重视抑郁症的残留症状

抑郁症是一种常见的心境障碍，已成为全球第4大致残疾病。据世界卫生组织（WHO）预测，到2020年，抑郁症将成为仅次于缺血性心脏病的第2位致残疾病。抑郁症的患病率较高，全球接近8％的成年人在一生中的某个时期患抑郁症。1998年，世界精神卫生调查委员会 （World Mental Health Survey Consortium, WMH ）对焦虑障碍、心境障碍、冲动一控制障碍及药物依赖的年患病率、     

抑郁症残留症状研究进展

对抑郁症残留症状的最新研究进展作一综述。     

不同起病年龄成年抑郁症患者残留症状特征

目的探讨不同起病年龄抑郁症患者急性期治疗后残留症状的特征。方法以8个城市11家医院门诊就诊的抑郁症患者为研究对象,依据患者起病年龄将其分为早发组(≤30岁)、中年组(30～60岁)、晚发组(≥60岁)。应用抑郁症状快速评估量表(brief 16-item quick inventory of depressive symptomatology self-report,QIDS-SR16)评估抑郁症患者残留症状严重程度,患者健康问卷躯体症状群量表(patient health questionnaire-15,PHQ-15)评估患者被常见躯体症状所困扰的严重程度,简明生活质量与满意度问卷(quality of life enjoyment and satisfaction questionnaire-short form,Q-LES-Q-SF)评估患者对生活质量的主观满意程度,席汉残疾量表(Sheehan disability scale,SDS)评估社会功能损害情况。结果共纳入1503例患者,经急性期治疗后,733例(48.8%)患者存在残留症状,常见残留症状为注意力/决策力下降(82.4%)、精力不足(79.6%)、兴趣减退(75.2%)、感觉沮丧(72.4%)、睡眠不深(72.3%)和反应迟钝(70.4%)。早发组残留症状中睡眠太多、食欲增加、体重增加及自杀观念发生率高于中年组和晚发组(P0.05);早发组和晚发组感觉沮丧症状发生率高于中年组(P0.05);中年组、晚发组入睡困难发生率高于早发组(P0.05)。感觉沮丧(β=1.85)、自杀观念(β=1.57)、兴趣减退(β=2.71)、反应迟钝(β=3.00)、坐立不安(β=1.55)与SDS总分关联具有统计学意义(P0.01)。结论不同起病年龄抑郁症患者残留症状的特征不同;患者社会功能受损与残留症状有关。     

抑郁症残留症状与复燃的关系

本文综述了抑郁症的残留症状与复燃的关系 ,并指出认识行为治疗能改善抑郁症的残留症状及降低复燃的可能性     

抑郁症残留症状及其防治——读者来信

精神分裂症的亚型中有一种称为＂残留型＂,一般指精神分裂症的急性阳性症状已经消失,而某些阴性症状却长期存在,请问抑郁症有没有这种亚型呢？应该怎样防治？     

抑郁症残留症状与复燃的关系

本文综述了抑郁症的残留症状与复燃的关系，并指出认识行为治疗能改善抑郁症的残留症状及降低复燃的可能性。     

抑郁症残留症状及对疾病结局影响

目的：调查抑郁症残留症状及危险因素和其对疾病结局影响。方法：选择100例治疗12周以上抑郁症患者,评估人口社会学资料、抑郁症状、生活事件、应对方式、社会支持、生活质量和社会功能。结果：贝克抑郁自评问卷（BDI）≥5分和汉密顿抑郁量表17项（HAMD17）≥8分的患者比例分别为53％和49％;残留症状与负性生活事件（t=-4．90,P=0．00）、积极应对方式（t=8．22,P=0．00）、消极应对方式（t=-4．53,P=0．00）、社会支持（t=2．01,P=0．05）及家庭支持（t=1．97,P=0．05）明显有关;有残留症状者生活质量和社会功能显著差于无残留症状者（P〈0．01）。结论：抑郁症患者残留症状发牛率相当高．需要心弹社会干预。     

抑郁症患者残留症状的治疗以及对抑郁复发的影响

在临床上我们经常可以看到许多患者经过抗抑郁治疗后仍或多或少存在一些残留症状,不管是在那些对抗抑郁剂有部分反应的,还是按现行的评定标准有效或临床痊愈的患者.残留症状的出现对预后的影响是多方面的,包括复发、复燃、工作能力的损害以及悲观的情绪.     

抑郁症患者中的强迫症状

以自制的强迫症状调查表对８０例抑郁症患者进行强迫症状的调查，以ＨＡＭＤ量表及Ｙ－Ｂ量表对抑郁症状及强迫症状进行评分。结果发现，出现强迫症状者有３４例，占４２．５％，其中强迫性回已出现例数最多，无一例出现强迫性穷思竭虑，部分病人的强迫症状出现在疾病早期，抑郁症状的ＨＡＭＤ评分与强迫症状的Ｙ－Ｂ评分之间有显著的综合相关性。强迫症状与抑郁症状常共存，对强迫症状与抑郁症之间关系的研究，有助于对强迫症状精神     

Partial remission,residual symptoms,and relapse in depression

Partial remission from depression, with residual symptoms, is an important problem in depression. This paper reviews the frequency and features of this outcome, and its association with relapse. Residual symptoms occur in many depressed patients after acute treatment. They span the typical symptoms of depression, except those characteristic of severe disorders. Other persistent abnormalities include social dysfunction, dysfunctional attitudes, hypothalamic-pituitary-adrenal axis overactivity, shortened REM sleep latency, and mood lowering after tryptophan depletion. Associations of some of these with residual symptoms are not clear. There is growing evidence for similar residual symptoms in bipolar disorder, particularly bipolar depression. The most important consequence of residual symptoms is a much-increased risk of relapse, particularly in the first year. Residual symptoms are a strong indication for vigorous and longer than usual continuation of antidepressant treatment, in order to prevent relapse. There is good evidence for the use of cognitive therapy as an adjunct.     

