焦虑和抑郁障碍共病的研究现状

章对焦虑和抑郁的关系、焦虑和抑郁障碍共病的流行病学、病因学和治疗，以及共病研究的意义和影响共病研究的因素作一综述。     

抑郁、焦虑对糖脂代谢的影响

目的:探讨抑郁、焦虑对糖脂代谢的影响。方法:152例患者按照HAMD、HAMA评定结果及CC-MD-3诊断标准分为抑郁组、焦虑组、共病组和对照组,均检测空腹血糖(FBG)、总胆固醇(TC)和甘油三酯(TG)水平并比较分析。结果:抑郁组、焦虑组和共病组的FBG、TG均明显高于对照组(P<0.05),共病组的FBG高于焦虑组(P<0.05),共病组的TC高于对照组(P<0.05);抑郁组的TG高于焦虑组(P<0.05)。结论:抑郁症、焦虑症和抑郁焦虑共病均可导致糖脂代谢异常,且抑郁、焦虑可能从不同方面影响糖脂代谢。     

焦虑抑郁共病的研究进展

焦虑障碍和抑郁障碍共病（简称焦虑、抑郁共病），据WHO和美国Michingan大学流行病学调查，共病率达50％，C．Lindsay Devane报道85％的抑郁患者伴有焦虑症状，58％的患者一生有焦虑症的诊断。广泛性焦虑（GAD）在社区的患病率可高达60％～90％。     

焦虑、抑郁和焦虑抑郁障碍共病心理社会因素分析及护理研究

目的 探讨焦虑、抑郁和焦虑抑郁障碍共病的相关因素,阐明心理社会因素对焦虑、抑郁和焦虑抑郁障碍共病的影响,旨在寻求有效的护理对策,对患者实施早期心理干预,改善患者的心理状态,提高患者的生存质量.方法 利用生活事件量表(LES)、社会支持评定量表(SSRS)、家庭环境量表中文版(FES-CV)、艾森克个性问卷(EPQ)、防御方式问卷(DSQ)对57名患者进行调查评定,部分指标与国内常模或正常对照组比较.结果 (1)抑郁、焦虑、共病组负性生活事件频度及生活事件总频度得分均高于正常对照组,有统计学意义(P<0.05);而3组患者之间负性生活事件得分比较无显著差异(P>0.05);(2)共病组、抑郁组、焦虑组社会支持分均显著高于正常对照组(P<0.05);共病组社会支持分显著高于抑郁组,而与焦虑组无显著差别;(3)共病组存在家庭功能缺陷,但显著较抑郁组和焦虑组为轻;(4)抑郁组、焦虑组和共病组神经质得分均显著高于正常对照组(P<0.05),而3组之间的EPQ各因子分比较无统计学意义;(5)DSQ结果示,3组患者不成熟防御机制和中间型防御机制得分显著高于正常对照组(P<0.05);抑郁组成熟防御机制均分低于共病组、焦虑组和正常组(P<0.05).结论 抑郁、焦虑和焦虑抑郁共病有着很多相似之处,都与心理社会因素有着密切的相关性,但又有各自的临床特点和表现形式,应针对其特点,有的放矢,实施合理有效的护理措施.     

