冠心病伴焦虑抑郁患者的临床特点研究

Clinical Characteristics of Anxious or Depressed Patients with Coronary Artery Disease

背景焦虑抑郁在冠心病(CAD)患者中高发,常迁延不愈,影响疾病的治疗与预后。然而在临床实际工作中,由于对这类患者的临床特点认识不足,漏诊率较高。目的分析CAD伴焦虑抑郁患者临床特点,为临床医生早期识别该病提供帮助。方法本研究为单中心横断面研究。连续选取2013年3-7月在同济大学附属同济医院明确诊断的CAD患者131例。采用一般信息调查表及贝克焦虑量表(BAI)、贝克抑郁量表(BDI)、症状自评量表(SCL-90,包括躯体化、强迫症状、人际关系敏感、抑郁、焦虑、敌对、恐怖、偏执、精神病性、其他症状10个维度)进行问卷调查,由患者独立填写问卷。结果共发放问卷131份,回收有效问卷120份,有效回收率为91.6%。120例患者中共39例(32.5%)患者伴焦虑或抑郁,其中38例(31.7%)患者伴焦虑,7例(5.8%)患者伴抑郁,6例(5.0%)患者同时伴焦虑抑郁。躯体化维度中,CAD伴焦虑抑郁患者“头痛”“头晕或晕倒”“胸痛”“呼吸有困难”“身体发麻或刺痛”“喉咙有梗塞感”“感到身体的某一部分软弱无力”“感到手或脚发重”阳性率高于CAD不伴焦虑抑郁患者(P<0.05)。强迫症状维度中,CAD伴焦虑抑郁患者“头脑中有不必要的想法或字句盘旋”“感到难以完成任务”“做事必须反复检查”“难以做出决定”“脑子变空了”“不能集中注意”“必须反复洗手、点数”阳性率高于CAD不伴焦虑抑郁患者(P<0.05)。人际关系敏感维度中,CAD伴焦虑抑郁患者“对旁人责备求全”“感到比不上他人”“感到对别人神经过敏”“感到在公共场合吃东西很不舒服”阳性率高于CAD不伴焦虑抑郁患者(P<0.05)。抑郁维度中,CAD伴焦虑抑郁患者“对异性的兴趣减退”“想结束自己的生命”“容易哭泣”“经常责怪自己”“感到孤独”“感到苦闷”“过分担忧”“对事物不感兴趣”“感到对前途没有希望”“感到任何事情都很困难”“感到自己没有什么价值”阳性率高于CAD不伴焦虑抑郁患者(P<0.05)。焦虑维度中,CAD伴焦虑抑郁患者“神经过敏”“无缘无故地感到害怕”“心跳得很厉害”“感到紧张或容易紧张”“感到坐立不安心神不宁”“感到要赶快把事情做完”阳性率高于CAD不伴焦虑抑郁患者(P<0.05)。恐怖维度中,CAD伴焦虑抑郁患者“害怕空旷的场所或街道”“怕乘电车公共汽车地铁或火车”“因为感到害怕而避开某些东西、场合或活动”“在商店或电影院等人多的地方感到不自在”“单独一人时神经很紧张”“害怕会在公共场合昏倒”阳性率高于CAD不伴焦虑抑郁患者(P<0.05)。偏执维度中,CAD伴焦虑抑郁患者“感到大多数人都不可信任”阳性率高于CAD不伴焦虑抑郁患者(P<0.05)。精神病性维度中,CAD伴焦虑抑郁患者“感到别人能控制您的思想”“即使和别人在一起也感到孤单”“为一些有关性的想法而很苦恼”“您认为应该因为自己过错而受到惩罚”“感到自己的身体有严重问题”“从未感到和其他人很亲近”阳性率高于CAD不伴焦虑抑郁患者(P<0.05)。其他症状维度中,CAD伴焦虑抑郁患者“胃口不好”“难以入睡”“想到死亡的事”“醒得太早”“睡得不稳不深”阳性率高于CAD不伴焦虑抑郁患者(P<0.05)。结论 CAD患者伴焦虑抑郁的比例较高,躯体化症状更为明显,同时CAD伴焦虑抑郁患者强迫症状、人际关系敏感、恐怖症状、精神病性症状十分明显,且存在明显的睡眠障碍。因此,对于存在相关症状的CAD患者,应当加强对其焦虑抑郁的评估。

