首发未治疗抑郁症患者自杀风险与情感气质的关系

目的探讨抑郁症患者自杀风险在情感气质特征方面的危险因素。方法来自我院门诊103例首发未治疗抑郁症患者,根据简明国际神经精神访谈(the mini international neuropsychiatric interview,MINI)5.0中文版自杀模块访谈结果,分为有自杀风险组和无自杀风险组。用情感气质量表(temperament evaluation of the Memphis,Pisa,Paris,and San Diego-auto questionnaire,TEMPS-A)评估情感气质,用汉密尔顿抑郁量表(Hamilton depression rating scale,HAMD)评估抑郁症状的严重程度。结果 45.6%(47/103)的抑郁症患者伴有自杀风险。与无自杀风险组患者相比,有自杀风险组患者女性、无业及未婚者较多,发病年龄较早,HAMD总分以及TEMPSA中循环气质、抑郁气质、焦虑气质评分较高(均P 0.05)。logistic回归分析显示,女性(OR=3.392,95%CI:1.246～9.232)、发病年龄(OR=0.924,95%CI:0.844～0.966)、HAMD总分(OR=1.134,95%CI:1.022～1.258)和循环气质评分(OR=1.204,95%CI:1.015～1.427)与自杀风险相关。结论女性、发病年龄早、抑郁症状严重和循环气质突出可能为首发抑郁症患者自杀风险的危险因素。     

脑磁图γ频段活动异常脑区与抑郁障碍患者自杀风险的相关性分析

目的:探索脑磁图(MEG)γ频段活动异常脑区与抑郁障碍患者自杀风险的相关性。方法:根据汉密尔顿抑郁量表-17项(HAMD-17)中自杀因子评分将56例抑郁障碍患者分为高自杀风险组(26例)及低自杀风险组(30例),给予其自杀风险量表(NGASR)评估;采用事件相关设计,以正性情绪任务时利用MEG采集γ频段下各脑区能量值,使用聚类置换检验法比较出抑郁障碍患者与健康对照组(50名)γ频段能量值差异有统计学意义的脑区,定义为与抑郁障碍相关的脑区;再在其中比较出高、低自杀风险组间γ频段能量值差异有统计学意义的脑区,分析其与NGASR评分相关性。结果:γ频段下发现35个与抑郁障碍相关脑区;其中与NGASR评分相关的脑区为右侧海马(r=-0. 299,P=0. 04)、右侧旁海马(r=-0. 307,P=0. 04)、左侧枕中回(r=-0. 299,P=0. 04)、右侧颞中回(r=-0. 301,P=0. 04)及右侧颞极(r=-0. 332,P=0. 02)。结论:抑郁障碍患者海马、颞叶、枕叶等脑区出现γ频段活动异常;可能与自杀风险相关。     

误诊为抑郁症的双相障碍Ⅱ型患者自杀风险的危险因素分析

目的探讨误诊为抑郁症的双相障碍Ⅱ型患者自杀风险的社会人口学及临床特征方面的危险因素。方法通过简明国际神经精神访谈(the Mini International Neuropsychiatric Interview,MINI)5.0中文版,对来自全国13个中心的1478例最初诊断为抑郁症的患者进行重新诊断,其中190例被诊断为双相障碍Ⅱ型,将这190例误诊患者按照有无自杀风险进行分组,从性别、年龄等社会人口学资料及起病年龄、是否伴有自杀观念等临床特征方面探讨被误诊患者自杀风险可能的危险因素。结果有自杀风险组共74例患者,无自杀风险组共116例。有自杀风险组与无自杀风险组相比,年龄更小[(34.45±11.18)vs.(37.23±13.22)],起病年龄更早[(26.20±9.16)vs.(30.37±11.59)],更常伴有自杀观念(82.4%vs.53.4%),差异均具有统计学意义(P<0.05)。Logistic回归分析显示,年龄(OR=0.969,95%CI:0.945~0.993)、伴有自杀观念(OR=4.129,95%CI:2.030~8.397)与误诊为抑郁症的双相障碍Ⅱ型患者发生自杀风险相关联(均P<0.05)。结论年龄小、伴有自杀观念可能是误诊为抑郁症的双相障碍Ⅱ型患者自杀风险的独立危险因素。     

