任泽普 译 安建雄 校专家简介:Kellner博士是新泽西医学和口腔大学精神学系主任、教授,医学院院长助理, 1994-2004年曾任美国《电休克杂志》主编,目前从事不同类型和方法电休克维持治疗的疗效比较。1.什么是MECT? MECT(Modified Electric Convulsive Therapy)即改良式电休克治疗或改良式电惊厥治疗,是在多参数生理监护下,全麻和肌松后给予适当的脉冲电流刺激,使大脑皮层广泛性放电,促使脑细胞发生一系列生理变化,从而达到治疗的目的。MECT的主要程序: 目前常用的电惊厥治疗程序是全麻、肌松、通电(给予少量电流,引起大脑皮层广泛性放电)。因操作在全麻下进行,患者感觉不到任何疼痛或不适。2. MECT适用范围: 药物治疗无效或疗效差的单相或双相抑郁症患者; 有严重自杀、易激惹、精神病性症状,或自理能力降低致脱水或营养不良的抑郁症患者; 药物治疗无效或疗效差的躁狂患者; 精神分裂症的幻觉、妄想、兴奋易激惹,尤其在疾病的早期阶段; 紧张状态:精神分裂症、抑郁症及其他疾病引起的紧张状态; 其他:合并抑郁的帕金森病、恶性综合症、难治性癫痫、疼痛、强迫症或焦虑障碍等及不愿药物治疗的情感障碍、精神分裂症、强迫症、疼痛、癫痫、其他疾病患者。以下情况可将MECT作为首选治疗方案:— 病情严重要求快速疗效者;— 其他治疗方法的风险性高于MECT时;— 患者以前发病时药物疗效差,而对MECT有良好的反应;— 患者倾向于MECT治疗3. MECT治疗的理论根据有哪些? MECT可作用于大脑的多个系统和多个区域。 抗癫痫作用:MECT引起一系列的痫样放电,由此大脑获得了终止痫样放电新机制,近20年精神药理学在心境障碍治疗方面最重要的一个发展就是引入了抗癫痫类的心境稳定剂,抗癫痫作用可能与MECT的抗抑郁作用有关。 神经内分泌机制:MECT引起大脑释放肽类物质,从而改善情绪;MECT能够纠正抑郁症患者的神经内分泌方面的异常—下丘脑-垂体-肾上腺轴功能异常,地塞米松抑制试验恢复正常。4. MECT需要多少次治疗才能获得治愈? 多数患者第一次治疗的当天就可以见到显著的临床疗效。大部分抑郁症患者经6-12次电惊厥治疗后获得治愈。5.何时选择MECT? 很多情况下,应该尽早考虑使用MECT。等到病情严重或者经过很多药物治疗后才选择MECT是不合适的,症状较重的典型抑郁患者应该较尽早选用MECT治疗,遗憾的是有的医生不愿意较早的选用MECT。6. MECT的禁忌症有哪些? MECT是一种非常安全有效的治疗方法,不存在绝对的禁忌症,有可能引发其它疾病甚至引起死亡的情况下仍可选择MECT治疗,但以下情况会增加MECT的风险:不稳定或严重的心血管疾患如心肌梗塞、不稳定心绞痛、供血不足性心力衰竭、瓣膜性心脏病、动脉瘤或血管畸形等;一些脑肿瘤或颅内占位性损伤的患者会导致颅内压增高; 近期脑梗的患者; 严重呼吸系统疾病如严重的慢性肺梗阻、哮喘、肺炎等。7. MECT会引起记忆损害吗? MECT会引起三种记忆损害:急性意识障碍、顺行性遗忘和逆行性遗忘症。急性意识障碍由癫痫发作和全麻引起,典型的持续20-30分钟后恢复。顺行性遗忘出现在治疗期间,多在治疗结束后1-2周后消失。逆行性遗忘是指记不起治疗期间的发生的一些事,大部分患者均能恢复。 记忆损害在过去较常见,随着MECT技术的改良,现在的治疗出现记忆损害已经较前大为减少。8. 重复MECT治疗是否会损害大脑? 大量证据显示MECT不会造成大脑结构损害。实际上,MECT可使神经释放营养物质,从而起到保护大脑的作用。9.MECT治疗期间要停用抗抑郁药和心境稳定剂吗? 以前,MECT治疗期间要停用所有的药物,但MECT时继续服用大部分抗抑郁药是安全的,目前有证据显示药物合用MECT可提高疗效并且可预防MECT后疾病的复发。另外,目前常用的新型抗抑郁药对心脏的毒性比三环类抗抑郁药降低很多。药物合用MECT在临床上很常见。有些药物会影响MECT治疗,如抗癫痫药、抗癫痫类的情感稳定剂、苯二氮卓类药物。10. MECT治疗有效是否需要延长疗程? MECT有2个缺点:记忆损害和高复发率。现在MECT一般每周3次,达到治愈后常规进行巩固治疗:减为每周1次,然后每2周1次。同时,MECT治疗期间多合用药物治疗以预防复发。对于多次复发的患者,可以考虑MECT维持治疗:巩固治疗后每月治疗1次(治疗间隔可调整)。11. 之前MECT无效的患者可以再行MECT吗? 某些特定阶段MECT无效的患者再行MECT可能会有效,治疗之前要仔细回顾之前的治疗和患者的状况,慎重选择,尤其是有超预期的认知损害者。 有时,MECT无效是因为治疗次数不够,研究表明,10次以上治疗无效才可以认为MECT无效,一般疗程(10–12次)过半治疗师应该评估诊断以保证无其他因素影响MECT的疗效,并个体化设置具体的参数。12.药物治疗无效的患者是否用MMECT后药物治疗可以显效? 尚不清楚。理论上可以,但难以开展这方面的研究;另一种可能是药物治疗部分有效的患者合用MECT可以获得治愈。药物维持治疗可以预防治愈患者复发。
据世界卫生组织统计全球有35,000,000痴呆患者,痴呆多见于阿尔茨海默病、中风和其他脑部疾病。如果有2项脑功能,如记忆和语言能力,降低就可能患有痴呆,其他的表现包括思维清晰度下降、情绪控制力减弱等。越来越多的证据提示多活动可以降低痴呆的患病风险。但大多数有关运动和痴呆关系的研究都依靠受试者自我报告来计算活动量。高强度的运动,如慢跑、骑车、打网球等,容易量化,但是低强度的运动,如步行、日常活动等,不易量化。加拿大森尼布鲁研究院和沃特卢大学研究员Middleton教授领导的小组采用一种科学的方法来量化活动量:受试者先喝少量氢和氧都标记过的水,然后通过尿检计算消耗的能量。他们的研究显示即使低强度的运动也可以降低痴呆的发生风险,而但能量消耗高的运动降低认知功能损害风险较能量消耗高低的运动高90%,研究结果发表在《内科学文献》上。法国的一项伴有心脏风险,如肥胖或糖尿病女性的运动与痴呆关系的研究结果示每天快速步行半小时就可以降低认知损害的风险。以上研究进一步证实了运动的脑功能改善作用。很显然体育锻炼可以使大脑更健康,而科学的研究使这一说法更加可信。