本文關(guān)鍵詞：抑郁癥復(fù)發(fā)的臨床因素分析，，由筆耕文化傳播整理發(fā)布。

        背景抑郁癥的病因仍然不明,故其臨床療效仍然不十分理想。抑郁癥的復(fù)發(fā)更加加重了病人的痛苦,防止抑郁癥復(fù)發(fā)是抑郁癥治療的關(guān)鍵�，F(xiàn)已證實(shí)抑郁癥與多種生物學(xué)和心理社會(huì)因素有關(guān),其中部分因素與發(fā)病有關(guān),而另外的因素則構(gòu)成的其反復(fù)復(fù)發(fā)的機(jī)制。哪些因素構(gòu)成抑郁癥反復(fù)復(fù)發(fā)的機(jī)制有待研究。目的本研究擬通過反復(fù)發(fā)作抑郁癥臨床特征、心理特征評(píng)估等相關(guān)因素的綜合分析,篩選出與抑郁癥復(fù)發(fā)有關(guān)的高危因素,探討其在抑郁癥復(fù)發(fā)中的心理生理機(jī)制,為抑郁癥的規(guī)范化治療,預(yù)防復(fù)發(fā)尋找策略和理論依據(jù)。方法采集2011年1月—2012年1月就診于天鄭州大學(xué)第一附屬醫(yī)院門診及住院的反復(fù)發(fā)作的抑郁癥患者91例,納入標(biāo)準(zhǔn)包括：①抑郁癥復(fù)發(fā)次數(shù)(≥2次)的抑郁癥患者；②符合美國精神疾病分類方案與診斷標(biāo)準(zhǔn)第四版(DSM-Ⅳ)中關(guān)于抑郁癥的診斷標(biāo)準(zhǔn)；③無頭顱外傷史、中樞神經(jīng)系統(tǒng)感染及器質(zhì)性精神障礙史；④漢族,年齡在18～60歲之間；⑤排除精神活性物質(zhì)與其他物質(zhì)所致精神障礙或非成癮物質(zhì)所致精神障礙；⑥自愿參加本研究,并由法定監(jiān)護(hù)人或監(jiān)護(hù)人簽署知情同意書。自編“抑郁癥復(fù)發(fā)調(diào)查問卷”。問卷內(nèi)容主要包括：年齡、婚姻、性別、文化程度、家族史、復(fù)發(fā)季節(jié)、服藥依從性、服藥種類及劑量、治療方式、臨床療效、間歇期社會(huì)功能及復(fù)發(fā)情況、經(jīng)濟(jì)情況和家庭支持系統(tǒng)等信息及條目。精神檢查參照DSM-Ⅳ軸Ⅰ障礙臨床定時(shí)檢查使用指南(研究版)(Structured clinical interview for DSM-IV axis I disorders,SCID-Ⅰ)實(shí)施。采用入院面談、電話隨訪相結(jié)合的方式逐項(xiàng)填寫,補(bǔ)充完成回訪信息。問卷調(diào)查均由研究組成員完成。資料處理統(tǒng)一輸入計(jì)算機(jī),用SPSS17.0軟件進(jìn)行數(shù)據(jù)分析與整理,統(tǒng)計(jì)方法采用x2檢驗(yàn)、logistic多元回歸分析及相關(guān)分析,檢驗(yàn)水準(zhǔn)。=0.05。結(jié)果(1)患者主訴頻度依次為：心情不好(59.3%)、胸悶(58.1%)、入睡困難(54.3%)、心慌(50.8%)、食欲差(42.3%)、肢體乏力(45.4%)、頭昏(38.7%)、尿頻(38.7%)、頭痛(35.5%)、胸痛(32.3%)、其他(28.3%)；(2)參照DSM-Ⅳ軸Ⅰ障礙臨床定時(shí)檢查使用指南(研究版)(Structured clinical interview for DSM-IV axis I disorders Research version)進(jìn)行精神檢查,主要癥狀出現(xiàn)的頻度依次為：情緒低落(95.3%)、睡眠障礙(82.4%)、興趣喪失(79.1%)、精力不足(59.5%)、活動(dòng)減少(49.8%)、反應(yīng)遲緩(42.3%)、體重變化(39.3%)、悲觀自責(zé)(34.6%)、自殺觀念或行為(28.6%)；(3)首次未選擇精神�？凭驮\原因頻度依次為：認(rèn)為是軀體疾病占60%,病恥感占24.4%,親人的態(tài)度4例占8.89%,就診不方便2例占4.5%,其他2.2%；(4)影響服藥治療依從性的因素頻度依次為：自覺病愈停藥者40例,因副作用停藥者19例,家庭不支持者16例,因?qū)W業(yè)、工作、結(jié)婚生子停藥者11例,改用其他方法治療者3例,經(jīng)濟(jì)能力差者2例；(5)分別高復(fù)發(fā)組與低復(fù)發(fā)組的性別、病前性格內(nèi)外傾向性、文化程度發(fā)現(xiàn)：與病前性格內(nèi)外傾向性、文化程度有顯著差異(P<0.05),與性別無顯著差異(P>0.05)；(6)分別比較高復(fù)發(fā)組與低復(fù)發(fā)組的有無精神疾病家族史、負(fù)性生活事件、服藥依從性、首次是否�？浦委煛⒅委煼绞�、用藥維持時(shí)間、季節(jié)因素發(fā)現(xiàn)：與有無精神疾病家族史、負(fù)性生活事件、服藥依從性、首次是否�？浦委�、治療方式、用藥維持時(shí)間有顯著差異(P<0.05),與季節(jié)因素?zé)o顯著差異(P>0.05)；(7)分別比較高復(fù)發(fā)組與低復(fù)發(fā)組的經(jīng)濟(jì)情況、社會(huì)支持、興趣愛好發(fā)現(xiàn)：與經(jīng)濟(jì)情況、社會(huì)支持、興趣愛好有顯著差異(P<0.05)；(8)多因素logistic回歸分析顯示經(jīng)篩選變量最終進(jìn)入回歸模型的變量有病前性格、文化程度、家族史、經(jīng)濟(jì)情況、用藥維持時(shí)間、服藥依從性、負(fù)性生活事件、興趣愛好8種因素為抑郁癥復(fù)發(fā)的主要危險(xiǎn)因子。多因素logistic回歸分析顯示：經(jīng)濟(jì)情況、用藥維持時(shí)間、服藥依從性、無負(fù)性生活事件、興趣愛好與抑郁癥反復(fù)復(fù)發(fā)成正相關(guān),是預(yù)防抑郁癥復(fù)發(fā)的保護(hù)性因素。而病前性格、文化程度、陽性家族史與抑郁癥反復(fù)發(fā)成負(fù)相關(guān),是抑郁癥復(fù)發(fā)的主要危險(xiǎn)因素。結(jié)論(1)患者家庭經(jīng)濟(jì)情況較好、用藥維持時(shí)間偏長、患者服藥依從性良好、生活中有較少生活事件、興趣愛好廣泛可以減少抑郁癥復(fù)發(fā)的頻率；(2)病前性格內(nèi)向、有陽性家族史者,則抑郁癥復(fù)發(fā)的頻度較高；(3)家族史在影響抑郁癥復(fù)發(fā)的危險(xiǎn)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.

