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1.
目的探讨文拉法辛缓释剂治疗老年抑郁症首次发病(以下简称首发)患者的有效性及安全性。方法采用随机、单盲对照法,将64例年龄大于60岁的抑郁症首发患者分为文拉法辛组[(75~150)mg/d]和氟西汀组[(20~40)mg/d],疗程均为8周。治疗前后以汉密尔顿抑郁量表(17项,HAMD)评估疗效;记录不良反应及实验室情况。结果实际完成观察63例,其中文拉法辛组31例,氟西汀组32例。治疗第2周末,文拉法辛组的HAMD总分较治疗前明显下降(P〈0.01),减分率高于氟西汀组(t=3.120,P〈0.05)。氟西汀组HAMD总分在治疗第4周末较治疗前明显下降(P〈0.01)。治疗第2,4周末,文拉法辛组有效率分别为16%和55%,氟西汀组分别为3%和25%,组间差异均有统计学意义(χ^2=9.828,P〈0.01;χ^2=18.748,P〈0.01)。治疗第6,8周末,文拉法辛组治愈率分别为39%和61%,氟西汀组分别为22%和47%,组间差异均有统计学意义(χ^2=6.817,P〈0.01;χ^2=3.945,P〈0.05);而两组有效率的差异无统计学意义(P〉0.05)。两组患者出现药物不良反应者各9例(分别占29%和28%),差异无统计学意义(χ^2=0.221,P〉0.05)。结论文拉法辛缓释剂治疗老年首发抑郁症患者起效较快、安全、疗效肯定,治疗第6,8周末时的治愈率高于氟西汀。  相似文献   

2.
目的:探讨双心医学模式下社区老年常见心脏疾病与抑郁症状共患情况。方法采用横断面调查法,共调查771名社区老年患者,采用流调研究用抑郁量表(CES-D)调查抑郁症状,追踪老年患者的门诊或住院病历记录调查其心血管疾病:包括心绞痛、冠心病和高血压。结果心血管疾病(不包括高血压)总患病率为22.7%,其中冠心病为20.5%,心绞痛为10.9%;高血压患病率为49.3%。抑郁症状在所有心血管疾病患者中的发生率是20.9%。伴心血管疾病老年人的抑郁症状发生率(33.1%)高于无心血管疾病者(18.3%),差异有统计学意义(χ^2=17.59,P〈0.001);有冠心病者的抑郁症状发生率(34.8%)高于无冠心病者(18.3%),差异有统计学意义(χ^2=20.25,P〈0.001);有心绞痛疾病患者的抑郁症状发生率(34.5%)高于无心绞痛疾病者(20.1%),差异有统计学意义(χ^2=9.19,P=0.002);有高血压患者的抑郁症状发生率(25.0%)高于无高血压者(18.4%),差异有统计学意义(χ^2=4.93,P=0.026)。结论社区老年人心血管疾病的罹患率高,在心血管疾病患者中抑郁症状的检出率比无心血管疾病患者高。需加强双心医学模式下对伴心血管疾患老年人的心理干预。  相似文献   

3.
目的探讨使用画钟测验(CDT)联合简易智力状况检查(MMSE)筛查老年认知功能障碍的可行性。方法采用多阶段分层整群抽样方法,抽取河北省石家庄市、唐山市、张家口市和邯郸市4个地区共3040名60岁以上老人,对所有被试采集一般人口学资料,同时进行CDT和MMSE评估。结果所有被调查者CDT平均(3.01士1.37)分,低于4分者为43.7%;其中男性老年人cDT〈4分者35.0%,明显低于女性的65.0%,差异有统计学意义(χ2=35.58,P〈0.01)。不同年龄段CDT〈4分者分别为60~64岁(32.2%),65~69岁(35.8%),70~74岁(45.6%),75~79岁(57.5%),≥80岁(75.1%)。不同文化程度CDT〈4分者分别为文盲82.8%,小学49.3%,初中35.7%,高中30.0%,大专以上24.8%。在2358名MMSE正常老年人中CDT测验低于正常者890名(37.74%);在1715名CDT测验正常的老年人中检测出MMSE异常者247名(14.40%)。按照CDTO~4分划分为5组进行MMSE评分比较,5组间比较差异有统计学意义(F=402.68,P〈0.01)。CDT得分与MMSE总分、视空间功能、计算力、命名、记忆力、定向力均呈正相关(r分别为0.575,0.423,0.438,0.106,0.249,0.357;P〈0.01)。结论CDT得分在一定程度上反映老年人认知、执行功能损害的状况,CDT联合MMSE可作为筛查老年人认知功能障碍的有效方法。  相似文献   

