北京大学精神卫生研究所黄悦勤：中国30年精神病与精神卫生学科研发展系统评价

精神病和精神卫生是医药卫生领域不可缺少的组成部分,系统总结我国精神病和精神卫生领域的研究进展,不论对总结过去的经验还是展望未来的发展都有重要意义。     

抑郁症患者的家庭负担和家庭功能评价

目的 评价抑郁症患者的家庭负担和家庭功能.方法 采用家庭负担量表(FBS)和家庭关怀度指数问卷(APGAR),对150例符合DSM-Ⅳ诊断标准的抑郁症患者的家庭负担和家庭功能进行评定,并与248个一般家庭进行比较,从家庭的角度评价抑郁症造成的疾病负担.结果 抑郁症患者FBS的家庭经济负担、家庭日常活动、家庭休闲娱乐活动、家庭成员心理健康4个因子的阳性回答率较高(分别为57.1%、51.6%、61.9%、78.6%),家庭成员生理健康、家庭关系两个因子的阳性回答率较低(分别为28.6%、39.7%);农村患者的家庭经济负担因子评分显著高于城镇患者[(1.14±0.09)分;(0.89±0.07)分,t =2.687,P ＜0.05],而家庭成员心理健康因子评分显著低于城镇患者[(0.42±0.36)分;(0.60±0.58)分,t =3.375,P ＜0.01];患抑郁症前存在功能障碍的家庭比例与对照组比较差异无显著性(24.6%,17.3%,χ2＝0.108,P ＞0.05),患病后出现功能障碍的家庭比例显著高于患病前和对照组(63.4%,24.6%,17.3%, P ＜0.01);患病后APGAR总分及各因子分均比患病前显著降低(均P ＜0.01).结论 抑郁症造成严重的家庭负担和家庭功能障碍.     

首次发病未用药老年抑郁症患者脑白质完整性的弥散张量成像研究

Objective To explore the white matter integrity by using diffusion tensor imaging (DTI) in first-episode, medication-naive geriatric patients with major depressive disorder.Methods Fifteen first-episode, medication-naive depressive patients and fifteen healthy controls underwent DTI scan.Fractional anisotropy (FA) of white matter was compared between the two groups using voxel-based approach.Results Compared with healthy controls, geriatric depressive patients showed significantly lower FA in left anterior cingulate (cluster size = 106 voxels, t = 3.21 ), right anterior cingulate ( cluster size =60 voxels, t = 2.71 ), right subgenual cingulate ( cluster size = 63 voxels, t = 3.37 ) and left brainstem ( cluster size = 62 voxels, t = 3.25 ) ( level of significance was uncorrected single-tailed P ＜ 0.01, threshold of cluster size ＞ 50 voxels).Conclusion Decrease of white matter integrity in bilateral anterior cingulate and right subgenual cingulate are present in the early stage of geriatric depression.Lesions of neural pathways by way of these regions may be involved in the pathophysiology of geriatric depression.     

儿童孤独症的血浆谷氨酸和γ-氨基丁酸水平及其与伴发癫痫的关系

目的 探讨血浆谷氨酸(Glu)和γ-氨基丁酸(GABA)水平异常与儿童孤独症的关系,及其在儿童孤独症易发癫痫病理机制中的作用.方法 从已经收集血样的儿童孤独症患者库(278例)中随机选择34例为总的患者组,其中不伴癫痫者30例(不伴癫痫组),伴癫痫者4例;而此库中所有伴发癫痫的27例患者为伴癫痫组,正常儿童36名为对照组.采用高效液相色谱法测定血浆Glu和GABA水平并进行上述3组间的比较.结果 孤独症患者伴发癫痫的比例为9.7%(27/278).总患者组的血浆Glu和GABA水平与对照组的差异均无统计学意义(t=1.09,P:0.28;t=0.56,P=0.58).两两比较:伴癫痫组血浆Glu水平显著高于不伴癫痫组和对照组(H=8.93,P=0.003;H=10.65,P=0.001),而后两组间的差异无统计学意义(H=0.00,P=1.00);此3组间血浆GABA水平差异无统计学意义(H=5.38,P=0.07,df=2).Pearson相关分析显示,患者组的血浆Glu及GABA水平分别与性别、年龄、病程、孤独症行为评定量表(Autism Behavior Checklist,ABC)评分等的相关均无统计学意义(P＞0.05).结论 仅在伴发癫痫的孤独症儿童中发现血浆Glu水平的异常增高,这可能是孤独症易发癫痫的病理机制之一.     

