矛盾性失眠患者个性特征与心理症状分析

目的探讨矛盾性失眠(PI)患者的心理症状和个性特征,为患者的主客观差异原因提供临床依据。方法根据多导睡眠图结果和患者主观感觉差异把患者分为正常组(10例)、PI组(28例)和原发性失眠组(30例),对其分别进行症状自评量表和明尼苏达多项人格测验(MMPI)评估。结果 (1) 3组90项症状自评量表(SCL-90)及各因子分差异均有统计学意义(P0.05)。经过两两比较,PI组和原发性失眠组患者的SCL-90总分、总均分、阴性项目数、阳性项目数、阳性项目平均分、躯体化、强迫状态和其他项目因子分别与正常组比较均明显升高(P0.05)。PI组患者人际关系敏感、抑郁、焦虑、敌对、偏执和精神病性因子明显高于原发性失眠组、正常组(P0.05);(2) 3组MMPI诈分、疑病、抑郁、癔症、心理变态、偏执、精神衰弱、精神分裂和社会内向因子分均有统计学意义(P0.05)。经两两比较,与正常组比较,PI组和原发性失眠组患者的诈分、疑病、抑郁、癔症、心理变态因子分明显升高(P0.05)。与正常组比较,PI组患者偏执、精神衰弱、精神分裂分因子明显升高(P0.05)。与原发性失眠组相比,PI组患者的社会内向因子分明显升高(P0.05)。结论失眠患者具有情绪易波动和神经质人格特点。PI患者在心理症状和个性上有别于原发性失眠,并可能对其主观感觉产生影响。     

孕妇心理抑郁焦虑及相关因素调查分析

目的 探讨孕妇抑郁焦虑及相关因素,为做好产前心理咨询提供依据,找出预防干预孕妇心理问题的措施.方法 采用抑郁自评量表(SDS)和焦虑自评量表(SAS),随机抽取在该院孕期保健门诊建立孕妇保健卡的孕妇280例进行调查,给孕妇讲明调查表的填写方法 ,由孕妇本人填写.结果 孕妇抑郁、焦虑高于正常人群(P<0.05),孕妇中有抑郁情绪占48.9%,焦虑情绪占63.8%.单因素分析结果 ,经期反应、孕期食欲影响胎儿健康,性别担心等因素与孕妇抑郁状态相关.结论 孕期应对孕妇进行心理保健、咨询、指导,加强孕产期健康教育,疏导孕妇心理压力,同时加强孕产期保健工作,提高孕妇身心健康.     

新冠肺炎疫情常态化防控下社区居民心理健康状况及相关因素

目的 调查在新冠肺炎疫情常态化防控下社区居民的心理健康状况并分析其相关因素。方法 本研究为横断面调查,采用滚雪球抽样法,于2020年8月28日-9月7日通过问卷星网络平台向居民发放调查问卷。采用患者健康问卷抑郁量表（PHQ-9）、广泛性焦虑量表（GAD-7）、失眠严重程度指数量表（ISI）及中文版知觉压力量表（CPSS）评估居民的心理健康状况。结果 476名居民抑郁、焦虑、失眠及高水平压力症状检出率分别为32.35%、21.22%、24.58%及48.74%。男性高水平压力症状检出率高于女性（χ²=5.269）,未婚、离异或丧偶居民的抑郁及焦虑症状检出率均高于已婚居民（χ²=5.251、8.851）,有心理服务需求的居民抑郁、焦虑、失眠及高水平压力症状检出率均高于无此需求的居民（χ²=46.316、66.934、20.153、21.576）,差异均有统计学意义（P<0.05或0.01）。相关分析显示,社区居民年龄与CPSS评分呈负相关（r=-0.171,P<0.01）,睡眠时间与PHQ-9、GAD-7及ISI评分均呈负相关（r=-0.210、-0.247、-0.297,P均<0.01）,关注疫情信息时长与ISI评分呈负相关（r=-0.097,P<0.05）。结论 在疫情常态化防控下,居民的抑郁、焦虑、失眠及高水平压力症状仍较常见。男性和年轻居民更有可能出现高水平压力症状,睡眠时间短和有心理服务需求的居民更有可能出现抑郁、焦虑及失眠症状,关注疫情信息时长越短越有可能出现失眠症状。     

