致炎细胞因子与抑郁障碍的相关性研究进展

抑郁障碍的发病机制和病因目前尚不清楚,目前越来越多的研究发现,细胞因子与抑郁障碍的发生发展存在着相关,本文就目前主要的致炎细胞因子与抑郁障碍的相关性进行综述。     

抑郁障碍患者自杀行为研究进展

自杀是抑郁障碍的常见并发症,同时也是抑郁障碍患者的主要死亡原因之一,本文对国内外抑郁障碍患者自杀行为的流行病学特点、相关因素等方面的研究进行了综述.     

未治疗抑郁障碍患者自杀风险与认知情绪调节策略的关系

目的探讨具有自杀风险的抑郁障碍患者在认知情绪调节策略方面的特征及其影响因素,以早期识别具有自杀风险的患者,有针对性地给予干预。方法选取117例来自北京回龙观医院门诊、经简明国际神经精神访谈(MINI)5. 0中文版筛查符合抑郁障碍诊断标准的未治疗抑郁障碍患者,根据MINI 5. 0中文版自杀模块的访谈结果,将患者分为自杀风险组(n=52)和无自杀风险组(n=65)。采用认知情绪调节问卷(CERQ-C)进行认知调节策略的测评,采用汉密尔顿抑郁量表17项版(HAMD-17)评定抑郁症状的严重程度。结果抑郁障碍患者自杀风险发生率为44. 4%(52/117)。与无自杀风险组相比,自杀风险组患者更多见于女性、未婚、平均年龄更小、发病年龄更早、HAMD-17总评分更高、伴精神病性症状率较高,自杀风险组自我责难、接受、沉思、灾难化4个认知调节策略维度及消极认知情绪调节评分均高于无自杀风险组(P均<0. 05)。Logistic回归分析显示,女性(OR=3. 539,95%CI:1. 383~9. 057)、发病年龄(OR=0. 931,95%CI:0. 895~0. 968)、HAMD-17总评分(OR=1. 207,95%CI:1. 063~1. 370)和灾难化(OR=1. 143,95%CI:1. 002~1. 305)与抑郁障碍患者自杀风险相关(P均<0. 05)。结论女性、发病年龄早、抑郁症状严重和灾难化可能为未治疗抑郁障碍患者自杀风险的危险因素。     

心理剧治疗转变抑郁障碍患者自杀态度的对照研究

目的探讨用心理剧治疗方法,引导出抑郁障碍患的自发性(自我教育),从而封自己产生新的认识并改变封自杀的态度,达到预防自杀的效果。方法在心理剧展开过程中,使患的心理冲突和情绪问题逐渐呈现,达到精神发泄和提高自信,并转变封自救的负性态度。心理剧治疗前后用自尊量表(SES)和自杀态度问卷(QSA)评分。结果心理剧治疗后自尊量表分明显提高,自杀态度问卷都从负性态度转变为正性态度,与治疗前比较差异显,随访中治疗组的复发再入院率略低。结论心理剧治疗能提高自信,使抑郁障碍患对自杀态度从负性向正性转变．     

重性抑郁障碍患者血清胆固醇水平与抑郁、自杀意念的相关分析

目的:探讨重性抑郁障碍(MDD)患者血清总胆固醇(TC)水平与抑郁、自杀意念的相关性。方法:收集108例MDD患者的一般及临床资料,检测其血清TC水平,并据此分为TC异常组和TC正常组,采用汉密尔顿抑郁量表-17项(HAMD-17)、自杀意念自评量表(SIOSS)对两组患者进行评定;采用Logistic回归方法对各相关因素进行分析。结果:入组的MDD患者中,44例(40. 7%)入TC异常组,64例入TC正常组; TC异常组HAMD-17总分及其中焦虑/躯体化、认知障碍、睡眠障碍因子分、以及SIOSS总分显著高于TC正常组(P均0. 01);以血清TC水平为因变量的Logistic回归分析显示,HAMD中的焦虑/躯体化因子和SIOSS总分纳入方程(P 0. 05或P 0. 01)。结论:MDD患者血清TC水平越高,其焦虑/躯体化症状和自杀意念越重。     

