depressive disorder

抑郁症
  • 文章类型: Journal Article
    为了证明风湿性疾病女性的性功能障碍(SD)负担,我们在系统性硬化症(SSc)患者中进行了横断面比较研究,系统性红斑狼疮(SLE),和Behçet综合征(BS)以及合适的健康对照(HC)。年龄匹配的女性SSc患者(n=50),SLE(n=49),和BS(n=54),在4月至10月期间,该研究包括52名女性HCs,2021年。记录了社会人口学特征,和心理测试,即,女性性功能指数(FSFI),贝克抑郁库存(BDI),身体导管刻度,进行婚姻调整测试(MAT)。比较量表得分,并使用二元逻辑回归来确定整个组中SD的预测因子。患者组的总FSFI和身体导管评分明显低于HC(p<0.001)。抑郁症在患者组中明显更常见。研究组之间的MAT评分没有显着差异。SSc患者在每个心理测量指数中得分最差,包括MAT。身体导管评分降低[OR0.974,95%CI(0.957-0.991),p=0.003]和低MAT评分[OR0.937,95%CI(0.896-0.980),p=0.005],并被诊断为SSc[OR6.6,95%CI(1.975-22.498),p=0.002],SLE[OR2.7,95%CI(0.998-7.753),p=0.050],和BS[OR2.8,95%CI(1.100-7.359),p=0.031],被确定为SD的独立预测因子。身体导管似乎是SD最重要的独立预测因子,SSc患者的SD负担似乎更重,可能是由于身体形象满意度差。
    To demonstrate the burden of sexual dysfunction (SD) among females with rheumatic diseases, we conducted a cross-sectional comparative study in patients with systemic sclerosis (SSc), systemic lupus erythematosus (SLE), and Behçet\'s syndrome (BS) along with suitable healthy controls (HCs). Age-matched female patients with SSc (n = 50), SLE (n = 49), and BS (n = 54), along with 52 female HCs were included in this study between April and October, 2021. Sociodemographic features were recorded, and psychometric tests, i.e., female sexual function index (FSFI), Beck depression inventory (BDI), body cathexis scale, and marital adjustment test (MAT) were performed. Scale scores were compared, and binary logistic regression was used to identify predictors for SD in the whole group. The total FSFI and body cathexis scores among the patient groups were significantly lower than those of the HCs (p < 0.001). Depression was significantly more frequent in the patient groups. MAT scores did not differ significantly between the study groups. Patients with SSc had the worst scores in each psychometric index, including MAT. Decreased body cathexis score [OR 0.974, 95% CI (0.957-0.991), p = 0.003] and low MAT score [OR 0.937, 95% CI (0.896-0.980), p = 0.005], and being diagnosed with SSc [OR 6.6, 95% CI (1.975-22.498), p = 0.002], SLE [OR 2.7, 95% CI (0.998-7.753), p = 0.050], and BS [OR 2.8, 95% CI (1.100-7.359), p = 0.031], were identified as independent predictors for SD. Body cathexis seems to be the most important independent predictor for SD, and the burden of SD appears heavier in patients with SSc, probably due to poor body image satisfaction.
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  • 文章类型: Journal Article
    目标:强迫移民的人数多年来一直在增加。许多被迫移民患有创伤后应激障碍(PTSD),抑郁症,和/或焦虑,需要治疗。这里,我们评估心理干预的有效性(CBT,EMDR,表现力/艺术,正念,混合元素,网络和心理教育)在减少PTSD症状方面,抑郁症,强迫移民的焦虑。
    方法:在PubMed和WebofScience中进行了系统搜索,并进行了预印本服务器和灰色文献的搜索(最终搜索日期:2023年9月1日)。随机效应频率和贝叶斯荟萃分析用于数据综合。
    结果:我们纳入了84项关于成人治疗效果的研究(合并N=6302)和32项关于儿童和青少年的研究(合并N=1097)。我们的数据显示创伤后应激障碍症状减轻,成人和儿童/青少年被迫移民的抑郁和焦虑症状。创伤后应激障碍的治疗前后效应(效应大小Cohen'sd)范围为-1.03至-0.26,抑郁从-0.91到-0.11,焦虑从-0.91到-0.60,每个研究设计的结果没有差异(即,RCT比较与非RCT比较与单臂治疗研究)。治疗效果在随访中仍然明显,而不是单一类型的治疗脱颖而出,优于其他治疗类型。种群的结构差异(例如,关于原籍国)而不是研究,然而,可能会阻碍治疗类型等研究特征之间比较的有效性。
    结论:我们的研究结果支持心理治疗在成人和儿童/青少年强迫移民中的有效性。
    OBJECTIVE: The number of forced migrants has been rising for years. Many forced migrants suffer from post-traumatic stress disorder (PTSD), depression, and/or anxiety and need treatment. Here, we evaluate the effectiveness of psychological interventions (CBT, EMDR, expressive/art, mindfulness, mixed elements, NET and psychoeducation) in reducing symptoms of PTSD, depression, and anxiety in forced migrants.
