目的 比较氨磺必利与喹硫平治疗精神分裂症的疗效和安全性.方法 随机选取2016年8月～2018年8月我院精神分裂症患者60例,随机分为氨磺必利组(30例)和喹硫平组(30例),比较两组患者的PNASS评分、临床疗效、不良反应发生情况.结果 治疗前,两组患者的一般精神病理、阳性症状、阴性症状评分及PANSS总分之间无明显差异(P＞0.05)两组患者治疗后的一般精神病理、阳性症状、阴性症状评分及PANSS总分均显著低于治疗前(P＜0.05),但组间没有差异;氨磺必利组和喹硫平组的总有效率无明显差异(P＞0.05).氨磺必利组的不良反应发生率23.3％(7/30)显著低于喹硫平组43.3％(13/30)(P＜0.05).结论 氨磺必利与喹硫平治疗精神分裂症的疗效相当,但氨磺必利较喹硫平不良反应少.

目的评价参芪五味子片治疗围绝经期综合征患者的有效性和安全性。方法将患者随机分为治疗组和对照组,治疗组口服参芪五味子片,对照组口服尼尔雌醇。分别于治疗前后检测两组患者血浆FSH、LH及E2水平并观察两组临床疗效及不良反应。结果治疗组总有效率为93.0%,对照组总有效率为96.3%,两组疗效相当(P>0.05);两组治疗后血浆中FSH、LH含量均较治疗前明显降低(P<0.05或P<0.01),未发现与治疗相关的不良反应,无严重不良事件发生。结论参芪五味子片能够改善围绝经期综合征,临床用药安全、有效。

Objective To explore cognitive function in elderly depressed patients.Methods 33 elderly people(aged over 60)(depression group) with the first episode of depression diagnosed according to CCMD-3 and elderly healthy people (aged over 60)(control group) were investigated.All subjects were interviewed in semi-structured manner with common data and case history questionnaire,HAMD,HAMA,MMSE,and measured event-related potentials.Results The score of MMSE was significantly lower in depression group than in control group.N2 and P3 latency in depression group were significantly longer than those in control group.In elderly depressed patients,N2 and P3 latency were positively related to psychomotor retardation item of HAMD,but negatively related to score of MMSE.Conclusion Elderly depressed patients have cognitive dysfunction.

目的:探讨老年抑郁症与生活事件及社会支持的关系。方法:对44例60岁以上首次发作患者（抑郁组）、42名健康老年人（对照组）使用自制调查表、生活事件量表和社会支持评定量表评定。结果:抑郁组精神疾病家族史（χ2=6.157,P=0.026）、现患躯体疾病（χ2=11.993,P=0.001）和长期困境（χ2=23.242,P=0.000）明显高于对照组。抑郁组负性生活事件总分（19.2±15.9）高于对照组（10.1±7.0）（u=2.531,P=0.011）。抑郁组社交问题得分（3.4±6.9）高于对照组（1.1±3.5）（u=2.226,P=0.026）。两组负性生活事件数的差异无显著性意义（P＞0.05）。抑郁组社会支持总分（38.9±6.6）明显低于对照组（43.5±4.9）（u=3.308,P=0.001）。抑郁组对支持利用度（5.9±2.7）明显低于对照组（8.4±1.7）（u=4.444,P=0.000）。两组客观支持分和主观支持分的差异无显著性意义（P＞0.05）。结论:阳性家族史、慢性应激和社会支持不足是老年抑郁症发病的重要危险因素。

Objective:To explore psychosocial factors of depressed elderly patients. Methods:33 elderly people with the first episode of depression diagnosed according to CCMD-3, and elderly healthy people were investigated with EPQ, SSRS (social support rating scale), LES (life event scale) and MMSE (mini mental state examination). Results:The rates of psychiatric family history, somatic diseases, risk factors for vascular disease and long-term difficulties were significantly higher in the depressive group than in control group. The score of MMSE was significantly lower in depressive group than in control group. The scores of negative life events and problems in social intercourse were significantly higher in depressive group than in control group. There were lower score of social support and its utility in the depressive group than in control group. The score of neuroticism was significantly higher in the depressive group. Most depressive elderly patients had the personality of neuroticism.Conclusion:Chronic stress, high neuroticism and severe cognitive impairment are important risk factors for depression in late life.[

AIM: To assess the efficacy and safety of risperidone and haloperidol in the treatment of behavioral and psychological symptoms of dementia (BPSD). METHODS: It was a randomized, double-blind trial. The dosage strategy was flexible. The course of treatment was 8 wk. Twenty-eight patients of risperidone group had taken risperidone (1.3± s 0.5) mg·d -1, 0.5-2 mg·d -1. Twenty-five patients of haloperidol group had taken haloperidol, (2.8± 0.9) mg·d -1, 1-4 mg·d -1. They were all examined with some relative scales, such as BEHAVE-AD and CMAI, and some laboratory tests. RESULTS: After treatment, the scores of BEHAVE-AD and CMAI of patients in both groups were significantly reduced (P0.01) and there was no significant difference between them (P0.05). The prominent adverse drug reactions of both drugs was extrapyramidal symptoms (EPS). The incidence of EPS was 23 % in risperidone group, 40 % in haloperidol group. CONCLUSION: Low-dose risperidone and haloperidol shows good efficacy for treating BPSD and good tolerance for patients.

