偏头痛伴有焦虑/抑郁及功能残疾的临床研究

目的探讨偏头痛伴焦虑/抑郁及功能残疾的相关功能残疾及影响因素。方法临床纳入94例确诊为偏头痛患者,并纳入70例健康人为对照组。分别发放焦虑自评量表(Self-rating anxiety scale,SAS)、抑郁自评量表(Self-rating depression scale,SDS)、匹兹堡睡眠量表(Pittsburgh sleep quality index,PQSI)、偏头痛残疾程度评估量表(Migraine disability assessment scale,MIDAS)、头痛影响测验(Headache impact test-6,HIT-6)调查问卷,对患者的相关进行记录并统计。结果偏头痛组并发焦虑、抑郁、睡眠障碍发生率为47.87%、50.00%、54.26%,对照组为5.71%、8.57%、24.29%,差异有统计学意义(P0.05);多元逐步分析显示:偏头痛伴焦虑/抑郁与患者的头痛程度重、病程长、有头痛家族史、睡眠质量差及生活满意度低有较为密切的联系(P0.05);患者头痛程度、发作频率、持续时间、伴发焦虑/抑郁是造成功能残疾的主要影响因素。结论头痛程度重、病程长、有头痛家族史、睡眠质量差及生活满意度低是偏头痛患者出现焦虑/抑郁等心理情绪发生的主要原因,而患者头痛程度、发作频率、持续时间、伴发焦虑、抑郁是造成患者发生功能残疾的主要原因。     

偏头痛并发焦虑抑郁等精神心理症状的相关因素分析

目的探讨偏头痛并发焦虑、抑郁等精神心理症状的相关危险因素。方法选择我院2010-03—2013-05收治的180例偏头痛患者作为研究对象,对伴焦虑、抑郁等精神心理症状患者进行相关危险因素分析。结果观察组偏头痛伴随焦虑、抑郁和睡眠障碍的发生率分别为42.2%、60.5%,均明显高于对照组(P0.05)。长期慢性发作、头痛程度重、持续时间长、发作频率高、睡眠质量差、生活满意度差等均为偏头痛伴焦虑抑郁患者的相关危险因素,且伴焦、抑郁、睡眠障碍患者的MIDAS分值均明显高于无精神心理症状患者,差异有统计学意义(P0.05)。结论偏头痛患者多伴较高的焦虑、抑郁以及睡眠障碍等,相关危险因素较多,对其生活质量有较大影响。临床医生应考虑患者伴随的相关精神心理状况,及时予以心理疏导,改善患者的睡眠质量,促进患者预后。     

共患不宁腿综合征对偏头痛患者情绪和睡眠的影响

目的探讨偏头痛患者的不宁腿综合征(RLS)的发病率及其对情绪和睡眠的影响。方法对200例偏头痛患者(偏头痛组)和100名正常成人(对照组)进行RLS发病率、严重程度、睡眠质量和焦虑及抑郁程度评分,比较偏头痛人群与对照组之间的差异。并对共患有RLS的偏头痛患者的情绪和睡眠情况进行分析。结果成人慢性偏头痛组的RLS发病率(16.25%)较对照组(5%)高,差异有统计学意义(P0.05);发作性偏头痛组的RLS发病率(12.5%)与对照组(5%)比较,差异无统计学意义(P0.05)。共患RLS的偏头痛患者较单纯偏头痛者的睡眠质量差、焦虑及抑郁评分高,差异有统计学意义(均P0.05)。头痛频率及RLS为抑郁、焦虑及睡眠障碍的影响因素(均P0.05)。偏头痛患者的汉密尔顿抑郁量表(HAMD)评分、汉密尔顿焦虑量表(HAMA)评分及匹茨堡睡眠质量量表(PSQI)评分与国际RLS评估量表(IRLS)的相关系数分别为rHAMD=0.397、rHAMA=0.434和rPSQI=0.500;RLS严重程度与抑郁、焦虑及睡眠障碍的严重程度呈正相关关系(均P0.05)。结论慢性偏头痛患者的RLS发病率更高,且RLS症状更严重。RLS的严重程度与抑郁、焦虑和睡眠障碍程度呈正相关关系。     

