老年期焦虑与抑郁共病患者的睡眠质量研究

目的　探讨老年焦虑与抑郁障碍共病患者的睡眠质量,为临床治疗方案的确定提供理论 依据。方法　采用焦虑自评量表(SAS)评价焦虑情绪的严重程度,抑郁自评量表(SDS)评价抑郁情绪的 严重程度,采用匹兹堡睡眠质量指数(PSQI)分别对37例老年期焦虑与抑郁共病、22例老年期焦虑症和 23例老年期抑郁患者的睡眠质量进行评定,并进行对照研究。结果　共病组入睡时间、催眠药物、 PSQI总分明显高于抑郁组(F值分别18.23,14.56,16.33,P<0.00);而睡眠障碍得分高于焦虑组(F= 2.127,P<0.05)。比较共病组病期、SDS、SAS与PSQI各成分间的相关性发现,病期与入睡时间、总分呈 负相关关系(P<0.05),SAS与入睡时间、催眠药物和PSQI总分呈正相关关系(P<0.05)。结论　老 年期焦虑抑郁共病比老年期抑郁症患者的睡眠质量降低更突出,其焦虑情绪与入睡困难和药物的使用 情况更为密切,提示在老年期焦虑抑郁障碍的临床治疗过程中,需改善睡眠障碍。     

月经性偏头痛患者焦虑抑郁症状及睡眠质量

目的 探讨月经性偏头痛患者的焦虑抑郁症状及睡眠质量,为防治月经性偏头痛及其共病提供参考。方法根据国际头痛疾病分类第3版(ICHD-3)诊断标准,选择2019年2月-2020年2月在川北医学院附属医院门诊就诊的501例女性偏头痛患者为研究对象,包括112例月经性偏头痛患者和389例非月经性偏头痛患者。收集患者的一般资料及临床资料,采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表24项版(HAMD-24)、头痛影响测评量表(HIT-6)和匹兹堡睡眠质量指数量表(PSQI)进行评定。结果 在月经性偏头痛患者中,单纯焦虑或抑郁症状、焦虑抑郁症状共存、睡眠障碍的检出率均高于非月经性偏头痛患者(χ²=4.198、4.355、5.236、8.624,P<0.05或0.01),月经性偏头痛患者HAMA、HAMD-17、PSQI和HIT-6评分均高于非月经性偏头痛患者(Z=-3.550、-2.723、-2.482、-4.717,P<0.05或0.01)。相关分析显示,月经性偏头痛患者PSQI评分与HAMA评分(r=0.338,P<0.01)、HAMD-24评分(...     

伴抑郁症状的焦虑障碍患者生活质量的研究

目的 探讨伴有抑郁症状的焦虑障碍患者的生活质量.方法 纳入符合美国精神障碍诊断与统计手册第4版焦虑障碍诊断标准的患者163例和162名正常对照,患者按是否伴有抑郁症状分为单纯焦虑组以及焦虑-抑郁共存组,采用焦虑自评量表(SAS)、抑郁自评量表(SDS)、匹兹堡睡眠质量指数表(PSQI)和世界卫生组织生命质量测定量表简表(WHOQOL-BREF)等分别评定受试者的情绪症状、睡眠和生活质量,采用SPSS18.0对两组进行比较.结果 46.6%(76/163)的焦虑障碍患者伴有抑郁症状.焦虑-抑郁共存组的SAS标准分、PSQI总分均高于单纯焦虑组(P<0.01),WHOQOL-BREF总分及生理、心理、社会关系及环境领域得分分别为[ (47.92±8.52 )、(10.17±2.64)、(11.12±2.55)、(11.29±2.27)、(10.69±2.65)],而单纯焦虑组和健康对照组相应得分分别为[(57.88±9.43)、(13.02±2.61)、(13.08±2.29)、(13.44±2.41)、(12.47±2.63)和(65.14±9.42)、(14.99±2.41)、(11.12±2.55)、(11.29±2.27)、(10.69±2.65)],前者各得分均分别高于后两者(P均小于0.01).结论 焦虑障碍患者常伴发抑郁症状,伴有抑郁症状的焦虑障碍患者生活质量更低.     