焦虑和抑郁障碍共病的临床现象学及心理社会因素和生物学研究

背景在当前的诊断分类标准中焦虑障碍和抑郁障碍是相互独立的两个疾病单元,但临床研究和流行病学研究均发现两者具有很高的共患率,焦虑和抑郁障碍共病与单纯焦虑或抑郁障碍相比具有症状重、病程慢性化、社会功能损害重、自杀率高和预后差等特征.认识焦虑和抑郁障碍共病的临床现象学、心理社会因素和生化学的特征,对介入临床康复干预措施具有理论指导意义. 目的探讨焦虑和抑郁障碍共病的临床现象学、心理社会因素和生化学的特征,以阐明它与焦虑障碍和抑郁障碍的关系. 设计以诊断为依据的病例-对照,研究. 单位两所大学医院的精神科. 对象 1999- 11/2000- 11在南京医科大学脑科医院住院的患者.按 DSM IV诊断标准收集 25例焦虑和抑郁障碍共病患者(共病组)、 30例主要抑郁症患者(抑郁组)、 14例广泛性焦虑障碍和 6例惊恐障碍患者(焦虑组). 方法对所有病例使用一般情况问卷、病史问卷、汉密顿抑郁量表( HAMD)、汉密顿焦虑量表( HAMA)、生活事件量表( LES)、社会支持评定量表( SSRS)、艾森克个性问卷( EPQ)进行调查评定,并作血浆单胺类神经递质( 5 羟色胺、去甲肾上腺素)测定.上述指标进行三组间比较或与中国常模比较. 主要观察指标各组患者的一般情况、病史情况、 HAMD,HAMA,LES,SSRS,EPQ的评定结果和血浆 5 羟色胺、 NE水平. 结果①共病组年龄 [(46.4± 9.2)岁 ]较抑郁组 [(37.4± 11.3)岁 ]和焦虑组 [(34.7± 7.4)岁 ]大、起病晚( P< 0.01).②共病组急性起病者( 13例)显著多于抑郁组( 9例)和焦虑组( 2例)( P< 0.01).③共病组的家族史( 8例)与抑郁组( 10例)相似( P >0.05).④共病组( 23例) 的自杀意念或行为的发生率显著高于焦虑组( 6例)( P< 0.01).⑤共病组的 HAMD评分( 42.32± 7.26)显著高于抑郁组( 30.70± 7.69)和焦虑组( 22.20± 6.18)( P< 0.01).⑥共病组的 HAMA评分( 27.48± 7.23)显著高于抑郁组( 18.07± 6.20)和焦虑组( 23.00± 6.84)( P< 0.01).⑦共病组的起效时间 [(12.4± 7.5) d]与抑郁组 [(11.7± 8.0) d]和焦虑组 [(9.6± 6.7) d]的差异无显著性( P >0.05);共病组的显效时间 [(52.2± 21.2) d]稍长于抑郁组 [(62.2± 17.1) d]( P >0.05),但显著长于焦虑组 [(32.9± 20.6) d]( P< 0.01).而共病组出院时的显效率( 92%)与抑郁组( 87%)和焦虑组( 85%)的差异无显著性( P >0.05).⑧共病组的负性生活事件评分( 22.1± 15.7)与抑郁组( 26.7± 16.8)、焦虑组( 29.8± 19.6)差异无显著性( P >0.05).⑨共病组的社会支持分( 43.5± 7.9)显著高于抑郁组( 36.2± 8.5)( P< 0.01),而与焦虑组( 39.9± 9.3)差异无显著性( P >0.05).⑩共病组和抑郁组、焦虑组一样, EPQ的神经质因子分均显著高于中国常模( P< 0.05～ 0.01). {11} 共病组存在着血浆单胺神经递质的异常,但与抑郁组、焦虑组均无显著差异( P >0.05). 结论焦虑和抑郁障碍共病具有不同于抑郁障碍和焦虑障碍的特征,但目前的证据尚不足以证明焦虑和抑郁障碍共病是一种新的疾病单元.     

焦虑、抑郁和焦虑抑郁共病社会心理因素研究及护理

目的探讨焦虑、抑郁和焦虑抑郁共病在整体护理影响因素中的心理社会因素,旨在为焦虑、抑郁和焦虑抑郁患者的整体护理有效实施提供可靠依据,对患者实施早期心理干预,改善患者心理状态,提高患者生存质量。方法利用生活事件量表（LES）、社会支持评定量表（SSRS）、家庭环境量表中文版（FES-CV）、艾森克个性问卷（EPQ）、防御方式问卷（DSQ）对61例患者进行调查评定,同时对60名医护人员作为正常对照组进行测评比较。结果抑郁组、焦虑组、共病组负性生活事件频度及生活事件总频度得分、社会支持得分、神经质得分均高于正常对照组,差异有统计学意义（P〈0．05）;共病组社会支持分高于抑郁组,与焦虑组无差别;共病组存在家庭功能缺陷,但较抑郁组和焦虑组为轻;3组患者DSQ不成熟防御机制和中间型防御机制得分高于正常对照组（P〈0．05）。结论抑郁、焦虑和焦虑抑郁一共病有着很多相似之处,都与心理社会因素有着密切的相关性,但又有各自的临床特点和表现形式,对抑郁、焦虑和焦虑抑郁共病在整体护理中心理社会因素实施护理干预提供了理论依据。     

