围绝经期女性抑郁障碍及相关因素研究

目的 探讨围绝经期女性抑郁障碍现状及相关因素.方法 使用抑郁自评量表(SDs)、焦虑自评量表(SAS)、匹兹堡睡眠质量指数量表(PSQI)、WHO生活质量测定简表(WHO-QOL-BREF)对320例40～59岁围绝经期女性进行测试.同时以30～39岁育龄女性和40～59岁非围绝经期女性为对照.结果 23.8%的围绝经期女性有抑郁障碍,抑郁障碍检出率较育龄女性(12.0%)及相同年龄段月经规律的非围绝经期女性(16.2%)高(X2=10.233,P<0.01),并且抑郁症状重(F=16.284,p<0.01).围绝经期女性的睡眠质量、生活质量各领域及健康状况均与其抑郁显著相关(P<0.01).结论 围绝经期女性较普通中年女性抑郁障碍的检出率高,抑郁症状重.睡眠质量、生活质量及健康状况是围绝经期女性抑郁障碍的主要影响因素.     

围绝经期抑郁障碍的临床表现与治疗进展

围绝经期是女性生命周期中的特殊阶段,该时期抑郁障碍的发病率明显增高。围绝经期抑郁障碍的临床表现存在特殊的躯体症状,同时情感症状和认知损害亦较为明显。围绝经期抑郁发病原因和机制存在较多争议,需要使用生物-心理-社会的治疗模式。本文将从发病机制、临床特点和治疗等方面进行综述。     

健康问题与疾病定量测试法逻辑判别系统对精神分裂症的多轴诊断及其效度

目的探讨健康问题与疾病定量测试法逻辑判别系统(RTHD-LVS)对偏执型和未定型精神分裂症的多轴诊断及其效度。方法运用RTHD对临床符合中国精神障碍分类与诊断标准第三版(CCMD-3)诊断为精神分裂症偏执型和未定型的患者106例进行半定式评估,然后运用RTHD-LVS科研版和临床版对这些病例进行再诊断。以临床诊断作为金标准,比较两种版本诊断与临床诊断的符合率及两种版本诊断的一致性。结果①轴l诊断:RTHD-LVS科研版轴l诊断与临床诊断符合者99例(93.4%),RTHD-LVS临床版轴l诊断与临床诊断符合者100例(94.3%)。RTHD-LVS两种版本对于偏执型和未定型精神分裂症的诊断一致性均较好(Kappa值分别为0.83和0.92)。②其他轴:本组患者中内向人格特征突出73例(68.8%)。病前1年内有肯定的精神刺激作为诱因者20例(18.9%)。最重社会功能损害稍差或更差者106例(100.0%),目前功能稍差或更差者81例(76.4%)。目前评为无效或恶化者40例(37.7%)。结论RTHD-LVS对精神分裂症患者作了全面的定性与定量评估,结果表明两种版本轴1精神障碍的诊断对精神分裂症诊断效度高,且两种版本之间的一致性好。     

围绝经期综合征有关情绪障碍的研究进展

本文复习与综述了围绝经期综合征有关情绪障碍的病因学、发病机制及治疗学的研究新进展。     

围绝经期情绪障碍与雌二醇相关性的探讨

目的探索雌二醇(E2)在女性围绝经期情绪障碍中的作用。方法对抑郁为主伴或不伴焦虑的围绝经期女患者57 例(病例组)及37名无抑郁焦虑症状群的健康女性(正常组)进行更年期症状量表(Gr)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、Zung氏焦虑自评量表(SAS)、Zung氏抑郁自评量表(SDS)及检测血雌激素(E2)。结果病例组的Gr、HAMD、HAMA 评分显著高于正常组(P<0．01),病例组的E2水平显著低于正常组(P<0．05);病例组E2与Gr中血管因子呈负相关(P<0．05),而其情绪障碍与E2无直接相关,但与Gr中血管因子的评分呈正相关(P<0．05),与Gr中性因子的评分呈正相关(P<0．01)。结论 E2在女性围绝经期情绪障碍的发生、发展中可能通过血管舒缩功能和性相关功能方面的改变而发挥间接作用。     

