头痛与抑郁焦虑障碍共病

头痛是最常见的临床表现之一,可占神经科或全科门诊就诊患者的l/4.头痛分为原发性头痛和继发性头痛,病因多样.头痛与抑郁、焦虑等精神疾患存在复杂的相互关系和相互影响,既可以是单纯的原发性头痛的表现,也可以是纯粹精神疾患的一个躯体症状,而原发性头痛又常与抑郁焦虑障碍等存在高发的共病,使得对之诊断和处理变得困难.     

轻度血管性认知功能障碍执行功能特点的研究

目的探讨轻度血管性认知功能障碍(MVCI)患者执行功能特点.为临床诊断提供依据。方法选择患者58例,分为MVCI组21例、脑血管病无认知障碍组(CVD组)15侧、对照组22例。测查各组患者记忆力、注意力、语言能力、执行功能、视觉空间功能及头颅MRI。结果 MVCI组总体认知功能、执行功能较CVD组明显下降(P<0.01)。MVCI组画钟测验、画图、语言、连线A和B、Stroop字和色、阿尔茨海默病评价量表认知分表(ADAScog)总分和单词回忆分项的Z值低于对照组的1.5个标准差,简易智能状态检查、语言流畅性测验、数字符号转换、Stroop字和色、ADAS-cog单词辨认成绩Z值低于对照组的1～1.5标准差。而CVD组与对照组以上指标差异无统计学意义(P>0.05)。结论 MVCI患者存在执行功能异常。MVCI诊断标准有较高的一致性和准确性。     

高血压与焦虑抑郁共病的研究进展

随着社会经济的快速发展,生活节奏加快,高血压与焦虑抑郁共病的发病率也逐年增加。焦虑抑郁是高血压的独立危险因素,同时高血压也导致焦虑抑郁的发生,二者互相影响,严重影响疾病的预后,现就高血压与焦虑抑郁共病的研究进展进行综述。     

老年期焦虑和抑郁障碍共病的治疗

本文对老年期焦虑障碍和抑郁障碍的流行病学，共患率，诊断和治疗等问题作一综述。     

高血压共病抑郁的脑结构磁共振研究进展

<正>高血压是中老年人常见的心身疾病,有研究预测在2025年全球将会有15亿6千万人患高血压。抑郁是一种高患病率和高致残率的疾病,给个人、家庭及社会带来巨大的影响。世界卫生组织相关统计表明,就疾病所造成的负担     

高血压患者抑郁和认知功能损害相关研究

目的观察高血压(EH)患者抑郁情绪和认知功能状况及其相关性。方法对200例乡村高血压患者和50例非高血压患者(对照组)采用抑郁自评量表和简易精神状态法分别测定其抑郁情绪和认知功能。结果高血压组抑郁评分明显高于对照组,与患者收缩压和舒张压正相关(P<0.05);高血压组认知功能评分明显低于对照组,与收缩压和舒张压负相关(P<0.01);抑郁评分与认知功能评分负相关(r=-0.514,P<0.01)。结论高血压患者存在着抑郁情绪障碍和认知功能明显减退。     

内科共病影响双相障碍患者病程

根据在美国国立精神卫生研究所（NIMH）主办的临床新药评价单元（NCDEU）会议上报告的LITMUS（中等剂量锂盐治疗研究）研究结果，双相I型和Ⅱ型障碍患者的共病负担较高，且与精神药物处方量增加相关。     

神经内科门诊抑郁障碍患者的临床特点探讨

目的探讨神经内科门诊抑郁障碍患者的临床特点。方法回顾性分析神经内科门诊2010-04~2015-06收治的144例抑郁障碍患者临床资料,对患者进行一般调查,采用流调中心抑郁量表和汉密顿抑郁量表(HAMD)进行评分。结果 1 644例门诊患者中诊断出抑郁障碍患者144例,占8.76%。老年患者抑郁障碍多发,60~77岁患者81例占56.25%。HAMD评分平均为(16.7±4.3)分。结论神经内科门诊抑郁障碍患者临床特点显著,可以作为临床治疗的参考指标。     

首次发作晚发抑郁障碍患者认知功能特征

目的考查首次发作晚发抑郁障碍(LOD)患者的认知功能特征。方法 LOD患者26例(LOD组)、轻度认知损害(MCI)患者35例(MCI组)和健康体检者44例(对照组),采用认知功能筛检工具(CASI)评估总体认知功能,跨文化神经心理成套测验评估不同领域认知功能,老年抑郁量表-30项评估情绪状况。结果 LOD组和MCI组CASI总分明显低于对照组(P0.05)。与对照组比较,LOD组患者言语记忆和视觉记忆各测验评分、言语流畅性(1 min)和连线测验A评分、注意力和集中注意能力评分均明显降低(P0.05);而MCI组患者仅言语记忆相关测验评分(CASI短时记忆、物品即刻回忆、物品5 min延迟回忆、段落逻辑记忆)、言语流畅性测验评分明显低于对照组(P0.05)。结论 LOD患者存在神经认知功能缺陷,且累及认知领域较MCI更广泛,推测与LOD额叶和颞叶功能受损有关。     

