老年与非老年抑郁症的临床特征差异

目的:探讨老年期抑郁症的临床特征。方法:以60例老年期抑郁症患者作老年组,选60例非老年期抑郁症患者为非老年组。对两组分别用汉密尔顿抑郁量表和汉密尔顿焦虑量表进行评定。结果:老年组抑郁症状中激越和疑病症状显著高于非老年组(P<0.01),老年组的躯体症状中自主神经系统症状、心血管系统症状和消化系统症状显著高于非老年组(P<0.05或P<0.01);躯体性焦虑和认知障碍、焦虑/躯体化和睡眠障碍的严重程度均显著高于非老年组(P<0.05或P<0.01)。结论:老年期抑郁症激越、疑病、躯体症状、焦虑、睡眠障碍及认知障碍等更加突出。     

首发与复发老年抑郁症患者的临床特征分析

目的 分析首发与复发老年抑郁症患者的临床特征异同点.方法 应用自制量表调查109例老年期首发抑郁症患者(老年首发组)与89例老年期复发抑郁症患者(老年复发组)的临床特征并进行比较.结果 老年首发组患者的激越、疑病症状、躯体症状和记忆减退,均显著高于复发组,差异均有统计学意义(P<0.05);老年首发组躯体症状中的心血管系统症状显著高于对照组,差异有统计学意义(P<0.05).结论 老年首发抑郁症不同于老年复发抑郁症,激越、疑病、躯体症状和记忆障碍等较为突出.     

门诊首发抑郁症临床现象学分析

目的　了解首发抑郁症临床特征。方法　采用自制一般情况调查表、自制抑郁及焦虑症状调查有对符合ICD 10抑郁发作诊断标准的 14 4例门诊首发抑郁症患者进行研究。采用汉密顿抑郁量表 (HAMD2 4)、汉密顿焦虑量表 (HAMA)评定疾病的严重程度 ;采用生活满意度量表 (LSR)、社会功能缺陷筛选量表 (SDSS)、生活事件量表 (LES)评定患者的生活质量和社会功能。结果　 14 4例首发抑郁症患者心境低落出现频率高达 10 0 % ,工作兴趣减少为 95 8% ,思维迟缓为 84 7% -能力减退感为 97 2 % ,早醒为 92 4 % ,睡眠不深为 90 3% ,性欲减退和 /或月经紊乱为 82 6 % ,同时伴有昼重夜轻 ,躯体化症状。男性患者的疑病症状出现频率显著高于女性 (P <0 0 5 ) ;男性患者的性欲减退、绝望感症状出现率高于女性 ;女性患者在自杀意念、精神性焦虑、躯体性焦虑、全身疲乏、晨夜夕轻症状出现频率多于男性 ,但无统计差异。 4 0岁以上患者组比 4 0岁以下组更易表现为睡眠不深、早醒、躯体性焦虑 (P <0 0 5 )。 6 1 1%的患者伴有一定程度的焦虑症状 ;6 0 %的患者伴有躯体化症状。重度抑郁的躯体化症状表现频率显著高于中度患者 (P <0 0 5或P <0 0 1) ,两者社会功能缺陷程度有显著性差异 (P <0 0 1)。结论　首发抑郁症临床以心     

血管性抑郁症的临床特征及治疗

本介绍血管性抑郁症的概况、临床特征及治疗原则,强调临床医生应重视这组特殊抑郁症。     

89例首发住院老年期抑郁症的临床特征分析

目的　研究首发住院老年期抑郁症的临床特征。方法　应用自编一般资料调查表 ,回顾 1994～ 2 0 0 1年 89例住院首发老年期抑郁症患者的临床特征 ,并与同期住院的 2 4 9例非老年期首发抑郁症比较。结果　老年期组男性有自杀观念者多于女性 ,并发躯体疾病者少于女性 (P <0 0 0 5 ) ;老年期组并发躯体疾病多于非老年期组 ,精神焦虑比青年组多 ,自杀观念和自杀行为比老年前期少 ,较多单一使用麦普替林 (P <0 0 5 ) ;临床疗效和非老年期无显著差异。结论　老年期抑郁症有较多的精神性焦虑。充分的治疗可以取得满意的疗效     