血脂水平及血脂综合指标与抑郁障碍患者自杀意念、临床特征的关系

目的:探讨血脂水平及血脂综合指标与抑郁障碍(MDD)患者自杀意念及临床特征的关系。方法:根据汉密尔顿抑郁量表17项(HAMD-17)条目3"自杀"评分≥1为界将122例首发MDD患者分为有自杀意念组(94例)及无自杀意念组(28例);对两组人口学资料、HAMD-17各维度评分、血脂水平[总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)]及血脂综合指标[动脉硬化指数(AI)、血浆致动脉硬化指数(AIP)、脂蛋白结合指数(LCI)]进行比较;采用Pearson相关分析研究差异指标与自杀意念等临床特征的关系。结果:有自杀意念组TG和LCI明显低于无自杀意念组(P均<0.05)。血清TG水平与HAMD-17条目3的得分呈负相关(r=-0.221,P=0.015),与睡眠障碍因子分呈正相关(r=0.238,P=0.008)。患者LCI与HAMD-17条目3的得分(r=-0.260,P=0.004)及认知障碍因子分(r=-0.192,P=0.034)呈负相关,与睡眠障碍因子分呈正相关(r=0.203,P=0.025)。结论:血清TG水平和LCI降低与MDD患...     

人类免疫缺陷病毒感染者抑郁障碍、自杀风险和日常生活能力的研究

目的研究人类免疫缺陷病毒(H IV)感染者抑郁症和自杀观念的流行情况及其与日常生活能力改变的关联。方法对28例H IV阳性者及23例H IV阴性者,用复合性国际诊断用检查提纲中文版调查抑郁症的总发生率和自杀史,用贝克抑郁问卷(BD I)评估当前抑郁障碍及自杀风险的严重程度,用日常生活能力问卷(ADL)评估H IV感染对日常生活能力的影响。结果(1)H IV阳性组和H IV阴性组中分别有22例(79%)和1例(4%)符合抑郁症的诊断标准(P<0.001);H IV阳性组BD I总分[(22.4±12.7)分]高于H IV阴性组[(6.6±7.8)分;P<0.001]。(2)H IV阳性组和H IV阴性组中分别有18例(64%)和2例(9%)有过自杀观念。(3)H IV阳性组ADL总分[(17.1±5.2)分]高于H IV阴性组[(14.0±0.0)分;P<0.001]。(4)BD I与H IV状况的交互作用是有显著贡献(F=23.95,P<0.001)的自变量,抑郁障碍与H IV状况的相互作用是有意义(F=13.29,P=0.001)的预测因子。结论H IV感染的人群中抑郁症的发生率及自杀风险均较高,抑郁的严重程度和日常生活能力受损有显著相关性。     

社会支持对重性抑郁障碍患者自杀意念的影响

目的探讨社会支持对重性抑郁障碍(MDD)患者自杀意念的影响,为临床降低其自杀意念、减少自杀行为的发生提供参考。方法采用二阶段调查法,以在武汉市精神卫生中心门诊就诊的、符合《精神障碍诊断与统计手册(第4版)》(DSM-IV)诊断标准的1135例MDD患者为研究对象。采用患者健康问卷抑郁量表(PHQ-9)、社会支持评定量表(SSRS)进行调查,采用二元Logistic回归分析探讨MDD患者自杀意念的影响因素。结果1135例MDD患者中,有688例(60.62%)存在自杀意念,有自杀意念者PHQ-9评分高于无自杀意念者,差异有统计学意义[(14.18±5.02)分vs.(11.07±4.61)分,t=10.497,P<0.01]。有自杀意念者的主观支持、对支持的利用度及SSRS总评分均低于无自杀意念者,差异均有统计学意义(P均<0.01)。以自杀意念为因变量,以客观支持、主观支持、对支持利用度及PHQ-9评分为自变量的二元Logistic回归模型为logit(P)=-0.286+0.026X1-0.035X2-0.063X3+0.128X4,其中主观支持和抑郁均对自杀意念有预测作用(B=-0.035、0.128,P<0.05或0.01)。结论存在抑郁症状及缺乏社会支持(尤其是主观支持)可能是MDD患者出现自杀意念的危险因素。     

