精神分裂症和抑郁症病人自杀的对照分析

近年来 ,对于精神分裂症自杀问题的研究逐渐增多 ,但多为自身病例对照研究[1～ 3 ] 。本文从比较精神病学和自杀现象学的角度 ,对精神分裂症和抑郁症病人发生自杀行为的诸多方面作一对照分析 ,期望能在实际工作中 ,为预测和防止精神分裂症病人的自杀提供一些参考依据。1　资料与方法1 1　资料　选取本地区所属九个县常住户口 ,于 1995年至1998年间在我院连续住院的精神分裂症病人 2 2 3例和抑郁症病人 118例 ,再诊断均符合ＣＣＭＤ— 2—Ｒ中精神分裂症和抑郁症(包括双相情感障碍———抑郁相 )的诊断标准[4 ] ,且排除伴有严重躯体疾病和酒…     

262例抑郁症自杀行为临床分析

目的：进一步提高对抑郁症自杀行为的认识。方法：C地262例住院抑郁症患者分类,将可能与自杀相关的因素列为观察指标逐个进行危险度分析,将P＜0．25的指标与类别再进行有序变量的Logistic回归分析。结果：当其他因素控制后,因子“妄想”在自行行为、仅有自杀意念及无自杀意念3组中,自杀危险度相差3．46倍。因子“失眠早醒”的自杀危险度则相关2．89倍。结论：有妄想、失眠早醒症状的抑郁症患者较易发生自杀。     

抑郁症患者下丘脑-垂体-肾上腺轴功能与自杀行为

目的：了解抑郁症患者自杀行为与下丘脑－垂体－肾上腺（ＨＰＡ）轴的关系。方法：对２５例抑郁症患者行地塞米松抑制试验（ＤＳＴ）,其中伴有自杀行为的１２例,不伴自杀行为的１３例,并进行为期１年的随访。结果：自杀组和无自且的ＤＳＴ脱抑制率无明显差异。血有皮质醇水平与汉密尔顿抑郁量（ＨＡＭＤ）评分有明显相关。随访期间所有受试者均未发生新的自杀行为。结论：抑随症患者的ＨＰＡ轴功能失调与自杀行为有关,但并不增加     

精神分裂症患者自杀行为与生长激素对阿朴吗啡的反应研究

本文对２６例精神分裂症患者行阿朴吗啡刺激生长激素释放试验，结果１３例有自杀行为的患者ＧＨ对阿朴吗啡反应明显较１３例无自杀行为的患者迟钝，且这种迟钝反应与自杀时间无相关，提示多巴胺功能低下可能是精神分裂症患者自杀行为的生物学标志。     

精神分裂症患者的自杀行为与生长激素对阿朴吗啡的反应

为了解多巴胺受体敏感度与自杀行为的关系，对１３例有过自杀行为的精神分裂症患者皮下注射阿朴吗啡０．５ｍｇ后测定血清生长激素浓度，同时用年龄、性别相匹配的１３例无自杀行为的精神分裂症患者作为对照。结果显示，有自杀行为的患者生长激素对阿朴吗啡的反应明显低于无自杀行为的患者（Ｐ＜０．０５）。提示生长激素对阿朴吗啡的迟钝反应可能是自杀行为的生物学标志     

抑郁症自杀行为的相关危险因素研究

目的　研究抑郁症自杀行为的危险因素。方法　按CCMD 2 R诊断标准收集 2 0 7例住院的抑郁症病人 ,采用多因素Logistic回归分析与抑郁症自杀行为有关的危险因素。 结果　抑郁症自杀未遂 6 6例 ( 31 9% ) ,自杀与绝望 (相对危险度RR =9 30 8)、负性生活事件 (RR =3 84 2 )、妄想 (RR =3 56 5)及自责 (RR =2 99)呈正相关。结论　提示绝望、负性生活事件、妄想及自责是抑郁症患者自杀的危险因素     

低血清胆固醇与女性抑郁症的自杀行为

目的　本文对女性抑郁症患者的血清胆固醇水平与自杀行为的关系进行了探讨。方法　对 116例样本进行血清胆固醇水平测定 ,其中抑郁症伴自杀行为的 40例 ,抑郁症不伴自杀行为的 3 6例 ,正常人 40例。结果　抑郁症伴有自杀行为组血清胆固醇水平明显低于无自杀行为组和正常对照组。血清胆固醇水平与自杀的严重程度呈明显相关。结论　我们认为低血清胆固醇水平可增加女性抑郁症自杀的风险。推测低血清胆固醇导致的自杀行为可能与中枢 5 羟色胺 ( 5 HT)功能降低有关。     