伴自杀倾向的住院抑郁障碍患者临床特征分析

目的 探讨住院抑郁障碍患者自杀倾向的相关因素。方法 选取2017年11月至2018年12月在首都医科大学附属北京安定医院住院治疗的1 160例抑郁障碍患者为研究对象，按照有无自杀倾向(包括自杀观念与自杀未遂)将其分为自杀倾向组(n=431)和无自杀倾向组(n=729)。比较两组患者的临床特征，采用二项Logistic回归分析住院抑郁障碍患者自杀倾向的相关因素。结果 单因素分析显示，两组患者的性别、冲动性格、精神活性物质依赖史、自杀家族史、重大精神创伤史、抑郁严重程度比较，差异有统计学意义(χ²=5.841、33.806、5.869、5.585、5.499、33.311;P<0.05)。二项Logistic回归分析显示，冲动性格(OR=2.445,95%CI=1.802～3.319)、有精神活性物质依赖史(OR=2.254,95%CI=1.038～4.894)、有重大精神创伤史(OR=1.533,95%CI=1.056～2.226)、抑郁症状严重程度较重(OR=2.754,95%CI=2.002～3.790)是住院抑郁障碍患者自杀倾向的影响因素(P<0....     

精神分裂症患者病耻感与自杀观念的关系

目的探讨精神分裂症患者感知的病耻感与自杀观念的关系,为精神分裂症的心理康复和自杀预防提供参考。方法采用方便入组的方法入组2010年2月-2014年10月在天津市滨海新区塘沽安定医院和北京回龙观医院门诊和住院治疗的精神分裂症患者121例,采用阳性和阴性症状量表(PANSS)、汉密尔顿抑郁量表17项版(HAMD-17)以及Link贬低-歧视感知量表(PDD)进行评定。结果 1与无自杀观念的精神分裂症患者相比,有自杀观念的患者PPD评分更高[(4.21±1.11)分vs.(3.09±1.01)分,t=5.71,P0.01]、自知力评分更低[(3.55±1.34)分vs.(4.83±1.26)分,t=5.41,P0.01],精神分裂症患者的自杀观念与PDD评分(r=0.46,P0.01)、自知力(r=-0.44,P0.01)及抑郁症状评分(r=0.30,P0.01)相关;2多元Logistic回归结果显示,精神分裂症患者的PDD评分越高(B=1.14,OR=3.13,P0.01,95%CI:1.86~5.25)、抑郁症状评分越高(B=0.11,OR=1.11,P=0.01,95%CI:1.02~1.22)、自知力越完整(B=-0.76,OR=0.47,P0.01,95%CI:0.32~0.70),自杀观念的风险越大(Logistic回归模型R2=0.51,P0.01)。结论精神分裂症患者感知病耻感的水平越高,可能存在自杀观念的风险越大。     

三甲综合医院心血管内科门诊原发性高血压患者抑郁障碍的现患率及相关因素

目的调查三级甲等综合医院心血管内科门诊原发性高血压患者抑郁障碍的现患率及其相关因素。方法 5名精神科专业人员对876例心血管内科门诊原发性高血压患者采用《美国精神疾病诊断与统计手册第四版》轴I精神障碍临床定式访谈中文版进行抑郁障碍的评估,并收集其社会人口学资料和临床特征因素。结果三甲医院门诊原发性高血压患者抑郁障碍的现患率为16.6%(145/876),高血压患者抑郁障碍的危险因素为女性(OR=2.817,95%CI:1.161~6.885)、年龄65岁及以上[以35~49岁为参照(OR=1.747,95%CI:1.118~2.688)]、无婚姻关系(OR=2.023,95%CI:1.203~3.398)、三级高血压[以一级为参照(OR=1.776,95%CI:1.226~2.333)]和冠心病(OR=2.018,95%CI:1.427~2.587)。结论三甲医院心血管内科门诊原发性高血压患者抑郁障碍患病率高,临床上需要予以重视。     

