老年与非老年抑郁症的临床特征差异

目的:探讨老年期抑郁症的临床特征。方法:以60例老年期抑郁症患者作老年组,选60例非老年期抑郁症患者为非老年组。对两组分别用汉密尔顿抑郁量表和汉密尔顿焦虑量表进行评定。结果:老年组抑郁症状中激越和疑病症状显著高于非老年组(P<0.01),老年组的躯体症状中自主神经系统症状、心血管系统症状和消化系统症状显著高于非老年组(P<0.05或P<0.01);躯体性焦虑和认知障碍、焦虑/躯体化和睡眠障碍的严重程度均显著高于非老年组(P<0.05或P<0.01)。结论:老年期抑郁症激越、疑病、躯体症状、焦虑、睡眠障碍及认知障碍等更加突出。     

米氮平与西酞普兰对老年抑郁症患者疗效及生活质量影响的对照研究

目的比较米氮平与西酞普兰治疗老年期抑郁症的疗效、不良反应及其对生活质量的影响。方法将符合入组标准的122例老年期抑郁症患者随机分为米氮平组62例,西酞普兰组60例。于治疗前和治疗后第2、4、6、8周末用汉密尔顿抑郁量表（HAMD）评定疾病严重程度和疗效;采用副反应量表（TESS）评定药物副反应,用生活质量综合评定问卷（GQOLI-74）于治疗前和治疗8周后评定生活质量。结果米氮平组有效率达67.7%,西酞普兰组有效率达70%;两组疗效差异不显著。但前者对食欲增加、睡眠和生活质量的改善显著优于后者（P〈0.05）。结论米氮平治疗老年抑郁症安全有效,改善睡眠好,不良反应少,能更好改善老年抑郁症患者的生活质量。     

首发与复发老年抑郁症患者的临床特征分析

目的 分析首发与复发老年抑郁症患者的临床特征异同点.方法 应用自制量表调查109例老年期首发抑郁症患者(老年首发组)与89例老年期复发抑郁症患者(老年复发组)的临床特征并进行比较.结果 老年首发组患者的激越、疑病症状、躯体症状和记忆减退,均显著高于复发组,差异均有统计学意义(P<0.05);老年首发组躯体症状中的心血管系统症状显著高于对照组,差异有统计学意义(P<0.05).结论 老年首发抑郁症不同于老年复发抑郁症,激越、疑病、躯体症状和记忆障碍等较为突出.     

老年期与非老年期抑郁症生活事件比较研究

本文探讨生活事件在老年期抑郁症发病中的作用。并与非老年期抑郁症比较。发现老年期组病前生活事件中家庭问题，躯体疾病和经济因素３项均高于非老年期组。据此认为老年人在重大的刺激下易于产生抑郁，因而如何正视或减少重大的生活事件刺激，加强社会支持系统对预防老年抑郁症的发生将起到重要作用。     

浏阳市乡村医务人员自杀、中毒急救与精神病学知识调查

目的:了解乡村医务人员在自杀、中毒急救及精神病学方面知识掌握的现状,为进一步培训提供依据.方法:采取分层随机整群抽样方法,抽取浏阳市下属大瑶、集里和永安3个乡,采用自编知识问卷对3个乡的中心医院及下属各村医务人员共110名集中进行不记名调查.结果:问卷3个部分(自杀、中毒急救及精神病学)平均得分显示,中毒急救知识最高(78.6±15.3)分,其次为精神病学知识(69.7±15.2)分,自杀相关知识平均得分最低(45.2±15.0)分,差异均有统计学意义(P<0.01).35岁以下组在问卷3个部分得分均高于35岁及以上组,除精神病学知识外,差异均有统计学意义(P<0.05).大专及以上学历组得分高于中专及以下学历组,乡级医务人员得分高于村级医务人员,差异有统计学意义(P<0.05).结论:浏阳市乡村医务人员尤其是村级医务人员在自杀、中毒急救与精神病学知识掌握方面还存在许多不足,有待培训加强.     