青少年抑郁症患者自杀行为的影响因素研究

目的 探讨家庭及其他因素对青少年抑郁症患者自杀行为的影响。方法 选取于 2020 年6 月至 2021 年 12 月在荆门市第二人民医院儿童青少年心理科住院的 126 例青少年抑郁症患者进行横断面调查,根据近 6 个月内是否有自杀行为分为自杀组（n=76）及非自杀组（n=50）。采用一般情况调查表、患者健康问卷抑郁症状群量表（PHQ-9）、自杀意念自评量表（SIOSS）、家庭亲密度与适应性评定量表（FACES Ⅱ-CV）对两组患者的一般资料、抑郁程度、自杀意念、家庭分型进行比较。采用 Spearman 相关分析患者自杀行为与一般资料、PHQ-9、SIOSS、FACES Ⅱ-CV 评分的相关性。采用二元 Logistic 回归模型对患者自杀行为的影响因素进行分析。结果 自杀组饮酒者占 40.8%（31/76）,有精神疾病家族史者占 27.6%（21/76）,分别高于非自杀组的 20.0%（10/50）、12.0%（6/50）,差异有统计学意义（P＜ 0.05）。自杀组患者 PHQ-9 评分、SIOSS 总分、绝望因子评分及睡眠因子评分高于非自杀组［19.0（15.0,21.8）分比 15.0（10.8,19.0）分、15.0（14.0,16.8）分比 13.0（11.0,15.0）分、12.0（10.3,12.0）分比 10.0（7.8,12.0）分、3.0（2.0,3.0）分比 2.0（1.0,3.0）分］,家庭亲密度评分低于非自杀组［50.5（43.3,57.0）分比 57.5（48.8,65.5）分］,差异均有统计学意义（P＜ 0.05）。自杀组患者中极端型家庭占 67.1%（51/76）,高于非自杀组的 44.0%（22/50）,差异有统计学意义（P＜ 0.05）。患者自杀行为与家庭亲密度呈负相关（r=-0.224,P＜0.05）,与 PHQ-9 评分、SIOSS 总分、绝望因子评分、睡眠因子评分、饮酒、有精神疾病家族史呈正相关（r=0.346、0.373、0.361、0.324、0.206、0.217、0.186;P＜ 0.05）。二元 Logistic 回归分析显示,饮酒（OR=3.066,95%CI=1.184～7.941）、家 庭 适 应 性 高（OR=1.126,95%CI=1.034～1.227）、PHQ-9 评 分 高（OR=1.197,95%CI=1.087～1.317）是青少年抑郁症患者自杀行为的危险因素（P＜ 0.05）,家庭亲密度高是自杀行为的保护因素（OR=0.878,95%CI=0.813～0.948）。结论 青少年抑郁症患者自杀行为发生率较高,家庭分型更多见于“僵硬 - 松散”的极端型家庭,有饮酒行为、严重抑郁、家庭关系不良者更容易自杀     

抑郁症患者自杀行为的临床分析

自杀行为是抑郁症的常见并发症,它会引起严重后果,据估计抑郁自杀构成所有自杀的1/2～2/3)。本文的目的在于对可能影响抑郁症患者自杀的诸多因素进行分析,以便及时进行危机干预。     

精神分裂症和抑郁症伴焦虑障碍的研究

目的 了解精神分裂症和抑郁症住院病人与焦虑障碍的共病发生率及相关因素分析。方法 住院精神分裂症病人41例和抑郁病人40例,用简明精神病量表（BPRS）、Hamilton抑郁量表（HAMD）、Hamilton焦虑量表（HAMA）、Liebowitz社交焦虑量表（LSAS）进行评定。结果 精神分裂症病人焦虑障碍的共病率为29．26％,抑郁症与焦虑障碍的共病率为50L。LSAS与HAMA呈正相关（r=0.465)。有关精神分裂症和抑郁症病人共病焦虑障碍经多元逐步回归可排除药源性焦虑。结论 对精神分裂症和抑郁症共患焦虑障碍应引起临床高度重视。     

临床治愈精神分裂症患者出院时抑郁情绪调查

目的：探讨临床治愈精神分裂症患者出院时抑郁情绪的状况及相关危险因素。方法选取86例临床治愈的精神分裂症患者,运用抑郁自评量表（SDS ）进行评估,与健康对照组进行比较,并分析与抑郁相关的影响因素。结果病例组SDS评分高于对照组（P＜0．01）,且病例组抑郁情绪的发生率高于对照组（ P＜0．01）;家庭月收入＜1000元、抗精神病药物的不良反应及婚姻和家庭关系差是抑郁情绪发生的危险因素。结论精神分裂症患者临床治愈后易出现抑郁情绪,家庭月收入、婚姻和家庭关系以及抗精神病药物的不良反应是发生抑郁情绪的危险因素。     

