Evaluating the effectiveness of hospitalized occupational rehabilitation on social functioning in chronic schizophrenic patients

AIM:To evaluate the effectiveness of hospitalized occupational rehabilitation for chronic schizophrenic patients in social functioning.METHODS:79 qualified cases were selected from chronic psychiatric inpatient departments,divided into two groups randomly,of which 45 cases of treatment group accepted hospitalized occupational rehabilitation,another 34 cases of control group accepted ordinary treatment.Social functioning was evaluated by the Scale of Social Skills of Chronic Schizophrenic In patients(SSSI). RESULTS:6 month course of research figured out that the rank of improvement of the total disability degree of the treatment was significantly larger than that of the control group(P< 0.05).Items of which rank of improvement of the treatment was significantly larger than those of the control group are participating in the occupational rehabilitation,social withdraw and concern and care about others (P< 0.01-0.05).The level of disability of 55.6%of the treatment decreased more than that of the control (26.5%) (P< 0.05) evaluated by SSSI.CONCLUSION:Hospitalized occupational rehabilitation is effective in improving social functioning of chronic schizophrenic patients,especially in improving items like participating in the occupational rehabilitation, social withdraw and concern and care about others.

The cost of obsessive- compulsive disorder (OCD) in China: a multi- center cross- sectional survey based on hospitals

Background Obsessive-compulsive disorder(OCD)is considered a very debilitating disorder with severe loss of quality of life and income.Aims This study estimates the quality of life and economic consequences of OCD in China.Methods The research team interviewed 639 patients with OCD in 13 hospitals in 12 cities in China.The direct method was used to get the direct cost of OCD.Indirect costs associated with OCD were estimated using the human capital approach.Linear regression analysis was conducted for quality of life and generalised linear model analysis was conducted for total cost.Sensitivity analysis was used to analyse the uncertainty of total cost.Results The mean quality of life score for OCD was 52.78(20.46).The annual total cost of OCD per capita was 24503.78(95%CI:22621.53 to 26386.03)renminbi(RMB)(US$3465.88(95%CI:US$3199.65 to US$3732.11)).The annual cost of OCD in China was estimated to be 37.74 billion(95%CI:34.95 billion to 40.53 billion)RMB(equal to US$5.34 billion(95%CI:US$4.94 billion to US$5.73 billion)).Sensitivity analysis showed that the total annual cost of OCD in China was between 23.15 billion RMB(US$3.27 billion)and 370.00 billion RMB(US$52.33 billion).Worse social function status,more psychiatric symptoms and higher Yale Brown Obsessive-Compulsive Scale(Y-BOCS)score were associated with worse quality of life.The numbers of clinic visits and hospitalisations,socioeconomic status,education,Y-BOCS scores and age were found to be significantly associated with total cost.Conclusions OCD is associated with low quality of life and high costs in China.The findings call for concerted efforts to improve services for patients with OCD.Improvements may include early detection and diagnosis,the provision of evidence-based treatments and relapse prevention strategies.

Interaction between catechol-O-methyltransferase Val/Met polymorphism and cognitive reserve for negative symptoms in schizophrenia

BACKGROUND Cognitive reserve(CR)and the catechol-O-methyltransferase(COMT)Val/Met polymorphism are reportedly linked to negative symptoms in schizophrenia.However,the regulatory effect of the COMT genotype on the relationship between CR and negative symptoms is still unexamined.AIM To investigate whether the relationship between CR and negative symptoms could be regulated by the COMT Val/Met polymorphism.METHODS In a cross-sectional study,54 clinically stable patients with schizophrenia underwent assessments for the COMT genotype,CR,and negative symptoms.CR was estimated using scores in the information and similarities subtests of a short form of the Chinese version of the Wechsler Adult Intelligence Scale.RESULTS COMT Met-carriers exhibited fewer negative symptoms than Val homozygotes.In the total sample,significant negative correlations were found between negative symptoms and information,similarities.Associations between information,similarities and negative symptoms were observed in Val homozygotes only,with information and similarities showing interaction effects with the COMT genotype in relation to negative symptoms(information,β=-0.282,95%CI:-0.552 to-0.011,P=0.042;similarities,β=-0.250,95%CI:-0.495 to-0.004,P=0.046).CONCLUSION This study provides initial evidence that the association between negative symptoms and CR is under the regulation of the COMT genotype in schizophrenia.

