肿瘤相关抑郁状态中医诊疗专家共识

Experts consensus on TCM diagnosis and treatment for tumor related depressive status

《肿瘤相关抑郁状态中医诊疗专家共识》由6部分组成:1定义:肿瘤相关抑郁是以肿瘤为基础疾病而引发的一组症状或状态,并非精神病性抑郁,推荐用"肿瘤相关抑郁状态"名词术语;建议用"郁证"作为中医病证名。2发病:心理因素、癌性疼痛、癌性疲乏、睡眠障碍、手术创伤、放疗、化疗与肿瘤相关抑郁状态发生密切相关;因郁致病、因病致郁以及肝郁、脾虚导致痰、湿、瘀相互交织是中医关键病因病机。3症状:由核心症状、心理症状与躯体症状三部分构成。其中,心境或情绪低落、兴趣缺乏与乐趣丧失是临床诊断的主要依据。4筛查:参考国际神经精神访谈量表,结合数字疼痛分级法制定调查问卷,对肿瘤患者进行抑郁状态筛查是为了区分精神病性抑郁症与肿瘤相关抑郁,以帮助肿瘤科医生能够迅速甄别、及时治疗或转诊。5诊断:参照中国精神障碍分类与诊断标准(CCMD-3),结合肿瘤患者诊治过程的心境变化来综合考虑。6治疗:必须与抗肿瘤同时进行。轻度抑郁状态可采用心理干预、音乐放松、教育引导、体育训练、针灸等非药物干预的综合疗法;中度以上抑郁状态,以中医辨证治疗为主,辅助抗抑郁药物治疗;严重抑郁状态或发展或/并构成精神疾病诊断时,应按照中国法律,及时转诊到精神病医院或转交精神科医生诊治。

Consensus on TCM diagnosis and treatment for tumor related depressive status includes six parts： ①Dei nition： Tumor related depressive status is dei ned as a group of depressive symptoms or depressive status rather than psychiatric depression. Thus, ‘tumor related depression or depressive status＇ is introduced in consensus as a standardized terminology, and ‘Yu Zheng（Depression syndrome）＇ is recommended in term of Chinese medicine. ②Pathogenesis： Factors including psychological stress, cancer pain, cancer fatigue, sleep disorders, operational trauma, radiotherapy, chemotherapy are highly related to tumor related depressive status. Tumors caused by depression, depression caused by tumor, as well as the concurrence of phlegm, dampness and stasis caused by liver depression and spleen deficiency are crucial pathogenesis. ③Symptoms： Symptoms are consisted of core symptoms, psychological symptoms and somatic symptoms. Depressed mood and loss of interests are chief gauges for diagnosis. ④Screening： Based on Mini-International Neuropsychiatric Interview（M.I.N.I） and numeric rating scale, questionnaire is drafted to distinguish psychiatric depression and tumor related depression, further help oncological physicians identify, treat and transfer patients with tumor related depression. ⑤Diagnosis： Diagnosis is supposed to be made according to Chinese Classii cation for Mental Disorders（CCMD-3）, taking patients＇ mood changes during diagnosis and treatment into consideration. ⑥Treatment： Treatments for tumor related depression must be conducted simultaneously with anti-tumor treatment. For mild depressive status, non-pharmacologic comprehensive therapies including psychological intervention, music relaxation, education guidance, physical training and acupuncture are recommended; for moderate conditions, Chinese medicine treatments based on syndrome differentiation combined with adjuvant antidepressants treatment are suggested; for severe conditions or conditions progressed to psychiatric disorders, patients are supposed to be transferred to psychiatric physician for specialized care.