欣百达防治伴有焦虑抑郁障碍的慢性偏头痛的疗效

目的:评价双通道再摄取抑制剂(欣百达)防治伴有焦虑抑郁障碍的慢性偏头痛的疗效.方法:采用焦虑自评量表(SAS)及抑郁自评量表(SDS)评价偏头痛患者的焦虑和抑郁程度;将同时伴有焦虑抑郁障碍的慢性偏头痛患者分为西比灵+乐松组(A组)、西比灵+乐松+欣百达组(B组),治疗后比较各组间的差异.结果:所观察偏头痛患者中有焦虑者占72.4%,抑郁者65.6%,焦虑抑郁共存者49.3%.治疗12周后,B组SDS和SAS评分明显降低(P<0.05),A组改善不明显(P>0.05).A组和B组治疗前后自身对照在头痛发作次数、持续时间及对生活的影响方面均有改善(P<0.05);治疗后B组症状改善程度较A组更明显(P<0.05).结论:双通道再摄取抑制剂(欣百达)对慢性偏头痛有明显防治效果,且改善慢性偏头痛伴随的情绪障碍.     

氟西汀和阿米替林治疗抑郁和焦虑障碍共病的疗效比较

目的：探讨氟西汀合并小剂量阿米替林治疗抑郁障碍和焦虑障碍共病(comorbid depression disorder and anxiety disorder，CDA)的效果和副反应。方法：在本院神经心理康复门诊中选择同时符合美国《精神障碍诊断统计手册》第4版关于抑郁障碍和焦虑障碍诊断标准的84例患者，随机分为常规剂量的氟西汀、阿米替林组和氟西汀合并小剂量阿米替林组(综合治疗组)。每组于治疗前、治疗后2，4和8周共4次行抑郁自评量表(SDS)和焦虑自评量表(SAS)评定以及治疗期间常见副反应发生率评定。结果：实际完成治疗观察77例。与治疗前相比，综合治疗组治疗2周SDS及SAS评分即明显下降，差异有显著性意义(P&;lt;O．05)。治疗8周的显效率为93％，明显高于氟西汀组(68％)和阿米替林组(7l％)，差异有显著性意义(，=6．793，P&;lt;O．05)。口干、便秘、头晕、嗜睡、心动加速、体质量增加等副反应发生率与氟西汀组相仿(P&;gt;O．05)，但明显少于阿米替林组(X^2=17．688～36．561，P&;lt;O．001)。结论：氟西汀合并小剂量阿米替林对CDA有良好治疗作用，且副反应较少。     

护理干预对偏头痛患者负性情绪和生活质量的影响

目的探讨护理干预对偏头痛患者心理状态和生活质量的影响。方法对45例偏头痛患者随机分为两组,对照组24例给予常规治疗、护理;实验组21例在常规治疗、护理的基础上给予护理干预;于护理干预前和8周末采用焦虑自评量表（SAS）、抑郁自评量表（SDS）和生活质量指数问卷（QLINDEX）对两组患者各调查评定1次,并比较两组的治疗效果。结果护理干预前两组患者SAS、SDS评分差异无统计学意义（P〉0．05）;8周末实验组与对照组SAS、SDS评分比较明显降低（P〈0．01;P〈0．05）;疗效评分实验组（11．02±4．25）与对照组（14．18±5．89）比较,差异有统计学意义（P〈0．05）;生活质量总指数实验组（8．65±1．86）明显高于对照组（7．12±1．98）,差异有统计学意义（P〈0．05）。结论护理干预有助于改善偏头痛的负性情绪,缓解偏头痛症状,减少复发的次数,提高患者的生活质量。     

