更年期妇女抑郁症状综合康复治疗

目的:观察综合康复治疗(雌激素、抗抑郁药物联合心理干预)对更年期妇女抑郁症状的临床疗效。方法:随机选取62例有抑郁症状的更年期妇女,治疗组33例给予雌激素(利维爱)、选择性5-羟色胺再摄取抑制剂(氟西汀)联合心理干预治疗,对照组29例给予雌激素(利维爱)治疗,结合抑郁自评量表(Zung量表)、汉密顿抑郁量表(HAMD)评分对两组患者进行抑郁症状的诊断和6周后的疗效评估。结果:两组患者Zung量表、HAMD评分治疗后均减分明显,且有非常显著性差异(P<0.01),治疗后两组间比较有显著性差异(P<0.01)。结论:综合康复治疗更年期妇女抑郁症状有较好的疗效。     

合用帕罗西汀治疗功能性消化不良的临床研究

目的 探讨合用抗抑郁药物帕罗西汀对伴有抑郁焦虑障碍的功能性消化不良(FD)的临床疗效.方法 将52例伴有抑郁焦虑障碍的FD患者随机分为常规组及抗抑郁组,每组各26例,疗程均为4周,观察治疗前后FD症状评分及Zung抑郁自评量表(SDS)、焦虑自评量表(SAS)评分变化.结果 治疗4周后抗抑郁组各项评分均显著下降(P<0.01),而常规组无明显改变(P>0.05);抗抑郁组总有效率为84.6%,SDS、SAS评分达常模范围的疗效为88.5%、84.6%,而常规组总有效率为30.8%,SDS、SAS评分达常模范围的疗效均为11.5%,差异均有统计学意义(P<0.01).结论 对伴有抑郁焦虑障碍的FD常规治疗效果欠佳,而合用抗抑郁药物帕罗西汀并辅以心理疏导治疗,既能显著改善症状,又能控制抑郁焦虑障碍.     

雌激素对妇女围绝经与绝经期抑郁障碍的影响

目的 探讨围绝经期与绝经期抑郁障碍妇女的雌激素水平以及用雌激素治疗妇女围绝经期与绝经期抑郁障碍的效果.方法 采用磁酶联免疫技术检测了30例围绝经期和绝经期抑郁障碍妇女血清雌激素、卵泡刺激素、黄体生成素水平.用雌激素(单用组)或联合应用抗抑郁药物(联合组)治疗围绝经期和绝经期抑郁障碍妇女,并用Hamiltom抑郁量表评估抑郁症状的治疗效果;用围绝经期及绝经期症状评分量表评估围绝经期和绝经期症状的治疗效果.结果 围绝经期与绝经期抑郁障碍妇女血清雌激素水平明显低于正常围绝经期及绝经期妇女(P＜0.05).治疗后两组Hamiltom抑郁量表总分均明显下降(P＜0.001);联合组和单用组的减分率分别为70.53%和58.24%,两组比较有显著性差异(P＜0.05).联合组和单用组的总有效率分别为93.33%和80%,联合组高于单用组,但无统计学意义(P＞0.05).治疗后两组围绝经期及绝经期症状评分均明显下降,差异非常显著(P＜0.001);联合组和单用组的减分率(73.99%和70.66%)、联合组和单用组的总有效率(96.67%和93.33%)也无明显差异(P＞0.05).结论 围绝经期与绝经期抑郁障碍的发生与雌激素水平的降低有关,因此采用雌激素治疗围绝经期与绝经期抑郁障碍可以取得良好的效果.受雌激素水平的影响,在原来抗抑郁药物的基础上,联合应用雌激素对提高疗效的作用更明显.     