帕罗西汀对围绝经期抑郁患者的效果及其对性激素、神经递质水平的影响

目的 探究围绝经期抑郁障碍患者应用帕罗西汀的效果及对血清神经递质、性激素水平的影响机制。方法 2019年7月～2021年7月期间89例围绝经期抑郁障碍患者作为研究对象,对照组44例给予雌激素替代疗法联合心理治疗,观察组45例增加帕罗西汀治疗,对比两组患者抑郁状况,血清性激素水平,神经递质水平,不良反应。结果 治疗12周后,观察组患者雌二醇水平高于对照组（P<0.05）,促黄体生成素及促卵泡生成激素水平低于对照组（P<0.05）;观察组Kupperman评分及汉密尔顿抑郁量表评分均低于对照组（P<0.05）;观察组脑源性神经营养因子、5-羟色胺及去甲肾上腺素水平均高于对照组（P<0.05）;观察组发生嗜睡、胃肠道不良反应、头痛例数与对照组比较差异无统计学差异（P>0.05）。结论 帕罗西汀治疗围绝经期抑郁障碍患者的效果显著,可明显提高患者神经递质水平,调节血清性激素水平,改善患者抑郁状态。     

舒肝解郁胶囊与舍曲林治疗围绝经期焦虑抑郁障碍疗效

对围绝经期综合征伴焦虑抑郁障碍的女性患者选择舒肝解郁胶囊治疗,并以舍曲林进行对照,报告如下。1对象和方法选择2010年7月至2011年8月我院门诊、桂林医学院附属医院医学心理科门诊、解放军181医院妇科门诊患者;     

艾司西酞普兰治疗围绝经期抑郁对照观察

目的：观察艾司西酞普兰联合激素对围绝经期中重度抑郁症的临床疗效。方法：50例围绝经期中重度抑郁症患者随机分为合用组和单用组。合用组给予艾司西酞普兰和替勃龙,单用组给予替勃龙,用Montgomery and Asberg抑郁量表（MADRS）和Kupperman绝经指数（KMI）对患者进行治疗8周观察。结果：完成研究43例,其中合用组22例,单用组21例。合用组有效率90．9％,对照组有效率71．4％。合用组治疗1周后MADRS评分与治疗前差异有显著性,而单用组到第2周与治疗前有差异。治疗第2周时,两组之间MADRS评分差异有显著性,这种差异一直持续到8周末。在KMI改善方面,两组在治疗第1周均比治疗前有显著改善,到第2周时,合用组与单用组间KMI评分差异有显著性,这种差异一直持续到8周末。结论：艾司西酞普兰联用雌激素能够在治疗1周内显著改善患者抑郁症状和KMI,并且能够持续改善患者的症状,这种疗效优于单用雌激素治疗。     

健康问题与疾病定量测试法逻辑判别系统对精神分裂症的再诊断

目的探讨健康问题与疾病定量测试法逻辑判别系统（RTHD-LVS）对偏执型和未定型精神分裂症的再诊断及其效度。方法对临床符合中国精神障碍分类与诊断标准第三版（CCMD-3）诊断为精神分裂症偏执型和未定型的患者106例运用RTHD进行半定式评估,然后将数据输入RTHD-LVS数据库,再运用RTHD-LVS科研版和临床版对这些病例进行再诊断。以临床诊断作为金标准,比较两种版本诊断与临床诊断的符合率、两种版本对精神分裂症亚型的诊断与临床诊断的一致性以及两种版本之间诊断的一致性。结果①RTHD-LVS科研版轴1诊断为精神分裂症的患者99例,与临床诊断符合率为94.3%。RTHD-LVS临床版轴1诊断为精神分裂症偏执型和未定型两种亚型的诊断符合率为94.3%。②RTHD-LVS两种版本之间对于精神分裂症偏执型和未定型两种亚型的诊断一致性均较好（Kappa值分别为0.83和0.92）。③两种版本对精神分裂症未定型及偏执型的诊断与临床诊断的一致性较差（Kappa值为0.29-0.61）。结论能够满足于临床需要,可应用于临床。     

