抑郁性神经症与抑郁症的临床特征比较──对CCMD－2的一点建议

本文对符合中国精神疾病分类方案与诊断标准（ＣＣＭＤ－２）的２３例抑郁性神经症和４７例抑郁症的临床特征、疗效以及随访结果进行了对比研究．临床症状和随访时社会功能恢复情况分别采用ＳＣＬ－９０及ＧＡＦ评定。结果显示抑郁性神经症和抑郁症除了人为规定的病程以及抑郁严重程度有不同外，两者并无本质上的差异；本文还对ＣＣＭＤ－２中抑郁性神经症的分类问题作了讨论。

抑郁性神经症与神经衰弱的临床鉴别诊断

本文对116例神经病患者进行临床诊断研究，其中66例诊断为抑郁性神经症，50例诊断为神经衰弱，然后对这两组的病例进行临床精神医学对比分析，结果发现这两类神经病中存在某些相似点和若干差异，根据这两类疾病的临床特征提出了这两类疾病鉴别的要点。

心理咨询——抑郁性神经症案例分析报告

在学生全面培育过程中,心理关注是帮助其成长、获得更高幸福感的重要方面。本文通过对一名抑郁性神经症学生的案例分析报告阐述心理咨询的过程与效果,供大家参考。

“肠漏-免疫激活”的弱化——运动减轻抑郁性神经炎症的新通路

“肠漏”指的是在外界应激、高脂膳食等作用下,肠道通透性发生改变,使得肠道内革兰氏阴性菌发生移位,产生一系列的免疫激活。脂多糖(lipopolysaccharide,LPS)是肠道革兰氏阴性菌的主要组成部分,也是内毒素的主要活性成分。应激能够损坏肠粘膜屏障,增加肠道通透性,从而使LPS移位进入血液,在血清中由LPS结合蛋白运输至单核细胞和巨噬细胞,再与Toll样受体4(Toll like receptor-4,TLR4)结合后激活机体的神经免疫系统,相关脑区免疫系统的激活可能导致抑郁行为的发生。TLR4信号通路过度激活是抑郁的触发因素之一。适度运动可以弱化“肠漏-免疫激活-抑郁性神经炎症”,缓解海马神经发生、神经营养因子的减少。运动对“肠漏-免疫激活”的调控是治疗抑郁行为的潜在靶点。对该机制的探讨、梳理,有助于正确理解“肠-脑”对话机制在抑郁行为发生中的作用,也为运动干预抑郁行为提供更多的研究思路。

27例抑郁性神经症误诊原因分析

抑郁症是一种以情感持续低落为基本特征,伴思维、意志力和性格障碍的反复发作的疾病。我院在1991～1993年的部分神经内科门诊和住院病人中,筛出152例神经病,按中华神经精神科杂志编委会1985年10月制定的抑郁性神经症诊断标准,其中27例修正诊断为抑郁性神经症,并进行了抗抑郁治疗,收到了满意的疗效。现将临床资料与误诊原因分析如下。 (1)一般资料:男12例,女15例,首次发病年龄15～54岁(平均25.5岁)。病程3个月至7年,22例发病前有精神因素,2例脑血管病后抑郁状态,3例未查到明确诱因,病前性格无特殊。

对比分析盐酸氟西汀对抑郁性神经障碍的治疗作用

目的对比分析盐酸氟西汀治疗对抑郁性神经障碍的临床疗效。方法选择抑郁性神经障碍患者98例,随机分为两组,即盐酸氟西汀治疗组和氟哌噻吨美利曲辛片治疗组。选择评价指标,采用SPSS17.0软件进行统计学分析。结果两组比较,盐酸氟西汀治疗组汉密尔顿抑郁量表总分优于氟哌噻吨美利曲辛片治疗组,P<0.05,差异具有明显统计学意义。结论盐酸氟西汀治疗对于抑郁性神经障碍具有更好的治疗作用。

