伴自杀行为抑郁症患者的临床特点

本文对１０５例抑郁症自杀行为者与１３７例无自杀行为者进行对照研究。结果表明，抑郁症有自杀行为者在病前有不良生活事件及具有早醒、焦虑、绝望、自责自罪和妄想者较无自杀组多见，且有显著性差异，提示具有上述症状的抑郁症患者具有潜在自杀的危险性，应引起社会、家庭和精神病学界的重视，以尽早发现、治疗并采取防范措施。     

抑郁症自杀行为的相关危险因素临床分析

目的　研究抑郁症自杀行为的危险因素 ,为预防自杀提供依据。方法　按 CCMD— 3诊断标准收集 2 1 1例住院的抑郁症患者 ,采用多因素 Logistic回归分析与抑郁症自杀行为有关的危险因素。结果　抑郁症自杀未遂 68例 (3 2 .2 % ) ,自杀与绝望 (相对危险度 RR=9.3 1 0 )、负性生活事件 (RR=3 .844)、自杀家族史 (RR=3 .62 7)、妄想 (RR=3 .783 )及自责 (RR= 2 .985 )呈正相关 (P均 <0 .0 1 )。结论　绝望、负性生活事件、自杀家族史、妄想及自责是抑郁症患者自杀的危险因素。     

住院抑郁症患者与精神分裂症患者自杀行为的分析

目的比较住院抑郁症患者与精神分裂症患者自杀行为的发生率、临床特征及自杀死亡率的差异。方法采用病史资料,精神检查和量表评定的方法 ,确定抑郁症32例,精神分裂症62例为研究对象,并在出院5年后追踪调查其自杀的情况。结果住院患者抑郁发作的自杀率为80.0%,自杀未遂为52.5%,精神分裂症自杀行为的发生率为32.4%,其中自杀未遂为21.9%,两类疾病自杀行为的人数所占百分比经卡方检验,差异显著(χ2=9.594,P0.01)。抑郁症自杀行为的影响因素以抑郁情绪为主(100%),绝望是自杀的直接原因,妄想(56.2%)、焦虑(25.0%)等次之;精神分裂症患者自杀的主要因素为幻觉妄想(59.7%),抑郁情绪(26.6%)次之。抑郁症与精神分裂症伴有自杀行为的患者5年追踪结果显示:两类患者都有自杀死亡行为,抑郁症的自杀死亡率高于精神分裂症(11.1%和8.8%)。结论抑郁症和精神分裂症的自杀需要长期的药物及心理干预。     

妄想性与非妄想性抑郁症的临床对照分析

目的：探讨妄想性抑郁症的临床特征。方法：对100例妄想性抑郁症与198年非妄想性性抑郁症进行临床对照分析。结果：妄想性抑郁症焦虑、激越、自责自罪，绝望，自杀行为的出现频率较高，往往需联合用药方能奏效。结论：妄想性抑郁症与非妄想性抑郁症在症状学及治疗学方面存在差异。     

妄想、抑郁与自杀行为的关系

目的：探讨妄想、抑郁与自杀行为的关系。方法：对100例妄想性抑郁症与198例非妄想性抑郁症自杀行的相对危险性是非妄想性抑郁症的3．45倍。结论：妄想性抑郁症的自杀行为较非妄想性抑郁症多见。     

住院精神分裂症与抑郁症患者自杀行为的临床特征比较

目的：比较精神分裂症与抑郁症住院病人自杀行为的发生比率，临床特征及自杀死亡率的差异。方法：采用病史询问、精神状态检查和定式评定的方法，确定精神分裂症有自杀行为者６４例，抑郁症３４例患者为研究对象，并在５年后追踪调查其自杀死亡的情况。结果：住院精神分裂症自杀行为的发生率为３３％，其中自杀未遂者为１２．９％；抑郁发作的自杀行为发生率为８９．５％，自杀未遂者为５７．９％。影响住院精神分裂症的自杀行为的主要因素为幻觉妄想；影响抑郁症自杀行为的影响因素除情绪障碍外，有８～１１％的病人伴有妄想症状。精神分裂症和抑郁症伴有自杀行为的追踪病例中病程在６年内自杀死亡的比率分别为２．９％和５．６％。结论：精神分裂症和抑郁症的自杀行为是精神科临床危机干预的重要内容，临床医师应当重视发病期精神症状对自杀行为的影响。     

