老年期抑郁症患者事件相关电位P300特征

目的：探讨有无自杀行为的老年期抑郁症患者认知功能的事件相关电位P300特征。方法：对60例老年期抑郁症患者（有自杀行为者20例，无自杀行为者40例）及60例性别、年龄匹配的正常老年人为对照，进行听觉诱发的事件相关电位P300检测。同时应用汉密尔顿抑郁量表（HAND）及老年认知功能量表（SECF）分别评价抑郁症组抑郁情绪及认知功能。结果：抑郁症组与对照组相比，P2、N2、P3潜伏期明显延长，P2、P3波幅明显降低；有自杀行为组N2、P3波幅比无自杀行为组明显降低。抑郁症组HAMD总分与P300各指标无相关，SECF总分与N2、P2、P3潜伏期显著负相关。结论：P300对老年期抑郁症患者早期认知功能损害评定具有一定价值，有、无自杀行为的老年期抑郁症患者认知功能损害不同。     

儿童期虐待与抑郁症患者临床特征的关系

目的探讨有儿童虐待经历的抑郁症患者的临床特点以及个性特征、社会支持对有儿童虐待经历抑郁症的影响。方法采用童年期创伤经历问卷（CECA．Q）、汉密尔顿抑郁量表（HAMD）、艾森克个性问卷（EPQ）、社会支持评定量表（SSRS），对连续住院的抑郁症患者134例进行测查；依据CECA．Q评定，分为虐待组（41例）和无虐待组（93例），比较两组的临床特点以及HAMD、EPQ、SSRS的评分。结果两组性别、首次发病年龄、家族史、病程之间差异有显著意义（P〈0.05）；虐待组、无虐待组中有自杀意念、自杀行为者分别为80．49％、60．22％、34．15%、13．97%，差异有显著意义（P〈0．05）；HAMD总分、焦虑／躯体化、睡眠障碍、绝望感因子分高于无虐待组，差异有显著意义（P〈0．01），两组精神质（P）、神经质（N）因子分差异有显著意义（P〈0．01），客观支持、支持利用度、总社会支持因子分差异有显著意义（P〈0．01）。结论儿童期虐待经历的抑郁症首次发病年龄小、焦虑／抑郁症状严重、自杀倾向高，具有精神质和不稳定个性、社会支持缺乏等特点。     

抑郁症和糖尿病共病患者临床特征的研究

目的探讨伴与不伴Ⅱ型糖尿病的抑郁症患者临床特征的差异。方法伴与不伴Ⅱ型糖尿病的抑郁症患者各30例进行1：1配对分组（A组和B组）,使用汉密尔顿抑郁量表（24项,HAMD）和简易智能精神状态检查量表（MMSE）评定两组患者的临床表现,对两组量表评分进行统计学分析。结果A组较B组在HAMD总分以及绝望感、迟缓等因子分增高均十分显著（P均〈0.01）,且焦虑/躯体化、认识障碍、睡眠障碍等因子分均显著增高（P均〈0.05）。A组较B组在MMSE总分以及定向力、回忆等因子分减少均十分显著（P均〈0.01）,记忆力、语言等因子分均显著减少（P均〈0.05）。两组HAMD评分与MMSE评分均呈非常显著负相关。结论抑郁症和Ⅱ型糖尿病共病时患者抑郁症状和认知功能损害均较仅患抑郁症者更为严重,且抑郁症状越严重认知功能损害越严重。     

百优解治疗98例慢性前列腺炎伴焦虑抑郁症的疗效观察

目的：探讨慢性前列腺炎（CP）患者伴有焦虑抑郁症的解决方法。方法：将98例CP伴有焦虑抑郁症的患者随机分为A、B两组，其中A组53例采用可乐必妥＋哈乐＋百优解；B线45例采用可乐必妥＋哈乐，连续门诊治疗6周。结果：A、B两组CP总有效率分别为87％和56％，焦虑抑郁症的缓解率分别为65％和21％。结论：对伴有焦虑抑郁症的CP患者在对前列腺炎本身治疗的同时也应针对焦虑抑郁症予以足够的重视和治疗，才能达到理想效果。     

