老年抑郁症不典型表现和潜在意义

情感障碍的老年病人常表现为不典型的症状,造成诊断上的困难。抑郁可能酷似假性痴呆、焦虑或某些躯体疾病,也可能是疼痛综合征或滥用酒精的潜在因素。老年人的抑郁可能是原发的或者是其他病的继发症状,如甲状腺疾病和未发现的新生物。有些常用药物,如降压药,也可引起抑郁。     

高血压伴焦虑抑郁障碍的研究进展

高血压作为全球高发的疾病,是许多心脑血管疾病的主要危险因素,给社会带来巨大的经济负担。近年来,焦虑障碍和抑郁障碍的发病率逐年上升,高血压共病焦虑抑郁的人数也在不断增加,现有的研究表明两者可能存在相互促进的关系,在发病机制上也有一定共通性,但两者共病的机制尚未完全阐明。本文就原发性高血压伴焦虑抑郁障碍的定义及诊断量表、流行病学、相互影响机制和治疗等展开综述。     

抑郁障碍的中医病因病机及单药治疗研究进展

<正>抑郁是各种原因引起的情感障碍,特征是持续性情绪低落,临床表现为精神情绪压抑欲哭,可伴有疲倦、反应迟钝、自卑自责等[1]。据研究,抑郁障碍已成为世界第四大疾患。全球疾病调查显示,至2010年,抑郁可能成为威胁全球人类健康,增加经济负担的疾病第二位,仅次于缺血性心脏病[2]。因此,抑郁障碍的治疗受到国际上普遍的关注,寻求其治疗的有效药物是临床实践的迫切需要。本研究根据近年来临床资料,从病名、病因病机、辨证分型、临床论治等方面对抑     

抑郁症认知功能障碍的研究进展

抑郁症是一种以显著而持久的情感或心境低落为主要特征的疾病,其病因尚不清楚.大量的研究资料提示,遗传、神经生化和心理社会等因素对本病的发生有明显影响.躯体疾病所伴发的抑郁障碍即继发性抑郁障碍可以有以下几种情况:(1)抑郁症状是躯体疾病临床表现的一部分;(2)抑郁是对严重躯体疾病的心理反应;(3)抑郁症状是药物引起的;(4)抑郁症为躯体疾病所诱发.目前大多数学者认为,抑郁症患者不仅具有特征性的情绪障碍,而且普遍存在着广泛的认知功能障碍,其中尤以晚发性抑郁患者显著,并且认为患者存在的认知功能障碍是痴呆发生的重要危险因素之一.     

非精神科医生对抑郁障碍的识别和相关因素

目的 了解非精神科医生对抑郁障碍的识别及相关因素.方法 对北京三所三级医院连续就诊患者进行横断面调查,抑郁障碍患者经国际神经精神科简式访谈问卷进行诊断,非精神科医生对抑郁障碍的"识别"定义为给予抑郁障碍患者精神类药物或建议精神科就诊.结果 非精神科医牛对抑郁障碍的识别率为21.0%,其中神经科医生的识别率为40.4%,明显高于心内科(22.4%)、消化科(3.8%)和妇科(2.0%)(x2=61.077,P<0.05).就诊于神经科、疾病对生活的影响大、有精神障碍病史、主诉精神心理主题、合并焦虑障碍是非精神科医生识别抑郁障碍的相关因素(P<0.05);精神心理主题主诉中,情绪问题和失眠问题与非精神科医牛对抑郁障碍识别的联系有统计学意义(P<0.05).结论 综合医院非精神科医牛对抑郁障碍的识别率较低;疾病对生活的影响大,有精神障碍的病史,主诉情绪和失眠问题的抑郁障碍患者更容易被医生识别.     

抑郁症与心血管疾病

抑郁症是一组综合征 ,包括多种症状和体征 ,涉及躯体和心理方面 ,前者包括睡眠障碍、食欲改变、疲劳感、精神运动迟缓或激越 ,心理症状包括丧失自尊或有自罪感、注意力不集中或犹豫不决、有自杀意念或想法等。给抑郁症下一个确切定义很不容易 ,通常将其解释为以情绪低落、哭泣、悲伤、失望、活动能力减退以及思维、认知功能迟缓为主要特征的一类情感障碍。这种障碍可能从情绪的所谓“正常”或轻度情绪不佳 ,发展到严重的抑郁 ,我们认为 ,这种解释便于临床上识别抑郁状态 ,即伴有躯体疾病的抑郁状态者。1　综合性医院中的抑郁障碍过去 3 0年…     

