Pyrazidol in the treatment of depression in patients with ischemic heart disease

AIM: To study efficacy and safety of pirazidol administration in depressive patients with ischemic heart disease (IHD). MATERIAL AND METHODS: Pirazidol was given in a dose 0.15-0.3 g/day for 4 weeks to 30 IHD patients aged 21-65 years. 21 of them had nosogenic depression, 9 patients had dysthymia. The efficacy of the antidepressive action was assessed by the Hamilton scale. RESULTS: The trend to a decrease in Hamilton scale scores was manifest by the end of the treatment week 2. To the end of the study the overall score median lowered from 17 to 9, most of the patients had the score sum under 11. Side effects were insignificant. In pirazidol combination with beta-blockers, blockers of calcium channels, antiaggregant, diuretic drugs, nitrates and other cardio- and angiotropic drugs unfavorable interactions were not registered. CONCLUSION: Pirazidol can be effectively used in the treatment of psychosomatic disorders in patients with cardiovascular diseases.     

氟西汀治疗老年抑郁症的疗效观察

目的:探讨氟西汀治疗老年抑郁症的疗效及安全性。方法:56例老年抑郁症患者随机分为两组:A组和B组,每组各28例。A组采用氟西汀治疗,B组采用阿米替林治疗,两组疗程均为6周。两组疗效评定采用汉密顿抑郁量表(HAMD),两组副反应评定采用副反应量表(TESS)。结果:A组治疗后第2、4、6周末HAMD评分与B组比较,无显著性差异(P>0.05),A组治疗后第2、4、6周末TESS评分明显低于B组(P<0.05)。A组总有效率为78.57%,B组总有效率为71.43%,两组比较,无显著性差异(P>0.05)。结论:氟西汀可作为治疗老年抑郁症的首选药物。     

躯体疾病合并抑郁症的发病情况及其治疗

目的 :观察躯体疾病合并抑郁症的发病情况以及不同治疗措施的疗效。方法 :6 8例患有躯体疾病患者填写Zung量表 (抑郁症自评表 ) ,按Zung量表评分标准 ,>4 0分且符合中国精神障碍分类与诊断标准的患者诊断为抑郁症。结果 :内科疾病组 5 5例中 2 5例 (45 .6 % )患有抑郁症 ,显著高于体检组 13例中 2例 (15 .4 % )患有抑郁症(P <0 .0 5 ) ;对内科疾病组 2 5例抑郁症患者中的 10例 ,在躯体疾病和心理治疗的基础上 ,加用抗抑郁药物治疗 ,其有效率 80 .0 % ,显著高于未加用抗抑郁药物治疗的患者 (40 % ,P <0 .0 5 )。结论 ;躯体疾病患者常合并有抑郁症 ;对这些患者同时给予适当的抗抑郁症药物治疗可以提高躯体疾病的治疗效果。     

心理护理对老年抑郁症患者临床效果观察

目的观察心理护理对老年抑郁症的临床疗效。方法将65例老年抑郁症患者随机分成干预组和对照组,2组均在药物治疗的同时予常规护理,干预组联合心理护理,比较2组患者治疗前后的抑郁状态,采用汉密尔顿抑郁量表分别于治疗前和治疗后2、4、6、8周进行疗效评定。结果 2组均疗效显著,干预组较对照组起效快,依从性好。结论在以抗抑郁药物治疗老年抑郁症的同时,应注重配合综合心理护理。     

住院老年慢性病患者抑郁情绪与应对方式的研究

目的了解住院老年慢性病患者抑郁情绪的发生情况、应对方式的特点及两者之间的相关性。方法以老年抑郁量表(GDS)和医学应对问卷(MCMQ)作为测量工具对61例住院老年慢性病患者进行问卷调查。结果老年慢性病患者抑郁发生率为42.62%,有生活事件创伤、自评失去对现实的控制能力、丧偶、自理能力差、文化程度低、病程长者抑郁量表得分高(P<0.05);老年慢性病患者多采用回避和屈服的应对方式,较少使用面对的应对方式;面对应对方式与抑郁呈负相关,面对的应对方式使用越少的患者越容易产生抑郁的情绪;屈服应对方式与抑郁情绪呈正相关,屈服的应对方式使用越多则患者的抑郁情绪越重(r=-0.456,0.619;P<0.05)。结论护理人员应注意评估老年慢性病患者抑郁情绪的易发生因素,对于更多地采取屈服应对方式的患者也要加强评估和监测,给予相应的护理干预,使患者树立面对疾病的信心,帮助患者疏导抑郁情绪。     

