曲唑酮对酒依赖患者焦虑抑郁症的疗效观察

目的 探讨曲唑酮对酒依赖患者焦虑抑郁症状的有效性.方法 采用随机数字表法将70例符合酒依赖伴发抑郁障碍患者分为研究组和对照组各35例.对照组给予临床常规戒酒治疗,研究组合用曲唑酮治疗,疗程8周,分别于入组时、治疗后第2、4、6、8周末进行汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、饮酒问卷(ADS)和密西根酒精依赖调查表(MAST)评定.结果 自第2周末起两组HAMA、HAMD评分比较差异均有统计学意义(P＜0.05).自第4周末起两组ADS、MAST评分比较差异均有统计学意义(P＜0.05).结论 曲唑酮能有效治疗酒依赖伴发的焦虑抑郁症状,降低饮酒欲望,强化酒依赖治疗效果.     

电针联合舍曲林治疗创伤后应激障碍的效果观察

目的观察电针联合舍曲林对创伤后应激障碍(PTSD)的疗效及安全性。方法将50例PTSD患者随机分为研究组(舍曲林联合电针治疗)和对照组(舍曲林治疗)各25例,均治疗4周。于治疗前和治疗4周末采用创伤后应激障碍检查表(PCL)及汉密尔顿焦虑量表(HAMA)评定疗效。结果共47位患者完成研究,两组治疗4周末PCL总评分、重现、回避、高警觉、HAMA评分均较治疗前低,差异有统计学意义(P0.05);研究组治疗4周末PCL总评分、重现、高警觉、HAMA评分低于对照组,差异有统计学意义(P0.05)。结论在舍曲林基础上联用电针治疗,能够增加舍曲林对PTSD的重现、高警觉核心症状和焦虑症状的疗效。     

帕罗西汀合并小剂量曲唑酮治疗伴勃起功能障碍抑郁症的对照研究

目的探讨帕罗西汀合并小剂量曲唑酮对伴有勃起功能障碍(ED)抑郁症患者的疗效及安全性。方法将101例伴有勃起功能障碍的抑郁症患者随机分为研究组(50例)和对照组(51例),研究组在常规给予帕罗西汀治疗的基础上,合并小剂量曲唑酮,对照组仅给予帕罗西汀,疗程6周;于治疗前及治疗后1、2、4、6周采用汉密顿抑郁量表(HAMD)、勃起功能国际指数评分问卷(IIEF-5)及副反应量表(TESS)评定疗效、勃起功能及副反应。结果对抑郁症状的治疗,2组疗效相当,研究组显效率为86.0%,对照组为78.4%;但1周末及2周末研究组HAMD评分显著低于对照组(P<0.05)。对勃起功能,2组的显效率分别为56.0%、21.6%,差异具有显著性(P<0.01);研究组的IIEF-5评分于4周末即显著高于对照组;ED改善与HAMD阻滞因子减分值呈正相关。2组间TESS评分无显著性差异。结论帕罗西汀合并小剂量曲唑酮治疗抑郁症起效快,且可显著改善患者的勃起功能,安全性高。     

认知行为和抗焦虑药治疗焦虑障碍的随机对照研究

目的探讨认知行为治疗、抗焦虑药及两者结合治疗焦虑障碍的疗效。方法将138例焦虑障碍患者随机分为认知行为治疗组(45例)、抗焦虑药物组(47例)及两者结合治疗组(46例),治疗12周并随访6个月。分别于治疗前、治疗12周末和随访6个月末进行汉密顿焦虑量表(HAMA)、功能大体评定量表(GAF)、生活满意度量表(LSR)和生活质量综合评定问卷(GQOLI-74)评定。结果3组脱落率比较差异无统计学意义(P>0.05)。与治疗前比较,3组12周末和随访6个月末HAMA总分及其差值均显著下降(P<0.001),GAF、LSR和GQOLI-74总均分显著提高(P<0.01)。3组间比较,治疗12周末、随访6个月末结合组的HAMA总分差值均显著低于认知行为组、药物组(P<0.01)。随访结束时,结合组和认知行为组GAF、LRS总均分明显高于药物组(P<0.01);结合组GQOLI-74总均分及维度均分(除维度4外)明显高于药物组(P≤0.01)。认知行为组不良反应明显低于药物组和结合组(P<0.001)。结论认知行为治疗、抗焦虑药和两者结合治疗焦虑障碍均有显著疗效,安全性好,结合治疗显示出明显优势。     