Who can benefit more from its twelve-week treatment:A prospective cohort study of blonanserin for patients with schizophrenia

BACKGROUND Blonanserin(BNS)is a well-tolerated and effective drug for treating schizophrenia.AIM To investigate which types of patients would obtain the most benefit from BNS treatment.METHODS A total of 3306 participants were evaluated in a 12-week,prospective,multicenter,open-label post-marketing surveillance study of BNS.Brief psychiatric rating scale(BPRS)scores were calculated to evaluate the effectiveness of BNS,and its safety was assessed with the incidence of adverse drug reactions.Linear regression was used to screen the influencing factors for the reduction of BPRS total score,and logistic regression was used to identify patients with a better response to BNS.RESULTS The baseline BPRS total score(48.8±15.03)decreased to 27.7±10.08 at 12 weeks(P<0.001).Extrapyramidal symptoms(14.6%)were found to be the most frequent adverse drug reactions.The acute phase,baseline BPRS total score,current episode duration,number of previous episodes,dose of concomitant antipsychotics,and number of types of sedative-hypnotic agents were found to be independent factors affecting the reduction of BPRS total score after treatment initiation.Specifically,patients in the acute phase with baseline BPRS total score≥45,current episode duration<3 months,and≤3 previous episodes derived greater benefit from 12-week treatment with BNS.CONCLUSION Patients in the acute phase with more severe symptoms,shorter current episode duration,fewer previous episodes,and a lower psychotropic drug load derived the greatest benefit from treatment with BNS.

Neurotransmitter changes in patients with Parkinson’s disease detected by encephalofluctuography technology: A non-randomized control study

BACKGROUND： Encephalofluctuograph Technology （ET） is an advanced and non-traumatic analytical method of brain function. ET can acquire super-slow waves from electroencephalic signals. Studies have shown that these particular spectra can reflect neurochemical processes in the brain. OBJECTIVE： To verify neurotransmitter changes in the brains Parkinson＇s disease （PD） patients through the use of ET. DESIGN, TIME AND SETTING： A non-randomized concurrent control experiment was performed at the Department of Neurology in Southern Building, General Hospital of Chinese PLA from August to December 2007. PARTICIPANTS： Sixty-one outpatients with PD were selected from the General Hospital of Chinese PLA from August 2007 to December 2007. In addition, 48 healthy subjects were selected as normal controls. METHODS： All patients underwent assessment of the sub scale Ⅱ, Ⅲ and V of the Unified Parkinson＇s Disease Rating Scale （UPDRS）, in which part Ⅱ was used to inform activity of daily living, part Ⅲ reflected athletic ability, and part Ⅴ was the Hoehn ＆ Yahr grade for symptoms evaluation. Correlation analysis was performed between dopamine levels and UPDRS assessment. Neurotransmitter changes were observed forty-eight prior to and 1.5 hours after medicating with Benserazide. The S1, S2, S4, S5, S7, and S 11 spectras respectively reflect gamma-aminobutyric acid （GABA）, glutamic acid （Glu）, 5-hydroxytryptamine （5-HT）, acetylcholine （ACh）, norepinephrine, and dopamine. MAIN OUTCOME MEASURES： Neurotransmitter changes in the brains of all subjects, and correlations between dopamine concentrations and UPDRS assessment. Neurotransmitter changes in a subgroup of patients prior to and 1.5 hours after medicating with Benserazide. RESULTS： Concentrations of 5-HT, ACh, and norepinephrine were decreased in the PD group, and GABA was increased. However, there was no significant difference compared with the normal control group （P 〉 0.05）. The level of dopamine in PD group was significantly lower than that in the control group （P 〈 0.01 ）. Dopamine concentrations in PD patients negatively correlated with UPDRS scores and the Hoehn ＆Yahr grade range （r = 0.4601, -0.4301, P 〈 0.01）. Dopamine levels increased significantly in PD patients 1.5 hours after medicating with Benserazide compared with before （P 〈 0.01）. CONCLUSION： Detection by ET demonstrated that dopamine concentrations were significantly decreased in the brains of PD patients, as well as played a role in the course of pathogenesis and therapy. These results provided useful information for future non-traumatic of PD.