Achieving remission with venlafaxine and fluoxetine in major depression: its relationship to anxiety symptoms

Venlafaxine, a serotonin and norepinephrine reuptake inhibitor (SNRI), produces significantly higher remission rates in depressed patients than do the selective serotonin reuptake inhibitors (SSRIs). In this analysis of pooled data, we explored the relationship between differences in treatment efficacy, early improvement of symptoms, and severity of baseline anxiety in depressed patients treated with either venlafaxine or fluoxetine. A pooled analysis was performed on data from 1,454 outpatients with major depression from five double-blind, randomized studies comparing the 6-week efficacy of venlafaxine (542 patients) with fluoxetine (555 patients). The Hamilton rating scale for depression (HAM-D) total and item scores were analyzed at different treatment times up to 6 weeks. Venlafaxine and fluoxetine both produced statistically significant higher response and remission rates compared with placebo starting from week 2 for response and weeks 3 to 4 for remission. Venlafaxine was statistically significantly superior to fluoxetine from week 3 until week 6 in respect of response rate, and from week 2 until week 6 for remission rate. After 1 week of treatment, greater improvement in individual symptoms was observed in the depressed mood, suicide, and psychic anxiety items of the HAM-D scale for both venlafaxine- and fluoxetine-treated patients compared with placebo. Improvement in psychic anxiety was statistically significantly greater with venlafaxine than with fluoxetine. The presence of baseline psychic anxiety correlated significantly to treatment outcome when analyzing the remission rates. In depressed patients with moderate anxiety (HAM-D psychic anxiety score < or = 2), venlafaxine statistically significantly increased remission rates compared with placebo from week 4 until week 6, while a significant effect of fluoxetine on remission rates was observed starting at week 6. Remission rates in the severely anxious depressed patients (score > 2) were statistically significantly higher with venlafaxine than placebo starting from week 3 until the end of the study period, but no difference could be observed between fluoxetine and placebo. Baseline severity of psychic anxiety had a significant impact on remission rates after treatment of patients diagnosed with depression. Venlafaxine's superior remission rates in the more severely anxious patients and its ability to improve psychic anxiety as early as week 1 compared with fluoxetine suggest that venlafaxine's early efficacy on anxiety symptoms may be the basis for its superior efficacy in depression.     

双相障碍缓解期残留症状的研究进展

双相障碍是一种具有高复发率和高致残率的重性精神障碍,其导致的伤残调整生命年在精神和物质使用障碍中排第6名［1］。即使经过系统的药物治疗,相当一部分达到临床缓解的患者仍然存在很多残留症状。国内关于双相障碍缓解期残留症状的研究还非常匮乏,本文将根据国外对于双相障碍缓解期残留症状的相关研究,针对双相患者缓解期的概念及评定标准,缓解期常见的残留症状,影响残留症状的因素以及关注残留症状的意义进行总结。     

区分亚临床抑郁(域下抑郁)与抑郁症残留症状(英文)

The terms‘sub-clinical’or‘subthreshold’are widely used in medicine to label individuals who are in the early stages of a disease process (e.g., cancer,hypertension, etc.) and to identify high-risk populations that need to be monitored or provided with specific preventative interventions or treatments. Because the pathophysiological changes that occur in the sub-clinical stages of a condition are similar to those that occur during the full-blown disease,     

The impact of residual symptoms on outcome of major depression

Unipolar depression should be viewed as a chronic illness with multiple phases rather than as a relapsing-remitting disorder. Incomplete remission from depression is common, with approximately one third of patients continuing to have residual depression at remission. Patients who have had a depressive episode spend more time with residual depressive symptoms than with major depression long term. The presence of residual symptomatology after an episode of depression is associated with an increased risk of short-term relapse, a long-term chronic course, higher risk of suicide attempts, poor social functioning, and poor outcome of comorbid medical illnesses.     

Residual symptoms of depression: clinical and theoretical implications.

Residual symptoms of variable intensity often persist following pharmaco/or psychotherapeutic interventions for treatment of major depression (MD). In several studies, such persistent symptoms have been clearly shown to be associated with a higher risk of relapse, chronicity and functional impairment, but their true nature is still controversial. Several authors consider that these symptoms belong to the range of depression proper and thus indicate that the current episode has been inadequately treated, a hypothesis reinforced by their frequent similarity with the symptoms preceding the full-blown picture of MD. However, in the current state of research, their connection with certain personality traits or comorbid disorders--notably anxiety disorders--cannot be completely ruled out. This article reviews the main data from the literature concerning residual symptoms and their treatment, as well as the issues related to their psychopathological meaning. In practice, once the state of a patient has been stabilized in partial remission of the depressive syndrome, the clinician should revise the current therapeutic strategy and seek to find how to return as fully as possible to the previous euthymic state.