拉莫三嗪与丙戊酸钠治疗双相抑郁的对照研究

目的评价拉莫三嗪治疗双相障碍抑郁发作的效果和安全性。方法对107例双相障碍抑郁发作患者采用随机、平行分组、对照的方法分别以拉莫三嗪和丙戊酸钠治疗,疗程8周,以汉密尔顿抑郁量表(HAMD)、临床疗效总评量表(CGI)在治疗前和治疗后第1、2、4、6、8周末评价疗效,同时采用治疗时出现的症状量表(TESS)进行安全性评估,在第1、2、4、6、8周末及需要时用Bech-Rafaelsen躁狂量表(BRMS)评定躁狂症状。结果拉莫三嗪组和丙戊酸钠组比较,两组有效率分别为75.5%和51.9%,治疗第6周和第8周末HAMD总分和减分率差异有统计学意义。治疗组不良反应明显较对照组发生率低。结论拉莫三嗪治疗双相障碍抑郁发作疗效优于丙戊酸钠,且前者不良反应较少,安全性高。     

慢性阻塞性肺病患者抑郁障碍发病率及治疗

目的 探讨慢性阻塞性肺病(COPD)患者抑郁障碍的发病率及治疗.方法 164例COPD患者均按中国精神障碍分类与诊断标准第三版(CCMD-3)诊断标准进行筛查,符合抑郁发作的患者随机分为两组,治疗组为常规治疗基础上加用盐酸氟西汀分散片,对照组为仅给予常规治疗,治疗4周,分别于治疗前和治疗后第1、2、4周末采用汉密尔顿抑郁量表(HAMD-17)评定抑郁症状,治疗前和治疗后第4周末进行肺功能检查.结果 患抑郁障碍者78例,发病率47.5％.治疗组HAMD总分在治疗后第2、4周末较治疗前有所下降,FEV1值在治疗后第4周末较治疗前有所上升,差异均有统计学意义(P ＜0.05,P＜0.01).两组间比较,治疗组HAMD总分低于对照组,FEV1值高于对照组,差异均有统计学意义(P＜0.05).结论 COPD患者伴发抑郁障碍的比例较高,合并抗抑郁治疗可进一步改善抑郁症状及肺功能.     

帕罗西汀联合奥氮平治疗躯体形式障碍的疗效观察

目的探讨帕罗西汀联合奥氮平对躯体形式障碍的疗效。方法将167例躯体形式障碍患者随机分为研究组和对照组,研究组即帕罗西汀联合奥氮平组,对照组为单用帕罗西汀组,治疗前后应用抑郁自评量表(SDS)和副反应量表(TESS)分别评定疗效及不良反应。结果治疗第2周末,研究组SDS评分较治疗前有显著性降低(P<0.05),而对照组无显著性变化。治疗第4周末及第8周末,两组SDS评分较治疗前均有显著性降低(P<0.05)。在第2周末及第4周末,研究组和对照组的治疗有效率有显著性差异(P<0.05)。两组均未出现严重不良反应。结论帕罗西汀联合奥氮平治疗躯体形式障碍较单用帕罗西汀,具有疗效好,起效快,不良反应少的优点。     

老年焦虑抑郁障碍共病54例临床研究

目的 探讨老年焦虑抑郁障碍的临床特征、诊断及治疗方法.方法 选取54例符合入组标准及排除标准的患者进行临床研究,归纳临床症状并进行统计分析.用汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)进行评分,对比治疗前后的评分变化,并以HAMA和HAMD减分率判定疗效.结果 老年焦虑障碍多与抑郁共病,躯体主诉多为其主要特点.治疗后第2周末开始起效,疗效随时间延长同步上升,治疗后第2、4、8周末HAMA、HAMD量表评分与治疗前比较,有显著性差异(P ＜0.05,P＜0.01).药物及心理治疗的总有效率90.75％.结论 老年焦虑障碍多与抑郁共病,及时干预治疗效果满意.     

