强迫障碍患者的共病人格障碍

目的:探讨强迫障碍(obsessive-compulsive disorder,OCD)患者共病轴Ⅱ人格障碍的情况。方法:对44例符合美国精神障碍诊断统计手册4版(Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition,DSM-IV)中OCD临床诊断标准的门诊和住院部患者,应用人格障碍诊断问卷4版(Per-sonality Diagnostic Questionnaire,PDQ+4)进行筛查。对筛查阳性者再用个性障碍晤谈手册(Personality Disorder Interview,PDI-IV)做半定式查询确定其中的人格障碍患者。结果:36名患者PDQ+4筛查阳性,阳性率为82%。36名阳性患者中有32名OCD患者同时符合人格障碍的诊断标准,共病率为73%(32/44),其中57%(25/44)的被试符合两种或两种以上人格障碍的诊断标准。共病率最高的3种人格障碍为C组的强迫型(64%)、回避型(57%)和A组的偏执型(21%)。结论:强迫障碍有较高的人格障碍共病率,其中共病率最高的为C组的强迫型和回避型。     

抑郁症与慢性疼痛共病情况及经济负担

目的:研究抑郁症与慢性疼痛共病的临床特点及经济负担状况.方法:对180例首诊抑郁症患者,用自编的躯体症状特点及经济负担调查问卷、汉密尔顿抑郁量表、慢性疼痛等级评价量表,调查抑郁症与慢性疼痛共病情况、临床特点及经济损害状况.结果:抑郁症与慢性疼痛共病患者出现率为14.9%,与单纯抑郁症组患者相比,抑郁症与慢性疼痛共病组的受教育年数低 [(10.1±3.7)vs.(12.0±3.6),P＜0.05]、病程长[平均秩次:93.8 vs.71.1,P<0.05]、外院就诊次数多[(3.6±2.9)vs.(2.6±1.8),P<0.01].共病组汉密尔顿抑郁量表总分、焦虑/躯体化因子分、认知障碍因子分均高于单纯组[(27.3±9.1)vs.(22.8±5.7)、(1.2±0.6)vs.(0.8±0.3)、(0.7±0.5)vs.(0.4±0.3);均P<0.05], 躯体症状以消化系统症状、头痛/头胀、性欲减退、皮肤麻木较突出.共病组人均间接经济负担高于单纯组,(平均秩次:91.4 vs.71.7,P<0.05),慢性疼痛程度与直接经济负担呈正相关(r=0.32,P<0.01).结论:抑郁症与慢性疼痛共病可能预示临床症状更重、治疗依从性更差、经济负担增加.     

老年抑郁症和焦虑障碍共病患者的临床特征

目的探讨老年抑郁症和焦虑障碍共病患者的临床特征。方法根据美国精神障碍诊断手册第四版(DSM-IV)的诊断标准,把78例老年抑郁症患者分为两组,单纯抑郁症组(抑郁症组,N=44)及抑郁症和焦虑障碍共病组(共病组N=34)。对所有对象评定一般人口学资料及老年抑郁量表(GDS)、汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)、简易智能状态评定量表(MMSE)和健康状况调查问卷(SF-36)等,比较两组患者间差异。结果抑郁症组与共病组患者的性别、年龄、病程、居住情况、家族史、民族、发病诱因和受教育年限等方面的差异无统计学意义(均P>0.05)。GDS总分(14.0±1.2/12.1±2.0,t=4.92)、HAMD(38.1±4.0/33.4±4.7,t=4.35)和HAMA总分(22.6±5.5/11.7±2.7,t=10.93)及其因子分、HAMD第3项(自杀)条目分、SF-36躯体功能(79.2±13.6/69.1±13.6,t=3.25)、社交功能(70.0±21.2/50.0±22.5,t=4.02)评分共病组均高于抑郁症组差异有统计学意义(均P<0.05)。结论老年抑郁症和焦虑障碍共病患者较单纯抑郁患者的抑郁和焦虑症状更重、自杀风险大、生活质量更差。     