抗抑郁护理在功能性便秘患者中的应用

目的：分析探讨抗抑郁护理在功能性便秘疾病患者中的临床价值和意义。方法选择海军总医院2010年12月-2012年12月90例功能性便秘患者按住院号随机均分为3组,A组患者采用常规护理,同时给予小剂量帕罗西汀;B组患者行抗抑郁护理;C组患者采用常规护理。分别于治疗前及干预后1,2周对各组患者抑郁自评量表（ SDS）、焦虑自评量表（ SAS）及药物不良反应进行统计学分析。结果3组间患者入院时平均SDS、SAS评分水平,差异均无统计学意义（ F分别为0．280,1．286;P＞0．05,LSD法两两比较分析均P＞0．05）。入院1周A、B组SDS、SAS评分略低于C组,差异均无统计学意义（F分别为1．927,1．286;P＞0．05,且LSD法两两比较分析均P＞0．05）;入院2周A、B组SDS、SAS评分明显低于C组,差异有统计学意义（F分别为16．337,17．733,P＜0．05,LSD法分析A、C组,B、C组间比较P＜0．05）。析因实验方差分析SDS、SAS改变与不同抗抑郁干预方式-时间因素均存在差异（ F分别为66．744,12．806;P＜0．01）,且存在交互作用。同时A组患者药物不良反应率明显高于B、C组患者,差异有统计学意义（χ2＝12．857,P＜0．01）。结论抗抑郁护理能明显缓解功能性便秘患者的焦虑、抑郁情绪及临床症状评分,并可有效避免抗抑郁药物引起的不良反应,具有重要的护理价值,值得临床推广。     

心理干预对慢性乙型肝炎患者家属抑郁及焦虑情绪的影响

目的：探讨心理干预对慢性乙型肝炎患者家属抑郁焦虑情绪的影响。方法选择慢性乙型肝炎患者家属68例,采用随机数字表法随机分为观察组（34例）和对照组（34例）。对照组给予常规护理健康教育,观察组在此基础上给予心理干预,家属均应用抑郁自评量表（ SDS ）及焦虑自评量表（SAS）评估干预前后的心理健康状况。结果干预前,患者家属 SDS 及 SAS评分分别为（39．81±5.34）,（34．67±4．61）分,均高于国内常模,差异有统计学意义（t值分别为9．71,8．92;P＜0．05）;干预前,两组患者家属SDS及SAS评分差异无统计学意义（ P＞0．05）;干预后,观察组患者家属SDS及SAS评分低于对照组,差异均有统计学意义（ t值分别为3．61,2．85;P＜0．05）。结论慢性乙型肝炎患者家属存在一定程度的抑郁焦虑状况,心理干预能改善患者家属的抑郁焦虑状况。     

温馨护理对老年冠心病伴负性情绪的影响研究

目的：探讨老年冠心病伴焦虑抑郁的临床特点及温馨护理对其影响。方法选取老河口市第一人民医院2010年2月到2012年10月入院治疗的70例冠心病伴焦虑抑郁的患者，随机分为治疗组35例与对照组35例，治疗组在药物治疗基础上，采取关注患者心理状况的温馨护理。两组患者入院时及治疗后4周分别进行焦虑自评量表（SAS）、抑郁自评量表（SDS），比较两组患者焦虑抑郁评分结果及临床疗效。结果治疗组与对照组入院时首次 SAS 、SDS 评分差异无统计学意义（P＞0．05）。经过4周治疗，治疗组 SAS 、SDS 评分明显低于对照组，差异有统计学意义（P＜0．05）；治疗组疗效明显优于对照组，差异有统计学意义（P＜0．05）。结论对老年冠心病伴焦虑抑郁的患者采取针对其临床特点的温馨护理，关注其心理状况变化较单纯的药物治疗疗效明显，能够很好地提高患者生存质量，具有临床应用价值。     

偏头痛患者的个性特征及情绪障碍

目的 探讨偏头痛的个性特征及情绪障碍。方法 应用艾克森个性问卷（EPQ）、抑郁自评量表（SDS）、焦虑自评量表（SAS）对30例偏头痛患盐酸氟桂利嗪治疗前后分别评分、比较，以30例健康志愿作为对照。结果 偏头痛组EPQ中N量表分值、SDS分值和SAS分值均明显高于对照组，治疗后各量表分值无明显变化。EPQ的N量表分值与SDS分值、SAS分值分别呈正相关。结论 偏头痛患情绪不稳定，存在明显的焦虑和抑郁特点。这些心理学改变可能是偏头痛发作的原因之一。临床上可对其进行干预，以保持长期的治疗效果。     