    METHODS: Systematic searches in PubMed and Web of Science and searches of preprint servers and grey literature were performed (final search date: 1 September 2023). Random-effects frequentist and Bayesian meta-analyses were used for data synthesis.
    RESULTS: We included 84 studies on treatment effects in adults (pooled N = 6302) and 32 on children and adolescents (pooled N = 1097). Our data show a reduction in symptoms of PTSD, depression and anxiety symptoms in both adults and child/adolescent forced migrants. Pooled pre- to post-treatment effects (effect size Cohen\'s d) ranged from -1.03 to -0.26 for PTSD, from -0.91 to -0.11 for depression and from -0.91 to -0.60 for anxiety, without there being differences in outcome per study design (i.e., RCT comparison vs. non-RCT comparison vs. single arm treatment study). Treatment effects remained evident over follow-up, and not a single type of treatment stood out as being superior to other treatment types. Structural differences in populations (e.g., regarding country of origin) over studies, however, could have hampered the validity of the comparisons between study characteristics such as treatment type.
    CONCLUSIONS: Our findings support the effectiveness of psychological treatment in adult and child/adolescent forced migrants.
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  • 文章类型: Journal Article
    背景:睡眠障碍可能会影响抑郁症心理治疗的反应。了解心理治疗过程中睡眠障碍的变化,确定睡眠障碍反应的危险因素可以为临床决策提供信息。
    方法:该分析包括2011年至2020年期间,来自伦敦八项改善获得心理治疗(IAPT)服务之一的18,915名接受高强度心理治疗的抑郁症患者。使用生长混合模型确定了睡眠障碍变化的不同轨迹。该研究还调查了确定的轨迹类别之间的关联,治疗前患者特征,以及服务使用的PHQ-9和GAD-7综合指标的最终治疗结果。
    结果:确定了六个不同的睡眠障碍轨迹:两个显示出改善,其中一组表现为初始恶化,而其他三组仅表现出有限的睡眠障碍变化,每个人都有不同的基线睡眠障碍。与轨迹类成员的关联基于:性别,种族,失业状况,抗抑郁药物的使用,长期健康状况,抑郁症状的严重程度,和功能损害。显示睡眠改善的团体从抑郁症治疗中获得了最好的最终结果,其次是一直睡得很好的群体。
    结论:使用关于睡眠障碍的单个项目,没有关于治疗依从性的数据。
    结论:这些发现揭示了抑郁症心理治疗过程中睡眠障碍的异质性。治疗期间更密切地监测睡眠障碍的变化可能会告知治疗计划。这包括决定何时纳入睡眠管理干预措施,以及是否通过干预措施改变或增加治疗以减少睡眠障碍。
    BACKGROUND: Sleep disturbance may impact response to psychological treatment for depression. Understanding how sleep disturbance changes during the course of psychological treatment, and identifying the risk factors for sleep disturbance response may inform clinical decision-making.
    METHODS: This analysis included 18,915 patients receiving high-intensity psychological therapy for depression from one of eight London-based Improving Access to Psychological Therapies (IAPT) services between 2011 and 2020. Distinct trajectories of change in sleep disturbance were identified using growth mixture modelling. The study also investigated associations between identified trajectory classes, pre-treatment patient characteristics, and eventual treatment outcomes from combined PHQ-9 and GAD-7 metrics used by the services.
    RESULTS: Six distinct trajectories of sleep disturbance were identified: two demonstrated improvement, while one showed initial deterioration and the other three groups displayed only limited change in sleep disturbance, each with varying baseline sleep disturbance. Associations with trajectory class membership were found based on: gender, ethnicity, unemployment status, antidepressant medication use, long-term health condition status, severity of depressive symptom, and functional impairment. Groups that showed improvement in sleep had the best eventual outcomes from depression treatment, followed by groups that consistently slept well.
