失眠认知行为治疗五大技术疗效因子及其治疗感受的质性研究

目的 研究失眠认知行为治疗（cognitive behavior therapy-insomnia, CBTI）中睡眠卫生教育、睡眠限制、刺激控制、放松训练以及认知疗法五大技术的疗效相关因素及治疗感受。方法 纳入21例失眠伴焦虑、抑郁症状患者开展连续8次CBTI，采用匹兹堡睡眠质量指数（Pittsburgh sleep quality index, PSQI）量表评估睡眠症状，运用质性研究方法，分别于第2、4、8次治疗后对患者进行关于治疗技术及自身感受的半结构式访谈，采用主题分析法对访谈资料进行编码和分析。结果 患者治疗后PSQI总分下降（13.55±1.97 vs. 6.91±2.43,P<0.05）。患者访谈表明CBTI五大技术对失眠症状均有改善效果。疗效相关因素包括：养成良好睡眠习惯，减少无效躺床时间，规律作息，建立正向联结，改变不良认知等。患者治疗感受包括：前期体验糟糕，难以离开床，需要长期坚持等。结论 CBTI治疗中的五大技术对睡眠均有帮助，患者会产生负面感受，需重视患者情绪变化及在执行过程中的困难。     

跨病种研究对精神疾病诊断标准的影响

概述：许多跨病种研究逐渐发现在不同的常见精神疾病之间——包括精神分裂症、双相情感障碍、和抑郁症,存在共同的遗传变异,而目前诊断系统中已经将这些疾病分为独立的精神障碍。这些跨病种研究对基于临床症状的精神障碍诊断传统系统是一种挑战,但是这否能够成为精神疾病分类的一种改进方法从而改善这些承受痛苦的患者的预后仍有待观察。     

跨病种研究对精神疾病诊断标准的影响（英文）

概述:许多跨病种研究逐渐发现在不同的常见精神疾病之间——包括精神分裂症、双相情感障碍、和抑郁症,存在共同的遗传变异,而目前诊断系统中已经将这些疾病分为独立的精神障碍。这些跨病种研究对基于临床症状的精神障碍诊断传统系统是一种挑战,但是这否能够成为精神疾病分类的一种改进方法从而改善这些承受痛苦的患者的预后仍有待观察。     

梅尼埃病患者抑郁状况及对眩晕、生活质量的影响

目的 探讨梅尼埃病抑郁状况及其对眩晕、生活质量的影响。方法 本研究纳入濮阳市安阳地区医院2018年5月～2023年5月80例梅尼埃病患者为研究对象,采用汉密尔顿抑郁量表（HAMD）评估患者抑郁情绪,根据评估结果设为抑郁组以及非抑郁组。采用眩晕评定量表（DARS）、耳鸣残障量表（THI）、耳闷视觉模拟量表（VAS）评分等评估眩晕相关症状,采用眩晕障碍量表（DHI）评估生活质量。结果 80例梅尼埃病患者中31例具有抑郁情绪;抑郁组DARS评分、THI评分、VAS评分显著高于非抑郁组（P<0.05）;抑郁组DHI量表躯体、情绪、功能评分均显著高于对照组（P<0.05）。结论 梅尼埃病患者抑郁情绪较为常见,并且抑郁情绪可能会加重梅尼埃病患者眩晕、耳鸣、耳闷等症状,降低患者生活质量。     

抑郁症状对精神分裂症患者的影响

目的:探讨抑郁症状对精神分裂症患者的影响.方法:对连续住院的206例精神分裂症患者应用Hamilton抑郁量表(HAMD)评定抑郁症状,并进行分析.结果:有抑郁症状的精神分裂症患者有下列特点:情绪低沉,生活被动,自杀率高,住院时间长.结论:抑郁症状不仅影响精神分裂症患者情绪,增加自杀危险,还干扰生活.     