应用激素替代治疗的围绝经期妇女抑郁焦虑症状调查

目的:以未采用激素替代治疗(hormone replacement therapy,HRT)的围绝经期妇女作为对照,了解同期应用HRT妇女的抑郁、焦虑症状发生情况。方法:在就诊于更年期专业门诊、既往无精神障碍及其他系统疾病史的40-60岁妇女中,选取未用HRT、测血FSH>40 Iu／L的90名妇女和应用HRT疗程长于4个月、有围绝经期综合征表现的89名妇女,采用17项汉密顿抑郁量表和汉密顿焦虑量表对每位患者进行评分。结果:两组间抑郁、焦虑评分差异显著,应用HRT组分数明显低于未用组。结论:HRT对抑郁、焦虑等情绪症状可能有积极的改善作用。     

合用帕罗西汀治疗功能性消化不良的临床研究

目的探讨合用抗抑郁药物帕罗西汀对伴有抑郁焦虑障碍的功能性消化不良（FD）的临床疗效。方法将52例伴有抑郁焦虑障碍的FD患者随机分为常规组及抗抑郁组，每组各26例，疗程均为4周，观察治疗前后FD症状评分及Zung抑郁自评量表（SDS）、焦虑自评量表（SAS）评分变化。结果治疗4周后抗抑郁组各项评分均显著下降（P〈0．01），而常规组无明显改变（P〉0．05）；抗抑郁组总有效率为84．6％，SDS、SAS评分达常模范围的疗效为88．5％、84．6％，而常规组总有效率为30．8％，SDS、SAS评分达常模范围的疗效均为11．5％，差异均有统计学意义（P〈0．01）。结论对伴有抑郁焦虑障碍的FD常规治疗效果欠佳，而合用抗抑郁药物帕罗西汀并辅以心理疏导治疗，既能显著改善症状，又能控制抑郁焦虑障碍。     

应用激素替代治疗的围绝经期妇女抑郁焦虑症状调查

目的:以未采用激素替代治疗(hormone replacement therapy,HRT)的围绝经期妇女作为对照,了解同期应用HRT妇女的抑郁、焦虑症状发生情况.方法:在就诊于更年期专业门诊、既往无精神障碍及其他系统疾病史的40～60岁妇女中,选取未用HRT、测血FSH＞40 IU/L的90名妇女和应用HRT疗程长于4个月、有围绝经期综合征表现的89名妇女,采用17项汉密顿抑郁量表和汉密顿焦虑量表对每位患者进行评分.结果:两组间抑郁、焦虑评分差异显著,应用HRT组分数明显低于未用组.结论:HRT对抑郁、焦虑等情绪症状可能有积极的改善作用.     

黛力新治疗女性更年期功能性消化不良的临床研究

目的:探讨黛力新治疗女性更年期功能性消化不良的疗效及安全性。方法:以症状自评量表(SCL-90)、Zung氏抑郁自评量表(SDS)、焦虑自评量表(SAS)对65例女性更年期功能性消化不良(FD)患者进行问卷调查,评测患者心理障碍发生情况。有焦虑或抑郁的患者32例,予以黛力新治疗4周,比较治疗前后症状改善程度及焦虑和抑郁评分。结果:更年期女性FD患者的躯体症状、抑郁、焦虑的积分较高,与同龄健康人比较差异有显著性意义(P<0·05);经黛力新治疗后症状改善明显,与治疗前相比SDS,SAS评分差异有显著性意义(P<0·05);无明显不良反应发生。结论:精神心理因素可能与女性更年期FD的发病有关,对此类患者应加强心理治疗。黛力新对伴有焦虑和抑郁的FD患者疗效确切,安全性好。     

功能性消化不良合并抑郁焦虑患者的临床心理干预及其效果

目的 探讨心理干预在功能性消化不良(FD)合并抑郁焦虑治疗中的作用.方法 将96例FD合并抑郁焦虑患者随机分为常规治疗组(对照组)和常规治疗加心理干预组(治疗组),每组各48例,对照组给予抗消化不良治疗,治疗组在此基础上结合心理干预治疗.治疗前后对两组患者进行抑郁自评量表(SDS)和焦虑自评量表(SAS)评分,并计算FD症状积分,对两组疗效及评分进行比较.结果 治疗组FD总有效率为83.33%(40/48),对照组FD总有效率为45.83%(22/48),两组比较差异有统计学意义(X~2=17.20,P<0.01);治疗组FD症状积分和SAS、SDS评分均明显好于对照组,差异有统计学意义(P<0.05);治疗组的SAS、SDS评分较治疗前有显著降低,而对照组改变不明显.结论 心理干预能明显改善FD合并抑郁焦虑患者的消化不良症状和抑郁焦虑症状.     

