精神分裂症与抑郁症、神经症听觉P300的比较

探讨精神分裂症，抑郁症和神经症听觉事件相关电位Ｐ３００的特点。方法 对２０例精神分裂症，１８例抑郁症和神经症患者与２０例下落空的Ｐ３００进行了对照研究。记录ＣＺ电极位置Ｐ３００的Ｎ２，Ｐ３成分，并进一步观察经药物治疗的精神分裂症和抑郁症组Ｐ３成分治疗前后的变化。     

抑郁症与神经症白细胞介素比较研究

目的：检测抑郁症、神经症患者血浆中白细胞介素2、6（IL－2、6）水平,探讨它们与细胞免疫的相关性及免疫反应的异同。方法：采用酶联免疫吸附法测定40例抑郁症、30例强迫症、48例其它类型神经症患者血浆中IL－2、6水平,以20例正常人作为对照组。结果：抑郁症组、强迫症组、其它类型神经症组IL－2均显著高于正常对照组,抑郁症组IL－6显著高于正常对照组。强迫症组、其它类型神经症组均显著低于正常对照组。结论：抑郁症、神经症患者均存在免疫学方面的改变,但两者的免疫改变不同,提示IL－2、6检测可能有助于两者的鉴别。     

神经症与抑郁症的躯体化症状及经济损失比较

目的：比较神经症和抑郁症躯体症状的特点及经济损失。方法：对初次就诊的神经症和抑郁症患者,采用自编躯体症状的特点及经济负担调查问卷,调查躯体症状及经济损失状况。结果：二者躯体症状所占的比例差异无显著性,神经症组的病程显著长于抑郁症组,外院就诊次数也多于后组,从其他科至医学心理科就诊的时间间隔长。抑郁症组汉密尔顿焦虑量表（HAMA）精神焦虑因子分、汉密尔顿抑郁量表（HAMD）总分、体质量、认知障碍、日夜变化、阻滞、绝望感因子分均高于神经症组,焦虑／躯体化因子分低于神经症组。躯体症状组HAMA总分及躯体焦虑因子分、HAMD总分、焦虑／躯体化、体质量、睡眠障碍、绝望感因子分均高于无躯体症状组。神经症组的直接经济损失重于抑郁症组。结论：抑郁症、神经症的抑郁、焦虑、躯体症状的表现有各自特点,躯体症状会加重抑郁和焦虑症状,均造成很大的经济负担。     

放松训练在神经症中的应用

目的　研究生物反馈放松训练在神经症治疗中的临床意义。方法　运用放松训练在生物反馈条件下为不停用口服药的神经症54例治疗 1 0次 ,设单纯口服药对照组 30例 ,两组治疗前后给予症状自评量表评定 ,1 5项指标统计学分析对照 ,肌电、皮温均数对照。结果　与治疗前比较治疗组 1 5项指标的下降均有显著性差异 ,对照组仅 2项有显著性差异 ,两组相比 1 0项指标有显著性差异。肌电均数下降治疗后与首次训练比较有显著性差异 ,皮温增高无显著性差异。结论　生物反馈放松训练对神经症有一定疗效 ,特别是长期服药效果不好的患者可在短期内获得多项症状缓解。     

抑郁症和神经症的人格特征和防御方式对照研究

目的探讨抑郁症和神经症病人的人格特征和防御方式的差异。方法对91例抑郁症、56例神经症病人和83例正常人评定了A型行为问卷（TABQ）和防御方式问卷（DSQ）。结果神经症的A型行为发生率显著高于正常对照组（P〈0．05）;抑郁症病人的A型行为总分和CH因子分显著低于正常对照组（P〈0．01）,而神经症病人的A型行为总分和TH因子分显著高于正常对照组（P〈0．05）;抑郁症病人较正常对照组较多使用退缩、躯体化、制止、理想化、假性利他、交往倾向,较少使用幽默、被动攻击、抱怨、幻想和期望。神经症病人较正常对照组较多使用投射、躯体化、理想化和交往倾向,较少使用幽默、幻想和回避。抑郁症比神经症病人较多使用退缩、制止、回避和假性利他,较少使用消耗倾向和期望。结论抑郁症和神经症病人具有不同的防御方式。     

