抑郁与焦虑共病障碍临床研究

目的:调查抑郁与焦虑共病障碍的发生率,探讨其特点及预后.方法:对150例抑郁障碍患者用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、社会功能缺陷筛选量表(SDSS)和临床疗效总评量表(CGI)评定,3个月后进行随访.结果:45.3%的抑郁障碍患者共病焦虑障碍,共病以广泛焦虑障碍与惊恐障碍为最多(分别为22.0%、13.3%);入组时及3个月末,共病组HAMD、HAMA、CGI及SDSS总分均显著高于抑郁组(P＜0.05),3个月末共病组HAMA减分率显著低于抑郁组(P＜0.05),HAMD减分率两组差异无显著性.结论:抑郁与焦虑共病障碍发生率高,具有抑郁及焦虑症状重、社会功能损害重,焦虑症状不易缓解等特征.     

焦虑和抑郁障碍共病的治疗

焦虑障碍包括广泛性焦虑障碍 (GAD) ,惊恐障碍 ,强迫症 (OCD) ,社交恐怖 ,混合性焦虑抑郁障碍 (MAD)和创伤后应激障碍 (PTSD)。其中 MAD在 ICD- 1 0中的定义是 :患者多见于初级保健机构 ,有一定程度的焦虑和抑郁症状 ,并伴有植物神经症状 ,但又不符合特定的焦虑症或抑郁症诊断标准 ,也应与应激性生活事件无关[1] 。焦虑和抑郁障碍在诊断标准中是相互独立的疾病实体 ,但通常在同一个体共存。当两组症状分别考虑时 ,足以符合相应的诊断标准 ,这种情况称为焦虑、抑郁障碍共病。这种共病在初级保健人群中的患病率达 1 9% ,与单一焦虑或…     

抑郁障碍和焦虑障碍共病专家研讨会会议纪要

抑郁障碍和焦虑障碍共病 (以下简称抑郁焦虑共病 )是当前全球精神病学界关注的热点之一 ,也正在逐渐引起国内同道的重视。为此 ,中华医学会精神病学分会焦虑障碍研究协作组邀请部分专家 ,于 2 0 0 3年 3月 3日在哈尔滨市召开抑郁焦虑共病专题研讨会。讨论的议题集中于临床 ,如抑郁焦虑共病的流行病学、临床现象学和治疗学。现将本次会议的主要发言内容纪要于下。张明园教授 (上海第二医科大学 ) :首先就抑郁焦虑共病的概念 ,谈几点个人观点 :( 1)共病 (comorbidity)也被译为同病、合病或其他 ;目前国内多习惯称为共病 ,其含义是指两种疾病共…     

脑卒中后焦虑抑郁共病研究进展

脑卒中患者除偏瘫外,还可出现一系列情感行为的变化,其中抑郁和焦虑是脑卒中后常见的心理障碍.有研究表明只有39.5%的情感障碍和59.3%的焦虑障碍是以单独的形式出现的,而焦虑抑郁共病（comorbid anxiety and depression,CAD）则是最常见的共病模式[1].这种情绪变化不仅影响患者的生存质量,也妨碍其神经功能的恢复,不仅给患者带来躯体上和精神上痛苦,而且增加了家庭和社会的负担,为此,越来越多的学者意识到脑卒中后抑郁焦虑共病早期诊断和积极干预的重要性.现将脑卒中后焦虑抑郁共病的研究情况作一介绍.     

焦虑障碍和抑郁障碍共病率较高的原因——读者来信

正编辑先生:在临床上,焦虑和抑郁可谓难兄难弟,常并肩出现,几乎所有涉及精神疾病共病的流行病学调查都显示,抑郁障碍和焦虑障碍的共病率位居首位。不知这是什么原因,请指教!读者答读者来信读者您好:在中国5个城市(北京、上海、广州、成都和长沙)的15家三级甲等综合医院的心血管科、消化科、神经科和妇科门诊对8,487例患者的诊断性调查显示,抑郁障碍的患病率是12.0%,焦虑障碍的     