艾司西酞普兰治疗老年精神分裂症伴抑郁患者的疗效评价

目的探讨艾司西酞普兰治疗老年精神分裂症伴抑郁患者的疗效。方法选取我院收治的老年精神分裂症伴抑郁患者90例,采用随机数字法分为对照组和观察组各45例,对照组采用西酞普兰治疗,观察组采用艾司西酞普兰治疗,治疗时间均为12周,根据阳性和阴性症状量表(PANSS)、汉密尔顿抑郁量表(HAMD)及不良反应量表(TESS)进行疗效评价。结果 2组治疗12周后,观察组有效率(86.7%)明显高于对照组(68.9%),差异有统计学意义(χ2=4.114,P=0.043)。与同组治疗前比较,治疗后4、8、12周末PANSS各因子分与总分均低于治疗前,差异具有统计学意义(P0.05)。观察组阴性因子分在治疗后4、8、12周末均低于对照组,观察组总分疗后8、12周末均低于对照组,差异具有统计学意义(P0.05)。治疗4、8、12周末2组HAMD评分均低于治疗前,且观察组均低于对照组,差异均有统计学意义(P0.05)。2组TESS评分比较差异无统计学意义(P0.05)。结论艾司西酞普兰治疗老年精神分裂症状伴抑郁疗效显著,且安全性较高。     

抑郁症和精神分裂症的快眼动睡眠研究

目的探讨抑郁症与精神分裂症的快眼动（ＲＥＭ）睡眠特征。方法用睡眠实验技术对正常受试者、抑郁症和精神分裂症患者各３０例进行多导睡眠图的通夜描录，并结合临床指标，对三组受试者的９项ＲＥＭ睡眠指标进行对照分析。结果抑郁症和精神分裂症有着不同的ＲＥＭ睡眠特征。抑郁症ＲＥＭ睡眠潜伏期（ＲＬ）缩短，ＲＥＭ活动度、强度、密度增高和睡眠次数增多，汉米尔顿抑郁量表分与ＲＬ呈负相关。精神分裂症ＲＥＭ睡眠指标个体间差异大，１０例患者睡眠图的觉醒阶段中发现ＲＥＭ睡眠的插入现象。结论研究抑郁症有异常ＲＥＭ睡眠指标，而ＲＬ则为反映抑郁程度的特殊指标；ＲＥＭ睡眠的插入代表了部分精神分裂症患者的电生理特征     

卡尔加里精神分裂症抑郁量表

本文重点介绍卡尔加里精神分裂症抑郁量表编制、译制及在我国临床使用的过程,指出卡尔加里精神分裂症抑郁量表能不受阴性症状及锥体外系症状的影响,更好地测评精神分裂症的抑郁症状,可在临床上推广应用.     

抑郁症与精神分裂症患者的脑电生理反应时间比较研究

目的 了解抑郁症及精神分裂症患者反应时间的特点.方法 应用国产脑电生理仪以及短音和视觉刺激,测查31例抑郁症、33例精神分裂症和30名正常对照组的反应时间.结果 精神分裂症组和抑郁症组及正常对照组在听反应时间和视反应时间两两比较上均有显著性差异:正常对照组听反应时间 (231±30)ms,精神分裂症患者(279±34)ms,抑郁症患者(264±33)ms,(F=17.81,P<0.01);正常对照组视反应时间 (246±30)ms,精神分裂症患者(394±47)ms,抑郁症患者(289±41)ms,(F=49.04,P<0.01)).上述三组第二轮听、视反应时间与警告信号后负电位(PINV)变化表现为同一趋势,即听、视反应时间延迟,PINV随之延长.结论 反应时间可辅助抑郁症和精神分裂症患者的认知功能评定.     

A comparative study on quality of life of patients of schizophrenia with and without depression

Depression in schizophrenia has been recognized as one of the important factors influencing the Quality of Life (QOL). For this study 60 patients with a clinical diagnosis of schizophrenia as per ICD-10 (DCR version) were divided into two groups (with and without depression) on the basis of their score on Calgary Depression Rating Scale for Schizophrenia (CDSS). Thereafter, all patients were assessed on Positive and Negative Syndrome Scale for Schizophrenia (PANSS) for psychopathology, on Lehman Quality of Life Interview (QOLI)-brief version for QOL, on World Health Organization Disability Assessment Schedule-II (WHODAS-II) for disability, on UKU Side Effect Rating Scale for side effects of drugs and on Social Support Questionnaire (SSQ) for perceived social support. The two (depressed and non-depressed schizophrenia) groups differed significantly on symptoms of general psychopathology of PANSS and disability as per WHODAS-II, with the depressed group scoring higher. In the total sample, positive symptoms and the symptoms of general psychopathology of PANSS had a strong negative correlation with all three (subjective, objective and combined) domains of QOL, whereas, disability and medication side effects had a negative correlation with subjective and combined domains of QOL. CDSS total score did not significantly correlate with QOL. General psychopathology symptoms of PANSS emerged as the sole significant predictor of subjective and combined QOL, while positive symptoms of PANSS emerged as the sole predictor of objective QOL. Hence, it can be concluded that general psychopathology on PANSS had significant effect whereas depression as rated on CDSS had no significant effect on QOL in patients with schizophrenia. Treatments to improve QOL in schizophrenia should focus on symptoms of general psychopathology of PANSS.     