丁螺环酮治疗伴随抑郁症焦虑症19例疗效观察

目的探讨丁螺环酮治疗伴随抑郁症状的焦虑症的疗效及不良反应作用。方法按中国精神障碍分类与诊断标准第3版诊断,随机选取收入本院的19例伴随抑郁症状的焦虑症患者,采用丁螺环酮治疗并进行临床观察,采用汉密尔顿焦虑量表、抑郁症专业量表及不良反应量表(TESS)进行评定。结果用丁螺环酮治疗19例伴抑郁症状的焦虑症总有效率为94.7%,对伴随严重焦虑症出现的轻、中度抑郁症状也有显著疗效,总有效率89.5%。其不良反应以头昏、头痛、口干、失眠等为常见,TESS评分同期比较差异均无统计学意义。结论丁螺环酮除具有良好的抗焦虑作用以外,抗抑郁症的疗效也是肯定的。     

Depression in the elderly. Characteristics and clinical management

Major depression and clinically significant depressive symptoms occur commonly in the community-dwelling, medically ill, and institutionalized elderly. Both major depression and depressive symptoms need thorough evaluation and treatment because of the significant morbidity and mortality associated with these syndromes. Depression may be difficult to diagnose, especially in the medically ill elderly, because of the masking of depressive symptoms by somatic complaints or the presumption that symptoms are attributable to concurrent medical illness. Therefore, the clinician must be alert to the possibility of depression in the elderly patient. Although no specific diagnostic test is available, rating scales can be useful in screening for depression in the elderly patient. It is necessary to rule out medical illness or medications as contributing factors to depression. Psychotherapy and psychopharmacology, alone or in combination, are effective treatments for most elderly patients with depression. ECT is a safe and effective treatment for major depression in this population. Depression in the elderly is potentially a chronic and relapsing illness with significant associated medical and social morbidity. Because of their frequent contact with the elderly, nurses play a particularly important role in the diagnosis and treatment of depression. They need to recognize typical and atypical symptoms of depression and must be familiar with the potential side effects of antidepressant treatment. Close monitoring for these potential side effects can minimize disability. By working as a team with physicians, psychologists, and others, nurses have a necessary role in the care of the elderly depressed patient.     

老年住院患者抑郁症状的综合康复治疗

目的 :观察抗抑郁药 (SSRIs)联合心理治疗对老年住院患者抑郁症状的临床疗效。方法 :6 0例伴抑郁症状的老年住院患者 ,结合Zung量表及HAMD评分进行抑郁症状的诊断以及应用SSRIs(帕罗西汀 )和心理干预治疗。结果 :综合治疗 6周后 ,6 0例患者的抑郁和躯体症状均有改善 ,Zung量表及HAMD评分均有下降 ,与治疗前比较差异有显著性 ,抑郁症状改善的有效率 >70 %。结论 :综合康复治疗对有抑郁症状的老年住院患者的康复有重要意义 ,SS RIs对老年患者安全有效。     

Pain and its relation to depressive symptoms in frail older people living in the community: an observational study

The association of pain and depression represents an important health problem that is correlated with high rates of disability, morbidity, greater consumption of health care resources, and socioeconomic difficulties. Understanding the interaction between pain and depression is an important issue in light of the fact that physicians frequently fail to accurately assess and diagnose pain symptoms, and that elderly patients suffering from pain are particularly likely to receive inaccurate treatments. The aim of the present study was to describe the prevalence of pain and to investigate the association between pain and depressive symptoms in a representative sample of frail elderly people living in the community (n=5,372). The results show that more than 15% and 40% of elderly patients experienced pain less than daily and daily, respectively. The average score on the depression scale was significantly lower in patients without pain (2.5+/-2.5) than patients with less than daily and daily pain (3.2+/-2.5 and 3.6+/-2.5, respectively) (P<0.001). Without substantial differences between men and women, the rate of each depressive symptom was significantly and progressively higher among patients suffering less than daily and daily pain compared to those without pain. In conclusion, this study provides evidence from a large sample of frail elderly people that individuals suffering pain present an elevated risk to experience depressive symptoms. Treatment models that put together the assessment and the treatment of both pain and depression are indispensable for better outcomes.     