甲基苯丙胺使用障碍者的焦虑、抑郁与睡眠状况调查

目的 探究甲基苯丙胺使用障碍（Mathemphatamine use disorder,MUD）患者的焦虑、抑郁和睡眠问题发生率。方法 共纳入462名MUD患者和312名正常对照。两组均使用汉密尔顿焦虑量表、汉密尔顿抑郁量表和匹兹堡睡眠质量指数分别对焦虑、抑郁和睡眠情况进行评估。结果 MUD患者的焦虑、抑郁及睡眠问题发生率均高于正常对照（焦虑：47.3%vs.3.1%;抑郁：50.2%vs.2.1%;睡眠问题：62.0%vs.31.7%）,所有P值均<0.001。多因素Logistic回归分析提示,MUD患者出现焦虑（OR=22.04,95%CI [8.75,55.49]）、抑郁（OR=38.79,95%CI [13.11,114.76]）和睡眠问题（OR=3.36,95%CI [2.25,5.02]）的风险比正常对照更大。结论 与对照组相比,MUD组更容易发生焦虑、抑郁与睡眠问题,在MUD的临床治疗中,要对焦虑、抑郁和睡眠问题进行评估和干预。     

重复经颅磁刺激对抑郁障碍患者睡眠质量改善的临床研究

研究背景 目前抑郁障碍患病率呈逐年升高之趋势,综合性医院就诊的抑郁障碍患者多以躯体化症状为主诉,尤以睡眠障碍最为常见,改善睡眠质量成为迫切的需要.本研究探讨重复经颅磁刺激(rTMS)对改善抑郁障碍患者睡眠质量的疗效.方法 以躯体化症状就诊的抑郁障碍患者随机分为单纯药物治疗组(药物治疗组)和rTMS联合药物治疗组(联合治疗组),分别采用汉密尔顿焦虑量表(HAMA)和抑郁量表(HAMD)评价两种治疗方法的疗效.结果 两种治疗方法在不同观察时间点,各项评分差异均有统计学意义(P=0.000),且治疗方法与观察时间点之间存在交互作用(均P=0.000).与药物治疗组相比,联合治疗组患者治疗1、2和4周时HAMA评分、HAMD总评分和躯体化症状评分降低(均P=0.000);治疗1周时睡眠障碍评分降低(P=0.001);治疗1和2周时抑郁症状评分降低(均P=0.000).与治疗前相比,药物治疗组患者各项评分除治疗后1周差异无统计学意义(P＞0.05)外,其余各观察时间点差异均有统计学意义(P=0.000);联合治疗组患者治疗后各项评分差异均有统计学意义(P=0.000).治疗后1、2和4周,两组治疗总有效率比较,联合治疗组[63.64％(14/22)、86.36％(19/22)、90.91％ (20/22)]高于药物治疗组[20％ (4/20)、55％ (11/20)、75％(15/20)],差异有统计学意义(均P=0.000).结论 重复经颅磁刺激联合药物治疗抑郁障碍患者起效早、效果好,尤其对睡眠质量的改善优于单纯药物治疗,可以提高抑郁障碍患者的治疗依从性.     

老年住院患者睡眠障碍、药物滥用情况及相关因素分析

目的了解因睡眠障碍住院治疗的老年人滥用药物的情况,同时对影响睡眠的相关因素进行分析,从而使老年人能更好地改善睡眠。方法应用匹兹堡睡眠指数量表、老年抑郁量表、自评焦虑量表等对因睡眠障碍住院的110例老年人（≥60岁）进行测评,对抑郁、焦虑等相关因素与睡眠障碍的关系进行分析。结果老年睡眠障碍的患者药物滥用以阿普唑仑（67.3%）和氯硝安定（16.4%）居多;抑郁和焦虑与睡眠障碍呈正相关;饮酒和患有其他疾病对睡眠障碍的影响有较明显差异,而性别和吸烟并未发现有影响。结论药物滥用情况在睡眠障碍的老年人群中较常见;同时,抑郁、焦虑、饮酒和伴发其他疾病等因素均对睡眠有一定的影响。     

