目的 探讨CYP2C19 基因多态性对舍曲林治疗儿童青少年抑郁症临床疗效和耐受性的影响.方法 连续招募 198 例18 岁以下的抑郁症患者,根据临床经验给予舍曲林100～200 mg/d治疗,疗程6 周.采用汉密尔顿抑郁量表17项(HAMD-17)于治疗前及治疗后第 2、4、6 周末评分以判断临床疗效,治疗后第 2、4、6 周末采用治疗中需处理的不良反应症状量表(TESS)评估患者的不良反应.采用DNA微阵列芯片法检测CYP2C19 基因型.依据CYP2C19 基因型,将患者分为慢代谢组、中等代谢组和快代谢组,分析药物疗效和耐受性.结果 198 例患者中有快代谢型 63 例(快代谢组),中等代谢型92 例(中等代谢组),慢代谢型43 例(慢代谢组).治疗后第6 周末,三组治疗有效率比较差异有统计学意义(P＜0.05),中等代谢组和慢代谢组治疗有效率均高于快代谢组(P＜0.05).中等代谢组和慢代谢组在治疗后第 2、4、6 周末HAMD-17 评分均较各自治疗前降低(P＜0.05).治疗后第 2、4、6 周末,不同代谢组之间HAMD-17 评分比较差异均存在统计学意义(P＜0.05).治疗 6 周后,两组不良反应发生率比较差异不存在统计学意义(P＞0.05).回归分析的结果提示,儿童青少年抑郁症患者快代谢型获得舍曲林疗效的机会仅为中等代谢型的 25.9%(P＜0.05).结论 CYP2C19 基因多态性对舍曲林治疗儿童青少年抑郁症的疗效和耐受性有影响,中等代谢型和慢代谢型优于快代谢型.

目的 观察加减通窍活血汤联合富马酸喹硫平片治疗双相情感障碍(BD)躁狂发作痰火扰神兼气血瘀滞证的临床疗效.方法 将114例BD躁狂发作痰火扰神兼气血瘀滞证患者按照随机数字表法分为2组,对照组57例予富马酸喹硫平片治疗,治疗组57例在对照组基础上联合加减通窍活血汤治疗.2组均治疗8周统计疗效,比较2组治疗前及治疗3 d、2周、4周、8周倍克-拉范森躁狂量表(BRMS)评分和副反应量表(TESS)评分变化情况,比较2组治疗前及治疗8周阳性和阴性精神症状评定量表(PANSS)、汉密尔顿抑郁量表(HAMD)评分、认知功能指标[包括威斯康星卡片分类测验(WCST)、言语记忆测验(HVLT-R)、视听觉注意力持续操作测验(CPT)]及血清脑源性神经营养因子(BD-NF)、白细胞介素-1β(IL-1β)、肿瘤坏死因子α(TNF-α)水平变化情况.结果 治疗组总有效率94.74％(54/57),对照组总有效率77.19％(44/57),治疗组疗效优于对照组(P<0.05).2组治疗3 d、2周、4周、8周BRMS评分与本组治疗前比较均降低(P<0.05),且治疗组治疗3 d、2周、4周、8周BRMS评分均低于对照组.2组治疗8周PANSS评分、HAMD评分与本组治疗前比较均降低(P<0.05),且治疗组治疗8周PANSS评分、HAMD评分均低于对照组(P<0.05).2组治疗8周CPT评分与本组治疗前比较均增加(P<0.05),WCST评分、HVLT-R评分虽然也有增加趋势但比较差异无统计学意义(P>0.05),治疗组治疗8周CPT评分高于对照组(P<0.05).2组治疗8周与本组治疗前比较BDNF水平增加(P<0.05),IL-1β、TNF-α水平降低(P<0.05),且治疗组治疗8周改善均优于对照组(P<0.05).2组治疗3 d、2周、4周、8周TESS评分组间比较差异均无统计学意义(P>0.05),但2组治疗2、4、8周TESS评分较本组治疗3 d均升高(P<0.05).结论 加减通窍活血汤联合富马酸喹硫平片治疗BD躁狂发作痰火扰神兼气血瘀滞证疗效确切,可有效控制患者的躁狂症状,改善精神和抑郁症状,提高其持续性注意力水平,促进BDNF表达,促进神经修复,降低IL-1β、TNF-α水平,降低炎性反应,且不会增加药物不良反应,安全可靠.

目的:讨论氨磺必利与利培酮治疗首发精神分裂症的临床疗效及安全性分析.方法:此次研究方式将60例患有精神分裂症的患者分为两组进行比较,所有患者的入院治疗时间均在2016年3月 ～2017年8月期间,其中一组患者采用磺必利进行治疗,而另一组采用利培酮进行治疗.结果:观察组患者的不良反应发生率为16.67％,研究组患者的不良反应发生率为30.00％,p<0.05,在治疗效果方面,两组患者的差异不明显,而治疗后患者PANSS分值明显下降,但是观察组和研究组患者的数据差异不大,p>0.05.结论:在治疗首发精神分裂症的临床中,氨磺必利与利培酮的两种治疗效果均较为理想,但是氨磺必利的不良反应较低,安全性较高.

