北京市长青园社区站门诊患者103例焦虑抑郁状态筛查

目的:筛查北京市长青园地区社区门诊就诊患者焦虑抑郁状态发生情况。方法:调查样本来源于整群抽取的2004-10在北京市长青园地区社区门诊就诊患者103例。采用医院焦虑抑郁量表(由14条目组成,其中7个条目评定焦虑,7个条目评定抑郁;0～7分属无症状,8～10分属症状可疑,11～21分属存在症状)进行调查。由患者本人如实填写上个月情绪变化,调查者根据量表筛查结果对不同性别、年龄、文化程度、工作状况以及疾病情况下焦虑、抑郁障碍发生情况进行分析评估。结果:103例受试对象的测试结果均纳入结果分析。①不同性别、年龄、文化程度、工作状况焦虑、抑郁障碍发生情况:抑郁障碍发生率高于焦虑障碍发生率(32.0%和21.4%)。男性抑郁障碍发生情况略多于女性(33%和31%);≥60岁离退休老年人中49.4%存在不同程度的情绪障碍;小学及小学以下文化程度的人群的焦虑、抑郁障碍发生率高于初中及以上文化水平的人群(焦虑:25%和20%;抑郁:28%和24%)。②不同疾病情况下焦虑、抑郁障碍发生情况:焦虑、抑郁患者和可疑症状人群患有两种以上慢性病占25.2%,3种以上慢性病占6.8%。结论:北京市长青园地区社区门诊就诊的患者中抑郁状态人数多于焦虑状态人数,焦虑和抑郁障碍的发生率男性略多于女性,文化程度低的发生率低于文化程度高者,患两种以上慢性病的离退休老年人有近半数人存在不同程度的焦虑和抑郁障碍。     

肺心病患者焦虑、抑郁状态的分析及护理

目的：了解肺心病患者的焦虑、抑郁状态，为做好护理工作，提高患者生活质量提供依据。方法：采用Zung的焦虑自评量表（SAS）和抑郁自评量表（SDS）对我院呼吸内科住院及门诊肺心病患者96例进行心理状况的调查，并对其原因进行了分析。结果：96例肺心病患者的焦虑和抑郁的均分均高于普通人群（P〈0．01）。焦虑的发生率为27．08％，抑郁的发生率为60．4％。结论：肺心病患者有明显的焦虑、抑郁情绪，护理上应注重患者心理状况的改善。     

湖北综合医院精神卫生服务现状及焦虑抑郁障碍诊治情况调查

目的了解湖北省综合医院精神卫生服务资源现状与焦虑抑郁障碍诊治情况。方法通过分类随机抽样方式抽取湖北省18所包括两个地区、三个级别的综合医院,并对其发放自编"综合医院精神卫生服务资源记录表"。结果 (1)其中有11(64.7%)所医院至少提供1种精神卫生服务,提供住院服务仅5(29.4%)所。综合医院中有364人从事精神卫生服务工作,其中二级医院318人(87.4%)多于三级医院46人(12.6%)。(2)2010年至2012年,综合医院焦虑抑郁患者收治人次呈逐年上升趋势,特别是三级医院(P<0.01);武汉地区治愈率明显高于其他区(P<0.01)。(3)开展精神卫生专业知识培训仅限于设有精神科的综合医院;其他地区对设置精神科与开展精神卫生专业知识培训的需求要明显高于武汉地区(P<0.05)。结论湖北省提供精神卫生服务水平在地区与各级综合医院之间存在明显不均衡,综合医院开展精神卫生专业培训有待进一步完善与加强。     

社区精神卫生工作人员抑郁状况调查

目的：了解社区精神卫生工作人员抑郁状况。方法对88名社区精神卫生服务工作人员采用流调中心用抑郁量表进行测评分析。结果本组社区精神卫生工作人员流调中心用抑郁量表评分范围0分—52分,平均(8.74±7.09)分,男性为(10.00±6.80)分,女性为(8.27±7.45)分;可能有抑郁症状检出率为7.9%,抑郁症状检出率为5.7%;各条目为3分检出率由高到低排名前5位的依次为：条目12(71.6%)、条目16(67.0%)、条目8(60.2%)、条目4(42.0%)、条目11(14.8%)。结论社区精神卫生工作人流调中心用抑郁量表评分低于全国城市常模,幸福感、快乐感、未来希望感及睡眠状况较差,应予以有针对性的干预。     

