抗抑郁剂联合治疗在抑郁症中的研究进展

抗抑郁剂联合治疗(combined therapy)策略即同时使用两种抗抑郁剂,是临床上经常使用的治疗选择,尤其是随着新一代抗抑郁剂的安全性显著提高.目前,选择性5-羟色胺再摄取抑制剂与不同抗抑郁剂联合使用已被广泛用于对单药治疗无效的患者.同时,为缩短起效时间,提高治愈率,也尝试将联合治疗应用于抑郁症的初始或早期治疗阶...     

抗抑郁剂对中老年抑郁患者血清褪黑素水平的影响

目的探讨抗抑郁剂对中老年抑郁患者血清褪黑素水平的影响。方法对47例中老年抑郁发作患者采用放射免疫法测定其血清褪黑素水平，并与抗抑郁剂治疗后比较。结果中老年抑郁发作患者血清褪黑素水平显著低于正常对照组（P〈0．05）；经4—8周抗抑郁剂治疗后，血清褪黑素水平又显著升高（P〈0．01）。结论抗抑郁剂可使中老年抑郁患者血清褪黑素水平升高。     

帕罗西汀治疗脑卒中后抑郁的对照研究

目的　探讨新型抗抑郁药帕罗西汀对脑卒中后抑郁的疗效、副作用以及对生活满意度的影响。方法　将神经科确诊的脑卒中患者在排除无其他严重躯体疾病的情况下 ,分为帕罗西汀治疗组和未经抗抑郁剂治疗组 ,进行抑郁症状、LSR评定和临床疗效比较分析。结果　帕罗西汀治疗组自第 2周末HAMD评分与治疗前相比有较明显下降 (P <0 .0 5 ) ,第 4周末评分下降更加明显 (P <0 .0 0 1)。帕罗西汀治疗组LSR评定与治疗前相比明显提高 ,未经抗抑郁剂治疗组无明显变化 ,两组相比有明显差异 ,(P <0 .0 0 1)。治疗结束时两组临床疗效差异也非常明显 (P <0 .0 0 5 ) ,副作用轻微。结论　帕罗西汀对脑卒中后抑郁有效 ,副作用少 ,能明显改善生活质量 ,间接支持生物学致病观点。     

新型抗抑郁剂与性功能障碍

随着新型抗抑郁剂 5 羟色胺再摄取抑制剂 (ＳＳＲＩ)和其他一些抗抑郁剂的大量使用 ,人们开始注意到服用此类药物患者出现的各类性功能障碍。甚至有人估计 ,服用ＳＳＲＩ者出现性功能障碍的比例高达 75 % [1 ] 。但迄今为止 ,患者常回避此类问题 ,许多临床医生对这方面的情况也缺乏足够的了解。而事实是 ,药物引起的性功能障碍显然会影响患者对治疗的接受及依从性。为此 ,我们对与ＳＳＲＩ及其他一些新型抗抑郁剂相关的性功能障碍及治疗的进展介绍于下。一、ＳＳＲＩ及其他抗抑郁剂所致性功能障碍的表现[1 6 ]根据美国精神障碍诊断与统计…     

儿童青少年抑郁症的治疗研究进展

本文综述了儿童青少年抑郁症治疗方面的研究进展。其中包括抗抑郁剂在儿童青少年中的特异性、安全性及有效性;新型抗抑郁剂SSRIs应用现状;儿童青少年抑郁症的自杀观点与新型抗抑郁剂有关吗?儿童青少年抑郁症应用SSRIs可能的理论观点。     

抗抑郁剂的应用情况调查

目的：了解抗抑郁剂的应用情况。方法：将我院１９９７年６月至１９９９年２月期间应用的抗抑郁剂的患者进行分组，分成三环类抗抑郁剂（ＴＣＡｓ）组，选择性５羟色胺再摄取抑制剂（ＳＳＲＩｓ）组和其它抗抑郁剂组，比较用药频度和脱落率。结果：ＴＣＡｓ的用药频度显著下降，而ＳＳＲＩｓ的用药频度显著上升；目前，ＳＳＲＩｓ的应用率显著高于ＴＣＡｓ；ＴＣＡｓ的脱落率显著高于ＳＳＲＩｓ。结论：ＳＳＲＩｓ和ＴＣＡｓ已共同成     