综合性医院抑郁障碍患者95例临床分析

目的 研究综合性医院抑郁障碍患者的临床特征,为正确诊断和及时治疗抑郁症提供临床依据。方法 用前瞻性的方法对95例抑郁患者进行了临床特点和相关因素的分析,治疗前后Zung量表评分分析。结果 抑郁患者最主要的躯体症状为睡眠障碍,其次为疲乏、头痛、心慌和胃肠不适。脑血管病后、胃肠疾病后以及心因性抑郁障碍分别为15.7％、13.7％和66.3％。其中脑血管病后抑郁障碍发病年龄和抑郁病程均明显高于其它两组(P<0.05)。结论 以躯体症状就诊是综合性医院抑郁患者的特点。脑血管病后抑郁障碍不能忽视。     

老年病抑郁症的心理护理

现代医学研究与实践证明 ,心理因素对老人健康长寿和晚年生活质量有很大影响。大家知道 ,人到老年常因疾病感到孤独、寂寞、空虚、幻想、抑郁等心理。比如常见的老年疾病“癌症、脑出血、脑梗塞、心脏病”等等 ,因这些疾病造成残疾和后遗症 ,使老人产生消极悲观情绪。老年病人的抑郁对疾病的恢复有极大的危害 ,因抑郁症可使病人的生理功能下降 ,比如 :情绪低落、食欲减退和睡眠障碍都可引起免疫力下降。据国外资料报道 :抑郁与脑内 5 羟色胺水平下降有关。还有可能是病人的促肾上腺皮质激素释放激素 (ＣＲＨ)和抗利尿激素 (ＶＰ)表达的神经…     

抑郁焦虑情绪与慢性心功能不全预后相关性的研究进展

慢性心力衰竭病人合并焦虑抑郁情绪障碍的临床发生率较高,焦虑抑郁可能加重心力衰竭病人的临床症状,增加心力衰竭病人死亡率。分析焦虑、抑郁影响心力衰竭病人预后的相关机制,对心力衰竭合并情绪障碍病人治疗进行分析总结和探讨。     

焦虑抑郁障碍与冠心病的相关性

<正>近些年来,情绪障碍与身体健康之间的关系越来越受到人们的重视,成为当今的热门话题。心血管疾病尤其是冠心病是威胁人类生命和健康的主要疾病,其发病率和死亡率均非常高,并发症严重且多样,而焦虑、抑郁障碍是心血管疾病常见的两个临床并发症。在双心医学领域,冠心病在精神障碍患者中的患病率非常高,尤其是存在焦虑抑郁障碍的患者。事实上,冠心病与焦虑抑郁障碍是相互关联的。两种疾病相互影响各自的发生、发展及预后。多项研究表明,冠心病患者并发焦虑、     

冠心病合并抑郁焦虑障碍常用量表评价

随着医学模式向社会-心理-生物综合医学模式转变,心理、社会因素在心血管疾病的发生、发展、预后和治疗中的作用越来越受到人们的关注。抑郁焦虑可能是冠心病的危险因素之一,可加速其进程,并且是患者预后不良的危险因素。然而,非精神科医务人员对冠心病合并抑郁焦虑的识别率很低,此类患者往往未能得到及时的诊断和治疗,甚至由于过度的检查和治疗,进一步加重了患者的心理障碍和经济负担。及早正确识别冠心病合并抑郁焦虑并对其进行干预是有待解决的问题。文章就如何识别冠心病患者合并抑郁焦虑障碍以及目前常用抑郁焦虑量表的应用及评价方面的研究现状做一综述。     

老年冠心病患者经皮冠状动脉介入治疗术后焦虑抑郁对不良心血管事件发生率的影响

目的探讨焦虑抑郁情绪对老年冠心病患者行经皮冠状动脉介入治疗(PCI)术后并发主要不良心血管事件(MACE)的影响。方法选取2012年3月至2015年9月在南充市身心医院实施PCI手术治疗的冠心病患者400例进行研究,根据PCI术后7~14 d患者是否并发焦虑和抑郁分组:焦虑抑郁组(n=88)和正常对照组(n=279)。对比两组患者PCI术后1年MACE的发生率,多因素logistic回归分析焦虑抑郁与患者PCI术后MACE的关系。结果焦虑抑郁组患者的MACE事件发生率为25.00%,高于正常组13.98%,差异具有统计学意义(x~2=5.864,P=0.015);逐步向前logistic回归分析结果表明高密度脂蛋白胆固醇(HDL-C)降低(OR=0.692)、冠脉病变支数增加(OR=2.987)、并发焦虑抑郁(OR=2.164)是老年冠心病患者PCI术后发生MACE事件的独立危险因素(P0.05)。结论老年冠心病患者PCI术后并发焦虑抑郁可增加MACE事件的发生率。     

