老年前期始发抑郁症的病例对照研究

为探讨老年前期（５０￣５９岁）始发的抑郁症的相关因素与临床特点，对３９例老年前期与４１例〈５０岁始发的抑郁症患者进行了病例对照研究。结果表明：老年前期抑郁症病前有更多的负性生活事件及躯体疾病，临床症状上有更多的焦虑、自杀、迟缓、疑病、性症状和躯体化症状等。     

抑郁症患者自身因素对其服药依从性的影响

目的 探讨抑郁症患者服药依从性的影响因素。方法 从北京安定医院精神疾病临床数 据与生物样本库的受试者数据库中选取符合分析要求的轻中度抑郁症患者（n=102）,按照服药依从性分 为两组,依从性好组（n=40）和依从性差组（n=62）。通过分析比较两组在年龄、性别、受教育年限、居住 地、婚姻状况、居住情况、家庭关系、家庭经济状况、发作次数、固定医生和疾病严重程度等方面的差异, 探讨上述因素对于患者服药依从性的影响。结果 经单因素分析依从性好组和依从性差组在受教育年 限、居住情况、家庭关系、家庭经济状况、发作次数、固定医生方面具有差异,差异有统计学意义（χ2/Z=8.516、 6.030、6.706、5.192、5.170、4.809,均P＜ 0.05）,且上述条目经 Logistic 回归分析显示均与患者服药依从 性相关（均P＜ 0.05）。结论 家庭关系不和睦、独居、家庭经济状况差、发作次数多、医生不固定、教育 水平低的轻中度抑郁症患者服药依从性更低。     

影响老年抑郁症预后的因素研究进展

老年抑郁症因其临床表现、生物学特征及特定社会心理因素与一般成年人抑郁症存在差异 ,其预后也相对较差 ,近年来 ,国外对影响老年抑郁症预后的相关因素研究发现 ,包括人口学、临床学、神经影像学、神经心理学和社会学等多种因素影响其预后 ,其中脑部某些部位白质 MRI高信号改变和神经心理学损害的特点 ,具有独特性、建设性意义。     

老年与非老年抑郁症的临床特征差异

目的:探讨老年期抑郁症的临床特征。方法:以60例老年期抑郁症患者作老年组,选60例非老年期抑郁症患者为非老年组。对两组分别用汉密尔顿抑郁量表和汉密尔顿焦虑量表进行评定。结果:老年组抑郁症状中激越和疑病症状显著高于非老年组(P<0.01),老年组的躯体症状中自主神经系统症状、心血管系统症状和消化系统症状显著高于非老年组(P<0.05或P<0.01);躯体性焦虑和认知障碍、焦虑/躯体化和睡眠障碍的严重程度均显著高于非老年组(P<0.05或P<0.01)。结论:老年期抑郁症激越、疑病、躯体症状、焦虑、睡眠障碍及认知障碍等更加突出。     

影响老年抑郁症预后的因素研究进展

老年抑郁症因其临床表现、生物学特征及特定社会心理因素与一般成年人抑郁症存在差异,其预后也相对较差,近年来,国外对影响老年抑郁症预后的相关因素研究发现,包括人口学、临床学、神经影像学、神经心理学和社会学等多种因素影响其预后,其中脑部某些部位白质MRI高信号改变和神经心理学损害的特点,具有独特性、建设性意义。     