无偿献血者全程健康教育实践与效果评价

目的：探讨社会心理因素对子宫全切除术患者的影响及护理对策。方法：将195例行子宫全切除术患者随机分为A组89例和B组106例，A组在子宫全切除术常规护理的基础上，加用认知、情绪和心理护理干预；B组仅给予子宫全切除术常规护理。分别采用艾森克个性问卷（EPQ）成人版、Zung焦虑自评量表（SAS）和抑郁自评量表（SDS）、生活事件量表（LES）及社会支持评定量表（SSRS）对两组患者进行评分并比较。结果：A组内外向分值高于B组，两组比较有极显著性差异（P〈0．01），而神经质、焦虑、抑郁、负性生活事件分值均低于B组，两组比较有显著性差异（P〈0．05，P〈0.01）。A组主观支持的分值低于B组，而对支持的利用度高于B组，两组比较均有极显著性差异（P〈0．01）。B组神经质分值与其SAS、SDS、LES分值之间均呈正相关（P〈0．01）。结论：B组患者具有明显的内向和神经质、焦虑、抑郁个性，并与负性生活事件有关，对全子宫切除患者实施心理干预，可降低其焦虑和抑郁的程度，提高其生活质量。     

曲唑酮与阿米替林治疗伴有焦虑症状的抑郁症

目的：比较曲唑酮与阿米替林治疗伴有焦虑症状的抑郁症的临床的疗效和副反应。方法：68例符合CCMD－2－R诊断标准的抑郁症伴有焦虑症状的患，随机分为两组，应用曲唑酮34例，阿米替林34例共治疗6周。采用汉密顿抑郁量表（HAMD）、焦虑量表（HAMA）和副反应量表（TESS）评定疗效和副反应。结果：曲唑酮与阿米替林治疗伴有焦虑症状的抑郁症均有效，二疗效相当（P＞0．05）。曲唑酮的副反应明显少于阿米替林（P＜0．01）。结论：曲唑酮治疗伴有焦虑症状的抑郁性神经症是一种安全、有效的药物。     

护理干预对糖尿病患者负性情绪的影响

目的 探讨护理干预对糖尿病患者负性情绪的影响。方法 将78例糖尿病患者随机分为干预组40例和对照组38例。对照组患者给予常规治疗及护理，干预组患者在此治疗的同时给予心理干预、认知重建、社会支持和多元化教育。分别于干预前及干预后4周用焦虑自评量表（SAS）和抑郁自评量表（SDS）对2组患者进行评定。结果干预前2组患者焦虑、抑郁评分差异无显著性（P＞0．05），4周后干预组患者焦虑、抑郁评分显著低于对照组（P＜0．05）。结论 护理干预有助于改善糖尿病患者的负性情绪，提高患者的生活质量。     

The course of migraine—a diary study in unselected patients

The course of disease and the predictive value of depression and anxiety in patients with migraine were prospectively examined. We recruited 393 migraineurs through articles in newspapers and performed a follow-up examination 30 months later. At baseline and follow-up, patients underwent a semistructured interview, filled out the Headache Impact Test (HIT-6), Self-rating Depression Scale (SDS) and Self-rating Anxiety Scale (SAS) and they kept a headache diary for 30 days. One hundred and fifty-one patients (38.6%) were seen at follow-up. The baseline data of patients with and without follow-up were comparable. At follow-up the number of headache days per month had decreased from 9.6 ± 5.8 to 8.1 ± 6.3 ( P  < 0.001) and the proportion of patients with chronic headache (15.4%) and medication overuse (13%) had remained stable. SDS and SAS scores were associated with a high migraine frequency and high initial SDS scores predicted high migraine frequency at follow-up. This longitudinal study in unselected patients with migraine not excluding subjects with chronic headache, medication overuse, depression or anxiety does not point towards migraine as a progressive disease in the vast majority of patients and confirms the importance of psychiatric comorbidity.     

盐酸氟桂利嗪预防性治疗偏头痛的疗效和安全性

目的：探讨盐酸氟桂利嗪预防性治疗偏头痛的有效性及安全性.方法：采用开放性研究,2120例偏头痛患者每日口服盐酸氟桂利嗪5～10 mg,治疗时间为12周,在治疗开始及4周末、8周末、12周末分别记录患者的头痛程度、频率、服药剂量、不良事件发生情况以及血压.结果：治疗后4周末、8周末及12周末与治疗前相比,头痛程度明显减轻（均P＜0.05）,频率明显减少（均P＜0.05）,盐酸氟桂利嗪用量亦明显减少（均P＜0.05）,未发现严重不良事件,治疗前后血压无明显变化（均P＞0.05）.结论：盐酸氟桂利嗪是一种安全有效的偏头痛预防性治疗药物.     