躯体化症状为主的抑郁症心率变异性对照研究

目的：探讨躯体化症状为主的抑郁症患者自主神经系统的特点及抑郁症躯体化表现的发生机制。方法：对30例躯体化症状为主的患者（A组）和30例情绪症状为主的患者（B组）及30例健康正常者（C组）分别进行汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）评定及短时（10min）心率变异性（HRV）分析。结果：A、B、C3组HRV分析指标RR间期标准差（SDNN）分别为（50.84±19.92）ms、（94.93±28.80）ms、（105.77±22.05）ms,A组显著低于C组（t=5.68,P〈0.01）,较B组低（t=3.73,P〈0.05）;3组LF/HF分别为（6.26±2.11）ms、（3.51±2.44）ms、（1.80±1.07）ms,A组显著高于C组（t=6.35,P〈0.01）,较B组高（t=2.50,P〈0.05）;A组HAMD评分（28.30±6.26）分高于B组（24.35±6.69）分,二者差异有显著性（t=3.14,P〈0.05）;A组HAMA评分（22.70±4.92）分显著高于B组（13.05±4.71）分,二者差异有显著性（t=6.17,P〈0.01）;HAMD焦虑/躯体化因子分与HRV指标SDNN、LF、HF、VLF和LF/HF均呈中度相关（r分别为0.49、0.61、0.58、0.50、0.63）（P〈0.05或P〈0.01）。结论：躯体化症状表现为主的抑郁症患者多伴有焦虑,自主神经功能紊乱。     

躯体化障碍与以躯体症状为主诉的抑郁症个性、躯体主诉、生活质量比较

目的探讨躯体化障碍与以躯体症状为主诉的抑郁症患者个性、躯体主诉、生活质量差异。方法对30例躯体化障碍和30例以躯体症状为主诉的抑郁症患者分别采用自编躯体症状主诉频数表,艾森克人格问卷（EPQ）、汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）、健康状况调查问卷（SF-36）等进行评定,对影响生活质量的某些因素进行多元回归分析。结果两组躯体主诉无显著性差异（P〉0．0．5）;躯体化障碍组E分显著低于抑郁症组,N分显著高于抑郁症组（P〈0．05）;两组HAMD总分无差异（P〉0．05）,躯体化障碍组焦虑／躯体化及认知障碍因子分显著高于抑郁症（P〈0．05）,躯体化障碍的HAMA总分及躯体性焦虑分显著高于抑郁症组（P〈0．05）;躯体化障碍组生理机能、生理职能、躯体疼痛分量表评分均显著低于抑郁症组（P〈0．05）;多元回归分析结果,影响两组患者生活质量的主要因素依次为HAMD总分、HAMA总分、EPQ精神质因子、病程。结论躯体化障碍与以躯体症状为主诉的抑郁症患者在个性、HAMA总分、躯体焦虑因子分、生活质量方面有差异,两者的个性、疾病严重程度、病程为影响生活质量的重要因素。     

抑郁症患者自杀行为与色氨酸羟化酶基因及单胺氧化酶A基因多态性的关联研究

目的:探讨抑郁症患者自杀行为与色氨酸羟化酶(TPH)、单胺氧化酶A(MAOA)基因多态性的相关性. 方法:符合中国精神障碍分类与诊断标准第3版抑郁症诊断标准患者212例,汉密尔顿抑郁量表评分≥17分,其中64例患者有自杀或自杀未遂行为(有自杀行为组),148例患者无自杀行为(无自杀行为组).采用聚合酶链式反应扩增及限制性片段长度多态性技术检测TPH、MAOA基因多态性,与抑郁症患者自杀行为进行关联分析. 结果:TPH基因型频数和等位基因频率上有自杀行为组与无自杀行为组差异有统计学意义(x2=6.058,P=0.048;x2=4.774,P=0.029),有自杀行为组A/A基因型和等位基因A频率分布显著高于无自杀行为组(P＜0.05).MAOA基因型频数和等位基因频率上有自杀行为组与无自杀行为组差异无统计学意义(x2=0.922,0.898;P均＞0.05). 结论:TPH基因多态性与抑郁症患者的自杀行为存在关联,MAOA基因多态性与抑郁症患者自杀行为可能无关联.     

