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The clinical data of 5 patients with autoimmune encephalitis admitted to the psychiatric department of the 904th Hospital of the Joint Logistics Service Force from January 2016 to June 2020 were retrospectively analyzed. Among 5 patients, 4 had stress psychological events within one month before the onset, and 3 had precursor symptoms such as fever and vomiting. They were all characterized by rapid progress of atypical mental and behavioral abnormalities and cognitive impairment. In terms of neurological symptoms, 1 case had faciobrachial dystonic seizures (FBDS), 3 cases had seizures, 2 cases had involuntary movement, and 4 cases had autonomic dysfunction, including central hypopnea, arrhythmia, blood pressure instability and paroxysmal facial flushing. Most neurological symptoms occur within 1 month of the onset. MRI revealed abnormalities in cerebral cortex, thalamus, temporal lobe and insular lobe in 4 cases; EEG demonstrated bilateral short-range medium amplitude θ wave in 2 cases. Abnormal cerebrospinal fluid (CSF) pressure was detected in 4 cases and 2 cases had abnormal cell number CSF. Three patients had positive anti-N-methyl-D-aspartate receptor (NMDAR) antibody, one patient had positive anti-LGI1 antibody, and one patient had positive anti-γ-aminobutyric acid B receptor (GABA BR) antibody. One case was discharged automatically, the remaining 4 patients were treated with glucocorticoid or combined with gamma globulin and cyclophosphamide, antiepileptic drugs, antipsychotic drugs and other symptomatic treatment, and their symptoms were relieved. Patients were followed up for six months, there was slightly slow residual reaction in 2 cases and personality change in 1 case. Autoimmune encephalitis characterized by mental symptoms is likely to be misdiagnosed as mental disorders. Clinicians should identify symptoms different from mental disorders, taking into account of the possibility of autoimmune encephalitis, to make early diagnosis and treatment.
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Objective To evaluate the harmful effects of olanzapine and quetiapine therapeusis on swallowing ability in patients with Alzheimer'disease (AD).Methods AD inpatients with behavioral and psychological symptoms were randomly divided into two groups,treated with olanzapine (n=42) or quetiapine (n=38) for 6 weeks.The patients were assessed with Kubota's water swallowing test and arterial oxygen saturation(SaO2) monitoring pre and pro treatment.Results After treatment,a significant higher score of water swallowing test (t =2.682,2.040;both P＜ 0.05)in either of two groups,and a significant raised degrade of SaO2 only in olanzapine group(t=4.313,P＜0.01)but not in quetiapine group (P＞0.05)were observed.There was a significant higher degrade of SaO2 in olanzapine group than that in quetiapine group (t=2.155,P＜0.05)at 6 weekend of the study.Before pharmacon,about 29％ (23/80) AD subjects were diagnosed as dysphagia.After pharmacon,more emerging dysphagia patients were surveyed in olanzapine group compared with that in quetiapine group(9/31 vs 2/26,x2=4.135,P＜0.05).No significant change (both P＞0.05) in scores of mini-mental state examination(MMSE) and a significant reduced score(t=3.019,2.867;both P＜0.01)of behavioral pathology in Alzheimer'disease rating scale (BEHAVE-AD) were found in both two groups at the end of study.There was no difference among the two groups with regard to score of MMSE or BEHAVE-AD after treatment(both P＞0.05).Conclusion Either olanzapine or quetiapine therapeutics might do some harmful effects on swallowing function in patients with AD,especially the former.
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Objective To study the liver fat content (LFC) in schizophrenia patients during olanzapine or aripipra?zol treatment, and to explore the relation between LFC and insulin resistance (IR). Methods Schizophrenia patients were randomly administered with olanzapine (10~25 mg/d, n=57) or aripiprazole (15~30 mg/d, n=47) for eight weeks. All sub?jects underwent sonographic quantification of LFC and homeostasis model assessment of insulin resistance index (HOMA-IR) once 0, 4, 8 weeks of treatment. Results Compared with baseline, the levels of HOMA-IR significantly in?creased after a 4-week and an 8-week of olanzapine treatment, and so did the LFC after an 8-week of olanzapine treat?ment (P0.05) or HOMA-IR (P>0.05) did not significantly changed at week 4 and 8 in ar?ipiprazol group. The increment of LFC, HOMA-IR at week 8 was significantly higher in olanzapine group than that in ar?ipiprazol group (P<0.05). The change of LFC after 8-weeks olanzapine treatment was positively correlated with the change of HOMA-IR (r=0.298, P=0.036). Conclusion Olanzapine treatment increases whereas aripiprazol has little ef?fect on liver fat and insulin resistance in schizophrenia.
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Objective To investigate the serum superoxide dismutase( SOD) ,malondialdehyde ( MDA) , and nitric oxide( NO) level in generalized anxiety disorder ( GAD) patients for exploring the importance of oxida?tive stress in etiology of GAD. Methods 42 cases of first episode patients with GAD ( GAD group) and 42 cases of health ( control group) matched with age and gender were included . Serum levels of SOD,MDA ,and NO were tested to analyze for a control study.Results GAD patients had significantly higher levels of SOD,MAD and NO than health controls ((858.09±137.32)×102 U/L vs (745.40±119.19) ×102 U/L;(10.92±3.42)mmol/L vs (7.52±2.32)mmol/L;(74.32±12.34) μmol/L vs(65.22±14.29) μmol/L), t=4.036,5.368,3.297;P=0.000, 0.000,0.003) . A positive relationship between SOD and total score of Hamilton Anxiety Scale( HAMA ) ,psychotic anxiety factor of HAMA,or somatic anxiety factor of HAMA was found in GAD group ( r=0.331,0.370,0.318;P=0.029,0.016,0.040).The level of MAD correlated with total score or psychotic anxiety factor of HAMA( r=0.311, 0.320;P=0.042,0.039).Conclusion It is suggested that the dysfunction of oxidative stress may play a role in pathogenesis of generalized anxiety disorder.