抑郁症康复技能训练程式对预防抑郁症复发和自杀的作用

目的探讨抑郁症康复技能训练程式对预防抑郁症复发和自杀的作用。方法将80例抑郁症患者随机分为康复技能训练组(干预组,40例)和健康教育组(对照组,40例)。对干预组和对照组分别应用抑郁症康复技能训练程式和健康教育方法进行干预4周,分别于基线、3个月、6个月、9个月和12个月随访两组抑郁症复发、住院、自杀求助和自杀死亡情况,并采用世界卫生组织生存质量测定量表简表评估生存质量。结果干预后12个月,干预组复发率(10.0%vs.42.5%)和住院率(5.0%vs.20.0%)均低于对照组,差异均有统计学意义(P0.05)。干预组自杀求助率高于对照组(25.5%vs.7.5%),差异有统计学意义(P0.05);两组自杀死亡率(0%vs.2.5%)差异无统计学意义(P0.05)。干预组生存质量总分在各随访时点均高于对照组,差异均有统计学意义(P0.05)。结论抑郁症康复技能训练程式能有效预防抑郁症患者复发和降低其自杀风险,并提高患者生存质量,具有推广应用价值。     

经颅多普勒观测抑郁症及神经症患者脑血流的研究

目的　了解抑郁症和神经症患者脑动脉血流情况 ,以探讨改进其治疗的问题。方法　用经颅多普勒超声 (TCD)检测 81例抑郁症患者 (A组 )及 76例神经症患者 (B组 )的双侧大脑中 (MCA)、大脑前 (ACA)和大脑后 (PCA)动脉和椎 基底动脉 (VA BA)血流速度 ,以及搏动指数 (PI)、阻力指数 (RI)等脉动性指标。并与 45名正常人 (对照组 )进行对照分析。结果　A ,B两组 3条大脑动脉的血流速度较对照组加快 ,椎 基底动脉血流速度呈A组减慢 ,B组加快。检查结果异常者在A组有 80 19% ,在B组有 89 4% ;而PI和RI值均属正常。结论　抑郁症和神经症患者 3条大脑动脉的血流速度加快 ,提示脑动脉痉挛。对抑郁症患者 ,椎 基底动脉血流速度减慢 ,可导致脑供血减少 ,这些血流动力学上的特征可能为进行改善患者脑血液循环的治疗提供线索     

认知训练在抑郁症治疗中的作用研究进展

认知训练用于治疗抑郁症逐渐受到关注。研究中使用的方法主要有注意训练、工作记忆 训练、元认知训练以及正念训练。目前针对抑郁症的认知训练中发现患者的注意、工作记忆等方面有 显著改善（即近迁移）,并且抑郁情绪、思维反刍、自杀观念等症状也会随认知功能的改善得到缓解（即远 迁移）。未来的研究应关注患者的个体差异对结果的影响,并且完善评估手段以考察认知训练在各个方 面的效果。     

边缘人格障碍与精神分裂症、抑郁症、神经症BS1测查对照分析

应用BSI对边缘人格障碍、精神分裂症、抑郁症、神经症及正常人进行测试,比较边缘人格障碍(BPD)在各组间的差异.结果是正常人BSI总分除与抑郁症差异不明显外(P>0.05).与其他组差异明显(P<005～0.01)。BPD各因子分在各组间均有显著差异(P<0.05～0.01),结果支持BPD是介于精神病与神经症间的精神障碍。BSI有助于几种精神疾病的临床鉴别。     

抑郁性神经症与抑郁症的诊断范畴问题

对上海精神卫生中心自１９９０年１月至１９９３年１０月间住院，且２诊断为抑郁性神弱下和抑郁症的二组病人在临床表现、病程、ＨＡＭＩＬＴＯＮ抑郁量表得分、治疗用药、转归等方面进行了调查。结果显示，二组病人在诊断所依据的主要方面，如临床表现和病程上很难加以区别，在用药和转归方面有显著差别，总体上，它们的共性多于不同点，建议将抑郁性神经症这一诊断单元归属于“心境障碍”中。     

