艾司西酞普兰与文拉法辛治疗首发抑郁症对照研究

目的 探讨艾司西酞普兰与文拉法辛缓释剂治疗首发抑郁症的临床疗效和安全性.方法 将80例抑郁症患者随机分为两组,每组40例,研究组口服艾司西酞普兰治疗,对照组口服文拉法辛缓释胶囊治疗,观察6周.于治疗前及治疗第1周、2周、4周、6周末采用汉密顿抑郁量表评定临床疗效,副反应量表评定不良反应.结果 治疗1周末起,两组汉密顿抑郁量表总分均较治疗前有显著下降(P＜0.01),治疗各时段两组汉密顿抑郁量表总分及减分率差异均无显著性(P＞0.05);治疗6周末,研究组痊愈率52.63%、有效率为81.58%,对照组分别为54.05%、78.38%,两组差异无显著性(χ2=0.015、0.120,P＞0.05).两组不良反应均轻微,多出现在用药初期,随着时间的延长均可减轻或缓解,研究组恶心、多汗不良反应发生率显著低于对照组(P＜0.05或0.01),其他不良反应发生率两组差异均无显著性(P＞0.05).结论 艾司西酞普兰与文拉法辛缓释剂治疗首发抑郁症疗效显著,起效快,但艾司西酞普兰安全性更高,依从性更好.     

阿立哌唑与利培酮治疗首发精神分裂症对照研究

目的 探讨阿立哌唑治疗首发精神分裂症的临床疗效及安全性.方法 将70例首发精神分裂症患者随机分为两组,每组35例,阿立哌唑组口服阿立哌唑治疗,利培酮组口服利培酮治疗,观察8周.于治疗前及治疗2周、4周、8周末采用阳性与阴性症状量表、副反应量表评定临床疗效和不良反应.结果 治疗第2周末起,两组阳性与阴性症状量表总分及各因子分均较治疗前有显著下降(P＜0.01),同期两组间评分差异均无显著性(P＞0.05);治疗8周末,阿立哌唑组总有效率91.43%,利培酮组为88.57%,两组差异无显著性(χ2=0.159,P＞0.05).两组不良反应均轻微,利培酮组体重增加、月经不调/泌乳、震颤、肌强直、静坐不能等发生率均显著高于阿立哌唑组(P＜0.05或0.01).结论 阿立哌唑治疗精神分裂症疗效显著且与利培酮相当、安全性高、依从性好.     

齐拉西酮与阿立哌唑治疗首发精神分裂症对照研究

目的 探讨齐拉西酮与阿立哌唑治疗首发精神分裂症的临床疗效和安全性.方法 将59例首发精神分裂症患者随机分为两组,齐拉西酮组29例,口服齐拉西酮治疗,阿立哌唑组30例,口服阿立哌唑治疗.观察6周.于治疗前及治疗第2周、4周、6周末采用阳性与阴性症状量表、副反应量表评定临床疗效及不良反应.结果 治疗2周末,两组阳性与阴性症状量表总分及阳性症状、一般病理因子分均较治疗前有显著下降(P＜0.01),4周末阴性症状较治疗前有显著下降(P＜0.01),同期两组间评分差异均无显著性(P＞0.05);治疗6周末,齐拉西酮组有效率为79.3%,阿立哌唑组为80.0%,两组差异无显著性(χ2=0.004,P＞0.05).两组不良反应发生率低,程度较轻微,差异无显著性(χ2=0.141,P＞0.05).结论 齐拉西酮与阿立哌唑治疗首发精神分裂症疗效显著,对阴性、阳性症状及一般精神病理症状均有效,起效快,安全性高,依从性好.     

Life and treatment goals of individuals hospitalized for first-episode nonaffective psychosis

First-episode psychosis typically emerges during late adolescence or young adulthood, interrupting achievement of crucial educational, occupational, and social milestones. Recovery-oriented approaches to treatment may be particularly applicable to this critical phase of the illness, but more research is needed on the life and treatment goals of individuals at this stage. Open-ended questions were used to elicit life and treatment goals from a sample of 100 people hospitalized for first-episode psychosis in an urban, public-sector setting in the southeastern United States. Employment, education, relationships, housing, health, and transportation were the most frequently stated life goals. When asked about treatment goals, participants' responses included wanting medication management, reducing troubling symptoms, a desire to simply be well, engaging in counseling, and attending to their physical health. In response to queries about specific services, most indicated a desire for both vocational and educational services, as well as assistance with symptoms and drug abuse. These findings are interpreted and discussed in light of emerging or recently advanced treatment paradigms—recovery and empowerment, shared decision-making, community and social reintegration, and phase-specific psychosocial treatment. Integration of these paradigms would likely promote recovery-oriented tailoring of early psychosocial interventions, such as supported employment and supported education, for first-episode psychosis.     