重复与单次自杀行为者的生活满意度、应对方式及社会支持

目的:比较重复与单次自杀行为者生活满意度主观感受方面的差异,了解重复与单次自杀行为者出院后不同时期应对方式和社会支持情况,丰富自杀干预理论素材。方法:用生活满意度主观评价条目询问115例住院自杀行为者对自杀5年前、1年前、1个月前、当前、自杀1个月后、1年后、5年后生活满意度,并在其出院18个月、3年、5年时,采用应对方式问卷(CSQ)和社会支持评定量表(SSQ)施测。将有自杀未遂史及出院后6年内再次出现自杀的列为重复自杀行为者,并与单次自杀行为者比较。结果:24例重复自杀行为者就诊住院时对不同时期生活满意度(当前满意度除外)主观评价及累加总分均低于91例单次自杀行为者[如总分(18.9±3.6)vs.(22.6±4.0);均P<0.05]。出院后3年、5年时评定,重复自杀行为者CSQ中的退避、自责、幻想得分高于单次自杀行为者,而CSQ中的解决问题、求助及SSQ的主观支持、支持利用度、支持总分低于单次自杀行为者(均P<0.05)。将应对方式、社会支持、主观满意度分别放入与精神疾病等变量进行logistic回归分析,结果患有精神疾病者(OR=3.39～7.68,均P<0.05)有较高的重复自杀风险,而同时将上述变量一起多因素logistic回归分析,所有变量与重复自杀的相关均无统计学意义(均P>0.05)。结论:相对单次自杀行为者,重复自杀者生活满意度主观评价低,应对方式不良,社会支持差,且具有持续性。精神疾病与生活满意度、应对方式、社会支持相互影响,这些因素中,精神疾病与重复自杀的联系可能更紧密些。     

精神分裂症与抑郁症自杀未遂行为对照分析

自杀是精神病人死亡的主要原因之一,其中抑郁症和精神分裂症最为常见[1]。本文对132例精神分裂症和32例抑郁症自杀未遂临床资料进行对照分析．抑郁症自杀未遂发生率（28．07％）显著高于精神分裂症（2．86％）。两组在发病年龄、病程、幻觉、妄想、自责自罪等方面有显著性差异。1资料来源本文为1990～1997年在找院住院的精神分裂症4620例、抑郁症114例,按CCMD－2－R[2]诊断标准,分别筛选出有自杀行为的精神分裂症132例和抑郁症32例。对2组年龄、婚姻、经济状况、家族史、病前性格、起病形式、病程、生活事件、临床特征、自杀时间和方式…     

抑郁症患者感觉诱发电位变化与自杀行为的相关研究

目的:探讨抑郁症患者感觉诱发电位(SEP)变化与自杀行为的关系。方法:应用国产脑诱发电位仪,记录了48例抑郁症患者和40名正常对照者的SEP。结果:(1)与正常对照组相比,抑郁症组均出现P2主成分波幅降低(正常对照组(6.1±2.5)μV,自杀史阳性组(2.7±1.9)μV,自杀史阴性组(3.8±2.7)μV,P0.01)。(2)抑郁症患者的SEP改变主要与有无自杀行为史可能相关。结论:自杀行为相关的生物学指标与SEP的关系有待下一步随访。     