生活事件对焦虑、抑郁和焦虑抑郁障碍共病的影响及护理对策

目的探讨焦虑、抑郁和焦虑抑郁障碍共病的相关因素,阐明生活事件对焦虑、抑郁和焦虑抑郁障碍共病的影响,旨在寻求有效的护理对策,对患者实施早期的心理干预,改善患者的心理状态,提高患者的生存质量。方法利用生活事件量表(LES)对57名患者进行调查评定,部分指标与国内常模或正常对照组比较。结果抑郁、焦虑、共病组负性生活事件频度及生活事件总频度得分均高于正常对照组,有统计学意义(P<0.05);而3组患者之间负性生活事件得分比较无显著差异(P>0.05)。结论抑郁、焦虑和焦虑抑郁障碍共病有着很多相似之处,都与生活事件有着密切的相关性,但又有各自的临床特点和表现形式,应针对其特点,有的放矢,实施合理有效的护理措施。     

急性脑卒中后焦虑抑郁共病相关因素调查

目的研究卒中后焦虑与抑郁共病（PSCAD）的发病率和相关因素,为卒中后焦虑、抑郁的干预提供依据。方法采用临床流行病学调查方法对308例脑卒中患者进行卒中后焦虑抑郁共病及其相关因素的现状调查,并相关因素进行分析。结果卒中后PSCAD发生率约为13.60%,卒中后焦虑、抑郁发生的相关因素有初发复发、经济收入、知识水平。结论卒中后焦虑、抑郁发生率较高,它的发生可能是社会心理学因素和神经生物学因素共同作用的结果。     

不安腿综合征和周期性腿动综合征与抑郁和焦虑的关系

不安腿综合征(RLS)和周期性肢体运动障碍(PLMD)与抑郁和焦虑的共病率很高。本文从病理机制、临床特征、诊断标准、与精神障碍共病、精神科药物对RLS和PLMD的影响及治疗等六个方面对RLS和PLMD进行了论述。进一步的系统研究以探索共病精神障碍,特别是焦虑和抑郁患者的RLS和PLMD的最优化治疗方案是十分必要的。     

舍曲林联合心理治疗抑郁和焦虑障碍共病临床研究

目的研究舍曲林联合心理治疗治疗抑郁、焦虑障碍共病的疗效及安全性。方法将58例抑郁、焦虑障碍共病患者随机分为舍曲林联合心理治疗组和单用舍曲林治疗组各29例进行对照研究．疗程8w．采用汉密顿焦虑量表、汉密顿抑郁量表及药物副作用量表评定临床疗效和不良反应。结果研究组抗焦虑、抗抑郁起效均较对照组快（P〈0．05或0．01）,抗焦虑疗效优于对照组（P〈0．05）,治疗8w末两组抗抑郁疗效相当。结论舍曲林联合心理治疗治疗抑郁、焦虑障碍共病起效快,疗效显著,安全性高,依从性好。     

住院患者焦虑情绪的识别和干预

系统阐述住院患者常见焦虑的临床特点和识别要点，重点介绍人院焦虑、手术焦虑、分离性焦虑、广泛性焦虑、惊恐发作的临床特点和干预对策，以帮助护士认识焦虑反应与焦虑性神经症的区别，掌握住院患者焦虑情绪的识别要点和焦虑的干预技巧，为患者提供科学、有效的心理护理。     

Cognitive Errors in Youth with Anxiety Disorders: The Linkages Between Negative Cognitive Errors and Anxious Symptoms

This study examined the linkages between negative cognitive errors and anxiety in a sample of children and adolescents referred for anxiety problems (N = 251). The Children's Negative Cognitive Error Questionnaire was used to assess cognitive errors and several self-report measures of anxiety were used to examine the specific linkages between cognitive errors and different aspects of children's anxiety phenomenology. Results indicated that each of the measures of anxiety (i.e., trait anxiety, manifest anxiety, and anxiety sensitivity) were significantly related to each of the cognitive errors examined (i.e., catastrophizing, overgeneralization, personalizing, and selective abstraction). The cognitive errors of catastrophizing, overgeneralization, and personalizing were still correlated with trait anxiety, anxiety sensitivity, and manifest anxiety while controlling for children's level of depression. In addition, the correlation between selective abstraction and anxiety sensitivity was still evident while controlling for children's level of depression. Stepwise regression analyses indicated that overgeneralization was the strongest predictor of trait anxiety, catastrophizing and personalizing were the strongest predictors of anxiety sensitivity and manifest anxiety, and overgeneralization and selective abstraction were the strongest predictors of depression. Results also indicated that age moderated the relation between some types of cognitive errors and anxiety. The results are discussed with respect to the development of cognitive models of anxiety in youth, future research directions, and potential treatment implications.     

