Treating comorbid anxiety and depression: Psychosocial and pharmacological approaches

Comorbid anxiety with depression predicts poor outcomes with a higher percentage of treatment resistance than either disorder occurring alone. Overlap of anxiety and depression complicates diagnosis and renders treatment challenging. A vital step in treatment of such comorbidity is careful and comprehensive diagnostic assessment. We attempt to explain various psychosocial and pharmacological approaches for treatment of comorbid anxiety and depression. For the psychosocial component, we focus only on generalized anxiety disorder based on the following theoretical models:(1) "the avoidance model";(2) "the intolerance of uncertainty model";(3) "the meta-cognitive model";(4) "the emotion dysregulation model"; and(5) "the acceptance based model". For depression, the following theoretical models are explicated:(1) "the cognitive model";(2) "the behavioral activation model"; and(3) "the interpersonal model". Integration of these approaches is suggested. The treatment of comorbid anxiety and depression necessitates specific psychopharmacological adjustments as compared to treating either condition alone. Serotonin reuptake inhibitors are considered first-line treatment in uncomplicated depression comorbid with a spectrum of anxiety disorders. Short-acting benzodiazepines(BZDs) are an important "bridging strategy" to address an acute anxiety component. In patients with comorbid substance abuse, avoidance of BZDs is recommended and we advise using an atypical antipsychotic in lieu of BZDs. For mixed anxiety and depression comorbid with bipolar disorder, we recommend augmentation of an antidepressant with either lamotrigine or an atypical agent. Combination and augmentation therapies in the treatment of comorbid conditions vis-à-vis monotherapy may be necessary for positive outcomes. Combination therapy with tricyclic antidepressants, gabapentin and selective serotonin/norepinephrine reuptake inhibitors(e.g., duloxetine) are specifically useful for comorbid chronic pain syndromes. Aripiprazole, quetiapine, risperidone and other novel atypical agents may be effective as augmentations. For treatment-resistant patients, we recommend a "stacking approach" not dissimilar from treatment of hypertension In conclusion, we delineate a comprehensive approach comprising integration of various psychosocial approaches and incremental pharmacological interventions entailing bridging strategies, augmentation therapies and ultimately stacking approaches towards effectively treating comorbid anxiety and depression.

Impact of comorbid anxiety and depression on quality of life and cellular immunity changes in patients with digestive tract cancers

AIM:A study was performed to investigate the impact of comorbid anxiety and depression (CAD) on quality of life (QOL) and cellular immunity changes in patients with digestive tract cancers. METHODS: One hundred and fifty-six cases of both sexes with cancers of the digestive tract admitted between March 2001 and February 2004 in the Department of Medical Oncology, First Affiliated Hospital of Xi'an Jiaotong University were randomly enrolled in the study. Depressive and anxiety disorder diagnoses were assessed by using the Structured Clinical Interview for DSM-IV. All adult patients were evaluated with the Hamilton depressive scale (HAMD, the 24-item version), the Hamilton anxiety scale (HAMA, a modified 14-item version), quality of life questionnaire-core 30 (QLQ-C30), social support rating scale (SSRS), simple coping style questionnaire (SCSQ), and other questionnaires, respectively. In terms of HAMD ≥ 20 and HAMA ≥ 14, the patients were categorized, including CAD (n = 31) in group A, anxiety disorder (n = 23) in group B, depressive disorder (n = 37) in group C, and non-disorder (n = 65) in group D. Immunological parameters such as T-lymphocyte subsets and natural killer (NK) cell activities in peripheral blood were determined and compared among the four groups. RESULTS: The incidence of CAD was 21.15% in patients with digestive tract cancers. The average scores of social support was 43.67±7.05 for 156 cases, active coping 20.34±7.33, and passive coping 9.55±5.51. Compared with group D, subjective support was enhanced slightly in group A, but social support, objective support, and utilization of support reduced, especially utilization of support with significance (6.16 vs7.80, P<0.05); total scores of active coping decreased, while passive coping reversed; granulocytes proliferated, monocytes declined, and lymphocytes declined significantly (32.87 vs 34.00, P<0.05); moreover, the percentage of CD3, CD4, CD8 and CD56 in T lymphocyte subsets was in lower level, respectively, and CD56 showed a significant decline in group A (26.02 vs 32.20, P<0.05), however, CD4/CD8 ratio increased. Physical function, role function, fatigue, sleeplessness and constipation had significant changes among different groups by one-way ANOVA, and group A was in poor QOL. It revealed that global health-related quality of life (QL) were positively correlated with active coping and CD56; CAD was negatively correlated with QL, active coping and CD56. Furthermore, the step-wise regression analysis suggested that utilization of support, CD56, active coping, fatigue, sleeplessness and depression were significant factors contributing to QOL. CONCLUSION: CAD, which can impair QOL and cellular immunity, occurs with a higher incidence in patients with digestive tract cancers. Hence, it is essential to improve mental health for them with specifically tailored interventions.

