抑郁症,综合治疗效果好

<正>抑郁症就像伤风感冒一样,是危害人类健康的常见情感障碍,故而被形象地称为"心灵感冒"。患了"心灵感冒"该如何治疗呢?关键在于早诊断,早发现,早治疗。只要得到恰当、及时的治疗,多数抑郁症患者可以拥有美好的人生。目前,抑郁症治疗方法包括药物治疗、心理治疗和物理治疗三种。其中,药物治疗是首选治疗手段。对于轻中度的抑郁症患者,可以考虑心理治疗或药物治疗。药物治疗很难取得满意疗效时,可以单用或合并使用物理治疗。全病程、     

10例女性抑郁症患者的治疗体会

抑郁症是一种常见的心境障碍,可由各种原因引起,以显著而持久的心境低落为主要临床特征,在我国抑郁症发病率为3%-5%,目前已经有超过2600万人患有抑郁症,其中女性患抑郁症的发病率是男性的2倍以上[2]。目前世界各国比较公认的病因包括:生物因素、心理因素和社会因素,我们通过对10例女性抑郁症患者采用综合性治疗方案,全程跟踪治疗,取得较好的疗效。     

围绝经期妇女抑郁症

围绝经期抑郁症是一种首次发生于围绝经期的情感障碍性疾病。近年来围绝期妇女抑郁症的发病率高,大大影响患者的工作和生活。迄今绝经与抑郁的关系尚不确定。目前认为,围绝经期抑郁障碍是多种因素综合作用的结果。其治疗主要是激素替代治疗(hormone replacement therapy,HRT)、抗抑郁药物治疗及二者联合治疗,此外,在药物治疗基础上的心理治疗及社会支持不容忽视。     

社会挫败应激模型的研究进展

抑郁症一直是临床公认难以治愈的疾病之一,其病因仍然没有统一的治疗标准,而现有的抗抑郁药物对抑郁症的治疗也未能达到完全有效。因此,建立有效的动物模型来模拟人类抑郁症的相关症状,来阐明其可能的病因及有效的治疗方法具有重要意义。本文主要探讨社会挫败应激范式的建立过程及其导致的与抑郁相关的行为学改变可能的神经生物学机制。     

抑郁症药物治疗不能断

有关心理学专家表示,我国心理疾病患者中以抑郁症最为常见。现今对抑郁症的治疗主要有药物治疗与心理治疗等方法,而抗抑郁药治疗是目前治疗抑郁症最主要的方式。     

更年期女性抑郁症与心血管疾病(综述)

抑郁症与心血管疾病之间存在密切的关系,其因果关系是双向的。抑郁症被认为是心血管病的一种重要的危险因素,而心血管疾病患者又是抑郁症的高危人群。更年期女性的抑郁症发病率及心血管疾病的发病率均明显升高。现通过对合并更年期女性抑郁症的心血管疾病患者的探讨,说明对此类患者抗抑郁治疗和心血管病治疗有同等重要性。     

围绝经期抑郁症的治疗进展

围绝经期是新发和复发抑郁症的危险期,围绝经期抑郁症（perimenopausal depressive disorder,PDD）是影响中年女性身心健康和生活质量的常见障碍。PDD发生的始动因素是由于卵巢功能衰退,雌激素分泌减少,对下丘脑、垂体的负反馈减弱,导致下丘脑-垂体-性腺轴的功能紊乱。女性围绝经期性激素水平的波动可增加抑郁症的患病风险。未经治疗的抑郁症不仅可以加重原有抑郁症疾病进程,而且增加躯体疾病的风险,包括加重心血管疾病、糖尿病和骨质疏松症等。关于PDD的治疗研究很多,目前主要以抗抑郁剂进行治疗,对一些难治性抑郁症考虑合并雌激素治疗,其可加速抗抑郁剂的起效时间。长期雌激素治疗会增加患乳腺癌、子宫内膜癌的风险,在雌激素治疗的同时一般合并应用孕激素。综述雌激素补充治疗和抗抑郁剂治疗以及两者的联合治疗。     

女性抑郁症与冠心病研究进展

冠心病是人类主要死亡原因之一.抑郁症与冠心病之间存在密切联系.抑郁症被认为是冠心病的一种重要危险因素,而冠心病患者又是抑郁症的高危人群.本文就更年期女性抑郁症患者合并冠心病的可能机制、临床表现、治疗以及预后等方面加以综述.     

