抑郁症复发要吃药多久_抑郁症复发的临床因素分析

  本文关键词：抑郁症复发的临床因素分析，，由笔耕文化传播整理发布。

        背景抑郁症的病因仍然不明,故其临床疗效仍然不十分理想。抑郁症的复发更加加重了病人的痛苦,防止抑郁症复发是抑郁症治疗的关键。现已证实抑郁症与多种生物学和心理社会因素有关,其中部分因素与发病有关,而另外的因素则构成的其反复复发的机制。哪些因素构成抑郁症反复复发的机制有待研究。目的本研究拟通过反复发作抑郁症临床特征、心理特征评估等相关因素的综合分析,筛选出与抑郁症复发有关的高危因素,探讨其在抑郁症复发中的心理生理机制,为抑郁症的规范化治疗,预防复发寻找策略和理论依据。方法采集2011年1月—2012年1月就诊于天郑州大学第一附属医院门诊及住院的反复发作的抑郁症患者91例,纳入标准包括：①抑郁症复发次数(≥2次)的抑郁症患者；②符合美国精神疾病分类方案与诊断标准第四版(DSM-Ⅳ)中关于抑郁症的诊断标准；③无头颅外伤史、中枢神经系统感染及器质性精神障碍史；④汉族,年龄在18～60岁之间；⑤排除精神活性物质与其他物质所致精神障碍或非成瘾物质所致精神障碍；⑥自愿参加本研究,并由法定监护人或监护人签署知情同意书。自编“抑郁症复发调查问卷”。问卷内容主要包括：年龄、婚姻、性别、文化程度、家族史、复发季节、服药依从性、服药种类及剂量、治疗方式、临床疗效、间歇期社会功能及复发情况、经济情况和家庭支持系统等信息及条目。精神检查参照DSM-Ⅳ轴Ⅰ障碍临床定时检查使用指南(研究版)(Structured clinical interview for DSM-IV axis I disorders,SCID-Ⅰ)实施。采用入院面谈、电话随访相结合的方式逐项填写,补充完成回访信息。问卷调查均由研究组成员完成。资料处理统一输入计算机,用SPSS17.0软件进行数据分析与整理,统计方法采用x2检验、logistic多元回归分析及相关分析,检验水准。=0.05。结果(1)患者主诉频度依次为：心情不好(59.3%)、胸闷(58.1%)、入睡困难(54.3%)、心慌(50.8%)、食欲差(42.3%)、肢体乏力(45.4%)、头昏(38.7%)、尿频(38.7%)、头痛(35.5%)、胸痛(32.3%)、其他(28.3%)；(2)参照DSM-Ⅳ轴Ⅰ障碍临床定时检查使用指南(研究版)(Structured clinical interview for DSM-IV axis I disorders Research version)进行精神检查,主要症状出现的频度依次为：情绪低落(95.3%)、睡眠障碍(82.4%)、兴趣丧失(79.1%)、精力不足(59.5%)、活动减少(49.8%)、反应迟缓(42.3%)、体重变化(39.3%)、悲观自责(34.6%)、自杀观念或行为(28.6%)；(3)首次未选择精神专科就诊原因频度依次为：认为是躯体疾病占60%,病耻感占24.4%,亲人的态度4例占8.89%,就诊不方便2例占4.5%,其他2.2%；(4)影响服药治疗依从性的因素频度依次为：自觉病愈停药者40例,因副作用停药者19例,家庭不支持者16例,因学业、工作、结婚生子停药者11例,改用其他方法治疗者3例,经济能力差者2例；(5)分别高复发组与低复发组的性别、病前性格内外倾向性、文化程度发现：与病前性格内外倾向性、文化程度有显著差异(P<0.05),与性别无显著差异(P>0.05)；(6)分别比较高复发组与低复发组的有无精神疾病家族史、负性生活事件、服药依从性、首次是否专科治疗、治疗方式、用药维持时间、季节因素发现：与有无精神疾病家族史、负性生活事件、服药依从性、首次是否专科治疗、治疗方式、用药维持时间有显著差异(P<0.05),与季节因素无显著差异(P>0.05)；(7)分别比较高复发组与低复发组的经济情况、社会支持、兴趣爱好发现：与经济情况、社会支持、兴趣爱好有显著差异(P<0.05)；(8)多因素logistic回归分析显示经筛选变量最终进入回归模型的变量有病前性格、文化程度、家族史、经济情况、用药维持时间、服药依从性、负性生活事件、兴趣爱好8种因素为抑郁症复发的主要危险因子。多因素logistic回归分析显示：经济情况、用药维持时间、服药依从性、无负性生活事件、兴趣爱好与抑郁症反复复发成正相关,是预防抑郁症复发的保护性因素。而病前性格、文化程度、阳性家族史与抑郁症反复发成负相关,是抑郁症复发的主要危险因素。结论(1)患者家庭经济情况较好、用药维持时间偏长、患者服药依从性良好、生活中有较少生活事件、兴趣爱好广泛可以减少抑郁症复发的频率；(2)病前性格内向、有阳性家族史者,则抑郁症复发的频度较高；(3)家族史在影响抑郁症复发的危险因子中居首位。

