神经内科门诊抑郁障碍患者的识别情况及其影响因素

目的 探讨神经内科门诊抑郁障碍患者的识别情况及其影响因素.方法 采用中文版流调用的抑郁自评量表对神经内科门诊的全部初诊患者(654例)进行筛查,得分＞16分者在其神经内科就诊完毕后征得患者的同意由精神科医师参照ICD-10进行诊断,对符合ICD-10抑郁障碍的78例患者进行汉密尔顿抑郁量表(HAMD)评分,及填写自制的一般情况调查问卷,并对识别抑郁的影响因素行单因素及Logistic多因素回归分析.结果 (1)神经内科医师对78例抑郁障碍患者中识别14例(17.95%),识别为功能性疾病31例(39.74%).(2)与未识别组相比,被识别组中躯体归因模式者多,家庭关系较差,病程较短.(3)被识别组主诉心理症状的比例(35.71%,5/14)高于末识别组(9.38%,6/64),而主诉躯体症状(包括头晕、头痛、乏力、失眠、纳差等)的比例(64.29%,9/14)低于未识别组(90.62%,58/64),差异有统计学意义(均P＜0.01).(4)伴有躯体疾病的抑郁障碍患者有89.18%(33/37)被漏诊;被识别组中伴有躯体疾病的比例(28.57%,4/14)明显低于未识别组(51.56%,33/64),差异有统计学意义(P＜0.05).(5)HAMD各因子分及总分比较,被识别组认知障碍、阻滞方面均重于未识别组(均P＜0.001).(6)Logistic回归分析显示,精神运动性迟滞、抑郁程度重,有利于被识别.结论 神经内科门诊抑郁障碍患者的识别率低.伴有躯体疾病的抑郁障碍多被漏诊;主诉为心理症状的抑郁及严重抑郁易于被神经内科医师识别.     

心理咨询门诊抑郁障碍的识别与氟西汀治疗

目的 探讨综合性医院心理咨询门诊抑郁障碍的识别与治疗。方法 将各科以躯体不适就诊，经多方检查治疗无效而转来心理咨询门诊的患，进行汉密尔顿抑郁量表（HAMD）测评，HAMD≥18分入组共69例，分别每日给氟西汀20mg治疗6周，治疗后查HAMD，并进行疗效评定。结果 69例中轻度、中度抑郁占73．9％，重度抑郁占26．1％，有81．2％的初诊患第一主诉是睡眠障碍和躯体不适，经服用抗抑郁剂氟西汀治疗6周后，HAMD评分明显下降（P＜0．01），痊愈67．3％，显效24．5％，进步4．9％，无效3．3％。治疗前后HAMD量表五项因子评分均有明显下降，具显意义（P＜0．01）。结论 心理咨询门诊抑郁患及时识别、诊断，适当应用抗抑郁剂可有效缓解抑郁症状和躯体症状，减少不必要的检查和治疗，利于患疾病的康复。     

神经科门诊抑郁症伴躯体症状分析

目的探讨综合医院神经科门诊抑郁症伴躯体症状的特点.方法对符合CCMD-2-R抑郁症诊断标准,抑郁自评量表(SDS)评分≥40分,汉密顿抑郁量表(HAMD)评分≥17分的73例神经科门诊患者进行临床及量表分析.结果头痛头晕为本组突出的躯体症状,成为第一主诉者占43.8%.患者均肯定有抑郁表现,各种抑郁症状出现率为67.1%～97.3%,且以兴趣减退者居多.SDS平均总粗分为(5038±8.50)分,HAMD平均(19.50±7.43)分.医院焦虑情绪自评量表(HAD-A)≥9分者明显多于<9分者,前者的SDS评分明显高于后者.结论神经科门诊抑郁症伴躯体症状患者以头痛头晕为第一主诉最多.抑郁常见症状以兴趣减退为常见.多为轻度抑郁,常伴焦虑,伴焦虑者的抑郁程度较重.     