伴混合特征的抑郁障碍患者发生非自杀性自伤的危险因素分析

目的 探讨抑郁障碍伴混合特征（DMX）患者发生非自杀性自伤（NSSI）的危险因素。 方法 选取 2021 年 5 月 4 日至 2022 年 7 月 29 日在首都医科大学附属北京安定医院抑郁症门诊就诊的 100 例 DMX 患者为研究对象，根据自我伤害行为问卷中近 1 年是否发生 NSSI 行为将患者分为 NSSI 组 （n=39）和非 NSSI 组（n=61）。采用 17 项汉密尔顿抑郁量表（HAMD-17）、汉密尔顿焦虑量表（HAMA）、杨 氏躁狂量表（YMRS）和哥伦比亚自杀量表（C-SSRS）4 个他评量表评估患者的抑郁、焦虑、躁狂严重程 度和自杀意念风险等级。采用患者健康问卷抑郁量表（PHQ-9）、广泛性焦虑障碍量表（GAD-7）和斯奈 思 - 汉密尔顿快感量表（SHAPS）3 个自评量表评估患者的抑郁、焦虑和快感缺失严重程度。采用多因 素 Logistic 回归模型分析 DMX 患者发生 NSSI 的危险因素。结果 两组患者年龄、居住方式、起病年龄、 HAMD-17 得分、PHQ-9 得分、SHAPS 得分以及自杀意念风险等级比较，差异有统计学意义（P＜ 0.05）。 多因素 Logistic 回归分析结果显示，年龄小（OR=0.900，95%CI=0.829～0.977，P=0.012）、HAMD-17 得分高 （OR=1.361，95%CI=1.013～1.829，P=0.042）、SHAPS 得分高（OR=1.147，95%CI=1.078～1.215，P＜ 0.001） 是 DMX 患者伴 NSSI 的危险因素。结论 年龄小、抑郁程度重、快感缺失程度重是 DMX 患者 NSSI 发生 的危险因素，在临床中应关注伴有此特征的 DMX 患者，尽早干预，以减少 NSSI 的发生。     

伴忧郁特征的抑郁症患者自杀风险因素分析

目的:探讨伴忧郁特征的抑郁症患者的自杀风险因素。方法:对“中国双相障碍患者诊断评估服务研究项目”中626例符合伴忧郁特征的抑郁症患者采用《简明国际神经精神访谈》(MINI)自杀模块评估自杀风险,并将患者分为自杀风险组(300例)和无自杀风险组(326例),比较两组的人口学及临床资料,采用Logistic回归分析伴忧郁特征抑郁症患者的自杀风险因素。结果:自杀风险组起病年龄明显小于无自杀风险组(t=-4. 390,P=0. 032),出现抑郁发作频繁(χ2=8. 036,P=0. 005)、伴非典型症状(χ2=4. 586,P=0. 032)、伴精神病性症状(χ2=15. 580,P 0. 001)、症状晨重暮轻(χ2=4. 501,P=0. 034)、伴不切实际的罪恶感(χ2=33. 105,P 0. 001)的比率明显高于无自杀风险组。Logistic回归分析显示,伴精神病性症状(OR=2. 38,P 0. 001)、伴不切实际的罪恶感(OR=2. 51,P 0. 001)与伴忧郁特征抑郁症患者的自杀风险因素相关(P均0. 001)。结论:伴精神病性症状、伴不切实际的罪恶感可能是伴忧郁特征抑郁症患者的自杀风险因素。     

女性双相情感障碍住院患者高自杀风险的相关因素 分析

目的 分析女性双相情感障碍（BD）住院患者高自杀风险的相关因素。方法 收集 2010 年 4 月至 2019 年 6 月首都医科大学附属北京安定医院 378 例女性 BD 住院患者的病历资料。根据患者 自杀风险,分为低自杀风险组（n=220）和高自杀风险组（n=158）。比较两组患者的一般人口学资料及 临床特征差异,采用二项 Logistic 回归分析女性 BD 住院患者高自杀风险的相关因素。结果 与低自 杀风险组相比,高自杀风险组患者的本次住院天数少、首发年龄及首次抑郁发作年龄小、总发作次 数及抑郁发作次数多、躁狂发作次数少、首发症状为抑郁者和双相Ⅱ型障碍者（BD-Ⅱ）比例高、有精 神病性症状者比例少,差异均有统计学意义（均P＜ 0.05）。二项Logistic回归分析显示,抑郁发作次数 （OR=1.56,95%CI=1.32～1.83）、BD类型（OR=2.30,95%CI=1.16～4.58）以及是否伴精神病性症状（OR=0.56, 95%CI=0.35～0.90）是女性 BD 患者高自杀风险的相关因素（P＜ 0.05）。结论 抑郁发作次数频繁、 BD-Ⅱ、不伴精神病性症状是影响女性 BD 患者高自杀风险的因素。     