    BackgroundThe etiology of depression remains unknown, the clinical efficacy is still not very ideal. Depressive relapse more aggravate the pain of the patient, to prevent the recurrence of depression is the key to treatment of depression. It has been proved that depression is associated with many biological and psychosocial factors, some factors associated with onset, while other factors constitute the relapse mechanism. The factors which constitute a depression relapse mechanism research.ObjectiveThis study proposed by recurrent depression clinical characteristics, psychological characteristics evaluation and treatment of factors related to the comprehensive analysis, and screened and depression relapse relevant risk factors, this paper discusses the psychological and physiological mechanism of the depression relapse, the standardization of the treatment for depression, prevent recurrence and theoretical basis for strategy.MethodsSequential acquisition in January2011in January2012, a doctor in zhengzhou university first day in hospital and clinic affiliated hospital of repeated attacks of105patients with depression, into the standards include:(1) depression recurrence rate quartile (twice) depression.(2) comply with the mental disease classification scheme and diagnosis standard fourth edition (DSM-IV) diagnosis standard and emotional disorders depressive episodes diagnostic criteria.(3) to rule out duplex obstacles family history and manic episodes of the history of the patients.(4) the age16-60.(5) no serious body disease history.6subjects informed consent.Series "depression relapse questionnaire". Questionnaire content mainly includes:age, marriage, gender, educational level, family history, recurrence season, medication compliance, medication types and measuring, treatment, efficacy and break social function and recurrence, economic conditions and family support system psychological characteristics. The interview, hospital outpatient follow-up phone follow-up, the way of the combination of the fill in item by item, added complete return information. Questionnaire survey by the group members are complete. Data processing unified into the computer and software with SPSS17.0data analysis and arrange, statistical methods the x2inspection, logistic regression analysis related analysis of inspection standard a=0.05.Results(1)The patient complained of frequency in order:a bad mood (59.3%), dizziness (58.1%), difficulty falling asleep (54.3%), home (50.8%), poor appetite (42.3%), limb weakness (45.4%), dizziness (38.7%), frequency (38.7%), headache (35.5%), chest pain (32.3%), other (28.3%).(2)The DSM-Ⅳ reference axis I disorder clinical guide to the use of timing check (Study Edition)(Structured clinical interview for DSM-IV axis I disorders Research version) is a psychiatric examination, the main symptom frequency in turn:the depression (95.3%), sleep disorders (82.4%), loss of interest (79.1%), lack of energy (59.5%), activity reduce (49.8%), slow (42.3%), weight change (39.3%), pessimistic self-blame(34.6%), a Dutch act perception or behavior (28.6%).(3)The first psychiatric hospital was selected as follows:that is why frequency of somatic diseases accounted for60%, stigma accounted for24.4%, their attitude in4cases accounted for8.89%,2cases were not easily accounted for4.5%, the other2.2%.(4)The effect of drug treatment compliance factors frequency were:perceived was stopped in40cases, because of side effects of drug withdrawal in19cases,16cases of family supporters, due to study, work, get married and have children stopped in11cases, with other methods of treatment in3cases, poor economic ability in2cases.(5)There were high relapse group and low recurrence group sex, premorbid character and tendency, culture level and found:premorbid personality and tendency, culture degree (P<0.05), and gender (P>0.05).(6)1compare high relapse group and low relapse groups with and without family history of psychosis, negative life events, medication compliance, whether the first specialist treatment, treatment, medication time, seasonal factors found:with and without family history of psychosis, negative life events, medication compliance, whether the first specialist treatment, treatment, medication maintenance time (P<0.05), and seasonal factors (P>0.05).(7)He compares high relapse group and low recurrence group economic condition, social support, interest found:and economic conditions, social support, interest hobby related (P<0.05).(8)The multivariate logistic regression analysis revealed by screening variables into regression model variables were premorbid personality, cultural level, family history, economic conditions, medication maintenance time, medication compliance, negative life events, hobbies8factors were the main risk factors for the recurrence of depression. A multivariate logistic regression analysis showed:the economic situation, medication to maintain the time, medication compliance, no negative life events, hobby is the prevention of recurrence of depression of protective factors. While the character before disease, education, family history is the major risk factors for recurrence of depression.Conclusion(1)The use of maintenance time, medication compliance, economic conditions, life events, hobbies5depression factor was repeated recurrence of protective factors and risk factors.(2)The premorbid personality, education, family history and depression relapse is negatively related to depression, are important risk factors of recurrence. (3) The influence of family history of depression recurrence risk factor occupies first place.

        抑郁症复发的临床因素分析

摘要5-8Abstract8-11前言12-131 材料与方法13-15    1.1 研究材料13    1.2 研究方法13-15        1.2.1 主要工具13-14        1.2.2 收集资料14        1.2.3 统计分析14-152 结果15-19    2.1 一般资料15-16        2.1.1 患者一般情况15        2.1.2 患者临床特征15-16        2.1.3 病程及复发次数16        2.1.4 其他16    2.2 高复发组与低复发患者的复发因素比较16-18        2.2.1 高复发组与低复发组一般情况比较16        2.2.2 高复发组与低复发组临床特征比较16-17        2.2.3 高复发组与低复发组心理社会因素比较17-18    2.3 影响抑郁症复发的多因素logistic回归分析18-193 讨论19-234 结论23-25参考文献25-28综述28-45    参考文献39-45附录45-48攻读学位期间发表文章情况48-49致谢49-50个人简历50

  本文关键词：抑郁症复发的临床因素分析，由笔耕文化传播整理发布。