辅助应用支持性心理疗法和认知行为治疗对老年抑郁症症状严重程度及生活质量的影响

目的探讨支持性心理疗法和认知行为治疗(CBT)辅助应用对老年抑郁症症状严重程度及生活质量的影响。方法研究对象选取我院2016年3月～2018年3月收治的老年抑郁症患者共136例,以随机数字表法分为A组(支持性心理疗法组,78例)和B组(CBT治疗组,78例),分别在舍曲林基础上加用支持性心理疗法和CBT疗法治疗;比较两组临床疗效。结果 B组近期疗效,治疗后HAMD17评分、GDS评分、WSCT评分及WHOQOL-BREF评分均显著优于A组、治疗前(P0.05)。结论相较于支持性心理疗法,CBT疗法辅助应用用于老年抑郁症患者治疗有助于缓解抑郁症状,改善认知功能,并有助于提高生存质量。     

回忆疗法联合帕罗西汀药物治疗在老年抑郁患者中的应用价值及对患者生活质量的影响

目的研究回忆疗法联合帕罗西汀药物治疗在老年抑郁患者中的应用价值及对其生活质量的影响。方法选择2015年1月~2016年12月在我院接受治疗的老年抑郁症患者150例,根据随机数表法将其分为对照组和实验组,每组各75例。对照组患者给予帕罗西汀治疗,20mg口服,每日1次;实验组患者在对照组的基础上联合应用回忆疗法。结果实验组患者的疗效好于对照组(P<0.05)。实验组患者治疗2周、治疗4周及治疗8周后的HAMD评分均低于对照组(P<0.05)。实验组患者的SF-36各维度评分均高于对照组,生活质量更好(P<0.05)。结论回忆疗法联合帕罗西汀药物治疗可以明显提高老年抑郁症患者的疗效,降低HAMD评分,改善生活质量,值得在临床推广应用。     

正念疗法治疗抑郁症的研究进展

抑郁症的非药物治疗手段是药物治疗的一种有效补充，正念疗法是近年开展较多的一种 心理治疗方法，现通过归纳总结近几年国内外正念及其相关疗法的内涵、作用机制，对正念疗法在抑郁 症患者中的应用研究现状进行综述，为将来进一步的研究和临床应用提供指导和支持。     

眼动脱敏与再加工在伴创伤症状的抑郁症治疗中应用的研究进展

抑郁症是一种常见心境障碍，复发率高，且相当比例的患者存在残留症状。研究发现抑郁症患者的创伤症状与其残留症状、复发均存在明显的相关关系，因此在抑郁症患者中干预创伤，可能是改善疾病症状及预后的有效手段。眼动脱敏与再加工是干预创伤的一种常用心理疗法，现就其在伴有创伤症状的抑郁症中的应用进展进行综述。     

抑郁症患者识别动态喜悦表情的功能磁共振研究

目的:探讨抑郁症患者动态喜悦表情加工的神经基础。方法:对15例女性抑郁症患者(抑郁症组)和15名女性健康志愿者(正常对照组)采用功能磁共振技术进行动态喜悦表情识别任务中的磁共振脑功能扫描,分析抑郁症患者与健康受试者在识别动态喜悦表情间的脑区活动差异。结果:在明确识别条件下,抑郁症组患者右枕中回(BA18)、右顶下小叶(BA40)、右楔前回(BA7)及双侧中央后回(BA7,BA5)等脑区活动增加,而双侧顶上小叶等脑区活动降低。而在不明确识别条件下,抑郁症患者右顶下小叶活动增加,而右楔叶、右中央后回及左顶上小叶活动降低。结论:抑郁症患者识别喜悦表情障碍可能是由于感知该表情面部运动能力存在缺陷所致。     

脑功能活动水平对抑郁症病情的影响

目的探讨脑功能活动水平对抑郁症病情的影响。方法选取我院2015年1月~2016年12月收治的抑郁症患者86例为研究对象。采用汉密尔顿抑郁量表(HAMD)评估患者抑郁状况。所有患者接受功能磁共振成像检测。结果 86例患者HAMD评分(23.5±4.3)分。HAMD评分与ReHo值呈正相关的脑区包括右侧颞下回(BA22)、右侧楔叶(BA18)、左侧上前扣带皮层(BA36)、左侧楔前叶(BA9)、左侧下后扣带皮层(BA25)、左侧上后扣带皮层(BA32)和左侧额极区(BA12)。HAMD评分与ReHo值呈负相关的脑区包括左侧中央后回(BA20)、右侧中央前回(BA38)、右侧背外侧前额叶(BA11)和右侧颞上回(BA41)。结论抑郁症患者多个脑区ReHo值存在异常,静息态下脑功能损害主要集中在默认网络和边缘系统等多个脑区。ReHo分析可反映抑郁症患者静息态下脑功能变化,具备成为抑郁症严重程度评估的有效工具。     