焦虑症与抑郁症的A型行为比较

目的 探索焦虑症与抑郁症的A型行为的异同。方法 应用A型行为问卷（TABQ）对40例焦虑患者和50例抑郁症患者及83例正常对照组进行评定。结果 焦虑症患者A型行为显著高于抑郁症患者及正常对照组：焦虑症患者A型行为总分和TH、CH因子分均高于正常对照组；抑郁症患者A型行为总分和TH、CH因子分与正常对照组比较无显著意义。结论 焦虑症患者具有普遍的A型行为倾向，抑郁症患者则无此现象。A型行为的评定可能有助于两种疾病的鉴别。     

老年期焦虑抑郁患者事件相关电位P300特征

目的：探讨老年期焦虑抑郁共病患者认知功能的事件相关电位P300特征。方法：对60例老年抑郁症患者（以伴有焦虑者为共病组25例，单纯抑郁症者为抑郁症组35例）及60名性别、年龄匹配的正常老年人（对照组）进行听觉诱发的事件相关电位P300检测。同时应用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）及老年认知功能量表（SECF）分别评价患者组抑郁、焦虑情绪及认知功能。结果：患者组P2、N2、P3潜伏期及反应时间比对照组明显延长，P2、P3波幅明显降低；共病组N2、P3波幅比抑郁症组明显降低，P3潜伏期明显延长。患者组HAMD、HAMA总分与P300各指标无相关，而SECF总分与N2、P2、P3潜伏期呈显著负相关。结论：P300对老年期抑郁症早期认知功能损害评定具有一定的价值，共病组患者认知功能损害程度大于抑郁症组。     

神经症与抑郁症的躯体化症状及经济损失比较

目的：比较神经症和抑郁症躯体症状的特点及经济损失。方法：对初次就诊的神经症和抑郁症患者，采用自编躯体症状的特点及经济负担调查问卷，调查躯体症状及经济损失状况。结果：二者躯体症状所占的比例差异无显著性，神经症组的病程显著长于抑郁症组，外院就诊次数也多于后组，从其他科至医学心理科就诊的时间间隔长。抑郁症组汉密尔顿焦虑量表（HAMA）精神焦虑因子分、汉密尔顿抑郁量表（HAMD）总分、体质量、认知障碍、日夜变化、阻滞、绝望感因子分均高于神经症组，焦虑／躯体化因子分低于神经症组。躯体症状组HAMA总分及躯体焦虑因子分、HAMD总分、焦虑／躯体化、体质量、睡眠障碍、绝望感因子分均高于无躯体症状组。神经症组的直接经济损失重于抑郁症组。结论：抑郁症、神经症的抑郁、焦虑、躯体症状的表现有各自特点，躯体症状会加重抑郁和焦虑症状，均造成很大的经济负担。     

Posttraumatic stress disorder comorbid with major depression: factors mediating the association with suicidal behavior

OBJECTIVE: The purpose of the study was to determine if patients with a history of major depressive episode and comorbid posttraumatic stress disorder (PTSD) have a higher risk for suicide attempt and differ in other measures of suicidal behavior, compared to patients with major depressive episode but no PTSD. In addition, to explore how PTSD comorbidity might increase risk for suicidal behavior in major depressive episode, the authors investigated the relationship between PTSD, cluster B personality disorder, childhood sexual or physical abuse, and aggression/impulsivity. METHOD: The subjects were 230 patients with a lifetime history of major depressive episode; 59 also had lifetime comorbid PTSD. The demographic and clinical characteristics of subjects with and without PTSD were compared. Multivariate analysis was used to examine the relationship between suicidal behavior and lifetime history of PTSD, with adjustment for clinical factors known to be associated with suicidal behavior. RESULTS: Patients with a lifetime history of PTSD were significantly more likely to have made a suicide attempt. The groups did not differ with respect to suicidal ideation or intent, number of attempts made, or maximum lethality of attempts. The PTSD group had higher objective depression, impulsivity, and hostility scores; had a higher rate of comorbid cluster B personality disorder; and were more likely to report a childhood history of abuse. However, cluster B personality disorder was the only independent variable related to lifetime suicide attempts in a multiple regression model. CONCLUSIONS: PTSD is frequently comorbid with major depressive episode, and their co-occurrence enhances the risk for suicidal behavior. A higher rate of comorbid cluster B personality disorder appears to be a salient factor contributing to greater risk for suicidal acts in patients with a history of major depressive episode who also have PTSD, compared to those with major depressive episode alone.     