住院抑郁障碍患者合并心境稳定剂治疗的调查分析

目的了解住院抑郁障碍患者合并心境稳定剂(MS)的治疗情况,通过对患者的临床特征进行对比分析,探讨抑郁障碍患者合并使用MS治疗的影响因素。方法回顾性分析2016年1月～12月住院治疗的145例抑郁障碍患者的临床资料,对合并或不合并MS治疗的抑郁障碍患者人口学资料和疾病特征进行比较。结果合并MS治疗的患者比例33.8%(49/145)。与未合并MS治疗组相比,合并MS治疗组多伴有精神病性症状(49.0%VS 33.3%,χ~2=4.350,P0.05)。多元回归分析显示,性别(OR=2.656,95%CI:1.162～6.073,P0.05)、自杀(OR=0.456,95%CI:0.214～0.968,P0.05)、精神病性症状(OR=2.327,95%CI:1.068～5.068,P0.05)是抑郁障碍患者药物治疗中联合使用MS的影响因素。结论女性、不伴有自杀、伴有精神病性症状的抑郁障碍患者可能更多的联合心境稳定剂进行治疗。     

伴非典型特征的抑郁症患者自杀未遂的危险因素分析

目的探讨伴非典型特征抑郁症患者自杀未遂的社会人口学及临床特征方面危险因素。方法来自全国13个中心的1172例抑郁症患者,纳入其中179例伴非典型特征患者,依据简明国际神经精神访谈(the Mini International Neuropsychiatric Interview,MINI)5.0中文版自杀模块的访谈结果,分为自杀未遂组和无自杀未遂组,通过多因素logistic回归分析伴非典型特征的抑郁症患者在性别、年龄等社会人口学资料及伴焦虑症状、伴精神病性症状等临床特征方面可能与自杀未遂相关的危险因素。结果伴非典型特征抑郁症患者自杀未遂的发生率为23.5%(42/179)。与无自杀未遂组患者相比,自杀未遂组患者更多伴有自杀观念、产后起病,更常使用抗抑郁剂以外的其他药物治疗(如抗精神病药、情感稳定剂及苯二氮类药)(均P0.05)。多因素logistic回归分析显示,既往住院次数(OR=1.730,95%CI:1.093~2.740)和自杀观念(OR=3.899,95%CI:1.506~10.092)与伴非典型特征的抑郁症患者发生自杀未遂相关(均P0.05)。结论既往住院次数多及伴有自杀观念是伴非典型特征抑郁症患者自杀未遂的主要危险因素。     

Childhood Exposure to Psychological Trauma and the Risk of Suicide Attempts: The Modulating Effect of Psychiatric Disorders

ObjectiveWe examined whether childhood exposure to psychological trauma is associated with greater suicidality and whether specific psychiatric disorders modulate this association in a representative sample of Korean adults.MethodsThe Korean version of the Composite International Diagnostic Interview 2.1 was administered to 6,027 subjects aged 18-74 years. Subjects who experienced a traumatic event before the age of 18 years, the childhood-trauma-exposure group, were compared with controls without childhood trauma exposure.ResultsChildhood exposure to psychological trauma was associated with lifetime suicidal ideation (OR=3.19, 95% CI=2.42-4.20), suicide plans (OR=4.15, 95% CI=2.68-6.43), and suicide attempts (OR=4.52, 95% CI=2.97-6.88). These associations weakened after further adjustment for any psychiatric disorders, but they were not eliminated. The risk of suicide attempts related to childhood trauma increased with the presence of a concurrent alcohol use, depressive, or eating disorder.ConclusionIn terms of clinical implications, patients with these disorders who have a history of childhood trauma should be carefully assessed for their suicide risk and aggressively treated for psychiatric disorders.     

