老年期痴呆抑郁和焦虑障碍共病研究

目的：了解老年期痴呆患者抑郁和焦虑障碍共病率及其相关因素。方法：将100例老年期痴呆患者分为两组，阿尔茨海默病（AD）组和血管性痴呆（VD）组。用简明精神病评定量表（BPRS）、Hamilton抑郁量表（HAMD）、Hamilton焦虑量表（HAMA）进行评定。结果：AD组有焦虑20例，伴抑郁17例；VD组有焦虑17例，伴抑郁15例。共病28例，AD组与VD组各14例。AD组与VD组在HAMD因子分有明显差异（P〈0．05）。结论：老年期痴呆患者抑郁和焦虑共病率较高，应引起高度重视。     

改良电针痉挛连续两次发作治疗重性抑郁症疗效分析

目的　探讨改良电针痉挛连续两次发作治疗重性抑郁症的疗效。方法　使用YA型电针痉挛治疗仪 ,对 64例重性抑郁症患者进行连续两次发作 (试验组 )和单次发作 (对照组 )治疗 ,采用HAMD抑郁量表评分。结果　试验组临床显效率为 82 3 % ,对照组为 60 0 % ,试验组的疗效显著性地优于对照组 (χ2 =3 94,P <0 0 5 )。HAMD抑郁量表评定 :两组治疗前后总分均值比较均有显著差异 (P <0 0 1) ,试验组和对照组治疗后总分均值有显著差异 (t=5 .10 8,P <0 0 1) ;两组 4次发作治疗后总分均值比较试验组显效快于对照组 ;试验组的绝望感、认知障碍、迟滞因子分均值减低比对照组更明显 (P <0 0 1)。结论　改良电针痉挛连续两次发作疗法见效快、疗效好 ,无明显副作用 ,是治疗重性抑郁症的一种新方法     

Dysphoric Rumination Impairs Concentration on Academic Tasks

Three studies investigated the effects of dysphoric rumination on concentration during 3 academic tasks—reading a passage from the GRE (Study 1), watching a videotaped lecture (Study 2), and proofreading written text (Study 3). Before performing these tasks, dysphoric and nondysphoric students were induced either to ruminate about themselves or to distract themselves by focusing on neutral images (all three studies) or by planning an event (Study 1). The results supported our hypothesis that dysphoric rumination, relative to distraction, would impair students' concentration. In all 3 studies, dysphoric ruminators reported difficulty concentrating, as well as interfering thoughts, during the relevant academic tasks. Furthermore, dysphoric ruminators were slower than dysphoric distractors in completing the tasks—specifically, reading the GRE passage (Study 1) and answering lecture comprehension questions (Study 2). In addition, dysphoric participants who ruminated showed impaired reading strategies (Study 1), reduced comprehension of academic material (Study 2), and poor proofreading performance (Study 3). These findings suggest that, in addition to its documented adverse effects on mood, thinking, and problem-solving, self-focused rumination interferes with instrumental behavior. Implications for social relationships and job performance are discussed.     

Effectiveness of electroconvulsive therapy in community settings.

BACKGROUND: Clinical trials indicate that electroconvulsive therapy (ECT) is the most effective treatment for major depression, but its effectiveness in community settings has not been examined. METHODS: In a prospective, naturalistic study involving 347 patients at seven hospitals, clinical outcomes immediately after ECT and over a 24-week follow-up period were examined in relation to patient characteristics and treatment variables. RESULTS: The sites differed markedly in patient features and ECT administration but did not differ in clinical outcomes. In contrast to the 70%-90% remission rates expected with ECT, remission rates, depending on criteria, were 30.3%-46.7%. Longer episode duration, comorbid personality disorder, and schizoaffective disorder were associated with poorer outcome. Among remitters, the relapse rate during follow-up was 64.3%. Relapse was more frequent in patients with psychotic depression or comorbid Axis I or Axis II disorders. Only 23.4% of ECT nonremitters had sustained remission during follow-up. CONCLUSIONS: The remission rate with ECT in community settings is substantially less than that in clinical trials. Providers frequently end the ECT course with the view that patients have benefited fully, yet formal assessment shows significant residual symptoms. Patients who do not remit with ECT have a poor prognosis; this underscores the need to achieve maximal improvement with this modality.     