Brains Gain From Physical Activity by Older PeopleIncreasing evidence suggests that being active can reduce a person's risk of dementia. Dementia is the name for the effects of Alzheimer's disease, stroke and other brain disorders.People may be considered to have dementia if they lose abilities in two or more areas such as memory and language skills. Other signs of dementia include a loss of ability to think clearly or control emotions.The World Health Organization says about thirty-five million people worldwide are living with dementia.Most studies of exercise and dementia depend on self-reporting -- asking people to report their levels of physical activity. Laura Middleton is a researcher at the Sunnybrook Research Institute and the University of Waterloo in Canada. She says there are problems with self-reporting.LAURA MIDDLETON: “It does a very good job of capturing jogging, or biking or tennis but does a relatively poor job of capturing low-intensity activity like walking or daily chores, which may also be important to the risk of cognitive impairment.So, Professor Middleton led a team in a new study to measure activity levels scientifically. The study lasted five years. Almost two hundred people took part. Their average age was seventy-five.The people drank small amounts of what scientists call doubly labeled water. It contains forms of hydrogen and oxygen that can mark, or label, these elements within body water. This way scientists can measure energy use through urine tests.Laura Middleton says the research showed that even low-intensity activity reduced the risk of thinking problems and memory loss.LAURA MIDDLETON: "Those with higher activity energy expenditure had ninety percent reduced risk of incident cognitive impairment over the follow-up period compared to those with very low activity energy expenditure.”The study is published in the Archives of Internal Medicine.In a second study, French researchers reported on exercise and dementia in women with heart risks like obesity or diabetes.Marie-Noel Vercambre of the Foundation for Public Health in Paris led the study. The findings suggest that even a half-hour walk at a quick speed every day could lower the risk of cognitive impairment.Dr. Eric Larson of the Group Health Research Institute in Seattle, Washington, wrote a commentary about the studies. He says the findings add to the evidence about the mental value of physical activity.ERIC LARSON: "It's not obvious to people that exercise would make your brain healthier. And as each study does more detailed analyses of special groups or a different way of making the measurements, it just makes the scientific basis for this relationship a lot more convincing."And that’s the VOA Special English Health Report, written by Caty Weaver. For more health news and to learn English, go to voaspecialenglish.com. I’m Jim Tedder.