精神分裂症药物治疗的“物稀为贵”（英文）

概述:在中国和其它亚洲国家中用抗精神病药联合治疗精神分裂症要比在西方国家更为常见,其原因尚不清楚,可能与临床医生的盲目信念有关,即认为用多种药物治疗更可能获得满意的临床疗效。抗精神病药物是治疗精神分裂症患者的主要方法,但抗精神病药物的联用及大剂量使用只会大幅增加风险而不会提高临床疗效。人们普遍认为大剂量使用抗精神病药以及多药联用与药物不良反应的发生率增加、持续时间延长、程度更严重等相关。新近的研究证据还表明,抗精神病药联用及抗精神病药物总剂量相应增高会导致较高的纹状体D2受体占有率(致使药物耐受及停药困难),并使精神分裂症中已受损的突触可塑性恶化(使与此状态相关的认知功能损害"雪上加霜")。临床医生需要在精神分裂症的精神药物治疗中遵循"物稀为贵"的原则。

The solute carrier transporters and the brain:Physiological and pharmacological implications

Solute carriers(SLCs)are the largest family of transmembrane transporters that determine the exchange of various substances,including nutrients,ions,metabolites,and drugs across biological membranes.To date,the presence of about 287 SLC genes have been identified in the brain,among which mutations or the resultant dysfunctions of 71 SLC genes have been reported to be correlated with human brain disorders.Although increasing interest in SLCs have focused on drug development,SLCs are currently still under-explored as drug targets,especially in the brain.We summarize the main substrates and functions of SLCs that are expressed in the brain,with an emphasis on selected SLCs that are important physiologically,pathologically,and pharmacologically in the blood-brain barrier,astrocytes,and neurons.Evidence suggests that a fraction of SLCs are regulated along with the occurrences of brain disorders,among which epilepsy,neurodegenerative diseases,and autism are representative.Given the review of SLCs involved in the onset and procession of brain disorders,we hope these SLCs will be screened as promising drug targets to improve drug delivery to the brain.

使用仿制度洛西汀或帕罗西汀治疗抑郁症:一项多中心、双盲、双安慰剂、随机对照临床试验（英文）

背景:本研究是经国家食品药品监督管理总局批准的仿制度洛西汀注册前试验(批准号:2006L01603)。目的:比较仿制度洛西汀和帕罗西汀治疗抑郁症患者的疗效和安全性。方法:这是一项双盲双安慰剂(double dummy)、多中心、有效药物(帕罗西汀)平行随机对照临床试验。将纳入的299例抑郁症患者随机分组,使用度洛西汀(n=149;40-60 mg/d)或帕罗西汀(n=150;20 mg/d)连续治疗8周。在基线和开始治疗后的第1、2、4、6和8周使用汉密尔顿抑郁量表(Hamilton Depression rating scale,HAMD-17)评估。缓解的定义为研究终点HAMD-17评分低于8分,治疗有效的定义为研究终点HAMD-17得分较基线至少降低了50%。根据报告的不良反应的发生率、严重程度以及实验室检查结果、心电图结果的变化来评估安全性。度洛西汀组中有三例患者在开始用药前退出,采用修正的意向治疗分析(intention-to-treat,ITT)方法以比较研究组146例患者和对照组150例患者的研究结果。结果:在8周的研究期间两组有均29例患者脱落。与基线比,两组HAMD-17评分在整个试验过程中均显著降低。根据ITT分析,研究终点时度洛西汀组和帕罗西汀组在疗效方面差异无统计学意义(67.1%v.71.3%,X2=0.62,p=0.433),缓解率(41.1%v.51.3%,X2=3.12,p=0.077)及不良作用发生率56.8%v.54.7%,X2=0.14,p=0.705)等方面的差异也无统计学意义。结论:对于在国内精神科门诊就医的抑郁症患者而言,急性期使用仿制度洛西汀与使用帕罗西汀同样安全有效。

