广州市某社区2型糖尿病患者抑郁发病率及其相关因素分析

目的:探索广州市某社区2型糖尿病患者中抑郁发作的患病率以及相关的影响因素.方法:采用连续入组2型糖尿病患者308例,应用一般情况调查表、社会支持量表(SSRS)、抑郁自评量表(SDS)、焦虑自评量表(SAS)调查2型糖尿病患者中抑郁发作的患病率,并通过Logistic回归方法分析伴有抑郁障碍的患者相关影响因素.结果:2...     

重固镇社区糖尿病患者抑郁症状调查

目的:了解社区中糖尿病患者抑郁症状的患病率,探讨糖尿病合并抑郁症状的可能影响因素。方法:应用SDS量表对重固镇社区卫生服务中心的83例糖尿病患者进行调查评定,并对其相关影响因素进行分析。结果:社区糖尿病患者抑郁症状患病率为38.55%,高于正常人群。糖尿病患者合并抑郁症状与空腹血糖偏高、体重指数增加、慢性并发症增加密切相关。结论:抑郁症状在社区糖尿病人群中有较高的患病率,社区卫生服务中心的团队应予以重视。     

2型糖尿病合并脂肪肝的危险因素分析（附226例分析）

2型糖尿病常常并发脂肪肝,长期的脂肪肝易导致肝硬化。为进一步探讨2型糖尿病脂肪肝的患病率及相关危险因素,现将226例糖尿病患者调查分析如下。     

抗抑郁药对2型糖尿病伴抑郁患者血糖的影响

抑郁症与糖尿病之间具有一定的生物学相关性,在2型糖尿病患者中,抑郁症的患病率很高,大量调查研究表明,糖尿病患者与普通人群相比其抑郁症的患病率有所增高,15%～20%的糖尿病患者患有严重性抑郁.     

社区2型糖尿病患者抑郁和焦虑情绪危险因素流行病学调查

目的了解本社区2型糖尿病患者抑郁、焦虑情绪的患病情况及其危险因素。方法调查社区2型糖尿病患者110例,应用一般情况调查表和汉密顿抑郁量表评价受试者的抑郁、焦虑情绪状态和影响因素。结果本组110例2型糖尿病患者中抑郁、焦虑情绪障碍患病率为31.82%。2型糖尿病患者中非抑郁、焦虑组与抑郁组的年龄、性别、病程、并发症、血糖控制情况、受教育程度、经常接受健康教育、积极参加社区活动、经常接受家人各种精神和物质帮助的人数在统计学上差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,性别、病程、是否积极参加社区活动、是否经常接受家人各种精神和物质帮助与抑郁、焦虑情绪正相关;并发症和受教育程度与抑郁、焦虑情绪负相关。结论 2型糖尿病患者中抑郁、焦虑患病率较高,应将心理治疗视为糖尿病治疗的一部分;性别为女、病程长、不积极参加社区活动、不经常接受家人各种精神和物质帮助为抑郁、焦虑情绪的危险因素,无并发症、受教育程度高是抑郁、焦虑情绪的保护因素。     

无锡市城市社区人群2型糖尿病患病现况调查

目的：了解和掌握中国城市社区自然人群2型糖尿病患病特点和主要影响因素。方法：采用整群抽样的方法,抽取无锡市城区二个行政区域内的二个街道中的4个居委会内居住1年以上（包括1年）的20岁以上居民,通过检测空腹血糖和面对面询问方法进行糖尿病患病率和影响因素调查。结果：无锡市城市社区2型糖尿患病率为10.20%,标化患病率为6.78%,其中现患标化患病率为4.66%,新发标化患病率为2.12%,空腹血糖受损标化患病率为1.85%;超重、肥胖人群和高血压人群中2型糖尿病和空腹血糖受损明显高于正常人群;高血糖和高血压、肥胖关系密切,糖尿病与年龄、职业、文化程度等多种因素有关。结论：无锡市糖尿病患病状况较严重,应针对高危人群开展综合防治工作。     

