抑郁障碍患者人格特征与发病关系的研究

目的探讨抑郁障碍患者的人格特征与其疾病发病间的关系。方法采用自评抑郁量表(SDS)、艾森克人格问卷 (EPQ)、应对方式评定量表 (WCRS)和归因方式问卷 (ASQ)对 76名抑郁障碍患者进行测试 ,同时选取 84名健康被试进行对照研究。结果①抑郁组患者在EPQ中神经质 (N)与精神质 (P)的得分显著高于健康组。②WCRS的结果显示在“宣泄接纳”、“退避调节”两个因子上 ,抑郁组的平均得分低于健康组。③在ASQ的得分中 ,抑郁组在负性事件归因的自身性、持久性和整体性均显著高于健康组。④抑郁障碍患者的“神经质”人格特质与应对方式的“宣泄接纳”和“退避调节”因子呈负相关 (r = 0 .474)。结论抑郁障碍患者的人格特征可表现为较强的神经质及孤僻、交往障碍 ,他们这种人格特征及应对和归因方式在其发病过程中起着重要作用。     

脑梗死后抑郁与负性生活事件相关性研究

目的　探讨脑梗死后抑郁与负性生活事件的关系。方法　将脑梗死患者按是否受负性生活事件影响分为 A(n=75 )、B(n=73)两组。采用抑郁自评量表 (SDS)及 Hamilton抑郁量表筛查 ,对两组进行比较分析 ,并观察其治疗效果。结果　A、B两组脑梗死后抑郁的发生率分别为 5 6 %、38.4 % ,两者比较差异显著 (P<0 .0 5 ) ;百忧解可显著改善或治愈脑梗死后抑郁 ,总有效率 6 1.7%。结论　脑梗死后抑郁发生与负性生活事件相关。百忧解治疗有效     

Effects of glucocorticoids on declarative memory function in major depression.

BACKGROUND: Major depression has been associated with hypercortisolemia in a subset of patients with depression. Administration of exogenous cortisol and other glucocorticoids to healthy human subjects has been observed to result in a transient impairment in verbal declarative memory function. The purpose of this study was to assess the effects of the glucocorticoid, dexamethasone, on verbal declarative memory function in patients with untreated unipolar major depressive disorder (MDD). METHODS: Fifty two men and women with (n = 28) and without (n = 24) MDD received placebo or dexamethasone (1 mg and 2 mg on 2 successive days) in a double-blind, randomized fashion. Declarative memory was assessed with paragraph recall at baseline (day 1) and day 3. RESULTS: There was a significant interaction between diagnosis and drug (dexamethasone vs. placebo) on paragraph recall. In the healthy subjects, memory improved from baseline to day 3 with placebo and was unchanged with dexamethasone, whereas in MDD patients memory function showed a pattern of decreasing with placebo and improving with dexamethasone from baseline to day 3. CONCLUSIONS: These findings are consistent with an altered sensitivity of declarative memory function in MDD to regulation by glucocorticoids. Possible explanations of the findings include alterations in glucocorticoid receptors in the hippocampus or other brain regions mediating declarative memory, or differential sensitivity to dexamethasone-induced reductions in cortisol, in patients with MDD.     

氟西汀对2型糖尿病合并抑郁症患者下丘脑-垂体肾上腺轴功能及临床疗效的影响

目的探讨氟西汀对 2型糖尿病合并抑郁症患者的下丘脑 垂体 肾上腺轴 (HPA)功能的影响及其临床意义。方法测定 98例 2型糖尿病患者和 3 4例正常对照组基础血皮质醇 (F ,0 8:0 0am、16:0 0pm)、小剂量地塞米松抑制试验 (DST)后血F、2 4h尿游离皮质醇 (UFC)。将 64例 2型糖尿病伴发抑郁症患者随机分成A组 (服用氟西汀组 ,3 2例 )和B组 (未服用氟西汀组 ,3 2例 )。予 6周治疗。分别于治疗前、后进行HAMD评分及代谢控制水平评估。结果 ( 1)血F( 0 8:0 0am、16:0 0pm)、2 4h尿UFC、DST脱抑制例数2型糖尿病患者较正常对照组增高 (P <0 .0 1) ,2型糖尿病伴抑郁症组 (DD组 )较无抑郁症组 (DM组 )增高(P <0 .0 5 ,P <0 .0 1)。 ( 2 )经 6周治疗后 ,服用氟西汀组 (A组 )较未服用氟西汀组 (B组 )糖皮质激素水平降低 (P <0 .0 1)、HAMD评分降低 (P <0 .0 1) ,糖脂代谢改善 (P <0 .0 5 ,P <0 .0 1)。 ( 3 ) 2 4h尿UFC与HbA1C呈正相关性 (r =0 .5 69,P <0 .0 1)、IR呈正相关 (r =0 .65 3 ,P <0 .0 1)、与HAMD评分呈正相关性 (r =0 .3 5 2 ,P <0 .0 5 )。结论 2型糖尿病及合并抑郁症患者HPA轴功能紊乱 ,加重了糖代谢紊乱和胰岛素抵抗 ;氟西汀干预治疗抑郁症可改善抑郁症和糖脂代谢。     