89例首发住院老年期抑郁症的临床特征分析

目的　研究首发住院老年期抑郁症的临床特征。方法　应用自编一般资料调查表 ,回顾 1994～ 2 0 0 1年 89例住院首发老年期抑郁症患者的临床特征 ,并与同期住院的 2 4 9例非老年期首发抑郁症比较。结果　老年期组男性有自杀观念者多于女性 ,并发躯体疾病者少于女性 (P <0 0 0 5 ) ;老年期组并发躯体疾病多于非老年期组 ,精神焦虑比青年组多 ,自杀观念和自杀行为比老年前期少 ,较多单一使用麦普替林 (P <0 0 5 ) ;临床疗效和非老年期无显著差异。结论　老年期抑郁症有较多的精神性焦虑。充分的治疗可以取得满意的疗效     

中国四城市社区居民卒中知识水平相关因素分析

目的 调查中国四城市社区居民卒中知识水平,分析其知识水平的相关因素。方法 在北京、上海、长沙及成都四城市各选择两个社区,在两个社区内以户为单位采用系统抽样方法,每个社区至少选择300户居民,每户确定一人填写自行设计的调查问卷。调查前统一培训社区医生,调查问卷由社区医生入户填写完成。调查问卷内容包括：①接受调查者的一般资料：性别、年龄、文化程度等;②卒中相关知识：卒中危险因素、高血压及糖尿病的治疗、卒中的早期症状、发生卒中症状后如何就诊,以及获得卒中知识来源等。结果 共完成2519份调查问卷。①社区居民对卒中危险因素的知晓率为44.2%～87.7%,对常见卒中症状的知晓率为58.2%～80.2%;②社区居民希望获取卒中知识的主要途径为医生讲解的健康大课堂（77.7%）、电视（73.1%）、报纸（59.6%）、宣传短片（43.6%）、杂志（39.2%）;③社区居民卒中知识积分与其文化程度正相关（rs =0.114,P <0.001）,与年龄呈负相关（rs =-0.152,P <0.001）;④女性的卒中知识水平高于男性（P <0.001）。结论 本研究所调查的中国四城市社区居民对卒中相关知识认知不足,需要给予健康教育。加强教育目标人群主要为高龄、低文化程度、男性及卒中风险高危的居民。教育途径主要应集中在医生（包括社区医生）举办的健康大课堂、电视及报纸等。     

艾司西酞普兰治疗老年抑郁症对照研究

目的:比较艾司西酞普兰与舍曲林治疗老年抑郁症的疗效和安全性. 方法:80例老年抑郁症患者随机分为艾司西酞普兰组和舍曲林组,每组40例,分别给予艾司西酞普兰和舍曲林治疗8周.采用蒙哥马利-阿斯伯格抑郁评价量表(MADRS),于治疗前及治疗1、2、4、6、8周评价疗效,并观察不良反应. 结果:治疗后两组MADRS评分均较治疗前明显下降;治疗各周的MADRS减分率以艾司西酞普兰组显著较高(P<0.05或P<0.01),起效更快,临床有效率和缓解率更高(P<0.05或P<0.01).两组不良反应均较少,艾司西酞普兰组不良反应发生率较舍曲林组更低(P<0.05). 结论:艾司西酞普兰和舍曲林治疗老年抑郁症疗效确切,服药依从性好.艾司西酞普兰起效快,不良反应少,适合老年抑郁症的一线用药.     

家庭干预对抑郁症患者康复的影响

目的 探讨家庭因素对抑郁症患者康复的影响.方法 将90例符合条件的抑郁症患者随机分为观察组与对照组,对观察组的家庭进行为期12个月讲座或者上门随访方式进行相关知识培训,为患者提供家庭关怀,对照组仅进行药物治疗.采用精神护理观察量表(NORS)对精神症状进行评估.对服药依从性、复发率进行评估.结果 观察组的健康状况、情绪变化等均优于对照组(NORS)(P<0.01),服药依从性优于对照组(P<0.05),复发率低于对照组(P<0.01).结论 家庭干预对抑郁症患者的康复具有积极作用.     