波士顿大学Vendrame博士的一项研究示服用5-羟色胺再摄取抑制剂(SSRIs)治疗的儿童出现睡眠周期性肢体运动的比例高达31.7%,比不服用SSRIs的儿童高5倍(7.8%),而且服用SSRIs患儿周期性肢体运动指数的中位数显著高于不服用SSRIs的儿童(分别为11.2和6.5)。SSRIs引起睡眠周期性肢体运动的机制尚不明了,但是可能与5-羟色胺介导的多巴胺抑制有关。该研究提示睡眠周期性肢体运动是儿童服用SSRIs常见的不良反应。
RICHARD HYER美国西北大学精神病学和行为科学系临床事务部副主席Frank博士的研究示:自杀是难以预测,但临床工作人员应该评估自杀风险并给予积极治疗。自杀风险因素包括:性别-女性非致死性自伤较男性多见,但男性成功自杀的比女性高3倍;年龄-青少年和青年自杀企图的更常见;社会因素有父母分居、家庭不和谐、儿童期受虐待、受恐吓、同伴欺负、失业、独居、未婚;内科医生和牙医是自杀风险最高的职业,其次为警察和军职人员;遗传;锂盐和氯氮平治疗有效提示自杀的生化机制;高风险的患者包括缺乏社会支持的、有家庭冲突的、诊断为精神分裂症或心境障碍的曾有过自杀病史的。电休克及药物治疗可增强自我的管理,而家庭支持对自杀的治疗尤为重要。Suicide Risk Factors Hide in Plain SightBy: RICHARD HYER, Clinical Psychiatry News Digital NetworkCHICAGO – The literature is clear that suicide cannot be predicted, but clinicians are obliged to assess it, said Dr. Cathy Frank, vice chair of clinical affairs in the department of psychiatry and behavioral sciences at Northwestern University, Chicago.There is no perfect algorithm, she said, and no standardized scale is associated with a high predictive value, despite a number of proposals.And so, most frustrating for the physician is the inability to accurately identify the potential suicide, Dr. Frank said as she reviewed current data on risk assessment and therapy, epidemiology, and risk factors at a seminar on reinventing inpatient psychiatry.In the United States alone, suicide claims a life every 16 minutes, adding up to 33,300 people annually, compared with 20,000 deaths by homicide, Dr. Frank reported, citing data from the Centers for Disease Control and Prevention.And, she explained, "It’s not just an illness of industrial populations." Worldwide, 1 million people die from suicide each year, a ratio of 16.7 suicides/100,000 lives (Lancet 2009;373:1372-81).Nonfatal self-injury is more common in females than males. "Men are three times as likely to complete a suicide ... so gender matters," Dr. Frank said. Patients who have attempted suicide once are five to six times more likely to attempt it again (Arch. Gen. Psychiatry 1983;40:249-57).Adolescents and young adults are the most likely to attempt suicide, and emergency department data suggest that 75% have a mental disorder and 9% have a diagnosis of alcohol abuse.There are a variety of social and biological risk factors. Social risk factors include parental separation, family discord, child abuse, bullying, peer victimization, unemployment, living alone, and never having been married.Physicians and dentists are the occupations most at risk, followed by police officers and military personnel. In 2006, male veterans of the Iraq and Afghanistan wars aged 18-29 years suffered 46 suicides/100,000 lives, a rate 2.3 times higher than in matched civilian population, according to the U.S. Department of Veterans Affairs. The availability of lethal weapons is key risk factor, because 60% of lethal attempts involve firearms. Men are more likely than are women to choose a violent death.Biological and genetic risk factors have also been identified for suicide. Suicide attempts and completions run in families, independent of psychiatric diagnosis, and adoption studies provide evidence of a genetic basis of, Dr. Frank reported."The effectiveness of lithium and clozapine suggests a biological mechanism for suicide," Dr. Frank said. Lithium has both antiaggressive and anti-impulsive effects, she said.High-risk patients include those with absence of social support, with family conflict, and patients diagnosed with schizophrenia or a mood disorder, along with those who have a history of suicide attempts.Known markers of acute risk are moderate to severe depression; current mania and/or psychosis; alcohol and/or substance abuse within the last month; hopelessness; and suicidal intent. Markers of moderate risk include mild depression, moderate anxiety, and a history of suicide attempts, as well as chronic pain. Patients at low risk might have anxiety that is neither moderate nor severe, depressive disorder, or bipolar disorder in remission.Treatment interventions depend on the patient’s mental state, and can range from electroconvulsive therapy and the use of psychotropic medications to straightforward self-management. Self-management is a key to successful treatment, said Dr. Frank, and should begin at admission, making patients active members of the treatment team and letting them help direct the course of treatment.Family involvement is