老年期抑郁症的研究进展

本文介绍了近年来老年期抑郁症的流行病学、神经化学、临床诊断以及治疗等方面的研究进展状况。     

老年期抑郁症的中医治疗

老年期抑郁症是指首次发病于老年期,它是常见的精神障碍之一,由于老年期抑郁症病机复杂,起病隐匿,所以在治疗上应辨证论治,除用药物外,心理辅导也起到了关键性作用,建立一套完备的抑郁症辨证沦治体系和特色的中医心理辅导理论能提高治疗效果.口前,抑郁症的发病率呈上升趋势,它属于最常见的精神障碍之一,据统计,世界上十大疾病中抑郁症名列第五位,其患病率超过了冠心病,它的主要临床表现为情绪低落、焦虑、迟滞和繁多的躯体不适症状[1,2].     

湖州市城区老年期抑郁症的流行病学调查

根据分层随机抽样方法，进行了老年期抑郁症的流行病学调查。在湖州市城区３２５３５名居民中，有２９９３名６５岁以上的老年人，抽取１０００名按统一的诊断标准调查，其中７９例患抑郁症，患病率为７９．００‰。资料表明，老年期抑郁症的发生与生活事件、社会支持的关系密切，老年期抑郁症患者的日常生活能力明显低于对照组。提示日常生活能力的下降除了年龄、躯体因素外，抑郁情绪也是一个不可忽视的因素。     

西酞普兰治疗老年期抑郁症的临床研究

目的探索对老年期抑郁症较理想的治疗药物。方法60例老年期抑郁症患者，随机分为2组，分别给予西酞普兰和阿米替林治疗，疗程6周。用汉密尔顿抑郁量表(HAMD)和副反应量表(TESS)评定疗效和不良反应。结果西酞普兰与阿米替林疗效相近，但西酞普兰较阿米替林起效快，不良反应较小。结论 西酞普兰是治疗老年期抑郁症的安全有效药物。     

老年抑郁症的临床诊断与抗抑郁药治疗进展

老年抑郁症的临床诊断与抗抑郁药治疗进展袁浩龙（常州市德安医院，常州２１３００３）调查有关抗抑郁药使用报告，发现３％的老年门诊病人服抗抑郁药，而在综合性医院接受抗抑郁药治疗的老年病人（主要为妇女）则超过１０％。为使临床医生对老年抑郁症的诊断与治疗有一了...     

老年抑郁症治疗和预防

老年抑郁症病人的冲动、自伤、自杀行为和日常生活自理能力的丧失 ,给病人及照料者带来了严重的危害和心理压力。可见 ,老年抑郁症是一种严重损害老人健康的疾病 ,需及时加以治疗。老年抑郁症的治疗主要有药物治疗、心理治疗和电休克治疗 3大类。1　药物治疗　　使用抗抑郁药物是治疗老年抑郁症最主要的手段。药代动力学研究表明 :老年人胃肠道ｐＨ和血流量下降使药物吸收增加 ;肝肾功能减退 ,使药物半衰期延长 ;血浆中蛋白含量减少 ,又使体内游离型药物浓度升高。因此 ,在同剂量的抗抑郁药治疗下 ,老年人的疗效高于青壮年病人 ,但不良反应…     

丁螺环酮联合米氮平治疗老年期抑郁症的对照研究

目的观察丁螺环酮联合米氮平治疗老年期抑郁症的疗效和安全性。方法57例老年抑郁症患者分为2组,丁螺环酮联合米氮平治疗30例,为研究组,单用米氮平27例,为对照组。采用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）和不良反应量表（TESS）分别观察疗效和不良反应,连续观察6周。结果 在治疗第1周,2组HAMD和HAMA评分均下降,但2组间有显著性差异（P〈0．01）。第2周末开始2组间HAMD和HAMA评分差异无显著性。第6周末2组显效率分别为83．3％和81．5％,差异无统计学意义（P〉0．05）。2组间TESS评分每周差异亦无统计学意义（P〉0．05）。结论 丁螺环酮联合米氮平治疗老年期抑郁症起效更快,病人的满意度和依从性更好。     

重视老年抑郁症的诊断及治疗

随着人口老龄化的加速，老年抑郁症的发病率有上升趋势，已成为一个重要的公共卫生问题。且老年抑郁症多与其他躯体疾患如心脑血管疾病、骨折、肿瘤等疾病并存，故有其特殊性，不仅值得精神科和神经科医师的关注，亦应引起广大内科医师的重视。抑郁症是一种情绪障碍，一般...     

Outcomes of geriatric depression.

Improvement in the methodology of longitudinal investigations and increasing research interest in depressive disorders led to findings of clinical and heuristic importance. Outcomes, such as chronicity of depression, relapse, recurrence, and development of dementia, appear to be predicted by different clinical and laboratory findings. Chronicity of depression may be predicted by long duration of the current or previous episodes, coexisting medical illness, high severity of depression, nonmelancholic presentation, delusions, and perhaps cognitive impairment and neuroradiologic abnormalities. Predictors of relapse and recurrence of geriatric depression include multiple previous depressive episodes, high severity of illness, "double depression," presence of "exit" events, and intercurrent medical illnesses. Development of dementia may be predicted by a transient dementia syndrome during a depressive episode ("pseudodementia"), onset of the first depressive episode in the senium, and neuroradiologic abnormalities such as cortical atrophy and rapidly evolving ventricular enlargement. Long-term antidepressant treatment, if not controlled by a research protocol, usually is of low intensity and has a questionable effect on the outcome of depression over a long period of time. For this reason, naturalistic treatment studies are useful for identifying subgroups of depressives and time periods of high risk for specific adverse outcomes. This knowledge is particularly important in frail elderly populations who are vulnerable to side effects of antidepressant treatments. The next step is to conduct controlled-treatment studies and examine the capability of antidepressant treatments to prevent adverse outcomes in the high-risk populations identified through naturalistic treatment studies. Controlled-treatment studies can provide findings that clinicians can use to assess the risk-benefit ratio of continuation and maintenance treatments of geriatric depression. The heuristic importance of knowing the outcome of geriatric depression is that it permits identification of clinically and, to some extent, biologically-homogeneous groups. Given the absence of specific and sensitive laboratory tests, outcome is perhaps the "next best thing" to brain autopsy for subclassifying geriatric depression. Biologic measures of structural and functional abnormalities can then be used in homogeneous subgroups for the pursuit of pathophysiologic or etiologic studies.     