抑郁症与正常人静息态脑功能变化对照研究

目的:利用功能磁共振成像(functional magnetic resonance imaging,fMRI)技术,研究静息状态下重性抑郁症患者经抗抑郁药治疗前后脑局部一致性变化的特点. 方法:20例重性抑郁症患者(抑郁症组),以20名在性别、年龄、受教育年限均与之相匹配的健康人作为对照(对照组),在抗抑郁治疗前和治疗10周进行静息状态fMRI扫描. 结果:与治疗前比较,抑郁症组治疗后大脑左侧黑质、左额中回(BA9,BA10)、左额内侧回(BA10)、左颞中回(BA21)、右额中回(BA11)、右额内侧回(BA25)、右额下回(BA45)及右颞上回(BA38)局部一致性减低.与对照组比较,抑郁症组治疗前双侧楔前叶(BA7)局部一致性增高,而治疗后右前扣带回腹侧(BA31)、右额下回(BA46)、右额内侧回(BAIO)及左海马旁回(BA36)局部一致性减低. 结论:静息状态下抑郁症患者存在部分脑功能异常,经抗抑郁治疗后可逆转.     

支持性心理疗法在老年抑郁症患者中的应用效果及对生活质量的影响

目的研究分析支持性心理疗法在老年抑郁症患者中的应用效果及对生活质量的影响。方法选取我院自2012-12—2013-12收治的老年抑郁症患者98例,以数字表法随机分成观察组和对照组各49例。2组患者均给予常规性抗抑郁药物治疗,对照组给予一般性常规心理疏导,观察组在对照组基础上给予支持性心理疗法。根据HAMD(汉密顿抑郁量表)、HAMA(汉密顿焦虑量表)评分判定患者临床治疗效果,根据患者健康评定量表(SF-36)评分判定生活质量情况。分别于治疗前及治疗后12周,对2组患者进行HAMD、HAMA评分及SF-36测量,并对比其得分情况及临床疗效。结果观察组患者治疗后12周HAMD及HAMA评分均显著低于治疗前以及对照组治疗后,观察组临床治疗显效率及总有效率显著高于对照组,差异均有统计学意义(均P0.05)。观察组治疗12周后SF-36各维度中,总体健康、心理功能、情感职能、精力以及躯体疼痛的得分均显著高于治疗前以及对照组治疗后的水平,差异均有统计学意义(均P0.05)。结论支持性心理疗法对于老年抑郁症患者应用效果良好,能够有效提高临床疗效,并利于提高患者生活质量,值得临床推荐。     

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.     

老年抑郁症：早发及晚发病例的比较

老年抑郁症：早发及晚发病例的比较【英】／ＢａｌｄｗｉｎＲＣ…∥ＢｒＪＰｓｙｃｈｉａｔｒｙ，１９９５，１６７（１１）：６４９－６５２老年抑郁症被认为与其他年龄时的抑郁症不同，原因是老年抑郁症可能有器质性基础。对此，目前尚有争议。本文对老年抑郁症患者中的...     

Diagnostic Difficulties and Treatment Implications

Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.     

Cognitive Dysfunction Associated with Antiepileptic Drug Therapy

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Carbamazepine Efficacy in Adults With Partial and Generalized Tonic-Clonic Seizures

Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.     

Etiologic and Preventive Aspects of Epilepsy in the Child–Bridging the Gap Between Laboratory and Clinic

Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Predisposing and Causative Factors in Childhood Epilepsy

Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non-febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.     

Anticonvulsant Drugs and Cognitive Function: A Review of the Literature

Summary: Alterations of cognitive function are separate from disturbances of behavior seen in association with epilepsy. The nature of the cognitive disability may to a certain extent depend on the seizure type. Partial seizures, mainly derived from a temporal lobe focus, impair memory tasks, while generalized seizures seem to have more effect on attentional abilities. A number of studies, reviewed in this paper, suggest that anticonvulsant drugs further impair cognitive function. Maximal impairments are seen in patients receiving polytherapy: rationalization of polytherapy improves cognitive abilities. Studies in children and adults have allowed differentiation of the effects of various commonly used antiepileptic agents. Maximal cognitive deficits are seen with. phenytoin, while phenobarbital and sodium valproate induce moderate disturbances, and carbamazepine seems relatively free from such toxicity. Further research is needed on the interrelationship between types of seizure disorders, types of anticonvulsant medications, and cognitive function.