轻性抑郁障碍临床特征分析

目的了解轻性抑郁障碍的临床特征。方法采用自制一般情况调查表、抑郁自评量表(self-rating depression scale,SDS)、汉密尔顿抑郁量表(Hamilton depresssion scale,HAMD)24项版本、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)及社会功能缺陷量表(social disability screening schedule,SDSS)分别对符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)诊断标准的35例轻性抑郁障碍(研究组)和56例重性抑郁障碍(对照组)患者进行评定,比较两组的差异。结果研究组SDSS总分、抑郁自评量表(SDS)总粗分、汉密尔顿抑郁量表24项版本(HAMD24)总分及体重、认识障碍、日夜变化、阻滞、睡眠障碍、绝望感等因子分值低于对照组(P0.01),同时抑郁情绪、有罪感、自杀、早醒、工作和兴趣减退、阻滞、体重减轻、自知力障碍、日夜变化、人格或现实解体、偏执症状、绝望感等症状出现的频率也均低于对照组(P0.01),而躯体性焦虑、全身症状、疑病等症状出现的频率及HAMA躯体性焦虑因子分值均高于对照组(P0.05或P0.01);研究组有88.57%的患者首次就诊于非精神科,明显高于对照组(P0.01)。结论轻性抑郁障碍患者躯体症状相对较多,而抑郁情绪及社会功能缺陷程度相对较轻,首次多在非精神科就诊。     

多发性硬化与抑郁、焦虑的相关性研究

目的 探讨多发性硬化(multiple sclerosis,MS)与抑郁、焦虑情感障碍的关系.方法 采用汉密尔顿抑郁量表(Hamilton depression,HAMD)、汉密尔顿焦虑量表(Hamilton Anxiety,HAMA)、扩展的残疾状况评分(Expanded disability status scale,EDSS)量表对86例多发性硬化患者、85例健康对照者进行评分,了解MS伴发抑郁焦虑,同时应用多元回归分析方法对抑郁焦虑障碍的相关因素进行分析.结果 MS患者抑郁障碍发生率为52.3%(45例),焦虑障碍发生率为32.6%(28例),抑郁伴发焦虑26.7%(13例),均较对照组明显升高(P<0.01).病情活动期、EDSS评分高者抑郁发生率亦高,女性患者抑郁发生率高.结论 MS患者抑郁焦虑发生率较高,早期识别及干预可以明显提高患者的生活质量.     

在校高中生功能性头痛患者抑郁障碍的调查研究

目的探讨在校高中生功能性头痛患者中焦虑/抑郁障碍的发生率及其特点,为临床治疗提供依据。方法入选对象分为病例组66例,对照组59例,均采用Zung氏焦虑自评量表和抑郁自评量表进行匿名测试,并附加要求注明性别、年级、病程、伴随症状以及农村或非农村家庭。结果焦虑、抑郁评分病例组明显高于对照组(P<0.01)。病例组与对照组相比,焦虑发生率分别为12.12%和0(P<0.05),抑郁发生率分别为48.48%和6.78%(P<0.01),焦虑者同时伴抑郁病例组中,有伴随症状者焦虑/抑郁障碍发生率明显较多(P<0.05);绝大多数焦虑/抑郁障碍患者均为病程1个月以上(P<0.01);高三患者焦虑、抑郁障碍发生率最高(P<0.05、0.01);男女相比以及城乡家庭相比差异无统计学意义(P>0.05)。结论在校高中生长时间的功能性头痛可引起焦虑/抑郁障碍,其发生率与病程、年级和是否伴随症状明显相关,而与性别、家庭无关。对头痛患者潜在焦虑/抑郁障碍的常规筛查有利于对这种共病的及早发现、及早干预和提高疗效。     

老年住院患者睡眠障碍、药物滥用情况及相关因素分析

目的了解因睡眠障碍住院治疗的老年人滥用药物的情况,同时对影响睡眠的相关因素进行分析,从而使老年人能更好地改善睡眠。方法应用匹兹堡睡眠指数量表、老年抑郁量表、自评焦虑量表等对因睡眠障碍住院的110例老年人（≥60岁）进行测评,对抑郁、焦虑等相关因素与睡眠障碍的关系进行分析。结果老年睡眠障碍的患者药物滥用以阿普唑仑（67.3%）和氯硝安定（16.4%）居多;抑郁和焦虑与睡眠障碍呈正相关;饮酒和患有其他疾病对睡眠障碍的影响有较明显差异,而性别和吸烟并未发现有影响。结论药物滥用情况在睡眠障碍的老年人群中较常见;同时,抑郁、焦虑、饮酒和伴发其他疾病等因素均对睡眠有一定的影响。     

