焦虑和抑郁障碍共病的研究现状

文章对焦虑和抑郁的关系、焦虑和抑郁障碍共病的流行病学、病因学和治疗,以及共病研究的意义和影响共病研究的因素作一综述。     

焦虑和抑郁障碍共病患者与抑郁症及焦虑症患者心理健康状况对比

目的:探讨焦虑和抑郁障碍共病患者与抑郁症和焦虑症患者心理健康状况下降的差异性。方法:选取2003-06/2004-08广州市脑科医院精神科门诊首次就诊的焦虑和抑郁障碍共病患者27例、抑郁症24例和焦虑症患者29例。采用症状自评量表(问卷共90项,每个项目按5级评分,参照全国成人常模标准:因子分<1.8分为正常;1.8～2.0分为轻度异常;2.1～3.0分为中度异常;>3.0分为重度异常),对3组患者分别进行测评,记录总分和9个因子分(包括:躯体化、强迫状态、人际关系敏感、抑郁、焦虑、敌对、恐怖、偏执和精神病性),比较各组间评分的差异。结果:有24例抑郁症患者、29例焦虑症患者和27例焦虑和抑郁障碍共病患者的测评结果纳入分析。①3组患者症状自评量表总分评定结果比较:焦虑和抑郁障碍共病患者明显高于单纯抑郁症患者和焦虑症患者(2.60±0.52,1.86±0.41和1.16±0.35;t=5.76,7.91,P<0.01)。②3组患者症状自评量表各因子分评定结果比较:焦虑和抑郁障碍共病患者躯体化、强迫、人际、抑郁、焦虑、敌对、恐怖、偏执、精神病性等因子得分均显著高于焦虑组(P<0.01);焦虑和抑郁障碍共病患者除敌对外,躯体化、强迫、人际、抑郁、焦虑、恐怖、偏执、精神病性等因子得分和总分均显著高于抑郁组(P<0.01)。结论:焦虑和抑郁障碍共病患者心理健康水平较单纯抑郁症和焦虑症患者下降程度更明显。     

焦虑和抑郁障碍共病患者与抑郁症及焦虑症患者心理健康状况对比

目的：探讨焦虑和抑郁障碍共病患者与抑郁症和焦虑症患者心理健康状况下降的差异性。方法：选取2003-06／2004-08广州市脑科医院精神科门诊首次就诊的焦虑和抑郁障碍共病患者27例、抑郁症24例和焦虑症患者29例。采用症状自评量表（问卷共90项，每个项目按5级评分，参照全国成人常模标准：因子分〈1．8分为正常；1．8-2．0分为轻度异常；2．1-3．0分为中度异常；〉3．0分为重度异常），对3组患者分别进行测评，记录总分和9个因子分（包括：躯体化、强迫状态、人际关系敏感、抑郁、焦虑、敌对、恐怖、偏执和精神病性），比较各组间评分的差异。结果：有24例抑郁症患者、29例焦虑症患者和27例焦虑和抑郁障碍共病患者的测评结果纳入分析。①3组患者症状自评量表总分评定结果比较：焦虑和抑郁障碍共病患者明显高于单纯抑郁症患者和焦虑症患者（2.60&;#177;0.52，1.86&;#177;0.41和1.16&;#177;0.35；t=5.76，7．91，P〈0．01）。②3组患者症状自评量表各因子分评定结果比较：焦虑和抑郁障碍共病患者躯体化、强迫、人际、抑郁、焦虑、敌对、恐怖、偏执、精神病性等因子得分均显著高于焦虑组（P〈0．01）；焦虑和抑郁障碍共病患者除敌对外，躯体化、强迫、人际、抑郁、焦虑、恐怖、偏执、精神病性等因子得分和总分均显著高于抑郁组（P〈0．01）。结论：焦虑和抑郁障碍共病患者心理健康水平较单纯抑郁症和焦虑症患者下降程度更明显。     

