妄想性与非妄想性抑郁症的临床对照分析

目的：探讨妄想性抑郁症的临床特征。方法：对100例妄想性抑郁症与198年非妄想性性抑郁症进行临床对照分析。结果：妄想性抑郁症焦虑、激越、自责自罪，绝望，自杀行为的出现频率较高，往往需联合用药方能奏效。结论：妄想性抑郁症与非妄想性抑郁症在症状学及治疗学方面存在差异。     

妄想性与非妄想性抑郁症临床特点比较

为探讨抑郁症的临床特点，本文对抑郁症患者按照有无妄想症状分为2组，结果显示，妄想性抑郁症组焦虑激越、绝望、自杀行为比非妄想性抑郁症组发生率高，可见于各种临床类型。两组病前性格有显著性差异。妄想性抑郁症以联合用药为多，非妄想性组以单用药为多。     

住院精神分裂症与抑郁症患者自杀行为的临床特征比较

目的：比较精神分裂症与抑郁症住院病人自杀行为的发生比率，临床特征及自杀死亡率的差异。方法：采用病史询问、精神状态检查和定式评定的方法，确定精神分裂症有自杀行为者６４例，抑郁症３４例患者为研究对象，并在５年后追踪调查其自杀死亡的情况。结果：住院精神分裂症自杀行为的发生率为３３％，其中自杀未遂者为１２．９％；抑郁发作的自杀行为发生率为８９．５％，自杀未遂者为５７．９％。影响住院精神分裂症的自杀行为的主要因素为幻觉妄想；影响抑郁症自杀行为的影响因素除情绪障碍外，有８～１１％的病人伴有妄想症状。精神分裂症和抑郁症伴有自杀行为的追踪病例中病程在６年内自杀死亡的比率分别为２．９％和５．６％。结论：精神分裂症和抑郁症的自杀行为是精神科临床危机干预的重要内容，临床医师应当重视发病期精神症状对自杀行为的影响。     

伴自杀行为抑郁症患者的临床特点

本文对１０５例抑郁症自杀行为者与１３７例无自杀行为者进行对照研究。结果表明，抑郁症有自杀行为者在病前有不良生活事件及具有早醒、焦虑、绝望、自责自罪和妄想者较无自杀组多见，且有显著性差异，提示具有上述症状的抑郁症患者具有潜在自杀的危险性，应引起社会、家庭和精神病学界的重视，以尽早发现、治疗并采取防范措施。     

对慢性抑郁的再分析

目的：进一步探讨慢性抑郁的影响因素。方法：将４２例慢性抑郁症与６０例非慢性抑郁症进行临床对照。结果：二者在抑郁症状，妄想出现的时间及、应激评分上均有显著差异。结论：慢性抑郁症除与心理社会因素有关外，与妄想与抑郁疗程中出现的时间，妄想的类别及应激强度等因素有关。     

住院抑郁症患者与精神分裂症患者自杀行为的分析

目的比较住院抑郁症患者与精神分裂症患者自杀行为的发生率、临床特征及自杀死亡率的差异。方法采用病史资料,精神检查和量表评定的方法 ,确定抑郁症32例,精神分裂症62例为研究对象,并在出院5年后追踪调查其自杀的情况。结果住院患者抑郁发作的自杀率为80.0%,自杀未遂为52.5%,精神分裂症自杀行为的发生率为32.4%,其中自杀未遂为21.9%,两类疾病自杀行为的人数所占百分比经卡方检验,差异显著(χ2=9.594,P0.01)。抑郁症自杀行为的影响因素以抑郁情绪为主(100%),绝望是自杀的直接原因,妄想(56.2%)、焦虑(25.0%)等次之;精神分裂症患者自杀的主要因素为幻觉妄想(59.7%),抑郁情绪(26.6%)次之。抑郁症与精神分裂症伴有自杀行为的患者5年追踪结果显示:两类患者都有自杀死亡行为,抑郁症的自杀死亡率高于精神分裂症(11.1%和8.8%)。结论抑郁症和精神分裂症的自杀需要长期的药物及心理干预。     

抑郁症自杀行为的相关危险因素临床分析

目的　研究抑郁症自杀行为的危险因素 ,为预防自杀提供依据。方法　按 CCMD— 3诊断标准收集 2 1 1例住院的抑郁症患者 ,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 68例 (3 2 .2 % ) ,自杀与绝望 (相对危险度 RR=9.3 1 0 )、负性生活事件 (RR=3 .844)、自杀家族史 (RR=3 .62 7)、妄想 (RR=3 .783 )及自责 (RR= 2 .985 )呈正相关 (P均 <0 .0 1 )。结论　绝望、负性生活事件、自杀家族史、妄想及自责是抑郁症患者自杀的危险因素。     

有精神病性症状抑郁症的现象学特征对照分析

目的 探讨有精神病性症状抑郁症的现象学特征。方法 将符合CCMD-3诊断标准的114例抑郁症,根据患者是否存在精神病性症状分组进行临床资料的对比分析。结果 37．7％的抑郁症存在着各类妄想等精神病症状;有精神病性症状抑郁症起病时有明显的社会心理因素,自杀行为要高于无精神病性症状抑郁症的3．5倍,联合治疗占81.4％,近期疗效两纽均较佳,但起效时间有精神病性症状抑郁症要慢。结论 两组病例在现象学及治疗学上均存在着明显差异。     