目的:探讨老年抑郁症的临床现象学特征.方法:按中国精神障碍分类与诊断标准第3版心境障碍抑郁发作诊断标准,收集33例60岁以上首次发作的患者(老年组),30例18～50岁首次发作的患者(青壮年组)进行对照研究.结果:老年组焦虑、激越、疑病、记忆减退、胃肠症状和伴发躯体疾病明显多于青壮年组,焦虑程度较青壮年组严重.老年组近期疗效比青壮年组差.结论:老年抑郁症症状特征及预后各方面均有自身的特点.

目的探讨利培酮治疗脑血管病所致精神障碍的疗效和安全性.方法将 86例脑血管病所致精神障碍患者 ,随机分为治疗组( 44例)和对照组( 42例),进行治疗观察和比较研究.疗效判定指标包括简明精神病评定量表( BPRS),临床总体印象量表( CGI),不良反应指标为副反应量表( TESS)及有关实验室检查.结果治疗结束,利培酮组和奋乃静组 BPRS评分分别为( 24.90± 3.74) ,( 24.90± 3.74) ,均较入组时均显著减低( P< 0.01);两组临床总有效率比较差异无显著性意义 (72%和 71%, P >0.05).但治疗组不良反应较对照组轻微,尤以活动减少、嗜睡的发生率显著少于对照组( P< 0.05).结论利培酮治疗脑血管病所致精神障碍疗效可靠、安全.

Objective To explore changes in immune functions,clinical features and psychological profiles of elderly depressed patients.Methods 24 elderly people aged over 60(depression group) with the first episode of depression diagnosed according to CCMD-3, and 26 elderly healthy people aged over 60(control group) were measured with cytokine and investigated with HAMD,HAMA,EPQ,and LES. Results Compared to control group, the serum levels of IL-1β and IL-6 were significantly higher in depression group than control group. The patients showed significantly elevated total scores on HAMD,HAMA and the N score of EPQ. The scores of negative life events and social intercourse problem were significantly higher in depression group than control group. The serum level of IL-6 was positively related to the scores of HAMD, HAMA, cognitive problem and somatic anxiety. Conclusion There are changes of immune activities in elderly depressed patients. Elderly depressed patients have bad condition on psychological profiles.

目的:探讨托吡酯对难治性抽动-秽语综合征的临床疗效及其副反应. 方法:对33例既往使用其他药物治疗无效的抽动-秽语综合征,改用氟哌啶醇或泰必利联合托吡酯治疗,并比较其疗前疗后的耶鲁综合抽动严重程度量表(YGTSS)及副反应量表(TESS)得分. 结果:疗后YGTSS量表中运动、发声及损害因子分较疗前显著降低,疗后发声与运动亦有显著好转,无明显副反应. 结论:托吡酯对抽动-秽语综合征有效,对发声的疗效优于对运动障碍的疗效.

Objective To investigate relationship between elderly dementia and plasma homocysteine level.Method 69 patients with elderly dementia(ED) and 69 heathy seniles were selected and their plasma homocysteine (Hcy)level was determined by high-performance liquid chromatography and fluorescene detector.Result Plasma Hcy level in study was (26.5± 11.8)μ mol/L while in control group it was (12.4± 2.4) μ mol/L,(P< 0.001). Conclusion Higher plasma Hcy level could be a risk factor to the onset of ED.

目的了解老年血管性痴呆(VD)患者的血浆总同型半胱氨酸(Hcy)水平.方法采用高效液相色谱仪和荧光检测技术,测定老年VD患者(n=51)和正常健康老人(n=51)血浆总Hcy水平.结果 VD组的血浆总Hcy水平为27.16±12.35μ mol/L,对照组的血浆总Hcy水平为12.73±2.46μ mol/L.经统计处理,表明两组血浆总Hcy水平存在显著差异(P<0.001).结论老年VD患者血浆总Hcy水平明显增高,高Hcy血症检测率显著高于对照组.