重性抑郁障碍或双相障碍患者抑郁发作伴随躁狂症状的临床特征

目的:了解重性抑郁障碍(MDD)或双相障碍抑郁发作患者出现躁狂症状的频率和程度。方法:对52例经简明国际神经精神访谈(MINI)、符合《美国精神障碍诊断与统计手册》第4版(DSMIV)重性抑郁障碍或双相障碍抑郁发作的患者,采用情感障碍评估量表(ADE)评估患者本次抑郁发作中出现的躁狂症状。结果:52例患者中有36例重性抑郁障碍,16例为双相障碍抑郁发作。至少有1条躁狂症状的患者达86.5%(n=45),至少有3条躁狂症状的患者占32.7%(n=17),而没有任何躁狂症状的患者仅占13.5%(n=7)。结论:抑郁发作患者大多存在不同程度的躁狂症状,及时识别这些症状,对诊断与治疗有指导意义。情感障碍评估量表是一个值得应用的评估情感发作的工具。     

易术心理剧治疗后抑郁症患者真实感受的质性研究

目的描述抑郁症患者参与易术心理剧治疗后的真实感受,探讨易术心理剧对抑郁症的治疗效果。方法从重庆医科大学附属第一医院精神科门诊患者中,筛选符合条件的抑郁症患者,进行易术心理剧团体干预。干预后,对16名参与研究的抑郁症患者进行真实感受的深度访谈并录音,对访谈内容进行转录、编码,描述结果并进行质性研究分析。结果易术心理剧团体干预后,抑郁症患者体验到的负性感受减少,正性感受增加;大部分患者认知发生良性改变、社会功能恢复;患者可将易术心理剧技术和经验带入生活,助人助己。结论易术心理剧团体干预有助于改善抑郁症患者的情绪、认知功能、社会功能,且能让患者在日常生活中持续获益。     

精神分裂症患者的情感体验和表达

背景:精神分裂症存在情感体验和表达障碍.然而,大多数以往研究往往只局限于情感体验(尤其是快感缺乏)或只针对表达.较少有同时研究精神分裂症患者情感体验和表达.目的:本研究旨在考察精神分裂症患者的快感体验和情感表达.尤其是,特别关注精神分裂症患者的情感障碍(包括快感体验和表达)和阴性症状之间的关系.方法:150例患者完成了愉快情绪体验量表(Temporal Experience of Pleasure Scale)和情感表达量表(Emoitonal Expressivity Scale)的评估.结果:精神分裂症患者表现出快感缺乏,但情感表达的能力完整.以阴性症状为主的精神分裂症患者在期待性愉快体验,尤其是抽象性期待愉快体验上的缺损更为明显结论:研究结果表明,精神分裂症患者存在出快感缺乏,但他们表达情感的能力似乎完好无损.快感缺乏尤以阴性症状为主的精神分裂症患者更为突出.     

精神分裂症患者的情感体验和表达（英文）

背景:精神分裂症存在情感体验和表达障碍。然而,大多数以往研究往往只局限于情感体验(尤其是快感缺乏)或只针对表达。较少有同时研究精神分裂症患者情感体验和表达。目的 :本研究旨在考察精神分裂症患者的快感体验和情感表达。尤其是,特别关注精神分裂症患者的情感障碍(包括快感体验和表达)和阴性症状之间的关系。方法 :150例患者完成了愉快情绪体验量表(Temporal Experience of Pleasure Scale)和情感表达量表(Emotional Expressivity Scale)的评估。结果 :精神分裂症患者表现出快感缺乏,但情感表达的能力完整。以阴性症状为主的精神分裂症患者在期待性愉快体验,尤其是抽象性期待愉快体验上的缺损更为明显结论:研究结果表明,精神分裂症患者存在出快感缺乏,但他们表达情感的能力似乎完好无损。快感缺乏尤以阴性症状为主的精神分裂症患者更为突出。     

心理社会因素对功能性消化不良的影响

目的：探讨功能性消化不良患者个性心理特征、情感表达能力、生活事件及心理健康水平。方法：采用艾森克个性问卷(EPQ)、多伦多述情障碍量表、生活事件量表(LES)、90项症状清单(SCL-90)对56例功能性消化不良患者进行对照研究。结果：功能性消化不良患者个性内倾，情绪不稳定，神经质明显，掩饰性高，存在述情障碍。病前1年内接受负性生活事件频度和生活事件总值均较对照组高。心理健康水平较对照组低。结论：个性心理特征、情感表达能力、病前生活事件与功能性消化不良发病相关，患者普遍存在抑郁情绪和疑病倾向。     

Some recommendations to assess depression in Chinese people in Australasia

OBJECTIVE: To provide some general recommendations for psychiatric assessment of depression among Chinese patients within a predominately Western society. METHOD: A literature review is provided with interpretive comments. RESULTS: The prevalence of depression reported in community studies undertaken in Chinese communities is very low. To what extent Chinese people experience and seek help for depression, and how they report depressive symptoms have long been topics of some importance. The impact of acculturation as well as concepts and interpretations of illness in traditional Chinese medicine are discussed. Awareness of sensitive issues and practices within the Chinese culture will facilitate communication between medical professionals and patients, resulting in more accurate identification and diagnosis of depressive disorders. CONCLUSION: Direct but culturally sensitive and empathic questioning of psychological symptoms is needed to unveil patients' explanatory models, as most Chinese initially nominate only somatic symptoms to health practitioners. Successfully treated patients can promote earlier and wider utilization of mental health services to other Chinese people.     

