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Dose,Plasma Level,and Treatment Outcome Among Methadone Patients in shanghai,China

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Neuroscience Bulletin 2016年第6期32卷 538-544页

作者： Haifeng Jiang Maureen Hillhouse Jiang Du Shujun Pan Ang Alfonso Jun Wang Zhirong Zhou Weijun Yuan Walter Ling Min Zhao shanghai mental health center Shanghai Jiao Tong University School of Medicine Shanghai 200030 China Department of Psychiatry Integrated Substance Abuse Program University of California at Los AngelesLos Angeles CA 90025 USA shanghai Yangpu district mental health center Shanghai 200093 China shanghai Xuhui district mental health center Shanghai 200232 China shanghai hongkou district mental health center Shanghai 200083 China

Abstract The purpose of this study was to investigate the blood levels of methadone in participants receiving methadone for the treatment of opioid dependence. After stabilization on methadone for four weeks, blood samples from 95 participants were collected between treatment weeks 4 and 12, before and after receiving doses of methadone, and its blood levels were measured. A multiple linear regression model was used to examine the associa- tion between methadone blood levels and the outcomes of methadone maintenance treatment （MMT）. Outcome dif- ferences between participants who had high （≥2） or low （〈2） peak-to-trough ratios were also compared using an independent sample t-test. The blood level of methadone was not correlated with the clinical outcome of MMT with the moderate range of doses given. However, the retention of patients who had a free peak-to-trough ratio 〉2 was significantly poorer than those whose ratio was 〈2. Thus, monitoring plasma methadone levels is unlikely to be effective for guiding dosing decisions in situations where compliance with MMT is already very high or when themethadone dose is no longer the dominant factor in determining the clinical outcome. However, monitoring plasma methadone levels is still helpful for guiding the dosage for patients with a rapid metabolism.

关键词： Methadone Plasma level Treatmentoutcome Metabolism

首发精神病患者与健康对照组额叶腹内侧Y-氨基丁酸浓度的比较（英文）

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上海精神医学 2015年第6期27卷 341-347页

作者：杨志磊朱雅靖宋振华梅力张建业陈天意王颖婵徐一峰江开达李瑶刘登堂 First-episode Schizophrenia and Early Psychosis Program Division of Psychotic Disorders Shanghai Mental Health Center Shanghai Jiao Tong University School of Medicine shanghai Jiading district mental health center School of Biomedical Engineering Shanghai Jiao Tong University shanghai hongkou district mental health center

背景：大脑中γ-氨基丁酸（γ-aminobutyric acid,GABA）的浓度和功能异常不仅是精神分裂症的一个重要病因学假说,而且也可能与认知功能下降和精神分裂症阴性症状相关。运用高场强磁共振波谱分析（magnetic resonance spectroscopy,MRS... 详细信息

背景：大脑中γ-氨基丁酸（γ-aminobutyric acid,GABA）的浓度和功能异常不仅是精神分裂症的一个重要病因学假说,而且也可能与认知功能下降和精神分裂症阴性症状相关。运用高场强磁共振波谱分析（magnetic resonance spectroscopy,MRS）的研究发现慢性精神分裂症患者额叶腹内侧（ventromedial prefrontal cortex,vmP FC）的GABA异常浓度,但患者既往使用抗精神病药物可能会对这些结果产生混杂。目标：比较首发精神病患者和健康对照组vmP FC中的GABA浓度,并评估vmP FC中GABA浓度与精神病性症状严重程度之间的关系。方法：共纳入22例首发精神病患者（10例精神分裂症患者和12例精神分裂样障碍患者）和23名健康对照者,应用单体素^1H-MRS来检测vmP FC中的GABA和其它代谢产物的浓度。22例患者中13例患者没有用过药物,9例患者使用抗精神病药物少于3天。采用阳性和阴性症状量表（the Positive and Negative Syndrome Scale,PANSS）评估患者组的精神病症状严重程度。结果：患者组vmP FC的GABA浓度的均值（SD）显著高于对照组（2.28[0.54]v.1.93[0.32]mM,t=2.62,p=0.012）。其它代谢产物的浓度——包括N-乙酰天冬氨酸（N-acetylaspartic acid,NAA）、谷氨酸（glutamic acid,GLU）和谷氨酰胺（glutamine,GLN）,在患者组和对照组之间没有显著差异。患者vmP FC中的GABA浓度与PANSS总分或三个PANSS分量表（阳性症状、阴性症状、一般精神病理）中的任何一个评分之间没有显著相关性。GABA浓度与病程之间无相关性,但与患者年龄显著相关（r=0.47,p=0.026）。结论：首发精神病患者vmP FC中的GABA浓度升高证实了该异常情况与药物使用是相互独立的。我们需要更大规模的研究来证实vmP FC中的GABA浓度与精神病症状严重程度之间不存在相关性,但这也提示脑部病理变化与临床症状之间存在若干个中间环节。

