重症抑郁症病人认知功能与变虑的关系

目的：探讨重症抑症病人的认知功能性失调与焦虑障碍的关系。方法：对２４例伴有严重焦虑障碍和２１例不伴有严重焦虑障碍的重症抑郁症病人在入院治疗前及常规药物治疗后，分别同时应用功能失调状况评定量表“ＤＡＳ”、ＨＡＭＤ抑郁量表及Ｂｅｃｋ抑郁自评量表“ＢＤＩ”进行测评与对照研究。结果：常规药物治疗后两组患抑郁症状严重程度（ＨＡＭＤ总分）明显减轻或消失，疗效显（Ｐ〈０．０１）。但是认知功能改善存在较大差异     

认知行为疗法在抑郁症治疗中的作用

目的:从护理角度探讨认知行为疗法在抑郁症治疗中的作用。方法:将84例抑郁症患者随机分为2组,采用单纯药物治疗和联合认知行为治疗,以Beck抑郁自评量表(BDI)、Hamilton抑郁量表17项(HAMD)、Beck制定的功能失调性状况评定量表(DAS)、社会功能缺陷状况评定量表(SDSS)量表为评定工具进行评定。结果:出院时2组BDI、HAMD、DAS评分较治疗前有明显下降(P<0.05),但联合治疗组DAS评分较单纯药物治疗组下降更明显(P<0.01)。出院后1年,2组BDI、HAMD、DAS评分比较有显著性差异(P<0.05)。结论:抑郁症状与认知障碍有密切相关,认知行为治疗对抑郁症的预后起重要作用,在整体护理中认知行为疗法作为精神病患者心理护理的重要手段之一。     

脑电生物反馈仪治疗伴有睡眠障碍的抑郁症疗效分析

目的:观察生物反馈仪对伴有睡眠障碍症状的抑郁症患者的疗效。方法:伴有睡眠障碍的抑郁症患者84例,随机分为观察组和对照组,各42例。对照组患者给予常规的药物及心理治疗,观察组患者在此基础上增加生物反馈仪治疗。于对治疗前,治疗后3、6周采用汉密尔顿抑郁量表(HAMD)和匹兹堡睡眠质量指数量表(PSQI)对2组进行测量并分析。结果:治疗前2组HAMD评分和PSQI评分差异无统计学意义(P0.05);治疗3、6周后,观察组的HAMD评分和PSQI评分均低于对照组(P0.05)。结论:药物联合脑电生物反馈仪治疗伴有睡眠障碍的抑郁症疗效优于单纯药物治疗。     

认知行为疗法在抑郁症治疗中的作用

目的：从护理角度探讨认知行为疗法在抑郁症治疗中的作用。方法：将84例抑郁症患随机分为2组，采用单纯药物治疗和联合认知行为治疗，以Beck抑郁自评量表（BDI）、Hamilton抑郁量表17项（HAMD）、Beek制定的功能失调性状况评定量表（DAS）、社会功能缺陷状况评定量表（SDSS）量表为评定工具进行评定。结果：出院时2组BDI、HAMD、DAS评分较治疗前有明显下降（P＜0．05），但联合治疗组DAS评分较单纯药物治疗组下降更明显（P＜0．01）。出院后1年，2组BDI、HAMD、DAS评分比较有显性差异（P＜0．05）。结论：抑郁症状与认知障碍有密切相关，认知行为治疗对抑郁症的预后起重要作用，在整体护理中认知行为疗法作为精神病患心理护理的重要手段之一。     

认知行为疗法对社区抑郁症患者的影响

目的了解在给予社区抑郁症患者药物治疗的同时,实施认知行为治疗的效果。方法选择顺德新桂社区82例抑郁症患者(设为实验组)在给予抗抑郁药物治疗的同时,配合社区认知行为治疗,与北区社区只应用药物治疗的82例抑郁症患者(治疗组)作对照;2周后应用Zung抑郁自评量表对患者进行心理状态测定。结果实验组抑郁症状减轻程度明显优于单纯应用药物治疗组。结论单纯药物治疗仅能减轻抑郁症状,采取药物与认知行为相结合的方法,可纠正抑郁症患者失调性认知程度,从而达到治疗的目的。     