孕妇焦虑抑郁情绪及产后抑郁症易感性人格的调查分析

目的探讨孕妇产前焦虑抑郁情绪及产后抑郁症易感性人格两者的关系。方法采用医院焦虑抑郁量表（HAD）和易感性人格类型量表（VPSQ）对278例孕妇进行测评分析。结果产前存在明显的焦虑、抑郁情绪者分别占10．1％和9．4％;在产后抑郁症易感性人格方面有36例〉120分的临界值。结论产前焦虑抑郁情绪的比例较高,对较严重者应实施心理干预。     

曲唑酮治疗失眠及其相关抑郁、焦虑的专家 共识

失眠是临床常见症状,多与抑郁和焦虑障碍等精神疾病同时或相继发生,且临床上常难 以界定两者之间的因果关系。鉴于失眠与抑郁、焦虑存在的交互作用,对抑郁、焦虑和失眠进行综合干 预和管理成为目前疾病治疗的新趋势。曲唑酮是一种具有镇静催眠作用的抗抑郁药,临床广泛用于失 眠及抑郁焦虑伴发或共病失眠的患者。为规范曲唑酮在失眠领域的应用,编写共识的专家组成员通过 复习曲唑酮相关文献,同时结合国内外指南的推荐,重新总结了药物的药代动力学数据、药理作用及相 关临床应用方法,并经过专家组的反复讨论达成共识,以期为广大临床医师合理使用该药提供参考。     

孕产期不同阶段的抑郁、焦虑症状筛查及 相关因素调查

目的 探讨孕产期不同阶段抑郁、焦虑发病状况及其影响因素。方法 采用方便抽样 方法,于2017 年10 月至2018 年1 月在北京市抽取妊娠不同时期孕产妇共620 名作为调查对象,自编 一般资料调查表,9 项患者健康问卷（PHQ-9）、7 项广泛性焦虑障碍量表（GAD-7）,分析孕产期抑郁、焦 虑状况及其影响因素。结果 本研究发现孕产期抑郁症状检出率为11.33%（68/600）,焦虑症状检出率 为23.83%（143/600）,抑郁伴焦虑症状检出率为7.83%（47/600）。孕早、中、晚期抑郁症状的检出率分别 为15.58%（12/77）、10.26%（8/78）、4.00%（3/75）,差异无统计学意义（P＞ 0.05）;产后6 个月以内、6 个月以 上的抑郁症状的检出率为8.75%（14/160）、14.76%（31/210）,差异无统计学意义（P＞ 0.05）。孕期焦虑症 状检出率分别为28.57%（22/77）、23.08%（18/78）、9.33%（7/75）,差异有统计学意义（P ＜ 0.05）;产后分别 为25.63%（41/160）、26.19%（55/210）,差异无统计学意义（P ＞ 0.05）。Logistic 回归分析发现,孕产期抑郁 症状的危险因素为非全职（OR：2.27,95%CI：1.33～3.86,P＜ 0.01）;孕产期焦虑症状的危险因素为月收 入≤ 5 000 元（OR：1.60,95%CI：1.02～2.50,P＜ 0.05）、非全职（OR：1.85,95%CI：1.15～2.97,P＜ 0.05）。 结论 PHQ-9及GAD-7可有效检出孕产期抑郁、焦虑症状。孕期和产后均有一定比例的抑郁、焦虑症状。 孕产期抑郁、焦虑症状的共同危险因素为工作不稳定。     