综合医院临床医师抑郁／焦虑障碍识别的对照分析

目的：分析综合医院临床医师对抑郁、焦虑的识别以及抑郁焦虑障碍与患者躯体症状的关系。方法从青海大学附属医院各科门诊及住院患者中选取200例作为实验组,另从同期人群中选取100例正常人做为对照组。用综合医院焦虑抑郁量表（HAD）自我评估筛检出抑郁、焦虑及抑郁合并焦虑症状病人,再由医学心理科专业医生使用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）评定抑郁、焦虑患病率,并进一步调查上述病人抗抑郁、抗焦虑的诊治情况,对比各组患者躯体主诉情况及诊断结果。结果实验组有抑郁/焦虑障碍者68例（34％）,对照组患抑郁/焦虑障碍者15例（15％）;实验组三种主诉症状的患者所占比例更大;实验组HAD 、HAMD及 HAMA三项量表评估结果均较之对照组更高。结论综合医院临床医师在疾病诊断中,患者躯体症状尤其是多种症状叠加时,可能存在抑郁/焦虑症状,应重点识别,充分结合患者的临床表现,提高临床抑郁/焦虑识别率。     

以躯体不适为主要症状的抑郁症误诊分析

目的分析综合医院中伴有躯体不适的抑郁症误诊情况,提高早期诊治率.方法将各科以躯体不适就诊经多方治疗无效而转来我院精神科门诊的患者,进行汉密顿抑郁量表(HAMD)评分,分值≥18分,且符合CCMD-2-R抑郁症诊断标准者80例,给予氟西汀治疗8周,进行疗效评定.结果80例患者中,轻、中度抑郁占82.5%,重度抑郁占17.5%.有77.5%的初诊患者的第一主诉是躯体不适和睡眠障碍,而不是抑郁症状.氟西汀治疗8周后,HAMD评分明显下降.结论对综合医院抑郁症患者及时识别、诊断,适当应用抗抑郁剂可有效缓解抑郁症状和躯体症状,减少不必要的检查和治疗,有利于患者的早日康复.     

躯体化障碍与以躯体症状为主诉的抑郁症个性、躯体主诉、生活质量比较

目的探讨躯体化障碍与以躯体症状为主诉的抑郁症患者个性、躯体主诉、生活质量差异。方法对30例躯体化障碍和30例以躯体症状为主诉的抑郁症患者分别采用自编躯体症状主诉频数表,艾森克人格问卷（EPQ）、汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）、健康状况调查问卷（SF-36）等进行评定,对影响生活质量的某些因素进行多元回归分析。结果两组躯体主诉无显著性差异（P〉0．0．5）;躯体化障碍组E分显著低于抑郁症组,N分显著高于抑郁症组（P〈0．05）;两组HAMD总分无差异（P〉0．05）,躯体化障碍组焦虑／躯体化及认知障碍因子分显著高于抑郁症（P〈0．05）,躯体化障碍的HAMA总分及躯体性焦虑分显著高于抑郁症组（P〈0．05）;躯体化障碍组生理机能、生理职能、躯体疼痛分量表评分均显著低于抑郁症组（P〈0．05）;多元回归分析结果,影响两组患者生活质量的主要因素依次为HAMD总分、HAMA总分、EPQ精神质因子、病程。结论躯体化障碍与以躯体症状为主诉的抑郁症患者在个性、HAMA总分、躯体焦虑因子分、生活质量方面有差异,两者的个性、疾病严重程度、病程为影响生活质量的重要因素。     

综合医院患者情感障碍的临床特点和治疗

目的 探讨综合性医院患者情感障碍的临床特点及治疗.方法 将各科以躯体不适就诊但经多方查治无效而转来心理门诊的患者,进行汉密尔顿抑郁量表(HAMD)测评,HAMD≥18分者入组100例,其中抑郁障碍70例.分别给予每日氟西汀20mg治疗6周,治疗前后查HAMD,并进行疗效评定.结果 70例中,轻度、中度抑郁占85.7%,重度抑郁占14.3%.有71.49%的初诊患者第一主诉是睡眠障碍和躯体不适.经服用抗抑郁剂氟西汀治疗6周后,HAMD评分结果明显下降(P＜0.01),痊愈率68.9%,显效率27.8%,进步1.64%,无效1.64%.治疗前后HAMD量表的五项因子评分均有明显下降,具有统计学意义(P＜0.01).结论 综合医院抑郁障碍患者及时识别、诊断,适当应用抗抑郁剂可有效缓解抑郁症状和躯体症状,减少不必要的检查和治疗,利于患者康复.     

