高危孕妇焦虑抑郁症状发生率及相关危险因素

背景：高危孕妇与普通孕妇相比在妊娠期会出现更多的并发症,高危因素作为一种应激因素更易诱发孕妇产生焦虑、抑郁等负面情绪症状。目前国内外对高危孕妇焦虑、抑郁症状的研究相对较少。
　　目标：调查产科高危妊娠孕妇焦虑、抑郁症状发生率及其相关危险因素。
　　方法：对197例孕中期（16-20周）的高危孕妇在妊娠最后4月每月进行综合性医院焦虑/抑郁量表（HAD）评估和风险因素调查。产后3-7天、42天及3月进行爱丁堡产后抑郁量表（EPDS）评估和风险因素调查。
　　结果：入组时高危孕妇HAD焦虑均分：3.69(2.76),抑郁均分：3.42(2.53)。焦虑症状14例(7.18%),抑郁症状10例(5.13%)。多因素分析显示,怀孕有无保胎（OR：8.162,95%CI：1.213-54.914）和乙肝阳性（OR：8.912,95%CI：1.052-75.498）与焦虑症状相关。尿糖阳性（OR：30.529,95%CI：1.312-710.610）和既往出血史（OR：7.122,95%CI：1.015-49.984）与抑郁症状相关。孕期影响高危孕妇焦虑、抑郁症状的因素有：近3月孕妇健康状况、担心胎儿健康、夫妻关系、婆媳关系等。
　　结论：高危妊娠孕妇焦虑、抑郁症状较常见。近3月孕妇健康状况、婆媳关系、夫妻关系、担心胎儿健康是高危孕妇孕期焦虑、抑郁症状的风险因素。     

音乐治疗合并心理干预对高危孕妇孕期和产后焦虑抑郁情绪的影响

目的:探索音乐治疗合并心理干预对高危孕妇孕期和产后焦虑抑郁情绪的影响。方法:将195位孕16~20周的高危孕妇随机分为干预组(98例)和对照组(97例);孕24周时对干预组进行1次音乐治疗培训,之后在家中30 min/d的聆听音乐直到分娩;孕25~29周每周1次团体心理治疗。对照组按常规产科流程产前检查。入组时及孕6~9个月每月1次综合性医院焦虑/抑郁量表(HAD)评估;产后3~7 d、42 d及3个月时分别进行爱丁堡产后抑郁调查表(EPDS)评估。结果:孕7及8个月干预组HAD评分显著高于对照组(P均0.05);分娩前干预组HAD评分较基线显著下降(P0.05),但两组间差异无统计学意义。产后各时点EPDS评分干预组显著低于对照组(P0.05或P0.01)。结论:音乐治疗结合团体心理干预能减轻高危妊娠孕妇分娩前的焦虑、抑郁情绪及产后的抑郁症状。     

孕妇的焦虑和抑郁情况的调查

目的调查孕妇孕期焦虑和抑郁情况及其相关因素。方法妊娠满16周者入组，予HAD量表及自制产前因素调查表等填写，追踪至孕38～40周再于一般情况调查表及HAD量表填写。结果孕16周时焦虑发生率10．8％，抑郁发生率6、9％；孕38～40周时焦虑发生率6、6％，抑郁发生率6．9％。孕16周和孕38～40周焦虑和抑郁共同的相关因素为：经济问题、担心分娩安全、孩子喂养、孩子健康；孕16周时焦虑还与年龄、既往不良孕产史、担心产后避孕等相关，而孕38～40周还与胎位、夫妻关系、胎儿性别等密切相关。结论孕期焦虑情绪占主要地位。孩子的健康及照料、经济问题和分娩安全是焦虑和抑郁的核心问题。     