抑郁症患者与非抑郁症人群中儿童期虐待与社会支持的关系

目的 研究抑郁症患者与非抑郁症人群中儿童期虐待与社会支持的关系。方法 本研究 采用非匹配的病例对照研究，对2014 年1 月至2017 年12 月北京安定医院符合入排标准的研究对象进行 研究，共连续纳入224 例抑郁症患者及214 例非抑郁症人群。采用调查问卷（自编）收集研究对象的基本 信息（年龄、性别、婚姻状态、教育水平、工作状态、吸烟史及体质量指数）、疾病史、精神疾病家族史；采 用儿童期虐待问卷中文版（CTQ-SF）评估研究对象16 岁前的经历；采用社会支持评定量表（SSRS）评估 研究对象在过去生活状态中获得的社会支持情况，包含客观支持、主观支持和支持利用3 个维度。采 用单因素分析对抑郁症患者与非抑郁症人群进行基本资料、CTQ-SF及SSRS 评分的比较，采用多因素 Logistic 回归分析影响成年期患者抑郁发生的因素。结果 抑郁症患者中有儿童期虐待经历者（93 例， 41.52%）多于非抑郁症人群（51 例，23.8%），差异有统计学意义（χ2=15.51，P ＜ 0.01）。多因素Logistic 回 归分析显示，儿童期虐待是成年期抑郁的重要危险因素（OR=2.030，95%CI：1.302～3.164）。抑郁症患者 社会支持总分［（32.33±7.45）分］、主观支持［8（6，10）分］、客观支持［17（14，21）分］及支持利用度得分 ［6（5，8）分］均低于非抑郁症人群［分别为（36.79±6.24）、9（7， 11）、20（17， 23）、8（6， 9）分］，差异均有统 计学意义（均P＜0.01）。抑郁症患者中，有儿童期虐待者社会支持得分［（30.41±7.99）分］、主观支持得分 ［7（5，9）分］、客观支持得分［（16.57±4.78）分］均低于无儿童期虐待经历者［分别为（33.70±6.76）、9（7，10）、 （18.53±4.35）］，差异均有统计学意义（均P ＜ 0.01）；非抑郁症人群中，有儿童期虐待者主观支持得分 ［8（6，10）分］低于无儿童期虐待经历者［9（7，11）分］，差异有统计学意义（P ＜ 0.01）。结论 儿童期虐 待是成年期抑郁症及获得社会支持的重要影响因素。     

老年期抑郁症的临床特点

目的探讨老年期抑郁症的临床特点。方法32例老年期抑郁症的患者，与随机抽取同期住院35例青壮年期患者进行对照研究。结果老年期抑郁症患者的发病大多有一定的诱因，早期症状不典型：症状有焦虑激越，体重降低，疑病，被害观念，睡眠感缺失等。结论老年期抑郁症有更为复杂的病因，但基本症状与青壮年一致。     

社区老年抑郁症研究进展

就老年抑郁症流行病学、病因、临床特征及其社区干预现状作一介绍。     

抑郁症患者的功能失调性认知初探

目的　探讨抑郁症状与功能失调性认知间的关系。方法　应用功能失调性状况评定量表 (DAS)、Beck抑郁自评量表 (BDI)和汉密尔顿抑郁量表 (HAMD)对 75例抑郁症患者 (抑郁症组 )于治疗前后 (抗抑郁剂 4～ 8周 )进行评定 ,采用DAS和BDI对 10 0名正常人 (对照组 )进行评定和比较。结果　 (1)抑郁发作期 (治疗前 )抑郁症组BDI总分 [(40 76± 10 6 7)分 ]、DAS总分 [(16 2 6 4± 19 4 8)分 ]及各项因子分 (除自主性态度 )均高于对照组 [BDI总分为 (6 6 4± 3 36 )分 ,DAS总分为 (12 5 0 5±2 0 34)分 ;P <0 0 1或P <0 0 5 ) ];(2 )恢复期 (治疗后 )抑郁症组的抑郁症状有所改善 ,BDI评分降至(9 6 5± 4 4 7)分 ,但DAS评分 [(15 0 6 3± 18 11)分 ]仍高于对照组 (t=4 738,P <0 0 1)。结论　功能失调性认知是抑郁症的一个特征性心理状态 ,构成了抑郁的易患性。     