环境应激对青少年抑郁影响的研究讲展

抑郁障碍是目前广泛的精神障碍形式之一,尤其是青少年,发病率呈上升趋势。抑郁症的病因、发病机制仍不明确,目前认为是由社会、心理、生物等多种因素相互作用、综合引起的疾病。青少年处于生长发育的关键期及人生的过渡阶段,应激过程对其心理健康产生重大影响,尤其是抑郁症,且相对于成年人有其独特的症状特点。本文主要从青少年抑郁症的症状特点、应激相关影响因素、压力评估方法等方面的进展进行论述,为青少年抑郁症的临床诊治提供参考。     

单、双相抑郁症临床特征及血清甲状腺激素水平比较探讨

目的:了解单、双相抑郁症临床特征和血清甲状腺激素水平的个体差异、特征.方法:笔者选取了2015.05.30-2017.03.22期间于本院进行治疗的30例单相抑郁症患者、48例双相抑郁症患者与60例正常人(参考组)作为研究样本,采用电化学发光免疫分析法测定三组患者的促甲状腺激素(TSH)水平、血清三碘甲状腺原氨酸(T3)、游离甲状腺激素(FT3,FT4)以及甲状腺素(T4),并对三组患者的甲状腺功能差异进行分析,同时采集单、双相抑郁症患者的临床特征,分析其差异.结果:对比临床特征发现单相抑郁组患者平均发病年龄高于双相抑郁症患者,但发病前的明显诱因多余双相抑郁症患者;双相抑郁抑郁症患者的平均FT3水平高于单相抑郁症患者和参考组,单相抑郁症患者平均血清FT4水平低于双相抑郁整患者和参考组.结论:单、双相抑郁症临床特征间差异比较明显,单相抑郁症患者有并发甲状腺功能减退的可能,而双相抑郁症患者的血清FT4水平特点较为明显,对于两种抑郁症的临床治疗,应当区别对待.     

高危轻症脑梗死患者卒中后抑郁的干预研究

目的研究抗抑郁治疗能否增加高危轻症脑梗死患者对卒中危险因素的控制能力,以降低卒中复发风险。方法取2010年1月至2012年1月入住于扬州市第一人民医院神经内科具有连续资料的急性轻症脑梗死患者98例,对53例同时有糖尿病、吸烟、高血压病以及血脂异常多种危险因素的轻症脑梗死患者卒中后抑郁进行了早期识别和口服药物干预、进行长期随访,并与45例未予以抗抑郁药物的轻症脑梗死患者进行了比较观察。结果抗抑郁治疗能提高高危轻症脑梗死患者的生活质量,改善轻症脑梗死患者对卒中危险因素的控制能力,以降低卒中复发风险。结论对高危轻症脑梗死患者予抗抑郁治疗能增加患者对卒中危险因素的控制能力,提高治疗依从性,改善生活质量,降低卒中复发风险。     

心律失常分析在现代医疗设备中的应用

介绍了心律失常检查q-各种医疗设备的应用,总结了这些设备的基本原理和检查方法,并比较了这些检查方法的优缺点和研究进展,为临床开展心律失常分析提供了方法,具有较高的使用价值。     

医疗保险付费方式的功能比较——县级公立医院补偿机制改革研究(六)

后付费方式、中付费方式和预付费方式是医疗保险的三种付费方式。不同的付费方式对医疗费用发挥不同的功能,对医疗机构产生不同的激励。比较三种付费方式的功能后得出结论:我国医疗保险付费方式将经历三个过程,第一个过程是后付费方式向中付费方式的转型,第二个过程是中付费方式向预付费方式的升级。医疗保险预付费方式的最大功能优势是建构医疗机构以成本为中心的经营模式,该经营模式主要通过两大机制发生关系转变:第一大机制是医疗保险的筹资机制将医疗服务供求双方的失衡关系转变为对等关系;第二大机制是医疗保险的预付费将医疗服务供、求、保三方的三角关系转变为直线关系。     

医疗器械溶血性能三种评价方法的比较

与血液接触的医疗器械和材料在临床前的安全性评价中经常要进行直接和/或间接溶血试验。目前使用频率较高的溶血试验方法主要有三种:NIH法、ASTM法和MHLW法。虽然三种方法在国际上常规评价医疗器械/材料溶血性能方面得到广泛认可,但是缺乏对三种方法进行比较研究的数据。目前ISO/TC 194工作组正在组织溶血Round robin(国际比对)试验,但是具体的试验草案还在完善当中。文章从原理、血源、方法和结果判定等方面对此三种方法进行了全面介绍,为Round robin试验提供理论方面的帮助。     

湖南省妇幼保健机构产后抑郁症防治现状及需求研究

目的通过对全省妇幼保健机构的抽样调查,了解产后抑郁症的防治能力和需求状况,为下一步有针对性地指产后抑郁症防治的开展,制定适合三级妇幼保健网络的孕产期心理保健方案奠定基础。方法采取多阶层随机整体取样的方法抽取湖南省16家妇幼保健机构和179位医务人员。结果在16所调查的妇幼保健机构中,开展了产后抑郁症筛查的机构7所,占43.8%,开展了心理咨询门诊的4所,占25.0%,配备了心理疏导、心理治疗设施设备的2所,占12.5%。179名被调查的医务人员中,有68.7%的认为所在机构对产后抑郁症的防治不能满足孕产妇的需求。结论全省妇幼保健机构对产后抑郁症的识别和干预机制不健全,网络覆盖不全面,医务人员的服务能力不强,下一步应逐步完善防治网络和强化能力建设。     