The lability of behavior as a marker of comorbid depression and anxiety

This study examines nine dynamical and three emotional aspects of behavior in depression and anxiety, singly and comorbidly. The study employs the Structure of Temperament Questionnaire Compact (STQ 77), whose 12 scales assess the energetic, lability and sensitivity aspects of behavior in the physical, social, mental and emotional domains. The STQ 77 was administered to 86 patients with Major Depression, 85 patients with an anxiety disorder, 43 patients with comorbid depression and anxiety, and 71 subjects without depression or anxiety disorder all presenting to a private outpatient clinical practice. Results: 1) Depression was associated with self-reports of increased impulsivity and rigidity of behavior;2) Depressed patients reported significantly lower physical energy, tempo of physical activity and plasticity of behavior. The presence of comorbid anxiety further worsened these effects;3) The ability to sustain attention on a mental task and to learn new information was lower in depressed patients than in other groups. Conclusions: comorbid depression and anxiety might be associates, decreasing adaptivity and the self-regulatory balance of behavior, leading to the de- velopment of extremes in behavioral reactivity (impulsivity and rigidity).

Rate of social anxiety disorder, its comorbidity with depression and paroxetine effects in outpatients in Japan

The prevalence of persons with social anxiety disorder (SAD) in Japan remains unknown. This study examined 293 patients with age between 20 and 60 at first visit on the outpatient clinic of psychiatry by the section of social phobia of M.I.N.I. and DSM-IV. After that, 10 patients with both SAD out of 16 patients (trial recruited) completed 12 weeks of treatment with paroxetine. Among 63 patients with 4 points and 40 patients with 3 points on the M.I.N.I., 21 patients (33%) and 16 patients (40%) were diagnosed as SAD on DSM-IV criteria, respectively. Together, 37 patients (12.6%) were diagnosed as SAD out of the 293 outpatients. Among 37 patients with SAD, 23 patients (62%) had comorbid depression. As for 10 patients after treatment with paroxetine, 8 patients improved from the point of recovery of depression (HAM-D scores below 10), whereas only 4 patients improved from the point of recovery of social phobia (L-SAS scores below 30). Three points as well as 4 points on the M.I.N.I. is meaningful for the diagnosis of SAD. For a while, paroxetine exerted less beneficial effects on SAD rather than on depression.

