Poor sleep in middle-aged women is not associated with menopause per se

Whether sleep problems of menopausal women are associated with vasomotor symptoms and/or changes in estrogen levels associated with menopause or age-related changes in sleep architecture is unclear. This study aimed to determine if poor sleep in middle-aged women is correlated with menopause. This study recruited women seeking care for the first time at the menopause outpatient department of our hospital. Inclusion criteria were an age ≥40 years, not taking any medications for menopausal symptoms, and no sleeping problems or depression. Patients were assessed with the Pittsburgh Sleep Quality Index (PSQI), modified Kupperman Index (KI), and Menopause Rating Scale (MRS). A PSQI score of <7 indicated no sleep disorder and ≥7 indicated a sleep disorder. Blood specimens were analyzed for follicle-stimulating hormone and estradiol levels. A total of 244 women were included in the study; 103 (42.2%) were identified as having a sleep disorder and 141 as not having one. In addition, 156 (64%) women were postmenopausal and 88 (36%) were not menopausal. Follicle-stimulating hormone and estradiol levels were similar between the groups. Patients with a sleep disorder had a significantly higher total modified KI score and total MRS score (both, P<0.001) compared with those without a sleep disorder. Correlations of the PSQI total score with the KI and MRS were similar in menopausal and non-menopausal women. These results do not support that menopause per se specifically contributes to sleep problems.     

Do different delivery systems of hormone therapy have different effects on psychological symptoms in surgically menopausal women? A randomized controlled trial

Objective

To compare the influence of different delivery forms of estrogen therapy on menopausal and psychological symptoms in surgically menopausal women.

Study design

Surgically menopausal women were assigned to a 1-year-therapy with oral conjugated estrogen 0.625 mg/day (n = 35), intranasal 300 μg/day estradiol hemihidrate (n = 33), percutaneous gel 1.5 mg/day estradiol hemihidrate (n = 32) or no treatment (control group, n = 32). Serum E₂ and FSH levels, Kupperman's Scale used to assess climacteric symptoms, Hamilton Depression Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS) scores were assessed before and after 1-year-therapy.

Results

After 1 year, the greatest increase in E₂ was in the oral group, followed by the transdermal gel, and then the intranasal group (oral vs transdermal gel: p = 0.022: oral vs intranasal: p = 0.0001; transdermal gel vs intranasal: p = 0.0001). All treatment groups improved significantly in total Kupperman index score and HARS (p < 0.05) with no difference between the groups. With regard to HDRS, all treatment groups improved significantly (p < 0.05) with the greatest improvement in the oral group, and no difference between transdermal gel and intranasal groups (oral vs transdermal gel: p = 0.015; oral vs intranasal: p = 0.001; transdermal gel vs intranasal: p = 0.735). Control group scored worse in all tests after study (p < 0.05). All scores correlated significantly with post-treatment serum E₂ and FSH levels (p < 0.001).

Conclusion

Oral, intranasal and percutaneous gel estradiol therapies significantly improve menopausal and psychological symptoms in surgically menopausal women with oral route better than transdermal gel and intranasal modalities against depressive mood.     

腔隙性服梗塞病人的焦虑和抑郁评定

目的　评定腔隙性脑梗塞病人的焦虑和抑郁。方法　病人于住院 1周时评定抑郁量表 ( HAMD)、抑郁自评量表( CES-D)和焦虑量表 ( HAMA) ,并与正常对照比较。结果　病人 HAMD总分 ( 8.2 3± 5.58分 )与对照组 ( 7.63± 3.4 2分 )无显著差异 ;CES-D总分 ( 1 6.2± 9.67分 )比对照组 ( 8.2 3± 7.75分 )显著为高 ;HAMA总分 ( 5.93± 3.83分 )与对照组( 5.94± 4 .1 1分 )无显著差异。结论　腔隙性脑梗塞病人存在不足综合征的抑郁 ;用 CES-D比用 HAMD更易检出不足综合征的抑郁 ;腔隙性脑梗塞病人在住院 1周时未检出明显焦虑。     

Hormone replacement therapy and vigilance: double-blind,placebo-controlled EEG-mapping studies with an estrogen-progestogen combination (Climodien,Lafamme) versus estrogen alone in menopausal syndrome patients