BRIEF REPORT: HEADACHE AND DEPRESSION

SYNOPSIS
Headache is the formost somatic symptom among depressed patients. Patients from an outpatient headache clinic, and from a field study were examined to determine the incidence of depression among headache sufferers. A preponderance of depressive criteria in the headache population was found. Depression was more common in non-paroxysmal headache sufferers than in migraine patients. Subjects with headache and depression required twice as many leave days per year as those suffering from headache alone. Vertebral-basilar insufficiency is a frequent cause of "depressive headache". Anti-depressant drugs should be used along with headache medication when depression is found. The relationship of depression and headache in the same patient is also discussed.     

住院老年慢性病患者疾病应对方式与焦虑、抑郁的相关性

目的了解住院老年慢性病患者疾病应对方式与焦虑、抑郁的相关性。方法以医院焦虑抑郁量表和医学应对问卷作为测量工具,对61名住院老年慢性病患者进行问卷调查。结果老年慢性病患者焦虑、抑郁的发生率均为9.84%,8.20%的患者同时合并焦虑、抑郁情绪。老年慢性病患者多采用“回避”和“屈服”的应对方式,且“屈服”的应对方式与焦虑、抑郁情绪呈正相关。“屈服”的应对方式与年龄、健康水平自测、性别、住院天数和文化程度等无关,与在以往工作中担当的职务和医药费的负担形式有关。结论护士在工作中应评估老年慢性病患者的心理健康状况及所采取的应对方式,通过针对性的心理护理措施指导和帮助患者采取积极的应对方式,从而提高患者的心理健康水平,促进患者更好地进行自我管理。     

Evaluation and management of geriatric depression in primary care

Geriatric depression is a common but frequently unrecognized or inadequately treated condition in the elderly population. Manifestations of major depression in elderly persons may hinder early detection; anxiety, somatic complaints, cognitive impairment, and concurrent medical and neurologic disorders are more frequent. Like major depression, minor depression, which is often ignored, produces morbidity for elderly persons. Both major and minor depression are associated with high mortality rates if left untreated. This article reviews the important aspects of geriatric depression for the nonpsychiatric clinician: the etiology of depressive conditions in the elderly population, the unique clinical features of depression in older people, important evaluation considerations in a population with many medical and neurologic comorbidities, and the nonpharmacological and pharmacological treatment options for managing depression in the geriatric population.     

关怀性触摸对失能老年人抑郁症状的干预效果

目的探索关怀性触摸对失能老年人抑郁症状的干预效果。方法由接受过培训的36名护生对某养老院36名失能老人(其中22名为重度抑郁患者、14名为轻度抑郁患者)进行连续6个月的关怀性触摸。干预前后,对失能老人和护生分别采用老年抑郁量表(geriatric depression scale,GDS)和护士人文关怀品质量表(护生版)进行测量。结果干预后失能老人的GDS得分低于干预前,护生的人文关怀品质评价量表得分优于干预前,差异均有统计学意义(均P0.05)。结论关怀性触摸不仅有助于改善失能老人的抑郁状况,同时能有效提高护生人文关怀品质。     

合曲林联合认知疗法治疗抑郁症对照研究

目的探讨舍曲林联合认知疗法治疗抑郁症的疗效和安全性。方法将80例门诊抑郁症患者随机分为两组,认知疗法组40例以舍曲林合并认知心理治疗,舍曲林组40例单一服用舍曲林治疗。疗程6周。应用抑郁自评量表（SDS）和汉密尔顿抑郁量表（HAMD）于治疗前和治疗2,4、6周末分别评定疗效。结果至治疗的4、6周末时,两组治疗后SDS和HAMD评分均较治疗前显著下降（P均〈0．05）;认知疗法组于治疗6周末SDS和HAMD评分均较舍曲林组显著为低（P〈0．05）。结论舍曲林联合认知疗法治疗抑郁症能迅速缓解症状,对各类抑郁症均有效。     

系统健康教育与心理干预对哮喘患者抑郁和躯体症状的影响

目的探讨健康教育与心理干预对哮喘患者抑郁和躯体症状的影响,为推行健康教育及心理干预提供参考依据。方法采用目的抽样法选取2007年3月至2008年3月某院确诊的48例支气管哮喘伴抑郁的患者,按随机数字表法将其分为干预组（n=24）和对照组（n=24）;对照组患者给予常规药物治疗、健康教育及心理干预;干预组患者在常规药物治疗的基础上进行系统地健康教育及心理干预,总疗程3个月。治疗前后两组患者均采用抑郁自评量表（self-rating depressivescale,SDS）、汉密顿抑郁量表（Hamilton depression rating scale,HRSD）进行评估,并对患者躯体症状改善情况进行分析。结果支气管哮喘患者中治疗前合并抑郁者占60%（48/80）。经过健康教育与心理支持治疗3个月后,两组患者的SDS、HRSD评分均低于治疗前（均P〈0.05）,且干预组与对照组比较,差异均有统计学意义（均P〈0.05）。干预组患者的躯体症状改善情况优于对照组,差异有统计学意义（P〈0.05）。结论支气管哮喘患者常合并抑郁,健康教育与心理干预不仅有助于支气管哮喘患者改善抑郁症状,而且有益于患者躯体症状的改善。     