Treatment of depression in patients with coronary heart disease

Depression and coronary heart disease are common conditions that often occur together. Evidence shows that the co-occurrence of these illnesses is not random but driven by depression as a risk factor for the occurrence and progression of coronary heart disease. This link is due, in part, to the impact that depression has on neuroendocrine pathways leading to increased platelet activation, cortisol and catecholamine excess, and altered autonomic nervous system function that influence the pathogenesis and progression of coronary atherosclerosis and subsequent heart disease. We know that treating depression in patients with coronary heart disease improves the symptoms and signs of depression. Evidence is less compelling that treating depression improves the morbidity and mortality of coronary heart disease. However, early findings suggest that some antidepressants may improve the course of coronary heart disease and improve patient compliance with various cardiac interventions. We outline a practical approach to the treatment of depression in patients with coronary heart disease. This approach includes education, counseling, antidepressant drugs, and referral when appropriate.     

Andropause and the development of cardiovascular disease presentation—more than an epi-phenomenon

Andropause refers to a generalized decline of male hormones, including testosterone and dehydroepiandrosterone in middle-aged and aging men. This decline in hormones has been associated with changes such as depression, loss of libido, sexual dysfunction, and changes in body composition. Aging has been associated with an abundance of concomitant diseases, in particular cardiovascular diseases, and although andropause is correlated to aging, a causal relationship between reduction of androgens and the development of chronic diseases such as atherosclerosis and heart failure has not been convincingly established yet. On the other hand, increasing data has emerged that revealed the effects of low levels of androgens on cardiovascular disease progression. As an example, low levels of testosterone have been linked to a higher incidence of coronary artery disease. Whether hormone replacement therapy that is used for andropausal men to alleviate symptoms of “male menopause” can halt progression of cardiovascular disease, remains controversially discussed, primarily due to the lack of well-designed, randomized controlled trials. At least for symptom improvement, the use of androgen replacement therapy in andropausal men may be clinically indicated, and with the appropriate supervision and follow up may prove to be beneficial with regard to preservation of the integrity of cardiovascular health at higher ages.     

老年冠心病患者经鼻胃镜检查的安全性分析

目的探讨老年冠心病患者经鼻胃镜检查的安全性。方法选择2012年1月至2012年12月在北京老年医院接受胃镜检查的65岁以上老年患者100例,分为经鼻胃镜及普通胃镜组（各50例）,每组再分为冠心病及非冠心病（各25例）,比较各组胃镜检查中心率、血压、血氧饱和度、心肌耗氧量及心电图变化。结果普通胃镜检查中,冠心病患者心率、血压、心肌耗氧量增加较非冠心病患者明显（P＜0.05）,血氧饱和度下降值较非冠心病患者高（P＜0.05）,冠心病患者心律失常及ST段下移发生率较非冠心病患者高（P＜0.05）;冠心病患者经鼻胃镜检查中,心率、血压、心肌耗氧量增加值较普通胃镜明显低（P＜0.05）,血氧饱和度下降值低（P＜0.05）,心律失常及ST段下降发生率低（P＜0.05）。结论老年冠心病患者经鼻胃镜检查耐受性好,对心血管影响小,安全性高。     

血管性抑郁与冠心病的关系

随着对血管性抑郁的深入研究发现,血管性疾病和抑郁性疾病之间是双向联系的：抑郁状态既是血管性疾病的危险因子,又可成为血管性疾病导致的后果之一。抑郁患者常常具有一种或多种不良生活方式及心血管疾病的危险因素,导致该类人群的冠心病高发。而冠心病患者的病情越严重,患抑郁症的可能性也越大。治疗方面,应对存在血管性抑郁或/和冠心病的患者进行相关因素的分析,以便更好的对相应的危险因素、生活方式进行干预,并同时注意患者用药的安全性、合理性。     