    CONCLUSIONS: Single item on sleep disturbance used, no data on treatment adherence.
    CONCLUSIONS: These findings reveal heterogeneity in the course of sleep disturbance during psychological treatment for depression. Closer monitoring of changes in sleep disturbance during treatment might inform treatment planning. This includes decisions about when to incorporate sleep management interventions, and whether to change or augment therapy with interventions to reduce sleep disturbance.
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  • 文章类型: Journal Article
    目的:确定共病抑郁对前庭神经鞘瘤切除术后再入院的影响。
    方法:回顾性数据库分析。
    方法:国家再入院患者数据库。
    方法:对全国再入院数据库(NRD)中具有前庭神经鞘瘤病史的患者进行回顾性分析,由国际疾病分类确定,第九次修订(ICD-9)代码225.1和ICD-10代码D33.3,他们在2020年接受了手术切除(ICD-904.01,ICD-10-PCS00BN0ZZ)。
    方法:治疗。
    方法:需要康复,需要程序,逗留时间,再入院成本,和保险状况。
    结果:在2020年切除前庭神经鞘瘤后,共有1997例患者再次入院。在这些病人中,290人患有共病抑郁症。有共患抑郁症病史的患者在再次入院后被转移到康复机构的比例明显更高(11.30%对4.30%,p<0.001)。住院时间(p=0.227)和总再入院费用(p=0.723)没有显著差异,但私人保险的比例明显较低(分别为55.40%和64.40%,p=0.027)。
    结论:抑郁症与更高的术后康复服务利用率和更高的医疗合并症相关,术前评估时应予以考虑。
    OBJECTIVE: To determine the impact of comorbid depression on readmission after vestibular schwannoma resection.
    METHODS: Retrospective database analysis.
    METHODS: National database of readmitted patients.
    METHODS: The Nationwide Readmission Database (NRD) was retrospectively reviewed for patients with history of vestibular schwannoma, identified by International Classification of Disease, Ninth Revision (ICD-9) code 225.1 and ICD-10 code D33.3, who underwent surgical resection (ICD-9 04.01, ICD-10-PCS 00BN0ZZ) in 2020.
    METHODS: Therapeutic.
    METHODS: Need for rehabilitation, need for procedures, length of stay, cost of readmission, and insurance status.
    RESULTS: A total of 1997 patients were readmitted after resection of vestibular schwannoma in 2020. Of these patients, 290 had history of a comorbid depressive disorder.A significantly higher proportion of patients with history of comorbid depression were transferred to a rehabilitation facility after readmission (11.30% versus 4.30%, p < 0.001). Length of stay (p = 0.227) and total readmission cost (p = 0.723) did not differ significantly, but a significantly lower proportion had private insurance (55.40% versus 64.40%, p = 0.027).
    CONCLUSIONS: Depression is associated with higher utilization of postoperative rehabilitation services and higher rates of medical comorbidities, and should be considered during preoperative evaluation.
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  • 文章类型: Journal Article
    背景:抑郁症的残留症状是严重的健康问题。然而,由于疾病的高度异质性,进展过程很难预测。本研究旨在:(1)根据同质数据对残留症状的变化规律进行分类,(2)确定这些模式的潜在预测因素。
    方法:在本研究中,我们进行了数据驱动的潜在类别增长分析(LCGA),以确定残留症状变化的明显趋势,对于抑郁症患者,在基线和基线后1/3/6个月使用QIDS-SR16进行纵向定量。还鉴定了基线特征(例如临床特征和认知功能)与不同进展趋势之间的关联。
    结果:残留症状的变化趋势分为四类:“轻度残留症状下降(15.4%)”,“残留症状消失(39.3%)”,“稳定残留症状(6.3%)”和“严重残留症状下降(39.0%)”。我们观察到第二类患者比其他患者表现出更有利的康复效果。严重程度,复发,多药,症状的药物依从性与残留症状的持续时间密切相关。此外,临床特征包括睡眠障碍,抑郁情绪,食欲或体重的改变,和浓缩困难已被确定为回收过程中的重要因素。
    结论:我们的研究结果表明,抑郁症患者的某些临床特征与急性治疗后残留症状恢复不良有关。这一启示在有针对性地关注特定患者以及相应地制定残留症状的早期干预策略方面具有重要价值。
    BACKGROUND: Residual symptoms of depressive disorders are serious health problems. However, the progression process is hardly predictable due to high heterogeneity of the disease. This study aims to: (1) classify the patterns of changes in residual symptoms based on homogeneous data, and (2) identify potential predictors for these patterns.