单相抑郁症自杀行为与父母育龄及胎次效应的研究

目的　探讨单相抑郁症自杀行为有否父母育龄及胎次效应。方法　采用严格的纳入标准 ,对 5 9例单相抑郁症患者的家系应用 Haldance和 Smith法进行研究。结果　单相抑郁症自杀行为与父母育龄及胎次的关系非常显著 ( x=2 .4>2 ,P<0 .0 5 ;6A>x6 A)。结论　单相抑郁症患者父母育龄越大和胎次越高者易发生自杀行为。提示适龄婚育对防止单相抑郁症自杀行为的发生具有重要意义     

Suicidal ideation and suicide attempts among child and adolescent psychiatric inpatients in Finland

BACKGROUND: The aim was to study the prevalence of, and factors associated with, suicidal ideation and suicide attempts among child and adolescent inpatients during hospital treatment. METHODS: The target group included all the child and adolescent psychiatric inpatients (n=504) in Finland on a chosen day. Suicidality was determined by the psychiatrist responsible for the inpatient treatment, using a questionnaire also exploring demographic, diagnostic, and treatment characteristics, as well as traumatic events of the patient. RESULTS: The rate of suicidal ideation was 37.6%, and suicide attempts 10.8%. The factors independently associated with suicidal ideation in multivariate analysis were the following: being affected by open adult sexual behaviour (OR 3.2), having depression (OR 2.5) or conduct disorder (OR 2.4) diagnosis, and manifesting violent acts (OR 2.4). The factors independently associated with suicide attempts were: manifesting violent acts (OR 8.1), having depression diagnosis (OR 5.3), being affected by open adult sexual behaviour (OR 4.9), involuntary treatment (OR 4.7), and being of the female sex (OR 3.7). Suicidal ideation was particularly prevalent among boy patients having conduct disorders, manifesting violent acts, and belonging to the age group under 13 years old. Suicide attempts were particularly prevalent among depressive adolescent girl patients. LIMITATIONS: Suicidality was based solely on the clinician's evaluation. CONCLUSIONS: Suicidal ideation and suicide attempts are common among child and adolescent psychiatric inpatients. Particular attention should be directed to inpatients who manifest violent acts or have depressive disorder.     

Suicidal behaviour during different phases of bipolar disorder

BACKGROUND: There are no previous studies comparing the prevalence and risk factors for suicidal behaviour during different phases of bipolar disorder. METHODS: In the Jorvi Bipolar Study (JoBS), 1630 psychiatric in- and outpatients were screened for bipolar disorders with the Mood Disorder Questionnaire. Using SCID I and II interviews, 191 patients were diagnosed with bipolar disorders (90 bipolar I, 101 bipolar II). Suicidal ideation was measured using the Scale for Suicidal Ideation (SSI). Prevalence and risk factors for ideation and attempts during different phases (depressive, mixed, depressive mixed and hypomanic/manic phases) were investigated. RESULTS: There were marked differences between phases regarding suicide attempts and level of suicidal ideation. Hopelessness predicted suicidal behaviour during the depressive phase, whereas a subjective rating of severity of depression and younger age predicted suicide attempts during mixed phases. LIMITATIONS: The relatively small sample size in some phases. CONCLUSIONS: Suicidal behaviour varied markedly between different phases of BD. Suicide attempts and suicidal ideation were related to phases which are associated with depressive aspects of the illness. Hopelessness and severity of depression were key indicators of risk in all phases.     

Body Composition,Sarcopenia, and Suicidal Ideation in Elderly Koreans: Hallym Aging Study

