Heart and mind: (1) relationship between cardiovascular and psychiatric conditions

The relationship of our emotions and psyche to heart disease is intriguing. In this article we have reviewed the evidence linking cardiovascular and neuropsychiatric disorders and the possible mechanisms and pathophysiology of this association. This review is derived from Medline searches (1966-2002) using the relevant search terms (psychiatric disease, cardiovascular disease, depression, anxiety, and pathophysiology). Finally, the possible role of using mood enhancing therapies (mainly antidepressants) and their safety in patients with cardiovascular disorders is briefly discussed. In a companion paper, the therapeutic aspects of these two conditions is highlighted.     

Association between common cardiovascular drugs and depression

Objective:Cardiovascular diseases are associated with an increased risk of depression, but it remains unclear whether treatment with cardiovascular agents decreases or increases this risk. The effects of drugs on individual usage are also often unknown. This review aimed to examine the correlation between depression and common cardiovascular drugs, develop more potent interventions for depression in cardiovascular patients, and further research on the bio-behavioural mechanisms linking cardiovascular drugs to depression.Data sources:The data in this review were obtained from articles included in PubMed, EMBASE, and Web of Science.Study selection:Clinical trials, observational studies, review literature, and guidelines about depression and cardiovascular drugs were selected for the article.Results:We systematically investigated whether the seven most used cardiovascular drugs were associated with altered risk of incident depression in this literature review. Statins have been proven to have antidepressant effects. Some studies believe angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blocker (ARB) can exert an antidepressant influence by acting on the renin-angiotensin system, but further clinical trials are needed to confirm this. Beta-blockers have previously been associated with depression, but the current study found no significant association between beta blockers and the risk of depression. Aspirin may have antidepressant effects by suppressing the immune response, but its role as an antidepressant remains controversial. calcium channel blockers (CCBs) can regulate nerve signal transduction by adjusting calcium channels, but whether this effect is beneficial or harmful to depression remains unclear. Finally, some cases have reported that nitrates and diuretics are associated with depression, but the current clinical evidence is insufficient.Conclusions:Statins have been proven to have antidepressant effect, and the antidepressant effects of ACEIs/ARB and aspirin are still controversial. CCBs are associated with depression, but it is unclear whether it is beneficial or harmful. No association has been found with β-blockers, diuretics, and nitrates.     

抑郁症与心血管疾病共病机制的研究进展

抑郁症与心血管疾病之间存在着双向关联,即抑郁症患者比健康个体更易罹患心血管疾病,反之亦然,且抑郁症还是预测心血管疾病患者预后的独立危险因素。本文总结了抑郁症与心血管疾病之间关系的流行病学证据,以及二者共病的潜在发生机制,包括生活方式、炎症、下丘脑-垂体-肾上腺轴及自主神经功能障碍等,这些机制的发现可能对预防及治疗抑郁症与心血管疾病共病有着重要意义,同时也提示早期对心血管疾病患者进行抑郁症筛查、管理,是一个十分重要且可以实现的目标。但如何实现还需要大量研究来确定抑郁症与心血管疾病共病患者的最佳管理方案。     

293例二类精神药品门诊处方分析

目的分析评价我院293例二类精神药品的使用情况,为精神药品的临床合理用药提供参考。方法选取河南科技大学第一附属医院2012年1-3月份门诊精神药品处方,按性别及年龄区间的处方数和连续用药情况等进行统计,并对各药的用药频度（DDDs）和药物利用指数（DUI）进行分析。结果在293例第二类精神药品中,5种药品的DUI小于1.0,有1种大于1.0;大于60岁的患者使用率高,连续用药时间也较长。结论我院二类精神药品使用基本合理,但一部分老年患者连续用药过长,呈现滥用甚至出现精神依赖性情况,应引起临床医师的高度重视。     

心血管疾病患者伴焦虑抑郁症状的临床分析

目的 :探讨心血管疾病患者伴焦虑抑郁症状的临床特征及治疗。方法 :对心血管内科住院的 10 47例心血管疾病伴焦虑抑郁症状的患者进行回顾性分析。结果 :心血管疾病患者中伴有焦虑抑郁症状者占 13 4% ;其常表现为类似心绞痛、类似左心衰的症状 ,可伴有心律失常 ;高血压病合并有焦虑抑郁患者对血压升高的耐受性差 ,动态血压检查以非杓型改变者居多 ;单纯使用心血管药物治疗效果欠佳 ,合并使用抗焦虑抑郁药物疗效显著。结论 :心血管疾病患者常伴有焦虑抑郁症状 ,应注意识别其类似于心血管疾病的躯体化症状 ,此类患者在原发心血管疾病治疗的同时加用抗焦虑抑郁药物治疗是安全有效的     