A qualitative exploration of depression in emerging adulthood: disorder, development, and social context

OBJECTIVE: One in four emerging adults will experience a depressive episode between the ages of 18-25. We examined the lived experience of emerging adults with a focus on their treatment seeking, development and the social context of their illness. METHOD: In-depth interviews were conducted with 15 participants with major or minor depression. Interviews were recorded, transcribed verbatim and analyzed using established qualitative methods. RESULTS: Emerging adults reported dynamic and complex interactions within and between thematic areas including identification as an individual with depression, interactions with the healthcare system, relationships with friends and family, and role transitions from childhood to adulthood. Depressed mood, concerns about self-identifying one's self as being depressed, the complexity of seeking care often without insurance or financial support, alienation from peers and family, and a sense of failure to achieve expected developmental milestones appeared to interact and exacerbate functional impairment. CONCLUSIONS: Further research is needed to better understand and intervene upon pathways that lead to poor outcomes such as delayed milestones among emerging adults with depression. Health care providers should be conscious of the unique vulnerabilities posed by depressive disorders in this age group.     

Is it always the same? Variability of depressive symptoms across six European countries

Using common diagnostic systems together with structured interviews to assess mental disorders has made it possible to compare diagnostic groups of mental disorders across countries. The implicit assumption is that the symptomatology of a particular disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) will not vary between different countries. However, it is conceivable that there will be some variability in the symptom patterns. The present study examines if differences in depressive symptom patterns across European countries can be found and if there are different associations between symptoms and the latent construct depression. Data from 4025 individuals of the European Study of the Epidemiology of Mental Disorders (ESEMeD) project were analysed. Individuals were interviewed using the Composite International Diagnostic Interview (CIDI 3.0). Confirmatory factor analysis was used to examine the associations between depressive symptoms and the latent construct of depression in each country. The proportions of endorsed symptoms of depression showed only slight variation across European countries and only minor to moderate differences in the associations between depressive symptoms and the latent construct depression. The results demonstrated that in European countries using a fully structured and standardized interview based on European-American diagnostic concepts leads to similar results with regard to depressive symptom patterns.     

Predictors of Depressive Symptomatology Among Lower Social Class Caregivers of Persons with Chronic Mental Illness

This study examined the predictors of depressive symptomatology among caregivers of persons with chronic mental illness. Data were collected through in-person interviews with family caregivers of 103 adults with chronic mental illness who were served by mental health case management agencies. The results indicated that insufficiency of overall social support was the most powerful predictor of caregiver depressive symptomatology. In addition, caregiver burden had a significant unique contribution to caregiver depressive symptomatology, with higher levels of burden associated with greater levels of caregiver depressive symptomatology. Higher levels of client behavioral problems and insufficient support from family members and mental health professionals related to the caregiving role were associated with higher levels of caregiver depressive symptomatology through their associations with care-giver burden. Caregiver race was not significantly related to caregiver burden or to caregiver depressive symptomatology after controlling for other variables. Over two-fifths of White caregivers and over one-quarter of Black caregivers were at risk for clinical depression. Implications for practice and research are discussed.     

Depression in the planet's largest ethnic group: the Chinese

OBJECTIVE: The authors reviewed the evidence for the claim that the Chinese tend to deny depression or express it somatically, examined the possible determinants of those characteristics, and explored implications of the findings for the diagnosis and management of depression in China and for psychiatry in the WEST: METHOD: This paper reviews and interprets original studies and literature reviews considering emotional distress, depression, neurasthenia, and somatization in Chinese subjects. RESULTS: Interpretation of the literature is complicated by the considerable heterogeneity among people described as "the Chinese" and by numerous factors affecting collection of data, including issues of illness definition, sampling, and case finding; differences in help-seeking behavior; idiomatic expression of emotional distress; and the stigma of mental illness. Despite difficulties in interpreting the literature, the available data suggest that the Chinese do tend to deny depression or express it somatically. CONCLUSIONS: The existing evidence supports the hypothesis that the Chinese tend to deny depression or express it somatically. However, Western influences on Chinese society and on the detection and identification of depression are likely to have modified the expression of depressive illness quite sharply since the early 1980s. Analyzing these changes may provide useful insight into the evolution of the diagnosis of depression in Western and other cultures.     

