精神分裂症患者与其健康同胞认知功能比较

目的比较精神分裂症患者、精神分裂症患者健康同胞及健康对照者在认知功能上的差异。方法100例精神分裂症患者（患者组）及其健康同胞100名（同胞组）,以及80名正常对照者（对照组）为研究对象,采用威斯康星卡片分类测验（WCST）、Stroop色词测验（SCWT）和言语流畅性测验（VFTr）来评定认知功能。比较各组在各个认知功能纬度方面差异。结果在WCST中,患者组及其同胞组的持续错误数均高于对照组（F=73．24,P〈0．01）;患者组持续错误数高于同胞组。在V丌中,患者组、同胞组和对照组差异无统计学意义。在SCWT,彩色文字阅读测验（Stroop—C）和彩色文字颜色阅读（Stroop—cw）测验,患者组和同胞组完成时间比对照组长（Stroop—C：F=49．20,P〈0．01;Stroop—CW：F=87．72,P〈0．01）;患者组完成时间比同胞组长。结论精神分裂症患者及其同胞均可能存在执行功能缺陷,精神分裂症患者的执行功能障碍较其同胞更为严重。     

有暴力行为男性精神分裂症患者执行功能研究

目的:研究有暴力行为的男性精神分裂症患者的执行功能。方法:对75例有暴力行为史的男性精神分裂症患者(暴力组)和43例无暴力行为史的男性精神分裂症患者(对照组)收集一般资料,评定阳性和阴性症状量表(PANSS),采用言语流畅性测验、连线测验(TMT)、威斯康星卡片分类测验(WCST)和Stroop色词测验评定受试者的执行功能。结果:暴力组的Stroop卡五2min内正确数成绩比对照组显著为差(t=-2.58,P=0.01),暴力组的WCST分类数成绩比对照组显著为差(t=-2.27,P=0.02)。其余认知指标(SIE正确数、SIE时间、卡四2min内正确数、卡四完成时间、卡五完成时间、WCST正确数、WCST错误数、WCST持续错误数、TMT-A时间、TMT-B时间、言语流畅正确数)两组间差异无统计学意义(P均≥0.05)。结论:有暴力行为史的男性精神分裂症患者执行功能较没有暴力行为史的损害明显。     

精神分裂症患者的认知功能和血清脑源性神经营养因子的相关性分析

目的探讨精神分裂症患者认知功能状况,分析其与血清脑源性神经营养因子的相关性。方法选取已确诊的居家精神分裂症患者36例,另选择34例健康对照组,收集一般人口学资料,运用威斯康星卡片分类测验(WCST)和Stroop色词测验评估所有受试者的认知功能,采用酶联免疫吸附法(ELISA)测定受试者的血清BDNF水平,HCY水平采用全自动生化分析仪检测。结果 WCST检测显示:病例组正确应答数、持续性应答数、完成测验用时高于对照组,错误应答数、非持续错误数低于于对照组,两组间差异均具有统计学意义(P0.05);STROOP测验显示:病例组与对照组正确数差异无统计学意义(P0.05),病例组BDNF水平与对照组差异无统计学意义,病例组HCY水平高于对照组,差异具有统计学意义;病例组血清HCY水平与Stroop正确数呈正相关(P0.05),BDNF水平与威斯康辛正确应答数、错误应答数、持续性错误数、非持续性错误数、完成测验用时和Stroop正确数均无相关性(P0.05)。结论精神分裂症患者,HCY水平高于对照组,精神分裂者患者的血清HCY浓度与认知功能存在一定的相关性。     

精神分裂症首次发病患者及其健康同胞认知功能的比较研究

目的 比较精神分裂症首次发病患者与健康同胞及正常对照认知功能的差异,探讨精神分裂症在认知功能领域的内表型.方法 采用目前常用的范畴流畅测验(CFT)、数字符号编码测验(DSCT)、连线测验(TMT)、韦克斯勒记忆量表第3版(WMS-Ⅲ)空间广度测验(WMS-ⅢSST)、霍普金斯词汇学习测验-修订版(HVLT-R)、简易视觉空间记忆测验-修订版(BVMT-R)、定步调听觉连续加法测验(PASAT)和威斯康星卡片分类测验-64(WCST-64)对92例精神分裂症首次发病患者(患者组)、56例健康同胞(同胞组)和62名健康对照者(对照组)的认知功能进行检测.结果 (1)患者组所有神经心理测验成绩均差于对照组,差异有统计学意义(P＜0.01).(2)同胞组的CFT、DSCT、TMT、HVLT-R即刻记忆和延迟记忆、BVMT-R即刻记忆、PASAT、WCST-64持续错误数、持续反应数和完成分类数的测验成绩差于对照组,差异有统计学意义(P＜0.05).(3)患者组与同胞组的CFT、WCST-64中的持续错误数、持续反应数和完成分类数测验成绩分别为(18.40±12.12)分比( 18.86±5.19)分、(16.48±8.19)分比(14.80±5.86)分、(18.76±10.91)分比(16.86 ±7.73)分、(1.33±2.81)分比(1.63±1.36)分,2组比较差异无统计学意义(P＞0.05),其他神经心理测验成绩比较,患者组差于同胞组,差异有统计学意义(P＜0.05).结论 精神分裂症首次发病患者存在处理速度、工作记忆、言语记忆、空间记忆、注意警觉和执行功能广泛性的认知功能损害,精神分裂症健康同胞存在处理速度、言语记忆、视觉记忆、注意警觉、执行功能的认知缺陷;语义流畅性功能和执行功能可能是精神分裂症的潜在内表型.     