高危孕妇焦虑抑郁症状发生率及相关危险因素（英文）

背景:高危孕妇与普通孕妇相比在妊娠期会出现更多的并发症,高危因素作为一种应激因素更易诱发孕妇产生焦虑、抑郁等负面情绪症状。目前国内外对高危孕妇焦虑、抑郁症状的研究相对较少。目标:调查产科高危妊娠孕妇焦虑、抑郁症状发生率及其相关危险因素。方法:对197例孕中期(16-20周)的高危孕妇在妊娠最后4月每月进行综合性医院焦虑/抑郁量表(HAD)评估和风险因素调查。产后3-7天、42天及3月进行爱丁堡产后抑郁量表(EPDS)评估和风险因素调查。结果:入组时高危孕妇HAD焦虑均分:3.69(2.76),抑郁均分:3.42(2.53)。焦虑症状14例(7.18%),抑郁症状10例(5.13%)。多因素分析显示,怀孕有无保胎(OR:8.162,95%CI:1.213-54.914)和乙肝阳性(OR:8.912,95%CI:1.052-75.498)与焦虑症状相关。尿糖阳性(OR:30.529,95%CI:1.312-710.610)和既往出血史(OR:7.122,95%CI:1.015-49.984)与抑郁症状相关。孕期影响高危孕妇焦虑、抑郁症状的因素有:近3月孕妇健康状况、担心胎儿健康、夫妻关系、婆媳关系等。结论:高危妊娠孕妇焦虑、抑郁症状较常见。近3月孕妇健康状况、婆媳关系、夫妻关系、担心胎儿健康是高危孕妇孕期焦虑、抑郁症状的风险因素。     

孕晚期综合性医院焦虑抑郁量表评分对产后抑郁症的预测研究

目的 分析孕晚期综合性医院焦虑抑郁量表(Hospital Anxiety and Depression Scale,HAD)评分对产后抑郁症的预测效果,为孕晚期识别产后抑郁症高危孕妇提供依据.方法 采用一般情况调查表及自编相关因素调查表和HAD,在孕晚期对1 230例孕妇进行测评,并于产后4周内采用HAD、爱丁堡产后抑郁量表(Edinburgh Postnatal Depression Scale,EPDS)再次对其进行测评,经受试者工作特征曲线法分析孕晚期HAD分值对产后抑郁症的预测效果.结果 (1)孕晚期焦虑、抑郁症状发生率为5.20％ (64/1 230)、4.07％ (50/1 230);产后抑郁症发生率为9.98％ (121/1 213).(2)根据两步筛查法确诊产后抑郁症患者121例(患者组)和健康对照者1 092名(对照组),2组在年龄、夫妻感情、工作学习压力、分娩育儿及产后抑郁知识的了解程度、产妇对胎儿的性别歧视及入组时HAD评分(A和D评分)以及产后EPDS评分上差异均有统计学意义(x2=6.54、6.92、8.07、23.82、21.88、10.24、9.26、6.63、5.66,均P＜0.05),而婚姻状况、性格、文化程度、职业、不良产史、孕期并发症、丈夫及家人对胎儿性别的歧视方面差异均无统计学意义.(3)经受试者工作特征曲线法分析,孕晚期HAD最佳临界值为9分,预测产后抑郁症的敏感度、特异度分别为86.21％和87.64％、95.43％和94.72％.(4)受试者工作特征曲线下面积分别为0.941和0.914.(5)孕晚期HAD最佳临界值和产后EPDS分值相关(r=0.852、0.846,均P＜0.01).(6)孕晚期HAD≥9分孕妇发生产后抑郁症的相对危险度分别增加15.891、18.264倍.结论 孕晚期可将HAD作为产后抑郁症高危孕妇的常规筛查工具,对HAD分值≥9分的孕妇应同时进行产后抑郁危险因素的综合评估.     

分娩前后孕产妇心理状态调查

目的:了解初产妇在分娩前后的焦虑、抑郁情况。方法:采用焦虑自评量表(SAS)、抑郁自评量表(SDS)和爱丁堡产后抑郁量表(EPDS)进行评定分析,测定血雌二醇和孕酮值。结果:分娩前后均有一定的焦虑和抑郁发生率。结论:应重视孕产妇的心理状态。     

围产期抑郁、焦虑的现况调查

目的 了解围产期孕产妇伴有焦虑、抑郁症状的状况,为孕产妇的心理保健工作提供科学依据.方法 选取2012年5月～2014年4月到昆明市妇幼保健院产前门诊的就诊孕28周的孕妇共968例作为调查对象,采用爱丁堡产后抑郁量表(EPDS)、焦虑自评量表(SAS)、生活质量评定量表(SF-12)对其孕28周、孕36周及产后1个月的情绪及生活质量进行评估.结果 孕28周、孕36周及产后1月有抑郁症状的孕妇分别为25.4％,24.5％和15.9％,有焦虑症状的孕妇分别为6.6％,7.9％及7.5％,随着时间推移孕妇的生活质量总体呈上升趋势.结论 抑郁、焦虑是孕产妇常见的心理障碍,建议在有条件的产前门诊开展心理健康的筛查,最大限度的保护母婴身心健康.     

