成都市儿童青少年抑郁障碍临床特征调查

目的 探讨成都市儿童青少年抑郁障碍的临床特征.方法 采用量表筛查和访谈结合的方法对成都市五城区6 ～ 16岁的4585名在校学生进行抑郁障碍调查.首先应用长处和困难问卷(strength and difficulty questionnaire,SDQ)进行筛查,筛查阳性的进一步用精神发育和健康状况评定量表(the development and well-being assessment,DAWBA)进行定式检查以明确诊断.诊断标准按照美国精神障碍诊断和统计手册第4版.结果 SDQ筛查阳性的占50.2%(2302/4585).共检出儿童青少年抑郁障碍患者55例,重性抑郁障碍29例,恶劣心境0例,未标明的抑郁障碍26例,总的抑郁障碍患病率1.2%(55/4585).起病年龄的中位数为13岁(P25:11岁,P75:15岁),高峰年龄在15岁,占21.8%(12/55).出现频率居前3位的抑郁症状依次是情绪低落(74.5%)、易激惹(72.7%)、精力减退(72.7%).34.5%(19/55)的儿童青少年抑郁障碍患者曾经试图伤害自己或自杀.55例患者中39例过去曾有抑郁发作,占70.9%.抑郁障碍对儿童青少年的学习、社交和娱乐具有不同程度的影响,74.5%(41/55)的患者学习受影响.患者的病情有轻有重,大多数(78.2%)为轻度或中度.结论 儿童青少年抑郁障碍应受到重视,做到早发现早治疗.     

重性抑郁障碍临床痊愈患者心理社会功能特征研究

目的:研究重性抑郁障碍患者在达到临床痊愈标准后心理社会功能的特点。方法:采用生活质量综合评定问卷(GQOLI-74)的躯体、心理、社会功能分量表、17项汉密顿抑郁量表(HAMD)、社会支持评定量表(SSS)和生活事件量表(LES),对32例经住院治疗后达到临床痊愈的重性抑郁障碍患者和32名正常人进行调查分析。结果:协变量方差分析显示,以客观社会支持或负性生活事件为协变量时;研究组躯体功能维度(F=5.75,P<0.05)及躯体不适感因子得分(F=5.51,P<0.05)显著低于对照组;研究组心理功能维度中的正性情感因子得分(F=4.75,P<0.05)显著高于对照组;研究组社会功能维度中的工作学习(t=-3.80,P<0.01)和婚姻家庭因子得分(t=-3.30,P<0.01)显著低于对照组,该维度中的社会支持因子(F=4.94,P<0.05)和业余娱乐生活因子得分(F=9.30,P<0.01)显著高于对照组;研究组总体生活质量因子得分(F=4.14,P<0.05)显著低于对照组。结论:临床痊愈的重性抑郁障碍患者心理功能可能已恢复至正常水平,躯体、社会功能可能尚未完全恢复。     

儿童青少年抑郁障碍患者认知功能损害特征的研究进展

抑郁障碍是儿童及青少年时期常见的精神心理疾病,给家庭和社会带来了巨大负担。儿 童青少年抑郁障碍患者的执行功能、注意力、学习记忆以及信息加工速度等认知功能存在不同程度的 损害,并会影响患者的成长、治疗效果及教育和社会功能。本文从神经心理测验的角度综述了儿童青 少年抑郁障碍患者不同维度的认知功能损害特征,为早期识别、干预治疗和改善预后提供参考。     