帕利哌酮对文拉法辛治疗躯体形式障碍的增效作用研究

目的探讨小剂量帕利哌酮对文拉法辛治疗躯体形式障碍的增效作用及安全性。方法将年龄在23～56岁之间符合CCMD-3躯体形式障碍诊断标准的患者58例随机分为对照组(文拉法辛组)及研究组(文拉法辛合并帕利哌酮组)各29例,治疗8周。于治疗前、治疗2、4、8周末分别应用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)及症状自评量表(SCL-90)评价疗效,应用副反应量表(TESS)评定不良反应,将两组结果加以分析、比较。结果治疗第2周末开始研究组HAMD及SCL-90抑郁因子分明显低于对照组(P<0.05);第4周末开始研究组HAMA及SCL-90躯体化、焦虑因子分明显低于对照组(P<0.05)。两组各时期TESS评分无显著差异(P>0.05)。治疗8周末研究组有效率为82.8%,对照组有效率为65.5%,两组间差异有显著性意义(P<0.05)。结论小剂量帕利哌酮对文拉法辛治疗躯体形式障碍的增效作用明显且安全,控制抑郁症状更加迅速。     

度洛西汀合并阿立哌唑治疗躯体形式障碍的临床对照研究

目的 观察度洛西汀合并阿立哌唑治疗躯体形式障碍的临床疗效.方法 将80例躯体形式障碍患者随机分为度洛西汀合并阿立哌唑组(研究组)和度洛西汀组(对照组),均进行6周系统治疗和观察,分别于治疗前、治疗后第1、2、4、6周末采用汉密尔顿抑郁量表(HAMD)总评分及其焦虑/躯体化因子评分进行疗效评定.结果 两组HAMD总分及焦虑/躯体化因子评分在治疗后第1、6周末有显著性差异(P＜0.05),在治疗后第2、4周末有极显著差异(P＜0.01).两组治疗后各阶段的临床显效率比较均有显著性差异(P＜0.05).两组患者总体副反应发生率无显著性差异(P＞0.05).结论 度洛西汀合并小剂量阿立哌唑治疗躯体形式障碍具有起效快、疗效好、不良反应少等优点.     

Recognition, management, and course of anxiety and depression in general practice

This article addresses the issues of recognition of psychiatric disorders by general physicians (GPs) and the effects of recognition on management and course. Among 1994 patients who were screened with the General Health Questionnaire and who were rated by their GP, 1450 (72.7%) had not been identified by the GP as having a psychiatric disorder in the year before the index visit. Among these "new" patients, 557 (38.4%) had positive General Health Questionnaire scores. Only 47% of the new patients who met Bedford College diagnostic criteria for anxiety, depression, or ill-defined disorder had their psychiatric disorder recognized by their GP. Among patients who met Bedford College criteria, mean episode durations were longer for anxiety disorders (20 to 22 months) than for depressive disorders (9 to 10 months). Among the new patients, those with psychiatric disorders recognized by the GP were more likely to receive mental health interventions. Recognition was associated with shorter episode duration among patients with an anxiety disorder, but not among patients with depressive or ill-defined disorders.     

Pathological worry in depressed and anxious patients

Anxious apprehension is present in all anxiety disorders and concerns have been raised that worry is not confined to Generalized Anxiety Disorder (GAD). The aims of the present project were three-fold. First, we reexamined whether the level of pathological worry is higher in patients with GAD than other anxiety disorders. Second, we compared worry scores of patients with "pure" GAD, "pure" MDD, and MDD with comorbid GAD. And third, to examine whether worry is specific to psychopathology in general rather than anxiety or depression, we included a control group (psychiatric outpatients without an affective or anxiety disorder). Twelve hundred outpatients were interviewed and completed the Penn State Worry Questionnaire (PSWQ) upon presentation for treatment. Patients with "pure" GAD had the highest scores. Depressed patients were similar to those with anxiety disorders other than GAD, and the control group showed worrying similar to that in general population and nonanxious samples.     