循征护理对慢性阻塞性肺疾病缓解期患者抑郁状态的作用

目的 探讨以循征护理方法对慢性阻塞性肺疾病缓解期患者抑郁状态的改善作用。方法选择2002-03／2004-08山东省青岛疗养院呼吸康复病房慢性阻塞性肺疾病缓解期住院患者42例，随机分为循征护理组和对照组，循征护理组针对患者个性问题上网检索查询护理方法后，严格实施个性化的心理行为干预措施，并严格实施；对照组接受常规护理。两组患者分别在入院和出院时采用美国国立精神卫生研究所流行病学研究中心的抑郁量表确定护理干预前后抑郁患者及其抑郁程度的变化，采用自行设计访谈式问卷调查相关因素，即慢性阻塞性肺疾病病情5项，医药费来源4项，家属关怀4项和日常生活4项内容，按5点评分法对5个因素的担心和需求程度进行打分以评估其心理压力改善情况。结果按意向处理分析，42例患者全部进入结果分析。①循征护理组患者护理后抑郁患者比护理前明显减少(2，8，P&;lt;0．001)，抑郁量表评分比护理前明显减低(13．65&;#177;1．47，15．98&;#177;2．88，P&;lt;0．01)；对照组护理前后的抑郁患者数量、抑郁量表评分均接近(P&;gt;0．05)。②循征护理组患者护理后5个因素需求程度较护理前明显降低(P&;lt;0．01)，而对照组变化不明显。结论慢性阻塞性肺疾病缓解期患者抑郁状态的循征护理可减轻患者的心理压力，改善其抑郁状态，其护理效果优于传统护理方法。     

北京市长青园地区老年人社区卫生服务需求意愿调查

目的：了解北京市长青园地区不同性别、婚姻状况以及文化程度的老年人对社区卫生服务的需求意愿，探索提高社区卫生服务质量的途径。 方法：于2004-10整群抽取北京市崇文区体育馆路医院长青园社区站2000-07／2004-03为该社区60岁以上老年人建立的全科医疗健康档案763份进行调查。由全科医护人员进行调查，采用社区站自行设计调查分类表，调查分类表的内容包括：对健康咨询、饮食指导、体格检查、家庭病床、上门服务的需求，以及对健康管理收费20元／年(每年2次体格检查，1次心电图检查)的评价。对长青园社区不同性别、婚姻状况、文化程度的老年人健康档案中的上述内容进行分类、登记、统计，所得数据以X~2检验进行统计学分析。 结果：763份档案均纳入结果分析。①长青园社区60岁以上老年人对不同形式的社区卫生服务的需求率和对健康档案管理收费的认可度：从高到低依次为健康咨询46．0％，饮食指导26．6％，体格检查24％，家庭病床1．8％，上门服务1．6％。对健康档案管理收费20元／年的评价：认为价格合理的56．7％，价格贵的33．0％，价格便宜的9．8％，价格太贵的0．5％②不同性别、婚姻状况、文化程度的长青园社区老年人对社区卫生服务的需求比较：不同性别和婚姻状况的老年人在社区卫生服务的需求差异无显著性；不同文化程度的老年人对社区卫生服务的需求率差异有显著性(P<0．005)，其中小学以下文化程度的老年人对健康咨询、饮食指导需求量比较大，初中以上文化程度的老年人除对健康咨询、饮食指导需求外，对体格检查的需求率较高。 结论：北京市长青园社区60岁以上老年人以健康咨询、饮食指导和体格检查的社区卫生服务形式需求最高；文化程度是影响老年人对社区卫生服务需求差异的主要因素，文化程度高的老年人对体格检查的需求多于文化程度低者。健康档案管理收费多数人认为价格合理，说明健康档案管理收费形式得到多数老年人认可，在社区内可实行健康管理收费，并探索更合理的管理和收费形式。     