Exposure to trauma and the clinical presentation of first-episode psychosis in South Africa

Objective

To evaluate the relationship between a history of traumatic experiences and the clinical features of first-episode psychosis (FEP).

Method

We tested associations between trauma variables and duration of untreated psychosis (DUP), age of onset (AO), PANSS-rated positive and negative symptoms and depressive symptoms (Calgary Depression Scale) in a sample of 54 FEP patients.

Results

Mean DUP was 34.4 weeks, while mean AO was 24.7 years. Witnessing a seriously violent assault (49%) was associated with high positive symptoms (p = 0.002), while a significant personal experience of racism and discrimination (39%) was associated with high depressive (p = 0.042) symptoms. Previous sexual assault (44% of females) was associated with high positive (p = 0.028) and negative (p = 0.035) symptoms with a trend association with depressive symptoms (p = 0.092).

Conclusion

Our findings suggest that previous traumatic experience is associated with positive and affective symptoms in FEP.     

Effects of risperidone and paliperidone pre-treatment on locomotor response following prenatal immune activation

Aim

Limited data are available regarding pharmacological characteristics of effective interventions for psychosis prevention. Enrollment challenges in psychosis prevention trials impede screening diverse interventions for efficacy. Relevant animal models could help circumvent this barrier. We previously described prevention with risperidone of abnormal behavior following neonatal hippocampal lesion. We aimed to extend those findings evaluating risperidone and paliperidone following prenatal immune activation, a developmental model of a schizophrenia risk factor. We evaluated a later developmental time point to determine persistent effects of drug treatment.

Methods

Pregnant Sprague-Dawley rats were injected with poly I:C or saline on gestational day 14. Offspring of poly I:C and saline-treated dams received risperidone (0.45 mg/kg/d), paliperidone (0.05 mg/kg/d), or vehicle from postnatal days 35-70. Locomotor responses to novelty, saline injection, and amphetamine (1 and 5 mg/kg) were determined at three months, i.e., 21 days following antipsychotic discontinuation.

Results

Risperidone and paliperidone had persistent effects on behavioral response to amphetamine (1 mg/kg) at 3 months, ameliorating the impact of prenatal immune activation on offspring of poly I:C-treated dams. Risperidone, but not paliperidone, also exerted persistent effects in offspring of saline-treated dams on locomotor response to saline and amphetamine (5 mg/kg) injection.

Conclusions

Risperidone and paliperidone pre-treatment of poly I:C offspring during peri-pubertal development stabilized response to amphetamine exposure persisting into early adulthood. Prenatal immune activation provides a model for evaluating effects of an environmental risk factor for schizophrenia, and has potential utility for identifying pharmacological approaches to early intervention.     

首发与复发抑郁症患者血清犬尿氨酸途径代谢物水平比较

背景 抑郁症发病机制至今尚未完全清楚,既往研究表明,犬尿氨酸途径（KP）在抑郁症发病中具有重要作用。目的 探讨首发和复发抑郁症患者血清KP代谢物水平的差异,并分析血清KP代谢物水平与抑郁症状严重程度的关系,为预防抑郁症复发提供参考。方法 连续纳入2016年11月-2018年12月在广州医科大学附属脑科医院门诊就诊的符合《精神障碍诊断与统计手册（第5版）》（DSM-5）诊断标准的136例抑郁障碍患者为研究组,其中首发组62例,复发组74例。同时纳入60例健康被试作为对照组。所有患者均接受汉密尔顿抑郁量表17项版（HAMD-17）评定。采用液相色谱串联质谱（LC-MS/MS）法检测抑郁障碍患者和对照组血清色氨酸（TRP）、犬尿氨酸（KYN）以及犬尿喹啉酸（KYNA）水平。采用偏相关分析考查抑郁症患者HAMD-17各因子评分及总评分与KP代谢物水平的关系。结果 与对照组相比,首发组和复发组TRP水平更低（t=-3.044、-4.477,P<0.05或0.01）,KYN/TRP更高（t=2.343、3.644,P<0.05或0.01）,差异均有统计学意义。与复发组相比,首发组和对照组KYNA水平更高（t=2.490、2.636,P<0.05或0.01）,KYNA/KYN更高（t=2.894、2.616,P均<0.01）,差异均有统计学意义。偏相关分析显示,首发抑郁症患者KYN/TRP与HAMD-17的焦虑/躯体化因子评分呈正相关（r=0.261,P<0.05）,KYNA/KYN与HAMD-17总评分及阻滞评分均呈负相关（r=-0.286、-0.282,P均<0.05）;复发抑郁症患者KYN/TRP与焦虑/躯体化评分呈正相关（r=0.280,P<0.05）。结论 首发和复发抑郁症患者血清KP代谢物水平存在差异,且复发患者KP代谢物水平异常更明显,KP代谢物可能是抑郁症辅助诊断及判断复发的潜在生物标志物。     