圣·约翰草提取物对伴有抑郁症的2型糖尿病合并高血压老年患者的疗效

目的 探讨抗抑郁植物药圣·约翰草提取物对伴有抑郁症的2型糖尿病合并高血压老年患者的临床疗效.方法 将106例伴有抑郁症的2型糖尿病合并高血压的老年患者随机分为药物治疗组(30例),心理治疗组(24例),物理治疗组(28例)和安慰剂组(26例),均治疗12周.以汉密尔顿抑郁量表(HAMD)减分率评定疗效,监测患者血压水平及糖化血红蛋白值(Hb)A1c.结果 (1)各组HAMD减分率分别为80%、54.2%、50%和37%,差异有统计学意义(P<0.05).药物治疗组疗效均优于其他3组(P<0.05).(2)治疗12周后,各治疗组收缩压及舒张压均较治疗前下降(P均<0.05),有效率差异有统计学意义(P均<0.05).(3)治疗12周后,各冶疗组HbA1c值均较治疗前有所下降(P<0.05).结论 圣·约翰草提取物能显著改善2型糖尿病合并高血压老年患者伴发的抑郁症,且有利于患者的血压和血精控制.     

Attempted suicide risk factors in major depressive disorder patients with atypical features

正Objective To explore the attempted suicide risk factors of socio-demographic and clinical characteristics in major depressive disorder patients with atypical features(e.g.increased appetite,weight gain and greater time spent sleeping).Methods This was a secondary analysis of the data from the Diagnostic Assessment Service for People with Bipolar Disorders in China(DASP),which was initiated by the Chinese Society of Psychiatry(CSP)and carried out in 13 major mental health centers in China.Totally 179 patients were diagnosed as atypical major     

The effect of bipolar I disorder and major depressive disorder on workforce function

This investigation was undertaken to explore and compare the effect of bipolar I disorder (BD) and major depressive disorder (MDD) on workforce function. The data for this analysis were procured from the Canadian Community Health Survey (CCHS 1.2). The sample consisted of 20 747 individuals (18 years or older and currently working); the proportions screening positive for lifetime BD and MDD were 2.4% and 11.2%, respectively. Individuals with BD or MDD had a significantly lower mean annual income, compared to people without these disorders. Individuals with BD had a signifi cantly lower annual income when compared to MDD (p < 0.05). Results from a multiple logistic regression also indicate that employed individuals with BD had greater odds of reporting one or more mental health disability days in the past two weeks, compared with those with MDD (OR = 1.6; 95% CI = 1.0 to 2.6). Currently employed individuals with BD had lower odds of "good job security" relative to those with MDD (OR = 0.6 95% CI = 0.5 to 0.9). The data herein underscore the pernicious effect of BD on workforce function, and suggest that opportunistic screening for BD in all individuals utilizing employment assistance programs for depression might be warranted.     

Frontal function, disability and caregiver burden in elderly patients with major depressive disorder

Caregivers of patients with late-life major depressive disorder experience a significant level of general caregiver burden. Disability in patients is possibly one of the origins of caregiver burden. Frontal lobe dysfunction might be the source of disability. This study investigated if frontal lobe dysfunction (body level) of patients with late-life major depressive disorder was associated with their disability (individual level), and if it led to a high level of caregiver burden (societal level). Thirty-four unselected pairs of caregivers and their family members with late-life major depressive disorder were recruited. Frontal Assessment Battery and Timed Instrumental Activities of Daily Living (TIADL) were used to assess patients' frontal function and disability, and Caregiver Burden Inventory was used to measure caregiver burden. Frontal Assessment Battery correlated with TIADL (r= -0.47; p<0.006). TIADL score was also associated with two subscales of the Caregiver Burden Inventory: social (r = 0.38, p=0.026) and time-dependent (r= 0.37, p= 0.033). This study supported the hypothesis that frontal lobe dysfunction in elderly patients with depression is associated with their disability in instrumental activities of daily living. Disability is related to social and time-dependent aspects of caregiver burden. Further studies to examine proposed cognitive interventions are suggested to reduce patient disability and caregiver burden.     