a particularly essential part of the guidelines and an integral part of treatment, Dr. Frank said. Families "are your eyes and ears." They can provide important collateral information and help assess risk, and family involvement may lower litigation risk. Family conflict, however, has been linked to inpatient suicide (J. Nerv. Ment. Dis. 2010;198:315-28).The patient’s "community" is now also part of every treatment plan at Dr. Frank’s institution. "No clinician can be everything at all moments to the patient. So how do we involve community?" she said. Community support might include the National Alliance on Mental Illness, Alcoholics Anonymous, Narcotics Anonymous, and bereavement support groups, for example. Dr. Frank also suggests removing weapons from the patient’s home.Dr. Frank disclosed no relevant conflicts of interest.
来自波士顿的消息:一项对53,530名患者进行的大规模分析研究发现,服用抗抑郁药治疗的患者有近1/3在增量前的6个月未服用初始处方剂量,因此很多需要增量的患者不是因为处方剂量的疗效差而是因为患者对治疗的依从性差。Poor Adherence Boosts Antidepressant DosingVitalsMajor Finding: Treatment nonadherence is behind dose escalation in one-third of patients who receive antidepressant therapy.Data Source: A large-scale analysis of patient nonadherence to chronic antidepressant therapy and subsequent prescribed dose escalation of the same medication using a national patient claims administrative database.Disclosures: Medco Health Solutions Inc. provided funding for the study. Dr. Muzina became an employee of Medco Neuroscience Resource Center after the study began and received no compensation for his participation.BOSTON — Nearly one-third of patients on antidepressant pharmacotherapy in a large-scale analysis did not take their original antidepressant dose as prescribed within the 6 months prior to dose escalation, a study has shown.The findings suggest that the lack of adequate treatment response that drives dosage increases in many patients might be linked to suboptimal medication adherence rather than to dose insufficiency, Dr. David J. Muzina reported at the institute.To evaluate patient nonadherence to chronic antidepressant therapy and a resulting upward dosage titration of the same medication, Dr. Muzina of Medco Health Solutions Inc. and his colleagues identified 53,530 patients from Medco's administrative patient claims database who were on antidepressant medications at the same dosage level for at least 6 months, followed by a subsequent submission of claims for a higher dose.Patients with only one claim for antidepressant medication in a 6-month period were excluded from the analysis, as were those taking multiple antidepressants, Dr. Muzina explained.To measure adherence status – which was determined by the proportion of days the patient possessed a supply of the medication, or the medication possession ratio (MPR) – researchers required a minimum of two claims for the same antidepressant drug. According to the National Committee for Quality Assurance's antidepressant performance measures, adherence was defined as an MPR of at least 80%, Dr. Muzina said.With respect to patient demographics and prescription characteristics, the study cohort was predominantly female (72%), with a mean age of 51 years. More than two-thirds of the sample (68%) filled their antidepressant prescriptions at retail pharmacies, and 62% received generic medications, Dr. Muzina said. Most of the prescriptions were ordered by nonpsychiatrists, with only 15% ordered by psychiatrists; nearly half of the 49,524 patients for whom Chronic Disease Scores (CDS) were available had scores indicating a high degree of comorbidity, he said. Of the full study cohort, “only 70.3% were adherent to their antidepressant medication in the 6 months prior to their dosage increase. Nearly 30% were nonadherent,” Dr. Muzina reported.Among the nonadherent patients, “one in four was in possession of their prescribed medication during less than 3 months of the 6-month period,” he said.An analysis of medication adherence by study subgroup – including age, sex, comorbidity, pharmacy channel (mail vs. retail), formulation (brand vs. generic), and prescriber (psychiatrist vs. nonpsychiatrist) – showed significant differences for all but the type of clinician prescriber, Dr. Muzina said, noting that similarly high rates of nonadherence were observed among the psychiatrist (30.4%) and nonpsychiatrist (29.5%) groups.Regarding pharmacy