脑卒中后情感障碍的心理干预及帕罗西汀治疗的临床研究

目的 探讨脑卒中后情感障碍的发生率、脑卒中部位与情感障碍的关系,以及口服帕罗西汀合并早期心理干预对脑卒中后情感障碍患者日常生活能力和神经功能康复的影响.方法 采用抑郁自评量表(SDS)、焦虑自评量表(SAS)对181例脑卒中患者进行筛查,对脑卒中后同时出现抑郁和焦虑的54例患者随机分成治疗组和对照组,在接受脑血管病常规治疗的基础上,治疗组加用帕罗西汀和心理干预.采用斯堪的那维亚脑卒中量表(SSS)、Barthel指数(BI)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)分别于治疗前、治疗后2周、4周及6周末进行评测.结果 181例患者中发生情感障碍81例(44.75 %),其中66.67%(54例)同时出现抑郁和焦虑,情感障碍的发生与额叶、左侧大脑半球、基底节病灶有关(P<0.05～0.001);治疗后治疗组HAMD、HAMA、SSS评分减少和BI评分增加,与对照组比较差异有统计学意义(均P<0.01),治疗后2～6周显效率显著优于对照组(P<0.05～0.01).结论 脑卒中后抑郁/焦虑的发生与脑卒中部位相关;对脑卒中后抑郁/焦虑的患者应用帕罗西汀合并心理干预治疗能显著提高患者神经功能康复程度,促进生活能力的恢复.     

脑卒中患者抑郁及生活质量的研究

目的 探讨老年脑卒中后抑郁（PSD）状态及其对患者生活质量的影响。方法 运用汉密尔顿抑郁量表（HAMD）、神经功能缺损量表（NFDS）和诺丁汉健康问卷（NHP）对318例脑卒中患者进行现状调查。结果 （1）脑卒中后抑郁的发生率为26．73％；（2）脑卒中后抑郁患者HAMD、NHP和NFDS评分高。结论 脑卒中后抑郁发生率较高，对患者的神经功能及生活质量有明显的影响，不利于脑卒中患者的康复。     

脑卒中后抑郁障碍患者的临床特征分析

目的探讨脑卒中后抑郁障碍患者的发生率、发病因素及临床特点,为其临床治疗提供理论依据。方法选取2010-07—2012-07于我院神经科住院治疗的脑卒中患者130例,并收集患者的一般临床资料及抑郁自评量表、汉密尔顿抑郁量表评分,对比分析PSD发生的相关因素及临床特点。结果130例脑卒中患者中,卒中后抑郁障碍者49例,发病率为37.69%,且多为轻度抑郁;PSD组与非PSD组年龄、性别、职业、脑卒中类型等因素间无显著差异(P均0.05),而脑卒中发生部位、神经功能障碍程度间存在显著性差异(P0.05);PSD组患者的焦虑/躯体化、运动阻滞、睡眠障碍、绝望感评分较非PSD组显著升高(P0.05),而体质量、认知障碍及病情的日夜变化评分间无显著差异(P0.05)。结论 PSD的发生率为37.69%,且以轻度抑郁为主,脑卒中发生部位及神经功能障碍程度是其发生的相关因素;临床应注意观察患者是否出现焦虑、体质量减轻、症状加重、情绪低落等,以便及时诊断,及时治疗。     