认知护理干预对抑郁症病人认识障碍影响的研究

[目的]观察认知护理干预对抑郁症病人认识障碍的影响。[方法]选择58例抑郁症病人,随机分为实验组(28例)和对照组(30例),对两组病人进行健康教育并给予常规治疗护理,实验组加用认知护理干预。4周后对两组病人用汉密顿抑郁量表(HAMD)评定,计算其中认识障碍因子分。[结果]实验组4周后的HAMD中认识障碍因子分明显低于对照组(P<0.01)。[结论]认知护理干预可明显改善抑郁症病人的认识障碍。     

曲唑酮与阿米替林治疗伴有焦虑症状的抑郁症

目的比较曲唑酮与阿米替林治疗伴有焦虑症状的抑郁症的临床的疗效和副反应。方法68例符合CCMD-2-R诊断标准的抑郁症伴有焦虑症状的患者,随机分为两组,应用曲唑酮34例,阿米替林34例共治疗6周。采用汉密顿抑郁量表(HAMD)、焦虑量表(HAMA)和副反应量表(TESS)评定疗效和副反应。结果曲唑酮与阿米替林治疗伴有焦虑症状的抑郁症均有效,二者疗效相当(P>0.05)。曲唑酮的副反应明显少于阿米替林(P<0.01)。结论曲唑酮治疗伴有焦虑症状的抑郁性神经症是一种安全、有效的药物。     

认知重建技术在老年抑郁症心理护理中的应用

[目的 ]观察认知重建技术在老年抑郁症病人心理护理工作中的作用。 [方法 ]在常规治疗和护理的基础上 ,实验组介入认知重建技术 ,并对实验组和对照组进行汉密尔顿抑郁量表 (HAMD)测评 ,根据其结果判定护理效果。 [结果 ]实验组认知障碍改善比对照组更明显 ,焦虑、阻滞、日夜变化和绝望感亦优于对照组。 [结论 ]将认知重建技术运用于老年抑郁症的心理护理工作中 ,可以有效地改善病人症状、缩短住院时间和服药巩固时间、降低复发率、减少医疗费用等。     

越鞠丸联合度洛西汀治疗伴有躯体焦虑抑郁症的临床观察

目的:观察越鞠丸联合度洛西汀治疗伴有躯体焦虑抑郁症的疗效。方法:将90例伴有躯体焦虑的抑郁症患者随机分为对照组和观察组各45例,2组给予度洛西汀治疗,观察组联用越鞠丸。疗程8周,用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、症状自评量表(SCL-90)评定疗效,采用副反应量表(TESS)评定不良反应。结果:2组治疗前后HAMD总分和躯体因子评分差异均有统计学意义(P0.05);与对照组比较,治疗后第4周末、第6周末、第8周末观察组的HAMD评分差异均有统计学意义(P0.05),观察组治疗后第8周末躯体因子评分差异有统计学意义(P0.05),TESS评分差异有统计学意义(P0.05)。结论:越鞠丸联合度洛西汀能有效改善抑郁症患者的躯体焦虑症状和抑郁症状,还可能减轻度洛西汀的不良反应。     

烧伤患者焦虑及抑郁障碍的药物治疗

目的 :研究抗焦虑和抗抑郁药物治疗对烧伤患者的焦虑障碍和 /或抑郁障碍的临床疗效 ,为建立合理的烧伤后心理治疗模式充实内容。方法 :选用焦虑自评量表 (SAS)、抑郁自评量表 (SDS)、Hamilton焦虑量表 (HAMA)以及抑郁量表 (HAMD)对 2 2 0例烧伤住院患者进行筛选 ,将 6 6例具有焦虑障碍和 /或抑郁障碍的烧伤患者分为治疗组和对照组 ,治疗组患者根据其焦虑或抑郁症状给予抗焦虑和抗抑郁药物治疗。结果 :治疗组患者的HAMA焦虑量表及HAMD抑郁量表的分值下降明显 ,有显著性差异 (P <0 .0 1)。结论 :精神障碍是烧伤患者不可忽视的并发症之一 ,抗焦虑和 /或抗抑郁药物治疗能够明显改善烧伤患者的焦虑障碍和 /或抑郁障碍     