狂躁抑郁性神经病的临床经验研究

目的对比分析米氮平结合碳酸锂治疗狂躁抑郁性神经病的临床疗效。方法选择狂躁抑郁性神经病98例,随机分为两组,即米氮平结合碳酸锂治疗组和阿米替林结合碳酸锂治疗组。应用SPSS17.0软件统计学分析。结果两组比较,米氮平结合碳酸锂治疗组总有效率高于阿米替林结合碳酸锂治疗组,P<0.05,差异具有统计学意义。结论米氮平结合碳酸锂治疗狂躁抑郁性神经病具有更好的治疗作用。

慢性抑郁症

本文有三个内容:一是为慢性抑郁下一个定义,并估计其患病率;二是试图进行分类:三是探讨使原发性重性抑郁症的病程趋于慢性的因素。

抑郁症蜜膏方

抑郁症,又称神经症性抑郁、抑郁障碍,是由生物、心理、社会因素引起,以持久的心境低落为主要症状的神经症。中医辨证选用蜜膏疗方,一般分为以下几型。1肝郁气滞型1.1柴胡疏肝膏验方:柴胡、赤芍药、白芍药、郁金、香附、川芎、延胡索、川楝子、炒枳壳、姜半夏、山楂、神曲、佛手各90 g,竹茹60 g,甘草45 g,蜂蜜500 g。用法:将诸药择净,研细,水煎3次,3液合并,文火浓缩,加入蜂蜜煮沸收膏即成。每次20 m L,每日3次,温开水适量送服。

Antidepressant-like Effects of Ginsenoside Rg1 in the Chronic Restraint Stress-induced Rat Model

Objective To investigate the ameliorating effect of ginsenoside Rg1 on the depression-like behaviors induced by chronic restraint stress(CRS)in rats and the underlying mechanisms.Methods Forty male Wistar rats were divided into 4 groups according to their baseline sucrose preference:control group,model group,and Rg1-treated groups(5 and 10 mg/kg).Except for control group,the groups were exposed to CRS(6 h/day)for 28 days.All drugs were intraperitoneally administered once daily to CRS rats after restraint stress for 14 days.The behavioral tests were carried out via the open field test(OFT),sucrose preference test(SPT),forced swim test(FST),and the Morris water maze(MWM)4 weeks following CRS induction.The levels of serum corticosterone(CORT)and the activities of the antioxidant defense biomarkers(SOD,MDA and GSH-x)in the prefrontal cortex(PFC)were analyzed using commercial ELISA kits.The levels of the neurotransmitter(5-HT,5-HIAA,Ach,NE,GABA and Glu)in the PFC were measured by ultra-performance liquid chromatography tandem mass spectrometry.The protein expression of BDNF,Trkb,Bax and Bcl-2 in the PFC was detected by western blotting.Results Owing to increased sucrose consumption in the SPT,decreased immobility time in the FST,and the improved cognitive performance in MWM,chronic treatment with Ginsenoside Rg1 was found to significantly attenuate depressionlike behaviors(anhedonia,behavioral despair and poor spatial memory)in rats.Moreover,CRS exposure caused evident alterations in the levels of the neurotransmitters(5-HT,5-HIAA,Ach,GABA and Glu)and the activities of the antioxidant defense biomarkers(SOD,MDA and GSH-x)in the PFC and the levels of corticosterone in serum.However,Ginsenoside Rg1 treatment could restore these levels to normal values.Additionally,Ginsenoside Rg1 treatment significantly reverted the decreased expression of BDNF,Trkb and Bcl-2 and the increased expression of Bax in the PFC of CRS rats.Conclusions Ginsenoside Rg1 could attenuate the CRS-induced depression-like behaviors,in part,by regulating neurotransmitter levels and HPA function,antagonizing oxidative stress and apoptosis,and restoring BDNF-TrkB signaling in PFC.Altogether,our results provide a novel basis regarding the potential therapeutic effects of Rg1 on depression.