度洛西汀与西酞普兰治疗不同症状抑郁症的对照研究

目的比较度洛西汀与西酞普兰治疗不同症状抑郁症的疗效。方法将126例符合CCMD-3抑郁痘诊断标准的患者,按不同主诉（精神症状或躯体症状）分为两组,每一组再随机分为两组,分别采用度洛西汀和西酞普兰治疗6周,用汉密尔顿抑郁量表（HAMD）评定疗效,用副反应量表（TESS）评定副反应。结果在以精神症状为主的患者中,度洛西汀组与西酞普兰组的有效率分别为84％和75％,两者比较差异无显著性（P〉0．05）,在以躯体症状为主的患者中,度洛西汀组与西酞普兰组的有效率分别为80％和55％,两者比较差异有显著性（P〈0．05）。结论与西酞普兰相比,度洛西汀治疗伴有躯体症状的抑郁症患者疗效更好．     

慢性原发性失眠的临床特点

目的：研究慢性原发性失眠的临床症状、伴发焦虑和抑郁的特点以及两者的关系。方法：选取慢性原发性失眠患者68例为原发性失眠组,选取有睡眠障碍的帕金森病患者62例为继发性失眠组。对两组研究对象的Athens失眠量表、焦虑自评量表和抑郁自评量表评分进行分析比较。结果：原发性失眠组Athens失眠量表总分和分项中入睡困难、早醒、总睡眠时间减少、总睡眠质量差的分值显著高于继发性失眠组（P〈0.01）。原发性失眠组焦虑自评量表得分与Athens失眠量表总分和睡眠维持困难、早醒、总睡眠质量差、白天躯体症状分项密切相关;抑郁自评量表得分与Athens失眠量表总分和早醒、总睡眠时间减少、总睡眠质量差、白天情绪改变、白天躯体症状分项密切相关。结论：慢性原发性失眠患者的入睡困难、早醒、总睡眠时间减少和总睡眠质量差是其临床特点。     

躯体化障碍患者的临床特征

目的:研究综合医院神经内科躯体化障碍患者的临床表现特点。方法:对于符合躯体化障碍诊断标准的90例患者,用自编调查表对患者进行一般资料调查,用躯体症状报告单对患者进行躯体症状统计,用抑郁自评量表(SDS)和焦虑自评量表(SAS)评定抑郁和焦虑状态。结果:躯体化障碍患者女性较男性多见,平均病程5年,过去一年就诊次数平均为12次。对医生的诊断和治疗不满意,85.6%的患者表示可疑或不信任。患者临床症状出现频率高的依次是头晕(74.4%)、头痛(71.1%)、睡眠障碍(70.0%)等。症状可以累及多个系统,其中慢性疼痛症状敏感性最高。躯体化障碍与抑郁焦虑障碍有很高的共患率,并且抑郁症状越严重,症状数目越多。结论:躯体化障碍临床症状复杂多样,其中慢性疼痛症状敏感性最高。     

The outcome of depressive disorders in neurology patients: a prospective cohort study

BACKGROUND: In a previous prospective study of 300 consecutive new attenders at neurology outpatient clinics, depressive disorders were diagnosed in 119 patients (40%) and major depressive disorder in 77 (26%). OBJECTIVE: To describe the eight month outcome of depression in this cohort. METHODS: Patients were reinterviewed eight months after their baseline assessment. Mental state was examined using the primary care evaluation of mental disorders (PRIME-MD) interview and the hospital anxiety and depression (HAD) self rating scale. Health status was measured using the medical outcome study 36 item short form scale (SF-36). RESULTS: Of the original cohort of 300, 226 (75%) participated in the follow up. Among them, 88 had a depressive disorder at baseline and 69 (78%) of those were still depressed at follow up; 54 had major depression at baseline and 46 (85%) of those still had a major depressive disorder at follow up. Among the 138 patients who had no depression at baseline, 20 new major depressive disorders had developed by the time of follow up. Resolution of major depressive disorders was associated with an improvement in health status. CONCLUSIONS: Most depressive disorders detected in neurology outpatients persist at an eight month follow up, and a substantial number of new cases arise. Resolution of depressive disorders, particularly major depressive disorder, is associated with an improvement in health status.     

