精神分裂症和抑郁症伴焦虑障碍的研究

目的 了解精神分裂症和抑郁症住院病人与焦虑障碍的共病发生率及相关因素分析。方法 住院精神分裂症病人41例和抑郁病人40例,用简明精神病量表（BPRS）、Hamilton抑郁量表（HAMD）、Hamilton焦虑量表（HAMA）、Liebowitz社交焦虑量表（LSAS）进行评定。结果 精神分裂症病人焦虑障碍的共病率为29．26％,抑郁症与焦虑障碍的共病率为50L。LSAS与HAMA呈正相关（r=0.465)。有关精神分裂症和抑郁症病人共病焦虑障碍经多元逐步回归可排除药源性焦虑。结论 对精神分裂症和抑郁症共患焦虑障碍应引起临床高度重视。     

老年期痴呆抑郁和焦虑障碍共病研究

目的：了解老年期痴呆患者抑郁和焦虑障碍共病率及其相关因素。方法：将100例老年期痴呆患者分为两组，阿尔茨海默病（AD）组和血管性痴呆（VD）组。用简明精神病评定量表（BPRS）、Hamilton抑郁量表（HAMD）、Hamilton焦虑量表（HAMA）进行评定。结果：AD组有焦虑20例，伴抑郁17例；VD组有焦虑17例，伴抑郁15例。共病28例，AD组与VD组各14例。AD组与VD组在HAMD因子分有明显差异（P〈0．05）。结论：老年期痴呆患者抑郁和焦虑共病率较高，应引起高度重视。     

抑郁症与焦虑障碍共病临床特征研究

目的 调查抑郁症和焦虑症障碍的共病率,以及对临床严重程度的影响.方法 采用前瞻性、多中心、队列研究.入组对象符合美国精神障碍诊断与统计手册(第4版)抑郁症的诊断标准, 采用17项汉密尔顿抑郁量表(HAMD)和焦虑量表(HAMA),社会功能缺陷筛选量表(SSDS)和临床大体量表(CGI)评估.观察流行病学资料,焦虑和抑郁症状群、自杀状况.用情感性障碍和精神分裂症检查提纲中有关焦虑障碍的诊断清单评定患者合并的焦虑障碍.结果 共入组508例患者,首次抑郁发作为269例(53.0%),294例(57.9%)有过自杀观念,55例(10.8%)曾有自杀行为.45例(8.9%)伴精神病性症状.HAMD量表总分平均为(32.6±7.7)分;HAMA量表平均为(21.0±7.3)分,其中78.5%患者大于14分.抑郁症患者焦虑障碍的共病发生率为68.9%(350例),16.7%共病多种焦虑障碍.焦虑障碍种类分布以广泛性焦虑障碍为主,为56.1%.焦虑对抑郁症的临床严重程度有显著统计学意义,但自杀观念和自杀行为在共病与非共病之间未见统计学意义.36.0%患者同时伴有躯体疾病.结论 抑郁症与焦虑共病在临床上是常见的现象,合并的焦虑障碍以广泛性焦虑障碍为主,1/3的患者合并躯体疾病,应引起临床医生重视.     

精神分裂症恢复期社交焦虑的研究

为探讨精神分裂症恢复期社交焦虑（SAD），对200例精神分裂症恢复期患者用汉密顿焦虑量表（HAMA），社交焦虑量表（LSAS）进行评分。结果，200例精神分裂症恢复期患者出现社交焦虑者占33．5％，其中社会功能和学习功能受影响者占41．79％。提示，对精神分裂症恢复期患者出现SAD者应引起高度重视。     