The aim of the double-blind, placebo-controlled study was to investigate the effects of a continuous combined estrogen-progestogen treatment (Climodien, Lafamme) as compared with estrogen alone on vigilance in insomniac postmenopausal syndrome patients, objectified by EEG mapping. METHODS: In a 3-arm, 2-month parallel group design phase, patients received a combination of estradiol valerate 2 mg and the novel progestogen dienogest 3 mg (Climodien 2/3) or estradiol valerate 2 mg alone or placebo. In a subsequent open-label phase, all patients received estradiol valerate 2 mg+dienogest 2 mg (Climodien 2/2). EEG mapping was carried out before and after the 2-month double-blind phase as well as after the 2-month open-label treatment. RESULTS: As compared with placebo, Climodien 2/3 induced a marked and highly significant increase in absolute power in all frequency bands, specifically in alpha-2 activity. Moreover, a significant increase in relative alpha-2 power, a decrease in relative delta and beta power as well as an acceleration of the dominant frequency and of the delta and alpha centroids suggested a marked improvement in vigilance. In contrast, under estradiol valerate 2 mg alone, only a slight augmentation of alpha and attenuation of relative delta and beta power occurred, suggesting only a slight vigilance improvement as compared with placebo. Thus, dienogest 2 mg increased the estrogen effect, which was also confirmed by a statistical evaluation of the differences between Climodien 2/3 and estradiol valerate alone (augmentation of alpha-2, attenuation of relative beta, acceleration of the dominant frequency). Moreover, Climodien 2/2 also markedly increased alpha-2 power, decreased relative beta-2 power and accelerated the alpha centroid. Finally, comparing Climodien 2/3 with Climodien 2/2, there was even a dose-efficacy relation. CONCLUSIONS: Estradiol valerate 2 mg improves vigilance slightly, thereby confirming previous findings. The additional administration of dienogest does not minimize the effect of estrogen, but on the contrary increases it, which makes the combination superior to both placebo and estradiol valerate alone. Vigilance improvement may be of great therapeutic benefit to menopausal syndrome patients at a time when increased adaptability is needed to adjust to increasing sexual, marital, occupational and social difficulties known to occur specifically in this period of life.     

Transcranial magnetic stimulation during pregnancy

The aim of the present study was to assess the safety and effectiveness of high-frequency repetitive transcranial magnetic stimulation (rTMS) in pregnant patients with depression. Thirty depressed pregnant patients received rTMS over the left prefrontal cortex for 6 days in a week, from Monday to Saturday for 3 weeks. The rTMS intensity was set at 100 % of the motor threshold. A 25-Hz stimulation with a duration of 2 s was delivered 20 times with 30-s intervals. A session comprised 1,000 magnetic pulses. Depression was rated using the 17-item Hamilton depression rating scale (HAMD) before and after treatment. Response was defined as a 50 % reduction of the HAMD score. Patients with HAMD scores less than 8 were considered to be in remission. The mean HAMD score for the study group decreased from 26.77?±?5.58 to 13.03?±?6.93 (p?<?0.001) after 18 sessions of rTMS. After the treatment period, 41.4 % of the study group demonstrated significant mood improvements as indexed by a reduction of more than 50 % on the HAMD score. In addition, 20.7 % attained remission (HAMD score?<?8), 34.5 % achieved a partial response, and 3.4 % had worsening in HAMD scores at the end of treatment. Treatment was well tolerated, and no significant adverse effects were reported. rTMS was well tolerated and found to be statistically and clinically effective in pregnant patients with treatment-resistant depression. This study contributed to the existing evidence of the antidepressant effect of rTMS in the treatment of depression in pregnancy.     

