门诊首发抑郁症临床现象学分析

目的　了解首发抑郁症临床特征。方法　采用自制一般情况调查表、自制抑郁及焦虑症状调查有对符合ICD 10抑郁发作诊断标准的 14 4例门诊首发抑郁症患者进行研究。采用汉密顿抑郁量表 (HAMD2 4)、汉密顿焦虑量表 (HAMA)评定疾病的严重程度 ;采用生活满意度量表 (LSR)、社会功能缺陷筛选量表 (SDSS)、生活事件量表 (LES)评定患者的生活质量和社会功能。结果　 14 4例首发抑郁症患者心境低落出现频率高达 10 0 % ,工作兴趣减少为 95 8% ,思维迟缓为 84 7% -能力减退感为 97 2 % ,早醒为 92 4 % ,睡眠不深为 90 3% ,性欲减退和 /或月经紊乱为 82 6 % ,同时伴有昼重夜轻 ,躯体化症状。男性患者的疑病症状出现频率显著高于女性 (P <0 0 5 ) ;男性患者的性欲减退、绝望感症状出现率高于女性 ;女性患者在自杀意念、精神性焦虑、躯体性焦虑、全身疲乏、晨夜夕轻症状出现频率多于男性 ,但无统计差异。 4 0岁以上患者组比 4 0岁以下组更易表现为睡眠不深、早醒、躯体性焦虑 (P <0 0 5 )。 6 1 1%的患者伴有一定程度的焦虑症状 ;6 0 %的患者伴有躯体化症状。重度抑郁的躯体化症状表现频率显著高于中度患者 (P <0 0 5或P <0 0 1) ,两者社会功能缺陷程度有显著性差异 (P <0 0 1)。结论　首发抑郁症临床以心     

经颅近红外光治疗广泛性焦虑障碍患者的应用

正广泛性焦虑障碍(Generalized Anxiety Disorder,GAD)是临床常见的焦虑障碍,以面对各种事件和场景表现出过度的、难以控制的担心和焦虑为特征,常常有乏力,肌肉紧张,疼痛,失眠等躯体症状[1]。GAD在普通人群中的终身患病率高达5.7%,平均发病年龄为30岁,女性患者是男性患者的2倍[2]。多数患者同时合并有一种以上的精神障碍,尤其是抑郁和失眠[3]。GAD会呈现出慢性病程,可严重影响患者的生存质量,患者常因病不能胜任学习工作,给个人、家庭、社会造成沉重的经济负担[4]。     

坦度螺酮治疗广泛性焦虑症疗效观察

目的 观察坦度螺酮对广泛性焦虑症患者焦虑、抑郁症状的疗效.方法 采用自身对照的研究方法,将符合入组标准的广泛性焦虑症患者服用坦度螺酮30-60mg/天治疗,在治疗的6周内给予汉密顿焦虑量表(HA-MA)、汉密顿抑郁量表(HAMD)评估疗效.采用心电图、血生化等测试评估其不良事件.结果 汉密顿焦虑量表分数在治疗的第1周、2周、4周及第6周呈现逐渐下降的趋势,与基线比较均有显著性差异(P＜0.01),在治疗的第2周显示出明显疗效(HAMA减分率为41.1%),治疗的第6周焦虑症状消失(HAMA 4.32±3.45,减分率为83.5%).汉密顿抑郁量表在治疗第6周较治疗初期的也显著下降,差异显著(t=11.47,P＜0.01).结论 坦度螺酮对广泛性焦虑症的焦虑症状具有良好的效果,同时也能改善患者的抑郁症状.     

米氮平与帕罗西汀治疗广泛性焦虑障碍的对照研究

目的评价米氮平治疗广泛性焦虑障碍的临床疗效及安全性。方法将76例符合中国精神障碍分类与诊断标准第三版（CCMD-3）诊断标准的广泛性焦虑障碍患者（GAD）随机分为米氮平组和帕罗西汀组治疗8周,采用汉密顿焦虑量表（HAMA）、临床疗效总评量表（CGI）、副反应量表（TESS）在治疗前和第2、4、6、8周评定临床疗效及不良反应。结果经8周治疗后,显效率分别为81.6%和84.2%,两组比较,差异无显著性（P〉0.05）。结论米氮平和帕罗西汀对广泛性焦虑障碍的治疗效果相当,且副反应轻,均可作为临床治疗GAD的一种选择。     

