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.     

社区老年糖尿病患者抑郁障碍现况调查

目的:调查社区老年糖尿病患者抑郁障碍的患病率及其危险因素。方法:对2015年采用多层次整群随机抽样法抽取的上海市浦东新区常住户籍≥60岁的3 579名老年居民进行调查;以《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)为诊断工具,对患有糖尿病的老人抑郁障碍患病率、抑郁障碍特点及其危险因素进行分析。结果:共有3 478位社区老年居民完成调查,525例(15.09%)符合糖尿病诊断,446例(12.82%)符合抑郁障碍诊断。糖尿病患者中100例(19.05%)共病抑郁障碍,2 953位非糖尿病老人中抑郁障碍的发生率为11.71%(346例);糖尿病组抑郁障碍检出率明显高于老年非糖尿病组(P0.05)。Logistic回归分析显示老年糖尿病患者共病抑郁障碍与年龄、有脑梗死病史及心脏病史相关。结论:社区老年糖尿病患者抑郁障碍患病率高,尤其是高龄及有心脑血管病史者。     

抑郁障碍患者非自杀性自伤行为及其风险因素分析

目的:探讨抑郁障碍患者非自杀性自伤(NSSI)行为及其风险因素。方法:采用自编的一般情况调查表收集153例抑郁障碍患者一般资料(性别、年龄、受教育年限、病程等);应用NSSI行为问卷对入组者进行评估并将其分为伴与不伴NSSI两组,应用简明国际神经精神访谈中文版(MINI)评估患者是否共病焦虑障碍;分析NSSI行为的风险因素。结果:59例(38. 6%)患者有NSSI行为,归为伴NSSI组;不伴NSSI组(94例)。伴NSSI组女性患者的比率及共病焦虑障碍的比率明显高于不伴NSSI组(P均0. 01),年龄明显低于不伴NSSI组(P 0. 05)。伴NSSI组中,女性患者NSSI行为方式依次为割伤、阻止伤口愈合、刺伤,男性患者依次为割伤、灼烧伤、过度摩擦皮肤;性别间NSSI行为分布比较差异有统计学意义(P 0. 05);共病焦虑障碍患者NSSI方式及频率与非共病焦虑障碍者比较差异具有统计学意义(P均0. 05)。二分类Logistic回归分析显示共病焦虑障碍是抑郁障碍患者NSSI危险因素。结论:抑郁障碍患者中NSSI行为发生率较高,尤其是女性患者;共病焦虑障碍抑郁障碍患者更容易发生NSSI。     

躯体形式障碍患者的人格障碍倾向调查

目的:探讨躯体形式障碍(SD)患者的人格障碍倾向。方法:对64例SD患者(SD组)和52名正常对照者(NC组)进行人格诊断问卷(PDQ-4)评估和比较。结果:SD组中,人格障碍筛查阳性为37例(57.81%),介于阳性与阴性间10例(15.6%);以C组人格障碍类型中的强迫型最常见。NC组中,人格障碍筛查阳性4例(7.7%),介于阳性与阴性间4例(7.7%)。SD组人格障碍筛查阳性率显著高于NC组(χ2=31.54,P0.001)。结论:SD患者人格障碍筛查阳性率较高,提示人格特质异常可能与SD的发病机制密切相关。     

在校高中生功能性头痛患者抑郁障碍的调查研究

目的探讨在校高中生功能性头痛患者中焦虑/抑郁障碍的发生率及其特点,为临床治疗提供依据。方法入选对象分为病例组66例,对照组59例,均采用Zung氏焦虑自评量表和抑郁自评量表进行匿名测试,并附加要求注明性别、年级、病程、伴随症状以及农村或非农村家庭。结果焦虑、抑郁评分病例组明显高于对照组(P<0.01)。病例组与对照组相比,焦虑发生率分别为12.12%和0(P<0.05),抑郁发生率分别为48.48%和6.78%(P<0.01),焦虑者同时伴抑郁病例组中,有伴随症状者焦虑/抑郁障碍发生率明显较多(P<0.05);绝大多数焦虑/抑郁障碍患者均为病程1个月以上(P<0.01);高三患者焦虑、抑郁障碍发生率最高(P<0.05、0.01);男女相比以及城乡家庭相比差异无统计学意义(P>0.05)。结论在校高中生长时间的功能性头痛可引起焦虑/抑郁障碍,其发生率与病程、年级和是否伴随症状明显相关,而与性别、家庭无关。对头痛患者潜在焦虑/抑郁障碍的常规筛查有利于对这种共病的及早发现、及早干预和提高疗效。     