channel and formulation, 19.2% of patients who filled their prescriptions by mail were nonadherent, which was significantly lower than the 34.6% of those who used a retail pharmacy.Those receiving generic-only drugs had a small but significantly higher nonadherence rate (30.2%) than the 28.9% rate that was observed among patients receiving brand-name drugs, according to Dr. Muzina.Older age, male sex, and a higher CDS – perhaps because of the increased interaction with clinicians required by sicker patients – were also associated with significantly improved adherence relative to their respective corollaries, he said.Although the study did not investigate the reasons for patient nonadherence, some possibilities include undesired or intolerable side effects, negative stigma, and forgetfulness, Dr. Muzina hypothesized.The findings are limited by the study's retrospective design and the use of an administrative claims database, which doesn't provide certain relevant clinical information, according to Dr. Muzina. However, he suggested that the results indicate that clinicians should investigate and address adherence issues in all patients on antidepressant medications prior to prescribing a dose increase “to enable patients with depression to fully benefit from their medications.”Additionally, factors associated with adherence to antidepressant treatment should be investigated in future studies, he said.
来自阿姆斯特丹的消息:德国波恩大学医院的研究发现磁休克治疗难治性抑郁症,疗效与电休克治疗相似但是患者恢复得更快。磁休克治疗是在全麻下进行,利用强磁场引发癫痫发作。与电休克治疗相比,磁休克治疗更容易控制癫痫发作的部位和扩散方式。Magnetic Seizure Therapy Matches ECT for DepressionArticle OutlineVitalsMajor Finding: This was one of only a few clinical studies of MST. It found comparable outcome to ECT but quicker recovery and reorientation.Data Source: Prospective study of 20 patients: 16 with major depressive disorder and 4 with bipolar disorder.Disclosures: The authors had no relevant financial conflicts of interest.AMSTERDAM – Magnetic seizure therapy yields outcomes similar to electroconvulsive therapy for the treatment of resistant depression but has the advantage of faster recovery.“For treatment-resistant depression, electroconvulsive therapy (ECT) is often the treatment of last resort. It has been applied for 75 years and is effective, but has cognitive side effects, relapse rates as high as 50%, and it carries a stigma,” said Dr. Sarah Kayser of the University Hospital of Bonn (Germany), who presented the findings at the meeting.Magnetic seizure therapy (MST), performed under general anesthesia, is a more focal form of convulsive therapy that uses a strong magnetic field to induce a seizure. It provides greater control over sites of seizure onset and patterns of seizure spread, she said. MST treatment is performed much like ECT. The main difference is that magnetic rather than electrical stimulation is applied to induce seisures.Previous studies on small groups of patients have suggested that MST is a successful antidepressant approach, with less potential for cognitive side effects, compared with ECT. Although the initial prototype machine was large and unwieldy with multiple components, the newer MagPro MST, which is made in Denmark, is much smaller and easier to work with, Dr. Kayser noted.The prospective study included 20 patients: 16 with a DSM-IV diagnosis of major depressive disorder and 4 with bipolar disorder. The average patient was a 50-year-old female who had had six lifetime episodes of illness, been treated with 18 medications, and been hospitalized four times, Dr. Kayser reported.The average duration of the most recent episode of illness was 6 years in the MST group and 3.5 years in the ECT group. One out of five patients had attempted suicide.Ten patients received ECT, and the other 10 received a full course (up to 12 treatments) of MST.The outcome measure of effectiveness was remission or a 50% reduction in depressive symptom severity according to the Hamilton Depression Rating Scale (HDRS28) and the Montgomery-sberg Depression Rating Scale (MADRS).The two treatment groups in the study both demonstrated significant improvement over baseline. Response criteria were met by 65% of the patients, whereas 53% met the criteria for remission, Dr. Kayser reported.The patients' mean scores on the HDRS28 declined by approximately 12 points in each treatment arm (P less than .001), and on the MADRS