4.
早发精神分裂症的临床特点分析   总被引:3,自引:1,他引:2  
目的 了解早发精神分裂症的临床特点。方法 采用回顾性调查法,对99例早发精神分裂症患者的临床资料进行统计分析。结果 早发精神分裂症早期都存有非特征性症状,多为慢性起病(60例60.61%),性格内向(79例79.8%),早期症状中精力、注意力下降三个年龄组(≤12岁组,~15岁组,~18岁组)比较差异具有显著性(χ^2=9.9 p〈0.01),临床症状中思维破裂(χ^2=9.9 p〈0.01)、非血统妄想(χ^2=6.93 p〈0.05)、自笑(χ^2=12.83 p〈0.01)在三个年龄组中比较差异具有显著性。结论 早发精神分裂症发病例数随年龄增大而增多,临床症状亦随发病年龄增大而渐明显、丰富。  相似文献   

5.
目的探讨舍曲林对2型糖尿病患者合并抑郁症的疗效。方法将60例合并抑郁症的2型糖尿病患者,随机分为研究组(服用舍曲林组,30例)和对照组(未服用舍曲林组,30例),治疗8周。以汉密尔顿抑郁量表(HAMD)评定疗效,用糖化血红蛋白(HbAlc)水平监测血糖控制情况。结果治疗8周后,研究组抑郁症状的改善明显优于对照组(P〈0.01),痊愈率(43.3%)和有效率(66.7%)均明显高于对照组(分别为16.7%和36.7%)(P〈0.01);研究组HbAlC水平较治疗前显著下降,且明显低于对照组(P〈0.01)。结论舍曲林能明显改善2型糖尿病患者的抑郁症状,更有利于患者血糖的控制。  相似文献   

6.
目的:调查抑郁症残留症状及危险因素和其对疾病结局影响。方法:选择100例治疗12周以上抑郁症患者,评估人口社会学资料、抑郁症状、生活事件、应对方式、社会支持、生活质量和社会功能。结果:贝克抑郁自评问卷(BDI)≥5分和汉密顿抑郁量表17项(HAMD17)≥8分的患者比例分别为53%和49%;残留症状与负性生活事件(t=-4.90,P=0.00)、积极应对方式(t=8.22,P=0.00)、消极应对方式(t=-4.53,P=0.00)、社会支持(t=2.01,P=0.05)及家庭支持(t=1.97,P=0.05)明显有关;有残留症状者生活质量和社会功能显著差于无残留症状者(P〈0.01)。结论:抑郁症患者残留症状发牛率相当高.需要心弹社会干预。  相似文献   

7.
目的 探讨北京市社区伴或不伴抑郁、焦虑症状的老年人认知功能的差异,分析抑郁、焦 虑发病状况及对认知功能的影响。方法 采用方便抽取方法,2017 年10 月—2018 年1 月在北京市6 家 社区中60 岁及以上的老年人群中进行问卷调查,包括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)及认知觉察缺陷问卷(PDQ-5),调查老年人群抑郁、焦虑状况及认 知功能损害情况。结果 共纳入622 名研究对象,抑郁症状检出率为8.36%(52/622),焦虑症状检出率 为12.54%(78/622),抑郁伴焦虑症状检出率为5.95%(37/622),认知功能损害检出率为43.73%(272/622)。 老年女性认知功能损害多于男性,差异有统计学意义(χ2=5.19,P< 0.01)。抑郁症状阳性者认知功能 损害比例(44/52,84.61%)高于阴性者(228/570,40.00%),差异有统计学意义(χ2=38.55,P < 0.01);焦 虑症状阳性者认知功能损害比例(67/78,85.90%)高于阴性者(205/544,37.68%),差异有统计学意义 (χ2=64.44,P< 0.01)。Logistic 回归分析发现,老年人群认知功能损害的危险因素为女性(OR=1.98, 95%CI=1.21~3.25,P < 0.01)、焦虑症状(OR=27.89,95%CI=3.54~219.45,P < 0.01)。结论 PHQ-9、 GAD-7 可有效检出老年人抑郁、焦虑症状,PDQ-5 可尽早发现老年人认知功能损害。老年女性伴有焦虑 症状的人群认知功能损害更显著。  相似文献   