老年慢性躯体疾病合并抑郁症的康复治疗

背景:躯体疾病与精神疾病之间存在着复杂的关系。躯体疾病对患者的脑功能产生影响,引起脑功能紊乱,并通过心理社会环境的改变而产生精神症状。老年人在慢性躯体疾病的基础上患抑郁症的比例较高,从而可使其病死率增加。目的:探讨单纯抗抑郁药物与心理及药物联合治疗对老年慢性躯体疾病合并抑郁症患者躯体疾病康复的影响。设计:随机分组对照观察。单位:华中科技大学同济医学院附属同济医院老年病科。对象:于2000-03/2003-01选择入住华中科技大学同济医学院附属同济医院老年病科患者102例,均有不同程度的睡眠障碍、不能用器质性疾病解释的心脏、消化道症状、慢性疼痛或全身症状;Zung量表评分>40分,平均(48.83±4.15)分。随机分为药物组(n=46)与综合组(n=56)。两组患者均有≥2种躯体症状,其中≥3种占81.0%。方法:根据两组患者不同原发病,遵循内科疾病治疗常规,予以正规治疗,同时予口服5-羟色胺再摄取抑制剂抗抑郁剂氟西汀,20mg/d,根据病情可于2周后酌情加量至40mg/d。综合组患者在开始服用抗抑郁药物的同时立即实施有效的心理指导,包括①明确患者抑郁和恐惧的焦点所在,予以安慰和心理援助,减低焦虑情绪。②提供有关疾病的基础知识,客观告知其病情及预后,鼓励学习有关康复技能和提高日常生活自理能力。③尽量满足患者需求,鼓励家庭和社会给予患者足够的心理和生活支持,协助患者和家庭之间建立良好的沟通,减少患者的隔绝感和孤独感,增加安全感。两组患者于治疗前、治疗2及8周时采用Zung量表和Spitzer生活质量指数评分进行抑郁状况和生活质量评分,Spitzer生活质量指数评分表包括活动、日常生活、健康、支持及前景等5个方面,最高10分,最低0分,分数越高表示生活质量越佳。主要观察指标:治疗前、治疗后2,8周时,两组患者Zung量表和Spitzer生活质量指数评分表评分结果。结果:两组患者均完成治疗,全部进入结果分析。①治疗2周时,药物组和综合组Zung量表总分均有下降,与治疗前比较差异有显著性意义[(41.12±2.60),(48.83±4.15),t=10.67,P<0.05];[(40.88±3.43),(49.03±4.21),t=11.24,P<0.05]。两组组间比较差异无显著性意义;治疗8周时两组Zung量表总分下降明显[(36.11±2.87),(30.71±3.62)],与治疗前比较差异均有显著性意义,且两组组间比较,综合组更优于药物组(P<0.05)。②治疗2周时,药物组和综合组治疗前后及组间Spitzer生活质量指数评分表评分差异均无显著性意义[(5.47±1.33),(5.32±1.04)];[(5.55±1.18),(5.27±1.35)]。治疗8周时药物组和综合组Spitzer生活质量指数评分表评分开始上升[(7.21±0.13),(8.83±0.32)],与治疗前比较差异有显著性意义,组间比较差异也有显著性意义。结论:积极有效的抗抑郁综合治疗明显改善患者躯体症状,无并发症出现,绝大多数患者对原发病的预后呈现乐观的心态。早期识别老年抑郁症,对促进原发疾病的康复具有非常重要的意义。     