心血管疾病并发焦虑抑郁症状2050例心理干预治疗分析

目的:了解心血管疾病并发焦虑抑郁症状的情况并探讨心理干预等对焦虑抑郁症状的影响。方法:对住院的2050例心血管疾病并发焦虑抑郁症状的患者进行回顾性分析。结果:心血管疾病患者中并发有焦虑抑郁症状者占56%;其常表现为类似心绞痛、左心衰竭症状,可并发有心律失常;高血压病并发有焦虑抑郁患者对血压升高的耐受性差,动态血压检查以非勺型改变者居多;单纯使用心血管药物治疗效果欠佳,心理干预,焦虑抑郁症状严重者结合抗焦虑抑郁药物疗效显著。结论:心血管疾病患者常并发焦虑抑郁症状,心理干预治疗等可有效改善患者的症状。     

COX‐2 inhibitors and the heart: are all coxibs the same?

The selective COX-2 inhibitors (coxibs) were originally developed to minimise the adverse effects of conventional non-steroidal anti-inflammatory drugs (NSAIDs) while maintaining the same analgesic and anti-inflammatory properties. Many large studies confirmed the improved gastric side effect profile of coxibs compared with non-selective NSAIDs; however, reports of increased cardiovascular morbidity and mortality followed, and the manufacturer Merck was forced to withdraw rofecoxib (Vioxx) from the market. Other coxibs have also either perished or had restrictions placed on their use. However, there seem to be significant differences between coxibs regarding their cardiovascular profiles, and the evidence for a class effect is dubious. In this paper, the current body of knowledge regarding the cardiovascular toxicities of coxibs is reviewed. The take home message for prescribing NSAIDs and those coxibs still on the market seems to be one of caution rather than contraindication, except in patients with significant cardiovascular risk factors.     

麻醉药品与精神药品临床应用及管理控制

目的目前，药物滥用已经成为对人类生存和发展构成重大威胁的全球化问题，引起各国政府高度重视，麻醉药品和精神药品在临床应用中需严加管制。方法对430例病人用药情况进行分析，评估。结果指导医务人员在诊疗工作中合理使用麻醉药品和精神药品。结论从各方面做出用药规定，采取严格管制措施，最大限度控制药物滥用现象。     

住院冠心病患者伴发抑郁障碍状况的临床探讨

目的探讨住院冠心病患者伴发抑郁障碍状况及影响因素。方法选择我院2011年4月～2012年12月心血管科收治的冠心病患者400例,采用抑郁自评量表（SDS）对所有患者进行抑郁障碍程度评定,并统计抑郁患者抑郁程度以及与性病关系,调查分析抑郁患者临床资料,总结冠心病伴发抑郁障碍影响因素,将抑郁障碍患者定义为实验组,随机抽取同等数量非抑郁冠心病患者作为对照组,调查两组患者功能失调性态度总分,进行认知评价。结果400例患者中无抑郁障碍患者为335例,抑郁障碍65例,占16．25％,65例抑郁患者中,轻度抑郁23例,中度抑郁35例,重度抑郁7例,各抑郁程度男女发生例数对比差异显著（P〈0．05）,对65例冠心病伴发抑郁患者临床资料进行调查分析,多因素Logistic回归分析结果显示,住院冠心病患者抑郁障碍与个人因素、经济因素、慢性病因素、突发事件因素、不良嗜好因素关系密切。实验组与对照组功能失调性态度总分对比,差异有统计学意义（P〈0．05）。结论影响冠心病患者抑郁障碍因素较多,其中性别为其中明显因素之一,其次为个人因素、经济因素、慢性病因素、突发事件因素、不良嗜好因素。冠心病患者认知评价水平也是影响其抑郁障碍的重要因素。     