Effectiveness of cognitive behavioral therapy-based interventions on health outcomes in patients with coronary heart disease:A metaanalysis

BACKGROUND Recently,the efficacy of cognitive behavioral therapy(CBT)-based intervention on health outcomes in patients with coronary heart disease(CHD)has been recognized in randomized controlled trials(RCTs),but no comprehensive systematic review has been conducted.To address this research gap,our study aimed to evaluate whether comprehensive CBT-based interventions positively affect health outcomes in CHD patients.It was hypothesized that CBT-based interventions are effective in:(1)Reducing depression,anxiety,and stress symptoms;(2)Reducing body mass index,blood pressure,and lipid levels;and(3)Improving quality of life,and exercise endurance.AIM To verify the effectiveness of CBT-based interventions on CHD patients through a meta-analysis of previous publications.METHODS Relevant RCTs published in English were obtained by searching electronic databases,including PubMed,Embase,Cochrane Central Register of Controlled Trials,Scopus,and Proquest,with the retrieval time from inception to August 2020.The primary outcomes were psychological factors(depression,anxiety,and stress symptoms),physiological factors(body mass index,blood pressure,blood lipids).The secondary outcomes included quality of life and exercise endurance.We used Review Manager 5.3 to conduct the meta-analysis and used the Physiotherapy Evidence Database tool to evaluate the quality of studies.RESULTS A total of 22 RCTs comprising 4991 patients with CHD were included in the systematic review and meta-analysis.The main analysis revealed that CBT-based intervention can reduce depression symptoms:-2.00[95%confidence interval(CI):-2.83 to-1.16,P<0.001];anxiety symptoms:-2.07(95%CI:-3.39 to-0.75,P=0.002);stress symptoms:-3.33(95%CI:-4.23 to-2.44,P<0.001);body mass index:-0.47(95%CI:-0.81 to-0.13,P=0.006);and improve physical functioning:3.36(95%CI:1.63 to 5.10,P=0.000)and mental functioning:6.91(95%CI:4.10 to 9.73,P<0.001).Moreover,subgroup analysis results showed that CBT-based interventions were more effective for symptoms of depression and anxiety in CHD patients when individual,as opposed to group treatment,and psycho-education,behavioral and cognitive strategies were applied as the core treatment approaches.CONCLUSION CBT-based interventions are effective treatment strategies for CHD patients,significantly improving their symptoms of depression,anxiety and stress,body mass index,and health-related quality of life.

氯氮平的合理使用:中国的经验(英文)

According to surveys conducted in ten provinces and independent municipalities in China, clozapine is the most commonly used antipsychotic medication in the country. These surveys reported that it was administered to 39.0% of all patients taking antipsychotic medication in 2002 and to 31.7%

EEG Source Localization Using Spatio-Temporal Neural Network

Source localization of focal electrical activity from scalp electroencephalogram (sEEG) signal is generally modeled as an inverse problem that is highly ill-posed. In this paper, a novel source localization method is proposed to model the EEG inverse problem using spatio-temporal long-short term memory recurrent neural networks (LSTM). The network model consists of two parts, sEEG encoding and source decoding, to model the sEEG signal and receive the regression of source location. As there does not exist enough annotated sEEG signals correspond to specific source locations, simulated data is generated with forward model using finite element method (FEM) to act as a part of training signals. A framework for source localization is proposed to estimate the source position based on simulated training data. Experiments are done on simulated testing data. The results on simulated data exhibit good robustness on noise signal, and the proposed network solves the EEG inverse problem with spatio-temporal deep network. The result show that the proposed method overcomes the highly ill-posed linear inverse problem with data driven learning.