血治疗浓度三环类药物引起谵妄

三环抗抑郁剂与其他具有显著抗胆碱能作用的药物一样,可以产生急性谵妄状态。近来有些报导认为:三环类药物的血浓度超过一般治疗浓度时可能出现谵妄。本文报导1例在治疗浓度之内发生谵妄如下: 患者31岁,女性,因单相抑郁症复发住院治疗,表现抑郁心境、悲观失望、失眠、厌食和精神运动迟滞。在以往两次抑郁发作时,ECT及三环抗抑郁剂治疗均有效。无酒     

住院精神疾病患者精神用药情况调查分析

目的 了解目前住院精神障碍患者的精神药物使用情况,提高诊疗水平.方法 采用一日法调查驻马店市精神卫生中心603例住院精神障碍患者诊断和治疗情况,并与上海市精神卫生中心2006年调查结果相比较.结果 精神分裂症居住院患者的诊断首位,联用两种精神药物的情况较多,联用两种抗焦虑和镇静催眠药物较普遍,以劳拉西泮和氯硝西泮为主.传统精神药物使用显著减少,氯氮平的使用仍居首位,情感稳定剂以丙戊酸钠和碳酸锂为主,抗抑郁剂以西酞普兰为多.我院精神药物使用情况与上海精神卫生中心比较存在一定的差异.结论 我院近年来精神药物使用情况已发生了显著变化,与新型精神药物疗效好,不良反应少,患者依从性高和社会经济状况的改善及卫生经济学的发展有关.     

新型抗抑郁剂与性功能障碍

新型抗抑郁剂引起的性功能障碍(NAISD)日益受到重视，他常使患者增加非依从性，引起抑郁复发^[1]。现对此作一综述。     

老年心身疾病患者生活质量与生活满意度的相关性研究

目的了解老年心身疾病患者生活质量和生活满意度的关系.方法采用诺丁汉健康问卷和生活满意度Z评定54例老年心身疾病患者的状况,与54例老年非心身疾病患者和健康老人对照.结果老年心身疾病患者的生活质量差于非心身疾病的老人和健康老人,主要表现在躯体活动、性生活、家务、嗜好和社会活动等方面;生活满意度也以老年心身疾病组患者为差;社交状况越差的老年患者,生活满意度越低.结论心理干预有助于改善老年心身疾病患者的生活质量.     

全程优质护理模式在脑部肿瘤立体定向放射治疗中的应用效果

目的 探讨全程优质护理模式在脑部肿瘤立体定向放射治疗（SRT）中的应用效果。方法 2015年6月到2016年4月收治SRT干预的脑部肿瘤86例,根据护理方法分为对照组和观察组,各43例。对照组接受常规护理干预,观察组接受全程优质护理模式干预。护理前后,采用世界卫生组织生存质量测定量表（WHOQOL-100）评价生活质量,采用焦虑自评量表（SAS）和抑郁自评量表（SDS）评价焦虑和抑郁情况,采用护理满意度自评量表评价护理满意度。结果 护理后,与对照组相比,观察组WHOQOL-100评分明显增高（P<0.01）,SAS、SDS评分均明显降低（P<0.01）,护理满意度明显增高（P<0.01）,总并发症发生率明显降低（P<0.01）。结论 脑部肿瘤SRT中应用全程优质护理,可有效改善病人生活质量及心理状况,减少并发症。     

脑卒中后抑郁的相关因素分析

目的:探讨脑卒中后抑郁的相关因素。方法:采用汉密尔顿抑郁量表(HAMD)对198例脑卒中患者进行现状调查。结果:73例脑卒中患者有抑郁表现,发生率为36.9%,经Logistic多元回归分析,脑卒中后抑郁的相关因素有负性生活事件、心血管病史、抑郁症史、病灶数目、病灶部位以及脑卒中史。结论:脑卒中后抑郁的相关因素有负性生活事件,心血管病史,抑郁症史、病灶数目,病灶部位以及脑卒中史。脑卒中后抑郁的发生可能是神经生物学因素和社会心理学因素共同作用的结果。     

Self-reported life satisfaction and treatment factors in patients with schizophrenia, major depression and anxiety disorder.

Our aim was to study the associations between life satisfaction and treatment factors and how depression affects these associations among patients with schizophrenia (n=403), major depression (n=349) and anxiety disorder (n=139) from a defined area. Treatment satisfaction and compliance were high, but life satisfaction was low regardless of diagnostic group. Patients with schizophrenia recorded better life satisfaction than patients with the other disorders. There were few independent associations between life satisfaction and treatment factors. Fortunately, factors amenable to treatment intervention, such as depression, problem-solving ability and social support, were independently related to life satisfaction in every diagnostic group. Depression decreased these associations significantly only in patients with schizophrenia. Life satisfaction and treatment satisfaction should be included as separate variables in treatment outcome studies.     