老年期脑梗死后抑郁危险因素探讨

目的 探讨老年期脑梗死后抑郁生发生率及其危险因素。方法 采用流调用抑郁自评量表（CESD）对78例住院老年期脑梗死病进行筛查,对≥16分者用汉密尔顿抑郁量表（HAMD）进一步检查,按有无抑郁分成抑郁级和对照组,并对2组临床资料进行统计分析。结果（1）78例中18例有抑郁情绪,抑郁发生率为23．08％。（2）2组对照发现抑郁组多见重度偏瘫和大脑半球梗死者。（3）非条件逐步Logistic回归分析发现脑梗死后抑郁危险因素是年龄、偏瘫和痴呆。结论 对老年期脑梗死病人需加强肢体功能和记忆功能训练,这对预防脑梗死后抑郁将起积极的作用。     

Confirmatory factor analysis of the geriatric depression scale

PURPOSE: The Geriatric Depression Scale (GDS) is widely used in clinical and research settings to screen older adults for depressive symptoms. Although several exploratory factor analytic structures have been proposed for the scale, no independent confirmation has been made available that would enable investigators to confidently identify scores for the subdimensions of depression represented in the scale. DESIGN AND METHODS: This article describes a confirmatory factor analysis of the 30-item GDS, with the factor structure based on an exploratory principal components analysis that was published earlier. The original study sample consisted of 327 community-dwelling adults aged 65-94 years. The confirmatory factor analysis was performed on data from an independent sample of 294 adults aged 60-98 years who resided in retirement facilities. RESULTS: The proposed final measurement model uses 26 of the items from the GDS in five factors and obtains a goodness-of-fit index of.90. The resulting distinct subdimensions are Dysphoric Mood, Withdrawal-Apathy-Vigor, Hopelessness, Cognitive, and Anxiety. IMPLICATIONS: Although results should be considered preliminary, the use of these five subdimensions as subscales for scoring purposes may improve the precision and utility of the GDS as an assessment tool for older adults in health, mental health, and research contexts.     

The spectrum of quality-of-life impairments in recurrent geriatric depression

BACKGROUND: Although recurrent major depression in elderly individuals is a disabling condition, only a few studies have systematically examined the magnitude and specificity of quality-of-life (QOL) impairments in such patients in comparison with matched controls or the elderly population. METHODS: We examined the variations in QOL scores of 100 elderly (age range 60-88 years) patients with moderate to severe recurrent major depression and compared them with published elderly population norms. Disease-specific Quality of Life in Depression Scale (QLDS) and generic Medical Outcomes Short Form-36 Health Survey (SF-36) QOL ratings obtained at baseline were analyzed. RESULTS: Compared with published elderly population norms, depressed subjects showed significant QOL impairments in five of eight baseline SF-36 items (p <.01). Women rated their QOL as worse than men on physical functioning and role physical (p <.01) and showed similar trends on all other QOL items. Compared with younger subjects, subjects aged older than 70 years reported lower QOL on the summary physical component (p <.01) and a trend for higher QOL on the summary mental component (p <.05) of the SF-36. Depression symptom ratings were correlated with some QOL measures, but accounted for less than 10% of the variance. CONCLUSIONS: Despite limitations, such as a cross-sectional design and indirect comparisons with norms generated from another study, our findings confirm the disabling nature of recurrent late-life depression and the importance of targeting both depressive symptoms and broader QOL outcomes in intervention trials.     

Development of an interview-based geriatric depression rating scale.

The geriatric depression rating scale (GDRS) is a new interview-based depression rating scale designed for use with adults 60 years of age or older. The scale was developed to fill a need for an instrument that would be sensitive to the problems encountered in assessing depression among older adults. The GDRS was designed by using items from the self-report Geriatric Depression Scale (GDS) as topic areas in a structured clinical interview similar to that of the Hamilton Rating Scale for Depression (HRSD). The 35-item rating scale was administered to 68 older individuals with a range of affective disturbance. The scale was found to have internal consistency and split-half reliability comparable to the HRSD and GDS. Concurrent validity, construct validity, external criterion validity, sensitivity, and specificity were all found to be acceptable.     

Cognitive slowing in Alzheimer's disease and geriatric depression.

Response slowing on psychological tasks is found both in Alzheimer's disease and depression. However, the underlying cause for this slowing may be different in the two disorders. This research examined whether the behavioral slowing found in Alzheimer patients results from a reduction in their rate of cognitive processing, whereas the slowing in depressed geriatric patients reflects a purely motor retardation. This hypothesis was tested using a task in which subjects had simply to determine the number of dots present in an array (i.e., enumeration). In all four subject groups (Alzheimer patients, depressed geriatric patients, healthy old controls, and healthy young controls), response time increased linearly with array size. The slope of this linear function (reflecting rate of enumeration) was the same in the normal and depressed patients, but was significantly greater in the Alzheimer patients, suggesting the presence of a cognitive slowing in Alzheimer's disease, but not in depression.