帕罗西汀联合心理干预治疗卒中后抑郁/焦虑的前瞻性对照研究

目的　探讨卒中后抑郁/焦虑对卒中患者日常生活能力和神经功能康复的影响,以及帕罗西汀联合早期心理干预的临床疗效。方法　采用抑郁自评量表(SDS)、焦虑自评量表(SAS)对272例脑卒中患者进行抑郁/焦虑状态评定,其中患有卒中后抑郁并发焦虑的81名患者随机分成3组,分别接受单用帕罗西汀治疗、帕罗西汀联合心理治疗以及不干预。采用斯堪的那维亚脑卒中量表(SSS)、Barthel指数(BI)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评测治疗前后的疗效。结果　急性脑卒中患者卒中后抑郁并焦虑患病率为29.78%,抑郁与焦虑共病率为65.85%,额叶、左侧大脑半球、基底节病灶与卒中后抑郁/焦虑的发生相关(额叶P <0.05、左侧大脑半球P <0.0001、基底节P <0.0001);治疗组I和治疗组II HAMD、HAMA、SSS评分减少和BI评分增加与对照组比较均有显著性差异(P均<0.01),治疗组II HAMD、HAMA、SSS评分减少和BI评分增加较治疗组I有显著性差异(P均<0.05)。结论　卒中后抑郁/焦虑的发生与脑卒中部位相关;卒中后抑郁/焦虑障碍明显降低患者神经功能康复程度和生活能力恢复;对卒中后抑郁/焦虑患者单用药物帕罗西汀或给予帕罗西汀联合心理干预治疗均能提高患者神经功能康复程度和生活能力恢复,而且帕罗西汀联合心理干预治疗疗效更满意     

老年脑卒中患者不同时期抑郁的特点及护理对策

目的 分析老年脑卒中患者不同时期抑郁障碍及其相关因素,并实施相应的护理.方法 选择65岁以上的老年脑卒中患者为观察对象,应用老年抑郁自评量表进行抑郁评估,以加拿大神经功能缺陷量表进行神经功能缺陷评估,重点观察急性组和慢性组老年脑卒中后抑郁障碍者的发病率、抑郁程度并对其进行对比分析其特点.结果 (1)急性组有抑郁障碍症状者占41.3%,慢性组有抑郁障碍症状者占52.4%,慢性组高于急性组.(2)慢性组抑郁自评量表评分显著高于急性组,差异有统计学意义[(23.15±2.01),(19.36±1.52),t=1.981,P＜0.05].(3)不同脑卒中发病部位抑郁障碍的发生情况不同,单一类型中脑卒中发病部位为额叶、颞叶、基底节时抑郁障碍发生率较高.结论 针对老年脑卒中患者不同病期卒中后抑郁的发病特点的差异,对急性期和慢性期卒中后抑郁进行有针对性的健康教育和护理.     

脑卒中后抑郁、焦虑发生率与影响因素分析

目的探讨脑卒中后抑郁、焦虑的发生情况和影响因素,为干预治疗提供参考依据.方法选择2002年3月-2003年3月收治的158例脑卒中非急性期患者,其中脑梗死135例,脑出血23例.采用抑郁自评量表(SDS)、焦虑自评量表(SAS)进行检测,同时进行日常生活活动能力量表(ADL)、画钟测验(CDT)和简易精神状态检查(MMSE).ADL＞26分视为存在生活活动能力障碍,MMSE评分根据患者文化程度的不同有所区别,分值越低,认知功能障碍程度越严重;CDT≤3分为存在认知功能障碍,SDS、SAS总分＞50分为抑郁、焦虑状态,＞60分,为中度抑郁、焦虑.结果158例脑卒中患者中轻度抑郁17例(10.76%),中、重度抑郁12例(7.60%);轻度焦虑28例(17.72%),抑郁与焦虑并存者21例(13.29%).57例存在抑郁和焦虑的患者,简易精神状态检查、日常生活活动能力评分和画钟测验存在障碍的比例(57.89%、42.11%、66.67%)明显高于非焦虑、抑郁者(35.64%、29.70%、46.53%).多因素逐步回归分析表明,卒中后抑郁与患者年龄、性别、患病次数无关,而与卒中后是否存在肢体活动障碍有关,且对患者认知功能有一定影响.结论脑卒中患者在恢复期易发生抑郁、焦虑等精神心理障碍,部分患者可两种状态并存,对患者病死率、生存质量、生活满意度和心理健康等有较大影响,应引起重视.     

