抑郁症患者认知功能损害及其影响因素研究

抑郁症的认知功能损害表现在执行功能、记忆力、注意力和心理加工速度等方面。本文从生理、心理和社会，积极和消极因素两个角度综述了年龄及首次发病年龄、认知偏差、情绪认知、孤独感、社会支持、病程与发作次数、病情严重程度、疾病伴随症状、药物、运动以及物理因素等对抑郁症患者认知功能损害的影响。通过对抑郁症患者认知功能损害及其影响因素的探讨，为抑郁症的识别、预防和治疗提供帮助。     

全科医生对躯体症状障碍的识别与处理

以躯体不适为主诉就诊于全科门诊的躯体症状障碍(somatic symptoms disorder,SSD)患者越来越多,这些患者常年受痛苦的躯体症状所困扰而就诊于各个综合医院的专科或全科门诊,但却无法得到正确地识别与处理.在西方大多数国家,全科医生提供大多数精神心理卫生服务.全科医生对于此类疾病的识别具有重要意义,更早...     

Somatization: a borderland between medicine and psychiatry.

Somatization is the tendency to experience and communicate psychologic distress in the form of somatic symptoms that the patient misinterprets as signifying serious physical illness. Patients with persistent somatization relentlessly seek medical diagnosis and treatment despite repeated reassurance that physical illness is either absent or insufficient to account for their symptoms and disability. Such abnormal illness behaviour leads to overuse of health care facilities and contributes to the high cost of health care. Somatization may occur transiently in response to stressful life events or it may be persistent and result in chronic partial or total disability. Diagnostic and therapeutic guidelines that may help physicians identify and manage such patients more effectively are discussed.     

胃癌患者焦虑抑郁情绪障碍调查与心理干预效果观察

目的评估胃癌患者的焦虑、抑郁状态,分析影响焦虑、抑郁心理的相关因素,提出心理干预对策。方法调查采用焦虑自评量表(SAS)、抑郁自评量表(SDS)和影响因素调查问卷表,并对结果进行统计分析。结果 81.12%的胃癌患者出现了不同程度焦虑、抑郁状态。引起胃癌患者焦虑抑郁的主要原因是害怕自己是胃癌、对手术效果怀疑、担心经济承受力等。经心理干预后,患者的焦虑、抑郁症状明显改善,与心理干预前比较,差异有统计学意义(P<0.01)。结论医护人员不仅要重视对患者躯体疾病的治疗更应关注并及时疏导患者所出现的心理问题,最大限度恢复患者的身心健康。     

心理干预在口腔癌治疗中的研究进展

口腔癌的治疗是临床医师面临的巨大挑战,口腔癌不仅威胁患者的生命健康,同时也易使患者产生严重的焦虑、抑郁等心理疾病,加重患者病情。心理干预的目的不仅要消除患者的恐惧、绝望等心理问题,还要改善患者的免疫力。心理干预的各种方法对口腔癌患者的治疗有着至关重要的作用。现就口腔癌的发生与心理疾病的关系以及心理干预在口腔癌患者治疗中的作用予以综述。     

炎症性肠病病人的心理症状及生活质量的相关分析

目的调查炎症性肠病（inflammatory bowel disease,IBD）群体的心理症状特点,研究心理症状与生活质量之间的关系,为伴有精神心理异常的IBD病人进行相应的心理治疗提供一定的理论依据。方法收集IBD病人159例和健康人群89名采用一般状况调查表、90项症状清单（SCL-90）量表、炎症性肠病生存质量问卷（IBDQ）与健康调查简表（SF-36）进行心理测评,根据得分进行统计学分析,了解IBD病人的心理症状及对其生活质量的影响。结果与健康人群比较,IBD病人总分、躯体化、抑郁、敌对、偏执及其他方面的阳性率及评分均较高（P < 0.05~P < 0.01）;SF-36得分,IBD病人在除精神健康外,其他各维度得分均低于健康人群（P < 0.01）;与SCL-90阴性的IBD病人相比,SCL-90阳性的IBD病人在总分、全身、肠道、情感方面得分均较低（P < 0.01）;多元线性回归分析显示,IBD病人生活质量的影响因素有（b=27.163,P < 0.01）、忧郁（b=-18.583,P < 0.01）、人际关系敏感（b=17.563,P < 0.05）、偏执（b=-14.316,P < 0.05）。结论IBD病人易合并明显的强迫、人际关系、抑郁、敌对等方面的异常心理症状,生活质量显著降低;生活质量主要受疾病病情、抑郁、人际关系敏感及偏执影响,处于疾病活动期时的病人,抑郁、偏执、人际关系敏感症状重,其生活质量低。     