述情障碍与抑郁关系的研究进展

述情障碍以不能识别情感、描述情感、不能与他人交流情感、缺乏幻想和外向性思维为特点。有的学认为述情障碍是一种稳定的人格特质，是抑郁症的易感因素，也有的学认为述情障碍是抑郁症的一种状态反应。本旨在对有关述情障碍与抑郁之间关系的研究献进行综述。     

抑郁障碍患者自杀未遂的危险因素分析

目的:分析抑郁障碍(MDD)患者自杀未遂的危险因素。方法:入组332例MDD患者,分为自杀未遂组(95例)和非自杀未遂组(237例);对入组者进行人口学与临床资料调查、汉密尔顿抑郁量表(HAMD-24)及汉密尔顿焦虑量表(HAMA-14)评估及血清甲状腺功能检测,并进行组间比较;分析自杀未遂的危险因素。结果:自杀未遂组年龄、首次发病年龄明显小于非自杀未遂组,病程、既往住院次数明显多于非自杀未遂组;单身、无业、受教育程度低、家族史阳性、伴有精神病性症状、共病焦虑障碍比率明显高于非自杀未遂组(P<0.05或P<0.01)。HAMD总分与焦虑躯体化、认知障碍、阻滞、绝望感、体质量、日夜变化因子分及HAMA评分明显高于非自杀未遂组(P<0.05或P<0.01)。血清游离三碘甲状腺原氨酸(FT3)水平明显高于非自杀未遂组(P<0.05)。多因素Logistic回归分析显示,伴有精神病性症状、既往住院次数、HAMD评分中认知障碍、绝望感因子是影响抑郁症患者自杀未遂的主要危险因素。结论:伴有精神病性症状、既往住院次数、HAMD评分中的认知障碍、绝望感因子可能为MDD患者...     

Blood levels of cytokines in elderly patients with major depressive disorder

Plasma concentrations of interleukin-iβ (IL-lβ), interleukin-6 (IL-6) and tumour necrosis factor a (TNFα) were measured in 10 elderly women with major depressive disorder (MDD) and in two groups of controls, one consisting of 10 age-matched healthy female volunteers and one consisting of 10 young healthy female volunteers. The cytokine concentrations were measured in MDD patients before and after 30 days of treatment with phosphatidylserine (BC-PS), 600 mg daily p.o. The plasma IL-1β IL-6 and TNFα concentrations did not differ significantly in young controls, elderly controls and MDD patients. BC-PS therapy, while significantly improving the depressive symptoms, did not alter the cytokine concentrations.     

Proteomic analysis of the CSF in unmedicated patients with major depressive disorder reveals alterations in suicide attempters

Abstract This is the first report on proteomic analysis of the cerebrospinal fluid (CSF) in unmedicated suicide attempters and non-attempters with major depressive disorder.Two-dimensional (2D) gel electrophoresis revealed that suicide attempters differed from non-attempters in one protein with an approximate molecular weight of 33 kD and an isoelectric point of 5.2. Proteomic analysis of the CSF is a promising non hypothesis-driven screening method for the detection of new candidate genes in neurobiological suicide research.     

Indicators of pretreatment suicidal ideation in adults with major depressive disorder

Morris DW, Trivedi MH, Husain MM, Fava M, Budhwar N, Wisniewski SR, Miyahara S, Gollan JK, Davis LL, Daly EJ, Rush AJ. Indicators of pretreatment suicidal ideation in adults with major depressive disorder. Objective: In order to evaluate the presence of treatment emergent suicidal ideation (SI), it becomes necessary to identify those patients with SI at the onset of treatment. The purpose of this report is to identify sociodemographic and clinical features that are associated with SI in major depressive disorder (MDD) patients prior to treatment with a selective serotonin reuptake inhibitor. Method: This multisite study enrolled 265 out‐patients with non‐psychotic MDD. Sociodemographic and clinical features of participants with and without SI were compared post hoc. Results: Social phobia, bulimia nervosa, number of past depressive episodes, and race were independently associated with SI by one or more SI measure. Conclusion: Concurrent social phobia and bulimia nervosa may be potential risk factors for SI in patients with non‐psychotic MDD. Additionally, patients with more than one past depressive episode may also be at increased risk of SI.     