抑郁症患者的家庭暴力及因素分析

目的:研究家庭暴力与抑郁症个性特点、社会支持、应对方式的关系,针对心理十预提供理论依据。方法:采用自行设计的家庭暴力调查表、汉密尔顿抑郁量表(HAMD)、社会支持评定量表、特质应对方式问卷和艾森克人格问卷(EPQ),对72例抑郁症患者进行评定和比较。结果:有家庭内暴力者38例(男16例,女22例),家庭暴力与抑郁症患者HAMD 抑郁总分呈正相关;有家庭暴力组男性的主观支持分、总社会支持分低于无家庭暴力组(18.8±4.9,22.6±3.4;33.7±8.2,39.6±6.4,P<0.05),消极应对分高于无家庭暴力组(34.9±4.7,30.1±6.5,P<0.05);有家庭暴力组女性的支持利用度分低于无家庭暴力组(6.1±2.0,8.1±2.0,P<0.05), EPQ的神经质评分高于无家庭暴力组(64.2±7.4,56.5±10.3,P<0.05)。结论:抑郁症患者的家庭暴力事件应予以重视,家庭暴力与男性抑郁症患者的绝望感、主观支持、总社会支持及消极应对方式相关;家庭暴力与女性的支持利用度和神经质个性相关。     

焦虑障碍与人格障碍的共病

目的:探讨焦虑障碍患者共病人格障碍的情况。方法:对127例符合DSM-IV轴I焦虑障碍的患者进行了DSM-IV轴II人格障碍的诊断评估,并进行汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、疾病严重程度(CGI-SI)、社会功能缺陷(SDSS)等评定。结果:①焦虑障碍与人格障碍的共病率为73.2%;②共病者焦虑障碍的发病年龄更早(P<0.01),焦虑障碍病程更长(P<0.05),疾病更加严重(P<0.01),其焦虑、抑郁水平更高(P<0.05;P<0.05),社会功能更差(P<0.01)。结论:焦虑障碍与人格障碍有较高的共病率,焦虑障碍与人格障碍共病患者的临床特征更加复杂。     

强迫障碍患者共病轴Ⅰ障碍的初步研究

目的研究强迫障碍(OCD)患者共病轴障碍的情况。方法符合DSM-IV临床诊断标准的44例OCD患者为被试,应用DSM-IV-TR轴I障碍定式临床检查病人版(SCID-I/P)半定试检查OCD患者共病轴障碍。结果 OCD与心境障碍的共病率为41%(18/44),OCD与其中的重性抑郁障碍(心境障碍的亚分类的一种)的共病率较高,为32%(14/44);OCD与其它的焦虑障碍共病率为27%(12/44),OCD与其中惊恐障碍伴/不伴广场恐怖(焦虑障碍的亚分类的一种)共病率较高,为11%(5/44)。结论 OCD可以与轴I障碍共病,其中OCD与重性抑郁障碍共病较常见,OCD与其它焦虑障碍的共病亦较常见。     

癫痫共病精神障碍住院患者的临床特征分析

目的对我院近两年来住院的癫痫患者进行回顾性研究,为规范治疗方案,改善预后提供循证依据。方法采用一般资料量表对50例患者住院资料进行整理,根据诊断与统计手册第五版(DSM-5).诊断系统对这类患者的病例记录资料进行规范诊断,分析临床特征。结果根据DSM-5诊断标准,癫痫脑病的比例明显下降(χ2=21.93,P0.01),癫痫共病双相情感障碍的比例明显增加(χ2=23.51,P0.01)。癫痫起病年龄越晚,共病双相情感障碍的可能性越大,差异有统计学意义(χ2=9.28,P0.05);难治性癫痫共病双相情感障碍所占比例较非难治性癫痫共病双相情感障碍比例低(χ2=12.78,P0.05);癫痫全面性发作共病双相情感障碍比例与部分性发作共病双相情感障碍比例无明显差异(χ2=11.67,P0.05)。结论临床实践中癫痫脑病诊断过多,癫痫共病双相情感障碍诊断不足。癫痫患者共病双相情感障碍与癫痫的发作特征、发病年龄及抗癫痫治疗的效果有关。     

