Chronic pain, depression, anxiety, somatoform disorders and hypochondria frequently coexist in the elderly,these symptoms make sleep disorders worse,social and live ability decrease in vicious cycle.Multiaspect treatment including physiological,psychological and behaviour therapy at the same time provides an effective method to chronic pain in the elderly in view of close relationship between pain and mental hygiene.

ObjectiveTo explore the effects of insomnia on heart rate variety(HRV) in aged hypertension patients. Methods259 subjects were divided into healthy group (74 cases),simple hypertension group (71 cases),coexisting hypertension and insomnia group (114 cases) which was sub-grouped to ＜5 years,5-9 years and ≥-10 years according to the duration of insomnia.All subjects had 24 h recordings of ECG.The data of HRV time domain (SDNN,SDANN and ASDNN) were collected and compared.ResultsHRV time domain was lower in healthy group than in the other two groups (F=12.02,10.54 and 4.27,P＜0.01),and decreased more significantly in coexisting hypertension and insomnia group compared with simple hypertension group(P＜0.01).The values of SDNN and SDANN in 5-9 years and ≥ 10 years subgroups decreased as compared with ＜ 5 years subgroup (F=8.63 and 4.54,P＜0.01),and these values further lower in ≥10 years subgroup than in 5-9 years subgroup (P＜ 0.01 ). ConclusionsInsomnia may lead to more serious disorder of automatic nervous system and further aggravated disorders appear in the elderly with hypertension along with increasing years of insomnia.

Objective To investigate the relationship between proinflammatory cytokines and cognitive function in patients with mild cognitive impairment (MCI).Methods From May 2007 to May 2009,70 patients (aged ≥ 60 years) with MCI were collected.Among them,50 cases were amnestic MCI,and 19 cases developed into AD.The cognitive function was assessed,and all patients were followed up.The venous blood samples were obtained and proinflammatory cytokines (IL-1α,IL 1β,IL-6,TNF-α) were detected by using enzyme linked immunosorbent assay.Results There were differences in the levels of proinflammatory cytokines between patients with aMCI and patients with Alzheimer's disease (AD) [IL-1β,(40.5 ± 7.7) μg/L vs.(38.6 ± 7.3) μg/L ; IL 6,(70.4 ±24.3) μg/'L vs.(53.6±20.5) μg/L;TNF-α,(58.6±13.5) μg/'L vs.(50.3±-17.1) μg/'L;t=3.537,2.229,2.226,P=0.002,0.039,0.039,respectively].Conclusions MCI is a preclinical state of AD.The cognitive function damage of MCI patients are different from that of AD patients,and the immune status of MCI patients is also changed.

Objective To evaluate the preventive effects of Haishe capsules on the conversion of amnestic mild cognitive impairment (aMCI) to Alzheimer's disease(AD).Methods Patients (n=120) with aMCI from our department were recruited and randomly divided into the treatment group and the control group (n=60 in each group).The treatment group was given 0.9 gram of Haishe capsules three times a day while the control group received no drug treatment.Data on the conversion ratio,memory and cognitive function were comparedbetween the groups in a 24-months follow-up.Results By the end of the study,12 patients in the treatment group and 15 in the control group dropped out.Valid data for 93 patients were available for statistical analysis (48 in the treatment group and 45 in the control group).The number of aMCI patients who converted to AD was 6,with a conversion ratio of 12.5％ (6/48);and the number of patients who went through conversion in the control group was 13,with a conversion ratio of 28.8％ (13/45).The difference in conversion between the two groups was statistically significant (x2 =3.83,P＜0.05).After 24 months,MMSE scores for the treatment group (25.52± 1.07) had no significant change compared with baseline levels,while MMSE scores for the control group decreased significantly(24.75--1.49) and were markedly lower than thosefor the treatment group (t=2.85,P＜0.05).MoCA scores for the treatment group (19.39 ±2.01) did not show decline until the end of the study,while those for the control group started to decrease about half way through the study and were lower than scores for the treatment group (t =2.41,P＜0.05).Compared with baseline levels,ADAS-Cogscores for the treatment group (7.62± 1.06) did not increase significantly during the course of the study.ADAS-Cogscores forthe control group were higher at both half way (7.70±0.75) and the end of the study (8.18±0.80)than base line levels,and there was a statistically significant difference in end-of-study ADAS-Cog scores between the two groups(t =-2.6,P＜ 0.05).Conclusions Haishe capsules not only effectively maintain memory and cognitive function,but also delay the conversion from aMCI to AD.

