课件：神经系统疾病合并抑郁焦虑.ppt

后面内容直接删除就行 资料可以编辑修改使用 资料可以编辑修改使用 资料仅供参考，实际情况实际分析 * Slide 63 目的： 让医生普遍关注卒中患者的抑郁情绪。 * Chronic Pain can be broadly divided into that of inflammatory or neuropathic origin. Both types can result in alteration of pain pathways at multiple levels. Peripheral damage to nerves in neuropathy leads to abnormal firing of sensory afferents, changes in sensory processing at spinal cord and higher centres. Similarly inflammatory pain may have components of central sensitisation due to increased sensory afferent firing, but also due to circulating inflammory mediators sensitising spinal cord and CNS pathways * KEY POINTS: The hippocampus is at a “vulnerable intersection” of cognitive, emotional, and neuroendocrine regulation. It is rich in glucocorticoid receptors and is a recipient of significant input from excitatory glutaminergic neurons The hippocampus, a region of the brain involved in emotional responses, may begin to atrophy in depression Investigators have found that approximately half of persons with severe depression exhibit high levels of the stress hormone, cortisol, which is thought to be toxic to neurons. (Source: J. Douglas Bremner, MD, Yale University) This combined toxic impact may precipitate changes in growth and plasticity in the hippocampus BACKGROUND: The MRI scans above were obtained from a healthy control (left scan) and a person with severe depression (right scan) Indications of hippocampal atrophy are apparent in the diminished size of the area outlined in red in the enlargement of the scan obtained from the patient with depression REFERENCE: Bremner JD, Narayan M, Anderson ER, et al. Hippocampal volume reduction in major depression. Am J Psychiatry 2000;157:115-118. * * QTc（QT间期）：心电图中，Q波至T波之间的距离，代表心室除极、复极的时间总合。 * 这个试验结果显示，再普乐对心脏QTc的影响很低，低于喹硫平（11%）和齐拉西酮（21%）。 * * （2）单胺氧化酶抑制剂（MAOI） 司来吉林（selegiline）：属于B型单胺氧化酶抑制剂（MAOI－B），t1/2为40h，24h由尿中排出52％，72h总排出率84％。 由于具有皮层兴奋作用，晚上服药可引起失眠，故服药时间在早、午；每片5mg，每日2次。 3、新型抗抑郁药 SSRIs 氟西汀 帕罗西汀 舍曲林 氟伏沙明 西酞普兰 艾司西酞普兰 SNRIs