精神分裂症伴强迫症状与强迫症比较研究

目的比较强迫症患者与精神分裂症伴强迫症状患者的强迫症状的临床差异。方法采用强迫症状评定量表(Y-B0CS)、Hamilton抑郁量表(HAMD)、Hamilton焦虑量表(HAMA)、阳性症状与阴性症状量表(PANSS),对56例强迫症患者和49例伴有强迫症状的精神分裂症患者进行评定,比较分析二者的临床差异及治疗结果。结果强迫症组的Y-BOCS、HAMD、HAMA等总分明显高于的精神分裂症伴强迫症状组(P<0.O1);治疗后两组各量表分均有明显下降(P<0.01),但强迫症组的症状改善优于精神分裂症伴强迫症状组(P<0.05)。结论强迫症患者的强迫体验、抑郁、焦虑等较明显,对治疗的反应也更好,对精神分裂症伴强迫症状的患者可联合用药。     

抑郁症患者脑电地形图改变对认知功能及与疗效的影响

目的:探讨抑郁症患者额颞叶脑电功率改变与认知功能及疗效的关系。方法:对40例抑郁症患者入院1周内行脑电地形图检查,并和32例正常对照组进行对照分析;同时对患者在治疗前后进行汉密尔顿抑郁量表(HAMD)评定。结果:(1)研究组额叶脑波α1(t=2.243,2.968,3.688,3.918),δ(t=3.639,2.517),θ(t=2.519,3.613,3.730)功率明显高于对照组,差异具有统计学意义(P0.05);(2)研究组颞叶脑波α2(t=-2.103,-2.944,-3.200,-4.548),α3(t=-3.102,-2.752,-3.047,-4.094),β(t=-3.015,-2.584,-3.842)功率明显低于对照组,差异具有统计学意义(P0.05);(3)左前额δ波功率与第2周末HAMD减分率有显著负相关(t=-2.429,P0.05);(4)左前额及右前颞β波功率、左前颞δ波功率与第6周末HAMD减分率有显著负相关(t=-2.365,-3.107,-3.979;P0.05);(5)右中颞δ波功率与第6周末HAMD减分率有显著正相关(t=2.248,P0.05)。结论:抑郁症患者存在额颞叶功能损伤影响认知功能;其抗抑郁剂治疗起效时间可能与左前额δ波功率有关;左前额及右前颞β波功率值可作为疗效的观察指标之一。     

Late-onset depression: can EEG abnormalities help in clinical sub-typing?

BACKGROUND: The purpose of this study was to determine the frequency of EEG abnormalities indicative of mild cerebrovascular dysfunction in patients with late-onset depression and to correlate these abnormalities with clinical features. METHODS: The subjects, aged > or = 50 years, were 51 outpatients with major depression diagnosed according to DSM-IV criteria. They were living in the community and prospectively selected at their initial consultation for mostly mild-moderate depression. We also included 32 normal age-matched controls. We examined basic rhythms and temporal slow waves on EEG and determined the Hamilton Rating Scale for Depression (HAMD) as a scale for the severity of psychiatric symptoms. RESULTS: Temporal slow waves were more common in depressed patients (47%) than in normal controls (22%). Depressed patients with temporal slow waves had significantly lower frequency of family history of mood disorders (P<0.05). There was no difference in the total score of HAMD between patients with and without temporal slow waves, however, each score of HAMD in patients with temporal slow waves showed a significantly lower score for "feeling of guilt" (P<0.01) and a significantly higher score for "general somatic symptoms" (P<0.01) and "hypochondriasis" (P<0.01). CONCLUSIONS: Our EEG study suggested that temporal slow waves, which were probably associated with subtle cerebrovascular lesions, might reflect vulnerability to late-onset depression. In addition, depressed patients with temporal slow waves could be classified as a subgroup of heterogeneous late-onset depression based on the clinical findings. These results must be interpreted within the limitations of the sample selection procedure.     

Remitted major depression is characterized by reduced prefrontal cortex reactivity to reward loss

Background

Major depression (MDD) is characterized by anhedonia. Although a growing body of literature has linked anhedonia in MDD to reduced frontostriatal activity during reward gains, relatively few studies have examined neural responsivity to loss, and no studies to date have examined neural responses to loss in euthymic individuals with a history of MDD. Methods: An fMRI monetary incentive delay task was administered to 19 participants with remitted MDD (rMDD) and 19 never depressed controls. Analyses examined group activation differences in brain reward circuitry during monetary loss anticipation and outcomes. Secondary analyses examined the association between self-reported rumination and brain activation in the rMDD group. Results: Compared to controls, the rMDD group showed less superior frontal gyrus activation during loss anticipation and less inferior and superior frontal gyri activation during loss outcomes (cluster corrected p’s<.05). Ruminative Responses Scale scores were negatively correlated with superior frontal gyrus activation (r=−.68, p=.001) during loss outcomes in the rMDD group. Limitations: Replication with a larger sample is needed. Conclusions: Euthymic individuals with a history of MDD showed prefrontal cortex hypoactivation during loss anticipation and outcomes, and the degree of superior frontal gyrus hypoactivation was associated with rumination. Abnormal prefrontal cortex responses to loss may reflect a trait-like vulnerability to MDD, although future research is needed to evaluate the utility of this functional neural endophenotype as a prospective risk marker.     