Evidence-based optimal treatment strategy of patients with angina pectoris

The author summarizes the evidences of angina pectoris' optimal treatment. The invasive treatment strategy became a frontrunner in this field as well. During the last years the number of percutaneous interventions became higher than bypass operations in many countries as well as in Hungary. The place of percutaneous interventions and bypass surgery in the treatment of angina pectoris is an important clinical problem. The author summarizes the data of three possible treatment options (medical therapy, percutaneous interventions and bypass surgery) of angina pectoris based on data of randomised trials. The evidences show that the first steps of therapy are - after the diagnosis - the influence of risk factors, life-style changes and optimal medical therapy. The optimal medical therapy consists of statin, aspirin and ACE inhibitor treatment besides antianginal therapy, where the beta blockers are regarded as first drugs of choice. Percutaneous interventions as initial treatment option are not recommended because we have no evidences that this intervention prolongs life and prevents myocardial infarction. If the patient remains symptomatic after medical treatment, it is necessary to perform revascularization. These procedures can improve the functional capacity more than medical treatment alone. The optimal treatment strategy of angina pectoris, based on evidence, is an important medical and economical problem.     

The bleeding severity index: validation and comparison to other methods for classifying bleeding complications of medical therapy

Reports of bleeding complications of medical therapy should be based on valid methods of classification, but the reproducibility of existing methods has not been tested. Therefore, we prospectively studied three methods to classify the severity of bleeding: a purely subjective implicit method, a previously published explicit method using brief criteria, and the bleeding severity index, which is a new explicit method using detailed criteria about the amount, rate, and consequences of bleeding. Three physicians independently reviewed abstracts of 168 patients treated with anticoagulants. The proportion of cases classified as major bleeding varied widely when the implicit method was used (2, 14 and 39%), less when the old explicit method was used (28, 40 and 47%), and not at all when the new bleeding severity index was used (20, 20 and 20%). Intraobserver agreement was excellent for both explicit methods (kappa greater than or equal to 0.95). However, interobserver agreement was better for the bleeding severity index (kappa = 0.87) than for the old explicit method (kappa = 0.69) or the implicit method (kappa = 0.39). We conclude that the classification of bleeding complications of medical therapy depends on the method used. In comparison to older methods, the bleeding severity index is highly reproducible and should be tested more widely to determine whether it can be applied to the burgeoning clinical research in anticoagulation and thrombolysis.     

介入治疗材料的应用发展

介入治疗材料作为一种新型的诊疗设备，已广泛地应用于临床治疗。介入材料具有良好的生物相容性是非常重要的，它关系到治疗的成败。本文就主要介入治疗材料的结构、特性进行论述。     

Medical and surgical therapies for pain associated with endometriosis

Endometriosis is a common condition for which a number of treatments have been proposed. Medical treatments are based on the hormonal responsiveness of endometriosis implants. These therapies include progestins (with or without estrogens), androgens, and gonadotropin-releasing hormone (GnRH) analogs. Surgical treatments may include hysterectomy with oophorectomy or organ-sparing surgery involving ablation or resection of visible lesions of endometriosis and restoration of pelvic anatomy. There are no studies that directly compare the effectiveness or adverse effects of medical therapy and surgical therapy. Studies on medical therapy compare different treatments with placebo or with other active treatments. Hormone-based therapies for endometriosis show 80%-100% effectiveness in relief of pelvic pain over a 6-month course of therapy. Serious adverse outcomes after medical therapy are unusual. Studies on surgical therapy are largely anecdotal, with noncomparative reports on a variety of surgical methods. A few comparative surgical studies have been reported. Because of the noncomparative nature of many of the surgical studies, the use of combinations of surgical procedures and techniques in the reported studies, and the reporting of results from surgeons with an unusually high level of technical skill, the gynecological practitioner has little basis in the literature for assessing the optimum surgical approach. Surgical complications are believed to be underreported and may be related to how aggressive a surgical procedure is undertaken.     

Improving Home Programme Compliance of Children with Learning Disabilities

Non-compliance of children with learning disabilities with occupational therapy home programmes is an all too familiar problem. Although therapists are generally quite accurate in estimating compliance, they are often unsure how to improve this. While most paediatric compliance research investigates compliance of children with medical regimens, the findings have relevance to occupational therapy. In this article the compliance literature is reviewed: methods of measuring and more importantly, improving compliance, are discussed. Factors to be considered when prescribing home programmes are presented, and methods used by occupational therapists are noted. A programme involving contingency contracting and token reinforcement is outlined.