脑卒中后抑郁状态与抑郁症患者的多导睡眠图对照研究

目的：探讨脑卒中后抑郁状态（PSD）患的睡眠图异常改变及与抑郁症之间的差异。方法：采用多导睡眠图对62例脑卒中和30例抑郁症患进行整夜睡眠描记，并与对照组比较。结果：PSD组与对照组和非抑郁组比较多项睡眠指标均有显性差异（P＜0．05－0．01）；PSD组的REM睡眠时间和密度明显低于抑郁症组，差异有显性（P＜0．01）。结论：PSD状态病人除具有睡眠障碍在多导睡眠图改变外，REM睡眠时间和密度是一个较为特征性的改变，PSD的发生可能与脑内5－羟色胺（5－TH）递质改变有关。     

脑卒中后抑郁患者的睡眠脑电图研究

目的：探讨脑卒中后抑郁状态患者的睡眠脑电图异常改变及与抑郁症患者之间的差异。方法：采用多导睡眠图对32例脑卒中抑郁患者和30例抑郁症患者进行睡眠描记，并与对照组比较。结果：PSD组的REM睡眠时间和密度明显低于抑郁症组，差异有显著性。结论：PSD患者REM睡眠时间和密度是一个较为特征性的改变，提示卒中后抑郁的发生可能与脑内5-羟色胺递质改变有关。     

脑卒中后抑郁患者睡眠障碍的临床研究

目的探讨脑卒中后抑郁患者(poststrokedepression,PSD)睡眠行为及睡眠进程的变化,并针对此变化提出PSD患者临床护理措施。方法自编睡眠调查表及多导睡眠仪对28例PSD患者的睡眠行为障碍进行调查和检测,并与28例无抑郁的脑卒中患者进行对照。结果抑郁组患者入睡困难、睡眠维持困难、睡眠过度及晨醒时伴心境恶劣倾向的发生率高于对照组(P<0.01);与对照组比较,抑郁组存在潜伏期长、觉醒时间长、觉醒次数多、睡眠效率低、睡眠维持率低和REM潜伏期短(P<0.01)。结论睡眠障碍是PSD的重要临床症状,睡眠行为与睡眠进程中各种检测指标的异常与PSD的病程发展及发病机理相关,临床上应高度重视睡眠障碍对PSD患者卒中康复的影响,并积极采取针对性护理措施提高PSD患者的睡眠质量。     

多道睡眠图指标评估脑卒中后抑郁的价值

目的：探讨多道睡眠图(polysomnograph，PSG)指标对脑卒中后抑郁(post-stroke depression，PSD)的诊断价值。方法：30例研究对象分为3组进行多道睡眠图检查并分析其结果：病例组为10例PSD患者，根据DSM-Ⅳ诊断标准确诊；对照组为10例脑卒中后无抑郁的患者；正常组为年龄、性别匹配的健康者。结果：与对照组、正常组比较，病例组睡眠结构发生明显变化，表现为睡眠潜伏期延长，快速动眼睡眠与非快速动眼睡眠(REM-NREM)周期次数增加；快速动眼睡眠(rapid eye movements，REM)潜伏期缩短；REM活动度、强度、密度增加；S1阶段睡眠增加，S2和S3 4阶段睡眠减少。总睡眠时间、慢波睡眠时间比正常组少，但与对照组之间无差异；3组之间觉醒时间、睡眠效率无明显差异。结论：PSD患者存在PSG指标变化，这些改变可能有助于PSD的诊断参考。     

多道睡眠图指标评估脑卒中后抑郁的价值

目的探讨多道睡眠图 ( polysomnograph,PSG)指标对脑卒中后抑郁 (post-stroke depression,PSD)的诊断价值. 方法 30例研究对象分为 3组进行多道睡眠图检查并分析其结果病例组为 10例 PSD患者,根据 DSM-Ⅳ诊断标准确诊;对照组为 10例脑卒中后无抑郁的患者;正常组为年龄、性别匹配的健康者. 结果与对照组、正常组比较,病例组睡眠结构发生明显变化,表现为睡眠潜伏期延长,快速动眼睡眠与非快速动眼睡眠( REM-NREM)周期次数增加;快速动眼睡眠( rapid eye movements,REM)潜伏期缩短; REM活动度、强度、密度增加; S1阶段睡眠增加, S2和 S3+ 4阶段睡眠减少.总睡眠时间、慢波睡眠时间比正常组少,但与对照组之间无差异. 3组之间觉醒时间、睡眠效率无明显差异. 结论 PSD患者存在 PSG指标变化,这些改变可能有助于 PSD的诊断参考.     

