心力衰竭患者焦虑抑郁症状及其相关因素

目的:观察心力衰竭患者焦虑症状(焦虑)和抑郁症状(抑郁)的发生情况及其相关因素. 方法:横断面研究.顺序入选心力衰竭住院患者684例,收集患者的一般资料和住院期间情况,填写Zung氏焦虑自评量表(Self-Rating Anxiety Scale,SAS)和抑郁自评量表(Self-Rating Depression Scale,SDS),进行统计学分析,评价心力衰竭患者焦虑、抑郁的评分情况及其相关因素. 结果:684例心力衰竭患者中有20.03%的患者存在焦虑,有23.39%的患者存在抑郁.性别和文化程度与心力衰竭患者合并焦虑相关(P均<0.05),性别和纽约心功能分级与心力衰竭患者合并抑郁相关(P均<0.05). 结论:心力衰竭患者中存在较高的焦虑和抑郁的发生率;女性、文化程度低的患者更易发生焦虑,女性、心功能分级高的患者更易发生抑郁.     

焦虑和抑郁量表在肝硬化患者临床应用中的信效度评价*

目的 应用焦虑自评量表（SAS）和抑郁自评量表（SDS）调查肝硬化患者心理障碍状况,评价其在肝硬化患者中应用的信效度。方法 应用SAS和SDS量表对138例肝硬化患者进行问卷调查, 采用Cronbach’s α系数、分半系数、组内相关系数（ICC）反映量表的同质信度。采用探索性因子分析量表的结构效度,计算Kaiser-Meyer-Olkin（KMO）值,并作巴特利特球形检验（BTS）判断因子分析是否合适,采用主成分分析法提取因子。结果 本组肝硬化患者焦虑和抑郁患病率分别为38.2%和63.1%;SAS量表的Cronbach’s α系数为0.777,SDS量表的Cronbach’s α系数为0.782,两个量表具有良好的同质性信度;分别对SAS量表提取4个主要因子,其方差解释比例分别为15.4%、14.9%、10.6%和10.2%,4个因子累计解释总方差的51.1%;对于SDS量表提取5个主要因子,其方差解释比例分别为14.0%、12.6%、11.9%、10.3%和8.4%,5个因子累计解释总方差的57.4%;SAS和SDS量表重测分析发现,两次测量结果高度相关（P<0.001）。结论 应用SAS和SDS量表调查肝硬化患者焦虑和抑郁情况具有良好的信效度,可以用于肝硬化患者心理障碍的测定。     

冠心病伴焦虑、抑郁症状患者实施心理干预的效果评价

目的 评价伴焦虑、抑郁症状的冠心病患者实施心理干预治疗的临床效果.方法 选取120例伴焦虑、抑郁症状的冠心病住院患者,将其随机分为对照组、心理干预组、综合干预组各40例.三组患者均给予冠心病常规治疗.心理干预组在常规治疗基础上接受既定方案的心理干预;综合干预组在常规治疗基础上另给予既定方案的心理干预及抗抑郁药物（黛力新片）治疗.采用焦虑自评量表（SAS）、抑郁自评量表（SDS）分别在患者入院时及干预4周后进行调查,评价其心理疗效,通过患者症状及心电图变化评价其临床疗效.结果 干预前,三组一般情况及SAS和SDS评分差异均无统计学意义（P均＞0.05）.干预4周后,心理干预组和综合干预组患者的SAD和SDS评分差值均较对照组明显升高（P均＜0.01）;综合干预组差值升高更明显（P＜0.01）;综合干预组和心理干预组的临床疗效均优于对照组（x2=26.911,P＜0.01x2=7.500,P＜0.0167）,综合干预组的总有效率高于心理干预组,差异有统计学意义（x2=8.538,P＜0.0167）.结论 对伴焦虑、抑郁症状的冠心病患者在常规内科治疗基础上实施心理干预能有效改善其心身症状,提高临床疗效;且在心理干预基础上加服抗抑郁药物可进一步提高疗效.     

对不同病程糖尿病患者的针对性心理干预研究

将入组患者391例区分为1年组、≤5年组和5年组,每组再随机分为干预组和对照组,根据病程组不同采取不同的心理干预措施。结果:治疗前1年组、≤年组、5年组SDS分值(41.46±9.34、37.74±9.48、42.60±9.93)和SAS分值(37.76±9.06、34.17±9.29、38.45±9.78)。治疗后各FBG、HbA1c及SDS分值和SAS分值较对照组明显降低。结论:有针对性的心里干预可改善抑郁和焦虑状态,FBG和HbA1c明显的改善。     

