Critical care medicine-related treatment is an interdisciplinary and multi-professional process,often leading to secondary or concomitant mental disorders in clinical practice.Currently,there is no consensus on the pharmacological treatment of related mental illnesses in China.The Chinese Society of Psychosomatic Medicine collaborated with the Critical Care Medicine expert group to form a consensus writing expert group.After a systematic review of relevant literature,summarizing published domestic and foreign literature,and extensive discussions,the consensus was developed.The consensus elaborates on the principles and processes of the standardized use of psychotropic drugs in critical care medicine,as well as the clinical indications,precautions,and specific drug selection of various psychiatric medications,providing feasible suggestions and guidance for the clinical application of psychiatric medications in the intensive care unit.

Humans ; Aripiprazole/therapeutic use* ; Schizophrenia/drug therapy* ; Antipsychotic Agents/therapeutic use* ; Risperidone ; China ; Treatment Outcome

【Objective】 To explore the action mechanism of vinpocetine in improving learning and memory disorders in depressive rats after modified electroconvulsive therapy (MECT). 【Methods】 The models of depressive rats were constructed by chronic unpredictable mild stress (CUMS) method. A total of 30 rats with depression were randomly divided into depression group, MECT group, and MECT+vinpocetine (10 mg/kg) group, with 10 in each group. A total of 10 untreated healthy rats were enrolled as control group. The learning and memory ability were tested by Morris water maze test and novel object recognition test. The depression state was evaluated by sugar preference test. The brain slices of the hippocampus were prepared for electrophysiological experiments. The density of dendritic spine was detected by Golgi staining. The expressions of endocannabinoids related genes [diacylglycerol lipase (DAGLα), monoacylglycerol lipase (MAGL), and endocannabinoid type-I receptor (CB1R)] were detected by qPCR and Western blotting. The lentivirus was injected to downregulate the expressions of CB1R and DAGLα in the hippocampus. After re-modeling and treatment, behavioral tests were performed. 【Results】 Compared with control group, sugar preference, spatial exploration time, relative discrimination index, long-term potentiation (LTP), density of dendritic spine, expressions of DAGLα and CB1R were decreased, while escape latency and MAGL were increased in depression group (P<0.05). Compared with depression group, sugar preference, escape latency, and MAGL were increased, while spatial exploration time, relative discrimination index, LTP, density of dendritic spine, expressions of DAGLα and CB1R were decreased in MECT group (P<0.05). Compared with depression group, sugar preference, spatial exploration time, relative discrimination index, LTP, density of dendritic spine, expressions of DAGLα and CB1R were increased, while escape latency and MAGL were decreased in MECT+vinpocetine group (P<0.05). Compared with MECT group, sugar preference, spatial exploration time, relative discrimination index, LTP, density of dendritic spine, expressions of DAGLα and CB1R were increased, while escape latency and MAGL were decreased in MECT+vinpocetine group (P<0.05). The down-regulation of DAGLα or CB1R by lentivirus could inhibit the improvement effect of vinpocetine on behavioral performance of depressive rats after MECT. 【Conclusion】 Vinpocetine can significantly improve learning and memory disorders in depressive rats after MECT, which may be related to regulating the expressions of endocannabinoid-related genes and enhancing synaptic plasticity.

Objective : To explore the effects of Blonanserin on hippocampal neurons damage and PI3K / AKT / GSK3 β signaling pathways in rats with MK-801 induced schizophrenia． Methods : The schizophrenia models were induced by one-time intraperitoneal injection of MK-801．A total of 48 SD rats were randomly divided into normal group，model group，Blonanserin group ( 1 mg / kg Blonanserin) and risperidone group (0. 54 mg / kg risperidone) ， with 12 cases in each group．The behaviors of rats were observed by stereotyped behavior assay，open field test and Morris water maze．The pathological damage of hippocampus was observed by HE staining，which was scored．The levels of serum glucose-lipid metabolism indexes were detected．The mRNA and proteins of phosphatidylinositol 3- kinase (PI3K) ，protein kinase B (AKT) and glycogen synthase kinase 3 β ( GSK3 β) in hippocampal tissues were detected by real-time fluorescent quantitative PCR and Western blot. Results : Compared with model group，scores of stereotyped behaviors，total distance in open field test，escape latency and score of pathological damage in hippo- campus decreased in Blonanserin group and risperidone group，while times of crossing platform original site，levels of PI3K，AKT and GSK3 β mRNA，and phosphorylation levels of PI3K，AKT and GSK3 increased (P ＜0. 05) . However，there was no significant difference in the above indexes between Blonanserin group and risperidone group．The differences in levels of fasting blood glucose ( FPG) ，glycosylated hemoglobin ( HbA1c) ，triglyceride (TG) ，total cholesterol (TC) ，high-density lipoprotein (HDL) and low-density lipoprotein (LDL) among normal group，model group and Blonanserin group was not statistically significant．However，levels of FPG，HbA1c，TG and TC in risperidone group were higher than those in the other three groups (P＜0. 05) ，and there was no signifi- cant change in HDL or LDL． Conclusion Blonanserin may protect schizophrenia rats from hippocampal neurons damage，improve cognitive function，learning and memory ability by activating PI3K / AKT / GSK3 β signaling path- ways.