Comorbidity of fear of progression and anxiety disorders in cancer patients

ObjectiveThe relation between fear of progression (FoP) and anxiety disorders remains unclear. Therefore, we investigated the comorbidity between clinical FoP and psychiatric anxiety disorders.MethodIn this cross-sectional study, 341 cancer patients undergoing acute inpatient care participated. A structured clinical interview (Structured Clinical Interview for DSM-IV Axis I) was used to identify Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition anxiety disorders and hypochondriasis. Patients completed measures of FoP (Fear of Progression Questionnaire), worries (Penn State Worry Questionnaire, Worry Domains Questionnaire), depression [Patient Health Questionnaire (PHQ): Depression], anxiety (PHQ: General Anxiety Disorder) and somatic symptoms (PHQ: Somatic Symptoms). We cross-tabulated FoP with the presence of anxiety disorders and studied associated variables.ResultsOf all patients studied, 17.6% suffered from an anxiety disorder. With regard to comorbidity, 68.3% suffered neither from clinical FoP nor from any anxiety disorder, 13.4% had not been diagnosed with an anxiety disorder but experienced clinical FoP, and 11.6% only suffered from an anxiety disorder. The remaining 6.7% suffered from FoP that was comorbid with an anxiety disorder. Patients with a pure FoP did not differ from patients with a pure anxiety disorder on nearly all symptom measures. Only a few associations between the comorbidity pattern and sociodemographic and clinical variables emerged.ConclusionClinical FoP appears to be a distinct phenomenon. It does not differ from anxiety disorders in its psychological and somatic burdens.     

心理动力性心理治疗合并药物治疗对焦虑障碍患者防御方式的影响

目的 了解心理动力性心理治疗合并药物治疗对焦虑障碍患者防御方式的影响.方法 本研究26例符合DSM- IV诊断标准的焦虑障碍患者进行6个月的心理动力性心理治疗合并药物治疗,对患者进行治疗前后防御方式问卷(DSQ)、汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评定及比较.结果 6个月重测时HAMD(4.79±5.86)和HAMA(5.42±7.204)均较治疗前(17.88±11.01)、(19.67±8.35)明显降低(t1=6.143,t2=6.989,P＜0.000).6个月后不成熟防御方式的评分下降显著(t=2.17,P=0.04);成熟型防御机制的评分增高显著(t=-4.84,P＜0.000);中间型防御机制评分下降显著(t=2.24,P=0.035).HAMA减分率与不成熟因子分下降率呈正相关(r=0.426,P=0.038).结论 心理动力性心理治疗合并药物治疗对焦虑障碍患者的焦虑和抑郁症状均有改善,并在改变症状的同时减少了不成熟防御机制的使用.心理动力性心理治疗合并药物治疗较单纯药物治疗更有助于焦虑症患者康复.     

Sympathetic reactivity in agoraphobic patients with and without personality disorders

OBJECTIVE: To compare sympathetic activity in agoraphobic patients with and without personality disorders before and after 11 weeks inpatient treatment. METHODS: Agoraphobic patients (n=38), 84% with panic disorder and 47% with personality disorders underwent cold pressure test (CPT), mental stress test (MST), and a specific anxiety test (SAT). Psychological assessments were done by the Bodily Sensations Questionnaire (BSQ), the Agoraphobic Cognitions Questionnaire (ACQ), Spielberger STAI-1 and -2, and a Stress Test Anxiety (STA) questionnaire. Sympathetic activity was measured by blood pressure, heart rate, epinephrine, and norepinephrine. RESULTS: The sympathetic activity did not differ significantly between patient groups, and the reactivity to stress was very low. The sympathetic reactivity remained unchanged after treatment, whereas psychiatric symptoms decreased. Correlations between sympathetic activity and psychological distress were not significant. CONCLUSION: Interpretation of bodily signals seems to be more important than the actual sympathetic activity in agoraphobic patients.     

Screening for anxiety disorders in depressed patients

The Psychiatric Diagnostic Screening Questionnaire (PDSQ) is a brief, psychometrically strong, questionnaire designed to screen for common Axis I disorders. In the present report, we examine the ability of the PDSQ to identify anxiety disorders in psychiatric outpatients with a principal diagnosis of major depressive disorder. Eight hundred patients presenting for treatment were evaluated with the Structured Clinical Interview for DSM-IV (SCID) after completing the PDSQ. Two hundred ninety-five patients had a principal diagnosis of major depressive disorder. The mean sensitivity and negative predictive value of the anxiety disorder subscales was 88.5% and 96.5% when all patients were considered, and 88.2% and 95.6% when only depressed patients were examined. The PDSQ's anxiety disorder subscales have high sensitivity and negative predictive value thereby indicating that the scale could function well as a screening instrument in depressed patients.     