重性抑郁障碍与双相障碍患者的共病研究

目的:调查重性抑郁障碍(MDD)和双相障碍患者(BD)精神科共病情况。方法:采用横断面调查方法,对2011年3月至8月符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)诊断标准的141例重性抑郁障碍和52例双相障碍患者进行一般情况问卷及国际神经精神科简式访谈问卷(MINI)调查。结果:重性抑郁障碍组和双相障碍组精神科共病率分别为30.0%和28.8%,两组共病率差异无统计学意义(χ2=0.016,P>0.05);两组共病焦虑障碍最为常见,其共病率分别为27.0%和15.4%,差异无统计学意义(χ2=2.799,P=0.094);共病酒精依赖或物质滥用差异有统计学意义(χ2=6.405,P=0.011)。结论:重性抑郁障碍和双相障碍与其他精神科疾病存在广泛共病,尤以焦虑障碍多见。     

焦虑和抑郁障碍共病患者的人格特征研究

目的 从探讨焦虑和抑郁障碍共病的人格特征。方法 按DSM-IV诊断标准收集25例焦虑和抑郁障碍共病患者（共病组）、3-例主要抑郁症患者（抑郁组）、14例广泛性焦虑障碍和6例惊恐障碍患者（焦虑组）。对所有病例使用TABP、EPQ进行调查评定。结果与正常对照组或国内常模比较。结果 共病组的A型行为发生率与抑郁组相似，显著低于焦虑组；而共病组的TH因子分与焦虑组一样，显著高于正常对照组；共病组和抑郁组、焦虑组一样，EPQ的N因子分均显著高于国内常模。结论 焦虑和抑郁障碍共病患者独特的人格特征并不明显。     

反社会型人格障碍共病边缘型人格障碍特质的影响因素

目的:探讨反社会型人格障碍(ASPD)共病边缘型人格障碍(BPD)的人口学及心理环境影响因素。方法:对1 804名服刑人员使用人格障碍诊断问卷(PDQ-4)进行评估,筛选出反社会型、边缘型及共病人群,采用自编一般资料问卷、患者健康问卷抑郁量表(PHQ-9)、广泛性焦虑量表(GAD-7)、儿童期虐待量表(CTQ-SF)、冲动性量表(BIS-11)、自杀意念量表(SIOSS)进行问卷调查。结果:ASPD共病BPD组在冲动性、儿童期虐待、焦虑、抑郁、自杀意念各个维度和因子的得分均高于ASPD组和BPD组,除儿童虐待中躯体虐待和性虐待外,其他维度和因子均存在显著差异(P0.05或P0.01)。Logstic回归显示,情感忽视、抑郁、绝望对ASPD形成共病人格产生影响。结论:童年期情感忽视和情绪问题可能是ASPD患者发展成ASPD共病BPD患者的影响因素。     

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.     

强迫障碍共病强迫型人格障碍的研究

目的:研究强迫型人格障碍(OCPD)在强迫障碍(OCD)中的共病情况,并研究OCD共病OCPD对OCD影响。方法:以69例门诊OCD患者为研究对象,采用DSM-Ⅳ轴Ⅱ障碍用临床定式检查(SCID-Ⅱ)研究强迫障碍患者的共病人格障碍(PD)情况,将研究对象分为2组:OCD共病OCPD组和OCD不共病OCPD组,对比研究2组间临床特征的不同。结果:79.7%强迫障碍患者合并有PD,C类中的OCPD和OCD共病率达43.5%。共病组较不共病组疾病严重程度更重,表现为发病年龄早、病程更长、强迫思维更严重。结论:OCPD和OCD关系密切,OCD共病OCPD是OCD严重程度的一个标志。     

Comorbid psychiatric disorders in late life depression.