Objective:To evaluate the efficacy and safety of Tyrosine Kinase Inhibitors (TKIs) combined with stereotactic body radiation therapy(SBRT) in the treatment of renal cell carcinoma (RCC) patients with bone metastasis.Methods:The clinical data of 80 RCC patients with bone metastasis in Sun Yat-sen University Cancer Center from April 2010 to April 2020 were analyzed retrospectively. Among them, 64 patients were medium or high risk according to the International Metastatic Renal Cell Carcinoma Database Consortium(IMDC) score. Twenty-four patients received TKI therapy alone(Group A), and the other 56 cases received TKIs combined with SBRT to bone metastastic lesions (Group B).Results:The median follow-up period was 20.7 months (4.8-115.6 months), 70 patients received second or third-line targeted drug therapy, and 4 patients in group A and 15 patients in group B received TKI plus immunotherapy. Fifty-four patients had symptoms of bone pain before radiotherapy, 46 patients were satisfied with the analgesic effect after SBRT treatment. Twelve patients got complete response (CR) after bone lesions, and 32 patients achieved partial response (PR). Forty patients died of disease progression during follow-up. The median OS was: 20.7 months vs not reached(Group A vs. Group B), and the 2-y OS and 5-y OS were 50% vs. 62%, and 19% vs. 56%, respectively ( P=0.006). There were only 2 patients (3.6%) had grade 3 SBRT related adverse events. Conclusions:SBRT combined with TKIs improved the quality of life and prolonged the overall survival of RCC patients with bone metastasis.

Objective· To investigate the prospective value of early postoperative PI-APD in children with hydronephrosis.Methods· Data of children with hydronephrosis who underwent pyeloplasty in Xinhua Hospital,Shanghai Jiao Tong University School of Medicine between Jan 2012 to Nov 2015 was collected.PI-APD was divided into 3 categories (≤ 19％,19％＜PI-APD＜40％ and ≥ 40％).The relationship between PI-APD value and the degree of renal function (DRF) and dilation recovery after surgery was analyzed.Results· There were 360 children with hydronephrosis.The median follow-up was 20 months.The PI-APD value (3 months after pyeloplasty) was positively correlated with the degree of DRF recovery (r=0.631,P=0.000).Five patients received redo-pyeloplasty.PI-APD of all these patients was ＜19％.Conclusion· PI-APD is a new feasible ultrasound parameter in pyeloplasty followup.PI-APD ≥ 40％ at the first post-operative visit predicts pyeloplasty success.PI-APD ≤ 19％ indicates close follow-up after operation.PI-APD can also help select children at high risk for repeat intervention after pyeloplasty.

Objective To investigate the antagonistic effect of ω-3PUFAs on cognitive impairment in MK-801-induced schizophrenia (SZ) rats and its mechanism.Methods Rat model of schizophrenia was induced by MK-801.Morris water maze was used to detect the change of cognitive function in rats.The number of neonatal neurons in hippocampus was detected by Brdu staining.CREB,p-CREB,BDNF,TrkB and p-TrkB levels were detected by Weston Blot.Results MK-801 induced schizophrenia-like cognitive impairment (the escape latency in the water maze test was (6.51±3.10)s for Ctr group,(15.27±6.20)s for Mod group;acrossing times was (4.63±1.06) times for Ctr group,(2.00±1.15) times for Mod group),reduced the number of neonatal neurons in hippocampus (the relative level of neonatal neuron number per unit area,Mod/Ctr was 0.656±0.066) and impaired the CREB/BDNF/TrkB pathway (the relative level of gray value,Mod/Ctr:CREB was 0.393±0.065,p-CREB was 0.591±0.015,BDNF was 0.716±0.115,TrkB was 0.787±0.029,p-TrkB was 0.586±0.013).ω-3PUFAs improved the CREB/BDNF/TrkB pathway activity by increasing CREB and TrKB level and their phosphorylation (the relative level of gray value,Pre/Ctr:CREB was 1.139±0.111,p-CREB was 0.845±0.243,BDNF was 0.864±0.133,TrkB was 0.916±0.022,p-TrkB was 0.952±0.047),and then recovered the number of neonatal neurons in hippocampus (the relative level of neonatal neuron number per unit area,Pre/ Ctr was 1.183±0.101),thereby reduced the cognitive dysfunction in schizophrenia rats(the escape latency in the water maze was (7.44±4.55)s for Pre;acrossing times was (3.86±1.68) times for Pre).Conclusion ω-3PUFAs can relieve the MK-801-induced schizophrenia-like cognitive impairment.