钠葡萄糖协同转运蛋白2抑制剂治疗2型糖尿病伴慢性肾脏病患者的临床应用及挑战

2型糖尿病（T2DM）是心脑血管不良事件的独立危险因素，约80%的T2DM患者死于心脑血管疾病。传统降糖药物在长期应用后可引起体质量增加、血压升高以及频发低血糖等不良反应，均可增加患者心脑血管不良事件发生风险。近年研究显示，新型降糖药物钠葡萄糖协同转运蛋白2（SGLT2）抑制剂可同时降低T2DM患者血糖水平、减轻体质量、降低血压、改善心脑血管结局，然而这些研究数据大多来源于肾功能良好和正常人群。在真实世界中，T2DM患者中20%~40%以上同时伴有慢性肾脏病（CKD），目前针对SGLT2抑制剂在T2DM伴CKD患者中应用的研究相对较少。本文总结了目前所累积的临床研究证据，包括SGLT2抑制剂对T2DM伴CKD患者血糖、血压、体质量、血脂等心脑血管不良事件危险因素以及对心脑血管结局的影响。得出SGLT2抑制剂可降低T2DM伴CKD患者血糖、血压和体质量，显著改善患者心脑血管结局，而且不同SGLT2抑制剂的心脑血管保护效果有所差异。     

Use of anti-inflammatory drugs by patients admitted with small or large bowel perforations and haemorrhage

The intake of anti-inflammatory drugs by 268 patients with colonic or small bowel perforation or haemorrhage was compared with that by a group of patients, matched for age and sex, with uncomplicated lower bowel disease. Patients with perforation or haemorrhage were more than twice as likely to be takers of anti-inflammatory drugs, but no association was detected with the intake of other types of drugs, particularly cardiovascular drugs. The association between complicated lower bowel disease and intake of anti-inflammatory drugs may be causal.     

综合医院心血管疾病与抑郁焦虑的相关研究进展

在综合医院里,心血管疾病是一类发生率和致死率较高的疾病,其风险因素和疾病预防一直是人们研究的重点.近年来,因心理因素如抑郁焦虑对心血管疾病患者的重要影响,使作为可控因素的心理因素成为研究关注的重点.抑郁焦虑可以增加心血管疾病的发生率,抑郁焦虑的人群出现心血管疾病的几率要比正常人群高,并且可以加重心血管疾病的不良后果如增...     

Psychotropic drugs and paediatrics: a critical need for more clinical trials

Many children in the USA are prescribed psychotropic drugs that have not been fully investigated in paediatric clinical trials. The common practice of prescribing psychotropic drugs off-label poses unknown and potentially serious short- and long-term consequences for these children. This paper briefly reviews the factors associated with the lack of paediatric clinical trials. We advocate a shift toward increasing paediatric trials with psychotropic drugs through a combination of adequate safety controls, additional reimbursement/compensation, a more organised and large-scale effort to collate results and outcomes across researchers and studies and additional public education about the importance of this research. In addition, we encourage the re-examination of the ethical standards for children's participation in phase 1 clinical trials as well as argue for longitudinal developmental studies on children who are prescribed off-label psychotropic drugs.     

风湿免疫病患者并发心血管疾病的研究进展

风湿免疫病是一组常见的慢性疾病，主要影响关节、肌腱、韧带、骨骼和肌肉组织，这类疾病可导致身体的残疾。尽管由于早期的诊断，积极有效的治疗，在过去的几十年里，风湿免疫病患者的死亡率明显下降，然而，和正常人群相比，风湿免疫病患者的死亡率仍然很高。流行病学证据显示较高的死亡率归因于风湿免疫病患者较高的并发症，尤其是心血管并发症，如缺血性心脏疾病、心瓣膜疾病、心肌病、心包疾病和心脏传导系统的异常。尽管风湿免疫病患者伴发心血管疾病的机理尚不完全清楚，但是传统心血管病的风险因子如吸烟、缺乏锻炼、高血压、高血脂、高血糖，风湿免疫病患者体内持续的慢性炎症和药物治疗带来的副作用如糖皮质激素的长期应用等可能是风湿免疫病患者伴发心血管疾病的主要原因。风湿免疫病可增加患心血管疾病的风险，而心血管疾病又是风湿病患者死亡的首要原因。因此有效的预防和治疗心血管并发症非常重要，了解风湿免疫病患者的心血管疾病的伴发情况，可以更好的帮助患者预防这些并发症，延长寿命，提高生活质量。本文综述了近年来风湿免疫病患者伴发心血管疾病的临床常见情况及这些伴发疾病的发病机理和预防治疗的研究进展。      