伴非典型特征的抑郁症患者自杀未遂的危险因素分析

目的探讨伴非典型特征抑郁症患者自杀未遂的社会人口学及临床特征方面危险因素。方法来自全国13个中心的1172例抑郁症患者,纳入其中179例伴非典型特征患者,依据简明国际神经精神访谈(the Mini International Neuropsychiatric Interview,MINI)5.0中文版自杀模块的访谈结果,分为自杀未遂组和无自杀未遂组,通过多因素logistic回归分析伴非典型特征的抑郁症患者在性别、年龄等社会人口学资料及伴焦虑症状、伴精神病性症状等临床特征方面可能与自杀未遂相关的危险因素。结果伴非典型特征抑郁症患者自杀未遂的发生率为23.5%(42/179)。与无自杀未遂组患者相比,自杀未遂组患者更多伴有自杀观念、产后起病,更常使用抗抑郁剂以外的其他药物治疗(如抗精神病药、情感稳定剂及苯二氮类药)(均P0.05)。多因素logistic回归分析显示,既往住院次数(OR=1.730,95%CI:1.093~2.740)和自杀观念(OR=3.899,95%CI:1.506~10.092)与伴非典型特征的抑郁症患者发生自杀未遂相关(均P0.05)。结论既往住院次数多及伴有自杀观念是伴非典型特征抑郁症患者自杀未遂的主要危险因素。     

Progress and challenges in research of the mechanisms of anhedonia in major depressive disorder

There is an increasing heavy disease burden of major depressive disorder (MDD) globally. Both high diagnostic heterogeneity and complicated pathological mechanisms of MDD pose significant challenges. There is much evidence to support anhedonia as a core feature of MDD. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, anhedonia is further emphasised as a key item in the diagnosis of major depression with melancholic features. Anhedonia is a multifaceted symptom that includes deficits in various aspects of reward processing, such as anticipatory anhedonia, consummatory anhedonia, and decision-making anhedonia. Anhedonia is expected to become an important clinicopathological sign for predicting the treatment outcome of MDD and assisting clinical decision making. However, the precise neurobiological mechanisms of anhedonia in MDD are not clearly understood. In this paper, we reviewed (1) the current understanding of the link between anhedonia and MDD; (2) the biological basis of the pathological mechanism of anhedonia in MDD; and (3) challenges in research on the pathological mechanisms of anhedonia in MDD. A more in-depth understanding of anhedonia associated with MDD will improve the diagnosis, prediction, and treatment of patients with MDD in the future.     

Down-rating lifetime suicide risk in major depression

For 25 years the medical profession has accepted that of every 100 individuals with major depressive disorder (MDD), 15 subjects will ultimately commit suicide. The present paper demonstrates that the lifetime suicide risk in this condition cannot be so high. Conservative age-specific calculations give a lifetime suicide risk in MDD of 3.5%. Selection of hospital-based, high suicide risk, study populations in the index research, when most sufferers are out-patients, is the primary contributor to the overestimation of suicide risk. Evolving classification systems are a further factor. In terms of suicide risk, MDD is not a homogenous diagnostic category. As has been reliably replicated, the small subgroup of patients who have experienced hospital admission do experience a much greater lifetime suicide risk.     

Magnetic motor threshold and response to TMS in major depressive disorder

OBJECTIVE: The aim of this study was to examine motor threshold (MT) during treatment with transcranial magnetic stimulation (TMS). METHOD: The TMS was administered to 46 patients with depression and 13 controls. TMS was performed at 90% power of measured MT. The stimulation frequency was 10 Hz for 6 s, for 20 trains, with 30 s inter-train intervals. The trial included 20 sessions. Patients and controls were assessed on various outcome measures. RESULTS: The MT values were comparable between patients and controls. Neither demographic nor clinical variables were factors in determining MT. MT was not shown to have any predictive value regarding outcome of treatment. CONCLUSION: In this study, MT at baseline or changes in MT during the treatment period were not able to discriminate between patients and controls and were not found to have any predictive value with regard to treatment outcome.