Age of onset of social anxiety disorder in depressed outpatients

Onset of social anxiety disorder (SAD) often precedes that of major depressive disorder (MDD) in patients with this comorbidity pattern. The current study examined the association between three SAD onset groups (childhood, adolescent, adulthood) and clinical characteristics of 412 psychiatric outpatients diagnosed with MDD and SAD based on a semi-structured diagnostic interview. Childhood and adolescent SAD onset groups were more likely to report an onset of MDD prior to age 18 and have made at least one prior suicide attempt compared to the adulthood onset group. The childhood SAD onset group also was more likely to have chronic MDD, poorer past social functioning, and an increased hazard of MDD onset compared to the adulthood onset group. Findings suggest that patients with an onset of SAD in childhood or adolescence may be particularly at risk for a more severe and chronic course of depressive illness.     

Association of comorbid posttraumatic stress disorder and major depression with greater risk for suicidal behavior

OBJECTIVE: Posttraumatic stress disorder (PTSD) increases the risk of suicidal behavior; a major depressive episode also increases the risk for suicidal behavior. The authors' goal was to examine the effect of comorbid PTSD and major depressive episode on suicidal behavior. METHOD: Inpatients with a diagnosis of major depressive episode (N=156) were assessed for PTSD, suicidal behavior, and clinical risk factors for suicidal acts. RESULTS: Patients with comorbid major depressive episode and PTSD were more likely to have attempted suicide, and women with both disorders were more likely to have attempted suicide than men with both disorders. Cluster B personality disorder and PTSD were independently related to history of suicide attempts. CONCLUSIONS: The greater rate of suicide attempts among patients with comorbid PTSD and major depressive episode was not due to differences in substance use, childhood abuse, or cluster B personality disorders.     

伴有焦虑症状的抑郁症临床分析

目的 :了解伴焦虑症状的抑郁症的临床特点。　方法 :对 37例伴焦虑症状的抑郁症与35例不伴焦虑症状的抑郁症进行临床对照分析。　结果 :伴焦虑症状的抑郁症患者动作减少、联想困难的发生率低 ,而自杀行为多见。　结论 :焦虑是抑郁症自杀的危险因子。尽快治疗焦虑症状可降低抑郁症患者自杀的危险性     

有无自杀意念抑郁症患者抑郁情绪、认知应对策略及应激的比较研究

目的:探讨有无自杀意念抑郁症患者抑郁情绪、认知应对策略及应激性生活事件的差异。方法:对143例抑郁症患者进行自编一般情况问卷、Beck抑郁自评量表(BDI)、认知情绪调节问卷中文版(CERQ-C)评定。结果:有自杀意念抑郁症发作患者BDI总分、婚姻家庭应激及社会生活应激分及CERQ-C适应性策略与不适应性策略总分显著高于无自杀意念抑郁症患者(P<0.05或P<0.01)。有自杀意念抑郁症患者抑郁总分与工作学习应激、婚姻家庭应激、社会生活应激及CERQ-C不适应性策略分呈显著正相关(r=0.569,0.470,0.341,0.303,P<0.05或P<0.01);无自杀意念抑郁症患者抑郁总分仅与婚姻家庭应激呈显著正相关(r=0.361,P<0.01)。结论:有自杀意念较无自杀意念抑郁症患者经历更多的负性生活事件,存在更严重的抑郁情绪,较多地采用认知应对策略。     

Group intervention for children bereaved by the suicide of a relative

OBJECTIVE: This study evaluated efficacy of a manual-based bereavement group intervention for children who suffered suicide of a parent or sibling. METHOD: Seventy-five families (102 children) were screened from medical examiners' lists of suicide victims. Fifty-two families (75 children) were eligible and assigned in alternating order to receive (27 families, 39 children) or not to receive (25 families, 36 children) the intervention. Intervention efficacy was evaluated as change in children's symptoms of anxiety, depression, posttraumatic stress, social adjustment, and parents' depressive symptoms from initial to outcome assessments. RESULTS: Changes in anxiety and depressive symptoms were significantly greater among children who received the intervention than in those who did not. A greater dropout of children assigned not to receive (75%) than to receive (18%) intervention led to an imbalance in retention of intervention and nonintervention participants. CONCLUSIONS: A bereavement group intervention focusing on reactions to death and suicide and strengthening coping skills can lessen distress of children bereaved after parental or sibling suicide. Such intervention may prevent future morbidities.     

Suicide-bereaved children and adolescents: a controlled longitudinal examination.