分听技术在抑郁障碍中的应用

抑郁症是危害全人类身心健康的常见精神疾病，被称为精神障碍中“普通感冒”。其发病率及患病率逐渐上升，据调查其终生患病率为17．1％，已成为世界各国疾病负担的主要原因之一，1996年WHO一项关于“疾病负担”的研究分析，以因疾病造成“伤残”或“功能缺损”(disability)统计，抑郁症导致的“伤残”仅次于慢性肺部疾病而居第二位，占全部疾     

精神分裂症抑郁症状的识别与诊断——四种抑郁量表的比较

目的 比较四种抑郁量表对精神分裂症抑郁症状的诊断效能.方法 100例符合CCMD-3精神分裂症诊断标准的患者进入研究,以CCMD-3抑郁发作标准判断是否存在有抑郁症状,同时进行CDSS-C、MADRS、HAMD-24、PANSS及RSESE测评.结果 (1)100例患者中符合CCMD-3抑郁发作标准诊断抑郁者22人,抑郁发生率为22％;(2)CDSS-C、MADRS、HAMD-24、PANSS-G相互之间相关性均较高,但只有CDSS-C与PANSS-N、阴性症状各条目及RSESE无相关;(3) CDSS-C与MADRS、HAMD- 24、PANSS- G6的工作特征曲线下面积(AUROC)分别为:0.933、0.826、0.883及0.887,CDSS-C的AUROC要明显高于其他三个抑郁量表(P＜0.05).结论 CDSS-C是较理想的测评精神分裂症抑郁症状的工具,可在临床尝试使用.     

Assessment and diagnosis of depression in people with intellectual disability

Background Despite widespread acceptance that depression can occur in adults with intellectual disability (ID), the difficulties encountered in its assessment and diagnosis have hampered the individual clinician, and meant that questions of prevalence, treatment choice and outcome remain problematic. Method The present paper reviews the progress in this field since three reviews, all published in the mid‐1990s, recommended further attention to three interlinked issues: diagnostic criteria, the symptoms of depression in this group and the lack of rating scales. Results Despite a further 11 published papers and other studies in progress, the method of diagnosis for people with severe and profound ID remains debatable, with some authors advocating adherence to standard criteria, others suggesting adding criteria to the standard ones and yet others believing that substitute criteria are called for. However, for those with mild to moderate ID, a consensus is emerging that standard diagnostic criteria are appropriate. There has been progress in examining some of the symptoms which might constitute depression in people with ID. New diagnostic criteria issued by the Royal College of Psychiatrists are to be welcomed. There is an assumption in much of the research that symptoms of behaviour commonly termed challenging or maladaptive must be atypical symptoms of depression, but none of the studies reviewed demonstrate this effectively. This is compounded by methodological flaws in the way that depressed samples are arrived at for further study. Although new rating scales have emerged, there is as yet no gold standard diagnostic tool for depression amongst people with ID. Conclusions It is suggested that, given these difficulties, the validity of the conceptual frameworks for depression is still in doubt. It remains the case that large‐scale, collaborative, prospective studies are called for.     

Increased depressive symptoms in menopausal age women with bipolar disorder: Age and gender comparison

Objective

Emerging data suggest the menopausal transition may be a time of increased risk for depression. This study examines the course of bipolar disorder focusing on depressive symptoms in menopausal transition age women, compared to similar-aged men as well as younger adult women and men.

Methods

Outpatients with bipolar disorder were assessed with the systematic treatment enhancement program for bipolar disorder (STEP-BD) affective disorders evaluation and longitudinally monitored during naturalistic treatment with the STEP-BD clinical monitoring form. Clinical status (syndromal/subsyndromal depressive symptoms, syndromal/subsyndromal elevation or mixed symptoms, and euthymia) was compared between menopausal transition age women (n = 47) and pooled similar-aged men (n = 30) 45-55 years old, younger women (n = 48) and men (n = 39) 30-40 years old.