40例抑郁症患者心身症状及抑郁焦虑共病情况调查

目的分析抑郁症患者的心身症状及与焦虑共病情况。方法对40例抑郁症患者进行症状自评量表(SCL-90)和汉密顿抑郁(HAMD)、汉密顿焦虑(HAMA)量表评定,将SCL-90得分与中国成人常模比较,对汉密顿量表焦虑、抑郁得分进行分级,分析共病情况。结果 40例抑郁症SCL-90的9个症状因子得分均明显高于常模(t=4.91～9.75,P<0.01),HAMD得分分级:重度29例(72.5%)、轻中度11例(27.5%),HAMA得分分级:中度焦虑3例(7.5%)、有肯定焦虑症状30例(75%)、没有明显焦虑7例(17.5%),抑郁焦虑共病率82.5%。结论抑郁症患者心身症状突出,抑郁焦虑共病率较高。     

Observation on the short-term efficacy of inverse moxibustion at the Baihui point and Dazhui point in preventing post-stroke depression

ObjectiveIn this study, inverse moxibustion was performed at the Baihui and Dazhui points in patients with ischemic stroke, and the Hamilton Depression Rating Scale 17 (HAMD) score, National Institute of Health Stroke Scale (NIHSS) score, modified Barthel index (MBI) score, and incidence of post-stroke depression (PSD) were observed.MethodsEighty patients with acute ischemic stroke were enrolled and randomly divided into two groups. All enrolled patients were given routine treatment for ischemic stroke, and those in the treatment group were also given moxibustion at the Baihui and Dazhui points. The course of treatment was four weeks. The HAMD, NIHSS, and MBI scores of the two groups were evaluated before and four weeks after the treatment. The differences between the groups and the incidence of PSD were evaluated to determine the effect of inverse moxibustion at the Baihui and Dazhui points on the HAMD, NIHSS, and MBI scores and prevention of PSD in patients with ischemic stroke.ResultsAfter the four weeks of treatment, the HAMD and NIHSS scores of the treatment group were lower than those of the control group, their MBI was higher than that of the control group, and their incidence of PSD was statistically significantly lower than that of the control group.ConclusionInverse moxibustion at the Baihui acupoint in patients with ischemic stroke can effectively promote the recovery of neurological function, improve depression, and reduce the incidence of PSD and should be considered for application in clinical practice.     

社会支持系统对脑卒中后抑郁的影响

目的探讨社会支持系统对脑卒中患者抑郁状态的影响。方法将80例脑卒中后抑郁患者随机分为支持组和对照组,支持组在常规治疗和护理的基础上增加社会支持的干预措施,对照组只接受常规的治疗和护理,比较两组患者入院后20天、30天的汉密尔顿抑郁量表(HAMD)评分的差异。结果两组患者汉密尔顿抑郁量表评分在干预后20天和30天均降低,而支持组HAMD评分降低更显著,经统计学比较具有显著性差异(t=6.313,8.057,P<0.01)。结论增加社会支持系统可以改善脑卒中后抑郁患者的抑郁状态,在促进疾病康复的同时达到提高护理质量的目的。     

药物联合心理护理干预对冠心病伴抑郁/焦虑患者的影响

目的了解药物联合心理护理干预对冠心病伴抑郁/焦虑患者的影响。方法将80例患者随机分为研究组和对照组。两组均给予抗抑郁药治疗,对研究组进行心理护理,对照组常规护理。观察8周,使用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD-17)、生活质量综合评定问卷(GQOLI-74)进行评分。依据评分改变情况判断心理护理在治疗中的作用。结果治疗2周后HAMA评分显示对照组与治疗前比较无明显变化,HAMA评分显示研究组与治疗前比较评分显著降低(t=4.43,P0.01),且研究组评分低于对照组(t=2.21,P0.05)。治疗2周后HAMD评分显示对照组与治疗前比较降低(t=2.26,P0.05),研究组评分与治疗前比较显著降低(t=4.43,P0.01),研究组评分低于对照组(t=2.34,P0.05)。研究组治疗后心理功能评分低于对照组(t=2.49,P0.05)。结论心理干预能有效缓解患者的抑郁焦虑情绪,改善患者的心理功能,优于单纯使用抗抑郁药物。     