they dropped approximately 12 points after ECT and 15 points after MST (P less than .001).Several aspects of recovery from the procedure were significantly better in the MST arm, compared with ECT, she reported. “Patients were quicker to breathe independently after anesthesia, and their reorientation time was faster, based on their answers to biographical questions such as name, date, and so forth,” she said.Mean recovery time (defined as independent breathing) was nearly 4 minutes after ECT, compared with approximately 1.5 minutes with MST (P less than .01).Reorientation time was 8 minutes vs. 2 minutes (P less than .01). EEG showed no effects on brain structure with either approach.Neither arm showed significant changes in cognitive outcomes, including learning and memory (verbal and visual), abstract knowledge, executive functions (verbal fluency), and speed of processing.This is an emerging treatment for severe depression that is being studied in only four clinical trials that are centered in New York/Dallas; Australia; Bonn, Germany; and Berlin.
来自奥兰多的消息:乔治亚州州立大学的Swahn博士对美国青少年健康调查研究1995年、1996年和2008年的数据分析发现:13岁前饮酒的青少年比不饮酒的自杀观念和自杀企图风险高,并且青春后期会进一步升高,但成年后则没无显著差异Early Alcohol Initiation Linked to Teen SuicideArticle OutlineVitalsMajor Finding: Risk for suicide ideation and/or attempt was higher in young adolescents who report drinking alcohol as preteenagers (adjusted odds ratio 2.40), compared with self-reported nondrinkers. Risk remains significantly elevated when they are resurveyed as older adolescents (OR, 3.13), but not as adults (OR, 1.71).Data Source: An initial and two follow-up surveys of 10,417 participants in the National Longitudinal Study of Adolescent HealthDisclosures: None was reported.ORLANDO — Adolescents who start drinking alcohol before age 13 are at a significantly increased risk for suicide ideation and attempts, even when controlling for depression, psychiatric treatment, and other risk factors.An emphasis on interventions to delay or prevent early alcohol initiation therefore could be beneficial, reported Monica H. Swahn, Ph.D., associate professor, Institute of Public Health, Georgia State University, Atlanta.Compared with self-reported nondrinkers, risk for suicide ideation and/or attempt was higher in young adolescents who reported drinking alcohol as preteenagers (adjusted odds ratio, 2.40). Risk remained elevated when the same cohort was resurveyed as older teens (adjusted OR, 3.13), Dr. Swahn reported.However, the risk for subsequent suicide was no longer significant when the same participants were surveyed as adults (OR, 1.71). Alcohol use, especially early alcohol use, may increase capacity for suicide behaviors. “Most of us talk about the inhibition, but there is also an indirect effect—alcohol can increase other risks.” Adverse effects on brain development and increased tolerance to pain are examples. Early initiation also might be an indicator of family dysfunction or poor coping strategies, Dr. Swahn said.“Until recently, very little research has examined the role of early alcohol use initiation, prior to age 13, as a specific risk factor for suicide,” Dr. Swahn said.To find out more, she and her associates conducted a secondary analysis of three prospective waves of data from the National Longitudinal Study of Adolescent Health. Of the total 10,417 participants, 13.8% reported drinking alcohol before the age of 13.The first survey in 1995 included a nationally representative group of adolescents in grades 7 through 12; the next wave of data was collected the following year; and a third wave assessed the same group in 2008. Only participants who reported suicide ideation were asked about an attempt, so the two variables were combined.The adolescent health study only includes self-reported data, a potential limitation of this study. No inclusion of any other circumstances around early alcohol use or suicidal behavior, as well as no consideration of changes in development or life circumstances, were other possible limitations, Dr. Swahn said.Future study could examine vulnerable subgroups, such as those who lost friends or family to suicide or those who experienced childhood maltreatment. In addition, Dr. Swahn would like to explore any patterns by gender or race/ethnicity.The American Foundation for Suicide Prevention provided a research grant for the study.