对神经内科门诊患者躯体症状群及生活质量的调查

目的调查综合医院神经内科门诊患者躯体症状群的检出率及与其它精神障碍症状群的共病特点,并评估伴有躯体症状群患者的生命质量。方法采用中文版患者健康问卷(patient health questionnaire,PHQ)及健康状况调查问卷(the short form-36 health survey,SF-36)对综合医院神经内科门诊患者进行调查,共收集有效问卷306份。结果符合躯体症状群的患者189例(61.8%);伴躯体症状群患者的SF-36各维度评分低于无任何精神障碍症状患者;SF-36各维度评分与躯体症状群评分呈负相关(r=-0.162～-0.632,P≤0.005)。结论在综合医院神经内科门诊就诊患者中,躯体症状群检出率较高,其生命质量较差,尤其以精神健康状况差为显著。     

对综合医院神经内科门诊患者焦虑症状群及生活质量的调查

目的调查综合医院神经内科门诊患者焦虑症状群的检出率;探讨神经内科门诊伴有焦虑症状群患者的生活质量。方法使用中文版患者健康问卷(patient health questionnaire,PHQ)、焦虑症状群分量表(GAD-7)及健康状况调查问卷(the short form-36health survey,SF-36)对综合医院神经内科门诊患者进行问卷调查。对受调查患者同时进行生活质量评估,采用Pearson简单相关法对资料进行相关性分析,分析焦虑症状群与生活质量之间的相关性。结果具有焦虑症状群患者97例/306例[31.7%(95%CI:26.5%~36.9%)];具有焦虑症状群的神经内科门诊患者的SF-36各维度评分低于不伴有焦虑症状群患者;SF-36各维度评分与GAD-7评分呈负相关,具有统计学意义。结论在综合医院神经内科门诊就诊者中,焦虑症状群检出率较高;具有焦虑症状群的神经内科患者生活质量较差,尤其以精神健康状况差为显著。     

Efficacy of extended-release venlafaxine in nondepressed outpatients with generalized anxiety disorder

OBJECTIVE: This study evaluated the efficacy and safety of fixed doses of once-daily extended-release (XR) venlafaxine in outpatients with generalized anxiety disorder without concomitant major depressive disorder. METHOD: Adult outpatients with generalized anxiety disorder but not major depressive disorder with total scores of 18 or higher on the Hamilton Rating Scale for Anxiety and scores of 2 or higher on its anxious mood and tension factors were eligible. Patients were randomly assigned to receive placebo or venlafaxine XR (75, 150, or 225 mg/day) for 8 weeks. Primary efficacy variables were final total and psychic anxiety factor scores on the Hamilton anxiety scale and final severity and global improvement item scores on the Clinical Global Impression (CGI) scale. RESULTS: Of the 377 patients entering the study, 370 were included in a safety analysis and 349 in an efficacy analysis. Adjusted mean scores at 8 weeks (last-observation-carried-forward analysis) were significantly lower for one or more of the venlafaxine XR groups in four of four primary and three of four secondary outcome measures than for the placebo group. These included a change of 1.7 (versus 1.3) from baseline on CGI severity item scores and a final score of 2.2 (versus 2.6) on the CGI global improvement item. All doses of venlafaxine XR were well tolerated. CONCLUSIONS: Venlafaxine XR is an effective and well-tolerated option for the short-term treatment of generalized anxiety disorder in outpatients without major depressive disorder.     

综合医院门诊患者焦虑、抑郁症状调查

目的：分析综合医院门诊患者中,焦虑、抑郁症状的发生率及其可能的影响因素。方法：选取4所综合医院2485例门诊患者,采用自编一般情况调查表及综合医院焦虑抑郁量表进行调查。结果：门诊患者中焦虑、抑郁发生率分别达到26.0%、26.6%,焦虑抑郁共发率达12.7%,明显高于普通人群。不同级别医院、科室、男女之间焦虑、抑郁评分有显著差异。结论：综合医院门诊患者中焦虑抑郁有较高的患病率,值得引起关注。     

Do medically unexplained symptoms matter? A prospective cohort study of 300 new referrals to neurology outpatient clinics