酒依赖与焦虑障碍的共病研究

目的探讨酒依赖与焦虑障碍之间的共病特征,以发病率为切入点进行深入分析。方法选取某院精神科收治的58例焦虑障碍患者作为本次的研究当中的研究组,另外选取58例具有酒依赖现象的焦虑障碍患者作为对照组,对两组患者的发病率进行对照比较。结果从性别方面来看,女性焦虑障碍患者在酒精使用障碍方面的发病率明显高于男性患者,另外两组患者之间进行对比,治愈难度具有明显的差异。结论酒依赖与焦虑障碍之间的关系较为密切,因此对于焦虑障碍患者的治疗当中应将予以酒依赖现象改善的措施作为治疗的主要方向,进而使得患者恢复至健康的精神状态。     

强迫障碍共病轴I及其与童年期创伤性经历的关系

目的研究强迫障碍(OCD)共病轴I及其与童年期创伤性经历的关系。方法符合DSM-IV临床诊断标准的44例OCD患者为被试,应用DSM-IV-TR轴I障碍定式临床检查病人版(SCID-I/P)半定试检查OCD患者共病轴心境障碍、焦虑障碍的情况,确定共病轴I障碍患者。用童年期创伤问卷(CTQ-SF)测查OCD患者的童年期创伤性经历。结果有25例OCD患者共病轴I心境障碍和或焦虑障碍。OCD共病轴I障碍除了情感虐待、躯体虐待、情感忽视和躯体忽视外,只有性虐待(Waldχ2=4.036,P0.05)1个因子进入Logistic回归方程。其中性虐待b=1.813,exp(b)=6.131,exp(b)95%的C.I.为(1.045～35.960),性虐待因子的回归系数(b)0,比值比(OR)=exp(b)1。结论 OCD患者童年期的性虐待是OCD共病轴I心境障碍和或焦虑障碍的危险因素。     

焦虑和抑郁障碍共病的研究现状

目的 了解焦虑和抑郁障碍共病的发病率及治疗。方法 查阅相关文献，就焦虑和抑郁共瘸的研究现状进行综鎏。结果 焦虑和抑郁共病的易患因素有遗传、心理社会因素、生化因素、免疫学、内分泌和神经电生理变化，临床上常采用誓焦虑和抗抑郁药联合应用的药物治疗，并辅以认知心理疗法的综合方案。结论 当前，对焦虑和抑郁障碍共病的研究，尚存在诊断一致性欠统一；对发病机制内在联系的复杂性认识不足；治疗和诊断脱节等问题。     

基诺族抑郁症的流行病学调查

目的:了解云南省景洪市基诺族抑郁症的患病情况及相关因素。方法:本研究为横断面研究。采用按比例单纯随机抽样原则抽取基诺族1977名15岁及以上的基诺族居民,采用自编的一般情况调查表、一般成人健康问卷(GHQ)进行精神疾病筛查,采用DSM-IV-TR轴I障碍定式临床检查病人版(SC ID-I/P)进行诊断,对抑郁症患者进行汉密尔顿抑郁量表(HAMD17)评分。结果:基诺族的抑郁症时点患病率为2.4%,女性患病率明显高于男性(4.0%vs.1.0%,P<0.001),各年龄段中以35~54岁组的患病率3.7%为最高,受教育年限多者患病率高于受教育年限低者(3.2%vs.1.4%,P<0.05);女性、目前工作状况不佳、缺乏家人理解以及存在自杀意念的人群抑郁症患病率较高;女性患者的HAMD得分较男性高,家人支持差者的HAMD得分较家庭支持好者高。结论:基诺族抑郁症的患病率与近年国内其他省市报告的患病率相近,在性别、年龄、受教育程度方面存在差异,以女性35~54岁人群和受教育程度较高者的患病率相对更高。     

Social status and the comorbidity of child depression and conduct disorder

This study examined the overlap between child depression and conduct disorder (D&CD) as a function of peer social status (i.e., popular, rejected, neglected, controversial, average) in a sample of 1,464 nonreferred 4th graders. Both D&CD were measured by self-report, peer nomination, and teacher ratings. Social status was assessed by peer nomination. A strong correlation (.73) was found between D&CD, even after accounting for shared method variance by confirmatory factor analysis. Furthermore, the number of Ss who scored high on both D&CD was greater than would be expected by chance alone. Multivariate tests revealed that rejected Ss scored higher than average Ss on measures of D&CD. Controversial boys also scored higher on measures of CD. However, analyses also revealed that the association between depression and rejected social status might be due to a subgroup of depressed children who also manifested symptoms of CD. Implications for assessment and treatment of child disorders are discussed.     