60例失眠患者抑郁情况及心理因素分析

目的 调查失眠患者的抑郁情况及心理状态.方法 60例失眠症患者为失眠组,对照组为在本院体检的无睡眠障碍的健康人60例,所有调查对象自愿填写并完成各个评价量表,包括症状自评量表、焦虑自评量表、抑郁自评量表和A型行为类型问卷.结果 失眠组症状自评表中10个调查项目均高于对照组,差异均有统计学意义（P＜0.05）.失眠组焦虑情况与抑郁情况评分显著高于对照组,差异具有统计学意义（P＜0.05）.失眠组A-、A和M型显著高于对照组,差异均具有统计学意义（χ2=10.21,P＜0.001; χ2=6.53,P＜0.05; χ2=18.77,P＜0.001）.结论 失眠患者多伴焦虑和抑郁,应主要采用心理干预,辅以抗焦虑、抗抑郁药物及调整患者人格,以改善患者睡眠情况.     

平顶山市肺癌初诊患者心理应激、焦虑抑郁现状及相关因素调查

目的 探讨平顶山市肺癌初诊患者心理应激、焦虑抑郁现状及相关因素.方法 2020年7月1日通过网络使用事件影响问卷(IES-R)、广泛性焦虑量表(GAD-7)和病人健康问卷(PHQ-9)对337名肺癌初诊患者进行调查.结果 共调查372名患者,收回有效问卷337份,有效率为90.59％.心理应激检出率64.69％,焦虑情...     

偏头痛发作与焦虑抑郁的相关因素研究

目的　探讨偏头痛患者伴随焦虑抑郁的情绪。方法　本组 5 8例患者均进行焦虑、抑郁量表的测试 ,用平均焦虑分值 ,平均抑郁分值与界限分值作 μ检验 ,进行评估。同时所有的患者均进行EEG检查。 结果　偏头痛患者伴随焦虑抑郁情绪总发生率 5 5 %,与年龄、病程、发作频率成正相关。EEG异常亦与焦虑抑郁情绪有一定的关系。结论　治疗偏头痛除控制症状外 ,应注意治疗患者的焦虑抑郁情绪 ,这对改善患者的生活质量 ,提高疗效至关重要     

不同行为类型乙型肝炎患者的焦虑和抑郁情绪调查结果

作者对不同行为类型乙型肝炎患者的情绪反应进行了调查。现将结果报告如下。１资料与方法１１对象本文对象为１２０例乙型肝炎患者（男７３例,女４７例,年龄平均为３２４±１１６岁）;既往均无精神病史;诊断为急性肝炎者５１例,慢性肝炎者６９例（均符合１９９...     

孕妇的焦虑和抑郁情况的调查

目的调查孕妇孕期焦虑和抑郁情况及其相关因素。方法妊娠满16周者入组，予HAD量表及自制产前因素调查表等填写，追踪至孕38～40周再于一般情况调查表及HAD量表填写。结果孕16周时焦虑发生率10．8％，抑郁发生率6、9％；孕38～40周时焦虑发生率6、6％，抑郁发生率6．9％。孕16周和孕38～40周焦虑和抑郁共同的相关因素为：经济问题、担心分娩安全、孩子喂养、孩子健康；孕16周时焦虑还与年龄、既往不良孕产史、担心产后避孕等相关，而孕38～40周还与胎位、夫妻关系、胎儿性别等密切相关。结论孕期焦虑情绪占主要地位。孩子的健康及照料、经济问题和分娩安全是焦虑和抑郁的核心问题。     

焦虑障碍和抑郁障碍人格特征的对照研究

目的探讨焦虑障碍和抑郁障碍人格基础是否相同。方法使用CPI-RC、HAMD和HAMA对符合DSM-Ⅵ焦虑障碍、抑郁障碍30例进行评定，并与30名正常人进行对照。结果1.焦虑组Do、Cs、Sy、Sp、Sa、In、Em高于抑郁组（P〈0.01），抑郁组Sc、Gi、To高于焦虑组（P〈0.01）；焦虑组除Em高于对照组（P〈0.01）外，In、Re、So、Sc、Gi、Cm、To、Ac、Ai、Ie、Py低于封照组（P〈0.05、P〈0.01）；抑郁组Sc、To、Fx与对照组无差别，其余各量表分均低于对照组。2.各组的人格类型构成分布有非常显着的差异（P〈0.01）。3.焦虑组和抑郁组的自我实现水平低于对照组（P〈0.01）。结论焦虑障碍和抑郁障碍的自我确认和人际适应水平以及人格类型不同。     