Psychological distress among latino family caregivers of adults with schizophrenia: the roles of burden and stigma

OBJECTIVE: Little research has focused on the mental health of Latino caregivers with a relative with schizophrenia, despite data showing that up to three-quarters of Latino persons with schizophrenia live with their families. This study examined the relation between caregivers' mental health and perceived burden and stigma and characteristics of the patient and caregiver. METHODS: Interviews were conducted in the language of preference (Spanish or English) in Wisconsin, California, and Texas with 85 Latinos caring for an adult with schizophrenia. Measures included the Center for Epidemiologic Studies-Depression Scale, the Zarit Burden Scale, and the Greenley Stigma Scale. RESULTS: General population studies of Mexican Americans have found that between 12% and 18% meet the cutoff for being at risk of depression; however, 40% of the sample met this criterion. Younger caregiver age, lower levels of caregivers' education, and higher levels of the patients' mental illness symptoms were predictive of higher levels of caregivers' depressive symptoms. Caregivers' perceived burden mediated the relation between patients' psychiatric symptoms and caregivers' depression. Caregivers' perceived stigma was significantly related to caregivers' depressive symptoms, even when the analyses statistically adjusted for psychiatric symptoms and demographic variables. CONCLUSIONS: The high rates of depressive symptoms among Latino families caring for a relative with schizophrenia suggest that interventions should include attention to the mental health and recovery of family caregivers in addition to the patient's recovery. Younger Latino caregivers and those with lower levels of education are particularly at risk of depression.     

Local perceptions of the mental health effects of the Rwandan genocide

The objectives of this study were to investigate how Rwandans perceive the mental health effects of the 1994 genocide, to investigate the local validity of western mental illness concepts, and (if these concepts were found to be valid) to provide data to adapt existing mental health assessment instruments for local use. We used three ethnographic methods to interview people in two rural areas in Rwanda: first, free listing provided a list of local terms for mental symptoms and disorders; second, key informant interviews then provided more detailed information about these disorders; and finally, pile sorts confirmed the relationships among symptoms and disorders that emerged from the other methods. We found that interviewees described the diagnostic symptoms of depression and posttraumatic stress disorder as results of the genocide and also described associated "local" symptoms not included in the established diagnostic criteria. They divided symptoms into a "mental trauma" syndrome that included the posttraumatic stress disorder symptoms and some depression and local symptoms, and a grief syndrome that included other depression and local symptoms. In the pile sorts, we focused on investigating mood disorders and confirmed that four of the locally described symptoms formed part of a local depression-like illness. The results suggest that depression occurs among this population and support the local content validity of depression assessment instruments, such as the Depression section of the Hopkins Symptom Checklist. Similar independent evidence of validity is missing from most cross-cultural surveys. Our work supports the need and feasibility for collecting this supporting evidence prior to conducting cross-cultural surveys using existing instruments.     

Patterns of health care costs associated with depression and substance abuse in a national sample

OBJECTIVE: The associations between self-reported depressive and substance use disorders and estimated health care costs were examined in a representative national sample. METHODS: Data were from the 1994 National Health Interview Survey (N=77,183). Respondents who reported depressive symptoms or major depression (depressive syndromes) or a substance abuse disorder in the past year were compared with respondents who did not report these conditions. The mean number of inpatient days and outpatient visits in both the general medical and the specialty mental health settings were determined, and costs per individual were calculated based on mean costs of such care in each respondent's geographic region. Multivariate models were constructed to calculate mean costs, controlling for demographic variables, insurance coverage, and physical health status. RESULTS: Individuals with self-reported depressive syndromes or substance abuse had mean health care costs that were $1,766 higher than costs for individuals without these conditions. Depressive syndromes were associated with increases in both inpatient and outpatient costs. However, substance abuse was almost exclusively associated with increased inpatient expenditures rather than outpatient costs. The magnitude of increased costs associated with mental disorders was substantially larger for patients in fee-for-service plans than for those in health maintenance organizations. Only 14.3 percent of visits made by individuals reporting depressive syndromes or substance abuse were made to specialty health providers (psychiatrists, psychologists, and social workers). CONCLUSIONS: Health care costs of people with self-reported mental illness varied significantly across diagnoses and systems of care. It is crucial that researchers estimating increased costs associated with mental illness account for both diagnostic and system factors that can influence the estimates.