抑郁障碍患者与焦虑障碍患者的个性测定比较

目的 探讨抑郁障碍患者与焦虑障碍患者的个性特征差异。方法 使用本土化的人格测量工具《中国人个性测量表2》（CPAI-2）对抑郁障碍患者和焦虑障碍患者进行调查。结果 在一般性格特征上两类人群在新颖性（t=2．39,P〈0．05）、多元思考（t=3．01,P〈0．01）、理智-情感（t=3．09,P〈0．01）、阿Q精神（t=2．26,P〈0．05）、老实-圆滑（t=-1．98,P〈0．05）、人际触觉（t=2．57,P〈0．05）等六个方面存在显著差异,在病态性格特征上两类人群在焦虑紧张（t=2．15,P〈0．05）、抑郁（t=-2．48,P〈0．01）、病态依赖（t=-2．34,P〈0．05）、兴奋性（t=2．42,P〈0．05）等四个方面存在显著差异。结论 抑郁障碍患者和焦虑障碍患者的个性特征存在有共性和个性。     

帕罗西汀对神经衰弱患者睡眠、抑郁与焦虑的影响

目的探讨帕罗西汀在治疗神经衰弱患者中的效果,并分析其对患者睡眠、抑郁与焦虑情绪的影响。方法选取我院46例神经衰弱患者,采用帕罗西汀对其进行治疗,疗程为8周,比较患者治疗前后的SDS、HAMD,并观察治疗前后的睡眠质量、抑郁与焦虑等情绪的变化。结果患者治疗前后的SDS、HAND的比较差异具有统计学意义(P<0.05),患者治疗后的睡眠质量、抑郁与焦虑等症状得到明显改善,差异有统计学意义(P<0.05)。结论应用帕罗西汀治疗神经衰弱具有很好的效果,且没有任何不良反应,值得在临床上推广应用。     

混合性焦虑抑郁障碍

前　　言[1,2 ]在普通门诊和精神科门诊寻求帮助的病人中 ,不少人表现出不同程度的焦虑和抑郁混合状态。ＶｏｎＫｏｒｆｆ等 (1987)对 12 4 2名基层保健部门的病人进行调查 ,根据大体健康问卷 (ＧＨＱ)、ＤＳＭ -Ⅲ会谈问卷 (ＤＩＳ)及基层医生的临床报告 ,一半以上的病人具有焦虑或抑郁症状 ,但只有 8%的人符合特定的ＤＳＭ -Ⅲ 5个诊断中的一个或多个诊断 (抑郁症、惊恐障碍、心境恶劣、广泛性焦虑或强迫症 )。Ｂａｒｒｅｔ等 (1988)运用定式问卷对 116 0名农村基层保健病人作了评估 ,发现许多具有精神症状的病人尽管存在着明显的与症状相…     

Relationship of attention-deficit-hyperactivity disorder symptoms, depressive/anxiety symptoms, and life quality in young men

Aim:  Attention-deficit–hyperactivity disorder (ADHD) continues to be among the most frequently missed of psychiatric diagnoses in adults because its presentation in adulthood so often mimics those of better-known disorders. The aim of the present study was to examine the relationship between ADHD symptoms, depression/anxiety symptoms, and life quality in young men.
Methods:  Nine hundred and twenty-nine draftees into the Taiwanese army completed the Adult ADHD Self-Report Scale (ASRS), the World Health Organization (WHO) Quality of Life–Brief Version, the Epworth Sleepiness Scale, the second edition of the Beck Depression Inventory, and the Beck Anxiety Scale. Based on high ASRS scores, a total of 328 adults (35.3%) were identified as having ADHD: 65 (7.0%) with definite ADHD and 263 (28.3%) with probable ADHD.
Results:  The 328 subjects in the ADHD group had more severe depressive, anxiety symptoms and daytime sleepiness, and had poorer quality of life than the 601 controls (all P  < 0.05).
Conclusions:  ADHD should be included in the differential diagnosis for young men presenting with anxiety, depression, daytime sleepiness, and poor quality of life.     