201例妇女孕期产后心理状态调查

目的:探讨孕期及产后妇女心理状况并分析相关影响因素。方法:对201例孕妇,采用焦虑自评量表(SAS)、抑郁自评量表(SDS)和爱丁堡产后抑郁量表(EPDS),在孕6个月后至分娩,产后1周、4周和12周4个时点进行心理状况评估。结果:4个时点焦虑症状发生率分别为3.48%、2.49%、1.00%和0.50%。产前抑郁症状的发生率11.94%,产后抑郁症状的发生率分别是22.39%,7.46%和9.95%。结论:妊娠及分娩对孕产妇心理有明显影响。     

产妇产后初期抑郁状况、影响因素及干预措施

目的分析产妇产后初期(产后第7天)抑郁状况,探讨相关影响因素及干预措施。方法选取2016年7月-2017年12月在泸县妇幼保健院分娩的85例产妇为研究对象,于产后第7天采用爱丁堡产后抑郁量表(EPDS)评定产妇抑郁状况,对EPDS筛查阳性者进行产后抑郁影响因素问卷调查,并予以相应的心理干预,比较其干预前后EPDS评分。结果 EPDS评分9分者共46例(54.12%),其中存在产后抑郁倾向者25例(29.41%)、产后抑郁者21例(24.71%)。EPDS阳性者产后初期出现抑郁症状的因素主要有:孕期知识掌握不足(47.83%)、家庭/社会支持不足(47.83%)、无法适应产后角色或(和)自身改变(43.48%)。阳性者干预前后EPDS评分比较差异有统计学意义[(16.26±5.34)分vs.(12.24±4.15)分,t=12.528,P=0.021]。结论产妇产后初期抑郁发生率较高,其影响因素较多,尽早采取心理干预措施可能有助于改善产妇的抑郁情绪。     

围产期妇女焦虑、抑郁调查

目的:了解孕产妇分娩前后焦虑、抑郁症状的发生率及变化特点. 方法:应用焦虑自评量表(SAS)、抑郁自评量表(SDS)、爱丁堡产后抑郁量表(EPDS)和生活事件量表(LES),对49例孕妇在孕35～40周、分娩后1周、4周和12周进行评估. 结果:4个时点SAS的焦虑发生率分别为10.2%、12.2% 、10.2%和6.1%;EPDS的抑郁发生率为8.2%、12.2%、4.1%和8.2%;SDS 4个因子分在分娩后持续下降.大专及以上文化者某些量表评分显著低于大专以下文化者. 结论:孕产妇在孕晚期和分娩后都有一定比例的焦虑和抑郁症状.     

Efficacy and Effectiveness of Child and Adolescent Psychotherapy and Pharmacotherapy

Decades of intervention research have produced a rich body of evidence on the effects of psychotherapies and pharmacotherapies with children and adolescents. Here we summarize and critique that evidence. We review findings bearing on the efficacy of psychosocial treatments and medications under controlled experimental conditions. We also report evidence, where available, on the effectiveness of both classes of treatment with clinically referred youth treated in real-world clinical contexts. In general, the large body of evidence on efficacy contrasts sharply with the small base of evidence on effectiveness. Addressing this gap through an enriched research agenda could contribute importantly to linking scientific inquiry and clinical practice—to the benefit of both ventures. This is one element of a multifaceted agenda for future research and for synthesis of research, which will require the interplay of multiple disciplines related to child and adolescent mental health.     

Satellite cells and myonuclei in young and elderly women and men

The overall aim of this study was to assess the effects of aging on the satellite cell population. Muscle biopsies were taken from the tibialis anterior muscle of healthy, moderately active young (age range, 20-32 years; n = 31) and elderly (age range, 70-83 years; n = 27) women and men with comparable physical activity pattern. Satellite cells and myonuclei were visualized using a monoclonal antibody against neural cell adhesion molecule and counterstained with Mayer's hematoxylin. An average of 211 (range, 192-241) muscle fibers were examined for each individual. Compared with the young women and men, the elderly subjects had a significantly lower (P < 0.011) number of satellite cells per muscle fiber but a significantly higher (P < 0.004) number of myonuclei per muscle fiber. The number of satellite cells relative to the total number of nuclei [satellite cells/(myonuclei + satellite cells)] was significantly lower in the elderly than in the young women and men. These results imply that a reduction in the satellite cell population occurs as a result of increasing age in healthy men and women.     