患者，男，20岁，学生。主诉间断性精神失常5年，加重4 d于2011年2月11日入院。患者缘于2005年7月因未考入理想的学校而出现情绪低落，话少，精神差，不出门，考虑问题多。2007年出现全身不适，胸闷，眼痛，有时双眼交替疼痛，就诊于北京安定医院，诊断为“阴性抑郁”，给予舍曲林治疗，10d后眼痛减轻能上学。2010年6月4日因病情波动2周入住我院，患者院外表现说话明显增多，认为家属不理解自己，情绪不稳，易激动，表示自己在学校受了大委屈而哭泣，自觉聪明。住我院诊断“双相情感—躁狂发作”。给丙戊酸钠，碳酸锂，富马酸喹硫平片治疗26d病情痊愈后出院。本次住院前4d，患者因情绪不稳，发脾气，拒绝服药，再次住院。住院后因拒药给氟哌啶醇注射液10mg肌内注射，20min后患者出现表情痛苦，烦躁不安、不能静坐、反复走动或原地踏步。极度痛苦，脉搏118次／min，给东莨菪碱0．3mg，氯硝西泮1mg肌内注射，上述症状仍无明显缓解，患者睡眠时和转移注意力后症状缓解，其余时间反复找大夫要药，说自己受不了，踏步踏样动作，左脚、右脚，轮流不停。后给予盐酸普奈洛尔、异丙嗪、地西泮口服，3d后症状逐渐缓解。

Objective:To investigate the clinical efficacy and safety of paroxetine combined with olanzapine in the treatment of senile depression.Methods:66 cases with depression were randomly divided into the study group and the control group.The study group were treated with paroxetine combined with olanzapine.The control group were only treated with paroxetine.They were observed for 8 weeks.We assessed the efficacy by the Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA) before and after the treatment of 1 week,2 weeks,4 weeks,8 weeks.We assessed the safety by the Treatment Emergent Symptom Scale(TESS).Results:The curative effect of paroxetine with small dose of olanzapine is significantly.The significant efficiency rate of the study group and the control group were 75% and 51.5% respectively.There was significant difference(P<0.05).Conclusion:Paroxetine Combined with olanzapine in the treatment of depression and anxiety has a rapid onset.It can improve curative effect.

Objective:To discuss the efficacy and safety of Shu Gan Jie Yu capsule combined with paroxetine in the treatment of senile depression complicated with anxiety.Methods:64 patients with senile depression combined with anxiety were selected,they were randomly divided into the treatment group and the control group.The treatment group was treated with Shu Gan Jie Yu capsule combined with paroxetine;the control group was treated with paroxetine individually,the course of treatment was 8 weeks. We evaluated the curative effect with hamilton depression scale(HAMD) and hamilton anxiety scale(HAMA).We evaluated the safety with the treatment emergent symptom scale(TESS).Results:HAMD and HAMA score of two groups were decreased after treatment;compared with before treatment,it was decreased significantly after 8 weeks with statistical significance.In the first and the second weekend,we compared the HAMD and HAMA score of the two groups,the difference was not significant;the differences of HAMD and HAMA score at the fourth and sixth weekend were statistically significant(P<0.01).After 8 weeks treatment,the total effective rate was 50% in the control group;the total efficiency rate was 75% in the treatment group,the treatment group was better than that of the control group(P<0.05).TESS scores of the two groups at 1,2,4 and 8 weeks after treatment were not statistically significant(P>0.05).Conclusion:The effect of Shu Gan Jie Yu capsule combined with paroxetine in the treatment of senile depression complicated with anxiety is better.

Objective To discuss the effect of shuganjieyu capsule combined with paroxetine in the treatment of se-nile depression. Methods 90 cases of patients with senile depression were randomly divided into treatment group and control group,esch of 45 cases. Treatment group was treated with shuganjieyu capsule combined with paroxetine. Control group was treated with paroxetine alone. The Hamilton Depression Rating Scale(HAMD)and the Hamilton Anxiety Scale(HAMA)were used to observe the effectiveness. Results After 6 weeks treatment,the total effective rate of treatment group was 86. 7% higer than 66. 7% of control group,the difference was statistically significant(P ﹤ 0. 05);the HAMD and HAMA scores were de-creased in both groups,compared with before treatment,the difference was statistically significant(P ﹤ 0. 01). In the first and second weekend,the difference of the HAMD and HAMA scores between the two groups was no statistically significant(P ﹥0. 05). In the fourth and sixth weedend,the HAMD and HAMA scores of treatment group were both lower than control group, the difference was statistically significant(P ﹤ 0. 01). Conclusion The treatment of shugan jieyu capsule combined with par-oxetine in senile epression has better clinical efficacy and less adverse reactions,has some clinical value.

在精神疾病司法鉴定中,一些人为了逃避外界不利于个人的处境,摆脱某种责任或获得某种个人利益,故意模拟或夸大精神疾病或精神损伤程度,这种行为被称为伪装精神疾病或称诈病.而刑事违法者大部分企图伪装精神疾病以达到逃避惩罚的目的.作者在对"血清皮质醇、醛固酮水平在伪装精神病司法鉴定中的作用研究"课题过程中,回顾了刑事违法者伪装精神疾病鉴别研究,现将有关情况报道如下:

1998年9月我们对邯郸市中学生恒牙数目发育异常进行了检查统计,现报告如下.

1998年我们对邯郸市中学生恒牙龋病发病情况进行流行病学调查 [1]的同时,就其恒牙形态发育异常也进行了调查统计,以了解恒牙形态发育异常的发病特点,为早期采取防治措施提供参考依据.报告如下.