精神心理因素在原发性胆汁反流性胃炎中的作用初步探讨

目的通过自评量表的评价探讨精神心理因素在原发性胆汁反流性胃炎患者发病中的作用。方法对符合原发性胆汁反流性胃炎(PBRG)诊断的164例患者和72例慢性浅表性胃炎(CSG)患者应用焦虑自评量表(SAS)和抑郁自评量表(SDS)分别进行问卷调查,并根据年龄分为3组:A组小于30岁;B组30~50岁;C组大于50岁。分别比较分析各组评分的特点。结果 A组PBRG患者与CSG患者焦虑和抑郁状态患病率比较有显著性差异(P<0.05),B组和C组PBRG患者与CSG患者焦虑和抑郁状态患病率分别比较无显著性差异(P>0.05),所有PBRG患者与CSG患者焦虑和抑郁状态患病率比较有显著性差异(P<0.05)。结论 PBRG患者较CSG患者焦虑和抑郁状态的发生更高,尤其是年轻PBRG患者较CSG患者焦虑和抑郁状态发生更明显,提示精神心理因素可能是PBRG特别是青年患者发病原因并可能在发病机制中起到一定作用。     

Depression and anxiety: effect on the migraine-obesity relationship

OBJECTIVE: To discern the effects of depression and anxiety on the migraine-obesity relationship. BACKGROUND: Migraine and obesity are highly prevalent conditions and are both independently linked to psychiatric conditions, mainly depression and anxiety. METHODS: Data are from an ongoing cross-sectional multicenter study on comorbid conditions in clinic patients seeking treatment for headache. The diagnosis of migraine was determined by the examining physician based on the International Classification of Headache Disorders (ICHD)-II criteria. Participants completed a self-administered questionnaire with information on demographics, headache features, and physician-diagnosed comorbid medical and psychiatric disorders. The questionnaire included scales for measuring current depression (PHQ-9), anxiety (BAI), and headache-related disability (HIT-6). RESULTS: A total of 721 migraineurs (88% women) from 8 different headache treatment centers were included in this study (mean age = 42 years, SD = 12). Aura was reported in 45% and chronic headache (>or=15 headache days/month) in 35% of the participants. Prevalence of obesity in our population was 30% and only 38% had normal weight. Obesity was more common in men (P= .004), African Americans (P= .026), and in lower education (P= .05) and household income (P=.05) groups. Current depression (PHQ-9 score >or=10) was noted in 42% and current anxiety (BAI score >or=8) in 70% of the obese migraineurs. In ordinal logistic regression, obesity was associated with current depression (odds ratio [OR]= 1.86, 95% confidence interval [CI]: 1.25 to 2.78) and anxiety (OR = 1.58, 95% CI: 1.12 to 2.22). A significant effect of depression on the body mass index (BMI) and headache frequency relationship was noted. Obese migraineurs with depression were more likely to have higher headache frequency (OR = 4.16, 95% CI: 1.92 to 8.99) and headache-related disability (OR = 7.10, 95% CI: 2.69 to 18.77) compared to normal weight migraineurs without depression. Similarly, obese migraineurs with anxiety were more likely to have higher headache frequency (OR = 1.96, 95% CI: 1.07 to 3.61) and headache-related disability (OR = 3.59, 95% CI: 1.64 to 7.86) compared to normal weight migraineurs without depression. Compared to migraineurs with either current depression or anxiety, those with both these conditions were more likely to have higher headache frequency (OR = 3.18, 95% CI: 1.86 to 5.43) and headache disability (OR = 6.13, 95% CI: 2.58 to 14.59). CONCLUSION: Depression and anxiety were common in obese migraineurs. The relationship of obesity with migraine frequency and migraine-related disability is modified by depression and by anxiety, with the strongest effect observed in migraineurs with both depression and anxiety.     

