Weekly news in mind 005

Posted by [陳璿丞] on Friday, April 17, 2020

TOC

本周選選

期刊

Predictors of recurrence of major depressive disorder

Predictors of recurrence of major depressive disorder 馬來西亞的研究,追蹤200多個病人出院後5年的資料, 有抽血也有做基因,當然也有填表格, 總之做得很詳細。論文是open access的。裡面也有附圖,有興趣的人可以讀一讀。結論就 是:

social avoidance and severity of previous MDD prognosticate recurrence, with ApaI +64978C>A genotypes acting in synergy with severity in potentiating the hazard of recurrence.

如果手邊沒有驗DNA的,患者上一次MDD的狀況還有 遠離人群 的情況(雖然現在遠離人群是大 家稱讚的事…),可以做為判斷。

什麼時候換clozapine比較好?多重用藥在schizophrenia是好事!?

  1. 有提到什麼時候換clozapine的好時機: 想換就早點換

Masuda et al found that clozapine was associated with better effectiveness outcomes than standard (ie, nonclozapine second-generation) antipsychotic drugs

the reasons for this are its risk of agranulocytosis and the consequent need for regular blood draws to monitor absolute neutrophil counts Additional medical risks include myocarditis and bowel obstruction, which are dangerous and require close attention and management. Sialorrhea and daytime sedation are also important problems

  1. 作者認為如果一般藥物反應不好,可以更早開立clozapine

People who do not respond to standard antipsychotic drugs should get a clozapine trial sooner rather than later.

  1. 多重用藥可以考慮

While combinations of treatments are commonly used and ac- cepted in treatment of bipolar disorder and major depressive disorder, this has been resisted in schizophrenia.

  1. 偷偷告訴你思覺失調的神秘配方

The only monotherapy among the top 10 treatments was clozapine. The secret ingredients of effective antipsychotic combinations appear to be clozapine and long-acting injectable drugs; all of the 10 best combinations included one of these.

  1. 另外一個研究團隊的神秘配方:

the study found that initiation of an antidepressant was associated with lower rates of psychiatric hospital- ization and emergency department visits than initiation of a second antipsychotic drug, a mood stabilizer, or a benzodiazepine.

podcasts

  • The Story of Schizophrenia - Andreessen Horowitz

    今天要來推薦一集podcast是知名的矽谷創投訪談一個作者Robert Kolker, 這集約37分鐘, 作者寫了一個真實的故事,這是一個家族,從1950年代,一直到現在;12個裡面有6個有 schizophrenia,他們這幾十年來的治療、社會的眼光、家屬照顧的負擔。會談中還有邀 請生物方面的專家聊聊基因的發展,很有趣。如果想要看書的話,書名是:Hidden Valley Road by Robert Kolker . 整個家族接受治療的故事就是整個精神醫學的發展史,從早期的精神分裂是因為媽媽照顧 不好,而有內在妄想和外在世界的分裂,到Insulin shock, lobectomy後來抗精神藥物的 產生,還有2000年本來希望全基因定序後可以找出特定的基因去治療或預防,但後來才發 現,這疾病真是太複雜了……。

本周部落格文章

推薦書

這周我讀了佛洛伊德:幽微的心靈世界,但好像已經絕版了。只能看看各大圖書館或是二手 書還有沒有。這本書雖然也是千篇一律的佛洛伊德自傳,不過更在乎他在醫學上的發現和錯 誤,還有即使他錯誤百出,為什麼現在的精神醫學界或心理學界仍然會推崇他。作者 Peter D. Kramer 是一名精神科醫師,出發的觀點會去推敲在當時有所限制的醫學環境和當時的證據,而佛洛 伊德建立學說的來源如何。不過看得出來,佛洛伊德不是個會搞政治的人,書裡面有一段寫 到:

佛洛伊德不懂得判斷人品,也是個紕漏百出的政客,榮格顯然不夠穩定且自私自利,佛洛伊 德仍信任他、交付他種種權力,期待他會絕對忠誠。後來,榮格限入精神崩潰,又與另一名 精神病患發生關係,最後在納粹時期,還投機地入反猶太活動…… 總括而言,佛洛伊德的手下大將都絕頂聰明卻起伏不定,多數反覆陷入情緒失調、憂鬱症和 躁鬱症。…

疫情心理健康

政府有整理一系列的心理健康資訊,資料非常豐富,適合衛教。 疫情心理健康- 心理及口腔健康司


  1. Association of hospitalization and all-cause discontinuation among patients with schizophrenia on clozapine vs other oral second-generation antipsychotics: a systematic review and meta-analysis of cohort studies [published online July 31, 2019]. JAMA Psychiatry [return]

comments powered by Disqus