齐拉西酮与奥氮平治疗早期精神分裂症的临床效果比较

目的 探讨齐拉西酮和奥氮平对于治疗早期精神分裂症的临床疗效及比较两者的安全性。方法 选取我院2017年9月～2019年2月收治的60例早期精神分裂症患者作为研究对象,采用数字随机法将所有患者分成对照组30例和观察组30例,对照组给予奥氮平治疗,观察组给予齐拉西酮治疗。2周为1个疗程,两组均进行8周4个疗程治疗。比较两组患者于治疗前和治疗后2、4、8周进行阳性和阴性症状量表(PANNS)评分,病情严重程度(SI)、疗效总评(GI)评分和不良反应。结果 治疗2周、4周后,两组患者的PANSS评分和SI、GI评分均较低于治疗前,但两组的PANSS评分和SI、GI评分比较,差异无统计学意义(P0.05);疗程结束后,观察组的患者PANSS评分和SI、GI评分均低于对照组,差异有统计学意义(P0.05);治疗期间,对照组的不良反应发生率高于观察组,差异有统计学意义(P0.05)。结论 对于治疗早期分裂症患者,齐拉西酮的长期治疗效果明显优于奥氮平,且安全可靠,值得临床上进一步推广。     

Glutamate hypothesis in schizophrenia

Schizophrenia is a chronic and severe psychiatric disorder that has profound impact on an individual’s life and on society. Thus, developing more effective therapeutic interventions is essential. Over the past quarter‐century, an abundance of evidence from pharmacologic challenges, post‐mortem studies, brain imaging, and genetic studies supports the role of glutamatergic dysregulation in the pathophysiology of schizophrenia, and the results of recent randomized clinical trials based on this evidence have yielded promising results. In this article, we review the evidence that alterations in glutamatergic neurotransmission, especially focusing on the N‐methyl‐d ‐aspartate receptor (NMDAR) function, may be a critical causative feature of schizophrenia, how this contributes to pathologic circuit function in the brain, and how these insights are revealing whole new avenues for treatment development that could reduce treatment‐resistant symptoms, which account for persistent disability.     

高海拔地区精神分裂症患考临床特征分析

目的:了解高海拔环境对精神分裂症的影响。方法:对106例高海拔地区精神分裂症患者(高海拔组)的临床特征、疗效、药物副作用进行调查,与同期106例平原精神分裂症患者(平原组)对照。结果:高海拔组临床症状以幻觉、疑病妄想、夸大妄想、紧张冲动行为及焦虑、抑郁等精神症状出现频率较高,而对照组以被害妄想、情感淡漠等精神症状出现频率较高(P<0.01或P<0.05);入院时高海拔组总体病情较重(P<0.01);两组间疗效无显著性差异;高海拔组药物不良反应多于平原组。结论:高海拔地区精神分裂症患者临床特征、总体病情严重程度、药物不良反应与平原地区有一定区别,可能与高海拔环境有关。     

奥兰扎平治疗精神分裂症58例临床观察

目的观察奥兰扎平治疗精神分裂症的临床疗效与安全性.方法选择58例精神分裂症病人,开始给予奥兰扎平5mg*d-1,3d后根据临床疗效、副反应情况酌情增加剂量,最大剂量不超过20mg*d-1,治疗8周.治疗前及治疗后每2周用PANSS、CGI、TESS量表评定1次.结果治疗后PANSS总分、各因子分较治疗前显著下降(P<0.01),副反应主要有抗胆碱症状、过度镇静、体重增加、一过性丙氨酸氨基转移酶升高.结论奥兰扎平是一种安全、有效、副作用较轻的抗精神病药.     

慢性老年精神分裂症患者认知功能及其与日常生活能力的比较研究

目的 :了解慢性老年精神分裂症患者认知功能和日常生活能力状况 ,探讨此类患者在额叶执行功能和记忆方面的神经心理功能障碍及其特征。方法 :采用简易智力状态检查 (MMSE)、日常生活能力量表 (ADL)、威斯康星卡片分类测验 (WCST)及韦氏记忆量表 (WMS)对 31例慢性老年精神分裂症和 31例正常对照组进行比较研究。结果 :慢性老年精神分裂症组MMSE得分明显低于正常对照组 (P <0 .0 1) ;而该组ADL总分明显高于正常对照组(P <0 .0 5 )。除非持续错误外 ,慢性老年精神分裂症患者的威斯康星卡片分类测验和韦氏记忆量表的各项测验成绩均差于对照组 (P <0 .0 5 )。结论 :慢性老年精神分裂症患者认知功能的障碍决定了患者日常生活能力的减退 ;这类患者有明显的额叶执行功能障碍和记忆障碍     