躯体化障碍患者的临床特征

目的:研究综合医院神经内科躯体化障碍患者的临床表现特点。方法:对于符合躯体化障碍诊断标准的90例患者,用自编调查表对患者进行一般资料调查,用躯体症状报告单对患者进行躯体症状统计,用抑郁自评量表(SDS)和焦虑自评量表(SAS)评定抑郁和焦虑状态。结果:躯体化障碍患者女性较男性多见,平均病程5年,过去一年就诊次数平均为12次。对医生的诊断和治疗不满意,85.6%的患者表示可疑或不信任。患者临床症状出现频率高的依次是头晕(74.4%)、头痛(71.1%)、睡眠障碍(70.0%)等。症状可以累及多个系统,其中慢性疼痛症状敏感性最高。躯体化障碍与抑郁焦虑障碍有很高的共患率,并且抑郁症状越严重,症状数目越多。结论:躯体化障碍临床症状复杂多样,其中慢性疼痛症状敏感性最高。     

原发性震颤患者睡眠质量的临床研究

目的评价原发性震颤患者睡眠质量,探讨原发性震颤(essential tremor,ET)患者睡眠障碍的临床特征及相关因素。方法采用匹兹堡睡眠质量指数(Pittsburgh sleep qualityindex,PQS1)、爱泼沃斯思睡量表(Epworth sleepiness scale,ESS)、汉密尔顿抑郁量表(Hamilton depression rating scale for depression,HAMD)对68例原发性震颤患者和70名正常对照者的睡眠状况及抑郁进行评估。结果 ET组睡眠障碍发生率为52.9%,较正常对照组高35.7%(P0.05);ET组抑郁评分(15.82±4.87)高于正常对照组(9.96±5.65)(P0.01);ET患者日间过度思睡发生率(44.1%)较正常对照组(15.7%)高(P0.01)。结论 ET患者总体睡眠质量差,伴发睡眠障碍较对照组常见,其临床主要表现为入睡困难、片断睡眠及日间过度思睡,睡眠障碍与年龄、抑郁有关。     

偏头痛患者失能因素分析

目的探讨影响偏头痛患者失能相关因素,为优化偏头痛患者管理提供帮助。方法选择本院门诊178例偏头痛患者,完成偏头痛残疾程度评估量表(MIDAS)和头痛影响测验调查问卷(HIT-6),并记录患者年龄、性别、频率(每月头痛发作次数)、头痛程度评分、初发头痛持续时间、体质量指数(BMI)、广泛性焦虑量表(GAD-7)评分、患者健康问卷抑郁量表(PHQ-9)评分、阿森斯失眠量表(AIS)评分及是否药物滥用、是否先兆性头痛。按MIDAS和HIT-6量表将偏头痛患者分为失能和无失能2组,比较2组年龄、性别、频率(每月头痛发作次数)、头痛程度、初发头痛持续时间、BMI、GAD-7、PHQ-9、是否药物滥用、是否先兆性头痛、是否睡眠障碍。再以与是否失能有统计意义的因素为自变量,是否失能为因变量,进行多元线性回归分析。结果单因素分析显示,是否药物滥用、疼痛程度评分、BMI、频率、PHQ-9评分、GAD-7评分、AIS评分与失能有关(P0.05)。多因素分析显示,抑郁、焦虑评分、AIS评分未进入回归方程(P0.05),是否药物滥用、疼痛程度评分、BMI、频率与失能独立相关(P0.05)。结论偏头痛患者滥用止痛药,发作时头痛程度,发作频率,体质量指数,焦虑影响患者失能。     

Prevalence and predictive factors for poor sleep quality among migraineurs in a tertiary hospital headache clinic

The aim of this study was to investigate the prevalence and predictive factors for poor sleep quality among migraineurs in a tertiary hospital headache clinic in southwest China. In this study, we used a visual analog scale (VAS), the Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS) to assess headache intensity, sleep quality as well as anxiety and depression symptoms. In 211 subjects who were assessed continuously, we found that the average PSQI score was 8.03 ± 4.71, and 130 (61.61 %) migraineurs exhibited poor sleep quality (PSQI >5). Poor sleep quality was largely expressed as experiencing an extended sleep latency period, daytime dysfunction, poor subjective sleep quality, and short sleep duration. The primary factors that predicted poor sleep quality included the migraine history and comorbidity with anxiety and/or depression. Moreover, we found that most migraineurs did not adopt treatment for their poor sleep quality. Only 17 (8.06 %) patients used sleeping medication to improve their poor sleep quality; however, this medication was not effective in 16 (94.12 %) patients. Therefore, it is highly important to resolve poor sleep quality in migraineurs.     