Background Anxiety and depression is common among patients with coronary artery disease(CAD), which protracts the course of disease,affecting the treatment and prognosis,with high rate of missed diagnosis.Clinical characteristics of these patients remain unexplored.Objective To identify the clinical characteristics of CAD patients with anxiety and depression,which can be helpful for early diagnosis.Methods In this single-center cross-sectional study,a total of 131 patients diagnosed with CAD in Tongji Hospital of Tongji University from March to July 2013 were enrolled.General Information Questionnaire,Beck Depression Inventory(BDI),Beck Anxiety Inventory(BAI),Symptom Checklist 90(SCL-90, composed of 10 dimensions,including somatization,obsessive-compulsive symptoms,interpersonal sensitivity,depression,anxiety, hostility,terror,paranoia,psychosis and other symptoms) were distributed and completed by the patients independently. Results A total of 131 questionnaires were distributed,and all were recovered,of which 120 were valid,with an effective response rate of 91.6%.Thirty-nine patients(32.5%) were accompanied by anxiety and/or depression,of which 38(31.7%) had anxiety,seven(5.8%) had depression,and six(5.0%) accompanied by both.In somatization dimension,compared to those without anxiety or depression,the CAD patients with anxiety and/or depression complained more“ headaches“”faintness or dizziness”“chest pain”“trouble breathing”“numbness or tingling in parts of your body”“ sense of obstruction in your throat”“feeling weak in parts of your body”“heavy feelings in your arms or legs”(P<0.05).In the dimension of obsessive-compulsive symptoms,the incidence of “unwanted thoughts or ideas that won't leave your head”“feeling difficult in getting things done”“having to check and double check what you do”“difficulty in making decisions”“your mind going blank”“trouble in concentrating”“having to repeat the same actions such as counting,washing”in CAD patients with anxiety and/or depression were higher than those without anxiety and/or depression (P<0.05).In the dimension of interpersonal sensitivity,the incidence of “ blaming others for perfection”“feeling inferior to others”“feeling very nervous about others” and “feeling uncomfortable about eating or drinking in public”in CAD patients with anxiety and/or depression were higher than those without anxiety or depression(P<0.05).In the depression dimension,the prevalence of “loss of sexual interest or pleasure”“thoughts of ending life”“crying easily”“blaming yourself”“feeling lonely”“feeling blue”“worrying too much about things”“feeling no interest in things”“feeling hopeless about the future”“feeling everything is difficult”“feeling of worthlessness”in CAD patients with anxiety and depression was higher than those without anxiety and depression (P<0.05).In anxiety dimension,“nervous or oversensitive”“suddenly scared for no reason”“heart pounding or racing”“feeling tense or keyed up”“feeling so restless you couldn't sit still”“feeling pushed to get things done”were more common in CAD patients with anxiety and/or depression than those CAD patients without anxiety or depression (P<0.05).In the dimension of terror,CAD patients with anxiety and/or depression had higher incidence of “feeling afraid in open spaces or on the street”“feeling afraid to travel on buses,subways or trains”“having to avoid certain things,places or activities”“feeling uneasy in crowds in shopping malls or theatres”“feeling nervous when you are left alone”“feeling afraid you will faint in public”than those CAD patients without anxiety or depression(P<0.05).In paranoid dimension,“feeling that most people cannot be trusted”were more prevalent in CAD patients with anxiety and/or depression than that in those without anxiety or depression(P<0.05).In the psychosis dimension,for CAD patients with anxiety and/or depression,the prevalence of “the idea that someone else can control your thoughts”“feeling lonely even when you are with people”“having thoughts about sex that bother you a lot”“the idea that you should be punished for your sins”“the idea that something serious is wrong with your body”“never feeling close to others personally”were higher than those without anxiety or depression(P<0.05). About other symptoms,CAD patients with anxiety and/or depression suffered more from “poor appetite”“trouble in falling sleep”“thoughts of death or dying”“awakening in the early morning”and“ restless or disturbed sleep”than those CAD patients without anxiety or depression(P<0.05).Conclusion The incidence of CAD patients with comorbid anxiety and depression is high,among whom the somatization disorders are more common and apparent.Besides,the obsessive-compulsive symptoms,interpersonal sensitivity,terror and psychotic symptoms among CAD patients with anxiety and/or depression are marked,as well as sleep disorders.Therefore,the assessment of anxiety and depression should be strengthened in CAD patients with related symptoms.