The impact of migraine on patients with major depressive disorder

BACKGROUND: The impact of migraine and other headache types among psychiatric outpatients with major depressive disorder (MDD) has not been fully described. OBJECTIVE: To investigate the impact of migraine on the severity, physical, and anxiety symptoms in patients with MDD and to examine the interaction between headache and depression. METHODS: This clinic-based study enrolled consecutive psychiatric outpatients meeting DSM-IV criteria for MDD. Headache types were diagnosed based on the International Classification of Headache Disorders, 2nd edition (2004). Three psychometric instruments were used to evaluate anxiety, depression, and physical components: the Hamilton Depression Rating Scale, the Beck Depression Inventory, and the Hospital Anxiety and Depression Scale. In addition, the interactions between headache and their depressive episode were also evaluated. RESULTS: Compared with patients without migraine, MDD patients with comorbid migraine (n = 73, 48.3%) had higher physical and anxiety scores on the three psychometric instruments. Migraine accounted for 5% to 11% of the variance of the total scores on the three psychometric scales. Approximately half (48.5%) of patients reported headache worsening during or after a depressive episode. CONCLUSIONS: Our study found that comorbidity of migraine in patients with MDD was associated with more anxiety and physical symptoms. Headache should not be considered as only a somatic symptom of depression, but should be treated as an important comorbid disorder because it might exacerbate or interact with depression during a depressive episode.     

康复期脑卒中后焦虑抑郁患者心理干预效果评价

目的 探讨支持性心理治疗和认知疗法对康复期脑卒中后焦虑抑郁患者的效果。 方法 将58例脑卒中后焦虑抑郁患者随机分为干预组和对照组,每组各29例。2组均接受系统的药物治疗和常规康复护理,干预组在此基础上给予支持性心理治疗和认知治疗。于治疗前及治疗2周末采用焦虑自评量表(SAS)评定2组焦虑症状改善情况,汉密顿抑郁量表(HAMD)评估2组抑郁症状改善情况。 结果 干预组干预2周末SAS评分明显低于对照组,HAMD减分率高于对照组。 结论 心理干预能有效改善康复期脑卒中患者的焦虑抑郁情绪,可以显著提高卒中患者的生存质量和生活质量。     

The Contribution of Anxiety Sensitivity to Obsessive–Compulsive and Anxiety Symptoms in a Naturalistic Treatment Setting

Anxiety sensitivity (AS), a fear of arousal-related sensations, is prevalent in a number of disorders. We examined the relationship between internalizing symptoms and the anxiety sensitivity components of physical, social, and cognitive concerns in a sample of 165 patients seeking treatment in a clinic specializing in cognitive behavioral therapy for anxiety-related disorders. Social anxiety symptoms were associated with greater social concerns. Cognitive concerns were characteristic of both depression and generalized anxiety symptoms, suggesting these two classes of symptoms may share AS symptomatology. Physical concerns were specifically related to panic symptoms. Although obsessive–compulsive symptoms were related to cognitive concerns using univariate regression, these symptoms were not strongly related to any of the anxiety sensitivity components when the correlation between disorders was taken into account. Thus, within the internalizing symptoms studied here, the anxiety sensitivity domains were most relevant to panic, social anxiety, generalized anxiety, and depressive symptoms and less related to obsessive–compulsive symptoms.     