The Psychosomatic Traits of“People with the Five Elements in Traditional Chinese Medicine”:A Qualitative Study

Objective To identify the representative attributes of the five elements of a person with a qualitative methodology and provide the basis for the clinical diagnosis and treatment of“people with the five elements in traditional Chinese medicine(TCM).”Methods Data collected from the literature review,two sessions of brainstorming of experts with related experience in“people with the five elements in TCM”from October 2020 to December 2020,and six rounds of in-depth interviews with 30 participants who had various attributes of the five elements from March 2021 to October 2021 were analyzed.Triangulation was used in this study,and theming and synthesizing were used to analyze the data.Results A total of 31 experts and 30 interviewees participated in this study.The median age of the experts and interviewees were 48.0 and 38.5 years,respectively;51.66%and 54.8%of experts and interviewees,respectively,were men.The descriptors of facial diagrams of“people with the five elements in TCM”were complexion,shape,distribution state of facial bones,convergence trend of facial muscles,and facial expression.A theoretical model of“people with the five elements in TCM”was shaped based on these findings.Conclusion The study suggests a possibility for bridging the gap between personality and bodily state,identifying an avenue for personality research from the perspective of TCM.

精神分裂症听觉稳态诱发电位中Gamma振荡的缺陷（英文）

背景:精神分裂症患者存在多种认知功能缺陷。Gamma振荡存在人脑中,与神经认知关系密切。听觉稳态反应(Auditory Steady-State Responses, ASSRs)是一种反映gamma振荡的神经电生理指标,既往研究发现精神分裂症患者40 Hz ASSRs诱发能量较健康者明显降低,不过ASSRs的相位指标与临床症状及神经认知缺陷的相关性尚有待系统研究。本研究旨在深入探索精神分裂症患者gamma节律神经活动缺陷及其与临床症状和神经认知间的相关性。目的:比较并验证精神分裂症与健康人群20 Hz和40Hz ASSRs能量和相位一致性的差异,探索精神分裂症ASSRs与神经认知缺陷的相关性。方法:记录24名精神分裂症患者和30名健康对照重复听觉刺激引起的听觉稳态诱发电位,采用阳性与阴性症状量表(PANSS)评估患者的临床症状,采用认知功能成套测验-共识版(MATRICS Consensus Cognitive Battery, MCCB)评估神经认知功能,计算ASSRs能量、锁相因子和相位一致性等指标与临床和认知评估的相关性。结果:病例组在信息处理速度(t=-2.39, p=0.021)、注意/警觉(t=-2.36, p=0.023)、词语学习(t=-3.11,p=0.003)、推理和问题解决(t=-2.60, p=0.012)等认知领域与对照组比较存在差异,40 Hz ASSRs能量比对照组明显降低(t=-2.291, p=0.032),锁相因子和试次间相位一致性指标均弱于健康对照(t=-3.017, p=0.004和t=3.131, p=0.003),且与推理和问题解决功能缺陷显著相关。结论:精神分裂症患者在多个认知领域存在缺陷且40Hz ASSRs能量偏低,特别是相位锁定特性和相位一致性较差,与推理能力和思维障碍存在一定关联。

中国的精神卫生法(草案)是保护患者公民权利的里程碑(英文)

The draft National Mental Health Law of China was released for public consultations on June 10,2011 [1].Following wide-ranging public consultations,the draft was further amended by the Standing Committee of the National People’s Congress on October 24,2011 [2,3].Although the penultimate draft has been finalized,there are continuous debates and concerns about its potential negative effects on mental health services in China.The article in this issue of the Shanghai Archives of Psychiatry by Professor Xie [4] argues that the proposed law over-emphasizes patient’s self-sufficiency and,thus,neglects traditional Chinese culture。

中国接受治疗的海洛因依赖患者中反社会人格障碍患病率的荟萃分析(英文)