Necdin蛋白与神经元的生长分化

在神经系统 ,Necdin只在成熟神经元的细胞核中表达 ,可能与成熟神经元分裂静止状态的保持有关。近年的研究表明 ,Necdin是一种生长抑制蛋白 ,能与多种因子如SV4 0大T抗原 ,腺病毒E1A ,转录因子E2F1以及肿瘤抑制蛋白p5 3等结合 ,在功能上类似于成视网膜瘤蛋白Rb。necdin基因缺陷时 ,会引起脑内 ,特别是下丘脑神经元分化障碍。人类necdin基因位于PWS综合征的基因缺失区 ,可能与PWS的一些症状有关。本文从Necdin蛋白的基本概况 ,生物功能以及Necdin与疾病三个方面进行了综述     

Retrospective and prospective design and data

The study of the presentation, symptomatology and family characteristics of an exclusively adolescent sample of patients with borderline personality disorder (BPD) was undertaken. Twenty-four cases of borderline personality disorder, 20 females, 4 males, identified using chart review and meeting the criteria of the Diagnostic Interview for Borderlines (DIB) and DSM III-R, were matched with psychiatric controls. Adolescents with borderline personality disorder were found to have high rates of affective symptomatology with Axis I diagnosis of major depressive disorder - MDD (DSM-III-R), and high rates of interpersonal psychopathology, i.e., manipulation, devaluation, and a pervasive sense of boredom. The latter seem to be characteristic as for adults with borderline personality disorder. The families were particularly angry and volatile.     

Cortisol levels and depression in men and women using heroin and cocaine

Abnormalities in the hypothalamic-pituitary-adrenal (HPA) axis are well documented in men using illicit drugs and/or infected with HIV; however, less is known about HPA function, or the health consequence of HPA dysfunction, in their female counterparts. People with depression exhibit hypercortisolemia, and depression is common in people with HIV or substance use problems. The current study investigated cortisol secretion in 209 demographically matched men and women, stratified by their HIV and drug use status. Self-reported depressive symptoms were evaluated using a standardized, validated questionnaire (CES-D). Women reported more depressive symptoms than men (p=.01). Male and female drug users exhibited higher cortisol concentrations (p=.03), and were more likely to report depressive symptoms (p=.04), than non-users. Depression was related to elevated cortisol concentrations for the study population (p=.03), and women with elevated cortisol concentrations were significantly more depressed than all other participants (p=.05). While it is unknown whether high cortisol concentrations precede depressive symptoms or vice versa, these data indicate that higher cortisol concentrations are associated with depressive symptoms in heroin and cocaine users, and that this association is more pronounced in women than men. HIV status did not act in an additive or synergistic way with drug use for either cortisol or CES-D measures in the current study. Unique therapies to treat the endocrine and mental health consequences of illicit drug use in men and women deserve consideration as depressive symptoms, and high cortisol concentrations associated with depressive symptoms, differ by gender.     

Opiate and digitalis receptor assays distinguish between neuroexcitant and inactive organochlorines and between anesthetics and convulsants

Specific binding of [3H]naloxone to rat brain tissue in vitro was inhibited by the excitant organochlorinated insecticides (OCI), by ether (E) and octanol (OCT), and by the convulsant indoklon (IND) and its anesthetic isomer, isoindoklon (ISO). In the presence of 100 mM NaCl the inhibition of naloxone binding by E, OCT and ISO was greatly potentiated, whereas that by OCI and IND was attenuated. KCl (100 mM) was equally effective as NaCl on the action of anesthetics, but the effect of the excitant drugs was, in contrast to NaCl, unaffected by KCl. Specific binding of [3H]ouabain in the absence of Na, was depressed by anesthetics and enhanced by neuroexcitants. In the presence of NaCl, which by itself inhibits ouabain binding to brain, both anesthetics and excitants enhanced ouabain binding. DDE, a non-insecticidal analog of DDT, and the dimethyl derivative of the OCI, lindane, were inactive in the receptor assays. These observations point to a unique isolated system which responds consistently to anesthetic agents as a class and, in a different way, to neuroexcitant compounds.     