脑卒中患者急性期发生抑郁的相关因素分析

目的探讨脑卒中患者急性期发生抑郁的相关因素。方法采用神经功能缺损评分(SSS)、日常生活能力评分(ADL)、汉密尔顿抑郁量表(HADM)及Zung’s抑郁自评量表(SDS)对134例急性脑卒中患者1月内进行测试,并进行相关性分析。结果卒中后抑郁(PSD)的发生率与卒中类型、年龄及性别无关;与患者运动功能障碍程度、病变部位呈正相关。结论脑卒中患者急性期抑郁发病率偏高,可能主要与内在因素、大脑功能及皮质下结构的损害有关。     

多发性硬化患者抑郁焦虑障碍与生活质量的关系

目的　探讨多发性硬化 ( multiple sclerosis,MS)患者中抑郁焦虑情感障碍发生率及抑郁焦虑与患者生活质量评定的关系。方法　采用汉密尔顿抑郁量表 ( HAMD)、汉密尔顿焦虑量表 ( HAMA)及 Spitzer生活质量指数 ( Spitzer quality of life index,QLI)量表 ,对 5 8例 MS患者及 5 0名健康人进行调查评分 ,并记录扩展的残疾状况评分 ( EDSS)和病程时间。应用多重回归统计方法对上述各项进行相关分析。结果　 MS患者抑郁情绪发生率为 48.3 % ( 2 8/5 8) ,焦虑情绪发生率为 3 2 .7% ( 1 9/5 8) ,抑郁合并焦虑发生率为 2 9.3 % ( 1 7/5 8) ,均较对照组明显升高 ( P <0 .0 1 ) ;生活质量较对照组明显减低 ( P <0 .0 1 )。抑郁焦虑情绪与生活质量有显著相关性 ,其中抑郁情绪为生活质量减低的重要预示因素。结论　MS患者中抑郁焦虑情感障碍发生率较高 ,抑郁焦虑情绪对生活质量评价有显著影响。     

卒中后抑郁及其治疗对神经功能康复的影响

目的　观察卒中后抑郁(PSD)的发生率和相关因素;探讨百优解抗抑郁治疗对卒中后抑郁患者神经功能康复的影响。方法　选取急性脑卒中患者132例(脑梗死78例,脑出血54 例),分别在病程2周、1月、3月、6月、12月行PSD诊断、神经功能缺损评分(SSS)、日常生活能力评分(ADL)、汉密尔顿抑郁量表( HAMD)评分,同时完成Zung’s 抑郁自评量表( SDS)和焦虑自评量表( SAS)。结果　(1)脑卒中患者中约44.70%出现抑郁症状;(2)卒中类型和性别与PSD发生率无相关性(P>0.05);(3)PSD的发生率和严重程度与神经功能缺损和日常生活能力下降程度有关。(4)PSD与病变部位、病灶大小、病灶半球利性均无相关性(P >0.05);(5)百优解能明显改善病程3、6 月时神经功能缺损,病程12月时不仅抑郁症状减轻,日常生活能力改善,神经功能缺损减轻尤为显著。结论　卒中后抑郁是急性脑血管病患者常见的长期并发症,并可影响患者神经功能康复的速度和程度。抗抑郁治疗能在抑郁症状明显改善的同时,促进患者神经功能和日常生活能力的恢复。     

多发性硬化与抑郁、焦虑的相关性研究

目的 探讨多发性硬化(multiple sclerosis,MS)与抑郁、焦虑情感障碍的关系.方法 采用汉密尔顿抑郁量表(Hamilton depression,HAMD)、汉密尔顿焦虑量表(Hamilton Anxiety,HAMA)、扩展的残疾状况评分(Expanded disability status scale,EDSS)量表对86例多发性硬化患者、85例健康对照者进行评分,了解MS伴发抑郁焦虑,同时应用多元回归分析方法对抑郁焦虑障碍的相关因素进行分析.结果 MS患者抑郁障碍发生率为52.3%(45例),焦虑障碍发生率为32.6%(28例),抑郁伴发焦虑26.7%(13例),均较对照组明显升高(P<0.01).病情活动期、EDSS评分高者抑郁发生率亦高,女性患者抑郁发生率高.结论 MS患者抑郁焦虑发生率较高,早期识别及干预可以明显提高患者的生活质量.     