Anxiety undermines quality of life in ALS patients and caregivers

Background: Although depression has been widely studied in amyotrophic lateral sclerosis (ALS), there is little information on anxiety. Objective: To detect anxiety in patients with ALS and their caregivers, comparing the diagnostic and the follow‐up phases of the disease and assessing its impact on quality of life (QoL). Methods: Anxiety has been evaluated with the State and Trait Anxiety Inventory in a series of 75 consecutive ALS patients and their primary caregivers. Anxiety has been related to depression, QoL, and satisfaction with life. Results: In patients, state anxiety was significantly higher during the diagnostic phase, whilst in caregivers it was similar in the two phases. Patients’ state anxiety was related to depression, shorter disease duration and lower satisfaction with life. Caregivers’ state anxiety was related to their trait anxiety. Whilst in patients QoL and satisfaction with life were similar in the two phases, in caregivers there was a significant decrease of satisfaction with life in the follow‐up phase. Conclusions: Treating neurologists should recognize that the diagnostic phase and the earlier period after the diagnosis is characterized by a high level of anxiety both in ALS patients and in their caregivers, and should propose pharmacological and psychological interventions to relieve this highly distressing disturbance.     

A retrospective chart review of the effects of modafinil on depression as monotherapy and as adjunctive therapy

Major depression is often refractory to antidepressants, and it is important to explore alternative medication treatments. Among the symptoms common with depression are energy loss/fatigue and anxiety. Modafinil has a novel mechanism of action and may have antidepressant properties. In a single outpatient clinic, data were systematically collected on all patients including those who began modafinil treatment for major depression. This clinician (C.P.) had used modafinil to treat major depression in patients who failed one or more adequate antidepressant treatments. To monitor changes during treatment, charting had included four rating scales: the Beck Depression Inventory, the Zung Self-Rating Depression Scale, and the Hamilton Depression and Hamilton Anxiety Rating Scales. A follow-up chart review identified 45 patients whose major depression was treated with modafinil over a 9-month period. The mean dose of modafinil was 184.3+/-100.0 mg/day (range=50-450 mg/day). For these 45 patients, all four rating scales showed significant improvement following 2 weeks and following 3 months of modafinil treatment. Fifteen of these patients were on modafinil monotherapy, and the remaining 30 on modafinil as an augmenting agent. For both subgroups, all three depression rating scales showed a significant improvement following 2 weeks and 3 months of modafinil treatment. This chart review provides preliminary evidence that modafinil treatment may be beneficial to those with major depression, even when unresponsive to other treatments.     

Current use of depression rating scales in mental health setting

Objective

This study was to investigate the current use of depression rating scales by psychiatrists and clinical psychologists in Korea.

Methods

The questionnaires from many psychiatrists and clinical psychologists were included in the analysis. The questionnaire was composed of items about examining the percentage of patients clinically using depression rating scales, reasons for not use of them, the degree of satisfaction, the perceived agreement rate between the result of depression rating scales and doctor''s clinical interview in the evaluation of patients with depressive symptoms. Data were analyzed by χ² and independent t-test.

Results

The clinical use of depression rating scales was more frequent in the psychologists than in the psychiatrists. The purposes for using depression rating scales were assessed into six areas, there was no significant difference in between two groups, and both groups pointed out their purpose as rating of severity and screening. The reasons for not using scales were that their interview may be sufficient for diagnosis and assessment of depressive patients and they are not familiar with the use of depression rating scales. The psychiatrists usually prefer the Beck Depression Inventory (BDI), Hamilton Depression Rating Scale and Symptom Checklist 90-Revision (SCL-90-R) in order of frequency, and the clinical psychologists are more likely to use the BDI, Minnesota Multiphasic Personality Inventory and SCL-90-R. Overall rate of satisfaction in the use of the scales was 67.29±14.45% and overall perceived agreement rate was 70.89±16.45%.

Conclusion

Currently used depression rating scales at the clinical practice were not various. Therefore, to heighten clinicians'' utility of these depression rating scales measures, either educational efforts or advertisements, or both, will be necessary to spread them wildly.     

