Psychiatrists' Use of Melatonin with Children

Background:  Melatonin is gaining popularity as a sedative agent with children. This study sought to characterise this practice more precisely as well as examine aspects of its safety and efficacy in order to develop treatment guidelines.
Method:  Postal surveys of two groups of psychiatrists: generic child psychiatrists and psychiatrists who regularly treat learning disabled children.
Results:  Both groups (all of the specialists and 81% of the non-specialists) reported regular but not frequent use of melatonin in their usual practice, mostly for night-settling sleep problems refractory to behavioural modification strategies, commonly in the context of neurodevelopmental disability (especially autism). Treatment was described as being 'usually successful' and side-effects were highly infrequent and mild in nature. Variations in most prescribing practices were identified (dosage, timing).
Conclusions:  Melatonin appears to represent a useful and relatively safe drug when used in specific circumstances; however, the evidence-base underpinning its use, particularly over the long-term, remains modest. Thus caution and clinical audit of practice is required.     

待分类的精神病性和非精神病性精神障碍与精神分裂症的对比分析

目的 探讨待分类的精神病性和非精神病性精神障碍临床特征。方法 对待分类的精神病性和非精神病性精神障碍与精神分裂症临床资料进行对比分析。结果 待分类的精神病性障碍与精神分裂症在发病年龄、复发率、阳性家族史、治疗和疗效上无显著性差异；待分类的非精神病性精神障碍在复发率、阳性家族史及治愈率上与前两者有显著性差异。结论 待分类的精神病性障碍与精神分裂症可能具有同源性，部分非精神病性精神障碍与两者可能不同源。     

Marital status and depression: a study of English national admission statistics

Data are presented from the English national statistics for first admissions with affective disorders during the years 1982-1985. Overall rates per 10(5) of the population aged over 15 years were 36.1 for men and 59.1 for women. The peak incidence for depressive neurosis was middle adulthood, that for affective psychosis much later. The widowed and divorced showed much higher rates than the single and married for all types of disorder. Marriage appeared less protective for women than for men. The age-incidence relationship among the divorced and widowed was exaggerated for depressive neurosis and reversed for psychosis. The results are interpreted in terms of a (possibly biological) releasing effect of age upon affective psychosis that could be overwhelmed by severely adverse social circumstances. The findings support the validity of the distinction between affective psychoses and depressive neurosis.     

Serum and red blood cell folate in depression

Serum folate concentrations were estimated in patients with major depressive disorders, lithium-treated patients, detoxified alcoholic patients and normal controls. Red blood cell (RBC) folate concentrations were also estimated in subgroups of patients with major depressive disorder and normal controls. Results showed significantly lower serum and RBC folate concentrations in patients with major depressive disorder than in normal controls. Lower serum folate concentrations were associated with greater severity of depression. There was no association between serum and RBC folate concentrations and endogenicity of depression or the presence of weight loss.     

Narrowband UVB therapy for vitiligo: does the repigmentation last?

BACKGROUND: Since 1997, a number of trials have shown promising results in treating generalized vitiligo with narrowband ultraviolet B (UVB) both in adults and children. However, there is little knowledge concerning the duration and permanency of the treatment-induced repigmentation. OBJECTIVE: Our main objective was to perform a follow-up trial of successfully treated patients receiving narrowband UVB for generalized vitiligo. METHODS: We have investigated to what degree the treatment-induced repigmentation remains stable for up to 2 years post-treatment. We performed an initial open trial including 31 patients with generalized vitiligo. They received narrowband UVB thrice weekly for up to 12 months. Patients experiencing > 75% repigmentation were defined responders and were included in the follow-up trial. Responders were followed every 6 months for up to 2 years after cessation of treatment. We observed the pigmentation status and registered any changes indicating loss of pigmentation and relapse. RESULTS: Eleven of the 31 treated patients were included in the follow-up trial. Six patients had relapse and five patients had stable response 24 months after cessation of treatment. Four out of six relapses were within 6 months post-treatment. CONCLUSION: In our study population of 31 patients with generalized vitiligo, five patients (16%) experienced > 75% stable repigmentation 2 years after cessation of a treatment programme of up to 1 years narrowband UVB therapy.     