The association of insomnia with anxiety disorders and depression: exploration of the direction of risk

The purpose of this study is to explore the direction of the association between insomnia and anxiety disorders and major depression among a community-based sample of adolescents to better understand their potential etiologic relationships. Data come from a community-based sample of 1014 youth aged 13–16. Structured interviews were conducted to assess DSM-IV diagnoses. Retrospectively reported ages of onset were used in Proportional Hazards models to estimate increased risk of one disorder associated with prior onset of the others. The lifetime associations of DSM-IV insomnia with each anxiety disorder and with depression were moderate (OR = 3.2–6.8). Among those with comorbid disorders, anxiety disorders preceded insomnia 73% of the time, while insomnia occurred first in 69% of comorbid insomnia and depression cases. Any prior anxiety disorder was associated with an increased risk of insomnia adjusting for gender, race/ethnicity, and depression prior to insomnia (HR = 3.5). However, prior insomnia was not significantly associated with onset of anxiety disorders. Prior depression was not associated with onset of insomnia, but prior insomnia was associated with onset of depression adjusting for gender, race/ethnicity, and any prior anxiety disorder (HR = 3.8). These results suggest distinct natural courses of development between DSM-IV insomnia, anxiety, and depression during adolescence. Additionally insomnia may have independent, and potentially etiologically distinct, directional associations with anxiety disorders versus depression.     

生物反馈治疗卒中后焦虑抑郁状态伴失眠的研究

目的 研究生物反馈治疗卒中恢复期焦虑抑郁状态伴失眠的疗效及安全性。 方法 纳入卒中恢复期焦虑抑郁伴失眠患者,均给予生物反馈训练,训练方法为每周五次,每次 30 min的自主神经系统放松康复训练。所有患者在训练前后评定汉密尔顿焦虑量表（Hamilton Anxiety Scale,HAMA）、汉密尔顿抑郁量表（Hamilton Depression Scale,HAMD）、匹兹堡睡眠质量指数量表 （Pittsburgh Sleep Quality Index,PSQI）、患者健康问卷-9（Patient Health Questionnaire-9,PHQ-9）、简 易精神状态检查表（Mi ni -mental State Examination,MMSE）、Fugle-Meyer肢体功能评分（Fugl e-Meyer Scale,FMS）、美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）以及 Barthel指数（Barthel Index,BI）,并采集患者的睡眠时间,对比分析训练前后这些量表评分及睡眠时 间的变化。 结果 研究共纳入并完成3 0例患者的数据统计。治疗后患者睡眠时间较治疗前显著增 加[（4.81±1.58）h vs（7.30±1.34）h,P＜0.001]。HA M A[（17.50±8.41）vs（9.00±7.01）]和 HAMD（[ 19.53±7.82）vs（9.23±4.42）]评分均有显著改善（均P＜0.001）。训练4周后患者的MMSE评 分有提高,Fugl e-Meyer分数增加,Barthel指数增加,但无统计学意义,NIHSS评分降低,差异有显著性 （P =0.033）。 结论 生物反馈疗法有利于卒中后焦虑抑郁伴失眠患者的睡眠和情绪改善,提高康复效果。     

Relapse insomnia increases greater risk of anxiety and depression: evidence from a population-based 4-year cohort study

