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Aspetti neurofisiologici e neuropsichiatrici della stimolazione magnetica transcranica 经颅磁刺激的神经生理和神经精神方面
Pub Date : 2010-12-01 DOI: 10.1016/j.quip.2009.04.005
Michela Walpoth , Giancarlo Giupponi , Roger Pycha , Christine Hörtnagl , Armand Hausmann , Alfredo C. Altamura , Bernardo Dell’Osso , Maurizio Pompili , Andreas Conca

Introduction

The authors review the literature in the field of Transcranial Magnetic Stimulation (TMS).

Materials and methods

For this purpose a PubMed search was performed. Additional information was gained by cross-referencing from papers found in the data base.

Results

Data from controlled studies as well as supplementary information from relevant review articles pertinent to the topic were used. History and the basics of TMS and repetitive Transcranial Magnetic Stimulation (rTMS) are presented. The ability of rTMS to non-invasively modulate higher cognitive functions such as learning and memory developed to a new exciting field. TMS, in fact, allows to transiently disrupt ongoing cortical processing, thus helping to enlighten the causal role of a specific brain area in a certain observable behaviour. Finally, rTMS clinical effectiveness in mood disorders, anxiety disorders, schizophrenic psychoses and Parkinson's disease, as well as in pain syndrome, is discussed.

Conclusions

RTMS in concert with functional neuroimaging methods allows to analyse neuronal networks. Long-Term Potentiation (LTP) and Long-Term Depression (LTD) are phenomena seen in preclinical studies after rTMS, thus reflecting plastic modulation of the brain. In fact, changes in brain plasticity are supposed to be putative mechanisms underlying the pathophysiology of psychiatric diseases like major depression.

作者对经颅磁刺激(TMS)领域的相关文献进行了综述。材料和方法为此,我们在PubMed上进行了检索。通过交叉参考数据库中找到的论文获得了额外的信息。结果数据来自对照研究,补充信息来自与本课题相关的相关综述文章。介绍了经颅磁刺激和重复经颅磁刺激(rTMS)的历史和基础。rTMS对学习和记忆等高级认知功能的非侵入性调节能力已发展成为一个令人兴奋的新领域。事实上,经颅磁刺激可以暂时中断正在进行的皮层处理,从而有助于揭示特定大脑区域在某些可观察行为中的因果作用。最后,讨论了rTMS在情绪障碍、焦虑症、精神分裂症和帕金森病以及疼痛综合征中的临床疗效。结论srtms与功能神经成像方法相结合可以分析神经网络。长期增强(Long-Term Potentiation, LTP)和长期抑郁(Long-Term Depression, LTD)是rTMS后临床前研究中出现的现象,反映了大脑的可塑性调节。事实上,大脑可塑性的变化被认为是精神疾病(如重度抑郁症)病理生理学的潜在机制。
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引用次数: 1
La terapia elettroconvulsivante nel trattamento della depressione maggiore resistente 电休克疗法治疗耐药抑郁症
Pub Date : 2010-12-01 DOI: 10.1016/j.quip.2010.10.003
Guido Di Sciascio , Salvatore Calò

Introduction

The efficacy of electroconvulsive therapy (ECT) in treating depressive symptoms has been established by different studies. This paper reviews the current knowledge of ECT in the treatment of major depressive disorder and its implications in clinical practice.

Materials and methods

In this review we analyzed studies on the efficacy and safety of ECT, quality of life, and factors predictive of response. A search of the literature was conducted in PubMed using the terms “electroconvulsive therapy”, “major depressive disorder”, “efficacy”, “tolerability”, “cognitive impairment”, “meta-analysis”, “quality of life”, “predictive response factors”, “maintenance treatment”.

Results

In a high percentage of patients ECT is associated with remission of symptoms and improvement of the quality of life. Factors predicting especially good ECT responses in depressed patients include psychomotor retardation, psychosis, and advanced age. Cognitive side-effects are the main limitation of ECT although efficacy and tolerability vary according to the used ECT technique.

Conclusions

ECT is one of the most powerful treatments available. Thanks to the improvements in technique, ECT has become even safer and more useful for treatment of acute phase of depression and for the prevention of new depressive episodes.

