Neurocognitive markers of suicidal ideation in patients with anxiety and mood disorders

Abstract

Objective: This study aims at identifying associations between cognitive function and suicidal ideation in the sample of patients with anxiety and mood disorders (AMD).

Methods: In sum, 186 (age = 39?±?12.3 years; 142 [76.3%] females) patients with AMD were enrolled in the study. Assessment included evaluation of socio-demographic information, medication use, anxiety and depression symptoms. Cognitive tests included measures of psychomotor performance and incidental learning using the Digit Symbol Test. Trail Making Tests respectively measured perceptual speed, task-switching and executive control. Additionally, 21 patients completed tests from the Cambridge Automated Neuropsychological Test Battery measuring set shifting (Interdimensional/extradimensional set-shift), executive planning (Stockings of Cambridge), and decision making (Cambridge Gamble Task [CGT]).

Results: Almost half (45.0%, n?=?86) of the study sample patients had experienced suicidal ideations. In multivariable regression analysis, suicidal ideation was associated with a greater overall proportion of bet and risk taking on the CGT task (β?=?0.726, p?=?.010 and β?=?0.634, p?=?.019), when controlling for socio-demographic characteristics, medication use, anxiety and depression symptoms.

Conclusions: Outpatients with AMD and suicidal ideation could be distinguished by the presence of cognitive deficits in the executive function domain, particularly in impulse-control and risk taking.     

北京市50家综合医院门诊患者抑郁障碍的调查

目的 了解北京地区综合医院门诊患者抑郁障碍的患病率。方法 随机抽取50家各级综合医院为调查现场，由精神科护士用自制抑郁筛选量表调查各科门诊患者2877例，由精神科医师对筛选阳性和10％的筛选阴性者以美国精神障碍诊断与统计手册第4版（DSM—Ⅳ）为金标准做出诊断。结果 （1）符合DSM—Ⅳ重性抑郁发作者为73例，现患病率为2．54％。其中内、外科患者的患病率（分别为3．03％和3．12％）高于其他科（1.58％）；而性别分布的差异无统计学意义。（2）抑郁障碍总的现患率、年患率和终生患病率分别为3．09％、3．65％和6．16％；其中，重性抑郁障碍分别为1．97％、2．53％和4．48％。（3）检出的73例重性抑郁发作患者中，仅10例（14％）因抑郁求助和接受医生提供的服务，并被正确识别。结论北京综合医院非心理科门诊患者抑郁障碍的现患率为3．09％；患者对抑郁问题而求助医生的比例低。     

181例离退休干部抑郁状况及影响因素的研究

目的 了解离退休干部抑郁状况及有关影响因素。方法对181例离退休干部进行GDS量表评定，并进行相关分析和逐步回归分析。结果离退休干部抑郁症状患病率为25．4％，对其影响的最主要因素为身体状况、生活感觉、性别、家庭关系，标准化回归系数分别为-0．294、0．260、-0．163、-0．169。结论必须从多方面采取综合干预措施，才能改善离退休干部的抑郁状况，从而达到心理健康水平。     

Relationships Between Arousal-Related Moods and Episodic Tension-Type Headache: A Biopsychological Study

An exploratory study was conducted examining arousal-related moods and episodic tension-type headache. Twelve subjects meeting International Headache Society criteria for episodic tension-type headache and 12 headache-free controls recorded headache activity and mood eight times daily for 14 consecutive days. Moods were measured using the Activation-Deactivation Adjective Check List, a self-report list that subjectively represents general arousal along two dimensions of Tension and Energy. Headache subjects had higher Tension levels than controls even in the absence of pain, and greater variation in this dimension as well. Within the headache group, Tension during pain-free periods was significantly lower than when experiencing headache, and was correlated with headache activity. The results were taken to support Thayer's (1989) biopsychological model of mood and arousal, and are discussed in terms of the model's heuristic value for general arousal and headache research.     