药物及情感干预治疗更年期妇女抑郁症状89例临床观察研究

观察2006年2月～2008年8月前来我中心咨询及就诊的89例更年期妇女抑郁症患者，年龄45～55岁，平均年龄（48．2&#177;3．6）岁。给心理治疗结合百优解、尼尔雌醇激素替代治疗对治疗前后进行Gteen更年期量表疗效评定。治疗8周后，对Green更年期量表进行焦虑症状、抑郁症状、躯体不适症状、血管舒缩症状、性兴趣各因素进行评定，结果显示评分显著降低，疗效佳，值得推广应用。     

认知疗法在治疗女性更年期综合征中的作用

目的：探讨认知疗法在治疗女性更年期综合征上的作用。方法：采用认知疗法合并药物治疗与单纯药物治疗进行疗效对比。用症状自评量表（SCL-90）评定。结果：将两组治疗前与治疗后SCL-90总分及因子分进行比较，结果发现，A组的躯体化、抑郁、焦虑、其他因子分和总分在治疗结束后均显著降低，B组只有抑郁、焦虑因子分显著降低。两组间比较有显著性差异。结论：认知疗法合并抗抑郁剂治疗女性更年期综合征能取得较理想效果。而单纯抗抑郁剂治疗仅能缓解患者的部分症状，远期疗效不理想，易复发。     

Mental health in F-111 maintenance workers: the study of Health Outcomes in Aircraft Maintenance Personnel (SHOAMP) general health and medical study

OBJECTIVE: We sought to contrast mood disorder symptoms in F-111 aircraft Deseal/Reseal maintenance personnel with appropriate comparisons. METHODS: Participants completed a comprehensive health assessment, including measures of mood disorder, self-reported mood symptom questionnaire items, and review of anxiolytic and depression medication. Multiple logistic regression was conducted for each outcome using exposure group and potential confounders as explanatory variables. RESULTS: There was high agreement between self-reported mood disturbance and objective tests. The exposed group was more likely to self-report previous diagnoses of depression/anxiety, had higher use of antidepressant medications, and had increased risk of diagnosis of depression/anxiety. Results were consistently strong against both comparison groups, with the exposed more likely to have mental distress and social dysfunction when compared with the Australian population. CONCLUSIONS: There is robust evidence for an association between F-111 Deseal/Reseal exposure and impaired mental health.     

慢性宫颈炎患者宫颈癌筛查过程中情绪障碍的调查分析

目的探讨慢性宫颈炎患者在进行宫颈癌筛查过程中情绪障碍发病率及可能的干预措施。方法采用HAMD、HAMA、SCL-90对患者的情绪障碍进行评定，采用健康教育的方式提高患者对疾病的认识，树立正确的健康观念，及结合心理治疗进行治疗。结果情绪障碍的发病率为39％，通过干预后，抑郁及焦虑症状得到明显缓解。结论宫颈炎患者情绪障碍发病率较高，采用健康教育及心理治疗相结合的方式进行干预效果明显。     

HRT and everyday memory at menopause: a comparison of two samples of mid-aged women

Research on the effect of hormone replacement therapy (HRT) on memory in mid-aged women is equivocal although findings indicate that oestrogen may enhance verbal memory. Mood may mediate the relationship between HRT and memory. This study examined the effect of HRT on mood and everyday memory in two samples of women between ages 40 and 60 years. In the cross-sectional comparison (N = 124), HRT users performed significantly better on tests of everyday and verbal memory. A within-woman comparison of 17 women showed that everyday memory, working memory, and delayed verbal memory improved after 3 months of HRT use. The improvement in memory was not mediated by mood. These results suggest that any effect of HRT on mood may be short-term but that some aspects of everyday memory are enhanced, particularly verbal memory. The development of the everyday.     