关键词：首发精神病首发精神分裂症未经药物治疗磁共振波谱 Y-氨基丁酸额叶腹内侧中国

How psychiatrists coordinate treatment for COVID-19: a retrospective study and experience from China

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General Psychiatry 2020年第4期33卷 174-178页

作者： Ling Yue Jingyi Wang Mingliang Ju Yi Zhu Lianghu Chen Lin Shi Bohai Shi Jun Chen Yifeng Shen Department of Psychiatry Shanghai Jiao Tong University School of MedicineAffiliated Shanghai Mental Health CenterShanghaiChina Department of Social Medicine School of Public HealthFudan UniversityShanghaiChina Department of Population Science and Experimental Medicine University College LondonLondonUK Department of Psychiatry Nanhui Mental Health Center of Pudong New AreaShanghaiChina Department of General Adult Psychiatry Xuhui District Mental Health CenterShanghaiChina Department of Psychiatry Hongkou District Mental Health CenterShanghaiChina

Background Patients with C0VID-19 are at high risk of developing mental health problems;however,the prevalence and management of mental disorders and how psychiatrists coordinate the treatment are unclear.Aims We aimed to investigate the mental health problems of patients infected with C0VID-19 and to identify the role of psychiatrists in the clinical treatment team during the pandemic.We also share the experience of psychiatric consultations of patients with COVID-19 in shanghai,China.Methods We analysed data from the psychiatric medical records of 329 patients with COVID-19 in the shanghai Public health Clinical center from 20 January to 8 March 2020.We collected information including sociodemographic characteristics,whether patients received psychiatric consultation,mental health symptoms,psychiatric diagnoses,psychiatric treatments and severity level of COVID-19.Results Psychiatric consultations were received by 84(25.5%)patients with COVID-19.The most common symptoms of mental health problems were sleep disorders(75%),anxiety(58.3%)and depressive symptoms(11.9%).The psychiatric consultation rate was highest in critically ill patients(69.2%),with affective symptoms or disturbed behaviour as their main mental health problems.Psychiatric diagnoses for patients who received consultation included acute stress reaction(39.3%),sleep disorders(33.3%),anxiety(15.5%),depression(7.1%)and delirium(4.8%).In terms of psychiatric treatments,86.9%of patients who received psychiatric consultation were treated with psychotropic medications,including non-benzodiazepine sedative-hypnotic agents(54.8%),antidepressants(26.2%),benzodiazepines(22.6%)and antipsychotics(10.7%).Among the 76 patients who were discharged from the hospital,79%had recovered from mental health problems and were not prescribed any psychotropic medications.The symptoms of the remaining 21%of patients had improved and they were prescribed medications to continue the treatment.Conclusions This is the first study to report psychiatric consultations for patients

关键词： treatment coordinate prescribed

关于社区精神分裂症人群个案管理的两年前瞻性病例对照研究(英文)

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上海精神医学 2014年第3期26卷 119-128页

作者：陈美娟吴国君汪作伟颜俊周建芳丁燕姜雅琴饶顺曾周卿倪花赵军苏艳莉胡俊张毅易正辉杨卫敏宋立升 shanghai mental health center Shanghai Jiao Tong University School of Medicine Shanghai China hongkou mental health center Shanghai China Xuhui mental health center Shanghai China

背景:以社区为基础的康复方案是精神分裂症患者综合治疗的基本要素。目标:评估以社区为基础的个案管理为精神分裂症患者提供康复服务的长期效果。方法:从上海两区共招募730名符合ICD-10精神分裂症诊断标准的社区居民,380名纳入个案管理... 详细信息