偏头痛家族聚集性患者临床特点及其一级亲属患病风险因素分析

目的观察偏头痛家族聚集性患者的临床特征,分析其一级亲属的患病风险因素。方法收集资料完整的偏头痛患者72例,根据有无偏头痛家族史分为两组,有偏头痛家族史组及无偏头痛家族史组。利用问卷采集两组患者临床资料,单因素分析筛选出有统计学意义的变量后进行多因素logistic回归分析其一级亲属患病的危险因素。结果 72例中至少有1名一级亲属患有偏头痛者37例,家族史阳性率为51.4%。与家族史阴性的偏头痛先证者比较,家族史阳性的先证者在性别(P=0.675)、年龄(P=0.598)、病程(P=0.419)、先兆(P=0.669)、头痛程度(P=0.837)、发作频率(P=0.465)及头痛伴随症状、头痛部位、头痛性质方面差异无统计学意义;与家族史阴性的头痛先证者比较,家族史阳性的先证者在起病年龄早(16岁)方面的差异(48.6%vs.22.9%,χ~2=5.186,P=0.023)及在头痛发作持续时间长(≥24 h)方面的差异(35.1%vs.14.3%,χ~2=4.170,P=0.041)有统计学意义(P0.05)。多因素回归发现,发病年龄早(OR=2.986,95%CI:1.621~5.503)、头痛发作持续时间长(OR=2.320,95%CI:1.219~4.415)的先证者,其一级亲属患病风险高(P0.05)。结论起病年龄早及头痛持续时间长的偏头痛患者,其一级亲属患偏头痛的风险更高。     

Effects of onabotulinumtoxinA treatment on efficacy,depression, anxiety,and disability in Turkish patients with chronic migraine

Chronic migraine causes a serious labour loss and disability in the society and increases the risk of depression and anxiety by negatively affecting the quality of life. The purpose of this study was to investigate the effects of onabotulinumtoxinA (BoNT-A) treatment on efficacy before and after treatment in our cases with chronic migraine as well as on depression, anxiety and disability caused by migraine. According to the International Headache Classification (ICHD-III beta version), 60 adult patients who were diagnosed with chronic migraine were included in the study. A total of 155 IU BoNT-A treatment from 31 regions was administered in accordance with the protocol of PREEMPT study. Information about the characteristics of patients’ headaches, background and family history, drugs they used was recorded. At the baseline and in the first and third month after the BoNT-A injection, VAS scores, the number of both headache days and attacks, the headache duration, the frequency of application to emergency services and the intake of both analgesics and triptans during attacks were evaluated. MIDAS, BDI and BAI were evaluated at the baseline and in the third month after the BoNT-A injection. BoNT-A injection provided a significant decrease in the number of days and severity of headaches, MIDAS disability scores and psychiatric complaints in cases with chronic migraine who did not respond to prophylactic treatments in the third month of the treatment.     

The burden of migraine to the individual suffer: a review

This review of the literature reveals that migraine is a common, chronic condition featuring episodic attacks which vary in severity and sympatomatology. Throbbing, unilateral headache, which is aggravated by activity, is the most prominent feature, although a high proportion of sufferers also experience phonophobia, photophobia, and nausea, which may lead to vomiting. Preceding aura is a less common feature of the attack. The frequency and duration of migraine attacks varies widely between individuals, though the median frequency is around 1 attack per month and median duration is roughly 24 h. Migraine attacks can have a profound effect on the day-to-day lives and well-being of the sufferer. In the long term, migraine may cause profound emotional changes and result in coping strategies that interfere with working, social and family life and many normal daily activities. These effects are apparent in quality of life studies on migraine patients. Thus, the impact of migraine on many quality of life parameters is similar to that of other chronic conditions such as osteoarthritis, diabetes and depression. Reduction in the personal burden of migraine can be facilitated by encouraging migraine sufferers to consult their doctor, through accurate diagnosis of migraine headaches and assessment of the disability suffered by the migraineurs, and through improved and well-executed treatment strategies.     

Psychiatric comorbidities of episodic and chronic migraine

Migraine is a prevalent disabling neurological disorder associated with a wide range of medical and psychiatric comorbidities. Population- and clinic-based studies suggest that psychiatric comorbidities, particularly mood and anxiety disorders, are more common among persons with chronic migraine than among those with episodic migraine. Additional studies suggest that psychiatric comorbidities may be a risk factor for migraine chronification (i.e., progression from episodic to chronic migraine). It is important to identify and appropriately treat comorbid psychiatric conditions in persons with migraine, as these conditions may contribute to increased migraine-related disability and impact, diminished health-related quality of life, and poor treatment outcomes. Here, we review the current literature on the rates of several psychiatric comorbidities, including depression, anxiety, and post-traumatic stress disorder, among persons with migraine in clinic- and population-based studies. We also review the link between physical, emotional, and substance abuse, psychiatric disorders, and migraine. Finally, we review the data on psychiatric risk factors for migraine chronification and explore theories and evidence underlying the comorbidity between migraine and these psychiatric disorders.     