S2B-2 Comorbidity of Anxiety and Depression Induced by Liang’s Contextual-Stress Box in Mice

Rationale:Comorbidity of depression and anxiety is one of the most common mental disorders in practice.Few experimental procedures,however,have focused on identifying mixed depression-and anxiety-like behaviors in animal models.Objectives:To develop a novel testing paradigm,the so-called Liang’s contextual-stress Box(briefly,Liang’s Box),for evaluating depression-and/or anxiety-like behaviors in mice.Methods:Liang’s Box consisted of a central area(CA)with three peripheral arms(PA).Mice were placed individually in the end of a peripheral arm facing to the central area and were allowed to travel around Liang’s Box.During a test period,behavioral parameters were recorded and collected by a video-tracking system named SMART 3.0(Panlab,Spain),including①Latency to CA,②Time spent in CA(CA-time),③Distance traveled in CA(CA-distance),④Distance traveled in PA(PA-distance),⑤Transition number between CA and PA,⑥Global activity,⑦CA-time/cm2,⑧PA-time/cm2,⑨CAdistance/cm2,and⑩PA-distance/cm2.In order to assess the reliability and validity of Liang’s Box and get baseline information,we undertook a series of experiment,including verifying consistency and stability in the various strains of mice(KM,ICR,and C57 BL/6 J mice),imposing high illumination,restraint and tail suspension stress,pre-treating with an anxiolytic(diazepam,buspirone)or antidepressant(desipramine,mianserin).Results:①There were not remarkable differences in all the parameters among KM,ICR,and C57 BL/6 J mice;②High illumination,restraint and tail suspension significantly increased the latency to CA and decreased the CA-time,CA-distance and transition number.However,these three types of stresses evoked different effect on global activity.High illumination increased activity,but restraint stress had no significant influence.In contrast with high illumination,tail suspension stress markedly reduced activity in mice;③The anxiolytics diazepam(0.25 mg·kg-1 and 0.5 mg·kg-1,i.p.)and buspirone(0.5 mg·kg-1 and 1.0 mg·kg-1,i.p.)significantly decreased latency to CA and transition number,and dosedependently increased the CA-time.However,they did not affect CA-or PA-distance,or global activity;④The antidepressants desipramine(10.0 mg·kg-1 and 30.0 mg·kg-1,i.p.)and mianserin(0.25 mg·kg-1 and 0.5 mg·kg-1,i.p.)significantly decreased latency to CA,and dose-dependently enhanced CA-time,CA-distance and transition number,while neither affected PA-distance or global activity.Conclusion:Our data suggest that Liang’s Box is a useful experimental instrument and method for screening and assessing potential antidepressants and/or anxiolytics.Moreover,depression-and anxiety-like behaviors induced by Liang’s Box in mice may be a new hybrid animal model to investigate the pathogenic mechanisms underlying the comorbidity of anxiety and depression.

Inhibitory gamma-aminobutyric acidergic neurons in the anterior cingulate cortex participate in the comorbidity of pain and emotion

Pain is often comorbid with emotional disorders such as anxiety and depression.Hyperexcitability of the anterior cingulate cortex has been implicated in pain and pain-related negative emotions that arise from impairments in inhibitory gamma-aminobutyric acid neurotransmission.This review primarily aims to outline the main circuitry(including the input and output connectivity)of the anterior cingulate cortex and classification and functions of different gamma-aminobutyric acidergic neurons;it also describes the neurotransmitters/neuromodulators affecting these neurons,their intercommunication with other neurons,and their importance in mental comorbidities associated with chronic pain disorders.Improving understanding on their role in pain-related mental comorbidities may facilitate the development of more effective treatments for these conditions.However,the mechanisms that regulate gamma-aminobutyric acidergic systems remain elusive.It is also unclear as to whether the mechanisms are presynaptic or postsynaptic.Further exploration of the complexities of this system may reveal new pathways for research and drug development.