8.
目的 探讨老年人感觉器官功能缺陷与认知功能损害的关系。方法 采用横断面随机整群分层抽样方法调查≥60岁河北省社区老年人,通过面对面的访谈获取一般人口学资料,并评估感觉器官缺陷状况包括视觉、听觉、味觉、嗅觉功能;同时采用简易精神状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)进行认知功能评定。结果 (1)调查3075名老年人,有感觉器官缺陷者共1223名(39.8%)。(2)感觉器官缺陷组MMSE总分和MoCA总分为(25.52±4.32),(22.03±5.49)分低于无感觉器官缺陷组(26.41±3.86),(23.17±5.04)分,差异有统计学意义(t分别为5.84,5.84,P〈0.01);(3)感觉器官缺陷被试者中检出认知功能损害者26.5%高于无感觉器官缺陷者18.8%,患白内障/眼底病变者中认知功能障碍检出率为24.6%高于未患白内障/眼底病变者20.5%,听力障碍者中认知功能障碍检出率为31.5%高于无听力障碍者19.1%,存在嗅觉障碍者中认知功能障碍检出率为19.1%低于未患嗅觉障碍者21.8%,存在味觉障碍者中认知功能障碍检出率为27.6%高于未惠味觉障碍者21.7%,差异均有统计学意义(X^2分别为25.58,13.47,55.08,7.82,9.96;P〈0.05);老视者中认知功能障碍检出率为21.7%,非老视者为22.2%,差异无统计学意义(X^2=0.09,P=0.954)。(4)以认知功能障碍为因变量,各个感觉器官缺陷为自变量进行Logistic回归分析:白内障/眼底病变(Wald=8.85,P=0.003,RR=1.09,95%CT:1.03~1.16)和听力障碍(Wald=7.52,P=0.006,RR=1.19,95%CI:1.05~1.34)是认知功能的影响因素。结论 存在感觉器官缺陷的老年人认知功能水平低于无感觉缺陷的老年人,其中视觉和听觉障碍是认知功能损害的高危因素。  相似文献   

9.
目的分析河北省城市社区老年人抑郁情绪的危险因素及与认知功能的相关性。方法采用多阶段整群随机抽样方法,于20lO年1~12月在河北省四地区60岁以上城市社区老年人进行问卷调查。按照流调用抑郁自评量表(cEs—D)得分将老年人分为有抑郁情绪组和无抑郁情绪组,评估抑郁症状的发生率,分析两组社会人口学资料、认知危险因素以及认知功能损害的发生率差异,并对抑郁情绪与认知功能进行相关分析。结果共完成3149倒有效问卷,其中有抑郁情绪组268例,无抑郁情绪组2881例,抑郁症状的发生率为8.51%。两组在性别,受教育水平,婚姻状况,居住方式,经历生活事件数量,业余活动及社交方面的差异有统计学意义(P〈0.05)。有抑郁情绪组MMSE得分(23.70±5.116)分、MoCA得分(19.14±5.980)分明显低于无抑郁情绪组(26.32=fi3.904),(23.05±5.233)分,ADL得分(27.25±12.782)分明显高于无抑郁情绪组(21.08±4.553)分,差异均有统计学意义(t分别为10.215,11.557,-16.871;P〈0.01)。Logistic多元回归分析显示,抑郁情绪的危险因素包括女性(β=0.667,β'=0.157,OR=1.949,95%CI—1.432~2.653,Wald=17.983,P=0.000)、经历生活事件[〉2件(β=1.960,β'=0.250,OR=7.100,95%CI=4.348~11.595,Wald=61.359,P=0.000),1~2件(8—0.892,β'=0.229,OR=2.441,95%CI—1.558~3.825,Wald=15.157,P=0.000)]及业余活动低(β=0.963,β'=0.162,OR=2.621,95%CI—1.909~3.598,Wald=35.489,P=0.000)。结论老年人抑郁情绪的影响因素较为复杂,存在抑郁症状的老年人其认知功能和生活能力均低于无抑郁情绪的老年人。  相似文献   

