石杉碱甲联合艾司西酞普兰对抑郁症临床疗效及认知功能的影响

目的:探讨石杉碱甲联合艾司西酞普兰对抑郁症的临床疗效及认知功能的影响。方法:选取60例抑郁症患者随机分为研究组和对照组,各30例,研究组采用石杉碱甲联合艾司西酞普兰,对照组单用艾司西酞普兰,均治疗8周,在治疗前后采用17项汉密尔顿抑郁量表(HAMD-17)、汉密尔顿焦虑量表(HAMA)为疗效指标,以威斯康星卡片分类测验(WCST)、韦氏记忆量表中国修订版(WMS-RC)评定认知功能,用不良反应量表(TESS)评定不良反应。结果:(1)治疗后研究组治疗总有效率(90.0%)、痊愈率(50.0%)与对照组的(86.7%、46.7%)比较差异无统计学意义(P>0.05),两组内HAMD-17、HAMA评分均低于治疗前(P<0.05),两组间HAMD-17、HAMA评分比较差异无统计学意义(P>0.05)。(2)治疗后研究组WCST中总测验次数、持续错误数、随机错误数均低于治疗前(P<0.05),对照组总测验次数低于治疗前(P<0.05),研究组和对照组WMSRC中长时记忆、短时记忆、即刻记忆及记忆商数均高于治疗前(P<0.05)。两组间比较,治疗后研究组WCST中随机错误数低于对照组,WMSRC中长时记忆、短时记忆、记忆商数均高于对照组(P<0.05)。(3)两组治疗后各种不良反应发生率比较差异无统计学意义(P>0.05)。结论:石杉碱甲联合艾司西酞普兰治疗抑郁症安全有效,与单用艾司西酞普兰者相当,能显著改善患者认知功能,明显优于单药治疗。

2型糖尿病患者抑郁情绪与甲状腺功能及其人格特征的关系研究

目的探讨2型糖尿病患者(T2DM)抑郁情绪与甲状腺功能及其人格特征的关系。方法选取2018年10月至2020年9月在杭州市第七人民医院、杭州市拱墅区社区卫生服务中心就诊的176例T2DM患者为研究对象,根据汉密尔顿抑郁量表(HAMD)-24评分结果(总分≥8分为存在抑郁),合并抑郁63例(观察组),未合并抑郁113例(对照组);比较两组患者甲状腺功能水平及人格特征评分,同时比较合并不同程度抑郁患者甲状腺功能水平及人格特征评分,以及分析观察组患者HAMD评分、甲状腺功能水平及人格特征评分间的相关性。结果观察组患者轻、中、重度抑郁分别为33、19、11例。观察组促甲状腺激素(TSH)水平及艾森克人格问卷(EPQ)的神经质、精神质及效度量表评分均明显高于对照组(均P<0.05),而FT_(3)、FT_(4)及T_(3)水平及EPQ的外倾性评分均明显低于对照组(均P<0.05);两组患者T_(4)水平比较,差异无统计学意义(P>0.05)。合并不同程度抑郁患者TSH水平及EPQ的神经质、精神质评分比较,均为轻度抑郁<中度抑郁<重度抑郁(均P<0.05);而FT_(3)、FT_(4)、T_(3)、T_(4)水平及EPQ的外倾性、效度量表评分比较,差异均无统计学意义(均P>0.05)。观察组患者HAMD评分与TSH水平及EPQ的神经质、精神质评分均呈正相关(r=0.855、0.984、0.947,均P<0.05);TSH水平与EPQ的神经质、精神质评分均呈正相关(r=0.836、0.815,均P<0.05);精神质评分与神经质评分呈正相关(r=0.941,P<0.05)。结论T2DM合并抑郁患者多具有神经质或精神质倾向的人格特征,可能存在甲状腺功能紊乱,且受抑郁程度影响。