Discordance between family report and clinical assessment of suicide attempts: a prospective study from the emergency department

BackgroundDeveloping accurate identification methods for individuals with suicide attempts and providing them with follow-up care and supports can be a vital component of all comprehensive suicide prevention strategies. However, because of the difficulties concerning one’s intentions behind injurious behaviour, identifying suicide attempts is a challenge for families and clinicians.AimsThe aim of this study was to investigate the differences between family report and clinical assessment for suicide attempts in the emergency department (ED).MethodsA total of 148 patients with suspected suicide attempts (SSAs) and 148 family caregivers in the ED were enrolled. The suicide risk module of the Chinese version of the MINI International Neuropsychiatric Interview and the self-report measure were used to assess those with SSA’s suicidal behaviours. The Family Adaptability and Cohesion Evaluation Scales and semi-structured interviews were used to investigate the characteristics of suicide risk and demographics of patients with SSA, as well as the rate and influencing factors of omitted suicide attempts reported by family caregivers.ResultsThe underreporting rate for family reported suicide attempts in the ED was 69.0%. The suicide attempts group indicated lower mean scores on perceptions of family resources, adaptability and cohesion. Patients'' suicide risk rating (OR=0.152, 95% CI: 0.037 to 0.620, p=0.009), adult-children relationship (OR=5.037, 95% CI: 1.478 to 17.167, p=0.010) and caregiver’s age (OR=0.279, 95% CI: 0.103 to 0.757, p=0.012) might be associated with underreporting by families. If patients committed suicide attempts through a falling injury or medication overdose, their families may have misreported the suicide attempt.ConclusionsThe discordance of suicide attempt records between family report and clinical assessment reveals the limitations of family self-reports when identifying suicide attempts. Interviews and observations, together with information from certain diagnoses, should be combined to accurately identify suicide attempters in the ED.     

Risk factors for suicidal ideation,plans and attempts in Malaysia — Results of an epidemiological survey

ObjectiveThis is an epidemiological study to determine the prevalence of suicidal behavior and its association with generalised anxiety disorder (GAD) and major depressive disorder (MDD) in a nationally representative sample.MethodSuicidal ideation, plans and attempts were assessed in face-to-face interviews of respondents selected by a multistage probability sampling using items on suicidality from the WHO SUPRE-MISS questionnaire. The Mini International Neuropsychiatric Interview (MINI) was used to generate DSM-IV diagnoses of GAD and MDD. A total of 19309 subjects were studied. Multivariate regression analysis was conducted controlling for demographic characteristics such as age, gender and ethnicity.ResultsThe prevalence estimates for suicide ideation, plans and attempts were 1.7% (95% CI: 1.4–1.9), 0.9% (CI: 0.7–1.1) and 0.5% (CI: 0.4–0.7) respectively. Younger people (16–24 years) had higher risk of suicidal behavior (OR: 2.6, CI: 1.08–6.2). Females (OR: 1.6, CI: 1.2–2.1) and Indians (OR: 3.3, CI: 2.2–4.9) also had higher risk.ConclusionThe prevalence of suicidal behavior in Malaysia is low, but it broadly corresponds to the pattern described in other countries. This national study confirms that Malaysians of Indian descent have much higher rates of suicidal behavior than other groups. The younger age group, females and the Indian ethnic group would need focused preventive efforts.     