2型糖尿病患者合并甲状腺疾病的调查分析

目的探讨2型糖尿病患者中甲状腺疾病的患病情况。方法调查413例住院的2型糖尿病患者和120例无糖尿病的健康体检人群的甲状腺功能。结果 2型糖尿病患者甲状腺功能异常的总患病率为20.58%,高于非糖尿病人群。甲状腺功能减退者(甲减及亚临床甲减)的患病率明显高于甲状腺功能亢进者(甲亢及亚临床甲亢),其中,亚临床甲减的患病率最高(9.93%),明显高于非糖尿病人群。在2型糖尿病患者中,与男性相比,女性甲状腺功能异常的患病率(24.88%)较高,亚临床甲减的性别差异更明显。结论 2型糖尿病患者甲状腺功能异常的患病率较高,尤以亚临床甲减常见,可能影响糖尿病的病情和预后,定期筛查和随访2糖尿病患者的甲状腺功能具有重要的临床意义。     

本职工代谢综合征流行病学调查

目的 旨在了解大型钢铁企业职工各年龄组、各种职业、各个工种及不同性别的代谢综合征的发病率,以便因人而异进行及早防治,延缓发展成糖尿病,心血管疾病的进程,提高生活质量及身体素质.方法 本研究2005年2月至5月采用分层随机整群抽样方法,横断面调查本钢主体单位20岁以上工人和干部3000人,选取有完整的身高、体质量、血糖,血脂、血压,腰围资料的人群共2028例,其中男性1142例,女性886例进行分析.代谢综合征的诊断根据2005年国际糖尿病联盟IDF代谢综合征全球统一定义.调查方法采用问卷调查、体格检查,生化指标检查,并进行统计学分析.结果 ①代谢综合征及各种相关疾病的标化患病率取调查资料完整者2028例,其中男性1142人,女性886人,平均年龄(50±14)岁,经2000年全国人口标准化后,本钢职工代谢综合征的患病率为10.23%,男性(15.2%)明显高于女性(5%),P＜0.01.超重、中心性肥胖、糖尿病,高血压、高三酰甘油血症的患病率分布为23.65%、16.86%、10.31%、23.93%、27.65%.②年龄、性别分层后MS及其相关疾病的患病率、不同年龄组、不同性别代谢综合征及其相关疾病的患病率不同.将调查人群按年龄分成20～30岁、30～40岁、40～50岁、50～60岁4个组.结果 显示,上述疾病的患病率随年龄增加而增加,50岁以上人群中为50岁以下人群的2～3倍.20～60岁各年龄段的代谢综合征患病率分别为3.45%、5.66%、7.87%,11.65%.男性代谢综合征患病率在20～30岁、30～40岁2组中显著高于女性(分别为10.7%:1.3%,16.0%:3.9%)P＜0.01;而50岁以上人群代谢综合征及其相关疾病患病率的性别差异无意义.③人群中代谢异常的分布状况本调查发现,在本钢职工中无代谢异常的只占30.8%,存在1种代谢异常者占25.6%,存在2种或2种以上代谢异常者占34.6%,具有3种或3种以上代谢异常者占18.03%.男性具有3种或3种以上代谢异常者的患病率显著高于女性(男性27.4%,女性11.2%)P＜0.01.结论 不同年龄组、不同性别代谢综合征及其相关疾病的患病率不同.50岁以上代谢综合征的患病率明显增高;男性代谢综合征患病率在20～30岁、30～40岁2组中显著高于女性;而50岁以上人群代谢综合征及其相关疾病患病率的性别差异无意义.出现这种现象考虑与现代社会生活节奏加快、压力增加、不良生活习惯导致肥胖、超重及各种代谢紊乱密切相关,代谢综合征患者的饮食现状不合理,需要改变.而代谢异常必须加强早期干预.     