不同的研究已经证实了电休克疗法(ECT)治疗抑郁症状的有效性。本文综述了电痉挛疗法治疗重度抑郁症的最新进展及其在临床实践中的意义。材料和方法在这篇综述中,我们分析了电痉挛治疗的有效性和安全性、生活质量和反应预测因素。在PubMed检索相关文献,检索词包括“电惊厥疗法”、“重度抑郁症”、“疗效”、“耐受性”、“认知障碍”、“荟萃分析”、“生活质量”、“预测反应因素”、“维持治疗”。结果电痉挛治疗后,大部分患者的症状得到缓解,生活质量得到改善。预测抑郁症患者良好电痉挛反应的因素包括精神运动迟缓、精神病和高龄。认知副作用是电痉挛疗法的主要局限性,尽管其疗效和耐受性因所使用的电痉挛疗法而异。结论中药是目前最有效的治疗方法之一。由于技术的进步,电痉挛疗法在治疗抑郁症的急性期和预防新的抑郁症发作方面变得更加安全和有用。
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引用次数: 0
Utilizzo dell’elettroencefalografia nelle psicosi oggi 今天在精神病中使用脑电图
Pub Date : 2010-12-01 DOI: 10.1016/j.quip.2010.10.004
Massimiliano Beghi , Cesare M. Cornaggia , Jacopo Santambrogio , Cecilia Perin , Cesare Cerri , Massimo Clerici

Introduction

The use of electroencephalography (EEG) in Psychiatry has decreased substantially in recent decades. To identify settings in which this type of testing is still considered useful, we conducted a critical analysis of the current literature on the use of standard EEG in the diagnosis and treatment of psychoses.

Materials and methods

The PubMed and Medline databases were searched for articles published since 2000, using the following keywords

“EEG”, “schizophrenia”, “psychosis”, “clozapine”, “olanzapine”, “risperidone”, “quetiapine”, “antipsychotics”, “street drugs”, and “aggression”.

Results

The review shows that EEG can be useful (and sometimes essential) in the differential diagnosis of an initial psychotic episode and ruling out organic conditions with psychotic symptoms (e.g., psychoses induced by street drugs, alcohol, encephalitis and other brain infections, meningiomas and other brain tumors, ictal or postictal psychoses in epilepsy, forced normalization, and delirium). To different extents, typical and atypical antipsychotics both seem to lower the seizure threshold, and this can lead to abnormalities on standard EEG. These effects are particularly common in patients treated with clozapine. In terms of prognosis, the presence of EEG anomalies before treatment seems to be predictive of poorer responses.

Conclusions

Standard EEG is not widely used in patients with psychoses, but in certain cases it can be in the diagnosis of these disorders and in assessments of prognosis.

近几十年来,脑电图(EEG)在精神病学中的应用大幅减少。为了确定在哪些情况下这种类型的测试仍然被认为是有用的,我们对目前关于使用标准脑电图诊断和治疗精神病的文献进行了批判性分析。材料和方法检索PubMed和Medline数据库自2000年以来发表的文章,检索关键词为:EEG、精神分裂症、精神病、氯氮平、奥氮平、利培酮、喹硫平、抗精神病药物、街头毒品和攻击性。结果:回顾显示脑电图在鉴别诊断初始精神病发作和排除伴有精神病症状的器质性疾病(如:街头毒品、酒精、脑炎和其他脑部感染、脑膜瘤和其他脑肿瘤、癫痫发作或发作后精神病、强迫正常化和谵妄)方面是有用的(有时是必要的)。典型和非典型抗精神病药物似乎在不同程度上降低了癫痫发作阈值,这可能导致标准脑电图异常。这些影响在氯氮平治疗的患者中尤其常见。在预后方面,治疗前脑电图异常的存在似乎预示着较差的反应。结论标准脑电图在精神病患者中应用并不广泛,但在某些情况下可用于精神病的诊断和预后评估。
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引用次数: 0
Cover 封面
Pub Date : 2010-12-01 DOI: 10.1016/S0393-0645(10)00061-7
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引用次数: 0
La neurostimolazione vagale in Neurologia e Psichiatria 神经学和精神病学中的迷走神经刺激
Pub Date : 2010-12-01 DOI: 10.1016/j.quip.2010.10.006
Gennaro Bussone , Cesare Peccarisi , Alberto Proietti Cecchini , Angelo Franzini

Introduction

Recent progress in biotechnology and neuroimaging has enlarged the possibilities for applying neurostimulation procedures to treat common neuropsychiatric conditions and chronic pain disorders. These conditions are refractory to pharmacological and other conventional treatments, to variable degrees, and are associated with a heavy social and economic burden. Refinements in neuroanatomical targeting have enlarged the clinical indications for these neurostimulation treatments, and increased the need to identify robust patient selection criteria. Neurostimulation is a relatively low invasivity procedure, and may be safer than conventional treatments, mainly because it is fully reversible, but also because it is highly flexible, offering a wide range of modulation (amplitude, duration, frequency) and stimulation (unipolar/bipolar, continuous/cycling, unilateral/bilateral) modes. There are various types of neurostimulation technique which promise great therapeutic potential now extending from Neurology to Psychiatry that is still only partly explored. The present paper reviews the clinical applications of these techniques, presenting main results and discussing limitations, with particular regard to newest applications of vagal nerve stimulation.