Objective:To compare the effectiveness of proximal femoral nail antirotation (PFNA) with intertrochanteric antegrade nail (InterTAN) in the treatment of intertrochanteric fractures in the elderly. Methods:A retrospective study of 62 elderly patients with intertrochanteric fractures who received two operation methods from Sep 2014 to May 2016 was done. There were 28 patients in PFNA group, and 34 patients in InterTAN group. The operation time, blood loss in operation, hospitalization time, healing time, and Harris hip joint functional score were compared and analyzed. Results:Operation time and the amount of intraoperative blood loss in PFNA group were less than that in InterTAN group. Hospitalization time,fracture healing time and Harris hip joint functional score after ten months had no significant difference between the two groups. And 59 cases in total were followed up with an average of 11.5 months (from 9 to 16 months) . In PFNA group, 27 patients were followed up, and one patient was lost to follow up, who died because of chronic renal insufficiency. The rest 26 patients all achieved bony union (including one case of hip versus) . At follow-up 9 months, hip joint function was excellent in 18 cases, good in 6, fair in 2, bad in 1, and the excellent-good rate was 88.9%. In InterTAN group,32 patients were followed up,and two cases were lost to follow up. In followed-up cases, there was one patient who was no healing of fracture. After hip arthroplasty, this patient got recovery. The hip joint function was excellent in 21 cases, good in 7, fair in 3, and bad in 1. The differences between the two groups were not statisticaly significant. Conclusion:Both PFNA and InterTAN can treat intertrochanteric fractures in the elderly with good result,but PFNA has obvious advantages over InterTAN on less hemorrhage and operation time.

OBJECTIVE: To investigate the effect of ziprasidone and olanzapine on glucose and lipid metabolism in first-episode schizophrenia. METHODS: A total of 260 schizophrenics were assigned randomly to receive ziprasidone or olanzapine for 6 weeks. The weight was measured at baseline, week 2, 4 and 6. Fasting blood glucose (FBS), fasting insulin, high-density lipoprotein (HDL), total-cholesterol (TC) and triglycerides (TG) were measured at baseline and the end of 6-week treatment. Low-density lipoprotein (LDL) was measured in some patients at baseline and the end of 6-week treatment. Body mass index (BMI) and insulin resistance index (IRI) were counted. RESULTS: A total of 245 patients completed the trial, including 121 ziprasidone patients and 124 olanzapine patients. The average dose was 137.5 mg/d for ziprasidone and 19.5 mg/d for olanzapine. Patients treated with olanzapine had higher weight gain than those treated with ziprasidone [(4.55±3.37) kg vs (-0.83±2.05) kg, P<0.001]. After the treatment, FBS, fasting insulin, HDL, TC, TG, LDL and IRI levels were significantly increased in the olanzapine group (all P values<0.001 ). However, in the ziprasidone group, FBS decreased significantly and HDL and TG levels increased significantly after the 6-week treatment (all P values<0.05). The mean changes of FBS, fasting insulin, TC, TG, LDL and IRI were significantly different in the two groups (all P values<0.001). CONCLUSION Ziprasidone has less glucose and lipid metabolic effect for first-episode schizophrenia patients in short-term treatment. However, olanzapine induces weight gain and dysfunction of glucose and lipid metabolism significantly, which is associated with increased risk of complications. When the doctors choose antipsychotics in the clinic, they should consider the side effects of the medication.
Adolescent ; Adult ; Benzodiazepines ; adverse effects ; therapeutic use ; Blood Glucose ; drug effects ; Female ; Humans ; Lipid Metabolism ; drug effects ; Male ; Middle Aged ; Olanzapine ; Piperazines ; adverse effects ; therapeutic use ; Schizophrenia ; drug therapy ; Thiazoles ; adverse effects ; therapeutic use ; Young Adult

OBJECTIVE: To compare the effect of 7 antipsychotic drugs on the life quality of schizophrenia patients including chlorpromazine, sulpiride, clozapine, risperidone, olanzapine, quetiapine, and aripiprazole. METHODS: A total of 1,227 stable schizophrenic patients within 5 years onset who took 1 of the 7 study medications as maintenance treatment were followed up for 1 year at 10 China sites. Patients were evaluated by the short form-36 health survey (SF-36) at the baseline and at the end of 1 year. RESULTS: The life quality was improved obviously at the end of the follow-up. There was significant difference in body pain, vitality, and mental health (P<0.05) among these antipsychotic drugs. CONCLUSION All 7 antipsychotic drugs can improve the life quality of schizophrenia patients. Atypical antipsychotic drugs, especially olazapine and quetiapine, are superior to typical antipsychotic drugs in improving life quality.
Adolescent ; Adult ; Antipsychotic Agents ; therapeutic use ; Benzodiazepines ; therapeutic use ; Dibenzothiazepines ; therapeutic use ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Olanzapine ; Quality of Life ; Quetiapine Fumarate ; Schizophrenia ; drug therapy ; Surveys and Questionnaires ; Young Adult