Subchronic Administration of Linalool Decreases Depressive-Like Behaviour in Restrained Rats

Objectives： The aim of this study was to investigate the effect of linalool in chronically stressed rats on their behaviour as related to depressive disorders and BDNF （brain-derived neurotropic factor） protein in the hippocampus. Methods： Either Tween 80 or linalool （50, 160, 500 mg/kg） was intraperitonealty administered to rats, daily, for two weeks. Some rats were housed in home cages but the others were induced with chronic restrained stress （15 min daily）. At the end of the treatment, the rats were assessed for depressive-like behaviour using the forced swimming test. At the end of the behaviour test, the animals were immediately decapitated and the hippocampus of each animal was removed for the measurement of the BDNF protein by ELISA. Result： The immobility time was significantly increased （p 〈 0.05） but time of climbing was significantly decreased （p 〈 0.05）. The restrained rats treated with linalool, 500 mg/kg, displayed immobility times less than those of their controls （p 〈 0.05） while these rats showed significantly more climbing than in the control rats （p 〈 0.05）. Linalool showed no effect on the BDNF protein in the hippocampus. Conclusions： linalool decreases behaviour related to depressive disorders but it has no effect on the BDNF protein in chronic restrained stress.

产后抑郁 不容忽视

最近一段时间,全国接连发生多起因产妇患上抑郁症而酿成的悲剧。对这种经常会给孕产妇及其家人带来困扰的病症,你到底了解多少呢?那些发生过的悲剧今年3月17日,漳州一名女子在将自己两个月大的女儿溺死后自杀身亡。据8月23日,患上了产后抑郁症的牛女士离家出走,只身一人从老家菏泽来到了9月2日,西安市一名出生才7天的男婴从11层的窗口坠落到一楼的水泥地青岛并在途中与人发生争执。上。经过检查,医院初步判断男婴的母亲有产后抑郁甚至产后精神病等问题。9月8日,福州一名26岁的女子将出生仅仅5天的儿子放在床上,从高楼跳下身亡。了解,她在生产5天后就患上了严重的产后抑郁症,为此一直在接受治疗。9月16日,泉州市一名女子站在34楼天台边缘,精神恍惚,救援人员趁其不备才顺利将其救下。据了解,该女子的宝宝只有几个月大,她患有产后抑郁症。

Clinical observation of acupuncture combined with medication for mild-to-moderate depression

Objective:To discuss the clinical efficacy and plausible mechanism of Tiao Yang Qu Xie(regulating Yang to eliminate pathogenic factors)needling method plus paroxetine in treating mild-to-moderate depression.Methods:Sixty-six patients with mild-to-moderate depression were divided into an observation group and a control group using the random number table method,each consisting of 33 cases.Another 25 healthy subjects were recruited as a healthy group.The control group took oral paroxetine tablets for treatment,and the observation group received additional acupuncture treatment 3 times weekly.Both groups underwent 4-week treatment.Before treatment,after 2-week and 4-week treatment,and 2 weeks after treatment(follow-up),the patients were assessed using the Hamilton depression scale-17-item(HAMD-17),self-rating depression scale(SDS),self-rating anxiety scale(SAS),and traditional Chinese medicine(TCM)pattern element identification scale for depression.The two groups each randomly contributed 25 cases to detect the protein content of brain-derived neurotrophic factor(BDNF)before treatment and after 4-week treatment,and compared with the healthy group.Results:After 2-week treatment,the markedly effective and total effective rates were significantly higher in the observation group than in the control group(P<0.05);after 4-week treatment,the observation group significantly surpassed the control group in comparing the markedly effective rate(P<0.05).After 2 and 4 weeks of treatment and at the follow-up,the HAMD-17 total score and sleep disorder factor score were lower in the observation group than in the control group(P<0.05);the anxiety-somatic score was lower in the observation group than in the control group after 2-week treatment(P<0.05).After 2 and 4 weeks of treatment and at the follow-up,the observation group was lower than the control group in comparing the scores of SDS,SAS,and TCM pattern element identification scale for depression(P<0.05).After 4-week treatment,the observation group had an increased serum BDNF protein content,higher than that in the control group(P<0.05)and had no significant difference compared to the healthy group(P>0.05).Conclusion:Compared to the use of oral paroxetine alone,acupuncture plus paroxetine can produce more significant efficacy in treating mild-to-moderate depression and act faster in improving sleep disorder and anxiety-somatic symptoms;increasing the serum BDNF protein content may be a part of the mechanism underlying its antidepressant actions.