针灸辅助治疗抑郁症的临床疗效

目的　探讨针灸辅助治疗抑郁症的临床疗效。方法　对 69例住院的抑郁症患者分为氟西汀合并针灸治疗组 ( A组 )与单独服用氟西汀治疗组 ( B组 ) ,并对临床资料进行分析 ,用 HAMD、CGI评定其临床疗效。结果　两组在第 4周末HAMD总分和因子分、疾病的严重程度 SI及 HAMD总分减分率有显著差异 ( P<0 .0 5 )。在第 6周末均有极显著差异 ( P<0 .0 1 ) ,A组的 HAMD总分减分率为 82 % ,B组为 69%。结论　针灸辅助治疗抑郁症具有较好的临床效果     

Automatic classification of the cats vigilance state.

A special purpose hardware system has been interfaced with a minicomputer for determining the vigilance state in the cat and for quantifying delta and sigma spindle activity in the sleep EEG. The computer agreement with manual scoring is 93.8% when the state is classified as awake. non-REM, or REM sleep. The system identifies six distinct vigilance states: REM sleep, slow-wave sleep 1 or 2 (distinguished by differences in EMG level), light sleep, resting and movement. Five day averages of vigilance state and EEG activity are presented for three animals, and the effects of 5 HTP and L-dopa on delta activity and sleep spindles have been quantified for one cat in order to demonstrate the system utility.     

Resting posterior versus frontal delta/theta EEG activity is associated with extraversion and the COMT VALMET polymorphism

Recent studies suggest that resting posterior versus frontal EEG delta/theta activity (delta/theta Pz–Fz) is both sensitive to pharmacological manipulations of neural dopamine and associated with the agency facet of extraversion (i.e., a motivational disposition comprising enthusiasm, energy, assertiveness, achievement striving and social dominance). These observations suggest that posterior versus frontal resting EEG delta/theta activity may represent a useful marker for investigating the molecular genetic basis of extraversion. The present study aimed to test the novel hypothesis of an association between delta/theta Pz–Fz and a functional polymorphism of the enzyme catechol-O-methyltransferase (COMT VAL¹⁵⁸MET) involved in dopamine catabolism. This was conducted in a large EEG data set from the Brain Resource International Database (BRID; resting EEG from N = 1093 healthy individuals, 382 of which also genotyped for COMT VAL¹⁵⁸MET). In summary, we (1) showed for the first time that the VAL allele is associated with increased delta/theta Pz–Fz; (2) replicated the association between extraversion and delta/theta Pz–Fz in a large, heterogeneous sample including both genders; and (3) documented that the VAL allele of the COMT VAL¹⁵⁸MET is associated with increased extraversion scores, as previously reported for an overlapping BRID sample. This coherent pattern of findings adds further support to the suggestion that the posterior–anterior distribution of resting EEG slow wave activity in the delta/theta range represents a useful tool for probing the dopaminergic basis of extraversion.     

Hormonal and psycho-relational aspects of sexual function during menopausal transition and at early menopause

Objective

The aim of the present observational, cross-sectional study was to examine the effects of hormonal and psycho-relational variables on sexual function during menopausal transition and at early postmenopause in women with hot flushes.

Study design

The sample comprised 138 women referred to a clinic for the treatment of hot flushes. They were categorised according to their stage of menopausal transition using the STRAW criteria: early menopausal transition (EMT) if their menstrual cycle was 7 or more days different from normal; late perimenopause (LMT) if they had experienced 60 days or more of amenorrhoea; and early postmenopause (EPM) if their amenorrhoea had lasted for at least 12 months but less than 4 years.

