头发中抗抑郁药及抗精神病药的检测及评价

目的 :为精神药物的中毒鉴定提供方法和依据。方法 :调查精神病患者头发中药物的存在状况 ,并建立头发中抗抑郁药和抗精神病药的GC/NPD和GC/MS分析方法。结果 :在32名精神病患者头发中检出了卡马西平、阿米替林、多虑平、安坦、氯丙嗪、泰尔登、三氟拉嗪、氯氮平等八种抗忧郁药和抗精神病药 ;并发现头发中氯丙嗪和氯氮平含量与剂量存在相关关系 ,相关系数分别为0 8047(P<0 001,n=16)和0 7097(P<0 001,n=16);且头发分段分析表明药物在毛干中的分布与用药史一致。结论 :头发分析可提供精神药物剂量史的信息 ,检出时限至少为药后16个月。     

Hippocampal Agenesis in an Individual who Engaged in Violent Criminal Behaviors After Discontinuing Carbamazepine and Paroxetine Treatment

Antidepressant discontinuation syndrome (ADS) occurs after abrupt discontinuation of an antidepressant medication. A 23‐year‐old man with right hippocampal agenesis demonstrated sexual crime (hypersexuality) since the age of eight and had been successfully treated with carbamazepine since the age of 13. He had required increased doses of paroxetine and carbamazepine owing to the development of an unstable affect after quitting his job. He abruptly stopped taking his medication for 3 days and his criminal behaviors re‐emerged. We examined changes in brain structure and activity before and after medication cessation, using MRI and functional MRI (fMRI). The image of a girl in a swimsuit increased activity in the thalamus only after medication discontinuation. The alteration in thalamic activity might induce hypersexuality. We conclude that a primary hypersexuality had been suppressed with carbamazepine and paroxetine treatment, and the discontinuation of the medication caused the hypersexuality.     

RP-HPLC测定全血中三环类抗抑郁药的研究

本文建立了反相高效液相色谱法，测定全血中三环类抗抑郁药：阿米替林、多虑平、三甲丙咪嗪、氯丙咪嗪、丙咪嗪、去甲丙咪嗪。以乙酸苯胺为内标物。血样碱化后，用正己烷：异戊醇（９９∶１）提取，０．１ｍｏｌ／Ｌ硫酸及提。色谱柱为ＨｙｐｅｒｓｉｌＣｌｓ；流动相为乙腈：０．０１ｍｏｌ／Ｌ磷酸二氢钾（含０．０１ｍｏｌ／Ｌ二乙胺的水溶液并加磷酸调至ｐＨ３．０（３∶７）；２１０ｎｍ检测。线性范围为０．０１５６—２．０ｕｇ／ｍｌ，最低检出浓度为１０ｎｇ／ｍｌ（在全血中）。本法简便、快速，适用于法庭毒物分析及临床治疗药物监测。     

Suicide and Psychiatrist's Liability in Italian Law Cases

The aim of the study is to analyze the factors that are most frequently associated with a verdict of guilty delivered to the psychiatrist in cases of a patient's suicide in Italian law. Twenty‐six sentences (1975–2009) were analyzed according to the claim of malpractice, patient characteristics, circumstances of the suicide, and reasons for the court's judgment. The court held the psychiatrist guilty in 12 cases, considering that the act of suicide was predictable and could have been avoided. Predictability was mainly related to errors in surveillance (7 cases), therapy (1 case), or both (2 cases). An error in diagnosis was considered to be related to the patient's death in two cases. Analysis of medical behavior considered to be erroneous and associated with a verdict of guilty provides an opportunity to discuss the topics relevant not only to practicing psychiatrists but also to experts assessing medical liability in cases of patient suicide.