北京市城区居民脑卒中知识、信念、行为效应性分析

目的 了解北京社区人群（年龄≥50岁）脑卒中防治知识、信念、行为现状,分析相关影响因素,为社区脑卒中防治提供依据。方法 于2008年6月至2009年3月,在北京崇文与石景山两个城区约10万自然人群中,按年龄性别构成整群随机抽取1350例年龄≥50岁的非卒中研究对象,进行面对面调查并由培训合格的社区医生填写统一问卷。问卷内容包括一般情况和脑卒中防治知识、信念、行为等相关资料。结果 脑卒中防治知识评分与信念和行为评分的相关系数分别为0.076（P =0.005）和0.245（P <0.01）,信念评分与行为评分的相关系数为0.208（P <0.01）。知识评分与文化程度相关,信念、行为评分与性别和年龄相关。结论 脑卒中防治知识、信念和行为三项评分呈相互一致性。同时信念和行为评分受到性别和年龄的影响,而与文化程度无关。     

村医对缺血性卒中抗栓药物应用知识干预分析

目的 评价村医对缺血性卒中抗栓药物应用知识干预的效果,探索适合村医的培训办法。 方法 通过自行设计问卷,对北流市20个乡镇500例村医进行缺血性卒中抗栓药物应用知识认知调 查,然后分为干预组和对照组。对干预组进行培训,内容包括：介绍抗栓药物种类、用法、不良反应 及二级预防抗栓药物应用规范。对照组不培训。半年后用相同问卷再调查。比较两组对药物应用知 识了解的效果。 结果 干预组和对照组分别纳入257例和225例村医,干预组干预后对抗栓药物的知识各项指标掌 握均显著增高,如同时知晓4个抗栓药物名称（29.57％ vs 10.20％,P <0.001）,4个不良反应的知 晓率（50.58％ vs 28.00％,P <0.001）,阿司匹林及氯吡格雷正确用法知晓率（71.60％ vs 36.00％; 61.09％ vs 24.89％）,卒中后抗栓药物应立即使用知晓率（68.48％ vs 29.78％,P <0.001）,需长 期应用知晓率（76.65％ vs 34.67％,P <0.001）,心瓣膜病应用华法林抗凝（69.65％ vs 25.33％, P <0.001）,复发性栓塞加抗血小板聚集药物（45.14％ vs 26.22％,P <0.001）等指标均显著高于对 照组。 结论 缺血性卒中抗栓药物应用知识的培训能有效促进村医对抗栓药物规范使用知识的掌握。     

How effective is advanced training concerning depression and suicidality among the elderly? Results of a pilot study.

Three Hundred and Seventy Four geriatric caregivers in Nuremberg and Munich participated in a four-hour advanced in-house training addressing the topic. "depression and suicidality in old age." Geriatric caregivers are key persons in early diagnosis of depressive symptoms and suicidality. The training focused on qualifying and sensitizing caregivers for these topics. A 12-item questionnaire was applied to measure the outcome parameters "knowledge and attitudes towards depression and suicidality in old age" within a pre-, post-, Three-months-follow-up design (rate of return = 58%). Short-term effectiveness of the advanced training "depression in old age" could be shown for most of the items. Significant long-term effects could be found concerning increase of knowledge about pharmacotherapy with antidepressants. Attitude towards "suicide in old age" also changed significantly. The training program was effective in improving knowledge and attitudes of geriatric caregivers concerning depression and suicidality.     