背景：西方国家的研究持续报道海洛因成瘾者共患反社会人格障碍（Anitsocial Personality Disorder，ASPD）的比率很高，但中国海洛因成瘾者共患ASPD的报道比率变异很大，可能是因为中国的临床医生在治疗物质滥用问题时没有考虑人格问题。这份报告对评估中国海洛因依赖患者共患ASPD比率的研究做了系统分析。方法：我们检索了中国数据库（中国知网，万方数据知识服务平台，台湾电子期刊服务网）和西方数据库（PubMed和EMBASE）的相关研究。两位作者独立检索文献，确定符合预定纳入和排除标准的文献，评价纳入研究的文献质量，并提取用于分析的数据。使用StatsDirect 3.0进行统计分析。 结果：检索到15项符合条件的研究，共有3692例海洛因依赖患者。其中仅有2项高质量研究。所有的研究都是在康复中心或医院进行的。在这些患者中合并ASPD终生患病率为30％（95％CI：23~38％），但这些研究结果的异质性很大（I2=95％，p＆lt;0.001）。 男性患者的患病率显著高于女性（44％比21％），注射吸毒患者的患病率显著高于烫吸的患者（44％比27％）。研究方法较严谨的报道的海洛因依赖者ASPD患病率较高。 结论：虽然现有的有关中国接受治疗的海洛因依赖患者共患ASPD的文献存在较大的方法学问题，但据我们的分析，估计这些患者中大约有三分之一的人是符合ASPD诊断标准的。进一步需要开展的工作是提高临床医生对这一问题的认识，比较伴ASPD患者与不伴ASPD患者的发病机制、治疗效果和复吸情况，制定出适合这个治疗相对困难的海洛因依赖患者亚群的针对性的干预措施并加以验证。

电休克治疗用于精神分裂症的激越症状:随机对照试验的meta分析（英文）

背景:躁动在精神分裂症治疗中是一个重大挑战。电休克疗法(ECT)对各种精神疾病是一种快速、有效、和安全的治疗,但ECT对精神分裂症的躁动治疗的相关meta分析还尚未报道。目标:系统地评估单一使用ECT或ECT合并使用其他抗精神病药物(APs)的对精神分裂症的躁动治疗的有效性和安全性。方法:进行随机对照试验(RCT)的系统文献搜索。两名独立评估者筛选研究、提取结果数据与现有数据的安全性、进行质量评估和数据合成。采用建议、评估、开发、和评价的工作组等级(GRADE)来判断主要成果的证据的总体水平。结果:一共确定了中国有七个RCTs,包括ECT单一使用(4个RCTs有5个治疗组,n=240)和ECT-APs合并使用(3个RCTs,n=240)。研究对象平均年龄34.3(4.5)岁,平均治疗时间为4.3(3.1)周。所有7个RCTs非盲法,并且根据Jadad量表7项RCTs均被评为低质量。样本的Meta分析发现与APs单一治疗相比,单一使用ECT或ECT-APs合并使用阳性和阴性症状量表(PANSS)的躁动子因子评分改善均无显著性差异(ECT单一使用:weighted mean difference(WMD)=-0.90,95%confidence interval(CI):(-2.91,1.11),p=0.38;ECT-APs合并使用:WMD=-1.34,(95%CI:-4.07,1.39),p=0.33)。然而,PANSS总分(WMD=-7.13,I^2=0%,p=0.004)和兴奋子因子评分(WMD=-1.97,p<0.0001)、ECT治疗14天后的PANSS总分(WMD=-7.13,I^2=0%,p=0.004)和第7天和第14天的兴奋子因子评分(WMD=-1.97to-1.92,p=0.002 to 0.0001)均显示单一使用ECT优于APs单一治疗。ECT-APs合并治疗结束时(WMD=-10.40,p=0.03)和治疗后7天(WMD=-5.01,p=0.02)的PANSS总分显示均优于APs单药治疗。头痛(p=0.0001,number-needed-to-harm(NNH)=3,95%CI=2-4)是唯一的ECT单一治疗后不良反应,并且ECT单一治疗组比APs单药治疗发生的更频繁。根据GRADE方法,主要结果的证据水平被评为"非常低"(37.5%)和"低"(50%)。结论:基于中国7个RCTs合并的数据发现ECT单一治疗或ECT-APs合并治疗在精神分裂症患者的躁动治疗中并没有优势。然而,ECT单一治疗或ECT-APs合并治疗均与PANSS总分减低显著有关。需要高质量的RCTs验证目前的解释。

非典型抗精神病药物治疗住院精神分裂症或双相障碍患者急性激越和敌对的疗效:一项系统综述的结果（英文）

急性激越和敌对是双相障碍和精神分裂症患者的常见症状。本综述中,我们讨论在双相障碍或精神分裂症患者中上述症状的发生率、临床评估策略、治疗方案以及目前国内外针对这些症状的治疗指南。在现有的方法中,有使用肌肉注射的抗精神病药物和最近获得批准的口服非典型抗精神病药物治疗双相障碍或精神分裂症住院患者的急性激越和敌对,我们详细讨论了支持这些方法的最新证据,并强调各个抗精神病药物之间的一些差异。