生物技术和神经成像的最新进展扩大了应用神经刺激程序治疗常见神经精神疾病和慢性疼痛障碍的可能性。这些疾病在不同程度上对药物和其他常规治疗难以治愈,并伴有沉重的社会和经济负担。神经解剖靶向的改进扩大了这些神经刺激治疗的临床适应症,并增加了确定稳健患者选择标准的需要。神经刺激是一种侵入性相对较低的治疗方法,可能比传统治疗更安全,主要是因为它是完全可逆的,但也因为它高度灵活,提供广泛的调节(幅度、持续时间、频率)和刺激(单极/双极、连续/循环、单侧/双侧)模式。有各种类型的神经刺激技术,承诺巨大的治疗潜力,现在从神经病学延伸到精神病学,仍然只是部分探索。本文综述了这些技术的临床应用,介绍了主要结果并讨论了局限性,特别是关于迷走神经刺激的最新应用。
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引用次数: 0
Poesia e follia. In ricordo di Alda Merini 诗歌和疯狂。为了纪念阿尔达·梅里尼
Pub Date : 2010-12-01 DOI: 10.1016/j.quip.2010.11.001
Alberto Giannelli
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引用次数: 0
Pub Date : 2010-12-01 DOI: 10.1016/j.quip.2010.01.002
Luigi Ferrannini, Paolo F. Peloso
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引用次数: 2
La fototerapia in Psichiatria: applicazioni, limiti e prospettive future 精神病学光疗:应用、限制和未来展望
Pub Date : 2010-12-01 DOI: 10.1016/j.quip.2010.10.002
Pasquale Scognamiglio, Palmiero Monteleone

Introduction

Light therapy is a therapeutic technique based on the use of light. Its use in Psychiatry has grown over the past 30 years since the discovery of its efficacy in the treatment of seasonal affective disorder. Its mechanism of action is related to the chronobiology of circadian rhythms and to the role of melatonin in the modulation of endogenous rhythms. This article provides a critical review of the literature dealing with the use of this treatment in seasonal depression and other mood disorders (nonseasonal depression and bipolar disorder), in eating disorders, and other psychiatric syndromes.

Conclusions

This review shows that light therapy may be considered the treatment of choice for seasonal affective disorder, but its use in other psychiatric syndromes needs further investigation.

光疗法是一种基于光的治疗技术。自从发现它对季节性情感障碍的治疗效果以来,它在精神病学中的应用在过去的30年里不断增长。其作用机制与昼夜节律的时间生物学和褪黑素在调节内源性节律中的作用有关。这篇文章提供了一个重要的文献综述处理使用这种治疗季节性抑郁症和其他情绪障碍(非季节性抑郁症和双相情感障碍),饮食失调和其他精神综合征。结论光疗可作为季节性情感障碍的治疗选择,但其在其他精神综合征中的应用有待进一步研究。
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引用次数: 0
Sindrome metabolica, disturbi dello spettro schizofrenico e trattamenti. Risultati di uno studio naturalistico 代谢综合征,精神分裂光谱紊乱和治疗。自然研究的结果
Pub Date : 2010-09-01 DOI: 10.1016/j.quip.2010.07.002
Maria Francesca Pantusa, Serena Paparo, Aurora Salerno

Introduction

Our aim was to estimate the prevalence of the metabolic syndrome (MS) among outpatients with schizophrenic-spectrum disorders who were receiving antipsychotic drugs.

Materials and methods

A retrospective study was conducted in a community-based public health clinic for psychiatric outpatients in southern Italy. NCEP ATP-III criteria for diagnosis of MS were evaluated by means of questionnaires, physical examination, and laboratory analyses in 134 outpatients (males/females: 72/62; mean age 45.4 ± 13.8 years; range 18-74 years). All had DSM-IV-TR based diagnoses of schizophrenia or a schizophreniform or schizoaffective disorder and had been on first- and/or second-generation antipsychotic (FGA and SGA) drug therapy for at least 12 weeks (mean 45.1 months).

Results

52/134 (38.8%) patients (61.5% of the women vs 38.5% of the men) met the criteria for MS. The most commonly observed manifestations were abdominal obesity (prevalence 92.3%, more common in women); hypertriglyceridemia (76.9%); and systolic hypertension (73.1%, more common in men). Only 22.4% of the patients were receiving antihypertensive treatment, 10.4% were on hypoglycemic therapy, and 2.9% were on lipid-lowering drugs. MS prevalence was not significantly related to treatment, but the group on FGA had significantly higher rates of hyperglycemia and low HDL cholesterol; the latter was also more common in patients on combined FGA-SGA therapy, as were systolic and diastolic hypertension and obesity.

