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。     

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.     

门诊慢性失眠患者躯体化症状自评量表的临床应用

目的评估躯体化症状自评量表(SSS)在综合医院门诊慢性失眠患者中的应用价值。方法采用SSS与焦虑自评量表(SAS)和抑郁自评量表(SDS)对373例慢性失眠患者和178例正常人进行测查,分析SSS的信度、效度和可行性。结果 SSS的Cronbach'sα系数为0.87,分半系数为0.83,重测信度为0.87(P<0.01);SSS总分与各因子分的相关系数在0.57~0.86之间,各因子分间的相关系数在0.31~0.68之间(均P<0.01);SSS-SAS、SSS-SDS、SAS-SDS的相关系数分别为0.63、0.60和0.69(均P<0.01)。结论 SSS具有较好的信度和效度,临床上可以应用SSS作为综合医院门诊慢性失眠患者的自评精神障碍筛查工具,尤其适用于伴随躯体症状的患者。     

团体认知行为治疗及佐匹克隆对原发性失眠患者睡眠质量影响的比较

目的:探讨团体认知行为治疗(GCBT)及佐匹克隆对原发性失眠患者睡眠质量影响的比较。方法:90例原发性失眠患者随机分为GCBT组及佐匹克隆组,每组45例;GCBT组采用GCBT、佐匹克隆组口服佐匹克隆7.5 mg;疗程均为12周。治疗前后分别进行匹兹堡睡眠质量指数(PSQI)、睡眠状况自评量表(SRSS)、症状自评量表(SCL-90)评估,应用多导睡眠监测(PSG)睡眠指标。结果:治疗前两组PSQI、SRSS评分、PSG指标、SCL-90评分差异无统计学意义;治疗后,两组PSQI评分均较治疗前明显下降(P均0.05),GCBT组睡眠质量、入睡时间、睡眠时间、睡眠效率、催眠药物因子分及总分明显低于佐匹克隆组(P0.05或P0.01);两组除服药助眠评分外,SRSS各因子评分较治疗前明显下降(P均0.05),GCBT组时间不足、休息质量、觉醒不够、入睡困难、睡眠不稳、早醒、多梦夜惊、服药助眠因子分及总分明显低于佐匹克隆组(P0.05或P0.01);两组PSG各项指标与治疗前有明显变化(P均0.05);GCBT组睡眠总时间(SPT)、总卧床时间(TIB)、非快动眼睡眠(NREM)1、NREM2、NREM3、快速动眼睡眠(REM)、缺乏慢波睡眠(SWS)与佐匹克隆组比较差异有统计学意义(P均0.01);GCBT组SCL-90评分躯体化、人际关系敏感、强迫症状因子评分明显低于佐匹克隆组(P0.05或P0.01)。结论:与口服佐匹克隆比较,GCBT改善原发性失眠患者的睡眠质量的疗效更好。     

神经症与抑郁症的躯体化症状及经济损失比较

目的：比较神经症和抑郁症躯体症状的特点及经济损失。方法：对初次就诊的神经症和抑郁症患者，采用自编躯体症状的特点及经济负担调查问卷，调查躯体症状及经济损失状况。结果：二者躯体症状所占的比例差异无显著性，神经症组的病程显著长于抑郁症组，外院就诊次数也多于后组，从其他科至医学心理科就诊的时间间隔长。抑郁症组汉密尔顿焦虑量表（HAMA）精神焦虑因子分、汉密尔顿抑郁量表（HAMD）总分、体质量、认知障碍、日夜变化、阻滞、绝望感因子分均高于神经症组，焦虑／躯体化因子分低于神经症组。躯体症状组HAMA总分及躯体焦虑因子分、HAMD总分、焦虑／躯体化、体质量、睡眠障碍、绝望感因子分均高于无躯体症状组。神经症组的直接经济损失重于抑郁症组。结论：抑郁症、神经症的抑郁、焦虑、躯体症状的表现有各自特点，躯体症状会加重抑郁和焦虑症状，均造成很大的经济负担。     

老年失眠症患者的生活质量及心理健康水平研究

目的　探讨老年失眠患者的生活质量及心理健康状况。方法　采用生活质量综合评定问卷(GQOLI 74 )和症状自评量表 (SCL 90 )、焦虑自评量表 (SAS)、抑郁自评量表 (SDS) ,对 78例老年失眠患者进行评定 ,并与 70例正常老年人对照。结果　老年失眠患者在躯体健康维度、心理健康维度、社会功能维度均差于对照组 ,且二组差异均有显著性 (P <0 .0 1) ,在SCL 90的总分、躯体化、焦虑、抑郁、恐惧等因子分及SAS、SDS评分与对照组相比差异均有显著性 (P <0 .0 1)。结论　老年失眠患者的总体生活质量不如健康组 ,存在明显的心理问题 ,主要表现为焦虑、恐惧、抑郁等 ,故在对老年失眠患者的治疗过程中 ,应注重心理治疗 ,以提高患者的生活质量。     

