孕产妇焦虑、抑郁情绪及其护理措施的初步研究

目的了解孕产妇焦虑、抑郁情绪,以便提供护理措施,使产妇顺利康复.方法对200例孕产妇产前及产后用抑郁自评量表(SDS)焦虑自评量表(SAS)测试和46例孕产妇神经介质(5-HT)的检测,然后作统计学处理.结果本文孕产妇产前焦虑发生率为38.34%、抑郁发生率为12.44%,明显高于产后的14.36%和5.85%;产前5-HT的水平明显低于产后.结论部分孕产妇产生有不同程度焦虑、抑郁情绪存在,直接关系到孕产妇心身健康.为此,我们提出了护理措施,并应引起临床工作者重视.     

产后抑郁症的心理因素分析及预防对策研究

目的分析产后抑郁症发病的心理因素,并探讨相应的对策。方法对820例孕妇于妊娠36~38周施测艾森克个性量表(EPQ)及焦虑、抑郁情绪测定量表(HAD),在产后4~6周施测爱丁堡产后抑郁量表(EPDS)。结果产后抑郁症患者在EPQ的N量表和P量表上的评分均显著高于无产后抑郁症产妇,在L量表上的评分则显著低于后者,两者在E量表上的评分无显著差异。孕期有焦虑、抑郁情绪的产妇产后抑郁症的发病率显著高于孕期无焦虑、抑郁情绪的产妇(2χ=21.43,26.39,P<0.005)。结论产妇产后抑郁症的发生既有其心理根源,也与其孕期的焦虑抑郁情绪有密切的关系。加强孕期保健、采取及时筛查与干预措施是预防产后抑郁症的关键。     

沈阳地区产妇产前产后情绪状态变化的研究

目的了解产妇产前产后的情绪变化情况,为其心理辅导、实施精神助产提供科学依据。方法应用焦虑自评量表（SA S）和抑郁自评量表（SDS）对我院2006年上半年来院就诊的孕35周以上的产前孕妇随机抽取220名、产后产妇220名进行测试,收回有效问卷434份（产前216份,产后218份）。量表均值用t检验与全国普通人口常规检测的标准数据（常模）进行组间比较,其他项目用χ2检验对产前产后的数据进行了比较。结果孕妇总体产前产后的SA S总粗分与全国正常群体模型（全国常模）相比无显著性差异,但产后明显少于产前（χ2=0.003,P〈0.01）。产前产后的SDS总粗分均明显低于全国常模（P〈0.01）,而产后的产妇SDS总粗分又稍低于产前。结论在调查的产妇中,产后焦虑和抑郁的出现情况明显低于产前,说明产妇分娩后多数人都处于情绪比较稳定的状态。     

社会支持与产前情绪对产妇产后抑郁的影响

目的研究孕产妇社会支持与产前焦虑和抑郁情绪对产后抑郁的影响。方法对274名产妇用一般情况调查表、自评焦虑量表、自评抑郁量表、社会支持评定量表和爱丁堡产后抑郁量表进行调查,对收集到的数据运用SPSS 17.0进行t检验、χ2检验、相关分析和多元逐步回归分析。结果①产后抑郁的发病率为18.20%;②产后抑郁组和正常组产妇在社会支持、产前焦虑和产前抑郁上均存在显著性差异(P0.01);③产前焦虑与社会支持总分、客观支持和支持利用度呈显著相关(r=-0.329,-0.282,-0.372),产前抑郁与社会支持总分、主观支持、客观支持呈显著相关(r=-0.482,-0.491,-0.587);产后抑郁与产前抑郁情绪、主观支持、客观支持、支持利用度和社会支持总分呈显著相关(r=0.408,-0.212,-0.238,-0.301,-0.232);④产前抑郁、社会支持利用度和主观支持进入抑郁的回归方程,它们能解释产后抑郁发生的29.7%。结论产前抑郁情绪、社会支持利用度和主观支持是影响产后抑郁形成的关键因素。     

