Advances in development of medications for alcoholism treatment

 Over the past decade, research on medications to treat alcohol problem has flourished. Naltrexone and acamprosate are tangible fruits of such endeavors and each has now earned approval in a large number of countries. Recent studies on naltrexone indicate that patient compliance is important if full benefits are to be achieved. Several laboratory studies with human subjects are beginning to elucidate the mechanisms underlying efficacy of naltrexone, as well as explaining variability of response among subpopulations of drinkers. In addition to these two agents, recent investigations have also demonstrated that the antidepressants desipramine, imipramine, and fluoxetine reduce mood-related symptoms and, to some extent, drinking itself in alcoholics who are depressed. Research to date suggests that opioid antagonists and selective serotonin reuptake inhibitors are more effective in reducing alcohol intake when used in combination. Clinical issues, methodology, and directions for future research are also reviewed in this article. In particular, issues addressed include alternative dosage regimens, necessary duration of treatment, employment of medications in combination, integration of pharmacologic agents with behavioral interventions, enhancement of patient compliance, and concurrent treatment of psychiatric comorbidity. Received: 16 December 1997 / Final version: 15 April 1998     

Comorbid disorders in hospitalized bipolar adolescents compared with unipolar depressed adolescents

This study examined comorbid psychiatric disorders in adolescents with bipolar disorder. Hospitalized bipolar adolescents (N=10) were compared to hospitalized adolescents with unipolar depression (N=33), and to adolescents with nonaffective psychiatric disorders (N=11). Results showed conduct disorder, attention-deficit hyperactivity disorder, psychosis, and having any DSM-III-R psychoactive substance use disorder were all significantly more common in the bipolar group than the unipolar depressed group. Comorbid anxiety disorder was present in 40–45% of the subjects in the unipolar and bipolar groups, but in none of the control group subjects. This study is supported in part by a grant to Dr. Borchardt from the University of Minnesota Graduate School.     

重性抑郁障碍患者躯体症状与脑源性神经营养因子和炎性因子的相关性研究

背景 大量证据表明抑郁障碍患者的躯体症状的风险比正常人高,但躯体易感性的机制尚不明确。部分研究认为前者脑源性神经营养因子前体(ProBDNF)、炎性因子水平比正常人高,而这是否与伴随的躯体症状有关还没有明确的结论。目的 探讨重性抑郁障碍(MDD)患者躯体症状与脑源性神经营养因子(BDNF)、炎性因子的特征及其相关性。方法 选取2019年2月至2020年12月山西医科大学第一医院精神卫生科门诊或住院部MDD患者59例与同期社区招募的健康志愿者32例作为研究对象。根据躯体化症状自评量表(SSS)将MDD患者分为伴躯体症状抑郁障碍(SD)组37例(SSS总分>36分)和不伴躯体症状抑郁障碍(NSD)组22例(SSS总分≤36分),32例健康志愿者为健康对照组(HC组)。收集临床资料,包括性别、年龄、受教育年限、17项汉密尔顿抑郁量表(HAMD-17)评分、SSS评分、BDNF、ProBDNF与炎性因子[C反应蛋白(CRP)、白介素4(IL-4)、白介素6(IL-6)、白介素10(IL-10)、白介素18(IL-18)、白介素23a(IL-23a)、高迁移率族蛋白B1(HMGB1)、肿瘤...     

妊娠早期女性非稳态负荷水平与抑郁的相关性研究

背景 已知慢性应激与抑郁发生相关,非稳态负荷（AL）作为评估机体慢性应激反应的综合生理指标可能在抑郁的发生过程中起着重要作用。目的 探讨妊娠早期女性AL水平与抑郁的关系。方法 采用便利抽样法,选取2021年11月—2022年6月于中国人民解放军联勤保障部队第901医院、六安市金安区妇幼保健院产检的630例妊娠早期女性为研究对象,根据有无抑郁分为抑郁组（n=162）和非抑郁组（n=468）。采用一般资料调查表、妊娠相关焦虑量表、爱丁堡产后抑郁量表进行问卷调查,通过体格检查和实验室检查收集AL相关数据。采用多因素Logistic回归模型分析妊娠早期女性AL与抑郁的相关性。结果 630例妊娠早期女性抑郁发生率为25.7%(162/630)。低水平AL(AL<3分)孕妇427例（67.8%）,高水平AL(AL≥3分)孕妇203例（32.2%）。多因素Logistic回归分析显示,高水平AL是妊娠早期女性抑郁的危险因素[OR=1.651,95%CI(1.096,2.489),P<0.05]。结论 妊娠早期女性AL与抑郁存在正向关联,高水平AL会增加抑郁的发生风险。     

