量子共振检测仪在评价精神分裂症治疗效果中的应用研究

目的探索量子共振检测仪评价精神分裂症治疗效果的可靠性。方法以西安市精神卫生中心2011年6月-12月100例住院精神分裂症患者和100例非精神疾病者为研究对象,将精神科医生检查出精神分裂症症状与量子共振检测结果进行比较分析。结果量子共振检测仪检测精神分裂症结果与医师精神检查结果相关性较高,P值、r值、Kappa值、Youden指数中大部分指标均有显著性意义。结论通过初步探索,量子共振检测仪可以考虑成为评价精神分裂症治疗效果的新工具。     

抑郁症生物标志物研究进展

抑郁症作为情感性障碍一种临床类型,是以显著而持久的情绪低落为主要特征的精神障碍。其主要表现是以情感低落、思维迟缓和精神运动性抑制三大症状为基本特征。部分抑郁症患者伴有严重的焦虑症状,出现自杀观念及行为,目前抑郁症已经成为精神科自杀率最高的疾病。抑郁症的病因十分复杂,迄今仍未完全阐明。生物标志物是指可以标记系统、器官、组织、细胞及亚细胞结构或功能的改变或可能发生改变的生化指标。生物标志物可用于疾病诊断、判断疾病分期或者用来评价新药物或新疗法在目标人群中的安全性及有效性。本文主要针对抑郁症与几种生物标志物之间的相关性研究作一综述。     

抑郁症的诊断和治疗(文献综述)

抑郁症的诊断关于抑郁症的诊断问题,应以抑郁症的基本障碍或核心症状为依据.抑郁症的基本障碍主要是情感和意志的受到抑制.到目前为止,尚未找出可靠的足以说明问题的体液、代谢、内分泌等方面特异变化的诊断依据.从而现在仍然主要依靠临床病相的表现,特别是精神症状的特征.综合文献中多数临床实践者提出以下几种依据[1-5]:①核心症状和基本特征;②病型;③周期性病程;④既往     

双重抑郁症与抑郁症临床特征的研究

目的 了解双重抑郁症与抑郁症患者的临床特征.方法 采用随机多级抽样方法,以美国精神障碍诊断与统计手册第4版-修订版( DSM-Ⅳ-TR)为诊断标准,以DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查患者版为诊断工具,以河北省流行病学调查的399例抑郁症患者为研究对象,其中符合双重抑郁症诊断标准患者56例(双重抑郁症组),符合抑郁症诊断标准患者343例(单一抑郁症组);采用功能大体评定量表( GAF)评定患者的功能状况.结果 399例抑郁症患者中,双重抑郁症的检出率为14.04％.单一抑郁症组和双重抑郁症组均有较高的其他精神障碍的共病率,分别为39.94％和48.21％,2组比较差异无统计学意义(x2=1.361,P＞0.05);均以共病未特定的焦虑障碍、特殊恐怖症、广泛性焦虑障碍、创伤后应激障碍、惊恐障碍、酒依赖/酒滥用等常见.双重抑郁症组患者精神运动性激越、优柔寡断、自杀未遂症状出现的频率均高于单一抑郁症组(P＜0.05),2组均以忧郁特征为常见临床特征(＞50％).2组GAF评分和疾病的严重程度比较差异无统计学意义(t=0.354,P＞0.05;x2 =0.655,P＞0.05).结论 抑郁症中双重抑郁症的比例不低,共病其他精神障碍均较常见,但双重抑郁症患者自杀的风险更高,做事情总是优柔寡断.     

感觉减退的分类和临床操作

<正>感觉减退是对事物的个别属性感受减退,即大刺激引起小感受,严重时不引起任何感受,即感觉缺失。精神科的感觉减退比感觉增强少见,多见于现实人格解体、躯体人格解体、抑郁症和谵妄,少见于精神分裂症、注意缺陷多动障碍、偏头痛和变性脑病[1]。但实际上,临床上进行症状判断时,几乎不使用感觉减退这一术语,因为教科书上所述的感觉减退过于简略。临床医生通常将感觉减退进行分解描述,这样在临床工作中才能更好的使用这一术语。     

精神科病人谵妄状态的临床分析

目的　研究精神科谵妄病人的临床特征以及诱发谵妄的危险因素 ,旨在为谵妄的早期发现、早期诊断和治疗提供参考依据。方法　分析 30例符合DSM Ⅳ谵妄诊断标准的精神科病人临床资料 ,以DSS为入组筛选工具和谵妄临床特征及其演变过程的再评估工具 ,并与同年龄、同性别、同诊断的 30例同期住院的非谵妄病人进行比较。结果　谵妄组患者注意力障碍、行为障碍、精神运动性兴奋、定向力障碍、认知障碍的DSS评分为 0的百分比分别为 1 0 0 %、90 %、86 7%、86 2 %及 76 6%。谵妄组患者在白细胞增高、中性粒细胞分类增高、HCT增高、血肌酐增高、血钾降低方面与对照组相比有显著性差异 (P <0 0 5 )。结论　精神科病人谵妄的核心症状是注意力障碍、行为障碍、精神运动性兴奋、定向力障碍、认知障碍。感染、红细胞压积 (HCT)增高、血肌酐增高、血钾降低为谵妄发生的危险因素。     

