Nefazodone for chronic daily headache prophylaxis: an open-label study

OBJECTIVE: To assess effectiveness, tolerability, and safety of nefazodone as a prophylactic agent for chronic daily headache. BACKGROUND: Nefazodone is a potent, selective 5-HT2 antagonist with a distinct and atypical mechanism of action. The evolution of intermittent migraine to chronic daily headache has been linked to up-regulation of 5-HT2 receptors as well as other factors. Other effective migraine prophylactic medications are also 5-HT2 antagonists. Although research has shown nefazodone to be an effective antidepressant with a good tolerability and safety profile, its potential role in headache prophylaxis has not been tested. DESIGN: This was a two-center, open-label study with a 4-week baseline, followed by 12 weeks of treatment with nefazodone at a median dose of 300 mg (mean, 303.66 +/- 65.57 mg; range, 100 to 450 mg depending on tolerability). Potential patients were required to report more than 15 days of headache per month for at least 3 months prior to screening. Only patients with at least 15 days of recorded headache during baseline were included in the final sample (N=52). Most patients (n=48) had a history of migraine based on International Headache Society criteria; 4 had primarily chronic tension-type headache, but with more migrainous features than permitted by International Headache Society criteria for a primary chronic tension-type headache diagnosis. RESULTS: Significant improvement was demonstrated for all headache diary measures, with significance levels ranging from P<.00001 for average intensity, duration, headache index (intensity x duration), peak intensity, headache days per week, and peak impairment, to P<.0033 for severe headache days per week, and P<.0051 for rescue medication days. During the last month of treatment, 71% of the patients completing the study showed at least a 50% reduction in headache index compared to baseline, and 59% had at least a 75% improvement. Visual analog scales completed at 4-week intervals showed significant improvement in patient ratings of overall headache status, quality of life, sleep, mood (P<.00001), and sexual function (P<.00053). Significant improvements were also observed in the Pain Disability Index (P<.00007), Beck Depression Inventory-II (P<.00001), Hamilton Rating Scale for Depression (P<.0008), and Hamilton Psychiatric Rating Scale for Anxiety (P<.00007). Headache indices for patients in the top quartile on the depression and anxiety scales (clinical depression/anxiety) did not differ from the other patients during baseline. However, patients who were depressed or anxious showed significantly more improvement over the course of 12 weeks of treatment (P<.0006 or less for the depression scales, P<.026 for anxiety). Common mild to moderate adverse events reported by 10% or more of the patients included fatigue, nausea, dry mouth, dizziness, sleep disturbance, blurred vision, irritability/nervousness, and sedation. Only 5 of the 52 patients discontinued the study due to adverse events: headache (2 patients), and nausea, sleep disturbance, and a drugged feeling (1 patient each). CONCLUSIONS: These results provide preliminary support for the efficacy of nefazodone in the prophylaxis of chronic daily headache. In this sample, nefazodone was safe and generally well tolerated. Patient ratings of sexual function improved over the course of treatment, in contrast to what is generally observed with most antidepressants. Nefazodone may be particularly beneficial for patients with chronic daily headache and comorbid depression. Further research is indicated.     

Monitoring improvement using a patient-rated depression scale during treatment with anti-depressants in general practice. A validation study on the Goldberg Depression Scale

Objective - To perform a pilot study on the value of the Goldberg Depression Scale as an instrument for monitoring improvement in depressed patients treated with anti-depressants in general practice. Design - A comparative study using simultaneous ratings on the observer-based 17-item Hamilton Depression Scale and the patientrated Goldberg Depression Scale. Setting - General practice. Patients - Twenty-one patients meeting the ICD-10 criteria of a moderate depressive episode were assessed at the time of inclusion and through three follow-up visits. Main outcome measures - Scores on the Goldberg Depression Scale compared to the Hamilton Depression Scale. Results - An acceptable internal and external validity of the Gold berg Depression Scale was demonstrated. The Loevinger coefficient varied from 0.25 at the time of diagnosis to 0.57, 0.65 and 0.69 by visits two, three and four. Factor analysis identified only one general factor explaining 50% or more of the variants, except at visit 1. When the Goldberg Depression Scale was correlated to the Hamilton Depression Scales, a coefficient of 0.74 was obtained (p < 0.001). Conclusion - This pilot study indicates that the Goldberg Depression Scale is suitable for monitoring improvement in depressed patients treated in general practice. Further studies are recommended.     