初产妇围产期血清性激素水平变化与心理障碍的关系

目的:探讨初产妇围产期血清性激素水平变化与心理障碍的关系。方法:通过放射免疫法测定本院2015年1月-2017年1月就诊的250例初产妇围产期血清雌二醇(E2)、孕酮(P)、催乳素(PRL)水平;通过汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、症状自评量表(SCL-90)评价初产妇心理状况,由精神科医生判断产妇是否存在心理障碍。结果:HAMA评分显示,焦虑发生率36.00%,HAMD评分显示抑郁发生率56.80%;与常模比较,初产妇抑郁、躯体化表现、恐怖评分均显著高(t=4.090,2.424,4.369;P0.05);专业精神科医生判断初产妇心理障碍发生率64.80%;心理障碍组孕早期、孕晚期、产后7d、产后42d血清E2水平均显著低于、P水平均显著高于非心理障碍组(t=-23.352,-17.513,-21.203,-15.756,6.029,15.901,49.691,6.554;P0.05);Pearson相关性分析显示HAMD评分与E2负相关(r=-0.182,P0.05),与P正相关(r=0.185,P0.05);SCL-90量表中抑郁因子与E2负相关(r=-0.229,P0.05);躯体化因子与E2负相关(r=-0.223,P0.05),与P正相关(r=0.158,P0.05)。结论:围产期低E2水平、高P水平是初产妇心理障碍发生的可能原因。     

临床应用导乐分娩对初产妇心理的影响

目的研究导乐分娩对初产妇分娩过程中心理状态的影响及对产后抑郁症的预防作用。方法选择定期在我院做产前检查的初产妇360例,将其随机分为导乐组(180例)和对照组(180例),导乐组采取导乐分娩,对照组采取常规分娩。观察和比较两组产妇分娩时的心理状态,并在产后4~6周对两组产妇均施测爱丁堡产后抑郁量表(EPDS),比较两组产妇产后抑郁症的发生率。结果导乐组产妇在分娩过程中的不良心理反应及产后抑郁症的发生率均显著低于对照组(χ2=50.4,P0.01;χ2=4.09,P0.05)。结论导乐分娩能有效降低初产妇在分娩过程中焦虑、抑郁等不良情绪,并且能有效降低产后抑郁症的发生率。     

产后心理干预及定时按摩子宫对产后出血的影响

目的:研究产后心理干预及定时按摩子宫对产后出血的影响。方法:选取本院2016年1月~2016年12月收治的1200例产后出血产妇作为研究对象,采用随机分组的方式,将其分为对照组和研究组,每组各600例,对照组采用子宫按摩护理法,研究组在对照组基础上联合产后心理干预护理。采用焦虑与抑郁自评量表评价产妇心理、情绪变化;并观察记录两组产妇实施护理前、护理后24h的出血量。结果:护理后研究组焦虑(Self-rating anxiety scale,SAS)和抑郁(Self-rating depression scale,SDS)评分明显低于对照组(P0.05);护理后产后24h出血量研究组明显低于对照组(P0.05)。结论:对产后出血产妇实施产后心理干预和定时按摩子宫护理能够降低产妇产后抑郁焦虑评分,保障产妇中枢神经系统正常,效果明显。     

女性腹部脂肪抽吸手术前后焦虑抑郁状态调查

目的探讨女性腹部脂肪抽吸手术前后焦虑、抑郁情绪反应的发生率及变化情况。方法采用焦虑自评量表、抑郁自评量表对行腹部脂肪抽吸女性病人76例及随机抽取正常青年女性104人为调查对象。结果术前焦虑状态、抑郁状态发生率分别为28.96%、23.67%,术后焦虑状态、抑郁状态发生率分别为23.69%、18.40%,分别与对照组比较均存在显著性差异（P〈0.05）,手术前后焦虑自评量表、抑郁自评量表评分比较,术后焦虑量表评分明显低于术前（P〈0.05）,高于对照组（P〈0.05）,而术后抑郁自评量表与术前比较无显著性差异（P〉0.05）。结论女性腹部脂肪抽吸手术前普遍存在焦虑、抑郁情绪障碍,在病人术前和术后应加强心理干预。     

心理干预对减轻初产妇焦虑情绪效果的影响

目的 观察早期心理干预对初产妇产前焦虑的影响.方法 采用ZUNG焦虑自评表(SAS)对164名初产妇焦虑情绪状况进行评定.结果 从评定分析干预组80例产妇中12例焦虑,对照组84例子产妇中有36例为焦虑.干预组与对照组焦虑值经t检验及χ2检验,干预后P值均＜0.05,有显著差异.结论 心理护理能有效减轻初产妇焦虑情绪,有利于分娩及产后恢复.     