背景:以社区为基础的康复方案是精神分裂症患者综合治疗的基本要素。目标:评估以社区为基础的个案管理为精神分裂症患者提供康复服务的长期效果。方法:从上海两区共招募730名符合ICD-10精神分裂症诊断标准的社区居民,380名纳入个案管理组和350名纳入对照组。个案管理涉及每月培训拜访患者和他们的家庭成员,侧重于鼓励患者坚持服药。在24个月中参加者每3个月使用Camberwell需求评价量表(CAN),阳性和阴性症状量表(PANSS),世界卫生组织残疾评定量表(WHO-DAS)和生活质量表(QOLS)进行一次评估。那些没有得到医生批准而停止服用抗精神病药物一个月或更长的患者被归为"自行决定停药"。结果:相比于常规治疗组(即每3个月的随访管理),参加个案管理计划的患者两年随访后停止服药率显著降低,阴性症状的严重程度显著降低,复发率降低并且再住院率也降低了。对停止服药有独立影响的其他因素包括文化程度(受教育程度越高,停药率越高),用药缺乏家庭监督,用药剂量较高,以及与药物相关的不良反应。结论:个案管理是一种可行而且有效的长期方法,可以改善社区精神分裂症患者的康复效果。我们的研究结果强调家人需要参与患者的用药管理,使用药物的最小有效剂量,并积极处理所有的副作用。

关键词：精神分裂症社区康复个案管理中止率社会功能康复随机对照试验盲法评估

Hypothalamic-Pituitary-End-Organ Axes:Hormone Function in Female Patients with Major Depressive Disorder

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Neuroscience Bulletin 2021年第8期37卷 1176-1187页

作者： Yuncheng Zhu Xiaohui Wu Rubai Zhou Oliver Sie Zhiang Niu Fang Wang Yiru Fang Division of Mood Disorders Shanghai Hongkou Mental Health CenterShanghai200083China Clinical Research center Shanghai Mental Health CenterShanghai Jiao Tong University School of MedicineShanghai200030China shanghai Medical College Fudan UniversityShanghai200032China shanghai Yangpu mental health center Shanghai200093China CAS center for Excellence in Brain Science and Intelligence Technology Shanghai200031China shanghai Key Laboratory of Psychotic Disorders Shanghai201108China

Classic hypothalamic-pituitary-end-organ feedback loops–the hypothalamic-pituitary-adrenal axis(HPAA),hypothalamic-pituitary-thyroidal axis(HPTA),and hypothalamic-pituitary-gonadal axis(HPGA)–are associated with the neuroendocrine and immune systems in major depressive disorder(MDD).Female patients with MDD present with evident neuroendocrine and immunological changes.Glucocorticoid,thyroid hormone,and reproductive steroid levels fluctuate with menstrual cycles,which might lead to glucocorticoid receptor resistance,impairment of triiodothyronine conversion,and sex hormone secretion disorders.In this review,we summarize the independent and interactive functions of these three axes in female MDD patients.The similar molecular structure of steroids implies an interrelationship between the hypothalamic-pituitary-end-organ axes and the competitive inhibitory effects at the receptor level,especially when considering the HPAA and HPGA.

关键词： Major depressive disorder Neurosecretory systems Sex steroid hormones

破坏性心境失调障碍的诊断与治疗的思考（英文）

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上海精神医学 2016年第5期28卷 289-292页

作者：陈俊汪作为方贻儒 Division of Mood Disorders Subsidiary Mental Health Centre of Shanghai Jiao Tong University Medical School Shanghai China mental health Centre of hongkou district Shanghai China

美国精神障碍诊断与统计分册第5版新增一个诊断类别为破坏性心境失调障碍,但是临床实践中对此认识仍然较为有限。因此,本文就该诊断类别的由来、诊断要点、治疗以及对临床实践的启示作一介绍,供临床参考。

关键词：破坏性心境失调障碍美国精神障碍诊断与统计分册第5版

Transmission of NOTCH4 and GRIK2 in a population of Han Chinese with schizophrenia and affective disorder

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Neural Regeneration Research 2008年第3期3卷 257-261页

作者： Zuowei Wang Yiru Fang Shaoping Zhang Shunying Yu Sanduo Jiang hongkou mental health center of shanghai Shanghai 200083 China shanghai mental health center Shanghai 200030 China