The First‐Episode Psychosis Outcome Study: premorbid and baseline characteristics of an epidemiological cohort of 661 first‐episode psychosis patients

Aims: Studies conducted in first‐episode psychosis (FEP) samples avoid many biases. However, very few studies are based on epidemiological cohorts treated in specialized FEP services. The aim of this file audit study was to examine premorbid and baseline characteristics of a large epidemiological sample of FEP. Methods: File audit study of all patients admitted to the Early Psychosis Prevention and Intervention Centre between 1998 and 2000 using a specialized questionnaire. Results: There were 661 patient files included in the study. Premorbid evaluation revealed high rates of substance use disorder (74.1%), history of psychiatric disorder (47.5%), past traumatic events (82.7%) suicide attempts (14.3%) and family history of psychiatric illness (55.6%). Baseline characteristics revealed high intensity of illness (mean CGI 5.5), high prevalence of lack of insight (62%) and high rate of comorbidity (70%). Conclusion: High rates of traumatic events or episodes of mental illness before treatment for FEP must be considered when designing treatment approaches because a too narrow focus on positive psychotic symptoms will inevitably lead to incomplete treatment. Additionally, early intervention programmes need sufficient range of resources to address the multiple challenges presented by FEP patients such as high severity of illness, comorbidities and functional impairment. Finally, observation of an important degree of functional impairment despite short duration of untreated psychosis suggests that while early detection of FEP is a necessary step in early intervention, it may not be sufficient to improve functional recovery in psychosis and that efforts aimed at identifying people during the prodromal phase of psychotic disorders should be pursued.     

Acetylcholinesterase inhibitors may improve myelin integrity.

Recent clinical trials have revealed that cholinergic treatments are efficacious in a wide spectrum of neuropsychiatric disorders that span the entire human lifespan and include disorders without cholinergic deficits. Furthermore, some clinical and epidemiological data suggest that cholinergic treatments have disease modifying/preventive effects. It is proposed that these observations can be usefully understood in a myelin-centered model of the human brain. The model proposes that the human brain's extensive myelination is the central evolutionary change that defines our uniqueness as a species and our unique vulnerability to highly prevalent neuropsychiatric disorders. Within the framework of this model the clinical, biochemical, and epidemiologic data can be reinterpreted to suggest that nonsynaptic effects of cholinergic treatments on the process of myelination and myelin repair contributes to their mechanism of action and especially to their disease modifying/preventive effects. The ability to test the model in human populations with safe and noninvasive imaging technologies makes it possible to undertake novel clinical trial efforts directed at primary prevention of some of the most prevalent and devastating of human disorders.     

Levels-of-processing effects in first-degree relatives of individuals with schizophrenia.

BACKGROUND: First-degree relatives of individuals with schizophrenia show cognitive impairments that are similar to but less severe than their ill relatives. We have shown that memory impairments can be improved and prefrontal cortical (PFC) activity increased in individuals with schizophrenia by providing beneficial encoding strategies. The current study used a similar paradigm to determine whether siblings of individuals with schizophrenia (SIBs) also show increases in brain activity when presented with beneficial encoding strategies. METHODS: Twenty-one SIBs and 38 siblings of healthy comparison subjects underwent functional magnetic resonance imaging scans while engaged in deep (abstract/concrete judgments) and shallow (orthographic judgments) encoding. Subjects were then given a recognition memory test. RESULTS: The groups did not differ on encoding or recognition accuracy, and the SIBs benefited from deep encoding to a similar degree as control subjects. The SIBs showed deep encoding-related activity in a number of PFC regions typically activated during semantic processing. However, SIBs showed more activity than control subjects in three subregions of PFC (left BA 44 & BA 47 bilaterally). CONCLUSIONS: Siblings of individuals with schizophrenia benefit from supportive verbal encoding conditions. Like individuals with schizophrenia, SIBs also show increased task-related activity in a larger number of PFC subregions than control subjects during deep verbal encoding.     

Sulpiride in negative schizophrenia: A placebo-controlled double-blind assessment

Twenty-four chronic schizophrenic long-stay hospital patients were identified, who had not received neuroleptic drugs for 8–30 (average 8 months) and met or exceeded a minimum criterion of severity of negative symptoms. They were rendomly alocated to either sulpiride 200 mg twice daily or matching placebo, on a double-blind basis for 12 weeks. The results showed that low-dose sulpiride was significantly better than placebo in relation to improvements in negative symptoms. The changes in social behaviour were complex and not obviously related to symptom improvement; exhibited abnormal behaviour, a major factor in preventing successful return to the community, consistently improved only on the active drug.