艾司西酞普兰治疗持续性躯体形式疼痛障碍的随机对照研究

目的 研究艾司西酞普兰治疗持续性躯体形式疼痛障碍的疗效和安全性.方法 采用随机对照、开放性设计,将门诊接受治疗的持续性躯体形式疼痛障碍患者随机分为两组,即治疗组(艾司西酞普兰组)40例,对照组(文拉法辛缓释剂组)40例,疗程6周,于治疗前及治疗后第1,2,4,6周末进行疗效评定,以汉密尔顿抑郁量表(HAMD)汉密尔顿焦虑量表(HAMA)减分情况评定疗效,不良反应症状量表(TESS)评定不良反应.结果 艾司西酞普兰与文拉法辛缓释剂治疗持续性躯体形式疼痛障碍均有疗效.治疗组与对照组的自觉症状缓解时间均缩短,临床疗效明显.HAMD,HAMA评分差异均无统计学意义.两组治疗6周后有效率(以减分率≥50％为标准)分别为:治疗组80％,对照组85％,P＞0.05.两组不良反应在第1周末对照组评分高于治疗组,两组差异有统计学意义(P＜0.01).结论 持续性躯体形式疼痛障碍患者多存在焦虑抑郁情绪,而使用艾司西酞普兰10 mg/d起效快,不良反应发生率低,安全性良好.     

Demographic characteristics, menopausal status, and depression in midlife immigrant women

The purpose of this cross-sectional analysis is to examine symptoms of depressed mood in relation to age, menopausal status, and length of residence in the United States in midlife women who are recent immigrants from the former Soviet Union. Data for this analysis are from a longitudinal study of the impact of acculturation on postimmigration health status and psychological well-being. The mean score for the Center for Epidemiological Studies-Depression (CES-D) scale was 23.56, with 77.3% of the women obtaining a score greater than the usual screening cutoff score for referral. Women taking antidepressant medications had a mean score of 30.52. CES-D scores varied significantly by age group. The lowest CES-D scores were reported by women aged 40-50, and women aged 55-60 had significantly higher scores than younger women and those over 65 years old. Total CES-D scores did not vary significantly by length of residence in United States or use of hormone therapy. Regression analysis indicated that even when use of antidepressant medication was held constant, age and residence in the United States were significant independent contributors to CES-D score: women who were older, had lived fewer years in the United States, and those who took antidepressants had higher CES-D scores. Cultural and immigration-related explanations for high scores on the depression scale are suggested.     

Quality of life and menopause: the role of estrogen

The use of estrogen or hormone replacement therapy (ERT/HRT) in preventing disease in menopausal women has been well documented. Less attention has been paid to the menopausal symptoms that can impair the quality of life of menopausal women, such as hot flushes, sleep disorders, sexual dysfunction, and alterations in mood. Researchers have used a variety of methods to investigate these concerns. Decreases in ovarian hormones that occur with menopause have been implicated in these symptoms. Ovarian hormones affect the central nervous system and urogenital tissues directly via receptors for estrogen, progesterone, and androgens. Changes in the symptoms of menopause consequential to estrogen therapy reflect the effect of this therapy on these tissues. Evidence supporting the effectiveness of ERT/HRT in the treatment of symptoms affecting quality of life is growing and supports the use of ERT/HRT during menopause. Because the most dramatic hormonal changes associated with menopause are related to estrogen and because estrogen is usually coadministered with a progestogen in patients with an intact uterus, this review is focused primarily on ERT/HRT. Because androgen therapy may also improve quality of life by enhancing perimenopausal and postmenopausal sexual desire, function, and general well-being, a brief discussion of androgen supplementation of ERT/HRT is also included. The ideal doses and combinations of hormones must be determined on an individual basis, taking into consideration benefits, risks, and interactions of the different hormone therapies.     