Measuring depressive symptoms in the naturalistic primary-care setting

BACKGROUND: The majority of individuals with major depressive disorder are diagnosed and treated in the primary-care setting. A quantifiable critical objective in the management of depression is to achieve and sustain full symptomatic remission. The HAMD-7 is a depression metric validated in both tertiary and primary-care settings. METHODS: Herein, we further characterise the psychometric properties of the HAMD-7 in depressed patients treated in primary-care settings. Several cut-scores were evaluated for maximum agreement; diagnostic efficacy statistics with the original HAMD-7 items were also evaluated. We compared performance of the HAMD-7 in primary care to a previously characterised tertiary sample. RESULTS: The depressive symptoms most frequently endorsed (>or=70%) and most sensitive to change during antidepressant treatment in depressed primary-care patients were depressed mood, guilt, work and activities, psychic and somatic anxiety and fatigue. LIMITATIONS: This is a post hoc analysis of a primary-care database; assumptions regarding the definition of symptomatic remission in depression affect interpretation. CONCLUSION: Measurement-based care with the HAMD-7 quantifies the severity of commonly reported depressive items and their responsivity to treatment. The HAMD-7, inclusive of the suicide item, is capable of tracking symptom progress, with a validated remission cut-score.     

老年COPD病人抑郁状况与社会支持相关性调查

[目的 ]探讨老年慢性阻塞性肺疾病 (COPD)病人抑郁情绪和社会支持之间的关系 ,为老年COPD病人提供合理、有效的社会支持提供依据。 [方法 ]采用抑郁量表和社会支持评定量表对年龄≥65岁 60例门诊COPD病人进行调查。[结果 ]无抑郁者 2 9例 ,可能抑郁者 16例 ,抑郁者 15例。其中 5 3例病人社会支持处于中等水平 ,7例病人处于高水平。病人抑郁得分与社会支持总分、主观支持总分、社会支持利用度得分存在负相关。 [结论 ]社会支持可能对减少抑郁发生率有积极作用。     

Frequency and outcomes of painful physical symptoms in a naturalistic population with major depressive disorder: an analysis of pooled observational studies focusing on subjects aged 65 years and over

Aims: To estimate the frequency of painful physical symptoms (PPS) in elderly subjects (≥ 65 years) with major depressive disorder (MDD) in real‐world clinical conditions and to establish whether PPS are associated with poor depression outcomes, including more severe depression and worse health‐related quality of life (HRQoL). Methods: Observational studies of MDD that included assessment of PPS and elderly subjects were screened. Measures of PPS were based on the Somatic Symptom Inventory (SSI) or Visual Analogue Scale (VAS). Data from a variety of depressive symptom severity and HRQoL scales were used. Analysis cohorts were based on age [aged ≥ 65 years (elderly) or < 65 years (younger)] and/or PPS status (presence or absence); five subsets were used to examine specific outcomes in matched elderly subjects. Results: Data from seven studies (representing 26 countries) were collated. Of the 11,477 subjects, 14% were aged ≥ 65 years and 71% were classified as having PPS (PPS+). PPS were more frequent in elderly subjects (74% vs. 70% of younger subjects) and were positively associated with being female and Hispanic, and negatively associated with being East Asian in the elderly. The presence of PPS was associated with more severe clinical symptomatology and comparatively poorer HRQoL in elderly subjects. Conclusions: PPS, although frequent in younger MDD patients, were slightly more frequent in elderly MDD patients and associated with comparatively poorer clinical and functional outcomes. As elderly patients report somatic symptoms more readily than emotional symptoms, physicians should consider depression in addition to physical causes when PPS are present.     

Characteristics of somatic symptoms among Chinese patients diagnosed with major depressive episode

PurposeThis study aimed to describe the clinical features of somatic symptoms among Chinese patients diagnosed with major depressive episode (MDE).MethodsA total of 213 inpatients with MDE from two mental health hospitals were recruited and investigated using the Somatic Symptom Inventory (SSI), Hamilton rating scale for depression, Hamilton rating scale for anxiety, and a demographic questionnaire.ResultsThe participants included 142 patients with unipolar depression and 71 patients with bipolar depression. The mean SSI score of all participants was 49.30 (SD = 14.80). “Feeling fatigued, weak, or tired all over” was found to be the most common somatic symptom (61.0% reported moderate levels or above), followed by “feeling of being not in as good physical health as most of your friends” (56.3%), and “feeling weak in parts of the body” (49.3%). “Headache” and “soreness in muscles” were common painful symptoms. Both patients with unipolar and bipolar depression had similar somatic symptoms, including painful and non-painful ones. The somatic symptoms of all participants were closely correlated with the severity of depression and anxiety (P < 0.01). Patients with anxiety, older age, low education, and negative life events in the last year had more somatic symptoms.ConclusionsInpatients with MDE of somatic symptoms are common, which were significantly correlated with the severity of depression and anxiety. Further efforts should focus on early recognition and integrated care model management of patients based on their characteristics to improve their quality of life and treatment outcomes.