In late life depression, common comorbid psychiatric disorders are alcohol use, anxiety, and personality disorders. Elderly depressed patients are three to four times more likely to have an alcohol use disorder compared with nondepressed elderly subjects, with a prevalence of 15%-30% in patients with late life major depression. While the presence of a comorbid alcohol use disorder may worsen the prognosis for geriatric depression, limited data suggest that successful treatment of depression combined with reducing alcohol use leads to the best possible outcomes. Most studies show that the overall prevalence of anxiety disorders, particularly panic disorder and obsessive-compulsive disorder, is low in geriatric depression, but generalized anxiety disorder may not be uncommon. It remains unclear if the presence of a comorbid anxiety disorder impacts on the treatment and prognosis of late life major depression. Personality disorders occur in 10%-30% of patients with late life major depression or dysthymic disorder, particularly in patients with early onset depressive illness. Cluster C disorders, including the avoidant, dependent, and obsessive-compulsive subtypes predominate, while Cluster B diagnoses, including borderline, narcissistic, histrionic and antisocial, are rare. Overall, the research database on comorbid psychiatric disorders in major and nonmajor late life depression is relatively sparse. Since comorbid psychiatric disorders affect clinical course and prognosis, and may worsen long-term disability in late life depression, considerably more research in this field is needed.     

Personality disorders in elderly patients with dysthymic disorder.

The authors evaluated personality disorders in elderly patients with DSM-IV dysthymic disorder (DD) to identify prevalent personality disorders and their clinical correlates. Outpatients (>/=60 years; N=76) with DD were evaluated; most were male (65.8%) and had late age at onset (>50 years: 60.5%). Axis II disorders were present in 31.2% of patients, with obsessive-compulsive personality disorder (OCD; 17.1%) and avoidant personality disorder (11.8%) being the most common. Personality disorders were associated with an earlier age at onset of depressive illness, greater lifetime history of comorbid Axis I disorders, greater severity of depressive symptoms, and lower socioeconomic status. Personality disorders occurred in a minority of elderly patients with DD and mainly comprised the obsessive-compulsive and avoidant subtypes, similar to reports of personality disorders in elderly patients with major depression. In contrast, young adults with DD have been shown consistently to have personality disorders at high frequency. Together with the predominance of late onset and the lack of psychiatric comorbidity, the current findings on personality disorders reinforce our view that DD in elderly patients is typically a different disorder from DD in young adults.     

Personality and personality disorders among patients with major depression in combination with dysthymic or cyclothymic disorders

Personality traits and personality disorders in 298 consecutive outpatients with pure major depression, major depression with dysthymic or cyclothymic disorder, pure dysthymic or cyclothymic disorder and other disorders were investigated. Patients with dysthymic or cyclothymic disorders alone or in combination with major depression showed more self-doubt, insecurity, sensitivity, compliance, rigidity and emotional instability. They were more schizoid, schizotypal, borderline and avoidant according to MCMI and had a higher prevalence of DSM-III Axis II diagnoses, and more borderline, avoidant, and passive-aggressive personality disorders, as measured by SIDP. All in all, dramatic and anxious clusters of personality disorders were more frequent among patients with dysthymic-cyclothymic disorders in addition to major depression than among patients with major depression only. The findings elucidated the close connection between the more chronic affective disorders and the personality disorders, irrespective of any concomitant diagnosis of major depression.     

Increased personality disorders and Axis I comorbidity in atypical depression

OBJECTIVE: Comparison of patients with and without atypical depression on comorbid Axis I and I disorders to determine whether atypical depression is associated with a higher comorbidity. METHOD: Twenty-nine major depressive disorder patients with and without atypical depression were compared on clinical measures using multiple regression analyses. RESULTS: Atypical depression predicted the presence of comorbid Axis I (100% vs 33%), Axis II (90% vs 35%), and both Axis I and II (65% vs 8.14%) disorders. Personality disorders did not mediate the relationship between atypical depression and Axis I comorbidity. CONCLUSIONS: The high prevalence of Axis I and II comorbidity in major depression may be explained, at least in part, by the presence of atypical depression. Our findings also suggest that the increased Axis I comorbidity observed in atypical depression is independent of the effects of personality disorders and is probably a direct effect of atypical depression subtype. Future research should confirm whether clinical findings associated with atypical depression are independent of their association with personality disorders in a larger sample of depressed patients and also examine treatment implications in atypical depression other than a preferential monoamine oxidase inhibitor responsivity.     