偏头痛与焦虑抑郁共病的研究进展

临床中,偏头痛患者常伴发焦虑抑郁,焦虑抑郁常与偏头痛共病,二者相互作用,不仅增加治疗难度,且影响患者正常生活。为促进二者共病的合理诊治,全面了解二者之间的关系,现对偏头痛与共病焦虑抑郁共病的疾病负担、全球负担、流行病学、共病机制、诊断及和治疗进行综述。

老年急性脑卒中后情绪障碍与机体营养及生活质量的相关性

目的分析老年急性脑卒中后情绪障碍与机体营养及生活质量的相关性。方法纳入2021年3月至2023年6月西安交通大学第二附属医院老年急性脑卒中亚急性期患者160例,分别采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、微型营养评估量表(MNA)、健康调查量表(SF-36)评估焦虑、抑郁、营养状态及生活质量,分析卒中后焦虑抑郁共病(PSCAD)与营养状态客观指标及MNA、SF-36的关系。采用SPSS 22.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、秩和检验及χ^(2)检验。结果160例患者HAMA得分(15.57±3.67)分,HAMD得分(13.54±4.23)分,56例判定为PSCAD;PSCAD组体质量指数、上臂肌团周径、前白蛋白、NMA评分低于非PSCAD组(P<0.05),两组NMA分级差异有统计学意义(P<0.05);PSCAD组SF-36量表体力、身体疼痛、一般健康、活力、社会功能、情感功能、心理健康均低于非PSCAD组(P<0.05);Pearson相关性分析显示,HAMA、HAMD与NMA、体力、身体疼痛、一般健康、活力、社会功能、情感功能、心理健康评分均呈负相关(P<0.05)。结论老年急性脑卒中患者中存在PSCAD的患者其机体营养状态和生活质量多个维度受明显影响,焦虑、抑郁情绪与营养状态及生活质量密切相关。

癫痫患者共患抑郁和焦虑危险因素分析及其与生存质量的关系

目的探讨成年癫痫患者共患抑郁和焦虑的危险因素及其与生活质量的关系。方法收集2022年5月至2023年1月神经内科诊断为癫痫、年龄≥18岁的患者。记录患者一般人口学资料及疾病相关信息。所有患者均进行生活质量、抑郁、焦虑量表测定。采用SPSS 26.0软件分别进行多元线性回归分析、多元有序logistic回归分析、秩和检验、皮尔逊相关性分析等。结果111例患者中49.5%的患者存在抑郁,43.2%的患者存在焦虑。抑郁评分与焦虑评分与发作类型、发作频率、生活质量、右侧颞叶相关,生活质量评分与焦虑评分和抑郁评分均呈负相关(P<0.01)。发作频率、发作类型、右侧颞叶是癫痫患者抑郁、焦虑的共同危险因素(P<0.05)。结论癫痫共患病抑郁和焦虑受发作频率和发作类型等的影响,而这种不良的情绪进一步影响患者的生活质量。癫痫发作的偏侧化与抑郁和焦虑状态的存在之间目前还没发现有明确的联系。

团体归因训练结合运动干预对抑郁焦虑共病青少年患者社会功能及自我效能感的影响

目的分析团体归因训练结合运动干预对抑郁焦虑共病青少年患者社会功能及自我效能的影响。方法纳入该院2022年11月至2023年12月期间收治的抑郁焦虑共病青少年患者386例进行研究,以抽签法随机分为对照组(n=193、运动干预)、观察组(n=193、团体归因训练结合运动干预),比较两组患者社会功能、自我效能感以及归因方式评分。结果护理后,观察组患者社会功能、自我效能感评分高于对照组,差异有统计学意义(P<0.05)。护理后,观察组内外维度、持续维度、普遍维度评分高于对照组,无望感评分低于对照组,差异有统计学意义(P<0.05)。结论针对焦虑抑郁共病青少年患者实施团体归因训练结合运动干预,能够提升患者的社会功能、强化其自我效能感且促使其形成积极的归因方式,值得推广。

Comparing the effects of depression,anxiety,and comorbidity on quality-of-life,adverse outcomes,and medical expenditure in Chinese patients with acute coronary syndrome