Behavioral avoidance mediates the relationship between anxiety and depressive symptoms among social anxiety disorder patients

This study investigated the relationship between social anxiety, depressive symptoms, and behavioral avoidance among adult patients with Social Anxiety Disorder (SAD). Epidemiological literature shows SAD is the most common comorbid disorder associated with Major Depressive Disorder (MDD), though the relationship between these disorders has not been investigated. In most cases, SAD onset precedes MDD, suggesting symptoms associated with SAD might lead to depression in some people. The present study addressed this question by investigating the mediational role of behavioral avoidance in this clinical phenomenon, using self-report data from treatment-seeking socially anxious adults. Mediational analyses were performed on a baseline sample of 190 individuals and on temporal data from a subset of this group. Results revealed behavioral avoidance mediated this relationship, and supported the importance of addressing such avoidance in the therapeutic setting, via exposure and other methods, as a possible means of preventing depressive symptom onset in socially anxious individuals.     

Disagreement between self-reported and clinician-ascertained suicidal ideation and its correlation with depression and anxiety severity in patients with major depressive disorder or bipolar disorder

ObjectivesTo study the disagreement between self-reported suicidal ideation (SR-SI) and clinician-ascertained suicidal ideation (CA-SI) and its correlation with depression and anxiety severity in patients with major depressive disorder (MDD) or bipolar disorder (BPD).MethodsRoutine clinical outpatients were diagnosed with the MINI-STEP-BD version. SR-SI was extracted from the 16 Item Quick Inventory of Depression Symptomatology Self-Report (QIDS-SR-16) item 12. CA-SI was extracted from a modified Suicide Assessment module of the MINI. Depression and anxiety severity were measured with the QIDS-SR-16 and Zung Self-Rating Anxiety Scale. Chi-square, Fisher exact, and bivariate linear logistic regression were used for analyses.ResultsOf 103 patients with MDD, 5.8% endorsed any CA-SI and 22.4% endorsed any SR-SI. Of the 147 patients with BPD, 18.4% endorsed any CA-SI and 35.9% endorsed any SR-SI. The agreement between any SR-SI and any CA-SI was 83.5% for MDD and 83.1% for BPD, with weighted Kappa of 0.30 and 0.43, respectively. QIDS-SR-16 score, female gender, and ≥4 year college education were associated with increased risk for disagreement, 15.44 ± 4.52 versus 18.39 ± 3.49 points (p = 0.0026), 67% versus 46% (p = 0.0783), and 61% versus 29% (p = 0.0096). The disagreement was positively correlated to depression severity in both MDD and BPD with a correlation coefficient R² = 0.40 and 0.79, respectively, but was only positively correlated to anxiety severity in BPD with a R² = 0.46.ConclusionSelf-reported questionnaire was more likely to reveal higher frequency and severity of SI than clinician-ascertained, suggesting that a combination of self-reported and clinical-ascertained suicidal risk assessment with measuring depression and anxiety severity may be necessary for suicide prevention.     

Association between fear of stigma, depressive and anxiety symptoms in patients with somatoform pain disorder

Objectives: There is still poor acceptance for pain without somatic causes, and patients with somatoform pain disorder carry a stigma per se. The aim of this study was to identify predictors of fear of stigma including depression, anxiety and somatisation among patients with somatoform pain disorder.Methods: 132 patients with somatoform pain disorder were investigated by using the Link Stigma Questionnaire, the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Whiteley-Index, and the Checklist for Somatisation.Results: Multiple linear regression analysis showed a significant positive association between fear of stigma and symptoms of depression and a negative association with patients' age.Conclusions: This is one of the first studies investigating this question among patients with somatoform pain disorder. Findings might indicate the importance of depressive symptoms for developing fear of stigma.     

抑郁症患者焦虑/躯体化症状早期的变化与氟西汀疗效的相关性研究

目的探讨抑郁症患者焦虑／躯体化症状的早期变化对氟西汀抗抑郁治疗达症状缓解的预测作用。方法对103例重症抑郁患者给予氟西汀治疗6w,剂量固定于20 mg／d,于治疗前及治疗后的第1、2、4、6w末用汉密顿抑郁量表17项(HAMD-17)评定临床症状,其中焦虑／躯体化因子分用来评定焦虑／躯体化症状。结果治疗6w末103例患者中32例(31．1％)达到症状缓解标准,71例(68．9 ％)未达到症状缓解标准。早期HAMD-17中焦虑／躯体化因子分及胃肠道症状条目分的变化与症状缓解存在正相关,而该因子中其余条目的变化与症状缓解不相关。结论HAMD-17中焦虑／躯体化因子分及胃肠道症状有关的条目分早期改善可能是氟西汀治疗后症状能基本缓解的预测因子。     