Improved detection of depression in primary care through severity evaluation

OBJECTIVES: To determine whether the use of a symptom severity measure to augment an existing Diagnostic and Statistical Manual of Mental Disorders-Third Edition, Revised (DSM-III-R) criteria-based depression screener (PRIME-MD) would decrease the difficulties associated with depression screening in primary care by filtering out patients with minimal impairment. STUDY DESIGN: The study design was secondary data analysis. POPULATION: The study sample comprised 1317 patients, with intentional oversampling by ethnicity and sex, presenting for routine care at a university family practice center in Galveston, Texas. OUTCOMES MEASURED: The primary outcomes were cross-sectional, health-related quality-of-life outcomes of subjects who met symptom severity criteria as well as criteria for a DSM-III-R mood disorder. Health care utilization outcomes were examined as secondary outcomes. RESULTS: The combination of a 6-item depression severity instrument and the PRIME-MD resulted in 71% of depressed subjects being categorized as severely symptomatic and 29% as minimally symptomatic. Severely symptomatic subjects had significantly worse SF-36 Mental Health Component Summary scale (MCS) scores than did minimally symptomatic subjects (32.8 vs 43.5, P <.05). Minimally symptomatic subjects had MCS scores similar to those of a third group of subjects who did not meet DSM-III-R "threshold" criteria for mood disorder but who were severely symptomatic. Adjusted health care utilization was higher for the initial 3-month charge period in the severely symptomatic depressed subjects compared with minimally symptomatic depressed subjects ($679.20 vs $462.38, P <.05). CONCLUSIONS: The 6-item depression severity measure effectively separated patients meeting DSM-III-R "threshold" depression criteria into 2 groups: one presenting with severe symptoms and impairment and the other presenting with mild symptoms and significantly less impairment. A strategy of initial screening using a brief depression severity instrument, followed with a DSM criteria-based instrument, could decrease the immediate clinician workload by one third and focus treatment on those most likely to benefit.     

The relationship between hormone replacement therapy use and psychological symptoms: no effects found in a New Zealand sample

The use of hormone replacement therapy (HRT) for treatment of negative mood or affect, including problems such as depression, is not recommended in current public health guidelines or by reviewers of recent scientific findings. In this article we describe a preliminary examination of the relationship of HRT use to psychological affect and distress in the general population of middle-aged New Zealand women. A questionnaire survey was sent to 1,000 New Zealand women between the ages of 45-60 who were selected at random from the electoral roll. Among 494 respondents, no relationship was found between any measure of positive or negative mood or distress and HRT use. Other study variables, such as menopausal symptoms and self-reported health, were more likely to predict psychological outcomes. Our study supports previous findings. Nevertheless, the use of HRT to treat negative mood is currently widely accepted by the public and promoted by pharmaceutical companies.     

THE RELATIONSHIP BETWEEN HORMONE REPLACEMENT THERAPY USE AND PSYCHOLOGICAL SYMPTOMS: NO EFFECTS FOUND IN A NEW ZEALAND SAMPLE

The use of hormone replacement therapy (HRT) for treatment of negative mood or affect, including problems such as depression, is not recommended in current public health guidelines or by reviewers of recent scientific findings. In this article we describe a preliminary examination of the relationship of HRT use to psychological affect and distress in the general population of middle-aged New Zealand women. A questionnaire survey was sent to 1,000 New Zealand women between the ages of 45-60 who were selected at random from the electoral roll. Among 494 respondents, no relationship was found between any measure of positive or negative mood or distress and HRT use. Other study variables, such as menopausal symptoms and self-reported health, were more likely to predict psychological outcomes. Our study supports previous findings. Nevertheless, the use of HRT to treat negative mood is currently widely accepted by the public and promoted by pharmaceutical companies.