抑郁症患者主观睡眠质量与其心理社会影响因素研究

目的探讨抑郁症患者主观睡眠质量与心理社会因素的关系。方法 对63例抑郁症患者使用匹兹堡睡眠质量指数 量表(PSQI),症状自评量表(SCL-90)、焦虑自评量表(SAS)、抑郁自评量表(SDS)、状态-特质焦虑问卷(STAI)、生活事件量表(LES) 和社会支持量表(SSRS)进行评定,并分析PSQI与另6个评定量表结果的关系。结果抑郁症患者有睡眠紊乱占总数77．8％。PSQI 总分和因子与SCL-90躯体化、强迫、抑郁、焦虑和总均分有显著相关性(P<0．05)。PSQI与SAS、STAI中的SAI呈正相关(P< 0．01),但与STAI中的TAI无相关关系(P>0.05)。SDS的躯体化障碍因子与除睡眠持续性因子外的PSQI因子和总分有明显相关性 (P<0．05)。PSQI中日间功能紊乱因子与社会支持总分显著相关(P<0．05);PSQI中睡眠持续性因子与支持利用度显著相关(P< 0．05)。而PSQI与LES无显著性相关(P>0．05)。结论抑郁症患者睡眠质量与躯体症状有较密切的关系,睡眠质量差患者的焦虑 程度重,改善患者睡眠质量对改善躯体化症状及焦虑状况有重要意义。     

青年学生的失眠及其相关因素

按照DSM-Ⅲ的诊断标准调查了537名青年学生的失眠症状,结果显示8.57%的学生经常有入睡困难,11.73%有再入睡困难,7.64%感到早晨醒得太早。以上述3项中任何1项做为判断标准,则16.57%的学生有失眠症状。相关因素分析提示自评健康状况差、生活不满意感、体育活动少、性格内向、学习负担重、考试失败、同学矛盾及名誉受损皆可增加失眠症状的危险性。焦虑、抑郁症状与失眠的因果关系有待于进一步探讨。     

坤泰胶囊联合雌二醇片/雌二醇地屈孕酮片治疗女性更年期失眠伴焦虑抑郁患者的疗效观察

目的观察女性更年期失眠伴焦虑抑郁患者应用坤泰胶囊联合雌二醇片/雌二醇地屈孕酮片治疗后效果。方法将我院107例女性更年期失眠伴焦虑抑郁患者采用随机数字表法分组,对照组53例予坤泰胶囊,观察组54例联合雌二醇片/雌二醇地屈孕酮片,对比两组患者临床疗效、性激素水平、睡眠质量、负性情绪及安全性。结果观察组总有效率、雌二醇(E2)水平高于对照组,卵泡生成激素(FSH)、黄体生成激素(LH)及匹兹堡睡眠质量指数(PSQI)、症状自评量表(SCL-90)、抑郁自评量表(SDS)、焦虑自测量表(SAS)低于对照组(P0.05);观察组不良事件发生率高于对照组(P0.05)。结论坤泰胶囊联合雌二醇片/雌二醇地屈孕酮片能够更有效治疗女性更年期失眠以及伴有的焦虑抑郁情绪。其机制可能与调节性激素水平,改善卵巢功能有关。     

神经内科患者失眠原因分析与护理

目的针对神经内科住院患者失眠的常见原因进行分析,积极采取措施,提高患者的睡眠质量。方法采用李建明等编制的睡眠状况自评量表(SRSS)进行调查。结果 SRSS总分普遍高于全国平均分值,其中女性患者早醒现象比较严重,占调查对象的30%,新入院患者表现为入睡困难,占调查对象的63%,部分重症患者表现为时睡时醒,占调查对象的7%。结论通过对神经内科住院患者的失眠原因进行分析,制定并实施相应护理措施,有效提高患者的睡眠质量,促进患者早日康复。     