艾司西酞普兰治疗老年抑郁症的临床研究

目的探讨艾司西酞普兰治疗老年抑郁症的疗效及不良反应。方法将72例符合CCMD-3诊断标准的老年抑郁症患者采用随机分组的对照方法 ,分为艾司西酞普兰组和西酞普兰组,治疗时间均为12周。两组分别在治疗后第2、4、8、12周末,采用汉密尔顿抑郁量表(HAMD)、临床总体印象量表(CGI)评定疗效,治疗中出现的症状量表(TESS)评定不良反应。结果两组12周末HAMD减分率分别为(49.06±19.99)分、(28.88±16.75)分,两组间差异具有显著性意义(P0.01);两组12周末CGI减分率分别为(2.02±1.00)分、(3.01±1.12)分,两组间差异亦具有显著性意义(P0.01);TESS评分两组间无显著性差异(P0.05)。结论艾司西酞普兰是既有效又安全的新型抗抑郁药,适合对老年抑郁症的治疗。     

上海地区老年抑郁症的流行病学调查

用老年抑郁量表(GDS)及DSM—Ⅲ—R诊断标准调查2235名老人中的重性抑郁症。发现34例重性抑郁症,占调查人口1.56‰,占老年人口15.1‰,其中女性患病率比男性高。随着年龄的增加,老年抑郁症的患病率也相应增高。发病率最高为1986年(2.42‰),最低1988年(1.5‰),城市组高于农村组。在发病诱因,精神症状,病程、治疗等方面,进行城市组与农村组的对比,另外,结合资料讨论了老年抑郁症的预防问题。     

Executive dysfunction and the course of geriatric depression.

BACKGROUND: Executive dysfunction is common in geriatric depression and persists after improvement of depressive symptoms. This study examined the relationship of executive impairment to the course of depressive symptoms among elderly patients with major depression. METHODS: A total of 112 nondemented elderly patients with major depression participated in an 8-week citalopram trial at a target daily dose of 40 mg. Executive functions were assessed with the initiation/perseveration subscale of the Dementia Rating Scale and the Stroop Color-Word test. Medical burden was rated with the Cumulative Illness Rating Scale. RESULTS: Both abnormal initiation/perseveration and abnormal Stroop Color-Word scores were associated with an unfavorable response of geriatric depression to citalopram. In particular, initiation/perseveration scores below the median (< or =35) and Stroop scores at the lowest quartile (< or =22) predicted limited change in depressive symptoms. Impairment in other Dementia Rating Scale cognitive domains did not significantly influence the outcome of depression. CONCLUSIONS: Executive dysfunction increases the risk for poor response of geriatric depression to citalopram. Because executive functions require frontostriatal-limbic integrity, this observation provides the rationale for investigation of the role of specific frontostriatal-limbic pathways in perpetuating geriatric depression. Depressed elderly patients with executive dysfunction require vigilant clinical attention because they might be at risk to fail treatment with a selective serotonin reuptake inhibiting antidepressant.     

社区卫生服务中心医务人员精神卫生知识的调查

目的 了解城区一级医疗机构(社区卫生服务中心)中医务人员的精神卫生知识水平,为在一级医疗机构中设置心理咨询专科作可行性的研究。方法 选取三所社区卫生服务中心(其中A院已经设立心理咨询专科6年;B、C院未设,但B院曾协助市精神卫生中心进行专项调研)在岗医务人员进行随机独立问卷调查,内容主要以患者向医务人员提出需了解的精神卫生知识,常见精神疾病的诊断和处理原则。以多选题和是非题的形式解答,解答对象不记名,但记录从医年限、职称、专业科室、精神卫生知识是接受培训还是自学获得。对问卷按掌握、基本掌握、熟悉、了解、基本不了解分成五类。结果A院中医务人员掌握、基本掌握和熟悉精神卫生知识的占81.39％,了解占9.30％,基本不了解仅2.33％。B院中掌握、基本掌握和熟悉精神卫生知识的占32.00％,了解占38.00％,基本不了解30.00％。C院掌握、基本掌握和熟悉精神卫生知识的占8.89％,了解占44.44％,基本不了解46.67％;但已经开设心理咨询专科门诊A院的高、中级人员都达到基本掌握和熟悉程度。工作年限、专业与掌握和了解精神卫生知识无显著关系。结论 在社区卫生服务中心设置心理咨询专科门诊服务是切实可行的,对充实一级医疗机构中医务人员的业务知识结构,完善社区卫生服务中心的功能有明显作用     