中学生的焦虑状况及与自尊和应付方式的关系研究

目的探讨中学生焦虑的状况及与自尊和应付方式之间的关系。方法采用状态-特质焦虑问卷(STAI)、自尊量表(SES)及应付方式问卷,对396名中学生进行测查,所得数据运用SPSS 10.0软件包进行统计处理。结果中学生状态焦虑和特质焦虑分高于全国常模,有显著性差异。中学生状态焦虑、特质焦虑分与自尊呈显著负相关。中学生焦虑水平与自责、幻想、逃避和合理化应付因子呈显著正相关,与问题解决、求助应付因子呈显著负相关。自尊对状态焦虑和特质焦虑有较强预测作用;解决问题、自责对状态焦虑和特质焦虑有很强预测作用,求助对特质焦虑有预测作用。高焦虑的中学生自尊水平低,倾向使用消极的应付方式。结论中学生的焦虑水平较高,自尊和应付方式是影响中学生焦虑的重要的内部心理因素。     

Death anxiety as a function of aging anxiety

To assess how different facets of aging anxiety contributed to the prediction of tangible and existential death anxiety, 167 Americans of various Christian denominations completed a battery of questionnaires. Multiple regression analyses, controlling for demographic variables and previously demonstrated predictors of death anxiety, revealed that the aging anxiety dimensions of physical appearance concern and fear of losses each positively predicted tangible death anxiety. In addition, the aging anxiety dimension of fear of losses predicted existential death anxiety. Results are discussed with respect to the multifaceted nature of death anxiety and how different forms of aging anxiety contribute to anxieties about death.     

Death Anxiety as a Function of Aging Anxiety

To assess how different facets of aging anxiety contributed to the prediction of tangible and existential death anxiety, 167 Americans of various Christian denominations completed a battery of questionnaires. Multiple regression analyses, controlling for demographic variables and previously demonstrated predictors of death anxiety, revealed that the aging anxiety dimensions of physical appearance concern and fear of losses each positively predicted tangible death anxiety. In addition, the aging anxiety dimension of fear of losses predicted existential death anxiety. Results are discussed with respect to the multifaceted nature of death anxiety and how different forms of aging anxiety contribute to anxieties about death.     

Responding to Anxiety with Rumination and Hopelessness: Mechanism of Anxiety-Depression Symptom Co-Occurrence?

The current research proposes that certain anxiety response styles (specifically, responding to anxiety symptoms with rumination or hopeless cognitions) may increase risk of depressive symptoms, contributing to anxiety-depression comorbidity. We delineate preliminary evidence for this model in three studies. In Study 1, controlling for anxiety response styles significantly reduced the association between anxiety and depressive symptoms in an undergraduate sample. In Study 2, these findings were replicated controlling for conceptually related variables, and anxiety interacted with anxiety response styles to predict greater depressive symptoms. In Study 3, anxiety response styles moderated the prospective association between anxiety and later depression in a generalized anxiety disorder sample. Results support a role for anxiety response styles in anxiety-depression co-occurrence, and show that hopeless/ruminative anxiety response styles can be measured with high reliability and convergent and divergent validity.     

Child-Focused Cognitive Behavioral Therapy for Pediatric Abdominal Pain Disorders Reduces Caregiver Anxiety in Randomized Clinical Trial

Pediatric functional abdominal pain disorders (FAPD) are associated with elevated anxiety in youth and their caregivers, both contributing to an adverse impact on functioning in youth with FAPD. While a CBT approach (ie, Aim to Decrease Anxiety and Pain Treatment [ADAPT]) is known to improve health outcomes for youth, it is unknown if child-focused treatment improves caregiver anxiety. This secondary analysis of a larger randomized clinical trial examined if child-focused CBT (ADAPT) for pain and anxiety also impacts caregiver anxiety and explored the relation between caregiver anxiety and child symptoms (ie, pain, disability, anxiety) after treatment. A total of 79 caregiver-child dyads were randomized to ADAPT plus treatment as usual (TAU) or TAU only. Caregiver anxiety and child outcomes (pain, disability, anxiety) were assessed at baseline and approximately 8 weeks later. Caregivers of children who completed ADAPT+TAU demonstrated lower anxiety compared to those who only received TAU. Moreover, regardless of treatment assignment, caregivers with greater anxiety had children who reported more pain and anxiety, but not functional disability at post-assessment. Results suggest a brief, child-focused intervention targeting pain and anxiety may also improve caregiver anxiety. As such, suggestions to improve future treatments are offered.PerspectiveCaregiver anxiety symptoms diminished after their child with functional abdominal pain completed a course of child-focused CBT targeting pain and anxiety. Further, caregiver anxiety was related to child-reported symptoms (pain and anxiety) after treatment. Therefore, improved caregiver mental health via a child-focused CBT may also improve pediatric outcomes.     