认知治疗与人际心理治疗对产后抑郁症的疗效比较

目的探讨认知治疗与团体人际心理治疗对产后抑郁症患者的疗效及差异。方法完成全程治疗及随访的产后押郁症患者共110例,37例予认知治疗,38例予团体人际心理治疗,35例接受一般随访。治疗前、治疗后3个月及6个月末分别对3组进行爱丁堡产后抑郁量表（EPDS）、汉密尔顿抑郁量表（HAMD）、功能失调性态度问卷（DAS）及人际问题问卷（IIP）测试。结果认知治疗组和人际心理治疗组随访3个月和6个月后的EPDS总分及HAMD总分均明显低于对照组（P〈0．05）,认知治疗及人际心理治疗组治疗后3个月及6个月的EPDS、HAMD总分低于治疗前（P〈0．05）。认知治疗组治疗后6个月的EPDS总分、HAMD总分及DAS总分均明显低于人际心理治疗组（P〈0．05）。结论认知治疗和团体人际心理治疗对产后抑郁症均有疗效,但认知治疗疗效更为显著。     

Preventing depression: a randomized trial of interpersonal psychotherapy‐adolescent skills training

Background: The study evaluated the efficacy of an indicated prevention program for adolescent depression. Methods: Fifty‐seven adolescents with elevated depression symptoms were randomized to receive Interpersonal Psychotherapy‐Adolescent Skills Training (IPT‐AST) or school counseling (SC). Hierarchical linear modeling examined differences in rates of change in depression symptoms and overall functioning and analysis of covariance examined mean differences between groups. Rates of depression diagnoses in the 18‐month follow‐up period were compared. Results: Adolescents in IPT‐AST reported significantly greater rates of change in depression symptoms and overall functioning than SC adolescents from baseline to post‐intervention. At post‐intervention, IPT‐AST adolescents reported significantly fewer depression symptoms and better overall functioning. During the follow‐up phase, rates of change slowed for the IPT‐AST adolescents, whereas the SC adolescents continued to show improvements. By 12‐month follow‐up, there were no significant mean differences in depression symptoms or overall functioning between the two groups. IPT‐AST adolescents reported significantly fewer depression diagnoses in the first 6 months following the intervention but by 12‐month follow‐up the difference in rates of diagnoses was no longer significant. Conclusions: IPT‐AST leads to an immediate reduction in depression symptoms and improvement in overall functioning. However, the benefits of IPT‐AST are not consistent beyond the 6‐month follow‐up, suggesting that the preventive effects of the program in its current format are limited. Future studies are needed to examine whether booster sessions lengthen the long‐term effects of IPT‐AST. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

Symptoms of interpersonal sensitivity in depression

Six self-rated items of interpersonal sensitivity (IPS) were examined in 174 depressed outpatients. These items were "feeling critical of others," "your feelings being easily hurt," "feeling others do not understand you or are unsympathetic," "feeling others are unfriendly," "feeling inferior to others," "feeling shy or uneasy with the opposite sex." The population was grouped into tertiles based on their pretreatment IPS score. High levels of IPS were associated with earlier onset and greater chronicity of depression, higher Hamilton Rating Scale for Depression (HRSD) score, more severe depressed mood, guilt, suicidality, impaired work and interest, retardation, depersonalization, paranoia, and cognitive symptoms of depression. More frequent atypical features were found, e.g., overeating/weight gain, self-pity, phobic avoidance, and panic attacks. Response to a monoamine oxidase (MAO) inhibitor drug increased at higher levels of IPS, while the response to a placebo decreased.     

抑郁性神经症与抑郁症的临床特征比较──对CCMD－2的一点建议

本文对符合中国精神疾病分类方案与诊断标准（ＣＣＭＤ－２）的２３例抑郁性神经症和４７例抑郁症的临床特征、疗效以及随访结果进行了对比研究．临床症状和随访时社会功能恢复情况分别采用ＳＣＬ－９０及ＧＡＦ评定。结果显示抑郁性神经症和抑郁症除了人为规定的病程以及抑郁严重程度有不同外，两者并无本质上的差异；本文还对ＣＣＭＤ－２中抑郁性神经症的分类问题作了讨论。     

The influence of interpersonal factors on the speed of recovery from major depression