Quality of life in depression and anxiety disorders: an exploratory follow-up study after intensive inpatient cognitive behaviour therapy

Thirty-seven patients with depression and anxiety disorder, who participated in an intensive inpatient cognitive behaviour therapy program for 6 weeks, were interviewed before treatment and 6 weeks after the end of treatment; in addition to other measures, quality of life was assessed with the Berlin Quality of Life Profile. Substantial reduction in subjective quality of life, objective functioning and environmental assets was found at baseline. At follow-up, according to clinical global impression, 13.5% of the patients were very much improved, 45.9% much improved; in 26.3% only slight improvement and in 16.2% no improvement was reported. Quality of life changed for the better in areas like work and education, leisure, housing, social relations, psychological well-being and a global rating of satisfaction with life, but not in marital relations, health in general and in finances.     

Correlates of suffering in amyotrophic lateral sclerosis

OBJECTIVES: 1) To determine the prevalence of pain, suffering, poor quality of life, depression, and hopelessness in people with ALS, and the correlates of suffering and poor quality of life; 2) to analyze the relationship between pain, suffering, quality of life, and attitudes toward life-sustaining medical treatment and physician-assisted suicide; and 3) to determine concordance between patients with ALS and their caregivers in rating the patients' pain, quality of life, and suffering. METHODS: Subjects completed a single interview. We measured the subject's pain, quality of life, suffering, hopelessness, depression, social support, perception of burden to others, level of disability, desire for life-sustaining medical treatment, and interest in assisted suicide. Caregivers also rated the patient's quality of life, pain, and suffering. RESULTS: A total of 100 subjects with ALS and 91 caregivers participated. Suffering was rated as 4 or greater on a six-point scale by 20% of subjects with ALS, and 19% rated their pain as 4 or greater on a six-point scale. Eleven percent had clinical depression. Physicians frequently failed to recognize and treat pain and depression. The correlates of suffering were increasing pain, hopelessness, and level of disability. The correlates of poor quality of life were poor social support and increasing hopelessness. The correlation between subjects' and caregivers' rating of the patient's suffering was r = 0.47. There was no relationship between subjects' ratings of pain, suffering, and quality of life, and their interest in life-sustaining treatment or physician-assisted suicide. CONCLUSION: Many patients with ALS suffer, and their suffering is correlated to pain and hopelessness. Physicians caring for patients with ALS frequently fail to recognize and treat their patients' pain and depression.     

伴有抑郁的2型糖尿病患者生活质量及家庭功能

目的:探讨伴有抑郁的2型糖尿病患者生活质量及家庭功能特征。方法:采用生活质量量表(QLESQ)、家庭功能量表(FAD)以及贝克抑郁量表(BDI)对50例2型糖尿病患者(糖尿病组)及50名正常人(正常对照组)进行调查。结果:38%(19/50例)的2型糖尿病患者伴有抑郁。糖尿病组FAD评分中情感卷入及行为控制维度在不健康家庭功能范围内;QLESQ总分(32.49±5.86)分明显低于正常对照组(37.76±5.38)分(P<0.01)。糖尿病组FAD的问题解决、角色和情感卷入维度与抑郁症状呈正相关(r分别=0.426、0.339、0.454,P<0.05或P<0.01);QLESQ总分与家庭功能的角色和行为控制维度呈负相关(r分别=-0.292、-0.344,P<0.01)。结论:伴发抑郁的2型糖尿病患者生活质量差且家庭功能有缺陷。     

Psychosocial function and life satisfaction after stroke.

BACKGROUND AND PURPOSE: This prospective study was designed to describe different aspects of psychosocial function after stroke and the development of changes over time. A major aim has been to identify mental, functional, and social factors associated with low life satisfaction late after stroke. METHODS: Social network, functional ability, leisure-time activities, experience of ill health, major depression, and life satisfaction were assessed repeatedly over 3 years in a population-based sample of 50 long-term survivors of stroke (mean age 71.4 years). RESULTS: Compared with a general elderly population, patients 3 years poststroke had more psychiatric symptoms, lower functional ability, and reduced life satisfaction. Contacts with children were maintained over the 3-year follow-up period, whereas contacts with friends and neighbors declined early after stroke and remained lower than in the general elderly population (p less than 0.05). When time dependency was analyzed, activities of daily living and somatic/neurological symptoms were found to change little after 3 months, while psychiatric symptoms showed changes later. Between 3 and 12 months poststroke, the prevalence of major depression decreased, leisure-time activities and social contacts were partly resumed, and life satisfaction improved (p less than 0.01). Once good life satisfaction was restored it was maintained, and poor life satisfaction at 1 year remained poor for the entire 3 years. CONCLUSIONS: It is concluded that major depression early after stroke, functional disability, and an impaired social network interact to reduce life satisfaction for the long-term survivors of stroke.