精神专科医院2015-2017年门诊第二类精神药品利用分析与评价

目的 对精神科2015～2017年门诊第二类精神药品利用情况进行调查分析与评价,为临床合理用药提供依据。方法 对2015～2017年本院第二类精神药品销售量、销售金额、用药频度（DDDs）及日均费用（DDC）等进行分析。结果 我院第二类精神药品的销售量、用药频度逐年递增,其中苯二氮卓类占主导地位。销售量前五位分别是氯硝西泮、劳拉西泮、艾司唑仑、阿普唑仑和右佐匹克隆,而奥沙西泮递增趋势明显,唑吡坦销售量逐年下降。DDDs较高前三位分别是氯硝西泮、阿普唑仑和劳拉西泮,奥沙西泮在2017年度DDDs上升明显,其余品种基本保持平稳状态。销售金额排序前三位分别是右佐匹克隆、劳拉西泮和氯硝西泮。DDC排序前三位分别是奥沙西泮、右佐匹克隆和唑吡坦,此三个品种的DDC均超过10元,DDC最低的两个品种为艾司唑仑和阿普唑仑,其DDC值均低于1元。 结论第二类精神药品在我院门诊使用基本合理,符合相关使用指导原则。个别品种使用率较高,存在一定程度的滥用,要加强管理,减少和避免产生依赖。     

Atrial Pacing to Control Heart Rate and Rhythm in Acute Cardiac Conditions

Increasing the heart rate by a bedside atrial pacing technique was successfully utilized to treat serious cardiac arrhythmia or failure in 13 patients. Nine of these had ventricular arrhythmia refractory to drugs. Seven had evidence of sinus node depression or disease since their sinus pacemaker was below 70 beats per minute under decompensated conditions. In five, coronary artery disease was associated with the bradycardia and in two, digitalis toxicity was related to depression of the intrinsic pacemaker rate. Two patients in the coronary group required implantation of a permanent demand ventricular pacemaker. Hemodynamic studies were performed in seven patients. Only one patient had no increase in cardiac output with pacing rates above his resting rate. The other six patients showed an increase in cardiac output from 22 to 81% at paced rates between 70 and 125/minute. The duration of pacing ranged from one hour to 14 days and averaged five days.     

Proteinuria: value as predictor of cardiovascular mortality in insulin dependent diabetes mellitus

The relation between diabetic microangiopathy and macroangiopathy was studied by analysing the relative mortality from cardiovascular disease in patients with insulin dependent diabetes mellitus with and without persistent proteinuria. The study group comprised 2890 diabetics diagnosed between 1933 and 1972 before the age of 31, and the study was conducted by using the linear logistic discrete failure time model. In patients with proteinuria the relative mortality from cardiovascular disease was 37 times that in the general population; in patients without proteinuria it was 4.2 times that in the general population. In both groups women had a relative mortality twice to 2.6 times that of men. In neither group was relative mortality correlated with duration of diabetes, suggesting that the association between diabetes and cardiovascular disease may be conferred by factors other than hyperglycaemia and hyperinsulinaemia. The high relative mortality from cardiovascular disease in diabetics with proteinuria indicates a strong association between diabetic microangiopathy and macroangiopathy, suggesting a common (pathogenetic?) mechanism for these two late diabetic complications.     

麻醉药品、一类精神药品使用措施与效果研究

目的:探讨一种切实可行的麻醉药品、一类精神药品医院使用管理方法。方法:加强医护人员癌症疼痛处理新知识的学习和临床应用,对癌症患者信息实行局域网内管理,并对新措施实施前后的数据进行统计学处理,一类精神药品使用方法类同。结果:经三级止痛阶梯疗法治疗的患者癌痛理想控制率为90.6%,药物依赖性产生率为3.1%,患者满意度为94.8%;非经系统治疗患者癌痛理想控制率为67.5%,药物依赖性产生率为27.5%,患者满意度为54.9%。结论:将麻醉药品、一类精神药品纳入局域网管理,对癌症患者进行三级止痛阶梯疗法系统治疗对于癌症患者疼痛的解除、提高抗癌疗效、延长病人存活天数都有积极意义。     

Factors Associated with Quality of Life in Acute Exacerbation of COPD

~~Factors Associated with Quality of Life in Acute Exacerbation of COPD