首发精神分裂症患者神经认知功能的遗传学分析

目的 探索精神分裂症患者及其亲属共同存在的神经认知功能损害,并对22号染色体上儿茶酚氧位甲基转移酶(COMT)基因和脯氨酸脱氢酶(PRODH)基因的5个候选单核苷酸多态性(SNP)位点进行相关的遗传学分析。方法 采用14个神经心理测验(共29项)对235例首发精神分裂症患者(患者组)、322名未患病亲属(亲属组)和133名正常对照(正常对照组)进行有关智力、注意、记忆、言语功能和执行功能等评定,比较各组间的神经认知功能有无差异,并对上述神经认知功能测验与COMT和PRODH基因的5个候选SNP进行定量性状的传递不平衡测试。结果 (1)患者组所有测验的成绩均差于正常对照组,差异有显著性(P<0.01和P<0.05),而亲属组的记忆、注意、言语功能和执行功能界于患者与正常对照之间;(2)PRODH1 195G/A与即刻逻辑记忆测验(P=0.03)、言语流畅性测验的正确数(P=0.03)和连线测验B的犯规数(P=0.01)相关,PRODH1945G/A与数字符号测验(P:0.01)、连线测验A的错误数(P:0.02)、HANOI塔测验的总分(P=0.01)、威斯康星卡片分类测验(WCST)的总错误数(P=0.01)、WCST的非持续错误数(P:0.02)和WCST的总分类数(P=0.02)相关。结论 精神分裂症患者在记忆、注意、言语功能和执行功能等方面存在广泛的神经认知功能损害,这种损害可能是精神分裂症的遗传“内表     

精神分裂症患者与健康同胞及正常人群认知功能的比较

目的:探讨精神分裂症患者与健康同胞及正常对照人群认知功能的特点。方法:采用数字划消测验(CT)、修订韦氏成人记忆量表(WMS-RC)、威斯康星卡片分类测验(WCST)对35例精神分裂症患者(患者组)、35例患者健康同胞(同胞组)及30例健康对照组(对照组)的认知功能进行测验。结果:患者组与同胞组记忆商数差异无统计学意义(P0.05);而与对照组记忆商数差异有统计学意义(P0.05)。在划消测验上患者组和同胞组指向与转移因子间差异有统计学意义(P0.05),而选择因子差异无统计学意义(P0.05);患者组和对照组在指向、转移与选择3个因子差异均有统计学意义(P0.05)。在WCST上患者组和同胞组持续时间数和持续错误数差异无统计学意义(P0.05),而分类完成数和总测验次数差异有统计学意义(P0.01);患者组与对照组比较,持续时间数、持续错误、分类完成数、总测验次数均差异有统计学意义(P0.01)。结论:精神分裂症患者及其健康同胞存在注意、记忆、执行功能方面的损害。     

儿童少年期精神分裂症患者及其一级亲属认知功能的对照研究

目的:探讨儿童少年期精神分裂症患者及其一级亲属的认知功能状况. 方法:对40例儿童少年期精神分裂症患者(患者组)、80名父母(患者父母组)及22名同胞(患者同胞组)采用注意力测验、WMS-R-逻辑记忆、数字广度、连线测验A和B、词汇流畅性测验、Stroop色词测验及威斯康星卡片分类测验(WCST)评定其认知功能,并与59名健康儿童(健康儿童对照组)及其父母(健康儿童父母组)80名进行比较. 结果:患者组除词汇流畅性测验以外,其他测验成绩差于健康儿童对照组;患者同胞组除数字顺背、词汇流畅性测验、连线测验-A、WCST正确应答数、WCST完成第1个分类应答数以外,其他测验成绩差于健康儿童对照组(P均＜0.001);患者父母组除数字顺背、词汇流畅性测验、连线测验-A以外,其他测验成绩差于健康儿童父母组(P＜0.01或P＜0.001).儿童精神分裂症患者与其父母在注意力测验、WMS-R-逻辑记忆、数字倒背、彩色文字阅读和彩色文字颜色阅读、WCST完成分数上呈正相关(r =0.350～0.615,P＜0.05或P＜0.001). 结论:儿童少年期精神分裂症患者及其一级亲属均存在广泛的认知功能缺陷,但患者的认知功能障碍更为严重.     