阿立哌唑与利培酮治疗首发女性精神分裂症对照研究

目的 探讨阿立哌唑与利培酮治疗首发女性精神分裂症患者的临床疗效和安全性.方法将60例首发女性精神分裂症患者随机分为两组,每组30例,研究组口服阿立哌唑治疗,对照组口服利培酮治疗,观察8周.于治疗前及治疗第2周、4周、6周、8周末采用阳性与阴性症状量表评定临床疗效,副反应量表评定不良反应.结果 治疗后两组阳性与阴性症状量表总分及各因子分均较治疗前有显著下降(P＜0.01),同期两组间比较差异均无显著性(P＞0.05).治疗8周末,研究组有效率为93.3%,对照组为90.0%,两组有效率差异无显著性(χ2=0.218,P＞0.05).两组不良反应均轻微,研究组锥体外系反应、停经及体质量增加发生率显著低于对照组,但直立性低血压发生率高于对照组(P＜0.05).结论 阿立哌唑治疗首发女性精神分裂症疗效显著且与利培酮相当,安全性更高,依从性更好.     

阿立哌唑与洛沙平治疗首发精神分裂症对照研究

目的 探讨阿立哌唑与洛沙平治疗首发精神分裂症患者的临床疗效和安全性.方法 将120例首发精神分裂症患者随机分为两组,每组60例,研究组口服阿立哌唑治疗,对照组口服洛沙平治疗,观察6周.于治疗前及治疗第2周、4周、6周末采用阳性与阴性症状量表评定临床疗效,副反应量表评定不良反应.结果 治疗后两组阳性与阴性症状量表总分及各因子分均较治疗前有显著下降(P＜0.01),同期两组间比较差异均无显著性(P＞0.05);治疗6周末,研究组显效率70.0%、有效率90.0%,对照组分别为76.7%、91.7%,两组疗效差异无显著性(P＞0.05).两组不良反应均较轻微,研究组恶心呕吐、头晕头痛、嗜睡不良反应发生率均显著高于对照组(P＜0.05或0.01);锥体外系反应、肌强直、体质量增加、内分泌改变、月经改变和泌乳、性欲改变不良反应发生率均显著低于对照组(P＜0.01).结论 阿立哌唑治疗首发精神分裂症疗效显著且与洛沙平相当,不良反应轻微,安全性高,依从性好,可作为治疗精神分裂的一线药物在临床推广应用.     

哌罗匹隆与奎硫平治疗首发精神分裂症的临床疗效比较

目的比较哌罗匹隆与奎硫平治疗首发精神分裂症的临床疗效。方法将该院2009年3月—2011年9月间收治的82例首发精神分裂症患者随机分为哌罗匹隆治疗组和奎硫平治疗组,每组各41例,观察两组患者的临床疗效及不良反应情况。结果哌罗匹隆组患者治疗后总有效率为95.1%,喹硫平组患者治疗后总有效率为92.7%,组间差异无统计学意义（P〉0.05）。哌罗匹隆组不良反应发生率为12.2%,喹硫平组不良反应发生率为9.8%,组间差异无统计学意义（P〉0.05）。结论哌罗匹隆与奎硫平治疗首发精神分裂症临床疗效确切,哌罗匹隆和临床疗效咯优于奎硫平是安全有效的抗精神病药物,值得临床进一步推广使用。