心理干预对首发精神分裂症患者的作用

目的:探讨心理干预对首发精神分裂症患者生活质量和社会功能的影响. 方法:120例首发精神分裂症患者随机分为观察组和对照组各60例.两组均给予阿立哌唑治疗,观察组在此基础上给予心理干预,观察8周,并随访6个月.采用阳性与阴性症状量表(PANSS)、世界卫生组织生活质量量表(WHOQOL-100)及社会功能缺陷筛选量表(SDSS)分别于入组时及随访结束时进行评估. 结果:入组时PANSS、WHOQOL-100及SDSS评分两组间比较差异均无统计学意义(P均>0.05);随访结束时,观察组PANSS总分、阴性症状、阳性症状和SDSS评分均显著低于对照组(P均<0.01);而WHOQOL-100中生活质量总评、独立性领域、社会关系领域评分均高于对照组(P<0.05或P<0.01). 结论:心理干预有助于缓解首发精神分裂症患者的精神症状,提高生活质量及社会功能.     

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.     

首发精神分裂症患者的生活质量评估

目的评估首发分裂症患者的生活质量，及生活质量与精神症状的相关性。方法评估447例患者基线、随访6个月、随访1年时阳性和阴性症状量表（PANSS）、健康状况调查问卷（SF-36）、社会功能缺陷筛选量表（SDSS）、生活满意度量表（LSR）。主要根据SF-36评估首发分裂症患者的生活质量，并将SF-36与PANSS、SDSS、LSR作相关分析。结果首发精神分裂症患者在躯体角色功能（RP）、社会功能（SF）、情绪角色功能（RE）3个维度平均分显著低于杭州市居民的数据。除精力（VT）外，其余7个维度与PANSS的阳性症状分、阴性症状分、一般精神病理分以及SDSS均呈负相关，与LSR呈正相关。而VT与PANSS的阴性症状分及LSR呈负相关。随访1年问躯体健康（PF）、躯体角色功能（RP）、躯体疼痛（BP）、总体健康（GH）、社会功能（SF）、情绪角色功能（RE）、心理健康（MH）等7个维度得分显著提高。结论首发分裂症患者的情绪角色功能、躯体角色功能和社会功能受损明显，经1年治疗后上述功能均能明显改善。除精力感外，精神症状缓解越明显，生活质量越高，提示了早期治疗的重要性。同时也表明SF-36可适用于评估分裂症患者的生活质量。     

小剂量米氮平合并帕罗西汀治疗广泛性焦虑障碍的研究

<正>本研究应用小剂量米氮平合并帕罗西汀治疗广泛性焦虑障碍(GAD),现报告如下。1对象和方法为2012年2月~2013年10月本院门诊及住院的GAD患者70例,均符合国际疾病分类第10版(ICD-10)的诊断标准;汉密顿焦虑量表(HAMA)≥21分;无严重躯体疾病、酒精和药物依赖史、自杀观念及行为;排除精神分裂症、心境障碍、其他神经症的诊断。随机分为两组,研究组:男16例,女20例;年龄32~65岁,平均(41.2±4.1)岁;总病程10~30     

广泛性焦虑和惊恐发作患者生活事件量表和社会支持量表评定

目的 探讨焦虑症患发病与心理社会因素的关系。方法 应用生活事件量表和社会支持量表对符合CCMD一3诊断标准的30例广泛性焦虑障碍和30例惊恐发作进行评定。结果 发现GAD组和PA组生活事件值及各因子分均显高于正常对照组；负性生活事件GAD组显高于PA组。SSRS评定显示，PA组客观支持分显高于GAD组和正常对照组。结论 广泛性焦虑和惊恐发作发病与心理社会因素有关。     

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.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

Sense of coherence as a predictor of subjective state of health: results of 4 years of follow-up of adults

A number of cross-sectional population studies have shown that a strong sense of coherence (SOC) is associated with various aspects of good perceived health. The association does not seem to be entirely attributable to underlying associations of SOC with other variables, such as age or level of education. OBJECTIVE: The aim of the study reported here was to determine whether SOC predicted subjective state of health. METHODS: The study was carried out as a two-way panel mail survey of 1976 individuals with 4 years interval for two collections of data. The statistical method used was multivariate cumulative logistic modeling. Age, initial subjective state of health, initial occupational training level, and initial degree of social integration were included as potential explanatory variables. RESULTS: A strong SOC predicted good health in women and men. CONCLUSIONS: SOC can be interpreted as an autonomous internal resource contributing to a favorable development of subjective state of health. SOC data should, however, be regarded as complementary to and not a substitute for information already known to be associated with increased risk of future ill health.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Bibliography of officers of department of mental hygiene

Psychiatric Quarterly -