抑郁症的注意功能研究进展

本文对抑郁症注意功能相关的神经心理学、神经电生理学、功能影像学、心理药物学及抑郁症的预后等研究进行综述。     

抑郁症注意负性偏向机制及干预研究进展

近年来研究发现抑郁症患者普遍存在明显的选择性注意偏向，主要表现为对负性情绪信 息的过度关注、难以解除和对正性情绪的注意偏向缺失。研究发现其不仅可能是抑郁症复发的重要因 素，而且可能作为抑郁诊断和评估的重要指标，乃至成为抑郁症治疗的重要靶点。然而，这一理论亟需 更多的证据支持。现对抑郁症患者注意负性偏向的机制及治疗进行阐述。     

抑郁症的注意网络功能研究

目的研究抑郁症的注意网络状况及其与临床症状的相互关系,以探索抑郁症注意缺陷特征及可能机制。方法对40例抑郁症患者(抑郁组)进行注意网络测定(ANT)和抑郁自评量表(SDS)及汉密顿抑郁量表(HAMD)的临床症状评定,并与正常对照组(n=40)ANT结果比较。结果抑郁组的警觉网络和执行控制网络效率较正常组有显著差异,定向网络效率无差异。抑郁症患者的年龄与平均反应时间呈正相关,与警觉网络效率呈负相关;警觉网络效率与HAMD得分及其睡眠障碍因子分呈负相关;执行控制网络效率与睡眠障碍因子分呈正相关。结论抑郁症患者存在警觉和执行控制注意网络的异常而定向网络保留正常,注意功能的异常与睡眠障碍相关。     

甲状腺激素与抑郁症研究进展

本文介绍甲状腺激素与抑郁症和抗抑郁治疗的关系以及甲状腺激素参与抑郁症病因的可能机制。     

抑郁症生物标志物研究进展

抑郁症作为情感性障碍一种临床类型,是以显著而持久的情绪低落为主要特征的精神障碍。其主要表现是以情感低落、思维迟缓和精神运动性抑制三大症状为基本特征。部分抑郁症患者伴有严重的焦虑症状,出现自杀观念及行为,目前抑郁症已经成为精神科自杀率最高的疾病。抑郁症的病因十分复杂,迄今仍未完全阐明。生物标志物是指可以标记系统、器官、组织、细胞及亚细胞结构或功能的改变或可能发生改变的生化指标。生物标志物可用于疾病诊断、判断疾病分期或者用来评价新药物或新疗法在目标人群中的安全性及有效性。本文主要针对抑郁症与几种生物标志物之间的相关性研究作一综述。     

注意偏向矫正训练对抑郁症患者影响

目的:探讨注意偏向矫正训练(Attention Bias Modification Training, ABM)对抑郁症患者情绪及注意偏向的影响。方法:选取80例首发抑郁症住院患者按照方便取样法分为常规治疗组40例(Routine treatment, RT)和注意偏向矫正训练组40例(Attention Bias Modification Training, AT),与60例健康对照组(HC)进行比较,采用“中文情绪词stroop任务”在入院初期和30 d ABM后进行注意偏向评估。结果:(1)入院时抑郁症患者组在中文情绪词stroop任务中负性词的反应时和错误数[(1209.20±254.12)ms,(2.18±1.64)次]均大于HC组[(1064.03±233.52)ms,(1.43±1.29)次],差异有统计学意义(t=3.462,P=0.001;t=2.887,P=0.005)。(2)治疗30 d后,RT组在负性词错误数方面多于AT组,差异有统计学意义[t=-4.057,P<0.001],进一步计算Cohen’s d值,两组负性词错误数减分值差异效应较大(d>0...     

抑郁症认知功能障碍神经生物学机制研究进展

认知功能障碍是许多精神障碍的症状性领域,抑郁症患者的认知缺陷是导致职业和功能 残疾的重要原因,多种相互作用的神经生物学机制（如神经炎症）与抑郁症的认知缺陷有关。现归纳与 抑郁症认知功能相关的多种生物学机制,包括神经回路损伤、神经递质系统、神经内分泌系统、炎症反 应、神经营养因子等,分析抑郁症合并认知功能障碍患者生物学机制的研究进展。目前,国内外尚缺乏 对抑郁症认知功能障碍的深入探索,将神经系统、内分泌系统和免疫系统整合起来,更深层次地探索抑 郁症认知功能障碍的生物学机制是未来的方向。     

