利培酮治疗首发精神分裂症的临床疗效观察

目的：观察利培酮治疗首发精神分裂症的疗效，副反应及最佳剂量。方法：首次使用可变剂量的利培酮治疗首发精神分裂症8周，使用阳性和阴性症状量表（PANSS）及不良反应症状量表（TESS）分别评定疗效和副反应。结果：全部病例完成8周治疗。治疗前后PANSS减分率比较，差异有极显著性（P＜0．001），显效率为81．63％，有效率达95．92％，起效时间在第2－4周，最佳剂量≤4mg/d，低剂量组（≤4mg/d)PANSS减分率大于高剂量组（＞4mg/d)，较多见副反应为EPS（20．41％），结论：低剂量利培酮（≤4mg/d)治疗首发精神分裂症安全，有效，病人依从性好。     

Cortisol and dehydroepiandrosterone-sulphate levels correlate with symptom severity in first-episode psychosis

Background

Dehydroepiandrosterone (DHEA) and its sulphate form (DHEA) are neuroactive steroids with antiglucocorticoid properties. An imbalance in the ratio of cortisol to DHEA(S) has been implicated in the pathophysiology of stress-related psychiatric disorders. This study prospectively investigated circulating cortisol, DHEAS and their ratio in first-episode psychosis (FEP) patients compared to healthy controls, and their relationship to perceived stress, psychotic, negative and mood symptoms.

Methods

Blood cortisol and DHEAS levels were obtained in 39 neuroleptic-naïve or minimally-treated FEP patients and 25 controls. Twenty-three patients and 15 controls received repeat assessments after 12 weeks. Perceived stress was assessed using the Perceived Stress Scale and symptoms were assessed in patients using standard rating scales.

Results

At baseline, no differences were observed in cortisol, DHEAS or the cortisol/DHEAS ratio between patients and controls. There were also no group differences in the change in these biological variables during the study period. Within FEP patients, decreases in cortisol and the cortisol/DHEAS ratio over time were directly related to the improvement in depression (r = 0.45; p = 0.031, r = 0.52; p = 0.01), negative (r = 0.51; p = 0.006, r = 0.55; p = 0.008) and psychotic symptoms (cortisol only, r = 0.53; p = 0.01). Perceived stress significantly correlated with DHEAS (r = 0.51; p = 0.019) and the cortisol/DHEAS ratio (r = −0.49; p = 0.024) in controls, but not patients, possibly reflecting an impaired hormonal response to stress in FEP patients.

Conclusions

These findings further support the involvement of the stress system in the pathophysiology of psychotic disorders, with implications for treatment strategies that modulate these neurosteroids.     

文拉法辛与氟西汀治疗首发抑郁症对照观察

目的探讨文拉法辛与氟西汀治疗首发抑郁症的疗效和安全性。方法将56例首发抑郁症患者随机分为两组,分别给予文拉法辛和氟西汀治疗8周。结果文拉法辛与氟西汀均具有良好的抗抑郁作用,疗效差异无显著性(t=0.86,P0.05)。结论文拉法辛和氟西汀都是治疗抑郁症较理想的药物。     

首发抑郁症患者脂代谢的研究

目的探讨首发抑郁症患者的脂代谢情况.方法对200例首发抑郁症患者及100名健康的人先进行体脂参数的测量,然后检测其空腹血浆甘油三脂、胆固醇的浓度.结果体脂参数,抑郁症组与对照组两组比较无统计学差异(P>0.05);抑郁症组甘油三脂(TG)值明显高于对照组,两组比较有显著性差异(P<0.01);而高密度脂蛋白(HDL—ch)、载脂蛋白A1(ApoA1)值抑郁症组明显低于对照组,两组比较有显著性差异(P<0.01),血浆总胆固醇(TC)、低密度脂蛋白胆固醇(LDL—ch)和载脂蛋白B(ApoB)值两组间均无统计学差异(P>0.05).结论首发抑郁症患者存在一定的脂代谢异常,临床医师应该对抑郁症患者的血脂进行随访监测,以便早期发现、治疗脂代谢性疾病.     

MMPI对首发偏执型精神分裂症的价值探讨

目的探讨MMPI（明尼苏达多项人格测查表）在首发偏执型精神分裂症中的特征及诊断价值。方法对首发偏执型精神分裂症患者,在未治疗前行MMP测试,分析其有效测评结果,并与之按1：1匹配正常组对照分析。结果首发偏执型精神分裂症患者组有2个效度量表及7个临床子量表的T分均与正常对照组差异有统计学意义;临床子量表两点测图Pa（偏执）、Se（精神分裂）模式的T分,患者组与正常对照组差异有统计学意义;MMPI的测试结果无法解决敏感性与特异性间矛盾,存在假阳性与假阴性结果。结论MMPI对首发偏执型精神分裂症的敏感性与特异性高于正常人群的随机水平,将其作为精神科临床辅助检查工具有一定的实用价值,但无法替代临床精神检查。     

Problems in remembering to carry out future actions in first-episode schizophrenia: Primary or secondary impairment?

