上海地区不同人群的饮酒相关问题的调查

使用饮酒相关问题调查表对481名社会人员及569名在校学生进行调查。结果发现,被调查者绝大多数(912人,占86.86％)赞成酒应该在人类社会中存在,支持者的理由是:在一些重要节日和祭礼上,酒是必不可少的。同时,多数被调查者反对酗酒行为,并主张禁止未成年人饮酒。本次调查结果也表明,为数不少的人对酒中毒/酒依赖有关知识知之甚少,对是否该送患者就诊茫然不知。提示今后应大力加强这方面的防治工作。而社会人群与在校学生对某些问题的看法也存在一定差异。     

抗巴金森症药物的滥用

抗巴金森症药物(苯海索、东莨菪碱、苯甲托品,开马君等)在精神科的应用几乎同抗精神病药物一样广泛而悠久。主要用于治疗抗精神病药物所致的锥体外系症状。然而,历来对是否应该预防性或长期使用这类药物,     

双相障碍抑郁发作患者氧化应激水平

目的:探讨自由基、抗氧化酶在双相障碍抑郁发作病理机制中的作用。方法:采用病例-对照研究设计,对56例符合美国精神障碍诊断与统计手册第4版诊断标准的门诊及住院双相障碍抑郁发作患者(包括双相Ⅰ型组23例及双相Ⅱ型组33例)以汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)评定抑郁症状,并检测血浆丙二醛(malondialdehyde,MDA)、超氧化物歧化酶(superoxide dismutase,SOD)、过氧化氢酶(catalase,CAT)以及谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-Px)含量,选择32名正常健康人作为对照(对照组),使用单因素方差分析以及多元线性回归分析比较各参数在组间差异及其与HAMD评分之间的关系。结果:双相Ⅰ型和Ⅱ型组MDA水平均高于对照组,SOD、CAT及GSH-Px水平低于对照组,差异均有统计学意义;多因素分析显示,在控制身高、体质量指数和年龄等因素后HAMD评分与血浆MDA水平呈正相关(β=0.46,P<0.05),与SOD(β=-0.27,P<0.05)、CAT(β=-0.41,P<0.05)和GSH-PX(β=-0.34,P<0.05)水平呈负相关。结论:氧化应激反应可能参与双相障碍抑郁发作的发生过程,疾病严重程度可能与氧化应激反应失衡有关。     

双相抑郁是否有必要使用抗抑郁药物？

双相障碍正日益被关注,学界认同这是一种具有高患病、高复发、高自杀风险和致残风险以及高负担等特征的重大精神疾病。上一期的《上海精神医学》刊登的一篇论著和述评,强调鉴别单相抑郁与双相抑郁存在着一定困难。要回答这个问题,首先需要明确尽管单相抑郁与双相抑郁的发作表现类似,但它们是不同的疾病。单相抑郁发作是情感、认知、意志行为的全面“抑制”,但双相抑郁则是双相障碍临床表象的一个极端,一个阶段性现象。     

抑郁症还是双相障碍？

1 病史简介 患者,男,34岁,工人,已婚。因反复烦躁不安、情绪低落发作19年,于2011年5月26日第1次住我院。患者于1992年读初中二年级时与同学打架后,对老师的处理方式不满,渐出现不愿意读书,眠差,情绪不稳定,烦躁,之后出现情绪低落,注意力不易集中,记忆力下降,兴趣减退,自1992年起休学。     

双相障碍I型患者治疗前后微小RNA206基因表达水平变化及与对照的比较

背景微小RNA206（MicroRNA-206,miRNA-206）可能是双相障碍的生物学标志之一,有待深入探究。目的评估双相障碍躁狂发作期外周血miRNA-206水平与患者临床状态的关系。方法采用美国精神障碍诊断与统计手册第4版轴I障碍定式临床检查,符合双相障碍I型躁狂发作期的新入院患者36例和年龄、性别匹配的健康对照者30名纳入研究。健康对照者入组时,双相障碍患者在基线、治疗后第2,4、8周末外周血淋巴细胞miRNA-206水平被检测。在检测miRNA-206水平相同时间点,采用杨氏躁狂量表（YoungManiaRatingScale,YMRS）评估双相障碍患者躁狂症状严重程度。结果在基线（Z=-0．02,P=0．988）和治疗后第2周末（Z=-0．17,P=O．864）、第4周末（Z=-0．86,P=O．392）、第8周末（Z=-1．29,P=0．197）,双相障碍患者与健康对照者之间外周血miRNA-206水平差异无统计学意义。对于双相障碍患者,在4个时间点miRNA-206水平与躁狂症状严重程度之间也无统计学明显相关（统计值依次为：rs=0．13,P=0．518;rs=0．12,P=0．532;rs=-0．18,P=0．361：rs=0．02,P=0．912）。结论外周血淋巴细胞miRNA-206水平可能不是双相障碍I型或躁狂发作期治疗效果的生物学标志。由于本研究检测患者与对照者之间差异的统计效能仅22％,今后需要大样本研究（可能应用不同技术检测miRNA-206水平）进一步验证。     