抑郁障碍共患其他精神障碍的研究

目的　探讨抑郁障碍与其他精神障碍的共患率及其对抑郁障碍患者的影响。方法经美国精神障碍诊断与统计手册第4版轴Ⅰ障碍用定式临床检查-临床版评定,对符合抑郁障碍诊断的366例患者评定汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)和临床疗效总评量表病情严重程度(CGI SI)。结果　(1)38 2%的抑郁症患者当前至少共患焦虑障碍、心境恶劣障碍、物质使用障碍、躯体形式障碍和饮食障碍等5种障碍中的1种。其中焦虑障碍共患率最高(26 5%, 97例),其次为心境恶劣障碍(13 4%, 49例),均高于共患其他3种障碍(P<0 01);而其他3种障碍共患率之间的差异无统计学意义。( 2 )共患焦虑障碍和心境恶劣障碍者的HAMD分别为( 29 25±6 22)分和(30 15±6 15 )分,HAMA分别为( 22 01±5 61 )分和( 20 36±5 36 )分,CGI SI分别为(5 32±0 99)分和(4 76±1 12)分,均高于无共患者[分别为( 26 02±6 06 )分, ( 16 76±5 26 )分,(4 02±1 08)分;均P<0 01]。( 3 )共患焦虑障碍和心境恶劣障碍的抑郁症患者中分别有84%和82%的患者期望治疗共患障碍。结论　抑郁障碍常共患焦虑障碍和心境恶劣障碍;其焦虑抑郁症状更严重,更期望治疗所共患的障碍。     

抑郁与焦虑共病障碍临床研究

目的:调查抑郁与焦虑共病障碍的发生率,探讨其特点及预后.方法:对150例抑郁障碍患者用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、社会功能缺陷筛选量表(SDSS)和临床疗效总评量表(CGI)评定,3个月后进行随访.结果:45.3%的抑郁障碍患者共病焦虑障碍,共病以广泛焦虑障碍与惊恐障碍为最多(分别为22.0%、13.3%);入组时及3个月末,共病组HAMD、HAMA、CGI及SDSS总分均显著高于抑郁组(P＜0.05),3个月末共病组HAMA减分率显著低于抑郁组(P＜0.05),HAMD减分率两组差异无显著性.结论:抑郁与焦虑共病障碍发生率高,具有抑郁及焦虑症状重、社会功能损害重,焦虑症状不易缓解等特征.     

利培酮对难治性抑郁症的辅助治疗作用

目的：探讨抗抑郁剂合并小剂量利培酮治疗难治性抑郁症的疗效及安全性。方法：共收集难治性抑郁症患者34例，给予抗抑郁剂与小剂量利培酮合并治疗4周，进行汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评定，并用副反应量表(TESS)观察不良反应。治疗前后测定血小板五经色胺(5—HT)浓度。结果：治疗1周末时，HAMD减分率显示有5．9％患者(2例)临床痊愈或显著有效，32．4％的患者(11例)进步；4周末时，临床痊愈或显著有效为50．0％(17例)，20．6％(7例)进步。副反应较轻。治疗前后血小板5—HT浓度差异无显著性。结论：抗抑郁剂合并小剂量利培酮治疗难洽性抑郁症可能是较安全可行的方法之一，起效较快，但疗效与血小板5—HT浓度不相关。     

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。     

国产吗氯贝胺与米帕明治疗抑郁症双盲对照研究

目的：评价国产吗氯胺片剂治疗抑郁症的临床疗效和副作用。方法：采用与米帕明的随机双盲对照方法，将符合ICD－10－RDC和CCMD－Ⅱ-R抑郁症的69例患者随机分为吗氯贝胺组（34例）和米帕明组（35例），治疗4周，采用Hamilton抑郁量表（HAMD）、Hamilton焦虑量表（HAMA）和治疗药物副作用量表（TESS）说定疗效和副作用。结果：两组治疗结束时的疗效和HAMD、HAMA减分率比较无显著差异（P＞0．05），两药均未见严重的不良反应，结论：吗氯胺是一种安全、有效的新一代抗抑郁药。     

西酞普兰与米氮平治疗伴有焦虑的抑郁症对照研究

目的:探讨西酞普兰对伴有焦虑的抑郁症的临床疗效和安全性。方法:将89例伴有焦虑的抑郁症患者随机分为两组,分别给予西酞普兰和米氮平治疗,用Hamilton抑郁量表(HAMD)、Hamilton焦虑量表(HAMA)、副反应量表(TESS)评定临床疗效和不良反应。结果:两组疗效差异无显著性。从治疗第1周末开始,两组HAMD、HAMA总分均有显著下降(P<0.01)。结论:西酞普兰治疗伴有焦虑的抑郁症起效快,疗效与米氮平相似。     

住院精神分裂症患者焦虑症状研究

目的：了解精神分裂症患者焦虑症状的发生率及其相关因素。方法：对112例精神分裂症住院患者采用自拟的一般情况调查表、汉密尔顿焦虑量表（HAMA）进行调查、评定及多因素分析。结果：住院精神分裂症患者焦虑症状的发生率为63.40%，相关因素经多元逐步回归分析，发现住院精神分裂症患者焦虑症状的发生和社会支持、住院次数、病程呈负相关，与自知力、躯体并发症呈正相关。     