抑郁患者血清皮质醇与血压在应激前后的变化

目的研究抑郁患者血清皮质醇浓度、血压在应激前后的变化以及它们之间的关系。方法分别在安静状态、心理应激状态和心理应激后 (恢复状态 )测量抑郁组和对照组的血清皮质醇浓度、血压 ,比较两组上述指标的差异 ,以及心理应激前后的变化。心理应激以规定时间内的计算试验模拟 ,血清皮质醇以酶联免疫试验检测 ,血压为常规检测。结果 1.皮质醇 :抑郁组在安静状态、应激状态、恢复状态的皮质醇浓度显著高于对照组 (P <0 .0 5 ) ,抑郁组应激前后皮质醇浓度的波动显著小于对照组 (P <0 .0 5 )。2 .收缩压 :安静状态和恢复状态时抑郁组的收缩压显著高于对照组 (P <0 .0 5 ) ,应激状态时两组无统计学差异 ;应激前后收缩压的波动两组无统计学差异。 3 .舒张压 :抑郁组在安静状态时舒张压显著高于对照组(P <0 .0 5 ) ,在应激状态和恢复状态时两组无统计学差异 ;应激前后舒张压的波动两组无统计学差异。结论抑郁患者存在基础血压升高 ,此现象可能与抑郁患者血清皮质醇浓度升高有关。     

双侧内囊前肢毁损术治疗难治性强迫症疗效及随访研究

目的　对难治性强迫症进行双侧内囊前肢毁损术治疗 ,评定手术疗效并进行 2年随访 ,以进一步探索脑外科手术对难治性强迫症的疗效 ,并探讨手术治疗的良好适应症。方法　对 2 8例难治性强迫症患者进行双侧内囊前肢毁损术治疗 ,并分别在手术前、手术后二周、手术后三月、手术后六月、手术后一年、手术后二年进行Y BOCS、HAMA、HAMD量表评定及术后疗效评定。结果　 (1)强迫症患者手术后各期Y BOCS评分、HAMA评分与手术前比较均下降 ,有极显著差异 (P <0 .0 0 1) ;(2 )手术后各期Y BOCS的强迫思维评分均有明显下降 (P <0 .0 0 1) ,强迫行为在手术后 1年和 2年 ,与手术前比较无明显改变 (P >0 .0 5 ) ;(3)手术后 2年的总有效率为 5 3.5 % ,明显低于手术后 3月的总有效率 (P <0 .0 1)。结论　采用双侧内囊毁损术有相当的治疗效果 ,对于难治性强迫症患者可作为一种补充治疗手段 ;手术治疗对强迫行为的长期疗效较差 ,以严重的强迫思维为主的难治性强迫症患者为手术更好的适应症。     

Effect of chronic oral domperidone therapy on gastrointestinal symptoms and gastric emptying in patients with parkinson's disease

This study investigated whether domperidone could improve gastrointestinal symptoms in patients with Parkinson's disease who were receiving levodopa therapy. A total of 11 patients were studied. Following a baseline gastric emptying test, patients were treated with a starting dose of domperidone 20 mg p.o. q.i.d. A follow-up gastric emptying test was repeated at least 4 months after starting domperidone therapy. At the beginning and at each 3-month follow-up visit, symptoms of nausea, vomiting, anorexia, abdominal bloating, heartburn, regurgitation, dysphagia, and constipation were evaluated and scored on a scale of 0–3. The overall mean follow-up period was 3 years. Compared with their baseline evaluation, patients experienced a significant improvement in all symptoms (p < 0.05) except dysphagia and constipation. Gastric emptying of an isotope-labeled solid meal was significantly faster, with a baseline result of 60.2 ± 6.4% retention of isotope 2 h after the meal compared with 37.0 ± 2.2% retention during domperidone therapy (p < 0.05). Patients' global assessment of Parkinson's disease remained stable or improved. Serum prolactin was elevated in all patients after domperidone therapy (p < 0.05). Domperidone therapy significantly reduces upper gastrointestinal symptoms and accelerates gastric emptying of a solid meal, but does not interfere with response to antiparkinsonism treatment.     

微机判断血气的程序设计和临床应用

将肺心病、慢性肾炎等338例次的血气分析结果输入计算机,应用我们设计的多结果血气判断微机程序判断酸碱紊乱状态,其结果与人工综合判断结果完全相符。而单结果计算机判断和单纯人工判断的结果与人工综合判断结果的符合率分别为88.2％和87.3％。表明多结果计算机判断程序能有效地避免误判、漏判。