问题 多项选择题

[案例三十]


患者,男性,40岁。罹患“精神分裂症”已半年,一直服用氯丙嗪治疗,期间基本能正常劳动,有时有多疑现象,目前维持剂量为200mg/d。家属反映:最近1月来患者言语明显减少,不愿外出活动,睡眠多,不时唉声叹气。

经过8周足剂量的抗抑郁治疗,患者心情没有明显好转,仍否认幻觉妄想,存部分自知力。此时门诊医生需要采取的措施包括:

A.更换另一种抗抑郁剂治疗

B.可考虑逐步停用氯丙嗪,更换其他抗精神病药物

C.电抽搐治疗

D.职业治疗

E.放松治疗

答案

参考答案:A,B

解析: 该患者系精神分裂症后抑郁,抑郁程度虽不是很重,但仍有自杀的危险,需要防范。可予以SSRI或SNRI等抗抑郁剂治疗。治疗剂量等同于或略低于抑郁症的治疗剂量。该患者经足量抗抑郁治疗8周后症状仍无明显改善,可以考虑换药,尽管电抽搐治疗(ECT)有效,但是中国抑郁症治疗指南推荐电抽搐治疗主要针对伴有严重消极自杀言行或木僵的患者(可立即作ECT)和难治性抑郁症患者(在抗抑郁药基础上合并ECT)。此外,该患者长期使用氯丙嗪治疗,尚需考虑氯丙嗪导致抑郁的可能性,加之患者睡眠多,故也可考虑更换为另一种镇静作用较轻的抗精神病药物。

单项选择题
单项选择题

Passage Two

Britain’s emissions of greenhouse gases, blamed by many scientists for contributing to global warming, have fallen by 14 percent since 1990, according to the latest government report.
British lakes and rivers are also on the road to recovery from acid rain poisoning, following successful curbs to air pollution from cars and heavy industry.
The report by the National Atmospheric Emissions Inventory (NAEI) attributed the drop in greenhouse gas emissions to several factors including: the introduction of catalytic converters on cars, a move toward low sulphur and lead-free petrol and a switch to gas from coal and oil in power generation.
Environment Minister Michael Meacher said the downward trend was welcome, but warned of complacency.
"Even though these figures are encouraging, we must not be complacent. There are still significant problems where we need to do more, for example, to further reduce greenhouse gases and harmful pollutants (污染物) such as ammonia and particulate matter," he said in a statement.
The government has a target to cut greenhouse gases by 23 percent by 2010 on 1990 levels. This is almost double the target of 12.5 percent to which the UK is committed under the Kyoto Protocol and there are signs that emissions are rising as generators return to using coal-fired power stations in the face of rising natural gas prices.
The Department of Environment Food and Rural Affairs (DEFRA) said substantial curbs on sulphur dioxide emissions across the UK and Europe had cut acid rain by half over the last 12 years. "Damaged freshwater lakes and streams are showing signs of recovery," it said.
But DEFRA warned of a new threat. "Nitrogen oxides and ammonia are the main air pollutants that must be tackled to stop future damage. "
The bulk of Britain’s ammonia emissions come from farm animal manure (粪肥), causing over-enrichment of land and waterways, said the report. Certain species rampage unchecked through this ultra-fertile environment, smothering the slower growing plants beneath them and choking streams and rivers. Nitrogen oxides enter the atmosphere from car exhausts and industry, creating health-damaging ozone and contributing to acid rain.

According to the passage, Britain has achieved success in all of the following EXCEPT ______.

A.reducing emissions of greenhouse gases

B.recovering lakes and rivers from pollution

C.preventing acid rain from falling

D.curbing air pollution from cars and heavy industry