OBJECTIVETo study the clinical effect of acupoint stimulating control (ASC) in treating obsessive compulsive neurosis.

METHODSThe comparative study was conducted in 65 patients with obsessive compulsive neurosis, they were divided into two groups, the 33 patients in the control group treated with chlorimipramine and the 32 in the tested group treated with ASC. The therapeutic efficacy and adverse reaction were assessed according to the standard for clinical efficacy evaluation by Yale-Brown scale for obsession (Y-BOCS)and adverse reaction scale.

RESULTSThe curative rate and markedly effective rate in the control group was 24.2% (8/33) and 27.3% (19/33), which in the tested group was 37.5% (12/32) and 34.4% (11/32) respectively. Significant difference was shown in comparison of Y-BOCS score between the two groups from the end of the 4th week of treatment (P < 0.05), indicating the efficacy in the tested group was better than that in the control group. Moreover, the occurrence of adverse reaction was higher in the control group than that in the tested group.

CONCLUSIONASC is a treatment with good effect, less adverse reaction and favourable safety superior to the treatment by chlorimipramine.

Acupuncture Points ; Adolescent ; Adult ; Aged ; Behavior Control ; methods ; Behavior Therapy ; Clomipramine ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Obsessive-Compulsive Disorder ; therapy ; Psychiatric Status Rating Scales ; Transcutaneous Electric Nerve Stimulation ; methods

Objective:To investigate the effects of sodium butyrate(NaB)on pathological processes such as autophagy and inflammation in an Alzheimer's disease(AD)model and related mechanisms.Methods:Aβ 25-35's action on PC12 cells was used to establish an in vitro AD model, in which microglial BV2 were treated with NaB.Based on treatments, there were a PC12 cells group, a PC12 cells+ Aβ 25-35 group, a PC12 cells+ Aβ 25-35+ NaB group, a BV2 cells group, a BV2 cells+ Aβ 25-35 group, and a BV2 cells+ Aβ 25-35+ NaB group.The expression of markers of the autophagy pathway and inflammatory proteins was evaluated by Western blot, immunofluorescence and EdU staining.Results:NaB was able to promote cell proliferation in the AD model and reduce the level of Tau protein hyperphosphorylation.NaB also inhibited the inflammatory response of microglia and reduce the expression of inflammatory response marker NLRP3(148.313±0.973 vs.113.291±1.218, t=38.91, P<0.001). At the same time, NaB promoted the expression of autophagy pathway proteins(including Beclin-1, LAMP-1 and LC3 Ⅱ/Ⅰ)in microglia. Conclusions:NaB can mitigate pathological changes in an AD model by promoting autophagy and reducing the inflammatory response.

Alzheimer Disease(AD) presently remains an irreversible disease.Consequently,with current research findings and clinical practices,we propose a new prevention and treatment perspective,summarized in four aspects:early-stage,comprehensive,systematic,and long term,which are interrelated and yet show varying significance depending on the circumstances.We hope this view will help improve AD-related practices in prevention,clinical management,research and education,better equipping us to face challenges posed by AD.

Medications are the main means for the treatment of mental illness, and it is of great significance to be familiar with the adverse reactions of psychotropic drugs for the formulation and optimization of treatment plans.The prolongation of the QT interval corrected by heart rate(QTc interval)is one of the most common cardiotoxic reactions after taking psychotropic drugs and may lead to torsade de pointes and increase the risk of sudden cardiac death.The elderly population is more prone to QTc interval prolongation.In this review, we focus on the relationship between common psychotropic drugs and QTc interval prolongation and influencing factors in the elderly population, so as to help clinicians avoid risk in drug selection.