BACKGROUND： Increasing evidence suggests overlapped genetic susceptibility across traditional classification systems that divided psychotic disorders into schizophrenia or affective disorder. OBJECTIVE： This study aimed to explore whether schizophrenia and affective disorder share genetic susceptibility in NOTCH4 and GRIK2 loci in a population of Han Chinese. DESIGN： Repetitive measurements. SETTING： The experiment was carried out at shanghai mental health center and hongkou mental health center of shanghai between January 2001 and June 2004. PARTICIPANTS： Sixty-five mixed pedigrees （suffering from various diseases, in combination with schizophrenia and affective disorder）, composed of 45 completed trios and 20 single-parent families, were selected from shanghai mental health center and hongkou mental health center of shanghai between January 2001 and June 2004. Probands received clinical diagnosis according to ICD-10; an independent clinician used identical criteria to review all diagnoses. All subjects were Han Chinese in origin and provided informed consent. There were 65 probands and 110 parents among the subjects. The probands comprised 30 males and 35 females： 33 with schizophrenia, 32 with affective disorder, mean age of （30.9 ± 9.8） years, mean age of onset （24.3 ± 8.8） years, mean duration （6.6 ± 7.0） years, and mean age of parents （58.8 ±10.9） years. METHODS： DNA samples from probands and their biological parents were extracted from peripheral blood according to standard methods. Four polymorphisms, -1725T/G and -25T/C in NOTCH4, rs6922753T/C and rs2227283G/A in GRIK2, were amplified and genotyped with PCR-RFLP techniques. MAIN OUTCOME MEASURES： Association between NOTCH4, GRIK2 polymorphism, and schizophrenia was analyzed by transmission disequilibrium test （TDT）. RESULTS： Sixty-five probands and 110 parents were included in the result analysis, with no dropouts. The results showed that the -25T/C polymorphism of NOTCH4 associated significantly with affective disorder and -1725G/-25T haplotype with sch

关键词： schizophrenia affective disorder NOTCH4 GRIK2 transmission disequilibrium test

对内观疗法辅助治疗精神分裂症疗效的1年随访:一项单盲、随机对照研究（英文）

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上海精神医学 2015年第4期27卷 220-227页

作者：张红李晨虎赵立宇占归来 shanghai Xuhui district mental health center

背景:目前的精神分裂症治疗常常只是部分有效。目的:评估在精神分裂症的治疗中使用辅助性内观疗法可能带来的益处,该疗法是一种源于日本、基于内省的认知方法。方法:在急性精神病性症状缓解后,235例具有初中以上学历的精神分裂症住院患... 详细信息

背景:目前的精神分裂症治疗常常只是部分有效。目的:评估在精神分裂症的治疗中使用辅助性内观疗法可能带来的益处,该疗法是一种源于日本、基于内省的认知方法。方法:在急性精神病性症状缓解后,235例具有初中以上学历的精神分裂症住院患者被随机分为对照组(n=112)或干预组(n=123)。前者接受常规药物治疗和住院康复治疗,后者在此基础上接受辅助性内观疗法,每天2小时,每周5天,为期4周。对所有患者在出院后进行12个月的随访。在基线、干预1个月后以及随访12个月后,采用阳性和阴性症状量表(Positive and Negative Syndrome Scale,PANSS)、个人和社会功能量表(Personal and Social Performance scale,PSP)以及自知力与治疗态度问卷(Insight and Attitude Questionnaire,ITAQ)分别对患者进行评估。对评估者使用盲法,隐瞒患者的分组情况。结果:在12个月的随访中干预组只有13例(10.6%)复发,但是对照组有23例(20.5%)复发(X2=4.50,p=0.034)。使用修正的意向治疗分析和重复测量方差分析,内观疗法组的PANSS、PSP和ITAQ总分均在12个月的随访中比对照组有更显著的改善。尽管两组之间药物剂量(氯丙嗪等效剂量)随时间变化趋势的差异并无统计学意义,但从入组到随访终点,干预组的平均剂量显著减少而对照组的减少在统计学上并不显著。结论:本研究有力支持了内观疗法作为辅助治疗在精神分裂症康复期是有效的。相比于常规治疗,辅以内观疗法可以维持急性治疗期间所取得的精神病性症状改善的疗效、提高对疾病的自知力、提高社会功能,并在一年的随访期内减少复发。这值得我们在更大、更多样化的精神分裂症患者样本中进一步研究这种治疗方法。