158例抑郁症患者共患焦虑障碍的临床分析

目的 研究综合医院精神科住院和门诊抑郁症患者共患焦虑障碍的频率。方法 使用精神现状检查(PSE)，结合90项症状清单(SCL-90)自评对入选个案进行评估。结果 37．99，5的抑郁症患者同时共患焦虑障碍，有30．4％的患者既往有过至少一次的焦虑障碍发作。结论 抑郁症常共患焦虑障碍，识别抑郁症中的焦虑障碍对治疗有指导作用。     

抑郁症和焦虑症动物模型的研究进展

1抑郁症的动物模型 抑郁症是一种常见的精神疾病，其终生患病率高达15％～20％。典型的临床症状包括抑郁心境、快感缺乏、无价值感及罪恶感等。常见的抑郁症症状还包括植物神经系统功能失调，如自发性运动、睡眠及体重改变等。最早的抑郁症模型来源于临床观察，即超过10％以上的服用抗高血压药物利舍平的患者出现了抑郁性症状。利舍平在动物身上引起了运动性抑制，这一抑制可以被5-羟色胺的前体5．HTP或去     

脑血管病性痴呆

痴呆指智能减退而言,其基本症状为记忆力减退,早期为近记忆力减退,随病情发展远记忆力也发生障碍,甚至连自己的名字、年龄也会忘记。定向力、计算力、理解判新力也发生障碍,并可继发其他精神症状,如情绪和行为障碍等。痴呆与失语症、缄默症、抑郁症不同,应注意鉴别。按痴呆程度可概括分为轻、中、重三度。轻度:注意力不集中、健忘、兴奋减退和计算障碍。中度:近记忆力障碍,定向力轻度障碍,脑力劳动困难。重度:定向力高度障碍,日常生活靠照顾,忘记年龄和年月     

抑郁症伴有精神病性症状的临床特征

为了探讨抑郁症伴精神病性症状的临床特征，对１２１例抑郁症患者按照伴有精神病性症状和不伴有精神病性症状分为２组，进行临床对照分析。结果显示，伴有精神病性症状的４７例（３８．８％），其绝望、精神运动性抑制、自责自罪、自杀行为显著高于不伴有精神病性症状者，自杀行为是不伴有精神病性症状者的３．９倍。在３６～５５岁的抑郁症患者中，精神病性症状显示频数较高（２５例／４１例，６１．０％）。这提示对伴有精神病性症状的抑郁症患者需谨防自杀发生，并需要联合治疗     

Screening for depression in a primary care setting in Vietnam

A Vietnamese Depression Scale (VDS) was developed in 1982 in the United States and has been used as a screening tool for depression and as the basis for a standardized interview to assess depression in the Vietnamese refugee populations. In this current study, the VDS was used in Ho Chi Minh City, Vietnam, to assess depression in patients who were already diagnosed with depression by Vietnamese psychiatrists and in patients presenting at a local primary care clinic. Of the 177 primary care clinic patients, 8.4% met the criteria for clinical depression based on the VDS. Results indicate a higher risk for depression among married and/or less than high school educated individuals. Discrepancies were found between the depression diagnosis by Vietnamese psychiatrists and VDS screening results. Among the participants interviewed who met the VDS criteria for depression, culture-specific phrases such as "desperate," "going crazy," and "low spirited and bored" were highly associated with symptoms of depression.     

Analysis of the symptoms of depression--a neural network approach

The purpose of this study is to determine the individual contribution, or importance number, of the symptoms to an analysis of depression, utilizing a neural network model. In addition, the presence of hopelessness and somatic complaints was examined, to determine their relevance to depression. Using Wave 1 data from Duke University's contribution in the Epidemiological Catchment Area (ECA) study, we created a mathematical model, a neural network, to map the relationship of nine symptoms of major depression, hopelessness and somatic complaints to the presence or absence of the formal diagnosis of depression, and performed a contribution analysis. The contribution analysis using the neural network revealed that the symptoms with the greatest impact on the occurrence of depression, or with the largest importance number for depression, were sadness, loss of interest, tiredness and sleeping trouble, in that order. The most frequently reported symptoms, though, were sadness, sleeping trouble, suicidal ideation, tiredness and poor concentration, in that order. Hopelessness and somatic symptoms were the lowest in their contribution to the diagnosis of depression. The study thus provides the hierarchy of the symptoms of depression and supports the DSM classification of major depression.     

