Predictors of mortality in an aging community-based cohort in Korea

Background: Multiple factors related to specific dimensions of health – general, physical and mental – contribute to mortality in the elderly, but their relative contributions to mortality risk is not well‐known. The objectives of this prospective population‐based cohort study were to measure mortality rates and to identify predictors of mortality in community‐dwelling men and women aged 65 years or older in Korea by examining self assessments of general health, objective medical burden, and measurement of cognition, mood and function. Methods: A total of 1245 elderly (529 men; 716 women) were followed up longitudinally for 3.5 years. Fixed predictor variables observed at baseline examined in Cox proportional hazards models were age, sex, education, chronic medical illnesses, self‐rated health, basic activities of daily living, depression measured by the Geriatric Depression Scale, and cognition measured by the Mini‐Mental State Examination. Results: Mortality rates were similar to those of the 2001 Korean population. Older age, male sex, poor self‐rated health and presence of cerebrovascular disease were significant predictors of mortality. Presence of ischemic heart disease and cerebrovascular disease at baseline predicted mortality in men, but not in women. Depression predicted mortality only when chronic medical illnesses were excluded from the model. Conclusions: Subjective self‐rated health and objective medical burden are strong independent predictors of mortality in this elderly community population, in addition to age and sex.     

Depression and immune function

Clinical studies have demonstrated that measures of cell-mediated immune function are altered in bereaved persons and depressed patients. This review article focuses on our recent observations of changes in T cell subpopulations and natural killer cytotoxicity in women undergoing adverse life events including conjugal bereavement. A reduction in natural cytotoxicity has also been found in depressed patients. The mechanism by which psychologic states might influence immune function is discussed.     

DSM-III symptom disorders (Axis I) and personality disorders (Axis II) in an outpatient population

Type and prevalence of Axis I and Axis II disorders (DSM-III) were assessed in a sample of 298 consecutive psychiatric outpatients. The instruments used were SCID and SIDP. About half of the Axis I diagnoses consisted of different subgroups of depression. Most patients had more than one diagnosis, anxiety being the second most common disorder. Eighty one percent of the subjects met the criteria for a personality disorder diagnosis; half of them obtained more than one Axis II diagnosis. Personality disorder was more common among men than among women. Avoidant and dependent personality disorders constituted the most frequent diagnoses.     

地段医院中抑郁性疾病的诊断和预后

为了解在地段医院中就诊的抑郁性疾病患者的诊断稳定性和预后，进行了一次随访研究。９０例患者，按当年的精神科诊断，３８例为抑郁性疾病（抑郁症１６例和抑郁性神经症２２例），５２例为非抑郁作神经症。８年后，应用和当年同样的评定工具和诊断标准进行再诊断。结果发现抑郁性疾病的诊断稳定性良好，Ｋａｐｐａ检验显示抑郁症的诊断预测效度为０．７３，抑郁性神经症为０．８４。比较抑郁症和抑郁性神经症的临床特征、预后和结局，两者大同小异。     

Initial lithium augmentation improves the antidepressant effects of standard TCA treatment in non-resistant depressed patients

The hypothesis was tested that an initial lithium-tricyclic antidepressant (TCA) combination has a better antidepressant effect than standard TCA treatment in non-refractory depression at the beginning of an episode. Twenty bipolar melancholic type depressed inpatients under lithium-TCA treatment were compared with 20 patients with the same diagnosis and TCA-placebo treatment for 5 weeks under double-blind conditions. All patients were male. Initial lithium-TCA treatment reduced depressive symptoms significantly more than antidepressant treatment with TCA and placebo after 5 weeks, but not in weeks 1 or 2. It can be concluded that lithium augmentation of TCA treatment should be started even at the beginning of antidepressant TCA treatment to provide a better treatment response in those patients who will profit from long-term lithium prophylaxis, e.g. bipolar patients with melancholic type depression.     

西酞普兰与氯丙咪嗪治疗颈椎间盘突出症术后抑郁焦虑症状的对照研究

目的比较西酞普兰与氯丙咪嗪治疗颈椎间盘突出症伴抑郁焦虑症状的疗效和不良反应。方法对200例颈椎间盘突出症伴抑郁焦虑症状患者分别以西酞普兰与氯丙咪嗪治疗,共治疗6周。采用汉密尔顿抑郁量表(HAMD)评定临床疗效,采用副反应量表(TESS)评定副反应。结果西酞普兰组有效率91%;氯丙咪嗪组有效率90%,2组疗效相当。但西酞普兰组起效时间平均(11.1±5.6)d,而氯丙咪嗪组平均(15.1±8.2)d,以西酞普兰组显著较快(P<0.01)。西酞普兰组不良反应发生率为13%,而氯丙咪嗪组发生率为50%,西酞普兰组不良反应发生率较低。结论西酞普兰治疗颈椎间盘突出症术后伴抑郁焦虑症状的疗效与氯丙咪嗪相当,副反应少,值得推广应用。     

不同眩晕证型两侧脑血流速度差变化与症状的关系研究

目的:为了观察不同眩晕证型中的脑血流速度差大于正常与临床症状之间的关系。方法:应用经颅多普勒超声检查方法,观察颅底各个相对应大血管血流速度两侧差值的变化。结果:各种不同眩晕证型之间的差值有非常显著性的差异,各个指标之间均存在着不同的差异,这些差异性的变化多数与临床表现的头痛有着密切的关系。结论:使用此方法可以更早期地评价不同眩晕证型脑血管功能状态的水平,以便为临床提供可靠的诊断依据。另一方面也充分地说明了经颅多普勒超声对脑血管功能的观察是一项十分敏感的观察指标。     

Scales of depression,ill-being and the quality of life—is there any difference? An assay in taxonomy

The application of a model based on the three time dimensions of past, present and future can be used to generate an alternative taxonomy for the classification of depression, ill-being and quality of life. In relation to time, depression can be defined as the passage from a healthy past to a painful present, ill-being as the painful present of the individual and the quality of life (QOL) as the degree to which the subject's present life is commensurate with his aspirations. Such an approach opens up conceptual and methodological areas of research which will allow the construction of a new type of scale. Depression scales should be constructed with two time dimensions: past and present; ill-being scales only refer to the present and QOL scales should have two time dimensions: present and future. It would be possible to combine these three scales into a single scale with three dimensions. Such a scale would enable depression and ill-being to be quantified, accurately diagnosed and monitored. The relative importance of principal symptoms could be assessed, facilitating the choice of therapy and follow-up methods.     

慢性再生障碍性贫血患者外周血T淋巴细胞亚群改变与中医分型的关系

用McAb和ABC法测定了38例慢性再生障碍性贫血(CAA)患者外周血T淋巴细胞亚群(简称T亚群)。与健康人相比,CAA的Ts明显增高(P<0.001),Th/T5明显降低(P<0.001)。并发现外周血Hb水平、病程、疗效及中医证型与T亚群相关。按气血两虚肾阳虚、肾阴虚、肾阴阳两虚的顺序,患者Th逐渐降低,Ts逐渐升高,Th/Ts明显降低。后两组比前两组Th/Ts下降更显著(P<0.01),提示阳损及阴时机体免疫机能发生更大的改变,从T亚群水平揭示了中医证型特别是肾阳虚、肾阴虚的内涵。