Studies on TCM Syndrome Types of Heroin-Dependence

Great advances have been achieved in abstinence treatment on heroin-dependence and prevention of drug-reusing, and a variety of traditional Chinese medicine (TCM) drugs or preparations have been developed and applied in clinic in recent years. The Zheng Tong Ning Granules (正通宁颗粒冲剂), for example, has been tested on healthy volunteers and proved to be more tolerable than clonidine1. However, they are designed only for certain symptoms appeared in a certain stage of the abstinence treatment. A comprehensive study on TCM syndrome types of heroin-dependence and the relevant treatment are still lacking. Following is our pioneer attempt made in this field.

Clozapine is strongly associated with the risk of pneumonia and inflammation

Clinicians need to remember that(1)systemic inflammations can increase clozapine level;(2)clozapine,by itself,can cause inflammation,particularly during titration that is too rapid for that patient;(3)clozapine may increase the risk of infection;and(4)more specifically,clozapine may be particularly strongly associated with the risk of pneumonia.Pneumonia appears to be associated with high mortality in clozapine patients around the world.Clinicians who are alert to the risk of pneumonia in clozapine patients may significantly decrease mortality in clozapine patients.There is no data on COVID-19 infections in clozapine patients,but based on what we know about clozapine pharmacology,we can hypothesise that clozapine,possibly by impairing immunological mechanisms,may increase the risk of pneumonia in infected patients.More importantly,once fever and/or pneumonia develops,the clozapine dose should be cut in half to decrease the risk of clozapine intoxication.If there is any doubt that in spite of halving the dose there are still signs of clozapine intoxication,completely stopping clozapine may be indicated.Once the signs of inflammation and fever have disappeared,the clozapine dose can be increased to the prior dosage level.

太极拳治疗精神分裂症:系统综述（英文）

背景:太极拳起源于中国,是一种适度的有氧运动,可促进身心的平衡和康复。这一运动已用作精神分裂症患者的辅助治疗。然而,还没有关于太极拳辅助治疗精神分裂症患者的meta分析或系统综述的报告。目的:用随机对照试验(RCT)的数据进行系统综述和meta分析来检验太极拳辅助治疗精神分裂症患者的疗效。方法:两位评估者各自系统地检索中英文数据库中用太极拳治疗精神分裂症患者的RCT研究,并进行研究项目的选择、数据提取、质量评估和数据合并。采用Review Manager(版本5.3)进行统计分析。采用推荐分级的评估、制定与评价(Cochrane Grades of Recommendation,Assessment,Development,and Evaluation,GRADE)来评估证据的强度。结果:在中国大陆和香港进行的6项RCTS研究中,共有483名参与者,其中干预组215例,对照组268例。试验平均持续16.0(6.2)周。我们发现在研究期间,干预组阴性症状改善情况与对照组相比有显著差异[5项试验,6个治疗组,n=451,SMD:-0.87(95%CI:-1.51,-0.24),p=0.007;I2=90%],其中2项研究用阳性和阴性症状量表(PANSS)中的阴性症状分量表评估,另外3项用阴性症状评定量表(SANS)评估。此外,研究期间研究组与对照组间阳性症状的改善没有显著性差异[4项试验,5个治疗组,n=391,SMD:-0.09(95%CI:-0.44,0.26),p=0.60;I2=65%],其中2项研究用PANSS阳性症状分量表评估,2项用阳性症状评定量表(SAPS)。所有纳入的RCT研究均未报告不良反应。根据GRADE评估,主要结局指标的证据强度"很低"。结论:抗精神病药辅以太极拳治疗精神分裂症患者的疗效的数据尚不足,难于得出该疗效如何的明确结论。此外,纳入研究的随访时间相对较短,所有的研究评估结局指标时都没有使用盲法。需要有高质量的随机试验才能做出临床建议。