Major depression in patients with panic disorder: factors associated with course and recurrence

The relationship between anxiety and depressive disorders has been the subject of considerable interest and controversy. In this study, the occurrence and course of affective illness was systematically examined in 63 patients meeting DSM-III-R criteria for panic disorder. Forty (63%) of the patients had experienced at least one major depressive episode. Of these, 13 (32.5%) experienced their first depressive episode prior to the onset of panic disorder, 15 (37.5%) experienced their first depressive episode after the onset of panic disorder, and in 12 (30.0%) the onset of the disorders was concurrent. Patients with agoraphobia had comparable rates of depression (68%) to patients without agoraphobia (53%, P = NS), and they had similar temporal patterns of depressive illness. Comorbidity with social phobia was associated with an increased longitudinal likelihood of major depression compared to patients without this comorbid diagnosis (P less than 0.05). Patients with longer duration of illness, early onset depression, melancholic depression, or family histories of anxiety or depression had an increased likelihood of having experienced recurrent depression. These findings are discussed in the context of current theories regarding the development of affective illness in patients with anxiety disorders.     

Axis I and Axis II disorder comorbidity in unipolar depression with anger attacks.

OBJECTIVE: We evaluated whether anger attacks in patients with major depressive disorder (MDD) are associated with higher rates of panic or other Axis I or II comorbid disorders. METHODS: 306 out-patients (163 women, mean age 39.5+/-10.5) with MDD were administered the Structured Clinical Interviews for Axis I and II Disorders, and the Anger Attacks Questionnaire. RESULTS: Patients with anger attacks showed only a trend toward a significantly higher rate of current panic disorder (P = 0.06) but no other difference in Axis I comorbidity. In addition patients with anger attacks had a slightly but significantly greater degree of depression severity. Consistent with previous studies, we have also found that depressed patients with anger attacks had significantly higher rates of dependent, avoidant, narcissistic, borderline, and antisocial personality disorders than those without anger attacks. CONCLUSION: Anger attacks do not appear to be associated with any specific pattern of Axis I comorbidity, but they are certainly linked with certain personality disorders. It is possible that the acute depressive state may have confounded the assessment of personality disorder rates, as well as the presence of anger attacks. On the other hand, both depressed patient groups (with or without anger attacks) were subject to the same confounding effect as their depression severity was rather comparable, thereby limiting the impact of this potential bias.     

Prevalence and comorbidity of dysthymic disorder among psychiatric outpatients.

We investigated prevalence and comorbidity of DSM-III dysthymic disorder in a psychiatric outpatient clinic. Seventy-five consecutive outpatients received structured interviews. Prevalence of dysthymic disorder was 36% in the consecutive sample. Thirty-four dysthymic and 56 non-dysthymic patients were compared for comorbidity. Dysthymic subjects were more likely to meet criteria for major depression, social phobia, and avoidant, self-defeating, dependent, and borderline personality disorders. Dysthymic disorder was usually of early onset, predating comorbid disorders, and had often not received adequate antidepressant treatment. These results help define dysthymic disorder as prevalent, usually predating axis I comorbidity, and associated with particular axis II diagnoses.     

基于潜在剖面分析的老年人抑郁分型及相关因素

目的:利用潜在剖面分析辨别老年人抑郁亚型,并分析抑郁亚型相关因素。方法:在社区选取8526名老年人,使用Zung抑郁自评量表(SDS)、健康促进生活方式量表(HPLP-C)、社会支持评定量表(SSRS)调查抑郁状况、行为方式和社会支持。利用潜在剖面分析对抑郁进行分型,采用回归混合模型(R3STEP)分析各类别的预测因子。结果:老年人抑郁可分为"抑郁低风险型"(C1,35.6%)、"高抑郁-稳定型"(C2,33.3%)及"低抑郁-不稳定型"(C3,31.1%)。以C1为参照,自我实现(OR=0.85、0.84)、健康责任(OR=1.25、1.12)、营养(OR=0.79、0.90)、SSRS得分(OR=0.95、0.97)、≥80岁(OR=1.36、1.33)、中等教育及以下(OR=0.71、0.81)是C2和C3的共性预测因子。结论:本研究提示,老年人抑郁存在不同的特征群体,应重点关注"低抑郁-不稳定型"老年人。     