Coping styles in fibromyalgia: effect of co-morbid posttraumatic stress disorder

To analyze coping styles of fibromyalgia (FM) patients with specific emphasis on differences in coping styles between fibromyalgia patients with and without post traumatic stress disorder (PTSD). Seventy-seven consecutive patients (40 women and 37 men) who fulfilled ACR criteria for FM, and 48 healthy controls, completed questionnaires measuring prevalence and severity of PTSD symptoms, including the structured clinical interview for DSM-III-R—non-patient edition (SCID-NP) and the clinician administered PTSD scale (CAPS). Subjects were divided into two groups based on the presence or absence of PTSD symptoms. Subsequently, coping styles were measured using the Albert Einstein College of Medicine (AECOM) Coping Style Questionnaire. Student t tests were used to compare the means of quantitative variables, and proportions were compared by Chi square tests. Analysis of variance (ANOVA) was used to compare the scores of the FM patients with and without PTSD, as well as to estimate the effect of gender on psychiatric variables. FM patients exhibit significantly higher levels of suppression (P < 0.00001), help-seeking (P < 0.007), replacement (P < 0.003), substitution (P < 0.002), and reversal (P < 0.004) compared with healthy controls. FM patients with PTSD and without PTSD differed significantly only on the suppression subscale (P < 0.02). FM patients that have PTSD presented higher suppression scores compared to FM patients without PTSD. No significant difference was noted on scales of minimization, help-seeking, replacement, blame, substitution, mapping, and reversal. Our results have delineated coping patterns of FM patients, identifying suppression, help-seeking, replacement, substitution and replacement as strategies more common among these patients. We further identified suppression as the only coping style significantly more common among FM patients with co-morbid PTSD then among FM patients without such a diagnosis. Our results may serve to further characterize cognitive and behavioral aspects of FM patients and subsequently guide therapeutic interventions.     

Echocardiographic features of malignant hypertension.

Computerised apex- and echocardiography was used to study left ventricular dimensions and function in 13 patients with untreated malignant hypertension and eight with severe benign hypertension. All patients had normal left ventricular cavity dimensions. Five benign hypertensives and malignant hypertensives with a previous history of hypertension had significant thickening of the septum and posterior wall. In eight malignant hypertensives without a previous history wall thicknesses were normal. The absence of ventricular hypertrophy in some cases of malignant hypertension suggests that it is sometimes of rapid onset and not preceded by a non-malignant phase. although fractional shortening and peak Vcf were normal in all the hypertensives, diastolic left ventricular function was frequently abnormal with delayed mitral valve opening, reduced peak rate of filling, and outward endocardial motion during isovolumic relaxation. Malignant hypertensives showed a cavity shape change during isovolumic contraction, and in those without a previous history the aortic second heart sound occurred earlier. The abnormalities of function are probably the result of a combination of factors including pressure overload, abnormal myocardial properties, and myocardial ischaemia, either regional or generalized and secondary to arteriolitis.     

Association of panic disorder and panic attacks with hypertension.

PURPOSE: Previous studies of the association between hypertension and panic disorder were uncontrolled or involved small numbers of patients. PATIENTS AND METHODS: We compared the prevalence of panic disorder and panic attacks in 351 patients with documented hypertension who were randomly selected from all hypertensive patients registered in one primary care practice with age- and gender-matched normotensive patients from the same practice and with hypertensive patients attending a hospital clinic. All three groups completed questionnaires for panic disorder based on standard criteria, as well as the Hospital Anxiety and Depression scale. RESULTS: The prevalence of current (previous 6 months) panic attacks was significantly greater in primary care patients with hypertension (17%, P <0.05) and hospital-based hypertensive patients (19%, P <0.01) than in normotensive patients (11%). Similar results were seen for lifetime panic attacks (35% versus 39% versus 22%; both P for comparisons with normotensive patients <0.001). The prevalence of panic disorder was significantly greater in primary care patients with hypertension (13%) than normotensive patients (8%, P <0.05). Anxiety scores were significantly higher in both hypertensive groups than in normotensive patients. Depression scores were significantly higher in hospital-based hypertensive patients than in the other two groups. The reported diagnosis of hypertension antedated the onset of panic attacks in a large majority of patients (P <0.01). CONCLUSIONS: Physicians caring for patients with hypertension should be aware of the significantly greater prevalence of panic attacks in these patients.     

Cognitive function characteristics of the remitted major depressive disorder:a prospective study

正Objective To explore the cognitive function characteristics in major depressive disorder(MDD)before and after 6-month treatment.Methods Assessed the severity of depression with 24-Item Hamilton Depression Rating Scale(HAMD24),103 MDD were matched with 104healthy controls(HCs).Both groups of the subjects were measured cognitive function with WSCT and neuro-