心脏急症与稳定性冠心病患者合并心理问题现状分析

目的 心脏急症患者、稳定性冠心病患者和冠状动脉造影阴性者合并心理疾患的比较.方法 对298例疑诊为冠心病的患者根据冠状动脉病变情况分为:急性冠状动脉综合征(ACS)组128例、稳定性冠心病组108例、阴性对照组62例.分别在入院冠状动脉造影前、冠状动脉造影后3 d、出院前1 d进行Zung抑郁自评量表(Zung self-rating depression scale,SDS)、Zung焦虑自评量表(Zung self-rating anxiety scale,SAS)、汉密尔顿抑郁量表(Hamilton depression rating scale,HRSD)进行评估.结果 ACS组患者入院时有抑郁症状和焦虑症状的患者分别占65.6%(84/128),78.9%(101/128);随着治疗的进行,抑郁和焦虑的比例明显下降,出院时分别占45.3%(58/128)和64.8%(83/128,P<0.05).入院时,稳定性冠心病患者的抑郁和焦虑的比例分别为18.5%(20/108)和26.9%(29/108),对照组分别为32.3%(20/62)和25.8%(16/62),两组患者抑郁、焦虑比例在治疗过程中并无明显变化(P>0.05).结论 心理问题和冠心病共存在心内科常见,在ACS中更为突出.对于稳定性冠心病和冠状动脉造影阴性的患者应注意心理因素的影响.     

Chronotropic incompetence in exercise testing.

Patients with chronotropic incompetence, defined as a failure of the heart rate response to exercise to rise to within two standard deviations of the expected increase with exercise, where studied and compared to patients with known coronary disease by angiogram with and without ST segment depression. 72% of the patients with chronotropic incompetence but without ST depression had significant coronary heart disease. The demonstration of chronotropic incompetence in exercise testing has important predictive implications and should be looked upon as carefully as ST segment changes. There was no evidence of SA node ischemia in these patients. Intrinsic heart rate measurements done in this study suggest autonomic dysfunction as a possible pathophysiologic mechanism for chronotropic incompetence. The heart rate response to exercise may be a useful predictor of the presence and severity of coronary disease. Therefore, a predicted heart rate response with standard deviation for age and sex should be included as part of the stress test protocol.     

Assessing the Presence and Severity of Depression in Subjects with Comorbid Coronary Heart Disease

Our understanding of how depression alters the origin and course of coronary heart disease is derived from subjective methodologies. Many psychiatric instruments were not tested for reliability and validity in subjects with comorbid medical illness, particularly coronary heart disease. They largely use scales of categoric or ordinal variables. Instruments used to assess coronary heart disease are considerably more objective and often use interval variables. By searching the websites of Circulation and the Journal of the American College of Cardiology, we entered the word “depression” on August 28, 2009. We ignored articles using “depression” in the context of cardiovascular concepts such as “ST-segment depression.” By searching articles dating back to 1995, we selected publications that studied the prognostic association of depression and coronary heart disease. There were 5 relevant publications: 3 from Circulation and 2 from the Journal of the American College of Cardiology. The methods used to assess coronary heart disease (specifically, myocardial infarction) are largely homogenous across the studies, but the methods used to assess depression are heterogeneous. Parameters used to diagnose myocardial infarction and determine its severity are precise, objective, and reliable, whereas those used to assess depression and its severity exhibit less precision and lack comparable objectivity and reliability. This mismatch may compromise our understanding of the link between coronary heart disease and depression in depressed patients with comorbid coronary heart disease. We propose using precise instruments to identify and quantitate coronary heart disease as outcome variables to assess psychiatric interventions and to better define depression in depressed patients with comorbid coronary heart disease. This should lead to a better understanding of the link between depression and comorbid coronary heart disease.     

舒适护理对老年慢性心衰患者抑郁和焦虑的干预观察

目的 探讨舒适护理对老年慢性心衰患者抑郁和焦虑的干预作用,以寻求有效的护理方法.方法 80例老年慢性心衰患者随机分为舒适护理组（40例）和常规护理对照组（40例）.对照组患者行常规护理,舒适护理组在与常规组患者相同的常规护理的基础上采取舒适护理.采用医院焦虑抑郁量表对患者的抑郁和焦虑程度进行评估.舒适护理观察从人院时开始进行,分别在观察开始前和观察开始后1m进行与检测,并对结果进行比较与分析.结果 观察开始后1 m,两组患者的抑郁和焦虑得分均比观察开始前明显降低（P＜0.05、P＜0.01）,组间比较发现舒适护理组患者抑郁和焦虑程度比常规护理组有更明显的改善（P＜0.05、P＜0.01）.结论 舒适护理能够改善老年慢性心衰患者抑郁和焦虑状况,是值得临床应用的护理良法.