抑郁症和焦虑障碍共病的研究现状

抑郁症和焦虑障碍的共病现象很常见，但目前在我国精神科临床实践中往往被忽略或未被认识到，本文着重总结两者共病的普遍性、临床特征、影响因素、严重危害及治疗，以期引起相应的重视并为临床提供可供借鉴的建议。     

老年焦虑抑郁障碍共病54例临床研究

目的 探讨老年焦虑抑郁障碍的临床特征、诊断及治疗方法.方法 选取54例符合入组标准及排除标准的患者进行临床研究,归纳临床症状并进行统计分析.用汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)进行评分,对比治疗前后的评分变化,并以HAMA和HAMD减分率判定疗效.结果 老年焦虑障碍多与抑郁共病,躯体主诉多为其主要特点.治疗后第2周末开始起效,疗效随时间延长同步上升,治疗后第2、4、8周末HAMA、HAMD量表评分与治疗前比较,有显著性差异(P ＜0.05,P＜0.01).药物及心理治疗的总有效率90.75％.结论 老年焦虑障碍多与抑郁共病,及时干预治疗效果满意.     

抑郁症和焦虑障碍共病的研究现状

抑郁症和焦虑障碍的共病现象很常见 ,但目前在我国精神科临床实践中往往被忽略或未被认识到 ,本文着重总结两者共病的普遍性、临床特征、影响因素、严重危害及治疗 ,以期引起相应的重视并为临床提供可供借鉴的建议     

焦虑与抑郁障碍共病患者症状与血清甲状腺激素水平的相关分析

目的探讨焦虑与抑郁障碍共病患者症状与血清甲状腺激素及促甲状腺激素(TSH)水平的相关性,为焦虑与抑郁障碍共病的治疗提供理论依据。方法采用单纯随机抽样法,于2014年1月-2015年6月在四川省人民医院心身医学中心抽取50例符合《美国精神障碍诊断与统计手册(第4版)》(DSM-Ⅳ)中焦虑与抑郁障碍共病诊断标准的首次住院患者为研究对象。采用化学发光分析法检测患者血清总三碘甲状腺原氨酸(TT_3)、总甲状腺素(TT_4)、游离三碘甲状腺原氨酸(FT_3)、游离甲状腺素(FT_4)、促甲状腺激素(TSH)水平,并对患者进行焦虑自评量表(SAS)、抑郁自评量表(SDS)及症状自评量表(SCL-90)评定。结果焦虑抑郁障碍共病患者的甲状腺激素各项及TSH水平与SAS、SDS评分均无相关性(P均0.05);TT_4水平与SCL-90的躯体化因子评分呈负相关;FT_4水平与SCL-90中的其他因子评分呈负相关。结论焦虑与抑郁障碍共病患者的症状水平与血清甲状腺激素水平有一定的相关性。甲状腺激素水平的异常与焦虑抑郁障碍共病患者躯体化症状、睡眠及饮食问题的产生有一定的关系。     

西酞普兰治疗焦虑和抑郁障碍共病的临床疗效观察

我们采用西酞普兰治疗焦虑抑郁共病,并观察其临床疗效和不良反应,现报道于后。     

Social anxiety disorder and depression in Saudi Arabia

The purpose of this study was to estimate the prevalence of depression in patients with social anxiety disorder (SAD) and to assess the relationship between the severity of SAD symptoms and depression. Ninety-eight consecutive patients with generalized SAD according to DSM-IV criteria were included in a cross-sectional case-control study. Patients were referred to a psychiatric outpatient clinic in a general hospital in Saudi Arabia. The Liebowitz Social Anxiety Scale was used to estimate the severity of SAD. Fifty-eight (59%) of the patients with SAD had another current psychiatric disorder. Forty (41%) patients had current depression, and 37 (92.5%) of them had it after SAD onset. Eleven of 16 patients with severe SAD (69%) had depression whereas only 29 of 82 of SAD patients with mild or moderate subtypes (35%) had depression. Patients with severe SAD were four times more likely to have depression than the patients with mild or moderate SAD even after controlling for confounding sociodemographic and clinical factors. Depression is common among patients with SAD, particularly the severe subtype. Early recognition and treatment of SAD, especially the severe subtype, may prevent the occurrence of depression. Prospective studies are needed to investigate the risk factors that may lead to depression in SAD.     