This study was conducted to assess the relationship between body composition and suicidal ideation among the Korean elderly population (n = 302; ≥ 65 years) who participated in the Hallym Aging Study in 2010. Body composition was measured using dual-energy X-ray absorptiometry, and obesity was measured by the indices of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and body fat percentage. Sarcopenia was defined as presence of both low muscle mass and low muscle function. Suicidal ideation was assessed using the Beck Scale for Suicide Ideation. We found no differences in body composition measures between subjects with suicidal ideation and those without. In the logistic regression analyses, there were no significant relationships for suicidal ideation according to body composition measures, including BMI, WC, WHR, WHtR, and body fat percentage in both sexes. After adjusting for age, smoking status, alcohol drinking, regular exercise, medical comorbidities, monthly income, education level, and presence of depressive symptoms, the odds ratio (OR) of suicidal ideation was higher in elderly men with sarcopenia compared to those without, whereas no significant relationships were observed in elderly women (OR 8.28, 95% confidence interval [CI] 1.20–61.34 in men; OR 0.79, 95% CI 0.07–8.43 in women). Sarcopenia is closely associated with an increased risk of suicidal ideation in elderly men.     

小学生行为问题综合干预效果研究

目的：探索一套治疗小学生行为问题持续有效的方法。方法：抽取3－5年级有行为问题的学生85名,分成干预组（N＝45名）和对照组（N＝40名）。应用个体心理治疗、家庭、学校及教育等方法,集中进行持续二年的综合干预。结果：干预二年后,显效率达75．56％。CBCL评定,干预组男性的分裂样、交往不良、强迫性和体诉因子分,女性的抑郁和社交退缩因子分都明显低于对照组。结论：综合干预对小学生行为问题持续有效,是通过各干预方法的作用特点共同产生的效果。     

BDNF promoter methylation and suicidal behavior in depressive patients

Introduction

Suicide is a major health problem, and depression is a major psychiatric cause of suicide. Suicide is influenced by the multifactorial interaction of many risk factors. Therefore, epigenetic research may lead to understandings that are applicable to suicide. This study investigated whether epigenetic changes are associated with suicidal behavior and evaluated the treatment outcome of suicidal ideation in depressive patients.

Methods

In 108 patients with major depression, the promoter methylation of the gene encoding brain-derived neurotrophic factor (BDNF) was measured. Sociodemographic and clinical characteristics including a history of previous depressive episodes, age at onset, duration of illnesses, family history of depression, and number of stressful life events as well as subjective perception of stress and assessment scales for depression (HAMD), anxiety (HAMA), function (SOFAS), disability (WHODAS-12), and quality of life (WHOQOL-BREF) were evaluated at baseline. Suicidal behavior was ascertained using a semistructured clinical interview with questions about severity and intent. Beck Scale for Suicide Ideation (BSS) was administered during 12 weeks of treatment with antidepressants.

Results

A higher BDNF promoter methylation status was significantly associated with a previous suicidal attempt history, suicidal ideation during treatment, and suicidal ideation at last evaluation as well as with higher BSS scores and poor treatment outcomes for suicidal ideation.

Limitations

Methylation status was investigated with limited area of the BDNF gene and sample size was relatively small.

Conclusions

BDNF methylation status could be a proxy marker for previous suicidal attempts and a clinical biomarker for poor treatment outcomes of suicidal ideation in depression.     

大学新生欺凌行为与自杀意念的回顾性研究

目的回顾性探讨大学新生传统、网络欺凌行为与自杀意念的关系,为开展相关研究和干预提供相关依据。方法采用《青少年生活环境与心理健康量表》中国版改良后进行测量,对昆明医学院大一1850名本科新生进行横断面调查。运用χ2检验、log istic回归分析等方法研究。结果在过去的12个月,在校88%以上的学生曾被语言欺凌,46%的学生曾使用语言欺凌别人。在网络上57%的大学生被暴力欺凌,欺凌别人以语言欺凌为主占25.8%。女生在传统被语言欺凌(χ2=22.53,P<0.001)、孤立欺凌别人(χ2=13.94,P<0.001)、暴力欺凌别人(χ2=6.16,P<0.05)、网络上被暴力欺凌(χ2=11.81,P<0.001)和暴力欺凌别人(χ2=41.597,P<0.001)的比率都比男生高。而男生在传统中被暴力欺凌(χ2=94.4,P<0.001)、被孤立欺凌(χ2=12.85,P<0.001)、在网络中被孤立欺凌(χ2=18.62,P<0.001)的比率比女生高。22.5%的大学新生在过去的12个月或者曾经有过自杀意念,自杀意念的发生率随着欺凌行为的增加而提高,传统和网络中的语言欺凌、孤立欺凌是自杀意念的预测因素。结论大学新生欺凌行为与自杀意念都较常见,而且二者间存在一定的关系,在进行心理干预时应同时考虑性别、不同欺凌方式和不同场所对自杀意念的影响差异。     