Prevalence of depression among patients seen in community health centres and community mental health centres

Depression is a common disorder in the general population. However, its prevalence among patients attending various health-care facilities is less well known. There have been very few Finnish studies of this topic. The Tampere Depression Project (TADEP) dealt with the prevalence of depression and factors associated with it in individuals seen in community health centres (CHC) and in psychiatric-service (PS) patients. The diagnosis of depression was based on a standardized Present State Examination interview and a DSM-III-R assessment, carried out on 436 CHC patients and 428 PS patients. The severity of depression was assessed using the Hamilton Rating Scale of Depression. About 10% of CHC patients and 50% of PS patients suffered from clinical depression. In addition to these, some depressive symptoms were displayed by just under 10% of subjects. Similar prevalence rates were obtained by the various methods used. The 1–year prevalence rate of clinical depression was 20% for the CHC patients and almost 60% for the PS patients. Mild depression represented the largest group. In the CHC group, depression was found more often in middle-aged and widowed subjects and in patients with a lower educational level and blue-collar workers than in others. In the PS group, depression was found more often in women, the oldest subjects and the widowed than in others.     

西酞普兰合并小剂量喹硫平治疗老年抑郁症的对照研究

目的探讨西酞普兰合并喹硫平治疗老年抑郁症的疗效及安全性。方法将92例符合CCMD-3诊断标准的老年抑郁症患者分为研究组（西酞普兰合并喹硫平组）和对照组（单用西酞普兰组）治疗12周,采用四级临床疗效及汉密尔顿抑郁量表（HAMD）评定疗效,治疗时出现的症状量表（TESS）评定不良反应。结果两组8周末HAMD总分分别为（8.13±4.87）,（11.72±3.89）,两组12周末HAMD总分分别为（6.99±3.05）、（10.12±3.11）,两组间差异均具有显著性意义（P〈0.05）,两组间药物不良反应无显著性差异（P〉0.05）。结论西酞普兰合并喹硫平治疗老年抑郁症的疗效更好,且不良反应无明显增加。     

Comparison of characteristics between geriatric and younger subjects with schizophrenia in community

Relatively little is known about the different characteristics of non-institutionalized geriatric and younger subjects with schizophrenia. This study compared demographic and clinical characteristics of all the geriatric, middle-age and young subjects with schizophrenia living in a Chinese rural community. Geriatric (age >/= 65 years) (N = 51), middle-age (age 41-64 years) (N = 263) and young subjects with schizophrenia (age 15-40 years) (N = 196) in a rural community were assessed with the Present State Examination and Social Disability Screening Schedule. Age at first onset was significantly older in geriatric male and female groups. While there were no significant differences of negative symptoms among the three groups, the rates of lifetime nuclear syndrome were significantly lower in geriatric subjects compared to the other two groups. Geriatric subjects were less likely to have been hospitalized (9.8%) than middle-age (19.0%) and younger subjects (24.8%). Although the duration of illness was significantly longer in geriatric subjects than in the other two groups, the clinical outcome was significantly better in the geriatric group and social functioning scores were similar among the three groups. Geriatric subjects were more likely to be female, with longer duration of illness, fewer "core" symptoms, relatively stable social functioning and clinical outcome. The pathogenesis and psychopathology of geriatric subjects may be different compared to younger subjects with schizophrenia.     

Subjective health measures and acute treatment outcomes in geriatric depression.