Eating-related anxiety in individuals with eating disorders

Although previous research has supported the importance of anxiety as an etiological and maintenance factor for eating disorders, the specific mechanisms are not well understood. The role of anxiety in the context of eating behavior is especially unclear. The purpose of this study was to identify anxiety-eliciting eating situations and anxiety management strategies patients use to mitigate anxiety experienced in the context of eating as determined by diagnostic groups and symptom patterns. Fifty-three eating disorder outpatients were administered the Eating and Anxiety Questionnaire (EAQ) and the Eating Disorder Diagnostic Scale. Ratings indicated significant anxiety in most eating situations, whereas management strategies were more limited yet regularly employed. Factor analysis of the EAQ revealed a 6-factor solution for anxiety management strategies and a 4-factor solution for anxiety-eliciting situations. These results indicate patients with eating disorders report high levels of anxiety associated with eating behaviors but utilize limited yet consistent anxiety management strategies. Effective intervention strategies for managing eating-related anxiety should be incorporated into treatment and may need to be specified for different diagnostic subgroups.     

Anxiety and depression in a primary care clinic. Comparison of Diagnostic Interview Schedule, General Health Questionnaire, and practitioner assessments

Over one half of all persons seen in a primary care clinic were identified as having anxiety or depressive disorder by the primary care provider, the General Health Questionnaire (GHQ), or the Diagnostic Interview Schedule (DIS). In only about 5% of all patients were findings positive on all three assessments concurrently. Both the GHQ and the practitioners identified over 30% of all patients as having a disorder, while about 8% had one or more of five DIS anxiety or depressive disorders (major depression, dysthymia, panic disorder, generalized anxiety disorder, or obsessive-compulsive disorder). Of the patients with DIS disorders 83% had positive GHQ scores, and 73% were identified by the practitioner as having a mental disorder.     

Anti-tumor necrosis factor-α therapy is associated with less frequent mood and anxiety disorders in patients with rheumatoid arthritis

Aims:  The purpose of the present study was to examine the current prevalence of mood and anxiety disorders, and factors related to mood and anxiety disorders in patients with rheumatoid arthritis (RA).
Method:  The study sample included 83 consecutive patients with RA who were admitted to a rheumatology outpatient clinic. Diagnoses of psychiatric disorders were determined using the Structured Clinical Interview for DSM-IV (SCID-I). To assess physical disability and disease activity, the Health Assessment Questionnaire and the Disease Activity Score, respectively, were used.
Results:  The prevalence of any mood or any anxiety disorder was 43.4%. The two most common psychiatric diagnoses were major depression (21.7%) and generalized anxiety disorder (16.9%). Mood and anxiety disorders were unrelated to sociodemographic features, disease-related factors, and medications for RA except anti-tumor necrosis factor-α (TNF-α). These disorders, however, were identified less frequently in patients with RA receiving anti-TNF-α drugs compared to patients who did not receive such medications.
Conclusion:  Patients with RA frequently have mood and anxiety disorders, and anti-TNF-α drugs may be useful for the mental status of these patients.     

History of depressive and/or anxiety disorders as a predictor of treatment response: A post hoc analysis of a 12-week, randomized, double-blind, placebo-controlled trial of paroxetine controlled release in patients with fibromyalgia

Background

Despite of a high comorbidity of depressive and/or anxiety disorders with fibromyalgia, information on the clinical implications of this comorbidity is limited but antidepressants are commonly prescribed to treat fibromyalgia in clinical practice. We investigated whether a history of depressive and/or anxiety disorders was associated with response to paroxetine controlled release (CR) in the treatment of fibromyalgia.

Methods

One hundred sixteen (116) fibromyalgia subjects were randomized to receive paroxetine CR or placebo for 12 weeks. The primary outcome was treatment response defined as ≥ 25% reduction in the Fibromyalgia Impact Questionnaire (FIQ) score. In multivariate logistic regression, we determined if a history of depression and/or anxiety disorders was an independent predictor of response to paroxetine CR.

Results

In logistic regression, the history of depression and/or anxiety did not predict treatment response as measured by ≥ 25% reduction in Fibromyalgia Impact Questionnaire (FIQ) score (OR = 0.66, 95% CI = .29–1.49, Wald = 0.97, p = 0.32), while the drug status (paroxetine CR) was significantly associated with treatment response (OR = 2.57, CI = 1.2–5.61, Wald = 5.5, p = 0.02).

Conclusion

A significant proportion of patients with fibromyalgia had a history of anxiety and or depressive disorders. However response to treatment of fibromyalgia symptoms with paroxetine CR was not associated with a history of depressive and/or anxiety disorders. Our findings need to be confirmed in more adequately-powered and well-designed subsequent studies.