Background:Depression and anxiety have been correlated with elevated risks for quality-of-life (QOL),adverse outcomes,and medical expenditure in patients with acute coronary syndrome (ACS).However,the relevant data are lacking for Chinese ACS populations,especially regarding different effects of major depression,anxiety,and comorbidity.The objective of this study was to evaluate the dynamic changes of depression and/or anxiety over 12 months and examine the effects of depression,anxiety,and comorbidity on QOL,adverse outcomes,and medical expenditure in Chinese patients with ACS.Methods:For this prospective longitudinal study,a total of 647 patients with ACS were recruited from North China between January 2013 and June 2015.Among them,531 patients (82.1%) completed 12-month follow-ups.Logistic regression model was utilized for analyzing the association of baseline major depression,anxiety,and comorbidity with 12-month all-cause mortality,cardiovascular events,QOL,and health expenditure.Results:During a follow-up period of 12 months,7.3% experienced non-fatal myocardial infarction (MI) and 35.8% cardiac rehospitalization.Baseline comorbidity,rather than major depression/anxiety,strongly predicted poor 12-month QOL as measured by short-form health survey-12 (odds ratio [OR]:1.77,95% confidence interval [CI]:1.22–2.52,P = 0.003).Regarding 12-month non-fatal MI and cardiac re-hospitalization,baseline anxiety (OR:2.83,95% CI:1.33–5.89,P<0.01;OR:4.47,95% CI:1.50–13.00,P<0.01),major depression (OR:2.58,95% CI:1.02–6.15,P<0.05;OR:5.22,95% CI:1.42–17.57,P<0.03),and comorbidity (OR:6.33,95% CI:2.96–13.79,P<0.0001,OR:14.08,95% CI:4.99–41.66,P<0.0001) were all independent predictors,and comorbidity had the highest predictive value.Number of re-hospitalization stay,admission frequency within 12 months and medical expenditure within 2 months were the highest in patients with ACS with comorbidity.Conclusions:Major depression and anxiety may predict 12-month non-fatal MI and cardiac re-hospitalization.However,comorbidity has the highest predictive value with greater medical expenditure and worse QOL in Chinese patients with ACS.And depression with comorbid anxiety may be a new target of mood status in patients with ACS.

Psychiatric Comorbidity in Patients with Psoriasis, Vitiligo, Acne, Eczema and Group of Patients with Miscellaneous Dermatological Diagnoses

Background: Dermatological conditions can be associated with high psychiatric comorbidity. Several studies reported high rates of depression and anxiety particularly for specific dermatological disorders such as psoriasis and acne. Aim: The aim of this study was to compare the rates of psychiatric symptoms in patients with psoriasis, acne, vitiligo, and eczema versus patients who had other dermatological conditions;and to compare each dermatological group versus healthy control subjects. Methods: This prospective cross-sectional study was conducted in dermatology outpatient clinics in Khartoum. Hospital Anxiety and Depression Scale (HADS) was used to assess symptoms of anxiety (HADS-A) and depression (HADS-D). ICD-10 criteria were used for clinical psychiatric diagnosis. Tabulated results were analyzed using Chi-square test. Significance was set at P < 0.05. Results: HADS-D scores above the cut off points were significantly higher in patients with psoriasis (P = 0.0062), vitiligo (P = 0.0054), acne (P = 0.0103) and eczema (P = 0.0359) compared with healthy subjects. Similarly, HADS-A scores above the cut off points were significantly higher in patients with psoriasis (P < 0. 0.0001), vitiligo (P = 0.0001), acne (P = 0.0143) and eczema (P = 0.0281) compared with healthy subjects. No significant difference between the control group and patients with other dermatologic conditions regarding both HADS-D and HADS-A scores. Using ICD-10 criteria for clinical psychiatric diagnoses indicated that 52.3% of dermatology patients had an associated ICD-10 diagnosis;most commonly anxiety disorders (28.6%), and depression (21.9%). ICD-10 diagnoses of anxiety disorders included: OCD (13.3%) generalized anxiety disorder (5.7%), panic disorder (4.8%), phobic anxiety disorder (3.8%) and post-traumatic stress disorder (0.95%). Conclusion: Dermatological conditions are associated with high rates of psychiatric comorbidity. Screening for anxiety and depressive symptoms may be helpful for early diagnosis and management of associated psychiatric symptoms.