Testing the Cognitive Content-Specificity Hypothesis of Social Anxiety and Depression: An Application of Structural Equation Modeling

The present research examined three key issues of the cognitive content-specificity hypothesis of social anxiety and depression using structural equation modeling (SEM) approach. First, using confirmatory factor analyses on data from a sample of 507 undergraduate students, we found that both positive and negative self-statements factors of the modified Social Interaction Self-Statement Test were empirically differentiated from those of the Automatic Thoughts Questionnaire-Positive and the Automatic Thoughts Questionnaire. Next, SEM was used to analyze data from a subsample of 489 students to identify unique and common cognitive contents that contribute to social anxiety or depressive symptoms and then to evaluate their magnitudes simultaneously. Both positive and negative social interaction self-statements were unique to social anxiety symptoms. However, negative depressive self-statement was specific to depressive symptoms, whereas positive affect self-statement was common to the symptoms of social anxiety and depression. Furthermore, the effects of unique components of self-statements seemed stronger than that of common component on the symptoms of social anxiety and depression. In conclusion, these findings provide general support for the cognitive content-specificity hypothesis of social anxiety and depression.     

Optimum number of sessions for depression and anxiety

AIM: To examine the relationship between the number of psychological treatment sessions completed by patients (1-5 sessions, 6-8 sessions, >8 sessions) and the change in self-rated depressive and anxiety symptoms using the Hospital Anxiety and Depression Scale (HADS). METHOD: Recording demographic characteristics and various clinical outcome measures for all referrals to the service and examining the relationship between changes in self-reported anxiety and depression symptoms. RESULTS: For depression, the study shows that having 6-8 sessions offers more benefit than 1-5 sessions. Having more than eight sessions does not confer any additional benefit. Indeed, there is little difference between 1-5 sessions and more than eight sessions for depression. For anxiety, symptoms appear to continue to improve with increasing numbers of treatment sessions. CONCLUSION: Beyond eight treatment sessions, there appears to be no additional improvement. This is not the case for anxiety, where continuing treatment sessions appear to reduce symptoms.     

认知行为疗法用于精神分裂症恢复期病人情绪障碍的效果评价

[目的 ]了解精神分裂症恢复期病人的自尊水平以及焦虑抑郁情绪 ,并进行认知治疗效果评价。 [方法 ]将14 4例恢复期精神分裂症病人随机分为研究组和对照组 ,研究组实施认知行为治疗 ,在治疗前后 ,分别采用焦虑自评量表 (SAS)、抑郁自评量表 (SDS)和自尊量表 (SES)、自卑感量表 (FIS)对两组进行评定。 [结果 ]研究组实施认知行为治疗前后SAS、SDS、SES、FIS评分以及焦虑抑郁的发生率 ,差异均有统计学意义 (P <0 .0 5 ) ,且治疗后两组间SAS、SDS、SES、FIS评分以及焦虑抑郁的发生率 ,差异也有统计学意义 (P <0 .0 5 )。 [结论 ]恢复期精神分裂症病人存在低自尊水平和焦虑抑郁症状 ,认知行为治疗可缓解恢复期精神分裂症病人的情绪障碍。     

Depressive symptoms in neurodegenerative diseases

Depressive symptoms are very common in chronic conditions. This is true so for neurodegenerative diseases. A number of patients with cognitive decline and dementia due to Alzheimer's disease and related conditions like Parkinson's disease, Lewy body disease, vascular dementia, frontotemporal degeneration amongst other entities, experience depressive symptoms in greater or lesser grade at some point during the course of the illness. Depressive symptoms have aparticular significance in neurological disorders, specially in neurodegenerative diseases, because brain, mind, behavior and mood relationship. A number of patients may develop depressive symptoms in early stages of the neurologic disease, occurring without clear presence of cognitive decline with only mild cognitive deterioration. Classically, depression constitutes a reliable diagnostic challenge in this setting. However, actually we can recognize and evaluate depressive, cognitive or motor symptoms of neurodegenerative disease in order to establish their clinical significance and to plan some therapeutic strategies. Depressive symptoms can appear also lately, when the neurodegenerative disease is fully developed. The presence of depression and other neuropsychiatric symptoms have a negative impact on the quality-of-life of patients and caregivers. Besides, patients with depressive symptoms also tend to further decrease function and reduce cognitive abilities and also uses to present more affected clinical status, compared with patients without depression. Depressive symptoms are treatable. Early detection of depressive symptoms is very important in patients with neurodegenerative disorders, in order to initiate the most adequate treatment. We review in this paper the main neurodegenerative diseases, focusing in depressive symptoms of each other entities and current recommendations of management and treatment.     