焦虑、抑郁和焦虑抑郁共病社会心理因素研究及护理

目的探讨焦虑、抑郁和焦虑抑郁共病在整体护理影响因素中的心理社会因素,旨在为焦虑、抑郁和焦虑抑郁患者的整体护理有效实施提供可靠依据,对患者实施早期心理干预,改善患者心理状态,提高患者生存质量。方法利用生活事件量表（LES）、社会支持评定量表（SSRS）、家庭环境量表中文版（FES-CV）、艾森克个性问卷（EPQ）、防御方式问卷（DSQ）对61例患者进行调查评定,同时对60名医护人员作为正常对照组进行测评比较。结果抑郁组、焦虑组、共病组负性生活事件频度及生活事件总频度得分、社会支持得分、神经质得分均高于正常对照组,差异有统计学意义（P〈0．05）;共病组社会支持分高于抑郁组,与焦虑组无差别;共病组存在家庭功能缺陷,但较抑郁组和焦虑组为轻;3组患者DSQ不成熟防御机制和中间型防御机制得分高于正常对照组（P〈0．05）。结论抑郁、焦虑和焦虑抑郁一共病有着很多相似之处,都与心理社会因素有着密切的相关性,但又有各自的临床特点和表现形式,对抑郁、焦虑和焦虑抑郁共病在整体护理中心理社会因素实施护理干预提供了理论依据。     

Considerations in the management of the patient with comorbid depression and anxiety

PURPOSE: To provide clinicians with guidelines for the assessment, evaluation, diagnosis, and management of comorbid depression and anxiety in the primary care setting. DATA SOURCES: Research-based articles in the medical and psychiatric literature, literature reviews by experts in the field, and DSM-IV-TR. CONCLUSIONS: Comorbid anxiety and depression occurs at a high rate in primary care, and is costly to both the individual and to society. These patients most often present in primary care settings, have more severe symptoms, and require more health care resources. The presentation of depression and anxiety together pose complicated diagnostic and treatment challenges, leading to inadequate diagnosis and treatment resulting in unnecessary patient distress and increased utilization of health care services. IMPLICATIONS FOR PRACTICE: This article is a review of comorbid depression and anxiety with a focus upon societal and patient significance and impact, under recognition and under treatment, diagnostic challenges, medical comorbidity, treatment considerations, and educational strategies. Effective assessment, evaluation, diagnosis and treatment can lead to better treatment outcomes and improved quality of life in primary care patients.     

Women's mental health nursing: depression, anxiety and stress during pregnancy

Depression affects more women than men, with a preponderance of cases occurring during prime childbearing years (15-44 years of age). Research shows newborns and infants exposed to maternal antepartum depression, anxiety and stress exhibit pronounced neurobiobehavioral dysregularities. The present study investigated the relationship between maternal psychosocial and biochemical profiles during the antepartum period. Participants were recruited from prenatal registration at a large metropolitan hospital in the southeastern USA--the sample consisted of 59 pregnant women (mean age = 22 years). Structured clinical interviews and maternal self-report were utilized to assess maternal psychosocial distress at mid- (26-28 weeks) and late- (32-34 weeks) gestation. Salivary cortisol levels served as an objective stress measure. The resultant high incidences of maternal depression, anxiety and stress provide evidence of the need for nurses to closely monitor psychosocial and biochemical profiles of all women to thwart the negative effects on the developing human foetus. Clinical nursing implications of the requisite consideration of antepartum maternal psychosocial conditions are discussed.     

Parental depression,child mental health problems,and health care utilization

BACKGROUND: Small controlled studies suggest that depression and other mental health problems are more common in children of parents with depression than in children of parents without depression. OBJECTIVES: This article examines relationships between parental depression and children's mental health problems and health care utilization in a nationally representative household sample of parents and their children. RESEARCH DESIGN: Cross sectional comparisons of sociodemographic characteristics, mental health problems and health expenditures of children whose parents either do or do not report depression in the 1997 Medical Expenditure Panel Survey data. SUBJECTS: A nationally representative sample of children, 3 to 18 years of age (n = 8,360) with one or more parents living in the household. MEASURES: Mental health problems, total health expenditures, and mental health expenditures. RESULTS: Children of parents with depression were approximately twice as likely as children of parents without depression to have a variety of mental health problems and were 2.8 times more likely to use mental health services in adjusted analyses. Among children with health and mental health expenditures, those whose parents report depression had significantly higher mean total annual child health expenditures ($282 vs. $214, t = 3.5, P = 0.0006) and child mental health expenditures ($513 vs. $338, t = 2.0, P = 0.05) than children whose parents did not report depression. CONCLUSIONS: Children of parents with depression are at increased risk for a range of health problems. Parental depression is also related to an increased child health and mental health service utilization and expenditure.     

