Use of brief psychiatric screening measures in a primary care sample

Patients seen in primary medical clinics report higher rates of major depression [Pérez-Stable et al., 1990: Arch Intern Med 15:1083-1088], and panic disorder [Sherbourne et al., 1996b: Von Korff et al., 1987: Arch Gen Psychiatry 44:152-156] than the general population. Primary care staff therefore need efficient methods of identifying patients with psychiatric disorders. The current study evaluates the use of several brief psychiatric screening measures for identifying patients with major depression and/or anxiety disorders. Participants were 213 primary care patients who received the Center for Epidemiological Studies Depression Scale (CES-D), the Beck Anxiety Inventory (BAI), and two new instruments, the Autonomic Nervous System Questionnaire (ANS) for assessing panic disorder and the Social Phobia Questionnaire (SPQ) for assessing social phobia. Participants received both the screening instruments and a structured diagnostic interview. Results suggest that the CES-D is a useful measure for detecting psychopathology, but it is not particularly specific to depression, the ANS was a highly sensitive and reasonably specific measure for panic disorder, and the SPQ was reasonably sensitive and specific for social phobia. The BAI was a relatively poor screening measure that added no significant information beyond the other measures.     

Recovery from a recurrent major depressive episode

Episode-related factors and antidepressant treatment adequacy may be important determinants of recovery from a major depressive episode (MDE). We compared recovered and nonrecovered patients on baseline sociodemographic, clinical and episode-related measurements. Twenty-five inpatients with recurrent major depressive disorder diagnosed by SADS-L participated in this naturalistic, prospective, longitudinal study. Recovery, which was defined as a sustained return to non-depressed status lasting > or = 8 consecutive weeks, was assessed at 6- and 12-month follow-up with the Streamlined Longitudinal Interval Continuation Evaluation (SLICE). Thirteen (52%) patients met recovery criteria. The cumulative proportion remaining depressed for at least 52 weeks was 42.5%. Recovered patients had shorter episodes preceding the index hospitalization (P = .01). Despite adequate antidepressant pharmacotherapy, the length of the current episode remains the most important correlate of recovery from MDE recurrence. Our small sample size and the uncontrolled nature of treatment may limit the generalizability of these findings.     

路优泰治疗胃炎伴抑郁症疗效观察

目的:观察路优泰治疗胃炎伴发抑郁症的疗效.方法:对74例胃炎伴发抑郁症者进行系统治疗,疗程4周～8周,观察疗程前后胃炎及伴发抑郁症相关症状的变化.结果:治疗组胃炎显效率80%以上,路优泰治疗胃炎伴发抑郁症安全有效,不良反应轻微少见,耐受性好.结论:路优泰是治疗胃炎伴发抑郁症的有效方法之一.     

米氮平治疗脑卒中后抑郁38例的疗效

目的 :探讨米氮平治疗脑卒中后抑郁的疗效及不良反应。方法 :将 81例脑卒中后抑郁病人分为 2组 ,其中米氮平组 38例 [男性 2 0例 ,女性 18例 ;年龄 (6 3±s 11)a],给米氮平d 1～ 2为 15mg,d3起 30mg,po ,qn ;丙米嗪组 4 3例 [男性 2 4例 ,女性19例 ;年龄 (6 4± 12 )a],给丙米嗪d 1～ 3为 2 5mg,d 4～ 6为 5 0mg,d 7起 75mg,po ,bid ,均6wk为一个疗程。结果 :治疗后米氮平组总有效率为 87% ,丙米嗪组为 84 % ,2组相比较差异无显著意义 (P >0 .0 5 )。米氮平组不良反应较丙米嗪组少。结论 :米氮平治疗脑卒中后抑郁疗效明显 ,不良反应少。     

不孕与情志关系初探

认为情志异常是影响女子不孕的重要因素。肝失疏泄可使气机失调,影响月经周期阴阳消长转化,导致排卵障碍,破坏肾气-天癸-冲任-胞宫生殖轴的协调与平衡,导致不孕。治疗当以疏肝解郁为主,辅以养血理脾,并应注重情志调节。     