TPH2基因单核苷酸多态性与单相抑郁及其自杀行为的关系

目的探讨色氨酸羟化酶2(TPH2)基因rs7305115单核苷酸多态性与单相抑郁及自杀行为的关系。方法提取197例单相抑郁患者和225名健康对照者基因组DNA,采用聚合酶链反应(polymerase chain reaction PCR)扩增包括TPH2基因rs7305115位点的312bp基因组DNA片段及PCR产物直接测序。结果在第7外显子周围未发现其它的单核苷酸多态性。单相抑郁患者和健康对照者TPH2 rs7305115基因型和等位基因频率无统计学意义的差别(P>0.05),但患者组内有自杀行为的个体携带基因型AA的频率及等位基因A的频率均较低,两组比较差异有统计学意义(P<0.05)。结论TPH2基因rs7305115单核苷酸多态性与单相抑郁无明显关联,与自杀行为有关联。其可能与抑郁症自杀行为易感性相关。     

大学生的父母教养方式、自杀意念、自杀态度的关系

目的:探讨父母教养方式与大学生自杀态度、自杀意念的关系,为自杀预防提供科学依据。方法:随机抽取长沙某本科院校大学生430名,用父母教养方式评价量表、自杀态度问卷、自杀意念问卷评估大学生的父母教养方式、自杀态度、自杀意念。结果:1大学生在自杀意念问卷的绝望、睡眠、乐观(t=2.128,-2.564,3.151;P0.05)上性别差异显著,在自杀意念总分上年级差异显著(F=3.007,P0.05);2父母教养方式各维度高低分组在对自杀行为性质的认识、对自杀者的态度、对自杀者家属的态度、绝望、睡眠、乐观、自杀意念总分上差异显著,且前者与后者相关显著。结论:父母更多使用积极的教养方式,较少使用消极的教养方式,有助于降低大学生自杀风险。     

Early Trauma and Relationships among Recent Stress,Depressive Symptoms,Anxiety Symptoms,and Suicidal Ideation in Korean Women

BackgroundEvidence continues to accumulate that the presence or absence of early trauma (ET) implies unique characteristics in the relationships between suicidal ideation and its risk factors. We examined the relationships among recent stress, depressive symptoms, anxiety symptoms, and suicidal ideation in Korean suicidal women with or without such a history.MethodsUsing data on suicidal adult females, 217 victims and 134 non-victims of ET, from the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior, we performed structural equation modeling to investigate the contribution of recent stress, depressive symptoms, and anxiety symptoms on suicidal ideation within each group according to the presence or absence of a history of ET.ResultsStructural equation modeling with anxiety and depressive symptoms as potential mediators showed a good fit. Recent stress had a direct effect on both depressive symptoms and anxiety symptoms in both groups. Only anxiety symptoms for victims of ET (standardized regression weight, 0.281; P = 0.005) and depressive symptoms for non-victims of ET (standardized regression weight, 0.326; P = 0.003) were full mediators that increased suicidal ideation. Thus, stress contributed to suicidal ideation by increasing the level of anxiety and depressive symptoms for victims and non-victims, respectively.ConclusionTailored strategies to reduce suicidal ideation should be implemented according to group type, victims or non-victims of ET. Beyond educating suicidal women in stress-management techniques, it would be effective to decrease anxiety symptoms for those with a history of ET and decrease depressive symptoms for those without such a history.