ObjectiveWe investigated the longitudinal impacts of insomnia on the subsequent developments of anxiety and depression during a four-year follow-up. We further categorized individuals with insomnia into different insomnia subgroups to examine whether the risk of anxiety and depression varies by subtype.MethodsParticipants were identified from National Health Insurance enrollees in Taiwan during 2002–2009. The study included 19,273 subjects with insomnia and 38,546 matched subjects without insomnia. All subjects did not have previous diagnosis of insomnia, sleep apnea, anxiety, or depression.ResultsCompared with non-insomniacs, insomniacs had a higher risk of developing anxiety only [adjusted hazard ratio (HR) = 8.83, 95% CI = 7.59–10.27], depression only (adjusted HR = 8.48, 95% CI = 6.92–10.39), and both anxiety and depression (adjusted HR = 17.98, 95% CI = 12.65–25.56). When breaking down the insomnia subgroups, individuals with a relapse of insomnia (adjusted HR = 10.42–26.80) had the highest risk of anxiety only, depression only, and both anxiety and depression, followed by persistent insomnia (adjusted HR = 9.82–18.98), then remitted insomnia (adjusted HR = 4.50–8.27). All three insomnia subgroups had a greater four-year cumulative incidence rate than the non-insomnia group for anxiety only, depression only, and both anxiety and depression (p < 0.0001).ConclusionOur findings reinforce the clinical predictor role of insomnia in the future onset of anxiety or/and depression. Awareness of insomnia and treatment of insomnia should be recommended at clinics, and patterns of insomnia should be monitored to help treatment and control of subsequent psychiatric disorders. Future research with comprehensive data collection is needed to identify factors that contribute to different insomnia subtypes.     

Anxiety and depression in primary care patients: predictors of symptom severity and developmental correlates

OBJECTIVE: A study in a German general practice used the Hospital Anxiety and Depression Scale (HADS) to determine the prevalence of anxiety and depression in 242 consecutive patients. The study had two additional goals: (1) to identify indicators of symptom severity and (2) to validate the HADS by relating it to measures of developmental psychopathology. METHODS: In addition to the HADS, clinical/sociodemographic data were collected. Patients filled up additional questionnaires measuring attachment characteristics, recalled parental rearing behavior, resilience, adverse childhood experiences, and physical complaints. RESULTS: Using HADS cutoff scores of > or =11 in total, we found that 21.1% of the patients showed clinically relevant anxiety levels; the rate for depression was 12.0%, that for anxiety or depression was 26.1%, and that for anxiety and depression combined was 7%. With the exception of psychiatric disorders, the HADS did not differentiate between subgroups with different somatic diseases. HADS scores were shown to be predicted by the patients' sex, family status, number of consultations, and subjective physical complaints. Patients with higher HADS scores also indicated lower resilience, more insecure attachment, and negative recalled parental rearing behavior. Resilience, attachment security, and specific parental behavior (control/warmth) independently predicted anxiety, depression, and physical complaints. CONCLUSION: This study provides further support for the usefulness of the HADS as a measure for routine screening for anxiety and depression and its relationship with constructs from developmental psychopathology. We recommend the use of the HADS in combination with potential indicators of symptom severity (fatigue, cardiovascular symptoms, high number of consultations) to identify patients needing psychosocial support.     

外伤后脊髓损伤患者抑郁焦虑水平影响因素

目的分析外伤后脊髓损伤患者的焦虑抑郁水平及其相关因素。方法对脊髓损伤患者50例进行问卷调查,包括-般状况调查表、艾森克人格问卷、社会支持量表、应付方式问卷。采用汉密顿抑郁、焦虑量表进行抑郁焦虑水平测评,并对其影响因素进行分析。结果50例患者中有抑郁症状者49例,焦虑症状者48例。其中抑郁程度轻度者8例,抑郁程度中度者19例,抑郁程度重度者22例;可能有焦虑者ll例,焦虑程度轻度者25例,明显焦虑者10例,重度焦虑者2例。人口学因素中,只有性别与焦虑有回归关系,性别与抑郁有相关性（r=-0．26）。抑郁程度与人格特征的内外向有关,焦虑程度与人格内外向和神经质有关,抑郁与应付方式中的自责、退避有回归关系,焦虑与应付方式的合理化呈回归关系,抑郁、焦虑水平与社会支持总分呈回归关系。结论外伤后脊髓损伤患者抑郁焦虑水平受到患者人格、应对方式等多因素的影响。     