冠心病患者自我管理能力与焦虑、抑郁的相关性研究

目的探讨冠心病患者焦虑抑郁对其自我管理能力的影响,为提高冠心病患者的自我管理能力提供依据。方法为描述性研究方法,采用自我管理能力测定量表、焦虑自评量表,抑郁自评量表对94例冠心病患者进行调查,并分析其相关性。结果 Pearson相关分析结果显示,冠心病患者焦虑得分与自我管理能力总分及各个维度得分无相关,抑郁总分与自我管理能力总分、自理技能、自我概念、健康知识水平维度的得分呈负相关(P<0.05)。结论抑郁情绪影响冠心病患者的自我管理能力,冠心病患者抑郁情绪越严重,自我管理能力越差。     

南京市浦口地区高血压人群抑郁和焦虑状况的病例对照研究

该文了解南京市浦口地区高血压患者的抑郁和焦虑状况。方法：采用病例对照研究，抽取35岁以上高血压患者326例，健康对照组414例；并使用Zung抑郁自评量表（SDS）和焦虑自评量表（SAS）评定调查对象抑郁和焦虑状况。结果：高血压病例组抑郁和焦虑自评量表的总积分及标准分均显著高于健康对照组（P〈0．01）。     

黛力新对冠心病伴焦虑抑郁患者治疗效果和生活质量的影响

目的探讨黛力新与抗心肌缺血治疗对冠心病伴焦虑抑郁患者的疗效和对生活质量的影响。方法冠心病伴焦虑抑郁患者128例,随机被均分为观察组和对照组,分别给予抗心肌缺血药物联合黛力新治疗,单纯抗心肌缺血治疗。疗程8周时观察临床症状、心电图及焦虑自评量表和抑郁自评量表评分的变化;半年后采用中国心血管病人生活质量评定问卷进行生活质量评估。结果观察组心绞痛和心电图疗效分别为92.19%和84.38%,明显高于对照组的79.69%和68.75%(P均<0.05),观察组焦虑自评量表和抑郁自评量表评分在治疗后显著下降(P均<0.01),且显著优于对照组(P均0.05);观察组中国心血管病人生活质量评定问卷的得分均高于对照组(P均<0.01)。结论黛力新治疗冠心病伴焦虑、抑郁患者效果良好,能够改善患者的生活质量。     

心力衰竭病人焦虑抑郁调查研究

目的:获得症状性心力衰竭(心衰)病人的焦虑、抑郁流行情况和相关的有效数据。方法:选择心衰病人112例。并发放焦虑自评量表(SAS)、抑郁自评量表(SDS),同时收集病人多项基本资料。用SPSS10.0软件分析病人各项情况与焦虑、抑郁自评量表得分之间的关系。结果:112例心衰病人中有20.5%的病人存在明显焦虑,有30.4%的病人存在明显抑郁。性别、心功能分级、有无心血管病家族史以及血型可以影响病人焦虑、抑郁量表得分,病人的焦虑、抑郁程度可以影响住院时间长短,体液因子C反应蛋白、高敏C反应蛋白及氨基酸末端脑钠素前体水平与焦虑、抑郁量表得分明显相关。结论:心衰病人中存在较高的焦虑、抑郁,心血管病人焦虑、抑郁情况值得临床医师重视。     

Anxiety and Depression in Ethnic Minorities With Chronic Heart Failure

BackgroundConsiderable evidence confirms the high prevalence of anxiety and depression in the patients with heart failure (HF). However, little is known about the relationship of race/ethnicity to psychosocial variables in this population. The purpose of this study was to examine and compare the incidence of anxiety and depression in a cohort of non-Hispanic blacks, Hispanics, and non-Hispanic whites with advanced systolic HF.Methods and ResultsTwo-hundred forty-one patients (7% non-Hispanic blacks, 22.8% Hispanics, 60.7% non-Hispanic whites) mean age 56.7 ± 13.0 years, male (70%), married (81%), retired (75%), New York Heart Association (NYHA) Class III (53.9%), and mean ejection fraction 31.2 ± 5.4%) from a single heart transplant facility were asked to complete a series of questionnaires to assess anxiety, depression, perceived control, social support, and financial stability. Non-Hispanic blacks had higher levels of anxiety (P = .048) and depression (P = .026) compared with Hispanics; a similar trend was noted when comparing non-Hispanic blacks and non-Hispanic whites, but these differences were not statistically significant. Perceived control was highest among Hispanics and lowest among non-Hispanic whites (P = .046). In a multivariate model race/ethnicity, perceived control, and social support accounted for 30% of the variance in anxiety while race/ethnicity, NYHA Class, perceived control, and social support accounted for 41% of the variance in depression.ConclusionsOur findings reveal that non-Hispanic blacks are more likely to be anxious and depressed than their counterparts. Because patient perceptions of control and social support are related to dysphorias known to influence morbidity and mortality, clinicians should regularly assess patients' concerns and assist in accessing appropriate services and treatments tailored to individual needs. Non-Hispanic blacks warrant increased scrutiny.     

Heart Failure Epidemiology in Patients With Diabetes Mellitus Without Coronary Heart Disease

Background

Epidemiology of patients with comorbid heart failure (HF) and diabetes mellitus (DM) without coronary heart disease (CHD) is not well described.