抑郁症患者心理治疗的临床研究

目的 通过对照的方法,对抑郁症患者使用单纯抗抑郁药物治疗和药物合并心理治疗的疗效进行比较,探讨心理治疗在抑郁症患者治疗中的作用.方法 选取抑郁症患者120例,随机分成两组.对照组60例,男女各半,年龄18～65岁,平均(38.9±2.53)岁;心理治疗组60例,男女各半,年龄19～67岁,平均(39.7±3.12)岁.两组患者均给予帕罗西汀(商品名赛乐特)20mg/d,对照组单纯用药物治疗,心理治疗组药物加心理治疗,疗程8周.分别于第0周(基线)、干预后第2周、第4周、第8周使用汉密顿抑郁量表(HAMD)和抑郁自评量表(SDS)进行评分.结果 药物合并心理治疗组的治疗效果优于对照组(P＜0.05),且治疗时间越长,两组的疗效差异越明显.结论 心理治疗对抑郁症患者的康复有积极的作用,药物治疗合并心理治疗较单纯药物治疗更有利.     

帕罗西汀对抑郁模型大鼠不同脑区环磷酸腺苷反应元件结合蛋白的影响

目的探讨帕罗西汀在不同用药时间对抑郁模型大鼠海马、前额叶皮质环磷酸腺苷反应元件结合蛋白（CREB）磷酸化（p-CREB）及总蛋白（t-CREB）水平的影响。方法成年雄性SpragueDawley大鼠36只，随机分为6组：对照组、抑郁模型组（以下简称模型组）、抑郁模型＋用药1d组（以下简称用药1d组）、抑郁模型＋用药1周组（以下简称用药1周组）、抑郁模型＋用药2周组（以下简称用药2周组）和抑郁模型＋用药4周组（以下简称用药4周组），每组各6只。抑郁模型的制作为强迫大鼠游泳4周，每天1次，每次15min。帕罗西汀的剂量为10m∥kg体质量，灌胃给药，时间分别为1d和1，2，4周，每天1次，于每次游泳前用药。采用Westernblot法检测各组大鼠海马及前额叶皮质的p-CREB和t-CREB水平。结果（1）模型组及用药1d、1周组大鼠海马p-CREB水平明显低于对照组（P〈0．01），用药2，4周组大鼠海马p-CREB水平与对照组的差异无统计学意义（P〉0．05）；模型组及各用药组海马t-CREB水平与对照组的差异无统计学意义（P〉0．05）。（2）模型组及用药1d和1，2周组大鼠前额叶皮质p-CREB水平均明显低于对照组（P〈0．05），用药4周组与对照组的差异无统计学意义（P〉0．05）。模型组及用药1d、1周组大鼠前额叶皮质t-CREB水平与对照组的差异无统计学意义（P〉0．05），用药2，4周组大鼠前额叶皮质t-CREB水平均明显高于对照组（P〈0．05或P〈0．01）。结论慢性强迫游泳导致大鼠海马及前额叶皮质CREB活性降低，长期使用帕罗西汀可逆转此效应，提高抑郁大鼠前额叶皮质的CREB水平。     

Applying item response theory to enhance health outcomes assessment

Background Health-related quality of life (HRQL) is an accepted outcome measure in patients with mood and anxiety disorders. Yet, surprisingly little attention has been paid to the determinants. In this paper we test the hypothesis that it is associated with personality traits while controlling for mental disorders. Methods A large sample of outpatients (n=640) with mood and anxiety disorders was studied. The empirically supported five factor model of normal personality traits was assessed using the NEO-FFI and includes: neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness. Mental disorders were assessed with the CIDI, and HRQL with the SF-36. Results Regression analyses revealed that the NEO-FFI scores, with the exception of conscientiousness, were significantly associated with SF-36 subscales and summary scores, independently from the mental disorders. The percentage of explained variance due to the personality traits was highest for the subscales Vitality (10.0%), Mental Health (13.3%) and the Mental Health Summary Score (9.5%). Furthermore, specific personality traits were related to specific SF-36 subscales. Conclusions A low HRQL of patients with mood or anxiety disorders is not only determined by the disease or the current health but is also shaped by personality traits that are relatively stable throughout an individual's life time.