关注老年心血管疾病患者的心理健康

心血管疾病是老年人常见病,是影响老年人心理健康的主要因素。而心理问题诱发或加重躯体疾病,并影响治疗效果,心理健康与治疗躯体疾病同等重要,临床医务人员不仅要重视药物等临床治疗,还要对患者的心理状况采用个体化心理干预,提高心理健康水平,减轻或消除患者的病理心理状态,以及由此引起的各种躯体症状,从而达到治疗目的;还可提早康复,预防复发,以减少医药费用。     

Perspectives on care at the close of life. Psychological considerations, growth, and transcendence at the end of life: the art of the possible

Patients with life-threatening illnesses face great psychological challenges and frequently experience emotional distress. Yet, the end of life also offers opportunities for personal growth and the deepening of relationships. When physical symptoms and suffering are controlled, it is easier to address patients' central concerns-about their families, about their own psychological integrity, and about finding meaning in their lives. Optimal end-of-life care requires a willingness to engage with the patient and family in addressing these distinct domains. In addition to supporting growth of patients and their caregivers, physicians need to recognize the impact of psychiatric disorders such as depression, anxiety, and delirium at the end of life and develop skills in diagnosing and treating these syndromes. Comments of a patient with pancreatic cancer, his son, and his physician help illuminate the potential opportunities presented when coping with life-threatening illness. Enhanced understanding of the common psychological concerns of patients with serious illness can improve not only the clinical care of the patient, but also the physician's sense of satisfaction and meaning in caring for the dying.     

Depression in children and adolescents

Childhood depression accounts for a substantial proportion of cases in child psychiatric clinics. Depression is more common in boys than girls in school age children and it becomes reverse during adolescents. The childhood depression can be wholly chemical, wholly due to psychological factors of a combination of both. The causes of depression can be discussed under three headings--genetic factors, biological factors and social factors. Some children display the classical symptoms of sadness, anxiety, restlessness, eating and sleeping problems while others present with physical problems like aches and pains which do not respond to treatment. Diagnosis depends on interview or questionnaire instruments to screen populations and some biological procedures to determine neuro-endocrine and other physical dysfunctions. Treatment consists of pharmacological treatment and psychological treatment. Tricyclic antidepressants, serotonin specific reuptake inhibitors and electroconvulsive therapy constitute pharmacological part of the treatment, whereas supportive, insight oriented, play, behaviour, family therapies and cognitive psychotherapy constitute psychological part.     

心理护理对癌症患者情绪的影响

目的探讨对癌症患者进行心理护理能否改善患者情绪障碍。方法对我院100例癌症患者进行心理护理,包括告之患有癌症、癌症的治疗与预后、癌症应对方法、癌症患者同伴教育等,比较心理护理前后患者的焦虑、抑郁程度变化。结果患者焦虑总分、精神症状总分、躯体症状总分在心理护理后明显低于心理护理前,差异有统计学意义（P〈0.05）,且随着心理护理的开展,焦虑程度进一步下降。心理护理前患者中无抑郁者3例（3%）,轻度抑郁36例（36%）,中度抑郁43例（43%）,重度抑郁18例（18%）;心理护理后无抑郁者26例（26%）,轻度抑郁45例（45%）,中度抑郁22例（22%）,重度抑郁7例（7%）,心理护理前后患者抑郁程度差异有统计学意义（P〈0.05）。结论心理护理可有效减轻癌症患者抑郁焦虑程度,提高心理卫生水平。     

基于菌-肠-脑轴的肠肽与焦虑抑郁关系的研究进展

焦虑抑郁是由于不良情绪引起机体出现应激反应而导致的躯体性障碍,是生物、心理和社会因素共同作用导致的心理、生理症状并存的疾病,是当代社会最常见的心理疾病。该病不仅降低个人的生活质量, 还给家庭和社会带来巨大的经济负担。近年来随着高通量测序、序列识别技术及肠道宏基因组学的成熟,肠道微生物的作用被广泛认识和重视。肠道与中枢神经系统间存在着复杂的双向交流,由内分泌、免疫、肠道神经系统等多个系统精心协调完成。因此,肠道又被称为是人体的“第二大脑”。既往研究表明,肠道微生物可能作为微炎性反应状态的启动者,其介导的肠道稳态失衡,进而导致“菌-肠-脑”功能紊乱,在焦虑抑郁的发病过程中起着重要的作用,但具体致病机制目前尚不明确。作为人体最大的内分泌器官,肠道可以分泌数十种不同的信号分子,多以肽类为主。而分泌到体循环中的肠肽可与免疫细胞和迷走神经末梢上的同源受体结合,从而实现间接的肠脑沟通。因此,本文就肠肽作为菌-肠-脑轴的信号分子对焦虑抑郁的影响进行综述,以期为焦虑抑郁的临床诊治提供一定的参考。通过调节肠道微生物来改变抑郁焦虑等心理疾病已成为神经科学和心理学的热点, 维护良好的肠道菌群可能是未来焦虑抑郁预防和治疗的重要方向。      