脑源性神经营养因子C270T基因多态性与精神分裂症精神病理症状和认知功能的关系

Background

Findings from previous studies linking brain-derived neurotrophic factor (BDNF) and schizophrenia are inconsistent and few studies have assessed the relationship between BDNF C270T gene polymorphisms and the clinical and cognitive symptoms of schizophrenia.

Aim

Compare the prevalence of the BDNF C270T gene polymorphisms between patients with schizophrenia and controls and, in the patients, assess the relationship of genotypes to the severity of symptoms.

Methods

BDNF C270T genotype and allele frequency were measured using Polymerase Chain Reaction methods in 224 drug-free patients with schizophrenia and 220 controls. Psychotic symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS), and cognitive functioning was assessed using the Wisconsin Card Sorting Test (WCST) and the Trail Making Test (TMT). In the patient group, differences in severity of symptoms across the three genotypes (i.e., C/C, C/T, and T/T) of C270T were assessed using one-way analysis of variance.

Results

The frequency of the T allele was much higher in patients than in controls (15.6% vs. 4.3%, χ²=31.47, p<0.001) and the C/T genotype was more common among patients than controls (27.7% vs. 7.7%, χ²=34.93, p<0.001). Compared to controls, patients performed poorly on all the cognitive tests, but there were no significant differences in the cognitive measures between patients with the three different genotypes. The total PANSS score, the PANSS negative symptoms subscale score, and the PANSS general psychopathology subscale score were not significantly different between the three groups of patients. However, the PANSS positive symptoms subscale score showed a small, statistically significant elevation in the severity of positive symptoms in the C/T genotype compared to the C/C genotype.

Conclusion

We confirm previous findings about differences in the prevalence of the BDNF C270T gene polymorphisms in schizophrenia, but do not find strong evidence of a relationship between different genotypes and the severity of the clinical or cognitive symptoms of schizophrenia. Clinical and cognitive symptoms in schizophrenia fluctuate over the course of the illness and with treatment, so stable, individual-specific measures of these parameters (that is, traits) need to be identified before it will be possible to definitively assess their relationship to different genotypes.     

2010版美国抑郁症治疗指南要点介绍

2010年10月,美国精神病学学会(APA)发布了第3版抑郁症治疗指南(以下简称指南),这是继2000年第2版抑郁症治疗指南发布后十年来的再次更新,通过搜集MEDLINE数据库1999年1月至2006年12月发表在PubMed的文献及在Cochrane系统数据库搜集的168篇荟萃分析,在第2版的基础上增加了最新的循证证据和治疗观念.     