Lifetime psychiatric symptoms in persons with schizophrenia who died by suicide compared to other means of death

The focus of this report is to compare the psychiatric symptomatology of individuals with schizophrenia who have died by suicide to those who have died by other means of death. This study includes individuals with a diagnosis of schizophrenia whose families donated their brain tissue to the Maryland Brain Collection between September 1989 and August 1998. The psychological autopsy method was used to assess the deceased individual's demographic and clinical characteristics, psychiatric symptoms and history of suicidal thoughts and attempts. Ninety-seven individuals with schizophrenia were identified for this study. Fifteen had committed suicide, while the remaining 82 died from other causes. Thoughts of suicide and previous suicide attempts were more frequent among the group that died from suicide (93% compared to 26%) (p < 0.0001). Suicide victims had a higher rate of depressive symptoms and were twice as likely to have a depressed mood. The incidence of thoughts of dying was 60% compared to 20% in those who did not commit suicide (p = 0.002). Loss of interest was reported to occur in 20% in the suicide group compared to 4% in the group of individuals that died from other causes (p = 0.05). Victims of suicide also had higher rates of positive symptoms throughout their lifetime including thought control, flight of ideas, and loose associations. Suicide is one of the leading cause of premature death in individuals with schizophrenia and identification of risk factors is of great importance. Individuals who die by suicide experience higher rates of depressive symptoms, suicidal thoughts and positive symptoms during their life.     

Interpersonal distances,coping strategies and psychopathology in patients with depression and schizophrenia

AIM: To explore (1) intergroup differences in comfortable interpersonal distances (CIDs) and the use of coping strategies; (2) the association of these parameters with individual symptomatology; and (3) the interplay between CIDs and coping styles in patients with depression and schizophrenia.METHODS: The parameters of interest were assessed by means of standardized questionnaires: CID and Coping Inventory for Stressful Situations. Psychopathology was evaluated with the Beck Depression Inventory and Positive and Negative Syndromes Scale. ANOVA, Pearson’s correlations and multiple regression analyses were used to examine relationships among the variables.RESULTS: Compared with controls, depressed patients were more distanced from family members, significant others and self-images, whereas patients with schizophrenia were less distanced from neutral and threat-related stimuli. Distancing from self-images was mostly associated with depression severity in depressed patients, whereas distancing from hostile and threat-related stimuli with the severity of psychotic and affective symptoms in patients with schizophrenia. Both patient groups used more emotion-oriented than task-oriented and avoidance-oriented coping strategies. Self-distancing among patients with schizophrenia was positively associated with the use of the social diversion coping, implying social support seeking.CONCLUSION: Patients with depression and schizophrenia use different maladaptive emotion - regulation strategies to cope with their symptoms and related distress. Training in stress management might provide these patients with skills for more effective emotion regulation.     

Executive functioning and verbal memory in young patients with unipolar depression and schizophrenia

Although neuropsychological studies have consistently reported executive deficits in schizophrenia, studies of executive functions in depression have produced equivocal results. The aim of this study was to examine the profile and the specificity of the executive impairment and its association with memory performance in young patients with unipolar depression. We compared patients with depression to normal control subjects and schizophrenics. Twenty young inpatients with unipolar depression, 14 schizophrenics and 20 age-, education- and IQ-matched control subjects were assessed with a neuropsychological battery including: (1) verbal memory task; (2) frontal tasks (WCST, Cognitive Estimate, Verbal fluency, verbal and visuo-spatial span) and a new complex sorting test (Delis test). Depressed patients and schizophrenics exhibited executive deficits. Unlike schizophrenics, depressed patients did not show memory impairment. Deficits in several 'higher-level' functions combined to produce executive impairments in patients with depression including complex integration for concept formation, spontaneous cognitive flexibility and initiation ability. Impaired functions in schizophrenia and in depressed patients were similar but were differently related to clinical variables. The pattern of memory failure in our schizophrenics is believed to reflect retrieval and encoding deficits. Our findings highlight the heterogeneity of skills grouped under the term 'executive functions' that are vulnerable in depression or schizophrenia.