西酞普兰联合心理干预对恶性肿瘤患者情绪障碍及生活质量的影响

目的通过对西酞普兰联合心理干预对恶性肿瘤患者情绪障碍及生活质量影响的观察和分析,以期提高患者的生活质量。方法采用随机、双盲、安慰剂平行对照实验研究。符合入组标准的患者按随机数字法分为西酞普兰组95例,安慰剂组93例。患者口服西酞普兰20nag或安慰剂,每天口服1次,疗程6周,治疗过程中两组患者均给予心理护理干预。分别于基线、治疗后1、2、4、6周末以汉密尔顿抑郁量表（HAMD－17）评定抑郁症状,汉密尔顿焦虑量表（I-lAMA）评定焦虑症状,恶性肿瘤患者生活质量调查问卷（QLQ－30,version3）评定生活质量,临床总体印象量表（CGI）之疾病严重程度、总的进步、疗效指数评定患者病情改善情况。结果治疗2周末两组HAMD评分的FAS比较差异有统计学意义[（14．01±2．71）分比（15．46±3．47）分,t=－3．124,P〈0．01],减分值的比较差异有统计学意义[（4．774-2．40）分比（3．68±2．21）分,t=3．170,P〈0．01];治疗4,6周末HAMD评分、减分值及HAMA评分、减分值比较差异均有统计学意义（t值分别为－7．950…6066,－7．124,5．553,－4．511,3．94l,－5．601,3．270;P〈0．01）;CGI评分结果表明,基线水平两组患者疾病严重程度比较无统计学意义（t=－0．45,P〉0．05）,6周末评分有统计学意义（t=-2．33,P〈0．05）;治疗后总健康状况比较,差异有统计学意义（u=2．908,P〈0．05）,6周末两组患者评定点进步情况比较,差异有统计学意义（u=-2．650,P〈0．05）;6周末两组患者疗效指数比较,差异有统计学意义（t=3．12,P〈0．05）。结论西酞普兰联合心理干预可以有效改善恶性肿瘤患者的抑郁、焦虑症状,改善患者的生活质量。     

曲唑酮与氟西汀治疗围绝经期抑郁症对照研究

目的：探讨曲唑酮与氟西汀治疗围绝经期抑郁症的临床疗效和安全性。方法将72例围绝经期抑郁症患者随机分为两组,每组36例,研究组口服曲唑酮治疗,对照组口服氟西汀治疗,观察6周。于治疗前后采用汉密顿抑郁量表、汉密顿焦虑量表评定临床疗效,副反应量表评定不良反应。结果研究组治疗1周末汉密顿焦虑量表总分、汉密顿抑郁量表总分及睡眠因子分显著低于对照组（ P＜0．05）;治疗6周末研究组显效率86．1％、有效率94．4％,对照组分别为77．8％、94．4％,两组比较差异无显著性（χ2＝0．84、0,P＞0．05）。研究组失眠及焦虑不安发生率显著低于对照组（P＜0．05）。结论曲唑酮与氟西汀治疗围绝经期抑郁症疗效均显著,但曲唑酮能够较快改善患者的焦虑及睡眠状况,治疗依从性更好。     

Nefazodone therapy in patients with treatment-resistant or treatment-intolerant depression and high psychiatric comorbidity.