Sleep duration,insomnia, and markers of systemic inflammation: Results from the Netherlands Study of Depression and Anxiety (NESDA)

Systemic inflammation has emerged as a potential pathway linking depressive and anxiety disorders with disease risk. Short and long sleep duration, as well as insomnia, are common among psychiatric populations and have previously been related to increased inflammation. The aim of the present study was to investigate associations between sleep duration and insomnia with biomarkers of inflammation and to explore whether these associations varied by psychiatric diagnostic status. To this end, self-reported measures of sleep duration, insomnia symptoms, and markers of inflammation, including C-reactive protein (CRP), interleukin-(IL)-6, and tumor necrosis factor (TNF)-α, were obtained in 2553 adults (aged 18–65 years) diagnosed with current/recent or remitted depressive and/or anxiety disorders and healthy controls enrolled in the Netherlands Study of Depression and Anxiety (NESDA). Regression analyses revealed associations between sleep duration and levels of CRP and IL-6 with higher levels observed in long sleepers. These associations remained statistically significant after controlling for age, gender, education, body mass index, smoking, alcohol consumption, medical comorbidities, medication use, psychotropic medication use, and psychiatric diagnostic status. There were no clear associations between insomnia symptoms and levels of inflammation. Relationships between sleep duration and inflammation did not vary as a function of psychiatric diagnostic status. These findings suggest that elevated levels of systemic inflammation may represent a mechanism linking long sleep duration and disease risk among those with and without depressive and anxiety disorders.     

Cross-sectional survey following a longitudinal study on mental health and insomnia of people with sporadic COVID-19

BACKGROUNDIn the post-pandemic era, the emergence of sporadic cases of coronavirus disease 2019 (COVID-19) and the scale of the pandemic are unpredictable. Therefore, the impact of sporadic cases of COVID-19 and isolation measures on mental health and sleep in different groups of people need to be analyzed. AIMTo clarify the severity of psychological problems and insomnia of staff and community residents around a hospital with sporadic cases of COVID-19, and their relationship with quarantine location and long-term changes.METHODSA cross-sectional survey was conducted on community residents and medical staff. Many of these medical staff had been subjected to different places of quarantine. Community residents did not experience quarantine. Hospital anxiety and depression scale (HADS), acute stress disorder scale (ASDS) and insomnia severity index (ISI) were used to evaluate anxiety and depression, acute stress disorder symptoms, and the severity of insomnia. Additionally, we conducted a 1-year follow-up study on medical staff, with related scales measurement immediately after and one year after the 2-wk quarantine period.RESULTSWe included 406 medical staff and 226 community residents. The total scores of ISI and subscale in HADS of community residents were significantly higher than that of medical staff. Further analysis of medical staff who experienced quarantine showed that 134 were quarantined in hotels, 70 in hospitals and 48 at home. Among all subjects, the proportions of HADS, ASDS and ISI scores above normal cutoff value were 51.94%, 19.17% and 31.11%, respectively. Multivariable logistic regression analysis found that subjects with higher total ASDS scores had a greater risk to develop anxiety and depression. The total ISI score for medical staff in hotel quarantine was significantly higher than those in home quarantine. Total 199 doctors and nurses who completed the 1-year follow-up study. Compared with baseline, HADS and ASDS scores decreased significantly one year after the end of quarantine, while ISI scores did not change significantly. CONCLUSIONSporadic COVID-19 cases had a greater psychological impact on residents in surrounding communities, mainly manifested as insomnia and depressive symptoms. Hotel quarantine aggravated the severity of insomnia in medical staff, whose symptoms lasted ≥ 1 year.