老年脑梗死患者恢复期情绪障碍的特征

背景脑卒中后情绪障碍以焦虑、抑郁常见,但是有关老年脑梗死患者恢复期情绪障碍的研究报告较少.目的探讨老年脑梗死患者恢复期情绪障碍的特点以及情绪障碍与神经功能障碍的关系.设计病例-对照研究.单位苏州市广济医院精神科和苏州市第二人民医院神经内科.对象2001-05/2003-06苏州市第二人民医院神经内科住院后出院的患者87例(病例组),男48例,女39例,年龄61～84岁.均首次发病,病程在第3个月的恢复期者.选择本院健康体检人员68例为对照组,神经系统检查和躯体检查正常,无精神病史,无痴呆表现,男39例,女29例,年龄60～82岁.方法根据统一的指导语,在病程第3个月完成症状自评量表(SCL-90)和改良爱丁堡-斯堪的那维亚量表(SSS)评定,一致性检验Kappa值为0.82.主要观察指标①SCL-90总分和因子分.②SSS总分.结果病例组SCL-90总分、阳性项目、阳性总分、阳性均分均高于对照组(t=4.14～8.09,P=0.000).病例组SCL-90躯体化因子、强迫因子、人际关系因子、抑郁因子、焦虑因子、恐怖因子、精神病性因子评分高于对照组(u=2.107～8.811,P=0.000).两组在敌对和偏执因子的差异无统计学意义(P＞0.05).病例组SCL-90总分及因子分与神经功能缺损总分呈正相关(r=0.806～0.293,P＜0.01).结论老年脑梗死患者恢复期常见抑郁、焦虑和恐怖等情绪障碍.其情绪障碍与神经功能缺损的严重程度有关.

Characteristics of mood disturbance in convalescent stage of senile cerebral infarct

BACKGROUND: Anxiety and depression are common in mood disturbance after cerebral apoplexy. However, there are few researches about mood disturbance in convalescent stage of senile cerebral infarct.OBJECTIVE: To investigate the characteristics of mood disturbance in convalescent stage of senile cerebral infarct and the relationship between mood disturbance and neural dysfunction.DESIGN: A case-controlled trial.SETTING: Department of Psychiatrics, Guangji Hospital and Department of Neurology, the Second People' s Hospital of Suzhou City.PARTICIPANTS: A total of 87 discharged patients(case group) including48 male and 39 female patients aged between 61 and 84 years old were selected from the inpatient department of Neurology of the Second People' s Hospital of Suzhou City during May 2001 and June 2003. They were all attacked for the first time, which were all convalescents in their 3rd months. A total of 68 healthy volunteers including 39 male and 29 female subjects aged between 60 and 82 years old who attended for physical check-up in our hospital were selected in control group, which had normal nervous system and physical check-up, no previous history of psychopathy, and no dementia.INTERVENTIONS: Patients were evaluated with symptom check list(SCL)-90 and modified SSS scales on the 3rd month of the course of disease with unified instructive language. Kappa was set at 0. 82 for consistency.MAIN OUTCOME MEASURES: ① SCL-90 total score and factor score;② SSS total score.RESULTS: SCL-90 total score, positive items, scores for positive items,and mean for positive scores of case group were significantly higher than that of control group(t=4.14-8.09, P=0.000) .Factor scores of somatization, compulsion, human relationship, depression, anxiety, phobia,and psychosis of case group were significantly higher than that of control group( u = 2. 107 - 8. 811, P = 0. 000) . There were no statistical significances in the factor scores of hostility and crankiness between two groups( P＞ 0. 05 ). SCL-90 total score was positively correlated with the total score of neural functional defect in case group( r = 0. 806 - 0. 293, P ＜ 0.01 ).CONCLUSION: Mood disturbance, such as, depression, anxiety and phobia are common in convalescent stage of senile cerebral infarct, which might be related with the severity of neural functional defect.