Results

Subjects included 164 bipolar disorder patients (67 type I, 82 type II, and 15 not otherwise specified), 34% were rapid cycling and 58% women. Bipolar II disorder/bipolar NOS was more common in women. Monitoring averaged 30 ± 22 months, with an average of 0.9 ± 0.5 clinic visits/month. Menopausal age women had a significantly greater proportion of visits with depressive symptoms (p < 0.05), significantly fewer euthymic visits (p < 0.05) and no difference in proportion of visits with elevated/mixed symptoms compared to pooled comparison group.

Conclusions

Menopausal transition age women with bipolar disorder experience a greater proportion of clinic visits with depressive symptoms compared to similarly aged men, and younger women and men with bipolar disorder. Further systematic assessment on the influence of the menopausal transition and reproductive hormones upon mood is needed to better inform clinical practice in treating women with bipolar disorder.     

帕罗西汀联合氟桂利嗪防治更年期偏头痛的疗效观察

目的 观察帕罗西汀联合氟桂利嗪防治更年期偏头痛的疗效.方法 将120例更年期偏头痛患者随机分成两组,帕罗西汀联合氟桂利嗪为研究组,单用氟桂利嗪为对照组,观察治疗前后偏头痛发作次数、持续时间的变化,同时采用汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)进行评定.共观察8周.结果 治疗8周末,研究组每周偏头痛发作次数(0.5±0.3)比治疗前减少(1.1±0.5),差异有统计学意义(t=8.0,P<0.01);偏头痛持续时间(h/次)比治疗前短(2.7±0.7,7.6±3.1,t=11.9,P<0.01).治疗8周末,对照组发作次数也比治疗前减少,差异有统计学意义(0.7±0.3,2.7±0.7,t=8.0,P<0.01),偏头痛持续时间(h/次)比治疗前短(2.7±0.7,7.4±3.1,t=11.5,P<0.01);治疗8周末,研究组的发作次数少于对照组(t=3.7,P<0.05),两组偏头痛持续时间差异无统计学意义(t=0,P>0.05).治疗8周末研究组HAMD和 HAMA低于对照组(HAMD:5.9±1.8,8.7±2.3,t=7.3,P<0.01;HAMA:4.9±1.7,8.8±2.1,t=11.2,P<0.01).结论 帕罗西汀联合氟桂利嗪对预防更年期偏头痛发作优于单用氟桂利嗪.     

抑郁症妇女绝经年龄的相关因素分析

目的:探讨抑郁症妇女与正常妇女绝经年龄的差异及相关因素分析.方法:对99例抑郁症妇女和50名正常妇女的绝经年龄采用自制调查表进行调查,并行统计分析.结果:抑郁症妇女绝经年龄平均42.8岁,较正常妇女显著提前6岁(P＜0.01).绝经年龄与发病年龄呈正相关(P＜0.01),与阳性家族史呈负相关(P＜0.01).结论:抑郁症可显著降低绝经年龄.     

The effectiveness of very short scales for depression screening in elderly medical patients

OBJECTIVE: To compare very short scales for screening for depression with longer, widely used scales. METHODS: Eighty-seven patients over the age of 60 who were admitted to rehabilitation wards or were attending a day rehabilitation facility at a British teaching hospital were screened for depression using the 1-item mental health inventory, and the 4-item, 15-item and 30-item geriatric depression scales. The sensitivity, specificity, and areas under receiver operating characteristic curves were compared, with the diagnostic criteria for research of ICD-10 providing the criterion diagnosis of depressive episode. RESULTS: All the scales had comparable sensitivity (82.4-100%), specificity (60.0-71.4%), and positive predictive values (33.3-42.9%). Comparison of receiver operating characteristic curves for each scale showed no statistically significant difference between them (range 0.80-0.88). CONCLUSIONS: The very short scales performed just as well as the widely used longer screening scales in this population. They are worthy of further examination in elderly populations at risk of depression, and may be particularly suitable for older adults due to their brevity and ease of use.     