老年慢性病共病患者抑郁焦虑状况及影响因素

目的 研究老年慢性病共病患者焦虑、抑郁的发生率及其影响因素,为临床早期干预提供依据。方法 收集2021年6月到2022年6月在北京市大兴区林校社区卫生中心就诊老年慢性病共病患者504例,采用问卷调查方法记录患者的年龄、性别、文化程度、家庭可支配收入、居住方式、慢性病种类、慢性病支出情况等一般资料。应用Zung焦虑自评量表(SAS)和抑郁自评量表(SDS)对504例老年慢性病患者进行评分,分析不同性别、可支配收入、文化程度、慢性病数量和居住方式等患者SAS和SDS评分的差别,采用多因素logistic回归分析不同因素对老年慢性病共病患者焦虑、抑郁状态的影响。结果 老年慢性病共病患者的焦虑发生率为49.80%,抑郁发生率为51.58%,同时伴有焦虑抑郁状态的发生率46.62%。可支配收入、文化程度、慢性病种类和居住方式不同的老年慢性病患者SAS和SDS评分差异有统计学意义(P均<0.01)。logistic回归分析显示,家庭可支配收入高(OR=0.457,95%CI:0.331~0.630)是老年慢性病共病患者焦虑的保护性因素,独居(OR=1.799,95%CI:1.494~2.166)和慢性病种类多(OR=2.086,95%CI:1.606~2.711)是焦虑状态的独立危险因素。文化程度高(OR=0.665,95%CI:0.508~0.872)和家庭可支配收入高(OR=0.466,95%CI:0.337~0.644)是老年慢性病共病患者抑郁状态的保护性因素,独居(OR=1.971,95%CI:1.628~2.385)和慢性病种类多(OR=1.795,95%CI:1.382~2.332)是抑郁状态的独立危险因素(P<0.05)。结论 老年慢性病共病患者的抑郁、焦虑状态的发生率高,独居和合并慢病种类多是焦虑抑郁状态的独立危险因素,应加强心理干预和社会支持。

安神合剂与黛力新合用对脑卒中后抑郁-焦虑共病神经功能缺损、负性心理及不良反应的影响

目的探讨脑卒中后抑郁-焦虑共病(post-stroke anxiety combined with depression,PSCAD)患者合用安神合剂与黛力新治疗对其神经功能缺损、负性心理及不良反应的影响。方法选取2019年8月—2021年5月医院收治PSCAD患者146例,随机数字表法分对照组及观察组,各73例。对照组予以黛力新治疗,观察组在对照组基础之上联用安神合剂;比较治疗前与治疗4周后两组中医证候相关积分,酶联免疫分析仪检测血清5-羟色胺(5-hydroxytryptamine,5-HT)、盐酸多巴胺(Dopamine hydrochloride,DA)以及去甲肾上腺素(Norepinephrine,NE)水平,美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评估神经功能缺损现象,选取特质焦虑分量表(Trait anxiety invento⁃ry,T-AI)、状态焦虑分量表(S-AI)和汉密尔顿抑郁量表与(Hamilton Depression Scale,HAMD)进行负性心理评估;比较两组治疗后不良反应的发生率。结果治疗后,观察组中医症候相关积分皆明显优于对照组(P<0.05);治疗后,观察组血清5-HT、DA及NE水平显著高于对照组,观察组NIHSS评分明显低于对照组(P<0.05);治疗后,观察组T-AI、S-AI和HAMD评分皆明显低于对照组(P<0.05)。观察组不良反应发生率低于对照组,但差异不存在统计学意义(P>0.05)。结论安神合剂与黛力新联用改善PSCAD患者神经功能缺损状况,有效调节负性心理,不增加不良反应发生率。