抑郁症发病机制的研究进展

抑郁症是一种常见的精神障碍疾病,主要表现为兴趣缺失、心境低落、意志活动减退、思维迟缓、认知功能受损,甚至引发患者的自杀倾向,且抑郁症具有高发病率、高复发率、高致残率和高自杀率的特点.WHO 预测,到2030年抑郁症将成为全球最大的疾病负担,威胁着人类的健康和社会的和谐[1].超过25％的抑郁症患者无法被治愈[2],因此,探索抑郁症的发病机制以求得研究得到更有效的治疗方法显得尤为重要.抑郁症的发病机制十分复杂,本文主要从神经元细胞的凋亡和增殖、5－HT 活性、线粒体功能障碍及神经炎性反应4个方面对抑郁症的相关发病机制进行综述。     

他可莫司治疗重症肌无力的研究进展

重症肌无力(myasthenia gravis,MG)是一种主要由乙酰胆碱受体抗体(acetylcholine receptor antibody,AChR-Ab)介导、细胞免疫依赖和补体参与的神经肌肉接头处的自身免疫性疾病.机体对自身AChR免疫应答异常是其发病本质,T细胞的异常激活是MG自身免疫反应发生的基础.他可莫司(tacrolimus,FK506)是一种新型免疫调节剂,可通过抑制神经钙调磷酸酶活性,进而抑制T细胞激活和各种细胞因子的产生而治疗MG,现就其目前研究进展报道如下.     

无功能性垂体腺瘤生长速率的研究现状

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Self reported attentional control with the Attentional Control Scale: factor structure and relationship with symptoms of anxiety and depression

The Attentional Control Scale (ACS) is a self-report questionnaire that has been developed to measure individual differences in attentional control. Despite its fairly widespread use, little is known about the psychometric properties of the scale in adult samples. In the present study, factor structure of the ACS and its relationship with symptoms of anxiety and depression was investigated in a total sample of 728 Icelandic university students. Exploratory factor analysis in sample 1 (n = 361), yielded two factors, labeled focusing and shifting. Confirmatory factor analysis in sample 2 (n = 367) showed a reasonable fit of this two factor model. The two factors correlated strongly (0.73). The two subscales showed different predictive validity in a set of hierarchical regression analyses where the focusing subscale made a significant prediction of anxiety scores when depression scores were controlled for, and the shifting subscale significant prediction of depression scores when anxiety scores were controlled for. These findings are discussed in relation to previous studies on attentional and executive control in anxiety and depression.     

米氮平与文拉法辛治疗抑郁症引起性功能障碍Meta分析

目的评价国内米氮平与文拉法辛治疗抑郁症对照研究引发性功能障碍的差异。方法应用循证医学的Meta分析，采用Peto固定效应模型法，对符合准的12篇对照研究文献性功能障碍的差异进行Meta分析。结果5项研究共313例纳入研究，米氮平治疗组共159例，发生性功能障碍1例，文拉法辛治疗组154例，发生性功能障碍15例，两组性功能障碍的发生率分别是0．63％和9．74％，综合检验两组差异有统计学意义（Z=2．96，P〈0．01；OR=0．10，959，6CI：0．06～0．56）。结论在治疗抑郁症中，文拉法辛比米氮平更容易引发性功能障碍，应特别加以关注。     

帕罗西汀合并小剂量曲唑酮治疗伴勃起功能障碍抑郁症的对照研究

目的探讨帕罗西汀合并小剂量曲唑酮对伴有勃起功能障碍(ED)抑郁症患者的疗效及安全性。方法将101例伴有勃起功能障碍的抑郁症患者随机分为研究组(50例)和对照组(51例),研究组在常规给予帕罗西汀治疗的基础上,合并小剂量曲唑酮,对照组仅给予帕罗西汀,疗程6周;于治疗前及治疗后1、2、4、6周采用汉密顿抑郁量表(HAMD)、勃起功能国际指数评分问卷(IIEF-5)及副反应量表(TESS)评定疗效、勃起功能及副反应。结果对抑郁症状的治疗,2组疗效相当,研究组显效率为86.0%,对照组为78.4%;但1周末及2周末研究组HAMD评分显著低于对照组(P<0.05)。对勃起功能,2组的显效率分别为56.0%、21.6%,差异具有显著性(P<0.01);研究组的IIEF-5评分于4周末即显著高于对照组;ED改善与HAMD阻滞因子减分值呈正相关。2组间TESS评分无显著性差异。结论帕罗西汀合并小剂量曲唑酮治疗抑郁症起效快,且可显著改善患者的勃起功能,安全性高。     

Attentional bias training in depression: Therapeutic effects depend on depression severity

Depressed individuals show maintained attention to negative information and reduced attention for positive information. Selective biases in information processing are considered to have an important role in the origin, maintenance and recurrence of depressive episodes. In two experiments we investigated the effects of attentional bias manipulation on mood and depressive symptoms. In experiment 1 we investigated the effects of attentional bias manipulation compared to a control procedure in a sample of dysphoric students (N = 48) showing mild to severe levels of depressive symptoms. In experiment 2 we investigated the same attentional training procedure in a sample of depressed in- and outpatients (N = 35). Mild improvements on symptom severity were observed in students showing mild depressive symptoms. However, in students showing moderate to severe depressive symptoms, depressive symptoms increased after the training. No beneficial effects of training on top of therapy and/or medication were found in depressed patients. These results indicate that therapeutic effects of attentional bias modification might be dependent on depression severity.     