北京市长青园地区老年人社区卫生服务需求意愿调查

目的：了解北京市长青园地区不同性别、婚姻状况以及文化程度的老年人对社区卫生服务的需求意愿,探索提高社区卫生服务质量的途径.方法：于2004-10整群抽取北京市崇文区体育馆路医院长青园社区站2000-07/2004-03为该社区60岁以上老年人建立的全科医疗健康档案763份进行调查.由全科医护人员进行调查,采用社区站自行设计调查分类表,调查分类表的内容包括：对健康咨询、饮食指导、体格检查、家庭病床、上门服务的需求,以及对健康管理收费20元/年（每年2次体格检查,1次心电图检查）的评价.对长青园社区不同性别、婚姻状况、文化程度的老年人健康档案中的上述内容进行分类、登记、统计,所得数据以x2检验进行统计学分析.结果：763份档案均纳入结果分析.①长青园社区60岁以上老年人对不同形式的社区卫生服务的需求率和对健康档案管理收费的认可度：从高到低依次为健康咨询46.0%,饮食指导26.6%,体格检查24%,家庭病床1.8%,上门服务1.6%.对健康档案管理收费20元/年的评价：认为价格合理的56.7%,价格贵的33.0%,价格便宜的9.8%,价格太贵的0.5%.②不同性别、婚姻状况、文化程度的长青园社区老年人对社区卫生服务的需求比较：不同性别和婚姻状况的老年人在社区卫生服务的需求差异无显著性;不同文化程度的老年人对社区卫生服务的需求率差异有显著性（P＜0.005）,其中小学以下文化程度的老年人对健康咨询、饮食指导需求量比较大,初中以上文化程度的老年人除对健康咨询、饮食指导需求外,对体格检查的需求率较高.结论：北京市长青园社区60岁以上老年人以健康咨询、饮食指导和体格检查的社区卫生服务形式需求最高;文化程度是影响老年人对社区卫生服务需求差异的主要因素,文化程度高的老年人对体格检查的需求多于文化程度低者.健康档案管理收费多数人认为价格合理,说明健康档案管理收费形式得到多数老年人认可,在社区内可实行健康管理收费,并探索更合理的管理和收费形式.     

The impacts of migraine and anxiety disorders on painful physical symptoms among patients with major depressive disorder

Background

No study has simultaneously investigated the impacts of migraine and anxiety disorders on painful physical symptoms (PPS) among patients with major depressive disorder (MDD). The study aimed to investigate this issue.

Methods

This open-label study enrolled 155 outpatients with MDD, who were then treated with venlafaxine 75 mg per day for four weeks. Eighty-five participants with good compliance completed the treatment. Migraine was diagnosed according to the International Classification of Headache Disorders. MDD and anxiety disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR. The visual analog scale (VAS) was used to evaluate the severity of eight PPS. Multiple linear and logistic regressions were used to investigate the impacts of migraine and anxiety disorders on PPS.

Results

Compared with patients without migraine, patients with migraine had a greater severity of PPS at baseline and post-treatment. After controlling for demographic variables and depressive severity, migraine independently predicted the intensities of eight PPS at baseline and four PPS post-treatment. Moreover, migraine independently predicted poorer treatment responses of chest pain and full remission of pains in the head, chest, neck and/or shoulder. Anxiety disorders predicted less full remission of pains in the abdomen and limbs.

Conclusion

Migraine and anxiety disorders have negative impacts on PPS among patients with MDD. Integrating the treatment of migraine and anxiety disorders into the management of depression might help to improve PPS and the prognosis of MDD.     