中医情志疗法对焦虑抑郁共病职业女性情绪及生活质量的影响

目的 探讨中医情志疗法对焦虑抑郁共病职业女性情绪及生活质量的影响。方法 选取2019年6月至2022年3月在自贡市第一人民医院心身医学科就诊的92例焦虑抑郁共病职业女性为研究对象,按随机数字表法分为对照组和试验组,每组46例。对照组采用常规抗焦虑抑郁药物治疗,试验组采用中医情志疗法联合抗焦虑抑郁药物治疗,对治疗前后两组焦虑、抑郁、生活质量评分以及中医证候积分比较。结果 与治疗前比较,治疗后两组焦虑、抑郁评分及中医证候积分明显降低,其生活质量评分明显提高(P<0.05),且试验组临床疗效优于对照组(P<0.05)。结论 中医情志疗法联合抗焦虑抑郁药物能明显改善焦虑抑郁共病职业女性情绪,提高其生活质量。

偏头痛共病焦虑抑郁的脑功能活动改变及针刺 对其调节作用机制:fMRI研究的Meta分析

[目的]评价偏头痛共病焦虑抑郁患者脑功能活动的改变及针刺治疗对其脑功能活动的影响。[方法]检索国内外数据库,时间从各数据库建库至2022年6月。系统收集以脑功能磁共振成像为观察指标的针刺治疗无先兆偏头痛文献,筛选出有偏头痛共病焦虑抑郁患者的临床脑功能影像研究,汇总针刺治疗对偏头痛共病焦虑抑郁脑功能影像数据,影像指标要求包含激活脑区的蒙特利尔神经学研究所或Talairach空间坐标,采用差异映射分析(SDM)软件进行体素Meta分析,得出其脑功能变化的特点及针刺治疗该疾病引起脑功能改变的一般规律。[结果]共检索到文献186篇,10篇文献符合纳入标准,共纳入418例患者及160例健康对照,对10项研究进行体素Meta分析后,结果显示偏头痛共病焦虑抑郁患者左尾状核的脑功能较健康对照受试者活跃,双侧枕中回及右侧枕上回脑区较健康对照活跃度降低;针刺治疗升高右额中回的脑功能(P<0.005)。[结论]针刺可通过增加偏头痛共病焦虑抑郁患者的右侧额中回功能活动来减轻患者的疼痛及焦虑抑郁相关症状;共病患者大脑的脑功能活动改变可能与偏头痛的慢性化及先兆症状相关。

北京市大兴区不同慢性病抑郁焦虑症状现状及其影响因素研究

目的 分析不同类型慢性病发生抑郁焦虑症状的差异及其影响因素,为改善慢性病患者心理健康、提高生存质量提供依据。方法 依托2017年北京市大兴区社区诊断项目开展问卷调查,采用χ2检验进行单因素分析,采用多元Logistic回归分析各类慢性病和慢性病共病对抑郁焦虑症状的影响。结果 共调查各类慢性病患者2502例。其中247例(9.9%)抑郁症状为轻度,76例(3.0%)为中度及以上;139例(5.6%)焦虑症状为轻度,45例(1.8%)为中度及以上。多因素分析显示,相对于未患该病种的人群,患呼吸系统疾病人群容易出现轻度抑郁和焦虑症状,患肌肉骨骼疾病、消化系统疾病人群容易出现轻度和中度及以上抑郁和焦虑症状,患慢性泌尿系统疾病易出现中度以上焦虑症状(P<0.05)。相对于女性、<30岁、未就业或退休、只患一种慢性病的人群,男性、41~50岁、51~60岁、60岁及以上是轻度抑郁和轻度焦虑症状的保护因素,慢性病共病是轻度抑郁和轻度焦虑症状的危险因素,41~50岁是中度及以上抑郁症状的保护因素,男性是中度及以上焦虑症状的保护因素,就业、慢性病共病是中度及以上抑郁和焦虑症状的危险因素(P<0.05)。结论 慢性病对患者的影响是多维的,慢性病患者尤其是共病者,更容易出现抑郁焦虑症状,应加强对慢性病患者心理健康的干预,提升健康宣教水平,及时疏导患者的抑郁焦虑情绪,保持良好的心态。