OBJECTIVE: The current study examined emotional and behavioral sequelae in children who have experienced parental suicide by completing a secondary analysis of data from the Grief Research Study, a longitudinal study of childhood bereavement. METHOD: Twenty-six suicide-bereaved (SB) children, aged 5 to 17 years, were compared with 332 children bereaved from parental death not caused by suicide (NSB) in interviews 1, 6, 13, and 25 months after the death. Children's emotional reactions to the death, psychiatric symptomatology, and psychosocial functioning after the parent's death were determined. RESULTS: Grief emotions were common in both groups. SB children were more likely to experience anxiety, anger, and shame than NSB children. SB children were more likely to have preexisting behavioral problems and more behavioral and anxiety symptoms throughout the first 2 years compared with NSB children. Indices of depression, suicidality, and psychosocial functioning differed minimally between groups. CONCLUSIONS: SB children experience some "common" elements of bereavement. In addition, they demonstrate some lifetime risk factors as well as subsequent pathology that suggests a negative behavioral trajectory. As these cohorts have not yet passed through the age of risk, long-term follow-up is critical.     

Depressed Suicide Attempters with Posttraumatic Stress Disorder

Posttraumatic stress disorder and major depressive disorder are well-established risk factors for suicidal behavior. This study compared depressed suicide attempters with and without comorbid posttraumatic stress disorder with respect to additional diagnoses, global functioning, depressive symptoms, substance abuse, history of traumatic exposure, and suicidal behavior. Adult patients consecutively admitted to a general hospital after a suicide attempt were interviewed and assessed for DSM-IV diagnosis and clinical correlates. Sixty-four patients (71%) were diagnosed with depression; of them, 21 patients (32%) had posttraumatic stress disorder. There were no group differences in social adjustment, depressive symptoms, or suicidal intent. However, the group with comorbid depression and posttraumatic stress disorder had more additional Axis I diagnoses, a higher degree of childhood trauma exposure, and more often reported previous suicide attempts, non-suicidal self-harm, and vengeful suicidal motives. These findings underline the clinical importance of diagnosis and treatment of posttraumatic stress disorder in suicide attempters.     

Anxiety in major depression: relationship to suicide attempts

OBJECTIVE: This study was an examination of the relationship of lifetime panic disorder and anxiety symptoms at index hospitalization to a history of a suicide attempt in patients with a major depressive episode. METHOD: A total of 272 inpatients with at least one major depressive episode, with or without a history of a suicide attempt, were entered into the study. They were given structured diagnostic interviews for axis I and axis II disorders. Suicide attempt history, current psychopathology, and traits of aggression and impulsivity were also assessed. RESULTS: The rates of panic disorder did not differ in the suicide attempters and nonattempters. Agitation, psychic anxiety, and hypochondriasis were more severe in the nonattempter group. A multivariate analysis confirmed that this effect was independent of aggression and impulsivity. CONCLUSIONS: Comorbid panic disorder in patients with major depression does not seem to increase the risk for lifetime suicide attempt. The presence of greater anxiety in the nonattempters warrants further investigation.     

Citalopram and suicidality in adult major depression and anxiety disorders

The suicide-related data on citalopram from controlled clinical trials in depression and anxiety disorders were analysed. Safety data from placebo-controlled and relapse prevention citalopram trials in depression/major depressive disorder (MDD) and anxiety were searched for specific events relating to fatal suicide, non-fatal self-harm or suicidal thoughts. Efficacy data (item 10, suicidal thoughts, on the Montgomery-Asberg Depression Rating Scale [MADRS]) were also analysed. In the clinical trial database, the number of adverse events (fatal suicide, non-fatal self-harm or suicidal thoughts) was low, both during the first 2 weeks of treatment and during the full treatment period, with no statistically significant differences between citalopram and placebo. There was one fatal suicide during treatment (after 12 weeks of double-blind treatment in a relapse-prevention trial) for a patient treated with citalopram (incidence: 0.4%; rate: 0.010) and none on placebo. Citalopram was significantly more efficacious than placebo in lowering suicidal thoughts, based on efficacy rating (MADRS, item 10). There was no indication from this review of clinical trial data that citalopram may increase the risk of suicide in patients with MDD or anxiety. However, the patients in these clinical trials represent a selected group, as those patients with a significant risk of suicide were excluded at trial onset.