The Role of Cognitive Factors in Childhood Social Anxiety: Social Threat Thoughts and Social Skills Perception

Models of cognitive processing in anxiety disorders state that socially anxious children display several distorted cognitive processes that maintain their anxiety. The present study investigated the role of social threat thoughts and social skills perception in relation to childhood trait and state social anxiety. In total, 141 children varying in their levels of social anxiety performed a short speech task in front of a camera and filled out self-reports about their trait social anxiety, state anxiety, social skills perception and social threat thoughts. Results showed that social threat thoughts mediated the relationship between trait social anxiety and state anxiety after the speech task, even when controlling for baseline state anxiety. Furthermore, we found that children with higher trait anxiety and more social threat thoughts had a lower perception of their social skills, but did not display a social skills deficit. These results provide evidence for the applicability of the cognitive social anxiety model to children.     

汶川地震救援人员一年后的焦虑状况及其影响因素

目的探讨某部汶川地震救援人员1年后的焦虑状况及其影响因素。方法在汶川地震1年后,应用状态一特质焦虑问卷、应对方式问卷、一般自我效能感量表、领悟社会支持量表对241名救援人员进行调查分析。结果（1）救援人员特质焦虑分[（37．57±4．06）分]明显低于国内常模[（41．11±7．74）分],而状态焦虑分[（44．24±5．03）分]明显高于国内常模[（39．71±8．89）分],差异有统计学意义（均P〈0．01）。（2）状态焦虑与应对方式中的幻想因子呈显著正相关（P〈0．01）,与退避因子呈显著负相关（P〈0．01）。特质焦虑与应对方式中的自责、退避、幻想和合理化因子呈显著正相关（均P〈0．01）;与自我效能感总分、领悟社会支持和应对方式中的解决问题、求助因子呈显著负相关（均P〈0．01）。（3）对救援人员状态焦虑的影响因素为特质焦虑、退避因子、幻想因子。结论地震救援人员状态焦虑受特质焦虑、应对方式所影响,要重视引导救援人员采取成熟的应对方式,以增强其自我效能感,提高心理抵抗能力。     

Critical care nurses' assessment of patients' anxiety: reliance on physiological and behavioral parameters.

BACKGROUND: Anxiety activates the sympathetic nervous system and hypothalamic-pituitary-adrenal axis and may increase morbidity and mortality in vulnerable critical care patients. Despite the adverse effects of anxiety, little is known about critical care nurses 'practices for assessing anxiety. OBJECTIVE: To determine the importance that critical care nurses place on evaluating anxiety and to describe clinical indicators used to assess anxiety. METHODS: Twenty-five hundred members of the American Association of Critical-Care Nurses received the Critical Care Nurse Anxiety Identification and Management Survey and were asked to rate the importance of anxiety assessment, to rate the importance of 61 anxiety indicators, and to select and rank the 5 most important anxiety indicators. RESULTS: Seven hundred eighty-three completed surveys (31.6%) were returned by female (92.0%), white (88.6%) staff nurses (74.2%) who practiced critical care nursing 32.5 hours (SD, 12.3 hours) weekly. Nearly three quarters (71.3%) of respondents thought that anxiety assessment is very important. Only 2 indicators, agitation and patients' verbalization of anxiety, were rated as very important to anxiety assessment. Thirty-nine indicators rated as important primarily included measurable physiological changes and observable behaviors. The top 5 anxiety indicators were agitation, increased blood pressure, increased heart rate, patients' verbalization of anxiety, and restlessness. CONCLUSION: Important indicators of anxiety included observable behaviors and measurable physiological changes. Reliance on these criteria may produce an inaccurate and incomplete anxiety evaluation in vulnerable patients and lead to poorer outcomes. A comprehensive, systematic anxiety assessment tool for valid and reproducible evaluation of patients' anxiety is needed.