抑郁症的多导睡眠脑电图研究

目的探讨抑郁症患者的多导睡眠图异常改变，与正常对照组之间的差异。方法采用多导睡眠仪（PSG）对20例抑郁症患者进行整夜睡眠描记，并与对照组比较。结果抑郁症组与正常组比较：睡眠潜伏期延长，慢波睡眠减少，维持率低；REM潜伏期缩短，密度增加。结论我们认为抑郁症患者存在入睡困难、易醒、早醒及浅睡为主的睡眠障碍，多导睡眠图特征性变化是以快动眼睡眠过度活跃为特征，表现为REM潜伏期（RL）缩短，REM密度增加，原因可能与5-羟色胺／去甲肾上腺素（5-HT/NE）能神经传递减少及／或胆碱能传递增加有关。笔者认为抑郁症患者REM睡眠的特征性改变对抑郁症的诊断及鉴别诊断有一定临床意义。     

抑郁症与不伴抑郁失眠症患者睡眠模式比较

目的 验证抑郁症和失眠症同源性假说。方法 采用多导睡眠图记录仪,记录并分析30例抑郁症患者和30例失眠症患者整夜的脑电图、眼电图、肌电图等。结果 抑郁症患者快动眼(REM)睡眠明显活跃,各项 REM指标均与失眠症患者有非常显著性差异( P <0.01);失眠症患者以睡眠持续性差、浅睡和觉醒增多以及深睡和REM睡眠明显受抑制为特征,不少患者的整个慢波睡眠(S3+S4)缺失。结论 抑郁症与不伴抑郁情绪的失眠症睡眠模式不同,抑郁症以 REM睡眠过度活跃为特征,而失眠症以非REM睡眠明显紊乱为主要特征。     

单相与双相障碍抑郁发作患者睡眠特征研究

目的探讨单相与双相障碍抑郁发作患者的睡眠特征。方法将46例单相抑郁发作患者设为单相抑郁组,28例双相障碍抑郁发作患者设为双相抑郁组,同期选取本院健康职工20名设为对照组,对3组进行汉密顿抑郁量表、睡眠状况自评量表测评并分析多导睡眠图。结果多导睡眠图描记观察指标中,3组睡眠总时间、睡眠期时间、慢波睡眠时间、入睡后觉醒时间、非快速眼动睡眠时间、睡眠效率、睡眠潜伏期、快速眼球运动潜伏期、快速眼球运动时间、快速眼球运动周期数、N2睡眠比例、N3潜伏期、N3睡眠时间、N3睡眠比例、觉醒睡眠比例、微觉醒总时间比较差异有显著性（P〈0．05或0．01）,单相抑郁组慢波睡眠时间、N2睡眠比例、N3睡眠时间、N3睡眠比例与双相抑郁组比较差异有显著性（P〈O．05或0．01）。结论单相与双相障碍抑郁发作患者常存在各种睡眠问题,与健康者比较多导睡眠图有特征性的改变。单相与双相障碍抑郁发作患者多导睡眠图相似,但单相抑郁发作患者的深睡眠更少。     

心理护理对脑卒中抑郁症患者接受康复干预及其疗效的影响

目的:观察心理护理对脑卒中抑郁症(poststrokedepression,PSD)患者康复疗效的影响。方法:100例符合PSD多模式方法诊断(multimodelapproachtodiagnosisofPSD,MMADD)中抑郁调查表(beckdepressioninventory,BDI)和汉密顿抑郁评定量表(Hamiltonrationscalefordepression,HRSD)标准确诊脑卒中抑郁症患者随机分成两组,心理护理组在进行康复治疗的同时辅加心理护理,对照组只进行康复治疗,两组治疗前后分别进行1次MMADD和功能独立检查(FIM)。结果:两组患者经6周康复治疗后,心理护理组及对照组患者功能独立检查评分均提高,心理护理组为(82.45±17.49)分,对照组为(71.71±15.56)分,两者比较差异有显著性意义(t=3.244,P<0.01);心理护理组抑郁状态明显改善,MMADD内心症状评分下降,对照组MMADD内心症状评分无明显改善,治疗后组间比较差异有显著性意义(P<0.01)。结论:心理护理对脑卒中抑郁症患者康复疗效有明显影响,对提高患者自信心,促进全面康复起重要作用。     