儿童期心理虐待对青少年抑郁障碍的影响：宽恕倾向的中介效应

目的 探讨儿童期心理虐待、宽恕倾向与青少年抑郁障碍的关系。方法 选取我院门诊或住院的青少年重性抑郁障碍患者76人作为研究组,选取80名健康青少年作为对照组,研究组和对照组施测儿童期心理虐待量表（CPMS）和Hearland宽恕量表（HFS）,以汉密尔顿抑郁量表（HAMD）评估研究组抑郁障碍严重程度。结果 研究组恐吓、贬损、干涉、纵容因子分高于对照组（P<0.05或0.01）;研究组自我宽恕和宽恕他人因子分低于对照组（P=0.000）。CPMS各因子分与HAMD大部分因子分呈正相关（P<0.05或0.01）;自我宽恕与焦虑/躯体化、体重、认知障碍、迟滞、绝望感呈负相关（P<0.05或0.01）。CPMS的恐吓、纵容对HAMD总分有预测作用（P<0.01）,可解释方差变异的39.7%;自我宽恕、宽恕他人对HAMD总分有预测作用（P=0.000）,可解释方差变异的64.2%。宽恕倾向在儿童期心理虐待与青少年抑郁严重程度之间起部分中介作用,中介效应占总效应的42.05%。结论 儿童期心理虐待、宽恕倾向是青少年抑郁障碍的预测因子,宽恕倾向是儿童期心理虐待与抑郁障碍严重程度...     

青少年抑郁障碍患者与双相情感障碍患者睡眠特征及其对自杀风险的影响

目的 比较青少年抑郁障碍患者和双相情感障碍患者睡眠结构特征的差异,探讨睡眠指标等因素对患者自杀风险的影响。方法 回顾性查阅广州医科大学附属脑科医院2019年1月1日-2021年6月30日符合《国际疾病分类（第10版）》（ICD-10）诊断标准的抑郁障碍（n=97）和双相情感障碍（n=52）住院青少年患者病历资料,收集患者的年龄、性别、体质量指数（BMI）、精神科诊断、自杀风险评估量表（NGASR）评分及多导睡眠监测（PSG）结果。根据NGASR评分结果,将患者分为两组：0~5分为自杀低风险组（n=32）,>5分为自杀高风险组（n=117）。以既往文献中80例正常青少年的PSG数据作为对照组资料。建立多元线性回归模型探讨青少年情感障碍患者自杀风险的影响因素。结果 自杀高风险组睡眠效率和N2期睡眠占比均低于自杀低风险组（Z=-2.138、-2.520,P均<0.05）。抑郁组总睡眠时间、N2期睡眠时间以及REM期睡眠时间均少于双相组（t=-2.822、-3.087、-2.277,P<0.05或0.01）;抑郁组和双相组REM期睡眠占比均低于对照组（t=-2.369、-2.069,P均<0.05）。线性回归分析显示,青少年情感障碍患者自杀风险的影响因素包括N1期睡眠时间（β=0.019,P<0.05）、性别（男性vs.女性,β=-4.051,P<0.01）以及诊断（双相情感障碍vs.抑郁障碍,β=-1.429,P<0.05）。结论 与青少年双相情感障碍患者相比,青少年抑郁障碍患者存在睡眠连续性差、浅睡眠更少的特点。N1期睡眠时间、女性以及诊断为抑郁障碍是青少年情感障碍患者自杀的影响因素。     

青少年抑郁障碍患者非自杀性自伤行为的特征及相关因素分析

目的 研究青少年抑郁障碍患者非自杀性自伤行为的特征及其相关因素。方法 选取安徽省某精神病专科医院符合《精神疾病诊断手册第五版》中青少年抑郁障碍诊断标准的门诊和住院患者共131例,采用汉密尔顿抑郁量表、童年创伤问卷、青少年非自杀性自伤问卷进行评估。结果 1）青少年抑郁障碍患者出现非自杀性自伤（Non-suicidal self-injury,NSSI）行为占总人数69.5%,NSSI行为按频率高低依次为：故意掐伤自己、故意割伤自己（如用刀片、玻璃等）、故意用拳头打击硬物;NSSI行为功能依次为：缓解压力或焦虑的心情、应对悲伤或失望的情绪、有伤害自己的欲望且无法停止;2）伴NSSI组和不伴NSSI组在性别、父母婚姻、抑郁得分、童年期创伤均有统计学差异（P<0.05）;3）青少年抑郁障碍患者NSSI行为与抑郁严重程度、童年期创伤呈显著正相关（r=0.513、r=0.356,P<0.01）;4）抑郁严重程度在童年期创伤与青少年抑郁障碍NSSI行为之间起中介作用。结论 童年期创伤会影响青少年抑郁障碍抑郁严重程度进而增加出现NSSI行为的风险。     