氯氮平撤药症状调查

目的：了解氯氮平的撤药症状。方法：对31例服用氯氮平治疗的精神分裂症患者停药1周，分别于停药前后予简明精神病评定量表(BPRS)、副反应量表(TESS)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评定疗效及不良反应。结果：停药后BPRS、TESS、HAMD、HAMA总分均明显高于停药前，停药后有25例(80％)精神症状恶化。结论：氯氮平的撤药症状发生频率高，症状多样。     

Lower subjective quality of life and the development of social anxiety symptoms after the discharge of elderly patients with remitted schizophrenia: a 5-year longitudinal study

ObjectivesRemitted schizophrenic patients living in the community often encounter difficulties in their daily lives, possibly leading to the development of social anxiety symptoms. Although several studies have reported the significance of social anxiety as a comorbidity in patients with schizophrenia, few longitudinal data are available on the development of social anxiety symptoms in patients with remitted schizophrenia, especially in association with the process of “deinstitutionalization.” The aims of this study were to assess the social anxiety symptoms in remitted outpatients with schizophrenia and to examine whether the development of social anxiety symptoms was associated with psychotic symptoms, social functioning, or subjective quality of life.MethodsFifty-six people with schizophrenia who were discharged through a deinstitutionalization project were enrolled in this longitudinal study and prospectively assessed with regard to their symptoms, social functioning, and subjective quality of life. The severity of social anxiety symptoms was measured using the Liebowitz Social Anxiety Scale (LSAS). Global/Social functioning and subjective quality of life were evaluated using the Global Assessment of Functioning Scale, the Social Functioning Scale, and the World Health Organization–Quality of Life 26 (WHO-QOL26).ResultsThirty-six patients completed the reassessment at the end of the 5-year follow-up period. The mean LSAS total score worsened over time, whereas other symptoms improved from the baseline. The mean WHO-QOL26 score in the worsened LSAS group was significantly lower than that in the stable LSAS group. At baseline, WHO-QOL26 scores were associated with an increase in the severity of social anxiety symptoms.ConclusionIn community-dwelling patients with remitted schizophrenia, a lower subjective quality of life might lead to the development of social anxiety symptoms, both concurrently and prospectively. To achieve a complete functional recovery, additional interventions for social anxiety may be needed.     

社工员干预对住院精神分裂症患者情绪的影响

目的：探讨医务社会工作人员（社工员）干预对住院精神分裂症患者焦虑、抑郁情绪的影响。方法：将79例伴有焦虑、抑郁情绪的恢复期精神分裂症患者随机分成研究组（服用抗精神病药联合社工员干预治疗）40例和对照组（单用抗精神病药治疗）39例。每周干预5次,每次2h,共2个月。以汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）及自知力和治疗态度问卷（ITAQ）在干预前、后进行评定比较。结果：干预后研究组HAMD、HAMA评分均较干预前显著降低（P均〈0.01）,ITAQ评分较干预前显著增高（P〈0.01）;两组间比较差异有统计学意义（P〈0.05或P〈0.01）。结论：社工员的干预对住院精神分裂症患者焦虑抑郁情绪的改善及治疗态度的好转有明显作用。     