Given the potentially severe functional impairment, morbidity, and high costs associated with refractory depression, it is important to explore all treatment options that may benefit patients with this disorder. This is a retrospective, uncontrolled analysis of our experience with nefazodone therapy in treatment-resistant and treatment-intolerant depression. Potential candidates for nefazodone therapy were referred by their treating psychiatrist. Documentation of failure to respond to previous antidepressant therapy, a diagnosis of clinical depression according to criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and completion of a Beck Depression Inventory (BDI) were required before initiation of nefazodone. A follow-up BDI was obtained after > or =4 weeks of nefazodone therapy. A Clinical Global Inventory (CGI) score was obtained retrospectively based on documentation of target symptoms in the clinical record of the last clinic visit. The study group consisted of 20 patients with treatment-resistant or treatment-intolerant major depression who received nefazodone therapy. The mean (+/- SD) age of the group was 48.1+/-9.4 years. The mean number of previously failed antidepressant trials was 1.9+/-0.6. Psychiatric comorbidity in this group was substantial, with posttraumatic stress disorder (PTSD) found in 11 (55%) patients, substance abuse in 3 (15%) patients, and personality disorder found in 2 (10%) patients. After treatment with nefazodone, 11 of 20 patients (55%) were rated on the CGI as much or very much improved. In addition, 9 patients (45%) had >20% improvement on BDI, 3 patients (15%) had 10% to 20% improvement, and 6 patients (30%) had <10% change. Two patients (10%) discontinued nefazodone therapy due to adverse effects. Analysis of our experience with nefazodone therapy in a population with treatment-resistant depression and a high degree of psychiatric comorbidity suggests that approximately 50% of patients may have substantial response to treatment, with a smaller proportion having a more modest clinical response. While receiving nefazodone therapy, most patients continued to take concurrently prescribed psychotropic medications, primarily anxiolytics or other antidepressants. Of interest was the positive drug response among a subgroup of individuals with depression and chronic, severe PTSD. Larger, controlled studies are needed to determine whether these preliminary observations are confirmed.     

观察放松训练联合有氧运动对乳腺癌患者心理调适与睡眠质量的影响

目的:观察放松训练联合有氧运动对乳腺癌患者心理调适与睡眠质量的影响.方法:选取2019年1月至2019年12月蚌埠医学院第一附属医院收治的乳腺癌患者74例作为研究对象,按照随机数字表法分为观察组和对照组,每组37例.对照组患者给予常规护理干预措施,观察组在对照组基础上给予放松训练联合有氧运动.采用汉密尔顿焦虑量表(Ha...     

The relationships between disability level, health-promoting lifestyle, and quality of life in outpatients with systemic lupus erythematosus

The purpose of this study was to explore the relationships between disability, health-promoting lifestyle and quality of life in SLE outpatients. Cross-sectional research design and purposive sampling were used in this study. One hundred and twenty-nine SLE outpatients from a medical center were sampled. Questionnaires, including the Visual Analogue Scale, Pittsburgh Sleep Quality Index, and The Hospital Anxiety and Depression Scale, were adopted in order to survey subject disabilities in terms of pain, fatigue, quality of sleep, anxiety, and depression. Health-promoting lifestyle was measured using the Health-Promoting Lifestyle Profile, while quality of life data were collected using Short-Form 36. Hierarchical regressions and a Sobel test were the major statistical procedures employed. Study results indicated that SLE patient self-reported pain and fatigue related to the SLE disease to be 27.7 +/- 26.2 and 37.4 +/- 26.6, respectively. Seventy-two percent of SLE patients were reported to be troubled by poor sleep quality, while 20%-32% suffered from severe anxiety and depression. The Health-Promoting Lifestyle Profile total score for SLE patients was 61.5 +/- 17.2. In terms of SLE patient quality of life (QOL), physical component summary (PCS) and mental component summary (MCS) scores were 45.3 +/- 9.1 and 43.8 +/- 9.7, respectively. Based on the hierarchical regressions and Sobel test, it was revealed that the health-promoting lifestyle has no significant effect on the physical component summary (p > .05). Fatigue was the mediator factor of health-promoting lifestyle to physical component summary of quality of life. Nevertheless, health-promoting lifestyle has a significant effect on the mental component summary (p <.05). Interestingly, the results showed facilitating health- promoting lifestyle in SLE patient could not enhance physical component summary of quality of life directly without an improvement in fatigue disability; however, facilitating health-promoting lifestyle had a direct and positive effect on the mental component summary of quality of life.     