不同透析膜对维持性血液透析者预后的影响

[目的] 探讨不同透析膜对维持性血液透析(MHD)患者预后的影响.[方法] 本院诊治的MHD患者105例,根据使用透析膜的不同分为三组,每组35例.A组采用B-16H型空心纤维血液透析器透析,B组采用F15型空心纤维血液透析器透析,C组采用CA-HP-150型血液透析器治疗,采用抑郁自评量表(SDS)及焦虑自评量表(SAS)评分进行抑郁评分测定,比较三组C反应蛋白(CRP)、白细胞介素-6(IL-6)及糖基化终末产物(AGEs)水平和甲状旁腺激素(PTH)、磷(P)、钙(Ca)及血清白蛋白(ALb)和血红蛋白(Hb)水平.[结果] 三组治疗前SAS、SDS评分相比较差异无显著性(P>0.05);C组治疗后SAS、SDS评分低于A、B组(P<0.05);C组治疗后CRP、IL-6、AGEs及PTH、P水平显著低于A、B组(P<0.05);C组治疗后Ca及ALb和Hb水平显著高于A、B组(P<0.05).[结论] MHD患者采用CA-HP-150型血液透析器治疗效果理想,其能改善患者矿物质代谢紊乱,缓解患者抑郁症状,值得推广应用.     

Prevalence and risk factors for depression and anxiety among outpatient migraineurs in mainland China

This study aimed to investigate the prevalence and risk factors for anxiety and depression symptoms in outpatient migraineurs in mainland China. In addition, we evaluated whether the Hospital Anxiety and Depression Scale (HADS) provided sufficient validity to screen depression and anxiety. A cross-sectional study was conducted consecutively at our headache clinic. Migraine was diagnosed according to International Classification of Headache Disorders, 2nd edition (ICHD-II). Demographic characteristics and clinical features were collected by headache questionnaire. Anxiety and depression symptoms about migraineurs were assessed using HADS. Several questionnaires were simultaneously used to evaluate patients with depressive disorder including the Hamilton Depression Rating Scale-17 (HAMD), Hamilton Anxiety Rating Scale (HAMA) and HADS. Pearson correlation analysis was applied to test the validity of HADS. 176 outpatients with migraine (81.8 % female) were included. Overall, 17.6 and 38.1 % participants had depression and anxiety, respectively. Possible risk factors for depression in migraineurs included headache intensity of first onset of migraine, migraine with presymptom, migraine with family history and migraine disability. The possible risk factors for anxiety included fixed attack time of headache in one day and poor sleeping, and age represented a protective factor for anxiety. The correlation coefficient of HADS-A and HADS-D with HAMA and HAMD was 0.666 and 0.508, respectively (P < 0.01). This study demonstrates that depression and anxiety comorbidity in our mainland Chinese migraineurs are also common, and several risk factors were identified that may provide predictive value. These findings can help clinicians to identify and treat anxiety and depression in order to improve migraine management.     

八段锦对慢性肾脏病3~5期非透析患者生活质量及心理状态的影响

目的:观察八段锦运动疗法对慢性肾脏病3~5期非透析患者生活质量及心理状态的影响。方法:采用随机数字表法,将符合标准的66例慢性肾脏病3~5期非透析患者随机分为运动组和对照组,每组各33例,对照组除常规治疗外,不采取任何干预措施,运动组在常规治疗基础上,予6个月的八段锦运动疗法干预。采用慢性肾衰竭生命质量量表(QLICD-CRF2.0)评估患者的生命质量情况,用焦虑自评量表(SAS)、抑郁自评量表(SDS)评估患者心理状态。结果:与治疗前相比,运动组在3个月及6个月后QLICD-CRF2.0评分、SAS评分、SDS评分均有改善(P<0.05),且6个月后比3个月后改善更明显(P<0.05);对照组在6个月后QLICD-CRF2.0评分有改善(P<0.05),而SAS评分及SDS评分与治疗前相比无统计学差异(P>0.05)。6个月后,运动组在改善QLICD-CRF2.0评分、SAS评分、SDS评分方面均优于对照组(P<0.05)。结论:八段锦运动疗法对改善慢性肾脏病3-5期非透析患者生活质量及焦虑抑郁状态有帮助。     