深圳市某企业员工睡眠状况与心理状况及其关系

目的探讨深圳市某企业员工的睡眠和心理健康问题及其关系。方法采用整群抽样方法抽取深圳市某企业200名员工,用阿森斯失眠量表(AIS-8)和一般健康问卷12项(GHQ12)对其睡眠状况和最近几周内总的健康状况进行调查。结果心理健康状况高危57例(30.8%)、中危43例(23.2%)、低危85例(45.9%)。失眠99例(53.5%)、可疑失眠44例(23.8%)、无失眠42例(22.7%)。相关分析显示,GHQ总评分与AIS总评分、AIS夜间睡眠评分和白天症状评分显著正相关(r=0.376、0.33、0.327,P0.01)。结论深圳市某企业员工可能存在心理健康问题和失眠问题;对失眠的干预可能有利于改善总体心理卫生状况。     

右美托咪定诱导睡眠平衡术对慢性顽固性原发性失眠症患者的疗效观察

目的:探讨右美托咪定诱导睡眠平衡术(DISBT)对慢性顽固性原发性失眠症患者的临床疗效。方法:将42例慢性顽固性原发性失眠症患者随机分为DISBT组(21例)给予DISBT治疗和对照组(21例)给予常规治疗。DISBT治疗时间为3 d,共行3次治疗。于治疗前、治疗后1周分别对两组进行匹兹堡睡眠质量指数、过度觉醒量表和汉密尔顿焦虑量表评估,并检测治疗前后睡眠结构和脑电频谱差异。结果:①两组治疗后匹兹堡睡眠质量指数、汉密尔顿焦虑量表分值均较治疗前降低(P<0.05);降低程度DISBT组>对照组(P<0.05)。②DISBT组睡眠结构中2期睡眠比例、脑电频谱β、γ频段相对功率值较治疗前减少(P<0.05),对照组则较冶疗前上升(P<0.05);DISBT组冶疗后3期睡眠比例及6频段相对功率值较治疗前上升(P<0.05);对照组则较治疗前下降(P<0.05)。③两组治疗后,过度觉醒量表总分较治疗前下降(P<0.05),降低程度DISBT组>对照组(P<0.05);对照组过度觉醒量表中极限数个数总和、反应因子及自省因子评分与治疗前相比差异无统计学意义(P>0.05),DISBT组则均较治疗前下降(P<0.05)。结论:右美托咪定诱导DISBT能有效降低失眠患者的脑皮质过度觉醒水平,纠正紊乱的睡眠-觉醒通路,改善患者失眠症状,是治疗慢性顽固性原发性失眠症的有效方法。     

右美托咪定对顽固性原发性失眠患者的脑电超慢涨落图的影响

目的 观察右美托咪定睡眠诱导平衡治疗后顽固性原发性失眠患者脑内神经递质活动的变化.方法 对23例顽固性原发性失眠且内科治疗效果不佳的患者实施右美托咪定睡眠诱导平衡治疗,每日1h,持续3d,对照组23例患者采用常规方案治疗.采用阿森斯失眠量表及过度觉醒量袁评估患者治疗前后的主观症状变化,并采用脑电超慢涨落技术对治疗前后的脑内神经递质分别进行检测.结果 治疗后治疗组阿森斯失眠量表及过度觉醒量表指标分值明显改善,治疗前患者脑内5-羟色胺活动水平偏低,去甲肾上腺素活动水平偏高,经睡眠诱导平衡治疗后5-羟色胺活动水平升高,去甲肾上腺素活动水平降低,差异具有统计学意义（P＜0.05）,余神经递质活动水平无明显变化,差异无统计学意义（P＞0.05）,且无严重治疗不良反应.结论 顽固性原发性失眠患者脑内神经递质存在5-羟色胺活动水平偏低,去甲肾上腺素活动水平偏高,右美托咪定睡眠诱导平衡术治疗可以调节它们的活动水平,同时患者的失眠症状及过度觉醒表现也有所改善.     

Is insomnia best categorized as a symptom or a disease?

Insomnia, defined by difficulty falling asleep or remaining asleep, early morning awakening and/or non-restorative sleep, and daytime consequences, is an important public health issue with a significant negative impact on individuals' physical and social performance, ability to work and quality of life, as well as on society as a whole. Chronic insomnia warrants treatment in the majority of cases, but it is often under-treated. Primary insomnia occurs independently of other factors, and is possibly related to a general psychophysiologic hyperarousal. Other types of insomnia occur in association with various conditions such as psychiatric disorders, medical disorders (e.g., chronic pain, dysfunction and movement disorders), circadian rhythm disorders and medication or substance use. These types of insomnia are diagnosed more frequently in the clinic. As a result, insomnia is traditionally viewed and treated as a symptom rather than a disease, with the majority of therapies aimed at resolving underlying medical factors. However, it is important to clearly establish whether co-morbidities are causative for or simply co-exist with insomnia, in order to recommend the most appropriate treatment and optimize treatment outcomes. Difficulties still arise when categorizing insomnia subtypes. Here, we highlight some of the major challenges for future research in classifying both primary insomnia and insomnia related to or associated with various conditions, and their relevance to primary care.     