2型糖尿病的流行病学研究探讨

目的对龙门县的2型糖尿病的患病率、糖耐量异常的流行病学情况进行调查。方法采用发放问卷表格的形式进行调查,并对参加调查的1500人进行血压、血糖、血脂的检查,所得的数据用统计软件16.0进行分析。结果酗酒、吸烟以及有糖尿病家族遗传史的患者患病率、糖耐量异常发生率明显高于对照组,两组对比具有统计学差异(P<0.05)。本调查发现,随着年龄的增长,糖尿病的发生率有增高的趋势,2型糖尿病患者的血脂水平、血压指数明显高于正常人群。结论年龄、家族遗传史、高血压、高血脂是2型糖尿病或者糖尿量异常的危险因素,预防和控制这一些危险因素在临床上对2型糖尿病的治疗有着重要的作用。     

2型糖尿病与骨质疏松关系的临床探讨

目的探讨2型糖尿病与骨质疏松的关系及临床意义。方法对92例2型糖尿病患者进行骨密度测定及糖化血红蛋白检测,并根据1年内数次糖化血红蛋白的平均值,分为控制较好组(糖化血红蛋白≤6%)和控制差组(糖化血红蛋白>6%),结合病程等相关因素进行分析。结果92例2型糖尿病患者中骨密度降低65例(70.7%),其中女性患病率为87.2%。1年内糖化血红蛋白平均高于正常水平,骨密度降低者血糖水平相对更高,两组差异有统计学意义(P<0.05)。结论2型糖尿病并发骨质疏松的患病率明显高于正常人群,以女性为著,病程在9年以上者明显;骨密度降低与糖化血红蛋白水平过高密切相关。     

Comparing Depressed Psychiatric Inpatients with and Without Coexisting Substance Use Disorders

ABSTRACT

Objectives: To better understand the complexities of coexisting substance abuse, this study explored psychosocial and clinical differences between individuals diagnosed only with a depressive disorder and those diagnosed with a depressive disorder coexisting with a substance use disorder.

Methods: Rates and sequelae of comorbidity were explored based on the medical records of patients admitted to the Alaska Psychiatric Institute (the only state-funded psychiatric hospital in Alaska) between January 1, 1993 and April 30, 2004. During this period, there were a total of 13,894 admissions for 7,317 patients. Of these patients, 469 met criteria for pure depressive disorders (with no past or current other psychiatric diagnoses); of these, 321 (68.4%) had coexisting substance use disorder and 148 (31.6%) had no coexisting substance use disorder.

Results: Findings revealed that patients with a depressive disorder and coexisting substance use have greater complexity in terms of psycho-social circumstances, demographics, and clinical presentation than do patients with a depressive disorder only; however, such patients have fewer admissions, shorter lengths of stay, and fewer total days in hospital.

Conclusions: These findings suggest that care must be taken when diagnosing individuals with depression as the presence of a coexisting substance use disorder may call for a different intervention strategy. These results differ from prior research examining coexisting schizophrenia and substance use disorders, suggesting that a substance use disorder has differing sequelae depending upon the type of coexisting psychiatric disorder.     

Deficiency in the Inhibitory Serine-Phosphorylation of Glycogen Synthase Kinase-3 Increases Sensitivity to Mood Disturbances

Bipolar disorder, characterized by extreme manic and depressive moods, is a prevalent debilitating disease of unknown etiology. Because mood stabilizers, antipsychotics, antidepressants, and mood-regulating neuromodulators increase the inhibitory serine-phosphorylation of glycogen synthase kinase-3 (GSK3), we hypothesized that deficient GSK3 serine-phosphorylation may increase vulnerability to mood-related behavioral disturbances. This was tested by measuring behavioral characteristics of GSK3α/β^{21A/21A/9A/9A} knockin mice with serine-to-alanine mutations to block inhibitory serine-phosphorylation of GSK3. GSK3 knockin mice displayed increased susceptibility to amphetamine-induced hyperactivity and to stress-induced depressive-like behaviors. Furthermore, serine-phosphorylation of GSK3 was reduced during both mood-related behavioral responses in wild-type mouse brain and in blood cells from patients with bipolar disorder. Therefore, proper control of GSK3 by serine-phosphorylation, which is targeted by agents therapeutic for bipolar disorder, is an important mechanism that regulates mood stabilization, and mice with disabled GSK3 serine-phosphorylation may provide a valuable model to study bipolar disorder.     