双相障碍躁狂发作和抑郁障碍患者心理理论研究

目的 比较双相障碍躁狂发作和抑郁障碍患者心理理论（theory of mind,ToM）损害及其错误类型与临床症状的相关性。方法 纳入躁狂发作患者54例，抑郁障碍患者54例，健康对照者52名。采用中文版社会认知视频测查工具（Chinese version of the movie for the assessment of social cognition,MASC-C）评估被试ToM能力，计算被试在MASC-C任务中正确得分及三种错误ToM得分（包括“ToM-过度”、“ToM-不足”及“没有-ToM”）。躁狂发作组采用杨氏躁狂量表（Young manic rating scale,YMRS）评定躁狂症状，抑郁障碍组使用24项汉密尔顿抑郁量表（24-item Hamilton depression scale,HAMD-24）评估抑郁症状。结果 躁狂发作组和抑郁障碍组MASC-C总分均低于对照组[25.0(23.0,28.0)、29.5(25.0,32.0) vs. 31.5(29.3,33.0)，均P<0.01]。躁狂发作组“ToM-过度”得分高于其他两组[9.5(8.0,10...     

焦虑和抑郁障碍的心理防御机制

本文就焦虑和抑郁障碍防御机制方面的研究进展作一综述。     

抑郁障碍的语音特征研究进展

近年来，关于抑郁障碍的语音特征研究受到广泛关注，并且结合机器算法探索将其应用 到抑郁症的诊断与识别领域。现对近年来研究发现的与抑郁障碍相关的语音特征，以及影响此类研究 结果的混杂因素进行综述，并对当前该领域存在的问题进行总结，进一步提出未来研究方向。     

Psychosocial characteristics of "double depression"

Thirty-nine patients with "double depression" (major depression and dysthymia) were compared to 38 patients with recurrent major depression without dysthymia on a number of severity of illness, psychosocial, and biological variables. No significant differences were found on any psychosocial or biological measure.     

Psychosocial situations, quality of depression and schizophrenia in adolescents

The relationships between acute life events and type of depression were evaluated among inpatient adolescents with schizophrenia. Forty-two adolescent inpatients were assessed, 25 with schizophrenia and 17 with personality disorder. Acute life events and other psychosocial situations were identified with the ICD-10 Axis V semistructured interviews. The Depression Equivalent Questionnaire for Adolescents (DEQ-A) and the Positive and Negative Symptom Scale (PANSS) were used to measure quality and severity of depression. In the patients with schizophrenia, psychosocial situations were related to the anaclitic type of depression, whereas in the subjects with personality disorder, they were highly correlated with introjective depression. In the schizophrenic group, the psychosocial situations related to depression were of a more intrapersonal nature and, in the personality-disordered group, they were more interpersonal. Environmental factors play an important role in the course of schizophrenia in adolescents and should remain a focus of study. Object relations theory may be of heuristic value in the investigation of these factors.     

Psychosocial treatment of adolescents with ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a disruptive behavior disorder that is associated with social, family, and academic impairment. These areas of impairment are predictive of negative outcomes for adolescents, such as peer rejection, low or failing grades, and family conflict. This article reviews impairment associated with adolescents with ADHD and treatment approaches for these youth, with an emphasis on recent findings. There is a need for more research targeted at developing effective interventions for adolescents with ADHD, establishing reliable and valid assessment instruments, and identifying effective dissemination procedures.     

Psychosocial management of depression

The treatment of depression in older people has to include consideration of psychosocial factors. Evidence for the efficacy of psychological therapies for depression in elderly out-patients is reviewed. To date CBT and brief psychodynamic therapies seem to be equally effective. Issues of loss are often associated with depression in later life, and grief therapy may be indicated in certain circumstances. The relationship of physical health and depression is a complex one, which needs to be addressed carefully and sensitively in therapy. Family therapy and group approaches are beginning to be used more often and psychosocial alternatives to benzodiazepines as anxiolytics and hypnotics are being developed. Therapists need to be aware of the personal issues raised by working with older people, and to be more flexible and accommodating in a variety of ways than may be necessary with many younger people     