Neuroendocrine aspects of the serotonergic hypothesis of depression

This review examines the role of serotonin (5-HT) in depression. Dysfunction of serotonergic neurons has been implicated as one of the causes of endogenous depression. Since serotonergic neurons innervate the hypothalamus and these neurons send collaterals to several other brain areas, it is possible that hypothalamic sites which control hormone secretion receive the same serotonergic afferents that innervate other limbic areas in the brain. Several investigators have devised neuroendocrine challenge tests measuring the effect of 5-HT agonists on plasma cortisol and prolactin in depressed patients. These tests help to identify dysfunctional 5-HT neurons, and are a "window into the brain." The secretion of cortisol and prolactin is increased predominantly by 5-HT1 receptors. However, changes in 5-HT2 receptors have also been implicated in depression. Results from our laboratory and by others suggest that brain serotonergic neurons stimulate renin and vasopressin secretion by activation of 5-HT2 receptors. Therefore, the renin and vasopressin response to 5-HT agonists should be included in neuroendocrine tests of serotonergic function in affective disorders. Since antidepressants produce a decrease in the density of 5-HT2 receptors, renin and vasopressin could be used to evaluate the antidepressant potential of new drugs.     

神经症的性压抑与心理因素的相关性研究

研究神经症患者潜在人格与性压抑和情绪的相关性.方法:对124例神经症患者进行了婚姻质量问卷(性生活、婚姻质量部份)、抑郁自评量表(以下简称SDS)、焦虑自评量表(以下简称SAS)及自编的性生活调查问卷、主题统觉测验(以下简称TAT)测评.结果:1、神经症伴性障碍组TAT潜在人格与对照组相比,在支配、性、援助、躯体社会攻击、财产破坏欲求、自我攻击、情绪变化欲求和情绪言语攻击性、躯体社会攻击、引诱、缺乏、丧失、灾害、丧失支持、躯体伤害压力上均较对照组显著增高,而成就欲求下降(P<005-001);与神经症无性障碍组相比,神经症伴性障碍组的成就、支配、教养、性欲求得分显著增高,情绪言语攻击欲求得分下降(P<001～005);2、神经症伴性障碍组的性生活质量低,性频度、性后快感均低.3、SDS、SAS与TAT中的负性欲求呈明显的相关性,性行为调查与婚姻质量量表中的性行为呈正相关.结论:神经症的性压抑与其潜在人格有密切的相关性.     

SCL-90抑郁和敌对因子特殊作用的量化研究

目的采用症状自评量表（SCL-90）对22831名大学入学新生进行心理健康状况普查,研究抑郁和敌对因子特殊作用。方法运用聚类分析把大学新生分为存在4个自然群：G1-无症状组;G2-轻度症状组;G3-中度症状组;G4-重度症状组。再对4个自然群进行回归分析。结果SCL-90新生测查中,抑郁因子对大学新生的心理问题的预测力最高;敌对因子等因子对大学新生中度心理问题具有较高预测力。结论抑郁和敌对因子对大学新生的心理问题干预具有较高的实践意义。     

西酞普兰与马普替林治疗老年抑郁症的对照研究

目的探讨西酞普兰与马普替林治疗老年抑郁症的疗效和不良反应。方法将80例老年抑郁症患者随机分成两组，一组服用西酞普兰，另一组服用马普替林，疗程6周。采用汉密顿抑郁量表（HAMD）及药物副反应量表（TESS）定疗效和不良反应。结果西酞普兰组显效率为80％；马普替林组显效率为72．5％，两组差异无显著性。西酞普兰组不良反应较马普替林组少而轻。结论西酞普兰治疗老年抑郁症的疗效确切，起效快，不良反应轻，依从性好。     

女性腹部脂肪抽吸手术前后焦虑抑郁状态调查

目的探讨女性腹部脂肪抽吸手术前后焦虑、抑郁情绪反应的发生率及变化情况。方法采用焦虑自评量表、抑郁自评量表对行腹部脂肪抽吸女性病人76例及随机抽取正常青年女性104人为调查对象。结果术前焦虑状态、抑郁状态发生率分别为28.96%、23.67%,术后焦虑状态、抑郁状态发生率分别为23.69%、18.40%,分别与对照组比较均存在显著性差异（P〈0.05）,手术前后焦虑自评量表、抑郁自评量表评分比较,术后焦虑量表评分明显低于术前（P〈0.05）,高于对照组（P〈0.05）,而术后抑郁自评量表与术前比较无显著性差异（P〉0.05）。结论女性腹部脂肪抽吸手术前普遍存在焦虑、抑郁情绪障碍,在病人术前和术后应加强心理干预。     

抑郁认知理论的研究进展

目的探讨抑郁认知理论的发展状况。方法从抑郁三联症和抑郁自我图式两方面对抑郁的认知理论的研究状况进行综述。结果抑郁三联症可缩减为对自我的消极想法1个维度,抑郁者消极自我图式中还存在大量积极信息。结论需要加强对抑郁认知理论的研究。