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Objective To explore the effect of repetitive transcranial magnetic stimulation(rTMS) treatment on the brain derived neurotrophic factor(BDNF) serum levels in depressive patients.Methods Sixty-eight unipolar depressions treated with venlafaxine were randomly assigned to the real rTMS group(n =34)and the sham rTMS group(n =34),which were accepted the real or the shame rTMS treatment on the left dorsolateral prefrontal lobes respectively.The Hamilton Rating Scale for Depression (HAMD) and BDNF serum was assayed before and after 4 weeks' treatment.Results 1) A significant increase of serum BDNF((12.2 ± 1.3) μg/L vs (5.6 ± 0.8) μg/L,t=-9.167,P=0.000;(11.4 ± 1.5)μg/L vs (6.0± 1.0)μg/L,t=-7.421,P=0.000)and a significant decline of HAMD((11.6 ± 1.7) score vs (32.6 ± 2.5) score,t =14.654,P =0.000 ; (4.2 ± 2.8) score vs (31.8 ± 3.2)score,t=12.089,P =0.000) were found after the treatment in the real and the shame group,and the real group changed more significantly than the shame group ((6.7 ± 0.8) μg/L vs (5.1 ± l.2) μg/L,t =2.690,P =0.009 ; (21.0 ± 2.1) score vs (17.6 ± 2.6) score,t =2.693,P =0.000).2) A negative correlation was found between the serum BDNF levels and the HAM D scores before the treatment(r =-0.530,P=0.003; r =-0.490,P =0.004),and a positive correlation between changes of BDNF levels and HAMD scores changes(r =0.439,P =0.006 ; r =0.454,P =0.005).Conclusion The rTMS treatment can increase serum BDNF levels in depressive patients.
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ObjectiveTo explore the relationship between brain iron deposition and pathogenesis of tardive dyskinesia (TD) in schizophrenia.MethodsThe corrected phase (CP) of basal ganglia was measured in schizophrenia with TD( n=18) and without TD( n =18 ) using susceptibility weighted imaging MRI.Abnormal Involuntary Movement Scale (AIMS) was applied for clinical assessment of TD.ResultsAfter adjusting for age,sexual,and antipsychotic dosage,the mean CP of substantia nigra (SN) and caudate nucleus (CN) were significantly lower in schizophrenia patients with TD ( ( - 0.194 ± 0.040 ) rad,( - 0.089 ± 0.023 ) rad) than those without TD ( ( - 0.163 ± 0.033 ) rad,( - 0.076 ± 0.013 ) rad ; P =0.022,0.023 ).Lower mean CP in CN correlated with higher severity score of AIMS in TD patients ( r =- 0.468,P =0.034).Logistic regression analysis showed that the lower CP vaule in SN (β=-72.12,P=0.029) and CN(β=- 156.43,P=0.037),aging (β=0.379,P=0.042)were associated with the onset of TD.ConclusionThe results imply that the excess iron accumulation in basal ganglia may be associated with pathogenesis of TD in schizophrenia.
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Objective To investigate the effects of left dorsolateral prefrontal cortex with 10HZ , 80%motor threshold repetitive transcranial magnetic stimulation ( rTMS ) on the cognitive function in unipolar depression. Method Sixty-nine patients with unipolar depression were randomly assigned to either the real rTMS group or the sham rTMS treatment( the control group) ,all patients were given extended releasing venlafaxine. the cognitive function was evaluated using P300 and Repeatable battery for the assessment of neuropsychological status ( RBANS-immediate memory, visuospatial, language, attention, delayed memory, total score), Wisconsin card sorting test ( WCST-Right responses, Completed categories, Total errors , Preservative errors, Nonpreservative errors ). The depression severity was assessed with the 24-item Hamilton Rating Scale for Depression(HAMD-24). All of tests were examined before and after six weeks with thirty times rTMS. Results At the end of six weeks treatments, regarding the WCST,real rTMS group showed better improvement in the right responses than control group(33.23±10.29 vs 27.09 ± 9.82, F= 16. 116 , P= 0. 000), besides right responses, real rTMS group had better performance in the rest items than control group(F=4.862 ～ 17.758, P= 0.031 ～ 0.000) ;concerning the RBANS, real rTMS group was significantly superior to control group in total score( (88.83 ± 16.48 ) vs (78.85 ± 13.51 ), F= 8. 425,P = 0. 005 ), besides total score , the real rTMS group had better performance in some rest factors than control group (F= 10.088 ～20. 801, P=0. 002 ～0.000);real rTMS group showed better improvement in the amplitude of P3than control group( (8.27 ± 2.97 ) μV vs ( 7.37 ± 2.66) μV, F= 5. 838 , P=0.018 ) ;real rTMS group demonstrated better improvement in HAMD-24 than control group( (4.7 ±2.4)vs ( 11.2 ±5.1 ), F= 29.537, P=0. 000).Conclusion rTMS can significantly improve cognitive function and depressive symptoms with unipolar depression.