    METHODS: In this study, we conducted a data-driven Latent Class Growth Analysis (LCGA) to identify distinct tendencies of changes in residual symptoms, which were longitudinally quantified using the QIDS-SR16 at baseline and 1/3/6 months post-baseline for depressed patients. The association between baseline characteristics (e.g. clinical features and cognitive functions) and different progression tendencies were also identified.
    RESULTS: The tendency of changes in residual symptoms was categorized into four classes: \"light residual symptom decline (15.4%)\", \"residual symptom disappears (39.3%)\", \"steady residual symptom (6.3%)\" and \"severe residual symptom decline (39.0%)\". We observed that the second class displayed more favorable recuperation outcomes than the rest of patients. The severity, recurrence, polypharmacy, and medication adherence of symptoms are intricately linked to the duration of residual symptoms\' persistence. Additionally, clinical characteristics including sleep disturbances, depressive moods, alterations in appetite or weight, and difficulties with concentration have been identified as significant factors in the recovery process.
    CONCLUSIONS: Our research findings indicate that certain clinical characteristics in patients with depressive disorders are associated with poor recovery from residual symptoms following acute treatment. This revelation holds significant value in the targeted attention to specific patients and the development of early intervention strategies for residual symptoms accordingly.
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  • 文章类型: Editorial
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  • 文章类型: Case Reports
    背景:重度抑郁症与严重合并症患者的不良结局有关。在移植患者中,重度抑郁症与较差的临床结局相关。
    方法:我们介绍了一例55岁男性因缺血性心力衰竭进行心脏移植的病例。移植六个月后,他情绪抑郁,在PHQ-9抑郁筛查量表上,快感和自杀意念评分为20/27。在接受米氮平30毫克/晚持续一周并持续存在高自杀风险后,决定输注氯胺酮24小时,观察到情绪显着改善,输注后24小时自杀意念消失。
    结论:移植患者的抑郁是与移植物丢失和移植后死亡率相关的一个因素。除了有利于其他负面结果,如深静脉血栓形成。
    结论:氯胺酮输注被证明是治疗心脏移植患者有自杀风险的重度抑郁症的有效和安全的选择。
    BACKGROUND: Major depressive disorder is related to unfavourable outcomes in patients with severe comorbidities. In transplant patients, major depression is associated with worse clinical outcomes.
    METHODS: We present the case of a 55-year-old man with a heart transplant due to heart failure of ischaemic origin. Six months after the transplant he developed depressed mood, anhedonia and suicidal ideation with a score of 20/27 on the PHQ-9 depression screening scale. After receiving mirtazapine 30 mg/night for a week and persisting with a high suicide risk, it was decided to administer ketamine infusion for 24 h, with which a significant improvement in mood was observed, and the disappearance of suicidal ideation 24 h after the infusion.
    CONCLUSIONS: Depression in transplant patients is a factor associated with graft loss and post-transplant mortality, in addition to favouring other negative outcomes such as deep vein thrombosis.
    CONCLUSIONS: Ketamine infusion was shown to be an effective and safe option to treat major depression with suicidal risk in a heart transplant patient.
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  • 文章类型: Editorial
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  • 文章类型: Journal Article
    本文介绍了波士顿青少年抑郁和焦虑神经影像学(BANDA)研究的主要数据和资源,人类连接体项目(HCP)的一个新的分支。数据来自215名青少年(14-17岁),其中152人在研究摄入时目前诊断为焦虑和/或抑郁障碍。数据包括横截面结构(T1和T2加权),功能(静止状态和三个任务),和扩散加权磁共振图像。未处理的和HCP最小预处理的成像数据在数据发布包中都是可用的。青少年和家长临床访谈数据,以及认知和神经心理学数据也包含在这些软件包中。发布包还提供了从评估青少年精神病理学关键特征的自我报告措施中收集的数据,包括:焦虑和抑郁症状维度,行为抑制/激活,暴露于紧张的生活事件,和冒险行为。最后,发布包包括从临床测量中获得的6个月和12个月的纵向数据.数据可通过国家心理健康数据档案研究所(ID:#2505)公开访问。
    This article describes primary data and resources available from the Boston Adolescent Neuroimaging of Depression and Anxiety (BANDA) study, a novel arm of the Human Connectome Project (HCP). Data were collected from 215 adolescents (14-17 years old), 152 of whom had current diagnoses of anxiety and/or depressive disorders at study intake. Data include cross-sectional structural (T1- and T2-weighted), functional (resting state and three tasks), and diffusion-weighted magnetic resonance images. Both unprocessed and HCP minimally-preprocessed imaging data are available within the data release packages. Adolescent and parent clinical interview data, as well as cognitive and neuropsychological data are also included within these packages. Release packages additionally provide data collected from self-report measures assessing key features of adolescent psychopathology, including: anxious and depressive symptom dimensions, behavioral inhibition/activation, exposure to stressful life events, and risk behaviors. Finally, the release packages include 6- and 12-month longitudinal data acquired from clinical measures. Data are publicly accessible through the National Institute of Mental Health Data Archive (ID: #2505).