冠心病伴抑郁与5-羟色胺转运体基因多态性的关系

目的：探讨5-羟色胺转运体基因多态性对冠心病伴抑郁的影响。方法：选择冠心病伴抑郁患者70例，以冠心病不伴抑郁患者70例作对照。采用聚合酶链反应技术检测受试对象5-羟色胺转运体基因上游调控区多态性位点（5-HTTLPR）与内含子2区（VNRT）2种基因多态性的分布频率。均经社会支持评定量表与应对方式问卷进行心理评定。结果：抑郁组5-HTFLPR的SS基因型及S等位基因频率显著高于对照组（均P〈0．01），VNRT基因型及等位基因频率分布2组差别无统计学意义（均P〉0．05）。SS基因型冠心病患者社会支持总分和积极应对分显著低于L5型及LL型（均P〈0．01）：消极应对分显著高于15型及LL型（均P〈0．01）。多元Logistic回归分析结果显示5-HTTLPR基因SS型与冠心病伴抑郁独立相关。结论：5-HTTLPR的SS基因型可能是冠心病患者伴发抑郁的易感基因之一。     

Onset and early behavioral effects of pharmacologically different antidepressants and placebo in depression.

This study was aimed at resolving the time course of clinical action of antidepressants (ADs) and the type of early behavioral changes that precede recovery in treatment-responsive depressed patients. The first goal was to identify, during the first 2 weeks of treatment, the onset of clinical actions of the selective serotonin reuptake inhibitor (SSRI), paroxetine, and the selective noradrenergic reuptake inhibitor, desipramine (DMI). The second aim was to test the hypothesis that the two pharmacologic subtypes would induce different early behavioral changes in treatment-responsive patients. The design was a randomized, parallel group, placebo-controlled, double-blind study for 6 weeks of treatment following a 1-week washout period. The study utilized measures of the major behavioral components of the depressive disorder as well as overall severity. The results indicated that the onset of clinical actions of DMI ranged from 3 to 13 days, averaged 13 days for paroxetine, and was 16-42 days for placebo. Furthermore, as hypothesized, the different types of ADs initially impacted different behavioral aspects of the disorder. After 1 week of treatment, DMI produced greater reductions in motor retardation and depressed mood than did paroxetine and placebo, and this difference persisted at the second week of treatment. Early improvement in depressed mood-motor retardation differentiated patients who responded to DMI after 6 weeks of treatment from those that did not. Paroxetine initially reduced anxiety more in responders than in nonresponders, and by the second week, significantly improved depressed mood and distressed expression in responders to a greater extent. Depressed patients who responded to placebo showed no consistent early pattern of behavior improvement. Early drug-specific behavioral changes were highly predictive of ultimate clinical response to the different ADs, results that could eventually be applied directly to clinical practice.     