Minority youth in foster care: managed care and access to mental health treatment

BACKGROUND: Public sector mental health treatment has been transformed in recent years by the advent of managed care, but investigators of managed care policy have not yet focused on ethnic minority children, especially those involved with the child welfare system. Because of an overrepresentation of high-need minority children, foster care in particular is important to consider. OBJECTIVES: The present study examined children placed in foster care and documented differences between minority children and youth (black persons, Hispanic persons, and white persons) in use of mental health services. The primary concern of the study was to consider whether there were differences in access to services or service use among the groups in the transition to capitated managed care. MATERIALS AND METHODS: Medicaid claims and encounter data for two experimental managed care sites and one comparison fee-for-service site are used in a "difference-in-difference" analysis to estimate a changes in inpatient, outpatient, and residential treatment center (RTC) utilization, controlling for patient characteristics. RESULTS: The study finds persistent declines in inpatient and outpatient use for all ethnic groups, persistent under-representation of Hispanic persons and black persons in treatment regardless of managed care, and greater use of RTCs by black persons and Hispanic persons that is attributable in part to managed care. CONCLUSIONS: Black and Hispanic children received more rather than less mental health care under capitated managed care. The significance of this shift, largely increased in use of RTCs, however, cannot be determined at present, as the effectiveness of treatment delivered in RTCs is not known.     

抑郁症与抑郁焦虑障碍共病临床特征对照研究

目的探讨抑郁症与抑郁焦虑障碍共病患者的临床特征。方法对34例抑郁焦虑障碍共病患者（研究组）和44例抑郁症患者（对照组）采用自拟一般人口学资料问卷统计一般资料,采用汉密顿抑郁量表及汉密顿焦虑量表评定两组患者的抑郁和焦虑状况,对评定结果进行对比分析。结果两组患者一般人口学资料均无显著性差异;研究组汉密顿抑郁量表总分、焦虑／躯体化、认知障碍、阻滞因子分以及自杀条目分均显著高于对照组（P〈0．01～0．05）;汉密顿焦虑量表总分、躯体性焦虑、精神性焦虑因子分,以及焦虑心境、紧张、抑郁心境、肌肉系统症状、感觉系统症状、心血管系统症状、胃肠道症状、植物神经症状及会诊时行为表现单项条目分均显著高于对照组（P均〈0．01）;其他因子或条目分均无显著性差异（P〉0．05）。结论抑郁焦虑障碍共病患者较单纯抑郁症患者的抑郁和焦虑症状更严重、自杀风险大。     

舍曲林联合心理治疗抑郁和焦虑障碍共病临床研究

目的研究舍曲林联合心理治疗治疗抑郁、焦虑障碍共病的疗效及安全性。方法将58例抑郁、焦虑障碍共病患者随机分为舍曲林联合心理治疗组和单用舍曲林治疗组各29例进行对照研究．疗程8w．采用汉密顿焦虑量表、汉密顿抑郁量表及药物副作用量表评定临床疗效和不良反应。结果研究组抗焦虑、抗抑郁起效均较对照组快（P〈0．05或0．01）,抗焦虑疗效优于对照组（P〈0．05）,治疗8w末两组抗抑郁疗效相当。结论舍曲林联合心理治疗治疗抑郁、焦虑障碍共病起效快,疗效显著,安全性高,依从性好。     