不同诊断类别抑郁症自杀的比较

对１８１例抑郁症按单相双相，妄想性与非妄想性，迟缓性和激越性三种诊断类别统计自杀问题，结果激越性抑郁症的自杀危机明显高于迟缓性抑郁症，妄想，焦虑和激越等症状与自杀为密切相关。     

抑郁症长期治疗措施

文献表明：70％的抑郁症患者有多次发作的可能，至少60％的病人需长期服努“。本文介绍抑郁症急性期、继续治疗期和维持治疗期的治疗方法。1急性治疗期1．三抑郁症急性期治疗’－”的方法，有电抽搐治疗（ECT）、抗抑郁药和心理治疗。对抑郁发作首选治疗方式通常由精神科医师决定，但应基于下列情况：安全性、有效性、病人躯体情况、疾病的严重程度、家庭经济情况。对伴有自杀行为的妄想性抑郁症应首选ECT．经性抑郁症可能只需心理治疗。不管选择哪种治疗，治疗目标是控制抑郁症状，使症状至少减轻50％，达到病人获得明显疗效。1．2ECT…     

Suicide attempts by hospitalized medical and surgical patients.

To characterize siucidal behavior among hospitalized medical and surgical patients, all suicide attempts in the Peter Bent Brigham Hospital were surveyed for seven years. Seventeen attempts occurred, non of them fatal. Only four patients were seriously ill, two with neoplasia. All the attempts were impulsive and were associated with stress and disturbances of impulse control. Anger, not depression, was the effect most often seen before the attempts. In all cases the precipitating stress was loss of emotional support. However, patient vulnerability to suicide seemed to be the key determinant. Fifteen patients had mental disorders, including eight with personality disorders, three with schizophrenia, three with organic brain syndromes, and one with manic depressive psychosis. Seven were psychotic, and six had made prior suicide attempts. These findings suggest that the characteristics of impulsive suicide should be considered when a suicide prevention program is being developed for a general hospital.     

Clinical application of low serum cholesterol as an indicator for suicide risk in major depression

BACKGROUND: Serum total cholesterol is reported to be associated with suicidality and violence. We explored the clinical applicability of low serum total cholesterol as an indicator for suicide risk in major depression. METHOD: We measured the serum cholesterol levels in 149 major depressive disorder patients admitted to an emergency room following a suicide attempt, in 149 non-suicidal depressive controls, and in 251 normal controls. RESULTS: Significant differences in total serum cholesterol levels were observed between the suicide patients and non-suicide depression patients and between violent suicide patients and non-violent suicide patients when age, sex, BMI and total serum protein levels were controlled. The cutoff point of 180 mg/dl gave a high sensitivity (82%), and the cutoff point 150 mg/dl gave a high specificity (72%). These points can be used as discriminative cutoffs between suicidal and non-suicidal depressive patients. LIMITATIONS: A longitudinal study is necessary to confirm the clinical applicability of serum cholesterol as a predictive indicator of suicide risk in depression. CONCLUSION: The results suggest that total cholesterol level may be a useful biological marker for the risk of suicide in depression patients.     

学龄儿童的抑郁

３２２名１０～１２岁小学五、六年级学生填写了Ｂｕｌｅｖｕｅ抑郁量表（ＢＩＤ）。抑郁症状的出现率３．４％～１１．５％，有自杀观念者５．９％。自杀观念与总分、心境恶劣、自卑和自杀、攻击性行为和社会交往４个因子的相关程度最高。３２２人中１０人（３．１％）为抑郁症检出者，临床表现与成人抑郁症相似，其中８人有自杀观念。结果提示抑郁情绪、自杀观念、抑郁症在学龄儿童中的出现率较高，应加强预防和治疗。     

A comparison between delusional and non-delusional depressives.

Delusional depressive episodes may represent more sever degrees of depressive manifestations or a distinct subtype of depressive illness. To test these two alternative hypotheses, characteristics on demographic, clinical and symptomatic variables, presence of personality disorders and familial loading were compared in 57 delusional and 57 non-delusional depressive patients. The delusional group did not differ on symptomatological intensity degree, clinical and familial loading characteristics. They did differ on higher distribution of Cluster 1 personality disorders. In the delusional sample the presence of mood incongruent psychotic features and hallucinations were evaluated as possible indicators of different subtypes of delusional depression.     