双心医学之中西医结合诊疗现状

多项研究表明,心血管疾病的临床症状在相当部分与精神和心理疾病的症状相重叠,即心血管疾病经常与精神和心理疾病共存,这使得单一的治疗很难得到良好的治疗效果,引起了近年来的医学界对于心脏和心理双重疾病的关注,即双心疾病。然而我国传统医学从整体出发,倡导"形神结合"的概念,认为心的形态和功能与心理密切相关,更贴近目前双心疾病的理念。但是目前大多数临床心脏病专家由于专业的限制性,多不具备诊断和治疗双心疾病的能力。另一方面由于现有精神科药物不良反应较多,以及大多数患者在心理上对精神科就诊具有抵抗性,这使得"双心疾病"在临床诊疗上面临困难。为探索"双心疾病"的临床特点,我国的有关学者已经开展过相关的流行病学研究,结果均比较支持心血管疾病与心理状况失常相伴而生的观点,印证了"双心疾病"存在的真实状况。在该类型疾病的临床诊治方面,中医和西医的治疗理念和思路方面存在着比较大的差异,这种差异体现在诊疗理念和方式方面的多重差异,如何将中西医治疗"双心疾病"的优势进行融合以提高临床的诊疗能力和精准度是亟待解决的重要问题。鉴于临床关于"双心疾病"诊疗方面的相关进展,在本文中将针对"双心疾病"的中西医诊疗思路和具体的措施等进行综述,以为临床提供更多的参考。      

造血干细胞移植患者心理困扰影响因素与干预的研究进展

心理困扰是多因素引起的不愉快的情绪体验,而这些体验会影响患者有效应对癌症及其躯体症状和治疗的能力,可以显著降低患者的生活质量,影响健康结局。心理困扰是造血干细胞移植(hematopoietic stem cell transplantation, HSCT)患者最常见的心理问题,被国际肿瘤协会列为第6项生命体征,常表现为焦虑抑郁、创伤后应激障碍、睡眠障碍、谵妄和疲乏等不适症状。目前,国内外已经对HSCT患者心理困扰影响因素及干预方法进行了大量研究。这些研究提示女性、年龄、疼痛、身体功能、消极应对和家庭社会功能低下等是HSCT患者发生心理困扰的影响因素。同时也报道了HSCT患者心理困扰的干预方法,主要包括心理行为疗法、运动疗法、音乐疗法、健康教育干预法和姑息护理。这些干预方法均被证实可以减轻患者的不良情绪,改善心理状态,降低心理困扰水平,进而提高患者的生活质量。这一系列的研究为HSCT患者实施护理干预提供了依据和理论指导,同时建议国内今后开展多中心、大样本的纵向研究,进一步明确HSCT患者心理困扰的影响因素及影响机制,探讨一种实用性、安全性和可行性较强的干预方案。本文通过查阅文献,就上述内容进行综述。      

Health of long term benzodiazepine users

The physical and psychological health of long term (over one year) users of benzodiazepines in one general practice was assessed by patients' self reporting of illness and by general practitioners' records. Of 3741 patients registered with the practice, 82 had been prescribed a benzodiazepine, and 64 of these agreed to enter the study. All but five of these patients were over 40 years of age, nearly a third (19) were given a diagnosis related to depression by interviewers, and between a third and a half reported a current physical illness. Long term treatment with benzodiazepines is not necessarily optimum management but may reflect the realities of general practice.     

Management of depression in patients with advanced cancer.

OBJECTIVE: To formulate guidelines on the assessment, diagnosis and treatment of depressive symptoms in patients with advanced cancer, based on a review of the literature and clinical experience. DATA SOURCES: Articles from a range of international, peer-reviewed journals, texts by acknowledged experts and diagnostic manuals. STUDY SELECTION: The works cited focused either on the prevalence and diagnosis of depression in patients with cancer or related conditions or on the management or treatment of depressive symptoms arising in these patients. DATA EXTRACTION: Information was summarised and integrated into the management strategy. SYNTHESIS: There is an increased frequency of depressive-type symptoms in patients with cancer. In assessing the mood of these patients the physician needs to consider a wide range of factors. Diagnostic issues regarding depression in the medically ill are still being clarified. A good rapport with the patient and an understanding of the emotional conflicts engendered in the individual are important for good management. Active psychotherapeutic strategies include cognitive therapy techniques, management of self-defeating patterns of thought and low morale, and psychosocial group treatments. The side effects of antidepressants in the medically ill may preclude their use, although cyclic antidepressants in a lower dose range have been found to be useful. CONCLUSIONS: There is a need for more research into the diagnosis of depression in the medically ill and the use of antidepressants and counselling techniques in patients with cancer. The adequate management of depressed mood which occurs commonly in the patient with advanced cancer requires an integration of biological, psychological and social perspectives. Orchestrating the use of supportive measures, counselling and antidepressants requires both clinical skill and humanity.     