Sleep disturbance in generalized anxiety disorder and its treatment

Sleep laboratory and epidemiological studies indicate that insomnia is a frequent finding in patients with psychiatric disorders. In this respect, insomnia associated with a major depression or an anxiety disorder, mainly generalized anxiety disorder (GAD), is the most prevalent diagnosis. According to available evidence, the sleep disturbance associated with mild-to-moderate GAD is a sleep-maintenance insomnia, and to a lesser extent a sleep-onset insomnia. Insomnia associated with mild-to-moderate GAD generally responds to psychological treatments and anxiolytic benzodiazepines. Moreover, concomitant administration of hypnotic medication can be contemplated in patients with severe GAD.     

The impact of anxiety and migraine on quality of sleep in patients with major depressive disorder

Objective

The aim of this study was to investigate the impact of anxiety disorders and migraine on sleep quality and to find the independent factors that predict sleep quality among patients with major depressive disorder (MDD).

Method

Psychiatric outpatients diagnosed with MDD were enrolled in the study. Major depressive disorder and 7 anxiety disorders were diagnosed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Migraine was diagnosed based on the International Classification of Headache Disorders, Second Edition. Headache intensity and frequency were reported by the subjects. The Pittsburgh Sleep Quality Index and Hamilton Depression Rating Scale were used to evaluate quality of sleep and depression severity, respectively. Multiple linear regressions were used to identify independent factors related to sleep quality.

Results

One hundred thirty-five subjects (34 men and 101 women) with MDD were enrolled in the study. Subjects with panic disorder and agoraphobia were found to have poorer Pittsburgh Sleep Quality Index scores. Subjects with panic disorder, agoraphobia, and migraine had higher scores for items relating to sleep quality in the Hamilton Depression Rating Scale. Headache intensity and frequency correlated with sleep disturbance. Panic disorder was independently predictive of poor sleep quality. Both migraine and panic disorder independently predicted a greater severity of depression.

Conclusion

Our study demonstrates the negative impact of panic disorder and migraine on MDD and some of the interrelations between depression, anxiety, and sleep quality. Future studies should further explore these interactions and consider possible therapeutic interventions.     

Fatigue and its association with sleep disorders,depressive symptoms and anxiety in patients with multiple sclerosis

Background and purposeThe aetiopathogenesis of fatigue in multiple sclerosis (MS) is not clear. It could be associated with structural changes of the central nervous system, but also with mood and sleep disorders. The purpose of the study was to evaluate frequency of fatigue and its association with sleep and mood disorders in MS patients.Material and methodsThe examined group consisted of 122 MS patients (mean age 37.7 ± 10.8 years). The following questionnaires were used: Fatigue Severity Scale (FSS), Epworth Sleepiness Scale (ESS), Athens Insomnia Scale (AIS), Montgomery-Asberg Depression Rating Scale (MADRS), and Hospital Anxiety and Depression Scale (HADS).ResultsFatigue was present in 75 MS patients (61.5%). Excessive daytime sleepiness was observed in 25 (20.5%), insomnia in 73 patients (59.8%). According to MADRS, depressive symptoms were present in 33 (27%), according to HADS in 15 people (12.3%). Anxiety was present in 32 patients (26.2%). We observed an association between fatigue (FSS) and sleep disorders (ESS, AIS) and also between fatigue and either depression (MADRS, HADS-D) or anxiety (HADS-A). The FSS score was not associated with age, sex, disease course and duration, Expanded Disability Status Stage (EDSS), treatment or level of education in MS patients. In inactive professionally people we noted significantly higher FSS scores (44.8 ± 13.8) in comparison with active individuals (37.2 ± 14.9; p = 0.0053).ConclusionsFatigue is a very common symptom in MS, sometimes associated with sleep disorders, depressive symptoms or anxiety. The treatable causes of fatigue in MS such as sleep and mood disturbances should be identified and treated.