Preventive effect of estrogen on depression-like behavior induced by chronic restraint stress

Objective To investigate the roles of estrogen and kalirin-7 in chronic restraint stress （CRS）-induced depression and the pathophysiological mechanism of depression. Methods Healthy female mice from Institute of Cancer Research （ICR） were randomly divided into 3 groups： control group, CRS group, and estrogen ＋ CRS group. CRS was used to establish the animal model of depression. Forced swimming test and immunohistochemistry method were utilized to investigate the animal behavior and kalirin-7 expression in the hippocampus, respectively. Results Compared with the control group, the CRS mice displayed depression-like behaviors, including a significant reduction in body weight, a significant increase in immobility time in forced swimming test, and a dramatic decrease in kalirin-7 expression in the hippocampus. However, administration of estrogen attenuated the CRS-induced negative behaviors, and simultaneously increased kalirin-7 expression. Conclusion Estrogen replacement therapy （ERT） could prevent CRS-induced depression-like behaviors in female ICR mice. Besides, kalirin-7 also plays a role in preventing CRS-induced depression-like behaviors.

Depressive Neurosis Treated by Acupuncture for Regulating the Liver―A Report of 176 Cases

Objective: To observe therapeutic effect of acupuncture for regulating the liver on depressive neurosis. Methods: In a multi-center randomized controlled trial, 440 patients were divided into 3 groups: Acupuncture group for regulating the liver (Acup., 176 cases) was treated by acupuncture at Siguan Points, i.e. bilateral Hegu (LI 4) and Taichong (LR 3), Baihui (GV 20) and Yintang (EX-HN3) plus ear-acupuncture, Prozac group (P., 176 cases) by oral administration of Prozac, and Non-acupoint needling group (NAN, 88 cases) by acupuncture at non-acupoints as acupuncture placebo. Self-rating Depression Scale (SDS) was examined before treatment, and one month, two and three months after treatment respectively to evaluate therapeutic effect, and Rating Scale for Side Effects (SERS) was used to evaluate the safety. Results: After one month of treatment, SDS scores in Acup. Group were significantly lower than that in P. Group (P<0.05) and than that in NAN Group (P<0.01), and SDS scores in P. Group were lower than that in NAN Group (P<0.05), showing the SDS scores in Acup. Group <P. Group <NAN Group. After 2 months of treatment, SDS scores in Acup. Group were also significantly lower than that in P. Group (P<0.01) and than that in NAN Group (P<0.01), and SDS scores in P. Group were also lower than that in NAN Group (P<0.05), showing the SDS scores in Acup. Group <P. Group <NAN Group. After 3 months of treatment, SDS scores in Acup. Group were also significantly lower than that in P. Group (P<0.01) and than that in NAN Group (P<0.01), and SDS scores in P. Group were also lower than that in NAN Group (P<0.01), showing the SDS score in Acup. Group <P. Group <NAN Group. After treatment, SERS scores were 0.16±0.95, 6.51±5.09 and 0.23±1.36 in Acup. Group, P. Group and NAN Group respectively. A significant difference existed between Acup. Group and P. Group (P<0.05), but no significant difference between Acup. Group and NAN Group (P>0.05), showing the SERS scores in Acup. Group <NAN Group <P. Group. No side effect was found in Acup. and NAN groups. Conclusion: The therapeutic effect of acupuncture on depressive neurosis is better than or similar to that of Prozac but with less side effect.