BACKGROUND: Prior research suggests that elderly patients are less likely to respond to antidepressant treatment if they have low self-rated health. However, successful treatment for depression has been associated with improvement in self-rated health and other health measures. OBJECTIVES: To examine measures of self-rated health, physical disability, and social function as predictors of treatment response in late-life depression, and to assess these same health measures as treatment outcomes. We hypothesized that greater impairment in these measures would predict poorer treatment response, and that these measures would show significant improvements with recovery from depression. METHOD: Subjects were enrolled in a depression intervention study for people aged 60 and older with recurrent unipolar major depression; they were assessed with measures of self-rated health, physical disability, and social functioning at baseline and at the end of treatment. Baseline measures were compared between the 88 remitters, 11 non-remitters, and seven dropouts. Additionally, changes in the measures were examined in subjects who recovered from the index depressive episode. RESULTS: Subjects with poorer self-rated health at baseline were more likely both to drop out of treatment and to not respond to adequate treatment. This relationship was independent of demographic measures, severity of depression, physical and social functioning, medical illness, personality, hopelessness, overall medication use, and side effects or non-compliance with treatment. CONCLUSION: Although this finding is preliminary because of the small number of dropouts and non-remitters, it suggests that lower self-rated health may independently predict premature discontinuation of treatment for depression. Additionally, subjects who recovered from depression showed significant improvements in self-rated health, physical disability, and social functioning.     

个案管理模式对社区老年抑郁症生活质量的影响

目的 探讨个案管理模式对我国社区老年抑郁症患者生活质量的影响.方法 将120例老年抑郁症患者随机分成干预组和对照组,干预组实行个案管理模式,即精神科医生、社区医生和个案管理员共同对老年抑郁症患者实施综合治疗方案,如健康教育、心理治疗和药物治疗等,对照组按照现行的医学模式进行.在治疗前,治疗第2、4、6、8、12周末分别应用汉密尔顿抑郁量表(Hamilton depression scale, HAMD17)和治疗时出现的症状量表(treatment emergent symptom scale, TESS)对两组患者的疗效和药物不良反应进行评定;在治疗前,治疗第4、8、12周末应用健康状况问卷(12-item short form health survey questionnaire,SF-12)对两组患者的生活质量进行评价.结果 在治疗12周末,干预组患者HAMD17总分(14.2±7.7)明显低于对照组HAMD17总分(24.9±5.9),两组间存在统计学差异(P=0.000);干预组有效率(83.1%)、临床治愈率(27.1%)明显高于对照组有效率(39.3%)、临床治愈率(5.4%),存在统计学差异(P=0.000和0.002);干预组SF-12的MCS(41.0±9.6)和PCS(39.3±9.2)均明显高于对照组的MCS(30.3±9.9)和PCS(30.5±6.8),两组间存在统计学差异(P=0.000);两组患者药物不良反应轻微.结论 应用个案管理模式可以有效地减轻老年抑郁症患者的抑郁症状,提高患者的生活质量.     

Effect of age on geriatric depression scale performance in Parkinson's disease

The purpose of this study was to compare the validity of the 15‐item Geriatric Depression Scale (GDS‐15) in nonelderly (<65 years), young‐elderly (age, 65–75), and old‐elderly (>75 years) patients with Parkinson's disease (PD). 57 nonelderly, 88 young‐elderly, and 81 old‐elderly PD patients were administered the GDS‐15 and the Structured Clinical Interview for DSM‐IV depression module. Receiver‐operating characteristic (ROC) curves were plotted for GDS‐15 scores against a DSM‐IV diagnosis of major or minor depression. The discriminant validity of the GDS‐15 was high for nonelderly, young‐elderly, and old‐elderly subjects (ROC area under curve = 0.92, 0.91, and 0.95, respectively), with optimal dichotomization at a cut‐off of 4/5 (85% sensitivity and 84% specificity in nonelderly; 89% sensitivity and 82% specificity in young‐elderly) and 5/6 (90% sensitivity and 90% specificity in old‐elderly). In conclusion, the GDS‐15 has comparable validity in younger and older PD patients, suggesting its appropriateness as a depression screening instrument in PD patients of all ages. © 2007 Movement Disorder Society