卒中急性期下尿路功能障碍与焦虑障碍相关性研究

目的 探讨卒中后下尿路功能障碍与焦虑障碍之间的关系,并通过病变部位及膀胱尿动力学方法探 讨其相关联系。 方法 据第4届全国脑血管学术会议修订诊断标准筛选卒中患者,据梗死部位分组,入院后行焦虑 自评量表（Sel f-rating Anxiety Scale,SAS）评分,记录其排尿日志,对焦虑障碍与排尿障碍的发生相关 性进行分析,并统计额叶损伤患者的发病率。 结果 额叶卒中组比非额叶组卒中后下尿路功能障碍（lower urinary tract dysfunction,LUTD）发生率 高约1.75倍,额叶卒中组比非额叶组卒中后焦虑障碍（post-stroke anxiety disorder,PSAD）发生率高约 2.16倍。尿动力检查提示：LUTD伴焦虑障碍者膀胱活动度明显增高。 结论 卒中后焦虑障碍及排尿障碍较为常见,且额叶卒中的发生率更高,以储尿期排尿障碍为主。 患者的排尿异常与其高级脑功能、日常生活能力、卒中后情绪等因素相关。尿流动力学改变多为逼尿 肌过度活动,但症状与尿流动力学表现不完全一致,必要时应做此检查以利于进一步治疗。     

脑卒中后抑郁的相关因素分析

目的:探讨脑卒中后抑郁的相关因素。方法:采用汉密尔顿抑郁量表(HAMD)对198例脑卒中患者进行现状调查。结果:73例脑卒中患者有抑郁表现,发生率为36.9%,经Logistic多元回归分析,脑卒中后抑郁的相关因素有负性生活事件、心血管病史、抑郁症史、病灶数目、病灶部位以及脑卒中史。结论:脑卒中后抑郁的相关因素有负性生活事件,心血管病史,抑郁症史、病灶数目,病灶部位以及脑卒中史。脑卒中后抑郁的发生可能是神经生物学因素和社会心理学因素共同作用的结果。     

脑卒中后睡眠障碍相关因素分析

目的 探讨脑卒中患者睡眠障碍的临床情况及相关影响因素.方法 选取山东省东营市胜利油田中心医院神经内科自2005年1月至2010年6月收治的脑卒中患者204例,以匹兹堡睡眠质量指数量表(PSQI)判定是否睡眠障碍,比较不同性别、年龄、脑卒中部位患者的睡眠障碍发生率.通过症状自评量表(SCL-90)比较睡眠障碍和无睡眠障碍患者的身心健康状况,通过汉密尔顿抑郁量表(HAMD)、Barthel指数和美国国立卫生研究院卒中量表(NIHSS)评分比较睡眠障碍和无睡眠障碍患者抑郁、生活能力及神经功能缺损程度的差异.结果 本组患者睡眠障碍95例,发生率为46.6%(95/204).女性患者睡眠障碍发生率较高,差异有统计学意义(P＜0.05).≥70岁患者睡眠障碍发生率最高(57.6%),其次为＜50岁(41.5%)、50～69岁人群(32.9%),脑卒中发生在皮质下患者的睡眠障碍发生率最高(64.2%),其次为大脑皮质(27.4%)、小脑(4.5%),差异均有统计学意义(P＜0.05).卒中部位位于左半球患者睡眠障碍发生率明显高于右半球患者,差异有统计学意义(P＜0.05);与脑卒中后无睡眠障碍患者比较,脑卒中后睡眠障碍患者SCL-90 9项指标、HAMD评分及NIHSS评分均较高,而Barthel指数较低,差异均有统计学意义(P＜0.05).结论 脑卒中患者睡眠障碍发生率较高,并与性别、年龄、卒中部位有关,可导致抑郁、焦虑、神经功能缺损,生活质量下降,临床治疗过程中应积极做好护理工作.

