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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 retinol-binding protein 4 (RBP4) level in olanzapinetreated schizophrenia with non-alcoholic fatty liver disease (NAFLD) via a case-control study and to explore its relationship with NAFLD.Methods Schizophrenia receiving olanzapine treatment,with or without NAFLD were enrolled as cases (n=60) or controls (n=60).The serum retinol-binding protein 4,metabolic syndrome component including body mass index (BMI),waist-to-hip ratio (WHR),fasting plasma glucose (FPG),total cholesterol (TG),total glycerin (TC) and blood pressure were assayed.TyG index,CT value ratio of liver and spleen were used for insulin resistance or NAFLD diagnosis and severity assessment respectively.Results The serum level of RBP4 was significantly higher in cases than that in controls ((70± 13)mg/L vs (52±12)mg/L ; t =4.943,P＜0.01) and the same result was showed after influencing factor adjustment thru covariance analysis (F=16.797,P＜0.01).Moreover,cases had significantly higher TyG index,BMI,WHR,FPG,TG and systolic pressure (t=2.383-4.300,P＜0.05-0.01).Cases with severe or moderate NAFLD had significantly elevated serum RBP4 level compared with mild cases((79± 16) mg/L,(72±8) mg/L vs (63t9) mg/L,d =16.2,9.9 ; P＜0.01,0.05).A significantly negative correlation between RBP4 level and the CT value ratio of liver and spleen (r=-0.244,P＜0.05),and a significantly positive correlation between RBP4 level and TyG index,BMI,WHR,TG(r=0.197-0.244,all P＜0.05) were observed.The partial coefficient between RBP4 level and CT value of liver and spleen was significant with influence adjusted(r=-0.453,P＜0.01).Logistic regression showed that serum RBP4 level(β3=0.105,P＜0.01)and TyG index,hyperlipidemia,obesity,central obesity or high blood pressure (β =1.288-9.711,P＜ 0.05-0.01) were closely associated with NAFLD.Conclusion A heighten serum RBP4 level may be one of NAFLD risk factors in schizophrenia treated with olanzapine.
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Objective:To investigate the relationship between dopamine D1 receptor ( DRD1 ) gene polymorphisms and clozapine efficacy in male schizophrenic patients. Methods:Totally 46 male schizophrenic patients were treated by clozapine for 6-8 weeks. The clinical response was determined by the Positive and Negative Symptom Scale (PANSS). DRD1 gene rs265981, rs5326, rs4532, rs1799914, rs686 and rs4867798 polymorphisms were detected by the gene sequencing, while plasma clozapine levels were monitored during the treatment. Results:The total clinical efficacy of clozapine response group and the non-response group was compared, the distribution of rs265981 genotype TT, TC and CC and allele T and C had statistically significant differences (P=0. 025;P=0. 005), and the distribution of rs686 genotype CC, CT and TC and allele C and T had statistically significant differences ( P=0. 044;P=0. 010). The negative symptom of the response group was compared with that of the non-response group, the distribution of rs4532 gen-otype GG, GA and AA and allele G and A had statistically significant differences (P=0. 034; P=0. 013). Conclusion: The poly-morphisms of DRD1 gene rs265981 and rs686 may have influence on the clinical efficacy of clozapine, and rs4532 may have influence on the negative symptom.
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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 develop the job burnout scale for military personnel and examine the reliability and validity of this scale. Methods A total of 1000 military personnels were chosen by random cluster sampling to outline the Job Burnout Scale for Military Personnel, with the subjects divided into group A and group B, 280 of them were tested by this scale and Chinese Maslach Burnout Inventory simultaneously (CMBI), In group A ( n=500 ) Exploratory Factor analysis and Correlation analysis were used, and in group B ( n = 500) Confirmatory factor analysis was used. Results The results of correlation analysis indicated that the Cronbach'α of total scale was 0.917, and that of subscales was 0.719 ～ 0.847; split-half reliability coefficient of total scale was 0.920, and that of subscales was 0.723 ～ 0.867. The correlation coefficient of total scale scores and each factor was 0.731 ～ 0.808 (P＜0.01 ) ,and the correlation coefficient ranged from 0.386 to 0.627 between the factors(P ＜ 0.01 ). According to the results of exploratory and confirmatory factor analysis, the sample data fitted better to the hypothesized structure of theoretical model ( Sense of achievement, Somatization, Self-assessment, Human relation, Demotivation) and the indexes of Chi-Square was 771. 914, the degrees of freedom was 395, the probability level was 0.000, the relative Chi-Square was 1.954, the root mean square error of approximation (RMSEA) was 0.044, and the goodness of fit index ( GFI ), comparative fit index ( CFI ), incremental fit index ( IFI ) were 0.904,0.919, 0.920 respectively. The correlation was significant between this scale and CMBI. Conclusion The Job Burnout Scale for Military Personnel has good reliability and validity.