老年抑郁症的研究进展

广义的老年抑郁症指发生于老年期 (≥ 6 0岁 )的抑郁症 ,包括原发性 (含青年或成年期发病 ,老年期复发 )和见之于老年期的各种继发性抑郁。狭义的老年抑郁症特指≥ 6 0岁首次发病的原发性抑郁。国际疾病分类第 10版、美国精神障碍诊断与统计手册第 4版 (DSM Ⅳ )和中国精神障碍分类与诊断标准第 3版均未将老年抑郁列为独立诊断类别。然而就发病年龄、临床相而言 ,老年抑郁症与一般抑郁症又确有诸多不同。有人认为老年抑郁症可能就是抑郁症的一个特殊亚型 ,但尚无定论。　流行病学老年抑郁症的发病率由于调查方法如样本来源、年龄结构、筛…     

慢性抑郁症的临床特征对照分析

目的 探讨慢性抑郁症患者的临床特征。方法 对258例住院抑郁症患者的有关临床资料进行回顾性调查。结果 有43例（16．7％）为慢性抑郁症患者；同非慢性者相比，其结果为慢性者多在25岁前起病，具神经质人格，病前多有负性生活事件及躯体疾病，且有明显的认识障碍及焦虑躯体化症状，较多伴有精神病性症状；经逐步回归分析，影响患者病程慢性化的主要因素为：病前神经质人格、负性生活事件、社会支持系统、精神病性症状。结论 抑郁症预后并不乐观，应加强社会心理因素的干预。     

单、双相抑郁症临床特征的对照分析

据报告,双相抑郁症被误诊为单相抑郁症者高达40％,严重影响病人的预后。为此,作者对单、双相抑郁症的临床特征进行了对照分析,旨在有助于临床诊治,并报道于后。     

慢性与非慢性抑郁症的临床特征比较

目的　旨在比较慢性与非慢性抑郁症的临床特征及其治疗对策。方法　对 42例慢性与 60例非慢性抑郁症病人进行临床对照。结果　慢性与非慢性抑郁症的抑郁症状和妄想症状在病程中出现时间、内容和应激评分方面均有显著差异。结论　此两种疾病心理社会因素、妄想症状在病程中出现的时间、种类及应激源等方面 ,均具有一定特征性     

不同性别首次发作抑郁症的临床特征对比

目的：探讨不同性别首次发作抑郁症临床特征的异同。方法：采用一般情况问卷、抑郁白评量表(SDS)和汉密顿抑郁量表(HAMD)对不同性别首发抑郁症患者进行测查。结果：女性首发抑郁症患者发病年龄显著低于男性，HAMD的躯体化／焦虑、睡眠因子显著高于男性，而认识障碍、迟缓和绝望因子评分显著较男性为低。另外，女性抑郁症患者的共病显著高于男性。结论：不同性别首次发作抑郁症的临床特征存在一定的差异。     

中国道家认知疗法并用盐酸米安色林与单用盐酸米安色林治疗老年抑郁症的对照研究

目的探讨道家认知疗法在老年抑郁症治疗中的作用。方法将68例老年抑郁症病人随机分为两 组,A组为道家认知疗法合并盐酸米安色林治疗组;B组为单纯用盐酸米安色林治疗组。治疗8周,于治疗前后分 别用汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)、临床疗效总评量表中的疗效总评分量表(CGI-GI)评定疗 效,半年后随访。结果A、B组的HAMD于治疗2周末已呈非常显著下降(P<0．01),HAMA于治疗4周末才出现 这种变化(P<0．01)。A组治疗8周未的3个量表评分均非常显著低于B组(P<0．01),有效率达96．9％,显著低 于B组的75％,半年复发率(6．3％)也显著低于B组(28．1％)。结论 中国道家认知疗法是适合中国老年抑郁症 的心理治疗方法。     

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.     

躯体化障碍与抑郁症的临床特征比较

目的：弄清躯体化障碍是否为一处陷匿形式的抑郁症。方法：按ＤＳＭ－Ⅳ诊断标准收集躯体化障碍５６例（Ａ组）、抑郁症５１例（Ｂ组）,对两级人列均用病史问卷及汉尔顿抑郁量表（ＨＡＭＤ）进行调查评定。结果：Ａ组躯体症状频率显著高于Ｂ组,抑郁症状频率和ＨＡＮＤ总分显著低于Ｂ组,两组在ＨＡＭＤ因子分析,疾病行为与态度、病程演变及发病背景方面存在显著差异。     

Unmet care needs,care provision and patient satisfaction in patients with a late life depression: a cross-sectional study

Background: Research has shown that some 30% of total care needs in people with late-life depression (LLD) are unmet. It is not known to what extent patients actually don't receive any care for these needs or consider the care to be insufficient and their satisfaction with the provided care.

Aim: The aim of this study is to obtain insight into the care provided in relation to the reported unmet care needs and satisfaction with the total care provided is examined.