意外伤骨科住院患者急性焦虑抑郁影响因素调查

背景:意外伤害事件易致受伤者产生强烈的情绪反应.国内对此类心理状况变化越来越重视,但针对该人群情绪反应的调查不足.综合医院骨科病房存在大量意外伤患者,目前缺少针对该人群情绪反应调查.目的:探讨意外伤骨科住院患者急性焦虑抑郁表现及影响因素.方法:对323例意外伤骨科住院患者进行创伤严重度评分(Injury Severity Score,ISS)、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)、汉密尔顿抑郁量表(Hamilton depression scale,HAMD)评估.结果:本调查共入组患者323例,其中男性213例,女性110例,平均年龄44.32(13.17)岁;住院时间2-40天,平均住院时间11.09(5.64)天.轻度创伤299人,中度创伤20人,重度创伤4人.ISS评分1-38分,平均8.09(4.86)分.HAMA量表报告人数最多的前3位症状分别为睡眠障碍、胃肠道症状和焦虑心境;HAMD量表报告人数最多的前三位症状为睡眠障碍、抑郁情绪和精神性焦虑.非条件Logistic回归分析显示女性(焦虑:OR=2.738,95%CI=1.511-4.962;抑郁:OR=2.622,95%CI=1.504-4.570)、住院时间长(焦虑:OR=1.091,95%CI=1.040-1.145;抑郁:OR=1.093,95%CI=1.044-1.144)为骨科意外伤患者发生焦虑抑郁的危险因素.结论:意外伤骨科住院患者急性焦虑抑郁症状集中在睡眠紊乱、胃肠道症状和焦虑抑郁情绪,女性患者对于意外伤的情绪反应较男性更强烈,焦虑抑郁症状持续存在与患者住院时间长相关,提示需要对意外伤骨科住院患者进行早期心理评估及干预.     

住院抑郁症患者疾病严重度的相关因素分析

目的探讨影响住院抑郁症患者疾病严重程度的相关因素。方法对符合(CCMD-2-R)抑郁症诊断标准的55例患者评定了一般情况问卷、生活事件量表(LES)、社会支持评定量表(SSRS)、A型行为问卷(TABQ)、汉密顿抑郁量表(HAMD)和汉密顿焦虑量表(HAMA)。结果住院抑郁症患者中92.7%存在中重度抑郁,83.6%存在中重度焦虑;HAMD和HAMA评分与A型行为量表总分、客观支持分存在显著正相关;社会支持量表的主观支持分和社会支持利用度与HAMD评分呈显著负相关。结论影响住院抑郁症患者疾病严重程度的因素主要是A型行为量表和社会支持量表的评分。     

抑郁症和冠心病共病患者的临床特征

目的:探讨伴发冠心病的抑郁症患者的临床特征.方法:对50例伴有冠心病的抑郁症患者(共病组)和50例单纯抑郁症患者(抑郁组),使用汉密尔顿抑郁量表24项(HAMD)、汉密尔顿焦虑量表(HAMA)和社会功能缺陷筛选量表(SDSS)评定临床表现和社会功能,使用舍曲林治疗12周后再次评定.结果:人组及治疗12周末,共病组HAM...     

A test of the tripartite model's prediction of anhedonia's specificity to depression: patients with major depression versus patients with schizophrenia

The tripartite model of depression and anxiety suggests that anhedonia represents a relatively specific marker of depression. A strong version of this view is that anhedonic symptoms would particularly characterize depressed patients, even when compared to another diagnostic group-schizophrenic patients-for whom anhedonic symptoms represent a well-studied feature. This prediction was tested among 102 VA psychiatric inpatients (95 men), ages 21-72 (M=43.56; S.D.=8.47), all of whom received diagnoses of either major depression (n=50) or schizophrenia (n=52) based on structured diagnostic interviews. As predicted, patients with major depression scored significantly higher on the anhedonic symptoms scale of the Beck Depression Inventory (BDI) than did patients with schizophrenia. However, there was no difference between the two groups on the BDI total score or the BDI non-anhedonic symptoms score. Consistent with the tripartite model, anhedonic symptoms were more related to depressive vs. schizophrenic diagnostic status, whereas non-anhedonic depressive symptoms were not. Within the study's limitations, results were interpreted as relatively strong support for the validity and extension of the tripartite model.     

Are there two depressive syndromes after stroke?

The objective of this study was to describe the clinical characteristics of minor depression after stroke and to compare this disorder with poststroke major depression and the nondepressed state. Ninety-four stroke inpatients were examined 8 weeks after stroke and reexamined 15 months later. Twenty-one (22%) of the 94 patients suffered from minor depression, 14 (15%) suffered from major depression, and 59 (63%) were not depressed. Minor depressed patients were twice as symptomatic as nondepressed patients but were only half as symptomatic as major depressed patients. Minor depressed patients were more likely than nondepressed patients to have a previous history of stroke and were more physically disabled. They were less likely than major depressed patients to have a family history of affective disorder. Depression symptom severity was associated with greater physical disability among minor but not major depressed patients. Fewer minor than major depressed patients were depressed at 15 months. These findings suggest that poststroke major and minor depression may be different depressive syndromes. Some cases of minor depression may be construed as an adjustment reaction to stroke disability.