG thalamic spindle waves are seen triggering S for only 4-5 days after ablation. Therefore, true NREMS is absent in chronic diencephalic cats although pre- and postsomniac behaviors persist. These animals are hyperactive and show a pronounced, permanent insomnia; however, a low dose of barbiturate triggers a dramatic REMS/atypical NREMS rebound. Cats without the thalamus (athalamic cats), initially show a dissociation between behavioral hyperactivity/insomnia and the neocortical EEG, which for 15-20 days exhibits only delta and slower oscillations. Fast, low-voltage W rhythms appear later on, first during REMS, but spindle waves and S postures are absent from the start, such that these cats also display only atypical NREMS. Athalamic cats also show barbiturate-sensitive insomnia. Cats with ablation of the frontal cortices or the caudate nuclei remain permanently hyperactive. They also show a mild, but significant hyposomnia, which is permanent in afrontal cats, but lasts for about a month in acaudates. The polygraphic/behavioral features of their S-W states remain normal. We conclude and propose that: (a) the control of the S-W system is highly complex and distributed, but is organized hierarchically in a well-defined rostro-caudal manner; the rostral-most or highest level (telencephalon), is the most functionally complex/adaptative and regulates the lower levels; the diencephalic/basal forebrain, or middle level, has a pivotal role in inducing switching between S and W and in coordinating the lowest (brainstem) and highest levels; (b) W can occur independently in both the forebrain and brainstem, but true NREMS- and REMS-generating mechanisms exist exclusively in the forebrain and brainstem, respectively; (c) forebrain and brainstem S-W processes can operate independently from each other and are preprogrammed at birth; this helps understanding normal and abnormal polygraphic/behavioral dissociations in humans and normal dissociations/splitting in aquatic mammals; (d) NREMS homeostasis is present in the IF, but only REMS pressure after deprivation persists in the decerebrate cat; (e) the thalamus engages in both NREMS and W; (f) insomnia in diencephalic cats is the result of an imbalance between antagonistic W- and S-promoting cellular groups in the ventral brain (normally modulated by the telencephalon); (g) the EEG waves, which are signature for each S-W state, appear to truly drive the concomitant behaviors, e.g. a hypothetical human IF could alternate between behavioral NREMS and W/arousal/awareness; (h) a role for REMS is to keep the individual sleeping at the end of the self-limiting NREMS periods. The need for accelerating research on telencephaling NREMS periods. The need for accelerating research on telencephalic S-W processes and downstream control of the lower S-W system levels is emphasized.     

Topical organization of the projections of neurons of the substantia nigra and the ventral field of the tegmentum of the midbrain to the head of the caudate nucleus of the cat

Neuroscience and Behavioral Physiology -     

Involvement of the striatum in the central regulation of the hormonal functions of the gonads

Studies reported here show that intrastriatal administration of corticoliberin to rats decreases the blood testosterone level. However, in conditions of chemical deficiency of dopaminergic transmission in the dorsal striatum induced by injection of 6-hydroxydopamine, the effect of this neurohormone did not appear. It is concluded that extrahypothalamic corticoliberin is involved in regulating the hormonal reproductive system acting via dopaminergic mechanisms. Translated from Rossiiskii Fiziologicheskii Zhurnal imeni I. M. Sechenova, Vol. 85, No. 4, pp. 594–597, April, 1999.     

Ultrastructure of the endothelium of the drainage system of the eye

The endothelium of the ocular drainage system (Schlemm’s canal, collector tubules, and aqueous veins) in primary juvenile glaucoma undergoes degenerative dystrophic changes with compensatory hypertrophy and proliferation at the initial stages of the glaucomatous process and atrophy and desquamation at advanced and terminal stages. Progressive decrease in the pinocytous function of endotheliocytes, reduction of the protein-synthesizing and mitochondrial compartments of the cytoplasm, and formation of autophagosomes reflect the process of endotheliocyte degeneration in general. __________ Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 145, No. 5, pp. 574–577, May, 2008