白介素-1β基因多态性及核因子-kB对精神分裂症首次发病患者血清白介素-1β水平的影响

目的 探讨精神分裂症患者白介素-1β(IL-1β)基因多态性及核因子-kB(NF-kB)对IL-1β水平的影响.方法 采用聚合酶链反应-限制性内切酶方法检测161例精神分裂症患者(患者组)和135名正常对照者(对照组)的IL-1β基因-511多态性位点和+3953多态性位点的基因型及等位基因频率;采用酶联免疫吸附法检测IL-1β在患者组和对照组血清中的蛋白表达及外周血单个核细胞( PBMC) NF-kB活性;采用逆转录-聚合酶链反应方法检测PBMC IL-1β mRNA表达水平.结果 (1) IL-1β -511G/A位点的等位基因G与精神分裂症存在名义上的关联(P=0.038,多重检验P =0.240),但+3953G/A多态性与精神分裂症无关联(P＞0.05).(2)患者组血清IL-1β水平[(25.93±13.30) ng/L]、PBMC中IL-1β mRNA( 1.30±0.30)表达以及NF-kB活性[(0.28±0.21) μg/L]均高于对照组[(14.19±7.86) ng/L、0.97±0.27、(0.20±0.17) μg/L;P均＜0.05];携带IL-1β基因-511A/G和+3953A/G位点基因型GA和AA的精神分裂症患者较GG携带者的IL-1β水平明显增高(P＜0.05).结论 精神分裂症患者外周血IL-1β水平的增高参与了疾病的病理生理过程,基因多态性和转录因子NF-kB均对细胞因子的分泌起了一定作用.     

新型非典型抗精神病药物联苯芦诺及其临床应用

在PubMed,Ovid,Springer,Proquest和Elsevier中搜索近期发表的关于新型非典型抗精神病药联苯芦诺及其临床应用的文献,进行分析、归纳和总结.联苯芦诺属于新型非典型抗精神病药物,在非典型抗精神病药物中又具有“非典型”特征,对多巴胺D2和5-HT1A受体具有部分激动作用,对5-HT2A、5-HT2c、H1、M1、α1和α2受体几乎没有亲和力.对精神分裂症阳性症状、阴性症状、认知症状和情感症状均有较好疗效,与H1、M1、α1和α2受体相关的不良反应较少,是一种有较好应用前景的药物.     

米氮平与氟西汀治疗抑郁症的对照研究

目的：评价米氮平(商品名：瑞美隆)与氟西汀治疗抑郁症的有效性和安全性。方法：采用中国精神障碍分类与诊断标准(第3版)抑郁症的诊断标准，分别对服用瑞美隆和氟西汀的96例抑郁症患者进行为期6周的观察，应用汉密顿抑郁量表和副反应量表评估和比较这两种药物治疗抑郁症的疗效和安全性。结果：经过6周治疗，瑞美隆组有效率和治愈率分别为85％．和63％，与氟西汀组(90％，56％)比较差异无显著性(χ^2=0．38～0.39，P&;gt;0．05)。而两组内汉密顿抑郁量表总分和因子分治疗前后比较差异均有显著性(t=0．52～3．94，P&;lt;0．01)。治疗1周后，瑞美隆组的有效率(63％)高于氟西汀组(31％)，差异有显著性(χ^2=9．41，P&;lt;0．05)。与氟西汀组相比，瑞美隆组嗜睡发生率较高，差异有显著性(χ^2=5．55，P&;lt;0．05)。氟西汀组失眠、兴奋或激越等副反应发生率高于瑞美隆组，差异均有显著性(χ^2=4．44，P&;lt;0．05)。不同起始剂量瑞美隆和氟西汀的汉密顿抑郁量表减分率无显著差异(t=1．57～2．09，P&;gt;0．05)，但起始量15mg／d的瑞美隆的嗜睡和眩晕或头昏副反应发生率低于30mg／d者(χ^2=5．35～9．52，P&;lt;0．05)。结论：瑞美隆是一种安全、有效的新型抗抑郁药物，起效较快，且有改善焦虑及睡眠作用，治疗宜从低剂量开始。     

盐酸米那普仑片临床用药建议

米那普仑(Milnacipran)作为5-羟色胺和去甲肾上腺素再摄取抑制剂类抗抑郁药，具有相对独特的药效和药代动力学特征，其抗抑郁治疗具有起效快、临床治愈率高，有良好的耐受性，长期服用可减少复发等特点，已经被多个国家、地区和学术组织的治疗指南推荐为抑郁症一线治疗药物。为进一步发挥其治疗优势，规范临床应用，基于近年来国内外循证医学证据，结合业内专家的临床经验，特提出本指导建议，为广大临床医师了解米那普仑适用性、安全性、特定人群应用等提供参考。