Main outcome measures

Sexual function was measured by using the Female Sexual Function Index (FSFI), while anxiety (state and trait), depression, eating disorder and marital adjustment were evaluated by validated self-report questionnaires. Levels of free testosterone (FT), dehydroepiandrosterone sulfate (DHEAS) and estradiol (E2) were also measured.

Results

Overall sexual function varied significantly with stage of menopause, with total FSFI score less in EPM than in EMT (p = .009). A similar pattern was evident on FSFI sub-scales for sexual desire (p = .02), arousal (p = .01) orgasm (p = .01) and also pain (p = .02), but not for lubrication and satisfaction. Ratings for anxiety, depression and eating disorder did not differ across the menopausal sub-groups, and neither did ratings of marital adjustment. Both FT (p = .01) and DHEAS (p = .03) levels were slightly reduced at EPM in comparison with EMT, as were E2 levels (p = .001 EMT versus LMT; p = .0001 LMT versus EPM). In multiple regression analyses, plasma FT level was the only factor to predict FSFI full score (β = .48; p = 0.004) in women at EMT, while in women at LMT the depression score was the only factor to do so (β = −.62; p = 0.0001). The best model predicting FSFI full score at EPM included levels of DHEAS and E2 levels and state anxiety score.

Conclusions

Hormonal and some psychological variables are relevant to sexual function in symptomatic women during menopausal transition and at early menopause but their role differs with the specific stage of reproductive ageing.     

抗抑郁治疗对颅骨骨折后抑郁的患者疗效及生活质量的影响

目的观察抗抑郁治疗对骨折后抑郁患者的疗效及生活质量的影响。方法将颅骨骨折后抑郁的患者122例随机分为米氮平治疗组(60例)和对照组(62例),于治疗前后进行汉密尔顿抑郁量表(HAMD)和神经功能缺损量表(CSS)、日常生活能力量表(ADL)评定。结果①治疗前两组的HAMD评分比较无显著性差异,治疗后的2、4、8周治疗组HAMD评分明显低于对照组(t=4.3,5.34,4.64;P0.01);②治疗前两组的CSS评分比较无显著性差异。治疗后的第6、8周评分较治疗组与对照组比较均明显降低(t=5.51,8.71,P0.001);③治疗前两组的ADL评分无显著性差异(t=0.74,P0.05),治疗后的第6、8周治疗组ADL评分明显高于对照组(t=20.83,12.88;P0.001)。结论抗抑郁剂治疗有利于颅骨骨折后抑郁患者神经功能康复,提高生活能力,减少并发症。     

改良森田疗法治疗抑郁症对照观察

目的探讨改良森田疗法合并药物治疗抑郁症的疗效与安全。方法对106例抑郁症患者随机分为2组,改良森田疗法合并药物组52例,氟西汀组54例,疗程8周,用汉密尔顿抑郁量表（HAMD）[1]、副反应量表（TESS）评定疗效和不良反应。结果治疗8周后改良森田疗法合并药物治疗抑郁症组汉密尔顿抑郁量表评分显著低于氟西汀组（t=-4.443,P〈0.01）;改良森田疗法合并药物治疗组主要不良副反应明显低于氟西汀组（χ2=13.07,P〈0.01）。结论改良森田疗法合并药物治疗是一种安全、有效的抗抑郁治疗方法。     

艾司西酞普兰联合喹硫平治疗难治性抑郁症疗效观察

目的了解艾司西酞普兰联合喹硫平治疗难治性抑郁症的疗效和不良反应。方法将患者分为研究组和对照组,研究组服用艾司西酞普兰和喹硫平,对照组服用艾司西酞普兰,疗程为8周。治疗前、治疗后第2、4、6、8周末分别采用汉密尔顿抑郁量表（HAMD）和临床总体印象量表（CGI）评定,依据HAMD总分减分率判定临床疗效。不良反应采用副反应量表（TESS）评定。结果研究组有效率70.59%,对照组有效率45.16%,两组相比差异有统计学意义（χ2=4.32,P〈0.05）。在第4周时HAMD评分研究组与对照组相比有统计学差异（t=2.61,P〈0.05）,第6周时CGI评分研究组与对照组相比有统计学差异（t=2.24,P〈0.05）,不良反应两组无统计学意义。结论艾司西酞普兰联合喹硫平能提高治疗难治性抑郁症的疗效。