安非他酮改善酒依赖患者症状的对照研究

目的探讨安非他酮对改善酒依赖患者症状的效果。方法将164例酒依赖患者随机分为研究组（83例）和对照组（81例）,研究组患者接受安非他酮系统治疗,对照组患者仅接受一般戒酒治疗,共治疗8周。入组患者在基线及治疗后第2、4、8周末应用饮酒问卷（ADS）、密西根酒精调查表（MAST）、抑郁自评量表（SDS）、焦虑自评量（SAS）、治疗中需处理的不良反应症状量表（TESS）评定疗效及不良反应。结果治疗后第2周末起,研究组患者ADS、MAST、SDS、SAS量表评分与基线时比较,有显著降低（P〈0．05）,而对照组患者各个量表评分在治疗后第4周末起才有显著降低（P〈0．05）。治疗后第2、4、8周末,研究组患者ADS、MAST、SDS、SAS量表评分均显著低于对照组（P〈0．05）。两组均未出现严重不良反应。结论安非他酮可有效、快速的改善酒依赖患者的酒精依赖及抑郁、焦虑症状。     

Are dysfunctional attitudes and beliefs about sleep unique to primary insomnia?

ObjectiveDysfunctional thinking about sleep is a central aspect in the perpetuation of primary insomnia and a target symptom of cognitive behavioral therapy for insomnia (CBT-I). Insomnia symptoms also occur in other sleep disorders, but it is not known to what extent it is related to dysfunctional thinking about sleep.MethodsThe Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) was administered to inpatients at a sleep center. The following groups were included: 34 patients with primary insomnia (PI), 30 patients with sleep apnea syndrome (SAS), 31 patients with restless legs syndrome (RLS), 26 patients with SAS comorbid with RLS (SAS + RLS), and 24 patients with idiopathic hypersomnia or narcolepsy. Eighty-four healthy subjects served as a control group. The DBAS scores were compared across the different sleep disorders and correlated with polysomnographic (PSG) variables, subjective sleep parameters, scores of the Beck Depression Inventory (BDI), and the Regensburg Insomnia Scale (RIS; measuring psychological symptoms of insomnia).ResultsCompared to healthy controls, DBAS scores were increased in PI, RLS and RLS + SAS. There was a low correlation between DBAS scores and PSG variables, moderate correlations between DBAS and subjective sleep parameters and BDI scores (r = 0.528), and a high correlation between DBAS and the RIS score (r = 0.603).ConclusionThe observation of increased DBAS scores in other sleep disorders besides primary insomnia underscores the usefulness of a broadened diagnostic procedure and suggests that CBT-I modules may be a complementary treatment tool for these disorders.     

CT引导下脉冲射频调节术联合胸椎旁神经阻滞对带状疱疹后神经痛患者疼痛程度及生活质量的影响

目的 探讨CT引导下脉冲射频调节术联合胸椎旁神经阻滞对带状疱疹后神经痛患者疼痛程度及生活质量的影响。方法 选取2019年4月-2021年6月医院疼痛科收治的97例带状疱疹后神经痛患者作为研究对象,随机分为神经阻滞组(n=32)、射频调节组(n=31)和联合组(n=34);所有患者均接受常规药物治疗,在此基础上神经阻滞组接受胸椎旁神经阻滞治疗,射频调节组接受计算机断层扫描(Computed tomography, CT)引导下脉冲射频调节术治疗,联合组则先行CT引导下脉冲射频调节术,后行胸椎旁神经阻滞治疗;根据治疗前和治疗8周后患者数字评分量表(Numerical rating scale, NRS)评分降低程度来评价临床疗效;于治疗前、治疗1、4、8周后采用NRS量表评估疼痛情况,阿森斯失眠量表(Athens insomnia scale, AIS)评估睡眠质量,焦虑自评量表(Self-rating anxiety scale, SAS)和抑郁自评量表(Self-rating depression scale, SDS)评估焦虑和抑郁程度,36项健康调查简表(36-Item short...     