Prevalence,Temporal Change,and Determinants of Anxiety and Depression in Hospitalized Patients With Heart Failure

BackgroundAnxiety and depression may be under-recognized in patients with heart failure (HF). We therefore investigated the prevalence and temporal change of these symptoms in hospitalized patients with HF.Methods and ResultsWe prospectively evaluated consecutive hospitalized patients with HF using the Hospital Anxiety and Depression Scale (HADS) on admission and at discharge. The HADS-A (anxiety) and HADS-D (depression) scores were categorized as follows; 0–7, no symptoms; 8–10, mild; and 11–21, significant anxiety or depression. Symptom worsening was defined as the HADS category at discharge being poorer than that on admission. Of 224 patients (mean age 77.5 years), 35 (16%) and 62 (28%) had significant symptoms of anxiety and depression, respectively. During hospitalization, the HADS-A significantly decreased (on admission; median 6 [interquartile range (IQR) 3–9] vs at discharge; median 4 [IQR 2–7], P < .01), whereas the HADS-D did not improve (on admission; median 8 [IQR 5–11] vs at discharge; median 8 [IQR 4–11], P =.82). Anxiety and depression worsened during hospitalization in 19 (10%) and 40 (21%) patients, respectively. Advanced age, higher natriuretic peptide levels, and acute-on-chronic HF were associated with worsening anxiety, and longer hospitalization length was associated with worsening depression.ConclusionsAnxiety and depression were common and depression persisted during HF hospitalization.     

Activation of the Ergoreceptors in Cardiac Patients With and Without Heart Failure

BackgroundThe presence of ergoreflex activity and its current relationship to hyperventilation and prognosis in cardiac patients is unclear. Therefore, we evaluated ergoreflex activity in cardiac patients with and without heart failure (CHF) as well as in healthy subjects, and we examined how ergoreceptor activity was related to a mortality risk score in CHF (MAGGIC).Methods and ResultsTwenty-five healthy subjects and 76 patients were included, among whom were 25 with ischemic heart disease (IHD), 24 with stable CHF, and 27 with unstable CHF. Ergoreflex activity was measured with a dynamic handgrip exercise, followed by post-handgrip regional circulatory occlusion (PH-RCO). Ergoreflex activity contributed significantly to ventilation (median [interquartile range] %V) in unstable CHF (81 [73-91] %V without PH-RCO, 92 [82–107] %V with PH-RCO, and 11 [6–20] difference in %V; P < .001) and was positively correlated with the MAGGIC risk score (Spearman ρ = 0.431; P = .002). No ergoreflex activity was observed in healthy subjects (−4 [−10 to 5] difference in %V), IHD (0 [−8 to 3] Diff in %V) and stable CHF (−3 [−11 to 6] difference in %V).ConclusionsErgoreflex activity contributes to hyperventilation, but only in CHF patients with persistent symptoms, and is closely related to the MAGGIC risk score. Ergoreflex activity was not present in patients with IHD or stable CHF, suggesting other reasons for the increased ventilatory drive in those patients.     

Validity of Self-rating Screening Scales for the Diagnosis of Depression and Anxiety in Adult Patients With Bronchiectasis

BackgroundThere are no previous studies aimed at assessing the validity of the screening scales for depression and anxiety in adult patients with bronchiectasis.AimsTo analyze the psychometric properties of Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI) and Hamilton Anxiety Scale and to evaluate the concordance for the diagnosis of depression and anxiety between these screening scales and the structured clinical interview in adult patients with bronchiectasis.MethodCross sectional study. 52 patients with bronchiectasis completed HADS, BDI and Hamilton Anxiety Scale; afterwards, were individually interviewed by a mental health care professional using the structured Mini International Neuropsychiatric Interview (MINI), which evaluates for depression and anxiety according to DSM-IV criteria.ResultsBased on MINI, 18 subjects (34.6%) had a diagnosis of depression and 25 (48.1%) had anxiety. Optimal cut-off values to detect depression were ≥9 for the HADS-D (sensitivity 0.833, specificity 0.971, AUC 0.962 [95% CI 0.918–1]), and 17 for BDI (sensitivity 0.889, specificity 0.912, AUC 0.978 [95% CI 0.945–1]). Optimal cut-off values to detect anxiety were ≥4 for the HADS-A (sensitivity 0.960, specificity 0.593, AUC 0.833 [95% CI 0.723–0.943]), and 17 for Hamilton Anxiety Scale (sensitivity 0.800, specificity 0.852, AUC 0.876 [95% CI 0.781–0.970]).ConclusionThe self-rating screening scales HADS, BDI and Hamilton Anxiety Scale are reliable tools to screen for depression and anxiety in adult patients with bronchiectasis. However, the use of specific cut-off values may improve the diagnostic accuracy of the previous scales in this specific group of patients.