Learning and forgetting new names and objects in MCI and AD

We studied how subjects with mild cognitive impairment (MCI), early Alzheimer's disease (AD) and age-matched controls learned and maintained the names of unfamiliar objects that were trained with or without semantic support (object definitions). Naming performance, phonological cueing, incidental learning of the definitions and recognition of the objects were tested during follow-up. We found that word learning was significantly impaired in MCI and AD patients, whereas forgetting patterns were similar across groups. Semantic support showed a beneficial effect on object name retrieval in the MCI group 8 weeks after training, suggesting that the MCI patients’ preserved semantic memory can compensate for impaired episodic memory. The MCI group performed equally well as the controls in the tasks measuring incidental learning and recognition memory, whereas the AD group showed impairment in this respect. Both the MCI and the AD group benefited less from phonological cueing than the controls. Our findings indicate that word learning is compromised in both MCI and AD, whereas long-term retention of newly learned words is not affected to the same extent. Incidental learning and recognition memory seem to be well preserved in MCI.     

相关性和一致性：这对相仿概念和测量方法的回顾与阐明

概述：一致性(agreement)和相关性(correlation)是两个广泛使用的概念,用来评估变量之间的关联。虽然二者相似且相关,但是它们代表关联完全不同的概念。评估变量之间的一致性假设变量测量的是相同的结构,而在变量测量完全不同的结构时也可以评估它们之间的相关性。这种概念上的差异就要求使用不同的统计方法,并且当评估一致性或相关性时,统计方法根据数据的分布和研究者的兴趣可能会有所不同。例如, Pearson相关性,作为评估连续变量之间相关性的一种普遍测量方法,只有用于符合线性关系的变量时才能提供有用的信息;当用于不符合线性关系的变量时就无法提供准确信息甚至会产生误导。同样地,内部相关性,作为一种评估连续变量之间一致性的常用方法,如果一致性不好的实质正好是研究兴趣所在,那么该测量就不能为研究者提供充分的信息。本报告回顾了一致性和相关性的概念,并讨论了几种常用方法在应用中的差异。     

Necdin蛋白与神经元的生长分化

在神经系统,Necdin只在成熟神经元的细胞核中表达,可能与成熟神经元分裂静止状态的保持有关.近年的研究表明,Necdin是一种生长抑制蛋白,能与多种因子如SV40大T抗原,腺病毒E1A,转录因子E2F1以及肿瘤抑制蛋白p53等结合,在功能上类似于成视网膜瘤蛋白Rb.necdin基因缺陷时,会引起脑内,特别是下丘脑神经元分化障碍.人类necdin基因位于PWS综合征的基因缺失区,可能与PWS的一些症状有关.本文从Necdin蛋白的基本概况,生物功能以及Necdin与疾病三个方面进行了综述.     

Oxytocin and vasopressin agonists and antagonists as research tools and potential therapeutics

We recently reviewed the status of peptide and nonpeptide agonists and antagonists for the V(1a), V(1b) and V(2) receptors for arginine vasopressin (AVP) and the oxytocin receptor for oxytocin (OT). In the present review, we update the status of peptides and nonpeptides as: (i) research tools and (ii) therapeutic agents. We also present our recent findings on the design of fluorescent ligands for V(1b) receptor localisation and for OT receptor dimerisation. We note the exciting discoveries regarding two novel naturally occurring analogues of OT. Recent reports of a selective VP V(1a) agonist and a selective OT agonist point to the continued therapeutic potential of peptides in this field. To date, only two nonpeptides, the V(2) /V(1a) antagonist, conivaptan and the V(2) antagonist tolvaptan have received Food and Drug Administration approval for clinical use. The development of nonpeptide AVP V(1a), V(1b) and V(2) antagonists and OT agonists and antagonists has recently been abandoned by Merck, Sanofi and Pfizer. A promising OT antagonist, Retosiban, developed at Glaxo SmithKline is currently in a Phase II clinical trial for the prevention of premature labour. A number of the nonpeptide ligands that were not successful in clinical trials are proving to be valuable as research tools. Peptide agonists and antagonists continue to be very widely used as research tools in this field. In this regard, we present receptor data on some of the most widely used peptide and nonpeptide ligands, as a guide for their use, especially with regard to receptor selectivity and species differences.