76例初产妇分娩前后焦虑、抑郁状况调查

目的：探讨初产妇分娩前后焦虑、抑郁情绪反应的发生率及变化情况。方法：应用焦虑自评量表、抑郁自评量表,对正常人及初产产妇进行调查,随机抽取正常人104人及在本院分娩的初产妇76人为调查对象。结果：产前焦虑状态、抑郁状态发生率28．95％、23．68％,产后焦虑状态、抑郁状态发生率分别为23．68％、18．42％。结论：产前保健中,要对孕妇加强心理卫生知识宣教。     

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。     

西酞普兰结合心理治疗对产后抑郁疗效观察

目的：比较单用西酞普兰与西酞普兰结合心理疗法治疗产后抑郁的临床疗效。方法：将58例符合CCMD-3抑郁症诊断标准的产后抑郁患者随机分成两组，分别给予单用西酞普兰20mg／日与西酞普兰20mg／日结合心理治疗，疗程6周。治疗前及治疗后1、2、4、6周末分别用汉密顿抑郁量表（HAMD）进行评定。结果：单用西酞普兰与西酞普兰结合心理疗法治疗产后抑郁均有比较理想的效果，但后者疗效更佳（t=2.24-6、64，P〈0．05）。结论：两酞普兰结合心理疗法治疗产后抑郁效果更好。     

A controlled study of a specific MAO A reversible inhibitor (R011-1163) and amitriptyline in depressive illness

A double blind comparative study of amitriptyline and a new reversible MAO A inhibitor R011-1163 was conducted in 25 depressed inpatients over 4 weeks. Response to treatment was assessed with the Hamilton depression rating scale, the Carroll depression self rating scale and the Visual analogue scale. Both drugs produced significant changes in depressive symptomatology (P less than 0.01, MANOVA) and there were no statistically significant differences between drugs (P greater than 0.05 MANOVA). Side effects were of mild to moderate severity with dry mouth the most commonly reported side effect of amitriptyline and vague, generalised headache in patients, treated with R011-1163.     

Prevalence rates and demographic characteristics associated with depression in pregnancy and the postpartum

Examined the prevalence of depression in a heterogeneous sample of 360 pregnant women. Subjects were assessed with respect to both depressive symptomatology and diagnostic status during pregnancy and after delivery. At both assessments, approximately 25% of the sample reported elevated levels of depressive symptomatology. In contrast, 10% of the women met diagnostic criteria for depression during pregnancy, and 6.8% were depressed postpartum. However, only half of the cases of postpartum depression were new onset (3.4%); the remaining women receiving a diagnosis in the postpartum had also been depressed during pregnancy. Finally, depression during pregnancy was related to different sociodemographic variables than was postpartum depression, suggesting that depression at these two times may be associated with different psychological or etiological factors.     

Ovarian hormone withdrawal-induced "depression" in female rats

Approximately 15% of child-bearing women develop postpartum depression (PPD), and many women with PPD experience anxious symptoms. It has been proposed that PPD is precipitated by the dramatic decline in reproductive hormones that occurs just after childbirth. To examine this hypothesis, ovariectomized female Sprague-Dawley rats underwent a hormone-simulated pregnancy (HSP) regimen; during the subsequent hormone withdrawal period, rats were tested in the forced swim test or elevated plus-maze, animal models of depression and anxiety, respectively. The HSP regimen consisted of injections with progesterone and escalating doses of estradiol benzoate for 22 days; control rats received daily vehicle injections. One, two, four or seven days after the last hormone injection, separate groups of rats were tested once on either the forced swim test or the elevated plus-maze. To examine any hormone withdrawal-induced changes in activity levels, spontaneous locomotor activity was measured at the same time points. At 2 and 4 days after the last hormone injection, HSP-treated females displayed significant increases in immobility relative to vehicle-treated females in the forced swim test. Behavior on the elevated plus-maze did not differ between the HSP and control groups at any of the withdrawal time points. There were also no differences in spontaneous locomotor activity between the HSP and control females at any of the withdrawal time points. The results of this study suggest that postpartum hormone withdrawal may contribute to depressive symptoms experienced after giving birth, and that the HSP-hormone withdrawal protocol may provide a useful animal model of PPD.     

The growth hormone response to apomorphine at 4 days postpartum in women with a history of major depression

We have examined the responsiveness of dopamine sensitive neurones in the postpartum period in woman with a history of major depression who are at high risk of experiencing a recurrence of illness in the postpartum period. Fourteen women were assessed at 36 weeks of pregnancy and during the 3 months following delivery, using the Schedule for Affective Disorders and Schizophrenia, including its change version. They were not depressed at initial assessment. Five of the 14 women went on to experience a postpartum relapse (2 major depressive disorder, 2 generalised anxiety disorder, 1 panic disorder). On the fourth day postpartum, ie before relapse, the growth hormone response to the dopamine agonist apomorphine was measured as an index of the functional state of hypothalamic dopamine D2 receptors. Women who subsequently relapsed had a significantly greater growth hormone response to apomorphine than those who remained well. This was particularly marked in women with anxiety/panic. The development of increased sensitivity of hypothalamic dopamine D2 receptors in the postpartum period appears to predict the onset of depressive and anxiety disorders.     