关键词：内观疗法精神分裂症复发社会功能随机对照试验中国

精神分裂症患者前额叶的GABA及谷氨酸浓度异常——活体1H-MRS研究（英文）

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上海精神医学 2017年第5期29卷 277-286页

作者：陈天意王颖婵张建业汪作为许嘉乐李瑶杨志磊刘登堂 Division of Psychiatric Disorders Shanghai Mental Health Center Shanghai Jiao Tong University School of Medicine Shanghai China shanghai hongkou mental health center Shanghai China College of Biomedical Engineering Shanghai Jiao Tong University Shanghai China Jiading district mental health center Shanghai China

背景:精神分裂症的病因及病理机制不明,传统的多巴胺(Dopamine,DA)假说不能完全解释其病理学及治疗学。谷氨酸(glutamate,Glu)及γ-氨基丁酸(γ-aminobutyric acid,GABA)假说认为精神分裂症患者脑内的Glu或GABA浓度异常。磁共振波谱(mag... 详细信息

背景:精神分裂症的病因及病理机制不明,传统的多巴胺(Dopamine,DA)假说不能完全解释其病理学及治疗学。谷氨酸(glutamate,Glu)及γ-氨基丁酸(γ-aminobutyric acid,GABA)假说认为精神分裂症患者脑内的Glu或GABA浓度异常。磁共振波谱(magnetic resonance spectroscopy,MRS)技术发现精神分裂症谷氨酸类物质水平在前额叶腹内侧(ventromedial prefrontal cortex,vmP FC)(包括前扣带回)(anterior cingulate cortex,ACC)升高。目的 :探讨谷氨酸系统(谷氨酸及γ-氨基丁酸)在精神分裂症原因学及病理机制中的作用。方法 :24例未服药精神分裂症患者及24例性别、年龄及教育程度相配的健康志愿者入组,应用西门子MRI 3T采集被试的磁共振波谱(magnetic resonance spectroscopy,MRS)数据,感兴趣区包括左侧前额叶背外侧(left dorsolateral prefrontal cortex,lD LPFC)、前额叶腹内侧(ventromedial prefrontal cortex,vmP FC)及前扣带回(anterior cingulate cortex,ACC),运用LCModel软件分析了感兴趣区的γ-氨基丁酸(γ-aminobutyric acid,GABA)、谷氨酸(glutamate,Glu)、谷氨酰胺(glutamine,Gln)、氮乙酰天冬氨酸(N-acetylaspartate,NAA)及氮乙酰天冬氨酸谷氨酸(N-acetylaspartylglutamate,NAAG)等物质浓度。同时应用阳性与阴性症状量表(positive and negative Syndrome scale,PANSS)及临床总体印象量表(Clinical Global Impression Scale,CGI)评估患者的精神症状和疾病严重程度。结果:精神分裂症组和健康对照组前扣带回的GABA浓度分别为1.90(Q1=1.55,Q3=2.09)及2.16(Q1=1.87,Q3=2.59)、Glu浓度分别为6.07(2.48)及6.54(1.99)、Gln浓度分别为0.36(Q1=0.00,Q3=0.74)及0.29(Q1=0.00,Q3=0.59),GABA浓度的组间差异有统计学意义(Z=-2.95,p=0.003),GABA/(NAA+NAAG)的组间差异有统计学意义(t=-2.72,p=0.012),而Glu及Gln的组间差异均无统计学意义。精神分裂症患者组的年龄与前扣带回的GABA浓度呈负相关(R=-0.494,p=0.014),与GABA/(NAA+NAAG)呈负相关(R=-0.473,p=0.020),但对照组无此相关性。经过FDR方法校正后,未发现临床症状与各代谢产物浓度无显著相关性。结论 :精神分裂症患者前额叶腹内侧的谷氨酸类物质浓度异常,而前扣带回的GABA浓度降低,支持精神分裂症脑内谷氨酸-GABA异常假说。精神分裂症患者前扣带回的GABA随年龄增长加速减退。临床症状与前扣带回的代谢物浓度可能相关。

关键词：精神分裂症磁共振波谱 γ- 氨基丁酸谷氨酸