Subtypes of depressive episodes according to ICD-10: prediction of risk of relapse and suicide

BACKGROUND: The long-term predictive ability of the ICD-10 subtypes of depression with melancholic syndrome and depression with psychosis has not been investigated. SAMPLING AND METHODS: All patients in Denmark who had a diagnosis of a single depressive episode at their first ever discharge during a period from 1994 to 1999 were identified. The risk of relapse leading to readmission and the risk of committing suicide were compared for patients discharged with an ICD-10 diagnosis of a single depressive episode with and without melancholic syndrome and for patients with and without psychotic symptoms, respectively. RESULTS: In all, 1,639 patients had a diagnosis of depressive episode without psychotic symptoms, 1,275 patients a diagnosis with psychotic symptoms, 293 a diagnosis without melancholic syndrome, and 248 a diagnosis with melancholic symptoms at first discharge. The risk of relapse leading to readmission was greater for patients with psychotic symptoms than for patients without, but no difference was found between the two groups in the risk of committing suicide during follow-up. No differences were found in the risk of relapse leading to readmission or suicide between patients with and without melancholic syndrome. CONCLUSIONS: The ICD-10 categorization into depression with and without psychotic symptoms seems to be clinically and prognostically useful, whereas the ICD-10 subtyping into melancholic and non-melancholic syndrome does not seem to have any long-term predictive value.     

Validation of the Thai Edinburgh Postnatal Depression Scale for screening postpartum depression

This study aimed to validate and determine an appropriate cut-off score on the Thai Edinburgh Postnatal Depression Scale (EPDS) as a screen for postpartum depression. A prospective cohort of postpartum women at 6-8 weeks were tested using the EPDS and clinically interviewed by psychiatrists to establish a DSM-IV diagnosis of major or minor depressions in a university hospital in Southern Thailand. Of 351 postpartum women interviewed, 38 postpartum women met the criteria for depressive disorders, major depression in four women (1%) and minor depressive disorder in 34 women (10%). The area under the curve was 0.84 (95% confidence interval 0.76-0.91). Using an EPDS cut-off sum score of 6/7, major and/or minor depression was detected with a sensitivity of 74%, specificity of 74%, positive predictive value of 26% and negative predictive value of 95%. When the cut-off score was higher, the sensitivity was lower but the specificity was higher. The Thai version of the EPDS is a valid self-report instrument and is useful in Thailand where no other screening instrument for postpartum depression is available.     

Clinically significant non-major depression in a community-dwelling elderly population: epidemiological findings

OBJECTIVE: The aim of this study was to investigate the 1-month prevalence, symptom profiles and demographic correlates in late-life clinically significant non-major depression (CSNMD) among a community-dwelling elderly population. METHODS: One thousand five hundred subjects aged 65 years and older, who were randomly selected from three communities in Taiwan, received comprehensive psychiatric assessment by trained psychiatrists. Two categorical diagnoses of depressive disorder, including major depression and CSNMD, were made. The 1-month prevalence was calculated. Frequencies of depressive symptoms across CSNMD and major depression were compared. The risks of CSNMD based on demographic characteristics were estimated using multinominal logistic regression. RESULTS: The 1-month prevalence of CSNMD among the community-dwelling elderly was 8.8%. Symptoms of diminished interest, appetite changes, sleep disturbance, worthlessness or inappropriate guilt, trouble in concentrating or indecisiveness, and suicidal thoughts or acts were less frequent in CSNMD than in major depression, but symptoms of depressed mood, psychomotor changes, and fatigue or loss of energy were as frequent in both categories of illness. CSNMD shares similar demographic risks, such as living in an urban area, female gender and low educational status, with major depression. CONCLUSIONS: CSNMD is common among community-dwelling elders in Taiwan, and with its identical demographic characteristics, but qualitatively different presentation, we suggest CSNMD may be considered part of a spectrum of severe late life depressions with a distinct manifestation. Major depression and CSNMD may share common demographic characteristics with different manifestation. We conclude that late-life depression is a dimensional disease.     

Cultural aspects of delusions: a psychiatric study of Egypt.

This paper deals with the cultural elements of the delusions of a sample of Egyptian psychiatric patients. After examination of clinical records, interviewing psychiatrists and reviewing literature, the author reaches the conclusion that the content of the patient's delusion varies directly in relation to his social class. For most of the low class men and women, the delusional symptoms, either megalomaniac or persecutory were fantasied in terms of the cultural religious institutions. Middle and upper class patients, however, much more frequently "secularized" their restitutive narcissistic and self esteem delusions in terms of science and class conception of power.     