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  • 文章类型: Journal Article
    背景:焦虑和抑郁是精神疾病,通常共存并具有某些共同特征。开发一种简单且具有成本效益的工具来评估阿拉伯语人群的焦虑和抑郁,主要居住在研究可能很艰巨的中低收入国家,将是非常有益的。该研究旨在将四项复合患者健康问卷-4(PHQ-4)翻译成阿拉伯语,并评估其心理测量特性,包括内部可靠性,性不变性,复合可靠性,以及与心理困扰程度的相关性。
    方法:在2023年2月至3月间招募了587名讲阿拉伯语的成年人。通过社交媒体网络分发了一个匿名的自我管理的GoogleForms链接。我们利用FACTOR软件探索阿拉伯PHQ-4的因子结构。
    结果:验证性因素分析(CFA)表明PHQ-4分数的双因素模型的拟合度适中(χ2/df=.13/1=.13,RMSEA=.001,SRMR=.002,CFI=1.005,TLI=1.000)。内部可靠性很好(麦当劳的欧米茄=0.86;克朗巴赫的阿尔法=0.86)。指数表明,配置,公制,标量不变性在性别上得到支持。在PHQ-4总分方面,男性和女性之间没有发现显着差异,PHQ-4焦虑评分,和PHQ-4抑郁评分。PHQ-4的总分及其抑郁和焦虑评分与较低的幸福感和较高的抑郁焦虑和压力量表(DASS)总分和子量表得分显着和中至强相关。
    结论:PHQ-4被证明是可靠的,有效,和具有成本效益的工具,用于评估与抑郁和焦虑相关的症状。为了评估阿拉伯PHQ-4的实际有效性,并进一步增强其结构效度的数据,未来的研究应在不同背景下和特定人群中评估该措施.
    BACKGROUND: Anxiety and depression are psychiatric disorders that often coexist and share some features. Developing a simple and cost-effective tool to assess anxiety and depression in the Arabic-speaking population, predominantly residing in low- and middle-income nations where research can be arduous, would be immensely beneficial. The study aimed to translate the four-item composite Patient Health Questionnaire - 4 (PHQ-4) into Arabic and evaluate its psychometric properties, including internal reliability, sex invariance, composite reliability, and correlation with measures of psychological distress.
    METHODS: 587 Arabic-speaking adults were recruited between February and March 2023. An anonymous self-administered Google Forms link was distributed via social media networks. We utilized the FACTOR software to explore the factor structure of the Arabic PHQ-4.
    RESULTS: Confirmatory factor analysis (CFA) indicated that fit of the two-factor model of the PHQ-4 scores was modest (χ2/df = .13/1 = .13, RMSEA = .001, SRMR = .002, CFI = 1.005, TLI = 1.000). Internal reliability was excellent (McDonald\'s omega = .86; Cronbach\'s alpha = .86). Indices suggested that configural, metric, and scalar invariance were supported across sex. No significant difference was found between males and females in terms of the PHQ-4 total scores, PHQ-4 anxiety scores, and PHQ-4 depression scores. The total score of the PHQ-4 and its depression and anxiety scores were significantly and moderately-to-strongly associated with lower wellbeing and higher Depression Anxiety and Stress Scale (DASS) total and subscales scores.
    CONCLUSIONS: The PHQ-4 proves to be a reliable, valid, and cost-effective tool for assessing symptoms related to depression and anxiety. To evaluate the practical effectiveness of the Arabic PHQ-4 and to further enhance the data on its construct validity, future studies should assess the measure in diverse contexts and among specific populations.
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