Monitoring improvement using a patient-rated depression scale during treatment with anti-depressants in general practice. A validation study on the Goldberg Depression Scale

OBJECTIVE: To perform a pilot study on the value of the Goldberg Depression Scale as an instrument for monitoring improvement in depressed patients treated with anti-depressants in general practice. DESIGN: A comparative study using simultaneous ratings on the observer-based 17-item Hamilton Depression Scale and the patient-rated Goldberg Depression Scale. SETTING: General practice. PATIENTS: Twenty-one patients meeting the ICD-10 criteria of a moderate depressive episode were assessed at the time of inclusion and through three follow-up visits. MAIN OUTCOME MEASURES: Scores on the Goldberg Depression Scale compared to the Hamilton Depression Scale. RESULTS: An acceptable internal and external validity of the Goldberg Depression Scale was demonstrated. The Loevinger coefficient varied from 0.25 at the time of diagnosis to 0.57, 0.65 and 0.69 by visits two, three and four. Factor analysis identified only one general factor explaining 50% or more of the variants, except at visit 1. When the Goldberg Depression Scale was correlated to the Hamilton Depression Scales, a coefficient of 0.74 was obtained (p < 0.001). CONCLUSION: This pilot study indicates that the Goldberg Depression Scale is suitable for monitoring improvement in depressed patients treated in general practice. Further studies are recommended.     

观察心理护理干预对焦虑症患者睡眠质量的影响

目的:观察心理护理干预对焦虑症患者睡眠质量的影响.方法:选取2018年5月至2019年12月哈尔滨职业技术学院收治的焦虑症患者60例作为研究对象,按照随机数字表法分为观察组和对照组,每组30例,对照组给与基础护理干预,观察组在对照组基础上给予心理护理干预.实施分组治疗,采用自制睡眠质量量表比较2组患者干预前后的睡眠质量...     

家庭治疗对神经症患者临床疗效及家庭功能和婚姻质量的影响

目的 探讨家庭治疗对神经症患者的临床疗效及家庭功能和婚姻质量的影响.方法 对72例神经症患者进行系统的家庭治疗,观察6周.于治疗前及治疗6周末,采用症状自评量表评定临床症状,汉密顿焦虑量表评定焦虑状况,汉密顿抑郁量表评定抑郁状况,婚姻质量问卷评定婚姻质量,家庭功能评定量表评定家庭功能状况,分析家庭治疗的疗效和各因素间的相关性.结果 治疗后入组患者症状自评量表总均分、躯体化、抑郁、焦虑因子分及汉密顿焦虑量表总分、汉密顿抑郁量表总分均较治疗前显著下降(P＜0.05);婚姻质量问卷总分、与亲友的关系、解决冲突方式、夫妻交流、婚姻满意度因子分均较治疗前显著提高(P＜0.05);家庭功能评定量表行为控制、沟通、家庭总的功能因子分均较治疗前显著下降(P＜0.05).症状自评量表总分与婚姻质量总分、夫妻交流因子分呈显著负相关(R=-0.34、-0.37,P＜0.05),与家庭功能评定量表行为控制、家庭总的功能因子分呈显著正相关(R=0.39、0.35,P＜0.05);汉密顿焦虑量表总分与家庭总的功能因子分呈显著正相关(R=0.46,P＜0.05);汉密顿抑郁量表总分与夫妻交流因子分呈显著负相关(R=-0.45,P＜0.05);家庭总功能因子分与婚姻质量总分、夫妻交流因子分呈显著负相关(R=-0.40、-0.49,P＜0.05).结论 系统式家庭治疗能有效改善神经症患者的躯体化、抑郁、焦虑等症状,显著提高婚姻质量和家庭功能;而婚姻质量与家庭功能的提高对促进患者的全面康复具有重要意义.     