The effects of repeated transcranial direct current stimulation on sleep quality and depression symptoms in patients with major depression and insomnia

ImportanceAlthough several strategies using transcranial direct current stimulation (tDCS) have been investigated to treat major depressive disorder (MDD), the efficacy of this treatment for patients with MDD who also have insomnia is unclear.ObjectiveTo observe the effects of tDCS on sleep quality and depressive symptoms in patients with MDD who have insomnia.MethodsWe conducted a randomized, double-blinded study involving adults with major depression and insomnia. We randomly assigned patients to either add tDCS or to sham tDCS to their regular treatment. After randomization, we treated a total of 90 patients at the Kangning Hospital, Ningbo, China. We allocated 47 patients to the tDCS group and 43 to the sham tDCS group. The tDCS treatment procedure included 20 sessions of 2-mA stimulation of the dorsolateral prefrontal cortex (DLPFC) for 30 min, which was followed by four weekly treatments. The anode and cathode electrodes were placed on the left and right DLPFC, respectively. We recorded the Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), Pittsburgh Sleep Quality Inventory (PSQI), and Polysomnography (PSG) at Day 1 and Day 28.ResultsCompared with the sham tDCS group, the active tDCS group showed improved total scores of SAS and SDS. PSQI total score and all PSQI sub-divisions, except for “sleep duration and sleep efficiency,” significantly improved after treatment. We also observed that tDCS affected sleep architecture, by increasing total sleep time and improving sleep efficiency through PSG.ConclusionsOur study demonstrated the effect of tDCS on sleep quality and depressive symptoms in patients with MDD and insomnia. These results suggested that tDCS stimulation not only improved symptoms of depression and anxiety but also had a positive effect on sleep quality in patients with MDD. For patients with depression and insomnia, tDCS stimulation could be a good supplement to drugs.     

抑郁症相关性失眠的临床特征与多导睡眠图研究

目的探讨抑郁症相关性失眠症状的临床特征与抑郁症睡眠的结构特征。方法对符合抑郁症诊断标准,且具有明显失眠症状的患者71例,进行了汉密尔顿抑郁量表、汉密尔顿焦虑量表、匹兹堡睡眠质量指数评定,以及整夜多导睡眠监测,并随机选取30例正常人作为对照组。结果抑郁症相关性失眠患者相对于对照组,睡眠症状方面表现出睡眠潜伏期长、维持时间短、睡眠效率低、睡眠质量差、日间功能受损、过多依赖安眠药。睡眠进程和连续性方面：总睡眠时间（TST）、睡眠效率（SE）、睡眠维持率（SMT）均短于对照组,清醒时间（WASO）、睡眠潜伏期（SL）长于对照组;睡眠结构方面：N1、N2比例长于对照组,N3、REM比例短于对照组;REM指标：REM潜伏期（RL）、REM周期数、REM时间（RT）均短于对照组,REM密度（RD）、REM活动度（RA）、REM强度（RI）均长于对照组。在抑郁症失眠组中,HAMD总分与,TST、TIB、SE、SMT、RL显著负相关;与RD、RA、RI正相关;HAMA总分与TST、TIB、SE、SMT负相关;PSQI总分与TST、TIB、SE、SMT显著负相关;睡眠潜伏期因子与SL、N2％显著负相关;睡眠持续性因子与TST、TIB负相关;催眠药物因子与SE、SMT、SL、N2％正相关。结论抑郁症相关性失眠患者失眠症状与普通失眠症相似;多导睡眠图的结果表明存在睡眠进程、睡眠结构及REM指标系列改变;抑郁的严重程度与REM指标相关,REM睡眠的改变可能是特异性的,可作为抑郁症诊断的参考。     

Insomnia symptoms and suicidality in the National Comorbidity Survey – Adolescent Supplement

ObjectiveIn this paper, we examined the relationship between insomnia symptoms and suicidality in a national sample of US adolescents, while controlling for several psychiatric disorders that are known to be associated with suicidality. Additionally, we examined whether insomnia symptoms interact to affect any suicidality variables.MethodsStudy participants were 10,123 adolescents between the ages of 13–18 from the National Comorbidity Survey – Adolescent Supplement (NCS-A).ResultsIn bivariate analyses, all insomnia symptoms (i.e., difficulty falling asleep, difficulty staying asleep, and early morning awakening) were associated with suicide ideation, plan and attempts. In multivariate analyses, controlling for substance use, mood and anxiety disorders, as well as important covariates, difficulties falling and staying asleep had a significant relationship with 12-month and lifetime suicide variables while early morning awakening did not.ConclusionsTwo of the three insomnia symptoms had a significant association with suicide thoughts and plan even after controlling for psychiatric disorders that were known to affect suicidality. Having trouble falling sleeping or staying asleep had both direct and indirect relationships (via substance use, mood and anxiety disorders) on suicidal behavior. Assessment and treatment of sleep disturbances may reduce the risk for suicidality in adolescents.