10.
西酞普兰治疗脑卒中后抑郁对照研究的Meta分析   总被引:1,自引:0,他引:1  
目的探讨西酞普兰治疗脑卒中后抑郁的疗效及不良反应的差异。方法用Meta分析对13项西酞普兰与其他抗抑郁剂治疗脑卒中后抑郁对照研究的文章进行再分析,评价其合并效应量大小和综合显著性检验。结果西酞普兰治疗前后的自身对照,合并效应量d=-5.84,95%CI(-7.39,-4.29),综合显著性检验(χ^2=54.46,P〈0.01),提示西酞普兰治疗脑卒中后抑郁前后症状学变化有非常显著性差异,效应极强;西酞普兰与对照药在第2周末和治疗结束后的组间比较,分别为d=-1.15,95%CI(-1.66,-0.63),χ^2=19.10,P〈0.01;d=-0.45,95%CI(-0.75,-0.16),χ^2=8.94,P〈0.01,提示西酞普兰组疗效好于对照组,且起效快;西酞普兰的不良反应显著少于对照药物。结论西酞普兰疗效优于对照药物,不良反应少。  相似文献   

11.
目的对联合心境稳定剂(MS)治疗的住院抑郁症患者的临床特征进行分析,探讨其影响因素,为临床治疗提供参考。方法回顾性分析2013年12月-2016年11月于首都医科大学附属北京安定医院抑郁症治疗中心住院的共472例抑郁症重度发作患者的临床资料,对联合或不联合MS治疗的抑郁症患者人口学资料和疾病特征进行比较。结果联合MS治疗的患者比例为8.3%(39/472)。与未联合MS治疗组相比,联合MS治疗组患者年龄较小(Z=-4.435,P0.01),更多男性(64.1%vs.37.6%,χ~2=10.451,P0.01),更多无配偶(41.0%vs.19.9%,χ~2=9.460,P0.01),更多无业(38.5%vs.21.0%,χ~2=6.253,P0.05),更多18岁前起病(43.6%vs.7.2%,χ~2=51.977,P0.01),更多难治性抑郁(17.9%vs.4.6%,χ~2=11.787,P0.01),较少伴有焦虑特征(23.1%vs.44.7%,χ~2=6.813,P0.01),抗精神病药物使用率更高(76.9%vs.54.5%,χ~2=7.311,P0.01)。多元回归分析显示,患者年轻(OR=0.9,95%CI:0.91~0.98,P0.05),男性(OR=2.4,95%CI:1.1~5.7,P0.05),18岁前起病(OR=0.2,95%CI:0.05~0.4,P0.01),难治性抑郁(OR=4.9,95%CI:1.5~15.9,P0.01),更多使用抗精神病药物(OR=2.4,95%CI:1.1~5.7,P0.05)均是联合MS治疗的影响因素。结论青壮年、起病早、男性、难治性、接受抗精神病药物治疗的抑郁症患者可能更多联合心境稳定剂进行治疗。  相似文献   

12.
老年与非老年抑郁症的临床特征差异   总被引:4,自引:0,他引:4  
目的:探讨老年期抑郁症的临床特征。方法:以60例老年期抑郁症患者作老年组,选60例非老年期抑郁症患者为非老年组。对两组分别用汉密尔顿抑郁量表和汉密尔顿焦虑量表进行评定。结果:老年组抑郁症状中激越和疑病症状显著高于非老年组(P<0.01),老年组的躯体症状中自主神经系统症状、心血管系统症状和消化系统症状显著高于非老年组(P<0.05或P<0.01);躯体性焦虑和认知障碍、焦虑/躯体化和睡眠障碍的严重程度均显著高于非老年组(P<0.05或P<0.01)。结论:老年期抑郁症激越、疑病、躯体症状、焦虑、睡眠障碍及认知障碍等更加突出。  相似文献   