Barriers to the effective management of depression in general practice

OBJECTIVE: The aim of this study was to investigate the effects of prior general practice training in mental health and practice location on general practitioner (GP) attitudes toward depression, self-confidence in assessing and treating depressed patients, identification of doctor, patient and practice barriers to the effective care of depressed patients in general medical practice and GP-reported current clinical practice. METHOD: Fifty-two (out of 123) Divisions of General Practice that responded to an invitation to participate in the study distributed 608 anonymous surveys to a representative sample of GPs; 420 (69%) were returned. The questionnaire focused on current clinical practice, perceived barriers to care of depressed patients and doctors' self-efficacy for assessing and treating depressed patients. It also consisted of two scales, based upon previous research, designed to assess doctors' attitudes towards depression and depressed patients. RESULTS: General practitioners who had undertaken mental health education and training more often used non-pharmacological treatments (p=0.00), as did female GPs (p=0.00). Male GPs (p=0.00) and those in rural settings (p=0.01) more often prescribed medication for depression. Those without mental health training more often identified incomplete knowledge about depression as a barrier to its effective management (p=0.00). Urban-based GPs (p=0.04) and those with prior mental health training (p=0.00) were more confident in the use of non-pharmacological treatments. Female GPs without mental health training were the least confident in the use of these methods (p=0.01). Overall, GPs with mental health training were more positive in their attitudes toward depression and their treatment of these patients (p=0.00). Female GPs appeared more positive in their attitudes toward depression than male GPs (p=0.01), although the results were not entirely consistent. CONCLUSIONS: Participation in mental health training by GPs appears to be related to their attitudes toward depressed patients and to their confidence and abilities to diagnose and manage the common mental disorders effectively.     

The impact of antistigma education on the attitudes of general practitioners regarding schizophrenia

The aim of this study was to examine the views and attitudes of general practitioners (GP) with respect to schizophrenia, and the changes in their attitudes after antistigma education. A total of 106 GPs working in 71 health institutions were included in the study. A questionnaire of 16 items, focussing on doctors' views and attitudes towards schizophrenia, was applied. Questions were about the views and attitudes of doctors towards general myths related to schizophrenia. Doctors were asked to select one of two responses: 'I agree' or 'I disagree', for statements such as 'schizophrenic patients cannot work' and 'schizophrenic patients are aggressive and dangerous'. After completing the questionnaire, all the GPs were given a single session of antistigma education. The questionnaire was repeated 3 months after training meetings in a subsample of 54 GPs which represented the whole sample in terms of gender, age, and years in medical practice. The authors found statistically significant, positive changes on five items out of the 16 items in the post-test survey when compared to attitudes before training, including items about the treatability of schizophrenia, harmfulness and untrustworthiness of schizophrenic patients. The authors' findings suggest that one antistigma education session, supported by the distribution of related documents, can improve GPs attitudes towards schizophrenia.     

Assessment of depression in older medical inpatients: Practice,attitudes and the effect of teaching

The objective of this study was to determine the extent to which junior doctors assess depression in older medical inpatients and how much this could be influenced by a teaching session and the availability of a depression rating scale; also to determine the attitudes to depression of hospital doctors and senior nurses involved in the medical care of older people. Case note scrutiny was used on two occasions before and after a teaching session and distribution of depression rating scales, together with administration of the Depression Attitude Questionnaire. Participants were medical inpatients over 65 years old at a district general hospital and medical and senior nursing staff involved in their assessment and care. No patient had a documented mental state assessment at admission. This was unchanged following intervention. The questionnaire suggested that the problem lay not with knowledge, but with willingness to be involved in managing depression. In conclusion, the management of depression in older medical inpatients was unsatisfactory. The questionnaire suggested that future interventions to improve care should focus on encouraging 'ownership' of depression management rather than providing 'one-off' teaching.     

Patients' Views on Electroconvulsive Therapy on Completion of a Course of Treatment

Patients' attitudes towards electroconvulsive therapy (ECT) on their completion of a course of treatment were studied using a semi-structured questionnaire. Twenty-six patients were seen before the junior doctors were trained in ECT administration and 28 patients afterwards. Most patients' attitudes were favourable, although very few fully understood the treatment. Training the junior doctors had no effect on patients' attitudes, but was associated with a shorter mean course length. ECT was acceptable to most patients who received it.     