A validation study of depressive syndromes in Parkinson's disease

The validity, sensitivity, and specificity of depressive symptoms for the diagnosis of major depression, minor depression, dysthymic disorder, and subsyndromal depression in Parkinson's disease (PD) were examined. A consecutive series of 173 patients with PD attending a Movement Disorders Clinic underwent a comprehensive psychiatric and neurological assessment. The symptoms of loss of interest/pleasure, changes in appetite or weight, changes in sleep, low energy, worthlessness or inappropriate guilt, psychomotor retardation/agitation, concentration deficits, and suicide ideation were all significantly associated with the presence of the DSM‐IV depressed mood criterion for major depression. The symptoms of changes in appetite, changes in sleep, low energy, low self‐esteem, poor concentration, and hopelessness were all significantly associated with the presence of the DSM‐IV criterion of sad mood for dysthymic disorder. Thirty percent of our sample met DSM‐IV diagnostic criteria for major depression, 20% met diagnostic criteria for dysthymic disorder, 10% met diagnostic criteria for minor depression, and 8% met clinical criteria for subsyndromal depression. Patients with either major or minor depression had significantly more severe deficits in activities of daily living, more severe cognitive impairments, and more severe Parkinsonism than patients with either dysthymic disorder or no depression. This study provides validation to the DSM‐IV diagnostic criteria for major depression and dysthymic disorder for use in PD. The categories of minor and subsyndromal depression may need further validation. © 2007 Movement Disorder Society     

A comparison of self-report and clinical diagnostic interviews for depression: diagnostic interview schedule and schedules for clinical assessment in neuropsychiatry in the Baltimore epidemiologic catchment area follow-up

BACKGROUND: The field of psychiatric epidemiology continues to employ self-report instruments, but the low degree of agreement between diagnoses achieved using these instruments vs. that achieved by psychiatrists in the clinical modality threatens the credibility of the results. METHODS: In the Baltimore Epidemiologic Catchment Area follow-up, 349 individuals who had a Diagnostic Interview Schedule (DIS) interview were blindly examined by psychiatrists using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Comparisons were made at the level of diagnosis, syndrome, and DSM-IV symptom group. Indexes of agreement were computed and characteristics of discrepant cases were identified. RESULTS: Agreement on diagnosis of major depressive disorder was only fair (kappa = 0.20), with the DIS missing many cases judged to meet criteria for diagnosis using the SCAN (29% sensitivity). A major source of discrepancy was respondents with false-negative diagnoses who repeatedly failed to report DIS symptoms attributed to life crises or medical conditions. Older age, male sex, and lower impairment were associated with underdetection by the DIS, using logistic regression analysis. In spite of the diagnostic discrepancy, there was substantial correlation in numbers of symptom groups in the 2 modalities (r = 0.49). Agreement was highest (about 55% sensitivity and 90% specificity) when both the SCAN and DIS thresholds were set at the level of depression syndrome instead of diagnosis. CONCLUSIONS: Weak agreement at the level of diagnosis continues to threaten the credibility of estimates of prevalence of specific disorders. A bias toward underreporting, as well as stronger agreement at the level of the depression syndrome and on ordinal measures of depressive symptoms, suggests that associations with risk factors are conservative.     

Rapid detection of major depression in epilepsy: a multicentre study

BACKGROUND: Depression is a common comorbid disorder in epilepsy but is not routinely assessed in neurology clinics. We aimed to create a rapid yet accurate screening instrument for major depression in people with epilepsy. METHODS: We developed a set of 46 items to identify symptoms of depression that do not overlap with common comorbid cognitive deficits or adverse effects of antiepileptic drugs. This preliminary instrument and several reliable and valid instruments for diagnosis of depression on the basis of criteria from the Diagnostic and Statistical Manual IV, depression symptom severity, health status, and toxic effects of medication were applied to 205 adult outpatients with epilepsy. We used discriminant function analysis to identify the most efficient set of items for classification of major depression, which we termed the neurological disorders depression inventory for epilepsy (NDDI-E). Baseline data for 229 demographically similar patients enrolled in two other clinical studies were used for verification of the original observations. FINDINGS: The discriminant function model for the NDDI-E included six items. Internal consistency reliability of the NDDI-E was 0.85 and test-retest reliability was 0.78. An NDDI-E score of more than 15 had a specificity of 90%, sensitivity of 81%, and positive predictive value of 0.62 for a diagnosis of major depression. Logistic regression showed that the model of association of major depression and the NDDI-E was not affected by adverse effects of antiepileptic medication, whereas models for depression and generic screening instruments were. The severity of depression symptoms and toxic effects of drugs independently correlated with subjective health status, explaining 72% of variance. Results from a separate verification sample also showed optimum sensitivity, specificity, and predictive power at a cut score of more than 15. INTERPRETATION: Major depression in people with epilepsy can be identified by a brief set of symptoms that can be differentiated from common adverse effects of antiepileptic drugs. The NDDI-E could enable rapid detection and improve management of depression in epilepsy in accordance with internationally recognised guidelines.