压力接种训练在生长激素型垂体瘤患者中的应用效果

目的探讨压力接种训练在生长激素型垂体瘤患者中的应用效果。方法选取2018年4月至2019年4月我院收治的生长激素型垂体瘤患者58例为研究对象,随机将其等分为对照组和试验组,对照组实施常规健康教育,试验组在对照组基础上给予压力接种训练,比较两组患者压力知觉量表(CPSS)、焦虑自评量表(SAS)及抑郁自评量表(SDS)的评分情况。结果入院时,两组患者CPSS,SAS,SDS评分比较差异无统计学意义(P>0.05);干预后,试验组CPSS,SAS,SDS评分均低于对照组(P<0.05)。结论将压力接种训练应用于生长激素型垂体瘤患者中能有效降低知觉压力,缓解其焦虑、抑郁情绪,临床应用效果满意。     

帕罗西汀治疗糖尿病伴发焦虑抑郁障碍对照研究

目的探讨帕罗西汀治疗糖尿病伴发焦虑抑郁障碍的临床疗效。方法将36例糖尿病伴发焦虑抑郁障碍患者随机分为研究组与对照组各18例,均给予糖尿病常规治疗。研究组联用帕罗西汀治疗,对照组联用安慰剂治疗,疗程8 w。采用焦虑自评量表,抑郁自评量表评定焦虑抑郁症状改善情况,并与国内常模进行对比分析。结果治疗前两组焦虑自评量表,抑郁自评量表评分均显著高于国内常模(P<0.05),有并发症与无并发症者、空腹血糖>10 mmol.L-1与<10 mmol.L-1者、胰岛素治疗与非胰岛素治疗者的总分均有显著性差异(P均<0.05);治疗8 w末焦虑自评量表、抑郁自评量表评分均较治疗前显著下降(P<0.05),研究组较对照组下降更显著(P<0.05)。结论糖尿病患者存在明显的焦虑抑郁障碍,帕罗西汀疗效显著,依从性好。     

Endometriosis is associated with prevalence of comorbid conditions in migraine

OBJECTIVE: To examine the headache characteristics of women with migraine and endometriosis (EM), and differences in the prevalence of comorbid conditions between female migraineurs with EM, without EM and nonheadache controls. BACKGROUND: Migraine and EM are common conditions in women of reproductive age, and both are influenced by ovarian hormones. The comorbidity of migraine and EM is newly recognized, but reasons for the association are uncertain. METHODS: This is a cross-sectional study of female headache outpatients and healthy controls conducted at University of Toledo and Duke University in 2005 and 2006. After a headache specialist determined headache frequency and diagnosis (based on criteria of the second International Classification of Headache Disorders), patients completed a self-administered electronic survey with information on demographics, headache-related disability, menstrual disorders, premenstrual dysphoric disorder (PMDD), vascular event risk, and comorbid conditions, including irritable bowel syndrome (IBS), fibromyalgia (FM), chronic fatigue syndrome (CFS), interstitial cystitis (IC), depression, and anxiety. RESULTS: Study enrolled 171 women with migraine and 104 controls. EM was reported more commonly in migraineurs than in controls (22% vs 9.6%, P < .01). Frequency of chronic headache was higher in migraineurs with EM compared to without EM (P= .002) and median headache-related disability scores were also higher in the EM group (P= .025). Symptoms of PMDD were more common in migraineurs, but frequency did not differ by EM status. Migraineurs with EM reported more menorrhagia, dysmenorrhea, and infertility compared to the migraine cohort without EM and to controls. Depression, anxiety, IBS, FM, CFS, and IC were more common in migraine with EM group than in controls. Anxiety (OR = 2.2, 95% CI 1.0-4.7), IC (OR = 10.6, 95% CI 1.9-56.5), and CFS (OR = 3.6, 95% CI 1.1-11.5) were more common in migraine with EM group, than in the cohort with migraine without EM. CONCLUSION: Prevalence of EM is higher in women with migraine than in nonheadache controls. Migraineurs with EM have more frequent and disabling headaches, and are more likely to have other comorbid conditions affecting mood and pain, compared to migraineurs without EM.