脑性瘫痪儿童父母焦虑及抑郁心理健康状况的临床研究

目的:分析比较痉挛型和不随意运动型脑瘫儿童父母焦虑及抑郁心理健康状况的特点,探讨父母焦虑及抑郁状况对脑瘫儿童康复治疗效果的影响。方法:采用Zung氏焦虑自评量表(SAS)、Zung氏抑郁自评量表(SDS)和自拟父母行为量表,对2019年1月—2019年10月在佳木斯大学附属第三医院确诊的100例痉挛型和不随意运动型脑瘫儿童父母(主要照料者)进行问卷调查。根据SAS和SDS结果,在父母焦虑抑郁组抽取痉挛型和不随意运动型脑瘫儿童各10例(共20例)为观察组,父母无焦虑抑郁组抽取痉挛型和不随意运动型脑瘫儿童各10例(共20例)为对照组。两组均接受常规康复治疗。于治疗前、治疗8周后采用粗大运动功能测试88项(GMFM-88)、儿童功能独立性测量(WeeFIM)、儿童生活质量量表3.0脑瘫模块简体中文版(PedsQL~(TM)3.0)评估。结果:痉挛型和不随意运动型脑瘫儿童父母焦虑及抑郁的心理健康状况特点有所不同。治疗8周后,两组GMFM-88评分、WeeFIM评分及PedsQL~(TM)3.0评分较治疗前均明显提高(P0.01)。治疗后两组GMFM-88评分无显著性差异(P0.05),但对照组WeeFIM评分及PedsQL~(TM)3.0评分均优于观察组(P0.05)。结论:两种类型脑瘫儿童父母焦虑及抑郁状况存在差别,父母焦虑抑郁状况对脑瘫儿童的功能独立性和生活质量产生消极影响,可能影响脑瘫儿童身心全面康复进程。     

中西医结合治疗脑卒中后焦虑抑郁共病临床分析

目的观察中西医结合治疗脑卒中后焦虑抑郁共病 (PSCAD)的临床疗效。方法对 35例PSCAD患者采用中西医结合治疗 ,并辅以康复治疗和心理治疗。在治疗前后采用焦虑自评量表 (SAS)、抑郁自评量表 (SDS)对患者进行测评 ,并对所获资料进行统计学分析。结果治疗后 ,患者焦虑、抑郁症状的消失率为 74.2 9% ;SAS、SDS标准分均数值均显著下降 (P <0 .0 0 1 ) ;各项目所引出的症状得分均数值亦明显下降。结论中西医结合治疗PSCAD可取得较好疗效     

米氮平治疗焦虑抑郁障碍共病临床研究

目的探讨米氮平治疗焦虑抑郁障碍共病的临床疗效及安全性。方法将49例焦虑抑郁障碍共病患者随机分为两组,研究组23例,脱落1例,对照组26例,脱落3例。研究组服用米氮平治疗,对照组服用阿米替林治疗。观察6w。于治疗前及治疗6w末采用汉密顿焦虑量表,汉密顿抑郁量表,副反应量表评定临床疗效及不良反应。结果研究组显效率为68%,对照组为65%(χ2=0.044,P>0.05);汉密顿焦虑量表、汉密顿抑郁量表评分,两组治疗6w末较治疗前均有极显著性下降(P均<0.01),同期两组间比较均无显著性差异(P均>0.05)。研究组不良反应发生率显著低于对照组(P<0.05或0.01)。结论米氮平治疗焦虑抑郁障碍共病疗效与阿米替林相当,但安全性更高,依从性好。     

Primary health care practitioners' tools for mental health care

The purpose of this study was to describe and analyse the content of mental health care from the practitioner's point of view. The specific aim of this paper was to outline the types of mental health care tools and the ways in which they are used by primary health care practitioners. The data were derived from interviews with doctors and nurses (n = 29) working in primary health care in six different health care centres of the Pirkanmaa region in Finland. The data were analysed by using qualitative content analysis. The tools of mental health care used in primary health care were categorized as communicative, ideological, technical and collaborative tools. The interactive tools are either informative, supportive or contextual. The ideological tools consist of patient initiative, acceptance and permissiveness, honesty and genuineness, sense of security and client orientation. The technical tools are actions related to the monitoring of the patient's physical health and medical treatment. The collaborative tools are consultation and family orientation. The primary health care practitioner him/herself is an important tool in mental health care. On the one hand, the practitioner can be categorized as a meta-tool who has control over the other tools. On the other hand, the practitioner him/herself is a tool in the sense that s/he uses his/her personality in the professional context. The professional skills and attitudes of the practitioner have a significant influence on the type of caring the client receives. Compared with previous studies, the present informants from primary health care seemed to use notably versatile tools in mental health work. This observation is important for the implementation and development of mental health practices and education.