医源性老年期神经质性焦虑抑郁障碍76例报告

Iatrogenic senile neurotic anxiety and depressive disorder:Report of 76 cases

目的探讨一类医源性老年期神经质性焦虑抑郁障碍的发病原因、临床特点及治疗方法。方法对76例以头部不适为主诉、伴有明显情绪障碍的老年患者,进行艾森克人格问卷(EPQ)N量表24个项目及医学应对方式问卷(MCMQ)测评,给予为期4周的抗焦虑及心理治疗,在治疗开始前及用药1周末、2周末、4周末及6月末随访时分别进行Zung抑郁及焦虑自评量表(SDS及SAS)评分,并进行统计学分析,结合患者对头部症状改善程度的自我描述评定疗效。结果 EPQ N量表24个项目测评粗分≥17分(神经质人格倾向)25例,8～17分(中间型)51例,二者所占总人数比例分别为32.89%及67.11%;MCMQ评分结果:面对(19.87±3.92)分,屈服(13.25±3.04)分,回避(7.63±2.37)分,面对及屈服分值均较高,回避分值较低;治疗开始前及用药1周末、2周末、4周末及6月末随访时SDS评分分别为:64.61±10.25、48.26±8.14、39.45±7.07、34.35±4.79、34.48±4.82,SAS评分分别为:58.36±9.64、48.03±8.01、40.54±6.31、31.30±4.22、32.17±4.35,治疗前与治疗后各时期评分差异均具有统计学意义(P<0.01),4周末与随访期末相比,二者差异均无统计学意义(P>0.05);头部症状4周内治疗效果评定:基本痊愈58例,显效16例,有效2例,无效0例。结论本组患者情绪障碍等神经症症状的发生、发展虽与患者自身的人格特点、缺乏灵活的应对策略有关,但医源性因素却起着至关重要的"扳机"与"催化剂"作用,短期的抗焦虑及心理治疗效果良好。

Objective To approach the etiology,clinical features and treatment of iatrogenic senile neurotic anxiety and depressive disorders.Methods Seventy-six senile patients with head uncomfortable,accompanied by significant emotional disorders,were given anxiety and psychological treatment for 4 weeks,and were examined by the Eysenck Personality Questionnaire（EPQ） N Table 24 projects and Medical Coping Modes Questionnaire（MCMQ）.The patients were evaluated by Zung selfrating depression and anxiety scale（SDS and SAS） before and after the treatment at the first week,second week,fourth week and sixth month.Effect was evaluated by improving head symptom.Results The scores of EPQ N Table 24 projects ≥ 17（typical emotional instability） in 25 cases,8～17（preferred instability） in 51 cases,the proportions was 32.89% and 67.11%,respectively.MCMQ score results： the face of（19.87±3.92）points,yielding（13.25±3.04）points,avoid the（7.63±2.37）points,the face（8） and yield（5） scores were higher;before the treatment and follow-up in the 1st week,2nd week and 4th week,the respective SDS score was 64.61±10.25,48.26±8.14,39.45±7.07,34.35±4.79,34.48±4.82;the respective SAS score was 58.36±9.64,48.03±8.01,40.54±6.31,31.30±4.22,32.17±4.35.The scores had significant difference before treatment and after treatment（P〈0.01）.Effect by head symptom improving degree： recovery 58 cases,evident effect 16 cases,efficacy 2 cases.Conclusion The occurrence and development of emotional disorders in patients with neurological symptoms is related with their personality defects,lack of flexible response strategy,especially largely iatrogenic factors.Short-term anti-anxiety and psychological treatment have well effectiveness.