Effects of pregnancy and delivery on serum prolyl endopeptidase (PEP) activity: alterations in serum PEP are related to increased anxiety in the early puerperium and to postpartum depression

BACKGROUND: There is now some evidence that anxiety or anxiety disorders are related to increased activity of serum prolyl endopeptidase (PEP) and that major depression is related to lower serum PEP. The aims of the present study were to examine (i) the effects of pregnancy and delivery on serum PEP and (ii) the relationships between serum PEP and postpartum depression, anxiety in the early puerperium and a past history of depression. METHODS: Serum PEP activity was measured in 11 healthy nonpregnant and in 98 pregnant women 3 days before delivery and 1 and 3 days after delivery. On the same occasions, pregnant females completed the Spielberger State Anxiety Inventory (STAI) and were divided into high and low anxiety responders, as defined by changes in the STAI. The presence of a previous depression and postpartum depression within 3 months of delivery was assessed by means of DSM-IV criteria. RESULTS: Serum PEP activity was significantly higher 1 and 3 days after delivery than before. Women with a past history of depression as well as anxiety responders had significantly increased serum PEP activity over nonpregnant women and puerperae with a negative history and anxiety nonresponders, respectively. Parturients who developed a postpartum major, but not minor, depression had significantly lower serum PEP than parturients without postpartum depression. The results were controlled for maternal and labor variables, such as type of analgesia and delivery, induction of labor, breast feeding, parity, and duration of pregnancy and labor. CONCLUSIONS: Our results show that, in puerperae, increased serum PEP is related to increased state anxiety in the early puerperium and that lowered serum PEP is related to a subsequent postpartum major depression. INTERPRETATION: The results suggest that increased serum PEP may be related to postpartum anxious blues and that lowered serum PEP may predispose toward postpartum major depression.     

Temperament and character in women with postpartum depression

Summary Objective: To investigate whether women with postpartum depression differ in personality traits from healthy postpartum women, healthy controls from the normal Swedish population and non-postpartum women with major depression. Methods: Forty-five women with postpartum depression were compared with 62 healthy postpartum women, 62 age-matched, healthy, non-postpartum women from a normal sample and 74 non-postpartum women with major depression from a clinical sample. The edinburgh postnatal depression scale was used in order to screen for postpartum depression. A clinical diagnostic interview was done including a rating with the Montgomery-Asberg depression rating scale. Personality i.e. temperament and character was measured by the temperament and character inventory. Results: Harm avoidance (HA) was higher (p < 0.001) and self-directedness (SD) scored lower (p < 0.001) in women with postpartum depression compared to healthy postpartum women. These differences were the most important differences between these two groups. Women with postpartum depression scored lower (p = 0.001) in cooperativeness (CO) and higher (p = 0.019) in self-transcendence (ST) compared to healthy postpartum women. Women with postpartum depression scored overall similar to women with major depression. Conclusion: High HA and low SD can be seen as vulnerability factors for developing a depression and especially in a stressful situation as childbirth.     

Oxytocin course over pregnancy and postpartum period and the association with postpartum depressive symptoms

During the postpartum period, women are at higher risk of developing a mental disorder such as postpartum depression (PPD), a disorder that associates with mother–infant bonding and child development. Oxytocin is considered to play a key role in mother–infant bonding and social interactions and altered oxytocin plasma concentrations were found to be associated with PPD. In the present study, we evaluated oxytocin plasma levels and depressive symptoms during pregnancy and the postpartum period in healthy women. We evaluated 100 women twice during pregnancy (weeks 35 and 38) and three times in the postpartum period (within 2 days and 7 weeks and 6 months after delivery) by measuring oxytocin plasma levels with enzyme-linked immunosorbent assay (ELISA) and assessing depressive symptoms with the Montgomery-Asberg Depression Rating Scale. Oxytocin plasma levels significantly increased from the 35th week of gestation to 6 months postpartum in all women. However, levels decreased from the 38th week of gestation to 2 days after delivery in participants with postpartum depressive symptoms, whereas they continuously increased in the group without postpartum depressive symptoms; the difference between the course of oxytocin levels in the two groups was significant (Δt2–t3: t?=?2.14; p?=?0.036*). Previous depressive episodes and breastfeeding problems predicted postpartum depressive symptoms. Our results indicate that alterations in the oxytocin system during pregnancy might be specific for women who develop postpartum depressive symptoms. Future studies should investigate whether oxytocin plasma levels might have predictive value in women at high risk for PPD.