13.
The prognosis of depression in old age   总被引:2,自引:0,他引:2  
A prospective follow-up of depressed elderly patients is described. The subjects, 91 men and 173 women aged 60 years or over, were diagnosed as depressed in an epidemiological study using the DSM-III criteria. One hundred ninety-nine patients suffered from dysthymic disorder. The mean duration of the follow-up was 14.9 +/- 4.3 months. Outcome was not associated with sex and was good in 41% of the cases. In men, poor outcome was associated with low social participation, low frequency of visiting contacts, and poor insight into the depressive disorder. In women, poor outcome was associated with multiple depressive symptoms, depression diagnosed previous to this study, not living alone, low social participation, low self-perceived health, diurnal variation of symptoms, and the occurrence of initial insomnia, loss of libido, and hypochondriacal and compulsive symptoms. Many similarities were found in factors associated with outcome between all depressed patients and the patients whose depression was diagnosed during our epidemiological study.  相似文献   

14.
A prospective follow-up of 199 elderly (60 + yr) patients (65 men and 134 women) suffering from dysthymic disorder and 42 elderly (60 + yr) patients (13 men and 29 women) suffering from major depression is described. The mean duration of the follow-up was 15.3 ± 4.3 months for dysthymic men, 15.2 ± 4.4 months for dysthymic women, 15.3 ± 4.0 months for major depressive men and 14.0 ± 4.2 months for major depressive women. Forty-three per cent of the dysthymic men, 38% of the dysthymic women, 39% of the major depressive men and 48% of the major depressive women had a good outcome. In dysthymic men, few visiting contacts were associated with poor outcome. In dysthymic women, poor outcome was associated with many depressive symptoms, low social participation, not living alone, low self-perceived health, intensive diurnal variation of symptoms, low interest in work and activities, low sexual interest, and hypochondrial and compulsive symptoms. In major depressive men, no variable was associated with outcome. In major depressive women, poor outcome was associated with diabetes mellitus, suicidal ideas or attempted suicide, and psychomotor agitation or psychomotor retardation.  相似文献   

15.
Prevalence and correlates of depression among Saudi elderly.   总被引:2,自引:0,他引:2  
OBJECTIVES: To assess the prevalence of depression and associated factors in elderly people in Saudi Arabia.METHOD: A cross-sectional national survey of the elderly population of Saudi Arabia was conducted between January 1994 and December 1995. A stratified two-stage sampling technique was used to select the study subjects. In the first stage, a random sample of primary health care centres (PHCs) was selected in each of the five administrative regions of the country. The family health records (FHR) of each selected PHC were reviewed and a list of the elderly (60 years and over) was compiled. In the second stage, a sample of the subjects was selected from the FHR and contacted for a personal interview. The subjects' physical, social and environmental health status were assessed by an interview during which a structured questionnaire was completed. The Geriatric Depression Scale (GDS) was used to screen for depression. Other items of information in the questionnaire included subjects' sociodemographic characteristics, activities of daily living (ADL), laboratory and radiological investigations.RESULTS: The total number of elderly subjects included in this study was 7970. Their mean age+/-standard deviations was 68.8+/-7.7 (male 69.1+/-.7.7; and female 67.7+/-7.5) years. Depressive symptoms were reported in 3110 (39%) of the subjects, and 8.4% were in the severe depressive symptoms score group. Personal characteristics that correlated strongly with depression were poor education (p=0.001), unemployment (p=0.001), divorced or widowed status (p=0.001), old age and being a female (p=0.001). Living in a remote rural area with poor housing arrangements and limited accessibility within the house and poor interior conditions were also significantly associated with high depressive symptoms (p=0.001). Limited privacy, such as having a particular room specified for the elderly, was associated with more depressive symptoms than sharing a room with another person (p=0. 001). Lower incomes inadequate for personal needs as well as depending on charity or other relatives were associated with more cases of depression (p=0.001). The proportion of cases of depression correlated positively with the number of medical diagnoses and medications received (p=0.001). Significant depression was associated with loss of a close relative, living alone and limited participation in recreational activities. Perception of poor health and dependence on others for daily activities were associated with more depressive symptoms (p=0.001). Also health problems, especially faecal or urinary incontinence, were associated with more depressive symptoms (p=0.001).CONCLUSION: Depressive symptoms are common among Saudi elderly. Detection and management rates were low. Primary care teams could help these patients if properly trained. A simple instrument such as the Geriatric Depression Scale is useful and easily administered.  相似文献   

