三种重性精神障碍甲状腺功能水平与疾病症状严重程度相关性

目的 分析慢性精神分裂症、慢性双相障碍及慢性重性抑郁障碍患者甲状腺功能的差异，及其与焦虑、抑郁及精神病性症状严重程度的关系。方法 纳入515例病程大于10年的精神分裂症（192例）、双相障碍（157例）及重性抑郁障碍（166例）患者，检测患者甲状腺功能指标，如促甲状腺激素（thyroid-stimulating hormone,TSH）、三碘甲状腺原氨酸（triiodothyronine,T3）、甲状腺素（thyroxine,T4）、游离三碘甲状腺原氨酸（free triiodothyronine,FT3）和游离甲状腺素（free thyroxine,FT4）水平。使用广泛性焦虑自评量表（generalized anxiety disorder,GAD-7）、9条目患者健康问卷（9-itempatienthealthquestionnaire,PHQ-9）和90项症状自评量表（symptom checklist-90,SCL-90）精神病性症状分量表分别评估所有患者焦虑、抑郁和精神病性症状。结果 相较于重性抑郁障碍组，精神分裂症组和双相障碍组的TSH和FT4水平更高（P<0.01...     

131I联合帕罗西汀对甲状腺功能亢进伴情绪障碍患者的效果

目的观察¹³¹I联合帕罗西汀治疗甲亢伴情绪障碍患者的临床效果及其对甲状腺功能的影响。方法选取我科2018年6月~2019年10月期间收治的109例甲状腺功能亢进伴情绪障碍患者作为研究对象,对照组54例给予¹³¹I治疗,观察组55例在对照组基础上加用帕罗西汀治疗,治疗两个月后对比两组患者的临床疗效、促甲状腺素(TSH)、游离甲状腺素(FT4)、游离三碘甲状腺原氨酸(FT3)水平和焦虑情况评分、抑郁情况评分、症状自评量表(SCL-90),以及两组用药后不良反应的发生情况。结果治疗后观察组总有效率为92.73%明显高于对照组的74.07%(P<0.05);治疗后两组患者体内TSH、FT4、FT3水平明显优于治疗前(P<0.05),治疗后观察组体内TSH、FT4、FT3水平明显优于对照组(P<0.05);治疗后两组患者SAS、SDS评分明显优于治疗前(P<0.05),治疗后观察组SAS、SDS评分明显优于对照组(P<0.05);两组患者不良反应发生率对比无统计学意义(P>0.05)。结论¹³¹I联合帕罗西汀能明显提高甲状腺功能亢进症伴情绪障碍患者的临床疗效,改善患者TSH、FT4、FT3水平,消除焦虑、抑郁情绪。     

精神分裂症患者的攻击行为与甲状腺轴

目的：探索甲状腺激素与精神分裂症患者冲动攻击行为的关系。方法：以既往史和外显攻击行为量表（MOAS）评分区分,有攻击行为者为研究组,无攻击行为者为对照组,比较两组的血清甲状腺激素水平,并对其与精神症状、攻击行为型之间的相关性进行检验。结果：研究组促甲状腺激素（TSH）水平较对照组升高,甲状腺素（T4）水平与言语攻击、对财产的攻击行为有显著性相关,三碘甲状腺原氨酸（T3）水平与焦虑抑郁症状有关。结论：甲状腺激素水平可能与精神分裂症患者的贡献行为有关。     

葡萄糖耐量降低人群述情障碍发生率及其与焦虑抑郁障碍的相关性研究

目的 了解2型糖尿病高危人群即葡萄糖耐量降低人群(impaired glucose tolerance,IGT)中述情障碍发生率及其与焦虑、抑郁症状的相关性.方法 采用多伦多述情障碍量表(TAS-20)、抑郁自评量表(SDS)、焦虑自评量表(SAS)对62例IGT但未达到糖尿病诊断患者进行评估,调查述情障碍发生率,并对其与抑郁、焦虑症状进行相关性分析.结果 述情障碍发生率为37.1％,IGI组SDS、SAS评分均显著高于中国常模(P ＜0.005) TAS-20总分与SDS、TASk0总分与SAS存在线性正相关(P＜0.01),TAS-20中因子1(F1,难以识别自己的情感)、因子2(F2,难以描述自己的情感)分别与SAS、SDS均存在正相关(P＜0.05),因子3(F3,外向性思维)与SDS存在负相关(P＜0.05).结论 2型糖尿病高危人群存在明显的述情障碍,且与焦虑、抑郁障碍高度相关.     