首发精神分裂症病人治疗前后认知功能改变及其与精神症状的相关研究

目的探讨利培酮治疗对未服药首发精神分裂症患者认知功能的影响,以及认知功能与症状变化的关联。方法采用威斯康星卡片分类测验、数字广度测试、词语流畅性测试、Stroop测试、连线测试评估42例首发未服药精神分裂症患者的执行功能、工作记忆、信息处理速度等变化;阳性和阴性症状量表评定患者精神症状;多元回归分析探讨认知功能与精神症状的关联。结果治疗前,患者组威斯康星测验持续错误数较对照组多(P0.001),完成分类数较对照组少(P=0.009);数字广度测试及词语流畅性分数(Ps0.001)均降低;Stroop及连线测试完成时间均较对照组延长(Ps0.001)。治疗后,患者组Stroop_B(P=0.022)、Stroop_C(P=0.033)完成时间较治疗前减少。治疗前连线测试A/B成绩越差,则阴性症状及总症状(Ps0.05)越严重;连线测试A成绩越差,阳性症状的改善越少(P=0.019)。结论精神分裂症患者发病早期存在认知功能损害;急性期治疗可改善精神病性症状及信息处理速度,但不改善执行功能及工作记忆;提示患者早期信息处理受损可能更接近状态性生物学标记,而执行功能、工作记忆受损更接近素质性生物学标记。     

慢性精神分裂症患者认知功能与血清C-反应蛋白的关联研究

目的:探讨慢性精神分裂症患者血清C-反应蛋白(CRP)水平与神经认知功能的相关性。方法:检测50例符合《美国精神障碍诊断与统计手册》第4版精神分裂症诊断标准的女性患者(患者组)和50名健康志愿者(正常对照组)血清CRP水平;采用阳性与阴性症状量表(PANSS)评估患者的临床症状,威斯康星卡片分类测试(WCST)、连线测试(TMT)评估患者的认知功能;对CRP水平与临床症状及认知功能进行相关分析并与正常对照组进行比较。结果:患者组血清CRP水平明显高于正常对照组(t=9.203,P0.001);WCST、TMT测验成绩明显差于正常对照组(t=4.462~6.815,P均0.001)。患者组血清CRP水平与PANSS总分及阴性症状分呈正相关(r=0.422,r=0.372;P0.05);与WCST正确数、完成分类数呈负相关(r=-0.364,r=-0.375;P0.05),与WCST错误总数、持续错误数、随机错误数呈正相关(r=0.341,r=0.346,r=0.381;P均0.05);与TMT-A、TMT-B呈正相关(r=0.411,r=0.483;P均0.05)。结论:慢性期精神分裂症患者存在明显免疫异常,血清CRP水平与认知功能和阴性症状密切相关。     

不同亚型(阳性、阴性)精神分裂症患者精神症状与神经认知功能状况分析

目的探究不同亚型精神分裂症精神症状与神经认知功能差异及相互关系。方法将我院精神分裂症患者59例按PANSS分为阳性组和阴性组,采用PANSS评定患者精神症状,顶叶认知功能采用木块图测验和Benton线方向判断测验,额叶认知功能采用连线测验和威斯康星卡片分类测验,颞叶认知功能采用逻辑记忆测验和视觉再生测验。结果在各项认知功能测定上,阳性组和阴性组均不同程度与对照组存在差异(P0.05),阳性组与阴性组在木块图测验、逻辑记忆测验、视觉再生测验、连线测验及威斯康星卡片分类测验均存在显著差异(P0.01);阳性精神症状与逻辑记忆测验、视觉再生测验、完成分类数存在显著正相关(P0.01),阴性精神症状与连线B时间、思维灵活性、持续性错误存在显著正相关(P0.01),与木块图测验,逻辑记忆测验、视觉再生测验、完成分类数存在显著负相关(P0.01)。结论不同亚型精神症状与神经认知功能存在差异,顶叶及额叶认知功能与阴性症状关系密切,颞叶认知功能与阴性、阳性症状关系密切。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.