Prevalence,detection and prescribing behavior in depressive syndromes. A German federal family physician study

This study examines the prevalence of depressive syndromes among unselected primary care patients as well as doctors' recognition and treatment rates. This nationwide study included a total of 20,421 patients attending their primary care doctors (n = 633) on the study's target day. Patients received a self-report questionnaire including the depression screening questionnaire (DSQ) to provide diagnoses of depressive disorders according to the criteria of DSM-IV and ICD-10. These data were compared to the doctor's evaluation form for each patient to assess the physician's diagnostic decision, assessment of clinical severity, and treatment choices. The findings confirm the high prevalence of depressive syndromes in primary care settings (11.3%) and underline the particular challenge posed by a high proportion of patients near the diagnosis threshold. Although recognition rates among more severe major depressive patients (59%) as well as treatments prescribed appear to be more favourable than in previous studies, the situation in less severe cases and the high proportion of doctors' definite depression diagnoses in patients who do not fulfill the diagnostic criteria still raise significant concerns.     

Perspectives towards predictive testing in Huntington disease

OBJECTIVE: Genetic counseling for individuals undergoing presymptomatic testing is lacking in India although testing is easily available. This has an impact on family members of Huntington's disease (HD), an autosomal dominant disease, wherein the age at onset of symptoms varies. AIM: We examine if attitudes differ towards presymptomatic testing for HD amongst HD family members, physicians and laypersons. MATERIALS AND METHODS: A modified questionnaire enquiring about opinions on various personal, family, social and future health care with regards to presymptomatic testing of HD was designed. A physician explained briefly about HD and presymptomatic testing of HD and recorded responses of unaffected family members of HD (n=25) and laypersons (n=50). Medical doctors (n=50) answered the questionnaire based on their knowledge of HD. RESULTS: HD family members, Medical doctors and laypersons were similar in their opinion to undergo the testing. Majority (60%) of HD family members did not wish to communicate test results with their friends when compared to the other two groups. Medical doctors and HD family members were more concerned about certainty of developing disease when the test results are positive. Majority (80%) of Medical doctors and less than half in the other groups felt that their decision to have a child would strongly depend on test results. Large proportion (80%) of HD family members did not wish to report their test results to their employers. CONCLUSIONS: Individuals with knowledge about HD and the test differ in their decision of sharing test results and reproductive choices.     

Nurses' attitudes towards depression: a study in Slovenia

Our aim was to discover nurses' attitudes towards depression and to test for the impact of education on these attitudes. Negative attitudes towards depression are one of the reasons for underestimation of depressive disorders in the community and the clinical setting. We developed a questionnaire on attitudes towards depression by using the principal component analysis. We observed overall changes in attitudes and differences in each dimension and compared them between nurses who attended education workshops and those who did not. We learnt that nurses have positive attitudes towards people suffering from depressive disorder and towards curing and healing from depression itself, but a somewhat neutral opinion on possible complications caused by depression. Overall, nurses' attendance at education workshops contributed to improvement in their attitudes. This in turn probably led to a decrease in the stigmatisation of depression.     

A UK national survey of the management of depression by geriatricians and old age psychiatrists

A national postal questionnaire on the management of depression in the elderly was completed by 89 geriatricians and 72 old age psychiatrists. Significant differences were noted in intended choice of antidepressant drugs (using case vignettes), knowledge of antidepressant drugs and knowledge of psychological treatments. Geriatricians were more likely to suggest dose ranges which were subtherapeutic and were not confident in prescribing newer antidepressants. Very few doctors had overtly negative attitudes towards ageing and depression. However, a need for more training was clearly identified, particularly for geriatricians and for older doctors of both groups. Doctors who were confident about their own abilities tended to also have a more positive approach to therapy and regarded depression as less difficult to treat. Older doctors, geriatricians and those who felt they needed more training in how to treat depression were more likely to use low doses or discontinue treatment too soon after recovery. The results suggest a need for training which focuses on these areas.