Antidepressant-associated maniform states in acute treatment of patients with bipolar-I depression

Medical records of 158 patients with bipolar depression were analysed for the incidence of a switch from depression to maniform states (mania and hypomania). Relation to psychopharmacological treatment was investigated. Thirty-nine (25%) patients of the total sample had switched to a maniform state during the treatment period in the hospital. Among that group the phenomenon occurred in 23 patients (15%) as a hypomania and in 16 patients (10%) as a mania. Patients with a switch were significantly more often treated with tricyclic antidepressants (TCA) than patients without switch (79.5% vs 51.3%). Mood stabilising medication might reduce the risk for switching, especially in patients treated with TCA; however, it seems not totally sufficient, since 59% of the switched patients received mood stabilisers. The switch phenomenon was not associated with sociodemographic or clinical data. Received: 23 September 1998 / Accepted: 28 September 1998     

A preliminary study of serotonergic antidepressants in treatment of dysthymia

Rosenthal, Jesse et al. A Preliminary Study of Serotonergic Antidepressants in the Treatment of Dysthymia. Prog. Neuro-Psychopharmacol. & Biol. Psychiat. 1992, 16(6): 933–941.

1. 1. There is increasing evidence that antidepressants may alleviate symptoms of dysthymia, but few prior studies on selective serotonergic agents.

2. 2. Twenty patients meeting criteria for dysthymia, but not meeting criteria for major depression, received open label trials of a serotonergic antidepressant, either fluoxetine or trazodone.

3. 3. Seventeen (85%) completed three-month medication trials, and of these, twelve (70.6% of completers) responded to treatment. Seven (41.2% of completers) were still in remission on followup at five months.

4. 4. Both fluoxetine and trazodone were well tolerated in dysthymics, and showed similar short-term effectiveness in treating dysthymic symptoms.

Temporal Delta Wave and Ischemic Lesions on MRI

Abstract: The present study was designed to determine the clinical significance of a temporal low-voltage irregular delta wave (TLID) on EEG. Among 808 EEG records examined during one year at our hospital, the TLID was commonly detected in patients with clinically diagnosed ischemic brain diseases such as multiple infarction. Subsequently, a relation of the TLID to ischemic lesions on MRI was examined in 50 elderly depressive patients. It was found that there was a close correlation between the occurrence of the TLID and small ischemic lesions on MRI (p<0.001). These results suggest that the TLID is a valuable indicator of minor ischemic changes of the brain.     

Control over uplifts and hassles and its relationship to adaptational outcomes

The relationship of perceived control over daily uplifts and hassles to depression and restraint was examined in a sample of 140 middle-class sixth graders. Results indicated that greater control over uplifts was associated with better functioning and lower control over hassles with poorer functioning, even after partialing out the respective number of uplifts and hassles reported. Moreover, when directly compared, control over uplifts showed more powerful associations with adaptational outcomes than did control over hassles. In a separate analysis, the number of uplifts over which children reported high control showed opposite relationships to adaptational outcomes than did the number of uplifts over which children reported low control. A different pattern appeared for hassles. Although the number of hassles with low control was associated with poorer functioning, the number of hassles over which children had high control was unrelated to adaptational outcomes. The possibility that control operates somewhat differently for positive and negative events is discussed.This research was supported by a grant to the second author from the Stanford Center for the Study of Families, Children and Youth. The authors are grateful to Rachelle Hacket for data analysis, Tom Gehring for data collection, and Susan Nolen-Hoeksema for critical comments.