        抑郁癥復(fù)發(fā)的臨床因素分析

摘要5-8Abstract8-11前言12-131 材料與方法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 收集資料14        1.2.3 統(tǒng)計(jì)分析14-152 結(jié)果15-19    2.1 一般資料15-16        2.1.1 患者一般情況15        2.1.2 患者臨床特征15-16        2.1.3 病程及復(fù)發(fā)次數(shù)16        2.1.4 其他16    2.2 高復(fù)發(fā)組與低復(fù)發(fā)患者的復(fù)發(fā)因素比較16-18        2.2.1 高復(fù)發(fā)組與低復(fù)發(fā)組一般情況比較16        2.2.2 高復(fù)發(fā)組與低復(fù)發(fā)組臨床特征比較16-17        2.2.3 高復(fù)發(fā)組與低復(fù)發(fā)組心理社會(huì)因素比較17-18    2.3 影響抑郁癥復(fù)發(fā)的多因素logistic回歸分析18-193 討論19-234 結(jié)論23-25參考文獻(xiàn)25-28綜述28-45    參考文獻(xiàn)39-45附錄45-48攻讀學(xué)位期間發(fā)表文章情況48-49致謝49-50個(gè)人簡歷50

  本文關(guān)鍵詞：抑郁癥復(fù)發(fā)的臨床因素分析，由筆耕文化傳播整理發(fā)布。