Anxiety and major depression comorbidity in a family study of obsessive-compulsive disorder

To understand the familial relationship between obsessive-compulsive disorder (OCD), other anxiety disorders, and major depressive disorder (MDD), we examined the rates of anxiety disorders and MDD in first-degree relatives of OCD probands and controls, the association between age at onset of OCD and the occurrence of other anxiety disorders and major depressive disorder in relatives of probands, and the co-transmission of specific anxiety disorders, MDD, and OCD within families of probands. Recurrence risks were estimated from 466 first-degree relatives of 100 probands with OCD and 113 first-degree relatives of 33 non-psychiatric controls. Rates of non-OCD anxiety disorders and MDD were comparable in relatives of OCD probands and controls. Rates of anxiety disorders and MDD were higher among case relatives with OCD than among case relatives without OCD and control relatives. Fifty percent of case relatives with OCD had at least one comorbid anxiety disorder. Early age at onset (<10 years) in probands was associated with higher rates of anxiety and depression comorbidity among case relatives with OCD but not among case relatives without OCD. The occurrence of specific anxiety disorders and MDD in case relatives was independent of the same comorbid diagnosis in the OCD probands. OCD, panic disorder, generalized anxiety disorder, and MDD occurred together more often than expected by chance among individuals with OCD. Furthermore, age at onset in probands is associated with specific anxiety and affective comorbidity among case relatives. These findings support the hypothesis that early- and late-onset OCD represent different etiologic variants.     

帕金森病伴抑郁和焦虑共病的研究

目的探讨帕金森病(PD)患者伴抑郁和焦虑共病的发生率及其相关因素。方法采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)对480名PD患者和105名正常对照者进行评分,采用统一PD评定量表第Ⅲ部分(UPDRSⅢ)、Hoehn-Yahr(H-Y)分期评定PD患者的运动症状,采用PD非运动症状(NMS)筛查问卷(NMSQ)、PD睡眠量表(PDSS)和蒙特利尔认知测验(MOCA)评定PD患者的NMS。结果 PD组中抑郁的发生率(19.4%)明显高于正常对照组(5.7%),焦虑的发生率(30.4%)明显高于正常对照组(14.3%),抑郁和焦虑共病的发生率(15.8%)也明显高于正常对照组(5.7%)(均P<0.01)。多元Logistc回归分析显示,抑郁的发生与NMSQ评分呈正相关(OR=1.21,95%CI:1.07~1.37);焦虑的发生与女性(OR=1.91,95%CI:1.04~3.50)、H-Y分期(OR=2.87,95%CI:1.23~6.70)、UPDRSⅢ评分(OR=1.03,95%CI:1.00~1.06)及NMSQ评分(OR=1.18,95%CI:1.10~1.26)呈正相关,而与PD...     

Patterns of comorbidity in panic disorder and major depression: findings from a nonreferred sample

Previous findings in referred adult samples document major depression as having important moderating effects on the patterns of comorbidity for panic disorder and major depression. This study evaluated whether these patterns of comorbidity are moderated by referral bias. Panic disorder (PD) and major depression (MD) were used to predict the risk for comorbid psychiatric disorders and functional outcomes using data from a large sample of adults who had not been ascertained on the basis of clinical referral (N=1,031). Participants were comprehensively assessed with structured diagnostic interview methodology to evaluate childhood and adult comorbid psychiatric disorders. PD increased the risk for anxiety disorders, independently of MD. MD increased the risk for mania, antisocial personality disorder, psychoactive substance use disorder, disruptive behavior disorders, overanxious disorder, social phobia, and generalized anxiety disorder, independently of PD. These results extend to nonreferred samples' previously reported findings documenting that MD has important moderating effects on patterns of comorbidity for PD and indicate that patterns of comorbidity for PD are not due to referral bias.     