Psychosocial development among adolescents with visual impairment

The psychosocial development of adolescents with visual impairment was studied in a group of 54 adolescents (40 boys, 14 girls) attending Finnish regular schools. Mean age was 14.0 (SD 0.87). The control group consisted of normally sighted adolescents of the same age level (N=385, 172 boys, 213 girls). Data were collected with self-report questionnaires. Results indicated that the adolescent group with visual impairment did not differ from the control group in the frequency of depression, distress symptoms or in their relations with parents and siblings. Adolescents with visual impairment less often had many friends and dates with other young people than those without visual impairment. They also reported more often feelings of loneliness and difficulties in making friends. Self-esteem, school achievement and social skills were lower in girls with visual impairment than in the control girls. In summary, our results showed that the psychosocial developmental outcomes of many adolescents with visual impairment were similar to their peers without visual impairment. However, some adolescents with visual impairment, especially girls, need more support in their psychosocial development. Accepted: 15 May 1997     

Psychosocial predictors of interictal depression

The purpose of this investigation was to attempt to determine whether some of the psychosocial complications associated with epilepsy are predictive of interictal depression. A wide variety of psychosocial, neuroepilepsy, and medication variables were assessed and related to self-reported depressive symptomatology in a sample of 102 adults with epilepsy. The results of multiple regression analysis revealed that four variables were predictive of increased depression: increased stressful life events, poor adjustment to seizures, financial stress, and female gender. The methodological limitations of this correlational approach and the need for a prospective longitudinal investigation are discussed.     

Clinical characteristics associated with the prescribing of SSRI medication in adolescents with major unipolar depression

Unipolar major depressions (MD) emerge markedly during adolescence. National Institute for Health and Care Excellence (NICE) UK recommends psychological therapies, with accompanying selective serotonin reuptake inhibitors (SSRIs) prescribed in severe cases only. Here, we seek to determine the extent and rationale of SSRI prescribing in adolescent MD before entering a randomised clinical trial. SSRI prescribing, together with their clinical characteristics was determined in 465 adolescent patients with MD prior to receiving a standardised psychological therapy as part of the Improving mood with psychoanalytic and cognitive therapies (IMPACT) clinical trial. Overall, 88 (19 %) had been prescribed antidepressants prior to psychological treatment. The clinical correlates varied by gender: respectively, depression severity in boys and self-harming behaviours in girls. Prescribing also differed between clinical research centres. Medical practitioners consider severity of depression in boys as an indicator for antidepressant prescribing. Self-injury in girls appears to be utilised as a prescribing aid which is inconsistent with past and current revised UK NICE guidelines.     

Psychosocial factors associated with help-seeking behavior among depressive adolescents

A group of 3,287 French school pupils between the age of 12 to 20 years, of whom 14.4% had sought consultation for depression, were investigated in order to analyse the factors related to the type of medical help obtained. Multivariate analyses showed that severe emotional distress alone did not explain the help-seeking behavior. Thus, among those adolescents with the same anxio-depressive level, girls, older adolescents, adolescents with parents living apart, with health worries, and adolescents often absent from school more often sought help for depression. Socioeconomic status, however, did not correlate with a higher level of consultation for depression. Adolescents attending medical services for depression had a higher consultation rate, for any reason, with general practitioners and with school nurses, in whom they confided more often than their counterparts. Nonmedical professionals also seemed to contribute to accessing to medical help for depression. Overall, those who consulted for depression, in very limited numbers turned to mental health services (8.4%).     

Psychosocial issue in children and adolescents with multiple sclerosis

In adult-onset multiple sclerosis (MS) cases, major depression, fatigue and psychological distress are common, whereas there is little information on these issues in children with the disease. The aim of this study was to assess psychosocial disorders in an Italian cohort of children and adolescent with MS. We evaluated 56 patients through self-assessment scales of depression (Children Depression Inventory) and fatigue (Fatigue Severity Scale), a psychiatric interview [Kiddie-SADS-Present and Lifetime Version (K-SADS-PL)] and an interview on school and everyday activities. Significant fatigue was found in 11 patients (20%). Twelve of the 39 patients who underwent the K-SADS-PL received a formal diagnosis of an affective disorder. Moreover, MS affected school activities in 28% of cases, daily living activities in 41% and social relationships in 28%. Our study confirms the critical role of psychosocial difficulties in children and adolescents with MS and provides a few cues to clinical management.