单用氟西汀与联合理性情绪疗法治疗抑郁症对照

目的观察理性情绪疗法在抑郁症治疗中的效果。方法将69例抑郁症患者随机分为两组，A组34例单用氟西汀治疗，B组35例采用理性情绪疗法合并氟西汀治疗。疾病严重程度及疗效采用汉密顿抑郁量表和抑郁自评量表评定，进行了为期12周的观察。结果A、B两组疗效在4周前无显著性差异，但在4～6周开始显示出差异（P〈0．05），8～12周有非常显著性差异（P〈0.01）。B组疗效明显优于A组。结论氟西汀联合理性情绪疗法对抑郁症的疗效比单纯氟西汀治疗更有效。     

Psychosocial factors associated with poor diabetes self-care management in a specialized Center in Mexico City

To examine the relationship between demographic, clinical and psychosocial variables and diabetes self-care management in Mexican type 2 diabetic patients. Cross-sectional study of 176 consecutive patients with type 2 diabetes aged 30-75 years, attending a tertiary health-care center in Mexico City. A brief medical history and previously validated questionnaires were completed. The study group consisted of 64 males/112 females, aged 55 +/- 11 years, mean diabetes duration of 12 +/- 8 years and HbA1c of 9.0 +/- 2.0%, 78.4% reported following the correct dose of diabetes pills or insulin, 58% ate the recommended food portions, and 44.3% did exercise three or more times per week. A good adherence to these three recommendations was observed in only 26.1% of the patients. These patients considered as a group were characterized by a greater knowledge about the disease (P < 0.00001), regular home blood glucose monitoring (P < 0.01), an inner perception of better diabetes control (P = 0.007), good health (P = 0.004) and better communication with their physician (P < 0.02). A poor adherence to two or the three main diabetes care recommendations was associated with a depressive state (OR 2.38, 95% CI 1.1-4.9, P < 0.01) and a history of excessive alcohol intake (OR 4.03, 95% CI 1.1-21.0, P = 0.03). Poor adherence to standard diabetes care recommendations is frequently observed in patients with type 2 diabetes attending a specialized health care center in Mexico City. Depression must be identified and treated effectively.     

伴有和不伴有抑郁的阿尔茨海默病患者在静音Stroop任务下脑功能激活的差异

目的 研究Alzheimer病(AD)与AD伴抑郁患者(depression in Alzheimer's disease,dAD)在注意任务下脑功能激活区的差异.方法 收集临床诊断轻度AD患者20例,符合《精神疾病诊断与统计手册第Ⅳ版》标准(DSM-Ⅳ),其临床痴呆评定量表(CDR)评分1.0,其中9例dAD患者符合国立精神疾病研究院制定的痴呆伴抑郁的诊断标准(NIMH-dAD标准),其康奈尔痴呆中抑郁量表评分(CSDD)＞12.另有10名健康老龄者为对照组.在静音Stroop任务下,计算完成任务的反应时间、错误率和漏报率等行为学指标,同时采集fMRI脑部功能图像,使用SPM2软件分析.结果 dAD、AD与对照组的反应时间(ms)分别为2214.4±107.1、2020.6±558.3、840.0±254.5,dAD与AD组均明显慢于对照组(P＜0.01),且dAD组比AD组更慢(P=0.04).dAD、AD、对照组的错误率分别为:8.3%、6.9%、0.7%;其漏报率分别为:3.6%、2.9%、0,虽然dAD与AD组在错误率(P=0.13)和漏报率(P=0.10)间并无差异,但均明显高于对照组(P＜0.01).对照组在双侧前额背外侧皮质、双侧前扣带回、右侧顶叶和左额下回有明显的激活.AD组仅在左侧顶叶、左前扣带回和右额叶背外侧皮质等有少量激活.dAD组仅在前额皮质和部分右侧前额背外侧皮质处有少量激活.结论 与对照组相比,AD伴有和不伴抑郁的患者均存在异常的脑功能成像,但二者间有着明显的差别,抑郁加重AD的注意功能损害.     

糖尿病是一种心血管疾病和心身疾病的观点探讨

本文就糖尿病患者最早就诊的是心血管内科医师,以及负性情绪可明显影响糖尿病的发展进行了分析,并提出改善心境可明显增加自我控制糖尿病的能力。     

米氮平与氯丙咪嗪治疗抑郁和焦虑共病的疗效对照

目的比较米氮平、氯丙咪嗪抗抑郁和焦虑的共病作用和不良反应。方法65例同时符合抑郁症与焦虑障碍诊断标准的门诊患者,HAMD17项评分总分≥17分,≤23分、HAMA总分≥14分, ≤29分。分别随机给予口服米氮平(简称A组)和氯丙咪嗪(简称B组)。研究全程为期4周。疗效评定按HAMD、HAMA得分≤7分为治愈,减分50％为有效。数据进行X2及t检验。结果入组时两组 HAMD、HAMA得分无显著性差异(t=0．32,P>0．05),治疗第1周A组HAMD得分下降比B组明显, HAMA得分下降更为明显。治疗第2周开始A组HAMD、HAMA得分下降均比B组来的显著。第4周末A组临床治愈18例(56．3％,18／32),临床有效28例(87．5％,28／32)。B组临床治愈15例(45．5％, 15／33)临床有效27例(81．9％,27／33)。米氮平组有效率87．5％,氯丙咪嗪组有效率81．9％,无显著性差异(X2分别为0．76、0．40,P>0．05)。B组的不良反应例数及严重程度均远高于A组。结论对具有抑郁和焦虑共病的患者可用米氮平治疗。