Improved Depressive Symptoms in Adults with Schizophrenia During a Smoking Cessation Attempt with Varenicline and Behavioral Therapy

Objective: Smoking prevalence rates are elevated in individuals with schizophrenia spectrum disorders (SSD) compared with the general population, with attendant disproportionate smoking-related morbidity and mortality. Pharmacotherapies that improve abstinence rates in this population are underutilized, partly due to concerns about neuropsychiatric safety, particularly for those with comorbid depression or prior suicide attempt. Prospective assessment of the psychiatric safety profile of varenicline in those with SSD is needed. Methods: Adult smokers with SSD entered a 12-week trial of varenicline and behavioral therapy for smoking cessation. Depressive symptoms were assessed with the Calgary Depression Scale for Schizophrenia (CDSS) at baseline and weekly thereafter. Participants with baseline and one or more postbaseline CDSS assessments, n = 179, were included in a secondary analysis of change in depressive symptoms with varenicline treatment, adjusting for abstinence status and baseline depressive symptoms. Results: Twenty-seven percent of participants had a CDSS score at baseline consistent with current major depressive disorder, and more than half had a prior suicide attempt. Forty-one percent (74/179) achieved two or more weeks of continuous abstinence at the end of treatment. CDSS scores declined 31% during the 12-week treatment period. Controlling for baseline CDSS scores, depressive symptoms declined over time in those who completed the trial, independent of abstinence status, and either declined or remained unchanged in those with major depressive disorder or prior suicide attempt or who were taking antidepressant medication. Those who did not complete the trial had no change in depressive symptoms. Discussion: Depressive symptoms declined in adults with schizophrenia during 12 weeks of varenicline treatment and cognitive behavioral therapy, independent of tobacco abstinence. Smokers with SSD who have significant depressive symptoms may be successful in smoking cessation attempts with pharmacotherapeutic aids such as varenicline while maintaining stable psychiatric symptoms. This is a secondary analysis of data collected as part of a clinical trial registered as NCT00621777, at www.clinicaltrials.gov.     

Saiko-ka-ryukotsu-borei-to,a herbal medicine,ameliorates chronic stress-induced depressive state in rotarod performance

Exposure to chronic stress is thought to play an important role in the etiology of depression. This disorder has been shown to involve disruption of the hypothalamo-pituitary-adrenal (HPA) system and dysfunction of the prefrontal cortex (PFC). We have demonstrated that chronic stress in rats induces similar HPA disruption or a depressive state caused by a reduction of dopaminergic and serotonergic transmission in the PFC. We have also shown that saiko-ka-ryukotsu-borei-to, a herbal medicine, prevents such chronic stress-induced HPA disruption. However, the behavioral and neurochemical bases of this drug remain unclear. Here we examined the effects of saiko-ka-ryukotsu-borei-to on the depressive behavioral state and the reduction of transmission resulting from chronic stress. The chronic stress was induced by water immersion and restraint (2 h/day) for 4 weeks followed by recovery for 10 days. The treatment with saiko-ka-ryukotsu-borei-to (100, 300, or 1000 mg/kg p.o.) ameliorated the stress-induced depressive state in a dose-dependent manner, evaluated by a rotarod test. A microdialysis study indicated that the drug treatment significantly prevented the chronic stress-induced decreases in extracellular concentrations of dopamine and serotonin in the PFC. These results suggest that saiko-ka-ryukotsu-borei-to ameliorates the chronic stress-induced depressive state based on the prevention of PFC dysfunction. These findings provide important information for treatment of depression.     

Effects of psychopharmacological treatment with antidepressants on the vascular system

Psychopharmacological treatment with antidepressants is an essential part of guideline-based treatment strategies in affective disorders, such as major depressive disorder, persistent depressive disorder, and bipolar disorder. Furthermore, antidepressants are frequently prescribed in patients with physical disorders, such as cardiovascular diseases, and comorbid depression. The type of association between physical diseases, particularly chronic diseases, and depression is bidirectional, meaning that affective disorders enhance the risk for the development of cardiovascular and metabolic disorders, and that cardiovascular/metabolic disorders enhance the risk for the development of depressive disorders. Therefore, knowledge of vascular side effects of psychopharmacological treatment is important for clinicians. This clinical orientated review article covers direct and indirect effects of commonly prescribed antidepressant drugs on the vascular system.     