抑郁症患者焦虑程度的调查及社区健康教育

目的了解抑郁症患者的焦虑程度及社区健康教育对患者的影响。方法2001年10月～2002年10月,在顺德新桂社区对122例抑郁症患者,应用抑郁自评、Zung氏焦虑量表(SAS、SDS)进行焦虑程度调查,并进行了社区健康教育,教育前后测定患者焦虑及抑郁程度,并进行比较。结果抑郁症患者在干预前的SAS、SDS评分均高于我国常模,健康教育干预前后的SAS、SDS评分结果比较,均P<0.01,差异有统计学意义。结论社区健康教育有利于减轻抑郁症患者的焦虑、抑郁情绪,从而也提高了治疗的效果。     

抑郁症与焦虑症脑血流灌注SPECT显像对照研究

目的：探讨抑郁症、焦虑症患者局部脑血流量（rCBF）的特点及脑单光子计算机断层扫描（SPECT）对抑郁症的诊断价值。方法：对21例抑郁症患者、17例焦虑症患者和20例正常对照者进行脑SPECT显像,并比较检查结果。结果：抑郁症组与正常对照组比较,双侧前额叶、颞叶前部、双侧扣带回前部、双侧顶叶、枕叶以及尾状核rCBF明显低于正常对照组（P＜0.05或0.01）。焦虑症组与正常对照组比较,额叶、部分颞叶和丘脑的rCBF明显低于正常对照组（P＜0.05或0.01）。抑郁症组与焦虑症组相比较,抑郁症组在双侧扣带回前部、右顶叶及尾状核的rCBF明显低于焦虑症组（P＜0.05或0.01）。结论：抑郁症和焦虑症对脑血流灌注均有重要影响,抑郁症患者在双侧扣带回前部、右顶叶及尾状核的脑血流灌注明显低于焦虑症组。SPECT脑灌注显像在抑郁症和焦虑症的诊断与鉴别诊断中具有重要价值。     

Pain and the onset of depressive and anxiety disorders

Patients with pain may be at increased risk of developing a first episode of depressive or anxiety disorder. Insight into possible associations between specific pain characteristics and such a development could help clinicians to improve prevention and treatment strategies. The objectives of this study were to examine the impact of pain symptomatology on depression and anxiety onset and to determine whether these associations are independent of subthreshold depressive and anxiety symptoms. Data from the Netherlands Study of Depression and Anxiety, collected between 2004 and 2011, were used. A total of 614 participants with no previous history and no current depression or anxiety at baseline were followed up for 4 years. Onset of depressive or anxiety disorder was assessed at 2- and 4-year follow-up by Composite International Diagnostic Interview. Baseline pain characteristics were location, duration, and severity, as assessed by chronic pain grade. Onset of depressive or anxiety disorder occurred in 15.5% of participants. Using Cox survival analyses, onset of depression and anxiety was associated with 6 pain locations (neck, back, head, orofacial area, abdomen, and joints; hazard ratio [HR] = 1.96 to 4.02; P < .05), increasing number of pain locations (HR = 1.29; P < .001), and higher severity of pain (HR = 1.57; P < .001). By contrast, there was no association with duration of pain symptoms (HR = 1.47; P = .12). Independent of subthreshold affective symptoms, only joint pain and increasing number of pain locations were still significantly associated with depression and anxiety onset. Clinicians should be aware that regardless of affective symptoms, pain, particularly at multiple locations, is a risk indicator for developing depressive and anxiety disorders.     

Screening for anxiety, depressive and somatoform disorders in rehabilitation—validity of HADS and GHQ-12 in patients with musculoskeletal disease

Purpose: The detection of patients with comorbid mental illness is of high clinical importance in orthopaedic rehabilitation. To simplify detection of cases, screening instruments are recommended. The study investigated the discriminant validity of the Hospital Anxiety and Depression Scale (HADS) and the General Health Questionnaire (GHQ-12) to identify patients with comorbid mental disorders, specifically anxiety, depressive and somatoform disorders.

Method: Two hundred and six patients with musculoskeletal disease from four orthopaedic rehabilitation clinics participated in a two-stage survey: (1) patients were assessed with the GHQ-12 and HADS; and (2) they were examined for DSM-IV mental disorders by clinical standardized interview (CIDI). Validity of the two instruments regarding the detection of mental disorders was compared using ROC-analysis and CIDI-diagnoses as criteria.