“诊籍”情志病的病因病机和证候分析

为发展中医心理学基础理论,笔者对西汉名医淳于意“诊籍”的心理学认识进行理论探索。诊籍中讲述了由于情志所引起的疾病,并且通过诊脉,用中药和针灸治疗此类患者,疗效显著,说明淳于意对情志的病因、病机和证候的认识已经达到相当高的水平。     

鼻咽癌放疗患者负性情绪与心理弹性及自我效能的关系

目的 探讨鼻咽癌放疗患者负性情绪与心理弹性及自我效能的关系.方法 分别应用Zung焦虑自评量表(SAS)、Zung抑郁自评量表(SDS)、心理弹性量表及中文版癌症自我效能感量表对60例接受放疗的鼻咽癌患者进行调查,分析鼻咽癌放疗患者SAS评分、SDS评分与心理弹性及自我效能的关系.结果 60例鼻咽癌放疗患者心理弹性评分为(58.33±2.25)分,SAS评分为(50.51±5.17)分,SDS评分为(47.51±4.38)分,自我效能评分为(20.70±2.98)分.不同年龄、学历、临床分期及是否接受过放疗宣教的鼻咽癌患者在SAS评分、SDS评分、心理弹性评分及自我效能评分等方面差异有统计学意义(P<0.05),不同经济状况的患者自我效能评分比较,差异有统计学意义(P<0.05).经Pearson分析,SAS评分、SDS评分与心理弹性及自我效能呈负相关(P<0.01).结论 鼻咽癌放疗患者负性情绪与心理弹性及自我效能有密切的关系,临床上可通过提高鼻咽癌放疗患者心理弹性及自我效能从而减轻患者焦虑、抑郁情绪,改善患者生活质量.     

抑郁症患者心理过程及其对服药依从性的影响

本文阐述了抑郁症患者心理过程及其对服药依从性不良影响,旨在为提高患者的服药依从性提供新思路.文章结合国内外已有研究,分别从抑郁症患者认知、情绪及意志的特点及其在服药依从行为中起到的作用进行总结,认为抑郁症患者的心理特点对服药依从性有影响.     

Assessment of Objective and Subjective Cognitive Function in Patients With Treatment-Resistant Depression Undergoing Repeated Ketamine Infusions

BackgroundSubanesthetic ketamine infusions can elicit rapid and sustained antidepressant effects, yet the potential cognitive impact of ketamine has not been thoroughly examined. This study measured changes in objective and subjective cognitive function following repeated ketamine treatment.MethodsThirty-eight patients with treatment-resistant depression were administered cognitive assessments before and after undergoing 7 i.v. ketamine infusions (0.5 mg/kg over 40 minutes) within a clinical trial examining the efficacy of single and repeated administrations. Depression severity and perceived concentration were evaluated with the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Quick Inventory of Depressive Symptoms Self-Report.ResultsTwenty-three participants (60.5%) responded after repeated infusions (≥50% decrease in MADRS total scores). We measured significant improvements in several cognitive domains, including attention, working memory, verbal, and visuospatial memory (effect sizes ranging from Cohen d = 0.37–0.79). Cognitive changes were attributed to reduction in depressive symptoms except for improvement in verbal memory, which remained significant after adjustment for change in MADRS total score (P = .029, η _p²=0.13). Only responders reported improvement in subjective cognitive function with repeated ketamine administration (MADRS item 6, P < .001, d = 2.00; Quick Inventory of Depressive Symptoms Self-Report item 10, P < .001, d = 1.36).ConclusionA short course of repeated ketamine infusions did not impair neurocognitive function in patients with treatment-resistant depression. Further research is required to understand the potential mediating role of response and remission on improved cognitive function accompanying ketamine treatment as well as to examine longer-term safety outcomes. ClinicalTrials.gov identifier {"type":"clinical-trial","attrs":{"text":"NCT01945047","term_id":"NCT01945047"}}NCT01945047