无抽搐电休克治疗对精神分裂症患者自传体记忆及疗效的影响

目的观察无抽搐电休克治疗(modified electroconvulsive therapy,MECT)对精神分裂症患者自传体记忆及疗效的影响。方法74例精神分裂症患者分为研究组(38例)和对照组(36例)。研究组采用无抽搐电休克治疗10~12次联合一种抗精神病药物,对照组单用一种抗精神病药物。两组均治疗12周。所有患者于治疗前和治疗后第4,8,12周末进行自传体记忆评估,并采用阳性和阴性症状量表(PANSS)评估疗效。结果(1)研究组的自传体事件记忆平均反应时在治疗后第4,8周末[分别为(2 058.84±200.06)ms,(1 883.61±202.17)ms],较治疗前[(1 765.27±203.23)ms]及对照组同期[分别为(1 787.03±192.82)ms,(1 762.01±195.25)ms]均明显延长,差异均有统计学意义[(t=6.346,2.545,P<0.05;t=5.945,2.630,P<0.05)];研究组的自传体事件记忆反应时在治疗后第12周末与治疗前比较差异无统计学意义(P>0.05)。(2)研究组和对照组的PANSS评分在治疗后各时间点均明显低于两组治疗前(均P<0.05),研究组的PANSS评分在治疗后各时间点[分别为(62.42±7.22)分,(49.32±5.54)分,(43.63±9.90)分]明显低于对照组同期[分别为(71.78±10.19)分,(56.14±5.95)分,(49.28±9.31)分],差异均有统计学意义(t=4.577,5.108,2.525;均P<0.05);研究组总有效率(94.7%)明显高于对照组(80.6%),差异有统计学意义(χ^2=9.287,P<0.05)。结论MECT治疗精神分裂症患者疗效显著,对自传体记忆有一定损害,但损害短暂且可逆。

Effect of soothing-liver and nourishing-heart acupuncture on early selective serotonin reuptake inhibitor treatment onset for depressive disorder and related indicators of neuroimmunology:a randomized controlled clinical trial

OBJECTIVE:To observe the effect of soothing-liver and nourishing-heart acupuncture on selective serotonin reuptake inhibitor(SSRIs) treatment effect onset in patients with depressive disorder and related indicators of neuroimmunology.METHODS:Overall,126 patients with depressive disorder were randomly divided into a medicine and acupuncture-medicine group using a random number table.Patients were treated for 6 consecutive weeks.The two groups were evaluated by the Montgomery-Asberg Depression Rating Scale(MADRS) and Side Effects Rating Scale(SERS) to assess the effect of the soothing-liver and nourishing-heart acupuncture method on early onset of SSRI treatment effect.Changes in serum 5-hydroxytryptamine(5-HT) and inflammatory cytokines before and after treatment were recorded and compared between the medicine group and the acupuncture-medicine group.RESULTS:The acupuncture-medicine group had significantly lower MADRS scores at weeks 1,2,4,and 6 after treatment compared with the medicine group(P < 0.01).The acupuncture group had significantly lower SERS scores at weeks 1,2,4,and 6 after treatment compared with the medicine group(P < 0.01).At 6 weeks after treatment,serum 5-HT in the acupuncture-medicine group was significantly higher compared with the medicine group(P <0.01).lnterleukin-6(IL-6) in the acupuncture-medicine group was significantly lower than that in the medicine group(P < 0.01),whereas there was no significant difference in IL-1(3 between the groups(P > 0.05).Anti-inflammatory cytokines IL-4 and IL-10 were significantly higher in the acupuncture-medicine group compared with the medicine group(P < 0.01,P < 0.05,respectively).CONCLUSION:The soothing-liver and nourishing-heart acupuncture method can effectively accelerate the onset of SSRI effects when treating depressive disorder and can significantly reduce the adverse reactions of SSRIs.Moreover,acupuncture can enhance serum 5-HT and regulate the balance of pro-inflammatory cytokines and anti-inflammatory cytokines.