2型糖尿病患者的知觉压力和抑郁、焦虑水平的相关性

目的分析2型糖尿病(T2DM)患者的知觉压力和抑郁、焦虑水平的相关性。方法选定本院2018年11月～2020年11月住院治疗的82例T2DM患者,以CPSS(中文版压力知觉量表)评估知觉压力,以SAS(焦虑自评量表)评分、SDS(抑郁自评量表)评分评估焦虑、抑郁水平,比较不同知觉压力组SAS评分、SDS评分,比较不同焦虑程度组CPSS评分、SDS评分,比较不同抑郁程度组CPSS、SDS评分,Pearson分析CPSS评分与SAS评分、SDS评分的相关性。结果压力较大组SAS评分、SDS评分均低于压力过大组,差异均存在统计学意义(P0.05)。轻度焦虑组CPSS评分、SDS评分均低于中度焦虑组,中度焦虑组CPSS评分、SDS评分均低于重度焦虑组,差异均存在统计学意义(P0.05)。CPSS评分与SAS评分、SDS评分呈正相关性,P0.05(r=0.796、0.804)。结论 T2DM患者知觉压力与抑郁、焦虑程度呈正相关性,通过减轻患者知觉压力,可以达到减轻不良情绪的效果。     

艾司西酞普兰对女性灼口综合征伴焦虑抑郁患者的疗效及细胞因子的影响

目的探讨艾司西酞普兰对女性灼口综合征伴焦虑抑郁患者的疗效及细胞因子的影响。方法选取2017年6月~2019年6月我院收治的91例女性灼口综合征伴焦虑抑郁患者作为主要研究对象,采用随机数字表法将患者分为观察组和对照组,两组患者均给予维生素B口服治疗,对照组(45例)给予心理治疗,观察组(46例)在对照组基础上增加艾司西酞普兰口服治疗,观察对比两组患者治疗前后焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、症状自评量表(SCL-90)评分和血清细胞因子水平及治疗后简明健康状况调查表(SF-36)评分和临床疗效。结果治疗后,观察组SF-36评分、总有效率高于对照组(P<0.05);观察组血清IL-6、TNF-α水平及SDS、SAS、SCL-90评分低于对照组(P<0.05)。结论艾司西酞普兰能够有效缓解女性灼口综合征伴焦虑抑郁患者不良情绪,调节细胞因子水平,改善患者心理健康水平及生活质量,从而提高治疗疗效。     

灼口综合征患者负性情绪,应对方式及人格状况的调查

目的研究灼口的抑郁、焦虑、应对方式和人格状况以及上述症状之间的相关性。方法选取我院2014年1月至2016年1月80例灼口综合征患者为研究组,并选取同期80例健康者为对照组,采用抑郁自评量表(SDS)、焦虑自评量表(SAS)、医学应对方式问卷(MCMQ)、艾森克人格问卷简式量表(EPQ-RSC)与视觉模拟评分法表(VAS)进行评估对比,并分析各症状的相关性。结果研究组患者的SDS和SAS评分比对照组显著增加(P0.05),口干症状与焦虑评分、疼痛程度呈正相关,疼痛程度与焦虑评分、抑郁评分呈正相关,应对方式中的回避、屈服与抑郁评分呈正相关,人格中的掩饰、神经质、精神质与抑郁评分、焦虑评分呈正相关(P0.05)。结论灼口综合征患者会产生口干、疼痛、人格异常、应对障碍、抑郁与焦虑等症状,各症状之间不是独立存在的,心理的障碍会加重生理的症状,因此在临床实际治疗中需注重加强心理干预。     

心理干预对改善精神分裂症患者家属心理状况的效果分析

目的 探讨心理干预对改善精神分裂症患者家属心理状况的效果.方法 采用症状自评量表(SCL-90)、焦虑自评量表(SAS)和抑郁自评量表(SDS)对229名精神分裂症患者家属进行调查,并对其进行为期4周的心理干预.结果 精神分裂症患者家属的SCL-90各因子、SAS和SDS的评分均显著高于全国常模(P<0.05),心理干预后,患者家属的SCL-90各因子、SAS和SDS的评分较干预前有显著性降低(P<0.05).结论 精神分裂症患者家属的心理问题状况较为严重,而心理干预可有效改善患者家属的心理状况.     

产后早期甲状腺激素、肾上腺皮质激素与产后抑郁的关系研究

目的 探讨产后早期甲状腺激素、肾上腺皮质激素与产后抑郁的关系.方法 选择2019年2月～2021年2月108例产妇为研究对象,产后4～6周采用爱丁堡产后抑郁量表(EPDS)评估抑郁情况,并设为抑郁组与非抑郁组.检测血清甲状腺素水平,包括甲状腺素(T4)、三碘甲状腺原氨酸(T3)以及促甲状腺激素(TSH),同时检测肾上腺...     