酒精依赖患者配偶应对方式相关因素

目的:对酒精依赖患者配偶的应对方式进行调查分析,探索应对方式的相关因素。方法:选取符合国际疾病分类(ICD-10)酒精依赖诊断标准的患者配偶118名(女性114名,男性4名)。采用一般资料问卷和应对方式问卷(CSQ)测查其人口学资料和应对方式得分。采用单样本t检验比较酒精依赖患者配偶应对方式各因子分与常模之间应对方式的差异,广义线性回归模型进行多因素分析。结果:酒精依赖患者配偶6种应对方式除解决问题外,其他应对方式得分高于常模(P<0.01)。患者配偶教育程度与解决问题得分正向关联(β=1.44,P<0.05),收入与合理化因子粗分负向关联(β=-0.91,P<0.05)。结论:酒精依赖患者配偶使用的应对方式均较普通人群多。教育程度较高的配偶更多的采取解决问题的应对方式;家庭收入较低的配偶更多的采取合理化的应对方式。     

中青年淋巴瘤患者的心理痛苦及相关因素

目的:了解中青年淋巴瘤患者的心理痛苦现状及其相关因素。方法:选取住院中青年淋巴瘤患者145例,采用心理痛苦温度计(DT)、疾病认知问卷简版(BIPQ)和恐惧疾病进展简化量表(FoP-Q-SF)评估患者的心理痛苦程度、负性疾病认知程度和恐惧疾病进展水平。DT≥4分为显著心理痛苦(4~6分为中度心理痛苦、7~10分为重度心理痛苦)。结果:中青年淋巴瘤患者的显著心理痛苦检出率为81.4%,中度检出率为42.8%,重度检出率为38.6%。多重线性回归分析结果显示,BIPQ和FoP-Q-SF得分与心理痛苦得分正向关联(β=0.27、0.28,均P<0.05),已婚、家庭月收入较高的患者其心理痛苦程度较低(β=0.25、-0.16,均P<0.05)。结论:中青年淋巴瘤患者的显著心理痛苦检出率高,婚姻状况、家庭月收入、疾病认知和恐惧疾病进展是心理痛苦的重要相关因素。     

Association study of tryptophan hydroxylase 2 gene polymorphisms in bipolar disorder patients with panic disorder comorbidity

Frequent comorbidity between panic disorder (PD) and mood disorders has been widely reported in clinical and epidemiological studies and, recently, an increasing attention has been paid to the cooccurrence of PD and bipolar disorder (BD). Several studies have shown that an imbalance of serotonin activity could be related to panic symptoms. Tryptophan hydroxylase 2 (TPH2) are plausible candidates for the association with PD. The aim of this study is to investigate a possible association between TPH2 gene polymorphisms and the PD comorbidity susceptibility.Our sample consisted of 515 patients; 274 patients with BD (subtypes I and II), including 45 patients with lifetime panic disorder comorbidity and 241 controls. These patients were genotyped for eight tagging single nucleotide polymorphisms of the gene of human TPH2. We found significant differences between patients with BD, with panic disorder comorbidity, and controls in the allelic analysis (rs4448731, P=0.0069; rs4565946, P=0.0359; rs4760820, P=0.0079; rs1487275, P=0.0439) and genotypic analysis (rs4448731, P=0.011; rs4760820, P=0.0259). We also identified significant differences between patients with BD, with and without panic disorder comorbidity in the allelic analysis (rs4448731, P=0.004; rs4565946, P=0.011; rs11179000, P=0.031; rs4760820, P=0.018; rs1487275, P=0.038; rs10879357, P=0.023) and genotypic analysis (rs4448731, P=0.004; rs4565946, P=0.010; rs4760820, P=0.023; rs10879357, P=0.052). The haplotype analysis in the group of patients with BD, with and without panic disorder comorbidity, was also significant (rs4448731-rs4565946, P=0.0190; rs4448731-rs4565946, P=0.0220; rs10506645-rs4760820, P=0.0360). Further studies are needed to replicate the positive association that we observed.