The relationship between risk factors for affective disorder and poststroke depression in hospitalised stroke patients.

The influence of psychiatric risk factors on the development of depression following stroke was examined in 88 patients undergoing inpatient rehabilitation. In this sample, 34 patients (38%) had a diagnosis of major or minor depression. Older age and a personal or family history of affective or anxiety disorder were associated significantly with major depression. Minor depression was more common among males and those patients with greater physical disability. Severity of depressive symptoms was associated with a personal or family history of affective or anxiety disorder and higher pre-stroke personality neuroticism. We conclude that certain psychiatric risk factors for affective disorder are strongly associated with poststroke depression. The implications of these findings for anticipating and managing poststroke depression are discussed.     

A case-control study on excessive daytime sleepiness in chronic migraine

BackgroundExcessive daytime sleepiness is a major clinical and health concern that can have varied and sometimes harmful consequences. Findings from uncontrolled studies suggest a high prevalence in patients with chronic migraine.MethodsIn a case-control study, we compared frequency data for excessive daytime sleepiness in 100 patients with chronic migraine and 100 healthy controls paired for sex and age, and assessed risk factors including lifestyle, sleep quality, anxiety, depression, concomitant disease and medications.ResultsThe frequency of excessive daytime sleepiness was higher in migraineurs (especially in those with medication overuse) than in controls (20% versus 6%; odds ratio 3.92, 95% CI 1.5–10.22), but was lower than previously reported and correlated with poor quality sleep and anxiolytic and antidepressant use.ConclusionsAgain confirming that disability in chronic migraine is multifactorial in origin, excessive daytime sleepiness, especially in migraineurs who overuse medications, adds to the multiple factors known to impair social and working function. Patients with chronic migraine might benefit from diagnostic interviews focussing also on sleep problems and from targeted psychoactive drug prescribing.     

Psychiatric screening for migraine patients

Psychiatric disorders in migraine patients have a higher prevalence than general population. The presence of psychiatric comorbidities may influence the complexity of the migraine pictures and be related to medication overuse. Severely impaired chronic migraineurs presenting with medication overuse are a challenge for headache clinics. Psychiatric comorbities, such as dependency-like behaviors, anxiety and mood symptoms, might account for headache-related disability and recurrent relapses into medication overuse after a successful detoxification. Within a sample of 63 chronic migraineurs with medication overuse and severe disability, we investigated to which extent clinical severity, affective states and attitudes about medication impact the overall functioning at time of detoxification. To unravel whether some of these factors could predict their long-term outcome, we followed and retest them 1 year after withdrawal. We hypothesized that the detoxification would have led to a partial improvement and not modified the attitudes toward medication and dependence. Detoxification improves most of the clinical and affective measures, but does not free from significant levels of pain intensity and headache-related disability. The partial benefit from detoxification, the severity bias and the maladaptive cognitive profile led us to believe that subgroups of chronic-relapsing migraineurs deserve a multidisciplinary approach that addresses not only the reduction of clinical severity but also specific cognitive and behavioral impairments.     

What is the link between migraine and psychiatric disorders? From epidemiology to therapeutics

The association between migraine and psychiatric disorders is well documented through numerous population-based studies. The results of these studies are coherent and show an increased risk of suffering from depression, bipolar disorders, numerous anxiety disorders, especially post-traumatic stress disorder. This raises the question of stress as a precipitating factor for migraine illness. Psychiatric comorbidity is even more frequent in chronic migraine than in episodic migraine patients. Many prospective studies have shown that psychiatric comorbidity could be considered as a risk factor for migraine chronicization. Psychiatric comorbidity is also responsible for an increase of the frequency of anti-migraine drug intake, a worsening of quality of life and a worsening of functional impairment. It is also responsible for an increase in the direct and indirect costs of migraine. The reason why psychiatric comorbidity is so high in migraineurs is not unambiguous. Multiple causal relationships and common etiological factors are linked. Recently, genome-wide association studies gave leads to a genetic common heritability between major depressive disorder and migraine. For clinicians, an important topic remains how to treat migraineurs with psychiatric comorbidity. These patients suffer frequently from severe migraine or refractory migraine. Antidepressant and anti-convulsive drugs can be useful, as well as psychological therapies. But moreover, it is of utmost importance to propose an integrated multidisciplinary approach to these difficult patients.