Comorbid psychiatric disorders in Arab children with Autism spectrum disorders

The objective of our study is to estimate the prevalence of comorbid psychiatric disorders in a sample of children with autism spectrum disorders (ASD) recruited from three Arab countries. We also examine the relationship between comorbidity and children's cognitive functioning and gender. Children who received a diagnosis of ASD (n = 60) from a child psychiatric outpatient clinic in Mansoura (Egypt), Al-Ahsa (Saudi Arabia) and Amman (Jordan) were included in this study. Comorbid diagnoses were established with a clinical interview and a semi-structured clinical interview for children and adolescents (SCICA). In addition, for all patients the cognitive evaluation was measured given the range in age and level of ability. Sixty-three percent of the children were diagnosed with at least one comorbid disorder. The most commonly reported comorbid disorders were anxiety disorders (58.3%), ADHD (31.6%), conduct disorders (23.3%), and major depressive disorder (13.3%). Out of the total sample, Obsessive compulsive disorder was the most prevalent anxiety disorder (55%). Elimination disorders were also diagnosed in 40% of patients. These findings emphasize a wide variety of psychiatric comorbidity afflicting youth with ASD and may be important targets for intervention.     

Bipolar obsessive-compulsive disorder and personality disorders

OBJECTIVES: Relatively few systematic data exist on the clinical impact of bipolar comorbidity in obsessive-compulsive disorder (OCD) and no studies have investigated the influence of such a comorbidity on the prevalence and pattern of Axis II comorbidity. The aim of the present study was to explore the comorbidity of personality disorders in a group of patients with OCD and comorbid bipolar disorder (BD). METHODS: The sample consisted of 204 subjects with a principal diagnosis of OCD (DSM-IV) and a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score>or=16 recruited from all patients consecutively referred to the Anxiety and Mood Disorders Unit, Department of Neuroscience, University of Turin over a period of 5 years (January 1998-December 2002). Diagnostic evaluation and Axis I comorbidities were collected by means of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Personality status was assessed by using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). Socio-demographic and clinical features (including Axis II comorbidities) were compared between OCD patients with and without a lifetime comorbidity of BD. RESULTS: A total of 21 patients with OCD (10.3%) met DSM-IV criteria for a lifetime BD diagnosis: 4 (2.0%) with BD type I and 17 (8.3%) with BD type II. Those without a BD diagnosis showed significantly higher rates of male gender, sexual and hoarding obsessions, repeating compulsions and lifetime comorbid substance use disorders, when compared with patients with BD/OCD. With regard to personality disorders, those with BD/OCD showed higher prevalence rates of Cluster A (42.9% versus 21.3%; p=0.027) and Cluster B (57.1% versus 29.0%; p=0.009) personality disorders. Narcissistic and antisocial personality disorders were more frequent in BD/OCD. CONCLUSIONS: Our results point towards clinically relevant effects of comorbid BD on the personality profiles of OCD patients, with higher rates of narcissistic and antisocial personality disorders in BD/OCD patients.     

Prevalence of personality disorders in patients with major depression and dysthymia.

The authors administered the Structured Clinical Interview for DSM-III-R Axis I (SCID-P) and Axis II (SCID-II) Disorders to 197 patients with major depression, 63 patients with dysthymia, and 32 patients with both major depression and dysthymia ("double depression"). Fifty percent of major depressive patients, 52% of dysthymic patients, and 69% of patients with double depression were diagnosed as having at least one personality disorder. Patients with a personality disorder had higher scores on the Beck Anxiety and Depression Inventories. The most commonly diagnosed personality disorders were from the anxious/fearful cluster, most notably avoidant and dependent personality disorders.     