自我护理对帕金森病病人精神状况的影响

[目的]探讨自我护理对帕金森病人精神状况的改善效果。[方法]将121例帕金森病病人随机分为对照组（53例）与观察组（68例）。对照组实施一般常规护理,观察组实施自我护理。分别在入院时和入院1个月后采用相关精神量表对两组病人进行测评。[结果]两组病人入院时一般情况、抑郁状况、睡眠状况、焦虑状况和日常生活能力状况比较差异无统计学意义（P 〉0.05）。实施自我护理1个月后,观察组焦虑/躯体化、体重、认识障碍、日夜变化、迟缓、睡眠障碍、绝望感和汉密顿抑郁量表（HRSD）总分及睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物和日间功能障碍和匹兹堡睡眠质量指数（PSQI）总分明显低于对照组,差异有统计学意义（P 〈0.01）;焦虑情绪和日常生活能力改善观察组明显优于对照组,差异有统计学意义（P 〈0.01）。[结论]对帕金森病病人实施自我护理,在减少相关药物使用的同时,有助于改善病人精神状况,从而提高生活质量。     

精神科护士睡眠质量及影响因素相关性的研究

目的 探讨精神科护士睡眠质量及其影响因素.方法 采用匹兹堡睡眠质量指数（PSQI）和焦虑自评量表（SAS）对160名精神科护士进行调查.结果 本组平均睡眠时间为（7.18±1.319）h,男护士睡眠时间低于女护士（P＜0.05）;睡眠质量较好（PSQI总分≤7分）护士占被调查者68.75%,有睡眠质量问题（PSQI总分＞7分）占被调查者31.25%,两组PSQI各成分得分和总分差异均有统计学意义（P＜0.01）;性别、学历、婚姻状态、技术职称在PSQI总分差异无统计学意义（P＞0.05）;20～30岁的护士及6～15年护龄的受试者PSQI得分最高（P＜0.05）;20～30岁、中专学历、单身护士群体睡眠质量问题的发生率最高（P＜0.01）;PSQI的7个成分得分及总分与焦虑情绪均具有相关性（P＜0.01）.结论 精神科护士睡眠质量低于普通人群,1/3有睡眠质量问题,睡眠质量与人口学因素及焦虑情绪存在明显交互作用.     

家庭长期氧疗对慢性阻塞性肺病患者生活质量的影响

目的 :探讨家庭长期氧疗 (LTDOT)对慢性阻塞性肺病 (COPD)患者躯体功能、心理情绪及社会活动能力的影响。方法 :对 30例COPD稳定期患者施以长期家庭氧疗 ,于氧疗前及氧疗后 (随访 3年 )每年 1次 ,测定一秒用力呼吸容积 (FEV1)、动脉血氧分压 (PaO2 )、动脉血二氧化碳分压 (PaCO2 ) 6分钟步行距离 (6MWD) ;用修订医学研究委员会呼吸困难评分标准对呼吸困难进行评价 ;用汉密顿抑郁量表 (HRSD)及汉密顿焦虑量表 (HAMA)进行心理状态评定 ;用老年人社交情况问卷表进行社会生活能力评定。结果 :氧疗后 1、2、3年与氧疗前 (基础值 )比较FEV1、PaO2 、6MWD明显提高 (P <0 0 1) ;呼吸困难分级评分明显降低 (P <0 0 1) ;社交情况评分明显提高 (P <0 0 1) ;HRSD及HAMA评分无明显变化 (P≥ 0 0 5 )。结论 :LTDOT能使COPD患者PaO2 保持较高水平 ,肺功能得以改善 ,改善呼吸困难程度 ,提高活动耐力 ,增加活动范围 ,改善社会活动能力 ,使COPD患者生活质量得以改善。但LTDOT对COPD患者的心理状态改善作用尚有限     

重复经颅磁刺激治疗非器质性失眠症大学生的疗效观察

目的:观察重复经颅磁刺激(rTMS)治疗非器质性失眠症大学生患者的临床疗效。方法:采用随机数字表法将72例非器质性失眠症大学生分为观察组及对照组,每组36例。观察组给予rTMS治疗,磁刺激部位为右侧背外侧前额叶皮质区,磁刺激频率1 Hz,磁刺激强度为120%静息运动阈值水平,对照组给予假磁刺激。于治疗前、治疗4周后分别...     

观察家庭康复干预联合音乐放松疗法对抑郁症患者心理及睡眠质量的影响

目的:观察家庭康复干预联合音乐放松疗法对抑郁症患者心理及睡眠质量的影响.方法:选取2019年3月至2020年3月江门市新会区第三人民医院收治的抑郁症患者80例作为研究对象,按照随机数字表法分为观察组和对照组,每组40例.对照组给予常规康复干预,观察组给予家庭康复干预联合音乐放松疗法,采用匹兹堡睡眠指数量表(Pittsb...     