老年期焦虑与抑郁共病患者的睡眠质量研究

目的　探讨老年焦虑与抑郁障碍共病患者的睡眠质量,为临床治疗方案的确定提供理论 依据。方法　采用焦虑自评量表(SAS)评价焦虑情绪的严重程度,抑郁自评量表(SDS)评价抑郁情绪的 严重程度,采用匹兹堡睡眠质量指数(PSQI)分别对37例老年期焦虑与抑郁共病、22例老年期焦虑症和 23例老年期抑郁患者的睡眠质量进行评定,并进行对照研究。结果　共病组入睡时间、催眠药物、 PSQI总分明显高于抑郁组(F值分别18.23,14.56,16.33,P<0.00);而睡眠障碍得分高于焦虑组(F= 2.127,P<0.05)。比较共病组病期、SDS、SAS与PSQI各成分间的相关性发现,病期与入睡时间、总分呈 负相关关系(P<0.05),SAS与入睡时间、催眠药物和PSQI总分呈正相关关系(P<0.05)。结论　老 年期焦虑抑郁共病比老年期抑郁症患者的睡眠质量降低更突出,其焦虑情绪与入睡困难和药物的使用 情况更为密切,提示在老年期焦虑抑郁障碍的临床治疗过程中,需改善睡眠障碍。     

甲状腺功能水平与双相情感障碍相关性的对照研究

目的 探索甲状腺功能与双相情感障碍的相关性.方法 以符合美国精神疾病分类与诊断标准第4版修订本(DSM-Ⅳ-TR)的双相情感障碍诊断标准的患者59例为研究对象,并选取41名健康人作为对照,应用酶联免疫吸附法(ELISA)分别测定所有研究对象的血清甲状腺激素水平,包括TT3、FT3、TT4、FT4及TSH.选用HAMD、HAMA及Bech-Rafaelsen躁狂量表评估患者组临床症状.结果 双相躁狂组中TT4、FT4水平明显高于对照组,FT3水平明显高于抑郁组,差异有统计学意义(P<0.01).双相抑郁组中TT3、FT3水平明显低于对照组,FT4水平则明显高于对照组,差异有统计学意义(P<0.01).按性别分层比较,女性双相躁狂组FT4水平与对照组相比明显升高,差异有统计学意义(P<0.05);女性双相抑郁组TT3明显低于对照组或双相躁狂组,FT4明显高于对照组,FT3则明显低于对照组,差异均有统计学意义(P<0.05),而男性躁狂组中仅TT4水平显著高于对照组(P<0.05).在双相抑郁患者中,HAMD总分与FT4呈负相关(r=-0.34,P=0.03).结论 双相情感障碍患者的甲状腺功能存在一定的改变,不同临床相甲状腺功能改变亦不相同,且这种变化以女性患者明显.     

难治性抑郁症患者甲状腺激素水平的分析

目的 探讨难治性抑郁症患者的甲状腺激素水平。方法 按性别、年龄1：1匹配选取难治性抑郁症患者和健康对照各30例，采用放射免疫法测定患者组治疗前和对照组血清TSH、T3、T4、FT3、FT4水平。结果 患者组异常者17例，占56．7％，对照组异常者2例，占6．7％，两组比较，患者组甲状腺激素水平出现异常的比率明显高于对照组，主要表现为TSH升高、T3降低、FT4降低，差异均有统计学意义（P〈0．05）。结论 难治性抑郁症患者中有56．7％的患者存在亚临床型甲状腺功能的减退。     

Influence of carbamazepine on serum thyroxine and triiodothyronine in patients with epilepsy

Hypothyroidism induced by anti-epileptic drug treatment gave rise to thyroid function test studies in patients treated with carbamazepine (CBZ) only. In 42 patients on long-term CBZ treatment thyroxine (T4), free T4-index (FT4I), and triiodothyronine (T3) concentrations in serum were significantly lower than in controls, while triiodothyronine uptake (T3U) and thyrotropin (TSH) concentrations did not differ between patients and controls. In 12 patients starting on CBZ, means T4, calculated FT4 and thyroxine binding globulin (TBG) were 1-5 months later reduced compared to the initial levels. Thus, CBZ reduced thyroid hormones, TBG and FT4I. A CBZ-induced increase in conversion and metabolism of the thyroid hormones could explain this effect. The normal T3U values and decreased concentrations of TBG make a competitive CBZ binding to TBG less probable. Although the thyroid hormones levels were found lowered in the patients, all remained clinically euthyroid during the study.     