Abstract：

Objective To explore the clinical features of sleep disorder in patients with stroke and its related factors. Methods Two hundred and four patients with stroke, admitted to our hospital from January 2005 to June 2010, were chosen; Pittsburgh Sleep Quality Index (PSQI) was employed to determine whether these patients had sleep disorder; the prevalences of sleep disorder in patients with different ages, genders and lesions of stroke were compared. Symptom Checklist-90 (SCL-90)questionnaire was used to compare the physical and mental conditions of patients with or without sleep disorder; Hamilton Depression Rating Scales (HAMD), Barthel index, and National Institutes of Health Stroke Scale (NIHSS) were employed to compare the differences of depression, viability and neurologic impairment in patients with or without sleep disorder. Results The prevalence of sleep disorder was 46.6% (95/204), and it was higher in female group (53.8% vs 38.8%; x2=3.851, P=0.033). Patients aged ≥70 years had the highest rate of sleep disorder (57.6%), followed by patients aged ＜50 years (41.5%),and then patients aged between 50 and 69 years showed the lowest rate (32.9%). The sites of stroke located in the subcortex, cortex, and cerebellum enjoyed their prevalences of 64.2%, 27.4% and 4.5%,respectively. The incidence of sleep disorder in patients with stroke located in the left hemisphere was obviously higher than that in the right hemisphere (x2=7.688, P=0.008). The results of 9 indexes of SCL-90, scores of HAMD and NIHSS in patients with sleep disorder were significantly higher than those in patients without sleep disorder, while the Barthel index was in the opposite position with obvious differences (P＜0.05). Conclusion High prevalence of sleep disorder in patients with stroke is noted,which is related to gender, age of the patients and the sites of stroke, and may lead to depression, anxiety,neurological functional deficit and decrease of life quality. And we should pay more attention to nursing care during all the treatment.     

Clinical study on depressive state following stroke

A clinical study was made on depressive state following stroke using stroke patients in the chronic stage. There were 118 stroke patients in the present study and 25 patients (21.2%) satisfied the diagnostic criteria for major depressive syndrome of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised (DSM-III-R). As for dispositional, social, and somatic factors, a tendency was observed for depressive state to develop at a high frequency among patients with a past history of mental disorder prior to development of stroke, patients residing in suburban area, patients engaged in domestic and agricultural work, and patients with a frequent history of physical disorders. A tendency was observed for depressive state to develop at a high frequency among patients showing B type in YG test and patients presenting laterality in electroencephalography. Among the 49 right stroke patients, depressive state was observed in 10 cases (20.4%), while among the 43 left stroke patients, depressive state was seen in 10 cases (23.2%) with the incidence of depressive state showing no difference by hemisphere stroke. Study of the clinical characteristics of depressive state by hemisphere stroke with the use of symptom items of Zung scale and Hamilton scale showed that patients in depressive state with right hemisphere stroke had high values in symptom items considered close to the essence of endogenous depression such as depressed mood, suicide, diurnal variation, loss of weight, and paranoid symptoms, while patients in depressive state with left hemisphere stroke had high values in symptom items having a nuance of so-called neurotic depression such as psychic anxiety, hypochondriasis, and fatigue. Comparison with endogenous depression patients indicated that right stroke patients rather than left stroke patients showed a clinical picture suggestive of endogenous depression. Antidepressant was effective in 71.4% of the cases, but no difference in effectiveness could be observed by hemisphere stroke. In stroke patients in the chronic stage the incidence of clinical depressive state was higher than 20%, and involved in its onset were not only brain organ lesions but also dispositional, social, and somatic factors and integration dysfunction in the emotional activity of the left and right hemisphere functions. As for the clinical picture, a picture considered close to endogenous depression was observed in right stroke patients, while that considered close to so-called neurotic depression was seen in left stroke patients. The therapeutic effect of antidepressant was almost equivalent to that for endogenous depression.     

脑卒中后焦虑抑郁共病的临床初步研究

目的 了解脑卒中后焦虑抑郁共病（PSCAD）的发生率、相关因素及症状特点，寻找防治措施。方法 采用SAS、SDS量表对115例脑卒中病人进行测评，收集年龄、病程、性别、卒中次数、肌力等资料，对所获资料统计分析。结果 PSCAD的发生率为27．83％，病程、卒中次数、偏瘫程度等与PSCAD的发生相关。常见焦虑症状有不幸预感、睡眠障碍、乏力、焦虑等，抑郁症有能力减退、忧郁、易激惹、食欲减退等。结论 宜注重防治脑卒中，加强心理、家庭、社会支持，适当选用抗焦虑、抑郁药物治疗。     

Mood state as a predictor of neuropsychological deficits following cardiac surgery