Prospective memory (PM) is the ability to remember to carry out intended actions in the future. Empirical evidence suggests that PM deficits exist in individuals with chronic schizophrenia. However, it is unclear whether PM deficits in first-episode schizophrenia exist independently from other neuropsychological deficits. Moreover, prior research using patients with first-episode has been limited to small inpatient samples. We aimed to clarify the nature and extent of PM deficits in individuals with first-episode schizophrenia, using a large outpatient sample. Participants were 91 clinically stable outpatients with first-episode schizophrenia and 83 healthy controls. PM was assessed using both a subjective self-reported checklist and a laboratory-based task capturing time- and event-based PM. A battery assessing verbal and visuo-spatial working memory, as well as executive functions was also administered. ANOVA analyses showed that patients with first-episode schizophrenia performed significantly poorer than healthy controls in time- and event-based PM. Stepwise linear regression analyses suggested that cognitive flexibility predicted time- and event-based PM; and working memory predicted event-based PM. Subgroup analyses showed that “cognitive-preserved” patients with first-episode schizophrenia tended to perform poorer in time-based PM deficit than healthy controls who were matched in IQ and other neuropsychological functions. Overall, our results provide substantial evidence to support that time-based PM deficits in first-episode schizophrenia are apparent and not entirely attributable to other neuropsychological deficits. PM may constitute a neuropsychological marker for schizophrenia.     

Temporal stability of smooth-pursuit eye tracking in first-episode psychosis

We evaluated the temporal stability of smooth-pursuit eye tracking in 38 schizophrenic, 42 nonschizophrenic psychotic (bipolar, depressive, paranoid psychotic, and schizophreniform), and 49 normal subjects. Pursuit performance was evaluated on two testing occasions separated by approximately 9.5 months. Retest reliability coefficients of root mean square (RMS) error scores for schizophrenic and normal subjects were .68 and .57, respectively. The reliability coefficients of RMS error scores for the nonschizophrenic psychotic patients ranged from .44 to .51. Level of psychological functioning was not significantly related to tracking performance, and most patients' pursuit performance remained stable despite changes in medication and clinical status. These results support the hypothesis that eye tracking dysfunction is a trait characteristic that can serve as a vulnerability indicator of schizophrenia.     

阿立哌唑联合小剂量氯氮平治疗首发精神分裂症的临床观察

目的探讨阿立哌唑联合小剂量氯氮平治疗首发精神分裂症的临床疗效。方法选择2015年1月~2016年1月住院治疗的首发精神分裂症患者70例,将70例患者随机分为观察组和对照组,每组35例,对照组予氯氮平初始剂量为50 mg/d,2周内渐加量至250~400 mg/d,疗程8周,可酌情使用β-受体阻滞剂、抗胆碱能药物和对症治疗的药物。观察组同时联合阿立哌唑初始剂量10 mg/d,每日1次口服,最大剂量30 mg/d,疗程8周,整个治疗过程中根据病情可酌情使用苯二氮卓类药和抗胆碱药。两组均不合并使用其他抗精神病药物。结果观察组治疗后的总有效率达94.29%,明显高于对照组83.86%,两组总有效率比较,差异无统计学意义(P0.05)。观察组与对照组患者治疗前的PANSS各项评分阳性症状、阴性症状、一般精神病理及总分组间比较,差异不显著(P0.05)。但治疗后4周、8周,观察组患者的PANSS各项评分阳性症状、阴性症状、一般精神病理及总分分别显著低于对照组,组间差异有统计学意义(P0.05)。观察组的并发症发生率显著低于对照组,差异有统计学意义(P0.05)。结论阿立哌唑联合小剂量氯氮平治疗首发精神分裂症疗效确切,可以显著改善患者的临床症状,不良反应少,安全性好,值得广泛推广和应用。     

奥氮平治疗首发精神分裂症的疗效分析

目的　探讨奥氮平治疗首发精神分裂症的临床疗效、不良反应。方法　将 3 6例符合 CCMD-2 -R诊断标准的首发精神分裂症病人予奥氮平治疗 8周 ,用阳性与阴性症状量表 ( PANSS)和副反应量表 ( TESS)评定其疗效和不良反应。结果　完成 8周治疗的 3 6例首发精神分裂症病人 ,基本痊愈 1 0例 ( 2 7.8% ) ,显进 1 2例 ( 3 3 .3 % ) ,进步 8例 ( 2 2 .2 % ) ,无效 6例( 1 6.7% ) ,总有效率为 83 .3 % ,不良反应少。结论　奥氮平治疗首发精神分裂症安全有效。