Diagnosing bipolar disorder: how can we do it better?

Accurate diagnosis of bipolar disorder is essential for effective treatment. The diagnosis of bipolar disorder is particularly complex, resulting in lengthy delays between first presentation and initiation of appropriate therapy. Inappropriate therapy destabilises the course and outcome of the disease. Although the defining features of bipolar disorder are manic or hypomanic episodes, patients typically present for treatment of depression and commonly deny symptoms of mood elevation. A correct diagnosis can easily be masked by comorbidities, personality issues and complex phenomenology. A diagnosis of bipolar disorder can be assisted by: asking about symptoms of mania or hypomania in every patient presenting with symptoms of depression. recognising mixed states in which manic and depressive symptoms occur simultaneously. identifying the features of bipolar depression that distinguish it from unipolar depression. There is a risk of over-diagnosis of bipolar disorder among patients who are histrionic, show abnormal illness behaviour and/or have issues of secondary gain.     

Effect of short-term Psychiatric Intervention in Cancer Patients

A total of 50 patients undergoing cancer treatment at Malignant Disease Treatment Centre were included in the present study aimed at evaluating the psychological status of cancer patients. All patients filled a specially designed proforma and the following psychological questionnaires : General Health Questionnaire, Carroll Rating Scale for Depression, State-Trait Anxiety Inventory, PGI General Well-being Scale and Quality of Life Scale. Analysis of the results showed that 22 (44%) of the cancer patients had psychiatric disorders and this number had reduced to 12 (24%) after therapy. The difference was statistically significant. Psychiatric treatment also resulted in a statistically significant reduction in level of depression as measured by Carroll Rating Scale for depression. Short term psychiatric treatment was found to be very useful in treating psychiatric morbidity and depression in cancer patients.Key Words: Cancer, Depression, Psychiatric morbidity     

Differential outcome of pure manic, mixed/cycling, and pure depressive episodes in patients with bipolar illness

We found significant differences in time to recovery and rates of chronicity in 155 patients with bipolar illness when the episodes were subtyped into those with manic symptoms alone (pure manic), depressive symptoms alone (pure depressed), or symptoms of depression and mania (mixed or cycling) up to the time of entry into a clinical research study. Most of the patients in all three groups who did not recover received levels of somatotherapy that were generally consistent with current recommendations for intensity of treatment appropriate to each condition. Based on a median follow-up of 18 months, the life-table estimate of the probability of remaining ill for at least one year was 7% for the pure manic patients compared with 32% in patients who entered the study with episodes that were mixed or cycling. Purely depressed patients had a 22% probability of remaining ill, approximating rates found in patients without bipolar illness who have episodes of depression. Different clinical variables were found to predict time to recovery in each of these groups. We propose that this subtyping of episodes may be a clinically useful part of the classification of bipolar disorders.     

闸北区某社区精神病患者失眠原因分析

目的：分析导致社区精神病患者失眠的相关因素，制定相应的管理措施，为社区精神病患者失眠的防治和护理提供参考依据。方法：在本社区居家康复的精神病患者中选取200例失眠症患者，对患者进行电话随访与上门随访，通过与患者及其亲友深入交流和沟通，了解总体情况、病情状况、药剂用量。并为患者建立个人信息档案，细致登记随访结果信息表格，对随访结果资料进行全面梳理与总结，并分析影响睡眠的相关因素。结果：难以入睡70例（35％），早醒64例（32％），时睡时醒9例（4．5％），彻夜不眠15例（7．5％）；失眠症与精神状况、社会因素、环境因素、心理因素、身体情况、药物不良反应等因素相关。结论：控制精神症状，消除疼痛和药物不良反应，加强心理疏导，创造良好的睡眠环境，培养良好的睡眠习惯是控制失眠的有效措施。做好社区精神病患者的睡眠状况监测，可防止意外的发生，保证治疗的顺利进行。     

乳腺癌患者焦虑抑郁诊疗现状分析*

女性乳腺癌患者焦虑抑郁情绪发生率高,可能与肿瘤发生部位特殊有关,其会加重患者化疗副反应,也对患者免疫系统、治疗积极性造成影响,从而影响患者的生存率。正确认识乳腺癌患者焦虑抑郁等心理问题,必要时给予干预已被视为乳腺癌综合性治疗中的重要一环。该文对此进行总结分析,旨在为乳腺癌焦虑抑郁患者的诊治提供帮助,更好地提高患者整体生存质量。