TPH2基因单核苷酸多态性与单相抑郁及其自杀行为的关系

目的探讨色氨酸羟化酶2(TPH2)基因rs7305115单核苷酸多态性与单相抑郁及自杀行为的关系。方法提取197例单相抑郁患者和225名健康对照者基因组DNA,采用聚合酶链反应(polymerase chain reaction PCR)扩增包括TPH2基因rs7305115位点的312bp基因组DNA片段及PCR产物直接测序。结果在第7外显子周围未发现其它的单核苷酸多态性。单相抑郁患者和健康对照者TPH2 rs7305115基因型和等位基因频率无统计学意义的差别(P>0.05),但患者组内有自杀行为的个体携带基因型AA的频率及等位基因A的频率均较低,两组比较差异有统计学意义(P<0.05)。结论TPH2基因rs7305115单核苷酸多态性与单相抑郁无明显关联,与自杀行为有关联。其可能与抑郁症自杀行为易感性相关。     

The close link between suicide attempts and mixed (bipolar) depression: implications for suicide prevention

BACKGROUND: Previous reports have shown a significant relationship between suicide ideation and mixed depression. The aim of this study was to explore the prevalence and clinical characteristics of mixed depression among non-violent suicide attempters. METHODS: Using a structured interview (modified Mini International Neuropsychiatric Interview) and assessing all the symptoms of 16 psychiatric diagnoses, the authors examined 100 consecutive nonviolent suicide attempters (aged 18-65) within 24 h after their attempts. Mixed depression was defined as a major depressive episode (MDE)/dysthymic disorder plus 3 or more co-occurring hypomanic symptoms, according to the definition validated by Akiskal and Benazzi [Akiskal, H.S., Benazzi, F., 2003a. Delineating depressive mixed states: Their therapeutic significance. Clin. Approaches Bipolar Disord. 2, 41-47, Akiskal, H.S., Benazzi, F., 2003b. Family history validation of the bipolar nature of depressive mixed states. J. Affect. Disord. 73, 113-122.]. RESULTS: Current mixed depression was present in 63.0% in the total sample, and in 70.8% among the 89 depressive suicide attempters. Irritability, distractibility and psychomotor agitation were present in more than 90% of the subjects with mixed depression. The rate of mixed depression was significantly higher among bipolar than non-bipolar depressive suicide attempters (90% vs. 62%). Patients with mixed depression had the following concurrent disorders: bipolar disorders 41.0%, panic disorder 30.0%, generalized anxiety disorder 89.0%, alcohol abuse/dependence 56.0%, and substance abuse 27.0%. Mixed depression versus non-mixed depression had the following significant associations (odds ratio=OR): females 2.4, bipolar II disorder 9.3, generalized anxiety disorder 41.3, irritability 101.6 and psychomotor agitation 61.1. LIMITATIONS: The study didn't include suicide attempters with very high risk of fatality. CONCLUSIONS: The important new finding of this study is the very high prevalence of mixed depression among depressed suicide attempters. The rates of mixed depression among bipolar and non-bipolar depressive suicide attempters were much higher than previously reported among nonsuicidal bipolar II and unipolar depressive outpatients, suggesting that suicide attempters come mainly from mixed depressives with predominantly bipolar II base. Irritability and psychomotor agitation were the strongest predictors of suicide attempt. From a public health standpoint, our data highlight the necessity of detecting and treating mixed (bipolar) depression in the prevention of suicidal behaviour.     

Prevalence and comorbidity of affective disorders in persons making suicide attempts in Hungary: importance of the first depressive episodes and of bipolar II diagnoses

BACKGROUND: The purpose of this study was to investigate the prevalence and comorbidity of affective disorders, especially current major depressive episode and bipolar disorder among suicide attempters in Hungary. METHODS: Using a structured interview (Mini International Neuropsychiatric Interview) determining 16 Axis I psychiatric diagnoses defined by the DSM-IV and a semistructured interview collecting background information, the authors examined 100 consecutive suicide attempters, aged 18-65. RESULTS: Eighty-eight percent of the attempters had one or more current diagnoses on Axis I. In 69% it was major depressive episode and 60% of them were suffering their first episode. Thirty-five percent of the patients with current major depressive episode had had hypomanic (n=19) or manic (n=5) episodes in the past. Seventy percent of the individuals received two or more current diagnoses on Axis I. Eighty-six percent of all current Axis I disorders (except major depressive episode) were diagnosed together with a current major depressive episode. The diagnosis of current major depressive episode and the number of current psychiatric disorders was significantly and positively related to the number of suicide attempts, but the diagnosis of past major depressive episode was not. LIMITATIONS: This study included suicide attempters who had presented selfpoisoning, but not individuals with very high risk of fatality. CONCLUSIONS: In suicide attempters there is a very high prevalence of affective disorders, especially major depression, first episode of major depression and bipolar II disorder. This study underlines the importance of early detection and treatment of psychiatric disorders for the prevention of suicidal behavior.     

Proposed delusional depression subtypes: preliminary evidence from a retrospective study of phenomenology and treatment course

An analysis of the phenomenology and treatment course of 52 subjects with delusional depression suggests that there may be various subtypes: bipolar, early-onset unipolar and possibly a late-onset unipolar. The bipolar subgroup tended to relapse in different but always psychotic directions, and was resistant to lithium carbonate treatment alone. Treatment refractoriness, delusional depressive recurrences, and a dementia-like presentation were associated with a small late-onset subgroup. A high rate of delusionally depressive relapses also characterized the early-onset unipolar group, however, patients with single episodes were found only in this subgroup.