Gambling Disorder Symptoms,Suicidal Ideation,and Suicide Attempts

Objective Gambling disorder (GD) patients have a higher suicide risk compared to the general population. The present study investigates the suicide-related risk factors of GD patients by analyzing GD diagnosis-related symptoms and suicide-related behaviors of subjects. Methods This study investigated which symptoms among GD diagnosis criteria are related to suicide risk in 142 patients diagnosed with GD. To analyze the relationship between GD symptoms and suicidal ideation and suicide attempt, the odds ratio (OR) was determined through multivariate logistic regression. Results The number of symptoms was significantly higher in the subjects who had suicidal ideation group and attempt group. In the cases of past suicide attempts, responses to withdrawal and escape questions were significantly higher; in the cases of ongoing suicidal ideation, responses to negative consequences and bailout questions were significantly higher. When depression was corrected, the ‘bailout’ item was, indicating that ‘bailout’ increased suicidal ideation (OR=4.937, 95% CI=1.009–24.164). In the suicide attempt group, ‘relieve’ item may increase suicide attempt (OR=6.978, 95% CI=1.300–35.562). Conclusion Past suicide attempts in GD patients correlated with withdrawal symptoms, and financial problem correlated with suicidal ideation. This suggests that evaluating suicide risk is important when evaluating GD patients, and evaluation of financial problems is important for GD patients with suicide risks.     

抑郁障碍患者自杀未遂的危险因素分析

目的:分析抑郁障碍(MDD)患者自杀未遂的危险因素。方法:入组332例MDD患者,分为自杀未遂组(95例)和非自杀未遂组(237例);对入组者进行人口学与临床资料调查、汉密尔顿抑郁量表(HAMD-24)及汉密尔顿焦虑量表(HAMA-14)评估及血清甲状腺功能检测,并进行组间比较;分析自杀未遂的危险因素。结果:自杀未遂组年龄、首次发病年龄明显小于非自杀未遂组,病程、既往住院次数明显多于非自杀未遂组;单身、无业、受教育程度低、家族史阳性、伴有精神病性症状、共病焦虑障碍比率明显高于非自杀未遂组(P<0.05或P<0.01)。HAMD总分与焦虑躯体化、认知障碍、阻滞、绝望感、体质量、日夜变化因子分及HAMA评分明显高于非自杀未遂组(P<0.05或P<0.01)。血清游离三碘甲状腺原氨酸(FT3)水平明显高于非自杀未遂组(P<0.05)。多因素Logistic回归分析显示,伴有精神病性症状、既往住院次数、HAMD评分中认知障碍、绝望感因子是影响抑郁症患者自杀未遂的主要危险因素。结论:伴有精神病性症状、既往住院次数、HAMD评分中的认知障碍、绝望感因子可能为MDD患者...     

Post-traumatic stress disorder among adolescents with bipolar disorder and its relationship to suicidality

OBJECTIVES: The aims of this cross-sectional pilot study were to ascertain the rates of post-traumatic stress disorder (PTSD) among adolescents with bipolar disorder (BPD) and major depressive disorder (MDD) relative to a comparison group comprised of non-affectively ill patients, and to determine whether PTSD is related to suicidal ideation and attempts. The impetus for the study was born of clinical impressions derived in the course of routine clinical practice. METHODS: Patients were screened by a single interviewer for BPD, MDD and PTSD, panic disorder, obsessive-compulsive disorder (OCD) and social phobia using the apposite modules from the Structured Clinical Interview for DSM-IV (SCID) and histories of suicidal ideation and attempts. The data were subjected to analysis using a logistic regression model. RESULTS: The database included 34 patients with BPD, 79 with MDD and 26 with a non-affective disorder. The risk for PTSD for a patient with BPD significantly exceeded that for a patient with MDD [odds ratio (OR) = 4.9, 95% confidence interval (CI) = 1.9-12.2, p = 0.001]. Patients with PTSD had an insignificantly increased risk for suicidal ideation (OR = 2.8, 95% CI = 0.9-8.9, p = 0.069), and a 4.5-fold significantly increased risk of having had a suicide attempt (OR = 4.5, 95% CI = 1.7-11.7, p = 0.002). The relationship between PTSD and suicide attempts remained significant even after controlling for the confounding effects of concurrent panic disorder, OCD and social phobia (OR = 3.4, 95% CI = 1.1-10.0, p = 0.023). CONCLUSIONS: Patients with BPD have a greater risk for PTSD than those with MDD. Post-traumatic stress disorder is significantly related to history of suicide attempts.     