我们对老年期抑郁障碍患者用SSRI制剂(舍曲林或氟西汀)治 疗，现将研究结果报告如下。 1　对象与方法 　　自1999年6月～2000年12月期间我院的门诊或住院患者，共73例。符合CCMD-2-R抑郁发作 的诊断标准，汉密尔顿抑郁量表(HAMD)>18分。其中男36例，女37例；年龄60～78岁，平均( 63.48±2.57)岁；病期0.3～5.5年，平均(0.67±0.96)年。舍曲林组37例，口服剂量 50～100mg/d,平均(59.09±14.44)mg/d；氟西汀组36例口服剂量20～40mg/d，平均(25.0 ±7.4)mg/d。6周为1疗程。 2　结果 　　两组于疗后1～2周开始见效，6周末时疗效更为明显。舍曲林组显著有效17例，有效16例， 无效4例，总有效率为89.2%；氟西汀组分别为16、15和5例，总有效率为86.1%，两组无显 著差异(P>0.05)。HAMD与抑郁自评量表(SDS)每2周评定1次，各次评分均较前1次显著 减少(P均<0.01)，疗后6周较疗前减少更显著(P<0.001)。但两组间无显著差异 (P均>0.05)。不良反应舍曲林组发生9例，包括头痛4例，头昏2例，嗜睡、震颤、腹 泻各1例。而

目的　评价托吡酯(TPM)单药治疗难治性癫痫(IE)的疗效及其不良反应.方法　选择56例各种类型发作的IE患者给予TPM单药治疗,前8 周为调整期,后8周为稳定期,总观察期16周.每2周观察1次,疗效评估每4周1次.并对不同时期TPM剂量与癫痫发作次数作相关分析以及观察不良反应.结果　 56例患者(15例因多种原因中途退出者不含在内)TPM剂量241.67±75.66 mg/d(1 50～600 mg/d).调整期随着TPM剂量增加患者癫痫发作频率逐渐减少,呈显著相关性 (r =0.6327,P<0.0001);稳定期TPM剂量不增加而患者癫痫发作次数继续减少,相关性呈现下降趋势(r=0.5921,P<0.001;r=0.4044,P<0.01).全组有效率为73.21%,包括6例完全不发作者.治疗初期18例患者出现一过性轻度不良反应,治疗中未见病情恶化者.结论　托吡酯能有效减少难治性癫痫临床发作,较佳疗效时间窗在第12～16周.

目的了解乌灵胶囊治疗神经症的临床效果及其不良反应.方法对所有入选对象(n=126),顿服乌灵胶囊3粒,3次/日,8周为一疗程.治疗前及治疗后第4、8周,进行SCL-90等量表评定比较.结果所有入选对象在治疗过程中均未见任何不良反应,总有效率为62.70%.神经衰弱、抑郁性神经症显效率明显高于其他症型,SCL-90评定比较发现,躯体化、人际关系敏感、抑郁、焦虑因子分明显下降.结论乌灵胶囊是临床治疗神经症疗效可靠、安全的药物之一,特别对改善神经衰弱症状以及躯体不适等效果较显著.

编辑:本刊以"笔谈综合"形式,刊出精神药物副反应的综合稿已连续39期,欢迎作者们继续来稿,所述及的精神药物副反应希望是比较罕见而能足以确定的真实病例,我刊拟继续刊出.本期由16个单位29位作者所撰写的17篇来稿综合而成.

目的对照研究舍曲林与氟西汀治疗老年期抑郁症的临床疗效及其副反应.方法随机以舍曲林50～100mg/日(治疗组)或氟西汀20～40mg/日(对照组)治疗,6周为一疗程.作治疗前、后比较.结果舍曲林与氟西汀疗效相近,两组间比较无显著性差异.但治疗后TESS评定的行为毒性和其它因子分高于治疗前,呈显著性差异(P<0.05).结论舍曲林抗抑郁疗效可靠,副反应优于氟西汀,对老年期患者更为适合.

目的观察Alzheimer病(AD)患者脑电图(EEG)、脑电地形图(BEAM)变化特点.方法以健康老人(n=35)为对照组,选择AD 患者(n=35)进行EEG、BEAM比较观察组.结果统计学处理表明,两组间呈显著性差异P值<0.001.AD组EEG、 BEAM改变,特别是慢波、慢波相对功率谱(饼形图)较正常组明显.结论 E EG、BEAM检查,对于AD早期诊断、评价老年人健康状况具有重要实用价值.

目的:观察正常老人与阿尔茨海默病(AD)患者脑电图(EEG)脑电地形图(BEAM)变化特点. 方法:选择正常老人30名,阿尔茨海默病患者30例,进行EEG、BEAM检测,对所获资料进行分析. 结果:正常组EEG示:α节律变慢,调节变差,α指数减少;δ、θ波随着年龄增大,有明显增加趋势.BEAM示:α频带能量值较低,δ、θ频带能量值相对增加.AD组EEG示:α节律变慢和α指数减少;弥漫性δ、θ波进一步增加.BEAM示:α频带能量值相对降低,δ、θ频带能量相对增加.两组间比较,呈显著性差异(P<0.001).AD组EEG、BEAM改变,特别是慢波、慢波相对功率谱(饼形图)较正常组明显增加. 结论:EEG、BEAM检查,对于AD早期诊断、客观评价老年人健康状况,都有着重要实用价值.

5-HT2A受体在抑郁症及抗抑郁剂的药理机制中起重要作用,五羟色胺能神经元功能障碍与Alzheimer病亦有关系.本文综述了近年来国外学者在该方面的研究结果,报道如下.