抑郁症患者焦虑症状、应付方式与人格特征的关系

背景:焦虑和抑郁的共病率各家报道不一,在抑郁症的病理心理学上,伴有焦虑症状的抑郁症患者的应付方式与人格及其与抑郁症状的关系等基本问题并不十分清楚。目的:分析伴有焦虑症状抑郁症患者的应付方式与人格的关系。设计:病例-对照观察。单位:中南大学湘雅二医院、湖南省脑科医院。对象:选择2002-06/2003-01在中南大学湘雅二医院、湖南省脑科医院住院的抑郁症患者88例。另选择中南大学湘雅二医院、中山大学部分职工及家属、临时工、学生中健康自愿者90人为正常对照组。方法:采用抑郁自评量表、焦虑自评量表、应付方式问卷、艾森克人格问卷进行调查评估。主要观察指标:①抑郁症组与正常对照组抑郁自评量表、焦虑自评量表、应付方式问卷、艾森克人格问卷评分比较。②有焦虑症状抑郁症组和无焦虑症状抑郁症组抑郁自评量表、焦虑自评量表、应付方式问卷、艾森克人格问卷评分比较。③抑郁症组各指标相关分析和逐步回归分析结果。结果:178名入选对象均进入结果分析。①抑郁症患者抑郁自评量表、焦虑自评量表、艾森克人格问卷的精神质、神经质两个维度的得分高于正常对照组,而艾森克人格问卷的内外向维度、积极应付方式得分低于对照组。②伴有焦虑症者抑郁自评量表、焦虑自评量表、艾森克人格问卷的精神质、神经质两个维度的得分明显高于不伴焦虑症者,积极应付方式得分低于无焦虑症组。③相关、回归分析表明抑郁症状的严重程度与焦虑自评量表、艾森克人格问卷的内外向维度及积极应付方式的关系更为密切。结论:①抑郁症患者的抑郁症状、焦虑症状、精神质较明显,偏内向,情绪不稳定,较少采用积极的应付方式。②有焦虑症状的抑郁症患者其抑郁症状较严重,精神质、神经质比较明显,较少采用积极的应付方式。③较少采用积极的应付方式可纳入人格特质的内外向维度之中。     

Levels of hopelessness in DSM-III disorders: A partial test of content specificity in depression

To determine the extent to which negativity about the future is specific to depression, the Hopelessness Scale (HS) scores of 199 patients diagnosed with major depressive disorder (MDD) were compared with those of 48 patients diagnosed with generalized anxiety disorder (GAD) and 76 psychiatric patients with mixed nonaffective, nonanxiety disorders. As predicted by the cognitive model, the MDD patients had higher mean HS scores than either the GAD or control patients. In addition, HS scores were more highly correlated with clinician-rated and self-report measures of depression than with measures of anxiety. Further, the positive relationships between the HS and measures of anxiety dropped to nonsignificant levels after the corresponding measures of depression were controlled for, while the HS remained correlated with depression after controlling for level of anxiety. The results were discussed as providing partial support for the content-specificity hypothesis (negative cognitive triad) of the cognitive model of depression.This study, from the Foundation for Cognitive Therapy, was supported by National Institute of Mental Health Grant MH38843 to Dr. Beck.     

A psychotropic drug treatment of psychiatric symptoms after stroke

Psychiatric syndromes are common in the patients with cerebrovascular disease. Poststroke depression (PSD) is a most frequent complication of after cerebrovascular disease. Depression affects 20-50% of patients within a year after stroke. PSD has a negative impact on functional recovery. Poststroke anxiety disorder, apathy and pathological laughing and crying are also frequent and under-detected symptoms. In this chapter, we described an outline mainly on treatment of PSD among these symptoms, in paticular, about antidepressant medications. There is an association between depression and atherosclerosis. Several trials have shown evidence that antidepressants may prevent depressive symptoms after stroke. The concept of "vascular depression" will suggest that the establishment of a new treatment strategy is demanded in future.