Method: A cross-sectional study of 99 people with LLD in an ambulatory setting.

Results: In 67% of patients, at least one unmet need was ascertained. In most cases (80%) care was actually provided for those needs by professionals and/or informal caregivers. Patients were satisfied with the care delivered for 81% of the reported care needs. Satisfaction was lowest for social care needs (67%). For six specific care needs it was demonstrated that dissatisfied patients were significantly more depressed than satisfied patients.

Conclusion: Even though patients might receive care for certain needs, this does not mean that their needs are met. A substantial proportion of patients with LDD feel that they need additional help for unmet needs.     

Diagnosis of late life depression: the view from primary care.

In the typical primary care practice, in which patients with a wide range of diseases and symptoms present with numerous needs, concerns, and requests, a chronic disease that lacks quantitative, biologically based diagnostic testing, such as depression, can present a daunting diagnostic challenge to even the best and most dedicated primary care physician. Depression does not compete well for patient and physician time and energy with other medical problems and medical co-morbidity in patients who seek care from their primary care physician. Primary care patients may be more comfortable with and accepting of depression being framed as a "normal" chronic disease rather than a psychiatric "brain" disease subject to cultural and generational stigmas, nihilism, and prejudice. Insurance parity in mental health care would make depression and other mental illness more legitimate in the eyes of patients, family members, employers, and physicians. Of particular value would be new and creative approaches to collaborative care, including telephone monitoring, nurse clinician outreach, and improved availability of psychiatric consultation in primary care, because elderly depressed patients often see the care of their depression as part of the integrated care of multiple chronic medical diseases, rather than a separate psychiatric problem to be referred for specialty care.     

The impact of psychosocial factors on late-life depression.

Mental illnesses in later life are multidimensional phenomena that occur in interpersonal, psychosocial, and biological contexts. With depression used as an example, the purpose of this article is to review how psychosocial variables contribute to the onset and maintenance of depression in late life, as well as influence treatment outcomes. Particular issues discussed are how these variables can be modified to prevent the onset and relapse of depression, how nonmodifiable risk factors can be addressed to prevent onset and relapse, and how research in this area needs to evolve to improve prevention and treatment.     

内观认知疗法对抑郁症患者临床症状、生活质量和社会功能的影响

目的探讨了内观认知疗法（NCT）合并药物对于改善抑郁症患者抑郁症状、社会功能和生活质量的疗效。方法对抑郁症患者在药物治疗基础上,分别合并给予NCT和支持性心理治疗（SP）;以汉密尔顿抑郁量表（HAMD-17）、抑郁自评量表（SDS）、临床总体印象量表（CGI）、健康状况调查问卷（SF-36）、社会功能量表（SFRS）进行评估。结果NcT治疗后较SP治疗后CGI—S、HAMD、SDS、SFRS评分降低;SF-36评分提高。结论合并药物治疗前提下NCT较SP能够更显著改善抑郁症患者的抑郁症状、社会功能和生活质量。     

阻塞性睡眠呼吸暂停患者临床特征与焦虑抑郁的相关分析

目的探索阻塞性睡眠呼吸暂停(OSA)患者的临床特征及其与焦虑抑郁症状的关系,为进一步研究两者间具体的发生机制提供参考。方法选取2018年3月-9月在四川省精神卫生中心行多导睡眠监测的患者238例,根据呼吸暂停低通气指数(AHI)分为OSA组(n=130)和非OSA组(n=108)。采用自制一般资料和临床症状调查问卷、Epworth嗜睡量表(ESS)和匹兹堡睡眠质量指数量表(PSQI)评定患者的临床症状和睡眠质量;采用汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表24项版(HAMD-24)评定患者的焦虑和抑郁症状。分析OSA组临床症状与焦虑抑郁的相关性。结果 OSA组打鼾(76.9%)、夜间憋醒(25.4%)、认知功能减退(76.9%)者均比非OSA组(分别为41.7%、13.0%、63.9%)多,且OSA组症状持续时间更长,差异均有统计学意义(P0.05或0.01)。OSA组ESS、HAMA和HAMD-24评分均高于非OSA组(P均0.01)。相关分析显示,OSA组临床症状持续时间与HAMA评分呈正相关(r=0.212,P=0.016);PSQI评分与HAMA、HAMD-24评分均呈正相关(r=0.217、0.211,P=0.014、0.017)。结论 OSA患者常伴有打鼾、夜间憋醒、认知功能减退,且症状持续时间仅与其焦虑水平有关,睡眠质量与焦虑、抑郁的关系均较密切。