OBJECTIVES: To determine (a) the proportion of patients referred to general neurology outpatient clinics whose symptoms are medically unexplained; (b) why they were referred; (c) health status and emotional disorder in this group compared with patients whose symptoms are explained by "organic" neurological disease. METHODS: The prospective cohort study with case note follow up at 6 months was carried out in the regional neurology service in Lothian, Scotland with 300 newly referred outpatients. Neurologists rated the degree to which patients' symptoms were explained by organic disease (organicity), GPs' reasons for referral, health status (SF-36), anxiety, and depressive disorders (PRIME-MD), RESULTS: Of 300 new patients 11% (95% confidence interval (95% CI) 7%-14%) had symptoms that were rated as "not at all explained" by organic disease, 19% (15% to 23%) "somewhat explained", 27% (22% to 32%) "largely explained", and 43% (37% to 49%) "completely explained" by organic disease. Reason for referral was not associated with "organicity". Comparison of these groups showed that although physical function was similar, the median number of physical symptoms and pain were greater in patients with lower organicity ratings (p<0.0005, p<0. 0005). Depressive and anxiety disorders were more common in patients with symptoms of lower organicity (70% of patients in the not at all group had an anxiety or depressive disorder compared with 32% in the completely explained group (p<0.0005). CONCLUSION: One third of new referrals to general neurology clinics have symptoms that are poorly explained by identifiable organic disease. These patients were disabled and distressed. They deserve more attention.     

自行编制的社区抑郁状态电话筛查问卷与常用抑郁和焦虑评定量表的一致性研究(下)

目的 研究自行编制的社区抑郁状态电话筛查问卷(community depression status screening questionnaire via telephone,CDSQ-T)与Hamilton抑郁量表(Hamilton depression rating scale,HAMD)、Hamilton焦虑量表(Hamilton anxiety rating scale,HAMA)、Zung抑郁自评量表(self-rating depression scale,SDS)、Zung焦虑自评量表(self-rating anxiety seale,SAS)的相关性和一致性.方法 对14～86岁458例门诊患者同时先后进行CDSQ-T与HAMD、HAMA、SDS、SAS量表的评估.比较CDSQ-T与四个量表总分的相关性和一致性.线性关系采用线性回归模型分析.结果 Pearson相关分析显示,CDSQ-T总分与HAMD、HAMA、SDS、SAS的总分均明显相关(r分别为0.79、0.71、0.76、0.72,P均小于0.05);CDSQ-T总分与HAMD、HAMA、SDS、SAS总分的回归方程中回归系数分别为0.56、0.61、0.91、0.81(P<0.05);CDSQ-T总分与HAMD、HAMA、SDS、SAS总分散点图拟合直线的决定系数R2分别为0.63、0.50、0.57、0.52(P<0.05).结论 CDSQ-T与HAMD、HAMA、SDS、SAS之间均具有显著的线性相关,尤其是与自评的抑郁量表的一致性最好.     

内科门诊患者抑郁情绪及相关因素的调查研究

目的了解哪些因素影响内科门诊患者抑郁情绪。方法以我院一个月内内科门诊患者作为调查对象,采用抑郁自评量表(SDS)和自编的问卷,从性别、经济状况、健康状况、人际关系、娱乐活动、社会地位、自我感受、工作压力、家中地位和生活情趣等多因素进行调查。结果内科门诊患者抑郁情绪与性别、健康状况、社会地位、生活情趣有密切关系,SDS得分高并有较多抑郁情绪(P<0.05～0.001);女性患者是男性患者2.2倍;高学历患者SDS分高于低学历患者,有显著性差异性(P<0.01)。结论内科门诊患者抑郁情绪是一种普遍现象,女性多于男性,高学历人群更易患抑郁情绪。     

Depression and hypochondriasis in family practice patients with somatization disorder

The relationships specified in DSM-III between somatization disorder and depression, and somatization disorder and hypochondriasis require further validation and easier methods of detection for use by primary care physicians. The authors investigated hypochondriacal and depressive symptoms in 13 family practice outpatients with somatization disorder. Pain complaints and depressive symptomatology were present in over 75% of this group, while hypochondriacal symptoms were present in 38%. The mean score on the somatization scale of the Hopkins Symptom Check List (HSCL-90) was greater than that reported for any other group. These findings support the separation of somatization disorder and hypochondriasis and suggest the need for better delineation of depressive subtypes in somatization disorder. The somatization scale of the HSCL-90 should be a useful screen for somatization disorder in future research.