发作性睡病的临床监测与特征分析

目的探讨多导睡眠图(ploysomnography;PSG)、多次睡眠潜伏期试验(multiplesleeplatencytest;MSLT)在发作性睡病(Narcolepsy;NC)和嗜睡症(lethargy;IH)患者诊断、鉴别诊断中的价值。方法对35例发作性睡病(NC)和30例嗜睡症(IH)进行整夜多导睡眠图(PSG)描记和多次睡眠潜伏期试验(MSLT),分析其睡眠参数异同。结果MSLT结果显示:NC组睡眠潜伏期和快动眼睡眠(REM)潜伏期显著缩短,入睡次数和REM睡眠出现次数明显多于IH组和对照组(P<0.01),睡眠潜伏期<5分钟和ROREMPs≥2次30例(85.7%),与IH组比较差异有统计学意义(P<0.01);整夜PSG结果显示:NC组总睡眠时间和深睡眠(SWS)百分比及REM潜伏期显著低于IH组和对照组,而S1阶段睡眠显著高于IH组,两组比较,差异具有统计学决心义(P<0.01)。结论NC患者具有明显的睡眠潜伏期缩短和反常的REM睡眠特征,MSLT、PSG对NC和IH的诊断和鉴别诊断具有重要参考价值。     

妄想性与非妄想性抑郁症的临床对照研究

为探讨妄想性与非妄想性抑郁症的临床特征差异,对71例妄想性抑郁症与132例非妄想性抑郁症进行了临床对照研究。结果显示,妄想性抑郁症的精神病家族史、幻觉、自责自罪、绝望、自杀行为等出现率显著高于非妄想性抑郁症;妄想性抑郁症的自杀行为危险性是非妄想性抑郁症的1.99倍;妄想性抑郁症可能需联合治疗。提示妄想性抑郁症可能是抑郁症中的一种独特的亚型,值得进一步探讨。     

Depression in Primary Care

Depression is a heterogeneous disorder with a wide range of presentations. Most patients with depression are seen in primary care, where it is often unrecognized; thus, screening for depression is important. Medical conditions can mimic depression and vice versa. For mild cases of depression, symptom monitoring and nonpharmacologic strategies are generally recommended initially, whereas psychotherapy and antidepressant drugs are first-line treatment for moderate to severe cases. Patients with depression often experience relapse, recurrence, or both, and multiple options are available. Primary care providers are central to screening, diagnosing, and subsequently treating or referring these patients.     

Optimism,pessimism, and postpartum depression

This study examined the role of dispositional optimism versus pessimism as a moderator of the tendency to become depressed after a specific stressful life change: the birth of a child. The optimism-pessimism dimension was operationally defined as generalized expectancies for favorable versus unfavorable life outcomes. Both optimism and depressive mood were assessed several weeks before childbirth. Depressive mood was measured again three weeks postpartum. Even after statistically controlling for initial dysphoria, optimism was inversely correlated with subsequent dysphoria. The effect of optimism was most pronounced among women who initially were not depressed, suggesting that optimism confers resistance to the development of depressive symptoms. Discussion centers on the relation between optimism and attributional style, and on the self-regulatory functions of optimism.     

Stress and attributional style as predictors of self-reported depression in children

Attributional approaches to depression, such as hopelessness theory (Abramson, Metalsky, & Alloy, 1989), suggest that a stable, global attributional style for negative events combined with failure to achieve a highly valued outcome will lead to depression. The current study assessed the ability of the interaction of attributional style and daily negative events to predict self-reported depression in children. Eighty-four children between the ages of 9 and 12 participated in this longitudinal study. Self-reported depression symptoms were assessed before and after exposure to stressful events. The data analysis consisted of stepwise hierarchical multiple-regression procedures. While attributional style alone did not predict change in self-reported depression symptoms following stressful events, the interaction of attributional style with stress did predict them. Stress predicted depression symptoms as well.This paper was based on the dissertation of J. Faye Dixon under the direction of Anthony Ahrens at The American University. Portions of this research were presented at the Midwestern Psychological Association Convention, Chicago, May 1991. We wish to thank Rebecca del Carmen, Mary Parpal, and Jon Rolf for their service as members of the dissertation committee. Further thanks go to Trail Blazers Camp for their cooperation in the collection of these data. Thanks also go to Emily Hauck, Dave Jobes, and Maureen Lyon for their help in coding data, and to Constance Hammen and three anonymous reviewers for their helpful comments on a prior draft of this paper.     