16.
目的:对上海市浦东新区慢性躯体疾病老年人共病抑郁障碍的患病率及其易感因素进行调查。方法:随机抽取浦东新区常住≥60岁老人3311名,对确诊患有慢性躯体疾病的1860例老人应用美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)轴I障碍定式临床检查患者版(SCID-I/P)作为诊断工具进行调查。结果:1860例老人中抑郁障碍时点患病率为10.91%(203例),其中恶劣心境119例(6.40%),重性抑郁发作84例(4.51%),男∶女=1∶1.05。共病抑郁障碍的患病率以高龄、独居、文化程度较高、家庭关系和邻里关系紧张、经济困难以及多种躯体疾病者为高(P均<0.01)。Logistic回归分析显示,高龄、独居、文化程度高、家庭关系紧张、多种躯体疾病是共病抑郁障碍的独立相关风险因素(P<0.05或P<0.01)。结论:上海市浦东新区慢性躯体疾病老年人随着疾病增多,共病抑郁障碍增加。  相似文献   

17.
OBJECTIVES: The primary purposes of this study were to determine the effect of dual sensory loss (i.e. combined hearing and vision loss) on depressive symptoms, to determine whether dual sensory loss has an effect on depressive symptoms when controlling for common covariates of depression, and to determine whether persons with dual sensory loss were more likely than those with a single sensory loss to experience depressive symptoms. DESIGN: Secondary analyses of 2001 National Health Interview Survey data. PARTICIPANTS: Nine thousand eight hundred and thirty-two people aged 55 and older residing in the community in the US. MEASUREMENTS: Self-report answers to questions about hearing and vision status, depressive symptoms, health, education level, poverty, social activities, social support, and functional disability (ADL and IADL status). RESULTS: Dual sensory loss had a significant effect on depressive symptoms (OR: 3.2, 95% CI: 2.8-4.0), which was lowered but still significant after controlling for covariates of depression (OR: 2.2, 95% CI: 1.7-2.9). Those with dual sensory loss were not significantly more likely than those with vision loss, but were significantly more likely than those with hearing loss, to experience symptoms of depression. CONCLUSION: Experiencing depressive symptoms is a problem that needs to be addressed with elderly persons with dual sensory loss. Not only is this population more likely to experience these symptoms, because of their sensory losses treatment for them may be problematical. Professionals working with the elderly should be aware of the increased risks of depressive symptoms in those with single or dual sensory loss, and should screen for them. If present, rehabilitation for sensory losses may help decrease them.  相似文献   

18.
Background: Mental disorders are among the most prevalent chronic conditions in old age, depression being the most widespread. The aim of this study was to examine the burden and distress reported by carers of elderly patients with depression. Method: Patients aged 60 or over starting outpatient treatment for depression and their relatives were included. Patients were assessed for the severity of depressive symptoms, behaviour and mood disturbance, and abilities of daily living. Relatives were assessed for burden and emotional distress. Results: Eighty-two patients and their relatives were included. Levels of carers' burden were high. Multiple linear regression showed that patients' behaviour and mood disturbance and relatives's emotional distress scores were independently associated with relatives' burden. Conclusions: Levels of burden were similar to those found in studies with carers of elderly people with dementia, indicating that depressive symptoms can be considered an important source of distress for caregivers. Accepted: 22 April 2002  相似文献   

19.
In 1985 a random sample of 612 elderly Chinese aged 65 and over living in the community in Sigapore was interviewed using the GMS-AGECAT package. The survey identified 35 cases and 28 subcases of depressive disorder. Five years later only 31 cases could be traced; in this subsample 10 were still depressed (32.3%), eight had recovered (25.8%), five were categorized as subcases of depression (16.1%), two were diagnosed as anxiety disorder (6.5%), one case was diagnosed as having dementia (3.2%) and five had died (16.1%). Only 25 subcases from the initial study could be traced; of these, three had developed depression (12.0%), 15 had recovered (60.0%), four remained as subcases (16.0%) and three had died (12.0%).  相似文献   

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