来自芝加哥的消息:匹兹堡大学的Raji博士在北美放射学会年会报告:每周步行5英里的轻度认知功能障碍和阿尔茨海默病患者磁共振三维成像示神经退行性变较久坐者显著减少,10年以上MMSE平均下降1分(久坐者平均下降5分)。Walking Linked to Slower Cognitive DeclinesIn patients with AD or MCI, walking 5 miles per week preserved brain volume and cut memory loss.By: SUSAN BIRK, Clinical Psychiatry News Digital NetworkVitalsMajor Finding: Among cognitively impaired subjects, cognitive scores on the MMSE declined on average by 1 point over 10 years in persons who walked 5 miles/wk, compared with 5 points in sedentary individuals.Data Source: Longitudinal study of 426 older adults. Disclosures: The study was funded by the National Institute of Aging, the American Heart Association, and the RSNA Research & Education Foundation. Dr. Raji had no financial disclosures.CHICAGO – Walking is associated with slower cognitive decline and greater preservation of brain volume in older adults with mild cognitive impairment or Alzheimer’s disease as well as in cognitively healthy older adults, a longitudinal study has shown. Patients with mild cognitive impairment (MCI) or Alzheimer’s disease (AD) who walked just 5 miles/wk – less than 0.75 mile/day – had significantly less neurodegeneration on three-dimensional volumetric MRI and a more than 50% reduction in cognitive decline and memory loss over 10 years than did sedentary cognitively impaired individuals, reported Cyrus A. Raji, Ph.D., of the University of Pittsburgh. "Physical activity may be a way to reduce risk [for AD] by strengthening brain structure," Dr. Raji said in a press briefing at the annual meeting of the Radiological Society of North America. He and his colleagues analyzed the responses of 1,479 participants to questionnaires in the 20-year, ongoing Cardiovascular Health Study–Cognition Study (CHS-CS). In 1989-1990, these subjects completed standardized, self-reported questionnaires of physical activity. Of these subjects, 927 underwent brain MRI in 1992-1994. In 1998-1999, 426 subjects underwent high-resolution, three-dimensional volumetric brain MRI. The three-dimensional imaging technique’s availability made it possible for Dr. Raji and his colleagues to look at "the brain itself and whether or not conserved brain conferred the reduced risk," he said. "The way physical activity reduces risk for Alzheimer’s disease, we believe, is that it preserves circulation to the brain. It preserves blood flow, and in so doing, it is preserving the health of neurons." Researchers divided the 426 subjects into those who were cognitively normal at the time of volumetric MRI (n = 299; mean age, 78 years) and those who were cognitively impaired (n = 127; mean age, 81 years) with either MCI (n = 83) or AD (n = 44). Among patients with AD or MCI, walking 5 miles/wk preserved brain volume and reduced memory loss over time as patients were developing the disease. The reduction in memory loss that was associated with walking remained stable even after researchers controlled for such factors as age, sex, race, education, subclinical stroke, head size, body fat composition, type II diabetes, cardiovascular disease, and hypertension. Normally aging patients who did not have MCI or AD at the time of volumetric MRI and who walked regularly also showed a significant reduction in brain atrophy over 10 years, compared with their more sedentary counterparts, as well as a 50% reduction in the risk of developing AD over a total of 13 years. The amount of walking needed to preserve brain volume and cognitive function, as measured by the 30-point Mini-Mental State Exam (MMSE) in these cognitively healthy patients, was slightly greater (6 miles/wk) than that for patients with AD or MCI. "If you could walk the 6 miles and achieve this preserved brain volume, you were able to reduce your risk of Alzheimer’s disease in the long run," Dr. Raji said. "Physical activity really has the power to preserve brain volume in normal aging and reduce the risk for future cognitive impairment." However, according to Dr. Raji, the most exciting finding was the positive effects of physical activity in people who already had AD or MCI at the time of volumetric MRI. The brain images of these patients revealed "preservation of brain volume in the exact same regions that benefit people with healthy aging, specifically, the prefrontal and temporal cortices," he said. Furthermore, the amount and magnitude of these effects were even larger than in the normally aging group. Among cognitively impaired subjects, scores on the MMSE declined on average by 1 point over 10 years in persons who walked 5 miles/wk, compared with 5 points in sedentary individuals. This statistically significant difference in the magnitude of memory loss was directly correlated with preserved hippocampal volume. "One-point changes on that test make a big difference," Dr. Raji added. "The ability of physical activity to preserve cognitive function over time ... is a substantial difference in the actual clinical symptoms that you would expect to see in people suffering from the memory loss of Alzheimer’s."
