成人心脏手术患者合并焦虑和抑郁的研究进展

焦虑是一种带有恐惧成分的强烈行为和心理反应,抑郁是一种以心境的高涨或低落为主的精神障碍,两种症状均伴有认知和行为的改变,是心脏病患者常见的共患病。心脏手术是引发患者特定情绪和生理反应的重要因素之一,术后持续或首发的抑郁和焦虑不仅会增加手术并发症、近期或远期的死亡率和医疗费用等,还会严重影响患者的社会功能和生活质量。随着生物-心理-社会医学模式的转变,对心脏手术患者进行围术期的心理状态和生物学风险评估必不可少。本文对心脏手术患者焦虑和抑郁的特点、相关机制及治疗干预等进行综述。     

帕罗西汀联合认知行为疗法治疗广泛性焦虑障碍对照研究

目的：探讨帕罗西汀联合认知行为疗法治疗广泛性焦虑障碍患者的疗效和安全性。方法将60例广泛性焦虑障碍患者按随机数字表法分为两组,每组30例,均晨口服帕罗西汀治疗,研究组联合认知行为治疗,观察8周。治疗前后采用汉密顿焦虑量表、汉密顿抑郁量表、症状自评量表评定疗效,副反应量表评定不良反应。结果两组汉密顿焦虑量表、汉密顿抑郁量表总分及症状自评量表躯体化、人际关系、抑郁、焦虑因子分均较治疗前显著下降（P＜0．01）,研究组评分显著低于对照组（ P＜0．05或0．01）;研究组总有效率为93．3％,对照组63．3％,研究组显著高于对照组（P＜0．01）。治疗后两组副反应量表评分及各项不良反应发生率比较差异均无显著性（P＞0．05）。结论帕罗西汀联合认知行为疗法治疗广泛性焦虑障碍患者具有协同增效作用,起效快,疗效显著,安全性高。     

Serotonin transporter polymorphism modifies the association between depressive symptoms and sleep onset latency complaint in elderly people: results from the ‘InveCe.Ab’ study

Previous studies have documented the involvement of the central nervous system serotonin in promoting wakefulness. There are few and conflicting results over whether there is an actual association between bearing the short allele of serotonin transporter promoter polymorphism (5‐HTTLPR) and worse sleep quality. This study examined whether sleep onset latency complaint is associated with the 5‐HTTLPR triallelic polymorphism in the SLC6A4 gene promoter and whether this polymorphism influences the relationship between sleep onset latency complaint and depressive symptoms in elderly people. A total of 1321 community‐dwelling individuals aged 70–74 years were interviewed for sleep onset latency complaint and for sleep medication consumption. Participants’ genomic DNA was typed for 5‐HTTLPR and rs25531 polymorphisms. Depressive symptoms were evaluated with the Geriatric Depression Scale Short form and general medical comorbidity was assessed by the Cumulative Illness Rating Scale. The presence of a past history of depression was recorded. The S′ allele of the 5‐HTTLPR triallelic polymorphism was associated with sleep onset latency complaint. This association was maintained after adjusting for depressive symptoms, sex, age, history of depression and medical comorbidity. After stratification for 5‐HTTLPR/rs25531, only in S′S′ individuals high depressive symptoms were actually associated with sleep onset latency complaint. These data indicate that the low‐expressing 5‐HTTLPR triallelic polymorphism is an independent risk factor for sleep onset latency disturbance. Furthermore, the 5‐HTTLPR genotype influences the association between depressive symptoms and sleep onset latency complaint.     

Non‐classical mechanism of α‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazolepropionic acid receptor channel block by fluoxetine

Antidepressants have many targets in the central nervous system. A growing body of data demonstrates the influence of antidepressants on glutamatergic neurotransmission. In the present work, we studied the inhibition of native Ca²⁺‐permeable and Ca²⁺‐impermeable α‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazolepropionic acid (AMPA) receptors in rat brain neurons by fluoxetine. The Ca²⁺‐impermeable AMPA receptors in CA1 hippocampal pyramidal neurons were weakly affected. The IC₅₀ value for the inhibition of Ca²⁺‐permeable AMPA receptors in giant striatal interneurons was 43 ± 7 μm . The inhibition of Ca²⁺‐permeable AMPA receptors was voltage dependent, suggesting deep binding in the pore. However, the use dependence of fluoxetine action differed markedly from that of classical AMPA receptor open‐channel blockers. Moreover, fluoxetine did not compete with other channel blockers. In contrast to fluoxetine, its membrane‐impermeant quaternary analog demonstrated all of the features of channel inhibition typical for open‐channel blockers. It is suggested that fluoxetine reaches the binding site through a hydrophobic access pathway. Such a mechanism of block is described for ligands of sodium and calcium channels, but was never found in AMPA receptors. Molecular modeling suggests binding of fluoxetine in the subunit interface; analogous binding was proposed for local anesthetics in closed sodium channels and for benzothiazepines in calcium channels.     

Current Approaches to the Management of Peripheral Neuropathic Pain

Symptoms and signs of neuropathic pain can be both positive and negative. Tricyclic antidepressants are the first-line treatment option for neuropathic pain. Opioid agonists have demonstrated efficacy in patients with neuropathic pain. Combination therapy in the management of neuropathic pain is not well researched.

?This report is adapted from paineurope 2015: Issue 1, ©Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, Ltd., and is distributed free of charge to health care professionals in Europe. Archival issues can be viewed via the Web site: www.paineurope.com, at which health professionals can find links to the original articles and request copies of the quarterly publication and access additional pain education and pain management resources.