神经系统疾病伴发抑郁障碍的诊疗特点

目的 比较神经系统疾病伴发抑郁障碍患者和单纯的抑郁障碍患者的生活质量以及疗效的差异,探讨神经系统疾病伴发抑郁障碍患者的临床诊疗特点.方法 用美国精神障碍诊断和统计手册第Ⅳ版(DSM-Ⅳ)作为抑郁障碍诊断依据;用汉密尔顿抑郁量表17项(HAMD-17)评价抑郁障碍严重程度;用简明健康状况调查表(SF-36)评价健康相关的生活质量,分别对2007年1月至2010年3月就诊于综合医院神经内科门诊和心理卫生科门诊的抑郁障碍患者在基线期和研究结束时(6周抗抑郁治疗)进行评估.结果 连续纳入神经系统疾病伴发抑郁障碍的患者共45例,平均年龄62岁,其中39例(86.7%)患者就诊于神经内科门诊;单纯抑郁障碍的患者49例,平均年龄35岁,其中42例(85.7%)就诊于心理卫生门诊.患者的抑郁严重程度和生活质量呈负相关即抑郁越严重生活质量越差,在基线期神经系统疾病伴发抑郁和单纯抑郁障碍的患者相比,生理机能评分(分别为61和83分,P=0.044)更低损害更突出,而精力受损不如单纯抑郁障碍的患者严重(分别为39和29分,P=0.007).经过6周抗抑郁治疗结束时两组患者缓解率和有效率差异无统计学意义.在疗效的评价中神经系统疾病伴发抑郁患者的疼痛(治疗前60分,治疗后65分,P=0.048)的恢复明显好于单纯的抑郁患者.结论 神经系统疾病伴发抑郁障碍的患者更多地就诊于综合医院的神经内科,其健康相关的生活质量的损害有别于单纯的抑郁障碍患者,而在接受抗抑郁治疗后可以获得同样的缓解率和有效率,正确地认识患者的临床特点有助于提高综合医院医师对抑郁障碍的诊治,提高患者的生活质量.

Clinical traits and treatment outcome for comorbidity of depression and neurological disorders

Objective To observe the clinical traits and treatment outcome of the comorbidity of depression and neurological disorders.Methods For patients diagnosed with depressive disorders based on the diagnostic and statistical manual of mental disorders-Ⅳ ( DSM-Ⅳ ) criteria in both outpatients clinics of neurology and psychology.The severity of depression in HAMD-17 scale and quality of life related to outpatients' emotional state and health in Short Form Health Survey (SF-36) were evaluated at the baseline and after a 6-week treatment respectively.Results Forty-five patients with concurrent depression and neurological disorders and 49 patients with depressive disorders were recruited.The impairs in outpatients with depressive disorder are various degree of both physical health and mental health.The severity of depression and quality of life had a negative correlation.The patients with concurrent depression and neurological disorders were elder and more bodily diseases than those with depressive disorders.According to the SF-36 scores,the patients with concurrent depression and neurological disorders had lower physical function scores(61 and 83 ,P =0.044) and higher vitality scores (39 and 29,P =0.007) than those patients with depression disorders at the baseline.After completing a 6-week treatment,both two groups have the same remission rate and response rate respectively.Bodily pain scores (60 at pre-treatment vs 65 at posttreatment,P = 0.048) changed more obviously in the patients with concurrent depression and neurological disorders.Conclusion More patients with concurrent depression and neurological disorders seek medical consultations at neurological clinics of a general hospital than those with depressive disorders.Their impairment extents of physical health factors were different And the anti-depressive regimens yield comparable rates of remission and efficacy.If a clinician knows these differences well,the diagnostic and therapeutic levels of the depressive patients will be boosted and their quality of life enhanced.