Objectives: mood disorders and neuropsychological deficits are both commonly reported occurrences after cardiac surgery. We examined the relationship between mood state and postoperative cognitive deficits in this population.Methods: assessments of neuropsychological functions and mood state (depression, anxiety, stress scales; DASS) were performed preoperatively and postoperatively on 147 patients undergoing cardiac surgery.Results: the incidence of preoperative depression, anxiety, and stress symptomatology was 16%, 27%, and 16%, respectively. The incidence of postoperative anxiety symptomatology significantly increased to 45% (p<0.001), while the incidence of depression and stress symptomatology remained stable (19% and 15%, respectively; ns). Changes in mood state did not influence changes in neuropsychological performance. Preoperative mood was a strong predictor of postoperative mood, and was related to postoperative deficits on measures of attention and memory.Conclusions: an assessment of preoperative mood is critical in identifying patients at risk of postoperative mood disorders and neuropsychological deficits. Measures assessing somatic manifestations of anxiety may not be suitable for a surgical population.     

Sociodemographic and psychopathologic predictors of first incidence of DSM-IV substance use, mood and anxiety disorders: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions

The objective of this study was to present nationally representative findings on sociodemographic and psychopathologic predictors of first incidence of Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV) substance, mood and anxiety disorders using the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. One-year incidence rates of DSM-IV substance, mood and anxiety disorders were highest for alcohol abuse (1.02), alcohol dependence (1.70), major depressive disorder (MDD; 1.51) and generalized anxiety disorder (GAD; 1.12). Incidence rates were significantly greater (P<0.01) among men for substance use disorders and greater among women for mood and anxiety disorders except bipolar disorders and social phobia. Age was inversely related to all disorders. Black individuals were at decreased risk of incident alcohol abuse and Hispanic individuals were at decreased risk of GAD. Anxiety disorders at baseline more often predicted incidence of other anxiety disorders than mood disorders. Reciprocal temporal relationships were found between alcohol abuse and dependence, MDD and GAD, and GAD and panic disorder. Borderline and schizotypal personality disorders predicted most incident disorders. Incidence rates of substance, mood and anxiety disorders were comparable to or greater than rates of lung cancer, stroke and cardiovascular disease. The greater incidence of all disorders in the youngest cohort underscores the need for increased vigilance in identifying and treating these disorders among young adults. Strong common factors and unique factors appear to underlie associations between alcohol abuse and dependence, MDD and GAD, and GAD and panic disorder. The major results of this study are discussed with regard to prevention and treatment implications.     

影响癌症患者生活质量的相关因素分析

目的探讨影响癌症患者生活质量的相关因素,提示干预措施。方法对124例癌症患者在入院一周内进行癌症病人生活质量问卷(EORCT QLQ-30)、艾森克人格问卷(EPQ)、防御方式问卷(DSQ)、生活事件量表(LES)、社会支持评定量表(SSRS)、汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)的评估,用t检验,多元逐步回归进行统计分析。结果单因素分析显示对患病知情有利于患者认知功能提高且恶心呕吐减少；病程长躯体功能及角色功能差；本组抑郁发生率为32．26%,焦虑发生率为29．84%,抑郁、焦虑对癌症患者生活质量的多项因子都有显著影响。多元分析结果表明,癌症患者生活质量总评与负性生活事件强度、疼痛、疲劳、社会支持利用度相关,社会功能与年龄、疲劳、HAMD总分有关。结论癌症患者的生活质量受多种因素影响,其中抑郁、焦虑等情绪障碍严重影响了癌症患者的生活质量,负性生活事件、神经质个性、年龄、病程也是影响患者生活质量的重要因素。针对相关因素进行干预有利于癌症患者生活质量的提高。     

Psychological effects of speech therapy

The study investigates the effect of speech therapy on the mood of aphasic stroke patients and their spouses. Patients were randomly allocated to receive speech therapy for 24 weeks starting at 10 weeks post stroke. Patient's mood was measured by means of simple rating scales and an adjective checklist. The mood of relatives was measured by The Goldberg General Health Questionnaire and The Wakefield Depression Inventory. Whereas depression and anxiety were surprisingly uncommon in aphasic patients, many spouses suffered depression and minor psychiatric disturbances. There were no significant differences between treated and untreated patients and their spouses on any measure. Speech therapy was not shown to have any psychological benefits.