拉莫三嗪治疗精神分裂症和双相抑郁及重性抑郁症耐受性与敏感性的文献分析

目的 分析拉莫三嗪在精神分裂症、双相抑郁和重性抑郁症急性期治疗中耐受性与敏感性.方法 选择符合急性期、随机双盲、安慰剂对照的关于拉莫三嗪治疗急性期精神分裂症、双相抑郁和重性抑郁症的临床试验进行分析;以不良事件引起治疗终止发生率为拉莫三嗪的耐受性指标,以皮疹和头痛为敏感性指标.分别计算拉莫三嗪(200 mg/d)事件发生率相对于安慰剂事件发生率增加(ARI),以及拉莫三嗪(200 mg/d)治疗相对于安慰剂治疗所致1例不良事件发生前需要治疗的患者数(NNH);显著性检验以95%可信区间(95%CI)表示.结果 (1)难治性精神分裂症4项、双相抑郁4项、难治性双相抑郁1项和重性抑郁症3项临床试验被分析;(2)在难治性精神分裂症、双相抑郁及难治性双相抑郁、重性抑郁症的急性治疗期,与安慰剂比较,拉莫三嗪(200 mg/d)相关不良事件引起治疗终止NNH(95%CI)依次为323(-23～20)、-47(-17～60)、-34(-10～22)和-32(-14～158)例,皮疹依次为133(-51～29)、-46(-18～83)、51(-16～10)和-31(-15～1208)例,头痛依次为-26(-11～61)、-168(-16～19)、-28(-6～9)和53(-24～13)例,差异无统计学意义(95%CI包括0).结论 拉莫三嗪单药或增效治疗精神分裂症、双相抑郁和重性抑郁症具有良好的耐受性与安全性.

Abstract：

Objective To compare the tolerability and sensitivity of lamotrigine in the treatment of schizophrenia, bipolar depression and major depressive disorder (MDD). Methods Data from randomized,double-blind, placebo-controlled trials of lamotrigine adjunctive or monotherapy in the acute treatment of treatment-resistant schizophrenia, bipolar depression, and MDD were used. The discontinuation due to adverse events (DAEs) was used as an index of tolerability. The reported headache and occurrence of rash were used as indexes of sensitivity. Absolute risk increase (ARI) and number needed to harm (NNH) of lamotrigine at dose of 200 mg/d relative to placebo for DAEs, headache, and rash were estimated with 95% confidence interval (CI) to reflect the magnitude of variance. Results Four trials in treatment-resistant schizophrenia, 4 in bipolar depression, 1 in treatment-resistant bipolar depression and 3 in major depressive disorder were analyzed. In the acute treatment of treatment-resistant schizophrenia, bipolar depression or treatment-resistant bipolar depression and major depressive disorder, lamotrigine 200 mg/d did not significantly increase the risk for DAEs [NNH 95% CI respectively as 323(-23 to 20) ,-47(-17 to 60), -34(-10 to 22) and-32(-14 to 158)], rash [NNH 95% CI respectively as 133 (-51 to 29),-46(-18 to 83), 51 (-16 to 10) and -31 (-15 to 1208)] and headache [NNH 95% CI respectively as -26(-11 to 61),-168 (-16 to 19),-28 (-6 to 9) and 53 (-24 to 13)] relative to placebo. Conclusion The available data indicate patients with schizophrenia, bipolar depression and major depressive disorder tolerate lamotrigine 200 mg/d as well as placebo and have a similar sensitivity to lamotrigine as to placebo.     

抑郁症首发未治疗患者情绪调控环路脑功能网络的静息态功能磁共振研究

Background  Reports on mood regulating circuit (MRC) indicated different activities between depressed patients and healthy controls. The functional networks based on MRC have not been described in major depression disorder (MDD). Both the anterior cingulate cortex (ACC) and thalamus are all the key regions of MRC. This study was to investigate the two functional networks related to ACC and thalamus in MDD.

Methods  Sixteen patients with MDD on first episode which never got any medication and sixteen matched health controls were scanned by 3.0 T functional magnetic resonance imaging (fMRI) during resting-state. The pregenual anterior cingulate cortex (pgACC) was used as seed region to construct the functional network by cortex section. The thalamus was used as seed region to construct the functional network by limbic section. Paired-t tests between-groups were performed for the seed-target correlations based on the individual fisher z-transformed correlation maps by SPM2.

Results  Depressed subjects exhibited significantly great functional connectivity (FC) between pgACC and the parahippocampus gyrus in one cluster (size 923) including left parahippocampus gyrus (–21, –49,7), left parietal lobe (–3, –46, 52) and left frontal lobe (–27, –46, 28). The one cluster (size 962) of increased FC on thalamus network overlapped the precuneus near to right parietal lobe (9, –52,46) and right cingulate gyrus (15, –43, 43) in health controls.

Conclusions  Abnormal functional networks exist in earlier manifestation of MDD related to MRC by both cortex and limbic sections. The increased functional connectivity of pgACC and decreased functional connectivity of thalamus is mainly involved in bias mood processing and cognition.

     

亚综合征抑郁外周血胰岛素样生长因子1受体基因表达研究

亚综合征抑郁(subsyndromal symptomatic depression,SSD)是一种亚临床状态,指患者同时有2个及2个以上的抑郁症状但少于5个,病程至少2周,却并不符合抑郁症(major depressive disorder,MDD)及心境恶劣障碍(dysthymic disorder,DD)的诊断标准[1]。目前尚缺乏有关SSD的病因遗传学研究,本课题组前期的全基因组外周血基因表达谱芯片分析显示,     

重性抑郁障碍与双相障碍患者的共病研究

目的:调查重性抑郁障碍(MDD)和双相障碍患者(BD)精神科共病情况。方法:采用横断面调查方法,对2011年3月至8月符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)诊断标准的141例重性抑郁障碍和52例双相障碍患者进行一般情况问卷及国际神经精神科简式访谈问卷(MINI)调查。结果:重性抑郁障碍组和双相障碍组精神科共病率分别为30.0%和28.8%,两组共病率差异无统计学意义(χ2=0.016,P>0.05);两组共病焦虑障碍最为常见,其共病率分别为27.0%和15.4%,差异无统计学意义(χ2=2.799,P=0.094);共病酒精依赖或物质滥用差异有统计学意义(χ2=6.405,P=0.011)。结论:重性抑郁障碍和双相障碍与其他精神科疾病存在广泛共病,尤以焦虑障碍多见。