非典型抗精神病药对精神分裂症患者血清甲状腺激素水平的影响

目的探讨非典型抗精神病药利培酮、奥氮平对精神分裂症患者甲状腺功能的影响。方法将符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)的54例精神分裂症患者,采用随机数字表法分成服用利培酮和奥氮平两组,其中利培酮组29例,给药初始剂量为4 mg/d,2周内逐渐加至6 mg/d,观察至8周末;奥氮平组25例,给药初始剂量为10 mg/d,2周内逐渐加至15mg/d,观察至8周末。分别在治疗前、治疗第8周末测血清总三碘甲状腺原氨酸(TT3)、血清总甲状腺素(TT4)、游离三碘甲状腺原氨酸(FT3)、血清游离甲状腺素(FT4)及促甲状腺激素(TSH)水平。结果利培酮组治疗前后血清TT3、TT4、FT3、FT4、TSH水平差异均无统计学意义(P0.05),奥氮平组治疗前后血清TT3、TT4、TSH水平差异无统计学意义(P0.05),治疗前后FT3、FT4差异有统计学意义[(3.01±0.28)pg/mlvs.(2.81±0.26)pg/ml,(0.91±0.2)pg/mlvs.(0.77±0.14)pg/ml,P0.05]。利培酮组治疗后血清TT3、FT3水平升高,较奥氮平组差异有统计学意义(P0.05)。结论利培酮对精神分裂症患者甲状腺功能无实质影响,奥氮平能影响精神分裂症患者血清FT3、FT4的水平,在治疗中应注意监测服用奥氮平的精神分裂症患者的甲状腺激素水平。     

急性脑出血患者血清甲状腺激素水平的变化及其意义

目的探讨急性脑出血患者血清甲状腺激素水平的变化及其意义。方法 65例急性脑出血患者于入院第1 d、第3 d、第7 d、第15 d,52名正常对照者于体检日进行血清三碘甲状腺原氨酸(T3)、甲状腺素(T4)、游离T3(FT3)、游离T4(FT4)和促甲状腺激素(TSH)水平检测和比较。并对不同病情及预后的急性脑出血患者入院第3 d的血清甲状腺激素水平进行比较。结果与正常对照组比较,急性脑出血组入院第1 d、第3 d、第7 d时血清T3、FT3水平明显降低,血清T4、FT4水平明显增高(均P<0.05)。与急性脑出血轻度亚组比较,中度亚组及重度亚组血清T3、FT3水平明显降低,血清T4、FT4及TSH水平明显增高(均P<0.05);与急性脑出血中度亚组比较,重度亚组血清T3、FT3水平明显降低,血清T4、FT4及TSH水平明显增高(均P<0.05)。与急性脑出血显著进步亚组比较,进步亚组及死亡亚组血清T3、FT3水平明显降低,血清T4、FT4及TSH水平明显增高(均P<0.05);与急性脑出血进步亚组比较,死亡亚组血清T3、FT3水平明显降低,血清T4、FT4及TSH水平明显增高(均P<0.05)。结论急性脑出血...     

An evaluation of basal hypothalamic-pituitary-thyroid axis function in depression: Results of a large-scaled and controlled study

In order to evaluate the function of the hypothalamic-pituitary-thyroid (HPT)-axis in unipolar depression, the authors measured basal 0800h plasma levels of free thyroxine (FT4), free triiodothyronine (FT3), and thyroid stimulating hormone (TSH) by means of the new, ultrasensitive assays (TSH-IRMA) in 69 healthy controls, 62 minor, 101 simple major, and 57 melancholic depressed subjects. Basal HPT-axis hormone levels of almost all (96.8%) unipolar depressed patients fell within the normal, euthyroid range. None of the major depressed subjects showed subclinical hypothyroidism. It was found that 8.8% of the melancholic subjects exhibited some degree of subclinical hyperthyroidism. Basal TSH-IRMA values were significantly lower in melancholic patients than in healthy controls, minor and simple major depressed patients, and in major vs. minor depressed subjects. FT4 circulating levels were significantly higher in melancholic patients than in all other subjects. Basal TSH-IRMA and FT4 levels were significantly correlated with severity of illness. In depression, there was a significant and negative correlation between basal TSH-IRMA values and FT4 concentrations. No significant gender- or age-related differences in TSH-IRMA or thyroid hormones were detected in depression. It is argued that—in depression research—the assays of basal TSH-IRMA should replace thyrotropin releasing hormone tests.     