Results: The HADS sumscale performed better in all analyses compared to the GHQ-12, specifically in detecting depressive and anxiety disorders. Best results are achieved for depressive disorders with an area under the curve (AUC) of 0.79, a sensitivity of 78% and a specificity of 71% (cutoff point = 16). The positive predictive value (PPV) is best for the detection of any mental disorder with a cut-off point of 16 (46%).

Conclusions: The HADS can be used as a screening instrument for the detection of comorbid depressive and anxiety disorders in patients with musculoskeletal disorders. Limitations in performance of screening instruments are due to: (1) different methodological approaches of tests (dimensional approach) and criterion (categorical approach); and (2) difficulties in diagnosing mental disorders in patients with prominent physical illness.     

Contraindicated medication use among patients in a memory disorders clinic

Background: Inappropriate or contraindicated use of medications in elderly patients is common and associated with poor outcomes. An important risk factor for adverse drug events is the increased sensitivity to drug effects on the central nervous system (CNS). There is a high rate of use of CNS-active drugs in patients with cognitive impairment, despite the fact that these medications may worsen cognition and be a possible “reversible” cause of memory loss.Objectives: The goals of this study were to establish the prevalence of these contraindicated medications in a population of elderly patients referred to a memory disorders clinic for evaluation and to determine if those individuals receiving contraindicated medications had specific characteristics. This included determining how many patients were concurrently being prescribed a cholinesterase inhibitor.Methods: The review included new patients consecutively evaluated for cognitive complaints in a memory disorders clinic between June 2003 and August 2004. Each patient underwent a comprehensive evaluation by a multi-disciplinary team during a 3-hour clinic appointment. A thorough history of cognitive deficits and associated symptoms was obtained by the physician, who also performed a comprehensive neurologic examination. All patients underwent neuropsychologic testing with an extensive cognitive battery. In addition, patients' electronic medical records were reviewed to determine a list of prescribed and over-the-counter medications at the time of the initial referral. Contraindicated medications were identified using the updated Beers criteria of medications that should be avoided in older patients with cognitive impairment or that have high CNS adverse effects.Results: A total of 100 patients (91 men, 9 women; mean [SD] age, 75.8 [9.7] years; 73% white) were included in the study. Eighty-six patients were determined at the time of evaluation to have some kind of cognitive impairment. They were mildly impaired, with a mean (SD) Mini-Mental State Examination score of 22.9 (5.1), based on a scale of 0 to 30. Twenty-two patients were taking ≥1 contraindicated medication that could potentially affect their cognition; the most frequently prescribed were benzodiazepines, oxybutynin, amitriptyline, fluoxetine, and diphenhydramine. Twenty-eight of the 100 patients were being treated with a cholinesterase inhibitor at the time of their evaluation; of these, 4 (14%) were also taking ≥1 medication with anticholinergic properties.Conclusions: Despite research evidence and recommendations to avoid these CNS-active medications because of their adverse effects, they continue to be prescribed in elderly patients with cognitive impairments. Further research is needed to determine strategies that will help reduce their administration in this population.     

Screening and assessing adolescent asthmatics for anxiety disorders

The purpose of this study was to evaluate a strategy designed to permit early detection of anxiety disorders in adolescent asthmatics. Adolescents with asthma (N = 53) were screened for anxiety disorders using the Trait subscale of the State-Trait Anxiety Inventory for Children [STAI-C (Trait)] and the Multidimensional Anxiety Scale for Children (MASC). Adolescents and their parents were individually evaluated by a nurse trained in the administration of the Anxiety Disorders Interview Schedule-IV: Parent and Child Versions (ADIS-IV: P&C). Of the participants, 21 (40%) met the diagnostic criteria for one or more anxiety disorders. The STAI-C (Trait) was more effective than the MASC in screening adolescents for risk of coexisting anxiety disorders. Nurses trained to administer the ADIS-IV: P&C diagnosed anxiety disorders with a high degree of accuracy. These results have important implications for resolving the problem of unrecognized and untreated anxiety disorders in the adolescent asthmatic population.