Conclusions

Our findings confirm a high prevalence of MS among subjects with schizophrenia. No significant relation between MS and treatment class emerged, but obesity and hypertension were more common in patients on combined FGA-SGA therapy. The low percentages of patients receiving therapy for hypertension, hyperglycemia, and/or dyslipidemia suggest that greater emphasis needs to be placed on the physical health of these patients.

我们的目的是估计在接受抗精神病药物治疗的精神分裂症谱系障碍门诊患者中代谢综合征(MS)的患病率。材料与方法在意大利南部一家社区公共卫生诊所对精神科门诊患者进行回顾性研究。通过问卷调查、体格检查和实验室分析对134例门诊患者(男/女:72/62;平均年龄45.4±13.8岁;范围:18-74岁)。所有患者均基于DSM-IV-TR诊断为精神分裂症或精神分裂样或精神分裂情感性障碍,并已接受第一代和/或第二代抗精神病药物(FGA和SGA)治疗至少12周(平均45.1个月)。结果134例患者中有52例(38.8%)(女性占61.5%,男性占38.5%)符合ms标准,最常见的表现为腹部肥胖(患病率92.3%,女性多见);高甘油三酯血症(76.9%);收缩期高血压(73.1%,男性更常见)。降压治疗占22.4%,降糖治疗占10.4%,降脂药物占2.9%。MS患病率与治疗无显著相关性,但FGA组高血糖和低HDL胆固醇发生率显著升高;后者在FGA-SGA联合治疗的患者中也更常见,收缩期和舒张期高血压和肥胖也是如此。结论我们的研究结果证实了MS在精神分裂症患者中的高患病率。MS与治疗类别无显著相关性,但肥胖和高血压在FGA-SGA联合治疗的患者中更为常见。接受高血压、高血糖和/或血脂异常治疗的患者比例较低,这表明需要更加重视这些患者的身体健康。
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引用次数: 1
Toward a scientific framework for the Personal Meaning Organization (PMO) paradigm: neuroimaging and genetic studies 迈向个人意义组织(PMO)范式的科学框架:神经成像和遗传研究
Pub Date : 2010-09-01 DOI: 10.1016/j.quip.2010.07.003
Bernardo Nardi , Giorgio Rezzonico , Cesario Bellantuono

Introduction

Reciprocity with primary care-givers drives subjects’ adaptive abilities towards the construction of the most useful Personal Meaning Organization (PMO) with respect to their developmental environment.

Materials and methods

We analyzed the post-rationalist approach over the last ten years focusing on the construction of a specific framework for distinguishing immediate experience from explanations of the experience, the moviola technique, and the analysis of awareness and resistance. Functional neuroimaging (fNI) was used to conduct a scientific in vivo study of PMO.

Results

Predictable, invariable care-giver behaviors allow an inward focus and a physical view of reciprocity: when reciprocity is high, a controller-type inward PMO develops; when it is low, the inward PMO develops in a detached manner. The Controller PMO is focused on the need for protection/exploration; the Detached PMO is focused on need for expression during isolation. Variable, non-predictable care-giver behavior allows an outward focus and a semantic view of reciprocity: when reciprocity is high, a contextualized outward PMO develops; when it is low, a principle-oriented outward PMO develops. The former interprets changes in the relational environment one by one; the latter focuses on the management of antithetical aspects of reality.

Discussion

Focusing on the PMO promotes the emergence of adaptive individual resources, thereby improving skills needed for the control of perturbing emotions and more flexible behavior strategies.

与初级照护者的互惠关系驱动被试在其发展环境中构建最有用的个人意义组织(PMO)的适应能力。材料和方法我们分析了近十年来的后理性主义方法,重点是构建一个特定的框架,以区分直接经验与对经验的解释、viola技术以及对意识和抵抗的分析。应用功能神经影像学(fNI)对PMO进行了科学的体内研究。结果可预测的、不变的照顾者行为允许内在关注和互惠的物理观:当互惠高时,控制型内向PMO发展;当它低时,内向的PMO以超然的方式发展。控制器PMO专注于保护/探索的需求;分离的PMO关注的是隔离期间的表达需求。可变的、不可预测的照顾者行为允许向外关注和语义互惠观:当互惠高时,情境化的向外PMO发展;当它较低时,一个以原则为导向的外向PMO发展。前者逐个解释关系环境的变化;后者侧重于管理现实的对立方面。关注PMO促进了适应性个体资源的出现,从而提高了控制令人不安的情绪和更灵活的行为策略所需的技能。
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引用次数: 7
期刊
Quaderni Italiani di Psichiatria
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