Alterations of the attentional networks in patients with anxiety disorders

Cognitive theories of emotion try to explain how anxious people attend to the world. Despite the increase in empirical research in this field, the specific or general attentional impairments of patients with anxiety disorder is not well defined. We decided to investigate the relationship between pathological anxiety and attentional mechanisms from the broader perspective of the attentional networks. In our study, patients with anxiety disorders and control participants carried out a task to assess efficiency of three attentional networks: orienting, alerting, and executive control. The main result was that anxiety disorders are related to both reduced effectiveness of the executive control network and difficulties in disengaging attention from invalid cues, even when using emotionally neutral information. This relationship between these attentional networks and anxiety may in part explain the problems in the day-to-day functioning of these patients.     

TRPV1受体与认知障碍相关性的研究进展

瞬时受体电位香草酸亚型1(TRPV1)受体与外周神经系统疾病的相关性已经得到证实,而近年来越来越多研究也证实TRPV1在中枢神经系统中的重要地位,其在海马区、皮层及中脑的广泛分布更是为TRPV1受体与认知学习记忆功能的相关性架起了桥梁。本文通过综述国内外TRPV1受体在中枢神经系统中的生物学作用,总结其与认知相关疾病的关系,旨在为TRPV1受体是否可作为治疗认知相关疾病的药物靶点提供理论依据。     

Sexual dysfunction and physicians' perception in medicated patients with major depression in Taiwan

Although prevalent during antidepressant treatment, sexual dysfunction (SD) is frequently ignored by both physicians and patients in Asia. In spite of impact of SD on medicated patients with major depression, sexual issues and illness remain a forbidden topic for most Asian people. The aims of this study were to: (1) estimate the prevalence of SD among stable outpatients taking different antidepressants in Taiwan; (2) investigate the factors related to SD; (3) compare physician-perceived with patient-reported prevalence rates of antidepressant-associated SD; and (4) study the differences of SD among antidepressant subgroups. In this cross-sectional observational study, 125 medicated patients with major depression were recruited. Patients were assessed using the Changes in Sexual Functioning Questionnaire (CSFQ), Taiwanese Depression Questionnaire (TDQ), Quality of Life Index (QOL), and neuroticism scores in the Maudsley Personality Inventory (MPI). Sixty-two physicians completed the Physician Antidepressant Experience Questionnaire. The estimated prevalence rate of SD was 53.6% (95% CI = 44.9-62.3%) in medicated patients with major depression. There were no significant differences in prevalence rate of SD among different antidepressants. The SD subgroup had poorer quality of life and lower moods than the non-dysfunction subgroup. An underestimation of the prevalence of SD by physicians was noted. Because antidepressant-associated SD is highly prevalent and seriously underestimated by physicians, greater physicians' recognition and better patients' education are imperative when prescribing antidepressants.     

Response conflict and frontocingulate dysfunction in unmedicated participants with major depression

Individuals with major depressive disorder (MDD) often exhibit impaired executive function, particularly in experimental tasks that involve response conflict and require adaptive behavioral adjustments. Prior research suggests that these deficits might be due to dysfunction within frontocingulate pathways implicated in response conflict monitoring and the recruitment of cognitive control. However, the temporal unfolding of conflict monitoring impairments in MDD remains poorly understood. To address this issue, we recorded 128-channel event-related potentials while 20 unmedicated participants with MDD and 20 demographically matched, healthy controls performed a Stroop task. Compared to healthy controls, MDD subjects showed larger Stroop interference effects and reduced N2 and N450 amplitudes. Source localization analyses at the time of maximal N450 activity revealed that MDD subjects had significantly reduced dorsal anterior cingulate cortex (dACC; Brodmann area 24/32) and left dorsolateral prefrontal cortex (Brodmann area 10/46) activation to incongruent relative to congruent trials. Consistent with the heterogeneous nature of depression, follow-up analyses revealed that depressed participants with the lowest level of conflict-related dACC activation 620 ms post-stimulus were characterized by the largest Stroop interference effects (relatively increased slowing and reduced accuracy for incongruent trials). Conversely, MDD participants with relatively stronger dACC recruitment did not differ from controls in terms of interference effects. These findings suggest that for some, but not all individuals, MDD is associated with impaired performance in trials involving competition among different response options, and reduced recruitment of frontocingulate pathways implicated in conflict monitoring and cognitive control.