Abstract

Previous research has established that a subsample of depressed patients may experience an early positive response to psychotherapy. The preconditions of this phenomenon were studied in 62 depressed adults receiving 16 weekly sessions of supportive–expressive dynamic psychotherapy. One third of the sample experienced an early rapid response (ERR), defined as a reduction of at least 50% of their intake Beck Depression Inventory score by Week 6. Despite equivalent ratings of working alliance between ERR and non-ERR patients, the former were five times more likely to recover. Pretherapy characteristics of depressed patients less likely to rapidly respond included a lower interpersonal mastery, a more domineering interpersonal style, and greater social isolation and attachment fears concerning intimacy. As a whole, these findings suggest that ERR and non-ERR patients present with dissimilar interpersonal patterns, requiring different psychotherapeutic approaches.     

Patient interpersonal impacts and the early therapeutic alliance in interpersonal therapy for depression

The therapeutic alliance consistently predicts positive psychotherapy outcomes. Thus, it is important to uncover factors that relate to alliance development. The goal of this study was to examine the association between patient interpersonal characteristics and alliance quality in interpersonal therapy for depression. Data derive from a subsample (n = 74) of a larger naturalistic database of outpatients treated at a mood disorders clinic of a university-affiliated psychiatric hospital. Following Session 3 of treatment, therapists completed the Impact Message Inventory (Kiesler & Schmidt, 1993) to assess patients' interpersonal impacts on them. Also following Session 3, patients completed the Working Alliance Inventory (Horvath & Greenberg, 1989) to assess alliance quality. As predicted, patients' affiliative interpersonal impacts, as perceived by their therapists, were positively associated with alliance quality, controlling for baseline depression severity. Although unrelated to the initial hypotheses, patients concurrently taking psychotropic medications reported better alliances than patients receiving psychotherapy only.     

Efficacy of interpersonal psychotherapy for postpartum depression

BACKGROUND: Postpartum depression causes women great suffering and has negative consequences for their social relationships and for the development of their infants. Research is needed to evaluate the efficacy of psychotherapy for postpartum depression. METHODS: A total of 120 postpartum women meeting DSM-IV criteria for major depression were recruited from the community and randomly assigned to 12 weeks of interpersonal psychotherapy (IPT) or to a waiting list condition (WLC) control group. Subjects completed interview and self-report assessments of depressive symptoms and social adjustment every 4 weeks. RESULTS: Ninety-nine of the 120 patients completed the protocol. Hamilton Rating Scale for Depression (HRSD) scores of women receiving IPT declined from 19.4 to 8.3, a significantly greater decrease than occurred in the WLC group (19.8 to 16.8). The Beck Depression Inventory (BDI) scores of women who received IPT declined from 23.6 to 10.6 over 12 weeks, a significantly greater decrease than occurred in the WLC group (23.0 to 19.2). A significantly greater proportion of women who received IPT recovered from their depressive episode based on HRSD scores of 6 or lower (37. 5%) and BDI scores of 9 or lower (43.8%) compared with women in the WLC group (13.7% and 13.7%, respectively). Women receiving IPT also had significant improvement on the Postpartum Adjustment Questionnaire and the Social Adjustment Scale-Self-Report relative to women in the WLC group. CONCLUSIONS: These findings suggest that IPT is an efficacious treatment for postpartum depression. Interpersonal psychotherapy reduced depressive symptoms and improved social adjustment, and represents an alternative to pharmacotherapy, particularly for women who are breastfeeding.     

The association of depression and perceptions of interpersonal relationships in patients with diabetes

OBJECTIVE: Using an instrument assessing interpersonal relationships in patients with diabetes, we hypothesized that a change in depression would be associated with a change in patients' perceptions of themselves and others in relationships. METHODS: Instruments assessing attachment, depression, and demographics were administered twice to 367 patients with diabetes in an HMO primary care setting, 10 months apart. We assessed change in capacity to rely on others (model of other) and to feel worthy of attention (model of self) according to depression change categories (unchanged, decreased, and increased depression). RESULTS: The degree to which patients reported being able to rely on others increased with a reduction in depressive symptoms (P = .02). The degree to which patients endorsed a sense that they were not worthy of attention in relationships increased with an increase in depressive symptoms (P = .02). CONCLUSION: A change in depressive symptoms is associated with a change in perception of interpersonal relationships in patients with diabetes.