The impact of major depressive disorder on the short- and long-term outcome of Crohn's disease treatment with infliximab

BACKGROUND: Major depressive disorder is the most common psychiatric diagnosis in Crohn's disease. In other chronic diseases, evidence suggests that depression influences the course of the disease. Strong evidence of such a mediating role of major depressive disorder in Crohn's disease has never been found. AIM: To assess the relationship between major depressive disorder and outcome of treatment of luminal Crohn's disease with infliximab. METHODS: In this prospective study, 100 consecutive unselected patients underwent assessment of psychosocial, demographical disease-related biological and clinical parameters at baseline and at 4 weeks after infliximab. Major depressive disorder was diagnosed using the Patient Health Questionnaire. Subsequently, the patients were followed up clinically until the next flare or during 9 months. RESULTS: The Crohn's disease responded in 75% of the patients, and remission was achieved in 60%. The presence of major depressive disorder at baseline predicted a lower remission rate (OR = 0.166, 95% CI = 0.049-0.567, P = 0.004). At follow-up, 88% of the patients needed retreatment. At univariate regression analysis, major depressive disorder significantly decreased time to retreatment (P = 0.001). Multivariate Cox regression confirmed major depressive disorder as an independent determinant of active disease both at baseline and at re-evaluation (hazard ratio = 2.271, 95% CI: 1.36-3.79, P = 0.002). CONCLUSION: Major depressive disorder is a risk factor for failure to achieve remission with infliximab and for earlier retreatment in patients with active luminal Crohn's disease. Assessment and management of major depressive disorder should be part of the clinical approach to patients with Crohn's disease.     

A preliminary trial of fluoxetine in refractory borderline patients

Borderline personality disorder is characterized by many of the symptoms associated with serotonin dysregulation, including affective lability, suicidal behaviors, and impulsive aggression. These provide an ideal clinical model for studying the treatment of these serious symptom presentations. The recent development of selective serotonin reuptake inhibitors such as fluoxetine makes it possible to study the role of serotonin in the etiology of affective and behavioral dyscontrol in borderline personality disorder. In this preliminary medication trial, 5 borderline personality disorder patients with severe symptoms resistant to phenelzine and neuroleptics were treated openly with fluoxetine 20 to 40 mg for 8 weeks, with weekly ratings of symptoms. The findings from this work suggested efficacy for fluoxetine in treating the depressive and impulsive symptoms of refractory patients with borderline personality disorder.     

The role of dopamine agonists in the treatment of depression in patients with Parkinson's disease: a systematic review

Depressive disorders as well as depressive symptoms are common in Parkinson's disease (PD) and an important factor affecting quality of life. Treatment of depressive symptoms not only improves mood but is also associated with improvement of motor symptoms, disability and cognitive symptoms. Currently, dopamine agonists are being suggested as an alternative to antidepressants for the treatment of depression in PD. The aim of this article is to systematically review the efficacy of dopamine agonists in the treatment of depression in PD. Since 1983, 19 studies have reported on the effects of dopamine agonists on depressive disorder, depressive symptoms or mood in PD. To date, no double-blind, placebo-controlled, randomized controlled trial of the treatment of major depressive disorder in PD with a dopamine agonist has been conducted. Studies of the effects of treatment with dopamine agonists on depressive symptoms in PD, or on mood in non-depressed PD patients, have yielded inconclusive results. Most studies are not designed to test effects on mood and are limited by methodological flaws. It can be concluded that, although the preliminary evidence of the effects on mood and depression in PD is interesting and in need of further study, there is as yet insufficient evidence to recommend dopamine agonists in the treatment of either depressive disorder or depressive symptoms in patients with PD. Treatment of depressive disorder and clinically relevant depressive symptoms should be based on pharmacological or non-pharmacological interventions with known efficacy in this population, such as citalopram, nortriptyline, desipramine or cognitive behavioural therapy. This strategy has the additional advantage of enabling the clinician to treat depressive symptoms independently of motor symptoms, thus avoiding potential complications of dopaminergic therapy.