未用药抑郁症自杀者的临床特征与HPA轴功能分析

目的探讨首发未用药的抑郁症自杀者与抑郁症非自杀者的临床特征和下丘脑—垂体—肾上腺轴功能状况。方法对112例首次发作未用药的抑郁症患者,按是否存在自杀(含自杀观念或行为)分为抑郁症自杀组(49例)和抑郁症非自杀组(63例),采用自编问卷调查患者社会人口学资料和早期抑郁发作的临床特征,包括首发年龄、抑郁程度、强迫和焦虑症状、有无自杀观念或行为等,患者治疗前均进行17项汉密尔顿抑郁量表(17-item Hamilton depression scale,HAMD-l7)、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)、Yale-Brown强迫量表(Yale-Brown obsessive compulsive scale,Y-BOCS)和自杀评估量表评定,并采用电化学发光法检测血清皮质醇(cortisol,CORT)和促肾上腺素皮质激素(adrenocorticotropic hormone,ACTH)水平。结果两组间就诊年龄、首发年龄、病程均无统计学差异(P0.05)。早期临床症状中,仅见抑郁症自杀组绝望感和性欲下降多于抑郁症非自杀组(P0.05)。抑郁症自杀组HAMD总分及认知障碍因子分和绝望感因子分高于抑郁症非自杀组(P0.01);HAMA总分、Y-BOCS总分和CORT与ACTH水平在两组间差异均无统计学意义(P0.05)。抑郁症自杀组自杀得分与早期临床特征、各量表总分、CORT和ACTH水平的相关性均无统计学意义(P0.05)。结论抑郁症自杀者相对无自杀者早期症状中性欲下降更明显,且认知障碍和绝望感等抑郁症状的程度更重。但早期临床特征和HPA轴功能状况尚不能为抑郁症患者发生自杀观念或行为提供佐证。     

Risk of Suicide Attempt after Thyroidectomy: A Nationwide Population Study in South Korea

ObjectiveTo investigate the association between thyroidectomy and suicide attempt. MethodsA nationwide population-based electronic medical records database of South Korea between January 1, 2009 and June 30, 2016 was used to investigate incidence rate ratios (IRRs) of suicide attempts and probable suicide attempts before and after thyroidectomy using a self-controlled case series design. ResultsIn 2,986 patients who attempted suicide or probable suicide, the IRRs of suicidal behaviors during risk periods one year before and after thyroidectomy were investigated. Generally, after thyroidectomy, there was no increase in IRR compared to the non-risk period. When data were analyzed according to thyroidectomy type, after partial thyroidectomy, IRR increased up to 1.43 (95% CI: 1.03–1.98, p=0.032) in the days 91–181 period. In the subgroup with major depressive disorder (MDD), the IRR increased up to 1.74 (95% CI: 1.21–2.51, p=0.003) before thyroidectomy, and increased up to 1.67 (95% CI: 1.16–2.41, p=0.006) after thyroidectomy. ConclusionAlthough the general risk of suicide attempt was not increased after thyroidectomy, patients with MDD showed increased risk of suicide attempt before and after thyroidectomy. These results suggest that suicidality should be evaluated when depressive symptoms are present in patients who have undergone thyroidectomy.     

血脂水平及血脂综合指标与抑郁障碍患者自杀意念、临床特征的关系

目的:探讨血脂水平及血脂综合指标与抑郁障碍(MDD)患者自杀意念及临床特征的关系。方法:根据汉密尔顿抑郁量表17项(HAMD-17)条目3"自杀"评分≥1为界将122例首发MDD患者分为有自杀意念组(94例)及无自杀意念组(28例);对两组人口学资料、HAMD-17各维度评分、血脂水平[总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)]及血脂综合指标[动脉硬化指数(AI)、血浆致动脉硬化指数(AIP)、脂蛋白结合指数(LCI)]进行比较;采用Pearson相关分析研究差异指标与自杀意念等临床特征的关系。结果:有自杀意念组TG和LCI明显低于无自杀意念组(P均<0.05)。血清TG水平与HAMD-17条目3的得分呈负相关(r=-0.221,P=0.015),与睡眠障碍因子分呈正相关(r=0.238,P=0.008)。患者LCI与HAMD-17条目3的得分(r=-0.260,P=0.004)及认知障碍因子分(r=-0.192,P=0.034)呈负相关,与睡眠障碍因子分呈正相关(r=0.203,P=0.025)。结论:血清TG水平和LCI降低与MDD患...