Momentary assessment technology as a tool to help patients with depression help themselves

Wichers M, Simons CJP, Kramer IMA, Hartmann JA, Lothmann C, Myin‐Germeys I, van Bemmel AL, Peeters F, Delespaul P, van Os J. Momentary assessment technology as a tool to help patients with depression help themselves. Objective: Given high relapse rates and residual symptoms in depression, new strategies to increase treatment effectiveness are required. A promising avenue is to investigate how electronic momentary assessment technology may contribute to clinical assessment and interventions in depression. Method: A literature search was conducted focusing on the potential contribution of momentary assessments to clinical applications in depression. Results: Momentary assessments are able to reveal subtle, small but repetitive and relevant patterns of emotional expression that predict future course of depression. A momentary assessment tool may expose manageable pieces of daily life behaviour contributing to the depressive experience that patients can influence. The use of this explicit knowledge of daily life experience is understudied with regard to its contribution to diagnostic assessment, monitoring of treatment effects and feedback interventions in depressed patients. The clinical application of momentary assessments may stimulate a shift from passive consumption of treatment to an active role for patients in their recovery and increased patient ownership. Conclusion: The precise, prospective and fine‐grained information that momentary assessment technology provides may contribute to clinical practice in various ways. Future studies should examine the clinical impact of its use and the feasibility of its implementation in mental health care.     

Assessment of late life depression.

This article focuses on diagnostic and nosologic challenges intrinsic to geriatric depression, including characteristics interfering with symptom and syndrome ascertainment, the impact of medical and cognitive disorders, the usefulness of screening instruments, and barriers imposed by treatment settings. The article also identifies gaps in existing knowledge and outlines a research agenda. Nosologic characterization of depressives syndromes contributed by specific medical disorders may lead to effective strategies for prevention and treatment of depression. Studies need to examine whether treatment of depression can improve the outcome of medical illnesses requiring active patient involvement in treatment. Considering disability a distinct aspect of health status may add an important dimension to the assessment of depression and result in complementary interventions aimed at depression and disability concurrently. The provisional criteria for depression of Alzheimer's disease, if validated, may facilitate treatment research. Studies need to characterize cognitive dysfunctions associated with later development of dementia or poor treatment response in patients with depression. Care managers working together with primary care physicians can improve the recognition and treatment of depressed elderly patients by obtaining the training in using validated instruments and treatment algorithms.     

Characterological depression in patients with narcissistic personality disorder

Abstract

Background: Depressive symptoms often occur in patients with personality disorders. Along the lines of the precious concepts of reactive and melancholic forms of depression, two different patterns of depressive symptoms can be identified. Reactive forms of depression is considered to be related to dysfunction of emotional regulation and social functioning, and to personality disorders. This study aimed at exploring the pattern of depressive symptoms in patients with Narcissistic Personality Disorder (NPD) compared to a group of depressed patients without Personality Disorder (PD). The Newcastle Diagnostic Depression Scale (NDDS) is a clinical instrument designed to differentiate reactive depression from melancholic depression.

Method: The study investigated patterns of depressive symptoms in 117 out-patients, divided into two groups. One group containing 56 patients with depressive symptoms by no PD and the other group comprised of 61 patients with depressive symptoms and NPD. The participants were interviewed using the Newcastle Diagnostic Depression Scale.

Results: There was a significant difference between the groups, as the NPD group suffered from reactive forms of depression. The NPD group showed a pattern of depressive symptoms characterized by fluctuation of the depressive state, without time demarcation of depressive episode, ruminations preoccupied with hostility and accusatory feelings towards other, but not self-accusatory feelings, fluctuation suicidal ideation triggered by external events accompanied by parasuicidal behavior, lack of neuro-vegetative symptoms such as insomnia with early wakening, loss of appetite and weight loss. The No PD group showed the opposite pattern.

Conclusion: Based on these results NDDS is considered to be an applicable instrument for identifying personality pathology in patients with depressive symptoms, by recognizing the specific pattern. This is thought to be important for adequate treatment planning.