Serum concentrations of circulating thyroid hormones in a group of depressed men

Levels of circulating total thyroxine (TT4), free thyroxine (FT4), total triiodothyronine TT3 and thyrotropin (TSH) were determined in 27 men with unipolar major depressive disorder ages 24-50, mean +/- SEM 36.9 +/- 2.9 years, and 38 healthy controls (HC) ages 20-50, mean +/- SEM 34.2 +/- 3.1 years. No significant differences were observed between HC and depressed men with regard to TT4 and FT4. Mean TT3 levels were lower, and mean TSH levels higher in depressed patients than in HC, p less than 0.05 for both, compatible with possible subclinical primary hypothyroidism in depressed patients. Consistent with this, an inverse correlation between basal TSH values and TT3 (r = -0.38, p less than 0.05) was noted in depressed but not in HC subjects.     

Carbamazepine and risk of hypothyroidism: a prospective study

OBJECTIVES - While carbamazepine (CBZ) decreases thyroid hormone concentrations it rarely causes hypothyroidism. We assessed prospectively the early effect of CBZ on thyroid status in thyroxine-supplemented hypothyroid patients, when compared with patients without a thyroid disorder. METHODS - In 29 patients, thyrotropin (TSH), total thyroxine (TT4) and free thyroxine (FT4) serum levels were assayed before starting CBZ, and then weekly for 7 weeks. Nineteen patients with no thyroid disorder (group A) were compared with 10 thyroxine-supplemented hypothyroid patients, stable before CBZ treatment (group B). RESULTS - In group A, TT4 decreased significantly by ca. 15-25%, starting from the first week (Friedman, P < 0.001). FT4 decline was smaller (ca. 10-15%) and delayed till the second week. FT4/TT4 ratio increased significantly (P < 0.001), while TSH only slightly (P = 0.073), never exceeding normal range. In group B, similar TT4 and FT4 decline was followed by significantly increasing TSH (P = 0.011), while the FT4/TT4 ratio was not significantly changed. In 3 of 10 patients TSH rose over 5 mIU/l, necessitating treatment adjustment. CONCLUSIONS - In patients with no thyroid disorder, CBZ causes hormonal changes of no clinical relevance, due to adaptive response. In T4-supplemented hypothyroid patients this adaptation is lacking, CBZ may precipitate subclinical or overt hypothyroidism, and early thyroid function monitoring seems advisable.     

Thyroid hormones in panic disorder, panic disorder with agoraphobia, and generalized anxiety disorder

Fifty-two patients with generalized anxiety disorder who had symptoms persisting for at least 6 months, 41 patients suffering from either panic disorder (32 patients) or panic disorder with agoraphobia (9 patients), and 14 control subjects were screened for thyroid disease. Total serum thyroxine (TT4), serum-free thyroxine index (FT4I), and triiodothyronine resin uptake (T3RU), were examined for the entire sample, using a one-way analysis of variance (ANOVA). No significant differences were found in TT4 (p = .24), FT4I (p = .24), and T3RU (p = .19). Thyroid-stimulating hormone (TSH) was examined in a subsample of 10 patients with generalized anxiety disorder, 11 with panic disorder or panic disorder with agoraphobia, and 10 controls. One-way ANOVA again showed no significant differences, although there was a trend (p = .07). This is the first report that compares generalized anxiety disorder patients, panic disorder patients, and patients with panic disorder and agoraphobia with controls on measures of thyroid function. It is also the first to report normal values in the thyroid indices of generalized anxiety disorder patients.     

Thyroid function in anxious and depressed patients

We measured serum thyroid hormone levels, and pre- and post-TRH administration serum thyrotropin (TSH) in 46 psychiatric inpatients with major depression (n = 20), anxiety disorder (n = 9), and anxious depression (n = 17), and in 56 healthy subjects. Basal serum triiodothyronine was lower in female patients with major depression and anxious depression than in healthy women (P less than 0.05). Basal serum thyroxine was lower in female patients with anxious depression than in controls; all patients showed lower basal serum TSH than controls. In healthy subjects, basal triiodothyronine and thyroxine, basal TSH, and delta TSH (the increment of TSH after TRH administration) correlated, whereas no correlation was found between triiodothyronine and thyroxine in male patients with major depression, or between TSH and delta TSH in female patients with major depression or anxious depression. In female patients, 45% with major depression, 25% with anxiety disorder, and 35% with anxious depression showed a blunted TSH response. We also investigated pre- and post-dexamethasone administration cortisol levels in these patients. The sensitivity obtained by the combination of the results of the TRH and dexamethasone suppression tests for major depression, anxiety disorder, and anxious depression was 45%, 55%, and 65%, respectively.