作者:任泽普 王 永 朱 焱喻小念 安建雄 随着“哇哇”的哭声,一个个新生命降临到这个世界,产妇吉女士和全家人都沉浸在幸福之中。然而一周后,吉女士出现情绪低落、易发脾气、不爱动、少语、觉得活着没意思、食欲差、失眠多梦、周身紧束感等,随着时间推移病情逐渐加重,全家都被笼罩在阴影之中,2周后被医生诊断为“产后抑郁”。吉女士为了下一代的健康,拒绝服用抗抑郁药,于是患者在航空总医院接受了“无痛电休克”治疗。令吉女士高兴的是,经过一次治疗后食欲和睡眠即显著改善,周身紧束感消失;四次治疗后患者心情明显好转、不再乱发脾气、开始对周围事物感兴趣、愿意与人交流、,病情明显好转的同时,可以放心地给宝宝哺乳,产妇及其全家都对治疗非常满意。据 世界卫生组织(WHO)统计,30%~70%的孕妇在生产后前2周(多在第3-4天出现)会经历一过性的轻度情绪低落(即“婴儿抑郁”、“baby blues”),如莫明哭泣或心绪欠佳等,多数产妇无需治疗在2周内可以好转,但有约13%的新妈妈症状表现较重、持续时间长、需要经过治疗才能好转,这就是大家常说的“产后抑郁”。 产后抑郁不但会损害产妇的身心健康,而且会间接影响婴儿的生理、心理的正常发育。患病母亲多对婴儿不理不问,厌恶或害怕接触孩子,甚至会出现伤害或杀死孩子、自伤、自杀等可怕的想法和行为。 产后抑郁危害严重,但往往被认为是正常的情绪波动而被忽视。一旦发现新妈妈持续2周或以上情绪低,高兴不起来,容易发脾气,对事情没有兴趣……,就该引起足够的重视,尽快到医院就诊。 目前抑郁症的治疗仍然以药物治疗为主,但产后抑郁的新妈妈需要哺乳,多数抗抑郁药会分泌到乳汁中,被婴儿摄入,从而影响婴儿的生长和发育,因而药物的使用受到严重限制;系统的心理治疗非常安全,但起效较慢,尤其病情较重的患者,只能作为辅助手段。 无痛苦电休克治疗(MECT)属于一种物理治疗,起初英国精神科医生受到屠夫用电击法使牲畜瘫软后方便宰杀的启发,尝试用同样的方法征服躁狂型精神病人,幸运的是部分病人经电击清醒后病情好转甚至痊愈,于是成为治疗精神疾病的经典疗法,但由于该方法不仅显得残忍,而且有一定危险而一度被弃用。上世纪末麻醉术得以迅猛发展并渗透到包括电休克在内的各个领域,使得电休克不仅再没有任何痛苦,而且变得格外安全,其死亡率已经降低到五十万分之一以下。 在美国,接受无痛苦电休克最多的病种之一就是患有抑郁的孕妇和产妇,原因在于这种方法不但安全而且起效快、疗效确切,由于不用服药,因此不用担心胎儿致畸作用和哺乳期婴儿发育,很容易被孕产妇接受。因治疗是在全身麻醉下进行,患者感觉不到任何疼痛或不适。大多数患者在第1次治疗的当天就可以获得显著疗效,6-12次即可痊愈。 目前我国电休克治疗基本限于精神病专科医院,给很多包括孕产妇在内的抑郁病人带来不便,航空总医院多学科疼痛医学中心的麻醉学家和精神学家紧密合作,引进并发展了无痛电休克技术,为需要电休克治疗的非精神病患者提供了方便。他们的积极工作受到国际同行重视,据悉国际电休克协会中国分会总部不久将落户于航空总医院。