抑郁症与焦虑障碍共病患者性格特点与干预后认知、执行功能改善效果

目的 探讨抑郁症与焦虑障碍共病患者性格特点与护理干预后认知、执行功能改善效果。方法 纳入2020年1月至2021年1月收治的64例抑郁症与焦虑障碍共病患者作为研究对象,并随机分为对照组与观察组,每组32例,2组均予以西药治疗,治疗过程中详细观察抑郁症与焦虑障碍共病患者性格特点,对照组在此期间予以常规护理,观察组则需根据患者临床性格特点予以针对性护理,应用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评定2组护理干预前、干预后抑郁、焦虑情况,应用威斯康星卡片分类测验分析系统(WCST)、蒙特利尔认知功能评定量表(MoCA)分别测定、评估护理干预前、干预后2组执行功能改善状况和认知功能。结果 干预前,2组HAMD、HAMA评分比较,差异无统计学意义(P>0.05),干预后,观察组HAMD、HAMA评分明显低于对照组(P<0.05),干预前,2组WCST检测结果各项指标对比无统计学意义(P>0.05),干预后,2组总测验次数、持续错误数、非持续错误数均有所降低,且观察组降低幅度更大(P<0.05),干预前,2组MoCA评分比较,差异无统计学意义(P>0.05),干预后,观察组MoCA评分明显低于对照组(P<0.05)。结论 临床上常见抑郁症与焦虑障碍共病的现象,依据患者性格特点予以针对性护理,可提升并巩固治疗成效,进一步改善患者认知功能及执行功能,对促进病情尽早康复具有积极作用。

抑郁症与焦虑障碍共病患者临床个性特点、影响因素、干预配合措施研究

目的探讨抑郁症与焦虑障碍共病患者的临床个性特点、影响因素以及护理配合情况。方法选取2019年12月至2020年12月精神内科收治的抑郁症与焦虑障碍共病患者72例,采用随机数字表法分为对照组和观察组,每组36例,患者均予以盐酸文拉法辛缓释片联合劳拉西泮片治疗,对其临床个性特点进行观察,分析影响因素,并予以不同的护理干预,其中对照组予以常规护理,观察组在具体分析临床个性特点、影响因素后予以针对性护理,应用HAMD、HAMA评定2组护理前、护理后4周心理状况,应用DAS量表对2组护理前、护理后4周实施自评问卷调查,检测2组护理前、护理后4周低切粘度、高切粘度、红细胞比容、血浆黏度等血液流变学状况。结果护理后4周,观察组HAMD、HAMA评分明显低于对照组(P<0.05);护理后4周,观察组各因子DAS分及DAS总分均明显低于对照组(P<0.05);护理后4周,2组各项血液流变学指标均降低,但观察组明显低于对照组(P<0.05)。结论临床上常见抑郁症与焦虑障碍共病的现象,依据患者临床个性特点予以针对性护理,可提升用药治疗成效,进一步改善失调性认知,缓解心理状况,促进病情尽早康复。

失眠症伴抑郁、焦虑症状中西医论治的研究进展

社会竞争加剧使人们的生活压力越来越大,失眠症的发病率也越来越高。长期失眠严重影响患者的生活与工作,并可导致生理和心理功能紊乱,大部分失眠症患者伴有抑郁、焦虑症状,为有效治疗带来困难。该文综述了近年来国内外的最新文献,总结了失眠症伴抑郁、焦虑症状的中西医发病机制及治疗方法,以期为更好地改善该类患者的睡眠质量,缓解其抑郁及焦虑症状提供参考。