观察帕罗西汀联合小剂量奥氮平治疗抑郁症合并睡眠障碍的治疗效果

目的:观察帕罗西汀联合小剂量奥氮平治疗抑郁症合并睡眠障碍的治疗效果.方法:选取2019年2月至2020年10月聊城市第四人民医院收治的抑郁症合并睡眠障碍患者84例作为研究对象,按照随机数字表法分为观察组和对照组,每组42例,对照组给予帕罗西汀治疗,观察组在对照组基础上联合给予小剂量奥氮平进行治疗;采用匹兹堡睡眠质量指数...     

急性脑卒中后睡眠障碍及相关因素研究

【目的】探讨急性脑卒中患者的睡眠障碍情况及其影响因素。【方法】采用匹兹堡睡眠质量指数问卷（PSQI）、神经功能缺损程度评分（NDS）、汉密尔顿抑郁量表（HAMD）对298例急性脑卒中住院患者进行调查【结果】脑卒中急性期睡眠障碍发生率为45．97％;对患者不同性别、年龄、卒中部位、NDS和HAMD评分等方面进行比较,睡眠障碍发生率的差异均具有统计学意义（P〈0．01或P〈0．05）。【结论】急性脑卒中后患者睡眠障碍的发生率较高,与患者年龄、性别、卒中部位、神经功能缺损程度及抑郁状态等因素相关。临床工作中应积极改善睡眠以提高患者生活质量。     

维持性血液透析患者睡眠质量、抑郁和生活质量相关关系的研究

目的探讨维持性血液透析患者睡眠质量、抑郁与生活质量之间的关系。方法收集符合标准维持性血液透析患者71例,采用匹兹堡睡眠质量指数（PSQI）评估睡眠质量,以简明健康状况调查表（SF-36量表）和BECK抑郁自评问卷（BDI）分别评估生活质量和抑郁情况。记录年龄、性别、婚姻、干体重、血红蛋白、铁蛋白、转铁蛋白饱和度、钙、磷、全段甲状旁腺激素、白蛋白、C-反应蛋白、透析前及透析后血肌酐、尿素氮。结果睡眠质量较差（PSQI评分〉5）的血液透析患者占76.1%;睡眠质量较好组患者的生活质量总分、生理及心理健康总分均高于睡眠质量较差组（P〈0.01）,睡眠质量较差组的抑郁评分高于睡眠质量较好组（P〈0.05）;中-重度抑郁患者（BDI评分≥8分）占63.4%,该组患者生活质量总分、生理及心理健康总分均低于非中-重度抑郁组（P〈0.01）,且睡眠质量差（P〈0.01）;SF-36生活质量总分、生理健康总分及心理健康总分和睡眠质量及抑郁相关（P〈0.01）,睡眠质量和抑郁是生活质量独立的危险因素。结论维持性血液透析患者睡眠质量较差、抑郁较为常见,睡眠和抑郁之间相互影响,并且降低了患者的生活质量。     

某部新兵睡眠质量与应对方式的相关性研究

目的：了解新兵的睡眠质量及其与应对方式的关系。方法对某部194名新兵应用匹兹堡睡眠质量指数和简易应对方式问卷进行测评分析。结果本组新兵睡眠质量异常检出率为17．0％,显著高于正常男性及2010年新兵（ P＜0．01）。本组新兵积极应对和消极应对维度分均显著低于正常人群（ P＜ 0．01） ,与2010年新兵及海军官兵比较差异均有显著性（ P＜ 0．05或0．01）。相关分析显示,积极应对维度分与匹兹堡睡眠质量指数总分及睡眠时间、睡眠干扰因素及白天功能障碍因子分呈显著负相关（ P＜0．05或0．01） ,而消极应对维度分与匹兹堡睡眠质量指数总分及各因子分呈显著正相关（ P＜0．05或0．01）。结论新兵的睡眠质量及应对方式状况不容乐观,应给予持续的关注;改善新兵的应对方式状况有助于其睡眠质量的提升。