Distinguishing generalized anxiety disorder from major depression: prevalence and impairment from current pure and comorbid disorders in the US and Ontario

Estimation of comparative disease burden in epidemiological surveys is complicated by the fact that high comorbidities exist among many chronic conditions. The easiest way to take comorbidity into consideration is to distinguish between pure and comorbid conditions and to evaluate the incremental effects of comorbid conditions in prediction equations. This approach is illustrated here in an analysis of the effects of pure and comorbid major depression (MD) and generalized anxiety disorder (GAD) on a number of different measures of role impairment in the US National Comorbidity Survey (NCS) and the Mental Health Supplement to the Ontario (Canada) Health Survey (the Supplement). Pure MD and pure GAD were found to have roughly equal independent associations with role impairments. The incremental effects of having comorbid MD and GAD were found to vary depending on the outcome under investigation. The paper closes with a discussion of the methodological complexities associated with generalizing to comorbidities that involve rare conditions or more than two disorders.     

Effects of a transdiagnostic group treatment for anxiety on secondary depression

Researchers have recently explored transdiagnostic anxiety treatments based on models of anxiety emphasizing a single common pathway across diagnostic categories. Results from a previous study [Norton and Hope, in press] indicated that a transdiagnostic approach was effective for both targeted and untargeted anxiety disorders. Consistent with the tripartite model, the transdiagnostic treatment should also influence symptoms of a broader pathology such as negative affectivity. This follow-up to Norton and Hope found significant decreases in depressed mood for clients undergoing transdiagnostic treatment for anxiety when compared to wait-list control participants. Although not statistically established, severity of depressive diagnoses seemed to generally decrease across treatment, whereas no change in severity occurred for those not receiving treatment.     

团体归因训练对抑郁症、焦虑症和强迫症的疗效

目的：验证团体归因训练对抑郁症、焦虑症和强迫症患者的临床治疗效果。方法：54例抑郁症、焦虑症和强迫症患者按照入组到开始治疗的时间分为3个基线组,每组进行为期8周的归因训练团体治疗,采用多基线实验设计,每隔2周评定汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HA-MA）,治疗前后评定抑郁自评量表（SDS）、焦虑自评量表（SAS）和社会功能缺陷筛选量表（SDSS）,强迫症组加测Yale-Brown强迫症量表（Y-BOCS）。结果：所有被试者治疗前后HAMD、HAMA、SDS、SAS量表得分差异均有统计学意义（t=18.41,19.85,6.33,6.97,P〈0.01）;强迫症组治疗前后Y-BOCS得分差异有统计学意义（t=5.47,P〈0.001）;所有被试治疗前后社会功能改善显著（Z=-6.41,P〈0.001）。结论：团体归因训练对抑郁症、焦虑症和强迫症患者治疗有效。     

Parental representation in patients with major depression, anxiety disorder and mixed conditions

Differences in parental bonding between patients with pure major depression, mixed anxiety-depression and pure anxiety disorders were investigated in 272 consecutive outpatients. A low parental care score seemed to be the best discriminating variable between the mixed group and the 3 other groups. This study supports previous family and twin studies as well as clinical studies emphasizing the mixed group as a special disorder group, possibly with a different etiology. The role of the father in child development seems to be particularly important.     

Hypoesthesia in generalised anxiety disorder and major depression disorder

Abstract

Objective: The determination of soft signs can be a conducive practice to understand the differential etiology between depression and anxiety. This study aims at examining malleolar hypoesthesia role in distinguishing between patients with generalised anxiety disorder (GAD) and major depression disorder (MDD).

Methods: This study examines the presence of malleolar hypoesthesia in patients with GAD (n?=?47) compared to patients with MDD (n?=?48) and healthy individuals (controls; n?=?99). The Wartenberg wheel, a medical device for neurological use, was employed to determine the presence of hypoesthesia on both sides of the ankles.

Results: The data revealed: i) MDD patients showed higher hypoesthesia than GAD patients (p?=?.008), ii) participants with hypoesthesia had higher anxiety and depression scores than participants without hypoesthesia (all p?<?.001) and iii) logistic regression model indicated that hypoesthesia can be a predictor of MDD relative to GAD diagnosis (Odds Ratio: 17.43 (1.40–217.09; p?=?.026)).

Conclusions: Malleolar hypoesthesia was higher in MDD than GAD. The detection of hypoesthesia may help to investigate the differential etiology between MDD and GAD diagnosis.