Current comorbidity of psychiatric disorders among DSM-IV major depressive disorder patients in psychiatric care in the Vantaa Depression Study

BACKGROUND: While numerous studies have documented the high comorbidity of major depressive disorder (MDD) with individual mental disorders, no published study has reported overall current comorbidity with all Axis I and II disorders among psychiatric patients with MDD, nor systematically investigated variations in current comorbidity by sociodemographic factors, inpatient versus outpatient status, and number of lifetime depressive episodes. METHOD: Psychiatric outpatients and inpatients in Vantaa, Finland, were prospectively screened for an episode of DSM-IV MDD, and 269 patients with a new episode of MDD were enrolled in the Vantaa Depression MDD Cohort Study. Axis I and II comorbidity was assessed via semistructured Schedules for Clinical Assessment in Neuropsychiatry, version 2.0, and Structured Clinical Interview for DSM-II-R personality disorders interviews. RESULTS: The great majority (79%) of patients with MDD suffered from 1 or more current comorbid mental disorders, including anxiety disorder (57%), alcohol use disorder (25%), and personality disorder (44%). Several anxiety disorders were associated with specific Axis II clusters, and panic disorder with agoraphobia was associated with inpatient status. The prevalence of personality disorders varied with inpatient versus outpatient status, number of lifetime depressive episodes, and type of residential area, and the prevalence of substance use disorders varied with gender and inpatient versus outpatient status. CONCLUSION: Most psychiatric patients with MDD have at least 1 current comorbid disorder. Comorbid disorders are associated not only with other comorbid disorders, but also with sociodemographic factors, inpatient versus outpatient status, and lifetime number of depressive episodes. The influence of these variations on current comorbidity patterns among MDD patients needs to be taken account of in treatment facilities.     

海洛因依赖与人格障碍共病调查

目的：调查海洛因依赖者的人格障碍共病状况。方法：采用美国精神障碍诊断与统计手册第4版（DSM-Ⅳ）系统轴Ⅱ人格障碍访谈问卷（SCID-II）（第2版）对90例海洛因依赖者进行评定及相关统计分析。结果：79例（87.8%）符合至少一种人格障碍,常见的为偏执型、强迫型、反社会型、未加标明组（被动攻击型及抑郁型）、边缘型、回避型、自恋型等,人均患2.5种人格障碍。以戏剧化-情绪组人格障碍最常见。结论：在海洛因依赖者中人格障碍共病现象相当普遍。     

The prevalence of atypical features across mood,anxiety, and personality disorders

This study examines and compares the prevalence rates of the atypical features subtype across each of the major mood, anxiety, and personality disorders (PDs). It also evaluates the impact that comorbid anxiety and PDs have on the likelihood that depressed patients will present with atypical symptoms. Eleven hundred thirty psychiatric outpatients were evaluated for the presence of atypical symptoms. All axis I diagnoses were made using the Structured Clinical Interview for DSM-IV (SCID). PDs were assessed in a subset of 530 patients using the Structured Interview for DSM-IV Personality Disorders (SIDP-IV). From a sample of 579 patients diagnosed with a current major depressive disorder, 22.5% met criteria for the atypical subtype. Prevalence rates were similar in bipolar and unipolar patients, although the pattern of symptoms was distinct. Prevalence rates were lower in patients with dysthymic disorder (12.5%), adjustment disorder with depressed mood (9.4%), and depression not otherwise specified (NOS) (7.9%). When major depression existed in the presence of a comorbid anxiety disorder, the likelihood of presenting with atypical features doubled. Nine percent of the patients diagnosed with an anxiety disorder (without a comorbid depressive disorder) met criteria for atypical features. Two of the four atypical symptoms, leaden paralysis and rejection sensitivity, were found to be especially prominent in nondepressed anxiety disorder patients. Of the 10 PDs listed in DSM-IV, only avoidant PD was associated with the atypical features subtype. In large part, this was accounted for by the high rate of rejection sensitivity in these patients. In conclusion, as many as one quarter of depressed patients who present for outpatient psychiatric treatment meet criteria for the atypical features subtype. There appears to be a strong association between anxiety and atypical depression, but the exact nature of this relationship needs to be further elucidated. It is unclear whether personality pathology is independently associated with the atypical features subtype.