Positive and negative depression coping in low-income African American women

The purpose of the study was to examine positive and negative depression coping (DC) in low-income African American women. Because low-income African American women have been shown to be vulnerable to depression symptom onset yet less accepting of treatment, DC in this population is of interest to researchers. Depression symptom severity, defense mechanisms, difficult life circumstances (DLC), and social support were examined as possible determinants of DC. In 244 mildly or moderately to severely depressed women, mature defense mechanisms predicted positive DC, and DLC predicted negative DC. Social support had no effect on positive or negative DC. Findings are discussed in terms of individual and community tailored rehabilitative psychotherapy to promote positive DC.     

Depression in children and adolescents: Assessment issues and recommendations

Energized by renewed research and clinical activities, the current status of assessments of child and adolescent depression merits review. With a multidisciplinary perspective, the present review considers levels of depression, diagnostic criteria, classification systems, and the relationship of childhood/adolescent depression to adult depression. Methods for the measurement of child and adolescent depression are described and evaluated: child self-report, peer nominations, ratings by significant others, measures of overt behavior, physiological measures, projectives, and measures of constructs related to depression (e.g., self-esteem). The use of children as the source of assessment data, the degree of convergence across measures, and problems in discriminant validity are identified as pertinent assessment issues. Recommendations include use of measures with established norms, cut scores, multiple assessment methods and periods, and multiple gating.This issues and recommendation paper, focusing on child and adolescent depression, was coordinated similarly to the Kendall, Hollon, Beck, Hammon, and Ingram (1987) paper relating to adult depression and use of the BDI. Together, they are intended to encourage and facilitate research and application across the life span. The authors thank Frances M. Sessa for comments on an earlier version of this paper.     

两种筛查量表早期发现产后抑郁的效果对比

目的比较产后抑郁筛查量表（PDSS）和爱丁堡产后抑郁量表（EPDS）在产后抑郁筛查中的应用价值。方法采用PDSS、EPDS及美国精神障碍诊断与统计手册第4版轴Ⅰ障碍定式临床检查患者版（SCID—I／P）同时对445名产后6周的妇女进行评定,以SCID—I／P作为产后抑郁诊断金标准。结果两种量表的临界值分别为74分和10分。PDSS的灵敏度（93．33％）和特异度（94．75％）的组合较好。PDSS与EPDS的ROC曲线下面积分别为0．978和0．872,差异均有统计学意义（P均〈0．05）。结论与EPDS相比,PDSS具有较好的筛检价值,是早期发现产后抑郁患者的简单、快速、准确的筛查工具。     

A test of the depressive realism hypothesis in clinically depressed subjects

Although the phenomenon of depressive realism has profound implications for the conceptualization of depression, the majority of studies have been conducted on analogue samples, thereby limiting the utility of these studies as investigations of clinical depression. The current study examined depressive realism in a noncontingent situation in samples of 15 clinically depressed, 15 remitted, and 15 never depressed females. Using a computerized version of the Alloy and Abramson (1979) judgment of noncontingency task, it was predicted that currently depressed subjects would demonstrate depressive realism, but that the other two groups would show comparable nonrealistic and positively biased distortions. The results provided limited support for the hypotheses. The nature and implications of the results are discussed in light of the depressive realism literature, and suggestions for future research are provided. The current study benefitted from the contributions of many people, including D. Addington, T. Rogers, and L. Radtke. Special thanks are extended to K. Mothersill and D. Austin for their assistance in subject recruitment. L. Abramson is also thanked for her input in the planning of the current study.     

爱丁堡产后抑郁量表在成都地区产妇中应用的效能研究

目的 探讨爱丁堡产后抑郁量表(EPDS)用于成都地区产妇的临床效能.方法 首先对EPDS进行翻译、回译及专家评价,然后采用EPDS中文译稿及Beck抑郁问卷(BDI)对732例产妇于产后3～14 d进行调查研究.结果 对EPDS进行翻译与回译的一致率均为100%;其内容效度比为0.9333;Cronbach'α系数为0.76;获得的2个公因子的累计方差贡献率为44.979%;EPDS与BDI之间的相关系数为0.584,P＜0.01. 结论 EPDS在成都地区产妇的应用中具有良好的临床性能,且简洁易懂,操作方便,易于为产妇及研究者所接受,是进行产后抑郁初步筛查的良好工具.